Management of hypercholesterolemia.

As a major risk factor for coronary heart disease, hypercholesterolemia is responsible for a significant number of illnesses and deaths, and contributes considerably to health care costs. Lowering cholesterol levels reduces the risk of coronary heart disease and may halt or reverse atherosclerosis. Lifestyle modifications include dietary measures and aerobic exercise. Pharmacologic therapy can further decrease cholesterol levels. Family physicians need to recognize patients at risk for hypercholesterolemia (and thus coronary heart disease), institute appropriate therapy and counsel family members about disease prevention.

Primary hypertension: the role of individualized therapy.

Approximately 50 million persons in the United States either have elevated blood pressure or take antihypertensive medication. Many other persons have risk factors predisposing them to hypertension. Current therapy for hypertension consists of lifestyle modification and pharmacologic regimens. Sodium restriction, weight loss, aerobic exercise and alcohol moderation form the foundation of hypertension management. Pharmacologic therapy is individualized within established guidelines. Several classes of drugs are effective in lowering blood pressure. The patient's personal characteristics, the presence of concomitant disease, and the physiologic side effects and cost of medications are factors to consider in the process of selecting a drug regimen. Successful management of hypertension is personally rewarding and decreases mortality, morbidity and the cost of medical care.

Clinical preventive medicine in business and industry: the economic impact.

Profits and earnings are the most important objectives for companies. Clinical preventive medicine programs reduce an employee's risk factors for illness, reduce absenteeism, and increase productivity. These programs can produce significant physiologic benefits for the employee, regardless of involvement level by the company. Cost-benefit analysis reveals benefit from smoking cessation, fitness, and some educational programs. The employer benefits from a happier and healthier work force which impacts on the public image.

Clinical preventive medicine in business and industry: a rational foundation.

The individual educational and intervention emphasis of clinical preventive medicine programs is successful in reducing an employee's risk for disease and injury. Although some studies note that decreased risk is found predominantly in those with low initial risk, a critical mass of healthful lifestyles may spread to non-participants in the organization, the halo effect. Thus, the more employees there are modeling a health lifestyle, the greater likelihood others will follow. Preventive medicine programs offer intangible advantages to the employer. Such programs demonstrate an attitude of caring for the employee which has an influence on the public. Happier employees tend to increase their level of socialization within a company. The ultimate effect is decreased employee risk, improved productivity, reduced absenteeism, and improved health at reduced cost.

The area support medical battalion: a concept validated by Operation Desert Shield/Storm.

Operation Desert Shield/Storm provided an opportunity to evaluate current medical assets and doctrine in support of Army air-land battle operations. The missions assigned to a medical company (clearing) during Operation Desert Shield/Storm demonstrated the value of the area support medical battalion as authorized under Medical Force 2000. The battalion, with a few personnel additions and advanced training, could have met all the challenges faced by the medical company (clearing). With the military's drawdown, units must be created which can operate efficiently and react to anticipated demands.

Control of type II diabetes. Reaping the rewards of exercise and weight loss.

After a complete physical examination to identify possible complications, patients with non-insulin-dependent (type II) diabetes mellitus should be placed on an exercise program and a weight-control diet. Individualizing these regimens according to patients' health goals and personal interests enhances the chance of success. Exercise guidelines must be followed to ensure the patient's safety. Weight loss, however moderate, should be encouraged, and once a reasonable weight is obtained, a balanced maintenance diet should be recommended. Patience and persistence by physicians and patients can bring success in management of type II diabetes with nonpharmacologic means.

Management of hypertension. Useful nonpharmacologic measures.

Hypertension is a chronic problem commonly seen by primary care physicians. Inadequate treatment may result in significant morbidity and even death. Therefore, all patients with hypertension or at risk for hypertension should be educated about nonpharmacologic measures to control blood pressure. Weight reduction and sodium restriction are cornerstones of nonpharmacologic management of hypertension. Although studies of the effects of aerobic exercise on blood pressure are not well designed, data confirm the value of such exercise. Relaxation therapy has been shown to lower blood pressure, but effects may be transient. Potassium and calcium supplementation has lowered blood pressure, but because study results are contradictory, the exact clinical criteria for use of such supplements have not been determined. Vegetarians have lower blood pressure than nonvegetarians, but no specific dietary components (eg, fiber, fat) have been documented as the beneficial factors. Because of its significant pressor effect, alcohol should be avoided by hypertensives. A low-fat diet is recommended to decrease cardiovascular risk and assist in weight control.

Success in basic combat training: the role of cigarette smoking.

We studied whether cigarette smoking affected a soldier's ability to complete basic combat training. Demographic and tobacco use information was collected from a cohort of soldiers before they began training. A list of all graduates was obtained and analyzed against the initial questionnaire data. In this prospective study, the smoking group comprised 339 soldiers and the nonsmoking group comprised 535 soldiers. We found that those soldiers who smoked one or more packs of cigarettes per day were at a greater risk for failing basic combat training (relative risk = 2.05, P = 0.092. There was no relationship observed between a soldier's education and his ability to complete basic combat training. Our data indicate that smoking one or more packs of cigarettes per day may adversely affect a soldier's ability to complete basic combat training.

Goal-oriented medical care.

The problem-oriented model upon which much of modern medical care is based has resulted in tremendous advancements in the diagnosis and treatment of many illnesses. Unfortunately, it is less well suited to the management of a number of modern health care problems, including chronic incurable illnesses, health promotion and disease prevention, and normal life events such as pregnancy, well-child care, and death and dying. It is not particularly conducive to an interdisciplinary team approach and tends to shift control of health away from the patient and toward the physician. Since when using this approach the enemies are disease and death, defeat is inevitable. Proposed here is a goal-oriented approach that is well suited to a greater variety of health care issues, is more compatible with a team approach, and places a greater emphasis on physician-patient collaboration. Each individual is encouraged to achieve the highest possible level of health as defined by that individual. Characterized by a greater emphasis on individual strengths and resources, this approach represents a more positive approach to health care. The enemy, not disease or death but inhumanity, can almost always be averted.

Cigarette smoking and upper respiratory infection among recruits in basic combat training.

STUDY OBJECTIVE: To determine the relation between cigarette smoking and upper respiratory infection or viral syndrome. DESIGN: A prospective cohort study of soldiers during 13 weeks of basic combat training. Each soldier received a smoking questionnaire before the beginning and at the conclusion of basic combat training. The incidence of respiratory illness among the recruits was evaluated. SETTING: Fort Benning, Georgia. PARTICIPANTS: 1230 soldiers met the criteria for inclusion and completed the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: According to the definition of smoking status in the initial questionnaire, smokers had a relative risk for upper respiratory infection of 1.46 (95% CI, 1.1 to 1.8). This effect was not substantially altered by different definitions of smoking status. CONCLUSIONS: Young military recruits who smoked during basic combat training had more upper respiratory infections than nonsmokers. Cigarette smoking can substantially increase the risk for upper respiratory infection in young men.