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PubMedDate not supplied

Evaluation of an Audiovisual Diabetes Education Program: negative results of a randomized trial of patients with non-insulin-dependent diabetes mellitus.

A randomized controlled trial was conducted to determine whether an education program specifically designed for patients with non-insulin-dependent diabetes and limited literacy could improve and sustain glucose and weight control. From a referral clinic, 120 obese (greater than 130 per cent of ideal body weight) diabetic patients who were not taking insulin were recruited. Of these, 55 per cent were female and 49 per cent were black; the mean age was 53 years. Mean glycosylated hemoglobin (HbA1%) was 10.2 per cent. Each subject was assigned to one of three groups: monthly group sessions with videotapes for diabetic persons with low literacy skills; monthly group sessions without videotapes; or no monthly sessions. After seven months, there had been 16 dropouts (13 per cent). Differences in weight changes between groups were significant (p less than 0.05); group 1 lost a median of 1 kg of weight (p less than 0.05) compared with a 0.1-kg loss and no change in groups 2 and 3, respectively. This weight loss was not sustained at 11 months. There was no significant change in HbA1%. Age, education, and compliance beliefs did not predict outcome. The authors conclude that the patient education programs did not result in sustained glucose or weight control.

Adult↗
PubMed1983

Role of electrophysiologic testing in the therapy of ventricular arrhythmias.

The past decade has witnessed important advances in the understanding of the mechanism underlying ventricular arrhythmias. It has become clear that sustained ventricular arrhythmias can generally be reproduced with programmed ventricular stimulation in the clinical electrophysiology laboratory. False positive results may, however, occur with very vigorous stimulation techniques, particularly in patients without documented arrhythmias. False negative results are not infrequent in victims of cardiac arrest. Ability or inability to initiate ventricular tachycardia during acute and chronic drug testing has predicted clinical failure or success, at least for conventional antiarrhythmics. Patients with sustained ventricular tachycardia and cardiac arrest occurring outside the peri-infarction period are those most likely to benefit from study. Conventional antiarrhythmic agents are successful in about one-third of patients with a high degree of concordance among these drugs. Amiodarone is frequently effective in patients with drug-refractory ventricular arrhythmias. However, its efficacy cannot be predicted by programmed stimulation. This is in striking contrast to Type 1A anti-arrhythmic agents.

Anti-Arrhythmia Agents↗
PubMed1990

Smoking cessation strategies: what works, what doesn't.

Health professionals can effectively help patients quit smoking with a minimal, intervention-oriented, office-based treatment program. Clear-cut, unequivocal, unambiguous, stop-smoking advice can produce sustained, 1-year abstinence rates in the 5% range. This capability has been clearly documented for physicians. Dental literature increasingly supports the same conclusion for dentists. These studies show that although the yield from such brief advice may seem small, it is 17 times greater than the yield which results from saying nothing. Moreover, because dentists and physicians see so many patients during the course of 1 year, the potential impact of such intervention is staggering. More than 3.5 million patients could be cured of tobacco dependence annually. While specialized smoking cessation treatment programs can achieve 1 year sustained abstinence rates as high as 70%, they reach relatively few patients and can only achieve such high success rates because of the intensive, time-consuming nature of their interventions. The impact of basic dental advice can be increased during regular follow-up visits, when "teachable moments" in dental health often occur. Impact of advice on the 1-year sustained abstinence rates can be increased by arranging to see the patient at regular follow-up visits after the target quit date has been set, making certain that the medication, nicotine polacrilex, is used correctly.(ABSTRACT TRUNCATED AT 250 WORDS)

Chewing Gum↗
PubMed1992

Recordings from the slow zone of reentry during burst pacing versus programmed premature stimulation for initiation of reentrant ventricular tachycardia in patients with coronary artery disease.

Programmed premature stimulation and burst pacing were compared for initiation of ventricular tachycardia (VT) in 16 patients with inducible sustained monomorphic VT. In all patients VT could be induced by programmed stimulation with 2 or 3 extrastimuli. On the other hand, initiation of VT by burst pacing was dependent on the length of the train; only 2 to 4 of the 11 trains tested could induce VT in any single patient. Recordings obtained from the slow zone of reentry showed that programmed premature stimulation that induced VT resulted in a critical degree of conduction delay as revealed by lengthening of local fractionated electrograms spanning 70 to 100% of the diastolic interval. Similarly, the last beat of a burst pacing train that induced VT was always followed by a similar degree of local conduction delay, whereas trains that failed to induce VT were followed by a lesser delay. It is concluded that although programmed stimulation with up to 3 extrastimuli was consistently successful in inducing VT, burst pacing succeeded in only 26% of the trials and was dependent on the length of the train, which varied from one patient to the other. Similar to what was shown previously in the experimental model of reentrant VT, burst pacing could initiate, conceal, terminate, and reinitiate reentry depending on the length of the train.

