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PubMed1999

Effects of a psychosocial intervention on survival among patients with stage I breast and prostate cancer: a matched case-control study.

CONTEXT: Psychosocial factors have been linked to the development and progression of cancer and shown to be relevant in cancer care. However, the evidence that psychosocial interventions affect cancer survival is less conclusive. Few methodologically sound studies have addressed this issue. OBJECTIVE: To investigate the effects of a 6-week psychosocial intervention on survival among patients with stage I breast and prostate cancer. DESIGN: Matched case-control. SETTING: 3 rural hospitals or cancer centers in central Pennsylvania. PATIENTS: 21 breast and 29 prostate stage I cancer patients (treatment group) matched with 74 breast and 65 prostate stage I cancer patients from the same hospitals who did not receive the intervention (control group). INTERVENTION: Six 2-hour health psychology classes conducted by a licensed staff psychologist. MAIN OUTCOME MEASURES: Survival time was compared between the 2 groups and with national norms. RESULTS: The intervention group lived significantly longer than did matched controls. At 4- to 7-year follow-up (median = 4.2 years), none of the breast cancer patients in the intervention group died, whereas 12% of those in the control group died. Twice as many matched-control prostate cancer patients died compared with those in the intervention group (28% vs 14%). Control group survival was similar to national norms. CONCLUSIONS: These results are consistent with prior clinical trials and suggest that short-term psychosocial interventions that encourage the expression of emotions, provide social support, and teach coping skills can influence survival among cancer patients. However, self-selection bias cannot be ruled out as an alternative explanation for the results. These interventions merit further consideration and research.

Aged↗
PubMed1998

Intervention classifications for nursing practice and the ICNP: cultural considerations for Korean nurses.

There are several intervention classifications for nursing practice. Yet, their relevancy and clarity for international use has not been evaluated. Thus, the paper presents a review of 4 major nursing intervention classifications (Saba's Home Health Care Classifications, Omaha's Intervention Scheme, Grobe's Nursing Intervention Lexicon & Taxonomy, and the International Classification for Nursing Practice) for Korean nursing practice. A simple comparison procedure utilized to determine the relevancy and clarity of each overall scheme and specific elements. The findings showed that general concepts for the top level of all the classifications were both relevant and clear. However, specific elements of lower levels became less clear and relevant because of the lack of definitions and cultural differences. In particular, interventions related to psycho-social and environmental components appeared to be either unclear or non-relevant for Korean nursing practice while interventions related to physiological components were found to be very relevant and clear. In conclusion, multiple levels of hierarchical intervention schemes and the absence of definitions impede clarity of intervention classifications. In addition, for international use, an intervention classification needs to be sensitive to cultural relevancy in its elements.

Evaluation Studies as Topic↗
PubMed1999

Chronic low back pain: early interventions.

Low back pain is a common and costly social problem. Many of the long term outcomes of chronic low back pain (CLBP), such as those related to occupational and social function or patient and family coping, are sensitive to nursing intervention. To identify potentially productive areas for nursing intervention research, studies from 1990 to 1998 were reviewed that investigated (a) potential early indicators that acute or subchronic low back pain would result in chronic pain and disability, (b) patient perspectives on adaptation to chronic pain, and (c) the value of interventions undertaken during the acute and subchronic phases of back pain to modify long-term outcomes. Sixteen quantitative studies were identified that prospectively investigated the natural history and outcomes of low back pain. Six qualitative studies that investigated the perspectives of patients with back pain were also identified. Ten randomized clinical trials were identified that investigated interventions undertaken during the acute or subchronic stages of back pain. Clinical interventions that included advice to re-engage in activity, support to develop personalized goals, reinforcement for healthy gains and appropriate functional activities, and physical conditioning exercises tended to be successful in returning patients to work or limiting their self-reported disability and pain. Interventions that promoted communication at the work-site or modified the patient's job were also successful in promoting a faster return to work. Nonetheless, this is a nascent area of research in need of improvements related to the selection of appropriate subjects and controls, the timing and duration of interventions, and the reliability with which interventions are implemented. Furthermore, patients with back pain are most likely to benefit when nursing theories about chronic pain are linked to clinical intervention research.

