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Effective self-care monitoring also requires being able to label and interpret changes in the body as normal or abnormal. Being able to interpret and label your symptoms, understanding the process of your disease, and knowing how to act and treat accordingly allows competency in knowing when to seek further medical help.
Self-care monitoring consists of both the perception and measurement of symptoms. This includes body awareness or body listening, recognizing symptoms relevant to health, and interpreting and labeling these symptoms.
For example, a patient with diabetes may use body listening to perceive feelings of shakiness and sweating.
These feelings are labeled as symptoms of low blood sugar, and the patient will decide how to act based on this information.
In heart attack patients, delays in seeking treatment for worsening symptoms have been found to contribute to poor health outcomes.
Changes in health status or body function can be monitored with various tools and technologies. The range and complexity of medical devices used in both hospital and homecare settings are increasing.
For example, various types of glucose monitors are used by patients with diabetes to track their blood sugar levels. Other devices can provide a more general set of information, such as a weight scale, blood pressure cuff , pulse oximeter , etc.
Less technological tools can include organizers, charts, and diagrams to trend or keep track of things such as amount of calories, mood, vital sign measurements, and more.
Barriers to monitoring can go unrecognized and end up interfering with effective self-care. Barriers can include knowledge deficits, undesirable self-care regimens, different instructions from multiple providers, and limitations to access related to income or disability.
Psychosocial factors such as motivation, anxiety , depression , confidence can also serve as barriers. Because self-care monitoring is conducted primarily by patients and their caregivers, it is necessary to work with patients closely on this topic.
Providers should assess the current self-care monitoring regimen and build off this to create an individualized plan of care.
When patients understand the symptoms that correspond with their disease, they can learn to recognize these symptoms early on.
Then they can self-manage their disease and prevent complications. Self-care management is defined as the response to signs and symptoms when they occur.
Self-care management involves the evaluation of physical and emotional changes and deciding if these changes need to be addressed.
Changes may occur because of illness, treatment, or the environment. Once treatment is done, it needs to be evaluated to judge whether it would be useful to do again in the future.
Treatments are based on the signs and symptoms experienced. Treatments are usually specific to the illness. Self-care management includes recognizing symptoms, treating the symptoms, and evaluating the treatment.
For example, a patient with asthma may recognize the symptom of shortness of breath. This patient can manage the symptom by using an inhaler and seeing if their breathing improves.
Regular self-care monitoring is needed to identify symptoms early and judge the effectiveness of treatments.
Access to care is a major barrier affecting self-care management. Access to the health care system is largely influenced by providers.
Many people suffering from a chronic illness do not have access to providers within the health care system for several reasons.
Three major barriers to care include: Financial barriers impact self-care management. The majority of insurance coverage is provided by employers.
Loss of employment is frequently accompanied by loss of health insurance and inability to afford health care.
In patients with diabetes and chronic heart disease, financial barriers are associated with poor access to care, poor quality of care, and vascular disease.
As a result, these patients have reduced rates of medical assessments, measurements of Hemoglobin A1C a marker that assesses blood glucose levels over the last 3 months , cholesterol measurements, eye and foot examinations, diabetes education, and aspirin use.
In addition, people with lower levels of education often lack resources to effectively engage in self-management behaviors.
Elderly patients are more likely to rate their symptoms differently and delay seeking care longer when they have symptoms. There are many reasons contributing to this difference in symptom experience.
Providers should be aware of the potential delay in provider-seeking behavior in elderly patients which could worsen their overall condition.
Prior experience contributes to the development of skills in self-care management. Experience helps the patient develop cues and patterns that they can remember and follow, leading to reasonable goals and actions in repeat situations.
This could lead to them recognizing their symptoms earlier, and seeking a provider sooner. Health care literacy is another factor affecting self-care management.
Health care literacy is the amount of basic health information people are able to understand. Health care literacy is the major variable contributing to differences in patient ratings of self-management support.
Individuals who can identify changes in their body are then able to come up with options and decide on a course of action. A poor healthcare experience may cause a patient to avoid returning to that same provider.
This creates a delay in acute symptom management. Providers must consider health literacy when designing treatment plans that require self-management skills.
A patient with multiple chronic illnesses may experience compounding effects of their illnesses. This can include worsening of one condition by the symptoms or treatment of another.
