Functional clinical nutrition is an integrative science; it uses dietary strategies, functional foods and medicinal plants, as well as combinations thereof. Both functional foods and medicinal ...plants, whether associated or not, form nutraceuticals, which can bring benefits to health, in addition to being included in the prevention and treatment of diseases. Some functional food effects from
L. (oats),
L. (brown flaxseed),
L. (soya) and
have been proposed for nutritional disorders through in vitro and in vivo tests. A formulation called a bioactive food compound (BFC) showed efficiency in the association of oats, flaxseed and soy for dyslipidemia and obesity. In this review, we discuss the effects of BFC in other nutritional disorders, as well as the beneficial effects of
in obesity, cardiovascular disease, diabetes mellitus type 2, metabolic syndrome, intestinal inflammatory diseases/colorectal carcinogenesis and malnutrition. In addition, we hypothesized that a BFC enriched with
could present a synergistic effect and play a potential benefit in nutritional disorders. The traditional consumption of
preparations can allow associations with other formulations, such as BFC. These nutraceutical formulations can be easily accepted and can be used in sweet preparations (fruit and/or vegetable juices, fruit and/or vegetable vitamins, porridges, yogurt, cream, mousses or fruit salads, cakes and cookies) or savory (vegetable purees, soups, broths and various sauces), cooked or not. These formulations can be low-cost and easy-to-use. The association of bioactive food substances in dietary formulations can facilitate adherence to consumption and, thus, contribute to the planning of future nutritional interventions for the prevention and adjuvant treatment of the clinical conditions presented in this study. This can be extended to the general population. However, an investigation through clinical studies is needed to prove applicability in humans.
Abstract Background Life expectancy in recent decades has increased the prevalence of chronic diseases in the population, requiring an approach to new health topics, such as discussions on quality of ...life and expectations about death and dying. The concept of advance directives (ADs) gives individuals the opportunity to make known their decisions about the treatments they would like to receive at the end of life. Despite the recognition of relevance in clinical practice, the applicability of the concept presents challenges, including establishing the appropriate prognosis for each patient and the ideal time to approach the patient. Some prognostic tools were developed, such as the surprise question (SQ): “Would you be surprised if your patient died in 12 months?” , which is used in some clinical settings to predict patient deaths and to make decisions regarding ADs. The main objective of the present study was to evaluate the behavior of second-year resident physicians (PGY-2) when the SQ was applied. Method In our observational study, from July 1, 2016, to February 28, 2017, (PGY-2) in the Internal Medicine Residency Program (IMRP) applied SQ to all patients with multiple and varied chronic no communicable comorbidities, who were followed up at the general medicine outpatient clinic (GMOC) of a tertiary university hospital in São Paulo- Brazil. The frequency of the outcome (death or non-death within 12 months) was analyzed by correlating it with the clinical data (impact of the studied variables). Results Eight hundred forty patients entered the study. Fitfty-two of them (6.2%) died within one year. PGY-2 predicted that two hundred and fourteen patients (25.5% of total) would die within a year (answer No to SQ), of which, 32 (14.9%) did so. The correct residents’ prognosis for the subgroup of 626 patients (answer “Yes” to SQ) was NPV = 96.8% (CI = 95.4%-98.2%) and PPV = 14.9% (CI 10.1%-19, 6%). Answering “Yes” to SQ correlated negatively to addressing AD while the outcomes death and the answer No to SQ were positively correlated, according to the number of comorbidities. Conclusion The SQ, in addition to care, contributed to health education, communication and care planning shared by the doctor and patient.
The prevalence of non-communicable chronic diseases has been on the rise and the co-occurrence of morbidities is becoming more common. Multimorbidities are found more frequently among women, those ...with a history of mental disorders, lower level of schooling, and unfavorable socioeconomic condition. Physical inactivity, smoking and obesity are also associated with multimorbidities. Its occurrence is directly related to the age, affecting the majority of the individuals with more than 50 years old. It is important to consider the possibility of comorbid conditions that aggravate, complicate or simulate the symptoms of the disease in the face of a patient with asthma and poor response to treatment. Among subjects with asthma, some conditions stand out as the most frequent: chronic rhinitis or rhinosinusitis, gastroesophageal reflux disease, obstructive sleep apnea syndrome, obesity, and cardiovascular disorders. Comorbidities reduce the chances of optimal asthma control. It is essential to assess and manage properly these complex situations, choosing wisely preventive strategies and treatment options to avoid adverse events and optimize outcomes. Medications for asthma have the potential to worsen cardiovascular conditions, while beta-adrenergic receptor blockers and angiotensin conversion enzyme inhibitors used for cardiovascular conditions, can worsen asthma. Handling properly these cases will save lives and resources. However, there are multiple gaps in knowledge requiring investigation in this field to inform integrated care pathways and policies. It is likely information may be obtained from real life studies and electronic medical databases. Communications between the providers and patients may be facilitated by electronic technology, opening a large window for guided self-management.