Atrioventricular Node↗
PubMed1999

Early family-based intervention in the path to alcohol problems: rationale and relationship between treatment process characteristics and child and parenting outcomes.

OBJECTIVE: Risk for subsequent development of alcohol problems is not uniform across the population of alcoholic families, but varies with parental comorbidity and family history. Recent studies have also identified disruptive child behavior problems in the preschool years as predictive of alcoholism in adulthood. Given the quality of risk structure in highest risk families, prevention programming is more appropriately family based rather than individual. METHOD: A family-based intervention program for the prevention of conduct problems among preschool-age sons of alcoholic fathers was implemented to change this potential mediating risk structure. A population-based recruitment strategy enrolled 52 alcoholic families in a 10-month intervention involving parent training and marital problem solving. The study examined the interplay between parent treatment investment and parent and therapist expectations and satisfaction in predicting change in child behavior and authoritative parenting style during the program, and for 6 months afterward among the 29 families whose sustained involvement allowed these effects to be evaluated. RESULTS: Parent expectations at pretreatment influenced their early investment in the program, which in turn predicted child and parenting outcomes. Parent and therapist satisfaction ratings during treatment were associated with one another and with expectations that the program would continue to promote changes in their child. Parent investment was a particularly salient influence on outcome, as higher investment throughout the program was associated with improvement in child behavior and authoritative parenting at termination. CONCLUSIONS: Findings indicate that treatment process characteristics mediate the influence of baseline parent functioning on treatment success and that treatment changes themselves predict later child outcomes.

Alcoholism↗
PubMed2005

[Monitoring and evaluation of health care programs in Subsaharian Africa].

The monitoring and evaluation is usually the weakest component of health programs in sub-Saharan Africa, what is undermining the sustainability of funding. The problems are complex and the weaknesses of the health systems are reflected on the monitoring and evaluation of specific programs. This paper gives an insight of the problems faced during field missions for monitoring and evaluation. The steps for building the M&E system have been reviewed and keys points for implementation have been provided.

Africa↗
PubMed1981

Further electrophysiologic and anatomic correlates in a canine model of chronic myocardial infarction susceptible to the initiation of sustained ventricular tachyarrhythmias.

A canine model of chronic myocardial infarction has been studied in which animals are susceptible to the initiation of sustained ventricular tachyarrhythmias using routine methods of programmed stimulation. The pacing-induced arrhythmias in this model are similar to those observed in man in their mode of initiation and termination, as well as in their response to both pacing and pharmacologic interventions. Indirect evidence has suggested a localized protected reentrant mechanism for these arrhythmias. The susceptibility to arrhythmia initiation in this model has been related to both electrophysiologic and histopathologic findings. Consistently, animals have demonstrated a marked heterogeneity of local properties of excitability and refractoriness at sites within areas of infarction. Correspondingly, animals have shown a marked inhomogeneity of histopathologic findings within areas of infarction, with close interspersing of normal and abnormal myocardium. Remarkably, even animals with small mottled infarctions, often less than 1 cm x 2 cm and electrocardiographically silent, were highly susceptible to the initiation of ventricular tachyarrhythmias, and especially fibrillation. Thus, initial provocative studies in this model have suggested its potential importance both in studying arrhythmia mechanisms and in evaluating the efficiency of potential antiarrhythmic interventions. In addition, this should be an ideal model in which to correlate pathophysiologic and morphologic alterations in the setting of chronic myocardial infarction.

Animals↗
PubMed2004

Biology, ecology and control of the Penthaleus species complex (Acari: Penthaleidae).

Blue oat mites, Penthaleus spp. (Acari: Penthaleidae), are major agricultural pests in southern Australia and other parts of the world, attacking various pasture, vegetable and crop plants. Management of these mites has been complicated by the recent discovery of three cryptic pest species of Penthaleus, whereas prior research had assumed a single species. The taxonomy, population genetics, ecology, biology and control of the Penthaleus spp. complex are reviewed. Adult Penthaleus have a dark blue-black body approximately 1 mm in length, and eight red-orange legs. Within Australia, they are winter pests completing two or three generations a season, depending on conditions. The summer is passed as diapausing eggs, when long-distance dispersal is thought to occur. The Penthaleus spp. reproduce by thelytokous parthenogenesis, with populations comprising clones that differ ecologically. The three pest Penthaleus spp. differ markedly in their distributions, plant hosts, timing of diapause egg production and response to pesticides, highlighting the need to develop control strategies that consider each species separately. Chemicals are the main weapons used in current control programs, however research continues into alternative more sustainable management options. Host plant resistance, crop rotations, conservation of natural enemies, and improved timing of pesticide application would improve the management of these pests. The most cost-effective and environmentally acceptable means of control will result from the integration of these practices combined with the development of a simple field-based kit to distinguish the different mite species.