This limits the self-care management of their other illnesses. One condition may have more noticeable symptoms than others.
Or the patient may be more emotionally connected to one illness, for example, the one they have had for a long time.
Stoplight and skill teaching allow patients and providers to work together to develop decision-making strategies. It separates signs and symptoms into three zones:.
The stoplight plan helps patients to make decisions about what actions to take for different signs and symptoms and when to contact their healthcare team with a problem.
The patient and their provider will customize certain signs and symptoms that fit in each stoplight category. Skills teaching is a learning opportunity between a healthcare provider and a patient where a patient learns a skill in self-care unique to his or her chronic illness.
Other skills may be applied when there is an exacerbation of a symptom. An exacerbation of a symptom means that the symptom is in a worsened state or is different from what the patient normally experiences.
The patient should not only learn the purpose of self-care skills. It is also important to learn when to apply skills in daily management of a chronic illness and how the skill might be modified or changed when the patient experiences an exacerbation of a symptom.
For example, a patient newly diagnosed with persistent asthma might learn about taking an oral medicine for daily management, control of chronic symptoms and prevention of an asthma attack.
However, there may come a time when the patient might be exposed to an environmental trigger or stress that causes an asthma attack. The patient starts to experience shortness of breath, chest tightness or wheezing.
When this unexpected symptom occurs, the skill of taking daily medicines and the medicine that is taken may change. Rather than taking an oral medicine daily, a different medication is needed for quick rescue and relief of symptoms.
Botts dots are not used where it is icy in the winter, because frost and snowplows can break the glue that holds them to the road, although they can be embedded in short, shallow trenches carved in the roadway, as is done in the mountainous regions of California.
For major roads risk can be reduced by providing limited access from properties and local roads, grade separated junctions and median dividers between opposite-direction traffic to reduce likelihood of head-on collisions.
The placement of energy attenuation devices e. Some road fixtures such as road signs and fire hydrants are designed to collapse on impact. Light poles are designed to break at the base rather than violently stop a car that hits them.
Highway authorities may also remove larger trees from the immediate vicinity of the road. Speed limits can improve road traffic safety and reduce the number of road traffic casualties from traffic collisions.
In their World report on road traffic injury prevention report, the World Health Organization WHO identify speed control as one of various interventions likely to contribute to a reduction in road casualties.
Road conditions are the collection of factors describing the ease of driving on a particular stretch of road, or on the roads of a particular locality, including the quality of the pavement surface , potholes , road markings, and weather.
It has been reported that "[p]roblems of transportation participants and road conditions are the main factors that lead to road traffic accidents".
For example, for autonomous vehicles such as self-driving cars , significant road conditions can include "shadowing and lighting changes, road surface texture changes, and road markings consisting of circular reflectors, dashed lines, and solid lines".
Various government agencies and private entities, including local news services, track and report on road conditions to the public, so that drivers going through a particular area can be aware of hazards that may exist in that area.
News agencies, in turn, rely on tips from area residents with respect to certain aspects of road conditions in their coverage area.
Water management systems can be used to reduce the effect of pollutants from roads. Road runoff is a major source of nickel , copper, zinc , cadmium , lead and polycyclic aromatic hydrocarbons PAHs , which are created as combustion byproducts of gasoline and other fossil fuels.
De-icing chemicals and sand can run off into roadsides, contaminate groundwater and pollute surface waters ;  and road salts can be toxic to sensitive plants and animals.
Roads are a chief source of noise pollution. In the early s it was recognized [ by whom? Regulations can restrict the use of engine braking.
Motor vehicle emissions contribute air pollution. Concentrations of air pollutants and adverse respiratory health effects are greater near the road than at some distance away from the road.
Traffic flows on the right or on the left side of the road depending on the country. Roads are generally built and maintained by the public sector using taxation although implementation may be through private contractors.
Public-private partnerships are a way for communities to address the rising cost by injecting private funds into the infrastructure. There are four main ones: Society depends heavily on efficient roads.
According to the New York State Thruway Authority,  some sample per-mile costs to construct multi-lane roads in several US northeastern states were:.
See List of countries by road network size. Eurasia, Africa, North America, South America, and Australia each have an extensive road network that connects most cities.