Humans↗
PubMed2000

Effect of early intervention of high-frequency oscillatory ventilation on the outcome in pediatric acute respiratory distress syndrome.

BACKGROUND: Acute respiratory failure in both pediatric and adult patient populations has been extensively studied with recent emphasis on ventilation strategies that can effect mortality outcome. This research in adults has focused on definitive trials of lung protective strategies that have been proposed following preliminary reports of their potential benefits. High frequency oscillatory ventilation has also been described as a lung protective strategy. For many institutions HFOV is today considered a routine therapy as a "rescue" method in acute pediatric respiratory failure. Because HFOV is considered to be a "rescue" therapy, intervention with HFOV is usually in the later stages of acute respiratory failure and consideration of the time to intervention has not been previously examined. OBJECTIVE: To evaluate the effect of time to intervention with high-frequency oscillatory ventilation (HFOV) on the survival of children with severe acute hypoxemic respiratory failure who were managed with lung protective strategies on conventional mechanical ventilation (CMV). METHODS: Twenty-six consecutive patients older 1 month of age with severe hypoxemic respiratory failure and ARDS who at some point in their management were treated with HFOV were evaluated. The mean age was 3.7 years and included three patients treated in the Pediatric Intensive Care Unit (17, 19 and 24 years). Mean weight was 13.8 kg and there were 17 males and 9 females. Nine patients met Extracorporeal Membrane Oxygenation (ECMO) criteria, although only two patients were cannulated. Upon admission to the PICU, patients were initially managed with lung protective strategies using Pressure Controlled Ventilation (PCV) or Pressure Regulated Volume Control (PRVC) modes with limited peak inspiratory pressure, high positive end-expiratory pressure, and permissive hypercapnia. If a Pa-CO2 reached > 75 torr (10.0 kPa) and/or pH < 7.20, tracheal gas insufflation (TGI) was instituted. If FiO2 remained above 0.6 and mean airway pressure (Paw) exceeded 15 cmH2O in order to maintain arterial saturation above 89% or if hypercapnia and/or acidosis on CMV with TGI persisted, the patients were switched to HFOV. An "Optimal Volume Strategy" with HFOV was utilized to recruit alveoli and optimize lung volume. Patients were returned to CMV when their mean airway pressure were between 15 and 20 cmH2O, FiO2 < 0.6, had no evidence of air-leak and/or improved chest X-rays, and did not desaturated during airway suctioning. Patients were offered ECMO if the hypoxemia persisted on HFOV and there were no contraindications to its use. The patients were stratified for analysis by the time to intervention with HFOV. Early intervention was defined as within the first 24 hours of mechanical ventilation (17 patients) and late intervention defined patients beyond 24 hours (9 patients). Demographic data (gender, age, weight, admission PRISM score), time of each mode of ventilation, oxygenation indices and outcomes were recorded for both groups of patients. MAIN RESULTS: The severity of respiratory failure at the time of HFOV intervention was comparable in both early and late groups (PaCO2/FiO2 83 vs. 79 torr, oxygenation index 27 vs. 33, AaDO2 421 torr (56 kPa) vs. 413 torr (55 kPa)). There were no differences in mean age, weight, admission PRISM score length of HFOV, length of CMV after HFOV (CMV post-HFOV) and the total duration of mechanical ventilation between the groups. We found a statistically significant difference in mortality with 58.8% of the early intervention patients surviving while only 12.5% of the late intervention patients survived. The overall survival rate was 42% (11/26 patients). CONCLUSION: Early use of HFOV within the first 24 hours of acute hypoxic respiratory failure in pediatric patients is associated with better survival. Use of this therapy should be considered early in the course of treatment of any pediatric patient meeting this definition. (Tab. 2, Fig. 1, Ref. 28.)

Adolescent↗
PubMed2000

Cancer care: impact of interventions on caregiver outcomes.

