RESUMO
AIMS: Short-term treatment with calcium channel blockers lowers levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) and reduces rhythm-related symptoms compared to treatment with beta-blockers. The aim of this study was to compare the longer-term effects of metoprolol and diltiazem for rate control in patients with permanent atrial fibrillation after six months. METHODS AND RESULTS: Men and women with permanent atrial fibrillation and preserved left ventricular systolic function were randomised to receive either diltiazem 360 mg or metoprolol 100 mg once daily. The primary endpoint was the level of NT-proBNP after a six-month treatment period. Secondary endpoints included heart rate, rhythm-related symptoms and exercise capacity. A total of 93 patients (mean age 71 ±7 years, 28 women) were randomised. After six months' treatment, mean levels of NT-proBNP decreased in the diltiazem group and increased in the metoprolol group, with a significant between-group difference (409.8 pg/mL, 95% CI: 230.6 - 589.1, P<0.001). Treatment with diltiazem significantly reduced rhythm-related symptoms compared to baseline, but no change was observed in the metoprolol group. Diltiazem and metoprolol had similar effects on heart rate and exercise capacity. CONCLUSION: Diltiazem reduced NT-proBNP levels and improved rhythm-related symptoms. Metoprolol increased peptide levels but had no impact on symptoms despite similar heart rate reduction. Non-dihydropyridine calcium channel blockers should be considered more often for rate control in permanent atrial fibrillation.
RESUMO
The present report presents the results and preliminary recommendations of a behavior analysis study of an oral rehydration therapy (ORT) promotion in four localities in San Marcos, Guatemala. In this study, we used behavioral observation techniques to look at one-to-one communication and health education efforts in health clinics as well as to evaluate the effectiveness of these health education efforts by observing mothers' behavioral skills in their own homes. Subsequently, we also observed canalizatión (outreach) strategies to see whether we could learn more from these health workers' activities, and conducted "behavioral focus group" research with teams of health workers to determine how best to promote effective health education activities to other health workers. Results of our study indicate that health workers already spent a substantial amount of time doing health education and primary prevention, and were fairly effective at doing so. Their communication, however, tended to be relatively unilateral and failed to involve some of the more progressive aspects of behavioral skills training.