Abstract:
BACKGROUND:Despite convincing evidence that lowering blood pressure decreases cardiovascular morbidity and mortality, the hypertension burden remains high and control rates are poor in developing countries. OBJECTIVE:To assess the effectiveness of 2 community-based interventions on blood pressure in hypertensive adults. DESIGN:Cluster randomized, 2 x 2 factorial, controlled trial. (ClinicalTrials.gov registration number: NCT00327574) SETTING:12 randomly selected communities in Karachi, Pakistan. PATIENTS:1341 patients 40 years or older with hypertension (systolic blood pressure >or=140 mm Hg, diastolic blood pressure >or=90 mm Hg, or already receiving treatment). MEASUREMENTS:Reduction in systolic blood pressure from baseline to end of follow-up at 2 years. INTERVENTION:Family-based home health education (HHE) from lay health workers every 3 months and annual training of general practitioners (GPs) in hypertension management. RESULTS:The age, sex, and baseline blood pressure-adjusted decrease in systolic blood pressure was significantly greater in the HHE and GP group (10.8 mm Hg [95% CI, 8.9 to 12.8 mm Hg]) than in the GP-only, HHE-only, or no intervention groups (5.8 mm Hg [CI, 3.9 to 7.7 mm Hg] in each; P < 0.001). The interaction between the main effects of GP training and HHE on the primary outcome approached significance (interaction P = 0.004 in intention-to-treat analysis and P = 0.044 in per-protocol analysis). LIMITATIONS:Follow-up blood pressure measurements were missing for 22% of patients. No mechanism was detected by which interventions lowered blood pressure. CONCLUSION:Family-based HHE delivered by trained lay health workers, coupled with educating GPs on hypertension, can lead to significant blood pressure reductions among patients with hypertension in Pakistan. Both strategies in combination may be feasible for upscaling within the existing health care systems of Indo-Asian countries. PRIMARY FUNDING SOURCE:Wellcome Trust.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Jafar TH,Hatcher J,Poulter N,Islam M,Hashmi S,Qadri Z,Bux R,Khan A,Jafary FH,Hameed A,Khan A,Badruddin SH,Chaturvedi N,Hypertension Research Group.doi
10.7326/0003-4819-151-9-200911030-00004subject
Has Abstractpub_date
2009-11-03 00:00:00pages
593-601issue
9eissn
0003-4819issn
1539-3704pii
151/9/593journal_volume
151pub_type
杂志文章,随机对照试验abstract::Dietary deficiency of vitamin B-12 has been reported, yet most people ingesting vitamin-B12-deficient diets even for many years appear to achieve a balance that does not lead to overt signs and symptoms of deficiency. I present the case of a vegan of 25 years' duration who developed severe neurologic abnormalities due...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-88-5-647
更新日期:1978-05-01 00:00:00
abstract::Care of persons with non-insulin-dependent diabetes mellitus (NIDDM) in the United Kingdom resembles that in the United States. However, health care practice in Europe is being influenced by the Saint Vincent Declaration, the joint European World Health Organization-International Diabetes Federation initiative, which ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-124-1_part_2-199601011-00015
更新日期:1996-01-01 00:00:00
abstract::A national registry was begun in 1981 to collect data from 32 centers on patients diagnosed by uniform criteria as having primary pulmonary hypertension. Entered into the registry were 187 patients with a mean age (+/- SD) of 36 +/- 15 years (range, 1 to 81), and a female-to-male ratio of 1.7:1 overall. The mean inter...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-107-2-216
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abstract:BACKGROUND:Telaprevir (TVR) plus peginterferon-α2a (PEG-IFN-α2a) and ribavirin substantially increases treatment efficacy for genotype 1 chronic hepatitis C virus (HCV) infection versus PEG-IFN-α2a-ribavirin alone. Its safety and efficacy in patients with HCV and HIV-1 are unknown. OBJECTIVE:To assess the safety and e...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-159-2-201307160-00654
更新日期:2013-07-16 00:00:00
abstract:OBJECTIVE:To determine the following: a reference range for serum calcitriol during hypercalcemia in a control group of patients with myeloma in whom calcitriol production is known to be appropriately suppressed; the incidence of elevated serum calcitriol levels in hypercalcemic patients with non-Hodgkin lymphoma accor...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
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更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:Previous research has supported screening for gonorrhea and chlamydia in asymptomatic, sexually active women (including pregnant women) who are younger than 25 years or at increased risk but not in other patient populations. PURPOSE:To update the 2005 and 2007 systematic reviews for the U.S. Preventive Serv...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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更新日期:2014-12-16 00:00:00
