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PubMed2001

Very low energy diets in the treatment of obesity.

Very low energy diets (VLEDs) are defined as diets which contain energy levels of less than 3.4 MJ (800 kcal) per day and contain daily allowances of all essential nutritional requirements. These diets have been in clinical use for more than 20 years. They are used as the only source of nutrition for 8-16 weeks, which usually achieves a weight loss of 1.5-2.5 kg per week. Before using this type of diet a medical investigation is necessary to evaluate contraindications and to check medication use during the diet. To facilitate maintenance, cognitive behavioural counselling should always be included in a weight reduction programme using a very low energy diet. VLEDs have no serious harmful effects and can safely be used in patients with various chronic diseases. Programmes using VLEDs produce better short-term weight loss than programmes without the diet. However, in randomized controlled trials VLED-based programmes have not achieved significantly better long-term maintenance than conventional programmes. VLEDs are used when rapid weight loss is necessary because of an obesity-related disease. In other patients with obesity it is an alternative to other conservative approaches for treatment of obesity. In type 2 diabetes it may improve long-term glucose metabolism better than conventional weight reducing diets. Some studies suggest that after a VLED-based programme long-term maintenance is better among men than women. This possible gender difference is an important topic for further research.

Affect↗
PubMed1994

Mortality in England in the eighteenth and the nineteenth centuries: a reply to Sumit Guha.

In the last issue of Social History of Medicine, Sumit Guha published a critique of the thesis presented in Szreter (1988), which argued that an increasing weight and diversity of social interventions were primarily responsible for the reduction in Britain's mortality achieved from the 1870s. Previoiusly neglected and harmful urban, factory, and eventually even home environments were improved, as both political and social as well as scientific approaches gradually changed, albeit in a locally diversified manner. Guha's critique is shown to be fundamentally misguided because it is premissed on the assumption that the disease ecologies of eighteenth- and of nineteenth-century England were essentially comparable. This ignores important recent research in the historical epidemiology and demography of seventeenth- and eighteenth-century England. In conclusion, it is suggested that some of the information presented by Guha in fact further supports the plausibility of the interpretation in Szreter (1988), rather than the McKeown thesis.

History, 18th Century↗
PubMed2005

High-grade isthmic dysplastic spondylolisthesis: monosegmental surgical treatment.

STUDY DESIGN: A prospective single arm cohort. OBJECTIVE.: To study the results of distraction reduction of high-grade isthmic dysplastic spondylolisthesis with posterior lumbar interbody fusion and posterior compression in a consecutive, prospectively collected series of adolescent patients. SUMMARY OF BACKGROUND DATA: High-grade isthmic dysplastic spondylolisthesis has been associated with a high complication and failure rate regardless of the method of surgical treatment, including in situ fusion, cast correction and fusion, anterior fusion, posterior instrumented fusion, and combination procedures. METHODS: A total of 18 adolescents with the diagnosis and a minimum 50% slip underwent the procedure of Gill decompression, temporary distraction with reduction of the deformity, complete lumbosacral discectomy, posterior lumbar interbody fusion with Harm's cage and autogenous iliac graft, and posterior monosegmental compression instrumentation with pedicular fixation. RESULTS: Follow-up ranged from 2.3 to 5 years. Slip improved from 77% to 13% and slip angle from 35 degrees to 3.8 degrees initially and 4.3 degrees at final follow-up. One patient had loss of 16 degrees of slip angle but achieved arthrodesis. Sacral inclination improved from 28 degrees to 39 degrees . There were no neurologic or infectious complications. There were no overt instrumentation failures. Arthrodesis was achieved in every instance. Two patients had structural complications, neither of which underwent reoperation. CONCLUSIONS: The index procedure provided near-anatomic correction of high-grade spondylolisthesis, which is maintained at a minimum 2-year follow-up without significant complications. There were two structural complications. Anterior column structural support and posterior compressive instrumentation help restore the necessary biomechanics to allow clinical fusion and success. This series has led the senior author to evolve his technique too ften include caudad fixation to the pelvis and/or cephalad fixation to L4.