Chronic heart failure in France is responsible for 160 000 hospitalizations per year. The treatment of chronic heart failure is multidisciplinary. Telemedicine (TLM) reinforces the therapeutic ...arsenal of this chronic pathology by the use of remote monitoring (TLS) on patients followed outside the care structure. This paradigm has proven its effectiveness with the help of digital networks and specific algorithms, which communicate through connected tools with the ICC patient. Clinical signs of worsening can trigger an alert that will be taken into account by the TLS. Early intervention on these warning signs avoids acute decompensation and a new hospitalization of the patient. The analysis of the results shows a rate of alerts that require the intervention of TLS teams, from 20 to 35% depending on the centers. The ETAPES program has set the regulatory framework for the TLS experiment for 4 years. It will end at the end of 2021. The feedback from the TLS centers is between 6 and 18 months. The satisfaction index of patients followed by TLS is 95%. The intermediate results (2018, 2019) and the evaluation of the ETAPES program, are in favor of TLS management of ICC patients. Therapeutic education and TLS improve patients' quality of life. The Ministry of Health plans a transition to the common law for TLS in 2022.
L'insuffisance cardiaque chronique en France, est responsable de 160 000 hospitalisations par an et son traitement est multidisciplinaire.
La télémédecine vient renforcer l'arsenal thérapeutique de ...cette pathologie chronique par l'utilisation de la télésurveillance (TLS) intervenant à distance sur les patients suivis hors de la structure de soins. Ce paradigme a fait la preuve de son efficacité à l'aide de réseaux digitaux et d'algorithmes spécifiques, qui communiquent par des outils connectés avec le patient ICC. Des signes cliniques d'aggravation peuvent déclencher une alerte qui va être prise en compte par la TLS. L'intervention précoce sur ces signes d'alerte évite la décompensation aiguë et une nouvelle hospitalisation du patient. L'analyse des résultats retrouve un taux d'alertes qui nécessitent l'intervention des équipes de TLS, de 20 à 35 % selon les centres. Le programme ETAPES a fixé le cadre réglementaire de l'expérimentation de la TLS pour 4 ans. Elle se termine à la fin de l'année 2021. Le retour d'expériences des centres TLS a un recul de 6 à 18 mois. L'indice de satisfaction des patients suivis par TLS est de 95 %.
Les résultats intermédiaires (2018, 2019) et l’évaluation du programme ETAPES, sont en faveur de la prise en charge par TLS des patients ICC. L’éducation thérapeutique et la TLS améliorent la qualité de vie des patients. Le ministère de la santé prévoit un passage dans le droit commun de la TLS en 2022.
Chronic heart failure in France is responsible for 160 000 hospitalizations per year. The treatment of chronic heart failure is multidisciplinary.
Telemedicine (TLM) reinforces the therapeutic arsenal of this chronic pathology by the use of remote monitoring (TLS) on patients followed outside the care structure. This paradigm has proven its effectiveness with the help of digital networks and specific algorithms, which communicate through connected tools with the ICC patient. Clinical signs of worsening can trigger an alert that will be taken into account by the TLS. Early intervention on these warning signs avoids acute decompensation and a new hospitalization of the patient. The analysis of the results shows a rate of alerts that require the intervention of TLS teams, from 20 to 35% depending on the centers. The ETAPES program has set the regulatory framework for the TLS experiment for 4 years. It will end at the end of 2021. The feedback from the TLS centers is between 6 and 18 months. The satisfaction index of patients followed by TLS is 95%.
The intermediate results (2018, 2019) and the evaluation of the ETAPES program, are in favor of TLS management of ICC patients. Therapeutic education and TLS improve patients' quality of life. The Ministry of Health plans a transition to the common law for TLS in 2022.
