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401076 Epidemiology Question: Select one of the following papers: Outcomes of obese Clozapine-treated in-patients with schizophrenia placed on six-month diet and physical activity program.   Reflux-Inducing Dietary Factors and Risk of Adenocarcinoma of the Esophagus and Gastric Cardia. Nutrition and Cancer Answer: The paper addresses a number of issues such as the weight increase among patients with schizophrenia and who are undergoing clozapine treatment. The weight increase among the schizophrenia patients is as a result of the enhanced appetite them. Diabetes Mellitus, cardiovascular disease, and hypertension are the other conditions of obesity among the schizophrenia patients, these conditions may be of serious detriment to the health of the patients (ARONSON, 2010). Clozapine drug is a benzodiazepine derivative and a generation antipsychotic for the treatment of schizophrenia patients. Clozapine is has been found out to be having a greater potential to induce weight increase in human beings (Aronson, 2013). Weight gained as a result of antipsychotics is a main cause of noncompliance which results in a discontinuation of treatment which in turn causes psychotic symptoms (Barnes, 2013). However metabolic changes such as reduced levels of insulin, higher levels of cholesterol, triglyceride, and glucose have been seen to be having a greater impact among long-term clozapine patients as compared to those who are treated with second-generation antipsychotics (Buckley, 2016).It is of great importance to manage the condition of weight gain among patients who are undergoing long-term medication of clozapine without implementing alternatives medications. The paper is of great importance as it explains the root causes of the unexpected weight increase among patients who are undergoing treatment with clozapine and what should be done to avoid the rise of obesity-related conditions to this patient which in turn can result to overall deteriorating of their health. Hormones of growth are considered to be very powerful agents in regulating and maintaining effective functioning of the cardiovascular system, it improves on how the cardiac system functions this is due to the fact that low levels of this hormones result in health diseases (DiPiro, 2014).  Exposure Or Intervention Of The Study Many innervations were put in place to avert this, such as the control of the diet which was implemented and championed by a registered dietician whose main intention was to ensure that the intake of calories was restricted within 1,300 and 1,500 kcal for women per day and 1,600 and 1800 kcal for men per day (Fawcett, 2013). The caloric intake was measured and accessed types of different foods which the patients ate which were including the vegetables and fruits, foods which were free of sugars, drinks and artificial sweeteners. The intake of the macronutrients was to ensure that the participants were in compliant with the expected results (French, 2014). The Taiwanese diet currently is 10% to 14% calories which are obtained from proteins 20 to 30 percent obtained from fats and 58 to 68 percent from was recommended that people of all ages should obtain 30 minutes of physical activities which are of moderate intensity such brisk walking in most days of the week. The physical activity programme was designed so as to fit the hospital environment in which the patients will be exercising. To motivate participants were awarded rewards such as soap, toilet papers, and drinks which are free of sugars (French, 2014).  The Study Design During The Study Body parameters and other anthropometric measurements were accessed after the overnight fasting of the participants. A body composition analyzer also measured body weight and the percentage of fats in the body. Audiometer was used to measure the height of the participants. Hip and waist circumferences were measured in centimeters. The BMI was achieved by calculating weight divided by the height squared. Waist to hip ratio was calculated dividing the waist circumference with hip circumference (James, 2011). The effectiveness of the treatment plan was assessed by covariance and variance analysis. The metabolic, hormonal an anthropometric data which was obtained from the study which was carried out as compared with the data which was obtained from the control group. Analysis of the metabolic and enzyme immunoassay, serum, glucose, cholesterol, triglyceride and pro lactic were measured from blood by using an autoanalyzer which measures glucose, triglyceride enzyme, and cholesterol respectively. Insulin, serum cortisol, and prolactin were measured by an enzyme immunoassay system (Jobson, 2017). Blood sampling was carried out after the overnight fasting whereby blood samples were drawn from the patients by a trained phlebotomist .from the blood samples which were drawn were used for the analysis of the metabolic rates and enzyme assay (Jobson, 2017). The controlled and randomized study which took place was undertaken so as to investigate and benefits of dietary control and the impacts of physical exercises on the patients who are suffering from the condition of obesity with patients of schizophrenia who are undergoing clozapine treatment (Kasper, 2014).  