Lifestyle Options Research Articles

Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk.

Obstructive sleep apnoea (OSA) is associated with increased cardiovascular disease (CVD) morbidity and mortality. It is accepted that OSA and obesity commonly coexist. The American Academy of Sleep Medicine recommends dietary-induced weight loss and exercise as lifestyle treatment options for OSA. However, most clinical trials upon which this recommendation is based have focused on establishing the effectiveness of calorie-restricted, often low-fat diets for improving OSA severity, whereas less attention has been given to the means through which weight loss is achieved (e.g. altered dietary quality) or whether diet or exercise mediates the associations between reduced weight, improved OSA severity and the CVD substrate. The current evidence suggests that the benefits of a low-carbohydrate or Mediterranean diet in overweight and obese individuals go beyond the recognised benefits of weight reduction. In addition, exercise has an independent protective effect on vascular health, which may counter the increased oxidative stress, inflammation and sympathetic activation that occur in OSA patients. This review aims to expand our understanding of the effects of diet and exercise on OSA and associated CVD complications, and sets the stage for continued research designed to explore optimal lifestyle strategies for reducing the CVD burden in OSA patients.

Genome‐wide identification of pathogenicity, conidiation and colony sectorization genes in Metarhizium robertsii

Metarhizium robertsii occupies a wide array of ecological niches and has diverse lifestyle options (saprophyte, insect pathogen and plant symbiont), that renders it an unusually effective model for studying genetic mechanisms for fungal adaptation. Here over 20,000 M. robertsii T-DNA mutants were screened in order to elucidate genetic mechanism by which M. robertsii replicates and persists in diverse niches. About 287 conidiation, colony sectorization or pathogenicity loci, many of which have not been reported in other fungi were identified. By analysing a series of conidial pigmentation mutants, a new fungal pigmentation gene cluster, which contains Mr-Pks1, Mr-EthD and Mlac1 was identified. A conserved conidiation regulatory pathway containing Mr-BrlA, Mr-AbaA and Mr-WetA regulates expression of these pigmentation genes. During conidiation Mr-BlrA up-regulates Mr-AbaA, which in turn controls Mr-WetA. It was found that Hog1-MAPK regulates fungal conidiation by controlling the conidiation regulatory pathway, and that all three pigmentation genes exercise feedback regulation of conidiation. This work provided the foundation for deeper understanding of the genetic processes behind M. robertsii adaptive phenotypes, and advances our insights into conidiation and pigmentation in this fungus.

Nonsurgical Management of Urinary Incontinence in Older Women

Purpose of Review Urinary incontinence is highly prevalent and very costly. Proper detection and evaluation of urinary incontinence can facilitate appropriate treatment options for older women. Our goal is to discuss first-line, nonsurgical management of urinary incontinence in older women. We include behavioral, lifestyle, and pharmacologic management options.

Breast Cancer Epidemiology, Prevention, and Screening.

Globally, breast cancer is both the most commonly occurring cancer and the commonest cause of cancer death among women. Available data suggest that incidence and mortality in high-resource countries has been declining whereas incidence and mortality in low-resource countries has been increasing. This pattern is likely to be due to changing risk factor profiles and differences in access to breast cancer early detection and treatment. Risk factors for breast cancer include increasing age, race, menarche history, breast characteristics, reproductive patterns, hormone use, alcohol use, tobacco use, diet, physical activity, and body habitus. Mutations in the BRCA 1 and BRCA 2 tumor suppressor genes are significantly associated with the development of breast and ovarian cancer by the age of 70. Survival depends on both stage and molecular subtype. As there are few signs and symptoms early on, early detection is an important strategy to improve outcomes. Major professional organizations in the United States and elsewhere recommend screening with mammography with appropriate follow up for an abnormal screening test, although they differ somewhat by recommended ages and frequency of screening. Studies suggest a 15%-40% mortality reduction secondary to screening, however, there are also concerns about harms, such as overdiagnosis (5%-54%) and overtreatment leading to long term complications, and false negatives (6%-46%). Identification of women at risk for BRCA1 and BRCA 2 mutations is also recommended with referral for genetic testing. Preventive interventions, such as lifestyle, medical, and surgical options are available for women testing positive for BRCA mutations.

Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is an increasingly common diagnosis seen in men over age 50 years. Primary care providers must be aware of patient presentation, diagnostic tests, appropriate lifestyle modifications, treatment options, and potential complications in order to properly manage and educate patients with BPH. If left untreated, BPH can significantly decrease a man's quality of life; however, many pharmacologic and surgical treatments are available to control the symptoms.

Abstract 469: Residential Lifestyle Interventions Reduce Blood Pressure in 18 Days

Background: Tight control of blood pressure can have long term positive effects, non-pharmacological interventions to achieve it are documented in this study. Hypothesis: Vegan diets together with other lifestyle changes can safely decrease blood pressure. Methods: Twelve years of data was used, 1196 patients participated in a lifestyle program in Weimar California. The intervention consisted in whole food plant based diet (WFPD), exercise, sleep hygiene, medical, psychological and spiritual therapies. Treatments of massage and hydrotherapy were also given. A physician monitored the progress of each patient during the 18 days. Blood pressure was measured at baseline, at the end of the first week (time 1) and at the end of the second week (time 2) and at the end of 18 days. Some patients need it to decrease their blood pressure medication during the 18 days. Data was process with SPSS statistics package. Results: From 1196 patients, 764 of them were females. Mean age at baseline was 60.7 SD 15. Both systolic and diastolic blood pressure were reduced throughout treatment. For systolic on average (in mm HG) at baseline: 132.21, at time 1: 125.3, at rime 2: 121.96, at the end : 121.4. For diastolic on average (in mm HG) at baseline: 76.1, time 1: 72.2, time 2: 70.86, at the end : 69.9. A repeated measures ANOVA determined that mean systolic blood pressure differed significantly between time points (F(3,3585) = 69.008, P < .001). Post hoc polynomial contrasts revealed a significant linear trend in the data from start to end (F(1,1195 = 206.474. p<.001, partial η 2 = .14)). A similar pattern was found for diastolic blood pressure. The overall ANOVA found a significant difference in time points (F(3,3585) = 34.738, P < .001). Post hoc polynomial contrasts also showed a significant linear trend (F(1,1195 = 109.031. p<.001, partial η 2 = .08). Participants lost 4.8 pounds on average by the end of the program. Conclusion: WFPD together with lifestyle interventions are associated with a significant reduction of systolic and diastolic blood pressures. Many patients reduced their blood pressure medication. Lifestyle interventions options should be offered to patients with hypertension.

Strategies to reduce the risk of falling: Cohort study analysis with 1-year follow-up in community dwelling older adults.

BackgroundAccording to the CDC, falls rank among the leading causes of accidental death in the United States, resulting in significant health care costs annually. In this paper we present information about everyday lifestyle decisions of the older adult that may help reduce the risk of falling. We pursued two lines of inquiry: first, we identify and then test known mutable fall risk factors and ask how the resolution of such problems correlates with changes in fall rates. Second, we identify a series of everyday lifestyle options that persons may follow and then ask, does such engagement (e.g., engagement in exercise programs) lessen the older adult’s risk of falling and if it does, will the relationship hold as the count of risk factors increases?MethodsUsing a secondary analysis of lifestyle choices and risk changes that may explain fall rates over one year, we drew on a data set of 13,623 community residing elders in independent housing sites from 24 US states. All older adults were assessed at baseline, and a subset assessed one year later (n = 4,563) using two interRAI tools: the interRAI Community Health Assessment and interRAI Wellness Assessment.ResultsFor the vast majority of risk measures, problem resolution is followed by lower rate of falls. This is true for physical measures such as doing housework, meal preparation, unsteady gait, transferring, and dressing the lower body. Similarly, this pattern is observed for clinical measures such as depression, memory, vision, dizziness, and fatigue. Among the older adults who had a falls risk at the baseline assessment, about 20 % improve, that is, they had a decreased falls rate when the problem risk improved. This outcome suggests that improvement of physical or clinical states potentially may result in a decreased falls rate. Additionally, physical exercise and cognitive activities are associated with a lower rate of falls.ConclusionsThe resolution of risk problems and physical and cognitive lifestyle choices are related to lower fall rates in elders in the community. The results presented here point to specific areas, that when targeted, may reduce the risk of falls. In addition, when there is problem resolution for specific clinical conditions, a decreased risk for falls also may occur.

