A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee. Improving self-care among older patients with type II diabetes: the "Sixty Something..." Study. The effects of patient characteristics and beliefs on responses to behavioral interventions for control of chronic diseases. Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Superiority of nonpharmacologic therapy compared to propranolol and placebo in men with mild hypertension: a randomized, prospective trial. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity. Impact of the fit and strong intervention on older adults with osteoarthritis. Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2x2 factorial design. A comparison of lay-taught and professional-taught arthritis self-management courses. The New Zealand Diabetes Passport Study: a randomized controlled trial of the impact of a diabetes passport on risk factors for diabetes-related complications. A pilot study of health education via a nurse-run telephone self-management programme for elderly people with osteoarthritis What is the magnitude of blood pressure response to a programme of moderate intensity exercise? Randomised controlled trial among sedentary adults with unmedicated hypertension. Randomised equivalence trial comparing three month and six month follow up of patients with hypertension by family practitioners Establishment of blood glucose monitoring system using the internet. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. A randomized controlled study of the Arthritis Self-Management Programme in the UK. Influence of Small-Group Education Sessions on Glucose Homeostasis in NIDDM Outcomes of self-help education for patients with arthritis. Impact of Intensive Educational Approach to Dietary Change in NIDDM A Controlled Trial on the Effects of Patient Education in the Treatment of Insulin-dependent Diabetes A reexamination of the effectiveness of self-care education for persons with arthritis. Long-term effects of self-management education for patients with Type 2 diabetes taking maximal oral hypoglycaemic therapy: a randomized trial in primary care. Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic. Relaxation training. Blood pressure lowering during the working day. Evaluation of a structured treatment and teaching programme on hypertension in general practice. Impact of computer-generated personalized goals on HbA(1c). Evaluation of a Pharmaceutical Care Model on Diabetes Management Relaxation therapy and high blood pressure. Usefulness of a systemic hypertension in-hospital educational program. Psychological treatment of essential hypertension: A controlled comparison of meditation and meditation plus biofeedback Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. Utilizing a 24-Hour Dietary Recall and Culturally Specific Diabetes Education in Mexican Americans With Diabetes Management of Obese Patients With Diabetes Mellitus: Comparison of Advice Education With Group Management Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. Problem oriented participatory education in the guidance of adults with non-insulin-treated type-II diabetes mellitus. Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diagnosed non-insulin-dependent diabetes mellitus. Association of Hemoglobin A1c with Cardiovascular Disease and Mortality in Adults: The European Prospective Investigation into Cancer in Norfolk Effects of education and relaxation training with essential hypertension patients. Adherence to diabetes control recommendations: impact of nurse telephone calls. Anxiety management training in the treatment of essential hypertension.
Abstract OBJECTIVE : To examine the impact of a nurse-coordinated intervention delivered to patients with non-insulin-dependent diabetes mellitus between office visits to primary care physicians . DESIGN : R and omized , controlled trial . SETTING : Veterans Affairs general medical clinic . PATIENTS : 275 veterans who had NIDDM and were receiving primary care from general internists . INTERVENTION : Nurse-initiated contacts were made by telephone at least monthly to provide patient education ( with special emphasis on regimens and significant signs and symptoms of hyperglycemia and hypoglycemia ) , reinforce compliance with regimens , monitor patients ’ health status , facilitate resolution of identified problems , and facilitate access to primary care . MEASUREMENTS : Glycemic control was assessed using glycosylated hemoglobin ( GHb ) and fasting blood sugar ( FBS ) levels . Health-related quality of life ( HRQOL ) was measured with the Medical Outcomes Study SF-36 , and diabetes-related symptoms were assessed using patients ’ self-reports of signs and symptoms of hyper- and hypoglycemia during the previous month . MAIN RESULTS : At one year , between-group differences favored intervention patients for FBS ( 174.1 mg/dL vs 193.1 mg/dL , p=0.011 ) and GHb ( 10.5 % vs 11.1 % , p=0.046 ) . Statistically significant differences were not observed for either SF-36 scores ( p=0.66 ) or diabetes-related symptoms ( p=0.23 ) . CONCLUSIONS : The intervention , design ed to be a pragmatic , low-intensity adjunct to care delivered by physicians , modestly improved glycemic control but not HRQOL or diabetes-related symptoms Osteoarthritis ( OA ) is a common and often disabling condition that predominately affects older adults . It is the commonest cause of locomotor disability and forms a major element of the workload in primary care . Previous studies suggest that there are both deficits in the knowledge patients have about their disease and extensive ' unmet ' information needs . This paper explores the patients ' perspective on the meaning and significance of living with arthritis , identified through quantitative and qualitative approaches undertaken during a trial that evaluated the effectiveness of a primary care-based patient education programme . This paper draws on qualitative and quantitative data from : the baseline interview ( knowledge of arthritis , satisfaction with services and support received in primary care ) ; patient diaries ( individual goals and reflections on treatment ) ; and group teaching sessions ( themes describing the patient 's experience ) . The different data sources were interrogated for common and divergent themes . One hundred and ninety-four participants were identified and 170 completed baseline interviews . Participants were predominantly female ( 73 % ) , with a mean age of 63 and arthritis of long-st and ing ; 55 % reported that they had had it for 5 years or more .  Use of primary care services was high , with 41 % consulting their GP in the 2 weeks before interview . Levels of information were low , with less than 25 % receiving support/advice about the disease , pain management or its impact upon daily life . Set against negative perceptions of the quality of services , patients ' personal priorities were for improved pain management and enhanced mobility/functional ability . The combined quantitative and qualitative data provide insight into the patients ' perspective on the causes and impact of knee OA , individual goals desired from treatment and the quality of care . There is consistent evidence of unmet needs for information and support and the priority placed by patients on finding strategies to cope with OA and maintaining independence . Even within a tightly defined study sample participating in the intervention , a diversity of experience and goals were revealed , which highlights the importance of taking account of context ual factors and individual differences when evaluating complex interventions A 10-session , self-management training program was design ed specifically for persons over 60 years of age having Type II diabetes . It targeted social learning variables , especially problem-solving skills and self-efficacy , found to be related to diabetes self-care in earlier correlational research . One hundred two adults were r and omized to immediate or delayed intervention conditions . At posttest , subjects in the immediate intervention condition showed significantly greater reductions in caloric intake and percent of calories from fat than control subjects . The intervention also produced greater weight reductions and increases in the frequency of glucose testing than did the control condition . Improvements among immediate intervention subjects were generally maintained at a 6-month follow-up . Intervention results from subjects receiving delayed intervention closely replicated those for immediate intervention subjects . We conclude that a relatively short-term program can improve self-management skills of older diabetic adults , and that there is an important need for such interventions Tests of behavioral interventions seldom examine changes in health beliefs and behaviors thought to be prerequisites of improved outcome health states and they do not attempt to specify how patient characteristics or pretest measures influence responses to the intervention . In this study an experimental nursing intervention , its impact on hypertensive patients ' beliefs about their disease , efficacy of medications and diet , as well as blood pressure and weight are described . Among patients from the experimental group , the ability of selected pretest variables to predict clinical outcomes and changes in clinical health states was evaluated . The intervention was successful in lowering diastolic blood pressure and altering certain beliefs held by the patients . The pretest characteristics were not successful in explaining hypertensive patients ' responses to the intervention . Explanations for this are pursued through remarks from the content analysis of the intervention protocol . From these observations , the original health belief model was revised . The discussion concludes with a set of research questions that may prove promising for future research OBJECTIVE Studies have suggested that the Arthritis Self-Management Program ( ASMP ) course is effective at reducing arthritis pain and health care costs  in volunteer participants . There have been no reports of trials of the ASMP in the context of primary care physicians ' practice s , where the potential for spreading the program may be greatest . We conducted a r and omized controlled trial of the ASMP course in a large primary care physician network . METHODS Patients with osteoarthritis , rheumatoid arthritis , or fibromyalgia were recruited for the study . Subjects in the intervention practice s received the 6 week course and those in the control practice s received only the ASMP book , without course .  