Social marketing analysis of 20 [corrected] years of hand hygiene promotion.

PubMed

Mah, Manuel W; Tam, Yat Cho; Deshpande, Sameer

2008-03-01

To assess published hand hygiene behavioral interventions that employed a social marketing framework and to recommend improvements to future interventions. We performed a systematic literature review by searching the PubMed database and the Cumulative Index to Nursing and Allied Health Literature for published articles about hand hygiene behavioral interventions in healthcare facilities, schools, and community settings. Our analysis included articles that describe multifaceted interventions and evaluated them with predefined social marketing benchmark criteria. Of 53 interventions analyzed in this review, 16 (30.2%) employed primary formative audience research, 5 (9.4%) incorporated social or behavioral theories, 27 (50.9%) employed segmentation and targeting of the audience, 44 (83.0%) used components of the "marketing mix," 3 (5.7%) considered the influence of competing behaviors, 7 (13.2%) cultivated relationships with the target audience, and 15 (28.3%) provided simple behavioral messages. Thirty-five (66.0%) of the interventions demonstrated a significant improvement in performance, but only 21 (39.6%) were considered to have a strong evaluative design. The median duration of the interventions was 8.0 months. From a social marketing perspective, the promotion of hand hygiene could be improved in several ways. The effectiveness of social marketing in hand hygiene promotion should be tested in future interventions.

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

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.

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.

The Evidence Base for Interventions Targeting Individuals With Work-Related PTSD: A Systematic Review and Recommendations.

PubMed

Torchalla, Iris; Strehlau, Verena

2018-03-01

The purpose of this study was to summarize the evidence base for interventions targeting individuals with work-related posttraumatic stress disorder (PTSD), to make recommendations for clinicians and administrative decision makers involved in their rehabilitation, and to guide future research in this area. Particular attention was given to studies that were conducted in naturalistic clinical settings or in a workers' compensation claim context. Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, PsycINFO, CINAHL, PILOTS, and EMBASE identified 11 articles. Study populations included railroad personnel, police officers, disaster workers, and individuals with industrial injuries. Interventions included trauma-focused cognitive-behavioral therapy and eye movement desensitization and reprocessing. Several studies specifically targeted workers who had failed to return to work (RTW) after standard PTSD treatment. The results suggest that psychotherapy interventions are beneficial for helping clients recover from PTSD symptoms and RTW. In studies that reported on work status, RTW rates increased over time and generally lay between 58% and 80% across follow-up time points. Narrative impressions were supplemented by calculation of Risk Differences for individuals working at pretreatment versus posttreatment. Clinical consideration, methodological issues limiting the current body of work, and recommendations for future research are discussed.

Immediate versus sustained effects: interrupted time series analysis of a tailored intervention.

PubMed

Hanbury, Andria; Farley, Katherine; Thompson, Carl; Wilson, Paul M; Chambers, Duncan; Holmes, Heather

2013-11-05

Detailed intervention descriptions and robust evaluations that test intervention impact--and explore reasons for impact--are an essential part of progressing implementation science. Time series designs enable the impact and sustainability of intervention effects to be tested. When combined with time series designs, qualitative methods can provide insight into intervention effectiveness and help identify areas for improvement for future interventions. This paper describes the development, delivery, and evaluation of a tailored intervention designed to increase primary health care professionals' adoption of a national recommendation that women with mild to moderate postnatal depression (PND) are referred for psychological therapy as a first stage treatment. Three factors influencing referral for psychological treatment were targeted using three related intervention components: a tailored educational meeting, a tailored educational leaflet, and changes to an electronic system data template used by health professionals during consultations for PND. Evaluation comprised time series analysis of monthly audit data on percentage referral rates and monthly first prescription rates for anti-depressants. Interviews were conducted with a sample of health professionals to explore their perceptions of the intervention components and to identify possible factors influencing intervention effectiveness. The intervention was associated with a significant, immediate, positive effect upon percentage referral rates for psychological treatments. This effect was not sustained over the ten month follow-on period. Monthly rates of anti-depressant prescriptions remained consistently high after the intervention. Qualitative interview findings suggest key messages received from the intervention concerned what appropriate antidepressant prescribing is, suggesting this to underlie the lack of impact upon prescribing rates. However, an understanding that psychological treatment can have long-term benefits was also cited. Barriers to referral identified before intervention were cited again after the intervention, suggesting the intervention had not successfully tackled the barriers targeted. A time series design allowed the initial and sustained impact of our intervention to be tested. Combined with qualitative interviews, this provided insight into intervention effectiveness. Future research should test factors influencing intervention sustainability, and promote adoption of the targeted behavior and dis-adoption of competing behaviors where appropriate.

Immediate versus sustained effects: interrupted time series analysis of a tailored intervention

PubMed Central

2013-01-01

Background Detailed intervention descriptions and robust evaluations that test intervention impact—and explore reasons for impact—are an essential part of progressing implementation science. Time series designs enable the impact and sustainability of intervention effects to be tested. When combined with time series designs, qualitative methods can provide insight into intervention effectiveness and help identify areas for improvement for future interventions. This paper describes the development, delivery, and evaluation of a tailored intervention designed to increase primary health care professionals’ adoption of a national recommendation that women with mild to moderate postnatal depression (PND) are referred for psychological therapy as a first stage treatment. Methods Three factors influencing referral for psychological treatment were targeted using three related intervention components: a tailored educational meeting, a tailored educational leaflet, and changes to an electronic system data template used by health professionals during consultations for PND. Evaluation comprised time series analysis of monthly audit data on percentage referral rates and monthly first prescription rates for anti-depressants. Interviews were conducted with a sample of health professionals to explore their perceptions of the intervention components and to identify possible factors influencing intervention effectiveness. Results The intervention was associated with a significant, immediate, positive effect upon percentage referral rates for psychological treatments. This effect was not sustained over the ten month follow-on period. Monthly rates of anti-depressant prescriptions remained consistently high after the intervention. Qualitative interview findings suggest key messages received from the intervention concerned what appropriate antidepressant prescribing is, suggesting this to underlie the lack of impact upon prescribing rates. However, an understanding that psychological treatment can have long-term benefits was also cited. Barriers to referral identified before intervention were cited again after the intervention, suggesting the intervention had not successfully tackled the barriers targeted. Conclusion A time series design allowed the initial and sustained impact of our intervention to be tested. Combined with qualitative interviews, this provided insight into intervention effectiveness. Future research should test factors influencing intervention sustainability, and promote adoption of the targeted behavior and dis-adoption of competing behaviors where appropriate. PMID:24188718

Motor skill interventions to improve fundamental movement skills of preschoolers with developmental delay.

PubMed

Kirk, Megan A; Rhodes, Ryan E

2011-07-01

Preschoolers with developmental delay (DD) are at risk for poor fundamental movement skills (FMS), but a paucity of early FMS interventions exist. The purpose of this review was to critically appraise the existing interventions to establish direction for future trials targeting preschoolers with DD. A total of 11 studies met the inclusion criteria. Major findings were summarized based on common subtopics of overall intervention effect, locomotor skill outcomes, object-control outcomes, and gender differences. Trials ranged from 8 to 24 weeks and offered 540-1700 min of instruction. The majority of trials (n = 9) significantly improved FMS of preschoolers with DD, with a large intervention effect (η(2) = 0.57-0.85). This review supports the utility of interventions to improve FMS of preschoolers with DD. Future researchers are encouraged to include more robust designs, a theoretical framework, and involvement of parents and teachers in the delivery of the intervention.

Interventions to Promote Colorectal Cancer Screening: An Integrative Review

PubMed Central

Rawl, Susan M.; Menon, Usha; Burness, Allison; Breslau, Erica S.

2012-01-01

Behavior change interventions to promote colorectal cancer (CRC) screening have targeted people in community and primary care settings, health care providers, and health systems. Randomized controlled trials provide the strongest evidence of intervention efficacy. The purpose of this integrative review was to evaluate trials of CRC screening interventions published between 1997 and 2007 and to identify knowledge gaps and future directions for research. Thirty-three randomized trials that met inclusion criteria were evaluated using a modified version of the TREND criteria. Significant intervention effects were reported in six out of ten trials focused on increasing fecal occult blood testing, four of seven trials focused on sigmoidoscopy or colonoscopy completion, and nine of 16 focused on completion of any screening test. Several effective interventions to promote CRC screening were identified. Future trials need to use theory to guide interventions, examine moderators and mediators, consistently report results, and use comparable outcome measures. PMID:22261002

Common and distinct neural targets of treatment: changing brain function in substance addiction.

PubMed

Konova, Anna B; Moeller, Scott J; Goldstein, Rita Z

2013-12-01

Neuroimaging offers an opportunity to examine the neurobiological effects of therapeutic interventions for human drug addiction. Using activation likelihood estimation, the aim of the current meta-analysis was to quantitatively summarize functional neuroimaging studies of pharmacological and cognitive-based interventions for drug addiction, with an emphasis on their common and distinct neural targets. More exploratory analyses also contrasted subgroups of studies based on specific study and sample characteristics. The ventral striatum, a region implicated in reward, motivation, and craving, and the inferior frontal gyrus and orbitofrontal cortex, regions involved in inhibitory control and goal-directed behavior, were identified as common targets of pharmacological and cognitive-based interventions; these regions were observed when the analysis was limited to only studies that used established or efficacious interventions, and across imaging paradigms and types of addictions. Consistent with theoretical models, cognitive-based interventions were additionally more likely to activate the anterior cingulate cortex, middle frontal gyrus, and precuneus, implicated in self-referential processing, cognitive control, and attention. These results suggest that therapeutic interventions for addiction may target the brain structures that are altered across addictions and identify potential neurobiological mechanisms by which the tandem use of pharmacological and cognitive-based interventions may yield synergistic or complementary effects. These findings could inform the selection of novel functional targets in future treatment development for this difficult-to-treat disorder. Copyright © 2013 Elsevier Ltd. All rights reserved.

Common and distinct neural targets of treatment: changing brain function in substance addiction

PubMed Central

Konova, Anna B.; Moeller, Scott J.; Goldstein, Rita Z.

2013-01-01

Neuroimaging offers an opportunity to examine the neurobiological effects of therapeutic interventions for human drug addiction. Using activation likelihood estimation, the aim of the current meta-analysis was to quantitatively summarize functional neuroimaging studies of pharmacological and cognitive-based interventions for drug addiction, with an emphasis on their common and distinct neural targets. More exploratory analyses also contrasted subgroups of studies based on specific study and sample characteristics. The ventral striatum, a region implicated in reward, motivation, and craving, and the inferior frontal gyrus and orbitofrontal cortex, regions involved in inhibitory control goal-directed behavior, were identified as common targets of pharmacological and cognitive-based interventions; these regions were observed when the analysis was limited to only studies that used established or efficacious interventions, and across imaging paradigms and types of addictions. Consistent with theoretical models, cognitive-based interventions were additionally more likely to activate the anterior cingulate cortex, middle frontal gyrus, and precuneus, implicated in self-referential processing, cognitive control, and attention. These results suggest that therapeutic interventions for addiction may target the brain structures that are altered across addictions and identify potential neurobiological mechanisms by which the tandem use of pharmacological and cognitive-based interventions may yield synergistic or complementary effects. These findings could inform the selection of novel functional targets in future treatment development for this difficult-to-treat disorder. PMID:24140399

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.

Eating disorders: Insights from imaging and behavioral approaches to treatment.

PubMed

Stice, Eric; Shaw, Heather

2017-11-01

Understanding factors that contribute to eating disorders, which affect 13% of females, is critical to developing effective prevention and treatment programs. In this paper, we summarize results from prospective studies that identified factors predicting onset and persistence of eating disorders and core symptom dimensions. Next, implications for intervention targets for prevention, and treatment interventions from the risk- and maintenance-factor findings are discussed. Third, given that evidence suggests eating disorders are highly heritable, implying biological risk and maintenance factors for eating disorders, we offer working hypotheses about biological factors that might contribute to eating disorders, based on extant risk factor findings, theory, and cross-sectional studies. Finally, potentially fruitful directions for future research are presented. We suggest that it would be useful for experimental therapeutics trials to evaluate the effects of reducing the risk factors on future onset of eating pathology and on reducing maintenance factors on the risk for persistence of eating pathology, and encourage researchers to utilize prospective high-risk studies so that knowledge regarding potential intervention targets for prevention and treatment interventions for eating disorders can be advanced. Using the most rigorous research designs should help improve the efficacy of prevention and treatment interventions for eating disorders.

Interventions to improve immigrant health. A scoping review

PubMed Central

Ortiz-Barreda, Gaby; Ben-Shlomo, Yoav; Holdsworth, Michelle; Salami, Bukola; Rammohan, Anu; Chung, Roger Yat-Nork; Padmadas, Sabu S.; Krafft, Thomas

2017-01-01

Abstract Background: Disparities in health between immigrants and their host populations have been described across countries and continents. Hence, interventions for improving health targeting general populations are not necessarily effective for immigrants. Aims: To conduct a systematic search of the literature evaluating health interventions for immigrants; to map the characteristics of identified studies including range of interventions, immigrant populations and their host countries, clinical areas targeted and reported evaluations, challenges and limitations of the interventions identified. Following the results, to develop recommendations for research in the field. Methods: A scoping review approach was chosen to provide an overview of the type, extent and quantity of research available. Studies were included if they empirically evaluated health interventions targeting immigrants and/or their descendants, included a control group, and were published in English (PubMed and Embase from 1990 to 2015). Results: Most of the 83 studies included were conducted in the USA, encompassed few immigrant groups and used a randomized controlled trial (RCT) or cluster RCT design. Most interventions addressed chronic and non-communicable diseases and attendance at cancer screening services, used individual targeted approaches, targeted adult women and recruited participants from health centres. Outcome measures were often subjective, with the exception of interventions for cardiovascular risk and diabetes. Generally, authors claimed that interventions were beneficial, despite a number of reported limitations. Conclusions: Recommendations for enhancing interventions to improve immigrant health are provided to help researchers, funders and health care commissioners when deciding upon the scope, nature and design of future research in this area. PMID:28339883

Future orientation: a construct with implications for adolescent health and wellbeing.

PubMed

Johnson, Sarah R Lindstrom; Blum, Robert W; Cheng, Tina L

2014-01-01

Multidisciplinary research has supported a relationship between adolescent future orientation (the ability to set future goals and plans) and positive adolescent health and development outcomes. Many preventive strategies - for example, contracepting, exercising - are based on taking actions in the present to avoid unwanted or negative future consequences. However, research has been hampered by unclear and often divergent conceptualizations of the future orientation construct. The present paper aims to integrate previous conceptual and operational definitions into a conceptual framework that can inform programs and services for youth and efforts to evaluate future orientation as a target for intervention. Recommendations focus on furthering the study of the construct through measurement synthesis as well as studies of the normative development of future orientation. Also suggested is the need to pair environmental intervention strategies with individual level efforts to improve future orientation in order to maximize benefits.

Future Orientation: A Construct with Implications for Adolescent Health and Wellbeing

PubMed Central

Lindstrom Johnson, Sarah; Blum, Robert W; Cheng, Tina L.

2016-01-01

Multi-disciplinary research has supported a relationship between adolescent future orientation (the ability to set future goals and plans) and positive adolescent health and development outcomes. Many preventive strategies—for example contracepting, exercising—are based on taking actions in the present to avoid unwanted or negative future consequences. However, research has been hampered by unclear and often divergent conceptualizations of the future orientation construct. The present paper aims to integrate previous conceptual and operational definitions into a conceptual framework that can inform programs and services for youth and efforts to evaluate future orientation as a target for intervention. Recommendations focus on furthering the study of the construct through measurement synthesis as well as studies of the normative development of future orientation. Also suggested is the need to pair environmental intervention strategies with individual level efforts to improve future orientation in order to maximize benefits. PMID:24523304

PTSD: from neurobiology to pharmacological treatments

PubMed Central

Kelmendi, Benjamin; Adams, Thomas G.; Yarnell, Stephanie; Southwick, Steven; Abdallah, Chadi G.; Krystal, John H.

2016-01-01

Posttraumatic stress disorder (PTSD) is a chronic debilitating psychiatric disorder characterized by symptoms of re-experience, avoidance, and hyperarousal that can arise immediately or many years after exposure to a traumatic event and injury. Although extensive research has been done over the past 30 years, the etiology of PTSD remains largely unknown. Several neurobiological systems have been implicated in the pathophysiology and vulnerability for developing PTSD; however, first-line pharmacotherapies are limited. Less than 30% achieve full remission, and even then, approved pharmacological treatments often take weeks for therapeutic effect. This article aims to review the pathophysiology of PTSD within multiple neurobiological systems and how these mechanisms are used as pharmacologic targets of treatment, as well as their potential for future targets of intervention. Highlights of the article We reviewed the neurobiological abnormalities in PTSD as they relate to well-established, preliminary, and future targets for pharmacological interventions. Abnormalities across different neurotransmitter systems have been implicated in the pathophysiology of PTSD but none of these systems function uniformly among all patients with PTSD First-line pharmacotherapy for PTSD provides a suboptimal response rates. Future pharmacological targets for PTSD include the cannabinoid and oxytocin systems, as well glutamatergic modulating agents. Drug development for PTSD should specifically address various dimensions of PTSD symptomatology. PMID:27837583

Obesity Prevention from Conception: A Workshop to Guide the Development of a Pan-Canadian Trial Targeting the Gestational Period

PubMed Central

Adamo, Kristi B; Shen, Garry X; Mottola, Michelle; Nascimento, Simony; Jean-Philippe, Sonia; Ferraro, Zachary M; Nerenberg, Kara; Smith, Graeme; Chari, Radha; Gaudet, Laura; Piccinini-Vallis, Helena; McDonald, Sarah; Atkinson, Stephanie; Godbout, Ariane; Robitaille, Julie; Davidge, Sandra T; Gruslin, Andrée; Prud’homme, Denis; Stacey, Dawn; Rossiter, Melissa; Goldfield, Gary S; Dodd, Jodie

2014-01-01

This report summarizes a meeting, Obesity Prevention from Conception, held in Ottawa in 2012. This planning workshop was funded by the Canadian Institutes of Health Research (CIHR) to bring together researchers with expertise in the area of maternal obesity (OB) and weight gain in pregnancy and pregnancy-related disease to attend a one-day workshop and symposium to discuss the development of a cross-Canada lifestyle intervention trial for targeting pregnant women. This future intervention will aim to reduce downstream OB in children through encouraging appropriate weight gain during the mother’s pregnancy. The workshop served to (i) inform the development of a lifestyle intervention for women with a high pre-pregnancy body mass index (BMI), (ii) identify site investigators across Canada, and (iii) guide the development of a grant proposal focusing on the health of mom and baby. A brief summary of the presentations as well as the focus groups is presented for use in planning future research.

Parental Perspectives on a Behavioral Health Music Intervention for Adolescent/Young Adult Resilience during Cancer Treatment: Report from the Children’s Oncology Group

PubMed Central

Docherty, Sharron L.; Robb, Sheri L.; Phillips-Salimi, Celeste; Cherven, Brooke; Stegenga, Kristin; Hendricks-Ferguson, Verna; Roll, Lona; Stickler, Molly Donovan; Haase, Joan

2012-01-01

Purpose This paper describes parental perspectives on the helpfulness and meaningfulness of a behavioral health music therapy intervention targeted to adolescents/young adults (AYA) with cancer undergoing stem cell transplantation. We demonstrate how qualitative methods may be used to understand critical aspects of an intervention and mechanisms by which the intervention impacts the target AYA outcomes resilience and quality of life. Methods A qualitative descriptive design was used to obtain parents’ perspectives. Maximum variation purposive sampling was used to sample 16 parents whose AYA had been randomized to the intervention group. A semi-structured, open-ended interview was conducted between 100 and 160 days following their AYA’s transplant. Results Results are grouped into three categories: (1) helpfulness and meaningfulness of the intervention to AYA adjustment to the transplantation experience; (2) helpfulness and meaningfulness of the intervention for parents; and (3) AYA ability to participate in the intervention during acute phase of transplantation. Conclusions Parents observed and interacted with their AYA who participated in a targeted, behavioral intervention. Thus parents were able to describe mechanisms through which the intervention was helpful and meaningful for the AYA and indirect personal benefits for themselves. The results suggest the importance of the targeted outcomes identified in the Resilience in Illness Model and mechanisms of action in the Contextual Support Model of Music Therapy and identifies approaches for future study. PMID:23332481

Parental perspectives on a behavioral health music intervention for adolescent/young adult resilience during cancer treatment: report from the children's oncology group.

PubMed

Docherty, Sharron L; Robb, Sheri L; Phillips-Salimi, Celeste; Cherven, Brooke; Stegenga, Kristin; Hendricks-Ferguson, Verna; Roll, Lona; Donovan Stickler, Molly; Haase, Joan

2013-02-01

This article describes parental perspectives on the helpfulness and meaningfulness of a behavioral health music therapy intervention targeted to adolescents/young adults (AYA) with cancer undergoing stem cell transplantation. We demonstrate how qualitative methods may be used to understand critical aspects of an intervention and mechanisms by which the intervention impacts the target AYA outcomes of resilience and quality of life. A qualitative descriptive design was used to obtain parents' perspectives. A maximum-variation purposive sampling technique was used to sample 16 parents whose AYA had been randomized to the intervention group. A semistructured open-ended interview was conducted between 100 and 160 days after the AYA's transplant. Results were grouped into three categories: (1) helpfulness and meaningfulness of the intervention to AYA adjustment to the transplantation experience; (2) helpfulness and meaningfulness of the intervention for parents; and (3) AYA ability to participate in the intervention during the acute phase of transplant. Parents observed and interacted with their AYA who participated in a targeted behavioral intervention. Thus, parents were able to describe mechanisms through which the intervention was helpful and meaningful for the AYA and indirect personal benefits for themselves. The results suggest the importance of the targeted outcomes identified in the Resilience in Illness Model and mechanisms of action in the Contextual Support Model of Music Therapy, and identify approaches for future study. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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

A community perspective on the role of fathers during pregnancy: a qualitative study

PubMed Central

2013-01-01

Background Defining male involvement during pregnancy is essential for the development of future research and appropriate interventions to optimize services aiming to improve birth outcomes. Study Aim: To define male involvement during pregnancy and obtain community-based recommendations for interventions to improve male involvement during pregnancy. Methods We conducted focus groups with mothers and fathers from the National Healthy Start Association program in order to obtain detailed descriptions of male involvement activities, benefits, barriers, and proposed solutions for increasing male involvement during pregnancy. The majority of participants were African American parents. Results The involved “male” was identified as either the biological father, or, the current male partner of the pregnant woman. Both men and women described the ideal, involved father or male partner as present, accessible, available, understanding, willing to learn about the pregnancy process and eager to provide emotional, physical and financial support to the woman carrying the child. Women emphasized a sense of “togetherness” during the pregnancy. Suggestions included creating male-targeted prenatal programs, enhancing current interventions targeting females, and increasing healthcare providers’ awareness of the importance of men’s involvement during pregnancy. Conclusions Individual, family, community, societal and policy factors play a role in barring or diminishing the involvement of fathers during pregnancy. Future research and interventions should target these factors and their interaction in order to increase fathers’ involvement and thereby improve pregnancy outcomes. PMID:23497131

History of psychosurgery: a psychiatrist's perspective.

PubMed

Lapidus, Kyle A B; Kopell, Brian H; Ben-Haim, Sharona; Rezai, Ali R; Goodman, Wayne K

2013-01-01

Interest in using neuromodulation to treat psychiatric disorders is rapidly increasing. The development of novel tools and techniques, such as deep brain stimulation (DBS), increases precision and minimizes risk. This article reviews the history of psychosurgical interventions and recent developments of DBS to provide a framework for understanding current options and future goals. We begin by discussing early approaches to psychosurgery, focusing on the widespread use of lobotomy and the subsequent backlash from the public and professionals in the field. Next, we discuss the development of stereotaxis. This technique allows for more targeted, precise interventions that produce discrete subcortical lesions. We focus on four stereotactic procedures that were developed using this technique: cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy. We subsequently review contemporary theory and approaches with relevance to psychosurgery. We discuss the systems and neurocircuitry that are thought to be involved in psychiatric illness and provide targets for intervention. This discussion includes presentation of basal ganglia thalamocortical pathophysiology including cortico-striato-thalamo-cortical loops. We focus the discussion on two psychiatric disorders that have been targets of neurosurgical interventions: obsessive-compulsive disorder and mood disorders such as major depressive disorder. Evidence from studies of DBS in psychiatric disorders, including efficacy and tolerability, is reviewed. Finally, we look to the future, exploring the possibilities for these approaches to increase understanding, transform societal views of mental illness, and improve treatment. Copyright © 2013 Elsevier Inc. All rights reserved.

Tobacco cessation intervention during pregnancy among Alaska Native women.

PubMed

Patten, Christi A

2012-04-01

This paper describes a community-based participatory research program with Alaska Native people addressing a community need to reduce tobacco use among pregnant women and children. Tobacco use during pregnancy among Alaska Native women is described along with development of a community partnership, findings from a pilot tobacco cessation intervention, current work, and future directions. Among Alaska Native women residing in the Yukon Kuskokwim Delta region of western Alaska, the prevalence of tobacco use (cigarette smoking and/or use of smokeless tobacco) during pregnancy is 79%. Results from a pilot intervention study targeting pregnant women indicated low rates of participation and less than optimal tobacco abstinence outcomes. Developing alternative strategies to reach pregnant women and to enhance the efficacy of interventions is a community priority, and future directions are offered.

Tobacco Cessation Intervention During Pregnancy Among Alaska Native Women

PubMed Central

2014-01-01

This paper describes a community-based participatory research program with Alaska Native people addressing a community need to reduce tobacco use among pregnant women and children. Tobacco use during pregnancy among Alaska Native women is described along with development of a community partnership, findings from a pilot tobacco cessation intervention, current work, and future directions. Among Alaska Native women residing in the Yukon Kuskokwim Delta region of western Alaska, the prevalence of tobacco use (cigarette smoking and/or use of smokeless tobacco) during pregnancy is 79%. Results from a pilot intervention study targeting pregnant women indicated low rates of participation and less than optimal tobacco abstinence outcomes. Developing alternative strategies to reach pregnant women and to enhance the efficacy of interventions is a community priority, and future directions are offered. PMID:22311690

Aging, the Central Nervous System, and Mobility in Older Adults: Interventions

PubMed Central

Hausdorff, Jeffrey M.; Studenski, Stephanie A.; Rosano, Caterina; Camicioli, Richard; Alexander, Neil B.; Chen, Wen G.; Lipsitz, Lewis A.; Carlson, Michelle C.

2016-01-01

Background: Research suggests that the central nervous system (CNS) and mobility are closely linked. CNS-mediated mobility impairment may represent a potentially new and prevalent syndrome within the older adult populations. Interventions targeting this group may have the potential to improve mobility and cognition and prevent disability. Methods: In 2012, the Gerontological Society of America (GSA) and the National Institute on Aging (NIA) sponsored a 3-year conference workshop series, “Aging, the CNS, and Mobility.” The goal of this third and final conference was to (i) report on the state of the science of interventions targeting CNS-mediated mobility impairment among community-dwelling older adults and (ii) partnering with the NIA, explore the future of research and intervention design focused on a potentially novel aging syndrome. Results: Evidence was presented in five main intervention areas: (i) pharmacology and diet; (ii) exercise; (iii) electrical stimulation; (iv) sensory stimulation/deprivation; and (v) a combined category of multimodal interventions. Workshop participants identified important gaps in knowledge and key recommendations for future interventions related to recruitment and sample selection, intervention design, and methods to measure effectiveness. Conclusions: In order to develop effective preventive interventions for this prevalent syndrome, multidisciplinary teams are essential particularly because of the complex nature of the syndrome. Additionally, integrating innovative methods into the design of interventions may help researchers better measure complex mechanisms, and finally, the value of understanding the link between the CNS and mobility should be conveyed to researchers across disciplines in order to incorporate cognitive and mobility measurements into study protocols. PMID:27154905

Effects of organisational-level interventions at work on employees' health: a systematic review.

PubMed

Montano, Diego; Hoven, Hanno; Siegrist, Johannes

2014-02-08

Organisational-level workplace interventions are thought to produce more sustainable effects on the health of employees than interventions targeting individual behaviours. However, scientific evidence from intervention studies does not fully support this notion. It is therefore important to explore conditions of positive health effects by systematically reviewing available studies. We set out to evaluate the effectiveness of 39 health-related intervention studies targeting a variety of working conditions. Systematic review. Organisational-level workplace interventions aiming at improving employees' health were identified in electronic databases and manual searches. The appraisal of studies was adapted from the Cochrane Back Review Group guidelines. To improve comparability of the widely varying studies we classified the interventions according to the main approaches towards modifying working conditions. Based on this classification we applied a logistic regression model to estimate significant intervention effects. 39 intervention studies published between 1993 and 2012 were included. In terms of methodology the majority of interventions were of medium quality, and four studies only had a high level of evidence. About half of the studies (19) reported significant effects. There was a marginally significant probability of reporting effects among interventions targeting several organisational-level modifications simultaneously (Odds ratio (OR) 2.71; 95% CI 0.94-11.12), compared to those targeting one dimension only. Despite the heterogeneity of the 39 organisational-level workplace interventions underlying this review, we were able to compare their effects by applying broad classification categories. Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously. To increase the number of successful organisational-level interventions in the future, commonly reported obstacles against the implementation process should be addressed in developing these studies.

Effects of organisational-level interventions at work on employees’ health: a systematic review

PubMed Central

2014-01-01

Background Organisational-level workplace interventions are thought to produce more sustainable effects on the health of employees than interventions targeting individual behaviours. However, scientific evidence from intervention studies does not fully support this notion. It is therefore important to explore conditions of positive health effects by systematically reviewing available studies. We set out to evaluate the effectiveness of 39 health-related intervention studies targeting a variety of working conditions. Methods Systematic review. Organisational-level workplace interventions aiming at improving employees’ health were identified in electronic databases and manual searches. The appraisal of studies was adapted from the Cochrane Back Review Group guidelines. To improve comparability of the widely varying studies we classified the interventions according to the main approaches towards modifying working conditions. Based on this classification we applied a logistic regression model to estimate significant intervention effects. Results 39 intervention studies published between 1993 and 2012 were included. In terms of methodology the majority of interventions were of medium quality, and four studies only had a high level of evidence. About half of the studies (19) reported significant effects. There was a marginally significant probability of reporting effects among interventions targeting several organisational-level modifications simultaneously (Odds ratio (OR) 2.71; 95% CI 0.94-11.12), compared to those targeting one dimension only. Conclusions Despite the heterogeneity of the 39 organisational-level workplace interventions underlying this review, we were able to compare their effects by applying broad classification categories. Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously. To increase the number of successful organisational-level interventions in the future, commonly reported obstacles against the implementation process should be addressed in developing these studies. PMID:24507447

Psychosocial treatments for schizophrenia.

PubMed

Mueser, Kim T; Deavers, Frances; Penn, David L; Cassisi, Jeffrey E

2013-01-01

The current state of the literature regarding psychosocial treatments for schizophrenia is reviewed within the frameworks of the recovery model of mental health and the expanded stress-vulnerability model. Interventions targeting specific domains of functioning, age groups, stages of illness, and human service system gaps are classified as evidence-based practices or promising practices according to the extent to which their efficacy is currently supported by meta-analyses and individual randomized controlled trials (RCTs). Evidence-based practices include assertive community treatment (ACT), cognitive behavior therapy (CBT) for psychosis, cognitive remediation, family psychoeducation, illness self-management training, social skills training, and supported employment. Promising practices include cognitive adaptive therapy, CBT for posttraumatic stress disorder, first-episode psychosis intervention, healthy lifestyle interventions, integrated treatment for co-occurring disorders, interventions targeting older individuals, peer support services, physical disease management, prodromal stage intervention, social cognition training, supported education, and supported housing. Implications and future directions are discussed.

Validation of a method to evaluate future impact of road safety interventions, a comparison between fatal passenger car crashes in Sweden 2000 and 2010.

PubMed

Strandroth, Johan

2015-03-01

When targeting a society free from serious and fatal road-traffic injuries, it has been a common practice in many countries and organizations to set up time-limited and quantified targets for the reduction of fatalities and injuries. In setting these targets EU and other organizations have recognized the importance to monitor and predict the development toward the target as well as the efficiency of road safety policies and interventions. This study aims to validate a method to forecast future road safety challenges by applying it to the fatal crashes in Sweden in 2000 and using the method to explain the change in fatalities based on the road safety interventions made until 2010. The estimation of the method is then compared to the true outcome in 2010. The aim of this study was to investigate if a residual of crashes produced by a partial analysis could constitute a sufficient base to describe the characteristics of future crashes. show that out of the 332 car occupants killed in 2000, 197 were estimated to constitute the residual in 2010. Consequently, 135 fatalities from 2000 were estimated by the model to be prevented by 2010. That is a predicted reduction of 41% compared to the reduction in the real outcome of 53%, from 332 in 2000 to 156 in 2010. The method was found able to generate a residual of crashes in 2010 from the crashes in 2000 that had a very similar nature, with regards to crash type, as the true outcome of 2010. It was also found suitable to handle double counting and system effects. However, future research is needed in order to investigate how external factors as well as random and systematic variation should be taken into account in a reliable manner. Copyright © 2015 Elsevier Ltd. All rights reserved.

A new prospect in cancer therapy: targeting cancer stem cells to eradicate cancer.

PubMed

Chen, Li-Sha; Wang, An-Xin; Dong, Bing; Pu, Ke-Feng; Yuan, Li-Hua; Zhu, Yi-Min

2012-12-01

According to the cancer stem cell theory, cancers can be initiated by cancer stem cells. This makes cancer stem cells prime targets for therapeutic intervention. Eradicating cancer stem cells by efficient targeting agents may have the potential to cure cancer. In this review, we summarize recent breakthroughs that have improved our understanding of cancer stem cells, and we discuss the therapeutic strategy of targeting cancer stem cells, a promising future direction for cancer stem cell research.

Smoking Beliefs Among Chinese Secondary School Students: A Theory-Based Qualitative Study.

PubMed

Zhao, Xiang; White, Katherine M; Young, Ross McD; Obst, Patricia L

2018-02-07

China has the world's greatest number of smokers but theory-based smoking interventions are rare. To develop an effective intervention, understanding the determinants of Chinese adolescent smoking is crucial. The Theory of Planned Behavior (TPB) is empirically supported to predict and assist in informing intervention strategies to change health-related behaviors. Based on the TPB, the elicitation of shared smoking beliefs among adolescents can inform future intervention designs among this at-risk population. We investigated the beliefs from six focus groups (N = 30) of one senior secondary school in Kunming, Yunnan Province, China. We used semi-structured questions based on the TPB framework, including prompts about behavioral (advantages and disadvantages), normative (important referents), and control (barriers and facilitators) beliefs. Following the Consensual Qualitative Research (CQR) methodology, data were discussed until consensus was reached. Auditing was undertaken by an external researcher. Seven domains (advantages, disadvantages, approvers, disapprovers, facilitators, barriers, and smoker images) were examined. Smoking as a gendered behavior, smoking as influenced by cultural and environmental contexts, smoking as a strategy to cope with stress, and awareness of the harm of smoking, are highlighted themes across domains. Data suggested an extended-TPB framework as an appropriate approach to adopt when addressing smoking beliefs among the target population. These beliefs can be utilized to inform future school-based interventions and public health campaigns targeting smoking among Chinese adolescents. A modified TPB approach has potential for future smoking interventions among Chinese adolescents. Beliefs elicited in this study form a strong basis for designing a location- and population-specific antismoking programme. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing: How Health Effects Are Measured Matters.

PubMed

Goldhaber-Fiebert, Jeremy D; Brandeau, Margaret L

2015-10-01

Current guidelines for economic evaluations of health interventions define relevant outcomes as those accruing to individuals receiving interventions. Little consensus exists on counting health impacts on current and future fertility and childbearing. Our objective was to characterize current practices for counting such health outcomes. We developed a framework characterizing health interventions with direct and/or indirect effects on fertility and childbearing and how such outcomes are reported. We identified interventions spanning the framework and performed a targeted literature review for economic evaluations of these interventions. For each article, we characterized how the potential health outcomes from each intervention were considered, focusing on quality-adjusted life-years (QALYs) associated with fertility and childbearing. We reviewed 108 studies, identifying 7 themes: 1) Studies were heterogeneous in reporting outcomes. 2) Studies often selected outcomes for inclusion that tend to bias toward finding the intervention to be cost-effective. 3) Studies often avoided the challenges of assigning QALYs for pregnancy and fertility by instead considering cost per intermediate outcome. 4) Even for the same intervention, studies took heterogeneous approaches to outcome evaluation. 5) Studies used multiple, competing rationales for whether and how to include fertility-related QALYs and whose QALYs to include. 6) Studies examining interventions with indirect effects on fertility typically ignored such QALYs. 7) Even recent studies had these shortcomings. Limitations include that the review was targeted rather than systematic. Economic evaluations inconsistently consider QALYs from current and future fertility and childbearing in ways that frequently appear biased toward the interventions considered. As the Panel on Cost-Effectiveness in Health and Medicine updates its guidelines, making the practice of cost-effectiveness analysis more consistent is a priority. Our study contributes to harmonizing methods in this respect. © The Author(s) 2015.

Evaluating Cost-Effectiveness of Interventions that Affect Fertility and Childbearing: How Health Effects are Measured Matters

PubMed Central

Goldhaber-Fiebert, Jeremy D.; Brandeau, Margaret L.

2015-01-01

Background Current guidelines for economic evaluations of health interventions define relevant outcomes as those accruing to individuals receiving interventions. Little consensus exists on counting health impacts on current and future fertility and childbearing. Objective To characterize current practices for counting such health outcomes. Design We developed a framework characterizing health interventions with direct and/or indirect effects on fertility and childbearing and how such outcomes are reported. We identified interventions spanning the framework and performed a targeted literature review for economic evaluations of these interventions. For each article, we characterized how the potential health outcomes from each intervention were considered, focusing on QALYs associated with fertility and childbearing. Results We reviewed 108 studies, identifying seven themes: 1) Studies were heterogeneous in reporting outcomes. 2) Studies often selected outcomes for inclusion that tend to bias toward finding the intervention to be cost-effective. 3) Studies often avoided the challenges of assigning QALYs for pregnancy and fertility by instead considering cost per intermediate outcome. 4) Even for the same intervention, studies took heterogeneous approaches to outcome evaluation. 5) Studies employed multiple, competing rationales for whether and how to include fertility-related QALYs and whose QALYs to include. 6) Studies examining interventions with indirect effects on fertility typically ignored such QALYs. 7) Even recent studies had these shortcomings. Limitations The review was targeted rather than systematic. Conclusions Economic evaluations inconsistently consider QALYs from current and future fertility and childbearing in ways that frequently appear biased towards the interventions considered. As the Panel on Cost-Effectiveness in Health and Medicine updates its guidelines, making the practice of cost-effectiveness analysis more consistent is a priority. Our study contributes to harmonizing methods in this respect. PMID:25926281

Foodservice employees benefit from interventions targeting barriers to food safety.

PubMed

York, Valerie K; Brannon, Laura A; Shanklin, Carol W; Roberts, Kevin R; Howells, Amber D; Barrett, Elizabeth B

2009-09-01

The number of foodborne illnesses traced to improper food handling in restaurants indicates a need for research to improve food safety in these establishments. Therefore, this 2-year longitudinal study investigated the effectiveness of traditional ServSafe (National Restaurant Association Educational Foundation, Chicago, IL) food-safety training and a Theory of Planned Behavior intervention program targeting employees' perceived barriers and attitudes toward important food-safety behaviors. The effectiveness of the training and intervention was measured by knowledge scores and observed behavioral compliance rates related to food-safety practices. Employees were observed for handwashing, thermometer usage, and proper handling of work surfaces at baseline, after receiving ServSafe training, and again after exposure to the intervention targeting barriers and negative attitudes about food-safety practices. Repeated-measures analyses of variance indicated training improved handwashing knowledge, but the intervention was necessary to improve overall behavioral compliance and handwashing compliance. Results suggest that registered dietitians; dietetic technicians, registered; and foodservice managers should implement a combination of training and intervention to improve knowledge and compliance with food-safety behaviors, rather than relying on training alone. Challenges encountered while conducting this research are discussed, and recommendations are provided for researchers interested in conducting this type of research in the future.

Psychological Therapies for Auditory Hallucinations (Voices): Current Status and Key Directions for Future Research

PubMed Central

Thomas, Neil; Hayward, Mark; Peters, Emmanuelle; van der Gaag, Mark; Bentall, Richard P.; Jenner, Jack; Strauss, Clara; Sommer, Iris E.; Johns, Louise C.; Varese, Filippo; García-Montes, José Manuel; Waters, Flavie; Dodgson, Guy; McCarthy-Jones, Simon

2014-01-01

This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation. PMID:24936081

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.

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

What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms.

PubMed

van Stralen, M M; Yildirim, M; te Velde, S J; Brug, J; van Mechelen, W; Chinapaw, M J M

2011-10-01

Obesity prevention requires effective interventions targeting the so-called energy balance-related behaviours (that is, physical activity, sedentary and dietary behaviours). To improve (cost-)effectiveness of these interventions, one needs to know the working mechanisms underlying behavioural change. Mediation analyses evaluates whether an intervention works via hypothesised working mechanisms. Identifying mediators can prompt intervention developers to strengthen effective intervention components and remove/adapt ineffective components. This systematic review aims to identify psychosocial and environmental mediators of energy balance-related behaviours interventions for youth. Studies were identified by a systematic search of electronic databases (PubMed, Embase, PsycINFO, ERIC and SPORTDiscus). Studies were included if they (1) were school-based randomised controlled or quasi-experimental studies; (2) targeted energy balance behaviours; (3) conducted among children and adolescents (4-18 years of age); (4) written in English; and (5) conducted mediation analyses. A total of 24 studies were included. We found strong evidence for self-efficacy and moderate evidence for intention as mediators of physical activity interventions. Indications were found for attitude, knowledge and habit strength to be mediators of dietary behaviour interventions. The few sedentary behaviour interventions reporting on mediating effects prevented us from forming strong conclusions regarding mediators of sedentary behaviour interventions. The majority of interventions failed to significantly change hypothesised mediators because of ineffective intervention strategies, low power and/or use of insensitive measures. Despite its importance, few studies published results of mediation analysis, and more high-quality research into relevant mediators is necessary. On the basis of the limited number of published studies, self-efficacy and intention appear to be relevant mediators for physical activity interventions. Future intervention developers are advised to provide information on the theoretical base of their intervention including the strategies applied to provide insight into which strategies are effective in changing relevant mediators. In addition, future research is advised to focus on the development, validity, reliability and sensitivity of mediator measures.

What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms

PubMed Central

van Stralen, M M; Yildirim, M; Velde, SJ te; Brug, J; van Mechelen, W; Chinapaw, M J M

2011-01-01

Objective: Obesity prevention requires effective interventions targeting the so-called energy balance-related behaviours (that is, physical activity, sedentary and dietary behaviours). To improve (cost-)effectiveness of these interventions, one needs to know the working mechanisms underlying behavioural change. Mediation analyses evaluates whether an intervention works via hypothesised working mechanisms. Identifying mediators can prompt intervention developers to strengthen effective intervention components and remove/adapt ineffective components. This systematic review aims to identify psychosocial and environmental mediators of energy balance-related behaviours interventions for youth. Method: Studies were identified by a systematic search of electronic databases (Pubmed, Embase, PsycINFO, ERIC and SPORTDiscus). Studies were included if they (1) were school-based randomised controlled or quasi-experimental studies; (2) targeted energy balance behaviours; (3) conducted among children and adolescents (4–18 years of age); (4) written in English; and (5) conducted mediation analyses. Results: A total of 24 studies were included. We found strong evidence for self-efficacy and moderate evidence for intention as mediators of physical activity interventions. Indications were found for attitude, knowledge and habit strength to be mediators of dietary behaviour interventions. The few sedentary behaviour interventions reporting on mediating effects prevented us from forming strong conclusions regarding mediators of sedentary behaviour interventions. The majority of interventions failed to significantly change hypothesised mediators because of ineffective intervention strategies, low power and/or use of insensitive measures. Conclusion: Despite its importance, few studies published results of mediation analysis, and more high-quality research into relevant mediators is necessary. On the basis of the limited number of published studies, self-efficacy and intention appear to be relevant mediators for physical activity interventions. Future intervention developers are advised to provide information on the theoretical base of their intervention including the strategies applied to provide insight into which strategies are effective in changing relevant mediators. In addition, future research is advised to focus on the development, validity, reliability and sensitivity of mediator measures. PMID:21487398

Aging, the Central Nervous System, and Mobility in Older Adults: Interventions.

PubMed

Varma, Vijay R; Hausdorff, Jeffrey M; Studenski, Stephanie A; Rosano, Caterina; Camicioli, Richard; Alexander, Neil B; Chen, Wen G; Lipsitz, Lewis A; Carlson, Michelle C

2016-11-01

Research suggests that the central nervous system (CNS) and mobility are closely linked. CNS-mediated mobility impairment may represent a potentially new and prevalent syndrome within the older adult populations. Interventions targeting this group may have the potential to improve mobility and cognition and prevent disability. In 2012, the Gerontological Society of America (GSA) and the National Institute on Aging (NIA) sponsored a 3-year conference workshop series, "Aging, the CNS, and Mobility." The goal of this third and final conference was to (i) report on the state of the science of interventions targeting CNS-mediated mobility impairment among community-dwelling older adults and (ii) partnering with the NIA, explore the future of research and intervention design focused on a potentially novel aging syndrome. Evidence was presented in five main intervention areas: (i) pharmacology and diet; (ii) exercise; (iii) electrical stimulation; (iv) sensory stimulation/deprivation; and (v) a combined category of multimodal interventions. Workshop participants identified important gaps in knowledge and key recommendations for future interventions related to recruitment and sample selection, intervention design, and methods to measure effectiveness. In order to develop effective preventive interventions for this prevalent syndrome, multidisciplinary teams are essential particularly because of the complex nature of the syndrome. Additionally, integrating innovative methods into the design of interventions may help researchers better measure complex mechanisms, and finally, the value of understanding the link between the CNS and mobility should be conveyed to researchers across disciplines in order to incorporate cognitive and mobility measurements into study protocols. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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.

Assessment of health impacts of decreased smoking prevalence in Copenhagen: Application of the DYNAMO-HIA model.

PubMed

Holm, Astrid Ledgaard; Brønnum-Hansen, Henrik; Robinson, Kirstine Magtengaard; Diderichsen, Finn

2014-07-01

Tobacco smoking is among the leading risk factors for chronic disease and early death in developed countries, including Denmark, where smoking causes 14% of the disease burden. In Denmark, many public health interventions, including smoking prevention, are undertaken by the municipalities, but models to estimate potential health effects of local interventions are lacking. The aim of the current study was to model the effects of decreased smoking prevalence in Copenhagen, Denmark. The DYNAMO-HIA model was applied to the population of Copenhagen, by using health survey data and data from Danish population registers. We modelled the effects of four intervention scenarios aimed at different target groups, compared to a reference scenario. The potential effects of each scenario were modelled until 2040. A combined scenario affecting both initiation rates among youth, and cessation and re-initiation rates among adults, which reduced the smoking prevalence to 4% by 2025, would have large beneficial effects on incidence and prevalence of smoking-related diseases and mortality. Health benefits could also be obtained through interventions targeting only cessation or re-initiation rates, whereas an intervention targeting only initiation among youth had marginal effects on morbidity and mortality within the modelled time frame. By modifying the DYNAMO-HIA model, we were able to estimate the potential health effects of four interventions to reduce smoking prevalence in the population of Copenhagen. The effect of the interventions on future public health depended on population subgroup(s) targeted, duration of implementation and intervention reach. © 2014 the Nordic Societies of Public Health.

Exploiting social influence to magnify population-level behaviour change in maternal and child health: study protocol for a randomised controlled trial of network targeting algorithms in rural Honduras

PubMed Central

Shakya, Holly B; Stafford, Derek; Hughes, D Alex; Keegan, Thomas; Negron, Rennie; Broome, Jai; McKnight, Mark; Nicoll, Liza; Nelson, Jennifer; Iriarte, Emma; Ordonez, Maria; Airoldi, Edo; Fowler, James H; Christakis, Nicholas A

2017-01-01

Introduction Despite global progress on many measures of child health, rates of neonatal mortality remain high in the developing world. Evidence suggests that substantial improvements can be achieved with simple, low-cost interventions within family and community settings, particularly those designed to change knowledge and behaviour at the community level. Using social network analysis to identify structurally influential community members and then targeting them for intervention shows promise for the implementation of sustainable community-wide behaviour change. Methods and analysis We will use a detailed understanding of social network structure and function to identify novel ways of targeting influential individuals to foster cascades of behavioural change at a population level. Our work will involve experimental and observational analyses. We will map face-to-face social networks of 30 000 people in 176 villages in Western Honduras, and then conduct a randomised controlled trial of a friendship-based network-targeting algorithm with a set of well-established care interventions. We will also test whether the proportion of the population targeted affects the degree to which the intervention spreads throughout the network. We will test scalable methods of network targeting that would not, in the future, require the actual mapping of social networks but would still offer the prospect of rapidly identifying influential targets for public health interventions. Ethics and dissemination The Yale IRB and the Honduran Ministry of Health approved all data collection procedures (Protocol number 1506016012) and all participants will provide informed consent before enrolment. We will publish our findings in peer-reviewed journals as well as engage non-governmental organisations and other actors through venues for exchanging practical methods for behavioural health interventions, such as global health conferences. We will also develop a ‘toolkit’ for practitioners to use in network-based intervention efforts, including public release of our network mapping software. Trial registration number NCT02694679; Pre-results. PMID:28289044

Priorities and needs for research on urban interventions targeting vector-borne diseases: rapid review of scoping and systematic reviews.

PubMed

Bermudez-Tamayo, Clara; Mukamana, Olive; Carabali, Mabel; Osorio, Lyda; Fournet, Florence; Dabiré, Kounbobr Roch; Turchi Marteli, Celina; Contreras, Adolfo; Ridde, Valéry

2016-12-01

This paper highlights the critical importance of evidence on vector-borne diseases (VBD) prevention and control interventions in urban settings when assessing current and future needs, with a view to setting policy priorities that promote inclusive and equitable urban health services. Research should produce knowledge about policies and interventions that are intended to control and prevent VBDs at the population level and to reduce inequities. Such interventions include policy, program, and resource distribution approaches that address the social determinants of health and exert influence at organizational and system levels.

Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review

PubMed Central

2012-01-01

Background Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds. Methods The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes. Results The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption. Conclusions While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base. PMID:22931474

Educational and home-environment asthma interventions for children in urban, low-income, minority families.

PubMed

Welker, Kristen; Nabors, Laura; Lang, Myia; Bernstein, Jonathan

2018-02-08

This review examined the impact of environmental change and educational interventions targeting young children from minority groups living in urban environments and who were from low-income families. A scoping methodology was used to find research across six databases, including CINAHL, ERIC, PsycINFO, PubMed, MEDLINE, and EMBASE. 299 studies were identified. Duplicates were removed leaving 159 studies. After reviewing for inclusion and exclusion criteria, 23 manuscripts were identified for this study: 11 featured home-environment change interventions and 12 emphasized education of children. Studies were reviewed to determine key interventions and outcomes for children. Both environmental interventions and educational programs had positive outcomes. Interventions did not always impact health outcomes, such as emergency department visits. Results indicated many of the environmental change and education interventions improved asthma management and some symptoms. A multipronged approach may be a good method for targeting both education and change in the home and school environment to promote the well-being of young children in urban areas. New research with careful documentation of information about study participants, dose of intervention (i.e., number and duration of sessions, booster sessions) and specific intervention components also will provide guidance for future research.

ASHA-Life Intervention Perspectives Voiced by Rural Indian Women Living With AIDS.

PubMed

Nyamathi, Adeline; Ekstrand, Maria; Srivastava, Neha; Carpenter, Catherine L; Salem, Benissa E; Al-Harrasi, Shawana; Ramakrishnan, Padma; Sinha, Sanjeev

2016-01-01

In this focus group study, we explored the experiences of 16 rural women living with AIDS (WLA) who participated in the Asha-Life (AL) intervention to gain an understanding of the environmental, psychosocial, and cultural impact of the AL on their lives. Four themes emerged among AL participants: (a) the importance of tangible support, (b) need for social support, (c) ongoing challenges to accessing antiretroviral therapy (ART), and (d) perspectives on future programs. Our research findings support the development of future programs targeting mother-child dyads which emphasize nutritional knowledge, while reducing barriers to receiving ART, and physical, emotional, and financial support.

Social Competence in Pediatric Brain Tumor Survivors: Application of a Model from Social Neuroscience and Developmental Psychology

PubMed Central

Hocking, Matthew C.; McCurdy, Mark; Turner, Elise; Kazak, Anne E.; Noll, Robert B.; Phillips, Peter; Barakat, Lamia P.

2014-01-01

Pediatric brain tumor (BT) survivors are at risk for psychosocial late effects across many domains of functioning, including neurocognitive and social. The literature on the social competence of pediatric BT survivors is still developing and future research is needed that integrates developmental and cognitive neuroscience research methodologies to identify predictors of survivor social adjustment and interventions to ameliorate problems. This review discusses the current literature on survivor social functioning through a model of social competence in childhood brain disorder and suggests future directions based on this model. Interventions pursuing change in survivor social adjustment should consider targeting social ecological factors. PMID:25382825

The influence of time perspective on cervical cancer screening among Latinas in the United States.

PubMed

Roncancio, Angelica M; Ward, Kristy K; Fernandez, Maria E

2014-12-01

To develop effective interventions to increase cervical cancer screening among Latinas, we should understand the role of cultural factors, such as time perspective, in the decision to be screened. We examined the relation between present time orientation, future time orientation, and self-reported cervical cancer screening among Latinas. A group of 206 Latinas completed a survey measuring factors associated with screening. Logistic regression analyses revealed that future time orientation was significantly associated with self-reported screening. Understanding the influence of time orientation on cervical cancer screening will assist us in developing interventions that effectively target time perspective and screening. © The Author(s) 2013.

Randomized Pilot of an Anxiety Sensitivity-Based Intervention for Individuals in a Substance Use Day Program.

PubMed

Worden, Blaise L; Genova, Marla; Tolin, David F

2017-01-01

Anxiety sensitivity (AS), or the tendency to appraise physical symptoms as intolerable or dangerous, may maintain the cycle between co-occurring anxiety and substance use disorders. This study examined preliminary efficacy of a brief intervention targeting AS for individuals with heterogeneous substance use disorders. Forty-one patients with high AS entering an addictions day program were randomized to treatment as usual (TAU) or to TAU plus a nine-hour AS-focused intervention that consisted of interoceptive exposures, psychoeducation about the cycle of problematic substance use and anxiety, and a single session of cognitive challenging (e.g., reviewing common cognitive distortions and decatastrophizing anxiety symptoms). Mixed-effects intent-to-treat models suggested that participants in the AS condition showed greater decreases in AS at post-treatment, but this effect was lost at follow-up three months later. Intervention conditions did not differ in change in percent days abstinent or self-reported anxiety, with both conditions showing significant improvement at post-treatment. Results suggest that the nine-hour AS-focused intervention led to a short-term benefit over TAU alone, but this benefit was not sustained at three months' follow-up. Future AS interventions may need to target specific subconstructs of AS for selected populations, or target emotional distress tolerance more broadly.

Post-intervention effects on screen behaviours and mediating effect of parental regulation: the HEalth In Adolescents study – a multi-component school-based randomized controlled trial

PubMed Central

2014-01-01

Background To improve effectiveness of future screen behaviour interventions, one needs to know whether an intervention works via the proposed mediating mechanisms and whether the intervention is equally effective among subgroups. Parental regulation is identified as a consistent correlate of screen behaviours, but prospective evidence as well as the mediation role of parental regulation is largely lacking. This study investigated post-intervention main effects on screen behaviours in the HEIA-intervention – a Norwegian school-based multiple-behaviour study, as well as mediation effects of parental regulation by adolescents’ and parents’ report. In addition, moderating effects of gender and weight status on the intervention and mediating effects were explored. Methods Participating schools were randomized to control (n = 25) or intervention (n = 12) condition. Adolescents (n = 908 Control; 510 Intervention) self-reported their weekday and weekend TV-viewing and computer/game-use. Change in adolescents’ behaviours was targeted through school and parents. Adolescents, mothers (n = 591 Control; 244 Interventions) and fathers (n = 469 Control; 199 Intervention) reported parental regulation of the screen behaviours post-intervention (at 20 month). The product-of-coefficient test using linear regression analysis was conducted to examine main and mediating effects. Results There was no intervention effect on the screen behaviours in the total sample. Gender moderated effect on weekend computer/game-use, while weight status moderated the effect on weekday TV-viewing and computer/game-use. Stratified analyses showed a small favourable intervention effect on weekday TV-viewing among the normal weight. Parental regulation did not mediate change in the screen behaviours. However, stronger parental regulation was associated with less TV-viewing and computer/game-use with effects being conditional on adolescents’ versus parental reports. Parental regulation of the screen behaviours, primarily by the parental report, was associated with change in the respective behaviours. Conclusion Multiple behaviour intervention may not affect all equally well, and the effect may differ by weight status and gender. In future interventions parents should be encouraged to regulate their adolescents’ TV-viewing and computer/game-use on both weekdays and weekends as parental regulation was identified as a determinant of these screen behaviours. However, future intervention studies may need to search for more effective intervention strategies targeting parental regulation. Trial registration Current Controlled Trials ISRCTN98552879 PMID:24568125

Impact of nutrition environmental interventions on point-of-purchase behavior in adults: a review.

PubMed

Seymour, Jennifer D; Yaroch, Amy Lazarus; Serdula, Mary; Blanck, Heidi Michels; Khan, Laura Kettel

2004-09-01

Nutrition interventions targeted to individuals are unlikely to significantly shift US dietary patterns as a whole. Environmental and policy interventions are more promising for shifting these patterns. We review interventions that influenced the environment through food availability, access, pricing, or information at the point-of-purchase in worksites, universities, grocery stores, and restaurants. Thirty-eight nutrition environmental intervention studies in adult populations, published between 1970 and June 2003, were reviewed and evaluated on quality of intervention design, methods, and description (e.g., sample size, randomization). No policy interventions that met inclusion criteria were found. Many interventions were not thoroughly evaluated or lacked important evaluation information. Direct comparison of studies across settings was not possible, but available data suggest that worksite and university interventions have the most potential for success. Interventions in grocery stores appear to be the least effective. The dual concerns of health and taste of foods promoted were rarely considered. Sustainability of environmental change was never addressed. Interventions in "limited access" sites (i.e., where few other choices were available) had the greatest effect on food choices. Research is needed using consistent methods, better assessment tools, and longer durations; targeting diverse populations; and examining sustainability. Future interventions should influence access and availability, policies, and macroenvironments.

Novel therapeutic strategies targeting fibroblasts and fibrosis in heart disease

PubMed Central

Gourdie, Robert G.; Dimmeler, Stefanie; Kohl, Peter

2016-01-01

Our understanding of cardiac fibroblast functions has moved beyond their roles in heart structure and extracellular matrix generation, and now includes contributions to paracrine, mechanical and electrical signalling during ontogenesis and normal cardiac activity. Fibroblasts have central roles in pathogenic remodelling during myocardial ischaemia, hypertension and heart failure. As key contributors to scar formation, they are crucial for tissue repair after interventions including surgery and ablation. Novel experimental approaches targeting cardiac fibroblasts are promising potential therapies for heart disease. Indeed, several existing drugs act, at least partially, through effects on cardiac connective tissue. This Review outlines the origins and roles of fibroblasts in cardiac development, homeostasis and disease; illustrates the involvement of fibroblasts in current and emerging clinical interventions; and identifies future targets for research and development. PMID:27339799

Psychological therapies for auditory hallucinations (voices): current status and key directions for future research.

PubMed

Thomas, Neil; Hayward, Mark; Peters, Emmanuelle; van der Gaag, Mark; Bentall, Richard P; Jenner, Jack; Strauss, Clara; Sommer, Iris E; Johns, Louise C; Varese, Filippo; García-Montes, José Manuel; Waters, Flavie; Dodgson, Guy; McCarthy-Jones, Simon

2014-07-01

This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

Efficacy of school-based interventions aimed at decreasing sugar-sweetened beverage consumption among adolescents: a systematic review.

PubMed

Vézina-Im, Lydi-Anne; Beaulieu, Dominique; Bélanger-Gravel, Ariane; Boucher, Danielle; Sirois, Caroline; Dugas, Marylène; Provencher, Véronique

2017-09-01

To verify the efficacy of school-based interventions aimed at reducing sugar-sweetened beverage (SSB) consumption among adolescents in order to develop or improve public health interventions. Systematic review of interventions targeting adolescents and/or the school environment. The following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL and EMBASE. Proquest Dissertations and Theses was also investigated for unpublished trials. Adolescents were defined as individuals between the ages of 12 and 17 years. A total of thirty-six studies detailing thirty-six different interventions tested among independent samples (n 152 001) were included in the review. Twenty interventions were classified as educational/behavioural and ten were classified as legislative/environmental interventions. Only six interventions targeted both individuals and their environment. Over 70 % of all interventions, regardless of whether they targeted individuals, their environment or both, were effective in decreasing SSB consumption. Legislative/environmental studies had the highest success rate (90·0 %). Educational/behavioural interventions only and interventions that combined educational/behavioural and legislative/environmental approaches were almost equally effective in reducing SSB consumption with success rates of 65·0 and 66·7 %, respectively. Among the interventions that had an educational/behavioural component, 61·5 % were theory-based. The behaviour change techniques most frequently used in interventions were providing information about the health consequences of performing the behaviour (72·2 %), restructuring the physical environment (47·2 %), behavioural goal setting (36·1 %), self-monitoring of behaviour (33·3 %), threat to health (30·6 %) and providing general social support (30·6 %). School-based interventions show promising results to reduce SSB consumption among adolescents. A number of recommendations are made to improve future studies.

Do Brief Alcohol Interventions Reduce Tobacco Use among Adolescents and Young Adults? A Systematic Review and Meta-Analysis

PubMed Central

Hennessy, Emily A.; Tanner-Smith, Emily E.; Steinka-Fry, Katarzyna T.

2015-01-01

This meta-analysis synthesizes studies of brief interventions (BIs) that targeted alcohol consumption and reported both alcohol and tobacco outcomes. It examines whether BIs reduce alcohol and tobacco use for adolescents and young adults among interventions that (1) directly targeted tobacco and alcohol use, or (2) did not target tobacco use but measured it as a secondary outcome. Multiple databases and grey literature sources were searched (1980–2012) resulting in the identification of 18 randomized or controlled quasi-experimental studies (5949 participants). Analyses were conducted using random effects inverse-variance weighted three-level models. BIs were associated with a significant reduction in alcohol consumption relative to control groups (ḡ = 0.11, 95% CI [0.04, 0.17]) but not with a significant decrease in tobacco use (ḡ = 0.07, 95% CI [−0.01, 0.16]). Directly addressing tobacco was not a significant moderator affecting tobacco use outcomes. Post-hoc exploratory analysis revealed potential questions to address with future research. PMID:26130030

Vitamin D analogues to target residual proteinuria: potential impact on cardiorenal outcomes

PubMed Central

Humalda, Jelmer K.; Goldsmith, David J. A.; Thadhani, Ravi; de Borst, Martin H.

2015-01-01

Residual proteinuria, the amount of proteinuria that remains during optimally dosed renin-angiotensin-aldosterone system (RAAS) blockade, is an independent risk factor for progressive renal function loss and cardiovascular complications in chronic kidney disease (CKD) patients. Dual RAAS blockade may reduce residual proteinuria but without translating into improved cardiorenal outcomes at least in diabetic nephropathy; rather, dual RAAS blockade may increase the risk of adverse events. These findings have challenged the concept of residual proteinuria as an absolute treatment target. Therefore, new strategies must be explored to address whether by further reduction of residual proteinuria using interventions not primarily targeting the RAAS benefit in terms of cardiorenal risk reduction would accrue. Both clinical and experimental intervention studies have demonstrated that vitamin D can reduce residual proteinuria through both RAAS-dependent and RAAS-independent pathways. Future research should prospectively explore vitamin D treatment as an adjunct to RAAS blockade in an interventional trial exploring clinically relevant cardiorenal end points. PMID:25609737

Factors that influence effective perioperative temperature management by anesthesiologists: a qualitative study using the Theoretical Domains Framework.

PubMed

Boet, Sylvain; Patey, Andrea M; Baron, Justine S; Mohamed, Karim; Pigford, Ashlee-Ann E; Bryson, Gregory L; Brehaut, Jamie C; Grimshaw, Jeremy M

2017-06-01

Inadvertent perioperative hypothermia (IPH) is associated with a range of adverse outcomes. Safe and effective warming techniques exist to prevent IPH; however, IPH remains common. This study aimed to identify factors that anesthesiologists perceive may influence temperature management during the perioperative period. After Research Ethics Board approval, semi-structured interviews were conducted with staff anesthesiologists at a Canadian academic hospital. An interview guide based on the Theoretical Domains Framework (TDF) was used to capture 14 theoretical domains that may influence temperature management. The interview transcripts were coded using direct content analysis to generate specific beliefs and to identify relevant TDF domains perceived to influence temperature management behaviour. Data saturation was achieved after 15 interviews. The following nine theoretical domains were identified as relevant to designing an intervention for practices in perioperative temperature management: knowledge, beliefs about capabilities, beliefs about consequences, reinforcement, memory/attention/decision-making, environmental context and resources, social/professional role/identity, social influences, and behavioural regulation. Potential target areas to improve temperature management practices include interventions that address information needs about individual temperature management behaviour as well as patient outcome (feedback), increasing awareness of possible temperature management strategies and guidelines, and a range of equipment and surgical team dynamics that influence temperature management. This study identified several potential target areas for future interventions from nine of the TDF behavioural domains that anesthesiologists perceive to drive their temperature management practices. Future interventions that aim to close the evidence-practice gap in perioperative temperature management may include these targets.

Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users.

PubMed

Stitzer, Maxine; Calsyn, Donald; Matheson, Timothy; Sorensen, James; Gooden, Lauren; Metsch, Lisa

2017-01-01

Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, medication check, viral load suppression; 47% of possible earnings) and two drug-use abatement (treatment entry; submission of drug negative UAs; 27% of earnings). The paper describes rationale for selection of targets, pay amounts and pay schedules. The CM program was compatible with and fully integrated into the PN intervention. The study design will allow comparison of behavioral and health outcomes for participants receiving PN with and without CM; results will inform future multi-target CM development. Copyright © 2016 Elsevier Inc. All rights reserved.

Early-Life Obesity Prevention: Critique of Intervention Trials During the First One Thousand Days.

PubMed

Reilly, John J; Martin, Anne; Hughes, Adrienne R

2017-06-01

To critique the evidence from recent and ongoing obesity prevention interventions in the first 1000 days in order to identify evidence gaps and weaknesses, and to make suggestions for more informative future intervention trials. Completed and ongoing intervention trials have had fairly modest effects, have been limited largely to high-income countries, and have used relatively short-term interventions and outcomes. Comparison of the evidence from completed prevention trials with the evidence from systematic reviews of behavioral risk factors shows that some life-course stages have been neglected (pre-conception and toddlerhood), and that interventions have neglected to target some important behavioral risk factors (maternal smoking during pregnancy, infant and child sleep). Finally, while obesity prevention interventions aim to modify body composition, few intervention trials have used body composition measures as outcomes, and this has limited their sensitivity to detect intervention effects. The new WHO Healthy Lifestyles Trajectory (HeLTI) initiative should address some of these weaknesses. Future early obesity prevention trials should be much more ambitious. They should, ideally: extend their interventions over the first 1000 days; have longer-term (childhood) outcomes, and improved outcome measures (body composition measures in addition to proxies for body composition such as the BMI for age); have greater emphasis on maternal smoking and child sleep; be global.

School intervention related to school and community violence.

PubMed

Jaycox, Lisa H; Stein, Bradley D; Wong, Marleen

2014-04-01

Schools are well positioned to facilitate recovery for students exposed to community or school violence or other traumatic life events affecting populations of youth. This article describes how schools can circumvent several key barriers to mental health service provision, outcomes that school interventions target, and the role of the family in school-based services. It includes a description of the history of schools in facilitating recovery for students exposed to traumatic events, particularly related to crisis intervention, and the current status of early intervention and strategies for long-term recovery in the school setting. Challenges and future directions are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

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

Beyond the dyad: making Developmental Origins of Health and Disease (DOHaD) interventions more inclusive.

PubMed

Pentecost, M; Ross, F C; Macnab, A

2018-02-01

Pregnant women, children under 2 and the first thousand days of life have been principal targets for Developmental Origins of Health and Disease interventions. This paradigm has been criticized for laying responsibility for health outcomes on pregnant women and mothers and through the thousand days focus inadvertently deflecting attention from other windows for intervention. Drawing on insights from the South African context, this commentary argues for integrated and inclusive interventions that encompass broader social framings. First, future interventions should include a wider range of actors. Second, broader action frameworks should encompass life-course approaches that identify multiple windows of opportunity for intervention. Using two examples - the inclusion of men, and engagement with adolescents - this commentary offers strategies for producing more inclusive interventions by using a broader social framework.

Non-responsiveness to intervention: children with autism spectrum disorders who do not rapidly respond to communication interventions.

PubMed

Ganz, Jennifer B; Lashley, Erin; Rispoli, Mandy Jenkins

2010-01-01

Providing a detailed description of two participants who failed to acquire functional communication skills following a verbal modelling intervention and Picture Exchange Communication System (PECS) training. Single-case research; Independent verbal requests, imitated verbal requests, word approximations and independent picture requests were assessed in a toddler and a pre-schooler with autism before and during two interventions. Although both participants used some vocalizations over the course of the study, experimental control was not demonstrated and the participants did not acquire a functional communication system prior to the cessation of intervention. Future research should include additional, detailed reports that provide insight to why some children with autism do not respond to particular communication interventions and should investigate the pairing of particular child characteristics with targeted interventions.

A systematic review of school-based eHealth interventions targeting alcohol use, smoking, physical inactivity, diet, sedentary behaviour and sleep among adolescents: a review protocol.

