Planning strategies for the avoidance of pitfalls in intervention research.

PubMed

Pruitt, R H; Privette, A B

2001-08-01

With the exception of large clinical trials, few studies in nursing and other social sciences test interventions. The discipline of nursing needs to maintain a full range of research designs for continued knowledge development. Intervention research presents unique opportunities and challenges for the novice as well as the seasoned researcher. Some of these methodological challenges include the complex nature of human subjects and interventions, including many factors that interfere with the study variables. Preliminary studies often reveal challenges that may not always be predicted or reflected in research texts. These challenges may be as important as the study results for success in future research efforts. Difficulties encountered in intervention research and suggested strategies for maintaining the integrity of the study are addressed. These challenges include maintaining an adequate sample size, intervention demands, measuring variables, timing issues, and experiencing unexpected events. Strategies presented include the importance of extensive planning, minimizing subject expectations and rewarding efforts, attention to control group members, incorporating retention strategies, expanding knowledge of variables and the study population, preliminary studies as well as anticipating unexpected events. The need for enhanced communication among nurse researchers, educators and clinicians is addressed. In the current health care arena, nurse researchers must understand organizational dynamics and marketing strategies. Collaborative research efforts can increase the visibility of nursing research as well as funding opportunities.

Cyberbullying Prevention and Intervention Efforts: Current Knowledge and Future Directions.

PubMed

Espelage, Dorothy L; Hong, Jun Sung

2017-06-01

Bullying is a serious public health concern that is associated with significant negative mental, social, and physical outcomes. Technological advances have increased adolescents' use of social media, and online communication platforms have exposed adolescents to another mode of bullying- cyberbullying. Prevention and intervention materials, from websites and tip sheets to classroom curriculum, have been developed to help youth, parents, and teachers address cyberbullying. While youth and parents are willing to disclose their experiences with bullying to their health care providers, these disclosures need to be taken seriously and handled in a caring manner. Health care providers need to include questions about bullying on intake forms to encourage these disclosures. The aim of this article is to examine the current status of cyberbullying prevention and intervention. Research support for several school-based intervention programs is summarised. Recommendations for future research are provided.

The construct of resilience: Implications for interventions and social policies

PubMed Central

LUTHAR, SUNIYA S.; CICCHETTI, DANTE

2007-01-01

The focus of this article is on the interface between research on resilience—a construct representing positive adaptation despite adversity —and the applications of this work to the development of interventions and social policies. Salient defining features of research on resilience are delineated, as are various advantages, limitations, and precautions linked with the application of the resilience framework to developing interventions. For future applied efforts within this tradition, a series of guiding principles are presented along with exemplars of existing programs based on the resilience paradigm. The article concludes with discussions of directions for future work in this area, with emphases on an enhanced interface between science and practice, and a broadened scope of resilience-based interventions in terms of the types of populations, and the types of adjustment domains, that are encompassed. PMID:11202047

Games for Health, 2011

DTIC Science & Technology

2011-06-01

The Games for Health Project, an effort organized by Digitalmill, Inc. with funding from the Robert Wood Johnson Foundation held its 7th Annual Games...features, media and design patterns associated with videogames. Some of this work is already being done by academia and grantees of Robert Wood ...for game-based interventions really exists (or doesn’t) that can be beneficial to future funding efforts by organizations such as Robert Wood Johnson

A preventive groupwork intervention with new immigrants to Israel.

PubMed

Roskin, M

1986-03-01

The act of immigration brings with it numerous major life changes and requires considerable social readjustment. Immigrants are, however, seldom offered specific training in how to effectively interact in a new culture. This paper describes an initial preventive groupwork effort to help English-speaking immigrants living in an Israeli absorption center to adjust successfully to life in a new culture. Suggestions for future preventive interventions with immigrants are considered.

Measuring impact of protected area management interventions: current and future use of the Global Database of Protected Area Management Effectiveness

PubMed Central

Coad, Lauren; Leverington, Fiona; Knights, Kathryn; Geldmann, Jonas; Eassom, April; Kapos, Valerie; Kingston, Naomi; de Lima, Marcelo; Zamora, Camilo; Cuardros, Ivon; Nolte, Christoph; Burgess, Neil D.; Hockings, Marc

2015-01-01

Protected areas (PAs) are at the forefront of conservation efforts, and yet despite considerable progress towards the global target of having 17% of the world's land area within protected areas by 2020, biodiversity continues to decline. The discrepancy between increasing PA coverage and negative biodiversity trends has resulted in renewed efforts to enhance PA effectiveness. The global conservation community has conducted thousands of assessments of protected area management effectiveness (PAME), and interest in the use of these data to help measure the conservation impact of PA management interventions is high. Here, we summarize the status of PAME assessment, review the published evidence for a link between PAME assessment results and the conservation impacts of PAs, and discuss the limitations and future use of PAME data in measuring the impact of PA management interventions on conservation outcomes. We conclude that PAME data, while designed as a tool for local adaptive management, may also help to provide insights into the impact of PA management interventions from the local-to-global scale. However, the subjective and ordinal characteristics of the data present significant limitations for their application in rigorous scientific impact evaluations, a problem that should be recognized and mitigated where possible. PMID:26460133

Piloting a psycho-social intervention for incarcerated women with trauma histories: lessons learned and future recommendations.

PubMed

Liebman, Rachel E; Burnette, Mandi L; Raimondi, Christina; Nichols-Hadeed, Corey; Merle, Patricia; Cerulli, Catherine

2014-08-01

Trauma and related mental health disorders are common among incarcerated women, but empirically sound mental health interventions are lacking in prisons. Implementing such interventions is fraught with legal and logistical barriers. These barriers can be particularly detrimental for trauma-specific interventions given the unique needs of trauma survivors, yet there is little documentation of these issues or how to address them. This study describes a pilot study of an 8-week, strengths-based, trauma-focused intervention for 26 incarcerated women. Women reported considerable mental health problems and trauma. The study highlights the importance of adapting stringent research methodologies for prison-based trauma interventions. For instance, women with trauma were reluctant to participate in an intervention advertised as trauma-based. Moreover, a randomized wait list control design was unfeasible because women wanted the support of their friends when discussing trauma and could not control their schedules 9 weeks in advance. Ultimately, this work may inform future efforts to implement effective trauma-based interventions behind prison walls. © The Author(s) 2013.

Readiness to Change Over Time: Change Commitment and Change Efficacy in a Workplace Health-Promotion Trial.

PubMed

Helfrich, Christian D; Kohn, Marlana J; Stapleton, Austin; Allen, Claire L; Hammerback, Kristen Elizabeth; Chan, K C Gary; Parrish, Amanda T; Ryan, Daron E; Weiner, Bryan J; Harris, Jeffrey R; Hannon, Peggy A

2018-01-01

Organizational readiness to change may be a key determinant of implementation success and a mediator of the effectiveness of implementation interventions. If organizational readiness can be reliably and validly assessed at the outset of a change initiative, it could be used to assess the effectiveness of implementation-support activities by measuring changes in readiness factors over time. We analyzed two waves of readiness-to-change survey data collected as part of a three-arm, randomized controlled trial to implement evidence-based health promotion practices in small worksites in low-wage industries. We measured five readiness factors: context (favorable broader conditions); change valence (valuing health promotion); information assessment (demands and resources to implement health promotion); change commitment (an intention to implement health promotion); and change efficacy (a belief in shared ability to implement health promotion). We expected commitment and efficacy to increase at intervention sites along with their self-reported effort to implement health promotion practices, termed wellness-program effort. We compared means between baseline and 15 months, and between intervention and control sites. We used linear regression to test whether intervention and control sites differed in their change-readiness scores over time. Only context and change commitment met reliability thresholds. Change commitment declined significantly for both control (-0.39) and interventions sites (-0.29) from baseline to 15 months, while context did not change for either. Only wellness program effort at 15 months, but not at baseline, differed significantly between control and intervention sites (1.20 controls, 2.02 intervention). Regression analyses resulted in two significant differences between intervention and control sites in changes from baseline to 15 months: (1) intervention sites exhibited significantly smaller change in context scores relative to control sites over time and (2) intervention sites exhibited significantly higher changes in wellness program effort relative to control sites. Contrary to our hypothesis, change commitment declined significantly at both Healthlinks and control sites, even as wellness-program effort increased significantly at HealthLinks sites. Regression to the mean may explain the decline in change commitment. Future research needs to assess whether baseline commitment is an independent predictor of wellness-program effort or an effect modifier of the HealthLinks intervention.

Enhancing Cultural and Contextual Intervention Strategies to Reduce HIV/AIDS Among African Americans

PubMed Central

2009-01-01

I describe 4 protective strategies that African Americans employ that may challenge current HIV prevention efforts: (1) an adaptive duality that protects identity, (2) personal control influenced by external factors, (3) long-established indirect communication patterns, and (4) a mistrust of “outsiders.” I propose the Sexual Health Model as a conceptual framework for HIV prevention interventions because it incorporates established adaptive coping strategies into new HIV-related protective skills. The Sexual Health Model promotes interconnectedness, sexual ownership, and body awareness, 3 concepts that represent the context of the African American historical and cultural experience and that enhance rather than contradict future prevention efforts. PMID:19762666

Reducing hospital readmission rates: current strategies and future directions.

PubMed

Kripalani, Sunil; Theobald, Cecelia N; Anctil, Beth; Vasilevskis, Eduard E

2014-01-01

New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

Cyberbullying Prevention and Intervention Efforts: Current Knowledge and Future Directions

PubMed Central

Hong, Jun Sung

2016-01-01

Bullying is a serious public health concern that is associated with significant negative mental, social, and physical outcomes. Technological advances have increased adolescents’ use of social media, and online communication platforms have exposed adolescents to another mode of bullying—cyberbullying. Prevention and intervention materials, from websites and tip sheets to classroom curriculum, have been developed to help youth, parents, and teachers address cyberbullying. While youth and parents are willing to disclose their experiences with bullying to their health care providers, these disclosures need to be taken seriously and handled in a caring manner. Health care providers need to include questions about bullying on intake forms to encourage these disclosures. The aim of this article is to examine the current status of cyberbullying prevention and intervention. Research support for several school-based intervention programs is summarised. Recommendations for future research are provided. PMID:28562094

A brief randomized controlled intervention targeting parents improves grades during middle school.

PubMed

Destin, Mesmin; Svoboda, Ryan C

2017-04-01

Despite a growing number of brief, psychosocial interventions that improve academic achievement, little research investigates how to leverage parents during such efforts. We designed and tested a randomized controlled intervention targeting parents to influence important discussions about the future and responses to academic difficulty experienced by their adolescent during eighth grade in the United States. We recruited experienced parents to convey the main messages of the intervention in a parent panel format. As expected, current parents who were randomly assigned to observe the parent panel subsequently planned to talk with their adolescents sooner about future opportunities and to respond more positively to experiences of academic difficulty than parents who were randomly assigned to a control group. The intervention also led to a significant increase in student grades, which was mediated by parents' responses to academic difficulty. We suggest an increase in experimental research that utilizes parents to influence student achievement. Copyright © 2017 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Overcoming Barriers to HIV Treatment Adherence: A Brief Cognitive Behavioral Intervention for HIV-Positive Adults on Antiretroviral Treatment

PubMed Central

Olem, David; Sharp, Kelly M.; Taylor, Jonelle M.; Johnson, Mallory O.

2014-01-01

Maximizing HIV treatment adherence is critical in efforts to optimize health outcomes and to prevent further HIV transmission. The Balance Project intervention uses cognitive behavioral approaches to improve antiretroviral medication adherence through promoting adaptive coping with medication side effect and distress related to HIV. This 5-session intervention has been documented to prevent nonadherence among persons living with HIV who experience high levels of distress associated with their antiretroviral medication side effects. We describe the theoretical underpinnings of the intervention, provide details of the training and session protocols with a case example, and discuss implications for future applications of the intervention in both research and clinical settings. PMID:24855332

Children facing a family member's acute illness: a review of intervention studies.

PubMed

Spath, Mary L

2007-07-01

A review of psycho-educational intervention studies to benefit children adapting to a close (parent, sibling, or grandparent) family member's serious illness was conducted. To review the literature on studies addressing this topic, critique research methods, describe clinical outcomes, and make recommendations for future research efforts. Research citations from 1990 to 2005 from Medline, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, and PsycINFO databases were identified. Citations were reviewed and evaluated for sample, design, theoretical framework, intervention, threats to validity, and outcomes. Reviewed studies were limited to those that included statistical analysis to evaluate interventions and outcomes. Six studies were reviewed. Positive outcomes were reported for all of the interventional strategies used in the studies. Reviewed studies generally lacked a theoretical framework and a control group, were generally composed of small convenience samples, and primarily used non-tested investigator instruments. They were diverse in terms of intervention length and intensity, and measured short-term outcomes related to participant program satisfaction, rather than participant cognitive and behavioral change. The paucity of interventional studies and lack of systematic empirical precision to evaluate intervention effectiveness necessitates future studies that are methodologically rigorous.

Advancing School-Based Interventions through Economic Analysis

ERIC Educational Resources Information Center

Olsson, Tina M.; Ferrer-Wreder, Laura; Eninger, Lilianne

2014-01-01

Commentators interested in school-based prevention programs point to the importance of economic issues for the future of prevention efforts. Many of the processes and aims of prevention science are dependent upon prevention resources. Although economic analysis is an essential tool for assessing resource use, the attention given economic analysis…

Systematic dissemination of a preschool physical activity intervention to the control preschools

PubMed Central

Howie, Erin K.; Brewer, Alisa E.; Brown, William H.; Saunders, Ruth P.; Pate, Russell R.

2016-01-01

For public health interventions to have a meaningful impact on public health, they must be disseminated to the wider population. Systematic planning and evaluation of dissemination efforts can aid translation from experimental trials to larger dissemination programs. The Study of Health and Activity in Preschool Environments (SHAPES) was a group-randomized intervention trial conducted in 16 preschools that successfully increased the physical activity of preschool age children. Following the completion of the research study protocol, the intervention was abbreviated, modified and implemented in four preschools who participated as control preschools in the original research study. The purposes of the current study were to describe the process of refining the intervention for dissemination to the control preschools, and to assess the acceptability of the resulting abbreviated intervention delivery. Five overarching behavioral objectives, informed by process evaluation, data from the original trial and collaboration with intervention teachers, were used to guide the implementation. Teachers in the dissemination classrooms reported high levels of acceptability, potential for sustainability of the program, and positive results in knowledge, skills, and child outcomes. Researchers can include a systematic approach to dissemination of effective intervention elements to the control participants in experimental studies to inform future dissemination efforts and begin to bridge the dissemination gap. PMID:27107302

Poverty and Health Disparities for American Indian and Alaska Native Children: Current Knowledge and Future Prospects

PubMed Central

Sarche, Michelle; Spicer, Paul

2008-01-01

This report explores the current state of knowledge regarding inequalities and their effect on American Indian and Alaska Native children, underscoring gaps in our current knowledge and the opportunities for early intervention to begin to address persistent challenges in young American Indian and Alaska Native children’s development. This overview documents demographic, social, health, and health care disparities as they affect American Indian and Alaska Native children, the persistent cultural strengths that must form the basis for any conscientious intervention effort, and the exciting possibilities for early childhood interventions. PMID:18579879

Narrative Means to Preventative Ends: A Narrative Engagement Framework for Designing Prevention Interventions

PubMed Central

Miller-Day, Michelle; Hecht, Michael L.

2013-01-01

This paper describes a Narrative Engagement Framework (NEF) for guiding communication-based prevention efforts. This framework suggests that personal narratives have distinctive capabilities in prevention. The paper discusses the concept of narrative, links narrative to prevention, and discusses the central role of youth in developing narrative interventions. As illustration, the authors describe how the NEF is applied in the keepin’ it REAL adolescent drug prevention curriculum, pose theoretical directions, and offer suggestions for future work in prevention communication. PMID:23980613

Factors involved in the collaboration between the national comprehensive cancer control programs and tobacco control programs: a qualitative study of 6 States, United States, 2012.

PubMed

Momin, Behnoosh; Neri, Antonio; Goode, Sonya A; Sarris Esquivel, Nikie; Schmitt, Carol L; Kahende, Jennifer; Zhang, Lei; Stewart, Sherri L

2015-05-28

Historically, federal funding streams to address cancer and tobacco use have been provided separately to state health departments. This study aims to document the impact of a recent focus on coordinating chronic disease efforts through collaboration between the 2 programs. Through a case-study approach using semistructured interviews, we collected information on the organizational context, infrastructure, and interaction between cancer and tobacco control programs in 6 states from March through July 2012. Data were analyzed with NVivo software, using a grounded-theory approach. We found between-program activities in the state health department and coordinated implementation of interventions in the community. Factors identified as facilitating integrated interventions in the community included collaboration between programs in the strategic planning process, incorporation of one another's priorities into state strategic plans, co-location, and leadership support for collaboration. Coalitions were used to deliver integrated interventions to the community. Five states perceived high staff turnover as a barrier to collaboration, and all 5 states felt that federal funding requirements were a barrier. Cancer and tobacco programs are beginning to implement integrated interventions to address chronic disease. Findings can inform the development of future efforts to integrate program activities across chronic disease prevention efforts.

Impact assessment of risk management interventions.

PubMed

Shryock, T R

2012-04-01

Much effort has been invested in the development and implementation of international recommendations to manage the risk of foodborne antimicrobial resistance, and monitoring programmes to measure bacterial antimicrobial resistance and antimicrobial product volumes. A variety of approaches have been recommended for various stakeholders in the food animal and food production sectors. Interestingly, much less consideration has been given to the establishment of success criteria for the individual interventions and even less for the cumulative effects, when all interventions are considered together as consecutive 'hurdles' along the food chain. The author explores the outcome and unforeseen consequences of these various interventions and appropriate methods that could provide data to assess their impact, as well as key learning experiences that should lead to refinements of such interventions in the future.

Successfully Sustaining Sex and Gender Issues in Undergraduate Medical Education: A Case Study

ERIC Educational Resources Information Center

van der Meulen, Francisca; Fluit, Cornelia; Albers, Mieke; Laan, Roland; Lagro-Janssen, Antoine

2017-01-01

Although several projects have addressed the importance of gender health issues in medical education, the sustainability of change efforts in medical education has rarely been addressed. Understanding the possible facilitators or barriers to sustainability may help to develop future interventions that are effective in maintaining gender health…

Early life programming as a target for prevention of child and adolescent mental disorders

PubMed Central

2014-01-01

This paper concerns future policy development and programs of research for the prevention of mental disorders based on research emerging from fetal and early life programming. The current review offers an overview of findings on pregnancy exposures such as maternal mental health, lifestyle factors, and potential teratogenic and neurotoxic exposures on child outcomes. Outcomes of interest are common child and adolescent mental disorders including hyperactive, behavioral and emotional disorders. This literature suggests that the preconception and perinatal periods offer important opportunities for the prevention of deleterious fetal exposures. As such, the perinatal period is a critical period where future mental health prevention efforts should be focused and prevention models developed. Interventions grounded in evidence-based recommendations for the perinatal period could take the form of public health, universal and more targeted interventions. If successful, such interventions are likely to have lifelong effects on (mental) health. PMID:24559477

Emerging issues in public health genomics

PubMed Central

Roberts, J. Scott

2014-01-01

This review highlights emerging areas of interest in public health genomics. First, recent advances in newborn screening (NBS) are described, with a focus on practice and policy implications of current and future efforts to expand NBS programs (e.g., via next-generation sequencing). Next, research findings from the rapidly progressing field of epigenetics and epigenomics are detailed, highlighting ways in which our emerging understanding in these areas could guide future intervention and research efforts in public health. We close by considering various ethical, legal and social issues posed by recent developments in public health genomics; these include policies to regulate access to personal genomic information; the need to enhance genetic literacy in both health professionals and the public; and challenges in ensuring that the benefits (and burdens) from genomic discoveries and applications are equitably distributed. Needs for future genomics research that integrates across basic and social sciences are also noted. PMID:25184533

Behavioral Health and Disasters: Looking to the Future

PubMed Central

Palinkas, Lawrence A.

2014-01-01

Along with other manmade and natural disasters, oil spills produce profound and long-term impacts on the behavioral health of their survivors. While previous and ongoing research has focused on producing evidence of the breadth and depth of these impacts, future efforts must begin to translate this evidence into developing and implementing policies, programs and practices that effectively contribute to their prevention and mitigation. Drawing upon a conceptual framework of the behavioral health impacts of oil spills developed from data collected in the aftermath of the Exxon Valdez oil spill in 1989, this paper examines potential interventions designed to prevent or mitigate biopsychosocial, interpersonal and intrapersonal impacts on behavioral health. Future efforts to translate behavioral health research into effective practice will require the formation and maintenance of academic-community partnerships for the purpose of building resilience to these impacts and providing targeted services to those most vulnerable to their long-term consequences. PMID:24443145

Invited Commentary: Built Environment and Obesity Among Older Adults—Can Neighborhood-level Policy Interventions Make a Difference?

PubMed Central

Yen, Irene H.

2009-01-01

Obesity is more prevalent and its consequences severe among middle-aged and older adults. Efforts to understand and address neighborhood-level causes of obesity in this population offer the potential to enhance health and reduce the costs of obesity for everyone. The accompanying paper by Li et al. (Am J Epidemiol. 2009;169(4):401–408) presents new data on the apparently significant interaction between neighborhood and individual characteristics on 1-year change in body weight and waist circumference. Despite methodological limitations in measurement, this paper supports the importance of future research that considers the complex relation between people and where they live. Efforts to design neighborhood-level policy interventions to effectively address the problem of obesity will require greater interdisciplinary collaboration. PMID:19153213

Pharmacology of manipulating lean body mass

PubMed Central

Sepulveda, Patricio V; Bush, Ernest D; Baar, Keith

2015-01-01

Summary Dysfunction and wasting of skeletal muscle as a consequence of illness decreases the length and quality of life. Currently, there are few, if any, effective treatments available to address these conditions. Hence, the existence of this unmet medical need has fuelled large scientific efforts.Fortunately, these efforts have shown many of the underlying mechanisms adversely affecting skeletal muscle health.With increased understanding have come breakthrough disease-specific and broad spectrum interventions, some progressing through clinical development.The present review focuses its attention on the role of the antagonistic process regulating skeletal muscle mass before branching into prospective promising therapeutic targets and interventions. Special attention is given to therapies in development against cancer cachexia and Duchenne muscular dystrophy before closing remarks on design and conceptualization of future therapies are presented to the reader. PMID:25311629

Promoting family meals: a review of existing interventions and opportunities for future research

PubMed Central

Dwyer, Laura; Oh, April; Patrick, Heather; Hennessy, Erin

2015-01-01

Evidence suggests that regular family meals protect against unhealthy eating and obesity during childhood and adolescence. However, there is limited information on ways to promote family meals as part of health promotion and obesity prevention efforts. The primary aim of this review was to synthesize the literature on strategies to promote family meals among families with school-aged children and adolescents. First, we reviewed interventions that assess family meals as an outcome and summarized strategies that have been used in these interventions. Second, we reviewed correlates and barriers to family meals to identify focal populations and target constructs for consideration in new interventions. During May 26–27, 2014, PubMed and PsycInfo databases were searched to identify literature on family meals published between January 1, 2000 and May 27, 2014. Two reviewers coded 2,115 titles/abstracts, yielding a sample of 139 articles for full-text review. Six interventions and 43 other studies presenting data on correlates of or barriers to family meals were included in the review. Four interventions resulted in greater family meal frequency. Although there were a small number of interventions, intervention settings were diverse and included the home, community, medical settings, the workplace, and the Internet. Common strategies were goal setting and interactive group activities, and intervention targets included cooking and food preparation, cost, shopping, and adolescent influence. Although methodological nuances may contribute to mixed findings, key correlates of family meals were employment, socioeconomic and demographic factors, family structure, and psychosocial constructs. Barriers to consider in future interventions include time and scheduling challenges, cost, and food preferences. Increasing youth involvement in mealtime, tailoring interventions to family characteristics, and providing support for families experiencing time-related barriers are suggested strategies for future research. PMID:26124690

Promoting family meals: a review of existing interventions and opportunities for future research.

PubMed

Dwyer, Laura; Oh, April; Patrick, Heather; Hennessy, Erin

2015-01-01

Evidence suggests that regular family meals protect against unhealthy eating and obesity during childhood and adolescence. However, there is limited information on ways to promote family meals as part of health promotion and obesity prevention efforts. The primary aim of this review was to synthesize the literature on strategies to promote family meals among families with school-aged children and adolescents. First, we reviewed interventions that assess family meals as an outcome and summarized strategies that have been used in these interventions. Second, we reviewed correlates and barriers to family meals to identify focal populations and target constructs for consideration in new interventions. During May 26-27, 2014, PubMed and PsycInfo databases were searched to identify literature on family meals published between January 1, 2000 and May 27, 2014. Two reviewers coded 2,115 titles/abstracts, yielding a sample of 139 articles for full-text review. Six interventions and 43 other studies presenting data on correlates of or barriers to family meals were included in the review. Four interventions resulted in greater family meal frequency. Although there were a small number of interventions, intervention settings were diverse and included the home, community, medical settings, the workplace, and the Internet. Common strategies were goal setting and interactive group activities, and intervention targets included cooking and food preparation, cost, shopping, and adolescent influence. Although methodological nuances may contribute to mixed findings, key correlates of family meals were employment, socioeconomic and demographic factors, family structure, and psychosocial constructs. Barriers to consider in future interventions include time and scheduling challenges, cost, and food preferences. Increasing youth involvement in mealtime, tailoring interventions to family characteristics, and providing support for families experiencing time-related barriers are suggested strategies for future research.

Development of an intervention to improve mental health for obstetric fistula patients in Tanzania

PubMed Central

Watt, Melissa H.; Wilson, Sarah M.; Sikkema, Kathleen J.; Velloza, Jennifer; Mosha, Mary V.; Masenga, Gileard G.; Bangser, Margaret; Browning, Andrew; Nyindo, Pilli M.

2015-01-01

Obstetric fistula is a debilitating childbirth injury that has been associated with high rates of psychological distress. Global efforts have helped to link women to surgical repair, but thus far no evidence-based interventions exist to address the psychological needs of these women during the hospital stay. In this paper, we describe the development of a psychological intervention for women in Tanzania who are receiving surgical care for an obstetric fistula. The intervention was developed based on theories of cognitive behavioral therapy and coping models. Content and delivery were informed by qualitative data collection with a range of stakeholders including women with fistula, and input from a study advisory board. The resulting intervention was six individual sessions, delivered by a trained community health nurse. The session topics were: 1) recounting the fistula story; 2) creating a new story about the fistula; 3) loss, grief and shame; 4) specific strategies for coping; 5) social relationships; and 6) planning for the future. A trial run of the intervention revealed that the intervention could be delivered with fidelity and was acceptable to patients. A future randomized control trial will evaluate the efficacy of this intervention to address the mental health symptoms of this population. PMID:25710896

Grade-Level Differences in Future-Oriented Self-Concept During Early Adolescence: Potential Relevance to School Nursing

PubMed Central

2016-01-01

The middle school and early high school years are a time of significant development, including an increasing ability to envision oneself in the future. Little is known about how adolescents’ future-oriented self-concept (i.e., possible selves) differs across grade levels, although this knowledge may aid in establishing rapport with students and building effective health-promotion and risk reduction interventions. Therefore, this study explored grade-level differences in hoped for and feared possible selves in a sample of 6th – 9th grade students (n = 2,498; Mage = 12.72, SD = 1.15; 51.3% female). Findings suggest that adolescents list a variety of possible selves, and the content differs according to grade-level. These findings offer helpful insight for intervention work aimed at improving student outcomes and preventing risk behavior. Understanding what adolescents hope and fear for themselves in the future may be particularly beneficial for school nurses in identifying the unique challenges students experience and tailoring health-promotion efforts. PMID:27222444

Grade-Level Differences in Future-Oriented Self-Concept During Early Adolescence: Potential Relevance to School Nursing.

PubMed

Stoddard, Sarah A; Pierce, Jennifer; Schmidt, Carissa J

2016-12-01

The middle school and early high school years are a time of significant development, including an increasing ability to envision oneself in the future. Little is known about how adolescents' future-oriented self-concept (i.e., possible selves) differs across grade levels, although this knowledge may aid in establishing rapport with students and building effective health promotion and risk reduction interventions. Therefore, this study explored grade-level differences in hoped for and feared possible selves in a sample of sixth- to ninth-grade students (n = 2,498; M age = 12.72, SD = 1.15; 51.3% female). Findings suggest that adolescents list a variety of possible selves, and the content differs according to grade level. These findings offer helpful insight for intervention work aimed at improving student outcomes and preventing risk behavior. Understanding what adolescents hope and fear for themselves in the future may be particularly beneficial for school nurses in identifying the unique challenges students experience and tailoring health promotion efforts. © The Author(s) 2016.

An exploratory study to examine intentions to adopt an evidence-based HIV linkage-to-care intervention among state health department AIDS directors in the United States.

PubMed

Norton, Wynne E

2012-04-02

Widespread dissemination and implementation of evidence-based human immunodeficiency virus (HIV) linkage-to-care (LTC) interventions is essential for improving HIV-positive patients' health outcomes and reducing transmission to uninfected others. To date, however, little work has focused on identifying factors associated with intentions to adopt LTC interventions among policy makers, including city, state, and territory health department AIDS directors who play a critical role in deciding whether an intervention is endorsed, distributed, and/or funded throughout their region. Between December 2010 and February 2011, we administered an online questionnaire with state, territory, and city health department AIDS directors throughout the United States to identify factors associated with intentions to adopt an LTC intervention. Guided by pertinent theoretical frameworks, including the Diffusion of Innovations and the "push-pull" capacity model, we assessed participants' attitudes towards the intervention, perceived organizational and contextual demand and support for the intervention, likelihood of adoption given endorsement from stakeholder groups (e.g., academic researchers, federal agencies, activist organizations), and likelihood of enabling future dissemination efforts by recommending the intervention to other health departments and community-based organizations. Forty-four participants (67% of the eligible sample) completed the online questionnaire. Approximately one-third (34.9%) reported that they intended to adopt the LTC intervention for use in their city, state, or territory in the future. Consistent with prior, related work, these participants were classified as LTC intervention "adopters" and were compared to "nonadopters" for data analysis. Overall, adopters reported more positive attitudes and greater perceived demand and support for the intervention than did nonadopters. Further, participants varied with their intention to adopt the LTC intervention in the future depending on endorsement from different key stakeholder groups. Most participants indicated that they would support the dissemination of the intervention by recommending it to other health departments and community-based organizations. Findings from this exploratory study provide initial insight into factors associated with public health policy makers' intentions to adopt an LTC intervention. Implications for future research in this area, as well as potential policy-related strategies for enhancing the adoption of LTC interventions, are discussed.

Psychosocial factors and theory in physical activity studies in minorities.

PubMed

Mama, Scherezade K; McNeill, Lorna H; McCurdy, Sheryl A; Evans, Alexandra E; Diamond, Pamela M; Adamus-Leach, Heather J; Lee, Rebecca E

2015-01-01

To summarize the effectiveness of interventions targeting psychosocial factors to increase physical activity (PA) among ethnic minority adults and explore theory use in PA interventions. Studies (N = 11) were identified through a systematic review and targeted African American/Hispanic adults, specific psychosocial factors, and PA. Data were extracted using a standard code sheet and the Theory Coding Scheme. Social support was the most common psychosocial factor reported, followed by motivational readiness, and self-efficacy, as being associated with increased PA. Only 7 studies explicitly reported using a theoretical framework. Future efforts should explore theory use in PA interventions and how integration of theoretical constructs, including psychosocial factors, increases PA.

Future Directions for Research in Autism Spectrum Disorders

PubMed Central

Damiano, Cara R.; Mazefsky, Carla A.; White, Susan W.; Dichter, Gabriel S.

2014-01-01

This article suggests future directions for research aimed at improved understanding of the etiology and pathophysiology of autism spectrum disorder (ASD) as well as pharmacologic and psychosocial interventions for ASD across the lifespan. The past few years have witnessed unprecedented transformations in the understanding of ASD neurobiology, genetics, early identification, and early intervention. However, recent increases in ASD prevalence estimates highlight the urgent need for continued efforts to translate novel ASD discoveries into effective interventions for all individuals with ASD. In this article we highlight promising areas for ongoing and new research expected to quicken the pace of scientific discovery and ultimately the translation of research findings into accessible and empirically supported interventions for those with ASD. We highlight emerging research in the following domains as particularly promising and pressing: (1) preclinical models; (2) experimental therapeutics; (3) early identification and intervention; (4) psychiatric comorbidities and the Research Domain Criteria (RDoC) initiative; (5) ecological momentary assessment; (6) neurotechnologies; and (7) the needs of adults with ASD. Increased research emphasis in these areas has the potential to hasten the translation of knowledge on the etiological mechanisms of ASD to psychosocial and biological interventions to reduce the burden of ASD on affected individuals and their families. PMID:25216048

Designing Interventions that Last: A Classification of Environmental Behaviors in Relation to the Activities, Costs, and Effort Involved for Adoption and Maintenance

PubMed Central

Moore, Harriet E.; Boldero, Jennifer

2017-01-01

Policy makers draw on behavioral research to design interventions that promote the voluntary adoption of environmental behavior in societies. Many environmental behaviors will only be effective if they are maintained over the long-term. In the context of climate change and concerns about future water security, behaviors that involve reducing energy consumption and improving water quality must be continued indefinitely to mitigate global warming and preserve scarce resources. Previous reviews of environmental behavior have focused exclusively on factors related to adoption. This review investigates the factors that influence both adoption and maintenance, and presents a classification of environmental behaviors in terms of the activities, costs, and effort required for both adoption and maintenance. Three categories of behavior are suggested. One-off behaviors involve performing an activity once, such as purchasing an energy efficient washing machine, or signing a petition. Continuous behaviors involve the performance of the same set of behaviors for adoption and for maintenance, such as curbside recycling. Dynamic behaviors involve the performance of different behaviors for adoption and maintenance, such as revegetation. Behaviors can also be classified into four categories related to cost and effort: those that involve little cost and effort for adoption and maintenance, those that involve moderate cost and effort for adoption and maintenance, those that involve a high cost or effort for adoption and less for maintenance, and those that involve less cost or effort for adoption and a higher amount for maintenance. In order to design interventions that last, policy makers should consider the factors that influence the maintenance as well as the adoption of environmental behaviors. PMID:29163265

Teaching High School Biology Students to Coordinate Text and Diagrams: Relations with Transfer, Effort, and Spatial Skill

NASA Astrophysics Data System (ADS)

Bergey, Bradley W.; Cromley, Jennifer G.; Newcombe, Nora S.

2015-10-01

There is growing evidence that targeted instruction can improve diagram comprehension, yet one of the skills identified in the diagram comprehension literature-coordinating multiple representations-has rarely been directly taught to students and tested as a classroom intervention. We created a Coordinating Multiple Representation (CMR) intervention that was an addition to an intervention focused on Conventions of Diagrams (COD) and tested their joint effects on diagram comprehension for near transfer (uninstructed biology diagrams), far transfer (uninstructed geology diagrams), and content learning (biology knowledge). The comparison group received instruction using a previously validated intervention that focused exclusively on COD. Participants were 9th-10th grade biology students (N = 158 from two schools), whose classes were randomly assigned to COD alone or COD + CMR conditions and studied with a pretest-posttest experimental design. Both groups showed significant growth in biology knowledge (d = .30-.53, for COD and COD + CMR, respectively) and biology diagram comprehension (d = .28-.57). Neither group showed far transfer. Analyses of student work products during the interventions suggest that gains were not simply due to the passage of time, because student effort was correlated with gains in both treatment groups. Directions for improving future CMR interventions are discussed.

Improving Environmental Health Literacy and Justice through Environmental Exposure Results Communication

PubMed Central

Ramirez-Andreotta, Monica D.; Brody, Julia Green; Lothrop, Nathan; Loh, Miranda; Beamer, Paloma I.; Brown, Phil

2016-01-01

Understanding the short- and long-term impacts of a biomonitoring and exposure project and reporting personal results back to study participants is critical for guiding future efforts, especially in the context of environmental justice. The purpose of this study was to evaluate learning outcomes from environmental communication efforts and whether environmental health literacy goals were met in an environmental justice community. We conducted 14 interviews with parents who had participated in the University of Arizona’s Metals Exposure Study in Homes and analyzed their responses using NVivo, a qualitative data management and analysis program. Key findings were that participants used the data to cope with their challenging circumstances, the majority of participants described changing their families’ household behaviors, and participants reported specific interventions to reduce family exposures. The strength of this study is that it provides insight into what people learn and gain from such results communication efforts, what participants want to know, and what type of additional information participants need to advance their environmental health literacy. This information can help improve future report back efforts and advance environmental health and justice. PMID:27399755

17 CFR Appendix B to Part 38 - Guidance on, and Acceptable Practices in, Compliance With Core Principles

Code of Federal Regulations, 2014 CFR

2014-04-01

.... The designated contract market must demonstrate that it is making a good-faith effort to resolve... decision-making and implementation of emergency intervention in the market. At a minimum, the DCM must have... COMMODITY FUTURES TRADING COMMISSION DESIGNATED CONTRACT MARKETS Pt. 38, App. B Appendix B to Part 38...

States Get Flexibility on Targets

ERIC Educational Resources Information Center

Hoff, David J.

2008-01-01

As President Bush nears the end of his tenure, his administration is putting its final stamp on the No Child Left Behind Act and trying to lay the groundwork for the law's future. This article reports on the latest effort of President Bush's administration that will allow as many as 10 states to create alternative interventions for schools that…

Attack-Related Life Disruption and Child Psychopathology in New York City Public Schoolchildren 6-Months Post-9/11

ERIC Educational Resources Information Center

Comer, Jonathan S.; Fan, Bin; Duarte, Cristiane S.; Wu, Ping; Musa, George J.; Mandell, Donald J.; Albano, Anne Marie; Hoven, Christina W.

2010-01-01

In the aftermath of disasters, understanding relationships between disaster-related life disruption and children's functioning is key to informing future postdisaster intervention efforts. The present study examined attack-related life disruptions and psychopathology in a representative sample (N = 8,236) of New York City public schoolchildren…

Pediatric Psychologist Use of Adherence Assessments and Interventions

PubMed Central

Rohan, Jennifer M.; Martin, Staci; Hommel, Kevin; Greenley, Rachel Neff; Loiselle, Kristin; Ambrosino, Jodie; Fredericks, Emily M.

2013-01-01

Objective To document current clinical practices for medical regimen adherence assessment and intervention in the field of pediatric psychology. Methods 113 members of the Society of Pediatric Psychology completed an anonymous online survey that assessed use of adherence assessments and interventions in clinical practice, barriers and facilitators to their use, and preferred resources for obtaining information on adherence assessments and interventions. Results Respondents reported using a range of adherence assessment and intervention strategies, some of which are evidence-based. Barriers to implementing these clinical strategies included time constraints and lack of familiarity with available clinical tools. Respondents reported that education about effective clinical tools would facilitate their use of adherence assessments and interventions. Conclusions Future research and clinical efforts in adherence should consider developing practical tools for clinical practice, making accessible resources to promote dissemination of these tools, and increase understanding of clinician implementation of adherence assessments and interventions. PMID:23658375

Comprehensive HIV Prevention for Transgender Persons.

PubMed

Neumann, Mary Spink; Finlayson, Teresa J; Pitts, Nicole L; Keatley, JoAnne

2017-02-01

Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk. By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons' HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels-socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education. We present current HIV prevention efforts that reach transgender persons and present others for future consideration.

Comprehensive HIV Prevention for Transgender Persons

PubMed Central

Neumann, Mary Spink; Finlayson, Teresa J.; Pitts, Nicole L.; Keatley, JoAnne

2017-01-01

Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk. By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons’ HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels—socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education. We present current HIV prevention efforts that reach transgender persons and present others for future consideration. PMID:27997228

Psychosocial Factors and Theory in Physical Activity Studies in Minorities

PubMed Central

Mama, Scherezade K.; McNeill, Lorna H.; McCurdy, Sheryl A.; Evans, Alexandra E.; Diamond, Pamela M.; Adamus-Leach, Heather J.; Lee, Rebecca E.

2015-01-01

Objectives To summarize the effectiveness of interventions targeting psychosocial factors to increase physical activity (PA) among ethnic minority adults and explore theory use in PA interventions. Methods Studies (N = 11) were identified through a systematic review and targeted African American/Hispanic adults, specific psychosocial factors, and PA. Data were extracted using a standard code sheet and the Theory Coding Scheme. Results Social support was the most common psychosocial factor reported, followed by motivational readiness, and self-efficacy, as being associated with increased PA. Only 7 studies explicitly reported using a theoretical framework. Conclusions Future efforts should explore theory use in PA interventions and how integration of theoretical constructs, including psychosocial factors, increases PA. PMID:25290599

Future Directions: How Virtual Reality Can Further Improve the Assessment and Treatment of Eating Disorders and Obesity.

PubMed

Gutiérrez-Maldonado, José; Wiederhold, Brenda K; Riva, Giuseppe

2016-02-01

Transdisciplinary efforts for further elucidating the etiology of eating and weight disorders and improving the effectiveness of the available evidence-based interventions are imperative at this time. Recent studies indicate that computer-generated graphic environments-virtual reality (VR)-can integrate and extend existing treatments for eating and weight disorders (EWDs). Future possibilities for VR to improve actual approaches include its use for altering in real time the experience of the body (embodiment) and as a cue exposure tool for reducing food craving.

Bullying Prevention Is Crime Prevention. A Report by Fight Crime: Invest in Kids.

ERIC Educational Resources Information Center

Kass, David; Evans, Phil; Shah, Rita

Asserting that prevention and intervention efforts to reduce bullying can serve to reduce later criminal behavior and save lives, this report identifies programs that have reduced bullying by as much as half and cut future arrests in half, and urges schools to invest in these programs. Chapter 1 of the report defines bullying and presents…

Translation of the Diabetes Prevention Program to Ethnic Communities in the United States.

PubMed

Hall, Daniel L; Lattie, Emily G; McCalla, Judith R; Saab, Patrice G

2016-04-01

The Diabetes Prevention Program (DPP), an evidenced-based lifestyle intervention for type 2 diabetes (T2D), has been translated for use with ethnic minority communities throughout the United States that are disproportionately at-risk for T2D. The present paper sought to critically review ethnic translation studies of the DPP with respect to translation methods utilized, the success of these methods, and alternative or supplemental methodologies for future translation efforts. Manuscripts reviewed were found by searching PubMed and PsycINFO, using the terms: "diabetes prevention program" AND ["translation" or "ethnic"]. Of 89 papers found, only 6 described ethnic translations of the DPP in the United States, and were included in this review. Translations of the DPP to African American, Hispanic/Latino, Native Hawaiian and Other Pacific Islander, Arab American, and American Indian and Native Alaskan communities were identified and reviewed. The most common translation strategies included group-based delivery and use of bilingual study personnel. Generally, these factors appeared to increase acceptability of the intervention within the ethnic communities reviewed, and should be considered in future efforts to implement and translate the DPP to ethnic communities in the United States.

Psychological response to the Oklahoma City bombing.

PubMed

Krug, R S; Nixon, S J; Vincent, R

1996-01-01

The bombing of the Alfred P. Murrah Federal Office Building in Oklahoma City was the most devastating terrorist activity that has occurred in America. Prevention of revictimization of persons seriously affected by the bombing was central to the planned response to this tragedy. Coordination and collaboration among local, state, and national agencies promoted effective clinical services provision, research facilitation, and prevention of revictimization. Information gathered from this cooperative effort will contribute to the effort to minimize the potential for such tragedies in the future as well as help to develop prevention and intervention strategies to reduce the effects when the next such disaster occurs.

Commentary: evidence to guide gun violence prevention in America.

PubMed

Webster, Daniel W

2015-03-18

Gun violence is a major threat to the public's health and safety in the United States. The articles in this volume's symposium on gun violence reveal the scope of the problem and new trends in mortality rates from gunfire. Leading scholars synthesize research evidence that demonstrates the ability of numerous policies and programs-each consistent with lessons learned from successful efforts to combat public health problems-to prevent gun violence. Each approach presents challenges to successful implementation. Future research should inform efforts to assess which approaches are most effective and how to implement evidence-based interventions most effectively.

Framework for Evaluating the Health Impact of the Scale-Up of Malaria Control Interventions on All-Cause Child Mortality in Sub-Saharan Africa.

PubMed

Yé, Yazoume; Eisele, Thomas P; Eckert, Erin; Korenromp, Eline; Shah, Jui A; Hershey, Christine L; Ivanovich, Elizabeth; Newby, Holly; Carvajal-Velez, Liliana; Lynch, Michael; Komatsu, Ryuichi; Cibulskis, Richard E; Moore, Zhuzhi; Bhattarai, Achuyt

2017-09-01

Concerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria's Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design. This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality.

From Project to Program: Tupange's Experience with Scaling Up Family Planning Interventions in Urban Kenya.

PubMed

Keyonzo, Nelson; Nyachae, Paul; Kagwe, Peter; Kilonzo, Margaret; Mumba, Feddis; Owino, Kenneth; Kichamu, George; Kigen, Bartilol; Fajans, Peter; Ghiron, Laura; Simmons, Ruth

2015-05-01

This paper describes how the Urban Reproductive Health Initiative in Kenya, the Tupange Project (2010-2015), successfully applied the ExpandNet approach to sustainably scale up family planning interventions, first in Machakos and Kakamega, and subsequently also in its three core cities, Nairobi, Kisumu and Mombasa. This new focus meant shifting from a "project" to a "program" approach, which required paying attention to government leadership and ownership, limiting external inputs, institutionalizing interventions in existing structures and emphasizing sustainability. The paper also highlights the project's efforts to prepare for the future scale up of Tupange's interventions in other counties to support continuing and improved access to family planning services in the new context of devolution (decentralization) in Kenya. Copyright © 2015. Published by Elsevier Ltd.

Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

PubMed

Billings, J Andrew; Bernacki, Rachelle

2014-04-01

Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions.

An exploratory study to examine intentions to adopt an evidence-based HIV linkage-to-care intervention among state health department AIDS directors in the United States

PubMed Central

2012-01-01

Background Widespread dissemination and implementation of evidence-based human immunodeficiency virus (HIV) linkage-to-care (LTC) interventions is essential for improving HIV-positive patients' health outcomes and reducing transmission to uninfected others. To date, however, little work has focused on identifying factors associated with intentions to adopt LTC interventions among policy makers, including city, state, and territory health department AIDS directors who play a critical role in deciding whether an intervention is endorsed, distributed, and/or funded throughout their region. Methods Between December 2010 and February 2011, we administered an online questionnaire with state, territory, and city health department AIDS directors throughout the United States to identify factors associated with intentions to adopt an LTC intervention. Guided by pertinent theoretical frameworks, including the Diffusion of Innovations and the "push-pull" capacity model, we assessed participants' attitudes towards the intervention, perceived organizational and contextual demand and support for the intervention, likelihood of adoption given endorsement from stakeholder groups (e.g., academic researchers, federal agencies, activist organizations), and likelihood of enabling future dissemination efforts by recommending the intervention to other health departments and community-based organizations. Results Forty-four participants (67% of the eligible sample) completed the online questionnaire. Approximately one-third (34.9%) reported that they intended to adopt the LTC intervention for use in their city, state, or territory in the future. Consistent with prior, related work, these participants were classified as LTC intervention "adopters" and were compared to "nonadopters" for data analysis. Overall, adopters reported more positive attitudes and greater perceived demand and support for the intervention than did nonadopters. Further, participants varied with their intention to adopt the LTC intervention in the future depending on endorsement from different key stakeholder groups. Most participants indicated that they would support the dissemination of the intervention by recommending it to other health departments and community-based organizations. Conclusions Findings from this exploratory study provide initial insight into factors associated with public health policy makers' intentions to adopt an LTC intervention. Implications for future research in this area, as well as potential policy-related strategies for enhancing the adoption of LTC interventions, are discussed. PMID:22471965

Identification of potential or preclinical cognitive impairment and the implications of sophisticated screening with biomarkers and cognitive testing: does it really matter?

PubMed

Gordon, Michael

2013-01-01

The last decade has seen an enormous growth in the interest in the recognition of and intervention in those diagnosed and living with the whole range of cognitive impairment and frank dementia. In the western world, the recognition of the impact on patients, families, health care systems, and societies that dementia poses has led to great efforts to help define the indicators for current and future dementia with the intention to treat those already afflicted even with the primarily symptomatic medications that exist and to recognize those at future risk with the hope of providing counselling to forestall its future development. The idea of "early diagnosis" appears at first glance to be attractive for the purposes of future planning and research studies, but it is not clear what the benefits and risks might be if screening processes define people at risk when beneficial interventions might not yet be determined. The ethical as well as financial implications must be explored and defined before implementation of such screening becomes a normal standard of practice.

Public Policies and Interventions for Diabetes in Latin America: a Scoping Review.

PubMed

Kaselitz, Elizabeth; Rana, Gurpreet K; Heisler, Michele

2017-08-01

Successful interventions are needed to diagnose and manage type 2 diabetes (T2DM) in Latin America, a region that is experiencing a significant rise in rates of T2DM. Complementing an earlier review exploring diabetes prevention efforts in Latin America, this scoping review examines the literature on (1) policies and governmental programs intended to improve diabetes diagnosis and treatment in Latin America and (2) interventions to improve diabetes management in Latin America. It concludes with a brief discussion of promising directions for future research. Governmental policies and programs for the diagnosis and treatment of diabetes in different Latin American countries have been implemented, but their efficacy to date has not been rigorously evaluated. There are some promising intervention approaches in Latin America to manage diabetes that have been evaluated. Some of these utilize multidisciplinary teams, a relatively resource-intensive approach difficult to replicate in low-resource settings. Other evaluated interventions in Latin America have successfully leveraged mobile health tools, trained peer volunteers, and community health workers (CHWs) to improve diabetes management and outcomes. There are some promising approaches and large-scale governmental efforts underway to curb the growing burden of type 2 diabetes in Latin America. While some of these interventions have been rigorously evaluated, further research is warranted to determine their effectiveness, cost, and scalability in this region.

Thirty Years of Disparities Intervention Research:What are We Doing to Close Racial and Ethnic Gaps in Health Care?

PubMed Central

Clarke, Amanda R.; Goddu, Anna P.; Nocon, Robert S.; Stock, Nicholas W.; Chyr, Linda C.; Akuoko, Jaleesa A.S.; Chin, Marshall H.

2013-01-01

Background A systematic scan of the disparities intervention literature will allow researchers, providers, and policymakers to understand which interventions are being evaluated to improve minority health and which areas require further research. Methods We systematically categorized 391 disparities intervention articles published between 1979 and 2011, covering 11 diseases. We developed a taxonomy of disparities interventions using qualitative theme analysis. We identified the tactic, or what was done to intervene; the strategy, or a group of tactics with common characteristics; and the level, or who was targeted by the effort. Results The taxonomy included 44 tactics, nine strategies, and six levels. Delivering education and training was the most common strategy (37%). Within education and training, the most common tactics were education about disease (14%) and self-management (11%), while communication-skills training (3%) and decision-making aids (1%) were less frequent. The strategy of actively engaging the community through tactics such as community health workers and outreach efforts accounted for 6.5% of tactics. Interventions most commonly targeted patients (50%) and community members who were not established patients of the intervening organization (32%). Interventions targeting providers (7%), the microsystem (immediate care team) (9%), organizations (3%), and policies (0.1%) were less common. Conclusions Disparities researchers have predominantly focused on the patient as the target for change; future research should also investigate how to improve the system that serves minority patients. Areas for further study include interventions that engage the community, educational interventions that address communication barriers, and the impact of policy reform on disparities in care. PMID:24128746

Nonmedical interventions for children with ASD: recommended guidelines and further research needs.

PubMed

Maglione, Margaret A; Gans, Daphna; Das, Lopamudra; Timbie, Justin; Kasari, Connie

2012-11-01

To use the findings of a systematic review of scientific evidence to develop consensus guidelines on nonmedical interventions that address cognitive function and core deficits in children with autism spectrum disorders (ASDs) and to recommend priorities for future research. The guidelines were developed by a Technical Expert Panel (TEP) consisting of practitioners, researchers, and parents. A systematic overview of research findings was presented to the TEP; guideline statements were drafted, discussed, debated, edited, reassessed, and presented for formal voting. The strength of evidence of efficacy varied by intervention type from insufficient to moderate. There was some evidence that greater intensity of treatment (hours per week) and greater duration (in months) led to better outcomes. The TEP agreed that children with ASD should have access to at least 25 hours per week of comprehensive intervention to address social communication, language, play skills, and maladaptive behavior. They agreed that applied behavioral analysis, integrated behavioral/developmental programs, the Picture Exchange Communication System, and various social skills interventions have shown efficacy. Based on identified gaps, they recommend that future research focus on assessment and monitoring of outcomes, addressing the needs of pre/nonverbal children and adolescents, and identifying the most effective strategies, dose, and duration to improve specific core deficits. The creation of treatment guidelines and recommendations for future research represents an effort by leading experts to improve access to services for children with ASDs while acknowledging that the research evidence has many gaps.

Assessing attitudes and actions of pediatric dentists toward childhood obesity and sugar-sweetened beverages.

PubMed

Wright, Robin; Casamassimo, Paul S

2017-06-01

Childhood obesity is a major US health concern, and oral health professionals have opportunities to participate in an interprofessional effort to intervene owing to their access to young patients and their abilities in addressing obesity-related dietary habits like consumption of sugar-sweetened beverages (SSBs). This study determined attitudes, behaviors, future intentions, and perceived barriers of pediatric dentists regarding efforts to prevent childhood obesity and reduce children's consumption of SSBs. The American Academy of Pediatric Dentistry conducted an online electronic survey with a convenience sample of approximately 7,450 pediatric dentists and pediatric dental residents during spring 2016. Over 17 percent of pediatric dentists offer childhood obesity interventions. Of those not providing interventions, 67 percent were interested in offering obesity-prevention services. Nearly 94 percent of pediatric dentists offer information or other interventions on consumption of SSBs. Statistically significant barriers to providing healthy weight interventions were fear of offending parents, appearing judgmental, or creating parent dissatisfaction and a lack of parental acceptance of guidance about weight management from a dentist. Significant barriers to SSB interventions were sufficient time and health professional education. More pediatric dentists stated they offer childhood obesity interventions than in previous surveys reporting 6 percent, but respondents suggested that a child's weight is seen as a medical rather than dental issue. Most pediatric dentists provide interventions related to consumption of SSBs, perceiving the issue as integral to their care of children. © 2017 American Association of Public Health Dentistry.

Communication technologies to improve HPV vaccination initiation and completion: A systematic review.

PubMed

Francis, Diane B; Cates, Joan R; Wagner, Kyla P Garrett; Zola, Tracey; Fitter, Jenny E; Coyne-Beasley, Tamera

2017-07-01

This systematic review examines the effectiveness of communication technology interventions on HPV vaccination initiation and completion. A comprehensive search strategy was used to identify existing randomized controlled trials testing the impact of computer-, mobile- or internet-based interventions on receipt of any dose of the HPV vaccine. Twelve relevant studies were identified with a total of 38,945 participants. The interventions were delivered using several different methods, including electronic health record (i.e. recall/reminder) prompts, text messaging, automated phone calls, interactive computer videos, and email. Vaccine initiation and completion was greater for technology-based studies relative to their control conditions. There is evidence that interventions utilizing communication technologies as their sole or primary mode for HPV vaccination intervention delivery may increase vaccination coverage. Communication technologies hold much promise for the future of HPV vaccination efforts, especially initiatives in practice-based settings. Copyright © 2017 Elsevier B.V. All rights reserved.

Best practices for preventing musculoskeletal disorders in masonry: stakeholder perspectives.

PubMed

Entzel, Pamela; Albers, Jim; Welch, Laura

2007-09-01

Brick masons and mason tenders report a high prevalence of work-related musculoskeletal disorders (WMSDs), many of which can be prevented with changes in materials, work equipment or work practices. To explore the use of "best practices" in the masonry industry, NIOSH organized a 2-day meeting of masonry stakeholders. Attendees included 30 industry representatives, 5 health and safety researchers, 4 health/safety specialists, 2 ergonomic consultants, and 2 representatives of state workers' compensation programs. Small groups discussed ergonomic interventions currently utilized in the masonry industry, including factors affecting intervention implementation and ways to promote diffusion of interventions. Meeting participants also identified various barriers to intervention implementation, including business considerations, quality concerns, design issues, supply problems, jobsite conditions and management practices that can slow or limit intervention diffusion. To be successful, future diffusion efforts must not only raise awareness of available solutions but also address these practical concerns.

Engagement with a social networking intervention for cancer-related distress.

PubMed

Owen, Jason E; Bantum, Erin O; Gorlick, Amanda; Stanton, Annette L

2015-04-01

Understanding patterns and predictors of engagement could improve the efficacy of Internet interventions. The purpose of the study was to characterize engagement in a multi-component Internet intervention for cancer survivors with distress. Data were derived from 296 cancer survivors provided with access to the Internet intervention and included self-report measures and directly-measured engagement with each component of the intervention. Over 12 weeks, average total engagement was 7.3 h (sd = 11.7), and 42 % of participants spent >3 h on the website. Participants spent more time using social networking components than structured intervention content. Greater early and total engagement was associated with previous chemotherapy, being female, and being recruited via the Internet. Early engagement was associated with greater fatigue and more social constraints. For many users, engagement with an Internet intervention was quite high. Reducing attrition and tailoring content to better meet the needs of those who do not engage should be a focus of future efforts.

Engagement with a Social Networking Intervention for Cancer-Related Distress

PubMed Central

Bantum, Erin O.; Gorlick, Amanda; Stanton, Annette L.

2014-01-01

Background Understanding patterns and predictors of engagement could improve the efficacy of Internet interventions. Purpose The purpose of the study was to characterize engagement in a multi-component Internet intervention for cancer survivors with distress. Methods Data were derived from 296 cancer survivors provided with access to the Internet intervention and included self-report measures and directly-measured engagement with each component of the intervention. Results Over 12 weeks, average total engagement was 7.3 h (sd=11.7), and 42% of participants spent >3 h on the website. Participants spent more time using social networking components than structured intervention content. Greater early and total engagement was associated with previous chemotherapy, being female, and being recruited via the Internet. Early engagement was associated with greater fatigue and more social constraints. Conclusions For many users, engagement with an Internet intervention was quite high. Reducing attrition and tailoring content to better meet the needs of those who do not engage should be a focus of future efforts. PMID:25209353

Multilevel selected primary prevention of child maltreatment.

PubMed

Peterson, Lizette; Tremblay, George; Ewigman, Bernard; Saldana, Lisa

2003-06-01

Few treatment studies and even fewer primary prevention studies have demonstrated successful reduction of child maltreatment. Successful preventive interventions have often been lengthy and expensive; shorter programs have been didactic and ineffective. The present investigation relied on a 7-level model of successful parenting to mount a time-limited, "selected" prevention effort with high-risk mothers. This program included modeling, role-playing, Socratic dialogue, home practice, and home visits. The study demonstrated effective intervention at every level of the model, including improvements in (a) parenting skills, (b) developmentally appropriate interventions, (c) developmentally appropriate beliefs, (d) negative affect, (e) acceptance of a responsible parent role, (f) acceptance of a nurturing parent role, and (g) self-efficacy. Directions for future research are considered.

A Test of Major Assumptions About Behavior Change: A Comprehensive Look at the Effects of Passive and Active HIV-Prevention Interventions Since the Beginning of the Epidemic

PubMed Central

Albarracín, Dolores; Gillette, Jeffrey C.; Earl, Allison N.; Glasman, Laura R.; Durantini, Marta R.; Ho, Moon-Ho

2009-01-01

This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIV-prevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts. PMID:16351327

Defining Safety in the Nursing Home Setting: Implications for Future Research.

PubMed

Simmons, Sandra F; Schnelle, John F; Sathe, Nila A; Slagle, Jason M; Stevenson, David G; Carlo, Maria E; McPheeters, Melissa L

2016-06-01

Currently, the Agency for Healthcare Research and Quality (AHRQ) Common Format for nursing homes (NHs) accommodates voluntary reporting for 4 adverse events: falls with injury, pressure ulcers, medication errors, and infections. In 2015, AHRQ funded a technical brief to describe the state of the science related to safety in the NH setting to inform a research agenda. Thirty-six recent systematic reviews evaluated NH safety-related interventions to address these 4 adverse events and reported mostly mixed evidence about effective approaches to ameliorate them. Furthermore, these 4 events are likely inadequate to capture safety issues that are unique to the NH setting and encompass other domains related to residents' quality of care and quality of life. Future research needs include expanding our definition of safety in the NH setting, which differs considerably from that of hospitals, to include contributing factors to adverse events as well as more resident-centered care measures. Second, future research should reflect more rigorous implementation science to include objective measures of care processes related to adverse events, intervention fidelity, and staffing resources for intervention implementation to inform broader uptake of efficacious interventions. Weaknesses in implementation contribute to the current inconclusive and mixed evidence base as well as remaining questions about what outcomes are even achievable in the NH setting, given the complexity of most resident populations. Also related to implementation, future research should determine the effects of specific staffing models on care processes related to safety outcomes. Last, future efforts should explore the potential for safety issues in other care settings for older adults, most notably dementia care within assisted living. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application.

PubMed

Barkhausen, Jörg; Kahn, Thomas; Krombach, Gabriele A; Kuhl, Christiane K; Lotz, Joachim; Maintz, David; Ricke, Jens; Schönberg, Stefan O; Vogl, Thomas J; Wacker, Frank K

2017-07-01

Background  MRI is attractive for the guiding and monitoring of interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure physiologic parameters like flow and cardiac function. Method  The current status of interventional MRI for the clinical routine was analyzed. Results  The effort needed for the development of MR-safe monitoring systems and instruments initially resulted in the application of interventional MRI only for procedures that could not be performed by other means. Accordingly, biopsy of lesions in the breast, which are not detectable by other modalities, has been performed under MRI guidance for decades. Currently, biopsies of the prostate under MRI guidance are established in a similar fashion. At many sites blind biopsy has already been replaced by MR-guided biopsy or at least by the fusion of MR images with ultrasound. Cardiovascular interventions are performed at several centers for ablation as a treatment for atrial fibrillation. Conclusion  Interventional MRI has been established in the clinical routine for a variety of indications. Broader application can be expected in the clinical routine in the future owing to the multiple advantages compared to other techniques. Key points   · Due to the significant technical effort, MR-guided interventions are only recommended in the long term for regions in which MRI either facilitates or greatly improves the intervention.. · Breast biopsy of otherwise undetectable target lesions has long been established in the clinical routine. Prostate biopsy is currently being introduced in the clinical routine for similar reasons. Other methods such as MR-guided focused ultrasound for the treatment of uterine fibroids or tumor ablation of metastases represent alternative methods and are offered in many places.. · Endovascular MR-guided interventions offer advantages for a number of indications and have already been clinically established for the treatment of children with congenital heart defects and for atrial ablation at individual centers. Greater application can be expected in the future.. Citation format · Barkhausen J, Kahn T, Krombach GA et al. White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application. Fortschr Röntgenstr 2017; 189: 611 - 623. © Georg Thieme Verlag KG Stuttgart · New York.

Heat stress intervention research in construction: gaps and recommendations.

PubMed

Yang, Yang; Chan, Albert Ping-Chuen

2017-06-08

Developing heat stress interventions for construction workers has received mounting concerns in recent years. However, limited efforts have been exerted to elaborate the rationale, methodology, and practicality of heat stress intervention in the construction industry. This study aims to review previous heat stress intervention research in construction, to identify the major research gaps in methodological issues, and to offer detailed recommendations for future studies. A total of 35 peer-reviewed journal papers have been identified to develop administrative, environmental or personal engineering interventions to safeguard construction workers. It was found that methodological limitations, such as arbitrary sampling methods and unreliable instruments, could be the major obstacle in undertaking heat stress intervention research. To bridge the identified research gaps, this study then refined a research framework for conducting heat stress intervention studies in the construction industry. The proposed research strategy provides researchers and practitioners with fresh insights into expanding multidisciplinary research areas and solving practical problems in the management of heat stress. The proposed research framework may foster the development of heat stress intervention research in construction, which further aids researchers, practitioners, and policymakers in formulating proper intervention strategies.

An acute post-rape intervention to prevent substance use and abuse.

PubMed

Acierno, Ron; Resnick, Heidi S; Flood, Amanda; Holmes, Melisa

2003-12-01

The trauma of rape is routinely associated with extreme acute distress. Such peri-event anxiety increases risk of developing psychopathology and substance use or abuse post-rape, with the degree of initial distress positively predicting future problems. Unfortunately, the nature of post-rape forensic evidence collection procedures may exacerbate initial distress, thereby potentiating post-rape negative emotional sequelae. Consequently, substance use may increase in an effort to ameliorate this distress. To address this, a two-part video intervention was developed for use in acute post-rape time frames to (a) minimize anxiety during forensic rape examinations, thereby reducing risk of future emotional problems, and (b) prevent increased post-rape substance use and abuse. Pilot study data with 124 rape victims indicated that the low-cost, easily administered intervention was effective in reducing risk of marijuana abuse at 6 weeks. Nonstatistically significant trends also were evident for reduced marijuana use. Trends were also noted in favor of the intervention in the subgroup of women who were actively using substances pre-rape (among pre-rape alcohol users, 28% viewers vs. 43% nonviewers met criteria for post-rape alcohol abuse; among pre-rape marijuana users, the rates of post-marijuana use were 17% vs. 43%).

A process evaluation of a social cognitive theory-based childhood obesity prevention intervention: the Comics for Health program.

PubMed

Branscum, Paul; Sharma, Manoj; Wang, Lihshing Leigh; Wilson, Bradley; Rojas-Guyler, Liliana

2013-03-01

Process evaluations are an often overlooked yet essential component of health promotion interventions. This study reports the results of a comprehensive process evaluation for the "Comics for Health" program, a childhood obesity prevention intervention implemented at 12 after-school programs. Qualitative and quantitative process data were collected using surveys, field notes, and open-item questionnaires, which assessed program fidelity, dose delivered, dose received, reach, recruitment, and context. Triangulation of methods was also employed to better understand how the program was implemented and received by the facilitator, staff members, and children in the program. Results indicated that program implementation had an almost perfect rate of fidelity with most lessons recording 100% tasks completed. Lessons were implemented in their intended order and lasted approximately 30 minutes as planned. After-school staff members reported that the program was well received by children, and this program should be replicated in the future. Attendance records showed that a majority of the children attended each lesson on the initial day of delivery (70.4%) and informal make-up lessons were implemented to compensate for the other children. Finally, several known sources of contamination were found such as past and concurrent exposure to similar health promotion interventions, which could potentially influence study outcomes. These findings will be used to help explain the results of this intervention and make recommendations for future intervention efforts.

Fiber Optic Force Sensors for MRI-Guided Interventions and Rehabilitation: A Review

PubMed Central

Iordachita, Iulian I.; Tokuda, Junichi; Hata, Nobuhiko; Liu, Xuan; Seifabadi, Reza; Xu, Sheng; Wood, Bradford; Fischer, Gregory S.

2017-01-01

Magnetic Resonance Imaging (MRI) provides both anatomical imaging with excellent soft tissue contrast and functional MRI imaging (fMRI) of physiological parameters. The last two decades have witnessed the manifestation of increased interest in MRI-guided minimally invasive intervention procedures and fMRI for rehabilitation and neuroscience research. Accompanying the aspiration to utilize MRI to provide imaging feedback during interventions and brain activity for neuroscience study, there is an accumulated effort to utilize force sensors compatible with the MRI environment to meet the growing demand of these procedures, with the goal of enhanced interventional safety and accuracy, improved efficacy and rehabilitation outcome. This paper summarizes the fundamental principles, the state of the art development and challenges of fiber optic force sensors for MRI-guided interventions and rehabilitation. It provides an overview of MRI-compatible fiber optic force sensors based on different sensing principles, including light intensity modulation, wavelength modulation, and phase modulation. Extensive design prototypes are reviewed to illustrate the detailed implementation of these principles. Advantages and disadvantages of the sensor designs are compared and analyzed. A perspective on the future development of fiber optic sensors is also presented which may have additional broad clinical applications. Future surgical interventions or rehabilitation will rely on intelligent force sensors to provide situational awareness to augment or complement human perception in these procedures. PMID:28652857

Framework for Evaluating the Health Impact of the Scale-Up of Malaria Control Interventions on All-Cause Child Mortality in Sub-Saharan Africa

PubMed Central

Yé, Yazoume; Eisele, Thomas P.; Eckert, Erin; Korenromp, Eline; Shah, Jui A.; Hershey, Christine L.; Ivanovich, Elizabeth; Newby, Holly; Carvajal-Velez, Liliana; Lynch, Michael; Komatsu, Ryuichi; Cibulskis, Richard E.; Moore, Zhuzhi; Bhattarai, Achuyt

2017-01-01

Abstract. Concerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria's Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design. This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality. PMID:28990923

Measurement of the bystander intervention model for bullying and sexual harassment.

PubMed

Nickerson, Amanda B; Aloe, Ariel M; Livingston, Jennifer A; Feeley, Thomas Hugh

2014-06-01

Although peer bystanders can exacerbate or prevent bullying and sexual harassment, research has been hindered by the absence of a validated assessment tool to measure the process and sequential steps of the bystander intervention model. A measure was developed based on the five steps of Latané and Darley's (1970) bystander intervention model applied to bullying and sexual harassment. Confirmatory factor analysis with a sample of 562 secondary school students confirmed the five-factor structure of the measure. Structural equation modeling revealed that all the steps were influenced by the previous step in the model, as the theory proposed. In addition, the bystander intervention measure was positively correlated with empathy, attitudes toward bullying and sexual harassment, and awareness of bullying and sexual harassment facts. This measure can be used for future research and to inform intervention efforts related to the process of bystander intervention for bullying and sexual harassment. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects

PubMed Central

Frank, Guido K.W.; Shott, Megan E.

2016-01-01

Anorexia nervosa is a severe psychiatric disorder without approved medication intervention. Every class of psychoactive medication has been tried to improve treatment outcome; however, randomized controlled trials have been ambiguous at best and across studies have not shown robust improvements in weight gain and recovery. Here we review the available literature on pharmacological interventions since anorexia nervosa came to greater public recognition in the 1960s. This will include a critical review of why those trials may not have been successful. We further provide a neurobiological background for the disorder and discuss how cognition, learning and emotion-regulating circuits could become treatment targets in the future. Making every effort to develop effective pharmacological treatment options for anorexia nervosa is imperative, as it continues to be a complex psychiatric disorder with high disease burden and mortality. PMID:27106297

Social-environmental factors and protective sexual behavior among sex workers: the Encontros intervention in Brazil.