Disability , pain , self-efficacy , mental health , and satisfaction were measured using vali date d instruments at baseline and at 4 months . RESULTS One hundred thirteen patients were recruited for the ASMP course  ( intervention ) and completed baseline and 4 month followup question naires . Eighty-four percent completed at least 4 of 6 classes . Seventy-four patients received the ASMP manual ( controls ) and completed both question naires . Patients in the intervention and control groups had similar baseline pain ( p = 0.94 ) , self-efficacy to control pain ( p = 0.90 ) , mental health ( p = 0.10 ) , and vitality scores ( p = 0.21 ) , but those in the intervention arm had slightly less disability ( p = 0.04 ) . At 4 months , there was no significant improvement from baseline in any endpoint and no difference between patients in the intervention and control groups ( all p > 0.2 ) . Patient satisfaction with arthritis care and outcomes was no different for intervention and control patients ( all p > 0.3 ) . All types of health care re source use were similar at baseline and followup for both intervention and control groups ( all p > 0.2 ) . CONCLUSION While the ASMP course has been found to be effective in other patient groups , there were no significant clinical benefits noted at 4 months in patients recruited from primary care practice OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization We compared the effects of nonpharmacologic therapy , propranolol monotherapy , and placebo on blood pressure , metabolic , exercise , and quality of life variables in a 12-week , r and omized , placebo-controlled trial of 79 male patients with hypertension . A significant reduction in diastolic blood pressure was observed with both nondrug therapy ( -8.0 + /- 1.08 mm Hg ) and propranolol ( -9.5 + /- 1.46 mm Hg ) compared to placebo ( -0.1 + /- 2.01 mm Hg ) . However , only patients receiving nonpharmacologic therapy showed a reduced body mass index , lower total and low-density lipoprotein serum cholesterol levels , and increased exercise tolerance compared to both propranolol and placebo . Patients receiving propranolol felt less anxious and unsure but showed a significant decrement in nocturnal penile tumescence compared to both placebo and nondrug therapy . Patients receiving nondrug therapy felt more energetic and reported improved sexual arousal and greater sexual satisfaction after treatment . Reductions in blood pressure in the nondrug treatment group were related to both weight reduction and improved fitness . We conclude that nondrug therapy is effective in controlling blood pressure in men with mild hypertension and is associated with improvements in weight , lipoprotein levels , and exercise tolerance compared to both propranolol and placebo .  Quality of life assessment s further support the use of nondrug therapy in this context OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone OBJECTIVE To determine whether a culturally appropriate clinic- and community-based intervention for African-American women with type 2 diabetes will increase  moderate-intensity physical activity ( PA ) . RESEARCH DESIGN AND METHODS In this r and omized controlled trial conducted at seven practice s in central North Carolina , 200 African-American women , > or = 40 years of age with type 2 diabetes , were r and omized to one of three treatment conditions : clinic and community ( group A ) , clinic only ( group B ) , or minimal intervention ( group C ) . The clinic-based intervention ( groups A and B ) consisted of four monthly visits with a nutritionist who provided counseling to enhance PA and dietary intake that was tailored to baseline practice s and attitudes ; the community-based intervention ( group A ) consisted of three group sessions and 12 monthly phone calls from a peer counselor and was design ed to provide social support and reinforce behavior change goals ; and the minimal intervention ( group C ) consisted of educational pamphlets mailed to participants . The primary study outcome was the comparison of PA levels between groups assessed at 6 and 12 months by accelerometer , which was worn while awake for 7 days . RESULTS Totals of 175 ( 88 % ) and 167 ( 84 % ) participants completed PA assessment at 6 and 12 months , respectively . For comparison of PA , the P value for overall group effect was 0.014 . Comparing group A with C , the difference in the average adjusted mean for PA was 44.1 kcal/day ( 95 % CI 13.1 - 75.1 , P = 0.0055 ) . Comparing group B with C , the difference in the average adjusted mean was 33.1 kcal/day ( 95 % CI 3.3 - 62.8 , P = 0.029 ) . The intervention was acceptable to participants : 88 % were very satisfied with clinic-based counseling to enhance PA , and 86 % indicated that the peer counselor 's role in the program was important . CONCLUSIONS The intervention was associated with a modest enhancement of PA and was acceptable to participants PURPOSE This study assessed the impact of a low cost , multicomponent physical activity intervention for older adults with lower extremity osteoarthritis . DESIGN AND METHODS A r and omized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence  ( n = 80 ) to a  wait list control group ( n = 70 ) . Assessment s were conducted at baseline and at 2 and 6 months following r and omization . The training program consisted of range of motion , resistance training , aerobic walking , and education-group problem solving regarding self-efficacy for exercise and exercise adherence . All training group participants developed individualized plans for posttraining adherence . RESULTS Relative to the persons in the control group , individuals who participated in the exercise program experienced a statistically significant improvement in exercise efficacy , a 48.5 % increase in exercise adherence , and a 13.3 % increase in 6-min distance walk that were accompanied by significant decreases in lower extremity stiffness at 2 and 6 months . Program participants also experienced a significant decrease in lower extremity pain and a borderline significant improvement in efficacy to adhere to exercise over time at 6 months ( p = .052 ) . In contrast , persons in the control group deteriorated over time on the efficacy and adherence measures and showed no change on the other measures . No adverse health effects were encountered . IMPLICATION S These benefits indicate that this low-cost intervention may hold great promise as one of a growing number of public health intervention strategies for older adults in the United States with osteoarthritis BACKGROUND Diary recording of pain and disabling activities in osteoarthritis ( OA ) is widely recommended , but , to our knowledge , its impact on symptoms has not been investigated . Exercise programmes have been shown to be effective when patients are closely supervised by nurses or physiotherapists ; however , data are lacking on the efficacy of an unsupervised home based exercise regimen in patients with OA . OBJECTIVES To evaluate the clinical efficacy of patient administered assessment tools and an unsupervised home based exercise programme alone or in combination in patients with OA . METHODS The study was a 24 week , open cluster r and omised controlled trial with a factorial design . Rheumatologists ( n = 867 ) were assigned to four groups according to the treatment given : st and ardised tools ( ST ; n = 220 ) , exercises ( EX ; n = 213 ) , both tools and exercises ( ST+EX ; n = 213 ) , or usual care ( n = 221 ) . Each rheumatologist was to enroll four patients who met the American College of Rheumatology criteria for OA ( three with knee OA , one with hip OA ) . " Tools " consisted of weekly recording of pain and disabling activities in a diary . A home based exercise programme was performed daily at least four times per week with the aid of videotape and booklet . In addition to exercise and assessment , all patients received 12.5 mg or 25 mg of the non-steroidal anti-inflammatory drug rofecoxib once daily . Outcome variables were : pain ( measured on a visual analogue scale , 0 - 100 ) ; Western Ontario and McMaster Universities Osteoarthritis Index , function subscale ( 0 - 100 ) ; and patient assessment of the quality of care ( 0 - 100 ) . RESULTS Overall , 2957 patients with OA ( 2216 knee , 741 hip ) were included . After 24 weeks , both pain and function improved in the ST , EX , ST+EX , and usual care groups ( mean ( SD ) -17 ( 27 ) , -20 ( 29 ) , -15 ( 27 ) , -19 ( 29 ) ; and -11 ( 19 ) , -12 ( 19 ) , -10 ( 19 ) , -11 ( 20 ) , respectively ) , without significant differences between groups . However , patients in the EX and ST+EX groups were more likely to agree that their rheumatologist had done his best to preserve their functional and physical activities . CONCLUSION Although patients ' assessment s favoured the exercise programme , results from this study failed to demonstrate a short term symptomatic effect of the two non-pharmacological treatments ( weekly recording of condition and exercise ) in patients with OA concurrently receiving nonsteroidal anti-inflammatory drugs One hundred subjects with arthritis were r and omized into lay-taught , or professional-taught 12-h arthritis self-management courses , or a control group .  