College physical education: an unrecognized agent of change in combating inactivity-related diseases

Physical activity patterns during the young adult years are likely to be important influences on habitual physical activity during overall adult life and, consequently, have significant implications for long-term health outcomes. The potential reach and impact of college physical education on the promotion of physical activity to a large segment of the American population has been largely unrecognized. Over the last generation, many colleges and universities have reduced or eliminated their physical education requirements. Nonetheless, physical education can make important contributions in the primary prevention of inactivity-related chronic diseases and to the general education of the college student. Awareness and advocacy are needed to strengthen college physical education programs.     

Skin temperature biofeedback for Raynaud's disease: A double-blind study

The lack of control procedures inherent in most of the experiments conducted to assess the effectiveness of skin temperature biofeedback in the treatment of Raynaud's disease renders the results inconclusive. In this study, control groups and a double-blind approach are adopted. Thirty-six patients, carefully screened for a diagnosis of primary Raynaud's disease, were assigned to a skin temperature increase group (N=12), to an EMG relaxation control group (N=12), or to a notreatment control group (N=12). All patients kept records of their symptoms for the duration of the study. Each subject in the two training groups received 20 sessions, the last 2 conducted under cold stress. Data analysis according to original group assignment, as well as following regrouping of subjects according to several learning criteria, showed that while all patients reported a marked decrease in the number of vasospastic attacks, no significant differences were found among the three groups on the clinical measures used to assess symptomatic relief. The general improvement reported must therefore be attributed to nonspecific factors.This study was supported in part by Rehabilitation Services Administration Grant No. 16-P-56810/5–17 to the University of Minnesota Medical Rehabilitation Research and Training Center. We are grateful to Gail Gaebe, Carla Grossman, Steve Janousek, Linda Rubbelke, and Scott Williamson, who served as blind assistants, and to Steve Sheffield for his technical support.     

Diagnosis of inflammatory bowel disease: an international multicentre scoring system.

Inflammatory bowel disease is being studied by the World Organisation of Gastroenterology (OMGE) Research Committee in a survey (currently) affecting 1696 patients presenting to 30 hospitals in 16 countries. A computer-aided diagnostic prediction system (when tested in 1056 patients) showed an accuracy of match between computer prediction and clinical diagnosis in 94% of these patients. Most centres, however, do not possess appropriate computing facilities. A simple diagnostic "scoring system", based on likelihood ratios, has therefore been developed, using a series of numbers set out on a single sheet of paper. The overall accuracy of the simple scoring system in the same 1056 patients was equivalent (93%) to the computer-aided system. In a further series of 510 "new" patients from eight fresh centres the diagnostic scoring system made a firm prediction in 490 cases (96%). Where made, the accuracy of match between the scoring system prediction and clinical diagnosis was 96%. It is suggested that this simple system, which requires no analytical resource and could be used by any gastroenterologist, might be of some value in clinical research and clinical practice.     

Raised respiratory rate in elderly patients: a valuable physical sign.

Measurements of respiratory rate in 82 long-stay patients aged 67-101 years yielded a normal range of 16-25 breaths a minute. In a prospective study of 60 consecutive acute admissions to a geriatric unit, 19 out of 21 patients diagnosed as lower respiratory tract infections had respiratory rates above the upper limit of normal on the day of diagnosis; the rise in respiratory rate preceded the clinical diagnosis. All eight patients who were diagnosed on admission as having a lower respiratory tract infection had a respiratory rate greater than 26, with a mean of 29.7 breaths a minute. Patients admitted for other conditions-for example, urinary tract infection-rarely had respiratory rates outside the normal range. Accurate measurement of respiratory rate is a valuable diagnostic aid in elderly patients.     

Medication nonadherence: an unrecognized cardiovascular risk factor

Nonadherence with prescribed drug regimens is a pervasive medical problem. Multiple variables affecting physicians and patients contribute to nonadherence, which negatively affects treatment outcomes. In patients with hypertension, medication nonadherence is a significant, often unrecognized, risk factor that contributes to poor blood pressure control, thereby contributing to the development of further vascular disorders such as heart failure, coronary heart disease, renal insufficiency, and stroke. Analysis of various patient populations shows that choice of drug, use of concomitant medications, tolerability of drug, and duration of drug treatment influence the prevalence of nonadherence. Intervention is required among patients and healthcare prescribers to increase awareness of the need for improved medication adherence. Within this process, it is important to identify indicators of nonadherence within patient populations. This review examines the prevalence of nonadherence as a risk factor in the management of chronic diseases, with a specific focus on antihypertensive medications. Factors leading to increased incidence of nonadherence and the strategies needed to improve adherence are discussed. Medication nonadherence, defined as a patient's passive failure to follow a prescribed drug regimen, remains a significant concern for healthcare professionals and patients. On average, one third to one half of patients do not comply with prescribed treatment regimens.[1-3] Nonadherence rates are relatively high across disease states, treatment regimens, and age groups, with the first several months of therapy characterized by the highest rate of discontinuation.[3] In fact, it has recently been reported that low adherence to beta-blockers or statins in patients who have survived a myocardial infarction results in an increased risk of death.[4] In addition to inadequate disease control, medication nonadherence results in a significant burden to healthcare utilization - the estimated yearly cost is $396 to $792 million.[1] Additionally, between one third and two thirds of all medication-related hospital admissions are attributed to nonadherence.[5,6]Cardiovascular disease, which accounts for approximately 1 million deaths in the United States each year, remains a significant health concern.[7] Risk factors for the development of cardiovascular disease are associated with defined risk-taking behaviors (eg, smoking), inherited traits (eg, family history), or laboratory abnormalities (eg, abnormal lipid panels).[7] A significant but often unrecognized cardiovascular risk factor universal to all patient populations is medication nonadherence; if a patient does not regularly take the medication prescribed to attenuate cardiovascular disease, no potential therapeutic gain can be achieved. Barriers to medication adherence are multifactorial and include complex medication regimens, convenience factors (eg, dosing frequency), behavioral factors, and treatment of asymptomatic conditions.[2] This review highlights the significance of nonadherence in the treatment of hypertension, a silent but life-threatening disorder that affects approximately 72 million adults in the United States.[7] Hypertension often develops in a cluster with insulin resistance, obesity, and hypercholesterolemia, which contributes to the risk imposed by nonadherence with antihypertensive medications. Numerous strategies to improve medication adherence are available, from enhancing patient education to providing medication adherence information to the healthcare team and will be discussed in this article.     

Genetics of Crohn disease, an archetypal inflammatory barrier disease

Chronic inflammatory disorders such as Crohn disease, atopic eczema, asthma and psoriasis are triggered by hitherto unknown environmental factors that function on the background of some polygenic susceptibility. Recent technological advances have allowed us to unravel the genetic aetiology of these and other complex diseases. Using Crohn disease as an example, we show how the discovery of susceptibility genes furthers our understanding of the underlying disease mechanisms and how it will, ultimately, give rise to new therapeutic developments. The long-term goal of such endeavours is to develop targeted prophylactic strategies. These will probably target the molecular interaction on the mucosal surface between the products of the genome and the microbial metagenome of a patient.