Uma abordagem do conceito de promoção da saúde que vai além das estratégias para mudar comportamentos individuais, incluindo no modo de vida, as condições dos contextos, incluindo as características físicas, sociais e
ambientes econômicos em que saúde e comportamento
são moldadas. O núcleo da estratégia é estimular a ação
contra as causas da falta de saúde nas comunidades.
This document summarizes a study that aims to use a mobile app and behavioral intervention to help lower blood pressure by following the DASH diet plan. Participants will use the app to track their diet, weight, blood pressure and activity levels over 12 weeks. They will also receive weekly counseling from health coaches. The main goal is to see if this mHealth approach can successfully reduce blood pressure and improve healthy behaviors. Materials for the study include a custom mobile app, web portal, Bluetooth devices to track metrics, and health coaches trained in the DASH plan and motivational interviewing.
A Study to Assess the Effectiveness of Abdominal Breathing Exercise in Reduct...ijtsrd
Background Abdominal breathing exercise is one among these. It reduces blood pressure by increasing baroreflex sensitivity and reducing sympathetic activity and chemo reflex activation. In India, it is reported that there are around 42 people are with pre hypertension, 15 are newly diagnose to have Hypertension and 31 are with known case of hypertension, and it kills nearly 8 million people every year worldwide. The noncompliance with treatment, stress and life style are found to be major reason for this doubling of disease within a decade, there “arises need for new therapies ‘and’ remedies. Objectives The study aimed to assess the effectiveness of abdominal breathing exercise in reducing mean blood pressure among hypertensive patients. Methods Pre experimental one group pre test – post test design was adopted for the study. 60 hypertensive patients from male and female medical general ward had been selected by convenient sampling. Tool comprised of Demographic proforma contained 9 items and sphygmomanometer, stethoscope and blood pressure monitoring table contained 3 items to record the readings. The reliability of the tool was tested by inter rater method and it was found to be r = 0.99. Abdominal breathing exercise was administered to the samples after pre assessment of mean blood pressure for ten minutes and post assessment of mean blood pressure is done at the gap of 5 minutes which is repeated 3 times a day and monitored for minimum of 3 days. ‘t’ test was used for finding the effectiveness, and Chi square test was used for finding out the association between mean blood pressure and selected demographic variables. Results It revealed that the mean differences in pre and post assessment was5.61 and ‘t’ value was 19.39 which is more than the ‘t’ table value. The overall findings of the study revealed that the Conclusion the study concluded that abdominal breathing exercise is found to be very effective in reducing the mean blood pressure. Arvind Singh Baghel | Dr. Neha Dubey | Bhoori Singh | Sunita Singh "A Study to Assess the Effectiveness of Abdominal Breathing Exercise in Reduction of Blood Pressure Among Hypertensive Patients in Selected Hospitals at Bhopal" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd42598.pdf Paper URL: https://www.ijtsrd.commedicine/nursing/42598/a-study-to-assess-the-effectiveness-of-abdominal-breathing-exercise-in-reduction-of-blood-pressure-among-hypertensive-patients-in-selected-hospitals-at-bhopal/arvind-singh-baghel
This document reviews the evidence for different types of exercise as a treatment for Parkinson's disease. It finds that cardiovascular exercise, balance training, and resistance training can all provide benefits. Cardiovascular exercise may improve gait, balance, quality of life, and reduce mortality risk. Balance training can improve gait, balance, and reduce falls, especially when combined with resistance training. Resistance training can increase muscle strength, endurance, and mobility. The review develops a suggested home-based exercise regimen combining these modalities to maximize benefits for patients with mild to moderate Parkinson's disease.
This document summarizes a pilot study on cardiovascular disease management for employees. The study examined employees who had been diagnosed with high blood pressure or high cholesterol. Lifestyle questionnaires assessed their diet, exercise, and stress levels. The results found that employees exposed to competitive or high-stress work environments had higher blood pressure and glucose levels. Recommendations included employers providing a healthier work environment with less stress, employees eating less junk food and cholesterol, engaging in regular exercise, and participating in support groups. The goal of the pilot study was to provide guidelines to help patients achieve a healthier lifestyle and reduce risk factors for cardiovascular disease.
Cardiometabolic diseases (CMDs), such as hypertension, excess weight, obesity, diabetes (type-2), and vascular diseases are considered lifestyle diseases. In the last three decades, these diseases have reached epidemic proportions worldwide [1]. According to the results of a recent study published in the journal Circulation, adopting five low-risk lifestyle factors may be linked to longer life spans in Americans [2]. Metabolic diseases, which are lifestyle diseases are preventable.
PREVALENCE OF DEPRESSION AND ITS ASSOCIATED FACTORS IN ADULTS WITH DIABETES M...pijans
The prevalence of Diabetes Mellitus has been rising steadily owing to several factors such as sedentary
lifestyle, obesity and an aging population. The prevalence of diabetes is predicted to double globally from
171 million in 2000 to 366 million in 2030 with a maximum increase in India with up to 79.4 million
individuals in India. Depression occurs frequently with diabetes but there are not many studies in India to
estimate its prevalence and associated factors. This study was done with the aim of estimating the
prevalence of depression among diabetes patients using the validated Patient Health Questionnaire-9 and
also its associated factors.
MD16510A - ISPOR US poster Medtronic v2.0Goran Medic
Cluster headache is a severe primary headache disorder characterized by recurring unilateral headaches. Chronic cluster headache (CCH) involves attacks occurring more than once daily without remission. A literature review found limited evidence on the burden and outcomes of recommended treatments for CCH. CCH was reported to have a substantial impact on work productivity and quality of life. Treatments like zolmitriptan nasal spray showed some efficacy compared to placebo, but outcomes were inconsistently reported. Overall, the review found an evidence gap in understanding the disease burden and treatment efficacy due to heterogeneity in reporting. More well-designed studies are needed.
This document summarizes a study that aims to use a mobile app and behavioral intervention to help lower blood pressure by following the DASH diet plan. Participants will use the app to track their diet, weight, blood pressure and activity levels over 12 weeks. They will also receive weekly counseling from health coaches. The main goal is to see if this mHealth approach can successfully reduce blood pressure and improve healthy behaviors. Materials for the study include a custom mobile app, web portal, Bluetooth devices to track metrics, and health coaches trained in the DASH plan and motivational interviewing.
A Study to Assess the Effectiveness of Abdominal Breathing Exercise in Reduct...ijtsrd
Background Abdominal breathing exercise is one among these. It reduces blood pressure by increasing baroreflex sensitivity and reducing sympathetic activity and chemo reflex activation. In India, it is reported that there are around 42 people are with pre hypertension, 15 are newly diagnose to have Hypertension and 31 are with known case of hypertension, and it kills nearly 8 million people every year worldwide. The noncompliance with treatment, stress and life style are found to be major reason for this doubling of disease within a decade, there “arises need for new therapies ‘and’ remedies. Objectives The study aimed to assess the effectiveness of abdominal breathing exercise in reducing mean blood pressure among hypertensive patients. Methods Pre experimental one group pre test – post test design was adopted for the study. 60 hypertensive patients from male and female medical general ward had been selected by convenient sampling. Tool comprised of Demographic proforma contained 9 items and sphygmomanometer, stethoscope and blood pressure monitoring table contained 3 items to record the readings. The reliability of the tool was tested by inter rater method and it was found to be r = 0.99. Abdominal breathing exercise was administered to the samples after pre assessment of mean blood pressure for ten minutes and post assessment of mean blood pressure is done at the gap of 5 minutes which is repeated 3 times a day and monitored for minimum of 3 days. ‘t’ test was used for finding the effectiveness, and Chi square test was used for finding out the association between mean blood pressure and selected demographic variables. Results It revealed that the mean differences in pre and post assessment was5.61 and ‘t’ value was 19.39 which is more than the ‘t’ table value. The overall findings of the study revealed that the Conclusion the study concluded that abdominal breathing exercise is found to be very effective in reducing the mean blood pressure. Arvind Singh Baghel | Dr. Neha Dubey | Bhoori Singh | Sunita Singh "A Study to Assess the Effectiveness of Abdominal Breathing Exercise in Reduction of Blood Pressure Among Hypertensive Patients in Selected Hospitals at Bhopal" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd42598.pdf Paper URL: https://www.ijtsrd.commedicine/nursing/42598/a-study-to-assess-the-effectiveness-of-abdominal-breathing-exercise-in-reduction-of-blood-pressure-among-hypertensive-patients-in-selected-hospitals-at-bhopal/arvind-singh-baghel
This document reviews the evidence for different types of exercise as a treatment for Parkinson's disease. It finds that cardiovascular exercise, balance training, and resistance training can all provide benefits. Cardiovascular exercise may improve gait, balance, quality of life, and reduce mortality risk. Balance training can improve gait, balance, and reduce falls, especially when combined with resistance training. Resistance training can increase muscle strength, endurance, and mobility. The review develops a suggested home-based exercise regimen combining these modalities to maximize benefits for patients with mild to moderate Parkinson's disease.
