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PubMed2000

EMDR for panic disorder with agoraphobia: comparison with waiting list and credible attention-placebo control conditions.

In a randomized controlled trial, eye movement desensitization and reprocessing (EMDR) for panic disorder with agoraphobia (PDA) was compared with both waiting list and credible attention-placebo control groups. EMDR was significantly better than waiting list for some outcome measures (questionnaire, diary, and interview measures of severity of anxiety, panic disorder, and agoraphobia) but not for others (panic attack frequency and anxious cognitions). However, low power and, for panic frequency, floor effects may account for these negative results. Differences between EMDR and the attention-placebo control condition were not statistically significant on any measure, and, in this case, the effect sizes were generally small (eta2 = .00-.06), suggesting the poor results for EMDR were not due to lack of power. Because there are established effective treatments such as cognitive-behavior therapy for PDA, these data, unless contradicted by future research, indicate EMDR should not be the first-line treatment for this disorder.

Adult↗

PubMed2001

Specialist epilepsy nurses for treating epilepsy.

BACKGROUND: Epilepsy is the most common serious neurological condition after stroke, with a 0.5 per cent prevalence, and a two to three per cent life time risk of being given a diagnosis of epilepsy in the developed world. As a result of the perceived deficiencies and suggestions to improve the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out-patient clinics (as opposed to the management of patients in general neurology clinics or general medical clinics) and nurse-based liaison services between primary (GP) and secondary/tertiary (hospital based) care. OBJECTIVES: The aim of this review is to overview the evidence from controlled trials investigating the effectiveness of specialist epilepsy nurses compared to routine care. SEARCH STRATEGY: The following databases were searched: The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 1999), MEDLINE, GEARS, BIDS (EMBASE=Excepta Medica), ECRI, Effectiveness Healthcare Bulletin, Effectiveness Matters, Bandolier, Evidence Based Purchasing, National Research Register, Vignettes and expert panels from Standing Group on Health Technology Assessment, PsycLit database, World Wide Web sites and reference lists of articles. SELECTION CRITERIA: All randomized controlled and quasi-randomized trials which considered specialist epilepsy nurse interventions with standard or alternative care were included in this review. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion and extracted the relevant data. The following outcomes were assessed: (a) seizure frequency (b) appropriateness of medication prescribed (c) social or psychological functioning scores (d) knowledge about epilepsy scores (e) objective measures of general health status/quality of life (f) patients' reports of information received (g) number of days spent on sick leave/missing school and employment status (h) costs of care (i) adverse effects. MAIN RESULTS: Three trials were included, two based in general practice and one in a neurology centre. The population of patients differed between trials, for example one study excluded patients with learning disabilities, and one only recruited patients with a new diagnosis. In view of this heterogeneity we decided not to pool results in a meta-analysis. As yet, there is no convincing evidence that specialist epilepsy nurses improve outcomes for people with epilepsy overall. Important outcomes (e.g. seizure frequency, psychosocial functioning, knowledge of epilepsy, general health status, work days lost, depression and anxiety scores) show no significant improvement. There is some evidence that those patients who have not had an epileptic seizure in the last six months are less at risk for depression. There is also evidence that newly diagnosed patients whose knowledge about epilepsy is poor may improve their epilepsy knowledge scores after nurse intervention. REVIEWER'S CONCLUSIONS: It is clearly plausible that specialist epilepsy nurses could improve quality in epilepsy care. However, there is as yet little evidence to support this assumption as the present research base is small. Further research is needed to investigate the effectiveness of specialist epilepsy nurses before such recommendations can be made.

Epilepsy↗

PubMed2000

Intravenous immunoglobulin for preventing infection in preterm and/or low-birth-weight infants.