PubMed

Lippman, Sheri A; Donini, Angela; Díaz, Juan; Chinaglia, Magda; Reingold, Arthur; Kerrigan, Deanna

2010-04-01

We sought to determine the association of social-environmental factors with condom use and sexually transmitted infections (STIs) among 420 sex workers participating in an STI/HIV prevention study in Corumbá, Brazil, to inform future intervention efforts. Participants provided urine samples for polymerase chain reaction testing of chlamydia and gonorrhea and responded to multi-item scales addressing perceived social cohesion, participation in networks, and access to and management of resources. We conducted multivariate log-linear and negative binomial regression analyses of these data. Increased social cohesion was inversely associated with number of unprotected sex acts in the preceding week among women (adjusted incidence rate ratio [IRR] = 0.80; P < .01), and there was a marginal association among men (adjusted IRR = 0.41; P = .08). Women's increased participation in social networks was associated with a decrease in frequency of unprotected sex acts (adjusted IRR = 0.83; P = .04), as was men's access to and management of social and material resources (IRR = 0.15; P = .01). Social-environmental factors were not associated with STIs. The social context within which populations negotiate sexual behaviors is associated with condom use. Future efforts to prevent STI/HIV should incorporate strategies to modify the social environment.

Social-Environmental Factors and Protective Sexual Behavior Among Sex Workers: The Encontros Intervention in Brazil

PubMed Central

Donini, Angela; Díaz, Juan; Chinaglia, Magda; Reingold, Arthur; Kerrigan, Deanna

2010-01-01

Objectives. We sought to determine the association of social–environmental factors with condom use and sexually transmitted infections (STIs) among 420 sex workers participating in an STI/HIV prevention study in Corumbá, Brazil, to inform future intervention efforts. Methods. Participants provided urine samples for polymerase chain reaction testing of chlamydia and gonorrhea and responded to multi-item scales addressing perceived social cohesion, participation in networks, and access to and management of resources. We conducted multivariate log-linear and negative binomial regression analyses of these data. Results. Increased social cohesion was inversely associated with number of unprotected sex acts in the preceding week among women (adjusted incidence rate ratio [IRR] = 0.80; P < .01), and there was a marginal association among men (adjusted IRR = 0.41; P = .08). Women's increased participation in social networks was associated with a decrease in frequency of unprotected sex acts (adjusted IRR = 0.83; P = .04), as was men's access to and management of social and material resources (IRR = 0.15; P = .01). Social–environmental factors were not associated with STIs. Conclusions. The social context within which populations negotiate sexual behaviors is associated with condom use. Future efforts to prevent STI/HIV should incorporate strategies to modify the social environment. PMID:19762673

An organizing framework for informal caregiver interventions: detailing caregiving activities and caregiver and care recipient outcomes to optimize evaluation efforts

PubMed Central

2011-01-01

Background Caregiver interventions may help improve the quality of informal care. Yet the lack of a systematic framework specifying the targets and outcomes of caregiver interventions hampers our ability to understand what has been studied, to evaluate existing programs, and to inform the design of future programs. Our goal was to develop an organizing framework detailing the components of the caregiving activities and the caregiver and care recipient outcomes that should be affected by an intervention. In so doing, we characterize what has been measured in the published literature to date and what should be measured in future studies to enable comparisons across interventions and across time. Methods Our data set comprises 121 reports of caregiver interventions conducted in the United States and published between 2000 and 2009. We extracted information on variables that have been examined as primary and secondary outcomes. These variables were grouped into categories, which then informed the organizing framework. We calculated the frequency with which the interventions examined each framework component to identify areas about which we have the most knowledge and under-studied areas that deserve attention in future research. Results The framework stipulates that caregiver interventions seek to change caregiving activities, which in turn affect caregiver and care recipient outcomes. The most frequently assessed variables have been caregiver psychological outcomes (especially depression and burden) and care recipient physical and health care use outcomes. Conclusions Based on the organizing framework, we make three key recommendations to guide interventions and inform research and policy. First, all intervention studies should assess quality and/or quantity of caregiving activities to help understand to what extent and how well the intervention worked. Second, intervention studies should assess a broad range of caregiver and care recipient outcomes, including considering whether expanding to economic status and health care use of the caregiver can be accommodated, to ease subsequent economic evaluations of caregiving. Third, intervention studies should measure a common set of outcomes to facilitate cross-time and cross-study comparisons of effectiveness. PMID:22107600

Emotion-Focused Family Therapy for Eating Disorders Across the Lifespan: A Pilot Study of a 2-Day Transdiagnostic Intervention for Parents.

PubMed

Lafrance Robinson, Adèle; Dolhanty, Joanne; Stillar, Amanda; Henderson, Katherine; Mayman, Shari

2016-01-01

Emotion-focused family therapy is a transdiagnostic approach that affords parents and caregivers a significant role in their loved one's recovery from an eating disorder. A 2-day intervention was developed on the basis of emotion-focused family therapy principles and delivered to 33 parents of adolescent and adult children. Data were collected pre- and post-intervention. Through education and skills practice, parents were taught strategies with respect to meal support and symptom interruption as well as emotion coaching. Parents were also supported to identify and work through their own emotional blocks that could interfere with their supportive efforts. Analyses revealed a significant increase in parental self-efficacy, a positive shift in parents' attitudes regarding their role as emotion coach and a reduction in the fears associated with their involvement in treatment, including a decrease in self-blame. Overall, this broad-based, low-cost intervention shows promise, and future research is warranted. Copyright © 2014 John Wiley & Sons, Ltd. A low-cost, intensive emotion-focused family therapy intervention shows promise for parents of individuals with an eating disorder, regardless of their loved one's age, symptom profile or involvement in treatment. Working with parents' emotions and emotional reactions to their child's struggles has the potential to improve supportive efforts. An emotion-focused family therapy intervention for parents yields high satisfaction rates, improves parental self-efficacy and reduces fears regarding their involvement, including self-blame. Copyright © 2014 John Wiley & Sons, Ltd.

A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention

PubMed Central

Tomori, Cecilia; Risher, Kathryn; Limaye, Rupali J.; Lith, Lynn Van; Gibbs, Susannah; Smelyanskaya, Marina; Celentano, David D.

2015-01-01

Health communication has played a pivotal role in HIV prevention efforts since the beginning of the epidemic. The recent paradigm of combination prevention, which integrates behavioral, biomedical, and structural interventions, offers new opportunities for employing health communication approaches across the entire continuum of care. We describe key areas where health communication can significantly enhance HIV treatment, care, and prevention, presenting evidence from interventions that include health communication components. These interventions rely primarily on interpersonal communication, especially individual and group counseling, both within and beyond clinical settings to enhance the uptake of and continued engagement in care. Many successful interventions mobilize a network of trained community supporters or accompagnateurs, who provide education, counseling, psychosocial support, treatment supervision and other pragmatic assistance across the care continuum. Community treatment supporters reduce the burden on overworked medical providers, engage a wider segment of the community, and offer a more sustainable model for supporting people living with HIV. Additionally, mobile technologies are increasingly seen as promising avenues for ongoing cost-effective communication throughout the treatment cascade. A broader range of communication approaches, traditionally employed in HIV prevention efforts, that address community and sociopolitical levels through mass media, school- or workplace-based education, and entertainment modalities may be useful to interventions seeking to address the full care continuum. Future interventions would benefit from development of a framework that maps appropriate communication theories and approaches onto each step of the care continuum in order to evaluate the efficacy of communication components on treatment outcomes. PMID:25007201

Enhancing the Evidence for Behavioral Counseling

PubMed Central

Alcántara, Carmela; Klesges, Lisa M.; Resnicow, Ken; Stone, Amy; Davidson, Karina W.

2015-01-01

U.S. Preventive Services Task Force (USPSTF) clinical guidelines at present rarely assign the highest grade recommendation to behavioral counseling interventions for chronic disease prevention or risk reduction because of concerns about the certainty and quality of the evidence base. As a result, the broad integration of behavioral counseling interventions in primary care remains elusive. Thus, there is an urgent need for novel perspectives on how to generate the highest-quality and -certainty evidence for primary care–focused behavioral counseling interventions. As members of the Society of Behavioral Medicine (SBM)—a multidisciplinary scientific organization committed to improving population health through behavior change—we review the USPSTF mandate and current recommendations for behavioral counseling interventions, and provide a perspective for the future that calls for concerted and coordinated efforts among SBM, USPSTF, and other organizations invested in the rapid and wider uptake of beneficial, feasible, and referable primary care–focused behavioral counseling interventions. This perspective highlights five areas for further development, including: (1) behavioral counseling–focused practice-based research networks; (2) promotion of USPSTF evidence standards and the increased use of pragmatic RCT design; (3) quality control and improvement procedures for behavioral counseling training; (4) systematic research on effective primary care–based collaborative care models; and (5) methodologic innovations that capitalize on disruptive technologies and healthcare transformation. Collective efforts to improve the health of all Americans in the 21st century and beyond must ensure that effective, feasible, and referable behavioral counseling interventions are embedded in modern primary care practice. PMID:26296553

The Comparative Efficacy of Lifestyle Intervention and Metformin by Educational Attainment in the Diabetes Prevention Program

PubMed Central

O’Brien, Matthew J.; Whitaker, Robert C.; Yu, Daohai; Ackermann, Ronald T.

2015-01-01

Objective Educational attainment is inversely associated with type 2 diabetes risk, but it is unknown whether education impacts individuals’ diabetes prevention efforts. We examined the comparative efficacy of intensive lifestyle intervention and metformin by educational attainment among participants in the Diabetes Prevention Program (DPP), an ongoing U.S. multi-site trial beginning in 1996. Methods We studied 2,910 DPP participants randomized to receive lifestyle intervention, metformin, or placebo. Stratifying by educational attainment, diabetes incidence and relative risk reductions by treatment assignment were estimated using Cox proportional hazards regression. Results 47% of participants had completed college and 53% had not. Compared to placebo, lifestyle participants who had completed college demonstrated a 68% reduction in diabetes incidence (95% CI=56, 77), whereas those with less education experienced a 47% risk reduction (95% CI=29, 61). For metformin participants, college graduates experienced a 49% relative risk reduction (95% CI=33, 62), compared to 23% (95% CI=1, 41) among those with lower educational attainment. There was a statistically significant education-by-treatment interaction with incident diabetes (p=0.03). Conclusions Intensive lifestyle intervention and metformin have greater efficacy among highly educated individuals. Future efforts to deliver these treatments and study their dissemination may be more effective if tailored to individuals’ educational background. PMID:26024851

The comparative efficacy of lifestyle intervention and metformin by educational attainment in the Diabetes Prevention Program.

PubMed

O'Brien, Matthew J; Whitaker, Robert C; Yu, Daohai; Ackermann, Ronald T

2015-08-01

Educational attainment is inversely associated with type 2 diabetes risk, but it is unknown whether education impacts individuals' diabetes prevention efforts. We examined the comparative efficacy of intensive lifestyle intervention and metformin by educational attainment among participants in the Diabetes Prevention Program (DPP), an ongoing U.S. multi-site trial beginning in 1996. We studied 2,910 DPP participants randomized to receive lifestyle intervention, metformin, or placebo. Stratifying by educational attainment, diabetes incidence and relative risk reductions by treatment assignment were estimated using Cox proportional hazards regression. 47% of participants had completed college and 53% had not. Compared to placebo, lifestyle participants who had completed college demonstrated a 68% reduction in diabetes incidence (95% CI=56, 77), whereas those with less education experienced a 47% risk reduction (95% CI=29, 61). For metformin participants, college graduates experienced a 49% relative risk reduction (95% CI=33, 62), compared to 23% (95% CI=1, 41) among those with lower educational attainment. There was a statistically significant education-by-treatment interaction with incident diabetes (p=0.03). Intensive lifestyle intervention and metformin have greater efficacy among highly educated individuals. Future efforts to deliver these treatments and study their dissemination may be more effective if tailored to individuals' educational background. Copyright © 2015 Elsevier Inc. All rights reserved.

Community Stakeholders' Perceptions of Major Factors Influencing Childhood Obesity, the Feasibility of Programs Addressing Childhood Obesity, and Persisting Gaps.

PubMed

Ganter, Claudia; Aftosmes-Tobio, Alyssa; Chuang, Emmeline; Blaine, Rachel E; Land, Thomas; Davison, Kirsten K

2016-04-01

Prior research has identified numerous factors contributing to increased rates of childhood obesity. However, few studies have focused explicitly on the experience of community stakeholders in low-income communities. This study sought to capture the perspectives of these on-the-ground experts regarding major factors contributing to childhood obesity as well as gaps in current prevention and control efforts. We conducted semi-structured interviews with 39 stakeholders from different community sectors (e.g., healthcare providers, childcare providers, teachers). Data were drawn from the Massachusetts Childhood Obesity Research Demonstration project, a multi-level, multi-sector intervention designed to reduce childhood obesity being implemented in two low-income communities in Massachusetts. Interviews were conducted at baseline, transcribed, coded using grounded theory approach, and analyzed in NVivo 10.0. The vast majority of stakeholders had recently participated in obesity prevention strategies, and nearly all of them identified gaps in prevention efforts either within their organizations or in the broader community. In addition to factors previously identified in the literature, several themes emerged including the need to change policies to increase physical activity during school, offer healthier snacks in schools and afterschool programs, and increase communication and collaboration within the community in prevention efforts. Community stakeholders can impact the success of interventions by bridging the gap between science and lived experience. The results of this study can guide future research by highlighting the importance of including stakeholders' frontline experiences with target populations, and using information on identified gaps to augment intervention planning efforts.

Mind the gap: race/ethnic and socioeconomic disparities in obesity.

PubMed

Krueger, Patrick M; Reither, Eric N

2015-11-01

Race/ethnic and socioeconomic status (SES) disparities in obesity are substantial and may widen in the future. We review nine potential mechanisms that recent research has used to explain obesity disparities. Those nine mechanisms fall into three broad groups-health behaviors, biological factors, and the social environment-which incorporate both proximate and upstream determinants of obesity disparities. Efforts to reduce the prevalence of obesity in the US population and to close race/ethnic and SES disparities in obesity will likely require the use of multifaceted interventions that target multiple mechanisms simultaneously. Unfortunately, relatively few of the mechanisms reviewed herein have been tested in an intervention framework.

Development of a Behavioral Sleep Intervention as a Novel Approach for Pediatric Obesity in School-aged Children.

PubMed

Hart, Chantelle N; Hawley, Nicola L; Wing, Rena R

2016-06-01

Despite being the focus of widespread public health efforts, childhood obesity remains an epidemic worldwide. Given the now well-documented consequences of obesity for childhood health and psychosocial functioning, as well as associated morbidity in adulthood, identifying novel, modifiable behaviors that can be targeted to improve weight control is imperative. Enhancing children's sleep may show promise in assisting with weight regulation. The present paper describes the development of a brief behavioral sleep intervention for school-aged children, including preliminary findings of this work as well as areas for future study. Copyright © 2016 Elsevier Inc. All rights reserved.

Workplace Interventions to Reduce Obesity and Cardiometabolic Risk

PubMed Central

Thorndike, Anne N.

2012-01-01

The worksite is ideal for implementing interventions to reduce obesity and cardiometabolic risk factors. Although worksite health promotion is not new, employer-sponsored wellness programs have become more widespread due to the rising prevalence and high cost of obesity. Over the past two decades, employers and researchers focused efforts on individual-based programs to change employees’ nutrition and exercise behaviors, but more recently, the worksite environment has been targeted. Overall, there is good evidence that individual-based worksite programs can produce modest weight loss, but the evidence for effects on other risk factors and on long-term health outcomes and costs is inconsistent. There is less evidence for the benefit of environmental-based interventions, and more data will be needed to establish conclusions about the benefits of these types of interventions. A major challenge for employers and researchers in the future will be to find the balance between effectiveness and economic viability of worksite wellness programs. PMID:22708000

Workplace Interventions to Reduce Obesity and Cardiometabolic Risk.

PubMed

Thorndike, Anne N

2011-02-01

The worksite is ideal for implementing interventions to reduce obesity and cardiometabolic risk factors. Although worksite health promotion is not new, employer-sponsored wellness programs have become more widespread due to the rising prevalence and high cost of obesity. Over the past two decades, employers and researchers focused efforts on individual-based programs to change employees' nutrition and exercise behaviors, but more recently, the worksite environment has been targeted. Overall, there is good evidence that individual-based worksite programs can produce modest weight loss, but the evidence for effects on other risk factors and on long-term health outcomes and costs is inconsistent. There is less evidence for the benefit of environmental-based interventions, and more data will be needed to establish conclusions about the benefits of these types of interventions. A major challenge for employers and researchers in the future will be to find the balance between effectiveness and economic viability of worksite wellness programs.

Storytelling/narrative theory to address health communication with minority populations.

PubMed

Lee, Haeok; Fawcett, Jacqueline; DeMarco, Rosanna

2016-05-01

To explain the development and application of storytelling/narrative theory in health disparities intervention research as a way to promote health communication and behavior change among racial, ethnic, and minority populations. The proposed storytelling theory helps explain that storytelling affects changes in attitude and health behavior of the viewer through realism, identification, and transportation. The proposed storytelling/narrative theory can be a guide to develop culturally grounded narrative interventions that have the ability to connect with hard-to-reach populations. Narrative communication is context-dependent because it derives meaning from the surrounding situation and provides situation-based stories that are a pathway to processing story content. Although storytelling is grounded in nursing practice and education, it is underutilized in nursing interventional research. Future efforts are needed to extend theory-based narrative intervention studies designed to change attitude and behaviors that will reduce health disparities among minorities. Copyright © 2015 Elsevier Inc. All rights reserved.

iLead-a transformational leadership intervention to train healthcare managers' implementation leadership.

PubMed

Richter, Anne; von Thiele Schwarz, Ulrica; Lornudd, Caroline; Lundmark, Robert; Mosson, Rebecca; Hasson, Henna

2016-07-29

Leadership is a key feature in implementation efforts, which is highlighted in most implementation frameworks. However, in studying leadership and implementation, only few studies rely on established leadership theory, which makes it difficult to draw conclusions regarding what kinds of leadership managers should perform and under what circumstances. In industrial and organizational psychology, transformational leadership and contingent reward have been identified as effective leadership styles for facilitating change processes, and these styles map well onto the behaviors identified in implementation research. However, it has been questioned whether these general leadership styles are sufficient to foster specific results; it has therefore been suggested that the leadership should be specific to the domain of interest, e.g., implementation. To this end, an intervention specifically involving leadership, which we call implementation leadership, is developed and tested in this project. The aim of the intervention is to increase healthcare managers' generic implementation leadership skills, which they can use for any implementation efforts in the future. The intervention is conducted in healthcare in Stockholm County, Sweden, where first- and second-line managers were invited to participate. Two intervention groups are included, including 52 managers. Intervention group 1 consists of individual managers, and group 2 of managers from one division. A control group of 39 managers is additionally included. The intervention consists of five half-day workshops aiming at increasing the managers' implementation leadership, which is the primary outcome of this intervention. The intervention will be evaluated through a mixed-methods approach. A pre- and post-design applying questionnaires at three time points (pre-, directly after the intervention, and 6 months post-intervention) will be used, in addition to process evaluation questionnaires related to each workshop. In addition, interviews will be conducted over time to evaluate the intervention. The proposed intervention represents a novel contribution to the implementation literature, being the first to focus on strengthening healthcare managers' generic skills in implementation leadership.

Towards Prevention of Breast Cancer: What Are the Clinical Challenges?

PubMed

Borgquist, Signe; Hall, Per; Lipkus, Isaac; Garber, Judy E

2018-05-01

The dramatic increase in breast cancer incidence compels a paradigm shift in our preventive efforts. There are several barriers to overcome before prevention becomes an established part of breast cancer management. The objective of this review is to identify the clinical challenges for improved breast cancer prevention and discuss current knowledge on breast cancer risk assessment methods, risk communication, ethics, and interventional efforts with the aim of covering the aspects relevant for a breast cancer prevention trial. Herein, the following five areas are discussed: (i) Adequate tools for identification of women at high risk of breast cancer suggestively entitled Prevent! Online. (ii) Consensus on the definition of high risk, which is regarded as mandatory for all risk communication and potential prophylactic interventions. (iii) Risk perception and communication regarding risk information. (iv) Potential ethical concerns relevant for future breast cancer prevention programs. (v) Risk-reducing programs involving multileveled prevention depending on identified risk. Taken together, devoted efforts from both policy makers and health care providers are warranted to improve risk assessment and risk counseling in women at risk for breast cancer to optimize the prevention of breast cancer. Cancer Prev Res; 11(5); 255-64. ©2018 AACR . ©2018 American Association for Cancer Research.

Improving Scotland's health: time for a fresh approach?

PubMed

Stone, D H

2012-05-01

Scotland's health remains the worst in the UK. There are several probable reasons for this. Of those that are amenable to change, health improvement policy has been excessively preoccupied with targeting individuals perceived to be 'at risk' rather than adopting a whole population perspective. Environmental as opposed to behavioural approaches to health improvement have been relatively neglected. To meet the challenge of Scotland's poor health more effectively in the future, new strategic thinking is necessary. Three initial steps are required: recognize that current approaches are inadequate and that fresh ideas are needed; identify the principles that should underlie future strategy development; translate these principles into achievable operational objectives. Five principles of a revitalized strategy to improve the health of Scotland in the future are proposed. These are start early and sustain effort; create a healthy and safe environment; reduce geographical as well as social inequalities in health; adopt an evidence-based approach to public health interventions; use epidemiology to assess need, plan interventions and monitor progress. These principles may then be translated into achievable operational policy and practice objectives.

A Preventive Intervention Program for Urban African American Youth Attending an Alternative Education Program: Background, Implementation, and Feasibility.

PubMed

Carswell, Steven B; Hanlon, Thomas E; O'Grady, Kevin E; Watts, Amy M; Pothong, Pattarapan

2009-01-01

This paper presents background, implementation, and feasibility findings associated with planning and conducting an after-school intervention program in an alternative education setting designed to prevent the initiation and escalation of violence and substance abuse among urban African American youth at high risk for life-long problem behaviors. Evolving from earlier preventive interventions implemented in clinic and school settings, the program, entitled The Village Model of Care, consisted of structured group mentoring, parental support, and community outreach services administered to alternative education students and their primary caregiver(s) during the school year. Over a two-year intake period, 109 youth participated in the present process evaluation study. Findings from the study not only provided relevant demographic information on the characteristics of youth likely to be included in such programs but also indicated the importance of including the family in the rehabilitation effort and the need for school administrative system support for the underlying alternative education approach. The information presented in this report has a direct bearing on the planning of future prevention efforts conducted in similar settings that are aimed at reducing problem behaviors and promoting positive lifestyles among high-risk youth.

The moderating effect of adherence-promoting interventions with clients on evidence-based practices for children and adolescents with mental health problems.

PubMed

Schwalbe, Craig; Gearing, Robin

2012-01-01

Poor adherence of children and adolescents to evidence-based psychosocial interventions remains a fundamental impediment to treatment effectiveness. To maintain client adherence, researchers and clinicians have employed a number of adherence-promoting strategies, from telephone calls and letters to providing transportation costs and child care to motivational enhancement therapies. However, the influence of adherence promoters on intervention outcomes has not been reported. This study examined the moderating effect of adherence-promoting strategies in a survey and meta-analysis of randomized clinical trials of cognitive behavioral treatments, interpersonal therapy, and psycho-education for children and adolescents with mental health problems (k = 33). Results indicated the type and intensity of adherence promoters' moderated study effect sizes according to client characteristics (age, gender, diagnosis). Preliminary findings suggest that males had higher effect sizes when more intensive adherence-promoting efforts were employed. Adherence-promoting efforts were associated with lower effect sizes for youths who were diagnosed with externalizing disorders. Results of this study suggest directions for future research to clarify clinical guidelines to maximize retention in evidence-based psychotherapy. © 2012 American Orthopsychiatric Association.

Beliefs about genetic influences on eating behaviors: Characteristics and associations with weight management confidence.

PubMed

Persky, Susan; Bouhlal, Sofia; Goldring, Megan R; McBride, Colleen M

2017-08-01

The development of precision approaches for customized health interventions is a promising application of genomic discovery. To optimize such weight management interventions, target audiences will need to be engaged in research and implementation efforts. Investigation into approaches that engage these audiences will be required to ensure that genomic information, particularly with respect to genomic influences on endophenotypes like eating behavior, is understood and accepted, and not associated with unintended adverse outcomes. We took steps to characterize healthy individuals' beliefs about genetic influences on eating behavior. Data were collected via online survey from 261 participants selected at random from a database. Respondents infrequently spontaneously identified eating behavior-related factors as running in families. However, those who perceived themselves as overweight and perceived a family history of overweight were more likely to attribute eating behavior to genetics on closed-ended assessments, β=0.252, p=0.039. Genetic attributions for eating behaviors were associated with lower confidence in ability to control eating and weight, β=-0.119, p=0.035. These exploratory findings shed light on beliefs about genetic influences on eating, a behavioral trait (rather than a disease). This investigation can inform future health intervention efforts. Published by Elsevier Ltd.

Racial and Ethnic Disparities in Breastfeeding

PubMed Central

Jones, Katherine M.; Queenan, John T.; Schulkin, Jay

2015-01-01

Abstract This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child. PMID:25831234

Physical Activity and Pregnancy: Past and Present Evidence and Future Recommendations

PubMed Central

Downs, Danielle Symons; Chasan-Taber, Lisa; Evenson, Kelly R.; Leiferman, Jenn; Yeo, SeonAe

2012-01-01

Purpose This review provides researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing maternal health complications, and inform future research. Methods We examined past and present physical activity and pregnancy studies and highlight key papers with a particular focus on maternal health outcomes to best inform physical activity promotion efforts. Results This review discusses: (a) historical overview of prenatal physical activity with a specific focus on the physical activity guidelines, how they have changed over time, and how evidence of the effect of prenatal activity on maternal/fetal health outcomes has impacted clinical recommendations; (b) existing tools and challenges associated with measuring prenatal physical activity; (c) empirical evidence on the multi-level determinants of prenatal activity to help guide future intervention work; (d) empirical evidence of prenatal activity on adverse maternal outcomes (gestational diabetes mellitus, preeclampsia, excessive gestational weight gain) from observational and intervention studies; and (e) summary/recommendations for future research and practice. Conclusions The physical activity and pregnancy literature has evolved over the past 50 years and there is currently sufficient empirical evidence to support the promotion of moderate to vigorous prenatal physical activity for maternal health benefits. Future studies and interventions should be carefully-designed, theoretically driven, and include validated and reliable measures of activity. Researchers and practitioners should also consider the multifaceted determinants and outcomes of prenatal physical activity and intervening to promote physical activity before, during, and after pregnancy. PMID:23367811

A streamlined failure mode and effects analysis.

PubMed

Ford, Eric C; Smith, Koren; Terezakis, Stephanie; Croog, Victoria; Gollamudi, Smitha; Gage, Irene; Keck, Jordie; DeWeese, Theodore; Sibley, Greg

2014-06-01

Explore the feasibility and impact of a streamlined failure mode and effects analysis (FMEA) using a structured process that is designed to minimize staff effort. FMEA for the external beam process was conducted at an affiliate radiation oncology center that treats approximately 60 patients per day. A structured FMEA process was developed which included clearly defined roles and goals for each phase. A core group of seven people was identified and a facilitator was chosen to lead the effort. Failure modes were identified and scored according to the FMEA formalism. A risk priority number,RPN, was calculated and used to rank failure modes. Failure modes with RPN > 150 received safety improvement interventions. Staff effort was carefully tracked throughout the project. Fifty-two failure modes were identified, 22 collected during meetings, and 30 from take-home worksheets. The four top-ranked failure modes were: delay in film check, missing pacemaker protocol/consent, critical structures not contoured, and pregnant patient simulated without the team's knowledge of the pregnancy. These four failure modes had RPN > 150 and received safety interventions. The FMEA was completed in one month in four 1-h meetings. A total of 55 staff hours were required and, additionally, 20 h by the facilitator. Streamlined FMEA provides a means of accomplishing a relatively large-scale analysis with modest effort. One potential value of FMEA is that it potentially provides a means of measuring the impact of quality improvement efforts through a reduction in risk scores. Future study of this possibility is needed.

Thinking about the future as a way to succeed in the present: a longitudinal study of future orientation and violent behaviors among African American youth.

PubMed

Stoddard, Sarah A; Zimmerman, Marc A; Bauermeister, José A

2011-12-01

Previous research has linked higher levels of hopelessness about one's future to violent behavior during adolescence; however, little is known about this relationship over time for adolescents. Using growth curve modeling, we tested the association between future orientation and violent behavior across the high school years of adolescence in a sample of African American youth (n = 681). Variation based on demographic characteristics (i.e., sex, SES, previous violence) was explored. At baseline, differences in violent behavior varied by demographic characteristics. Overall, violent behavior decreased with age. Higher levels of future orientation were associated with greater decreases in violent behavior over time. Demographic characteristics were not associated with change in violent behavior overtime. Our findings suggest that future orientation can act as a promotive factor for at risk African American youth. Interventions that help support the development of future goals and aspirations could play a vital role in violence prevention efforts.

Toward ethnocultural diversification of higher education.

PubMed

Hall, Gordon C Nagayama; Martinez, Charles R; Tuan, Mia; McMahon, Timothy R; Chain, Jennifer

2011-07-01

Attitudes toward ethnocultural diversification in higher education mirror attitudes toward paying taxes. Dissenters are opposed to paying taxes or to ethnocultural diversification. Passive Supporters value the benefits of taxes or ethnocultural diversification, but pay taxes or engage in diversity efforts only when required to do so. Active Supporters pay taxes or support diversity efforts even if they are not required to do so. Mandatory approaches to decrease the resistance of Dissenters to ethnocultural diversification may be necessary, whereas compelling voluntary approaches may be useful to mobilize Passive Supporters. Solutions need to be tailored to the needs of European Americans and persons of color. This article offers a conceptual framework for future research and interventions.

Toward Ethnocultural Diversification of Higher Education

PubMed Central

Nagayama Hall, Gordon C.; Martinez, Charles R.; Tuan, Mia; McMahon, Timothy R.; Chain, Jennifer

2011-01-01

Attitudes toward ethnocultural diversification in higher education mirror attitudes toward paying taxes. Dissenters are opposed to paying taxes or to ethnocultural diversification. Passive Supporters value the benefits of taxes or ethnocultural diversification, but pay taxes or engage in diversity efforts only when required to do so. Active Supporters pay taxes or support diversity efforts even if they are not required to do so. Mandatory approaches to decrease the resistance of Dissenters to ethnocultural diversification may be necessary, whereas compelling voluntary approaches may be useful to mobilize Passive Supporters. Solutions need to be tailored to the needs of European Americans and persons of color. This article offers a conceptual framework for future research and interventions. PMID:21787056

A community-based obesity prevention program for minority children: rationale and study design for Hip-Hop to Health Jr.

PubMed

Fitzgibbon, Marian L; Stolley, Melinda R; Dyer, Alan R; VanHorn, Linda; KauferChristoffel, Katherine

2002-02-01

BACKGROUND; The increasing prevalence of overweight among children in the United States presents a national health priority. Higher rates of overweight/obesity among minority women place their children at increased risk. Although increased rates of overweight are observed in 4- to 5-year-old children, they are not observed in 2- to 3-year-old children. Therefore, early prevention efforts incorporating families are critical. The primary aim of Hip-Hop to Health Jr. is to alter the trajectory toward overweight/obesity among preschool African-American and Latino children. This 5-year randomized intervention is conducted in 24 Head Start programs, where each site is randomized to either a 14-week dietary/physical activity intervention or a general health intervention. This paper presents the rationale and design of the study. Efficacy of the intervention will be determined by weight change for the children and parent/caretaker. Secondary measures include reductions in dietary fat and increases in fiber, fruit/vegetable intake, and physical activity. Baseline data will be presented in future papers. The problem of overweight/obesity is epidemic in the United States. Behaviors related to diet and physical activity are established early in life and modeled by family members. Early intervention efforts addressing the child and family are needed to prevent obesity later in life. This paper describes a comprehensive, family-oriented obesity prevention program for minority preschool children. Copyright 2002 American Health Foundation and Elsevier Science (USA).

Enhancing the Evidence for Behavioral Counseling: A Perspective From the Society of Behavioral Medicine.

PubMed

Alcántara, Carmela; Klesges, Lisa M; Resnicow, Ken; Stone, Amy; Davidson, Karina W

2015-09-01

U.S. Preventive Services Task Force (USPSTF) clinical guidelines at present rarely assign the highest grade recommendation to behavioral counseling interventions for chronic disease prevention or risk reduction because of concerns about the certainty and quality of the evidence base. As a result, the broad integration of behavioral counseling interventions in primary care remains elusive. Thus, there is an urgent need for novel perspectives on how to generate the highest-quality and -certainty evidence for primary care-focused behavioral counseling interventions. As members of the Society of Behavioral Medicine (SBM)--a multidisciplinary scientific organization committed to improving population health through behavior change--we review the USPSTF mandate and current recommendations for behavioral counseling interventions and provide a perspective for the future that calls for concerted and coordinated efforts among SBM, USPSTF, and other organizations invested in the rapid and wider uptake of beneficial, feasible, and referable primary care-focused behavioral counseling interventions. This perspective highlights five areas for further development, including (1) behavioral counseling-focused practice-based research networks; (2) promotion of USPSTF evidence standards and the increased use of pragmatic RCT design; (3) quality control and improvement procedures for behavioral counseling training; (4) systematic research on effective primary care-based collaborative care models; and (5) methodologic innovations that capitalize on disruptive technologies and healthcare transformation. Collective efforts to improve the health of all Americans in the 21st century and beyond must ensure that effective, feasible, and referable behavioral counseling interventions are embedded in modern primary care practice. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Mind the Gap: Race\\Ethnic and Socioeconomic Disparities in Obesity

PubMed Central

Reither, Eric N.

2016-01-01

Race/ethnic and socioeconomic status (SES) disparities in obesity are substantial and may widen in the future. We review seven potential mechanisms that recent research has used to explain obesity disparities. Those seven mechanisms fall into three broad groups—health behaviors, biological and developmental factors, and the social environment—which incorporate both proximate and upstream determinants of obesity disparities. Efforts to reduce the prevalence of obesity in the U.S. population and to close race/ethnic and SES disparities in obesity will likely require the use of multifaceted interventions that target multiple mechanisms simultaneously. Unfortunately, relatively few of the mechanisms reviewed herein have been tested in an intervention framework. PMID:26377742

Commentary: Demonstrating Cost-Effectiveness in Pediatric Psychology

PubMed Central

2014-01-01

Objective Changes in the health care system and payment plans will likely require pediatric psychologists to illustrate the impact of their services. Cost-effectiveness analyses are one method of demonstrating the potential economic benefits of our services but are rarely used by pediatric psychologists. Method A hypothetical cost-effectiveness analysis was conducted, comparing the costs and outcomes between a behavioral adherence intervention and no intervention for youth with acute lymphoblastic leukemia. Results Results illustrate how pediatric psychologists can use cost-effectiveness analyses to demonstrate the economic impact of their work. Conclusions Efforts to conduct economic analyses could allow pediatric psychologists to advocate for their services. Implications and future directions are discussed. PMID:24752732

Enhancing Placebo Effects: Insights From Social Psychology

PubMed Central

SLIWINSKI, JIM; ELKINS, GARY R.

2012-01-01

Placebo effects are widely recognized as having a potent impact upon treatment outcomes in both medical and psychological interventions, including hypnosis. In research utilizing randomized clinical trials, there is usually an effort to minimize or control placebo effects. However, in clinical practice there may be significant benefits in enhancing placebo effects. Prior research from the field of social psychology has identified three factors that may enhance placebo effects, namely: priming, client perceptions, and the theory of planned behavior. These factors are reviewed and illustrated via a case example. The consideration of social-psychological factors to enhance positive expectancies and beliefs has implications for clinical practice as well as future research into hypnotic interventions. PMID:23488251

Countdown to 2015 and beyond: fulfilling the health agenda for women and children.

PubMed

Requejo, Jennifer Harris; Bryce, Jennifer; Barros, Aluisio J D; Berman, Peter; Bhutta, Zulfiqar; Chopra, Mickey; Daelmans, Bernadette; de Francisco, Andres; Lawn, Joy; Maliqi, Blerta; Mason, Elizabeth; Newby, Holly; Presern, Carole; Starrs, Ann; Victora, Cesar G

2015-01-31

The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort. Copyright © 2015 Elsevier Ltd. All rights reserved.

Teaching Goal-Setting for Weight-Gain Prevention in a College Population: Insights from the CHOICES Study.

PubMed

Gardner, Jolynn; Kjolhaug, Jerri; Linde, Jennifer A; Sevcik, Sarah; Lytle, Leslie A

2013-01-01

This article describes the effectiveness of goal setting instruction in the CHOICES (Choosing Healthy Options in College Environments and Settings) study, an intervention evaluating the effectiveness of weight gain prevention strategies for 2-year college students. Four hundred and forty-one participants from three community colleges were recruited. Participants randomized into the intervention (n=224) enrolled in a course that taught strategies to help maintain or achieve a healthy weight. Participants were instructed in SMART (Specific, Measurable, Attainable, Realistic, Time-based) and behavioral goal-setting practices. Throughout the course, participants set goals related to improving their sleep, stress-management, exercise, and nutrition." Intervention participants set four hundred eighteen goals. Each goal was carefully evaluated. The efforts to teach behavioral goal-setting strategies were largely successful; however efforts to convey the intricacies of SMART goal-setting were not as successful. Implications for effective teaching of skills in setting SMART behavioral goals were realized in this study. The insights gained from the goal-setting activities of this study could be used to guide educators who utilize goals to achieve health behavior change. Based on the results of this study, it is recommended that very clear and directed instruction be provided in addition to multiple opportunities for goal-setting practice. Implications for future interventions involving education about goal-setting activities are discussed.

Books and reading: evidence-based standard of care whose time has come.

PubMed

Zuckerman, Barry; Augustyn, Marilyn

2011-01-01

Reach Out and Read (ROR) is the only systematically evaluated clinical activity to promote child development in primary care used throughout the United States. The ROR intervention is straightforward: clinicians provide advice about the benefits of reading aloud, as well as directly giving books to high-risk children and parents to take home at each pediatric visit of children aged 6 months to 5 years. ROR builds upon a significant evidence base of the value of reading aloud to young children. The studies evaluating ROR from different sites from subjects from different racial backgrounds and numerous outcome measures are consistently positive. From its initial single site at Boston City Hospital in 1989, to over 4600 clinical sites in 2010, over 30 000 clinicians distributed over 6.2 million books a year to 3.9 million children across the United States. The future efforts for ROR include integrating mental health competencies found in American Academy of Pediatrics guidelines as part of residency and clinician training into the ROR paradigm, quality improvement to ensure fidelity to the intervention, and expanded pediatric clinician involvement in local early childhood/school readiness community efforts. Finally, the most important future goal is the adoption of giving advice about reading aloud and giving developmentally appropriate books to high-risk families as best practice by official bodies. Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Simulation-Based Learning Strategies to Teach Undergraduate Students Basic Surgical Skills: A Systematic Review.

PubMed

Theodoulou, Iakovos; Nicolaides, Marios; Athanasiou, Thanos; Papalois, Apostolos; Sideris, Michail

2018-02-16

We aimed to identify and critically appraise all literature surrounding simulation-based learning (SBL) courses, to assess their relevance as tools for undergraduate surgical education, and create a design framework targeted at standardizing future SBL. We performed a systematic review of the literature using a specific keyword strategy to search at MEDLINE database. Of the 2371 potentially eligible titles, 472 were shortlisted and only 40 explored active interventions in undergraduate medical education. Of those, 20 were conducted in the United States, 9 in Europe and 11 in the rest of the world. Nineteen studies assessed the effectiveness of SBL by comparing students' attributes before and after interventions, 1 study assessed a new tool of surgical assessment and 16 studies evaluated SBL courses from the students' perspectives. Of those 40 studies, 12 used dry laboratory, 7 wet laboratory, 12 mixed, and 9 cadaveric SBL interventions. The extent to which positive results were obtained from dry, wet, mixed, and cadaveric laboratories were 75%, 57%, 92%, and 100%, respectively. Consequently, the SBL design framework was devised, providing a foundation upon which future SBL interventions can be designed such that learning outcomes are optimized. SBL is an important step in surgical education, investing in a safer and more efficient generation of surgeons. Standardization of these efforts can be accelerated with SBL design framework, a comprehensive guide to designing future interventions for basic surgical training at the undergraduate level. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Impact of a two-city community cancer prevention intervention on African Americans.

PubMed Central

Blumenthal, Daniel S.; Fort, Jane G.; Ahmed, Nasar U.; Semenya, Kofi A.; Schreiber, George B.; Perry, Shelley; Guillory, Joyce

2005-01-01

We report the first multisite, multicomponent community intervention trial to focus on cancer prevention in African Americans. The project explored the potential of historically black medical schools to deliver health information to their local communities and used a community-based participatory research approach. The intervention consisted of culturally sensitive messages at appropriate educational levels delivered over an 18-month period and tested in predominantly black census tracts in Nashville, TN and Atlanta, GA. Chattanooga, TN and Decatur, GA served as comparison cities. Results were evaluated by pre- and postintervention random-digit dial telephone surveys. The intervention cities showed an increase in reported contact with or knowledge of the project. There was little or no effect on knowledge or attitudes in the intervention cities. Compared to Chattanooga, Nashville showed an increase in percentage of women receiving Pap smears. Compared to Decatur, Atlanta showed an increase in percentage of age-appropriate populations receiving digital rectal exams, colorectal cancer screenings and mammograms. The results of this community intervention trial demonstrated modest success and are encouraging for future efforts of longer duration. PMID:16334495

Effectiveness of Parent-Focused Interventions to Increase Teen Driver Safety:A Critical Review

PubMed Central

Curry, Allison E.; Peek-Asa, Corinne; Hamann, Cara J.; Mirman, Jessica H.

2015-01-01

Purpose We critically reviewed recent parent-directed teen driving interventions in order to summarize their success in meeting stated goals; identify promising intervention components and knowledge gaps; aid in the selection, adaptation, and dissemination of effective interventions; and guide future research efforts. Methods We focused on interventions that included a direct parent component, explicitly stated outcomes related to the teen and/or their parents, were evaluated for parent or teen outcomes, targeted drivers under age 21, and had at least one evaluation study published since 1990 and in English. We conducted a comprehensive systematic search of 26 online databases between November 2013 and January 2014 and identified 34 papers representing 18 interventions. Results Several interventions—in particular those that had an active engagement component, incorporated an in-vehicle data recorder system, and had a strong conceptual approach—show promise in improving parental supervisory behaviors during the learner and early independent phases, increasing teen driver skill acquisition, and reducing teens' risky driving behaviors. Conclusions We identify essential characteristics of effective parent-involved teen driving interventions and their evaluation studies, propose a comprehensive and multi-tiered approach to intervention, and discuss several research areas and overarching issues for consideration. PMID:26112737

To boost or to CRUNCH? Effect of effortful encoding on episodic memory in older adults is dependent on executive functioning

PubMed Central

Fu, Li; Maes, Joseph H. R.; Kessels, Roy P. C.; Daselaar, Sander M.

2017-01-01

It is essential to develop effective interventions aimed at ameliorating age-related cognitive decline. Previous studies found that effortful encoding benefits episodic memory in older adults. However, to date it is unclear whether this benefit is different for individuals with strong versus weak executive functioning (EF). Fifty-one older adults were recruited and divided into low (N = 26) and high (N = 25) functioning groups, based on their EF capacity. All participants performed a semantic and a perceptual incidental encoding task. Each encoding task was performed under four difficulty levels to establish different effort levels. Encoding was followed by a recognition task. Results showed that the high EF group benefitted from increased effort in both tasks. However, the low EF group only showed a beneficial effect under low levels of effort. Results are consistent with the Compensation-Related Utilization of Neural Circuits Hypothesis (CRUNCH) and suggest that future research directed at developing efficient memory strategies to reduce negative cognitive aging effects should take individual cognitive differences among older adults into account, such as differences in EF. PMID:28328979

The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review

PubMed Central

2011-01-01

Background Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. We reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT) of HIV in low- and middle-income countries (LMICs). This article presents syntheses of evidence on the costs, effects and cost-effectiveness of HIV MTCT strategies for LMICs from the published literature and evaluates their implications for policy and future research. Methods Candidate studies were identified through a comprehensive database search including PubMed, Embase, Cochrane Library, and EconLit restricted by language (English or French), date (January 1st, 1994 to January 17th, 2011) and article type (original research). Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion. We searched article bibliographies to identify additional studies. Two authors independently assessed eligibility and extracted data from studies retained for review. Study quality was appraised using a modified BMJ checklist for economic evaluations. Data were synthesised in narrative form. Results We identified 19 articles published in 9 journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks. In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health. Conclusions and Recommendations Interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Future cost-effectiveness analyses can help to ensure that pMTCT interventions for LMICs reach their full potential by focussing on unanswered questions in four areas: local assessment of rapidly evolving HIV MTCT options; strategies to improve coverage and reach underserved populations; evaluation of a more comprehensive set of MTCT approaches including primary HIV prevention and reproductive counselling; integration of HIV MTCT and other sexual and reproductive health services. PMID:21306625

Dose-Response Relationship between Antimicrobial Drugs and Livestock-Associated MRSA in Pig Farming1

PubMed Central

Dohmen, Wietske; Bos, Marian E.H.; Verstappen, Koen M.; Houben, Manon; Wagenaar, Jaap A.; Heederik, Dick J.J.

2015-01-01

The farming community can be a vehicle for introduction of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in hospitals. During 2011–2013, an 18-month longitudinal study aimed at reducing the prevalence of LA-MRSA was conducted on 36 pig farms in the Netherlands. Evaluations every 6 months showed a slight decrease in MRSA prevalence in animals and a stable prevalence in farmers and family members. Antimicrobial use, expressed as defined daily dosages per animal per year, decreased 44% during the study period and was associated with declining MRSA prevalence in pigs. MRSA carriage in animals was substantially higher at farms using cephalosporins. Antimicrobial use remained strongly associated with LA-MRSA in humans regardless of the level of animal contact. A risk factor analysis outlined potential future interventions for LA-MRSA control. These results should encourage animal and public health authorities to maintain their efforts in reducing antimicrobial use in livestock and ask for future controlled intervention studies. PMID:25989456

Applying the lessons of maternal mortality reduction to global emergency health

PubMed Central

Skog, Alexander P; Tenner, Andrea G; Wallis, Lee A

2015-01-01

Abstract Over the last few decades, maternal health has been a major focus of the international community and this has resulted in a substantial decrease in maternal mortality globally. Although, compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality, there has been less focus on global efforts to improve comprehensive emergency systems. The thoughtful and specific application of the concepts used in the effort to decrease maternal mortality could lead to major improvements in global emergency health services. The so-called three-delay model that was developed for maternal mortality can be adapted to emergency service delivery. Adaptation of evaluation frameworks to include emergency sentinel conditions could allow effective monitoring of emergency facilities and further policy development. Future global emergency health efforts may benefit from incorporating strategies for the planning and evaluation of high-impact interventions. PMID:26240463

Maintained Physical Activity Induced Changes in Delay Discounting.

PubMed

Sofis, Michael J; Carrillo, Ale; Jarmolowicz, David P

2017-07-01

Those who discount the subjective value of delayed rewards less steeply are more likely to engage in physical activity. There is limited research, however, showing whether physical activity can change rates of delay discounting. In a two-experiment series, treatment and maintenance effects of a novel, effort-paced physical activity intervention on delay discounting were evaluated with multiple baseline designs. Using a lap-based method, participants were instructed to exercise at individualized high and low effort levels and to track their own perceived effort. The results suggest that treatment-induced changes in discounting were maintained at follow-up for 13 of 16 participants. In Experiment 2, there were statistically significant group-level improvements in physical activity and delay discounting when comparing baseline with both treatment and maintenance phases. Percentage change in delay discounting was significantly correlated with session attendance and relative pace (min/mile) improvement over the course of the 7-week treatment. Implications for future research are discussed.

Estimating the number of cases of acute gastrointestinal illness (AGI) associated with Canadian municipal drinking water systems.

PubMed

Murphy, H M; Thomas, M K; Medeiros, D T; McFADYEN, S; Pintar, K D M

2016-05-01

The estimated burden of endemic acute gastrointestinal illness (AGI) annually in Canada is 20·5 million cases. Approximately 4 million of these cases are domestically acquired and foodborne, yet the proportion of waterborne cases is unknown. A number of randomized controlled trials have been completed to estimate the influence of tap water from municipal drinking water plants on the burden of AGI. In Canada, 83% of the population (28 521 761 people) consumes tap water from municipal drinking water plants serving >1000 people. The drinking water-related AGI burden associated with the consumption of water from these systems in Canada is unknown. The objective of this research was to estimate the number of AGI cases attributable to consumption of drinking water from large municipal water supplies in Canada, using data from four household drinking water intervention trials. Canadian municipal water treatment systems were ranked into four categories based on source water type and quality, population size served, and treatment capability and barriers. The water treatment plants studied in the four household drinking water intervention trials were also ranked according to the aforementioned criteria, and the Canadian treatment plants were then scored against these criteria to develop four AGI risk groups. The proportion of illnesses attributed to distribution system events vs. source water quality/treatment failures was also estimated, to inform the focus of future intervention efforts. It is estimated that 334 966 cases (90% probability interval 183 006-501 026) of AGI per year are associated with the consumption of tap water from municipal systems that serve >1000 people in Canada. This study provides a framework for estimating the burden of waterborne illness at a national level and identifying existing knowledge gaps for future research and surveillance efforts, in Canada and abroad.

Evaluation of active transition, a website-delivered physical activity intervention for university students: pilot study.

PubMed

Kwan, Matthew; Faulkner, Guy; Bray, Steven

2013-04-29

While physical activity in individuals tends to decline steadily with age, there are certain periods where this decline occurs more rapidly, such as during early adulthood. Interventions aimed at attenuating the declines in physical activity during this transition period appear warranted. The purpose of the study was to test the feasibility and efficacy of a theoretically informed, website-delivered physical activity intervention aimed at students entering university. Using a quasi-experimental design, 65 participants (44 females; mean age 18.51, SD 0.91) were assigned to either an intervention (receiving website access plus weekly prompts) or comparison condition (receiving unprompted website access only), completing questionnaires at baseline and follow-up 8 weeks later. The intervention website, "Active Transition", was specifically designed to target students' physical activity cognitions and self-regulatory skills. Intervention usage was low, with only 47% (18/38) of participants assigned to the intervention condition logging into the website 2 or more times. Among the broader student sample, there were significant declines in students' physical activity behaviors (F1,63=18.10, P<.001), attitudes (F1,62=55.19, P<.001), and perceived behavioral control (F1,62 =17.56, P<.001). In comparisons between intervention users (29/65, individuals logging in 2 or more times) and non-users (36/65, individuals logging in once or not at all), there was a significant interaction effect for intervention usage and time on perceived behavioral control (F1,62=5.13, P=.03). Poor intervention usage suggests that future efforts need to incorporate innovative strategies to increase intervention uptake and better engage the student population. The findings, however, suggest that a website-delivered intervention aimed at this critical life stage may have positive impact on students' physical activity cognitions. Future studies with more rigorous sampling designs are required.

Cervical Cancer Control for Hispanic Women in Texas: Effective Strategies from Research and Practice

PubMed Central

Fernandez, Maria E.; Savas, Lara S.; Lipizzi, Erica; Smith, Jennifer S.; Vernon, Sally W.

2014-01-01

Purpose Hispanic women in Texas have among the highest rates of cervical cancer incidence and mortality in the country. Increasing regular Papanicolaou test screening and HPV vaccination are crucial to reduce the burden of cervical cancer among Hispanics. This paper presents lessons learned from community-based cervical cancer control programs in Texas and highlights effective intervention programs, methods and strategies. Methods We reviewed and summarized cervical cancer control efforts targeting Hispanic women in Texas, focusing on interventions developed by researchers at the University of Texas, School of Public Health. We identified commonalities across programs, highlighted effective methods, and summarized lessons learned to help guide future intervention efforts. Results Community-academic partnerships were fundamental in all steps of program development and implementation. Programs reviewed addressed psychosocial, cultural, and access barriers to cervical cancer control among low-income Hispanic women. Intervention approaches included lay health worker (LHW) and navigation models and used print media, interactive tailored media, photonovellas, client reminders, one-on-one and group education sessions. Conclusions Small media materials combined with LHW and navigation approaches were effective in delivering Pap test screening and HPV vaccination messages and in linking women to services. Common theoretical methods included in these approaches were modeling, verbal persuasion, and facilitating access. Adaptation of programs to an urban environment revealed that intensive navigation was needed to link women with multiple access barriers to health services. Collectively, this review reveals 1) the importance of using a systematic approach for planning and adapting cervical cancer control programs; 2) advantages of collaborative academic-community partnerships to develop feasible interventions with broad reach; 3) the use of small media and LHW approaches and the need for tailored phone navigation in urban settings; and 4) coordination and technical assistance of community-based efforts as a way to maximize resources. PMID:24398135

Social marketing approaches to nutrition and physical activity interventions in early care and education centres: a systematic review.

PubMed

Luecking, C T; Hennink-Kaminski, H; Ihekweazu, C; Vaughn, A; Mazzucca, S; Ward, D S

2017-12-01

Social marketing is a promising planning approach for influencing voluntary lifestyle behaviours, but its application to nutrition and physical activity interventions in the early care and education setting remains unknown. PubMed, ISI Web of Science, PsycInfo and the Cumulative Index of Nursing and Allied Health were systematically searched to identify interventions targeting nutrition and/or physical activity behaviours of children enrolled in early care centres between 1994 and 2016. Content analysis methods were used to capture information reflecting eight social marketing benchmark criteria. The review included 135 articles representing 77 interventions. Two interventions incorporated all eight benchmark criteria, but the majority included fewer than four. Each intervention included behaviour and methods mix criteria, and more than half identified audience segments. Only one-third of interventions incorporated customer orientation, theory, exchange and insight. Only six interventions addressed competing behaviours. We did not find statistical significance for the effectiveness of interventions on child-level diet, physical activity or anthropometric outcomes based on the number of benchmark criteria used. This review highlights opportunities to apply social marketing to obesity prevention interventions in early care centres. Social marketing could be an important strategy for early childhood obesity prevention efforts, and future research investigations into its effects are warranted. © 2017 World Obesity Federation.

Process evaluation of a food marketing and environmental change intervention in Tiendas that serve Latino immigrants in North Carolina.

PubMed

Baquero, Barbara; Linnan, Laura; Laraia, Barbara A; Ayala, Guadalupe X

2014-11-01

This article describes a comprehensive process evaluation of an efficacious store-based intervention that increased store customers' fruit and vegetable consumption. The process evaluation plan was designed at study inception and implemented at baseline, during the intervention, and at immediate postintervention. Four Latino food stores were randomly assigned either to an intervention or to a control condition. Data were collected from store managers, employees, and 139 Latino customers. Researchers used manager, employee, and customer interviews; weekly observations of the store environment; and implementation logs to assess reach, dose delivered, dose received, and fidelity. Results indicated that it is possible to reach customers in a store-based intervention. Indicators of dose delivered demonstrated that the intervention was implemented as planned, and in the case of employee training, it exceeded the plan. Dose received data indicated that customers moderately engaged with the intervention activities. Together these suggest that the intervention was delivered with good fidelity. Comprehensive process evaluation efforts can facilitate the identification and elimination of barriers to implementation. This approach can serve as a model for future store-based interventions. The study demonstrated that it is feasible to implement Latino food store-based interventions to increase access to and consumption of fruits and vegetables. © 2014 Society for Public Health Education.

Retail food environments research: Promising future with more work to be done.

PubMed

Fuller, Daniel; Engler-Stringer, Rachel; Muhajarine, Nazeem

2016-06-09

As members of the scientific committee for the Food Environments in Canada conference, we reflect on the current state of food environments research in Canada. We are very encouraged that the field is growing and there have been many collaborative efforts to link researchers in Canada, including the 2015 Food Environments in Canada Symposium and Workshop. We believe there are 5 key challenges the field will need to collectively address: theory and causality; replication and extension; consideration of rural, northern and vulnerable populations; policy analysis; and intervention research. In addressing the challenges, we look forward to working together to conduct more sophisticated, complex and community-driven food environments research in the future.

Point of Care Technologies for HIV

PubMed Central

Hewlett, Indira K.

2014-01-01

Effective prevention of HIV/AIDS requires early diagnosis, initiation of therapy, and regular plasma viral load monitoring of the infected individual. In addition, incidence estimation using accurate and sensitive assays is needed to facilitate HIV prevention efforts in the public health setting. Therefore, more affordable and accessible point-of-care (POC) technologies capable of providing early diagnosis, HIV viral load measurements, and CD4 counts in settings where HIV is most prevalent are needed to enable appropriate intervention strategies and ultimately stop transmission of the virus within these populations to achieve the future goal of an AIDS-free generation. This review discusses the available and emerging POC technologies for future application to these unmet public health needs. PMID:24579041

New forecasting methodology indicates more disease and earlier mortality ahead for today's younger Americans.

PubMed

Reither, Eric N; Olshansky, S Jay; Yang, Yang

2011-08-01

Traditional methods of projecting population health statistics, such as estimating future death rates, can give inaccurate results and lead to inferior or even poor policy decisions. A new "three-dimensional" method of forecasting vital health statistics is more accurate because it takes into account the delayed effects of the health risks being accumulated by today's younger generations. Applying this forecasting technique to the US obesity epidemic suggests that future death rates and health care expenditures could be far worse than currently anticipated. We suggest that public policy makers adopt this more robust forecasting tool and redouble efforts to develop and implement effective obesity-related prevention programs and interventions.

College Student Drinking Research From the 1940s to the Future: Where We Have Been and Where We Are Going

PubMed Central

Kilmer, Jason R.; Cronce, Jessica M.; Larimer, Mary E.

2014-01-01

Objective: College student drinking is not a new phenomenon, yet the field of research studying college student drinking is relatively young. In recognition of the 75th anniversary of what is now the Journal of Studies on Alcohol and Drugs, this article reviews the path from the first article to focus exclusively on college student drinking as the topic (published in 1945) to the current state of the science and attempts to look forward to the next steps in the field’s research agenda. Method: Articles were selected by consensus of the authors from incarnations of the journal and other academic journals based on their relevance to the genesis of current best practices regarding college student drinking prevention. Results: Major eras and themes include (a) early efforts to describe and understand college student drinking; (b) building foundations for prevention and intervention efforts in response to growing concerns about high-risk drinking; (c) the emergence of harm-reduction efforts, normative interventions, and efforts to document campus strategies; (d) efficacious prevention efforts and high-risk drinking; (e) the “Call to Action” Task Force Report from the National Institute on Alcohol Abuse and Alcoholism; and (f) updates to the science (including emerging technology). Conclusions: Understanding the rich history of science related to college drinking prevention should prepare and guide our field for the next 75 years of scientific advances, leading to even greater understanding of the etiology and topology of college student drinking as well as more effective methods to reduce alcohol-related harms. PMID:24565309

A streamlined failure mode and effects analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ford, Eric C., E-mail: eford@uw.edu; Smith, Koren; Terezakis, Stephanie

Purpose: Explore the feasibility and impact of a streamlined failure mode and effects analysis (FMEA) using a structured process that is designed to minimize staff effort. Methods: FMEA for the external beam process was conducted at an affiliate radiation oncology center that treats approximately 60 patients per day. A structured FMEA process was developed which included clearly defined roles and goals for each phase. A core group of seven people was identified and a facilitator was chosen to lead the effort. Failure modes were identified and scored according to the FMEA formalism. A risk priority number,RPN, was calculated and usedmore » to rank failure modes. Failure modes with RPN > 150 received safety improvement interventions. Staff effort was carefully tracked throughout the project. Results: Fifty-two failure modes were identified, 22 collected during meetings, and 30 from take-home worksheets. The four top-ranked failure modes were: delay in film check, missing pacemaker protocol/consent, critical structures not contoured, and pregnant patient simulated without the team's knowledge of the pregnancy. These four failure modes hadRPN > 150 and received safety interventions. The FMEA was completed in one month in four 1-h meetings. A total of 55 staff hours were required and, additionally, 20 h by the facilitator. Conclusions: Streamlined FMEA provides a means of accomplishing a relatively large-scale analysis with modest effort. One potential value of FMEA is that it potentially provides a means of measuring the impact of quality improvement efforts through a reduction in risk scores. Future study of this possibility is needed.« less

College student drinking research from the 1940s to the future: where we have been and where we are going.

PubMed

Kilmer, Jason R; Cronce, Jessica M; Larimer, Mary E

2014-01-01

College student drinking is not a new phenomenon, yet the field of research studying college student drinking is relatively young. In recognition of the 75th anniversary of what is now the Journal of Studies on Alcohol and Drugs, this article reviews the path from the first article to focus exclusively on college student drinking as the topic (published in 1945) to the current state of the science and attempts to look forward to the next steps in the field's research agenda. Articles were selected by consensus of the authors from incarnations of the journal and other academic journals based on their relevance to the genesis of current best practices regarding college student drinking prevention. Major eras and themes include (a) early efforts to describe and understand college student drinking; (b) building foundations for prevention and intervention efforts in response to growing concerns about high-risk drinking; (c) the emergence of harm-reduction efforts, normative interventions, and efforts to document campus strategies; (d) efficacious prevention efforts and high-risk drinking; (e) the "Call to Action" Task Force Report from the National Institute on Alcohol Abuse and Alcoholism; and (f) updates to the science (including emerging technology). Understanding the rich history of science related to college drinking prevention should prepare and guide our field for the next 75 years of scientific advances, leading to even greater understanding of the etiology and topology of college student drinking as well as more effective methods to reduce alcohol-related harms.

The Use of Technology to Advance HIV Prevention for Couples.

PubMed

Mitchell, Jason W

2015-12-01

The majority of HIV prevention studies and programs have targeted individuals or operated at the community level. This has also been the standard approach when incorporating technology (e.g., web-based, smartphones) to help improve HIV prevention efforts. The tides have turned for both approaches: greater attention is now focusing on couple-based HIV prevention and using technology to help improve these efforts for maximizing reach and potential impact. To assess the extent that technology has been used to help advance HIV prevention with couples, a literature review was conducted using four databases and included studies that collected data from 2000 to early 2015. Results from this review suggest that technology has primarily been used to help advance HIV prevention with couples as a tool for (1) recruitment and data collection and (2) intervention development. Challenges and limitations of conducting research (e.g., validity of dyadic data) along with future directions for how technology (e.g., mHealth, wearable sensors) can be used to advance HIV prevention with couples are then discussed. Given the growing and near ubiquitous use of the Internet and smartphones, further efforts in the realm of mHealth (e.g., applications or "apps") and eHealth are needed to develop novel couple-focused HIV-preventive interventions.

Disease emergence from global climate and land use change.

PubMed

Patz, Jonathan A; Olson, Sarah H; Uejio, Christopher K; Gibbs, Holly K

2008-11-01

Climate change and land use change can affect multiple infectious diseases of humans, acting either independently or synergistically. Expanded efforts in empiric and future scenario-based risk assessment are required to anticipate problems. Moreover, the many health impacts of climate and land use change must be examined in the context of the myriad other environmental and behavioral determinants of disease. To optimize prevention capabilities, upstream environmental approaches must be part of any intervention, rather than assaults on single agents of disease. Clinicians must develop stronger ties, not only to public health officials and scientists, but also to earth and environmental scientists and policy makers. Without such efforts, we will inevitably benefit our current generation at the cost of generations to come.

Reducing inequalities in cancer outcomes: what works?

PubMed

Bickell, Nina A; Paskett, Electra D

2013-01-01

Despite efforts to reduce disparities in cancer outcomes among vulnerable populations, certain subgroups do not experience the gains made in the reduction of cancer incidence and mortality. In this article, we review recent trial data reporting on patient-, physician-, and system-centered interventions to improve quality and reduce disparities in cancer care spanning patient navigation to health reform. We conclude with data from a state that implemented a multitiered approach, targeting patient and systems barriers, that serves as a guide for future endeavors.

Where does the Occluded Artery Trial leave the late open artery hypothesis?

PubMed Central

Lamas, Gervasio A; Hochman, Judith S

2007-01-01

As of April 2007 the early open artery hypothesis is alive and well, but the late open artery hypothesis is adrift. For the foreseeable future, stable patients with persistent occlusion of the infarct artery late after myocardial infarction, and without severe ischaemia or uncontrollable angina, should be managed initially with optimal medical treatment alone, and not with percutaneous coronary intervention. Efforts should focus on establishing reperfusion earlier, including reducing the time to patient presentation. PMID:17933981

Recruiting future neuroscientists: what asking the recruits can teach us.

PubMed

Willcockson, Irmgard U; Phelps, Cynthia L

2004-12-01

Many different strategies are used to recruit students into scientific research careers, including neuroscience research. These strategies are rarely based on knowledge about students; instead, activities are selected based on their ease of implementation. The goal of the LEARN Project is to encourage high school students into mental health science research using the theme of learning and memory. One intervention the authors developed is five Web-based biographies introducing students to contemporary neuroscientist role models studying learning and memory. To guide the design of this intervention, the authors created a survey to determine where students obtain career information and who and what influences their career selection. In a convenience sample of 124 students, the authors found that almost all students use the Internet for information about careers, in addition to consulting family members and teachers. Students' career selections are influenced most by family members, teachers, and people already in the field. The most important factors students look for in their future career are money, fun, and a good match between current interests and future careers. The data affirm the value of outreach efforts that go beyond students to include a broader audience of parents and teachers who play a critical role in career selection.

SPIRITUALITY AND RELIGION AMONG HIV-INFECTED INDIVIDUALS

PubMed Central

Szaflarski, Magdalena

2017-01-01

Spirituality and religion are important to many people living with HIV (PLWH). Recent research has focused on special populations (ethnic-minorities, women, and youth), spirituality/religion measurement, mediating/moderating mechanisms, and individual and community-level interventions. Spirituality/religion in PLWH has been refined as a multidimensional phenomenon which improves health/quality of life directly and through mediating factors (healthy behaviors, optimism, social support). Spirituality/religion helps people to cope with stressors, especially stigma/discrimination. Spiritual interventions utilizing the power of prayer and meditation and addressing spiritual struggle are under way. Faith-based community interventions have focused on stigma and could improve individual outcomes through access to spiritual/social support and care/treatment for PLWA. Community engagement is necessary to design/implement effective and sustainable programs. Future efforts should focus on vulnerable populations; utilize state-of the art methods (randomized clinical trials, community-based participatory research); and, address population-specific interventions at individual and community levels. Clinical and policy implications across geographic settings also need attention. PMID:23996649

Spirituality and religion among HIV-infected individuals.

PubMed

Szaflarski, Magdalena

2013-12-01

Spirituality and religion are important to many people living with HIV (PLWH). Recent research has focused on special populations (ethnic-minorities, women, and youth), spirituality/religion measurement, mediating/moderating mechanisms, and individual and community-level interventions. Spirituality/religion in PLWH has been refined as a multidimensional phenomenon, which improves health/quality of life directly and through mediating factors (healthy behaviors, optimism, social support). Spirituality/religion helps people to cope with stressors, especially stigma/discrimination. Spiritual interventions utilizing the power of prayer and meditation and addressing spiritual struggle are under way. Faith-based community interventions have focused on stigma and could improve individual outcomes through access to spiritual/social support and care/treatment for PLWA. Community engagement is necessary to design/implement effective and sustainable programs. Future efforts should focus on vulnerable populations; utilize state-of-the-art methods (randomized clinical trials, community-based participatory research); and, address population-specific interventions at individual and community levels. Clinical and policy implications across geographic settings also need attention.

Open-source platforms for navigated image-guided interventions.

PubMed

Ungi, Tamas; Lasso, Andras; Fichtinger, Gabor

2016-10-01

Navigation technology is changing the clinical standards in medical interventions by making existing procedures more accurate, and new procedures possible. Navigation is based on preoperative or intraoperative imaging combined with 3-dimensional position tracking of interventional tools registered to the images. Research of navigation technology in medical interventions requires significant engineering efforts. The difficulty of developing such complex systems has been limiting the clinical translation of new methods and ideas. A key to the future success of this field is to provide researchers with platforms that allow rapid implementation of applications with minimal resources spent on reimplementing existing system features. A number of platforms have been already developed that can share data in real time through standard interfaces. Complete navigation systems can be built using these platforms using a layered software architecture. In this paper, we review the most popular platforms, and show an effective way to take advantage of them through an example surgical navigation application. Copyright © 2016 Elsevier B.V. All rights reserved.

School-based prevention programs for depression and anxiety in adolescence: a systematic review.

PubMed

Corrieri, Sandro; Heider, Dirk; Conrad, Ines; Blume, Anne; König, Hans-Helmut; Riedel-Heller, Steffi G

2014-09-01

School-based interventions are considered a promising effort to prevent the occurrence of mental disorders in adolescents. This systematic review focuses on school-based prevention interventions on depression and anxiety disorders utilizing an RCT design, starting from the year 2000. Based on an online search (PubMed, Scirus, OVID, ISI) and bibliographic findings in the eligible articles, 28 studies providing information were reviewed. The search process ended on 2 May 2011. The majority of interventions turn out to be effective, both for depression (65%) and anxiety (73%). However, the obtained overall mean effect sizes calculated from the most utilized questionnaires can be considered rather small (CDI: -0.12; RCMAS: -0.29). The majority of the reviewed school-based interventions shows effectiveness in reducing or preventing mental disorders in adolescents. However, effect size computation revealed only small-scale effectiveness. Future studies have to consider the impact of program implementation variations. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Lessons from a primary-prevention program for lead poisoning among inner-city children.

PubMed

Dugbatey, Kwesi; Croskey, Valda; Evans, R Gregory; Narayan, Gopal; Osamudiamen, Osa-Edoh

2005-12-01

This study evaluated the impact on childhood lead poisoning of a primary-prevention educational-intervention program for pregnant women in St. Louis, Missouri. The women were predominantly poor and of African-American, Hispanic, Asian, and Caucasian backgrounds. The interventions, tailored for each woman on the basis of responses to a survey and environmental measurements, included case management with hands-on instruction on cleaning techniques, property maintenance, hygiene, and nutrition to reduce exposure of newborns to lead. It was hypothesized that the probability of lead poisoning (blood lead levels greater than 10 microg/dL) would be reduced among mothers who received the interventions compared with those who received only printed educational material. Contrary to expectations, none of the interventions reduced the likelihood of lead poisoning among participating children. In the process of the study, however, a number of valuable lessons related to recruitment and commitment of participants emerged that can inform future efforts of this nature.

A model of mindful parenting: implications for parent-child relationships and prevention research.

