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Random digit dialing in Chicago CARDIA: comparison of individuals with unlisted and listed telephone numbers.

Young adult blacks and whites aged 18-30 years of both low and high educational levels were recruited through random digit dialing to participate in the Chicago, Illinois, portion of a longitudinal study, Coronary Artery Risk Development in Young Adults (CARDIA). Overall, 31% of randomly selected persons eligible to participate had unlisted telephone numbers--about 50% of black men and women and 11% and 17% of white men and women, respectively. There was no difference in proportions of numbers unlisted by educational level, except for white men, who were more likely to have unlisted numbers at a low educational level than at a high educational level. There was no consistent pattern of differences in rates of participation across race, sex, or education subgroups for unlisted and listed numbers, and there were no significant differences for selected health measures, except smoking. The findings suggest that in Chicago, there is a potential bias in estimates of sociodemographic characteristics from the exclusion of unlisted numbers, but it is likely to be insignificant if recruitment is stratified according to race, sex, and education. Within strata, there was little bias with respect to the attributes measured. Ideally, to guard against possible bias, random digit dialing is recommended as the preferred way to select a representative population-based sample.

Adolescent↗

Aerobic exercise, lipids and lipoproteins in overweight and obese adults: a meta-analysis of randomized controlled trials.

OBJECTIVE: Use the meta-analytic approach to examine the effects of aerobic exercise on lipids and lipoproteins in overweight and obese adults. DATA SOURCES: (1) Computerized literature searches, (2) cross-referencing from review and original articles, (3) hand searching, and (4) expert review of reference list. STUDY SELECTION: (1) randomized controlled trials, (2) aerobic exercise > or =8 weeks, (3) adult humans > or =18 y of age, (4) all subjects overweight or obese (BMI > or =25 kg/m(2)), (5) studies published in journal, dissertation, or master's thesis format, (6) studies published in the English-language, (7) studies published between 1 January 1955 and 1 January 2003, (8) assessment of one or more of the following lipid and/or lipoprotein variables: total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG). DATA ABSTRACTION: Dual-coding by the first two authors (inter-rater agreement=0.96). RESULTS: In total, 13 studies representing 31 groups (17 exercise, 14 control), 613 subjects (348 exercise, 265 control), and up to 17 outcomes were available for pooling. Across all categories, random-effects modeling resulted in statistically significant improvements for TC (X +/- s.e.m., - 3.4+/-1.7 mg/dl, 95% CI, - 6.7 to - 0.2 mg/dl) and TG (X +/-s.e.m., - 16.1+/-7.3 mg/dl, 95% CI, - 30.2 to - 2.1 mg/dl) but not HDL (X +/- s.e.m., 1.6+/-0.8 mg/dl, 95% CI, - 0.02 to 3.2 mg/dl) or LDL (X +/-s.e.m., - 0.5+/-1.3 mg/dl, 95% CI, - 3.0 to 2.0 mg/dl). Changes were equivalent to improvements of 2% (TC), 11% (TG), 3% (HDL), and 0.3% (LDL). After conducting sensitivity analyses (each study deleted from the model once), only decreases in TG remained statistically significant. Increases in HDL were associated with increases in maximum oxygen consumption (VO(2 max) in ml/kg/min, r=0.75, P=0.002) and decreases in body weight (r=0.77, P<0.001), while decreases in LDL were associated with decreases in body weight (r=0.75, P=0.009). CONCLUSIONS: Aerobic exercise decreases TG in overweight and obese adults. However, a need exists for additional randomized controlled trials in various overweight and/or obese populations above and beyond those included in our analysis.

Body Weight↗

Aerobic exercise and HDL2-C: a meta-analysis of randomized controlled trials.

