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This is a double-blind randomized placebo-controlled crossover clinical trial of efficacy and safety of an FDA-approved angiotensin receptor blocker losartan to improve cardiopulmonary outcomes in individuals with pre-Chronic Obstructive Pulmonary Disease COPD due to prolonged exposure to secondhand tobacco smoke. Secondhand tobacco smoke SHS remains a major public health problem. This is important particularly as the generations that endured the highest amount of SHS exposure are aging, which could potentially accentuate the SHS-related occult health problems that may have been previously too subtle to be recognized. Although acute and subacute health effects of exposure to SHS have been studied, its long-term consequences have been more difficult to examine in part due to challenges with exposure assessment. Nonsmoking flight attendants FA who worked on commercial aircrafts before the enactment of the smoking ban were exposed to heavy SHS in aircraft cabin for many years, in a range similar to the nicotine exposure burden experienced by 'light' smokers. The regularity of this intense exposure in the cabin work environment lends itself to relatively accurate SHS exposure quantification through employment history, and makes the exposed FA a unique population in which the long-term health effects of previous exposure to SHS could be examined as a form of 'natural' experiment that is also generalizable to other SHS exposed populations. Over the past several years, the investigators recruited a nonsmoking cohort of FA with such history of cabin SHS exposure who had subclinical signs and symptoms of pulmonary disease. Furthermore, while the FA in this cohort had no history of known cardiovascular disease , and were able to perform well on maximum effort exercise testing, they had an abnormal cardiovascular hypertensive response to exercise HRE that was associated with their cabin SHS exposure. Subtle abnormal cardiovascular response to exercise in the absence of overt disease, such as what the investigators observed in this cohort, has been described in other populations with likely subclinical disease and is suggested to be associated with impaired cardiovascular function with potential future adverse outcomes. However, the underlying mechanisms that contribute to these abnormal cardiovascular responses are unclear, and the rationale for initiation of preventative medical interventions in this setting remains unproven. Thus, the nature and clinical significance of these subtle abnormalities demands further investigation. The investigators will perform cardiac magnetic resonance imaging MRI to measure myocardial dimensions and function including left ventricular LV mass, volume, ejection fraction LVEF , and diastolic function. The investigators will also measure aortic stiffness by regional pulse wave velocity PWV measurement in the thoracic aorta from the MRI. Specific Aim 2- Determine whether HRE is associated with abnormal circulatory markers of cardiovascular disease in those with prolonged SHS exposure but without overt disease. The investigators will examine subjects' peripheral blood samples for circulatory markers of systemic inflammation, vascular function, and prothrombotic state including ACE, C-reactive protein CRP , endothelin-1 ET-1 , P-selectin, fibrinogen, and von Willebrand Factor vWF. Moreover, the investigators will perform molecular phenotyping of peripheral blood monocytes, an important culprit in atherogenesis, using mass cytometry in search for a proinflammatory profile associated with cardiovascular disease. The investigators will perform a placebocontrolled double-blind randomized controlled trial RCT in subjects with HRE but without known cardiovascular disease to determine the efficacy and safety of blocking the reninangiotensin system in reducing HRE and improving exercise capacity, a proxy for improved cardiovascular health. We will not share your information with anyone other than the team in charge of this study, which might include an external sponsor. Submitting your contact information does not obligate you to participate in research. Summary Eligibility for people ages 40 years and up full criteria Location at San Francisco, California Dates study started March Mehrdad Arjomandi. Description Summary This is a double-blind randomized placebo-controlled crossover clinical trial of efficacy and safety of an FDA-approved angiotensin receptor blocker losartan to improve cardiopulmonary outcomes in individuals with pre-Chronic Obstructive Pulmonary Disease COPD due to prolonged exposure to secondhand tobacco smoke. The hypothesis of this study is that: Prolonged exposure to secondhand tobacco smoke SHS , even when remote, is associated with occult cardiovascular disease as determined by a abnormal cardiac structure and function, b abnormal vascular structure and function, and c abnormal circulatory mediators, which altogether generate a hypertensive response to exertion and limit exercise capacity. Management of hypertensive response to