Agriculture↗
PubMed1984

Pacing termination of ventricular tachycardia: influence of antiarrhythmic-slowed ectopic rate.

The success of pacing stimuli interruption of ventricular tachycardia (VT) was examined in 77 episodes of sustained VT induced in 31 patients undergoing programmed electrical stimulation studies. Once VT was induced, a trial to terminate the arrhythmia by means of the technique of entrainment was attempted. If this failed, rapid burst pacing faster than the VT was begun to try and terminate the tachycardia. In 30 patients off antiarrhythmic agents, entrainment was effective in terminating VT in 27%, while burst pacing was also effective in 27%. In 37% of patients, VT was accelerated or ventricular fibrillation was produced by pacing techniques, and these patients required defibrillation. Following antiarrhythmic therapy that failed to prevent VT induction but did result in slowing of VT rate, entrainment was only successful in 23% of trials, while burst pacing was successful in 34% of trials. The incidence of acceleration of VT on therapy was 32%. There was no appreciable difference in acceleration noted with or without antiarrhythmic therapy. Regardless of therapy, the slower the VT rate, the greater success of pacing termination of VT and the lower the incidence of VT acceleration. Antiarrhythmic agents that significantly slow the VT rate increase the success rate of pacing stimuli interruption of VT and decrease the incidence of VT acceleration and thus the need for defibrillation. The results suggest that antiarrhythmic agents that slow the VT rate may increase the effectiveness of antiarrhythmic pacemakers in terminating VT.

Adult↗
PubMed1990

Ventricular tachycardia in the infarcted, Langendorff-perfused human heart: role of the arrangement of surviving cardiac fibers.

Electrophysiologic and histologic studies were performed on Langendorff-perfused human hearts from patients who underwent heart transplantation because of extensive infarction. In nine hearts, 15 sustained ventricular tachycardias could be induced by programmed stimulation. In all hearts, mapping of epicardial and endocardial electrical activity during tachycardia was carried out. Histologic examination of the infarcted area between the site of latest activation of one cycle and the site of earliest activation of the next cycle revealed zones of viable myocardial tissue. In two hearts in which the time gap between latest and earliest activation was small, surviving myocardial tissue constituted a continuous tract that traversed the infarct. In three other hearts in which the time gap was large, surviving tissue consisted of parallel bundles that coursed separately over a few hundred micrometers, then merged into a single bundle and finally branched again. The direction of the fibers within the bundles was perpendicular to the direction of the activation front in that area. A similar type of inhomogeneous anisotrophy and activation delay was found in an infarcted papillary muscle removed from one of the explanted hearts and studied in a tissue bath during basic stimulation. Histologic examination of this preparation revealed that the delay was caused by a zigzag route of activation over branching and merging bundles of surviving myocytes separated by connective tissue.

Cardiac Pacing, Artificial↗
PubMed2005

Could visible light contribute to the development of leukaemia and other cancers in children?

This paper suggests to rigorously test the hypothesis that there are causal links between visible light and the development of leukaemia and other cancers in children. Light can be considered as a candidate risk factor because it suppresses melatonin biosynthesis which may play a role in a series of anticancer defences. Indeed, melatonin may offer some protection against all "hallmarks of cancer" [i.e., self-sufficiency in growth signals; insensitivity to growth-inhibitory signals; evasion of programmed cell death (apoptosis); limitless replicative potential; sustained angiogenesis; tissue invasion and metastasis] recently suggested by Hanahan and Weinberg. Already ongoing investigations into the possible nexus of light, endocrine systems and the development of cancers will be further fueled by recent insights into photoreception and -- transduction, including the discovery of "novel" photoreceptors in the eye. Among a variety of different photosensory tasks, these receptors constitute crucial gates for light information from the environment which is employed for the temporal organization of our physiology and it has been proposed that chronodisruption, i.e., a significant disturbance of the coordination and thus order of biological rhythms, could contribute to the development of cancers. With regard to public health, the pervasive exposures to light -- at work and in homes -- imply that visible radiation could be a strong risk factor defined epidemiologically as a causal contributor to disease in a large proportion of cases. Importantly, if light were to be corroborated as a contributor to cancers in children, it would be amenable to manipulations with the perspective of reducing inherent risks significantly. In fact, it could be much easier -- and much more effective -- to reevaluate and modify lighting systems than to manipulate other possible determinants of the chronic processes of cancer such as genetic, nutritional or lifestyle factors.