Medical and Surgical Treatment Options for Nonalcoholic Steatohepatitis.

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the USA with a growing prevalence worldwide. Nonalcoholic steatohepatitis (NASH), progressive form of NAFLD, can lead to the development of cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. Treatment of NASH may decrease the risk of progressive disease. Treatment for NAFLD should center around weight loss and exercise. Pharmacotherapy with vitamin E and pioglitazone should be considered for those with NASH, especially those with fibrosis. Weight loss surgery is also an effective treatment for NASH in individuals with other indications for surgery. In this review, we will discuss the currently available therapies for NASH including lifestyle, pharmacologic, and surgical options.

Who Reaps the Benefits of Social Change? Exploration and Its Socioecological Boundaries

We investigated the interplay between the personality trait exploration and objective socioecological conditions in shaping individual differences in the experience of two individual-level benefits of current social change: new lifestyle options, which arise from the societal trend toward individualization, and new learning opportunities, which accrue from the societal trend toward lifelong learning. We hypothesized that people with higher trait exploration experience a greater increase in lifestyle options and learning opportunities--but more so in social ecologies in which individualization and lifelong learning are stronger, thus offering greater latitude for exploring the benefits of these trends. We employed structural equation modeling in two parallel adult samples from Germany (N = 2,448) and Poland (N = 2,571), using regional divorce rates as a proxy for individualization and Internet domain registration rates as a proxy for lifelong learning. Higher exploration was related to a greater perceived increase in lifestyle options and in learning opportunities over the past 5 years. These associations were stronger in regions in which the trends toward individualization and lifelong learning, respectively, were more prominent. Individuals higher in exploration are better equipped to reap the benefits of current social change--but the effects of exploration are bounded by the conditions in the social ecology.

Short-Term Lifestyle Strategies for Sustaining Cognitive Status.

Cognitive decline impacts older adults, particularly their independence. The goal of this project was to increase understanding of how short-term, everyday lifestyle options, including physical activity, help an older adult sustain cognitive independence. Using a secondary analysis of lifestyle choices, we drew on a dataset of 4,620 community-dwelling elders in the US, assessed at baseline and one year later using 2 valid and reliable tools, the interRAI Community Health Assessment and the interRAI Wellness tool. Decline or no decline on the Cognitive Performance Scale was the dependent variable. We examined sustaining one's status on this measure over a one-year period in relation to key dimensions of wellness through intellectual, physical, emotional, social, and spiritual variables. Engaging in physical activity, formal exercise, and specific recreational activities had a favorable effect on short-term cognitive decline. Involvement with computers, crossword puzzles, handicrafts, and formal education courses also were protective factors. The physical and intellectual domains of wellness are prominent aspects in protection from cognitive decline. Inherent in these two domains are mutable factors suitable for targeted efforts to promote older adult health and well-being.

Validating prediction scales of type 2 diabetes mellitus in Spain: the SPREDIA-2 population-based prospective cohort study protocol

IntroductionThe incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide. When diagnosed, many patients already have organ damage or advance subclinical atherosclerosis. An early diagnosis could allow the implementation...