PURPOSE: Use the meta-analytic approach to examine the effects of aerobic exercise on high-density lipoprotein two cholesterol (HDL2-C) in adults. STUDY SOURCES: (1) Computerized literature searches; (2) cross-referencing from retrieved articles; (3) hand-searching; and (4) expert review of our reference list. STUDY SELECTION: (1) Randomized controlled trials; (2) aerobic exercise > or = 8 weeks; (3) adults > or = 18 years of age; (4) studies published in journal, dissertation, or master's thesis format; (5) studies published in the English-language between January 1, 1955 and January 1, 2003; and (6) assessment of HDL2-C in the fasting state. DATA ABSTRACTION: All coding conducted by both authors, independent of each other. Discrepancies were resolved by consensus. RESULTS: Nineteen randomized controlled trials representing 20 HDL2-C outcomes from 984 males and females (516 exercise, 468 control) were pooled for analysis. Using random-effects modeling and bootstrap confidence intervals (BCI), a statistically significant increase of approximately 11% was observed for HDL2-C (X +/- S.E.M., 2.6 +/- 0.9 mg/dl, 95% BCI, 1.0-4.4 mg/dl). With each study deleted from the model once, results remained statistically significant. Increases in HDL2-C were independent of decreases in body weight, body mass index (kg/m2), and percent body fat. CONCLUSION: Aerobic exercise increases HDL2-C in adults.

Adult↗

Metaanalysis of the effects of intensive glycemic control on late complications of type I diabetes mellitus.

OBJECTIVE: To estimate the effects of intensive glycemic control on the progression of diabetic retinopathy and nephropathy, and to assess the risks of severe hypoglycemia and diabetic ketoacidosis. DESIGN: Metaanalysis of published randomized controlled trials. SETTING: As listed in each study. PATIENTS: Five hundred twenty-nine patients from 16 randomized controlled trials. MEASUREMENTS: We searched for all studies with sufficient data for analysis. The overall difference in the risk of retinopathy or nephropathy progression was analyzed, and the overall difference in the incidence of hypoglycemia or diabetic ketoacidosis was estimated. RESULTS: Compared to conventionally treated patients, the risk of retinopathy progression was statistically insignificantly higher after 6 to 12 months of intensive therapy (odds ratio [OR] 2.11; 95% confidence interval [CI], 0.54 to 8.31). After more than 2 years of intensive therapy the risk of retinopathy progression was lower (OR 0.49; 95% CI, 0.28 to 0.85). The risk of nephropathy progression was also decreased significantly in the intensive therapy group (OR 0.32; 95% CI, 0.19 to 0.55). When compared to conventional control, intensive therapy reduced glycosylated hemoglobin (%) by 1.4 with a 95% CI ranging from 1.1 to 1.8. The overall incidence of severe hypoglycemia increased by 9.1 episodes/100 person-years (95% CI, -1.4 to 19.6) in the intensively treated patients. The incidence of diabetic ketoacidosis increased by 12.6 episodes/100 person-years (95% CI, 8.7 to 16.5) in those who received continuous subcutaneous insulin infusion. CONCLUSION: Long-term intensive glycemic control significantly reduced the risks of diabetic retinopathy and nephropathy progression among type I diabetes patients when compared with randomly assigned controls. However, long-term continuous subcutaneous insulin infusion was associated with an increased incidence of diabetic ketoacidosis, and intensive therapy might cause more severe hypoglycemic reactions in some patients.

Blood Glucose↗

Effect of population screening and treatment for Helicobacter pylori on dyspepsia and quality of life in the community: a randomised controlled trial. Leeds HELP Study Group.

BACKGROUND: Infection with Helicobacter pylori is the main cause of peptic-ulcer disease. Treatment of this infection might lower the prevalence of dyspepsia in the community and improve quality of life. We investigated this possibility in a double-blind randomised controlled trial. METHODS: Individuals aged 40-49 years were randomly selected from the lists of 36 primary-care centres. A researcher interviewed participants with a validated dyspepsia questionnaire and the psychological general wellbeing index (PGWB). H. pylori status was assessed by the carbon-13-labelled urea breath test. Infected participants were randomly assigned active treatment (omeprazole 20 mg, clarithromycin 250 mg, and tinidazole 500 mg, each twice daily for 7 days) or identical placebo. Participants were followed up at 6 months and 2 years. FINDINGS: Of 32,929 individuals invited, 8455 attended and were eligible; 2324 were positive for H. pylori and were assigned active treatment (1161) or placebo (1163). 1773 (76%) returned at 2 years. Dyspepsia or symptoms of gastro-oesophageal reflux were reported in 247 (28%) of 880 in the treatment group and 291 (33%) of 871 in the placebo group (absolute-risk reduction 5% [95% CI 1-10]). H. pylori treatment had no significant effect on quality of life (mean difference in PGWB score between groups 0.86 [-0.33 to 2.05]). INTERPRETATION: Community screening and treatment for H. pylori produced only a 5% reduction in dyspepsia. This small benefit had no impact on quality of life.

