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Continued progress over the next decade in reducing premature morbidity and mortality from chronic disease will require that health communication efforts target a significant proportion of the American public that has not been influenced by the health promotion efforts of the 1980s. Focus groups conducted with members of the hard-to-reach American public showed that while being healthy seemed to be important to participants, and they were generally aware of what to do to stay healthy, they had a different operational definition of health than that used in health promotion programs. Participants seemed to believe that better health behaviors would build their resistance to acute illnesses, that is, keep them healthy, but that chronic diseases, such as cancer and diabetes, were due to fate and heredity and beyond their individual control. The focus group results show that participants had not made the link between chronic disease prevention and the importance of diet, exercise, and weight control. Although most of them seemed to express a genuine interest in "doing better," they were not able to supply more than superficial examples of how such changes might be made. Surprisingly, there were more similarities than differences in participants' attitudes and beliefs, with the similarities cutting across boundaries of race-ethnicity, age, and sex. Interest in changing behaviors was only slightly more pronounced among female rather than male, and older rather than younger, participants. However, there was not much evidence from the participants that they were actively seeking health information or trying to reconcile conflicting knowledge and beliefs.
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PMID:Promoting healthy diets and active lives to hard-to-reach groups: market research study. 211 79

The aging process alters body composition so that nutritional status changes as we get older. The aging process shows interindividual variability in its rate of development. Determinants of the rates of aging of systems and tissues are largely genetic. Premature aging of cells and tissues is due to genetic factors and to long-term exposure to physical or chemical environments that cause irreversible tissue damage. Whereas maximal lifespan is fixed for us all, individuals vary in life expectancy both because of variability in the risk of genetic disease which shortens life and because of variable capability for avoidance of those factors in our environment which cause early aging. Early aging as well as geriatric disease foreshorten life, but both can be prevented to some extent by diet or by diet and exercise. Diseases that can be nutritionally prevented, giving us a greater chance of achieving our genetically determined lifespans, include nutritional deficiency states and chronic diet-related diseases such as non-insulin-dependent diabetes, hypertension, coronary artery disease, and cancer. Disabilities resulting from these diseases and from degenerative arthritis are also subject to modulation by diet. The nutritional requirements of the elderly are mostly similar to those of younger people. Elderly usually need fewer calories and similar nutrient intakes compared with those of younger people. Elderly with higher needs for specific nutrients include homebound or institutionalized people who lack sunlight exposure and therefore require more vitamin D. Nutritional requirements to promote longer life expectancy and freedom from disabilities that result from chronic disease include restriction of food energy and fat. Nutritional assessment of the elderly is aimed at identifying not only the presence of deficiency states but also states of nutrient excess and chronic diet-related diseases. There are certain problems in carrying out nutritional assessment in the elderly, but techniques are now available which make valid assessment possible even in the oldest old. Those who live longest have less genetic risk of premature aging, but as a result of native intelligence, education, coping skills, and higher socioeconomic status, they also have a greater likelihood of eating a diet that best meets their long-term nutritional needs. Those most at risk for developing malnutrition as they get older are those who lack food access because of poverty, because of disability resulting from chronic geriatric disease, or because of a combination of these factors. Malnutrition is found in elderly in our society who live in their own homes if they are indigent, isolated, and homebound because of disability.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Geriatric nutrition. 218 27

The Pittsburgh project evaluating the epidemiology and etiology of insulin-dependent diabetes mellitus (IDDM) is currently one of the large ongoing studies of childhood diabetes. This paper traces the evolution of the project, from the initial basic epidemiologic approach in the early 1980s, to the current thrust where complex molecular genetic approaches are being incorporated into population-based research. The epidemiology models employed in the Pittsburgh project are similar to those that could be used in many areas of chronic disease research. The integration of immunogenetics into epidemiology produces a powerful approach for understanding the complex interaction of host susceptibility and environmental agents that contribute to the development of IDDM.
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PMID:Evolution of the Pittsburgh studies of the epidemiology of insulin-dependent diabetes mellitus. Pittsburgh Diabetes Epidemiology and Etiology Research Group. 218 62

Dietary treatment of diabetes has long been the cornerstone of management of this common disease. Recent recommendations to increase the proportion of carbohydrate with concomitant reduction of dietary fat appear to be prudent, but scant data are available to support this supposition in the elderly. Modification of the source of carbohydrate as a means of providing better blood glucose control is based on limited data in controlled settings and needs to be tested in community settings before widespread alterations in the dietary composition can be widely recommended. Current recommendations for protein composition of the diet are probably adequate for the elderly diabetic patient who does not have obvious protein depletion. General guidelines for the dietary management of elderly diabetic patients are summarized in Table 5. Management of the elderly diabetic patient presents a strong challenge to the physician. Dietary recommendations for such patients should be highly individualized; patients' food preferences, ethnic background, financial resources, and support system should be taken into consideration. Simple recommendations drafted with the help of the patient are more likely to be successful. The elderly are often at risk for nutritional deficiency, and the presence of chronic disease such as diabetes profoundly affects metabolism, putting these individuals at still higher risk. Unfortunately, our current understanding of this problem is limited and additional research in this area is essential.
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PMID:Nutritional status and dietary management of elderly diabetic patients. 222 53

