1/13. Systems approach to childhood and adolescent obesity prevention and treatment in a managed care organization.OBJECTIVE: To outline an intervention approach to childhood and adolescent obesity prevention and treatment, that will systematically facilitate effective communication, provide long-term social support and access to resources, that may be accessed proactively or on demand. Furthermore, this approach operates in an environment that involves all critical parties: child/adolescent, family-unit, physician and allied health professionals. SYSTEMS thinking APPROACH: The objective is to bring together all key stakeholders and consider the interrelationships among them as a common process. In a managed care setting, this may be accomplished by optimizing the contributions of care delivery, health promotion and information systems. SETTING: A not-for-profit, community governed Managed Care Organization (MCO) in the midwestern united states. telephone-based, centralized services facilitate a process of access, communication, documentation and intervention implementation. CASE STUDIES:Two case studies are presented as examples of how access is obtained, the intervention is tailored to individual needs, communication is established, documentation is organized and long-term support is facilitated. CONCLUSIONS: A systems thinking approach to obesity prevention and treatment in youth has great potential. In a MCO setting, such an approach may be implemented, since integrated health care delivery systems may allow a common process to be established that can bring together all key stakeholders.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
2/13. New multilobe "accordion" flaps for three-dimensional reconstruction of wide, full-thickness defects in the oral floor.When reconstructing a wide, full-thickness intraoral defect, the following principles are necessary for active food transport and improved swallowing and speech. First, the flap should touch the palate and obliterate the oral cavity. Second, jaw or flap excursion should not be hindered by tethering of the flap in the neck. And third, all surfaces of the tongue and oral floor, and the dead space of the floor should be reconstructed. To accomplish these goals, two new designs, similar to an accordion, using an anterolateral thigh flap and a deep inferior epigastric perforator flap have been developed. The outlines of multilobe flaps create an accordion-type structure of the tongue and oral floor complex. The advantages of the new designs using anterior thigh or deep inferior epigastric perforator flaps are follows: First, three-dimensional intraoral reconstitution allows maximal movement postoperatively of the reconstructed tongue. Second, the donor sites are so far from the tongue that simultaneous flap elevation is possible for tumor resectioning. Third, even in obese patients, totally or partially thin flaps are available. And fourth, in most patients the donor defects can be closed directly.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
3/13. Type 2 diabetes in children and adolescents: an emerging disease.The incidence of type 2 diabetes is increasing in the United States, and minority populations in particular seem to be affected. In the past, it was thought that type 2 diabetes occurred only in adults. However, an alarming epidemic has emerged, and children as young as 8 years of age are now being diagnosed with the disease. The purpose of this article is to present pediatric nurse practitioners with the most recent information about type 2 diabetes in children and adolescents, summarize current understanding about diagnosis, and outline treatment options.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
4/13. The use of indirect calorimetry in the clinical management of adolescents with nutritional disorders.Indirect calorimetry is a noninvasive, inexpensive technique used to determine resting energy expenditure. Its use provides the clinician with objective information that can be used to design, implement, and evaluate efficacy of treatment in the nutritional management of adolescents with anorexia nervosa, bulimia nervosa, chronic dieting behavior, and obesity. This chapter outlines the theoretical framework, interpretation of data, and clinical applications of indirect calorimetry and presents case examples to underscore its utility in adolescents with eating disorders.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
5/13. psychophysiologic disorders in children and adolescents.Psychosomatic disorders in children and and adolescents is a topic that covers a wide variety of illnesses and one which is difficult if not impossible to define accurately. In general, chronic emotional states, often nonspecific, serve as strong contributors to the development of a physical illness. The particular illness is often dictated by varying degrees of biological predisposition in one physiological system-i.e., such a predisposition in the respiratory system may lead to asthma or in the gastrointestinal system to ulcerative colitis. In some cases the biological factor is large and the emotional factor minimal, while in other cases the reverse is true. In the early days of research in psychosomatic disorders it was widely believed that each disorder was accompanied by certain specific emotional problems. Further study has shown this is not true. It was also felt that many, if not most of these disorders could be cured by psychotherapy, and this also has proven to be a fallacy. we have moved more and more to the team approach. Since both psyche and soma are involved, more than one specialist is usually required. In children and adolescents this may involve a child psychiatrist, a pediatrician, an allergist or gastroenterologist, a social worker and a psychologist. It requires time and patience to form an effective and smoothly functioning team in which all members respect one another's potential contribution. Some examples of team operation are presented and some of the problems outlined. In addition, there is attention given to the special problems of the adolescent and also the child with chronic nonspecific physical complaints as well as the child who requires hospitalization.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