The purpose of this review is to examine the research literature on interventions aimed at caregivers who, in the current health care environment, are assuming increasing responsibility for the complex care of significant others experiencing cancer. The general aim of the review is to synthesize the literature on interventions targeted to cancer caregivers and to summarize outcomes associated with the various intervention strategies described. Three broad categories of interventions were described in the literature: (1) educational, (2) counseling/psychotherapeutic, and (3) hospice and palliative home care. The review included studies that met the following criteria: data-based studies that described an intervention aimed at assisting caregivers to care for patients with cancer, studies published between 1975 and January 1999, and studies published in English. A total of 29 published papers was included. Although the original intent was to limit the review to studies that associated interventions with outcomes, a lack of well-delineated outcome variables was revealed as a major gap in the literature. Thus, some studies that did not include outcome variables were reviewed and the following conclusions made: (1) there is a dearth of data-based literature describing interventions aimed at caregivers; interventions that are described often lack well-defined effects due to a lack of or poor operationalization of outcomes; (2) of the small number of studies in this area, many used small samples and lacked randomization; and (3) studies often revealed selection bias to well-adjusted caregivers who were accepting of support, able to obtain respite care in order to participate, and often willing to avail themselves of a group-style intervention.

Caregivers↗
PubMed2000

Interventions for children with diabetes and their families.

The purpose of this review is to examine the research literature on interventions for children with type 1 diabetes and their families, with a specific focus on three types of intervention (educational and psychosocial/behavioral interventions that focus on individuals with diabetes and family interventions for families, usually parents, of individuals with diabetes). The aim of the review is to determine what interventions produce what outcomes in what populations of children and families. The review includes articles that met the following criteria: (a) empirical study reporting the impact of an intervention on such outcomes as knowledge, behavior, self-care, and metabolic control; (b) children with type 1 diabetes and/or their families as primary subjects; (c) publication between 1980 and January 1, 1999; and (d) publication in English. A total of 41 published papers were included. On the basis of this review, conclusions are as follows: (a) Educational interventions are useful in improving diabetes knowledge but not consistently helpful in improving metabolic control; (b) psychosocial interventions, especially coping skills training and peer support, assist primarily adolescents to improve adjustment and sometimes metabolic control; and (c) family interventions may be helpful in reducing parent-child conflict about diabetes management and care.

Adaptation, Psychological↗
PubMed2000

Brief intervention for female heavy drinkers in routine general practice: a 3-year randomized, controlled study.

BACKGROUND: Today, heavy drinking is a common health hazard among women. The evidence in favor of providing some kind of brief intervention to reduce drinking is quite convincing. However, we do not know if intervention works in a natural environment of routine health care. The purpose of this study was to evaluate the effectiveness of long-lasting, brief alcohol intervention counseling for women in a routine general practice setting. METHODS: In five primary care outpatient clinics in a Finnish town, 118 female early-phase heavy drinkers who consulted their general practitioners for various reasons were given brief alcohol intervention counseling. Intervention groups A (n = 40) and B (n = 38) were offered seven and three brief intervention sessions, respectively, over a 3-yr period. The control group C (n = 40) was advised to reduce drinking at baseline. Main outcome measures were self-reported weekly alcohol consumption, carbohydrate-deficient transferrin, mean corpuscular volume (MCV), aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase. RESULTS: Depending on the outcome measure and the study group, clinically meaningful reduction of drinking was found in 27% to 75% of the heavy drinkers. Within all the groups, MCV significantly decreased. However, there were no statistically significant differences between study groups A, B, and C in the mean changes between the beginning and endpoint in the main outcome measures. CONCLUSIONS: The present study indicated that minimal advice, as offered to group C, was associated with reduced drinking as much as the brief intervention, as offered to groups A and B, given over a 3-yr period. Furthermore, in the routine setting of the general practice office, the effectiveness of the brief intervention may not be as good as in special research conditions. The factors possibly reducing the effectiveness in a routine setting are unknown. Thus, different methods of implementing brief intervention need to be evaluated to find better ways to support general practice personnel in their efforts to help heavy-drinking female patients to reduce their drinking.

Adult↗
PubMed2001

Current status of family intervention science.