This document summarizes a pilot study on cardiovascular disease management for employees. The study examined employees who had been diagnosed with high blood pressure or high cholesterol. Lifestyle questionnaires assessed their diet, exercise, and stress levels. The results found that employees exposed to competitive or high-stress work environments had higher blood pressure and glucose levels. Recommendations included employers providing a healthier work environment with less stress, employees eating less junk food and cholesterol, engaging in regular exercise, and participating in support groups. The goal of the pilot study was to provide guidelines to help patients achieve a healthier lifestyle and reduce risk factors for cardiovascular disease.
Cardiometabolic diseases (CMDs), such as hypertension, excess weight, obesity, diabetes (type-2), and vascular diseases are considered lifestyle diseases. In the last three decades, these diseases have reached epidemic proportions worldwide [1]. According to the results of a recent study published in the journal Circulation, adopting five low-risk lifestyle factors may be linked to longer life spans in Americans [2]. Metabolic diseases, which are lifestyle diseases are preventable.
PREVALENCE OF DEPRESSION AND ITS ASSOCIATED FACTORS IN ADULTS WITH DIABETES M...pijans
The prevalence of Diabetes Mellitus has been rising steadily owing to several factors such as sedentary
lifestyle, obesity and an aging population. The prevalence of diabetes is predicted to double globally from
171 million in 2000 to 366 million in 2030 with a maximum increase in India with up to 79.4 million
individuals in India. Depression occurs frequently with diabetes but there are not many studies in India to
estimate its prevalence and associated factors. This study was done with the aim of estimating the
prevalence of depression among diabetes patients using the validated Patient Health Questionnaire-9 and
also its associated factors.
MD16510A - ISPOR US poster Medtronic v2.0Goran Medic
Cluster headache is a severe primary headache disorder characterized by recurring unilateral headaches. Chronic cluster headache (CCH) involves attacks occurring more than once daily without remission. A literature review found limited evidence on the burden and outcomes of recommended treatments for CCH. CCH was reported to have a substantial impact on work productivity and quality of life. Treatments like zolmitriptan nasal spray showed some efficacy compared to placebo, but outcomes were inconsistently reported. Overall, the review found an evidence gap in understanding the disease burden and treatment efficacy due to heterogeneity in reporting. More well-designed studies are needed.
Garlic may help reduce blood pressure in hypertensive patients. A study of 40 hypertensive patients found that those who took garlic capsules daily for 3 weeks saw significant reductions in both their systolic and diastolic blood pressure compared to baseline. The control group who did not take garlic saw no significant changes. Garlic appears to stimulate the production of nitric oxide and hydrogen sulfide in the body, causing blood vessels to dilate and lower blood pressure. Larger clinical studies are still needed to confirm these effects.
This study analyzed data from hyperuricemia screening programs in India to determine the prevalence of high uric acid levels. The results showed that 25.8% of over 29,000 subjects had hyperuricemia. Males and older individuals over 50 years of age had higher rates of elevated uric acid. Over 30% of subjects with type 2 diabetes, hypertension, or both conditions also exhibited hyperuricemia. The proportion with high uric acid increased with longer duration of diabetes and hypertension. The study concludes screening for uric acid levels may help identify risks of comorbidities and complications.
Moderate alcohol consumption as risk factor for adverse brain outcomes and co...BARRY STANLEY 2 fasd
Recent longitudinal study. No mention of fasd or prenatal / pre conceptual alcohol consumption.
If the conclusions are correct how much more do they apply to the fetus, newborn and adolescent/
Munro, S., Lewin, S., Swart, T., & Volmink, J. (2007). A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health, 7, 104-120.
Factors affecting quality of life in patients with diabetesFrank Reynold
Diabetes affects the quality of life of patients, and these effects differ from patient to another. So, how diabetes affects quality of life of diabetic patients and what are the factors behind that?
This study analyzed the prescription patterns of antihypertensive drugs prescribed to 137 patients in India to determine adherence to JNC 7 guidelines. The most frequently prescribed classes of drugs were diuretics, followed by calcium channel blockers, beta blockers, ACE inhibitors, and ARBs. Combination drug therapy was prescribed to 72% of patients, most commonly a combination of a calcium channel blocker and beta blocker. The prescription patterns were found to adhere to JNC 7 guidelines, which recommend diuretics as first-line treatment and combination therapy including a diuretic for stage 2 hypertension.
"ABSTRACT
Background. Asthma is a chronic airway inflammation. There is increasing evidence confirming in severe or persistent asthma systemic inflammation can occur. Spillover of inflammatory mediators into the circulation is generally considered to be the source of this systemic inflammation. Obesity is well known to be associated with systemic inflammation too. Both asthma and obesity often occur in the same individual. We examined the independent and synergistic associations of asthma uncontrolled and obesity with systemic inflammation using high-sensitivity C-reactive protein (hs-CRP).
Methods. This was an observational study with cross-sectional approach in 48 asthma subjects with aged 18 – 55 years old without diabetes, cardiovascular disease, hypertension and non smoker. The study was performed in the Hasanuddin Teaching Hospital South Sulawesi Indonesia. Asthma control was assessed using asthma control test (ACT).
Results : Mean of hs-CRP levels were significantly higher in uncontrolled asthma than controlled asthma (4.23 + 3.11 vs 0.92 + 0.61 ; p=0.001). The high hs-CRP levels were most found in uncontrolled asthma patients than controlled asthma. Obese Subject with uncontrolled asthma have higher hs-CRP levels compared to obese subject with controlled asthma (p=0.026). In non obese subject with uncontrolled asthma have also siginificant higher hs-CRP compared to non obese controlled asthma (p=0.005). Hs-CRP level significantly higher in uncontrolled asthma both in obese and non-obese subject. Hs-CRP levels in asthma subject were not influenced by age (p=1.000), gender (p=0.822), family history of asthma (p=0.117), long duration of asthma (p=0.117) and used of steroid. (p=0.358).
Conclusion : Uncontrolled Asthma associated with systemic inflammation both in obese and non obese subject. These findings underline a potensial CVD risk in asthma especially with uncontrolled status.
"
Acupuncture and/or moxibustion for the treatment of lumbar disc herniation: q...LucyPi1
This document summarizes a systematic review that assesses the quality of 18 systematic reviews on the use of acupuncture and/or moxibustion for treating lumbar disc herniation. It finds that acupuncture and moxibustion show some advantages in efficacy and safety for lumbar disc herniation treatment. However, the quality of evidence is generally low according to GRADE assessments. While the methodological quality of the reviews was moderate and report quality was good, the original research had poor quality, which was reflected in the low quality of evidence ratings. More high-quality studies are still needed to determine if acupuncture is more effective than other treatments.
Xx health, health related quality of life, and quality of lifeYelmi Reni Putri SY
This document discusses the terms "health", "health-related quality of life (HRQoL)", and "quality of life (QoL)" and attempts to differentiate between them. It reviews the history and definitions of the terms from literature. It finds that while health and QoL can be distinguished, defining and differentiating HRQoL is problematic, as some definitions of HRQoL do not sufficiently differentiate it from either health or QoL. It concludes that the current concept of HRQoL is confusing and a clearer definition is needed.
Health Related Quality of Life (HRQoL) in pulmonary medicineZia Hashim
HRQoL is a multidimensional concept that assesses the impact of disease and treatment on physical, mental, and social aspects of health. It goes beyond morbidity and mortality to evaluate aspects like symptoms, emotional state, and ability to perform daily activities. HRQoL is increasingly recognized as an important patient-centered outcome. It can be measured using validated questionnaires that are either generic or disease-specific. The SGRQ and CAT are commonly used to evaluate HRQoL in chronic respiratory diseases in clinical research and practice respectively. Assessing HRQoL provides clinicians a fuller picture of patients' health and well-being compared to physiological measures alone.
