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PubMed1999

Interventions targeted toward patients to increase mammography use.

The objective of this study was to determine the effects of patient-based mammography screening strategies. We performed a meta-analysis and included United States studies that met the following criteria: (a) randomized or concurrent control design; (b) defined outcomes; and (c) data available for reanalysis. Interventions were classified as behavioral, cognitive, or sociological and further categorized by the type of control group (active versus usual care), number of interventions, and mode of intervention (interactive versus static). Data were combined using DerSimonian and Laird random effects models to yield summary effect sizes. A total of 63 interventions in 43 studies met the inclusion criteria. Behavioral interventions increased screening by 13.2% [95% confidence interval (CI), 4.7-21.2] compared with usual care, and by 13.0% (95% CI, 8.7-17.4) when using multiple strategies and 5.6% (95% CI, 0.6-10.6) when using a single intervention compared to active controls. Cognitive interventions using generic education strategies had little impact on screening, but those that used theory-based education (e.g., health belief model) increased rates by 23.6% (95% CI, 16.4-30.1) compared with usual care. Sociological interventions also increased screening rates. Interventions using a theoretical framework were the most effective in increasing screening rates. The ability of these interventions to increase screening among subgroups and improve rates of ongoing screening, as well as the costs of these strategies, is unknown and is an important area for future research.

Adult↗
PubMed2000

HIV risk reduction behavioral interventions with heterosexual adolescents.

This article provides a comprehensive review of research on the effects of behavioral interventions on heterosexual adolescents' HIV sexual-risk behavior. It details adolescents' risk of sexually transmitted HIV infection and describes challenges associated with adolescent intervention research, including obtaining school and parent approval and the validity of self-reported measures. It describes central characteristics of 36 controlled intervention studies assessing the HIV sexual-risk behavior of over 30,000 male and female adolescents 11-21 years of age. It summarizes the participants' race/ethnicity and age, the theoretical framework, and the intervention setting, duration and outcome. This review reveals that the most commonly assessed behavioral outcomes were condom use and abstinence, and the largest effects sized were on condom use and condom acquisition. Effect sizes for abstinence and number of sexual partners were the smallest. Perceived self-efficacy and behavioral interventions were the most commonly assessed theoretical mediators. Key questions this research engaged in included whether behavioral skills can be increased, whether intervention-induced behavior change can be sustained, whether matching the race/ethnicity and gender of facilitators and participants enhances the effectiveness of culturally sensitive interventions, whether classroom teachers can effectively facilitate interventions, whether the behavior of high-risk populations can be changed, and which kinds of interventions are most effective. This review concludes that carefully designed theory-based interventions that take into account the characteristics of the particular population or culture can cause positive changes in adolescents' HIV sexual-risk behavior, but boundary conditions for their effectiveness still need to be identified. Several suggestions for additional research are proffered.

Adolescent↗
PubMed2001

[Results of community intervention trial for chronic obstructive pulmonary diseases and chronic cor-pulmonale from 1992 to 1999].

OBJECTIVE: To evaluate the effect of community intervention for COPD and chronic cor-pulmonale. METHODS: The baseline survey of the study was carried out in 1992. The total population was randomly divided into intervention and control regions. From 1992 the comprehensive community intervention trial was conducted in the intervention region. The data of baseline study has been published elsewhere. The family inquiry was made in all baseline population, 50 percent of high risk population and 100 percent of COPD and cor pulmonale population were reexamined. RESULTS: Of the 3,739 subjects who should be investigated 3,316 subjects were really investigated (88.7% of responsive rate). Of 814 subjects randomly abstracted from 3,316 in intervention and control regions, the awareness rates of smoking harm to health were 95.0% and 80.0%, of how to prevent and treat COPD were 62.0% and 35.7%, of regular visit by doctors were 46.1% and 27.0% respectively. The rate of ex-smoker was 28.2% in intervention region more than that of 23% in control region (P = 0.004). Of 3,075 subjects undergone lung function test, FEV1 decrements per capita yearly were 32.0 ml and 37.9 ml (P = 0.001); FVC decrement were 42.0 ml and 48.3 ml (P = 0.012) in intervention and control regions. The prevalence increment in COPD were 5.6% and 8.0% (P = 0.03), cor-pulmonale were 3.5% and 6.7% (P = 0.02) compared to baseline survey in both regions. The mortality of cor-pulmonale were 72.9 and 95 per 100,000 per year (P = 0.0044) from 1995 to 1999. CONCLUSION: The rate of quiting smoke is significantly increased by intervention. The declination of lung function significantly decreases. The increment in prevalence of COPD and cor-pulmonale significantly decreases. The mortality of cor-pulmonale decreases significantly in intervention region. The results indicates that the comprehensive intervention in community is an important measurement for decreasing incidence of COPD and mortality of cor-pulmonale.

