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PubMed2001

Preparing for the drug free years: session-specific effects of a universal parent-training intervention with rural families.

Like their urban counterparts, adolescents from rural areas are at risk for health and behavior problems, including alcohol and other drug use. This study tested the effects on parenting practices of specific sessions of a parent-training intervention, Preparing for the Drug Free Years, designed to prevent adolescent substance abuse and other problem behaviors. Two hundred and nine rural families were randomly assigned to an intervention or a wait-list control condition. Analyses of covariance comparing adjusted posttest scores revealed that parents in the intervention condition reported significant improvements in parenting behaviors targeted by specific intervention sessions when compared with controls. Effects were most pronounced among mothers. No significant effects were found for nontargeted parenting behaviors, and targeted behaviors were most improved among parents attending relevant program sessions. These results strengthen the internal validity of the study and increase the plausibility that reported improvements were due to the intervention.

Adolescent↗

PubMed2002

Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension.

BACKGROUND: Hypertrophy and concentric remodeling of the left ventricle are important manifestations of hypertension that are associated with increased morbidity and mortality. Although lifestyle interventions are efficacious in lowering blood pressure, evidence that they have a beneficial effect on target organs has been lacking. OBJECTIVE: To assess the effects of regular aerobic exercise or exercise plus weight management counseling on left ventricular mass and geometry in overweight, sedentary men and women with high-normal or mildly elevated blood pressure. METHODS: Eighty-two participants in a randomized, controlled trial were assigned to supervised aerobic exercise only, a behavioral weight management program that included exercise, or a waiting-list control group for 6 months. Blood pressure and echocardiographic measures of left ventricular structure were measured at baseline and at the conclusion of the treatment phase. RESULTS: The 45 women and 37 men had a mean +/- SD age of 47 +/- 9 years and had a mean +/- SD blood pressure of 140 +/- 10/93 +/- 5 mm Hg. Blood pressure fell by 7/6 mm Hg in the weight management group and by 3/4 mm Hg in the aerobic exercise group. In association with these decreases in blood pressure, participants in the intervention groups exhibited significant decreases in left ventricular relative wall thickness (P =.003), posterior wall thickness (P =.05), and septal thickness (P =.004) and a trend toward a decrease in indexed left ventricular mass (P =.08) relative to the control group. CONCLUSIONS: In a cohort of overweight, sedentary men and women, exercise and weight loss reduced blood pressure and induced favorable changes in left ventricular structure.

Adult↗

PubMed1998

Effect of fluticasone in severe polyposis.

OBJECTIVES: To investigate the effect of intranasal corticosteroids in the treatment of polyps in patients with severe polyposis listed for surgical treatment and to determine the treatment effect on the progression of the disease. DESIGN: A double-blind, randomized, parallel-group, placebo-controlled, 12-week study at a single center. SETTING: A tertiary referral center in London, England. PATIENTS: Thirty-four patients with severe polyposis listed for endoscopic surgical treatment. INTERVENTION: By random allocation, fluticasone propionate aqueous nasal spray (FPANS), 200 microg twice a day; beclomethasone dipropionate aqueous nasal spray, 200 microg twice a day; or placebo nasal spray twice a day was administered. Patients received 2 actuations to each nostril in the morning and in the evening. MAIN OUTCOME MEASURES: Efficacy end points were the need for polypectomy at the end of treatment, the results of acoustic rhinometry, the polyp score, the peak nasal inspiratory flow rate, and an assessment of symptoms. RESULTS: The polyp score was significantly decreased in the FPANS-treated group (P < or = .01). The nasal cavity volume was significantly increased in both the FPANS-treated group and the group receiving beclomethasone compared with placebo (P < or = .01) at the end of treatment. The percentage change in the mean morning peak nasal inspiratory flow rate was greater in the FPANS-treated group, with a significant effect observed at week 2 (P = .01). Nasal blockage was significantly decreased in both active groups compared with the group receiving placebo. No significant difference was observed between the treatment groups in the number of patients requiring polypectomy. CONCLUSIONS: Fluticasone and beclomethasone aqueous nasal sprays are effective in treating the symptoms of severe nasal polyps. There was some evidence that the group treated with FPANS responded more quickly to intervention and that the magnitude of the response was greater than in the group receiving beclomethasone.

Administration, Intranasal↗

PubMed1987

Evaluation of a special nursing home unit for dementia sufferers: a randomised controlled comparison with community care.