BACKGROUND: Nosocomial infections continue to be a significant cause of morbidity and mortality among preterm and/or low birth weight infants. Maternal transport of immunoglobulins to the fetus mainly occurs after 32 weeks gestation and endogenous synthesis does not begin until several months after birth. Administration of intravenous immunoglobulin provides IgG that can bind to cell surface receptors, provide opsonic activity, activate complement, promote antibody dependent cytotoxicity, and improve neutrophilic chemoluminescence. Intravenous immunoglobulin thus has the potential of preventing or altering the course of nosocomial infections. OBJECTIVES: To assess the effectiveness/safety of intravenous immunoglobulin (IVIG) administration (compared to placebo or no intervention) to preterm (< 37 weeks gestational age at birth) and/or low birth weight (LBW) (< 2500 g BW) infants in preventing nosocomial infections. SEARCH STRATEGY: Medline, Embase, Cochrane Library and Reference Update Databases were searched in November 1997 using keywords: immunoglobulin and infant-newborn and random allocation or controlled trial or randomized controlled trial (RCT). The reference lists of identified RCTs, personal files and Science Citation Index were searched. No language restrictions were applied. SELECTION CRITERIA: The criteria used to select studies for inclusion in this overview were: 1) DESIGN: RCTs in which administration of IVIG was compared to a control group that received a placebo or no intervention. 2) POPULATION: preterm (< 37 weeks gestational age) and/or LBW (<2500 g) infants. 3) INTERVENTION: IVIG for the prevention of bacterial/fungal infection during initial hospital stay (8 days or longer). (Studies that were primarily designed to assess the effect of IVIG on humoral immune markers were excluded as were studies in which the follow-up period was one week or less). 4) At least one of the following outcomes was reported: sepsis, any serious infection, death from all causes, death from infection, length of hospital stay, intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD). DATA COLLECTION AND ANALYSIS: Two reviewers independently abstracted information for each outcome reported in each study, and one researcher (AO) checked for any discrepancies and pooled the results. Relative risk (RR) and Risk Difference (RD) with 95% confidence intervals (CI) using the fixed effects model are reported. When a statistically significant RD was found the number needed to treat (NNT) was also calculated with 95% CIs. The results include all accepted studies in which the outcome of interest was reported. When statistically significant heterogeneity was found for an outcome, secondary (sensitivity) analyses were performed including only studies of the highest quality. MAIN RESULTS: Fifteen studies met inclusion criteria. These included 5,054 preterm and/or LBW infants and reported on at least one of the outcomes of interest for this systematic review. When all studies were combined there was a statistically significant reduction in sepsis, one or more episodes [RR 0.83 (95% CI 0.72, 0.97); RD -0.028 (95% CI -0.006, -0.051); NNT 36 (95% CI 20, 167)]. There was significant between-study heterogeneity. When, in a sensitivity analysis, the high quality studies were combined, the results remained significant [RR 0.78 (95% CI 0.62, 0.98); RD -0.031(95% CI -0.003, -0.059); NNT 32 (95% CI 17, 333]. For this analysis there was no statistically significant between-study heterogeneity. A statistically significant reduction was also found for any serious infection, one or more episodes, when all studies were combined [RR 0.85 (95% CI 0.75, 0. 95); RD -0.032 (95% CI -0.010, -0.054,); NNT 31 (95% CI 19, 100). There was statistically significant between-study heterogeneity. When, in a sensitivity analysis, the high quality studies were combined the results remained statistically significant [RR 0.80 (95% CI

Cross Infection↗

PubMedDate not supplied

Effect of patient notification of formulary change on formulary adherence.

OBJECTIVE: To evaluate the impact of patient notification of impending formulary changes on formulary adherence. METHODS: This pilot program in a large, Midwest-based health insurer utilized a randomized controlled trial research design. A list of 30 chronic-use medications that were to change formulary status were selected for the pilot. A review of adjudicated pharmacy claims records was performed to identify patients receiving one or more of the formulary change medications on the list. Members of 112 individual health plans of this large health insurer, all of whom were subject to the same drug formulary, were randomized to either the intervention (letter) or control arm. Patients in the intervention arm were sent a targeted communication that described the patient.s formulary change medication(s) and provided therapeutic option(s) for the formulary change medication(s). Pharmacy claims for patients in both arms were examined at 110 days after the date of the mailing to determine if there was a switch to a formulary alternative. Multivariate regression modeling was performed to adjust for baseline differences between the arms. RESULTS: A total of 7,247 unique formulary change medication regimens were identified (3,817 in the control arm and 3,430 in the letter arm) for 6,518 subjects (3,387 in the control arm and 3,131 in the letter arm). A higher proportion of formulary change medication regimens in the intervention arm were switched to a formulary alternative compared with the control arm (19.2% vs. 12.0%, P<0.001). After adjustment for baseline differences, regression modeling indicated that subjects in the intervention arm were 1.33 times more likely to switch to a formulary alternative (P<0.001). CONCLUSION: A letter-based, formulary change notification program is a pragmatic and effective strategy to increase drug formulary adherence. Such a program does not restrict access to medications but, rather, provides education and personalized information that may allow patients to participate more actively in their pharmacotherapy decision making.