Child↗
PubMed2006

Enteric infections and the vaccines to counter them: future directions.

While it is well-recognized that diarrheal diseases remain the second most frequent cause of mortality among children <60 months of age in the developing world, there is nevertheless a need to obtain more precise mortality and hospitalization burden data in populations living in the world's least developed areas. There is also a glaring need to obtain robust etiology data in relation to the different diarrheal disease clinical syndromes, including serotypes of Shigella and antigenic types of ETEC. Because of the poor uptake of the new typhoid and cholera vaccines licensed since 1985, it will be important to create reliable, long-term demand for the next generation of enteric vaccines, including new rotavirus, Shigella and ETEC vaccines. The first priority is to get individual vaccines licensed. Post-licensure, it will then be simpler to investigate the clinical acceptability, immunogenicity and effectiveness of various combinations of the individual licensed enteric vaccines. The extensive gut mucosal surface with its many sites for induction of immune responses make it likely that co-administrations will be successful. Partnerships of public and private agencies in the developing and the industrialized world will have to be forged to create a reliable demand for new enteric vaccines and to assure adequate, sustained supplies of affordable products. Systematic implementation programs will have to be created in the least developed, high burden, high mortality countries to deliver enteric vaccines and to document their impact after introduction.

Bacterial Infections↗
PubMed1986

Effects of diltiazem on reperfusion-induced arrhythmias in vitro and in vivo.

The effects of the calcium antagonist, diltiazem, on myocardial injury during ischemia and reperfusion were studied both in vitro, in the isolated rat heart, and in vivo, in a closed-chest pig model. In the isolated rat heart, administration of diltiazem before or at the onset of ischemia resulted in a dose-dependent reduction of the incidence and duration of ventricular fibrillation. This reduction was associated with a dose-dependent reduction in overflow of ATP catabolites (adenosine, inosine, hypoxanthine and xanthine). Both changes were significant at concentrations of 3 X 10(-7) M diltiazem and higher. When 3 X 10(-7) M diltiazem was administered upon reperfusion no effect on the incidence of ventricular fibrillation and on ischemia induced total purine overflow was observed. However, the duration of ventricular fibrillation and purine overflow at 5 min after reperfusion were significantly reduced. In the pig experiments all untreated animals (n = 8) showed accelerated idioventricular rhythm (AIVR) upon reperfusion which lasted for 22 +/- 5 min after which sinus rhythm returned. Only two out of five treated animals (450 micrograms/kg/2 h) had an AIVR. Upon reperfusion both groups showed a substantial rise in noradrenaline concentration in the coronary sinus blood, but after 5 min this was significantly less in the treated group. Creatine kinase-kinetics were not altered by diltiazem, but the maximum creatine kinase level was significantly reduced. Within 4 days after the acute experiment 50% of the untreated animals died suddenly, whereas no sudden deaths occurred in the diltiazem group (P less than 0.05). Seven days after the acute experiment, sustained ventricular tachycardia could be induced with programmed electrical stimulation in three out of four surviving untreated pigs. In none of the diltiazem treated pigs was ventricular tachycardia inducible. The results of this study show that the calcium antagonist diltiazem can beneficially influence the events during ischemia and during reperfusion, both in vitro and in vivo; this benefit is associated with a reduction of ATP catabolism, creatine kinase release and noradrenaline overflow. Furthermore, diltiazem reduces electrical instability in the chronic phase of myocardial infarction.

Adenosine Triphosphate↗
PubMed1978

Bilateral nephrectomy for hypertension in patients with chronic renal failure on a dialysis program.

During the last 6 years 33 bilateral nephrectomies have been performed for severe hypertension in patients with chronic renal failure on a dialysis program. Nephrectomy resulted in a prompt and sustained reduction in blood pressure, an improved sense of well-being and a gain of weight. Despite the fact that the mean hematocrit decreased from 25 to 18 per cent all patients thrived. The nephrectomy group showed an 85 per cent 5-year cumulative survival rate compared to 55 per cent in the non-nephrectomy group. There was 1 mortality and low morbidity. Simultaneous nephrectomy by 2 teams, using a posterior approach, proved more satisfactory than an anterior or bilateral flank apprach. The indications for and arguments against bilateral nephrectomy are discussed.