The Study Population The participants who took place in the study included the 753 hospitalized the years of 2003 and 2004 .all the patients who were diagnosed they had a DSM-iv schizophrenia and all of them were between the age of 18 and 65 years old. They considered having the patients taking at least 300mg of the prescribed clozapine orally daily for at least one year and having a body mass of which is greater than 27kg/m2 (Koslow, 2013).The people with such mass are considered to be obese.patients who were  taking any other antipsychotic other than clozapine were excluded  and if they were taking any other lipid which was lowering their medications, and if they  had any  abnormal condition of ambulatory functions, failure of organs, patients who have  serious mental illness, and the patients who were pregnant or lactating, patients who had mental retardation, patients who had disabilities which were preventing them from walking and the ones who were in an acute condition of mental illness (Thakore, 2012). Using the criteria of inclusion and exclusion 56 patients were randomly selected and they were divided between the study group and the other group which was to act as the control group. The study was then performed following strict rules and regulations which were according to the declaration of Helsinki and which was approved by the Yu-li veteran’s hospitals of ethics review committees. All the patients who were to participate were provided with information informing them about the study before they took part in it.thi9s was to ensure that the rights of the patients were not violated in any way and also it was to ensure that the safety of the patients who were to participate was not interfiled with at any given point (Rodney, 2014). The Main Findings Of The Study Of all the patients who were to undertake the study fifty-three of them managed to complete the study three of them withdrew from the study and all of them were from the control group, they withdrew because all of them were discharged from hospital during the second month of the study. The 53 who remained all of them were patients with schizophrenia undergoing clozapine treatment and other obesity-related conditions (Philip G. Janicak, 2011). Twenty-five out of the fifty-three who remained were assigned to the control group while the rest were to remain the study the control group, 11 men were there which was 44 percent and 14 women which were 56 percent no significant differences were noted between the control and the study group in gender distribution in the groups and the average age of the participants. There were significant differences which were noted between the control group and the study group in terms of glucose, prolactin, cholesterol and insulin levels after the three months of intervention. There was a significant decrease from triglyceride baseline levels and cortisol concentration (Pagoto, 2014). Internal Validity Of The Study The results which were presented had a very high level of accuracy and its very hard for them to change or be biased at any point because the study demonstrates the benefits of the intervention which took six months which was consisting of the integration  of the dietary control and the  programme which supports regular physical for the obese patients and schizophrenia are being treated with the the innervations which were taken they resulted in a big decrease in the BMI, waist and hip circumferences, the percentage of fats in the body (Nordentoft, 2013). All the patients who were participating showed a positive change in the anthropometric measurements, no amelioration in the triglyed and the insulin levels and they also showed a lower molar ratio. The dietary guidelines and principles suggest the loss of weight at the rate of o.5 to1.0 kg per week may occur in a safer manner which ensures that the patients with obesity have reduced for up to six months which the study was conducted, data collected and results were given (Nordentoft, 2013). The participants diets contained 200 to 300 fewer kilocalories approximately per day than what the participants used to consume initially which resulted to them becoming obese the patients were expected to expend 600 to 700 kcal per week which was to result in more energy through the physical activities which were increased conclusion for this level was reached to minimise any possible adverse effect which was to come from the new approach of diet which was adopted (Nasrallah, 2013). Mental and emotional instability among the obese patients who were undergoing treatment with clozapine who had consumed many levels of calories as compared to the other patients. The specific physical activities which were selected were suitable for the patients with obese and also who were also suffering from the condition of schizophrenia on clozapine treatment because they were much uncomplicated and mild and they were not holding any danger for these patients. Walking does not require any expensive equipment or fac9lities.walking can be done by one person or when it is a group of people. Obesity patients who have a severe mental illness can take walking as part of their physical activities which in turn help them reduce weight (Miller, 2015). The Special Mechanism Illustrated/Suggested According to the results all the 28 patients in the study group, they all completed the programme of six months which was ensuring diet control innervations and also an organized physical activities programme. The level at which the patients were complying and consequently the success rate which was observed may be lower than what was expected during the time of the study if the participants would have been outpatients rather the inpatient who took part in the study (Meyer, 2013). However, the high success levels made it possible to interpret the results at the end of the programme which was organised .patients were able to be guided in ways which they should be eating in a healthy way and also the minimal physical activities which they should be involving themselves in which may enable them to improve their condition (Meyer, 2013). The programme which was organised was of great benefit to the patients which was enabling them to reap many health benefits .within the hospital environment the key health care professionals were there to ensure that the weight management intervention was implemented in a proper way which was to ensure that the programme had a great benefit to the patients who were undertaking it (Merete, 2014). The treatment and prevention of the weight gain in the patients with psychiatric are very hard but it can be achieved. Even the smallest reduction of weight have a benefit. For the obese patients with schizophrenia who are undergoing treatment with clozapine. The programme intervention yielded a significant reduction in BMI, body weight, hip circumference and waist circumference (Marie Chisholm-Burns, 2010). This was suggesting that that the programme had been able to reduce BMI and also the results indicated that there was an improvement in various measures by the time the programme was ending, some of the parameters were reduced after the third month of the programme but others were reduced after six months when the programme was ending (Koslow, 2013). The entire participant’s anthropometry which included the BMI, body weight, waist and hip circumferences, physical activities and the dietary behavior was closely monitored regularly all through the period which the study was carried out. from the observations which were carried out during the study it showed that there was a great improvement among the patients who were willing to take part in the six month programme where the patients were encouraged to be having regular exercises and their diet was to be monitored so as to see the interventions which were to be put in place to ensure the obesity among patients who were undertaking treatment with clozapine (Fawcett, 2013). External Validity Of The Finding And The Overall Quality Of The Discussion It was found out that all the innervations which were involved in the control of dietary and the physical exercises which were done for the six months improved the health of the patients and the level of obesity among them was going down. the treatment of clozapine to be of great risk to the patients of obesity as they influences the increase of weight in the patients who are undergoing treatment the reports of the researches which have been done initially shows that the patients with schizophrenia have led to development of medical conditions and other ailments which puts the patients who are undergoing treatments with clozapine the risks of developing other complications which are closely related to obesity (Jobson, 2017). The physical activities and dietary control tried to normalize the condition of the patients this is because the physical activities and metabolic rates benefits were realized when the program was ending. The patients with obesity were advised to adopt this so as to reduce the cases of obesity. There were further proposals which were to make the patients adopt a lifestyle which supports regular physical exercises and the controlled diet (DiPiro, 2014). References ARONSON. (2010). Side Effects of Drugs Annual, Volume 27. new york Elsevier, Aronson, K. (2013). Meyler’s Side Effects of Psychiatric Drugs. london: Elsevier, Barnes, E. (2013). Revue Canadienne de Psychiatrie, Volume 49, Issues 1-6. new york Canadian Psychiatric Association. Buckley, P. F. (2016). Treatment–Refractory Schizophrenia: A Clinical Conundrum. PARIS: Springer Science & Business Media. DiPiro, J. (2014). Pharmacotherapy Principles and Practice, Third Edition. PARIS: McGraw Hill Professional. Fawcett, J. (2013). Textbook of Treatment Algorithms in Psychopharmacology. Sydney: Wiley. French, D. P. (2014). Schizophrenic Psychology: New Research. london: Nova Publishers, James, E. (2011). The American Journal of Psychiatry, Volume 1. London: American Psychiatric Association. Jobson, K. O. (2017). Biology Digest, Volume 23. yokohama: Plexus Pub. Kasper, S. (2014). Schizophrenia, Second Edition. sidney: CRC Press. Koslow, S. H. (2013). A Concise Guide to Understanding Suicide: Epidemiology, Pathophysiology, and Prevention. chicago: Cambridge University Press. Marie Chisholm-Burns. (2010). Pharmacotherapy Principles and Practice, Third Edition. berlin: McGraw Hill Professional. Merete, N. (2014). Forebyggelse af psykiske sygdomme. berlin: Munksgaard Danmark. Meyer, J. M. (2013). Schizophrenia Bulletin, Volume 33, Issue 1. London: U.S. Department of Health, Education, and Welfare. Miller, D. A. (2015). Drug-induced Diseases: Prevention, Detection, and Management. chicago: American Society of Health-System Pharmacists. Nasrallah, H. A. (2013). Medical Illness and Schizophrenia. chicago: American Psychiatric Pub. Nordentoft, M. (2013). Physical Activity Epidemiology 2nd Edition. PARIS: Human Kinetics. Pagoto, S. (2014). Psychological Co-morbidities of Physical Illness: A Behavioral Medicine Perspective. london: printer Science & Business Media. Philip G. Janicak. (2011). Schizophrenia: Recent Advances in Diagnosis and Treatment. london: Springer Science & Business. Rodney, T. (2014). Antipsychotic Drugs and Their Side-effects. chicago: Academic Press. Thakore, J. H. (2012). Metabolic Effects of Psychotropic Drugs. chicago: Karger Medical and Scientific Publishers,

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