This review has focused on the potential of Macrobiotic nutrition for human health since it is probably the most complete science regarding food as medicine. With approximately 5000 years of ...evolution, time has allowed Macrobiotics to develop to a very high level of complexity, to the point of adapting to each individual or circumstance. Macrobiotics is part of what is known as Oriental Medicine, and claims that health is not only the result of a correct proportion of food, but also of the balance between the two energies, yin and yang, in the individual and his environment. Currently there are schools, private clinics and macrobiotic restaurants in all the most advanced countries in the world, but this discipline is still far from official academic careers and there is still very scarce related research. The present document provides an overview of the fundamental pillars of this type of diet, reviews the main scientific research regarding this discipline or about the type of diet on which it is based, and focuses on its potential to heal chronic diseases such as cancer and diabetes.
Esta revisión se ha centrado en el potencial de la nutrición Macrobiótica para la salud humana, ya que es probablemente la ciencia más completa sobre el alimento como medicina. Con aproximadamente 5000 años de evolución, el tiempo le ha permitido a la Macrobiótica desarrollarse a un nivel de complejidad muy alto, al punto de adaptarse a cada individuo o circunstancia. La Macrobiótica forma parte de lo que se conoce como medicina Oriental, y afirma que la salud no es sólo el resultado de una correcta proporción de alimentos, sino también del equilibrio entre las dos energías, el yin y el yang, en el individuo y su entorno. Actualmente existen escuelas, clínicas privadas y restaurantes macrobióticos en todos los países más avanzados del mundo, pero esta disciplina aún está lejos de las carreras académicas oficiales y todavía hay muy poca investigación sobre ella. Este documento da una visión general de los pilares fundamentales de este tipo de alimentación, repasa las principales investigaciones científicas que la estudian o sobre el tipo de dieta en la que se basa, y se centra en su potencial para curar enfermedades crónicas como el cáncer y la diabetes.
Opinion/feedback Among side effects, fatigue is the most common symptoms described by patients in a wide range of chronic diseases. Described as “being drained physically, but also mentally and ...emotionally,” often seen as the most distressing symptom, fatigue interferes with daily life by impairing quality of life, functional capacity, self-perception and social participation; it is potentially debilitating and it is associated with significant morbidity. Yet it remains relatively unknown, me-considered mis-assessed and mis-treated, partly due to the still limited understanding of its pathophysiology, its complex assessment, the lack of effective treatments (no medicine against fatigue apart specific pathological conditions) and of training to its management. The optimal management of fatigue is a key issue in the course of care, helping to reduce the burden associated with the disease and treatments. We will review the scientific evidence showing that PA is one of the best ways to handle the fatigue and fight against PA rupture, which is generally following the diagnosis, without compromising ongoing treatments. However, fatigue is a major obstacle to adherence to a regular PA. Systematic rest is an aggravating factor of fatigue. This is why only well-designed and conducted PA programs will help a person to start intelligently activity again (i.e., programs involving evaluation, programming, individualization in their design, and adapted support and monitoring in their implementation, all framed by a qualified professional). We will develop latest recommendations for the management of fatigue by PA and innovative indications for optimal programs.
The future of chronic diseases Kopczyński, J; Wojtyniak, B; Goryński, P ...
Central European journal of public health
9, Issue:
1
Journal Article
Peer reviewed
Major chronic diseases continue to be the main health scourge of the most developed countries, have only recently been retreating in frequency in the fledgling market economies, and are becoming ...dominant in many populous areas of the developing world. The descriptive evidence from the developments of the near past strongly suggests that much of the control outcomes have already been achieved with the existent imperfect causative knowledge. The continuation of desirable trends in major chronic diseases in some places like Central & Eastern Europe, is uncertain within the intermediate time range without gaining more etiological clues, among which the role of medical care is worthy of reconsideration. Other factors can grow in importance, like obesity, which may be freed from the suppressive influence of cigarette smoking to trigger major mass pathologies, like type 2 diabetes mellitus, arterial hypertension, some cancers etc. The role of social underpriviledge seems recalcitrant, although the part played by social share of biological risk agents may diminish in response to educational persuasion. The remotest destinies of some chronic diseases may depend on the mixture of external and genetic influences ending as predispositions towards some ailments, antecedents of which might have protected their carriers from dangers of the past unfriendly environment, like obesity (or diabetes) against famine, or hypertension against inefficient defense reaction. The resulting medium-range prediction of well-being for inhabitants of more developed world may not be forbidding, since increasing life expectancy needs not be synonymous with disability, and attaining old age does not require excessive sacrifice, beyond reducing number smoked, or preserving decent respiratory volumes.