Adolescent↗
PubMed1991

Hypertension and coronary artery disease. Can the chain be broken?

Hypertension is an established risk factor for all the clinical sequelae of coronary artery disease. Despite this, individual therapeutic trials of antihypertensive therapy have not demonstrated the expected reduction in coronary morbidity and mortality. This apparent failure is perhaps not surprising when one considers the multifactorial nature of coronary artery disease and the different ways in which hypertension may affect the coronary circulation. Much debate has also centered on the antihypertensive therapy used in major trials in that it may in some way prevent the reduction in coronary mortality. However, thus far no clear evidence of a harmful effect has emerged. Reducing coronary mortality in hypertensive patients is a major challenge but one that can be effectively surmounted by approaching these different factors in a concerted manner. The ultimate goal must be to prevent the development of hypertension and left ventricular hypertrophy, but until such time as that can be achieved, the early detection of hypertension is mandatory. The optimal levels of systolic and diastolic blood pressures must be established. Studies on the more recent antihypertensive agents hold promise for a more specific effect on the atherosclerotic process as well as sustained control of arterial blood pressure. In this regard, it would seem essential to develop more precise ways of quantifying atherosclerosis and thus clarifying the nature of its relation to hypertension. Finally, management of hypertension must include precise assessment of the patient's overall cardiovascular risk status and appropriate and aggressive management of all risk factors for coronary artery disease.

Animals↗
PubMed1985

Effect of thyroid hormone supplementation on survival after bacterial infection.

During nonthyroidal illness in man and a number of experimental animals, serum total thyroid hormone levels are decreased. To determine whether the reduction in thyroid hormones that occurs during nonthyroidal illness is beneficial or harmful to the host, an experimental animal model was developed. Male Sprague-Dawley rats were infected with Streptococcus pneumoniae type I, a known human pathogen. By 40 h after inoculation, serum total and free T4 and total T3 decreased significantly. Serum free T3 also decreased slightly but not significantly. When infected animals were injected daily with T4, there was a decrease in the time to death and significant increase in the total number of deaths compared to controls receiving vehicle alone. Control experiments showed that T4 did not affect the growth of S. pneumoniae on blood agar plates, and the injected T4 did not cause hyperthyroidism. These results suggest that the decrease in serum thyroid hormone that occurs during nonthyroidal illness is beneficial and may serve a role in maintaining homeostasis by conserving metabolic energy during infection as an important adaptation that prolongs survival.

Animals↗
PubMed2000

Risks and benefits of preoperative high dose methylprednisolone in surgical patients: a systematic review.

BACKGROUND: A single preoperative high dose of methylprednisolone (15 to 30 mg/kg) has been advocated in surgery, because it may inhibit the surgical stress response and thereby improve postoperative outcome and convalescence. However, these potential clinical benefits must be weighed against possible adverse effects. OBJECTIVE: To conduct a risk-benefit analysis using a meta-analysis, to compare complication rates and clinical advantages associated with the use of high dose methylprednisolone in surgical patients. METHODS: Randomised controlled trials of high dose methylprednisolone in elective and trauma surgery were systematically searched for in various literature databases. Outcome data on adverse effects, postoperative pain and hospital stay were extracted and statistically pooled in fixed-effects meta-analyses. RESULTS: We located 51 studies in elective cardiac and noncardiac surgery, as well as traumatology. Pooled data failed to show any significant increase in complication rates. In patients treated with corticosteroids, nonsignificantly more gastrointestinal bleeding and wound complications were observed; the 95% confidence interval boundaries of the numbers-needed-to-harm were 59 and 38, respectively. The only significant finding was a reduction of pulmonary complications (risk difference -3.5%; 95% confidence interval -1.0 to -6.1), mainly in trauma patients. CONCLUSION: For patients undergoing surgical procedures, a perioperative single-shot administration of high dose methylprednisolone is not associated with a significant increase in the incidence of adverse effects. In patients with multiple fractures, limited evidence suggests promising benefits of glucocorticoids on pulmonary complications.

Animals↗
PubMed1999

Canadian Asthma Consensus Report, 1999. Canadian Asthma Consensus Group.