This document discusses the shift in diabetes management from prescriptive guidelines to individualized care. It outlines several factors that have driven this change, including a lack of evidence supporting one treatment over another and recognition that lasting improvement requires considering patient preferences. The document also describes challenges in implementing individualized care within current healthcare systems. It advocates selecting treatments based on a patient's underlying pathologies and broader cardiovascular risk rather than just their diabetes type.
This study analyzed differences in health parameters between dietary groups using data from the Austrian Health Interview Survey. Over 1,300 participants were matched by age, sex, and socioeconomic status into four dietary groups: vegetarian, carnivorous with high fruit/vegetable intake, carnivorous with low meat intake, and carnivorous with high meat intake. The study found that vegetarians had a lower BMI but poorer overall health, with higher rates of cancer, allergies, and mental health issues. They also had greater healthcare needs and lower quality of life compared to the other dietary groups. The results suggest public health programs are needed to address health risks related to nutrition.
A study of 23,000 Americans over age 45 found that maintaining seven healthy lifestyle factors can significantly reduce the risk of stroke. These factors included regular physical activity, low cholesterol, a healthy diet, controlled blood pressure, ideal weight, controlled blood sugar, and not smoking. Participants were categorized based on their adherence to these factors, and those with optimal adherence had an 8% lower stroke risk than those with inadequate adherence. Within 5 years, 432 strokes occurred, and controlled blood pressure showed the strongest influence in reducing risk by 60%. Adopting a healthy lifestyle through diet, exercise, weight control and not smoking can best minimize one's stroke risk.
This study examined the association between herpes zoster infection and risk of peripheral arterial disease using a nationwide cohort in Taiwan. The study found that patients with herpes zoster had a 13% higher risk of developing peripheral arterial disease compared to those without herpes zoster, after adjusting for risk factors. Female sex and older age were also associated with small increases in risk. While antiviral treatment for herpes zoster did not affect risk of peripheral arterial disease, larger prospective studies are still needed to determine if treatment can reduce risk.
This document discusses evidence-based guidelines for diabetes treatment. It addresses where clinical judgement comes from, including tradition, authority, science, analysis of evidence, and personal factors. It also discusses the concept of evidence, the rise of "robot physicians" following guidelines rigidly, and issues with how guidelines are developed and can extend disease boundaries and therapeutic futility. Overall, the document questions some aspects of clinical practice guidelines and their relationship to evidence, authority, and competing interests.
The document describes the use of the Roy Adaptation Model in caring for a patient diagnosed with breast cancer who underwent breast-conserving surgery. The Roy Adaptation Model evaluates patients across four modes of adaptation: physiologic, self-concept, role function, and interdependence. The case study applies the nursing process based on the Roy Adaptation Model by assessing the patient in the four modes and identifying nursing diagnoses to develop a holistic care plan. The goal is to increase the patient's adaptation through meeting needs across the four modes of the model.
This document discusses natural history and prognosis in epidemiology. It defines natural history as the stages of a disease, including the presymptomatic stage, clinical disease stage, and recovery/disability/death stage. Prognosis is defined as the prediction of a disease's course and the probability of future events, though outcomes may differ for individuals. Prognosis is based on patient groups and helps determine treatment. Factors like residual heart function affect prognosis for myocardial infarction patients. Prognosis assessments should include quality of life measures in addition to mortality. Randomly selected patient groups are needed to determine natural history and prognosis to avoid selection bias.
Abstract—Asthma is a chronic inflammatory disease of the airways that affects people of all ages. It may manifest as severe attacks, which can require urgent health care. It causes limitations in daily activities, loss of school and work days, lung function impairment, reduced quality of life, and an adverse socioeconomic burden. There is no cure of asthma, once it is diagnosed it can be managed by a good treatment plan, so that patient can live a better quality of life with the disease. This present study was planned to compare the effect of traditional treatment alone and in combination with Root Heal Therapy on asthma cases. A Quincy experiment was conducted on 60 patients of Asthma, who were taking treatment from a physician working in Jaipuriya Hospital, Jaipur. Out of these 60 asthama patients who were receiving traditional treatment, 30 patients were given this RHT along with traditional treatment. Baseline status of asthma and Asthma Quality of life Questionnaire (AQLQ) was assessed. These cases were followed for 18 months, again they were assessed as per AQLQ. Changes in status of asthma in both the group over this period were compared with Chi-square test and Unpaired 't' test. It was found that significantly more cases were benefited with this RHT in the form of number of spells of asthma, duration of illness due to asthma, mean days of activity loss and proportion of cases needed hospitalization during last one year. Pulmonary Function test were also better in experimental group than control group. Although mean number of eosinofills decrease was also found higher in experimental group but it was not found significant. It is concluded that Quality of life of these asthma cases were significantly improved on physical, emotional, social and occupational domains of life in cases with RHT than the cases only on traditional treatment.
REVIEW Open AccessWeight Science Evaluating the Evidence .docxjoellemurphey
REVIEW Open Access
Weight Science: Evaluating the Evidence for a
Paradigm Shift
Linda Bacon1*, Lucy Aphramor2,3
Abstract
Current guidelines recommend that “overweight” and “obese” individuals lose weight through engaging in lifestyle
modification involving diet, exercise and other behavior change. This approach reliably induces short term weight
loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the
putative benefits of improved morbidity and mortality. Concern has arisen that this weight focus is not only
ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to
food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health
goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight
stigmatization and discrimination. This concern has drawn increased attention to the ethical implications of
recommending treatment that may be ineffective or damaging. A growing trans-disciplinary movement called
Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a
shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is
associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure,
blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as
self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss
treatment and without the contraindications associated with a weight focus. This paper evaluates the evidence
and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.
Introduction
Concern regarding “overweight” and “obesity” is reflected
in a diverse range of policy measures aimed at helping
individuals reduce their body mass index (BMI)1. Despite
attention from the public health establishment, a private
weight loss industry estimated at $58.6 billion annually in
the United States [1], unprecedented levels of body dissa-
tisfaction [2] and repeated attempts to lose weight [3,4],
the majority of individuals are unable to maintain weight
loss over the long term and do not achieve the putative
benefits of improved morbidity and mortality [5].
Concern has arisen that this weight focused paradigm is
not only ineffective at producing thinner, healthier
bodies, but also damaging, contributing to food and body
preoccupation, repeated cycles of weight loss and regain,
distraction from other personal health goals and wider
health determinants, reduced self-esteem, eating disor-
ders, other health decrement, and weight stigmatization
and discrimination [6-8]. As evidence-based competen-
cies are more firmly embedded in health practitioner
standa ...
Advocacy for Health Equity: A Synthesis ReviewDRIVERS
This document provides a summary and synthesis of evidence from academic and gray literature on advocacy for health equity. It finds that advocacy efforts face many barriers, including the current economic environment that tends to blame disadvantaged groups for health issues. Effective advocacy should raise awareness of social determinants of health through education and training. Advocacy organizations have a key role in bridging research, policy, and civil society to promote policies that improve health equity. More research is still needed, especially on applying findings outside high-income countries.
The document is a summary of evidence-based guidelines for managing high blood pressure in adults. It recommends:
1) Treating hypertensive persons aged 60 or older to a blood pressure goal of less than 150/90 mm Hg, and those aged 30-59 to less than 140/90 mm Hg.
2) Initiating drug treatment for nonblack populations with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, or thiazide-type diuretics. For black populations, recommend calcium channel blockers or thiazide-type diuretics.
3) Treating hypertensive adults with diabetes or chronic kidney disease to
Garlic may help reduce blood pressure in hypertensive patients. A study of 40 hypertensive patients found that those who took garlic capsules daily for 3 weeks saw significant reductions in both their systolic and diastolic blood pressure compared to baseline. The control group who did not take garlic saw no significant changes. Garlic appears to stimulate the production of nitric oxide and hydrogen sulfide in the body, causing blood vessels to dilate and lower blood pressure. Larger clinical studies are still needed to confirm these effects.
This study analyzed data from hyperuricemia screening programs in India to determine the prevalence of high uric acid levels. The results showed that 25.8% of over 29,000 subjects had hyperuricemia. Males and older individuals over 50 years of age had higher rates of elevated uric acid. Over 30% of subjects with type 2 diabetes, hypertension, or both conditions also exhibited hyperuricemia. The proportion with high uric acid increased with longer duration of diabetes and hypertension. The study concludes screening for uric acid levels may help identify risks of comorbidities and complications.
