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The national high blood pressure education program.

Effect of Diet, Tobacco and Heredity on Lipid Metabolism and Hypertension

Background: With an increasing research focus on multiple health behaviour change interventions, a methodological issue requiring further investigation is whether or not to employ pre-trial behavioural screening to exclude participants who are achieving a pre-specified level of one or more behaviours. Behavioural screening can be used to direct limited resources to participants most in need of a behaviour change intervention; but may reduce the representativeness of the sample and limit comparability with trials that do not employ pre-trial behavioural screening. Furthermore, the impact of this type of screening on intervention participation and intervention effects is unknown. Methods: Data for this study come from the Logan Healthy Living Program, a randomised, controlled telephone counselling lifestyle intervention trial which did not employ behavioural screening prior to randomisation. Screening for physical activity, diet or the combination was simulated using baseline trial data. To examine the impact of behavioural screening on intervention participation (in terms of participant characteristics, intervention dose received and retention), characteristics of participants included an excluded under the various screening scenarios were compared. To examine the impact of behavioural screening on intervention effects, results from the main trial analysis were compared with results obtained from the same analyses performed separately for each of the screened groups. Results: Simulated pre-trial behavioural screening impacted minimally on intervention dose received and trial retention rate. Beyond the anticipated effect of reducing baseline levels of the behaviours being screened for, behavioural screening affected baseline levels of behaviours not targeted by screening, and participants’ demographic and health-related characteristics. Behavioural screening impacted on intervention effects in ways that were anticipated and positive, but also unexpected and detrimental. Physical activity screening (alone or in combination with diet) resulted in improved intervention effects for physical activity, while fruit and vegetable screening had no impact on intervention effects for these outcomes. All three types of screening impacted detrimentally on intervention effects for behaviours not being targeted by screening. Conclusions: Behavioural screening may have desirable and undesirable consequences in the context of multiple behaviour intervention trials, and thus its potential merits and pitfalls should be carefully considered.

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The impact of behavioural screening on intervention outcomes in a randomised, controlled multiple behaviour intervention trial

Corticosteroid withdrawal (CSWD) protocols to minimize the risk of cardiovascular events after kidney transplantation have been reported. However, most of them were within one year post-transplant, and the pathological survey after CSWD was poorly done. We conducted the present retrospective study to elucidate the usefulness and safety of late-steroid withdrawal more than one year after transplantation in kidney recipients with pathological evaluation. Twenty kidney recipients with stable graft function more than one year post-transplant, and whose corticosteroid (CS) was withdrawn were enrolled in this study. The change in their clinical parameters of graft function (sCr and uP/Cr), metabolic profiles, and histological graft status (Banff 97 scoring system) were studied pre- and post-CSWD, and compared with a control cohort taking continuous CS. The dose of CS was tapered gradually and has been maintained with the minimal dose of CS (1.25-5 mg of prednisone) by three months after transplant. CS was furthermore reduced thereafter, if graft function had been stable more than one year and a patient wanted CS to be withdrawn, then a graft biopsy was undertaken. CSWD was accomplished between 16 and 195 (median 41.5) months post-transplant, if there was no significant histological graft damage or on-going acute rejection. A repeat biopsy was carried out two to 21 months after CSWD. In contrast, the observation point of the control cohort was 24 to 49 (median 36.5) months after transplant, and the second biopsy was done five to 30 months after the initial biopsy. The control cohort took 2.5 to 5 (median 2.5) mg of prednisone daily. There were no significant alterations of graft function between pre- and post-CSWD (sCr: 1.14 ± 0.1 and 1.17 ± 0.1 mg/dL. respectively, p = 0.3299, uP/Cr: 0.12 ± 0.01 and 0.21 ± 0.06, respectively, p = 0.0574). The hypertension rate between both groups was not different between double biopsy points. In addition the rates of glucose intolerance and hyperlipidemia were comparable between two points in both cohorts. There was no significant change in the acute/active lesion scoring (2 tl and 3 il were only positive factors before CSWD and they all returned to t0 and i0 after CSWD). Moreover, chronic/sclerosing allograft nephropathy scorings were minimal and similar between pre- and post-CSWD compared with the control. CSWD for more than one year is safe for patients whose graft functions are stable with pathological confirmation; however, a longer follow-up study is warranted.

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Citations

Effect of Diet, Tobacco and Heredity on Lipid Metabolism and Hypertension

The impact of behavioural screening on intervention outcomes in a randomised, controlled multiple behaviour intervention trial

Late corticosteroid withdrawal can be safely performed for kidney recipients with stable graft function under pathological confirmation.

Diet and blood pressure elevation in children and adolescents.

Epidemiology of hypertension in children