PubMed

Champion, Katrina E; Newton, Nicola C; Spring, Bonnie; Wafford, Q Eileen; Parmenter, Belinda J; Teesson, Maree

2017-12-06

Six key behavioural risk factors (risky alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and unhealthy sleep patterns) have been identified as strong determinants of chronic disease, such as cardiovascular disease, diabetes and cancers. School-based interventions targeting these multiple health risk behaviours among adolescents have the potential to halt the trajectory towards later disease, whilst online and mobile technology interventions offer advantages in terms of student engagement, reach and scalability. Despite this, the efficacy of eHealth school-based interventions targeting these six health risk behaviours among adolescents has not been evaluated. The proposed systematic review aims to address this by determining the nature and efficacy of existing eHealth school-based interventions targeting multiple health risk behaviours among adolescents. A systematic search of the MEDLINE, Embase, PsycINFO and Cochrane Library databases will be conducted to identify eligible published papers. Eligible studies will be randomised controlled trials, including cluster randomised controlled trials, of interventions targeting two or more of the following lifestyle risk behaviours: alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and sleep. Eligible studies will be those evaluating interventions delivered in a secondary school setting among participants 11-18 years of age, via an eHealth platform (Internet, computers of mobile technology). Two reviewers will independently screen studies for eligibility, extract data and assess the risk of bias. Study outcomes will be summarised in a narrative synthesis, and meta-analyses will be conducted where it is appropriate to combine studies. It is anticipated that the results from this review will serve to inform the development of future eHealth multiple health behaviour interventions for adolescents by identifying common characteristics of effective programs and highlighting knowledge gaps in the evidence base. PROSPERO CRD42017072163.

"Extremely minimally invasive": recent advances in nanotechnology research and future applications in neurosurgery.

PubMed

Mattei, Tobias A; Rehman, Azeem A

2015-01-01

The term "nanotechnology" refers to the development of materials and devices that have been designed with specific properties at the nanometer scale (10(-9) m), usually being less than 100 nm in size. Recent advances in nanotechnology have promised to enable visualization and intervention at the subcellular level, and its incorporation to future medical therapeutics is expected to bring new avenues for molecular imaging, targeted drug delivery, and personalized interventions. Although the central nervous system presents unique challenges to the implementation of new therapeutic strategies involving nanotechnology (such as the heterogeneous molecular environment of different CNS regions, the existence of multiple processing centers with different cytoarchitecture, and the presence of the blood-brain barrier), numerous studies have demonstrated that the incorporation of nanotechnology resources into the armamentarium of neurosurgery may lead to breakthrough advances in the near future. In this article, the authors present a critical review on the current 'state-of-the-art' of basic research in nanotechnology with special attention to those issues which present the greatest potential to generate major therapeutic progresses in the neurosurgical field, including nanoelectromechanical systems, nano-scaffolds for neural regeneration, sutureless anastomosis, molecular imaging, targeted drug delivery, and theranostic strategies.

First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents.

PubMed

Letourneau, Elizabeth J; McCart, Michael R; Sheidow, Ashli J; Mauro, Pia M

2017-01-01

There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N=45) or usual services (US; N=60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

Current Trends in Exercise Intervention Research, Technology, and Behavioral Change Strategies for People With Disabilities: A Scoping Review.

PubMed

Lai, Byron; Young, Hui-Ju; Bickel, C Scott; Motl, Robert W; Rimmer, James H

2017-10-01

This review synthesized physical activity and exercise intervention literature for the past 10 yrs for people with physical and cognitive disabilities including intervention characteristics, behavior change strategies, and types of technologies used to improve targeted outcomes. Systematic searches yielded 132 eligible studies. The major disability groups were multiple sclerosis (41%), stroke (15%), and spinal cord injury (12%). Research designs primarily involved randomized controlled trials (61%) versus quasi-experimental designs (39%). Approximately 20% of the interventions used some form of the following technology: information and communication technology (48%), interactive technology (37%), or electronic gauges (30%). Eighteen percent of studies used intervention strategies based on behavioral theory, which was typically combined with technology to promote activity and increase adherence in generally larger study samples. The three prevailing theories included social cognitive theory (58%), supportive accountability theory (21%), and transtheoretical model (21%). Upon completing the intervention, studies reported primarily significant outcomes (80%). Exercise research for PWD has grown in both quantity and quality, but several gaps remain. Study findings provide a roadmap for future exercise trials on understudied populations and highlight technology and behavior change theory as drivers of future intervention research.

First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents

PubMed Central

Letourneau, Elizabeth J.; McCart, Michael R.; Sheidow, Ashli J.; Mauro, Pia M.

2016-01-01

There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N = 45) or usual services (US; N = 60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions. PMID:27629581

Effective intervention or child's play? A review of video games for diabetes education.

PubMed

DeShazo, Jonathan; Harris, Lynne; Pratt, Wanda

2010-10-01

The purpose of this study is (1) to identify diabetes education video games and pilot studies in the literature, (2) to review themes in diabetes video game design and evaluation, and (3) to evaluate the potential role of educational video games in diabetes self-management education. Studies were systematically identified for inclusion from Medline, Web of Science, CINAHL, EMBASE, Psychinfo, IEEE Xplore, and ACM Digital Library. Features of each video game intervention were reviewed and coded based on an existing taxonomy of diabetes interventions framework. Nine studies featuring 11 video games for diabetes care were identified. Video games for diabetes have typically targeted children with type 1 diabetes mellitus and used situation problem-solving methods to teach diet, exercise, self-monitored blood glucose, and medication adherence. Evaluations have shown positive outcomes in knowledge, disease management adherence, and clinical outcomes. Video games for diabetes education show potential as effective educational interventions. Yet we found that improvements are needed in expanding the target audience, tailoring the intervention, and using theoretical frameworks. In the future, the reach and effectiveness of educational video games for diabetes education could be improved by expanding the target audience beyond juvenile type 1 diabetes mellitus, the use of tailoring, and increased use of theoretical frameworks.

Improving diet and physical activity to reduce population prevalence of overweight and obesity: an overview of current evidence.

PubMed

Stephens, Samantha K; Cobiac, Linda J; Veerman, J Lennert

2014-05-01

The aim of this study is to provide an overview of interventions to reduce or prevent overweight or obesity and improve diet or physical activity. A review of meta-analyses and/or systematic reviews of these interventions in any setting or age group were conducted. Narrative systematic reviews were included for intervention categories with limited meta-analyses available. Summary measures including weighted mean difference, standardised mean difference, and I-squared, were examined. A total of 60 meta-analyses and 23 systematic reviews met the inclusion criteria. Dietary interventions and multi-component interventions targeting overweight and obesity appeared to have the greatest effects, particularly in comparison with workplace or technology or internet-based interventions. Pharmaceutical and surgical interventions produced favourable results for specific population sub-groups (i.e. morbidly obese). Population-wide strategies such as policy interventions have not been widely analysed. The effectiveness of the interventions to assist in maintaining behaviour or weight change remains unclear. Various individually targeted interventions were shown to reduce body weight, although effect sizes were typically modest, and the durability of effects has been questioned. New approaches to evaluating population-based interventions, such as taxes and regulation, are recommended. Future research modelling the long-term effects of interventions across the lifespan would also be beneficial. Copyright © 2014 Elsevier Inc. All rights reserved.

The Cancer, Educate to Prevent Model-the Potential of School Environment for Primary Prevention of Cancer.

PubMed

Barros, A; Santos, H; Moreira, L; Ribeiro, N; Silva, L; Santos-Silva, F

2016-12-01

Cancer represents one of the main causes of death worldwide; consequently, preventive interventions are of utmost importance in public health education. The leading model of cancer prevention campaigns is based on general and undifferentiated actions mediated by health professionals, focusing on the technical and scientific information but rather ineffective in changing the symbolic, cognitive and practical relationship with the disease. New intervention models are thus required to address cancer literacy, being early interventions targeted to specific groups an elective counterpoint to contribute to positive and durable changes in cancer prevention. Our aim is to evaluate the feasibility and impact of cancer prevention programmes planned as focused interventions in restricted targets and mediated by non-healthcare professionals to increase cancer literacy and promote preventive behaviours. This pilot study evaluates schools' potential as a vehicle for cancer prevention education in a reality shaped by traditional health prevention campaigns. We developed a protocol of systematic surveying in order to review and, in the future, optimize and replicate this ecological model of intervention to other groups and contexts. The implementation of this model has been successful in which concerns to the effectiveness of the training programme for teachers. This led to the development of impactful cancer prevention education projects by trainees targeted to their students, allowing us to argue that it contributes to knowledge and practice in this complex as consensual priority area of intervention.

Digital Storytelling: Families' Search for Meaning after Child Death.

PubMed

Rolbiecki, Abigail J; Washington, Karla; Bitsicas, Katina

2017-01-01

Bereaved families that collectively make meaning of their grief experiences often function better than those that do not, yet most social work bereavement interventions target individuals rather than family units. In this article, authors describe an innovative social work intervention that employs digital storytelling. This is a narrative technique that combines photography, music, and spoken word to help families bereaved by child death make meaning of their loss and envision a future without their deceased child.

Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review.

PubMed

Schoeppe, Stephanie; Alley, Stephanie; Van Lippevelde, Wendy; Bray, Nicola A; Williams, Susan L; Duncan, Mitch J; Vandelanotte, Corneel

2016-12-07

Health and fitness applications (apps) have gained popularity in interventions to improve diet, physical activity and sedentary behaviours but their efficacy is unclear. This systematic review examined the efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour in children and adults. Systematic literature searches were conducted in five databases to identify papers published between 2006 and 2016. Studies were included if they used a smartphone app in an intervention to improve diet, physical activity and/or sedentary behaviour for prevention. Interventions could be stand-alone interventions using an app only, or multi-component interventions including an app as one of several intervention components. Outcomes measured were changes in the health behaviours and related health outcomes (i.e., fitness, body weight, blood pressure, glucose, cholesterol, quality of life). Study inclusion and methodological quality were independently assessed by two reviewers. Twenty-seven studies were included, most were randomised controlled trials (n = 19; 70%). Twenty-three studies targeted adults (17 showed significant health improvements) and four studies targeted children (two demonstrated significant health improvements). Twenty-one studies targeted physical activity (14 showed significant health improvements), 13 studies targeted diet (seven showed significant health improvements) and five studies targeted sedentary behaviour (two showed significant health improvements). More studies (n = 12; 63%) of those reporting significant effects detected between-group improvements in the health behaviour or related health outcomes, whilst fewer studies (n = 8; 42%) reported significant within-group improvements. A larger proportion of multi-component interventions (8 out of 13; 62%) showed significant between-group improvements compared to stand-alone app interventions (5 out of 14; 36%). Eleven studies reported app usage statistics, and three of them demonstrated that higher app usage was associated with improved health outcomes. This review provided modest evidence that app-based interventions to improve diet, physical activity and sedentary behaviours can be effective. Multi-component interventions appear to be more effective than stand-alone app interventions, however, this remains to be confirmed in controlled trials. Future research is needed on the optimal number and combination of app features, behaviour change techniques, and level of participant contact needed to maximise user engagement and intervention efficacy.

Culturally-Informed Interventions for Substance Abuse Among Indigenous Youth in the United States: A Review.

PubMed

Liddell, Jessica; Burnette, Catherine E

2017-01-01

Given the disproportionately high levels of alcohol and other drug abuse among Indigenous youth in the United States, the purpose of this systematic review was to explicate the current state of empirically-based and culturally-informed substance abuse prevention and intervention programs for Indigenous youth (ages 9-18). The 14 articles that met inclusion criteria for this review were analyzed both in terms of the cultural intervention itself (primary population, intervention, core tenants, focus of intervention, intervention goals, location, intervention location, and program length) and their evaluation approach. Results indicate variable integration of cultural components with the majority of interventions taking place in schools and treatment facilities, targeting primarily individuals. There is a current gap in research on culturally-informed substance abuse interventions for Indigenous youth, which this review begins to address. Promising areas of future research and interventions include bringing communities and families into treatment and prevention.

Exploiting social influence to magnify population-level behaviour change in maternal and child health: study protocol for a randomised controlled trial of network targeting algorithms in rural Honduras.

PubMed

Shakya, Holly B; Stafford, Derek; Hughes, D Alex; Keegan, Thomas; Negron, Rennie; Broome, Jai; McKnight, Mark; Nicoll, Liza; Nelson, Jennifer; Iriarte, Emma; Ordonez, Maria; Airoldi, Edo; Fowler, James H; Christakis, Nicholas A

2017-03-13

Despite global progress on many measures of child health, rates of neonatal mortality remain high in the developing world. Evidence suggests that substantial improvements can be achieved with simple, low-cost interventions within family and community settings, particularly those designed to change knowledge and behaviour at the community level. Using social network analysis to identify structurally influential community members and then targeting them for intervention shows promise for the implementation of sustainable community-wide behaviour change. We will use a detailed understanding of social network structure and function to identify novel ways of targeting influential individuals to foster cascades of behavioural change at a population level. Our work will involve experimental and observational analyses. We will map face-to-face social networks of 30 000 people in 176 villages in Western Honduras, and then conduct a randomised controlled trial of a friendship-based network-targeting algorithm with a set of well-established care interventions. We will also test whether the proportion of the population targeted affects the degree to which the intervention spreads throughout the network. We will test scalable methods of network targeting that would not, in the future, require the actual mapping of social networks but would still offer the prospect of rapidly identifying influential targets for public health interventions. The Yale IRB and the Honduran Ministry of Health approved all data collection procedures (Protocol number 1506016012) and all participants will provide informed consent before enrolment. We will publish our findings in peer-reviewed journals as well as engage non-governmental organisations and other actors through venues for exchanging practical methods for behavioural health interventions, such as global health conferences. We will also develop a 'toolkit' for practitioners to use in network-based intervention efforts, including public release of our network mapping software. NCT02694679; Pre-results. 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/.

Telephone, print, and Web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review.

PubMed

Goode, Ana D; Lawler, Sheleigh P; Brakenridge, Charlotte L; Reeves, Marina M; Eakin, Elizabeth G

2015-12-01

Broad-reach (non-face-to-face) modalities offer an accessible and cost-effective means to provide behavior change programs in diverse and growing cancer survivor populations. The purpose of this systematic review is to evaluate the efficacy of physical activity, dietary, and/or weight control interventions for cancer survivors in which telephone, short-message service, print, and/or Web is the primary method of delivery. A structured search of PubMed, Embase, Web of Science, CINAHL, and CENTRAL (May 2013) was conducted. Included studies focused and reported on physical activity (PA) and dietary change and/or weight control in adult cancer survivors, delivered at least 50% of intervention contacts by broad-reach modality and included a control group. Study design, intervention features, and behavioral/weight outcomes were extracted, tabulated, and summarized. Twenty-seven studies were included; 22 telephone, three Web, and two print. Sixteen studies targeted PA, two diet, and nine targeted multiple behaviors. Most studies (18/27) targeted a single survivor group, namely breast cancer (n = 12). Nineteen of 27 studies found evidence for initiation of behavior change, with only eight reporting on maintenance and one on cost-effectiveness. This review provides support for broad-reach modalities, particularly the telephone, in the delivery of lifestyle interventions to cancer survivors. Future research should evaluate (1) newer technologies (i.e., SMS and mobile phone applications), (2) interventions for diverse cancer survivors and those targeting multiple behaviors, (3) long-term outcomes, and 4) cost-effectiveness. Broad-reach lifestyle interventions are effective, with further research needed to evaluate their generalizability and integration into cancer care.

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.

Biomarkers and patient selection for PI3K/Akt/mTOR targeted therapies: current status and future directions.

PubMed

Bartlett, John M S

2010-11-01

The phosphatidylinositol 3-kinase (PI3K)/Akt/ mammalian target of rapamycin (mTOR) pathway regulates a broad spectrum of physiologic and pathologic processes. In breast cancer mutation, amplification, deletion, methylation, and posttranslational modifications lead to significant dysregulation of this pathway leading to more aggressive and potentially drug-resistant disease. Multiple novel agents, targeting different nodes within the pathway are currently under development by both commercial and academic partners. The key to the successful validation of these markers is selection of the appropriate patient groups using biomarkers. This article reviews current progress in this area, highlighting the key molecular alterations described in genes within the PI3K/Akt/mTOR pathway that may have an effect on response to current and future therapeutic interventions. Herein, gaps in current knowledge are highlighted and suggestions for future research directions given that may facilitate biomarker development in partnership with current drug development.

HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action.

PubMed

Poteat, Tonia; Malik, Mannat; Scheim, Ayden; Elliott, Ayana

2017-08-01

The purpose of this review is to summarize the available evidence-based HIV prevention interventions tailored for transgender people. A limited number of evidence-based HIV prevention interventions have been tested with transgender populations. Most existing interventions target behavior change among transgender women, with only one HIV prevention program evaluated for transgender men. Studies addressing biomedical interventions for transgender women are ongoing. Few interventions address social and structural barriers to HIV prevention, such as stigma, discrimination, and poverty. Evidence-based multi-level interventions that address the structural, biomedical, and behavioral risks for HIV among transgender populations, including transgender men, are needed to address disparities in HIV prevalence. Future research should address not only pre-exposure prophylaxis uptake and condom use but also structural barriers that limit access to these prevention strategies.

Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents: a randomized clinical trial.

PubMed

Zatzick, Douglas; Russo, Joan; Lord, Sarah Peregrine; Varley, Christopher; Wang, Jin; Berliner, Lucy; Jurkovich, Gregory; Whiteside, Lauren K; O'Connor, Stephen; Rivara, Frederick P

2014-06-01

Violence and injury risk behaviors, alcohol and drug use problems, and posttraumatic stress disorder (PTSD) and depressive symptoms occur frequently among adolescents presenting to acute care medical settings after traumatic physical injury. To test the effectiveness of a stepped collaborative care intervention targeting this constellation of risk behaviors and symptoms in randomly sampled hospitalized adolescents with and without traumatic brain injury. A pragmatic randomized clinical trial was conducted at a single US level I trauma center. Participants included 120 adolescents aged 12 to 18 years randomized to intervention (n = 59) and control (n = 61) conditions. Stepped collaborative care intervention included motivational interviewing elements targeting risk behaviors and substance use as well as medication and cognitive behavioral therapy elements targeting PTSD and depressive symptoms. Adolescents were assessed at baseline before randomization and 2, 5, and 12 months after injury hospitalization. Standardized instruments were used to assess violence risk behaviors, alcohol and drug use, and PTSD and depressive symptoms. The investigation attained more than 95% adolescent follow-up at each assessment point. At baseline, approximately one-third of the participants endorsed the violence risk behavior of carrying a weapon. Regression analyses demonstrated that intervention patients experienced significant reductions in weapon carrying compared with controls during the year after injury (group × time effect, F3,344 = 3.0; P = .03). At 12 months after the injury, 4 (7.3%) intervention patients vs 13 (21.3%) control patients reported currently carrying a weapon (relative risk, 0.31; 95% CI, 0.11-0.90). The intervention was equally effective in reducing the risk of weapon carrying among injured adolescents with and without traumatic brain injury. Other treatment targets, including alcohol and drug use problems and high levels of PTSD and depressive symptoms, occurred less frequently in the cohort relative to weapon carrying and were not significantly affected by the intervention. Collaborative care intervention reduced the risk of adolescent weapon carrying during the year after the injury hospitalization. Future investigation should replicate this preliminary observation. If the finding is replicated, orchestrated investigative and policy efforts could systematically implement and evaluate screening and intervention procedures targeting youth violence prevention at US trauma centers. clinicaltrials.gov identifier: NCT00619255.

Understanding the Association Between School Climate and Future Orientation.

PubMed

Lindstrom Johnson, Sarah; Pas, Elise; Bradshaw, Catherine P

2016-08-01

Promoting students' future orientation is inherently a goal of the educational system. Recently, it has received more explicit attention given the increased focus on career readiness. This study aimed to examine the association between school climate and adolescents' report of future orientation using data from youth (N = 27,698; 49.4 % female) across 58 high schools. Three-level hierarchical linear models indicated that perceptions of available emotional and service supports, rules and consequences, and parent engagement were positively related to adolescents' future orientation. Additionally, the school-level average future orientation was significantly related to individuals' future orientation, indicating a potential influence of contextual effects on this construct. Taken together, these findings suggest that interventions targeting school climate may hold promise for promoting future orientation.

Team-Based Care with Pharmacists to Improve Blood Pressure: a Review of Recent Literature.

PubMed

Kennelty, Korey A; Polgreen, Linnea A; Carter, Barry L

2018-01-18

We review studies published since 2014 that examined team-based care strategies and involved pharmacists to improve blood pressure (BP). We then discuss opportunities and challenges to sustainment of team-based care models in primary care clinics. Multiple studies presented in this review have demonstrated that team-based care including pharmacists can improve BP management. Studies highlighted the cost-effectiveness of a team-based pharmacy intervention for BP control in primary care clinics. Little information was found on factors influencing sustainability of team-based care interventions to improve BP control. Future work is needed to determine the best populations to target with team-based BP programs and how to implement team-based approaches utilizing pharmacists in diverse clinical settings. Future studies need to not only identify unmet clinical needs but also address reimbursement issues and stakeholder engagement that may impact sustainment of team-based care interventions.

Home Environmental Interventions for the Prevention or Control of Allergic and Respiratory Diseases: What Really Works.

PubMed

Le Cann, Pierre; Paulus, Hélène; Glorennec, Philippe; Le Bot, Barbara; Frain, Sophie; Gangneux, Jean Pierre

Home health care workers interventions have been implemented in western countries to improve health status of patients with respiratory diseases especially asthma and allergic illnesses. Twenty-six controlled studies dealing with prevention and control of these diseases through home environmental interventions were reviewed. After a comprehensive description of the characteristics of these studies, the effectiveness of each intervention was then evaluated in terms of participants' compliance with the intervention program, improvement of quality of the indoor environment, and finally improvement of health outcomes, in detailed tables. Limitations and biases of the studies are also discussed. Overall, this review aims at giving a toolbox for home health care workers to target the most appropriate measures to improve health status of the patient depending on his and/or her environment and disease. Only a case-by-case approach with achievable measures will warrant the efficacy of home interventions. This review will also provide to the research community a tool to better identify targets to focus in future evaluation studies of home health care workers action. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Behavioral interventions for agitation in older adults with dementia: an evaluative review.

PubMed

Spira, Adam P; Edelstein, Barry A

2006-06-01

Older adults with dementia commonly exhibit agitated behavior that puts them at risk of injury and institutionalization and is associated with caregiver stress. A range of theoretical approaches has produced numerous interventions to manage these behavior problems. This paper critically reviews the empirical literature on behavioral interventions to reduce agitation in older adults with dementia. A literature search yielded 23 articles that met inclusion criteria. These articles described interventions that targeted wandering, disruptive vocalization, physical aggression, other agitated behaviors and a combination of these behaviors. Studies are summarized individually and then evaluated. Behavioral interventions targeting agitated behavior exhibited by older adults with dementia show considerable promise. A number of methodological issues must be addressed to advance this research area. Problem areas include inconsistent use of functional assessment techniques, failure to report quantitative findings and inadequate demonstrations of experimental control. The reviewed studies collectively provide evidence that warrants optimism regarding the application of behavioral principles to the management of agitation among older adults with dementia. Although the results of some studies were mixed and several studies revealed methodological shortcomings, many of them offered innovations that can be used in future, more rigorously designed, intervention studies.

Impact of computer-mediated, obesity-related nutrition education interventions for adolescents: a systematic review.

PubMed

Ajie, Whitney N; Chapman-Novakofski, Karen M

2014-06-01

The purpose of this systematic review was to evaluate recent research regarding the use of computer-based nutrition education interventions targeting adolescent overweight and obesity. Online databases were systematically searched using key words, and bibliographies of related articles were manually searched. Inclusion/exclusion criteria were applied and included studies evaluated for their ability to achieve their objectives and for quality using the Nutrition Evidence Library appraisal guidelines for research design and implementation. Of the 15 studies included, 10 were randomized controlled trials. Two studies targeted weight loss, 2 targeted weight maintenance, and 11 targeted dietary improvement with or without physical activity. At least half of in-school (60%) and nonschool interventions (80%) exhibited significantly positive effects on nutrition- or obesity-related variables. Small changes in diet, physical activity, knowledge, and self-efficacy were shown; however, few results were sustained long term. Recommendations included application of health behavior theory and computer tailoring for feedback messages. Future research should include thorough description of intervention content (messages, theory, multimedia, etc.), application of rigorous methodology, as well as consideration of covariates such as parental involvement and gender. With further research and evidentiary support, this approach to obesity-related nutrition education has the potential to be successful. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Targeting activator protein 1 signaling pathway by bioactive natural agents: Possible therapeutic strategy for cancer prevention and intervention.

PubMed

Tewari, Devesh; Nabavi, Seyed Fazel; Nabavi, Seyed Mohammad; Sureda, Antoni; Farooqi, Ammad Ahmad; Atanasov, Atanas G; Vacca, Rosa Anna; Sethi, Gautam; Bishayee, Anupam

2018-02-01

Activator protein 1 (AP-1) is a key transcription factor in the control of several cellular processes responsible for cell survival proliferation and differentiation. Dysfunctional AP-1 expression and activity are involved in several severe diseases, especially inflammatory disorders and cancer. Therefore, targeting AP-1 has recently emerged as an attractive therapeutic strategy for cancer prevention and therapy. This review summarizes our current understanding of AP-1 biology and function as well as explores and discusses several natural bioactive compounds modulating AP-1-associated signaling pathways for cancer prevention and intervention. Current limitations, challenges, and future directions of research are also critically discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Literature Synthesis of Health Promotion Research in Salons and Barbershops

PubMed Central

Linnan, Laura A.; D’Angelo, Heather; Harrington, Cherise B.

2015-01-01

Context Barbershops and beauty salons are located in all communities and frequented by diverse groups of people, making them key settings for addressing health disparities. No studies have reviewed the growing body of literature describing studies promoting health in these settings. This review summarized the literature related to promoting health within barbershops and beauty salons to inform future approaches that target diverse populations in similar settings. Evidence Acquisition We identified and reviewed published research articles describing formative research, recruitment, and health-related interventions set in beauty salons and barbershops. PubMed and other secondary search engines were searched in 2010 and again in 2013 for English-language papers indexed from 1990 through August 2013. The search yielded 110 articles, 68 of which were formerly reviewed, and 54 were eligible for inclusion. Evidence Synthesis Included articles were categorized as formative research (n=27), recruitment (n=7), or intervention (n=20). Formative research studies showed that owners, barbers/stylists, and their customers were willing participants, clarifying the feasibility of promoting health in these settings. Recruitment studies demonstrated that salon/shop owners will join research studies and can enroll customers. Among intervention studies, level of stylist/barber involvement was categorized. More than 73.3% of intervention studies demonstrated statistically significant results, targeting mostly racial/ethnic minority groups and focusing on a variety of health topics. Conclusions Barbershops and beauty salons are promising settings for reaching populations most at risk for health disparities. Although these results are encouraging, more rigorous research and evaluation of future salon- and barbershop-based interventions are needed. PMID:24768037

Scoping Review of Research on the Effectiveness of Food-Safety Education Interventions Directed at Consumers.

PubMed

Sivaramalingam, Bhairavi; Young, Ian; Pham, Mai T; Waddell, Lisa; Greig, Judy; Mascarenhas, Mariola; Papadopoulos, Andrew

2015-07-01

Improper food handling by consumers at home is a major cause of foodborne illness. Therefore, effective education strategies are essential to change consumers' food safety attitudes and behaviors. The purpose of this scoping review was to identify and characterize primary literature examining the effectiveness of consumer food-safety education interventions. Ten bibliographic databases were searched using a comprehensive search strategy. Citations were identified; two reviewers screened them for relevance and characterized relevant articles. To ensure results would be applicable to end users, stakeholders were engaged to provide input on the review scope, methods, and results. We identified 246 relevant articles, of which 150 were quantitative, 66 qualitative, and 30 mixed-method research studies. Most studies (64.2%) were published in the United States, using an uncontrolled before-and-after study design (31.3%), and investigated the effectiveness of community-based training sessions and workshops (52.0%). Research gaps were found in the number of randomized controlled studies conducted, academic- and school-based courses and curricula investigated, and interventions targeting high-risk populations (e.g., pregnant women, those who are immunocompromised) and using new media channels (e.g., social media). Key opportunities to enhance the utility of future primary research investigating consumer food-safety interventions include the following: using studies based on behavior-change theories and formative research; engaging the target population in the research; using validated instruments to measures outcomes; and reporting intervention characteristics and outcomes completely. Results of this review can be used to prioritize future primary research and decision-making in this area.

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.

Psychosocial Interventions for Patients and Caregivers in the Age of New Communication Technologies: Opportunities and Challenges in Cancer Care

PubMed Central

BADR, HODA; CARMACK, CINDY L.; DIEFENBACH, MICHAEL A.

2014-01-01

Interactive health communication technologies (IHCTs) present a new opportunity and challenge for cancer control researchers who focus on couple and family-based psychosocial interventions. In this article we first present findings from a systematic review of eight studies that utilized IHCTs in psychosocial interventions with cancer patients and their caregivers. Although this research area is still in its infancy, studies suggest that it is feasible to incorporate IHCTs in such interventions, that IHCTs are generally well-accepted by patients and caregivers, and that the choice of technology is largely dependent on intervention target (i.e., patient, caregiver, or both) and outcomes (e.g., decision-making, symptom management, lifestyle behaviors). A major research gap has been the lack of integration of Web 2.0 technologies (e.g., social media), despite the fact that social support and communication are frequently targeted components of interventions that involve cancer patients and their caregivers. Given this, we next present findings from a qualitative study that we conducted to describe the different needs and preferences of 13 cancer survivors and 12 caregivers with regard to social media use. Finally, we discuss some of the opportunities and challenges of using IHCTs in psychosocial interventions for cancer patients and their caregivers and propose directions for future research. PMID:25629218

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji.

PubMed

Webster, Jacqui; Pillay, Arti; Suku, Arleen; Gohil, Paayal; Santos, Joseph Alvin; Schultz, Jimaima; Wate, Jillian; Trieu, Kathy; Hope, Silvia; Snowdon, Wendy; Moodie, Marj; Jan, Stephen; Bell, Colin

2018-01-30

This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji

PubMed Central

Webster, Jacqui; Pillay, Arti; Suku, Arleen; Gohil, Paayal; Santos, Joseph Alvin; Schultz, Jimaima; Wate, Jillian; Trieu, Kathy; Hope, Silvia; Snowdon, Wendy; Moodie, Marj; Jan, Stephen; Bell, Colin

2018-01-01

This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally. PMID:29385758

A Mental Health Storytelling Intervention Using Transmedia to Engage Latinas: Grounded Theory Analysis of Participants’ Perceptions of the Story’s Main Character

PubMed Central

Martinez, Adrienne; Soderlund, Patricia D

2018-01-01

Background Transmedia storytelling was used to attract English-speaking Latina women with elevated symptoms of depression and anxiety to engage in an intervention that included videos and a webpage with links to symptom management resources. However, a main character for the storyline who was considered dynamic, compelling, and relatable by the target group was needed. Objective We conducted interviews with 28 English-speaking Latinas (target group) with elevated symptoms of depression or anxiety who participated in an Internet-accessible transmedia storytelling intervention. The objective of this study was to examine participants’ perceptions of the lead character of the story. Development of this character was informed by deidentified data from previous studies with members of the target group. Critique of the character from a panel of therapists informed editing, as did input from women of the target group. Methods All interviews were conducted via telephone, audio-recorded, and transcribed. Data analysis was guided by grounded theory methodology. Results Participants embraced the main character, Catalina, related to her as a person with an emotional life and a temporal reality, reported that they learned from her and wanted more episodes that featured her and her life. Grounded theory analysis led to the development of one category (She “just felt so real”: relating to Catalina as a real person with a past, present, and future) with 4 properties. Properties included (1) relating emotionally to Catalina’s vulnerability, (2) recognizing shared experiences, (3) needing to support others while simultaneously lacking self-support, and (4) using Catalina as a springboard for imagining alternative futures. Participants found Catalina’s efforts to pursue mental health treatment to be meaningful and led them to compare themselves to her and consider how they might pursue treatment themselves. Conclusions When creating a story-based mental health intervention to be delivered through an app, regardless of type, careful development of the main character is valuable. Theoretical guidance, previous deidentified data from the target group, critique from key stakeholders and members of the target group, and preliminary testing are likely to enhance the main character’s relatability and appropriateness, which can increase sustained engagement. PMID:29720357

A Mental Health Storytelling Intervention Using Transmedia to Engage Latinas: Grounded Theory Analysis of Participants' Perceptions of the Story's Main Character.

PubMed

Heilemann, MarySue V; Martinez, Adrienne; Soderlund, Patricia D

2018-05-02

Transmedia storytelling was used to attract English-speaking Latina women with elevated symptoms of depression and anxiety to engage in an intervention that included videos and a webpage with links to symptom management resources. However, a main character for the storyline who was considered dynamic, compelling, and relatable by the target group was needed. We conducted interviews with 28 English-speaking Latinas (target group) with elevated symptoms of depression or anxiety who participated in an Internet-accessible transmedia storytelling intervention. The objective of this study was to examine participants' perceptions of the lead character of the story. Development of this character was informed by deidentified data from previous studies with members of the target group. Critique of the character from a panel of therapists informed editing, as did input from women of the target group. All interviews were conducted via telephone, audio-recorded, and transcribed. Data analysis was guided by grounded theory methodology. Participants embraced the main character, Catalina, related to her as a person with an emotional life and a temporal reality, reported that they learned from her and wanted more episodes that featured her and her life. Grounded theory analysis led to the development of one category (She "just felt so real": relating to Catalina as a real person with a past, present, and future) with 4 properties. Properties included (1) relating emotionally to Catalina's vulnerability, (2) recognizing shared experiences, (3) needing to support others while simultaneously lacking self-support, and (4) using Catalina as a springboard for imagining alternative futures. Participants found Catalina's efforts to pursue mental health treatment to be meaningful and led them to compare themselves to her and consider how they might pursue treatment themselves. When creating a story-based mental health intervention to be delivered through an app, regardless of type, careful development of the main character is valuable. Theoretical guidance, previous deidentified data from the target group, critique from key stakeholders and members of the target group, and preliminary testing are likely to enhance the main character's relatability and appropriateness, which can increase sustained engagement. ©MarySue V Heilemann, Adrienne Martinez, Patricia D Soderlund. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.05.2018.

Promoting Parent and Child Physical Activity Together: Elicitation of Potential Intervention Targets and Preferences.

PubMed

Rhodes, Ryan E; Lim, Clarise

2018-02-01

Promoting physical activities that involve both parents and their children would be very useful to the improved health and well-being of families, yet coactivity interventions have been particularly unsuccessful in past research. The purpose of this study was to elicit the salient parental beliefs about coactivity framed through theory of planned behavior in order to inform future intervention content. A representative sample of Canadian parents ( N = 483) with children aged 6 to 14 years completed belief elicitation measures of theory of planned behavior, as well as coactivity and program preferences. Analyses included content theming by physical activity belief and preference through tallies of the percentages of parents endorsing each belief. Exploratory analyses of differences in endorsed themes were conducted by parent (mother, father), age of child (6-10 years, 11-14 years), and sex of the child. The results showed that behavioral beliefs about health, interpersonal and educational/learning opportunities and control beliefs about lack of time, various incompatible parent/child factors, parental health, and bad weather were dominant themes. Most of these themes did not vary in endorsement by parent and child characteristics. By contrast, preferences for various activities varied by parent and child characteristics, yet parents overwhelmingly desired the activities to be outdoors, close to home, after work, and originally delivered from community health professionals via Internet or face-to face means. Overall, the findings provide several considerations for specific targets to improve future physical activity intervention approaches among parents and their children.

Relational Interventions for Maltreated Children

PubMed Central

Valentino, Kristin

2016-01-01

Child maltreatment may be best characterized as a pathogenic relational experience which primarily occurs in the mother-child relationship. As such, enhancing the mother-child relationship is the key process that should be targeted in intervention approaches for child maltreatment. Two salient and modifiable components of the mother-child relationship are highlighted: maternal sensitivity and attachment organization. It is argued, from a developmental psychopathology perspective, why focusing on these issues hold the most promise for interrupting negative developmental cascades and promoting resilience among maltreated children. Utilization of a tiered approach to delivering increasingly intensive relational interventions is recommended as are future directions for translational research and dissemination. PMID:28138967

Use of a time series design to test effectiveness of a theory-based intervention targeting adherence of health professionals to a clinical guideline.

PubMed

Hanbury, Andria; Wallace, Louise; Clark, Michael

2009-09-01

The aim of this study was to test the effectiveness of a theory of planned behaviour intervention to increase adherence of community mental health professionals to a national suicide prevention guideline. Routinely collected audit adherence data from an intervention and control site were collected and analysed using time series analysis to test whether the intervention significantly increased adherence. The effects of a local and national event on adherence were also examined. A Theory of Planned Behaviour (TPB) questionnaire, developed from interview findings, was administered to the health professionals. Subjective norms were found to be the most significant predictor of intention to adhere to the guideline, and were targeted with an interactive educational intervention. Time series analysis applied to routinely collected audit adherence data was used to test intervention effectiveness. The TPB accounted for 58% of the variance in intention to adhere, with subjective norms the only significant predictor. The intervention did not significantly increase adherence; however, the national and local events were found to have significantly increased adherence. The TPB was a useful framework for exploring barriers to adherence; however, this did not translate into an effective intervention. Future research should seek collaboration with local experts, and use this information in combination with the TPB, to develop interventions. Collaborative research with experts in pedagogy may also help to develop more effective interventions, particularly education-based interventions that require adult learning.

Lay Health Influencers: How They Tailor Brief Tobacco Cessation Interventions

PubMed Central

Yuan, Nicole P.; Castañeda, Heide; Nichter, Mark; Nichter, Mimi; Wind, Steven; Carruth, Lauren; Muramoto, Myra

2014-01-01

Interventions tailored to individual smoker characteristics have increasingly received attention in the tobacco control literature. The majority of tailored interventions are generated by computers and administered with printed materials or Web-based programs. The purpose of this study was to examine the tailoring activities of community lay health influencers who were trained to perform face-to-face brief tobacco cessation interventions. Eighty participants of a large-scale, randomized controlled trial completed a 6-week qualitative follow-up interview. A majority of participants (86%) reported that they made adjustments in their intervention behaviors based on individual smoker characteristics, their relationship with the smoker, and/or setting. Situational contexts (i.e., location and timing) primarily played a role after targeted smokers were selected. The findings suggest that lay health influencers benefit from a training curriculum that emphasizes a motivational, person-centered approach to brief cessation interventions. Recommendations for future tobacco cessation intervention trainings are presented. PMID:21986244

Lay health influencers: how they tailor brief tobacco cessation interventions.

PubMed

Yuan, Nicole P; Castañeda, Heide; Nichter, Mark; Nichter, Mimi; Wind, Steven; Carruth, Lauren; Muramoto, Myra

2012-10-01

Interventions tailored to individual smoker characteristics have increasingly received attention in the tobacco control literature. The majority of tailored interventions are generated by computers and administered with printed materials or web-based programs. The purpose of this study was to examine the tailoring activities of community lay health influencers who were trained to perform face-to-face brief tobacco cessation interventions. Eighty participants of a large-scale, randomized controlled trial completed a 6-week qualitative follow-up interview. A majority of participants (86%) reported that they made adjustments in their intervention behaviors based on individual smoker characteristics, their relationship with the smoker, and/or setting. Situational contexts (i.e., location and timing) primarily played a role after targeted smokers were selected. The findings suggest that lay health influencers benefit from a training curriculum that emphasizes a motivational, person-centered approach to brief cessation interventions. Recommendations for future tobacco cessation intervention trainings are presented.

Interventions to reduce racial and ethnic disparities in health care.

PubMed

Chin, Marshall H; Walters, Amy E; Cook, Scott C; Huang, Elbert S

2007-10-01

In 2005, the Robert Wood Johnson Foundation created Finding Answers: Disparities Research for Change, a program to identify, evaluate, and disseminate interventions to reduce racial and ethnic disparities in the care and outcomes of patients with cardiovascular disease, depression, and diabetes. In this introductory paper, we present a conceptual model for interventions that aim to reduce disparities. With this model as a framework, we summarize the key findings from the six other papers in this supplement on cardiovascular disease, diabetes, depression, breast cancer, interventions using cultural leverage, and pay-for-performance and public reporting of performance measures. Based on these findings, we present global conclusions regarding the current state of health disparities interventions and make recommendations for future interventions to reduce disparities. Multifactorial, culturally tailored interventions that target different causes of disparities hold the most promise, but much more research is needed to investigate potential solutions and their implementation.

Smartphone delivery of a hope intervention: Another way to flourish.

PubMed

Daugherty, Douglas A; Runyan, Jason D; Steenbergh, Timothy A; Fratzke, Betty Jane; Fry, Brian N; Westra, Emma

2018-01-01

Positive interventions have shown promise for fostering hedonic (happiness) and eudaimonic (flourishing) well-being. However, few studies have focused on positive interventions that target hope as a means of increasing well-being, and none have examined the use of smartphone app-based systems for delivering interventions in the moments and contexts of daily life-an approach called ecological momentary intervention (EMI). We conducted a quasi-experimental pilot study using a pretest and posttest design to examine the feasibility and potential impact of a mobile app-based hope EMI. Participants appeared to engage with the intervention and found the experience to be user-friendly, helpful, and enjoyable. Relative to the control group, those receiving the intervention demonstrated significantly greater increases in hope; however, there were no between-group differences in hedonic and eudaimonic well-being. The authors recommend future research to examine the potential of EMI mobile apps to cultivate hope and promote flourishing.

Smartphone delivery of a hope intervention: Another way to flourish

PubMed Central

Runyan, Jason D.; Steenbergh, Timothy A.; Fratzke, Betty Jane; Fry, Brian N.; Westra, Emma

2018-01-01

Positive interventions have shown promise for fostering hedonic (happiness) and eudaimonic (flourishing) well-being. However, few studies have focused on positive interventions that target hope as a means of increasing well-being, and none have examined the use of smartphone app-based systems for delivering interventions in the moments and contexts of daily life—an approach called ecological momentary intervention (EMI). We conducted a quasi-experimental pilot study using a pretest and posttest design to examine the feasibility and potential impact of a mobile app-based hope EMI. Participants appeared to engage with the intervention and found the experience to be user-friendly, helpful, and enjoyable. Relative to the control group, those receiving the intervention demonstrated significantly greater increases in hope; however, there were no between-group differences in hedonic and eudaimonic well-being. The authors recommend future research to examine the potential of EMI mobile apps to cultivate hope and promote flourishing. PMID:29856805

The systemic inflammatory response syndrome.

PubMed

Robertson, Charles M; Coopersmith, Craig M

2006-04-01

The systemic inflammatory response syndrome (SIRS) is the body's response to an infectious or noninfectious insult. Although the definition of SIRS refers to it as an "inflammatory" response, it actually has pro- and anti-inflammatory components. This review outlines the pathophysiology of SIRS and highlights potential targets for future therapeutic intervention in patients with this complex entity.

Psychosocial Determinants of Suicide Attempts among Black South African Adolescents: A Qualitative Analysis

ERIC Educational Resources Information Center

Shilubane, Hilda N.; Ruiter, Robert A. C.; Bos, Arjan E. R..; van den Borne, Bart; James, Shamagonam; Reddy, Priscilla S.

2012-01-01

In South Africa, one in five adolescents attempt suicide. Suicide attempts continue to rise. We aimed to identify psychosocial target points for future educational interventions. One-to-one semi-structured interviews were conducted to explore psychosocial factors associated with past suicide attempts among suicide survivors in Limpopo province,…

Prevention Programmes Targeting Emotional and Social Development in Preschoolers: Current Status and Future Directions

ERIC Educational Resources Information Center

Stefan, Catrinel A.; Miclea, Mircea

2010-01-01

Early intervention has become a widely recognised practice because preschool years offer the best timing for preventing early onset conduct problems. Moreover, some factors have been consistently identified as putting children at risk for developing mental health problems, as well as school readiness problems. Such risk factors are poor…

Global school-based childhood obesity interventions: a review.

PubMed

Ickes, Melinda J; McMullen, Jennifer; Haider, Taj; Sharma, Manoj

2014-08-28

The issue of childhood overweight and obesity has become a global public health crisis. School-based interventions have been developed and implemented to combat this growing concern. The purpose of this review is to compare and contrast U.S. and international school-based obesity prevention interventions and highlight efficacious strategies. A systematic literature review was conducted utilizing five relevant databases. Inclusion criteria were: (1) primary research; (2) overweight or obesity prevention interventions; (3) school-based; (4) studies published between 1 January 2002 through 31 December 2013; (5) published in the English language; (6) child-based interventions, which could include parents; and (7) studies that reported outcome data. A total of 20 interventions met the inclusion criteria. Ten interventions each were implemented in the U.S. and internationally. International interventions only targeted elementary-aged students, were less likely to target low-income populations, and were less likely to be implemented for two or more years in duration. However, they were more likely to integrate an environmental component when compared to U.S. interventions. Interventions implemented in the U.S. and internationally resulted in successful outcomes, including positive changes in student BMI. Yet, varying approaches were used to achieve success, reinforcing the fact that a one-size-fits-all approach is not necessary to impact childhood obesity. However, building on successful interventions, future school-based obesity prevention interventions should integrate culturally specific intervention strategies, aim to incorporate an environmental component, and include parents whenever possible. Consideration should be given to the potential impact of long-term, frequent dosage interventions, and subsequent follow-up should be given attention to determine long-term efficacy.

Text messaging-based smoking cessation intervention: a narrative review.

PubMed

Kong, Grace; Ells, Daniel M; Camenga, Deepa R; Krishnan-Sarin, Suchitra

2014-05-01

Smoking cessation interventions delivered via text messaging on mobile phones may enhance motivations to quit smoking. The goal of this narrative review is to describe the text messaging interventions' theoretical contents, frequency and duration, treatment outcome, and sample characteristics such as age and motivation to quit, to better inform the future development of this mode of intervention. Studies were included if text messaging was primarily used to deliver smoking cessation intervention and published in English in a peer-reviewed journal. All articles were coded by two independent raters to determine eligibility and to extract data. Twenty-two studies described 15 text messaging interventions. About half of the interventions recruited adults (ages 30-40) and the other half targeted young adults (ages 18-29). Fourteen interventions sent text messages during the quit phase, 10 had a preparation phase and eight had a maintenance phase. The number of text messages and the duration of the intervention varied. All used motivational messages grounded in social cognitive behavioral theories, 11 used behavioral change techniques, and 14 used individually tailored messages. Eleven interventions also offered other smoking cessation tools. Three interventions yielded smoking cessation outcomes greater than the control condition. The proliferation of text messaging in recent years suggests that text messaging interventions may have the potential to improve smoking cessation rates. Detailed summary of the interventions suggests areas for future research and clinical application. More rigorous studies are needed to identify components of the interventions that can enhance their acceptability, feasibility and efficacy. Copyright © 2013. Published by Elsevier Ltd.

Screening trematodes for novel intervention targets: a proteomic and immunological comparison of Schistosoma haematobium, Schistosoma bovis and Echinostoma caproni

PubMed Central

HIGÓN, MELISSA; COWAN, GRAEME; NAUSCH, NORMAN; CAVANAGH, DAVID; OLEAGA, ANA; TOLEDO, RAFAEL; STOTHARD, J. RUSSELL; ANTÚNEZ, ORETO; MARCILLA, ANTONIO; BURCHMORE, RICHARD; MUTAPI, FRANCISCA

2011-01-01

SUMMARY With the current paucity of vaccine targets for parasitic diseases, particularly those in childhood, the aim of this study was to compare protein expression and immune cross-reactivity between the trematodes Schistosoma haematobium, S. bovis and Echinostoma caproni in the hope of identifying novel intervention targets. Native adult parasite proteins were separated by 2-dimensional gel electrophoresis and identified through electrospray ionisation tandem mass spectrometry to produce a reference gel. Proteins from differential gel electrophoresis analyses of the three parasite proteomes were compared and screened against sera from hamsters infected with S. haematobium and E. caproni following 2-dimensional Western blotting. Differential protein expression between the three species was observed with circa 5% of proteins from S. haematobium showing expression up-regulation compared to the other two species. There was 91% similarity between the proteomes of the two Schistosoma species and 81% and 78·6% similarity between S. haematobium and S. bovis versus E. caproni, respectively. Although there were some common cross-species antigens, species-species targets were revealed which, despite evolutionary homology, could be due to phenotypic plasticity arising from different host-parasite relationships. Nevertheless, this approach helps to identify novel intervention targets which could be used as broad-spectrum candidates for future use in human and veterinary vaccines. PMID:21729355

Protease Inhibitors of Parasitic Flukes: Emerging Roles in Parasite Survival and Immune Defence.

PubMed

Ranasinghe, Shiwanthi L; McManus, Donald P

2017-05-01

Protease inhibitors play crucial roles in parasite development and survival, counteracting the potentially damaging immune responses of their vertebrate hosts. However, limited information is currently available on protease inhibitors from schistosomes and food-borne trematodes. Future characterization of these molecules is important not only to expand knowledge on parasitic fluke biology but also to determine whether they represent novel vaccine and/or drug targets. Moreover, protease inhibitors from flukes may represent lead compounds for the development of a new range of therapeutic agents against inflammatory disorders and cancer. This review discusses already identified protease inhibitors of fluke origin, emphasizing their biological function and their possible future development as new intervention targets. Copyright © 2016 Elsevier Ltd. All rights reserved.

Preventing stroke: a narrative review of community interventions for improving hypertension control in black adults.

PubMed

Connell, Patricia; Wolfe, Charles; McKevitt, Christopher

2008-03-01

Incidence rates for stroke and hypertension are higher in black ethnic groups of African descent in the USA and UK than in white groups, suggesting a need for targeted intervention. We conduct a narrative review of published research evidence on community interventions to manage hypertension among black ethnic groups, and explore the concept of cultural sensitivity in these interventions. Data sources comprised computer-aided searches of published studies over the years 1981 to March 2006, on community strategies for improving hypertension control targeting black groups, and further references from these articles. Twenty-seven relevant studies were identified. Health education was associated with improvements in knowledge about hypertension, while education combined with individualised support for patients to self-manage hypertension, including goal setting and monitoring to enhance patient self-management of hypertension, and family support in managing hypertension were associated with reductions in blood pressure levels and improvements in blood pressure control. Collaboration with black communities, using local or minority ethnic staff, conducting preliminary research with target groups to investigate perceptions and canvass ideas for the intervention design were common methods assumed to achieve cultural sensitivity. Studies, however, provided insufficient robust evidence of the effectiveness of these strategies in terms of quantifiable outcomes, although this criterion is contested, with social justice arguments being offered instead. Implicit assumptions about homogeneity and shared interests within the 'community', and representation of 'community' views have implications for the effectiveness of interventions. These findings highlight areas for the future development of interventions to reduce hypertension rates in black groups, and factors that need to be robustly investigated and explicitly addressed in intervention design.

Behavior change is not one size fits all: psychosocial phenotypes of childhood obesity prevention intervention participants.

PubMed

Burgermaster, Marissa; Contento, Isobel; Koch, Pamela; Mamykina, Lena

2018-01-17

Variability in individuals' responses to interventions may contribute to small average treatment effects of childhood obesity prevention interventions. But, neither the causes of this individual variability nor the mechanism by which it influences behavior are clear. We used qualitative methods to characterize variability in students' responses to participating in a childhood obesity prevention intervention and psychosocial characteristics related to the behavior change process. We interviewed 18 students participating in a school-based curriculum and policy behavior change intervention. Descriptive coding, summary, and case-ordered descriptive meta-matrices were used to group participants by their psychosocial responses to the intervention and associated behavior changes. Four psychosocial phenotypes of responses emerged: (a) Activated-successful behavior-changers with strong internal supports; (b) Inspired-motivated, but not fully successful behavior-changers with some internal supports, whose taste preferences and food environment overwhelmed their motivation; (c) Reinforced-already practiced target behaviors, were motivated, and had strong family support; and (d) Indifferent-uninterested in behavior change and only did target behaviors if family insisted. Our findings contribute to the field of behavioral medicine by suggesting the presence of specific subgroups of participants who respond differently to behavior change interventions and salient psychosocial characteristics that differentiate among these phenotypes. Future research should examine the utility of prospectively identifying psychosocial phenotypes for improving the tailoring of nutrition behavior change interventions. © Society of Behavioral Medicine 2018.

Disrupting the downward spiral of chronic pain and opioid addiction with mindfulness-oriented recovery enhancement: a review of clinical outcomes and neurocognitive targets.

PubMed

Garland, Eric L

2014-06-01

Prescription opioid misuse and addiction among chronic pain patients are problems of growing medical and social significance. Chronic pain patients often require intervention to improve their well-being and functioning, and yet, the most commonly available form of pharmacotherapy for chronic pain is centered on opioid analgesics--drugs that have high abuse liability. Consequently, health care and legal systems are often stymied in their attempts to intervene with individuals who suffer from both pain and addiction. As such, novel, nonpharmacologic interventions are needed to complement pharmacotherapy and interrupt the cycle of behavioral escalation. The purpose of this paper is to describe how the downward spiral of chronic pain and prescription opioid misuse may be targeted by one such intervention, Mindfulness-Oriented Recovery Enhancement (MORE), a new behavioral treatment that integrates elements from mindfulness training, cognitive-behavioral therapy, and positive psychology. The clinical outcomes and neurocognitive mechanisms of this intervention are reviewed with respect to their effects on the risk chain linking chronic pain and prescription opioid misuse. Future directions for clinical and pharmacologic research are discussed.

Training motor responses to food: A novel treatment for obesity targeting implicit processes.

PubMed

Stice, Eric; Lawrence, Natalia S; Kemps, Eva; Veling, Harm

2016-11-01

The present review first summarizes results from prospective brain imaging studies focused on identifying neural vulnerability factors that predict excessive weight gain. Next, findings from cognitive psychology experiments evaluating various interventions involving food response inhibition training or food response facilitation training are reviewed that appear to target these neural vulnerability factors and that have produced encouraging weight loss effects. Findings from both of these reviewed research fields suggest that interventions that reduce reward and attention region responses to high calorie food cues and increase inhibitory region responses to high calorie food cues could prove useful in the treatment of obesity. Based on this review, a new conceptual model is presented to describe how different cognitive training procedures may contribute to modifying eating behavior and important directions for future research are offered. It is concluded that there is a need for evaluating the effectiveness of more intensive food response training interventions and testing whether adding such training to extant weight loss interventions increases their efficacy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study.

PubMed

Sze, Yan Yan; Daniel, Tinuke Oluyomi; Kilanowski, Colleen K; Collins, R Lorraine; Epstein, Leonard H

2015-12-16

The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives. Our study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions. We recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m(2). Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention. All 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight. We showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions.

Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study

PubMed Central

Daniel, Tinuke Oluyomi; Kilanowski, Colleen K; Collins, R Lorraine

2015-01-01

Background The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives. Objective Our study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions. Methods We recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m2. Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention. Results All 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight. Conclusions We showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions. PMID:26678959

Improving the Quality of Survivorship for Older Adults with Cancer

PubMed Central

Mohile, Supriya G.; Hurria, Arti; Cohen, Harvey J.; Rowland, Julia H.; Leach, Corinne R.; Arora, Neeraj K.; Canin, Beverly; Muss, Hyman; Magnuson, Allison; Flannery, Marie; Lowenstein, Lisa; Allore, Heather; Mustian, Karen; Demark-Wahnefried, Wendy; Extermann, Martine; Ferrell, Betty; Inouye, Sharon; Studenski, Stephanie; Dale, William

2016-01-01

In May 2015, the Cancer and Aging Research Group (CARG), in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent decline or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) utilize standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the prior two U13 meetings, this conference provides the framework for future research to improve the evidence base for the clinical care of older adults with cancer. PMID:27172129

How to support patients with severe mental illness in their parenting role with children aged over 1 year? A systematic review of interventions.

PubMed

Schrank, Beate; Moran, Katherine; Borghi, Cristiana; Priebe, Stefan

2015-12-01

There are well-established risks for parents with severe mental illness (i.e. psychotic and bipolar disorders), both for their children and themselves. Interventions to help parents fulfil their role should therefore be a public health objective, but their implementation needs to be underpinned by research evidence. This systematic review determines what is known about the nature and effectiveness of interventions for parents with severe mental illness. We conducted a narrative synthesis of controlled and uncontrolled studies reporting interventions for this patient group after the post-natal period (i.e. after the child has turned 1 year old). Eighteen publications reported data from 15 studies. All but two studies were rated as low quality studies. Interventions included home visiting programmes, complex community programmes, residential treatments, and online interventions. Interventions targeted diverse areas, with parenting skills and understanding the impact of mental illness on parenting most frequently addressed. Both parent and child-related outcomes improved, but children were only assessed via observers and follow-up times were short. Interventions were diverse with respect to their nature and effectiveness. Future interventions should combine different intervention strategies to target multiple areas in a flexible manner. The addition of positively focussed and resource-oriented components should be investigated. Trials should include direct assessments of both parents and children, outcomes that are relevant from a public health perspective, and establish the long-term effects ideally until children have reached 18 years of age.

Text Messaging-Based Smoking Cessation Intervention: A Narrative Review

PubMed Central

Kong, Grace; Ells, Daniel; Camenga, Deepa R.; Krishnan-Sarin, Suchitra

2014-01-01

Introduction Smoking cessation interventions delivered via text messaging on mobile phones may enhance motivations to quit smoking. The goal of this narrative review is to describe the text messaging interventions’ theoretical contents, frequency and duration, treatment outcome, and sample characteristics such as age and motivation to quit, to better inform the future development of this mode of intervention. Methods Studies were included if text messaging was primarily used to deliver smoking cessation intervention and published in English in a peer-reviewed journal. All articles were coded by two independent raters to determine eligibility and to extract data. Results Twenty-two studies described 15 text messaging interventions. About half of the interventions recruited adults (ages 30-40s) and the other half targeted young adults (ages 18-29). Fourteen interventions sent text messages during the quit phase, 10 had a preparation phase and eight had a maintenance phase. The number of text messages and the duration of the intervention varied. All used motivational messages grounded in social cognitive behavioral theories, 11 used behavioral change techniques, and 14 used individually tailored messages. Eleven interventions also offered other smoking cessation tools. Three interventions yielded smoking cessation outcomes greater than the control condition. Conclusions The proliferation of text messaging in recent years suggests that text messaging interventions may have the potential to improve smoking cessation rates. Detailed summary of the interventions suggest areas for future research and clinical application. More rigorous studies are needed to identify components of the interventions that can enhance their acceptability, feasibility and efficacy. PMID:24462528

What are the 'active ingredients' of interventions targeting the public's engagement with antimicrobial resistance and how might they work?

PubMed

McParland, Joanna L; Williams, Lynn; Gozdzielewska, Lucyna; Young, Mairi; Smith, Fraser; MacDonald, Jennifer; Langdridge, Darren; Davis, Mark; Price, Lesley; Flowers, Paul

2018-05-27

Changing public awareness of antimicrobial resistance (AMR) represents a global public health priority. A systematic review of interventions that targeted public AMR awareness and associated behaviour was previously conducted. Here, we focus on identifying the active content of these interventions and explore potential mechanisms of action. The project took a novel approach to intervention mapping utilizing the following steps: (1) an exploration of explicit and tacit theory and theoretical constructs within the interventions using the Theoretical Domains Framework (TDFv2), (2) retrospective coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1, and (3) an investigation of coherent links between the TDF domains and BCTs across the interventions. Of 20 studies included, only four reported an explicit theoretical basis to their intervention. However, TDF analysis revealed that nine of the 14 TDF domains were utilized, most commonly 'Knowledge' and 'Environmental context and resources'. The BCT analysis showed that all interventions contained at least one BCT, and 14 of 93 (15%) BCTs were coded, most commonly 'Information about health consequences', 'Credible source', and 'Instruction on how to perform the behaviour'. We identified nine relevant TDF domains and 14 BCTs used in these interventions. Only 15% of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context. This methodological approach provides a useful way of retrospectively mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content. Statement of contribution What is already known on this subject? Evidence of the effectiveness of interventions that target the public to engage them with AMR is mixed; the public continue to show poor knowledge and misperceptions of AMR. Little is known about the common, active ingredients of AMR interventions targeting the public and information on explicit theoretical content is sparse. Information on the components of AMR public health interventions is urgently needed to enable the design of effective interventions to engage the public with AMR stewardship behaviour. What does this study add? The analysis shows very few studies reported any explicit theoretical basis to the interventions they described. Many interventions share common components, including core mechanisms of action and behaviour change techniques. The analysis suggests components of future interventions to engage the public with AMR. © 2018 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review.

PubMed

Kaplan, Deanna M; Palitsky, Roman; Carey, Angela L; Crane, Tracy E; Havens, Cody M; Medrano, Michael R; Reznik, Samantha J; Sbarra, David A; O'Connor, Mary-Frances

2018-07-01

Maladaptive repetitive thought (RT), the frequent and repetitive revisiting of thoughts or internal experiences, is associated with a range of psychopathological processes and disorders. We present a synthesis of prior research on maladaptive RT and develop a framework for elucidating and distinguishing between five forms of maladaptive RT. In addition to the previously studied maladaptive RT (worry, rumination, and obsession), this framework is used to identify two additional forms of maladaptive RT (yearning and interoceptive RT). We then present a review of extant psychotherapy intervention research targeting maladaptive RT, focusing both on specific empirically based treatment strategies, and also constructs within treatments that impact maladaptive RT. The paper concludes with recommendations for future basic and intervention research on maladaptive RT and related psychopathologies. © 2018 Wiley Periodicals, Inc.

'Get Your Life Back': process and impact evaluation of an asthma social marketing campaign targeting older adults.

PubMed

Evers, Uwana; Jones, Sandra C; Iverson, Don; Caputi, Peter

2013-08-15

Asthma in older adults is underdiagnosed and poorly self-managed. This population has little knowledge about the key symptoms, the prevalence among older adults, and the serious consequences of untreated asthma. The purpose of this study was to undertake a multifaceted evaluation of a social marketing campaign to increase asthma awareness among older adults in a regional Australian community. A cohort of older adults in an intervention region (n = 316) and a control region (n = 394) were surveyed immediately prior to and following the social marketing campaign. Campaign awareness, message recall, materials recognition, and actions taken as a result of the campaign were assessed in both regions. Asthma knowledge and perceptions, experience of asthma symptoms, and general health were also assessed in both regions at baseline and follow-up. Analyses were conducted to explore the effects of the campaign in the intervention region, and to examine outcomes among different audience segments. The survey data showed that those in the target segments (Wheezers and Strugglers) had better message recall, and were more likely to report having taken action to control their respiratory symptoms. The campaign significantly increased the number of calls to an asthma information line from the target audience in the intervention community. A theory-based social marketing campaign conducted over 3-months increased the asthma information seeking behaviours of older adults in the intervention community compared to the control community. Recommendations are outlined for future community health promotion campaigns targeting older adults.

Social cognition interventions for people with schizophrenia: a systematic review focussing on methodological quality and intervention modality.

PubMed

Grant, Nina; Lawrence, Megan; Preti, Antonio; Wykes, Til; Cella, Matteo

2017-08-01

People with a diagnosis of schizophrenia have significant social and functional difficulties. Social cognition was found to influences these outcomes and in recent years interventions targeting this domain were developed. This paper reviews the existing literature on social cognition interventions for people with a diagnosis of schizophrenia focussing on: i) comparing focussed (i.e. targeting only one social cognitive domain) and global interventions and ii) studies methodological quality. Systematic search was conducted on PubMed and PsycInfo. Studies were included if they were randomised control trials, participants had a diagnosis of schizophrenia or schizoaffective disorder, and the intervention targeted at least one out of four social cognition domains (i.e. theory of mind, affect recognition, social perception and attribution bias). All papers were assessed for methodological quality. Information on the intervention, control condition, study methodology and the main findings from each study were extracted and critically summarised. Data from 32 studies fulfilled the inclusion criteria, considering a total of 1440 participants. Taking part in social cognition interventions produced significant improvements in theory of mind and affect recognition compared to both passive and active control conditions. Results were less clear for social perception and attributional bias. Focussed and global interventions had similar results on outcomes. Overall study methodological quality was modest. There was very limited evidence showing that social cognitive intervention result in functional outcome improvement. The evidence considered suggests that social cognition interventions may be a valuable approach for people with a diagnosis of schizophrenia. However, evidence quality is limited by measure heterogeneity, modest study methodology and short follow-up periods. The findings point to a number of recommendations for future research, including measurement standardisation, appropriately powered studies and investigation of the impact of social cognition improvements on functioning problems. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Improving a web-based employability intervention for work-disabled employees: results of a pilot economic evaluation.

PubMed

Noben, Cindy; Evers, Silvia; Genabeek, Joost van; Nijhuis, Frans; de Rijk, Angelique

2017-04-01

Purpose The purpose of this study is to improve web-based employability interventions for employees with work-related health problems for both intervention content and study design by means of a pilot economic evaluation. Methods Uptake rate analysis for the intervention elements, cost effectiveness, cost utility and subgroup analyses were conducted to identify potential content-related intervention improvements. Differences in work ability and quality-adjusted life years and overall contribution of resource items to the total costs were assessed. These were used to guide study design improvements. Results Sixty-three participants were a-select allocated to either the intervention (n = 29) or the control (n = 34) group. Uptake regarding the intervention elements ranged between 3% and 70%. Cost-effectiveness and cost-utility analyses resulted in negative effects although higher total costs. Incremental effects were marginal (work ability -0.51; QALY -0.01). Conclusions The web-based tool to enhance employability among work disabled employees requires improvements regarding targeting and intensity; outcome measures selected and collection of cost data. With respect to the studies of disability and rehabilitation, the findings and methods presented in this pilot economic evaluation could guide the assessment of future assistive "e-health" technologies. IMPLICATIONS FOR REHABILITATION The methods presented in this pilot economic evaluation have large potentials to guide the assessment of future assistive e-health technologies addressing work-disabilities. The findings show that the web-based tool requires content related improvements with respect to targeting and intensity to enhance employability among work disabled employees. The findings show that the web-based tool would benefit from improvements related to the study design by more adequately selecting and collecting both outcome measures and cost data. The burden attributable to large-scale studies and implementation issues were prevented as the outcomes of the pilot economic evaluation did not support the implementation of the web-based tool.

Opportunity costs and financial incentives for Hispanic youth participating in a family-based HIV and substance use preventive intervention.

PubMed

McCollister, Kathryn E; Freitas, Derek M; Prado, Guillermo; Pantin, Hilda

2014-02-01

This paper presents results from a pilot study of the synergies between the opportunity costs incurred by research participants, participant compensation, and program attendance in a family-based substance use and HIV preventive intervention for Hispanic adolescents in Miami-Dade County, Florida. To estimate parent/caretaker cost per session and cost for the duration of the intervention, we administered the Caretaker Drug Abuse Treatment Cost Analysis Program to a random sample of 34 families who participated in a recent clinical trial of Familias Unidas. The total opportunity cost per parent/caretaker was under $40 per group session, under $30 per family session, and just over $570 for the duration of the intervention. Participants were compensated between $40 and $50 per session and attended more than 79% of family and group sessions. Parents and caretakers incurred a cost of approximately $30-40 per intervention session for which they were adequately compensated. Attendance was very good overall for this group (>79%) and significantly higher than attendance in a comparable uncompensated study group from another recent Familias Unidas trial that targeted similar youth. Findings suggest that incentives should be considered important for future implementations of Familias Unidas and similar family-based interventions that target minority and low-SES populations.

Opportunity Costs and Financial Incentives for Hispanic Youth Participating in a Family-Based HIV and Substance Use Preventive Intervention

PubMed Central

McCollister, Kathryn E.; Freitas, Derek M.; Prado, Guillermo; Pantin, Hilda

2013-01-01

This paper presents results from a pilot study of the synergies between the opportunity costs incurred by research participants, participant compensation, and program attendance in a family-based substance use and HIV preventive intervention for Hispanic adolescents in Miami-Dade County, Florida. To estimate parent/caretaker cost per session and cost for the duration of the intervention, we administered the Caretaker Drug Abuse Treatment Cost Analysis Program (Caretaker DATCAP) to a random sample of 34 families who participated in a recent clinical trial of Familias Unidas. The total opportunity cost per parent/caretaker was under $40 per group session, under $30 per family session, and just over $570 for the duration of the intervention. Participants were compensated between $40 and $50 per session and attended more than 79% of family and group sessions. Parents and caretakers incurred a cost of approximately $30–40 per intervention session for which they were adequately compensated. Attendance was very good overall for this group (>79%) and significantly higher than attendance in a comparable uncompensated study group from another recent Familias Unidas trial that targeted similar youth. Findings suggest that incentives should be considered important for future implementations of Familias Unidas and similar family-based interventions that target minority and low-SES populations. PMID:24162106

Sexual risk reduction among non-injection drug users: report of a randomized controlled trial.

PubMed

Castor, Delivette; Pilowsky, Daniel J; Hadden, Bernadette; Fuller, Crystal; Ompad, Danielle C; de Leon, Cora L; Neils, Greg; Hoepner, Lori; Andrews, Howard F; Latkin, Carl; Hoover, Donald R

2010-01-01

We conducted a randomized controlled trial of a sexual risk-reduction intervention targeting non-injection drug users (NIDUs) and members of their drug-use/sexual networks (N=270). The intervention was based primarily on the social-influencing approach, and was delivered in four sessions. Sexual risk behaviors were examined at baseline, and 3, 6, 9, and 12 months after the completion of the intervention using the vaginal equivalent episodes (VEE), a weighted sexual risk behavior index. VEE scores decreased in both the active and control conditions in the first six months post-intervention and continued to decline in the control group. However, in the active condition, VEE scores increased after the nine-month assessment and approached baseline levels by the 12-month assessment. There was no evidence of significant differences in high-risk sexual behaviors between the intervention and control conditions. Future studies are needed to improve behavioral interventions in this population.

Enhancing Shared Decision Making Through Carefully Designed Interventions That Target Patient And Provider Behavior.

