Background The dietary habits of Americans are creating serious health concerns, including obesity, hypertension, diabetes, cardiovascular disease, and even some types of cancer. While considerable attention has been focused on calorie reduction and weight loss, approaches are needed that will not only help the population reduce calorie intake but also consume the type of healthy, well-balanced diet that would prevent this array of medical complications.Objective To design an Internet-based nutrition education program and to explore its effect on weight, blood pressure, and eating habits after 12 months of participation.Methods We designed the DASH for Health program to provide weekly articles about healthy nutrition via the Internet. Dietary advice was based on the DASH diet (Dietary Approaches to Stop Hypertension). The program was offered as a free benefit to the employees of EMC Corporation, and 2834 employees and spouses enrolled. Enrollees voluntarily entered information about themselves on the website (food intake), and we used these self-entered data to determine if the program had any effect. Analyses were based upon the change in weight, blood pressure, and food intake between the baseline period (before the DASH program began) and the 12th month. To be included in an outcome, a subject had to have provided both a baseline and 12th-month entry.Results After 12 months, 735 of 2834 original enrollees (26%) were still actively using the program. For subjects who were overweight/obese (body mass index > 25; n = 151), weight change at 12 months was -4.2 lbs (95% CI: -2.2, -6.2; P < .001). For subjects with hypertension or prehypertension at baseline (n = 62), systolic blood pressure fell 6.8 mmHg at 12 months (CI: -2.6, -11.0; P < .001; n = 62). Diastolic pressure fell 2.1 mmHg (P = .16). Based upon self-entered food surveys, enrollees (n = 181) at 12 months were eating significantly more fruits, more vegetables, and fewer grain products. They also reduced consumption of carbonated beverages. Enrollees who had visited the website more often tended to have greater blood pressure and weight loss effect, suggesting that use of the DASH for Health program was at least partially responsible for the benefits we observed.Conclusions We have found that continued use of a nutrition education program delivered totally via the Internet, with no person-to-person contact with health professionals, is associated with significant weight loss, blood pressure lowering, and dietary improvements after 12 months. Effective programs like DASH for Health, delivered via the Internet, can provide benefit to large numbers of subjects at low cost and may help address the nutritional public health crisis.
Objective-With the upsurge in online dietary modification programmes, online dietary assessment tools are needed to capture food intake. Although the DASH (Dietary Approaches to Stop Hypertension) diet is recommended by the US Department of Agriculture, there are no online instruments that capture DASH food servings. Our objective was to assess the validity of a new, short, online dietary questionnaire developed to capture intake of DASH food servings. The DASH Online Questionnaire (OLQ) was validated against the well-known Block Food Frequency Questionnaire (FFQ).Design-This was a cross-sectional validation of the DASH OLQ, which contained eleven food groups (breakfast cereals; dairy; drinks; fats and oils; fruits; grains and snacks; meat, fish and poultry; mixed dishes; sweets; vegetables; and nuts, seeds and legumes). Each subject completed a DASH OLQ once weekly for four weeks and one 98. NIH Public Access Author ManuscriptPublic Health Nutr. Author manuscript; available in PMC 2010 May 1. Results-There were significant positive correlations between the Block FFQ and the DASH OLQ for all food groups ranging from r=0·8 for the nuts/seeds/legumes category to r = 0·3 for vegetables and mixed dishes. A comparison of nutrient intakes found strong positive correlations in all nutrient categories. Of particular interest in the DASH diet and the web-based nutrition and physical activity programme were total fat (r=0·62), total carbohydrate (r=0·67), total K (r=0·68), total Ca (r =0·69), total vitamin C (r=0·60) and total energy intake (r=0·68). There is an ongoing need to improve eating habits and offer preventive approaches for weight management in the USA(1-3). The Internet offers great possibilities in this regard because information can be sent to a very large audience at a relatively low cost. Our nutrition research group, made up of physicians, dietitians and nutritionists from Boston University Medical Center, Duke University Medical Center and the USDA Human Nutrition Center on Aging at Tufts University, has developed an online lifestyle modification programme based on the DASH (Dietary Approaches to Stop Hypertension) diet. The DASH Online Questionnaire (OLQ) was created to capture food intake and provide realtime feedback in the form of progress reports to participants enrolled in the DASHforHealth.com programme. The aim of the DASHforHealth.com programme is to provide easily accessible nutrition education for those seeking to improve their health and/or combat weight issues via the Internet. Data collected using the DASH OLQ showed that participants significantly increased their daily fruit and vegetable consumption after one year in the DASHfor-Health.com online programme(4). The DASHforHealth.com programme is currently being offered to several US corporations as an employee wellness programme, as well as to the general public for individual subscription. We chose the DASH diet as the focus of our web-based educational programme because of its proven benefits in the areas of blood pressure reduc...
