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PubMed2000

Interventions aimed at decreasing the risk of mother-to-child transmission of HIV infection.

BACKGROUND: At the end of 1998 over 33 million people were infected with the human immunodeficiency virus (HIV) and over one million children had been infected from their mothers. OBJECTIVES: The objective of this review was to assess what interventions may be effective in decreasing the risk of mother-to-child transmission of HIV infection as well as their effect on neonatal and maternal mortality and morbidity. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. SELECTION CRITERIA: Randomised trials comparing any intervention aimed at decreasing the risk of mother-to-child transmission of HIV infection compared with placebo or no treatment, or any two or more interventions aimed at decreasing the risk of mother-to-child transmission of HIV infection. DATA COLLECTION AND ANALYSIS: Trial quality assessments and data extraction were undertaken by the reviewer. MAIN RESULTS: Zidovudine Four trials comparing zidovudine with placebo involving 1585 participants were included. Compared with placebo, there was a significant reduction in the risk of mother-to-child transmission with any zidovudine (relative risk (RR) 0.54, 95% confidence interval (CI) 0.42-0.69). There is no evidence that 'long course therapy' is superior to 'short course therapy'. Nevirapine One trial compared intrapartum and postnatal nevirapine with intrapartum and postnatal zidovudine in 626 women, the majority of whom breast fed their infants. Compared with zidovudine, there was a significant reduction in the risk of mother-to-child transmission of HIV with nevirapine (RR 0.58, 95% CI 0.40-0.83). No trials are available comparing nevirapine with placebo. Caesarean section One trial comparing elective caesarean section with anticipation of vaginal delivery involving 436 participants was included. Compared with vaginal delivery, there was a significant reduction in the risk of mother-to-child transmission of HIV infection with caesarean section (RR 0.17, 95% CI 0.05-0.55). Immunoglobulin One trial comparing hyperimmune immunoglobulin plus zidovudine with non-specific immunoglobulin plus zidovudine involving 501 participants was included. The addition of hyperimmune immunoglobulin to zidovudine does not appear to have any additional effect on the risk of mother-to-child transmission (RR 0.67, 95% CI 0.29-1.55). REVIEWER'S CONCLUSIONS: Zidovudine, nevirapine and delivery by elective caesarean section appear to be very effective in decreasing the risk of mother-to-child transmission of HIV infection.

Anti-HIV Agents↗
PubMed2000

Interventions for treating chronic pelvic pain in women.

BACKGROUND: Chronic pelvic pain is common in women in the reproductive age group and it causes disability and distress and results in significant costs to health services. The pathogenesis of chronic pelvic pain is poorly understood. Often, investigation by laparoscopy reveals no obvious cause for pain. There are several possible explanations for chronic pelvic pain including undetected irritable bowel syndrome, the vascular hypothesis where pain is thought to arise from dilated pelvic veins in which blood flow is markedly reduced and altered spinal cord and brain processing of stimuli in women with chronic pelvic pain. As the pathophysiology of chronic pelvic pain is not well understood, its treatment is often unsatisfactory and limited to symptom relief. Currently, the main approaches to treatment include counselling or psychotherapy, attempting to provide reassurance using laparoscopy to exclude serious pathology, progestogen therapy such as medroxyprogesterone acetate, and surgery to interrupt nerve pathways. OBJECTIVES: We aimed to identify and review treatments for chronic pelvic pain in women in the reproductive years. The review included studies of patients with a diagnosis of pelvic congestion syndrome but excluded those with pain known to be caused by i) endometriosis, ii) primary dysmenorrhoea (period pain), iii) pain due to chronic pelvic inflammatory disease, or iv) irritable bowel syndrome. SEARCH STRATEGY: The search strategy adopted by the Cochrane Menstrual Disorders and Subfertility Group was used. SELECTION CRITERIA: Randomised controlled trials (RCTs) with women who had chronic pelvic pain, excluding endometriosis, primary dysmenorrhoea, pain due to chronic pelvic inflammatory disease, or irritable bowel syndrome. The reviewers were prepared to consider studies of any intervention including lifestyle, physical, medical, surgical and psychological treatments. Outcome measures were pain rating scales, quality of life measures, economic analyses and adverse events. DATA COLLECTION AND ANALYSIS: For each included trial, information was collected regarding the method of randomisation, allocation concealment, blinding, whether an intention to treat analysis could possibly be performed and relevant interventions and outcomes (see previous sections). Data were extracted independently by the two reviewers, using forms designed according to the Cochrane guidelines. MAIN RESULTS: Seven studies were identified of which four were of good methodological quality. One study was reported in a brief abstract only and was excluded. Progestagen (Medroxyprogesterone acetate) was associated with a reduction of pain during treatment. Counselling supported by ultrasound scanning was associated with reduced pain and improvement in mood. A multidisciplinary approach was beneficial for some outcome measures. Adhesiolysis was not associated with an improved outcome apart from where adhesions were severe. REVIEWER'S CONCLUSIONS: Further studies to confirm these observations are needed, together with full reporting of those studies which have been undertaken. Given the prevalence and health care costs associated with chronic pelvic pain in women, randomised controlled trials of other medical, surgical and psychological interventions are urgently required.