OBJECTIVES: To provide physicians with current guidelines for the diagnosis and optimal management of asthma in children and adults, including pregnant women and the elderly, in office, emergency department, hospital and clinic settings. OPTIONS: The consensus group considered the roles of education, avoidance of provocative environmental and other factors, diverse pharmacotherapies, delivery devices and emergency and in-hospital management of asthma. OUTCOMES: Provision of the best control of asthma by confirmation of the diagnosis using objective measures, rapid achievement and maintenance of control and regular follow-up. EVIDENCE: The key diagnostic and therapeutic recommendations are based on the 1995 Canadian guidelines and a critical review of the literature by small groups before a full meeting of the consensus group. Recommendations are graded according to 5 levels of evidence. Differences of opinion were resolved by consensus following discussion. VALUES: Respirologists, immunoallergists, pediatricians and emergency and family physicians gave prime consideration to the achievement and maintenance of optimal control of asthma through avoidance of environmental inciters, education of patients and the lowest effective regime of pharmacotherapy to reduce morbidity and mortality. BENEFITS, HARMS AND COSTS: Adherence to the guidelines should be accompanied by significant reduction in patients' symptoms, reduced morbidity and mortality, fewer emergency and hospital admissions, fewer adverse side-effects from medications, better quality of life for patients and reduced costs. RECOMMENDATIONS: Recommendations are included in each section of the report. In summary, after a diagnosis of asthma is made based on clinical evaluation, including demonstration of variable airflow obstruction, and contributing factors are identified, a treatment plan is established to obtain and maintain optimal asthma control. The main components of treatment are patient education, environmental control, pharmacotherapy tailored to the individual and regular follow-up. VALIDATION: The recommendations were distributed to the members of the Canadian Thoracic Society Asthma and Standards Committees, as well as members of the board of the Canadian Thoracic Society. In addition, collaborating groups representing the Canadian Association of Emergency Physicians, the Canadian College of Family Physicians, the Canadian Paediatric Society and the Canadian Society of Allergy and Immunology were asked to validate the recommendations. The recommendations were discussed at regional meetings throughout Canada. They were also compared with the recommendations of other similar groups in other countries. DISSEMINATION AND IMPLEMENTATION: An implementation committee has established a strategy for disseminating these guidelines to physicians, other health professionals and patients and for developing tools and means that will help integrate the recommendations into current asthma care. The plan is outlined in this report.

Adolescent↗
PubMed2006

[Application of white-rot fungi in composting lead-contaminated waste].

Simulative lead polluted wastes which containing unpolluted soil, household waste, straw, bran and lead nitrate were prepared. Inoculation of white-rot fungi and uninoculation in composting of lead-contaminated waste were studied. Change of chemical factor, biological parameter and biological toxicity analyses with time during the composting process were determined to study effect of heavy metal on composting process and probability of application of white-rot fungi in composting of metal-contaminated waste. The results show the composting of lead-contaminated waste inoculated white-rot fungi could be successfully processed, which lead to the reduction of the bioavailability of Pb in compost and alleviate the potential harm from heavy metal. Under this composting process, for the final compost, pH, water-soluble organic carbon/nitrogen, volatile solid, lignin and coarse fibre remained reached 7.9, 4.01, 36.1%, 22.4g, 30.1g, respectively. In addition, 63.38% of Pb in residual fraction and 0% of Pb in soluble-exchangeable fraction were found in final compost, and the germination index of final compost reached 121%.

Biodegradation, Environmental↗
PubMed1989

Medication errors and nursing responsibility.

Medication errors could effectively be reduced by systematically identifying, eliminating, or minimizing human and system risks. However, errors associated with random events may never be controlled by risk reduction efforts because of the unpredictability of the events preceding the error. Identifying and reducing risks is as important as acknowledging medication errors after they occur. A preliminary model including risks and types of medication errors is presented in Fig 1. Additional classification and explanation is needed in order to identify strategies to reduce medication errors. Medication administration is a nursing function that incorporates scientific knowledge, technical skill, and ritualistic practice. When nurses give medications and make medication errors, they remember their responsibility to do good and avoid harm. Nurses can better exert this responsibility by taking a more prospective, risk-reduction approach to medication errors.

