Lifestyle Alterations Research Articles

Evaluation of 28 years of surgical treatment of children and young adults with familial adenomatous polyposis

Background In this retrospective study, 28 years of surgical treatment of children and young adults with familial adenomatous polyposis (FAP) was analyzed. Methods Forty-three patients were operated on before the age of 26 years. Endoscopic aspects, operative data, and complications were analyzed, and the resection specimens were reevaluated. Functional outcome was assessed by telephone questionnaire. Results Primary ileorectal anastomosis (IRA) was performed in 34 patients with a mean age of 16 years (range, 7-25 years). Primary ileal-pouch anal anastomosis (IPAA) was performed in 9 patients at a mean age of 19 years (range, 15-24 years). Secondary excision of the rectum was performed in 7 patients. Overall, rectal carcinoma was present in 4 patients, at the age of 35, 36, 37, and 38 years. Two patients, aged 39 and 40 years, died because of invasive carcinoma with distant metastasis. The functional outcome and postoperative complications after both procedures were similar to those described in literature for children with FAP. Most patients did not experience alterations in lifestyle, and there was no urinary incontinence. Conclusions In this retrospective study, both IRA and IPAA showed to be feasible techniques in young patients with FAP. A prospective study with a sufficient follow-up is needed to compare both techniques in this specific group of patients.

A Skeleton Tells Its Own Story: Forensic Analyses of Skeletal Elements for the Science Classroom Laboratory

The techniques of forensic anthropology and pathology can provide new information to increase student interest in studying the structural details of the human skeleton. We present a simplified methodology for assessing skeletal ethnicity, sex, age, and stature. An inexpensive method has been devised for constructing an osteometric board to allow students to measure long bones accurately. The effects of aging and the influence of lifestyle alterations on skeletal elements are presented along with the prediction of their effects on the living individual. This laboratory is intended to acquaint students with the process of collecting and analyzing data, interpreting scientific results, and assessing the accuracy of their conclusions. Gathering and analyzing their own data sets gives students a better understanding of the scientific method and an increased ability to translate this understanding to other scientific disciplines.

Hepatitis C and hepatic steatosis

Hepatic steatosis is commonly seen in patients with chronic hepatitis C infection, and the two together have a greater association than by chance alone. Hepatitis C virus is closely associated with lipid metabolism throughout its lifecycle. Hepatic steatosis is more common in genotype 3 infection, due to direct viral effects including through microsomal triglyceride transfer protein, peroxisome proliferator activating receptor, and sterol regulatory element binding protein. In non-genotype 3 infection, hepatic steatosis is considered largely to be due to alterations in host metabolism, particularly through insulin resistance. The clinical relevance of this association has yet to be fully explored. Hepatic steatosis is associated with increased hepatic fibrosis and a reduced level of sustained virological response to pegylated interferon and ribavirin. Small studies trialing adjuvant anti-diabetic therapies or HMG-CoA reductase inhibitors with pegylated-interferon and ribavirin have shown an improved sustained virological response and reduced viral titer. Furthermore, simple lifestyle alterations showed positive effects on parameters of disease activity. These insights raise the possibility of novel treatment options.

A qualitative study of work participation in early rheumatoid arthritis

Aims This article details a qualitative study aiming to explore the impact of rheumatoid arthritis (RA) on participation in paid work during the first two years after diagnosis. Methods In-depth semi-structured interviews using the Model of Human Occupation Worker Role Interview were used to explore the impact of a diagnosis of RA on the participant's lived experience, the meaning of work from the participant's point of view, and whether there was any change in perception or attitude towards work and work ability since diagnosis. Qualitative methods were felt to be appropriate to capture the lived experience of participation and engagement in work. Interviews were conducted on entry to the study and were repeated at six-month follow-up. Transcripts from the interviews were subjected to interpretative phenomenological analysis. Findings Ten individuals with RA in paid employment participated in the study. The mean age was 38 years. The mean duration from diagnosis was 14.2 months. Participants identified work-specific changes and external lifestyle alterations made early in the disease trajectory to support maintenance of the worker role. The personal meaning of work and the importance of the worker role in shaping self-identity emerged as an important factor in determining work participation. Qualitative factors influenced the type and extent of changes made to work and determined the impact of RA on work. These findings suggest that from early in the disease course RA influences the individual's normal lifestyle and work participation. Conclusions Qualitative assessment of work participation demonstrated that paid work was affected in the early phase of RA. Work intervention needs to shift to encompass such factors which influence maintenance of the worker role.