Applicants for a newly opened special unit for dementia sufferers were randomly allocated to full-time care in the unit or placed on a waiting list and offered periodic respite care in the meantime. All applicants were living in the community at the time of random assignment. Both groups were followed up for three months to assess the effects on the dementia sufferers and on their family care-givers. Care-givers initially had a high level of psychological symptoms, which was greatly reduced after admission of the dementia sufferer to full-time care. By contrast, the care-givers of the community care group of sufferers continued to have a high level of symptoms. Dementia sufferers continued to deteriorate with both forms of care, with little difference between the two groups. Admission of dementia sufferers to full-time care in a special unit appears to be of great benefit to the psychological health of their care-givers and has no adverse effects on the dementia sufferers themselves.

Activities of Daily Living↗

PubMed2001

Aerobic exercise and resting blood pressure in older adults: a meta-analytic review of randomized controlled trials.

BACKGROUND: It is well established that resting systolic and diastolic blood pressure (SBP and DBP, respectively) increases as one ages. This study used the meta-analytic approach to examine the effects of aerobic exercise for reducing resting SBP and DBP in older adults. METHODS: Study data were compiled through use of the following: (i) computer searches (MEDLINE, Current Contents, and Sport Discus), (ii) cross-referencing from bibliographies of retrieved studies and review articles, and (iii) an expert who reviewed our reference list. Inclusion criteria and sources for this study were (i) randomized trials, (ii) aerobic activity as the only exercise intervention, (iii) a nonexercise control group, (iv) an assessment of changes in resting SBP and/or DBP, (v) within-study ages of subjects > or = 50 years, (vi) English-language studies published in journals, and (vii) studies published between January 1966 and January 1998. Net changes in resting BP were calculated as the exercise minus control group difference. RESULTS: Fourteen primary outcomes were derived from seven studies. Decreases of approximately 2% and 1% were found for resting SBP and DBP, with only changes in SBP as statistically significant (SBP, mean +/- SD = -2 +/- 3 mm Hg, 95% confidence interval [CI] = -4 to -1 mm Hg; DBP, mean +/- SD = -1 +/- 2 mm Hg, 95% CI = -2 to 0 mm Hg). CONCLUSIONS: This study supports the efficacy of aerobic exercise for reducing resting SBP in older adults. However, a need exists for studies that address the effectiveness of this intervention for reducing resting BP in older adults.

Aged↗

PubMed2004

Folate for depressive disorders: systematic review and meta-analysis of randomized controlled trials.

The objective of this review was to determine the effectiveness, adverse effects and acceptability of folate in the treatment of depression. Electronic databases (Cochrane Controlled Trials Register and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register) and reference lists were searched, and authors, experts and pharmaceutical companies contacted to identify randomized controlled trials that compared treatment with folic acid or 5'-methyltetrahydrofolic acid to an alternative treatment, for patients with a diagnosis of depressive disorder. Three randomized trials (247 participants) were included. Two studies assessed the use of folate in addition to other treatment, and found that adding folate reduced Hamilton Depression Rating Scale (HDRS) scores on average by a further 2.65 points [95% confidence interval (CI) 0.38-4.93]. Fewer patients treated with folate experienced a reduction in their HDRS score of less than 50% at 10 weeks (relative risk 0.47, 95% CI 0.24-0.92). The remaining study found no statistically significant difference when folate alone was compared with trazodone. The identified trials did not find evidence of any problems with the acceptability or safety of folate. The limited available evidence suggests folate may have a potential role as a supplement to other treatment for depression. It is currently unclear if this is the case both for people with normal folate levels, and for those with folate deficiency.

Administration, Oral↗

PubMed2003

A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type.

This study tested whether a hypnosis-based intervention showed promise as a treatment for patients with conversion disorder, motor type. Forty-four outpatients with conversion disorder, motor type, or somatization disorder with motor conversion symptoms, were randomly assigned to a hypnosis or a waiting-list condition. The hypnosis-condition patients were more improved relative to baseline and the waiting-list controls. Improvement was evident on an observational index of behavioral symptoms associated with the motor conversion and on an interview measure of extent of motor disability. No effect was obtained on a nonspecific measure of broad psychopathology immediately posttreatment. At 6-month follow-up, improvement was maintained across the behavioral and interview measures. The effect size of hypnotizability as a predictor of treatment outcome was comparable to that found for other individual patient differences associated with psychotherapy outcome although non-significant. Hypnotizability scored above patient expectations as a predictor of treatment outcome.