Moderate alcohol consumption as risk factor for adverse brain outcomes and co...BARRY STANLEY 2 fasd
Recent longitudinal study. No mention of fasd or prenatal / pre conceptual alcohol consumption.
If the conclusions are correct how much more do they apply to the fetus, newborn and adolescent/
Munro, S., Lewin, S., Swart, T., & Volmink, J. (2007). A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health, 7, 104-120.
Factors affecting quality of life in patients with diabetesFrank Reynold
Diabetes affects the quality of life of patients, and these effects differ from patient to another. So, how diabetes affects quality of life of diabetic patients and what are the factors behind that?
This study analyzed the prescription patterns of antihypertensive drugs prescribed to 137 patients in India to determine adherence to JNC 7 guidelines. The most frequently prescribed classes of drugs were diuretics, followed by calcium channel blockers, beta blockers, ACE inhibitors, and ARBs. Combination drug therapy was prescribed to 72% of patients, most commonly a combination of a calcium channel blocker and beta blocker. The prescription patterns were found to adhere to JNC 7 guidelines, which recommend diuretics as first-line treatment and combination therapy including a diuretic for stage 2 hypertension.
"ABSTRACT
Background. Asthma is a chronic airway inflammation. There is increasing evidence confirming in severe or persistent asthma systemic inflammation can occur. Spillover of inflammatory mediators into the circulation is generally considered to be the source of this systemic inflammation. Obesity is well known to be associated with systemic inflammation too. Both asthma and obesity often occur in the same individual. We examined the independent and synergistic associations of asthma uncontrolled and obesity with systemic inflammation using high-sensitivity C-reactive protein (hs-CRP).
Methods. This was an observational study with cross-sectional approach in 48 asthma subjects with aged 18 – 55 years old without diabetes, cardiovascular disease, hypertension and non smoker. The study was performed in the Hasanuddin Teaching Hospital South Sulawesi Indonesia. Asthma control was assessed using asthma control test (ACT).
Results : Mean of hs-CRP levels were significantly higher in uncontrolled asthma than controlled asthma (4.23 + 3.11 vs 0.92 + 0.61 ; p=0.001). The high hs-CRP levels were most found in uncontrolled asthma patients than controlled asthma. Obese Subject with uncontrolled asthma have higher hs-CRP levels compared to obese subject with controlled asthma (p=0.026). In non obese subject with uncontrolled asthma have also siginificant higher hs-CRP compared to non obese controlled asthma (p=0.005). Hs-CRP level significantly higher in uncontrolled asthma both in obese and non-obese subject. Hs-CRP levels in asthma subject were not influenced by age (p=1.000), gender (p=0.822), family history of asthma (p=0.117), long duration of asthma (p=0.117) and used of steroid. (p=0.358).
Conclusion : Uncontrolled Asthma associated with systemic inflammation both in obese and non obese subject. These findings underline a potensial CVD risk in asthma especially with uncontrolled status.
"
Acupuncture and/or moxibustion for the treatment of lumbar disc herniation: q...LucyPi1
This document summarizes a systematic review that assesses the quality of 18 systematic reviews on the use of acupuncture and/or moxibustion for treating lumbar disc herniation. It finds that acupuncture and moxibustion show some advantages in efficacy and safety for lumbar disc herniation treatment. However, the quality of evidence is generally low according to GRADE assessments. While the methodological quality of the reviews was moderate and report quality was good, the original research had poor quality, which was reflected in the low quality of evidence ratings. More high-quality studies are still needed to determine if acupuncture is more effective than other treatments.
Xx health, health related quality of life, and quality of lifeYelmi Reni Putri SY
This document discusses the terms "health", "health-related quality of life (HRQoL)", and "quality of life (QoL)" and attempts to differentiate between them. It reviews the history and definitions of the terms from literature. It finds that while health and QoL can be distinguished, defining and differentiating HRQoL is problematic, as some definitions of HRQoL do not sufficiently differentiate it from either health or QoL. It concludes that the current concept of HRQoL is confusing and a clearer definition is needed.
Health Related Quality of Life (HRQoL) in pulmonary medicineZia Hashim
HRQoL is a multidimensional concept that assesses the impact of disease and treatment on physical, mental, and social aspects of health. It goes beyond morbidity and mortality to evaluate aspects like symptoms, emotional state, and ability to perform daily activities. HRQoL is increasingly recognized as an important patient-centered outcome. It can be measured using validated questionnaires that are either generic or disease-specific. The SGRQ and CAT are commonly used to evaluate HRQoL in chronic respiratory diseases in clinical research and practice respectively. Assessing HRQoL provides clinicians a fuller picture of patients' health and well-being compared to physiological measures alone.
This document discusses the shift in diabetes management from prescriptive guidelines to individualized care. It outlines several factors that have driven this change, including a lack of evidence supporting one treatment over another and recognition that lasting improvement requires considering patient preferences. The document also describes challenges in implementing individualized care within current healthcare systems. It advocates selecting treatments based on a patient's underlying pathologies and broader cardiovascular risk rather than just their diabetes type.
This study analyzed differences in health parameters between dietary groups using data from the Austrian Health Interview Survey. Over 1,300 participants were matched by age, sex, and socioeconomic status into four dietary groups: vegetarian, carnivorous with high fruit/vegetable intake, carnivorous with low meat intake, and carnivorous with high meat intake. The study found that vegetarians had a lower BMI but poorer overall health, with higher rates of cancer, allergies, and mental health issues. They also had greater healthcare needs and lower quality of life compared to the other dietary groups. The results suggest public health programs are needed to address health risks related to nutrition.
A study of 23,000 Americans over age 45 found that maintaining seven healthy lifestyle factors can significantly reduce the risk of stroke. These factors included regular physical activity, low cholesterol, a healthy diet, controlled blood pressure, ideal weight, controlled blood sugar, and not smoking. Participants were categorized based on their adherence to these factors, and those with optimal adherence had an 8% lower stroke risk than those with inadequate adherence. Within 5 years, 432 strokes occurred, and controlled blood pressure showed the strongest influence in reducing risk by 60%. Adopting a healthy lifestyle through diet, exercise, weight control and not smoking can best minimize one's stroke risk.
This study examined the association between herpes zoster infection and risk of peripheral arterial disease using a nationwide cohort in Taiwan. The study found that patients with herpes zoster had a 13% higher risk of developing peripheral arterial disease compared to those without herpes zoster, after adjusting for risk factors. Female sex and older age were also associated with small increases in risk. While antiviral treatment for herpes zoster did not affect risk of peripheral arterial disease, larger prospective studies are still needed to determine if treatment can reduce risk.
This document discusses evidence-based guidelines for diabetes treatment. It addresses where clinical judgement comes from, including tradition, authority, science, analysis of evidence, and personal factors. It also discusses the concept of evidence, the rise of "robot physicians" following guidelines rigidly, and issues with how guidelines are developed and can extend disease boundaries and therapeutic futility. Overall, the document questions some aspects of clinical practice guidelines and their relationship to evidence, authority, and competing interests.
The document describes the use of the Roy Adaptation Model in caring for a patient diagnosed with breast cancer who underwent breast-conserving surgery. The Roy Adaptation Model evaluates patients across four modes of adaptation: physiologic, self-concept, role function, and interdependence. The case study applies the nursing process based on the Roy Adaptation Model by assessing the patient in the four modes and identifying nursing diagnoses to develop a holistic care plan. The goal is to increase the patient's adaptation through meeting needs across the four modes of the model.
This document discusses natural history and prognosis in epidemiology. It defines natural history as the stages of a disease, including the presymptomatic stage, clinical disease stage, and recovery/disability/death stage. Prognosis is defined as the prediction of a disease's course and the probability of future events, though outcomes may differ for individuals. Prognosis is based on patient groups and helps determine treatment. Factors like residual heart function affect prognosis for myocardial infarction patients. Prognosis assessments should include quality of life measures in addition to mortality. Randomly selected patient groups are needed to determine natural history and prognosis to avoid selection bias.
