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By I. Yugul. University of Wisconsin-Stevens Point.

D intoxication 10 mg prednisolone may be sufficient while in malignancy doses up to 60 mg/d may be required buy cheap ciprofloxacin 1000mg. Causes of hypocalcaemia 1- Renal failure 2- Hypoparathyroidism (surgical cheap ciprofloxacin online mastercard, idiopathic discount 1000 mg ciprofloxacin free shipping, pseudohypoparathyroidism) 3- Vitamin D deficiency 4- Hypoalbuminaemia 5- Acute pancreatitis In renal failure, hypocalcaemia is due to the lack of activation of vitamin D and to the hyperphosphataemia which will cause drop of serum calcium. The presence of acidosis will delay the manifestations of hypocalcaemia by increasing serum ionised calcium. Vitamin D deficiency may be due to decreased intake, decreased exposure to sun light, defective gut absorption or lack of its activation. Hypovitaminosis D is characterized with hypocalcaemia, hypophosphataemia and hyperparathyroidism. While in chronic hypocalcaemia the main features are depression, irritability, intracarnial calcification. Metabolic Acidosis Metabolic acidosis can result from the generation or the ingestion of acid; or from the loss of bicarbonate ions with consequent accumulation of H+ in the circulation. But in practice, the term acidosis is usually used whether the pH level is within the normal range or lower. Causes of metabolic acidosis with high anion gap are: • Lactic acidosis; the anion toxic substance here is lactate • Diabetic ketoacidosis with accumulation of acetoacetic acid; B- hydroxybuteric acid • Intoxication with methyl alcohol; Ethylene glycol, paraldehyde and salicylates. Renal causes of metabolic acidosis with normal Anion gap: 1- Diamox, a diuretic which causes bicarbonate wastage (bicarbonaturia). Treatment: 1- Treatment of the etiologic cause 2- If there is respiratory failure, assisted respiration (ventilator) should be provided. Diuretic therapy, secondary aldosteronism in cirrhotics and severe vomiting are the common causes of metabolic alkalosis. Clinical features: 1- Manifestations of the cause 2- Manifestations of neuromuscular irritability owing to the decreased ionized calcium. Treatment: 1- Of the cause 2- Support respiratory and renal compensatory mechanisms. Etiology And Classification Of Hypertension: Hypertension, according to severity and target organ damage (of retina, kidney, heart) could be classified into benign or malignant. Etiologically, hypertension may be classified as essential (primary) or secondary. This may be due to diseases of the renal artery as renal artery stenosis (renovascular hypertension) or disease of the renal parenchyma as glomerulonephritis (Renoparenchymal hypertension). On the contrary, in the presence of renal artery stenosis this group of drugs are contraindicated. Plasma sodium will be high and bicarbonate will be above 30 mmol/L, also plasma renin will be low. Treatment depends mainly on surgical excision and in bilateral cases steroid replacement may be needed. C- Pheochromocytoma: This is a tumour of chromaffin cells occurring in all age stages. In children, the tumour is always highly malignant (neuroblastoma and medulloblastoma), while in adults the tumour is always benign. In 90% of cases the tumours is in adrenal medulla while in 10% the tumour is extra-adrenal affecting the sympathetic chain. Beside the clinical criteria of this tumour, serum and urinary catecholamine assay will confirm the diagnosis. The tumour is extremely sensitive to X-ray contrast media, on exposure it will secrete a huge amount of catecholamine with fatal outcome. So, in hypertensive patient if pheochromocytoma is expected, this should be excluded first; by catecholamine assay before the patient is subjected to the contrast media. Treatment is by hypotensive drugs having A and B-adrenergic blocking properties as labetalol and carvedilol. Abdominal paracentesis, vigorous diuretic therapy and bleeding- especially gastrointestinal-are known precipitating factors. Laboratory assessment will show a progressive increase in serum creatinine and blood urea. Mainly those with potentially reversible acute liver disease and those awaiting orthotopic liver transplantation. As protein in urine decreases the surface tension, it causes frothy urine which may be observed by some patients (bile salts and detergents used in toilets do the same). Dipstick is a plastic strip, attached to it is a paper impregnated with chemical substance (tetrabromophenol) which is normally yellow in colour and changes according to amount of protein in urine (0, +, ++, +++). Proteinuria detected by dip stick test should be confirmed by collecting the 24 hours urine and testing for quantity of proteinuria using chemical methods. Definitions: • Proteinuria is a secretion of an abnormal amount of protein in urine. Most of this protein is albumin and Tamm Horsfall protein with smaller amounts of immunoglobulins. False negative proteinuria is observed when protein excretion is mainly Bence Jones proteinuria and when urine is very diluted. Abnormality in permeability of the glomerular basement membrane because of glomerular disease or abnormal glomerular hemodynamics. Functional proteinuria: There is no organic change in the kidney tissue: it is usually less than 1 gm/d and is reversible. Possibly, it is due to