The Diabetes Atherosclerosis Intervention Study (DAIS): a study conducted in cooperation with the World Health Organization. The DAIS Project Group

The incidence of coronary artery disease is greatly increased in those with diabetes mellitus. The largest number of those who have coronary artery disease have non-insulin-dependent diabetes (NIDDM). Lipoprotein abnormalities have been identified among the several risk factors that could account for this increase in atherosclerosis. There have been many studies demonstrating that correction of dyslipoproteinaemias will reduce the risk of coronary disease in non-diabetic populations. Current advice to those with diabetes is based on extrapolations from such studies. However, the justification for this, and the treatment targets are unclear as there has been no direct test of the lipid hypothesis in diabetes. This paper describes the protocol of the first intervention trial designed to examine directly whether correcting dyslipoproteinaemia in men and women with NIDDM will reduce their coronary artery disease. The Diabetes Atherosclerosis Intervention Study (DAIS), is a multinational angiographic study using the 200 mg micronized form of fenofibrate in a double-blind, placebo-controlled protocol.     

The Montreal Type A Intervention Project: Major findings.

Reports a comparison of 3 short-term treatments in modifying behavioral and cardiovascular reactivity to laboratory psychosocial stressors in healthy Type A (coronary-prone) men. 107 men (mean age 37 yrs) completed the treatments and evaluations—33 in aerobic exercise group, and 37 each in cognitive-behavioral stress management and weight-training groups. The stress management group showed significantly greater changes in behavioral reactivity (reductions of 13 to 23% below initial values) than the 2 physical exercise groups, which did not differ significantly from each other. For physiological reactivity, changes attributable to intervention were trivial for all 3 treatment groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The anatomy of a consultation: a teaching method

Two dosages of Smokeless Tobacco (ST) extract were given to gravid Sprague-Dawley rats by oral gavage on gestational days (GD) 6-20. The low dosage contained ST extract equivalent to 1.33 mg/kg nicotine (STD-1), and the high dosage contained ST extract equivalent to 4.0 mg/kg nicotine (STD-2). Dams were dosed three times daily at 8 a.m., 11 a.m., and 2 p.m., thus providing total daily nicotine equivalent dosages of 4 mg/kg/day and 12 mg/kg/day. Controls received equivalent amounts of distilled water by gavage. Dams were allowed to deliver and all experimental pups were fostered to control mothers. On postnatal day 1 (PND 1) litters were culled to 4 +/- 1 females and 4 +/- 1 males. Weights, physical landmark development, and behavioral performance of pups were monitored during pre- and post-weaning periods. Behavioral tests included: surface righting, negative geotaxis, swimming development, open-field activity, active avoidance in shuttle box, and Cincinnati swimming maze. Our results show that the STD-2 dose resulted in reduced maternal weight gain. Offspring weights were reduced in a dose-related manner, with the most consistent weight deficits seen in the STD-2 group until PND29. Consistent STD-1 weight deficits were seen up to PND 8. The incidence of deaths was increased in the STD-2 dosage group. No significant treatment-related differences were observed in development of physical landmarks. Male STD-2 pups righted faster than controls, and significant differences were noted in swimming development with the STD-1 group of pups performing less effectively than controls. Activity levels, assessed during both pre- and post-weaning periods were not affected. No treatment-related differences were seen in the active avoidance shuttle box or Cincinnati swimming maze tests, which assessed learning. Female brain weights were reduced in the STD-1 treatment group.     

Effects of cigarette smoking on the angiographic evolution of coronary atherosclerosis. A Canadian Coronary Atherosclerosis Intervention Trial (CCAIT) Substudy. CCAIT Study Group