This paper describes FitKids360, a stage 2 pediatric weight management program. FitKids360 is a physician-referred, multicomponent, low-cost healthy lifestyle program for overweight and obese youth 5–16 years of age and their families. FitKids360 provides an evidence-based approach to the treatment of pediatric overweight by targeting patients' physical activity, screen time, and dietary behaviors using a family-centered approach. The intervention begins with a two-hour orientation and assessment period followed by six weekly sessions. Assessments include lifestyle behaviors, anthropometry, and the Family Nutrition and Physical Activity (FNPA) survey, which screens for obesogenic risk factors in the home environment. Outcomes are presented from 258 patients who completed one of 33 FitKids360 classes. After completing FitKids360, patients increased moderate to vigorous physical activity by 14 minutes (P = 0.019), reduced screen time by 44 minutes (P < 0.001), and improved key dietary behaviors. Overall, FNPA scores increased by 9% (P < 0.001) and 69% of patients with “high risk” FNPA scores at baseline dropped below the “high risk” range by followup. Patients also lowered BMIs (P = 0.011) and age- and sex-adjusted BMI z-scores (P < 0.001) after completing the 7-week program. We hope this report will be useful to medical and public health professionals seeking to develop stage 2 pediatric obesity programs.
A 4-year-old Border collie was presented with one episode of collapse, altered mentation, and a suspected pharyngeal stick injury. Magnetic resonance imaging (MRI) and computed tomography showed a linear foreign body penetrating the right oropharynx, through the foramen ovale and the brain parenchyma. The foreign body was surgically removed and medical treatment initiated. Complete resolution of clinical signs was noted at recheck 8 weeks later. Repeat MRI showed chronic secondary changes in the brain parenchyma. To the authors' knowledge, this is the first report of the advanced imaging findings and successful treatment of a penetrating oropharyngeal intracranial foreign body in a dog.
Direction of travel may influence gait characteristics and thereby both determination of local reference intervals and discriminatory ability between normal and abnormal limbs. Consistent walkway room setup and use of multiple passes in both directions appear sensible in order to minimise error between measurements at different times, and to compensate for the effect of direction of travel on outcome measures. Effect of osteoarthritis OBJECTIVESTo evaluate the effect of the degree of osteoarthritis on the measurement of patella tendon angle (PTA) and determine intra-and inter-observer variability. METHODSRetrospective observational clinical study using preoperative medio-lateral surgical planning radiographs for tibial tuberosity advancement (TTA). Degree of osteoarthritis scored by two individuals. Measurement of PTA performed by three different individuals on 87 stifle radiographs by the standard conventional tibial plateau method. Measurement of PTA performed on three occasions, with at least seven days between measurements. RESULTSThe osteoarthritis score agreement was 48%. Weighted Kappa analysis revealed a fair strength of agreement between observers. The intra-observer average bias between PTA measurements 1 and 3 ranged from −0.38 to −0.94°. Inter-observer bias in angle measurement ranged from −0.92 to −2.00°. Observer 1 had the narrowest range of PTA differences (12.1°), and observer 3 the highest (23.5°). Observer 2 had the lowest mean bias (−0.38°). The mean bias was lowest between observers 1 & 2 (−0.92°) and highest between 1 & 3 (−2.0°). The mean intra-observer standard deviation of the PTA measurement differences was 2.90° and inter-observer was 2.26°. Kruskal-Wallis testing revealed no evidence of a difference in PTA with regards to degree of osteoarthritis present. There was no evidence of a change in variability of the PTA with higher or lower osteoarthritis scores. STATEMENT (CONCLUSIONS)Overall degree of osteoarthritis did not appear to affect the variability of the patellar tendon angle measured. Variability in PTA measured between observers may affect the clinical outcome of surgery.Medio-lateral humeral intracondylar fissure screw placement -4.5 mm titanium screws Guy BeynonFitzpatrick Referrals, Godalming, United Kingdom OBJECTIVESEvaluating the influence of categorical patient variables on the time elapsed from the surgical date and date of the final recheck following treatment of humeral intracondylar fissure in dogs with medio-lateral placement of 4.5 mm titanium screws. METHODSRetrospective data analysis was applied to 100 dogs treated for humeral intracondylar fissure. The breed, sex, age, weight, date of surgery and date of final recheck were reviewed. RESULTSThirty eight of the study group diagnosed with a humeral intracondylar fissure were treated with a 4.5 mm titanium screw placed in a medio-lateral direction. The mean duration of time between the surgical date and final recheck was 69 days. Six of the cases required revision surgery due to inadequate screw placement. Five case...
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