Eurasia and Africa are connected by roads on the Sinai Peninsula. Antarctica has very few roads and no continent-bridging network, though there are a few ice roads between bases, such as the South Pole Traverse.
Bahrain is the only island country to be connected to a continental network by road the King Fahd Causeway to Saudi Arabia.
Even well-connected road networks are controlled by many different legal jurisdictions, and laws such as which side of the road to drive on vary accordingly.
Many populated domestic islands are connected to the mainland by bridges. Even on mainlands, some settlements have no roads connecting with the primary continental network, due to natural obstacles like mountains or wetlands, remoteness, or general expense.
Unpaved roads or lack of roads are more common in developing countries , and these can become impassible in wet conditions. Most disconnected settlements have local road networks connecting ports, buildings, and other points of interest.
For long-distance trips, passengers usually travel by air and rent a car upon arrival. If facilities are available, vehicles and cargo can also be shipped to many disconnected settlements by boat, or air transport at much greater expense.
The island of Great Britain is connected to the European road network by Eurotunnel Shuttle — an example of a car shuttle train which is a service used in other parts of Europe to travel under mountains and over wetlands.
In polar areas, disconnected settlements are often more easily reached by snowmobile or dogsled in cold weather, which can produce sea ice that blocks ports, and bad weather that prevents flying.
For example, resupply aircraft are only flown to Amundsen—Scott South Pole Station October to February, and many residents of coastal Alaska have bulk cargo shipped in only during the warmer months.
Permanent darkness during the winter can also make long-distance travel more dangerous in polar areas. Continental road networks do reach into these areas, such as the Dalton Highway to the North Slope of Alaska, the R21 highway to Murmansk in Russia, and many roads in Scandinavia though due to fjords water transport is sometimes faster.
Large areas of Alaska, Canada, Greenland, and Siberia are sparsely connected. For example, all 25 communities of Nunavut are disconnected from each other and the main North American road network.
Road transport of people and cargo by may also be obstructed by border controls and travel restrictions. For example, travel from other parts of Asia to South Korea would require passage through the hostile country of North Korea.
Moving between most countries in Africa and Eurasia would require passing through Egypt and Israel, which is a politically sensitive area. Some places are intentionally car-free , and roads if present might be used by bicycles or pedestrians.
Additional intercontinental and transoceanic fixed links have been proposed, including a Bering Strait crossing that would connect Eurasia-Africa and North America, a Malacca Strait Bridge to the largest island of Indonesia from Asia, and a Strait of Gibraltar crossing to connect Europe and Africa directly.
From Wikipedia, the free encyclopedia. A demarcated land route with a suitable surface between places. This article is about a route, thoroughfare or way that supports travel by a means of conveyance.
For a place outside a port a ship can lie at anchor, see Roadstead. For public roads, see Highway. For other routes, see Thoroughfare.
For other uses, see Road disambiguation. History of road transport. Environmental impacts of roads. Right- and left-hand traffic. The specific problem is: Cities list on the mainland not connected is either incomplete, America centric, or not formulated has examples.
Please help improve this section if you can. September Learn how and when to remove this template message. Embankment transportation Gravel road List of countries by road network size List of roads and highways Pedestrian zone Road slipperiness Road transport Track bed Trade route.
Ways of the World: National Department of Transport South Africa. Archived from the original on Most of the provisions apply on all roads throughout Great Britain, although there are some exceptions.
The land over which a public right of way exists is known as a highway; and although most highways have been made up into roads, and most easements of way exist over footpaths, the presence or absence of a made road has nothing to do with the distinction.
Historically, a highway comprehended any path in which members of the public had the right to pass and re-pass without let or hindrance. The term embraced footpaths, bridleways, driftways and so forth.
The advent of the motor vehicle and its peculiar requirements has seen increasing distinctions between paths over which walkers and riders have a right of way and those ways that are predominantly used by motor vehicles.
The former may be usefully termed "rights of way" and are the subject of a separate entry in this web and the latter may be termed "highways.
A passage through the country for the use of the people. Roads are public or private. Public roads are laid out by public authority, or dedicated by individuals to public use.
