CME : Your SA Journal of CPD - Volume 23, Issue 6, 2005
Volume 23, Issue 6, 2005
Author John L. StraughanSource: CME : Your SA Journal of CPD 23, pp 274 –276 (2005)More Less
Unhealthy foods are widely sold. <br>Overweight / obesity is pandemic. <br>Metabolic syndrome as a major consequence is rampant. <br>Hypertension, dyslipidaemia and dysglycaemia are readily measurable metabolic syndrome identifiers. <br>High levels of morbidity and mortality ensue. <br>Costs to the nation's health and to the national health bill are enormous. <br>The fast-food industry plays a huge role by providing unhealthy food and drink. <br>Growing numbers of prominent persons display obesity - providing poor role models. <br>The challenges - educational, preventive and management - are great, both for the public and private sectors.
Author Simon WhitesmanSource: CME : Your SA Journal of CPD 23, pp 277 –278 (2005)More Less
Acute stress is adaptive and protective. <br>Chronic stress is maladaptive and pathogenic. <br>Most chronic stress has a significant psychological and / or social component. <br>Perception of events, either internal or external, will determine whether the stress axis is activated. <br>The functional neuroendocrine-immune pathways, based on a shared molecular language, is the basis by which the mind / brain affects the immune system. <br>Most chronic stress is immunosuppressive. <br>Certain patient populations are at greater risk of stress-associated immune suppression causing immune-related illness. <br>Stress should be considered a risk factor for illness rather than a cause. <br>Stress reduction can be implemented at the primary health care level as a therapeutic and preventive tool through the integration of self care into primary care. <br>A balanced immune system is optimal for health and is founded on a balanced lifestyle.
Author Larry LoebensteinSource: CME : Your SA Journal of CPD 23, pp 280 –281 (2005)More Less
The thalamus, hippocampus and amygdala are all structures that respond to the perception of danger stimuli. <br>Anxiety disorders include the various forms of phobia, post-traumatic stress disorder, obsessive compulsive disorder and generalised anxiety disorder. <br>The central feature of panic is an overwhelming and powerful element in all these disorders. <br>The frontal or thinking and planning areas of the brain are significantly excluded in the presence of the arousal process triggered by anxiety, as their functioning could delay and interfere with a speedy response to danger. <br>The power of anxiety will overwhelm any rational thought that might have been lodged in the frontal areas. <br>Most classes of antidepressant have panic-blocking properties, the mode of action being very poorly understood. <br>Cognitive behaviour therapeutic intervention is directed towards better anxiety management rather than towards original causes or putative precipitating events. <br>Outcomes studies in the treatment of anxiety disorders demonstrate that combined therapy in the form of antidepressant medication and cognitive behaviour therapy has the best outcome. <br>Whereas anxiety forces an individual to monitor the danger in the external environment, cognitive behaviour therapy redirects the individual to monitor and manage their internal environment in situations of varying anxiety intensity.
Author Lesley CarewSource: CME : Your SA Journal of CPD 23, pp 283 –284 (2005)More Less
In contemporary society there are many alternative structures to that which traditionally has been considered to be a family, i.e. a group of people functioning as a single household. <br>In systems theory, a family is considered to be a structure of interrelated parts in which the whole is greater than the sum of its parts. <br>Any action taken by one member will affect other members and the structure as a whole. <br>Children frequently present with behavioural problems or anxiety secondary to family stress. <br>Individual risk and resilience factors relate to temperament, pre-morbid psychiatric history and psychosocial functioning. <br>The MacMaster model of family functioning defines 6 important areas influencing adjustment: <ul><li> problem-solving ability</li> <li> communication</li> <li> roles</li> <li>affective responsiveness</li> <li>affective involvement</li> <li> behaviour control.</li></ul> The family doctor is uniquely positioned to guide an individual to ameliorate the consequences of their choices by recognising dysfunctional behaviours and communication and recommending alternatives. <br>This needs to be a conscious action with a clear purpose to prevent the doctor from being absorbed into the family's dysfunctional patterns.
