Antiarrhythmic agents have modest efficacy in preventing atrial fibrillation (AF) recurrence. Although retrospective analyses have suggested a preventive effect of inhibitors of the renin-angiotensin system (RAS) on AF development in patients with congestive heart failure or hypertension, the value of these agents has not been evaluated in patients with AF but without a high prevalence of hypertension or heart failure.
A retrospective analysis of the Canadian Trial of Atrial Fibrillation (CTAF) was conducted. CTAF demonstrated the superiority of amiodarone (A) over sotalol or propafenone (SP) in maintaining sinus rhythm in patients with AF. Of the 403 patients randomly assigned in CTAF, 11.7% of the A group and 12.7% of the SP group were receiving a RAS inhibitor at baseline. By multivariate analysis (including all the risk factors known to be associated with AF available in the database), the use of RAS blockers in addition to antiarrhythmic agents was not associated with additional benefit against AF development. There was a recurrence of AF in 59 patients (38.3%) and 14 patients (29.8%) of groups A and A-RAS, respectively, while 93 patients (61.6%) and 32 patients (62.8%) of the SP and SP-RAS groups, respectively, experienced recurrent AF.
Blocking the RAS did not provide additional benefit against AF recurrence in CTAF patients treated with an antiarrhythmic drug. These results underscore the need for randomized clinical trials to clearly define the role of RAS inhibitors in treating AF.
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Little is known about whether the accuracy of tools for assessment of sexual offender recidivism risk holds across ethnic minority offenders. I investigated the predictive validity across ethnicity for the RRASOR and the Static-99 actuarial risk assessment procedures in a national cohort of all adult male sex offenders released from prison in Sweden 1993-1997. Subjects ordered out of Sweden upon release from prison were excluded and remaining subjects (N = 1303) divided into three subgroups based on citizenship. Eighty-three percent of the subjects were of Nordic ethnicity, and non-Nordic citizens were either of non-Nordic European (n = 49, hereafter called European) or African Asian descent (n = 128). The two tools were equally accurate among Nordic and European sexual offenders for the prediction of any sexual and any violent nonsexual recidivism. In contrast, neither measure could differentiate African Asian sexual or violent recidivists from nonrecidivists. Compared to European offenders, AfricanAsian offenders had more often sexually victimized a nonrelative or stranger, had higher Static-99 scores, were younger, more often single, and more often homeless. The results require replication, but suggest that the promising predictive validity seen with some risk assessment tools may not generalize across offender ethnicity or migration status. More speculatively, different risk factors or causal chains might be involved in the development or persistence of offending among minority or immigrant sexual abusers.
Département des Sciences de santé Communautaire, Service de Toxicomanie, Université de Sherbrooke, Campus de Longueuil, 1111, rue St-Charles Ouest, Tour Ouest, Bureau 500, Longueuil, QC, Canada J4K 5G4. email@example.com
The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.
Predictors for repetition of suicide attempts were evaluated among 92 adolescent suicide attempters 9 years after an index suicide attempt (90% females). Five were dead, two by suicide. Thirty-one (42%) of 73 had repeated a suicide attempt. In multiple Cox regression analysis, four factors had an independent predictive effect: comorbid disorders, hopelessness, having ever received treatment for mental or behavior problems, and having a father exerting control without affection. Prediction on an individual level was difficult. Since almost half repeated a suicidal act, the best strategy is to evaluate all adolescent suicide attempters thoroughly and provide treatment as needed.
This paper is a report of a study to investigate the stability of self-reported eating disorder symptoms, factors associated with them and the predictors of their recurrence.
In western cultures, eating-related problems during adolescence are common but usually temporary. However, in approximately 10% of cases disordered eating is sustained, increasing the risk of a full-blown eating disorder. To distinguish adolescents with temporary eating problems from those whose problems are likely to continue, healthcare providers need to understand the progress of disordered eating and the features of high-risk adolescents.
The two-stage prospective survey was conducted with a school-based sample of adolescents aged 15-17 years. At baseline, in 2003-2004, the SCOFF ('Sick', 'Control', 'One', 'Fat' and 'Food') questionnaire was administered to students in the 9th year of schooling in Finland. Follow-up assessment took place 1 year later, and 372 students provided data at both assessments. Binary logistic regression analysis was performed to investigate which factors predict the recurrence of eating disorder symptoms, defined as the occurrence of eating disorder symptoms at both assessments.
Five per cent of the students reported eating disorder symptoms at both assessments. Typically, they had multiple psychological problems and health complaints. Anxiety perceived earlier in adolescence resulted in an estimated odds ratio of the logistic model of 20 for the recurrence of eating disorder symptoms.
Earlier anxiety rather than dissatisfaction with appearance had a statistically significant effect on the progress of eating problems. Longitudinal research is needed to confirm the results. Until further knowledge is available, nurses should follow-up all adolescents with disordered eating to identify a possible need for intervention.
To test the hypothesis that a statin could reduce the recurrence rate of atrial fibrillation after electrical cardioversion (EC), we performed an open, controlled multicenter study. Patients (n = 114) who had atrial fibrillation >48 hours and who were scheduled for EC were randomized to receive 40 mg of pravastatin once daily for 3 weeks before and 6 weeks after EC or no drug in addition to standard therapy. Pravastatin did not reduce the recurrence rate of atrial fibrillation after EC.
OBJECTIVE: The aim of this study was to explore changes in health as reported by cystitis-prone females after having received prophylactic acupuncture treatment for recurrent cystitis. DESIGN: A qualitative study based on written free text answers on the women's own experience of changes related to health after completion of TCM acupuncture treatment. Data were analyzed using Giorgi's phenomenological approach. SETTING: Subjects living in the Bergen area, Norway, were recruited by advertisement in local newspapers and included provided they had had three or more episodes of lower UTI during the previous 12 months. RESULTS: The main topics reported were related to improved pressure during micturition and more complete bladder emptying; more normal bowel movement and less abdominal discomfort; more energy, reduced stress level, and better sleep. Only a few reported feeling worse. CONCLUSION: The symptoms described as relieved by the women in our study seem to fit TCM theory for diagnoses of their vulnerability to cystitis. Qualitative methods have a role in TCM research that may enrich our knowledge in other ways than traditional quantitative methods may.