Outcomes , knowledge , exercise , relaxation , disability , pain , and number of physician visits were measured aat baseline and 4 months . Professional-taught groups demonstrated greater knowledge gain while lay-taught groups had greater changes in relaxation ( p less than .01 ) and a tendency toward less disability . Although it is impossible to draw definitive conclusions , this study suggests that lay leaders can teach arthritis self-management courses with results similar to those achieved by professionals AIMS To assess the efficacy ( change in HbA1c ) of a patient-held communication , self-empowerment and educational device for people with diabetes  ( the New Zeal and Diabetes Passport ) in patients with poor glycaemic control . RESEARCH DESIGN AND METHODS A 12-month , multicentre , general practice -based r and omized controlled trial in urban , provincial and rural New Zeal and involving 398 people with poorly controlled Type 1 or Type 2 diabetes . The intervention included a specifically design ed and piloted New Zeal and Diabetes Passport including information relating to diabetes knowledge , self- assessment s , and guidance concerning how to engage with diabetes health professionals . The primary end point was change in HbA1c . Assessment s were made at 0 , 6 and 12 months . RESULTS Two hundred and twenty-two patients received the Passport , 176 the control booklet , coming from 69 and 66 general practitioners , respectively . Use of the Passport was associated with a relative reduction in HbA1c of 0.4 % ( P = 0.017 ) and a relative increase in weight of 1.0 kg/m2 ( P = 0.028 ) , but no changes in diabetes knowledge , attitudes to diabetes or risk factors for diabetic tissue damage . CONCLUSIONS The dissemination of the New Zeal and Diabetes Passport , in isolation , was not associated with improvements in either diabetes knowledge or self-empowerment . While a small improvement in glycaemic control occurred , this was probably due to changes in insulin therapy in the intervention group . It is possible that linking the use of the Passport with other behavioural and educational interventions may make the Passport more useful . Further study is required to confirm the effect of such multifaceted interventions We conducted a pilot study of a nurse-run telephone self-management programme for elderly people with osteoarthritis ( OA ) . Thirty-two subjects , aged 60 years or more , with a diagnosis of OA were recruited from two hospital rheumatology clinics and were r and omized to a control or intervention group . The intervention group received six weekly mailings of OA health education modules , a relaxation audio-tape and six weekly 45 min follow-up telephone self-management sessions . There was a 100 % compliance rate in the intervention group , and all subjects completed baseline and three-month interviews ; one subject in each group was lost to six-month follow-up . There were no significant differences in self-management between the control and intervention groups . However , at three months there were improvements in the intervention group ( relative to baseline ) on some outcome measures . The results suggest that the telephone may be a useful tool for reinforcing health-promoting activities for patients BACKGROUND Current guidelines for the management of hypertension recommend regular , moderate intensity aerobic exercise such as brisk walking as a means of blood pressure reduction . However , there is a lack of consistent evidence regarding the magnitude of blood pressure response to such a prescription . In particular , no well design ed studies have investigated the efficacy of a programme of exercise meeting current guidelines . AIM To investigate the effect of a six-week programme of moderate intensity exercise on daytime ambulatory blood pressure ( 10.00 am to 10.00 pm ) among unmedicated , sedentary adults aged 25 years to 63 years with office blood pressure of 150 mmHg to 180 mmHg systolic and /or 91 mmHg to 110 mmHg diastolic . METHOD R and omised controlled trial of participants carrying out 30 minutes of moderate intensity exercise ( brisk walking or equivalent ) five days per week for six weeks compared with controls who maintained existing levels of physical activity . RESULTS Compliance with the exercise programme was high . The reduction in mean daytime ambulatory blood pressure between baseline and six-week follow-up was greater in the intervention group than in the control group for both systolic and diastolic blood pressure . However , this net hypotensive effect was not statistically significant ( systolic = -3.4 mmHg , 95 % CI = -7.4 to 0.6 ; diastolic = -2.8 mmHg , 95 % CI = -5.8 to 0.2 ) . Adjusting for baseline differences in mean ambulatory blood pressure in an analysis of covariance led to a reduction in the estimated magnitude of the effect ( systolic = -1.9 mmHg , 95 % CI = -5.4 to 1.7 , P = 0.31 ; diastolic = -2.2 mmHg , 95 % CI = -4.9 to 0.5 , P = 0.11 ) . CONCLUSION Despite high compliance with the exercise programme , the magnitude of the hypotensive effect of moderate intensity exercise was not as great as that found in studies of higher intensity exercise among hypertensives . Expectations of general practitioners and patients that a programme of moderate intensity exercise will lead to a clinical ly important reduction in the individual 's blood pressure are unlikely to be realised Abstract Objective To compare blood pressure control , satisfaction , and adherence to drug treatment in patients with treated hypertension followed up by their family physicians either every three months or every six months for three years . Design R and omised equivalence clinical trial . Setting s 50 family practice s in south eastern Ontario , Canada . Participants 609 patients aged 30 - 74 years with essential hypertension receiving drug treatment whose hypertension had been controlled for at least three months before entry into the study . Results 302 patients were r and omly assigned to follow up every three months and 307 to follow up every six months . Baseline variables in the two groups were similar . As expected , patients in the six month group had significantly fewer visits , but patients in both groups visited their doctor more frequently than their assigned interval . Mean blood pressure was similar in the groups , as was control of hypertension . Patient satisfaction and adherence to treatment were similar in the groups . About 20 % of patients in each group had blood pressures that were out of control during the study . Conclusions Follow up of patients with treated essential hypertension every six months is equivalent to follow up every three months . Patient satisfaction and adherence to treatment are the same for these follow up intervals . As about 20 % of patients ' hypertension was out of control at any time during the study in both groups , the frequency of follow up may not the most important factor in the control of patients ' hypertensionby family practitioners OBJECTIVE The Internet is used worldwide as a communication tool . To improve the quality of diabetes control , we investigated the effectiveness of an Internet-based blood glucose monitoring system ( IBGMS ) on controlling the changes in HbA(1c ) levels . RESEARCH DESIGN AND METHODS We conducted a r and omized clinical trial involving 110 patients who visited the outpatient clinic at the Kangnam St. Mary 's Hospital for 3 months . The study subjects were treated with IBGMS for 12 weeks , and the control group received the usual outpatient management over the same period .  HbA(1c ) and other laboratory tests were performed twice , once at the beginning of the study and again at the end of the study . RESULTS The test results from the beginning of the study established that there were no significant differences between the two groups with respect to age , sex , diabetes duration , BMI , blood pressure , HbA(1c ) , and other laboratory data . On follow-up examination 12 weeks later , HbA(1c ) levels were significantly decreased from 7.59 to 6.94 % within the intervention group ( P < 0.001 ) . At the end of the study , HbA(1c ) levels in the intervention group were significantly lower than in the control group after adjusting the baseline HbA(1c ) ( 6.94 vs. 7.62 % ; P < 0.001 , respectively ) . Among patients with baseline HbA(1c ) < 7.0 % , the patients in the intervention group had lower HbA(1c ) than those in the control group ( 6.38 vs. 6.99 % ; P < 0.05 ) . Among the patients with a baseline HbA(1c ) > or = 7.0 % , the difference between the two groups appeared more obvious : HbA(1c ) levels at the end of the study were 8.12 % . CONCLUSIONS This new IBGMS result ed in a significant reduction of HbA(1c ) during the study period . We propose that this IBGMS be used as a method for improving diabetes control OBJECTIVE To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes . RESEARCH DESIGN AND METHODS A prospect i ve , r and omized , repeated measures study was conducted on the Texas-Mexico border in Starr County . A total of 256 r and omly selected individuals with type 2 diabetes between 35 and 70 years of age , diagnosed with type 2 diabetes after 35 years of age , and accompanied by a family member or friend were included . The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses , dietitians , and community