PubMed

Duncan, Larissa G; Coatsworth, J Douglas; Greenberg, Mark T

2009-09-01

This paper introduces a model of "mindful parenting" as a framework whereby parents intentionally bring moment-to-moment awareness to the parent-child relationship. This is done by developing the qualities of listening with full attention when interacting with their children, cultivating emotional awareness and self-regulation in parenting, and bringing compassion and nonjudgmental acceptance to their parenting interactions. First, we briefly outline the theoretical and empirical literature on mindfulness and mindfulness-based interventions. Next, we present an operational definition of mindful parenting as an extension of mindfulness to the social context of parent-child relationships. We discuss the implications of mindful parenting for the quality of parent-child relationships, particularly across the transition to adolescence, and we review the literature on the application of mindfulness in parenting interventions. We close with a synopsis of our own efforts to integrate mindfulness-based intervention techniques and mindful parenting into a well-established, evidence-based family prevention program and our recommendations for future research on mindful parenting interventions.

Initial Weight Loss Response as an Indicator for Providing Early Rescue Efforts to Improve Long-term Treatment Outcomes.

PubMed

Unick, Jessica L; Pellegrini, Christine A; Demos, Kathryn E; Dorfman, Leah

2017-09-01

There is a large variability in response to behavioral weight loss (WL) programs. Reducing rates of obesity and diabetes may require more individuals to achieve clinically significant WL post-treatment. Given that WL within the first 1-2 months of a WL program is associated with long-term WL, it may be possible to improve treatment outcomes by identifying and providing additional intervention to those with poor initial success (i.e., "early non-responders"). We review the current literature regarding early non-response to WL programs and discuss how adaptive interventions can be leveraged as a strategy to "rescue" early non-responders. Preliminary findings suggest that adaptive interventions, specifically stepped care approaches, offer promise for improving outcomes among early non-responders. Future studies need to determine the optimal time point and threshold for intervening and the type of early intervention to employ. Clinicians and researchers should consider the discussed factors when making treatment decisions.

Diversifying the STEM pipeline

PubMed Central

Boelter, Christina; Link, Tanja C.; Perry, Brea L.; Leukefeld, Carl

2017-01-01

Structured Abstract Purpose The current paper focuses on the description and evaluation of a two-year STEM intervention targeting underserved middle schools students from minority and low SES backgrounds. Design/methodology/approach Middle school students from low-income and minority backgrounds (n = 166) were targeted to participate in a two-year, intensive, hands-on science and technology intervention to increase their interest in biomedical and health sciences. Quantitative and qualitative data were collected from TRY-IT! Students as well as a control group that did not participate in the intervention, teachers, and parents to assess changes in attitudes and knowledge with respect to a variety of STEM-related topics. Findings Quantitative analyses did not reveal significant long-lasting differences between the TRY-IT! and the control group, thus providing a mixed assessment of the effectiveness of the intervention. However, qualitative student responses collected during the second year of participation revealed positive attitudes toward the program experience and benefits of their exposure to science. In light of these findings, insights drawn from reflecting on successes and challenges experienced during the course of planning and implementing the study are provided to guide future programs and research. Originality/value The intervention was developed in response to the continued under representation of minority and lower SES individuals in STEM careers. An effort to boost positive attitudes toward science and math, as well as confidence in the accessibility of STEM careers among this population is important given the promising outlook of this career field compared to others for future generations. PMID:28553067

Objective measures of adoption of patient lift and transfer devices to reduce nursing staff injuries in the hospital setting.

PubMed

Schoenfisch, Ashley L; Pompeii, Lisa A; Myers, Douglas J; James, Tamara; Yeung, Yeu-Li; Fricklas, Ethan; Pentico, Marissa; Lipscomb, Hester J

2011-12-01

Interventions to reduce patient-handling injuries in the hospital setting are often evaluated based on their effect on outcomes such as injury rates. Measuring intervention adoption could address how and why observed trends in the outcome occurred. Unit-level data related to adoption of patient lift equipment were systematically collected at several points in time over 5 years on nursing units at two hospitals, including hours of lift equipment use, equipment accessibility, and supply purchases and availability. Various measures of adoption highlighted the adoption process' gradual nature and variability by hospital and between units. No single measure adequately assessed adoption. Certain measures appear well-correlated. Future evaluation of primary preventive efforts designed to prevent patient-handling injuries would be strengthened by objective data on intermediate measures that reflect intervention implementation and adoption. Copyright © 2011 Wiley Periodicals, Inc.

Evaluation of a Participatory Ergonomics Intervention in Small Commercial Construction Firms

PubMed Central

Dale, Ann Marie; Jaegers, Lisa; Welch, Laura; Gardner, Bethany T.; Buchholz, Bryan; Weaver, Nancy; Evanoff, Bradley A.

2017-01-01

Background Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participatory ergonomics (PE) interventions that engage workers and employers in reducing work injury risks have shown mixed results. Methods Eight-six workers from seven contractors participated in a PE program. A logic model guided the process evaluation and summative evaluation of short term and intermediate impacts and long term outcomes from surveys and field records. Results Process measures showed good delivery of training, high worker engagement, and low contractor participation. Workers’ knowledge improved and workers reported changes to work practices and tools used; contractor provision of appropriate equipment was low (33%). No changes were seen in symptoms or reported physical effort. Conclusions The PE program produced many worker-identified ergonomic solutions, but lacked needed support from contractors. Future interventions should engage higher levels of the construction organizational system to improve contractor involvement for reducing WMSD. PMID:27094450

Effectiveness of Parent-Focused Interventions to Increase Teen Driver Safety: A Critical Review.

PubMed

Curry, Allison E; Peek-Asa, Corinne; Hamann, Cara J; Mirman, Jessica H

2015-07-01

We critically reviewed recent parent-directed teen driving interventions to summarize their success in meeting stated goals; identify promising intervention components and knowledge gaps; aid in the selection, adaptation, and dissemination of effective interventions; and guide future research efforts. We focused on interventions that included a direct parent component, explicitly stated outcomes related to the teen and/or their parents, were evaluated for parent or teen outcomes, targeted drivers younger than the age of 21 years, and had at least one evaluation study published since 1990 and in English. We conducted a comprehensive systematic search of 26 online databases between November 2013 and January 2014 and identified 34 articles representing 18 interventions. Several interventions-in particular, those that had an active engagement component, incorporated an in-vehicle data recorder system, and had a strong conceptual approach-show promise in improving parental supervisory behaviors during the learner and early independent phases, increasing teen driver skill acquisition, and reducing teens' risky driving behaviors. We identify essential characteristics of effective parent-involved teen driving interventions and their evaluation studies, propose a comprehensive and multitiered approach to intervention, and discuss several research areas and overarching issues for consideration. Copyright © 2015 Society for Adolescent Health and Medicine. All rights reserved.

Rural parents' vaccination-related attitudes and intention to vaccinate middle and high school children against influenza following educational influenza vaccination intervention

PubMed Central

Painter, Julia E.; Pazol, Karen; Gargano, Lisa M.; Orenstein, Walter; Hughes, James M.; DiClemente, Ralph J.

2011-01-01

Objective: This study examined changes in parental influenza vaccination attitudes and intentions after participating in school-based educational influenza vaccination intervention. Methods: Participants were drawn from three counties participating in a school-based influenza vaccination intervention in rural Georgia (baseline N=324; follow-up N=327). Data were collected pre- and post-intervention from phone surveys with parents’ with children attending middle- and high-school. Attitudes, beliefs, vaccination history, and intention to vaccinate were assessed.  Results:  Parents who participated in the intervention conditions reported significantly higher influenza vaccination rates in their adolescents, relative to a control group, as well as increased vaccination rates post-intervention participation relative to their baseline rates. Intervention participants reported greater intention to have their adolescent vaccinated in the coming year compared to control parents.  Significant differences were observed post intervention in perceived barriers and benefits of vaccination. Conclusions: These findings suggest that a school-delivered educational influenza vaccination intervention targeting parents and teens may influence influenza vaccination in rural communities. Future influenza vaccination efforts geared toward the parents of rural middle- and high-school students may benefit from addressing barriers and benefits of influenza vaccination. PMID:22048112

“The Women, They Maltreat Them…Therefore, We Cannot Assure That the Future Society Will Be Good”: Male Perspectives on Gender-Based Violence: A Focus Group Study With Young Men in Haiti

PubMed Central

Gabrie, Naïka C.; Sloand, Elizabeth; Gary, Faye; Hassan, Mona; Bertrand, Desiree R.; Campbell, Jacquelyn

2016-01-01

The purpose of this study was to explore the perceptions of violence against women (VAW) held by Haitian men to gain a better understanding of why VAW occurs. Women in Haiti have experienced significant violence, both before and following the 2010 earthquake. Fifteen men ages 26 to 47 participated in a focus group. The data revealed three themes: men's beliefs about VAW and its context, factors influencing VAW, and recommended interventions. When approaching VAW, men must be part of the collective effort. Their insights are valuable when planning and implementing interventions to decrease VAW in Haiti and worldwide. PMID:26361648

"The women, they maltreat them… therefore, we cannot assure that the future society will be good": Male perspectives on gender-based violence: A focus group study with young men in Haiti.

PubMed

Gabriel, Naïka C; Sloand, Elizabeth; Gary, Faye; Hassan, Mona; Bertrand, Desiree R; Campbell, Jacquelyn

2016-07-01

The purpose of this study was to explore the perceptions of violence against women (VAW) held by Haitian men to gain a better understanding of why VAW occurs. Women in Haiti have experienced significant violence, both before and following the 2010 earthquake. Fifteen men aged 26 to 47 participated in a focus group. The data revealed three themes: men's beliefs about VAW and its context, factors influencing VAW, and recommended interventions. When approaching VAW, men must be part of the collective effort. Their insights are valuable when planning and implementing interventions to decrease VAW in Haiti and worldwide.

Methods to Improve the Selection and Tailoring of Implementation Strategies

PubMed Central

Powell, Byron J.; Beidas, Rinad S.; Lewis, Cara C.; Aarons, Gregory A.; McMillen, J. Curtis; Proctor, Enola K.; Khinduka, Shanti K.; Mandell, David S.

2015-01-01

Implementing behavioral health interventions is a complicated process. It has been suggested that implementation strategies should be selected and tailored to address the contextual needs of a given change effort; however, there is limited guidance as to how to do this. This article proposes four methods (concept mapping, group model building, conjoint analysis, and intervention mapping) that could be used to match implementation strategies to identified barriers and facilitators for a particular evidence-based practice or process change being implemented in a given setting. Each method is reviewed, examples of their use are provided, and their strengths and weaknesses are discussed. The discussion includes suggestions for future research pertaining to implementation strategies and highlights these methods' relevance to behavioral health services and research. PMID:26289563

A Hybrid Effectiveness-Implementation Trial of an Evidence-Based Exercise Intervention for Breast Cancer Survivors

PubMed Central

Beidas, Rinad S.; Paciotti, Breah; Barg, Fran; Branas, Andrea R.; Brown, Justin C.; Glanz, Karen; DeMichele, Angela; DiGiovanni, Laura; Salvatore, Domenick

2014-01-01

Background The primary aims of this hybrid Type 1 effectiveness-implementation trial were to quantitatively assess whether an evidence-based exercise intervention for breast cancer survivors, Strength After Breast Cancer, was safe and effective in a new setting and to qualitatively assess barriers to implementation. Methods A cohort of 84 survivors completed measurements related to limb volume, muscle strength, and body image at baseline, 67 survivors completed measurements 12 months later. Qualitative methods were used to understand barriers to implementation experienced by referring oncology clinicians and physical therapists who delivered the program. Results Similar to the efficacy trial, the revised intervention demonstrated safety with regard to lymphedema, and led to improvements in lymphedema symptoms, muscular strength, and body image. Comparison of effects in the effectiveness trial to effects in the efficacy trial revealed larger strength increases in the efficacy trial than in the effectiveness trial (P < .04), but few other differences were found. Qualitative implementation data suggested significant barriers around intervention characteristics, payment, eligibility criteria, the referral process, the need for champions (ie, advocates), and the need to adapt during implementation of the intervention, which should be considered in future dissemination and implementation efforts. Conclusions This trial successfully demonstrated that a physical therapy led strength training program for breast cancer survivors can be implemented in a community setting while retaining the effectiveness and safety of the clinical trial. However, during the translation process, strategies to reduce barriers to implementation are required. This new program can inform larger scale dissemination and implementation efforts. PMID:25749601

Outcomes of a Family-Based HIV Prevention Intervention for Substance Using Juvenile Offenders

PubMed Central

Tolou-Shams, Marina; Dauria, Emily; Conrad, Selby M.; Kemp, Kathleen; Johnson, Sarah; Brown, Larry K.

2017-01-01

Approximately 80% of all arrested youth are diverted from detention and supervised in the community through probation, specialty courts and other community-based diversion efforts. Justice-involved youth have greater psychiatric impairment, substance use and sexual risk behaviors than their non-justice-involved peers. Family-based interventions to address mental health, substance use and recidivism have been successful in improving these youth outcomes; but the lack of integration of HIV/STI prevention is notable given the co-occurrence of substance use, delinquency and sexual risk-taking behaviors among justice-involved youth. Moreover, emotion dysregulation may be an important and understudied underlying construct of these co-occurring risk behaviors for justice-involved youth. Study participants were 47 caregiver-youth dyads enrolled in a juvenile drug court program. As part of a pilot efficacy trial, dyads were randomized to a 5-session family-based integrated substance use and HIV/STI prevention intervention that relied on affect management strategies for risk reduction or an adolescent-only psychoeducation condition matched for time and attention. Data collected at baseline and 3 months post-intervention suggest that a family-based integrated affect management substance use and HIV prevention pilot intervention may lead to justice-involved youths’ enhanced motivation to change their marijuana use, decreased marijuana use and decreased risky sexual behavior over time. Future research is required to replicate these pilot trial findings and should also examine family-level mediators and moderators of treatment response, particularly with respect to HIV prevention efforts for these youth. PMID:28476263

Family risk and related education and counseling needs: perceptions of adults with bipolar disorder and siblings of adults with bipolar disorder.

PubMed

Peay, H L; Hooker, G W; Kassem, L; Biesecker, B B

2009-03-01

Genetics and mental health professionals increasingly provide education and counseling related to risk for psychiatric illness, but there is insufficient evidence about patient perceptions and needs to guide such interventions. Affected individuals and relatives may perceive increased family risk and have interest in genetic education and counseling. Our objectives were to explore perceptions of family vulnerability, perceived control, and coping strategies related to familial risk and needs from genetic counseling. Our methods included conducting semi-structured interviews (n = 48) with individuals with bipolar disorder (BPD) and unaffected siblings. Content analysis generated descriptive data that provide guidance for clinical interventions and themes to evaluate in future studies. The results showed that participants perceived increased personal and family risk, attributing BPD to genes and family environment. Causal attributions were often uncertain and at times inconsistent. Participants wished to modify psychiatric risk to relatives, but were uncertain how to do so; despite the uncertainty, most parents reported risk-modification efforts. Efforts to cope with family vulnerability included monitoring and cognitive distancing. Participants endorsed the usefulness of education and psychological support, but described more ambivalence about receiving risk assessment. Educational and supportive interventions around family risk for BPD should focus on perceptions of cause and vulnerability, reproductive decision-making, and early intervention and risk modification in young relatives. Psychological support is an important component. Providers should evaluate patient coping strategies, which could facilitate or hinder genetic counseling interventions, and should not assume interest in quantitative risk assessment. 2009 Wiley-Liss, Inc.

Clostridium difficile infection

PubMed Central

Vedantam, Gayatri; Clark, Andrew; Chu, Michele; McQuade, Rebecca; Mallozzi, Michael; Viswanathan, V. K.

2012-01-01

Clostridium difficile infection is the leading cause of antibiotic- and healthcare-associated diarrhea, and its containment and treatment imposes a significant financial burden, estimated to be over $3 billion in the USA alone. Since the year 2000, CDI epidemics/outbreaks have occurred in North America, Europe and Asia. These outbreaks have been variously associated with, or attributed to, the emergence of Clostridium difficile strains with increased virulence, an increase in resistance to commonly used antimicrobials such as the fluoroquinolones, or host susceptibilities, including the use of gastric acid suppressants, to name a few. Efforts to elucidate C. difficile pathogenic mechanisms have been hampered by a lack of molecular tools, manipulatable animal models, and genetic intractability of clinical C. difficile isolates. However, in the past 5 y, painstaking efforts have resulted in the unraveling of multiple C. difficile virulence-associated pathways and mechanisms. We have recently reviewed the disease, its associated risk factors, transmission and interventions (Viswanathan, Gut Microbes 2010). This article summarizes genetics, non-toxin virulence factors, and host-cell biology associated with C. difficile pathogenesis as of 2011, and highlights those findings/factors that may be of interest as future intervention targets. PMID:22555464

Recruitment, training outcomes, retention, and performance of community health advisors in two tobacco control interventions for Latinos.

PubMed

Woodruff, Susan I; Candelaria, Jeanette I; Elder, John P

2010-04-01

Community Health Advisors (CHAs) are indigenous lay health advisors who, with training, can create health awareness, disseminate health information and support behavior change in their communities. Little data are available that describe the characteristics, recruitment, training, retention, and performance of CHAs. The present study described the characteristics, recruitment process, training outcomes, retention activities, and performance of two sets of CHAs who delivered tobacco-related interventions in the local Latino community. The Tobacco Control in Latino Communities (TCLC) Center trained 35 CHAs to conduct either a smoking cessation program for Spanish-speaking adult smokers or a behavioral problem-solving intervention to reduce environmental tobacco smoke (ETS) exposure among low-income Latino children. Theoretical psychosocial constructs related to behavior change, general self-esteem, general self-efficacy, and demographics were collected from CHAs before and after training. Additional measures captured the level of professionalism exercised and effort undertaken by the CHAs, as well actual outcomes of their efforts. Of the 33 women and 2 men CHAs recruited, 86% were originally from Mexico, most had a high school education, most were married, and the average monthly household income was $1,100-$1,400. Mean participant age was 42 years, and level of acculturation was relatively low. There were changes in the desired direction pre-to-post training for both ETS and smoking cessation program CHAs for most of the psychosocial constructs. Expert ratings of CHA performance were good, and recipients of the CHAs' efforts showed positive changes in behavior. This information may aid in planning for recruitment and evaluation of CHAs for future tobacco control programs.

Future Expectations, Attitude Toward Violence, and Bullying Perpetration During Early Adolescence: A Mediation Evaluation.

PubMed

Stoddard, Sarah A; Varela, Jorge J; Zimmerman, Marc A

2015-01-01

Hopeful future expectations have been linked to positive developmental outcomes in adolescence; however, the association between future expectations and bullying perpetration has received less attention. We examined the relationship between future expectations and physical and relational bullying perpetration and tested a mediation model that linked future expectations with bullying through attitude toward violence. Structural equation modeling was used to examine the relationship between future expectations and bullying perpetration (relational and physical) and to test whether these relationships were mediated by attitude toward violence in a sample of U.S. seventh-grade students (Mage = 12.86 years, N = 196, 60% female, 46% African American). Attitude toward violence fully mediated the relationship between future expectations and physical bullying (indirect effects = -0.08, 95% CI [-0.15, -0.01], R = .17). The relationship between future expectations and relational bullying was partially mediated by attitudes toward violence (indirect effects = -0.07, 95% CI [-0.14, -0.002], R = .20). Our findings suggest that future expectations can play a role in reducing attitude toward violence and physical and relational bullying perpetration among youth. Interventions that help support the development of future goals and aspirations could play a vital role in bullying prevention efforts.

Eastern Carolina Asthma Prevention Program (ECAPP): An Environmental Intervention Study Among Rural and Underserved Children with Asthma in Eastern North Carolina

PubMed Central

Kearney, Gregory D; Johnson, Lisa C; Xu, Xiaohui; Balanay, Jo Anne G; Lamm, Kevin M; Allen, Daniel L

2014-01-01

OBJECTIVE Asthma is the most common chronic childhood condition affecting 6.3 million (US) children aged less than 18 years. Home-based, multi-component, environmental intervention studies among children with asthma have demonstrated to be effective in reducing asthma symptoms. In this study, a local hospital and university developed an environmental intervention research pilot project, Eastern Carolina Asthma Prevention Program (ECAPP), to evaluate self-reported asthma symptoms, breathing measurements, and number of asthma-related emergency department (ED) visits among low-income, minority children with asthma living in rural, eastern North Carolina. Our goal was to develop a conceptual model and demonstrate any asthma respiratory improvements in children associated with our home-based, environmental intervention. METHODS This project used a single cohort, intervention design approach to compare self-reported asthma-related symptoms, breathing tests, and ED visits over a 6 month period between children with asthma in an intervention study group (n = 12) and children with asthma in a control study group (n = 7). The intervention study group received intense asthma education, three home visits, 2 week follow-up telephone calls, and environmental intervention products for reducing asthma triggers in the home. The control group received education at baseline and 2 week calls, but no intervention products. RESULTS At the end of the study period, significant improvements were observed in the intervention group compared with the control group. Overall, the intervention group experienced a 58% (46 ± SD 26.9) reduction in self-reported asthma symptoms; 76% (34 ± SD 29.7) decrease in rescue medicine; 12% (145 ± SD 11.3) increase in controller medicine; 37% decrease in mean exhaled nitric oxide levels and 33% fewer ED asthma-related visits. CONCLUSION As demonstrated, a combination of efforts appeared effective for improving asthma respiratory symptoms among children in the intervention group. ECAPP is a low cost pilot project that could readily be adapted and expanded into other communities throughout eastern North Carolina. Future efforts could include enhanced partnerships between environmental health professionals at local health departments and pediatric asthma programs at hospitals to carry out ECAPP. PMID:25057240

The Obesity Prevention Initiative: A Statewide Effort to Improve Child Health in Wisconsin.

PubMed

Adams, Alexandra K; Christens, Brian; Meinen, Amy; Korth, Amy; Remington, Patrick L; Lindberg, Sara; Schoeller, Dale

2016-11-01

Obesity rates have increased dramatically, especially among children and disadvantaged populations. Obesity is a complex issue, creating a compelling need for prevention efforts in communities to move from single isolated programs to comprehensive multisystem interventions. To address these issues, we have established a childhood Obesity Prevention Initiative (Initiative) for Wisconsin. This Initiative seeks to test community change frameworks that can support multisystem interventions and provide data for local action as a means for influencing policies, systems, and environments that support individuals’ healthy eating and physical activity. The Initiative is comprised of three components: (1) infrastructure to support a statewide obesity prevention and health promotion network with state- and local-level public messaging and dissemination of evidence-based solutions (healthTIDE); (2) piloting a local, multisetting community-led intervention study in 2 Wisconsin counties; and (3) developing a geocoded statewide childhood obesity and fitness surveillance system. This Initiative is using a new model that involves both coalition action and community organizing to align resources to achieve health improvement at local and state levels. We expect that it will help lead to the implementation of cohesive and sustainable policy, system, and environment health promotion and obesity prevention strategies in communities statewide, and it has the potential to help Wisconsin become a national model for multisetting community interventions to address obesity. Addressing individual-level health through population-level changes ultimately will result in reductions in the prevalence of childhood obesity, current and future health care costs, and chronic disease mortality.

The Obesity Prevention Initiative: A Statewide Effort to Improve Child Health in Wisconsin.

PubMed

Adams, Alexandra K; Christens, Brian; Meinen, Amy; Korth, Amy; Remington, Patrick L; Lindberg, Sara; Schoeller, Dale

2016-11-01

Obesity rates have increased dramatically, especially among children and disadvantaged populations. Obesity is a complex issue, creating a compelling need for prevention efforts in communities to move from single isolated programs to comprehensive multisystem interventions. To address these issues, we have established a childhood Obesity Prevention Initiative (Initiative) for Wisconsin. This Initiative seeks to test community change frameworks that can support multisystem interventions and provide data for local action as a means for influencing policies, systems, and environments that support individuals' healthy eating and physical activity. The Initiative is comprised of three components: (1) infrastructure to support a statewide obesity prevention and health promotion network with state- and local-level public messaging and dissemination of evidence-based solutions (healthTIDE); (2) piloting a local, multisetting community-led intervention study in 2 Wisconsin counties; and (3) developing a geocoded statewide childhood obesity and fitness surveillance system. This Initiative is using a new model that involves both coalition action and community organizing to align resources to achieve health improvement at local and state levels. We expect that it will help lead to the implementation of cohesive and sustainable policy, system, and environment health promotion and obesity prevention strategies in communities statewide, and it has the potential to help Wisconsin become a national model for multisetting community interventions to address obesity. Addressing individual-level health through population-level changes ultimately will result in reductions in the prevalence of childhood obesity, current and future health care costs, and chronic disease mortality.

Exploring Factors Associated with Nonchange in Condom Use Behavior following Participation in an STI/HIV Prevention Intervention for African-American Adolescent Females

PubMed Central

Sales, Jessica M.; Brown, Jennifer L.; DiClemente, Ralph J.; Rose, Eve

2012-01-01

To enhance future STI/HIV prevention efforts, this study examined factors associated with adolescents' failure to improve their condom use behaviors after participating in an STI/HIV prevention intervention. African-American adolescent females (N = 205; M age = 17.9) in an STI/HIV prevention intervention trial completed ACASI interviews and provided self-collected vaginal swabs to assess two prevalent STIs at baseline and 6 months after intervention. Analyses compared those who increased condom use after intervention (change group) to those whose condom use did not increase (nonchange group). 43.4% did not increase their condom use after the intervention and were more likely to have an STI at followup (χ 2 = 4.64, P = .03). In a multivariate logistic regression model, the nonchange group was more likely to have (a) higher sensation seeking (AOR = .91, P = .023), (b) a boyfriend (AOR = .32, P = .046), and/or (c) a physical abuse history (AOR = .56, P = .057). There were also differences in the extent to which psychosocial mediators changed between the two groups. Findings highlight the need to tailor STI/HIV interventions to adolescents with a greater degree of sensation seeking and address key relationship characteristics and trauma histories to bolster intervention efficacy. PMID:22690331

“Is this normal? Is this not normal? There’s no set example”: Sexual Health Intervention Preferences of LGBT Youth in Romantic Relationships

PubMed Central

Greene, George J.; Fisher, Kimberly A.; Kuper, Laura; Andrews, Rebecca; Mustanski, Brian

2014-01-01

Limited research has examined the romantic relationships of lesbian, gay, bisexual and transgender youth (LGBT) despite evidence of relationship-oriented risks, including STI/HIV infection, unplanned pregnancy, and interpersonal violence. In efforts to inform future dyadic sexual health interventions for LGBT youth, this couples-based study aimed to identify the most salient sexual and relationships concerns of young same-sex couples and to assess their preferences for intervention content and format. Participants were a subset 36 young, racially and ethnically diverse, same-sex couples (N = 72 individuals) recruited from two on-going longitudinal studies. Interviews were coded using a constant comparison method and a process of inductive and deductive thematic analysis was used to interpret the data. The analysis yielded the following intervention themes: addressing sexual risk and protective behaviors, improving communication, coping with family and relationship violence, and identifying role models and sources of support. The couples reported a clear preference for small group interventions and many recommended a mixed format approach for intervention delivery (i.e., including dyadic and online sessions). Additionally, recommendations for participant recruitment included a combination of Internet-based and social network referrals. PMID:25678895

"Is this normal? Is this not normal? There's no set example": Sexual Health Intervention Preferences of LGBT Youth in Romantic Relationships.

PubMed

Greene, George J; Fisher, Kimberly A; Kuper, Laura; Andrews, Rebecca; Mustanski, Brian

2015-03-01

Limited research has examined the romantic relationships of lesbian, gay, bisexual and transgender youth (LGBT) despite evidence of relationship-oriented risks, including STI/HIV infection, unplanned pregnancy, and interpersonal violence. In efforts to inform future dyadic sexual health interventions for LGBT youth, this couples-based study aimed to identify the most salient sexual and relationships concerns of young same-sex couples and to assess their preferences for intervention content and format. Participants were a subset 36 young, racially and ethnically diverse, same-sex couples ( N = 72 individuals) recruited from two on-going longitudinal studies. Interviews were coded using a constant comparison method and a process of inductive and deductive thematic analysis was used to interpret the data. The analysis yielded the following intervention themes: addressing sexual risk and protective behaviors, improving communication, coping with family and relationship violence, and identifying role models and sources of support. The couples reported a clear preference for small group interventions and many recommended a mixed format approach for intervention delivery (i.e., including dyadic and online sessions). Additionally, recommendations for participant recruitment included a combination of Internet-based and social network referrals.

Alcohol and Drug Abuse Intervention and Prevention Program. Annual Report 1988-89.

ERIC Educational Resources Information Center

Rapaport, Ross J.

Institutions of higher learning are taking responsibility for and becoming part of the societal effort to combat alcohol/drug problems. There are a number of national and state efforts which specifically target higher education for prevention, education, intervention, treatment, and referral efforts. Considerable efforts are currently underway to…

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative.

PubMed

Du, Lidan; Pinga, Victor; Klein, Alyssa; Danton, Heather

2015-01-01

Nutrition is a multisectoral problem; current state of empirical evidence for agricultural interventions' impacts on nutrition is weak. In the past 10 years, both agriculture and nutrition have risen on the global policy agenda. Several recent international movements have created great momentum for nutrition among global political leaders and policymakers. The 2008 world food price crisis prompted larger investment pledges to agricultural development. The U.S. Government launched the Feed the Future initiative in 2009 to address global hunger and food security, with a primary goal to reduce poverty and undernutrition by simultaneously promoting inclusive agriculture sector growth and improved nutritional status for women and children. With operations in 19 focus countries, Feed the Future provides an important laboratory of learning where efforts can be effective and, once proven, taken to scale to make agriculture work for nutrition. The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project has been conducting a series of research on the Feed the Future initiative. This chapter will first provide a review of the nutrition narrative in relation to food and nutrition, introduce the current understanding of linkages between agriculture and nutrition and the Feed the Future initiative's efforts to strengthen the nutritional impact of agricultural and economic growth activities, and describe an extensive review of how the design and early implementation of Feed the Future activities linked agriculture and nutrition. Finally, the chapter presents an updated framework that incorporates ways to improve nutrition outcomes of agricultural programming in the broader context of food system. © 2015 Elsevier Inc. All rights reserved.

Changes in Attitudes toward Guns and Shootings following Implementation of the Baltimore Safe Streets Intervention.

PubMed

Milam, Adam J; Buggs, Shani A; Furr-Holden, C Debra M; Leaf, Philip J; Bradshaw, Catherine P; Webster, Daniel

2016-08-01

Among youth 15 to 24 years of age, homicide and nonfatal shootings are the leading causes of mortality and morbidity. Urban youth's attitudes and perceptions about the use of gun violence to resolve conflict present a major barrier to efforts to reduce gun homicides and nonfatal shootings. The current investigation extends the existing literature on attitudes toward guns and shootings among high-risk youth ages 18 to 24 by measuring perceived norms and viewpoints regarding gun violence in two analogous Baltimore City neighborhoods pre-implementation and 1-year post-implementation of the Safe Streets intervention (adapted from the CeaseFire/Cure Violence intervention). The Safe Streets intervention is designed for communities with high rates of gun violence and utilizes outreach workers to identify and build trusting relationships with youth ages 15 to 24 who are at greatest risk of being involved in gun violence. The outreach workers also position themselves in the community so that they can rapidly intervene in disputes that have the potential to lead to gun violence. Chi-squared tests and exploratory structural equation modeling (ESEM) were used to examine changes in attitudes toward gun violence 1 year after the implementation of the Safe Streets intervention. There was a statistically significantly improvement in 43 % of the attitudes assessed in the intervention community post-intervention compared to 13 % of the attitudes in the control community. There was a statistically significant improvement in the violent attitudes toward personal conflict resolution scale after implementation of the intervention in both the intervention (b = -0.522, p < 0.001) and control community (b = -0.204, p < 0.032). Exposure to the intervention (e.g., seeing stop shooting signs in your neighborhood) was also associated with the nonviolent attitudes toward conflict scale. Overall, the study found greater improvement in attitudes toward violence in the intervention community following the implementation of the Safe Streets program. These findings offer promising insights into future community violence prevention efforts.

Implementation Science: Why it matters for the future of social work.

PubMed

Cabassa, Leopoldo J

2016-01-01

Bridging the gap between research and practice is a critical frontier for the future of social work. Integrating implementation science into social work can advance our profession's effort to bring research and practice closer together. Implementation science examines the factors, processes, and strategies that influence the uptake, use, and sustainability of empirically-supported interventions, practice innovations, and social policies in routine practice settings. The aims of this paper are to describe the key characteristics of implementation science, illustrate how implementation science matters to social work by describing several contributions this field can make to reducing racial and ethnic disparities in mental health care, and outline a training agenda to help integrate implementation science in graduate-level social work programs.

Implementation Science: Why it matters for the future of social work

PubMed Central

Cabassa, Leopoldo J.

2016-01-01

Bridging the gap between research and practice is a critical frontier for the future of social work. Integrating implementation science into social work can advance our profession’s effort to bring research and practice closer together. Implementation science examines the factors, processes, and strategies that influence the uptake, use, and sustainability of empirically-supported interventions, practice innovations, and social policies in routine practice settings. The aims of this paper are to describe the key characteristics of implementation science, illustrate how implementation science matters to social work by describing several contributions this field can make to reducing racial and ethnic disparities in mental health care, and outline a training agenda to help integrate implementation science in graduate-level social work programs. PMID:28216992

Attack-Related Life Disruption and Child Psychopathology in New York City Public Schoolchildren 6-Months Post-9/11

PubMed Central

Comer, Jonathan S.; Fan, Bin; Duarte, Cristiane S.; Wu, Ping; Musa, George J.; Mandell, Donald J.; Albano, Anne Marie; Hoven, Christina W.

2014-01-01

In the aftermath of disasters, understanding relationships between disaster-related life disruption and children’s functioning is key to informing future postdisaster intervention efforts. The present study examined attack-related life disruptions and psychopathology in a representative sample (N = 8,236) of New York City public schoolchildren (Grades 4–12) surveyed 6 months after September 11, 2001. One in 5 youth reported a family member lost their job because of the attacks, and 1 in 3 reported their parents restricted their postattack travel. These forms of disruption were, in turn, associated with elevated rates of probable posttraumatic stress disorder and other anxiety disorders (and major depressive disorder in the case of restricted travel). Results indicate that adverse disaster-related experiences extend beyond traumatic exposure and include the prolonged ripple of postdisaster life disruption and economic hardship. Future postdisaster efforts must, in addition to ensuring the availability of mental health services for proximally exposed youth, maintain a focus on youth burdened by disaster-related life disruption. PMID:20589558

Setting up a cohort study in speech and language therapy: lessons from The UK Cleft Collective Speech and Language (CC-SL) study.

PubMed

Wren, Yvonne; Humphries, Kerry; Stock, Nicola Marie; Rumsey, Nichola; Lewis, Sarah; Davies, Amy; Bennett, Rhiannon; Sandy, Jonathan

2018-05-01

Efforts to increase the evidence base in speech and language therapy are often limited by methodological factors that have restricted the strength of the evidence to the lower levels of the evidence hierarchy. Where higher graded studies, such as randomized controlled trials, have been carried out, it has sometimes been difficult to obtain sufficient power to detect a potential effect of intervention owing to small sample sizes or heterogeneity in the participants. With certain clinical groups such as cleft lip and palate, systematic reviews of intervention studies have shown that there is no robust evidence to support the efficacy of any one intervention protocol over another. To describe the setting up of an observational clinical cohort study and to present this as an alternative design for answering research questions relating to prevalence, risk factors and outcomes from intervention. The Cleft Collective Speech and Language (CC-SL) study is a national cohort study of children born with cleft palate. Working in partnership with regional clinical cleft centres, a sample size of over 600 children and 600 parents is being recruited and followed up from birth to age 5 years. Variables being collected include demographic, psychological, surgical, hearing, and speech and language data. The process of setting up the study has led to the creation of a unique, large-scale data set which is available for researchers to access now and in future. As well as exploring predictive factors, the data can be used to explore the impact of interventions in relation to individual differences. Findings from these investigations can be used to provide information on sample criteria and definitions of intervention and dosage which can be used in future trials. The observational cohort study is a useful alternative design to explore questions around prevalence, risk factors and intervention for clinical groups where robust research data are not yet available. Findings from such a study can be used to guide service-delivery decisions and to determine power for future clinical trials. © 2017 Royal College of Speech and Language Therapists.

Digital Technologies in the Treatment of Anxiety: Recent Innovations and Future Directions.

PubMed

Firth, Joseph; Torous, John; Carney, Rebekah; Newby, Jill; Cosco, Theodore D; Christensen, Helen; Sarris, Jerome

2018-05-19

This review aims to provide a comprehensive overview of the efficacy, limitations, and future of e-health treatments for anxiety. Within this, we provide detail on "first-generation" e-health approaches, such as computerized therapies. Additionally, we assess the emergence and early efficacy of newer methods of treatment delivery, including smartphone apps and virtual reality interventions, discussing the potential and pitfalls for each. There is now substantial clinical research demonstrating the efficacy of internet-delivered cognitive behavioral therapy in the treatment of anxiety. However, the ability of these interventions for engaging patients in "real-world" settings is unclear. Recently, smartphone apps for anxiety have presented a more popular and ubiquitous method of intervention delivery, although the evidence base supporting these newer approaches drastically falls behind the extensive marketing and commercialization efforts currently driving their development. Meanwhile, the increasing availability of novel technologies, such as "virtual reality" (VR), introduces further potential of e-health treatments for generalized anxiety and anxiety-related disorders such as phobias and obsessive compulsive disorder, while also creating additional challenges for research. Although still in its infancy, e-health research is already presenting several promising avenues for delivering effective and scalable treatments for anxiety. Nonetheless, several important steps must be taken in order for academic research to keep pace with continued technological advances.

Commentary: demonstrating cost-effectiveness in pediatric psychology.

PubMed

McGrady, Meghan E

2014-07-01

Changes in the health care system and payment plans will likely require pediatric psychologists to illustrate the impact of their services. Cost-effectiveness analyses are one method of demonstrating the potential economic benefits of our services but are rarely used by pediatric psychologists. A hypothetical cost-effectiveness analysis was conducted, comparing the costs and outcomes between a behavioral adherence intervention and no intervention for youth with acute lymphoblastic leukemia. Results illustrate how pediatric psychologists can use cost-effectiveness analyses to demonstrate the economic impact of their work. Efforts to conduct economic analyses could allow pediatric psychologists to advocate for their services. Implications and future directions are discussed. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Hemoglobin A1c as a Diagnostic Tool: Public Health Implications From an Actor–Network Perspective

PubMed Central

Rock, Melanie

2012-01-01

Public health arguments for collecting hemoglobin A1c (HbA1c) data, particularly in clinical settings, should be reframed to place more emphasis on nonmedical determinants of population health. We compare individual- with population-level interpretations of HbA1c titers. This comparison reveals that public health researchers need to pay close attention to diagnostic tests and their uses, including rhetorical uses. We also synthesize historical and current evidence to map out 2 possible scenarios for the future. In the first scenario, prevention efforts emphasize primary care and focus almost entirely downstream. The second scenario anticipates downstream interventions but also upstream interventions targeting environments. Our analysis adapts actor–network theory to strategic planning and forecasting in public health. PMID:22095361

Primary and Secondary Prevention Trials in Alzheimer Disease: Looking Back, Moving Forward

PubMed Central

Hsu, David C.; Marshall, Gad A.

2015-01-01

The field of Alzheimer disease (AD) prevention has been a culmination of basic science, clinical, and translational research. In the past three years since the new 2011 AD diagnostic guidelines, large-scale collaborative efforts have embarked on new clinical trials with the hope of someday preventing AD. This review will shed light on the historical and scientific contexts in which these trials were based on, as well as discuss potential challenges these trials may face in the coming years. Primary preventive measures, such as lifestyle, multidomain, medication, and supplemental interventions, will be analyzed. Secondary prevention as represented by disease-modifying interventions, such as anti-amyloid therapy and pioglitazone, will also be reviewed. Finally, hypotheses on future directions for AD prevention trials will be proposed. PMID:27697063

Addressing Low Colorectal Cancer Screening in African Americans: Using Focus Groups to Inform the Development of Effective Interventions.

PubMed

May, Folasade P; Whitman, Cynthia B; Varlyguina, Ksenia; Bromley, Erica G; Spiegel, Brennan M R

2016-09-01

African Americans have the highest burden of colorectal cancer (CRC) in the United States of America (USA) yet lower CRC screening rates than whites. Although poor screening has prompted efforts to increase screening uptake, there is a persistent need to develop public health interventions in partnership with the African American community. The aim of this study was to conduct focus groups with African Americans to determine preferences for the content and mode of dissemination of culturally tailored CRC screening interventions. In June 2013, 45-75-year-old African Americans were recruited through online advertisements and from an urban Veterans Affairs system to create four focus groups. A semi-structured interview script employing open-ended elicitation was used, and transcripts were analyzed using ATLAS.ti software to code and group data into a concept network. A total of 38 participants (mean age = 54) were enrolled, and 59 ATLAS.ti codes were generated. Commonly reported barriers to screening included perceived invasiveness of colonoscopy, fear of pain, and financial concerns. Facilitators included poor diet/health and desire to prevent CRC. Common sources of health information included media and medical providers. CRC screening information was commonly obtained from medical personnel or media. Participants suggested dissemination of CRC screening education through commercials, billboards, influential African American public figures, Internet, and radio. Participants suggested future interventions include culturally specific information, including details about increased risk, accessing care, and dispelling of myths. Public health interventions to improve CRC screening among African Americans should employ media outlets, emphasize increased risk among African Americans, and address race-specific barriers. Specific recommendations are presented for developing future interventions.

Staying Connected: A Feasibility Study Linking American Indian and Alaska Native Trauma Survivors to their Tribal Communities

PubMed Central

Tsosie, Ursula; Nannauck, Sweetwater; Buchwald, Dedra; Russo, Joan; Geiss Trusz, Sarah; Foy, Hugh; Zatzick, Douglas

2013-01-01

The objective of this investigation was to assess the feasibility of a culturally tailored care management intervention for physically injured American Indian/Alaska Native (AI/AN) patients. The intervention was initiated at a Level I trauma center and aimed to link AI/AN patients to their distant tribal communities. Thirty AI/AN patients were randomized to the intervention or to usual care. Assessments at baseline, 3 months, and 6 months included self-reported lifetime cumulative trauma burden, Native healing requests, and symptoms of posttraumatic stress, depression, and alcohol use. Generalized estimating equations ascertained differences between groups over time. Ninety-four percent of eligible patients participated; follow-up at 3 and 6 months was 83%. Participants had high numbers of lifetime traumas (mean = 5.1, standard deviation = 2.6). No differences between the intervention and control groups were observed in posttraumatic stress symptoms, depression symptoms, or alcohol use at baseline or follow-up time points. Among intervention patients, 60% either requested or participated in traditional Native healing practices and 75% reported that the intervention was helpful. This effectiveness trial demonstrated the feasibility of recruiting and randomizing injured AI/AN patients. Future efforts could integrate evidence-based interventions and traditional Native healing into stepped collaborative care treatment programs. PMID:22168295

Association of intervention outcomes with practice capacity for change: Subgroup analysis from a group randomized trial

PubMed Central

Litaker, David; Ruhe, Mary; Weyer, Sharon; Stange, Kurt C

2008-01-01

Background The relationship between health care practices' capacity for change and the results and sustainability of interventions to improve health care delivery is unclear. Methods In the setting of an intervention to increase preventive service delivery (PSD), we assessed practice capacity for change by rating motivation to change and instrumental ability to change on a one to four scale. After combining these ratings into a single score, random effects models tested its association with change in PSD rates from baseline to immediately after intervention completion and 12 months later. Results Our measure of practices' capacity for change varied widely at baseline (range 2–8; mean 4.8 ± 1.6). Practices with greater capacity for change delivered preventive services to eligible patients at higher rates after completion of the intervention (2.7% per unit increase in the combined effort score, p < 0.001). This relationship persisted for 12 months after the intervention ended (3.1%, p < 0.001). Conclusion Greater capacity for change is associated with a higher probability that a practice will attain and sustain desired outcomes. Future work to refine measures of this practice characteristic may be useful in planning and implementing interventions that result in sustained, evidence-based improvements in health care delivery. PMID:18485216

An "Intelligent" Optical Design Program

NASA Astrophysics Data System (ADS)

Bohachevsky, I. O.; Viswanathan, V. K.; Woodfin, G.

1984-06-01

Described is a general approach to the development of computer programs capable of designing image-forming optical systems without human intervention and of improving their performance with repeated attempts. The approach utilizes two ideas: 1) interpretation of technical design as a mapping in the configuration space of technical characteristics and 2) development of an "intelligent" routine that recognizes global optima. Examples of lens systems designed and used in the development of the general approach are presented, current status of the project is summarized, and plans for the future efforts are indicated.

Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy.

PubMed

Shediac-Rizkallah, M C; Bone, L R

1998-03-01

Attention to the sustainability of health intervention programs both in the US and abroad is increasing, but little consensus exists on the conceptual and operational definitions of sustainability. Moreover, an empirical knowledge base about the determinants of sustainability is still at an early stage. Planning for sustainability requires, first, a clear understanding of the concept of sustainability and operational indicators that may be used in monitoring sustainability over time. Important categories of indicators include: (1) maintenance of health benefits achieved through an initial program, (2) level of institutionalization of a program within an organization and (3) measures of capacity building in the recipient community. Second, planning for sustainability requires the use of programmatic approaches and strategies that favor long-term program maintenance. We suggest that the potential influences on sustainability may derive from three major groups of factors: (1) project design and implementation factors, (2) factors within the organizational setting, and (3) factors in the broader community environment. Future efforts to develop sustainable health intervention programs in communities can build on the concepts and strategies proposed here.

Integrating movement in academic classrooms: understanding, applying and advancing the knowledge base.

PubMed

Webster, C A; Russ, L; Vazou, S; Goh, T L; Erwin, H

2015-08-01

In the context of comprehensive and coordinated approaches to school health, academic classrooms have gained attention as a promising setting for increasing physical activity and reducing sedentary time among children. The aims of this paper are to review the rationale and knowledge base related to movement integration in academic classrooms, consider the practical applications of current knowledge to interventions and teacher education, and suggest directions for future research. Specifically, this paper (i) situates movement integration amid policy and research related to children's health and the school as a health-promoting environment; (ii) highlights the benefits of movement integration; (iii) summarizes movement integration programs and interventions; (iv) examines factors associated with classroom teachers' movement integration; (v) offers strategies for translating research to practice and (vi) forwards recommendations for future inquiry related to the effectiveness and sustainability of efforts to integrate movement into classroom routines. This paper provides a comprehensive resource for developing state-of-the-art initiatives to maximize children's movement in academic classrooms as a key strategy for important goals in both education and public health. © 2015 World Obesity.

Validation and Verification of Future Integrated Safety-Critical Systems Operating under Off-Nominal Conditions

NASA Technical Reports Server (NTRS)

Belcastro, Christine M.

2010-01-01

Loss of control remains one of the largest contributors to aircraft fatal accidents worldwide. Aircraft loss-of-control accidents are highly complex in that they can result from numerous causal and contributing factors acting alone or (more often) in combination. Hence, there is no single intervention strategy to prevent these accidents and reducing them will require a holistic integrated intervention capability. Future onboard integrated system technologies developed for preventing loss of vehicle control accidents must be able to assure safe operation under the associated off-nominal conditions. The transition of these technologies into the commercial fleet will require their extensive validation and verification (V and V) and ultimate certification. The V and V of complex integrated systems poses major nontrivial technical challenges particularly for safety-critical operation under highly off-nominal conditions associated with aircraft loss-of-control events. This paper summarizes the V and V problem and presents a proposed process that could be applied to complex integrated safety-critical systems developed for preventing aircraft loss-of-control accidents. A summary of recent research accomplishments in this effort is also provided.

Workaholism: An overview and current status of the research

PubMed Central

Andreassen, Cecilie Schou

2014-01-01

Aims: This article addresses the stable tendency of excessive and compulsive working (i.e., workaholism). The main aim is to provide an updated oversight of the research area related to definition, prevalence, assessment, causes, outcomes, intervention as well as proposed future research directions. The target-population is both researchers and clinicians. Methods: The findings are identified by narratively reviewing the literature. Results: Research into workaholism has expanded over the last two decades. Several screening instruments to identify workaholics have been developed. The vast majority of these are based on seemingly atheoretical foundations, lacking convergent validity with each other and with related constructs. Research generally shows that workaholism is related to impaired health and well-being as well as to conflicts between work and family life. Workaholism is probably caused and maintained by a range of factors, although solid empirical underpinnings for suggested antecedents are currently sparse. So far no well-evaluated interventions for workaholism exist. Conclusions: At present, workaholism as a construct lacks conceptual and empirical clarity. Future research efforts should prioritize longitudinal studies as well as studies incorporating unbiased, firm parameters of both health and behavior. PMID:25215209

Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study.

PubMed

Baker, Phillip; Gill, Timothy; Friel, Sharon; Carey, Gemma; Kay, Adrian

2017-03-01

Effective obesity prevention requires a synergistic mix of population-level interventions including a strong role for government and the regulation of the marketing, labelling, content and pricing of energy-dense foods and beverages. In this paper we adopt the agenda of the Australian Federal Government (AFG) as a case study to understand the factors generating or hindering political priority for such 'regulatory interventions' between 1990 and 2011. Using a theoretically-guided process tracing method we undertook documentary analysis and conducted 27 interviews with a diversity of actors involved in obesity politics. The analysis was structured by a theoretical framework comprising four dimensions: the power of actors involved; the ideas the actors deploy to interpret and portray the issue; the institutional and political context; and issue characteristics. Despite two periods of sustained political attention, political priority for regulatory interventions did not emerge and was hindered by factors from all four dimensions. Within the public health community, limited cohesion among experts and advocacy groups hampered technical responses and collective action efforts. An initial focus on children (child obesity), framing the determinants of obesity as 'obesogenic environments', and the deployment of 'protecting kids', 'industry demonization' and 'economic costs' frames generated political attention. Institutional norms within government effectively selected out regulatory interventions from consideration. The 'productive power' and activities of the food and advertising industries presented formidable barriers, buttressed by a libertarian/neolibertarian rhetoric emphasizing individual responsibility, a negative view of freedom (as free from 'nanny-state' intervention) and the idea that regulation imposes an unacceptable cost on business. Issue complexity, the absence of a supportive evidence base and a strict 'evidence-based' policy-making approach were used as rationales to defer political priority. Overcoming these challenges may be important to future collective action efforts attempting to generate and sustain political priority for regulatory interventions targeting obesity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Early intervention for psychotic disorders: Real-life implementation in Hong Kong.

PubMed

Wong, Gloria H Y; Hui, Christy L M; Tang, Jennifer Y M; Chang, Wing-Chung; Chan, Sherry K W; Xu, Jia-Qi; Lin, Jessie J X; Lai, Dik-Chee; Tam, Wendy; Kok, Joy; Chung, Dicky; Hung, S F; Chen, Eric Y H

2012-03-01

Hong Kong is among the first few cities in Asia to have implemented early intervention for psychosis in 2001. Substantial changes in psychosis service have since taken place. We reviewed available outcome data in Hong Kong, with reference to the philosophy of early intervention in psychosis, discussing experience and lessons learned from the implementation process, and future opportunities and challenges. Data accumulated in the past decade provided evidence for the benefits and significance of early intervention programmes: patients under the care of early intervention service showed improved functioning, milder symptoms, and fewer hospitalizations and suicides. Early intervention is more cost-effective compared with standard care. Stigma and misconception remains an issue, and public awareness campaigns are underway. In recent years, a critical mass is being formed, and Hong Kong has witnessed the unfolding of public service extension, new projects and organizations, and increasing interest from the community. Several major platforms are in place for coherent efforts, including the public Early Assessment Service for Young people with psychosis (EASY) programme, the Psychosis Studies and Intervention (PSI) research unit, the independent Hong Kong Early Psychosis Intervention Society (EPISO), the Jockey Club Early Psychosis (JCEP) project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. The first decade of early intervention work has been promising; consolidation and further development is needed on many fronts of research, service and education. Copyright © 2012 Elsevier B.V. All rights reserved.

Effectiveness of Social Media-based Interventions on Weight-related Behaviors and Body Weight Status: Review and Meta-analysis.

PubMed

An, Ruopeng; Ji, Mengmeng; Zhang, Sheng

2017-11-01

We reviewed scientific literature regarding the effectiveness of social media-based interventions about weight-related behaviors and body weight status. A keyword search were performed in May 2017 in the Clinical-Trials.gov, Cochrane Library, PsycINFO, PubMed, and Web of Science databases. We conducted a meta-analysis to estimate the pooled effect size of social media-based interventions on weight-related outcome measures. We identified 22 interventions from the keyword and reference search, including 12 randomized controlled trials, 6 pre-post studies and 3 cohort studies conducted in 9 countries during 2010-2016. The majority (N = 17) used Facebook, followed by Twitter (N = 4) and Instagram (N = 1). Intervention durations averaged 17.8 weeks with a mean sample size of 69. The meta-analysis showed that social media-based interventions were associated with a statistically significant, but clinically modest reduction of body weight by 1.01 kg, body mass index by 0.92 kg/m2, and waist circumstance by 2.65 cm, and an increase of daily number of steps taken by 1530. In the meta-regression there was no doseresponse effect with respect to intervention duration. The boom of social media provides an unprecedented opportunity to implement health promotion programs. Future interventions should make efforts to improve intervention scalability and effectiveness.

Expecting the unexpected: applying the Develop-Distort Dilemma to maximize positive market impacts in health.

PubMed

Peters, David H; Paina, Ligia; Bennett, Sara

2012-10-01

Although health interventions start with good intentions to develop services for disadvantaged populations, they often distort the health market, making the delivery or financing of services difficult once the intervention is over: a condition called the 'Develop-Distort Dilemma' (DDD). In this paper, we describe how to examine whether a proposed intervention may develop or distort the health market. Our goal is to produce a tool that facilitates meaningful and systematic dialogue for practitioners and researchers to ensure that well-intentioned health interventions lead to productive health systems while reducing the undesirable distortions of such efforts. We apply the DDD tool to plan for development rather than distortions in health markets, using intervention research being conducted under the Future Health Systems consortium in Bangladesh, China and Uganda. Through a review of research proposals and interviews with principal investigators, we use the DDD tool to systematically understand how a project fits within the broader health market system, and to identify gaps in planning for sustainability. We found that while current stakeholders and funding sources for activities were easily identified, future ones were not. The implication is that the projects could raise community expectations that future services will be available and paid for, despite this actually being uncertain. Each project addressed the 'rules' of the health market system differently. The China research assesses changes in the formal financing rules, whereas Bangladesh and Uganda's projects involve influencing community level providers, where informal rules are more important. In each case, we recognize the importance of building trust between providers, communities and government officials. Each project could both develop and distort local health markets. Anyone intervening in the health market must recognize the main market perturbations, whether positive or negative, and manage them so as to maximize the benefits to the health system and population health.

Survey of nongovernmental organizations providing pediatric cardiovascular care in low- and middle-income countries.

PubMed

Nguyen, Nguyenvu; Jacobs, Jeffrey P; Dearani, Joseph A; Weinstein, Samuel; Novick, William M; Jacobs, Marshall L; Massey, Jeremy; Pasquali, Sara K; Walters, Henry L; Drullinsky, David; Stellin, Giovanni; Tchervenkov, Christo I

2014-04-01

Nearly 90% of the children with heart disease in low- and middle-income countries (LMICs) cannot access cardiovascular (CV) services. Limitations include inadequate financial, human, and infrastructure resources. Nongovernmental organizations (NGOs) have played crucial roles in providing clinical services and infrastructure supports to LMICs CV programs; however, these outreach efforts are dispersed, inadequate, and lack coordination. A survey was sent to members of the World Society for Pediatric and Congenital Heart Society and PediHeart. A clearinghouse was created to provide information on NGO structures, geographic reach, and scope of services. The survey identified 80 NGOs supporting CV programs in 92 LMICs. The largest outreach efforts were in South and Central America (42%), followed by Africa (18%), Europe (17%), Asia (17%), and Asia-Western Pacific (6%). Most NGOs (51%) supported two to five outreach missions per year. The majority (87%) of NGOs provided education, diagnostics, and surgical or catheter-based interventions. Working jointly with LMIC partners, 59% of the NGOs performed operations in children and infants; 41% performed nonbypass neonatal operations. Approximately a quarter (26%) reported that partner sites do not perform interventions in between missions. Disparity and inadequacy in pediatric CV services remain an important problem for LMICs. A global consensus and coordinated efforts are needed to guide strategies on the development of regional centers of excellence, a global outcome database, and a CV program registry. Future efforts should be held accountable for impacts such as growth in the number of independent LMIC programs as well as reduction in mortality and patient waiting lists.

Survey of Nongovernmental Organizations Providing Pediatric Cardiovascular Care in Low- and Middle-Income Countries

PubMed Central

Nguyen, Nguyenvu; Jacobs, Jeffrey P.; Dearani, Joseph A.; Weinstein, Samuel; Novick, William M.; Jacobs, Marshall L.; Massey, Jeremy; Pasquali, Sara K.; Walters, Henry L.; Drullinsky, David; Stellin, Giovanni; Tchervenkov, Christo I.

2014-01-01

Background Nearly 90% of the children with heart disease in low- and middle-income countries (LMICs) cannot access cardiovascular (CV) services. Limitations include inadequate financial, human, and infrastructure resources. Nongovernmental organizations (NGOs) have played crucial roles in providing clinical services and infrastructure supports to LMICs CV programs; however, these outreach efforts are dispersed, inadequate, and lack coordination. Methods A survey was sent to members of the World Society for Pediatric and Congenital Heart Society and PediHeart. Results A clearinghouse was created to provide information on NGO structures, geographic reach, and scope of services. The survey identified 80 NGOs supporting CV programs in 92 LMICs. The largest outreach efforts were in South and Central America (42%), followed by Africa (18%), Europe (17%), Asia (17%), and Asia-Western Pacific (6%). Most NGOs (51%) supported two to five outreach missions per year. The majority (87%) of NGOs provided education, diagnostics, and surgical or catheter-based interventions. Working jointly with LMIC partners, 59% of the NGOs performed operations in children and infants; 41% performed nonbypass neonatal operations. Approximately a quarter (26%) reported that partner sites do not perform interventions in between missions. Conclusions Disparity and inadequacy in pediatric CV services remain an important problem for LMICs. A global consensus and coordinated efforts are needed to guide strategies on the development of regional centers of excellence, a global outcome database, and a CV program registry. Future efforts should be held accountable for impacts such as growth in the number of independent LMIC programs as well as reduction in mortality and patient waiting lists. PMID:24668973

Harm reduction and cessation efforts and interest in cessation resources among survivors of smoking-related cancers

PubMed Central

Berg, Carla J.; Carpenter, Matthew J.; Jardin, Bianca; Ostroff, Jamie S.

2013-01-01

Purpose Despite the well-established risks associated with persistent smoking, many cancer survivors who were active smokers at the time of cancer diagnosis continue to smoke. In order to guide the development of tobacco cessation interventions for cancer survivors, a better understanding is needed regarding post-diagnosis quitting efforts. Thus, we examined quitting and reduction efforts and interest in cessation resources among cancer survivors who self-identified as current smokers at the time of diagnosis. Methods We conducted analyses of survey participants (n=54) who were current smokers at the time of cancer diagnosis and were continued smokers at the time of assessment. We also conducted semi-structured interviews (n=21) among a subset of those who either continued to smoke or quit smoking post cancer diagnosis. Results Among our survey participants, 22.2% had ever used behavioral cessation resources and 66.7% had use pharmacotherapy, while 62.8% had interest in future use of behavioral cessation resources and 75.0% had interest in pharmacotherapy. The majority reported some quitting efforts including making quit attempts, using cessation medications, and reducing their daily cigarette consumption. Semi-structured interview data revealed various strategies used to aid in smoking reduction and cessation as well as variability in preferences for cessation resources. Conclusions Cancer patients who smoke following diagnosis often engage in smoking reduction and cessation-related behaviors, which may reflect their motivation to reduce their smoking-related risks. They also report high interest in cessation resources. Thus, it is important to explore the acceptability and effectiveness of different cessation intervention components among this group. PMID:23307036

Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners: a theory-informed interview study.

PubMed

Newlands, Rumana; Duncan, Eilidh M; Prior, Maria; Elouafkaoui, Paula; Elders, Andrew; Young, Linda; Clarkson, Jan E; Ramsay, Craig R

2016-01-29

General dental practitioners (GDPs) regularly prescribe antibiotics to manage dental infections although most infections can be treated successfully by local measures. Published guidance to support GDPs to make appropriate prescribing decisions exists but there continues to be wide variation in dental antibiotic prescribing. An interview study was conducted as part of the Reducing Antibiotic Prescribing in Dentistry (RAPiD) trial to understand the barriers and facilitators of using local measures instead of prescribing antibiotics to manage bacterial infections. Thirty semi-structured one-to-one telephone interviews were conducted using the Theoretical Domains Framework (TDF). Responses were coded into domains of the TDF and sub-themes. Priority domains (high frequency: ≥50 % interviewees discussed) relevant to behaviour change were identified as targets for future intervention efforts and mapped onto 'intervention functions' of the Behaviour Change Wheel system. Five domains (behavioural regulation, social influences, reinforcement, environmental context and resources, and beliefs about consequences) with seven sub-themes were identified as targets for future intervention. All participants had knowledge about the evidence-based management of bacterial infections, but they reported difficulties in following this due to patient factors and time management. Lack of time was found to significantly influence their decision processes with regard to performing local measures. Beliefs about their capabilities to overcome patient influence, beliefs that performing local measures would impact on subsequent appointment times as well as there being no incentives for performing local measures were also featured. Though no knowledge or basic skills issues were identified, the participants suggested some continuous professional development programmes (e.g. time management, an overview of published guidance) to address some of the barriers. The domain results suggest a number of intervention functions through which future interventions could change GDPs' antibiotic prescribing for bacterial infections: imparting skills through training, providing an example for GDPs to imitate (i.e. modelling) or creating the expectation of a reward (i.e. incentivisation). This is the first theoretically informed study to identify barriers and facilitators of evidence-based management of patients with bacterial infections among GDPs. A pragmatic approach is needed to address the modifiable barriers in future interventions intended to change dentists' inappropriate prescribing behaviour.

Start-Up and Ongoing Practice Expenses of Behavioral Health and Primary Care Integration Interventions in the Advancing Care Together (ACT) Program.

PubMed

Wallace, Neal T; Cohen, Deborah J; Gunn, Rose; Beck, Arne; Melek, Steve; Bechtold, Donald; Green, Larry A

2015-01-01

Provide credible estimates of the start-up and ongoing effort and incremental practice expenses for the Advancing Care Together (ACT) behavioral health and primary care integration interventions. Expenditure data were collected from 10 practice intervention sites using an instrument with a standardized general format that could accommodate the unique elements of each intervention. Average start-up effort expenses were $44,076 and monthly ongoing effort expenses per patient were $40.39. Incremental expenses averaged $20,788 for start-up and $4.58 per patient for monthly ongoing activities. Variations in expenditures across practices reflect the differences in intervention specifics and organizational settings. Differences in effort to incremental expenditures reflect the extensive use of existing resources in implementing the interventions. ACT program incremental expenses suggest that widespread adoption would likely have a relatively modest effect on overall health systems expenditures. Practice effort expenses are not trivial and may pose barriers to adoption. Payers and purchasers interested in attaining widespread adoption of integrated care must consider external support to practices that accounts for both incremental and effort expense levels. Existing knowledge transfer mechanisms should be employed to minimize developmental start-up expenses and payment reform focused toward value-based, Triple Aim-oriented reimbursement and purchasing mechanisms are likely needed. © Copyright 2015 by the American Board of Family Medicine.

Gender-specific HIV prevention interventions for women who use alcohol and other drugs: The evolution of the science and future directions

PubMed Central

Wechsberg, Wendee M.; Deren, Sherry; Myers, Bronwyn; Kirtadze, Irma; Zule, William A.; Howard, Brittni; El-Bassel, Nabila

2015-01-01

The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women’s risk behavior, their roles in sexual relationships, and gender power dynamics, and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs. It looks at three generations of women-focused HIV research interventions, including first-generation projects that started in the 1990s, second-generation efforts where projects expanded in scope and included adaptions of evidence-based interventions for global relevance, and finally third-generation projects currently underway that combine biobehavioral methods and are being implemented in real-world settings. Because women who use AODs continue to report risk behaviors related to HIV, emphasis should be placed on training scientists to conduct gender-specific studies, increasing funding for new studies, and advocating to ensure that stigma-free services are available for these at-risk women. PMID:25978479

Increasing physical activity through mobile device interventions: A systematic review.

PubMed

Muntaner, Adrià; Vidal-Conti, Josep; Palou, Pere

2016-09-01

Physical inactivity is a health problem that affects people worldwide and has been identified as the fourth largest risk factor for overall mortality (contributing to 6% of deaths globally). Many researchers have tried to increase physical activity levels through traditional methods without much success. Thus, many researchers are turning to mobile technology as an emerging method for changing health behaviours. This systematic review sought to summarise and update the existing scientific literature on increasing physical activity through mobile device interventions, taking into account the methodological quality of the studies. The articles were identified by searching the PubMed, SCOPUS and SPORTDiscus databases for studies published between January 2003 and December 2013. Studies investigating efforts to increase physical activity through mobile phone or even personal digital assistant interventions were included. The search results allowed the inclusion of 11 studies that gave rise to 12 publications. Six of the articles included in this review reported significant increases in physical activity levels. The number of studies using mobile devices for interventions has increased exponentially in the last few years, but future investigations with better methodological quality are needed to draw stronger conclusions regarding how to increase physical activity through mobile device interventions. © The Author(s) 2015.

Newborn Care in the Home and Health Facility: Formative Findings for Intervention Research in Cambodia

PubMed Central

Bazzano, Alessandra N.; Taub, Leah; Oberhelman, Richard A.; Var, Chivorn

2016-01-01

Global coverage and scale up of interventions to reduce newborn mortality remains low, though progress has been achieved in improving newborn survival in many low-income settings. An important factor in the success of newborn health interventions, and moving to scale, is appropriate design of community-based programs and strategies for local implementation. We report the results of formative research undertaken to inform the design of a newborn health intervention in Cambodia. Information was gathered on newborn care practices over a period of three months using multiple qualitative methods of data collection in the primary health facility and home setting. Analysis of the data indicated important gaps, both at home and facility level, between recommended newborn care practices and those typical in the study area. The results of this formative research have informed strategies for behavior change and improving referral of sick infants in the subsequent implementation study. Collection and dissemination of data on newborn care practices from settings such as these can contribute to efforts to advance survival, growth and development of newborns for intervention research, and for future newborn health programming. PMID:28009812

Modeling spatial invasion of Ebola in West Africa.

PubMed

D'Silva, Jeremy P; Eisenberg, Marisa C

2017-09-07

The 2014-2016 Ebola Virus Disease (EVD) epidemic in West Africa was the largest ever recorded, representing a fundamental shift in Ebola epidemiology with unprecedented spatiotemporal complexity. To understand the spatiotemporal dynamics of EVD in West Africa, we developed spatial transmission models using a gravity-model framework at both the national and district-level scales, which we used to compare effectiveness of local interventions (e.g. local quarantine) and long-range interventions (e.g. border-closures). The country-level gravity model captures the epidemic data, including multiple waves of initial epidemic growth observed in Guinea. We found that local-transmission reductions were most effective in Liberia, while long-range transmission was dominant in Sierra Leone. Both models illustrated that interventions in one region result in an amplified protective effect on other regions by preventing spatial transmission. In the district-level model, interventions in the strongest of these amplifying regions reduced total cases in all three countries by over 20%, in spite of the region itself generating only ∼0.1% of total cases. This model structure and associated intervention analysis provide information that can be used by public health policymakers to assist planning and response efforts for future epidemics. Copyright © 2017 Elsevier Ltd. All rights reserved.

ARV robotic technologies (ART): a risk reduction effort for future unmanned systems

NASA Astrophysics Data System (ADS)

Jaster, Jeffrey F.

2006-05-01

The Army's ARV (Armed Robotic Vehicle) Robotic Technologies (ART) program is working on the development of various technological thrusts for use in the robotic forces of the future. The ART program will develop, integrate and demonstrate the technology required to advance the maneuver technologies (i.e., perception, mobility, tactical behaviors) and increase the survivability of unmanned platforms for the future force while focusing on reducing the soldiers' burden by providing an increase in vehicle autonomy coinciding with a decrease in the total number user interventions required to control the unmanned assets. This program will advance the state of the art in perception technologies to provide the unmanned platform an increasingly accurate view of the terrain that surrounds it; while developing tactical/mission behavior technologies to provide the Unmanned Ground Vehicle (UGV) the capability to maneuver tactically, in conjunction with the manned systems in an autonomous mode. The ART testbed will be integrated with the advanced technology software and associated hardware developed under this effort, and incorporate appropriate mission modules (e.g. RSTA sensors, MILES, etc.) to support Warfighter experiments and evaluations (virtual and field) in a military significant environment (open/rolling and complex/urban terrain). The outcome of these experiments as well as other lessons learned through out the program life cycle will be used to reduce the current risks that are identified for the future UGV systems that will be developed under the Future Combat Systems (FCS) program, including the early integration of an FCS-like autonomous navigation system onto a tracked skid steer platform.

Female Condoms=Missed Opportunities: Lessons Learned from Promotion-centered Interventions.

PubMed

Maksut, Jessica L; Eaton, Lisa A

2015-01-01

The female condom is a barrier contraceptive device that is underutilized despite its effectiveness at preventing both unintended pregnancy and sexually transmitted infections (STIs). Prior research has highlighted that the underuse of the female condom as a contraceptive option is owing in large part to social stigma, and lacking or incorrect information about the product. In an attempt to better understand the discrepancy between the female condom's documented effectiveness and its general lack of uptake, we conducted a systematic search and qualitatively reviewed 20 published intervention studies that focus on efforts to promote the female condom. The strategies that each intervention used were coded and carefully examined. We obtained information regarding relevant characteristics of the studies, including intervention setting, sampling strategy, participant demographics, and methodology used. We found that the majority of the studies had significant positive findings concerning the female condom, for example, many were effective at demonstrating participant uptake as well as increasing the number of protected sex acts. Additionally, perceived ability to use the device was a significant predictor of female condom use in multiple studies. Finally, the studies tended to include younger women; only 10.0% (n=2) reported having participants with a mean age older than 30), meaning that older women generally have not been well-served by previous efforts to promote the use of the female condom. We offer guidelines for improving female condom uptake and recommendations for future research that seeks to establish and utilize best practice promotional strategies for female condoms. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff.

PubMed

Vamos, Cheryl A; Cantor, Allison; Thompson, Erika L; Detman, Linda A; Bronson, Emily A; Phelps, Annette; Louis, Judette M; Gregg, Anthony R; Curran, John S; Sappenfield, William M

2016-10-01

Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.

