Moving Canadian governmental policies beyond a focus on individual lifestyle: some insights from complexity and critical theories.

This paper explores why Canadian government policies, particularly those related to obesity, are 'stuck' at promoting individual lifestyle change. Key concepts within complexity and critical theories are considered a basis for understanding the continued emphasis on lifestyle factors in spite of strong evidence indicating that a change in the environment and conditions of poverty isare needed to tackle obesity. Opportunities to get 'unstuck' from individual-level lifestyle interventions are also suggested by critical concepts found within these two theories, although getting 'unstuck' will also require cross-sectoral collective action. Our discussion focuses on the Canadian context but will undoubtedly be relevant to other countries, where health promoters and others engage in similar struggles for fundamental government policy change.

MEDGuide and patient package inserts--again?

This article will trace the history and effects of the PPI from the time of its original concept by the FDA in the early 1970's to its current status. It will also address the response to this FDA initiative by the industry, medical community and consumer groups. Initiatives in other countries and future issues will also be discussed.

Clinical detection of sarcopenic obesity by bioelectrical impedance analysis.

To assess whether bioelectrical impedance analysis (BIA) provides clinically useful information on body composition beyond that obtained from measuring height and weight, we clinically classified 306 obese patients (233 females and 73 males) into tertiles of increasing fat-free mass estimated by BIA. Because fat-free mass by BIA is an estimate of lean body mass, the lowest tertile was clinically defined as sarcopenic obesity (reduced lean body mass), as contrasted with proportionate or muscular obesity in the next two tertiles. Fat mass in patients in each of the above tertiles based on BIA was then compared with fat mass estimated by using the equations of Garrow and Webster with body mass index (weight/height2). BIA-estimated fat mass was 4.3 kg greater in the sarcopenic group (n = 102) than predicted from body mass index. Fat mass predicted by BIA in the proportionate (n = 102) and muscular (n = 102) groups differed by less than the SEE of fat mass predicted by BMI. In premenopausal women at increased risk of breast cancer BIA showed a high prevalence of sarcopenic obesity (28/30) in these women at normal body mass indexes. Thus, BIA may be clinically useful for demonstrating sarcopenic obesity, but additional studies are needed to determine the metabolic and clinical significance of sarcopenic obesity.

An analysis of drug information desired by the patient. (Are patients being told everything they wish to know under OBRA '90?).

The need for patient package inserts (PPI) has been a controversial issue for many years. In August 1995, the FDA proposed 'MedGuide', a mandatory PPI programme. Recent efforts to educate patients about drug therapy include the OBRA '90 (Omnibus Budget Reconciliation Act of 1990) requirement for pharmacists to offer counselling to all patients receiving prescription drugs. In order to assess if patient information needs are being met, an 18-item survey was distributed to 873 patients at eight randomly selected New Jersey pharmacies until 100 patients had anonymously responded. Seventy-five per cent or more of respondents indicated that they received the following information from a health professional: medication name, reason prescribed, how often to take and duration of therapy. Less than 50% of respondents received information concerning: storage conditions, over-the-counter (OTC) or prescription only (Rx) interactions, what happens to the body if a dose is missed and how to avoid side-effects. Using a five item scale, every item was rated as important by at least 60% of respondents. Although information was reaching the majority of patients who responded, there were still some gaps between that which they considered to be important and information actually received. Some additional intervention might be beneficial to help to bridge these informational gaps.

Biostimulation of wound healing by lasers: experimental approaches in animal models and in fibroblast cultures.

Recent evidence suggests that low-energy lasers, such as an He-Ne laser, might stimulate wound healing. In this review we are summarizing our recent observations indicating that low-energy lasers enhance collagen gene expression both in skin fibroblast cultures in vitro, as well as in animal models of wound healing in vivo.

Biostimulation of wound healing in vivo by a helium-neon laser.

Clinical observations have suggested that low-energy lasers might stimulate wound healing. To understand the mechanism of the biostimulation, we previously examined the effects of low-energy lasers on collagen production by human skin fibroblasts and reported an increase of collagen synthesis in vitro. To examine the effects of low-energy lasers in vivo, hairless mice were experimentally wounded, sutured, and subjected to laser irradiation by a helium-neon laser with a power output of 1.56 mW and an energy fluence of 1.22 Joules/cm2. Experimental wounds were subjected to laser treatment every other day for 2 months; control wounds remained untreated. Specimens from the wounds were then examined for histological findings, tensile strength, and total collagen content. Results demonstrated a considerable improvement in the tensile strength of the laser-irradiated wounds at 1 and 2 weeks. Furthermore, the total collagen content was significantly increased at 2 months when compared with control wounds. These results suggest a beneficial effect of the helium-neon laser on wound healing in vivo.

Demonstration of elevated type I and type III procollagen mRNA levels in cutaneous wounds treated with helium-neon laser. Proposed mechanism for enhanced wound healing.

To assess laser modulation of wound healing, full-thickness cutaneous wounds were produced in the backs of pigs, and subjected to treatment with helium-neon laser. For comparison, some wounds were treated with non-laser energy source (a tungsten light) or left untreated as controls. Type I and type III procollagen mRNA levels were determined in the wounds by molecular hybridization with cDNA probes. The results indicated that type I and type III mRNA levels were markedly increased at days 17 and 28 of the healing in wounds treated with He-Ne laser, when compared to control or tungsten light-treated wounds. The results suggest that helium-neon laser stimulates wound healing by enhancing procollagen gene expression. These observations may have relevance to previous clinical studies suggesting that helium-neon laser stimulates wound healing.

Skin closure by Nd:YAG laser welding.

Skin incisions 6 mm in length were made on the backs of hairless mice. Control wounds were closed with interrupted 5-0 Prolene sutures, and experimental wounds were approximated and closed by laser welding using a Nd:YAG laser. The wounds were examined daily, and specimens were excised at weekly intervals for histopathologic study, transmission electron microscopy, tensile strength determination, and type I collagen-specific messenger ribonucleic acid measurements. The laser-welded wounds demonstrated rapid healing. Histologic study showed a functional scar tissue at day 7 and a minimal residue of the original wound at day 14. Tensile strength of the control and experimental wounds was similar at all time points. The levels of collagen-specific messenger ribonucleic acid were significantly higher in the sutured group in comparison with the laser group or with normal control skin. This study suggests that laser welding might have advantages over suturing, since the former is sterile and nontactile, does not require introduction of foreign material into the wound, and provides subjectively improved cosmetic results.