Dietary factors and cancers of breast, endometrium, and ovary: strategies for modifying fat intake in African American women.

PubMed

Hargreaves, M K; Buchowski, M S; Hardy, R E; Rossi, S R; Rossi, J S

1997-06-01

Modification of dietary fat and fiber could help prevent cancers of the breast, endometrium, and ovary that are prevalent in African-American women. Dietary intervention programs aimed at reducing fat intake have had mixed results in this population. The transtheoretic model is proposed for achieving dietary change. Strategies for changing health behaviors in African-American women include heightening sensitivity to cultural values among health educators and the use of multiple strategies to reinforce messages. To stimulate healthier eating, it is important to incorporate the distinct habitual eating patterns into innovative intervention methods, using effective behavioral change methods.

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.

Intervention Mapping as a Participatory Approach to Developing an HIV prevention Intervention in Rural African American Communities

PubMed Central

Corbie-Smith, Giselle; Akers, Aletha; Blumenthal, Connie; Council, Barbara; Wynn, Mysha; Muhammad, Melvin; Stith, Doris

2011-01-01

Southeastern states are among the hardest hit by the HIV epidemic in this country, and racial disparities in HIV rates are high in this region. This is particularly true in our communities of interest in rural eastern North Carolina. Although most recent efforts to prevent HIV attempt to address multiple contributing factors, we have found few multilevel HIV interventions that have been developed, tailored or tested in rural communities for African Americans. We describe how Project GRACE integrated Intervention Mapping (IM) methodology with community based participatory research (CBPR) principles to develop a multi-level, multi-generational HIV prevention intervention. IM was carried out in a series of steps from review of relevant data through producing program components. Through the IM process, all collaborators agreed that we needed a family-based intervention involving youth and their caregivers. We found that the structured approach of IM can be adapted to incorporate the principles of CBPR. PMID:20528128

Reducing occupational sitting: Workers' perspectives on participation in a multi-component intervention.

PubMed

Hadgraft, Nyssa T; Willenberg, Lisa; LaMontagne, Anthony D; Malkoski, Keti; Dunstan, David W; Healy, Genevieve N; Moodie, Marj; Eakin, Elizabeth G; Owen, Neville; Lawler, Sheleigh P

2017-05-30

Office workers spend much of their time sitting, which is now understood to be a risk factor for several chronic diseases. This qualitative study examined participants' perspectives following their involvement in a cluster randomised controlled trial of a multi-component intervention targeting prolonged workplace sitting (Stand Up Victoria). The intervention incorporated a sit-stand workstation, individual health coaching and organisational support strategies. The aim of the study was to explore the acceptability of the intervention, barriers and facilitators to reducing workplace sitting, and perceived effects of the intervention on workplace culture, productivity and health-related outcomes. Semi-structured interviews (n = 21 participants) and two focus groups (n = 7) were conducted with intervention participants at the conclusion of the 12 month trial and thematic analysis was used to analyse the data. Questions covered intervention acceptability, overall impact, barriers and facilitators to reducing workplace sitting, and perceived impact on productivity and workplace culture. Overall, participants had positive intervention experiences, perceiving that reductions in workplace sitting were associated with improved health and well-being with limited negative impact on work performance. While sit-stand workstations appeared to be the primary drivers of change, workstation design and limited suitability of standing for some job tasks and situations were perceived as barriers to their use. Social support from team leaders and other participants was perceived to facilitate behavioural changes and a shift in norms towards increased acceptance of standing in the workplace. Multi-component interventions to reduce workplace sitting, incorporating sit-stand workstations, are acceptable and feasible; however, supportive social and environmental conditions are required to support participant engagement. Best practice approaches to reduce workplace sitting should address the multiple levels of influence on behaviour, including factors that may act as barriers to behavioural change.

Evaluation of a Community-Based Intervention to Promote Rear Seating for Children

PubMed Central

Greenberg-Seth, Jennifer; Hemenway, David; Gallagher, Susan S.; Ross, Julie B.; Lissy, Karen S.

2004-01-01

Objectives. We evaluated the short-term effect of a community-based effort to promote child rear seating in a low-income Hispanic community. Methods. Child seating patterns were observed pre- and postintervention at intersections in 1 intervention and 2 control cities. Brief interviews assessed exposure to program messages. Results. Child rear seating increased from 33% to 49% in the intervention city (P < .0001), which represented a greater increase than that in the control cities (P < .0001). The greatest improvement was observed in relatively higher-income areas. Rear seating was significantly correlated with reported program exposure. Incentives and exposure to the program across multiple channels seemed to have the greatest effect. Conclusions. Independent of legislation, community-based programs incorporating incentives can increase child rear seating. PMID:15249307

Robotic intelligence kernel

DOEpatents

Bruemmer, David J [Idaho Falls, ID

2009-11-17

A robot platform includes perceptors, locomotors, and a system controller. The system controller executes a robot intelligence kernel (RIK) that includes a multi-level architecture and a dynamic autonomy structure. The multi-level architecture includes a robot behavior level for defining robot behaviors, that incorporate robot attributes and a cognitive level for defining conduct modules that blend an adaptive interaction between predefined decision functions and the robot behaviors. The dynamic autonomy structure is configured for modifying a transaction capacity between an operator intervention and a robot initiative and may include multiple levels with at least a teleoperation mode configured to maximize the operator intervention and minimize the robot initiative and an autonomous mode configured to minimize the operator intervention and maximize the robot initiative. Within the RIK at least the cognitive level includes the dynamic autonomy structure.

Audiovisual preconditioning enhances the efficacy of an anatomical dissection course: A randomised study.

PubMed

Collins, Anne M; Quinlan, Christine S; Dolan, Roisin T; O'Neill, Shane P; Tierney, Paul; Cronin, Kevin J; Ridgway, Paul F

2015-07-01

The benefits of incorporating audiovisual materials into learning are well recognised. The outcome of integrating such a modality in to anatomical education has not been reported previously. The aim of this randomised study was to determine whether audiovisual preconditioning is a useful adjunct to learning at an upper limb dissection course. Prior to instruction participants completed a standardised pre course multiple-choice questionnaire (MCQ). The intervention group was subsequently shown a video with a pre-recorded commentary. Following initial dissection, both groups completed a second MCQ. The final MCQ was completed at the conclusion of the course. Statistical analysis confirmed a significant improvement in the performance in both groups over the duration of the three MCQs. The intervention group significantly outperformed their control group counterparts immediately following audiovisual preconditioning and in the post course MCQ. Audiovisual preconditioning is a practical and effective tool that should be incorporated in to future course curricula to optimise learning. Level of evidence This study appraises an intervention in medical education. Kirkpatrick Level 2b (modification of knowledge). Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

The role of exercise training in the management of chronic kidney disease.

PubMed

Howden, Erin J; Coombes, Jeff S; Isbel, Nicole M

2015-11-01

In this review, we summarize recent studies of exercise interventions in chronic kidney disease (CKD), potential benefits, discuss barriers to implementation and make practical recommendations for incorporating exercise training into the care of patients with CKD. Interventions targeting increased fitness and physical activity are effective and may have multiple potential benefits. Recommendations regarding physical activity advice have been incorporated into the recent update of the KDIGO CKD guidelines, which suggest that patients perform 30 min of moderate intensity exercise on most days of the week. Exercise as simple, popular and inexpensive as walking appears to be associated with significant health benefits. More vigorous exercise requires increased supervision but can be safely prescribed to patients with a broad range of comorbidities and may be associated with greater gains in health. Physical activity, cardiorespiratory fitness and muscle function are low in patients with CKD. A sedentary lifestyle has been associated with increased mortality, morbidity and the risk factors that drive progression of both kidney and cardiac disease. There is much to learn about the benefits of different modalities of exercise but the time has come to routinely prescribe exercise interventions as part of standard nephrological care.

A Community-Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression.

PubMed

Valdez, Carmen R; Ramirez Stege, Alyssa; Martinez, Elizabeth; D'Costa, Stephanie; Chavez, Thomas

2017-07-23

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low-income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers. © 2017 Family Process Institute.

Conceptual Frameworks for the Workplace Change Adoption Process: Elements Integration from Decision Making and Learning Cycle Process.

PubMed

Radin Umar, Radin Zaid; Sommerich, Carolyn M; Lavender, Steve A; Sanders, Elizabeth; Evans, Kevin D

2018-05-14

Sound workplace ergonomics and safety-related interventions may be resisted by employees, and this may be detrimental to multiple stakeholders. Understanding fundamental aspects of decision making, behavioral change, and learning cycles may provide insights into pathways influencing employees' acceptance of interventions. This manuscript reviews published literature on thinking processes and other topics relevant to decision making and incorporates the findings into two new conceptual frameworks of the workplace change adoption process. Such frameworks are useful for thinking about adoption in different ways and testing changes to traditional intervention implementation processes. Moving forward, it is recommended that future research focuses on systematic exploration of implementation process activities that integrate principles from the research literature on sensemaking, decision making, and learning processes. Such exploration may provide the groundwork for development of specific implementation strategies that are theoretically grounded and provide a revised understanding of how successful intervention adoption processes work.

Leveraging the U.S. Criminal Justice System to Access Women for HIV Interventions.

PubMed

Meyer, Jaimie P; Muthulingam, Dharushana; El-Bassel, Nabila; Altice, Frederick L

2017-12-01

The criminal justice (CJ) system can be leveraged to access women for HIV prevention and treatment programs. Research is lacking on effective implementation strategies tailored to the specific needs of CJ-involved women. We conducted a scoping review of published studies in English from the United States that described HIV interventions, involved women or girls, and used the CJ system as an access point for sampling or intervention delivery. We identified 350 studies and synthesized data from 42 unique interventions, based in closed (n = 26), community (n = 7), or multiple/other CJ settings (n = 9). A minority of reviewed programs incorporated women-specific content or conducted gender-stratified analyses. CJ systems are comprised of diverse access points, each with unique strengths and challenges for implementing HIV treatment and prevention programs for women. Further study is warranted to develop women-specific and trauma-informed content and evaluate program effectiveness.

[Health promotion based on assets: how to work with this perspective in local interventions?

PubMed

Cofiño, Rafael; Aviñó, Dory; Benedé, Carmen Belén; Botello, Blanca; Cubillo, Jara; Morgan, Antony; Paredes-Carbonell, Joan Josep; Hernán, Mariano

2016-11-01

An asset-based approach could be useful to revitalise health promotion or community health interventions combining work with multiple partnerships, positive health, community engagement, equity and orientation of health determinants. We set some recommendations about how to incorporate the assets model in programmes, projects and interventions in health promotion. Some techniques are described for assets mapping and some experiences with this methodology being developed in different regions are systematised. We propose the term "Asset-based Health Promotion/Community Health" as an operational definition to work at the local level with a community engagement and participatory approach, building alliances between different institutions at the state-regional level and trying to create a framework for action with the generation of evaluations and evidence to work on population interventions from the perspective of positive health. Copyright © 2016 SESPAS. All rights reserved.

Comparing multiple competing interventions in the absence of randomized trials using clinical risk-benefit analysis

PubMed Central

2012-01-01

Background To demonstrate the use of risk-benefit analysis for comparing multiple competing interventions in the absence of randomized trials, we applied this approach to the evaluation of five anticoagulants to prevent thrombosis in patients undergoing orthopedic surgery. Methods Using a cost-effectiveness approach from a clinical perspective (i.e. risk benefit analysis) we compared thromboprophylaxis with warfarin, low molecular weight heparin, unfractionated heparin, fondaparinux or ximelagatran in patients undergoing major orthopedic surgery, with sub-analyses according to surgery type. Proportions and variances of events defining risk (major bleeding) and benefit (thrombosis averted) were obtained through a meta-analysis and used to define beta distributions. Monte Carlo simulations were conducted and used to calculate incremental risks, benefits, and risk-benefit ratios. Finally, net clinical benefit was calculated for all replications across a range of risk-benefit acceptability thresholds, with a reference range obtained by estimating the case fatality rate - ratio of thrombosis to bleeding. Results The analysis showed that compared to placebo ximelagatran was superior to other options but final results were influenced by type of surgery, since ximelagatran was superior in total knee replacement but not in total hip replacement. Conclusions Using simulation and economic techniques we demonstrate a method that allows comparing multiple competing interventions in the absence of randomized trials with multiple arms by determining the option with the best risk-benefit profile. It can be helpful in clinical decision making since it incorporates risk, benefit, and personal risk acceptance. PMID:22233221

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

Multiple hypotheses testing of fish incidence patterns in an urbanized ecosystem

USGS Publications Warehouse

Chizinski, C.J.; Higgins, C.L.; Shavlik, C.E.; Pope, K.L.

2006-01-01

Ecological and evolutionary theories have focused traditionally on natural processes with little attempt to incorporate anthropogenic influences despite the fact that humans are such an integral part of virtually all ecosystems. A series of alternate models that incorporated anthropogenic factors and traditional ecological mechanisms of invasion to account for fish incidence patterns in urban lakes was tested. The models were based on fish biology, human intervention, and habitat characteristics. However, the only models to account for empirical patterns were those that included fish invasiveness, which incorporated species-specific information about overall tolerance and fecundity. This suggests that species-specific characteristics are more important in general distributional patterns than human-mediated dispersal. Better information of illegal stocking activities is needed to improve human-mediated models, and more insight into basic life history of ubiquitous species is needed to truly understand underlying mechanisms of biotic homogenization. ?? Springer 2005.

Using the Consolidated Framework for Implementation Research to implement and evaluate national surgical planning

PubMed Central

Saluja, Saurabh; Silverstein, Allison; Mukhopadhyay, Swagoto; Lin, Yihan; Raykar, Nakul; Keshavjee, Salmaan; Samad, Lubna; Meara, John G

2017-01-01

The Lancet Commission on Global Surgery defined six surgical indicators and a framework for a national surgical plan that aimed to incorporate surgical care as a part of global public health. Multiple countries have since begun national surgical planning; each faces unique challenges in doing so. Implementation science can be used to more systematically explain this heterogeneous process, guide implementation efforts and ultimately evaluate progress. We describe our intervention using the Consolidated Framework for Implementation Research. This framework requires identifying characteristics of the intervention, the individuals involved, the inner and outer setting of the intervention, and finally describing implementation processes. By hosting a consultative symposium with clinicians and policy makers from around the world, we are able to specify key aspects of each element of this framework. We define our intervention as the incorporation of surgical care into public health planning, identify local champions as the key individuals involved, and describe elements of the inner and outer settings. Ultimately we describe top-down and bottom-up models that are distinct implementation processes. With the Consolidated Framework for Implementation Research, we are able to identify specific strategic models that can be used by implementers in various settings. While the integration of surgical care into public health throughout the world may seem like an insurmountable challenge, this work adds to a growing effort that seeks to find a way forward. PMID:29225930

The knowledge-attitude dissociation in geriatric education: can it be overcome?

PubMed

Koh, Gerald C H; Merchant, Reshma A; Lim, Wee Shiong; Amin, Zubair

2012-09-01

A knowledge-attitude dissociation often exists in geriatrics where knowledge but not attitudes towards elderly patients improve with education. This study aims to determine whether a holistic education programme incorporating multiple educational strategies such as early exposure, ageing simulation and small group teaching results in improving geriatrics knowledge and attitudes among medical students. We administered the 18-item University of California Los Angeles (UCLA) Geriatric Knowledge Test (GKT) and the Singapore-modified 16-item UCLA Geriatric Attitudes Test (GAT) to 2nd year students of the old curriculum in 2009 (baseline reference cohort, n = 254), and before and after the new module to students of the new curriculum in 2010 (intervention cohort, n = 261), both at the same time of the year. At baseline, between the baseline reference and intervention cohort, there was no difference in knowledge (UCLA-GKT Score: 31.6 vs 33.5, P = 0.207) but attitudes of the intervention group were worse than the baseline reference group (UCLA-GAT Score: 3.53 vs 3.43, P = 0.003). The new module improved both the geriatric knowledge (UCLA-GKT Score: 34.0 vs 46.0, P <0.001) and attitudes (UCLA-GAT Score: 3.43 vs 3.50, P <0.001) of the intervention cohort. A geriatric education module incorporating sound educational strategies improved both geriatric knowledge and attitudes among medical students.

Incorporating Quality of Life Metrics in Interventional Oncology Practice.

PubMed

Li, David; Madoff, David C

2017-12-01

Interventional radiologists care for a large number of cancer patients with the breadth of palliative intent minimally invasive procedures that we provide. Understanding our meaningful impact on patients' quality of life is essential toward validating our role in the palliation of cancer patients. As such, it is critically important for interventional radiologists to understand common instruments used for the reporting of patient's quality of life measures. Common instruments used to measure pain and quality of life for cancer patients include the numerical rating scale, visual analog scale, brief pain inventory, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Functional Assessment of Cancer Therapy. An ideal quality of life instrument should be a patient reported outcome measure across multiple domains (e.g., physical health, psychological, social), and be both validated and reliable.

Intervention for Anxiety and Problem Behavior in Children with Autism Spectrum Disorder and Intellectual Disability.

PubMed

Moskowitz, Lauren J; Walsh, Caitlin E; Mulder, Emile; McLaughlin, Darlene Magito; Hajcak, Greg; Carr, Edward G; Zarcone, Jennifer R

2017-12-01

There is little research on the functional assessment and treatment of anxiety and related problem behavior in children with autism spectrum disorder (ASD), particularly those with intellectual and developmental disability (IDD). In a recent study, we evaluated a multimethod strategy for assessing anxiety in children with ASD and IDD (Am J Intellect Dev Disabil 118:419-434, 2013). In the present study, we developed treatments for the anxiety and associated problem behavior in these same children. A multiple baseline design was used to evaluate the effectiveness of a multicomponent intervention package, incorporating individualized strategies from Positive Behavior Support and Cognitive Behavioral Therapy. During intervention, all three participants showed substantial decreases in anxiety and problem behavior and significant increases in respiratory sinus arrhythmia in the situations that had previously been identified as anxiety-provoking.

Systematic reviews, overviews of reviews and comparative effectiveness reviews: a discussion of approaches to knowledge synthesis.

PubMed

Hartling, Lisa; Vandermeer, Ben; Fernandes, Ricardo M

2014-06-01

The Cochrane Collaboration has been at the forefront of developing methods for knowledge synthesis internationally. We discuss three approaches to synthesize evidence for healthcare interventions: systematic reviews (SRs), overviews of reviews and comparative effectiveness reviews. We illustrate these approaches with examples from knowledge syntheses on interventions for bronchiolitis, a common acute paediatric condition. Some of the differences among these approaches are subtle and methods are not necessarily mutually exclusive to a single review type. Systematic reviews bring together evidence from multiple studies in a rigorous fashion for a single intervention or group of interventions. Systematic reviews, as they have developed within healthcare, often focus on single or select interventions and direct pairwise comparisons; therefore, end-users may need to read several individual SRs to inform decision making. Overviews of reviews compile information from multiple SRs relevant to a single health problem. Overviews provide the end-user with a quick overview of the available evidence; however, overviews are dependent on the methods and decisions employed at the SR level. Furthermore, overviews do not often integrate evidence from different SRs quantitatively. Comparative effectiveness reviews, as we define them here, synthesize relevant evidence from individual studies to describe the relative benefits (or harms) of a range of interventions. Comparative effectiveness reviews may use statistical methods (network meta-analysis) to incorporate direct and indirect evidence; therefore, they can provide stronger inferences about the relative effectiveness (or safety) of interventions. While potentially more expensive and time-consuming to produce, a comparative effectiveness review provides a synthesis of a range of interventions for a given condition and the relative efficacy across interventions using consistent and standardized methodology. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Improving Socialization for High School Students with ASD by Using their Preferred Interests

PubMed Central

Koegel, Robert; Kim, Sunny; Koegel, Lynn; Schwartzman, Ben

2013-01-01

There has been a paucity of research on effective social interventions for adolescents with ASD in inclusive high school settings. The literature, however, suggests that incorporating the student with ASD’s special interests into activities may help improve their socialization with typical peers. Within the context of a multiple baseline across participants design, we implemented lunchtime activities incorporating the adolescent with ASD’s preferred interests that were similar to ongoing activities already available at the schools. Results showed this increased both level of engagement and their rate of initiations made to typical peers. Social validation measures suggest that both adolescents with ASD and typical peers enjoyed participating in these activities and that the results generalized to other similar activities. PMID:23361918

Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol

PubMed Central

Hogue, Aaron; Bobek, Molly; Tau, Gregory Z.; Levin, Frances R.

2014-01-01

Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions. PMID:25505817

Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol.

PubMed

Hogue, Aaron; Bobek, Molly; Tau, Gregory Z; Levin, Frances R

2014-10-01

Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions.

Social marketing-based communications to integrate and support the HEALTHY study intervention

PubMed Central

DeBar, LL; Schneider, M; Ford, EG; Hernandez, AE; Showell, B; Drews, KL; Moe, EL; Gillis, B; Jessup, AN; Stadler, DD; White, M

2009-01-01

The HEALTHY study was a randomized, controlled, multicenter, middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Participants were a racially, ethnically and geographically diverse cohort from across the United States. Here, we describe the conceptual underpinnings and design of the social marketing-based communications component of the HEALTHY study intervention that combined changes in the school nutrition and physical education (PE) environment with behavior change initiatives. The communications intervention component coordinated multiple elements to deliver campaigns that served to integrate and support all aspects of the HEALTHY intervention. The campaigns unfolded across five semesters of middle school, each targeting a specific theme related to the HEALTHY objectives. Communications campaigns comprised (1) core elements such as branding, posters, banners and visual and verbal messaging, (2) student events supporting the nutrition, PE and behavior intervention components through the application of social marketing and communications strategies, including the incorporation of student-generated media and (3) distribution of premiums and theme enhancers to extend the visibility of the study beyond the intervention environment. Formative research conducted with students, parents and school administrators was used to refine the communications strategy. Student peer communicators selected from the student body were involved to influence the normative student environment. Marketing and creative design experts developed a brand, logo, activities and materials. In the latter half of the study, student-generated messages and media were used to reflect local interests and culture and enhance peer influence. The HEALTHY intervention delivery and impact were strengthened by the communications strategies. The HEALTHY experience provides practical considerations for systematically incorporating a social marketing-based communications approach within future school-based health behavior interventions. PMID:19623190

Social marketing-based communications to integrate and support the HEALTHY study intervention.