Harm reduction and cessation efforts and interest in cessation resources among survivors of smoking-related cancers.

PubMed

Berg, Carla J; Carpenter, Matthew J; Jardin, Bianca; Ostroff, Jamie S

2013-03-01

Despite the well-established risks associated with persistent smoking, many cancer survivors who were active smokers at the time of cancer diagnosis continue to smoke. In order to guide the development of tobacco cessation interventions for cancer survivors, a better understanding is needed regarding post-diagnosis quitting efforts. Thus, we examined quitting and reduction efforts and interest in cessation resources among cancer survivors who self-identified as current smokers at the time of diagnosis. We conducted analyses of survey participants (n = 54) who were current smokers at the time of cancer diagnosis and were continued smokers at the time of assessment. We also conducted semi-structured interviews (n = 21) among a subset of those who either continued to smoke or quit smoking post-cancer diagnosis. Among our survey participants, 22.2 % had ever used behavioral cessation resources and 66.7 % had use pharmacotherapy, while 62.8 % had interest in future use of behavioral cessation resources and 75.0 % had interest in pharmacotherapy. The majority reported some quitting efforts including making quit attempts, using cessation medications, and reducing their daily cigarette consumption. Semi-structured interview data revealed various strategies used to aid in smoking reduction and cessation as well as variability in preferences for cessation resources. Cancer patients who smoke following diagnosis often engage in smoking reduction and cessation-related behaviors, which may reflect their motivation to reduce their smoking-related risks. They also report high interest in cessation resources. Thus, it is important to explore the acceptability and effectiveness of different cessation intervention components among this group. Cancer survivors who smoke demonstrate actions toward harm reduction and cessation. They should inquire about potential resources that might facilitate their efforts among their healthcare providers and enlist support and advice from others around them to bolster their efforts.

An Evaluation of Evidence-Based Interventions to Increase Compliance among Children with Autism

ERIC Educational Resources Information Center

Fischetti, Anthony T.; Wilder, David A.; Myers, Kristin; Leon-Enriquez, Yanerys; Sinn, Stephanie; Rodriguez, Rebecka

2012-01-01

We evaluated 4 evidence-based interventions to increase compliance. Three children with autism who exhibited noncompliance when asked to relinquish a preferred toy were exposed sequentially to interventions that included a reduction in response effort, differential reinforcement, and guided compliance. Results indicated that effort reduction alone…

Workplace interventions for workers with musculoskeletal disabilities: a descriptive review of content.

PubMed

Durand, M J; Vézina, N; Loisel, P; Baril, R; Richard, M C; Diallo, B

2007-03-01

Despite the convergence of scientific data to the effect that interventions in the workplace promote a healthy return to work, the interventions carried out in the real work environment appear to be very heterogeneous and ill-defined. The goal of this review is to identify the different objectives pursued through the workplace interventions carried out in the context of a rehabilitation program, and to describe the activities involved. A descriptive review of the literature, including various research designs, was carried out. This review reveals great heterogeneity in the content of interventions offered in the workplace to workers with musculoskeletal disabilities. The objectives of workplace interventions may range from gathering information in order to reproduce work demands in a clinical setting, to gradually exposing workers to the demands of the real work environment, or permanently reducing the demands of the work situation. A descriptive analysis of the literature also brings to light the diversity of actions carried out, human resources used, and workplace environments involved, while highlighting the few documented process outcome evaluations that have been done of workplace interventions. It is recommended that in future research in this area, efforts be made to better describe the components of the interventions, to develop process outcomes representing the multidimensional results obtained in the workplace, and to differentiate between temporary and permanent modifications made to the work situation.

Neuroimaging of Reading Intervention: A Systematic Review and Activation Likelihood Estimate Meta-Analysis

PubMed Central

Barquero, Laura A.; Davis, Nicole; Cutting, Laurie E.

2014-01-01

A growing number of studies examine instructional training and brain activity. The purpose of this paper is to review the literature regarding neuroimaging of reading intervention, with a particular focus on reading difficulties (RD). To locate relevant studies, searches of peer-reviewed literature were conducted using electronic databases to search for studies from the imaging modalities of fMRI and MEG (including MSI) that explored reading intervention. Of the 96 identified studies, 22 met the inclusion criteria for descriptive analysis. A subset of these (8 fMRI experiments with post-intervention data) was subjected to activation likelihood estimate (ALE) meta-analysis to investigate differences in functional activation following reading intervention. Findings from the literature review suggest differences in functional activation of numerous brain regions associated with reading intervention, including bilateral inferior frontal, superior temporal, middle temporal, middle frontal, superior frontal, and postcentral gyri, as well as bilateral occipital cortex, inferior parietal lobules, thalami, and insulae. Findings from the meta-analysis indicate change in functional activation following reading intervention in the left thalamus, right insula/inferior frontal, left inferior frontal, right posterior cingulate, and left middle occipital gyri. Though these findings should be interpreted with caution due to the small number of studies and the disparate methodologies used, this paper is an effort to synthesize across studies and to guide future exploration of neuroimaging and reading intervention. PMID:24427278

The promises and limitations of gender-transformative health programming with men: critical reflections from the field.

PubMed

Dworkin, Shari L; Fleming, Paul J; Colvin, Christopher J

2015-01-01

Since the 1994 International Conference on Population and Development, researchers and practitioners have engaged in a series of efforts to shift health programming with men from being gender-neutral to being more gender-sensitive and gender-transformative. Efforts in this latter category have been increasingly utilised, particularly in the last decade, and attempt to transform gender relations to be more equitable in the name of improved health outcomes for both women and men. We begin by assessing the conceptual progression of social science contributions to gender-transformative health programming with men. Next, we briefly assess the empirical evidence from gender-transformative health interventions with men. Finally, we examine some of the challenges and limitations of gender-transformative health programmes and make recommendations for future work in this thriving interdisciplinary area of study.

The promises and limitations of gender-transformative health programming with men: critical reflections from the field

PubMed Central

Dworkin, Shari L.; Fleming, Paul J.; Colvin, Christopher J.

2015-01-01

Since the 1994 International Conference on Population and Development, researchers and practitioners have engaged in a series of efforts to shift health programming with men from being gender-neutral to being more gender-sensitive and gender-transformative. Efforts in this latter category have been increasingly utilised, particularly in the last decade, and attempt to transform gender relations to be more equitable in the name of improved health outcomes for both women and men. We begin by assessing the conceptual progression of social science contributions to gender-transformative health programming with men. Next, we briefly assess the empirical evidence from gender-transformative health interventions with men. Finally, we examine some of the challenges and limitations of gender-transformative health programmes and make recommendations for future work in this thriving interdisciplinary area of study. PMID:25953008

Child Community Mental Health Services in Asia Pacific and Singapore’s REACH Model

PubMed Central

Lim, Choon Guan; Loh, Hannah; Renjan, Vidhya; Tan, Jason; Fung, Daniel

2017-01-01

In recent decades, there have been concerted efforts to improve mental health services for youths alongside the challenges of rising healthcare costs and increasing demand for mental health needs. One important phenomenon is the shift from traditional clinic-based care to community-based mental health services to improve accessibility to services and provide patient-centred care. In this article, we discuss the child and adolescent community mental health efforts within the Asia-Pacific region. We also discuss Singapore’s community and school-based mental health service, known as the Response, Early Intervention and Assessment in Community Mental Health (REACH). This article discusses how REACH has evolved over the years in response to the changing needs of youths in Singapore. Finally, we discuss the current challenges and future directions for youth mental health care. PMID:28984830

Two-Year Predictors of Runaway and Homeless Episodes Following Shelter Services among Substance Abusing Adolescents

PubMed Central

Slesnick, Natasha; Guo, Xiamei; Brakenhoff, Brittany; Feng, Xin

2013-01-01

Given high levels of health and psychological costs associated with the family disruption of homelessness, identifying predictors of runaway and homeless episodes is an important goal. The current study followed 179 substance abusing, shelter-recruited adolescents who participated in a randomized clinical trial. Predictors of runaway and homeless episodes were examined over a two year period. Results from the hierarchical linear modeling analysis showed that family cohesion and substance use, but not family conflict or depressive symptoms, delinquency, or school enrollment predicted future runaway and homeless episodes. Findings suggest that increasing family support, care and connection and reducing substance use are important targets of intervention efforts in preventing future runaway and homeless episodes amongst a high risk sample of adolescents. PMID:24011094

Evaluation of a participatory ergonomics intervention in small commercial construction firms.

PubMed

Dale, Ann Marie; Jaegers, Lisa; Welch, Laura; Gardner, Bethany T; Buchholz, Bryan; Weaver, Nancy; Evanoff, Bradley A

2016-06-01

Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participatory ergonomics (PE) interventions that engage workers and employers in reducing work injury risks have shown mixed results. Eight-six workers from seven contractors participated in a PE program. A logic model guided the process evaluation and summative evaluation of short-term and intermediate impacts and long-term outcomes from surveys and field records. Process measures showed good delivery of training, high worker engagement, and low contractor participation. Workers' knowledge improved and workers reported changes to work practices and tools used; contractor provision of appropriate equipment was low (33%). No changes were seen in symptoms or reported physical effort. The PE program produced many worker-identified ergonomic solutions, but lacked needed support from contractors. Future interventions should engage higher levels of the construction organizational system to improve contractor involvement for reducing WMSD. Am. J. Ind. Med. 59:465-475, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

The Affordable Care Act and genetic testing for inheritable cancer syndromes: impact on high-risk underserved minorities.

PubMed

Walcott, Farzana L; Dunn, Barbara K; DeShields, Mary; Baquet, Claudia

2014-02-01

Genetic testing for inheritable cancer syndromes is becoming a critical part of preventive health services. The Patient Protection and Affordable Care Act (PPACA) Essential Health Benefits package addresses breast cancer susceptibility-gene testing for women who are unaffected by cancer. The absence of provisions for 1) men, 2) cancer patients, 3) other inheritable cancer syndromes, and 4) risk-reducing interventions are limitations of PPACA. We discuss provisions and limitations of PPACA pertaining to genetic testing and effects on high-risk populations, in particular minorities. The PPACA is the beginning of an ongoing process of incorporating genetic testing in the armamentarium of cancer prevention. Future efforts should focus on ensuring equitable access to genetic testing as a preventive service under PPACA to high-risk populations other than women. Consideration should also be given to provisions for risk-reducing interventions, especially in underserved minority populations, who are known to underutilize genetic testing and may have limited financial resources for medical intervention.

Neurocognitive interventions for children and adolescents surviving cancer.

PubMed

Butler, Robert W; Mulhern, Raymond K

2005-01-01

It is well recognized that many cures for childhood leukemia and brain tumors entail some relatively permanent neurocognitive and psychological costs to the patient and family. As cure rates have improved over the past three decades, increasing efforts have been directed toward reducing treatment-related late effects. The particular focus of this review will be on interventions for the neuropsychological late effects associated with the treatment of acute lymphoblastic leukemia (ALL) and malignant brain tumors. We will first briefly review current approaches to the medical treatment of ALL and brain tumors to provide an appreciation of potential sources of brain injury. We will then summarize the existing literature on types of neuropsychological deficits found among survivors, with special attention to variables that place some children at greater risk. Then, there will be a discussion of approaches to intervention for these deficits-specifically, cognitive remediation, pharmacology, and ecological alterations in the classroom. Finally, we will present directions for future research in the field.

Occupational health hazards in the interventional laboratory: progress report of the Multispecialty Occupational Health Group.

PubMed

Miller, Donald L; Klein, Lloyd W; Balter, Stephen; Norbash, Alexander; Haines, David; Fairobent, Lynne; Goldstein, James A

2010-09-01

The Multispecialty Occupational Health Group (MSOHG), formed in 2005, is an informal coalition of societies representing professionals who work in, or are concerned with, interventional fluoroscopy. The group's long-term goals are to improve occupational health and operator and staff safety in the interventional laboratory while maintaining quality patient care and optimal use of the laboratory. MSOHG has conducted a dialogue with equipment manufacturers and has developed a list of specific objectives for research and development. The group has also represented the member societies in educating regulators, in educating interventionalists, and in fostering and collaborating on research into occupational health issues affecting interventionalists. Not least of the group's accomplishments, as a result of their collaboration in MSOHG, the group's members have developed a mutual respect that can serve as a basis for joint efforts in the future among interventionalists of different medical specialties. Copyright 2010 SIR. Published by Elsevier Inc. All rights reserved.

Allergen Avoidance in Allergic Asthma

PubMed Central

Cipriani, Francesca; Calamelli, Elisabetta; Ricci, Giampaolo

2017-01-01

Allergic asthma is the most frequent disease among the chronic respiratory disorders in pediatric age with an important social impact. In the last years, many efforts have been made to identify effective preventive approaches to get a better control of symptoms and to obtain the best future outcomes for the patients. In patients with allergic asthma triggered by the exposure to indoor allergens, the avoidance is the first intervention to prevent the appearance or the worsening of bronchial symptoms. This review article summarized the most recent evidence from literature about the efficacy of specific control interventions for the most important allergens. Even if a wide spectrum of interventions has been suggested and may help to reduce exposure to trigger allergy for sensitized patients suffering from respiratory allergy, evidence supporting the efficacy of these approaches is still weak and subject of controversy. However, the exposure control to specific airborne allergens is still widely recommended and may be effective as part of a holistic approach to reduce the severity of allergic respiratory symptoms in sensitized individuals. PMID:28540285

Changing the Future of Obesity: Science, Policy and Action

PubMed Central

Gortmaker, Steven L; Swinburn, Boyd; Levy, David; Carter, Rob; Mabry, Patricia L.; Finegood, Diane; Huang, Terry; Marsh, Tim; Moodie, Marj

2011-01-01

The global obesity epidemic has been on the rise for four decades, yet sustained prevention efforts have barely begun. An emerging science using quantitative models has provided key insights into the dynamics of this epidemic, and made it possible to combine different pieces of evidence and calculate the impact of behaviors, interventions and policies at multiple levels – from person to population. Forecasts indicate large effects of high levels of obesity on future population health and economic outcomes. Energy gap models have quantified the relationships of changes in energy intake and expenditure to weight change, and documented the dominant role of increasing intake on obesity prevalence. The empirical evidence base for effective interventions is limited but growing. Several cost-effective policies are identified that governments should prioritize for implementation. Systems science provides a framework for organizing the complexity of forces driving the obesity epidemic and has important implications for policy-makers. Multiple players (including governments, international organizations, the private sector, and civil society) need to contribute complementary actions in a coordinated approach. Priority actions include policies to improve the food and built environments, cross-cutting actions (such as leadership, health-in-all policies, and monitoring), and much greater funding for prevention programs. Increased investment in population obesity monitoring would improve the accuracy of forecasts and evaluations. Embedding actions within existing systems in both health and non-health sectors (trade, agriculture, transport, urban planning, development) can greatly increase impact and sustainability. We call for a sustained worldwide effort to monitor, prevent and control obesity. PMID:21872752

Fifty communities putting prevention to work: accelerating chronic disease prevention through policy, systems and environmental change.

PubMed

Bunnell, Rebecca; O'Neil, Dara; Soler, Robin; Payne, Rebecca; Giles, Wayne H; Collins, Janet; Bauer, Ursula

2012-10-01

The burden of preventable chronic diseases is straining our nation's health and economy. Diseases caused by obesity and tobacco use account for the largest portions of this preventable burden. CDC funded 50 communities in 2010 to implement policy, systems, and environmental (PSE) interventions in a 2-year initiative. Funded communities developed PSE plans to reduce obesity, tobacco use, and second-hand smoke exposure for their combined 55 million residents. Community outcome objectives and milestones were categorized by PSE interventions as they related to media, access, promotion, pricing, and social support. Communities estimated population reach based on their jurisdiction's census data and target populations. The average proportion of each community's population that was reached was calculated for each intervention category. Outcome objectives that were achieved within 12 months of program initiation were identified from routine program records. The average proportion of a community's jurisdictional population reached by a specific intervention varied across interventions. Mean population reach for obesity-prevention interventions was estimated at 35%, with 14 (26%) interventions covering over 50% of the jurisdictional populations. For tobacco prevention, mean population reach was estimated at 67%, with 16 (84%) interventions covering more than 50% of the jurisdictional populations. Within 12 months, communities advanced over one-third of their obesity and tobacco-use prevention strategies. Tobacco interventions appeared to have higher potential population reach than obesity interventions within this initiative. Findings on the progress and potential reach of this major initiative may help inform future chronic disease prevention efforts.

Documenting pharmacist interventions on an intranet.

PubMed

Simonian, Armen I

2003-01-15

The process of developing and implementing an intranet Web site for clinical intervention documentation is described. An inpatient pharmacy department initiated an organizationwide effort to improve documentation of interventions by pharmacists at its seven hospitals to achieve real-time capture of meaningful benchmarking data. Standardization of intervention types would allow the health system to contrast and compare medication use, process improvement, and patient care initiatives among its hospitals. After completing a needs assessment and reviewing current methodologies, a computerized tracking tool was developed in-house and integrated with the organization's intranet. Representatives from all hospitals agreed on content and functionality requirements for the Web site. The site was completed and activated in February 2002. Before this Web site was established, the most documented intervention types were Renal Adjustment and Clarify Dose, with a daily average of four and three, respectively. After site activation, daily averages for Renal Adjustment remained unchanged, but Clarify Dose is now documented nine times per day. Drug Information and i.v.-to-p.o. intervention types, which previously averaged less than one intervention per day, are now documented an average of four times daily. Approximately 91% of staff pharmacists are using this site. Future plans for this site include enhanced accessibility to the site with wireless personal digital assistants. The design and implementation of an intranet Web site to document pharmacists' interventions doubled the rate of intervention documentation and standardized the intervention types among hospitals in the health system.

Systematic review of dietary interventions with college students: directions for future research and practice.

PubMed

Kelly, Nichole R; Mazzeo, Suzanne E; Bean, Melanie K

2013-01-01

To clarify directions for research and practice, research literature evaluating nutrition and dietary interventions in college and university settings was reviewed. Systematic search of database literature. Postsecondary education. Fourteen research articles evaluating randomized controlled trials or quasi-experimental interventions targeting dietary outcomes. Diet/nutrition intake, knowledge, motivation, self-efficacy, barriers, intentions, social support, self-regulation, outcome expectations, and sales. Systematic search of 936 articles and review of 14 articles meeting search criteria. Some in-person interventions (n = 6) show promise in improving students' dietary behaviors, although changes were minimal. The inclusion of self-regulation components, including self-monitoring and goal setting, may maximize outcomes. Dietary outcomes from online interventions (n = 5) were less promising overall, although they may be more effective with a subset of college students early in their readiness to change their eating habits. Environmental approaches (n = 3) may increase the sale of healthy food by serving as visual cues-to-action. A number of intervention approaches show promise for improving college students' dietary habits. However, much of this research has methodological limitations, rendering it difficult to draw conclusions across studies and hindering dissemination efforts. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Employing a teen advisory board to adapt an evidence-based HIV/STD intervention for incarcerated African-American adolescent women.

PubMed

Latham, Teaniese P; Sales, Jessica M; Renfro, Tiffaney L; Boyce, Lorin S; Rose, Eve; Murray, Colleen C; Wingood, Gina M; DiClemente, Ralph J

2012-10-01

This manuscript assesses priorities and challenges of adolescent females by conducting a meeting with teen advisory board (TAB) members to collect information regarding their lives and experiences pre-, during and post-incarceration in a juvenile detention facility. Multiple themes emerged regarding the impact of incarceration on young African-American females, including experiencing a loss of personal liberties, the importance of making money upon release, unfaithfulness by partners on the 'outside', substance use and lack of control over their environment upon release, including parents, peers and male sexual partners. Based on feedback from TAB members, unique barriers and challenges were identified that suggested areas where adaptations to an evidenced-based HIV/sexually transmitted disease (STD) intervention would be justified to more adequately meet the needs of this particular subgroup of young African-American women. Adaptations to the evidence-based interventions included enhancing activities related to goal setting, emotion regulation skills, decision-making, recognizing and utilizing support networks and addressing the relationship between substance use and risky sexual behavior. Future health education efforts focusing on either the creation of new HIV/STD interventions or adaptations to existing interventions should consider utilizing advisory boards with members of the priority population at the earliest stages of intervention planning.

A randomized intervention trial to reduce mechanical exposures in the Colombian flower industry.

PubMed

Barrero, L H; Ceballos, C; Ellegast, R; Pulido, J A; Monroy, M; Berrio, S; Quintana, L A

2012-01-01

Evidence on the effectiveness of ergonomic interventions to reduce mechanical demands and upper-extremity MSDs is scarce in agriculture. We conducted an intervention to reduce mechanical exposures during manual flower cutting through job rotation, education and reduction of force requirements. One-hundred and twenty workers (20 to 60 years old; 89% women) from six companies that cultivate roses participated in this study. Three companies were randomly assigned to control and intervention groups. We studied changes between baseline and follow-up in self-reported effort and upper-extremity postures, kinematics and muscular activity. Most of the observed changes were moderate for both groups. The intervention group showed differential improvements compared to the control group for the maximum wrist radial deviation and forearm pronation, and acceleration of the forearm supination-pronation and elbow flexion-extension; and the muscular activity of the flexor and extensor carpi radialis and the flexor carpi ulnaris. However, we also observed that the maximum ulnar deviation, velocity of the wrist flexion-extension and muscular activity of the extensor carpi ulnaris improved more in the control group. These mixed results may be related to limited time for intervention adjustment, and uncontrolled task changes in the control group. Future research should address these issues and test other solutions.

Jordan M. Braciszewski: APA/APAGS Award for Distinguished Graduate Student in Professional Psychology.

PubMed

2011-11-01

Presents Jordan M. Braciszewski as the 2011 winner of the American psychological Association APA/APAGS Award for Distinguished Graduate Student in Professional Psychology. "For his concerted efforts to identify the needs of homeless and other at-risk populations and to design and provide necessary services for them. Jordan M. Braciszewski is committed to using applied psychological science and evidence-based intervention methods to assist the most disadvantaged in our society. He has already provided additions to the relevant research literature and has volunteered countless hours of his time to implement community-based interventions and provide direct services himself. He has sought out the training experiences necessary to assist him in doing an even better job in the future in these public service activities." (PsycINFO Database Record (c) 2011 APA, all rights reserved). 2011 APA, all rights reserved

Review of corruption in the health sector: theory, methods and interventions.

PubMed

Vian, Taryn

2008-03-01

There is increasing interest among health policymakers, planners and donors in how corruption affects health care access and outcomes, and what can be done to combat corruption in the health sector. Efforts to explain the risk of abuse of entrusted power for private gain have examined the links between corruption and various aspects of management, financing and governance. Behavioural scientists and anthropologists also point to individual and social characteristics which influence the behaviour of government agents and clients. This article presents a comprehensive framework and a set of methodologies for describing and measuring how opportunities, pressures and rationalizations influence corruption in the health sector. The article discusses implications for intervention, and presents examples of how theory has been applied in research and practice. Challenges of tailoring anti-corruption strategies to particular contexts, and future directions for research, are addressed.

Twitter, Millennials, and Nursing Education Research.

PubMed

Stephens, Teresa M; Gunther, Mary E

2016-01-01

This article reports the use of Twitter as an intervention delivery method in a multisite experimental nursing research study. A form of social networking, Twitter is considered a useful means of communication, particularly with millennials. This method was chosen based on current literature exploring the characteristics of millennial students. Ahern's Model of Adolescent Resilience served as the theoretical framework. Participants were 70 junior-level baccalaureate nursing students, ages 19-23, at two state-supported universities. Twitter was found to be a convenient, cost-effective, and enjoyable means of intervention delivery for the researcher. Participants in the experimental and control groups expressed positive feelings about the use of Twitter. The findings contribute to future efforts to use social media in nursing research and education to increase faculty-student engagement, promote critical reflection, provide social support, reinforce course content, and increase the sense of community.

Commentary: Increasing the Connectivity Between Implementation Science and Public Health: Advancing Methodology, Evidence Integration, and Sustainability.

PubMed

Chambers, David A

2018-04-01

Gaps remain between the outcomes of biomedical research and their application within clinical and community settings. The field of implementation science, also referred to as dissemination and implementation research, is intended to improve the adoption, uptake, and sustainability of evidence-based health interventions. The articles in this volume's symposium on implementation science and public health identify important directions in the effort to maximize the impact of research on public and population health. Leading researchers present reviews of the use of quasi-experimental designs in implementation science, the movement toward enhancing evidence-based public health, and intervention sustainability. Each article presents lessons learned from prior research and recommendations for the next generation of studies. Collectively, the symposium offers a road map for future implementation science that seeks to optimize public health.

A Community-Based Participatory Planning Process and Multilevel Intervention Design: Toward Eliminating Cardiovascular Health Inequities

PubMed Central

Schulz, Amy J.; Israel, Barbara A.; Coombe, Chris M.; Gaines, Causandra; Reyes, Angela G.; Rowe, Zachary; Sand, Sharon; Strong, Larkin L.; Weir, Sheryl

2010-01-01

The elimination of persistent health inequities requires the engagement of multiple perspectives, resources and skills. Community-based participatory research is one approach to developing action strategies that promote health equity by addressing contextual as well as individual level factors, and that can contribute to addressing more fundamental factors linked to health inequity. Yet many questions remain about how to implement participatory processes that engage local insights and expertise, are informed by the existing public health knowledge base, and build support across multiple sectors to implement solutions. We describe a CBPR approach used to conduct a community assessment and action planning process, culminating in development of a multilevel intervention to address inequalities in cardiovascular disease in Detroit, Michigan. We consider implications for future efforts to engage communities in developing strategies toward eliminating health inequities. PMID:21873580

Establishing the Research Agenda for Increasing the Representation of Women in Engineering and Computing

PubMed Central

Buse, Kathleen; Hill, Catherine; Benson, Kathleen

2017-01-01

While there is an extensive body of research on gender equity in engineering and computing, there have been few efforts to glean insight from a dialog among experts. To encourage collaboration and to develop a shared vision of the future research agenda, a 2 day workshop of 50 scholars who work on the topic of gender in engineering and computing was held at a rural conference center. The structure of the conference and the location allowed for time to reflect, dialog, and to craft an innovative research agenda aimed at increasing the representation of women in engineering and computing. This paper has been written by the conference organizers and details the ideas and recommendations from the scholars. The result is an innovative, collaborative approach to future research that focuses on identifying effective interventions. The new approach includes the creation of partnerships with stakeholders including businesses, government agencies, non-profits and academic institutions to allow a broader voice in setting research priorities. Researchers recommend incorporating multiple disciplines and methodologies, while expanding the use of data analytics, merging and mining existing databases and creating new datasets. The future research agenda is detailed and includes studies focused on socio-cultural interventions particularly on career choice, within undergraduate and graduate programs, and for women in professional careers. The outcome is a vision for future research that can be shared with researchers, practitioners and other stakeholders that will lead to gender equity in the engineering and computing professions. PMID:28469591

Establishing the Research Agenda for Increasing the Representation of Women in Engineering and Computing.

PubMed

Buse, Kathleen; Hill, Catherine; Benson, Kathleen

2017-01-01

While there is an extensive body of research on gender equity in engineering and computing, there have been few efforts to glean insight from a dialog among experts. To encourage collaboration and to develop a shared vision of the future research agenda, a 2 day workshop of 50 scholars who work on the topic of gender in engineering and computing was held at a rural conference center. The structure of the conference and the location allowed for time to reflect, dialog, and to craft an innovative research agenda aimed at increasing the representation of women in engineering and computing. This paper has been written by the conference organizers and details the ideas and recommendations from the scholars. The result is an innovative, collaborative approach to future research that focuses on identifying effective interventions. The new approach includes the creation of partnerships with stakeholders including businesses, government agencies, non-profits and academic institutions to allow a broader voice in setting research priorities. Researchers recommend incorporating multiple disciplines and methodologies, while expanding the use of data analytics, merging and mining existing databases and creating new datasets. The future research agenda is detailed and includes studies focused on socio-cultural interventions particularly on career choice, within undergraduate and graduate programs, and for women in professional careers. The outcome is a vision for future research that can be shared with researchers, practitioners and other stakeholders that will lead to gender equity in the engineering and computing professions.

Assessing Interventions to Manage West Nile Virus Using Multi-Criteria Decision Analysis with Risk Scenarios

PubMed Central

Hongoh, Valerie; Campagna, Céline; Panic, Mirna; Samuel, Onil; Gosselin, Pierre; Waaub, Jean-Philippe; Ravel, André; Samoura, Karim; Michel, Pascal

2016-01-01

The recent emergence of West Nile virus (WNV) in North America highlights vulnerability to climate sensitive diseases and stresses the importance of preventive efforts to reduce their public health impact. Effective prevention involves reducing environmental risk of exposure and increasing adoption of preventive behaviours, both of which depend on knowledge and acceptance of such measures. When making operational decisions about disease prevention and control, public health must take into account a wide range of operational, environmental, social and economic considerations in addition to intervention effectiveness. The current study aimed to identify, assess and rank possible risk reduction measures taking into account a broad set of criteria and perspectives applicable to the management of WNV in Quebec under increasing transmission risk scenarios, some of which may be related to ongoing warming in higher-latitude regions. A participatory approach was used to collect information on categories of concern to relevant stakeholders with respect to WNV prevention and control. Multi-criteria decision analysis was applied to examine stakeholder perspectives and their effect on strategy rankings under increasing transmission risk scenarios. Twenty-three preventive interventions were retained for evaluation using eighteen criteria identified by stakeholders. Combined evaluations revealed that, at an individual-level, inspecting window screen integrity, wearing light colored, long clothing, eliminating peridomestic larval sites and reducing outdoor activities at peak times were top interventions under six WNV transmission scenarios. At a regional-level, the use of larvicides was a preferred strategy in five out of six scenarios, while use of adulticides and dissemination of sterile male mosquitoes were found to be among the least favoured interventions in almost all scenarios. Our findings suggest that continued public health efforts aimed at reinforcing individual-level preventive behaviours combined with the application of larvicides to manage the risk of WNV infection are the interventions most acceptable and effective at reaching current management objectives now and under future theoretical transmission risk. PMID:27494136

Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men.

PubMed

Johnson, Wayne D; Diaz, Rafael M; Flanders, William D; Goodman, Michael; Hill, Andrew N; Holtgrave, David; Malow, Robert; McClellan, William M

2008-07-16

Men who have sex with men (MSM) remain at great risk for HIV infection. Program planners and policy makers need descriptions of interventions and quantitative estimates of intervention effects to make informed decisions concerning prevention funding and research. The number of intervention strategies for MSM that have been examined with strong research designs has increased substantially in the past few years. 1. To locate and describe outcome studies evaluating the effects of behavioral HIV prevention interventions for MSM.2. To summarize the effectiveness of these interventions in reducing unprotected anal sex.3. To identify study characteristics associated with effectiveness.4. To identify gaps and indicate future research, policy, and practice needs. We searched electronic databases, current journals, manuscripts submitted by researchers, bibliographies of relevant articles, conference proceedings, and other reviews for published and unpublished reports from 1988 through December 2007. We also asked researchers working in HIV prevention about new and ongoing studies. Studies were considered in scope if they examined the effects of behavioral interventions aimed at reducing risk for HIV or STD transmission among MSM. We reviewed studies in scope for criteria of outcome relevance (measurement of at least one of a list of behavioral or biologic outcomes, e.g., unprotected sex or incidence of HIV infections) and methodologic rigor (randomized controlled trials or certain strong quasi-experimental designs with comparison groups). We used fixed and random effects models to summarize rate ratios (RR) comparing intervention and control groups with respect to count outcomes (number of occasions of or partners for unprotected anal sex), and corresponding prevalence ratios (PR) for dichotomous outcomes (any unprotected anal sex vs. none). We used published formulas to convert effect sizes and their variances for count and dichotomous outcomes where necessary. We accounted for intraclass correlation (ICC) in community-level studies and adjusted for baseline conditions in all studies. We present separate results by intervention format (small group, individual, or community-level) and by type of intervention delivered to the comparison group (minimal or no HIV prevention in the comparison condition versus standard or other HIV prevention in the comparison condition). We examine rate ratios stratified according to characteristics of participants, design, implementation, and intervention content. For small group and individual-level interventions we used a stepwise selection process to identify a multivariable model of predictors of reduction in occasions of or partners for unprotected anal sex. We used funnel plots to examine publication bias, and Q (a chi-squared statistic with degrees of freedom = number of interventions minus 1) to test for heterogeneity. We found 44 studies evaluating 58 interventions with 18,585 participants. Formats included 26 small group interventions, 21 individual-level interventions, and 11 community-level interventions. Sixteen of the 58 interventions focused on HIV-positives. The 40 interventions that were measured against minimal to no HIV prevention intervention reduced occasions of or partners for unprotected anal sex by 27% (95% confidence interval [CI] = 15% to 37%). The other 18 interventions reduced unprotected anal sex by 17% beyond changes observed in standard or other interventions (CI = 5% to 27%). Intervention effects were statistically homogeneous, and no independent variable was statistically significantly associated with intervention effects at alpha=.05. However, a multivariable model selected by backward stepwise elimination identified four study characteristics associated with reduction in occasions of or partners for unprotected anal sex among small group and individual-level interventions at alpha=.10. The most favorable reductions in episodes of or partners for unprotected anal sex (33% to 35% decreases) were observed among studies with count outcomes, those with shorter intervention spans (<=1 month), those with better retention in the intervention condition than in the comparison condition, and those with minimal to no HIV prevention intervention delivered to the comparison condition. Because there were only 11 community-level studies we did not search for a multivariable model for community-level interventions. In stratified analyses including only one variable at a time, the greatest reductions (40% to 54% decreases) in number of episodes of or partners for unprotected anal sex among community-level interventions were observed among studies where groups were assigned randomly rather than by convenience, studies with shorter recall periods and longer follow-up, studies with more than 25% non-gay identifying MSM, studies in which at least 90% of participants were white, and studies in which the intervention addressed development of personal skills. Behavioral interventions reduce self-reported unprotected anal sex among MSM. These results indicate that HIV prevention for this population can work and should be supported. Results of previous studies provide a benchmark for expectations in new studies. Meta-analysis can inform future design and implementation in terms of sample size, target populations, settings, goals for process measures, and intervention content. When effects differ by design variables, which are deliberately selected and planned, awareness of these characteristics may be beneficial to future designs. Researchers designing future small group and individual-level studies should keep in mind that to date, effects of the greatest magnitude have been observed in studies that used count outcomes and a shorter intervention span (up to 1 month). Among small group and individual-level studies, effects were also greatest when the comparison condition included minimal to no HIV prevention content. Nevertheless, statistically significant favorable effects were also seen when the comparison condition included standard or other HIV prevention content. Researchers choosing the latter option for new studies should plan for larger sample sizes based on the smaller expected net intervention effect noted above. When effects differ by implementation variables, which become evident as the study is conducted but are not usually selected or planned, caution may be advised so that future studies can reduce bias. Because intervention effects were somewhat stronger (though not statistically significantly so) in studies with a greater attrition in the comparison condition, differential retention may be a threat to validity. Extra effort should be given to retaining participants in comparison conditions. Among community-level interventions, intervention effects were strongest among studies with random assignment of groups or communities. Therefore the inclusion of studies where assignment of groups or communities was by convenience did not exaggerate the summary effect. The greater effectiveness of interventions including more than 25% non-gay identifying MSM suggests that when they can be reached, these men may be more responsive than gay-identified men to risk reduction efforts. Non-gay identified MSM may have had less exposure to previous prevention messages, so their initial exposure may have a greater impact. The greater effectiveness of interventions that include efforts to promote personal skills such as keeping condoms available and behavioral self-management indicates that such content merits strong consideration in development and delivery of new interventions for MSM. And the finding that interventions were most effective for majority white populations underscores the critical need for effective interventions for MSM of African and Latino descent. Further research measuring the incidence of HIV and other STDs is needed. Because most studies were conducted among mostly white men in the US and Europe, more evaluations of interventions are needed for African American and Hispanic MSM as well as MSM in the developing world. More research is also needed to further clarify which behavioral strategies (e.g., reducing unprotected anal sex, having oral sex instead of anal sex, reducing number of partners, avoiding serodiscordant partners, strategic positioning, or reducing anal sex even with condom use) are most effective in reducing transmission among MSM, the messages most effective in promoting these behaviors, and the methods and settings in which these messages can be most effectively delivered.

Controlling range expansion in habitat networks by adaptively targeting source populations.

PubMed

Hock, Karlo; Wolff, Nicholas H; Beeden, Roger; Hoey, Jessica; Condie, Scott A; Anthony, Kenneth R N; Possingham, Hugh P; Mumby, Peter J

2016-08-01

Controlling the spread of invasive species, pests, and pathogens is often logistically limited to interventions that target specific locations at specific periods. However, in complex, highly connected systems, such as marine environments connected by ocean currents, populations spread dynamically in both space and time via transient connectivity links. This results in nondeterministic future distributions of species in which local populations emerge dynamically and concurrently over a large area. The challenge, therefore, is to choose intervention locations that will maximize the effectiveness of the control efforts. We propose a novel method to manage dynamic species invasions and outbreaks that identifies the intervention locations most likely to curtail population expansion by selectively targeting local populations most likely to expand their future range. Critically, at any point during the development of the invasion or outbreak, the method identifies the local intervention that maximizes the long-term benefit across the ecosystem by restricting species' potential to spread. In so doing, the method adaptively selects the intervention targets under dynamically changing circumstances. To illustrate the effectiveness of the method we applied it to controlling the spread of crown-of-thorns starfish (Acanthaster sp.) outbreaks across Australia's Great Barrier Reef. Application of our method resulted in an 18-fold relative improvement in management outcomes compared with a random targeting of reefs in putative starfish control scenarios. Although we focused on applying the method to reducing the spread of an unwanted species, it can also be used to facilitate the spread of desirable species through connectivity networks. For example, the method could be used to select those fragments of habitat most likely to rebuild a population if they were sufficiently well protected. © 2016 Society for Conservation Biology.

Interdisciplinary modeling and analysis to reduce loss of life from tsunamis

NASA Astrophysics Data System (ADS)

Wood, N. J.

2016-12-01

Recent disasters have demonstrated the significant loss of life and community impacts that can occur from tsunamis. Minimizing future losses requires an integrated understanding of the range of potential tsunami threats, how individuals are specifically vulnerable to these threats, what is currently in place to improve their chances of survival, and what risk-reduction efforts could be implemented. This presentation will provide a holistic perspective of USGS research enabled by recent advances in geospatial modeling to assess and communicate population vulnerability to tsunamis and the range of possible interventions to reduce it. Integrated research includes efforts to characterize the magnitude and demography of at-risk individuals in tsunami-hazard zones, their evacuation potential based on landscape conditions, nature-based mitigation to improve evacuation potential, evacuation pathways and population demand at assembly areas, siting considerations for vertical-evacuation refuges, community implications of multiple evacuation zones, car-based evacuation modeling for distant tsunamis, and projected changes in population exposure to tsunamis over time. Collectively, this interdisciplinary research supports emergency managers in their efforts to implement targeted risk-reduction efforts based on local conditions and needs, instead of generic regional strategies that only focus on hazard attributes.

Life Satisfaction Moderates the Effectiveness of a Play-Based Parenting Intervention in Low-Income Mothers and Toddlers

PubMed Central

Brock, Rebecca L.; Kochanska, Grazyna; O'Hara, Michael W.; Grekin, Rebecca S.

2015-01-01

This multi-method multi-trait study examined moderators and mediators of change in the context of a parenting intervention. Low-income, diverse mothers of toddlers (average age 30 months; N=186, 90 girls) participated in a play-based intervention (Child-Oriented Play versus Play-as-Usual) aimed at increasing children's committed compliance and reducing opposition toward their mothers, observed in prohibition contexts, and at reducing mother-rated children's behavior problems 6 months after the intervention. Mothers’ subjective sense of life satisfaction and fulfillment during the intervention and objective ratings of psychosocial functioning by clinicians, obtained in a clinical interview were posed as moderators, and mothers’ observed power-assertive discipline immediately following the intervention was modeled as a mediator of its impact. We tested moderated mediation using structural equation modeling, with all baseline scores (prior to randomization) controlled. Mothers’ subjective sense of life satisfaction moderated the impact of the intervention, but clinicians’ ratings did not. For mothers highly satisfied with their lives, participating in Child-Oriented Play group, compared to Play-as-Usual group, led to a reduction in power-assertive discipline which, in turn, led to children's increased compliance and decreased opposition and externalizing problems. There were no effects for mothers who reported low life satisfaction. The study elucidates the causal sequence set in motion by the intervention, demonstrates the moderating role of mothers’ subjective life satisfaction, highlights limitations of clinicians’ ratings, and informs future prevention and intervention efforts to promote adaptive parenting. PMID:25860810

Life Satisfaction Moderates the Effectiveness of a Play-Based Parenting Intervention in Low-Income Mothers and Toddlers.

PubMed

Brock, Rebecca L; Kochanska, Grazyna; O'Hara, Michael W; Grekin, Rebecca S

2015-10-01

This multi-method multi-trait study examined moderators and mediators of change in the context of a parenting intervention. Low-income, diverse mothers of toddlers (average age 30 months; N = 186, 90 girls) participated in a play-based intervention (Child-Oriented Play versus Play-as-Usual) aimed at increasing children's committed compliance and reducing opposition toward their mothers, observed in prohibition contexts, and at reducing mother-rated children's behavior problems 6 months after the intervention. Mothers' subjective sense of life satisfaction and fulfillment during the intervention and objective ratings of psychosocial functioning by clinicians, obtained in a clinical interview were posed as moderators, and mothers' observed power-assertive discipline immediately following the intervention was modeled as a mediator of its impact. We tested moderated mediation using structural equation modeling, with all baseline scores (prior to randomization) controlled. Mothers' subjective sense of life satisfaction moderated the impact of the intervention, but clinicians' ratings did not. For mothers highly satisfied with their lives, participating in Child-Oriented Play group, compared to Play-as-Usual group, led to a reduction in power-assertive discipline which, in turn, led to children's increased compliance and decreased opposition and externalizing problems. There were no effects for mothers who reported low life satisfaction. The study elucidates the causal sequence set in motion by the intervention, demonstrates the moderating role of mothers' subjective life satisfaction, highlights limitations of clinicians' ratings, and informs future prevention and intervention efforts to promote adaptive parenting.

Exploring why young African American women do not change condom-use behavior following participation in an STI/HIV prevention intervention

PubMed Central

Sales, J. M.; DiClemente, R. J.; Davis, T. P.; Sullivan, S.

2012-01-01

Human immunodeficiency virus (HIV) interventions can significantly reduce risky sexual behaviors among vulnerable populations. However, not everyone exposed to an intervention will reduce their sexual risk behavior. This qualitative study sought to identify factors associated with young African American females’ lack of increase in condom use post-participation in an HIV prevention intervention. Semi-structured interviews were conducted with 50 young African American women (18–23 years; approximately half were mothers) after participating in a demonstrated effective HIV prevention intervention; 24 did not increase condom use post-intervention. Interviews were thematically coded for barriers to condom-use post-intervention. Although nearly all young women reported partner-associated challenges to using condoms, there were relational differences observed among those who changed their condom use versus those who did not. Many ‘non-changers’ were engaged in non-stable ‘on and off’ relationships, with high rates of infidelity, often with the father of their child, in which they were fearful of requesting condom use. ‘Non-changers’ also reported more substance use, feeling incapable of change and not thinking about condom use. Thus, future HIV prevention efforts may benefit from incorporating strategies on how young mothers can maintain a non-sexual relationship with their child’s father, as well as elaborating on the intersection of substance use and risky sexual decision-making. PMID:22641793

Effectiveness of universal parental support interventions addressing children's dietary habits, physical activity and bodyweight: A systematic review.

PubMed

Kader, Manzur; Sundblom, Elinor; Elinder, Liselotte Schäfer

2015-08-01

The evidence regarding effectiveness of parental support interventions targeting children's health behaviours is weak. We aimed to review: 1) effectiveness of universal parental support interventions to promote dietary habits, physical activity (PA) or prevent overweight and obesity among children 2-18years and 2) effectiveness in relation to family socio-economic position. Thirty five studies from 1990 to 2013 were identified from major databases. Quality was assessed by four criteria accounting for selection and attrition bias, fidelity to intervention, and outcome measurement methodology, categorizing studies as strong, moderate or weak. Four intervention types were identified: face-to-face counselling, group education, information sent home, and telephone counselling. Face-to-face or telephone counselling was effective in changing children's diet, while there was only weak evidence for improvement in PA. Sending home information was not effective. Concerning body weight, group education seemed more promising than counselling. Intervention effectiveness was generally higher in younger compared to older children. In groups with low socio-economic position, group-based approaches appeared promising. In the future efforts should be made to improve reporting of intervention content, include a power calculation for the main outcome, the use of high quality outcome assessment methodology, and a follow-up period of at least 6months. Copyright © 2015 Elsevier Inc. All rights reserved.

Design and implementation of a physical activity intervention to enhance children's use of the built environment (the CUBE study).

PubMed

Oreskovic, Nicolas M; Goodman, Elizabeth; Park, Elyse R; Robinson, Alyssa I; Winickoff, Jonathan P

2015-01-01

Adequate physical activity promotes physical and mental health and decreases obesity risk. However, most adolescents do not attain recommended physical activity levels and effective interventions are lacking. Physical activity trials rarely incorporate built environment use patterns. This paper describes the design and rationale of the Children's Use of the Built Environment (CUBE) Study, an office-based intervention designed to teach youth how to use their surrounding built environment to increase physical activity. CUBE is a 6-month intervention trial among 60 overweight and obese 10-16 year old adolescents from a community health center in Massachusetts. The study began in the winter of 2013. Patients are sequentially assigned to either the intervention or control group. Baseline physical activity by accelerometry and location by GPS, along with measured height, weight, and blood pressure are collected. Control subjects receive standard of care lifestyle counseling. Intervention subjects receive tailored recommendations on how to increase their physical activity based on their accelerometer and GPS data. Data collections are repeated at end-of-treatment, and again 3 months later. The findings from this study should help guide future efforts to design interventions aimed at increasing adolescent physical activity as well as to inform design professionals and government officials charged with creating outdoor spaces where adolescents spend time. Copyright © 2014 Elsevier Inc. All rights reserved.

Physical activity intervention effects on perceived stress in working mothers: the role of self-efficacy.

PubMed

Mailey, Emily L; McAuley, Edward

2014-01-01

Working mothers often report elevated stress, and efforts to improve their coping resources are needed to buffer the detrimental effects of stress on health. This study examined the impact of changes in physical activity, self-efficacy, and self-regulation across the course of a brief intervention on subsequent levels of stress in working mothers. Participants (N = 141) were randomly assigned to an intervention or control condition (2:1 ratio). The intervention was conducted in Illinois between March 2011 and January 2012 and consisted of two group-mediated workshop sessions with content based on social cognitive theory. Participants completed measures of physical activity, self-efficacy, self-regulation, and perceived stress at baseline, immediately postintervention, and 6-month follow-up. Stress levels declined across the 6-month period in both groups. Changes in stress were negatively associated with changes in self-efficacy and self-regulation among intervention participants only. Regression analyses revealed the intervention elicited short-term increases in physical activity, self-efficacy, and self-regulation, but only changes in self-efficacy predicted perceived stress at 6-month follow-up. These results suggest that enhancing self-efficacy is likely to improve working mothers' perceived capabilities to cope with stressors in their lives. Future interventions should continue to focus on increasing self-efficacy to promote improvements in physical activity and psychological well-being in this population.

SCIRehab Project Series: The Psychology Taxonomy

PubMed Central

Wilson, Catherine; Huston, Toby; Koval, Jill; Gordon, Samuel A; Schwebel, Andrea; Gassaway, Julie

2009-01-01

Context: The integration of psychologists as members of the rehabilitation team has occurred in conjunction with the evolution and adoption of interdisciplinary teams as the standard of care in spinal cord injury (SCI) rehabilitation. Although the value of psychological services during rehabilitation is endorsed widely, specific interventions and their association with patient outcomes have not been examined adequately. Objective: To address this shortcoming, psychologists from 6 SCI centers collaborated to develop a psychology intervention taxonomy and documentation framework. Methods: Utilizing an interactive process, the lead psychologists from 6 centers compiled an inclusive list of patient characteristics assessed and interventions delivered in routine psychological practice at the participating rehabilitation facilities. These were systematically grouped, defined, and compared. Results: The resulting taxonomy became the basis of a documentation framework utilized by psychologists for the study. The psychology taxonomy includes 4 major clinical categories (assessment, psychotherapeutic interventions, psychoeducational interventions, and consultation) with 5 to 10 specific activities in each category. Conclusions: Examination of psychological interventions and their potential association with positive outcomes for persons who sustain SCI requires the development of a taxonomy. Results of these efforts illustrate similarities and differences in psychological practice among SCI centers and offer the opportunity to blend research and clinical practice in an innovative approach to evidence-based practice improvement. The established taxonomy provides a basic framework for future studies on the effect of psychological interventions. PMID:19810633

A Taxonomy of Fatigue Concepts and Their Relation to Hearing Loss

PubMed Central

Hornsby, Benjamin W.Y.; Naylor, Graham; Bess, Fred H.

2016-01-01

Fatigue is common in individuals with a variety of chronic health conditions and can have significant negative effects on quality of life. Although limited in scope, recent work suggests persons with hearing loss may be at increased risk for fatigue, in part due to effortful listening that is exacerbated by their hearing impairment. However, the mechanisms responsible for hearing loss-related fatigue, and the efficacy of audiologic interventions for reducing fatigue, remain unclear. To improve our understanding of hearing loss-related fatigue, as a field it is important to develop a common conceptual understanding of this construct. In this paper the broader fatigue literature is reviewed to identify and describe core constructs, consequences and methods for assessing fatigue and related constructs. Finally, our current knowledge linking hearing loss and fatigue is described and may be summarised as follows: Hearing impairment increases the risk of subjective fatigue and vigor deficits.Adults with hearing loss require more time to recover from fatigue after work, and have more work absences.Sustained, effortful, listening can be fatiguing.Optimal methods for eliciting and measuring fatigue in persons with hearing loss remain unclear and may vary with listening condition.Amplification may minimize decrements in cognitive processing speed during sustained effortful listening. Future research is needed to develop reliable measurement methods to quantify hearing loss-related fatigue; explore factors responsible for modulating fatigue in people with hearing loss; and identify and evaluate potential interventions for reducing hearing loss-related fatigue. PMID:27355763

Understanding policies and physical activity: frontiers of knowledge to improve population health.

PubMed

Eyler, Amy; Brownson, Ross; Schmid, Tom; Pratt, Michael

2010-03-01

With increasing evidence of the detrimental effects of physical inactivity, there is interest in enhancing research on policies that may influence physical activity in communities. Given the potential policy impact, a framework that organized and conceptualized policy interventions and priorities for public health efforts to promote physical activity was developed. In addition, the Physical Activity Policy Research Network (PAPRN) was formed as a way to operationalize the contents of the framework. Recommendations for future work in this area include enhancing transdisciplinary collaborations, raising the priority of policy evaluation, studying policies at all levels, and emphasizing dissemination of findings.

Recurrent epidemic cycles driven by intervention in a population of two susceptibility types

NASA Astrophysics Data System (ADS)

Juanico, Drandreb Earl O.

2014-03-01

Epidemics have been known to persist in the form of recurrence cycles. Despite intervention efforts through vaccination and targeted social distancing, infectious diseases like influenza continue to appear intermittently over time. I have undertaken an analysis of a stochastic epidemic model to explore the hypothesis that intervention efforts actually drive epidemic cycles. Time series from simulations of the model reveal oscillations exhibiting a similar temporal signature as influenza epidemics. The power-spectral density indicates a resonant frequency, which approximately corresponds to the apparent annual seasonality of influenza in temperate zones. Asymptotic solution to the backward Kolmogorov equation of the dynamics corresponds to an exponentially-decaying mean-exit time as a function of the intervention rate. Intervention must be implemented at a sufficiently high rate to extinguish the infection. The results demonstrate that intervention efforts can induce epidemic cycles, and that the temporal signature of cycles can provide early warning of imminent outbreaks.

Research Advances at the Institute for Nutritional Sciences at Shanghai, China12

PubMed Central

Chen, Yan; Lin, Xu; Liu, Yong; Xie, Dong; Fang, Jing; Le, Yingying; Ke, Zunji; Zhai, Qiwei; Wang, Hui; Guo, Feifan; Wang, Fudi; Liu, Yi

2011-01-01

Nutrition-related health issues have emerged as a major threat to public health since the rebirth of the economy in China starting in the 1980s. To meet this challenge, the Chinese Academy of Sciences established the Institute for Nutritional Sciences (INS) at Shanghai, China ∼8 y ago. The mission of the INS is to apply modern technologies and concepts in nutritional research to understand the molecular mechanism and provide means of intervention in the combat against nutrition-related diseases, including type 2 diabetes, metabolic syndrome, obesity, cardiovascular diseases, and many types of cancers. Through diligent and orchestrated efforts by INS scientists, graduate students, and research staff in the past few years, the INS has become the leading institution in China in the areas of basic nutritional research and metabolic regulation. Scientists at the INS have made important progress in many areas, including the characterization of genetic and nutritional properties of the Chinese population, metabolic control associated with nutrient sensing, molecular mechanisms underlying glucose and lipid metabolism, regulation of metabolism by adipokines and inflammatory pathways, disease intervention using functional foods or extracts of Chinese herbs, and many biological studies related to carcinogenesis. The INS will continue its efforts in understanding the optimal nutritional needs for Chinese people and the molecular causes associated with metabolic diseases, thus paving the way for effective and individualized intervention in the future. This review highlights the major research endeavors undertaken by INS scientists in recent years. PMID:22332084

Boys Are Victims, Too: The Influence of Perpetrators' Age and Gender in Sexual Coercion Against Boys.

PubMed

Miller, Jacqueline A; Smith, Edward A; Caldwell, Linda L; Mathews, Catherine; Wegner, Lisa

2018-06-01

Sexual coercion among adolescent boys in South Africa is an underresearched topic despite the frequency of such events. Although quantitative research has illuminated the prevalence of sexual coercion toward boys, it has provided little understanding of the context of sexual coercion for adolescent boys. Given the often severe consequences of sexual coercion, it is important to further understand these experiences to inform prevention efforts. The current study aims to provide a more nuanced understanding of the context of sexual coercion. Data come from the baseline assessment for a translational research evaluation of a school-based intervention. The current study focuses on a subset of early and middle adolescent boys who reported experiencing sexual coercion ( n = 223). Analyses examine boys' reports of their perpetrators' characteristics and details about the sexual coercion encounter. Logistic regression is used to examine how coercion tactics used by the perpetrator differs depending on the perpetrator's age and gender. Eighth-grade boys were most likely to report that their perpetrator was a similar-aged female and that perpetrator's age played a particularly important role in what tactics were used. Adult perpetrators were more likely to use physical force, threaten them, harass them electronically, and drink or use drugs at the time. Results provide important insight into boys' experiences of sexual coercion that have implications for both future research and intervention efforts. Although much research is needed on the topic, intervention programs should recognize that both male and female adolescents can be victim and perpetrator.

Multilevel Opportunities to Address Lung Cancer Stigma across the Cancer Control Continuum.

PubMed

Hamann, Heidi A; Ver Hoeve, Elizabeth S; Carter-Harris, Lisa; Studts, Jamie L; Ostroff, Jamie S

2018-05-22

The public health imperative to reduce the burden of lung cancer has seen unprecedented progress in recent years. Realizing fully the advances in lung cancer treatment and control requires attention to potential barriers in their momentum and implementation. In this analysis, we present and evaluate the argument that stigma is a highly significant barrier to fulfilling the clinical promise of advanced care and reduced lung cancer burden. This evaluation of lung cancer stigma is based on a multilevel perspective that incorporates the individual, persons in their immediate environment, the healthcare system, and the larger societal structure which shapes perceptions and decisions. We also consider current interventions and interventional needs within and across aspects of the lung cancer continuum, including prevention, screening, diagnosis, treatment, and survivorship. Current evidence suggests that stigma detrimentally impacts psychosocial, communication, and behavioral outcomes over the entire lung cancer control continuum and across multiple levels. Interventional efforts to alleviate stigma in the context of lung cancer show promise, yet more work is needed to evaluate their impact. Understanding and addressing the multi-level role of stigma is a crucial area for future study in order to realize the full benefits offered by lung cancer prevention, control, and treatment. Coordinated, interdisciplinary, and well-conceptualized efforts have the potential to reduce the barrier of stigma in the context of lung cancer and facilitate demonstrable improvements in clinical care and quality of life. Copyright © 2018. Published by Elsevier Inc.

Research advances at the Institute for Nutritional Sciences at Shanghai, China.

PubMed

Chen, Yan; Lin, Xu; Liu, Yong; Xie, Dong; Fang, Jing; Le, Yingying; Ke, Zunji; Zhai, Qiwei; Wang, Hui; Guo, Feifan; Wang, Fudi; Liu, Yi

2011-09-01

Nutrition-related health issues have emerged as a major threat to public health since the rebirth of the economy in China starting in the 1980s. To meet this challenge, the Chinese Academy of Sciences established the Institute for Nutritional Sciences (INS) at Shanghai, China ≈ 8 y ago. The mission of the INS is to apply modern technologies and concepts in nutritional research to understand the molecular mechanism and provide means of intervention in the combat against nutrition-related diseases, including type 2 diabetes, metabolic syndrome, obesity, cardiovascular diseases, and many types of cancers. Through diligent and orchestrated efforts by INS scientists, graduate students, and research staff in the past few years, the INS has become the leading institution in China in the areas of basic nutritional research and metabolic regulation. Scientists at the INS have made important progress in many areas, including the characterization of genetic and nutritional properties of the Chinese population, metabolic control associated with nutrient sensing, molecular mechanisms underlying glucose and lipid metabolism, regulation of metabolism by adipokines and inflammatory pathways, disease intervention using functional foods or extracts of Chinese herbs, and many biological studies related to carcinogenesis. The INS will continue its efforts in understanding the optimal nutritional needs for Chinese people and the molecular causes associated with metabolic diseases, thus paving the way for effective and individualized intervention in the future. This review highlights the major research endeavors undertaken by INS scientists in recent years.

Geographic Mapping as a Tool for Identifying Communities at High Risk for Fires.

PubMed

Fahey, Erin; Lehna, Carlee; Hanchette, Carol; Coty, Mary-Beth

2016-01-01

The purpose of this study was to evaluate whether the sample of older adults in a home fire safety (HFS) study captured participants living in the areas at highest risk for fire occurrence. The secondary aim was to identify high risk areas to focus future HFS interventions. Geographic information systems software was used to identify census tracts where study participants resided. Census data for these tracts were compared with participant data based on seven risk factors (ie, age greater than 65 years, nonwhite race, below high school education, low socioeconomic status, rented housing, year home built, home value) previously identified in a fire risk model. The distribution of participants and census tracts among risk categories determined how well higher risk census tracts were sampled. Of the 46 census tracts where the HFS intervention was implemented, 78% (n = 36) were identified as high or severe risk according to the fire risk model. Study participants' means for median annual family income (P < .0001) and median home value (P < .0001) were significantly lower than the census tract means (n = 46), indicating participants were at higher risk of fire occurrence. Of the 92 census tracts identified as high or severe risk in the entire county, the study intervention was implemented in 39% (n = 36), indicating 56 census tracts as potential areas for future HFS interventions. The Geographic information system-based fire risk model is an underutilized but important tool for practice that allows community agencies to develop, plan, and evaluate their outreach efforts and ensure the most effective use of scarce resources.

Text Messaging Intervention for Teens and Young Adults With Diabetes

PubMed Central

Cousineau, Tara; Franko, Debra L.; Schultz, Alan T.; Trant, Meredith; Rodgers, Rachel; Laffel, Lori M. B.

2014-01-01

Adolescents and young adults use text messaging as their primary mode of communication, thus providing an opportunity to use this mode of communication for mobile health (mHealth) interventions. Youth with diabetes are an important group for these mHealth initiatives, as diabetes management requires an enormous amount of daily effort and this population has difficulty achieving optimal diabetes management. Goal setting and self-efficacy are 2 factors in the management of diabetes. We examined the feasibility of a healthy lifestyle text messaging program targeting self-efficacy and goal setting among adolescents and young adults with diabetes. Participants, ages 16-21, were assigned to either a text messaging group, which received daily motivational messages about nutrition and physical activity, or a control group, which received paper-based information about healthy lifestyle. Both groups set goals for nutrition and physical activity and completed a measure of self-efficacy. Participants’ mean age was 18.7 ± 1.6 years old, with diabetes duration of 10.0 ± 4.6 years, and A1c of 8.7 ± 1.7%. The text messaging intervention was rated highly and proved to be acceptable to participants. Self-efficacy, glycemic control, and body mass index did not change over the course of the short, 1-month pilot study. Positive, daily, motivational text messages may be effective in increasing motivation for small goal changes in the areas of nutrition and physical activity. These interventions may be used in the future in youth with diabetes to improve diabetes care. Utilizing more targeted text messages is an area for future research. PMID:25172879

Text messaging intervention for teens and young adults with diabetes.

PubMed

Markowitz, Jessica T; Cousineau, Tara; Franko, Debra L; Schultz, Alan T; Trant, Meredith; Rodgers, Rachel; Laffel, Lori M B

2014-09-01

Adolescents and young adults use text messaging as their primary mode of communication, thus providing an opportunity to use this mode of communication for mobile health (mHealth) interventions. Youth with diabetes are an important group for these mHealth initiatives, as diabetes management requires an enormous amount of daily effort and this population has difficulty achieving optimal diabetes management. Goal setting and self-efficacy are 2 factors in the management of diabetes. We examined the feasibility of a healthy lifestyle text messaging program targeting self-efficacy and goal setting among adolescents and young adults with diabetes. Participants, ages 16-21, were assigned to either a text messaging group, which received daily motivational messages about nutrition and physical activity, or a control group, which received paper-based information about healthy lifestyle. Both groups set goals for nutrition and physical activity and completed a measure of self-efficacy. Participants' mean age was 18.7 ± 1.6 years old, with diabetes duration of 10.0 ± 4.6 years, and A1c of 8.7 ± 1.7%. The text messaging intervention was rated highly and proved to be acceptable to participants. Self-efficacy, glycemic control, and body mass index did not change over the course of the short, 1-month pilot study. Positive, daily, motivational text messages may be effective in increasing motivation for small goal changes in the areas of nutrition and physical activity. These interventions may be used in the future in youth with diabetes to improve diabetes care. Utilizing more targeted text messages is an area for future research. © 2014 Diabetes Technology Society.

Well-Being in Residency: A Systematic Review

PubMed Central

Raj, Kristin S.

2016-01-01

Background  Rates of physician burnout have increased in recent years, and high burnout levels are reported by physicians in training. Objective  This review of the research on resident well-being seeks to identify factors associated with well-being, summarize well-being promotion interventions, and provide a framework for future research efforts. Methods  Keywords were used to search PubMed, PsycINFO, and MEDLINE. Studies included were conducted between 1989 and 2014. The search yielded 82 articles, 26 which met inclusion criteria, and were assessed using the Medical Education Research Study Quality Instrument. Results  Articles measured resident well-being and associated factors, predictors, effects, barriers, as well as interventions to improve well-being. Factors identified in psychological well-being research—autonomy, building of competence, and strong social relatedness—are associated with resident well-being. Sleep and time away from work are associated with greater resident well-being. Perseverance is predictive of well-being, and greater well-being is associated with increased empathy. Interventions focused on health and coping skills appear to improve well-being, although the 3 studies that examined interventions were limited by small samples and single site administration. Conclusions  An important step in evolving research in this area entails the development of a clear definition of resident well-being and a scale for measuring the construct. The majority (n = 17, 65%) of existing studies are cross-sectional analyses of factors associated with well-being. The literature summarized in this review suggests future research should focus on factors identified in cross-sectional studies, including sleep, coping mechanisms, resident autonomy, building competence, and enhanced social relatedness. PMID:28018531

Pre- and post-harvest interventions to reduce pathogen contamination in the U.S. beef industry

USDA-ARS?s Scientific Manuscript database

Significant effort has been targeted at reducing the risk of pathogens in U.S. beef products since the mid-1990s. These efforts were focused on E. coli O157:H7 after it was declared an adulterant in ground beef or its components. Initial efforts were composed primarily of post-harvest interventions ...

The Behavioral Economics of Young Adult Substance Abuse

PubMed Central

Murphy, James G.; Dennhardt, Ashley A.

2016-01-01

Alcohol and drug use peaks during young adulthood and can interfere with critical developmental tasks and set the stage for chronic substance misuse and associated social, educational, and health-related outcomes. There is a need for novel, theory-based approaches to guide substance abuse prevention efforts during this critical developmental period. This paper discusses the particular relevance of behavioral economic theory to young adult alcohol and drug misuse, and reviews available literature on prevention and intervention strategies that are consistent with behavioral economic theory. Behavioral economic theory predicts that decisions to use drugs and alcohol are related to the relative availability and price of both alcohol and substance-free alternative activities, and the extent to which reinforcement from delayed substance-free outcomes is devalued relative to the immediate reinforcement associated with drugs. Behavioral economic measures of motivation for substance use are based on relative levels of behavioral and economic resource allocation towards drug versus alternatives, and have been shown to predict change in substance use over time. Policy and individual level prevention approaches that are consistent with behavioral economic theory are discussed, including brief interventions that increase future orientation and engagement in rewarding alternatives to substance use. Prevention approaches that increase engagement in constructive future-oriented activities among young adults (e.g., educational/vocational success) have the potential to reduce future health disparities associated with both substance abuse and poor educational/vocational outcomes. PMID:27151545

Suicide among American Indian/Alaska Native military service members and veterans.

PubMed

O'Keefe, Victoria M; Reger, Greg M

2017-08-01

Many American Indian/Alaska Native (AI/AN) communities experience high suicide rates. However, there is little discussion in epidemiological and empirical literature about suicide-related outcomes among AI/AN military service members or veterans. This article briefly reviews the literature on AI/AN suicide and discusses what is known about Native military service member and veteran suicide mortality and self-directed violence. Recent studies suggest high suicide death rates among AI/AN military service members and veterans. Discussion includes the potential for unique cultural protective and risk factors that could inform prevention efforts and some of the novel existing efforts to support AI/AN veterans are reviewed. Given concerning suicide rates among military service members and veterans, it is important for future research to clarify the risk to AI/AN military service members and veterans and how to best develop and implement effective suicide prevention/interventions. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Engaging parents in evidence-based treatments in schools: Community perspectives from implementing CBITS.

PubMed

Santiago, Catherine Decarlo; Pears, Gillian; Baweja, Shilpa; Vona, Pamela; Tang, Jennifer; Kataoka, Sheryl H

2013-12-01

This study explored parent engagement in an evidence-based treatment, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), which was delivered in a school setting. To examine the successes and challenges in engaging parents in this school-based program, we conducted qualitative interviews by phone to obtain data from clinicians, parents, and other school personnel across eleven schools from 3 different regions of the United States. Almost all of these schools served low-income and ethnically diverse communities. We describe general impressions of parent engagement, parent reactions and preferences with regard to CBITS, barriers to parent engagement, and how to overcome barriers from multiple perspectives. Parent engagement across schools varied, with extensive outreach and relatively good parent engagement in CBITS described in some schools, while in other schools, efforts to engage parents were not as consistent. Implications for future efforts to engage parents in school-based treatments are discussed.

Engaging parents in evidence-based treatments in schools: Community perspectives from implementing CBITS

PubMed Central

Santiago, Catherine DeCarlo; Pears, Gillian; Baweja, Shilpa; Vona, Pamela; Tang, Jennifer; Kataoka, Sheryl H.

2013-01-01

This study explored parent engagement in an evidence-based treatment, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), which was delivered in a school setting. To examine the successes and challenges in engaging parents in this school-based program, we conducted qualitative interviews by phone to obtain data from clinicians, parents, and other school personnel across eleven schools from 3 different regions of the United States. Almost all of these schools served low-income and ethnically diverse communities. We describe general impressions of parent engagement, parent reactions and preferences with regard to CBITS, barriers to parent engagement, and how to overcome barriers from multiple perspectives. Parent engagement across schools varied, with extensive outreach and relatively good parent engagement in CBITS described in some schools, while in other schools, efforts to engage parents were not as consistent. Implications for future efforts to engage parents in school-based treatments are discussed. PMID:24273613

The National Violent Death Reporting System: overview and future directions.

PubMed

Blair, Janet M; Fowler, Katherine A; Jack, Shane P D; Crosby, Alexander E

2016-04-01

To describe the National Violent Death Reporting System (NVDRS). This is a surveillance system for monitoring the occurrence of homicides, suicides, unintentional firearm deaths, deaths of undetermined intent, and deaths from legal intervention (excluding legal executions) in the US. This report provides information about the history, scope, data variables, processes, utility, limitations, and future directions of the NVDRS. The NVDRS currently operates in 32 states, with the goal of future expansion to all 50 states, the District of Columbia, and US territories. The system uses existing primary data sources (death certificates, coroner/medical examiner reports, and law enforcement reports), and links them together to provide a comprehensive picture of the circumstances surrounding violent deaths. This report provides an overview of the NVDRS including a description of the system, discussion of its expanded capability, the use of new technologies as the system has evolved, how the data are being used for violence prevention efforts, and future directions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

From the Classroom to the Field: Intervention Training to Address Sexual Harassment in the Geosciences

NASA Astrophysics Data System (ADS)

Marin-Spiotta, E.; Barnes, R.; Berhe, A. A.; Hastings, M. G.; Mattheis, A.; Schneider, B.; Williams, B. M.

2017-12-01

Here I report on collaborative efforts by the Earth Science Women's Network, the Association for Women Geoscientists and the American Geophysical Union to empower the earth and space science community to stop and prevent sexual harassment (SH) as part of a new NSF ADVANCE Partnership award. We aim to develop strategies of bystander intervention and to enhance ethics training of current and future geoscientists. We focus on geoscientists because it is one of the least diverse of the STEM fields. Little data on how sexual harassment affects women with intersectional identities in the geosciences leads to a lack of awareness of the unique challenges faced by minority women and a lack of appropriate institutional response. The geosciences have an additional challenge: research and training at off-campus field sites where access to support networks and clear guidelines for conduct are weakened or absent. The outcomes of our project are: (1) Broader recognition of how SH affects different populations; (2) Development and dissemination of mechanisms for heads, chairs, faculty and future geoscientists to identify, prevent and stop harassment; and (3) Adoption of codes of conduct by geoscientists.

Introduction to Preharvest Food Safety.