Preventive Health Behaviors in Unaffected High-Risk Women: The Impact of Perceived vs Actual Risk and Preferred Involvement in Decision-Making.

Abstract Background: While major advances have been made in the diagnosis and treatment of breast cancer, more limited progress has been made in the prevention of the disease. Although several clinical trials have demonstrated the advantages of lifestyle alteration, weight loss and use of anti-estrogens, uptake of such strategies is generally sporadic in women at high risk. It has been particularly challenging to engage even women at very high risk in clinical trials aimed at primary prevention. These decisions may be influenced by several factors, among which perceived risk, actual risk and preferences for participation in preventive decision making may be particularly important. In this project, we seek to describe how perceived risk, actual risk and the preferred level of involvement in the decision jointly impact the risk management intentions and subsequent decisions.Methods: As a regular component of risk assessment process at the High Risk Breast Assessment Clinic (HRBAC) of the Ottawa Regional Women's Breast Health Centre, a detailed questionnaire is administered to women referred to the clinic before their first risk assessment consultation. The questionnaire includes several items required for calculating actual risk (using Gail score) as well as questions concerning health practices (breast screening, clinical breast examination, breast self-examination) and lifestyle practices (weight, height, smoking, alcohol and physical activity). Women's perceived risk is assessed by the following question: “What do you think the likelihood is of you developing breast cancer in your lifetime?”, and women are required to provide a percentage to express their risk. Women are also asked to indicate their intentions about breast cancer prevention and to identify which prevention strategy is the most important to them. Preferred role involvement in decision making is also assessed by the following question: “What role would you like to take in making your decision?”and women are classified as active or passive. Patient's charts are used to obtain information about the prevention decisions that women made 1 year after receiving risk counselling.We hypothesize that risk reduction counselling will weaken the association between perceived risk and prevention decisions and conversely will strengthen the correlation between actual risk and risk reduction option considered by women.Results: Correlational and chi-square analyses of the demographic data, actual(calculated0 and perceived risk, as well as prevention behaviour uptake obtained from 300 patients will be presented. A low correlation between perceived and actual risks is expected before patients receive risk counselling at the clinic. Statistically reliable association between perceived risk and precounselling prevention intentions and a low level association between actual risk and precounselling prevention intentions are also expected. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1040.

Obesity in pregnancy: prevalence and metabolic consequences

Rates of obesity have increased exponentially worldwide to almost epidemic proportions. This is associated with a marked increase in adverse maternal and perinatal outcomes and subsequent burden on health care resources. In particular, maternal obesity is linked to numerous metabolic complications including subfertility, gestational diabetes, hypertensive disorders of pregnancy and thromboembolism with potential long-term health consequences for both mother and child. The underlying pathophysiology linking maternal obesity and adverse outcomes is complex but is likely to involve alterations in glucose and lipid metabolism, inflammation, perturbances in adipokines and vascular dysfunction all seen in obese women. Intervention studies are underway to determine whether alteration of maternal lifestyle can improve maternal and fetal outcomes.

Raising HDL cholesterol in women

High-density lipoprotein cholesterol (HDL-C) concentration is essential in the determination of coronary heart disease (CHD) risk in women. This is especially true in the postmenopausal state, where lipid profiles and CHD risk mimic that of age-matched men. Thus, interventions designed to reduce CHD risk by raising HDL-C levels may have particular significance during the transition to menopause. This review discusses HDL-C-raising therapies and the role of HDL in the primary prevention of CHD in women. Lifestyle-based interventions such as dietary change, aerobic exercise regimens, and smoking cessation are initial steps that are effective in raising HDL-C, and available data suggest women respond similarly to men with these interventions. When combined with pharmacotherapy, the effects of these lifestyle alterations are further amplified. Though studies demonstrating gender-specific differences in therapy are limited, niacin continues to be the most effective agent in raising HDL-C levels, especially when used in combination with fibrate or statin therapy. Emerging treatments such as HDL mimetic therapy show much promise in further raising HDL-C levels and improving cardiovascular outcomes.