exercise HRE via blocking of the renin-angiotensin system, using an angiotensin-converting enzyme ACE receptor blocker, reduces the hypertensive response and improves exercise capacity, proxies for long-term cardiovascular health outcomes. Eligibility You can join if… Open to people ages 40 years and up Must be able to understand and provide informed consent. Must have a history of occupational exposure to secondhand tobacco smoke for at least 5 years such as flight attendants who worked for airlines before the smoking ban on aircrafts went into effect or casino workers who worked at casinos with no smoke-free policies. You CAN'T join if Inability or unwillingness of a participant to give written informed consent or comply with study protocol. Subject is pregnant, breast-feeding, or plans to become pregnant. History of angioedema. Blood pressure less than 90 mm Hg systolic or 60 mm Hg diastolic while standing or sitting. Current regular use of NSAIDs defined as daily use on 5 or more days of the week for more than one month. Potassium supplementation or serum potassium level of 5. Current use of a potassium sparing diuretic. History of clinically overt pulmonary disease that may interfere with study procedures, including: greater than mild asthma, COPD, emphysema, chronic interstitial lung disease , and pulmonary hypertension. Neuromuscular disorders or physical disability to perform exercise testing using an ergometer. Significant history of recreational drug use other than marijuana as defined by: recreational drug use within the last 30 years of recruitment or recreational drug use at a frequency of more than once a month before 30 years. Marijuana use more than once a week. Other uncontrolled chronic illnesses which in the judgment of the study physician would interfere with completing study procedures. Failure to keep screening appointments or other indicators of non-adherence. Concomitant participation in another interventional study. MRI Scan Participation Exclusion Criteria - The participants will be excluded from the MRI portion of the study if they have a metallic object embedded or implanted in their body that is incompatible with Magnetic Resonance MR scanning, including MR incompatible pacemaker or defibrillator. Arjomandi grew up in Ahvaz, a small city in Southwestern Iran, and moved to the United States in in the aftermath of Iranian revolution , Iraq's invasion of Iran , and his family displacement inside Iran Contact us about this trial. Email You typed. Did you mean? Are you human? Send to study team. The study team should get back to you in a few business days. You will also receive an email with next steps.

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Background: Drug abuse is a major issue and one of the main causes of health, psychological, and social problems. Studies have shown the effectiveness of narrative therapy in reducing psychological symptoms of addiction. The present study aimed to assess the effectiveness of group narrative therapy on depression, quality of life QoL , and anxiety among people with amphetamine addiction in Kermanshah, Iran. The participants were randomly divided into intervention and control groups. The intervention group followed 10 sessions of narrative therapy, whereas the control group received routine psychiatric care. The data collection tools included a demographic data form, Beck depression inventory-II, QoL questionnaire, and Beck anxiety inventory. The data were analyzed using SPSS software version These variables did not show a significant change in the control group. Conclusion: Group narrative therapy reduced the level of depression and anxiety in patients with amphetamine addiction. However, their QoL was unaffected by the therapy. Studies have shown the effectiveness of narrative therapy in patients with substance abuse alcoholism. Group narrative therapy has shown to reduce depression in women and anxiety in students prior to an examination. While group narrative therapy reduced the level of depression and anxiety in patients with amphetamine addiction, their quality of life was not improved. In parallel with other treatments, narrative therapy is recommended as a short-term, low-cost, and affordable method to treat depression and anxiety in patients with drug addictions. Drug abuse is a major issue in the twenty-first century and one of the main causes of health, psychological, and social problems. The growing trend of substance abuse, particularly among the youth is a major concern of families and society as a whole. The Iranian Drug Control Headquarter announced an estimation of about 1. According to the UNOCD, the use of amphetamine-type stimulants methamphetamine is the second most commonly abused substance after marijuana. During the comedown phase, as the effect of the drug wears off, feelings of depression, restlessness, and fatigue set in and the users feel the urge to take more of the substance to overcome these negative effects. Moreover, psychological symptoms include mood and anxiety disorders, confusion, insomnia, and aggressive