PubMed

Torrence, Mary E

2016-10-01

This introductory article provides an overview of preharvest food safety activities and initiatives for the past 15 years. The section on traditional areas of preharvest food safety focuses on significant scientific advancements that are a culmination of collaborative efforts (both public health and agriculture) and significant research results. The highlighted advancements provide the foundation for exploring future preharvest areas and for improving and focusing on more specific intervention/control/prevention strategies. Examples include Escherichia coli and cattle, Salmonella and Campylobacter in poultry, and interventions and prevention and control programs. The section on "nontraditional" preharvest food safety areas brings attention to potential emerging food safety issues and to future food safety research directions. These include organic production, the FDA's Produce Rule (water and manure), genomic sequencing, antimicrobial resistance, and performance metrics. The concluding section emphasizes important themes such as strategic planning, coordination, epidemiology, and the need for understanding food safety production as a continuum. Food safety research, whether at the pre- or postharvest level, will continue to be a fascinating complex web of foodborne pathogens, risk factors, and scientific and policy interactions. Food safety priorities and research must continue to evolve with emerging global issues, emerging technologies, and methods but remain grounded in a multidisciplinary, collaborative, and systematic approach.

Fundamental Cardiovascular Research: Returns on Societal Investment: A Scientific Statement From the American Heart Association.

PubMed

Hill, Joseph A; Ardehali, Reza; Clarke, Kimberli Taylor; Del Zoppo, Gregory J; Eckhardt, Lee L; Griendling, Kathy K; Libby, Peter; Roden, Dan M; Sadek, Hesham A; Seidman, Christine E; Vaughan, Douglas E

2017-07-21

Recent decades have witnessed robust successes in conquering the acutely lethal manifestations of heart and vascular diseases. Many patients who previously would have died now survive. Lifesaving successes like these provide a tremendous and easily recognized benefit to individuals and society. Although cardiovascular mortality has declined, the devastating impact of chronic heart disease and comorbidities on quality of life and healthcare resources continues unabated. Future strides, extending those made in recent decades, will require continued research into mechanisms underlying disease prevention, pathogenesis, progression, and therapeutic intervention. However, severe financial constraints currently jeopardize these efforts. To chart a path for the future, this report analyzes the challenges and opportunities we face in continuing the battle against cardiovascular disease and highlights the return on societal investment afforded by fundamental cardiovascular research. © 2017 American Heart Association, Inc.

Focus on flaviviruses: current and future drug targets.

PubMed

Geiss, Brian J; Stahla, Hillary; Hannah, Amanda M; Gari, Amanda M; Keenan, Susan M

2009-05-01

Infection by mosquito-borne flaviviruses (family Flaviviridae) is increasing in prevalence worldwide. The vast global, social and economic impact due to the morbidity and mortality associated with the diseases caused by these viruses necessitates therapeutic intervention. There is currently no effective clinical treatment for any flaviviral infection. Therefore, there is a great need for the identification of novel inhibitors to target the virus life cycle. In this article, we discuss structural and nonstructural viral proteins that are the focus of current target validation and drug discovery efforts. Both inhibition of essential enzymatic activities and disruption of necessary protein–protein interactions are considered. In addition, we address promising new targets for future research. As our molecular and biochemical understanding of the flavivirus life cycle increases, the number of targets for antiviral therapeutic discovery grows and the possibility for novel drug discovery continues to strengthen.

What is the problem with breast-feeding? A qualitative analysis of infant feeding perceptions.

PubMed

Stewart-Knox, B; Gardiner, K; Wright, M

2003-08-01

Breast-feeding rates are low in Northern Ireland (NI) compared with other regions of Europe. The aim of this study has therefore been to define and explore factors determining infant feeding decisions with a view to the planning of future research and intervention needs. Participants were approached at convenience from the throughput of women attending a large teaching hospital antenatal clinic to take part in focus group discussion. Dominant themes indicated that the main barriers to breast-feeding are restricted freedom and independence associated with family issues, return to work, societal embarrassment and perceived social isolation. The dialogue suggested that breast-feeding leads to inability to carry out everyday activities and social exclusion. Incompatible social norms make it difficult for mothers to breast-feed successfully. This implies that future promotional efforts should take a societal approach.

Parental HIV/AIDS and psychosocial adjustment among rural Chinese children.

PubMed

Fang, Xiaoyi; Li, Xiaoming; Stanton, Bonita; Hong, Yan; Zhang, Liying; Zhao, Guoxiang; Zhao, Junfeng; Lin, Xiuyun; Lin, Danhua

2009-01-01

To assess the relationship between parental HIV/AIDS and psychosocial adjustment of children in rural central China. Participants included 296 double AIDS orphans (children who had lost both their parents to AIDS), 459 single orphans (children who had lost one parent to AIDS), 466 vulnerable children who lived with HIV-infected parents, and 404 comparison children who did not experience HIV/AIDS-related illness and death in their families. The measures included depressive symptoms, loneliness, self-esteem, future expectations, hopefulness about the future, and perceived control over the future. AIDS orphans and vulnerable children consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. The level of psychosocial adjustment was similar between single orphans and double orphans, but differed by care arrangement among double orphans. The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the psychosocial wellbeing of these children.

Predictors of responses to stress among families coping with poverty-related stress.

PubMed

Santiago, Catherine DeCarlo; Etter, Erica Moran; Wadsworth, Martha E; Raviv, Tali

2012-05-01

This study tested how poverty-related stress (PRS), psychological distress, and responses to stress predicted future effortful coping and involuntary stress responses one year later. In addition, we explored age, sex, ethnicity, and parental influences on responses to stress over time. Hierarchical linear modeling analyses conducted with 98 low-income families (300 family members: 136 adults, 82 school-aged children, 82 adolescents) revealed that primary control coping, secondary control coping, disengagement, involuntary engagement, and involuntary disengagement each significantly predicted future use of that response. Primary and secondary control coping also predicted less maladaptive future responses to stress, while involuntary responses to stress undermined the development of adaptive responding. Age, sex, and interactions among PRS and prior coping were also found to predict certain responses to stress. In addition, child subgroup analyses demonstrate the importance of parental modeling of coping and involuntary stress responses, and warmth/nurturance and monitoring practices. Results are discussed with regard to the implications for preventive interventions with families in poverty.

A systematic scoping review of complementary and alternative medicine mind and body practices to improve the health of veterans and military personnel.

PubMed

Elwy, A Rani; Johnston, Jennifer M; Bormann, Jill E; Hull, Amanda; Taylor, Stephanie L

2014-12-01

Meditation, imagery, acupuncture, and yoga are the most frequently offered mind and body practices in the Department of Veterans Affairs. Yet, the research on mind and body practices has been critiqued as being too limited in evidence and scope to inform clinical treatment. We conducted a systematic scoping review of mind and body practices used with veterans or active duty military personnel to identify gaps in the literature and make recommendations for future primary research. Following systematic literature review methodology, we searched 5 databases using 27 different National Center for Complementary and Alternative Medicine-defined mind and body practices as text words, keywords, and MeSH terms through June 30, 2014. We also conducted handsearches of 4 previous reviews. Active duty military members or veterans 18 years or older participating in mind and body practice interventions globally. Data were extracted from studies meeting 5 inclusion criteria. The quality of randomized controlled trials (RCTs) was assessed using an existing checklist. Of 1819 studies identified, 89 interventions (50 RCTs) published between 1976 and 2014, conducted in 9 countries, using 152 different measures to assess 65 health and well-being outcomes met our inclusion criteria. Most interventions took place in the United States (n=78). Meditation practices (n=25), relaxation techniques including imagery (n=20), spinal manipulation including physical therapy (n=16), and acupuncture (n=11) were the most frequently studied practices. Methodological quality of most RCTs was rated poorly. Meditation and acupuncture practices are among the most frequently offered and studied mind and body practices. Future research should include yoga as it is currently understudied among veterans and military personnel. A repository of mind and body intervention outcome measures may further future research efforts, as would conducting pragmatic trials and more robust RCTs.

Mediation of an efficacious HIV risk reduction intervention for South African men.

PubMed

O'Leary, Ann; Jemmott, John B; Jemmott, Loretta S; Bellamy, Scarlett; Icard, Larry D; Ngwane, Zolani

2015-10-01

"Men, Together Making a Difference!" is an HIV/STD risk-reduction intervention that significantly increased self-reported consistent condom use during vaginal intercourse compared with a health-promotion attention-control intervention among men (N = 1181) in Eastern Cape Province, South Africa. The present analyses were designed to identify mediators of the intervention's efficacy. The potential mediators were Social Cognitive Theory (SCT) constructs that the intervention targeted, including several aspects of condom-use self-efficacy, outcome expectancies, and knowledge. Mediation was assessed using a product-of-coefficients approach where an α path (the intervention's effect on the potential mediator) and a β path (the potential mediator's effect on the outcome of interest, adjusting for intervention) were estimated independently in a generalized estimating equations framework. Condom-use negotiation self-efficacy, technical-skill self-efficacy, and impulse-control self-efficacy were significant mediators. Although not mediators, descriptive norm and expected friends' approval of condom use predicted subsequent self-reported condom use, whereas the expected approval of sexual partner did not. The present results suggest that HIV/STD risk-reduction interventions that draw upon SCT and that address self-efficacy to negotiate condom use, to apply condoms correctly, and to exercise sufficient control when sexually aroused to use condoms may contribute to efforts to reduce sexual risk behavior among South African men. Future research must examine whether approaches that build normative support for condom use among men's friends are also efficacious.

An evidence-based stress management intervention for allogeneic hematopoietic stem cell transplant caregivers: development, feasibility and acceptability.

PubMed

Simoneau, Teresa L; Kilbourn, Kristin; Spradley, Janet; Laudenslager, Mark L

2017-08-01

Caregivers of cancer patients face challenges impacting their physical, psychological and social well-being that need attention in the form of well-designed and tested interventions. We created an eight-session individual stress management intervention for caregivers of allogeneic hematopoietic stem cell transplant (Allo-HSCT) recipients. This intervention, tested by randomized control trial, proved effective in decreasing distress. Herein, we describe the intervention including theoretical framework, development, and elements of fidelity. Implementation challenges along with recommendations for refinement in future studies are discussed with the goal of replication and dissemination. Seventy-four of 148 caregivers received stress management training following randomization. The intervention occurred during the 100-day post-transplant period when caregivers are required. The training provided integrated cognitive behavioral strategies, psychoeducation, and problem-solving skills building as well as use of a biofeedback device. Seventy percent of caregivers completed all eight sessions indicating good acceptability for the in-person intervention; however, most caregivers did not reliably use the biofeedback device. The most common reason for drop-out was their patient becoming gravely ill or patient death. Few caregivers dropped out because of study demands. The need for flexibility in providing intervention sessions was key to retention. Our evidence-based stress management intervention for Allo-HSCT caregivers was feasible. Variability in acceptability and challenges in implementation are discussed and suggestions for refinement of the intervention are outlined. Dissemination efforts could improve by using alternative methods for providing caregiver support such as telephone or video chat to accommodate caregivers who are unable to attend in-person sessions.

Predictors of non-response and non-compliance in African American lupus patients: Findings from the Balancing Lupus Experiences with Stress Strategies (BLESS) Study.

PubMed

Williams, Edith M; Zhang, Jiajia; Zhou, Jie; Kamen, Diane; Oates, James C

2014-02-01

Arthritis self-management education has demonstrated significant improvements in health distress, self-reported global health, and activity limitation, with trends toward improvement in self efficacy and mental stress management. Consequently, numerous national agencies have recommended arthritis self-management education to complement medical care. Despite these recommendations, arthritis self-management education has reached only a limited number of people. Compliance is also a persistent problem in standardized programs. As part of the Balancing Lupus Experiences with Stress Strategies (BLESS) Study, a validated psychosocial stress intervention was piloted among a cohort of African American lupus patients participating in an SLE database project at the Medical University of South Carolina (MUSC). Recruitment attempts were made with the 330 database participants who met eligibility requirements for the study. While enrollment was limited to 30 participants (n=15 controls and n=15 intervention), two of the participants assigned to the intervention group did not attend any intervention sessions and several participants did not complete post-intervention questionnaires. Therefore, data were analyzed on 30 participants at baseline, 25 (n=13 controls and n=12 intervention) at post-intervention, and 22 (n=12 controls and n=10 intervention) at four months post-intervention. In an effort to characterize those who fully participated in the study and those who were non-compliant or non-responsive to recruitment attempts, we obtained descriptive data from African-American Lupus patients participating in the SLE Clinic Database Project. This information can be used to develop and refine future intervention activities.

Stopping the revolving door: a meta-analysis on the effectiveness of interventions for criminally involved individuals with major mental disorders.

PubMed

Martin, Michael S; Dorken, Shannon K; Wamboldt, Ashley D; Wootten, Sarah E

2012-02-01

Faced with high and increasing rates of mental disorder within the criminal justice system (CJS), a range of interventions have been implemented in an effort to prevent continued involvement in criminal activities among this population. A meta-analytic review was undertaken to consider the effectiveness of interventions for criminally involved adults with a mental disorder targeting either improved criminal justice or mental health outcomes. Furthermore, characteristics that were hypothesized to predict better outcomes were examined. Studies that considered sex offender interventions, or focused solely on antisocial personality, intellectual and cognitive, or substance use disorders were excluded. Results assuming a fixed-effects model combining 37 effect sizes from 25 studies (N = 15,678) support the effectiveness of these interventions in terms of reductions in any CJS involvement (d = 0.19 excluding one outlier). Interventions had no significant effect on an aggregate mental health outcome (d = 0.00). However, when considering distinct mental health outcomes, intervention participants had significantly better functioning (d = 0.20) and fewer symptoms (d = 0.12). There were no significant effects of the interventions on mental health service or medication use. Moderator analyses identified seven sample, intervention, and design characteristics that were related to the magnitude of the effect sizes for criminal justice outcomes, and suggest implications for service provision, policy, and research. Results suggested some relationship between intervention effects on mental health and criminal justice reinvolvement, although future research is needed in this area, especially given the absence of mental health outcome data in many studies. (c) 2012 APA, all rights reserved.

Ecological Interventionist Causal Models in Psychosis: Targeting Psychological Mechanisms in Daily Life

PubMed Central

Reininghaus, Ulrich; Depp, Colin A.; Myin-Germeys, Inez

2016-01-01

Integrated models of psychotic disorders have posited a number of putative psychological mechanisms that may contribute to the development of psychotic symptoms, but it is only recently that a modest amount of experience sampling research has provided evidence on their role in daily life, outside the research laboratory. A number of methodological challenges remain in evaluating specificity of potential causal links between a given psychological mechanism and psychosis outcomes in a systematic fashion, capitalizing on longitudinal data to investigate temporal ordering. In this article, we argue for testing ecological interventionist causal models that draw on real world and real-time delivered, ecological momentary interventions for generating evidence on several causal criteria (association, time order, and direction/sole plausibility) under real-world conditions, while maximizing generalizability to social contexts and experiences in heterogeneous populations. Specifically, this approach tests whether ecological momentary interventions can (1) modify a putative mechanism and (2) produce changes in the mechanism that lead to sustainable changes in intended psychosis outcomes in individuals’ daily lives. Future research using this approach will provide translational evidence on the active ingredients of mobile health and in-person interventions that promote sustained effectiveness of ecological momentary interventions and, thereby, contribute to ongoing efforts that seek to enhance effectiveness of psychological interventions under real-world conditions. PMID:26707864

Something new in the air: Paying for community-based environmental approaches to asthma prevention and control.

PubMed

Tschudy, Megan M; Sharfstein, Joshua; Matsui, Elizabeth; Barnes, Charles S; Chacker, Stacey; Codina, Rosa; Cohn, John R; Sandel, Megan; Wedner, H James

2017-11-01

Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. However, emerging payment approaches offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes, and their key characteristic is a focus on the value rather than the volume of services. These new payment models for environmental interventions can be divided into 2 categories: enhanced fee-for-service reimbursement and set payments per patient that cover asthma-related costs. Several pilot programs across the United States are underway, and as they prove their value and as payment increasingly becomes aligned with better outcomes at lower cost, these efforts should have a bright future. Physicians should be aware that these new possibilities are emerging for payment of the goods and services needed for indoor environmental interventions for their patients with asthma. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Biomedical HIV Prevention Including Pre-exposure Prophylaxis and Opiate Agonist Therapy for Women Who Inject Drugs: State of Research and Future Directions.

PubMed

Page, Kimberly; Tsui, Judith; Maher, Lisa; Choopanya, Kachit; Vanichseni, Suphak; Mock, Philip A; Celum, Connie; Martin, Michael

2015-06-01

Women who inject drugs (WWID) are at higher risk of HIV compared with their male counterparts as a result of multiple factors, including biological, behavioral, and sociostructural factors, yet comparatively little effort has been invested in testing and delivering prevention methods that directly target this group. In this article, we discuss the need for expanded prevention interventions for WWID, focusing on 2 safe, effective, and approved, yet underutilized biomedical prevention methods: opiate agonist therapy (OAT) and oral pre-exposure prophylaxis (PrEP). Although both interventions are well researched, they have not been well examined in the context of gender. We discuss the drivers of women injectors' higher HIV risk, review the effectiveness of OAT and PrEP interventions among women, and explain why these new HIV prevention tools should be prioritized for WWID. There is substantial potential for impact of OAT and PrEP programs for WWID in the context of broader gender-responsive HIV prevention initiatives. Although awaiting efficacy data on other biomedical approaches in the HIV prevention research "pipeline," we propose that the scale-up and implementation of these proven, safe, and effective interventions are needed now.

How the science of injury prevention contributes to advancing home fire safety in the USA: successes and opportunities.

PubMed

Gielen, Andrea C; Frattaroli, Shannon; Pollack, Keshia M; Peek-Asa, Corinne; Yang, Jingzhen G

2018-06-01

In the decades since the landmark report-America Burning-was published in 1973, the number of home fire deaths has shrunk from >5500 per year to 2650 in 2015. This paper: (1) describes how science and practice in injury prevention and fire and life safety contributed to successful interventions, and (2) identifies emerging strategies and future opportunities to prevent home fire-related deaths. The aims are addressed through the lens of population health research, with a focus on the work of selected Centers for Disease Control and Prevention-funded Injury Control Research Centers. Results are organised using the Haddon Matrix and an ecological model. We found evidence to support interventions that address all components of both the matrix and the model, including: reduced ignition propensity cigarettes, stop smoking campaigns, housing codes, residential sprinkler systems, smoke alarms, community risk reduction, school-based educational programmes, and fire and burn response systems. Future reductions are likely to come from enhancing residential sprinkler and smoke alarm technology, and increasing their utilisation; expanding the use of community risk reduction methods; and implementing new technological solutions. Despite the successes, substantial disparities in home fire death rates remain, reflecting underlying social determinants of health. Most of the evidence-supported interventions were focused on changing the policy and community environments to prevent home fires and reduce injury when a fire occurs. Future prevention efforts should give high priority to addressing the continued disparities in home fire deaths. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Factors affecting smoking cessation efforts of people with severe mental illness: a qualitative study.

PubMed

Rae, Jennifer; Pettey, Donna; Aubry, Tim; Stol, Jacqueline

2015-01-01

People with severe mental illness are much more likely to smoke than are members of the general population. Smoking cessation interventions that combine counseling and medication have been shown to be moderately effective, but quit rates remain low and little is known about the experiences of people with severe mental illness in smoking cessation interventions. To address this gap in knowledge, we conducted a qualitative study to investigate factors that help or hinder the smoking cessation efforts of people with severe mental illness. We recruited 16 people with severe mental illness who had participated in a clinical trial of two different smoking cessation interventions, one involving nicotine replacement therapy only and the other nicotine replacement therapy combined with motivational interviewing and a peer support group. We conducted open-ended, semi-structured interviews with participants, who ranged in age from 20 to 56 years old, were equally distributed by gender (eight men and eight women), and were predominantly Caucasian (n = 13, 81%). Primary mental illness diagnoses included schizophrenia/schizoaffective disorder (n = 6, 38%), depression (n = 5, 31%), bipolar disorder (n = 4, 25%), and anxiety disorder (n = 1, 6%). At entry into the clinical trial, participants smoked an average of 22.6 cigarettes per day (SD = 13.0). RESULTS indicated that people with mental illness have a diverse range of experiences in the same smoking cessation intervention. Smoking cessation experiences were influenced by factors related to the intervention itself (such as presence of smoking cessation aids, group supports, and emphasis on individual choice and needs), as well as individual factors (such as mental health, physical health, and substance use), and social-environmental factors (such as difficult life events and social relationships). An improved understanding of the smoking cessation experiences of people with severe mental illness can inform the delivery of future smoking cessation interventions for this population. The results of this study suggest the importance of smoking cessation interventions that offer a variety of treatment options, incorporating choice and flexibility, so as to be responsive to the evolving needs and preferences of individual clients.

Correlates of Alcohol-Related Regretted Sex among College Students

PubMed Central

Orchowski, Lindsay M.; Mastroleo, Nadine R.; Borsari, Brian

2012-01-01

The prevalence of alcohol-related regretted sex in college students warrants a better understanding of the characteristics of students who report such experiences. Therefore, the present study examined correlates of regretted sexual experiences involving alcohol use among two specific high-risk college student samples: Students mandated to alcohol intervention (N = 522) and volunteer first-year students transitioning to college (N = 481). Results indicated that alcohol-related regretted sex occurred in similar rates in mandated and volunteer students, with approximately 25% of the students reporting at least one occurrence in the past month. Women were more likely to report alcohol-related regretted sex compared to men. The belief that alcohol use would result in “liquid courage” was associated with alcohol-related regretted sex among college students, even after accounting for greater alcohol use and problem alcohol use behaviors. These findings have significant implications for intervention efforts and future research. PMID:22448762

Tobacco control efforts in the Gulf Cooperation Council countries: achievements and challenges.

PubMed

Hassounah, S; Rawaf, D; Khoja, T; Rawaf, S; Hussein, M S; Qidwai, W; Majeed, A

2014-08-19

This paper reports a review into the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council (GCC) member states and Yemen. It further reviews structured policy-oriented interventions (in line with the MPOWER package of 6 evidence-based tobacco control measures) that represent government actions to strengthen, implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. Our findings show that tobacco control in the GCC countries has witnessed real progress over the past decades. These are still early days but they indicate steps in the right direction. Future investment in implementation and enforcement of the Framework Convention on Tobacco Control, production of robust tobacco control legislation and the establishment of universally available tobacco cessation services are essential to sustain and strengthen tobacco control in the GCC region.

Development and evaluation of a mass media Theory of Planned Behaviour intervention to reduce speeding.

PubMed

Stead, Martine; Tagg, Stephen; MacKintosh, Anne Marie; Eadie, Douglas

2005-02-01

The Theory of Planned Behaviour (TPB) has been widely applied to the explanation of health and social behaviours. However, despite its potential to inform behaviour change efforts, there have been surprisingly few attempts to use the TPB to design actual interventions. In 1998, the Scottish Road Safety Campaign implemented a 3-year mass media campaign to reduce speeding on Scotland's roads which was explicitly shaped by the TPB's three main predictors: Attitude, Subjective Norms and Perceived Behavioural Control. A 4-year longitudinal cohort study examined the impact of the campaign on communications outcomes and on TPB constructs. Overall, empirical support was found for the decision to use TPB as the theoretical underpinning of the advertising. The advertising was effective in triggering desired communications outcomes, and was associated with significant changes in attitudes and affective beliefs about speeding. In conclusion, future directions for road safety advertising and for TPB research are discussed.

Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings

PubMed Central

Anderson, Deverick J.; Cochran, Ronda L.; Hicks, Lauri A.; Srinivasan, Arjun; Dodds Ashley, Elizabeth S.

2017-01-01

Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. An expert panel rated 90 candidate metrics on a 9-point Likert scale for association with 4 criteria: improved antimicrobial prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records. Experts further refined, added, or removed metrics during structured teleconferences and re-rated the retained metrics. Six metrics were rated >6 in all criteria: 2 measures of Clostridium difficile incidence, incidence of drug-resistant pathogens, days of therapy over admissions, days of therapy over patient days, and redundant therapy events. Fourteen metrics rated >6 in all criteria except feasibility were identified as targets for future development. PMID:27927866

Therapy for Specific Problems: Youth Tobacco Cessation

PubMed Central

Curry, Susan J.; Mermelstein, Robin J.; Sporer, Amy K.

2010-01-01

Cigarette smoking is the leading cause of premature morbidity and mortality in the United States. The majority of children smoke their first cigarette in early adolescence, and many older teens have well-established dependence on nicotine. Efforts to promote and support smoking cessation among these youth smokers are critical. The available experimental studies of youth cessation interventions find that behavioral interventions increase the chances of youth smokers achieving successful cessation. Currently there is insufficient evidence for the effectiveness of pharmacological treatments with youth smokers. Many innovative studies have been compromised by challenges in recruiting sufficient numbers of youth, obtaining approval for waivers of parental consent, and high attrition in longitudinal studies. Key areas for future work include bridging the fields of adolescent development and treatment design, matching treatments to developmental trajectories of smoking behavior, better understanding treatment processes and treatment moderators, and building demand for evidence-based cessation treatments. PMID:19035825

The role of theory in research to develop and evaluate the implementation of patient safety practices.

PubMed

Foy, Robbie; Ovretveit, John; Shekelle, Paul G; Pronovost, Peter J; Taylor, Stephanie L; Dy, Sydney; Hempel, Susanne; McDonald, Kathryn M; Rubenstein, Lisa V; Wachter, Robert M

2011-05-01

Theories provide a way of understanding and predicting the effects of patient safety practices (PSPs), interventions intended to prevent or mitigate harm caused by healthcare or risks of such harm. Yet most published evaluations make little or no explicit reference to theory, thereby hindering efforts to generalise findings from one context to another. Theories from a wide range of disciplines are potentially relevant to research on PSPs. Theory can be used in research to explain clinical and organisational behaviour, to guide the development and selection of PSPs, and in evaluating their implementation and mechanisms of action. One key recommendation from an expert consensus process is that researchers should describe the theoretical basis for chosen intervention components or provide an explicit logic model for 'why this PSP should work.' Future theory-driven evaluations would enhance generalisability and help build a cumulative understanding of the nature of change.

Treatments for fragile X syndrome: a closer look at the data.

PubMed

Hall, Scott S

2009-01-01

Research into the determinants and developmental course of fragile X syndrome (FXS) has made remarkable progress over the last 25 years. However, treatments to ameliorate the symptoms of FXS have been less forthcoming. While there is optimism in the field that the pace of intervention research is quickening, there has been a bias toward psychopharmacological approaches to treatment. A closer look at the data from those investigations reveals a paucity of evidence that medications can improve intellectual and adaptive functioning in FXS, or decrease associated behavioral and/or emotional issues. Work in other related disorders (e.g., autism) has shown that dramatic improvements in intellectual and adaptive functioning, as well as behavioral and emotional problems, can occur if intensive behavioral treatment is begun early in the child's life. It is hoped that future research efforts will evaluate these intensive early intervention strategies in children with FXS, perhaps in combination with pharmacological approaches.

Innovations in the Use of Interactive Technology to Support Weight Management

PubMed Central

Spruijt-Metz, D.; Wen, C.K.F.; O’Reilly, G.; Li, M.; Lee, S; Emken, B.A.; Mitra, U.; Annavaram, M.; Ragusa, G.; Narayanan, S.

2015-01-01

New and emerging mobile technologies are providing unprecedented possibilities for understanding and intervening on obesity-related behaviors in real time. However, the mobile health (mHealth) field has yet to catch up with the fast-paced development of technology. Current mHealth efforts in weight management still tend to focus mainly on short message systems (SMS) interventions, rather than taking advantage of real-time sensing to develop Just-In-Time, Adaptive Interventions (JITAIs). This paper will give an overview of the current technology landscape for sensing and intervening on three behaviors that are central to weight management; diet, physical activity, and sleep. Then five studies that really dig into the possibilities that these new technologies afford will be showcased. We conclude with a discussion of hurdles that mHealth obesity research has yet to overcome, and a future-facing discussion. PMID:26364308

Prerequisites for a healthy lifestyle-experiences of persons with psychosis.

PubMed

Wärdig, Rikard Erik; Bachrach-Lindström, Margareta; Foldemo, Anniqa; Lindström, Torbjörn; Hultsjö, Sally

2013-08-01

The purpose of this study is to explore prerequisites for a healthy lifestyle as described by individuals diagnosed with psychosis. Forty participants who had performed a lifestyle intervention focusing on physical activities and lifestyle education were interviewed. Conventional content analysis was used. The results are described in two categories: (1) Individual Prerequisites and (2) Being a Part of Society. The individuals said that they got stuck in a state of planning without taking action. It was pointless to make a bigger effort because the psychotic disorder could, at any time, worsen the prerequisites. They also said that they wanted to live like everybody else and therefore tried to adopt a normal lifestyle. Future interventions or professional support by mental health nurses and other health care givers should target the transition from planning to action to achieve a healthy lifestyle, and should help the individual to taking part in society.

The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome.

PubMed

Palmer, Shea; Cramp, Fiona; Clark, Emma; Lewis, Rachel; Brookes, Sara; Hollingworth, William; Welton, Nicky; Thom, Howard; Terry, Rohini; Rimes, Katharine A; Horwood, Jeremy

2016-06-01

Joint hypermobility syndrome (JHS) is a heritable disorder associated with laxity and pain in multiple joints. Physiotherapy is the mainstay of treatment, but there is little research investigating its clinical effectiveness. To develop a comprehensive physiotherapy intervention for adults with JHS; to pilot the intervention; and to conduct a pilot randomised controlled trial (RCT) to determine the feasibility of conducting a future definitive RCT. Patients' and health professionals' perspectives on physiotherapy for JHS were explored in focus groups (stage 1). A working group of patient research partners, clinicians and researchers used this information to develop the physiotherapy intervention. This was piloted and refined on the basis of patients' and physiotherapists' feedback (stage 2). A parallel two-arm pilot RCT compared 'advice' with 'advice and physiotherapy' (stage 3). Random allocation was via an automated randomisation service, devised specifically for the study. Owing to the nature of the interventions, it was not possible to blind clinicians or patients to treatment allocation. Stage 1 - focus groups were conducted in four UK locations. Stages 2 and 3 - piloting of the intervention and the pilot RCT were conducted in two UK secondary care NHS trusts. Stage 1 - patient focus group participants (n = 25, three men) were aged > 18 years, had a JHS diagnosis and had received physiotherapy within the preceding 12 months. The health professional focus group participants (n = 16, three men; 14 physiotherapists, two podiatrists) had experience of managing JHS. Stage 2 - patient participants (n = 8) were aged > 18 years, had a JHS diagnosis and no other musculoskeletal conditions causing pain. Stage 3 - patient participants for the pilot RCT (n = 29) were as for stage 2 but the lower age limit was 16 years. For the pilot RCT (stage 3) the advice intervention was a one-off session, supplemented by advice booklets. All participants could ask questions specific to their circumstances and receive tailored advice. Participants were randomly allocated to 'advice' (no further advice or physiotherapy) or 'advice and physiotherapy' (an additional six 30-minute sessions over 4 months). The physiotherapy intervention was supported by a patient handbook and was delivered on a one-to-one patient-therapist basis. It aimed to increase patients' physical activity through developing knowledge, understanding and skills to better manage their condition. Data from patient and health professional focus groups formed the main outcome from stage 1. Patient and physiotherapist interview data also formed a major component of stages 2 and 3. The primary outcome in stage 3 related to the feasibility of a future definitive RCT [number of referrals, recruitment and retention rates, and an estimate of the value of information (VOI) of a future RCT]. Secondary outcomes included clinical measures (physical function, pain, global status, self-reported joint count, quality of life, exercise self-efficacy and adverse events) and resource use (to estimate cost-effectiveness). Outcomes were recorded at baseline, 4 months and 7 months. Stage 1 - JHS is complex and unpredictable. Physiotherapists should take a long-term holistic approach rather than treating acutely painful joints in isolation. Stage 2 - a user-informed physiotherapy intervention was developed and evaluated positively. Stage 3 - recruitment to the pilot RCT was challenging, primarily because of a perceived lack of equipoise between advice and physiotherapy. The qualitative evaluation provided very clear guidance to inform a future RCT, including enhancement of the advice intervention. Some patients reported that the advice intervention was useful and the physiotherapy intervention was again evaluated very positively. The rate of return of questionnaires was low in the advice group but reasonable in the physiotherapy group. The physiotherapy intervention showed evidence of promise in terms of primary and secondary clinical outcomes. The advice arm experienced more adverse events. The VOI analysis indicated the potential for high value from a future RCT. Such a trial should form the basis of future research efforts. A future definitive RCT of physiotherapy for JHS seems feasible, although the advice intervention should be made more robust to address perceived equipoise and subsequent attrition. Current Controlled Trials ISRCTN29874209. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 47. See the NIHR Journals Library website for further project information.

Obesity prevention and obesogenic behavior interventions in child care: A systematic review.

PubMed

Sisson, Susan B; Krampe, Megan; Anundson, Katherine; Castle, Sherri

2016-06-01

Review peer-reviewed interventions designed to reduce obesity and improve obesogenic behaviors, including physical activity, diet, and screen time, at child care centers. Interventions components and outcomes, study design, duration, use of behavioral theory, and level of social ecological influence are detailed. Article searches were conducted from March 2014, October 2014, March 2015, January 2016 across three databases. Eligible interventions were conducted in child care settings, included 3-to-5-year-old children, included an outcome measure of obesity or obesogenic behavior, and published in English. Study design quality was assessed using Stetler's Level of Quantitative Evidence. All unique records were screened (n=4589): 237 articles were assessed for eligibility. Of these, 97 articles describing 71 interventions met inclusion criteria. Forty-four articles included multi-level interventions. Twenty-nine interventions included an outcome measure of obesity. Forty-one interventions included physical activity. Forty-five included diet. Eight included screen time. Fifty-five percent of interventions were Level II (randomized controlled trials), while 37% were Level III (quasi-experimental or pre-post only study design), and 8% were Level IV (non-experimental or natural experiments). Most interventions had the intended effect on the target: obesity 48% (n=14), physical activity 73% (n=30), diet 87% (n=39), and screen time 63% (n=5). Summarizing intervention strategies and assessing their effectiveness contributes to the existing literature and may provide direction for practitioners and researchers working with young children in child care. Most interventions produced the targeted changes in obesity and obesity-associated behaviors, supporting current and future efforts to collaborate with early-care centers and professionals for obesity prevention. Copyright © 2016 Elsevier Inc. All rights reserved.

Self-control and Task Timing Shift Self-efficacy and Influence Willingness to Engage in Effortful Tasks

PubMed Central

Ein-Gar, Danit; Steinhart, Yael

2017-01-01

Self-efficacy constitutes a key factor that influences people's inclination to engage in effortful tasks. In this study, we focus on an interesting interplay between two prominent factors known to influence engagement in effortful tasks: the timing of the task (i.e., whether the task is scheduled to take place in the near or distant future) and individuals' levels of self-control. Across three studies, we show that these two factors have an interacting effect on self-efficacy. Low self-control (LSC) individuals report higher self-efficacy for distant-future effortful tasks than for near-future tasks, whereas high self-control (HSC) individuals report higher self-efficacy for near-future tasks than for distant future tasks. We further demonstrate how self-efficacy then molds individuals' willingness to engage in those effortful tasks. Given that a particular task may comprise effortful aspects alongside more enjoyable aspects, we show that the effects we observe emerge with regard to a task whose effortful aspects are salient and that the effects are eliminated when the enjoyable aspects of that same task are highlighted. PMID:29075225

Development and field testing of a consumer shared decision-making training program for adults with low literacy.

PubMed

Muscat, Danielle M; Morony, Suzanne; Shepherd, Heather L; Smith, Sian K; Dhillon, Haryana M; Trevena, Lyndal; Hayen, Andrew; Luxford, Karen; Nutbeam, Don; McCaffery, Kirsten

2015-10-01

Given the scarcity of shared decision-making (SDM) interventions for adults with low literacy, we created a SDM training program tailored to this population to be delivered in adult education settings. Formative evaluation during program development included a review of the problem and previous efforts to address it, qualitative interviews with the target population, program planning and field testing. A comprehensive SDM training program was developed incorporating core SDM elements. The program aimed to improve students' understanding of SDM and to provide them with the necessary skills (understanding probabilistic risks and benefits, personal values and preferences) and self-efficacy to use an existing set of questions (the AskShareKnow questions) as a means to engage in SDM during healthcare interactions. There is an ethical imperative to develop SDM interventions for adults with lower literacy. Generic training programs delivered direct-to-consumers in adult education settings offer promise in a national and international environment where too few initiatives exist. Formative evaluation of the program offers practical insights into developing consumer-focused SDM training. The content of the program can be used as a guide for future efforts to engage consumers in SDM. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Mobile Health Technology in the Prevention and Management of Type 2 Diabetes.

PubMed

Muralidharan, Shruti; Ranjani, Harish; Anjana, Ranjit Mohan; Allender, Steven; Mohan, Viswanathan

2017-01-01

Essential steps in diabetes prevention and management include translating research into the real world, improving access to health care, empowering the community, collaborative efforts involving physicians, diabetes educators, nurses, and public health scientists, and access to diabetes prevention and management efforts. Mobile phone technology has shown wide acceptance across various ages and socioeconomic groups and offers several opportunities in health care including self-management as well as prevention of Type 2 diabetes mellitus (T2DM). The future seems to lie in mobile health (mHealth) applications that can use embedded technology to showcase advanced uses of a smartphone to help with prevention and management of chronic disorders such as T2DM. This article presents a narrative review of the mHealth technologies used for the prevention and management of T2DM. Majority (48%) of the studies used short message service (SMS) technology as their intervention while some studies (29%) incorporated applications for medication reminders and insulin optimization for T2DM management. Few studies (23%) showed that, along with mHealth technology, health-care professionals' support resulted in added positive outcomes for the patients. This review highlights the fact that an mHealth intervention need not be restricted to SMS alone.

Managing pain in the workplace: a focus group study of challenges, strategies and what matters most to workers with low back pain.

PubMed

Tveito, Torill Helene; Shaw, William S; Huang, Yueng-Hsiang; Nicholas, Michael; Wagner, Gregory

2010-01-01

Most working adults with low back pain (LBP) continue to work despite pain, but few studies have assessed self-management strategies in this at-work population. The purpose of this study was to identify workplace challenges and self-management strategies reported by workers remaining at work despite recurrent or persistent LBP, to be used as a framework for the development of a workplace group intervention to prevent back disability. Workers with LBP (n = 38) participated in five focus groups, and audio recordings of sessions were analysed to assemble lists of common challenges and coping strategies. A separate analysis provided a general categorisation of major themes. Workplace pain challenges fell within four domains: activity interference, negative self-perceptions, interpersonal challenges and inflexibility of work. Self-management strategies consisted of modifying work activities and routines, reducing pain symptoms, using cognitive strategies and communicating pain effectively. Theme extraction identified six predominant themes: knowing your work setting, talking about pain, being prepared for a bad day, thoughts and emotions, keeping moving and finding leeway. To retain workers with LBP, this qualitative investigation suggests future intervention efforts should focus on worker communication and cognitions related to pain, pacing of work and employer efforts to provide leeway for altered job routines.

Use of Community Readiness Model to Develop and Evaluate a Pilot Culinary Training Program for School Nutrition Staff.

PubMed

Hildebrand, Deana A; Blevins, Priscilla; Carl, Lillian; Brown, Barbara; Betts, Nancy M; Poe, Tiffany

2018-02-01

Use the Community Readiness Model (CRM) to develop and evaluate a contextually appropriate pilot culinary training program for school nutrition staff members. Mixed methods to guide intervention development. Six school districts in rural and urban areas of a southwestern state. School nutrition staff (n = 36; female; <1 to >20 years' experience). Pre- and post-training assessments used the CRM. Findings from the pre-assessment were used to develop the pilot culinary training intervention. Readiness to integrate new food preparation methods into existing practices. The researchers used t and Wilcoxon tests to compare overall readiness and dimension scores (P ≤ .05). Thematic analysis was used to identify themes from the discussion component of the assessments. Overall readiness increased from vague awareness to preparation (P = .02). Improved dimensions were knowledge of efforts (P = .004), leadership (P = .05), and knowledge of issues (P = .04). Themes included barriers, leadership, and motivation. The CRM was useful for developing and evaluating a contextually appropriate and effective culinary training program for school nutrition staff. Future efforts should address the provision of additional resources such as on-site chefs, small equipment grants, and engaging school stakeholders. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Assessing community readiness for overweight and obesity prevention in pre-adolescent girls: a case study

PubMed Central

2013-01-01

Background Childhood overweight and obesity is a global public health concern. For girls in particular, being overweight or obese during pre-adolescence (aged 7–11 years) has intergenerational implications for both the mother and her future offspring. In the United Kingdom (UK) there is increasing interest in community targeted interventions but less is known about how to tailor these approaches to the needs of the community. This study applied the Community Readiness Model (CRM), for the first time in the UK, to demonstrate its applicability in designing tailored interventions. Methods Community readiness assessment was conducted using semi-structured key informant interviews. The community’s key informants were identified through focus groups with pre-adolescent girls. The interviews addressed the community’s efforts; community knowledge of the efforts; leadership; community climate; community knowledge of the issue and resources available to support the issue. Interviews were conducted until the point of theoretical saturation and questions were asked separately regarding physical activity (PA) and healthy eating and drinking (HED) behaviours. The interviews were transcribed verbatim and were firstly analysed thematically and then scored using the assessment guidelines produced by the CRM authors. Results Readiness in this community was higher for PA than for HED behaviours. The lowest scores related to the community’s ’resources’ and the ’community knowledge of the issue’; affirming these two issues as the most appropriate initial targets for intervention. In terms of resources, there is also a need for resources to support the development of HED efforts beyond the school. Investment in greater physical education training for primary school teachers was also identified as an intervention priority. To address the community’s knowledge of the issue, raising the awareness of the prevalence of pre-adolescent girls’ health behaviours is a priority at the local community level. Inconsistent school approaches contributed to tensions between schools and parents regarding school food policies. Conclusions This study has identified the readiness level within a UK community to address the behaviours related to overweight and obesity prevention in pre-adolescent girls. The focus of an intervention in this community should initially be resources and raising awareness of the issue within the community. PMID:24359213

Screening, management, and treatment of intimate partner violence among women in low-resource settings.

PubMed

Schwab-Reese, Laura M; Renner, Lynette M

2018-01-01

The prevention of intimate partner violence continues to be a high priority for health practitioners and researchers around the world. Screening practices and intervention efforts utilized within high- and/or middle-income areas may not translate effectively to low-resource areas due to differences in financial, social, and physical context. However, little is known about the evidence-base of intervention efforts in such areas. Using the Arksey and O'Malley framework for scoping reviews, the purpose of this review was to synthesize what is known about intimate partner violence screening, management, and treatment in low-resource areas. A total of 31 programs reported across 34 articles were included in this scoping review. The programs incorporated a range of intervention activities, including group-based education and skill-development combined with microfinance to screening and referral to community resources. Slightly less than half of the studies (n = 14) were randomized controlled trials or clustered randomized controlled trials. Many barriers were common across the programs, including limited financial support, lack of community support, and lack of coordination across programs. Despite considerable barriers related to the limited available resources, the literature base had many strengths, such as strong evaluation methodologies, inclusion of a theoretical or conceptual framework to guide the intervention, and community engagement before and during the intervention implementation. However, insufficient statistical power and barriers related to cultural differences or inadequate cultural sensitivity were also common. With a variety of barriers to program implementation noted within the articles, it is important for researchers and practitioners to consider the geographic, social, cultural, and economic contexts when implementing intimate partner violence programs in low-resource areas. Given the significant differences in context across low-resource areas, additional research to establish effective protocols for tailoring and implementing evidence-based programs using a community-engaged framework would be beneficial to future research and practice.

Future Air Transportation System Breakout Series Report

NASA Technical Reports Server (NTRS)

2001-01-01

This presentation discusses: AvSTAR Future System Effort Critically important; Investment in the future; Need to follow a systems engineering process; and Efforts need to be worked in worldwide context

Screening and Intervention for Comorbid Substance Disorders, PTSD, Depression, and Suicide: A Trauma Center Survey.

PubMed

Love, Jeff; Zatzick, Douglas

2014-07-01

Few investigations have examined screening and intervention procedures for comorbid substance use and mental disorders at trauma centers in the United States, although these disorders are endemic among survivors of traumatic injury. In 2006, the American College of Surgeons (ACS) mandated that level I and level II trauma centers screen for alcohol use problems and that level I centers provide brief intervention for those who screen positive. The ACS is expected to recommend best practice policy guidelines for screening for drug use problems and posttraumatic stress disorder (PTSD). This study examined screening and intervention procedures for the full spectrum of comorbid mental and substance use disorders at U.S. trauma centers. Respondents at all level I and level II trauma centers (N=518) in the United States were asked to complete a survey describing screening and intervention procedures for alcohol and drug use problems, suicidality, depression, and PTSD. There were 391 (75%) respondents. Over 80% of trauma centers routinely screened for alcohol and drug use problems. Routine screening and intervention for suicidality, depression, and PTSD were markedly less common; in fact, only 7% of centers reported routine screening for PTSD. Consistent with ACS policy, level I centers were significantly more likely than level II centers to provide alcohol intervention. Alcohol screening and intervention occurred frequently at U.S. trauma centers and appeared to be responsive to ACS mandates. In the future, efforts to orchestrate clinical investigation and policy could enhance screening and intervention procedures for highly prevalent, comorbid mental disorders.

Malaria in Uganda: challenges to control on the long road to elimination. I. Epidemiology and current control effort

PubMed Central

Yeka, Adoke; Gasasira, Anne; Mpimbaza, Arthur; Achan, Jane; Nankabirwa, Joaniter; Nsobya, Sam; Staedke, Sarah G.; Donnelly, Martin J.; Wabwire-Mangen, Fred; Talisuna, Ambrose; Dorsey, Grant; Kamya, Moses R.; Rosenthal, Philip J.

2012-01-01

In the recent past there have been several reports of successes in malaria control, leading some public health experts to conclude that Africa is witnessing an epidemiological transition, from an era of failed malaria control to progression from successful control to elimination. Successes in control have been attributed to increased international donor support leading to increased intervention coverage. However, these changes are not uniform across Africa. In Uganda, where baseline transmission is very high and intervention coverage not yet to scale, the malaria burden is not declining and has even likely increased in the last decade. In this article we present perspectives for the future for Uganda and other malaria endemic countries with high baseline transmission intensity and significant health system challenges. For these high burden areas,malaria elimination is currently not feasible, and early elimination programs are inappropriate, as they would further fragment already fragmented and inefficient malaria control systems. Rather, health impacts will be maximized by aiming to achieve universal coverage of proven interventions in the context of a strengthened health system. PMID:21756863

Some Current Dimensions of the Behavioral Economics of Health-Related Behavior Change

PubMed Central

Bickel, Warren K.; Moody, Lara; Higgins, Stephen T.

2016-01-01

Health-related behaviors such as tobacco, alcohol and other substance use, poor diet and physical inactivity, and risky sexual practices are important targets for research and intervention. Health-related behaviors are especially pertinent targets in the United States, which lags behind most other developed nations on common markers of population health. In this essay we examine the application of behavioral economics, a scientific discipline that represents the intersection of economics and psychology, to the study and promotion of health-related behavior change. More specifically, we review what we consider to be some core dimensions of this discipline when applied to the study health-related behavior change. Behavioral economics (1) provides novel conceptual systems to inform scientific understanding of health behaviors, (2) translates scientific understanding into practical and effective behavior-change interventions, (3) leverages varied aspects of behavior change beyond increases or decreases in frequency, (4) recognizes and exploits trans-disease processes and interventions, and (5) leverages technology in efforts to maximize efficacy, cost effectiveness, and reach. These dimensions are overviewed and their implications for the future of the field discussed. PMID:27283095

Exploring positive hospital ward soundscape interventions.

PubMed

Mackrill, J; Jennings, P; Cain, R

2014-11-01

Sound is often considered as a negative aspect of an environment that needs mitigating, particularly in hospitals. It is worthwhile however, to consider how subjective responses to hospital sounds can be made more positive. The authors identified natural sound, steady state sound and written sound source information as having the potential to do this. Listening evaluations were conducted with 24 participants who rated their emotional (Relaxation) and cognitive (Interest and Understanding) response to a variety of hospital ward soundscape clips across these three interventions. A repeated measures ANOVA revealed that the 'Relaxation' response was significantly affected (n(2) = 0.05, p = 0.001) by the interventions with natural sound producing a 10.1% more positive response. Most interestingly, written sound source information produced a 4.7% positive change in response. The authors conclude that exploring different ways to improve the sounds of a hospital offers subjective benefits that move beyond sound level reduction. This is an area for future work to focus upon in an effort to achieve more positively experienced hospital soundscapes and environments. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Brief Online Training Enhances Competitive Performance: Findings of the BBC Lab UK Psychological Skills Intervention Study

PubMed Central

Lane, Andrew M.; Totterdell, Peter; MacDonald, Ian; Devonport, Tracey J.; Friesen, Andrew P.; Beedie, Christopher J.; Stanley, Damian; Nevill, Alan

2016-01-01

In conjunction with BBC Lab UK, the present study developed 12 brief psychological skill interventions for online delivery. A protocol was designed that captured data via self-report measures, used video recordings to deliver interventions, involved a competitive concentration task against an individually matched computer opponent, and provided feedback on the effects of the interventions. Three psychological skills were used; imagery, self-talk, and if-then planning, with each skill directed to one of four different foci: outcome goal, process goal, instruction, or arousal-control. This resulted in 12 different intervention participant groups (randomly assigned) with a 13th group acting as a control. Participants (n = 44,742) completed a competitive task four times—practice, baseline, following an intervention, and again after repeating the intervention. Results revealed performance improved following practice with incremental effects for imagery-outcome, imagery-process, and self-talk-outcome and self-talk-process over the control group, with the same interventions increasing the intensity of effort invested, arousal and pleasant emotion. Arousal-control interventions associated with pleasant emotions, low arousal, and low effort invested in performance. Instructional interventions were not effective. Results offer support for the utility of online interventions in teaching psychological skills and suggest brief interventions that focus on increasing motivation, increased arousal, effort invested, and pleasant emotions were the most effective. PMID:27065904

The concurrent and longitudinal associations of temperament and nutritional risk factors in early childhood.

PubMed

van den Heuvel, M; Chen, Y; Abdullah, K; Maguire, J L; Parkin, P C; Birken, C S

2017-12-01

Early childhood temperament is increasingly recognized as an important attribute that may impact screen time use, outdoor play and childhood obesity. The relationship between temperament and nutrition in preschool children is less clear. The objective of the study is to investigate if temperament dimensions (negative affectivity, effortful control and surgency) in early childhood are associated with nutritional risk factors. Six hundred seventy-eight children were followed (mean age at baseline visit 3.1 years; mean time to follow-up 16.5 months). Parents reported on child temperament and nutritional risk factors during regularly scheduled well-child clinic visits. A mixed effect model demonstrated a significant association between higher negative affectivity (1.03; 95% CI 0.69 to 1.37) and higher effortful control (-0.88; 95% CI -1.27 to -0.49) on concurrent nutritional risk, independent of covariates. Multivariate linear regression analysis identified that higher effortful control, and not negative affectivity, was significantly associated with a decrease in nutritional risk (-0.67; 95% CI -1.10 to -0.24) over time, independent of covariates. There was no relationship identified between surgency and nutritional risk. Three-year-old children with higher effortful control had reduced nutritional risk at 5 years of age. Future nutritional risk prevention strategies may benefit from interventions to increase effortful control in early childhood. © 2016 World Obesity Federation.

Evaluation of an educational intervention on villagers’ knowledge, attitude and behaviour regarding transmission of Schistosoma japonicum in Sichuan province, China

PubMed Central

Wang, Shuo; Carlton, Elizabeth J.; Chen, Lin; Liu, Yang; Spear, Robert C.

2013-01-01

Health education is an important component of efforts to control schistosomiasis. In China, while education programmes have been implemented intensively, few articles in recent years in either the Chinese or English literature report randomised, controlled interventions of the impacts on knowledge, attitudes and behaviours .Thus, we designed and carried out a cluster-randomised controlled education intervention trial that targeted 706 adults from rural areas in 28 villages in Sichuan, China. We evaluated the effects of the intervention on five endpoints: (1) schistosomiasis knowledge, (2) attitudes towards infection testing and treatment, (3) use of personal protective equipment (PPE), (4) reducing defecation in the field, and (5) reducing dermal contact with potentially contaminated water sources. The results indicated that people in both the intervention and control groups showed improvement in knowledge, attitudes and reduction in field-defecation in the follow-up surveys. However, there was little evidence that suggested statistically significant differences between the two groups regarding any endpoint. Participation in intervention classes was associated with age, gender, occupation and education level. Our study suggests short-term health education interventions may not be effective in improving schistosomiasis knowledge or in the adoption of health-protective behaviours. This might be partially due to the spontaneous learning process of people subject to repeated surveys and other disease control activities. Considering the difficulties of occupationassociated behaviour change and knowledge reinforcement in general, longer-term education programmes should be considered in the future. PMID:23711611

Multilevel Intervention Research: Lessons Learned and Pathways Forward

PubMed Central

Taplin, Stephen H.; Foster, Mary K.; Fagan, Pebbles; Kaluzny, Arnold D.

2012-01-01

This summary reflects on this monograph regarding multilevel intervention (MLI) research to 1) assess its added value; 2) discuss what has been learned to date about its challenges in cancer care delivery; and 3) identify specific ways to improve its scientific soundness, feasibility, policy relevance, and research agenda. The 12 submitted chapters, and discussion of them at the March 2011 multilevel meeting, were reviewed and discussed among the authors to elicit key findings and results addressing the questions raised at the outset of this effort. MLI research is underrepresented as an explicit focus in the cancer literature but may improve implementation of studies of cancer care delivery if they assess contextual, organizational, and environmental factors important to understanding behavioral and/or system-level interventions. The field lacks a single unifying theory, although several psychological or biological theories are useful, and an ecological model helps conceptualize and communicate interventions. MLI research designs are often complex, involving nonlinear and nonhierarchical relationships that may not be optimally studied in randomized designs. Simulation modeling and pilot studies may be necessary to evaluate MLI interventions. Measurement and evaluation of team and organizational interventions are especially needed in cancer care, as are attention to the context of health-care reform, eHealth technology, and genomics-based medicine. Future progress in MLI research requires greater attention to developing and supporting relevant metrics of level effects and interactions and evaluating MLI interventions. MLI research holds an unrealized promise for understanding how to improve cancer care delivery. PMID:22623606

The Implementation of Internet Interventions for Depression: A Scoping Review.

PubMed

Drozd, Filip; Vaskinn, Linda; Bergsund, Hans Bugge; Haga, Silje Marie; Slinning, Kari; Bjørkli, Cato Alexander

2016-09-08

Depression is one of the most common mental health problems among adults, but effective treatments are not widely accessible. The Internet holds promise as a cost-effective and convenient delivery platform of interventions for depression. However, studies suggest that Internet interventions are not widely available in routine settings. The aim of this study was to review the literature and examine whether there are systematic differences in reporting of the various implementation components on Internet interventions for depression, and then to examine what is known about and is characteristic of the implementation of these Internet interventions in regular care settings. We performed a scoping review, drawing upon a broad range of the literature on Internet interventions for depression in regular care, and used the active implementation framework to extract data. Overall, the results suggested that knowledge about the implementation of Internet interventions for depression in regular care is limited. However, guided support from health professionals emphasizing program adherence and recruitment of end users to the interventions emerged as 2 main themes. We identified 3 additional themes among practitioners, including their qualifications, training, and supervision, but these were scarcely described in the literature. The competency drivers (ie, staff and user selection, training, and supervision) have received the most attention, while little attention has been given to organizational (ie, decision support, administration, and system intervention) and leadership drivers. Research has placed little emphasis on reporting on the implementation of interventions in practice. Leadership and organizational drivers, in particular, have been largely neglected. The results of this scoping review have implications for future research and efforts to successfully implement Internet interventions for depression in regular care.

The Implementation of Internet Interventions for Depression: A Scoping Review

PubMed Central

Vaskinn, Linda; Bergsund, Hans Bugge; Haga, Silje Marie; Slinning, Kari; Bjørkli, Cato Alexander

2016-01-01

Background Depression is one of the most common mental health problems among adults, but effective treatments are not widely accessible. The Internet holds promise as a cost-effective and convenient delivery platform of interventions for depression. However, studies suggest that Internet interventions are not widely available in routine settings. Objective The aim of this study was to review the literature and examine whether there are systematic differences in reporting of the various implementation components on Internet interventions for depression, and then to examine what is known about and is characteristic of the implementation of these Internet interventions in regular care settings. Methods We performed a scoping review, drawing upon a broad range of the literature on Internet interventions for depression in regular care, and used the active implementation framework to extract data. Results Overall, the results suggested that knowledge about the implementation of Internet interventions for depression in regular care is limited. However, guided support from health professionals emphasizing program adherence and recruitment of end users to the interventions emerged as 2 main themes. We identified 3 additional themes among practitioners, including their qualifications, training, and supervision, but these were scarcely described in the literature. The competency drivers (ie, staff and user selection, training, and supervision) have received the most attention, while little attention has been given to organizational (ie, decision support, administration, and system intervention) and leadership drivers. Conclusions Research has placed little emphasis on reporting on the implementation of interventions in practice. Leadership and organizational drivers, in particular, have been largely neglected. The results of this scoping review have implications for future research and efforts to successfully implement Internet interventions for depression in regular care. PMID:27608548

MO-DE-204-01: Radiation Doses in Over 50 Developing Countries of Asia, Africa, Eastern European and Latin America

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rehani, M.

2016-06-15

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented.more » Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.« less

MO-DE-204-00: International Symposium: Patient Dose Reduction in Diagnostic Radiology

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

2016-06-15

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented.more » Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.« less

MO-DE-204-02: Optimization of the Patient CT Dose in Europe

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tsapaki, V.

2016-06-15

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented.more » Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.« less

The Mediating Role of Psychological Capital on the Association between Occupational Stress and Job Satisfaction among Township Cadres in a Specific Province of China: A Cross-Sectional Study

PubMed Central

Shang Guan, Chang-Yue; Li, Yu; Ma, Hong-Lin

2017-01-01

Background: Township cadres, considered as basic executors of state policy, play an important role in Chinese society. Their job satisfaction is a vital issue for township management, but there are few studies on this topic in China. The goal of this study is to analyze the relationship between occupational stress and job satisfaction, and to further examine whether psychological capital (PsyCap) can serve as a mediator between stress and job satisfaction in Chinese township cadres. Methods: A cross-sectional survey was carried out during the period of from October 2015 to January 2016 in Liaoning Province of China. The questionnaires, which consisted of an effort-reward imbalance scale, Minnesota Satisfaction Questionnaire (MSQ) for job satisfaction, and the psychological capital questionnaire (PCQ-24), as well as questions about demographic characteristics, were distributed to 1800 township cadres and complete responses were received from 1525 participants. Structural equation modeling was used to examine the role that psychological capital played in mediating between occupational stress and job satisfaction. Results: In the present study, effort-reward ratio (ERR= 11 × effort/6 × reward) was negatively associated with job satisfaction (r = −0.372, p < 0.001), whereas psychological capital was positively associated with job satisfaction in township cadres (r = 0.587, p < 0.001) from a specific province in China. Psychological capital is a mediator between the association of job stress and job satisfaction. Conclusions: Psychological capital partially mediated the relationship between job stress and job satisfaction among Chinese township cadres. Interventions to improve Chinese township cadres’ job satisfaction should be developed in the future, especially the enhancement of PsyCap. Interventions need to be verified in further cohort studies. At present, we are only proposing a theoretical model. Intervention effects need to be validated in further cohort studies. PMID:28846644

MO-DE-204-03: Radiology Dose Optimisation - An Australian Perspective

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schick, D.

2016-06-15

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented.more » Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kofler, J.

The main topic of the session is to show how dose optimization is being implemented in various regions of the world, including Europe, Australia, North America and other regions. A multi-national study conducted under International Atomic Energy Agency (IAEA) across more than 50 less resourced countries gave insight into patient radiation doses and safety practices in CT, mammography, radiography and interventional procedures, both for children and adults. An important outcome was the capability development on dose assessment and management. An overview of recent European projects related to CT radiation dose and optimization both to adults and children will be presented.more » Existing data on DRLs together with a European methodology proposed on establishing and using DRLs for paediatric radiodiagnostic imaging and interventional radiology practices will be shown. Compared with much of Europe at least, many Australian imaging practices are relatively new to the task of diagnostic imaging dose optimisation. In 2008 the Australian Government prescribed a requirement to periodically compare patient radiation doses with diagnostic reference levels (DRLs), where DRLs have been established. Until recently, Australia had only established DRLs for computed tomography (CT). Regardless, both professional society and individual efforts to improved data collection and develop optimisation strategies across a range of modalities continues. Progress in this field, principally with respect to CT and interventional fluoroscopy will be presented. In the US, dose reduction and optimization efforts for computed tomography have been promoted and mandated by several organizations and accrediting entities. This presentation will cover the general motivation, implementation, and implications of such efforts. Learning Objectives: Understand importance of the dose optimization in Diagnostic Radiology. See how this goal is achieved in different regions of the World. Learn about the global trend in the dose optimization and future prospectives. M. Rehani, The work was a part of the work of IAEA where I was an employee and IAEA is a United Nations organization.« less

The Mediating Role of Psychological Capital on the Association between Occupational Stress and Job Satisfaction among Township Cadres in a Specific Province of China: A Cross-Sectional Study.

PubMed

Shang Guan, Chang-Yue; Li, Yu; Ma, Hong-Lin

2017-08-28

Background : Township cadres, considered as basic executors of state policy, play an important role in Chinese society. Their job satisfaction is a vital issue for township management, but there are few studies on this topic in China. The goal of this study is to analyze the relationship between occupational stress and job satisfaction, and to further examine whether psychological capital (PsyCap) can serve as a mediator between stress and job satisfaction in Chinese township cadres. Methods : A cross-sectional survey was carried out during the period of from October 2015 to January 2016 in Liaoning Province of China. The questionnaires, which consisted of an effort-reward imbalance scale, Minnesota Satisfaction Questionnaire (MSQ) for job satisfaction, and the psychological capital questionnaire (PCQ-24), as well as questions about demographic characteristics, were distributed to 1800 township cadres and complete responses were received from 1525 participants. Structural equation modeling was used to examine the role that psychological capital played in mediating between occupational stress and job satisfaction. Results : In the present study, effort-reward ratio (ERR= 11 × effort/6 × reward) was negatively associated with job satisfaction (r = -0.372, p < 0.001), whereas psychological capital was positively associated with job satisfaction in township cadres (r = 0.587, p < 0.001) from a specific province in China. Psychological capital is a mediator between the association of job stress and job satisfaction. Conclusions : Psychological capital partially mediated the relationship between job stress and job satisfaction among Chinese township cadres. Interventions to improve Chinese township cadres' job satisfaction should be developed in the future, especially the enhancement of PsyCap. Interventions need to be verified in further cohort studies. At present, we are only proposing a theoretical model. Intervention effects need to be validated in further cohort studies.

The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial.

PubMed

Hartin, Phillip J; Nugent, Chris D; McClean, Sally I; Cleland, Ian; Tschanz, JoAnn T; Clark, Christine J; Norton, Maria C

2016-08-02

Health education and behavior change programs targeting specific risk factors have demonstrated their effectiveness in reducing the development of future diseases. Alzheimer disease (AD) shares many of the same risk factors, most of which can be addressed via behavior change. It is therefore theorized that a behavior change intervention targeting these risk factors would likely result in favorable rates of AD prevention. The objective of this study was to reduce the future risk of developing AD, while in the short term promoting vascular health, through behavior change. The study was an interventional randomized controlled trial consisting of subjects who were randomly assigned into either treatment (n=102) or control group (n=42). Outcome measures included various blood-based biomarkers, anthropometric measures, and behaviors related to AD risk. The treatment group was provided with a bespoke "Gray Matters" mobile phone app designed to encourage and facilitate behavior change. The app presented evidence-based educational material relating to AD risk and prevention strategies, facilitated self-reporting of behaviors across 6 behavioral domains, and presented feedback on the user's performance, calculated from reported behaviors against recommended guidelines. This paper explores the rationale for a mobile phone-led intervention and details the app's effect on behavior change and subsequent clinical outcomes. Via the app, the average participant submitted 7.3 (SD 3.2) behavioral logs/day (n=122,719). Analysis of these logs against primary outcome measures revealed that participants who improved their high-density lipoprotein cholesterol levels during the study duration answered a statistically significant higher number of questions per day (mean 8.30, SD 2.29) than those with no improvement (mean 6.52, SD 3.612), t97.74=-3.051, P=.003. Participants who decreased their body mass index (BMI) performed significantly better in attaining their recommended daily goals (mean 56.21 SD 30.4%) than those who increased their BMI (mean 40.12 SD 29.1%), t80 = -2.449, P=.017. In total, 69.2% (n=18) of those who achieved a mean performance percentage of 60% or higher, across all domains, reduced their BMI during the study, whereas 60.7% (n=34) who did not, increased their BMI. One-way analysis of variance of systolic blood pressure category changes showed a significant correlation between reported efforts to reduce stress and category change as a whole, P=.035. An exit survey highlighted that respondents (n=83) reported that the app motivated them to perform physical activity (85.4%) and make healthier food choices (87.5%). In this study, the ubiquitous nature of the mobile phone excelled as a delivery platform for the intervention, enabling the dissemination of educational intervention material while simultaneously monitoring and encouraging positive behavior change, resulting in desirable clinical effects. Sustained effort to maintain the achieved behaviors is expected to mitigate future AD risk. ClinicalTrails.gov NCT02290912; https://clinicaltrials.gov/ct2/show/NCT02290912 (Archived by WebCite at http://www.webcitation.org/6ictUEwnm).

The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial

PubMed Central

Nugent, Chris D; McClean, Sally I; Cleland, Ian; Tschanz, JoAnn T; Clark, Christine J; Norton, Maria C

2016-01-01

Background Health education and behavior change programs targeting specific risk factors have demonstrated their effectiveness in reducing the development of future diseases. Alzheimer disease (AD) shares many of the same risk factors, most of which can be addressed via behavior change. It is therefore theorized that a behavior change intervention targeting these risk factors would likely result in favorable rates of AD prevention. Objective The objective of this study was to reduce the future risk of developing AD, while in the short term promoting vascular health, through behavior change. Methods The study was an interventional randomized controlled trial consisting of subjects who were randomly assigned into either treatment (n=102) or control group (n=42). Outcome measures included various blood-based biomarkers, anthropometric measures, and behaviors related to AD risk. The treatment group was provided with a bespoke “Gray Matters” mobile phone app designed to encourage and facilitate behavior change. The app presented evidence-based educational material relating to AD risk and prevention strategies, facilitated self-reporting of behaviors across 6 behavioral domains, and presented feedback on the user’s performance, calculated from reported behaviors against recommended guidelines. Results This paper explores the rationale for a mobile phone–led intervention and details the app’s effect on behavior change and subsequent clinical outcomes. Via the app, the average participant submitted 7.3 (SD 3.2) behavioral logs/day (n=122,719). Analysis of these logs against primary outcome measures revealed that participants who improved their high-density lipoprotein cholesterol levels during the study duration answered a statistically significant higher number of questions per day (mean 8.30, SD 2.29) than those with no improvement (mean 6.52, SD 3.612), t97.74=−3.051, P=.003. Participants who decreased their body mass index (BMI) performed significantly better in attaining their recommended daily goals (mean 56.21 SD 30.4%) than those who increased their BMI (mean 40.12 SD 29.1%), t80 = −2.449, P=.017. In total, 69.2% (n=18) of those who achieved a mean performance percentage of 60% or higher, across all domains, reduced their BMI during the study, whereas 60.7% (n=34) who did not, increased their BMI. One-way analysis of variance of systolic blood pressure category changes showed a significant correlation between reported efforts to reduce stress and category change as a whole, P=.035. An exit survey highlighted that respondents (n=83) reported that the app motivated them to perform physical activity (85.4%) and make healthier food choices (87.5%). Conclusions In this study, the ubiquitous nature of the mobile phone excelled as a delivery platform for the intervention, enabling the dissemination of educational intervention material while simultaneously monitoring and encouraging positive behavior change, resulting in desirable clinical effects. Sustained effort to maintain the achieved behaviors is expected to mitigate future AD risk. Trial Registration ClinicalTrails.gov NCT02290912; https://clinicaltrials.gov/ct2/show/NCT02290912 (Archived by WebCite at http://www.webcitation.org/6ictUEwnm) PMID:27485822

The dynamics of de-adoption: a case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention.

PubMed

McKay, Virginia R; Margaret Dolcini, M; Hoffer, Lee D

2017-12-01

Evidence-based intervention (EBI) de-adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de-adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010-2014), but then de-adopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semi-structured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues' implementation framework, we developed a narrative of RESPECT implementation, delivery, and de-adoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT de-adoption had wide-reaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI de-adoption as a phase of the implementation cycle. Furthermore, EBI de-adoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.

Parent-focused child maltreatment prevention: improving assessment, intervention, and dissemination with technology.

PubMed

Self-Brown, Shannon; Whitaker, Daniel J

2008-11-01

The goal of this article is to examine how technology has been and can be utilized to enhance parent-focused child maltreatment (CM) prevention efforts. The authors begin with a brief discussion of the current state of the CM prevention field. In the sections that follow, they review studies that have examined the use of technology across three facets of prevention: identification of CM, administration/augmentation of CM prevention programs, and broad dissemination and implementation of evidenced-based CM prevention programs. They conclude with a discussion of limitations and problems related to the use of technology as a tool to enhance CM prevention and future directions.

Peer Crowd Identification and Indoor Artificial UV Tanning Behavioral Tendencies

PubMed Central

STAPLETON, JEROD; TURRISI, ROB; HILLHOUSE, JOEL

2014-01-01

In this study, the relation between peer crowd identification and indoor tanning behavioral tendencies was examined. Participants were 174 undergraduate students at a large university in the USA. Results indicated peer crowd identification was significantly associated with indoor artificial UV tanning behavioral tendencies (attitudes, normative beliefs, past year use and intentions) independent of gender and skin type. Participants who identified with the popular peer crowd were at the greatest risk for indoor tanning UV exposure while identification with the brain crowd was protective against such behavior. The findings are discussed in terms of implications for future skin cancer intervention efforts. PMID:18809645

A survey of keystroke dynamics biometrics.

PubMed

Teh, Pin Shen; Teoh, Andrew Beng Jin; Yue, Shigang

2013-01-01

Research on keystroke dynamics biometrics has been increasing, especially in the last decade. The main motivation behind this effort is due to the fact that keystroke dynamics biometrics is economical and can be easily integrated into the existing computer security systems with minimal alteration and user intervention. Numerous studies have been conducted in terms of data acquisition devices, feature representations, classification methods, experimental protocols, and evaluations. However, an up-to-date extensive survey and evaluation is not yet available. The objective of this paper is to provide an insightful survey and comparison on keystroke dynamics biometrics research performed throughout the last three decades, as well as offering suggestions and possible future research directions.

Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach.

PubMed

Brendryen, Håvar; Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo; Duckert, Fanny

2013-01-23

Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels. The descriptions of the treatment rationale for Balance, the alcohol intervention reported herein, provides an intervention blueprint that will aid in interpreting the results from future program evaluations. It will ease comparisons of program rationales across interventions, and may assist intervention development. By putting just-in-time therapy within a complete theoretical and practical context, including the tunnel delivery strategy and the self-regulation perspective, we have contributed to an understanding of how multiple delivery strategies in eHealth interventions can be combined. Additionally, this is a call for action to improve the reporting practices within eHealth research. Possible ways to achieve such improvement include using a systematic and structured approach, and for intervention reports to be published after peer-review and separately from evaluation reports.

Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach

PubMed Central

Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo; Duckert, Fanny

2013-01-01

Background Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. Objective The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. Methods We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. Results The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels. Conclusions The descriptions of the treatment rationale for Balance, the alcohol intervention reported herein, provides an intervention blueprint that will aid in interpreting the results from future program evaluations. It will ease comparisons of program rationales across interventions, and may assist intervention development. By putting just-in-time therapy within a complete theoretical and practical context, including the tunnel delivery strategy and the self-regulation perspective, we have contributed to an understanding of how multiple delivery strategies in eHealth interventions can be combined. Additionally, this is a call for action to improve the reporting practices within eHealth research. Possible ways to achieve such improvement include using a systematic and structured approach, and for intervention reports to be published after peer-review and separately from evaluation reports. PMID:23612478

Operation Occupation: A College and Career Readiness Intervention for Elementary Students

ERIC Educational Resources Information Center

Mariani, Melissa; Berger, Carolyn; Koerner, Kathleen; Sandlin, Cassie

2017-01-01

This article describes efforts undertaken to design, deliver, and evaluate a college and career readiness (CCR) unit for fifth-grade students. Preliminary findings from the school counselor-developed and -delivered intervention, Operation Occupation, supported interdisciplinary efforts between counselors and classroom teachers. Pre- and…

Language Disorders in Adolescents: Current Needs and Future Directions.

PubMed

Nippold, Marilyn A

2016-11-01

Adolescents with developmental language disorders often do not receive the type of intervention that would improve their ability to speak, listen, read, and write effectively. Part of the problem is that many of these young people show no obvious symptoms of a language disorder, yet they struggle on a daily basis to succeed at school-related tasks that require a sophisticated level of language development. This article discusses some of the challenges these students face and makes suggestions for what could be done to address the issues. These suggestions include continuing the effort to advocate strongly for the rights of adolescents, increasing collaboration between speech-language pathologists and other professionals in the schools, and making changes to training programs in communication sciences and disorders to better prepare future speech-language pathologists to work with adolescents. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Two-year predictors of runaway and homeless episodes following shelter services among substance abusing adolescents.

PubMed

Slesnick, Natasha; Guo, Xiamei; Brakenhoff, Brittany; Feng, Xin

2013-10-01

Given high levels of health and psychological costs associated with the family disruption of homelessness, identifying predictors of runaway and homeless episodes is an important goal. The current study followed 179 substance abusing, shelter-recruited adolescents who participated in a randomized clinical trial. Predictors of runaway and homeless episodes were examined over a two year period. Results from the hierarchical linear modeling analysis showed that family cohesion and substance use, but not family conflict or depressive symptoms, delinquency, or school enrollment predicted future runaway and homeless episodes. Findings suggest that increasing family support, care and connection and reducing substance use are important targets of intervention efforts in preventing future runaway and homeless episodes amongst a high risk sample of adolescents. Copyright © 2013 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Understanding the ecology of child maltreatment: a review of the literature and directions for future research.

PubMed

Freisthler, Bridget; Merritt, Darcey H; LaScala, Elizabeth A

2006-08-01

Studies examining neighborhood characteristics in relation to social problems, including child maltreatment, have proliferated in the past 25 years. This article reviews the current state of knowledge of ecological studies of child maltreatment. Taken as a whole, these 18 studies document a stable ecological relationship among neighborhood impoverishment, housing stress, and rates of child maltreatment, as well as some evidence that unemployment, child care burden, and alcohol availability may contribute to child abuse and neglect. The authors include a discussion of methodological difficulties in conducting research at the neighborhood level and present a set of recommendations for future research that emphasizes movement from a simple examination of neighborhood-level characteristics toward a theoretically driven explication of processes and mechanisms supported by appropriate multilevel modeling techniques. The final goal of such efforts would be to enable practitioners to develop evidence-based neighborhood interventions that would prevent and reduce child abuse and neglect.

Salty or Sweet: Exploring the Challenges of Groundwater Salinization Within a Sustainability Framework

NASA Astrophysics Data System (ADS)

Basu, N. B.; Van Meter, K. J.; Tate, E.

2012-12-01

In semi-arid to arid landscapes under intensive irrigation, groundwater salinization can be a persistent and critical problem, leading to reduced agricultural productivity, limited access to fresh drinking water, and ultimately desertification. It is estimated that in India alone, problems of salinity are now affecting over 6 million hectares of agricultural land. In villages of the Mewat district of Haryana in Northern India, subsistence-level farming is the primary source of income, and farming families live under serious threat from increasing salinity levels, both in terms of crop production and adequate supplies of drinking water. The Institute for Rural Research and Development (IRRAD), a non-governmental organization (NGO) working in Mewat, has taken an innovative approach in this area to problems of groundwater salinization, using check dams and rainwater harvesting ponds to recharge aquifers in the freshwater zones of upstream hill areas, and to create freshwater pockets within the saline groundwater zones of down-gradient areas. Initial, pilot-scale efforts have led to apparent success in raising groundwater levels in freshwater zones and changing the dynamics of encroaching groundwater salinity, but the expansion of such efforts to larger-scale restoration is constrained by the availability of adequate resources. Under such resource constraints, which are typical of international development work, it becomes critical to utilize a decision-analysis framework to quantify both the immediate and long-term effectiveness and sustainability of interventions by NGOs such as IRRAD. In the present study, we have developed such a framework, linking the climate-hydrological dynamics of monsoon driven systems with village-scale socio-economic attributes to evaluate the sustainability of current restoration efforts and to prioritize future areas for intervention. We utilize a multi-dimensional metric that takes into account both physical factors related to water availability as well as socio-economic factors related to the capacity to deal with water stress. This metric allows us to evaluate and compare water-driven sustainability at the village, block, and district levels in Northern India based on a combination of readily available census and water resource data. Further, we utilize a pressure-response framework that considers monsoonal dynamics and effectively evaluates the effects of intervention efforts over time. Our results indicate that in arid to semi-arid regions, where problems of groundwater salinity are paramount, scaling factors corresponding to salinity levels as well as the relative size of the saline zone must be incorporated into indicators of water access and availability to accurately reflect overall sustainability. More importantly, the results point towards the value of incorporating dynamic, multi-dimensional sustainability metrics into decision-analysis frameworks used to aid in resource prioritization and the evaluation of intervention efforts.

Evaluating international development investments based on ecosystem services impact

NASA Astrophysics Data System (ADS)

Fremier, A. K.; Brauman, K. A.; Mulligan, M.; Chaplin-Kramer, R.; Gordon, L.; Luedeling, E.; Jones, S. K.; DeClerck, F.

2016-12-01

Engineered water-control structures to supply water for agriculture are frequently funded by international development to an effort to improve human wellbeing. Dams, reservoirs, and other forms of water control frequently have negative impacts on other water users; however, their sustainability in the face of climate change and evolving watershed processes have been called into question. Increasingly, planning for and evaluation of investments in water control require integration of these larger scale impacts and dependencies. Ecosystem service approaches can use local to regional scale knowledge to integrate a broader scope of project impacts by quantifying trade-offs in multiple services across proposed development interventions and future scenarios (economic, climate, demographic). Here, we illustrate the role an ecosystem service approach can play in investment decision making to evaluate the impact of small reservoirs on human wellbeing in the Upper Volta Basin of West Africa. Our project has four components: (1) design of a spatially explicit regional-level social-ecological characterization; (2) construction of future scenario analyses for rainfed and irrigated production system interventions; (3) co-design and co-development of benefit sharing mechanisms at the reservoir catchment level and enhancing institutional capacity to implement these mechanisms through training, professional development and targeting tools; and (4) intervention decision analysis to identify benefits, costs and risks associated with decision options. We illustrate how this approach highlights different outcomes than standard cost-benefit analysis focused narrowly on the single project. Anticipated outcomes are development of ecosystem services-based methods for more equitably and sustainably evaluating development interventions and identifying management approaches to water-impoundment structures that promote a range of ecosystem services to provide food security to a broader population.

Energy expenditure and enjoyment of common children's games in a simulated free-play environment.

PubMed

Howe, Cheryl A; Freedson, Patty S; Feldman, Henry A; Osganian, Stavroula K

2010-12-01

To measure the energy expenditure and enjoyment of children's games to be used in developing a school-based intervention for preventing excessive weight gain. Healthy weight (body mass index [BMI] < 85th percentile) and overweight or obese (BMI ≥ 85th percentile) third-grade children (15 boys; 13 girls) were recruited. In a large gymnasium, children performed 10 games randomly selected from 30 games used in previous interventions. Total energy expenditure was measured with a portable metabolic unit and perceived enjoyment was assessed using a 9-point Likert scale of facial expressions. Mean physical activity energy expenditure (PAEE = total energy expenditure minus resting metabolism) and enjoyment of the games were adjusted for sex and BMI classification. PAEE and enjoyment were compared using a repeated-measures ANOVA with sex, BMI classification, and games as main effects. The games elicited a moderate intensity effort (mean ± standard deviation = 5.0 ± 1.3 metabolic equivalents, 123 ± 36 kcal/30 min). PAEE was higher for boys than for girls (0.12 ± 0.04 versus 0.11 ± 0.04 kcal/kg/min) and for healthy weight compared with overweight children (0.13 ± 0.04 versus 0.11 ± 0.03 kcal/kg/min). Twenty-two of the 30 games elicited a sufficiently high PAEE (≥ 100 kcal/30 min) and enjoyment (≥ neutral expression) for inclusion in future school-based interventions. Not all children's games are perceived as enjoyable or resulted in an energy expenditure that was sufficiently high for inclusion in future physical activity interventions to prevent the excess weight gain associated with childhood obesity. Copyright © 2010 Mosby, Inc. All rights reserved.

Current Perspectives on Therapy Dog Welfare in Animal-Assisted Interventions

PubMed Central

Glenk, Lisa Maria

2017-01-01

Simple Summary In animal-assisted interventions (AAIs) animals are used as adjuncts to therapy to positively affect human health. The practice of implementing dogs into therapeutic environments is emerging and as a result, there has been a growing scientific interest on human health outcomes over the past decades. Research efforts into the canine perspective of AAIs have been scarce. Accordingly, there is little consensus on the impact of such interventions on the animals involved. This paper aimed to contribute to the limited body of knowledge by reviewing available studies on therapy dogs’ welfare during AAIs. Moreover, discussion of theoretical and methodological issues, implications for practice and suggestions for future research are provided. Abstract Research into the effects of animal-assisted interventions (AAIs) has primarily addressed human health outcomes. In contrast, only few publications deal with the therapy dog experience of AAIs. This paper provides an overview on potential welfare threats that therapy dogs may encounter and presents the results of a review of available studies on welfare indicators for therapy dogs during AAIs. Previous investigations used physiological and behavioral welfare indicators and dog handler surveys to identify work-related stress. Research outcomes are discussed in the light of strengths and weaknesses of the methods used. Study results suggest that frequency and duration of AAI sessions, novelty of the environment, controllability, age and familiarity of recipients modulate animal welfare indicators. However, this review reveals that currently, clear conclusions on how the well-being of dogs is influenced by the performance in AAIs are lacking due to the heterogeneity of programs, recipient and session characteristics, small dog sample sizes and methodological limitations. This paper further aimed to identify unresolved difficulties in previous research to pave the way for future investigations supporting the applicability of scientific findings in practice. PMID:28157145

Pain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts.

PubMed

Schumacher, Karen L; Plano Clark, Vicki L; West, Claudia M; Dodd, Marylin J; Rabow, Michael W; Miaskowski, Christine

2014-11-01

Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. The aim was to describe day-to-day pain medication management from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management by patients and family caregivers in the context of multiple complex health systems. We qualitatively analyzed audio-recorded intervention sessions that included extensive dialogue between patients, family caregivers, and nurses about pain medication management during the 10-week intervention. The health systems context for pain medication management included multiple complex systems for clinical care, reimbursement, and regulation of analgesic prescriptions. Pain medication management processes particularly relevant to this context were getting prescriptions and obtaining medications. Responsibilities that fell primarily to patients and family caregivers included facilitating communication and coordination among multiple clinicians, overcoming barriers to access, and serving as a final safety checkpoint. Significant effort was required of patients and family caregivers to insure safe and effective pain medication management. Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Qualitative Assessment of a Novel Efficacy-Focused Training Intervention for Public Health Workers in Disaster Recovery.

PubMed

Tower, Craig; Altman, Brian A; Strauss-Riggs, Kandra; Iversen, Annelise; Garrity, Stephanie; Thompson, Carol B; Walsh, Lauren; Rutkow, Lainie; Schor, Kenneth; Barnett, Daniel J

2016-08-01

We trained local public health workers on disaster recovery roles and responsibilities by using a novel curriculum based on a threat and efficacy framework and a training-of-trainers approach. This study used qualitative data to assess changes in perceptions of efficacy toward Hurricane Sandy recovery and willingness to participate in future disaster recoveries. Purposive and snowball sampling were used to select trainers and trainees from participating local public health departments in jurisdictions impacted by Hurricane Sandy in October 2012. Two focus groups totaling 29 local public health workers were held in April and May of 2015. Focus group participants discussed the content and quality of the curriculum, training logistics, and their willingness to engage in future disaster recovery efforts. The training curriculum improved participants' understanding of and confidence in their disaster recovery work and related roles within their agencies (self-efficacy); increased their individual- and agency-level sense of role-importance in disaster recovery (response-efficacy); and enhanced their sense of their agencies' effective functioning in disaster recovery. Participants suggested further training customization and inclusion of other recovery agencies. Threat- and efficacy-based disaster recovery trainings show potential to increase public health workers' sense of efficacy and willingness to participate in recovery efforts. (Disaster Med Public Health Preparedness. 2016;10:615-622).

Improved wound management at lower cost: a sensible goal for Australia.

PubMed

Norman, Rosana E; Gibb, Michelle; Dyer, Anthony; Prentice, Jennifer; Yelland, Stephen; Cheng, Qinglu; Lazzarini, Peter A; Carville, Keryln; Innes-Walker, Karen; Finlayson, Kathleen; Edwards, Helen; Burn, Edward; Graves, Nicholas

2016-06-01

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Lessons learnt from a feasibility study on price incentivised healthy eating promotions in workplace catering establishments.

PubMed

Mackison, D; Mooney, J; Macleod, M; Anderson, A S

2016-02-01

It is recognised that the worksite catering sector is likely to play a pivotal role in influencing dietary intake in adults of working age. The present study aimed to assess the feasibility of engaging worksites in a healthy eating intervention, implementing a price incentivised main meal intervention and measuring indicative intervention responses to inform the design of a future trial. Workplaces registered with the Scottish Healthy Living Award were invited to participate. The EatSMART intervention (a reduced price, healthy meal combination plus promotions) was implemented over 10 weeks in two worksites. Implementation was assessed by observational and sales data. Indicative effects on food habits were measured using online pre- and post-intervention questionnaires. Focus group discussions and interviews were used to determine catering staff and consumer acceptability. Thirty-seven worksites were invited to participate and four worksites responded positively. Two sites (with 1600 and 500 employees, respectively) participated. Both required significant implementation support. Estimated sales data indicated that the uptake of promoted items varied by week (range 60-187 items) and by site. A poor response rate from questionnaires limited the evaluation of intervention impact. Consumers reported improved value for money and quality. Both sites reported an intention to continue the intervention delivery. Significant efforts are required to engage worksite catering teams and implement healthy eating interventions. Evaluation methods require further development to improve data collection. Responses from consumers and catering staff suggest that further work in this area would be welcomed. © 2014 The British Dietetic Association Ltd.

Positive future orientation as a mediator between traumatic events and mental health among children affected by HIV/AIDS in rural China.

PubMed

Zhang, Jintao; Zhao, Guoxiang; Li, Xiaoming; Hong, Yan; Fang, Xiaoyi; Barnett, Douglas; Lin, Xiuyun; Zhao, Junfeng; Zhang, Liying

2009-12-01

The current study was designed to explore the effect of future orientation in mediating the relationship between traumatic events and mental health in children affected by HIV/AIDS in rural China. Cross-sectional data were collected from 1221 children affected by HIV/AIDS (755 AIDS orphans and 466 vulnerable children). Future orientation among children was measured using three indicators (future expectation, hopefulness toward the future, and perceived control over the future). Measures of mental health consisted of depression, loneliness, and self-esteem. Children's experience of any traumatic events was measured using a modified version of the Life Incidence of Traumatic Events-Student Form. Mediation analysis was conducted using structural equation modeling (SEM) methods. Among the children surveyed, most of the traumatic indicators were negatively associated with future expectation, hopefulness, perceived control, and self-esteem, and positively associated with depression and loneliness. The SEM of mediation analysis demonstrated an adequate fit. Future orientation fully mediated the relationship between traumatic events and mental health and accounted for 67.9% of the total effect of traumatic events on mental health. Results of this study support the positive effect of future expectation in mediating the relationship between traumatic events and mental health among children affected by HIV/AIDS in China. Future mental health promotion and intervention efforts targeting children affected by HIV/AIDS should include components that can mitigate the negative impact of traumatic events on their lives. These components may aim to develop children's positive future expectations, increase their hopefulness toward the future, and improve their perceived control over the future.

Realizing universal health coverage for maternal health services in the Republic of Guinea: the use of workforce projections to design health labor market interventions.

PubMed

Jansen, Christel; Codjia, Laurence; Cometto, Giorgio; Yansané, Mohamed Lamine; Dieleman, Marjolein

2014-01-01

Universal health coverage requires a health workforce that is available, accessible, and well-performing. This article presents a critical analysis of the health workforce needs for the delivery of maternal and neonatal health services in Guinea, and of feasible and relevant interventions to improve the availability, accessibility, and performance of the health workforce in the country. A needs-based approach was used to project human resources for health (HRH) requirements. This was combined with modeling of future health sector demand and supply. A baseline scenario with disaggregated need and supply data for the targeted health professionals per region and setting (urban or rural) informed the identification of challenges related to the availability and distribution of the workforce between 2014 and 2024. Subsequently, the health labor market framework was used to identify interventions to improve the availability and distribution of the health workforce. These interventions were included in the supply side modeling, in order to create a "policy rich" scenario B which allowed for analysis of their potential impact. In the Republic of Guinea, only 44% of the nurses and 18% of the midwives required for maternal and neonatal health services are currently available. If Guinea continues on its current path without scaling up recruitment efforts, the total stock of HRH employed by the public sector will decline by 15% between 2014 and 2024, while HRH needs will grow by 22% due to demographic trends. The high density of HRH in urban areas and the high number of auxiliary nurses who are currently employed pose an opportunity for improving the availability, accessibility, and performance of the health workforce for maternal and neonatal health in Guinea, especially in rural areas. Guinea will need to scale up its recruitment efforts in order to improve health workforce availability. Targeted labor market interventions need to be planned and executed over several decades to correct entrenched distortions and mismatches between workforce need, supply, and demand. The case of Guinea illustrates how to design and operationalize HRH interventions based on workforce projections to accompany and facilitate universal health coverage reforms.

Realizing universal health coverage for maternal health services in the Republic of Guinea: the use of workforce projections to design health labor market interventions

PubMed Central

Jansen, Christel; Codjia, Laurence; Cometto, Giorgio; Yansané, Mohamed Lamine; Dieleman, Marjolein

2014-01-01

Background Universal health coverage requires a health workforce that is available, accessible, and well-performing. This article presents a critical analysis of the health workforce needs for the delivery of maternal and neonatal health services in Guinea, and of feasible and relevant interventions to improve the availability, accessibility, and performance of the health workforce in the country. Methods A needs-based approach was used to project human resources for health (HRH) requirements. This was combined with modeling of future health sector demand and supply. A baseline scenario with disaggregated need and supply data for the targeted health professionals per region and setting (urban or rural) informed the identification of challenges related to the availability and distribution of the workforce between 2014 and 2024. Subsequently, the health labor market framework was used to identify interventions to improve the availability and distribution of the health workforce. These interventions were included in the supply side modeling, in order to create a “policy rich” scenario B which allowed for analysis of their potential impact. Results In the Republic of Guinea, only 44% of the nurses and 18% of the midwives required for maternal and neonatal health services are currently available. If Guinea continues on its current path without scaling up recruitment efforts, the total stock of HRH employed by the public sector will decline by 15% between 2014 and 2024, while HRH needs will grow by 22% due to demographic trends. The high density of HRH in urban areas and the high number of auxiliary nurses who are currently employed pose an opportunity for improving the availability, accessibility, and performance of the health workforce for maternal and neonatal health in Guinea, especially in rural areas. Conclusion Guinea will need to scale up its recruitment efforts in order to improve health workforce availability. Targeted labor market interventions need to be planned and executed over several decades to correct entrenched distortions and mismatches between workforce need, supply, and demand. The case of Guinea illustrates how to design and operationalize HRH interventions based on workforce projections to accompany and facilitate universal health coverage reforms. PMID:25429245

What is the role played by physical activity and exercise in the frailty syndrome? Perspectives for future research.

PubMed

de Souto Barreto, Philipe

2010-01-01

Exercise and physical activity play an important role in physical frailty, but we do not know if they are markers, components and/or correlates of this syndrome. The purpose of this paper is briefly to discuss the potential roles played by physical activity and exercise on the development and progression of frailty, and to propose directions for future research in this field. Exercise practice lowers the levels of some frailty markers, such as tumor necrosis factor-alpha, interleukin-6, C-reactive protein, and uric acid, and also resistance to insulin. The influence of exercise on the main frailty domains is also well established in the literature. Exercise improves muscle strength, gait speed, cognition (particularly executive control related-tasks), weight maintenance, mood and, to a lesser extent, feelings of energy. Although exercise and physical activity positively influence the main frailty markers and domains, most findings were obtained for other elderly populations (e.g., healthy elderly, clinical populations). For future research, efforts must be made to define some key concepts (exercise or physical activity) in selecting study samples and in establishing intervention length. Attention must also be paid to identifying the most efficacious exercise interventions regarding type, frequency, intensity and session duration, and approaching a dose-response relationship between a physically active life-style and frailty. Thus, further research, especially longitudinal randomized controlled trials, is needed to understand the role of physical activity and exercise in the frailty syndrome.

The behavioral economics of young adult substance abuse.

PubMed

Murphy, James G; Dennhardt, Ashley A

2016-11-01

Alcohol and drug use peaks during young adulthood and can interfere with critical developmental tasks and set the stage for chronic substance misuse and associated social, educational, and health-related outcomes. There is a need for novel, theory-based approaches to guide substance abuse prevention efforts during this critical developmental period. This paper discusses the particular relevance of behavioral economic theory to young adult alcohol and drug misuse, and reviews of available literature on prevention and intervention strategies that are consistent with behavioral economic theory. Behavioral economic theory predicts that decisions to use drugs and alcohol are related to the relative availability and price of both alcohol and substance-free alternative activities, and the extent to which reinforcement from delayed substance-free outcomes is devalued relative to the immediate reinforcement associated with drugs. Behavioral economic measures of motivation for substance use are based on relative levels of behavioral and economic resource allocation towards drug versus alternatives, and have been shown to predict change in substance use over time. Policy and individual level prevention approaches that are consistent with behavioral economic theory are discussed, including brief interventions that increase future orientation and engagement in rewarding alternatives to substance use. Prevention approaches that increase engagement in constructive future-oriented activities among young adults (e.g., educational/vocational success) have the potential to reduce future health disparities associated with both substance abuse and poor educational/vocational outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

A Framework for Public Health Action: The Health Impact Pyramid

PubMed Central

2010-01-01

A 5-tier pyramid best describes the impact of different types of public health interventions and provides a framework to improve health. At the base of this pyramid, indicating interventions with the greatest potential impact, are efforts to address socioeconomic determinants of health. In ascending order are interventions that change the context to make individuals' default decisions healthy, clinical interventions that require limited contact but confer long-term protection, ongoing direct clinical care, and health education and counseling. Interventions focusing on lower levels of the pyramid tend to be more effective because they reach broader segments of society and require less individual effort. Implementing interventions at each of the levels can achieve the maximum possible sustained public health benefit. PMID:20167880

From Efficacy to Effectiveness and Beyond: What Next for Brief Interventions in Primary Care?

PubMed Central

O’Donnell, Amy; Wallace, Paul; Kaner, Eileen

2014-01-01

Background: Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However, lack of understanding about their “active ingredients” and concerns over the extent to which current approaches remain faithful to their original theoretical roots has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base to assess the extent to which it has achieved the four key levels of intervention research: efficacy, effectiveness, implementation, and demonstration. Methods: Narrative overview based on (1) the results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare and (2) synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare. Results: The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation, and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption. Conclusion: Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across different study contexts. Thus, while unanswered questions remain, given the positive evidence amassed to date, research efforts should maintain a continued focus on promoting sustained implementation of screening and brief alcohol intervention approaches in primary care to ensure that those who might benefit from screening and brief alcohol interventions actually receive such support. PMID:25221524

Performance Modeling of a Pilot in a Free Flight Mode. 1; A Free Flight Self-Separation Cancellations Due to the Requirement for Procedural Intervention

NASA Technical Reports Server (NTRS)

Ntuen, Celestine A.

1999-01-01

Developments are being made that allow pilots to have more flexibility over the control of their aircraft. This new concept is called Free Flight. Free Flight strives to move the current air traffic system into an age where space technology is used to its fullest potential. Self-separation is one part of the Free Flight system. Self-separation provides pilots the opportunity to choose their own route to reach a specified destination provided that they maintain the 'minimum required separation distance between airplanes. In the event that pilots are unable to maintain separation, controllers will need to have the aircraft separation authority passed back to them. This situation is known as a procedural intervention point. This project attempted to examine and diagnose those particular situations in an effort to avoid reaching a procedural intervention point in the near future. Crews that reached procedural intervention points were compared with crews that made similar maneuver types in the same scenario, but did not reach procedural intervention points. Results showed that there were no significant differences between crews in a high-density acute angle flight conditions. However, significant differences in maneuver times, following the detection of an intruder aircraft and following the time the intruder aircraft came into view, were found in a low-density, acute angle scenario.

Do Children’s Learning-Related Behaviors Moderate the Impacts of an Empirically-Validated Early Literacy Intervention?

PubMed Central

Hart, Sara A.; Piasta, Shayne B.; Justice, Laura M.

2016-01-01

The present study included 314 children who had been involved in Project STAR, and explored how two learning-related behaviors, interest in literacy and effortful control, moderated the impact of the literacy intervention on reading outcomes. Results indicated significant associations of both learning-related behaviors with reading, with the children with the highest literacy interest and effortful control in the intervention group showing the highest reading outcomes. These results indicate that accounting for a greater breadth of possible moderators of intervention impacts is an important area to explore. PMID:28216991

The Role of Mentoring in Fostering Executive Function, Effort, and Academic Self-Concept

ERIC Educational Resources Information Center

Meltzer, Lynn; Basho, Surina; Reddy, Ranjini; Kurkul, Katelyn

2015-01-01

This exploratory study examined the impact of an in-school intervention program that blends peer mentoring with executive function strategy instruction for at-risk learners. More specifically, the study focused on evaluating the effects of the SMARTS Executive Function and Mentoring intervention on students' strategy use, effort, academic…

Current knowledge and future research on infant feeding in the context of HIV: basic, clinical, behavioral, and programmatic perspectives.

PubMed

Young, Sera L; Mbuya, Mduduzi N N; Chantry, Caroline J; Geubbels, Eveline P; Israel-Ballard, Kiersten; Cohan, Deborah; Vosti, Stephen A; Latham, Michael C

2011-05-01

In 2008, between 129,000 and 194,000 of the 430,000 pediatric HIV infections worldwide were attributable to breastfeeding. Yet in many settings, the health, economic, and social consequences of not breastfeeding would have dire consequences for many more children. In the first part of this review we provide an overview of current knowledge about infant feeding in the context of HIV. Namely, we describe the benefits and risks of breastmilk, the evolution of recommended infant feeding modalities in high-income and low-income countries in the last two decades, and contextualize the recently revised guidelines for infant feeding in the context of HIV current knowledge. In the second section, we suggest areas for future research on the postnatal prevention of mother-to-child transmission of HIV (PMTCT) in developing and industrialized countries. We suggest two shifts in perspective. The first is to evaluate PMTCT interventions more holistically, to include the psychosocial and economic consequences as well as the biomedical ones. The second shift in perspective should be one that contextualizes postnatal PMTCT efforts in the cascade of maternal health services. We conclude by discussing basic, clinical, behavioral, and programmatic research questions pertaining to a number of PMTCT efforts, including extended postnatal ARV prophylaxis, exclusive breastfeeding promotion, counseling, breast milk pasteurization, breast milk banking, novel techniques for making breast milk safer, and optimal breastfeeding practices. We believe the research efforts outlined here will maximize the number of healthy, thriving, HIV-free children around the world.

Where are the young men in HIV prevention efforts? Comments on HIV prevention programs and research from young men who sex with men in Los Angeles county.

PubMed

Holloway, Ian W; Cederbaum, Julie A; Ajayi, Antonette; Shoptaw, Steven

2012-12-01

Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted with a diverse sample of YMSM (N = 100, M(age) = 25.0 years) in Los Angeles, California, to identify facilitators and barriers to participation in HIV prevention programs. Summative content analyses were used to evaluate transcribed field notes from these interviews. Results showed that 28.0 % of all participants had previously attended an HIV prevention program, and that 21.3 % of those who were also asked if they had ever participated in any research pertaining to HIV prevention had done so. A significantly higher percentage of those who had participated in HIV prevention programs had been tested for HIV in the past 6 months compared to those who had not (p < .05). The most frequently mentioned barriers to participation in such a program were being too busy to attend (12.0 %), not perceiving themselves to be at risk for HIV infection (14.0 %), and believing that they already knew everything they needed to know about HIV transmission (23.0 %). YMSM suggested that future interventions should use technology (e.g., the Internet, mobile devices), engage their social networks, and highlight HIV prevention as a means for community connection. Collectively, these results provide some explanations for why YMSM account for a minority of HIV prevention program participants and offer possible directions for future HIV prevention efforts that target YMSM.

Has the DOTS Strategy Improved Case Finding or Treatment Success? An Empirical Assessment

PubMed Central

Obermeyer, Ziad; Abbott-Klafter, Jesse; Murray, Christopher J. L.

2008-01-01

Background Nearly fifteen years after the start of WHO's DOTS strategy, tuberculosis remains a major global health problem. Given the lack of empirical evidence that DOTS reduces tuberculosis burden, considerable debate has arisen about its place in the future of global tuberculosis control efforts. An independent evaluation of DOTS, one of the most widely-implemented and longest-running interventions in global health, is a prerequisite for meaningful improvements to tuberculosis control efforts, including WHO's new Stop TB Strategy. We investigate the impact of the expansion of the DOTS strategy on tuberculosis case finding and treatment success, using only empirical data. Methods and Findings We study the effect of DOTS using time-series cross-sectional methods. We first estimate the impact of DOTS expansion on case detection, using reported case notification data and controlling for other determinants of change in notifications, including HIV prevalence, GDP, and country-specific effects. We then estimate the effect of DOTS expansion on treatment success. DOTS programme variables had no statistically significant impact on case detection in a wide range of models and specifications. DOTS population coverage had a significant effect on overall treatment success rates, such that countries with full DOTS coverage benefit from at least an 18% increase in treatment success (95% CI: 5–31%). Conclusions The DOTS technical package improved overall treatment success. By contrast, DOTS expansion had no effect on case detection. This finding is less optimistic than previous analyses. Better epidemiological and programme data would facilitate future monitoring and evaluation efforts. PMID:18320042

Current Knowledge and Future Research on Infant Feeding in the Context of HIV: Basic, Clinical, Behavioral, and Programmatic Perspectives12

PubMed Central

Young, Sera L.; Mbuya, Mduduzi N. N.; Chantry, Caroline J.; Geubbels, Eveline P.; Israel-Ballard, Kiersten; Cohan, Deborah; Vosti, Stephen A.; Latham, Michael C.

2011-01-01

In 2008, between 129,000 and 194,000 of the 430,000 pediatric HIV infections worldwide were attributable to breastfeeding. Yet in many settings, the health, economic, and social consequences of not breastfeeding would have dire consequences for many more children. In the first part of this review we provide an overview of current knowledge about infant feeding in the context of HIV. Namely, we describe the benefits and risks of breastmilk, the evolution of recommended infant feeding modalities in high-income and low-income countries in the last two decades, and contextualize the recently revised guidelines for infant feeding in the context of HIV current knowledge. In the second section, we suggest areas for future research on the postnatal prevention of mother-to-child transmission of HIV (PMTCT) in developing and industrialized countries. We suggest two shifts in perspective. The first is to evaluate PMTCT interventions more holistically, to include the psychosocial and economic consequences as well as the biomedical ones. The second shift in perspective should be one that contextualizes postnatal PMTCT efforts in the cascade of maternal health services. We conclude by discussing basic, clinical, behavioral, and programmatic research questions pertaining to a number of PMTCT efforts, including extended postnatal ARV prophylaxis, exclusive breastfeeding promotion, counseling, breast milk pasteurization, breast milk banking, novel techniques for making breast milk safer, and optimal breastfeeding practices. We believe the research efforts outlined here will maximize the number of healthy, thriving, HIV-free children around the world. PMID:22332055

Biomedical HIV prevention including pre-exposure prophylaxis and opiate agonist therapy for women who inject drugs: State of research and future directions

PubMed Central

Page, Kimberly; Tsui, Judith; Maher, Lisa; Choopanya, Kachit; Vanichseni, Suphak; Mock, Philip A.; Celum, Connie; Martin, Michael

2015-01-01

Women who inject drugs are at higher risk of HIV compared to their male counterparts as a result of multiple factors including biological, behavioral and socio-structural, yet comparatively little effort has been invested in testing and delivering prevention methods that directly target this group. In this paper, we discuss the need for expanded prevention interventions for women who inject drugs, focusing on two safe, effective, and approved, yet underutilized biomedical prevention methods: opiate agonist therapy (OAT) and oral pre-exposure prophylaxis (PrEP). While both interventions are well researched they have not been well examined in the context of gender. We discuss the drivers of women injectors’ higher HIV risk, review the effectiveness of OAT and PrEP interventions among women, and explain why these new HIV prevention tools should be prioritized for women who inject drugs. There is substantial potential for impact of OAT and PrEP programs for women who inject drugs in the context of broader gender-responsive HIV prevention initiatives. While awaiting efficacy data on other biomedical approaches in the HIV prevention research ‘pipeline’, we propose that the scale up and implementation of these proven, safe, and effective interventions are needed now. PMID:25978484

Behavior change interventions: the potential of ontologies for advancing science and practice.

PubMed

Larsen, Kai R; Michie, Susan; Hekler, Eric B; Gibson, Bryan; Spruijt-Metz, Donna; Ahern, David; Cole-Lewis, Heather; Ellis, Rebecca J Bartlett; Hesse, Bradford; Moser, Richard P; Yi, Jean

2017-02-01

A central goal of behavioral medicine is the creation of evidence-based interventions for promoting behavior change. Scientific knowledge about behavior change could be more effectively accumulated using "ontologies." In information science, an ontology is a systematic method for articulating a "controlled vocabulary" of agreed-upon terms and their inter-relationships. It involves three core elements: (1) a controlled vocabulary specifying and defining existing classes; (2) specification of the inter-relationships between classes; and (3) codification in a computer-readable format to enable knowledge generation, organization, reuse, integration, and analysis. This paper introduces ontologies, provides a review of current efforts to create ontologies related to behavior change interventions and suggests future work. This paper was written by behavioral medicine and information science experts and was developed in partnership between the Society of Behavioral Medicine's Technology Special Interest Group (SIG) and the Theories and Techniques of Behavior Change Interventions SIG. In recent years significant progress has been made in the foundational work needed to develop ontologies of behavior change. Ontologies of behavior change could facilitate a transformation of behavioral science from a field in which data from different experiments are siloed into one in which data across experiments could be compared and/or integrated. This could facilitate new approaches to hypothesis generation and knowledge discovery in behavioral science.

Behavioral and Psychological Phenotyping of Physical Activity and Sedentary Behavior: Implications for Weight Management.

PubMed

Bryan, Angela D; Jakicic, John M; Hunter, Christine M; Evans, Mary E; Yanovski, Susan Z; Epstein, Leonard H

2017-10-01

Risk for obesity is determined by a complex mix of genetics and lifetime exposures at multiple levels, from the metabolic milieu to psychosocial and environmental influences. These phenotypic differences underlie the variability in risk for obesity and response to weight management interventions, including differences in physical activity and sedentary behavior. As part of a broader effort focused on behavioral and psychological phenotyping in obesity research, the National Institutes of Health convened a multidisciplinary workshop to explore the state of the science in behavioral and psychological phenotyping in humans to explain individual differences in physical activity, both as a risk factor for obesity development and in response to activity-enhancing interventions. Understanding the behavioral and psychological phenotypes that contribute to differences in physical activity and sedentary behavior could allow for improved treatment matching and inform new targets for tailored, innovative, and effective weight management interventions. This summary provides the rationale for identifying psychological and behavioral phenotypes relevant to physical activity and identifies opportunities for future research to better understand, define, measure, and validate putative phenotypic factors and characterize emerging phenotypes that are empirically associated with initiation of physical activity, response to intervention, and sustained changes in physical activity. © 2017 The Obesity Society.

Effects on work ability, job strain and quality of life of monitoring depression using a self-assessment instrument in recurrent general practitioner consultations: A randomized controlled study.

PubMed

Petersson, E-L; Wikberg, C; Westman, J; Ariai, N; Nejati, S; Björkelund, C

2018-05-01

Depression reduces individuals' function and work ability and is associated with both frequent and long-term sickness absence. Investigate if monitoring of depression course using a self-assessment instrument in recurrent general practitioner (GP) consultations leads to improved work ability, decreased job strain, and quality of life among primary care patients. Primary care patients n = 183, who worked. In addition to regular treatment (control group), intervention patients received evaluation and monitoring and used the MADRS-S depression scale during GP visit at baseline and at visits 4, 8, and 12 weeks. Work ability, quality of life and job strain were outcome measures. Depression symptoms decreased in all patients. Significantly steeper increase of WAI at 3 months in the intervention group. Social support was perceived high in a significantly higher frequency in intervention group compared to control group. Monitoring of depression course using a self-assessment instrument in recurrent GP consultations seems to lead to improved self-assessed work ability and increased high social support, but not to reduced job strain or increased quality of life compared to TAU. Future studies concerning rehabilitative efforts that seek to influence work ability probably also should include more active interventions at the workplace.

Towards interruption of schistosomiasis transmission in sub-Saharan Africa: developing an appropriate environmental surveillance framework to guide and to support 'end game' interventions.

PubMed

Stothard, J Russell; Campbell, Suzy J; Osei-Atweneboana, Mike Y; Durant, Timothy; Stanton, Michelle C; Biritwum, Nana-Kwadwo; Rollinson, David; Ombede, Dieudonné R Eloundou; Tchuem-Tchuenté, Louis-Albert

2017-01-14

Schistosomiasis is a waterborne parasitic disease in sub-Saharan Africa, particularly common in rural populations living in impoverished conditions. With the scale-up of preventive chemotherapy, national campaigns will transition from morbidity- to transmission-focused interventions thus formal investigation of actual or expected declines in environmental transmission is needed as 'end game' scenarios arise. Surprisingly, there are no international or national guidelines to do so in sub-Saharan Africa. Our article therefore provides an introduction to key practicalities and pitfalls in the development of an appropriate environmental surveillance framework. In this context, we discuss how strategies need to be adapted and tailored to the local level to better guide and support future interventions through this transition. As detection of egg-patent infection in people becomes rare, careful sampling of schistosome larvae in freshwater and in aquatic snails with robust species-specific DNA assays will be required. Appropriate metrics, derived from observed prevalence(s) as compared with predetermined thresholds, could each provide a clearer insight into contamination- and exposure-related dynamics. Application could be twofold, first to certify areas currently free from schistosomiasis transmission or second to red-flag recalcitrant locations where extra effort or alternative interventions are needed.

A Pilot Study of Expressive Writing Intervention among Chinese Speaking Breast Cancer Survivors

PubMed Central

Lu, Qian; Zheng, Dianhan; Young, Lucy; Kagawa-Singer, Marjorie; Loh, Alice

2013-01-01

Objective Little attention has been focused on Asian American breast cancer survivor's psychological needs. No outcome based psychosocial interventions have been reported to target at this population. Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic white breast cancer populations. This pilot study aimed to test the cultural sensitivity, feasibility, and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors. Methods Participants (N=19) were asked to write about their deepest thoughts and feelings, their coping efforts, and positive thoughts and feelings regarding their experience with breast cancer each week for three weeks. Health outcomes were assessed at baseline, three, and six months after the intervention. A Community-Based Participatory Research Approach (CBPR) is used. Results Expressive writing was associated with medium and large effect sizes (ηp2= 0.066~0.208) in improving multiple health outcomes (quality of life, fatigue, posttraumatic stress, intrusive thoughts, and positive affect) at follow-ups. Participants perceived the study to be valuable. The study yielded high compliance and completion rates. Conclusion Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors. In addition, CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied populations. Future studies employing randomized controlled trial designs are warranted. PMID:22229930

Interventions to prevent softball related injuries: a review of the literature

PubMed Central

Pollack, K; Canham-Chervak, M; Gazal-Carvalho, C; Jones, B; Baker, S

2005-01-01

Objectives: To examine the published evidence on interventions to prevent softball related injuries among adults, and to encourage more epidemiologic research as a foundation for future softball injury prevention efforts. Methods: The authors reviewed literature identified from six electronic databases for studies on softball related injuries. The search was limited to studies written in the English language, published between 1970 and 2002, and involving adult populations. Research was excluded that evaluated baseball ("hard ball") related injuries or was aimed at injury treatment. Identified studies were categorized by study design. Intervention/prevention papers were evaluated further and described in detail. Results: The search strategy identified 39 studies specifically related to softball. Most studies were case reports/case series (n = 13) or descriptive studies (n = 11); only four were analytic or intervention/prevention studies. Studies collected data in a variety of ways, often without denominator data to permit calculation of injury rates. Studies also did not differentiate between slow or fast pitch softball activities and most did not mention the type of softball that was used. Conclusions: Surprisingly few studies exist on interventions to reduce injuries during softball, one of the most popular recreational sports in the US. Of the existing literature, much attention has been on sliding related injuries, which comprise only a segment of softball injuries. Basic epidemiologic studies describing the nature, severity, and risk factors for softball injuries in a variety of populations are needed, followed by additional intervention evaluation studies aimed at modifiable risk factors. PMID:16203835

A Systematic Review of Interventions to Reduce Problematic Substance Use Among Transgender Individuals: A Call to Action

PubMed Central

Glynn, Tiffany R.; van den Berg, Jacob J.

2017-01-01

Abstract Persons who are transgender (i.e., individuals who are assigned one sex at birth, but who do not identify with that sex) are at elevated risk for developing problematic substance use. Recent studies indicate that transgender persons have high rates of alcohol use, illicit drug use, and nonmedical use of prescription drugs and evince more severe misuse of these substances compared with nontransgender individuals. Despite the high rates of substance use among transgender persons and the multiple conceptual and narrative recommendations for substance use treatments, there is a lack of consensus or awareness of empirically tested interventions and programs effective for this population. Thus, it is critical to examine current substance use interventions for transgender individuals to identify gaps in the field and to immediately put forth efforts to reduce problematic substance use. This systematic review is the first to attempt a comprehensive identification and synthesis of the available evidence on interventions for reducing problematic substance use among transgender persons. Reflective of the state of the field regarding transgender care for substance use, we found a deficiency of studies to include in this systematic review (n=2). Perhaps the most important conclusion of this review is that well-designed, theoretically informed culturally sensitive research focused on developing and rigorously testing interventions for substance use among transgender individuals is alarmingly scarce. This review discusses barriers to intervention design and synthesizes treatment recommendations for future work. PMID:28861547

Sedentary time in older adults: a critical review of measurement, associations with health, and interventions.

PubMed

Copeland, Jennifer L; Ashe, Maureen C; Biddle, Stuart Jh; Brown, Wendy J; Buman, Matthew P; Chastin, Sebastien; Gardiner, Paul A; Inoue, Shigeru; Jefferis, Barbara J; Oka, Koichiro; Owen, Neville; Sardinha, Luís B; Skelton, Dawn A; Sugiyama, Takemi; Dogra, Shilpa

2017-11-01

Sedentary time (ST) is an important risk factor for a variety of health outcomes in older adults. Consensus is needed on future research directions so that collaborative and timely efforts can be made globally to address this modifiable risk factor. In this review, we examined current literature to identify gaps and inform future research priorities on ST and healthy ageing. We reviewed three primary topics:(1) the validity/reliability of self-report measurement tools, (2) the consequences of prolonged ST on geriatric-relevant health outcomes (physical function, cognitive function, mental health, incontinence and quality of life) and(3) the effectiveness of interventions to reduce ST in older adults. A trained librarian created a search strategy that was peer reviewed for completeness. Self-report assessment of the context and type of ST is important but the tools tend to underestimate total ST. There appears to be an association between ST and geriatric-relevant health outcomes, although there is insufficient longitudinal evidence to determine a dose-response relationship or a threshold for clinically relevant risk. The type of ST may also affect health; some cognitively engaging sedentary behaviours appear to benefit health, while time spent in more passive activities may be detrimental. Short-term feasibility studies of individual-level ST interventions have been conducted; however, few studies have appropriately assessed the impact of these interventions on geriatric-relevant health outcomes, nor have they addressed organisation or environment level changes. Research is specifically needed to inform evidence-based interventions that help maintain functional autonomy among older adults.This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Community-based efforts to prevent obesity: Australia-wide survey of projects.

PubMed

Nichols, Melanie S; Reynolds, Rebecca C; Waters, Elizabeth; Gill, Timothy; King, Lesley; Swinburn, Boyd A; Allender, Steven

2013-08-01

Community-based programs that affect healthy environments and policies have emerged as an effective response to high obesity levels in populations. Apart from limited individual reports, little is currently known about these programs, limiting the potential to provide effective support, to promote effective practice, prevent adverse outcomes and disseminate intervention results and experience. The aim of the present study was to identify the size and reach of current community-based obesity prevention projects in Australia and to examine their characteristics, program features (e.g. intervention setting), capacity and approach to obesity prevention. Detailed survey completed by representatives from community-based obesity prevention initiatives in Australia. There was wide variation in funding, capacity and approach to obesity prevention among the 78 participating projects. Median annual funding was Au$94900 (range Au$2500-$4.46 million). The most common intervention settings were schools (39%). Forty per cent of programs focused on a population group of ≥50000 people. A large proportion of respondents felt that they did not have sufficient resources or staff training to achieve project objectives. Community-based projects currently represent a very large investment by both government and non-government sectors for the prevention of obesity. Existing projects are diverse in size and scope, and reach large segments of the population. Further work is needed to identify the full extent of existing community actions and to monitor their reach and future 'scale up' to ensure that future activities aim for effective integration into systems, policies and environments. SO WHAT? Community-based programs make a substantial contribution to the prevention of obesity and promotion of healthy lifestyles in Australia. A risk of the current intervention landscape is that effective approaches may go unrecognised due to lack of effective evaluations or limitations in program design, duration or size. Policy makers and researchers must recognise the potential contribution of these initiatives, to both public health and knowledge generation, and provide support for strong evaluation and sustainable intervention designs.

Effects of psycho-behavioral interventions on immune functioning in cancer patients: a systematic review.

PubMed

Tong, Guixian; Geng, Qingqing; Cheng, Jing; Chai, Jing; Xia, Yi; Feng, Rui; Zhang, Lu; Wang, Debin

2014-01-01

This study aimed at summarizing evidence about effects of psycho-behavioral interventions (PBIs) on immune responses among cancer patients and analyzing quality of published studies so as to inform future researches. Literature retrieval utilized both highly inclusive algorithms searching randomized controlled studies published in English and Chinese and manual searching of eligible studies from references of relevant review papers. Two researchers examined the articles selected separately and extracted the information using a pre-designed form for soliciting data about the trials (e.g., sample size, disease status, intervention, immune responses) and quality ratings of the studies. Both narrative descriptions and meta-analysis (via Review manager 5) were used synthesizing the effects of PBIs on immune responses among cancer patients and state of art of the researches in this area. Seventy-six RCTs met inclusion criteria. PBIs implemented were divided into three major categories including psychological state adjustment, physical activity and dietary modification. Immune indicators measured included CD4+ cells, CD8+ cells, CD4/CDC8+ ratio, CD3+ cells, NK cell activity, etc. Effects of PBIs on immune responses documented in individual papers were mixed and pooled analysis of CD4+ cells, CD4+/CD8+ ratio, CD3+ cells, NKCA, IgG, IgM and IL-2 showed modest effects. However, there were huge discrepancies in intervention effects between studies published in English and Chinese and the results should be interpreted with caution. Besides, most studies suffer from some quality flaws concerning blinding, randomization procedures, compliance, attrition and intention-to-treat analyses, etc. Although there are considerable evidences of PBI effects on some immune indicators, the effect sizes are modest and it is still premature to conclude whether PBIs have effects on immune functions among cancer patients. There is a clear need for much more rigorous efforts in this area and future researches should pay particular attention to intervention dose and focus, sample size and comparable immune measures.

Achievements and future path of Tehran municipality in urban health domain: An Iranian experience

PubMed Central

Damari, Behzad; Riazi-Isfahani, Sahand

2016-01-01

Background: According to national laws and world experiences; provision, maintenance, and improving citizens’ health are considered to be the essential functions of municipalities as a "social institute". In order to equitably promote health conditions at urban level, particularly in marginal areas, since 2004 targeted efforts have been implemented in the municipality of Tehran metropolis. This study was intended to identify and analyze these targeted measures and tries to analyze health interventions in a conceptual framework and propose a future path. Methods: This is a qualitative study with content analysis approach. Reviewing documents and structured interviews with national health policy making and planning experts and executive managers of 22-region municipalities of Tehran metropolis were used to collect data. The data were analyzed on the basis of conceptual framework prepared for urban health in 4 domains including municipal interventions, goal achievements, drivers and obstacles of success, and the way forward. Results: From the viewpoint of interviewees, these new health actions of Tehran municipality are more based on public participation and the municipality was able to prioritize health issue in the programs and policies of Tehran city council. Tehran municipality has accomplished three types of interventions to improve health, which in orders of magnitude are: facilitative, promotional, and mandatory interventions. Development and institutionalization of public participation is the greatest achievement in health-oriented actions; and expansion of environmental and physical health-oriented facilities and promoting a healthy lifestyle are next in ranks. Conclusion: Since management alterations seriously challenges institutionalization of actions and innovations especially in the developing countries, it is suggested that mayors of metropolitan cities like Tehran document and review municipal health measures as soon as possible and while eliminating overlapping of interventions with other sectors, design and approve the charter of "health promoting municipality". The most important role of municipalities in this charter would be coordinating health improvement of citizens. This charter, when approved as a national policy could be used for other cities too. PMID:27390693

A Systematic Review of Palliative Care Intervention Outcomes and Outcome Measures in Low-Resource Countries.

PubMed

Potts, Maryellen; Cartmell, Kathleen B; Nemeth, Lynne; Bhattacharjee, Gautam; Qanungo, Suparna

2018-05-01

To meet the growing need for palliative care in low-resource countries, palliative care programs should be evidence based and contextually appropriate. This study was conducted to synthesize the current evidence to guide future programmatic and research efforts. This systematic review evaluated palliative care outcome measures, outcomes, and interventions in low-resource countries. After title searches, abstracts and full-text articles were screened for inclusion. Data were extracted to report on intervention models, outcome measures used, and intervention outcomes. Eighteen papers were reviewed, reporting on interventions conducted across nine low-resource countries. These interventions evaluated home-based palliative care models; a community-managed model; palliative care integrated with hospitals, hospices, or HIV clinics; and models focused on patients' self-management. Three studies were randomized controlled trials. Other studies used nonrandomized trials, cohort studies, mixed methods, pre-post test evaluation, cost-accounting evaluation, and cross-sectional surveys. Thirteen studies measured physical outcomes, 10 using multidimensional instruments. Nine studies measured psychological outcomes, eight using multidimensional instruments. Nine studies measured social outcomes, seven using multidimensional instruments. Nine studies measured outcomes across multiple domains. Across outcomes evaluated, results were reported in the direction of benefit associated with palliative care interventions. Many palliative care intervention models exist to serve patients in low-resource countries. Yet, limited high-quality evidence from low-resource countries is available to document intervention outcomes. Rigorous experimental studies and greater measurement of multidimensional aspects of palliative care are needed to advance the science of palliative care in low-resource settings. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Increasing referral of at-risk travelers to travel health clinics: evaluation of a health promotion intervention targeted to travel agents.

PubMed

MacDougall, L A; Gyorkos, T W; Leffondré, K; Abrahamowicz, M; Tessier, D; Ward, B J; MacLean, J D

2001-01-01

Increases in travel-related illness require new partnerships to ensure travelers are prepared for health risks abroad. The travel agent is one such partner and efforts to encourage travel agents to refer at-risk travelers to travel health clinics may help in reducing travel-attributable morbidity. A health promotion intervention encouraging travel agents to refer at-risk travelers to travel health clinics was evaluated. Information on the knowledge, attitudes, and behaviors of travel agents before and after the intervention was compared using two self-administered questionnaires. The Wilcoxon signed rank test was used to compare the mean difference in overall scores to evaluate the overall impact of the intervention and also subscores for each of the behavioral construct groupings (attitudes, barriers, intent, and subjective norms). Multiple regression techniques were used to evaluate which travel agent characteristics were independently associated with a stronger effect of the intervention. A small improvement in travel agents overall attitudes and beliefs (p =.03) was found, in particular their intention to refer (p =.01). Sixty-five percent of travel agents self-reported an increase in referral behavior; owners or managers of the agency were significantly more likely to do so than other travel agents (OR = 7.25; 95% CI: 1.64 32.06). Older travel agents, those that worked longer hours and those with some past referral experience, had significantly higher post-intervention scores. Travel agents can be willing partners in referral, and agencies should be encouraged to develop specific referral policies. Future research may be directed toward investigating the role of health education in certification curricula, the effectiveness of different types of health promotion interventions, including Internet-facilitated interventions, and the direct impact that such interventions would have on travelers attending travel health clinics.

Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss: a systematic review.

PubMed

Palmer, Keith T; Harris, Elizabeth C; Linaker, Cathy; Barker, Mary; Lawrence, Wendy; Cooper, Cyrus; Coggon, David

2012-02-01

To assess the effectiveness of interventions in community and workplace settings to reduce sickness absence and job loss in workers with musculoskeletal disorders (MSDs). Relevant randomized controlled trials (RCTs) and cohort studies, published since 1990, were identified by screening citations from 35 earlier systematic reviews and by searching MEDLINE and Embase until April 2010. Effects were estimated by intervention category and other features, including study quality. Among 42 studies (including 34 RCTs), 27 assessed return to work (RTW), 21 duration of sickness absence and 5 job loss. Interventions included exercise therapy, behavioural change techniques, workplace adaptations and provision of additional services. Studies were typically small {median sample 107 [inter-quartile range (IQR) 77-148]} and limited in quality. Most interventions appeared beneficial: the median relative risk (RR) for RTW was 1.21 (IQR 1.00-1.60) and that for avoiding MSD-related job loss was 1.25 (IQR 1.06-1.71); the median reduction in sickness absence was 1.11 (IQR 0.32-3.20) days/month. However, effects were smaller in larger and better-quality studies, suggesting publication bias. No intervention was clearly superior, although effort-intensive interventions were less effective than simple ones. No cost-benefit analyses established statistically significant net economic benefits. As benefits are small and of doubtful cost-effectiveness, employers' practice should be guided by their value judgements about the uncertainties. Expensive interventions should be implemented only with rigorous cost-benefit evaluation planned from the outset. Future research should focus on the cost-effectiveness of simple, low-cost interventions, and further explore impacts on job retention.

Vulnerability to heatwaves and implications for public health interventions - A scoping review.

PubMed

Mayrhuber, Elisabeth Anne-Sophie; Dückers, Michel L A; Wallner, Peter; Arnberger, Arne; Allex, Brigitte; Wiesböck, Laura; Wanka, Anna; Kolland, Franz; Eder, Renate; Hutter, Hans-Peter; Kutalek, Ruth

2018-05-31

Heatwaves form a serious public health threat, especially for vulnerable groups. Interventions such as active outreach programs, exposure reduction measures and monitoring and mapping of at-risk groups are increasingly implemented across the world but little is known about their effect. To assess how vulnerable groups are identified and reached in heat health interventions, to understand the effectiveness and efficiency of those interventions, and to identify research gaps in existing literature. We performed a literature search in relevant scientific literature databases and searched with a four element search model for articles published from 1995 onward. We extracted data on intervention measures, target group and evaluation of effectiveness and efficiency. We identified 23 eligible studies. Patterns exist in type of interventions 1) to detect and 2) to influence extrinsic and intrinsic risk and protective factors. Results showed several intervention barriers related to the variety and intersection of these factors, as well as the self-perception of vulnerable groups, and misconceptions and unfavorable attitudes towards intervention benefits. While modest indications for the evidence on the effectiveness of interventions were found, efficiency remains unclear. Interventions entailed logical combinations of measures, subsumed as packages. Evidence for effective and efficient intervention is limited by the difficulty to determine effects and because single measures are mutually dependent. Interventions prioritized promoting behavioral change and were based on behavioral assumptions that remain untested and mechanisms not worked out explicitly. Multifaceted efforts are needed to tailor interventions, compiled in heat health warning systems and action plans for exposure reduction and protection of vulnerable populations, to fit the social, economic and geographical context. Besides adequately addressing relevant risk and protective factors, the challenge is to integrate perspectives of vulnerable groups. Future research should focus on intervention barriers and improving the methods of effectiveness and efficiency evaluation. Copyright © 2018 Elsevier Inc. All rights reserved.

Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis.

PubMed

Ash, Tayla; Agaronov, Alen; Young, Ta'Loria; Aftosmes-Tobio, Alyssa; Davison, Kirsten K

2017-08-24

A wide range of interventions has been implemented and tested to prevent obesity in children. Given parents' influence and control over children's energy-balance behaviors, including diet, physical activity, media use, and sleep, family interventions are a key strategy in this effort. The objective of this study was to profile the field of recent family-based childhood obesity prevention interventions by employing systematic review and quantitative content analysis methods to identify gaps in the knowledge base. Using a comprehensive search strategy, we searched the PubMed, PsycIFO, and CINAHL databases to identify eligible interventions aimed at preventing childhood obesity with an active family component published between 2008 and 2015. Characteristics of study design, behavioral domains targeted, and sample demographics were extracted from eligible articles using a comprehensive codebook. More than 90% of the 119 eligible interventions were based in the United States, Europe, or Australia. Most interventions targeted children 2-5 years of age (43%) or 6-10 years of age (35%), with few studies targeting the prenatal period (8%) or children 14-17 years of age (7%). The home (28%), primary health care (27%), and community (33%) were the most common intervention settings. Diet (90%) and physical activity (82%) were more frequently targeted in interventions than media use (55%) and sleep (20%). Only 16% of interventions targeted all four behavioral domains. In addition to studies in developing countries, racial minorities and non-traditional families were also underrepresented. Hispanic/Latino and families of low socioeconomic status were highly represented. The limited number of interventions targeting diverse populations and obesity risk behaviors beyond diet and physical activity inhibit the development of comprehensive, tailored interventions. To ensure a broad evidence base, more interventions implemented in developing countries and targeting racial minorities, children at both ends of the age spectrum, and media and sleep behaviors would be beneficial. This study can help inform future decision-making around the design and funding of family-based interventions to prevent childhood obesity.

Future so bright? Delay discounting and consideration of future consequences predict academic performance among college drinkers.

PubMed

Acuff, Samuel F; Soltis, Kathryn E; Dennhardt, Ashley A; Borsari, Brian; Martens, Matthew P; Murphy, James G

2017-10-01

College student drinking is a major public health concern and can result in a range of negative consequences, from acute health risks to decreased academic performance and drop out. Harm reduction interventions have been developed to reduce problems associated with drinking but there is a need to identify specific risk/protective factors related to academic performance among college drinkers. Behavioral economics suggests that chronic alcohol misuse reflects a dysregulated behavioral process or reinforcer pathology-alcohol is overvalued and the value of prosocial rewards are sharply discounted due, in part, to their delay. This study examined delay discounting, consideration of future consequences (CFC) and protective behavioral strategies (PBS) as predictors of academic success (grade point average; GPA) and engagement (time devoted to academic activities) among 393 college drinkers (61% female). In multivariate models, PBS were associated with greater academic engagement, but were not with academic success. Lower discounting of delayed rewards and greater CFC were associated with both academic success and engagement among drinkers. Previous research suggests that future time orientation is malleable, and the current results provide support for efforts to enhance future time orientation as part of alcohol harm-reduction approaches. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A National Partnership-Based Summer Learning Initiative to Engage Underrepresented Students with Science, Technology, Engineering and Mathematics

NASA Technical Reports Server (NTRS)

Melvin, Leland

2010-01-01

In response to the White House Educate to Innovate campaign, NASA developed a new science, technology, engineering, and mathematics (STEM) education program for non-traditional audiences that also focused on public-private partnerships and nationwide participation. NASA recognized that summer break is an often overlooked but opportune time to engage youth in STEM experiences, and elevated its ongoing commitment to the cultivation of diversity. The Summer of Innovation (SoI) is the resulting initiative that uses NASA's unique missions and resources to boost summer learning, particularly for students who are underrepresented, underserved and underperforming in STEM. The SoI pilot, launched in June 2010, is a multi-faceted effort designed to improve STEM teaching and learning through partnership, multi-week summer learning programs, special events, a national concluding event, and teacher development. The SoI pilot features strategic infusion of NASA content and educational resource materials, sustainability through STEM Learning Communities, and assessments of effectiveness of SoI interventions with other pilot efforts. This paper examines the inception and development of the Summer of Innovation pilot project, including achievements and effectiveness, as well as lessons learned for future efforts.

A neuroscience perspective on sexual risk behavior in adolescence and emerging adulthood

PubMed Central

VICTOR, ELIZABETH C.; HARIRI, AHMAD R.

2016-01-01

Late adolescence and emerging adulthood (specifically ages 15–24) represent a period of heightened sexual risk taking resulting in the greatest annual rates of sexually transmitted infections and unplanned pregnancies in the US population. Ongoing efforts to prevent such negative consequences are likely to benefit from a deepening of our understanding of biological mechanisms through which sexual risk taking emerges and biases decision making during this critical window. Here we present a neuroscience framework from which a mechanistic examination of sexual risk taking can be advanced. Specifically, we adapt the neurodevelopmental triadic model, which outlines how motivated behavior is governed by three systems: approach, avoidance, and regulation, to sexual decision making and subsequent risk behavior. We further propose a testable hypothesis of the triadic model, wherein relatively decreased threat-related amygdala reactivity and increased reward-related ventral striatum reactivity leads to sexual risk taking, which is particularly exaggerated during adolescence and young adulthood when there is an overexpression of dopaminergic neurons coupled with immature top-down prefrontal cortex regulation. We conclude by discussing how future research based on our adapted triadic model can inform ongoing efforts to improve intervention and prevention efforts. PMID:26611719

Emotion malleability beliefs, emotion regulation, and psychopathology: Integrating affective and clinical science.

PubMed

Kneeland, Elizabeth T; Dovidio, John F; Joormann, Jutta; Clark, Margaret S

2016-04-01

Beliefs that individuals hold about whether emotions are malleable or fixed, also referred to as emotion malleability beliefs, may play a crucial role in individuals' emotional experiences and their engagement in changing their emotions. The current review integrates affective science and clinical science perspectives to provide a comprehensive review of how emotion malleability beliefs relate to emotionality, emotion regulation, and specific clinical disorders and treatment. Specifically, we discuss how holding more malleable views of emotion could be associated with more active emotion regulation efforts, greater motivation to engage in active regulatory efforts, more effort expended regulating emotions, and lower levels of pathological distress. In addition, we explain how extending emotion malleability beliefs into the clinical domain can complement and extend current conceptualizations of major depressive disorder, social anxiety disorder, and generalized anxiety disorder. This may prove important given the increasingly central role emotion dysregulation has been given in conceptualization and intervention for these psychiatric conditions. Additionally, discussion focuses on how emotion beliefs could be more explicitly addressed in existing cognitive therapies. Promising future directions for research are identified throughout the review. Copyright © 2016 Elsevier Ltd. All rights reserved.

Parental HIV/AIDS and Psychosocial Adjustment among Rural Chinese Children

PubMed Central

Fang, Xiaoyi; Stanton, Bonita; Hong, Yan; Zhang, Liying; Zhao, Guoxiang; Zhao, Junfeng; Lin, Xiuyun; Lin, Danhua

2009-01-01

Objective To assess the relationship between parental HIV/AIDS and psychosocial adjustment of children in rural central China. Methods Participants included 296 double AIDS orphans (children who had lost both their parents to AIDS), 459 single orphans (children who had lost one parent to AIDS), 466 vulnerable children who lived with HIV-infected parents, and 404 comparison children who did not experience HIV/AIDS-related illness and death in their families. The measures included depressive symptoms, loneliness, self-esteem, future expectations, hopefulness about the future, and perceived control over the future. Results AIDS orphans and vulnerable children consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. The level of psychosocial adjustment was similar between single orphans and double orphans, but differed by care arrangement among double orphans. Conclusion The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the psychosocial wellbeing of these children. PMID:19208701

Playing the Long Game: Considering the Future of Augmentative and Alternative Communication Research and Service.

PubMed

Reichle, Joe; Drager, Kathryn; Caron, Jessica; Parker-McGowan, Quannah

2016-11-01

This article examines the growth of aided augmentative and alternative communication (AAC) in providing support to children and youth with significant communication needs. Addressing current trends and offering a discussion of needs and probable future advances is framed around five guiding principles initially introduced by Williams, Krezman, and McNaughton. These include: (1) communication is a basic right and the use of AAC, especially at a young age, can help individuals realize their communicative potential; (2) AAC, like traditional communication, requires it to be fluid with the ability to adapt to different environments and needs; (3) AAC must be individualized and appropriate for each user; (4) AAC must support full participation in society across all ages and interests; and (5) individuals who use AAC have the right to be involved in all aspects of research, development, and intervention. In each of these areas current advances, needs, and future predictions are offered and discussed in terms of researchers' and practitioners' efforts to a continued upward trajectory of research and translational service delivery. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Smoke-free air policies: past, present and future.

PubMed

Hyland, Andrew; Barnoya, Joaquin; Corral, Juan E

2012-03-01

Smoke-free policies have been an important tobacco control intervention. As recently as 20 years ago, few communities required workplaces and hospitality venues to be smoke-free, but today approximately 11% of the world's population live in countries with laws that require these places to be smoke-free. This paper briefly summarises important milestones in the history of indoor smoke-free policies, the role of scientific research in facilitating their adoption, a framework for smoke-free policy evaluation and industry efforts to undermine regulations. At present, smoke-free policies centre on workplaces, restaurants and pubs. In addition, many jurisdictions are now beginning to implement policies in outdoor areas and in shared multiunit housing settings. The future of smoke-free policy development depends on credible scientific data that documents the health risks of secondhand smoke exposure. Over the next 20 years smoke-free policies will very likely extend to outdoor and private areas, and changes in the types of tobacco products that are consumed may also have implications for the nature and scope of the smoke-free policies of the future.

Stakeholder Education for Community-Wide Health Initiatives: A Focus on Teen Pregnancy Prevention.

PubMed

Finley, Cara; Suellentrop, Katherine; Griesse, Rebecca; House, Lawrence Duane; Brittain, Anna

2018-01-01

Teen pregnancies and births continue to decline due in part to implementation of evidence-based interventions and clinical strategies. While local stakeholder education is also thought to be critical to this success, little is known about what types of strategies work best to engage stakeholders. With the goal of identifying and describing evidence-based or best practice strategies for stakeholder education in community-based public health initiatives, we conducted a systematic literature review of strategies used for effective stakeholder education. Over 400 articles were initially retrieved; 59 articles met inclusion criteria. Strategies were grouped into four steps that communities can use to support stakeholder education efforts: identify stakeholder needs and resources, develop a plan, develop tailored and compelling messaging, and use implementation strategies. These strategies lay a framework for high-quality stakeholder education. In future research, it is important to prioritize evaluating specific activities taken to raise awareness, educate, and engage a community in community-wide public health efforts.

Pew Memorial Trust policy synthesis: 3. Adolescent pregnancy: the responsibilities of policymakers.

PubMed Central

Mitchell, F; Brindis, C

1987-01-01

In recent years, adolescent pregnancy and childbearing have emerged as major health and social policy issues, sparking debates in local and national forums. The concern is a response to rates of adolescent sexual activity, pregnancy, and out-of-wedlock childbirth that have risen sharply in the past 20 years. The deleterious effects of early parenthood, especially in poor communities, have been amply documented; education, future employment, and health status are among the areas affected. Efforts at intervention have ranged from preventing pregnancy by encouraging celibacy to trying to enhance the options available to those who are already parents. Many of these efforts have fallen short, proving unequal to the complexity of the issues being tackled. Relatively successful approaches have also been developed, however, and the synthesis describes several. Strategies addressing the needs of adolescents comprehensively and involving a multiplicity of concerned players appear to be most effective in the long term. There is a pressing need for more program documentation to substantiate this and other promising strategies. PMID:3679836

Engaging Communities in Identifying Local Strategies for Expanding Integrated Employment During and After High School.

PubMed

Carter, Erik W; Blustein, Carly L; Bumble, Jennifer L; Harvey, Sarah; Henderson, Lynnette M; McMillan, Elise D

2016-09-01

Amidst decades of attention directed toward improving employment outcomes for people with intellectual and developmental disabilities (IDD), few efforts have been made to engage communities in identifying local solutions for expanding integrated employment opportunities. We examined the implementation and outcomes of "community conversation" events held in 6 geographically and economically diverse locales. Each event used an asset-based dialogue approach called the World Café ( Brown & Isaacs, 2005 ) to solicit ideas from a broad cross-section of community members on improving integrated employment that reflect local priorities and possibilities. Six key themes encapsulated the 1,556 strategies generated by the almost 400 attendees. Although considerable consistency was found among the categories of strategies raised across events, the manner in which those individual strategies would be implemented locally reflected the unique accent of each community. Attendees also viewed these events as promising and productive pathways for identifying next steps for their community. We offer recommendations for community-level intervention efforts and suggest directions for future research.