Chronic Disease↗
PubMed2000

Mass media interventions: effects on health services utilisation.

BACKGROUND: The mass media frequently cover health related topics, are the leading source of information about important health issues, and are targeted by those who aim to influence the behaviour of health professionals and patients. OBJECTIVES: To assess the effects of mass media on the utilisation of health services. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE, EMBASE, Eric, PsycLit, and reference lists of articles. We hand searched the journals Communication Research (February 1987 to August 1996), European Journal of Communication (1986 to 1994), Journal of Communication (winter 1986 to summer 1996), Communication Theory (February 1991 to August 1996), Critical Studies in Mass Communication (March 1984 to March 1995) and Journalism Quarterly (1986 to summer 1996). SELECTION CRITERIA: Randomised trials, controlled clinical trials, controlled before-and-after studies and interrupted time series analyses of mass media interventions. The participants were health care professionals, patients and the general public. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Seventeen studies were included. All used interrupted time series designs. Fourteen evaluated the impact of formal mass media campaigns, and three of media coverage of health related issues. The overall methodological quality was variable. Six studies did not perform any statistical analysis, and seven used inappropriate statistical tests (ie not taking into account the effect of time trend). All of the studies apart from one concluded that mass media was effective. These positive findings were confirmed by our re-analysis in seven studies. The direction of effect was consistent across studies towards the expected change. The pooled effect sizes for studies assessing the impact of mass media on similar aspects of care revealed an effect upon the utilisation of health services that could not be explained by chance alone, ranging from -1.96 (95%CI -1. 19 to -2.73) for campaigns promoting immunisation programmes, to -1. 12 (95%CI -0.49 to -2.36) for those concerning cancer screening. REVIEWER'S CONCLUSIONS: Despite the limited information about key aspects of mass media interventions and the poor quality of the available primary research, there is evidence that these channels of communication may have an important role in influencing the use of health care interventions. Those engaged in promoting better uptake of research information in clinical practice should consider mass media as one of the tools that may encourage the use of effective services and discourage those of unproven effectiveness.

Health Education↗
PubMed2000

Interventions for treating plantar heel pain.