hemodynamic changes or to minor glomerular disease which are reversible. Chronic interstitial nephritis such as bacterial (pyelonephritis), gouty nephropathy, analgesic nephropathy or nephrolithiasis. Tubular proteinuria such as Fanconi syndrome, heavy metal intoxication (lead, cadmium), multiple myeloma, hypokalaemic nephropathy, polycystic kidney disease and medullary cystic kidney disease. Primary glomerular disease: refers to all types previously discussed under glomerulonephritis. Characterization of proteinuria: After diagnosis of proteinuria by dip stick test, it should be confirmed by quantitative estimation of 24 hours proteinuria. Further assessment may include electrophoresis or immunoelectrophoresis to determine the type of abnormal protein excreted. Kidney function tests: serum creatinine, creatinine clearance, electrolytes (Na, K, Ca, Po4). Examination of the kidney for its size, state of parenchyma, the presence of stone, back pressure change or pyelonephritic changes. Investigations to discover malignancy which could be the etiologic cause of proteinuria e. Renal biopsy will give the final answer for the diagnosis of the kidney lesion causing proteinuria. In gross hematuria, urine looks red if alkaline, but brown or coca-cola like if urine is acidic due to denaturation of the hemoglobin.

On the one hand discount 750 mg ciprofloxacin mastercard, a small cell with a small variance compared to the other groups has the effect of inflating the F value order genuine ciprofloxacin online, that is order 500 mg ciprofloxacin mastercard, of increasing the chance of a type I error. Frequency table Parity Valid Cumulative Frequency Per cent per cent per cent Valid Singleton 180 32. In this example, Analysis of variance 119 the dependent variable is weight and the factor is parity. The plots that are most useful to request are the box plots, histograms and normality plots. The Descriptives table shows that means and medians for weight in each group are approximately equal and the values for skewness and kurtosis are all between −1and +1, suggesting that the data are close to normally distributed. However, the data for babies with one sibling do not appear to conform to a normal distribution based on these tests because the P values of 0. The normal Q–Q plot for babies with one sibling deviates slightly from normality at both extremities. Although the histogram for babies with three or more siblings is not classically bell shaped, the normal Q–Q plot suggests that this distribution conforms to an approximately normal bell curve. However, the outliers should be confirmed as correct values and not data Analysis of variance 121 Histogram for parity = Singleton 25 Mean = 4. Once they are verified as correctly recorded data points, the decision to include or omit outliers from the analyses is the same as for any other statistical tests. In a study with a large sample size, it is expected that there will be a few outliers (see Chapter 2). In this data set, the outliers will be retained in the analyses and the residuals will be examined for the presence of extreme values (discussed later in this chapter) to ensure that these outliers do not have an undue influence on the results. Therefore, each sum of squares is divided by its respective degree of freedom (df ) to compute the mean variance, that is, the mean square. The degrees of freedom for the between-group sum of squares is the number of groups minus 1, that is, 4 − 1 = 3, and for the within-group sum of squares is the number of cases in the total sample minus the number of groups, that is, 550 − 4 = 546. Therefore, the null hypothesis is rejected and we conclude that there is a significant difference in the mean population values of the four parity groups. Eta squared is calculated as the ratio of the factor variance to the total variance and values range from 0 to 1. Eta squared can be converted to Cohen’s f which gives an average standardized differ- ence between the mean values of the groups. The formula is as follows: √ 2 Cohen’s f = (1 − 2) √ Thus for the model above, Cohen’s f = 0. However, eta squared is a biased estimate of the strength of association, in that it overestimates the effects, especially for small sample sizes. B W T W Thus for this example, if the sample size in all cells had been equal, 2 0. Alternatively, post-hoc tests, which may involve all possible comparisons between group means can be used. Post-hoc tests are often considered to be data dredg- ing and therefore inferior to the thoughtfulness of planned or aprioricomparisons. It is always better to conduct a small number of planned comparisons rather than a large number of unplanned post-hoc tests. When the F test is not significant, it is unwise to explore whether there are any between-group differences. Pairwise comparisons are used to determine which groups are statistically significantly different from each other. Group-wise comparisons are used to identify subsets of means that differ significantly from each other. A conservative test is one in which the actual P value is larger than the true P level, and the probability of a type I error occurring will be less than the level of significance specified ( ). Thus, conservative tests may incorrectly fail to reject the null hypothesis because a larger effect size between means is required for significance. A