The public have the use of such roads, but the owner of the land over which they are made and the owners of land bounded on the highway, have, prima facie, a fee in such highway, ad medium filum viae, subject to the easement in favor of the public Private roads are, such as are used for private individuals only, and are not wanted for the public generally.
Environment and Planning B: The New York Times. Nutritional counseling can help overweight subjects to learn dietary behaviors for weight gain prevention.
It is more effective when a kind of healthy diet such as DASH is followed. We should note the limitation of these studies such as self-reported data, more proportion of men than women in the study, their design, no representative sample, dropout rate, motivated participants, and low dietary compliance.
Long-term maintenance of the lost body weight can be described as a success. Although meal replacement has beneficial effects on weight loss, it cannot guarantee weight maintenance.
It seems that consuming fewer calories helps people to maintain the weight loss. Some special behaviors are also associated with better weight loss maintenance.
Consuming a lower amount of sugar sweetened beverages, not being awake late at night, and consuming more healthy foods are some examples of such behaviors.
No special food can definitely promote weight maintenance. Therefore, there is a necessity to develop further research to find strategies in obesity management, focusing on the successful maintenance of weight loss.
All authors have read and approved the content of the manuscript. National Center for Biotechnology Information , U. J Res Med Sci.
Fatemeh Azizi Soeliman and Leila Azadbakht. Author information Article notes Copyright and License information Disclaimer. Box , Isfahan, Iran. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.
This article has been cited by other articles in PMC. Diet, feeding behavior, weight loss. Meal replacement One of methods that have been used a lot for preventing weight gain is meal replacement.
Table 1 Meal replacement and weight maintenance. Open in a separate window. Different macronutrient compositions in the diet Some researchers have tried changing macronutrient percents to find the most effective dietary mixture for weight maintenance.
Table 2 Macronutrient component and weight maintenance. Dietary behaviors Comparison of patients who have maintained their weight loss more than re-gainers shows that the subjects in first group stay late less at night, have increased physical activity after weight loss, drink less sugar sweetened beverages, eat less calorie from protein, and they have more emotional support.
Special foods Some studies have assessed the effects of special foods on weight maintenance. Table 3 Diet, Food, and weight maintenance.
Footnotes Source of Support: Do mental disorders and eating patterns affect long-term weight loss maintenance? A comparison of meal replacements and medication in weight maintenance after weight loss.
J Am Coll Nutr. The definition of weight maintenance. Human biology of weight maintenance after weight loss. The effect of eating behavior on weight loss and maintenance during a lifestyle intervention.
Taking control of your personal eating and exercise environment: A weight maintenance program. Predictors of long-term weight maintenance. A meta-analysis of US studies.
Am J Clin Nutr. Successful weight-loss maintenance in relation to method of weight loss. Who does not gain weight?
Prevalence and predictors of weight maintenance in young women. Weight maintenance and relapse in obesity: Prevalence and predictors of weight-loss maintenance in a biracial cohort: Results from the coronary artery risk development in young adults study.
Am J Prev Med. Enhancing Long-term Weight Loss Maintenance: Efficacy of a meal replacement diet plan compared to a food-based diet plan after a period of weight loss and weight maintenance: A randomized controlled trial.
Value of structured meals for weight management: Risk factors and long-term weight maintenance. A structured diet and exercise program promotes favorable changes in weight loss, body composition, and weight maintenance.
J Am Diet Assoc. Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: A 6-mo randomized, controlled trial.
One-year weight maintenance after significant weight loss in healthy overweight and obese subjects: Does diet composition matter?
Determining optimal approaches for weight maintenance: A moderate-protein diet produces sustained weight loss and long-term changes in body composition and blood lipids in obese adults.
Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. The effect of dietary glycemic index on weight maintenance in overweight subjects: Metabolic and behavioral compensations in response to caloric restriction: Implications for the maintenance of weight loss.
Better dietary adherence and weight maintenance achieved by a long-term moderate-fat diet. The effect of a high-MUFA, low-glycaemic index diet and a low-fat diet on appetite and glucose metabolism during a 6-month weight maintenance period.
Meal timing and composition influence ghrelin levels, appetite scores and weight loss maintenance in overweight and obese adults. Factors associated with the maintenance or achievement of the weight loss goal at follow-up among participants completing an adapted diabetes prevention program.
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