Adult↗

Evaluating a culturally adapted question prompt list to improve end-of-life communication among indonesian migrant caregivers: A randomized controlled trial with qualitative insights.

OBJECTIVE: Indonesian caregivers serve as essential providers of end-of-life (EOL) care in Taiwan. But often face communication challenges due to language, cultural, and hierarchical barriers. This study evaluated the effectiveness of a culturally adapted Question Prompt List (QPL). METHODS: This study employed a two-arm randomized controlled trial design supplemented with qualitative interviews. The study was conducted in a hospice ward and home care setting within a medical center in Taiwan. A total of sixty Indonesian caregivers were recruited and randomly assigned to either the intervention group (n&#x202f;=&#x202f;30) or the control group (n&#x202f;=&#x202f;30). The intervention group received routine end-of-life (EOL) education along with a culturally adapted Question Prompt List (QPL), which consisted of 37 items covering domains including the dying process, emotional support, communication, symptom management, and care decision-making. The control group received routine EOL education. Outcome measures included caregiving preparedness, communication self-efficacy, satisfaction, and question-asking behavior. In addition, semi-structured interviews were conducted with eight participants, and the data were analyzed using thematic content analysis. RESULTS: Analysis of covariance revealed no statistically significant between-group differences in caregiving preparedness (F = 1.58, p&#x202f;=&#x202f;.215 [-0.41, 0.44]) or communication selfefficacy (F = 0.83, p&#x202f;=&#x202f;.366 [-0.44, 0.79]). However, communication satisfaction was significantly higher in the intervention group (F = 4.19, p&#x202f;<&#x202f;.05 [0.04, 0.44]). The number of questions asked was also significantly higher in the intervention group (t&#x202f;=&#x202f;-4.35, p&#x202f;<&#x202f;.001 [-5.41, -1.98]). Thematic analysis of qualitative data identified 4 themes and 14 subthemes, illustrating how the QPL reduced anxiety, clarified care needs, and improved confidence. CONCLUSIONS: A culturally adapted QPL can enhance communication engagement and satisfaction among migrant caregivers. PRACTICE IMPLICATIONS: Integrating culturally tailored QPLs into caregiver education and palliative care practice may promote more inclusive and effective communication.

Humans↗

Patients' satisfaction with dental care provided by public dental clinics in Dar es Salaam, Tanzania.

BACKGROUND: In Tanzania, patient satisfaction with dental services has received only minor attention. OBJECTIVE: To assess patients' satisfaction with public dental health services in Dar es Salaam. DESIGN: A cross-sectional study. SETTING: Five public dental clinics randomly selected from a list of all the nine public dental clinics in Dar es Salaam. SUBJECTS: Five hundred and sixteen consecutive patients, 193 males and 323 females aged between 12 and 77 years who, during the study period between July and November, 2002 were attending five dental clinics were randomly selected. RESULTS: No significant differences in patients' satisfaction level (overall or for the specific studied items) were found in all the five public dental clinics. The answers to the specific sub-items, apart from time spent with doctor, were around the average with very few responses with a high ranking. CONCLUSIONS: Findings indicate a moderate level of patient satisfaction with dental care offered in public dental clinics in Dar es Salaam. Areas identified as needing improvement included; technical quality of care, interpersonal aspects and communication.

Adolescent↗

Efficacy of brief telephone psychotherapy with callers to a suicide hotline.

The efficacy of two types of theapy conducted exclusively over the telephone was studied. Clients (N=55) were recruited from a pool of callers to a suicide hotline and were randomly assigned to a waiting list control (WC) or Solution Focused Brief Therapy (SFBT) or Common Factors Therapy (CFT). It was hypothesized that improvements would be significantly higher in the two therapy conditions compared to the waitlist control and SFBT would be significantly more efficacious than CFT. Results confirmed that improvement was significantly higher in the two treatment conditions compared to the waitlist control, but no difference in improvement was found between SFBT and CFT. The implications of these findings for suicide hotlines are discussed.

