Study of perception and behaviour in patients with coronary heart disease about risk factors and life style modification in tertiary care hospital, Bhavnagar

Background: Non-communicable diseases are now the major cause of death in India, with cardiovascular diseases being the dominant cause. Very few studies had been done regarding patients perception of risk factors, behaviour change and counselling. So this study is based on patient perspective and role of health education for patients. The objective of the study was to identify the risk factors of CHD, to assess behaviour changes whether lifestyle and habits modified by patients of CHD, to assess perception, to assess effectiveness of counselling.Methods: A cross-sectional study was conducted in 174 patients attending follow up Out Patient Department in Tertiary Care Hospital, Bhavnagar using questionnaire which includes personal data, BMI, history of risk factors, behaviour change and medical counselling. Data was analyzed by epi info and appropriate statistical tests were applied.Results: Total 73 patients were addicted to tobacco; smoking or alcohol. Mean duration of addiction was 22.43 years. Counselling was given by doctors at the time of illness to 94% patients. Counselling regarding disease, risk factors, lifestyle modification has got positive effect in 96% patients and only 4% patients were in need of further future counselling.Conclusions: More and more emphasis should be given to preventive aspect and population should be given counselling before actual illness.

Medical Management of Chronic Pancreatitis: What Can Physicians Do? / 대한췌담도학회지

Chronic pancreatitis is characterized by the progressive inflammation and irreversible fibrosis of pancreas causing pancreatic dysfunctions and various complications. The most common symptom is abdominal pain. In addition various complications such as pseudocyst, biliary or duodenal obstruction, pancreatic ascites, splenic vein thrombosis and pseudoaneurysm can develop according to the degree of inflammation or the progression of disease. So, management of chronic pancreatitis needs multidisciplinary approach in many cases. The treatment method can be divided into life style modifications, medications, endoscopic or radiological interventions and surgeries. In most cases, the specific treatments are recommended not only by the evidence-based guidelines but also by the experts' opinions due to the lack of randomized controlled trials with sufficient number of patients. Life style modifications and medication for the pain and the pancreatic exocrine insufficiency will be addressed in this section.

Study on Risk factors, presentation and management of stroke in a tertiary care hospital

Background and Objectives: Many studies in recent years have focused attention on identification of risk factors associated with stroke. However, most of these studies have been conducted in the developed countries. Only few studies have been conducted in Nepal. So the present study has been undertaken with the aim of determining the risk factors and management pattern of stroke and makes the people aware of those factors. Material and Methods: It is a descriptive prospective study conducted with 50 consecutive patients who presented in medicine and emergency department at Universal College of Medical Science, Bhairahawa, Nepal from December 2009 to July 2010. Data were collected using a standard questionnaire and encounter form after receiving a verbal consent from the patient. The collected data were coded, tabulated and analyzed using SPSS version- 16. Results: The present study showed that 56% of stroke patients were male. Hemorrhagic stroke (60%) was more than the ischemic stroke (40%).The age was common non modifiable risk factor. The common–modifiable risk factors were hypertension (86%), alcohol consumption (74%) and smoking (56%). Calcium channel blocker (44.18%) and combination of it with Diuretic (18.60%) and ACE inhibitors (20.93%) were the commonly prescribed drugs for lowering blood pressure. Prescribed drugs therapy and lifestyle modification improved the health condition of patients (80%). The non compliance to the drugs was due to multiple dosages (51.52%), side effects (18.18%) and forgetfulness (18.18%). Conclusion: Finding of this study will be helpful for the practitioners as well as researcher in the future. Practitioners can make people aware on the risk factors and preventive measures of the stroke. Researchers will be helped by knowing the commonest risk factors of stroke and its management pattern.

Small Dense LDL: Risk Factor for Coronary Artery Disease (CAD) and its Therapeutic Modulation.