workers . The intervention involved 3 months of weekly instructional sessions on nutrition , self-monitoring of blood glucose , exercise , and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes . The approach was culturally competent in terms of language , diet , social emphasis , family participation , and incorporation of cultural health beliefs . Outcomes included indicators of metabolic control ( HbA(1c ) and fasting blood glucose ) , diabetes knowledge , and diabetes-related health beliefs . RESULTS Experimental groups showed significantly lower levels of HbA(1c ) and fasting blood glucose at 6 and 12 months and higher diabetes knowledge scores . At 6 months , the mean HbA(1c ) of the experimental subjects was 1.4 % below the mean of the control group ; however , the mean level of the experimental subjects was still high ( > 10 % ) . CONCLUSIONS This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans , particularly for those individuals with HbA(1c ) levels > 10 % The objective of this study was to determine whether the Arthritis Self-Management Programme ( ASMP ) improves perceptions of control , health behaviours and health status , and changes use of health care re sources . The design was a pragmatic r and omized controlled study ; participants were allocated to ASMP ( Intervention Group ) or a 4-month waiting-list Control Group . The Intervention Group completed a 12-month follow-up . In total , 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group . Main outcome measures included : arthritis self-efficacy , health behaviours ( exercise , cognitive symptom management , diet and relaxation ) and health status ( pain , fatigue , anxiety , depression and positive affect ) . At 4 months follow-up , the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales . Performance of a range of health behaviours ( cognitive symptom management , communication with physicians , dietary habit , exercise and relaxation ) was significantly greater among the Intervention Group . The Intervention Group were significantly less depressed and had greater positive mood . In addition , trends towards decreases on fatigue and anxiety were noted . Physical functioning , pain and GP visits remained stable at 4 months . A similar pattern of findings was found at 12 months follow-up for the Intervention Group . Furthermore , a significant improvement was found on pain and visits to GPs had decreased . Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months , all effects were independent of the type of arthritis . The findings suggest that the ASMP is effective in promoting improvements in perception of control , health behaviours and health status , when delivered in UK setting In patients with non-insulin-dependent diabetes mellitus ( NIDDM ) , the influence of knowledge about their disease on the treatment and control of the disease is not clear . We evaluated the efficacy of educational group meetings with NIDDM patients on improving their knowledge of the disease and on disease management .  Fifty-one NIDDM patients were r and omly assigned to either intervention or control groups . The intervention group participated in courses of three weekly lessons presented by a physician , nurse , and dietitian once every 4 mo . The intervention and control groups were also followed once every 2 mo in the clinic by the same staff . Medical treatment remained unchanged during the study . After a 12-mo follow-up of the intervention group , no significant improvement in their knowledge of diabetes could be demonstrated . However , mean fasting and postpr and ial blood glucose levels and HbA1c improved significantly in comparison with the control goup . The same tendency was evident with the weight and lipoprotein profile . We conclude that educational group therapy can improve diabetes control in patients with NIDDM Behavioral and health status outcomes of an unreinforced , self-help education program for arthritis patients taught by lay persons were examined in 2 ways : a 4-month r and omized experiment and a 20-month longitudinal study . At 4 months , experimental subjects significantly exceeded control subjects in knowledge , recommended behaviors , and in lessened pain . These changes remained significant at 20 months . The course was inexpensive and well-accepted by patients , physicians , and other health professionals The aim of this study was to compare the effects of an intensive educational approach incorporating longer time , greater simplicity , repetition , and cognitive motivational techniques with a conventional one in subjects with established non-insulin-dependent diabetes mellitus ( NIDDM ) whose weight , glycemic control , and diet were not optimal . Subjects were r and omly allocated to intensive or conventional education .  Of 350 subjects , 70 met the study criteria , which included established NIDDM ( ≥3 mo ) , suboptimal recent glycemic control , dietary fat intake ≥35 % of total energy intake , and body massindex ≥25 kg/m2 . The intensive approach was associated with significantly greater improvements in dietary compliance , dietary intake ( complex carbohydrate , [ P = 0.013 ] , legumes [ P < 0.0001 ] , fiber [ P < 0.0001 ] , total fat [ P < 0.004 ] , saturated fat [ P < 0.004 ] ) , and total cholesterol level ( P = 0.007 ) . The transient improvement in glycemic control was similar in both groups . An intensive education program can improve dietary compliance in established NIDDM subjects more than a conventional one . These recommended dietary improvements achieve better improvement in total cholesterol but do not necessarily improve glycemic control The effect of patient education on diabetic control in insulin-treated diabetic adults was studied in 77 subjects r and omized into two groups : intensive patient education ( group A ) and control ( group B ) . The subjects in group A received intensive patient instruction , both individually and in small groups , from a team of physicians , teaching nurses , and a dietitian . The patients in group B received a short instruction course consisting mainly of printed material . A highly significant improvement in diabetic control was observed in both groups immediately after the education programs , with gradual return to the original level during the following 3–6 mo . No difference was observed between the two groups in any of the measured parameters during the 18-mo investigation . Factors related to good control during the study included the length of school education , the quality of the control at the beginning of the study , and the high degree of self-confidence and lack of signs of anxiety in the psychological tests . The results demonstrate that the effects of educational programs are of limited value if they do not lead to permanent changes in attitudes and motivation , which are critical factors affecting long-term diabetic control We examined the effectiveness of 2 models of arthritis self-care intervention , the home study model and the small group model . The effects of disease diagnosis and duration , self-care behavior , perceived helplessness , social support , treatment choice , and formal education level on outcomes among persons with arthritis who participated in these programs were evaluated . A pretest-posttest control group design was utilized in the initial experimental study ; comparison group design s were used in the longitudinal studies . Three hundred seventy-four subjects completed the interventions and 12 months of research followup . We found that the intervention models had a statistically significant positive impact on arthritis knowledge , self-care behavior , perceived helplessness , and pain . These findings did not vary when the effects of education level , disease diagnosis and duration , informal social support , and treatment choice were controlled . The small group intervention was more effective in bringing about initial improvements in pain and depression , whereas the home study intervention was more effective in maintaining improvements in perceived helplessness . Changes in perceived helplessness and self-care behavior appear to explain in part the observed improvement in pain AIMS Education is an essential part of the management of patients with Type 2 diabetes , but the long-term effects are unclear and not well investigated in primary care . METHODS Fifty-four patients ( 39 - 75 years ) treated with maximal dosages of oral hypoglycaemic agents , needing to start insulin ( HbA(1c ) > or = 7.0 % ) , were r and omly allocated to a 6-month educational programme by a diabetes nurse ( DN group ) or usual care ( UC group ) . Main outcome measures were HbA(1c ) , number of patients with HbA(1c ) < 7.0 % , and number of patients treated with insulin 18 months after baseline . RESULTS Six weeks after the intervention HbA(1c ) levels had improved from 8.2 ( 1.1 ) to 7.2 ( 1.3 ) in the DN group , and from 8.8 ( 1.5 ) to 8.4 ( 1.7 ) in the UC group . Adjusted for baseline values , at 6 weeks HbA(1c ) improved 0.7 % ( 95 % confidence interval 0.1 , 1.4 ) more in DN than in UC . Of the patients in DN , 60 % reached HbA(1c ) < 7.0 % compared with 17 % in UC ( P < 0.01 ) . However , at 18 months there were no significant differences for HbA(1c ) , number of patients with HbA(1c ) < 7.0 % , or number treated with insulin . CONCLUSIONS Education was effective in improving glycaemic control and in delaying the need for insulin therapy in patients treated with maximal oral hypoglycaemic therapy . The reduced effect after 1 year was probably due to the discontinuation of the educational programme . Short-term education should not be offered without regular reinforcements integrated into st and ard diabetes care BACKGROUND This study was done to determine the efficacy and ease of administration of education/behavior modification classes , provided by a nurse and a dietitian in a primary care clinic for improving control of type 2 diabetes mellitus .  