Impact of the Northern Studies Stream and Rehabilitation Studies programs on recruitment and retention to rural and remote practice: 2002-2010

A shortage of rehabilitation practitioners in rural and/or remote (rural/remote) practice areas has a negative impact on healthcare delivery. In Northern Ontario, Canada, a shortage of rehabilitation professionals (audiology, occupational therapy, physiotherapy, speech-language pathology) has been well documented. In response to this shortage, the Northern Studies Stream (NSS) and Rehabilitation Studies (RS) programs were developed with the mandate to increase the recruitment and retention of rehabilitation professionals to Northern Ontario. However, the number of NSS or RS program graduates who choose to live and work in Northern Ontario or other rural/remote areas, and the extent to which participation in these programs or other factors contributed to their decision, is largely unknown. Between 2002 and 2010, a total of 641 individuals participated in the NSS and RS programs and were therefore eligible to participate in the study. Current contact information was obtained for 536 of these individuals (83.6%) who were eligible to participate in the study. An internet-hosted survey was administered in June of 2011. The survey consisted of 48 questions focusing on personal and professional demographics, postgraduate practice and experience, educational preparation, and factors affecting recruitment and retention decisions. A total of 280 respondents completed the survey (response rate 52%). Of these, 95 (33.9%) reported having chosen rural or remote practice following graduation. Multiple factors predictive of recruitment and retention to rural/remote practice were identified. Of particular note was that individuals raised in a rural or remote community were 3.3 times more likely to work in a rural or remote community after graduation. Recruitment was strongly associated with length of time immersed in rural/remote education settings and to participation in the NSS academic semester. Job satisfaction, professional networking opportunities, and rural lifestyle options were identified as important factors for retention in rural/remote practice areas. The NSS and RS programs have experienced encouraging recruitment outcomes in the past 10 years. Recruitment and retention of rehabilitation therapists to rural/remote locations appears to be positively and significantly affected by the origins of the health professional. The completion of both academic and clinical education in a rural/remote setting and longer duration of rural/remote education were positively associated with an increased likelihood of choosing to practice in a rural/remote area following entry to practice. These findings have potential implications for admission criteria to rehabilitation education programs with a rural curriculum focus as well as implications for postgraduate mentorship programs and employers in rural/remote areas.

Androgen-deprivation therapy and bone loss in prostate cancer patients: a clinical review.

Androgen-deprivation therapy (ADT) has become a standard of care in the management of advanced prostate cancer or as an adjunct therapy. However, ADT is associated with a well-known deleterious effect on bone health, resulting in a decrease in bone-mass density (BMD) and increased risk for fracture. With the longer life expectancy of prostate cancer patients, improvement of the quality of life has become increasingly important. Therefore, adequate screening, prevention and treatment of BMD loss is paramount. Zoledronic acid and denosumab have shown promising results in recent studies, which has led to the Food and Drug Administration approval of these treatment options in various settings throughout the course of the disease, including the prevention of ADT-associated bone loss. This review focuses on the various parameters that impact BMD loss in men initiating ADT, on the specific effect of ADT on bone health and on various lifestyle modifications and treatment options such as bisphosphonates, osteoclast-targeted therapy and selective estrogen-receptor modulators that have shown promising results in recent studies.

Neighborhood Sustainability Assessment: Evaluating Residential Development Sustainability in a Developing Country Context

Rapid urbanization, improved quality of life, and diversified lifestyle options have collectively led to an escalation in housing demand in our cities, where residential areas, as the largest portion of urban land use type, play a critical role in the formation of sustainable cities. To date there has been limited research to ascertain residential development layouts that provide a more sustainable urban outcome. This paper aims to evaluate and compare sustainability levels of residential types by focusing on their layouts. The paper scrutinizes three different development types in a developing country context—i.e., subdivision, piecemeal, and master-planned developments. This study develops a “Neighborhood Sustainability Assessment” tool and applies it to compare their sustainability levels in Ipoh, Malaysia. The analysis finds that the master-planned development, amongst the investigated case studies, possesses the potential to produce higher levels of sustainability outcomes. The results reveal insights and evidence for policymakers, planners, development agencies and researchers; advocate further studies on neighborhood-level sustainability analysis, and; emphasize the need for collective efforts and an effective process in achieving neighborhood sustainability and sustainable city formation.