Adult↗

Safety outcomes in meta-analyses of phase 2 vs phase 3 randomized trials: Intracranial hemorrhage in trials of bolus thrombolytic therapy.

CONTEXT: Recent studies have reported disagreement between meta-analysis of small trials and subsequent large trials addressing the same question. However, disagreement for uncommon but serious adverse safety outcomes has not been examined. OBJECTIVE: To explore disagreement for serious adverse safety (intracranial hemorrhage [ICH]) and efficacy outcomes between meta-analysis of phase 2 (small) vs meta-analysis of phase 3 (large) randomized controlled trials comparing the efficacy of bolus thrombolytic therapy with infusion for acute myocardial infarction (AMI). DATA SOURCES: Electronic databases (MEDLINE, Cochrane Database of Clinical Trials) between January 1980 and December 1999 using the search terms thrombolysis, thrombolytic therapy, and myocardial infarction; conference proceedings; and reference lists. STUDY SELECTION: Fifteen randomized trials comparing thrombolytic agents administered by bolus injection with standard infusion therapy in patients with AMI. DATA EXTRACTION: Data on ICH, other causes of stroke, total mortality, and reinfarction were independently extracted from each study by 2 observers. DATA SYNTHESIS: Meta-analysis of 9 phase 2 trials (n = 3956) revealed a lower risk of ICH with bolus thrombolytic therapy (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.27-1.01), which was not statistically significant. Meta-analysis of 6 phase 3 trials (n = 62 673) indicated a significant increase in risk of ICH (OR, 1.25; 95% CI, 1.06-1.49). These results were significantly different (P =.01). There was no disagreement for efficacy outcomes. Phase 2 trials included younger and heavier patients with lower baseline blood pressures, and were more often open-label. Subgroup analyses suggested that each of these factors was associated with a lower estimate of risk of ICH with bolus agents. CONCLUSIONS: Our results suggest that when therapeutic interventions are associated with a potential for uncommon but serious adverse safety outcomes, there may be differences between small phase 2 and large phase 3 trials that result in their disagreement for safety but not necessarily efficacy outcomes. Further investigation of the frequency and causes of disagreement between small and large trials for safety outcomes is warranted.

Clinical Trials, Phase II as Topic↗

Perceived sexual dysfunction amongst patients with inflammatory bowel disease.

300 patients with inflammatory bowel disease (IBD) were randomly selected from the community-based register held in Leicester. They were invited to participate in a study investigating personal problems of patients with IBD. 188 patients agreed to participate and were subsequently sent a previously validated questionnaire. A similar questionnaire was sent to buddy controls of similar age, sex and background (n = 76) as well as matched controls drawn at random from general practitioner lists (n = 46). Details sought included demographic data, patients' perception of their disease severity, data relating to treatment, family history, fertility, frequency of sexual intercourse and the effect IBD had on personal relationships. 150 questionnaires were returned from patients (response rate 80%) and 122 from controls. The reliability of a randomly selected group of questionnaires was assessed by direct interview 4 months after the main study (n = 20). There were no demographic differences between the patient and control groups (age: t = 0.67, ns; duration of marriage: t = 0.92, and marital status/number with a regular partner: chi 2 = 14, 12 d.f., p = 0.3). Dyspareunia was commoner amongst patients (n = 15, 38%) than controls (n = 7, 18%), although this was not statistically significant (z = 2.6). There was no significant difference in the overall frequency of sexual intercourse amongst patient and control groups (chi 2 = 12.78, 12 d.f.), even when comparing those with infrequent or no sexual intercourse (chi 2 = 6.98, 4 d.f.) The reliability of these results was confirmed after 4 months when there was no difference in responses in the re-interviewed group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Catheter-related interventions to prevent peritonitis in peritoneal dialysis: a systematic review of randomized, controlled trials.

