Effectiveness of cognitive–behavioral therapy based on the Mediterranean diet for the treatment of obesity

ObjectiveThe Mediterranean dietary pattern improves cardiovascular disease factors. More research is needed on the usefulness of a Mediterranean dietary pattern in terms of weight loss. The objective of this study was to assess the effectiveness of behavioral therapy based on the Mediterranean diet for the treatment of obesity and to determine the main obstacles to weight loss.MethodsA total of 1406 obese subjects (body mass index, 31 ± 5 kg/m²), aged 20–65 y, from a Mediterranean area in southeast Spain were subjected to a weight-reduction program. To evaluate effectiveness, weight loss, body fat distribution, biochemical variables, blood pressure changes, mean duration of treatment, percentage of attrition, and the ability to fulfill a Mediterranean diet pattern were assessed. To determine the main barriers to losing weight, a “Barriers to Weight Loss” checklist was completed.ResultsThe behavioral therapy program was effective for the treatment of obesity. The average weight loss was 7.7 kg. The duration of treatment was 34 wk. Eighty-nine percent of subjects fulfilled the Mediterranean principles during the program, and all the variables studied were significantly improved. Attrition was 4–9%, with the main reason being stress (37%). Main obstacles to weight loss were “losing motivation,” being “prone to stress-related eating,” and being liable to eat when bored. Recording food intake and assisting group therapy were also important tools for losing weight (P ≤ 0.05).ConclusionsDietary/behavioral treatment based on Mediterranean dietary principles is effective in clinical practice. Nutrition professionals should encourage their patients to record food intake and to attend group therapy.     

The interaction of dietary fat and antiestrogen treatment on DMBA‐induced mammary tumors in the rat

This study was designed to determine whether an estrogenic mechanism is in volved in dietary fat‐modulated tumor development and growth. Female Sprague‐Dawley rats were placed on a semipurified low‐fat (2% fat), high‐saturated fat (20% fat), or high‐polyunsaturatedfat (20% fat) diet at 21 days of age. A single dose of7,12‐dimethylbenz[at]anthracene (DMBA, 10 mg) was administered intragastrically at 50 days of age. Two studies were performed. One tested the effectiveness of antiestrogen treatment (either tamoxifen or analog II) on tumor development when it was given one week prior to and one week after DMBA treatment in animals consuming a high‐polyunsaturated fat diet. The second six‐week study tested the antiestrogen effectiveness in arresting tumor growth and in producing regressions of established DMBA‐induced tumors in rats consuming various levels and types of fat.

The results of these studies indicate that both antiestrogens employed reduced the rate of growth and increased the number of regressions of established DMBA‐induced tumors. In general, this was true in animals fed diets with a high content of either saturated or polyunsaturated fats and to a lesser extent in animals fed a low‐fat diet. Tamoxifen produced a somewhat greater reduction in the growth of established tumor than did analog II. However, analog II, which is a more biologically “pure” antiestrogen, reduced the incidence of animals with mammary tumors and total tumor burden when administered one week beforeandone week after DMBA dosing. Tamoxifen, which is a partial estrogen‐agonist, did not alter tumor incidence, but it did reduce the total tumor burden under these same experimental conditions. We concluded that estrogens may be partially responsible for the observed dietary fat enhancement of breast tumor development.     

Does correcting myths about the flu vaccine work? An experimental evaluation of the effects of corrective information

Seasonal influenza is responsible for thousands of deaths and billions of dollars of medical costs per year in the United States, but influenza vaccination coverage remains substantially below public health targets. One possible obstacle to greater immunization rates is the false belief that it is possible to contract the flu from the flu vaccine. A nationally representative survey experiment was conducted to assess the extent of this flu vaccine misperception. We find that a substantial portion of the public (43%) believes that the flu vaccine can give you the flu. We also evaluate how an intervention designed to address this concern affects belief in the myth, concerns about flu vaccine safety, and future intent to vaccinate. Corrective information adapted from the Centers for Disease Control and Prevention (CDC) website significantly reduced belief in the myth that the flu vaccine can give you the flu as well as concerns about its safety. However, the correction also significantly reduced intent to vaccinate among respondents with high levels of concern about vaccine side effects – a response that was not observed among those with low levels of concern. This result, which is consistent with previous research on misperceptions about the MMR vaccine, suggests that correcting myths about vaccines may not be an effective approach to promoting immunization.     