BACKGROUND: Although smoking increases both the risk of developing coronary disease and the risk of coronary events in patients with known coronary atherosclerosis, the effect of smoking on the evolution of coronary atherosclerosis as assessed by serial angiography is poorly defined. METHODS AND RESULTS: Ninety smokers with coronary atherosclerosis shown on a recent angiogram and with fasting cholesterol levels between 220 and 300 mg/dL were enrolled in a randomized, double-blind, placebo-controlled trial of cholesterol-lowering therapy, along with 241 nonsmokers and exsmokers. Lovastatin at a mean dose of 36 mg/d lowered total and LDL cholesterol by 21 +/- 11% and 29 +/- 11%, respectively, but these levels changed by < 2% in placebo-treated patients. Coronary arteriography was repeated after 2 years in 72 smokers and their 557 lesions were measured blindly with an automated quantitative system, along with 1752 lesions in 227 nonsmokers. Coronary change score, the per-patient mean of the minimal lumen diameter changes for all qualifying lesions, worsened by 0.16 +/- 0.16 mm in smokers and by 0.07 +/- 0.15 mm in nonsmokers in the placebo group (P < .001). Lovastatin-treated smokers had less worsening (0.07 +/- 0.15 mm) than placebo-treated smokers (P = .024). One or more coronary lesions progressed in 16 of 34 lovastatin-treated smokers and in 28 of 38 placebo-treated smokers (47% versus 74%, P < .001). In the placebo group, new coronary lesions developed in 21 of 38 smokers and in 28 of 115 nonsmokers (55% versus 24%, P < .001); fewer lovastatin-treated smokers developed new lesions (15% versus 55%, P < .001). CONCLUSIONS: Smoking accelerates coronary progression and new lesion formation as assessed by serial quantitative coronary arteriography. Lovastatin slows the progression of coronary atherosclerosis and prevents the development of new coronary lesions in smokers.     

The Early Childhood Intervention Project: Building capacity for service delivery.

Presents the evaluation design and case study outcomes for 28 children (aged 3–5 yrs) from the 1st 3 yrs of the Ohio Early Childhood Intervention (ECI) project. The ECI project was designed to help build the capacity of professionals for intervention design. Capacity building refers to preparing educational systems for change and, specific to this report, providing valid conceptual and procedural guidelines for early intervention. The foundations of the ECI project are ecobehavioral analysis, ecological consultation, and naturalistic intervention design. The acronym PASSKey (Planned Activity, Strategic Sampling, Keystone behavior) describes 3 major aspects of the assessment-intervention guidelines. Validity evidence for the guidelines is based on single case quasi-experimental (accountability and case study) designs documented by comprehensive early childhood case portfolios. In addition, estimates were obtained of the consultants' time spent in problem solving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Natural history of coronary atherosclerosis using quantitative angiography in men, and implications for clinical trials of coronary regression. The Harvard Atherosclerosis Reversibility Project Study Group

Previous studies of the natural history of coronary disease generally relied on estimates of percent stenosis derived from visual assessment of the coronary angiogram. In a study of 26 patients, serial quantitative angiography was performed 3 years apart to determine changes in both absolute measurements of the luminal diameter and relative percent stenosis. Initially, the mean minimal diameter of 74 coronary obstructions was 1.94 +/- 0.09 mm, the mean "normal" reference diameter was 3.06 +/- 0.11 mm, and the mean percent stenosis was 37%. At follow-up, there was a mild reduction of 0.12 +/- 0.04 mm (6%) in the minimal diameter (p < 0.005), and an increase in percent stenosis to 39% (p = 0.03). The average diameter of 85 arterial segments without a focal obstruction either initially or at follow-up showed mild but significant progression (-0.11 +/- 0.04 mm; p = 0.02). Using a minimal change of 0.27 mm in arterial diameter as a categoric variable, progression occurred in 26% of 74 arterial segments, no significant change in 65%, and regression in 9%. The only significant determinant of disease progression was the initial severity of disease. Obstructed arteries with a larger initial minimal diameter and presumably milder disease progressed more rapidly than did those with a smaller diameter (r = -0.42; p = 0.0002). There was no effect of age on the rate of progression (r = 0.02; p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)     

Isolation of Chlamydia pneumoniae from the coronary artery of a patient with coronary atherosclerosis. The Chlamydia pneumoniae/Atherosclerosis Study Group