Looking at the field as a whole through metaanalysis, Shadish et al concluded (based on 162 studies) that marital and family therapies were significantly more effective than no treatment and at least as effective as other forms of psychotherapy. Although these reviews and others are positive, individual studies raise many questions. For instance, based on research findings, family treatments increasingly have become standard care for patients with schizophrenia. It remains unclear what degree and type of family involvement is needed for which patients at which stage of their disorder. In the area of anxiety and depression, there are too few studies to make any strong conclusion. Although investigators such as Barrett, Cobham, and Diamond have produced some positive results, the Lewinsohn and Clark studies fail to demonstrate the added benefit of family involvement. Although Brent's study showed CBT to reduce depression faster, family therapy and supportive therapy did just as well in the long run, and family conflict was a strong risk factor for relapse. In the area of anorexia, Russell and Robins produced strong results from family interventions, whereas Geist found no difference between different types of family interventions. Family treatments for obesity have been inconsistent. In a metaanalysis of 41 studies, parental involvement did not contribute significantly to outcomes. In the Epstein study, however, which included 5- and 10-year follow-up, the results of family intervention were impressive. Although many of these studies can be cited for various methodologic flaws, the most consistent problem is that sample sizes are too small to detect difference between two or more active treatments. The most consistent findings (and most well-done, large studies) that support the efficacy of family-based interventions are done with externalizing problems. Work groups led by Patterson, Eisenstadt, Webster-Stratton, Alexander, and Henggeler all have produced impressive reductions of oppositional and antisocial behavior. Clinical programs that treat these populations without using a family-based intervention as at least a component of a treatment package are seriously ignoring the findings of contemporary intervention science. Programs of research by Henggeler, Szapocznik, and Liddle demonstrate similarly impressive results for substance abusing adolescents. Although preliminary results from the Dennis et al study suggest that various treatment approaches may benefit this population. Family interventions have had less success in reducing ADHD symptoms, yet these psychosocial treatments have been essential in reducing much of the family and school behavior problems associated with this disorder. Many investigators would agree that a combined medication and family treatment approach may be the treatment of choice for children with ADHD. In fact, many studies across various disorders suggest that patients respond best to comprehensive treatment packages, of which a family treatment is at least one component. Although the data are promising, many challenges lie ahead. Although collectively many family intervention studies exist, many disorders lack enough rigorous and large-scale investigations to make any strong conclusions. Kazdin argues that sample sizes of 150 are essential to detect significant differences between active treatments, and few of the reviewed studies include these kinds of patient numbers. Furthermore, not enough committed and sophisticated family treatment researchers have carried out some of the major studies. For example, the Brent study on depression and the Barkley study of ADHD, although testing family approaches, lacked well-developed and published treatment manuals, a demonstration of the necessary expertise to supervise these treatments, and data about training and adherence to these models. Although the absence of expertise limits investigator allegiance biases, treatment development and modification are essential for tailoring family treatments to target family processes specific to each disorder. Investigators such as Patterson and Liddle have invested great effort in rigorously dismantling the treatment process, identifying and refining essential ingredients, and repackaging more potent treatment protocols. This process has paid off well. Programmatic treatment development is needed for many disorders to address myriad questions. What are the essential disorder-specific family processes that should be targeted by interventions? Hostility, criticism, communication, attachment and autonomy, attributional sets, and behavior management are important processes of family life, but each may have more relative importance for specific disorders. With a greater understanding of these processes, treatments could be tailored to target these mechanisms more efficiently and effectively. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed2001

[Initial results and long-term outcome of percutaneous coronary intervention in patients with previous coronary artery bypass grafting].