BACKGROUND: Ten percent of people may experience pain under the heel (plantar heel pain) at some time. Injections, insoles, heel pads, strapping and surgery have been common forms of treatment offered. The absolute and relative effectiveness of these interventions are poorly understood. OBJECTIVES: The objective of this review was to identify and evaluate the evidence for effectiveness of treatment in treating plantar heel pain. SEARCH STRATEGY: MEDLINE (from 1966 to December 1997), EMBASE and the Cochrane Library were searched. Three podiatry journals (The Foot, The Chiropodist (later The Journal of British Podiatric Medicine), and The British Journal of Podiatric Medicine) were handsearched. We contacted known investigators in the field to identify unpublished data or research in progress. Non English language reports were excluded from the review. SELECTION CRITERIA: Randomised and quasi randomised trials of interventions for plantar heel pain in adults. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated studies for inclusion, extracted data and assessed study quality. Additional information was obtained by direct contact with investigators. No poolable data were identified. Where measures of variance were available we have calculated the weighted mean differences based on visual analogue scale (VAS) scores. MAIN RESULTS: Eleven randomised trials involving 465 participants were included. Study quality was generally poor, and pooling of data was not possible. All studies measured a reduction in heel pain as the primary outcome. Seven trials evaluated interventions against placebo/dummy or no treatment. There was limited evidence for the effectiveness of topical corticosteroid, administered by iontophoresis in reducing pain. There was no evidence for the effectiveness of injected corticosteroid. There was limited evidence for the effectiveness of low energy extracorporeal shock wave therapy in reducing night pain, resting pain and pressure pain in the short term (12 weeks). In individuals with chronic pain (longer than six months), there was limited evidence for the effectiveness of dorsiflexion night splints in reducing pain. There was no evidence to support the effectiveness of therapeutic ultrasound, low-intensity laser therapy, exposure to an electron generating device or insoles with magnetic foil. No randomised trials evaluating orthotic devices, surgery, or radiotherapy against a control population were identified. There was limited evidence for the superiority of corticosteroid injections over orthotic devices. REVIEWER'S CONCLUSIONS: Although there is limited evidence for the effectiveness of local corticosteroid therapy, the effectiveness of other frequently employed treatments in altering the clinical course of plantar heel pain has not been established in comparative studies. Well designed and conducted randomised studies are required.

Adrenal Cortex Hormones↗
PubMed2000

Pretest assessment as a component of safer sex intervention: a pilot study of brief one-session interventions for women partners of male injection drug users in New York City.

This pilot study evaluated whether brief safer sex interventions for women partners of male injection drug users significantly influenced perceptions of partner risk, human immunodeficiency virus (HIV) knowledge, correct condom usage, and self-reported consistent safer sex (abstinence or 100% of vaginal-penile intercourse acts protected by male or female condoms). The study also examined the impact of pretest assessment on those variables since pretest assessment may challenge participants' current knowledge, safer sex practices, and partner communication techniques. The study randomly assigned participants to pretest or no pretest assessment. Each group was also assigned randomly to a presentation modality: (1) safer sex pamphlet review only, (2) pamphlet review with demonstration of several safer sex alternatives, or (3) pamphlet review with skills practice to mastery with one safer sex alternative of the woman's choice. For the last two conditions, a 35-minute interactive session covered prevention efficacy of safer sex methods for HIV, sexually transmitted infections, pregnancy, correct use, eroticization, local cost and availability, and partner objections. At 7 weeks postintervention, a higher proportion of women who took pretest assessment reported consistent safer sex (66.7%) compared to those without pretests (55.6%). Assignment to the interactive interventions (skills or demonstration) had little additional impact over pretest assessment for these women. Among women who did not take pretests, the interactive interventions had strong effects; 76.9% reported consistent safer sex versus 33.3% in the pamphlet review group. There were additional specific effects for pretest assessment on HIV knowledge and partner risk perception and for interactive intervention on correct condom usage. Brief interventions appear to have some positive short-term effects. Pretest assessment may be an important component of brief interventions.

Adult↗
PubMed1991

The Tromsø Survey: the Family Intervention study--the effect of intervention on some coronary risk factors and dietary habits, a 6-year follow-up.

While most intervention studies on coronary heart disease have focused on the high-risk person only, the present study used the family as the unit of intervention. In the study 1373 high-risk men, ages 30-54 years, were identified on the basis of high total cholesterol (TC) and/or low relative high-density lipoprotein cholesterol (HDL-C) (HDL-C/TC) following the 1979/1980 survey in Tromsø. The men and their families were randomly allocated to a control or intervention condition. The intervention families were given advice on diet, smoking, and exercise. At rescreening in 1986/1987, significantly lower risk factor levels were found in both the intervention men and their spouses compared with those in the control group. For children, the differences were small and mostly nonsignificant. Men, spouses, and children in the intervention group reported more favorable dietary habits than those in the control group. No differences were found in smoking or leisure time physical activity.