The acceptability to patients and professionals of remote blood pressure monitoring using mobile phones

AimTo establish the acceptability of telemetric monitoring of blood pressure to patients and clinicians.BackgroundTelemetric monitoring of blood pressure (BP) may allow clinicians and patients, in partnership, to more quickly control high BP through medication and lifestyle alterations. However, it is not clear if patients and clinicians would find such a system acceptable.MethodsQuestionnaire study followed by focus groups of patients with high BP, and clinicians involved in managing BP.FindingsWe received responses from 25 (50%) practice nurses, 76 (50%) general practitioners and 126 (62%) patients. We ran three focus groups of patients and clinicians. Participants were supportive of the technology, willing to try it, thought it would encourage adherence to medication and lifestyle and felt it would diagnose problems sooner than current methods. However, both groups thought the technology would be more useful for new patients or those whose BP was uncontrolled. They were concerned that individual high readings might provoke anxiety and thought patients would need reassurances about this. Clinicians were concerned about workload and the responsibility to act immediately when faced with a continuous stream of readings, regardless of how inconvenient this may be.ConclusionParticipants, in general, welcomed this technology and thought it would aid adherence to medication and lifestyle advice, but felt it was most suitable to those with newly diagnosed or uncontrolled hypertension. Patients will need to be educated and reassured about the nature of occasional high readings and the need to consider average BP.

Hypoglycemic pharmacological treatment of type 2 diabetes: Targeting the endothelium

Cardiovascular disease is by far the most common complication of type 2 diabetes and also the most serious one. Suffering from type 2 diabetes mellitus not only dramatically increases the risk of cardiovascular disease but is also associated with poor survival, both acutely and in the long term after a myocardial infarction. In fact, total mortality from coronary artery disease in subjects with type 2 diabetes mellitus, without a previous myocardial infarction, is as high as that of non-diabetic individuals with a previous infarction. Intense research efforts have thus been directed towards exploring the reasons for why particularly type 2 diabetic patients have such a poor prognosis suffering from cardiovascular disease. Obesity-related type 2 diabetes ("diabesity"), including the metabolic syndrome, is rapidly rising in prevalence. About 80% of all type 2 diabetes co-exists with insulin resistance. Endothelial dysfunction is a ubiquitous abnormality in insulin-resistant states that might contribute to premature atherosclerosis in a multifactorial and complex way. Low grade inflammation may play a role in development insulin resistance and type 2 diabetes and it has been proposed that atherosclerosis is basically an inflammatory disease. Thus, the pathophysiology of insulin resistance, the metabolic syndrome, and atherosclerosis may share inflammatory basis as a common denominator. Also, insulin resistance is not confined to skeletal muscle, adipose tissue and the liver, but also to the endothelium. Insulin resistance and endothelial dysfunction co-exist, where chronic inflammation may be a crucial factor. Accordingly, the possibility that physical activity or pharmacological agents that increase insulin sensitivity also improve endothelial function, or vice versa, has been investigated. Many different alterations in life style and drugs that improve endothelial function are known to lower the risk of contracting diabetes. In this review, the pharmacological treatment available against type 2 diabetes mellitus is discussed with particular emphasis on its impact on the endothelium.

The Translational Research Working Group Developmental Pathway for Lifestyle Alterations

The Translational Research Working Group (TRWG) was created as a national initiative to evaluate the current status of National Cancer Institute's investment in translational research and envision its future. The TRWG conceptualized translational research as a set of six developmental processes or pathways focused on various clinical goals. One of those pathways describes the development of lifestyle alterations, which can, variously, be recommended to prevent cancer, modify a patient's adherence and response to cancer treatment, ameliorate side effects of cancer treatments, or improve prognosis and quality of life in cancer patients and survivors. The lifestyle alteration pathway was conceived not as a comprehensive description of the corresponding real-world processes, but rather as a tool designed to facilitate movement of a candidate lifestyle alteration through the translational process up to the point where it could be handed off for definitive testing, when appropriate. This article discusses key issues associated with the development of lifestyle alterations in light of the pathway.

The Translational Research Working Group Developmental Pathways: Introduction and Overview

The Translational Research Working Group (TRWG) was created as a national initiative to evaluate the current status of the National Cancer Institute's investment in translational research and envision its future in an inclusive, representative, and transparent manner. To clarify the challenges facing translational research and facilitate its deliberations, the TRWG conceptualized translational research as a set of developmental processes or pathways focused on various clinical goals. Drawing on the collective knowledge of the TRWG members, six pathways were derived, with two addressing the development of tools designed to characterize an individual's cancer-related health status (biospecimen-based and image-based assessment modalities) and four addressing the development of interventions intended to change cancer-related health status (drugs or biological agents, immune response modifiers, interventive devices, and life-style alterations). The pathways, which share a number of common structural elements, are graphically represented by schematic flowcharts that capture relevant contingencies, decision points, and interdependencies. They are conceived not as comprehensive descriptions of the corresponding real-world processes but as tools designed to serve specific purposes including research program management and research project management, coordination of research efforts, and professional and lay education and communication. Further development of the pathways is encouraged, as is application of the pathway concept to translational research on other diseases.

