As part of a prospective, randomized study, the psychological effects of two different treatment regimens on the diagnosis of children and adolescents aged 3-15 years with insulin-dependent diabetes insipidus were evaluated. Conventional treatment was compared to a new regimen with a crisis programme which included a milieu therapeutic setting. A total of 38 families were randomly assigned to the 2 groups and followed over a period of 2 years after initial treatment. Parents' experiences of family climate and function over this period were registered and a test battery for the children was administered on five separate occasions. No decisive difference between the two groups was found. Few significant differences were found. Further investigation of the effects of the new treatment regimen on selected groups of families with defined extra needs is suggested.
Objective Hostility is associated with coronary artery disease (CAD). One candidate mechanism may be autonomic nervous system (ANS) dysregulation. In this study, we report the effect of cognitive behavioral treatment (CBT) on ANS regulation. Methods Participants were 158 healthy young adults, high in hostility measured by the Cook- Medley (CM) Hostility and Spielberger Trait Anger (TA) scales. Participants were also interviewed using the Interpersonal Hostility Assessment Technique (IHAT). They were randomized to a 12-week CBT program for reducing hostility or a wait-list control group. The outcome measures were pre-ejection period (PEP), low-frequency blood pressure variability (LF-BPV), and high-frequency heart rate variability (HF-HRV) measured at rest and in response to and recovery from cognitive and orthostatic challenge. Linear mixed models were used to examine group × session and group × session × period interactions while controlling for sex and age. Contrasts of differential group and session effects were used to examine reactivity and recovery from challenge. Results After Bonferroni correction, 2-way and 3-way interactions failed to achieve significance for PEP, LF-BPV or HF-HRV (p>0.002) indicating that hostility reduction treatment failed to influence ANS indices. Conclusion Reduction in anger and hostility failed to alter ANS activity at rest or in response to or recovery from challenge. These findings raise questions about whether autonomic dysregulation represents a pathophysiological link between hostility and heart disease.
BackgroundTranslating evidence into practice requires adaptation to facilitate the implementation of efficacious interventions. A novel highly challenging balance training program (HiBalance) was found to improve gait, balance, and physical activity in persons with Parkinson’s disease (PD) in an earlier randomized controlled trial. This study aimed to describe the adaptation process and feasibility of implementing the HiBalance program for PD within primary healthcare settings.MethodFeasibility was assessed in terms of study processes and scientific evaluation. Nine persons with mild–moderate PD were enrolled in this pre–post feasibility study. The dose of the original program was adapted by reducing therapist‐led training sessions from three to two times weekly. Outcome measures were substituted with ones more clinically feasible. One group (n = 5) received HiBalance training three times weekly for 10 weeks while another (n = 4) trained twice weekly plus a once weekly home exercise program (HEP). Balance performance was the primary outcome, while secondary outcomes (e.g., gait speed, physical activity level, concerns of falling, and health‐related quality of life) were also evaluated.ResultsRegarding process feasibility, attendance was high (approximately 90%) in both groups, and experiences of the group and home training were positive. Newly selected outcome measures were feasible. The scientific evaluation revealed few adverse events and no serious injuries occurred. Concerning outcomes per group, the average change in balance performance and gait speed was equal to, or exceeded, the minimally worthwhile treatment effect commonly used in PD.ConclusionThe findings support the feasibility, in terms of process and scientific evaluation, of the adapted HiBalance program for implementation within clinical settings. A sufficiently powered study is required to ascertain whether the newly proposed program offers similar short and long‐term effects as the original program.
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