OBJECTIVES: The incidence of percutaneous coronary intervention following bypass surgery(coronary artery bypass grafting: CABG) is not low, but the outcomes of patients requiring percutaneous coronary intervention after CABG are not well known. METHODS: From June 1970 to June 2000, 2,981 patients underwent CABG at our institute using 6,747 grafts including 2,875 saphenous vein graft(SVG), 3,042 internal thoracic artery(ITA), 706 gastro-epiploic artery(GEA), 122 radial artery(RA), and 2 others. Three hundred twenty-seven patients underwent subsequent percutaneous coronary intervention in 520 lesions(104 SVG, 97 ITA, 12 GEA, 8 RA, 299 native artery). The initial results and long-term outcome following percutaneous coronary intervention in these 520 consecutive procedures were evaluated retrospectively. RESULTS: Percutaneous coronary intervention to arterial grafts were performed mainly within the early post-operative period, whereas percutaneous coronary intervention to vein grafts had two periodic peaks in the early post-operative period and at 7 years after CABG. Procedural success rate of percutaneous coronary intervention was 90% for SVG, 81% for ITA, 58% for GEA, 88% for RA, and 87% for native arteries. Restenosis rate was 56% for SVG, 30% for ITA, 83% for GEA, 83% for RA, and 49% for native arteries. Cardiac events after percutaneous coronary intervention with previous CABG were greater in cases of ITA, followed by native arteries, SVG, GEA and RA(p = 0.0046). In the early post-operative period, there was no significant difference between ITA and SVG. In the chronic stage, the prognosis of cardiac events after PCI for SVG was worse than for ITA. CONCLUSIONS: Percutaneous coronary intervention after CABG requires strategic consideration based on target-specific initial results and long-term outcome.

Adult↗
PubMed2002

Fetal health surveillance: a community-wide approach versus a tailored intervention for the implementation of clinical practice guidelines.

BACKGROUND: The decreased use of electronic fetal monitoring (EFM) for healthy women in labour and the increased provision of professional support to all women in labour is recommended by experts. We evaluated the effectiveness of a community-wide approach to transferring research results to practice using a regional committee, newsletter articles and annual conference presentations compared with an additional tailored hospital intervention involving workshops to enhance self-efficacy for nurses, policy review, multidisciplinary meetings, rounds and unit discussions. METHODS: We compared the proportion of women at low risk who received EFM and the proportion of nurses' time spent providing labour support before and after the intervention within each of 4 hospitals (2 tertiary and 2 secondary). One hospital of either type was randomly selected to receive the tailored intervention. Randomly selected charts (n = 200) were reviewed for the use of EFM at each hospital before (1995) and after (1996) the intervention. Trained observers at randomly selected times recorded the nurses' activities, including time spent providing labour support before and after the intervention. RESULTS: At the intervention secondary hospital, there was a large decrease in the use of EFM, from 90.1% before to 41.0% after the intervention (p < 0.001), but no change in nurses' time spent providing labour support. At the intervention tertiary hospital there was no change in EFM rates, but there was a small, statistically significant increase in time spent providing labour support (23.5% to 29.8%, p < 0.001). A negative effect on time spent providing labour support was found at the control secondary hospital (decrease from 19.6% to 12.8%, p < 0.001), with no change in the EFM rate. At the control tertiary hospital there was a small decrease in the use of EFM, from 99.5% to 91.4% (p < 0.001), but no change in time spent providing labour support. INTERPRETATION: The results are mixed, and the tailored intervention thus appeared to have limited effects. No association was found between the reduction in the use of EFM and an increase in nurses' time spent providing labour support.

Canada↗
PubMedDate not supplied

[Communication interventions: windows of opportunity].

OBJECTIVE: An understanding of how verbal and non verbal language develops and how it is related to social behavior is essential in order to devise effective interventions for children with disorders of communication. We review the literature on interventions for children with communication disorders from the perspective of the clinical neurologist emphasizing both therapeutic and pharmacological interventions. FINDINGS: Our knowledge on effective interventions in children with disorders of communications is limited due to the heterogeneity of the population and the lack of well controlled studies. There is some limited data suggesting that therapeutic interventions for children with language impairments are most effective if all forms of communication are emphasized. Interventions should be adapted to the age of presentation and associated clinical findings of the child. CONCLUSIONS: A multimodal intervention approach is essential to maximize the potential of children with communication disorders. The role of medication in interventions for children with disorders of communication is limited to the treatment of associated symptoms that may interfere with the ability of a child to receive non pharmacological therapeutic interventions.

Brain↗
PubMed2003

The cost effectiveness of 5 interventions to increase mammography adherence in a managed care population.