China↗
PubMed2002

Evaluation of community based intervention for the protection of children from small arms and explosive devices during the war: observational study.

AIM: To evaluate the influence of a community-based intervention aimed at reducing the risk of unintentional injuries caused by small arms and explosive devices accessible to children during the 1991-1995 war in Croatia. METHOD: From May 5 to June 15 in 1994 and 1995, we performed a cross-sectional survey on exposure of the children in Croatia to different small arms and explosive devices, using specially prepared questionnaires. The survey was conducted in Dubrovnik-Neretva and Karlovac counties, where community-based intervention was carried out, and Lika-Senj and Sisak-Moslavina counties, where only national intervention was implemented. The sample included a total of 5,317 parents and 2,581 children. The response rate was 98%. All participants were asked to give answers according to current situation. RESULTS: Approximately a third of children in the counties without community-based intervention and a fifth in the counties with community-based intervention could access small arms and explosive devices at home. Boys were more exposed than girls (p=0.001). In the communities with community-based intervention, children were less exposed to the devices, such as small-arms, hand grenades, and explosives, which were the main cause of injuries. In 1994, parents in counties without community-based intervention handled weapons in front of their children in 45% cases vs 31% of those in the counties with community-based intervention (p<0.001). In 1995, the percentages were 44 and 32, respectively (p<0.001). CONCLUSION: Although it is impossible to quantify the exact amount of risk reduction due to health intervention alone, community-based intervention reduced the exposure of children to weapons.

Adolescent↗
PubMed2003

[Evaluation of effectiveness of intervention on risk factors for cerebrovascular disease in three cities of China].

OBJECTIVE: To evaluate the effects of community intervention on risk factors of cerebrovascular disease. METHODS: With cluster sampling, 2,586 and 2,723 women and men aged 35 to 74 were selected randomly as intervention cohort and control cohort, respectively, from about 300 thousand community population in Beijing, Shanghai and Changsha, during 1997 to 2000. Their blood pressure, levels of blood lipid, body mass index (BMI) were measured and status of smoking and alcohol consumption were surveyed as indices of evaluation. Health education for smoking quit, alcohol consumption restriction and reinforced treatment for diabetic and hypertensive patients were implemented in the intervention communities. And, 2,544 and 2,533 persons in the two cohorts responded three years after intervention, and then all the indices mentioned above were measure again for them. RESULTS: Average reduction in systolic blood pressure by 3.21 mm Hg and serum level of total cholesterol by 0.58 mmol/L was achieved in intervention cohort after intervention, but with 0.48 mmol/L increase in triglyceride. Average blood levels of both high density lipoprotein-cholesterol (HDL-C) and glucose increased in the two cohorts after intervention, but with 0.30 mmol/L net increase of blood glucose in control cohort. There was no significant difference in average increase of HDL-C between the two cohorts. BMI increased by 0.56 in control cohort, and no significant change in intervention cohort. Proportion of smoking decreased by 5.4% in men and 2.4% in women of intervention cohort, and no change in control cohort. CONCLUSION: Level of risk factors for cerebrovascular disease reduced significantly with community intervention.

Adult↗
PubMed2004

[Intervention study on healthy lifestyle of children].