Introduction: The sequelae post-COVID can affect different systems. In this sense, considering the multi-factorial etiology of COVID-19, multi-professional interventions could be a relevant strategy ...for recovery health indicators. Objective: This study aimed to investigate the effects of multi-professional intervention on body composition, physical fitness, and biomarkers in overweight COVID-19 survivors with different symptomatology. Methodology: A non-randomized parallel group intervention included 69 volunteers (BMI ≥25 kg/m 2 ), divided into three groups according to SARS CoV-2 symptomatology, but only 35 finished the longitudinal protocol control group ( n = 11); moderate group ( n = 17) and severe group ( n = 7). The groups were submitted to a multi-professional program (nutritional intervention, psychoeducation, and physical exercise intervention) for 8 weeks, and the volunteers underwent body composition assessments (primary outcome) and physical and biochemical tests (secondary outcome) in pre- and post-intervention. This study was registered on the Clinical Trials Registration Platform number: RBR-4mxg57b and with the local research ethics committee protocol under number: 4,546,726/2021. Results: After the 8-week multi-professional intervention, the following results were observed for the moderate COVID-19 group: improved dynamic strength of lower- and ( p = 0.003), upper-limbs ( p = 0.008), maximal isometric lumbar-traction strength ( p = 0.04), flexibility ( p = 0.0006), and albumin ( p = 0.0005), as well as a reduction in the C reactive protein (CRP) ( p = 0.003) and fasting glucose ( p = 0.001); for the severe COVID-19 group: an improvement in dynamic lower-body strength ( p = 0.001), higher values of albumin ( p = 0.005) and HDL-c ( p = 0.002), and lower values of CRP ( p = 0.05), and for the control group: an improvement in sit-up repetitions ( p = 0.008), and a reduction of CRP ( p = 0.01), fasting glucose ( p = 0.001) and total cholesterol ( p = 0.04) were identified. All experimental groups reduced triglycerides after intervention ( p < 0.05). Conclusion: Finally, 8 weeks of multiprofessional intervention can be an efficient tool for reversing the inflammatory process and promoting improvements in daily activities and quality of life, although it is believed that the severe COVID-19 group needs longer interventions to improve different health indicators. Clinical Trial Registration: https://ensaiosclinicos.gov.br/ , identifier: RBR-4mxg57b.
고령화와 만성질환의 만연 등으로 인한 헬스케어환경의 급격한 변화는 착용형 인체센서, 무선네트워크 및 스마트폰이 결합한 새로운 적용영역을 창출하고 있다. 본 연구는 예외 관리적 관점에서 재택환자의 일상의 건강상태를 효과적으로 모니터링하며, 재택환자는 스마트폰을 활용한 건강모니터링을 통해 자기관리 및 적절한 건강 개입을 할 수 있는 시스템을 제공함으로써 ...새로운 의료서비스를 창출할 수 있는 기반을 제공하였다. 특히 기존 연구에서는 스마트폰이 단지 데이터 전달자로서의 역할에 그친 데 반하여, 본 연구에서는 스마트폰의 컴퓨팅 기능을 활용하여 의료인의 재택환자 일상생활 관리를 위한 데이터가공, 모니터링 시스템의 핵심인 필터링과 큐잉 등의 전처리과정을 구현함으로써 시스템의 효율성을 높였고, 환자 스스로의 자기관리를 위한 UX 디자인을 제시하였다. 제안 시스템의 성능을 검증하기 위해 총 94,467건의 실제 임상 데이터를 수집하여 제안시스템을 테스트한 결과 전체 대비 64.8%가 필터링 되는 등 높은 효율성이 검증되었다.
Recent changes in health care environment including aging population and prevalence of chronic disease encourage the adoption of new innovative technological solutions including wearable vital sensors, wireless networks, and smart phone. In this paper, we present an effective at-home lifestyle monitoring system that can be used for self-management and health intervention of patient himself in the Management-by-Exception perspectives. We implemented the filtering and queuing algorithms as a preprocessor of monitoring system to enhance efficiency of proposed system, and the effective UX design for self-management of patients themselves. The 94,467 actual clinic data was used to test the efficiency of the proposed system. As as a result, 64.8% of the incoming vital data was identified to be filtered out.
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