Pathogenesis of coronary artery disease (CAD) is multi-factorial and many risk factors are associated with development of CAD. LDL-C has been an important target for therapeutic interventions and has been extensively studied. But, various studies have indicated that estimation of LDL-C is not enough to assess the risk. Moreover, LDL particles vary in their content, density and size which have different physico-chemical properties. In this paper, the role of small dense (sd) LDL in risk assessment for CAD and its response to different therapeutic modalities available have been reviewed.

The Effect of Metabolic Syndrome Management Program in a Public Health Center / 農村醫學 地域保健

OBJECTIVES: The aims of this study were to evaluate the effect of a metabolic syndrome management program on participants enrolled in a public health center program in, Seoul, Korea for 6 months and to analyze the changes in their life habits and risk factors for treating their metabolic syndrome. METHODS: Participants enrolled in a metabolic syndrome program at a public health center and answered questionnaires. Their waist circumference and, blood pressure were measured and their blood was tested. Based on the results, the participants were classified into 3 groups. Then, the center provided a metabolic syndrome management intervention program for the individual groups and analyzed the changes in participants' life habits and risk factors after 6 months. RESULTS: After the intervention, the active group, showed improved physical activity, increased eating habits by 0.7 points, and decreased drinking and smoking; however, these results were not statistically significant. As for the Participants' overall health status, all groups positively changed a statistically significant result. In regard to the change in risk factors for metabolic syndrome in the active group, systolic and diastolic blood pressure and triglyceride levels were, statistically significantly decreased, meanwhile, an increase was found in HDL cholesterol level, waist measurement, and anteprandial glucose level; but the result were not statistically significant. Their review rate was 19.0%; 29.4% in the active group, 19.0% in motivating group A, and 14.5% in motivating group B. CONCLUSIONS: Participants showed changes in some life habits and risk factors, a result still far from the program's goal to improve residents' health status (improved living habits and variations in risk factors); thus, it is necessary to supplement this program for better performance.

The effect of a life style modification campaign for Bangkok provincial electricity officers.

Background: Office workers with sedentary life styles might be at risk to become obese and later develop cardiovascular risk factors. A life style modification campaign (LSMC) had been introduced to 4,300 provincial electricity officers (PEO) during July 2007-June 2008. The campaign was designed with the aim to encourage behavioral change within a large organization. Objective: To evaluate the effectiveness of the LSMC on improving health status among PEOs who attended the program regularly, occasionally, and rarely. Methods: A quasi experimental study was performed to compare pre- and post- health status records (HSR) including: body mass index (BMI), systolic blood pressure (SBP), waist-hip circumference ratio (WHC), skin fold measurement (SFM), hand grip strength (HG), body flexibility (BF) and cardio-respiratory fitness (CRF) of the PEOs who attended the LSMC. Results: After 1 year of LSMC, there were 173 PEOs who completed the program. Within the regularly attending group, we found statistically significant improvement in BMI, SBP, WHC, SFM, and CRF with p-values of 0.02, 0.03, <0.001, <0.001 and 0.048 respectively. Meanwhile the group that occasionally and rarely attended the program did not do as well. Conclusion: The LSMP has demonstrated its effectiveness in reducing modifiable risk factors within the well compliant group. The benefit toward work performance or the cost effectiveness of the campaign was not included in this study.

A trial on the Effects of Life Style Interventions in High-Normal Blood Pressure.