behaviors. Considering such harmful consequences on both the individual and society, authorities are forced to take measures against drug addiction. Previous studies have shown that, compared to pharmacological intervention, replacement therapy naltrexone combined with psychological and social interventions cognitive-behavioral therapy is only effective when treating a case of substance abuse. However, additional treatments are required to provide a comprehensive set of clinical tools to effectively treat drug-dependent individuals. Narrative therapy, based on postmodern philosophy, has been recently proposed as a relatively new approach to lessen the impact of a problem on the individuals as well as their families. According to this theory, people tend to view life as a continuous and logical narrative in order to advance their future goals and expectations. Subsequently, they gain a new perspective, learn to identify the root cause of a problem, and adopt a new approach to resolve an issue. Based on the acquired new set of skills, beliefs, and values, they can re-write their life story and in turn, reduce the impact of a problematic event on their lives. Several studies, with encouraging results, have been conducted on narrative therapy. In some studies, the main phases of the therapy were externalizing the problem, evaluation by the therapist, re-writing the story, and solidifying the story. To the best of our knowledge, few studies have been conducted on the effectiveness of narrative therapy on variables associated with amphetamine addiction. Hence, the present study aimed to assess the effectiveness of group narrative therapy on depression, quality of life QoL , and anxiety among people with amphetamine addiction in Kermanshah, Iran. A randomized clinical trial was conducted during at Farabi Hospital and a few private addiction treatment centers in Kermanshah, Iran. Initially, a total of 60 methamphetamine-dependent patients were assessed for eligibility to participate in the study. The inclusion criteria were low depression score between 14 and 19 , age years, high school education level as a minimum , and willingness to participate. The exclusion criteria were patients with physical health problems that could hinder the psychotherapy, suicidal tendency, and undergoing concurrent psychiatric treatment. Subsequently, 20 patients were excluded from the study. In accordance with a similar study 22 and based on the convenience sampling method, the sample size of 26 was determined. The allocation sequence was generated using a list of random numbers by an independent researcher. During the intervention, 14 individuals discontinued their participation or became unreachable. The intervention group followed 10 sessions of group narrative therapy table 1 , 13 whereas the control group received routine psychiatric care. However, in compliance with ethical requirements, the participants in the control group also received group narrative therapy upon completion of the study. Figure 1. Written informed consent was obtained from the participants. Demographic characteristics included age, education level, employment, and marital status. The questionnaires were completed by all participants pre- and post-intervention. BDI-II is a item self-report questionnaire that measures the severity of depression in adults. BDI-II measures the physical, behavioral, and cognitive symptoms of depression. Each item is scored on a 4-point scale ranging from 0 to 3; corresponding to the severity of depression from mild to severe. The total score can range from 0 to SF is a item self-report questionnaire that measures both the physical and mental QoL. It includes eight dimensions, namely physical function, physical role functioning, bodily pain, general health perceptions, vitality, social role functioning, emotional role functioning, and mental health. Higher scores indicate higher QoL. The Persian version of SF was validated by Montazeri and colleagues using the known-groups technique as well as assessments of convergent validity. Based on the results of the known-groups technique, they showed that the Persian version of SF could distinguish demographic subgroups by age and sex. The range of variation in convergent validity coefficients was between 0. BAI is a item self-report questionnaire that measures the severity of anxiety in adolescents and adults. Each item of the questionnaire is scored on a 4-point scale ranging from 0 to 3; corresponding to the severity of anxiety from mild to severe. They confirmed the validity of the questionnaire; correlation coefficient 0. The data were analyzed with descriptive and inferential statistics using SPSS software version Quantitative variables mean and standard deviation were analyzed using descriptive statistics. The demographic characteristics of the participants in both groups were similar table 2. As shown in table 3, the effect of group narrative therapy on the intervention group was notable. It indicated a notable effect of group narrative therapy in the intervention group. It indicated