Individualisierte Presbyopiekorrektur bei der Kataraktoperation: Monovision und Multifokallinsen

The cataract operation has transformed from a procedure for correcting spherical and astigmatic errors to one for correcting even presbyopia. Higher demands by the patients and more and more complex and individual lifestyle options need customised concepts of presbyopic correction, taking also into account comorbidities and neuroadaption. One concept for achieving this goal is multifocal lenses, undergoing a renaissance these days. Monovision using monofocal lenses is a cost neutral alternative with very few side effects, if well performed. It is defined by the far focus of one eye and the near focus of the other. Binocularity of human vision enables multiple options by combining different means of presbyopia correction. But it also complicates making the right choice. This underlines the importance of an accurate patient selection and the precise definition of what to achieve for each individual patient.

Factors affecting recruitment and retention of rehabilitation professionals in Northern Ontario, Canada: a cross-sectional study

Historically, Northern Ontario, Canada, has been an underserviced area for health care, including the rehabilitation professions of occupational therapy, physiotherapy, speech-language pathology and audiology. The Rehabilitation Studies and Northern Studies Stream programs were created in the 1990s to improve the recruitment and retention of rehabilitation professionals to Northern Ontario. However, no recent research has been conducted examining the factors that lead to rehabilitation professionals relocating to and remaining in the region. A cross-sectional survey of rehabilitation professionals living and working in Northern Ontario was administered in 2009. Information collected included demographics and a rating of the personal and professional factors that had an impact on an individual's decision to continue living and working in Northern Ontario. A total of 345 individuals completed the survey (response rate 57%). Multiple personal and professional factors were closely linked to recruitment and retention with differences noted between those individuals originally from Northern Ontario and those who were not. Rural or remote education experiences and rural/remote origin were identified as important recruitment factors while job satisfaction and lifestyle options were important factors for retention of rehabilitation professionals to rural and remote areas of practice. This study has provided updated information specific to the recruitment and retention of rehabilitation professionals in Northern Ontario, Canada. These findings support previous work examining health professions worldwide and have clear implications for educational programs, funding agencies, and health human resource planning in underserviced areas.

Ethical Aspects of Obesity Management in Children

Introduction: Childhood obesity is a growing global health problem, but in the view of medical ethics, obesity management in children is associated with challenges. Method and materials: This study is a comprehensive review in English (Cochrane Library, and PubMed) and Persian literature which pointed to the ethical aspects of pediatrics obesity management with content analysis. Results: In the childhood obesity interventions, clinical trials should be carefully designed with obtaining approval of ethics committee, selection of the appropriate outcomes, contributing to the family, the assent of the child and consent of family, confidentiality, truth telling, fairness and avoiding discrimination and stigma paid investments. Each of community, government, health systems, media and family have special responsibilities in these interventions that cause a somehow violation of personal freedom, privacy invasion and interference with lifestyle options. In the meantime, with the help of four ethical principles (Autonomy, Beneficence, Justice, Non-maleficence) interventions within the ethical boundaries can be identified. In principle of autonomy with regard to parents are the child’s legal guardians, sometimes with focus on the right refuse obesity interventions. But Islamic ethics and sound medical judgment dictate that with the observance of other moral principles [like la darar wa la dirar (No harm and no harassment) and maslaha (benefit)] in the cases of severe or complicated obesity which obviously affected the lifetime or health of the child done interventions, in the view of duty-oriented. However, obesity in children can be deemed a kind of negligence or neglect of children's health and opposed with provisions of the Convention of rights of children which based on medical paternalistic attitude build Medical intervention obligatory. Conclusion: To fight obesity, appropriate interventions require full compliance with medical ethics in schools, families and society. In this context, the compiling of ethical guidelines in child obesity interventions will be helpful. Keywords: Obesity, Children, Management, medical Ethical.