BACKGROUND: Atherosclerosis is pathologically similar to a chronic inflammatory response. Recent reports have suggested that Chlamydia pneumoniae may play a role in the pathogenesis of atherosclerosis. OBJECTIVE: To determine, by using various detection methods, whether C. pneumoniae is present in the coronary arteries of patients with coronary atherosclerosis. DESIGN: Multicenter investigation. SETTING: The Jewish Hospital Heart and Lung Institute in Louisville, Kentucky, and several laboratories. PATIENTS: 12 patients seeking heart transplantation. MEASUREMENTS: Culture for C. pneumoniae was done in HEp-2 cell monolayers. Other methods of detection included polymerase chain reaction (PCR) assay, immunocytochemistry, transmission electron microscopy, and in situ hybridization. RESULTS: Chlamydia pneumoniae was cultured from atherosclerotic plaques in one patient with severe coronary artery disease. The organism was found in the atheromas of this patient by PCR assay, immunocytochemistry, electron microscopy, and in situ hybridization. In addition, at least one testing method showed C. pneumoniae in coronary artery tissue in six of nine additional patients with coronary atherosclerosis. CONCLUSIONS: This study provides direct evidence of the presence of viable C. pneumoniae in atheromatous lesions. A chronic inflammatory response caused by a persistent infection of the coronary arteries may explain the link between C. pneumoniae and atherosclerosis.     

Metabolic and immune parameters at clinical onset of insulin-dependent diabetes: a population-based study. IMDIAB Study Group. Immunotherapy Diabetes

The age at diagnosis of insulin-dependent diabetes mellitus (type I DM) varies between childhood and adulthood. The aim of this study was to define the immunologic and metabolic characteristics of the disease according to the age at which it is diagnosed. We evaluated the residual beta-cell function (basal and stimulated C-peptide) and frequency of two major islet cell-related autoantibodies, glutamic acid decarboxylase (GAD) and tyrosine phosphatase-like molecule (IA-2ic), at the onset of type I DM. A population-based study was performed with 235 consecutive cases of recent-onset (<4 weeks) type I DM (ages 5 to 45 years) diagnosed in the Lazio region of central Italy. Five age groups were considered: patients diagnosed between ages 5 and 7 years (n = 10), 7 and 10 years (n = 38), 10 and 17 years (n = 94), 17 and 20 years (n = 17), and 20 and 45 years (n = 76). Patients diagnosed before puberty had significantly reduced C-peptide secretion compared with patients diagnosed at a later age (P < .02). Glycosylated hemoglobin (HbA1c) did not differ at diagnosis between the different age groups. Patients diagnosed at puberty or after required significantly less insulin compared with younger patients (P < .04). GAD antibodies were found in 65% and IA-2ic antibodies in 59% of patients. GAD antibodies tended to be more frequent in patients diagnosed after age 17 compared with younger patients (P = .05), while IA-2ic antibodies were not age-related. These data suggest that (1) the extent of beta-cell damage differs between patients diagnosed before and after puberty, the process being more destructive in children less than 7 years of age, when C-peptide levels are the lowest; and (2) residual beta-cell function at diagnosis is not influenced by the presence or absence of islet cell-related antibodies. These findings have implications for trials in type I DM diagnosis aimed at protecting beta cells from end-stage destruction and in attempts to prevent the disease in susceptible individuals.     

Rating group therapist interventions: The validation of the Group Psychotherapy Intervention Rating Scale.

The present study seeks to establish the validity of the Group Psychotherapy Intervention Rating Scale (GPIRS), an observer-rated measure of the quality of group leader interventions. Concurrent validity was tested by comparing GPIRS results to 2 group gold standard process measures, the Hill Interaction Matrix and the Group Climate Questionnaire. Significant correlations between leader intervention scores and group member perceptions of group climate, as well as verbal interaction scores, were found. In addition, results indicated correlations between interventions aimed to gain balance between confrontation and warmth and member-rated levels of cohesion. Results lend support for the concurrent validity of the GPIRS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facial rejuvenation: use of a teaching model in care planning

Rejuvenation of the aging face is in high demand by baby boomers. Facial rejuvenation can consist of various treatments, from chemical peeling with Phenol, TCA, Jessner solution, glycolic acid, and CO2 laser resurfacing. All of these treatments have similar side effects. Nurses play an important role in the educating patients and in treating these side effects. This can be accomplished through a Teaching Model in care Planning.     

The Participatory Intervention Model: A framework for conceptualizing and promoting intervention acceptability.