PubMed

DeBar, L L; Schneider, M; Ford, E G; Hernandez, A E; Showell, B; Drews, K L; Moe, E L; Gillis, B; Jessup, A N; Stadler, D D; White, M

2009-08-01

The HEALTHY study was a randomized, controlled, multicenter, middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Participants were a racially, ethnically and geographically diverse cohort from across the United States. Here, we describe the conceptual underpinnings and design of the social marketing-based communications component of the HEALTHY study intervention that combined changes in the school nutrition and physical education (PE) environment with behavior change initiatives. The communications intervention component coordinated multiple elements to deliver campaigns that served to integrate and support all aspects of the HEALTHY intervention. The campaigns unfolded across five semesters of middle school, each targeting a specific theme related to the HEALTHY objectives. Communications campaigns comprised (1) core elements such as branding, posters, banners and visual and verbal messaging, (2) student events supporting the nutrition, PE and behavior intervention components through the application of social marketing and communications strategies, including the incorporation of student-generated media and (3) distribution of premiums and theme enhancers to extend the visibility of the study beyond the intervention environment. Formative research conducted with students, parents and school administrators was used to refine the communications strategy. Student peer communicators selected from the student body were involved to influence the normative student environment. Marketing and creative design experts developed a brand, logo, activities and materials. In the latter half of the study, student-generated messages and media were used to reflect local interests and culture and enhance peer influence. The HEALTHY intervention delivery and impact were strengthened by the communications strategies. The HEALTHY experience provides practical considerations for systematically incorporating a social marketing-based communications approach within future school-based health behavior interventions.

Use of synthesized data to support complex ad-hoc queries in an enterprise information warehouse: a diabetes use case.

PubMed

Rogers, Patrick; Erdal, Selnur; Santangelo, Jennifer; Liu, Jianhua; Schuster, Dara; Kamal, Jyoti

2008-11-06

The Ohio State University Medical Center (OSUMC) Information Warehouse (IW) is a comprehensive data warehousing facility incorporating operational, clinical, and biological data sets from multiple enterprise system. It is common for users of the IW to request complex ad-hoc queries that often require significant intervention by data analyst. In response to this challenge, we have designed a workflow that leverages synthesized data elements to support such queries in an more timely, efficient manner.

Multiple Household Water Sources and Their Use in Remote Communities With Evidence From Pacific Island Countries

NASA Astrophysics Data System (ADS)

Elliott, Mark; MacDonald, Morgan C.; Chan, Terence; Kearton, Annika; Shields, Katherine F.; Bartram, Jamie K.; Hadwen, Wade L.

2017-11-01

Global water research and monitoring typically focus on the household's "main source of drinking-water." Use of multiple water sources to meet daily household needs has been noted in many developing countries but rarely quantified or reported in detail. We gathered self-reported data using a cross-sectional survey of 405 households in eight communities of the Republic of the Marshall Islands (RMI) and five Solomon Islands (SI) communities. Over 90% of households used multiple sources, with differences in sources and uses between wet and dry seasons. Most RMI households had large rainwater tanks and rationed stored rainwater for drinking throughout the dry season, whereas most SI households collected rainwater in small pots, precluding storage across seasons. Use of a source for cooking was strongly positively correlated with use for drinking, whereas use for cooking was negatively correlated or uncorrelated with nonconsumptive uses (e.g., bathing). Dry season water uses implied greater risk of water-borne disease, with fewer (frequently zero) handwashing sources reported and more unimproved sources consumed. Use of multiple sources is fundamental to household water management and feasible to monitor using electronic survey tools. We contend that recognizing multiple water sources can greatly improve understanding of household-level and community-level climate change resilience, that use of multiple sources confounds health impact studies of water interventions, and that incorporating multiple sources into water supply interventions can yield heretofore-unrealized benefits. We propose that failure to consider multiple sources undermines the design and effectiveness of global water monitoring, data interpretation, implementation, policy, and research.

The feasibility and RE-AIM evaluation of the TAME health pilot study.

PubMed

Lewis, Zakkoyya H; Ottenbacher, Kenneth J; Fisher, Steve R; Jennings, Kristofer; Brown, Arleen F; Swartz, Maria C; Martinez, Eloisa; Lyons, Elizabeth J

2017-08-14

Conducting 5 A's counseling in clinic and utilizing technology-based resources are recommended to promote physical activity but little is known about how to implement such an intervention. This investigation aimed to determine the feasibility and acceptability, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, of a pragmatic, primary care-based intervention that incorporated 5 A's counseling and self-control through an activity monitor. Primary care patients (n = 40) 55-74 years of age were recruited and randomized to receive a pedometer or an electronic activity monitor (EAM), Jawbone UP24, to monitor activity for 12 weeks. Participants were also invited to a focus group after completing the intervention. Stakeholders (n = 36) were recruited to provide feedback. The intervention recruitment rate was 24.7%. The attrition rate was 20% with a significantly higher rate for the pedometer group (p = 0.02). The EAM group increased their minutes of physical activity by 11.1 min/day while the pedometer maintained their activity (0.2 min/day), with no significant group difference. EAM participants liked using their monitor and would continue wearing it while the pedometer group was neutral to these statements (p < 0.05). Over the 12 weeks there were 490 comments and 1094 "likes" given to study peers in the corresponding application for the UP24 monitor. Some EAM participants enjoyed the social interaction feature while others were uncomfortable talking to strangers. Participants stated they would want counseling from a counselor and not their physician or a nurse. Other notable comments included incorporating multiple health behaviors, more in-person counseling with a counselor, and having a funding source for sustainability. Overall, the study was well-received but the results raise a number of considerations. Practitioners, counselors, and researchers should consider the following before implementing a similar intervention: 1) utilize PA counselors, 2) target multiple health behaviors, 3) form a social support group, 4) identify a funding source for sustainability, and 5) be mindful of concerns with technology. clinicaltrials.gov- NCT02554435 . Registered 24 August 2015.

Effect of Fordyce Happiness Model on depression, stress, anxiety, and fatigue in patients with multiple sclerosis.

PubMed

Khayeri, Fereydoon; Rabiei, Leili; Shamsalinia, Abbas; Masoudi, Reza

2016-11-01

This study was conducted to investigate the effect of Fordyce Happiness Model (FHM) on depression, stress, anxiety, and fatigue in MS patients. In this clinical trial, 140 MS patients assigned to experimental and control groups. Depression, anxiety, stress, and fatigue were measured by Depression Anxiety Stress Scale-21 and Piper Standard Scale before and immediately and three months after the implementation of FHM. The data were analyzed by SPSS 18. Independent t-test indicated that total scores of stress, depression, and fatigue of the two groups were not significantly different before the intervention but were significantly different after the intervention (P˂0.05). Moreover, anxiety scores of the two were not significantly different after the intervention (P˃0.05). FHM can assist MS patients to manage their disease and associated problems in life. Besides that, since FHM is efficient and costless, it can be incorporated into the health interventions for MS patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mobile Phone Interventions for the Secondary Prevention of Cardiovascular Disease.

PubMed

Park, Linda G; Beatty, Alexis; Stafford, Zoey; Whooley, Mary A

2016-01-01

Mobile health in the form of text messaging and mobile applications provides an innovative and effective approach to promote prevention and management of cardiovascular disease (CVD); however, the magnitude of these effects is unclear. Through a comprehensive search of databases from 2002-2016, we conducted a quantitative systematic review. The selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. A large majority of studies (22 of 28, 79%) demonstrated text messaging, mobile applications, and telemonitoring via mobile phones were effective in improving outcomes. Some key factors associated with successful interventions included personalized messages with tailored advice, greater engagement (2-way text messaging, higher frequency of messages), and use of multiple modalities. Overall, text messaging appears more effective than smartphone-based interventions. Incorporating principles of behavioral activation will help promote and sustain healthy lifestyle behaviors in patients with CVD that result in improved clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Generating Gratitude in the Workplace to Improve Faculty Job Satisfaction.

PubMed

Stegen, Amy; Wankier, Jamie

2018-06-01

The current nursing shortage affects all settings. In an effort to promote retention of nursing faculty, an "attitude of gratitude" was cultivated to improve job satisfaction and increase collaboration in one school of nursing. This was a quantitative study using a convenience sample of faculty at one school of nursing. A presurvey of faculty on perceived gratitude levels and job satisfaction was administered prior to the start of the school year. Multiple gratitude interventions were implemented throughout the year and a postsurvey was administered to measure the effectiveness of interventions. The findings of this study show an improvement of 17.9% in overall job satisfaction, which is consistent with other studies on the topic. Collaboration was not affected by gratitude interventions. Implementing gratitude is a cost-effective and easy way to improve job satisfaction to increase faculty retention rates. [J Nurs Educ. 2018;57(6):375-378.]. Copyright 2018, SLACK Incorporated.

Mobile Phone Interventions for the Secondary Prevention of Cardiovascular Disease

PubMed Central

Park, Linda G.; Beatty, Alexis; Stafford, Zoey; Whooley, Mary A.

2016-01-01

Mobile health in the form of text messaging and mobile applications provides an innovative and effective approach to promote prevention and management of cardiovascular disease (CVD); however, the magnitude of these effects is unclear. Through a comprehensive search of databases from 2002–2016, we conducted a quantitative systematic review. The selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. A large majority of studies (22 of 28, 79%) demonstrated text messaging, mobile applications, and telemonitoring via mobile phones were effective in improving outcomes. Some key factors associated with successful interventions included personalized messages with tailored advice, greater engagement (2-way text messaging, higher frequency of messages), and use of multiple modalities. Overall, text messaging appears more effective than smartphone-based interventions. Incorporating principles of behavioral activation will help promote and sustain healthy lifestyle behaviors in patients with CVD that result in improved clinical outcomes. PMID:27001245

Potential treatment mechanisms in a mindfulness-based intervention for people with progressive multiple sclerosis.

PubMed

Bogosian, Angeliki; Hughes, Alicia; Norton, Sam; Silber, Eli; Moss-Morris, Rona

2016-11-01

To explore putative mediators of a mindfulness-based intervention to decrease distress in people with multiple sclerosis (MS) and to explore the patients' perspectives on this intervention. We used an explanatory mixed methods design incorporating quantitative data from a pilot randomized control trial and a qualitative interview study with people who completed the mindfulness intervention. People with MS (n = 40) completed standardized measures of distress (outcome), and acceptance, decentring, self-compassion, and self-efficacy (potential mediators). Semi-structured interviews (n = 15) of patients' experiences of the mindfulness intervention were analysed deductively and inductively. Decentring post-intervention explained 13% of the 3-month change in distress and between 27% and 31% of concurrent changes in distress. Acceptance changed only slightly, and as a result, the indirect effect accounts for only 2% of future distress and between 3% and 11% of concurrent distress. Qualitative data showed that acceptance and self-compassion needed more time to develop, whereas decentring could be implemented readily after being introduced in the sessions. Self-efficacy also had a large mediating effect. Participants in their interviews talked about group dynamics and prior expectations as essential elements that determine their engagement with the course and their level of satisfaction. Mindfulness interventions for people with a chronic progressive condition may benefit from focusing on helping them to accept daily challenges and teach them to recognize their thoughts and feelings, allowing time for acceptance and self-compassion to develop. Group dynamics also play a fundamental role in the success of the mindfulness interventions. Statement of Contribution What is already known on this subject? Mindfulness courses improve psychological well-being for people with chronic conditions. Mindfulness courses have been successful in improving psychological well-being and symptom management for people with multiple sclerosis but we do not know how these courses work. What does this study add? Decentering and self-efficacy appear to be key mechanisms leading to reduced distress. Acceptance and self-compassion may need more time and practice to develop. Group dynamics and expectations of the mindfulness courses were also important elements of mindfulness. © 2016 The British Psychological Society.

Rationale, design and methods of the HEALTHY study behavior intervention component

PubMed Central

Venditti, EM; Elliot, DL; Faith, MS; Firrell, LS; Giles, CM; Goldberg, L; Marcus, MD; Schneider, M; Solomon, S; Thompson, D; Yin, Z

2009-01-01

HEALTHY was a multi-center primary prevention trial designed to reduce risk factors for type 2 diabetes in adolescents. Seven centers each recruited six middle schools that were randomized to either intervention or control. The HEALTHY intervention integrated multiple components in nutrition, physical education, behavior change and communications and promotion. The conceptual rationale as well as the design and development of the behavior intervention component are described. Pilot study data informed the development of the behavior intervention component. Principles of social learning and health-related behavior change were incorporated. One element of the behavior intervention component was a sequence of peer-led, teacher-facilitated learning activities known as FLASH (Fun Learning Activities for Student Health). Five FLASH modules were implemented over five semesters of the HEALTHY study, with the first module delivered in the second semester of the sixth grade and the last module in the second semester of the eighth grade. Each module contained sessions that were designed to be delivered on a weekly basis to foster self-awareness, knowledge, decision-making skills and peer involvement for health behavior change. FLASH behavioral practice incorporated individual and group self-monitoring challenges for eating and activity. Another element of the behavior intervention component was the family outreach strategy for extending changes in physical activity and healthy eating beyond the school day and for supporting the student's lifestyle change choices. Family outreach strategies included the delivery of newsletters and supplemental packages with materials to promote healthy behavior in the home environment during school summer and winter holiday breaks. In conclusion, the HEALTHY behavior intervention component, when integrated with total school food and physical education environmental changes enhanced by communications and promotional campaigns, is a feasible and acceptable mechanism for delivering age-appropriate social learning for healthy eating and physical activity among an ethnically diverse group of middle school students across the United States. PMID:19623189

Rationale, design and methods of the HEALTHY study behavior intervention component.

PubMed

Venditti, E M; Elliot, D L; Faith, M S; Firrell, L S; Giles, C M; Goldberg, L; Marcus, M D; Schneider, M; Solomon, S; Thompson, D; Yin, Z

2009-08-01

HEALTHY was a multi-center primary prevention trial designed to reduce risk factors for type 2 diabetes in adolescents. Seven centers each recruited six middle schools that were randomized to either intervention or control. The HEALTHY intervention integrated multiple components in nutrition, physical education, behavior change and communications and promotion. The conceptual rationale as well as the design and development of the behavior intervention component are described. Pilot study data informed the development of the behavior intervention component. Principles of social learning and health-related behavior change were incorporated. One element of the behavior intervention component was a sequence of peer-led, teacher-facilitated learning activities known as FLASH (Fun Learning Activities for Student Health). Five FLASH modules were implemented over five semesters of the HEALTHY study, with the first module delivered in the second semester of the sixth grade and the last module in the second semester of the eighth grade. Each module contained sessions that were designed to be delivered on a weekly basis to foster self-awareness, knowledge, decision-making skills and peer involvement for health behavior change. FLASH behavioral practice incorporated individual and group self-monitoring challenges for eating and activity. Another element of the behavior intervention component was the family outreach strategy for extending changes in physical activity and healthy eating beyond the school day and for supporting the student's lifestyle change choices. Family outreach strategies included the delivery of newsletters and supplemental packages with materials to promote healthy behavior in the home environment during school summer and winter holiday breaks. In conclusion, the HEALTHY behavior intervention component, when integrated with total school food and physical education environmental changes enhanced by communications and promotional campaigns, is a feasible and acceptable mechanism for delivering age-appropriate social learning for healthy eating and physical activity among an ethnically diverse group of middle school students across the United States.

A Systematic Review of Interventions to Improve Adherence to Melanoma Preventive Behaviors for Individuals at Elevated Risk

PubMed Central

Wu, Yelena P.; Aspinwall, Lisa G.; Conn, Bridgid M.; Stump, Tammy; Grahmann, Bridget; Leachman, Sancy A.

2016-01-01

Background and Objectives To examine the effectiveness of behavioral interventions for melanoma prevention targeted to individuals at elevated risk due to personal and/or family history. Methods Through literature searches in 5 search databases (through July 2014), 20 articles describing 14 unique interventions focused on melanoma prevention among individuals at elevated risk for the disease were identified. Interventions targeting only patients undergoing active treatment for melanoma were excluded. Results The average study quality was moderate. The majority of interventions (6 out of 9, 66% of studies) led to improvements in one or more photoprotective behaviors, particularly for improvements in use of protective clothing (3 out of 5, 60% of studies), and frequency and/or thoroughness of skin self-examinations (9 out of 12, 75%). Fewer interventions (5 out of 14, 36%) targeted uptake of total body skin examinations (60% led to improvements). Also, fewer interventions targeted all three preventive behaviors (5 out of 14, 36%). Conclusions Findings suggest future interventions should aim to improve adherence across multiple preventive behaviors, over a longer time period (past 8 months post-intervention), and target high-risk children. Studies should include adequate sample sizes to investigate moderators and mediators of intervention effectiveness. Interventions may be strengthened by new techniques, such as incorporating family members (e.g., to improve thoroughness of skin self-examinations) and eHealth technology. PMID:27090434

The 'values journey' of nursing and midwifery students selected using multiple mini interviews; Year One findings.

PubMed

Callwood, Alison; Bolger, Sarah; Allan, Helen T

2018-05-01

To explore how adult, child and mental health nursing and midwifery students, selected using multiple mini interviews, describe their 'values journey' following exposure to the clinical practice environment. Values based recruitment (VBR) incorporates assessment of healthcare students' personal values using approaches like multiple mini interviews. Students' experience of adjustment to their values during their programme is conceptualized as a 'values journey'. The impact of VBR in alleviating erosion of personal values remains unclear. A cross-professional longitudinal cohort study was commenced at one university in England in 2016 with data collection points at the end of years one, two and three. Non-probability consecutive sampling resulted in 42 healthcare students (8 adult, 8 child and 9 mental health nursing and 17 midwifery students) taking part. Six semi-structured focus groups were conducted at the end of participants' Year One (DC1). Data analysis incorporated inductive and deductive approaches in a hybrid synthesis. Participants described a 'values journey' where their values, particularly communication, courage and wanting to make a difference, were both challenged and retained. Participants personal journeys also acknowledged the: 'courage it takes to use values'; 'reality of values in practice' and 'need for self-reflection on values'. A 'values journey' may begin early in a healthcare student's education programme. This is important to recognize so that appropriate interventions designed to support students in higher education and clinical practice can be implemented. The values incorporated in VBR should be continually evaluated for fitness for purpose. © 2017 John Wiley & Sons Ltd.

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

Using Intervention Mapping for child development and wellbeing programs in early childhood education and care settings.

PubMed

O'Connor, Amanda; Blewitt, Claire; Nolan, Andrea; Skouteris, Helen

2018-06-01

Supporting children's social and emotional learning benefits all elements of children's development and has been associated with positive mental health and wellbeing, development of values and life skills. However, literature relating to the creation of interventions designed for use within the early childhood education and care settings to support children's social and emotional skills and learning is lacking. Intervention Mapping (IM) is a systematic intervention development framework, utilising principles centred on participatory co-design methods, multiple theoretical approaches and existing literature to enable effective decision-making during the development process. Early childhood pedagogical programs are also shaped by these principles; however, educators tend to draw on implicit knowledge when working with families. IM offers this sector the opportunity to formally incorporate theoretical, evidence-based research into the development of early childhood education and care social and emotional interventions. Emerging literature indicates IM is useful for designing health and wellbeing interventions for children within early childhood education and care settings. Considering the similar underlying principles of IM, existing applications within early childhood education and care and development of interventions beyond health behaviour change, it is recommended IM be utilised to design early childhood education and care interventions focusing on supporting children's social and emotional development. Copyright © 2018 Elsevier Ltd. All rights reserved.

A review of HIV/AIDS system-level interventions

PubMed Central

Bauermeister, José A.; Tross, Susan; Ehrhardt, Anke A.

2010-01-01

The escalating HIV/AIDS epidemic worldwide demands that on-going prevention efforts be strengthened, disseminated, and scaled-up. System-level interventions refer to programs aiming to improve the functioning of an agency as well as the delivery of its services to the community. System-level interventions are a promising approach to HIV/AIDS prevention because they focus on (a) improving the agency’s ability to adopt evidence-based HIV prevention and care programs; (b) develop and establish policies and procedures that maximize the sustainability of on-going prevention and care efforts; and (c) improve decision-making processes such as incorporating the needs of communities into their tailored services. We reviewed studies focusing on system-level interventions by searching multiple electronic abstracting indices, including PsycInfo, PubMed, and ProQuest. Twenty-three studies out of 624 peer-reviewed studies (published from January 1985 to February 2007) met study criteria. Most of the studies focused on strengthening agency infrastructure, while other studies included collaborative partnerships and technical assistance programs. Our findings suggest that system-level interventions are promising in strengthening HIV/AIDS prevention and treatment efforts. Based on our findings, we propose recommendations for future work in developing and evaluating system-level interventions. PMID:18369722

Soul mate: exploring the concept of soul.

PubMed

Fenske, Joan M

2011-09-01

This article describes an "advanced practice" registered nurse's skill in using multiple theoretical frameworks to make meaning of her severely developmentally disabled son's untimely death. Aspects of religion, spirituality, and philosophy are presented plus how related practices, such as used within Alcoholics Anonymous, are incorporated into everyday life are referenced. Creating unique rituals and ceremonies demonstrates the power of the mind as a partner in the healing process when grief seems insurmountable. This article, titled "Soul Mate" discusses how individuals create their own healing narratives when confronted with grief and tragedy. Nursing interventions, sensitive to this process, support and promote the grief process. Eliciting, recognizing, and accepting a patient's unique self-made rituals and ceremonies as they cope with a beloved's death and dying enhances their nursing interventions. © 2011 The Author(s)

Storytelling in community intervention research: lessons learned from the walk your heart to health intervention.

PubMed

LeBron, Alana M; Schulz, Amy J; Bernal, Cristina; Gamboa, Cindy; Wright, Conja; Sand, Sharon; Valerio, Melissa; Caver, Deanna

2014-01-01

Contextually and culturally congruent interventions are urgently needed to reduce racial, ethnic, and socioeconomic inequities in physical activity and cardiovascular disease. To examine a community-based participatory research (CBPR) process that incorporated storytelling into a physical activity intervention, and consider implications for reducing health inequities. We used a CBPR process to incorporate storytelling in an existing walking group intervention. Stories conveyed social support and problem-solving intervention themes designed to maintain increases in physical activity over time, and were adapted to the walking group context, group dynamics, challenges, and traditions. After describing of the CBPR process used to adapt stories to walking group sites, we discuss challenges and lessons learned regarding the adaptation and implementation of stories to convey key intervention themes. A CBPR approach to incorporating storytelling to convey intervention themes offers an innovative and flexible strategy to promote health toward the elimination of health inequities.

