Barbershop-based BP monitoring improved hypertension control rate
Victor R. Arch Intern Med. 2010;doi:10.1001/archinternmed.2010.390.
Hypertensive male barbershop patrons whose barbers offered BP screenings and physician referrals at the time of their haircut exhibited better hypertension control rates than male patrons who received only pamphlets, a study found.
Such health outreach programs are becoming common in barbershops across the country, according to the study. They may ultimately reach more blacks than church-based programs, which only certain sections of the population attend regularly. “Black-owned barbershops hold special appeal for community-based intervention trials because they are a cultural institution that draws a large and loyal male clientele and provides an open forum for discussion of numerous topics, including health, with influential peers,” the researchers wrote.
Ronald G. Victor, MD, and colleagues identified 17 black-owned barbershops with 95% black male clientele in Dallas County, Texas. All black male customers were offered baseline BP screenings during a 10-week period. The researchers then randomly assigned the barbershops into an intervention group, in which barbers were trained to continually offer BP screenings and promote physician follow-up with peer-based messaging, or a comparison group, in which patrons received a standard BP pamphlet.
“The intervention’s theoretical underpinning was adapted from the successful AIDS Community Demonstration Projects that mobilized community peers to deliver intervention messages with role model stories and made medical equipment available in the daily environment,” the researchers wrote.
Interventions were performed in nine shops with 75 hypertensive men per shop. The comparison group consisted of eight shops with 77 hypertensive patrons per shop. At the end of 10 months, the hypertension control rate increased in the intervention group vs. the comparison group (absolute group difference, 8.8%; 95% CI, 0.8-16.9). The intervention’s effect on hypertension control was not affected by adjusting for several covariates, including age, baseline BP, college education, marital status or smoking status, and participation at both baseline and follow-up (P=.03). The researchers observed a borderline effect of intervention on systolic BP change (absolute group difference, –2.5 mm Hg; 95% CI, –5.3 to 0.3).
“If the intervention could be implemented in the approximately 18,000 black-owned barbershops in the United States to reduce systolic BP by 2.5 mm Hg in the approximately 50% of hypertensive US black men who patronize these barbershops, we project that about 800 fewer MIs, 550 fewer strokes, and 900 fewer deaths would occur in the first year alone, saving about $98 million in CHD care and $13 million in stroke care,” the researchers wrote.
__________________________________________________ ____________________________
Bystander chest compression-only CPR linked with survival benefit for cardiac arrest
Bobrow B. JAMA. 2010;304:1447-1454.
Cone D. JAMA. 2010;304:1493-1495.
The application of chest compression-only CPR by a layperson bystander was associated with increased survival in patients experiencing out-of-hospital cardiac arrest, results from a new analysis suggested.
Researchers observed 5,272 patients with out-of-hospital cardiac arrests during the 5-year follow-up period of the prospective, observational study. All patients were at least 18 years of age and had out-of-hospital cardiac arrests between 2005 and 2009. The relationship between layperson bystander administering CPR and survival to discharge was characterized using multivariable logistic regression analysis. The primary outcome was survival to hospital discharge, which was determined by a review of hospital records.
According to the results, 4,415 out-of-hospital cardiac arrests were reported and 779 were excluded from the analysis because the CPR was administered by a health care professional or were evaluated in a medical facility; this included 666 people who received conventional CPR, 849 who received compression-only CPR and 2,900 who received no bystander CPR.
Rates of survival to hospital discharge were higher in the compression-only group (13.3%; 95% CI, 11.0-15.6) when compared with the group with no bystander intervention (5.2%; 95% CI, 4.4-6.0) and the conventional CPR group (7.8%; 95% CI, 5.8-9.8). The researchers also reported an increase in layperson CPR from 2005 to 2009 (28.2% to 39.9%, P<.001), along with an increase in the proportion of compression-only CPR during the same time period (19.6% to 75.9%, P<.001). In increase in overall survival was also reported from 2005 to 2009 (3.7% to 9.8%, P<.001).
“Implementation of a 5-year, multifaceted, statewide public education campaign that officially endorsed and encouraged chest compression-only CPR was associated with a significant increase in the rate of bystander CPR for adults who experienced out-of-hospital cardiac arrest,” the researchers concluded. “Furthermore, chest compression-only CPR was independently associated with an increased rate of survival compared with no bystander CPR or conventional CPR.”
In an accompanying editorial, David C. Cone, MD, of Yale University School of Medicine in New Haven, Conn., said the findings regarding compression-only CPR were in line with those of previous trials that had suggested a theoretical advantage but did not offer much confirmatory data, adding that the results were encouraging, and no associations with neurologically impaired survival were reported.
“Taken together, these findings, along with the findings of the compression-only CPR trials and the findings reported by Bobrow et al suggesting a survival benefit, should encourage and justify continuing investigations involving compression-only CPR,” Cone wrote.