liberal test is one in which the actual P value is smaller than the true P value and the probability of a type I error occurring will be greater than the level of significance specified. Thus, liberal tests may result in the incorrect acceptance of the null hypothesis. The choice of post-hoc test should be determined by equality of the variances, equality of group sizes and by the acceptability of the test in a particular research discipline. For example, Scheffe and Tukey’s honestly significant difference tests are often used in psy- chological research, Bonferroni in clinical applications and Duncan in epidemiological studies. On the other hand, confirmatory studies are those which are designed to col- lect definitive proof of a predefined hypothesis that will be used in final decision making in clinical settings. Between the two extremes of exploratory studies and confirmatory studies, there is a wide range of different types of investigations − in all studies it is important to make a considered decision about what method, if any, is used to control the type I error rate. The Multiple Comparisons table shows the mean difference between each pair of groups, the significance and the confidence intervals around the difference in means between groups. SigmaPlot can be used to plot the mean differences and 95% confi- dence intervals as a scatter plot with horizontal error bars using the commands shown in Box 3. This figure shows that three of the comparisons have error bars that cross the zero line of no difference. The remaining three comparisons do not cross the zero line of no difference and are statistically significant as indicated by the P values in the Multiple Comparisons table. Therefore, each P level obtained from a Bonferroni test in the Multiple Comparisons table should be evaluated at the critical level of 0. The mean values are identical but the confidence intervals are adjusted so that they are wider as shown in Figure 5. Under this test, there is a progressive comparison between the largest and smallest mean values until a difference that is not significant at the P < 0. The output from this test is presented as subsets of groups that are not significantly different from one another. Thus in the table, the mean values for groups of singletons and babies with one sibling are not significantly different from one another with a P value of 0. Similarly, the mean values of groups with one sibling, two siblings, or three or more siblings are not Homogeneous Subsets Weight (kg) Subset for alpha = 0. Singletons do not appear in the same subset as babies with two siblings or with three or more siblings which indicates that the mean weight of singletons is significantly different from these two groups at the P < 0. Means plot A means plot provides a visual presentation of the mean value for each group. It also provides visual evidence as to why the group with one sibling is not significantly different from singletons or babies with two siblings or with three or more siblings, and why singletons are significantly different from the groups with two siblings or with three or more siblings. Also, the line connecting the mean value of each group should be removed because the four groups are independent of one another. However, the cell sizes are unequal and therefore the weighted linear term is used. The table shows that the weighted linear term sum of squares is significant at the P = 0. The P value for the linear term-weighted indicates that the slope of the line through the plot is signifi- cantly different from zero. The descriptive statistics show that the mean weight increases as parity increases.

Of these purchase ciprofloxacin 250mg with visa, the patients who previously had J Rehabil Med Suppl 55 Poster Abstracts 123 history of stoke or cognitive impairment had excluded and forty 415 one patients were enrolled purchase 750mg ciprofloxacin. Cakci 1Dıskapı Yıldırım Beyazıt Education and Reserach Hospital order discount ciprofloxacin, Physi- ity was graded as mild, moderate, or severe on the Fazekas scale. Rehabilitation Center, Department of Physical Therapy and Reha- Results: Severe leukoaraiosis was diagnosed in 2 patients (4. There to bilateral masseter muscles in early stroke patients with dyspha- were no signifcant difference in the baseline characteristics of the gia. Material and Methods: Ninety-eight patients with dysphagia study cohort by leukoaraiosis severity except for age and modifed within the frst month after ischemic stroke included in this study. Results: During inpatient rehabilitation, were administered at pretreatment, posttreatment, and 1-month he was consulted to psychiatry for suspected hallucinations and posttreatment. Recent studies has showed homocystein tendency of the Delta band power spectra in both brain hemispheres. Ahmad bilitation robot is a new physical therapy technology to provide 1Department of Rehabilitation Medicine, Penang General Hos- high-precision, high repeatability of training and visual, auditory pital, Penang, Malaysia, 2Rehabilitation Physician and Head of comprehensive feedback. Our study was designed to observe the Department, Department of Rehabilitation Medicine- Penang Gen- effect of upper limb rehabilitation robot for upper limb function in eral Hospital, Penang, Malaysia stroke patients. Material and Methods: One hundred