Abstract—Asthma is a chronic inflammatory disease of the airways that affects people of all ages. It may manifest as severe attacks, which can require urgent health care. It causes limitations in daily activities, loss of school and work days, lung function impairment, reduced quality of life, and an adverse socioeconomic burden. There is no cure of asthma, once it is diagnosed it can be managed by a good treatment plan, so that patient can live a better quality of life with the disease. This present study was planned to compare the effect of traditional treatment alone and in combination with Root Heal Therapy on asthma cases. A Quincy experiment was conducted on 60 patients of Asthma, who were taking treatment from a physician working in Jaipuriya Hospital, Jaipur. Out of these 60 asthama patients who were receiving traditional treatment, 30 patients were given this RHT along with traditional treatment. Baseline status of asthma and Asthma Quality of life Questionnaire (AQLQ) was assessed. These cases were followed for 18 months, again they were assessed as per AQLQ. Changes in status of asthma in both the group over this period were compared with Chi-square test and Unpaired 't' test. It was found that significantly more cases were benefited with this RHT in the form of number of spells of asthma, duration of illness due to asthma, mean days of activity loss and proportion of cases needed hospitalization during last one year. Pulmonary Function test were also better in experimental group than control group. Although mean number of eosinofills decrease was also found higher in experimental group but it was not found significant. It is concluded that Quality of life of these asthma cases were significantly improved on physical, emotional, social and occupational domains of life in cases with RHT than the cases only on traditional treatment.
REVIEW Open AccessWeight Science Evaluating the Evidence .docxjoellemurphey
REVIEW Open Access
Weight Science: Evaluating the Evidence for a
Paradigm Shift
Linda Bacon1*, Lucy Aphramor2,3
Abstract
Current guidelines recommend that “overweight” and “obese” individuals lose weight through engaging in lifestyle
modification involving diet, exercise and other behavior change. This approach reliably induces short term weight
loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the
putative benefits of improved morbidity and mortality. Concern has arisen that this weight focus is not only
ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to
food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health
goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight
stigmatization and discrimination. This concern has drawn increased attention to the ethical implications of
recommending treatment that may be ineffective or damaging. A growing trans-disciplinary movement called
Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a
shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is
associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure,
blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as
self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss
treatment and without the contraindications associated with a weight focus. This paper evaluates the evidence
and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.
Introduction
Concern regarding “overweight” and “obesity” is reflected
in a diverse range of policy measures aimed at helping
individuals reduce their body mass index (BMI)1. Despite
attention from the public health establishment, a private
weight loss industry estimated at $58.6 billion annually in
the United States [1], unprecedented levels of body dissa-
tisfaction [2] and repeated attempts to lose weight [3,4],
the majority of individuals are unable to maintain weight
loss over the long term and do not achieve the putative
benefits of improved morbidity and mortality [5].
Concern has arisen that this weight focused paradigm is
not only ineffective at producing thinner, healthier
bodies, but also damaging, contributing to food and body
preoccupation, repeated cycles of weight loss and regain,
distraction from other personal health goals and wider
health determinants, reduced self-esteem, eating disor-
ders, other health decrement, and weight stigmatization
and discrimination [6-8]. As evidence-based competen-
cies are more firmly embedded in health practitioner
standa ...
Advocacy for Health Equity: A Synthesis ReviewDRIVERS
This document provides a summary and synthesis of evidence from academic and gray literature on advocacy for health equity. It finds that advocacy efforts face many barriers, including the current economic environment that tends to blame disadvantaged groups for health issues. Effective advocacy should raise awareness of social determinants of health through education and training. Advocacy organizations have a key role in bridging research, policy, and civil society to promote policies that improve health equity. More research is still needed, especially on applying findings outside high-income countries.
The document is a summary of evidence-based guidelines for managing high blood pressure in adults. It recommends:
1) Treating hypertensive persons aged 60 or older to a blood pressure goal of less than 150/90 mm Hg, and those aged 30-59 to less than 140/90 mm Hg.
2) Initiating drug treatment for nonblack populations with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, or thiazide-type diuretics. For black populations, recommend calcium channel blockers or thiazide-type diuretics.
3) Treating hypertensive adults with diabetes or chronic kidney disease to
The document summarizes the key findings and recommendations from a systematic review of evidence on the management of high blood pressure conducted by the Eighth Joint National Committee panel members. The panel recommends treating hypertensive patients aged 60 or older to a blood pressure goal of less than 150/90 mm Hg, and those aged 30-59 to a goal of less than 140/90 mm Hg. For nonblack patients, including those with diabetes, initial drug treatment should include a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker. For black patients, including those with diabetes, a calcium channel blocker or thiazide-type di
This document discusses the relationship between epidemiology and public health. It argues that epidemiology has become too focused on identifying disease risk factors and transmission, and has lost sight of its original goal of improving overall population health. It proposes that epidemiology should adopt a more holistic approach that integrates biological, social, and analytical perspectives to better inform public health interventions and policies. Recent decades have seen the growth of international training programs to develop epidemiologists able to address global health challenges.
The new guidelines for treatment of primary hypertension. JNC 8. Samir Rafla-JNC 8-2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults.
This document summarizes guidelines from the Eighth Joint National Committee for the management of high blood pressure in adults. It recommends treating hypertensive patients aged 60 or older to a blood pressure goal of less than 150/90 mm Hg, and those aged 30-59 to a diastolic goal of less than 90 mm Hg. For those under 60, the recommended goal is less than 140/90 mm Hg based on expert opinion due to insufficient evidence. The same thresholds and goals are recommended for hypertensive adults with diabetes or chronic kidney disease under age 60. The guidelines recommend initial drug treatment for nonblack patients with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers,
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document summarizes the recommendations from an expert panel on the management of high blood pressure in adults. Key recommendations include:
1) Treating all adults aged 60 or older to a blood pressure under 150/90 mm Hg and those aged 30-59 to under 140/90 mm Hg.
2) Initial drug treatment for most nonblack adults should include a thiazide diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker. For black adults, initial treatment is a calcium channel blocker or thiazide diuretic.
3) Treatment goals are the same for adults with diabetes or nondiabetic kidney disease as the
This document summarizes the development of health communication as a field over the past 25 years. It begins by describing the Stanford Heart Disease Prevention Program in 1971 as a seminal project that applied communication strategies to promote preventive health behaviors. Since then, the field has grown substantially, establishing university centers, securing research funding, and contributing to more effective health promotion campaigns. Key strategies discussed include social marketing, which applies commercial marketing approaches to social causes like health, and audience segmentation to target messages. The document traces how approaches from early projects have been applied more broadly to address other health issues.
This document discusses the types of evidence needed to inform public health actions and policies regarding obesity. It argues that public health actions should be based on three types of evidence: 1) difference-making evidence from descriptive epidemiology about risks and correlations; 2) evidence about the biological and social levels targeted by interventions; and 3) mechanistic evidence from studies testing causal hypotheses. Together, these three evidentiary components can provide the understanding of disease causation needed to design effective and targeted public health policies and interventions.
Diabetes Evidence Based Practice Paper.pdfsdfghj21
The document discusses using an evidence-based practice paper to improve population health outcomes for diabetes. It recommends explaining how evidence-based practices could better manage diabetes and provide a higher return on investment. The Health Belief Model is presented as a framework to help those with diabetes manage their condition through behavior change. Specifically, it could encourage self-care behaviors important for chronic disease management.
This document provides an overview of epidemiology including its history, definitions, objectives, and uses. It discusses how Hippocrates and John Snow helped establish epidemiology as a field through their studies of disease outbreaks. Key concepts in epidemiology are defined such as studying disease distribution, determinants, and applying knowledge to control health problems. The aims, objectives, and methods of epidemiology are described. The differences between clinical medicine and epidemiology are outlined. Finally, the various uses of epidemiology in healthcare management, understanding disease processes, public health practice, and clinical prevention are explained.
Current trends in cardiovascular assessmentAlfred Bett
This paper describe the emerging trends of assessing cardiovascular in health care setting with the aim of improving the quality of service delivery to patient. It considers the increased case of people affected by heart attack
Hypertension, also known as high blood pressure, can lead to damage of blood vessels and increase the risk of heart attack, stroke, and other conditions if left untreated. Treatment of hypertension involves lifestyle changes like healthy diet, exercise, reducing alcohol intake, as well as drug therapy. This paper argues that incorporating both lifestyle modifications and medical treatment is crucial for effective management of high blood pressure.
This document summarizes guidelines from the Eighth Joint National Committee for the management of high blood pressure in adults. It recommends treating hypertensive persons aged 60 or older to a blood pressure goal of less than 150/90 mm Hg, and those aged 30-59 to a diastolic goal of less than 90 mm Hg. For those under 60, the recommended goal is less than 140/90 mm Hg based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or chronic kidney disease. The guidelines recommend initial drug treatment for nonblack populations with ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics. For black populations, calcium channel blockers or th
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1. The document defines key terms related to health promotion and outlines the five principles of the Ottawa Charter for health promotion.