Background: This experimental (Intervention) study was conducted with objective of evaluating the outcome of non-pharmacological approach (lifestyle intervention) through reducing the modifiable risk factors on high normal blood pressure or pre-hypertension (systolic blood pressure130- 139mm of Hg and diastolic blood pressure 85-89 mm of Hg).The study was provided risk reduction management intervention was given on subjects of high normal blood pressure through adequate physical activity, tobacco cessation, dietary advice for unhealthy to healthy diet, reduction of salt intake, reduction of over weight & stress management etc. Materials and methods: The study was conducted among 434 respondents aged 30 -50 years during the period from June 2008 to May 2009 with intervention for 6 months.Random sampling, those cases were fulfilled the inclusion and exclusion. High-normal BP were found out through BP measurement & clinical examination then sample population were selected by randomization: odds numbers in study group (intervention group) and even numbers in control group (comparision group). After obtaing informed consent data were collected by interview, clinical examination, anthropometric measurement and investigations. It was three phases, first phase were case identification & intervention for study group, second phase was follow up and third phase was outcome measurement for both groups. Cases were hold a record card with contact number. Results: After six month mean difference of blood pressure, lipid profile, weight were changed both the groups but changed was significant in the study group. Mean systolic blood pressure reduced 4.1±6.0 in the study group and 1.2±6.4 in the control group,(p< 0.001). Mean diastolic pressure reduced 3.5±4.9 in study group and 1.2±6.4 in control group (p<0.001). Mean total cholesterol, LDL cholesterol and triglycerides decreased in the study group 19.7±18.6, 10.6±14.6 and 15.4 ±21 respectivley and in control group mean of all these parameters decreased to 11.5±16.5, 5.1±12.9 and 6.7±23.2 respectively. Mean HDL cholesterol for men and women in the study group was raised to 5.6±5.9 and 4.5± 6.4 respectively (p<0.001). Mean weight reduced 1.94±1.59 in study group and 0.06±1.44 in the control group (p<0.001). Conclusion: The final outcome of the study was that mean high normal blood pressure was found to reduced due to intervention of non- pharmacological management. So, If we encourages subjects after 40 years for routine health check up in hospital setting & service for risk factor detection & management (preventive cardiology), we will reduce the risk factors of high normal blood pressure (pre-hypertension) & cardiovascular diseases to some extent. Encourages population to stay with normal blood pressure & healthy life style.

Is It Reasonable to Treat a Metabolic Syndrome as a Single Disease Entity?

An early aggressive approach to screen and to manage the metabolic syndrome is of urgent need in Korea because of the recent nation-wide epidemic of the macrovascular disease and type 2 diabetes mellitus. Although the clinical definitions of the metabolic syndrome proposed by many organizations are still unclear in terms of the pathogenesis of the disease, those definitions are clearly valuable to identify those at high risk for diabetes mellitus and/or a cardiovascular event by clustering a number of easily measurable clinical findings. This article briefly reviews the debates on the definition and pathogenesis of the metabolic syndrome and highlights recent studies that demonstrate the effectiveness of therapeutic lifestyle changes and various drug trials in improving or preventing the components of the metabolic syndrome. The initial intervention should begin as early as possible with a healthy nutrition, daily physical activity, and appropriate annual screening. The initial step of intervention should be focused on the appropriate weight reduction goal with intensified lifelong lifestyle modifications, while it is not always enough and pharmacologic therapies are required in most patients. Weight reduction medications that can improve insulin sensitivity including biguanide and thiazolidinedion might be appropriate for the correction of the underlying pathogenesis of the disease.

The Effects of Short Term Comprehensive Life Style Modification Program on Glycemic Metabolism, Lipid Metabolism and Body Composition in Type 2 Diabetes Mellitus / 간호학회지

PURPOSE: This study was to evaluate the effects of a short term comprehensive life style modification program on glycemic metabolism, lipid metabolism and body composition in type 2 diabetes mellitus patients. METHOD: A nonequivalent control group with a pre post test was designed. Data collection was done from October 2003 to June, 2004 at a hospital. Glycemic metabolism was measured by a.c., p.c. and HbA1c, and lipid metabolism was measured by cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Body Composition was measured by body weight, body mass index, waist, measurement waist per hip ratio, body fat, muscle weight and abdominal fat tissue(intra abdominal distance). The Experimental group, which was composed of 29 participants, was educated based on a life style modification protocol at a weekly meeting for 12 weeks and carried out exercise, diet along individual parameters and self monitoring, while 24 participants in the control group received only diet education. RESULT: 1.The experimental group showed a significant lower a.c.(t=2.11, p=.04) and HbA1 c(t=2.65, p=.01) compared to those of the control group. 2. The experimental group showed a significant lower LDL than the results of the control group(t=2.42, p=.02). 3. The experimental group showed a significant lower weight(t=3.09, p=.00), BMI(t=3.01, p=.00), body fat(t=2.94, p=.01) and abdominal fat tissue(t=3.05, p=.01) than those of the control group. CONCLUSION: The results provided evidence for the effectiveness of a short term comprehensive life style modification program composed of exercise, diet, support, self efficacy elevation and self monitoring in type 2 diabetes mellitus.