patients with acute stroke were randomly divided into a control group (50 cases) Introduction/Background: Intensive rehabilitation medicine ser- and a therapy group (50 cases). All of the patients were treated vices, when offered as an organized and structured inpatient pro- with conventional medical treatment and rehabilitation training. Moreover, these scores continued to rise:12-week and daily sessions of therapy, with an average stay of 3. Conclusion: Robot- in chronic stroke patients and subsequently offers renewed hope based rehabilitation can be applied to patients with acute stroke in and potential for these patients who should no longer be side-lined a clinical setting and may be benefcial for improving the upper as “dead end cases”. The treatment group was treated with and lower limb function in post-stroke patients. Two cases of the observation group At the time of discharge, all of the evaluated items showed a statis- off, shedding 4. Three cases of the treatment group tically signifcant improvement relative to the scores at admission. In upper limb function, there was no statistically signif- cidence of shoulder pain in control group increased (p<0. Hiroshi2 1Tokyo Metropolitan University, Graduate School of Human Health Introduction/Background: The program of prolonged stretching Sciences, Tokyo, Japan, 2Hanno-Seiwa Hospital, Rehabilitation in conjunction with local injections of nerve blocking agents after 3 Center, Saitama, Japan, Saitama Medical University, Department stroke aims to improve upper limb function, but current evidence of Neurology and Cerebrovascular Medicine, Saitama, Japan, of functional benefts of exercise for arm function is discussed. We 4 have evaluated the effects of combination of the stretching train- Saitama Medical University, Department of Rehabilitation Medi- ing and local botulinum-toxin injections. Material and Methods: cine, Saitama, Japan 30 patients with post stroke time from 1 to 15 years were investi- Introduction/Background: It is important to be able to predict gated. Were measured the active and passive movements and rest- whether a patient will be able to walking and activities of daily liv- ing angles of paretic upper limb. Analysis was purpose of this study was to classify stroke patients by their prop- made using Mann-Whitney U-test, Wilcoxon matched pairs test erties into several groups, and investigate their association with and Spearman correlation. Material and Methods: Seventy-two frst attack stroke dle and proximal joints of the 2, 3, 4, 5 fngers decreased after 30 patients with severe hemiplegia at admission were included in this days of the treatment (p=0. No relationships between post stroke time rhage in 51 and subarachnoid hemorrhage in 6. We divided stroke patients into group by their properties days of the integrated therapy of the local injections of the botuli- and physical function on admission by the cluster analysis. Age, possibly prevent stroke patients from performing independent daily time from stroke onset, nutritional status, neurological symptom, activities as well as increase the risk of recurrent stroke. Hence, trunk ability and knee extension muscle strength on the non-paretic early interventions incorporating with aerobic training are sug- side at admission were signifcantly difference among the groups. However, this might not be feasible or practical for stroke signifcantly difference among the groups. The purpose of this study was to compare sults suggest that the classifcation of severely hemiplegic stroke the one-leg versus two-leg symptom-limited cycling tests in early- patients is useful to predict prognosis in a rehabilitation hospital. Material and Methods: This study recruited 6 male subacute stroke patients (onset time: 2 weeks to 3 months) with an averaged age of 47. Conclusion: This pilot study sug- Tsukuba, Japan, 4University of Tsukuba Hospital, Department of gests that for subacute stroke patients with very low ftness levels, Neurosurgery, Tsukuba, Japan physiological responses induced by one-leg cycling test are similar to those by two-leg cycling test. More studies to further confrm Introduction/Background: In patients with hemiplegia after stroke, this evidence are needed. Hussein1 dependently maintain standing posture using an All-in-One suspen- 1 Cheras Rehabilitation Hospital, Department of Rehabilitation sion device, and had detectable bio-electric potential from hip fexor Medicine, Kuala Lumpur, Malaysia muscles within 30 days after onset. Involvement of the cardiovascular system particu- 10m walking test and 12 grade recovery grading. Gait changes were larly aortic dilatation and dissection places high risk of morbidity investigated by two-dimensional motion analysis (Dartfsh Software and mortality in individuals with Marfan Syndrome. Material and Methods: Descriptive case report to high- sion angle and stance phase duration of the affected limb. In accord- light the complexities and challenges of stoke rehabilitation of a ance, increased step length and walking velocity,and improvement young individual with Marfan Syndrome. Conclusion: The observation indicates pos- gentleman with Marfan Syndrome was referred to the inpatient re- sibility of enhancing early functional recovery by early intervention habilitation facility for developing a massive right middle cerebral in cases with