Family History of Cardiovascular Disease, Perceived Cardiovascular Disease Risk, and Health-Related Behavior

More than 82 million Americans have 1 or more forms of cardiovascular disease (CVD), accounting for 32.8% of all deaths in the United States. Although the evidence for the familial aggregation of CVD is strong, the relationship between family history (FH) of CVD, perceived risk for CVD, and health-related behavior is poorly understood. The objective of this article was to review and summarize the published research on the relationship between an FH of CVD, an individual's perceived risk, and health-related behavior to make recommendations for clinical practice and future research. A literature search was conducted using PubMed, CINAHL Plus, and PsycINFO to identify articles that examined the relationship between an FH of CVD, perceived CVD risk, and health-promoting behaviors. A total of 263 unique articles were reviewed. A total of 238 were excluded, resulting in a total of 25 articles included in the review. There was a positive relationship between a reported FH of CVD and perceived risk. However, the relationship between an FH of CVD and health-related behavior change and perceived risk and behavior change was inconsistent. A person's awareness of his or her FH of CVD or his or her own risk for CVD is not a sufficient predictor of changes in his or her health-related behavior. Future studies are needed to better explain the processes by which perceived CVD risk or FH of CVD can be used to affect health-related behavior changes. It appears that both FH and perceived personal risk for CVD are necessary but not sufficient conditions to change health-related behavior in high-risk populations. Future studies should also test interventions that help individuals with an FH of CVD attribute increased personal risk to themselves for developing CVD, while providing lifestyle management options to minimize their risk.

Improving patient waiting times: a simulation study of an obesity care service

BackgroundObesity care services are often faced with the need to adapt their resources to rising levels of demand. The main focus of this study was to help prioritise planned investments...

Surgical Management of Obesity and the Relationship to Cardiovascular Disease

The World Health Organization estimates that by 2015 the number of adults who are overweight (body mass index [BMI], 25.0–29.9 kg/m2) or obese (BMI ≥30 kg/m2) will surpass 1.5 billion.1 Excess body weight is an independent risk factor for mortality.2 Among the constellation of weight-related comorbidities that bring the greatest burden for obese patients and their healthcare providers are diabetes mellitus and cardiovascular disease (CVD). Obesity, diabetes mellitus, and CVD cannot be successfully addressed in isolation; therefore, weight loss achieved by any means is a key component of comprehensive cardiovascular care.3,4 Obesity prevention is the ideal scenario. However, in the midst of an obesity pandemic, treatment options are essential. The initial approach must always address lifestyle and dietary choices, which contribute so greatly to the current obesogenic environment. A healthy lifestyle is easily prescribed but challenging to maintain. Stalonas et al5 demonstrated not only that patients who diet usually regain their lost weight within 5 years but also that the average subject was 1.5 lb heavier at follow-up than on entering the program. A recent systematic review of dietary and lifestyle options demonstrated no conclusive evidence for sustainable weight loss.6 However, it is possible for intensive lifestyle coaching to achieve moderate weight loss, as demonstrated by Appel et al.7 Of their 392 obese subjects, those receiving in-person support lost a mean of 5.1 kg ( P <0.001 for comparison with control subjects) and those receiving only telephone/Internet support lost a mean of 4.6 kg ( P <0.001 for comparison with control subjects) at 24 months. The superiority of bariatric surgery over pharmacological and lifestyle interventions in modulating weight, hyperglycemia, and hypertriglyceridemia has been demonstrated by meta-analysis.8 Few studies have directly compared medical and surgical management of obesity, but 2 head-to-head comparisons …