Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty

Purpose: We sought to identify patient-reported barriers and facilitators to healthy eating and physical activity among patients before or after knee arthroplasty.

Materials and methods: Twenty patients with knee osteoarthritis aged 40–79 years who had knee arthroplasty surgery scheduled or completed within 3 months were interviewed. Interview topics included perceived barriers and facilitators to healthy eating and activity before or after surgery. Interviews were coded and analyzed using constant comparative analysis.

Results: Interviews were completed with 11 pre-operative (67.1?±?7.6?years, 45.5% female, BMI 31.2?±?6.3) and nine post-operative patients (61.7?±?11.7 years, 44.4% female, BMI 30.2?±?4.7?kg/m²). The most commonly identified personal barriers to healthy eating identified were desire for high-fat/high-calorie foods, managing overconsumption and mood. Factors related to planning, portion control and motivation to improve health were identified as healthy eating facilitators. Identified personal barriers for activity included pain, physical limitations and lack of motivation, whereas facilitators included having motivation to improve knee symptoms/outcomes, personal commitment to activity and monitoring activity levels.

Conclusion: Identifying specific eating and activity barriers and facilitators, such as mood and motivation to improve outcomes, provides critical insight from the patient perspective, which will aid in developing weight management programs during rehabilitation for knee arthroplasty patients.

• Implications for rehabilitation

• This study provides insight into the identified barriers and facilitators to healthy eating and physical activity in knee arthroplasty patients, both before and after surgery.

• Intrapersonal barriers that may hinder engagement in physical activity and rehabilitation include pain, physical limitations and lack of motivation; factors that may help to improve activity and the rehabilitation process include being motivated to improve knee outcomes, having a personal commitment to activity and tracking activity levels.

• Barriers that may interfere with healthy eating behaviors and knee arthroplasty rehabilitation include the desire for high-fat/high-calorie foods, overeating and mood; whereas planning and portion control may help to facilitate healthy eating.

• Understanding barriers and facilitators to healthy eating and physical activity can help guide rehabilitation professionals with their discussions on weight management with patients who had or are contemplating knee arthroplasty.

     

Gastric antral vascular ectasia:clinical presentation and therapeutic management

The gastric antral vascular ectasia (GAVE) or watermelon stomach is an increasingly recognized cause of persistent upper gastrointestinal bleeding, which has typical endoscopic and histological findings. This disease is most frequent in elderly women, and several associated conditions have been well established. Some patients with severe portal hypertensive gastropathy may have a GAVE like appearence. Nevertheless, a correct diagnosis is relevant in order to choose an appropiate treatment. The objective of the current study is to analyze the clinical features and treatment of a group of patients with GAVE evaluated at our Institution. A review of the current literature was also performed. Six women and three men with GAVE were admitted at the Buenos Aires British Hospital between November 1998 and January 2004. Endoscopic biopsy was performed in eight patients and was consistent with GAVE in all cases. Four patients with chronic anaemia as unique manifestation were successfully treated with iron supplements. Endoscopic treatment was performed in 4 patients, 3 of them were treated with bipolar electrocautery and 1 with argon plasma coagulation. An antrectomy was carried out in the ninth patient. The resolution of the bleeding was observed in all cases with the different therapeutics options used.     

Maternal triglyceride levels and newborn weight in pregnant women with normal glucose tolerance.