PubMed

Tai-Seale, Ming; Elwyn, Glyn; Wilson, Caroline J; Stults, Cheryl; Dillon, Ellis C; Li, Martina; Chuang, Judith; Meehan, Amy; Frosch, Dominick L

2016-04-01

Patient-provider communication and shared decision making are essential for primary care delivery and are vital contributors to patient experience and health outcomes. To alleviate communication shortfalls, we designed a novel, multidimensional intervention aimed at nudging both patients and primary care providers to communicate more openly. The intervention was tested against an existing intervention, which focused mainly on changing patients' behaviors, in four primary care clinics involving 26 primary care providers and 300 patients. Study results suggest that compared to usual care, both the novel and existing interventions were associated with better patient reports of how well primary care providers engaged them in shared decision making. Future research should build on the work in this pilot to rigorously examine the comparative effectiveness and scalability of these interventions to improve shared decision making at the point of care. Project HOPE—The People-to-People Health Foundation, Inc.

Using computer technology for HIV prevention among African-Americans: development of a tailored information program for safer sex (TIPSS)

PubMed Central

Noar, Seth M.; Webb, Elizabeth M.; Van Stee, Stephanie K.; Redding, Colleen A.; Feist-Price, Sonja; Crosby, Richard; Troutman, Adewale

2011-01-01

New prevention options are urgently needed for African-Americans in the United States given the disproportionate impact of HIV/AIDS on this group. This combined with recent evidence supporting the efficacy of computer technology-based interventions in HIV prevention led our research group to pursue the development of a computer-delivered individually tailored intervention for heterosexually active African-Americans—the tailored information program for safer sex (TIPSS). In the current article, we discuss the development of the TIPSS program, including (i) the targeted population and behavior, (ii) theoretical basis for the intervention, (iii) design of the intervention, (iv) formative research, (v) technical development and testing and (vi) intervention delivery and ongoing randomized controlled trial. Given the many advantages of computer-based interventions, including low-cost delivery once developed, they offer much promise for the future of HIV prevention among African-Americans and other at-risk groups. PMID:21257676

When a Baby Dies: A Systematic Review of Experimental Interventions for Women After Stillbirth.

PubMed

Huberty, Jennifer L; Matthews, Jeni; Leiferman, Jenn; Hermer, Janice; Cacciatore, Joanne

2017-07-01

To identify and evaluate intervention studies (ie, experimental study in which the participants undergo some kind of intervention in order to evaluate its impact) that target mental and/or physical health outcomes in women who have experienced stillbirth and to provide specific recommendations for future research and intervention work. A librarian conducted an initial search using CINAHL, Cochrane Library, PsycInfo, PubMed, SocIndex, and Web of Knowledge in the spring of 2016. Reference mining provided further articles. Articles were eligible if they were: (1) published in English, (2) published in a peer-reviewed journal, (3) published in 1980 or later, (4) an intervention that evaluated (qualitative or quantitative methods) mental and/or physical health, and (5) included women who had experienced a stillbirth (in utero fetal death at ≥20 weeks of gestation). The combined searches produced 2733 articles (including duplicates). After duplicate articles were removed (n = 928), the research team screened the titles, abstracts, and full texts (when necessary) for eligibility (n = 1805). Two articles were identified that met our eligibility criteria. Conclusion for Practice: There is a lack of intervention research in women with stillbirth. It is imperative to develop and implement interventions to improve both mental and physical health in this population, especially in the interconception period (ie, stillbirth aftercare). Future intervention research is needed to determine appropriate support and efficacious delivery of support interventions, feasibility and effectiveness of physical activity interventions and complementary approaches, appropriate timing and dose of interventions, and culturally sensitive interventions appropriate for racial/ethnic minority women with stillbirth.

Raising Citizens: Parenting Education Classes and Somali Mothers' Experiences of Childrearing in Canada

ERIC Educational Resources Information Center

Fellin, Melissa

2015-01-01

Mothers are viewed as the people who are raising future citizens of Canada; therefore, their parenting practices are being targeted for intervention by civic organizations funded by the state. In this article, I argue that modernity narratives and neoliberalism approaches to mothering inform parenting education classes for Somali refugee women to…

Linking the "Know-That" and "Know-How" Knowledge through Games: A Quest to Evolve the Future for Science and Engineering Education

ERIC Educational Resources Information Center

Vahed, A.; McKenna, S.; Singh, S.

2016-01-01

This paper responds to Muller's notions of "knowing-that" and "knowing how". The paper addresses how educational interventions that are designed in line with targeted discipline-specific subjects can enhance the balance between professional practice and disciplinary knowledge in professionally accredited programmes at…

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…

Social cognitive interventions for people with schizophrenia: A systematic review.

PubMed

Tan, Bhing-Leet; Lee, Sara-Ann; Lee, Jimmy

2018-06-01

Social cognition is the mental process which underpins social interactions. Increasingly, it has been recognized to be impaired in people with schizophrenia, resulting in functional problems. Correspondingly, the past ten years have seen huge developments in the study of interventions to ameliorate social cognitive deficits among people with schizophrenia. In the present review, we systematically reviewed published studies on social cognitive interventions from 2005 to 2015. Of the 61 studies included in this review, 20 were on broad-based social cognitive interventions, which incorporated neurocognitive training, specialized learning technique or virtual reality social skills training. On the other hand, 31 studies on targeted interventions either focused on specific social cognitive domains, or a range of domains. Improvements in emotion processing and theory of mind were often reported, while social perception and attributional style were less frequently measured. Both broad-based and targeted interventions achieved gains in social functioning, albeit inconsistently. Lastly, nine studies on the use of oxytocin and one study on transcranial direct current stimulation reported positive preliminary results in higher-order cognition and facial affect recognition respectively. This review revealed that a wide range of social cognitive interventions is currently available and most have shown some promise in improving social cognition outcomes. However, there is a need to use a common battery of measurements for better comparisons across interventions. Future research should examine combination therapies and the sustainability of gains beyond the intervention period. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Community-based interventions in prepared-food sources: a systematic review.

PubMed

Gittelsohn, Joel; Lee-Kwan, Seung Hee; Batorsky, Benjamin

2013-10-31

Food purchased from prepared-food sources has become a major part of the American diet and is linked to increased rates of chronic disease. Many interventions targeting prepared-food sources have been initiated with the goal of promoting healthful options. The objective of this study was to provide a systematic review of interventions in prepared-food sources in community settings. We used PubMed and Google Scholar and identified 13 interventions that met these criteria: 1) focused on prepared-food sources in public community settings, 2) used an impact evaluation, 3) had written documentation, and 4) took place after 1990. We conducted interviews with intervention staff to obtain additional information. Reviewers extracted and reported data in table format to ensure comparability. Interventions mostly targeted an urban population, predominantly white, in a range of income levels. The most common framework used was social marketing theory. Most interventions used a nonexperimental design. All made use of signage and menu labeling to promote healthful food options. Several promoted more healthful cooking methods; only one introduced new healthful menu options. Levels of feasibility and sustainability were high; sales results showed increased purchasing of healthful options. Measures among consumers were limited but in many cases showed improved awareness and frequency of purchase of promoted foods. Interventions in prepared-food sources show initial promising results at the store level. Future studies should focus on improved study designs, expanding intervention strategies beyond signage and assessing impact among consumers.

Community-Based Interventions in Prepared-Food Sources: A Systematic Review

PubMed Central

Lee-Kwan, Seung Hee; Batorsky, Benjamin

2013-01-01

Introduction Food purchased from prepared-food sources has become a major part of the American diet and is linked to increased rates of chronic disease. Many interventions targeting prepared-food sources have been initiated with the goal of promoting healthful options. The objective of this study was to provide a systematic review of interventions in prepared-food sources in community settings. Methods We used PubMed and Google Scholar and identified 13 interventions that met these criteria: 1) focused on prepared-food sources in public community settings, 2) used an impact evaluation, 3) had written documentation, and 4) took place after 1990. We conducted interviews with intervention staff to obtain additional information. Reviewers extracted and reported data in table format to ensure comparability. Results Interventions mostly targeted an urban population, predominantly white, in a range of income levels. The most common framework used was social marketing theory. Most interventions used a nonexperimental design. All made use of signage and menu labeling to promote healthful food options. Several promoted more healthful cooking methods; only one introduced new healthful menu options. Levels of feasibility and sustainability were high; sales results showed increased purchasing of healthful options. Measures among consumers were limited but in many cases showed improved awareness and frequency of purchase of promoted foods. Conclusion Interventions in prepared-food sources show initial promising results at the store level. Future studies should focus on improved study designs, expanding intervention strategies beyond signage and assessing impact among consumers. PMID:24176084

Can mental health interventions change social networks? A systematic review.

PubMed

Anderson, Kimberley; Laxhman, Neelam; Priebe, Stefan

2015-11-21

Social networks of patients with psychosis can provide social support, and improve health and social outcomes, including quality of life. However, patients with psychosis often live rather isolated with very limited social networks. Evidence for interventions targeting symptoms or social skills, are largely unsuccessful at improving social networks indirectly. As an alternative, interventions may directly focus on expanding networks. In this systematic review, we assessed what interventions have previously been tested for this and to what extent they have been effective. A systematic review was conducted of randomised controlled trials, testing psychosocial interventions designed to directly increase the social networks of patients with psychosis. Searches of five online databases (PsycINFO, CINAHL, Cochrane Database, MEDLINE, Embase), hand searching of grey literature, and both forward and backward snowballing of key papers were conducted and completed on 12 December 2014. Trial reports were included if they were written in English, the social network size was the primary outcome, participants were ≥ 18 years old and diagnosed with a psychotic disorder. Five studies (n = 631 patients) met the complete inclusion criteria. Studies were from different countries and published since 2008. Four trials had significant positive results, i.e. an observable increase in patients' social network size at the end of the intervention. The interventions included: guided peer support, a volunteer partner scheme, supported engagement in social activity, dog-assisted integrative psychological therapy and psychosocial skills training. Other important elements featured were the presence of a professional, and a focus on friendships and peers outside of services and the immediate family. Despite the small number and heterogeneity of included studies, the results suggest that interventions directly targeting social isolation can be effective and achieve a meaningful increase in patients' networks. Thus, although limited, the existing evidence is encouraging, and the range of interventions used in the reported trials leave various options for future research and further improvements. Future research is needed to test the findings in different settings, identify which components are particularly effective, and determine to what extent the increased networks, over time, impact on patients' symptoms and quality of life.

To be seen, confirmed and involved - a ten year follow-up of perceived health and cardiovascular risk factors in a Swedish community intervention programme

PubMed Central

Emmelin, Maria; Weinehall, Lars; Stenlund, Hans; Wall, Stig; Dahlgren, Lars

2007-01-01

Background Public health interventions are directed towards social systems and it is difficult to foresee all consequences. While targeted outcomes may be positively influenced, interventions may at worst be counterproductive. To include self-reported health in an evaluation is one way of addressing possible side-effects. This study is based on a 10 year follow-up of a cardiovascular community intervention programme in northern Sweden. Methods Both quantitative and qualitative approaches were used to address the interaction between changes in self-rated health and risk factor load. Qualitative interviews contributed to an analysis of how the outcome was influenced by health related norms and attitudes. Results Most people maintained a low risk factor load and a positive perception of health. However, more people improved than deteriorated their situation regarding both perceived health and risk factor load. "Ideal types" of attitude sets towards the programme, generated from the interviews, helped to interpret an observed polarisation for men and the lower educated. Conclusion Our observation of a socially and gender differentiated intervention effect suggests a need to test new intervention strategies. Future community interventions may benefit from targeting more directly those who in combination with high risk factor load perceive their health as bad and to make all participants feel seen, confirmed and involved. PMID:17672911

A Systematic Review of Physical Activity Interventions in Hispanic Adults

PubMed Central

Ickes, Melinda J.; Sharma, Manoj

2012-01-01

Healthy People 2020 aims to achieve health equity, eliminate disparities, and improve the health of all groups. Regular physical activity (PA) improves overall health and fitness and has the capability to reduce risk for chronic diseases. Identifying barriers which relate to the Hispanic population is important when designing PA interventions. Therefore, the purpose was to review existing PA interventions targeting Hispanic adults published between 1988 and 2011. This paper was limited to interventions which included more than 35% Hispanic adults (n = 20). Most of the interventions were community based (n = 16), although clinical, family-based, and faith-based settings were also represented. Interventions incorporated theory (n = 16), with social cognitive theory and transtheoretical model being used most frequently. Social support was integral, building on the assumption that it is a strong motivator of PA. Each of the interventions reported success related to PA, social support, and/or BMI. Lessons learned should be incorporated into future interventions. PMID:22496702

Effects of 21st birthday brief interventions on college student celebratory drinking: A systematic review and meta-analysis.

PubMed

Steinka-Fry, Katarzyna T; Tanner-Smith, Emily E; Grant, Sean

2015-11-01

College students' 21st birthday celebrations often involve consumption of extreme amounts of alcohol as well as alcohol-related risks. This systematic review aims to determine whether birthday-focused, individually-targeted, no-contact (email or letter-based) brief alcohol interventions (BAIs) reduce college students' 21st birthday celebratory drinking. A systematic search identified 9 randomized evaluations with 10 interventions to reduce 21st birthday drinking. Quantity of alcohol consumed and estimated blood alcohol concentration (BAC) were measured. Random-effects meta-analysis was used to summarize the effects of the interventions. There was no evidence that birthday-focused BAIs reduce quantities of alcohol consumed during birthday celebrations (g = 0.05, 95% CI [-0.03 to 0.13]). The interventions were associated with significant reductions in estimated BAC levels (g = 0.20, 95% CI [0.07 to 0.33]), but this effect was small in absolute terms. The quality of this body of evidence was very low, as evaluated using the GRADE approach. In particular, it was limited by substantial participant attrition post-randomization due to included studies' recruitment and randomization procedures. There is no evidence that birthday-focused, individually-targeted BAIs reduce the quantity of alcohol consumed by students during 21st birthday celebrations, although these interventions may yield small beneficial effects on estimated BAC. Many methodological concerns were identified in included studies. This area of research would benefit from theory-based RCTs that are well-designed and executed. Future research should also investigate strategies other than birthday-focused, individually-targeted, brief interventions to curb 21st birthday celebratory drinking. Copyright © 2015 Elsevier Ltd. All rights reserved.

Process Evaluation of the Type 2 Diabetes Mellitus PULSE Program Randomized Controlled Trial: Recruitment, Engagement, and Overall Satisfaction.

PubMed

Aguiar, Elroy J; Morgan, Philip J; Collins, Clare E; Plotnikoff, Ronald C; Young, Myles D; Callister, Robin

2017-07-01

Men are underrepresented in weight loss and type 2 diabetes mellitus (T2DM) prevention studies. To determine the effectiveness of recruitment, and acceptability of the T2DM Prevention Using LifeStyle Education (PULSE) Program-a gender-targeted, self-administered intervention for men. Men (18-65 years, high risk for T2DM) were randomized to intervention ( n = 53) or wait-list control groups ( n = 48). The 6-month PULSE Program intervention focused on weight loss, diet, and exercise for T2DM prevention. A process evaluation questionnaire was administered at 6 months to examine recruitment and selection processes, and acceptability of the intervention's delivery and content. Associations between self-monitoring and selected outcomes were assessed using Spearman's rank correlation. A pragmatic recruitment and online screening process was effective in identifying men at high risk of T2DM (prediabetes prevalence 70%). Men reported the trial was appealing because it targeted weight loss, T2DM prevention, and getting fit, and because it was perceived as "doable" and tailored for men. The intervention was considered acceptable, with men reporting high overall satisfaction (83%) and engagement with the various components. Adherence to self-monitoring was poor, with only 13% meeting requisite criteria. However, significant associations were observed between weekly self-monitoring of weight and change in weight ( r s = -.47, p = .004) and waist circumference ( r s = -.38, p = .026). Men reported they would have preferred more intervention contact, for example, by phone or email. Gender-targeted, self-administered lifestyle interventions are feasible, appealing, and satisfying for men. Future studies should explore the effects of additional non-face-to-face contact on motivation, accountability, self-monitoring adherence, and program efficacy.

The impact of a universal intervention targeting perfectionism in children: An exploratory controlled trial.

PubMed

Vekas, Eva J; Wade, Tracey D

2017-11-01

Perfectionism is considered to be an underlying mechanism of relevance to a broad array of indicators of psychological distress. The current research examined the impact of a three-session intervention targeting perfectionism in children on perfectionism, self-criticism, and well-being. The design of the current study can be considered quasi-experimental as the intervention and control classes were not randomly allocated but decided by convenience factors at the school level. Students (aged 10.08-12.79 years) were allocated to the intervention (N = 107, 41 boys) or control condition (N = 105, 33 boys), completing self-report assessments on perfectionism, self-criticism, and well-being at baseline, post-intervention, and 3-month follow-up. At post-intervention, children in the intervention group had significantly lower perfectionism than the control group (d = 0.35, 95% confidence intervals [CI]: 0.07-0.62) and at 3-month follow-up had significantly higher levels of well-being (d = 0.33, 95% CI: 0.06-0.60). As predicted by theory, decreases in perfectionism mediated the relationship between condition and improved well-being. This exploratory study provides evidence for the usefulness of a brief universal prevention programme targeting perfectionism. Future research should use more robust designs, explore longer-term effects, and the impact on a wider range of variables, including scholastic achievement. Clinical implications Perfectionism linked with negative outcomes in children can be decreased in a classroom setting. Decreasing perfectionism leads to improved well-being in children. Limitations More rigorous designs along with better assessment of perfectionism are required in further evaluations. The impact of perfectionism on scholastic achievement in children requires further investigation. © 2017 The British Psychological Society.

Just-in-Time Feedback in Diet and Physical Activity Interventions: Systematic Review and Practical Design Framework

PubMed Central

Robertson, Michael C; Dunton, Genevieve Fridlund; Kerr, Jacqueline; Haffey, Meghan E; Burnett, Taylor; Basen-Engquist, Karen; Hicklen, Rachel S

2018-01-01

Background The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of health behavior goals. Objective The goals of this systematic review were to summarize data on the content characteristics of feedback messaging used in diet and physical activity (PA) interventions and to develop a practical framework for designing just-in-time feedback for behavioral interventions. Methods Interventions that included just-in-time feedback on PA, sedentary behavior, or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. Results The review included 31 studies (15/31, 48%, targeting PA or sedentary behavior only; 13/31, 42%, targeting diet and PA; and 3/31, 10%, targeting diet only). All studies used just-in-time feedback, 30 (97%, 30/31) used personalized feedback, and 24 (78%, 24/31) used goal-oriented feedback, but only 5 (16%, 5/31) used actionable feedback. Of the 9 studies that tested the efficacy of providing feedback to promote behavior change, 4 reported significant improvements in health behavior. In 3 of these 4 studies, feedback was continuously available, goal-oriented, or actionable. Conclusions Feedback that was continuously available, personalized, and actionable relative to a known behavioral objective was prominent in intervention studies with significant behavior change outcomes. Future research should determine whether all or some of these characteristics are needed to optimize the effect of feedback in just-in-time interventions. PMID:29567638

Effects of 21st Birthday Brief Interventions on College Student Celebratory Drinking: A Systematic Review and Meta-Analysis

PubMed Central

Steinka-Fry, Katarzyna T.; Tanner-Smith, Emily E.; Grant, Sean

2015-01-01

Introduction College students' 21st birthday celebrations often involve consumption of extreme amounts of alcohol as well as alcohol-related risks. This systematic review aims to determine whether birthday-focused, individually-targeted, no-contact (email or letter-based) brief alcohol interventions (BAIs) reduce college students' 21st birthday celebratory drinking. Methods A systematic search identified 9 randomized evaluations with 10 interventions to reduce 21st birthday drinking. Quantity of alcohol consumed and estimated blood alcohol concentration (BAC) were measured. Random-effects meta-analysis was used to summarize the effects of the interventions. Results There was no evidence that birthday-focused BAIs reduce quantities of alcohol consumed during birthday celebrations (ḡ = 0.05, 95% CI [-0.03 to 0.13]). The interventions were associated with significant reductions in estimated BAC levels (ḡ = 0.20, 95% CI [0.07 to 0.33]), but this effect was small in absolute terms. The quality of this body of evidence was very low, as evaluated using the GRADE approach. In particular, it was limited by substantial participant attrition post-randomization due to included studies' recruitment and randomization procedures. Conclusions There is no evidence that birthday-focused, individually-targeted BAIs reduce the quantity of alcohol consumed by students during 21st birthday celebrations, although these interventions may yield small beneficial effects on estimated BAC. Many methodological concerns were identified in included studies. This area of research would benefit from theory-based RCTs that are well-designed and executed. Future research should also investigate strategies other than birthday-focused, individually-targeted, brief interventions to curb 21st birthday celebratory drinking. PMID:26093502

Factors affecting acceptability of an email-based intervention to increase fruit and vegetable consumption.

PubMed

Kothe, Emily J; Mullan, Barbara A

2014-09-30

Fresh Facts is a 30-day email-delivered intervention designed to increase the fruit and vegetable consumption of Australian young adults. This study investigated the extent to which the program was acceptable to members of the target audience and examined the relationships between participant and intervention characteristics, attrition, effectiveness, and acceptability ratings. Young adults were randomised to two levels of message frequency: high-frequency (n = 102), low-frequency (n = 173). Individuals in the high-frequency group received daily emails while individuals in the low-frequency group received an email every 3 days. Individuals in the high-frequency group were more likely to indicate that they received too many emails than individuals in the low-frequency group. No other differences in acceptability were observed. Baseline beliefs about fruit and vegetables were an important predictor of intervention acceptability. In turn, acceptability was associated with a number of indicators of intervention success, including change in fruit and vegetable consumption. The findings highlight the importance of considering the relationship between these intervention and participant factors and acceptability in intervention design and evaluation. Results support the ongoing use of email-based interventions to target fruit and vegetable consumption within young adults. However, the relationships between beliefs about fruit and vegetable consumption and acceptability suggest that this intervention may be differentially effective depending on individual's existing beliefs about fruit and vegetable consumption. As such, there is a pressing need to consider these factors in future research in order to minimize attrition and maximize intervention effectiveness when interventions are implemented outside of a research context.

Development and evaluation of a mobile intervention for heavy drinking and smoking among college students.

PubMed

Witkiewitz, Katie; Desai, Sruti A; Bowen, Sarah; Leigh, Barbara C; Kirouac, Megan; Larimer, Mary E

2014-09-01

Nearly all college student smokers also drink alcohol, and smoking and heavy episodic drinking (HED) commonly co-occur. However, few studies have examined the factors that concurrently influence smoking and HED among college students and, to date, no interventions have been developed that target both HED and smoking in this population. The objective of the current study was to develop and evaluate a mobile feedback intervention that targets HED and smoking. Participants (N = 94) were non-treatment-seeking college students (M(age) = 20.5 years, SD = 1.7) who engaged in at least a single HED episode in the past 2 weeks and reported concurrent smoking and drinking at least once a week. Participants were randomized to receive either the mobile intervention for 14 days, complete mobile assessments (without intervention) for 14 days, or complete minimal assessments (without intervention or mobile assessments). At a 1-month follow-up, compared with the minimal assessment condition, we observed significant reductions in the number of cigarettes per smoking day in both the mobile intervention (d = 0.55) and mobile assessment (d = 0.45) conditions. Among those randomized to the mobile intervention, receiving more modules of the intervention was significantly associated with a lower likelihood of any drinking during the 14-day assessment period and significant reductions in smoking at 1-month follow-up. The mobile intervention did not result in significant reductions in HED or concurrent smoking and drinking. Future research should continue to examine ways of using technology and the real-time environment to improve interventions for HED and smoking.

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.

Social Communication is an Emerging Target for Pharmacotherapy in Autism Spectrum Disorder - A Review of the Literature on Potential Agents.

PubMed

Baribeau, Danielle A; Anagnostou, Evdokia

2014-02-01

To review the published literature and registered clinical trials on pharmacologic interventions targeting social communication impairment in Autism Spectrum Disorder (ASD). A comprehensive search of several databases (PubMed, MEDLINE, PsycINFO, Clinical trials.gov) was conducted to identify pharmacologic agents that have been, or will be, tested as treatments for social communication impairment in individuals with ASD. Evidence from basic science research supporting rational drug discovery is surveyed. Data from animal models and early clinical trials suggest that novel and existing compounds, including N-methyl-D-aspartate (NMDA) modulators, γ-aminobutyric acid (GABA) agonists, metabotropic glutamate receptor (mGluR) antagonists and neuropeptides, may enhance social communication/function in ASD. Results from numerous Phase 2 and Phase 3 clinical trials are expected in the near future. Recent evidence suggests that social communication may be an appropriate target for pharmacologic manipulation. It is hoped that, in combination with behavioural interventions, novel therapeutics may soon be clinically available to help improve social outcomes.

Targeting cancer metabolism: dietary and pharmacological interventions

PubMed Central

Vernieri, Claudio; Casola, Stefano; Foiani, Marco; Pietrantonio, Filippo; de Braud, Filippo; Longo, Valter

2016-01-01

Most tumors display oncogene-driven reprogramming of several metabolic pathways, which are crucial to sustain their growth and proliferation. In recent years, both dietary and pharmacological approaches that target deregulated tumor metabolism are beginning to be considered for clinical applications. Dietary interventions exploit the ability of nutrient-restricted conditions to exert broad biological effects, protecting normal cells, organs and systems, while sensitizing a wide variety of cancer cells to cytotoxic therapies. On the other hand, drugs targeting enzymes or metabolites of crucial metabolic pathways can be highly specific and effective, but must be matched with a responsive tumor, which might rapidly adapt. In this Review, we illustrate how dietary and pharmacological therapies differ in their effect on tumor growth, proliferation and metabolism, and discuss the available preclinical and clinical evidence in favor or against each of them. We also indicate, when appropriate, how to optimize future investigations on metabolic therapies on the basis of tumor- and patient-related characteristics. PMID:27872127

The Spatial Distribution of Hepatitis C Virus Infections and Associated Determinants--An Application of a Geographically Weighted Poisson Regression for Evidence-Based Screening Interventions in Hotspots.

PubMed

Kauhl, Boris; Heil, Jeanne; Hoebe, Christian J P A; Schweikart, Jürgen; Krafft, Thomas; Dukers-Muijrers, Nicole H T M

2015-01-01

Hepatitis C Virus (HCV) infections are a major cause for liver diseases. A large proportion of these infections remain hidden to care due to its mostly asymptomatic nature. Population-based screening and screening targeted on behavioural risk groups had not proven to be effective in revealing these hidden infections. Therefore, more practically applicable approaches to target screenings are necessary. Geographic Information Systems (GIS) and spatial epidemiological methods may provide a more feasible basis for screening interventions through the identification of hotspots as well as demographic and socio-economic determinants. Analysed data included all HCV tests (n = 23,800) performed in the southern area of the Netherlands between 2002-2008. HCV positivity was defined as a positive immunoblot or polymerase chain reaction test. Population data were matched to the geocoded HCV test data. The spatial scan statistic was applied to detect areas with elevated HCV risk. We applied global regression models to determine associations between population-based determinants and HCV risk. Geographically weighted Poisson regression models were then constructed to determine local differences of the association between HCV risk and population-based determinants. HCV prevalence varied geographically and clustered in urban areas. The main population at risk were middle-aged males, non-western immigrants and divorced persons. Socio-economic determinants consisted of one-person households, persons with low income and mean property value. However, the association between HCV risk and demographic as well as socio-economic determinants displayed strong regional and intra-urban differences. The detection of local hotspots in our study may serve as a basis for prioritization of areas for future targeted interventions. Demographic and socio-economic determinants associated with HCV risk show regional differences underlining that a one-size-fits-all approach even within small geographic areas may not be appropriate. Future screening interventions need to consider the spatially varying association between HCV risk and associated demographic and socio-economic determinants.

Identifying the Correlates and Barriers of Future Planning Among Parents of Individuals With Intellectual and Developmental Disabilities.

PubMed

Burke, Meghan; Arnold, Catherine; Owen, Aleksa

2018-04-01

Although individuals with intellectual and developmental disabilities (IDD) are living longer lives, fewer than half of parents of individuals with IDD conduct future planning. The correlates and barriers to future planning must be identified to develop targeted interventions to facilitate future planning. In this study, 388 parents of individuals with IDD responded to a national, web-based survey. Participants who were older, more educated, attended more parent training and support activities, and had children with fewer functional abilities, were more likely to engage in future planning. Reported barriers to future planning included: (a) lack of available services, (b) financial challenges, (c) reluctance of family members, (d) lack of time, (e) the emotional nature of future planning, (f) inertia, and (g) a lack of family members to be caregivers. Implications for policy, practice, and future research are discussed.

A new perspective on optimal care for patients with COPD.

PubMed

Postma, Dirkje; Anzueto, Antonio; Calverley, Peter; Jenkins, Christine; Make, Barry J; Sciurba, Frank C; Similowski, Thomas; van der Molen, Thys; Eriksson, Göran

2011-06-01

Worldwide, clinicians face the task of providing millions of patients with the best possible treatment and management of COPD. Currently, management primarily involves short-term 'here-and-now' goals, targeting immediate patient benefit. However, although there is considerable knowledge available to assist clinicians in minimising the current impact of COPD on patients, relatively little is known about which dominant factors predict future risks. These predictors may vary for different outcomes, such as exacerbations, mortality, co-morbidities, and the long-term consequences of COPD. We propose a new paradigm to achieve 'optimal COPD care' based on the concept that here-and-now goals should be integrated with goals to improve long-term outcomes and reduce future risks. Whilst knowledge on risk factors for poorer outcomes in COPD is growing and some data exist on positive effects of pharmacological interventions, information on defining the benefits of all commonly used interventions for reducing the risk of various future disease outcomes is still scarce. Greater insight is needed into the relationships between the two pillars of optimal COPD care: 'best current control' and 'future risk reduction'. This broader approach to disease management should result in improved care for every COPD patient now and into the future.

Current and future delivery systems for engineered nucleases: ZFN, TALEN and RGEN.

PubMed

Ul Ain, Qurrat; Chung, Jee Young; Kim, Yong-Hee

2015-05-10

Gene therapy by engineered nucleases is a genetic intervention being investigated for curing the hereditary disorders by targeting selected genes with specific nucleotides for establishment, suppression, abolishment of a function or correction of mutation. Here, we review the fast developing technology of targeted genome engineering using site specific programmable nucleases zinc finger nucleases (ZFNs), transcription activator like nucleases (TALENs) and cluster regulatory interspaced short palindromic repeat/CRISPR associated proteins (CRISPR/Cas) based RNA-guided DNA endonucleases (RGENs) and their different characteristics including pros and cons of genome modifications by these nucleases. We have further discussed different types of delivery methods to induce gene editing, novel development in genetic engineering other than nucleases and future prospects. Copyright © 2014 Elsevier B.V. All rights reserved.

Intervention Mapping to develop a Social Cognitive Theory-based intervention for chronic pain tailored to individuals with HIV.

PubMed

Merlin, Jessica S; Young, Sarah R; Johnson, Mallory O; Saag, Michael; Demonte, William; Kerns, Robert; Bair, Matthew J; Kertesz, Stefan; Turan, Janet M; Kilgore, Meredith; Clay, Olivio J; Pekmezi, Dorothy; Davies, Susan

2018-06-01

Chronic pain is an important comorbidity among individuals with HIV. Behavioral interventions are widely regarded as evidence-based, efficacious non-pharmacologic interventions for chronic pain in the general population. An accepted principle in behavioral science is that theory-based, systematically-developed behavioral interventions tailored to the unique needs of a target population are most likely to be efficacious. Our aim was to use Intervention Mapping to systematically develop a Social Cognitive Theory (SCT)-based intervention for chronic pain tailored to individuals with HIV that will improve pain intensity and pain-related functional impairment. Our Intervention Mapping process was informed by qualitative inquiry of 24 patients and seven providers in an HIV primary care clinic. The resulting intervention includes group and one-on-one sessions and peer and staff interventionists. We also developed a conceptual framework that integrates our qualitative findings with SCT-based theoretical constructs. Using this conceptual framework as a guide, our future work will investigate the intervention's impact on chronic pain outcomes, as well as our hypothesized proximal mediators of the intervention's effect.

The Integration of a Family Systems Approach for Understanding Youth Obesity, Physical Activity, and Dietary Programs

PubMed Central

Wilson, Dawn K.; St. George, Sara M.; Lawman, Hannah; Segal, Michelle; Fairchild, Amanda

2012-01-01

Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth. PMID:20689989

Targeting Cardiomyocyte Ca2+ Homeostasis in Heart Failure

PubMed Central

Røe, Åsmund T.; Frisk, Michael; Louch, William E.

2015-01-01

Improved treatments for heart failure patients will require the development of novel therapeutic strategies that target basal disease mechanisms. Disrupted cardiomyocyte Ca2+ homeostasis is recognized as a major contributor to the heart failure phenotype, as it plays a key role in systolic and diastolic dysfunction, arrhythmogenesis, and hypertrophy and apoptosis signaling. In this review, we outline existing knowledge of the involvement of Ca2+ homeostasis in these deficits, and identify four promising targets for therapeutic intervention: the sarcoplasmic reticulum Ca2+ ATPase, the Na+-Ca2+ exchanger, the ryanodine receptor, and t-tubule structure. We discuss experimental data indicating the applicability of these targets that has led to recent and ongoing clinical trials, and suggest future therapeutic approaches. PMID:25483944

A user-centered model for designing consumer mobile health (mHealth) applications (apps).

PubMed

Schnall, Rebecca; Rojas, Marlene; Bakken, Suzanne; Brown, William; Carballo-Dieguez, Alex; Carry, Monique; Gelaude, Deborah; Mosley, Jocelyn Patterson; Travers, Jasmine

2016-04-01

Mobile technologies are a useful platform for the delivery of health behavior interventions. Yet little work has been done to create a rigorous and standardized process for the design of mobile health (mHealth) apps. This project sought to explore the use of the Information Systems Research (ISR) framework as guide for the design of mHealth apps. Our work was guided by the ISR framework which is comprised of 3 cycles: Relevance, Rigor and Design. In the Relevance cycle, we conducted 5 focus groups with 33 targeted end-users. In the Rigor cycle, we performed a review to identify technology-based interventions for meeting the health prevention needs of our target population. In the Design Cycle, we employed usability evaluation methods to iteratively develop and refine mock-ups for a mHealth app. Through an iterative process, we identified barriers and facilitators to the use of mHealth technology for HIV prevention for high-risk MSM, developed 'use cases' and identified relevant functional content and features for inclusion in a design document to guide future app development. Findings from our work support the use of the ISR framework as a guide for designing future mHealth apps. Results from this work provide detailed descriptions of the user-centered design and system development and have heuristic value for those venturing into the area of technology-based intervention work. Findings from this study support the use of the ISR framework as a guide for future mHealth app development. Use of the ISR framework is a potentially useful approach for the design of a mobile app that incorporates end-users' design preferences. Copyright © 2016 Elsevier Inc. All rights reserved.

Lifestyle-focused interventions at the workplace to reduce the risk of cardiovascular disease--a systematic review.

PubMed

Groeneveld, Iris F; Proper, Karin I; van der Beek, Allard J; Hildebrandt, Vincent H; van Mechelen, Willem

2010-05-01

The goal of this review was to summarize the evidence for an effect of lifestyle-targeted interventions at the workplace on the main biological risk factors for cardiovascular disease (CVD). We performed an extensive systematic literature search for randomized controlled trials (RCT) that met the following inclusion criteria: (i) targeted at workers; (ii) aimed at increasing physical activity and/or improving diet; and (iii) measured body weight, body fat, blood pressure, blood lipids and/or blood glucose. We used a nine-item methodological quality list to determine the quality of each study. A best-evidence system was applied, taking into account study quality and consistency of effects. Our review included 31 RCT, describing a diversity of interventions (eg counseling, group education, or exercise). Of these studies, 18 were of high quality. Strong evidence was found for a positive effect on body fat, one of the strongest predictors of CVD risk. Among populations "at risk", there was strong evidence for a positive effect on body weight. Due to inconsistencies in results between studies, there was no evidence for the effectiveness of interventions on the remaining outcomes. We found strong evidence for the effectiveness of workplace lifestyle-based interventions on body fat and, in populations at risk for CVD, body weight. Populations with an elevated risk of CVD seemed to benefit most from lifestyle interventions; supervised exercise interventions appeared the least effective intervention strategy. To gain better insight into the mechanisms that led to the intervention effects, the participants' compliance with the intervention and the lifestyle changes achieved should be reported in future studies.

Proprioception: where are we now? A commentary on clinical assessment, changes across the life course, functional implications and future interventions.

PubMed

Suetterlin, Karen Joan; Sayer, Avan Aihie

2014-05-01

Proprioception, the sense of where one is in space, is essential for effective interaction with the environment. A lack of or reduction in proprioceptive acuity has been directly correlated with falls and with reduced functional independence in older people. Proprioceptive losses have also been shown to negatively correlate with functional recovery post stroke and play a significant role in other conditions such as Parkinson's disease. However, despite its central importance to many geriatric syndromes, the clinical assessment of proprioception has remained remarkably static. We look at approaches to the clinical assessment of proprioception, changes in proprioception across the life course, functional implications of proprioception in health and disease and the potential for targeted interventions in the future such as joint taping, and proprioception-specific rehabilitation and footwear.

Effectiveness of psychological interventions to improve quality of life in people with long-term conditions: rapid systematic review of randomised controlled trials.

PubMed

Anderson, Niall; Ozakinci, Gozde

2018-03-27

Long-term conditions may negatively impact multiple aspects of quality of life including physical functioning and mental wellbeing. The rapid systematic review aimed to examine the effectiveness of psychological interventions to improve quality of life in people with long-term conditions to inform future healthcare provision and research. EBSCOhost and OVID were used to search four databases (PsychInfo, PBSC, Medline and Embase). Relevant papers were systematically extracted by one researcher using the predefined inclusion/exclusion criteria based on titles, abstracts, and full texts. Randomized controlled trial psychological interventions conducted between 2006 and February 2016 to directly target and assess people with long-term conditions in order to improve quality of life were included. Interventions without long-term condition populations, psychological intervention and/or patient-assessed quality of life were excluded. From 2223 citations identified, 6 satisfied the inclusion/exclusion criteria. All 6 studies significantly improved at least one quality of life outcome immediately post-intervention. Significant quality of life improvements were maintained at 12-months follow-up in one out of two studies for each of the short- (0-3 months), medium- (3-12 months), and long-term (≥ 12 months) study duration categories. All 6 psychological intervention studies significantly improved at least one quality of life outcome immediately post-intervention, with three out of six studies maintaining effects up to 12-months post-intervention. Future studies should seek to assess the efficacy of tailored psychological interventions using different formats, durations and facilitators to supplement healthcare provision and practice.

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

Couple-Oriented Education and Support Intervention for Osteoarthritis: Effects on Spouses’ Support and Responses to Patient Pain

PubMed Central

Martire, Lynn M.; Schulz, Richard; Keefe, Francis J.; Rudy, Thomas E.; Starz, Terence W.

2009-01-01

The purpose of this study was to determine whether a couple-oriented education and support intervention for osteoarthritis was more efficacious than a similar patient-oriented intervention in terms of enhancing spouses’ support of patients and their positive and negative responses to patient pain. Repeated-measures analyses of covariance with the completers sample (N = 103 dyads) showed that at the postintervention assessment, patients in the couple-oriented intervention reported a greater decrease in their spouses’ punishing responses (e.g., anger, irritation) than did patients in the patient-oriented intervention. In addition, a trend effect was observed in regard to the advantage of couple-oriented intervention for increasing spouses’ attempts to distract patients from their pain. At the 6-month follow-up, patients in the couple-oriented intervention reported greater increased spouse support than those in the patient-oriented intervention. Findings illustrate the value of examining change in specific types of marital interactions targeted in a couples intervention, and the need to strengthen the impact of future couple-oriented interventions. PMID:19946460

Mental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis.

PubMed

Gates, Jesse; Killackey, Eóin; Phillips, Lisa; Álvarez-Jiménez, Mario

2015-08-01

People with psychotic disorders have reduced life expectancy compared with the general population. This difference is primarily due to increased prevalence of cardiovascular disease associated with antipsychotic drugs and with modifiable risk factors, including weight gain, low exercise, poor diet, and high prevalence of cigarette smoking. We review non-pharmacological interventions for physical health behaviour in patients with chronic and first-episode psychosis. Our findings suggest that weight loss and attenuation of weight gain are achievable but limited and might not persist beyond the end of an intervention. Evidence for smoking cessation interventions is scarce. The case for early intervention to prevent deterioration of physical health is strong. We propose a framework for development of interventions, which addresses three main factors largely absent in previous research: (1) examination of aetiological factors related to poor physical health, (2) theory-driven interventions that target aetiological factors, and (3) assessment of feasibility. Copyright © 2015 Elsevier Ltd. All rights reserved.

Toward risk reduction: predicting the future burden of occupational cancer.

PubMed

Hutchings, Sally; Rushton, Lesley

2011-05-01

Interventions to reduce cancers related to certain occupations should be evidence-based. The authors have developed a method for forecasting the future burden of occupational cancer to inform strategies for risk reduction. They project risk exposure periods, accounting for cancer latencies of up to 50 years, forward in time to estimate attributable fractions for a series of forecast target years given past and projected exposure trends and under targeted reduction scenarios. Adjustment factors for changes in exposed numbers and levels are applied in estimation intervals within the risk-exposure periods. The authors illustrate the methods by using a range of scenarios for reducing lung cancer due to occupational exposure to respirable crystalline silica. Attributable fractions for lung cancer due to respirable crystalline silica could be potentially reduced from 2.07% in 2010 to nearly 0% by 2060, depending on the timing and success of interventions. Focusing on achieving compliance with current exposure standards in small industries can be more effective than setting standards at a lower level. The method can be used to highlight high-risk carcinogens, industries, and occupations. It is adaptable for other countries and other exposure situations in the general environment and can be extended to include socioeconomic impact assessment.

Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial.

PubMed

Anguera, Joaquin A; Gunning, Faith M; Areán, Patricia A

2017-06-01

Existing treatments for depression are known to have only modest effects, are insufficiently targeted, and are inconsistently utilized, particularly in older adults. Indeed, older adults with impaired cognitive control networks tend to demonstrate poor response to a majority of existing depression interventions. Cognitive control interventions delivered using entertainment software have the potential to not only target the underlying cerebral dysfunction associated with depression, but to do so in a manner that is engaging and engenders adherence to treatment protocol. In this proof-of-concept trial (Clinicaltrials.gov #: NCT02229188), individuals with late life depression (LLD) (22; 60+ years old) were randomized to either problem solving therapy (PST, n = 10) or a neurobiologically inspired digital platform designed to enhance cognitive control faculties (Project: EVO™, n = 12). Given the overlapping functional neuroanatomy of mood disturbances and executive dysfunction, we explored the impact of an intervention targeting cognitive control abilities, functional disability, and mood in older adults suffering from LLD, and how those outcomes compare to a therapeutic gold standard. EVO participants demonstrated similar improvements in mood and self-reported function after 4 weeks of treatment to PST participants. The EVO participants also showed generalization to untrained measures of working memory and attention, as well as negativity bias, a finding not evident in the PST condition. Individuals assigned to EVO demonstrated 100% adherence. This study provides preliminary findings that this therapeutic video game targeting cognitive control deficits may be an efficacious LLD intervention. Future research is needed to confirm these findings. © 2016 Wiley Periodicals, Inc.

‘Get Your Life Back’: process and impact evaluation of an asthma social marketing campaign targeting older adults

PubMed Central

2013-01-01

Background Asthma in older adults is underdiagnosed and poorly self-managed. This population has little knowledge about the key symptoms, the prevalence among older adults, and the serious consequences of untreated asthma. The purpose of this study was to undertake a multifaceted evaluation of a social marketing campaign to increase asthma awareness among older adults in a regional Australian community. Methods A cohort of older adults in an intervention region (n = 316) and a control region (n = 394) were surveyed immediately prior to and following the social marketing campaign. Campaign awareness, message recall, materials recognition, and actions taken as a result of the campaign were assessed in both regions. Asthma knowledge and perceptions, experience of asthma symptoms, and general health were also assessed in both regions at baseline and follow-up. Analyses were conducted to explore the effects of the campaign in the intervention region, and to examine outcomes among different audience segments. Results The survey data showed that those in the target segments (Wheezers and Strugglers) had better message recall, and were more likely to report having taken action to control their respiratory symptoms. The campaign significantly increased the number of calls to an asthma information line from the target audience in the intervention community. Conclusions A theory-based social marketing campaign conducted over 3-months increased the asthma information seeking behaviours of older adults in the intervention community compared to the control community. Recommendations are outlined for future community health promotion campaigns targeting older adults. PMID:23947479

The role of cost-effectiveness analysis in developing nutrition policy.

PubMed

Cobiac, Linda J; Veerman, Lennert; Vos, Theo

2013-01-01

Concern about the overconsumption of unhealthy foods is growing worldwide. With high global rates of noncommunicable diseases related to poor nutrition and projections of more rapid increases of rates in low- and middle-income countries, it is vital to identify effective but low-cost interventions. Cost-effectiveness studies show that individually targeted dietary interventions can be effective and cost-effective, but a growing number of modeling studies suggest that population-wide approaches may bring larger and more sustained benefits for population health at a lower cost to society. Mandatory regulation of salt in processed foods, in particular, is highly recommended. Future research should focus on lacunae in the current evidence base: effectiveness of interventions addressing the marketing, availability, and price of healthy and unhealthy foods; modeling health impacts of complex dietary changes and multi-intervention strategies; and modeling health implications in diverse subpopulations to identify interventions that will most efficiently and effectively reduce health inequalities.

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.

The feasibility and acceptability of a diet and exercise trial in overweight and obese black breast cancer survivors: The Stepping STONE study.

PubMed

Sheppard, Vanessa B; Hicks, Jennifer; Makambi, Kepher; Hurtado-de-Mendoza, Alejandra; Demark-Wahnefried, Wendy; Adams-Campbell, Lucile

2016-01-01

Black breast cancer survivors have high rates of obesity and low physical activity levels. Little is known about the acceptability and feasibility of interventions in this population. A two-arm RCT was launched to assess the efficacy of a culturally targeted 12-week multimodal lifestyle intervention in overweight and obese black survivors. Intervention components included nutrition education, exercise groups, and survivor-led motivational interviewing phone sessions. The analytic sample included women who completed the trial (intervention n=10; control n=12). Anthropometric measures, physical activity, and VO2max were assessed at baseline and follow-up. Change scores (intervention vs. control) were assessed with Wilcoxon rank-sum tests. A process evaluation assessed intervention acceptability. Overall adherence was 70% and overall satisfaction was high (86%). Despite the 5% weight loss target, the intervention group lost 0.8% but BMI improved. Total physical activity levels increased in the intervention vs. control arm (+3501METmin/week vs. +965METmin/week, respectively). VO2max improved in the intervention group (+0.10±1.03kg/L/min). Intervention participants reduced energy intake (-207.3±31.5kcals) and showed improvements in fat intake (-15.5±3.8g), fiber (+3.2±1.2g) and % energy from fat (-4.8±3.1%). Survivors suggested providing diet/exercise information within a cancer context. Group and individualized intervention strategies are acceptable to black survivors. Observed differences between self-report and objective outcomes may suggest reporting bias or changes in body composition. Increasing supervised intervention components and assessment of body composition will be important for future trials. Copyright © 2015. Published by Elsevier Inc.

Inventory and perspectives of chronic disease management programs in Switzerland: an exploratory survey.

PubMed

Peytremann-Bridevaux, Isabelle; Burnand, Bernard

2009-10-07

To describe chronic disease management programs active in Switzerland in 2007, using an exploratory survey. We searched the internet (Swiss official websites and Swiss web-pages, using Google), a medical electronic database (Medline), reference lists of pertinent articles, and contacted key informants. Programs met our operational definition of chronic disease management if their interventions targeted a chronic disease, included a multidisciplinary team (>/=2 healthcare professionals), lasted at least six months, and had already been implemented and were active in December 2007. We developed an extraction grid and collected data pertaining to eight domains (patient population, intervention recipient, intervention content, delivery personnel, method of communication, intensity and complexity, environment, clinical outcomes). We identified seven programs fulfilling our operational definition of chronic disease management. Programs targeted patients with diabetes, hypertension, heart failure, obesity, psychosis and breast cancer. Interventions were multifaceted; all included education and half considered planned follow-ups. The recipients of the interventions were patients, and healthcare professionals involved were physicians, nurses, social workers, psychologists and case managers of various backgrounds. In Switzerland, a country with universal healthcare insurance coverage and little incentive to develop new healthcare strategies, chronic disease management programs are scarce. For future developments, appropriate evaluations of existing programs, involvement of all healthcare stakeholders, strong leadership and political will are, at least, desirable.

A Randomized Controlled Trial of Two Syntactic Treatment Procedures With Cantonese-Speaking, School-Age Children With Language Disorders.

PubMed

To, Carol K S; Lui, Hoi Ming; Li, Xin Xin; Lam, Gary Y H

2015-08-01

In this study, we aimed to evaluate the efficacy of sentence-combining (SC) and narrative-based (NAR) intervention approaches to syntax intervention using a randomized-controlled-trial design. Fifty-two Cantonese-speaking, school-age children with language impairment were assigned randomly to either the SC or the NAR treatment arm. Seven children did not receive treatment as assigned. Intervention in both arms targeted the same complex syntactical structures. The SC group focused on sentence combination training, whereas the NAR group made use of narratives in which the target structures were embedded. Pretest and posttest performances measured using a standardized language assessment were subjected to analyses of covariance mixed-effect-model analyses of variance. Children in both treatment arms demonstrated significant growth after 4 months of intervention. The main effect between treatment arms and time was not significant after controlling the pretest performance, suggesting that both treatment approaches showed similar effects. The main effect of time was significant. This study provided evidence to support language intervention in the school years in Cantonese-speaking children. However, neither approach was shown to be more efficacious than the other. Future researchers could examine the effects of a longer treatment period and include functional outcome measures.

Improving the quality of survivorship for older adults with cancer.

PubMed

Mohile, Supriya G; Hurria, Arti; Cohen, Harvey J; Rowland, Julia H; Leach, Corinne R; Arora, Neeraj K; Canin, Beverly; Muss, Hyman B; Magnuson, Allison; Flannery, Marie; Lowenstein, Lisa; Allore, Heather G; Mustian, Karen M; Demark-Wahnefried, Wendy; Extermann, Martine; Ferrell, Betty; Inouye, Sharon K; Studenski, Stephanie A; Dale, William

2016-08-15

In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent the decline of or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) use standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the 2 prior U13 meetings, this conference provided the framework for future research to improve the evidence base for the clinical care of older adults with cancer. Cancer 2016;122:2459-68. © 2016 American Cancer Society. © 2016 American Cancer Society.

Neuromodulation interventions for addictive disorders: challenges, promise, and roadmap for future research.

PubMed

Spagnolo, Primavera A; Goldman, David

2017-05-01

Addictive disorders are a major public health concern, associated with high relapse rates, significant disability and substantial mortality. Unfortunately, current interventions are only modestly effective. Preclinical studies as well as human neuroimaging studies have provided strong evidence that the observable behaviours that characterize the addiction phenotype, such as compulsive drug consumption, impaired self-control, and behavioural inflexibility, reflect underlying dysregulation and malfunction in specific neural circuits. These developments have been accompanied by advances in neuromodulation interventions, both invasive as deep brain stimulation, and non-invasive such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation. These interventions appear particularly promising as they may not only allow us to probe affected brain circuits in addictive disorders, but also seem to have unique therapeutic applications to directly target and remodel impaired circuits. However, the available literature is still relatively small and sparse, and the long-term safety and efficacy of these interventions need to be confirmed. Here we review the literature on the use of neuromodulation in addictive disorders to highlight progress limitations with the aim to suggest future directions for this field. Published by Oxford University Press on behalf of the Guarantors of Brain 2016. This work is written by US Government employees and is in the public domain in the United States.

Individual, employment and psychosocial factors influencing walking to work: Implications for intervention design

PubMed Central

Esliger, Dale W.; Taylor, Ian M.; Sherar, Lauren B.

2017-01-01

Background Promoting walking for the journey to and from work (commuter walking) is a potential strategy for increasing physical activity. Understanding the factors influencing commuter walking is important for identifying target groups and designing effective interventions. This study aimed to examine individual, employment-related and psychosocial factors associated with commuter walking and to discuss the implications for targeting and future design of interventions. Methods 1,544 employees completed a baseline survey as part of the ‘Walking Works’ intervention project (33.4% male; 36.3% aged <30 years). Multivariate logistic regression was used to examine the associations of individual (age, ethnic group, educational qualifications, number of children <16 and car ownership), employment-related (distance lived from work, free car parking at work, working hours, working pattern and occupation) and psychosocial factors (perceived behavioural control, intention, social norms and social support from work colleagues) with commuter walking. Results Almost half of respondents (n = 587, 49%) were classified as commuter walkers. Those who were aged <30 years, did not have a car, had no free car parking at work, were confident of including some walking or intended to walk to or from work on a regular basis, and had support from colleagues for walking were more likely to be commuter walkers. Those who perceived they lived too far away from work to walk, thought walking was less convenient than using a car for commuting, did not have time to walk, needed a car for work or had always travelled the same way were less likely to be commuter walkers. Conclusions A number of individual, employment-related and psychosocial factors were associated with commuter walking. Target groups for interventions to promote walking to and from work may include those in older age groups and those who own or have access to a car. Multi-level interventions targeting individual level behaviour change, social support within the workplace and organisational level travel policies may be required in order to promote commuter walking. PMID:28182714

Individual, employment and psychosocial factors influencing walking to work: Implications for intervention design.

PubMed

Adams, Emma J; Esliger, Dale W; Taylor, Ian M; Sherar, Lauren B

2017-01-01

Promoting walking for the journey to and from work (commuter walking) is a potential strategy for increasing physical activity. Understanding the factors influencing commuter walking is important for identifying target groups and designing effective interventions. This study aimed to examine individual, employment-related and psychosocial factors associated with commuter walking and to discuss the implications for targeting and future design of interventions. 1,544 employees completed a baseline survey as part of the 'Walking Works' intervention project (33.4% male; 36.3% aged <30 years). Multivariate logistic regression was used to examine the associations of individual (age, ethnic group, educational qualifications, number of children <16 and car ownership), employment-related (distance lived from work, free car parking at work, working hours, working pattern and occupation) and psychosocial factors (perceived behavioural control, intention, social norms and social support from work colleagues) with commuter walking. Almost half of respondents (n = 587, 49%) were classified as commuter walkers. Those who were aged <30 years, did not have a car, had no free car parking at work, were confident of including some walking or intended to walk to or from work on a regular basis, and had support from colleagues for walking were more likely to be commuter walkers. Those who perceived they lived too far away from work to walk, thought walking was less convenient than using a car for commuting, did not have time to walk, needed a car for work or had always travelled the same way were less likely to be commuter walkers. A number of individual, employment-related and psychosocial factors were associated with commuter walking. Target groups for interventions to promote walking to and from work may include those in older age groups and those who own or have access to a car. Multi-level interventions targeting individual level behaviour change, social support within the workplace and organisational level travel policies may be required in order to promote commuter walking.

Tweeting back: predicting new cases of back pain with mass social media data.

PubMed

Lee, Hopin; McAuley, James H; Hübscher, Markus; Allen, Heidi G; Kamper, Steven J; Moseley, G Lorimer

2016-05-01

Back pain is a global health problem. Recent research has shown that risk factors that are proximal to the onset of back pain might be important targets for preventive interventions. Rapid communication through social media might be useful for delivering timely interventions that target proximal risk factors. Identifying individuals who are likely to discuss back pain on Twitter could provide useful information to guide online interventions. We used a case-crossover study design for a sample of 742 028 tweets about back pain to quantify the risks associated with a new tweet about back pain. The odds of tweeting about back pain just after tweeting about selected physical, psychological, and general health factors were 1.83 (95% confidence interval [CI], 1.80-1.85), 1.85 (95% CI: 1.83-1.88), and 1.29 (95% CI, 1.27-1.30), respectively. These findings give directions for future research that could use social media for innovative public health interventions. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Research and application: scale of knowledge, attitude, and behavior of lifestyle intervention in a diabetes high-risk population].

PubMed

Wang, W J

2016-07-06

There is a large population at high risk for diabetes in China, and there has been a dramatic increase in the incidence of diabetes in the country over the past 30 years. Interventions targeting the individual risk factors of diabetes can effectively prevent diabetes; these include factors such as an unhealthy diet, lack of physical activity, overweight, and obesity, among others. Evaluation of related knowledge, attitudes, and behaviors before and after intervention using appropriate scales can measure population demands and the effectiveness of interventions. Scientificity and practicability are basic requirements of scale development. The theoretical basis and measuring items of a scale should be consistent with the theory of behavior change and should measure the content of interventions in a standardized and detailed manner to produce good validity, reliability, and acceptability. The scale of knowledge, attitude, and behavior of lifestyle intervention in a diabetes high-risk population is a tool for demand evaluation and effect evaluation of lifestyle intervention that has good validity and reliability. Established by the National Center for Chronic and Noncommunicable Disease Control and Prevention, its use can help to decrease the Chinese population at high risk for diabetes through targeted and scientifically sound lifestyle interventions. Future development of intervention evaluation scales for useing in high-risk populations should consider new factors and characteristics of the different populations, to develop new scales and modify or simplify existing ones, as well as to extend the measurement dimensions to barriers and supporting environment for behaviors change.

What's the Point?: A Review of Reward Systems Implemented in Gamification Interventions.

PubMed

Lewis, Zakkoyya H; Swartz, Maria C; Lyons, Elizabeth J

2016-04-01

Rewards are commonly used in interventions to change behavior, but they can inhibit development of intrinsic motivation, which is associated with long-term behavior maintenance. Gamification is a novel intervention strategy that may target intrinsic motivation through fun and enjoyment. Before the effects of gamified interventions on motivation can be determined, there must be an understanding of how gamified interventions operationalize rewards, such as point systems. The purpose of this review is to determine the prevalence of different reward types, specifically point systems, within gamified interventions. Electronic databases were searched for relevant articles. Data sources included Medline OVID, Medline PubMed, Web of Science, CINAHL, Cochrane Central, and PsycINFO. Out of the 21 articles retrieved, 18 studies described a reward system and were included in this review. Gamified interventions were designed to target a myriad of clinical outcomes across diverse populations. Rewards included points (n = 14), achievements/badges/medals (n = 7), tangible rewards (n = 7), currency (n = 4), other unspecified rewards (n = 3), likes (n = 2), animated feedback (n = 1), and kudos (n = 1). Rewards, and points in particular, appear to be a foundational component of gamified interventions. Despite their prevalence, authors seldom described the use of noncontingent rewards or how the rewards interacted with other game features. The reward systems relying on tangible rewards and currency may have been limited by inhibited intrinsic motivation. As gamification proliferates, future research should explicitly describe how rewards were operationalized in the intervention and evaluate the effects of gamified rewards on motivation across populations and research outcomes.

Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy.

PubMed

Parasoglou, Prodromos; Rao, Smita; Slade, Jill M

2017-06-01

The present review highlights current concepts regarding the effects of diabetic peripheral neuropathy (DPN) in skeletal muscle. It discusses the lack of effective pharmacologic treatments and the role of physical exercise intervention in limb protection and symptom reversal. It also highlights the importance of magnetic resonance imaging (MRI) techniques in providing a mechanistic understanding of the disease and helping develop targeted treatments. This review provides a comprehensive reporting on the effects of DPN in the skeletal muscle of patients with diabetes. It also provides an update on the most recent trials of exercise intervention targeting DPN pathology. Lastly, we report on emerging MRI techniques that have shown promise in providing a mechanistic understanding of DPN and can help improve the design and implementation of clinical trials in the future. Impairments in lower limb muscles reduce functional capacity and contribute to altered gait, increased fall risk, and impaired balance in patients with DPN. This finding is an important concern for patients with DPN because their falls are likely to be injurious and lead to bone fractures, poorly healing wounds, and chronic infections that may require amputation. Preliminary studies have shown that moderate-intensity exercise programs are well tolerated by patients with DPN. They can improve their cardiorespiratory function and partially reverse some of the symptoms of DPN. MRI has the potential to bring new mechanistic insights into the effects of DPN as well as to objectively measure small changes in DPN pathology as a result of intervention. Noninvasive exercise intervention is particularly valuable in DPN because of its safety, low cost, and potential to augment pharmacologic interventions. As we gain a better mechanistic understanding of the disease, more targeted and effective interventions can be designed. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

Early food for future health: a randomized controlled trial evaluating the effect of an eHealth intervention aiming to promote healthy food habits from early childhood.

PubMed

Helle, Christine; Hillesund, Elisabet Rudjord; Omholt, Mona Linge; Øverby, Nina Cecilie

2017-09-20

Childhood overweight and obesity is a global public health challenge. Primary prevention initiatives targeting parents have been called for to encourage a positive feeding environment and healthy eating habits that may lay a good foundation for future health. At the same time, there is a need for interventions which combine accessibility and scalability with cost effectiveness. Today's parents are extensive Internet-users, but only a few randomized controlled trials have investigated the use of Internet to promote healthy eating habits in early childhood. In Early Food for Future Health we have developed and will evaluate an Internet-based tool for parents of children between 6 and 12 months, aiming to increase knowledge about infant nutrition and foster protective feeding behavior. During springtime 2016, parents of children aged between 3 and 5 months were recruited through Norwegian child health centres and announcements on Facebook. After completing the baseline questionnaire, 718 parents were individually randomized to intervention- or control group. The intervention group received monthly emails with links to an age-appropriate web-site when their child was between 6 and 12 months. The control group received ordinary care from the child health centres. The data-collection is ongoing. All participants will be followed up at ages 12 and possibly 24 and 48 months, with questionnaires relating to eating behaviour and feeding practices, food variety and diet quality. Providing guidance and counseling to parents of infants is an important task for health authorities and the public child health services. Early Food for Future health is an intervention focusing on promoting early healthy food-habits which may prevent childhood overweight and obesity. If proven to be effective, Early Food for Future Health can be used by parents and public health nurses for supplementary guidance on feeding practices and diet. This study has the potential to provide greater insight and understanding regarding early parental feeding practices, child eating behavior and the development and efficacy of Internet-based public health interventions. ISRCTN13601567 .

Feelings and intervention judgments as mediators in the risk perception-intention relationship.

PubMed

Soureti, Anastasia; Hurling, Robert; Cobain, Mark R; van Mechelen, Willem; Chinapaw, Mai

2013-07-01

To explore the mediating role of measures of persuasion in the relationship between risk perceptions and intentions. The first study included 413 obese subjects (mean age = 45.3 years); the second study, 781 overweight subjects (mean age = 46.6 years). All measures were assessed by self-report. Feelings and intervention judgments were mediators in the relationship between risk perceptions and intention to eat healthier, do more physical activity (study 1) and intention to reduce saturated fat (study 2). Feelings was the only mediator in the relationship between risk perceptions and intention to stop smoking (study 1). Future interventions targeting risk perceptions to increase intentions are likely to be more effective if subjects find the information emotionally impactful, credible, and engaging.

Dysfunctional adipose tissue and low-grade inflammation in the management of the metabolic syndrome: current practices and future advances

PubMed Central

van Greevenbroek, Marleen M. J.; Schalkwijk, Casper G.; Stehouwer, Coen D.A.

2016-01-01

The ongoing worldwide obesity epidemic makes the metabolic syndrome an increasingly important entity. In this review, we provide a short background on the metabolic syndrome, we discuss recent developments in the three main options that have been identified for intervention in the metabolic syndrome, i.e. lifestyle and surgical and pharmacological interventions, and we focus on different views in the literature and also include our own viewpoints on the metabolic syndrome. In addition, we discuss some emerging treatment targets for adipose tissue dysfunction and low-grade inflammation, i.e. activation of the inflammasome and the complement system, and consider some selected opportunities for intervention in these processes. PMID:27803798

Spanish-Language Consumer Health Information Technology Interventions: A Systematic Review.

PubMed

Chaet, Alexis V; Morshedi, Bijan; Wells, Kristen J; Barnes, Laura E; Valdez, Rupa

2016-08-10

As consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions. Our aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics. A narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author's last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics. We included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the most common health domains targeted by consumer health IT interventions. More than half of the interventions were culturally tailored. The most frequently used evaluation metric was behavior/attitude change, followed by usability and knowledge retention. This study characterizes the existing body of research exploring consumer health IT interventions for the US Spanish-speaking Latino population. In doing so, it reveals three primary needs within the field. First, while the increase in studies targeting the Latino population in the last decade is a promising advancement, future research is needed that focuses on Latino subpopulations previously overlooked. Second, preliminary steps have been taken to culturally tailor consumer health IT interventions for the US Spanish-speaking Latino population; however, focus must expand beyond intervention content. Finally, the field should work to promote long-term evaluation of technology efficacy, moving beyond intermediary measures toward measures of health outcomes.

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

A Two-Week Psychosocial Intervention Reduces Future Aggression and Incarceration in Clinically Aggressive Juvenile Offenders.

PubMed

Kendall, Ashley D; Emerson, Erin M; Hartmann, William E; Zinbarg, Richard E; Donenberg, Geri R

2017-12-01

There is a largely unmet need for evidence-based interventions that reduce future aggression and incarceration in clinically aggressive juvenile offenders serving probation. We addressed this gap using a group randomized controlled trial. Offenders both with and without clinical aggression were included, enabling comparison of intervention effects. Juveniles 13 to 17 years old (N = 310, mean = 16 years, 90% African-American, 66% male) on probation were assigned to a 2-week intervention targeting psychosocial factors implicated in risky behavior (e.g., learning strategies to manage "hot" emotions that prompt risk taking) or to an equally intensive health promotion control. Participants completed aggression measures at baseline, 6-, and 12-month follow-up and reported on incarceration at 12 months. Spline regression tested symptom change. Among clinically aggressive offenders (n = 71), the intervention arm showed significantly greater reductions in aggression over the first 6 months compared with controls. Juveniles from the intervention no longer met clinical criteria, on average, but clinically significant symptoms persisted in the control group. By 12 months, participants from the intervention appeared to maintain treatment gains, but their symptom levels no longer differed significantly from those in the control. However, the intervention group was nearly 4 times less likely than controls to report incarceration. Intervention effects were significantly stronger for offenders with clinical than with nonclinical (n = 239) baseline aggression. A 2-week intervention expedited improvements in aggression and reduced incarceration in clinically aggressive juvenile offenders. The findings underscore the importance of directing intervention resources to the most aggressive youth. Clinical trial registration information-PHAT Life: Preventing HIV/AIDS Among Teens in Juvenile Justice (PHAT Life); http://clinicaltrials.gov/; NCT02647710. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Economic evaluation of targeted cancer interventions: critical review and recommendations.

PubMed

Elkin, Elena B; Marshall, Deborah A; Kulin, Nathalie A; Ferrusi, Ilia L; Hassett, Michael J; Ladabaum, Uri; Phillips, Kathryn A

2011-10-01

Scientific advances have improved our ability to target cancer interventions to individuals who will benefit most and spare the risks and costs to those who will derive little benefit or even be harmed. Several approaches are currently used for targeting interventions for cancer risk reduction, screening, and treatment, including risk prediction algorithms for identifying high-risk subgroups and diagnostic tests for tumor markers and germline genetic mutations. Economic evaluation can inform decisions about the use of targeted interventions, which may be more costly than traditional strategies. However, assessing the impact of a targeted intervention on costs and health outcomes requires explicit consideration of the method of targeting. In this study, we describe the importance of this principle by reviewing published cost-effectiveness analyses of targeted interventions in breast cancer. Few studies we identified explicitly evaluated the relationships among the method of targeting, the accuracy of the targeting test, and outcomes of the targeted intervention. Those that did found that characteristics of targeting tests had a substantial impact on outcomes. We posit that the method of targeting and the outcomes of a targeted intervention are inextricably linked and recommend that cost-effectiveness analyses of targeted interventions explicitly consider costs and outcomes of the method of targeting.

Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review.

PubMed

Amoakoh-Coleman, Mary; Borgstein, Alexander Berend-Jan; Sondaal, Stephanie Fv; Grobbee, Diederick E; Miltenburg, Andrea Solnes; Verwijs, Mirjam; Ansah, Evelyn K; Browne, Joyce L; Klipstein-Grobusch, Kerstin

2016-08-19

Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs. We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC. The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper. A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones. mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to address this gap.

Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review

PubMed Central

Borgstein, Alexander Berend-Jan; Sondaal, Stephanie FV; Grobbee, Diederick E; Miltenburg, Andrea Solnes; Verwijs, Mirjam; Ansah, Evelyn K; Browne, Joyce L; Klipstein-Grobusch, Kerstin

2016-01-01

Background Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs. Objective We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC. Methods The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper. Results A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones. Conclusions mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to address this gap. PMID:27543152

Sales effects of product health information at points of purchase: a systematic review.

PubMed

van 't Riet, Jonathan

2013-03-01

Information about healthy and unhealthy nutrients is increasingly conveyed at the point of purchase. Many studies have investigated the effects of product health information on attitudes and intentions, but the empirical evidence becomes sketchier when the focus of research is actual purchase behaviour. The present paper provides an overview of empirical evidence on the effectiveness of product health information for food products at the point of purchase. A systematic literature review was conducted. Only studies were included that assessed the effect of product health information at the point of purchase on actual purchase behaviour, using data provided by stores' sales records or obtained by investigating customer receipts as the primary outcome measure. The included studies' target group comprised supermarket clientele. Several studies found no significant effects of product health information on actual purchase behaviour. Interventions were more likely to be effective when they lasted for a longer time, when they included additional intervention components, and when they targeted the absence of unhealthy nutrients instead of or in addition to the presence of healthy nutrients. No strong evidence for the effectiveness of product health information was found. The effect of intervention duration, additional promotional activities and targeting of healthy v. unhealthy nutrients should be closely examined in future studies.

Outcomes of a Behavioral Intervention to Reduce HIV Risk among Drug-involved Female Sex Workers

PubMed Central

Surratt, Hilary L.; O’Grady, Catherine; Kurtz, Steven P.; Levi-Minzi, Maria A.; Chen, Minxing

2014-01-01

Although street-based female sex workers (FSWs) are highly vulnerable to HIV, they often lack access to needed health services and medical care. This paper reports the results of a recently completed randomized intervention trial for FSWs in Miami, Florida, which tested the relative efficacy of two case management interventions that aimed to link underserved FSWs with health services and to reduce risk behaviors for HIV. Participants were recruited using targeted sampling strategies and were randomly assigned to: a Strengths-Based/Professional Only (PO) or a Strengths-Based/Professional-Peer condition (PP). Follow-up data were collected 3 and 6 months post-baseline. Outcome analyses indicated that both intervention groups displayed significant reductions in HIV risk behaviors and significant increases in services utilization; the Professional-Peer condition provided no added benefit. HIV seropositive FSWs responded particularly well to the interventions, suggesting the utility of brief strengths-based case management interventions for this population in future initiatives. PMID:24558098

Translational Neuroscience as a Tool for Intervention Development in the Context of High-Adversity Families

PubMed Central

Fisher, Philip A.