OBJECTIVE: To determine the cost effectiveness of 5 combinations of strategies for increasing adherence to mammography recommendations in a population of women between the ages of 50 and 85 years enrolled in a large midwestern health maintenance organization. STUDY DESIGN: A randomized control trial comparing interventions believed to increase mammography adherence. PATIENTS AND METHODS: Intervention strategies included 5 combinations of physician recommendation, telephone, and in-person counseling. A total of 652 participants were randomly assigned to 1 of 6 intervention groups and 628 (95.9%) were available at 6-month follow-up. A logistic regression model with adherence as the dependent variable and group as the independent variable was used to test for significant differences between groups. A ratio of cost to improvement in mammogram adherence evaluated the cost effectiveness at 6 months. RESULTS: All 5 interventions resulted in significantly higher rates of adherence compared to no intervention. However, when considering costs, only 1 emerged as the superior strategy for the overall study population. In-person counseling was the most cost-effective strategy overall, followed closely by in-person counseling and physician's letter intervention. For women contemplating mammography, the telephone contact and physician's letter combination was the most cost-effective intervention. For women not contemplating mammography, the physician's letter was superior. The physician's letter worked best with women who had previous mammograms. For women with no mammogram history, the in-person counseling and physician's letter combination was clearly superior. CONCLUSIONS: The cost effectiveness of mammography screening interventions varies based on women's prior history of mammograms and their future intent. Further, managed care organization member characteristics can be used to determine the most cost-effective mammography screening intervention based on individual readiness.

Aged↗
PubMed2001

[A dietary intervention study on the hypertensive high risk population in a northern rural area of Beijing].

To investigate the relationship between optimal living mode, healthy dietary pattern and the incidence of primary hypertension, a dietary intervention study on hte hypertensive high risk population was carried out in Fangshan district of Beijing during 1997-1999. The subjects were divided into two groups: control group and intervention group. A 3-day-dietary-recall combined with weighing method and a healthy diet education program were used in the study. The results indicated that the dietary pattern was not reasonable in the hypertensive high risk population. After two-year-intervention, the dietary pattern of people in the intervention group has changed distinctively. Compared with the results in 1997, the dietary risk factors decreased obviously in the intervention group, but increased in control group, such as high energy, fat, oil and cholesterol which can promote hypertension. Furthermore, in the past two years, the number of over weight + obese people increased by 24.6% in control group, but was no change in the intervention group. The intervention group subjects experienced an average decline of 3.7 and 5.1 mmHg of systolic blood pressure(SBP) and diastolic blood pressure(DBP) respectively, and new cases of hypertension observed in the intervention group were significantly lower than in control group. Thus it can be considered that the dietary intervention may be effective for the high risk population and play a very important role in the prevention of hypertension.

Adult↗
PubMedDate not supplied

[Probability of success in tobacco quitting during the course of two simple medical interventions].

INTRODUCTION AND OBJECTIVES: Counselling for tobacco quitting could be improved by informing smokers about the likelihood of success in quitting over time since the start of an intervention for smoking cessation. This study assessed the change in the probability of success in tobacco quitting during the course of two simple medical interventions for smoking cessation. METHODS: Prospective study in three worksites in the Basque Country (Spain), which underwent two interventions for quitting. Intervention 1 consisted of sporadic, brief (30 seconds-1 minute) and unstructured medical advice to quit. Intervention 2 consisted of brief (5-8 minutes) structured medical counselling for tobacco quitting in a first visit, followed by reinforcement advice on 3 occasions during 3 months, accompanied by nicotine patches individualized according to nicotine dependence. Results are expressed as a "relative measure of success" or rate of proportions (RP) calculated as the predictive value of achieving tobacco abstinence at 12 months for those with tobacco abstinence at 2 days, 15 days and 3 months from the start of each intervention divided by the percentage abstinent at 12. RESULTS: For the 103 smokers subjected to intervention 1, RP was 1.7 (CI 95%: 1.0-3.4) at 2 days, 2.3 (1.2-4.6) at 15 days, and 3.4 (1.8-6.5) at 3 months. For the 114 subjects who underwent intervention 2, RP was 1.3 (1.0-2.1) at 2 days, 1.9 (1.2-2.8) at 15 days, and 2.6 (1.8-3.8) at 3 months. Results did not change materially after stratification by number of cigarettes smoked, or nicotine dependence. CONCLUSIONS: Remaining abstinent from tobacco smoking at 3 months after the start of a quitting intervention increases the likelihood of success in quitting at 12 months.