OBJECTIVE: To set up valid, feasible and reliable intervention to help children with a healthy life-style. METHODS: Children of grades 3, 4 and 5 in Taoyuan elementary school in Taiyuan city, Shanxi province were studied by self-administered knowledge, attitudes and behaviors questionnaire on health, in May 1999. Results indicated that there were some problems in knowledge, attitudes and behaviors on health among children. Children were assigned to intervention group and control group. The balance between the two groups was tested statistically. Children of the intervention group received intervention for half a year. After intervention, knowledge, attitude and behavior of children on health in both groups were assessed again. RESULTS: After intervention the mean scores of health knowledge, attitudes and behaviors of intervention group were significantly higher than that in control group (P < 0.01). After intervention, the total mean score of knowledge, attitudes and behaviors on health has been improved from 125.70 +/- 16.95 on pre-test to 156.84 +/- 21.72 on post-test in intervention group. The mean score of knowledge on health was increased form 47.54 +/- 10.07 to 68.19 +/- 12.92 while the mean score of attitudes increased from 17.87 +/- 3.66 to 20.92 +/- 4.31 and the mean score of healthy behavior increased from 60.30 +/- 9.08 to 67.74 +/- 10.44 respectively. CONCLUSION: Methods used in the intervention study seemed to be appropriate and the contents suitable.

Child↗
PubMed2004

[Effectiveness of a quality improvement intervention in reducing cardiovascular risk in hypertensive patients].

INTRODUCTION AND OBJECTIVES: To evaluate the effect of a quality improvement intervention on the reduction of cardiovascular risk in patients with hypertension. PATIENTS AND METHOD: Quasi-experimental study involving two primary care centres. One centre was assigned to implement a quality improvement intervention (n = 482 patients), while at the other center "usual care" procedures were followed (control group, n = 360 patients). The quality improvement intervention consisted of a combined program designed for the medical staff and comprising audit, feedback, training sessions and implementation of clinical practice guidelines during 6 months. The main outcome measures were blood pressure, lipid levels, diabetes, smoking and cardiovascular risk. These values were compared before the intervention and after one year. RESULTS: The baseline characteristics of the patients were similar in both groups. Absolute cardiovascular risk decreased from 15.85% to 14.36% (P< .05) in the intervention group, and no significant change was observed in the control group (15.17% to 15.76%). The intervention led to a 2.07% decrease in cardiovascular risk (95%CI, 1.21-2.93; P< .05). The percentage of patients with high cardiovascular risk (> 20% at 10 years) decreased in the intervention group from 30% to 25%, and increased in the control group from 28% to 30%. Relative cardiovascular risk decreased from 2.03 to 1.75 (P< .05) in the intervention group, and from 1.98 to 1.92 (P> .05) in the control group. The intervention thus led to a 0.25 decrease in relative risk (95%CI: 0.14-0.35). CONCLUSIONS: Absolute and relative cardiovascular risk in patients with hypertension was reduced by a quality improvement intervention. The percentage of patients with high cardiovascular risk was also reduced.

Aged↗
PubMed2004

The effect of an educational intervention on improving rational drug use.

OBJECTIVE: To evaluate the effect of an educational intervention on rational drug use amongst Primary Health Care workers in two Local Government Areas (LGAs), Mushin and Ikeja, in Lagos State. METHODS: Mushin was randomly selected as the intervention LGA while Ikeja was selected as the control L.G.A. A structured educational intervention designed to improve prescribing practices was carried in Mushin LGA for four weeks. Drug use indicators were measured before, at two weeks and three months post intervention. RESULTS: At baseline, most of the drug-use indicators in the intervention LGA were significantly worse (p < 0.05) than the control LGA. However, at the two-week evaluation, the educational programme achieved a significant reduction in the average number of drugs in the intervention LGA from 7.3+ 2.8 to 6.3 + 2.3 (p=0.000) compared to the control LGA where there was no significant change (from 4.9+ to 4.8+2.2, p=0.647). There was also a significant increase in the percentage of patients rationally managed from 18% to 30% (p=0.0005) in the intervention LGA unlike the control LGA (from 33% to 31%,p=0.693.). The rate of change in the average number of drugs prescribed was significantly higher in the intervention LGA (+14% )compared to the control LGA (+2%,p=0.0000). The improvements were not sustained at the three-month evaluation, as most of the indicators were similar to values obtained at the baseline. CONCLUSION: The intervention programme significantly improved rational drug use in the short-term period only. Other cost effective and sustainable intervention models for improving prescribing practices should be developed.