Adolescent↗

PubMed1999

A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder.

This study tested a family-based skills-building intervention in veterans with chronic combat-related posttraumatic stress disorder (PTSD). Veterans and a family member were randomly assigned to 1 of 3 conditions: (a) waiting list, (b) 18 sessions of twice-weekly exposure therapy, or (c) 18 sessions of twice-weekly exposure therapy followed by 16 sessions of behavioral family therapy (BFT). Participation in exposure therapy reduced PTSD positive symptoms (e.g., reexperiencing and hyperarousal) but not PTSD negative symptoms. Positive symptom gains were maintained at 6-month follow-up. However, participation in BFT had no additional impact on PTSD symptoms.

Adult↗

PubMed1998

Increased contact with community mental health resources as a potential benefit of family education.

OBJECTIVE: This study examined the hypothesis that families of adults with severe mental illness who participate in either a group family education workshop or individual family consultation will try to seek more assistance from community services than those in a control group assigned to a waiting list. METHODS: A total of 225 family members who agreed to participate in the study were randomly assigned to one of three conditions: a ten-week group workshop, individual family consultation, or a waiting list (control group). Family members were interviewed about the extent of their contact with mental health professionals, providers, and community resources at baseline, termination of the interventions, and at six months after termination. RESULTS: No differences were found between conditions in the extent of family members' contact with three types of services: conventional, psychosocial, and ancillary mental health services. CONCLUSIONS: Neither of the educational interventions produced any change in behaviors of families seeking advice and assistance on behalf of their ill relative from the three types of services examined. Modifications in the interventions may be worthwhile. Increasing family members' contacts with community resources on behalf of their ill relative may increase the benefits of the intervention to the family as well as to the ill relative.

Adult↗

PubMed2000

Reducing risk factors for eating disorders: comparison of an Internet- and a classroom-delivered psychoeducational program.

This controlled trial compared Internet- (Student Bodies [SB]) and classroom-delivered (Body Traps [BT]) psychoeducational interventions for the reduction of body dissatisfaction and disordered eating behaviors/attitudes with a control condition. Participants were 76 women at a private university who were randomly assigned to SB, BT, or a wait-list control (WLC) condition. Measures of body image and eating attitudes and behaviors were measured at baseline, posttreatment, and 4-month follow-up. At posttreatment, participants in SB had significant reductions in weight/shape concerns and disordered eating attitudes compared with those in the WLC condition. At follow-up, disordered behaviors were also reduced. No significant effects were found between the BT and WLC conditions. An Internet-delivered intervention had a significant impact on reducing risk factors for eating disorders.

Adult↗

PubMed1993

A residential recovery program for homeless alcoholics: differences in program recruitment and retention.

This paper describes the Sober Transitional Housing and Employment Project (STHEP), a long-term residential recovery program in Los Angeles for homeless alcoholics. This NIAAA community demonstration project aimed to reintegrate homeless alcoholics into the urban environment and to increase levels of sobriety, housing, and employment. Participants first completed a 90-day program in a rural location and then transferred to a downtown recovery home for an additional 120 days. Services included enhanced vocational and housing assistance and specialized group activities. The evaluation examined patterns of recruitment and program retention, in comparison to a control group which received only the first phase, without enhanced services. Whites, women, and younger residents were less likely to sign up for the project waiting list and to accept entry into the project when randomized. STHEP participants were more likely to complete the first phase, particularly black males, compared to the control group. Upon completion of the second phase, whites were more likely to discharge to a rental situation, blacks to a sober group living facility, and women to live with others. Differences in program recruitment and completion may be explained by employment history, economic status, and gender, race, and age differences in subsistence patterns while homeless. The findings suggest the need for program planners to take into consideration the diverse backgrounds and needs of homeless alcoholics and to match individual needs to services.

Alcoholism↗

PubMed2001

Nutrient intake of obese female binge eaters.