METHODS Patients were divided r and omly into two groups . Eighteen patients completed 6 months of structured , office-based classes , and 20 similar patients served as control subjects . All were patients of the same group practice and had their usual office visits .  Glycemic control , lipid levels , body weight , knowledge about diabetes , medication requirements , and symptoms were monitored during the 6 months , with follow-up at 12 months . RESULTS At the end of 6 months , the intervention group had significant reductions in mean fasting blood glucose , glycosylated hemoglobin , total cholesterol , and low-density lipoprotein cholesterol ( LDL-C ) values . Their mean body weight was significantly reduced at 12 months , and their knowledge of diabetes was improved . Control patients had significant improvement only in glycosylated hemoglobin and body weight at 6 months . Minimal physician time was required . CONCLUSION The education/behavior modification program was clinical ly worthwhile , and it was easy to administer Controlled studies have demonstrated that relaxation training can lead to significant in-clinic blood pressure ( BP ) reductions in patients with essential hypertension . We examined the BP-lowering effect of relaxation training during the working day . Forty-two patients being treated for essential hypertension with diastolic BPs greater than 90 mm Hg were r and omized into either a relaxation training program or no treatment .  Multiple BP measurements were made during the working hours , using an ambulatory monitoring device , before and after training . Significant work-site differences between groups were evident after treatment both for systolic and diastolic pressures . These results suggest that relaxation therapy leads to a reduction in BP that is evident in the natural environment , providing new evidence that the procedure is a useful adjunct to the treatment of hypertensive patients OBJECTIVE Evaluation of a structured hypertension treatment and teaching programme in general practice . DESIGN Prospect i ve controlled trial ; follow-up period 18 months . SETTING 10 primary health care practice s. PRACTICE S AND PATIENTS : From each practice 20 patients ( 30 to 60 years old , mean of the last two blood pressure measurements at or above 160 and /or 95 mmHg ) were r and omly selected ; in 5 practice s these patients were to participate in the treatment and teaching programme ; in the remaining 5 practice s hypertension care was continued without the availability of such a programme ( controls ) . INTERVENTION Structured treatment and teaching programme based upon four group sessions for patients mainly conducted by paramedical personnel . MAIN OUTCOME MEASURES Blood pressure , body weight , prescription of antihypertensive drugs - as documented in the patient 's records . MAIN RESULTS Of the 100 control patients 26 and of the 100 intervention patients 14 were lost to observation ; 46 patients had agreed to participate in the programme . The mean number of prescribed antihypertensive agents per patient decreased in the intervention group ( 1.8 + /- 1.3 at baseline , vs 1.2 + /- 1.2 at follow-up ) compared to the control group ( 1.6 + /- 1.3 vs 1.8 + /- 1.6 ) ; difference 0.8 ( 95 % CI 0.4 to 1.1 ) , p < 0.0001 . In the control group 9 % and in the intervention group 33 % of patients had documented reductions of body weight ( p < 0.0001 ) . Blood pressure decreased in the intervention group ( 162 + /- 14/100 + /- 7 mmHg at baseline , vs 154 + /- 16/95 + /- 9 mmHg at follow-up ) compared to the control group ( 161 + /- 13/98 + /- 7 mmHg vs 158 + /- 18/96 + /- 11 mmHg ) ; differences for systolic blood pressure 5 ( 95 % CI 0 to 10 ) mmHg , p = 0.071 ; for diastolic blood pressure 4 ( 1 to 7 ) mmHg , p = 0.018 . CONCLUSIONS The introduction of a structured hypertension treatment and teaching programme in general practice may lead to significant improvements of hypertension care OBJECTIVE The public is increasingly aware of the importance of HbA(1c ) testing , yet the vast majority of patients with diabetes do not know their HbA(1c ) status or goal . We set forth to evaluate the impact of a system that provides uniquely formatted and personalized reports of diabetes status and goals on changes in HbA(1c ) levels . RESEARCH DESIGN AND METHODS A total of 150 patients with diabetes were r and omized to receive either st and ard care or intervention  inclusive of a computer-generated 11 " x 17 " color poster depicting an individual 's HbA(1c ) status and goals along with personalized steps to aid in goal achievement . All patients enrolled received diabetes education during the 3 months before enrollment .  HbA(1c )  was performed at baseline and 6 months . RESULTS At baseline , there were no significant differences between patient groups in terms of age , sex , education level , race , and HbA(1c ) or lipid levels . Among patients with baseline HbA(1c ) > or = 7.0 % , there was an 8.6 % ( 0.77 % absolute ) reduction in HbA(1c ) among control subjects compared with a 17.0 % ( 1.69 % absolute ) decline in the intervention group ( P = 0.032 ) . There were no differences between the control and intervention groups with respect to the frequency of patients experiencing any decline in HbA(1c ) ( 63 vs. 69 % , P = 0.87 ) ; among these patients experiencing a decline , the most substantial reductions were seen with the control group , which had a 13.3 % ( 1.15 % absolute ) decline compared with the intervention patients , who reduced their HbA(1c ) by 24.2 % ( 2.26 % absolute reduction ; P = 0.0048 ) . At study close , 77 % of the patients had their poster displayed on their refrigerator . CONCLUSIONS This unique and personalized computer-generated intervention result ed in HbA(1c ) lowering comparable to that of hypoglycemic agents OBJECTIVE : To assess the effectiveness of a pharmaceutical care model on the management of non-insulin-dependent diabetes mellitus ( NIDDM ) in urban African-American patients . DESIGN : Eligible patients were r and omized to either a pharmacist intervention or control group and followed over a 4-month period . Patients in the intervention group received diabetes education , medication counseling , instructions on dietary regulation , exercise , and home blood glucose monitoring , and evaluation and adjustment of their hypoglycemic regimen . Patients in the control group continued to receive st and ard medical care provided by their physicians . SETTING : A university-affiliated internal medicine outpatient clinic . PARTICIPANTS : The study population consisted of urban African-American patients with NIDDM currently attending the clinic . MAIN OUTCOME MEASURES : Primary outcome measures included fasting plasma glucose and glycated hemoglobin concentrations . Secondary outcome endpoints included blood pressure , serum creatinine , creatinine clearance , microalbumin to creatinine ratio , total cholesterol , triglycerides , high-density lipoprotein , and low-density lipoprotein concentrations . Quality -of-life assessment s were performed in both groups at baseline and at the end of the study . RESULTS : Thirty-nine patients ( 17 intervention , 22 control ) completed the study . The intervention group consisted of 12 women and 5 men with a mean ± SD age of 59 ± 12 years , total body weight ( TBW ) of 93 ± 22 kg , body mass index ( BMI ) of 34 ± 7 kg/m2 , and duration of NIDDM 6.8 ± 6.5 years . The control group consisted of 15 women and 7 men with a mean age of 65 ± 12 years , TBW of 88 ± 19 kg , BMI of 33 ± 7 kg/m2 , and a duration of NIDDM of 6.2 ± 4.8 y. Significant improvement in glycated hemoglobin ( p = 0.003 ) and fasting plasma glucose ( p = 0.015 ) was achieved in the intervention group . No change in glycemia was observed in the control subjects . Statistically significant differences in the final glycated hemoglobin ( p = 0.003 ) and fasting plasma glucose ( p = 0.022 ) concentrations were noted between groups . No significant changes in blood pressure control , lipid profile , renal function parameters , weight , or quality -of-life measures were noted within or between groups . CONCLUSIONS : Our data demonstrate the effectiveness of pharmaceutical care in the reduction of hyperglycemia associated with NIDDM in a group of urban African-American patients Thirty-one patients receiving medical treatment for essential hypertension were r and omly distributed into three groups : ( 1 ) relaxation therapy , ( 2 ) nonspecific therapy , and ( 3 ) medical treatment only . The nonspecific therapy group spent the same amount of time with the therapists as the relaxation group but was not given a specific therapy .  