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PubMed1994

Diabetic foot infections. Pathophysiology and treatment.

Foot infections are among the most common reasons for hospital admission of the diabetic patient. A diabetic foot infection represents a failure by the patient and his management team to understand and correct the multifactorial conditions that predisposed the patient to the infection. Efforts directed toward prevention of the foot infection are much more likely to meet with success than is therapy of the established foot infection. This preventive approach is likely to lead to a reduction in the incidence of major amputations and thereby improve life expectancy. Understanding the pathophysiology associated with the diabetic foot is essential to the care of the diabetic patient. If a breach in skin integrity occurs, prompt assessment of vascular, neural, soft tissue, and wound status enhances the possibility of a successful clinical outcome. The complexity of the management of a diabetic requires the knowledge and skill of a multidisciplinary team, which usually includes an internist, podiatrist, rehabilitation specialist, prosthetist, dietitian, and social worker in addition to a surgeon interested in caring for the complications of diabetic feet. The goals of this multispecialty group are to optimize local wound care, provide correct foot wear, improve glucose control, educate the patient concerning diet and life style changes, and identify the presence of peripheral neuropathies and reconstructable arterial lesions. This combined medical team approach has been documented to substantially reduce the incidence of major and minor amputations in the diabetic.

Amputation, Surgical↗
PubMed1993

Weight loss intervention in phase 1 of the Trials of Hypertension Prevention. The TOHP Collaborative Research Group.

BACKGROUND: Phase 1 of the Trials of Hypertension Prevention was a collaborative, randomized controlled clinical trial designed to determine the feasibility and efficacy of selected nonpharmacologic interventions in reducing or preventing an increase in diastolic blood pressure. METHODS: Participants aged 30 to 54 years who had a high-normal diastolic blood pressure (80 to 89 mm Hg), and were between 115% and 165% of their desirable body weight, were randomly assigned to either an 18-month weight loss intervention (n = 308) or a usual-care control condition (N = 256). Intervention consisted of 14 weekly group meetings followed by monthly maintenance sessions. Intervention participants received training in behavioral self-management technique and were asked to make life-style changes aimed at achieving a moderate reduction in energy intake and an increase in physical activity. RESULTS: The average weight losses in the intervention group at 6, 12, and 18 months of follow-up were 6.5, 5.6, and 4.7 kg for men and 3.7, 2.7, and 1.6 kg for women. The mean (+/- SE) change in diastolic blood pressure for intervention participants compared with controls at termination was -2.8 +/- 0.6 mm Hg for men and -1.1 +/- 0.9 mm Hg for women. For systolic blood pressure, the corresponding change was -3.1 +/- 0.7 mm Hg for men and -2.0 +/- 1.3 mm Hg for women. Blood pressure reductions were greater for those who lost larger amounts of weight. Sex-related differences in blood pressure response were largely due to the smaller amount of weight lost by women, and sex differences in weight loss could be accounted for by differences in baseline body weight. CONCLUSIONS: During an 18-month follow-up period, this weight reduction program was shown to be an effective nonpharmacologic intervention for reducing blood pressure in overweight adults with high-normal blood pressure.

Adult↗
PubMed1993

Outreach childbirth education classes for low-income families: a strategy for program development.

Childbirth and parenting education programs are coming to the forefront of public health initiatives aimed at the reduction of infant mortality and low birth-weight in high-risk groups in the United States. Childbirth education programs have proven effective in helping parents make positive life style changes and can play an important role in the reduction of risks associated with poor pregnancy outcomes. Childbirth education gives parents the knowledge, desire, and confidence they need to change their health behaviors. The Florida Outreach Childbirth Education Project offers an example of a statewide program designed to serve a high risk population: low-income, low-literacy families.

Female↗
PubMed1977

Patient education by videotape after myocardial infarction: an empirical evaluation.

Patients recovering from myocardial infarction (MI) or other heart diseases at St. Francis Hospital, Hartford, Ct, were educated by videotape or by staff lectures on alternating weeks. Both programs included the following: risk factors for MI, medications, diet, MI symptoms and life style changes. Patients were interviewed before and after the educational program. The MI patients under the age of 60 scored equally well on an informational test irrespective of the type of education program experienced. Older MI patients were significantly more likely to complete the educational program when it was given by videotape; those discontinuing attendance at lectures were less psychologically motivated to participate but were not necessarily more ill. Overall, higher education was the single most significant predictor of superior scores following patient education. Implications for the coronary care ward of the success of videotape in educating MI patients are discussed.