2017-01-01

The use of theory-driven models to develop and evaluate family-based intervention programs has a long history in psychology. Some of the first evidence-based parenting programs to address child problem behavior, developed in the 1970s, were grounded in causal models derived from longitudinal developmental research. The same translational strategies can also be applied to designing programs that leverage emerging scientific knowledge about the effects of early adverse experiences on neurobiological systems to reduce risk and promote well-being. By specifying not only behavioral targets but also affected underlying neural systems, interventions can become more precise and efficient. This chapter describes the development of a program of research focusing on an intervention for young children in foster care. The intervention emerged from social learning theory research and employs a translational neuroscience approach. The conceptual model guiding the research, which incorporates behavioral domains as well as stress-regulatory neural systems, is described. Finally, future directions for translational neuroscience in family-based intervention research are considered. PMID:27589501

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

Dysbiosis of gut microbiota and microbial metabolites in Parkinson's Disease.

PubMed

Sun, Meng-Fei; Shen, Yan-Qin

2018-04-26

Gut microbial dysbiosis and alteration of microbial metabolites in Parkinson's disease (PD) have been increasingly reported. Dysbiosis in the composition and abundance of gut microbiota can affect both the enteric nervous system and the central nervous system (CNS), indicating the existence of a microbiota-gut-brain axis and thereby causing CNS diseases. Disturbance of the microbiota-gut-brain axis has been linked to specific microbial products that are related to gut inflammation and neuroinflammation. Future directions should therefore focus on the exploration of specific gut microbes or microbial metabolites that contribute to the development of PD. Microbiota-targeted interventions, such as antibiotics, probiotics and fecal microbiota transplantation, have been shown to favorably affect host health. In this review, recent findings regarding alterations and the role of gut microbiota and microbial metabolites in PD are summarized, and potential molecular mechanisms and microbiota-targeted interventions in PD are discussed. Copyright © 2018. Published by Elsevier B.V.

The Role of Food Parenting Skills and the Home Food Environment in Children's Weight Gain and Obesity.

PubMed

Gerards, S M P L; Kremers, S P J

2015-03-01

This paper presents an overview to provide readers with an update on the literature about the relation between parental influences (general parenting and food parenting practices) and children's weight-related outcomes. It first summarizes the evidence regarding the role of food parenting practices in shaping and maintaining children's nutritional and weight status. It then describes empirical evidence on the relation between general parenting and children's weight status. This evidence is less convincing, possibly because general parenting has a different, more distal role in influencing child behavior than parenting practices. General parenting may moderate the impact of food parenting practices on children's nutrition behaviors. Finally, we discuss studies on interventions targeting childhood overweight and obesity. There is no consensus on the optimal intervention targets (i.e., general parenting and/or food parenting practices). Based on the overview, we offer suggestions for future research.

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

Challenging the current approaches to multiple myeloma- and other cancer-related bone diseases: from bisphosphonates to targeted therapy.

PubMed

Kleber, Martina; Udi, Josefina; Metzke, Barbara; Terpos, Evangelos; Roodmann, G David; Morgan, Gareth; Dispenzieri, Angela; Einsele, Hermann; Wäsch, Ralph; Engelhardt, Monika

2012-06-01

An international myeloma meeting entitled "Challenging the current approaches to multiple myeloma- and other cancer-related bone diseases: from bisphosphonates to targeted therapy" was held in Freiburg, Germany in July 2011 to discuss novel insights into and approaches to myeloma bone disease and other bone-seeking tumors. This review briefly summarizes the most prominent data of the meeting and current literature on our understanding of bone disease, the role of imaging techniques, operative interventions and systemic bone-seeking treatment, all of which should further improve our future therapeutic choices.

Persuasive technology for health and wellness: State-of-the-art and emerging trends.

PubMed

Orji, Rita; Moffatt, Karyn

2018-03-01

The evolving field of persuasive and behavior change technology is increasingly targeted at influencing behavior in the area of health and wellness. This paper provides an empirical review of 16 years (85 papers) of literature on persuasive technology for health and wellness to: (1.) answer important questions regarding the effectiveness of persuasive technology for health and wellness, (2.) summarize and highlight trends in the technology design, research methods, motivational strategies, theories, and health behaviors targeted by research to date, (3.) uncover pitfalls of existing persuasive technological interventions for health and wellness, and (4.) suggest directions for future research.

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

Systematic, theoretically-grounded development and feasibility testing of an innovative, preventive web-based game for children exposed to acute trauma

PubMed Central

Marsac, Meghan L.; Winston, Flaura K.; Hildenbrand, Aimee K.; Kohser, Kristen L.; March, Sonja; Kenardy, Justin; Kassam-Adams, Nancy

2015-01-01

Background Millions of children are affected by acute medical events annually, creating need for resources to promote recovery. While web-based interventions promise wide reach and low cost for users, development can be time- and cost-intensive. A systematic approach to intervention development can help to minimize costs and increase likelihood of effectiveness. Using a systematic approach, our team integrated evidence on the etiology of traumatic stress, an explicit program theory, and a user-centered design process to intervention development. Objective To describe evidence and the program theory model applied to the Coping Coach intervention and present pilot data evaluating intervention feasibility and acceptability. Method Informed by empirical evidence on traumatic stress prevention, an overarching program theory model was articulated to delineate pathways from a) specific intervention content to b) program targets and proximal outcomes to c) key longer-term health outcomes. Systematic user-testing with children ages 8–12 (N = 42) exposed to an acute medical event and their parents was conducted throughout intervention development. Results Functionality challenges in early prototypes necessitated revisions. Child engagement was positive throughout revisions to the Coping Coach intervention. Final pilot-testing demonstrated promising feasibility and high user-engagement and satisfaction. Conclusion Applying a systematic approach to the development of Coping Coach led to the creation of a functional intervention that is accepted by children and parents. Development of new e-health interventions may benefit from a similar approach. Future research should evaluate the efficacy of Coping Coach in achieving targeted outcomes of reduced trauma symptoms and improved health-related quality of life. PMID:25844276

Tackling psychosocial risk factors for adolescent cyberbullying: Evidence from a school-based intervention.

PubMed

Barkoukis, Vassilis; Lazuras, Lambros; Ourda, Despoina; Tsorbatzoudis, Haralambos

2016-01-01

Cyberbullying is an emerging form of bullying that takes place through contemporary information and communication technologies. Building on past research on the psychosocial risk factors for cyberbullying in this age group, the present study assessed a theory-driven, school-based preventive intervention that targeted moral disengagement, empathy and social cognitive predictors of cyberbullying. Adolescents (N = 355) aged between 16 and 18 years were randomly assigned into the intervention and the control group. Both groups completed anonymous structured questionnaires about demographics, empathy, moral disengagement and cyberbullying-related social cognitive variables (attitudes, actor prototypes, social norms, and behavioral expectations) before the intervention, post-intervention and 6 months after the intervention. The intervention included awareness-raising and interactive discussions about cyberbullying with intervention group students. Analysis of covariance (ANCOVA) showed that, after controlling for baseline measurements, there were significant differences at post-intervention measures in moral disengagement scores, and in favorability of actor prototypes. Further analysis on the specific mechanisms of moral disengagement showed that significant differences were observed in distortion of consequences and attribution of blame. The implications of the intervention are discussed, and guidelines for future school-based interventions against cyberbullying are provided. © 2015 Wiley Periodicals, Inc.

A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity.

PubMed

Turyk, Mary; Banda, Elizabeth; Chisum, Gay; Weems, Dolores; Liu, Yangyang; Damitz, Maureen; Williams, Rhonda; Persky, Victoria

2013-09-01

Home-based, multifaceted interventions have been effective in reducing asthma morbidity in children. However, identification of independent components that contribute to outcomes and delineating effectiveness by level of asthma symptoms would help to refine the intervention and target appropriate populations. A community health educator led asthma intervention implemented in a low-income African-American neighborhood included asthma management education, individually tailored low-cost asthma home trigger remediation, and referrals to social and medical agencies, when appropriate. Changes in asthma morbidity measures were assessed in relation to implementation of individual intervention components using multivariable logistic regression. Among the 218 children who completed the year-long program, there were significant reductions in measures of asthma morbidity, including symptoms, urgent care visits, emergency department (ED) visits, hospitalizations, missed school days, and missed work days for caretakers. We also found significant decreases in the prevalence of many home asthma triggers and improvements in asthma management practices. Improvement in caretaker's ability to manage the child's asthma was associated with reduction in ED visits for asthma and uncontrolled asthma. Specific home interventions, such as repair of water leaks and reduced exposure to plants, dust, clutter and stuffed toys, may be related to reduction in asthma morbidity. This program was effective in reducing asthma morbidity in low-income African-American children and identified specific interventions as possible areas to target in future projects. Furthermore, the intervention was useful in children with persistent asthma symptoms as well as those with less frequent asthma exacerbations.

Culturally Targeted Strategies for Diabetes Prevention in Minority Population.

PubMed

Lagisetty, Pooja A; Priyadarshini, Shubadra; Terrell, Stephanie; Hamati, Mary; Landgraf, Jessica; Chopra, Vineet; Heisler, Michele

2017-02-01

Purpose The purpose of this study is to (a) assess the effectiveness of culturally tailored diabetes prevention interventions in minority populations and (b) develop a novel framework to characterize 4 key domains of culturally tailored interventions. Prevention strategies specifically tailored to the culture of ethnic minority patients may help reduce the incidence of diabetes. Methods We searched PubMed, EMBASE, and CINAHL for English-language, randomized controlled trials (RCTs) or quasi-experimental (QE) trials testing culturally tailored interventions to prevent diabetes in minority populations. Two reviewers independently extracted data and assessed risk of bias. Inductive thematic analysis was used to develop a framework with 4 domains (FiLLM: Facilitating [ie, delivering] Interventions Through Language, Location, and Message). The framework was used to assess the overall effectiveness of culturally tailored interventions. Results Thirty-four trials met eligibility criteria. Twelve studies were RCTs, and 22 were QE trials. Twenty-five out of 34 studies (74%) that used cultural tailoring demonstrated significantly improved A1C, fasting glucose, and/or weight loss. Of the 25 successful interventions, 21 (84%) incorporated at least 3 culturally targeted domains. Seven studies used all 4 domains and were all successful. The least utilized domain was delivery (4/34) of the intervention's key educational message. Conclusions Culturally tailoring interventions across the 4 domains of facilitators, language, location, and messaging can be effective in improving risk factors for progression to diabetes among ethnic minority groups. Future studies should evaluate how specific tailoring approaches work compared to usual care as well as comparative effectiveness of each tailoring domain.

Health information technology adoption: Understanding research protocols and outcome measurements for IT interventions in health care.

PubMed

Colicchio, Tiago K; Facelli, Julio C; Del Fiol, Guilherme; Scammon, Debra L; Bowes, Watson A; Narus, Scott P

2016-10-01

To classify and characterize the variables commonly used to measure the impact of Information Technology (IT) adoption in health care, as well as settings and IT interventions tested, and to guide future research. We conducted a descriptive study screening a sample of 236 studies from a previous systematic review to identify outcome measures used and the availability of data to calculate these measures. We also developed a taxonomy of commonly used measures and explored setting characteristics and IT interventions. Clinical decision support is the most common intervention tested, primarily in non-hospital-based clinics and large academic hospitals. We identified 15 taxa representing the 79 most commonly used measures. Quality of care was the most common category of these measurements with 62 instances, followed by productivity (11 instances) and patient safety (6 instances). Measures used varied according to type of setting, IT intervention and targeted population. This study provides an inventory and a taxonomy of commonly used measures that will help researchers select measures in future studies as well as identify gaps in their measurement approaches. The classification of the other protocol components such as settings and interventions will also help researchers identify underexplored areas of research on the impact of IT interventions in health care. A more robust and standardized measurement system and more detailed descriptions of interventions and settings are necessary to enable comparison between studies and a better understanding of the impact of IT adoption in health care settings. Copyright © 2016 Elsevier Inc. All rights reserved.

Effectiveness of a Text Messaging-Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial.

PubMed

Thomas, Kristin; Müssener, Ulrika; Linderoth, Catharina; Karlsson, Nadine; Bendtsen, Preben; Bendtsen, Marcus

2018-06-25

Excessive drinking among university students is a global challenge, leading to significant health risks. However, heavy drinking among students is widely accepted and socially normalized. Mobile phone interventions have attempted to reach students who engage in excessive drinking. A growing number of studies suggest that text message-based interventions could potentially reach many students and, if effective, such an intervention might help reduce heavy drinking in the student community. The objective of this study was to test the effectiveness of a behavior change theory-based 6-week text message intervention among university students. This study was a two-arm, randomized controlled trial with an intervention group receiving a 6-week text message intervention and a control group that was referred to treatment as usual at the local student health care center. Outcome measures were collected at baseline and at 3 months after the initial invitation to participate in the intervention. The primary outcome was total weekly alcohol consumption. Secondary outcomes were frequency of heavy episodic drinking, highest estimated blood alcohol concentration, and number of negative consequences attributable to excessive drinking. A total of 896 students were randomized to either the intervention or control group. The primary outcome analysis included 92.0% of the participants in the intervention group and 90.1% of the control group. At follow-up, total weekly alcohol consumption decreased in both groups, but no significant between-group difference was seen. Data on the secondary outcomes included 49.1% of the participants in the intervention group and 41.3% of the control group. No significant between-group difference was seen for any of the secondary outcomes. The present study was under-powered, which could partly explain the lack of significance. However, the intervention, although theory-based, needs to be re-assessed and refined to better support the target group. Apart from establishing which content forms an effective intervention, the optimal length of an alcohol intervention targeting students also needs to be addressed in future studies. International Standard Randomised Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/70Ax4vXhd). ©Kristin Thomas, Ulrika Müssener, Catharina Linderoth, Nadine Karlsson, Preben Bendtsen, Marcus Bendtsen. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 25.06.2018.

Spatiotemporal Analysis of Malaria in Urban Ahmedabad (Gujarat), India: Identification of Hot Spots and Risk Factors for Targeted Intervention

PubMed Central

Parizo, Justin; Sturrock, Hugh J. W.; Dhiman, Ramesh C.; Greenhouse, Bryan

2016-01-01

The world population, especially in developing countries, has experienced a rapid progression of urbanization over the last half century. Urbanization has been accompanied by a rise in cases of urban infectious diseases, such as malaria. The complexity and heterogeneity of the urban environment has made study of specific urban centers vital for urban malaria control programs, whereas more generalizable risk factor identification also remains essential. Ahmedabad city, India, is a large urban center located in the state of Gujarat, which has experienced a significant Plasmodium vivax and Plasmodium falciparum disease burden. Therefore, a targeted analysis of malaria in Ahmedabad city was undertaken to identify spatiotemporal patterns of malaria, risk factors, and methods of predicting future malaria cases. Malaria incidence in Ahmedabad city was found to be spatially heterogeneous, but temporally stable, with high spatial correlation between species. Because of this stability, a prediction method utilizing historic cases from prior years and seasons was used successfully to predict which areas of Ahmedabad city would experience the highest malaria burden and could be used to prospectively target interventions. Finally, spatial analysis showed that normalized difference vegetation index, proximity to water sources, and location within Ahmedabad city relative to the dense urban core were the best predictors of malaria incidence. Because of the heterogeneity of urban environments and urban malaria itself, the study of specific large urban centers is vital to assist in allocating resources and informing future urban planning. PMID:27382081

Interventional procedure based on nanorobots propelled and steered by flagellated magnetotactic bacteria for direct targeting of tumors in the human body.

PubMed

Martel, Sylvain; Felfoul, Ouajdi; Mohammadi, Mahmood; Mathieu, Jean-Baptiste

2008-01-01

Flagellated bacteria used as bio-actuators may prove to be efficient propulsion mechanisms for future hybrid medical nanorobots when operating in the microvasculature. Here, we briefly describe a medical interventional procedure where flagellated bacteria and more specifically MC-1 Magnetotactic Bacteria (MTB) can be used to propel and steer micro-devices and nanorobots under computer control to reach remote locations in the human body. In particular, we show through experimental results the potential of using MTB-tagged robots to deliver therapeutic agents to tumors even the ones located in deep regions of the human body. We also show that such bacterial nanorobots can be tracked inside the human body for enhanced targeting under computer guidance using MRI as imaging modality. MTB can not only be guided and controlled directly towards a specific target, but we also show experimentally that these flagellated bacterial nanorobots can be propelled and steered in vivo deeply through the interstitial region of a tumor. The targeting efficacy is increased when combined with larger ferromagnetic micro-carriers being propelled by magnetic gradients generated by a MRI platform to carry and release nanorobots propelled by a single flagellated bacterium near the arteriocapillar entry. Based on the experimental data obtained and the experience gathered during several experiments conducted in vivo with this new approach, a general medical interventional procedure is briefly described here in a biomedical engineering context.

An integrated approach to panic prevention targeting the empirically supported risk factors of smoking and anxiety sensitivity: theoretical basis and evidence from a pilot project evaluating feasibility and short-term efficacy.

PubMed

Feldner, Matthew T; Zvolensky, Michael J; Babson, Kimberly; Leen-Feldner, Ellen W; Schmidt, Norman B

2008-10-01

Consistent with a risk reduction model of targeted prevention, the present investigation piloted and empirically evaluated the feasibility and short-term efficacy of a first-generation panic prevention program that targeted two malleable risk factors for panic development-anxiety sensitivity and daily cigarette smoking. Members of a high risk cohort, defined by high levels of anxiety sensitivity and current daily smoking (n=96), were randomly assigned to either (1) a one session intervention focused on proximally increasing motivation to quit smoking and reducing anxiety sensitivity to distally prevent the development of panic or (2) a health information control condition of comparable length. Participants were followed for 6 months. Consistent with hypotheses, those in the treatment condition showed reduced anxiety sensitivity and this effect was maintained across the follow-up period. Limited evidence also suggested the intervention increased motivation to quit smoking. We discuss how this prevention protocol can be modified in the future to enhance its effects as part of second-generation larger-scale outcome evaluations.

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

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.

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.

Stem cell therapy: MRI guidance and monitoring.

PubMed

Kraitchman, Dara L; Gilson, Wesley D; Lorenz, Christine H

2008-02-01

With the recent advances in magnetic resonance (MR) labeling of cellular therapeutics, it is natural that interventional MRI techniques for targeting would be developed. This review provides an overview of the current methods of stem cell labeling and the challenges that are created with respect to interventional MRI administration. In particular, stem cell therapies will require specialized, MR-compatible devices as well as integration of graphical user interfaces with pulse sequences designed for interactive, real-time delivery in many organs. Specific applications that are being developed will be reviewed as well as strategies for future translation to the clinical realm. (Copyright) 2008 Wiley-Liss, Inc.

F.O.R.E.play: the utility of brief sexual health interventions among college students.

PubMed

Moore, Erin W; Smith, William E; Folsom, Ashlee R B

2012-01-01

The authors aimed to determine the most effective brief sexual health intervention for college students, while also evaluating students' preferences for learning about sexual health, in order to develop a university program. A total of 302 students enrolled in an introductory college course participated and were randomly assigned to 1 of 3 brief interventions during a regularly scheduled class and completed pre- and postsurveys assessing knowledge, motivation to use condoms, and condom self-efficacy. Findings indicated that having an actual person in charge of the learning process resulted in higher knowledge gains and highlighted a student preference for discussion-based learning, viewing pictures of sexually transmitted infections, and hearing real-life experiences about the consequences of unsafe sex. These findings will be used to tailor a future intervention targeting college students for use with freshmen students at this university.

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.

Relative Effectiveness of Reading Intervention Programs for Adults with Low Literacy.

PubMed

Sabatini, John P; Shore, Jane; Holtzman, Steven; Scarborough, Hollis S

2011-01-01

To compare the efficacy of instructional programs for adult learners with basic reading skills below the seventh grade level, 300 adults were randomly assigned to one of three supplementary tutoring programs designed to strengthen decoding and fluency skills, and gains were examined for the 148 adult students who completed the program. The three intervention programs were based on or adapted from instructional programs that have been shown to benefit children with reading levels similar to those of the adult sample. Each program varied in its relative emphasis on basic decoding versus reading fluency instruction. A repeated measures MANOVA confirmed small to moderate reading gains from pre- to post-testing across a battery of targeted reading measures, but no significant relative differences across interventions. An additional 152 participants who failed to complete the intervention differed initially from those who persisted. Implications for future research and adult literacy instruction are discussed.

A Randomized Controlled Trial of a Group Motivational Interviewing Intervention for Adolescents with a First Time Alcohol or Drug Offense

PubMed Central

D’Amico, Elizabeth J.; Hunter, Sarah B.; Miles, Jeremy N.V.; Ewing, Brett A.; Osilla, Karen Chan

2013-01-01

Group Motivational Interviewing (MI) interventions that target youth at-risk for alcohol and other drug (AOD) use may prevent future negative consequences. Youth in a teen court setting (n=193; 67% male, 45% Hispanic; mean age 16.6 (SD = 1.05) were randomized to receive either a group MI intervention, Free Talk, or usual care (UC). We examined client acceptance, intervention feasibility and conducted a preliminary outcome evaluation. Free Talk teens reported higher quality and satisfaction ratings, and MI integrity scores were higher for Free Talk groups. AOD use and delinquency decreased for both groups at three months, and 12-month recidivism rates were lower but not significantly different for the Free Talk group compared to UC. Results contribute to emerging literature on MI in a group setting. A longer term follow-up is warranted. PMID:23891459

Effects of video modeling on communicative social skills of college students with Asperger syndrome.

PubMed

Mason, Rose A; Rispoli, Mandy; Ganz, Jennifer B; Boles, Margot B; Orr, Kristie

2012-01-01

Empirical support regarding effective interventions for individuals with autism spectrum disorder (ASD) within a postsecondary community is limited. Video modeling, an empirically supported intervention for children and adolescents with ASD, may prove effective in addressing the needs of individuals with ASD in higher education. This study evaluated the effects of video modeling without additional treatment components to improve social-communicative skills, specifically, eye contact, facial expression, and conversational turntaking in college students with ASD. This study utilized a multiple baseline single-case design across behaviors for two post-secondary students with ASD to evaluate the effects of the video modeling intervention. Large effect sizes and statistically significant change across all targeted skills for one participant and eye contact and turntaking for the other participant were obtained. The use of video modeling without additional intervention may increase the social skills of post-secondary students with ASD. Implications for future research are discussed.

A Review of Services and Interventions for Runaway and Homeless Youth: Moving Forward.

PubMed

Slesnick, Natasha; Dashora, Pushpanjali; Letcher, Amber; Erdem, Gizem; Serovich, Julianne

2009-07-01

Research focused on the impact of community-based services and treatment interventions designed to intervene in the lives of runaway and homeless youth has increased in the last two decades in the U.S. and internationally. In light of the tremendous need for identifying effective strategies to end homelessness and its associated problems among youth, this paper summarizes and critiques the findings of the extant literature including U.S., international, and qualitative studies. Thirty-two papers met criteria for inclusion in the review. Among the conclusions are that comprehensive interventions which target the varied and interconnected needs of these youth and families may be worthy of more study than studies that isolate the intervention focus on one problem. Also, more research incorporating design strategies that increase the reliability and validity of study findings is needed. Other preliminary conclusions and future directions are offered.

Just-in-Time Feedback in Diet and Physical Activity Interventions: Systematic Review and Practical Design Framework.

PubMed

Schembre, Susan M; Liao, Yue; Robertson, Michael C; Dunton, Genevieve Fridlund; Kerr, Jacqueline; Haffey, Meghan E; Burnett, Taylor; Basen-Engquist, Karen; Hicklen, Rachel S

2018-03-22

The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of health behavior goals. The goals of this systematic review were to summarize data on the content characteristics of feedback messaging used in diet and physical activity (PA) interventions and to develop a practical framework for designing just-in-time feedback for behavioral interventions. Interventions that included just-in-time feedback on PA, sedentary behavior, or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. The review included 31 studies (15/31, 48%, targeting PA or sedentary behavior only; 13/31, 42%, targeting diet and PA; and 3/31, 10%, targeting diet only). All studies used just-in-time feedback, 30 (97%, 30/31) used personalized feedback, and 24 (78%, 24/31) used goal-oriented feedback, but only 5 (16%, 5/31) used actionable feedback. Of the 9 studies that tested the efficacy of providing feedback to promote behavior change, 4 reported significant improvements in health behavior. In 3 of these 4 studies, feedback was continuously available, goal-oriented, or actionable. Feedback that was continuously available, personalized, and actionable relative to a known behavioral objective was prominent in intervention studies with significant behavior change outcomes. Future research should determine whether all or some of these characteristics are needed to optimize the effect of feedback in just-in-time interventions. ©Susan M Schembre, Yue Liao, Michael C Robertson, Genevieve Fridlund Dunton, Jacqueline Kerr, Meghan E Haffey, Taylor Burnett, Karen Basen-Engquist, Rachel S Hicklen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.03.2018.

Systematic review of dietary trans-fat reduction interventions

PubMed Central

Bromley, Helen; Kypridemos, Chris; O’Flaherty, Martin; Lloyd-Williams, Ffion; Guzman-Castillo, Maria; Pearson-Stuttard, Jonathan; Capewell, Simon

2017-01-01

Abstract Objective To systematically review published studies of interventions to reduce people’s intake of dietary trans-fatty acids (TFAs). Methods We searched online databases (CINAHL, the CRD Wider Public Health database, Cochrane Database of Systematic Reviews, Ovid®, MEDLINE®, Science Citation Index and Scopus) for studies evaluating TFA interventions between 1986 and 2017. Absolute decrease in TFA consumption (g/day) was the main outcome measure. We excluded studies reporting only on the TFA content in food products without a link to intake. We included trials, observational studies, meta-analyses and modelling studies. We conducted a narrative synthesis to interpret the data, grouping studies on a continuum ranging from interventions targeting individuals to population-wide, structural changes. Results After screening 1084 candidate papers, we included 23 papers: 12 empirical and 11 modelling studies. Multiple interventions in Denmark achieved a reduction in TFA consumption from 4.5 g/day in 1976 to 1.5 g/day in 1995 and then virtual elimination after legislation banning TFAs in manufactured food in 2004. Elsewhere, regulations mandating reformulation of food reduced TFA content by about 2.4 g/day. Worksite interventions achieved reductions averaging 1.2 g/day. Food labelling and individual dietary counselling both showed reductions of around 0.8 g/day. Conclusion Multicomponent interventions including legislation to eliminate TFAs from food products were the most effective strategy. Reformulation of food products and other multicomponent interventions also achieved useful reductions in TFA intake. By contrast, interventions targeted at individuals consistently achieved smaller reductions. Future prevention strategies should consider this effectiveness hierarchy to achieve the largest reductions in TFA consumption. PMID:29200523

Motivating smokers to quit using computer-generated letters that target either reduction or cessation: A population-based randomized controlled trial among smokers who do not intend to quit.

PubMed

Meyer, Christian; Ulbricht, Sabina; Haug, Severin; Broda, Anja; Bischof, Gallus; Rumpf, Hans-Jürgen; John, Ulrich

2016-09-01

This study examined the long-term efficacy of individualized counseling letters that targeted either smoking abstinence or reducing the number of cigarettes smoked per day to promote future cessation. A nationwide random-digit-dialing telephone sample was used to identify smokers from the general adult population (participation proportion: 54.5%). In total, 1462 participants (48% female) who did not intend to quit within the next six months and who smoked ten or more cigarettes a day were randomized to one of two intervention groups or an assessment-only control condition. The interventions consisted of three tailored letters that were sent after baseline and follow-up assessments after three and six months. Follow-up data on smoking status were provided by 82% and 77% of the participants 12 and 24 months after study inclusion, respectively. Generalized estimation equation (GEE) models adjusted for potential baseline confounders and multiple imputation of missing follow-up data were used to estimate intervention effects. At 24-month follow-up prevalence of 7-day point abstinence was 8.4%, 12.9% and 14.7% in the control, abstinence intervention and reduction intervention condition, which corresponds to a number needed to treat of 22 (95%-CI: 11-707) and 16 (95%-CI: 9-53). Adjusted GEE analyses revealed that the smoking reduction intervention (ORadj=2.3, p<0.01) but not the abstinence intervention (ORadj=1.4, p=0.20) increased the odds of 6-month prolonged abstinence compared with the control condition. No significant differences appear when directly comparing both intervention groups. Smoking reduction should be considered as an alternative intervention goal for smokers who are unable or unwilling to quit. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Effects of a kindergarten-based, family-involved intervention on motor performance ability in 3- to 6-year-old children: the ToyBox-study.

PubMed

Birnbaum, Julia; Geyer, Christine; Kirchberg, Franca; Manios, Yannis; Koletzko, Berthold

2017-02-01

This study targeted to examine the effect of the ToyBox-intervention, a kindergarten-based, family-involved intervention, aiming to improve preschooler's energy-related behaviours (e.g., physical activity) on motor performance ability. Physical activity sessions, classroom activities, environmental changes and tools for parents were the components of the 1-year intervention. The intervention and control were cluster-randomised, and children's anthropometry and two motor test items (jumping from side to side, JSS and standing long jump, SLJ) were assessed. A total of 1293 (4.6 ± 0.69 years; 52% boys) from 45 kindergartens in Germany were included (intervention, n = 863; control, n = 430). The effect was assessed using generalised estimating equation. The intervention group showed a better improvement in JSS (Estimate 2.19 jumps, P = 0.01) and tended to improve better in SLJ (Estimate 2.73 cm, P = 0.08). The intervention was more effective in boys with respect to SLJ (P of interaction effect = 0.01). Children aged <4.5 years did not show a significant benefit while older children improved (JSS, Estimate 3.38 jumps, P = 0.004; SLJ, Estimate 4.18 cm, P = 0.04). Children with low socio-economic status improved in JSS (Estimate 5.98 jumps, P = 0.0001). The ToyBox-intervention offers an effective strategy to improve specific components of motor performance ability in early childhood. Future programmes should consider additional strategies specifically targeting girls and younger aged children. BMI: body mass index; SES: socio-economic status; JSS: jumping from side to side; SLJ: standing long jump; SD: standard deviation; GEE: generalised estimating equation.

Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis.

PubMed

Dalton, Kieran; O'Brien, Gary; O'Mahony, Denis; Byrne, Stephen

2018-06-08

computerised interventions have been suggested as an effective strategy to reduce potentially inappropriate prescribing (PIP) for hospitalised older adults. This systematic review and meta-analysis examined the evidence for efficacy of computerised interventions designed to reduce PIP in this patient group. an electronic literature search was conducted using eight databases up to October 2017. Included studies were controlled trials of computerised interventions aiming to reduce PIP in hospitalised older adults (≥65 years). Risk of bias was assessed using Cochrane's Effective Practice and Organisation of Care criteria. of 653 records identified, eight studies were included-two randomised controlled trials, two interrupted time series analysis studies and four controlled before-after studies. Included studies were mostly at a low risk of bias. Overall, seven studies showed either a statistically significant reduction in the proportion of patients prescribed a potentially inappropriate medicine (PIM) (absolute risk reduction {ARR} 1.3-30.1%), or in PIMs ordered (ARR 2-5.9%). However, there is insufficient evidence thus far to suggest that these interventions can routinely improve patient-related outcomes. It was only possible to include three studies in the meta-analysis-which demonstrated that intervention patients were less likely to be prescribed a PIM (odds ratio 0.6; 95% CI 0.38, 0.93). No computerised intervention targeting potential prescribing omissions (PPOs) was identified. this systematic review concludes that computerised interventions are capable of statistically significantly reducing PIMs in hospitalised older adults. Future interventions should strive to target both PIMs and PPOs, ideally demonstrating both cost-effectiveness data and clinically significant improvements in patient-related outcomes.

Work, Weight, and Wellness: the 3W Program: a worksite obesity prevention and intervention trial.

PubMed

Williams, Andrew E; Vogt, Thomas M; Stevens, Victor J; Albright, Cheryl A; Nigg, Claudio R; Meenan, Richard T; Finucane, Melissa L

2007-11-01

In this paper, we describe the aims, intervention, and design of the Work, Weight, and Wellness program, a group-randomized worksite obesity prevention and intervention trial being conducted at 31 hotels with 11,559 employees on the island of Oahu in Hawaii. We report baseline prevalence of overweight and obesity, and the distribution of BMI (kilograms per meter squared) across sex, race, and job categories. We also describe factors that have influenced intervention adoption and employee participation. The study's primary outcome is change in BMI among hotel employees over a 2-year intervention period. The intervention includes environmental and group components that target diet, physical activity, and weight management. Men, Pacific Islanders, and individuals employed in managerial or facility maintenance roles had higher prevalence of obesity and higher mean BMI than women and individuals from other races or in other occupational categories. These results may be helpful in guiding choices about the adoption or design of future worksite and community interventions addressing at-risk ethnically diverse populations and are especially relevant to the hotel industry and similar industries.

Development of a fully automated, web-based, tailored intervention promoting regular physical activity among insufficiently active adults with type 2 diabetes: integrating the I-change model, self-determination theory, and motivational interviewing components.

PubMed

Moreau, Michel; Gagnon, Marie-Pierre; Boudreau, François

2015-02-17

Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that fewer than half of people with type 2 diabetes in Canada are sufficiently active to meet the recommendations, effective programs targeting the adoption of regular physical activity (PA) are in demand for this population. Many researchers argue that Web-based, tailored interventions targeting PA are a promising and effective avenue for sedentary populations like Canadians with type 2 diabetes, but few have described the detailed development of this kind of intervention. This paper aims to describe the systematic development of the Web-based, tailored intervention, Diabète en Forme, promoting regular aerobic PA among adult Canadian francophones with type 2 diabetes. This paper can be used as a reference for health professionals interested in developing similar interventions. We also explored the integration of theoretical components derived from the I-Change Model, Self-Determination Theory, and Motivational Interviewing, which is a potential path for enhancing the effectiveness of tailored interventions on PA adoption and maintenance. The intervention development was based on the program-planning model for tailored interventions of Kreuter et al. An additional step was added to the model to evaluate the intervention's usability prior to the implementation phase. An 8-week intervention was developed. The key components of the intervention include a self-monitoring tool for PA behavior, a weekly action planning tool, and eight tailored motivational sessions based on attitude, self-efficacy, intention, type of motivation, PA behavior, and other constructs and techniques. Usability evaluation, a step added to the program-planning model, helped to make several improvements to the intervention prior to the implementation phase. The intervention development cost was about CDN $59,700 and took approximately 54 full-time weeks. The intervention officially started on September 29, 2014. Out of 2300 potential participants targeted for the tailored intervention, approximately 530 people visited the website, 170 people completed the registration process, and 83 corresponded to the selection criteria and were enrolled in the intervention. Usability evaluation is an essential step in the development of a Web-based tailored intervention in order to make pre-implementation improvements. The effectiveness and relevance of the theoretical framework used for the intervention will be analyzed following the process and impact evaluation. Implications for future research are discussed.

A culturally appropriate intervention to improve health behaviors in Hispanic mother-child dyads.

PubMed

Bender, Melinda S; Nader, Philip R; Kennedy, Christine; Gahagan, Sheila

2013-04-01

Obesity interventions targeting Hispanic preschool children are still nascent, and few are culturally appropriate. We evaluated the feasibility of a culturally relevant 9-month intervention program to improve health behaviors in low-income Mexican mothers with 3- to 5-year-old children. A community engagement approach was used to culturally and linguistically tailor an intervention program that was pilot tested with 33 mother-child dyads enrolled from a large California urban health center. A one-group, pretest-posttest design assessed changes in children's consumption of sugar-sweetened beverages (SSB), mothers' pedometer steps, and BMI. Data were collected at baseline, postintervention and at 6 months postintervention. At postintervention, SSB consumption had significantly decreased for soda and other sugary drinks with a modest reduction for 100% juice. Consumption of water had significantly increased, whereas milk had an increased trend. Maternal step counts significantly increased for weekdays by 69% and weekend days by 49%. Overall, maternal BMI decreased while children's BMI% remained stable. At 6 months postintervention, children's soda and juice consumption reverted toward baseline levels, as did maternal step counts, but children's consumption of sugary drinks remained lower, while water and milk remained higher. Findings suggest that a culturally relevant intervention was feasible for improving target health behaviors in a low-income Mexican community. Future work should assess an enhanced intervention including a maintenance phase for long-term adherence to health behavior changes and influence on maternal and child BMI.

A Culturally Appropriate Intervention To Improve Health Behaviors in Hispanic Mother–Child Dyads

PubMed Central

Nader, Philip R.; Kennedy, Christine; Gahagan, Sheila

2013-01-01

Abstract Background Obesity interventions targeting Hispanic preschool children are still nascent, and few are culturally appropriate. We evaluated the feasibility of a culturally relevant 9-month intervention program to improve health behaviors in low-income Mexican mothers with 3- to 5-year-old children. Methods A community engagement approach was used to culturally and linguistically tailor an intervention program that was pilot tested with 33 mother–child dyads enrolled from a large California urban health center. A one-group, pretest–posttest design assessed changes in children's consumption of sugar-sweetened beverages (SSB), mothers' pedometer steps, and BMI. Data were collected at baseline, postintervention and at 6 months postintervention. Results At postintervention, SSB consumption had significantly decreased for soda and other sugary drinks with a modest reduction for 100% juice. Consumption of water had significantly increased, whereas milk had an increased trend. Maternal step counts significantly increased for weekdays by 69% and weekend days by 49%. Overall, maternal BMI decreased while children's BMI% remained stable. At 6 months postintervention, children's soda and juice consumption reverted toward baseline levels, as did maternal step counts, but children's consumption of sugary drinks remained lower, while water and milk remained higher. Conclusions Findings suggest that a culturally relevant intervention was feasible for improving target health behaviors in a low-income Mexican community. Future work should assess an enhanced intervention including a maintenance phase for long-term adherence to health behavior changes and influence on maternal and child BMI. PMID:23514697

Mediating mechanisms of a military Web-based alcohol intervention.

PubMed

Williams, Jason; Herman-Stahl, Mindy; Calvin, Sara L; Pemberton, Michael; Bradshaw, Michael

2009-03-01

This study explored the mediating mechanisms of two Web-based alcohol interventions in a sample of active duty United States military personnel. Personnel were recruited from eight bases and received the Drinker's Check-Up (N=1483), Alcohol Savvy (N=688), or served as controls (N=919). The interventions drew on motivational interviewing and social learning theory and targeted multiple mediators including social norms, perceived risks and benefits, readiness to change, and coping strategies. Baseline data were collected prior to the intervention and follow-up data on alcohol consumption were gathered 1 month and 6 months after program completion. Two mediation models were examined: (1) a longitudinal two-wave model with outcomes and mediators assessed concurrently at the 1-month follow-up; and (2) a three-wave model in which the causal chain was fully lagged. Results indicated strong support for the role of perceived descriptive norms in transmitting the effects of the Drinker's Check-Up, with consistent mediation across the majority of alcohol outcome measures for both the concurrent and fully lagged mediation models. These results suggest that web-based interventions that are effective in lowering perceived norms about the frequency and quantity of drinking may be a viable strategy for reducing alcohol consumption in military populations. The results did not support program mediation by the other targeted variables, indicating the need for future research on the effective components of alcohol interventions. The mediation models also suggest reasons why program effects were not found for some outcomes or were different across programs.

In Vivo Biomarkers for Targeting Colorectal Neoplasms

PubMed Central

Hsiung, Pei-Lin; Wang, Thomas

2011-01-01

Summary Colorectal carcinoma continues to be a leading cause of cancer morbidity and mortality despite widespread adoption of screening methods. Targeted detection and therapy using recent advances in our knowledge of in vivo cancer biomarkers promise to significantly improve methods for early detection, risk stratification, and therapeutic intervention. The behavior of molecular targets in transformed tissues is being comprehensively assessed using new techniques of gene expression profiling and high throughput analyses. The identification of promising targets is stimulating the development of novel molecular probes, including significant progress in the field of activatable and peptide probes. These probes are being evaluated in small animal models of colorectal neoplasia and recently in the clinic. Furthermore, innovations in optical imaging instrumentation are resulting in the scaling down of size for endoscope compatibility. Advances in target identification, probe development, and novel instruments are progressing rapidly, and the integration of these technologies has a promising future in molecular medicine. PMID:19126961

Can We Use Neurocognition to Predict Repetition of Self-Harm, and Why Might This Be Clinically Useful? A Perspective

PubMed Central

de Cates, Angharad N.; Broome, Matthew R.

2016-01-01

Over 800,000 people die by suicide each year globally, with non-fatal self-harm 20 times more common. With each episode of self-harm, the risks of future self-harm and suicide increase, as well as personal and healthcare costs. Therefore, early delineation of those at high risk of future self-harm is important. Historically, research has focused on clinical and demographic factors, but risk assessments based on these have low sensitivity to predict repetition. Various neurocognitive factors have been associated with self-harming behavior, but it is less certain if we can use these factors clinically (i) as risk markers to predict future self-harm and (ii) to become therapeutic targets for interventions. Recent systematic reviews and meta-analyses of behavioral tasks and fMRI studies point to an emerging hypothesis for neurocognition in self-harm: an underactive pre-frontal cortex is unable to respond appropriately to non-emotional stimuli, or inhibit a hyperactive emotionally-/threat-driven limbic system. However, there is almost no imaging data examining repetition of self-harm. Extrapolating from the non-repetition data, there may be several potential neurocognitive targets for interventions to prevent repeat self-harm: cognitive training; pharmacological regimes to promote non-emotional neurocognition; or other techniques, such as repetitive transcranial magnetic stimulation. Hence, there is an urgent need for imaging studies examining repetition and to test specific hypotheses. Until we investigate the functional neurocognitive basis underlying repetition of self-harm in a systematic manner using second-generational imaging techniques, we will be unable to inform third-generational imaging and potential future clinical applications. PMID:26858659

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

Luck Is Not a Strategy: Inefficient Coercion In Operation Allied Force

DTIC Science & Technology

2015-12-01

leadership had little idea how to execute coercion. To improve the outcomes of future military interventions, it is essential that the United States...military and political leadership devotes far more resources to strategic planning and analysis instead of hoping that operationally proficient...used to coerce a target state to concede to diplomatic demands, but it also showed that the United States’ military and political leadership had

Reducing myocardial infarct size: challenges and future opportunities

PubMed Central

Bulluck, Heerajnarain; Yellon, Derek M; Hausenloy, Derek J

2016-01-01

Despite prompt reperfusion by primary percutaneous coronary intervention (PPCI), the mortality and morbidity of patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) remain significant with 9% death and 10% heart failure at 1 year. In these patients, one important neglected therapeutic target is ‘myocardial reperfusion injury’, a term given to the cardiomyocyte death and microvascular dysfunction which occurs on reperfusing ischaemic myocardium. A number of cardioprotective therapies (both mechanical and pharmacological), which are known to target myocardial reperfusion injury, have been shown to reduce myocardial infarct (MI) size in small proof-of-concept clinical studies—however, being able to demonstrate improved clinical outcomes has been elusive. In this article, we review the challenges facing clinical cardioprotection research, and highlight future therapies for reducing MI size and preventing heart failure in patients presenting with STEMI at risk of myocardial reperfusion injury. PMID:26674987

What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis.

PubMed

Lawrenson, John G; Graham-Rowe, Ella; Lorencatto, Fabiana; Rice, Stephen; Bunce, Catey; Francis, Jill J; Burr, Jennifer M; Aluko, Patricia; Vale, Luke; Peto, Tunde; Presseau, Justin; Ivers, Noah M; Grimshaw, Jeremy M

2018-05-01

Diabetic retinopathy screening (DRS) is effective but uptake is suboptimal. To determine the effectiveness of quality improvement (QI) interventions for DRS attendance; describe the interventions in terms of QI components and behaviour change techniques (BCTs); identify theoretical determinants of attendance; investigate coherence between BCTs identified in interventions and determinants of attendance; and determine the cost-effectiveness of QI components and BCTs for improving DRS. Phase 1 - systematic review of randomised controlled trials (RCTs) evaluating interventions to increase DRS attendance (The Cochrane Library, MEDLINE, EMBASE and trials registers to February 2017) and coding intervention content to classify QI components and BCTs. Phase 2 - review of studies reporting factors influencing attendance, coded to theoretical domains (MEDLINE, EMBASE, PsycINFO and sources of grey literature to March 2016). Phase 3 - mapping BCTs (phase 1) to theoretical domains (phase 2) and an economic evaluation to determine the cost-effectiveness of BCTs or QI components. Phase 1 - 7277 studies were screened, of which 66 RCTs were included in the review. Interventions were multifaceted and targeted patients, health-care professionals (HCPs) or health-care systems. Overall, interventions increased DRS attendance by 12% [risk difference (RD) 0.12, 95% confidence interval (CI) 0.10 to 0.14] compared with usual care, with substantial heterogeneity in effect size. Both DRS-targeted and general QI interventions were effective, particularly when baseline attendance levels were low. All commonly used QI components and BCTs were associated with significant improvements, particularly in those with poor attendance. Higher effect estimates were observed in subgroup analyses for the BCTs of 'goal setting (outcome, i.e. consequences)' (RD 0.26, 95% CI 0.16 to 0.36) and 'feedback on outcomes (consequences) of behaviour' (RD 0.22, 95% CI 0.15 to 0.29) in interventions targeting patients and of 'restructuring the social environment' (RD 0.19, 95% CI 0.12 to 0.26) and 'credible source' (RD 0.16, 95% CI 0.08 to 0.24) in interventions targeting HCPs. Phase 2 - 3457 studies were screened, of which 65 non-randomised studies were included in the review. The following theoretical domains were likely to influence attendance: 'environmental context and resources', 'social influences', 'knowledge', 'memory, attention and decision processes', 'beliefs about consequences' and 'emotions'. Phase 3 - mapping identified that interventions included BCTs targeting important barriers to/enablers of DRS attendance. However, BCTs targeting emotional factors around DRS were under-represented. QI components were unlikely to be cost-effective whereas BCTs with a high probability (≥ 0.975) of being cost-effective at a societal willingness-to-pay threshold of £20,000 per QALY included 'goal-setting (outcome)', 'feedback on outcomes of behaviour', 'social support' and 'information about health consequences'. Cost-effectiveness increased when DRS attendance was lower and with longer screening intervals. Quality improvement/BCT coding was dependent on descriptions of intervention content in primary sources; methods for the identification of coherence of BCTs require improvement. Randomised controlled trial evidence indicates that QI interventions incorporating specific BCT components are associated with meaningful improvements in DRS attendance compared with usual care. Interventions generally used appropriate BCTs that target important barriers to screening attendance, with a high probability of being cost-effective. Research is needed to optimise BCTs or BCT combinations that seek to improve DRS attendance at an acceptable cost. BCTs targeting emotional factors represent a missed opportunity to improve attendance and should be tested in future studies. This study is registered as PROSPERO CRD42016044157 and PROSPERO CRD42016032990. The National Institute for Health Research Health Technology Assessment programme.

Patient decision making: strategies for diabetes diet adherence intervention.

PubMed

Kavookjian, Jan; Berger, Bruce A; Grimley, Diane M; Villaume, William A; Anderson, Heidi M; Barker, Kenneth N

2005-09-01

Patient self-care is critical in controlling diabetes and its complications. Lack of diet adherence is a particular challenge to effective diabetes intervention. The Transtheoretical Model (TTM) of Change, decision-making theory, and self-efficacy have contributed to successful tailoring of interventions in many target behaviors. The purpose of this study was to develop a diagnostic tool, including TTM measures for the stages of change, decisional balance, and self-efficacy, that pharmacists involved in diabetes intervention can use for patients resistant to a diet regimen. A questionnaire was developed through a literature review, interviews with diabetic patients, an expert panel input, and pretesting. Cross-sectional implementation of the questionnaire among a convenience sample of 193 type 1 and type 2 diabetic patients took place at 4 patient care sites throughout the southeastern United States. Validated measures were used to collect respondent self-report for the TTM variables and for demographic and diabetes history variables. Social desirability was also assessed. Relationships among TTM measures for diet adherence generally replicated those established for other target behaviors. Salient items were identified as potential facilitators (decisional balance pros) or barriers (decisional balance cons and self-efficacy tempting situations) to change. Social desirability exhibited a statistically significant relationship with patient report of diet adherence, with statistically significant differences in mean social desirability across race categories. The TTM measures for the stages of change, decisional balance, and self-efficacy are useful for making decisions on individually tailored interventions for diet adherence, with caution asserted about the potential of diabetes patients to self-report the target behavior in a socially desirable manner. Future research directions, implications, and limitations of the findings are also presented.

Predicting Health Resilience in Pediatric Type 1 Diabetes: A Test of the Resilience Model Framework

PubMed Central

Huang, Bin; Pendley, Jennifer Shroff; Delamater, Alan; Dolan, Lawrence; Reeves, Grafton; Drotar, Dennis

2015-01-01

Objectives This research examined whether individual and family-level factors during the transition from late childhood to early adolescence protected individuals from an increased risk of poor glycemic control across time, which is a predictor of future diabetes-related complications (i.e., health resilience). Methods This longitudinal, multisite study included 239 patients with type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c. Individual and family-level factors included: demographic variables, youth behavioral regulation, adherence (frequency of blood glucose monitoring), diabetes self-management, level of parental support for diabetes autonomy, level of youth mastery and responsibility for diabetes management, and diabetes-related family conflict. Results Longitudinal mixed-effects logistic regression indicated that testing blood glucose more frequently, better self-management, and less diabetes-related family conflict were indicators of health resilience. Conclusions Multiple individual and family-level factors predicted risk for future health complications. Future research should develop interventions targeting specific individual and family-level factors to sustain glycemic control within recommended targets, which reduces the risk of developing future health complications during the transition to adolescence and adulthood. PMID:26152400

Pandemic controllability: a concept to guide a proportionate and flexible operational response to future influenza pandemics.

PubMed

McCaw, J M; Glass, K; Mercer, G N; McVernon, J

2014-03-01

The 2009 H1N1 influenza pandemic posed challenges for governments worldwide. Strategies designed to limit community transmission, such as antiviral deployment, were largely ineffective due to both feasibility constraints and the generally mild nature of disease, resulting in incomplete case ascertainment. Reviews of national pandemic plans have identified pandemic impact, primarily linked to measures of transmissibility and severity, as a key concept to incorporate into the next generation of plans. While an assessment of impact provides the rationale under which interventions may be warranted, it does not directly provide an assessment on whether particular interventions may be effective. Such considerations motivate our introduction of the concept of pandemic controllability. For case-targeted interventions, such as antiviral treatment and post-exposure prophylaxis, we identify the visibility and transmissibility of a pandemic as the key drivers of controllability. Taking a case-study approach, we suggest that high-impact pandemics, for which control is most desirable, are likely uncontrollable with case-targeted interventions. Strategies that do not rely on the identification of cases may prove relatively more effective. By introducing a pragmatic framework for relating the assessment of impact to the ability to mitigate an epidemic (controllability), we hope to address a present omission identified in pandemic response plans.

Development of a Fully Automated, Web-Based, Tailored Intervention Promoting Regular Physical Activity Among Insufficiently Active Adults With Type 2 Diabetes: Integrating the I-Change Model, Self-Determination Theory, and Motivational Interviewing Components

PubMed Central

Moreau, Michel; Gagnon, Marie-Pierre

2015-01-01

Background Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that fewer than half of people with type 2 diabetes in Canada are sufficiently active to meet the recommendations, effective programs targeting the adoption of regular physical activity (PA) are in demand for this population. Many researchers argue that Web-based, tailored interventions targeting PA are a promising and effective avenue for sedentary populations like Canadians with type 2 diabetes, but few have described the detailed development of this kind of intervention. Objective This paper aims to describe the systematic development of the Web-based, tailored intervention, Diabète en Forme, promoting regular aerobic PA among adult Canadian francophones with type 2 diabetes. This paper can be used as a reference for health professionals interested in developing similar interventions. We also explored the integration of theoretical components derived from the I-Change Model, Self-Determination Theory, and Motivational Interviewing, which is a potential path for enhancing the effectiveness of tailored interventions on PA adoption and maintenance. Methods The intervention development was based on the program-planning model for tailored interventions of Kreuter et al. An additional step was added to the model to evaluate the intervention’s usability prior to the implementation phase. An 8-week intervention was developed. The key components of the intervention include a self-monitoring tool for PA behavior, a weekly action planning tool, and eight tailored motivational sessions based on attitude, self-efficacy, intention, type of motivation, PA behavior, and other constructs and techniques. Usability evaluation, a step added to the program-planning model, helped to make several improvements to the intervention prior to the implementation phase. Results The intervention development cost was about CDN $59,700 and took approximately 54 full-time weeks. The intervention officially started on September 29, 2014. Out of 2300 potential participants targeted for the tailored intervention, approximately 530 people visited the website, 170 people completed the registration process, and 83 corresponded to the selection criteria and were enrolled in the intervention. Conclusions Usability evaluation is an essential step in the development of a Web-based tailored intervention in order to make pre-implementation improvements. The effectiveness and relevance of the theoretical framework used for the intervention will be analyzed following the process and impact evaluation. Implications for future research are discussed. PMID:25691346

Molecular biology of anal squamous cell carcinoma: implications for future research and clinical intervention.

PubMed

Bernardi, Maria-Pia; Ngan, Samuel Y; Michael, Michael; Lynch, A Craig; Heriot, Alexander G; Ramsay, Robert G; Phillips, Wayne A

2015-12-01

Anal squamous cell carcinoma is a human papillomavirus-related disease, in which no substantial advances in treatment have been made in over 40 years, especially for those patients who develop disease relapse and for whom no surgical options exist. HPV can evade the immune system and its role in disease progression can be exploited in novel immunotherapy platforms. Although several studies have investigated the expression and inactivation (through loss of heterozygosity) of tumour suppressor genes in the pathways to cancer, no clinically valuable biomarkers have emerged. Regulators of apoptosis, including survivin, and agents targeting the PI3K/AKT pathway, offer opportunities for targeted therapy, although robust data are scarce. Additionally, antibody therapy targeting EGFR may prove effective, although its safety profile in combination with standard chemoradiotherapy has proven to be suboptimal. Finally, progress in the treatment of anal cancer has remained stagnant due to a lack of preclinical models, including cell lines and mouse models. In this Review, we discuss the molecular biology of anal squamous cell carcinoma, clinical trials in progress, and implications for novel therapeutic targets. Future work should focus on preclinical models to provide a resource for investigation of new molecular pathways and for testing novel targets. Copyright © 2015 Elsevier Ltd. 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.

Using the Intervention Mapping and Behavioral Intervention Technology Frameworks: Development of an mHealth Intervention for Physical Activity and Sedentary Behavior Change.

PubMed

Direito, Artur; Walsh, Deirdre; Hinbarji, Moohamad; Albatal, Rami; Tooley, Mark; Whittaker, Robyn; Maddison, Ralph

2018-06-01

Few interventions to promote physical activity (PA) adapt dynamically to changes in individuals' behavior. Interventions targeting determinants of behavior are linked with increased effectiveness and should reflect changes in behavior over time. This article describes the application of two frameworks to assist the development of an adaptive evidence-based smartphone-delivered intervention aimed at influencing PA and sedentary behaviors (SB). Intervention mapping was used to identify the determinants influencing uptake of PA and optimal behavior change techniques (BCTs). Behavioral intervention technology was used to translate and operationalize the BCTs and its modes of delivery. The intervention was based on the integrated behavior change model, focused on nine determinants, consisted of 33 BCTs, and included three main components: (1) automated capture of daily PA and SB via an existing smartphone application, (2) classification of the individual into an activity profile according to their PA and SB, and (3) behavior change content delivery in a dynamic fashion via a proof-of-concept application. This article illustrates how two complementary frameworks can be used to guide the development of a mobile health behavior change program. This approach can guide the development of future mHealth programs.

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

A cluster-randomized controlled trial evaluating the effects of delaying onset of adolescent substance abuse on cognitive development and addiction following a selective, personality-targeted intervention programme: the Co-Venture trial.

PubMed

O'Leary-Barrett, Maeve; Mâsse, Benoit; Pihl, Robert O; Stewart, Sherry H; Séguin, Jean R; Conrod, Patricia J

2017-10-01

Substance use and binge drinking during early adolescence are associated with neurocognitive abnormalities, mental health problems and an increased risk for future addiction. The trial aims to evaluate the protective effects of an evidence-based substance use prevention programme on the onset of alcohol and drug use in adolescence, as well as on cognitive, mental health and addiction outcomes over 5 years. Thirty-eight high schools will be recruited, with a final sample of 31 schools assigned to intervention or control conditions (3826 youth). Brief personality-targeted interventions will be delivered to high-risk youth attending intervention schools during the first year of the trial. Control school participants will receive no intervention above what is offered to them in the regular curriculum by their respective schools. Public/private French and English high schools in Montreal (Canada). All grade 7 students (12-13 years old) will be invited to participate. High-risk youth will be identified as those scoring one standard deviation or more above the school mean on one of the four personality subscales of the Substance Use Risk Profile Scale (40-45% youth). Self-reported substance use and mental health symptoms and cognitive functioning measured annually throughout 5 years. Primary outcomes are the onset of substance use disorders at 4 years post-intervention (year 5). Secondary intermediate outcomes are the onset of alcohol and substance use 2 years post-intervention and neuropsychological functions; namely, the protective effects of substance use prevention on cognitive functions generally, and executive functions and reward sensitivity specifically. This longitudinal, cluster-randomized controlled trial will investigate the impact of a brief personality-targeted intervention program on reducing the onset of addiction 4 years-post intervention. Results will tease apart the developmental sequences of uptake and growth in substance use and cognitive development in adolescence using developmentally sensitive neuropsychological measures. © 2017 Society for the Study of Addiction.

Structured representation for core elements of common clinical decision support interventions to facilitate knowledge sharing.

PubMed

Zhou, Li; Hongsermeier, Tonya; Boxwala, Aziz; Lewis, Janet; Kawamoto, Kensaku; Maviglia, Saverio; Gentile, Douglas; Teich, Jonathan M; Rocha, Roberto; Bell, Douglas; Middleton, Blackford

2013-01-01

At present, there are no widely accepted, standard approaches for representing computer-based clinical decision support (CDS) intervention types and their structural components. This study aimed to identify key requirements for the representation of five widely utilized CDS intervention types: alerts and reminders, order sets, infobuttons, documentation templates/forms, and relevant data presentation. An XML schema was proposed for representing these interventions and their core structural elements (e.g., general metadata, applicable clinical scenarios, CDS inputs, CDS outputs, and CDS logic) in a shareable manner. The schema was validated by building CDS artifacts for 22 different interventions, targeted toward guidelines and clinical conditions called for in the 2011 Meaningful Use criteria. Custom style sheets were developed to render the XML files in human-readable form. The CDS knowledge artifacts were shared via a public web portal. Our experience also identifies gaps in existing standards and informs future development of standards for CDS knowledge representation and sharing.

Managing Loss and Change: Grief Interventions for Dementia Caregivers in a CBT-Based Trial.

PubMed

Meichsner, Franziska; Schinköthe, Denise; Wilz, Gabriele

2016-05-01

Dementia caregivers often experience loss and grief related to general caregiver burden, physical, and mental health problems. Through qualitative content analysis, this study analyzed intervention strategies applied by therapists in a randomized-controlled trial in Germany to assist caregivers in managing losses and associated emotions. Sequences from 61 therapy sessions that included interventions targeting grief, loss, and change were transcribed and analyzed. A category system was developed deductively, and the intercoder reliability was satisfactory. The identified grief intervention strategies were recognition and acceptance of loss and change,addressing future losses,normalization of grief, and redefinition of the relationship Therapists focused on identifying experienced losses, managing associated feelings, and fostering acceptance of these losses. A variety of cognitive-behavioral therapy-based techniques was applied with each strategy. The findings contribute to understanding how dementia caregivers can be supported in their experience of grief and facilitate the development of a manualized grief intervention. © The Author(s) 2015.

Management of bipolar disorders in women by nonpharmacological methods

PubMed Central

Naik, Sujit Kumar

2015-01-01

Several reasons justify the need for nonpharmacological interventions for bipolar disorder (BD) in women. This review focuses on psychosocial therapies for BDs in women. The research evidence for a wide range of psychosocial interventions for the management of BDs in women has been presented. All the interventions have some common components like targeting disease management, information regarding illness, and coping skills. There also are distinctive features like cognitive restructuring and self-rated mood charts in cognitive behavior therapy, regulation of sleep/wake cycles and daily routines in interpersonal sleep regulation therapy, and communication skill training in family treatments. Many psychosocial interventions hold promise as adjunctive therapies for bipolar patients. In India, there is a considerable dearth of literature in this area due lack of skilled staff for psychosocial interventions. Future trials need to: Clarify which populations are most likely to benefit from which strategies; identify putative mechanisms of action; systematically evaluate costs, benefits, and generalizability of effects, and record adverse effects. PMID:26330644

Transmission-blocking interventions eliminate malaria from laboratory populations

PubMed Central

Blagborough, A. M.; Churcher, T. S.; Upton, L. M.; Ghani, A. C.; Gething, P. W.; Sinden, R. E.

2013-01-01

Transmission-blocking interventions aim to reduce the prevalence of infection in endemic communities by targeting Plasmodium within the insect host. Although many studies have reported the successful reduction of infection in the mosquito vector, direct evidence that there is an onward reduction in infection in the vertebrate host is lacking. Here we report the first experiments using a population, transmission-based study of Plasmodium berghei in Anopheles stephensi to assess the impact of a transmission-blocking drug upon both insect and host populations over multiple transmission cycles. We demonstrate that the selected transmission-blocking intervention, which inhibits transmission from vertebrate to insect by only 32%, reduces the basic reproduction number of the parasite by 20%, and in our model system can eliminate Plasmodium from mosquito and mouse populations at low transmission intensities. These findings clearly demonstrate that use of transmission-blocking interventions alone can eliminate Plasmodium from a vertebrate population, and have significant implications for the future design and implementation of transmission-blocking interventions within the field. PMID:23652000

Reducing Clinical Inertia in Hypertension Treatment: a Pragmatic Randomized Controlled Trial

PubMed Central

Huebschmann, Amy G.; Mizrahi, Trina; Soenksen, Alyssa; Beaty, Brenda L.; Denberg, Thomas D.

2012-01-01

Clinical inertia is a major contributor to poor blood pressure (BP) control. We tested the effectiveness of an intervention targeting physician, patient, and office system factors with regard to outcomes of clinical inertia and BP control. We randomized 591 adult primary care patients with elevated BP (mean systolic BP ≥140 or mean diastolic BP ≥90 mm Hg) to intervention or usual care. An outreach coordinator raised patient and provider awareness of unmet BP goals, arranged BP-focused primary care clinic visits, and furnished providers with treatment decision support. The intervention reduced clinical inertia (−29% vs. −11%, p=0.001). Nonetheless, ΔBP did not differ between intervention and usual care (−10.1/−4.1 vs. −9.1/−4.5 mm Hg, p = 0.50 and 0.71 for systolic and diastolic BP, respectively). Future primary care-focused interventions might benefit from the use of specific medication titration protocols, treatment adherence support, and more sustained patient follow-up visits. PMID:22533659

Testing three pathways to substance use and delinquency among low-income African American adolescents☆

PubMed Central

Marotta, Phillip L.; Voisin, Dexter R.

2017-01-01

Objective Mounting literature suggests that parental monitoring, risky peer norms, and future orientation correlate with illicit drug use and delinquency. However, few studies have investigated these constructs simultaneously in a single statistical model with low income African American youth. This study examined parental monitoring, peer norms and future orientation as primary pathways to drug use and delinquent behaviors in a large sample of African American urban adolescents. Methods A path model tested direct paths from peer norms, parental monitoring, and future orientation to drug use and delinquency outcomes after adjusting for potential confounders such as age, socioeconomic, and sexual orientation in a sample of 541 African American youth. Results Greater scores on measures of risky peer norms were associated with heightened risk of delinquency with an effect size that was twice in magnitude compared to the protective effects of future orientation. Regarding substance use, greater perceived risky peer norms correlated with the increased likelihood of substance use with a standardized effect size 3.33 times in magnitude compared to the protective effects of parental monitoring. Conclusions Findings from this study suggest that interventions targeting risky peer norms among adolescent African American youth may correlate with a greater impact on reductions in substance use and delinquency than exclusively targeting parental monitoring or future orientation. PMID:28974824

Testing three pathways to substance use and delinquency among low-income African American adolescents.

PubMed

Marotta, Phillip L; Voisin, Dexter R

2017-04-01

Mounting literature suggests that parental monitoring, risky peer norms, and future orientation correlate with illicit drug use and delinquency. However, few studies have investigated these constructs simultaneously in a single statistical model with low income African American youth. This study examined parental monitoring, peer norms and future orientation as primary pathways to drug use and delinquent behaviors in a large sample of African American urban adolescents. A path model tested direct paths from peer norms, parental monitoring, and future orientation to drug use and delinquency outcomes after adjusting for potential confounders such as age, socioeconomic, and sexual orientation in a sample of 541 African American youth. Greater scores on measures of risky peer norms were associated with heightened risk of delinquency with an effect size that was twice in magnitude compared to the protective effects of future orientation. Regarding substance use, greater perceived risky peer norms correlated with the increased likelihood of substance use with a standardized effect size 3.33 times in magnitude compared to the protective effects of parental monitoring. Findings from this study suggest that interventions targeting risky peer norms among adolescent African American youth may correlate with a greater impact on reductions in substance use and delinquency than exclusively targeting parental monitoring or future orientation.

Optimizing psychosocial interventions in first-episode psychosis: current perspectives and future directions.

PubMed

Breitborde, Nicholas Jk; Moe, Aubrey M; Ered, Arielle; Ellman, Lauren M; Bell, Emily K

2017-01-01

Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychotic-spectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis.

Spanish-Language Consumer Health Information Technology Interventions: A Systematic Review

PubMed Central

Chaet, Alexis V; Morshedi, Bijan; Wells, Kristen J; Barnes, Laura E

2016-01-01

Background As consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions. Objective Our aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics. Methods A narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author’s last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics. Results We included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the most common health domains targeted by consumer health IT interventions. More than half of the interventions were culturally tailored. The most frequently used evaluation metric was behavior/attitude change, followed by usability and knowledge retention. Conclusions This study characterizes the existing body of research exploring consumer health IT interventions for the US Spanish-speaking Latino population. In doing so, it reveals three primary needs within the field. First, while the increase in studies targeting the Latino population in the last decade is a promising advancement, future research is needed that focuses on Latino subpopulations previously overlooked. Second, preliminary steps have been taken to culturally tailor consumer health IT interventions for the US Spanish-speaking Latino population; however, focus must expand beyond intervention content. Finally, the field should work to promote long-term evaluation of technology efficacy, moving beyond intermediary measures toward measures of health outcomes. PMID:27511437

Mediators of improved child diet quality following a health promotion intervention: the Melbourne InFANT Program.

PubMed

Spence, Alison C; Campbell, Karen J; Crawford, David A; McNaughton, Sarah A; Hesketh, Kylie D

2014-11-04

Young children's diets are currently suboptimal. Given that mothers have a critical influence on children' diets, they are typically a target of interventions to improve early childhood nutrition. Understanding the maternal factors which mediate an intervention's effect on young children's diets is important, but has not been well investigated. This research aimed to test whether maternal feeding knowledge, maternal feeding practices, maternal self-efficacy, and maternal dietary intakes acted as mediators of the effect of an intervention to improve child diet quality. The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a cluster-randomized controlled trial, conducted from 2008-2010. This novel, low-dose, health promotion intervention was delivered quarterly over 15 months and involved educational activities, promotion of peer discussion, a DVD and written materials. Post-intervention, when children were approximately 18 months of age, child diets were assessed using multiple 24-hour recalls and a purpose-developed index of diet quality, the Obesity Protective Dietary Index. Maternal mediators were assessed using a combination of previously validated and purpose-deigned tools. Mediation analysis was conducted using the test of joint significance and difference of coefficients methods. Across 62 parents' groups in Melbourne, Australia, 542 parents were recruited. Post- intervention, higher maternal feeding knowledge and lower use of foods as rewards was found to mediate the direct intervention effect on child diet quality. While other aspects of maternal feeding practices, self-efficacy and dietary intakes did not act as mediators, they were associated with child diet quality. Mediation analysis of this novel health promotion intervention showed the importance of maternal feeding knowledge and use of foods as rewards in impacting child diet quality. The other maternal factors assessed were appropriate targets but further research on how to impact these in an intervention is important. This evidence of intervention efficacy and mediation provides important insights for planning future interventions. Current Controlled Trials ISRCTN81847050, registered 23 November 2007.

Target population's requirements on a community-based intervention for stimulating physical activity in hard-to-reach physically disabled people: an interview study.

PubMed

Krops, Leonie A; Folkertsma, Nienke; Hols, Doortje H J; Geertzen, Jan H B; Dijkstra, Pieter U; Dekker, Rienk

2018-05-31

To explore ideas of the target population about a community-based intervention to stimulate physical activity in hard-to-reach physically disabled people. Semi-structured interviews were performed with 21 physically disabled people, and analyzed using thematic analyses. Findings were interpreted using the integrated Physical Activity for People with a Disability and Intervention Mapping model. The intervention should aim to stimulate intrinsic motivation and raise awareness for the health effects of physical activity. It should provide diverse activities, increase visibility of these activities, and improve image of physical activity for physically disabled people. Participants suggested to provide individual coaching sessions, increase marketing, present role models, and assign buddies. Potential users should be approached personally through intermediate organizations, or via social media and word of mouth promotion. Participants suggested that users, government, sponsors, and health insurers should finance the intervention. Self-responsibility for being physically active was strongly emphasized by participants. An intervention to stimulate physical activity in hard-to-reach physically disabled people should be individualized, include personal support, and should include marketing to improve image of physical activity of physically disabled people. The intervention that fulfills these requirements should be developed and tested for effects in future research. Implications for rehabilitation An intervention to stimulate physical activity in physically disabled people should aim to raise awareness for the health effects of physical activity, stimulate intrinsic motivation, offer diverse activities, increase the visibility of the possible activities, and improve the image of physical activity for physically disabled people. An intervention should include both individual- and environmental-level intervention methods. Physically disabled people most emphasized individual-level characteristics of an intervention. For intervention development, professionals should take into account that physically disabled people believe that being physically active is a person's own responsibility.