2. It describes different approaches to health promotion, including medical, behavioral change, educational, empowerment, and societal change approaches. Examples are given for each.
3. The importance of health promotion is discussed in terms of changing disease patterns, rising healthcare costs, the role of populations in improving health, and limitations of medical services. Health promotion aims to empower individuals and communities.
This document summarizes the debate around dietary guidelines recommending reduced fat intake issued in the 1970s-80s. It discusses a recent review finding that the best evidence available at the time did not support recommending reduced fat intake to lower heart disease risk. While most health organizations agreed saturated fat raises heart disease risk, recent studies have questioned this diet-heart hypothesis. The debate around dietary fat guidelines remains ongoing and polarized among nutrition researchers.
This document provides guidelines for the management of high blood pressure in adults based on a rigorous review of evidence from randomized controlled trials. Some of the key recommendations include:
1) For adults aged 60 years or older, the guideline recommends initiating antihypertensive drug treatment when systolic blood pressure is 150 mmHg or higher or diastolic blood pressure is 90 mmHg or higher.
2) For adults aged 30-59 years, the guideline recommends initiating antihypertensive drug treatment when systolic blood pressure is 140 mmHg or higher or diastolic blood pressure is 90 mmHg or higher.
3) The guideline recommends treating hypertension in adults aged 18-29 based on an overall systolic blood
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Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
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Using theory to guide policy health promot. int.-1996
1. HEALTH PROMOTION INTERNATIONAL
C Oxford University Press 1996
Vol. 11, No. I
Printed in Great Britain
Using theory to guide policy relevant health promotion
research
KATHRYN DEAN
Research and Training Consultant, Population Health Studies, Copenhagen, Denmark
SUMMARY
The concept of health promotion has evolved into a
strategy for improving health that goes beyond indi-
vidual behaviour to include the physical, social and
economic environments in which health and behaviour
are shaped. The core of the strategy is to stimulate action
against the root causes of ill health in communities. A
prerequisite for effective health promotion action is valid
knowledge about how forces protect or damage health
in daily life. Developing and using theory to guide the
collection, analysis and evaluation of empirical evidence
is a neglected aspect of obtaining the knowledge needed
for promoting health. Population interventions to
reduce cholesterol provide an example that illustrates
the consequences of basing community health policy
and programmes on findings from empirical research
without developing a logically sound theoretical basis
for identifying inconsistencies and contradictions in the
findings. The use of theory to guide research to support
health promotion action is discussed.
Key words: health promotion; informed action; theory
INTRODUCTION
The field of health promotion is infusing new
thinking into population health research and the
policy making process for health. Originating in a
critique of traditional health education (Green
and Raeburn, 1988), the concept of health
promotion has evolved into a strategy for
improving health that goes beyond individual
behaviour to include the physical, social and
economic environments in which both health and
behaviour are shaped (World Health Organiza-
tion (WHO), 1984; Kickbusch, 1986). The core
of the strategy is to stimulate action on the root
causes of ill health in communities.
What then, it might be asked, has theory, a core
element of 'basic' research, to do with health
promotion? Since health promotion research is
supposed to support action, it is, in the minds of
many, limited to 'action' research. When focused
on community health, action research involves
attempts to change policies, environments,
professional services or the personal behaviour of
individuals in order to improve health. Frequently
it involves implementing and assessing the effects
of interventions. Clearly, action and/or action
research based on faulty 'basic research', will lead
to uncertain problem identification or incorrect
assumptions that misdirect policy (Orosz, 1994).
A prerequisite for action that addresses the
root causes of poor health in communities is valid
knowledge about the forces that protect and
damage health in daily life. Characterized as a
'knowledge challenge' (Kickbusch and Dean,
1992; Labonte, 1994), a health promotion
strategy involves assuring a valid knowledge base
to inform the action. Without entering the deep
and muddy waters of debates about the differ-
ences between basic and applied research, this
paper asserts that theory is essential to valid and
meaningful research, however conceptualized.
Since the central concerns of theory building have
19
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2. 20 K. Dean
to do with explaining phenomena in both the most
comprehensive and the most precise way possible
(Selltiz et al., 1976; Suppe, 1977a), it might be
concluded that theory is the most fundamental
prerequisite of a policy science, and that the
absence of theory and effective theory building
are serious weaknesses of much of the existing
research available for the policy making process
for improving the health of populations.
In order to explore these issues, a detailed
example will be used to illustrate the conse-
quences of basing community health policy and
programmes on findings from empirical research
without developing a logically sound theoretical
basis for identifying inconsistencies and contra-
dictions in the findings. Based on this example,
the use of theory to guide basic and applied
research to support health promotion action will
be discussed.
COMMUNITY INTERVENTIONS TO
REDUCE CHOLESTEROL
In the 1980s, major health policy initiatives
directed toward reducing cardiovascular disease
involved population interventions to reduce
cholesterol blood levels. A well-documented
higher risk of death from coronary heart disease
among persons with elevated levels of blood
cholesterol formed the basis of the policies
focused on activating people to lower blood
cholesterol. The goal was to contribute to improv-
ing public health by shifting the distribution of
blood cholesterol concentrations for entire
populations (Consensus Conference, 1985;
Study Group, 1987). Extensive public funds were
used in many countries on interventions and
health education focused on getting people to
change their diets, obtain blood cholesterol
measurements and even use drugs to reduce
cholesterol levels. After extremely costly popula-
tion based programmes had been in place for
some time, it became known that not only high,
but also low levels of blood cholesterol are asso-
ciated with disease and death—that there is a
'U-shaped curve' in the relationship between
blood cholesterol and mortality.
Muldoon and his colleagues (1990), conducted
a meta-analysis, a quantitative review of the
evidence, on findings from primary prevention
trials of the type that had been used to justify this
community health policy. The purpose of the
meta-analysis was to determine the effects of
lowering blood cholesterol on total and case
specific mortality. In order to enhance the
comparability of the findings and reduce statis-
tical effects from combining data from different
studies, rigorous criteria were developed for
accepting experimental trials into the study. Each
project had to have: (i) been a randomized clinical
prevention trial of serum cholesterol reduction;
(ii) included a treatment group that received
instructions for a diet and/or drugs to reduce
cholesterol and a control group; (iii) resulted in
the lowering of cholesterol in the intervention
group relative to the control group; and (iv)
reported both total and cause specific mortality in
the results of the trial. Six randomized trials total-
ling 24 847 male participants could be accepted
on the basis of these criteria.
The results of the meta-analysis showed that
while each trial reported evidence of success in
lowering blood cholesterol levels, the evidence of
any reduced coronary heart disease (CHD)
mortality was weak, and overall survival among
men who underwent lipid lowering treatment was
not improved. Furthermore, mortality not related
to illness was nearly twice as high in the inter-
vention groups as in the control groups, a finding
consistent for all six studies whether or not the
cholesterol lowering treatment was carried out
with drugs or dietary education. These highly
consistent and disturbing results were reported
about the same time that other investigators were
uncovering similar findings (Holme, 1990;
Strandberg etal., 1991).
The evidence from studies of cholesterol
reduction was presented for evaluation in a US
National Heart, Lung and Blood Institute expert
conference in 1990 (Conference Report, 1992).
The experts reviewed and discussed existing data
on the left-hand limb (association between low
cholesterol and mortality) of the U-shaped curve,
the term that is used to represent the greater
mortality found among persons with both high
and low blood cholesterol levels. Presenting
results of a statistical overview of available cohort
studies with findings involving 68 406 deaths, a
study of unprecedented size, it was documented
that the higher mortality rates associated with low
blood cholesterol held both across studies and for
a diverse range of causes. Especially high excess
death rates from digestive system conditions and
from less common diverse causes were found, but
also cancer, respiratory system and injury deaths
were associated with low cholesterol.
The findings of higher risk of death from causes
3. other than CHD held for both men and women.
At the same time, however, the second major
finding of the conference report was the 'surpris-
ing observation' that for women 'high blood
cholesterol is not associated with all-cause mor-
tality nor even with cardiovascular mortality'
(Hulley et al., 1992). Three major conclusions
were drawn from the findings presented in the
expert conference:
• the association between low blood cholesterol
and noncardiovascular deaths indicated the
need to review policies aimed at shifting entire
population distributions of blood cholesterol
to lower levels;
• the lack of association between high blood
cholesterol and cardiovascular deaths in
women indicated that, except for those with
coronary disease or other high risk of CHD
death, 'it no longer seems wise to screen for and
treat high blood cholesterol in women';
• the findings in primary prevention trials of
cholesterol intervention that the increase in
non-CHD mortality rates is similar to the
decrease in CHD death rates indicated that,
except for people who already have coronary
disease, it is unwise to treat high blood choles-
terol with drugs.