The role of ultrasound in the prediction of preterm labour

Preterm labour (PTL) before 34 weeks gestation which complicates 3-4% of pregnancies is one of the most challenging problems in modern maternity are. It is the single most important cause of neonatal morbidity and mortality and disability in children and adults. About 75% of neonatal deaths occur in infants born prematurely, with over two thirds of these arising in the 30-40% of preterm infants who are delivered before 32 weeks gestation. Although there has been an overall increase in the survival rate, there has been an increase in the short-term morbidity and long term physical and mental disability in infant survivors of very preterm birth. Reduction in the consequences of PTL can either be through strategies involving primary or secondary prevention. Primary prevention in the form of alterations in lifestyle has failed to have any impact on the incidence of PTL. Consequently the only real strategy has to be based on secondary preventative strategies. These involved early diagnosis and improved secondary/tertiary care. This review article focuses on the imaging aspect of secondary prevention and highlights the evidence to support the use of ultrasound in preterm labour. Keywords : Preterm labour; Ultrasound; Cervical length O & G Forum Vol. 18 (3) 2008: pp. 67-70

Assessment of atherosclerotic cardiovascular risk and management of dyslipidemia in obese children

As the prevalence of childhood obesity increases there is potential for an increase in prevalence and an earlier onset of coronary artery disease. Comorbidities of obesity such as dyslipidemia, insulin resistance syndrome, hypertension, sedentary lifestyle or associated lifestyle factors, like tobacco smoke exposure may result in premature onset of atherosclerosis. Obese children may have other diseases, which can also accelerate the development of atherosclerosis. As clinical atherosclerotic cardiovascular disease does not manifest in obese children, assessment of non-invasive markers of vessel function and structure may be helpful in further stratifying risk and in monitoring effects of intervention. Broad social and cultural changes outside the scope of the health sector are probably most effective in curtailing the epidemic of obesity and thus minimizing its cardiovascular manifestations. Pediatric health care providers should be diligent in screening and providing counseling regarding potential cardiovascular risk factors. Lifestyle alterations resulting in optimal weight management are of foremost importance in preventing the cardiovascular effects of obesity. A select group of children may be at high risk of premature cardiovascular disease despite rigorous implementation of these measures. These children may benefit from pharmacological therapy of dyslipidemia, insulin resistance syndrome or hypertension. Statins have been proven to be effective in decreasing blood low-density lipoprotein cholesterol levels in children and appear safe in the short-term, but their effect in eventually altering the timeline of atherosclerotic cardiovascular disease manifestations in adult life or its associated mortality and morbidity is unclear. The effect of risk factor modification on vascular functional and structural end points will continue to be a resource for evidence-based therapy in these children in the absence of hard clinical outcomes data. This article addresses an overview of assessment of atherosclerotic cardiovascular risk in obese children, but is restricted to an overview of the management of one risk factor - dyslipidemia.

Ischemic Etiology of Incontinence in Women: A Theory and A Review

Incontinence in women is a major health problem. In a recent study, incontinence affects more than 10 million Americans, 85% of whom are women. Incontinence can result in an extremely altered life style, and is the main reason that women are admitted to nursing homes. Care for the incontinent patient represents an enormous expense nationally.

Women Donʼt Alter Lifestyle, Even with Family History of Heart Disease

Women Donʼt Alter Lifestyle, Even with Family History of Heart Disease

Lifestyle Exposures and Eye Diseases in Adults

To provide a perspective of observed associations between lifestyle exposures and eye diseases in adults. Summary of recent epidemiologic studies. Nonsystematic review of the literature. Data suggest that some lifestyle exposures (e.g., smoking) are significantly associated with risk of several different diseases, suggesting that altering behaviors may decrease risk. Where risk is inherent to an occupational or recreational activity, eye protection is likely to decrease risk. Although data are imperfect, it seems that some lifestyle alterations may decrease the risk of eye diseases at little or no risk to the individual.