As many as 15 to 50% of end-stage kidney disease patients are on peritoneal dialysis (PD), but peritonitis limits its more widespread use. Several PD catheter-related interventions (catheter designs, surgical insertion approaches, and connection methods) have been purported to reduce the risk of peritonitis in PD. The goal was to assess the trial evidence supporting their use. The Cochrane CENTRAL Registry, MEDLINE, EMBASE, and reference lists were searched for randomized trials of catheter types and related interventions in PD. Two reviewers extracted data on the rates of peritonitis and exit-site/tunnel infection, catheter removal/replacement, technique failure, and all-cause mortality. Analysis was by a random effects model, and results are expressed as relative risk and 95% confidence intervals. Thirty-seven eligible trials (2822 patients) were identified: eight of surgical strategies of catheter insertion, eight of straight versus coiled catheters, 10 of Y-set versus conventional spike systems, four of Y-set versus double-bag systems, and seven of other interventions. Despite the large total number of patients, few trials covered the same interventions, small numbers of patients were enrolled in each trial, and the methodologic quality was suboptimal. Y-set and twin-bag systems were superior to conventional spike systems (seven trials, 485 patients; relative risk, 0.64; 95% confidence intervals 0.53 to 0.77), and no other catheter-related intervention was demonstrated to prevent peritonitis in PD. This systematic review demonstrates that of all catheter-related interventions designed to prevent peritonitis in PD, only disconnect (twin-bag and Y-set) systems have been proved to be effective (compared with conventional spike systems). Despite the importance of PD as a renal replacement therapy modality and the large number of patients who receive it, it is still not known whether any particular PD catheter designs, implantation techniques, or modalities are effective, given the limitations of available trials.

Adult↗

Covariate-based constrained randomization of group-randomized trials.

Group-randomized study designs are useful when individually randomized designs are either not possible, or will not be able to estimate the parameters of interest. Blocked and/or stratified (for example, pair-matched) designs have been used, and their properties statistically evaluated by many researchers. Group-randomized trials often have small numbers of experimental units, and strong, geographically induced between-unit correlation, which increase the chance of obtaining a "bad" randomization outcome. This article describes a procedure--random selection from a list of acceptable allocations--to allocate treatment conditions in a way that ensures balance on relevant covariates. Numerous individual- and group-level covariates can be balanced using exact or caliper criteria. Simulation results indicate that this method has good frequency properties, but some care may be needed not to overly constrain the randomization. There is a trade-off between achieving good balance through a highly constrained design, and jeopardizing the appearance of impartiality of the investigator and potentially departing from the nominal Type I error.

Algorithms↗

Detecting and managing elder abuse: challenges in primary care. The Research Subcommittee of the Elder Abuse and Self-Neglect Task Force of Hamilton-Wentworth.

OBJECTIVE: To determine family physicians' perceptions of barriers and strategies in the effective detection and appropriate management of abused elderly people. DESIGN: Questionnaire survey; the protocol included an advance notification letter and 3 follow-up mailings. SETTING: Regional Municipality of Hamilton-Wentworth, Ont. PARTICIPANTS: All active nonspecialist physicians who reported seeing elderly patients in their practices were eligible for inclusion. Fifty health service organization (HSO) physicians were randomly selected from among those listed with the HSO Mental Health Program, and 200 fee-for-service physicians were randomly selected from the Canadian Medical Directory. Of the 189 eligible physicians 122 returned completed questionnaires, a response rate of 65%. OUTCOME MEASURES: Physicians' ratings of the importance of potential barriers in assisting older people experiencing abuse and of the usefulness of strategies for dealing with elder abuse. RESULTS: Physicians identified the following barriers as fairly or very important: denial of abuse, resistance to intervention, not knowing where to call for help, lack of protocols to assess and respond to abuse, lack of guidelines about confidentiality, fear of reprisal, and lack of knowledge of the prevalence and definition of elder abuse. Strategies deemed to be helpful included a single agency to call, a directory of services, a list of resource people, an educational package, guidelines for detection and management, reimbursement for time spent on legal matters, continuing education, revision of fee structure and a central library of resources on elder abuse. CONCLUSION: Although the physicians perceived numerous barriers to their detection and management of elder abuse, they identified many strategies that could be implemented at a local level. Preparation of an algorithm to help physicians is the next phase of this work.

Aged↗

Antimicrobial agents to prevent peritonitis in peritoneal dialysis: a systematic review of randomized controlled trials.