Blood pressures were measured at a different time and in a different place from the behavioral treatments . The relaxation therapy group showed a significant reduction in blood pressure postreatment compared with the nonspecific therapy and medical treatment only groups , even when those patients whose medication was increased were excluded from the data analysis . At follow-up six months post-treatment , the relaxation group showed a slight decrement in treatment effects , while both the nonspecific therapy and medical treatment only groups showed continued improvement ; thus , there was not a significant difference between groups The effects of an educational program on compliance and blood pressure ( BP ) control were assessed in 47 hypertensive patients hospitalized for nonhypertension-related diseases . Patients were r and omized to receive either a question naire and an educational program ( group I , 25 ) or question naire only ( group II , 22 ) . Baseline clinical characteristics , admission diagnoses and antihypertensive medications were similar between the groups . Antihypertensive medications used by patients before the trial were not changed . Eight weeks after the initial intervention , patients in group I showed a significant reduction in both systolic and diastolic BP ( 137/89 vs 154/98 mm Hg , p = 0.005 and 0.006 , respectively ) and improved compliance ( 96 vs 36 % , p = 0.04 ) , compared with patients in group II . An education program in patients with high BP is an effective method to improve compliance and BP control in the short-term Twenty-one patients with essential hypertension were r and omly allocated to eight 1-hour sessions of meditation training , meditation plus biofeedback-aided relaxation , or a no-treatment control group . Statistically significant falls in systolic and diastolic blood pressure occurred after both training programs , although overall reductions in blood pressure were not significantly greater in either program than in the control group . Meditation plus biofeedback-aided relaxation produced falls in diastolic blood pressure earlier in the training program than did meditation alone . All patients practice d meditation regularly between training sessions : The amount of practice did not correlate with the amount of blood pressure reduction after training . On question naire measures of psychological symptoms and personality , sex differences emerged , with females showing significant abnormalities in hostility scores and males showing significantly raised levels of somatopsychic symptoms . In females , outward-directed hostility fell significantly and assertiveness increased after training , but in males , somatopsychic symptoms were unchanged To maximize disease control , patients must participate effectively in their medical care . The authors developed an intervention design ed to increase the involvement of  patients  in medical decision making . In a 20-minute session just before the regular visit to a physician , a clinic assistant review ed the medical record of each experimental patient with him/her , guided by a diabetes algorithm . Using systematic prompts , the assistant encouraged patients to use the information gained to negotiate medical decisions with the doctor . A r and omized trial was conducted in two university hospital clinics to compare this intervention with st and ard educational material s in sessions of equal length . The mean pre-intervention glycosylated hemoglobin ( HbA1 ) values were 10.6 + /- 2.1 % for 33 experimental patients and 10.3 + /- 2.0 % for 26 controls . After the intervention the mean levels were 9.1 + /- 1.9 % in the experimental group ( p less than 0.01 ) and 10.6 + /- 2.22 % for controls . Analysis of audiotapes of the visits to the physician showed the experimental patients were twice as effective as controls in eliciting information from the physician . Experimental patients reported significantly fewer function limitations . The authors conclude that the intervention is feasible and that it changes patient behavior , improves blood sugar control , and decreases functional limitations Two objectives were established for this study : 1 ) to assess the impact of a culturally specific , intensive diabetes education program on dietary patterns , and 2 ) to assess nutrient consumption relative to the Recommended Dietary Allowances . The study population consisted of elderly Mexican Americans with diabetes living in Harlingen and Brownsville , Texas . The experimental group ( n=78 ) participated in an intense , 2-hour nutrition education session , while the  control group ( n=74 )  did not . The education session was conducted for groups of eight subjects via videotapes and interactive discussion . All groups experienced significant weight loss except the women in the experimental group . After the education program , however , the experimental women had increased the percentage of calories consumed daily from carbohydrate . Mean calcium consumption was substantially less than the RDA in all groups , and inadequate amounts of ascorbic acid and vitamin A often were consumed . Intensive , frequent , long-term follow-up appears essential for more sustained results The purpose of our study was to compare the effect on diabetes control of group management with the advice-educational technique traditionally used in managing obese out patients with poorly controlled non-insulin-dependent diabetes mellitus ( NIDDM ) . Forty-one patients were r and omly assigned to these two treatment programs , and 32 patients completed the 6-mo study . Initially , patients were seen for 1-h sessions at 1- and 2-wk intervals and later at 1-mo intervals . Patients were asked to do home blood glucose monitoring , decrease caloric intake , increase exercise , and if they were taking insulin , to adjust the dose to attain approximate euglycemia  and to stabilize food and exercise patterns  . The combined groups reduced mean ± SD glycohemoglobin from 10.9 ± 3.1 to 9.4 ± 2.4 % ( P < .05 ) . Internal Health Locus of Control Scale was negatively and significantly correlated with initial and subsequent glycohemoglobin values ( the more internal , the lower the glycohemoglobin ) . At the end of the study the patients in the group management program had significantly lower blood glucose levels than those given advice and education , but no significant differences in glycohemoglobin values or percentage overweight were observed . One patient had a normal initial glycohemoglobin , and only 4 patients had values in the normal range of 4–6.8 % at the end of the study . Better management programs need to be developed for treating obese out patients with NIDDM CONTEXT Weight loss , sodium reduction , increased physical activity , and limited alcohol intake are established recommendations that reduce blood pressure ( BP ) . The Dietary Approaches to Stop Hypertension ( DASH ) diet also lowers BP . To date , no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations . OBJECTIVE To determine the effect on BP of 2 multicomponent , behavioral interventions . DESIGN , SETTING , AND PARTICIPANTS R and omized trial with enrollment at 4 clinical centers ( January 2000-June 2001 ) among 810 adults ( mean [ SD ] age , 50 [ 8.9 ] years ; 62 % women ; 34 % African American ) with above-optimal BP , including stage 1 hypertension ( 120 - 159 mm Hg systolic and 80 - 95 mm Hg diastolic ) , and who were not taking antihypertensive medications . INTERVENTION Participants were r and omized to one of 3 intervention groups : ( 1 ) " established , " a behavioral intervention that implemented established recommendations ( n = 268 ) ; ( 2 ) " established plus DASH,"which also implemented the DASH diet ( n = 269 ) ; and ( 3 ) an " advice only " comparison group ( n = 273 ) . MAIN OUTCOME MEASURES Blood pressure measurement and hypertension status at 6 months . RESULTS Both behavioral interventions significantly reduced weight , improved fitness , and lowered sodium intake . The established plus DASH intervention also increased fruit , vegetable , and dairy intake . Across the groups , gradients in BP and hypertensive status were evident . After subtracting change in advice only , the mean net reduction in systolic BP was 3.7 mm Hg ( P<.001 ) in the established group and 4.3 mm Hg ( P<.001 ) in the established plus DASH group ; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg ( P = .43 ) . Compared with the baseline hypertension prevalence of 38 % , the prevalence at 6 months was 26 % in the advice only group , 17 % in the established group ( P = .01 compared with the advice only group ) , and 12 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .12 compared with the established group ) . The prevalence of optimal BP ( < 120 mm Hg systolic and < 80 mm Hg diastolic ) was 19 % in the advice only group , 30 % in the established group ( P = .005 compared with the advice only group ) , and 35 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .24 compared with the established group ) . CONCLUSION Individuals with above-optimal BP , including stage 1 hypertension , can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk OBJECTIVE Evaluation of a self-management program for patients with osteoarthritis ( OA ) of the hip or knee . The program , which consisted of 6 weekly sessions of 2 hours , included health education by a peer and physical exercises taught by a physical therapist . METHODS R and omized controlled trial . Inclusion criteria were diagnosis of OA of the hip or knee according to ACR clinical and radiographic criteria and age 55 to 75 years . EXCLUSION CRITERIA on waiting list for joint replacement . There were pretest , posttest , and followup ( 6 months ) assessment s. The experimental group consisted of 56 patients , the control group 49 . Outcome variables were pain , quality of life , activity restrictions , knowledge about OA , self-efficacy , body mass index ( BMI ) , and mobility measures . Attention was also paid to effects on health care utilization and lifestyle behavior . RESULTS Significant MANOVA group x time effects ( p < 0.05 , one-sided ) were found for pain , quality of life , strength of the left M. quadriceps , knowledge , self-efficacy , BMI , physically active lifestyle , and visits to the physical therapist . Most effects were moderate at posttest assessment and smaller at followup . No effects were found for range of motion and functional tasks . CONCLUSION The program was reasonably effective , but more attention should be paid to proactive followup interventions