자연주의적 탐구조사(Naturalistic Inquiry)

Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

https://www.who.int/respiratory/copd/GOLD_WR_06.pdf

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)62167-9.pdf

Frailty in elderly people

The adolescent brain and age-related behavioral manifestations

Statistical methods in cancer research

Background: A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay, Quebec. To address this problem, a diet and activity intervention during pregnancy, which was based on social learning theory, was initiated in 4 Cree communities. Methods: A prospective intervention compared dietary, weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy. A control period in 4 communities (July 1995–March 1996) was followed by an intervention period (April 1996–January 1997) when subjects were offered regular, individual diet counselling, physical activity sessions and other activities related to nutrition. Results: The intervention and control groups did not differ at baseline regarding their mean age (24.3 years [SD 6.29] v. 23.8 years [SD 5.86]), mean prepregnancy weight (81.0 kg [SD 19.46] v. 78.9 kg [SD 17.54]) and mean gestational age at recruitment (17.1 weeks [SD 7.06] v. 18.5 weeks [SD 6.92]). The intervention did not result in differences in diet measured at 24–30 weeks9 gestation, rate of weight gain over the second half of pregnancy (0.53 kg per week [SD 0.32] v. 0.53 kg per week [SD 0.27]) or plasma glucose level (50 g oral glucose screen) between 24 and 30 weeks (7.21 mmol/L [SD 2.09] v. 7.43 mmol/L [SD 2.10]). Mean birth weights were similar (3741 g [SD 523] v. 3686 g [SD 686]), as was maternal weight at 6 weeks post partum (88.1 kg [SD 16.8] v. 86.4 kg [SD 19.0]). The only changes in dietary intake were a reduction in caffeine (pregnancy) and an increase in folate (post partum). Interpretation: This intervention had only a minor impact on diet; finding ways of encouraging appropriate body weight and activity levels remains a challenge.

/pdf/intervening-to-reduce-weight-gain-in-pregnancy-and-i6y65mps2h.pdf

Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation.

Objective To evaluate the impact of nutritional supplementation on nutritional status, muscle strength, perceived health, and functional status in a population of community-living, frail, undernourished elderly people. Design A 16-week intervention study in which subjects were randomized to an experimental or a control group and visited in their home on a monthly basis. Outcome variables were measured at the start and end of the study at subjects' homes by a dietitian blinded to treatment assignment. Subjects/setting 83 elderly people (experimental group: n=42; control group: n=41; mean age=80±7 years) receiving community home-care services and at high risk for undernutrition. Intervention Provision of a nutrient-dense protein-energy liquid supplement and encouragement to improve intake from other foods. Outcome measures Anthropometric indexes, handgrip strength, isometric elbow flexion and leg extension strength, lower extremity function, perceived health, and functional status. Statistical analyses Study groups were compared on an "intention to treat" basis using analysis of variance for repeated measures and unpaired and paired t tests and their nonparametric equivalents where appropriate. Results Total energy intake (1,772vs 1,440kcal; P P P P =.04). Applications/conclusions Nutrition intervention is feasible in free-living, frail, undernourished elderly people and results in significant improvement of nutritional status with respect to energy and nutrient intake and weight gain. Weight loss can be stopped and in some cases reversed; however, increased physical activity may also be required to improve health and functional status. J Am Diet Assoc. 2002;102:1088-1095.

Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial.

Understanding differences in dietary patterns by smoking status is important for nutritionists and health educators involved in helping individuals to make healthy dietary and lifestyle choices. Although smokers have a poor quality diet compared with nonsmokers, no study has examined nutritional adequacy and variability in the nutrient intake of smokers. The aim of this study was to compare dietary habits of smokers with nonsmokers in terms of nutrient intake, food groups contributing to nutrient intake, nutritional adequacy and day-to-day variation in nutrient intake. Noninstitutionalized adults aged 18--65 y (n = 1543) who participated in the Food Habits of Canadians Survey (1997--1998) were studied. Subjects, selected from across Canada using a multistage, random-sampling strategy, completed an in-home 24-h dietary recall. Repeat interviews were conducted in a subsample to estimate variability in nutrient intake. Smokers had higher intakes of total and saturated fat, and lower intakes of folate, vitamin C and fiber than nonsmokers. There were no significant differences in calcium, zinc and vitamin A intakes or day-to-day variation in nutrient intake by smoking status. Smokers consumed significantly fewer fruits and vegetables than nonsmokers, leading to lower intakes of folate and vitamin C. In conclusion, smokers have a less healthy diet than nonsmokers, placing them at higher risk for chronic disease as a result of both dietary and smoking habits. Diet may act as a confounder in smoking-disease relationships.

/pdf/fruit-and-vegetable-consumption-is-lower-and-saturated-fat-3g8am2jrif.pdf

Fruit and Vegetable Consumption Is Lower and Saturated Fat Intake Is Higher among Canadians Reporting Smoking

Nutrition Risk Factors for Institutionalization in a Free-Living Functionally Dependent Elderly Population

Objectives Dysphagia affects 35% to 60% of the institutionalized elderly population. This study aimed at evaluating the nutrient intake of frail institutionalized elderly persons with dysphagia and to assess the impact of Sainte-Anne's Hospital Advanced Nutritional Care program on dietary intake and weight. Design A 12-week intervention study. Subjects/setting Ninety-three individuals residing in a Montreal, Canada, long-term care facility who were aged at least 65 years were evaluated. Seventeen subjects with a body mass index (BMI; calculated as kg/m 2 ) 7.5% within 3 months and with dysphagia were included. Intervention The treated group (n=8; aged 82.5±4.41 years, weight 55.9±12.1 kg, BMI 22.4±3.93) received Sainte-Anne's Hospital reshaped minced- or pureed-texture foods with thickened beverages where required. The control group (n=9; aged 84.6±3.81 years, weight 54.3±7.49 kg, BMI 21.2±2.31) maintained traditional nourishment. Main Outcome Measures Macronutrient and micronutrient intake, weight, and BMI were measured at baseline, 6 weeks, and 12 weeks. Statistics Student t tests were performed to evaluate change within and between groups. Results The treatment and control groups were similar at baseline, having a mean age of 82.5±4.41 years vs 84.6±3.81 years and BMI of 22.4±3.93 vs 21.2±2.31, respectively. The average weight in the treated group increased compared to the control group (3.90±2.30 vs –0.79±4.18 kg; P =0.02). Similarly, the treated group presented an increased intake of energy, proteins, fats, total saturated fats, monounsaturated fats, potassium, magnesium, calcium, phosphorus, zinc, vitamin B-2, and vitamin D compared to control subjects ( P Conclusion Institutionalized elderly patients with dysphagia can eat better and increase body weight via a diversified, modified in texture, and appealing oral diet that meets their nutrition needs.

http://prophagia.com/pdf/ADAJ-Oct06-A%20Novel%20Dysphagia%20Diet.pdf

Katherine Gray-Donald

Papers

Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation.

Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial.

Fruit and Vegetable Consumption Is Lower and Saturated Fat Intake Is Higher among Canadians Reporting Smoking

Nutrition Risk Factors for Institutionalization in a Free-Living Functionally Dependent Elderly Population

A novel dysphagia diet improves the nutrient intake of institutionalized elders.