The authors propose a participatory approach for conceptualizing and implementing research-based interventions that has as its primary aim the development of acceptable and sustainable change efforts. The Participatory Intervention Model (PIM), rooted in participatory action research, provides a mechanism for integrating theory, research, and practice and for promoting involvement of stakeholders in intervention efforts. The authors present evidence of PIM's capacity for promoting intervention acceptability, drawing on their research experiences in international sexual-risk prevention work. The authors conclude with a discussion of PIM's potential for bridging the gap between research and practice, addressing cultural diversity, fostering partnerships, promoting disciplined reflective practice, and integrating the multiple roles of the school psychologist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Employee Assistance Program: A Systems Intervention Model for Health Care Settings.

The August 1979 special issue of Professional Psychology on psychologists in health care settings covered activities of psychologists in a variety of such settings. The importance of a "life-space developmental frame of reference" is described by Donald Wertlieb (1979) in "A Preventive Mental Health Paradigm for Health Care Psychologists." We should like to respond to his argument for a preventive health frame of reference by drawing your attention to the employee assistance program as one such prevention and early intervention model for both the academic and nonacademic staffs of universities and colleges. The University of Missouri-Columbia Employee Assistance Program (EAP) is an example of such a program. We have recently completed our fourth year of operation and have provided services during these 4 years to over 500 faculty, staff, and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Race/ethnicity misclassification of persons reported with AIDS. The AIDS Mortality Project Group and The Supplement to HIV/AIDS Surveillance Project Group

Oxidative modification of high density lipoproteins (HDL) may alter their capacity to mediate cellular cholesterol efflux. We studied the kinetics of copper-mediated oxidation of HDL and cholesterol efflux mediated by unmodified and oxidized HDL (oxHDL). Oxidation was measured by increases in absorbance at 234 nm (delta A234), production of thiobarbituric acid reactive substances (TBARS) and loss of trinitrobenzene sulfonic acid reactivity. Oxidation was dependent on copper concentration and showed a lag phase and propagation phase. Efflux of cholesterol from J774 macrophages measured by appearance of cellular [3H]cholesterol in the medium was lower by 16% after 4 h and 36% after 24 h with oxHDL compared to HDL. OxHDL-mediated efflux was also lower by 27% to 37% at lipoprotein concentrations of 10 to 200 micrograms protein/ml. Cholesterol efflux correlated negatively with TBARS production (r = -0.97, P < 0.003) and delta A234 (r = -0.77, P < 0.080). There was no difference in efflux mediated by apoproteins prepared from HDL and oxHDL. Efflux measured by change in cholesterol mass in medium was 78% lower with oxHDL. Inhibition of oxidation with butylated hydroxytoluene maintained the capacity of HDL to stimulate efflux. These results suggest that oxidation of HDL may impair its protective role against atherosclerosis.     

The Child Anxiety Prevention Study: Intervention model and primary outcomes.

The article presents the intervention model and primary outcomes of a preventive intervention designed to reduce anxiety symptoms and prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Participants were 40 volunteer children (mean age = 8.94 years; 45% girls; 90% Caucasian) whose parents met criteria for a broad range of anxiety disorders. Families were randomly assigned to an 8-week cognitive–behavioral intervention, the Coping and Promoting Strength program (CAPS; n = 20) or a wait list control condition (WL; n = 20). Independent evaluators (IEs) conducted diagnostic interviews, and children and parents completed measures of anxiety symptoms. Assessments were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment. On the basis of intent to treat analyses, 30% of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0% in the CAPS group. IE and parent-reported (but not child-reported) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up assessment in the CAPS but not the WL group. Parental satisfaction with the intervention was high. Findings suggest that a family-based intervention may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coeliac disease: frequent occurrence after clinical onset of insulin-dependent diabetes mellitus. Childhood Diabetes in Finland Study Group

Coeliac disease was searched for in a series of 776 children with newly diagnosed IDDM. During the follow-up of 2 to 3 years from diagnosis, reticulin and gliadin antibodies were measured, and a jejunal biopsy was performed in those cases with high levels of antibodies; 19 children were identified with coeliac disease, giving the prevalence of 2.4%. In only one case had coeliac disease been diagnosed before IDDM. Nine patients with proven coeliac disease were negative for antibodies when IDDM was diagnosed, but became positive within 24 months. All patients found to have coeliac disease were positive for IgA reticulin antibodies, but only 12 of 18 (67%) showed a high level of IgA gliadin antibodies. Of the 18 patients genotyped for HLA DR locus, 14 (78%) were positive for DR3 and 10 (56%) were positive for DR4. DQB1*0201 allele was present in 17 of 18 patients (94%). Coeliac disease in children with IDDM tends to develop soon after diabetes is diagnosed. Routine screening for coeliac disease is recommended repeatedly during the first years after the diagnosis of IDDM.     