Female↗

PubMed1996

The Psychological Management of Tinnitus: Comparison of a Combined Cognitive Educational Program, Education Alone and a Waiting-List Control.

Sixty subjects with chronic tinnitus were randomly allocated to one of three experimental conditions: (1) cognitive coping skills training (attention diversion, imagery training and thought management skills) combined with education. (2) education-only, or (3) waiting-list control. The two treatment groups improved significantly more than the waiting-list control on measures of frequency of use of coping strategies, benefits derived from the use of coping strategies, irrational beliefs and knowledge about tinnitus. Subjects who received the combined cognitive/education intervention demonstrated significantly greater reductions in distress and handicaps associated with tinnitus, and engagement in dysfunctional cognitions, than the subjects who received education alone. No significant effects were obtained on measures of depression, locus of control, or on daily ratings of subjective loudness, noticeability or bothersomeness of the tinnitus. At the 12-month follow-up, the differential treatment effects had dissipated. Although the treatment resulted in statistically significant effects, the size of the clinical effects is rather modest. Implications for the further development of treatment techniques are discussed.

Journal Article↗

PubMed2001

Cognitive treatment of pathological gambling.

This study evaluated the efficacy of a cognitive treatment package for pathological gambling. Sixty-six gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment or wait-list control conditions. Cognitive correction techniques were used first to target gamblers' erroneous perceptions about randomness and then to address issues of relapse prevention. The dependent measures used were the South Oaks Gambling Screen, the number of DSM-IV criteria for pathological gambling met by participants, as well as gamblers' perception of control, frequency of gambling, perceived self-efficacy, and desire to gamble. Posttest results indicated highly significant changes in the treatment group on all outcome measures, and analysis of data from 6- and 12-month follow-ups revealed maintenance of therapeutic gains. Recommendations for clinical interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.

Adult↗

PubMed1993

Efficacy of cognitive therapy for chronic low back pain.

The effects of outpatient group cognitive therapy, relaxation training, and cognitive therapy in combination with relaxation training on chronic low back pain and associated physical and psychosocial disability were evaluated and compared. One-hundred and two mildly disabled chronic low back pain patients were assigned randomly to a waiting-list (WL) control condition and the 3 treatments. Patient self-report and observational measures were obtained pretreatment and post-treatment for all conditions, and at 6- and 12-month follow-ups for the treatment conditions. Pain intensity decreased significantly pre- to post-treatment for patients in all 3 treatment conditions, but not the WL condition. Depressive symptoms and disability improved significantly in all conditions (including the waiting list) from pretreatment to post-treatment, with no statistically significant differences among treatments. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no statistically significant differences between treatments.

Adaptation, Psychological↗

PubMedDate not supplied

Type 2 diabetes in southern Kerala: variation in prevalence among geographic divisions within a region.

BACKGROUND: Numerous surveys carried out in India report the high prevalence of type 2 diabetes. Such studies have not included the population of Kerala. We estimated the prevalence of type 2 diabetes mellitus in Neyyattinkara taluk, Thiruvananthapuram district, Kerala state. METHODS: All panchayat wards in the taluk were grouped into urban, highland, midland or coastal, and one ward from each stratum was randomly selected for the study. All households were listed and adults, 20 years or older, screened for high (> 110 mg/dl) random blood sugar (RBS) by a glucometer test. Those with high RBS were reassessed by a fasting oral glucose tolerance test (OGTT), consisting of initial examination of venous blood for fasting plasma glucose (FPG) values, administration of 75 g of glucose dissolved in distilled water, and examination of venous blood for postprandial plasma glucose (PPPG) exactly 2 hours after the administration of glucose. Diabetes was diagnosed according to the World Health Organization criteria as either FPG > 139 mg/dl, or PPPG > 199 mg/dl, or both. Impaired glucose tolerance (IGT) was diagnosed if PPPG was 140-199 mg/dl. RESULTS: Out of 4988 eligible subjects, 3899 were available for the study, a response rate of 78.2%. Response was highest in the highland area (86.2%), and lowest in the coastal area (73.6%). The overall crude prevalence rate of type 2 diabetes was 5.9%. It was highest in the urban (12.4%), followed by midland (8.1%), highland (5.8%), and coastal (2.5%) regions. Ageing was associated with greater prevalence of type 2 diabetes in all regions and both sexes. Women showed a higher prevalence in the highland and coastal areas and men in the urban and midland areas. When compared to a population with standard age structure suggested by the World Health Organization for international comparisons, prevalence in the age group 30-64 years was found to be 16.9% in the urban, 10.1% in the midland, 6.8% in the highland and 3.6% in the coastal regions, respectively. Overall age-adjusted prevalence of type 2 diabetes in 30-64-year-olds in Neyyattinkara was 9.2% among men, 7.4% among women, and 8.2% for all persons. There was not much difference in prevalence if the American Diabetes Association criteria for diagnosis were used. The prevalence of impaired glucose tolerance was fairly low in this population. Out of 229 diabetics in the sample, 175 (76.5%) were already diagnosed and under treatment, while our survey identified 54 new diabetics (23.5%). CONCLUSION: Though prevalence of type 2 diabetes is high in this population, the detection rate is also high. However, impaired fasting glucose and impaired glucose tolerance are low. The reasons for this need to be elucidated.