Pediatric Trichotillomania

PubMed Central

Harrison, Julie P.; Franklin, Martin E.

2012-01-01

Trichotillomania (TTM) is an impulse control disorder characterized by chronic hair-pulling, distress, and impairment. Although the negative effects of TTM are documented and often readily evident, there remains a paucity of psychopathology and treatment research on this disorder, particularly in pediatric populations. In an effort to improve assessment of pediatric TTM, several TTM-specific instruments for youth have now been developed to reliably identify symptoms and examine related phenomenology. Instrument development has now yielded instruments to evaluate TTM and related symptoms in the context of clinical trials of youth, and the first randomized controlled trial of any treatment for pediatric TTM was recently published. Using the initial pediatric TTM studies as building blocks, future research is now needed to create a stronger body of knowledge about the relative and combined efficacy of potential interventions for TTM in youth, as well as to examine the effects of TTM phenomenology and comorbidity on treatment outcome. Dissemination efforts must also be heightened for this knowledge to best reach these vulnerable populations. PMID:22437627

Initial Progress Toward Development of a Voice-Based Computer-Delivered Motivational Intervention for Heavy Drinking College Students: An Experimental Study

PubMed Central

Lechner, William J; MacGlashan, James; Wray, Tyler B; Littman, Michael L

2017-01-01

Background Computer-delivered interventions have been shown to be effective in reducing alcohol consumption in heavy drinking college students. However, these computer-delivered interventions rely on mouse, keyboard, or touchscreen responses for interactions between the users and the computer-delivered intervention. The principles of motivational interviewing suggest that in-person interventions may be effective, in part, because they encourage individuals to think through and speak aloud their motivations for changing a health behavior, which current computer-delivered interventions do not allow. Objective The objective of this study was to take the initial steps toward development of a voice-based computer-delivered intervention that can ask open-ended questions and respond appropriately to users’ verbal responses, more closely mirroring a human-delivered motivational intervention. Methods We developed (1) a voice-based computer-delivered intervention that was run by a human controller and that allowed participants to speak their responses to scripted prompts delivered by speech generation software and (2) a text-based computer-delivered intervention that relied on the mouse, keyboard, and computer screen for all interactions. We randomized 60 heavy drinking college students to interact with the voice-based computer-delivered intervention and 30 to interact with the text-based computer-delivered intervention and compared their ratings of the systems as well as their motivation to change drinking and their drinking behavior at 1-month follow-up. Results Participants reported that the voice-based computer-delivered intervention engaged positively with them in the session and delivered content in a manner consistent with motivational interviewing principles. At 1-month follow-up, participants in the voice-based computer-delivered intervention condition reported significant decreases in quantity, frequency, and problems associated with drinking, and increased perceived importance of changing drinking behaviors. In comparison to the text-based computer-delivered intervention condition, those assigned to voice-based computer-delivered intervention reported significantly fewer alcohol-related problems at the 1-month follow-up (incident rate ratio 0.60, 95% CI 0.44-0.83, P=.002). The conditions did not differ significantly on perceived importance of changing drinking or on measures of drinking quantity and frequency of heavy drinking. Conclusions Results indicate that it is feasible to construct a series of open-ended questions and a bank of responses and follow-up prompts that can be used in a future fully automated voice-based computer-delivered intervention that may mirror more closely human-delivered motivational interventions to reduce drinking. Such efforts will require using advanced speech recognition capabilities and machine-learning approaches to train a program to mirror the decisions made by human controllers in the voice-based computer-delivered intervention used in this study. In addition, future studies should examine enhancements that can increase the perceived warmth and empathy of voice-based computer-delivered intervention, possibly through greater personalization, improvements in the speech generation software, and embodying the computer-delivered intervention in a physical form. PMID:28659259

Building peace education in the Islamic educational context

NASA Astrophysics Data System (ADS)

Abu-Nimer, Mohammed; Nasser, Ilham

2017-04-01

Following the events of 9/11, many misconceptions entered the policy-making platform with regard to the need for education reforms in the Muslim world. Based upon Western cultural and societal norms and increased scepticism of the role of religion in violence, these assumptions have triggered a strong wave of calls for a top-down approach to reform formal state schools in predominantly Muslim countries, These calls often meet with resistance at national and community levels. This article seeks to examine these misconceptions and investigate why educational reform efforts through top-down frameworks which are especially motivated by countering violent extremism or terrorism have had only limited success. Many major international intergovernmental organisations, non-governmental organisations and governments have invested time and effort into education measures aiming to build peace and coexistence in Muslim countries, but they have been unable to build a relationship of trust with community leaders and school authorities. The authors argue that the main reason for defiance is reformers' failure to closely examine the cultural context of their chosen setting and work with existing tools and local institutions. Illustrating their point with a case study of an intervention carried out in informal Qur'anic schools in Niger, West Africa, the authors offer an alternative method which fosters changes from within. They argue that this model has a better chance of sustainability and could thus be used as the basis for future interventions.

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

PubMed Central

Wing, R.; Wadden, T. A.; Knowler, W. C.; Lawlor, M.; Evans, M.; Killean, T.; Montez, M.; Espeland, M. A.; Zhang, P.

2017-01-01

Summary Objective The Action for Health in Diabetes (Look AHEAD) trial was a randomized controlled clinical trial to compare the effects of 10 years of intensive lifestyle intervention (ILI) with a control condition of diabetes support and education (DSE) on health outcomes in over 5,000 participants with type 2 diabetes. The ILI had significantly greater weight losses than DSE throughout the trial. The goal of this analysis is to describe the cost of delivering the intervention. Methods The ILI was designed to promote weight loss and increase physical activity. It involved a combination of group plus individual intervention sessions, with decreasing frequency of contact over the 10 years. The intervention incorporated a variety of strategies, including meal replacement products, to improve weight loss outcomes. The costs of intervention delivery were derived from staff surveys of effort and from records of intervention materials from the 16 US academic clinical trial sites. Costs were calculated from the payer perspective and presented in 2012 dollars. Results During the first year, when intervention delivery was most intensive, the annual cost of intervention delivery, averaged (standard deviation) across clinical sites, was $2,864.6 ($513.3) per ILI participant compared with $202.4 ($76.6) per DSE participant. As intervention intensity declined, costs decreased, such that from years 5 to 9 of the trial, the annual cost of intervention was $1,119.8 ($227.7) per ILI participant and $102.9 ($33.0) per DSE participant. Staffing accounted for the majority of costs throughout the trial, with meal replacements and materials to promote adherence accounting for smaller shares. Conclusions The sustained weight losses produced by the Look AHEAD intervention were supported by intervention costs that were within the range of other weight loss programmes. Future work will include an evaluation of the cost‐effectiveness of the ILI and will contain additional follow‐up data. PMID:28392928

Intensive Intervention in Mathematics

ERIC Educational Resources Information Center

Powell, Sarah R.; Fuchs, Lynn S.

2015-01-01

Students who demonstrate persistent mathematics difficulties and whose performance is severely below grade level require "intensive intervention". Intensive intervention is an individualized approach to instruction that is more demanding and concentrated than Tier 2 intervention efforts. We present the elements of intensive intervention…

Effects of Transformational and Transactional Leadership on Cognitive Effort and Outcomes during Collaborative Learning within a Virtual World

ERIC Educational Resources Information Center

Kahai, Surinder; Jestire, Rebecca; Huang, Rui

2013-01-01

Computer-supported collaborative learning is a common e-learning activity. Instructors have to create appropriate social and instructional interventions in order to promote effective learning. We performed a study that examined the effects of two popular leadership interventions, transformational and transactional, on cognitive effort and outcomes…

34 CFR 303.11 - Early intervention program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Early intervention program. 303.11 Section 303.11... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND... intervention program. As used in this part, early intervention program means the total effort in a State that...

34 CFR 303.11 - Early intervention program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Early intervention program. 303.11 Section 303.11... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND... intervention program. As used in this part, early intervention program means the total effort in a State that...

Female arsonists: key features, psychopathologies, and treatment needs.

PubMed

Gannon, Theresa A

2010-01-01

Female-perpetrated arson is a topic that has received relatively little research attention from either psychiatrists or psychologists. In this review, available research regarding the characteristics, psychopathologies, and current treatment efforts with female arsonists is reviewed. Evaluation of current research with female arsonists suggests that very few researchers have compared female arsonists either to suitable female offender control groups or male arsons. Consequently, clinical knowledge and practice regarding female-perpetrated arson is underdeveloped relative to both other areas of forensic-clinical psychiatry and to knowledge of male arsonists. Suggestions are made for translating current research into arson interventions with female arsonists. Core arenas for future treatment and research provision are also highlighted.

A Survey of Keystroke Dynamics Biometrics

PubMed Central

Yue, Shigang

2013-01-01

Research on keystroke dynamics biometrics has been increasing, especially in the last decade. The main motivation behind this effort is due to the fact that keystroke dynamics biometrics is economical and can be easily integrated into the existing computer security systems with minimal alteration and user intervention. Numerous studies have been conducted in terms of data acquisition devices, feature representations, classification methods, experimental protocols, and evaluations. However, an up-to-date extensive survey and evaluation is not yet available. The objective of this paper is to provide an insightful survey and comparison on keystroke dynamics biometrics research performed throughout the last three decades, as well as offering suggestions and possible future research directions. PMID:24298216

Update on combat psychiatry: from the battle front to the home front and back again.

PubMed

Ritchie, Elspeth Cameron

2007-12-01

The U.S. military has long emphasized the principles of prevention and early intervention in preparing for and treating those afflicted by the psychological wounds of war. This article opens with lessons learned by the U.S. military through wartime during the past century. Current practice in the military's employment of stress control teams is reviewed. Updates in the military efforts in Operation Iraqi Freedom and Operation Enduring Freedom to prevent and to limit psychological casualties are stressed. Misconduct has occurred in this conflict; future steps to reduce aberrant behavior by soldiers are discussed. The challenges of reintegration at home, by both healthy and wounded soldiers, are highlighted.

Impaired black physicians: a methodology for detection and rehabilitation.

PubMed Central

Carter, J. H.

1989-01-01

The author contends that the great majority of black physicians lead happy and productive lives. Regrettably, black physicians must not only cope with stress related to marriage, finances, parenting, and other daily problems, but they must also cope with institutional racism. Consequently, some black physicians become impaired. This article discusses issues related to the problem of impairment in black physicians and suggests a methodology for detection and rehabilitation. It is the author's belief that future intervention should be culturally compatible and that black physicians themselves must bolster the effort to prevent impairment. At an empirical level, the author brings together the sparse amount of epidemiological and cultural data related to the subject. PMID:2664199

Antenatal Breastfeeding Education and Support: Summary and Analysis of 2 Cochrane Publications.

PubMed

Jacobsen, Noelle

Key breastfeeding outcomes identified by the World Health Organization, the United Nations Children's Fund, the American Academy of Pediatrics, and Healthy People 2020 include early initiation, any such feeding at 6 months of age, and exclusivity. Broader themes in the current literature include infants who ever breastfed and overall duration. Healthcare providers need to know what current practices demonstrate effectiveness. A review of 2 Cochrane articles on which interventions impact these selected outcomes does not reveal any significant implications for clinical practice. Scant evidence exists to support any specific support efforts or educational outreach to improve these outcomes. A discussion of potential strategies to consider for future research and clinical practice is put forth.

The Achilles tendon: fundamental properties and mechanisms governing healing

PubMed Central

Freedman, Benjamin R.; Gordon, Joshua A.; Soslowsky, Louis J.

2014-01-01

Summary This review highlights recent research on Achilles tendon healing, and comments on the current clinical controversy surrounding the diagnosis and treatment of injury. The processes of Achilles tendon healing, as demonstrated through changes in its structure, composition, and biomechanics, are reviewed. Finally, a review of tendon developmental biology and mechano transductive pathways is completed to recognize recent efforts to augment injured Achilles tendons, and to suggest potential future strategies for therapeutic intervention and functional tissue engineering. Despite an abundance of clinical evidence suggesting that current treatments and rehabilitation strategies for Achilles tendon ruptures are equivocal, significant questions remain to fully elucidate the basic science mechanisms governing Achilles tendon injury, healing, treatment, and rehabilitation. PMID:25332943

Transdisciplinary translational behavioral (TDTB) research: opportunities, barriers, and innovations.

PubMed

Czajkowski, Susan M; Lynch, Minda R; Hall, Kara L; Stipelman, Brooke A; Haverkos, Lynne; Perl, Harold; Scott, Marcia S; Shirley, Mariela C

2016-03-01

The translation of basic behavioral science discoveries into practical strategies represents a promising approach to developing more effective preventive interventions to improve health. Since translational research inevitably involves making use of diverse perspectives from multiple disciplines, it is best conducted as a transdisciplinary enterprise. In this paper, we discuss current strategies used by NIH to support transdisciplinary translational behavioral (TDTB) research, summarize successful efforts, and highlight challenges encountered in conducting such work (ranging from conceptual to organizational to methodological). Using examples from NIH-funded projects we illustrate the potential benefits of, and barriers to, pursuing this type of research and discuss next steps and potential future directions for NIH-supported TDTB research.

Young Adults’ Attitudes and Perceptions of Obesity and Weight Management: Implications for Treatment Development

PubMed Central

Lanoye, Autumn; Gorin, Amy A.; LaRose, Jessica Gokee

2017-01-01

Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight related constructs. The aim of this review is to explore young adults’ attitudes toward obesity and weight management, with particular attention to those factors that may play a role in development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults’ perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group. PMID:26923688

Conceptualizing and Re-Evaluating Resilience Across Levels of Risk, Time, and Domains of Competence

PubMed Central

Shaw, Daniel S.

2009-01-01

This article examines potential theoretical constraints on resilience across levels of risk, time, and domain of outcome. Studies of resilience are reviewed as they relate to the prevalence of resilience across levels of risk (e.g., single life events vs. cumulative risk), time, and domains of adjustment. Based on a thorough review of pertinent literature, we conclude that resilience, as a global construct, appears to be rare at the highest levels of risk, and that resilience may benefit from a narrower conceptualization focusing on specific outcomes at specific timepoints in development. The implication of this conclusion for future research and intervention efforts is then discussed. PMID:18379875

Progress and Future Directions in Research on the Psychosis Prodrome: A Review for Clinicians

PubMed Central

Woodberry, Kristen A; Shapiro, Daniel I; Bryant, Caitlin; Seidman, Larry J.

2016-01-01

The psychosis prodrome, or period of clinical and functional decline leading up to acute psychosis, offers a unique opportunity for identifying mechanisms of psychosis onset and testing early intervention strategies. We summarize major findings and emerging directions in prodromal research and provide recommendations for clinicians working with individuals suspected to be at high risk for psychosis. The past two decades of research have led to three major advances. First, tools and criteria have been developed that can reliably identify imminent risk for a psychotic disorder. Second, longitudinal clinical and psychobiological data from large multisite studies are strengthening individual risk assessment and offering insights into potential mechanisms of illness onset. Third, psychosocial and pharmacological interventions are demonstrating promise for delaying or preventing the onset of psychosis in help-seeking, high-risk individuals. The dynamic psychobiological processes implicated in both risk and onset of psychosis, including altered gene expression, cognitive dysfunction, inflammation, gray and white matter brain changes, and vulnerability-stress interactions suggest a wide range of potential treatment targets and strategies. The expansion of resources devoted to early intervention and prodromal research worldwide raises hope for investigating them. Future directions include identifying psychosis-specific risk and resilience factors in children, adolescents, and non-help-seeking community samples, improving study designs to test hypothesized mechanisms of change, and intervening with strategies that better engage youth, their environmental contexts, and neurodevelopmental targets to improve functional outcomes. Prospective research on putatively prodromal samples has the potential to substantially reshape our understanding of mental illness and our efforts to combat it. PMID:26954594

Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions.

PubMed

Schultz, William M; Kelli, Heval M; Lisko, John C; Varghese, Tina; Shen, Jia; Sandesara, Pratik; Quyyumi, Arshed A; Taylor, Herman A; Gulati, Martha; Harold, John G; Mieres, Jennifer H; Ferdinand, Keith C; Mensah, George A; Sperling, Laurence S

2018-05-15

Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment. © 2018 American Heart Association, Inc.

Natural disaster management: experience of an academic institution after a 7.8 magnitude earthquake in Ecuador.

PubMed

Cordero-Reyes, A M; Palacios, I; Ramia, D; West, R; Valencia, M; Ramia, N; Egas, D; Rodas, P; Bahamonde, M; Grunauer, M

2017-03-01

This case study describes the implementation of an academic institution's disaster management plan. Case study. USFQ's Medical School developed a six-phase disaster relief plan consisting of: induction, establishing a base camp, crisis management and mental health aid, creation of multidisciplinary teams and multi-agency teams, and reconstruction. Each phase uses a community-oriented approach to foster survivor autonomy and recovery. Our methodology facilitated the successful implementation of multidisciplinary interventions to manage the earthquake's aftermath on the personal, community and regional levels, treated and prevented psychological and physical morbidity among survivors and promoted healthy living conditions and independence. A multidisciplinary response team that addresses medical needs, mental health, education, food, nutrition and sanitation is highly effective in contributing to timely, effective relief efforts. The short- and long-term solutions we describe could be applicable to other academic centres' interventions in future disaster scenarios around the world. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Underage drinking: does the minimum age drinking law offer enough protection?

PubMed

Green, Rivka; Jason, Hannah; Ganz, Debora

2015-05-01

Underage drinking is a significant problem in the US. It is responsible for several thousand mortalities and fatalities each year, both among minors and other members of society. Additionally, underage alcohol consumption produces a severe economic burden in the US. Introduction to alcohol in youth poses serious long-term risks for adolescents, including occupational, educational, and psychosocial impairments, and increases the risk for developing alcohol abuse disorders in adulthood. In order to address and mitigate this problem, the US has set a minimum age drinking law of 21 in all 50 states, and has implemented several supplementary laws limiting the possession and consumption of alcohol. Though these laws have successfully reduced underage drinking, several additional strategies are noteworthy, including preventative and intervention efforts incorporating environmental, individual, communal, and parental factors. The following literature review describes these concepts as they relate to underage drinking laws in the US. Directions for future research, interventions, and ongoing challenges related to the minimum drinking age in the US are also discussed.

Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: a Literature Update.

PubMed

Jaarsma, Tiny; Cameron, Jan; Riegel, Barbara; Stromberg, Anna

2017-04-01

As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful. Recent studies in heart failure patients confirm that factors described in the theory of self-care of chronic illness are relevant for heart failure patients. Experiences and skills, motivation, habits, cultural beliefs and values, functional and cognitive abilities, confidence, and support and access to care are all important to consider when developing or improving interventions for patients with heart failure and their families. Additional personal and contextual factors that might influence self-care need to be explored and included in future studies and theory development efforts.

The Geography of Diabetes in London, Canada: The Need for Local Level Policy for Prevention and Management

PubMed Central

Tompkins, Jordan W.; Luginaah, Isaac N.; Booth, Gillian L.; Harris, Stewart B.

2010-01-01

Recent reports aimed at improving diabetes care in socially disadvantaged populations suggest that interventions must be tailored to meet the unique needs of the local community—specifically, the community’s geography. We have examined the spatial distribution of diabetes in the context of socioeconomic determinants of health in London (Ontario, Canada) to characterize neighbourhoods in an effort to target these neighbourhoods for local level community-based program planning and intervention. Multivariate spatial-statistical techniques and geographic information systems were used to examine diabetes rates and socioeconomic variables aggregated at the census tract level. Creation of a deprivation index facilitated investigation across multiple determinants of health. Findings from our research identified ‘at risk’ neighbourhoods in London with socioeconomic disadvantage and high diabetes. Future endeavours must continue to identify local level trends in order to support policy development, resource planning and care for improved health outcomes and improved equity in access to care across geographic regions. PMID:20623032

Clinic-wide Intervention Lowers Financial Risk and Improves Revenue to HIV Clinics Through Fewer Missed Primary Care Visits

PubMed Central

Gardner, Lytt I.; Marks, Gary; Wilson, Tracey E.; Giordano, Thomas P.; Sullivan, Meg; Raper, James L.; Rodriguez, Allan E.; Keruly, Jeanne; Malitz, Faye

2016-01-01

We calculated the financial impact in 6 HIV clinics of a low-effort retention in care intervention involving brief motivational messages from providers, patient brochures, and posters. We used a linear regression model to calculate absolute changes in kept primary care visits from the preintervention year (2008–2009) to the intervention year (2009–2010). Revenue from patients’ insurance was also assessed by clinic. Kept visits improved significantly in the intervention year versus the preintervention year (P < 0.0001). We found a net-positive effect on clinic revenue of +$24,000/year for an average-size clinic (7400 scheduled visits/year). We encourage HIV clinic administrators to consider implementing this low-effort intervention. PMID:25559605

How can we improve online HIV and STD prevention for men who have sex with men? Perspectives of hook-up website owners, website users, and HIV/STD directors.

PubMed

Wohlfeiler, Dan; Hecht, Jennifer; Volk, Jonathan; Fisher Raymond, H; Kennedy, Tom; McFarland, Willi

2013-11-01

Internet-based interventions have potential to reduce HIV and STD transmission among men who meet male sexual partners online. From November 2009 to May 2010 we surveyed dating and hook-up website users (n = 3,050), website owners (n = 18), and health department HIV/STD directors (n = 81) to identify structural and behavioral prevention interventions that could be implemented online and which a majority of website users were willing to use, owners were willing to implement, and HIV/STD directors perceived to be effective. A majority of each of the three stakeholder groups agreed on the following: (1) automated HIV/STD testing reminders, (2) local STD test site directories, (3) links to sex-positive safe sex videos, (4) access to sexual health experts, (5) profile options to include safer sex preference, (6) chat rooms for specific sexual interests, (7) filtering partners by their profile information, and (8) anonymous e-card partner notification for STD exposure. Findings help build consensus about how to prioritize resources for implementing online HIV and STD prevention interventions and highlight differences between stakeholders to guide future discussion about how to advance prevention efforts.

Pharmacologic and genetic strategies to enhance cell therapy for cardiac regeneration.

PubMed

Kanashiro-Takeuchi, Rosemeire M; Schulman, Ivonne Hernandez; Hare, Joshua M

2011-10-01

Cell-based therapy is emerging as an exciting potential therapeutic approach for cardiac regeneration following myocardial infarction (MI). As heart failure (HF) prevalence increases over time, development of new interventions designed to aid cardiac recovery from injury are crucial and should be considered more broadly. In this regard, substantial efforts to enhance the efficacy and safety of cell therapy are continuously growing along several fronts, including modifications to improve the reprogramming efficiency of inducible pluripotent stem cells (iPS), genetic engineering of adult stem cells, and administration of growth factors or small molecules to activate regenerative pathways in the injured heart. These interventions are emerging as potential therapeutic alternatives and/or adjuncts based on their potential to promote stem cell homing, proliferation, differentiation, and/or survival. Given the promise of therapeutic interventions to enhance the regenerative capacity of multipotent stem cells as well as specifically guide endogenous or exogenous stem cells into a cardiac lineage, their application in cardiac regenerative medicine should be the focus of future clinical research. This article is part of a special issue entitled "Key Signaling Molecules in Hypertrophy and Heart Failure." Copyright © 2011 Elsevier Ltd. All rights reserved.

First Step to Understand Intergroup Bias and Cohesion from the One World Experiment: A Pilot Project to Evaluate the Effect of the 'Pale Blue Dot' Hypothesis

NASA Astrophysics Data System (ADS)

Fukushima, K.; Venugopal, R.

2018-02-01

The One World Experiment was carried out as a pilot effort in Cape Town, South Africa, to test whether exposure to an astronomy intervention affects empathy and altruism in children. The intervention focused on introducing children to knowledge around the Earth's position in the Universe and collecting data to assess the effect. This paper presents the project background as well as the methodology and results from the project's first phase, designed to understand the possible difference in empathetic response between a child and other 'ingroup' and 'outgroup' children; for any child, an 'ingroup' child is one belonging to their own social group (in this case, nationality), and an 'outgroup' child is one belonging to a social group other than their own. It is found that the students across the study have a strong cohesion to those of the same nationality but that there is no nationality bias in their feelings towards how other children share their joy with them. Full analysis of the data, which will compare the control group and experimental group results and focuses on the impact of astronomy intervention, is underway for future publication.

Systematic review: internet-based program for youth smoking prevention and cessation.

PubMed

Park, Eunhee; Drake, Emily

2015-01-01

To review the characteristics and effects Internet-based youth smoking prevention and cessation programs. Systematic review of published articles in peer-reviewed journals in the past 10 years, focused on Internet-based youth smoking prevention and cessation programs. Twelve articles were selected based on the following criteria: studies reporting the outcomes of Internet-based smoking cessation or prevention intervention programs for adolescents who are younger than 24 years. The components of youth Internet-based smoking intervention programs are analyzed based on study features (i.e., sample, design, theoretical basis, analysis, outcome measures) and program characteristics (i.e., focus, setting, frequency, duration, intensity, and different components) that make the programs effective. The most common components of effective Internet-based programs are identified as the following: the use of multimedia, tailored approaches, personalized feedback, and interactive features. The characteristics and effects of the programs vary, but most programs show positive results in youth smoking prevention and cessation in spite of the studies' limitations. The evidence from this review provides useful information of recent efforts related to Internet-based youth smoking prevention and cessation programs, which can have significant clinical implications in developing future innovative youth smoking prevention and intervention programs. © 2014 Sigma Theta Tau International.

Some current dimensions of the behavioral economics of health-related behavior change.

PubMed

Bickel, Warren K; Moody, Lara; Higgins, Stephen T

2016-11-01

Health-related behaviors such as tobacco, alcohol and other substance use, poor diet and physical inactivity, and risky sexual practices are important targets for research and intervention. Health-related behaviors are especially pertinent targets in the United States, which lags behind most other developed nations on common markers of population health. In this essay we examine the application of behavioral economics, a scientific discipline that represents the intersection of economics and psychology, to the study and promotion of health-related behavior change. More specifically, we review what we consider to be some core dimensions of this discipline when applied to the study health-related behavior change. Behavioral economics (1) provides novel conceptual systems to inform scientific understanding of health behaviors, (2) translates scientific understanding into practical and effective behavior-change interventions, (3) leverages varied aspects of behavior change beyond increases or decreases in frequency, (4) recognizes and exploits trans-disease processes and interventions, and (5) leverages technology in efforts to maximize efficacy, cost effectiveness, and reach. These dimensions are overviewed and their implications for the future of the field discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Reducing Binge Drinking in Adolescents through Implementation of the Strategic Prevention Framework

PubMed Central

Anderson-Carpenter, Kaston D.; Watson-Thompson, Jomella; Chaney, Lisa; Jones, Marvia

2016-01-01

The Strategic Prevention Framework (SPF) is a conceptual model that supports coalition-driven efforts to address underage drinking and related consequences. Although the SPF has been promoted by the U.S. Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention and implemented in multiple U.S. states and territories, there is limited research on the SPF’s effectiveness on improving targeted outcomes and associated influencing factors. The present quasi-experimental study examines the effects of SPF implementation on binge drinking and enforcement of existing underage drinking laws as an influencing factor. The intervention group encompassed 11 school districts that were implementing the SPF with local prevention coalitions across eight Kansas communities. The comparison group consisted of 14 school districts that were matched based on demographic variables. The intervention districts collectively facilitated 137 community-level changes, including new or modified programs, policies, and practices. SPF implementation supported significant improvements in binge drinking and enforcement outcomes over time (p < .001), although there were no significant differences in improvements between the intervention and matched comparison groups (p > .05). Overall, the findings provide a basis for guiding future research and community-based prevention practice in implementing and evaluating the SPF. PMID:27217310

Not just the needle: the state of HIV-prevention science among substance users and future directions.

PubMed

Shoptaw, Steve; Montgomery, Brooke; Williams, Chyvette T; El-Bassel, Nabila; Aramrattana, Apinun; Metsch, Lisa; Metzger, David S; Kuo, Irene; Bastos, Francisco I; Strathdee, Steffanie A

2013-07-01

Efforts to prevent HIV transmission among substance-using populations have focused primarily among injection drug users, which have produced measurable reductions in HIV incidence and prevalence. By contrast, the majority of substances used worldwide are administered by noninjectable means, and there is a dearth of HIV prevention interventions that target noninjecting substance users. Increased surveillance of trends in substance use, especially cocaine (including crack) and methamphetamine, in addition to new and emerging substances (eg, synthetic cannabinoids, cathinones, and other amphetamine analogs) are needed to develop and scale up effective and robust interventions for populations at risk for HIV transmission via sexual behaviors related to noninjection substance use. Strategies are needed that address unique challenges to HIV prevention for substance users who are HIV infected and those who are HIV uninfected and are at high risk. We propose a research agenda that prioritizes (1) combination HIV-prevention strategies in substance users; (2) behavioral HIV prevention programs that reduce sexual transmission behaviors in nontreatment seeking individuals; (3) medical and/or behavioral treatments for substance abuse that reduce/eliminate substance-related sexual transmission behaviors; and (4) structural interventions to reduce HIV incidence.

Model-based transcriptome engineering promotes a fermentative transcriptional state in yeast

PubMed Central

Michael, Drew G.; Maier, Ezekiel J.; Brown, Holly; Gish, Stacey R.; Fiore, Christopher; Brown, Randall H.; Brent, Michael R.

2016-01-01

The ability to rationally manipulate the transcriptional states of cells would be of great use in medicine and bioengineering. We have developed an algorithm, NetSurgeon, which uses genome-wide gene-regulatory networks to identify interventions that force a cell toward a desired expression state. We first validated NetSurgeon extensively on existing datasets. Next, we used NetSurgeon to select transcription factor deletions aimed at improving ethanol production in Saccharomyces cerevisiae cultures that are catabolizing xylose. We reasoned that interventions that move the transcriptional state of cells using xylose toward that of cells producing large amounts of ethanol from glucose might improve xylose fermentation. Some of the interventions selected by NetSurgeon successfully promoted a fermentative transcriptional state in the absence of glucose, resulting in strains with a 2.7-fold increase in xylose import rates, a 4-fold improvement in xylose integration into central carbon metabolism, or a 1.3-fold increase in ethanol production rate. We conclude by presenting an integrated model of transcriptional regulation and metabolic flux that will enable future efforts aimed at improving xylose fermentation to prioritize functional regulators of central carbon metabolism. PMID:27810962

Girls on the move program to increase physical activity participation.

PubMed

Robbins, Lorraine B; Gretebeck, Kimberlee A; Kazanis, Anamaria S; Pender, Nola J

2006-01-01

Because physical inactivity poses serious health risks, interventions are urgently needed to reverse the increasingly sedentary lifestyles of adolescent girls. The aim of this study was to determine the feasibility of "Girls on the Move," an individually tailored computerized physical activity (PA) program plus nurse counseling intervention, in increasing PA. A pretest-posttest control group design was used with 77 racially diverse sedentary girls in Grades 6, 7, and 8 from two middle schools. Each of the instructional grades was randomly assigned to either an intervention or control condition. After completing computerized questionnaires, each girl in the control group received a handout listing the PA recommendations. To encourage PA, each girl in the intervention group received computerized, individually tailored feedback messages based on her responses to the questionnaires, individual counseling from the school's pediatric nurse practitioner (PNP), and telephone calls and mailings from a trained research assistant. At 12 weeks, girls in both groups responded to the questionnaires. No differences in self-reported PA emerged between the intervention and control groups at Weeks 1 (baseline) and 12 (postintervention). Repeated measures ANOVA showed a significant interaction between group and time for social support for PA, F(1, 69) = 5.73, p = .019, indicating that the intervention group had significantly greater social support across time than did the control group. From baseline to postintervention, social support increased for the intervention group but decreased for the control group. Reasons for the lack of significant differences between the groups on the PA measures were cited. Important information that could inform subsequent studies that test interventions to increase youth PA was acquired from conducting this study. Future efforts to increase PA participation might include this approach for enhancing social support for PA.

Tackling overweight and obesity: does the public health message match the science?

PubMed

Hafekost, Katherine; Lawrence, David; Mitrou, Francis; O'Sullivan, Therese A; Zubrick, Stephen R

2013-02-18

Despite the increasing understanding of the mechanisms relating to weight loss and maintenance, there are currently no validated public health interventions that are able to achieve sustained long-term weight loss or to stem the increasing prevalence of obesity in the population. We aimed to examine the models of energy balance underpinning current research about weight-loss intervention from the field of public health, and to determine whether they are consistent with the model provided by basic science. EMBASE was searched for papers published in 2011 on weight-loss interventions. We extracted details of the population, nature of the intervention, and key findings for 27 articles. Most public health interventions identified were based on a simple model of energy balance, and thus attempted to reduce caloric consumption and/or increase physical activity in order to create a negative energy balance. There appeared to be little consideration of homeostatic feedback mechanisms and their effect on weight-loss success. It seems that there has been a lack of translation between recent advances in understanding of the basic science behind weight loss, and the concepts underpinning the increasingly urgent efforts to reduce excess weight in the population. Public health weight-loss interventions seem to be based on an outdated understanding of the science. Their continued failure to achieve any meaningful, long-term results reflects the need to develop intervention science that is integrated with knowledge from basic science. Instead of asking why people persist in eating too much and exercising too little, the key questions of obesity research should address those factors (environmental, behavioral or otherwise) that lead to dysregulation of the homeostatic mechanism of energy regulation. There is a need for a multidisciplinary approach in the design of future weight-loss interventions in order to improve long-term weight-loss success.

Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss – a systematic review

PubMed Central

Palmer, Keith T; Harris, Clare; Linaker, Cathy; Barker, Mary; Lawrence, Wendy; Cooper, Cyrus; Coggon, David

2012-01-01

This systematic review assesses the effectiveness of interventions in community and workplace settings to reduce sickness absence and job loss in workers with musculoskeletal disorders (MSDs). Relevant studies (randomised controlled trials (RCTs) and cohort studies published since 1990) were identified by screening citations in 35 earlier systematic reviews and from searches of Medline and Embase to April 2010. Among 42 studies (54 reports) including 34 RCTs, 27 assessed return to work, 21 duration of sickness absence, and five job loss. Interventions included exercise therapy, behavioural change techniques, workplace adaptations and provision of additional services. Studies were typically small (median sample size 107 (inter-quartile range (IQR) 77 to 148) and limited in quality. Most interventions were reported as beneficial: the median relative risk (RR) for return to work was 1.21 (IQR 1.00 – 1.60) and that for avoiding MSD-related job loss, 1.25 (IQR 1.06-1.71); the median reduction in sickness absence was 1.11 (IQR 0.32 to 3.20) days/month. However, effects were smaller in the larger and better quality studies, suggesting publication bias. No intervention was clearly superior to others, although effort-intensive interventions were less effective than simple ones. No cost-benefit analyses established statistically significant net economic benefits. Given that benefits are small and of doubtful cost-effectiveness, employers’ practice should be guided by their value judgements about the uncertainties. Expensive interventions should be implemented only with rigorous cost-benefit evaluation planned from the outset. Future research should focus on the cost-effectiveness of simple low cost interventions, and further explore impacts on job retention. PMID:21415023

Crowdsourcing for Conducting Randomized Trials of Internet Delivered Interventions in People with Serious Mental Illness: A Systematic Review

PubMed Central

Naslund, John A.; Aschbrenner, Kelly A.; Marsch, Lisa A.; McHugo, Gregory J.; Bartels, Stephen J.

2015-01-01

Objective Online crowdsourcing refers to the process of obtaining needed services, ideas, or content by soliciting contributions from a large group of people over the Internet. We examined the potential for using online crowdsourcing methods for conducting behavioral health intervention research among people with serious mental illness (SMI). Methods Systematic review of randomized trials using online crowdsourcing methods for recruitment, intervention delivery, and data collection in people with SMI, including schizophrenia spectrum disorders and mood disorders. Included studies were completed entirely over the Internet without any face-to-face contact between participants and researchers. Databases and sources Medline, Cochrane Library, Web of Science, CINAHL, Scopus, PsychINFO, Google Scholar, and reference lists of relevant articles. Results We identified 7 randomized trials that enrolled N=1,214 participants (range: 39 to 419) with SMI. Participants were mostly female (72%) and had mood disorders (94%). Attrition ranged from 14% to 81%. Three studies had attrition rates below 25%. Most interventions were adapted from existing evidence-based programs, and consisted of self-directed education, psychoeducation, self-help, and illness self-management. Six studies collected self-reported mental health symptoms, quality of life, and illness severity. Three studies supported intervention effectiveness and two studies showed improvements in the intervention and comparison conditions over time. Peer support emerged as an important component of several interventions. Overall, studies were of medium to high methodological quality. Conclusion Online crowdsourcing methods appear feasible for conducting intervention research in people with SMI. Future efforts are needed to improve retention rates, collect objective outcome measures, and reach a broader demographic. PMID:26188164

Feasibility and acceptability of Facebook for health promotion among people with serious mental illness.

PubMed

Naslund, John A; Aschbrenner, Kelly A; Marsch, Lisa A; Bartels, Stephen J

2016-11-01

Elevated obesity rates are a major contributor to the significantly reduced life expectancy impacting people with serious mental illness. With over 1.5 billion Facebook users worldwide, this platform may afford opportunities for reaching individuals with serious mental illness outside professional settings and fostering social support for adopting healthier behaviors. In this mixed methods pilot study, we explored the feasibility and acceptability of using Facebook to support a group lifestyle intervention for weight loss among obese adults with serious mental illness. Nine of eleven participants enrolled in a six-month lifestyle intervention delivered through a community mental health center agreed to join a private Facebook group to support their healthy eating and exercise goals. We measured participants' use of the Facebook group and collected post-intervention feasibility and acceptability questionnaires followed by in-depth qualitative interviews to elicit participants' perspectives and recommendations for improving the use of Facebook. Of 188 posts to the Facebook group, the majority (79%) were from participants compared to study staff (21%). Participants also posted 186 comments, 299 likes, and recorded 1316 page views. Participants were positive about opportunities to interact and support each other outside group sessions, found content posted by other participants to be helpful, and indicated that the Facebook group was safe to use. Participants provided constructive feedback, including recommendations for more detailed instructions for accessing the group and posting content, finding ways to encourage more interaction within the group, and tips for responding to notifications or alerts directly from the Facebook website. These findings suggest that Facebook may be feasible for supporting health promotion efforts targeting people with serious mental illness. Participants provided valuable feedback that can inform the use of Facebook for future health promotion efforts targeting this high-risk group.

Urine culture guided antibiotic interventions: A pharmacist driven antimicrobial stewardship effort in the ED.

PubMed

Zhang, Xi; Rowan, Nicole; Pflugeisen, Bethann Mangel; Alajbegovic, Sanjin

2017-04-01

Antibiotics are overprescribed for abnormal urine tests including asymptomatic bacteriuria (AB), contributing to rising antimicrobial resistance rates. Pharmacists reviewed urine cultures daily from emergency department (ED) encounters to assess antibiotic appropriateness. We studied antibiotic prescribing practices and assessed compliance to national guidelines, correlations with urine analysis (UA) components, and opportunities for antimicrobial stewardship in the ED. This quality improvement project (QIP) was a prospective cohort study at a community hospital ED, with data collected from finalized urine cultures resulting October 30, 2014 through January 5, 2015. Analyses were conducted using Chi-squared and Fisher Exact tests and stepwise multiple logistic regression. Urine cultures from 457 encounters were reviewed, of which 136 met the inclusion criteria as non-pregnant and asymptomatic for urinary tract infection (UTI). 43% of 136 patients were treated with antibiotics, for a total of 426 antibiotic days. Pharmacist interventions for these patients resulted in 122/426 (29%) of potential antibiotic days saved. Factors found to significantly increase the odds of antibiotic prescribing in asymptomatic patients included presence of leukocyte esterase (OR=4.5, 95% CI: 1.2-17.2; p=0.03) or nitrites (OR=10.8, 95% CI: 1.7-68.1; p=0.01) in the urine and age≥75 (OR=3.5, 95% CI: 1.2-9.6, p=0.02). Pharmacist intervention in discontinuing or modifying antibiotics for asymptomatic patients with urine cultures reduced unnecessary antibiotic exposure and was a first step in antimicrobial stewardship efforts in the ED. Future work includes limiting urine tests and subsequent antibiotic therapy for non-pregnant asymptomatic patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Feasibility and acceptability of Facebook for health promotion among people with serious mental illness

PubMed Central

Naslund, John A; Aschbrenner, Kelly A; Marsch, Lisa A; Bartels, Stephen J

2016-01-01

Objective Elevated obesity rates are a major contributor to the significantly reduced life expectancy impacting people with serious mental illness. With over 1.5 billion Facebook users worldwide, this platform may afford opportunities for reaching individuals with serious mental illness outside professional settings and fostering social support for adopting healthier behaviors. In this mixed methods pilot study, we explored the feasibility and acceptability of using Facebook to support a group lifestyle intervention for weight loss among obese adults with serious mental illness. Methods Nine of eleven participants enrolled in a six-month lifestyle intervention delivered through a community mental health center agreed to join a private Facebook group to support their healthy eating and exercise goals. We measured participants’ use of the Facebook group and collected post-intervention feasibility and acceptability questionnaires followed by in-depth qualitative interviews to elicit participants’ perspectives and recommendations for improving the use of Facebook. Results Of 188 posts to the Facebook group, the majority (79%) were from participants compared to study staff (21%). Participants also posted 186 comments, 299 likes, and recorded 1316 page views. Participants were positive about opportunities to interact and support each other outside group sessions, found content posted by other participants to be helpful, and indicated that the Facebook group was safe to use. Participants provided constructive feedback, including recommendations for more detailed instructions for accessing the group and posting content, finding ways to encourage more interaction within the group, and tips for responding to notifications or alerts directly from the Facebook website. Conclusions These findings suggest that Facebook may be feasible for supporting health promotion efforts targeting people with serious mental illness. Participants provided valuable feedback that can inform the use of Facebook for future health promotion efforts targeting this high-risk group.

Moving from data collection to application: a systematic literature review of surgical capacity assessments and their applications.

PubMed

Carlson, Lucas C; Lin, Joseph A; Ameh, Emmanuel A; Mulwafu, Wakisa; Donkor, Peter; Derbew, Miliard; Rodas, Edgar; Mkandawire, Nyengo C; Dhanaraj, Mitra; Yangni-Angate, Herve; Sani, Rachid; Labib, Mohamed; Barbero, Roxana; Clarke, Damian; Smith, Martin D; Sherman, Lawrence; Mutyaba, Frederick A; Alexander, Philip; Hadley, Larry G P; VanRooyen, Michael J; Kushner, Adam L

2015-04-01

Over the past decade, assessments of surgical capacity in low- and middle-income countries (LMICs) have contributed to our understanding of barriers to the delivery of surgical services in a number of countries. It is yet unclear, however, how the findings of these assessments have been applied and built upon within the published literature. A systematic literature review of surgical capacity assessments in LMICs was performed to evaluate current levels of understanding of global surgical capacity and to identify areas for future study. A reverse snowballing method was then used to follow-up citations of the identified studies to assess how this research has been applied and built upon in the literature. Twenty-one papers reporting the findings of surgical capacity assessments conducted in 17 different LMICs in South Asia, East Asia and Pacific, Latin America and the Caribbean, and sub-Saharan Africa were identified. These studies documented substantial deficits in human resources, infrastructure, equipment, and supplies. Only seven additional papers were identified which applied or built upon the studies. Among these, capacity assessment findings were most commonly used to develop novel tools and intervention strategies, but they were also used as baseline measurements against which updated capacity assessments were compared. While the global surgery community has made tremendous progress in establishing baseline values of surgical capacity in LMICs around the world, further work is necessary to build upon and apply the foundational knowledge established through these efforts. Capacity assessment data should be coordinated and used in ongoing research efforts to monitor and evaluate progress in global surgery and to develop targeted intervention strategies. Intervention strategy development may also be further incorporated into the evaluation process itself.

Group-based social skills interventions for adolescents with higher-functioning autism spectrum disorder: a review and looking to the future

PubMed Central

McMahon, Camilla M; Lerner, Matthew D; Britton, Noah

2013-01-01

In this paper, we synthesize the current literature on group-based social skills interventions (GSSIs) for adolescents (ages 10–20 years) with higher-functioning autism spectrum disorder and identify key concepts that should be addressed in future research on GSSIs. We consider the research participants, the intervention, the assessment of the intervention, and the research methodology and results to be integral and interconnected components of the GSSI literature, and we review each of these components respectively. Participant characteristics (eg, age, IQ, sex) and intervention characteristics (eg, targeted social skills, teaching strategies, duration and intensity) vary considerably across GSSIs; future research should evaluate whether participant and intervention characteristics mediate/moderate intervention efficacy. Multiple assessments (eg, parent-report, child-report, social cognitive assessments) are used to evaluate the efficacy of GSSIs; future research should be aware of the limitations of current measurement approaches and employ more accurate, sensitive, and comprehensive measurement approaches. Results of GSSIs are largely inconclusive, with few consistent findings across studies (eg, high parent and child satisfaction with the intervention); future research should employ more rigorous methodological standards for evaluating efficacy. A better understanding of these components in the current GSSI literature and a more sophisticated and rigorous analysis of these components in future research will lend clarity to key questions regarding the efficacy of GSSIs for individuals with autism spectrum disorder. PMID:23956616

Recruitment for a Diabetes Prevention Program translation effort in a worksite setting.

PubMed

Taradash, J; Kramer, M; Molenaar, D; Arena, V; Vanderwood, K; Kriska, Andrea M

2015-03-01

The success of the Diabetes Prevention Program (DPP) lifestyle intervention has led to community-based translation efforts in a variety of settings. One community setting which holds promise for the delivery of prevention intervention is the worksite; however, information regarding recruitment in this setting is limited. The current effort describes the initial processes surrounding provision of an adapted DPP lifestyle intervention at a corporate worksite. Investigators and key management at the worksite collaborated to develop and implement a recruitment plan for the intervention focusing on 1) in-person onsite activities and 2) implementation of a variety of media recruitment tools and methods. Adult, non-diabetic overweight/obese employees and family members with pre-diabetes and/or the metabolic syndrome were eligible for the study. Telephone pre-screening was completed for 176 individuals resulting in 171 eligible for onsite screening. Of that number, 160 completed onsite screening, 107 met eligibility criteria, and 89 enrolled in the study. Support from worksite leadership, an invested worksite planning team and a solid recruitment plan consisting of multiple strategies were identified as crucial elements of this effective workplace recruitment effort. A worksite team successfully developed and implemented a recruitment plan using existing mechanisms appropriate to that worksite in order to identify and enroll eligible individuals. The results of this effort indicate that employee recruitment in a worksite setting is feasible as the first step in offering onsite behavioral lifestyle intervention programs as part of a widespread dissemination plan to prevent diabetes and lower risk for cardiovascular disease. Copyright © 2015 Elsevier Inc. All rights reserved.

Long-Term Effectiveness of a Stress Management Intervention at Work: A 9-Year Follow-Up Study Based on a Randomized Wait-List Controlled Trial in Male Managers.

PubMed

Li, Jian; Riedel, Natalie; Barrech, Amira; Herr, Raphael M; Aust, Birgit; Mörtl, Kathrin; Siegrist, Johannes; Gündel, Harald; Angerer, Peter

2017-01-01

Short- and medium-term effectiveness (up to 3 years) of individual level stress management interventions (SMI) at work were demonstrated, yet long-term effectiveness remains unexplored. We therefore aimed to address this research gap. 94 male middle managers participated in a randomized wait-list controlled trial between 2006 and 2008 and in a post-trial-follow-up survey in 2015. During the first two years, all received an 18-hour psychotherapeutic SMI intervention which was based on the Effort-Reward Imbalance (ERI) model: tackling stressor on mismatch between effort and reward and promoting recovery on overcommitment. Work stress (i.e., ERI indicators) was the primary outcome, and the secondary outcome was depressive symptoms. The long-term effectiveness of the SMI was examined by mixed modeling, using an external control group ( n = 94). Effort and reward were substantially improved with significant intervention ⁎ time interaction effects ( p < 0.001) compared to the external control group; effects on overcommitment and depressive symptoms were also significant ( p < 0.05 and p < 0.01, resp.), though their trajectories in the intervention group were less sustainable. The effectiveness of this psychotherapeutic SMI at work based on the ERI model was observed over a 9-year period, particularly on the effort-reward ratio.

Social Support and HIV-related Risk Behaviors: A Systematic Review of the Global Literature

PubMed Central

Li, Xiaoming; Stanton, Bonita

2013-01-01

Existing empirical evidence has well documented the role of social support in both physical and psychological well-being among various populations. In the context of HIV prevention, the rapid increase of studies on social support merits a systematic review to synthesize the current global literature on association between social support and HIV-related risk behaviors. The current review reveals a complex picture of this relationship across diverse populations. Existing studies indicate that higher levels of social support are related to fewer HIV-related risk behaviors among female sex workers and people living with HIV/AIDS and heterosexual adults in general. However, influences of social support on HIV-related risk behaviors are inconsistent within drug users, men who have sex with men and adolescents. These variations in findings may be attributed to different measurement of social support in different studies, specific context of social support for diverse population, or various characteristics of the social networks the study population obtained support from. Future studies are needed to explore the mechanism of how social support affects HIV-related risk behaviors. HIV prevention intervention efforts need to focus on the positive effect of social support for various vulnerable and at-risk populations. Future efforts also need to incorporate necessary structure change and utilize technical innovation in order to maximize the protective role of social support in HIV risk prevention or reduction. PMID:23921582

Student peer assessment in evidence-based medicine (EBM) searching skills training: an experiment

PubMed Central

Eldredge, Jonathan D.; Bear, David G.; Wayne, Sharon J.; Perea, Paul P.

2013-01-01

Background: Student peer assessment (SPA) has been used intermittently in medical education for more than four decades, particularly in connection with skills training. SPA generally has not been rigorously tested, so medical educators have limited evidence about SPA effectiveness. Methods: Experimental design: Seventy-one first-year medical students were stratified by previous test scores into problem-based learning tutorial groups, and then these assigned groups were randomized further into intervention and control groups. All students received evidence-based medicine (EBM) training. Only the intervention group members received SPA training, practice with assessment rubrics, and then application of anonymous SPA to assignments submitted by other members of the intervention group. Results: Students in the intervention group had higher mean scores on the formative test with a potential maximum score of 49 points than did students in the control group, 45.7 and 43.5, respectively (P = 0.06). Conclusions: SPA training and the application of these skills by the intervention group resulted in higher scores on formative tests compared to those in the control group, a difference approaching statistical significance. The extra effort expended by librarians, other personnel, and medical students must be factored into the decision to use SPA in any specific educational context. Implications: SPA has not been rigorously tested, particularly in medical education. Future, similarly rigorous studies could further validate use of SPA so that librarians can optimally make use of limited contact time for information skills training in medical school curricula. PMID:24163593

A Systematic Review of Culturally Specific Interventions to Increase Physical Activity for Older Asian Americans.

PubMed

Katigbak, Carina; Flaherty, Erin; Chao, Ying-Yu; Nguyen, Tam; Cheung, Daphne; Yiu-Cho Kwan, Rick

Physical activity (PA) is a significant modifiable risk factor for cardiovascular disease. For older adults, engaging in PA is shown to improve cardiac status, reduce cognitive, and functional decline, and improve overall quality of life. However, only 17% of Asian American adults meet the 2008 federal recommended guidelines for aerobic and muscle strengthening activity; and there is a paucity of data reporting on older Asian Americans - a rapidly growing, underserved group. While data pertaining to Asian Americans is frequently reported at the aggregate level, this masks differences (eg, language, culture, income) among Asian ethnic subgroups that may impact health behaviors. The purpose of this review was to identify intervention, and cultural adaptation strategies in studies promoting PA for older Asian Americans. A comprehensive literature search was performed to identify interventions published between 1996-2016 focused on improving PA among older Asian Americans (> 60 years old). Data were abstracted to examine intervention study designs, cultural adaptation strategies, theoretical frameworks, and physical activity measures. Nine studies met the review's inclusion criteria. Community-based recruitment approaches were widely used, and all studies employed cultural adaptation to varying degrees. Most studies reported improvements in PA outcomes, focused on Chinese Americans, and relied on self-reports of PA, while few aimed to increase PA using a multi-component approach. Future studies would benefit from larger sample sizes, a wider representation of Asian ethnic subgroups, and concentrated efforts to implement deep level adaptations that may increase the salience and sustainability of these interventions.

Derivation and Evaluation of a Risk-Scoring Tool to Predict Participant Attrition in a Lifestyle Intervention Project.

PubMed

Jiang, Luohua; Yang, Jing; Huang, Haixiao; Johnson, Ann; Dill, Edward J; Beals, Janette; Manson, Spero M; Roubideaux, Yvette

2016-05-01

Participant attrition in clinical trials and community-based interventions is a serious, common, and costly problem. In order to develop a simple predictive scoring system that can quantify the risk of participant attrition in a lifestyle intervention project, we analyzed data from the Special Diabetes Program for Indians Diabetes Prevention Program (SDPI-DP), an evidence-based lifestyle intervention to prevent diabetes in 36 American Indian and Alaska Native communities. SDPI-DP participants were randomly divided into a derivation cohort (n = 1600) and a validation cohort (n = 801). Logistic regressions were used to develop a scoring system from the derivation cohort. The discriminatory power and calibration properties of the system were assessed using the validation cohort. Seven independent factors predicted program attrition: gender, age, household income, comorbidity, chronic pain, site's user population size, and average age of site staff. Six factors predicted long-term attrition: gender, age, marital status, chronic pain, site's user population size, and average age of site staff. Each model exhibited moderate to fair discriminatory power (C statistic in the validation set: 0.70 for program attrition, and 0.66 for long-term attrition) and excellent calibration. The resulting scoring system offers a low-technology approach to identify participants at elevated risk for attrition in future similar behavioral modification intervention projects, which may inform appropriate allocation of retention resources. This approach also serves as a model for other efforts to prevent participant attrition.

Interventions for coordination of walking following stroke: systematic review.

PubMed

Hollands, Kristen L; Pelton, Trudy A; Tyson, Sarah F; Hollands, Mark A; van Vliet, Paulette M

2012-03-01

Impairments in gait coordination may be a factor in falls and mobility limitations after stroke. Therefore, rehabilitation targeting gait coordination may be an effective way to improve walking post-stroke. This review sought to examine current treatments that target impairments of gait coordination, the theoretical basis on which they are derived and the effects of such interventions. Few high quality RCTs with a low risk of bias specifically targeting and measuring restoration of coordinated gait were found. Consequently, we took a pragmatic approach to describing and quantifying the available evidence and included non-randomised study designs and limited the influence of heterogeneity in experimental design and control comparators by restricting meta-analyses to pre- and post-test comparisons of experimental interventions only. Results show that physiotherapy interventions significantly improved gait function and coordination. Interventions involving repetitive task-specific practice and/or auditory cueing appeared to be the most promising approaches to restore gait coordination. The fact that overall improvements in gait coordination coincided with increased walking speed lends support to the hypothesis that targeting gait coordination gait may be a way of improving overall walking ability post-stroke. However, establishing the mechanism for improved locomotor control requires a better understanding of the nature of both neuroplasticity and coordination deficits in functional tasks after stroke. Future research requires the measurement of impairment, activity and cortical activation in an effort to establish the mechanism by which functional gains are achieved. Copyright © 2011 Elsevier B.V. All rights reserved.

Counseling to Prevent Obesity Among Preschool Children: Acceptability of a Pilot Urban Primary Care Intervention

PubMed Central

McKee, M. Diane; Maher, Stacia; Deen, Darwin; Blank, Arthur E.

2010-01-01

PURPOSE To help design effective primary care-based interventions, we explored urban parents’ reactions to a pilot and feasibility study designed to address risk behaviors for obesity among preschool children. METHODS We conducted 3 focus groups (2 in English, 1 in Spanish) to evaluate the pilot intervention. Focus group participants explored the acceptability of the pilot intervention components (completion of a new screening tool for risk assessment, discussion of risk behaviors and behavior change goal setting by physicians, and follow-up contacts with a lifestyle counselor) and the fidelity of the pilot intervention delivery. RESULTS Parents expressed a desire to change behaviors to achieve healthier families. They believed that doctors should increase their focus on healthy habits during visits. Parents were more accepting of nutrition discussions than increasing activity (citing a lack of safe outdoor space) or decreasing sedentary behaviors (citing many benefits of television viewing). Contacts with the lifestyle counselor were described as empowering, with parents noting her focus on strategies to achieve change for the whole family while recognizing that many food behaviors relate to cultural heritage. Parents expressed frustration with physicians for offering advice about changing behavior but not how to achieve it, for dismissing concerns about picky eating or undereating, and in some cases for labels of overweight that they believed were inappropriately applied. CONCLUSIONS Parents welcomed efforts to address family lifestyle change in pediatric visits. The model of physician goal setting with referral for behavior change counseling is highly acceptable to families. Future interventions should acknowledge parental concerns about undereating and perceived benefits of television viewing. PMID:20458109

Lifestyle intervention to prevent obesity during pregnancy: Implications and recommendations for research and implementation.

PubMed

Hill, Briony; McPhie, Skye; Moran, Lisa J; Harrison, Paul; Huang, Terry T-K; Teede, Helena; Skouteris, Helen

2017-06-01

Maternal obesity and excessive gestational weight gain (GWG) are significant contributors to the global obesity epidemic. However, isolated lifestyle interventions to address this in pregnancy appear to have only modest benefit and responses can be variable. This paper aims to address the question of why the success of lifestyle interventions to prevent excessive GWG is suboptimal and variable. We suggest that there are inherent barriers to lifestyle change within pregnancy as a life stage, including the short window available for habit formation; the choice for women not to prioritise their weight; competing demands including physiological, financial, relationship, and social situations; and lack of self-efficacy among healthcare professionals on this topic. In order to address this problem, we propose that just like all successful public health approaches seeking to change behaviour, individual lifestyle interventions must be provided in the context of a supportive environment that enables, incentivises and rewards healthy changes. Future research should focus on a systems approach that integrates the needs of individuals with the context within which they exist. Borrowing from the social marketing principle of 'audience segmentation', we also need to truly understand the needs of individuals to design appropriately tailored interventions. This approach should also be applied to the preconception period for comprehensive prevention approaches. Additionally, relevant policy needs to reflect the changing evidence-based climate. Interventions in the clinical setting need to be integrally linked to multipronged obesity prevention efforts in the community, so that healthy weight goals are reinforced throughout the system. Copyright © 2016 Elsevier Ltd. All rights reserved.

The 'third wave' of HIV prevention: filling gaps in integrated interventions, knowledge, and funding.

PubMed

Sepúlveda, Jaime

2012-07-01

There is growing optimism in the global health community that the HIV epidemic can be halted. After decades of relying primarily on behavior change to prevent HIV transmission, a second generation of prevention efforts based on medical or biological interventions such as male circumcision and preexposure prophylaxis--the use of antiretroviral drugs to protect uninfected, at-risk individuals--has shown promising results. This article calls for a third generation of HIV prevention efforts that would integrate behavioral, biological, and structural interventions focused on the social, political, and environmental underpinnings of the epidemic, making use of local epidemiological evidence to target affected populations. In this third wave, global programs should deliver HIV prevention services together with cost-effective interventions for reproductive health and for tuberculosis, malaria, and other diseases. Additionally, new efforts are needed to address gaps in HIV prevention research, evaluation, and implementation. Increased and sustained funding, along with evidence-based allocation of funds, will be necessary to accelerate the decline in new HIV infections.

Moving Beyond of The Alphabet Soup of HIV Prevention

PubMed Central

Collins, Chris; Coates, Thomas J.; Curran, James

2010-01-01

It is time to scrap the “ABCs” and elevate the debate on HIV prevention beyond the incessant controversies over individual interventions. The ABCs are a woefully incomplete list of necessary prevention interventions, but the goal should not be to just add more letters to the prevention alphabet. Instead, advancing global HIV prevention means holding national gover nments, donors and global agencies accountable for prevention efforts that are tailored to national epidemics, bring quality interventions to a scale, and address environmental factors in vulnerability. The debate is not so much about one intervention or another, but whether countries have a comprehensive prevention effort in place that responds to their own unique situations. PMID:18641471

Understanding pathways for scaling up health services through the lens of complex adaptive systems.

PubMed

Paina, Ligia; Peters, David H

2012-08-01

Despite increased prominence and funding of global health initiatives, efforts to scale up health services in developing countries are falling short of the expectations of the Millennium Development Goals. Arguing that the dominant assumptions for scaling up are inadequate, we propose that interpreting change in health systems through the lens of complex adaptive systems (CAS) provides better models of pathways for scaling up. Based on an understanding of CAS behaviours, we describe how phenomena such as path dependence, feedback loops, scale-free networks, emergent behaviour and phase transitions can uncover relevant lessons for the design and implementation of health policy and programmes in the context of scaling up health services. The implications include paying more attention to local context, incentives and institutions, as well as anticipating certain types of unintended consequences that can undermine scaling up efforts, and developing and implementing programmes that engage key actors through transparent use of data for ongoing problem-solving and adaptation. We propose that future efforts to scale up should adapt and apply the models and methodologies which have been used in other fields that study CAS, yet are underused in public health. This can help policy makers, planners, implementers and researchers to explore different and innovative approaches for reaching populations in need with effective, equitable and efficient health services. The old assumptions have led to disappointed expectations about how to scale up health services, and offer little insight on how to scale up effective interventions in the future. The alternative perspectives offered by CAS may better reflect the complex and changing nature of health systems, and create new opportunities for understanding and scaling up health services.

Building Level Principals as Change Agents in a Response to Intervention Reform Initiative

ERIC Educational Resources Information Center

Ninni, Kristen

2010-01-01

The purpose of this study was to examine the role of the principal in a systems change effort. Utilizing Response to Intervention (RtI) as a means of studying principals as change agents, this researcher examined the principals' ability to implement and sustain a reform effort such as RtI as perceived by the principal, problem solving team, and…

Fetal Treatment 2017: the Evolution of Fetal Therapy Centers

PubMed Central

MOON-GRADY, Anita J.; BASCHAT, Ahmet; CASS, Darrell; CHOOLANI, Mahesh; COPEL, Joshua; CROMBLEHOLME, Timothy M.; DEPREST, Jan; EMERY, Stephen P.; EVANS, Mark I.; LUKS, Francois; NORTON, Mary E.; RYAN, Greg; TSAO, Kuojen; WELCH, Ross; HARRISON, Michael

2017-01-01

More than 3 decades ago, a small group of physicians and other practitioners active in what they called “fetal treatment” authored an opinion piece outlining the current status and future challenges anticipated in the field. Many advances in maternal, neonatal, and perinatal care and diagnostic and therapeutic modalities have been made in the intervening years, yet a thoughtful re-assessment of the basic tenets put forth in 1982 has not been published. The present effort will aim to provide a framework for contemporary redefinition of the field of fetal treatment, with brief discussion of the necessary minimum expertise and systems-base for provision of different types of interventions on both a mother and fetus. Our goal will be to present an opinion that encourages the advancement of thoughtful practice, ensuring that current and future patients have realistic access to centers with a range of fetal therapies with appropriate expertise, experience, subspecialty and institutional support while remaining focused on excellence in care, collaborative scientific discovery, and maternal autonomy and safety. PMID:28531885

2014 Section on Pediatrics Knowledge translation Lecture: Clinicians and researchers on the same path toward facilitating family goals for mobility & participation

PubMed Central

Damiano, Diane L.; Leonard, Rebecca

2015-01-01

BACKGROUND The Knowledge Translation (KT) Lecture at CSM 2014 was a personal perspective from a researcher who had been a therapist and a longtime clinician, now a Ph.D. candidate. OBJECTIVE To better integrate research and clinical care, so KT is a seamless rather than separate process. KEY POINTS KT can be enhanced by improved receptivity to evidence, and increasing use of research designs that encourage and even require clinician involvement, from single-subject designs to large-scale pragmatic trials. Clinical practice databases and hiring therapists to provide intervention in research efforts also serve to integrate research and clinical care. Limitations of applying mean group research results to an individual patient were also discussed and suggest an important unanswered topic for future research. CONCLUSION We all need to assume responsibility for the researcher-clinician partnership, making our jobs more joyful and fulfilling, and hopefully the biggest beneficiaries will be our current and future patients. PMID:25822350

Success in School for Justice-Involved Girls: Do Specific Aspects of Developmental Immaturity Matter?

PubMed Central

Haney-Caron, Emily; Goldstein, Naomi E. S.; Giallella, Christy L.; Kemp, Kathleen; Romaine, Christina Riggs

2016-01-01

Developmental immaturity (DI) may help explain some of the variability in aspects of academic achievement among girls in the juvenile justice system, a population with high rates of truancy, dropout, and school failure. This study examined the relationships among the decision making and independent functioning components of DI, verbal intelligence, and academic achievement within this population. Using data from 60 girls in residential juvenile justice facilities, multiple regression analyses indicated that verbal IQ moderated the relationship between the DI construct of decision making and academic achievement. Self-reported school attendance and number of previous arrests did not significantly mediate the relationship between DI and academic achievement. These results may indicate that the decision-making factor of DI may be particularly important, and, if results are replicated, future intervention efforts could focus more on improving this skill within this juvenile justice population. Additionally, the overall importance of the full DI construct is an important area of future study. PMID:28082833

Targeting Hispanic populations: future research and prevention strategies.

PubMed Central

Ramirez, A G; McAlister, A; Gallion, K J; Villarreal, R

1995-01-01

Minority populations face a wide variety of economic, institutional, and cultural barriers to health care. These barriers and low levels of education and income pose significant challenges for health professionals in developing cancer research and prevention-control strategies. It is suggested that specific segments of Hispanic populations fit the model of an underdeveloped country in the intermediate stage of epidemiological transition. Since noncommunicable diseases have not yet fully emerged in some of these Hispanic population segments, the opportunity exists to apply primordial prevention strategies. Such campaigns would focus on dissuading members of these populations from adopting negative health behaviors while promoting positive lifestyle choices. Optimal programs would increase cancer screening participation and discourage risk behaviors through community-oriented, population-based interventions. Future directions in prevention and control efforts for minority populations should include expanded health insurance coverage, improved access to health care, greater emphasis on minority recruitment in health care fields, focused epidemiologic and clinical research, and identification and replication of effective components within existing prevention-control programs. PMID:8741800

Motivation for and use of social networking sites: Comparisons among college students with and without histories of non-suicidal self-injury.

PubMed

Jarvi, Stephanie M; Swenson, Lance P; Batejan, Kristen L

2017-07-01

This research examines potential differences in social network use and motivation for social network use by non-suicidal self-injury (NSSI) status. 367 (73% women; M age = 20.60) college students were recruited in November-December 2011. A random sample of 2,500 students was accessed through a university registrar to recruit students interested in an online survey assessing NSSI and various health-related behaviors. Social network use and motivations for social networks did not differ by NSSI status. Results suggest that it is not patterns of use or motivation to use social networks that could lead to concern about online behavior (i.e., behavior increasing risk of future NSSI) among those with NSSI history. Rather, future preventive and intervention efforts should address the NSSI-related content that is available online, since this is unregulated, often explicit, and commonly includes "pro-NSSI" content that may be problematic and increase risk among vulnerable individuals.

Enhancing Human Responses to Climate Change Risks through Simulated Flooding Experiences

NASA Astrophysics Data System (ADS)

Zaalberg, Ruud; Midden, Cees

Delta areas are threatened by global climate change. The general aims of our research were (1) to increase our understanding of climate and flood risk perceptions and the factors that influence these judgments, and (2) to seek for interventions that can contribute to a realistic assessment by laypersons of long-term flooding risks. We argue that awareness of one's own vulnerability to future flooding and insights into the effectiveness of coping strategies is driven by direct flooding experiences. In the current research multimodal sensory stimulation by means of interactive 3D technology is used to simulate direct flooding experiences at the experiential or sensory level, thereby going beyond traditional persuasion attempts using fear-evoking images. Our results suggest that future communication efforts should not only use these new technologies to transfer knowledge about effective coping strategies and flooding risks, but should especially be directed towards residents living in flood prone areas, but who lack direct flooding experiences as their guiding principle.

Injury to the Preterm Brain and Cerebral Palsy: Clinical Aspects, Molecular Mechanisms, Unanswered Questions, and Future Research Directions

PubMed Central

Babcock, Michael A.; Kostova, Felina V.; Ferriero, Donna M.; Johnston, Michael V.; Brunstrom, Jan E.; Hagberg, Henrik; Maria, Bernard L.

2013-01-01

Cerebral palsy will affect nearly 10% of the 60,000 very-low-birth-weight infants born in the United States in the next year, and an even greater percentage will display some form of permanent neurological impairment resulting from injury to the preterm brain. The 2008 Neurobiology of Disease in Children Symposium, held in conjunction with the 37th annual meeting of the Child Neurology Society, aimed to define current knowledge and to develop specific aims for future clinical, translational, and fundamental science. A complex interplay of both destructive and developmental forces is responsible for injury to the preterm brain. Advances in imaging and histology have implicated a variety of cell types, though pre-oligodendrocyte injury remains the focus. Research into different mechanisms of injury is facilitating new neuroprotective and rehabilitative interventions. A cooperative effort is necessary to translate basic research findings into clinically effective therapies and better care for these children. PMID:19745084

Future Directions in Painful Knee Osteoarthritis: Harnessing Complexity in a Heterogeneous Population

PubMed Central

George, Steven Z.; Maluf, Katrina S.; Stevens-Lapsley, Jennifer E.

2014-01-01

This perspective article proposes a conceptual model for the pain experience for individuals diagnosed with knee osteoarthritis (OA). Pain in knee OA is likely a heterogeneous, multifactorial phenomenon that involves not only the OA disease process but also elements specific to patient psychology and pain neurophysiology. The relevant contributions to the pain experience for any individual patient remain difficult, if not impossible, to definitively determine, and the rationale for many clinical treatment decisions arises primarily from a mechanistic understanding of OA pathophysiology. The Osteoarthritis Research Society International (OARSI) recently identified “phenotyping” of OA pain as a research priority to “better target pain therapies to individual patients.” This perspective article proposes that contributions from 3 domains—knee pathology, psychological distress, and pain neurophysiology—should be considered equally important in future efforts to understand pain phenotypes in knee OA. Ultimately, characterization of pain phenotypes may aid in the understanding of the pain experience and the development of interventions specific to pain for individual patients. PMID:24179141

2014 section on pediatrics knowledge translation lecture: clinicians and researchers on the same path toward facilitating family goals for mobility and participation.

