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PubMedDate not supplied

Hypercholesterolemia. Prevention and control.

In the last few years, public concern about cholesterol has become a national preoccupation. Concerned consumers increasingly direct their questions about cholesterol to the nurses with whom they come in contact. Nurses in any setting who are knowledgeable about cholesterol are in an ideal position to teach current, accurate, potentially life-saving information about it. Nurses everywhere have a responsibility to assist consumers to achieve the goals of the National Cholesterol Education Program (NCEP) panel of experts within the next few years. This article describes the prevention and control of hypercholesterolemia through dietary and life-style changes. Drug therapy for control of hypercholesterolemia is discussed. Specific nursing interventions that are designed to assist people to achieve the NCEP goals are outlined.

Anticholesteremic Agents↗
PubMed1986

Recurrence of stenoses after coronary angioplasty.

Recurrence remains a major problem after PTCA. The recurrence rate is higher in patients with diabetes, patients 70 years of age or older, and patients with severe coronary artery disease. Intimal tearing during the procedure may lower the recurrence rate. Recurrence in patients with multivessel angioplasty is higher than for those with single-vessel angioplasty, and it appears to be cumulative. The nurse can play an important role in risk-factor modification, teaching, and promoting smooth transitions in life-style changes after patients undergo angioplasty. Through education by the nurse, patients can learn to recognize angina and learn how to seek treatment for recurrence of ischemic symptoms. Lastly, the nurse can play an important role in patient follow-up. This can be done by reinforcing and encouraging patient compliance. Through further research the management and control of recurrence can be better understood.

Adult↗
PubMed1988

Reflux esophagitis. Diagnosis, pathophysiology, and management.

Reflux esophagitis is a common disorder in which esophageal inflammation is caused by the reflux of gastric contents. The diagnostic approach includes documentation that reflux is present, that the patient's symptoms are caused by the reflux, and that esophageal mucosal damage has occurred. Therapy is guided by the current multifactorial pathophysiology model, which includes efficacy of the antireflux mechanism, volume of gastric fluid, potency of refluxed material, esophageal clearance, and tissue resistance factors. Although recurrences are common, treatment with life style changes supplemented with combinations of liquid antacids, H2 blockers, sucralfate, bethanechol, and metoclopramide is usually effective.

Diagnosis, Differential↗
PubMed1988

Economic impact of type II diabetes mellitus.

Diabetes is a dangerous, expensive disease with a major economic impact. The cost to the nation in 1984 was estimated to be $14 billion. We now believe the total costs approach $20 billion. Of this, $10.5 billion is guesstimated to be direct cost due to the diagnosis and treatment of the disease, while indirect costs (due to complications, work days lost, decreased productivity, and premature death) are about $9.5 billion. A typical patient with NIDDM and hypertension spends about $1000 per year for doctor visits, lab tests, oral diabetes tablets, blood pressure medications, lancets and blood test strips (4 per week), and miscellaneous expenses. NIDDM is clearly the major diabetes cost to the nation because it represents 85 to 90 per cent of all diabetes and because half the patients are undiagnosed and untreated. We believe the morbidity, mortality, and economic burden of NIDDM can be favorably affected by a concerted national effort as defined by the National Diabetes Advisory Board in its 1987 National Long Range Plan to Combat Diabetes. Finally, one must not forget the "other costs" of NIDDM, which are statistically unmeasurable: emotional costs, loss of freedom, inconvenient life style changes, and the permanent dependence on "others" (family, professionals, and so on) for help.

Costs and Cost Analysis↗
PubMed1986

Public education in cancer prevention.

Life-style is now recognized as a main determinant of cancer risk. Public education is an important component of cancer control programmes and has been shown to be effective in leading to life-style changes. Four basic types of education programmes are reviewed: for increasing the public's awareness of cancer, for changing specific risk behaviour (such as stopping smoking), for learning self-examination skills (such as breast self-examination), and for promoting early cancer detection in the community.To change human behaviour it is best to approach the risk habit through the same forces that develop and sustain the habit. Simply giving information of an association between specific habits and cancer, even if repeated several times, will lead to increased public awareness and encourage some to make a minimal effort to change their behaviour, but in general the new habit does not persist and continuing and intensifying this approach are ineffective. An alternative strategy utilizes socially active forces to support the prevention practice and remove possible barriers to action. For example, an antismoking programme should create a favourable social image of the non-smoker. Although a culturally and socially relevant mass media campaign can influence knowledge and beliefs and induce people to participate in a screening activity, this needs to be supplemented over a period of time by personal contact methods, such as group discussions, telephone conversations and home visits, in order to promote a regular screening habit. Contrary to popular opinion, mass communication methods can be expensive on a per person cost-effectiveness basis because of low participation rates and weakness in sustaining healthy behaviour.