that the group narrative therapy had no effect on the intervention group and was similar to the QoL in the control group table 3. The results of the present study showed that group narrative therapy reduced the level of depression and anxiety in patients with amphetamine addiction. These findings were confirmed by other similar studies. Narrative therapy enables such patients to re-discover their abilities and improves their sense of self-value and empowerment. As a result, such patients regain self-esteem and ability to deal with depression. It was found that group narrative therapy reduced the symptoms of anxiety in the intervention group compared to the control group. The findings of various similar studies confirmed our results. Talking about personal experiences and life events allows individuals to formulate a logical sequence, in the form of a timeline, and to review and process their memories, feelings, and thoughts. Consequently, they can rationally reconsider past experiences and present events, and re-define the future. The results showed that group narrative therapy did not improve the QoL of amphetamine addicts. A comparable study also reported no improvement on QoL among cancer patients. They concluded that long therapy sessions were more effective, however, it would not affect the QoL of terminally ill patients e. The main drawback of narrative therapy was the re-experiencing of past memories and emotions, which could cause unpleasant flashbacks and exacerbate the symptoms of an illness. As a result, patients can adjust their expectations and better adhere to the treatments. However, additional therapies should be sought to prevent the recurrence of substance abuse. The main limitations of the present study were associated with inhomogeneity and variation of confounding variables personality, physical, and psychological factors as well as the diversity of social, economic, and cultural variables. In addition, the findings of the present study could not be generalized due to the low sample size. Group narrative therapy reduced the level of depression and anxiety in patients with amphetamine addiction. However, the QoL was unaffected by the therapy. Attention should be paid to their psychological trauma, but considering the risks associated with substance abuse and dependence, non-pharmacological methods are the preferred approach to treat such patients. In parallel with other treatments, narrative therapy is recommended as a short-term, low-cost, and affordable method to treat depression and anxiety in patients with addiction. It is recommended that future studies examine the effectiveness of narrative therapy on different populations, evaluate the long-term effect of the therapy, and address the limitations of the present study. Shakeri, J. Iranian Journal of Medical Sciences , 45 2 , Iranian Journal of Medical Sciences , ; 45 2 : Guide for Authors. Submit Manuscript. Guide for Reviewers. Contact Us. Suggestion and Complain. Introduction Drug abuse is a major issue in the twenty-first century and one of the main causes of health, psychological, and social problems. Patients and Methods A randomized clinical trial was conducted during at Farabi Hospital and a few private addiction treatment centers in Kermanshah, Iran. Volume 45, Issue 2 March Pages Profile on PlumX. Homework review; mind and body relaxation exercises; improve eye contact skills; a reminder to keep daily accounts of ABCs; homework assignment. Homework review; identification of the basic assumptions about addiction and group discussion; training on how to create a new internal voice related to the basic assumption; continue with mind, body relaxation, and other exercises e. Homework review, training on how to identify addiction and group discussion; teaching corrective thinking and adding D disputing and E effective philosophy to ABCs; homework assignment relaxation and other exercises, making a new diary with a fresh mind on ABCDE, and practicing self-reward. Homework review; training on how to change problematic behavioral patterns; practicing exposure and response prevention techniques; practicing elimination, obstruction, and procrastination of preoccupation with drug addiction linked depression through techniques such as procrastination, diaphragm respiration; homework assignment using the new behavioral techniques in different situations. Homework review; building a satisfying relationship with oneself e. Homework review; rewrite the life story from the present to the future and rename it; relaxation session; training on how to create a new story; homework assignment review of all sessions and indicating the best and worst elements. Homework review; group discussion about the achieved transformations due to sessions; secondary analysis of the self-assessment tests; identification of attitudes; training on assertive reaction strategies against those having a negative attitude toward drug addicts; homework assignment implementation of the acquired strategies in everyday life.

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