PubMed

Damiano, Diane L; Leonard, Rebecca

2015-01-01

The knowledge translation (KT) lecture at the Combined Sections Meeting 2014 was a personal perspective from a researcher who had been a therapist and a longtime clinician, now a PhD candidate. To better integrate research and clinical care, KT is a seamless rather than separate process. Knowledge translation can be enhanced by improved receptivity to evidence, and increasing use of research designs that encourage and even require clinician involvement, from single-subject designs to large-scale pragmatic trials. Clinical practice databases and hiring therapists to provide intervention in research efforts also serve to integrate research and clinical care. Limitations of applying mean group research results to an individual patient were also discussed and suggest an important unanswered topic for future research. We all need to assume responsibility for the researcher-clinician partnership, making our jobs more joyful and fulfilling, and hopefully the biggest beneficiaries will be our current and future patients.

Increasing the acceptance of internet-based mental health interventions in primary care patients with depressive symptoms. A randomized controlled trial.

PubMed

Ebert, D D; Berking, M; Cuijpers, P; Lehr, D; Pörtner, M; Baumeister, H

2015-05-01

Internet-based interventions (IBI) are effective in treating depression. However, uptake rates in routine care are still limited. Hence, this study aimed to (1) assess the acceptance of IBIs in primary care patients with depressive symptoms and to (2) examine the effects of a brief acceptance facilitating intervention in the form of an informational video on patients' acceptance of IBIs. Primary care patients (N=128) with Minor or Major Depression were randomly assigned to an intervention (IG) or control group (CG). Patients in the IG were shown a brief informational video about IBIs before receiving a questionnaire that assessed their acceptance of IBIs and other secondary outcomes. Patients of the CG filled out the questionnaire immediately. Baseline acceptance of IBIs in the CG was high for 6.3%, moderate for 53.1% and low for 40.6% of patients. Acceptance of IBIs was significantly higher in the IG when compared to the CG (d=.71, 95%-CI:.09-2.91). Except for social influence and the general attitude towards psychological treatment, all secondary outcomes were also significantly improved (e.g. effort- (d=.40) and performance-expectancy: d=.65; knowledge about Internet interventions d=.35). Depression of the participants was only assessed using a self-report measure (PHQ-9). Primary care patients' acceptance of IBIs for depressive symptoms was low but could be increased significantly using a brief acceptance facilitating intervention on the basis of an informational video. Future studies should further examine the potential of acceptance facilitating interventions for patients and health care providers to exploit the public health impact of IBIs. Copyright © 2015 Elsevier B.V. All rights reserved.

Initial Progress Toward Development of a Voice-Based Computer-Delivered Motivational Intervention for Heavy Drinking College Students: An Experimental Study.

PubMed

Kahler, Christopher W; Lechner, William J; MacGlashan, James; Wray, Tyler B; Littman, Michael L

2017-06-28

Computer-delivered interventions have been shown to be effective in reducing alcohol consumption in heavy drinking college students. However, these computer-delivered interventions rely on mouse, keyboard, or touchscreen responses for interactions between the users and the computer-delivered intervention. The principles of motivational interviewing suggest that in-person interventions may be effective, in part, because they encourage individuals to think through and speak aloud their motivations for changing a health behavior, which current computer-delivered interventions do not allow. The objective of this study was to take the initial steps toward development of a voice-based computer-delivered intervention that can ask open-ended questions and respond appropriately to users' verbal responses, more closely mirroring a human-delivered motivational intervention. We developed (1) a voice-based computer-delivered intervention that was run by a human controller and that allowed participants to speak their responses to scripted prompts delivered by speech generation software and (2) a text-based computer-delivered intervention that relied on the mouse, keyboard, and computer screen for all interactions. We randomized 60 heavy drinking college students to interact with the voice-based computer-delivered intervention and 30 to interact with the text-based computer-delivered intervention and compared their ratings of the systems as well as their motivation to change drinking and their drinking behavior at 1-month follow-up. Participants reported that the voice-based computer-delivered intervention engaged positively with them in the session and delivered content in a manner consistent with motivational interviewing principles. At 1-month follow-up, participants in the voice-based computer-delivered intervention condition reported significant decreases in quantity, frequency, and problems associated with drinking, and increased perceived importance of changing drinking behaviors. In comparison to the text-based computer-delivered intervention condition, those assigned to voice-based computer-delivered intervention reported significantly fewer alcohol-related problems at the 1-month follow-up (incident rate ratio 0.60, 95% CI 0.44-0.83, P=.002). The conditions did not differ significantly on perceived importance of changing drinking or on measures of drinking quantity and frequency of heavy drinking. Results indicate that it is feasible to construct a series of open-ended questions and a bank of responses and follow-up prompts that can be used in a future fully automated voice-based computer-delivered intervention that may mirror more closely human-delivered motivational interventions to reduce drinking. Such efforts will require using advanced speech recognition capabilities and machine-learning approaches to train a program to mirror the decisions made by human controllers in the voice-based computer-delivered intervention used in this study. In addition, future studies should examine enhancements that can increase the perceived warmth and empathy of voice-based computer-delivered intervention, possibly through greater personalization, improvements in the speech generation software, and embodying the computer-delivered intervention in a physical form. ©Christopher W Kahler, William J Lechner, James MacGlashan, Tyler B Wray, Michael L Littman. Originally published in JMIR Mental Health (http://mental.jmir.org), 28.06.2017.

Micronutrient Research, Programs, and Policy: From Meta-analyses to Metabolomics123

PubMed Central

Allen, Lindsay H.

2014-01-01

Micronutrient deficiencies are widespread among women and children in undernourished populations. Research has identified effective approaches to their prevention, including supplementation, fortification, and dietary and other public health interventions. These interventions have made tremendous improvements in the quality of life, health, and survival of populations around the world, yet the impact varies by nutrient, population, and the outcomes chosen that reflect nutritionally driven change. The WHO guides governments and agencies toward effective strategies to prevent micronutrient deficiencies in women and children, but these are often informed by imperfect studies with limited measures of impact and the inadequate program evaluations and survey databases produced by the nutrition community. The resulting knowledge gaps limit our ability to discern what interventions are effective, under what conditions, among whom, and perhaps most important, why. However, we are moving into an era of opportunity to apply the tools of modern nutrition science, including improved methods of assessing nutritional status, “omics,” bioarchival access, systems biology thinking, and interdisciplinary collaborations, that can deepen and broaden our understanding of how micronutrients affect health, how their deficiencies diminish human capacity, and how interventions can improve the well-being of those in need. Relevant training and greater cross-disciplinary efforts will be required to ensure a cell-to-society approach that can systematically address where, to whom, and how to provide micronutrients in the future. PMID:24829487

The Roles of Behavioral and Social Science Research in the Fight Against HIV/AIDS: A Functional Framework.

PubMed

Gaist, Paul; Stirratt, Michael J

2017-08-01

Landmark advances have been made in HIV/AIDS prevention and treatment. These include proof-of-concept and public health implementation of preexposure prophylaxis and "treatment as prevention" to reduce HIV transmission as well as definitive evidence of the clinical gain from early antiretroviral treatment initiation. Significant progress has been made in understanding and addressing the social contexts and behavioral factors that impact HIV prevention, care, and treatment interventions. These include facilitating uptake of testing and counseling, developing technology-based interventions that increase viral suppression, reducing HIV/AIDS-related stigma, and addressing other sociobehavioral and structural barriers to care and treatment. This evolving landscape provides an important juncture to assess current and future directions for HIV/AIDS behavioral and social science research (BSSR). We propose a functional framework for HIV/AIDS-related BSSR, highlighting 4 primary BSSR domains: (1) understanding vulnerable populations and contexts of risk ("Basic BSSR"); (2) improving behavioral and social factor approaches to risk reduction, prevention, and care ("Elemental BSSR"); (3) strengthening the design and outcomes of biomedically focused research in HIV/AIDS treatment and prevention ("Supportive BSSR"); and (4) contributing building blocks to integrated HIV/AIDS prevention and treatment approaches ("Integrative BSSR"). These domains and their resulting confluence at the highest level underscore how fundamental and essential BSSR is to current and future efforts to prevent, treat, and cure HIV/AIDS.

Resilience canvas: a heuristic tool for socio-hydrological management under change

NASA Astrophysics Data System (ADS)

Mao, F.; Clark, J.; Buytaert, W.; Karpouzoglou, T.; Dewulf, A.; Hannah, D. M.

2016-12-01

Although resilience thinking has been gaining interest in managing socio-hydrological systems in a changing world, there are still gaps between the resilience theory and its applications in policy making and management. This research introduces the notion of the "resilience canvas" as a heuristic tool to support social-hydrological water management under change. We argue that resilience is a set of three systematic properties including absorptive, adaptive and transformative capacities. For socio-hydrological systems, each capacity type arises from different sources and can be managed in different ways. The "resilience canvas" can be constructed by combining absorptive and adaptive capacities as the x and y axes. At the corners of the two-dimensional space, four resulting quadrates are found, including most resilient, vulnerable, susceptible, and resistant system states. The resilience canvas can be used not only to understand the development trajectories of socio-hydrological systems at different scales from single river basin to global level, but also to design bespoke interventions and strategies to maintain or enhance resilience. To address projected change-induced uncertainties, this research recommends that future efforts should be focused on shifting socio-hydrological systems from resistant towards resilient status. This implies that interventions including ecosystem restoration, technological innovations and developments in institutional arrangements and management practices, such as polycentric governance and public participation, may play important roles to address future uncertainties and enhance resilience.

Estimating benefits of past, current, and future reductions in smoking rates using a comprehensive model with competing causes of death.

PubMed

van Meijgaard, Jeroen; Fielding, Jonathan E

2012-01-01

Despite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes. The objective of this study was to use a life course model with multiple competing causes of death to elucidate the ongoing benefits of tobacco-use control efforts on US death rates. We used a continuous-time life course simulation model for the US population. We modeled smoking initiation and cessation and 20 leading causes of death as competing risks over the life span, with the risk of death for each cause dependent on past and current smoking status. Risk parameters were estimated using data from the National Health Interview Survey that were linked to follow-up mortality data. Up to 14% (9% for men, 14% for women) of the total gain in life expectancy since 1960 was due to tobacco-use control efforts. Past efforts are expected to further increase life expectancy by 0.9 years for women and 1.3 years for men. Additional reduction in smoking prevalence may eventually yield an average 3.4-year increase in life expectancy in the United States. Coronary heart disease is expected to increase as a share of total deaths. A dynamic individual-level model with multiple causes of death supports assessment of the delayed benefits of improved tobacco-use control efforts. We show that past smoking reduction efforts will translate into further increases in life expectancy in the coming years. Smoking will remain a major contributor to preventable illness and death, worthy of continued interventions.

Effort-reward imbalance and self-rated health among Gambian healthcare professionals.

PubMed

Darboe, Amadou; Lin, I-Feng; Kuo, Hsien-Wen

2016-04-11

The effort-reward imbalance (ERI) model of work stress has been widely applied in investigating association between psychosocial factors at work and health. This study examined associations between perceived psychosocial work stress as measured by the ERI model and self-rated health (SRH) among nurses and environmental health officers (EHOs) working in secondary public healthcare facilities in the Gambia. A cross-sectional study on a random sample of 287 health care professionals (201 nurses and 86 EHOs). A 22-item ERI questionnaire was used to collect data on the psychosocial factors defined by the ERI model. SRH was assessed using a single item measure. The distribution of subjective health was not statistically different between nurses and EHOs. However, our study uncovered significant associations between perceived psychosocial work stress and subjective health. Specifically, we found that a perceived high effort-reward imbalance (ER-ratio > 1) is a significant risk factor for poor SRH, in both occupational groups. However, over-commitment was not significantly associated with poor SRH in the two groups. When efforts and rewards were considered as separate variables in the analysis, rewards were inversely associated with poor SRH in both groups. Because of the high perceived Effort-Reward Imbalance among healthcare professionals at secondary public healthcare facilities, it is necessary to modify working conditions through improvement of psychosocial work environment, such as reasonable allocation of resources to increase pay, incentives or other forms of rewards from government. Interventions that could mitigate and prevent stress at work are worth considering in future healthcare policies.

Masked hypertension and effort-reward imbalance at work among 2369 white-collar workers.

PubMed

Boucher, P; Gilbert-Ouimet, M; Trudel, X; Duchaine, C S; Milot, A; Brisson, C

2017-10-01

Hypertension is an important risk factor of cardiovascular diseases, the leading cause of death worldwide. Adverse effects of psychosocial factors at work might increase the risk of masked hypertension, but evidences are still scarce. The objective of this study is then to determine whether adverse psychosocial work factors from the effort-reward imbalance (ERI) model are associated with the prevalence of masked hypertension in a population of white-collar workers. White-collar workers were recruited from three public organizations. Blood pressure was measured at the workplace for manually operated measurements (mean of the first three readings taken by a trained assistant) followed by ambulatory measurements (mean of all subsequent readings taken during the working day). Masked hypertension was defined as manually operated BP<140/90 mm Hg and ambulatory BP ⩾135/85 mm Hg. ERI exposure at work was measured using Siegrist's validated questionnaire. Blood pressure readings were obtained from 2369 workers (participation proportion: 85%). ERI exposure (OR: 1.53 (95% CI: 1.16-2.02) and high efforts at work (OR: 1.61 (95% CI: 1.13-1.29) were associated with masked hypertension, after adjusting for sociodemographic and cardiovascular risk factors. Workers exposed to an imbalance between efforts spent at work and reward had a higher prevalence of masked hypertension. High efforts at work might be of particular importance in explaining this association. Future studies should be designed to investigate how clinicians can include questions on psychosocial work factors to screen for masked hypertension and how workplace interventions can decrease adverse psychosocial exposures to lower BP.

Psychosocial work environment and the risk of coronary heart disease.

PubMed

Peter, R; Siegrist, J

2000-06-01

Remarkable changes in the working situation have led to the increasing importance of psychomentally and socio-emotionally demanding conditions at work. With the help of theoretical models, those highly prevalent psychosocial work environments were conceptualized which influence the risk of coronary heart disease by enhanced activation of the autonomic nervous system. One of the most prominent theoretical approaches, the job strain model, and a more recent approach, the effort-reward imbalance model, are discussed in the paper. Findings from prospective and cross-sectional studies indicate that job strain and effort-reward imbalance at work define specific conditions of chronic work stress that are associated with an elevated risk of coronary heart disease (CHD). Respective multivariate odds-ratios range from 1.2 to 5.0 with respect to job strain, and from 1.5 to 6.1 with respect to effort-reward imbalance. These associations are explained neither by established behavioral or biomedical risk factors nor by physical and chemical hazards at work, rather they define independent, new work-related risk conditions. There is additional evidence that effort-reward imbalance may mediate the association of some traditional occupational exposures, such as shift work, with cardiovascular risk: in a cross-sectional study, prevalence odds ratios of hypertension and atherogenic lipids attributable to effort-reward imbalance were relatively highest among shiftworkers as compared to daytime workers. Preliminary results from intervention programs based on the theoretical models document favorable effects on health. Information derived from theoretical models on psychosocial work environment may help to better identify populations at risk and to develop and apply specific, theory-guided preventive activities in the future.

Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines.

PubMed

Gottlieb, Sami L; Low, Nicola; Newman, Lori M; Bolan, Gail; Kamb, Mary; Broutet, Nathalie

2014-03-20

An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts. Copyright © 2014 Elsevier Ltd. All rights reserved.

Sustained attention in infancy as a longitudinal predictor of self-regulatory functions.

PubMed

Johansson, Maria; Marciszko, Carin; Gredebäck, Gustaf; Nyström, Pär; Bohlin, Gunilla

2015-11-01

Previous literature suggests that attention processes such as sustained attention would constitute a developmental foundation for the self-regulatory functions executive functioning and effortful control (e.g., Garon, Bryson, & Smith, 2008; Rothbart, Derryberry, & Posner, 1994). Our main aim was to test this hypothesis by studying whether sustained attention at age 1 year can predict individual differences in self-regulatory functions at age 2 years. Longitudinal data from 66 infants and their parents were included in the study. Sustained attention was assessed during free play at age 1 year; executive functioning, measured using an eye-tracking version of the A-not-B task, and effortful control, measured using parental ratings, were assessed at both age 1 and age 2 years. The results did support a longitudinal prediction of individual differences in 2-year-olds' self-regulatory functions as a function of sustained attention at age 1 year. We also found significant improvement in both executive functioning and effortful control over time, and the two self-regulatory constructs were related in toddlerhood but not in infancy. The study helps increase our understanding of the early development of self-regulatory functions necessary for identifying developmental risks and, in the future, for developing new interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

Improving police interventions during mental health-related encounters: Past, present and future

PubMed Central

Wood, Jennifer D.; Watson, Amy C.

2017-01-01

There are calls across America for police to re-imagine themselves as “guardians” rather than “warriors” in the performance of their innumerable duties. The contentious history of police attitudes and practices surrounding encounters with people affected by mental illnesses can be understood through the lens of this wider push toward guardianship. At least as far back as the de-institutionalization of mental health care and the profound lack of community-based resources to fill service deficits, the role of police as mental health interventionists has been controversial and complex. This paper reviews the first wave of reform efforts designed to re-shape police sensibilities and practices in the handling of mental health-related encounters. We argue that such efforts, centred on specialized training and cooperative agreements with the health care sector, have advanced a guardian mindset through improved knowledge and attitudes about mental health vulnerabilities and needs. Building on the progress made, we suggest there are critical opportunities for a new wave of efforts that can further advance the guardianship agenda. We highlight three such opportunities: (1) Enhancing experiences of procedural justice during mental health-related encounters; (2) Building the evidence base through integrated data sets; and (3) Balancing a “case-based” focus with a “place-based” focus. PMID:29200799

Reported Systems Changes and Sustainability Perceptions of Three State Departments of Health Implementing Multi-Faceted Evidence-Based Fall Prevention Efforts.

PubMed

Smith, Matthew Lee; Schneider, Ellen C; Byers, Imani N; Shubert, Tiffany E; Wilson, Ashley D; Towne, Samuel D; Ory, Marcia G

2017-01-01

Although the concepts of systems change and sustainability are not new, little is known about the factors associated with systems change sustaining multi-state, multi-level fall prevention efforts. This exploratory study focuses on three State Departments of Health (DOH) that were awarded 5-year funding from the Centers for Disease Control and Prevention to simultaneously implement four separate yet related evidence-based fall prevention initiatives at the clinical, community, and policy level. The purpose of this study was to examine changes in partnerships and collaborative activities that occurred to accomplish project goals (examining changes in the context of "before funding" and "after funding was received"). Additionally, this study explored changes in State DOH perceptions about action related to sustainability indicators in the context of "during funding" and "after funding ends." Findings from this study document the partnership and activity changes necessary to achieve defined fall prevention goals after funding is received, and that the importance of sustainability indicator documentation is seen as relevant during funding, but less so after the funding ends. Findings from this study have practice and research implications that can inform future funded efforts in terms of sector and stakeholder engagement necessary for initiating, implementing, and sustaining community- and clinical-based fall prevention interventions.

An airline study of advanced technology requirements for advanced high speed commercial engines. 3: Propulsion system requirements

NASA Technical Reports Server (NTRS)

Sallee, G. P.

1973-01-01

The advanced technology requirements for an advanced high speed commercial transport engine are presented. The results of the phase 3 effort cover the requirements and objectives for future aircraft propulsion systems. These requirements reflect the results of the Task 1 and 2 efforts and serve as a baseline for future evaluations, specification development efforts, contract/purchase agreements, and operational plans for future subsonic commercial engines. This report is divided into five major sections: (1) management objectives for commercial propulsion systems, (2) performance requirements for commercial transport propulsion systems, (3) design criteria for future transport engines, (4) design requirements for powerplant packages, and (5) testing.

What's culture got to do with it? Prevention programs for African American adolescent girls.

PubMed

Corneille, Maya A; Ashcroft, Amie M; Belgrave, Faye Z

2005-11-01

This paper examines prevention programming for African American girls by placing the prevention process within the larger African and African American cultural context. We provide an overview of the theories and issues we consider most relevant to African American culture, including Africentric theory, ethnic identity, gender identity and relational theory, developmental issues, the community context, and historical considerations. Drawing from our own drug prevention work, we provide examples of how to incorporate culture into prevention programs to make them most relevant for the target population. We also summarize our own efforts to create culturally appropriate prevention interventions and their impact on the girls in our programs. We conclude with suggested directions for future research into culture-specific prevention programs.

Developing Medications Targeting Glutamatergic Dysfunction in Autism: Progress to Date

PubMed Central

Fung, Lawrence K.; Hardan, Antonio Y.

2015-01-01

Pharmacologic treatments targeting specific molecular mechanisms relevant for autism spectrum disorder (ASD) are beginning to emerge in early drug development. This article reviews the evidence for the disruption of glutamatergic neurotransmission in animal models of social deficits and summarizes key pre-clinical and clinical efforts in developing pharmacologic interventions based on modulation of glutamatergic systems in individuals with ASD. Understanding the pathobiology of the glutamatergic system has led to the development of new investigational treatments for individuals with ASD. Specific examples of medications that modulate the glutamatergic system in preclinical and clinical studies are described. Finally, we will discuss the limitations of current strategies and future opportunities in developing medications targeting the glutamatergic system for treating individuals with ASD. PMID:26104862

College students' responses to mental health status updates on Facebook.

PubMed

Egan, Katie G; Koff, Rosalind N; Moreno, Megan A

2013-01-01

Facebook is widely used by the college population, and previous research has shown that mental health references on Facebook are common. Focus groups of college students were held to determine their views of mental health references seen in their peers' Facebook profiles. Students' views of mental health references varied from being serious calls for help, to being jokes or attention-seeking behavior. Responses to mental health references depended on the participants' offline relationship with the poster. Students would contact close friends through a phone call or in-person conversation, but would not approach acquaintances. The prevalence of mental health references on Facebook, and the awareness of these references by college students, may present opportunities for future peer intervention efforts.

The Effects of a Growth Mindset Intervention on the Beliefs about Intelligence, Effort Beliefs, Achievement Goal Orientations, and Academic Self-Efficacy of LD Students with Reading Difficulties

ERIC Educational Resources Information Center

Baldridge, Mary Caufield

2010-01-01

The overall purpose of this study was to examine the effects of a "growth mindset" intervention on the beliefs about intelligence, effort beliefs, achievement goals, and academic self-efficacy of learning disabled (LD) students with reading difficulties. The treatment group consisted of 12 high school LD students with reading difficulties. This…

HIV patient retention: the implementation of a North Carolina clinic-based protocol.

PubMed

Keller, Jennifer; Heine, Amy; LeViere, Anna Finestone; Donovan, Jenna; Wilkin, Aimee; Sullivan, Kristen; Quinlivan, Evelyn Byrd

2017-05-01

Decreased visit attendance leads to poor health outcomes, decreased viral suppression, and higher mortality rates for persons living with HIV. Retention in care is an important factor in improving health status for people living with HIV but continues to be a challenge in clinical settings. This paper details the development and implementation of the NC-LINK Retention Protocol, a clinic-based protocol to locate and reengage out-of-care patients, as part of overall clinic retention efforts. The protocol was implemented as one of four interventions of the NC-LINK Systems and Linkages Project, a multi-site initiative funded by the HIV/AIDS Bureau and the Special Projects of National Significance. Lists of out-of-care patients who had not received HIV medical care in over nine months and did not have a future appointment were created each month. Patient navigators, case managers, and other staff then followed a standardized protocol to locate and reengage these patients in care. A total of 452 patients were identified for reengagement services. Of those, 194 (43%) returned to care, 108 (24%) had another definitive outcome (incarcerated, deceased, or relocated) and 150 (33%) were referred for additional follow-up to locate and reengage in care. In summary, 67% of patients were located through the efforts of the clinic staff. The results of this intervention indicate that it is possible to successfully integrate a protocol into the existing infrastructure of a clinic and reengage a majority of out-of-care patients into medical care.

An Undergraduate Research Fellowship Program to Prepare Nursing Students for Future Workforce Roles

PubMed Central

Slattery, Mary Jo; Logan, Bridget; Mudge, Bridget; Secore, Karen; Von Reyn, LInda J.; Maue, Robert A.

2016-01-01

It is important for nurses today and for those joining the workforce in the future to have familiarity and training with respect to interprofessional research, evidence-based practice, and quality improvement. In an effort to address this need, we describe a 10-week summer research program that immerses undergraduate nursing students in a broad spectrum of clinical and translational research projects as part of their exposure to advanced nursing roles. In doing so, the program increases the ability of the students to participate in research, effectively interact with academic medical center researchers, and incorporate elements of evidence-based practice into future nursing interventions. Their mentors are nurses practicing in roles as nurse researcher, advanced practice nurses involved in evidence-based practice or quality improvement, and clinical trials research nurses. Each student is matched with 3 of these mentors and involved in 3 different projects. Through this exposure, the students benefit from observing multiple nursing roles, taking an active role in research-related activities participating in interdisciplinary learning experiences. Overall, the program provides benefits to the students, who demonstrate measured improvement with respect to the program objectives, and to their mentors and each of the participating organizations. PMID:27964811

The role of tobacco outlet density in a smoking cessation intervention for urban youth.

PubMed

Mennis, Jeremy; Mason, Michael; Way, Thomas; Zaharakis, Nikola

2016-03-01

This study investigates the role of tobacco outlet density in a randomized controlled trial of a text messaging-based smoking cessation intervention conducted among a sample of 187 primarily African American youth in a midsize U.S. city. A moderated mediation model was used to test whether the indirect effect of residential tobacco outlet density on future smoking was mediated by the intention to smoke, and whether this indirect effect differed between adolescents who received the intervention and those who did not. Results indicated that tobacco outlet density is associated with intention to smoke, which predicts future smoking, and that the indirect effect of tobacco outlet density on future smoking is moderated by the intervention. Tobacco outlet density and the intervention can be viewed as competing forces on future smoking behavior, where higher tobacco outlet density acts to mitigate the sensitivity of an adolescent to the intervention's intended effect. Smoking cessation interventions applied to youth should consider tobacco outlet density as a contextual condition that can influence treatment outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of a Decision-Making Curriculum for Teaching Adolescents with Disabilities to Resist Negative Peer Pressure.

PubMed

Khemka, Ishita; Hickson, Linda; Mallory, Sarah B

2016-07-01

This study was designed to assess the impact of a decision-making curriculum (PEER-DM) on the social peer relationship knowledge and self-protective decision-making skills of adolescents with disabilities in hypothetical situations involving negative peer pressure. A randomized design was used to assign students with disabilities from self-contained special education classes to an intervention group (n = 22) or a wait-list control group (n = 20). ANCOVA analyses, using pretest scores as covariates, indicated that students who were trained on PEER-DM had significantly higher effective decision-making action and correct risk perception scores, relative to participants in the control group. This study provides supporting evidence that PEER-DM is a promising intervention for students with disabilities, including those with identified autism spectrum disorders, during transition years to help them develop a better understanding of positive and negative peer relationships and learn systematic decision-making skills for improved handling of social situations in the school and community, especially situations involving negative peer pressure. The study adds credence to using systematic, strategy-based decision making interventions designed to address the cognitive, emotional and motivational processes underlying adolescent decision making in sensitive interpersonal situations involving peer pressure. The study points to the lack of preparedness to handle situations of negative peer pressure as a serious social and health risk for adolescents with disabilities that deserves urgent and concerted attention in transition services programming. Implications for future curriculum-development efforts and replication of treatment findings are discussed. Future research examining disability-specific patterns of decision-making in peer situations and comparisons with typically developing populations is recommended.

Relationships between familial HIV/AIDS and symptoms of anxiety and depression: the mediating effect of bullying victimization in a prospective sample of South African children and adolescents.

PubMed

Boyes, Mark E; Cluver, Lucie D

2015-04-01

South African children and adolescents living in HIV/AIDS-affected families are at elevated risk of both symptoms of anxiety and depressive symptoms. Poverty and HIV/AIDS-related stigma are additional risk factors for these negative mental health outcomes. Community level factors, such as poverty and stigma, are difficult to change in the short term and identifying additional potentially malleable mechanisms linking familial HIV/AIDS with mental health is important from an intervention perspective. HIV/AIDS-affected children are also at increased risk of bullying victimization. This longitudinal study aimed to determine whether prospective relationships between familial HIV/AIDS and both anxiety symptoms and depressive symptoms operate indirectly via bullying victimization. Adolescents (M = 13.45 years, 56.67 % female, n = 3,515) from high HIV-prevalent (>30 %) communities in South Africa were interviewed and followed-up one year later (n = 3,401, 96.70 % retention). Census enumeration areas were randomly selected from urban and rural sites in two provinces, and door-to-door sampling included all households with a resident child/adolescent. Familial HIV/AIDS at baseline assessment was not directly associated with mental health outcomes 1 year later. However, significant indirect effects operating via bullying victimization were obtained for both anxiety and depression scores. Importantly, these effects were independent of poverty, HIV/AIDS-related stigma, and baseline mental health, which highlight bullying victimization as a potential target for future intervention efforts. The implementation and rigorous evaluation of bullying prevention programs in South African communities may improve mental health outcomes for HIV/AIDS-affected children and adolescents and this should be a focus of future research and intervention.

Dating and substance use in adolescent peer networks: a replication and extension.

PubMed

Kreager, Derek A; Haynie, Dana L; Hopfer, Suellen

2013-03-01

The current report examined associations between romantic partner, peer and individual substance use behaviors in a sample of American adolescents. The report used two waves of data (8th and 9th grades) from the Partnerships to Enhance Resilience (PROSPER) intervention project and focused on dating couples and their friends in 54 sampled school-cohorts. Hierarchical logistic regression models examined the associations between friend, partner and friend-of-partner substance use and daters' future drinking and smoking. Surveys administered in rural Pennsylvania and Iowa secondary schools. A total of 744 dating couples. Student participants completed questionnaires that assessed substance use, background characteristics and dating and friend nominations. Friend, partner and friend-of-partner substance use were assessed at each wave directly from respective reports. Consistent with a bridging hypothesis, friends-of-partner drinking had a strong and independent association with subsequent drunkenness (b = 1.40, P < 0.01) and drinking (b = 0.82, P < 0.01) among daters, and these associations did not vary by gender. A similar association was not observed for smoking, where partner (b = 0.77, P < 0.01) and direct friends (b = 1.19, P < 0.05) smoking showed strong and significant associations with future smoking, but friends-of-partner smoking did not (b = -0.44, P > 0.10). Romantic partner and peer behaviors have substantially different associations with adolescent drinking and smoking. Intervention efforts aimed at reducing teenage smoking should be aimed at proximal peer and romantic relationships, whereas interventions of teenage drinking should also include the wider circle of indirect friends. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

Desarrollo de una intervención grupal para la prevención del VIH en parejas heterosexuales.

PubMed

Pérez-Jiménez, David; Escabí Montalvo, Aracelis; Del Carmen Cabrera Aponte, María

2010-01-01

HIV preventive efforts with heterosexual couples are almost nonexistent. We designed a group intervention based on the Information-Motivation-Behavioral Skills model with the aim of increasing male condom use and promoting the practice of mutual masturbation as a safer sex alternative. We carried out a pilot study with four couples to evaluate the feasibility of the intervention and the aspects of content and format that needed to be modified. Findings reflect that participants were very satisfied with the intervention and they found it entertaining and innovative. They were very comfortable with its format, as well as with the activities. The findings confirm the feasibility of this intervention and the need to direct preventive efforts to this population.

77 FR 29351 - Disease, Disability, and Injury Prevention and Control; Special Interest Projects (SIPs): Initial...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-17

... Indoor Tanning among Young Adults to Inform Future Public Health Policy Efforts to Prevent Skin Cancer... Frequent Indoor Tanning among Young Adults to Inform Future Public Health Policy Efforts to Prevent Skin...

The role of conversation in health care interventions: enabling sensemaking and learning.

PubMed

Jordan, Michelle E; Lanham, Holly J; Crabtree, Benjamin F; Nutting, Paul A; Miller, William L; Stange, Kurt C; McDaniel, Reuben R

2009-03-13

Those attempting to implement changes in health care settings often find that intervention efforts do not progress as expected. Unexpected outcomes are often attributed to variation and/or error in implementation processes. We argue that some unanticipated variation in intervention outcomes arises because unexpected conversations emerge during intervention attempts. The purpose of this paper is to discuss the role of conversation in shaping interventions and to explain why conversation is important in intervention efforts in health care organizations. We draw on literature from sociolinguistics and complex adaptive systems theory to create an interpretive framework and develop our theory. We use insights from a fourteen-year program of research, including both descriptive and intervention studies undertaken to understand and assist primary care practices in making sustainable changes. We enfold these literatures and these insights to articulate a common failure of overlooking the role of conversation in intervention success, and to develop a theoretical argument for the importance of paying attention to the role of conversation in health care interventions. Conversation between organizational members plays an important role in the success of interventions aimed at improving health care delivery. Conversation can facilitate intervention success because interventions often rely on new sensemaking and learning, and these are accomplished through conversation. Conversely, conversation can block the success of an intervention by inhibiting sensemaking and learning. Furthermore, the existing relationship contexts of an organization can influence these conversational possibilities. We argue that the likelihood of intervention success will increase if the role of conversation is considered in the intervention process. The generation of productive conversation should be considered as one of the foundations of intervention efforts. We suggest that intervention facilitators consider the following actions as strategies for reducing the barriers that conversation can present and for using conversation to leverage improvement change: evaluate existing conversation and relationship systems, look for and leverage unexpected conversation, create time and space where conversation can unfold, use conversation to help people manage uncertainty, use conversation to help reorganize relationships, and build social interaction competence.

The role of conversation in health care interventions: enabling sensemaking and learning

PubMed Central

Jordan, Michelle E; Lanham, Holly J; Crabtree, Benjamin F; Nutting, Paul A; Miller, William L; Stange, Kurt C; McDaniel, Reuben R

2009-01-01

Background Those attempting to implement changes in health care settings often find that intervention efforts do not progress as expected. Unexpected outcomes are often attributed to variation and/or error in implementation processes. We argue that some unanticipated variation in intervention outcomes arises because unexpected conversations emerge during intervention attempts. The purpose of this paper is to discuss the role of conversation in shaping interventions and to explain why conversation is important in intervention efforts in health care organizations. We draw on literature from sociolinguistics and complex adaptive systems theory to create an interpretive framework and develop our theory. We use insights from a fourteen-year program of research, including both descriptive and intervention studies undertaken to understand and assist primary care practices in making sustainable changes. We enfold these literatures and these insights to articulate a common failure of overlooking the role of conversation in intervention success, and to develop a theoretical argument for the importance of paying attention to the role of conversation in health care interventions. Discussion Conversation between organizational members plays an important role in the success of interventions aimed at improving health care delivery. Conversation can facilitate intervention success because interventions often rely on new sensemaking and learning, and these are accomplished through conversation. Conversely, conversation can block the success of an intervention by inhibiting sensemaking and learning. Furthermore, the existing relationship contexts of an organization can influence these conversational possibilities. We argue that the likelihood of intervention success will increase if the role of conversation is considered in the intervention process. Summary The generation of productive conversation should be considered as one of the foundations of intervention efforts. We suggest that intervention facilitators consider the following actions as strategies for reducing the barriers that conversation can present and for using conversation to leverage improvement change: evaluate existing conversation and relationship systems, look for and leverage unexpected conversation, create time and space where conversation can unfold, use conversation to help people manage uncertainty, use conversation to help reorganize relationships, and build social interaction competence. PMID:19284660

Improving the health of mental health staff through exercise interventions: a systematic review.

PubMed

Fibbins, Hamish; Ward, Philip B; Watkins, Andrew; Curtis, Jackie; Rosenbaum, Simon

2018-04-01

Exercise interventions are efficacious in reducing cardiometabolic risk and improving symptoms in people with severe mental illness, yet evidence guiding the implementation and scalability of such efforts is lacking. Given increasing efforts to address the disparity in physical health outcomes facing people with a mental illness, novel approaches to increasing adoption of effective interventions are required. Exercise interventions targeting mental health staff may improve staff health while also creating more positive attitudes towards the role of lifestyle interventions for people experiencing mental illness. We aimed to determine the feasibility, acceptability and effectiveness of exercise interventions delivered to staff working in mental health services. A systematic review was conducted from database inception, until November 2017. Studies recruiting staff participants to receive an exercise intervention were eligible for inclusion. Five studies met the inclusion criteria. Physical health interventions for mental health staff were feasible and acceptable with low dropout rates. Reductions in anthropometric measures and work-related stress were reported. Limited evidence suggests that exercise interventions targeting mental health staff are feasible and acceptable. Further research is required to determine the efficacy of such interventions and the impact such strategies may have on staff culture and patient outcomes.

The Built Environment and Child Health: An Overview of Current Evidence.

PubMed

Gascon, Mireia; Vrijheid, Martine; Nieuwenhuijsen, Mark J

2016-09-01

Urbanization and the shaping of the built environment have provided a number of socioeconomic benefits, but they have also brought unwanted side effects on health. We aimed to review the current epidemiological evidence of the associations between the built environment, closely related exposures, and child health. We focused on growth and obesity, neuropsychological development, and respiratory and immune health. We used existing review articles and supplemented these with relevant work published and not included in existing reviews. The present review shows that there is good evidence for an association between air pollution and fetal growth restriction and respiratory health, whereas for other exposure and outcome combinations, further evidence is needed. Future studies should make efforts to integrate the different built environment features and to include the evaluation of environments other than home, as well as accessibility, qualitative and perception assessment of the built environment, and, if possible, with improved and standardized tools to facilitate comparability between studies. Efforts are also needed to conduct longitudinal and intervention studies and to understand potential mechanisms behind the associations observed. Finally, studies in low- and middle-income countries are needed.

Meeting Report: Pancreatic Cancer Chemoprevention Translational Workshop

PubMed Central

Miller, Mark Steven; Allen, Peter; Brentnall, Teresa; Goggins, Michael; Hruban, Ralph H.; Petersen, Gloria M.; Rao, Chinthalapally V.; Whitcomb, David C.; Brand, Randall E.; Chari, Suresh; Klein, Alison; Lubman, David; Rhim, Andrew; Simeone, Diane M.; Wolpin, Brian; Umar, Asad; Srivastava, Sudhir; Steele, Vernon E.; Ann Rinaudo, Jo

2016-01-01

Pancreatic cancer is the 4th leading cause of cancer related deaths in the US with a 5 year survival rate of <10%. The Division of Cancer Prevention of the NCI sponsored the Pancreatic Cancer Chemoprevention Translational Workshop on September 10–11th 2015. The goal of the workshop was to obtain information regarding the current state of the science and future scientific areas that should be prioritized for pancreatic cancer prevention research, including early detection and intervention for high-risk precancerous lesions. The workshop addressed the molecular/genetic landscape of pancreatic cancer and precursor lesions; high risk populations and criteria to identify a high risk population for potential chemoprevention trials; identification of chemopreventative/immuopreventative agents; and use of potential biomarkers and imaging for assessing short term efficacy of a preventative agent. The field of chemoprevention for pancreatic cancer is emerging and this workshop was organized to begin to address these important issues and promote multi-institutional efforts in this area. The meeting participants recommended the development of an NCI working group to coordinate efforts, provide a framework, and identify opportunities for chemoprevention of pancreatic cancer. PMID:27518363

A two-month follow-up evaluation testing interventions to limit the emergence and spread of antimicrobial resistant bacteria among Maasai of northern Tanzania.

PubMed

Roulette, Casey J; Caudell, Mark A; Roulette, Jennifer W; Quinlan, Robert J; Quinlan, Marsha B; Subbiah, Murugan; Call, Douglas R

2017-12-15

In sub-Saharan Africa, efforts to control antimicrobial resistance (AMR) are aggravated by unregulated drug sales and use, and high connectivity between human, livestock, and wildlife populations. Our previous research indicates that Maasai agropastoralists-who have high exposure to livestock and livestock products and self-administer veterinary antibiotics-harbor antibiotic resistant Escherichia coli (E. coli). Here, we report the results of a public health intervention project among Maasai aimed at reducing selection and transmission of E. coli bacteria. Research was conducted in two Maasai communities in Northern Tanzania. Participants were provided with health knowledge and technological innovations to facilitate: 1) the prudent use of veterinary antibiotics (tape measures and dosage charts to calculate livestock weight for more accurate dosage), and, 2) the pasteurization of milk (thermometers), the latter of which was motivated by findings of high levels of resistant E. coli in Maasai milk. To determine knowledge retention and intervention adoption, we conducted a two-month follow-up evaluation in the largest of the two communities. Retention of antimicrobial knowledge was positively associated with retention of bacterial knowledge and, among men, retention of bacterial knowledge was associated with greater wealth. Bacterial and AMR knowledge were not, however, associated with self-reported use of the innovations. Among women, self-reported use of the thermometers was associated with having more children and greater retention of knowledge about the health benefits of the innovations. Whereas 70% of women used their innovations correctly, men performed only 18% of the weight-estimation steps correctly. Men's correct use was associated with schooling, such that high illiteracy rates remain an important obstacle to the dissemination and diffusion of weight-estimation materials. Our results indicate that dietary preferences for unboiled milk, concerns over child health, and a desire to improve the health of livestock are important cultural values that need to be incorporated in future AMR-prevention interventions that target Maasai populations. More generally, these findings inform future community-health interventions to limit AMR.

Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions

PubMed Central

Williams, Emily C.; Hahn, Judith A.; Saitz, Richard; Bryant, Kendall; Lira, Marlene C.; Samet, Jeffrey H.

2016-01-01

Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol’s impact on transmission, care, co-infections and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV. Alcohol use appears to have additive and potentially synergistic effects on common HIV-related comorbidities. We find that interventions to modify drinking and improve HIV-related risks and outcomes have had limited success to date, and we recommend research in several areas. Consistent with Office of AIDS Research/National Institutes of Health priorities, we suggest research to better understand how and at what levels alcohol influences comorbid conditions among PLWH, to elucidate the mechanisms by which alcohol use is impacting comorbidities, and to understand whether decreases in alcohol use improve HIV-relevant outcomes. This should include studies regarding whether state-of-the-art medications used to treat common co-infections are safe for PLWH who drink alcohol. We recommend that future research among PLWH include validated self-report measures of alcohol use and/or biological measurements, ideally both. Additionally, subgroup variation in associations should be identified to ensure that the risks of particularly vulnerable populations are understood. This body of research should serve as a foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol-related interventions and treatments for PLWH in healthcare settings. By making further progress on understanding how alcohol use affects PLWH in the era of HIV as a chronic condition, this research should inform how we can mitigate transmission, achieve viral suppression, avoid exacerbating common comorbidities of HIV and alcohol use and make progress toward the 90-90-90 goals for engagement in the HIV treatment cascade. PMID:27696523

Spatial distribution and cluster analysis of retail drug shop characteristics and antimalarial behaviors as reported by private medicine retailers in western Kenya: informing future interventions.

PubMed

Rusk, Andria; Highfield, Linda; Wilkerson, J Michael; Harrell, Melissa; Obala, Andrew; Amick, Benjamin

2016-02-19

Efforts to improve malaria case management in sub-Saharan Africa have shifted focus to private antimalarial retailers to increase access to appropriate treatment. Demands to decrease intervention cost while increasing efficacy requires interventions tailored to geographic regions with demonstrated need. Cluster analysis presents an opportunity to meet this demand, but has not been applied to the retail sector or antimalarial retailer behaviors. This research conducted cluster analysis on medicine retailer behaviors in Kenya, to improve malaria case management and inform future interventions. Ninety-seven surveys were collected from medicine retailers working in the Webuye Health and Demographic Surveillance Site. Survey items included retailer training, education, antimalarial drug knowledge, recommending behavior, sales, and shop characteristics, and were analyzed using Kulldorff's spatial scan statistic. The Bernoulli purely spatial model for binomial data was used, comparing cases to controls. Statistical significance of found clusters was tested with a likelihood ratio test, using the null hypothesis of no clustering, and a p value based on 999 Monte Carlo simulations. The null hypothesis was rejected with p values of 0.05 or less. A statistically significant cluster of fewer than expected pharmacy-trained retailers was found (RR = .09, p = .001) when compared to the expected random distribution. Drug recommending behavior also yielded a statistically significant cluster, with fewer than expected retailers recommending the correct antimalarial medication to adults (RR = .018, p = .01), and fewer than expected shops selling that medication more often than outdated antimalarials when compared to random distribution (RR = 0.23, p = .007). All three of these clusters were co-located, overlapping in the northwest of the study area. Spatial clustering was found in the data. A concerning amount of correlation was found in one specific region in the study area where multiple behaviors converged in space, highlighting a prime target for interventions. These results also demonstrate the utility of applying geospatial methods in the study of medicine retailer behaviors, making the case for expanding this approach to other regions.

Micro-costing studies in the health and medical literature: protocol for a systematic review

PubMed Central

2014-01-01

Background Micro-costing is a cost estimation method that allows for precise assessment of the economic costs of health interventions. It has been demonstrated to be particularly useful for estimating the costs of new interventions, for interventions with large variability across providers, and for estimating the true costs to the health system and to society. However, existing guidelines for economic evaluations do not provide sufficient detail of the methods and techniques to use when conducting micro-costing analyses. Therefore, the purpose of this study is to review the current literature on micro-costing studies of health and medical interventions, strategies, and programs to assess the variation in micro-costing methodology and the quality of existing studies. This will inform current practice in conducting and reporting micro-costing studies and lead to greater standardization in methodology in the future. Methods/Design We will perform a systematic review of the current literature on micro-costing studies of health and medical interventions, strategies, and programs. Using rigorously designed search strategies, we will search Ovid MEDLINE, EconLit, BIOSIS Previews, Embase, Scopus, and the National Health Service Economic Evaluation Database (NHS EED) to identify relevant English-language articles. These searches will be supplemented by a review of the references of relevant articles identified. Two members of the review team will independently extract detailed information on the design and characteristics of each included article using a standardized data collection form. A third reviewer will be consulted to resolve discrepancies. We will use checklists that have been developed for critical appraisal of health economics studies to evaluate the quality and potential risk of bias of included studies. Discussion This systematic review will provide useful information to help standardize the methods and techniques for conducting and reporting micro-costing studies in research, which can improve the quality and transparency of future studies and enhance comparability and interpretation of findings. In the long run, these efforts will facilitate clinical and health policy decision-making about resource allocation. Trial registration Systematic review registration: PROSPERO CRD42014007453. PMID:24887208

A Changing Landscape for Vitamin A Programs: Implications for Optimal Intervention Packages, Program Monitoring, and Safety.

PubMed

Klemm, Rolf D W; Palmer, Amanda C; Greig, Alison; Engle-Stone, Reina; Dalmiya, Nita

2016-06-01

Vitamin A deficiency (VAD) remains a widespread public health problem in the developing world, despite changes in under-5 mortality rates, morbidity patterns, and intervention options. This article considers the implications of a changing epidemiologic and programmatic landscape for vitamin A (VA) programs. We review progress to prevent VAD and its health consequences, assess gaps in VA status and intervention coverage data, and assess data needed to guide decisions regarding the optimal mix, targeting, and dose of VA interventions to maximize benefit and minimize risk. Vitamin A supplementation programs have contributed to the reduction in under-5 mortality rates, but alone, do not address the underlying problem of inadequate dietary VA intakes and VAD among preschool-aged children in the developing world. A combination of VA interventions (eg, supplementation, fortified foods, multiple micronutrient powders, and lipid-based nutrient supplements) will be required to achieve VA adequacy in most settings. Current efforts to measure the coverage of multiple VA interventions, as well as whether and how much VA children are receiving, are few and fragmented. Where intervention overlap exists, further effort is needed to monitor VA intakes, ensuring that targeted groups are consuming adequate amounts but not exceeding the tolerable upper intake level. Vitamin A status data will also be critical for navigating the changing landscape of VA programs. Data from these monitoring efforts will help to guide decisions on the optimal mix, targeting, and exposure to VA interventions to maximize public health benefit while minimizing any potential risk. © The Author(s) 2016.

Taking innovative vector control interventions in urban Latin America to scale: lessons learnt from multi-country implementation research.

PubMed

Quintero, Juliana; García-Betancourt, Tatiana; Caprara, Andrea; Basso, Cesar; Garcia da Rosa, Elsa; Manrique-Saide, Pablo; Coelho, Giovanini; Sánchez-Tejeda, Gustavo; Dzul-Manzanilla, Felipe; García, Diego Alejandro; Carrasquilla, Gabriel; Alfonso-Sierra, Eduardo; Monteiro Vasconcelos Motta, Cyntia; Sommerfeld, Johannes; Kroeger, Axel

2017-09-01

Prior to the current public health emergency following the emergence of chikungunya and Zika Virus Disease in the Americas during 2014 and 2015, multi-country research investigated between 2011 and 2013 the efficacy of novel Aedes aegypti intervention packages through cluster randomised controlled trials in four Latin-American cities: Fortaleza (Brazil); Girardot (Colombia), Acapulco (Mexico) and Salto (Uruguay). Results from the trials led to a scaling up effort of the interventions at city levels. Scaling up refers to deliberate efforts to increase the impact of successfully tested health interventions to benefit more people and foster policy and program development in a sustainable way. The different scenarios represent examples for  a 'vertical approach' and a 'horizontal approach'. This paper presents the analysis of a preliminary process evaluation of the scaling up efforts in the mentioned cites, with a focus on challenges and enabling factors encountered by the research teams, analysing the main social, political, administrative, financial and acceptance factors.

Peer volunteer perspectives following a complex social cognitive intervention: a qualitative investigation.

PubMed

McHugh, J E; Lee, O; Aspell, N; Connolly, L; Lawlor, B A; Brennan, S

2016-09-01

Peer volunteers can be key to delivering effective social cognitive interventions due to increased potential for social modeling. We consulted peer volunteers who had just taken part in an 8-week social and nutritional mealtime intervention with older adults living alone, to seek their evaluation of the intervention. Semi-structured focus groups were used with a total of 21 volunteers (17 female) and two facilitators. Thematic analysis was used to interrogate the data. Six themes (16 sub-themes) are discussed. Peer volunteers described the importance of the socializing aspect of the intervention, of pairing considerations and compatibility in peer interventions, of considering the needs of the participant, of benefits to the volunteers, and of the practical considerations of conducting an intervention. Volunteers also discussed considerations for future research and services for older adults living alone. Volunteers found their involvement in the intervention to be personally beneficial, and revealed some valuable considerations for the researchers to take forward to future research. Results are pertinent to intervention design and could inform future social cognitive and other peer-oriented interventions for older adults living alone.

A Comparison of Dance Interventions in People with Parkinson Disease and Older Adults

PubMed Central

McNeely, ME; Duncan, RP; Earhart, GE

2015-01-01

It is important for our aging population to remain active, particularly those with chronic diseases, like Parkinson disease (PD), which limit mobility. Recent studies in older adults and people with PD suggest dance interventions provide various motor benefits. The literature for dance in PD is growing, but many knowledge gaps remain, relative to what is known in older adults. The purpose of this review is to: 1) detail results of dance intervention studies in older adults and in PD, 2) describe limitations of dance research in these populations, and 3) identify directions for future study. Generally, a wide variety of dance styles have been investigated in older adults, while a more limited subset has been evaluated in PD. Measures vary widely across studies and a lack of standardized outcomes measures hinders cross-studies comparisons. Compared to the dance literature in older adults, there is a notable absence of evidence in the PD literature in outcome domains related to cardiovascular health, muscle strength, body composition, flexibility, and proprioception. As a whole, the dance literature supports substantial and wide-ranging benefits in both populations, but additional effort should be dedicated to well-designed comparative studies using standardized outcome measures to identify optimal treatment programs. PMID:25771040

A comparison of dance interventions in people with Parkinson disease and older adults.

PubMed

McNeely, M E; Duncan, R P; Earhart, G M

2015-05-01

It is important for our aging population to remain active, particularly those with chronic diseases, like Parkinson disease (PD), which limit mobility. Recent studies in older adults and people with PD suggest dance interventions provide various motor benefits. The literature for dance in PD is growing, but many knowledge gaps remain, relative to what is known in older adults. The purpose of this review is to: (1) detail results of dance intervention studies in older adults and in PD, (2) describe limitations of dance research in these populations, and (3) identify directions for future study. Generally, a wide variety of dance styles have been investigated in older adults, while a more limited subset has been evaluated in PD. Measures vary widely across studies and a lack of standardized outcomes measures hinders cross-studies comparisons. Compared to the dance literature in older adults, there is a notable absence of evidence in the PD literature in outcome domains related to cardiovascular health, muscle strength, body composition, flexibility, and proprioception. As a whole, the dance literature supports substantial and wide-ranging benefits in both populations, but additional effort should be dedicated to well-designed comparative studies using standardized outcome measures to identify optimal treatment programs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

What is needed to eliminate new pediatric HIV infections: The contribution of model-based analyses

PubMed Central

Doherty, Katie; Ciaranello, Andrea

2013-01-01

Purpose of Review Computer simulation models can identify key clinical, operational, and economic interventions that will be needed to achieve the elimination of new pediatric HIV infections. In this review, we summarize recent findings from model-based analyses of strategies for prevention of mother-to-child HIV transmission (MTCT). Recent Findings In order to achieve elimination of MTCT (eMTCT), model-based studies suggest that scale-up of services will be needed in several domains: uptake of services and retention in care (the PMTCT “cascade”), interventions to prevent HIV infections in women and reduce unintended pregnancies (the “four-pronged approach”), efforts to support medication adherence through long periods of pregnancy and breastfeeding, and strategies to make breastfeeding safer and/or shorter. Models also project the economic resources that will be needed to achieve these goals in the most efficient ways to allocate limited resources for eMTCT. Results suggest that currently recommended PMTCT regimens (WHO Option A, Option B, and Option B+) will be cost-effective in most settings. Summary Model-based results can guide future implementation science, by highlighting areas in which additional data are needed to make informed decisions and by outlining critical interventions that will be necessary in order to eliminate new pediatric HIV infections. PMID:23743788

Exploring Instructional Strategies and Learning Theoretical Foundations of eHealth and mHealth Education Interventions.

PubMed

Tamim, Suha R; Grant, Michael M

2016-05-19

This qualitative study aimed at exploring how health professionals use theories and models from the field of education to create ehealth and mhealth education interventions in an effort to provide insights for future research and practice on the development and implementation of health promotion initiatives. A purposeful sample of 12 participants was selected, using criterion and snowballing sampling strategies. Data were collected and analyzed from semistructured interviews, planning materials, and artifacts. The findings revealed that none of the participants used a specific learning theory or an instructional model in their interventions. However, based on participants' description, three themes emerged: (1) connections to behaviorist approaches to learning, (2) connections to cognitivist approaches to learning, and (3) connections to constructivist approaches to learning. Suggested implications for practice are (1) the design of a guidebook on the interplay of learning theories, instructional models, and health education and (2) the establishment of communities of practice. Further research can (1) investigate how learning theories and models intertwine with health behavior theories and models, (2) evaluate how the different instructional strategies presented in this study affect learning outcomes and health behavior change processes, and (3) investigate factors behind the instructional strategies choices made by health professionals. © 2016 Society for Public Health Education.

Intervention for individuals with fetal alcohol spectrum disorders: treatment approaches and case management.

PubMed

Paley, Blair; O'Connor, Mary J

2009-01-01

Exposure to alcohol in utero is considered to be the leading cause of developmental disabilities of known etiology. The most severe consequence of such exposure, fetal alcohol syndrome (FAS), is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system (CNS) dysfunction. Some individuals with prenatal alcohol exposure (PAE) do not meet the full criteria for FAS, but instead are diagnosed with partial FAS, alcohol related neurodevelopmental disorder (ARND), or alcohol related birth defects (ARBD). The entire continuum of effects from PAE is increasingly being referred to under the umbrella term of fetal alcohol spectrum disorders (FASDs). An extensive body of research has documented major cognitive, behavioral, adaptive, social, and emotional impairments among individuals with FASDs. Although FAS was identified in the U.S. over 35 years ago, the development, evaluation, and dissemination of evidence-based interventions for individuals with FASDs have lagged behind significantly. Encouragingly, however, in recent years there has been a marked increase in efforts to design and test interventions to remediate the impairments associated with prenatal alcohol exposure. This article will review treatment needs and considerations for individuals with FASDs and their families, current empirically tested treatment approaches, case management issues, and suggestions for future directions in research on the treatment of FASDs. (c) 2009 Wiley-Liss, Inc.

Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs.

PubMed

Yoshida, Yilin; Simoes, Eduardo J

2018-04-18

Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives. Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist. The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.

Assessing the Social Skills and Problem Behaviors of Adolescents With Severe Disabilities Enrolled in General Education Classes.

PubMed

Lyons, Gregory L; Huber, Heartley B; Carter, Erik W; Chen, Rui; Asmus, Jennifer M

2016-07-01

Although enhancing the social competence of students with severe disabilities has long remained a prominent focus of school-based intervention efforts, relatively little attention has focused on identifying the most critical social and behavioral needs of students during high school. We examined the social skills and problem behaviors of 137 adolescents with severe disabilities from the vantage point of both special educators and parents. We sought to identify areas of potential intervention need, explore factors associated with social skill and problem behavior ratings, and examine the extent to which teachers and parents converged in their assessments of these needs. Our findings indicate teachers and parents of high school students with severe disabilities rated social skills as considerably below average and problem behaviors as above average. In addition, lower social skills ratings were evident for students with greater support needs, lower levels of overall adaptive behavior, and a special education label of autism. We found moderate consistency in the degree to which teachers and parents aligned in their assessments of both social skills and problem behavior. We offer recommendations for assessment and intervention focused on strengthening the social competence of adolescents with severe disabilities within secondary school classrooms, as well as promising avenues for future research.

Support for Training Effectiveness Assessment and Data Interoperability (STEADI)

DTIC Science & Technology

2017-05-02

will guide future efforts of the services to broadly incorporate IPA concepts across the continuum of training . Throughout the course of this effort...data access issues for marksmanship training systems. In comparison to updating Pipeline, the registry also offered more flexibility, eased future...development would be required, SP2 offers a good starting point to accelerate development efforts and lower costs to ARL. Acting as the central glue

Medical societies, patient education initiatives, public debate and marketing of unproven stem cell interventions.

PubMed

Weiss, Daniel J; Turner, Leigh; Levine, Aaron D; Ikonomou, Laertis

2018-02-01

Businesses marketing unproven stem cell interventions proliferate within the U.S. and in the larger global marketplace. There have been global efforts by scientists, patient advocacy groups, bioethicists, and public policy experts to counteract the uncontrolled and premature commercialization of stem cell interventions. In this commentary, we posit that medical societies and associations of health care professionals have a particular responsibility to be an active partner in such efforts. We review the role medical societies can and should play in this area through patient advocacy and awareness initiatives. Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

The Effects of 6 Months of Progressive High Effort Resistance Training Methods upon Strength, Body Composition, Function, and Wellbeing of Elderly Adults.

PubMed

Steele, James; Raubold, Kristin; Kemmler, Wolfgang; Fisher, James; Gentil, Paulo; Giessing, Jürgen

2017-01-01

The present study examined the progressive implementation of a high effort resistance training (RT) approach in older adults over 6 months and through a 6-month follow-up on strength, body composition, function, and wellbeing of older adults. Twenty-three older adults (aged 61 to 80 years) completed a 6-month supervised RT intervention applying progressive introduction of higher effort set end points. After completion of the intervention participants could choose to continue performing RT unsupervised until 6-month follow-up. Strength, body composition, function, and wellbeing all significantly improved over the intervention. Over the follow-up, body composition changes reverted to baseline values, strength was reduced though it remained significantly higher than baseline, and wellbeing outcomes were mostly maintained. Comparisons over the follow-up between those who did and those who did not continue with RT revealed no significant differences for changes in any outcome measure. Supervised RT employing progressive application of high effort set end points is well tolerated and effective in improving strength, body composition, function, and wellbeing in older adults. However, whether participants continued, or did not, with RT unsupervised at follow-up had no effect on outcomes perhaps due to reduced effort employed during unsupervised RT.

Behaviour change intervention to improve shared toilet maintenance and cleanliness in urban slums of Dhaka: a cluster-randomised controlled trial.

PubMed

Alam, Mahbub-Ul; Winch, Peter J; Saxton, Ronald E; Nizame, Fosiul A; Yeasmin, Farzana; Norman, Guy; Masud, Abdullah-Al; Begum, Farzana; Rahman, Mahbubur; Hossain, Kamal; Layden, Anita; Unicomb, Leanne; Luby, Stephen P

2017-08-01

Shared toilets in urban slums are often unclean and poorly maintained, discouraging consistent use and thereby limiting impacts on health and quality of life. We developed behaviour change interventions to support shared toilet maintenance and improve user satisfaction. We report the intervention effectiveness on improving shared toilet cleanliness. We conducted a cluster-randomised controlled trial among users of 1226 shared toilets in 23 Dhaka slums. We assessed baseline toilet cleanliness in January 2015. The six-month intervention included provision of hardware (bin for solid waste, 4 l flushing bucket, 70 l water reservoir), and behaviour change communication (compound meetings, interpersonal household sessions, signs depicting rules for toilet use). We estimated the adjusted difference in difference (DID) to assess outcomes and accounted for clustering effects using generalised estimating equations. Compared to controls, intervention toilets were more likely to have water available inside toilet cubicles (DID: +4.7%, 95% CI: 0.2, 9.2), access to brush/broom for cleaning (DID: +8.4%, 95% CI: 2, 15) and waste bins (DID: +63%, 95% CI: 59, 66), while less likely to have visible faeces inside the pan (DID: -13%, 95% CI: -19, -5), the smell of faeces (DID: -7.6%, 95% CI: -14, -1.3) and household waste inside the cubicle (DID: -4%, 95% CI: -7, -1). In one of few efforts to promote shared toilet cleanliness, intervention compounds were significantly more likely to have cleaner toilets after six months. Future research might explore how residents can self-finance toilet maintenance, or employ mass media to reduce per-capita costs of behaviour change. © 2017 John Wiley & Sons Ltd.

Innovative approaches for improving maternal and newborn health--A landscape analysis.

PubMed

Lunze, Karsten; Higgins-Steele, Ariel; Simen-Kapeu, Aline; Vesel, Linda; Kim, Julia; Dickson, Kim

2015-12-17

Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle-income countries, but their implementation has been challenging. Innovative MNH approaches have the potential to accelerate progress and to lead to better health outcomes for women and newborns, but their added value to health systems remains incompletely understood. This study's aim was to analyze the landscape of innovative MNH approaches and related published evidence. Systematic literature review and descriptive analysis based on the MNH continuum of care framework and the World Health Organization health system building blocks, analyzing the range and nature of currently published MNH approaches that are considered innovative. We used 11 databases (MedLine, Web of Science, CINAHL, Cochrane, Popline, BLDS, ELDIS, 3ie, CAB direct, WHO Global Health Library and WHOLIS) as data source and extracted data according to our study protocol. Most innovative approaches in MNH are iterations of existing interventions, modified for contexts in which they had not been applied previously. Many aim at the direct organization and delivery of maternal and newborn health services or are primarily health workforce interventions. Innovative approaches also include health technologies, interventions based on community ownership and participation, and novel models of financing and policy making. Rigorous randomized trials to assess innovative MNH approaches are rare; most evaluations are smaller pilot studies. Few studies assessed intervention effects on health outcomes or focused on equity in health care delivery. Future implementation and evaluation efforts need to assess innovations' effects on health outcomes and provide evidence on potential for scale-up, considering cost, feasibility, appropriateness, and acceptability. Measuring equity is an important aspect to identify and target population groups at risk of service inequity. Innovative MNH interventions will need innovative implementation, evaluation and scale-up strategies for their sustainable integration into health systems.

Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis.

PubMed

Marie, N; Luckett, T; Davidson, P M; Lovell, M; Lal, S

2013-12-01

Previous systematic reviews have found patient education to be moderately efficacious in decreasing the intensity of cancer pain, but variation in results warrants analysis aimed at identifying which strategies are optimal. A systematic review and meta-analysis was undertaken using a theory-based approach to classifying and comparing educational interventions for cancer pain. The reference lists of previous reviews and MEDLINE, PsycINFO, and CENTRAL were searched in May 2012. Studies had to be published in a peer-reviewed English language journal and compare the effect on cancer pain intensity of education with usual care. Meta-analyses used standardized effect sizes (ES) and a random effects model. Subgroup analyses compared intervention components categorized using the Michie et al. (Implement Sci 6:42, 2011) capability, opportunity, and motivation behavior (COM-B) model. Fifteen randomized controlled trials met the criteria. As expected, meta-analysis identified a small-moderate ES favoring education versus usual care (ES, 0.27 [-0.47, -0.07]; P = 0.007) with substantial heterogeneity (I² = 71 %). Subgroup analyses based on the taxonomy found that interventions using "enablement" were efficacious (ES, 0.35 [-0.63, -0.08]; P = 0.01), whereas those lacking this component were not (ES, 0.18 [-0.46, 0.10]; P = 0.20). However, the subgroup effect was nonsignificant (P = 0.39), and heterogeneity was not reduced. Factoring in the variable of individualized versus non-individualized influenced neither efficacy nor heterogeneity. The current meta-analysis follows a trend in using theory to understand the mechanisms of complex interventions. We suggest that future efforts focus on interventions that target patient self-efficacy. Authors are encouraged to report comprehensive details of interventions and methods to inform synthesis, replication, and refinement.

Targeting Health Behaviors to Reduce Health Care Costs in Pediatric Psychology: Descriptive Review and Recommendations

PubMed Central

Hommel, Kevin A.

2016-01-01

Objective Recent efforts to enhance the quality of health care in the United States while reducing costs have resulted in an increased emphasis on cost containment and the introduction of new payment plans. The purpose of this review is to summarize the impact of pediatric health behavior change interventions on health care costs. Methods A review of PubMed, PsycINFO, and PEDE databases identified 15 articles describing the economic outcomes of pediatric health behavior change interventions. Data describing the intervention, health outcome, and economic outcome were extracted. Results All interventions targeting cigarette smoking (n = 3) or the prevention of a chronic medical condition (n = 5) were predicted to avert hundreds of dollars in health care costs per patient. Five of the seven interventions targeting self-management were associated with reductions in health care costs. Conclusions Pediatric health behavior change interventions may be a valuable component of efforts to improve population health while reducing health care costs. PMID:26359311

Taking care of suicidal patients with new technologies and reaching-out means in the post-discharge period

PubMed Central

Falcone, Giulia; Nardella, Adele; Lamis, Dorian A; Erbuto, Denise; Girardi, Paolo; Pompili, Maurizio

2017-01-01

Suicide is a global public health problem with over one million people dying by suicide each year worldwide. Research efforts have focused on developing and testing novel suicide prevention strategies employing recent technological advances. In order to provide a review regarding the role of new technologies (e.g., postcards/letters, text messages, crisis cards, telephone contacts, online interventions) in suicide prevention, we searched PubMed, ScienceDirect, ResearchGate, and Crisis to identify all papers in English from 1977 to 2016. Our results indicated that brief contact interventions show promise in reducing the number of episodes of repeated self-harm and/or suicide attempts following discharge from the Emergency Department or psychiatric units. Innovative methods of contact (e.g., text messages) are easily implemented by clinicians and received by patients in the period of post discharge and have been shown to be beneficial. However, more research employing randomized clinical trials investigating the potential benefits of these novel suicide prevention methods is warranted. Future researchers should continue improving and testing new technologies in the prevention of suicide. PMID:29043154

Trajectories of risk for early sexual activity and early substance use in the Fast Track prevention program.

PubMed

2014-02-01

Children who exhibit early-starting conduct problems are more likely than their peers to initiate sexual activity and substance use at an early age, experience pregnancy, and contract a sexually-transmitted disease [STD], placing them at risk for HIV/AIDS. Hence, understanding the development of multi-problem profiles among youth with early-starting conduct problems may benefit the design of prevention programs. In this study, 1,199 kindergarten children (51% African American; 47% European American; 69% boys) over-sampled for high rates of aggressive-disruptive behavior problems were followed through age 18. Latent class analyses (LCA) were used to define developmental profiles associated with the timing of initiation of sexual activity, tobacco and alcohol/drug use and indicators of risky adolescent sex (e.g. pregnancy and STD). Half of the high-risk children were randomized to a multi-component preventive intervention (Fast Track). The intervention did not significantly reduce membership in the classes characterized by risky sex practices. However, additional analyses examined predictors of poor outcomes, which may inform future prevention efforts.

Warfighter nutrition: current opportunities and advanced technologies report from a Department of Defense workshop.

PubMed

Deuster, Patricia A; Weinstein, Ali A; Sobel, Annette; Young, Andrew J

2009-07-01

The Uniformed Services University hosted a conference in July 2008 entitled "Warfighter Nutrition: Advanced Technologies and Opportunities" with Health Affairs and the Defense Advanced Research Projects Agency to develop strategic and tactical plans that could enhance Force Health Protection (FHP) by optimizing warfighter nutrition within the Department of Defense (DoD). The conference focused on three aspects of military nutrition: (1) fueling the forces, or garrison feeding; (2) performance optimization or operational feeding during deployment; and (3) nutritional interventions to support health reset and healing. Presentations by speakers addressed practical interventions (i.e., ready for implementation now) and advanced technologies (i.e., approaches meriting prioritized research and development efforts to transition into application). The conference concluded that nutritional optimization represents an integral and proactive approach to prevent illness, injury, and performance degradation throughout all phases of military service. The overarching consensus achieved was that warfighter nutrition, as a cornerstone of FHP, warrants the critical attention of both medical and line leadership to move quickly to support current initiatives and future advanced technologies.

Expert meeting on Child Growth and Micronutrient Deficiencies--New Initiatives for Developing Countries to Achieve Millennium Development Goals: executive summary report.

PubMed

Usfar, Avita A; Achadi, Endang L; Martorell, Reynaldo; Hadi, Hamam; Thaha, Razak; Jus'at, Idrus; Atmarita; Martianto, Drajat; Ridwan, Hardinsyah; Soekirman

2009-01-01

Undernutrition in early childhood has long-term physical and intellectual consequences. Improving child growth should start before the age of two years and be an integrated effort between all sectors, covering all aspects such as diet and nutrient intake, disease reduction, optimum child care, and improved environmental sanitation. To discuss these issues, the Indonesian Danone Institute Foundation organized an expert meeting on Child Growth and Micronutrient Deficiencies: New Initiatives for Developing Countries to Achieve Millennium Development Goals. The objective of the meeting was to have a retrospective view on child growth: lessons learned from programs to overcome under-nutrition in the developed countries and to relate the situation to the Indonesian context, as well as to discuss implications for future programs. Recommendations derived from the meeting include focus intervention on the window of opportunity group, re-activation of the Integrated Health Post at the village level, improvement of infant and young child feeding, expand food fortification intervention programs, strengthen supplementation programs with multi-micronutrient, and strengthening public and private partnership on food related programs.