Adolescent↗
PubMed2006

Traumatic pediatric bile duct injury: nonoperative intervention as an alternative to surgical intervention.

BACKGROUND: Nonoperative management of blunt pediatric liver injuries has become the standard of care in the absence of hemodynamic instability. However, associated bile duct injuries remain as difficult challenges. Few case reports have demonstrated the benefits of conservative approaches, but others have found better outcomes with surgical intervention. In this study, we report on our experience with interventional endoscopic and radiologic management of 5 pediatric patients with bile duct injuries who underwent unsuccessful surgical interventions. METHODS: We conducted a retrospective review of medical records of all pediatric patients who were admitted with major blunt liver trauma and bile duct injuries over a period of 5 years. RESULTS: There were 5 patients (4 boys and 1 girl) whose ages range from 3 to 11 years in this study. All patients had major liver laceration and bilomas. Two had intrahepatic and 3 had extra hepatic bile duct injuries (2 right hepatic ducts and 1 junction of cystic duct with common bile duct). All of them underwent previous laparotomies, once in 2 patients, twice in 2 patients, and thrice in 1 patient. All 5 patients were eventually treated successfully with interventional endoscopic and radiologic techniques. Three underwent endoscopic retrograde cholangiopancreatography stenting with percutaneous drainage. Two patients were managed with percutaneous drainage alone. The follow-up is up to 2.5 years with normal liver function test and bile duct ultrasound. CONCLUSION: With the current advancement in endoscopic retrograde cholangiopancreatography and intervention radiology techniques, we believe that interventional endoscopic and radiologic management of bile duct injuries caused by blunt trauma in children is successful and efficacious even after multiple laparotomies.

Bile Ducts↗
PubMed2006

Effects of delayed psychosocial interventions versus early psychosocial interventions for women with early stage breast cancer.

OBJECTIVE: The importance of psychosocial counselling after a diagnosis of cancer has been acknowledged and many intervention studies have been carried out, with the aim to find out which types of intervention are most effective in enhancing quality of life in cancer patients. A factor which could be part of effective counselling could be the time of offering psychosocial counselling. The aim of this study was to research the effect of time of enrolment in a psychosocial group intervention on psychosocial adjustment. METHODS: In the present study, 67 women with early stage breast cancer were randomised in a psychosocial group intervention program starting within 4 months after surgery or in the same intervention program starting at least 3 months later. RESULTS: The main conclusion of this study is that women who started with their intervention early were less distressed at 6 months follow-up than women who were in the delayed condition. Medical and demographic variables were predictive for some psychosocial adjustment indicators, but were not associated with time of enrolment. Regardless of time of enrolment, women improved in distress, body image and recreational activities, but showed a decrease in social interaction. CONCLUSION: Though results are limited, based on these results we suggest that psychosocial counselling should be offered as soon after diagnosis or surgery for breast cancer. PRACTICE IMPLICATIONS: Women diagnosed with primary breast cancer should be able to start with psychological counselling soon after being diagnosed, to prevent them from becoming distressed at long term.

Adaptation, Psychological↗
PubMedDate not supplied

Reduction in exposure to carcinogenic aflatoxins by postharvest intervention measures in west Africa: a community-based intervention study.