BACKGROUND: A large proportion (15% to 50%) of the end-stage renal disease population are on peritoneal dialysis (PD). The major limitation is peritonitis, which leads to technique failure, hospitalization, and increased mortality. Oral, nasal, and topical antibiotic prophylaxis; exit-site disinfectants; and other antimicrobial interventions are used to prevent it. This study was conducted to assess what evidence supports these approaches. METHODS: The Cochrane CENTRAL Registry, MEDLINE, EMBASE, and reference lists were searched for randomized trials of antimicrobial agents in patients on PD. Two reviewers extracted data on the number of patients with 1 or more episodes and rates of peritonitis and exit-site and tunnel infection, catheter removal and/or replacement, technique failure, antibiotic toxicity, and all-cause mortality. Analysis was by means of a random-effects model, and results are expressed as relative risk (RR) and 95% confidence intervals (CI). RESULTS: Nineteen eligible trials (1,949 patients) were identified. Nasal mupirocin compared with placebo significantly reduced the exit-site and tunnel infection rate (1 trial; 2,716 patient-months; RR, 0.58; 95% CI, 0.40 to 0.85), but not peritonitis rate (1 trial; 2,716 patient-months; RR, 0.84; 95% CI, 0.44 to 1.60). Perioperative intravenous antibiotic therapy compared with no treatment significantly reduced the risk for early peritonitis (4 trials; 335 patients; RR, 0.35; 95% CI, 0.15 to 0.80), but not exit-site and tunnel infection (3 trials; 114 patients; RR, 0.32; 95% CI, 0.02 to 4.81). CONCLUSION: Based on 1 study, nasal mupirocin reduces exit-site and tunnel infection, but not peritonitis. Based on 4 studies, preoperative intravenous prophylaxis reduces early peritonitis, but not exit-site and tunnel infection. No other antimicrobial intervention has proven efficacy. Given the large number of patients on PD therapy and the importance of peritonitis, the lack of adequately powered randomized trials to inform decision making about strategies to prevent peritonitis is striking.

Anti-Infective Agents↗

Motivational enhancement and self-help treatments for problem gambling.

Two brief treatments for problem gambling were compared with a waiting-list control in a randomized trial. Eighty-four percent of participants (N = 102) reported a significant reduction in gambling over a 12-month follow-up period. Participants who received a motivational enhancement telephone intervention and a self-help workbook in the mail, but not those who received the workbook only, had better outcomes than participants in a 1-month waiting-list control. Participants who received the motivational interview and workbook showed better outcomes than those receiving the workbook only at 3- and 6-month follow-ups. At the 12-month follow-up, the advantage of the motivational interview and workbook condition was found only for participants with less severe gambling problems. Overall, these results support the effectiveness of a brief telephone and mail-based treatment for problem gambling.

Adult↗

Prevalence of iron, vitamin A, and iodine deficiencies amongst adolescent pregnant mothers.

OBJECTIVE: The present study was undertaken to assess the prevalence of iron, vitamin A and iodine deficiencies amongst rural Adolescent Pregnant Mothers (APM). METHODS: Survey was conducted amongst APM in a rural block; district Udham Singh Nagar, Uttaranchal State. In the district, all blocks were enlisted and one block was randomly selected. Further, villages in the block were listed (n = 64) and five villages were randomly selected for the detailed study. All APM residing in the selected villages were included for the detailed study. The data on socio demographic parameters was collected utilizing a pre-tested semi-structured questionnaire. Anaemia was assessed by hemoglobin estimation with the help of the HemoCue instrument. Vitamin-A deficiency (VAD) was assessed by presence of night blindness utilizing a pre-tested semi structured proforma. Iodine Deficiency was assessed by the clinical examination of the thyroid gland and estimating the Urinary Iodine Excretion (UIE) levels of each subject. Nutrient intake was assessed by the 24-hr dietary recall method. RESULTS: One hundred and fifty one APM, belonging to low socio economic group, were selected for the study. The occupation of the families was farming, but the APM were housewives. The mean age of the APM was 17.8 +/- 1.5 yr. Eighty nine percent of the APM were in the age group 16-19 yr. Sixty percent of the APM were in the gestational age of 24 weeks and more. It was found that 46.0% of the APM were anaemic (Hb < 11.0 gm/dl). Sixteen percent of the study subjects had presence of night blindness. Fifteen percent of the subjects had Goiter. Median UIE level in the subjects studied was 95.0 micrograms/l. Concomitant prevalence of the three deficiencies was amongst 2.0% of the population. The 24-hour dietary intake revealed that the mean consumption of retinol and iron was only 13 and 28% of the recommended dietary allowance, respectively. CONCLUSION: The findings of the present study indicated that Anaemia, Vitamin A, and Iodine deficiency existed as public health problems in the APM of the study area.