Adult↗
PubMed2003

Maximizing the synergy between pharmacotherapy and psychosocial therapies for schizophrenia.

Although the traditional antipsychotic medications were a major advancement in schizophrenia therapeutics and made possible the era of deinstitutionalization, just maintaining a patient out of the hospital no longer can be viewed as the final goal of treatment. Most patients are able to maintain outpatient status despite persistent psychotic symptoms, pervasive negative symptoms and poor social competence. It is hoped that the availability of the atypical antipsychotic drugs will improve significantly compliance, treatment of symptoms, and possibly relapse rates and overall outcome. It should be the norm and not the exception for patients to be treated with these new medications as early as possible in their illness. The clinician should not be complacent and quick to accept persistent psychosis, and patients with various forms of treatment resistance should be tried early in the course of illness with clozapine (or other medications as they become available if they show superiority for treatment-resistant patients). Pharmacologic interventions aimed at deficit symptoms may become available in the future. Psychosocial interventions have a place in the modern therapeutic armamentarium. Relatively simple sustained family interventions and more comprehensive ACT programs are effective for relapse prevention and reduction of the "revolving door syndrome," whereas patients with psychosis nonresponsive to medication may benefit from new modalities of CBT. For patients with persistent negative symptoms and limited social competence, SST is indicated where available, and even in places where staff may be limited and social skills and other programs difficult to implement, family psychoeducational interventions can be carried out to good effect.

Antipsychotic Agents↗
PubMedDate not supplied

Sustainability of prevention.

This paper outlines the guidelines for sustaining prevention and makes suggestions for getting from the field's current status to greater levels of permanence for prevention. The paper begins by reviewing the status of prevention, then focuses on major considerations for achieving sustainability, including two processes of institutionalization, comprehensive programming and professionalism.

Adolescent↗
PubMed1986

Reproducibility of arrhythmia induction with intracardiac electrophysiologic testing: patients with clinical sustained ventricular tachyarrhythmias.

In order to characterize the day to day reproducibility of arrhythmias provoked during electrophysiologic stimulation, 114 patients with documented sustained clinical ventricular tachyarrhythmias were studied. Two baseline electrophysiologic tests were performed in the drug-free state and within 6 to 24 hours of one another. There was a significant increment (p less than or equal to 0.02) in the induction of sustained ventricular tachyarrhythmias as the number of programmed extrastimuli increased from one (10% induction) to four (64% induction). Provoked arrhythmias were observed to be more frequently nonreproducible (as reflected in a major change in rate or duration, or both, of an induced ventricular arrhythmia between baseline tests) as the number of extrastimuli increased from one (7%) to four (27%). Nonreproducibility with three and four extrastimuli was not significantly greater than when two extrastimuli were utilized. Electrophysiology-directed drug trials should be interpreted in light of this observed variability in induced arrhythmias.

Adolescent↗
PubMed2003

Unexplained syncope in patients with structural heart disease and no documented ventricular arrhythmias: value of electrophysiologically guided implantable cardioverter defibrillator therapy.

AIMS: To evaluate electrophysiologically guided implantable cardioverter defibrillator (ICD) therapy in patients with syncope, structural heart disease and no documented sustained ventricular tachycardia (sVT). METHODS AND RESULTS: Programmed ventricular stimulation (PVS) was performed in 52 patients (age 62+/-10 years): 40 patients had ischaemic and 12 patients had idiopathic dilated cardiomyopathy. On PVS sVT and ventricular fibrillation were induced in seven and four patients, respectively, and two patients spontaneously experienced symptomatic sVT. These patients received an ICD (ICD group, n=13). Non-inducible patients were left on conventional therapy (non-ICD group, n=39). During 5+/-2.8 years five ICD patients received therapies, all appropriate. There were seven non-sudden deaths and overall survival analysis revealed no significant difference. Recurrent syncope occurred in five ICD and four non-ICD patients and did not correlate well with sVT. The positive and negative predictive values of PVS for tachyarrhythmias or sudden death were 36 and 98%, respectively. CONCLUSION: Syncope per se does not necessarily herald a bad prognosis. PVS identifies high-risk patients. Induction of ventricular fibrillation with double or triple extrastimuli is of limited value. Patients with poor left ventricular function and bad clinical condition benefit most from an ICD. Syncope and sVT are not necessarily correlated during follow-up, which may merit consideration.

Aged↗