Treatment/intervention studies

The Diabetes Control and Complications Trial (DCCT), the Stockholm Diabetes Intervention Study (DIS), the United Kingdom Prospective Diabetes Study (UKPDS), and the Japanese Kumamoto study show unequivocally that vigorous treatment of diabetes can decrease both the morbidity and mortality of the disease by reducing chronic complications. 

Sarti, E., Schantz, P.M., Avila, G., Ambrosio, J., Medina-Santillan, R. and Flisser, A. (2000) Mass treatment against human taeniasis for the control of cysticercosis a population-based intervention study. Transactions of the Royal Society of Tropical Medicine and Hygiene 94, 85-89. 

Perhaps the role of cognitive-behavioral treatments ought to be tested, as both depression and chronic pain tend to be responsive to cognitive and behavioral interventions. To our knowledge, very few, if any, treatments have studied the combined effects of pharmacotherapy and behavioral or physical therapies. Given the complex nature of FM, a multifactorial approach may be the most effective (40) and an important area to explore with more scientific rigor. 

Population-based studies examining the causes, incidence and persistence of sleep disturbances in AD patients are lacking consequently, little is known about the risk factors for their development. Therefore, one must look to the literature concerning sleep disturbance in the non-demented elderly and factor this with clinical assessment of individual AD patients to make informed inferences about the AD population in order to arrive at effective treatment interventions for individual patients [4],... 

There has been some success with vitamin A and its derivatives for treatment of certain types of cancer (Niles, 2000). However, the use of P-carotene as a therapeutic agent suffered a setback when the results from two of three large human intervention studies indicated that high doses of P-carotene caused an increased risk of lung cancer in smokers and subjects exposed to asbestos. This increased risk is thought to be due to metabolites associated with high doses of p-carotene in the presence of smoke (Russell, 2004). 

Intervention studies usually measure relative or absolute risk. Analysis can either be done on (1) intention to treat, which compares outcome on the subjects assigned to each groups regardless of whether they continued with the intervention strategy, or (2) randomized treatment, which measures the outcome observed in the subjects being treated. The preferred method is intention to treat, which avoids bias that can arise from different levels of participation due to loss of follow-up (the loss of contact with subjects) however, the true effects of the intervention may sometimes be diminished. 

Secondary intervention studies are few. A study in Japan [240(Ib)] identified infants at high risk of house dust mite allergy and asthma postnatally, on the basis of early manifestations of atopy (i.e. eczema and food allergy). Children were enrolled during the 1st year of life and randomised to house dust mite prevention which resulted in a substantial reduction in house dust mite allergen levels. At the 1-year follow-up, children in the active treatment group had lower levels of IgE antibody, prevalence of positive skin prick test responses to house dust mite, and lower incidence of wheezing episodes. Follow-up is awaited. 

In most studies, patients with rheumatoid arthritis have lower BMD and more fractures than do age-matched controls.Common disease pathways, inclnding proinflammatory cytokines and the OPG/RANK/RANKL system, may be responsible along with increased glucocorticoid use, hypogonadism, decreased activity, and increased fall risk. Patients taking glucocorticoids should be managed with calcium and vitamin D snpplementation plus a bisphosphonate. Otherwise, standard osteoporosis prevention and treatment interventions are recommended. 

Elevated serum cholesterol levels and in particular LDL-cholesterol levels are strongly associated with cardiovascular mortality across the spectrum of epidemiologic studies and pharmacologic intervention studies in primary and secondary prevention trials (Ligure 4.4). In the Cholesterol Treatment Trialists Collaborators meta-analysis of >90,000 patients studied in 14 randomized trials of statin therapy, a reduction in LDL cholesterol of 1 mmol/L (39 mg/dL) was associated with a 12% proportional reduction in all-cause mortality, predominantly driven by a 19% proportional reduction in cardiovascular mortality (45). Among patients with pre-existing heart disease there were 14 fewer deaths per 1000 participants per mmol LDL cholesterol reduction, as well as an approximately 25% reduction in major adverse cardiac events. 

Interventional approaches have an established role in the treatment of symptomatic patients with drug-refractory AF. Randomized trials will assess catheter ablation as first line therapy as an alternative to anti-arrhythmic drug therapy, with emphases on efficacy, safety, and survival (Table 6.1). The Radiofrequency Ablation versus Antiarrhythmic Drugs for Atrial Fibrillation Treatment (RAAFT) study is a multicenter, randomized trial designed to assess the efficacy and... 

Duckers, H.J., Verhaagen J., de Bruijn, E. and Gispen, W.H. (1994). Effective use of a neurotrophic ACTH 4-9 analog in the treatment of a peripheral demyelinating syndrome (experimental allergic neuritis). An intervention study. Brain 117 365-374. 

In an intervention study with schoolchildren 8—10 years old in Malawi, Furnee et al. (1997) examined the relationship of intestinal parasite treatment and oral iodized oil efficacy. Severely iodine-deficient schoolchildren with a single parasitic infestation, either A. lumbricoides (n = 44), hookworm (n = 42), or Entamoeba histolytica (n = 24), were randomly allocated to receive or not receive treatment before taking a 1ml oral supplement (490 mg Iodine) of iodized ethyl esters from poppyseed oil. After supplementation, urinary iodine concentrations were measured regularly, to define time intervals indicating moderate iodine deficiency before urinary iodine concentrations returned to 0.40 mmol/1. Treatment with metronidazole for E. histolytica increased the protection period from 2.0 to 21.0 weeks P < 0.05). For all untreated children, the duration effect was 9.2 weeks shorter P < 0.001) than for their treated peers (16.8 weeks). They concluded that, by interfering with absorption, intestinal parasitic infestations reduce the efficacy of oral supplementation with iodized ethyl esters (Table 52.8). 

In summary, there is a wide range of treatment interventions which aim to change the dysfunctional cognitions and behaviours associated with the patterns of over-commitment, which can lead to the individual becoming burned out. However, while these standard CBT interventions have been found to be helpful when the dysfunctional beliefs and behaviours associated with bum-out are flexible and of moderate severity, they have not been found to be effective with more extreme, rigid and inflexible beliefs and behavioural patterns. Unfortunately, the patterns of over-commitment described in this section are often chronic and entrenched. Where this is the case, the use of a more in-depth schema-focused approach to therapy is recommended (as outlined in Part 3 of this book). In particular, a schema-focused model of burnout and a case study illustrating the use of schema therapy to treat burnout can be found in Chapter 15. 

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