Addressing astronomy misconceptions and achieving national science standards utilizing aspects of multiple intelligences theory in the classroom and the planetarium

NASA Astrophysics Data System (ADS)

Sarrazine, Angela Renee

The purpose of this study was to incorporate multiple intelligences techniques in both a classroom and planetarium setting to create a significant increase in student learning about the moon and lunar phases. Utilizing a free-response questionnaire and a 25 item multiple choice pre-test/post-test design, this study identified middle school students' misconceptions and measured increases in student learning about the moon and lunar phases. The study spanned two semesters and contained six treatment groups which consisted of both single and multiple interventions. One group only attended the planetarium program. Two groups attended one of two classes a week prior to the planetarium program, and two groups attended one of two classes a week after the planetarium program. The most rigorous treatment group attended a class both a week before and after the planetarium program. Utilizing Rasch analysis techniques and parametric statistical tests, all six groups exhibited statistically significant gains in knowledge at the 0.05 level. There were no significant differences between students who attended only a planetarium program versus a single classroom program. Also, subjects who attended either a pre-planetarium class or a post- planetarium class did not show a statistically significant gain over the planetarium only situation. Equivalent effects on student learning were exhibited by the pre-planetarium class groups and post-planetarium class groups. Therefore, it was determined that the placement of the second intervention does not have a significant impact on student learning. However, a decrease in learning was observed with the addition of a third intervention. Further instruction and testing appeared to hinder student learning. This is perhaps an effect of subject fatigue.

Incorporating geographic settings into a social network analysis of injection drug use and bloodborne pathogen prevalence.

PubMed

Wylie, John L; Shah, Lena; Jolly, Ann

2007-09-01

Using social network analysis, we investigated how communal meeting places can link injection drug user (IDU) populations and create opportunities for the transmission of bloodborne pathogens. In our locale, specific hotels played a key role in the injection drug scene. Within this hotel network some IDU injected at only one hotel while others injected at multiple hotels; this latter group potentially acted as spatial bridges linking relatively distinct hotel networks. Pathogen prevalence showed a gradation with the highest prevalence occurring at the centre of the network. Consistent with pathogen prevalence, people most central to the network were more likely to engage in risky injection practices. Incorporating geographic place into analyses involving IDU can contribute to an understanding of pathogen transmission patterns in an area and assist public health efforts to develop targeted intervention programs.

Using Multidisciplinary Focus Groups to Inform the Development of mI SMART: A Nurse-Led Technology Intervention for Multiple Chronic Conditions

PubMed Central

Theeke, Laurie A.; Theeke, Elliott; Mallow, Brian K.

2016-01-01

Used as integrated tools, technology may improve the ability of healthcare providers to improve access and outcomes of care. Little is known about healthcare teams' preferences in using such technology. This paper reports the findings from focus groups aimed at evaluating a newly developed primary care technology platform. Focus groups were completed in academic, outpatient, and community settings. Focus groups were attended by 37 individuals. The participants included professionals from multiple disciplines. Both prescribing (N = 8) and nonprescribing healthcare team members (n = 21) completed the focus groups and survey. The majority were practicing for more than 20 years (44.8%) in an outpatient clinic (62%) for 20–40 hours per week (37.9%). Providers identified perceived obstacles of patient use as ability, willingness, and time. System obstacles were identified as lack of integration, lack of reimbursement, and cost. The positive attributes of the developed system were capability for virtual visits, readability, connectivity, user-friendliness, ability to capture biophysical measures, enhanced patient access, and incorporation of multiple technologies. Providers suggested increasing capability for biophysical and symptom monitoring for more common chronic conditions. Technology interventions have the potential to improve access and outcomes but will not be successful without the input of users. PMID:27504199

Shared decision making in the United States: policy and implementation activity on multiple fronts.

PubMed

Frosch, Dominick L; Moulton, Benjamin W; Wexler, Richard M; Holmes-Rovner, Margaret; Volk, Robert J; Levin, Carrie A

2011-01-01

Shared decision making in the United States has become an important element in health policy debates. The recently passed federal health care reform legislation includes several key provisions related to shared decision making (SDM) and patient decision support. Several states have passed or are considering legislation that incorporates SDM as a key component of improved health care provision. Research on SDM is funded by a range of public and private organizations. Non-profit, for-profit, academic and government organizations are developing decision support interventions for numerous conditions. Some interventions are publicly available; others are distributed to patients through health insurance and healthcare providers. A significant number of clinical implementation projects are underway to test and evaluate different ways of incorporating SDM and patient decision support into routine clinical care. Numerous professional organizations are advocating for SDM and social networking efforts are increasing their advocacy as well. Policy makers are intrigued by the potential of SDM to improve health care provision and potentially lower costs. The role of shared decision making in policy and practice will be part of the larger health care reform debate. 2011. Published by Elsevier GmbH.

"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.

Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis.

PubMed

Hall, Daniel L; Luberto, Christina M; Philpotts, Lisa L; Song, Rhayun; Park, Elyse R; Yeh, Gloria Y

2018-05-10

Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined mind-body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR. Six electronic databases were systematically searched from inception to May 2017, using a strategy that included multiple terms for RCTs, cancer, mind-body medicine, and FCR. Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes on self-report measures of FCR were computed by using random-effects models. Nineteen RCTs (pooled N = 2806) were included. Most studies (53%) were published since 2015 and targeted a single cancer type (84%; mostly breast). Intervention sessions (median = 6, mode = 4) tended to last 120 minutes and occur across 1.5 months. Delivery was predominantly in-person (63%) to either groups (42%) or individuals (42%). Most interventions incorporated multiple mind-body components (53%), commonly cognitive-behavioral skills (58%), or meditative practices (53%). Small-to-medium pooled effect sizes were observed postintervention (Hedges' g = -0.36, 95% CI = -0.49, -0.23, P < .001) and at follow-up assessments (median = 8 months, P < .001). Potential modifiers (control group design, group/individual delivery, use of cognitive-behavioral or mindfulness skills, number of mind-body components, cancer treatment status, and number of sessions) did not reach statistical significance. Mind-body interventions are efficacious for reducing FCR, with small-to-medium effect sizes that persist after intervention delivery ends. Recommendations include testing effects among survivors of various cancers and exploring the optimal integration of mind-body practices for managing fundamental uncertainties and fears during cancer survivorship. Copyright © 2018 John Wiley & Sons, Ltd.

A Systematic Review of Interventions to Enhance Healthy Lifestyle Behaviors in Adolescents Delivered via Mobile Phone Text Messaging.

PubMed

Loescher, Lois J; Rains, Stephen A; Kramer, Sandra S; Akers, Chelsie; Moussa, Renee

2018-05-01

To systematically review healthy lifestyle interventions targeted to adolescents and delivered using text messaging (TM). PubMed, Embase, CINAHL, PsycINFO, and Web of Science databases. Study Inclusion Criteria: Research articles published during 2011 to 2014; analyses focused on intervention targeting adolescents (10-19 years), with healthy lifestyle behaviors as main variables, delivered via mobile phone-based TM. The authors extracted data from 27 of 281 articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Adolescent and setting characteristics, study design and rigor, intervention effectiveness, challenges, and risk of bias. Across studies, 16 (59.3%) of 27 included non-Caucasians. The gender was split for 22 (81.5%) of 27 studies. Thirteen studies were randomized controlled trials. There was heterogeneity among targeted conditions, rigor of methods, and intervention effects. Interventions for monitoring/adherence (n = 8) reported more positive results than those for health behavior change (n = 19). Studies that only included message delivered via TM (n = 14) reported more positive effects than studies integrating multiple intervention components. Interventions delivered using TM presented minimal challenges, but selection and performance bias were observed across studies. Interventions delivered using TM have the potential, under certain conditions, to improve healthy lifestyle behaviors in adolescents. However, the rigor of studies varies, and established theory and validated measures have been inconsistently incorporated.

Treatment Planning and Image Guidance for Radiofrequency Ablations of Large Tumors

PubMed Central

Ren, Hongliang; Campos-Nanez, Enrique; Yaniv, Ziv; Banovac, Filip; Abeledo, Hernan; Hata, Nobuhiko; Cleary, Kevin

2014-01-01

This article addresses the two key challenges in computer-assisted percutaneous tumor ablation: planning multiple overlapping ablations for large tumors while avoiding critical structures, and executing the prescribed plan. Towards semi-automatic treatment planning for image-guided surgical interventions, we develop a systematic approach to the needle-based ablation placement task, ranging from pre-operative planning algorithms to an intra-operative execution platform. The planning system incorporates clinical constraints on ablations and trajectories using a multiple objective optimization formulation, which consists of optimal path selection and ablation coverage optimization based on integer programming. The system implementation is presented and validated in phantom studies and on an animal model. The presented system can potentially be further extended for other ablation techniques such as cryotherapy. PMID:24235279

CHILE: An Evidence-Based Preschool Intervention for Obesity Prevention in Head Start

PubMed Central

Sanders, Sarah G.; FitzGerald, Courtney A.; Keane, Patricia C.; Canaca, Glenda F.; Volker-Rector, Renee

2012-01-01

BACKGROUND Obesity is a major concern among American Indians and Hispanics. The Child Health Initiative for Lifelong Eating and Exercise (CHILE) is an evidence-based intervention to prevent obesity in children enrolled in 16 Head Start (HS) Centers in rural communities. The design and implementation of CHILE are described. METHODS CHILE uses a socio-ecological approach to improve dietary intake and increase physical activity. The intervention includes: a classroom curriculum; teacher and food service training; family engagement; grocery store participation; and health care provider support. RESULTS Lessons learned from CHILE include: the need to consider availability of recommended foods; the necessity of multiple training sessions for teachers and food service; the need to tailor the family events to local needs; consideration of the profit needs of grocery stores; and sensitivity to the time constraints of health care providers. CONCLUSIONS HS can play an important role in preventing obesity in children. CHILE is an example of a feasible intervention that addresses nutrition and physical activity for preschool children that can be incorporated into HS curricula and aligns with HS national performance standards. PMID:23343323

The Impact of a Student-Led Pedometer Intervention Incorporating Cognitive-Behavioral Strategies on Step Count and Self-Efficacy

ERIC Educational Resources Information Center

Raedeke, Thomas D.; Focht, Brian C.; King, Jenna S.

2010-01-01

This study evaluated the effectiveness of a student-led physical activity intervention that incorporated pedometers and cognitive-behavioral strategies. Undergraduate students (N = 117) enrolled in upper division exercise and sport science courses recruited participants. Participants in the cognitive-behavioral intervention condition received…

Housing and Child Welfare: Emerging Evidence and Implications for Scaling up Services

PubMed Central

Farrell, Anne F.; Marcal, Katherine E.; Chung, Saras; Hovmand, Peter S.

2018-01-01

Inadequate housing threatens family stability in communities across the United States. This study reviews emerging evidence on housing interventions in the context of scale-up for the child welfare system. In child welfare, scale-up refers to the extent to which fully implemented interventions sustainably alleviate family separations associated with housing instability. It incorporates multiple aspects beyond traditional measures of effectiveness including costs, potential reach, local capacities for implementation, and fit within broader social services. The framework further encompasses everyday circumstances faced by service providers, program administrators, and policymakers who allocate resources under conditions of scarcity and uncertainty. The review of current housing interventions reveals a number of systemic constraints for scale-up in child welfare. Reliance on rental assistance programs limits capacity to address demand, while current practices that target the most vulnerable families may inadvertently diminish effectiveness of the intervention and increase overall demand. Alternative approaches that focus on homelessness prevention and early intervention must be tested in conjunction with community initiatives to increase accessibility of affordable housing. By examining system performance over time, the scalability framework provides an opportunity for more efficient coordination of housing services within and outside of the child welfare system. PMID:28815623

Patient-Centered Appointment Scheduling Using Agent-Based Simulation

PubMed Central

Turkcan, Ayten; Toscos, Tammy; Doebbeling, Brad N.

2014-01-01

Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling. PMID:25954423

Storytelling in Community Intervention Research: Lessons Learned From the Walk Your Heart to Health Intervention

PubMed Central

LeBron, Alana M. W.; Schulz, Amy J.; Bernal, Cristina; Gamboa, Cindy; Wright, Conja; Sand, Sharon; Valerio, Melissa; Caver, Deanna

2015-01-01

Background Contextually and culturally congruent interventions are urgently needed to reduce racial, ethnic, and socio economic inequities in physical activity and cardiovascular disease. Objectives To examine a community-based participatory research (CBPR) process that incorporated storytelling into a physical activity intervention, and consider implications for reducing health inequities. Methods We used a CBPR process to incorporate storytelling in an existing walking group intervention. Stories conveyed social support and problem-solving intervention themes designed to maintain increases in physical activity over time, and were adapted to the walking group context, group dynamics, challenges, and traditions. Lessons Learned After describing of the CBPR process used to adapt stories to walking group sites, we discuss challenges and lessons learned regarding the adaptation and implementation of stories to convey key intervention themes. Conclusions A CBPR approach to incorporating storytelling to convey intervention themes offers an innovative and flexible strategy to promote health toward the elimination of health inequities. PMID:25727980

"Who has ever loved a drug addict? It's a lie. They think a 'teja' is as bad person": multiple stigmas faced by women who inject drugs in coastal Kenya.

PubMed

Mburu, Gitau; Ayon, Sylvia; Tsai, Alexander C; Ndimbii, James; Wang, Bangyuan; Strathdee, Steffanie; Seeley, Janet

2018-05-25

A tenth of all people who inject drugs in Kenya are women, yet their social contexts and experiences remain poorly understood. This paper reports how multiple forms of stigma are experienced by women who inject drugs in coastal Kenya and the impact that they have on their ability to access essential health services. In 2015, in-depth interviews and focus group discussions were held with 45 women who inject drugs in two coastal towns. These data were supplemented with in-depth interviews with five individual stakeholders involved in service provision to this population. Data were analyzed thematically using NVivo. Women who inject drugs experience multiple stigmas, often simultaneously. These included the external stigma and self-stigma of injection drug use, external gender-related stigma of being a female injecting drug user, and the external stigma of being HIV positive (i.e., among those living with HIV). Stigma led to rejection, social exclusion, low self-esteem, and delay or denial of services at health facilities. HIV and harm reduction programs should incorporate interventions that address different forms of stigma among women who inject drugs in coastal Kenya. Addressing stigma will require a combination of individual, social, and structural interventions, such as collective empowerment of injecting drug users, training of healthcare providers on issues and needs of women who inject drugs, peer accompaniment to health facilities, addressing wider social determinants of stigma and discrimination, and expansion of harm reduction interventions to change perceptions of communities towards women who inject drugs.

Clinical and Vitamin Response to a Short-Term Multi-Micronutrient Intervention in Brazilian Children and Teens: From Population Data to Interindividual Responses.

PubMed

Mathias, Mariana Giaretta; Coelho-Landell, Carolina de Almeida; Scott-Boyer, Marie-Pier; Lacroix, Sébastien; Morine, Melissa J; Salomão, Roberta Garcia; Toffano, Roseli Borges Donegá; Almada, Maria Olímpia Ribeiro do Vale; Camarneiro, Joyce Moraes; Hillesheim, Elaine; de Barros, Tamiris Trevisan; Camelo-Junior, José Simon; Campos Giménez, Esther; Redeuil, Karine; Goyon, Alexandre; Bertschy, Emmanuelle; Lévêques, Antoine; Oberson, Jean-Marie; Giménez, Catherine; Carayol, Jerome; Kussmann, Martin; Descombes, Patrick; Métairon, Slyviane; Draper, Colleen Fogarty; Conus, Nelly; Mottaz, Sara Colombo; Corsini, Giovanna Zambianchi; Myoshi, Stephanie Kazu Brandão; Muniz, Mariana Mendes; Hernandes, Lívia Cristina; Venâncio, Vinícius Paula; Antunes, Lusania Maria Greggi; da Silva, Rosana Queiroz; Laurito, Taís Fontellas; Rossi, Isabela Ribeiro; Ricci, Raquel; Jorge, Jéssica Ré; Fagá, Mayara Leite; Quinhoneiro, Driele Cristina Gomes; Reche, Mariana Chinarelli; Silva, Paula Vitória Sozza; Falquetti, Letícia Lima; da Cunha, Thaís Helena Alves; Deminice, Thalia Manfrin Martins; Tambellini, Tâmara Hambúrguer; de Souza, Gabriela Cristina Arces; de Oliveira, Mariana Moraes; Nogueira-Pileggi, Vicky; Matsumoto, Marina Takemoto; Priami, Corrado; Kaput, Jim; Monteiro, Jacqueline Pontes

2018-03-01

Micronutrients are in small amounts in foods, act in concert, and require variable amounts of time to see changes in health and risk for disease. These first principles are incorporated into an intervention study designed to develop new experimental strategies for setting target recommendations for food bioactives for populations and individuals. A 6-week multivitamin/mineral intervention is conducted in 9-13 year olds. Participants (136) are (i) their own control (n-of-1); (ii) monitored for compliance; (iii) measured for 36 circulating vitamin forms, 30 clinical, anthropometric, and food intake parameters at baseline, post intervention, and following a 6-week washout; and (iv) had their ancestry accounted for as modifier of vitamin baseline or response. The same intervention is repeated the following year (135 participants). Most vitamins respond positively and many clinical parameters change in directions consistent with improved metabolic health to the intervention. Baseline levels of any metabolite predict its own response to the intervention. Elastic net penalized regression models are identified, and significantly predict response to intervention on the basis of multiple vitamin/clinical baseline measures. The study design, computational methods, and results are a step toward developing recommendations for optimizing vitamin levels and health parameters for individuals. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Integrating technology into complex intervention trial processes: a case study.

PubMed

Drew, Cheney J G; Poile, Vincent; Trubey, Rob; Watson, Gareth; Kelson, Mark; Townson, Julia; Rosser, Anne; Hood, Kerenza; Quinn, Lori; Busse, Monica

2016-11-17

Trials of complex interventions are associated with high costs and burdens in terms of paperwork, management, data collection, validation, and intervention fidelity assessment occurring across multiple sites. Traditional data collection methods rely on paper-based forms, where processing can be time-consuming and error rates high. Electronic source data collection can potentially address many of these inefficiencies, but has not routinely been used in complex intervention trials. Here we present the use of an on-line system for managing all aspects of data handling and for the monitoring of trial processes in a multicentre trial of a complex intervention. We custom built a web-accessible software application for the delivery of ENGAGE-HD, a multicentre trial of a complex physical therapy intervention. The software incorporated functionality for participant randomisation, data collection and assessment of intervention fidelity. It was accessible to multiple users with differing levels of access depending on required usage or to maintain blinding. Each site was supplied with a 4G-enabled iPad for accessing the system. The impact of this system was quantified through review of data quality and collation of feedback from site coordinators and assessors through structured process interviews. The custom-built system was an efficient tool for collecting data and managing trial processes. Although the set-up time required was significant, using the system resulted in an overall data completion rate of 98.5% with a data query rate of 0.1%, the majority of which were resolved in under a week. Feedback from research staff indicated that the system was highly acceptable for use in a research environment. This was a reflection of the portability and accessibility of the system when using the iPad and its usefulness in aiding accurate data collection, intervention fidelity and general administration. A combination of commercially available hardware and a bespoke online database designed to support data collection, intervention fidelity and trial progress provides a viable option for streamlining trial processes in a multicentre complex intervention trial. There is scope to further extend the system to cater for larger trials and add further functionality such as automatic reporting facilities and participant management support. ISRCTN65378754 , registered on 13 March 2014.

Methods Used in Economic Evaluations of Testing and Diagnosis for Ovarian Cancer: A Systematic Review.

PubMed

Sharma, Vishal; Sundar, Sudha S; Breheny, Katie; Monahan, Mark; Sutton, Andrew John

2016-06-01

There are multiple tests available that can help diagnose ovarian cancer, and the cost-effective analysis of these diagnostic interventions is essential for making well-informed decisions regarding resource allocation. There are multiple factors that can impact on the conclusions drawn from economic evaluations including test accuracy, the impact of the testing pathway on patient costs and outcomes, and delays along the ovarian cancer test-treat pathway. The objective of this study was to evaluate how test accuracy, the choice of perspective, and delays along the testing and diagnostic pathway have been incorporated in economic evaluations of testing for ovarian cancer. A systematic review of published literature was undertaken to identify economic evaluations (eg, cost-effectiveness, cost-utility analysis) focused on testing and diagnosis for ovarian cancer. Seven studies met the inclusion criteria. Six studies incorporated test accuracy and its impact on patients to some extent. Four studies adopted a societal perspective, but only one considered the costs incurred by patients on the testing and diagnosis pathway. Where delays on the testing pathway were incorporated into the analysis, these were frequently due to false-negative test results leading to delays in patients accessing treatment. Any anxiety that patients might experience as a result of a positive test was not considered in these studies. The impact on patients of receiving a positive test in terms of anxiety and the costs incurred by patients having to attend for testing and diagnosis are rarely considered. Delays along the testing and diagnosis pathway can have a major effect on patient outcomes, and it is important that these are acknowledged in economic evaluations focused on testing. Future economic analysis should incorporate these key determinants in order that diagnostic tests for ovarian cancer can be robustly evaluated.

eHealth Familias Unidas: Pilot Study of an Internet Adaptation of an Evidence-Based Family Intervention to Reduce Drug Use and Sexual Risk Behaviors Among Hispanic Adolescents

PubMed Central

Estrada, Yannine; Molleda, Lourdes; Murray, Ashley; Drumhiller, Kathryn; Tapia, Maria; Sardinas, Krystal; Rosen, Alexa; Pantin, Hilda; Perrino, Tatiana; Sutton, Madeline; Cano, Miguel Ángel; Dorcius, Daphney; Wendorf Muhamad, Jessica; Prado, Guillermo

2017-01-01

This paper describes the Internet adaptation of an evidenced-based intervention for Hispanic families, eHealth Familias Unidas, and explores whether an Internet-based format is feasible and acceptable to Hispanic families. Core intervention components from the evidence-based intervention, Familias Unidas, were transposed into a video format and edited for content. Additionally, interactive exercises and a soap opera series were incorporated to reinforce intervention content and optimize participant engagement and retention. To understand the feasibility and acceptability of eHealth Familias Unidas, we conducted a pilot study and examined findings from: (1) session completion rates for both e-parent group sessions and family sessions (n = 23 families); and (2) qualitative data collected from Hispanic parents (n = 29) that received the eHealth intervention. Engagement and attendance in the intervention showed that 83% of families engaged in the intervention and that there was an overall session completion rate of 78%. Qualitative interviews were conducted mid and post intervention with a combined total of 29 participants. A general inductive approach was used to derive themes from the collected data. Overall, parents expressed positive feedback in regards to the intervention and stated that there were multiple lessons learned from participating in eHealth Familias Unidas. Findings indicate that an Internet-based family intervention is not only feasible and acceptable for Hispanic families, but also offers a viable option to ameliorate barriers to participation and implementation of preventive interventions. PMID:28273862

Incorporating science and engineering practices into preservice secondary science teachers' planning practices: Testing the efficacy of an intervention

NASA Astrophysics Data System (ADS)

Wargo, Brian M.