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.

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.

The Behavior Education Support and Treatment (BEST) school intervention program: pilot project data examining schoolwide, targeted-school, and targeted-home approaches.

PubMed

Waschbusch, Daniel A; Pelham, William E; Massetti, Greta

2005-08-01

As part of a pilot project, four elementary schools were randomly assigned to receive one of four interventions: (a) a schoolwide intervention that incorporated universal and targeted treatment, (b) a targeted-school intervention delivered to individual students in regular and special education classrooms, (c) a targeted-home intervention delivered in home and regular classroom settings, and (d) a control condition that did not receive a designated intervention. Results showed that the behavior of disruptive children in all schools improved during the course of the year, with some evidence that interventions provided complementary effects. These findings support the continued use of behavioral interventions in elementary schools and argue for interventions that combine different methods of delivering interventions.

Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized control trial

PubMed Central

Latham, Nancy K.; Ni, Pengsheng; Jette, Alan M.

2015-01-01

Objectives This study examined whether self-efficacy mediated the effect of the HIP Rehab exercise program on activity limitations in older adults after hip fracture, and whether the mediation effect was different between different gender and age groups. Design Randomized controlled trial (RCT) Setting Community Participants Two hundred and thirty two participants aged 79±9.4 years with hip fracture were randomly assigned to intervention (n=120) or attention control (n=112) groups. Interventions The 6-month intervention, the HIP Rehab, is a functionally-oriented, home-based exercise program. Data was collected at baseline, post-intervention (6 months), and follow-up (9 months). Main outcome measure Activity Measure for Post-Acute Care (AM-PAC) Results The mediation effect of the HIP Rehab exercise program on Basic Mobility function through self-efficacy for exercise was significant at 9 months (βindirect=0.21). Similarly, the mediation effect of the intervention on Daily Activity function through self-efficacy for exercise was significant at 9 months (βindirect=0.49). In subgroup analyses, the mediation effect was significant at 9 months in the younger group (≤79 years old) in comparison to the older group, and was significant in females in comparison to males. Conclusion Self-efficacy may play a partial mediating role for the effect on some longer-term functional outcomes in the HIP Rehab intervention. The results suggest that program components that target self-efficacy should be incorporated in the future hip fracture rehabilitation interventions. Age and gender of the targeted participants may also need to be considered when developing interventions. PMID:25701101

Evaluating the sustainability, scalability, and replicability of an STH transmission interruption intervention: The DeWorm3 implementation science protocol.

PubMed

Means, Arianna Rubin; Ajjampur, Sitara S R; Bailey, Robin; Galactionova, Katya; Gwayi-Chore, Marie-Claire; Halliday, Katherine; Ibikounle, Moudachirou; Juvekar, Sanjay; Kalua, Khumbo; Kang, Gagandeep; Lele, Pallavi; Luty, Adrian J F; Pullan, Rachel; Sarkar, Rajiv; Schär, Fabian; Tediosi, Fabrizio; Weiner, Bryan J; Yard, Elodie; Walson, Judd

2018-01-01

Hybrid trials that include both clinical and implementation science outcomes are increasingly relevant for public health researchers that aim to rapidly translate study findings into evidence-based practice. The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions. The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. DeWorm3 will use stakeholder mapping to identify individuals who influence or are influenced by school-based or community-wide mass drug administration (MDA) for STH and to evaluate network dynamics that may affect study outcomes and future policy development. Individual interviews and focus groups will generate the qualitative data needed to identify factors that shape, contextualize, and explain DeWorm3 trial outputs and outcomes. Structural readiness surveys will be used to evaluate the factors that drive health system readiness to implement novel interventions, such as community-wide MDA for STH, in order to target change management activities and identify opportunities for sustaining or scaling the intervention. Process mapping will be used to understand what aspects of the intervention are adaptable across heterogeneous implementation settings and to identify contextually-relevant modifiable bottlenecks that may be addressed to improve the intervention delivery process and to achieve intervention outputs. Lastly, intervention costs and incremental cost-effectiveness will be evaluated to compare the efficiency of community-wide MDA to standard-of-care targeted MDA both over the duration of the trial and over a longer elimination time horizon.

Systematic reviews: causes of non-adherence to P2Y12 inhibitors in acute coronary syndromes and response to intervention

PubMed Central

Weinman, John; Ashworth, Lucy; Smethurst, Peter; El Khoury, Jad; Moloney, Clare

2016-01-01

To understand the factors associated with non-adherence to oral antiplatelet (OAP) therapy in acute coronary syndromes (ACS), and where interventions have modified these factors. Linked systematic reviews were undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines, using CINAHL Plus, MEDLINE, PsycINFO and PubMed databases. The searches were limited to studies available in English and published from 2000 onwards; last run in June 2015. Review 1: factors. Fifteen articles were identified that reported 25 different factors associated with OAP non-adherence. Factors were categorised into: Demographic, Treatment, Healthcare System Processes, Clinical, Opportunity (ie, factors outside the patients, such as cost and healthcare access) and Psychosocial. It was not possible to determine if any of these factors were more impactful than others, either overall or temporally. Review 2: interventions. Six articles were identified that described interventions targeting adherence in patients with acute coronary syndromes (ACS)/coronary artery disease (CAD). Four broad categories of intervention were identified: treatment counselling and education, educational materials, SMS reminders and telephone monitoring and reinforcement delivered different practitioners. Only reminder-based interventions had a consistently successful impact on adherence outcomes at both 3 and 12 months. A number of factors are associated with OAP non-adherence, and encouragingly, there is some evidence of the effectiveness of intervention to modify treatment adherence in patients with ACS/CAD. Future evaluations ensuring a better cohesion between the factors studied as associated with non-adherence and those targeted by intervention would further increase understanding and lead to improved results. PMID:27843565

Animal Models, Learning Lessons to Prevent and Treat Neonatal Chronic Lung Disease

PubMed Central

Jobe, Alan H.

2015-01-01

Bronchopulmonary dysplasia (BPD) is a unique injury syndrome caused by prolonged injury and repair imposed on an immature and developing lung. The decreased septation and decreased microvascular development phenotype of BPD can be reproduced in newborn rodents with increased chronic oxygen exposure and in premature primates and sheep with oxygen and/or mechanical ventilation. The inflammation caused by oxidants, inflammatory agonists, and/or stretch injury from mechanical ventilation seems to promote the anatomic abnormalities. Multiple interventions targeted to specific inflammatory cells or pathways or targeted to decreasing ventilation-mediated injury can substantially prevent the anatomic changes associated with BPD in term rodents and in preterm sheep or primate models. Most of the anti-inflammatory therapies with benefit in animal models have not been tested clinically. None of the interventions that have been tested clinically are as effective as anticipated from the animal models. These inconsistencies in responses likely are explained by the antenatal differences in lung exposures of the developing animals relative to very preterm humans. The animals generally have normal lungs while the lungs of preterm infants are exposed variably to intrauterine inflammation, growth abnormalities, antenatal corticosteroids, and poorly understood effects from the causes of preterm delivery. The animal models have been essential for the definition of the mediators that can cause a BPD phenotype. These models will be necessary to develop and test future-targeted interventions to prevent and treat BPD. PMID:26301222

Mediators of the effect of the JUMP-in intervention on physical activity and sedentary behavior in Dutch primary schoolchildren from disadvantaged neighborhoods

PubMed Central

2012-01-01

Background Important health benefits can be achieved when physical activity in children from low socio-economic status is promoted and sedentariness is limited. By specifying the mediating mechanisms of existing interventions one can improve future physical activity interventions. This study explored potential mediators of the long-term effect of the school-based multicomponent JUMP-in intervention on sport participation, outdoor play and screen time in Dutch primary schoolchildren from disadvantaged neighborhoods. Methods In total, 600 primary schoolchildren (aged 9.8 ± 0.7, 51% girls, 13% Dutch ethnicity, 35% overweight) from 9 intervention and 10 control schools were included in the analyses. JUMP-in was developed using Intervention Mapping, and targeted psychological and environmental determinants of physical activity. Outcome behaviors were self-reported sport participation, outdoor play, TV-viewing behavior and computer use. Potential mediators were self-reported psychological, social and physical environmental factors. Results JUMP-in was effective in improving sport participation after 20 months, but not in improving outdoor play, or reducing TV-viewing or computer time. JUMP-in was not effective in changing hypothesized mediators so no significant mediated effects could be identified. However, changes in self-efficacy, social support and habit strength were positively associated with changes in sport participation, and changes in social support, self-efficacy, perceived planning skills, enjoyment and habit strength were positively associated with changes in outdoor play. Changes in enjoyment was positively associated with changes in TV-viewing while parental rules were negatively associated. Having a computer in the bedroom and enjoyment were positively associated with changes in computer use, while changes in parental rules were negatively associated. Conclusions Besides a significant positive effect on sports participation, no significant intervention effect on outdoor play, screen time or any of the potential mediators was found. This suggest that other (unmeasured) factors operated as mediating mechanisms of the intervention, that we used unsuccessful intervention strategies, that the strategies were inappropriately implemented, or that children are unable to accurately recall past activities and cognitions. Additionally, the school setting might not be the sole channel to influence leisure time activities. Still, several personal and environmental constructs were found to be relevant in predicting change in sport participation, outdoor play and screen behavior and seem to be potential mediators. Future interventions are recommended including more effective strategies targeting these relevant constructs, addressing different constructs (e.g. pedagogic skills of parents), and focusing on different implementation settings. Trail registration ISRCTN17489378 PMID:23130806

Interventions to Reduce College Student Drinking: State of the Evidence for Mechanisms of Behavior Change

PubMed Central

Reid, Allecia E.; Carey, Kate B.

2015-01-01

Interventions to reduce college student drinking, although efficacious, generally yield only small effects on behavior change. Examining mechanisms of change may help to improve the magnitude of intervention effects by identifying effective and ineffective active ingredients. Informed by guidelines for establishing mechanisms of change, we conducted a systematic review of alcohol interventions for college students to identify (a) which constructs have been examined and received support as mediators, (b) circumstances that enhance the likelihood of detecting mediation, and (c) the extent of evidence for mechanisms of change. We identified 61 trials that examined 22 potential mediators of intervention efficacy. Descriptive norms consistently mediated normative feedback interventions. Motivation to change consistently failed to mediate motivational interviewing interventions. Multiple active ingredient interventions were not substantially more likely to find evidence of mediation than single ingredient interventions. Delivering intervention content remotely reduced likelihood of finding support for mediation. With the exception of descriptive norms, there is inadequate evidence for the psychosocial constructs purported as mechanisms of change in the college drinking literature. Evidence for mechanisms will be yielded by future studies that map all active ingredients to targeted psychosocial outcomes and that assess potential mediators early, inclusively, and at appropriate intervals following interventions. PMID:26164065

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

Advances in family-based interventions in the neonatal ICU.

PubMed

Welch, Martha G; Myers, Michael M

2016-04-01

Despite advances in medical care, preterm infants remain at risk for many adverse outcomes. This article reviews findings from several recent neonatal ICU (NICU) interventions and a trial of a novel nurture-based approach, Family Nurture Intervention (FNI). Recent trials reviewed here find positive effects of a variety of family-related interventions focused on parental guidance. These interventions target prescribed physical activities with infants, parents' stress, and the parents' ability to recognize their positive and negative behaviors with their infants. Beneficial effects include reductions in parenting stress, maternal anxiety, and depression. A different approach, FNI, is aimed at establishing mother-infant emotional connection. As in other trials, FNI also decreased maternal symptoms of anxiety and depression, and increased maternal sensitivity. Additionally, FNI led to positive short and long-term effects on infant neurobehavioral outcomes at term and 18 months. A number of recent parent-based NICU interventions have been effective at reducing preterm parent stress. Another, FNI, has positive effects on both maternal and infant outcomes and promises to be cost-effective. Future decreases in long-term morbidity in preterm infants will increasingly rely on nonmedical interventions. Therefore, the rigorous development and testing of such interventions should be a high priority in perinatology research.

A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women

PubMed Central

2012-01-01

Background The Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive systematic review, without geographic, language or date limitations, to update current knowledge on the effectiveness of existing intervention strategies to enhance breast and cervical screening uptake in Asian women. Methods This study systematically reviewed studies published as of January 2010 to synthesize knowledge about effectiveness of cancer screening interventions targeting Asian women. Fifteen multidisciplinary peer-reviewed and grey literature databases were searched to identify relevant studies. Results The results of our systematic review were reported in accordance with the PRISMA Statement. Of 37 selected intervention studies, only 18 studies included valid outcome measures (i.e. self-reported or recorded receipt of mammograms or Pap smear). 11 of the 18 intervention studies with valid outcome measures used multiple intervention strategies to target individuals in a specific Asian ethnic group. This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions. The effectiveness of community-based or workplace-based group education programs increases when additional supports, such as assistance in scheduling/attending screening and mobile screening services are provided. Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake. Media campaigns and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake. Intervention effectiveness appears to vary with ethnic population, methods of program delivery, and study setting. Conclusions Despite some limitations, our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors, such as type of intervention and study population characteristics. While some studies demonstrated the effectiveness of certain intervention programs, the cost effectiveness and long-term sustainability of these programs remain questionable. When adopting an intervention program, it is important to consider the impacts of social-and cultural factors specific to the Asian population on cancer screening uptake. Future research is needed to develop new interventions and tools, and adopt vigorous study design and evaluation methodologies to increase cancer screening among Asian women to promote population health and health equity. PMID:22676147

A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women.

PubMed

Lu, Mingshan; Moritz, Sabina; Lorenzetti, Diane; Sykes, Lindsay; Straus, Sharon; Quan, Hude

2012-06-07

The Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive systematic review, without geographic, language or date limitations, to update current knowledge on the effectiveness of existing intervention strategies to enhance breast and cervical screening uptake in Asian women. This study systematically reviewed studies published as of January 2010 to synthesize knowledge about effectiveness of cancer screening interventions targeting Asian women. Fifteen multidisciplinary peer-reviewed and grey literature databases were searched to identify relevant studies. The results of our systematic review were reported in accordance with the PRISMA Statement. Of 37 selected intervention studies, only 18 studies included valid outcome measures (i.e. self-reported or recorded receipt of mammograms or Pap smear). 11 of the 18 intervention studies with valid outcome measures used multiple intervention strategies to target individuals in a specific Asian ethnic group. This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions. The effectiveness of community-based or workplace-based group education programs increases when additional supports, such as assistance in scheduling/attending screening and mobile screening services are provided. Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake. Media campaigns and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake. Intervention effectiveness appears to vary with ethnic population, methods of program delivery, and study setting. Despite some limitations, our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors, such as type of intervention and study population characteristics. While some studies demonstrated the effectiveness of certain intervention programs, the cost effectiveness and long-term sustainability of these programs remain questionable. When adopting an intervention program, it is important to consider the impacts of social-and cultural factors specific to the Asian population on cancer screening uptake. Future research is needed to develop new interventions and tools, and adopt vigorous study design and evaluation methodologies to increase cancer screening among Asian women to promote population health and health equity.

Review of Refugee Mental Health Interventions Following Resettlement: Best Practices and Recommendations

PubMed Central

Murray, Kate E; Davidson, Graham R; Schweitzer, Robert D

2013-01-01

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psycho-educational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement. PMID:20950298

Review of refugee mental health interventions following resettlement: best practices and recommendations.

PubMed

Murray, Kate E; Davidson, Graham R; Schweitzer, Robert D

2010-10-01

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement. © 2010 American Orthopsychiatric Association.

Web-based health interventions for family caregivers of elderly individuals: A Scoping Review.

PubMed

Wasilewski, Marina B; Stinson, Jennifer N; Cameron, Jill I

2017-07-01

For the growing proportion of elders globally, aging-related illnesses are primary causes of morbidity causing reliance on family members for support in the community. Family caregivers experience poorer physical and mental health than their non-caregiving counterparts. Web-based interventions can provide accessible support to family caregivers to offset declines in their health and well-being. Existing reviews focused on web-based interventions for caregivers have been limited to single illness populations and have mostly focused on the efficacy of the interventions. We therefore have limited insight into how web-based interventions for family caregiver have been developed, implemented and evaluated across aging-related illness. To describe: a) theoretical underpinnings of the literature; b) development, content and delivery of web-based interventions; c) caregiver usage of web-based interventions; d) caregiver experience with web-based interventions and e) impact of web-based interventions on caregivers' health outcomes. We followed Arksey and O'Malley's methodological framework for conducting scoping reviews which entails setting research questions, selecting relevant studies, charting the data and synthesizing the results in a report. Fifty-three publications representing 32 unique web-based interventions were included. Over half of the interventions were targeted at dementia caregivers, with the rest targeting caregivers to the stroke, cancer, diabetes and general frailty populations. Studies used theory across the intervention trajectory. Interventions aimed to improve a range of health outcomes for caregivers through static and interactive delivery methods Caregivers were satisfied with the usability and accessibility of the websites but usage was generally low and declined over time. Depression and caregiver burden were the most common outcomes evaluated. The interventions ranged in their impact on health and social outcomes but reductions in perception of caregiver burden were consistently observed. Caregivers value interactive interventions that are tailored to their unique needs and the illness context. However, usage of the interventions was sporadic and declined over time, indicating that future interventions should address stage-specific needs across the caregiving trajectory. A systematic review has the potential to be conducted given the consistency in caregiver burden and depression as outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

[Child maltreatment prevention: the pediatrician's function. Part 1: Overview, evidence, risk factors, protective factors and triggers].

PubMed

Mouesca, Juan P

2015-12-01

Child maltreatment is a common and serious problem. It harms children in the short and long term, affecting their future health and their offspring. Primary, secondary, tertiary and quaternary preventing interventions target on child abuse are described. Evidence-based recommendations on child abuse prevention and examples of researches with proven efficacy are detailed. Risk factors, protective factors and triggers of child abuse and their relationships are described.

Comparison of tobacco control scenarios: quantifying estimates of long-term health impact using the DYNAMO-HIA modeling tool.

PubMed

Kulik, Margarete C; Nusselder, Wilma J; Boshuizen, Hendriek C; Lhachimi, Stefan K; Fernández, Esteve; Baili, Paolo; Bennett, Kathleen; Mackenbach, Johan P; Smit, H A

2012-01-01

There are several types of tobacco control interventions/policies which can change future smoking exposure. The most basic intervention types are 1) smoking cessation interventions 2) preventing smoking initiation and 3) implementation of a nationwide policy affecting quitters and starters simultaneously. The possibility for dynamic quantification of such different interventions is key for comparing the timing and size of their effects. We developed a software tool, DYNAMO-HIA, which allows for a quantitative comparison of the health impact of different policy scenarios. We illustrate the outcomes of the tool for the three typical types of tobacco control interventions if these were applied in the Netherlands. The tool was used to model the effects of different types of smoking interventions on future smoking prevalence and on health outcomes, comparing these three scenarios with the business-as-usual scenario. The necessary data input was obtained from the DYNAMO-HIA database which was assembled as part of this project. All smoking interventions will be effective in the long run. The population-wide strategy will be most effective in both the short and long term. The smoking cessation scenario will be second-most effective in the short run, though in the long run the smoking initiation scenario will become almost as effective. Interventions aimed at preventing the initiation of smoking need a long time horizon to become manifest in terms of health effects. The outcomes strongly depend on the groups targeted by the intervention. We calculated how much more effective the population-wide strategy is, in both the short and long term, compared to quit smoking interventions and measures aimed at preventing the initiation of smoking. By allowing a great variety of user-specified choices, the DYNAMO-HIA tool is a powerful instrument by which the consequences of different tobacco control policies and interventions can be assessed.

Comparison of Tobacco Control Scenarios: Quantifying Estimates of Long-Term Health Impact Using the DYNAMO-HIA Modeling Tool

PubMed Central

Kulik, Margarete C.; Nusselder, Wilma J.; Boshuizen, Hendriek C.; Lhachimi, Stefan K.; Fernández, Esteve; Baili, Paolo; Bennett, Kathleen; Mackenbach, Johan P.; Smit, H. A.

2012-01-01

Background There are several types of tobacco control interventions/policies which can change future smoking exposure. The most basic intervention types are 1) smoking cessation interventions 2) preventing smoking initiation and 3) implementation of a nationwide policy affecting quitters and starters simultaneously. The possibility for dynamic quantification of such different interventions is key for comparing the timing and size of their effects. Methods and Results We developed a software tool, DYNAMO-HIA, which allows for a quantitative comparison of the health impact of different policy scenarios. We illustrate the outcomes of the tool for the three typical types of tobacco control interventions if these were applied in the Netherlands. The tool was used to model the effects of different types of smoking interventions on future smoking prevalence and on health outcomes, comparing these three scenarios with the business-as-usual scenario. The necessary data input was obtained from the DYNAMO-HIA database which was assembled as part of this project. All smoking interventions will be effective in the long run. The population-wide strategy will be most effective in both the short and long term. The smoking cessation scenario will be second-most effective in the short run, though in the long run the smoking initiation scenario will become almost as effective. Interventions aimed at preventing the initiation of smoking need a long time horizon to become manifest in terms of health effects. The outcomes strongly depend on the groups targeted by the intervention. Conclusion We calculated how much more effective the population-wide strategy is, in both the short and long term, compared to quit smoking interventions and measures aimed at preventing the initiation of smoking. By allowing a great variety of user-specified choices, the DYNAMO-HIA tool is a powerful instrument by which the consequences of different tobacco control policies and interventions can be assessed. PMID:22384230

Mixed methods evaluation of a randomized control pilot trial targeting sugar-sweetened beverage behaviors.

PubMed

Zoellner, Jamie; Cook, Emily; Chen, Yvonnes; You, Wen; Davy, Brenda; Estabrooks, Paul

2013-02-01

This Excessive sugar-sweetened beverage (SSB) consumption and low health literacy skills have emerged as two public health concerns in the United States (US); however, there is limited research on how to effectively address these issues among adults. As guided by health literacy concepts and the Theory of Planned Behavior (TPB), this randomized controlled pilot trial applied the RE-AIM framework and a mixed methods approach to examine a sugar-sweetened beverage (SSB) intervention (SipSmartER), as compared to a matched-contact control intervention targeting physical activity (MoveMore). Both 5-week interventions included two interactive group sessions and three support telephone calls. Executing a patient-centered developmental process, the primary aim of this paper was to evaluate patient feedback on intervention content and structure. The secondary aim was to understand the potential reach (i.e., proportion enrolled, representativeness) and effectiveness (i.e. health behaviors, theorized mediating variables, quality of life) of SipSmartER. Twenty-five participants were randomized to SipSmartER (n=14) or MoveMore (n=11). Participants' intervention feedback was positive, ranging from 4.2-5.0 on a 5-point scale. Qualitative assessments reavealed several opportunties to improve clarity of learning materials, enhance instructions and communication, and refine research protocols. Although SSB consumption decreased more among the SipSmartER participants (-256.9 ± 622.6 kcals), there were no significant group differences when compared to control participants (-199.7 ± 404.6 kcals). Across both groups, there were significant improvements for SSB attitudes, SSB behavioral intentions, and two media literacy constructs. The value of using a patient-centered approach in the developmental phases of this intervention was apparent, and pilot findings suggest decreased SSB may be achieved through targeted health literacy and TPB strategies. Future efforts are needed to examine the potential public health impact of a large-scale trial to address health literacy and reduce SSB.

Televised entertainment-education to prevent adolescent alcohol use: perceived realism, enjoyment, and impact.

PubMed

van Leeuwen, Lonneke; Renes, Reint Jan; Leeuwis, Cees

2013-04-01

Alcohol use among adolescents is a concern in the Netherlands because of its high prevalence and risks. To discourage adolescents from drinking alcohol, a televised entertainment-education (E-E) intervention was developed. This study investigated responses of adolescents on perceived realism and enjoyment of the E-E intervention, as well as its impact on alcohol drinking behavior. Viewers perceived the E-E narratives to be credible and enjoyable but did not relate to the characters in the narratives. However, exposure to the E-E intervention predicted desired changes in alcohol drinking behavior, intentions to decrease alcohol use, and perceived normative pressure, especially in less educated viewers. These findings demonstrate that E-E is a promising strategy to target adolescent alcohol use. Future research will focus on the individual processes and story elements that account for the positive results.

New arrows in the quiver for targeting care management: high-risk versus high-opportunity case identification.

PubMed

Bernstein, Richard H

2007-01-01

"Care management" purposefully obscures the distinctions between disease and case management and stresses their common features: action in the present to prevent adverse future outcomes and costs. It includes identifying a high-need population by referrals, screening, or data analysis, assessing those likely to benefit from interventions, intervening, evaluating the intervention, and adjusting interventions when needed. High-risk individuals can be identified using at least 9 techniques, from referrals and questionnaires to retrospective claims analysis and predictive models. Other than referrals, software based on the risk-adjustment methodology that we have adapted can incorporate all these methodologies. Because the risk adjustment employs extensive case mix and severity adjustment, it provides care managers with 3 innovative ways to identify not only high-risk individuals but also high-opportunity cases.

Personalized Health Planning With Integrative Health Coaching to Reduce Obesity Risk Among Women Gaining Excess Weight During Pregnancy

PubMed Central

Yang, Nancy Y.; Wroth, Shelley; Parham, Catherine; Strait, Melva

2013-01-01

Health coaching is an emerging behavioral intervention to improve outcomes in chronic disease management and prevention; however, no studies have investigated its utility in postpartum women who have gained excess weight during pregnancy. A 32-year-old primigravida woman who was overweight at conception and gained 23 lbs more than Institute of Medicine recommendations for her pre-pregnancy body mass index participated in a 6-month personalized health planning with integrative health coaching (PHPIHC) intervention. The intervention included a baseline health risk assessment review with a healthcare provider and eight biweekly, 30-minute telephonic health coaching sessions. The participant demonstrated improvement in physical activity, energy expenditure, knowledge, and confidence to engage in healthpromoting behaviors. Although the participant did not reach the target weight by completion of the health coaching sessions, follow up 8 months later indicated she achieved the target goal (within 5% of prepregnancy weight). This case report suggests that PHP-IHC can support postpartum women in returning to pre-pregnancy weight after gaining excess gestational weight. Future research and clinical trials are needed to determine the best timing, length, and medium (online, in-person, telephonic) of PHP-IHC for postpartum women. PMID:24278848

Behaviour Centred Design: towards an applied science of behaviour change.

PubMed

Aunger, Robert; Curtis, Valerie

2016-12-01

Behaviour change has become a hot topic. We describe a new approach, Behaviour Centred Design (BCD), which encompasses a theory of change, a suite of behavioural determinants and a programme design process. The theory of change is generic, assuming that successful interventions must create a cascade of effects via environments, through brains, to behaviour and hence to the desired impact, such as improved health. Changes in behaviour are viewed as the consequence of a reinforcement learning process involving the targeting of evolved motives and changes to behaviour settings, and are produced by three types of behavioural control mechanism (automatic, motivated and executive). The implications are that interventions must create surprise, revalue behaviour and disrupt performance in target behaviour settings. We then describe a sequence of five steps required to design an intervention to change specific behaviours: Assess, Build, Create, Deliver and Evaluate. The BCD approach has been shown to change hygiene, nutrition and exercise-related behaviours and has the advantages of being applicable to product, service or institutional design, as well as being able to incorporate future developments in behaviour science. We therefore argue that BCD can become the foundation for an applied science of behaviour change.

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.

Statistical synthesis of contextual knowledge to increase the effectiveness of theory-based behaviour change interventions.

PubMed

Hanbury, Andria; Thompson, Carl; Mannion, Russell

2011-07-01

Tailored implementation strategies targeting health professionals' adoption of evidence-based recommendations are currently being developed. Research has focused on how to select an appropriate theoretical base, how to use that theoretical base to explore the local context, and how to translate theoretical constructs associated with the key factors found to influence innovation adoption into feasible and tailored implementation strategies. The reasons why an intervention is thought not to have worked are often cited as being: inappropriate choice of theoretical base; unsystematic development of the implementation strategies; and a poor evidence base to guide the process. One area of implementation research that is commonly overlooked is how to synthesize the data collected in a local context in order to identify what factors to target with the implementation strategies. This is suggested to be a critical process in the development of a theory-based intervention. The potential of multilevel modelling techniques to synthesize data collected at different hierarchical levels, for example, individual attitudes and team level variables, is discussed. Future research is needed to explore further the potential of multilevel modelling for synthesizing contextual data in implementation studies, as well as techniques for synthesizing qualitative and quantitative data.

Behaviour Centred Design: towards an applied science of behaviour change

PubMed Central

Aunger, Robert; Curtis, Valerie

2016-01-01

ABSTRACT Behaviour change has become a hot topic. We describe a new approach, Behaviour Centred Design (BCD), which encompasses a theory of change, a suite of behavioural determinants and a programme design process. The theory of change is generic, assuming that successful interventions must create a cascade of effects via environments, through brains, to behaviour and hence to the desired impact, such as improved health. Changes in behaviour are viewed as the consequence of a reinforcement learning process involving the targeting of evolved motives and changes to behaviour settings, and are produced by three types of behavioural control mechanism (automatic, motivated and executive). The implications are that interventions must create surprise, revalue behaviour and disrupt performance in target behaviour settings. We then describe a sequence of five steps required to design an intervention to change specific behaviours: Assess, Build, Create, Deliver and Evaluate. The BCD approach has been shown to change hygiene, nutrition and exercise-related behaviours and has the advantages of being applicable to product, service or institutional design, as well as being able to incorporate future developments in behaviour science. We therefore argue that BCD can become the foundation for an applied science of behaviour change. PMID:27535821

[Interprofessional Collaboration as a Modality to Resolve Therapeutic Impasses in Child Psychiatry: A Review].

PubMed

Bordeleau, Lyne; Leblanc, Jeannette

Child and adolescent intervention in child psychiatric clinics generates a high risk of therapeutic impasses for clinicians. Among the factors that contribute to this situation are the increasing severity of the problems of young people who are referred to psychiatric clinics and the obligation for professionals to collaborate with various actors surrounding the patient. This literature review explores the possibility that an intervention targeting indicators of interprofessional collaboration can help resolved the therapeutic impasses encountered by professionals working in child psychiatry. The article begins with a description of the impasse in therapeutic clinical child psychiatry. It then introduces a broad look at research about interprofessional collaboration and its effects on mental health service delivery. Finally, it examines the structuring model of the interprofessional collaboration process of D'Amour et al. in order to highlight the indicators that may be related to the resolution of clinical therapeutic impasses in child psychiatry. This review examines the possible interventions that could be done when targeting indicators of D'Amour et al.'s interprofessional collaboration model in order to improve therapeutic impasses resolution. A promising direction for future research which could contribute to therapeutic impasses resolution in child psychiatry is proposed.

Antenatal physical activity: a qualitative study exploring women's experiences and the acceptability of antenatal walking groups.

PubMed

Currie, Sinéad; Gray, Cindy; Shepherd, Ashley; McInnes, Rhona J

2016-07-22

Regular physical activity (PA) can be beneficial to pregnant women, however, many women do not adhere to current PA guidelines during the antenatal period. Patient and public involvement is essential when designing antenatal PA interventions in order to uncover the reasons for non-adherence and non-engagement with the behaviour, as well as determining what type of intervention would be acceptable. The aim of this research was to explore women's experiences of PA during a recent pregnancy, understand the barriers and determinants of antenatal PA and explore the acceptability of antenatal walking groups for further development. Seven focus groups were undertaken with women who had given birth within the past five years. Focus groups were transcribed and analysed using a grounded theory approach. Relevant and related behaviour change techniques (BCTs), which could be applied to future interventions, were identified using the BCT taxonomy. Women's opinions and experiences of PA during pregnancy were categorised into biological/physical (including tiredness and morning sickness), psychological (fear of harm to baby and self-confidence) and social/environmental issues (including access to facilities). Although antenatal walking groups did not appear popular, women identified some factors which could encourage attendance (e.g. childcare provision) and some which could discourage attendance (e.g. walking being boring). It was clear that the personality of the walk leader would be extremely important in encouraging women to join a walking group and keep attending. Behaviour change technique categories identified as potential intervention components included social support and comparison of outcomes (e.g. considering pros and cons of behaviour). Women's experiences and views provided a range of considerations for future intervention development, including provision of childcare, involvement of a fun and engaging leader and a range of activities rather than just walking. These experiences and views relate closely to the Health Action Process Model which, along with BCTs, could be used to develop future interventions. The findings of this study emphasise the importance of involving the target population in intervention development and present the theoretical foundation for building an antenatal PA intervention to encourage women to be physically active throughout their pregnancies.

[Success factors in public healthy eating campaigns: a case study].

PubMed

Aschemann-Witzel, J; Pérez-Cueto, F J A; Strand, M; Verbeke, W; Bech-Larsen, T

2012-01-01

Public campaigns and interventions are rarely fully evaluated regarding their effectiveness. The analysis of past, successful activities can contribute to the future development of public campaigns and interventions for healthier eating. The study of public campaigns and interventions for healthier eating aimed at identifying the underlying success factors and describing their relation. Interviews were conducted with representatives of 11 cases that had been identified as especially successful in an earlier research step. The interviews were analysed with regard to possible success factors and the latter used to develop a model of success factor interrelation. It was found that success of the cases was first, attributed to characteristics of the macro environment or to public private partnerships in the initiation of campaigns, second, to the engagement of social communities, elements of empowerment of the target group and the implementation of social marketing measures, and thirdly, in citizens adoption of the campaign and in accompanying structural changes. The model and identified success factors underline that success can stem from three crucial phases: the set up of a campaign, the conduction and finally, the interrelation with the citizen. The model can serve as a guide in the future development of campaigns.

Improving Written Language Performance of Adolescents with Asperger Syndrome

PubMed Central

Delano, Monica E

2007-01-01

The effects of a multicomponent intervention involving self-regulated strategy development delivered via video self-modeling on the written language performance of 3 students with Asperger syndrome were examined. During intervention sessions, each student watched a video of himself performing strategies for increasing the number of words written and the number of functional essay elements. He then wrote a persuasive essay. The number of words written and number of functional essay elements included in each essay were measured. Each student demonstrated gains in the number of words written and number of functional essay elements. Maintenance of treatment effects at follow-up varied across targets and participants. Implications for future research are suggested. PMID:17624076

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

Antitumorigenic targets of cannabinoids - current status and implications.

PubMed

Ramer, Robert; Hinz, Burkhard

2016-10-01

Molecular structures of the endocannabinoid system have gained interest as potential pharmacotherapeutical targets for systemic cancer treatment. The present review covers the contribution of the endocannabinoid system to cancer progression. Particular focus will be set on the accumulating preclinical data concerning antimetastatic, anti-invasive and anti-angiogenic mechanisms induced by cannabinoids. The main goal of targeting endocannabinoid structures for systemic anticancer treatment is the comparatively good safety profile of cannabinoid compounds. In addition, antitumorigenic mechanisms of cannabinoids are not restricted to a single molecular cascade but involve multiple effects on various levels of cancer progression such as angiogenesis and metastasis. Particularly the latter effect has gained interest for pharmacological interventions. Thus, drugs aiming at the endocannabinoid system may represent potential 'antimetastatics' for an upgrade of a future armamentarium against cancer diseases.

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.

How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults.

PubMed

Gardner, Benjamin; Smith, Lee; Lorencatto, Fabiana; Hamer, Mark; Biddle, Stuart J H

2016-01-01

Sedentary behaviour - i.e., low energy-expending waking behaviour while seated or lying down - is a health risk factor, even when controlling for physical activity. This review sought to describe the behaviour change strategies used within interventions that have sought to reduce sedentary behaviour in adults. Studies were identified through existing literature reviews, a systematic database search, and hand-searches of eligible papers. Interventions were categorised as 'very promising', 'quite promising', or 'non-promising' according to observed behaviour changes. Intervention functions and behaviour change techniques were compared across promising and non-promising interventions. Twenty-six eligible studies reported thirty-eight interventions, of which twenty (53%) were worksite-based. Fifteen interventions (39%) were very promising, eight quite promising (21%), and fifteen non-promising (39%). Very or quite promising interventions tended to have targeted sedentary behaviour instead of physical activity. Interventions based on environmental restructuring, persuasion, or education were most promising. Self-monitoring, problem solving, and restructuring the social or physical environment were particularly promising behaviour change techniques. Future sedentary reduction interventions might most fruitfully incorporate environmental modification and self-regulatory skills training. The evidence base is, however, weakened by low-quality evaluation methods; more RCTs, employing no-treatment control groups, and collecting objective data are needed.

How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults

PubMed Central

Gardner, Benjamin; Smith, Lee; Lorencatto, Fabiana; Hamer, Mark; Biddle, Stuart JH

2016-01-01

Sedentary behaviour – i.e., low energy-expending waking behaviour while seated or lying down – is a health risk factor, even when controlling for physical activity. This review sought to describe the behaviour change strategies used within interventions that have sought to reduce sedentary behaviour in adults. Studies were identified through existing literature reviews, a systematic database search, and hand-searches of eligible papers. Interventions were categorised as ‘very promising’, ‘quite promising’, or ‘non-promising’ according to observed behaviour changes. Intervention functions and behaviour change techniques were compared across promising and non-promising interventions. Twenty-six eligible studies reported thirty-eight interventions, of which twenty (53%) were worksite-based. Fifteen interventions (39%) were very promising, eight quite promising (21%), and fifteen non-promising (39%). Very or quite promising interventions tended to have targeted sedentary behaviour instead of physical activity. Interventions based on environmental restructuring, persuasion, or education were most promising. Self-monitoring, problem solving, and restructuring the social or physical environment were particularly promising behaviour change techniques. Future sedentary reduction interventions might most fruitfully incorporate environmental modification and self-regulatory skills training. The evidence base is, however, weakened by low-quality evaluation methods; more RCTs, employing no-treatment control groups, and collecting objective data are needed. PMID:26315814

Your blues ain't like mine: considering integrative antiracism in HIV prevention research with black men who have sex with men in Canada and the United States.

PubMed

Nelson, LaRon E; Walker, Ja'Nina J; DuBois, Steve N; Giwa, Sulaimon

2014-12-01

Evidence-based interventions have been developed and used to prevent HIV infections among black men who have sex with men (MSM) in Canada and the United States; however, the degree to which interventions address racism and other interlocking oppressions that influence HIV vulnerability is not well known. We utilize integrative antiracism to guide a review of HIV prevention intervention studies with black MSM and to determine how racism and religious oppression are addressed in the current intervention evidence base. We searched CINAHL, PsychInfo, MEDLINE and the CDC compendium of evidence-based HIV prevention interventions and identified seventeen interventions. Three interventions targeted black MSM, yet only one intervention addressed racism, religious oppression, cultural assets and religious assets. Most interventions' samples included low numbers of black MSM. More research is needed on interventions that address racism and religious oppression on HIV vulnerability among black MSM. Future research should focus on explicating mechanisms by which multiple oppressions impact HIV vulnerability. We recommend the development and integration of social justice tools for nursing practice that aid in addressing the impacts of racism and other oppressions on HIV vulnerability of black MSM. © 2014 John Wiley & Sons Ltd.

More Useful, or Not So Bad? Evaluating the Effects of Interventions to Reduce Perceived Cost and Increase Utility Value with College Physics Students

NASA Astrophysics Data System (ADS)

Rosenzweig, Emily Quinn

In the present study I developed and evaluated the effects of two interventions designed to target students' motivation to learn in an introductory college physics course. One intervention was designed to improve students' perceptions of utility value and the other was designed to reduce students' perceptions of cost. Utility value and cost both are central constructs from Eccles and colleagues' expectancy-value theory of motivation (Eccles-Parsons et al., 1983). Students (N = 148) were randomly assigned to receive the cost intervention, the utility value intervention, or one of two control conditions. Compared to a survey control condition, neither intervention impacted overall students' motivation, measured at 3 time points over the semester, or their course outcomes. In moderation analyses, neither intervention impacted any students' perceptions of utility value. However, both interventions impacted some students' perceptions of cost, competence-related beliefs, and course outcomes positively while impacting these variables for other students negatively. The cost intervention benefitted consistently and in different ways students who had low baseline competence-related beliefs, low prior achievement, strong malleable beliefs about intelligence, or who were female. However, the intervention showed consistent undermining effects on motivation and/or achievement for students with strong fixed beliefs about intelligence. The utility value intervention benefitted consistently the course outcomes of students who had low baseline competence-related beliefs, low prior achievement, or who were female. The intervention showed less consistent undermining effects on motivation for students with strong fixed beliefs about intelligence, high baseline competence-related beliefs, or high prior achievement. Prior researchers have shown that utility value interventions improve course outcomes for some students who are at risk for underachievement. The present study extends prior work by showing that utility value interventions benefit similar students in college physics courses. It also demonstrates that a cost intervention is a viable way to impact at-risk students' physics course outcomes. Future researchers should consider carefully moderating variables and how to mitigate potential undermining effects for some students when implementing future expectancy-value-theory-based interventions in college physics courses.

Unintended changes in cognition, mood, and behavior arising from cell-based interventions for neurological conditions: ethical challenges.

PubMed

Duggan, P S; Siegel, A W; Blass, D M; Bok, H; Coyle, J T; Faden, R; Finkel, J; Gearhart, J D; Greely, H T; Hillis, A; Hoke, A; Johnson, R; Johnston, M; Kahn, J; Kerr, D; King, P; Kurtzberg, J; Liao, S M; McDonald, J W; McKhann, G; Nelson, K B; Rao, M; Regenberg, A; Smith, K; Solter, D; Song, H; Sugarman, J; Traystman, R J; Vescovi, A; Yanofski, J; Young, W; Mathews, D J H

2009-05-01

The prospect of using cell-based interventions (CBIs) to treat neurological conditions raises several important ethical and policy questions. In this target article, we focus on issues related to the unique constellation of traits that characterize CBIs targeted at the central nervous system. In particular, there is at least a theoretical prospect that these cells will alter the recipients' cognition, mood, and behavior-brain functions that are central to our concept of the self. The potential for such changes, although perhaps remote, is cause for concern and careful ethical analysis. Both to enable better informed consent in the future and as an end in itself, we argue that early human trials of CBIs for neurological conditions must monitor subjects for changes in cognition, mood, and behavior; further, we recommend concrete steps for that monitoring. Such steps will help better characterize the potential risks and benefits of CBIs as they are tested and potentially used for treatment.

Community embedded reproductive health interventions for adolescents in Latin America: development and evaluation of a complex multi-centre intervention

PubMed Central

2013-01-01

Background Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and reproductive health information, services and counselling. To date, many adolescent health programmes have targeted a single determinant of sexual and reproductive health. However, recent evidence suggests that the complexity of sexual and reproductive health issues demands an equally multi-layered and comprehensive approach. Methods This article describes the development, implementation and evaluation design of the community-embedded reproductive health care for adolescents (CERCA) study in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador) and Managua (Nicaragua). Project CERCA’s research methodology builds on existing methodological frameworks, namely: action research, community based participatory research and intervention-mapping. The interventions in each country address distinct target groups (adolescents, parents, local authorities and health providers) and seek improvement of the following sexual health behaviours: communication about sexuality, sexual and reproductive health information-seeking, access to sexual and reproductive health care and safe sexual relationships. In Managua, we implemented a randomised controlled study, and in Cochabamba and Cuenca we adopted a non-randomised controlled study to evaluate the effectiveness of Project CERCA interventions, in addition to a process evaluation. Discussion This research will result in a methodological framework that will contribute to the improved design and implementation of future adolescent sexual and reproductive health interventions. Trial registration ClinicalTrials.gov (NCT01722084) PMID:23311647

The physical inactivity matrix: lessons from the classification of physical inactivity interventions.

PubMed

Kypri, Kypros; Donaldson, Alex; Johnstone, Elizabeth

2006-05-01

Physical inactivity (PI), a leading modifiable cause of disease and injury, is endemic in industrialised nations. Although considerable research has been undertaken in this field, we lack a system to synthesise the research literature to inform policy and identify research needs. The aims of this study were to (1) develop a system to classify physical inactivity intervention studies, (2) examine the distribution of PI interventions published in the peer-reviewed health literature using the system, and (3) consider implications for future research. We developed the Physical Inactivity Matrix (PIM), with 12 intervention points, created by the intersection of two dimensions: the intervention target (individual, physical environment and social/cultural environment) and the activity focus (transport, work/school, leisure and consumer). A formal search of the health research literature identified 529 eligible studies and each was classified into one of the 12 cells of the PIM. Most studies were categorised as: individual-leisure (68%), individual-work/school (12%) or social/cultural environment-leisure (13%). Only 4% targeted the physical environment. The findings of this initial application of the PIM support the call for greater investment in policies, interventions and research that focus on the relationship between the environment and PI, and transportation in particular. There would be merit in establishing the inter-rater reliability of the PIM and applying it to a wider variety of studies, including those published in the transportation and urban planning literatures. The PIM could be a useful tool for monitoring trends in research directions and funding levels over time and across countries.

STOCKING THE GENETIC SUPERMARKET: REPRODUCTIVE GENETIC TECHNOLOGIES AND COLLECTIVE ACTION PROBLEMS

PubMed Central

Gyngell, Chris; Douglas, Thomas

2015-01-01

Reproductive genetic technologies (RGTs) allow parents to decide whether their future children will have or lack certain genetic predispositions. A popular model that has been proposed for regulating access to RGTs is the ‘genetic supermarket’. In the genetic supermarket, parents are free to make decisions about which genes to select for their children with little state interference. One possible consequence of the genetic supermarket is that collective action problems will arise: if rational individuals use the genetic supermarket in isolation from one another, this may have a negative effect on society as a whole, including future generations. In this article we argue that RGTs targeting height, innate immunity, and certain cognitive traits could lead to collective action problems. We then discuss whether this risk could in principle justify state intervention in the genetic supermarket. We argue that there is a plausible prima facie case for the view that such state intervention would be justified and respond to a number of arguments that might be adduced against that view. PMID:24720568

Reducing young driver road trauma: guidance and optimism for the future

PubMed Central

Senserrick, T M

2006-01-01

This paper highlights lessons from each of the Expert Panel papers in the present supplement that provide guidance for future research and initiatives. Although some shortfalls still remain in our understanding, it is argued that much has been learned and we are ready for more translation, implementation, and evaluation of multilevel interventions to help reduce young driver road trauma. Non‐use of restraints, speeding, driving at night and with passengers, and fatigue are highlighted as key risk factors to address. “Best practice” intervention is proposed as implementing and strengthening graduated driver licensing systems and complementary candidate programs and research, such as hazard perception training programs. A schematic cognitive‐perceptual model to explain the crash sequence process is explored. There is optimism that meaningful impacts can be made, especially coupled with the advances in vehicle technologies, but caution is necessary in the absence of targeted “real world” evaluations and broader implementation and diffusion strategies. PMID:16788114

Weathering the storm: Improving therapeutic interventions for cytokine storm syndromes by targeting disease pathogenesis.

PubMed

Weaver, Lehn K; Behrens, Edward M

2017-03-01

Cytokine storm syndromes require rapid diagnosis and treatment to limit the morbidity and mortality caused by the hyperinflammatory state that characterizes these devastating conditions. Herein, we discuss the current knowledge that guides our therapeutic decision-making and personalization of treatment for patients with cytokine storm syndromes. Firstly, ICU-level supportive care is often required to stabilize patients with fulminant disease while additional diagnostic evaluations proceed to determine the underlying cause of cytokine storm. Pharmacologic interventions should be focused on removing the inciting trigger of inflammation and initiation of an individualized immunosuppressive regimen when immune activation is central to the underlying disease pathophysiology. Monitoring for a clinical response is required to ensure that changes in the therapeutic regimen can be made as clinically warranted. Escalation of immunosuppression may be required if patients respond poorly to the initial therapeutic interventions, while a slow wean of immunosuppression in patients who improve can limit medication-related toxicities. In certain scenarios, a decision must be made whether an individual patient requires hematopoietic cell transplantation to prevent recurrence of disease. Despite these interventions, significant morbidity and mortality remains for cytokine storm patients. Therefore, we use this review to propose a clinical schema to guide current and future attempts to design rational therapeutic interventions for patients suffering from these devastating conditions, which we believe speeds the diagnosis of disease, limits medication-related toxicities, and improves clinical outcomes by targeting the heterogeneous and dynamic mechanisms driving disease in each individual patient.

Applying the Intervention Mapping protocol to develop a kindergarten-based, family-involved intervention to increase European preschool children's physical activity levels: the ToyBox-study.

PubMed

De Craemer, M; De Decker, E; De Bourdeaudhuij, I; Verloigne, M; Duvinage, K; Koletzko, B; Ibrügger, S; Kreichauf, S; Grammatikaki, E; Moreno, L; Iotova, V; Socha, P; Szott, K; Manios, Y; Cardon, G

2014-08-01

Although sufficient physical activity is beneficial for preschoolers' health, activity levels in most preschoolers are low. As preschoolers spend a considerable amount of time at home and at kindergarten, interventions should target both environments to increase their activity levels. The aim of the current paper was to describe the six different steps of the Intervention Mapping protocol towards the systematic development and implementation of the physical activity component of the ToyBox-intervention. This intervention is a kindergarten-based, family-involved intervention implemented across six European countries. Based on the results of literature reviews and focus groups with parents/caregivers and kindergarten teachers, matrices of change objectives were created. Then, theory-based methods and practical strategies were selected to develop intervention materials at three different levels: (i) individual level (preschoolers); (ii) interpersonal level (parents/caregivers) and (iii) organizational level (teachers). This resulted in a standardized intervention with room for local and cultural adaptations in each participating country. Although the Intervention Mapping protocol is a time-consuming process, using this systematic approach may lead to an increase in intervention effectiveness. The presented matrices of change objectives are useful for future programme planners to develop and implement an intervention based on the Intervention Mapping protocol to increase physical activity levels in preschoolers. © 2014 World Obesity.

Implementing a Complex Intervention to Support Personal Recovery: A Qualitative Study Nested within a Cluster Randomised Controlled Trial

PubMed Central

Leamy, Mary; Clarke, Eleanor; Le Boutillier, Clair; Bird, Victoria; Janosik, Monika; Sabas, Kai; Riley, Genevieve; Williams, Julie; Slade, Mike

2014-01-01

Objective To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams. Design Process evaluation nested within a cluster randomised controlled trial (RCT). Participants 28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports. Setting 14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention. Results The factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles. Conclusions Three findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure. Trial Registration Controlled-Trials.com ISRCTN02507940 PMID:24875748

Implementing a complex intervention to support personal recovery: a qualitative study nested within a cluster randomised controlled trial.

PubMed

Leamy, Mary; Clarke, Eleanor; Le Boutillier, Clair; Bird, Victoria; Janosik, Monika; Sabas, Kai; Riley, Genevieve; Williams, Julie; Slade, Mike

2014-01-01

To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams. Process evaluation nested within a cluster randomised controlled trial (RCT). 28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports. 14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention. The factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles. Three findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure. Controlled-Trials.com ISRCTN02507940.

Culturally Targeted Strategies for Diabetes Prevention in Minority Populations: A Systematic Review and Framework

PubMed Central

Lagisetty, Pooja A.; Priyadarshini, Shubadra; Terrell, Stephanie; Hamati, Mary; Landgraf, Jessica; Chopra, Vineet; Heisler, Michele

2017-01-01

Purpose The purpose of this study is to (a) assess the effectiveness of culturally tailored diabetes prevention interventions in minority populations and (b) develop a novel framework to characterize four key domains of culturally tailored interventions. Prevention strategies specifically tailored to the culture of ethnic minority patients may help reduce the incidence of diabetes. Methods We searched PubMed, EMBASE, and CINAHL for English-language, randomized controlled trials (RCTs) or quasi-experimental (QE) trials testing culturally tailored interventions to prevent diabetes in minority populations. Two reviewers independently extracted data and assessed risk of bias. Inductive thematic analysis was used to develop a framework with four domains (FiLLM: Facilitating [i.e., delivering] Interventions through Language, Location and Message). The framework was used to assess the overall effectiveness of culturally tailored interventions. Results Thirty-four trials met eligibility criteria. Twelve studies were randomized controlled trials, and 22 were quasi-experimental trials. Twenty-five out of 34 studies (74%) that used cultural tailoring demonstrated significantly improved Hemoglobin A1C, fasting glucose, and/or weight loss. Of the 25 successful interventions, 21 (84%) incorporated at least three culturally targeted domains. Seven studies used all four domains and were all successful. The least utilized domain was delivery (4/34) of the intervention’s key educational message. Conclusions Culturally tailoring interventions across the four domains of facilitators, language, location, and messaging can be effective in improving risk factors for progression to diabetes among ethnic minority groups. Future studies should evaluate how specific tailoring approaches work compared to usual care as well as comparative effectiveness of each tailoring domain. Registration (PROSPERO registration: CRD42015016914) PMID:28118127

Improvements in maternal depression as a mediator of intervention effects on early childhood problem behavior

PubMed Central

Shaw, Daniel S.; Connell, Arin; Dishion, Thomas J.; Wilson, Melvin N.; Gardner, Frances

2009-01-01

Maternal depression has been consistently linked to the development of child problem behavior, particularly in early childhood, but few studies have examined whether reductions in maternal depression serve as a mediator in relation to changes associated with a family-based intervention. The current study addressed this issue with a sample of 731 families receiving services from a national food supplement and nutrition program. Families with toddlers between ages 2 and 3 were sereened and then randomized to a brief family intervention, the Family Check-Up, which included linked interventions that were tailored and adapted to the families needs. Follow-up intervention services were provided at age 3 and follow-up of child outcomes oecurred at ages 3 and 4. Latent growth models revealed intervention effects for early externalizing and internalizing problems from 2 to 4, and reductions in maternal depression from ages 2 to 3. In addition, reductions in maternal depression mediated improvements in both child externalizing and internalizing problem behavior after accounting for the potential mediating effects of improvements in positive parenting. The results are discussed with respect to targeting maternal depression in future intervention studies aimed at improving early child problem behavior. PMID:19338691

Vision rehabilitation interventions following mild traumatic brain injury: a scoping review.

PubMed

Simpson-Jones, Mary E; Hunt, Anne W

2018-04-10

To broadly examine the literature to identify vision interventions following mild traumatic brain injury. Objectives are to identify: (1) evidence-informed interventions for individuals with visual dysfunction after mild traumatic brain injury; (2) professions providing these interventions; (3) gaps in the literature and areas for further research. A scoping review was conducted of four electronic databases of peer-reviewed literature from the databases earliest records to June 2017. Articles were included if the study population was mild traumatic brain injury/concussion and a vision rehabilitation intervention was tested. Two independent reviewers screened articles for inclusion, extracted data, and identified themes. The initial search identified 3111 records. Following exclusions, 22 articles were included in the final review. Nine studies evaluated optical devices, such as corrective spectacles, contact lenses, prisms, or binasal occlusion. Two studies assessed vision therapy. Ten studies examined vision therapy using optical devices. One study investigated hyperbaric oxygen therapy. Optometrists performed these interventions in most of the studies. Future research should address quality appraisal of this literature, interventions that include older adult and pediatric populations, and interdisciplinary interventions. There are promising interventions for vision deficits following mild traumatic brain injury. However, there are multiple gaps in the literature that should be addressed by future research. Implications for Rehabilitation Mild traumatic brain injury may result in visual deficits that can contribute to poor concentration, headaches, fatigue, problems reading, difficulties engaging in meaningful daily activities, and overall reduced quality of life. Promising interventions for vision rehabilitation following mild traumatic brain injury include the use of optical devices (e.g., prism glasses), vision or oculomotor therapy (e.g., targeted exercises to train eye movements), and a combination of optical devices and vision therapy. Rehabilitation Professionals (e.g., optometrists, occupational therapists, physiotherapists) have an important role in screening for vision impairments, recommending referrals appropriately to vision specialists, and/or assessing and treating functional vision deficits in individuals with mild traumatic brain injury.

The Physiology, Pathology, and Pharmacology of Voltage-Gated Calcium Channels and Their Future Therapeutic Potential

PubMed Central

Zamponi, Gerald W.; Striessnig, Joerg; Koschak, Alexandra

2015-01-01

Voltage-gated calcium channels are required for many key functions in the body. In this review, the different subtypes of voltage-gated calcium channels are described and their physiologic roles and pharmacology are outlined. We describe the current uses of drugs interacting with the different calcium channel subtypes and subunits, as well as specific areas in which there is strong potential for future drug development. Current therapeutic agents include drugs targeting L-type CaV1.2 calcium channels, particularly 1,4-dihydropyridines, which are widely used in the treatment of hypertension. T-type (CaV3) channels are a target of ethosuximide, widely used in absence epilepsy. The auxiliary subunit α2δ-1 is the therapeutic target of the gabapentinoid drugs, which are of value in certain epilepsies and chronic neuropathic pain. The limited use of intrathecal ziconotide, a peptide blocker of N-type (CaV2.2) calcium channels, as a treatment of intractable pain, gives an indication that these channels represent excellent drug targets for various pain conditions. We describe how selectivity for different subtypes of calcium channels (e.g., CaV1.2 and CaV1.3 L-type channels) may be achieved in the future by exploiting differences between channel isoforms in terms of sequence and biophysical properties, variation in splicing in different target tissues, and differences in the properties of the target tissues themselves in terms of membrane potential or firing frequency. Thus, use-dependent blockers of the different isoforms could selectively block calcium channels in particular pathologies, such as nociceptive neurons in pain states or in epileptic brain circuits. Of important future potential are selective CaV1.3 blockers for neuropsychiatric diseases, neuroprotection in Parkinson’s disease, and resistant hypertension. In addition, selective or nonselective T-type channel blockers are considered potential therapeutic targets in epilepsy, pain, obesity, sleep, and anxiety. Use-dependent N-type calcium channel blockers are likely to be of therapeutic use in chronic pain conditions. Thus, more selective calcium channel blockers hold promise for therapeutic intervention. PMID:26362469

Effect of intensive structured care on individual blood pressure targets in primary care: multicentre randomised controlled trial.

PubMed

Stewart, Simon; Carrington, Melinda J; Swemmer, Carla H; Anderson, Craig; Kurstjens, Nicol P; Amerena, John; Brown, Alex; Burrell, Louise M; de Looze, Ferdinandus J; Harris, Mark; Hung, Joseph; Krum, Henry; Nelson, Mark; Schlaich, Markus; Stocks, Nigel P; Jennings, Garry L

2012-11-20

To determine the effectiveness of intensive structured care to optimise blood pressure control based on individual absolute risk targets in primary care. Pragmatic multicentre randomised controlled trial. General practices throughout Australia, except Northern Territory, 2009-11. Of 2185 patients from 119 general practices who were eligible for drug treatment for hypertension according to national guidelines 416 (19.0%) achieved their individual blood pressure target during a 28 day run-in period of monotherapy. After exclusions, 1562 participants not at target blood pressure (systolic 150 (SD 17) mm Hg, diastolic 88 (SD 11) mm Hg) were randomised (1:2 ratio) to usual care (n=524) or the intervention (n=1038). Computer assisted clinical profiling and risk target setting (all participants) with intensified follow-up and stepwise drug titration (initial angiotensin receptor blocker monotherapy or two forms of combination therapy using angiotensin receptor blockers) for those randomised to the intervention. The control group received usual care. The primary outcome was individual blood pressure target achieved at 26 weeks. Secondary outcomes were change in mean sitting systolic and diastolic blood pressure, absolute risk for cardiovascular disease within five years based on the Framingham risk score, and proportion and rate of adverse events. On an intention to treat basis, there was an 8.8% absolute difference in individual blood pressure target achieved at 26 weeks in favour of the intervention group compared with usual care group (358/988 (36.2%) v 138/504 (27.4%)): adjusted relative risk 1.28 (95% confidence interval 1.10 to 1.49, P=0.0013). There was also a 9.5% absolute difference in favour of the intervention group for achieving the classic blood pressure target of ≤ 140/90 mm Hg (627/988 (63.5%) v 272/504 (54.0%)): adjusted relative risk 1.18 (1.07 to 1.29, P<0.001). The intervention group achieved a mean adjusted reduction in systolic blood pressure of 13.2 mm Hg (95% confidence interval -12.3 to -14.2 mm Hg) and diastolic blood pressure of 7.7 mm Hg (-7.1 to -8.3 mm Hg) v 10.1 mm Hg (-8.8 to 11.3 mm Hg) and 5.5 mm Hg (-4.7 to -6.2 mm Hg) in the usual care group (P<0.001). Among 1141 participants in whom five year absolute cardiovascular risk scores were calculated from baseline to the 26 week follow-up, the reduction in risk scores was greater in the intervention group than usual care group (14.7% (SD 9.3%) to 10.9% (SD 8.0%); difference -3.7% (SD 4.5%) and 15.0% (SD 10.1%) to 12.4% (SD 9.4%); -2.6% (SD 4.5%): adjusted mean difference -1.13% (95% confidence interval -0.69% to -1.63%; P<0.001). Owing to adverse events 82 (7.9%) participants in the intervention group and 10 (1.9%) in the usual care group had their drug treatment modified. In a primary care setting intensive structured care resulted in higher levels of blood pressure control, with clinically lower blood pressure and absolute risk of future cardiovascular events overall and with more people achieving their target blood pressure. An important gap in treatment remains though and applying intensive management and achieving currently advocated risk based blood pressure targets is challenging.

Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism.

PubMed

Kasari, Connie; Gulsrud, Amanda; Paparella, Tanya; Hellemann, Gerhard; Berry, Kathleen

2015-06-01

This study compared effects of two parent-mediated interventions on joint engagement outcomes as augmentations of an early intervention program for toddlers with autism spectrum disorder (ASD). Participants included 86 toddlers (range 22-36 months) with ASD and their primary caregiver. Caregiver-child dyads were randomized to receive 10 weeks of hands-on parent training in a naturalistic, developmental behavioral intervention (joint attention, symbolic play, engagement and regulation-JASPER) or a parent-only psychoeducational intervention (PEI). Dose was controlled in terms of researcher-parent contact and early intervention services received by the child. Results yielded significant effects of the JASPER intervention on the primary outcome of joint engagement. The treatment effect was large (Cohen's f² = .69) and maintained over the 6-month follow-up. JASPER effects were also found on secondary outcomes of play diversity, highest play level achieved, and generalization to the child's classroom for child-initiated joint engagement. The PEI intervention was found to be effective in reducing parenting stress associated with child characteristics. All secondary effects were generally small to moderate. These data highlight the benefit of a brief, targeted, parent-mediated intervention on child outcomes. Future studies may consider the combination of JASPER and PEI treatments for optimal parent and child outcomes. Trial registry no. NCT00999778. (c) 2015 APA, all rights reserved).

Interventions targeting loneliness and social isolation among the older people: An update systematic review.

PubMed

Poscia, Andrea; Stojanovic, Jovana; La Milia, Daniele Ignazio; Duplaga, Mariusz; Grysztar, Marcin; Moscato, Umberto; Onder, Graziano; Collamati, Agnese; Ricciardi, Walter; Magnavita, Nicola

2018-02-01

This systematic review aims to summarize and update the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social isolation among older persons. A search of PubMed, ISI Web of science, SCOPUS, The Cochrane Library, and CINAHL databases was performed. The terminology combined all possible alternatives of the following keywords: social isolation, loneliness, old people, intervention and effectiveness. Eligible studies were published between January 2011 and February 2016 in English or Italian language and regarded the implementation of loneliness/social isolation interventions among the older generations. Outcome measures in terms of the intervention effects needed to be reported. In total, 15 quantitative and five qualitative studies were ultimately included in this review. Eighteen interventions were reported across the quantitative studies. Six out of 11 group interventions (55%), one out of four mixed interventions (25%) and all three individual interventions reported at least one significant finding related to loneliness or social isolation. Our review suggested that new technologies and community engaged arts might be seen as a promising tool for tackling social isolation and loneliness among the older individuals. Future studies need to work on methodological quality and take into consideration the suggestions of the present literature in order to provide firm evidence. Copyright © 2017 Elsevier Inc. All rights reserved.

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

Targeting Feeding and Eating Behaviors: Development of the Feeding Dynamic Intervention for Caregivers of 2- to 5-Year-Old Children

PubMed Central

Eneli, Ihuoma U.; Watowicz, Rosanna P.; Hummel, Jessica; Ritter, Jan; Lumeng, Julie C.

2015-01-01

Targeting feeding dynamics, a concept centered on the roles and interaction of the caregiver and child in a feeding relationship, may have significant potential for obesity intervention. The aim of this paper is to describe the 3-phase development of the Feeding Dynamics Intervention (FDI), an acceptability and feasibility study on implementing the feeding dynamic roles (Study 1), development of the FDI content (Study 2), and a pilot study on use of the 6-lesson FDI to promote behaviors consistent with a feeding dynamic approach (Study 3). Sample population was mothers with young children, 2–5 years old. An effect size (Hedges' g) greater than 0.20 was seen in more than half (57%) of maternal feeding behaviors, with the largest effect sizes (Hedges' g ≥ 0.8) occurring with behaviors that represent the mother adopting her roles of determining what food is served, not using food as a reward, and not controlling her child's intake. There was a significant decline in Pressure to Eat behaviors (2.9 versus 2.2, p < 0.01) and Monitoring (4.1 versus 3.5, p < 0.001). The FDI emerged as an acceptable and implementable intervention. Future studies need to investigate effects of the FDI on the child's eating behaviors, self-regulation of energy intake, and anthropometrics. PMID:26199741

A Systematic Review of Intervention Studies Examining Nutritional and Herbal Therapies for Mild Cognitive Impairment and Dementia Using Neuroimaging Methods: Study Characteristics and Intervention Efficacy

PubMed Central

MacMillan, Freya; Camfield, David A.; Seto, Sai W.

2017-01-01

Neuroimaging facilitates the assessment of complementary medicines (CMs) by providing a noninvasive insight into their mechanisms of action in the human brain. This is important for identifying the potential treatment options for target disease cohorts with complex pathophysiologies. The aim of this systematic review was to evaluate study characteristics, intervention efficacy, and the structural and functional neuroimaging methods used in research assessing nutritional and herbal medicines for mild cognitive impairment (MCI) and dementia. Six databases were searched for articles reporting on CMs, dementia, and neuroimaging methods. Data were extracted from 21/2,742 eligible full text articles and risk of bias was assessed. Nine studies examined people with Alzheimer's disease, 7 MCI, 4 vascular dementia, and 1 all-cause dementia. Ten studies tested herbal medicines, 8 vitamins and supplements, and 3 nootropics. Ten studies used electroencephalography (EEG), 5 structural magnetic resonance imaging (MRI), 2 functional MRI (fMRI), 3 cerebral blood flow (CBF), 1 single photon emission tomography (SPECT), and 1 positron emission tomography (PET). Four studies had a low risk of bias, with the majority consistently demonstrating inadequate reporting on randomisation, allocation concealment, blinding, and power calculations. A narrative synthesis approach was assumed due to heterogeneity in study methods, interventions, target cohorts, and quality. Eleven key recommendations are suggested to advance future work in this area. PMID:28303161

Challenges of a community based pragmatic, randomised controlled trial of weight loss maintenance.

PubMed

Randell, Elizabeth; McNamara, Rachel; Shaw, Christine; Espinasse, Aude; Simpson, Sharon Anne

2015-12-18

Randomised controlled trials (RCTs) have a reputation for being inherently difficult to deliver as planned and often face unforeseen challenges and delays, particularly in relation to organisational and governance difficulties, participant interest, constraints due to allocation of costs, local investigator interest and lengthy bureaucracy. Recruitment is often difficult and the challenges faced often impact on the cost and delivery of a successful trial within the funded period. This paper reflects upon the challenges faced in delivering a pragmatic RCT of weight loss maintenance in a community setting and suggests some potential solutions. The weight loss maintenance in adults trial aimed to evaluate the impact of a 12 month, individually tailored weight maintenance intervention on BMI 3 years from randomisation. Participants were recruited primarily from participant identification centres (PICs)-GP surgeries, exercise on referral schemes and slimming world. The intervention was delivered in community settings. A recruitment strategy implementation plan was drafted to address and monitor poor recruitment. Delays in opening and recruitment were experienced early on. Some were beyond the control of the study team such as; disagreement over allocation of national health service costs and PIC classification as well as difficulties in securing support from research networks. That the intervention was delivered in community settings was often at the root of these issues. Key items to address at the design stage of future trials include feasibility of eligibility criteria. The most effective element of the recruitment implementation plan was to refocus sources of recruitment and target only those who could fulfil the eligibility criteria immediately. Learnings from this trial should be kept in mind by those designing similar studies in the future. Considering potential governance, cost and research network support implications at the design stage of pragmatic trials of any community-based complex intervention is paramount. The appropriateness and viability of inclusion criteria also require careful consideration as does use of a targeted advertising strategy. ISRCTN35774128, 12/01/2010.

Predicting Health Resilience in Pediatric Type 1 Diabetes: A Test of the Resilience Model Framework.

PubMed

Rohan, Jennifer M; Huang, Bin; Pendley, Jennifer Shroff; Delamater, Alan; Dolan, Lawrence; Reeves, Grafton; Drotar, Dennis

2015-10-01

This research examined whether individual and family-level factors during the transition from late childhood to early adolescence protected individuals from an increased risk of poor glycemic control across time, which is a predictor of future diabetes-related complications (i.e., health resilience). This longitudinal, multisite study included 239 patients with type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c. Individual and family-level factors included: demographic variables, youth behavioral regulation, adherence (frequency of blood glucose monitoring), diabetes self-management, level of parental support for diabetes autonomy, level of youth mastery and responsibility for diabetes management, and diabetes-related family conflict. Longitudinal mixed-effects logistic regression indicated that testing blood glucose more frequently, better self-management, and less diabetes-related family conflict were indicators of health resilience. Multiple individual and family-level factors predicted risk for future health complications. Future research should develop interventions targeting specific individual and family-level factors to sustain glycemic control within recommended targets, which reduces the risk of developing future health complications during the transition to adolescence and adulthood. © The Author 2015. 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.

Integrated case management for work-related upper-extremity disorders: impact of patient satisfaction on health and work status.