Adult↗

PubMed2004

GPs' and physicians' interpretation of risks, benefits and diagnostic test results.

BACKGROUND: Understanding pre-test probability and baseline risks helps to interpret the results of diagnostic tests and the benefits of treatment, but how good is the understanding of these concepts? OBJECTIVES: Our aim was to assess the ability of GPs and consultant physicians to make accurate estimates and understand the application of pre-test probability and baseline risk for two common clinical conditions. METHODS: A two-stage questionnaire survey based on case scenarios of patients with angina and congestive heart failure was carried out of 202 physicians, randomly selected from the members of the Royal College of Physicians in the NW of England, 205 GPs randomly chosen from the practice list of the NW Health Authorities and 128 MRCGP examiners attending an examiners meeting. A total of 115, 106 and 81 members of these groups, respectively, responded to the first stage, and 44, 46 and 64 to the second. The main outcome measures were the stated likelihood of true ischaemic heart disease (IHD) being present and the predicted 1-year mortality; the impact of changing prevalence and baseline risk on these results; and interpretation of different methods of risk presentation. RESULTS: Estimates of pre-test probability of IHD being present ranged from 5 to 100% and of baseline risk of 1-year mortality from 0 to 86%. More GP examiners and consultant physicians understood the impact of increasing age on the test result than did the random sample of GPs. A majority of each group correctly said that increasing age would reduce the number needed to treat (NNT). Presentation of benefit as relative risk reduction was a greater stimulus to starting treatment than the NNT or measures of population impact. CONCLUSION: Clinicians should collect data to allow a better knowledge of the likelihood of disease and of baseline risk in their patient populations. Methods to increase the understanding of the influence of pre-test probability on diagnostic test results and of how to quantify and demonstrate the impact of the benefit of interventions should be explored.

Clinical Competence↗

PubMed2005

Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial.

BACKGROUND: Internal medicine residents must be competent in Advanced Cardiac Life Support (ACLS) for board certification. PURPOSE: The purpose was to use a medical simulator to assess baseline proficiency in ACLS and determine the impact of an intervention on skill development. METHOD: This was a randomized trial with wait-list controls. After baseline evaluation in all residents, the intervention group received 4 education sessions using a medical simulator. All residents were then retested. After crossover, the wait-list group received the intervention, and residents were tested again. Performance was assessed by comparison to American Heart Association guidelines for treatment of ACLS conditions with interrater and internal consistency reliability estimates. RESULTS: Performance improved significantly after simulator training. No improvement was detected as a function of clinical experience alone. The educational program was rated highly.

Academic Medical Centers↗

PubMed1989

Cognitive-behavioral therapy for migraine headaches: a minimal-therapist-contact approach versus a clinic-based approach.

The efficacy of a clinic-based cognitive-behavioral program for the treatment of common migraine was compared to the same approach using a minimal-therapist-contact format by means of a randomized controlled trial. Forty-eight subjects between 18 and 50 years of age completed the program. Following four weeks of recording headache activity, subjects were randomly assigned to a waiting list control condition or to one of the two treatment conditions. Treatment was followed by four weeks of recording of headache activity immediately posttreatment and again six months later. Multivariate analysis of variance indicated that there was a significant reduction in headache frequency, duration and peak intensity following treatment for both treated groups. These reductions were maintained at six months follow-up. Treatment for the minimal-contact group was significantly more cost-effective than for the clinic group.

Adult↗

PubMed2003

Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions.

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions.

Aged↗

PubMed2002

Informing participants of allocation to placebo at trial closure: postal survey.