Defective HLA class II expression in monocytes of type 1 diabetic patients. The Childhood Diabetes in Finland Study Group

Activation of T-helper cells is modulated by the intensity of HLA class II expression on antigen-presenting cells. We evaluated whether any abnormalities could be found in the expression of HLA-DR and -DQ molecules on monocytes in type 1 diabetic subjects. DR and DQ molecules were induced by human recombinant interferon-gamma on cultured peripheral blood monocytes obtained from children with type 1 diabetes (N = 28), their siblings (N = 18) and unrelated healthy controls (N = 21). The response in DQ induction varied considerably between different individuals, but the average responsiveness was significantly lower in patients compared to siblings and unrelated controls. In addition to the diabetic subjects deficient DQ induction was also observed in three siblings. One of them had high levels of islet cell antibodies and presented with diabetes 6 months later, and another had active rheumatoid arthritis. The response in DR induction was also slightly lower in patients than in siblings, but did not differ from that in unrelated controls. The results suggest abnormalities in the regulation of HLA class II expression in type 1 diabetic subjects possibly reflecting the ongoing autoimmune process.     

Microalbuminuria is not rare before 5 years of IDDM. EURODIAB IDDM Complications Study Group and the WHO Multinational Study of Vascular Disease in Diabetes Study Group

Microalbuminuria is thought to be rare in people with insulin-dependent diabetes mellitus (IDDM) for less than 5 years. We measured its prevalence in 733 clinic-attending IDDM patients with diabetes duration of 1-5 years in two large multicenter studies [EURODIAB IDDM Complications Study and the World Health Organization (WHO) Multinational Study]. We also compared characteristics of microalbuminuric patients with IDDM for 1-5 years versus more than 5 years' duration. Albumin excretion rate was measured from a timed 24-h urine collection in the EURODIAB Study. Proteinuria was measured by the salicylsulphonic acid test in the WHO Study. The prevalence of microalbuminuria (20-200 micrograms/min, EURODIAB) was 18% [95% confidence interval (CI) 13%-22%)]. The prevalence of light proteinuria was 15% (9%-20%, WHO study). Raised protein excretion was a consistent finding in 34 of the 36 centers. The increased cardiovascular risk (raised blood pressure and total cholesterol) associated with microalbuminuria in patients with IDDM for more than 5 years was also apparent in those with diabetes for 1-5 years. However, repeat urine testing suggested that microalbuminuria before 5 years was more likely to be transient or reversible. In conclusion, these two studies in 36 centers, which used different methods more than 10 years apart, show consistently that raised urinary albumin excretion occurs before 5 years of IDDM. The clinical significance of this needs to be examined by prospective observation.     

Linkage and association between a CD4 gene polymorphism and IDDM in Danish IDDM patients. The Danish IDDM Epidemiology and Genetics Group, and The Danish Study Group of Diabetes in Childhood

PURPOSE: Our purpose was to determine the neuroradiologic findings of Marinesco-Sj?gren syndrome on plain skull radiographs, CT, and MR images. METHODS: Eight patients with proved Marinesco-Sj?gren syndrome (age range, 4 to 56 years) had a total of nine CT scans, seven MR imaging studies, and two plain radiographic examinations of the skull. The findings were reviewed retrospectively, with particular attention to the size of the posterior fossa and cerebellum. RESULTS: All patients had hypoplastic cerebellar hemispheres and a hypoplastic vermis in a small posterior fossa. One patient had a midline posterior fossa cyst and another had agenesis of the corpus callosum. CONCLUSION: Hypoplasia of the cerebellar hemispheres and the vermis and a small posterior fossa are the most prominent neuroradiologic findings in Marinesco-Sj?gren syndrome.