IMPORTANCE OF KNOWING AND USING
RELEVANT RESEARCH LITERATURE
Actually, it turns out, as noted by Hulley and his
colleagues (1992), that this 'U-shaped curve' had
been reported for two decades. Moreover,
Muldoon and his colleagues (1990) had noted
that, although large primary prevention trials had
found evidence suggesting that lowering serum
cholesterol concentrations reduced the incidence
of coronary events, predominantly myocardial
infarction, only one had found mortality from
heart disease lowered significantly after choles-
terol reduction.
If one examines research literature other than
that from controlled clinical trials, evidence that
would have foreseen these findings goes back to at
least 1962 (Groen et al). In an investigation
conducted in Holland, cholesterol research was
placed in a lifestyle context, with the result that
the findings differed considerably from simple
predictive correlations between measures of
cholesterol and CHD mortality. The study
involved comparative analyses of behavioural
Using theory to guidepolicy 21
and health variables in populations of Benedic-
tine and Trappist monks living in cloistered
monasteries.
It was found that blood cholesterol levels were
much higher in all age groups for the Benedictine
monks compared to the Trappist monks. The
essentially vegetarian diet of the Trappist monks
is much stricter than that of the Benedictines. This
is evidence that diet can affect blood cholesterol,
also shown in the cholesterol intervention trials.
Cardiovascular disease incidence was, however,
in spite of the higher cholesterol levels of the
Benedictines, the same in both monk populations,
and much lower than in the general male popula-
tion of comparable age in Holland. The findings
show that even if blood cholesterol is a contrib-
uting factor in cardiovascular disease, it is not a
sufficient cause. Social and psychosocial pro-
cesses, as either component causes or modifiers
of disease processes, appear to be the determining
influences. This study illustrates that it is research
on lifestyle, understood as patterns and ways of
living (Coreil et al., 1985), rather than cholesterol
or any other risk factor that is needed for under-
standing health and disease.
Geoffrey Rose (1985), in a discussion of
problems and limitations of the risk factor model
of research on population health, unintentionally,
but powerfully, illustrated the potential problems
that would arise from action connecting choles-
terol and heart disease in a simple causal model.
He used findings from the Framingham Study, a
comprehensive longitudinal investigation of
health outcomes in a US population sample, to
juxtapose the serum cholesterol curve of the
persons in the cohort study who developed CHD
over the curve of those who did not develop heart
disease. The curves showed a comparable range
and peak in the cholesterol values of those who
did and did not develop disease, rendering the
powerful relative risks produced from the data
unimpressive.
Rose felt that research focused on individuals
constrains knowledge about the causes of
diseases. With roots in clinical practice, the
purpose of both case control and cohort epi-
demiological studies, he noted, is to discover how
sick and healthy individuals differ. He pointed out
that the use of relative risk as the measure of
aetiological force in this paradigm has almost
excluded the use of any other approach in
epidemiology, even though relative risk 'is no
measure at all of aetiological outcome or of public
health importance' (p. 32). Rose reminded us
4. 22 K. Dean
that, while considerable information is available
about the characteristics of individuals suscep-
tible to various diseases, 'most non-infectious
diseases are still of largely unknown aetiology'.
These considerations led Rose to the conclu-
sion that research should focus on populations
rather than individuals—ecological comparisons
in contrast to relative risk approaches. Using
CHD as an example, he pointed out that even with
screening to detect early disease, there is weak
ability to predict the future for individual patients.
His suggested solution, looking at population
averages and attempting to shift the curve of
whole populations on specific risk factors is,
however, the approach that was found to be
dangerous in the overview of research findings on
the U-shaped curve with regard to cholesterol
related mortality. Rose's recommendation, aimed
at preventing cardiovascular disease in popula-
tions instead of detecting disease at an early stage
in individuals, was still centred in a risk factor
cause and effect model of disease.
Both relative risk approaches to specific aetiol-
ogy and ecological studies examining group
differences on specific phenomena look away
from the differential impact of causal influences in
the presence of other causes and over periods of
time. Rose's synthesis of findings pointing to the
limitations of the relative risk paradigm in a sense
replicate those of the research in Holland
described above, but without the theoretical force
of the lifestyle study for suggesting contributing
causes.
THEORY, THE NEGLECTED COMPONENT
The evidence provided by the cholesterol studies,
whether they stem from randomized trials, case
control, cohort or ecological studies, centre on
statistical effects and predictions. Detecting a
statistical effect of a factor that remains after
other influences are removed by randomization
or statistical 'control' does not provide the infor-
mation needed for understanding the statistical
connection between the two variables. Relation-
ships between variables that have been tested and
replicated may be true, but remain so unspecified
that they do not provide meaningful knowledge
(Merton, 1949). It is necessary to learn the
conditions under which statistical correlations
hold, are modified or disappear to understand
causal processes determining health in the real
world. A theoretical logic for transferring statisti-
cal correlations into causal processes and for
investigating inconsistencies and contradictions
in the findings, such as that developed by Rosen-
berg (1968), is absent in the risk factor model of
disease. This problem is a major barrier for
understanding the meaning of statistical correla-
tions between specific factors and disease.
The cholesterol example is illustrative because
results available in the research literature
contained theoretical insight suggesting alterna-
tive directions long before the costly and perhaps
dangerous interventions led those responsible for
them to conclude that the policy needed to be
changed. One wonders at the power given statisti-
cal predictions in this body of work, as if the
statistical connections between two factors had
real meaning for the health outcomes of individ-
ual people.
Even without an awareness of research findings
such as those from the investigation in Holland
and those presented by Rose, or without stopping
to think about the reality constraints of statistical
correlations, one wonders why cholesterol was
given such unique power as a cause of CHD.
Should not cholesterol be regarded as a biological
marker expressing a state of physicochemical
processes in the individual at a given time, an
outcome or at least an intermediate outcome,
rather than a cause? What theoretical logic was
presented and tested that could grant cholesterol
the causal status justifying intervention affecting
the health of general populations and the use of
huge amounts of limited public health resources?
The purpose of scientific theory and methods is
to expand knowledge about causal processes. All
research designs and statistical models have
limitations for testing theories. The details of how
scientific methods fall short fill numerous texts on
research methodology. Research granting a
methodological approach a primacy that hides its
limitations, and without theoretical frameworks
to illuminate the limitations, should never be the
basis of health policy and action. The over-
whelming consensus is that methods appropriate
for given research questions (fallible as they are)
should be used to test theories (Stolzenberg and
Land, 1983). This means that both action and
basic research in pursuit of knowledge to inform
health policy would always be an interplay
between expanding theory and improving
methods (Dean, 1993).
5. Using theory to guide policy 23
CHANGING VIEWS ABOUT THE ROLE OF
THEORY
The meaning and importance of theory have
changed periodically throughout the history of
science. Long traditions of separating theory from
empirical observations had serious consequences
on scientific research, including that conducted in
population based sciences (Bernert, 1983). The
weaknesses of atheoretical empirical work are
now widely recognized (Faust, 1984; Maclure,
1985; Dean, 1993). Suppe (1977b) discussing
major contemporary views on theory building,
reached the conclusion that only in primitive
science, where the development of theories is
neglected, does the verification of empirical pre-
dictions maintain a central position. A major
function of theory is to organize and integrate
information for discovery (Shapere, 1977).
The above observations do not mean that
developing and using theory guarantees 'truth' or
even necessarily the advancement of knowledge.
Theory, an aid to human cognitive limitations,
helps to organize information in the body of
knowledge for further inquiry (Faust, 1984).
When not tested and modified appropriately,
theory can become transformed from a scientific
thesis about reality relationships into a rationale
for a belief system.
Competing theories are also important for
gaining new knowledge. The interpretation of
observations considered true within the frame-
work of a particular theory will be only partial
truths, or even false, in the context of another
theory. Gillett (1994) illustrates this with the
example of the corpuscular theory of light being
considered false when wave theory became
dominant, but regaining importance with quan-
tum theory. The revived importance of corpuscu-
lar theory was not, however, considered to
discredit wave theory. Both became part of a new
understanding of particles and the development
of a new theory of light. This example is useful
because it illustrates that different theories, some-
times opposing or contradictory and sometimes
complimentary, as well as the modification of
theory, are core aspects of advancing scientific
knowledge. Referring back to the cholesterol
example, the point is that empirical observations
are always partial representations conveying
certain truths and concealing others.