A Prospective Study of the Modified Atkins Diet for Intractable Epilepsy in Adults

The ketogenic diet is not typically offered to adults with epilepsy due to the significant lifestyle alterations needed for its use. The modified Atkins diet has been recently demonstrated to be therapeutic for children without the need for an admission, fasting period, weighing of foods, or fluid, calorie, and protein restriction. A prospective, open-label study was performed of adults over 18 years of age, having at least weekly seizures and prior use of at least two anticonvulsants. Carbohydrates were initially restricted to 15 g/day, fats were encouraged, and fluids, protein, and calories were allowed ad lib. Thirty patients, with age ranging from 18 to 53 years, were enrolled. Using an intent-to-treat analysis, 47% had a >50% seizure reduction after 1 and 3 months on the diet; 33% after 6 months. In those with seizure reduction, the median time to improvement was 2 weeks (range: 1-8 weeks). The mean weight loss was 6.8 kg, p < 0.001. Body-mass index (BMI) decrease correlated with efficacy at 3 months, p = 0.03. Ten subjects (30%) discontinued the diet prior to 3 months. Side effects included increased cholesterol (mean 187 to 201 mg/dL), blood urea nitrogen (BUN; 13 to 16 mg/dL), and urine calcium to creatinine ratio (0.14 to 0.19). A modified Atkins diet appears to demonstrate preliminary efficacy for adults with intractable epilepsy, especially in those who lost weight. Considering the rapid response in those who improved, but somewhat high discontinuation rate, a 2-month trial period may be adequate to assess for efficacy.

The Science of Healthy Aging

Healthy aging and longevity depend on successful and dynamic interactions among biological, psychological, and environmental factors. Biological aging occurs mainly during the period of survival beyond the evolutionarily required essential lifespan (ELS). Natural selection processes for survival and successful reproduction have selected for a range of genetically determined ELS-assuring maintenance and repair systems (MRSs). The progressive failure of MRSs, and the consequent accumulation of molecular heterogeneity and damage, underlie the biological basis of aging, age-related diseases, and eventual death. However, the genetic processes of MRSs operate in a complex hierarchy of factors which range from intracellular molecular factors to physiological, psychological, environmental, and other stochastic factors, including chance. This view also facilitates setting up a framework for understanding, researching, and developing effective and realistic strategies for aging intervention, prevention, and therapies. Manipulating genes and the milieu in which genes and gene products operate opens up novel possibilities of aging intervention and prevention. Gene therapy, stem cells, and modulation through functional foods, nutriceuticals, cosmeceuticals and lifestyle alterations, including mild stress-induced hormesis, are examples of such strategies at various levels of development and practice.

The effects of smoking on bone health

Osteoporotic fractures are a major public health problem in most developed countries and an increasing concern in much of the developing world. This healthcare burden will increase significantly worldwide over the next 20 years due to aging of the population. Smoking is a key lifestyle risk factor for bone loss and fractures that appears to be independent of other risk factors for fracture such as age, weight, sex and menopausal status. This review discusses the effects of smoking on bone health in pre-menopausal and post-menopausal women and men. Data from twin studies and the three main published meta-analyses are presented. Possible mechanisms by which smoking affects bone mass are reviewed. Despite smoking being a major lifestyle risk factor for osteoporosis, the mechanisms underlying smoking-associated bone loss and fracture risk remain poorly understood. The effect appears dose-dependent, and may be, at least partially, reversible. However, more work is required to confirm and characterize the reversibility of smoking-associated bone defects. Finally, strategies for quitting smoking are discussed. Encouragement of lifestyle alterations, including smoking cessation, should be a major component of any bone therapeutic programme.

Irritable bowel syndrome and bloating

Gaseous symptoms in irritable bowel syndrome (IBS) including eructation, flatulence, and bloating occur as a consequence of excess gas production, altered gas transit, abnormal perception of normal amounts of gas within the gastrointestinal tract, or dysfunctional somatic muscle activity in the abdominal wall. Because of the prominence of gaseous complaints in IBS, recent investigations have focussed on new insights into pathogenesis and novel therapies of bloating. The evaluation of the IBS patient with unexplained gas and bloating relies on careful exclusion of organic disease with further characterisation of the underlying condition with directed functional testing. Treatment of gaseous symptomatology in IBS should be targeted to pathophysiologic defects whenever possible. Available therapies include lifestyle alterations, dietary modifications, enzyme preparations, adsorbents and agents which reduce surface tension, treatments that alter gut flora, and drugs that modulate gut transit.