Adolescent↗
PubMed2003

[Evaluation on a cohort based population intervention project regarding risk factors for cerebrovascular diseases].

OBJECTIVE: To analyze the changes of risk factors in cerebrovascular diseases in cohort-based population after intervention and evaluating the intervention effect. METHODS: In 1987, an intervention cohort and a control cohort were selected randomly in urban areas of Changsha. Risk factors in cerebrovascular diseases were investigated in two cohort populations aged over 35 years as baseline indication. Then comprehensive prevention of cerebrovascular diseases was carried out in intervention cohort during 1987 - 2000. After intervention for 14 years, a reexamination was taken in the two groups noted above. RESULTS: After 14 years, the prevalence of diabetes mellitus, hypertension, mean systolic and diastolic pressure, weight increased from 33.8% to 35.7%, 30 to 129 per 10,000, 128.41 mm Hg to 134.49 mm Hg, 77.78 mm Hg to 78.54 mm Hg, 54.80 kg to 57.78 kg in the intervention group, respectively while the baseline indication increased from 35.9% to 56.8%, 30 to 228 per 10,000, 127.70 mm Hg to 141.80 mm Hg, 78.27 mm Hg to 82.89 mm Hg, 54.92 kg to 59.69 kg in the control one. The changes were of statistical significance in each group except diastolic pressure and the prevalence of hypertension in intervention group, but all the parameters increased significantly in the control group; rate of alcohol intake decreased significantly in two groups, but rate of cigarette smoking decreased with no significance. The changes between two groups were not significant either; the cumulative incidence of stroke was significantly lower in intervention cohort (3.4%) than in control cohort (4.7%). CONCLUSION: The risk factors for cerebrovascular diseases (such as hypertension, diabetes mellitus etc.) were increasing along with by aging. Intervention programs can delay the increase of risk factors and down-regulate the incidence of stroke.

Alcohol Drinking↗
PubMed2003

Child- and parent-targeted interventions: the Memphis GEMS pilot study.

OBJECTIVE: To assess the feasibility, acceptability, and outcomes of 2 versions of a culturally relevant, family-based intervention to prevent excess weight gain in pre-adolescent African-American girls. DESIGN: Three-arm, 12-week parallel group randomized controlled pilot trial. SETTING: Community centers in Memphis, Tennessee. PARTICIPANTS: Sixty African-American girls, aged 8 to 10 years, with a body mass index (BMI) > or = 25th percentile of the CDC growth charts, along with their parents/caregivers. INTERVENTIONS: The active interventions involved highly interactive weekly group sessions with either girls (child-targeted program) or parents/caregivers (parent-targeted program). Content focused on knowledge and behavior change skills to promote healthy eating and increased physical activity. The comparison intervention focused on global self-esteem. MAIN OUTCOME MEASURES: Given the lack of power and the limited time frame of the pilot study, outcomes were evaluated on the basis of implementation measures and changes in physical activity (accelerometer data), and in consumption of sweetened beverages and water, as estimated from questionnaires. Changes in body mass index, waist circumference, and body composition were also examined. RESULTS: The Memphis GEMS pilot intervention met all recruitment, retention, implementation, and participation goals, and was given high rating by both participants and interventionists. With respect to the comparison intervention, girls in both the child-targeted and parent-targeted interventions demonstrated a trend toward reduced body mass index and waist circumference. In addition, girls in the active intervention groups reduced their consumption of sweetened beverages by 34%, increased their level of moderate-to-vigorous activity by 12%, and increased their serving; of water by 1.5%. CONCLUSIONS: The findings from this pilot study demonstrated the feasibility, perceived acceptability, and efficacy of culturally relevant, obesity prevention interventions for pre-adolescent African-American girls and their parents/caregivers.