Humans↗
PubMed2002

Chemoprevention of breast cancer: a summary of the evidence for the U.S. Preventive Services Task Force.

PURPOSE: Chemoprevention offers promise as a strategy for reducing morbidity and mortality from breast cancer in women. This review examined the evidence for the effectiveness of chemoprevention in women without a history of breast cancer. DATA SOURCES: MEDLINE (1966 to December 2001). STUDY SELECTION: English-language, randomized, controlled trials (RCTs) of chemoprevention of breast cancer in women without a previous diagnosis of breast cancer were examined, and 4 relevant trials, 3 involving tamoxifen and 1 involving raloxifene, were selected. Trials that provided data on the harms of tamoxifen or raloxifene, studies of the costs of chemoprevention, and studies of risk assessment were also reviewed. DATA EXTRACTION: Four reviewers independently abstracted data on key variables, including study population, sample size, randomization, treatment, and outcomes. DATA SYNTHESIS: The largest of the RCTs of tamoxifen reported a 49% reduction in relative risk (0.51 [95% CI, 0.39 to 0.66]) for invasive cancer among women with an estimated 5-year breast cancer risk of at least 1.66%. The other tamoxifen trials did not observe a statistically significant benefit, but only a few women in each trial took tamoxifen during the entire study period. The raloxifene study of postmenopausal women with osteoporosis found a 76% reduction in relative risk (0.24 [CI, 0.13 to 0.44]) for invasive breast cancer. Tamoxifen and raloxifene were effective only against estrogen receptor-positive tumors. Both drugs increased risk for venous thromboembolic disease and hot flashes; tamoxifen increased risk for endometrial cancer and stroke. CONCLUSIONS: Tamoxifen and raloxifene reduce the incidence of estrogen receptor-positive breast cancer in women. The relative risk reduction seems similar across all breast cancer risk groups. The absolute risk reduction varies by risk factors for breast cancer, however, and must be balanced against the potential harms to judge the appropriateness of treatment for individual women.

Anticarcinogenic Agents↗
PubMedDate not supplied

Metabolic engineering of Escherichia coli to enhance recombinant protein production through acetate reduction.

Genetic and metabolic engineering provide powerful and effective tools for the systematic manipulation and fine tuning of cellular metabolic activities. In this study, successful application of such techniques to enhance recombinant protein production by reducing acetate accumulation in Escherichia coli is presented. The alsS gene from Bacillus subtilis encoding the enzyme acetolactate synthase was introduced into E. coli cells using a multicopy plasmid. This newly introduced heterologous enzyme modifies the glycolytic fluxes by redirecting excess pyruvate away from acetate to acetolactate. Acetolactate is then converted to a nonacidic and less harmful byproduct acetoin, which appears in the broth. Furthermore, comparative fermentation studies show that the reduction in acetate accumulation leads to a significant improvement of recombinant protein production. The expression of a model recombinant CadA/beta-galactosidase fusion protein, under the control of a strong pH-regulated promoter, was found to increase by about 60% for the specific protein activity (to a level of 30% of total cellular protein) and 50% in terms of the volumetric activity in a batch fermenter. In fed-batch cultivation, the engineered strain achieved a volumetric recombinant protein yield of 1.6 million units/mL (about 1.1 g/L of beta-galactosidase), which represented a 220% enhancement over the control strain. In the meantime, acetate excretion was maintained below 20 mM compared with 80 mM for the control, and the final cell density was improved by 35%.

Acetates↗
PubMed2006

[Are invitations to mammography screening a reasonable basis for informed consent?-- Secondary publication].

There is a delicate balance between the benefits and harms of mammography screening, and women should decide for themselves, on an informed basis. The invitation to have a mammography is the only source of information provided to all eligible women, and we explored whether it provides such a basis. We collected invitations from English-speaking and Scandinavian countries. The major benefit of screening, a reduction in breast cancer mortality, was mentioned in 30 of 31 invitations, whereas the most important harms, overdiagnosis and overtreatment, were not mentioned in any of the invitations.