abstract:OBJECTIVE:To assess the accuracy of Histoplasma capsulatum variety capsulatum polysaccharide antigen testing for the identification of histoplasmosis relapse in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN:A retrospective study using stored specimens. SETTING:A referral center and several priva...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-115-12-936
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abstract::Many investigations consider the presence of e antigen (HBeAg) valuable in predicting which patients with acute hepatitis B are at risk of remaining infected and developing chronic liver disease. We tested this hypothesis in a retrospective study of serial samples from patients undergoing long-term hemodialysis. We fo...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-3-310
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abstract:BACKGROUND:Pulmonary embolism is a common clinical disorder that is associated with high morbidity and mortality if untreated. It is important to confirm or rule out the diagnosis in patients with clinical suspicion of the disease. PURPOSE:To evaluate various diagnostic strategies for excluding pulmonary embolism. DA...
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pub_type: 杂志文章,评审
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更新日期:2003-06-17 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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abstract:OBJECTIVE:To determine the most effective and safe dose of enoxaparin to prevent deep venous thrombosis in high-risk surgical patients. DESIGN:A double-blind, randomized, multicenter clinical trial. SETTING:Private, university, and government hospitals in the United States. PATIENTS:572 patients having elective hip ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-121-2-199407150-00001
更新日期:1994-07-15 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:1988-06-01 00:00:00
abstract:OBJECTIVE:To determine whether low bone density and other risk factors for osteoporosis are associated with stress fractures in athletes. DESIGN:Case-control study. SETTING:Institutional sports injury clinic with primary and secondary care. PARTICIPANTS:Twenty-five athletes (nineteen women) with scintigraphically co...
journal_title:Annals of internal medicine
pub_type: 杂志文章
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abstract::Four hemodialysis patients receiving deferoxamine for metal overload had fatal rhinocerebral rhizopus infections. Serious fungal infections are not commonly seen in patients on dialysis, and none of these patients had the usual risk factors for rhizopus infection. Deferoxamine is being used with increased frequency in...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-107-5-678
更新日期:1987-11-01 00:00:00
abstract::Twenty-nine men with stage III or unresectable stage II malignant germ cell tumors and no previous chemotherapy received treatments with the VAB-6 protocol. The VAB-6 regimen is a 1-year program beginning with three successive inductions at 3-to-4-week intervals: day 1--cyclophosphamide, 600 mg/m of body surface area ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
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abstract:Description:Recommendation on screening for urinary incontinence in women by the Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives. The WPSI's recommendations are intended to guide clinical practice and coverage of services for t...
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pub_type: 杂志文章,实务指引
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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abstract::Aspects of phosphate biochemistry pertinent to therapy, the distribution of phosphorus in body compartments, therapeutic phosphorus preparations, prevention of hypophosphatemia, therapeutic guidelines, and side-effects of phosphorus therapy are reviewed. Severe hypophosphatemia (less than 0.32 mmol/litre or less than ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:1979-04-01 00:00:00
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Annals of internal medicine
pub_type: 指南,杂志文章,实务指引,评审
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更新日期:1989-07-15 00:00:00
abstract:BACKGROUND:Elevated blood pressure (BP) is the largest contributing risk factor to all-cause and cardiovascular mortality. PURPOSE:To update a systematic review on the benefits and harms of screening for high BP in adults and to summarize evidence on rescreening intervals and diagnostic and predictive accuracy of diff...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:1996-06-15 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:1979-03-01 00:00:00