detectable motor related bio-electric potential. This occurred immediately upon comple- other hand, physical therapy for acute phase stroke rehabilitation tion of Bentall procedure; which was performed to treat his aortic induces neural facilitation by voluntary loading on the affected limb valve and ascending aorta disease. The stroke related impairments were dense left hemiplegia, visuo-spatial defcits and psychological effect with low 426 mood. He endured a Kaohsiung, Taiwan, 2Kaohsiung Municipal Cijin Hospital- Kaohsi- prolonged stroke rehabilitation phase, with strict cardiac precau- ung Medical University, Department of Physical Medicine and Re- tions. He progressively improved and became independent within a habilitation, Kaohsiung, Taiwan, 3Chang Gung University, Physi- course of 6 months. Conclusion: Marfan Syndrome is a connective cal Therapy Department and Graduate Institute of Rehabilitation tissue disease with multi-system complications. This system improves motor functions of the a 20 years old lady who was diagnosed with right acoustic neuroma hemiparetic upper limbs. Here we investigated the effectiveness of and developed neurological defcits (dysphonia, dysphagia, ipsilat- this system in chronic stroke patients. Material and Methods: Par- eral peripheral facial paralysis, ipsilateral hearing loss, contralateral ticipants: The eleven patients (male: female, 6:5; mean age: 65. Six control patients who underwent training without this sys- tine infract after the surgery. Interventions: The patients undergoing dual electrical muscle was diagnosed with left trigeminal schwannoma and developed stimulation of the upper limb and controle patients trained for 60 neurological defcits (dysphagia, contralateral central facial palsy, min per day, 5 days per week for 3 weeks. Main Outcome Meas- contralateral hemiparesis and hemi-sensory defcits) resulted from ure: Outcomes were assessed using the upper extremity compo- left pontine hemorrhage after the surgery. Conclusion: This study demonstrates that our therapies, they achieved moderate to high level of independence one new dual muscle electrical stimulation system may be effective for year after the event.

I am a physician assistant who has been practicing primary care generic ciprofloxacin 750 mg without prescription, nutrition buy ciprofloxacin amex, and integrative medicine since 1983 ciprofloxacin 1000 mg visa. I know that lifestyle habits and actions have a one-to-one correlation with how we look and feel and what diseases we get. Sometimes, when I see how much people are suffering physi- cally, mentally, and emotionally from unnecessary illness, I want to just grab them and say, “This doesn’t have to happen! Or better yet, have them read about the lifestyle habits of successfully aging populations from around - xxvii - staying healthy in the fast lane the world who are living functional and meaningful lives into their eighties, nineties, and one hundreds with minimal chronic dis- ease. Their children, grandchildren, and relatives who adopt the modern, Western lifestyle get these chronic diseases as soon as they start living this lifestyle, either by immigrating to the West or as the Western lifestyle comes to them due to globalization. The best part about all of this is that it isn’t even difficult—at least not the know-how. The major chronic diseases of developed coun- tries (heart disease; diabetes; stroke; bone loss; arthritis; aging eye disorders such as macular degeneration, glaucoma, and cataracts; aging neurological disorders such as Alzheimer’s and Parkinson’s; and most cancers) are largely preventable, are sometimes revers- ible, or can, at the very least, be significantly delayed or diminished in severity by practicing what I call the 9 Simple Steps to Optimal Health. I will show you these nine simple steps that are guaranteed to improve your health if you apply them daily and consistently! My Challenge to You I am going to challenge you on every page in this book to take the healthcare reform debate out of the hands of the politicians and take charge of creating your own healthcare insurance or se- curity. If we all practiced these 9 Simple Steps to Optimal Health we could save billions of dollars as a country, be so much more productive work-wise, and be more present to our families and loved ones. Collectively we could focus our energies and talents on solving the world’s difficult problems. The first step is to educate yourself with understandable, credible, and practical health infor- mation. That is my commitment to you: to provide health infor- mation that is non-hyped, factual, and usable in the busy, modern world. Stop blaming big pharmaceutical companies, the - xxviii - introduction fast- and processed-food industries, health insurance companies, your employer, corporate agribusiness, the “hospital-industrial complex,” and, yes, good old Uncle Sam. The third step is to take daily action and practice these health principles consistently and with intention. Personal Responsibility: The Key to Being Healthy Yes, government officials could obviously be less wasteful, more efficient and accountable, and not give subsidies to make unhealthy food cheaper, and on and on. But the truth is you can take the issue out of their hands immediately by living these simple lifestyle practices right now! The last time I ate