Adult↗
PubMed2003

[Hematocrit as an indicator for coronary intervention in patients with acute myocardial infarction].

OBJECTIVES: Primary coronary intervention in patients with acute myocardial infarction complicated by persistent massive intracoronary thrombus is frequently difficult. Higher incidence of thrombus formation is associated with high hematocrit score. This study investigated the relationship between high hematocrit score and primary coronary intervention in patients with acute myocardial infarction. METHODS: Forty-five patients with acute myocardial infarction were divided into two groups according to hematocrit score on admission, the high hematocrit group (hematocrit > or = 48%, n = 8) and the low hematocrit group (hematocrit < 48%, n = 37). Time period required for coronary intervention (intervention time), number of balloon inflations, presence of persistent massive intracoronary thrombus, need for adjunctive intracoronary thrombolysis, need for intraaortic balloon pumping and achieved rate of Thrombolysis in Myocardial Infarction (TIMI) 3 were compared between the two groups. The relationships between hematocrit and intervention time or number of balloon inflations were also investigated. RESULTS: Intervention time (2.7 +/- 1.4 vs 1.4 +/- 0.7 hr, p = 0.0003), number of balloon inflations (12 +/- 9 vs 3 +/- 2 times, p = 0.0001), presence of persistent massive intracoronary thrombus (100% vs 5%, p < 0.0001), intracoronary thrombolysis (63% vs 3%, p = 0.0003), and intraaortic balloon pumping (63% vs 14%, p = 0.0092) were significantly higher in the high hematocrit group. However, the rate of TIMI 3 (25% vs 95%, p < 0.0001) was significantly lower in the high hematocrit group. The relationships between hematocrit and intervention time (r2 = 0.16, p = 0.0033), and hematocrit and number of balloon inflations (r2 = 0.19, p = 0.0015) showed positive correlations. CONCLUSIONS: Primary coronary intervention for patients with acute myocardial infarction showing high hematocrit score on admission is likely to be difficult due to the presence of persistent massive intracoronary thrombus. Therefore, coronary interventional strategy for intracoronary thrombolysis in patients with acute myocardial infarction should include measurement of hematocrit score.

Aged↗
PubMed2004

[Influence of interventional radiotherapy for severe postpartum hemorrhage on postpartum menorrhea].

OBJECTIVE: To discuss the influence of interventional radiotherapy for treating severe postpartum hemorrhage on postpartum menorrhea. METHODS: From Mar. 1995 to Feb. 2002, 18 cases of severe postpartum hemorrhage treated with arterial embolization served as the interventional group. Twenty parturients without postpartum complication were recruited as control group. The continuance of lochia, recovery of menorrhea between the two groups were compared. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E(2)) of the non-lactating women in the two groups were assayed during the 3rd-5th days of the first menstrual cycle. RESULTS: Continuance times of lochia were (33.9 +/- 2.0) days, and (36.2 +/- 3.1) days in interventional group and control group, respectively. Recovery times of menorrhea were (75 +/- 17) days, and (95 +/- 16) days in interventional group and control group. The quantity of the postpartum menorrhea was 1.3 +/- 0.1 times of that before delivery in interventional group, 1.3 +/- 0.2 times of that in control group. The number of menstrual cycle before recovery to normal menorrhea was 2 cycles in interventional group, 1.9 cycles in control group. Postpartum menstrual cycle was (33.9 +/- 2.2) days in interventional group, (33.2 +/- 1.6) days in control group. Serum FSH, LH, E(2) of the non-lactating women during the 3rd approximately 5th days of the first menstrual cycle were (5.2 +/- 1.1) U/L, (7.5 +/- 1.6) U/L, (262 +/- 14) pmol/L in interventional group, (4.3 +/- 2.1) U/L, (6.3 +/- 1.3) U/L, (280 +/- 12) pmol/L in control group. There was no significant difference between the two groups (P > 0.05). CONCLUSIONS: No obvious influence of interventional radiotherapy for postpartum hemorrhage on postpartum menorrhea was observed.

Adult↗