Comment↗
PubMed2004

Importance of beam-beam tune spread to collective beam-beam instability in hadron colliders.

In hadron colliders, electron-beam compensation of beam-beam tune spread has been explored for a reduction of beam-beam effects. In this paper, effects of the tune-spread compensation on beam-beam instabilities were studied with a self-consistent beam-beam simulation in model lattices of Tevatron and Large Hodron Collider. It was found that the reduction of the tune spread with the electron-beam compensation could induce a coherent beam-beam instability. The merit of the compensation with different degrees of tune-spread reduction was evaluated based on beam-size growth. When two beams have a same betatron tune, the compensation could do more harm than good to the beams when only beam-beam effects are considered. If a tune split between two beams is large enough, the compensation with a small reduction of the tune spread could benefit beams as Landau damping suppresses the coherent beam-beam instability. The result indicates that nonlinear (nonintegrable) beam-beam effects could dominate beam dynamics and a reduction of beam-beam tune spread by introducing additional beam-beam interactions and reducing Landau damping may not improve the stability of beams.

Journal Article↗
PubMed1997

Adjuvant radiotherapy and chemotherapy for stage II or IIIA non-small-cell lung cancer after complete resection. Provincial Lung Cancer Disease Site Group.

GUIDELINE QUESTIONS: 1) Does the use of postoperative, adjuvant radiotherapy or chemotherapy, alone or in combination, improve survival rates among patients with completely resected, pathologically confirmed stage II or IIIA non-small-cell lung cancer (NSCLC)? 2) Does the use of radiotherapy reduce the risk of local recurrence among patients with completely resected stage II or IIIA NSCLC? OBJECTIVE: To make recommendations about the use of postoperative adjuvant radiotherapy and chemotherapy in the treatment of patients with completely resected stage II or IIIA NSCLC. OUTCOMES: Overall survival and disease-free survival are the primary outcomes of interest. A secondary outcome of interest is local disease control. PERSPECTIVES (VALUES): Evidence was collected and reviewed by 4 members of the Lung Cancer Disease Site Group (Lung Cancer DSG) of the Cancer Care Ontario Practice Guidelines Initiative. The evidence-based recommendation resulting from this review was approved by the Lung Cancer DSG, which comprises medical oncologists, radiation oncologists, pathologists, surgeons and a medical sociologist. A community representative was present at 1 meeting during which the recommendation was discussed. QUALITY OF EVIDENCE: One meta-analysis and 22 randomized controlled trials (RCTs) were published between 1962 and 1996. The RCTs compared surgery plus radiotherapy with surgery alone; surgery plus adjuvant chemotherapy with surgery alone; surgery plus radiotherapy with surgery plus both chemotherapy and radiotherapy. Many studies included patients with stage IIIB NSCLC; some included patients with incompletely resected stage I NSCLC or with small cell lung cancer (maximum 10%). Older studies used chemotherapy or radiation that would now be considered inferior according to current standards of practice. BENEFITS: There was no survival benefit with adjuvant radiotherapy alone, although 3 RCTs reported a reduction in the rate of local recurrence among patients treated with adjuvant radiotherapy. The meta-analysis showed that postoperative, cisplatin-based chemotherapy alone reduced the relative risk of death by 13% (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.74 to 1.02); in combination with radiotherapy it resulted in a 6% reduction in the relative risk of death (HR 0.94, 95% CI 0.79 to 1.11). HARMS: Postoperative adjuvant chemotherapy with alkylating agents was found in the meta-analysis to increase the relative risk of death by 15%. A study involving prolonged adjuvant chemotherapy (busulfan or cytoxan daily for 2 years) reported that 4 of 726 patients had hematologic malignancies. In 1 study, only 53% of patients received all 4 cycles of chemotherapy with cyclophosphamide-doxorubicin-cisplatin (CAP); in another, 22% of patients refused therapy with CAP because of nausea and vomiting. PRACTICE GUIDELINE: There is evidence from RCTs that postoperative radiotherapy reduces rates of local recurrence by 11% to 18% (or 1.6 to 19-fold) among patients with completely resected, pathologically confirmed stage II or IIIA NSCLC. Therefore, if the outcome of interest is a reduction in the frequency of local tumour recurrence, radiotherapy is recommended. However, there is no evidence of a survival benefit from postoperative radiotherapy alone. In a meta-analysis, postoperative chemotherapy with or without radiotherapy resulted in a slightly reduced (statistically nonsignificant) risk of death among patients with surgically resected stage II or IIIA NSCLC. The survival benefit was small and achieved only with chemotherapy regimens that produced substantial toxic effects and that are no longer used. Newer chemotherapy regimens are currently being evaluated as adjuvant therapy, but there is insufficient evidence of benefit at this time to recommend them. Therefore, if the outcome of interest is survival, there is insufficient evidence to recommend current chemotherapy regimens with or without radiotherapy as postoperative, adjuvant the