PubMed

Feuerstein, Michael; Huang, Grant D; Ortiz, Jose M; Shaw, William S; Miller, Virginia I; Wood, Patricia M

2003-08-01

An integrated case management (ICM) approach (ergonomic and problem-solving intervention) to work-related upper-extremity disorders was examined in relation to patient satisfaction, future symptom severity, function, and return to work (RTW). Federal workers with work-related upper-extremity disorder workers' compensation claims (n = 205) were randomly assigned to usual care or ICM intervention. Patient satisfaction was assessed after the 4-month intervention period. Questionnaires on clinical outcomes and ergonomic exposure were administered at baseline and at 6- and 12-months postintervention. Time from intervention to RTW was obtained from an administrative database. ICM group assignment was significantly associated with greater patient satisfaction. Regression analyses found higher patient satisfaction levels predicted decreased symptom severity and functional limitations at 6 months and a shorter RTW. At 12 months, predictors of positive outcomes included male gender, lower distress, lower levels of reported ergonomic exposure, and receipt of ICM. Findings highlight the utility of targeting workplace ergonomic and problem solving skills.

Macro-Level Approaches to HIV Prevention Among Ethnic Minority Youth

PubMed Central

Prado, Guillermo; Lightfoot, Marguerita; Brown, C. Hendricks

2013-01-01

The HIV epidemic continues to disproportionately affect ethnic minority youth. These disconcerting health disparities indicate that although existing HIV preventive strategies for ethnic minority youth have been efficacious, they have not significantly reduced the impact of the epidemic in this population. Macro-level interventions, such as structural or policy interventions, have the potential to impact the HIV epidemic at a population level, and thus reduce the HIV health disparities that exist among ethnic minority youth and other segments of the U.S. population. This article calls for a paradigm shift to develop, evaluate, and disseminate interventions that target upstream/macro-level factors or that, at a minimum, integrate both a macro and individual level perspective. The article also discusses the challenges in developing and evaluating such interventions. Psychologists and other behavioral scientists can play a critical role in reducing the impact of HIV on ethnic minority youth by integrating macro-level approaches to future HIV prevention strategies. PMID:23688095

Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence

PubMed Central

Boyd, Jenna E.; Lanius, Ruth A.; McKinnon, Margaret C.

2018-01-01

Mindfulness-based treatments for posttraumatic stress disorder (PTSD) have emerged as promising adjunctive or alternative intervention approaches. A scoping review of the literature on PTSD treatment studies, including approaches such as mindfulness-based stress reduction, mindfulness-based cognitive therapy and metta mindfulness, reveals low attrition with medium to large effect sizes. We review the convergence between neurobiological models of PTSD and neuroimaging findings in the mindfulness literature, where mindfulness interventions may target emotional under- and overmodulation, both of which are critical features of PTSD symptomatology. Recent emerging work indicates that mindfulness-based treatments may also be effective in restoring connectivity between large-scale brain networks among individuals with PTSD, including connectivity between the default mode network and the central executive and salience networks. Future directions, including further identification of the neurobiological mechanisms of mindfulness interventions in patients with PTSD and direct comparison of these interventions to first-line treatments for PTSD are discussed. PMID:29252162

Family process and youth internalizing problems: A triadic model of etiology and intervention.

PubMed

Schleider, Jessica L; Weisz, John R

2017-02-01

Despite major advances in the development of interventions for youth anxiety and depression, approximately 30% of youths with anxiety do not respond to cognitive behavioral treatment, and youth depression treatments yield modest symptom decreases overall. Identifying networks of modifiable risk and maintenance factors that contribute to both youth anxiety and depression (i.e., internalizing problems) may enhance and broaden treatment benefits by informing the development of mechanism-targeted interventions. A particularly powerful network is the rich array of family processes linked to internalizing problems (e.g., parenting styles, parental mental health problems, and sibling relationships). Here, we propose a new theoretical model, the triadic model of family process, to organize theory and evidence around modifiable, transdiagnostic family factors that may contribute to youth internalizing problems. We describe the model's implications for intervention, and we propose strategies for testing the model in future research. The model provides a framework for studying associations among family processes, their relation to youth internalizing problems, and family-based strategies for strengthening prevention and treatment.

Videos to influence: a systematic review of effectiveness of video-based education in modifying health behaviors.

PubMed

Tuong, William; Larsen, Elizabeth R; Armstrong, April W

2014-04-01

This systematic review examines the effectiveness of videos in modifying health behaviors. We searched PubMed (1975-2012), PsycINFO (1975-2012), EMBASE (1975-2012), and CINAHL (1983-2012) for controlled clinical trials that examined the effectiveness of video interventions in changing health behaviors. Twenty-eight studies comprised of 12,703 subjects were included in the systematic review. Video interventions were variably effective for modifying health behaviors depending on the target behaviors to be influenced. Video interventions appear to be effective in breast self-examination, prostate cancer screening, sunscreen adherence, self-care in patients with heart failure, HIV testing, treatment adherence, and female condom use. However, videos have not shown to be effective in influencing addiction behaviors when they are not tailored. Compared to loss-framing, gain-framed messages may be more effective in promoting certain types of health behavior change. Also, video modeling may facilitate learning of new behaviors and can be an important consideration in future video interventions.

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

High-Intensity Focused Ultrasound Therapy: an Overview for Radiologists

PubMed Central

Kim, Young-sun; Choi, Min Joo; Lim, Hyo Keun; Choi, Dongil

2008-01-01

High-intensity focused ultrasound therapy is a novel, emerging, therapeutic modality that uses ultrasound waves, propagated through tissue media, as carriers of energy. This completely non-invasive technology has great potential for tumor ablation as well as hemostasis, thrombolysis and targeted drug/gene delivery. However, the application of this technology still has many drawbacks. It is expected that current obstacles to implementation will be resolved in the near future. In this review, we provide an overview of high-intensity focused ultrasound therapy from the basic physics to recent clinical studies with an interventional radiologist's perspective for the purpose of improving the general understanding of this cutting-edge technology as well as speculating on future developments. PMID:18682666

Understanding adherence to treatment and physical activity in children with hemophilia: The role of psychosocial factors.

PubMed

Bérubé, Sarah; Cloutier-Bergeron, Audrey; Amesse, Claudine; Sultan, Serge

2017-02-01

The objective of this study was to identify psychosocial factors to explain intentions of children and adolescents with hemophilia to adhere to recommendations for self-care. Twenty-four patients with hemophilia A and B, aged 6-18 years old, and their parents, completed a survey. Measures assessed factors from the theory of planned behavior, physical activity, and medical treatment adherence. The results indicate that past behaviors, attitudes, and subjective norms explained a large proportion of the intention to engage in future nonrecommended physical activity. This study supports the need to investigate motivational factors underlying behaviors in larger scale studies and identifies targets for future interventions.

Reducing sexual risk behaviors: secondary analyses from a randomized controlled trial of a brief web-based alcohol intervention for underage, heavy episodic drinking college women.

PubMed

Bountress, Kaitlin E; Metzger, Isha W; Maples-Keller, Jessica L; Gilmore, Amanda K

2017-01-01

Alcohol use and sexual risk behaviors (SRBs) are significant problems on college campuses. College women are at particularly high risk for negative consequences associated with sexually transmitted infections (STIs) and unwanted pregnancy. The current study ( n = 160) examined the effect of a brief, web-based alcohol intervention ( n = 53) for college women on reducing SRBs compared to an assessment only control ( n = 107) with a randomized controlled trial. Outcome measures included condom use assertiveness and number of vaginal sex partners and data were collected at baseline and three-month follow-up. Regression analyses revealed that the alcohol intervention was associated with higher levels of condom use assertiveness at a three-month follow-up. Additionally, more alcohol use was associated with less condom use assertiveness for those with more significant sexual assault histories. These findings suggest that alcohol interventions may impact college women's beliefs but not behavior, and future interventions should more explicitly target both alcohol and sexual risk to decrease risky behaviors.

Interventions to reduce adverse health outcomes resulting from manifestations of gender bias amongst immigrant populations: a scoping review.

PubMed

Januwalla, Alia; Pulver, Ariel; Wanigaratne, Susitha; O'Campo, Patricia; Urquia, Marcelo L

2018-06-19

Immigrants to Western countries increasingly originate from countries with pervasive gender inequalities, where women experience disproportionately high rates of threats to their well-being. Health and social services in countries of settlement encounter several adverse outcomes linked to gender bias among immigrant groups. Little is known about interventions implemented to address manifestations of gender bias among immigrant populations. A scoping review was undertaken to describe the literature on existing interventions and determine knowledge gaps. Nine academic and grey literature databases were searched for literature, with four reviewers screening the results. Of the 29 included reports, most targeted domestic violence amongst the Latino population in the United States, with few interventions focusing on other outcomes, populations, and settings. The majority reported achieving their objective, although 13 interventions were not evaluated. Future research and practice to address gender bias among immigrants may benefit from expanding on ethnic diversity, designing and reporting evaluations, addressing the context of gender inequities, tailoring to local community needs, and engaging community-based groups.

Is there an app for that? Mobile phones and secondary prevention of cardiovascular disease.

PubMed

Neubeck, Lis; Cartledge, Susie; Dawkes, Susan; Gallagher, Robyn

2017-09-01

Advances in technology coupled with increased penetration of mobile phones and smart devices are rapidly changing healthcare delivery. Mobile phone applications ('apps'), text messages, and Internet platforms used alone or in combination are now providing interventions targeting people with multiple cardiovascular risk factors. The present article will review the emerging evidence regarding apps and discuss their potential role in providing secondary prevention interventions via mobile phones. Seven recent randomized controlled trials used text messages or apps for six to 12 months, with or without differing combinations of other technology platforms. All studies, involved cardiac and diabetes populations, and demonstrated at least one positive improvement to cardiovascular risk factor profiles. When measured, acceptability of the intervention was high. Mobile apps and technology can deliver positive outcomes in the management of cardiovascular risk factors. However, because of the complexity of combination interventions, it is difficult to determine the 'active' ingredient. A future challenge for researchers and clinicians will be to respond quickly to these rapidly evolving interventions in order to ensure the delivery of effective, evidence-based outcomes.

Systematic review of HIV prevention interventions in China: a health communication perspective.

PubMed

Xiao, Zhiwen; Noar, Seth M; Zeng, Lily

2014-02-01

To examine whether communication strategies and principles have been utilized in the HIV prevention intervention programs conducted in China. Comprehensive literature searches were conducted using PsycINFO, Medline, and Academic Search Complete with combinations of a number of keywords. Studies were included if they (1) were conducted in China and published prior to October 2011; (2) tested interventions promoting HIV/sexual risk reduction; and (3) reported empirical outcome evaluations on HIV knowledge, condom use and other condom-related variables. Data on 11 dimensions were extracted and analyzed, including formative research, theory, message targeting, messenger and channels, process evaluation, evaluation design, outcome measures. The majority of the 45 intervention studies were not theory-based, did not report conducting formative research or process evaluation, used pretest-posttest control group designs, combined nonmedia channels, printed and visual materials, and employed HIV knowledge and condom use as outcome measures. Many HIV prevention interventions in China have been successful in reducing HIV risk-related outcomes. This literature has its weaknesses; however, the current review illuminates gaps in the literature and points to important future directions for research.

Peer Coaching Interventions for Parents of Children with Type 1 Diabetes.

PubMed

Tully, Carrie; Shneider, Caitlin; Monaghan, Maureen; Hilliard, Marisa E; Streisand, Randi

2017-06-01

Peer support is a promising model of providing psychosocial support to parents of children with type 1 diabetes. This review seeks to discuss the findings of the existing literature in peer coaching as it relates to parents and diabetes as well as to identify gaps in knowledge for future intervention development and implementation. Peer support programs vary widely with regard to recruitment, training, and delivery protocols. Across most programs, ongoing support and supervision are provided to peer coaches. Despite inconsistent effects on psychosocial and child health outcomes, parent coaching is consistently a highly acceptable and feasible intervention with parents of children with T1D. Current evidence supports use of parent coaching as part of a multicomponent intervention or program to increase patient satisfaction, but more research is needed to determine if it can stand alone as an active mechanism for behavior change. The use of peer coach interventions for parents of young children with diabetes is feasible to implement and highly acceptable. However, more research is needed to understand the enduring impact for target parents and peer coaches alike, as well as impact on child outcomes.

Reducing sexual risk behaviors: secondary analyses from a randomized controlled trial of a brief web-based alcohol intervention for underage, heavy episodic drinking college women

PubMed Central

Bountress, Kaitlin E.; Metzger, Isha W.; Maples-Keller, Jessica L.; Gilmore, Amanda K.

2017-01-01

Background Alcohol use and sexual risk behaviors (SRBs) are significant problems on college campuses. College women are at particularly high risk for negative consequences associated with sexually transmitted infections (STIs) and unwanted pregnancy. Methods The current study (n = 160) examined the effect of a brief, web-based alcohol intervention (n = 53) for college women on reducing SRBs compared to an assessment only control (n = 107) with a randomized controlled trial. Outcome measures included condom use assertiveness and number of vaginal sex partners and data were collected at baseline and three-month follow-up. Results Regression analyses revealed that the alcohol intervention was associated with higher levels of condom use assertiveness at a three-month follow-up. Additionally, more alcohol use was associated with less condom use assertiveness for those with more significant sexual assault histories. Conclusions These findings suggest that alcohol interventions may impact college women’s beliefs but not behavior, and future interventions should more explicitly target both alcohol and sexual risk to decrease risky behaviors. PMID:28428737

A systematic review of electronic audit and feedback: intervention effectiveness and use of behaviour change theory.

PubMed

Tuti, Timothy; Nzinga, Jacinta; Njoroge, Martin; Brown, Benjamin; Peek, Niels; English, Mike; Paton, Chris; van der Veer, Sabine N

2017-05-12

Audit and feedback is a common intervention for supporting clinical behaviour change. Increasingly, health data are available in electronic format. Yet, little is known regarding if and how electronic audit and feedback (e-A&F) improves quality of care in practice. The study aimed to assess the effectiveness of e-A&F interventions in a primary care and hospital context and to identify theoretical mechanisms of behaviour change underlying these interventions. In August 2016, we searched five electronic databases, including MEDLINE and EMBASE via Ovid, and the Cochrane Central Register of Controlled Trials for published randomised controlled trials. We included studies that evaluated e-A&F interventions, defined as a summary of clinical performance delivered through an interactive computer interface to healthcare providers. Data on feedback characteristics, underlying theoretical domains, effect size and risk of bias were extracted by two independent review authors, who determined the domains within the Theoretical Domains Framework (TDF). We performed a meta-analysis of e-A&F effectiveness, and a narrative analysis of the nature and patterns of TDF domains and potential links with the intervention effect. We included seven studies comprising of 81,700 patients being cared for by 329 healthcare professionals/primary care facilities. Given the extremely high heterogeneity of the e-A&F interventions and five studies having a medium or high risk of bias, the average effect was deemed unreliable. Only two studies explicitly used theory to guide intervention design. The most frequent theoretical domains targeted by the e-A&F interventions included 'knowledge', 'social influences', 'goals' and 'behaviour regulation', with each intervention targeting a combination of at least three. None of the interventions addressed the domains 'social/professional role and identity' or 'emotion'. Analyses identified the number of different domains coded in control arm to have the biggest role in heterogeneity in e-A&F effect size. Given the high heterogeneity of identified studies, the effects of e-A&F were found to be highly variable. Additionally, e-A&F interventions tend to implicitly target only a fraction of known theoretical domains, even after omitting domains presumed not to be linked to e-A&F. Also, little evaluation of comparative effectiveness across trial arms was conducted. Future research should seek to further unpack the theoretical domains essential for effective e-A&F in order to better support strategic individual and team goals.

Effectiveness of Sleep-Based Interventions for Children with Autism Spectrum Disorder: A Meta-Synthesis.

PubMed

Cuomo, Belinda M; Vaz, Sharmila; Lee, Elinda Ai Lim; Thompson, Craig; Rogerson, Jessica M; Falkmer, Torbjorn

2017-05-01

Sleep problems are common in children with autism spectrum disorder (ASD). This meta-synthesis collated eight previously published systematic reviews examining the efficacy of sleep interventions in children with ASD in an attempt to present a clear analysis of trialed interventions. The collated reviews consider five major groups of sleep interventions for children with ASD: melatonin therapy, pharmacologic treatments other than melatonin, behavioral interventions, parent education/education programs, and alternative therapies (massage therapy, aromatherapy, and multivitamin and iron supplementation). These eight reviews were based on 38 original studies and address the efficacy of interventions across 17 sleep problem domains. The results of this meta-synthesis suggest that no single intervention is effective across all sleep problems in children with ASD. However, melatonin, behavioral interventions, and parent education/education program interventions appear the most effective at ameliorating multiple domains of sleep problems compared with other interventions. Due to the heterogeneous causative factors and presentations of disordered sleep, further research into the effectiveness of sleep interventions may target specific phenotypic subgroups rather than a broad analysis across the general ASD population. Similarly, future research needs to consider the efficacy of different polytherapeutic approaches in order to provide clinicians with evidence to inform best practice. In the meantime, this review supports clinicians' decision making for a majority of the identified sleep problems in the ASD population. © 2017 Pharmacotherapy Publications, Inc.

How much can we save? Impact of different emission scenarios on future snow cover in the Alps

NASA Astrophysics Data System (ADS)

Marty, Christoph; Schlögl, Sebastian; Bavay, Mathias; Lehning, Michael

2017-02-01

This study focuses on an assessment of the future snow depth for two larger Alpine catchments. Automatic weather station data from two diverse regions in the Swiss Alps have been used as input for the Alpine3D surface process model to compute the snow cover at a 200 m horizontal resolution for the reference period (1999-2012). Future temperature and precipitation changes have been computed from 20 downscaled GCM-RCM chains for three different emission scenarios, including one intervention scenario (2 °C target) and for three future time periods (2020-2049, 2045-2074, 2070-2099). By applying simple daily change values to measured time series of temperature and precipitation, small-scale climate scenarios have been calculated for the median estimate and extreme changes. The projections reveal a decrease in snow depth for all elevations, time periods and emission scenarios. The non-intervention scenarios demonstrate a decrease of about 50 % even for elevations above 3000 m. The most affected elevation zone for climate change is located below 1200 m, where the simulations show almost no snow towards the end of the century. Depending on the emission scenario and elevation zone the winter season starts half a month to 1 month later and ends 1 to 3 months earlier in this last scenario period. The resulting snow cover changes may be roughly equivalent to an elevation shift of 500-800 or 700-1000 m for the two non-intervention emission scenarios. At the end of the century the number of snow days may be more than halved at an elevation of around 1500 m and only 0-2 snow days are predicted in the lowlands. The results for the intervention scenario reveal no differences for the first scenario period but clearly demonstrate a stabilization thereafter, comprising much lower snow cover reductions towards the end of the century (ca. 30 % instead of 70 %).

A theory-based online health behaviour intervention for new university students (U@Uni:LifeGuide): results from a repeat randomized controlled trial.

PubMed

Cameron, David; Epton, Tracy; Norman, Paul; Sheeran, Paschal; Harris, Peter R; Webb, Thomas L; Julious, Steven A; Brennan, Alan; Thomas, Chloe; Petroczi, Andrea; Naughton, Declan; Shah, Iltaf

2015-12-07

This paper reports the results of a repeat trial assessing the effectiveness of an online theory-based intervention to promote healthy lifestyle behaviours in new university students. The original trial found that the intervention reduced the number of smokers at 6-month follow-up compared with the control condition, but had non-significant effects on the other targeted health behaviours. However, the original trial suffered from low levels of engagement, which the repeat trial sought to rectify. Three weeks before staring university, all incoming undergraduate students at a large university in the UK were sent an email inviting them to participate in the study. After completing a baseline questionnaire, participants were randomly allocated to intervention or control conditions. The intervention consisted of a self-affirmation manipulation, health messages based on the theory of planned behaviour and implementation intention tasks. Participants were followed-up 1 and 6 months after starting university. The primary outcome measures were portions of fruit and vegetables consumed, physical activity levels, units of alcohol consumed and smoking status at 6-month follow-up. The study recruited 2,621 students (intervention n=1346, control n=1275), of whom 1495 completed at least one follow-up (intervention n=696, control n=799). Intention-to-treat analyses indicated that the intervention had a non-significant effect on the primary outcomes, although the effect of the intervention on fruit and vegetable intake was significant in the per-protocol analyses. Secondary analyses revealed that the intervention had significant effects on having smoked at university (self-report) and on a biochemical marker of alcohol use. Despite successfully increasing levels of engagement, the intervention did not have a significant effect on the primary outcome measures. The relatively weak effects of the intervention, found in both the original and repeat trials, may be due to the focus on multiple versus single health behaviours. Future interventions targeting the health behaviour of new university students should therefore focus on single health behaviours. Current Controlled Trials ISRCTN07407344 .

Development and preliminary evaluation of an integrated treatment targeting parenting and depressive symptoms in mothers of children with attention-deficit/hyperactivity disorder.

PubMed

Chronis-Tuscano, Andrea; Clarke, Tana L; O'Brien, Kelly A; Raggi, Veronica L; Diaz, Yamalis; Mintz, Abigail D; Rooney, Mary E; Knight, Laura A; Seymour, Karen E; Thomas, Sharon R; Seeley, John; Kosty, Derek; Lewinsohn, Peter

2013-10-01

More than 50% of mothers of children with attention-deficit/hyperactivity disorder (ADHD) have a lifetime history of major depressive disorder (MDD). Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD. For these reasons, we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD. This integrated intervention incorporated elements of 2 evidence-based treatments: behavioral parent training (BPT) and cognitive behavioral depression treatment. Ninety-eight mothers with at least mild depressive symptoms were randomized to receive either standard BPT (n = 51) or the integrated parenting intervention for ADHD (IPI-A; n = 47). Participants were assessed at baseline, posttreatment, and 3- to 6-month follow-up on measures of (a) self-reported maternal depressive symptoms, (b) observed positive and negative parenting, and (c) observed and mother-reported child disruptive behavior and mother-reported child and family impairment. The IPI-A produced effects of small to moderate magnitude relative to BPT on maternal depressive symptoms, observed negative parenting, observed child deviance, and child impairment at posttreatment and on maternal depressive symptoms, child disruptive behavior, child impairment and family functioning at follow-up. Contrary to expectations, the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up. This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD. Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Understanding women's mammography intentions: a theory-based investigation.

PubMed

Naito, Mikako; O'Callaghan, Frances V; Morrissey, Shirley

2009-01-01

The present study compared the utility of two models (the Theory of Planned Behavior and Protection Motivation Theory) in identifying factors associated with intentions to undertake screening mammography, before and after an intervention. The comparison was made between the unique components of the two models. The effect of including implementation intentions was also investigated. Two hundred and fifty-one women aged 37 to 69 years completed questionnaires at baseline and following the delivery of a standard (control) or a protection motivation theory-based informational intervention. Hierarchical multiple regressions indicated that theory of planned behavior variables were associated with mammography intentions. Results also showed that inclusion of implementation intention in the model significantly increased the association with mammography intentions. The findings suggest that future interventions aiming to increase screening mammography participation should focus on the theory of planned behavior variables and that implementation intention should also be targeted.

Youth, Technology and HIV: Recent Advances and Future Directions

PubMed Central

Hightow-Weidman, Lisa B.; Muessig, Kathryn E.; Bauermeister, Jose; Zhang, Chen; LeGrand, Sara

2015-01-01

Technology, including mobile technologies and social media, offers powerful tools to reach, engage, and retain youth and young adults in HIV prevention and care interventions both in the United States and globally. In this report we focus on HIV, technology, and youth, presenting a synthesis of recently published (Jan 2014-May 2015) observational and experimental studies relevant for understanding and intervening on HIV risk, prevention and care. We present findings from a selection of the 66 relevant citations identified, highlighting studies that demonstrate a novel approach to technology interventions among youth in regard to content, delivery, target population or public health impact. We discuss current trends globally and in the US in how youth are using technology, as well as emergent research issues in this field – including the need for new theories for developing technology-based HIV interventions and new metrics of engagement, exposure, and evaluation. PMID:26385582

Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials.

PubMed

Ebert, David Daniel; Zarski, Anna-Carlotta; Christensen, Helen; Stikkelbroek, Yvonne; Cuijpers, Pim; Berking, Matthias; Riper, Heleen

2015-01-01

Anxiety and depression in children and adolescents are undertreated. Computer- and Internet-based cognitive behavioral treatments (cCBT) may be an attractive treatment alternative to regular face-to-face treatment.This meta-analysis aims to evaluate whether cCBT is effective for treating symptoms of anxiety and depression in youth. We conducted systematic searches in bibliographical databases (Pubmed, Cochrane controlled trial register, PsychInfo) up to December 4, 2013. Only randomized controlled trials in which a computer-, Internet- or mobile-based cognitive behavioral intervention targeting either depression, anxiety or both in children or adolescents up to the age of 25 were compared to a control condition were selected. We employed a random-effects pooling model in overall effect analyses and a mixed effect model for sub-group analyses. Searches resulted in identifying 13 randomized trials, including 796 children and adolescents that met inclusion criteria. Seven studies were directed at treating anxiety, four studies at depression, and two were of a transdiagnostic nature, targeting both anxiety and depression. The overall mean effect size (Hedges' g) of cCBT on symptoms of anxiety or depression at post-test was g=0.72 (95% CI:0.55-0.90, numbers needed to be treated (NNT)=2.56). Heterogeneity was low (I²=20.14%, 95% CI: 0-58%). The superiority of cCBT over controls was evident for interventions targeting anxiety (g=0.68; 95% CI: 0.45-0.92; p < .001; NNT=2.70) and for interventions targeting depression (g=0.76; 95% CI: 0.41-0.12; p < .001; NNT=2.44) as well as for transdiagnostic interventions (g=0.94; 95% CI: 0.23-2.66; p < .001; NNT=2.60). Results provide evidence for the efficacy of cCBT in the treatment of anxiety and depressive symptoms in youth. Hence, such interventions may be a promising treatment alternative when evidence based face-to-face treatment is not feasible. Future studies should examine long-term effects of treatments and should focus on obtaining patient-level data from existing studies, to perform an individual patient data meta-analysis.

Pharmacogenomic strategies against microbial resistance: from bright to bleak to innovative.

PubMed

Dandekar, Thomas; Dandekar, Gudrun

2010-09-01

The last decade saw an alarming increase in antibiotic resistance in infections, with more than 13 million deaths per year from infections. Counter strategies include hygiene, antibiotic restriction and new antibiotics such as quinupristin, linezolid, tigecycline, daptomycin and dalbavancin. Presently, pharmacogenomics with basic research is revealing new antimicrobial peptides and is applying old drugs in new ways to break resistance. New approaches with host-directed drug targeting emerge to circumvent resistance. A future systems perspective from large-scale molecular techniques and bioinformatic modeling allows pharmacogenomics to reveal new intervention angles. This includes the fight against resistance and its transmission, improved vaccines, disarmament of microbes and antibiotic options from novel molecular targets (lipids, RNA and carbohydrates). Such a system perspective is also essential for improved diagnostics and individualized medicine. However, an increase in public awareness and closer cooperation of industry and basic research are essential to turn research into powerful new drugs that will enable us to treat new arising infections in the future.

Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes.

PubMed

Silver, Julie K; Baima, Jennifer

2013-08-01

Cancer prehabilitation, a process on the continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment, includes physical and psychological assessments that establish a baseline functional level, identifies impairments, and provides targeted interventions that improve a patient's health to reduce the incidence and the severity of current and future impairments. There is a growing body of scientific evidence that supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments. This is the first review of cancer prehabilitation, and the purpose was to describe early studies in the noncancer population and then the historical focus in cancer patients on aerobic conditioning and building strength and stamina through an appropriate exercise regimen. More recent research shows that opportunities exist to use other unimodal or multimodal prehabilitation interventions to decrease morbidity, improve physical and psychological health outcomes, increase the number of potential treatment options, decrease hospital readmissions, and reduce both direct and indirect healthcare costs attributed to cancer. Future research may demonstrate increased compliance with acute cancer treatment protocols and, therefore, improved survival outcomes. New studies suggest that a multimodal approach that incorporates both physical and psychological prehabilitation interventions may be more effective than a unimodal approach that addresses just one or the other. In an impairment-driven cancer rehabilitation model, identifying current and anticipating future impairments are the critical first steps in improving healthcare outcomes and decreasing costs. More research is urgently needed to evaluate the most effective prehabilitation interventions, and combinations thereof, for survivors of all types of cancer.

Improving Translation from Preclinical Studies to Clinical Trials in Acute Kidney Injury.

PubMed

Fiorentino, Marco; Kellum, John A

2018-05-23

Several cellular and molecular targets and mechanisms have been investigated in preclinical studies of acute kidney injury (AKI), but translation in successful clinical studies has failed to date. This article reviews many issues that have limited this and the potential future perspectives in AKI prevention and treatment. Preclinical models of AKI should closely mimic the complexity of human AKI, considering the importance of several comorbidities in determining the clinical course and outcomes in the human disease. Moreover, studies should test novel interventions in models where AKI is already established, instead of focusing only at primary prevention. AKI definitions and endpoints in animal studies should be similar to those applied in clinical studies; in particular, AKI biomarkers should be implemented to guide patient selection for clinical trials and monitor intervention efficacy. In this scenario, cell-cycle arrest biomarkers have been widely investigated as AKI predictors in both preclinical and clinical studies and they serve as useful tools for future interventional studies. A better understanding of human AKI through a large collection of biological samples and kidney biopsies and omics applications, and an iterative relationship between preclinical and clinical studies are critical steps to improve future preclinical models and clinical trials. Finally, given the great variability in clinical manifestation of AKI, a strong collaboration between research centers and industry is recommended. Key messages: Several methodological issues have hampered the translation of basic research findings in clinical studies, and overcoming these obstacles is necessary to achieve success. © 2018 S. Karger AG, Basel.

Review of parental activation interventions for parents of children with special health care needs.

PubMed

Mirza, M; Krischer, A; Stolley, M; Magaña, S; Martin, M

2018-05-01

A large number of U.S. children are identified as having special health care needs (CSHCN). Despite parents' central role in managing their child's needs, many parents report difficulties in navigating service systems, finding information about their child's condition, and accessing health care and community resources. Therefore, there is a need for interventions that "activate" parents of children with special health care needs to increase their knowledge, skills, and confidence in managing, coordinating, and advocating for their child's needs. This study sought to review the existing literature and examine the effects of parent support interventions that focus on parental activation either in part or whole, on child, parent, or family outcomes. Specific aims included (a) summarizing the nature and content of interventions; (b) describing changes in relevant outcomes; (c) identifying limitations and making recommendations for future research. Following electronic databases were searched: MEDLINE, EMBASE, PsycINFO via ProQuest, PubMed, Cumulative Index to Nursing and Allied Health via EBSCO, Education Resources Information Center (ERIC) via ProQuest, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), and Google Scholar. Twenty-two studies were selected, data were extracted, and quality was assessed using standardized procedures. Five intervention categories were identified: parent-to-parent supports, psycho-educational groups, content-specific groups, community health worker model, and self-management-based interventions. Although most studies showed positive effects of the intervention, evidence was inconsistent for parental outcomes such as self-efficacy, confidence, strain, depression, and perceived social support. Evidence was more consistent in showing improvement in parent coping and in use of community-based services and resources. There is a need to boost active ingredients of interventions that specifically target enhancing parent skill sets relevant to areas of self-efficacy, confidence, and empowerment. Future studies must also adapt intervention and study design to recruit socioeconomically vulnerable families. © 2018 John Wiley & Sons Ltd.

mHealth Interventions for Health System Strengthening in China: A Systematic Review

PubMed Central

Zhang, Jing; Luo, Rong; Chen, Shi; Petrovic, Djordje; Redfern, Julie; Xu, Dong Roman; Patel, Anushka

2017-01-01

Background With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. Objective The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. Methods We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. Results A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. Conclusions We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care. PMID:28302597

Social network targeting to maximise population behaviour change: a cluster randomised controlled trial.

PubMed

Kim, David A; Hwong, Alison R; Stafford, Derek; Hughes, D Alex; O'Malley, A James; Fowler, James H; Christakis, Nicholas A

2015-07-11

Information and behaviour can spread through interpersonal ties. By targeting influential individuals, health interventions that harness the distributive properties of social networks could be made more effective and efficient than those that do not. Our aim was to assess which targeting methods produce the greatest cascades or spillover effects and hence maximise population-level behaviour change. In this cluster randomised trial, participants were recruited from villages of the Department of Lempira, Honduras. We blocked villages on the basis of network size, socioeconomic status, and baseline rates of water purification, for delivery of two public health interventions: chlorine for water purification and multivitamins for micronutrient deficiencies. We then randomised villages, separately for each intervention, to one of three targeting methods, introducing the interventions to 5% samples composed of either: randomly selected villagers (n=9 villages for each intervention); villagers with the most social ties (n=9); or nominated friends of random villagers (n=9; the last strategy exploiting the so-called friendship paradox of social networks). Participants and data collectors were not aware of the targeting methods. Primary endpoints were the proportions of available products redeemed by the entire population under each targeting method. This trial is registered with ClinicalTrials.gov, number NCT01672580. Between Aug 4, and Aug 14, 2012, 32 villages in rural Honduras (25-541 participants each; total study population of 5773) received public health interventions. For each intervention, nine villages (each with 1-20 initial target individuals) were randomised, using a blocked design, to each of the three targeting methods. In nomination-targeted villages, 951 (74·3%) of 1280 available multivitamin tickets were redeemed compared with 940 (66·2%) of 1420 in randomly targeted villages and 744 (61·0%) of 1220 in indegree-targeted villages. All pairwise differences in redemption rates were significant (p<0·01) after correction for multiple comparisons. Targeting nominated friends increased adoption of the nutritional intervention by 12·2% compared with random targeting (95% CI 6·9-17·9). Targeting the most highly connected individuals, by contrast, produced no greater adoption of either intervention, compared with random targeting. Introduction of a health intervention to the nominated friends of random individuals can enhance that intervention's diffusion by exploiting intrinsic properties of human social networks. This method has the additional advantage of scalability because it can be implemented without mapping the network. Deployment of certain types of health interventions via network targeting, without increasing the number of individuals targeted or the resources used, could enhance the adoption and efficiency of those interventions, thereby improving population health. National Institutes of Health, The Bill & Melinda Gates Foundation, Star Family Foundation, and the Canadian Institutes of Health Research. Copyright © 2015 Elsevier Ltd. All rights reserved.

Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework.

PubMed

Little, Elizabeth A; Presseau, Justin; Eccles, Martin P

2015-06-17

Behavioural theory can be used to better understand the effects of behaviour change interventions targeting healthcare professional behaviour to improve quality of care. However, the explicit use of theory is rarely reported despite interventions inevitably involving at least an implicit idea of what factors to target to implement change. There is a quality of care gap in the post-fracture investigation (bone mineral density (BMD) scanning) and management (bisphosphonate prescription) of patients at risk of osteoporosis. We aimed to use the Theoretical Domains Framework (TDF) within a systematic review of interventions to improve quality of care in post-fracture investigation. Our objectives were to explore which theoretical factors the interventions in the review may have been targeting and how this might be related to the size of the effect on rates of BMD scanning and osteoporosis treatment with bisphosphonate medication. A behavioural scientist and a clinician independently coded TDF domains in intervention and control groups. Quantitative analyses explored the relationship between intervention effect size and total number of domains targeted, and as number of different domains targeted. Nine randomised controlled trials (RCTs) (10 interventions) were analysed. The five theoretical domains most frequently coded as being targeted by the interventions in the review included "memory, attention and decision processes", "knowledge", "environmental context and resources", "social influences" and "beliefs about consequences". Each intervention targeted a combination of at least four of these five domains. Analyses identified an inverse relationship between both number of times and number of different domains coded and the effect size for BMD scanning but not for bisphosphonate prescription, suggesting that the more domains the intervention targeted, the lower the observed effect size. When explicit use of theory to inform interventions is absent, it is possible to retrospectively identify the likely targeted factors using theoretical frameworks such as the TDF. In osteoporosis management, this suggested that several likely determinants of healthcare professional behaviour appear not yet to have been considered in implementation interventions. This approach may serve as a useful basis for using theory-based frameworks such as the TDF to retrospectively identify targeted factors within systematic reviews of implementation interventions in other implementation contexts.

Evaluation of interventions to prevent injuries: an overview

PubMed Central

Dannenberg, A.; Fowler, C.

1998-01-01

Overview of issues involved in evaluating the effectiveness of injury interventions is presented. An intervention should be evaluated to show it prevents injuries in the target population, to identify unintended consequences, to correct problems that limit effectiveness, to justify current and future resources from funding agencies, and to guide its replication elsewhere. Problems in conducting evaluations include obtaining sufficient resources, coping with rare events, establishing reliability and validity of measurement instruments, separating effects of multiple simultaneous events, and adjusting for the time lag between an intervention and its effects. When feasible, changes in injury rates (documented by medical records) should be used. These are more convincing for demonstrating intervention effectiveness than changes in observed or reported behaviors or in knowledge and attitudes (documented by surveys). Quasiexperimental evaluation designs are often useful, such as measuring injury rates before and after an intervention in a time series design, or intervening in one of two comparable communities in a non-equivalent control group design. Evaluations using true experimental designs, in which individuals or groups are randomized to receive or not receive an intervention, are highly desirable but are often difficult due to logistical or ethical considerations. An evaluation component should be integral to the introduction of any new injury intervention. PMID:9666371

The Efficacy of Behavioral Interventions in Reducing HIV Risk Behaviors and Incident Sexually Transmitted Diseases in Heterosexual African Americans

PubMed Central

Darbes, Lynae; Crepaz, Nicole; Lyles, Cynthia; Kennedy, Gail; Rutherford, George

2009-01-01

Objective To conduct a meta-analytic review of HIV interventions for heterosexual African Americans to determine the overall efficacy in reducing HIV-risk sex behaviors and incident sexually transmitted diseases (STD) and identify intervention characteristics associated with efficacy. Methods Comprehensive searches included electronic databases from 1988 to 2005, handsearches of journals, reference lists of articles, and contacts with researchers. Thirty-eight randomized controlled trials met the selection criteria. Random-effects models were used to aggregate data. Results Interventions significantly reduced unprotected sex (OR = 0.75, 95% CI = 0.67, 0.84, 35 trials, N = 14,682) and marginally significantly decreased incident STD (OR = 0.88, 95% CI = 0.72, 1.07, 10 trials, n = 10,944). Intervention characteristics associated with efficacy include: (1) culturally tailored, (2) aiming to influence social norms in promoting safe sex behaviour, (3) utilizing peer education, (4) providing skills training on correct use of condoms and communication skills needed for negotiating safer sex, and (5) multiple sessions and opportunities to practice learned skills. Conclusion Interventions targeting heterosexual African Americans are efficacious in reducing HIV-risk sex behaviors. Efficacious intervention components identified in this review should be incorporated into the development of future interventions and further evaluated for effectiveness. PMID:18525264

Minor Children of Palliative Patients: A Systematic Review of Psychosocial Family Interventions

PubMed Central

Krattenmacher, Thomas; Beierlein, Volker; Grimm, Johann Christian; Bergelt, Corinna; Romer, Georg; Möller, Birgit

2012-01-01

Abstract Although the whole family is affected by a parent's palliative disease, palliative care research does not yet routinely consider patients' minor children. Children's and adolescents' psychosocial functioning may be impaired during prolonged parental disease with poor prognosis. Therefore, more and more health care providers are establishing clinical initiatives for families of palliative patients with minor children. However, the number of these family interventions, as well as their theoretical and empirical backgrounds and evidence base, has yet to be determined. The purpose of this study was to systematically review structured and published interventions for this target group, as well as empirical studies on these interventions. The evidence base and impact of interventions on families were considered. Literature published between 1980 and present focusing on psychosocial family-, child- or parent-centered interventions during palliative care was retrieved from PsycINFO®, Embase, MEDLINE®, CINAHL®, and PSYNDEX databases. Five interventions met the inclusion criteria. Programs focused on different populations, had diverse empirical and theoretical backgrounds and features, and were evaluated by studies of varying methodological quality. This systematic review illustrates the lack of well designed and elaborated intervention concepts and evaluation studies in this field, highlighting the necessity of conceptual and methodological rigor to inform clinical practice on a sustainable basis in the future. PMID:22849598

A narrative review on cervical interventions in adults with chronic whiplash-associated disorder

PubMed Central

Yeung, Euson; Tong, Tiffany; Reed, Nick

2018-01-01

Introduction Whiplash injuries are common in society, but clinical interventions are inconclusive on the most effective treatment. Research and reviews have been completed with the goal of determining clinical interventions that are effective for whiplash injuries and disorders, but literature has not recently been summarised on best practices for cervical spine interventions for adults with chronic whiplash. Purpose The objective of this narrative review is to update and expand on previous works, to provide recommendations for clinical interventions and future research in the area of cervical spine rehabilitation for adults with chronic whiplash-associated disorder. Method The Arskey and O’Malley methodology was used for this narrative review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched from 2003 to April 2017. Two reviewers screened titles and abstracts for relevance to the review, and content analysis summarised the study findings. A total of 14 citations were included in the final review. Findings Exercise-based interventions targeted at the cervical spine appear most beneficial for adults with chronic whiplash-associated disorder (WAD). Invasive interventions still require more rigorous studies to deem their effectiveness for this population. Conclusion Further research is required to investigate and determine clinically relevant results for cervical spine intervention in patients with chronic WAD. PMID:29719724

Computerised decision support in physical activity interventions: A systematic literature review.

PubMed

Triantafyllidis, Andreas; Filos, Dimitris; Claes, Jomme; Buys, Roselien; Cornelissen, Véronique; Kouidi, Evangelia; Chouvarda, Ioanna; Maglaveras, Nicos

2018-03-01

The benefits of regular physical activity for health and quality of life are unarguable. New information, sensing and communication technologies have the potential to play a critical role in computerised decision support and coaching for physical activity. We provide a literature review of recent research in the development of physical activity interventions employing computerised decision support, their feasibility and effectiveness in healthy and diseased individuals, and map out challenges and future research directions. We searched the bibliographic databases of PubMed and Scopus to identify physical activity interventions with computerised decision support utilised in a real-life context. Studies were synthesized according to the target user group, the technological format (e.g., web-based or mobile-based) and decision-support features of the intervention, the theoretical model for decision support in health behaviour change, the study design, the primary outcome, the number of participants and their engagement with the intervention, as well as the total follow-up duration. From the 24 studies included in the review, the highest percentage (n = 7, 29%) targeted sedentary healthy individuals followed by patients with prediabetes/diabetes (n = 4, 17%) or overweight individuals (n = 4, 17%). Most randomized controlled trials reported significantly positive effects of the interventions, i.e., increase in physical activity (n = 7, 100%) for 7 studies assessing physical activity measures, weight loss (n = 3, 75%) for 4 studies assessing diet, and reductions in glycosylated hemoglobin (n = 2, 66%) for 3 studies assessing glycose concentration. Accelerometers/pedometers were used in almost half of the studies (n = 11, 46%). Most adopted decision support features included personalised goal-setting (n = 16, 67%) and motivational feedback sent to the users (n = 15, 63%). Fewer adopted features were integration with electronic health records (n = 3, 13%) and alerts sent to caregivers (n = 4, 17%). Theoretical models of decision support in health behaviour to drive the development of the intervention were not reported in most studies (n = 14, 58%). Interventions employing computerised decision support have the potential to promote physical activity and result in health benefits for both diseased and healthy individuals, and help healthcare providers to monitor patients more closely. Objectively measured activity through sensing devices, integration with clinical systems used by healthcare providers and theoretical frameworks for health behaviour change need to be employed in a larger scale in future studies in order to realise the development of evidence-based computerised systems for physical activity monitoring and coaching. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Burden of osteoporosis and fractures.

PubMed

Keen, Richard W

2003-09-01

Osteoporosis currently affects up to one in three women and one in 12 men. In 1990, there were 1.6 million hip fractures per annum worldwide and this number is estimated to reach 6 million by 2050. This increase in the number of fractures is due to an increase in the number of elderly people in the population, improved survival, and an increase in the age-specific fracture rates of unknown etiology. The rising number of osteoporotic fractures and their associated morbidity will place a heavy burden on future health care resources. In the United States, the cost for the management of osteoporosis has been estimated at $17 billion. The majority of this cost is spent on the acute surgical and medical management following hip fracture, and the subsequent rehabilitation. Currently, only minimal costs are utilized for treatment and prevention of osteoporosis. Hopefully, however, an accurate assessment of the burden of osteoporosis on the individual and the health care system will enable the targeting of resources to tackle this growing problem. With an increasing number of effective pharmaceutical interventions, it is critical that these agents are targeted to those at greatest risk for future fracture. This will ultimately reduce the burden of osteoporosis in future years.

The effectiveness of interventions in supporting self-management of informal caregivers of people with dementia; a systematic meta review.

PubMed

Huis In Het Veld, Judith G; Verkaik, Renate; Mistiaen, Patriek; van Meijel, Berno; Francke, Anneke L

2015-11-11

Informal caregivers of people with dementia are challenged in managing the consequences of dementia in daily life. The objective of this meta-review was to synthesize evidence from previous systematic reviews about professional self-management support interventions for this group. In March 2014, searches were conducted in PubMed, CINAHL, Cochrane Library, Embase and PsycINFO. The PRISMA Statement was followed. Interventions were grouped using Martin's targets of self-management, covering 5 targets: relationship with family, maintaining an active lifestyle, psychological wellbeing, techniques to cope with memory changes and information about dementia. Using an evidence synthesis, the outcomes from the included interventions were synthesized and conclusions were drawn about the level of evidence for the effectiveness of interventions within each target. Ten high-quality systematic reviews were selected. Evidence exists for the effectiveness of professional self-management support interventions targeting psychological wellbeing on stress and social outcomes of informal caregivers. In addition, evidence exists for the effectiveness of interventions targeting information on ability/knowledge. Limited evidence was found for the effectiveness of interventions targeting techniques to cope with memory change on coping skills and mood, and for interventions targeting information on the outcomes sense of competence and decision-making confidence of informal caregivers. Scientific evidence exists for the effectiveness of a number of professional self-management support interventions targeting psychological wellbeing and information. Health care professionals could take account of the fact that psycho-education was integrated in most of the self-management support interventions that were found to be effective in this meta-review. Furthermore, longer and more intensive interventions were associated with greater effects.

Windows of Opportunity for Lifestyle Interventions to Prevent Gestational Diabetes Mellitus

PubMed Central

Phelan, Suzanne

2017-01-01

Gestational diabetes mellitus (GDM) is linked with several acute maternal health risks and long-term development of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM similarly increases offspring risk of early life health complications and later disease. GDM recurrence is common, affecting 40–73% of women, and augments associated maternal/fetal/child health risks. Modifiable and independent risk factors for GDM include maternal excessive gestational weight gain and pre-pregnancy overweight and obesity. Lifestyle interventions that target diet, activity, and behavioral strategies can effectively modify adiposity. Randomized clinical trials testing the effects of lifestyle interventions during pregnancy to reduce excessive gestational weight gain have generally shown mixed effects on reducing GDM incidence. Trials testing the effects of postpartum lifestyle interventions among women with a history of GDM have shown reduced incidence of diabetes and improved cardiovascular disease risk factors. However, the long-term effects of inter-pregnancy or pre-pregnancy lifestyle interventions on subsequent GDM remain unknown. Future adequately powered and well-controlled clinical trials are needed to determine the effects of lifestyle interventions to prevent GDM and identify pathways to effectively reach reproductive-aged women across all levels of society, before, during, and after pregnancy. PMID:27487229

The Cellie Coping Kit for Children with Injury: Initial feasibility, acceptability, and outcomes.

PubMed

Marsac, M L; Weiss, D; Kohser, K L; Van Allen, J; Seegan, P; Ostrowski-Delahanty, S; McGar, A; Winston, F K; Kassam-Adams, N

2018-04-15

Physical and psychological challenges can arise from paediatric injury, which can impact child health outcomes. Evidence-based resources to promote recovery are limited. The low cost, portable Cellie Coping Kit for Children with Injury provides evidence-based strategies to help children manage injury-related challenges. This study aimed to describe intervention feasibility and explore initial outcomes (learning, quality of life [QOL], and trauma symptoms). Three independent pilot studies were conducted. Child-parent dyads (n = 61) participated in the intervention; ~36% completed a 4-week follow-up assessment. Results suggested that the intervention was feasible (e.g., 95% of parents would recommend the intervention; >85% reported that it was easy to use). Over 70% of participants reported learning new skills. No statistically significant differences were detected for children's QOL or trauma symptoms preintervention to postintervention. Preliminary research suggests that the Cellie Coping Kit for Children with Injuries is a feasible, low-cost, preventive intervention, which may provide families with strategies to promote recovery from paediatric injury. Future research, including a randomized controlled trial, ought to further examine targeted long-term intervention outcomes. © 2018 John Wiley & Sons Ltd.

How often should general practitioners provide nutrition care to patients? A forecasting activity to determine the target frequency for chronic-disease management in Australia.

PubMed

Ball, Lauren; Lee, Patricia; Ambrosini, Gina L; Hamilton, Kyra; Tuffaha, Haitham

2016-11-01

Supporting patients to have healthy dietary behaviours contributes significantly to preventing and managing lifestyle-related chronic diseases. 'Nutrition care' refers to any practice provided by a health professional to support a patient to improve their dietary behaviours and subsequent health outcomes. Approximately 3% of consultations by Australian general practitioners (GPs) involve the provision of nutrition care. The aim of the present paper was to forecast the potential implications of a higher frequency of nutrition care by GPs. Evidence on the effect of improved dietary behaviours on chronic disease outcomes, number of Australian adults estimated to have poor dietary behaviours and effectiveness of GPs providing nutrition care were taken into consideration. Using hypertension as a case example, for GPs to provide nutrition care to all hypertensive adults who would benefit from improved dietary behaviours, GPs would need to provide nutrition care in a target rate of 4.85% of consultations or 4.5 million different patients each year. The target aligns with the existing priorities for supporting chronic-disease prevention and management in Australia by increasing the rate that brief lifestyle interventions are provided by primary health professionals. This conservative target presents a considerable challenge for GPs, support staff, researchers and policy makers, but can be used to inform future interventions to support nutrition care by GPs.

Impact of a brief intervention on self-regulation, self-efficacy and physical activity in older adults with type 2 diabetes

PubMed Central

Olson, Erin A.; McAuley, Edward

2015-01-01

Despite evidence of the benefits of physical activity, most individuals with type 2 diabetes do not meet physical activity recommendations. The purpose of this study was to test the efficacy of a brief intervention targeting self-efficacy and self-regulation to increase physical activity in older adults with type 2 diabetes. Older adults (Mage = 61.8 ± 6.4) with type 2 diabetes or metabolic syndrome were randomized into a titrated physical activity intervention (n = 58) or an online health education course (n = 58). The intervention included walking exercise and theory-based group workshops. Self-efficacy, self-regulation and physical activity were assessed at baseline, post-intervention, and a follow-up. Results indicated a group by time effect for self-regulation [F(2,88) = 14.021, p < .001, η2 = .24] and self-efficacy [F(12,77) = 2.322, p < .05, η2 = .266] with increases in the intervention group. The intervention resulted in short-term increases in physical activity (d = .76, p < .01), which were partially maintained at the six-month follow-up (d = .35, p < .01). The intervention increased short-term physical activity but was not successful at maintaining increases in physical activity. Similar intervention effects were observed in self-efficacy and self-regulation. Future research warrants adjusting intervention strategies to increase long-term change. PMID:26162648

A Review of Technology-Based Youth and Family-Focused Interventions

PubMed Central

Prinz, Ronald J.

2017-01-01

In the past 10 years, mental and behavioral health has seen a proliferation of technology-based interventions in the form of online and other computer-delivered programs. This paper focuses on technology-based treatment and preventive interventions aimed at benefitting children and adolescents via either involving the parents and families, or only the youth. The review considered only technology-based interventions that had at least one published study with a randomized controlled trial design. Questions being addressed included: (1) What are the technology-based interventions in the mental/behavioral health area that have been systematically evaluated in published studies? (2) What are the common and unique characteristics of these interventions and their application with respect to sample characteristics, target problems, and technology characteristics (platforms, structures, elements, and communication formats)? and (3) Which intervention approaches and strategies have accrued the greatest evidence? The review identified 30 technology-based psychosocial interventions for children and families, 19 of which were parent or family-focused (32 studies) and 11 of which were youth-focused (in 13 studies). For the parent/family-focused interventions, greatest promise was found in those that addressed either youth behavioral problems or depressive/anxious symptoms, as well as more general bolstering of parenting efficacy. The youth-focused interventions showed some promise in reducing depressive/ anxious symptoms. Advantages and disadvantages of the technology-based approaches were considered, and areas for future research and development were discussed. PMID:27787701

Impact of a brief intervention on self-regulation, self-efficacy and physical activity in older adults with type 2 diabetes.

PubMed

Olson, Erin A; McAuley, Edward

2015-12-01

Despite evidence of the benefits of physical activity, most individuals with type 2 diabetes do not meet physical activity recommendations. The purpose of this study was to test the efficacy of a brief intervention targeting self-efficacy and self-regulation to increase physical activity in older adults with type 2 diabetes. Older adults (Mage = 61.8 ± 6.4) with type 2 diabetes or metabolic syndrome were randomized into a titrated physical activity intervention (n = 58) or an online health education course (n = 58). The intervention included walking exercise and theory-based group workshops. Self-efficacy, self-regulation and physical activity were assessed at baseline, post-intervention, and a follow-up. Results indicated a group by time effect for self-regulation [F(2,88) = 14.021, p < .001, η (2) = .24] and self-efficacy [F(12,77) = 2.322, p < .05, η (2) = .266] with increases in the intervention group. The intervention resulted in short-term increases in physical activity (d = .76, p < .01), which were partially maintained at the 6-month follow-up (d = .35, p < .01). The intervention increased short-term physical activity but was not successful at maintaining increases in physical activity. Similar intervention effects were observed in self-efficacy and self-regulation. Future research warrants adjusting intervention strategies to increase long-term change.

A Review of Technology-Based Youth and Family-Focused Interventions.

PubMed

MacDonell, Kathleen Watson; Prinz, Ronald J

2017-06-01

In the past 10 years, mental and behavioral health has seen a proliferation of technology-based interventions in the form of online and other computer-delivered programs. This paper focuses on technology-based treatment and preventive interventions aimed at benefitting children and adolescents via either involving the parents and families, or only the youth. The review considered only technology-based interventions that had at least one published study with a randomized controlled trial design. Questions being addressed included: (1) What are the technology-based interventions in the mental/behavioral health area that have been systematically evaluated in published studies? (2) What are the common and unique characteristics of these interventions and their application with respect to sample characteristics, target problems, and technology characteristics (platforms, structures, elements, and communication formats)? and (3) Which intervention approaches and strategies have accrued the greatest evidence? The review identified 30 technology-based psychosocial interventions for children and families, 19 of which were parent or family-focused (32 studies) and 11 of which were youth-focused (in 13 studies). For the parent/family-focused interventions, greatest promise was found in those that addressed either youth behavioral problems or depressive/anxious symptoms, as well as more general bolstering of parenting efficacy. The youth-focused interventions showed some promise in reducing depressive/anxious symptoms. Advantages and disadvantages of the technology-based approaches were considered, and areas for future research and development were discussed.

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.

Instrument Deployment for Mars Rovers

NASA Technical Reports Server (NTRS)

Pedersen, Liam; Bualat, Maria; Kunz, C.; Lee, Susan; Sargent, Randy; Washington, Rich; Wright, Anne; Clancy, Daniel (Technical Monitor)

2002-01-01

Future Mars rovers, such as the planned 2009 MSL rover, require sufficient autonomy to robustly approach rock targets and place an instrument in contact with them. It took the 1997 Sojourner Mars rover between 3 and 5 communications cycles to accomplish this. This paper describes the technologies being developed and integrated onto the NASA Ames K9 prototype Mars rover to both accomplish this in one cycle, and to extend the complexity and duration of operations that a Mars rover can accomplish without intervention from mission control.

Explaining the effects of a 1-year intervention promoting a low fat diet in adolescent girls: a mediation analysis.

PubMed

Haerens, Leen; Cerin, Ester; Deforche, Benedicte; Maes, Lea; De Bourdeaudhuij, Ilse

2007-11-09

Although it is important to investigate how interventions work, no formal mediation analyses have been conducted to explain behavioral outcomes in school-based fat intake interventions in adolescents. The aim of the present study was to examine mediation effects of changes in psychosocial determinants of dietary fat intake (attitude, social support, self-efficacy, perceived benefits and barriers) on changes in fat intake in adolescent girls. Data from a 1-year prospective intervention study were used. A random sample of 804 adolescent girls was included in the study. Girls in the intervention group (n = 415) were exposed to a multi-component school-based intervention program, combining environmental changes with a computer tailored fat intake intervention and parental support. Fat intake and psychosocial determinants of fat intake were measured with validated self-administered questionnaires. To assess mediating effects, a product-of-coefficient test, appropriate for cluster randomized controlled trials, was used. None of the examined psychosocial factors showed a reliable mediating effect on changes in fat intake. The single-mediator model revealed a statistically significant suppression effect of perceived barriers on changes in fat intake (p = 0.011). In the multiple-mediator model, this effect was no longer significant, which was most likely due to changes in perceived barriers being moderately related to changes in self-efficacy (-0.30) and attitude (-0.25). The overall mediated-suppressed effect of the examined psychosocial factors was virtually zero (total mediated effect = 0.001; SE = 7.22; p = 0.992). Given the lack of intervention effects on attitudes, social support, self-efficacy and perceived benefits and barriers, it is suggested that future interventions should focus on the identification of effective strategies for changing these theoretical mediators in the desired direction. Alternatively, it could be argued that these constructs need not be targeted in interventions aimed at adolescents, as they may not be responsible for the intervention effects on fat intake. To draw any conclusions regarding mediators of fat-intake change in adolescent' girls and regarding optimal future intervention strategies, more systematic research on the mediating properties of psychosocial variables is needed.

Movement as Medicine for Type 2 Diabetes: protocol for an open pilot study and external pilot clustered randomised controlled trial to assess acceptability, feasibility and fidelity of a multifaceted behavioural intervention targeting physical activity in primary care.

PubMed

Avery, Leah; Sniehotta, Falko F; Denton, Sarah J; Steen, Nick; McColl, Elaine; Taylor, Roy; Trenell, Michael I

2014-02-03

Physical activity (PA) and nutrition are the cornerstones of diabetes management. Several reviews and meta-analyses report that PA independently produces clinically important improvements in glucose control in people with Type 2 diabetes. However, it remains unclear what the optimal strategies are to increase PA behaviour in people with Type 2 diabetes in routine primary care. This study will determine whether an evidence-informed multifaceted behaviour change intervention (Movement as Medicine for Type 2 Diabetes) targeting both consultation behaviour of primary healthcare professionals and PA behaviour in adults with Type 2 diabetes is both acceptable and feasible in the primary care setting. An open pilot study conducted in two primary care practices (phase one) will assess acceptability, feasibility and fidelity. Ongoing feedback from participating primary healthcare professionals and patients will provide opportunities for systematic adaptation and refinement of the intervention and study procedures. A two-arm parallel group clustered pilot randomised controlled trial with patients from participating primary care practices in North East England will assess acceptability, feasibility, and fidelity of the intervention (versus usual clinical care) and trial processes over a 12-month period. Consultation behaviour involving fidelity of intervention delivery, diabetes and PA related knowledge, attitudes/beliefs, intentions and self-efficacy for delivering a behaviour change intervention targeting PA behaviour will be assessed in primary healthcare professionals. We will rehearse the collection of outcome data (with the focus on data yield and quality) for a future definitive trial, through outcome assessment at baseline, one, six and twelve months. An embedded qualitative process evaluation and treatment fidelity assessment will explore issues around intervention implementation and assess whether intervention components can be reliably and faithfully delivered in routine primary care. Movement as Medicine for Type 2 Diabetes will address an important gap in the evidence-base, that is, the need for interventions to increase free-living PA behaviour in adults with Type 2 diabetes. The multifaceted intervention incorporates an online accredited training programme for primary healthcare professionals and represents, to the best of our knowledge, the first of its kind in the United Kingdom. This study will establish whether the multifaceted behavioural intervention is acceptable and feasible in routine primary care. Movement as Medicine for Type 2 Diabetes (MaMT2D) was registered with Current Controlled Trials on the 14th January 2012: ISRCTN67997502. The first primary care practice was randomised on the 5th October 2012.

Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized controlled trial.

PubMed

Chang, Feng-Hang; Latham, Nancy K; Ni, Pengsheng; Jette, Alan M

2015-06-01

To examine whether self-efficacy mediated the effect of the Home-based Post-Hip Fracture Rehabilitation program on activity limitations in older adults after hip fracture and whether the mediating effect was different between sex and age groups. Randomized controlled trial. Community. Participants with hip fracture (N=232; mean age ± SD, 79±9.4y) were randomly assigned to intervention (n=120, 51.7%) and attention control (n=112, 48.3%) groups. The 6-month intervention, the Home-based Post-Hip Fracture Rehabilitation, is a functionally oriented, home-based exercise program. Data were collected at baseline, postintervention (6mo), and follow-up (9mo). Activity Measure for Post-Acute Care. The mediating effect of the Home-based Post-Hip Fracture Rehabilitation program on Basic Mobility function through self-efficacy for exercise was significant at 9 months (βindirect=.21). Similarly, the mediating effect of the intervention on Daily Activity function through self-efficacy for exercise was significant at 9 months (βindirect=.49). In subgroup analyses, the mediating effect was significant at 9 months in the younger group (age, ≤79y) in comparison to the older group and was significant in women in comparison to men. Self-efficacy may play a partial mediating role in the effect on some longer-term functional outcomes in the Home-based Post-Hip Fracture Rehabilitation intervention. The results suggest that program components that target self-efficacy should be incorporated in future hip fracture rehabilitation interventions. Age and sex of the targeted participants may also need to be considered when developing interventions. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A Review of Hip Hop-Based Interventions for Health Literacy, Health Behaviors, and Mental Health.

PubMed

Robinson, Cendrine; Seaman, Elizabeth L; Montgomery, LaTrice; Winfrey, Adia

2018-06-01

African-American children and adolescents experience an undue burden of disease for many health outcomes compared to their White peers. More research needs to be completed for this priority population to improve their health outcomes and ameliorate health disparities. Integrating hip hop music or hip hop dance into interventions may help engage African-American youth in health interventions and improve their health outcomes. We conducted a review of the literature to characterize hip hop interventions and determine their potential to improve health. We searched Web of Science, Scopus, PsycINFO, and EMBASE to identify studies that assessed hip hop interventions. To be included, studies had to (1) be focused on a psychosocial or physical health intervention that included hip hop and (2) present quantitative data assessing intervention outcomes. Twenty-three articles were identified as meeting all inclusion criteria and were coded by two reviewers. Articles were assessed with regards to sample characteristics, study design, analysis, intervention components, and results. Hip hop interventions have been developed to improve health literacy, health behavior, and mental health. The interventions were primarily targeted to African-American and Latino children and adolescents. Many of the health literacy and mental health studies used non-experimental study designs. Among the 12 (of 14) health behavior studies that used experimental designs, the association between hip hop interventions and positive health outcomes was inconsistent. The number of experimental hip hop intervention studies is limited. Future research is required to determine if hip hop interventions can promote health.

Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people.

PubMed

Gibbs, Andrew; Willan, Samantha; Misselhorn, Alison; Mangoma, Jaqualine

2012-06-14

Young people in southern and eastern Africa remain disproportionately vulnerable to HIV with gender inequalities and livelihood insecurities being key drivers of this. Behavioural HIV prevention interventions have had weak outcomes and a new generation of structural interventions have emerged seeking to challenge the wider drivers of the HIV epidemic, including gender inequalities and livelihood insecurities. We searched key academic data bases to identify interventions that simultaneously sought to strengthen people's livelihoods and transform gender relationships that had been evaluated in southern and eastern Africa. Our initial search identified 468 articles. We manually reviewed these and identified nine interventions that met our criteria for inclusion. We clustered the nine interventions into three groups: microfinance and gender empowerment interventions; supporting greater participation of women and girls in primary and secondary education; and gender empowerment and financial literacy interventions. We summarise the strengths and limitations of these interventions, with a particular focus on what lessons may be learnt for young people (18-24). Our review identified three major lessons for structural interventions that sought to transform gender relationships and strengthen livelihoods: 1) interventions have a narrow conceptualisation of livelihoods, 2) there is limited involvement of men and boys in such interventions, 3) studies have typically been done in stable populations. We discuss what this means for future interventions that target young people through these methods.

Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people

PubMed Central

Gibbs, Andrew; Willan, Samantha; Misselhorn, Alison; Mangoma, Jaqualine

2012-01-01

Background Young people in southern and eastern Africa remain disproportionately vulnerable to HIV with gender inequalities and livelihood insecurities being key drivers of this. Behavioural HIV prevention interventions have had weak outcomes and a new generation of structural interventions have emerged seeking to challenge the wider drivers of the HIV epidemic, including gender inequalities and livelihood insecurities. Methods We searched key academic data bases to identify interventions that simultaneously sought to strengthen people's livelihoods and transform gender relationships that had been evaluated in southern and eastern Africa. Our initial search identified 468 articles. We manually reviewed these and identified nine interventions that met our criteria for inclusion. Results We clustered the nine interventions into three groups: microfinance and gender empowerment interventions; supporting greater participation of women and girls in primary and secondary education; and gender empowerment and financial literacy interventions. We summarise the strengths and limitations of these interventions, with a particular focus on what lessons may be learnt for young people (18–24). Conclusions Our review identified three major lessons for structural interventions that sought to transform gender relationships and strengthen livelihoods: 1) interventions have a narrow conceptualisation of livelihoods, 2) there is limited involvement of men and boys in such interventions, 3) studies have typically been done in stable populations. We discuss what this means for future interventions that target young people through these methods. PMID:22713350

A topographical map approach to representing treatment efficacy: a focus on positive psychology interventions.

PubMed

Gorlin, Eugenia I; Lee, Josephine; Otto, Michael W

2018-01-01

A recent meta-analysis by Bolier et al. indicated that positive psychology interventions have overall small to moderate effects on well-being, but results were quite heterogeneous across intervention trials. Such meta-analytic research helps condense information on the efficacy of a broad psychosocial intervention by averaging across many effects; however, such global averages may provide limited navigational guidance for selecting among specific interventions. Here, we introduce a novel method for displaying qualitative and quantitative information on the efficacy of interventions using a topographical map approach. As an initial prototype for demonstrating this method, we mapped 50 positive psychology interventions targeting well-being (as captured in the Bolier et al. [2013] meta-analysis, [Bolier, L., Haverman, M., Westerhof, G. J., Riper, H., Smit, F., & Bohlmeijer, E. (2013). Positive psychology interventions: A meta-analysis of randomized controlled studies. BMC Public Health, 13, 83]). Each intervention domain/subdomain was mapped according to its average effect size (indexed by vertical elevation), number of studies providing effect sizes (indexed by horizontal area), and therapist/client burden (indexed by shading). The geographical placement of intervention domains/subdomains was determined by their conceptual proximity, allowing viewers to gauge the general conceptual "direction" in which promising intervention effects can be found. The resulting graphical displays revealed several prominent features of the well-being intervention "landscape," such as more strongly and uniformly positive effects of future-focused interventions (including, goal-pursuit and optimism training) compared to past/present-focused ones.

Cost-effectiveness of targeted and tailored interventions on colorectal cancer screening use.

PubMed

Lairson, David R; DiCarlo, Melissa; Myers, Ronald E; Wolf, Thomas; Cocroft, James; Sifri, Randa; Rosenthal, Michael; Vernon, Sally W; Wender, Richard

2008-02-15

Colorectal cancer (CRC) screening is cost-effective but underused. The objective of this study was to determine the cost-effectiveness of targeted and tailored behavioral interventions to increase CRC screening use by conducting an economic analysis associated with a randomized trial among patients in a large, racially and ethnically diverse, urban family practice in Philadelphia. The incremental costs per unit increase were measured in individuals who were screened during the 24 months after intervention. Percent increase in screening was adjusted for baseline differences in the study groups. Each intervention arm received a targeted screening invitation letter, stool blood test (SBT) cards, informational booklet, and reminder letter. Tailored interventions incrementally added tailored messages and reminder telephone calls. Program costs of the targeted intervention were 42 dollars per participant. Additional costs of adding tailored print materials and of delivering a reminder telephone call were 150 dollars and 200 dollars per participant, respectively. The cost per additional individual screened was 319 dollars when comparing the no intervention group with the targeted intervention group. The targeted intervention was more effective and less costly than the tailored intervention. Although tailoring plus reminder telephone call was the most effective strategy, it was very costly per additional individual screened. Mailed SBT cards significantly boosted CRC screening use. However, going beyond the targeted intervention to include tailoring or tailoring plus reminder calls in the manner used in this study did not appear to be an economically attractive strategy. Cancer 2008. (c) 2007 American Cancer Society.

Workplace Interventions to Prevent Disability from Both the Scientific and Practice Perspectives: A Comparison of Scientific Literature, Grey Literature and Stakeholder Observations.

PubMed

Williams-Whitt, Kelly; Bültmann, Ute; Amick, Benjamin; Munir, Fehmidah; Tveito, Torill H; Anema, Johannes R

2016-12-01

Purpose The significant individual and societal burden of work disability could be reduced if supportive workplace strategies could be added to evidence-based clinical treatment and rehabilitation to improve return-to-work (RTW) and other disability outcomes. The goal of this article is to summarize existing research on workplace interventions to prevent disability, relate these to employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with an expert panel with direct employer experience. Results Evidence from randomized trials and other research designs has shown general support for job modification, RTW coordination, and organizational support, but evidence is still lacking for interventions at a more granular level. Grey literature reports focused mainly on job re-design and work organization. Panel feedback focused on organizational readiness and the beliefs and values of senior managers as critical factors in facilitating changes to disability management practices. While the scientific literature is focused on facilitating improved coping and reducing discomforts for individual workers, the employer-directed grey literature is focused on making group-level changes to policies and procedures. Conclusions Future research might better target employer practices by tying interventions to positive workplace influences and determinants, by developing more participatory interventions and research designs, and by designing interventions that address factors of organizational change.

Our Choice/Nuestra Opción: the Imperial County, California, Childhood Obesity Research Demonstration study (CA-CORD).