BACKGROUND: Aflatoxins are fungal metabolites that frequently contaminate staple foods in much of sub-Saharan Africa, and are associated with increased risk of liver cancer and impaired growth in young children. We aimed to assess whether postharvest measures to restrict aflatoxin contamination of groundnut crops could reduce exposure in west African villages. METHODS: We undertook an intervention study at subsistence farms in the lower Kindia region of Guinea. Farms from 20 villages were included, ten of which implemented a package of postharvest measures to restrict aflatoxin contamination of the groundnut crop; ten controls followed usual postharvest practices. We measured the concentrations of blood aflatoxin-albumin adducts from 600 people immediately after harvest and at 3 months and 5 months postharvest to monitor the effectiveness of the intervention. FINDINGS: In control villages mean aflatoxin-albumin concentration increased postharvest (from 5.5 pg/mg [95% CI 4.7-6.1] immediately after harvest to 18.7 pg/mg [17.0-20.6] 5 months later). By contrast, mean aflatoxin-albumin concentration in intervention villages after 5 months of groundnut storage was much the same as that immediately postharvest (7.2 pg/mg [6.2-8.4] vs 8.0 pg/mg [7.0-9.2]). At 5 months, mean adduct concentration in intervention villages was less than 50% of that in control villages (8.0 pg/mg [7.2-9.2] vs 18.7 pg/mg [17.0-20.6], p<0.0001). About a third of the number of people had non-detectable aflatoxin-albumin concentrations at harvest. At 5 months, five (2%) people in the control villages had non-detectable adduct concentrations compared with 47 (20%) of those in the intervention group (p<0.0001). Mean concentrations of aflatoxin B1 in groundnuts in household stores in intervention and control villages were consistent with measurements of aflatoxin-albumin adducts. INTERPRETATION: Use of low-technology approaches at the subsistence-farm level in sub-Saharan Africa could substantially reduce the disease burden caused by aflatoxin exposure.

Aflatoxin B1↗
PubMed1996

Perinatal intervention trial in Africa: effect of a birth canal cleansing intervention to prevent HIV transmission.

BACKGROUND: Perinatal transmission of human immunodeficiency virus (HIV) type 1 contributes significantly to infant mortality. Exposure in the birth canal may account for some transmission. We examined the efficacy of a birth canal washing procedure in reducing perinatal transmission in Malawi. METHODS: The infection status of infants of 3327 control women (conventional delivery procedures) was compared with that of 3637 infants of intervention-delivered women. The infants' HIV status was determined by polymerase chain reaction on dried blood spots collected at 6 and 12 weeks of age. The intervention consisted of manual cleansing of the birth canal with a cotton pad soaked in 0.25% chlorhexidine, which was done on admission in labour and every 4 h until delivery. FINDINGS: No adverse reactions to the intervention procedure were seen. 2094 (30%) of the enrolled women were HIV-infected, and 59% of their infants were seen in follow-up. Among 982 vaginal vertex singleton deliveries to HIV-infected women, 269 (27%) infants were infected. The intervention had no significant impact on HIV transmission rates (27% in 505 intervention women compared with 28% in 477 control women), except when membranes were ruptured more than 4 h before delivery (transmission 25% in the intervention group vs 39% in the control group). INTERPRETATION: If birth canal exposure is an important risk factor, different or additional methods to reduce the risk of perinatal HIV transmission should be tested. Alternatively, perhaps birth canal exposure is not a major contributor to perinatal infection risk.

Adult↗
PubMed1997

Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry.

OBJECTIVES: This study sought to determine whether infrapopliteal transcatheter interventions can salvage ischemic limbs in diabetic patients referred for below the knee amputation at our institution. BACKGROUND: The value of transcatheter interventions in diabetic crural arteries is controversial. Tissue oxygen partial pressure (TCO2) levels < 40 mm Hg predict poor wound healing. METHODS: Percutaneous interventions were performed in 29 consecutive diabetic patients in need of limb salvage. Technical success was defined as < 20% residual vessel stenosis. Clinical success was defined as the avoidance of amputation and achievement of wound healing. At hospital discharge, patients were treated with Coumadin and aspirin. Ankle-brachial index (ABI) and TCO2 measurements were obtained before and after the intervention. RESULTS: After 12-month follow-up, six patients had presistent wounds, whereas 23 experienced wound healing. Forty of the 50 infrapopliteal arteries successfully dilated were occluded, with a mean (+/-SD) lesion length of 18.0 +/- 3.5 cm. After the procedure, TCO2 improved from 27.82 +/- 9.97 mm Hg (95% confidence interval [CI] 23.95 to 31.69) to 54.5 +/- 14.73 mm Hg (95% CI 48.79 to 60.21, p < 0.0001), whereas the ABI did not (p > 0.2). TCO2 predicted procedural and clinical success (p < 0.0182). CONCLUSIONS: Infrapopliteal transcatheter interventions in diabetic patients may salvage the majority of limbs doomed to amputation. Although TCO2 measurements are valuable in predicting wound healing and success after interventions, ABI measurements are not.