Adult↗
PubMedDate not supplied

[Obesity, central body fat distribution and ischemic cardiopathy in the Mexican population].

An age- and sex-matched case-control study was conducted to evaluate the relation of obesity and body fat distribution with the occurrence of coronary heart disease in mexicans. Obesity was measured in 150 couples by bioelectrical impedance with an EZ comp 1000 computer (body composition), and by estimating the body mass index. Skinfold anthropometry was used to assess central fat distribution. Two fat distribution indices were calculated, a ratio of central to peripheral skinfolds (central pattern) and a ratio of upper to lower body skinfolds (android pattern). Those subjects who had a percentage of body fat, by bioelectrical impedance, greater than 20%, had a 20 fold higher risk to develop acute myocardial infarction. The risk of coronary heart disease was also high in those with a central fat distribution and even higher in those with an android pattern. Both obesity and abdominal fat distribution are closely related to coronary heart disease. There is a need to promote life-styles changes and to reduce obesity, to prevent the occurrence of coronary heart disease in Mexico.

Aged↗
PubMed1996

[Worsening factors for the progression of impaired glucose tolerance to diabetes mellitus learning from prospective studies].

Although non-insulin-dependent diabetes mellitus (NIDDM) is essentially a genetic disorder, environmental factors after birth including modernization-westernization and its related life style changes play an important role for the development of diabetes. Former prospective studies have indicated high prevalence of diabetes among the subjects with greater impairement of glucose tolerance, family history of diabetes, history of gestational diabetes and obesity. Beside these, more attention has been paid to the elevation of serum fatty acids and food composition as the provocative factors. In some populations, insulin resistance has been suggested to be a major cause of diabetes. In contrast, we have shown that most of the Japanese patients with NIDDM have impaired early insulin response after glucose loading and this should be important as a predictor for NIDDM.

Body Mass Index↗
PubMed1996

Study of pulmonary and autonomic functions of asthma patients after yoga training.

"The concept of yoga is helpful for the treatment of Bronchial Asthma", has created a great interest in the medical research field. In order to investigate whether autonomic functions and pulmonary functions are improved in asthma patients after short term yoga training, a study was conducted with nine diagnosed bronchial asthma patients. Yoga training was given for seven days in a camp in Adhyatma Sadhna Kendra, New Delhi. The autonomic function tests to measure the parasympathetic reactivity (Deep Breathing test, Valsalva Manouever), Sympathetic reactivity (Hand Grip test, Cold Pressure test), and pulmonary function tests FVC, FEV1, PEFR, PIF, BHT and CE were recorded before and after yoga training. The resting heart rate after yoga training (P < 0.05) was significantly decreased (89.55 +/- 18.46/min to 76.22 +/- 16.44/min). The sympathetic reactivity was reduced following yoga training as indicated by significant (P < 0.01) reduction in DBP after HGT. There was no change in parasympathetic reactivity. The FVC, FEV1, PEFR did not show any significant change. The PIF (P < 0.01), BHT (P < 0.01) and CE (P < 0.01) showed significant improvement. The results closely indicated the reduction in sympathetic reactivity and improvement in the pulmonary ventilation by way of relaxation of voluntary inspiratory and expiratory muscles. The "comprehensive yogic life style change programme for patients of Bronchial Asthma" have shown significant benefit even within a short period.

Adolescent↗
PubMed1997

Trends in cancer incidence in Connecticut.

The population-based Connecticut Tumor Registry was used to examine recent trends (1980-84 to 1990-94) in average annual age-standardized incidence rates (ASRs) for invasive cancers. Noteworthy were the increase for lung cancer in women (but a decline in men), the sharp increase for prostate cancer (but little change in female breast cancer), increases for melanoma of skin (both sexes) and non-Hodgkin's lymphoma (especially in males), and declines for colon and rectum (both sexes). Reducing cancer incidence rates will require expanded primary prevention efforts, involving mainly behavioral or life-style changes, with an important role for primary-care physicians.