OBJECTIVE: To compare the 6-month change in selected nutrients and number of binge days (from 7-day food records) between obese binge eaters randomly assigned to either a behavioral self-management (BSM) or waiting list control (WLC) group. Within each of the 2 groups, the average intake of selected nutrients on binge and nonbinge days at baseline and at 6 months were compared. DESIGN: A randomized, controlled, intervention study with assessments at entry and 6 months later. SUBJECTS: Forty-six women in the BSM group and 36 in the WLC group completed the 6-month measurement. Participants were 25 to 50 years of age, 30 to 90 pounds overweight, did not have a history of physical or psychological illnesses, and scored 20 or greater on the binge eating scale. INTERVENTION: Participants in the BSM intervention received 6 months of weekly, 1-hour classes taught by registered dietitians. Participants in the WLC group were not contacted during the 6 months. OUTCOME MEASURES: The main outcome measures were change in energy consumed (kilocalories); percentage of energy from fat, protein, and carbohydrate; grams of fiber/1,000 kcal; and change in the number of self-reported binge days. STATISTICAL ANALYSES: Weight at 6 months was compared using a 2-sample t test. The change in the number of binge days at 6 months and the amount of change in selected nutrients by group was compared using the 2-sample t test. The paired t test was used to compare the average nutrient intakes on binge and nonbinge days within groups. RESULTS: No significant difference was found in the 6-month change between groups in any of the selected nutrients. The BSM group reported a greater reduction in binge days between baseline and 6 months compared with the WLC group (mean 1.0 vs 1.7, P < 0.03). Within the BSM group at 6 months, energy intake and percentage of energy from fat on nonbinge days were significantly reduced compared with binge days. At baseline within the WLC group, energy intake increased and percentage of energy from protein decreased significantly on nonbinge days compared with binge days. Within the WLC group at 6 months, energy intake and percentage of energy from fat significantly decreased and percentage of energy from protein significantly increased on nonbinge days. CONCLUSIONS: Our results suggest that collecting dietary information from participants identified with binge eating disorder is challenging. Dietitians who conduct behavioral weight management programs may require additional training in identifying and understanding the psychological characteristics of participants with binge-eating disorder.

Adult↗

PubMed1999

Efficacy of metformin in the treatment of NIDDM. Meta-analysis.

OBJECTIVE: The results differ concerning randomized controlled trials of the effects of metformin on blood glucose regulation and body weight. To get a systematic overview, a meta-analysis of the efficacy of metformin was performed by comparing metformin with placebo and sulfonylurea. RESEARCH DESIGN AND METHODS: All randomized controlled trials published since 1957 were selected by searching the Current List of Medical Literature, Cumulated Index Medicus, Medline, and Embase, Meta-analysis was performed calculating weighted mean difference (WMD) of fasting blood glucose, glycosylated hemoglobin, and body weight. RESULTS: Nine randomized controlled trials comparing metformin with placebo and ten comparing metformin with sulfonylurea were identified. The WMD between metformin and placebo after treatment for fasting blood glucose was -2.0 mmol/l (95% CI -2.4 to -1.7) and for glycosylated hemoglobin -0.9% (95% CI -1.1 to -0.7). Body weight WMD was not significant after treatment. Sulfonylurea and metformin lowered blood glucose and glycosylated hemoglobin equally, while there was a significant WMD of body weight (-2.9 kg [95% CI -4.4 to -1.1]) because of a 1.7-kg mean increase after sulfonylurea and a 1.2-kg mean decrease after metformin. CONCLUSIONS: Metformin lowers blood glucose and glycosylated hemoglobin significantly, compared with placebo. Metformin and sulfonylurea have an equal effect on fasting blood glucose and glycosylated hemoglobin, but the body weight is significantly lower after metformin compared with sulfonylurea treatment because of an increase in body weight after sulfonylurea treatment.

Blood Glucose↗

PubMed1999

A randomized, controlled trial of exercise and education for individuals with fibromyalgia.

OBJECTIVE: To evaluate the efficacy of a 6-week exercise and educational program for patients with fibromyalgia. METHODS: Forty-one subjects were randomly assigned to the program or served as waiting list controls. Program outcome was assessed with a 6-minute walk test, the Fibromyalgia Impact Questionnaire, a Self-Efficacy Scale, and a "knowledge" questionnaire (based on information provided during the educational sessions). Waiting list control subjects subsequently completed the program. Program outcome was reassessed 3 or 6 months post-program. RESULTS: The program produced significant improvements in 6-minute walk distance, well-being, fatigue, self-efficacy (for controlling pain and other symptoms), and knowledge. At followup, immediate gains in walk distance, well-being, and self-efficacy were maintained, but gains in fatigue and knowledge were lost. CONCLUSION: Short-term exercise and educational programs can produce immediate and sustained benefits for patients with fibromyalgia. The benefits of our program may be due to exercise or education since both interventions were given.