6/13. Clinical nutrition in primary health care.Nutritional diagnosis and management are important aspects of general practice. This information, which is presented in two parts, offers the general practitioner a practical framework and an approach to nutritional advice. Part 1 outlines the clinical conditions and principles involved in nutritional diagnosis with a management approach to macrovascular disease and obesity. Part 2 covers protein malnutrition, eating disorders, osteoporosis, nutrient toxicity, cancer, inherited metabolic disorders, nutrient deficiency and diabetes mellitus. This material is based on a seminar organised by Kellogg (australia) Pty Ltd in Melbourne in 1989 and the material is reproduced with the kind permission of Kellogg (australia) Pty Ltd.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
7/13. Postoperative respiratory depression and unresponsiveness following epidural opiate administration: a case report.The profound segmental antinociception that epidural opioids offer has increased their use over the last 2 decades. Though side effects may accompany the use of epidural opioids, clinicians have found that the advantages far outweigh the disadvantages. The following case report outlines a patient's postoperative course in which she experienced respiratory depression while receiving epidural opioids. The pharmacokinetics of lipophilic vs hydrophilic opioids in relation to the occurrence of respiratory depression is discussed.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
8/13. hypocalcemia, hypovitaminosis d osteopathy, osteopenia, and secondary hyperparathyroidism 32 years after jejunoileal bypass.OBJECTIVE: To detail, for the first time, the results of bone histomorphometry, micro-computed tomography, and the calcium-vitamin D-parathyroid hormone (PTH) axis in a unique patient 32 years after undergoing a jejunoileal bypass (JIB) procedure for obesity. methods: A case report is presented, serial results of serum chemistry studies before and after treatment are outlined, and histomorphometric data on a bone biopsy specimen are summarized. RESULTS: In a 65-year-old woman with chronic lymphedema who had undergone JIB >3 decades earlier, baseline serum studies showed the following: total calcium, 6.2 mg/dL (normal, 8.5 to 10.5); ionized calcium, 0.87 mmol/L (normal, 1.15 to 1.35); creatinine, 1.3 mg/dL (normal, 0.6 to 1.0); albumin, 2.0 g/dL (normal, 3.0 to 5.0); magnesium, 1.0 mg/dL (normal, 1.5 to 2.1); phosphorus, 3.1 mg/dL (normal, 2.5 to 4.5); potassium, 3.1 mEq/L (normal, 3.5 to 5.0); alkaline phosphatase, 204 U/L (normal, 50 to 136); PTH, 311 pg/mL (normal, 10 to 60); 25-hydroxyvitamin D, <7 ng/mL (normal, 10 to 60); and 1,25-dihydroxyvitamin D, 37 pg/mL (normal, 25.1 to 66.1). Histomorphometry of an undecalcified iliac crest bone biopsy specimen demonstrated increased osteoid surface of 59.4% (Z-score = 5.6), increased mineralization lag time of 90.1 days (Z-score = 2.96), decreased adjusted apposition rate of 0.05 mm3/mm2/yr (Z-score = -2.45), but increased volume-based bone formation rate of 0.715 mm3/mm3/yr (Z-score = 2.0). tetracycline labeling was diffuse and smudged, and the osteoblast-osteoid interface was decreased, indicating a mineralization defect. Increased cortical porosity, but no evidence of significant marrow fibrosis, was noted, whereas cancellous bone volume was decreased to 15.2% (Z-score = -0.92). Micro-computed tomography of bone biopsy specimens confirmed both increased cortical porosity and decreased cancellous bone volume. Vitamin D and calcium therapy resulted in near-normal or low-normal levels of 25-hydroxyvitamin D and calcium and improvement in PTH and alkaline phosphatase levels during a 9-month period. CONCLUSION: Significant hypovitaminosis D osteopathy, osteopenia, and hypocalcemia attributable to vitamin d deficiency may remain a problem in patients with unreversed JIB operations after more than 3 decades. Clinicians should be aware of this important clinical problem.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
9/13. Obstructive sleep apnoea: a new disease for papua new guinea?Obstructive sleep apnoea is a common disorder in western societies and has a strong association with obesity and alcohol use. The condition has not previously been recorded in papua new guinea. The clinical details of 2 patients from Papua New Guinea with obstructive sleep apnoea are described, and the principles of treatment of this condition are outlined. sleep apnoea is likely to become an increasing problem in papua new guinea.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
10/13. A comprehensive outpatient weight reduction program: dietary patterns, psychological considerations, and treatment principles.A comprehensive outpatient approach to weight reduction has the best chance of long-term success. This article outlines the dietitian's role and summarizes dietary patterns and psychological problems encountered in such a program at the University of virginia Clinical Nutrition Center. patients were assisted in making gradual changes in eating patterns through nutrition education and the use of behavior modification techniques. Initial food diaries often reflected a low intake of fruits, vegetables, whole grains, and legumes; increased consumption of these high-fiber foods is advocated as an aid to weight loss. Psychological support is an important component of the weight reduction process. The dietitian must be adequately prepared to provide this therapy but also must be able to recognize when patients should be referred for further psychological counseling. Two case studies are presented to illustrate the sabotage which must be dealt with by patients as they lose weight and struggle to maintain that weight loss.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
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