and to the selection of participants A population -based study on the therapeutic effects of a diabetes teaching programme ( DTP ) based on problem oriented participatory education (POPE)--a method based on learner activity in group meetings -- was undertaken at the Primary Health Care Centre , Kisa , Sweden , in collaboration with educationalists . A control group was given conventional classroom teaching . To be included a patient had to be aged 55 - 73 years , to live in his own home , and to have non-insulin-treated type II diabetes mellitus . The therapeutic effects of the DTP were studied before , during , and after POPE with regard to three factors , diabetes related knowledge , behaviour assessed by dietary and exercise habits , and the quality of the anti-diabetic therapy as assessed by metabolic profile including Hb-A1 . Significant improvement in knowledge and transient improvement in Hb-A1 concentration were recorded among patients taking part in a DTP adjusted to their individual problems and needs . When improvement in metabolic control does not last , group meetings should be continued for more than the three months used in the present study . We believe that such improvement is intimately bound up with the psycho-social process that is involved in the group meetings and that helps the patient to cope with the disease in particular and life in general Compliance with dietary recommendations and the effect of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids were studied in 86 obese subjects ( aged 40 to 64 years ) with recently diagnosed non-insulin-dependent diabetes mellitus ( NIDDM ) . After three months of basic education , the subjects were r and omly separated into an intervention group ( n = 40 ) and a conventional treatment group ( n = 46 ) . Members of the intervention group participated in 12 months of intensified education ; those in the conventional group visited local health centers . Compliance with dietary instructions was monitored through food records . Intensified dietary therapy result ed in greater weight loss , better metabolic control , and a less atherogenic lipid profile than conventional treatment . Intake of energy and saturated fatty acids tended to decline in the intervention group . A higher percentage of patients in the intervention group had a total fat intake of 30 % of energy or less after 15 months ( 32.5 % [ 12 of 38 ] vs 17.4 % [ 8 of 46 ] ) . Similarly , more patients in the intervention group had a saturated fatty acid intake of 10 % or less of total energy intake at the end of the study ( 35.0 % [ 13 of 38 ] vs 8.7 % [ 4 of 46 ] ) . The mean dietary cholesterol intake was within recommendations in both groups at the end of the study . The relative percentage of linoleic acid of serum lipids increased significantly and the relative percentage of palmitic acid of serum triglycerides , phospholipids , and cholesterol esters decreased in the intervention group . These changes indicate that intensified dietary therapy improved the quality of fat in the diet of patients with NIDDM Context Several studies suggest that blood glucose levels are associated with cardiovascular disease , even at blood glucose values that do not meet diagnostic criteria for diabetes . Contribution Among adult residents of Norfolk , United Kingdom , there was a continuous relationship between hemoglobin A1c levels and cardiovascular disease and total mortality . This relationship was apparent even among persons without diabetes . Implication s These observations justify the need for studies that address whether improvements in glycemic control might improve health outcomes in persons who do not have diabetes . The Editors Diabetes mellitus is of major and increasing global public health importance ( 1 ) . Persons with diabetes are at increased risk for premature disability and death associated with vascular , renal , retinal , and neuropathic complications . Raised fasting and postchallenge blood glucose levels in an oral glucose tolerance test are used to diagnose diabetes . The diagnostic threshold is based on the shape of the risk curve between glucose levels and specific microvascular complications of diabetes ( 2 - 6 ) . Diabetes also increases the risk for macrovascular diseases , such as coronary heart disease and stroke ( 7 ) . In contrast to microvascular disease , increasing evidence suggests that the relationship between blood glucose level and macrovascular disease is continuous and does not have an obvious threshold ( 2 , 8 , 9 ) . Hemoglobin A1c concentration is an indicator of average blood glucose concentrations over the preceding 3 months ; it is useful for characterizing dysglycemia in population studies because it is simpler to perform than the oral glucose tolerance test ( 10 ) . In a 3-year follow-up of men in a prospect i ve study , we previously reported that hemoglobin A1c concentrations were related to cardiovascular disease and all-cause mortality ( 11 ) . However , we had insufficient power to examine risk relationships at concentrations close to the diagnostic threshold of 7 % or to examine the relationship in women . We report the relation between hemoglobin A1c concentrations and fatal and nonfatal coronary heart disease , cardiovascular disease events , and all-cause mortality in men and women after an average of 6 years of follow-up . Methods The European Prospect i ve Investigation into Cancer in Norfolk ( EPICNorfolk ) is a prospect i ve population study of 25 623 men and women who were between 40 and 79 years of age and who resided in Norfolk , United Kingdom . Participants were recruited from general practice registers . Information on the recruitment process is available elsewhere ( 12 ) . Between 1993 and 1997 , participants completed a health and lifestyle question naire . Participants were asked whether a doctor had ever told them that they have any of the conditions contained in a list that included diabetes , heart attack , and stroke . People with known diabetes were defined as those who responded yes to the diabetes option of this question . Smoking history was derived from responses ( yes or no ) to the questions : Have you ever smoked as much as 1 cigarette a day for as long as a year ? and Do you smoke cigarettes now ? At a clinic , trained nurses performed a health examination for each participant . Body mass index was estimated as weight (kg)/height ( m2 ) , and waist-to-hip ratio was determined by measurements of the circumference of the waist and hips . Blood pressure was measured by using an Accutorr ( Data scope , Mahwah , New Jersey ) noninvasive  blood pressure  monitor after the participant had been seated for 5 minutes . The mean of 2 readings was used for analysis . Nonfasting blood sample s were taken ; sample s for assay were stored in a refrigerator at 4 C until transport within 1 week of sampling to the Department of Clinical Biochemistry , University of Cambridge . Starting in 1995 , hemoglobin A1c was measured on fresh EDTA blood sample s by using high-performance liquid chromatography ( BioRad Diamat Automated Glycosylated Haemoglobin Analyser , Hemel Hempstead , United Kingdom ) . We report results for follow-up to January 2003 , an average of about 6 years . All participants were flagged for death certification at the Office of National Statistics ; vital status was obtained for the entire cohort . Trained nosologists coded death certificates according to the International Classification of Diseases , Ninth or Tenth Revisions ( ICD-9 or ICD-10 ) . Cardiovascular death ( stroke , coronary heart disease , and other vascular causes ) was defined as those whose underlying cause of death was coded as ICD-9 400448 or ICD-10 I10I79 . Death from coronary heart disease was defined as those whose cause of death was coded as ICD-9 410414 or ICD-10 I22I25 . Participants admitted to a hospital were identified by their National Health Service number . Hospitals were linked to the East Norfolk Health Authority data base , which identifies all hospital contacts throughout Engl and and Wales for Norfolk residents . We used the same ICD diagnostic codes described in the preceding paragraphs to ascertain hospital episodes of cardiovascular disease and coronary heart disease in our cohort . Participants were identified as having a coronary heart disease event during follow-up if they had a hospital admission or died with coronary heart disease as the cause of death . Of the coronary heart disease events identified , 21 % ( 112 of 529 ) were fatal ; of the cardiovascular disease events , 23 % ( 197 of 806 ) were fatal . In men , 24 % ( 76 of 321 ) of deaths were attributed to heart disease and 29 % ( 117 of 321 ) were attributed to cardiovascular disease . In women , 18 % ( 36 of 200 ) of deaths were attributed to heart disease and 35 % ( 70 of 200 ) were attributed to cardiovascular causes . The Norwich Ethics Committee approved the study , and participants gave signed informed consent . Statistical Analysis These analyses , undertaken by using SPSS software , version 10.0 ( SPSS , Inc. , Chicago , Illinois ) , included 10 232 men and women age 45 to 79 years who completed the health and lifestyle question naire and had available hemoglobin A1c measurements . We divided the cohort into 7 categories on the basis of baseline data : known diabetes , high likelihood of previously undiagnosed diabetes ( no personal history of diabetes but a hemoglobin A1c concentration 7 % ) , and hemoglobin A1c concentrations in 0.5percentage point intervals ( < 5 % , 5 % to 5.4 % , 5.5 % to 5.9 % , 6.0 % to 6.4 % , and 6.5 % to 6.9 % ) . We examined risk factor distributions and then coronary heart disease , cardiovascular disease , and all-cause mortality