OBJECTIVE: To determine the predictive value of serum triglyceride levels (TG) for neonatal weight in pregnant women with positive diabetic screening but normal glucose tolerance. RESEARCH DESIGN AND METHODS: We enrolled 180 pregnant Caucasian women with positive diabetic screening. All women underwent a 3-h 100-g oral glucose tolerance test (OGTT) at 27th +/- 4 week of gestation. At the time of OGTT, we measured: fasting plasma glucose, fasting lipids profile and determined ApoE polymorphisms to evaluate the effects on lipid levels. In 83 women with normal glucose tolerance and at term delivery we evaluated the association between maternal serum TG, specific maternal parameters known to affect fetal growth and newborn weight. RESULTS: Based on OGTT, gestational diabetes mellitus (GDM) was diagnosed in 36 women (20%), impaired glucose tolerance (IGT) in 23 (13%), and normal glucose tolerance (NGT) in 121 (67%). Serum TG concentration was significantly higher in women with GDM (2.47 +/- 0.77 mmol/l) as compared with NGT (1.99 +/- 0.64 mmol/l) or IGT (1.98 +/- 0.81 mmol/l) (P < 0.01). ApoE3 allelic frequency was 86%, ApoE2 and ApoE4 were 5 and 9%, respectively. We found no clear-cut association between apoE genotype and serum TG concentration. Macrosomia and LGA newborns were more frequent in IGT than in GDM or NGT (P < 0.01). In the 83 women with positive diabetic screening but normal glucose tolerance who delivered at term, the incidence of LGA infants was significantly higher in those with TG levels higher than the 75th percentile (> 2.30 mmol/l) (21%) than in mothers who had normal TG levels (4.5%) (P < 0.05). Pre-pregnancy BMI (r(2) = 0.067), weight gain during pregnancy (r(2) = 0.062), fasting serum TG (r(2) = 0.09), and 2-h post-OGTT glucose levels (r(2) = 0.044) were all associated with neonatal body weight (all P < 0.05 or less). However, on a multiple regression analysis, only pre-pregnancy BMI (F-test = 7.26, P < 0.01), and fasting serum TG (F-test = 4.07, P < 0.01) were independently associated with birth weight. CONCLUSIONS: Pre-pregnancy BMI and fasting maternal serum TG determined in the last trimester of gestation were independently associated with neonatal birth weight in women with normal glucose tolerance, but positive screening test. TG levels measured in the third trimester of pregnancy are independent of the genetic polymorphism of ApoE.     

Comparison of exercise thallium-201 perfusion scintigraphy and coronarography in the prognostic stratification of patients with post-infarction residual ischemia]

The goals of this study were: 1) to determine and compare the prognostic utility of exercise 201Thallium scintigraphy with coronary angiography in patients with residual ischemia at the symptom limited bicycle exercise testing performed at hospital discharge after a first uncomplicated acute myocardial infarction 2) to verify the ability of perfusion scintigraphy to identify better than coronary angiography a subset of these patients at low risk for future events, despite the ischemic response at the exercise stress testing. Accordingly, follow-up data were obtained prospectively for 72 consecutive patients with adequate left ventricular rest systolic function, and with exercise induced greater than or equal to 1 mm ST-segment depression and/or typical angina pectoris. A planar 201Thallium scintigraphy and coronary angiography were performed within 2 months after acute myocardial infarction. By 31 +/- 29 months 38 patients had no events, while 34 experienced a cardiac event: 3 died of cardiac causes, 2 had nonfatal recurrent myocardial infarction, 29 were rehospitalized for severe class III or IV angina pectoris (4 were treated medically, 25 were revascularized: 20 had coronary bypass surgery, 5 coronary angioplasty). Each of the 3 angiographic classification of coronary artery disease (number of vessels with greater than or equal to 70% reduction of luminal diameter, jeopardy score and Gensini score) accurately identified patients with subsequent cardiac event by Mantel and Cox analysis (respectively p = 0.01, p = 0.0000, p = 0.002). Among 201Thallium variables, the number of segments demonstrating redistribution on delayed images (p = 0.0000), the number of segments with persistent defect (p = 0.0003) and increased 201Thallium uptake by the lungs (p = 0.0100) effectively stratified the probability of survival by the same analysis. Furthermore, the number of perfusion defects, either transient or persistent, with exercise 201Thallium scintigraphy provide additive prognostic information to any of the 3 angiographic coronary artery disease classifications considered. On the contrary, when 201Thallium stress findings are known, coronary angiography data in general are not additive in risk stratification. 17 patients with no reversible perfusion defect remained stable at follow up (52 +/- 28 months) despite development of typical angina pectoris (11/17) and/or ischemic ST segment depression (12/17) during exercise testing.(ABSTRACT TRUNCATED AT 400 WORDS)     