OBJECTIVES: To assess whether and how investigators of placebo controlled randomised trials inform participants of their treatment allocation at trial closure and to assess barriers to feedback. DESIGN: Postal survey with a semistructured questionnaire. PARTICIPANTS: All investigators who published a placebo controlled randomised trial in 2000 in five leading medical journals, and a random sample of 120 trials listed in the national research register database. MAIN OUTCOME MEASURES: Number of investigators who informed participants of their treatment allocation at trial closure, methods for delivering the information, and barriers to unmasking treatment. RESULTS: 45% of investigators informed either all or most participants of their treatment allocation, and 55% did not inform any participant or only informed those who asked. The main reasons for not informing participants were that the investigators never considered this option (40%) or to avoid biasing results at study follow up (24%). CONCLUSION: Further research is required to examine sensitive ways to communicate treatment information to trial participants.

Communication↗

PubMed1996

A controlled trial of cognitive-behavioural treatment of hypochondriasis.

BACKGROUND: Hypochondriasis is a distressing disorder for which there is no adequate established treatment. This study evaluates the effect of cognitive-behavioural treatment of hypochondriasis, compared with a waiting list control. METHOD: Thirty-two patients were randomly assigned to either cognitive-behavioural therapy or a no treatment waiting list control. Cognitive-behavioural treatment consisted of 16 individual treatment sessions over a four-month period. The waiting list control lasted for four months and was followed by 16 sessions of cognitive-behavioural treatment. Assessments were made before allocation and after treatment or waiting list control. Patients who had cognitive-behavioural treatment were reassessed three months after completion of treatment. RESULTS: Paired comparisons on post-treatment/wait scores indicated that the cognitive-behavioural group showed significantly greater improvements than the waiting list on all but one patient rating, all therapist ratings and all assessor ratings. After three months the benefits of therapy were maintained. CONCLUSIONS: Cognitive-behavioural treatment is an effective therapy for hypochondriasis. Implications of the study are discussed.

Adult↗

PubMed2002

Impact of a relaxation training on psychometric and immunologic parameters in tinnitus sufferers.

OBJECTIVE: Tinnitus often entails severe psychological distress. Reversely, tinnitus may be considered as a chronic stressor. Based on this hypothesis, we investigated whether improving stress-managing capabilities would influence psychological and stress-related immunological parameters in chronic tinnitus sufferers. METHODS: Tinnitus (TPs, n=26) and non-tinnitus participants (NTPs, n=13) took part in a standardised 10-week relaxation program. An additional group of tinnitus sufferers (n=18), randomly assigned to a waiting list, served as control (TC) subjects. Mood, perceived stress, global quality of life, and tinnitus disturbance were assessed before and after the intervention. The stress-sensitive immunological parameters TNF-alpha, IL-6, and IL-10 were measured before, during, and at the end of the intervention. RESULTS: The program resulted in a significantly decreased perception of stress, anxious depression, anger, and tinnitus disturbance, paralleled by a reduction of TNF-alpha. No alterations were noted for IL-6 or IL-10. For the NTPs and TCs, no relevant psychological or immune changes could be observed. CONCLUSION: The data suggest that (1) the training offered improved stress-managing capabilities in chronic tinnitus sufferers, and (2) TNF-alpha may be conceived as a stress marker.

Adult↗

PubMed2000

Breast feeding practices in relation to endometrial cancer risk, USA.

OBJECTIVE: Breast feeding is associated with reduced estrogen, a profile that should be associated with decreased endometrial cancer incidence. We analyzed data from a population-based case-control study of Wisconsin women to evaluate the relation between lactation and endometrial cancer risk. METHODS: Cases (n = 586) were identified from a statewide tumor registry; controls (n = 1653) were selected randomly from driver's license lists and Medicare beneficiary files. Breast feeding practices and other factors were ascertained by telephone interview. RESULTS: Compared with parous women who did not breast feed, the multivariate relative risk for women who breast fed for at least 2 weeks was 0.90 [95% confidence interval (CI) 0.72-1.13]; increasing duration was not strongly associated with risk of disease (p for trend 0.4). More recent breast feeding was associated with significantly reduced risks. The relative risk for lactation within the recent three decades was 0.58 (95% CI 0.36-0.96) and for first breast feeding at age 30 or greater was 0.50 (95% CI 0.28-0.90). There was a suggestion that risk was increased in women who used lactation suppressant hormones--usually estrogens--more recently (p = 0.1) or at a later age (p = 0.1). CONCLUSIONS: This study suggests that, like breast cancer, endometrial cancer is modestly inversely associated with lactation.