Carcinoma, Non-Small-Cell Lung↗
PubMed2001

Preventive health care, 2001 update: screening mammography among women aged 40-49 years at average risk of breast cancer.

OBJECTIVE: A previous review by the Canadian Task Force on the Periodic Health Examination (now the Canadian Task Force on Preventive Health Care) in 1994 indicated fair evidence to exclude mammographic breast cancer screening of women aged 40-49 from the periodic health examination. This current review considers the available new and updated evidence regarding the effect of screening mammography on breast cancer mortality among women in this age group at average risk of breast cancer. OPTIONS: Screening mammography starting at either age 40 or age 50. OUTCOME: Reduction in breast cancer mortality. EVIDENCE: The MEDLINE and CANCERLIT databases were searched for relevant articles published from 1966 to January 2000. Of 68 references obtained, at least 22 were published after the 1994 review. To date, the only trial designed to assess the mortality benefits of screening mammography among women aged 40-49 did not have adequate power to exclude a clinically significant benefit. Other results from randomized controlled trials (RCTs) are post-hoc subgroup analyses of larger trials. BENEFITS, HARMS AND COSTS: Screening mammography offers the potential for significant benefits in addition to mortality reduction, including early diagnosis, less aggressive therapy and improved cosmetic results. However, the risks of screening include increased biopsy rates and the psychological effects of false reassurance or false-positive results. Although several of the trials reviewed constitute level I evidence (RCT), at present their conflicting results, methodologic differences and, most important, uncertainty about the risk:benefit ratio of screening precludes the assignment of a "good" or "fair" rating to recommendations drawn from them. VALUES: The strength of evidence was evaluated using the methods of the Canadian Task Force on Preventive Health Care. A high value was placed on changes in survival. When evidence was available, value was also placed on potential quality-of-life implications. RECOMMENDATION: Current evidence regarding the effectiveness of screening mammography does not suggest the inclusion of the manoeuvre in, or its exclusion from, the periodic health examination of women aged 40-49 years at average risk of breast cancer (grade C recommendation). Upon reaching the age of 40, Canadian women should be informed of the potential benefits and risks of screening mammography and assisted in deciding at what age they wish to initiate the manoeuvre. VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care. SPONSORS: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.

Adult↗
PubMed1996

Ethical issues surrounding multifetal pregnancy reduction and selective termination.

MFPR and selective terminations satisfy the criteria of enabling pregnancies to continue with the least harm and most benefits to all involved. The surviving infants can be saved from certain death (abortion) or higher risks of severe harm and death and of an extended stay in neonatal intensive care (premature delivery). In the hands of trained operators, MFPR and selective termination is, in our opinion, the best means to protect the mother's health and well-being, given it is available and approved by the parents. MFPR and selective termination avoid the trauma of abortion of a wanted pregnancy, enable the parents to achieve the goal of having their own child, and avoid the dangers of delivery of multiple premature infants. There is no doubt that any procedure that involves the death of a fetus will be hotly argued despite the potential for greater good. We acknowledge that it will be impossible to convince those who cannot morally accept the taking of any life regardless of the circumstances. We hope, however, that we have shown there is a place for MFPR and selective termination in a very limited number of circumstances and the ethical probity of MFPR and selective termination as an option in such cases.