Adolescent↗

Comparison of hemodialysis, hemofiltration, and acetate-free biofiltration for ESRD: systematic review.

BACKGROUND: We performed a systematic review of randomized controlled trials (RCTs) comparing hemodialysis (HD), hemofiltration (HF), hemodiafiltration (HDF), and acetate-free biofiltration (AFB) in the treatment of patients with end-stage renal disease to assess their clinical effectiveness. METHODS: The Cochrane CENTRAL Registry, MEDLINE, EMBASE, CINAHL, the American College of Physicians Database, Database of Abstracts of Reviews of Effectiveness, and reference lists were searched for randomized trials of HF, HDF, and AFB compared with HD; HDF compared with AFB; and HF compared with HDF. Two reviewers extracted data for all-cause mortality; hypotension, headache, nausea, vomiting, and any other adverse symptoms; quality of life (QoL); hospitalization; dialysis adequacy; and end-of-treatment beta 2 -microglobulin levels. Analysis was by means of a random-effects model, and results are expressed as relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs). RESULTS: Eighteen eligible trials (588 patients) were identified. HDF was associated with significantly greater mortality risk than HD (4 trials, 326 patients; RR, 3.52; 95% CI, 1.37 to 9.47). Risk for mortality was not different among the other comparisons. Risks for hypotension episodes and dialysis-related symptoms were not significantly different with HD, HF, HDF, and AFB (18 trials, 583 patients). QoL, assessed by using an unvalidated scoring tool, appeared to be significantly improved in patients on HDF therapy than those on HD therapy (1 trial, 67 patients; WMD, 0.6; 95% CI, 0.3 to 0.9), but this was not evident when validated QoL assessment tools were used. Use of AFB compared with HDF was not associated with a significant difference in risk for hospitalization (1 trial, 11 patients; WMD, -0.45; 95% CI, -1.42 to 0.52). HDF in comparison to HD did not reduce the risk for carpal tunnel syndrome (1 trial, 67 patients; RR, 2.04; 95% CI, 0.59 to 7.00). Kt/V was significantly different with HDF compared with HD (3 trials, 124 patients; WMD, 0.14; 95% CI, 0.05 to 0.22). No other substantial data for these interventions and their impact on major patient-centered outcomes were available. CONCLUSION: The trials assessed were not powered adequately and had suboptimal method quality. It is not possible on the basis of effectiveness to prefer one extracorporeal renal replacement therapy modality to the other for end-stage kidney disease because significant differences in clinically important outcomes have not been shown by available published RCTs.

Acetates↗

Evaluation of an 8-week mailed healthy-weight intervention.

BACKGROUND: This study investigated the impact of a low-intensity, healthy-weight intervention among adult volunteers in a low-income, inner-city neighborhood. The intervention, which comprised 18 pamphlets mailed to participants' homes over 8 weeks, focused on increasing awareness of healthy weight ranges, increasing self-acceptance and satisfaction with weight, and improving eating habits, while downplaying dieting and weight loss. METHODS: Subjects were recruited from households randomly selected from residential telephone subscriber lists. The 188 volunteers (23.0% of 816 persons contacted) were randomly assigned to intervention or control status. Psychosocial and behavioral measures were administered by telephone 1 week before and 2 weeks after the intervention. RESULTS: After exposure to the pamphlets, intervention subjects were more likely than controls to know how to control their weight. They were more satisfied with their weight and less likely to report they were too heavy. They reported less high-fat/junk food consumption, more improvements in their eating habits, and more frequent exercise. CONCLUSION: This inexpensive, low-intensity intervention was effective in supporting change processes among volunteers who wanted to learn about weight control, to improve eating habits, and to improve health.

Adult↗