The New Standards Framework (NRC, 2012) explicitly calls for teachers to engage students in science and engineering practices (SEPs) as they develop knowledge of scientific phenomena and canonical disciplinary ideas. This study analyzed six pre-service secondary science teachers' (PSSSTs') incorporation of SEPs into their planning practices before, during, and after an instructional intervention. The intervention, which was nested into an instructional methods course, supported the PSSSTs by representing the practices they were to engage their own students with. The PSSSTs were then able to decompose and approximate those scientific practices in their lesson planning, thereby developing pedagogical design capacity (PDC). The PSSSTs were interviewed to determine what affordances and constraints they felt when planning for incorporating SEPs into their lesson planning. Analysis of the lesson plans showed that 50% of the PSSSTs incorporated SEPs into their lesson plans when only provided a written description of the SEPs and prompted to do so. During the instructional intervention, 83% of the PSSSTs incorporated SEPs into their lesson plans. After the instructional intervention, the PSSSTs were no longer required to incorporate SEPs into their lesson planning nor were they required to hand in lesson plans for a grade. Instead, they wrote lesson plans for their cooperating teachers and for their own use. Surprisingly, the PSSSTs not only continued to incorporate SEPs into their lessons, but did so more completely by incorporating a diversity of sub-SEPs and more of them in their lessons. This is significant because this may indicate that the instructional intervention has longevity. Interview data suggests that PSSSTs experience both internal and external affordances and constrains when attempting to incorporate SEPs into their lesson planning. Three categories of issues (epistemic, logistical, and curricular) emerged in the results and influence how teachers interact with the SEPs as they plan lessons. This study reiterates the need for teacher educators to engage in instruction that represents aspects of scientific practice, allows for its decomposition, and engages pre-service teachers in approximating those practices.

The motivation, skills, and decision-making model of "drug abuse" prevention.

PubMed

Sussman, Steve; Earleywine, Mitchell; Wills, Thomas; Cody, Christine; Biglan, Tony; Dent, Clyde W; Newcomb, Michael D

2004-01-01

This article summarizes the theoretical basis for targeted prevention programs as they apply to different high-risk groups. We explain the advantages and disadvantages of different definitions of risk and discuss strategies for preventing drug use related problems in high-risk youth. Productive prevention programs for many at-risk groups share similar components, including those that address motivation, skills, and decision making. We present key aspects of these three components and link them to theories in clinical psychology, social psychology, sociology, and chemical dependence treatment. Among a total of 29 promising targeted prevention programs, we describe examples of empirically evaluated, intensive interventions that have made a positive impact on the attitudes and behavior of multiple problem youth. Incorporating the perspectives of multiple disciplines appears essential for progress in drug abuse and other problem behavior prevention.

Quality of life among people with multiple sclerosis: Replication of a three-factor prediction model.

PubMed

Bishop, Malachy; Rumrill, Phillip D; Roessler, Richard T

2015-01-01

This article presents a replication of Rumrill, Roessler, and Fitzgerald's 2004 analysis of a three-factor model of the impact of multiple sclerosis (MS) on quality of life (QOL). The three factors in the original model included illness-related, employment-related, and psychosocial adjustment factors. To test hypothesized relationships between QOL and illness-related, employment-related, and psychosocial variables using data from a survey of the employment concerns of Americans with MS (N = 1,839). An ex post facto, multiple correlational design was employed incorporating correlational and multiple regression analyses. QOL was positively related to educational level, employment status, job satisfaction, and job-match, and negatively related to number of symptoms, severity of symptoms, and perceived stress level. The three-factor model explained approximately 37 percent of the variance in QOL scores. The results of this replication confirm the continuing value of the three-factor model for predicting the QOL of adults with MS, and demonstrate the importance of medical, mental health, and vocational rehabilitation interventions and services in promoting QOL.

More than just tracking time: Complex measures of user engagement with an internet-based health promotion intervention.

PubMed

Baltierra, Nina B; Muessig, Kathryn E; Pike, Emily C; LeGrand, Sara; Bull, Sheana S; Hightow-Weidman, Lisa B

2016-02-01

There has been a rise in internet-based health interventions without a concomitant focus on new methods to measure user engagement and its effect on outcomes. We describe current user tracking methods for internet-based health interventions and offer suggestions for improvement based on the design and pilot testing of healthMpowerment.org (HMP). HMP is a multi-component online intervention for young Black men and transgender women who have sex with men (YBMSM/TW) to reduce risky sexual behaviors, promote healthy living and build social support. The intervention is non-directive, incorporates interactive features, and utilizes a point-based reward system. Fifteen YBMSM/TW (age 20-30) participated in a one-month pilot study to test the usability and efficacy of HMP. Engagement with the intervention was tracked using a customized data capture system and validated with Google Analytics. Usage was measured in time spent (total and across sections) and points earned. Average total time spent on HMP was five hours per person (range 0-13). Total time spent was correlated with total points earned and overall site satisfaction. Measuring engagement in internet-based interventions is crucial to determining efficacy. Multiple methods of tracking helped derive more comprehensive user profiles. Results highlighted the limitations of measures to capture user activity and the elusiveness of the concept of engagement. Copyright © 2016 Elsevier Inc. All rights reserved.

Everyday memory strategies for medication adherence.

PubMed

Boron, Julie Blaskewicz; Rogers, Wendy A; Fisk, Arthur D

2013-01-01

The need to manage chronic diseases and multiple medications increases for many older adults. Older adults are aware of memory declines and incorporate compensatory techniques. Everyday memory strategies used to support medication adherence were investigated. A survey distributed to 2000 households in the Atlanta metropolitan area yielded a 19.9% response rate including 354 older adults, aged 60-80 years. Older adults reported forgetting to take their medications, more so as their activity deviated from normal routines, such as unexpected activities. The majority of older adults endorsed at least two compensatory strategies, which they perceived to be more helpful in normal routines. Compensatory strategies were associated with higher education, more medications, having concern, and self-efficacy to take medications. As memory changes, older adults rely on multiple cues, and perceive reliance on multiple cues to be helpful. These data have implications for the design and successful implementation of medication reminder systems and interventions. Copyright © 2013 Mosby, Inc. All rights reserved.

[Patient-centred prescription model to improve adequate prescription and therapeutic adherence in patients with multiple disorders].

PubMed

Espaulella-Panicot, Joan; Molist-Brunet, Núria; Sevilla-Sánchez, Daniel; González-Bueno, Javier; Amblàs-Novellas, Jordi; Solà-Bonada, Núria; Codina-Jané, Carles

Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making. The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role. There has recently been a significant increase in knowledge in the area of adequacy of prescription and adherence. In this context, we must find a model must be found that incorporates this knowledge into clinical practice by the professionals. Person-centred prescription is a medication review model that includes different strategies in a single intervention. It is performed by a multidisciplinary team, and allows them to adapt the pharmacological plan of patients with clinical complexity. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

Heterogeneity in multiple transmission pathways: modelling the spread of cholera and other waterborne disease in networks with a common water source.

PubMed

Robertson, Suzanne L; Eisenberg, Marisa C; Tien, Joseph H

2013-01-01

Many factors influencing disease transmission vary throughout and across populations. For diseases spread through multiple transmission pathways, sources of variation may affect each transmission pathway differently. In this paper we consider a disease that can be spread via direct and indirect transmission, such as the waterborne disease cholera. Specifically, we consider a system of multiple patches with direct transmission occurring entirely within patch and indirect transmission via a single shared water source. We investigate the effect of heterogeneity in dual transmission pathways on the spread of the disease. We first present a 2-patch model for which we examine the effect of variation in each pathway separately and propose a measure of heterogeneity that incorporates both transmission mechanisms and is predictive of R(0). We also explore how heterogeneity affects the final outbreak size and the efficacy of intervention measures. We conclude by extending several results to a more general n-patch setting.

Improving the appropriateness of antimicrobial use in primary care after implementation of a local antimicrobial guide in both levels of care.

PubMed

Fernández Urrusuno, Rocío; Flores Dorado, Macarena; Vilches Arenas, Angel; Serrano Martino, Carmen; Corral Baena, Susana; Montero Balosa, Ma Carmen

2014-08-01

This study aims to assess the effectiveness of multiple interventions carried out during the implementation of a guide, on the improvement of the appropriateness of antimicrobial prescribing in primary care. This is a cross-sectional before/after study carried out in Aljarafe Health Care Area (Andalusia, Spain), with a population of 368,728 inhabitants assisted in 37 health centers. Subjects include patients with antibiotic prescriptions during 2009 (pre-intervention phase) or 2012 (postintervention phase) selected by simple random sampling (confidence level, 95%; accuracy, 5%), with infections registered in the electronic clinical history. This study involve training sessions in primary care centers and hospital services, incorporation of the electronic guide to the Health Care Service Websites, and incorporation of the guide to the Digital Health History as a tool to support decision making. Difference on appropriate antibiotic prescribing before and after interventions resulted from the study. Other variables also include age, gender, type of pharmacy, antibiotic prescribed, number of treatments per year, infection site, and main comorbidities In addition, this study uses computerized pharmacy records of reimbursed and dispensed drugs and electronic medical histories. The percentage of appropriate antibiotic prescribing increased from 36% in 2009 to 57% in 2012 (p < 0.001) is shown. The improvement was observed in all age patients of any sex and was higher among working-age patients and patients with comorbidities. The best results were observed in the group of beta-lactams and in the treatment of respiratory and skin infections. The realization of multifactorial interventions involving professionals from both levels of care could be an effective strategy to improve the use of antimicrobials in primary care.

Prevention of bile duct injury: the case for incorporating educational theories of expertise.

PubMed

McKinley, Sophia K; Brunt, L Michael; Schwaitzberg, Steven D

2014-12-01

Over 700,000 laparoscopic cholecystectomies are performed yearly in the US. Despite multiple advantages of laparoscopic surgery, the increased rate of bile duct injury (BDI) compared to the traditional, open approach to cholecystectomy remains problematic. Due to the seriousness of bile duct injury, the time has come for an aggressive educational campaign to better train laparoscopic surgeons in order to reduce the incidence of this life-threatening and expensive complication. We performed a literature review of what is currently known about the causes of bile duct injury during laparoscopic cholecystectomy. Based on these reviews, we identified educational theories of expertise that may be relevant in understanding variable rates of BDI between surgeons. Finally, we applied educational theories of expertise to the problem of BDI in laparoscopic cholecystectomy to propose how to develop and design an effective educational approach for the prevention of BDI. Multiple studies demonstrate that the primary causes of BDI during laparoscopic cholecystectomy are non-technical. Additionally, there exists a learning curve in which the rates of BDI are higher in a surgeon's earlier cases compared to later cases and that some surgeons perform laparoscopic cholecystectomy with significantly fewer injuries than others. Educational theories indicate that interventions that optimize novice to expert development require (1) revealing expert knowledge to novices and (2) scaffolding the mental habits of expert-like learners. BDI is an appropriate target for the application of educational theories of expertise. Designing better educational interventions for the prevention of BDI will require uncovering the hidden knowledge of expert surgeons and incorporating the processes of reinvestment and progressive problem solving that are inherent to expert performance.

The Challenge of Multiple Perspectives: Multiple Solution Tasks for Students Incorporating Diverse Tools and Representation Systems

ERIC Educational Resources Information Center

Kordaki, Maria

2015-01-01

This study focuses on the role of multiple solution tasks (MST) incorporating multiple learning tools and representation systems (MTRS) in encouraging each student to develop multiple perspectives on the learning concepts under study and creativity of thought. Specifically, two types of MST were used, namely tasks that allowed and demanded…

Psychosomatic Medicine for Non-Psychiatric Residents: Video Education and Incorporation of Technology.

PubMed

Saunders, J; Gopalan, P; Puri, N; Azzam, P N; Zhou, L; Ghinassi, F; Jain, A; Travis, M; Ryan, N D

2015-12-01

Psychiatric education for non-psychiatric residents varies between training programs, and may affect resident comfort with psychiatric topics. This study's goals were to identify non-psychiatric residents' comfort with psychiatric topics and to test the effectiveness of a video intervention. Residents in various departments were given a survey. They were asked to rank their comfort level with multiple psychiatric topics, answer questions about medical decision making capacity (MDMC), watch a 15-min video about MDMC, and answer a post-test section. In total, 91 Internal Medicine, General Surgery, and Obstetrics and Gynecology residents responded to the study. Of the 91 residents, 55 completed the pre- and post-test assessments. There was no significant difference in correct responses. Residents' comfort levels were assessed, and a significant improvement in comfort level with MDMC was found. This study highlights potential opportunities for psychiatric education, and suggests brief video interventions can increase resident physicians' comfort with a psychiatric topic.

Role of Sonographic Imaging in Occupational Therapy Practice

PubMed Central

2015-01-01

Occupational therapy practice is grounded in the delivery of occupation-centered, patient-driven treatments that engage clients in the process of doing to improve health. As emerging technologies, such as medical imaging, find their way into rehabilitation practice, it is imperative that occupational therapy practitioners assess whether and how these tools can be incorporated into treatment regimens that are dually responsive to the medical model of health care and to the profession’s foundation in occupation. Most medical imaging modalities have a discrete place in occupation-based intervention as outcome measures or for patient education; however, sonographic imaging has the potential to blend multiple occupational therapy practice forms to document treatment outcomes, inform clinical reasoning, and facilitate improved functional performance when used as an accessory tool in direct intervention. Use of medical imaging is discussed as it relates to occupational foundations and the professional role within the context of providing efficient, effective patient-centered rehabilitative care. PMID:25871607

The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk?

PubMed Central

Segev-Jacubovski, Orit; Herman, Talia; Yogev-Seligmann, Galit; Mirelman, Anat; Giladi, Nir; Hausdorff, Jeffrey M

2011-01-01

In this article, we briefly summarize the incidence and significant consequences of falls among older adults, the insufficient effectiveness of commonly used multifactorial interventions and the evidence linking falls and cognitive function. Recent pharmacologic and nonpharmacologic studies that evaluated the effects of cognitive therapy on fall risk are reviewed. The results of this article illustrate the potential utility of multiple, diverse forms of cognitive therapy for reducing fall risk. The article also indicates that large-scale, randomized controlled trials are warranted and that additional research is needed to better understand the pathophysiologic mechanisms underlying the interplay between human mobility, fall risk and cognitive function. Nonetheless, we suggest that multimodality interventions that combine motor and cognitive therapy should, eventually, be incorporated into clinical practice to enable older adults and patients to move safer and with a reduced fall risk. PMID:21721921

The second Chicago televised smoking cessation program: a 24-month follow-up.

PubMed Central

Warnecke, R B; Langenberg, P; Wong, S C; Flay, B R; Cook, T D

1992-01-01

OBJECTIVES. As smoking decreases in the population, the remaining smoking population will change, and cessation initiatives will have to incorporate strategies designed for these smokers. METHODS. To study patterns of response to a cessation intervention composed of 20 televised segments and the American Lung Association Freedom from Smoking in 20 Days manual, this study compared cessation rates over 24 months in a cohort of smokers who registered for a cessation program with those in a cohort selected from the smoking population at large. RESULTS. At post intervention, multiple point prevalence of cessation among participants, adjusted for baseline smoking, was 14% among registrants and 6% in the population; at 24 months the adjusted rates were 6% and 2%, respectively. Heavy smokers benefited more than light smokers, and there was a consistent dose-response relationship between extent of exposure to the intervention and cessation. CONCLUSION. The effects of the intervention were strongest for those who read the manual and watched the programs daily. Manual use was important, and those who did not read it did not appear to benefit. Compared to the population and given full participation, heavy smokers benefited more than lighter smokers. PMID:1585964

Examining the Unique Influence of Interpersonal and Intrapersonal Drinking Perceptions on Alcohol Consumption Among College Students*

PubMed Central

Mallett, Kimberly A.; Bachrach, Rachel L.; Turrisi, Rob

2009-01-01

Objective: Interventions for college student drinking often incorporate interpersonal factors such as descriptive and/or injunctive norms to correct misperceptions about campus drinking (e.g., BASICS [Brief Alcohol Screening and Intervention for College Students] and social-norms campaigns). Some interventions also focus on intra-personal factors of alcohol consumption, which can be considered as one's own perception of drinking, one's attitude toward drinking, and one's intended outcome related to drinking. The current study sought to extend previous work by examining relationships between both inter- and intrapersonal perceptions of drinking and reported drinking behavior. Method: College students (N = 303) completed questionnaires assessing drinking behaviors, perceptions of other students' attitudes toward drinking (i.e., injunctive norms), their perception of the quantity and frequency of student/friend drinking (i.e., descriptive norms), and their attitudes and perceptions toward their own alcohol consumption (i.e., intrapersonal factors). Results: Multiple regressions were used to analyze the unique influence between inter- and intrapersonal drinking perceptions and drinking behavior. Conclusions: Among the interpersonal perceptions of drinking, only closest friend's drinking significantly predicted alcohol consumption, whereas all three intrapersonal factors significantly predicted alcohol consumption. Suggestions for enhancing college student drinking interventions are discussed. PMID:19261229

Toward a Developmentally-Informed Approach to Parenting Interventions: Seeking Hidden Effects

PubMed Central

Brock, Rebecca L.; Kochanska, Grazyna

2015-01-01

Drawing from developmental psychology and psychopathology, we propose a new, developmentally-informed approach to parenting interventions that focuses on elucidating changes in the unfolding developmental process between the parent and child. We present data from 186 low-income mothers of toddlers, randomly assigned to Child-Oriented Play group or Play-as-Usual group. We examined the maladaptive cascade from child difficulty to mother adversarial, negative parenting to child maladjustment, well documented in the literature. The measures incorporated multiple observations and reports. As expected, the sequence from child difficulty (Pretest) to mother adversarial, negative parenting (Posttest 1, after 3-month intervention) to child maladjustment (Posttest 2, 6 months later) was present in Play-as-Usual group, but absent, or defused, in Child-Oriented Play group. The findings are consistent with a view of intervention presumably enhancing the mother-child relationship, which in turn served to moderate future mother-child dynamics, altering its otherwise anticipated negative trajectory. A closer examination of the cascade revealed that, at Posttest 1, mothers in Play-as-Usual group engaged in more adversarial, negative parenting (controlling for Pretest) than mothers in Child-Oriented Play group when their children were of high difficulty. The intervention appears to exert its primary influence on the cascade by weakening the link between child difficulty and maternal adversarial, negative parenting. PMID:27063895

Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings

PubMed Central

Crowe, Sonya; Brown, Katherine; Tregay, Jenifer; Wray, Jo; Knowles, Rachel; Ridout, Deborah A; Bull, Catherine; Utley, Martin

2017-01-01

Background Improving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors. Methods Soft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources. Results A ‘Rich Picture’ was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning. Conclusions When tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further consideration. PMID:28062603

Implementing a Culturally and Linguistically Responsive Phonics Curriculum That Incorporates Music to Meet the Needs of English Language Learners in the Response to Intervention Process

ERIC Educational Resources Information Center

Miller, Danielle Denise

2013-01-01

The purpose of this study is to investigate the effect of the Sing, Spell, Read, Write (SSRW) phonics curriculum that uses explicit and systematic methods and incorporates music to teach literacy skills implemented as a tier-two reading intervention in the Response to Intervention process to meet the cultural and linguistic needs of English…

Integrating Decision Making and Mental Health Interventions Research: Research Directions

PubMed Central

Wills, Celia E.; Holmes-Rovner, Margaret

2006-01-01

The importance of incorporating patient and provider decision-making processes is in the forefront of the National Institute of Mental Health (NIMH) agenda for improving mental health interventions and services. Key concepts in patient decision making are highlighted within a simplified model of patient decision making that links patient-level/“micro” variables to services-level/“macro” variables via the decision-making process that is a target for interventions. The prospective agenda for incorporating decision-making concepts in mental health research includes (a) improved measures for characterizing decision-making processes that are matched to study populations, complexity, and types of decision making; (b) testing decision aids in effectiveness research for diverse populations and clinical settings; and (c) improving the understanding and incorporation of preference concepts in enhanced intervention designs. PMID:16724158

Financing structural interventions: going beyond HIV-only value for money assessments.

PubMed

Remme, Michelle; Vassall, Anna; Lutz, Brian; Luna, Jorge; Watts, Charlotte

2014-01-28

Structural interventions can reduce HIV vulnerability. However, HIV-specific budgeting, based on HIV-specific outcomes alone, could lead to the undervaluation of investments in such interventions and suboptimal resource allocation. We investigate this hypothesis by examining the consequences of alternative financing approaches. We compare three approaches for deciding whether to finance a structural intervention to keep adolescent girls in school in Malawi. In the first, HIV and non-HIV budget holders participate in a cross-sectoral cost-benefit analysis and fund the intervention if the benefits outweigh the costs. In the second silo approach, each budget holder considers the cost-effectiveness of the intervention in terms of their own objectives and funds the intervention on the basis of their sector-specific thresholds of what is cost-effective or not. In the third cofinancing approach, budget holders use cost-effectiveness analysis to determine how much they would be willing to contribute towards the intervention, provided that other sectors are willing to pay for the remaining costs. In addition, we explore approaches for determining the HIV share in the cofinancing scenario. We find that efficient structural interventions may be less likely to be prioritized, financed and taken to scale where sectors evaluate their options in isolation. A cofinancing approach minimizes welfare loss and could be incorporated in a sector budgeting perspective. Structural interventions may be underimplemented and their cross-sectoral benefits foregone. Cofinancing provides an opportunity for multiple HIV, health and development objectives to be achieved simultaneously, but will require effective cross-sectoral coordination mechanisms for planning, implementation and financing.