Clients’ and RTW experts’ view on the utility of FCE for the assessment of physical work ability,prognosis for work participation and advice on return to work

Purpose

To describe clients’ and experts’ view on the utility of functional capacity evaluation (FCE) for the assessment of physical work ability, prognosis for work participation and advice on return to work (RTW).

Methods

Semi-structured telephone interviews were performed with fourteen clients and fifteen RTW experts. Qualitative data were analysed independently by two researchers. The codes were compared and combined in higher-order topics until consensus was reached by three researchers.

Results

For the assessment of physical work ability, FCE was found useful according to both groups, because it provided an overview of the physical abilities. Clients indicated that FCE confirmed and/or altered their view on their work ability. RTW experts were able to verify consistency between verbal information and performance of the client. For making a prognosis of work participation, only RTW experts found FCE useful. For the advice on RTW, both groups found FCE useful. The RTW trajectory could be clearly outlined. Both groups indicated that clients felt they were being taken seriously by performing FCE.

Conclusions

Clients and RTW experts indicated FCE as being useful for the assessment of physical work ability and advice on RTW. Only RTW experts indicated FCE as being useful for making a prognosis for work participation.     

Surveillance results of nosocomial infections of the ICU in Kenézy Hospital, based on two years data

INTRODUCTION: According to data in the literature, the number of nosocomial infections in the ICU is far higher than in non-ICU patients. As a result of improving lifesaving technologies, the risk of nosocomial infections increases in ICUs. Utilization of epidemiological methods is recommended for the detection and follow up of nosocomial infections. Aims: Prospective surveillance to assess the epidemiology of nosocomial infections in an ICU. METHODS: Kenézy Hospital is a country hospital with 1637 beds and a 16-bed central ICU. During the investigated period (01. 04. 2004-31. 03. 2006) 1490 patients, with a total 8058 ICU days, were hospitalised in the mixed medical-surgical ICU. The commonest primary diagnosis were respiratory failure, multiple trauma and head injury. Surveillance was performed by a trained infection control nurse and was supervised by an infection control physician and infectious disease physician. CDC definitions were used to define nosocomial infections. RESULTS: A total of 194 nosocomial infections in 134 patients were detected during the study period. The overall incidence and incidence density of nosocomial infections were 13.0 per 100 patients and 24.0 per 1000 patient-days. Respiratory tract infections (44.3%) were the most frequent nosocomial infection, followed by urinary tract (21.1%) and bloodstream infections (20.1%). CONCLUSIONS: Nosocomial surveillance is useful in detecting nosocomial infections in ICU. A multidisciplinary approach and partnership between the physicians and infection control nurses is needed. Patient-to-nurse ratio is an independent risk factor for nosocomial infections in intensive care, this must be kept in mind when planning rationalization of the number of nursing staff.     

Does a stressful psychosocial work environment mediate the effects of shift work on cardiovascular risk factors?

OBJECTIVES: Associations between shift work, chronic psychosocial work stress, and 2 important cardiovascular risk factors, hypertension and atherogenic lipids were studied.The hypothesis was tested that psychosocial work stress, as defined by the model of effort-reward imbalance, mediates the effects of shift work on cardiovascular risk. METHODS: Altogether 2288 male participants aged 30-55 years in the baseline screening of the Swedish WOLF (work organization, lipids, and fibrinogen) study underwent a clinical examination and answered a standardized questionnaire measuring shiftwork schedules, effort-reward imbalance at work, and health-adverse behavior. RESULTS: In addition to the direct effects of shift work on cardiovascular risk, mediating effects of effort-reward imbalance at work were found. The respective odds ratios (OR) ranged from 2.18 to 2.27 for hypertension and from 1.34 to 1.45 for atherogenic lipids. While the effects remained significant after extensive confounder control concerning hypertension, part of the observed effect on atherogenic lipids was due to behavioral influences. CONCLUSIONS: Despite obvious limitations, the results indicated that a stressful psychosocial work environment acts as a mediator of health-adverse effects of shift work on hypertension and, partly, atherogenic lipids. In terms of occupational health the findings call for a more comprehensive assessment of the health risks associated with shift work.     