PubMed

Ayala, Guadalupe X; Ibarra, Leticia; Binggeli-Vallarta, Amy; Moody, Jamie; McKenzie, Thomas L; Angulo, Janette; Hoyt, Helina; Chuang, Emmeline; Ganiats, Theodore G; Gahagan, Sheila; Ji, Ming; Zive, Michelle; Schmied, Emily; Arredondo, Elva M; Elder, John P

2015-02-01

Despite recent declines among young children, obesity remains a public health burden in the United States, including among Latino/Hispanic children. The determining factors are many and are too complex to fully address with interventions that focus on single factors, such as parenting behaviors or school policies. In this article, we describe a multisector, multilevel intervention to prevent and control childhood obesity in predominantly Mexican-origin communities in Southern California, one of three sites of the CDC-funded Childhood Obesity Research Demonstration (CA-CORD) study. CA-CORD is a partnership between a university-affiliated research institute, a federally qualified health center, and a county public health department. We used formative research, advisory committee members' recommendations, and previous research to inform the development of the CA-CORD project. Our theory-informed multisector, multilevel intervention targets improvements in four health behaviors: fruit, vegetable, and water consumption; physical activity; and quality sleep. Intervention partners include 1200 families, a federally qualified health center (including three clinics), 26 early care and education centers, two elementary school districts (and 20 elementary schools), three community recreation centers, and three restaurants. Intervention components in these sectors target changes in behaviors, policies, systems, and the social and physical environment. Evaluation activities include assessment of the primary outcome, BMI z-score, at baseline, 12-, and 18-months post-baseline, and sector evaluations at baseline, 12, and 24 months. Identifying feasible and effective strategies to prevent and control childhood obesity has the potential to effect real changes in children's current and future health status.

Our Choice/Nuestra Opción: The Imperial County, California, Childhood Obesity Research Demonstration Study (CA-CORD)

PubMed Central

Ibarra, Leticia; Binggeli-Vallarta, Amy; Moody, Jamie; McKenzie, Thomas L.; Angulo, Janette; Hoyt, Helina; Chuang, Emmeline; Ganiats, Theodore G.; Gahagan, Sheila; Ji, Ming; Zive, Michelle; Schmied, Emily; Arredondo, Elva M.; Elder, John P.

2015-01-01

Abstract Background: Despite recent declines among young children, obesity remains a public health burden in the United States, including among Latino/Hispanic children. The determining factors are many and are too complex to fully address with interventions that focus on single factors, such as parenting behaviors or school policies. In this article, we describe a multisector, multilevel intervention to prevent and control childhood obesity in predominantly Mexican-origin communities in Southern California, one of three sites of the CDC-funded Childhood Obesity Research Demonstration (CA-CORD) study. Methods: CA-CORD is a partnership between a university-affiliated research institute, a federally qualified health center, and a county public health department. We used formative research, advisory committee members' recommendations, and previous research to inform the development of the CA-CORD project. Our theory-informed multisector, multilevel intervention targets improvements in four health behaviors: fruit, vegetable, and water consumption; physical activity; and quality sleep. Intervention partners include 1200 families, a federally qualified health center (including three clinics), 26 early care and education centers, two elementary school districts (and 20 elementary schools), three community recreation centers, and three restaurants. Intervention components in these sectors target changes in behaviors, policies, systems, and the social and physical environment. Evaluation activities include assessment of the primary outcome, BMI z-score, at baseline, 12-, and 18-months post-baseline, and sector evaluations at baseline, 12, and 24 months. Conclusions: Identifying feasible and effective strategies to prevent and control childhood obesity has the potential to effect real changes in children's current and future health status. PMID:25584664

The Female Athlete Body (FAB) study: Rationale, design, and baseline characteristics.

PubMed

Stewart, Tiffany M; Pollard, Tarryn; Hildebrandt, Tom; Beyl, Robbie; Wesley, Nicole; Kilpela, Lisa Smith; Becker, Carolyn Black

2017-09-01

Eating Disorders (EDs) are serious psychiatric illnesses marked by psychiatric comorbidity, medical complications, and functional impairment. Research indicates that female athletes are often at greater risk for developing ED pathology versus non-athlete females. The Female Athlete Body (FAB) study is a three-site, randomized controlled trial (RCT) designed to assess the efficacy of a behavioral ED prevention program for female collegiate athletes when implemented by community providers. This paper describes the design, intervention, and participant baseline characteristics. Future papers will discuss outcomes. Female collegiate athletes (N=481) aged 17-21 were randomized by site, team, and sport type to either FAB or a waitlist control group. FAB consisted of three sessions (1.3h each) of a behavioral ED prevention program. Assessments were conducted at baseline (pre-intervention), post-intervention (3weeks), and six-, 12-, and 18-month follow-ups. This study achieved 96% (N=481) of target recruitment (N=500). Few group differences emerged at baseline. Total sample analyses revealed moderately low baseline instances of ED symptoms and clinical cases. Health risks associated with EDs necessitate interventions for female athletes. The FAB study is the largest existing RCT for female athletes aimed at both reduction of ED risk factors and ED prevention. The methods presented and population recruited for this study represent an ideal intervention for assessing the effects of FAB on both the aforementioned outcomes. We anticipate that findings of this study (reported in future papers) will make a significant contribution to the ED risk factor reduction and prevention literature. Copyright © 2017 Elsevier Inc. All rights reserved.

Coaching Older Adults and Carers to have their preferences Heard (COACH): A randomised controlled trial in an intermediate care setting (study protocol).

PubMed

Masters, Stacey; Gordon, Jason; Whitehead, Craig; Davies, Owen; Giles, Lynne C; Ratcliffe, Julie

2012-01-01

Frail older people who are considering movement into residential aged care or returning home following a hospital admission often face complex and difficult decisions.Despite research interest in this area, a recent Cochrane review was unable to identify any studies of interventions to support decision-making in this group that met the experimental or quasi-experimental study design criteria. This study tests the impact of a multi-component coaching intervention on the quality of preparation for care transitions, targeted to older adults and informal carers. In addition, the study assesses the impact of investing specialist geriatric resources into consultations with families in an intermediate care setting where decisions about future care needs are being made. This study was a randomised controlled trial of 230 older adults admitted to intermediate care in Australia. Masked assessment at 3 and 12 months examined physical functioning, health-related quality of life and utilisation of health and aged care resources. A geriatrician and specialist nurse delivered a coaching intervention to both the older person and their carer/family. Components of the intervention included provision of a Question Prompt List prior to meeting with a geriatrician (to clarify medical conditions and treatments, medications, 'red flags', end of life decisions and options for future health care) and a follow-up meeting with a nurse who remained in telephone contact. Participants received a printed summary and an audio recording of the meeting with the geriatrician. The costs and outcomes of the intervention are compared with usual care. Australian New Zealand Clinical Trials Registry (ACTRN12607000638437).

Design of a Digital-Based, Multicomponent Nutrition Guidance System for Prevention of Early Childhood Obesity

PubMed Central

Black, Maureen M.; Saavedra, Jose M.

2016-01-01

Interventions targeting parenting focused modifiable factors to prevent obesity and promote healthy growth in the first 1000 days of life are needed. Scale-up of interventions to global populations is necessary to reverse trends in weight status among infants and toddlers, and large scale dissemination will require understanding of effective strategies. Utilizing nutrition education theories, this paper describes the design of a digital-based nutrition guidance system targeted to first-time mothers to prevent obesity during the first two years. The multicomponent system consists of scientifically substantiated content, tools, and telephone-based professional support delivered in an anticipatory and sequential manner via the internet, email, and text messages, focusing on educational modules addressing the modifiable factors associated with childhood obesity. Digital delivery formats leverage consumer media trends and provide the opportunity for scale-up, unavailable to previous interventions reliant on resource heavy clinic and home-based counseling. Designed initially for use in the United States, this system's core features are applicable to all contexts and constitute an approach fostering healthy growth, not just obesity prevention. The multicomponent features, combined with a global concern for optimal growth and positive trends in mobile internet use, represent this system's future potential to affect change in nutrition practice in developing countries. PMID:27635257

A systematic review of implementation strategies to deliver guidelines on obstetric care practice in low- and middle-income countries.

PubMed

Imamura, Mari; Kanguru, Lovney; Penfold, Suzanne; Stokes, Tim; Camosso-Stefinovic, Janette; Shaw, Beth; Hussein, Julia

2017-01-01

Healthcare measures to prevent maternal deaths are well known. However, effective implementation of this knowledge to change practice remains a challenge. To assess whether strategies to promote the use of guidelines can improve obstetric practices in low- and middle-income countries (LMICs). Electronic databases were searched up to February 7, 2014, using relevant terms for implementation strategies (e.g. "audit," "education," "reminder"), and maternal mortality. Randomized and non-randomized studies of implementation strategies targeting healthcare professionals within the formal health services in LMICs were included. Cochrane methodological guidance was followed. Because of heterogeneity in the interventions, a narrative synthesis was completed. Nine studies met the inclusion criteria. Moderate-to-low-quality evidence was found to show improvement in the areas of doctor-patient communication (one study), analgesic provision (one study), the management of emergencies (two studies) and maternal and late neonatal mortality (one study each). Intervention effects were not consistent across studies. Implementation strategies targeting health professionals could lead to improvement in obstetric care in LMICs. Future research should explore what feature of an intervention is effective in one context and how this could be translated into another context. CRD42014010310. © 2016 International Federation of Gynecology and Obstetrics.

Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association.

PubMed

Suglia, Shakira F; Koenen, Karestan C; Boynton-Jarrett, Renée; Chan, Paul S; Clark, Cari J; Danese, Andrea; Faith, Myles S; Goldstein, Benjamin I; Hayman, Laura L; Isasi, Carmen R; Pratt, Charlotte A; Slopen, Natalie; Sumner, Jennifer A; Turer, Aslan; Turer, Christy B; Zachariah, Justin P

2018-01-30

Adverse experiences in childhood and adolescence, defined as subjectively perceived threats to the safety or security of the child's bodily integrity, family, or social structures, are known to be associated with cardiometabolic outcomes over the life course into adulthood. This American Heart Association scientific statement reviews the scientific literature on the influence of childhood adversity on cardiometabolic outcomes that constitute the greatest public health burden in the United States, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. This statement also conceptually outlines pathways linking adversity to cardiometabolic health, identifies evidence gaps, and provides suggestions for future research to inform practice and policy. We note that, despite a lack of objective agreement on what subjectively qualifies as exposure to childhood adversity and a dearth of prospective studies, substantial evidence documents an association between childhood adversity and cardiometabolic outcomes across the life course. Future studies that focus on mechanisms, resiliency, and vulnerability factors would further strengthen the evidence and provide much-needed information on targets for effective interventions. Given that childhood adversities affect cardiometabolic health and multiple health domains across the life course, interventions that ameliorate these initial upstream exposures may be more appropriate than interventions remediating downstream cardiovascular disease risk factor effects later in life. © 2017 American Heart Association, Inc.

Do Sexual Assault Bystander Interventions Change Men's Intentions? Applying the Theory of Normative Social Behavior to Predicting Bystander Outcomes.

PubMed

Mabry, Amanda; Turner, Monique Mitchell

2016-01-01

The high prevalence of sexual assault on college campuses has led to the implementation of health communication programs to prevent sexual assault. A few novel programs focus on primary prevention by targeting social norms related to gender and masculinity among men through bystander intervention. Guided by the theory of normative social behavior, this study sought to examine the relative effect of campaigns communicating positive versus negative injunctive norms and the interaction between exposure to such campaign messages and perceived descriptive norms and relevant cognitive moderators (e.g., outcome expectations, injunctive norms, group identity, ego involvement) among men. A 2 (high/low descriptive norms) × 2 (high/low moderator) × 3 (public service announcement) independent groups quasi-experimental design (N = 332) was used. Results indicated that messages communicating positive injunctive norms were most effective among men who were least likely to engage in bystander intervention. Furthermore, descriptive norms played a significant role in behavioral intentions, such that those with stronger norms were more likely to report intentions to engage in bystander behaviors in the future. Similarly, the moderators of aspiration, injunctive norms, social approval, and ego involvement had a significant positive effect on behavioral intentions. These findings have important implications for future message design strategy and audience segmentation.

Value of MR contrast media in image-guided body interventions.

PubMed

Saeed, Maythem; Wilson, Mark

2012-01-28

In the past few years, there have been multiple advances in magnetic resonance (MR) instrumentation, in vivo devices, real-time imaging sequences and interventional procedures with new therapies. More recently, interventionists have started to use minimally invasive image-guided procedures and local therapies, which reduce the pain from conventional surgery and increase drug effectiveness, respectively. Local therapy also reduces the systemic dose and eliminates the toxic side effects of some drugs to other organs. The success of MR-guided procedures depends on visualization of the targets in 3D and precise deployment of ablation catheters, local therapies and devices. MR contrast media provide a wealth of tissue contrast and allows 3D and 4D image acquisitions. After the development of fast imaging sequences, the clinical applications of MR contrast media have been substantially expanded to include pre- during- and post-interventions. Prior to intervention, MR contrast media have the potential to localize and delineate pathologic tissues of vital organs, such as the brain, heart, breast, kidney, prostate, liver and uterus. They also offer other options such as labeling therapeutic agents or cells. During intervention, these agents have the capability to map blood vessels and enhance the contrast between the endovascular guidewire/catheters/devices, blood and tissues as well as direct therapies to the target. Furthermore, labeling therapeutic agents or cells aids in visualizing their delivery sites and tracking their tissue distribution. After intervention, MR contrast media have been used for assessing the efficacy of ablation and therapies. It should be noted that most image-guided procedures are under preclinical research and development. It can be concluded that MR contrast media have great value in preclinical and some clinical interventional procedures. Future applications of MR contrast media in image-guided procedures depend on their safety, tolerability, tissue specificity and effectiveness in demonstrating success of the interventions and therapies.

Peer-Based Social Media Features in Behavior Change Interventions: Systematic Review

PubMed Central

Weal, Mark; Morrison, Leanne; Yardley, Lucy

2018-01-01

Background Incorporating social media features into digital behavior change interventions (DBCIs) has the potential to contribute positively to their success. However, the lack of clear design principles to describe and guide the use of these features in behavioral interventions limits cross-study comparisons of their uses and effects. Objective The aim of this study was to provide a systematic review of DBCIs targeting modifiable behavioral risk factors that have included social media features as part of their intervention infrastructure. A taxonomy of social media features is presented to inform the development, description, and evaluation of behavioral interventions. Methods Search terms were used in 8 databases to identify DBCIs that incorporated social media features and targeted tobacco smoking, diet and nutrition, physical activities, or alcohol consumption. The screening and review process was performed by 2 independent researchers. Results A total of 5264 articles were screened, and 143 articles describing a total of 134 studies were retained for full review. The majority of studies (70%) reported positive outcomes, followed by 28% finding no effects with regard to their respective objectives and hypothesis, and 2% of the studies found that their interventions had negative outcomes. Few studies reported on the association between the inclusion of social media features and intervention effect. A taxonomy of social media features used in behavioral interventions has been presented with 36 social media features organized under 7 high-level categories. The taxonomy has been used to guide the analysis of this review. Conclusions Although social media features are commonly included in DBCIs, there is an acute lack of information with respect to their effect on outcomes and a lack of clear guidance to inform the selection process based on the features’ suitability for the different behaviors. The proposed taxonomy along with the set of recommendations included in this review will support future research aimed at isolating and reporting the effects of social media features on DBCIs, cross-study comparisons, and evaluations. PMID:29472174

Modeling social transmission dynamics of unhealthy behaviors for evaluating prevention and treatment interventions on childhood obesity.

PubMed

Frerichs, Leah M; Araz, Ozgur M; Huang, Terry T-K

2013-01-01

Research evidence indicates that obesity has spread through social networks, but lever points for interventions based on overlapping networks are not well studied. The objective of our research was to construct and parameterize a system dynamics model of the social transmission of behaviors through adult and youth influence in order to explore hypotheses and identify plausible lever points for future childhood obesity intervention research. Our objectives were: (1) to assess the sensitivity of childhood overweight and obesity prevalence to peer and adult social transmission rates, and (2) to test the effect of combinations of prevention and treatment interventions on the prevalence of childhood overweight and obesity. To address the first objective, we conducted two-way sensitivity analyses of adult-to-child and child-to-child social transmission in relation to childhood overweight and obesity prevalence. For the second objective, alternative combinations of prevention and treatment interventions were tested by varying model parameters of social transmission and weight loss behavior rates. Our results indicated child overweight and obesity prevalence might be slightly more sensitive to the same relative change in the adult-to-child compared to the child-to-child social transmission rate. In our simulations, alternatives with treatment alone, compared to prevention alone, reduced the prevalence of childhood overweight and obesity more after 10 years (1.2-1.8% and 0.2-1.0% greater reduction when targeted at children and adults respectively). Also, as the impact of adult interventions on children was increased, the rank of six alternatives that included adults became better (i.e., resulting in lower 10 year childhood overweight and obesity prevalence) than alternatives that only involved children. The findings imply that social transmission dynamics should be considered when designing both prevention and treatment intervention approaches. Finally, targeting adults may be more efficient, and research should strengthen and expand adult-focused interventions that have a high residual impact on children.

Modeling Social Transmission Dynamics of Unhealthy Behaviors for Evaluating Prevention and Treatment Interventions on Childhood Obesity

PubMed Central

Frerichs, Leah M.; Araz, Ozgur M.; Huang, Terry T. – K.

2013-01-01

Research evidence indicates that obesity has spread through social networks, but lever points for interventions based on overlapping networks are not well studied. The objective of our research was to construct and parameterize a system dynamics model of the social transmission of behaviors through adult and youth influence in order to explore hypotheses and identify plausible lever points for future childhood obesity intervention research. Our objectives were: (1) to assess the sensitivity of childhood overweight and obesity prevalence to peer and adult social transmission rates, and (2) to test the effect of combinations of prevention and treatment interventions on the prevalence of childhood overweight and obesity. To address the first objective, we conducted two-way sensitivity analyses of adult-to-child and child-to-child social transmission in relation to childhood overweight and obesity prevalence. For the second objective, alternative combinations of prevention and treatment interventions were tested by varying model parameters of social transmission and weight loss behavior rates. Our results indicated child overweight and obesity prevalence might be slightly more sensitive to the same relative change in the adult-to-child compared to the child-to-child social transmission rate. In our simulations, alternatives with treatment alone, compared to prevention alone, reduced the prevalence of childhood overweight and obesity more after 10 years (1.2–1.8% and 0.2–1.0% greater reduction when targeted at children and adults respectively). Also, as the impact of adult interventions on children was increased, the rank of six alternatives that included adults became better (i.e., resulting in lower 10 year childhood overweight and obesity prevalence) than alternatives that only involved children. The findings imply that social transmission dynamics should be considered when designing both prevention and treatment intervention approaches. Finally, targeting adults may be more efficient, and research should strengthen and expand adult-focused interventions that have a high residual impact on children. PMID:24358234

Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis.

PubMed

Chen, Xiaoqi; Coombes, Brooke K; Sjøgaard, Gisela; Jun, Deokhoon; O'Leary, Shaun; Johnston, Venerina

2018-01-01

At present, there is no consolidated evidence for workplace-based interventions for the prevention and reduction of neck pain in office workers. The purpose of this review was to investigate the effectiveness of workplace-based interventions for neck pain in office workers. MEDLINE, PEDro, CINAHL, and CENTRAL were searched for trials published since inception and before May 31, 2016. Randomized controlled trials (RCTs) were considered when they met the following criteria: population consisted of office workers, intervention(s) was performed at the workplace, outcome measures included neck and/or neck/shoulder pain intensity and incidence/prevalence, and comparator groups included no/other intervention. Data were extracted by 1 reviewer using predefined data fields and checked by a second reviewer. Risk of bias was assessed by 2 independent reviewers using the 2015 Cochrane Back and Neck Group guidelines. Evidence quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Twenty-seven RCTs were included. There was moderate-quality evidence that neck/shoulder strengthening exercises and general fitness training were effective in reducing neck pain in office workers who were symptomatic, although the effect size was larger for strengthening exercises. Greater effects were observed with greater participation in exercise. Ergonomic interventions were supported by low-quality evidence. Data could not be obtained from some studies for meta-analysis and assessment of risk of bias. Reporting bias might have been present because only studies in the English language were included. Workplace-based strengthening exercises were effective in reducing neck pain in office workers who were symptomatic, and the effect size was larger when the exercises were targeted to the neck/shoulder. Future RCTs of ergonomic interventions targeted at office workers who are symptomatic are required. More research on neck pain prevention is warranted. © 2017 American Physical Therapy Association

Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up.

PubMed

Hardcastle, Sarah J; Taylor, Adrian H; Bailey, Martin P; Harley, Robert A; Hagger, Martin S

2013-03-28

Intensive diet and physical activity interventions have been found to reduce cardiovascular disease (CVD) risk, but are resource intensive. The American Heart Association recently recommended motivational interviewing (MI) as an effective approach for low-intensity interventions to promote health-related outcomes such as weight loss. However, there is limited research evaluating the long-term effectiveness of MI-based interventions on health-related outcomes associated with CVD risk. The current research evaluated the effectiveness of a six-month low-intensity MI intervention in a UK primary-care setting in maintaining reductions in CVD risk factors at12 months post-intervention. Primary-care patients were randomised to an intervention group that received standard exercise and nutrition information plus up to five face-to-face MI sessions, delivered by a physical activity specialist and registered dietician over a 6-month period, or to a minimal intervention comparison group that received the standard information only. Follow-up measures of behavioural (vigorous and moderate physical activity, walking, physical activity stage-of-change, fruit and vegetable intake, and dietary fat intake) and biomedical (weight, body mass index [BMI], blood pressure, cholesterol) outcomes were taken immediately post-intervention and at a 12-month follow-up occasion. Intent-to-treat analyses revealed significant differences between groups for walking and cholesterol. Obese and hypercholesterolemic patients at baseline exhibited significant improvements in BMI and cholesterol respectively among those allocated to the intervention group compared to the comparison group. Post-intervention improvements in other health-related outcomes including blood pressure, weight, and BMI were not maintained. The present study suggests that a low-intensity MI counselling intervention is effective in bringing about long-term changes in some, but not all, health-related outcomes (walking, cholesterol levels) associated with CVD risk. The intervention was particularly effective for patients with elevated levels of CVD risk factors at baseline. Based on these findings future interventions should be conducted in a primary care setting and target patients with high risk of CVD. Future research should investigate how the long-term gains in health-related outcomes brought about by the MI-counselling intervention in the current study could be extended to a wider range of health outcomes.

A lifestyle intervention study targeting individuals with low socioeconomic status of different ethnic origins: important aspects for successful implementation.

PubMed

Teuscher, Dorit; Bukman, Andrea J; van Baak, Marleen A; Feskens, Edith J M; Renes, Reint Jan; Meershoek, Agnes

2017-07-25

Evaluation of the implementation process of trials is important, because the way a study is implemented modifies its outcomes. Furthermore, lessons learned during implementation can inform other researchers on factors that play a role when implementing interventions described in research. This study evaluates the implementation of the MetSLIM study, targeting individuals with low socioeconomic status of different ethnic origins. The MetSLIM study was set up to evaluate the effectiveness of a lifestyle programme on waist circumference and other cardio-metabolic risk factors. The objective of this evaluation was to identify components that were essential for the implementation of the MetSLIM study and to inform other researchers on methodological aspects when working with inadequately reached populations in health research. In this evaluation study the experiences of health professionals, study assistants, a community worker and regional research coordinators involved in the MetSLIM study were explored using semi-structured interviews. Questionnaires were used to evaluate participants' satisfaction with the lifestyle intervention. Our analyses show that a flexible recruitment protocol eventually leads to recruitment of sufficient participants; that trust in the recruiter is an important factor in the recruitment of individuals with low socioeconomic status of different ethnic origins; and that health professionals will unavoidably shape the form of intervention activities. Furthermore, our evaluation shows that daily practice and research mutually influence each other and that the results of an intervention are a product of this interaction. Health promotion research would benefit from a perspective that sees intervention activities not as fixed entities but rather as social interaction that can take on numerous forms. Analysing and reporting the implementation process of studies, like in this evaluation, will allow readers to get a detailed view on the appropriateness of the (intended) study design and intervention for the targeted population. Evaluation studies that shed light on the reasons for adaptations, rather than describing them as deviation from the original plan, would point out methodological aspects important for a study's replication. Furthermore, they would show how various factors can influence the implementation, and therewith initiate a learning cycle for the development of future intervention studies. Netherlands Trial Register NTR3721 (since November 27, 2012).

Improved facial affect recognition in schizophrenia following an emotion intervention, but not training attention-to-facial-features or treatment-as-usual.

PubMed

Tsotsi, Stella; Kosmidis, Mary H; Bozikas, Vasilis P

2017-08-01

In schizophrenia, impaired facial affect recognition (FAR) has been associated with patients' overall social functioning. Interventions targeting attention or FAR per se have invariably yielded improved FAR performance in these patients. Here, we compared the effects of two interventions, one targeting FAR and one targeting attention-to-facial-features, with treatment-as-usual on patients' FAR performance. Thirty-nine outpatients with schizophrenia were randomly assigned to one of three groups: FAR intervention (training to recognize emotional information, conveyed by changes in facial features), attention-to-facial-features intervention (training to detect changes in facial features), and treatment-as-usual. Also, 24 healthy controls, matched for age and education, were assigned to one of the two interventions. Two FAR measurements, baseline and post-intervention, were conducted using an original experimental procedure with alternative sets of stimuli. We found improved FAR performance following the intervention targeting FAR in comparison to the other patient groups, which in fact was comparable to the pre-intervention performance of healthy controls in the corresponding intervention group. This improvement was more pronounced in recognizing fear. Our findings suggest that compared to interventions targeting attention, and treatment-as-usual, training programs targeting FAR can be more effective in improving FAR in patients with schizophrenia, particularly assisting them in perceiving threat-related information more accurately. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

"Communicate to vaccinate": the development of a taxonomy of communication interventions to improve routine childhood vaccination.

PubMed

Willis, Natalie; Hill, Sophie; Kaufman, Jessica; Lewin, Simon; Kis-Rigo, John; De Castro Freire, Sara Bensaude; Bosch-Capblanch, Xavier; Glenton, Claire; Lin, Vivian; Robinson, Priscilla; Wiysonge, Charles S

2013-05-11

Vaccination is a cost-effective public health measure and is central to the Millennium Development Goal of reducing child mortality. However, childhood vaccination coverage remains sub-optimal in many settings. While communication is a key feature of vaccination programmes, we are not aware of any comprehensive approach to organising the broad range of communication interventions that can be delivered to parents and communities to improve vaccination coverage. Developing a classification system (taxonomy) organised into conceptually similar categories will aid in: understanding the relationships between different types of communication interventions; facilitating conceptual mapping of these interventions; clarifying the key purposes and features of interventions to aid implementation and evaluation; and identifying areas where evidence is strong and where there are gaps. This paper reports on the development of the 'Communicate to vaccinate' taxonomy. The taxonomy was developed in two stages. Stage 1 included: 1) forming an advisory group; 2) searching for descriptions of interventions in trials (CENTRAL database) and general health literature (Medline); 3) developing a sampling strategy; 4) screening the search results; 5) developing a data extraction form; and 6) extracting intervention data. Stage 2 included: 1) grouping the interventions according to purpose; 2) holding deliberative forums in English and French with key vaccination stakeholders to gather feedback; 3) conducting a targeted search of grey literature to supplement the taxonomy; 4) finalising the taxonomy based on the input provided. The taxonomy includes seven main categories of communication interventions: inform or educate, remind or recall, teach skills, provide support, facilitate decision making, enable communication and enhance community ownership. These categories are broken down into 43 intervention types across three target groups: parents or soon-to-be-parents; communities, community members or volunteers; and health care providers. Our taxonomy illuminates and organises this field and identifies the range of available communication interventions to increase routine childhood vaccination uptake. We have utilised a variety of data sources, capturing information from rigorous evaluations such as randomised trials as well as experiences and knowledge of practitioners and vaccination stakeholders. The taxonomy reflects current public health practice and can guide the future development of vaccination programmes.

“Communicate to vaccinate”: the development of a taxonomy of communication interventions to improve routine childhood vaccination

PubMed Central

2013-01-01

Background Vaccination is a cost-effective public health measure and is central to the Millennium Development Goal of reducing child mortality. However, childhood vaccination coverage remains sub-optimal in many settings. While communication is a key feature of vaccination programmes, we are not aware of any comprehensive approach to organising the broad range of communication interventions that can be delivered to parents and communities to improve vaccination coverage. Developing a classification system (taxonomy) organised into conceptually similar categories will aid in: understanding the relationships between different types of communication interventions; facilitating conceptual mapping of these interventions; clarifying the key purposes and features of interventions to aid implementation and evaluation; and identifying areas where evidence is strong and where there are gaps. This paper reports on the development of the ‘Communicate to vaccinate’ taxonomy. Methods The taxonomy was developed in two stages. Stage 1 included: 1) forming an advisory group; 2) searching for descriptions of interventions in trials (CENTRAL database) and general health literature (Medline); 3) developing a sampling strategy; 4) screening the search results; 5) developing a data extraction form; and 6) extracting intervention data. Stage 2 included: 1) grouping the interventions according to purpose; 2) holding deliberative forums in English and French with key vaccination stakeholders to gather feedback; 3) conducting a targeted search of grey literature to supplement the taxonomy; 4) finalising the taxonomy based on the input provided. Results The taxonomy includes seven main categories of communication interventions: inform or educate, remind or recall, teach skills, provide support, facilitate decision making, enable communication and enhance community ownership. These categories are broken down into 43 intervention types across three target groups: parents or soon-to-be-parents; communities, community members or volunteers; and health care providers. Conclusions Our taxonomy illuminates and organises this field and identifies the range of available communication interventions to increase routine childhood vaccination uptake. We have utilised a variety of data sources, capturing information from rigorous evaluations such as randomised trials as well as experiences and knowledge of practitioners and vaccination stakeholders. The taxonomy reflects current public health practice and can guide the future development of vaccination programmes. PMID:23663327

A review of patient-centred post-fracture interventions in the context of theories of health behaviour change.

PubMed

Sujic, R; Gignac, M A; Cockerill, R; Beaton, D E

2011-08-01

The purpose of this literature review is to determine whether and to what extent current post-fracture osteoporosis interventions utilize theories of health behaviour change and whether those that are theory-based are more successful in producing desired behaviour changes. Studies were identified by applying additional criteria to the final selection stage of a systematic review of non-surgical osteoporosis interventions in the orthopaedic environment. We identified 42 primary studies targeted at patients and improving post-fracture osteoporosis care. As well as describing the studies (in terms of design, population, interventions, outcomes), we focused on theoretical framework and elements of behaviour change models. The 42 studies included in this review utilized a variety of post-fracture interventions; however, none of them reported using an underlying theoretical base. Only three studies drew on what we felt to be elements of a theoretical framework. The lack of theoretically based studies points to a currently under-utilized area of behaviour change research that could be applied to post-fracture interventions in order to make them more effective. Despite an abundance of literature supporting theories of behaviour change, post-fracture osteoporosis interventions do not report utilizing these theories. Theories of behaviour change could be applied to post-fracture osteoporosis interventions to explain why patients initiate osteoporosis management. Future research should explore the application of theories of health behaviour change to post-fracture interventions.

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 2: Liver and Other Applications in Oncology.

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

2017-11-01

Background  MRI is attractive for guiding and monitoring interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure flow and cardiac function. Methods  Technical solutions have been developed for all procedural steps including imaging guidance, MR-safe catheters and instruments and patient monitoring. This has led to widening of the clinical applications. Interventional MRI is becoming increasingly important for the treatment of patients suffering from malignant diseases. The detectability of masses and consequently their accessibility for biopsy is higher, compared to other modalities, due to the high intrinsic soft tissue contrast of MRI. Temperature-dependent sequences allow for minimally invasive and tissue-sparing ablation (A-0 ablation). Conclusion  Interventional MRI has become established in the clinical routine for a variety of indications, including biopsies and tumor ablation. Since the economic requirement of covering costs by reimbursement is met and interventional MRI decreases the mortality and morbidity of interventional procedures, broader application of interventional MRI can be expected in the clinical routine in the future. Key points   · Particularly for the treatment of oncological patients, interventional MRI is superior to other methods with respect to minimal invasiveness and tissue protection due to the ability to exactly determine tumor borders and to visualize and control the size of the ablation area on the basis of MR temperature measurement.. · Due to the better visualization of targets and the effects of ablation in tissue, interventional MRI can lower the mortality and morbidity associated with these interventions for many indications.. · The complex comparison of costs and reimbursement shows that this application can be performed in a cost-covering manner and broader 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 2: Liver and Other Applications in Oncology. Fortschr Röntgenstr 2017; 189: 1047 - 1054. © Georg Thieme Verlag KG Stuttgart · New York.

The Utility of a Brief Web-Based Prevention Intervention as a Universal Approach for Risky Alcohol Use in College Students: Evidence of Moderation by Family History.

PubMed

Neale, Zoe E; Salvatore, Jessica E; Cooke, Megan E; Savage, Jeanne E; Aliev, Fazil; Donovan, Kristen K; Hancock, Linda C; Dick, Danielle M

2018-01-01

Background: Alcohol use on college campuses is prevalent and contributes to problems that affect the health, emotional wellbeing, and academic success of college students. Risk factors, such as family history of alcohol problems, predict future alcohol problems, but less is known about their potential impact on intervention effectiveness. The purpose of this study was to examine the effect of an intervention implemented in a non-randomized sample of drinking and non-drinking college freshmen. Methods: Freshmen college students recruited for the intervention study ( n = 153) completed a web-adaptation of the Brief Alcohol Screening and Intervention for College Students (BASICS) at the start of spring semester. We compared their 30-days post-intervention alcohol initiation, number of drinking days (DAYS), drinks per occasion (DRINKS), maximum drinks in 24 h (MAX24) and alcohol use disorder symptoms (AUDsx) to 151 comparison participants retrospectively matched on demographics and baseline alcohol use behaviors. We also tested baseline DRINKS, DAYS, AUDsx, MAX24, and parental family history (PFH) of alcohol problems as moderators of the effect of the intervention. Results: At follow-up, intervention participants had lower rates of AUDsx than comparison participants, especially among baseline drinkers. Among participants drinking 3+ days/month at baseline, intervention participants showed fewer DAYS at follow-up than the comparison group participants. BASICS was also associated with a decreased likelihood of initiation among baseline non-drinkers. PFH significantly interacted with treatment group, with positive PFH intervention participants reporting significantly fewer AUDsx at follow-up compared to positive PFH comparison participants. We found no evidence for an effect of the intervention on DRINKS or MAX24 in our analyses. Conclusions: Results suggest some indication that novel groups, such as non-drinkers, regular drinkers, and PFH positive students may experience benefits from BASICS. Although conclusions were limited by lack of randomization and short follow-up period, PFH positive and low to moderate drinking groups represent viable targets for future randomized studies.

Dietary patterns in obese pregnant women; influence of a behavioral intervention of diet and physical activity in the UPBEAT randomized controlled trial.

PubMed

Flynn, Angela C; Seed, Paul T; Patel, Nashita; Barr, Suzanne; Bell, Ruth; Briley, Annette L; Godfrey, Keith M; Nelson, Scott M; Oteng-Ntim, Eugene; Robinson, Sian M; Sanders, Thomas A; Sattar, Naveed; Wardle, Jane; Poston, Lucilla; Goff, Louise M

2016-11-29

Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes. In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care. The dietary intervention aimed to reduce glycemic load and saturated fat intake. Diet was assessed using a food frequency questionnaire (FFQ) at baseline (15 +0 -18 +6 weeks' gestation), post intervention (27 +0 -28 +6 weeks) and in late pregnancy (34 +0 -36 +0 weeks). Dietary patterns were characterized using factor analysis of the baseline FFQ data, and changes compared in the control and intervention arms. Patterns were related to pregnancy outcomes in the combined control/intervention cohort (n = 1023). Four distinct baseline dietary patterns were defined; Fruit and vegetables, African/Caribbean, Processed, and Snacks, which were differently associated with social and demographic factors. The UPBEAT intervention significantly reduced the Processed (-0.14; 95% CI -0.19, -0.08, P <0.0001) and Snacks (-0.24; 95% CI -0.31, -0.17, P <0.0001) pattern scores. In the adjusted model, baseline scores for the African/Caribbean (quartile 4 compared with quartile 1: OR = 2.46; 95% CI 1.41, 4.30) and Processed (quartile 4 compared with quartile 1: OR = 2.05; 95% CI 1.23, 3.41) patterns in the entire cohort were associated with increased risk of gestational diabetes. In a diverse cohort of obese pregnant women an intensive dietary intervention improved Processed and Snack dietary pattern scores. African/Caribbean and Processed patterns were associated with an increased risk of gestational diabetes, and provide potential targets for future interventions. Current controlled trials; ISRCTN89971375.

Obesity prevention for children with physical disabilities: a scoping review of physical activity and nutrition interventions.

PubMed

McPherson, Amy C; Keith, Rebekah; Swift, Judy A

2014-01-01

Children with disabilities are at higher risk of obesity, engage in less physical activity and report poorer quality dietary habits than their non-disabled peers. This study reviewed current evidence on interventions designed to facilitate weight management and/or weight-related behaviors (i.e. physical activity and/or healthy eating habits) in children with physical disabilities. A scoping review was performed using established methodology. Data from studies meeting specific inclusion criteria were extracted and analyzed using summary statistics, and common characteristics thematically identified. Thirty-four articles were included in the synthesis. No long-term obesity prevention interventions were identified. The majority of research focused upon children with cerebral palsy, and had case study, quasi- or non-experimental designs. All interventions reporting positive outcomes (n = 18) addressed physical activity, with common themes including using motivational strategies for the child and child self-direction. Incremental increases in workload and engaging in strength training for longer than 15 minutes were also effective. Interventions targeting body weight/composition did not report success in the long term. A robust evidence base is lacking for long-lasting obesity interventions for children with physical disabilities. Current research provides some insights into the specific components that should be considered when planning such interventions in the future.

Targeting premeal anxiety in eating disordered clients and normal controls: a preliminary investigation into the use of mindful eating vs. distraction during food exposure.

PubMed

Marek, Ryan J; Ben-Porath, Denise D; Federici, Anita; Wisniewski, Lucene; Warren, Mark

2013-09-01

Studies have demonstrated that negative affect increases prior to food intake in individuals diagnosed with an eating disorder. Mindfulness has been supported empirically to treat experiential avoidance stemming from anxiety. Thus, the current objective in this study is to empirically compare mindfulness vs. thought suppression invention during a food exposure in both clinical and nonclinical samples. In a 2 (Group: clinical vs. nonclinical) × 2 (INTERVENTION: mindfulness vs. distraction) counterbalanced within treatment design, the current investigation sought to determine the differential effectiveness of a brief mindfulness intervention vs. a brief distraction intervention in women diagnosed with AN and BN in a clinical and nonclinical sample during a food exposure. Results indicated that the eating disorder group reported a significant increase in negative affect after the mindfulness intervention as compared to the distraction intervention, whereas the nonclinical group reported a significant decrease in negative affect after the mindfulness intervention as compared to the distraction intervention. Preliminary findings suggest that clinicians may want to proceed cautiously when using mindful eating in those with severe eating disorders during the early stages of food exposure. Limitations and future directions are discussed. Copyright © 2013 Wiley Periodicals, Inc.

Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy.

PubMed

Gifford, Wendy; Davies, Barbara; Tourangeau, Ann; Lefebre, Nancy

2011-01-01

Research describes leadership as important to guideline use. Yet interventions to develop current and future leaders for this purpose are not well understood. To describe the planning and evaluation of a leadership intervention to facilitate nurses' use of guideline recommendations for diabetic foot ulcers in home health care. Planning the intervention involved a synthesis of theory and research (qualitative interviews and chart audits). One workshop and three follow-up teleconferences were delivered at two sites to nurse managers and clinical leaders (n=15) responsible for 180 staff nurses. Evaluation involved workshop surveys and interviews. Highest rated intervention components (four-point scale) were: identification of target indicators (mean 3.7), and development of a team leadership action plan (mean 3.5). Pre-workshop barriers assessment rated lowest (mean 2.9). Three months later participants indicated their leadership performance had changed as a result of the intervention, being more engaged with staff and clear about implementation goals. Creating a team leadership action plan to operationalize leadership behaviours can help in delivery of evidence-informed care. Access to clinical data and understanding team leadership knowledge and skills prior to formal training will assist nursing management in tailoring intervention strategies to identify needs and gaps. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

A systematic review comparing antiretroviral adherence descriptive and intervention studies conducted in the USA.

PubMed

Sandelowski, Margarete; Voils, Corrine I; Chang, Yunkyung; Lee, Eun-Jeong

2009-08-01

We examined the extent to which studies aimed at testing interventions to improve antiretroviral adherence have targeted the facilitators of and barriers known to affect adherence. Of the 88 reports reviewed, 41 were reports of descriptive studies conducted with US HIV-positive women and 47 were reports of intervention studies conducted with US HIV-positive persons. We extracted from the descriptive studies all findings addressing any factor linked to antiretroviral adherence and from the intervention studies, information on the nature of the intervention, the adherence problem targeted, the persons targeted for the intervention, and the intervention outcomes desired. We discerned congruence between the prominence of substance abuse as a factor identified in the descriptive studies as a barrier to adherence and its prominence as the problem most addressed in those reports of intervention studies that specified the problems targeted for intervention. We also discerned congruence between the prominence of family and provider support as factors identified in the descriptive studies as facilitators of adherence and the presence of social support as an intervention component and outcome variable. Less discernible in the reports of intervention studies was specific attention to other factors prominent in the descriptive studies, which may be due to the complex nature of the problem, individualistic and rationalist slant of interventions, or simply the ways interventions were presented. Our review raises issues about niche standardization and intervention tailoring, targeting, and fidelity.

The four key characteristics of interpersonal emotion regulation.

PubMed

Niven, Karen

2017-10-01

Emotion researchers are increasingly interested in processes by which people influence others' feelings. Although one such process, interpersonal emotion regulation, has received particular attention in recent years, there remains confusion about exactly how to define this process. The present article aims to distinguish interpersonal emotion regulation from other, related processes by outlining its four key characteristics. Specifically, interpersonal emotion regulation is presented as a process of (i) regulation, that (ii) has an affective target, (iii) is deliberate, and (iv) has a social target. Considering these characteristics raises questions for future research concerning factors that may influence the process of interpersonal emotion regulation, why interpersonal emotion regulation sometimes fails, and whether interventions can improve people's use of interpersonal emotion regulation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Can paramedics use FRAX (the WHO Fracture Risk Assessment Tool) to help GPs improve future fracture risk in patients who fall? Protocol for a randomised controlled feasibility study.

PubMed

Clarke, Shane; Bradley, Rachel; Simmonds, Bethany; Salisbury, Chris; Benger, Jonathan; Marques, Elsa; Greenwood, Rosemary; Shepstone, Lee; Robinson, Maria; Appleby-Fleming, John; Gooberman-Hill, Rachael

2014-09-03

Currently identification, and therefore, management of patients at risk of osteoporotic fracture in the UK is suboptimal. As the majority of patients who fracture have fallen, it follows that people who fall can usefully be targeted in any programme that aims to reduce osteoporotic fracture. Targeting vulnerable patients who are likely to benefit from intervention may help shift the management of fracture prevention into primary care, away from emergency departments. Paramedics who attend to patients who have fallen may be well placed to assess future fracture risk, using the Fracture Risk Assessment Tool (FRAX) and communicate that information directly to general practitioners (GPs). This feasibility study takes the form of a pragmatic, randomised controlled trial aimed at exploring and refining issues of study design, recruitment, retention, sample size and acceptability preceding a large-scale study with fracture as the end point. Patients (aged >50) who fall, call an ambulance, are attended by a study paramedic and give verbal consent will be asked FRAX and fall questions. Patients who subsequently formally consent to participation will be randomised to control (usual care) or intervention groups. Intervention will constitute transmission of calculated future fracture risk to the patients' GP with suitable, evidence-based recommendations for investigation or treatment. 3 months after the index fall, data (proportion of patients in each group undergoing investigation or starting new treatment, quality of life and health economic) will be collected and analysed using descriptive statistics. A nested qualitative study will explore issues of acceptability and study design with patients, paramedics and GPs. This protocol was approved by NRES Committee South Central Oxford C in October 2012. Research Ethics Committee ref.12/SC/0604. The study findings will be disseminated through peer-reviewed journals, conference presentations and local public events. A publication plan and authorship criteria have been preagreed. 36245726. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Design and rationale for NOURISH-T: a randomized control trial targeting parents of overweight children off cancer treatment.

PubMed

Stern, Marilyn; Ewing, Lin; Davila, Esther; Thompson, Amanda L; Hale, Gregory; Mazzeo, Suzanne

2015-03-01

Approximately 40% of off-treatment pediatric cancer survivors (PCS) are overweight or obese, which increases their risk for negative long-term physical health complications. Consistent with the Institute of Medicine's (IOM) emphasis on patients transitioning from treatment to cancer survivorship and increasing long-term healthy behaviors in these survivors, we plan to conduct a pilot RCT to address the increasing overweight/obesity rates among PCS by targeting their caregivers as agents for PCS behavior change. We plan to focus on parents' behaviors, attitudes and roles in promoting healthier eating and physical activity (PA) in PCS and adapt an evidence-informed, manualized parent intervention - NOURISH - found to be effective for parents of overweight and obese children and adolescents in reducing child and adolescent BMI. We plan to adapt NOURISH for caregivers of 5-12 year old PCS (6 months-4 years off active cancer treatment). Our pilot feasibility RCT - NOURISH-T (Nourishing Our Understanding of Role modeling to Improve Support for Healthy Transitions) evaluates: 1) the preliminary efficacy of NOURISH-T for PCS, compared with an Enhanced Usual Care (EUC) control condition, and 2) factors to consider to improve future adaptations of the intervention. The project will enroll caregivers of PCS at two pediatric oncology clinics into the 6-week intervention (or EUC) with assessments occurring pre- and post-6 weeks of intervention, and at a 4-month follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

Belief-level markers of physical activity among young adult couples: comparisons across couples without children and new parents.

PubMed

Rhodes, Ryan E; Blanchard, Chris M; Benoit, Cecilia; Levy-Milne, Ryna; Naylor, Patti Jean; Symons Downs, Danielle; Warburton, Darren E R

2014-01-01

The health benefits of regular moderate-vigorous intensity physical activity (MVPA) are well established, yet young adults, particularly parents, often show declines in MVPA and may represent a critical population for intervention. Theory-based correlates used to guide future interventions are scant in this population. The purpose of this study was to examine theory of planned behaviour (TPB) belief-level constructs as correlates of directly assessed MVPA across cohorts of couples without children and with their first child over the initial 12 months. Participants were 238 adults (102 not expecting a child, 136 expecting first child) who completed baseline demographics, belief measures of the TPB and seven-day accelerometry, followed by assessments at 6 and 12 months. Results showed select medium-sized belief-PA correlations with sex and cohort interactions. Overall, women had larger affect-based behavioural belief associations with MVPA than men (e.g. PA relieves stress), and among new parents, mothers showed larger associations with control over MVPA than fathers. Mothers also had larger associations between control beliefs and MVPA compared to women without children (e.g. domestic duties, bad weather). Extremely high means and low variability on the behavioural beliefs show limited room for possible changes in intervention while control beliefs had low means suggesting room for change. Interventions targeting control among new mothers may be paramount for increasing MVPA, yet the TPB yielded less insight into the targets for promoting MVPA among young men.

Enhancing early child care quality and learning for toddlers at risk: the responsive early childhood program.

PubMed

Landry, Susan H; Zucker, Tricia A; Taylor, Heather B; Swank, Paul R; Williams, Jeffrey M; Assel, Michael; Crawford, April; Huang, Weihua; Clancy-Menchetti, Jeanine; Lonigan, Christopher J; Phillips, Beth M; Eisenberg, Nancy; Spinrad, Tracy L; de Villiers, Jill; de Villiers, Peter; Barnes, Marcia; Starkey, Prentice; Klein, Alice

2014-02-01

Despite reports of positive effects of high-quality child care, few experimental studies have examined the process of improving low-quality center-based care for toddler-age children. In this article, we report intervention effects on child care teachers' behaviors and children's social, emotional, behavioral, early literacy, language, and math outcomes as well as the teacher-child relationship. The intervention targeted the use of a set of responsive teacher practices, derived from attachment and sociocultural theories, and a comprehensive curriculum. Sixty-five childcare classrooms serving low-income 2- and 3-year-old children were randomized into 3 conditions: business-as-usual control, Responsive Early Childhood Curriculum (RECC), and RECC plus explicit social-emotional classroom activities (RECC+). Classroom observations showed greater gains for RECC and RECC+ teachers' responsive practices including helping children manage their behavior, establishing a predictable schedule, and use of cognitively stimulating activities (e.g., shared book reading) compared with controls; however, teacher behaviors did not differ for focal areas such as sensitivity and positive discipline supports. Child assessments demonstrated that children in the interventions outperformed controls in areas of social and emotional development, although children's performance in control and intervention groups was similar for cognitive skills (language, literacy, and math). Results support the positive impact of responsive teachers and environments providing appropriate support for toddlers' social and emotional development. Possible explanations for the absence of systematic differences in children's cognitive skills are considered, including implications for practice and future research targeting low-income toddlers.

Interventions That Target Criminogenic Needs for Justice-Involved Persons With Serious Mental Illnesses: A Targeted Service Delivery Approach.

PubMed

Wilson, Amy Blank; Farkas, Kathleen; Bonfine, Natalie; Duda-Banwar, Janelle

2018-05-01

This research describes the development of a targeted service delivery approach that tailors the delivery of interventions that target criminogenic needs to the specific learning and treatment needs of justice-involved people with serious mental illnesses (SMIs). This targeted service delivery approach includes five service delivery strategies: repetition and summarizing, amplification, active coaching, low-demand practice, and maximizing participation. Examples of how to apply each strategy in session are provided, as well as recommendations on when to use each strategy during the delivery of interventions that target criminogenic needs. This targeted service delivery approach makes an important contribution to the development of interventions for justice-involved people with SMI by increasing the chances that people with SMI can participate fully in and benefit from these interventions that target criminogenic needs. These developments come at a critical time in the field as the next generation of services for justice-involved people with SMI are being developed.

Stocking the genetic supermarket: reproductive genetic technologies and collective action problems.

PubMed

Gyngell, Chris; Douglas, Thomas

2015-05-01

Reproductive genetic technologies (RGTs) allow parents to decide whether their future children will have or lack certain genetic predispositions. A popular model that has been proposed for regulating access to RGTs is the 'genetic supermarket'. In the genetic supermarket, parents are free to make decisions about which genes to select for their children with little state interference. One possible consequence of the genetic supermarket is that collective action problems will arise: if rational individuals use the genetic supermarket in isolation from one another, this may have a negative effect on society as a whole, including future generations. In this article we argue that RGTs targeting height, innate immunity, and certain cognitive traits could lead to collective action problems. We then discuss whether this risk could in principle justify state intervention in the genetic supermarket. We argue that there is a plausible prima facie case for the view that such state intervention would be justified and respond to a number of arguments that might be adduced against that view. © 2014 The Authors. Bioethics published by John Wiley & Sons Ltd.

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

Initial Outcomes From a 4-Week Follow-Up Study of the Text4baby Program in the Military Women’s Population: Randomized Controlled Trial

PubMed Central

Wallace Bihm, Jasmine; Szekely, Daniel; Nielsen, Peter; Murray, Elizabeth; Abroms, Lorien; Snider, Jeremy

2014-01-01

Background The use of mobile phone technologies for health promotion and disease prevention has advanced rapidly in recent years. Text4baby is a theory-based mobile health (mHealth) program in which text messages are delivered to pregnant women and new mothers to improve their health care beliefs and behaviors and improve health status and clinical outcomes. Recent evaluations of Text4baby have found that it improves targeted health attitudes and beliefs, but effects on behavior have not yet been determined. Objective In this study, investigators aimed to evaluate Text4baby in the military women’s population. Methods Investigators conducted a randomized controlled trial at Madigan Army Medical Center in Tacoma, Washington, from December 2011 through September 2013. All participants were pregnant women first presenting for care at Madigan. Investigators conducted a baseline assessment using a 24-item, self-administered online survey of attitudes and behaviors related to Text4baby message content. Participants were randomized to Text4baby plus usual care (intervention) or usual care alone (control). Investigators analyzed treatment effects of Text4baby on short-term targeted outcomes 4 weeks post enrollment. Results For this study, 943 patients were randomized and completed a baseline assessment. The average patient age was 28 years and nearly 70% self-identified as Caucasian. 48.7% of enrollees (459/943) completed the first follow-up assessment. Higher rates of single and working/in-school patients dropped out of the intervention arm of the study, and we adjusted for this finding in subsequent models. However, while investigators were unable to re-survey these participants, only 1.9% of Text4baby enrollees (18/943) dropped the service during the study period. Adjusted and unadjusted logistic generalized estimating equation models were developed to assess intervention effects on measured outcomes. In the model adjusting for age, marital status, having had a previous baby, and race/ethnicity, there was a significant effect of Text4baby intervention exposure on increased agreement with belief in the importance of taking prenatal vitamins (OR 1.91, 95% CI 1.08-3.34, P=.024). All of these attitudes had been targeted by at least one text message during the 4-week evaluation period examined in this study. In unadjusted models, there was a significant effect of intervention exposure on belief in the importance of visiting a health care provider to be a healthy new mother (OR 1.52, 95% CI 1.01-2.31, P=.046) and in the health risks of alcohol during pregnancy (OR 2.06, 95% CI 1.00-4.31, P=.05). No behavioral effects of the intervention were observed in this analysis. Conclusions Text4baby is a promising program that offers lessons for future mHealth activities. This large-scale study demonstrated initial effects of the program on attitudes and beliefs targeted by the messages received by women during the study period. Results confirm previous findings from Text4baby studies and other mHealth research. Future analyses will examine dosage effects of the intervention on behaviors and clinical outcomes. PMID:24846909

Mobile technology-based interventions for adult users of alcohol: A systematic review of the literature.

PubMed

Fowler, Lauren A; Holt, Sidney L; Joshi, Deepti

2016-11-01

Worldwide, 16% of people aged 15 and older engage in harmful use of alcohol. Harmful alcohol use leads to a host of preventable negative social and health consequences. Mobile technology-based interventions provide a particularly promising avenue for the widespread and cost-effective delivery of treatment that is accessible, affordable, individualized, and destigmatized to both alcohol-dependent and nondependent individuals. The present review sought to summarize the current literature on mobile technology-based interventions among adult users of alcohol and determine the efficacy of such interventions. Five databases were searched in December 2015 (Jan. 2004-Dec. 2015). Inclusion criteria were: participants aged 18 or older, interventions delivered through mobile-technology, and outcome measurement of alcohol reduction/cessation. Eight studies met inclusion criteria. The majority of the studies reviewed found positive effects of the intervention, even though the interventions themselves varied in design, length, dosage, and target population, and were pilot or preliminary in nature. Findings from this review highlight the promising, yet preliminary state of research in this area. Studies with adequate power and valid design are necessary to evaluate the potential of mobile technology-based interventions on long-term alcohol behavior outcomes. Furthermore, future research should elucidate what the most effective length of time is for a mobile technology-based intervention, how often individuals should receive messages for maximum benefit, and determine the comparative effectiveness of mobile technology interventions with other efficacious interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using the intervention mapping protocol to develop a maintenance programme for the SLIMMER diabetes prevention intervention.

PubMed

Elsman, Ellen B M; Leerlooijer, Joanne N; Ter Beek, Josien; Duijzer, Geerke; Jansen, Sophia C; Hiddink, Gerrit J; Feskens, Edith J M; Haveman-Nies, Annemien

2014-10-27

Although lifestyle interventions have shown to be effective in reducing the risk for type 2 diabetes mellitus, maintenance of achieved results is difficult, as participants often experience relapse after the intervention has ended. This paper describes the systematic development of a maintenance programme for the extensive SLIMMER intervention, an existing diabetes prevention intervention for high-risk individuals, implemented in a real-life setting in the Netherlands. The maintenance programme was developed using the Intervention Mapping protocol. Programme development was informed by a literature study supplemented by various focus group discussions and feedback from implementers of the extensive SLIMMER intervention. The maintenance programme was designed to sustain a healthy diet and physical activity pattern by targeting knowledge, attitudes, subjective norms and perceived behavioural control of the SLIMMER participants. Practical applications were clustered into nine programme components, including sports clinics at local sports clubs, a concluding meeting with the physiotherapist and dietician, and a return session with the physiotherapist, dietician and physical activity group. Manuals were developed for the implementers and included a detailed time table and step-by-step instructions on how to implement the maintenance programme. The Intervention Mapping protocol provided a useful framework to systematically plan a maintenance programme for the extensive SLIMMER intervention. The study showed that planning a maintenance programme can build on existing implementation structures of the extensive programme. Future research is needed to determine to what extent the maintenance programme contributes to sustained effects in participants of lifestyle interventions.

Managing future air quality in megacities: A case study for Delhi

NASA Astrophysics Data System (ADS)

Amann, Markus; Purohit, Pallav; Bhanarkar, Anil D.; Bertok, Imrich; Borken-Kleefeld, Jens; Cofala, Janusz; Heyes, Chris; Kiesewetter, Gregor; Klimont, Zbigniew; Liu, Jun; Majumdar, Dipanjali; Nguyen, Binh; Rafaj, Peter; Rao, Padma S.; Sander, Robert; Schöpp, Wolfgang; Srivastava, Anjali; Vardhan, B. Harsh

2017-07-01

Megacities in Asia rank high in air pollution at the global scale. In many cities, ambient concentrations of fine particulate matter (PM2.5) have been exceeding both the WHO interim targets as well as respective national air quality standards. This paper presents a systems analytical perspective on management options that could efficiently improve air quality at the urban scale, having Delhi as a case study. We employ the newly developed GAINS-City policy analysis framework, consisting of a bottom up emission calculation combined with atmospheric chemistry-transport calculation, to derive innovative insights into the current sources of pollution and their impacts on ambient PM2.5, both from emissions of primary PM as well as precursors of secondary inorganic and organic aerosols. We outline the likely future development of these sources, quantify the related ambient PM2.5 concentrations and health impacts, and explore potential policy interventions that could effectively reduce environmental pollution and resulting health impacts in the coming years. The analysis demonstrates that effective improvement of Delhi's air quality requires collaboration with neighboring States and must involve sources that are less relevant in industrialized countries. At the same time, many of the policy interventions will have multiple co-benefits on development targets in Delhi and its neighboring States. Outcomes of this study, as well as the modelling tools used herein, are applicable to other urban areas and fast growing metropolitan zones in the emerging Asian regions.

Moderating factors of video-modeling with other as model: a meta-analysis of single-case studies.

PubMed

Mason, Rose A; Ganz, Jennifer B; Parker, Richard I; Burke, Mack D; Camargo, Siglia P

2012-01-01

Video modeling with other as model (VMO) is a more practical method for implementing video-based modeling techniques, such as video self-modeling, which requires significantly more editing. Despite this, identification of contextual factors such as participant characteristics and targeted outcomes that moderate the effectiveness of VMO has not previously been explored. The purpose of this study was to meta-analytically evaluate the evidence base of VMO with individuals with disabilities to determine if participant characteristics and targeted outcomes moderate the effectiveness of the intervention. Findings indicate that VMO is highly effective for participants with autism spectrum disorder (IRD=.83) and moderately effective for participants with developmental disabilities (IRD=.68). However, differential effects are indicated across levels of moderators for diagnoses and targeted outcomes. Implications for practice and future research are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Measuring populations to improve vaccination coverage

NASA Astrophysics Data System (ADS)

Bharti, Nita; Djibo, Ali; Tatem, Andrew J.; Grenfell, Bryan T.; Ferrari, Matthew J.

2016-10-01

In low-income settings, vaccination campaigns supplement routine immunization but often fail to achieve coverage goals due to uncertainty about target population size and distribution. Accurate, updated estimates of target populations are rare but critical; short-term fluctuations can greatly impact population size and susceptibility. We use satellite imagery to quantify population fluctuations and the coverage achieved by a measles outbreak response vaccination campaign in urban Niger and compare campaign estimates to measurements from a post-campaign survey. Vaccine coverage was overestimated because the campaign underestimated resident numbers and seasonal migration further increased the target population. We combine satellite-derived measurements of fluctuations in population distribution with high-resolution measles case reports to develop a dynamic model that illustrates the potential improvement in vaccination campaign coverage if planners account for predictable population fluctuations. Satellite imagery can improve retrospective estimates of vaccination campaign impact and future campaign planning by synchronizing interventions with predictable population fluxes.

Measuring populations to improve vaccination coverage

PubMed Central

Bharti, Nita; Djibo, Ali; Tatem, Andrew J.; Grenfell, Bryan T.; Ferrari, Matthew J.

2016-01-01

In low-income settings, vaccination campaigns supplement routine immunization but often fail to achieve coverage goals due to uncertainty about target population size and distribution. Accurate, updated estimates of target populations are rare but critical; short-term fluctuations can greatly impact population size and susceptibility. We use satellite imagery to quantify population fluctuations and the coverage achieved by a measles outbreak response vaccination campaign in urban Niger and compare campaign estimates to measurements from a post-campaign survey. Vaccine coverage was overestimated because the campaign underestimated resident numbers and seasonal migration further increased the target population. We combine satellite-derived measurements of fluctuations in population distribution with high-resolution measles case reports to develop a dynamic model that illustrates the potential improvement in vaccination campaign coverage if planners account for predictable population fluctuations. Satellite imagery can improve retrospective estimates of vaccination campaign impact and future campaign planning by synchronizing interventions with predictable population fluxes. PMID:27703191

Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels.

PubMed

McCullough, Amanda R; Ryan, Cristín; O'Neill, Brenda; Bradley, Judy M; Elborn, J Stuart; Hughes, Carmel M

2015-08-22

Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients' adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3). We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients' adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3). Eight TDF domains were perceived to influence patients' and HCPs' behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in secondary care. Efficacy should be measured using pulmonary exacerbations, hospital admissions and quality of life (Stage 3). Twelve BCTs form the intervention content. An individualised selection from these 12 BCTs will be delivered to all patients over several face-to-face visits in secondary care. Future research should focus on developing physical materials to aid delivery of the intervention prior to feasibility and pilot testing. If effective, this intervention may improve adherence and health outcomes for those with bronchiectasis in the future.

21st century trucking: A trajectory for ergonomics and road freight.

PubMed

Bedinger, M; Walker, G H; Piecyk, M; Greening, P

2016-03-01

Over the past decade there has been significant pressure to minimise emissions and safety risks related to commercial driving. This pressure to meet the triple bottom line of cost, environment, and society has often resulted in the rapid application of vehicle technologies designed to mitigate undesired effects. Often the cognitive and behavioural effects of technologies on the commercial driver have not received in-depth analysis to determine comprehensive viability. As such, this paper aims to identify a timescale for implementation for future technologies for UK road freight, and likely associated human factors issues, improving upon the currently employed 'trial-and-error' approach to implementation which may carry high economic, environmental, safety-related risk. Thought experiments are carried out to broadly explore these future systems. Furthermore, this work aims to examine whether technology alone will be enough to meet future CO2 reduction targets, and assess the role of behavioural and systems interventions for future research. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

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

Large Dog Relinquishment to Two Municipal Facilities in New York City and Washington, D.C.: Identifying Targets for Intervention

PubMed Central

Weiss, Emily; Slater, Margaret; Garrison, Laurie; Drain, Natasha; Dolan, Emily; Scarlett, Janet M.; Zawistowski, Stephen L.

2014-01-01

Simple Summary While the overall trend in euthanasia has been decreasing nationally, large dogs are at a higher risk of euthanasia than other-sized dogs in most animal shelters in the United States. We hypothesized that one way to increase the lives saved with regard to large dogs in shelters is to keep them home in the first place when possible. Our research is the first to collect data in New York City and Washington, D.C., identifying the process leading to the owner relinquishment of large dogs. We found that targets for interventions to decrease large dog relinquishment are likely different in each community. Abstract While the overall trend in euthanasia has been decreasing nationally, large dogs are at a higher risk of euthanasia than other sized dogs in most animal shelters in the United States. We hypothesized one way to increase the lives saved with respect to these large dogs is to keep them home when possible. In order to develop solutions to decrease relinquishment, a survey was developed to learn more about the reasons owners relinquish large dogs. The survey was administered to owners relinquishing their dogs at two large municipal facilities, one in New York City and one in Washington, D.C. There were 157 responses between the two facilities. We found both significant similarities and differences between respondents and their dogs from the two cities. We identified opportunities to potentially support future relinquishers and found that targets for interventions are likely different in each community. PMID:26480315

Harnessing the potential of noninvasive in vivo preclinical imaging of the immune system: challenges and prospects.

PubMed

Diken, Mustafa; Pektor, Stefanie; Miederer, Matthias

2016-10-01

Preclinical imaging has become a powerful method for investigation of in vivo processes such as pharmacokinetics of therapeutic substances and visualization of physiologic and pathophysiological mechanisms. These are important aspects to understand diseases and develop strategies to modify their progression with pharmacologic interventions. One promising intervention is the application of specifically tailored nanoscale particles that modulate the immune system to generate a tumor targeting immune response. In this complex interaction between immunomodulatory therapies, the immune system and malignant disease, imaging methods are expected to play a key role on the way to generate new therapeutic strategies. Here, we summarize examples which demonstrate the current potential of imaging methods and develop a perspective on the future value of preclinical imaging of the immune system.

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

Teaching Functional Play Skills to a Young Child with Autism Spectrum Disorder through Video Self-Modeling.

PubMed

Lee, Sharon Y; Lo, Ya-Yu; Lo, Yafen

2017-08-01

The researchers used a single-case, multiple probe design across three sets of toys (i.e., farm toy, doctor's clinic toy, and rescue toy) to examine the effects of video self-modeling (VSM) on the functional play skills of a 5-year-old child with autism spectrum disorder. The findings showed a functional relation between VSM and increased percentages of functional play actions across the toy sets. The participant's percentages of the targeted functional play skills for the intervention toys remained high 1 week and 2 weeks after the intervention ceased. Additionally, preliminary generalization results showed slight improvement in the percentages of functional play actions with the generalization toys that were not directly taught. Limitations, practical implications, and directions for future research are discussed.

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

Assessing the Generalizability of Randomized Trial Results to Target Populations

PubMed Central

Stuart, Elizabeth A.; Bradshaw, Catherine P.; Leaf, Philip J.

2014-01-01

Recent years have seen increasing interest in and attention to evidence-based practices, where the “evidence” generally comes from well-conducted randomized trials. However, while those trials yield accurate estimates of the effect of the intervention for the participants in the trial (known as “internal validity”), they do not always yield relevant information about the effects in a particular target population (known as “external validity”). This may be due to a lack of specification of a target population when designing the trial, difficulties recruiting a sample that is representative of a pre-specified target population, or to interest in considering a target population somewhat different from the population directly targeted by the trial. This paper first provides an overview of existing design and analysis methods for assessing and enhancing the ability of a randomized trial to estimate treatment effects in a target population. It then provides a case study using one particular method, which weights the subjects in a randomized trial to match the population on a set of observed characteristics. The case study uses data from a randomized trial of School-wide Positive Behavioral Interventions and Supports (PBIS); our interest is in generalizing the results to the state of Maryland. In the case of PBIS, after weighting, estimated effects in the target population were similar to those observed in the randomized trial. The paper illustrates that statistical methods can be used to assess and enhance the external validity of randomized trials, making the results more applicable to policy and clinical questions. However, there are also many open research questions; future research should focus on questions of treatment effect heterogeneity and further developing these methods for enhancing external validity. Researchers should think carefully about the external validity of randomized trials and be cautious about extrapolating results to specific populations unless they are confident of the similarity between the trial sample and that target population. PMID:25307417

Assessing the generalizability of randomized trial results to target populations.

PubMed

Stuart, Elizabeth A; Bradshaw, Catherine P; Leaf, Philip J

2015-04-01

Recent years have seen increasing interest in and attention to evidence-based practices, where the "evidence" generally comes from well-conducted randomized trials. However, while those trials yield accurate estimates of the effect of the intervention for the participants in the trial (known as "internal validity"), they do not always yield relevant information about the effects in a particular target population (known as "external validity"). This may be due to a lack of specification of a target population when designing the trial, difficulties recruiting a sample that is representative of a prespecified target population, or to interest in considering a target population somewhat different from the population directly targeted by the trial. This paper first provides an overview of existing design and analysis methods for assessing and enhancing the ability of a randomized trial to estimate treatment effects in a target population. It then provides a case study using one particular method, which weights the subjects in a randomized trial to match the population on a set of observed characteristics. The case study uses data from a randomized trial of school-wide positive behavioral interventions and supports (PBIS); our interest is in generalizing the results to the state of Maryland. In the case of PBIS, after weighting, estimated effects in the target population were similar to those observed in the randomized trial. The paper illustrates that statistical methods can be used to assess and enhance the external validity of randomized trials, making the results more applicable to policy and clinical questions. However, there are also many open research questions; future research should focus on questions of treatment effect heterogeneity and further developing these methods for enhancing external validity. Researchers should think carefully about the external validity of randomized trials and be cautious about extrapolating results to specific populations unless they are confident of the similarity between the trial sample and that target population.

A Systematic Review of Obesity Prevention Intervention Studies among Immigrant Populations in the US.

PubMed

Tovar, Alison; Renzaho, Andre M N; Guerrero, Alma D; Mena, Noereem; Ayala, Guadalupe X

2014-01-01

The aim of this review was to systematically assess the effectiveness of obesity prevention and control interventions in US immigrant populations across the life course, from preschool-age to adults. A systematic review of relevant studies was undertaken and eligible articles included. The initial search identified 684 potentially relevant articles, of which only 20 articles met the selection criteria, representing 20 unique studies. They were divided into interventions that targeted adults (n=7), interventions that targeted children (n=5) and pilot studies (n=8). The majority of interventions targeted Latinos, predominately Mexican-origin populations. Among the interventions targeting adults, five had an effect on obesity related outcomes. However, they tended to use less rigorous study designs. Among the interventions that targeted children, three had a positive effect on obesity-related outcomes. Three of the eight pilot studies had an effect on obesity-related outcomes. There is a paucity of data on effective interventions but a great need to address obesity prevention to help inform health policies and programs to reduce migration-related obesity inequalities.

Rural Asthma: Current Understanding of Prevalence, Patterns, and Interventions for Children and Adolescents.