School-based systems change for obesity prevention in adolescents: outcomes of the Australian Capital Territory 'It's Your Move!'

PubMed

Malakellis, Mary; Hoare, Erin; Sanigorski, Andrew; Crooks, Nicholas; Allender, Steven; Nichols, Melanie; Swinburn, Boyd; Chikwendu, Cal; Kelly, Paul M; Petersen, Solveig; Millar, Lynne

2017-10-01

The Australian Capital Territory 'It's Your Move!' (ACT-IYM) was a three-year (2012-2014) systems intervention to prevent obesity among adolescents. The ACT-IYM project involved three intervention schools and three comparison schools and targeted secondary students aged 12-16 years. The intervention consisted of multiple initiatives at individual, community, and school policy level to support healthier nutrition and physical activity. Intervention school-specific objectives related to increasing active transport, increasing time spent physically active at school, and supporting mental wellbeing. Data were collected in 2012 and 2014 from 656 students. Anthropometric data were objectively measured and behavioural data self-reported. Proportions of overweight or obesity were similar over time within the intervention (24.5% baseline and 22.8% follow-up) and comparison groups (31.8% baseline and 30.6% follow-up). Within schools, two of three the intervention schools showed a significant decrease in the prevalence of overweight and obesity (p<0.05). There was some evidence of effectiveness of the systems approach to preventing obesity among adolescents. Implications for public health: The incorporation of systems thinking has been touted as the next stage in obesity prevention and public health more broadly. These findings demonstrate that the use of systems methods can be effective on a small scale. © 2017 The Authors.

Using Economic Evidence to Set Healthcare Priorities in Low‐Income and Lower‐Middle‐Income Countries: A Systematic Review of Methodological Frameworks

PubMed Central

Mitton, Craig; Doyle‐Waters, Mary M.; Drake, Tom; Conteh, Lesong; Newall, Anthony T.; Onwujekwe, Obinna; Jan, Stephen

2016-01-01

Abstract Policy makers in low‐income and lower‐middle‐income countries (LMICs) are increasingly looking to develop ‘evidence‐based’ frameworks for identifying priority health interventions. This paper synthesises and appraises the literature on methodological frameworks – which incorporate economic evaluation evidence – for the purpose of setting healthcare priorities in LMICs. A systematic search of Embase, MEDLINE, Econlit and PubMed identified 3968 articles with a further 21 articles identified through manual searching. A total of 36 papers were eligible for inclusion. These covered a wide range of health interventions with only two studies including health systems strengthening interventions related to financing, governance and human resources. A little under half of the studies (39%) included multiple criteria for priority setting, most commonly equity, feasibility and disease severity. Most studies (91%) specified a measure of ‘efficiency’ defined as cost per disability‐adjusted life year averted. Ranking of health interventions using multi‐criteria decision analysis and generalised cost‐effectiveness were the most common frameworks for identifying priority health interventions. Approximately a third of studies discussed the affordability of priority interventions. Only one study identified priority areas for the release or redeployment of resources. The paper concludes by highlighting the need for local capacity to conduct evaluations (including economic analysis) and empowerment of local decision‐makers to act on this evidence. PMID:26804361

An integrative psychotherapist's account of his focus when treating self-critical patients.

PubMed

Shahar, Golan

2013-09-01

This article presents the factors on which I focus as an integrative psychotherapist when treating self-critical patients. I first describe my personal version of psychotherapy integration. Drawing principally from Wachtel's cyclical psychodynamic model, I also incorporate existential and neurocognitive elements highlighting patients' future-oriented thinking and goal-directed action. I then relate this integrative model to the vexing clinical problem of self-criticism. Finally, I outline three types of interventions I attempt to implement in each session: (1) Multiple-Selves Analysis (MSA); (2) Behavioral Activation (BA), conceptualized integratively; and (3) use of therapist's presence. 2013 APA, all rights reserved

The utility of a composite biological endpoint in HIV/STI prevention trials.

PubMed

Hartwell, Tyler D; Pequegnat, Willo; Moore, Janet L; Parker, Corette B; Strader, Lisa C; Green, Annette M; Quinn, Thomas C; Wasserheit, Judith N; Klausner, Jeffrey D

2013-11-01

A human immunodeficiency virus (HIV) as a biological endpoint in HIV prevention trials may not be feasible, so investigators have used surrogate biological outcomes. In a multisite trial, the epidemiology of STIs may be different across sites and preclude using one STI as the outcome. This study explored using a composite STI outcome to address that problem. The combined biological endpoint was the incidence of any of six new STIs (chlamydia, gonorrhea, trichomonas (women only), syphilis, herpes simplex virus type 2 infection and HIV) during a 24-month follow up period. We investigated how a composite STI outcome would perform compared to single and dual STI outcomes under various conditions. We simulated outcomes for four populations that represented a wide range of sex and age distributions, and STI prevalences. The simulations demonstrated that a combined biologic outcome was superior to single and dual STI outcomes in assessing intervention effects in 82 % of the cases. A composite biological outcome was effective in detecting intervention effects and might allow more investigations to incorporate multiple biological outcomes in the assessment of behavioral intervention trials for HIV prevention.

Incorporating Vocabulary Instruction in Individual Reading Fluency Interventions with English Language Learners

ERIC Educational Resources Information Center

Johnston, Lauren E.; Mercer, Sterett H.; Geres-Smith, Rhonda

2018-01-01

The purpose of this preliminary study was to determine whether incorporating vocabulary instruction in individual reading fluency interventions for English Language Learners (ELLs) would improve reading comprehension. Two vocabulary instructional procedures were contrasted with a fluency-building only condition in an alternating-treatments design…

A model for making project funding decisions at the National Cancer Institute.

PubMed

Hall, N G; Hershey, J C; Kessler, L G; Stotts, R C

1992-01-01

This paper describes the development of a model for making project funding decisions at The National Cancer Institute (NCI). The American Stop Smoking Intervention Study (ASSIST) is a multiple-year, multiple-site demonstration project, aimed at reducing smoking prevalence. The initial request for ASSIST proposals was answered by about twice as many states as could be funded. Scientific peer review of the proposals was the primary criterion used for funding decisions. However, a modified Delphi process made explicit several criteria of secondary importance. A structured questionnaire identified the relative importance of these secondary criteria, some of which we incorporated into a composite preference function. We modeled the proposal funding decision as a zero-one program, and adjusted the preference function and available budget parametrically to generate many suitable outcomes. The actual funding decision, identified by our model, offers significant advantages over manually generated solutions found by experts at NCI.

Translating the Social-Ecological Perspective Into Multilevel Interventions for Family Planning: How Far Are We?

PubMed

Schölmerich, Vera L N; Kawachi, Ichiro

2016-06-01

Scholars and practitioners frequently make recommendations to develop family planning interventions that are "multilevel." Such interventions take explicit account of the role of environments by incorporating multilevel or social-ecological frameworks into their design and implementation. However, research on how interventions have translated these concepts into practice in the field of family planning-and generally in public health-remains scarce. This article seeks to review the current definitions of multilevel interventions and their operationalization in the field of family planning. First, we highlight the divergent definitions of multilevel interventions and show the persistent ambiguity around this term. We argue that interventions involving activities at several levels but lacking targets (i.e., objectives) to create change on more than one level have not incorporated a social-ecological framework and should therefore not be considered as "multilevel." In a second step, we assess the extent to which family planning interventions have successfully incorporated a social-ecological framework. To this end, the 63 studies featured in Mwaikambo et al.'s systematic review on family planning interventions were reexamined. This assessment indicates that the multilevel or social-ecological perspective has seldom been translated into interventions. Specifically, the majority of interventions involved some form of activity at the community and/or organizational level, yet targeted and measured intrapersonal change as opposed to explicitly targeting/measuring environmental modification. © 2016 Society for Public Health Education.

Forced Ambiguity of the Leucine Codons for Multiple-Site-Specific Incorporation of a Noncanonical Amino Acid

PubMed Central

Kwon, Inchan; Choi, Eun Sil

2016-01-01

Multiple-site-specific incorporation of a noncanonical amino acid into a recombinant protein would be a very useful technique to generate multiple chemical handles for bioconjugation and multivalent binding sites for the enhanced interaction. Previously combination of a mutant yeast phenylalanyl-tRNA synthetase variant and the yeast phenylalanyl-tRNA containing the AAA anticodon was used to incorporate a noncanonical amino acid into multiple UUU phenylalanine (Phe) codons in a site-specific manner. However, due to the less selective codon recognition of the AAA anticodon, there was significant misincorporation of a noncanonical amino acid into unwanted UUC Phe codons. To enhance codon selectivity, we explored degenerate leucine (Leu) codons instead of Phe degenerate codons. Combined use of the mutant yeast phenylalanyl-tRNA containing the CAA anticodon and the yPheRS_naph variant allowed incorporation of a phenylalanine analog, 2-naphthylalanine, into murine dihydrofolate reductase in response to multiple UUG Leu codons, but not to other Leu codon sites. Despite the moderate UUG codon occupancy by 2-naphthylalaine, these results successfully demonstrated that the concept of forced ambiguity of the genetic code can be achieved for the Leu codons, available for multiple-site-specific incorporation. PMID:27028506

Forced Ambiguity of the Leucine Codons for Multiple-Site-Specific Incorporation of a Noncanonical Amino Acid.

PubMed

Kwon, Inchan; Choi, Eun Sil

2016-01-01

Multiple-site-specific incorporation of a noncanonical amino acid into a recombinant protein would be a very useful technique to generate multiple chemical handles for bioconjugation and multivalent binding sites for the enhanced interaction. Previously combination of a mutant yeast phenylalanyl-tRNA synthetase variant and the yeast phenylalanyl-tRNA containing the AAA anticodon was used to incorporate a noncanonical amino acid into multiple UUU phenylalanine (Phe) codons in a site-specific manner. However, due to the less selective codon recognition of the AAA anticodon, there was significant misincorporation of a noncanonical amino acid into unwanted UUC Phe codons. To enhance codon selectivity, we explored degenerate leucine (Leu) codons instead of Phe degenerate codons. Combined use of the mutant yeast phenylalanyl-tRNA containing the CAA anticodon and the yPheRS_naph variant allowed incorporation of a phenylalanine analog, 2-naphthylalanine, into murine dihydrofolate reductase in response to multiple UUG Leu codons, but not to other Leu codon sites. Despite the moderate UUG codon occupancy by 2-naphthylalaine, these results successfully demonstrated that the concept of forced ambiguity of the genetic code can be achieved for the Leu codons, available for multiple-site-specific incorporation.

Using Multiple Outcomes of Sexual Behavior to Provide Insights Into Chlamydia Transmission and the Effectiveness of Prevention Interventions in Adolescents.

PubMed

Enns, Eva Andrea; Kao, Szu-Yu; Kozhimannil, Katy Backes; Kahn, Judith; Farris, Jill; Kulasingam, Shalini L

2017-10-01

Mathematical models are important tools for assessing prevention and management strategies for sexually transmitted infections. These models are usually developed for a single infection and require calibration to observed epidemiological trends in the infection of interest. Incorporating other outcomes of sexual behavior into the model, such as pregnancy, may better inform the calibration process. We developed a mathematical model of chlamydia transmission and pregnancy in Minnesota adolescents aged 15 to 19 years. We calibrated the model to statewide rates of reported chlamydia cases alone (chlamydia calibration) and in combination with pregnancy rates (dual calibration). We evaluated the impact of calibrating to different outcomes of sexual behavior on estimated input parameter values, predicted epidemiological outcomes, and predicted impact of chlamydia prevention interventions. The two calibration scenarios produced different estimates of the probability of condom use, the probability of chlamydia transmission per sex act, the proportion of asymptomatic infections, and the screening rate among men. These differences resulted in the dual calibration scenario predicting lower prevalence and incidence of chlamydia compared with calibrating to chlamydia cases alone. When evaluating the impact of a 10% increase in condom use, the dual calibration scenario predicted fewer infections averted over 5 years compared with chlamydia calibration alone [111 (6.8%) vs 158 (8.5%)]. While pregnancy and chlamydia in adolescents are often considered separately, both are outcomes of unprotected sexual activity. Incorporating both as calibration targets in a model of chlamydia transmission resulted in different parameter estimates, potentially impacting the intervention effectiveness predicted by the model.

Identifying novel interventional strategies for psychiatric disorders: integrating genomics, 'enviromics' and gene-environment interactions in valid preclinical models.

PubMed

McOmish, Caitlin E; Burrows, Emma L; Hannan, Anthony J

2014-10-01

Psychiatric disorders affect a substantial proportion of the population worldwide. This high prevalence, combined with the chronicity of the disorders and the major social and economic impacts, creates a significant burden. As a result, an important priority is the development of novel and effective interventional strategies for reducing incidence rates and improving outcomes. This review explores the progress that has been made to date in establishing valid animal models of psychiatric disorders, while beginning to unravel the complex factors that may be contributing to the limitations of current methodological approaches. We propose some approaches for optimizing the validity of animal models and developing effective interventions. We use schizophrenia and autism spectrum disorders as examples of disorders for which development of valid preclinical models, and fully effective therapeutics, have proven particularly challenging. However, the conclusions have relevance to various other psychiatric conditions, including depression, anxiety and bipolar disorders. We address the key aspects of construct, face and predictive validity in animal models, incorporating genetic and environmental factors. Our understanding of psychiatric disorders is accelerating exponentially, revealing extraordinary levels of genetic complexity, heterogeneity and pleiotropy. The environmental factors contributing to individual, and multiple, disorders also exhibit breathtaking complexity, requiring systematic analysis to experimentally explore the environmental mediators and modulators which constitute the 'envirome' of each psychiatric disorder. Ultimately, genetic and environmental factors need to be integrated via animal models incorporating the spatiotemporal complexity of gene-environment interactions and experience-dependent plasticity, thus better recapitulating the dynamic nature of brain development, function and dysfunction. © 2014 The British Pharmacological Society.

RESILIENCE IN VULNERABLE POPULATIONS WITH TYPE 2 DIABETES MELLITUS AND HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

PubMed Central

Pesantes, M. Amalia; Lazo-Porras, María; Abu Dabrh, Abd Moain; Avila-Ramirez, Jaime R.; Caycho, Maria; Villamonte, Georgina Y.; Sanchez-Perez, Grecia P.; Málaga, Germán; Bernabé-Ortiz, Antonio; Miranda, J. Jaime

2015-01-01

Background Patients with chronic conditions and limited access to healthcare experience stressful challenges due to the burden of managing both their conditions and their daily life demands. Resilience provides a mechanism of adapting to stressful experiences. We conducted a systematic review and meta-analysis to synthesize the evidence about interventions to enhance resiliency in managing hypertension or type-2 diabetes in vulnerable populations, and to assess the efficacy of these interventions on clinical outcomes. Methods We searched multiple databases from early inception through February 2015 including randomized controlled trials that enrolled patients with type-2 diabetes or hypertension. All interventions that targeted resilience in vulnerable populations were included. Data were synthesized to describe the characteristics and efficacy of resilience interventions. We pooled the total effects by calculating standardized mean difference using the random-effects model. Results The final search yielded seventeen studies. All studies were conducted in the United States and generally targeted minority participants. Resiliency interventions used diverse strategies; discussion groups or workshops were the most common approach. Conclusions Interventions aimed at enhancing the resiliency of patients from vulnerable groups are diverse. Outcomes were not fully conclusive. There was some evidence that resilience interventions had a positive effect on HbA1c levels, but not blood pressure. The incorporation of resiliency-oriented interventions into the arsenal of prevention and management of chronic conditions appears to be an opportunity that remains to be better investigated and exploited, and there is need to pursue further understanding of the core components of any intervention that claims to enhance resilience. PMID:26239007

Are Cultural Values and Beliefs Included in U.S. Based HIV Interventions?

PubMed Central

Wyatt, Gail E.; Williams, John K.; Gupta, Arpana; Malebranche, Dominique

2013-01-01

Objective To determine the extent to which current U.S. based HIV/AIDS prevention and risk reduction interventions address and include aspects of cultural beliefs in definitions, curricula, measures and related theories that may contradict current safer sex messages. Method A comprehensive literature review was conducted to determine which published HIV/AIDS prevention and risk reduction interventions incorporated aspects of cultural beliefs. Results This review of 166 HIV prevention and risk reduction interventions, published between 1988 and 2010, identified 34 interventions that varied in cultural definitions and the integration of cultural concepts. Conclusion HIV interventions need to move beyond targeting specific populations based upon race/ethnicity, gender, sexual, drug and/or risk behaviors and incorporate cultural beliefs and experiences pertinent to an individual’s risk. Theory based interventions that incorporate cultural beliefs within a contextual framework are needed if prevention and risk reduction messages are to reach targeted at risk populations. Implications for the lack of uniformity of cultural definitions, measures and related theories are discussed and recommendations are made to ensure that cultural beliefs are acknowledged for their potential conflict with safer sex skills and practices. PMID:21884721

Incorporating video modeling into a school-based intervention for students with autism spectrum disorders.

PubMed

Wilson, Kaitlyn P

2013-01-01

Video modeling is an intervention strategy that has been shown to be effective in improving the social and communication skills of students with autism spectrum disorders, or ASDs. The purpose of this tutorial is to outline empirically supported, step-by-step instructions for the use of video modeling by school-based speech-language pathologists (SLPs) serving students with ASDs. This tutorial draws from the many reviews and meta-analyses of the video modeling literature that have been conducted over the past decade, presenting empirically supported considerations for school-based SLPs who are planning to incorporate video modeling into their service delivery for students with ASD. The 5 overarching procedural phases presented in this tutorial are (a) preparation, (b) recording of the video model, (c) implementation of the video modeling intervention, (d) monitoring of the student's response to the intervention, and (e) planning of the next steps. Video modeling is not only a promising intervention strategy for students with ASD, but it is also a practical and efficient tool that is well-suited to the school setting. This tutorial will facilitate school-based SLPs' incorporation of this empirically supported intervention into their existing strategies for intervention for students with ASD.

Prevalence of Erectile Dysfunction and Associated Factors in Korean Older Adults With Coronary Artery Disease.

PubMed

Son, Youn-Jung; Jang, Miyoun; Jun, Eun-Young

2016-10-01

The current study aimed to identify the prevalence and associated factors of erectile dysfunction (ED) among 161 Korean adults 60 and older with coronary artery disease (CAD). ED was diagnosed in 72.2% of patients-the prevalence of which was significantly associated with age, education, employment, monthly income, frequency of sexual intercourse, body mass index, and low-density lipoprotein. Health-related quality of life (HRQoL) was lower in patients with ED than in those without ED (p < 0.001). Hierarchical multiple regression analysis revealed that ED significantly influenced HRQoL in patients with CAD after adjusting for sociodemographic and disease-related characteristic variables (p < 0.001). Interventions and training courses for health care providers should focus on improving caregivers' knowledge and communication skills with patients and spouses regarding sexual health. Furthermore, guidelines to improve HRQoL in patients with CAD should consider incorporating sexual counseling. [Journal of Gerontological Nursing, 42(10), 32-41.]. Copyright 2016, SLACK Incorporated.

A Systematic Review of Behavioral Interventions to Reduce Condomless Sex and Increase HIV Testing for Latino MSM.

PubMed

Pérez, Ashley; Santamaria, E Karina; Operario, Don

2017-12-15

Latino men who have sex with men (MSM) in the United States are disproportionately affected by HIV, and there have been calls to improve availability of culturally sensitive HIV prevention programs for this population. This article provides a systematic review of intervention programs to reduce condomless sex and/or increase HIV testing among Latino MSM. We searched four electronic databases using a systematic review protocol, screened 1777 unique records, and identified ten interventions analyzing data from 2871 Latino MSM. Four studies reported reductions in condomless anal intercourse, and one reported reductions in number of sexual partners. All studies incorporated surface structure cultural features such as bilingual study recruitment, but the incorporation of deep structure cultural features, such as machismo and sexual silence, was lacking. There is a need for rigorously designed interventions that incorporate deep structure cultural features in order to reduce HIV among Latino MSM.

Incorporating Family Assessment and Individualized Family Service Plans into Early Intervention Programs: A Developmental, Decision Making Process.

ERIC Educational Resources Information Center

Kochanek, Thomas T.; Friedman, Donna Haig

The monograph presents essential components of a decision making sequence used to incorporate formalized family assessment and service planning procedures into two existing early intervention programs in Massachusetts. The 1-year effort used a consultant to: (1) redefine screening and assessment processes to include both child and family centered…

Evaluation of the Effectiveness of a Problem-Solving Intervention Addressing Barriers to Cardiovascular Disease Prevention Behaviors in 3 Underserved Populations: Colorado, North Carolina, West Virginia, 2009

PubMed Central

Bryant, Lucinda L.; Leary, Janie M.; Vu, Maihan B.; Hill-Briggs, Felicia; Samuel-Hodge, Carmen D.; McMilin, Colleen R.; Keyserling, Thomas C.

2014-01-01

Introduction In low-income and underserved populations, financial hardship and multiple competing roles and responsibilities lead to difficulties in lifestyle change for cardiovascular disease (CVD) prevention. To improve CVD prevention behaviors, we adapted, pilot-tested, and evaluated a problem-solving intervention designed to address barriers to lifestyle change. Methods The sample consisted of 81 participants from 3 underserved populations, including 28 Hispanic or non-Hispanic white women in a western community (site 1), 31 African-American women in a semirural southern community (site 2), and 22 adults in an Appalachian community (site 3). Incorporating focus group findings, we assessed a standardized intervention involving 6-to-8 week group sessions devoted to problem-solving in the fall of 2009. Results Most sessions were attended by 76.5% of participants, demonstrating participant adoption and engagement. The intervention resulted in significant improvement in problem-solving skills (P < .001) and perceived stress (P < .05). Diet, physical activity, and weight remained stable, although 72% of individuals reported maintenance or increase in daily fruit and vegetable intake, and 67% reported maintenance or increase in daily physical activity. Conclusion Study results suggest the intervention was acceptable to rural, underserved populations and effective in training them in problem-solving skills and stress management for CVD risk reduction. PMID:24602586

Toward a developmentally informed approach to parenting interventions: Seeking hidden effects.