Adult↗

PubMedDate not supplied

Aerobic exercise and lipids and lipoproteins in patients with cardiovascular disease: a meta-analysis of randomized controlled trials.

PURPOSE: Use the meta-analytic approach to examine the effects of aerobic exercise on lipids and lipoproteins in adults with cardiovascular disease (CVD). METHODS: Studies were retrieved via electronic databases, review of reference lists from retrieved articles, including reviews, and hand searching. Inclusion criteria were: (1) randomized controlled trials, (2) aerobic exercise >or=4 weeks as an intervention, (3) studies published in English language only between January 1, 1955 and January 1, 2005, (4) studies published in journals or as dissertations or master's theses, (5) human subjects >or=18 years, (6) all subjects diagnosed with some type of CVD, and (7) pre and post data available for total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and/or triglycerides (TG). Random-effects models were used for data analysis. RESULTS: Of the more than 3,000 studies reviewed, a total of 10 representing 1,260 subjects (580 exercise, 680 control) were included in our analysis. There was a statistically significant increase of 9% in HDL-C (mean +/- SEM, 3.7 +/- 1.3 mg/dL; 95% CI, 1.2 to 6.1 mg/dL) and a statistically significant decrease of 11% in TG (-19.3 +/- 5.4 mg/dL; 95% CI, -30.1 to -8.5 mg/dL), but no statistically significant decreases in TC or LDL-C (TC, -8.8 +/- 6.8 mg/dL; 95% CI, -22.3 to 4.7 mg/dL; LDL-C, -7.7 +/- 6.0 mg/dL; 95% CI, -19.5 to 4.2 mg/dL). CONCLUSIONS: The present findings suggest that chronic aerobic exercise increases HDL-C and decreases TG in adults, especially men, with CVD.

Biomarkers↗

PubMed1997

Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-type 2 antibody titers in symptomatic HIV-seropositive gay men.

This study tested the effects of a 10-week group cognitive-behavioral stress management (CBSM) intervention on mood and immunologic parameters in HIV-seropositive gay men whose disease had progressed to a symptomatic stage. Men were randomized to either CBSM or a modified waiting-list control group. The CBSM intervention significantly decreased self-reported dysphoria, anxiety, and total distress. Individuals who practiced relaxation more consistently had significantly greater drops in dysphoria. The intervention also decreased herpes simplex virus-Type 2 (HSV-2) immunoglobulin G antibody titers. The control group showed no significant changes in either mood or antibody titers. Individual difference analyses revealed that decreases in dysphoria significantly predicted lower HSV-2 antibody titers by the end of the 10-week period. Neither group displayed changes in HSV-Type 1 antibody titers or in CD4+ or CD8+ cell numbers.

Adult↗

PubMed1996

A survey of the prevalence of biting by the Blandford fly during 1993.

To assess the frequency of bites by the Blandford fly, a postal survey was carried out at the end of the 1993 biting season. Questionnaires were sent to a random sample of 1,500 people, selected from the lists of the two general practices in Blandford Forum, and satisfactory replies were obtained from 1203 (80%). Altogether, 194 (16%) of subjects reported one or more insect bites, during the 2-month season, that had led to skin swelling more than 2.5 cm across. Of these, more than a quarter had suffered associated systemic symptoms, in the form of fever or joint pain. One hundred and forty-nine had used medications for bites, 20 had consulted a doctor, and seven had taken time off work or school. Bites were more common in females (22%) than males (9%). This difference was due largely to a higher frequency of bites on the legs. Risk might be reduced substantially in women by wearing trousers, especially in those who spend a lot of time outdoors.

Adolescent↗

PubMed1997

Therapy for youths with anxiety disorders: a second randomized clinical trial.

Ninety-four children (aged 9-13 years) with anxiety disorders were randomly assigned to cognitive behavioral treatment or waiting-list control. Outcomes were evaluated using diagnostic status, child self-reports, parent and teacher reports, cognitive assessment and behavioral observation: maintenance was examined using 1-year follow-up data. Analyses of dependent measures indicated significant improvements over time, with the majority indicating greater gains for those receiving treatment. Treatment gains returned cases to within nondeviant limits (i.e., normative comparisons) and were maintained at 1-year follow-up. Client age and comorbid status did not moderate outcomes. A preliminary examination of treatment segments suggested that the enactive exposure (when it follows cognitive-educational training) was an active force in beneficial change. Discussion includes suggestions for future research.

Adolescent↗