Prediction of the length of service at the onset of coal workers’ pneumoconiosis based on neural network

Abstract

Three environmental parameters, i.e. dust concentrations, dust dispersion, and free silica content, were introduced into the traditional indices of the neural network model in order to construct a new prediction index and explore a new method for preventing the incidence of pneumoconiosis with intelligent accuracy and universality. Data of the pneumoconiosis patients from Huabei Mining Group (HBMG) of China from 1980 to 2017 were collected. SPSS22.0 was used to develop the combined models based on Back Propagation (BP) neural network model, Radial Basis Function (RBF) neural network model, and Multiple Linear Regression (MLR) model. The paired sample t-test was performed between the real and predicted values. According to this model, it was predicted that 382 coal workers in HBMG were likely to suffer from pneumoconiosis in 2022 and the incidence rate was 4.48%. It is necessary to take prevention measures and transfer these workers from their current positions. In four combined models, the BP-MLR combined model achieved the optimal error parameters and the most accurate prediction. This study provided a scientific basis for effective control and prevention of the incidence of the pneumoconiosis.     

Should the decisions of ethics committees be based on community values?

Medicine, Health Care and Philosophy -     

Therapeutic results in patients with malignant granulosa cell tumors at the Gynecologic Clinic of the city of Pécs]

In the Department of Obstetrics and Gynecology, University Medical School of Pecs, Hungary 92 patients had been treated with malignant human granulosa cell tumor between 1960-1997. The youngest patient was 14 years old, the oldest 77. The average age was 52.5 years. The disease occurred mostly in 50-60 year old women, and most of them have never given birth before. In 64 cases (69%) metrorrhagia and low abdominal pain were the leading symptoms. 61% of cases the disease was diagnosed in the 1st stage, 14% in the 2nd, 18.5% in the 3rd, and 6.5% in the 4th stage. According to the endometrial histologic examination, data of increased estradiol production was found in 75% of the patients. Along with granulosa cell tumor breast cancer occurred in 2 cases, endometrial carcinoma was diagnosed in 4 cases, and atypical endometrial hyperplasia in 6 cases. After the operation 67 patients received radiation therapy, 5 chemotherapy and 16 combined radiation and chemotherapy. The 2 year survival rate of the 87 patients treated between 1960-1994 was 87.4% the 5 year survival rate was 64.4%. In the stage 1 had 92.4% of patients lived 2 years tumor free, 83.0% lived 5 years without recurrence of tumor. The cleaned 5 year survival rate was found in 88%. With the survey of the youngest patient's case the authors pointed out the highly malignant, rapid course, and the changing of the sera hormones during the therapy.     

Doing care work on the fly – exploring the unnoticed socio-emotional skills of male ambulance staff

Prehospital ambulance work is a healthcare arena hitherto neglected by sociologists of health and illness. This is unfortunate because it is an interesting and dynamic area, and in contrast to most healthcare sectors, it is male dominated. Via ethnographic fieldwork, this article examines the particular caring practices and socio-emotional skills that ambulance staff use in practising prehospital care work. The empirical analysis outlines six recurring prehospital practices: medicine work, machine work, scene management, becalming work, communication work and bodywork. Each practice represents a different element of prehospital care practice and is best understood as a repertoire, as many different assemblages of these care practices can work effectively in prehospital situations. The article concludes that despite institutionalised blue-collar masculinity, numeric dominance and scarce formal education in ambulance psychology, male ambulance staff are generally proud and reflexive care practitioners.     

Students’ opinions about the effects of preclinical patient contacts on their learning

Several reasons have been given why students should have contacts with real patients early in the undergraduate medical curriculum, i.e., in the preclinical phase. However, it is not clear exactly what effects early patient contacts have with regard to knowledge construction and the development of clinical reasoning skills. We sought students’ views of the effects of preclinical real patient contacts on their learning, knowledge construction and development of clinical reasoning. Twenty-four students in the third and last preclinical year of a 6-year undergraduate medical programme were divided into three focus groups which met twice, after which saturation was reached. The discussions were recorded and transcribed. Summaries of the discussions were approved by the students after some modifications. Atlas-ti software was used to create a coding framework resulting in identification of main themes and sub themes. Early patient contacts motivate students to study, help them understand the impact of illness on patients’ lives, and enhance professional socialisation and memory processes. Students distinguish between analytic and non-analytic clinical reasoning in connection with real patients. Analytic reasoning involves clinical and basic science knowledge. Non-analytic reasoning involves pattern recognition and is made possible by experiential learning from different patient contacts. The students indicate that seeing real patients early in their training has several positive effects on their learning. The contacts enhance knowledge construction and clinical reasoning. Although our results will have to be validated by quantitative, observational and experimental research, they imply that educational benefits are to be gained from real patient contacts in the preclinical phase of medical education.