PubMed

Brock, Rebecca L; Kochanska, Grazyna

2016-05-01

Drawing from developmental psychology and psychopathology, we propose a new, developmentally informed approach to parenting interventions that focuses on elucidating changes in the unfolding developmental process between the parent and child. We present data from 186 low-income mothers of toddlers, randomly assigned to a child-oriented play group or a play-as-usual group. We examined the maladaptive cascade from child difficulty to mother adversarial, negative parenting to child maladjustment, well documented in the literature. The measures incorporated multiple observations and reports. As expected, the sequence from child difficulty (pretest) to mother adversarial, negative parenting (Posttest 1, after 3-month intervention) to child maladjustment (Posttest 2, 6 months later) was present in the play-as-usual group, but absent, or defused, in the child-oriented play group. The findings are consistent with a view of intervention presumably enhancing the mother-child relationship, which in turn served to moderate future mother-child dynamics, altering its otherwise anticipated negative trajectory. A closer examination of the cascade revealed that, at Posttest 1, mothers in the play-as-usual group engaged in more adversarial, negative parenting (controlling for pretest) than did mothers in the child-oriented play group when their children were of high difficulty. The intervention appears to exert its primary influence on the cascade by weakening the link between child difficulty and maternal adversarial, negative parenting.

Incorporating Psychological Predictors of Treatment Response into Health Economic Simulation Models: A Case Study in Type 1 Diabetes.

PubMed

Kruger, Jen; Pollard, Daniel; Basarir, Hasan; Thokala, Praveen; Cooke, Debbie; Clark, Marie; Bond, Rod; Heller, Simon; Brennan, Alan

2015-10-01

. Health economic modeling has paid limited attention to the effects that patients' psychological characteristics have on the effectiveness of treatments. This case study tests 1) the feasibility of incorporating psychological prediction models of treatment response within an economic model of type 1 diabetes, 2) the potential value of providing treatment to a subgroup of patients, and 3) the cost-effectiveness of providing treatment to a subgroup of responders defined using 5 different algorithms. . Multiple linear regressions were used to investigate relationships between patients' psychological characteristics and treatment effectiveness. Two psychological prediction models were integrated with a patient-level simulation model of type 1 diabetes. Expected value of individualized care analysis was undertaken. Five different algorithms were used to provide treatment to a subgroup of predicted responders. A cost-effectiveness analysis compared using the algorithms to providing treatment to all patients. . The psychological prediction models had low predictive power for treatment effectiveness. Expected value of individualized care results suggested that targeting education at responders could be of value. The cost-effectiveness analysis suggested, for all 5 algorithms, that providing structured education to a subgroup of predicted responders would not be cost-effective. . The psychological prediction models tested did not have sufficient predictive power to make targeting treatment cost-effective. The psychological prediction models are simple linear models of psychological behavior. Collection of data on additional covariates could potentially increase statistical power. . By collecting data on psychological variables before an intervention, we can construct predictive models of treatment response to interventions. These predictive models can be incorporated into health economic models to investigate more complex service delivery and reimbursement strategies. © The Author(s) 2015.

Can job redesign interventions influence a broad range of employee outcomes by changing multiple job characteristics? A quasi-experimental study.

PubMed

Holman, David; Axtell, Carolyn

2016-07-01

Many job redesign interventions are based on a multiple mediator-multiple outcome model in which the job redesign intervention indirectly influences a broad range of employee outcomes by changing multiple job characteristics. As this model remains untested, the aim of this study is to test a multiple mediator-multiple outcome model of job redesign. Multilevel analysis of data from a quasi-experimental job redesign intervention in a call center confirmed the hypothesized model and showed that the job redesign intervention affected a broad range of employee outcomes (i.e., employee well-being, psychological contract fulfillment, and supervisor-rated job performance) through changes in 2 job characteristics (i.e., job control and feedback). The results provide further evidence for the efficacy and mechanisms of job redesign interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Using Economic Evidence to Set Healthcare Priorities in Low-Income and Lower-Middle-Income Countries: A Systematic Review of Methodological Frameworks.

PubMed

Wiseman, Virginia; Mitton, Craig; Doyle-Waters, Mary M; Drake, Tom; Conteh, Lesong; Newall, Anthony T; Onwujekwe, Obinna; Jan, Stephen

2016-02-01

Policy makers in low-income and lower-middle-income countries (LMICs) are increasingly looking to develop 'evidence-based' frameworks for identifying priority health interventions. This paper synthesises and appraises the literature on methodological frameworks--which incorporate economic evaluation evidence--for the purpose of setting healthcare priorities in LMICs. A systematic search of Embase, MEDLINE, Econlit and PubMed identified 3968 articles with a further 21 articles identified through manual searching. A total of 36 papers were eligible for inclusion. These covered a wide range of health interventions with only two studies including health systems strengthening interventions related to financing, governance and human resources. A little under half of the studies (39%) included multiple criteria for priority setting, most commonly equity, feasibility and disease severity. Most studies (91%) specified a measure of 'efficiency' defined as cost per disability-adjusted life year averted. Ranking of health interventions using multi-criteria decision analysis and generalised cost-effectiveness were the most common frameworks for identifying priority health interventions. Approximately a third of studies discussed the affordability of priority interventions. Only one study identified priority areas for the release or redeployment of resources. The paper concludes by highlighting the need for local capacity to conduct evaluations (including economic analysis) and empowerment of local decision-makers to act on this evidence. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

"I'm in this world for a reason": Resilience and recovery among American Indian and Alaska Native two-spirit women.

PubMed

Elm, Jessica H L; Lewis, Jordan P; Walters, Karina L; Self, Jen M

2016-01-01

American Indian and Alaska Native sexual minority (two-spirit) women are vulnerable to substance misuse and mental health challenges due to multiple minority oppressed status and exposure to stress and trauma. Yet, these women find pathways toward healing and wellness. We conducted a qualitative data analysis of interviews derived from a national health study and gained an understanding of 11 two-spirit women's resilience and recovery patterns. Emergent from the data, a braided resiliency framework was developed which elucidates multilayered abilities, processes, and resources involved in their resiliency. We recommend that resilience-promoting strategies be incorporated into substance misuse and mental health interventions.

Resilience in Vulnerable Populations With Type 2 Diabetes Mellitus and Hypertension: A Systematic Review and Meta-analysis.

PubMed

Pesantes, M Amalia; Lazo-Porras, María; Abu Dabrh, Abd Moain; Ávila-Ramírez, Jaime R; Caycho, María; Villamonte, Georgina Y; Sánchez-Pérez, Grecia P; Málaga, Germán; Bernabé-Ortiz, Antonio; Miranda, J Jaime

2015-09-01

Patients with chronic conditions and limited access to health care experience stressful challenges resulting from the burden of managing both their conditions and their daily life demands. Resilience provides a mechanism of adapting to stressful experiences. We conducted a systematic review and meta-analysis to synthesize the evidence about interventions to enhance resiliency in managing hypertension or type 2 diabetes in vulnerable populations and to assess the efficacy of these interventions on clinical outcomes. We searched multiple databases from early inception through February 2015 including randomized controlled trials that enrolled patients with type 2 diabetes or hypertension. All interventions that targeted resilience in vulnerable populations were included. Data were synthesized to describe the characteristics and efficacy of resiliency interventions. We pooled the total effects by calculating standardized mean difference using the random-effects model. The final search yielded 17 studies. All studies were conducted in the United States and generally targeted minority participants. Resiliency interventions used diverse strategies; discussion groups or workshops were the most common approach. Interventions aimed at enhancing the resiliency of patients from vulnerable groups are diverse. Outcomes were not fully conclusive. There was some evidence that resiliency interventions had a positive effect on hemoglobin A1C levels but not blood pressure. The incorporation of resiliency-oriented interventions into the arsenal of preventing and managing chronic conditions appears to be an opportunity that remains to be better investigated and exploited, and there is need to pursue further understanding of the core components of any intervention that claims to enhance resilience. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Are cultural values and beliefs included in U.S. based HIV interventions?

PubMed

Wyatt, Gail E; Williams, John K; Gupta, Arpana; Malebranche, Dominique

2012-11-01

To determine the extent to which current United States based human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions address and include aspects of cultural beliefs in definitions, curricula, measures and related theories that may contradict current safer sex messages. A comprehensive literature review was conducted to determine which published human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions incorporated aspects of cultural beliefs. This review of 166 human immunodeficiency virus (HIV) prevention and risk reduction interventions, published between 1988 and 2010, identified 34 interventions that varied in cultural definitions and the integration of cultural concepts. human immunodeficiency virus (HIV) interventions need to move beyond targeting specific populations based upon race/ethnicity, gender, sexual, drug and/or risk behaviors and incorporate cultural beliefs and experiences pertinent to an individual's risk. Theory based interventions that incorporate cultural beliefs within a contextual framework are needed if prevention and risk reduction messages are to reach targeted at risk populations. Implications for the lack of uniformity of cultural definitions, measures and related theories are discussed and recommendations are made to ensure that cultural beliefs are acknowledged for their potential conflict with safer sex skills and practices. Copyright © 2011. Published by Elsevier Inc.

Institutional Incorporation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Residency Training: Achieving a Sustainable Curriculum

ERIC Educational Resources Information Center

Scott, Denise M.; McLaurin-Jones, TyWanda; Brown, Fannie D.; Newton, Robin; Marshall, Vanessa J.; Kalu, Nnenna; Cain, Gloria E.; Taylor, Robert E.

2012-01-01

The success of implementing a screening, brief intervention and referral to treatment (SBIRT) program within a medical residency program for sustainability is contingent upon a well-crafted training curriculum that incorporates substance abuse education and clinical practice skills. The goal of the Howard University (HU) SBIRT program is to train…

Can we incorporate geriatric assessment in the management of acute lymphoblastic leukemia in older adults?

PubMed

Loh, Kah Poh; Liesveld, Jane L; O'Dwyer, Kristen M

2018-04-05

Acute lymphoblastic leukemia (ALL) is an uncommon disease. Approximately 14% of new ALL cases occur in adults aged 60 and over, and the three-year overall survival in this population is poor at 12.8%. Older adults with ALL are heterogeneous in terms of their underlying health status, which can make treatment selection challenging given the disease rarity and limited inclusion of older patients in clinical trials. A comprehensive geriatric assessment (CGA) is a compilation of tools to assess multiple domains such as physical function and cognition, and may assist in guiding treatment selection and supportive care interventions. However, studies on the use of CGA are limited in older adults with ALL. In this review, we discuss the utility of CGA in patients with various hematologic malignancies. Using two patient cases of ALL, we also describe how CGA may be use to guide treatment and supportive care interventions. Copyright © 2018 Elsevier Inc. All rights reserved.

Severe community-acquired pneumonia: timely management measures in the first 24 hours.

PubMed

Phua, Jason; Dean, Nathan C; Guo, Qi; Kuan, Win Sen; Lim, Hui Fang; Lim, Tow Keang

2016-08-28

Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools. The bundles include early guideline-concordant antibiotics including macrolides, early haemodynamic support (lactate measurement, intravenous fluids, and vasopressors), and early respiratory support (high-flow nasal cannulae, lung-protective ventilation, prone positioning, and neuromuscular blockade for acute respiratory distress syndrome).While the proposed interventions appear straightforward, multiple barriers to their implementation exist. To successfully decrease mortality for severe CAP, early and close collaboration between emergency medicine and respiratory and critical care medicine teams is required. We propose a workflow incorporating these interventions.

Evaluating Frameworks That Provide Value Measures for Health Care Interventions.

PubMed

Mandelblatt, Jeanne S; Ramsey, Scott D; Lieu, Tracy A; Phelps, Charles E

2017-02-01

The recent acceleration of scientific discovery has led to greater choices in health care. New technologies, diagnostic tests, and pharmaceuticals have widely varying impact on patients and populations in terms of benefits, toxicities, and costs, stimulating a resurgence of interest in the creation of frameworks intended to measure value in health. Many of these are offered by providers and/or advocacy organizations with expertise and interest in specific diseases (e.g., cancer and heart disease). To help assess the utility of and the potential biases embedded in these frameworks, we created an evaluation taxonomy with seven basic components: 1) define the purpose; 2) detail the conceptual approach, including perspectives, methods for obtaining preferences of decision makers (e.g., patients), and ability to incorporate multiple dimensions of value; 3) discuss inclusions and exclusions of elements included in the framework, and whether the framework assumes clinical intervention or offers alternatives such as palliative care or watchful waiting; 4) evaluate data sources and their scientific validity; 5) assess the intervention's effect on total costs of treating a defined population; 6) analyze how uncertainty is incorporated; and 7) illuminate possible conflicts of interest among those creating the framework. We apply the taxonomy to four representative value frameworks recently published by professional organizations focused on treatment of cancer and heart disease and on vaccine use. We conclude that each of these efforts has strengths and weaknesses when evaluated using our taxonomy, and suggest pathways to enhance the utility of value-assessing frameworks for policy and clinical decision making. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Is Stacking Intervention Components Cost-Effective? An Analysis of the Incredible Years Program

ERIC Educational Resources Information Center

Foster, E. Michael; Olchowski, Allison E.; Webster-Stratton, Carolyn H.

2007-01-01

The cost-effectiveness of delivering stacked multiple intervention components for children is compared to implementing single intervention by analyzing the Incredible Years Series program. The result suggests multiple intervention components are more cost-effective than single intervention components.

Social Support Networks: An Underutilized Resource for the Prevention of HIV and other Sexually Transmitted Diseases among Hispanic/Latino Migrants and Immigrants.

PubMed

Painter, Thomas M

2018-01-01

Hispanic/Latino migrants and immigrants are vulnerable to infection by HIV and other sexually transmitted diseases (STDs). Participation in social support networks helps them cope with circumstances in the U.S. Studies of Hispanic/Latino migrants suggest that participation may also be protective against HIV/STD infection. However the studies do not satisfactorily explain how participation leads to protective actions, and recommend externally-induced interventions for HIV/STD prevention rather than incorporating the spontaneously occurring forms of social support they describe. Given the potential protective effects of support networks, a database search was conducted to ascertain the extent to which published HIV/STD prevention interventions for these populations incorporate their support networks. Very few interventions were identified and fewer still incorporate support networks. This commentary calls for research to understand more fully how support networks affect HIV/STD risks among Hispanic/Latino migrants and immigrants and identifies potential benefits of incorporating these networks in HIV/STD prevention for these vulnerable populations.

[Effectiveness of interventions for improving drug prescribing in Primary Health Care].

PubMed

Zavala-González, Marco Antonio; Cabrera-Pivaral, Carlos Enrique; Orozco-Valerio, María de Jesús; Ramos-Herrera, Igor Martín

2017-01-01

To determine the effectiveness of interventions for improving drug prescribing in Primary Health Care units. Systematic review and meta-analysis. Searches were made in MedLine © , ScienceDirect © , Springer © , SciELO © , Dialnet © , RedALyC © and Imbiomed © , in Spanish, English and Portuguese, using keywords "drug prescribing", "intervention studies" and "primary health care", indexed in each data base up to August 2014. Experimental and quasi-experimental studies were included that had a CASP-score>5 and that evaluated effect of any type intervention on the quality of drug prescription in Primary Health Care. A total of 522 articles were found, and an analysis was performed on 12 that reported 17 interventions: 64.7% educational, 23.5% incorporating pharmacists into the health team, and 11.8% on the use of computer applications. The strong "intervention/improvement" associations were educational interventions OR=2.47 (95% CI; 2.28 - 2.69), incorporation of pharmacists OR=3.28 (95% CI; 2.58 4.18), and use of computer applications OR=10.16 (95% CI; 8.81 -11.71). The use of interventions with computer applications showed to be more effective than educational interventions and incorporation pharmacists into the health team. Future studies are required that include economic variables such as, implementation costs, drug costs and other expenses associated with health care and treatment of diseases. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Network meta-analysis of diagnostic test accuracy studies identifies and ranks the optimal diagnostic tests and thresholds for health care policy and decision-making.

PubMed

Owen, Rhiannon K; Cooper, Nicola J; Quinn, Terence J; Lees, Rosalind; Sutton, Alex J

2018-07-01

Network meta-analyses (NMA) have extensively been used to compare the effectiveness of multiple interventions for health care policy and decision-making. However, methods for evaluating the performance of multiple diagnostic tests are less established. In a decision-making context, we are often interested in comparing and ranking the performance of multiple diagnostic tests, at varying levels of test thresholds, in one simultaneous analysis. Motivated by an example of cognitive impairment diagnosis following stroke, we synthesized data from 13 studies assessing the efficiency of two diagnostic tests: Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), at two test thresholds: MMSE <25/30 and <27/30, and MoCA <22/30 and <26/30. Using Markov chain Monte Carlo (MCMC) methods, we fitted a bivariate network meta-analysis model incorporating constraints on increasing test threshold, and accounting for the correlations between multiple test accuracy measures from the same study. We developed and successfully fitted a model comparing multiple tests/threshold combinations while imposing threshold constraints. Using this model, we found that MoCA at threshold <26/30 appeared to have the best true positive rate, whereas MMSE at threshold <25/30 appeared to have the best true negative rate. The combined analysis of multiple tests at multiple thresholds allowed for more rigorous comparisons between competing diagnostics tests for decision making. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial

PubMed Central

Spink, Martin J; Fotoohabadi, Mohammad R; Wee, Elin; Landorf, Karl B; Hill, Keith D; Lord, Stephen R

2011-01-01

Objective To determine the effectiveness of a multifaceted podiatry intervention in preventing falls in community dwelling older people with disabling foot pain. Design Parallel group randomised controlled trial. Setting University health sciences clinic in Melbourne, Australia. Participants 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to a multifaceted podiatry intervention and 152 to routine podiatry care, with 12 months’ follow-up. Interventions Multifaceted podiatry intervention consisting of foot orthoses, advice on footwear, subsidy for footwear ($A100 voucher; £65; €74), a home based programme of foot and ankle exercises, a falls prevention education booklet, and routine podiatry care for 12 months. The control group received routine podiatry care for 12 months. Main outcome measures Proportion of fallers and multiple fallers, falling rate, and injuries resulting from falls during follow-up. Results Overall, 264 falls occurred during the study. 296 participants returned all 12 calendars: 147 (96%) in the intervention group and 149 (98%) in the control group. Adherence was good, with 52% of the participants completing 75% or more of the requested three exercise sessions weekly, and 55% of those issued orthoses reporting wearing them most of the time. Participants in the intervention group (n=153) experienced 36% fewer falls than participants in the control group (incidence rate ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01). The proportion of fallers and multiple fallers did not differ significantly between the groups (relative risk 0.85, 0.66 to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One fracture occurred in the intervention group and seven in the control group (0.14, 0.02 to 1.15, P=0.07). Significant improvements in the intervention group compared with the control group were found for the domains of strength (ankle eversion), range of motion (ankle dorsiflexion and inversion/eversion), and balance (postural sway on the floor when barefoot and maximum balance range wearing shoes). Conclusions A multifaceted podiatry intervention reduced the rate of falls in community dwelling older people with disabling foot pain. The components of the intervention are inexpensive and relatively simple to implement, suggesting that the programme could be incorporated into routine podiatry practice or multidisciplinary falls prevention clinics. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000065392. PMID:21680622

The Effectiveness of Incorporating a Play-based Intervention to Improve Functional Mobility for a Child with Relapsed Acute Lymphoblastic Leukaemia: A Case Report.

PubMed

Vercher, Paula; Hung, You-Jou; Ko, Mansoo

2016-12-01

Acute lymphoblastic leukaemia (ALL) is one of the most common forms of cancer seen in children, accounting for one-fourth of all childhood cancers. These children typically present with decreased functional mobility, weakened lower extremity muscle strength and reduced exercise endurance and interests because of disease progressions and chemotherapy treatments. The purpose of this case report was to examine the effectiveness of incorporating a play-based physical therapy (PT) intervention programme to improve functional mobility for an inpatient with relapsed ALL undergoing chemotherapy. The patient was a 3-year-old male admitted to the hospital for relapsed ALL. He was diagnosed approximately 1 year earlier for which he had undergone chemotherapy and was later considered in remission at that time. When the patient relapsed, he underwent another round of chemotherapy and was waiting for a bone marrow transplant during his treatment during the course of this case report. For PT intervention, therapeutic exercises were incorporated into play to strengthen his lower extremity strength and muscle endurance. Functional activities were also incorporated into play to improve his aerobic capacity and overall quality of life. Multi-attribute health status classification system (HUI3) utility scores, 6-minute walk test distance (6MWT), lower extremity (LE) strength, transfer and tolerated treatment time were assessed to identify the effect of a PT intervention. Despite experiencing fatigue, the patient completed most of the treatments incorporated into play. After 5 weeks of PT intervention, the participant improved on HUI3 (pre: 0.72 and post: 0.92), 6MWT (pre: 156 ft and post: 489 ft), LE strength (squat), transfer (sit to stand) and tolerated treatment time (pre: 16 minutes and post: 44 minutes). This case report suggests that incorporating a play-based PT intervention programme could be physically tolerable and functionally beneficial for a young child with relapsed ALL undergoing inpatient chemotherapy. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings.

PubMed

Crowe, Sonya; Brown, Katherine; Tregay, Jenifer; Wray, Jo; Knowles, Rachel; Ridout, Deborah A; Bull, Catherine; Utley, Martin

2017-08-01

Improving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors. Soft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources. A 'Rich Picture' was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning. When tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further consideration. 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/.

Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial.

PubMed

Kasari, Connie; Kaiser, Ann; Goods, Kelly; Nietfeld, Jennifer; Mathy, Pamela; Landa, Rebecca; Murphy, Susan; Almirall, Daniel

2014-06-01

This study tested the effect of beginning treatment with a speech-generating device (SGD) in the context of a blended, adaptive treatment design for improving spontaneous, communicative utterances in school-aged, minimally verbal children with autism. A total of 61 minimally verbal children with autism, aged 5 to 8 years, were randomized to a blended developmental/behavioral intervention (JASP+EMT) with or without the augmentation of a SGD for 6 months with a 3-month follow-up. The intervention consisted of 2 stages. In stage 1, all children received 2 sessions per week for 3 months. Stage 2 intervention was adapted (by increased sessions or adding the SGD) based on the child's early response. The primary outcome was the total number of spontaneous communicative utterances; secondary measures were the total number of novel words and total comments from a natural language sample. Primary aim results found improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD (JASP+EMT+SGD) as opposed to spoken words alone (JASP+EMT). Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better posttreatment outcomes. Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD. Future studies should further explore the tailoring design used in this study to better understand children's response to treatment. Clinical trial registration information-Developmental and Augmented Intervention for Facilitating Expressive Language (CCNIA); http://clinicaltrials.gov/; NCT01013545. Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City.