Clinical Competence↗
PubMed2005

Interventional treatment with autoexpandable stents in iliofemoral arterial diseases.

UNLABELLED: The importance of peripheral arterial diseases is revealed by statistical data, which showed a frequency of arterial diseases equal to the one of stable angina Traditional treatment of these patients was the surgical bypass, but an alternative therapy in these cases is the interventional treatment. Arguments for this option could be: it is less expensive, it decreases the hospitalization time, it does not require general anesthesia, and complications are less frequent and less severe. Interventional treatment is recommended especially in cases of short, isolated lesions of great vessels. During the last years, indications for interventional treatment were expanded to more difficult and complex cases, due to the advances in technology of endoluminal treatment products and the recently introduced laser angioplasty technology. MATERIAL AND METHOD: Among the interventional techniques we apply in our clinic, we mention: percutaneous transluminal angioplasty, intraarterial stent implantation, laser angioplasty and intraarterial thrombolysis, some of them peformed with IVUS control. In a period of 14 years we examined a total number of 6,532 patients suffering from peripheral arterial obstructive diseases. In the past 3 years, in our new laboratory of interventional cardiology, new procedures have been introduced in the algorithm of interventional treatment, such as laser angioplasty. Invasive diagnosis performed in the Cardiology Clinic consisted in aortography in 746 cases and peripheral arteriography in 2035 cases. Interventional treatment consisted in percutaneous transluminal angioplasty (1.240 procedures, 756 performed in the latest 3 years), intraarterial thrombolysis (214 procedures), laser angioplasty (since June 2002-130 procedures performed) and stent implant (since 2001-61 cases). Axillar approach was also introduced in 2001 and was applied in 23% of cases. RESULTS: We recorded a 76.5% success rate using only PTA for repermeabilisation of the lower limb arteries. Association of intraarterial thrombolysis increased the success rate to 91%. Using laser angioplasty and autoexpandable stent implantation, the success rate achieved was 100%. CONCLUSION: Interventional treatment is an important alternative in the complex algorithm of treatment in PAOB. Intraarterial stenting significantly improves the immediate and the long term results of interventional treatment, and autoexpandable stents with thermal memory show superior results. Laser angioplasty is an adjuvant method which significantly improves the results of interventional treatment. In all these methods, a very important role plays the good cooperation of the team formed by cardiologist, angiologist and vascular surgeon.

Angioplasty, Balloon, Laser-Assisted↗
PubMed2006

[Early psychological interventions in children after trauma].

Early psychological interventions within the first hours, days or weeks after a traumatic event aim to avoid or minimize middle- or long-term mental-health problems. To date, there are no articles in German language available that review the field of early psychological interventions in children. This paper defines this field, summarizes current early psychological interventions and reviews the literature on effectiveness of early interventions. Most of the early psychological interventions in children after trauma that are reported in the literature are not evidence based. Moreover, current knowledge is limited by a number of methodological problems. First, most studies have no control groups and the samples are small. Second, different timeframes and interventions complicate a comparison of different studies. For future research, randomised controlled studies with manualised interventions and repeated follow-ups are demanded. In clinical practice, the lack of studies on effectiveness of early psychological interventions in children leads to a simple transfer of intervention strategies from adults. This practice needs to be questioned. Importantly, the consideration of developmental aspects is crucial. To date, no evidence-based advise can be given with regard to early psychological interventions in children. Moreover, it remains unclear, how to involve the parents.

Acute Disease↗
PubMedDate not supplied

Dietary changes among husbands of participants in a low-fat dietary intervention.