Angiography↗
PubMed2002

Persistence of normotension after discontinuation of lifestyle intervention in the trial of TONE. Trial of Nonpharmacologic Interventions in the Elderly.

BACKGROUND: Weight loss and sodium reduction programs are effective in treating hypertension, but there is little information about the persistence of the benefit after discontinuation of the intervention. METHODS: The Trial of Nonpharmacologic Interventions in the Elderly (TONE) was a four-center controlled clinical trial of weight loss, reduced sodium intake, or both in maintaining normotension after withdrawal of antihypertensive drug therapy in older men and women whose hypertension was controlled with a single antihypertensive medication. Information on maintenance of normotension without need for drug therapy was obtained on 222 of 223 participants at the Robert Wood Johnson Medical School clinical center on average of 48.4 months (range 45 to 54 months) after the end of TONE. RESULTS: At the end of TONE follow-up, 43% of participants in the combined intervention group were off medication compared with 25% in the usual care group (P = .011). At 48 months after the end of TONE and discontinuation of contact of the participants with the clinical center, 23% of the combined intervention group v 7% in the usual care group were off medication (P = .012). CONCLUSIONS: Some benefits of structured dietary intervention appears to persist long term in a significant number of patients after discontinuation of the intervention.

Aged↗
PubMedDate not supplied

Comparison of interventions in prehospital care by standing orders versus interventions ordered by direct [on-line] medical command.

OBJECTIVE: The aim of this study was to compare the patient care measures provided by paramedics according to standing orders versus measures ordered by direct [on-line] medical command in order to determine the types and frequency of medical command orders. DESIGN: Prospective identification of patient care measures done as part of a prehospital quality assurance program. SETTING: An urban paramedic service in the northeast United States with direct medical command from three local hospitals. PARTICIPANTS: One thousand eight paramedic reports from October 1992 through March 1993. INTERVENTIONS: All patient care interventions recorded as done by standing orders or by direct medical command orders. Errors in patient care were determined by the same criteria as in the prior two studies of the same system. RESULTS: Direct medical command gave orders in 143/1,008 (14.2%) cases. Paramedics performed 2,453/2,624 (93.5%) of the total patient care interventions using standing orders. In 61 cases (6.1%), medical command ordered a potentially beneficial intervention not specified by standing orders or not done by the paramedic. 21/171 (12.3%) command orders were for additional doses of epinephrine or atropine in cardiac arrest cases (where the initial doses had been given under standing orders), and 59/171 (34.5%) were for interventions already mandated or permitted by standing orders. The paramedic error rate was 0.6%, and the medical command error rate was 1.8% (unchanged form the prior study of the same standing-orders system). CONCLUSION: Direct medical command gave orders in 14% of cases in this standing-orders system, but 35% of command orders only reiterated the standing orders. More selective and reduced uses of on-line command could be done in this system with no change in the types or numbers of patient care interventions performed.

Clinical Protocols↗
PubMed2004

Modelling return-to-work intervention strategies: a method to help target interventions.

The aim of this study is twofold: 1) to investigate the relationship between the probability of receiving an intervention by the occupational physician and the probability of return-to-work (RTW) of sick workers; 2) to explore the use of simultaneous modelling of the intervention and RTW process. Analyses are performed on population level using data from a major longitudinal survey on work incapacity and RTW in the Netherlands. A bivariate probit model is used to estimate the correlation between the probability of intervention and the probability of RTW A bivariate hazard model is applied to explore the joint distribution of the waiting times for the intervention and RTW The results of this study show that the probability of receiving an intervention from the occupational physician is not correlated with the probability of RTW Neither is the timing of both events correlated. The analyses do not indicate that the intervention by the occupational physician provides incentives for sick workers to RTW quicker.