This study assesses whether nonhospitalized adolescents with chronic diseases differ from their healthy peers on standardized measurements of depression, self-esteem, and life events. The study group consisted of 80 patients (20 with sickle cell disease, 40 with asthma, and 20 with diabetes). All patients had been admitted at least twice in the preceding year, had their disease for at least 2 years, and were between the ages of 12 and 18. The control group consisted of 100 adolescents, matched for age and socioeconomic status, from local schools. All subjects completed a questionnaire compiled from the Beck Depression Inventory (BDI), the Rosenberg Scale of Self-Esteem, and the McCutcheon Life Events Checklist. Adolescents with chronic disease had higher depression scores (p less than 0.001) and lower self-esteem (p less than 0.001) than their healthy age-matched controls. There was no statistically significant difference in life events between the chronic disease and control groups. Depression, self-esteem, and life events did not differ significantly among the three disease groups. These findings suggest a need for intervention strategies to address depression and low self-esteem in adolescents with chronic disease.
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PMID:Depression, self-esteem, and life events in adolescents with chronic diseases. 226 97

This paper presents a guide for assessing a diabetic patient's level of personal responsibility. In the general population, high levels of personal responsibility have been shown to be related to psychological well-being and are especially appropriate for chronic disease such as diabetes. With diabetes, patients are required to deliver virtually all of the daily self-care. Successful adaptation to this role is enhanced when patients are able to accept personal responsibility for having and treating their diabetes. The paper describes five levels of personal responsibility starting with the lowest level in which patients feel overwhelmed, hopeless, and helpless and ending with the highest level in which patients accept diabetes as a fact of their lives and fully accept responsibility for it. A discussion of assessing the patient's level of personal responsibility and responding appropriately to patients at different levels is included.
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PMID:A guide for assessing a patient's level of personal responsibility for diabetes management. 229 Jul 81

Diabetes is a chronic disease; its successful management is largely dependent on the elderly individual's compliance with the treatment regimen. Teaching efforts for elderly clients with diabetes should be tailored to meet the many age-related conditions that affect learning abilities. These include prior experience with the disease, sensory perceptual changes, short-term memory loss, and lack of formal education. Orem's theory of self-care provides an appropriate framework for nurses who work with elderly diabetic clients. For these clients, nursing goals are geared toward having the older person remain as independent and healthy as possible.
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PMID:Self-care for the elderly diabetic. 229 28

This paper presents a summary and a brief theoretical introduction to time series ARIMA modeling of single subject data. Time series, a statistical technique that may be appropriate when data are measured repeatedly and at nearly equal intervals of time, has potential research applications in the study of chronic diseases such as diabetes, hypertension, and herpes simplex. Both intervention models and multivariate models are covered, with examples illustrating the utility of time series techniques in chronic disease research. Time series modeling of a subject with diabetes before and after being placed on a regimen of chlorpropamide is used to demonstrate the potential of intervention analysis. Multivariate time series techniques are illustrated by modeling the relationship between exercise and blood glucose, and by modelling the relationship between psychosocial distress and lymphocyte subsets of the cellular immune system.
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PMID:The individual over time: time series applications in health care research. 231 14

Type 2 (non-insulin-dependent) diabetes mellitus is the major form of the disease in all societies. Its public health impact appears to be increasing and the greatest genetic predisposition to the disease is encountered in developing communities. The reduction or elimination of disease in whole populations is a fundamental goal in public health. Whilst several factors are associated with the development of Type 2 diabetes, it is not clear how they cause the disease, if indeed they do, nor whether they act in the same way in all populations. Risk factors may be true determinants of a disease but alternatively they may be associated with its occurrence only by virtue of an innocent relationship with the true causes. Furthermore, known risk factors usually explain only a small proportion of any chronic disease. The role of risk factors in disease causation is therefore of fundamental importance in considering disease prevention. Two alternative strategies for prevention of disease in populations have been proposed. The population strategy seeks to remove the causes of disease in communities as a whole, whilst the high-risk strategy aims to identify subjects at increased risk, and to intervene selectively. The population approach should be tried and carefully evaluated in selected communities at above-average risk of several noncommunicable diseases. However, certain epidemiological features of Type 2 diabetes, including the distributional characteristics of glycaemia and the complications of hyperglycaemia, the clustering of cardiovascular risk factors in the diabetic subpopulation, as well as uncertainties over the causal nature of known risk factors, suggest that a high-risk approach to prevention is also appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Primary prevention of type 2 (non-insulin-dependent) diabetes mellitus. 240 78

In mice with streptozotocin-induced diabetes of 3 days' duration, the hexokinase/glucose-6-phosphatase (HK/G6Pase) ratio in the kidney was enhanced by 52% (mean +/- SEM: 0.40 +/- 0.04 vs. 0.26 +/- 0.03; p less than 0.02) compared to control mice as a result of a 25% increase of HK (16.68 +/- 0.93 vs. 13.31 +/- 1.04 nmol/min/mg protein; p = 0.05) and a 17% decrease of G6Pase (42.51 +/- 2.75 vs. 51.25 +/- 1.89; p less than 0.05). In contrast, as expected, the corresponding ratio (HK + glucokinase/G6Pase) was strikingly reduced in the liver. In 9-day diabetic mice, the kidney enzyme changes were much smaller; however, in a chronic disease such as diabetes, even minimal deviations from the normal may lead to significant metabolic changes with time. The enhanced HK/G6Pase ratio in the diabetic kidney suggests an increase in glucose utilization. This may contribute to the increased synthesis of glycogen, glycoproteins (including basement membrane) and RNA (via provision of ribose-phosphate) occurring in the diabetic kidney and supports the view that the kidney (as opposed to other tissues) shows an 'anabolic response' to diabetes.
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PMID:Increased hexokinase/glucose-6-phosphatase ratio in the diabetic kidney as index of glucose overutilization. 255 19


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