A dietary intervention delivered to one family member with a beneficial impact on other members could provide a cost-effective approach to public health dietary intervention programs. The Women's Health Trial (WHT) was a study in which women were randomized to be trained in adopting a low-fat diet or to continue their normal diet. The intervention women consumed 21% of total calories from fat versus 38% for control women at six months postrandomization. Husbands of women in the Seattle Clinical Center of the WHT were surveyed between 1985 and 1988 to determine whether and to what extent the husbands' diets changed at six months. Ninety-one intervention men and 162 control men, 79% of those eligible, participated. Intervention men reported an average weight loss of 2.4 pounds, compared to an average 0.7-lb loss among controls (P = .03). Based on self-reported change of specific foods, we found that intervention men more often reduced butter, margarine, eggs, and red meat over the six months than did control men (P less than .001). Based on nutrient consumption estimated by a food frequency questionnaire, intervention husbands consumed 34% of total calories from fat versus 36% for controls (P = 0.04). The number of meals shared with wives per week modified the effect of the intervention: among the intervention group, for every three meals shared, an accompanying one percentage point reduction in percentage of calories from fat occurred in the husband's diet. Thus, we suggest that dietary intervention programs attended by one spouse appear to exert a small beneficial effect on the other spouse.

Aged↗
PubMed1982

Effects of two years' educational intervention on dietary habits, serum cholesterol and blood pressure among 13 to 15 year old adolescents. The North Karelia youth project.

A school and community based intervention to influence CVD risk factors and promote health in 13 to 15 year old children was carried out in North Karelia, Finland. The intervention was at two levels: 1) an intensive intervention in two schools and 2) a county-wide intervention in the remaining schools. Three pairs of matched schools were evaluated the two intensive intervention schools, two schools representing the county-wide intervention and two reference county schools. 851 children, their parents and teachers were studied before the intervention (1978) and after the intervention in 1980. The effect of intervention on serum and HDL-cholesterol, blood pressure and dietary habits is reported in this paper. The intervention had effect on fat use in both sexes and on total serum cholesterol in girls. Although there were some reported changes in the salt consumption in the desired direction these had no effect on blood pressure levels.

Adolescent↗
PubMed1995

Psychiatric intervention in primary care for mothers whose schoolchildren have psychiatric disorder.

BACKGROUND: Psychiatric disorder in schoolchildren has been linked to increased general practice attendance rates. This increase may, in part, be a result of maternal stress focused on the disturbed child, and of a decrease in confidence in parenting. AIM: A study was undertaken to pilot the feasibility of a single session, psychiatric intervention in primary care for mothers of disturbed children and to examine uptake rates and reported immediate and long-term effects. METHOD: Single psychiatric sessions by a child psychiatrist in general practice were offered to mothers of 26 schoolchildren. The schoolchildren (age range 7-12 years, mean nine years) were frequent attenders in general practice with physical symptoms, and were identified from research interviews carried out with a parent (usually their mother) as psychiatrically disordered. The main outcome measures were the mothers' ratings of helpfulness of the intervention; degree of behavioural, emotional or health problems in their children and confidence in managing them; the Rutter A parental behaviour questionnaire; and children's yearly general practice attendance rates. RESULTS: Sixteen mothers (62%) who were offered appointments attended for the intervention. Nine of the 14 who responded at three-month follow up (64%) reported that the intervention had been markedly or extremely helpful. The main areas of perceived improvement at both three months and at 18-24 months were in the child's behaviour, emotional and health problems, and in the mother's confidence in dealing with these. Mothers also found the specific advice discussed and the ability to talk to somebody about the problems helpful. Mothers were less likely to find the intervention extremely or markedly useful where the child had had previous psychiatric intervention. The mean yearly attendance rate for the whole group of 23 children (data missing for three) decreased from 6.5 consultations before the intervention to 2.8 afterwards; there was a non-significant trend for the drop in attendance to be more marked in the group whose mothers attended the intervention and who felt helped by it, than among the group of children whose mothers only reported finding the intervention slightly useful. CONCLUSION: Standardized child psychiatric interventions which may be used in the primary care setting appear acceptable and may be helpful to mothers in addressing psychiatric disorders associated with somatic presentation in their schoolchildren.

Attitude to Health↗
PubMed1995

[Changes in arterial pressure and smoking habit following 3 years of multifactorial intervention].

