Arch Intern Med
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Randomized Controlled Trial Multicenter Study
Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial.
Despite the richness in antioxidants of the Mediterranean diet, to our knowledge, no randomized controlled trials have assessed its effect on in vivo lipoprotein oxidation. ⋯ Individuals at high cardiovascular risk who improved their diet toward a TMD pattern showed significant reductions in cellular lipid levels and LDL oxidation. Results provide further evidence to recommend the TMD as a useful tool against risk factors for CHD. Trial Registration isrctn.org Identifier: ISRCTN35739639.
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Randomized Controlled Trial
Simultaneous vs sequential counseling for multiple behavior change.
Many patients in primary care settings present with multiple behavioral risk factors for cardiovascular disease. Research has provided little information on the most effective ways to approach multiple behavior change counseling in clinical settings. ⋯ Long-term multiple behavior change is difficult in primary care. This study provides strong evidence that addressing multiple behaviors sequentially is not superior to, and may be inferior to, a simultaneous approach.
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Two guidelines addressing palliative sedation have been published in the Netherlands in 2002 and 2003. The objective of the present study is to determine adherence to the guidelines for palliative sedation with regard to prescription. The study is restricted to the practice of continuous deep palliative sedation. ⋯ The rate of 43% noncompliance to the guidelines was mostly owing to the omission of continued antipsychotic treatment for delirium and the use of morphine as the single therapy for the purpose of deep sedation. Future efforts, like better use and knowledge of the guidelines and a larger involvement of consultation teams, should increase adherence to the guidelines.
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The reasons for racial differences in health care are not well known, but the characteristics of hospitals where people receive care may be an important factor in the quality of care that patients receive. Therefore, we sought to determine the proportion and volume of elderly black vs white patients treated at hospitals and examine the characteristics and performances of hospitals that care for disproportionately high volumes of black patients. ⋯ Hospital care for black patients in the United States is remarkably concentrated in a small percentage of hospitals, although the hospitals that care for a high proportion of black patients have only marginally worse quality of care than those that care for a low proportion of black patients. The level of concentration of black patients provides a fresh opportunity to improve care for black patients by targeting efforts toward a small group of hospitals.
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Cross-sectional studies find an elevated prevalence of depression among subjects with diabetes mellitus (DM). The causal mechanisms and temporal sequence of this association have not been clearly delineated. This study investigated the prospective relationship between DM and depressive symptoms. ⋯ Among well-functioning older adults, DM is associated with increased risk of depressive symptoms.