With the increasing prevalence of obesity in the United Kingdom, the search for an effective weight reducing diet is a priority in helping to reverse this trend. A 12-week dietary intervention study was carried out to test the effectiveness of an energy-restricted, low-fat, sugar-containing diet on weight loss in sedentary overweight men. The study also aimed to assess eating behaviour, to measure change in attitude towards sugar-containing foods and to measure the impact of the study on perceived quality of life. Subjects were recruited from three UK cities; Edinburgh, Birmingham and London. Seventy-six men, aged between 25 and 60 years, completed the study. Baseline diets were assessed by a 7-day diet diary. Compliance to the subsequent dietary advice was measured on four occasions post intervention, by 4-day diaries. Measures of body weight status were also monitored. Eating behaviour, attitudes towards sugar-containing foods and quality of life were assessed by questionnaire. Significant reductions in body weight (5.2%), body fat (11.2%) and waist:hip ratio (3%) were observed following reported dietary changes that included a reduction in reported energy intake of 3.2 MJ/day (770 kcal/day), a reduction in the percent energy from fat (from 38.1% to 26.2%), an increase in the percent energy from total carbohydrate (from 44.4% to 54%) and from protein (from 17.3% to 20.6%). Subjects scored relatively highly for dietary restraint and emotional eating, and were strongly influenced by external eating cues. On completion of the 12-week study, subjects had a more positive attitude towards sugar-containing foods and perceived an improved quality of life. It is concluded, therefore, that including sugar-containing foods in a weight-reducing diet may be an effective strategy to achieve a palatable, low-fat, high-carbohydrate diet, which promotes weight loss in overweight individuals.
Objective This study investigated the relationship between continuity of care (having one's own doctor and a regular site of care), and receipt of preventive services in a population of adult feefor-service Medicaid enrollees with physical disabilities. Methods A random sample of 555 physically disabled Rhode Island Medicaid enrollees aged 18-64 were surveyed by telephone. Respondents were asked about receipt of six preventive services in the previous year. They were also asked whether they had their own doctor and whether they had a regular site of care. Regression analyses with propensity score corrections for selection bias were used to test the associations between care continuity measures and the number of preventive services received, as well as the receipt of each individual service. Results After adjustment for predisposing, enabling and need factors, respondents with their own doctor received 0.73 more preventive services than peers without their own doctor, and respondents who had a usual site of care received 0.85 more services than peers who received care at the ED or who had no regular site. The influences of having a regular doctor and a usual site of care varied according to type of preventive service, and these influences appear to be largely complementary rather than overlapping. Conclusions Study findings suggest that care models for adults with physical disabilities should include mechanisms to ensure both physician and site continuity. A strong primary care component that links individual patients with a personal doctor, as well as care protocols that ensure receipt of preventive services appears to be optimal for medically needy populations.
Book reviews and the clinician then comes to the key chapters on fatigue, muscle damage and pain, with a final review of the changes occurring in muscle diseases.This text is based on undergraduate and postgraduate courses and will be of interest to scientists and physiologists as well as clinicians.I have found this book both fascinating and useful, but part of the fascination is that some of our practical sports medicine problems, such as severe post-exertional muscle pain, are not yet fully explicable. This book encourages both dipping and further study in pursuit of clinical answers and is highly recommended. Sons, 1993, £19.95. ISBN 0 471 94079 8 Fred Brouns has written an excellent scientific overview of the relationship between nutrition and sporting performance. Beginning with a general introduction to the subject, Brouns gently leads the reader through the nutritional aspects, in relation to sport, of macronutrients (carbohydrate, fat, protein), micronutrients (minerals, trace elements, vitamins), fluids and electrolytes, and nutritional ergogenic aids. The book concludes with a summary chapter and a brief outline of metabolism for those who are a little rusty on their metabolic pathways.The manuscript is based on a large number of recent scientific reviews and publications (numbering 216 and including references up to 1992) which have appeared in peer reviewed scientific journals. As Brouns states in his preface "This means that these publications have generally survived the criticisms of reviewers and that the interpretations are in line with existing scientific consensus". Comments and statements about such controversial topics as vitamin supplementation, the use of bee pollen, Lcarnitine or branch chain amino acids as ergogenic aids, or the composition of oral rehydration beverages for sport are all therefore backed up by worthy references. This is one of the book's great strengths.Another strength is the "readability" of the book. So many scientific texts can be dry and hard work but Brouns has managed to keep the text light yet informative, even bringing humour to the book with well selected photographs, though the quality of the black and white photography is not of a very high standard.The wide audience of athletes looking for a book that will tell them what to eat and drink, and when, may be frustrated by the lack of such information here. This is, however, an excellent book for those who want to know the theory behind the practice of sports nutrition. It will therefore have greatest appeal to coaches, sports scientists and those involved in sports medicine.
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