BACKGROUND: The feasibility of successfully reducing cardiovascular risk factors is supported by large studies. Nevertheless, controversy remains about the actual efficacy of some lifestyle interventions. This report assess the effectiveness of different levels of intervention at the work-site on blood pressure and smoking. METHODS: At the beginning of the program 1.193 men and 362 women were included in it. Individualized face-to-face counseling was given to employees by four different occupational physicians. After 3 years, 980 individuals remained in the study. The differences among the four groups allowed us to distinguish three different levels of intensity of interventions and a fourth group that was the reference one. Observed changes in blood pressure were compared using analysis of covariance. Adjusted odds ratio of smoking quit rates were calculated by logistic regression. RESULTS: Intensive intervention was significantly different from control group and the group of mild intervention. Moderate intervention was the only one to bring about a significant reduction of arterial blood pressures. This reduction was consistent with the lower threshold used in this group to classify diastolic blood pressure as high. Smoking quit rate was 22% for intensive and moderate interventions. Adjusted odds ratio for quitting smoking was 5.81 (95% CL 1.29-26.14) for moderate and 8.2 (IC 95% 1.75-38.46) for intensive intervention. CONCLUSIONS: A lower threshold for starting intervention measures on blood pressure is suggested to achieve better results. As the intensity of interventions was stronger, smoking quit rates were higher.

Adult↗
PubMed1995

Supplementary carrying compared with advice to increase responsive parenting as interventions to prevent persistent infant crying.

OBJECTIVE: To compare two interventions (supplementary carrying, increased parental responsiveness) introduced from birth for their effectiveness in reducing the amounts of crying in general community infants at 2, 6, and 12 weeks age. DESIGN AND PARTICIPANTS: Mothers and infants in newborn wards of maternity hospitals were assigned to carrying intervention, responsiveness intervention, or control groups. Follow-up measures were used to confirm that the interventions were implemented and to determine their effects on infant crying. SETTING AND MEASUREMENTS: Diary measurements completed in the home were employed to measure the aspects of parental behavior targeted by the interventions. Audio recordings, diaries, and questionnaires assessed the amounts the infants cried and the impact of the crying on their mothers and the health services. Sample sizes at 6 weeks of age were 59 (carrying intervention), 57 (responsiveness intervention), and 94 infants (control group). RESULTS: The carrying intervention successfully increased the amounts the infants were carried, particularly while settled, to the target levels. The responsiveness intervention led to more limited increases in carrying and to a modest increase in feeding frequency, but did not affect measures of parental interactiveness and play. No differences in amounts of crying and fussing were found between the three groups of infants on any of the measures. Subsidiary analyses confirmed that the dependent variable (infant fuss/crying) and main independent variable (carrying while settled) were not significantly correlated. CONCLUSION: It is not, at present, possible to recommend either supplementary carrying or increased parental responsiveness as primary, preventative interventions to reduce infant crying.

Crying↗
PubMed1994

Early intervention in low-birth-weight premature infants. Results through age 5 years from the Infant Health and Development Program.

OBJECTIVE: To evaluate the persistence of effects on health and development at age 5 years of the Infant Health and Development Program, an early childhood intervention that was provided to low-birth-weight (LBW) premature infants from neonatal discharge through age 3 years. DESIGN: Randomized, controlled, multicenter trial, stratified by two LBW groups: lighter (< or = 2000 g) and heavier (2001 to 2500 g). SETTING: Eight socioeconomically heterogeneous clinical sites. PARTICIPANTS: Of 985 eligible infants weighing 2500 g or less and at 37 weeks' or less gestational age, 377 infants were randomly assigned to the intervention group and 608 to the follow-up only group. About two thirds of the infants in each group were in the lighter LBW stratum, and one third were in the heavier LBW stratum. INTERVENTION: The intervention group received home visits (from neonatal discharge through age 3 years) as well as center-based schooling (from 1 to 3 years of age). Children in both groups received pediatric surveillance. MAIN OUTCOME MEASURES: Cognitive development, behavioral competence, and health status. RESULTS: At age 5 years, the intervention group had full-scale IQ scores similar to children in the follow-up only group. However, in the heavier LBW stratum, children in the intervention group had higher full-scale IQ scores (3.7 points higher; P = .03) and higher verbal IQ scores (4.2 points higher; P = .02). No significant differences between intervention and follow-up only groups in cognitive measures at age 5 years were noted in the lighter LBW infants. The intervention and follow-up groups were similar in behavior and health measures regardless of LBW stratum. CONCLUSION: The early childhood intervention provided in the first 3 years of life had effects on heavier LBW premature infants' IQ and verbal performance at age 5 years that were not observed for lighter LBW premature infants. The intervention did not affect health or behavior at age 5 years in either LBW stratum.