PubMed

Martínez-Andrade, Gloria Oliva; Cespedes, Elizabeth M; Rifas-Shiman, Sheryl L; Romero-Quechol, Guillermina; González-Unzaga, Marco Aurelio; Benítez-Trejo, María Amalia; Flores-Huerta, Samuel; Horan, Chrissy; Haines, Jess; Taveras, Elsie M; Pérez-Cuevas, Ricardo; Gillman, Matthew W

2014-03-20

Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children's height and weight and parents reported children's diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. ClinicalTrials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.

Applying dynamic simulation modeling methods in health care delivery research-the SIMULATE checklist: report of the ISPOR simulation modeling emerging good practices task force.

PubMed

Marshall, Deborah A; Burgos-Liz, Lina; IJzerman, Maarten J; Osgood, Nathaniel D; Padula, William V; Higashi, Mitchell K; Wong, Peter K; Pasupathy, Kalyan S; Crown, William

2015-01-01

Health care delivery systems are inherently complex, consisting of multiple tiers of interdependent subsystems and processes that are adaptive to changes in the environment and behave in a nonlinear fashion. Traditional health technology assessment and modeling methods often neglect the wider health system impacts that can be critical for achieving desired health system goals and are often of limited usefulness when applied to complex health systems. Researchers and health care decision makers can either underestimate or fail to consider the interactions among the people, processes, technology, and facility designs. Health care delivery system interventions need to incorporate the dynamics and complexities of the health care system context in which the intervention is delivered. This report provides an overview of common dynamic simulation modeling methods and examples of health care system interventions in which such methods could be useful. Three dynamic simulation modeling methods are presented to evaluate system interventions for health care delivery: system dynamics, discrete event simulation, and agent-based modeling. In contrast to conventional evaluations, a dynamic systems approach incorporates the complexity of the system and anticipates the upstream and downstream consequences of changes in complex health care delivery systems. This report assists researchers and decision makers in deciding whether these simulation methods are appropriate to address specific health system problems through an eight-point checklist referred to as the SIMULATE (System, Interactions, Multilevel, Understanding, Loops, Agents, Time, Emergence) tool. It is a primer for researchers and decision makers working in health care delivery and implementation sciences who face complex challenges in delivering effective and efficient care that can be addressed with system interventions. On reviewing this report, the readers should be able to identify whether these simulation modeling methods are appropriate to answer the problem they are addressing and to recognize the differences of these methods from other modeling approaches used typically in health technology assessment applications. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A Systematic Review Exploring the Social Cognitive Theory of Self-Regulation as a Framework for Chronic Health Condition Interventions

PubMed Central

Tougas, Michelle E.; Hayden, Jill A.; McGrath, Patrick J.; Huguet, Anna; Rozario, Sharlene

2015-01-01

Background Theory is often recommended as a framework for guiding hypothesized mechanisms of treatment effect. However, there is limited guidance about how to use theory in intervention development. Methods We conducted a systematic review to provide an exemplar review evaluating the extent to which use of theory is identified and incorporated within existing interventions. We searched electronic databases PubMed, PsycINFO, CENTRAL, and EMBASE from inception to May 2014. We searched clinicaltrials.gov for registered protocols, reference lists of relevant systematic reviews and included studies, and conducted a citation search in Web of Science. We included peer-reviewed publications of interventions that referenced the social cognitive theory of self-regulation as a framework for interventions to manage chronic health conditions. Two reviewers independently assessed articles for eligibility. We contacted all authors of included studies for information detailing intervention content. We describe how often theory mechanisms were addressed by interventions, and report intervention characteristics used to address theory. Results Of 202 articles that reported using the social cognitive theory of self-regulation, 52% failed to incorporate self-monitoring, a main theory component, and were therefore excluded. We included 35 interventions that adequately used the theory framework. Intervention characteristics were often poorly reported in peer-reviewed publications, 21 of 35 interventions incorporated characteristics that addressed each of the main theory components. Each intervention addressed, on average, six of eight self-monitoring mechanisms, two of five self-judgement mechanisms, and one of three self-evaluation mechanisms. The self-monitoring mechanisms ‘Feedback’ and ‘Consistency’ were addressed by all interventions, whereas the self-evaluation mechanisms ‘Self-incentives’ and ‘External rewards’ were addressed by six and four interventions, respectively. The present review establishes that systematic review is a feasible method of identifying use of theory as a conceptual framework for existing interventions. We identified the social cognitive theory of self-regulation as a feasible framework to guide intervention development for chronic health conditions. PMID:26252889

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

Virtual TeamSTEPPS(®) Simulations Produce Teamwork Attitude Changes Among Health Professions Students.

PubMed

Sweigart, Linda I; Umoren, Rachel A; Scott, Patrician J; Carlton, Kay Hodson; Jones, James A; Truman, Barbara; Gossett, Evalyn J

2016-01-01

The majority of the estimated 400,000 or more patient deaths per year in the United States are from preventable medical errors due to poor communication. Team training programs have been established to teach teamwork skills to health professions students. However, it is often challenging to provide this training at a physical site. A brief intervention using a virtual learning environment with TeamSTEPPS(®)-based scenarios is described. Using a pretest-posttest design, the effects on teamwork attitudes in 109 health professional students from two institutions and multiple disciplines were measured using the TeamSTEPPS Teamwork Attitudes questionnaire. Participants showed significant attitude changes in the categories of leadership, situation monitoring, mutual support, and communication (p ⩽ .05), with significance in four of the six indicator attitudes in the communication section at the p ⩽ .001 level. These findings indicate the potential impact that virtual learning experiences may have on teamwork attitudes in learners across professions on multiple campuses. Copyright 2016, SLACK Incorporated.

The role of low-grade inflammation and metabolic flexibility in aging and nutritional modulation thereof: a systems biology approach.

PubMed

Calçada, Dulce; Vianello, Dario; Giampieri, Enrico; Sala, Claudia; Castellani, Gastone; de Graaf, Albert; Kremer, Bas; van Ommen, Ben; Feskens, Edith; Santoro, Aurelia; Franceschi, Claudio; Bouwman, Jildau

2014-01-01

Aging is a biological process characterized by the progressive functional decline of many interrelated physiological systems. In particular, aging is associated with the development of a systemic state of low-grade chronic inflammation (inflammaging), and with progressive deterioration of metabolic function. Systems biology has helped in identifying the mediators and pathways involved in these phenomena, mainly through the application of high-throughput screening methods, valued for their molecular comprehensiveness. Nevertheless, inflammation and metabolic regulation are dynamical processes whose behavior must be understood at multiple levels of biological organization (molecular, cellular, organ, and system levels) and on multiple time scales. Mathematical modeling of such behavior, with incorporation of mechanistic knowledge on interactions between inflammatory and metabolic mediators, may help in devising nutritional interventions capable of preventing, or ameliorating, the age-associated functional decline of the corresponding systems. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

A qualitative study of tobacco interventions for LGBTQ+ youth and young adults: overarching themes and key learnings.

PubMed

Bruce Baskerville, N; Wong, Katy; Shuh, Alanna; Abramowicz, Aneta; Dash, Darly; Esmail, Aamer; Kennedy, Ryan

2018-01-18

Smoking prevalence is very high among lesbian, gay, bisexual, transgendered and queer (LGBTQ+) youth and young adults (YYA) compared to non-LGBTQ+ YYA. A knowledge gap exists on culturally appropriate and effective prevention and cessation efforts for members of this diverse community, as limited interventions have been developed with and for this population, and there are very few studies determining the impact of these interventions. This study identifies the most salient elements of LGBTQ+ cessation and prevention interventions from the perspective of LGBTQ+ YYA. Three descriptions of interventions tailored for LGBTQ+ YYA (group cessation counselling, social marketing, and a mobile phone app with social media incorporated), were shared with LGBTQ+ YYA via 24 focus groups with 204 participants in Toronto and Ottawa, Canada. Open-ended questions focused on their feelings, likes and dislikes, and concerns about the culturally modified intervention descriptions. Framework analysis was used to identify overarching themes across all three intervention descriptions. The data revealed eight overarching themes across all three intervention descriptions. Smoking cessation and prevention interventions should have the following key attributes: 1) be LGBTQ+ - specific; 2) be accessible in terms of location, time, availability, and cost; 3) be inclusive, relatable, and highlight diversity; 4) incorporate LGBTQ+ peer support and counselling services; 5) integrate other activities beyond smoking; 6) be positive, motivational, uplifting, and empowering; 7) provide concrete coping mechanisms; and 8) integrate rewards and incentives. LGBTQ+ YYA focus group participants expressed a desire for an intervention that can incorporate these key elements. The mobile phone app and social media campaign were noted as potential interventions that could include all the essential elements.

Enhancing Student Motivation and Engagement: The Effects of a Multidimensional Intervention

ERIC Educational Resources Information Center

Martin, Andrew J.

2008-01-01

The present study sought to investigate the effects of a multidimensional educational intervention on high school students' motivation and engagement. The intervention incorporated: (a) multidimensional targets of motivation and engagement, (b) empirically derived intervention methodology, (c) research-based risk and protective factors, (d)…

Feasibility of incorporating functionally relevant virtual rehabilitation in sub-acute stroke care: perception of patients and clinicians.

PubMed

Demers, Marika; Chan Chun Kong, Daniel; Levin, Mindy F

2018-03-11

To determine user satisfaction and safety of incorporating a low-cost virtual rehabilitation intervention as an adjunctive therapeutic option for cognitive-motor upper limb rehabilitation in individuals with sub-acute stroke. A low-cost upper limb virtual rehabilitation application incorporating realistic functionally-relevant unimanual and bimanual tasks, specifically designed for cognitive-motor rehabilitation was developed for patients with sub-acute stroke. Clinicians and individuals with stroke interacted with the intervention for 15-20 or 20-45 minutes, respectively. The study had a mixed-methods convergent parallel design that included a focus group interview with clinicians working in a stroke program and semi-structured interviews and standardized assessments (Borg Perceived Exertion Scale, Short Feedback Questionnaire) for participants with sub-acute stroke undergoing rehabilitation. The occurrence of adverse events was also noted. Three main themes emerged from the clinician focus group and patient interviews: Perceived usefulness in rehabilitation, satisfaction with the virtual reality intervention and aspects to improve. All clinicians and the majority of participants with stroke were highly satisfied with the intervention and perceived its usefulness to decrease arm motor impairment during functional tasks. No participants experienced major adverse events. Incorporation of this type of functional activity game-based virtual reality intervention in the sub-acute phase of rehabilitation represents a way to transfer skills learned early in the clinical setting to real world situations. This type of intervention may lead to better integration of the upper limb into everyday activities. Implications for Rehabilitation • Use of a cognitive-motor low-cost virtual reality intervention designed to remediate arm motor impairments in sub-acute stroke is feasible, safe and perceived as useful by therapists and patients for stroke rehabilitation.    • Input from end-users (therapists and individuals with stroke) is critical for the development and implementation of a virtual reality intervention.

Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial.

PubMed

Spink, Martin J; Menz, Hylton B; Fotoohabadi, Mohammad R; Wee, Elin; Landorf, Karl B; Hill, Keith D; Lord, Stephen R

2011-06-16

To determine the effectiveness of a multifaceted podiatry intervention in preventing falls in community dwelling older people with disabling foot pain. Parallel group randomised controlled trial. University health sciences clinic in Melbourne, Australia. 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to a multifaceted podiatry intervention and 152 to routine podiatry care, with 12 months' follow-up. Multifaceted podiatry intervention consisting of foot orthoses, advice on footwear, subsidy for footwear ($A100 voucher; £65; €74), a home based programme of foot and ankle exercises, a falls prevention education booklet, and routine podiatry care for 12 months. The control group received routine podiatry care for 12 months. Proportion of fallers and multiple fallers, falling rate, and injuries resulting from falls during follow-up. Overall, 264 falls occurred during the study. 296 participants returned all 12 calendars: 147 (96%) in the intervention group and 149 (98%) in the control group. Adherence was good, with 52% of the participants completing 75% or more of the requested three exercise sessions weekly, and 55% of those issued orthoses reporting wearing them most of the time. Participants in the intervention group (n=153) experienced 36% fewer falls than participants in the control group (incidence rate ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01). The proportion of fallers and multiple fallers did not differ significantly between the groups (relative risk 0.85, 0.66 to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One fracture occurred in the intervention group and seven in the control group (0.14, 0.02 to 1.15, P=0.07). Significant improvements in the intervention group compared with the control group were found for the domains of strength (ankle eversion), range of motion (ankle dorsiflexion and inversion/eversion), and balance (postural sway on the floor when barefoot and maximum balance range wearing shoes). A multifaceted podiatry intervention reduced the rate of falls in community dwelling older people with disabling foot pain. The components of the intervention are inexpensive and relatively simple to implement, suggesting that the programme could be incorporated into routine podiatry practice or multidisciplinary falls prevention clinics. Australian New Zealand Clinical Trials Registry ACTRN12608000065392.

Facilitating evaluations of innovative, competence-based assessments: creating understanding and involving multiple stakeholders.

PubMed

Gulikers, Judith T M; Baartman, Liesbeth K J; Biemans, Harm J A

2010-05-01

Schools are held more responsible for evaluating, quality assuring and improving their student assessments. Teachers' lack of understanding of new, competence-based assessments as well as the lack of key stakeholders' involvement, hamper effective and efficient self-evaluations by teachers of innovative, competence-based assessments (CBAs). While evaluating two CBAs in Agricultural Vocational Education and Training institutions, two interventions in the evaluation process aimed to tackle these problems were examined: (1) starting with explicating the CBA in the teacher team using a concrete explication format and (2) qualitatively involving key stakeholders (i.e., teachers, students and employers) in the evaluation of the CBA through mixed-group interviews. Quantitative and qualitative analysis, as well as stakeholders' perceptions are used to find indications for the added value of these interventions for evaluation and further improvement of the CBAs. Results show that external facilitation is needed to make both interventions work. However, under this condition, explicating the CBA led to more complete, concrete and shared understandings of the actual CBA among teachers and mixed-groups interviews resulted in more concrete and elaborate evaluations of the CBAs' quality and more ideas for improvement. Both interventions can facilitate building up elaborate, more valid and concrete arguments for CBA quality in self-evaluations, certainly in the case of evaluating innovative assessments. Lessons learned will provide guidelines for incorporating the interventions into other evaluations of innovative programs. Copyright 2009 Elsevier Ltd. All rights reserved.

Integrating Participatory Design and Health Literacy to Improve Research and Interventions.

PubMed

Neuhauser, Linda

2017-01-01

Health communication is an essential health promotion strategy to convert scientific findings into actionable, empowering information for the public. Health communication interventions have shown positive outcomes, but many efforts have been disappointing. A key weakness is that expert-designed health communication is often overly generic and not adequately aligned with the abilities, preferences and life situations of specific audiences. The emergence of the field of health literacy is providing powerful theoretical guidance and practice strategies. Health literacy, in concert with other determinants of health, has greatly advanced understanding of factors that facilitate or hinder health promotion at individual, organizational and community settings. However, health literacy models are incomplete and interventions have shown only modest success to date. A challenge is to move beyond the current focus on individual comprehension and address deeper factors of motivation, self-efficacy and empowerment, as well as socio-environmental influences, and their impact to improve health outcomes and reduce health disparities. Integrating participatory design theory and methods drawn from social sciences and design sciences can significantly improve health literacy models and interventions. Likewise, researchers and practitioners using participatory design can greatly benefit from incorporating health literacy principles into their efforts. Such interventions at multiple levels are showing positive health outcomes and reduction of health disparities, but this approach is complex and not yet widespread. This chapter focuses on research findings about health literacy and participatory design to improve health promotion, and practical guidance and case examples for researchers, practitioners and policymakers.

The Value of Interrupted Time-Series Experiments for Community Intervention Research

PubMed Central

Biglan, Anthony; Ary, Dennis; Wagenaar, Alexander C.

2015-01-01

Greater use of interrupted time-series experiments is advocated for community intervention research. Time-series designs enable the development of knowledge about the effects of community interventions and policies in circumstances in which randomized controlled trials are too expensive, premature, or simply impractical. The multiple baseline time-series design typically involves two or more communities that are repeatedly assessed, with the intervention introduced into one community at a time. It is particularly well suited to initial evaluations of community interventions and the refinement of those interventions. This paper describes the main features of multiple baseline designs and related repeated-measures time-series experiments, discusses the threats to internal validity in multiple baseline designs, and outlines techniques for statistical analyses of time-series data. Examples are given of the use of multiple baseline designs in evaluating community interventions and policy changes. PMID:11507793

Integrated health messaging for multiple neglected zoonoses: Approaches, challenges and opportunities in Morocco.

PubMed

Ducrotoy, M J; Yahyaoui Azami, H; El Berbri, I; Bouslikhane, M; Fassi Fihri, O; Boué, F; Petavy, A F; Dakkak, A; Welburn, S; Bardosh, K L

2015-12-01

Integrating the control of multiple neglected zoonoses at the community-level holds great potential, but critical data is missing to inform the design and implementation of different interventions. In this paper we present an evaluation of an integrated health messaging intervention, using powerpoint presentations, for five bacterial (brucellosis and bovine tuberculosis) and dog-associated (rabies, cystic echinococcosis and leishmaniasis) zoonotic diseases in Sidi Kacem Province, northwest Morocco. Conducted by veterinary and epidemiology students between 2013 and 2014, this followed a process-based approach that encouraged sequential adaptation of images, key messages, and delivery strategies using auto-evaluation and end-user feedback. We describe the challenges and opportunities of this approach, reflecting on who was targeted, how education was conducted, and what tools and approaches were used. Our results showed that: (1) replacing words with local pictures and using "hands-on" activities improved receptivity; (2) information "overload" easily occurred when disease transmission pathways did not overlap; (3) access and receptivity at schools was greater than at the community-level; and (4) piggy-backing on high-priority diseases like rabies offered an important avenue to increase knowledge of other zoonoses. We conclude by discussing the merits of incorporating our validated education approach into the school curriculum in order to influence long-term behaviour change. Copyright © 2015 Elsevier B.V. All rights reserved.

Community health worker interventions to promote psychosocial outcomes among people living with HIV—A systematic review

PubMed Central

Kim, Kyounghae; Murphy, Jeanne; Cudjoe, Joycelyn; Wilson, Patty; Sharps, Phyllis; Farley, Jason E.

2018-01-01

Background Community health worker (CHW) interventions are a successful strategy to promote health among HIV-negative and persons living with HIV (PLWH). Psychosocial factors are critical dimensions of HIV/AIDS care contributing to prognosis of the disease, yet it is unclear how CHW interventions improve psychosocial outcomes in PLWH. The purpose of this study was to critically appraise the types, scope, and nature of CHW interventions designed to address psychosocial outcomes in PLWH. Methods We performed database searches—PubMed, EMBASE, CINAHL, and Cochrane—to identify randomized controlled trials published in English before April 2017. Fourteen articles met the eligibility criteria. Results Half of the studies were conducted in the United States. Social cognitive theory was used more than once in nine theory-guided studies. CHW interventions were largely focused on reducing depression (n = 6) or stigma related to HIV (n = 4), or promoting quality of life (n = 4), social support (n = 4), and self-efficacy (n = 4). Didactic methods and role-playing were used to train CHWs. CHWs played multiple roles in delivering intervention, including a counselor and a supporter (n = 10), educator (n = 5), or a navigator (n = 3). CHW intervention fidelity was assessed in 4 studies. Five studies found positive changes in six psychosocial outcomes including quality of life (2 of 4) and self-efficacy (2 of 4). CHW interventions had no effect on social support in 2 of 4 studies, and stigma in 3 of 4 studies. None of the CHW interventions were successful in reducing depressive symptoms among PLWH. Conclusions Evidence partially supported the use of CHWs in promoting psychosocial outcomes in PLWH. Future CHW intervention should be expanded in scope to address key psychosocial determinants of HIV/AIDS outcomes such as health literacy. Further, fidelity measures should be incorporated into intervention delivery. PMID:29689054

Translating the Social-Ecological Perspective into Multilevel Interventions for Family Planning: How Far Are We?

ERIC Educational Resources Information Center

Schölmerich, Vera L. N.; Kawachi, Ichiro

2016-01-01

Scholars and practitioners frequently make recommendations to develop family planning interventions that are "multilevel." Such interventions take explicit account of the role of environments by incorporating multilevel or social-ecological frameworks into their design and implementation. However, research on how interventions have…

Value Reappraisal as a Conceptual Model for Task-Value Interventions

ERIC Educational Resources Information Center

Acee, Taylor W.; Weinstein, Claire Ellen; Hoang, Theresa V.; Flaggs, Darolyn A.

2018-01-01

We discuss task-value interventions as one type of relevance intervention and propose a process model of value reappraisal whereby task-value interventions elicit cognitive-affective responses that lead to attitude change and in turn affect academic outcomes. The model incorporates a metacognitive component showing that students can intentionally…

Designing an evaluation for a multiple-strategy community intervention: the North Coast Stay on Your Feet program.

PubMed

van Beurden, E; Kempton, A; Sladden, T; Garner, E

1998-02-01

Evaluation of the North Coast Stay on Your Feet falls prevention program is described as a case study of a comprehensive evaluation design for multi-strategic community interventions. Qualitative and quantitative methods were used to evaluate the program at formative, process and outcome levels. Formative evaluation used literature review, focus groups, mail-out and telephone survey methods to gather evidence from publications, older people, health workers, local business, media and government bodies. It included an analysis of demographic and hospital databases and identified incidence, causal pathways, knowledge, attitudes, behaviour, consequences and effectiveness of potential strategies. Process evaluation employed auditing, monitoring and telephone surveys to maintain an inventory of intervention activities and to track the reach of the program. Outcome evaluation involved a longitudinal study of intervention and control cohorts, surveyed before, during and after the intervention by telephone to monitor changes in knowledge, attitudes, risk and falls incidence. The survey instrument was designed for both formative and outcome evaluation, and analysis reflected the research design by incorporating repeat measures and adjusting for bias and confounding. Outcome validity was cross-checked via hospital admission rates. A novel, integrated framework for presenting inputs, activities and outcomes from all stages of the program is described. This framework facilitated feedback to stakeholders and enabled subsequent rapid adjustment of the intervention. Rigorous evaluation combined with clear presentation of findings helped to engender intersectoral support and obtain funding grants for extended implementation and evaluation. It also helped Stay on Your Feet to become a model for other falls prevention programs within Australia and internationally.