Adult↗

PubMed2026

Smoke-Free Home Intervention in Permanent Supportive Housing: A Cluster Randomized Clinical Trial.

IMPORTANCE: Chronic diseases related to tobacco use and secondhand smoke exposure are the leading causes of death among formerly homeless adults living in permanent supportive housing (PSH) in the US. OBJECTIVE: To evaluate the efficacy of a brief, smoke-free home intervention in promoting voluntary smoke-free home adoption among PSH residents. DESIGN, SETTING, AND PARTICIPANTS: In this cluster randomized clinical trial, data collection occurred from January 11, 2022, to March 31, 2025. Participants were residents aged 18 years or older who smoked cigarettes at home in 40 multiunit PSH sites in the San Francisco Bay area, randomized to intervention or waiting list control clusters, and housing staff who worked at the study sites. INTERVENTION: Residents in intervention sites received one-on-one in-person coaching from research staff on adopting a smoke-free home; waiting list control site residents received no interventions during the study but were offered the intervention once the intervention group completed follow-up. Staff in both intervention and control sites received training on providing brief tobacco cessation coaching. MAIN OUTCOMES AND MEASURES: Primary outcomes were smoke-free home adoption for at least 90 days and 7-day carbon monoxide-verified point prevalence abstinence (PPA; expired carbon monoxide level ≤5 ppm) at 6 months. Secondary outcomes were any adoption (≥1 day) of a smoke-free home in the past 90 days among residents and changes in Smoking Knowledge, Attitudes, and Practices (S-KAP) scores among staff. RESULTS: The trial enrolled 400 residents (mean [SD] age, 54.5 [10.7] years; 251 [63.1%] male), 191 in the intervention and 209 in the control cluster. At 6 months, 13 residents (6.8%) in the intervention and 10 (4.8%) in the control group adopted a smoke-free home for at least 90 days (odds ratio [OR], 1.45; 95% CI, 0.69-3.07). Few residents achieved 7-day PPA, though more intervention residents (12 [6.3%]) achieved it compared with controls (2 [1.0%]) (OR, 6.94; 95% CI, 1.69-28.45). Intervention residents had greater odds than control residents of any smoke-free home adoption of at least 1 day (121 [63.4%] vs 77 [36.8%]; adjusted OR, 3.83 [95% CI, 2.63-5.57]). Among staff, mean (SD) S-KAP scores increased at 6 months vs baseline for beliefs (by 0.21 [0.55] points) and practices (by 0.24 [0.61] points) pertaining to providing cessation treatment. CONCLUSIONS AND RELEVANCE: In this cluster randomized clinical trial, the brief intervention did not result in a significant increase in smoke-free home adoption for at least 90 days, though more residents in the intervention than the control group attempted adoption for at least 1 day. These findings support the scalability of this approach to reduce smoking in PSH, but more intensive interventions may be needed to sustain intervention effects. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04855357.

Humans↗

PubMed2003

Influence of polymorphisms in VDR and COLIA1 genes on the risk of osteoporotic fractures in aged men.

BACKGROUND: Osteoporosis in chronic renal failure is a common finding caused by several factors, including age. In the last decade, the likely effect of genetic markers related with the appearance and evolution of osteoporosis has been mainly studied in women, with no categorical results. The aim of this study was to assess the influence of polymorphisms of the vitamin D receptor (VDR) and COLIA1 genes on the risk of osteoporotic fractures in men older than 50 years. METHODS: The study population comprised 156 men, aged 64 +/- 9 (50-86), randomly selected from the population list of Oviedo, Spain. Prevalent vertebral fractures and incident non-vertebral fractures were identified, as well as several genetic polymorphisms. Prevalent vertebral fractures were considered according to the Genant grade 2 classifications. The analyzed genetic polymorphisms were located on restriction sites BsmI (B,b), ApaI (A,a), and TaqI (T,t) in the VDR and on Sp1 (S,s) in COLIA1. RESULTS: Although none of the VDR gene polymorphisms separately analyzed showed any differences between fractured and non-fractured men, the utilization of haplotypes could be employed in order to find osteoporotic fractures in men. By contrast, the COLIA1 polymorphism was associated with osteoporotic fractures. The percentage of prevalent vertebral fractures was significantly higher in the "ss" genotype with respect to the other genotypes. These results show that in men, the "ss" genotype of COLIA1 polymorphism could be the best osteoporotic fracture risk genetic predictor, independent of bone mass values.

Aged↗