Child Behavior↗
PubMed1993

The intervention effects of a community-based hypertension control programme in two rural South African towns: the CORIS Study.

The objective of the hypertension programme of the Coronary Risk Factor Study (CORIS) was to evaluate the effectiveness of the first 4 years of community-based intervention. The hypertension intervention model comprised a blood pressure station where the whole population was screened for hypertension, non-drug management was provided and hypertensives were monitored after referral to general practitioners for drug therapy. Two levels of intervention were maintained: in the high-intensity intervention town (N = 2,278) hypertensives were actively followed up, and in the low-intensity intervention town (N = 2,620) no active follow-up procedure existed. A third town acted as control (N = 2,290). In the cohort which was hypertensive at baseline, the net decreases in systolic blood pressure (mean +/- SE) after correction for changes in the control town were 0.5 +/- 2.2 mmHg (men) and 4.5 +/- 2.2 mmHg (women) in the low-intensity intervention town, and 5.6 +/- 2.3 mmHg (men) and 7.5 +/- 2.2 mmHg (women) in the high-intensity intervention town. The net decrease in diastolic blood pressure was 3.4 +/- 1.2 mmHg (men) and 4.4 +/- 1.1 mmHg (women) in the low-intensity intervention town, and 6.1 +/- 1.2 mmHg (men) and 5.9 +/- 1.1 mmHg (women) in the high-intensity intervention town. These reductions were statistically significant with one exception. The changes in the total population in the 3 communities after 4 years of intervention were similar to those found in the hypertensive cohort.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Transient intervention with oltipraz protects against aflatoxin-induced hepatic tumorigenesis.

Oltipraz [5-(2-pyrazinyl)-4-methyl-1,2-dithiole-3-thione] protects against aflatoxin B1-induced hepatocarcinogenesis in rats when fed before and during carcinogen exposure; however, such an exposure-chemoprotection intervention paradigm is not directly relevant to most human populations. To model and assess the possible efficacy of short term interventions targeted at individuals at risk for sustained exposure to aflatoxins, 175-g male F344 rats were treated daily with 25 micrograms of aflatoxin B1, p.o., for 28 days. One week after the start of aflatoxin B1 exposure, half of the animals were fed a diet supplemented with 0.075% oltipraz for 10 days; these rats were then restored to the unsupplemented AIN-76A diet for the remainder of the experimental period. Livers were analyzed 2 or 3 months after the last aflatoxin B1 dose for burden of glutathione S-transferase P (GST-P)-positive foci, as an index of presumptive preneoplastic tumors. The transient intervention with oltipraz reduced the volume percent of hepatic GST-P-positive foci by 54% (P = 0.047) and 72% (P = 0.004) at 2 and 3 months, respectively. A strong positive correlation was also observed between the extent of fibrosis in the livers of these animals and the hepatic burden of GST-P-positive foci, implying that cytotoxicity is associated with the tumorigenic process. This protection may reflect alterations in the metabolism and disposition of aflatoxin B1 induced by oltipraz. Glutathione S-transferase catalyze the detoxication of aflatoxin-8,9-oxide and were found to be rapidly induced in the livers of animals after the beginning of the oltipraz intervention. Glutathione S-transferase activity remained significantly (P < 0.05) higher until 9 days after the end of the oltipraz intervention. In contrast, levels of hepatic aflatoxin-DNA adducts were not significantly reduced until 4 days after the beginning of the intervention but remained significantly (P < 0.05) lower up to 11 days after the end of the intervention. The cumulative reduction in levels of hepatic aflatoxin-DNA adducts (approximately 25%) by the oltipraz intervention underestimated the reduction in the hepatic burden of GST-P-positive foci. The significant protection against presumptive preneoplastic tumors, despite the delay of intervention, suggests that oltipraz may exert substantial activity against the cytotoxic and autopromoting action of repeated exposures to aflatoxin B1 and supports the utility of intervention trials with oltipraz in individuals chronically consuming aflatoxin B1-contaminated foods, particularly in regions with high incidences of liver cancer.

Aflatoxin B1↗