Adult↗
PubMed2004

The intervention selection bias: an underrecognized confound in intervention research.

Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex offending, and juvenile delinquency. The intervention selection bias is most adequately controlled in randomized studies or strong quasi-experimental designs, although recent statistical innovations can enhance weaker designs. The most important points are to increase awareness of the intervention selection bias and to systematically evaluate plausible alternative explanations of data before making causal conclusions.

Child↗
PubMed2002

A pilot study of immune and mood outcomes of a community-based intervention for dementia caregivers: the PLST intervention.

Providing care to a family member with dementia is conceptualized as a chronic stressor with adverse psychological and physical effects. The purpose of this pilot study was to evaluate mood and immune outcomes of caregivers exposed to a community-based psychoeducational nursing intervention based on the progressively lowered stress threshold (PLST) model. The PLST intervention is designed to strengthen the psychological resources of dementia caregivers by teaching methods of preventing and/or managing behavioral problems exhibited by the person with dementia. Mood and immune outcomes were compared between caregivers randomly assigned to receive either the PLST or a comparison intervention. Results of this pilot study suggest that caregivers who received the PLST intervention showed significantly stronger T-cell proliferative responses to both PHA and ConA, indicating an improvement in T-cell immune function immediately after the in-home intervention (T2) and again after 6 months of telephone support for application of the PLST model (T3). Findings do not support the hypothesis that the PLST intervention had a significant effect on total mood disturbance or natural killer cell cytotoxicity over the course of the study.

Aged↗
PubMed2000

[Interventional magnetic resonance imaging--non-invasive imaging for interventions].

As a prerequisite for MR-guidance of interventional procedures, instruments have to be well depicted in the MR image without obscuring or distorting the underlying anatomy. For non-vascular interventions the imaging speed has to be in the range of seconds while control of vascular interventions requires real time imaging speed. The imaging contrast has to be maintained as well as a high spatial resolution. Furthermore, sufficient patient access has to be provided by the MR scanner. Neither an ideal magnet nor the optimal single sequence are available to fulfill the above-mentioned criteria. The type of sequence--gradient echo versus spin echo--together with changing of the echo time and phase encoding direction will ensure an appropriate size of the artifact and thereby of the appearance of the instrument in the MR image. The feasibility of non-vascular MR-guided interventions has been proved at field strengths ranging from 0.064 T to 1.5 T. Bone biopsies, soft tissue biopsies, drainages, and control of interstitial thermo- and cryotherapy have been reported. For vascular interventions, different real time MR strategies are currently under investigation. The development of dedicated catheters and guide wires has enabled MR-guided dilatations, stenting, placement of vena cava filters, and TIPS procedures. Considering the fast progress being made in this field, there can be no question that interventional MRI will become a well-accepted clinical tool offering potential advantages such as excellent soft tissue contrast, multiplanar imaging, flow measurements, high resolution imaging of vessel walls, and lack of ionizing radiation.

Artifacts↗
PubMed2001

Lowering HIV risk among ethnic minority drug users: comparing culturally targeted intervention to a standard intervention.

To test the efficacy of culturally targeted acquired immunodeficiency syndrome (AIDS) prevention programs on ethnic minority street drug users, 669 African-American and Puerto Rican drug users were assigned to receive either the National Institute on Drug Abuse (NIDA) standard intervention or a culturally competent enhanced intervention in a quasi-experimental study. The standard intervention was a two-session educational program, while both the African-American and Puerto Rican enhanced interventions provided additional AIDS information in a culturally appropriate fashion. Although human immunodeficiency virus (HIV) risk behaviors, as measured by Bell's risk indices, decreased, there were no meaningful significant differences between interventions. However, participants who went into drug treatment programs showed greater reduction in HIV risk behavior. Cultural interventions may provide better outcome if they concentrate on getting participants into drug treatment.

Acquired Immunodeficiency Syndrome↗