Colonic Neoplasms↗
PubMedDate not supplied

Patients' opinion and use of non-proven therapies related to their view on cancer aetiology.

BACKGROUND: The aim of the study was to investigate patients' attitudes to and use of nonproven therapies (NPTs) in view of their opinions about causes of cancer. MATERIAL AND METHODS: A comparative questionnaire-based study was given to patients with non-malignant disease (n = 305) seen in general practice and cancer patients (n = 252) seen at the Department of Oncology, University Hospital of Tromsø. RESULTS: Among non-cancer patients significantly more NPT-positive than NPT-negative patients considered the environment to be an important cancer cause (74% versus 52%) and that food and drink may be carcinogenic (57% versus 40%). For cancer patients, there was no such difference. 60% of non-cancer patients and 35% of cancer patients believed that life style changes could alter the natural course of cancer. In both groups of patients, the NPT-positive believed, to a higher degree than the NPT-negative, that the outcome of cancer could be improved by a change in life style (69% and 48% versus 53% and 29%). CONCLUSION: Patients positive to NPTs have firmer beliefs with respect to the importance of environmental factors than non-believers/-users. Moreover, these patients believed more strongly than NPT-negative patients that change of lifestyle may influence the outcome of cancer positively.

Adolescent↗
PubMed1998

Bioactive phytochemicals with emphasis on dietary practices.

Diet can modify the pathophysiological processes of various metabolic disorders and can be an effective preventive strategy for various disease processes most of which are known to involve oxidative damage. Both nutrient and non-nutrient components of the diet have been recognized for their anti-oxidant and other potential benefits. Plant foods contain phytochemicals such as flavonoids, phenolic acids, etc., which show biological activity. Some common foods used in Indian culinary practices were assessed for their anti-oxidant, anti-mutagenic and anti-carcinogenic effects and vitamin D activity and evaluated for their plausible biological effects. Green leafy vegetables had the highest anti-oxidant activity followed by wheat and rice. Cooking decreased this activity. Eugenol, the active principle of clove, was shown to offer protection against CCl4 induced hepatotoxicity in rats. It also showed anti-peroxidative activity in addition to decrease in O2 formation. Studies on the anti-carcinogenic effect of turmeric/curcumin revealed that both are potent anti-mutagens in vivo and reduce the adducted DNA levels in liver of rates challenged with B(a)P. In another study, Syrian hamsters receiving turmeric/curcumin through diet or local paint on cheek pouch had lower tumour burden as well as adducted DNA level against 7-12-DMBA challenge. Turmeric/curcumin were found to be better anti-tumour agents when given in the post initiation phase of carcinogenesis. The beneficial effect of turmeric was found to be due to its anti-oxidant potential. Studies on humans at risk of palatal cancer due to reverse smoking showed that turmeric (1 g/day) for 9 months had a significant impact on the regression of precancerous lesions. Onion and garlic also possess anti-mutagenic principle. Further studies on the bioactive phytochemicals in plants showed that certain plants belonging to Solanaceae (Cestrum diurnum, Lycopersicon esculentum and Solanum melongena) have calcinogenic potential and vitamin D like activity. In view of the vast data on bioactive principles from plants, it is suggested that dietary prevention coupled with other life-style changes in perhaps the right answer for prevention of cancer and other chronic diseases in India.

Animals↗
PubMed1987

Life-style correlates of risk factor change in young adults: an eight-year study of coronary heart disease risk factors in the Framingham offspring.