PubMed

Estrada, Robin Dawson; Ownby, Dennis R

2017-06-01

Asthma is the most common chronic illness of children and adolescents in the USA. While asthma has been understood to disproportionately affect urban dwellers, recent investigations have revealed rural pediatric asthma prevalence to be very similar to urban and to be more closely correlated with socioeconomic and environmental factors than geographic location or population density. Rural children experience factors unique to location that impact asthma development and outcomes, including housing quality, cigarette smoke exposure, and small/large-scale farming. Additionally, there are challenging barriers to appropriate asthma care that frequently are more severe for those living in rural areas, including insurance status, lack of primary care providers and pulmonary specialists, knowledge deficits (both patient and provider), and a lack of culturally tailored asthma interventions. Interventions designed to address rural pediatric asthma disparities are more likely to be successful when targeted to specific challenges, such as the use of school-based services or telemedicine to mitigate asthma care access issues. Continued research on understanding the complex interaction of specific rural environmental factors with host factors can inform future interventions designed to mitigate asthma disparities.

Technology-based Interventions for Substance Use and Comorbid Disorders: An Examination of the Emerging Literature

PubMed Central

Sugarman, Dawn E.; Campbell, Aimee N.C.; Iles, Brittany R.; Greenfield, Shelly F.

2016-01-01

Among individuals with substance use disorders (SUDs), comorbidity with other psychiatric disorders is common and often noted as the rule rather than the exception. Standard care providing integrated treatment for comorbid diagnoses simultaneously has been shown to be effective. Technology-based interventions (TBIs) have the potential to provide a cost-effective platform for and greater accessibility to integrated treatments. For the purposes of this review, we defined TBIs as interventions in which the primary targeted aim of the intervention was delivered by automated computer, internet, or mobile system with minimal to no live therapist involvement. A search of the literature identified nine distinct TBIs for SUDs and comorbid disorders. An examination of this limited research showed promise, particularly for TBIs that address problematic alcohol use, depression, and/or anxiety. Additional randomized controlled trials of TBIs for comorbid SUDs and anxiety and depression are needed, as is future research developing TBIs that address SUDs and comorbid eating disorders and psychotic disorders. Ways of leveraging the full capabilities of what technology can offer should also be further explored. PMID:28475504

Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: Response expectancies and emotional distress

PubMed Central

Montgomery, Guy H.; Hallquist, Michael N.; Schnur, Julie B.; David, Daniel; Silverstein, Jeffrey H.; Bovbjerg, Dana H.

2010-01-01

Hypnosis is widely recognized as an empirically supported intervention to improve postsurgical outcomes. However, to date, no research has examined mediators of hypnotic benefit among surgery patients. The present study was designed to test the hypotheses that response expectancies and emotional distress would mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). In a sample of 200 women undergoing breast conserving surgery (mean age = 48.50 years), structural equation modeling revealed the following: 1) hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p< .0001), but not by distress (p=.12); 2) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p=.02), but not by nausea expectancy (p=.10); 3) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p=.0001) and presurgical distress (p=.02). These results improve understanding of the underlying mechanisms responsible for hypnotic phenomena in the surgical setting, and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery. PMID:20099953

A Review of e-Health Interventions for Maternal and Child Health in Sub-Sahara Africa.

PubMed

Obasola, Oluwaseun Ireti; Mabawonku, Iyabo; Lagunju, Ikeoluwa

2015-08-01

To review e-health interventions for maternal and child health (MCH) and to explore their influence on MCH practices in sub-Sahara Africa (SSA). Keyword searches were used to retrieve articles from four databases and the websites of organisations involved in e-health projects for MCH in SSA. A total of 18relevant articles were retrieved using inclusion and exclusion criteria. The researchers reveal the prevalence of the application of mobile phones for MCH care and the influence of the use of information and communication technology (ICT) for delivering MCH information and services to target populations. There is a need to move the application of ICT for MCH care from pilot initiatives to interventions involving all stakeholders on a sub-regional scale. These interventions should also adopt an integrated approach that takes care of the information needs at every stage along the continuum of care. It is anticipated that the study would be useful in the evolution and implementation of future ICT-based programmes for MCH in the region.

The uses of cognitive training technologies in the treatment of autism spectrum disorders.

PubMed

Wass, Sam V; Porayska-Pomsta, Kaska

2014-11-01

In this review, we focus on research that has used technology to provide cognitive training - i.e. to improve performance on some measurable aspect of behaviour - in individuals with autism spectrum disorders. We review technology-enhanced interventions that target three different cognitive domains: (a) emotion and face recognition, (b) language and literacy, and (c) social skills. The interventions reviewed allow for interaction through different modes, including point-and-click and eye-gaze contingent software, and are delivered through diverse implementations, including virtual reality and robotics. In each case, we examine the evidence of the degree of post-training improvement observed following the intervention, including evidence of transfer to altered behaviour in ecologically valid contexts. We conclude that a number of technological interventions have found that observed improvements within the computerised training paradigm fail to generalise to altered behaviour in more naturalistic settings, which may result from problems that people with autism spectrum disorders experience in generalising and extrapolating knowledge. However, we also point to several promising findings in this area. We discuss possible directions for future work. © The Author(s) 2013.

Atherosclerosis. Potential targets for stabilization and regression.

PubMed

Schwartz, C J; Valente, A J; Sprague, E A; Kelley, J L; Cayatte, A J; Mowery, J

1992-12-01

Reviewed are various aspects of atherosclerotic plaque stabilization and regression in humans and experimental animals. Plaque regression is a function of the dynamic balance among initiation, progression, stabilization, and removal of plaque constituents. Pseudoregression, the result of the triad thrombolysis, age- or lesion-dependent arterial dilatation, and relaxation of vasospasm, may readily give rise to angiographic misinterpretation. Although lowering of plasma cholesterol and low density lipoprotein-cholesterol has demonstrated significant clinical benefits in a number of clinical trials, the magnitude of angiographic regressive changes is relatively small despite aggressive lipid-lowering regimens. The emerging need for alternative or complementary therapeutic interventions has been emphasized. In particular, they should be targeted to pivotal cellular or molecular mechanisms in initiation, progression, or stabilization. Potentially important therapeutic targets include the use of antioxidants or free radical scavengers such as Probucol or its analogues, butylated hydroxytoluene, tocopherols, and possibly the tocotrienols. Other therapeutic targets include intimal monocyte-macrophage recruitment, macrophage cholesterol acyltransferase inhibition, stimulation of the high density lipoprotein-mediated reverse cholesterol transport system, smooth muscle cell migration to and proliferation in the arterial intima, and intimal connective tissue synthesis. Whether the isoprenylated proteins associated with the cholesterol biosynthetic pathway will give rise to compounds regulating smooth muscle cell growth has yet to be determined. Because of the importance of thrombosis in the pathogenesis and progression of lesions, the need to develop interventional strategies targeted at endothelial cell thromboresistance and thromboregulation must assume a high priority in future research and development. Other areas of therapeutic promise include the calcium channel blockers and angiotensin converting enzyme inhibitors.(ABSTRACT TRUNCATED AT 250 WORDS)

Using the Internet to promote physical activity: a randomized trial of intervention delivery modes.

PubMed

Steele, Rebekah; Mummery, W Kerry; Dwyer, Trudy

2007-07-01

A growing number of the population are using the Internet for health information, such as physical activity (PA). The aim of this study was to examine the effectiveness of delivery modes for a behavior change program targeting PA. A randomized trial was conducted with 192 subjects randomly allocated to either a face-to-face, Internet-mediated, or Internet-only arm of a 12-wk intervention. Subjects included inactive adults with Internet access. The primary outcome variable was self-reported PA, assessed at four time points. The results showed no group x time interaction for PA F(6, 567) = 1.64, p > 0.05, and no main effect for group F(2, 189) = 1.58, p > 0.05. However, a main effect for time F(3, 567) = 75.7, p < 0.01 was observed for each group. All groups were statistically equivalent immediately post-intervention (p < 0.05), but not at the follow-up time points (p > 0.05). The Internet-mediated and Internet-only groups showed similar increases in PA to the face-to-face group immediately post-intervention. This study provides evidence in support of the Internet in the delivery of PA interventions and highlights avenues for future research.

Economics of Obesity — Learning from the Past to Contribute to a Better Future

PubMed Central

Ananthapavan, Jaithri; Sacks, Gary; Moodie, Marj; Carter, Rob

2014-01-01

The discipline of economics plays a varied role in informing the understanding of the problem of obesity and the impact of different interventions aimed at addressing it. This paper discusses the causes of the obesity epidemic from an economics perspective, and outlines various justifications for government intervention in this area. The paper then focuses on the potential contribution of health economics in supporting resource allocation decision making for obesity prevention/treatment. Although economic evaluations of single interventions provide useful information, evaluations undertaken as part of a priority setting exercise provide the greatest scope for influencing decision making. A review of several priority setting examples in obesity prevention/treatment indicates that policy (as compared with program-based) interventions, targeted at prevention (as compared with treatment) and focused “upstream” on the food environment, are likely to be the most cost-effective options for change. However, in order to further support decision makers, several methodological advances are required. These include the incorporation of intervention costs/benefits outside the health sector, the addressing of equity impacts, and the increased engagement of decision makers in the priority setting process. PMID:24736685

Translating Genetic Research into Preventive Intervention: The Baseline Target Moderated Mediator Design

PubMed Central

Howe, George W.; Beach, Steven R. H.; Brody, Gene H.; Wyman, Peter A.

2016-01-01

In this paper we present and discuss a novel research approach, the baseline target moderated mediation (BTMM) design, that holds substantial promise for advancing our understanding of how genetic research can inform prevention research. We first discuss how genetically informed research on developmental psychopathology can be used to identify potential intervention targets. We then describe the BTMM design, which employs moderated mediation within a longitudinal study to test whether baseline levels of intervention targets moderate the impact of the intervention on change in that target, and whether change in those targets mediates causal impact of preventive or treatment interventions on distal health outcomes. We next discuss how genetically informed BTMM designs can be applied to both microtrials and full-scale prevention trials. We use simulated data to illustrate a BTMM, and end with a discussion of some of the advantages and limitations of this approach. PMID:26779062

Translating Genetic Research into Preventive Intervention: The Baseline Target Moderated Mediator Design.

PubMed

Howe, George W; Beach, Steven R H; Brody, Gene H; Wyman, Peter A

2015-01-01

In this paper we present and discuss a novel research approach, the baseline target moderated mediation (BTMM) design, that holds substantial promise for advancing our understanding of how genetic research can inform prevention research. We first discuss how genetically informed research on developmental psychopathology can be used to identify potential intervention targets. We then describe the BTMM design, which employs moderated mediation within a longitudinal study to test whether baseline levels of intervention targets moderate the impact of the intervention on change in that target, and whether change in those targets mediates causal impact of preventive or treatment interventions on distal health outcomes. We next discuss how genetically informed BTMM designs can be applied to both microtrials and full-scale prevention trials. We use simulated data to illustrate a BTMM, and end with a discussion of some of the advantages and limitations of this approach.

A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work?

PubMed

Walczak, Adam; Butow, Phyllis N; Bu, Stella; Clayton, Josephine M

2016-01-01

To identify and synthesise evidence for interventions targeting end-of-life communication. Database, reference list and author searches were conducted to identify evaluations of end-of-life communication-focussed interventions. Data were extracted, synthesised and QUALSYST quality analyses were performed. Forty-five studies met inclusion criteria. Interventions targeted patients (n=6), caregivers (n=3), healthcare professionals (HCPs n=24) and multiple stakeholders (n=12). Interventions took various forms including communication skills training, education, advance care planning and structured practice changes. Substantial heterogeneity in study designs, outcomes, settings and measures was apparent and study quality was variable. A substantial number of end-of-life communication interventions have been evaluated. Interventions have particularly targeted HCPs in cancer settings, though patient, caregiver and multi-focal interventions have also been evaluated. While some interventions were efficacious in well-designed RCTs, most evidence was from less robust studies. While additional interventions targeting patients and caregivers are needed, multi-focal interventions may more effectively remove barriers to end-of-life communication. Despite the limitations evident in the existing literature, healthcare professionals may still derive useful insights into effective approaches to end-of-life communication if appropriate caution is exercised. However, additional RCTs, implementation studies and cost-benefit analyses are required to bolster arguments for implementing and resourcing communication interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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.

Work Site-Based Environmental Interventions to Reduce Sedentary Behavior: A Systematic Review.

PubMed

Hutcheson, Amanda K; Piazza, Andrew J; Knowlden, Adam P

2018-01-01

The purpose of this investigation was to systematically review work site-based, environmental interventions to reduce sedentary behavior following preferred reporting items for systematic reviews and meta-analyses guidelines. Data were extracted from Medical Literature Analysis and Retrieval System Online, Cochrane Central Register of Controlled Trials, and Web of Science between January 2005 and December 2015. Inclusion criteria were work site interventions, published in peer-reviewed journals, employing environmental modalities, targeting sedentary behavior, and using any quantitative design. Exclusion criteria were noninterventions and non-English publications. Data extracted included study design, population, intervention dosage, intervention activities, evaluation measures, and intervention effects. Data were tabulated quantitatively and synthesized qualitatively. A total of 15 articles were identified for review and 14 reported statistically significant decreases in sedentary behavior. The majority of studies employed a randomized controlled trial design (n = 7), used inclinometers to measure sedentary behavior (n = 9), recruited predominantly female samples (n = 15), and utilized sit-to-stand desks as the primary intervention modality (n = 10). The mean methodological quality score was 6.2 out of 10. Environmental work site interventions to reduce sedentary behavior show promise because work sites often have more control over environmental factors. Limitations of this intervention stream include inconsistent measurement of sedentary behavior, absence of theoretical frameworks to guide program development, and absence of long-term evaluation. Future studies should include clear reporting of intervention strategies and explicit operationalization of theoretical constructs.

A Systematic Review of Promising Strategies of Faith-Based Cancer Education and Lifestyle Interventions Among Racial/Ethnic Minority Groups.

PubMed

Hou, Su-I; Cao, Xian

2017-09-13

Church-based interventions have been used to reach racial/ethnic minorities. In order to develop effective programs, we conducted a comprehensive systematic review of faith-based cancer prevention studies (2005~2016) to examine characteristics and promising strategies. Combination terms "church or faith-based or religion," "intervention or program," and "cancer education or lifestyle" were used in searching the five major databases: CINAHL; ERIC; Health Technology Assessments; MEDLINE; and PsycInfo. A total of 20 studies met study criteria. CDC's Community Guide was used to analyze and review group interventions. Analyses were organized by two racial groups: African American (AA) and Latino/Hispanic American groups. Results showed most studies reviewed focused on breast cancer alone or in combination with other cancers. Studies of Latino/Hispanic groups targeted more on uninsured, Medicare, or Medicaid individuals, whereas AA studies generally did not include specific insurance criteria. The sample sizes of the AA studies were generally larger. The majority of these studies reviewed used pre-post, posttest only with control group, or quasi-experience designs. The Health Belief Model was the most commonly used theory in both groups. Community-based participatory research and empowerment/ecological frameworks were also used frequently in the Latino/Hispanic studies. Small media and group education were the top two most popular intervention strategies in both groups. Although one-on-one strategy was used in some Latino studies, neither group used reducing client out-of-pocket costs strategy. Client reminders could also be used more in both groups as well. Current review showed church-based cancer education programs were effective in changing knowledge, but not always screening utilization. Results show faith-based cancer educational interventions are promising. To maximize intervention impact, future studies might consider using stronger study designs, incorporating a variety of proven effective strategies, including those frequently used evidence-based strategies, as well as exploring promising strategies among specific target groups.

Evaluating Exercise Prescription and Instructional Methods Used in Tai Chi Studies Aimed at Improving Balance in Older Adults: A Systematic Review.

PubMed

Wu, Yin; MacDonald, Hayley V; Pescatello, Linda S

2016-10-01

To develop an evaluation instrument to determine to what extent Tai Chi interventions aimed at improving the balance of older adults disclosed their exercise prescription (Ex R x ) and instructional methods and met best-practice exercise recommendations for balance improvement. Review. PubMed, Scopus, and CINAHL databases were searched from their inception until August 22, 2014. Adults aged 60 and older without debilitating disease. Three electronic databases were searched to identify randomized controlled trials (RCTs) of Tai Chi interventions aimed at improving balance in older adults without severe debilitating diseases. Three Ex R x (frequency, time, intervention length) and 10 instructional (e.g., style, number of forms) methods of the included RCTs were evaluated. Twenty-seven interventions were identified from 26 RCTs. On average, Tai Chi was performed for a mean 56.5 ± 14.4 minutes per session for 2.8 ± 1.4 sessions per week for 19.7 ± 12.7 weeks. Most interventions reported all three Ex R x methods items, with a mean reporting rate of 92.6 ± 19.2%. For the 10 instructional methods items, the mean reporting rate was 41.1 ± 18.0%, significantly lower than for the Ex R x methods items (P < .001). Fewer than half of the interventions reported unsupervised practice (15%), progression (22%), or the use of breathing (30%) and relaxation (15%) techniques. The instructional methods items most important for targeting Tai Chi practice to improve balance were not routinely disclosed, with only 15% reporting names of forms and 52% reporting movement principles. Most Tai Chi interventions disclosed their Ex R x methods yet routinely failed to report instructional methods. To increase the effectiveness of Tai Chi to improve balance in older adults, future RCTs should disclose their Ex R x and instructional methods, especially methods that target balance. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Balanced: a randomised trial examining the efficacy of two self-monitoring methods for an app-based multi-behaviour intervention to improve physical activity, sitting and sleep in adults.

PubMed

Duncan, Mitch J; Vandelanotte, Corneel; Trost, Stewart G; Rebar, Amanda L; Rogers, Naomi; Burton, Nicola W; Murawski, Beatrice; Rayward, Anna; Fenton, Sasha; Brown, Wendy J

2016-07-30

Many adults are insufficiently physically active, have prolonged sedentary behaviour and report poor sleep. These behaviours can be improved by interventions that include education, goal setting, self-monitoring, and feedback strategies. Few interventions have explicitly targeted these behaviours simultaneously or examined the relative efficacy of different self-monitoring methods. This study aims to compare the efficacy of two self-monitoring methods in an app-based multi-behaviour intervention to improve objectively measured physical activity, sedentary, and sleep behaviours, in a 9 week 2-arm randomised trial. Participants will be adults (n = 64) who report being physically inactive, sitting >8 h/day and frequent insufficient sleep (≥14 days out of last 30). The "Balanced" intervention is delivered via a smartphone 'app', and includes education materials (guidelines, strategies to promote change in behaviour), goal setting, self-monitoring and feedback support. Participants will be randomly allocated to either a device-entered or user-entered self-monitoring method. The device-entered group will be provided with a activity tracker to self-monitor behaviours. The user-entered group will recall and manually record behaviours. Assessments will be conducted at 0, 3, 6, and 9 weeks. Physical activity, sedentary behaviour and sleep-wake behaviours will be measured using the wrist worn Geneactiv accelerometer. Linear mixed models will be used to examine differences between groups and over time using an alpha of 0.01. This study will evaluate an app-based multi-behavioural intervention to improve physical activity, sedentary behaviour and sleep; and the relative efficacy of two different approaches to self-monitoring these behaviours. Outcomes will provide information to inform future interventions and self-monitoring targeting these behaviours. ACTRN12615000182594 (Australian New Zealand Clinical Trials Registry. Registry URL: www.anzctr.org.au ; registered prospectively on 25 February 2015).

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.

Cost-effectiveness of targeted versus tailored interventions to promote mammography screening among women military veterans in the United States.

PubMed

Lairson, David R; Chan, Wen; Chang, Yu-Chia; del Junco, Deborah J; Vernon, Sally W

2011-05-01

We conducted an economic evaluation of mammography promotion interventions in a population-based, nationally representative sample of 5500 women veterans. Women 52 years and older were randomly selected from the National Registry of Women Veterans and randomly assigned to a survey-only control group and two intervention groups that varied in the extent of personalization (tailored vs. targeted). Effectiveness measures were the prevalence of at least one self-reported post-intervention mammogram and two post-intervention mammograms 6-15 months apart. Incremental cost-effectiveness ratios (ICERs) were the incremental cost per additional person screened. Uncertainty was examined with sensitivity analysis and bootstrap simulation. The targeted intervention cost $25 per person compared to $52 per person for the tailored intervention. About 27% of the cost was incurred in identifying and recruiting the eligible population. The percent of women reporting at least one mammogram were .447 in the control group, .469 in the targeted group, and .460 in the tailored group. The ICER was $1116 comparing the targeted group to the control group (95% confidence interval (CI)=$493 to dominated). The tailored intervention was dominated (more costly and less effective) by the targeted intervention. Decision-makers should consider effectiveness evidence and the full recruitment and patient time costs associated with the implementation of screening interventions when making investments in mammography screening promotion programs. Identification and recruitment of eligible participants add substantial costs to outreach screening promotion interventions. Tailoring adds substantial cost to the targeted mammography promotion strategy without a commensurate increase in effectiveness. Although cost-effectiveness has been reported to be higher for some in-reach screening promotion interventions, a recent meta-analysis revealed significant heterogeneity in the effect sizes of published health-plan based intervention studies for repeat mammography (i.e., some studies reported null effects compared with control groups). Copyright © 2010 Elsevier Ltd. All rights reserved.

Public acceptability of government intervention to change health-related behaviours: a systematic review and narrative synthesis

PubMed Central

2013-01-01

Background Governments can intervene to change health-related behaviours using various measures but are sensitive to public attitudes towards such interventions. This review describes public attitudes towards a range of policy interventions aimed at changing tobacco and alcohol use, diet, and physical activity, and the extent to which these attitudes vary with characteristics of (a) the targeted behaviour (b) the intervention and (c) the respondents. Methods We searched electronic databases and conducted a narrative synthesis of empirical studies that reported public attitudes in Europe, North America, Australia and New Zealand towards interventions relating to tobacco, alcohol, diet and physical activity. Two hundred studies met the inclusion criteria. Results Over half the studies (105/200, 53%) were conducted in North America, with the most common interventions relating to tobacco control (110/200, 55%), followed by alcohol (42/200, 21%), diet-related interventions (18/200, 9%), interventions targeting both diet and physical activity (18/200, 9%), and physical activity alone (3/200, 2%). Most studies used survey-based methods (160/200, 80%), and only ten used experimental designs. Acceptability varied as a function of: (a) the targeted behaviour, with more support observed for smoking-related interventions; (b) the type of intervention, with less intrusive interventions, those already implemented, and those targeting children and young people attracting most support; and (c) the characteristics of respondents, with support being highest in those not engaging in the targeted behaviour, and with women and older respondents being more likely to endorse more restrictive measures. Conclusions Public acceptability of government interventions to change behaviour is greatest for the least intrusive interventions, which are often the least effective, and for interventions targeting the behaviour of others, rather than the respondent him or herself. Experimental studies are needed to assess how the presentation of the problem and the benefits of intervention might increase acceptability for those interventions which are more effective but currently less acceptable. PMID:23947336

Dissonance-based interventions for health behaviour change: a systematic review.

PubMed

Freijy, Tanya; Kothe, Emily J

2013-05-01

Increasing evidence suggests that various health behaviours are amenable to change following the induction of cognitive dissonance. This systematic review sought to evaluate the effectiveness and methodological quality of dissonance-based health behaviour interventions and to explore identified sources of heterogeneity in intervention effects. Bibliographic databases were searched for relevant articles from inception to March 2012. Only studies targeting non-clinical health behaviour in non-clinical populations were included in the review. One author extracted data and assessed quality of evidence and a second author verified all content. Reports of 20 studies were included. A variety of health behaviours and outcome measures were addressed across studies. Most studies produced one or more significant effects on measures of behaviour, attitude or intention. Across studies, methodological risk for bias was frequently high, particularly for selection bias. Gender and self-esteem were identified as potential moderator variables. The evidence for the effectiveness of dissonance-based interventions was generally positive. The hypocrisy paradigm was found to be the most commonly applied research paradigm and was most effective at inciting change across a range of health behaviours. There was no observable link between type of target behaviour and positive outcomes. Researchers are encouraged to minimize potential for bias in future studies and explore moderators of the dissonance effect. What is already known on this subject? A recent meta-analysis indicates that dissonance-based interventions primarily based on the induced compliance paradigm are effective for eating disorder prevention (Stice, Shaw, Becker, & Rohde, 2008, Prev. Sci., 9, 114). However, it is currently unclear whether such outcomes are generalizable to interventions targeting non-clinical health behaviours such as smoking, sun protection and sexual risk taking. Other research indicates that studies based on the hypocrisy paradigm may lead to changes in non-clinical health behaviours (Stone & Fernandez, 2008, Soc. Personal. Psychol. Compass, 2, 1024; Stone & Focella, 2011, Self Identity, 10, 295) although this literature lacks systematic evaluation of interventions across a range of experimental paradigms. What does this study add? The hypocrisy paradigm appears most effective in inciting change across a range of non-clinical health behaviours. The dissonance effect may be moderated by variables such as self-esteem and gender. Risk of bias needs to be minimised to increase the validity of studies within this topic area. © 2013 The British Psychological Society.

Implementation of targeted medication adherence interventions within a community chain pharmacy practice: The Pennsylvania Project.

PubMed

Bacci, Jennifer L; McGrath, Stephanie Harriman; Pringle, Janice L; Maguire, Michelle A; McGivney, Melissa Somma

2014-01-01

To identify facilitators and barriers to implementing targeted medication adherence interventions in community chain pharmacies, and describe adaptations of the targeted intervention and organizational structure within each individual pharmacy practice. Qualitative study. Central and western Pennsylvania from February to April 2012. Rite Aid pharmacists staffed at the 118 Pennsylvania Project intervention sites. Qualitative analysis of pharmacists' perceptions of facilitators and barriers experienced, targeted intervention and organizational structure adaptations implemented, and training and preparation prior to implementation. A total of 15 key informant interviews were conducted from February to April 2012. Ten pharmacists from "early adopter" practices and five pharmacists from "traditionalist" practices were interviewed. Five themes emerged regarding the implementation of targeted interventions, including all pharmacists' need to understand the relationship of patient care programs to their corporation's vision; providing individualized, continual support and mentoring to pharmacists; anticipating barriers before implementation of patient care programs; encouraging active patient engagement; and establishing best practices regarding implementation of patient care services. This qualitative analysis revealed that there are a series of key steps that can be taken before the execution of targeted interventions that may promote successful implementation of medication therapy management in community chain pharmacies.

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.

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.

Windows of Opportunity for Lifestyle Interventions to Prevent Gestational Diabetes Mellitus.

PubMed

Phelan, Suzanne

2016-11-01

Gestational diabetes mellitus (GDM) is linked with several acute maternal health risks and long-term development of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM similarly increases offspring risk of early-life health complications and later disease. GDM recurrence is common, affecting 40 to 73% of women, and augments associated maternal/fetal/child health risks. Modifiable and independent risk factors for GDM include maternal excessive gestational weight gain and prepregnancy overweight and obesity. Lifestyle interventions that target diet, activity, and behavioral strategies can effectively modify body weight. Randomized clinical trials testing the effects of lifestyle interventions during pregnancy to reduce excessive gestational weight gain have generally shown mixed effects on reducing GDM incidence. Trials testing the effects of postpartum lifestyle interventions among women with a history of GDM have shown reduced incidence of diabetes and improved cardiovascular disease risk factors. However, the long-term effects of interpregnancy or prepregnancy lifestyle interventions on subsequent GDM remain unknown. Future adequately powered and well-controlled clinical trials are needed to determine the effects of lifestyle interventions to prevent GDM and identify pathways to effectively reach reproductive-aged women across all levels of society, before, during, and after pregnancy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tools, harmonization and standardization procedures of the impact and outcome evaluation indices obtained during a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study.

PubMed

Mouratidou, T; Miguel, M L; Androutsos, O; Manios, Y; De Bourdeaudhuij, I; Cardon, G; Kulaga, Z; Socha, P; Galcheva, S; Iotova, V; Payr, A; Koletzko, B; Moreno, L A

2014-08-01

The ToyBox-intervention is a kindergarten-based, family-involved intervention targeting multiple lifestyle behaviours in preschool children, their teachers and their families. This intervention was conducted in six European countries, namely Belgium, Bulgaria, Germany, Greece, Poland and Spain. The aim of this paper is to provide a descriptive overview of the harmonization and standardization procedures of the baseline and follow-up evaluation of the study (and substudies). Steps related to the study's operational, standardization and harmonization procedures as well as the impact and outcome evaluation assessment tools used are presented. Experiences from the project highlight the importance of safeguarding the measurement process to minimize data heterogeneity derived from potential measurement error and country-by-country differences. In addition, it was made clear that continuing quality control and support is an important component of such studies. For this reason, well-supported communication channels, such as regular email updates and teleconferences, and regular internal and external meetings to ensure smooth and accurate implementation were in place during the study. The ToyBox-intervention and its harmonized and standardized procedures can serve as a successful case study for future studies evaluating the efficacy of similar interventions. © 2014 World Obesity.

Use of a glucose management service improves glycemic control following vascular surgery: an interrupted time-series study.

PubMed

Wallaert, Jessica B; Chaidarun, Sushela S; Basta, Danielle; King, Kathryn; Comi, Richard; Ogrinc, Greg; Nolan, Brian W; Goodney, Philip P

2015-05-01

The optimal method for obtaining good blood glucose control in noncritically ill patients undergoing peripheral vascular surgery remains a topic of debate for surgeons, endocrinologists, and others involved in the care of patients with peripheral arterial disease and diabetes. A prospective trial was performed to evaluate the impact of routine use of a glucose management service (GMS) on glycemic control within 24 hours of lower-extremity revascularization (LER). In an interrupted time-series design (May 1, 2011-April 30, 2012), surgeon-directed diabetic care (Baseline phase) to routine GMS involvement (Intervention phase) was compared following LER. GMS assumed responsibility for glucose management through discharge. The main outcome measure was glycemic control, assessed by (1) mean hospitalization glucose and (2) the percentage of recorded glucose values within target range. Statistical process control charts were used to assess the impact of the intervention. Clinically important differences in patient demographics were noted between groups; the 19 patients in the Intervention arm had worse peripheral vascular disease than the 19 patients in the Baseline arm (74% critical limb ischemia versus 58%; p = .63). Routine use of GMS significantly reduced mean hospitalization glucose (191 mg/dL Baseline versus 150 mg/dL Intervention, p < .001). Further, the proportion of glucose values in target range increased (48% Baseline versus 78% Intervention, p = .05). Following removal of GMS involvement, measures of glycemic control did not significantly decrease for the 19 postintervention patients. Routine involvement of GMS improved glycemic control in patients undergoing LER. Future work is needed to examine the impact of improved glycemic control on clinical outcomes following LER.

Social cognitive mediators of the effect of the MobileMums intervention on physical activity.

PubMed

Fjeldsoe, Brianna S; Miller, Yvette D; Marshall, Alison L

2013-07-01

To explore whether improvements in physical activity following the MobileMums intervention were mediated by changes in Social Cognitive Theory (SCT) constructs targeted in the intervention (barrier self efficacy, goal setting skills, outcome expectancy, social support, and perceived environmental opportunity for exercise). This paper also examined if the mediating constructs differed between initial (baseline to 6 weeks) and overall (baseline to 13 weeks) changes in physical activity. Secondary analysis of data from a randomized controlled trial involving 88 postnatal women (<12 months postpartum). Participants were randomized to receive either the 12-week MobileMums intervention or a minimal-contact control condition. Physical activity and proposed mediators were assessed by self-report at baseline, 6 weeks, and 13 weeks. Walking for Exercise frequency was assessed using the Australian Women's Activity Survey and frequency of moderate-to-vigorous physical activity (MVPA) was assessed using a single-item question. Initial improvements in goal-setting skills mediated the relationship between experimental condition and initial changes in MVPA, αβ (95% CI) = 0.23(0.01, 0.59), and Walking for Exercise, αβ (95% CI) = 0.34(0.06, 0.73). Initial improvements in barrier self efficacy mediated the relationship between experimental condition and initial change in MVPA, αβ (95% CI) = 0.36(0.12, 0.65), but not Walking for Exercise. None of the SCT outcomes significantly mediated the relationship between experimental condition and overall (baseline to 13 weeks) change in frequency of MVPA or Walking for Exercise. Future interventions with postnatal women using SCT should target barrier self-efficacy and goal setting skills in order to increase physical activity. PsycINFO Database Record (c) 2013 APA, all rights reserved.

A Meta-Analytic Review of the Penn Resiliency Program’s Effect on Depressive Symptoms

PubMed Central

Brunwasser, Steven M.; Gillham, Jane E.; Kim, Eric S.

2015-01-01

Objectives The purpose of this review was to evaluate whether the Penn Resiliency Program (PRP), a group cognitive-behavioral intervention, is effective in targeting depressive symptoms in youth. Data sources We identified 17 controlled evaluations of PRP (N = 2498) measuring depressive symptoms via an online search of PsycInfo, Medline, ERIC, and ProQuest Dissertations and Theses, and by requesting data from PRP researchers. Review methods We combined effect sizes (ESs; Glass’s d), using random effects models at post-intervention and two follow-up assessments. Results PRP participants reported fewer depressive symptoms at post-intervention and both follow-up assessments compared to youth receiving no intervention, with ESs ranging from 0.11 to 0.21. Limited data show no evidence that PRP is superior to active control conditions. Subgroup analyses showed that PRP’s effects were significant at 1 or more follow-up assessments among studies using both targeted and universal approaches, when group leaders were research team members and community providers, among participants with both low and elevated baseline symptoms, and among boys and girls. Preliminary analyses suggest that PRP’s effects on depressive disorders may be smaller than those reported in a larger meta-analysis of depression prevention programs for older adolescents and adults. Conclusion We found evidence that PRP significantly reduces depressive symptoms through at least 1 year post-intervention. Future PRP research should examine whether PRP’s effects on depressive symptoms lead to clinically meaningful benefits for its participants, whether the program is cost-effective, whether CBT skills mediate program effects, and whether PRP is effective when delivered under real-world conditions. PMID:19968381

'You started something … then I continued by myself': a qualitative study of physical activity maintenance.

PubMed

Wahlich, Charlotte; Beighton, Carole; Victor, Christina; Normansell, Rebecca; Cook, Derek; Kerry, Sally; Iliffe, Steve; Ussher, Michael; Whincup, Peter; Fox-Rushby, Julia; Limb, Elizabeth; Furness, Cheryl; Harris, Tess

2017-11-01

Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation (PACE-UP) trial, a three-armed primary care pedometer-based walking intervention in those aged 45-75 years, demonstrated increased PA levels at 12 months. A three-year follow-up was conducted to evaluate long-term PA maintenance, including a qualitative component. Aim To examine facilitators and barriers to PA maintenance in mid-life and older adults previously involved in a PA trial. Semi-structured telephone interviews were conducted with 60 PACE-UP participants across all study arms. Interviews were audio-recorded, transcribed verbatim and coded independently by researchers, prior to thematic analysis. Findings Two-thirds of participants felt since the PACE-UP trial they had an awareness of PA, with the pedometer reported as 'kick-starting' regular activity, and then helped them to maintain regular activity. PA facilitators included: maintaining good health, self-motivation, social support and good weather. Lack of time was the most frequently cited barrier. Other barriers were often the inverse of the facilitators; for example, poor health and bad weather. Participants described the type of 'top-up' intervention they would find beneficial to aid PA maintenance (eg, text messages, online resources and walking groups). A challenge for future PA interventions is to transform barriers into facilitators; for example, educating trial participants about the value of PA for many chronic health conditions to change this from inhibiting to promoting PA. Participants provided ideas for encouraging PA maintenance which could be incorporated into future interventions.

Future clinical challenges in multiple sclerosis: Relevance to sphingosine 1-phosphate receptor modulator therapy.

PubMed

Hohlfeld, Reinhard; Barkhof, Frederik; Polman, Chris

2011-02-22

The limitations of established therapies for multiple sclerosis (MS) are well-known and include the need for injections, treatment adherence and convenience issues, partial efficacy, and, in some cases, a risk of potentially life-threatening adverse events, such as progressive multifocal leukoencephalopathy. Recently, attention has focused on developing more effective therapies that are administered orally and target neurodegeneration as well as inflammation. In this review, we provide an outlook on the future clinical challenges for MS treatment and management, and focus specifically on the emerging sphingosine 1-phosphate receptor (S1PR) modulators. We highlight the importance of improving our understanding of the neurobiological basis of MS to develop well-tolerated targeted therapies and the need to include advanced MRI assessments that quantify neurodegeneration in interventional studies in MS. As more treatments become available, often with complex pharmacodynamic actions, objective assessment of benefit-to-risk profiles becomes increasingly important to ensure that patients receive appropriate care. Pharmacovigilance and immune monitoring will become important aspects of patient treatment and management in the future. With respect to S1PR modulation, we review the experimental agents that are in clinical development for MS and summarize the steps taken in postmarketing surveillance to ensure that fingolimod (FTY720) has a well-characterized safety profile.

Randomized controlled trial of a web-based indoor tanning intervention: Acceptability and preliminary outcomes.

PubMed

Stapleton, Jerod L; Manne, Sharon L; Darabos, Katie; Greene, Kathryn; Ray, Anne E; Turner, Amber L; Coups, Elliot J

2015-12-01

This article describes the acceptability and preliminary behavioral outcomes of a pilot randomized control trial of a web-based indoor tanning intervention for young adult women. The intervention targets indoor tanning users' perceptions of the benefits and value of tanning and addresses the role of body image-related constructs in indoor tanning. Participants were 186 young adult women who reported indoor tanning at least once in the past 12 months. The study design was a 2-arm randomized controlled trial with pre- and postintervention assessments and random assignment to an intervention or control condition. Intervention acceptability was assessed by obtaining participants' evaluation of the intervention. Regression analyses were used to test for intervention condition differences in preliminary behavioral outcomes measured at 6 weeks postintervention. Participants provided favorable evaluations of the intervention on several dimensions and a highly positive overall rating. Intervention participants were more likely to report abstaining from indoor tanning and indicated a lower likelihood of using indoor tanning in the future compared with control participants on the postintervention assessment. No differences were found for sunburns. The results of this pilot randomized controlled trial provide evidence that the indoor tanning intervention is acceptable to participants and may encourage cessation of indoor tanning behavior. The findings provide preliminary support for an indoor tanning intervention that engages tanners to challenge their beliefs about the benefits of indoor tanning. The use of a web-based indoor tanning intervention is unique and provides strong potential for dissemination. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Pedagogical Approaches to and Effects of Fundamental Movement Skill Interventions on Health Outcomes: A Systematic Review.

PubMed

Tompsett, Claire; Sanders, Ross; Taylor, Caitlin; Cobley, Stephen

2017-09-01

Fundamental movement skills (FMS) are assumed to be the basic prerequisite motor movements underpinning coordination of more integrated and advanced movement capabilities. FMS development and interventions have been associated with several beneficial health outcomes in individual studies. The primary aim of this review was to identify FMS intervention characteristics that could be optimised to attain beneficial outcomes in children and adolescents, while the secondary aim was to update the evidence as to the efficacy of FMS interventions on physiological, psychological and behavioural health outcomes. A systematic search [adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines] was conducted in seven databases. Studies were included if they conducted an FMS intervention and targeted at least one physiological, behavioural or psychological outcome in school-aged children (5-18 years). Twenty-nine studies examining the effect of FMS interventions relative to controls were identified. Specialist-led interventions, taught in conjunction with at-home practice and parent involvement, appeared more efficacious in enhancing FMS proficiency than school physical education alone. Intervention environments encouraging psychological autonomy were likely to enhance perceived and actual competence in FMS alongside physical activity. FMS interventions had little influence on overweight/obesity reduction, strength or flexibility. In 93% of studies, evidence indicated interventions improved FMS motor proficiency. Favourable specific physiological, psychological and behavioural outcomes were also identified across a variety of interventions. With reference to clinical and normative school-age populations, future studies should be directed toward determining validated standard FMS assessments to enable accurate effect estimates, permit intervention comparisons and improve the efficacy of FMS development.

Estimating the Economic Value of Information for Screening in Disseminating and Targeting Effective School-based Preventive Interventions: An Illustrative Example.

PubMed

Johnston, Stephen S; Salkever, David S; Ialongo, Nicholas S; Slade, Eric P; Stuart, Elizabeth A

2017-11-01

When candidates for school-based preventive interventions are heterogeneous in their risk of poor outcomes, an intervention's expected economic net benefits may be maximized by targeting candidates for whom the intervention is most likely to yield benefits, such as those at high risk of poor outcomes. Although increasing amounts of information about candidates may facilitate more accurate targeting, collecting information can be costly. We present an illustrative example to show how cost-benefit analysis results from effective intervention demonstrations can help us to assess whether improved targeting accuracy justifies the cost of collecting additional information needed to make this improvement.

Adapting Technological Interventions to Meet the Needs of Priority Populations.

PubMed

Linke, Sarah E; Larsen, Britta A; Marquez, Becky; Mendoza-Vasconez, Andrea; Marcus, Bess H

2016-01-01

Cardiovascular diseases (CVD) comprise the leading cause of mortality worldwide, accounting for 3 in 10 deaths. Individuals with certain risk factors, including tobacco use, obesity, low levels of physical activity, type 2 diabetes mellitus, racial/ethnic minority status and low socioeconomic status, experience higher rates of CVD and are, therefore, considered priority populations. Technological devices such as computers and smartphones are now routinely utilized in research studies aiming to prevent CVD and its risk factors, and they are also rampant in the public and private health sectors. Traditional health behavior interventions targeting these risk factors have been adapted for technology-based approaches. This review provides an overview of technology-based interventions conducted in these priority populations as well as the challenges and gaps to be addressed in future research. Researchers currently possess tremendous opportunities to engage in technology-based implementation and dissemination science to help spread evidence-based programs focusing on CVD risk factors in these and other priority populations. Copyright © 2016 Elsevier Inc. All rights reserved.

Socioeconomic aspects of neglected tropical diseases.

PubMed

Conteh, Lesong; Engels, Thomas; Molyneux, David H

2010-01-16

Although many examples of highly cost-effective interventions to control neglected tropical diseases exist, our understanding of the full economic effect that these diseases have on individuals, households, and nations needs to be improved to target interventions more effectively and equitably. We review data for the effect of neglected tropical diseases on a population's health and economy. We also present evidence on the costs, cost-effectiveness, and financing of strategies to monitor, control, or reduce morbidity and mortality associated with these diseases. We explore the potential for economies of scale and scope in terms of the costs and benefits of successfully delivering large-scale and integrated interventions. The low cost of neglected tropical disease control is driven by four factors: the commitment of pharmaceutical companies to provide free drugs; the scale of programmes; the opportunities for synergising delivery modes; and the often non-remunerated volunteer contribution of communities and teachers in drug distribution. Finally, we make suggestions for future economic research. Copyright 2010 Elsevier Ltd. All rights reserved.

Interventions targeted at primary care practitioners to improve the identification and referral of patients with co-morbid obesity: a realist review protocol.

PubMed

Blane, David N; Macdonald, Sara; Morrison, David; O'Donnell, Catherine A

2015-05-01

Obesity is one of the most significant public health challenges in the developed world. Recent policy has suggested that more can be done in primary care to support adults with obesity. In particular, general practitioners (GPs) and practice nurses (PNs) could improve the identification and referral of adults with obesity to appropriate weight management services. Previous interventions targeted at primary care practitioners in this area have had mixed results, suggesting a more complex interplay between patients, practitioners, and systems. The objectives of this review are (i) to identify the underlying 'programme theory' of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity and (ii) to explore how and why GPs and PNs identify and refer individuals with obesity, particularly in the context of weight-related co-morbidity. This protocol will explain the rationale for using a realist review approach and outline the key steps in this process. Realist review is a theory-led approach to knowledge synthesis that provides an explanatory analysis aimed at discerning what works, for whom, in what circumstances, how, and why. In this review, scoping interviews with key stakeholders involved in the planning and delivery of adult weight management services in Scotland helped to inform the identification of formal theories - from psychology, sociology, and implementation science - that will be tested as the review progresses. A comprehensive search strategy is described, including scope for iterative searching. Data analysis is outlined in three stages (describing context-mechanism-outcome configurations, exploring patterns in these configurations, and developing and testing middle-range theories, informed by the formal theories previously identified), culminating in the production of explanatory programme theory that considers individual, interpersonal, and institutional/systems-level components. This is the first realist review that we are aware of looking at interventions targeted at primary care practitioners to improve the weight management of adults with obesity. Engagement with stakeholders at an early stage is a unique feature of realist review. This shapes the scope of the review, identification of candidate theories and dissemination strategies. The findings of this review will inform policy and future interventions. PROSPERO CRD42014009391.

Movement as Medicine for Type 2 Diabetes: protocol for an open pilot study and external pilot clustered randomised controlled trial to assess acceptability, feasibility and fidelity of a multifaceted behavioural intervention targeting physical activity in primary care

PubMed Central

2014-01-01

Background Physical activity (PA) and nutrition are the cornerstones of diabetes management. Several reviews and meta-analyses report that PA independently produces clinically important improvements in glucose control in people with Type 2 diabetes. However, it remains unclear what the optimal strategies are to increase PA behaviour in people with Type 2 diabetes in routine primary care. Methods This study will determine whether an evidence-informed multifaceted behaviour change intervention (Movement as Medicine for Type 2 Diabetes) targeting both consultation behaviour of primary healthcare professionals and PA behaviour in adults with Type 2 diabetes is both acceptable and feasible in the primary care setting. An open pilot study conducted in two primary care practices (phase one) will assess acceptability, feasibility and fidelity. Ongoing feedback from participating primary healthcare professionals and patients will provide opportunities for systematic adaptation and refinement of the intervention and study procedures. A two-arm parallel group clustered pilot randomised controlled trial with patients from participating primary care practices in North East England will assess acceptability, feasibility, and fidelity of the intervention (versus usual clinical care) and trial processes over a 12-month period. Consultation behaviour involving fidelity of intervention delivery, diabetes and PA related knowledge, attitudes/beliefs, intentions and self-efficacy for delivering a behaviour change intervention targeting PA behaviour will be assessed in primary healthcare professionals. We will rehearse the collection of outcome data (with the focus on data yield and quality) for a future definitive trial, through outcome assessment at baseline, one, six and twelve months. An embedded qualitative process evaluation and treatment fidelity assessment will explore issues around intervention implementation and assess whether intervention components can be reliably and faithfully delivered in routine primary care. Discussion Movement as Medicine for Type 2 Diabetes will address an important gap in the evidence-base, that is, the need for interventions to increase free-living PA behaviour in adults with Type 2 diabetes. The multifaceted intervention incorporates an online accredited training programme for primary healthcare professionals and represents, to the best of our knowledge, the first of its kind in the United Kingdom. This study will establish whether the multifaceted behavioural intervention is acceptable and feasible in routine primary care. Trial registration Movement as Medicine for Type 2 Diabetes (MaMT2D) was registered with Current Controlled Trials on the 14th January 2012: ISRCTN67997502. The first primary care practice was randomised on the 5th October 2012. PMID:24491134

Multidisciplinary approaches to managing osteoarthritis in multiple joint sites: a systematic review.

PubMed

Finney, Andrew; Healey, Emma; Jordan, Joanne L; Ryan, Sarah; Dziedzic, Krysia S

2016-07-08

The National Institute for Health and Care Excellence's Osteoarthritis (OA) guidelines recommended that future research should consider the benefits of combination therapies in people with OA across multiple joint sites. However, the clinical effectiveness of such approaches to OA management is unknown. This systematic review therefore aimed to identify the clinical and cost effectiveness of multidisciplinary approaches targeting multiple joint sites for OA in primary care. A systematic review of randomised controlled trials. Computerised bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, HBE, HMIC, AMED, Web of Science and Cochrane). Studies were included if they met the following criteria; a randomised controlled trial (RCT), a primary care population with OA across at least two different peripheral joint sites (multiple joint sites), and interventions undertaken by at least two different health disciplines (multidisciplinary). The Cochrane 'Risk of Bias' tool and PEDro were used for quality assessment of eligible studies. Clinical and cost effectiveness was determined by extracting and examining self-reported outcomes for pain, function, quality of life (QoL) and health care utilisation. The date range for the search was from database inception until August 2015. The search identified 1148 individual titles of which four were included in the review. A narrative review was conducted due to the heterogeneity of the included trials. Each of the four trials used either educational or exercise interventions facilitated by a range of different health disciplines. Moderate clinical benefits on pain, function and QoL were reported across the studies. The beneficial effects of exercise generally decreased over time within all studies. Two studies were able to show a reduction in healthcare utilisation due to a reduction in visits to a physiotherapist or a reduction in x-rays and orthopaedic referrals. The intervention that showed the most promise used educational interventions delivered by GPs with reinforcement by practice nurses. There are currently very few studies that target multidisciplinary approaches suitable for OA across multiple joint sites, in primary care. A more consistent approach to outcome measurement in future studies of this nature should be considered to allow for better comparison.

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review.

PubMed

Laws, Rachel; Campbell, Karen J; van der Pligt, Paige; Russell, Georgina; Ball, Kylie; Lynch, John; Crawford, David; Taylor, Rachael; Askew, Deborah; Denney-Wilson, Elizabeth

2014-08-01

Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families. Searches of major electronic databases identified articles published from 1993-2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity. Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m(2) to -0.54 kg/m(2) for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3-5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery. There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required. PROSPERO Registration no: CRD42013006536.

Interventions to enhance effective communication during over-the-counter consultations in the community pharmacy setting: A systematic review.

PubMed

Seubert, Liza J; Whitelaw, Kerry; Hattingh, Laetitia; Watson, Margaret C; Clifford, Rhonda M

2017-12-13

Easy access to effective over-the-counter (OTC) treatments allows self-management of some conditions, however inappropriate or incorrect supply or use of OTC medicines can cause harm. Pharmacy personnel should support consumers in their health-seeking behaviour by utilising effective communication skills underpinned by clinical knowledge. To identify interventions targeted towards improving communication between consumers and pharmacy personnel during OTC consultations in the community pharmacy setting. Systematic review and narrative analysis. Databases searched were MEDLINE, EMBASE, Psycinfo, Cochrane Central Register and Cochrane Database of Systematic Reviews for literature published between 2000 and 30 October 2014, as well as reference lists of included articles. The search was re-run on 18 January 2016 and 25 September 2017 to maximise the currency. Two reviewers independently screened retrieved articles for inclusion, assessed study quality and extracted data. Full publications of intervention studies were included. Participants were community pharmacy personnel and/or consumers involved in OTC consultations. Interventions which aimed to improve communication during OTC consultations in the community pharmacy setting were included if they involved a direct measurable communication outcome. Studies reporting attitudes and measures not quantifiable were excluded. The protocol was published on Prospero Database of Systematic Reviews. Of 4978 records identified, 11 studies met inclusion criteria. Interventions evaluated were: face-to-face training sessions (n = 10); role-plays (n = 9); a software decision making program (n = 1); and simulated patient (SP) visits followed by immediate feedback (n = 1). Outcomes were measured using: SP methodology (n = 10) and a survey (n = 1), with most (n = 10) reporting a level of improvement in some communication behaviours. Empirical evaluation of interventions using active learning techniques such as face-to-face training with role-play can improve some communication skills. However interventions that are not fully described limit the ability for replication and/or generalisability. This review identified interventions targeting pharmacy personnel. Future interventions to improve communication should consider the consumer's role in OTC consultations. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

mHealth Interventions for Health System Strengthening in China: A Systematic Review.

PubMed

Tian, Maoyi; Zhang, Jing; Luo, Rong; Chen, Shi; Petrovic, Djordje; Redfern, Julie; Xu, Dong Roman; Patel, Anushka

2017-03-16

With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care. ©Maoyi Tian, Jing Zhang, Rong Luo, Shi Chen, Djordje Petrovic, Julie Redfern, Dong Roman Xu, Anushka Patel. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 16.03.2017.

A Meta-Analysis of the Impact of Universal and Indicated Preventive Technology-Delivered Interventions for Higher Education Students.

PubMed

Conley, Colleen S; Durlak, Joseph A; Shapiro, Jenna B; Kirsch, Alexandra C; Zahniser, Evan

2016-08-01

The uses of technology-delivered mental health treatment options, such as interventions delivered via computer, smart phone, or other communication or information devices, as opposed to primarily face-to-face interventions, are proliferating. However, the literature is unclear about their effectiveness as preventive interventions for higher education students, a population for whom technology-delivered interventions (TDIs) might be particularly fitting and beneficial. This meta-analytic review examines technological mental health prevention programs targeting higher education students either without any presenting problems (universal prevention) or with mild to moderate subclinical problems (indicated prevention). A systematic literature search identified 22 universal and 26 indicated controlled interventions, both published and unpublished, involving 4763 college, graduate, or professional students. As hypothesized, the overall mean effect sizes (ESs) for both universal (0.19) and indicated interventions (0.37) were statistically significant and differed significantly from each other favoring indicated interventions. Skill-training interventions, both universal (0.21) and indicated (0.31), were significant, whereas non-skill-training interventions were only significant among indicated (0.25) programs. For indicated interventions, better outcomes were obtained in those cases in which participants had access to support during the course of the intervention, either in person or through technology (e.g., email, online contact). The positive findings for both universal and indicated prevention are qualified by limitations of the current literature. To improve experimental rigor, future research should provide detailed information on the level of achieved implementation, describe participant characteristics and intervention content, explore the impact of potential moderators and mechanisms of success, collect post-intervention and follow-up data regardless of intervention completion, and use analysis strategies that allow for inclusion of cases with partially missing data.

Cost effectiveness of targeted HIV prevention interventions for female sex workers in India.

PubMed

Prinja, Shankar; Bahuguna, Pankaj; Rudra, Shalini; Gupta, Indrani; Kaur, Manmeet; Mehendale, S M; Chatterjee, Susmita; Panda, Samiran; Kumar, Rajesh

2011-06-01

To ascertain the cost effectiveness of targeted interventions for female sex workers (FSW) under the National AIDS Control Programme in India. A compartmental mathematical Markov state model was used over a 20-year time horizon (1995-2015) to estimate the cost effectiveness of FSW targeted interventions, with a health system perspective. The incremental costs and effects of FSW targeted interventions were compared against a baseline scenario of mass media for the general population alone. The incremental cost-effectiveness ratio was computed at a 3% discount rate using HIV infections averted and disability-adjusted life-years (DALY) as benefit measures. It was assumed that the transmission of the HIV virus moves from a high-risk group (FSW) to the client population and finally to the general population (partners of clients). Targeted interventions for FSW result in a reduction of 47% (1.6 million) prevalent and 36% (2.7 million) cumulative HIV cases, respectively, in 2015. Adult HIV prevalence in India, with and without (mass media only) FSW interventions, would be 0.25% and 0.48% in 2015. Indian government and development partners spend an average US $104 (INR4680) per HIV infection averted and US $10.7 (INR483) per DALY averted. Discounting at 3%, FSW targeted interventions cost US $105.5 (INR4748) and US $10.9 (INR490) per HIV case and DALY averted, respectively. At the current gross domestic product in India, targeted intervention is a cost-effective strategy for HIV prevention in India.

Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study

PubMed Central

Basen-Engquist, Karen; Cox, Matthew G; Lyons, Elizabeth J; Carmack, Cindy L; Blalock, Janice A; Demark-Wahnefried, Wendy

2016-01-01

Background Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors’ interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. Objective The aim of this study was to determine the factors that predict cancer survivors’ interest in new technology-based health behavior intervention modalities versus traditional modalities. Methods Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants’ demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. Results In total, 1053 respondents to the survey (56.3% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9% very/extremely interested) and lowest for smartphone–based interventions (73/847, 8.6%), with interest in clinic-based (147/847, 17.3%) and telephone-delivered (143/847, 16.9%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone–based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. Conclusions This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors’ current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants’ demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population. PMID:28410164

Addressing adolescents’ risk and protective factors related to risky behaviours: Findings from a school-based peer-education evaluation in the Western Cape

PubMed Central

Timol, Furzana; Vawda, Mohammed Yacoob; Bhana, Arvin; Moolman, Benita; Makoae, Mokhantso; Swartz, Sharlene

2016-01-01

Abstract Background: Peer-education programmes aim to bring about attitudinal and behavioural changes in their target audience. In the South African educational context, peer education is a favoured approach in dealing with issues such as HIV and AIDS, sexual decision-making and substance misuse. Given the reliance on peer-education programmes in the educational system, it is important to establish how well they are working. This study aims to assess the effect of an extensive, structured, time-limited, curriculum-based, peer-led educational programme on first-year high school learners in public schools in the Western Cape Province of South Africa. Method: The curriculum called ‘Listen Up’ addresses issues such as supporting peers, sexual decision-making, healthy relationships, HIV risk, alcohol misuse and unwanted pregnancy in seven structured sessions. The programme targeted adolescents in Grade 8 growing up in what are considered to be risky environments in public schools in the Western Cape during 2012 and 2013. The intervention was evaluated based on 10 scales sourced from published literature related to the outcome indicators of future orientation, sensation-seeking, self-efficacy in sexual relations, HIV transmission knowledge, HIV prevention knowledge, HIV attitudes, sexual attitudes, decision-making, healthy relationships and social support. Descriptive statistics were used to analyse demographic and community characteristics and analyses of variance were used to detect differences between groups. The surveys were administered to a total of 7709 learners across three waves of the study in 27 peer intervention schools and eight control schools. Results: Immediately post intervention, statistically significant differences were noted for the intervention schools when compared to their baseline levels on measures of future orientation, self-efficacy in sexual relations, knowledge regarding HIV transmission, knowledge regarding HIV prevention and knowledge in terms of healthy relationships. Comparing baseline values with results collected between five and seven months post intervention, statistically significant results were noted for self-efficacy in sexual relations and knowledge regarding HIV transmission. Conclusion: The findings of this study suggest that peer-education can improve adolescents’ self-efficacy in sexual relations as well as knowledge regarding the transmission of HIV and therefore can contribute to the prevention of HIV transmission among adolescents. PMID:27892820

Addressing adolescents' risk and protective factors related to risky behaviours: Findings from a school-based peer-education evaluation in the Western Cape.

PubMed

Timol, Furzana; Vawda, Mohammed Yacoob; Bhana, Arvin; Moolman, Benita; Makoae, Mokhantso; Swartz, Sharlene

2016-12-01

Peer-education programmes aim to bring about attitudinal and behavioural changes in their target audience. In the South African educational context, peer education is a favoured approach in dealing with issues such as HIV and AIDS, sexual decision-making and substance misuse. Given the reliance on peer-education programmes in the educational system, it is important to establish how well they are working. This study aims to assess the effect of an extensive, structured, time-limited, curriculum-based, peer-led educational programme on first-year high school learners in public schools in the Western Cape Province of South Africa. The curriculum called 'Listen Up' addresses issues such as supporting peers, sexual decision-making, healthy relationships, HIV risk, alcohol misuse and unwanted pregnancy in seven structured sessions. The programme targeted adolescents in Grade 8 growing up in what are considered to be risky environments in public schools in the Western Cape during 2012 and 2013. The intervention was evaluated based on 10 scales sourced from published literature related to the outcome indicators of future orientation, sensation-seeking, self-efficacy in sexual relations, HIV transmission knowledge, HIV prevention knowledge, HIV attitudes, sexual attitudes, decision-making, healthy relationships and social support. Descriptive statistics were used to analyse demographic and community characteristics and analyses of variance were used to detect differences between groups. The surveys were administered to a total of 7709 learners across three waves of the study in 27 peer intervention schools and eight control schools. Immediately post intervention, statistically significant differences were noted for the intervention schools when compared to their baseline levels on measures of future orientation, self-efficacy in sexual relations, knowledge regarding HIV transmission, knowledge regarding HIV prevention and knowledge in terms of healthy relationships. Comparing baseline values with results collected between five and seven months post intervention, statistically significant results were noted for self-efficacy in sexual relations and knowledge regarding HIV transmission. The findings of this study suggest that peer-education can improve adolescents' self-efficacy in sexual relations as well as knowledge regarding the transmission of HIV and therefore can contribute to the prevention of HIV transmission among adolescents.

Using text messages to bridge the intention-behavior gap? A pilot study on the use of text message reminders to increase objectively assessed physical activity in daily life.

PubMed

Schwerdtfeger, Andreas R; Schmitz, Catalina; Warken, Matthias

2012-01-01

Sedentarism is a serious health concern in industrialized countries throughout the world. We examined whether a text message-based intervention, targeted at increasing daily levels of physical activity, would be more effective than a standard psychoeducational intervention and a control condition. Sixty-three individuals (43 women) with a mean age of 23.7 years participated in the study. They were randomly assigned to a psychoeducational standard intervention; an augmented intervention with additional short text messages sent to the mobile phones to remind participants of their action plans, and a control condition. Objectively assessed physical activity and self-efficacy were assessed pre- and post-intervention. Participants in the control condition showed a significant decline in physical activity from pre-assessment to post-assessment, whereas participants in both intervention arms exhibited a slight increase. Moreover, the augmented intervention resulted in a marginally significant increase in self-efficacy, whereas the standard intervention resulted in a significant decrease. The findings suggest that short text messages reminding individuals of their action plans are not more effective than an intervention without text messages, although there seems to be a beneficial effect on self-efficacy, which might facilitate behavior change in the long-term. Challenging aspects of the research design (e.g., reactivity of the assessment protocol) are discussed and suggestions for future research are highlighted.

Anxiety Outcomes after Physical Activity Interventions: Meta-Analysis Findings

PubMed Central

Conn, Vicki S.

2011-01-01

Background Although numerous primary studies have documented the mental health benefits of physical activity (PA), no previous quantitative synthesis has examined anxiety outcomes of interventions to increase PA. Objectives This meta-analysis integrates extant research about anxiety outcomes from interventions to increase PA among healthy adults. Method Extensive literature searching located published and unpublished PA intervention studies with anxiety outcomes. Eligible studies reported findings from interventions designed to increase PA delivered to healthy adults without anxiety disorders. Data were coded from primary studies. Random-effects meta-analytic procedures were completed. Exploratory moderator analyses using meta-analysis ANOVA and regression analogues were conducted to determine if report, methods, sample, or intervention characteristics were associated with differences in anxiety outcomes. Results Data were synthesized across 3,289 subjects from 19 eligible reports. The overall mean anxiety effect size (d-index) for two-group comparisons was 0.22 with significant heterogeneity (Q = 32.15). Exploratory moderator analyses found larger anxiety improvement effect sizes among studies that included larger samples, used random allocation of subjects to treatment and control conditions, targeted only PA behavior instead of multiple health behaviors, included supervised exercise (vs. home-based PA), used moderate or high-intensity instead of low-intensity PA, and suggested subjects exercise at a fitness facility (vs. home) following interventions. Discussion These findings document that some interventions can decrease anxiety symptoms among healthy adults. Exploratory moderator analyses suggest possible directions for future primary research to compare interventions in randomized trials to confirm causal relationships. PMID:20410849

Systematic Review of Universal Resilience-Focused Interventions Targeting Child and Adolescent Mental Health in the School Setting.

PubMed

Dray, Julia; Bowman, Jenny; Campbell, Elizabeth; Freund, Megan; Wolfenden, Luke; Hodder, Rebecca K; McElwaine, Kathleen; Tremain, Danika; Bartlem, Kate; Bailey, Jacqueline; Small, Tameka; Palazzi, Kerrin; Oldmeadow, Christopher; Wiggers, John

2017-10-01

To examine the effect of universal, school-based, resilience-focused interventions on mental health problems in children and adolescents. Eligible studies were randomized controlled trials (RCTs) of universal, school-based interventions that included strategies to strengthen a minimum of 3 internal resilience protective factors, and included an outcome measure of mental health problems in children and adolescents aged 5 to 18 years. Six databases were searched from 1995 to 2015. Results were pooled in meta-analyses by mental health outcome (anxiety symptoms, depressive symptoms, hyperactivity, conduct problems, internalizing problems, externalizing problems, and general psychological distress), for all trials (5-18 years). Subgroup analyses were conducted by age (child: 5-10 years; adolescent: 11-18 years), length of follow-up (short: post-≤12 months; long: >12 months), and gender (narrative). A total of 57 included trials were identified from 5,984 records, with 49 contributing to meta-analyses. For all trials, resilience-focused interventions were effective relative to a control in reducing 4 of 7 outcomes: depressive symptoms, internalizing problems, externalizing problems, and general psychological distress. For child trials (meta-analyses for 6 outcomes), interventions were effective for anxiety symptoms and general psychological distress. For adolescent trials (meta-analyses for 5 outcomes), interventions were effective for internalizing problems. For short-term follow-up, interventions were effective for 2 of 7 outcomes: depressive symptoms and anxiety symptoms. For long-term follow-up (meta-analyses for 5 outcomes), interventions were effective for internalizing problems. The findings may suggest most promise for using universal resilience-focused interventions at least for short-term reductions in depressive and anxiety symptoms for children and adolescents, particularly if a cognitive-behavioral therapy-based approach is used. The limited number of trials providing data amenable for meta-analysis for some outcomes and subgroups, the variability of interventions, study quality, and bias mean that it is not possible to draw more specific conclusions. Identifying what intervention qualities (such as number and type of protective factor) achieve the greatest positive effect per mental health problem outcome remains an important area for future research. Systematic Review of Universal Resilience Interventions Targeting Child and Adolescent Mental Health in the School Setting; http://dx.doi.org/10.1186/s13643-015-0172-6; PROSPERO CRD42015025908. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

A stage of change approach to reducing occupational ill health.

PubMed

Whysall, Z; Haslam, C; Haslam, R

2006-11-01

Interventions targeted by stage of change have been shown to improve the efficacy of public health promotion initiatives in areas such as smoking cessation, alcohol reduction, and mammography screening. Targeted interventions are designed to tackle the key attitudes, beliefs, and intentions that underpin an individual's health-related behavior. Work-related ill health is an increasingly serious issue, the most common cause of which in both the UK and the US is musculoskeletal disorders. This study examined whether the stage approach could be applied to workplace interventions aimed at improving occupational health. A total of 24 multi-component occupational interventions aimed at reducing musculoskeletal disorders were monitored over a period of 4-6 months. In half of these cases, approaches were targeted according to workers' stage of change. Targeted interventions were found to be significantly more effective in promoting risk awareness and desired behavior change among workers. Significant reductions were also found in self-reported musculoskeletal discomfort among workers having received targeted interventions. No significant differences were found in self-reported musculoskeletal discomfort among workers following standard interventions. Stage-matched approaches may offer scope for substantially improving the efficacy of occupational health and safety interventions by increasing the uptake, implementation, and maintenance of risk-reducing measures.

An eHealth Intervention to Promote Physical Activity and Social Network of Single, Chronically Impaired Older Adults: Adaptation of an Existing Intervention Using Intervention Mapping

PubMed Central

Peels, Denise A; Berendsen, Brenda AJ; Bolman, Catherine AW; Lechner, Lilian

2017-01-01

Background Especially for single older adults with chronic diseases, physical inactivity and a poor social network are regarded as serious threats to their health and independence. The Active Plus intervention is an automated computer-tailored eHealth intervention that has been proven effective to promote physical activity (PA) in the general population of adults older than 50 years. Objective The aim of this study was to report on the methods and results of the systematic adaptation of Active Plus to the wishes and needs of the subgroup of single people older than 65 years who have one or more chronic diseases, as this specific target population may encounter specific challenges regarding PA and social network. Methods The Intervention Mapping (IM) protocol was used to systematically adapt the existing intervention to optimally suit this specific target population. A literature study was performed, and quantitative as well as qualitative data were derived from health care professionals (by questionnaires, n=10) and the target population (by focus group interviews, n=14), which were then systematically integrated into the adapted intervention. Results As the health problems and the targeted behavior are largely the same in the original and adapted intervention, the outcome of the needs assessment was that the performance objectives remained the same. As found in the literature study and in data derived from health professionals and focus groups, the relative importance and operationalization of the relevant psychosocial determinants related to these objectives are different from the original intervention, resulting in a refinement of the change objectives to optimally fit the specific target population. This refinement also resulted in changes in the practical applications, program components, intervention materials, and the evaluation and implementation strategy for the subgroup of single, chronically impaired older adults. Conclusions This study demonstrates that the adaptation of an existing intervention is an intensive process in which adopting the IM protocol is an invaluable tool. The study provides a broad insight in adapting interventions aimed at single older adults with a chronic disease. It is concluded that even when the new target population is a sizable segment of the original target population, the adapted intervention still needs considerable changes to optimally fit the needs and situational differences of the narrower target population. PMID:29170146

A mathematical model of the impact of present and future malaria vaccines.

PubMed

Wenger, Edward A; Eckhoff, Philip A

2013-04-15

With the encouraging advent of new malaria vaccine candidates, mathematical modelling of expected impacts of present and future vaccines as part of multi-intervention strategies is especially relevant. The impact of potential malaria vaccines is presented utilizing the EMOD model, a comprehensive model of the vector life cycle coupled to a detailed mechanistic representation of intra-host parasite and immune dynamics. Values of baseline transmission and vector feeding behaviour parameters are identified, for which local elimination is enabled by layering pre-erythrocytic vaccines of various efficacies on top of high and sustained insecticide-treated net coverage. The expected reduction in clinical cases is further explored in a scenario that targets children by adding a pre-erythrocytic vaccine to the EPI programme for newborns. At high transmission, there is a minimal reduction in clinical disease cases, as the time to infection is only slightly delayed. At lower transmission, there is an accelerating community-level protection that has subtle dependences on heterogeneities in vector behaviour, ecology, and intervention coverage. At very low transmission, the trend reverses as many children are vaccinated to prevent few cases. The maximum-impact setting is one in which the impact of increasing bed net coverage has saturated, vector feeding is primarily outdoors, and transmission is just above the threshold where small perturbations from a vaccine intervention result in large community benefits.

Current and future strategies for the nutritional management of cardiometabolic complications of androgen deprivation therapy for prostate cancer.

PubMed

Turner, Lauren; Poole, Karen; Faithfull, Sara; Griffin, Bruce A

2017-12-01

Androgen deprivation therapy (ADT) is used widely as part of a combined modality for the treatment of prostate cancer. However, ADT has also been associated with the development of cardiometabolic complications that can increase mortality from cardiovascular events. There is emerging evidence to suggest that ADT-related cardiometabolic risk can be mitigated by diet and lifestyle modification. While the clinical focus for a nutritional approach for achieving this effect is unclear, it may depend upon the timely assessment and targeting of dietary changes to the specific risk phenotype of the patient. The present review aims to address the metabolic origins of ADT-related cardiometabolic risk, existing evidence for the effects of dietary intervention in modifying this risk, and the priorities for future dietary strategies.