USING THEORY IN HEALTH PROMOTION
RESEARCH
A great deal of health promotion research has
been limited to the health related behaviour of
individuals. When some form of theoretical
framework is used in research on behaviour and
health, it is generally based on theories developed
by social psychologists. These theories are used
quite loosely and rarely modified or rejected
when very little of the 'variance' in the behavioural
practice is explained. It has been argued that these
models are more 'idea-sets' than the type of
theories usually developed to provide scientific
explanation (Research Unit in Health and Beha-
vioural Changes (RUHBC), 1989). Influenced
both by risk factor epidemiology and social
psychology, this work provided the knowledge
base for health education. In recent years, more
studies have focused on social environments and
structural determinants of health (Milio, 1986).
Starting slowly as a critique of traditional health
education, the shift gained force with the evolu-
tion of the field of health promotion.
The term 'health promotion', generally traced
to the Lalonde Report (1974), remained for some
time a vaguely conceived umbrella term very
often used in relation to quite traditional research
and programmes (McQueen, 1994). It was after
the WHO (1984), Health Promotion: A Discus-
sion Document on the Concept of Principles, and
the Ottawa Charter (WHO, 1986), launched 2
years later at the first International Conference on
Health Promotion, that the process of estab-
lishing research, education and publication struc-
tures moved rapidly forward.
Much has been done to shift the health pro-
motion research agenda. Still, a great deal of the
research conducted in the field continues to rely
on the risk factor tradition, methodological
approaches and the social psychological thinking
from which the field emerged. New theoretical
thinking is present in the field conceptually and
implicitly, but making theory explicit and a strong
force guiding research and explanation has not
yet occurred. While health promotion cannot lay
claim to well-developed theories of its own, even
in its infancy, this young field developed a strong
conceptual base that provides a framework for
theory development. Theories embedded in the
concepts and principles of health promotion
(WHO, 1984) and the Ottawa Charter (WHO,
1986) can guide the various types of research on
institutions, populations and individuals that are
6. 24 K. Dean
needed to provide knowledge for health pro-
moting action.
The health field concept (Lalonde, 1974),
modified on the basis of the Ottawa Charter (Rae-
burn and Rootman, 1989), summarizes domains
for research and action. Other models and con-
ceptual frameworks have been put forward as
well. The characteristics that best describe the
types of research needed to provide the know-
ledge for health promoting action are contextual-
ism and dynamism (Dean et al., 1993). The
emphasis on environments, communities and
policy opens the way for theories of multilevel
influences that can expand knowledge about the
causal processes that people are exposed to in the
contexts of daily living.
Bringing together theory and knowledge from
diverse sources is a central idea in Shapere's
(1977) concept of theoretical domains. In his
thinking, theory and empirical research are
mutually interdependent. The development of a
theoretical domain in research to promote health
would entail discovering causal processes by
exploring and then fitting together moderating
influences instead of trying to reduce complexity
to a simple connection between two factors. A
statistical relationship between two variables can
only be a starting point for understanding the
context in which the two variables relate to each
other, and for identifying the conditions that
modify the relationship.
Developing the context in a theoretical domain
examining how lifestyles affect health would
involve fitting together findings from different
types of studies, as well as integrating different
levels of influence into investigations of lifestyle
and health. The contexts in which people live their
daily lives involve social conditions and oppor-
tunities for learning and practising life skills.
Social norms and formal legal statutes, as well as
the resources that shape both personal skills and
supportive environments, make up the domain in
which lifestyles are formed and maintained. It is
necessary to study the formal and informal rules
governing the context in a research domain
(Gillett, 1994).
Specific health related behaviours would have
limited meaning or relevance in a lifestyle
research domain. Theories would postulate how
ways of living protect or damage health. Trans-
lated into empirical research, patterns of behav-
iour (their separate, joint and interactive effects
on health) in the context of daily life, would be
studied with complementary types of research
methodologies. Cholesterol levels might be
studied to obtain knowledge about the causal pro-
cesses leading some people with high cholesterol
to develop heart disease while others remain
healthy. This would involve identifying how inter-
vening influences such as general behavioural
patterns, stress, supportive environments and
available resources affect the health of people
with family histories of high cholesterol and/or
heart disease.
Thus in a lifestyle framework, meaningful
research would seek to understand the influence
of living situations, and of cultural and subgroup
learning and expectations on behavioural prac-
tices. Another important area of inquiry would be
the progressive nature of health damaging habits
for some people. 'Addiction' research needs to
study environmental demands and the moder-
ating effects of personal skills and of support
available in social networks.
Time, generally neglected in population health
research, is another major force determining the
contextual nature of causation. Lifestyle theory,
developing the interplay of environmental con-
text and behavioural patterns would need to be
tested with methods capable of disentangling the
effects of age, period and cohort aspects of causal
processes (Riley, 1993). The contribution of any
specific influence is not necessarily stable over
time, and there may be social group differences in
the relative stability of influences. Take, for
example, the impact of diet at different periods of
life. A deficiency in childhood of nutrients needed
for normal development will have far more
serious consequences for health, functioning and
longevity than the same deficiency in late life
(Barker, 1988).
For other influences, the impact at different
periods of the life course may reverse. The
physiological caustic effects of a substance such
as alcohol may be far less for young active people
with rapid metabolism than for old people who
are less active and whose metabolic processes
have altered character. At the same time, alcohol
presents other dangers to young people relative to
older people. The role of peer pressure is
especially strong in youth, and may contribute to
overuse or dangerous use of alcohol or other
mood altering substances among young people
relative to mature adults. Accidents, especially
those involving alcohol and/or speeding in motor
vehicles, are a major cause of death and disability
for young males. Variations in how influences
affect outcomes need to be understood for effec-
7. Using theory to guide policy 25
tive health promotion. It is not possible to infuse
the time dimension into studies of causal
processes without theory to organize existing
knowledge for the development of plausible
explanations.
MOVING FORWARD
The field of health promotion has already taken
great strides in shifting the research agenda to
subjects more in tune with real community health
needs. It is now important to assure that the some-
times heavily rhetorical discussions on the subject
of health promotion do not impede progress. In
order to continue and build on the contributions
already made to public health, the field of health
promotion 'must now move beyond the rhetoric
of its developmental years' (McQueen, 1994).
'Action' research and other forms of research to
inform health policy are not new. They have
always existed in the field of public health.
Throughout an extended period in this century,
research became dominated by the biological
experimental paradigm, and indeed action
research in that tradition did form the basis of
community health policy. The policies focused on
shifting the cholesterol curves of general popula-
tions resulted from action research accepted in
the policy making process.
Changing the focus of the health debate and the
renewed emphasis on the environmental deter-
minants of health are important contributions of
the field. Community health programmes have,
however, received high priority in the past only to
be dismantled, and even within thefieldof health
promotion research and programmes have not
always risen above the individualized risk factor
approaches (Green, 1994).
Research simply shifting the focus from 'risk
factors' to 'risk conditions' is not sufficient for
improving knowledge. The risk factor model itself
has built in limitations. Like so many dysfunc-
tional dichotomies that are being challenged in
contemporary science, arguments about the
micro-macro determinants of health, and their
counterpart, the nature-nurture division, are
both reductionistic approaches (Lewontin et al,
1984; Lewontin, 1991). Both fail to acknowledge
the multidimensional and interactive nature of the
causal processes that shape health and func-
tioning.
CONCLUSION
Theory for guiding health promotion research
needs to build in the complexity involved in real
causal processes that shape health over time.
Relationships among influences can then be
explored with the range of research designs,
qualitative as well as quantitative, for studying
research issues, and with analytic approaches that
are capable of studying direct, indirect and
moderating relationships.
'The 1990s represent the watershed for health
promotion. Now health promotion must show its
utility to the skeptics, as well as those who have
had their consciousness raised by its rhetoric'
(McQueen, 1994, p. 336). Action that is not based
on valid knowledge will discredit the field. Theory
based in the concepts and principles of health
promotion can guide research to new knowledge
about health and health related quality of life.
Addressfor correspondence
Kathryn Dean
Population Health Studies
Ribegade 6 st.tv
DK-2100 Copenhagen
Denmark
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