Health Education↗
PubMedDate not supplied

A small-group approach to teaching family medicine.

The authors describe a method for teaching preclinical medical students some important family medicine concepts utilizing a seminar format which allows for improved student-teacher interaction and individualization of material. These seminars, on family health behavior, compliance, behavioral interventions for life-style change, and managing stress, were designed to encourage freshman medical students to understand and apply concepts concerning health behavior and attitudes, both personally and professionally. The format of these sessions included the use of self-assessment instruments, discussion, role play, and case studies. Results of student evaluations indicate they perceived the seminars positively. Specific areas of positive value included the content and small-group related processes. The seminars also provided data useful for developing programs for students.

Education, Medical, Undergraduate↗
PubMed1985

Obesity a family matter: creating new behavior.

The family as culture transmitter plays a role in the development of health maintenance practices. A review of the epidemiological variables associated with obesity suggests that familial factors--genetic and environmental--have a significant effect on the onset, causes, and prognosis of treatment. Chances of success in losing weight may depend upon the extent of family functioning or upon finding a support system within and/or outside the family. The weight control program described is family oriented. Life-style changes learned in the group meetings reach home and affect family members. Four-pronged in its approach (nutrition, behavior change, exercise, and a positive support system), the program uses "skill builders," which are special situational modules that deal with specific family situations. A skill builder offers a step-by-step guided approach to identifying and changing problem behavior in the area of diet and exercise, e.g., eating in social situations, new food shopping patterns, and the role of significant others in the weight loss process.

Adolescent↗
PubMed1985

On the advantage of screening kindergarten children for atherogenesis-related risk indicators.

On the basis of our practical experience we can recommend screening of young children outside the clinic. Our methodology has proven to be appropriate for this purpose. Among young children, three groups are easily accessible: Newborns - since delivery occurs mostly in a clinic; infants up to one year - since these children are provided with basic medical care, and kindergarten children. According to our experience, kindergartens are favorable places for screening children because many children are together in one place. Children of this age can be easily motivated to cooperate during the examination, and since they stay in the kindergartens for a considerable period of the day, they only can be guided by nurses who can provide positive motivation for educational programs. As an additional advantage, the cooperation between nurses and parents, as well as positive influence on the parents, by the nurses might be taken into account. In this context, nurses must be regarded as key persons for strategies when considering life-style changes. Identifying children at risk at this early age could shorten the pathogenetic period and increase the chance for regression of the atherosclerotic disease process. Furthermore, children of this age are willing to learn and to change their habits. There is also a possibility that children may implant in their families experiences and information obtained in the kindergartens. Such parents might be more open to advice from kindergarten personnel, and thus also profit for themselves. An additional and valuable advantage of screening kindergarten children is the possibility of detecting first-degree relatives at risk before clinical manifestation of the disease, thereby having a good chance for successful intervention.

Arteriosclerosis↗
PubMed1979

The development and evaluation of a behavioral weight-reduction program.

The development of a comprehensive weight-reduction program and its implementation in the clinic are described. The program consisted of explicit instructions on food monitoring, stimulus control, chaining, exercise, and self-reinforcement. The results of pilot research indicated that the program produced reliable weight loss and that its implementation in a group format was more positive. A formal experiment evaluated the effectiveness of program components in a 2 x 2 factorial design after ten weeks of treatment and at three-month and one-year follow-ups. There was significant weight loss with no main or interaction effects. At follow-up, those exposed to exercise and/or contingency management better maintained their weight loss or continued to lose. Data on the implementation of the program in a clinical setting are presented and these results compare favorably with reports from other clinics using behavior modification. It is suggested that our more positive results may be related to an emphasis on activity and life-style change in addition to changing eating behavior.

Adolescent↗
PubMed1984

Ethnicity and cancer prevention in a tri-ethnic urban community.

A pilot study of knowledge and behavior regarding primary cancer prevention was conducted in a tri-ethnic urban community. Knowledge of smoking and dietary risk factors was substantial, but awareness of cancer safeguards involving reduced sun exposure and mouth and proctological examinations was low. One of five respondents had taken measures to prevent cancer, and these persons tended to rate their own risk higher than respondents who made no life-style changes. Self-motivated behavior change focused on avoidance of cancer-promoting food. Blacks differed from whites and Mexican-Americans in awareness of cancer cause and prevention, particularly regarding dietary factors and behavior modification. The findings have implications for the design of cancer control measures in multiethnic communities.

Adult↗
PubMed1981

Protocol for a study of nutritional factors and the low risk of colon cancer in Southern retirement areas.