The Relationship between Treatment Intention and Compliance in Newly Detected Hypertensive Patients / 예방의학회지

OBJECTIVES: To analyse the psychosocial factors associated with hypertension management(drug treatment and life style modification) of newly detected cases and to understand and assess their behavioral intention or behaviors. METHODS: The survey area was a combined urban and rural area in Chungnam province, Korea, and the sampling method was cluster sampling. Study subjects included 541 newly detected cases of hypertension rated above stage 2 by JNC-VI from a community survey. The first survey was applied to 383 of these patients in order to discern their psychosocial characteristics. A follow-up survey was given to 345 persons with an 11-month interval following monthly telephone counseling concerning medication and life style modification by trained nurses. The final study subjects for analysis comprised 271 persons after excluding cases of incomplete data and change of address. RESULTS: Among the 85(33.2%) new patients who had intended to undergo drug treatment, 30(35.3%) persons were treated with antihypertensive agent after 11- month interval, while among the patients with no intention to receive treatment, only 36(21.1%) persons were treated. Hypertensive patients with a high intention score revealed a high score in life style modification compliance as well. Seventy three percent of the variance of behavioral intention to undergo hypertension management was explained by the patients attitude toward performing the behavior and subjective norm associated with behaviors related to the theory of reasoned action in structural modeling. Actual behaviors related positively with behavioral intention. The coefficient of determination was 0.255. CONCLUSION: Improving the compliance level of hypertensive patients in respect to drug treatment or life style modification requires a build up of positive behavioral intention, and caregivers must pay more attention to eventually converting behavioral intention to actual behaviors.

Factors related to awareness of hypertension

BACKGROUND: Hypertension is a common disease and one of the most important risk of cardiovascular disease. Majority of patients with hypertension are unaware of their conditions until complications develop. Awareness of hypertension is important in treating and controlling of hypertension. Therefore, we conducted a study on the factors related to awareness of hypertension. METHODS: Awareness of hypertension was evaluated by measuring blood pressure(BP) in 3,344 subjects visiting a health promotion center in Pusan National University Hospital from June 1996 to May 1997. All subjects completed a questionnaire including socio-demographjc factors and family history. Hypertension was defined as systolic BP above 140mmHg and/or diastolic BP above 90mmHg. 135 subjects were diagnosed as hypertension. RESULTS: Among 315hypertensives, only 135 subjects(42.9%) were aware of their conditions. With respect to sex, women had a better awareness of hypertension than men(51.6% vs 36.9%, P<0.05). The awareness was greater for the subjects aged over 60years than for the subjects aged 30-49 years(53.3% vs36.5%), and it was statistically significant(P<0.05). The subjects with stage III hypertension had a better awareness of hypertension than the subjects with stage I(65.5% vs 32.6%, P<0.05) In the occupation-types, the awareness was highest in the group without occupations. But except the group without occupations(56.2%), the awareness was highest in the group of domestic affairs(housewives, 53.2%). Education level and monthly mean income were not related to awareness of hypertension. With respect to marital state, the rate of awareness is highest in the group of widows or widowers(55.8%, P<0.05). The subjects with family history of hypertension had a better awareness of hypertension than the subjects without(59.6% vs 35.7%, P<0.05). The rate of alcohol drinking(47.4% vs 66.7%), smoking(21.5% vs 31.6%) and high salt intake(17.0% vs 25.0%) were lower and the performance rate of regular exercise(24.4% vs 13.3%) was higher in those who were aware of their hypertensions than those who were not. CONCLUSIONS: The awareness of hypertension was also associated with sex, age, marital sate, occupation, stage of hypertension, family history of hypertension, and was related to performance of lifestyle modification (alcohol drinking, smoking, salt intake, exercise).