Congenital Abnormalities↗
PubMed2002

The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up.

AIMS: To examine the long-term impact of brief and early interventions for hazardous and harmful alcohol consumption. DESIGN: A 9-month and 10-year follow-up of subjects recruited into a randomized controlled trial of a range of alcohol-related brief interventions. SETTING: General practices, the outpatient or acute care services of a major city hospital, and a privately run health screening programmeme. PARTICIPANTS: The cohort of 554 (non-dependent) hazardous and harmful drinkers recruited into the Australian arm of the Phase II World Health Organization collaborative project on identification and treatment of persons with harmful alcohol consumption. INTERVENTION: The effectiveness of three forms of intervention, ranging from 5 to 60 minutes in duration, were compared with a no-treatment control condition. MEASUREMENTS: Included drinking behaviour and biological markers of alcohol use. In addition, at 10 years subjects were asked about symptoms of diagnosable alcohol use disorders and their experience of alcohol-related psychological, social and physical harm. Mortality was also assessed. FINDINGS: Results provide further evidence for the short-term effectiveness of alcohol-related brief interventions. In comparison to controls, subjects offered intervention: (1) report significantly lower consumption; and (2) less unsafe drinking at 9-month follow-up. The intensity of intervention was not related to the amount of change in drinking behaviour. Analysis at 10 years failed to find any differences in outcomes between intervention and control groups in median consumption, mean reduction in consumption from baseline to follow-up, mortality and ICD-10 diagnoses of alcohol dependence or harmful alcohol use. CONCLUSIONS: This study failed to find evidence that brief advice and counselling without regular follow-up and reinforcement can sustain significant long-term reductions in drinking behaviour at 10-year follow-up.

Adult↗
PubMed2000

Coronary artery disease: the role of lipids, hypertension and smoking.

Pioneering epidemiological projects such as the Seven Countries study, and the Framingham Heart study established the classical risk factor concept for coronary heart disease (CAD). These landmark studies showed that a raised serum total cholesterol, high blood pressure (systolic and diastolic) and smoking increase the risk of developing CHD in men and women in a graded fashion. Women develop CHD about 10 years later than men and women's risk is smaller. In the years and decades following these early studies many more prospective cohort studies primarily in the US and Europe have confirmed the early findings. In Germany two occupational and one population based cohort studies have contributed further information on this topic. In addition interactions between the three classical risk factors have been quantified, demonstrating for example that smoking carries a much higher risk for CHD in persons with high cholesterol values. Most cohort studies have confirmed that the relative risks for the classical risk factors are very similar. However, the respective absolute risks can differ tremendously, indicating that many more factors such as socio-economic conditions, nutrition, physical activity and others are of importance for the development of CHD. The scientific community, however, did not accept the consistent findings from the many observational studies as proof of causality. They required evidence that the risk for CHD could be reduced when the respective risk factor(s) was (were) diminished or eliminated. The late 1960s early 1970s thus saw the beginning of the era of randomized controlled trials (RCTs) following the advice of Archibald Cochrane who once wrote "we have to find that point on the distribution curve where therapy does more good than harm". We now know from meta-analyses of RCTs that a 1% reduction in serum cholesterol produces a 2-3% decline in risk for CHD and we can achieve reductions in total cholesterol of 20% or more. Regarding treatment of high blood pressure, meta-analyses of RCTs have shown that a reduction of 1 mmHg in diastolic blood pressure (DBP) produces a 2-3% decline in risk of CHD, and we can achieve reductions in DBP on average of 5-6 mmHg. With regard to smoking cessation, observational studies have shown that within 1-5 years of cessation those who stop smoking have a 50-70% lower risk than current smokers. Thus the findings from observational studies, RCTs and studies on mechanisms have clearly established the importance of the three classical risk factors for CHD. The successful treatment of these risk factors will not only lower the burden of CHD in the population but promises to be the most effective way of improving the health of the whole population.

Coronary Disease↗