Colon cancer shows a distinct geographic pattern in the United States, with mortality rates in the Northeast exceeding those in the South by about 50%. The North-South gradient remains even after adjustment for differences in urbanization and socioeconomic status. Those counties in the South that attract large numbers of retirees from the North retain the low colon mortality rates characteristic of the South, even at older ages. This observation implies either that certain life-style changes associated with migration at retirement rapidly reduce the risk of colon cancer or that individuals migrate selectively, based on some correlate of health. A specific hypothesis related to the former possibility is that consumption of fruits and vegetables, and the associated vitamin C, carotene, and fiber, is elevated in the South and related to the reduced risk of colon cancer. A protocol is presented for a case-control interview study in Southern retirement areas to assess these possible explanations. A detailed residential history, as well as information on frequency of consumption of specific foods, food groups, and micronutrients, will be collected by interview and will be complemented by selected serum micronutrient determinations and fecal mutagenicity assays.

Adult↗
PubMed1995

[Heart failure in elderly patients].

The incidence and prevalence of congestive heart failure increase exponentially with advancing age. Congestive heart failure in the elderly is characterized by a multifactorial etiology, a high proportion of accompanying degenerative changes of the cardiovascular system and age-specific problems regarding diagnosis and treatment. The treatment strategy is the same as in younger patients, but the higher incidence of adverse effects and complications demands special awareness. The majority of decompensations leading to hospitalization are precipitated by insufficient compliance in life style change and drug intake.

Adult↗
PubMed1995

The economic impact of corporate wellness programs: past and future considerations.

1. A primary goal of health promotion is to motivate individuals to make positive life-style changes. 2. Health promotion is multifaceted and each company must select the most appropriate method(s) of intervention for their employees. 3. In any company, a successful health promotion program requires an advocate or champion who functions as the initiator and leader for program development. Employee involvement, from inception to ongoing development of all programs, is also necessary for success. 4. To positively impact health care costs, health promotion programs should be well planned, well timed, and appropriately marketed. Needs of all workers (i.e., blue collar, minorities) should be considered.

Forecasting↗
PubMed1995

Cancer outlook: an African perspective.

In all western populations, mortality rates from cancer are high and even increasing: moreover, incidence rates of some cancers are also rising. As to propitiousness of preventive factors, genetic, gender, and age are beyond alteration: much the same applies to certain protective factors, e.g. late menarche, teenage pregnancy, high parity, long lactation, and greater physical activity. Influential dietary factors, i.e. intakes of energy, fat and fibre, often do not lend themselves to major alteration. Although reductions in smoking have occurred, the practice remains widespread and the intake of alcohol remains high. In developing countries, such as Africa, life-style changes are occurring and the population is incurring all risk factors mentioned. Whereas cancer is relatively uncommon in rural dwellers in developing countries, it is increasing in the huge peri-urban and urban populations due to changes in diet and way of life. Although knowledge should enable us to halve cancer's burden, hopes for meaningful changes are meagre. Survival time can be lengthened by more effective screening, especially of the very susceptible, and by further advances in treatment. Since known risk factors account for only half or less of occurrences of cancer, further rises, or, hopefully, welcome falls, could conceivably occur in the future. We must continue to try to educate the public regarding cancer avoidance: compliance by even a small proportion of those at risk could benefit huge numbers.

Africa↗
PubMed1994

A prospective study of serum lipoproteins after coronary artery bypass surgery.

We examined the acute and long-term effects of coronary artery bypass (CABG) surgery on serum lipid, lipoprotein and apolipoprotein levels. One series of 34 patients having CABG surgery was studied pre-operatively and for six weeks afterwards, and another 22 patients were investigated before and two years after CABG surgery. None of the patients studied received any lipid-lowering drug therapy or specific dietary advice. In both groups, pre-operative serum lipoprotein (a) (Lp(a)) and serum triglyceride concentrations were raised and serum high-density lipoprotein (HDL) cholesterol and apolipoprotein AI (apo AI) were low compared to healthy people. Acutely, there were profound decreases of 40-60% in the serum levels of cholesterol (p < 0.001), low-density lipoprotein cholesterol (p < 0.05), triglycerides (p < 0.01), Lp(a) (p < 0.05) and apolipoprotein B (apo B) (p < 0.05). There was a small decrease in serum apo A1 (p < 0.05), and serum HDL cholesterol showed no change. All these variables regained their pre-operative values within six weeks. Two years postoperatively, serum Lpa was 40% less than its pre-operative concentration (p < 0.001) and HDL cholesterol had increased (p < 0.001). Triglyceride levels decreased (p < 0.02) when beta-blockade was withdrawn. The long-term decrease in Lp(a) following surgery is unlikely to be due either to stopping beta-blockers or to life-style changes. Myocardial ischaemia relieved by the operation may have been partially responsible for its previously raised concentration.

Adult↗
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↗
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↗