Non-HDL cholesterol predicts coronary heart disease in primary prevention: findings from an Italian 40-69 year-old cohort in general practice.

OBJECTS: Non-HDL cholesterol is now recommended as an index of risk associated with combined dyslipidemia, and it has also been found useful in predicting coronary heart disease (CHD) risk in patients with diabetes. We studied the association between known CHD risk factors, enclosed non-HDL cholesterol, and a "high CHD risk condition", i.e. a "5-years CHD risk >15%" in general practice. METHODS: We studied 4,085 40-69 year-old diabetic (no. 489) and non-diabetic (no. 3,596) individuals from an opportunistic cohort. Cross-sectional descriptive statistics, and age- and gender-adjusted multiple logistic exponential betas have been calculated. RESULTS: About 12% of the participants had diabetes. Age- and gender-adjusted comparison showed that all the study variables were significantly worse in diabetic vs. non-diabetic individuals (except cigarette smoking, total blood cholesterol and the ratio of total to HDL cholesterol). They had a mean "5-year CHD-risk" significantly higher than non-diabetic individuals (18.8+/-11.9% vs 7.5+/-6.9%, P<0.01), and a four-fold prevalence of "5-years CHD risk >15%" (55.4% vs 11.1%, P<0.01). As to diabetic individuals, the study variables associated to a "high CHD risk condition" were cigarette smoking, systolic blood pressure, and non-HDL blood cholesterol levels. As to non-diabetic individuals cigarette smoking, systolic blood pressure, and HDL (inversely) and non-HDL blood cholesterol levels were associated to a "high CHD risk condition". CONCLUSIONS: Non-HDL cholesterol--and cigarette smoking and systolic blood pressure--strongly predicted a "high CHD risk condition" both in diabetic and non-diabetic individuals.

Hypnosis as an aid for tinnitus patients.

This study was undertaken to evaluate hypnosis versus stress management as therapeutic modalities in the treatment of tinnitus. Participants were recruited from the local tinnitus association and the Otolaryngology Division of the Department of Surgery. The instruments were the following standardized tests (NIMH Diagnostic Int. Schedule; SCL 90R, Beck Depression Inventory) in addition to a tinnitus questionnaire. Improvement was shown on 5 separate scales, some alleviated by both types of treatment and others singularly by hypnosis or stress management. The data reinforce the use of behavioral techniques and suggest that different techniques may be more appropriate for specific symptoms.

Changes in students' attitudes following a course on death and dying: a controlled comparison.

This study evaluated the effect of a death-education course on the death-related anxiety and attitudes toward death of 71 medical students not yet exposed to clinical rotations and four health care professionals. The Collect-Lester Fear of Death Scale and a semantic differential technique measuring attitudes toward the dying patient and his or her family were administered to course attendees before and after the course and to freshman students not taking the course. The 75 course attendees and the 93 controls completed the baseline measures, and 71 course attendees and 46 controls responded to the post-course evaluation. The course did not produce significant changes on the four Collett-Lester subscales, although there was an overall decline in anxiety when the two groups were combined (p = 0.035). Semantic differential scales showed no change for controls but a marked improvement in attitudes toward "treating the dying patient" and "dealing with the dying patient's family" for attendees (p < 0.001 for both). In summary, course participation resulted in improvement in students' attitudes toward dealing with death.

Learning to care for dying patients: a controlled longitudinal study of a death education course.

BACKGROUND: This study examines the long-term impact of a medical-school death education course on death-related anxiety and attitudes. METHODS: A four-year longitudinal, controlled study design was used. Ninety-nine course participants and 92 controls were initially evaluated using the Collett-Lester Fear of Death Scale and a semantic differential technique measuring attitudes toward the dying patient and his or her family. The evaluation was repeated at the end of the course and yearly thereafter. RESULTS: Attitudes towards "treating the dying patient" and "dealing with the dying patient's family" were improved as a result of the course. The effects were sustained throughout medical school, with significant differences between the groups at the end of the course (p < 0.001) and for third-year students (p < or = 0.002). Regarding fear of death, analyses showed no significant group-time interaction at any test period (p > or = 0.13). CONCLUSIONS: Preclinical education has an enduring effect on attitudes involving end-of-life care.