rates by hemoglobin A1c and diabetes category . Age-adjusted odds ratios were calculated by using logistic regression models . We used a Cox proportional hazards model to determine the independent contribution of hemoglobin A1c to total mortality and cardiovascular and coronary heart disease after adjustment for age , body mass index , waist-to-hip ratio , systolic blood pressure , blood cholesterol concentrations , cigarette smoking , and history of heart attack or stroke . Participants with missing baseline data for 1 or more risk factors ( 130 men and 186 women ) were excluded from the multivariate analyses . Role of the Funding Sources The funding sources had no role in the design , conduct , and reporting of the study or in the decision to su bmi t the manuscript for publication . Results Table 1 presents characteristics of the participants according to hemoglobin A1c concentration and self-reported diabetes . Those with known diabetes had higher mean ( SD ) hemoglobin A1c concentrations ( 8.0 % 1.9 % ) than the rest of the study sample ( 5.3 % 0.7 % ) . They were older and had a higher body mass index , waist-to-hip ratio , and systolic blood pressure ; they were also more likely to report having had a previous heart attack or stroke . Participants with probable but previously undiagnosed diabetes ( hemoglobin A1c 7 % ) shared these characteristics . Mean risk factor levels rose with increasing concentration of hemoglobin A1c less than 7 % . Table 1 . Distribution of Variables by  Hemoglobin A1c Concentration and Known Diabetes in 4662 Men and 5570 Women Age 45 to 79 Years ( European Prospect i ve Investigation into Cancer in Norfolk , 1995 to 1997 ) Table 2 shows adjusted odds ratios for hemoglobin A1c concentrations , diabetes status , and outcomes .  Persons with known or undiagnosed diabetes had a greater risk for all-cause mortality and cardiovascular or coronary heart disease than those without diabetes . Risk for coronary heart or cardiovascular disease and total mortality increased throughout the whole range of hemoglobin A1c concentrations ; those with hemoglobin A1c concentrations less than 5 % had the lowest rates . For men , a gradient of increasing rates through the distribution was apparent for all end points . For women , odds ratios for cardiovascular or coronary heart disease did not increase significantly until the hemoglobin A1c concentration reached 6 % ; odds ratios were very high in women with concentrations greater than 7 % . Table 2 . Rates and Age-Adjusted Relative Risks for Total Coronary Heart Disease Events , Cardiovascular Disease Events , and All-cause Mortality by Category of Hemoglobin A1c Concentration and Known Diabetes in 4462 Men and 5570 Women Age 45 to 79 Years ( European Prospect i ve Investigation into Cancer in Norfolk , 1995 to 2003 ) Table 3 shows outcomes after adjustment for age alone and then after adjustment for age and other risk factors . In men , known diabetes predicted coronary heart and cardiovascular disease events and total mortality with approximate 2-fold relative risks . These relative risks were only slightly attenuated after adjustment for known risk factors . In women , known diabetes status predicted an approximate 5-fold increase in risk for coronary heart and 3-fold increase in risk for cardiovascular disease events ; these increases were attenuated after adjustment for known risk factors to 3-fold and 2-fold risk , respectively . In men and women , hemoglobin A1c concentrations predicted an increased risk for Thirty subjects with essential hypertension were assigned r and omly to either a no treatment control , education , or education with relaxation training group . Independent blood pressure recordings were collected by medical staff at pretest , posttest , and 8-week follow-up . Results suggest a significant interaction between treatment and time for the dependent physiological measure , systolic blood pressure . During the pretest to follow-up period , the control group averaged a 5.9 mm . Hg . increase , the education with relaxation group an 8.8 mm . Hg . decrease , and the education group a 14.9 mm . Hg . decrease in systolic blood pressure . There was no significant difference in group means for diastolic blood pressure within groups over time . As measured at follow-up , education appeared more effective in reducing systolic blood pressure than education with relaxation training . More than one-third of subjects associated unpleasant side effects with their antihypertensive medication . Almost all treatment subjects rated the education and relaxation as helpful for underst and ing and managing their hypertension BACKGROUND Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications . AIM The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin ( HbA1c ) levels and adherence to diabetes control recommendations . METHODS A r and omized design with control and experimental groups being assessed pre- and post intervention was used to assess the effectiveness of nurse telephone calls .  Twenty patients were r and omly assigned to an intervention group and 16 to a control group . The goal of the intervention was to keep blood glucose concentrations close to the normal range ( HbA1c < 7 % ) . The intervention was applied to the intervention group for 12 weeks , and consisted of continued education and reinforcement of diet , exercise , medication adjustment recommendations , as well as frequent self-monitoring of blood glucose levels . Telephone intervention was performed twice per week for the first month and then weekly for the second and third month . Participants were requested to write self-management logs including blood glucose levels , diet and an exercise diary . A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail . All medication adjustments were communicated to participants ' doctors . The HbA1c and diabetes adherence were measured before and after the intervention . RESULTS Patients in the intervention group had a mean decrease of 1.2 % in HbA1c levels and those in the control group had a mean increase of 0.6 % in HbA1c levels . The intervention group had greater diet and blood glucose testing adherence than the control group . CONCLUSION These findings indicate that a nurse telephone intervention can improve HbA1c , and diet and blood glucose testing adherence Abstract The study was conducted to assess the efficacy of Anxiety Management Training as an adjunctive treatment for essential hypertension . Twenty-one patients with essential hypertension , all but one of whom were on antihypertension medication , were r and omly assigned either to an Anxiety Management Training condition or a waiting-list control condition . At the time of a posttest assessment session , compared to subjects in the control condition , subjects in the Anxiety Management Training condition manifested a decrease in resting systolic and diastolic blood pressure and a decrease in systolic and diastolic blood pressure following a stressful task . At the time of a follow-up assessment session , subjects in the Anxiety Management Training condition not only manifested good maintenance of reduced blood pressure but also exhibited a further decrease in resting systolic blood pressure and a decrease in systolic blood pressure during the stressful task
Context Do self-management programs improve outcomes of adults with chronic conditions ?
The Editors Chronic diseases are conditions that are usually incurable .
Although often not immediately life-threatening , they place substantial burdens on the health , economic status , and quality of life of individuals , families , and communities ( 1 ) .
Diabetes mellitus affects approximately 10 % of persons 65 years of age and older and increases the risk for other chronic conditions , including ischemic heart disease , renal disease , and visual impairment ( 2 ) .
Despite this enthusiasm , experts do not agree on the definition of what constitutes a chronic disease self-management program , which elements of self-management programs are essential regardless of the clinical condition , or which elements are important for specific conditions .
Several recent review s on chronic disease  self-management  interventions have been published , including 2 Cochrane collaborations ( 6 - 13 ) .
Almost all have been disease-specific .
Almost all previous review s have been disease-specific or addressed specific intervention components within specific disease conditions ( 14 - 17 ) .
In our review , we sought to quantitatively assess chronic disease self-management  programs for older adults within and across disease conditions .
We used empirical data from the literature to address 2 research questions : First , do chronic disease self-management programs result in improved disease-related outcomes for specific chronic diseases of high prevalence in older adults ?
Second , if self-management interventions are effective , are there specific components that are most responsible for the effect , within or across disease conditions ?
To address these questions , we focused on evaluating the effect of self-management programs  for the 3 chronic conditions that have been most commonly studied in controlled trials of older adults : osteoarthritis , diabetes mellitus , and hypertension .
On the basis of a conceptual framework derived from the clinical literature and from discussion s with social scientists with expertise in self-management , we defined chronic disease self-management as a systematic intervention that is targeted toward patients with chronic disease .
We attempted to underst and the characteristics particular to chronic disease self-management programs that may be most responsible for their effectiveness .