Source: CME : Your SA Journal of CPD 23, pp 286 –288 (2005)More Less
For over 2 decades, nutritional guidelines for optimal health have emphasised low-fat, high-carbohydrate intake. <br>During this time the incidence of obesity has increased, despite reduced fat intake. <br>The metabolic syndrome was identified in 1988, and linked with high circulating levels of insulin and insulin resistance. <br>In 1981 the concept of the glycaemic index showed that all complex carbohydrates are not equal and that processed carbohydrate products produce large glycaemic responses with high insulin demands. <br>It is possible that by encouraging increased carbohydrate intake, the incidence of metabolic syndrome was increased. <br>Through fat restriction, the intake of fish oil (EPA) has been low. EPA has been shown to be beneficial in reducing cardiovascular disease risk, which is high in patients suffering from the metabolic syndrome. <br>Nutritional guidelines for optimal health should be based on low GI, and allow for higher intakes of fish oil or omega-3 rich fats.
Author Rodger MeyerSource: CME : Your SA Journal of CPD 23, pp 290 –293 (2005)More Less
Not all drug use is drug addiction. <br>Drug use may be a choice, a symptom or an illness and the management differs for each group. <br>Addiction is about a specific type of relationship with drug use identified by a loss of control over the use. <br>Treatment of addiction is hindered by much mythology. <br>Detox should never be confused with drug addiction treatment.
Author David P. Van VeldenSource: CME : Your SA Journal of CPD 23, pp 294 –298 (2005)More Less
Comprehensive lifestyle changes along with the usual medical management can reverse what were previously held to be irreversible processes. <br>Doctors now realise the importance of the more holistic bio-psycho-social approach to health and disease for whole-person wellness. <br>Lifestyle modifications to increase the healing potentials of the body include a healthy diet, avoiding environmental toxins, smoking cessation, exercise, stress reduction, music and, for some, spiritual enlightenment. <br>In order to develop and understand effective management protocols for disease treatment, the holistic, interactive nature of a person needs to be understood. <br>We do have control of the phenotypic expression of disease tendencies even if we cannot alter our basic genetic blueprint. <br>Caring effectively for the physical body by eating the right foods, getting sufficient rest and relaxation, regular exercise, smoking cessation, alcohol in moderation and the prevention of substance abuse remains one of the most important components of optimal health.
Author Ryan KohlerSource: CME : Your SA Journal of CPD 23, pp 300 –302 (2005)More Less
Lack of physical activity results in overweight and unfit people. People generally ask their doctors for advice on diet and exercise in order to look better. <br>Regular physical activity contributes to overall wellbeing and not simply to improved appearance. <br>Total physical fitness results in improved muscle strength, improved muscle resistance, flexibility and cardiovascular fitness. <br>This can be achieved by exercising for at least 30 minutes for a minimum of 3 times a week. <br>Cycling, swimming, walking and running are excellent forms of exercise because they use the large muscle groups. <br>People should aim to exercise at 70 - 80% of their maximum heart rate (calculated as 220 minus age - unless on rate-reducing cardiovascular drugs).
Author Adrian R. HorakSource: CME : Your SA Journal of CPD 23, pp 303 –306 (2005)More Less
CVD is the major cause of premature death and disability in the Western world. <br>A number of important risk factors have now been identified which play a pivotal role in the development of CVD. <br>Lifestyle modification and therapy of many of these modifiable risk factors can have a significant impact on the growing incidence of CVD, improving the prognosis of many potential sufferers of this disease. <br>Risk stratification of patients identifies those at highest risk for the development of CVD. <br>Therefore, patients with established CVD need intensive therapy, which includes lifestyle changes (smoking, healthy food choices and physical activity) as well as treatment with statins, antihypertensives and aspirin, when indicated. <br>Patients at potentially high risk should also be counselled about lifestyle modification as mentioned above, and considered for pharmacological intervention. <br>Aggressive treatment of risk factors and lifestyle modification will have significant long-term beneficial effects on cardiovascular outcomes.
Source: CME : Your SA Journal of CPD 23, pp 307 –309 (2005)More Less
Our current population of elderly is steadily increasing as is the population's life expectancy (longevity), although not necessarily the healthy life expectancy (years lived without disability). <br>Life-span studies suggest that heritability accounts for less than 35% of variance in human survival duration. <br>Therefore 'genetic' theories and 'environmental' theories of ageing are interlinked and may be regarded as comprising different aspects of the same phenomenon. <br>The genetic theories hypothesise ageing as the consequence of somatic mutations, multiple genetic errors and programmed cell death, while environmental theories focus on oxidative stress resulting from microvascular pathology (especially in the brain) and lifestyle. <br>Cardiovascular risk factors are paramount in the production of atherosclerosis which determines the degree of disability and the expression of dementia. <br>Lifestyle changes concentrating on cardiovascular risk factors are recognised as delaying the onset and severity of dementias such as Alzheimer's disease as well as reducing disability.