a meal, Uncle Sam didn’t grab my fork and stick it in a fat, juicy steak or grab a piece of pizza and stuff it into my mouth. Uncle Sam didn’t make me take the escalator versus the steps or park as close as possible when I go shopping so that I would not have to walk farther… Are you catching my drift? Make simple, good choices about what you put into your mouth every time you eat and commit to moving every day, and our current healthcare crisis will become a non-issue. We will become more productive as a nation, and you will have more time and money to be you. Those industries that don’t have our real health interests at heart will have no power. If we stay well, insurance companies, big pharma, and factory medicine have no muscle. If daily, we make the right whole-food choices and exercise, not only do we stay healthy, but agribusiness and the fast-food industries will then have to change or die. It could happen literally overnight with the simple daily choices we make to feed ourselves. The onus is on you once you educate yourself and understand some basic principles. Once you understand and re- ally believe that there are cultures and individuals who have mini- - xxix - staying healthy in the fast lane mal chronic disease, you will begin to see the fundamental lifestyle practices that allow them to achieve this state of health. Once you understand, by simply looking at the figures in this book, how the modern diet and lifestyle have changed over the last fifty to one hundred years, setting the stage for these diseases, then the prac- ticing of these 9 Simple Steps to Optimal Health is a “no-brainer. Preventive Care You might ask, “If it is so obvious, Kirk, why isn’t everybody al- ready doing these things and experiencing health and vitality even into old age? This is a backward model that can only lead to more chronic disease, more suffering, and more unnecessary medical expenditures. We don’t compensate people and professionals for preventing these chronic diseases in the first place. We don’t give economic incentives for patients to stay well or to businesses to keep their employees well. Insurance companies have no incen- tive to encourage prevention of disease if they keep raising pre- miums to treat more chronic diseases and we (individuals, busi- nesses, and government) keep paying the premiums. So with our current healthcare model, unless the “pain” is great enough or the country goes bankrupt, it can’t and won’t lead to necessary change. I must say, though, that as a society, we may be approaching the pain threshold that will make us act. When I began to write this book, I imagined that I would be talking to you, the individual reader, as I would one of my patients. Yet for many people, a deeper understanding is important because it puts a reason behind the recommendations. Many people jump on and off healthful practices because they don’t really understand how health works; they are very frustrated and looking for a “quick fix” that never really works in the long run. I strongly believe that if you understand why we are unhealthy as individuals, a country, and now the world, and understand the “how to” of these 9 Simple Steps to Optimal Health, you will be able to stay on a positive, health-promoting lifestyle. The truth is that good health is much simpler than investing in the stock market, running a business, or being a working mother with three chil- dren. You will experience an immediate return if you just keep practicing these principles 80 to 90 percent of the time. Having a healthy workforce and a strong economy can only enhance our security as a nation. Leading the World to Good Health With this example of positively changing the health of the Unit- ed States, and thereby improving our economy, work productiv- - xxxi - staying healthy in the fast lane ity, quality of life, and environment, we (the United States) can be the world leader we should be. In this free market system full of positive, health-promoting entrepreneurship, in conjunction with “lean” government, we can show other countries how to help their own people be healthy and productive and reduce this needless toll of suffering and cost that comes from chronic diseases related to the modern lifestyle. The message in this book is not just meant for the individual or even for my own country; it is meant for the whole world. Even in the days before she passed, she never lost her positive spirit or her will to succeed. One of my favorite memories of her is huffing and puffing, attached to her oxygen tubing and using her walker as she slowly crossed my dance floor, cheering herself on. The nutrition and exercise data are there; the ex- amples of successfully aging cultures living with minimal chronic disease are there. Chronic diseases, such as heart disease, cancer, diabetes, high blood pressure, stroke, arthritis, bone loss, and degenerative neu- rologic and ocular diseases are increasing worldwide as the world urbanizes. These chronic conditions account for 70 percent of all deaths in the United States and 60 percent of all deaths worldwide. These chronic conditions can be significantly reduced, their progression slowed, and some virtually eliminated by lifestyle changes involv- ing diet, increased physical activity, and positive mental condition- ing.

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