This paper describes the life-style and behavioral correlates of change in coronary heart disease risk factors measured eight years apart in the young adult offspring of the Framingham Heart Study cohort. Changes in total cholesterol, lipoprotein cholesterols (high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol), and blood pressure were observed longitudinally in 397 men and 497 women who were aged 20-29 years at entry into the study. Stepwise multiple linear regression procedures were used to identify characteristics and their changes that were significantly associated with risk factor changes in each sex. The attribute most strongly and consistently related to lipoprotein and blood pressure changes in both sexes was change in body mass index (p less than or equal to 0.01 or p less than or equal to 0.001). In addition to weight gain, increases in alcohol consumption in men (p less than or equal to 0.001) and beginning oral contraceptive use in women (p less than or equal to 0.01) were associated with increases in blood pressure over the study period. Weight loss, stopping or decreasing cigarette consumption (p less than or equal to 0.01), increasing alcohol intake (p less than or equal to 0.01), and, in women, discontinuing oral contraceptive use (p less than or equal to 0.01) also were independently related to improvements in lipoprotein profiles during follow-up. After adjustment for all life-style correlates of risk factor change, simple self-assessments of physical activity or activity change were negatively associated with changes in VLDL cholesterol (p less than or equal to 0.01) and the total cholesterol/HDL cholesterol ratio (p less than or equal to 0.05) in men and positively associated with changes in HDL cholesterol (p less than or equal to 0.05) in women. Sociodemographic and behavioral characteristics that made a further independent contribution to increases in the total cholesterol/HDL cholesterol ratio in men were blue-collar occupation and trait Type A behavior pattern (p less than or equal to 0.05). Unexplained, but provocative, results of this study included the associations of interim vasectomy with increases in total cholesterol in men (p less than or equal to 0.05) and of number of livebirths with decreases in total cholesterol and HDL cholesterol in women (p less than or equal to 0.01). These findings are among the first to offer prospective evidence which suggests that habits and behaviors during young adulthood have a substantial effect on lipid and lipoprotein profiles in men and women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1987

The prevention of health risks in Cuba.

Cuba still has a double burden of health risks. It must contend with some risks to health that persist in underdeveloped rural areas, and it must also deal with the risk factors associated with modern, urban living conditions. The economic and social changes fostered in the postrevolutionary period have reduced the relative importance of the first set of factors, but the changes have also introduced or intensified a myriad of factors derived from their own successes. In this article, the risk factors of greatest concern in contemporary Cuba are described, and the strategies adopted to combat these risk factors, together with the ways in which such strategies are shaped by Cuba's social and economic development are discussed.

Chronic Disease↗
PubMed1989

Soviet women and the autonomous family.

"The USSR family is changing in form from that of a social collectivity, a bedrock conception to socialism, to that of an autonomous family. Autonomy discloses a lack of homogeneity, an independence of choices over life-styles and a flexibility toward an interpretation given to the meaning of a socialistic state. Women are exceedingly active in making greater use of their legal rights to divorce and abortion and demanding equal status with men both in the workplace and in the home. Women are initiating major social changes, are readily adapting to changing relations and patterns in a complex society and are serving to spearhead changes in the family unit. These factors have generated major changes in the normative, behavioral and structural dimensions of marriage and family life in the Soviet Union."

Abortion, Induced↗
PubMed1998

Emerging population issues among adolescents and youth.

The authors "examine the emerging population issues of adolescents and youth [in Sri Lanka]. The demographic pressures have resulted in the expansion of the numbers in this age category which in turn has caused problems of employment creation. The educational expansion has brought about changes in the age at marriage and life styles, which in turn has created the need for greater attention on reproductive health issues among adolescents and youth."

Adolescent↗
PubMed1992

[[Work behavior of youth and recent changes in the fertility rate in Japan]].

"This paper observes and analyzes labor supply behavior and work attitude of...youth and discusses the impact they may have had on the recent change in [the] fertility rate in Japan." The author observes trends toward later marriage and a leisure-oriented life-style, and concludes that these shifts have helped to lower the fertility rate to 1.53 as of 1991. (SUMMARY IN ENG)

Asia↗
PubMed1997

Why does attachment style change?

Adult attachment research has proceeded on the assumption that attachment style is relatively stable and affects future functioning. However, researchers have become interested in attachment instability and predictors of attachment style change. In this article, 2 conceptualizations of attachment style change were examined: Attachment style change is a reaction to current circumstances, and attachment style change is an individual difference in susceptibility to change that is associated with stable vulnerability factors. A total of 155 women were assessed after high school graduation, and 6 months and 2 years later. Results primarily supported the conceptualization of attachment style change as an individual difference. Specifically, some women may be prone to attachment fluctuations because of adverse earlier experiences, and women who show attachment fluctuations are similar to women with stably insecure attachments.

Adaptation, Psychological↗