Assigning protein functions by comparative genome analysis: protein phylogenetic profiles

Determining protein functions from genomic sequences is a central goal of bioinformatics. We present a method based on the assumption that proteins that function together in a pathway or structural complex are likely to evolve in a correlated fashion. During evolution, all such functionally linked proteins tend to be either preserved or eliminated in a new species. We describe this property of correlated evolution by characterizing each protein by its phylogenetic profile, a string that encodes the presence or absence of a protein in every known genome. We show that proteins having matching or similar profiles strongly tend to be functionally linked. This method of phylogenetic profiling allows us to predict the function of uncharacterized proteins.     

Variation in the HTR1A and HTR2A genes and social adjustment in depressed patients

Background

Social adjustment is impaired in depressed patients. The difficulty to adjust to social circumstances has been hypothesized to be one of the causes of depression, as well as a consequence of the disorder. Genetic variation in the serotonin transporter gene has been previously associated with social adjustment levels in patients with mood disorders.

Methods

We investigated whether variations on the HTR1A (rs6295) and HTR2A (rs7997012) genes were associated with levels of social adjustment using the Social Adjustment Scale in two samples of depressed patients (total n=156).

Results

Patients carrying the GG genotype of the HTR2A-rs7997012 showed better social adjustment in areas of work and family unit bonding.

Limitations

These findings did not survive correction for multiple testing and should be interpreted with caution.

Conclusion

Our finding is in line with previous observations that have associated the G allele of the HTR2A-rs7997012 with higher rate of antidepressant response. The HTR2A-rs7997012 is worthy of further investigation in studies examining factors that are related to depression course and outcome.     

Oxidative stress-dependent MMP-13 activity underlies glucose neurotoxicity

Background

A complication of diabetes is neuropathy, a condition of sensory axon degeneration that originates in the epidermis. The mechanisms remain unknown but reactive oxygen species (ROS) have been implicated in this condition. In this study, we assessed the role of ROS and a candidate downstream target, MMP-13 in glucose-induced sensory axon degeneration in zebrafish and mice.

Role of kidney in the catabolic clearance of human platelet antiheparin proteins from rat circulation

Stimulated platelets release at least two antiheparin proteins: platelet factor 4 (PF4) and low affinity platelet factor 4 (LA-PF4) from which beta-thromboglobulin (beta TG) is derived. We have found previously marked elevation of LA-PF4/beta TG antigen in platelet poor plasma of patients with chronic renal failure, whereas levels of PF4 remained normal. Therefore, we examined the role of the kidneys in the metabolic clearance of LA-PF4/beta TG and PF4. The supernates of aggregates of thrombin-stimulated human platelets were injected into sham operated control rats, nephrectomized rats, and into rats with acute ureteral ligation. The disappearance of human LA-PF4/beta TG antigen and PF4 in rat plasma determined by specific radioimmunoassays followed biphasic exponential curves. The half-lives (t1/2) for the fast and slow components of LA-PF4 in control rats were 6.4 and 68.4 min. Nephrectomy significantly increased these times to 9.7 and 144 min, while ureteral ligation resulted in no significant change. Comparison of the level of LA-PF4/beta TG antigen and of creatinine in aorta and in renal vein showed 25%-30% extraction of these compounds by the kidney. Less than 0.1% of the total LA-PF4 antigen injected was recovered in the urine of control rats. In contrast to these results, the clearance of PF4 was not affected by nephrectomy. In conclusion: (1) functional renal tissue is necessary for normal clearance of LA- PF4/beta TG, but renal excretion does not play a major role in its elimination suggesting that the protein is catabolized by the kidney; and (2) catabolic clearance of PF4 does not depend on functioning kidney tissue.