Concept Mapping as an Approach to Facilitate Participatory Intervention Building.

PubMed

L Allen, Michele; Schaleben-Boateng, Dane; Davey, Cynthia S; Hang, Mikow; Pergament, Shannon

2015-01-01

A challenge to addressing community-defined need through community-based participatory intervention building is ensuring that all collaborators' opinions are represented. Concept mapping integrates perspectives of individuals with differing experiences, interests, or expertise into a common visually depicted framework, and ranks composite views on importance and feasibility. To describe the use of concept mapping to facilitate participatory intervention building for a school-based, teacher-focused, positive youth development (PYD) promotion program for Latino, Hmong, and Somali youth. Particiants were teachers, administrators, youth, parents, youth workers, and community and university researchers on the projects' community collaborative board. We incorporated previously collected qualitative data into the process. In a mixed-methods process we 1) generated statements based on key informant interview and focus group data from youth workers, teachers, parents, and youth in multiple languages regarding ways teachers promote PYD for Somali, Latino and Hmong youth; 2) guided participants to individually sort statements into meaningful groupings and rate them by importance and feasibility; 3) mapped the statements based on their relation to each other using multivariate statistical analyses to identify concepts, and as a group identified labels for each concept; and 4) used labels and statement ratings to identify feasible and important concepts as priorities for intervention development. We identified 12 concepts related to PYD promotion in schools and prioritized 8 for intervention development. Concept mapping facilitated participatory intervention building by formally representing all participants' opinions, generating visual representation of group thinking, and supporting priority setting. Use of prior qualitative work increased the diversity of viewpoints represented.

Home programs for upper extremity recovery post-stroke: a survey of occupational therapy practitioners.

PubMed

Donoso Brown, Elena V; Fichter, Renae

2017-12-01

Upper extremity hemiparesis is an impairment post-stroke that impacts quality of life. Home programs are an intervention strategy used by many occupational therapists to support continued motor recovery post-stroke, yet little is known about how these programs are designed and implemented. The purpose of this study was to describe how occupational therapy practitioners approach this task and specifically what strategies they use to support adherence and what types of technology are most commonly used. An on-line survey methodology was used. Participants were recruited through multiple sources including state associations and occupational therapy educational program directors. A total of 73 occupational therapy practitioners submitted complete surveys. It was found that majority of occupational therapy practitioners in the sample (n = 53) reported creating home programs focused on upper extremity motor recovery more than 80% of the time. Range of motion and strengthening were reported as being in the top three most commonly used interventions by more than half the sample, however incorporating clients' goals and interests were reported most often as strategies to create meaning in the home program. Respondents also reported limited incorporation of technology and strategies to support adherence. Personal motivation was reported by occupational therapy practitioners to be a key moderator of adherence to a home program. Occupational therapy practitioners often provide home programs for individuals post-stroke focusing on upper extremity function. Future research that aims to understand stakeholders' perspectives on home programs and determine effective strategies for ensuring adherence is needed.

Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns.

PubMed

Lalmolda, C; Coll-Fernández, R; Martínez, N; Baré, M; Teixidó Colet, M; Epelde, F; Monsó, E

2017-01-01

Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0-1] vs 1 [0-2.5]; P =0.022) and in days of admission (0 [0-7] vs 7 [0-12]; P =0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient -0.785, P =0.014, and R 2 =0.219). A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.

Dimensionality and R4P: A Health Equity Framework for Research Planning and Evaluation in African American Populations.

PubMed

Hogan, Vijaya; Rowley, Diane L; White, Stephanie Baker; Faustin, Yanica

2018-02-01

Introduction Existing health disparities frameworks do not adequately incorporate unique interacting contributing factors leading to health inequities among African Americans, resulting in public health stakeholders' inability to translate these frameworks into practice. Methods We developed dimensionality and R4P to integrate multiple theoretical perspectives into a framework of action to eliminate health inequities experienced by African Americans. Results The dimensional framework incorporates Critical Race Theory and intersectionality, and includes dimensions of time-past, present and future. Dimensionality captures the complex linear and non-linear array of influences that cause health inequities, but these pathways do not lend themselves to approaches to developing empirically derived programs, policies and interventions to promote health equity. R4P provides a framework for addressing the scope of actions needed. The five components of R4P are (1) Remove, (2) Repair, (3) Remediate, (4) Restructure and (5) Provide. Conclusion R4P is designed to translate complex causality into a public health equity planning, assessment, evaluation and research tool.

Exploring the facilitators and barriers to engagement in physical activity for people with multiple sclerosis.

PubMed

Kayes, Nicola M; McPherson, Kathryn M; Schluter, Philip; Taylor, Denise; Leete, Marta; Kolt, Gregory S

2011-01-01

To explore the relationship that cognitive behavioural and other previously identified variables have with physical activity engagement in people with multiple sclerosis (MS). This study adopted a cross-sectional questionnaire design. Participants were 282 individuals with MS. Outcome measures included the Physical Activity Disability Survey--Revised, Cognitive and Behavioural Responses to Symptoms Questionnaire, Barriers to Health Promoting Activities for Disabled Persons Scale, Multiple Sclerosis Self-efficacy Scale, Self-Efficacy for Chronic Diseases Scales and Chalder Fatigue Questionnaire. Multivariable stepwise regression analyses found that greater self-efficacy, greater reported mental fatigue and lower number of perceived barriers to physical activity accounted for a significant proportion of variance in physical activity behaviour, over that accounted for by illness-related variables. Although fear-avoidance beliefs accounted for a significant proportion of variance in the initial analyses, its effect was explained by other factors in the final multivariable analyses. Self-efficacy, mental fatigue and perceived barriers to physical activity are potentially modifiable variables which could be incorporated into interventions designed to improve physical activity engagement. Future research should explore whether a measurement tool tailored to capture beliefs about physical activity identified by people with MS would better predict participation in physical activity.

Exploring change in a group-based psychological intervention for multiple sclerosis patients.

PubMed

Borghi, Martina; Bonino, Silvia; Graziano, Federica; Calandri, Emanuela

2018-07-01

The study is focused on a group-based cognitive behavioral intervention aimed at promoting the quality of life and psychological well-being of multiple sclerosis patients. The study investigates how the group intervention promoted change among participants and fostered their adjustment to the illness. The intervention involved six groups of patients (a total of 41 patients) and included four consecutive sessions and a 6-month follow-up. To explore change, verbatim transcripts of the intervention sessions were analyzed using a mixed-methods content analysis with qualitative data combined with descriptive statistics. The categories of resistance and openness to change were used to describe the process of change. Resistance and openness to change coexisted during the intervention. Only in the first session did resistance prevail over openness to change; thereafter, openness to change gradually increased and stabilized over time, and openness to change was then always stronger than resistance. The study builds on previous research on the effectiveness of group-based psychological interventions for multiple sclerosis patients and gives methodological and clinical suggestions to health care professionals working with multiple sclerosis patients. Implications for rehabilitation The study suggests that a group-based cognitive behavioral intervention for multiple sclerosis patients focused on the promotion of identity redefinition, a sense of coherence and self-efficacy in dealing with multiple sclerosis fosters the process of change and may be effective in promoting patients' adjustment to their illness. Health care professionals leading group-based psychological interventions for multiple sclerosis patients should be aware that resistance and openness to change coexist in the process of change. The study suggests that the duration of the intervention is a crucial factor: a minimum of three sessions appears to be necessary for group participants to develop greater openness to change and follow-up sessions should be implemented to maintain positive changes among participants. The use of qualitative instruments to evaluate group interventions captures the complexity of processes and gives useful indications to health professionals to improve rehabilitation programs.

Memory rehabilitation for the working memory of patients with multiple sclerosis (MS).

PubMed

Mousavi, Shokoufeh; Zare, Hossein; Etemadifar, Masoud; Taher Neshatdoost, Hamid

2018-05-01

The main cognitive impairments in multiple sclerosis (MS) affect the working memory, processing speed, and performances that are in close interaction with one another. Cognitive problems in MS are influenced to a lesser degree by disease recovery medications or treatments,but cognitive rehabilitation is considered one of the promising methods for cure. There is evidence regarding the effectiveness of cognitive rehabilitation for MS patients in various stages of the disease. Since the impairment in working memory is one of the main MS deficits, a particular training that affects this cognitive domain can be of a great value. This study aims to determine the effectiveness of memory rehabilitation on the working memory performance of MS patients. Sixty MS patients with cognitive impairment and similar in terms of demographic characteristics, duration of disease, neurological problems, and mental health were randomly assigned to three groups: namely, experimental, placebo, and control. Patients' cognitive evaluation incorporated baseline assessments immediately post-intervention and 5 weeks post-intervention. The experimental group received a cognitive rehabilitation program in one-hour sessions on a weekly basis for 8 weeks. The placebo group received relaxation techniques on a weekly basis; the control group received no intervention. The results of this study showed that the cognitive rehabilitation program had a positive effect on the working memory performance of patients with MS in the experimental group. These results were achieved in immediate evaluation (post-test) and follow-up 5 weeks after intervention. There was no significant difference in working memory performance between the placebo group and the control group. According to the study, there is evidence for the effectiveness of a memory rehabilitation program for the working memory of patients with MS. Cognitive rehabilitation can improve working memory disorders and have a positive effect on the working memory performance of these patients.

Experimental protocol of a randomized controlled clinical trial investigating exercise, subclinical atherosclerosis, and walking mobility in persons with multiple sclerosis.

PubMed

Griffith, Garett; Klaren, Rachel E; Motl, Robert W; Baynard, Tracy; Fernhall, Bo

2015-03-01

This randomized controlled trial (RCT) will investigate the effects of a home-based aerobic exercise training regimen (i.e., cycle ergometry) on subclinical atherosclerosis and walking mobility in persons with multiple sclerosis (MS) and minimal disability. This RCT will recruit 54 men and women who have an Expanded Disability Status Scale characteristic of the 1st stage of MS (i.e., 0-4.0) to participate in a 3 month exercise or stretching intervention, with assessments of subclinical atherosclerosis and walking mobility conducted at baseline, week 6 (midpoint), and week 12 (conclusion) of the program. The exercise intervention will consist of 3 days/week of cycling, with a gradual increase of duration followed by an increase in intensity across the 3 month period. The attention-control condition will incorporate stretching activities and will require the same contact time commitment as the exercise condition. Both study groups will participate in weekly video chat sessions with study personnel in order to monitor and track program adherence. Primary outcomes will consist of assessments of vascular structure and function, as well as several walking tasks. Additional outcomes will include questionnaires, cardiorespiratory fitness assessment, and a 1-week free-living physical activity assessment. This investigation will increase understanding of the role of aerobic exercise as part of a treatment plan for managing subclinical atherosclerosis and improving walking mobility persons in the 1st stage of MS. Overall, this study design has the potential to lead to effective aerobic exercise intervention strategies for this population and improve program adherence. Copyright © 2015 Elsevier Inc. All rights reserved.

A Group-Based Motivational Interviewing Brief Intervention to Reduce Substance Use and Sexual Risk Behavior among Homeless Young Adults

PubMed Central

Tucker, Joan S.; D’Amico, Elizabeth J.; Ewing, Brett A.; Miles, Jeremy N. V.; Pedersen, Eric R.

2017-01-01

Homeless young adults ages 18–25 exhibit high rates of alcohol and other drug (AOD) use, and sexual risk behaviors such as unprotected sex. Yet few programs exist for this population that are both effective and can be easily incorporated into settings serving this population. This pilot cluster cross-over randomized controlled trial evaluates AWARE, a voluntary four session group-based motivational interviewing (MI) intervention to reduce AOD use and sexual risk behavior. We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County (mean age=21.8 years; 73% male; 79% heterosexual; 31% non-Hispanic White, 25% African American, 24% Hispanic, 21% multiracial/other). Surveys were completed at baseline and three months after program completion. Retention in the AWARE program was excellent (79% attended multiple sessions) and participants reported high levels of satisfaction with the program. AWARE participants self-reported positive change in their past 3 month and past 30 day alcohol use (ps ≤ .05), motivation to change drug use (ps < .05), and condom use self-efficacy (p = .05) compared to the control group. Among those with multiple sex partners, AWARE participants showed a decrease in unprotected sexual events (p < .05), whereas the control group did not. Results from this pilot evaluation are promising, suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use. Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes. PMID:28340904

The information architecture of behavior change websites.

PubMed

Danaher, Brian G; McKay, H Garth; Seeley, John R

2005-05-18

The extraordinary growth in Internet use offers researchers important new opportunities to identify and test new ways to deliver effective behavior change programs. The information architecture (IA)-the structure of website information--is an important but often overlooked factor to consider when adapting behavioral strategies developed in office-based settings for Web delivery. Using examples and relevant perspectives from multiple disciplines, we describe a continuum of website IA designs ranging from a matrix design to the tunnel design. The free-form matrix IA design allows users free rein to use multiple hyperlinks to explore available content according to their idiosyncratic interests. The more directive tunnel IA design (commonly used in e-learning courses) guides users step-by-step through a series of Web pages that are arranged in a particular order to improve the chances of achieving a goal that is measurable and consistent. Other IA designs are also discussed, including hierarchical IA and hybrid IA designs. In the hierarchical IA design, program content is arranged in a top-down manner, which helps the user find content of interest. The more complex hybrid IA design incorporates some combination of components that use matrix, tunnel, and/or hierarchical IA designs. Each of these IA designs is discussed in terms of usability, participant engagement, and program tailoring, as well as how they might best be matched with different behavior change goals (using Web-based smoking cessation interventions as examples). Our presentation underscores the role of considering and clearly reporting the use of IA designs when creating effective Web-based interventions. We also encourage the adoption of a multidisciplinary perspective as we move towards a more mature view of Internet intervention research.

Effects of a Strategic Intervention with iPad Practice on the Multiplication Fact Performance of Fifth-Grade Students with Learning Disabilities

ERIC Educational Resources Information Center

Ok, Min Wook; Bryant, Diane Pedrotty

2016-01-01

This study investigated the effects of explicit, strategic intervention with iPad application practice on the multiplication fact performance and strategy use of elementary students with learning disabilities (LD) using a single-case, multiple probe design across participants. Four fifth-grade students with LD received 15 1:1 intervention sessions…

Translation system engineering in Escherichia coli enhances non-canonical amino acid incorporation into proteins.

PubMed

Gan, Rui; Perez, Jessica G; Carlson, Erik D; Ntai, Ioanna; Isaacs, Farren J; Kelleher, Neil L; Jewett, Michael C

2017-05-01

The ability to site-specifically incorporate non-canonical amino acids (ncAAs) into proteins has made possible the study of protein structure and function in fundamentally new ways, as well as the bio synthesis of unnatural polymers. However, the task of site-specifically incorporating multiple ncAAs into proteins with high purity and yield continues to present a challenge. At the heart of this challenge lies the lower efficiency of engineered orthogonal translation system components compared to their natural counterparts (e.g., translation elements that specifically use a ncAA and do not interact with the cell's natural translation apparatus). Here, we show that evolving and tuning expression levels of multiple components of an engineered translation system together as a whole enhances ncAA incorporation efficiency. Specifically, we increase protein yield when incorporating multiple p-azido-phenylalanine(pAzF) residues into proteins by (i) evolving the Methanocaldococcus jannaschii p-azido-phenylalanyl-tRNA synthetase anti-codon binding domain, (ii) evolving the elongation factor Tu amino acid-binding pocket, and (iii) tuning the expression of evolved translation machinery components in a single vector. Use of the evolved translation machinery in a genomically recoded organism lacking release factor one enabled enhanced multi-site ncAA incorporation into proteins. We anticipate that our approach to orthogonal translation system development will accelerate and expand our ability to site-specifically incorporate multiple ncAAs into proteins and biopolymers, advancing new horizons for synthetic and chemical biotechnology. Biotechnol. Bioeng. 2017;114: 1074-1086. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

AAC Modeling Intervention Research Review

ERIC Educational Resources Information Center

Sennott, Samuel C.; Light, Janice C.; McNaughton, David

2016-01-01

A systematic review of research on the effects of interventions that include communication partner modeling of aided augmentative and alternative communication (AAC) on the language acquisition of individuals with complex communication needs was conducted. Included studies incorporated AAC modeling as a primary component of the intervention,…

Incorporating Cultural Perspectives into Diabetes Self-Management Programs for East Asian Immigrants: A Mixed-Study Review.

PubMed

Park, Chorong; Nam, Soohyun; Whittemore, Robin

2016-04-01

It is important to understand East Asian immigrants (EAIs)' unique perspectives in managing diabetes in order to provide culturally-competent care. However, it is not known whether EAIs' perspectives are addressed in diabetes self-management interventions developed for EAIs. Therefore, a mixed-study review was conducted to identify EAIs' perspective from qualitative research (n = 9 studies) and to evaluate the components of EAI diabetes self-management interventions (n = 7). Themes from the qualitative synthesis demonstrated that EAIs have unique cultural values and traditional health beliefs while struggling with multi-contextual barriers due to immigration. The evaluation of EAI diabetes self-management interventions revealed that there was a lack of consensus on cultural strategies for EAIs' across the interventions. Addressing language barriers was the only factor consistently integrated in the cultural components of intervention by employing bilingual interventionists. EAIs' perspectives and experiences need to be incorporated in the future diabetes self-management interventions to better provide culturally-competent care.

Healthy urban environments for children and young people: A systematic review of intervention studies.

PubMed

Audrey, Suzanne; Batista-Ferrer, Harriet

2015-11-01

This systematic review collates, and presents as a narrative synthesis, evidence from interventions which included changes to the urban environment and reported at least one health behaviour or outcome for children and young people. Following a comprehensive search of six databases, 33 primary studies relating to 27 urban environment interventions were included. The majority of interventions related to active travel. Others included park and playground renovations, road traffic safety, and multi-component community-based initiatives. Public health evidence for effectiveness of such interventions is often weak because study designs tend to be opportunistic, non-randomised, use subjective outcome measures, and do not incorporate follow-up of study participants. However, there is some evidence of potential health benefits to children and young people from urban environment interventions relating to road safety and active travel, with evidence of promise for a multi-component obesity prevention initiative. Future research requires more robust study designs incorporating objective outcome measures. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Health Literacy and ESL study: a community-based intervention for Spanish-speaking adults.

PubMed

Soto Mas, Francisco; Ji, Ming; Fuentes, Brenda O; Tinajero, Josefina

2015-04-01

Although Hispanics have a documented high risk of limited health literacy, there is a scarcity of research with this population group, and particularly with Hispanic immigrants who generally confront language barriers that have been related to low health literacy. The National Action Plan to Improve Health Literacy identified community-based English-language instruction as a strategy that can facilitate a health literate society. However, the literature lacks discussion on this type of intervention. This randomized control trial aimed to test the feasibility of using conventional English-as-a-second-language (ESL) instruction for improving health literacy among Spanish-speaking adults. Objectives included the development, implementation, and evaluation of a health literacy/ESL curriculum. The Test of Functional Health Literacy in Adults (TOFHLA) in English was used to assess health literacy levels. Analyses included independent sample t test, chi-square, and multiple linear regression. A total of 155 people participated. Results showed a significantly higher increase in the TOFHLA posttest score in the intervention group (p = .01), and noticeable differences in health literacy levels between groups. Results indicate that ESL constitutes a promising venue for improving health literacy among Spanish-speaking adults. Incorporating health literacy-related content may provide additional benefits.

The Health Literacy and ESL Study: A Community-Based Intervention for Spanish-Speaking Adults

PubMed Central

MAS, FRANCISCO SOTO; JI, MING; FUENTES, BRENDA O.; TINAJERO, JOSEFINA

2015-01-01

Although Hispanics have a documented high risk of limited health literacy, there is a scarcity of research with this population group, and particularly with Hispanic immigrants who generally confront language barriers that have been related to low health literacy. The National Action Plan to Improve Health Literacy identified community-based English-language instruction as a strategy that can facilitate a health literate society. However, the literature lacks discussion on this type of intervention. This randomized control trial aimed to test the feasibility of using conventional English-as-a-second-language (ESL) instruction for improving health literacy among Spanish-speaking adults. Objectives included the development, implementation, and evaluation of a health literacy/ESL curriculum. The Test of Functional Health Literacy in Adults (TOFHLA) in English was used to assess health literacy levels. Analyses included independent sample t test, chi-square, and multiple linear regression. A total of 155 people participated. Results showed a significantly higher increase in the TOFHLA posttest score in the intervention group (p = .01), and noticeable differences in health literacy levels between groups. Results indicate that ESL constitutes a promising venue for improving health literacy among Spanish-speaking adults. Incorporating health literacy-related content may provide additional benefits. PMID:25602615

Impact of free delivery policy on utilization of maternal health services in county referral hospitals in Kenya.

PubMed

Njuguna, John; Kamau, Njoroge; Muruka, Charles

2017-06-21

Kenya has a high maternal mortality rate. Provision of skilled delivery plays a major role in reducing maternal mortality. Cost is a hindrance to the utilization of skilled delivery. The Government of Kenya introduced a policy of free delivery services in government facilities beginning June 2013. We sought to determine the impact of this intervention on facility based deliveries in Kenya. We compared deliveries and antenatal attendance in 47 county referral hospitals and 30 low cost private hospitals not participating in the free delivery policy for 2013 and 2014 respectively. The data was extracted from the Kenya Health Information System. Multiple regression was done to assess factors influencing increase in number of deliveries among the county referral hospitals. The number of deliveries and antenatal attendance increased by 26.8% and 16.2% in county referral hospitals and decreased by 11.9% and 5.4% respectively in low cost private hospitals. Increase in deliveries among county referral hospitals was influenced by population size of county and type of county referral hospital. Counties with level 5 hospitals recorded more deliveries compared to those with level 4 hospitals. This intervention increased the number of facility based deliveries. Policy makers may consider incorporating low cost private hospitals so as to increase the coverage of this intervention.

[Resident evaluation of general surgery training programs].

PubMed

Espinoza G, Ricardo; Danilla E, Stefan; Valdés G, Fabio; San Francisco R, Ignacio; Llanos L, Osvaldo

2009-07-01

The profile of the general surgeon has changed, aiming to incorporate new skills and to develop new specialties. To assess the quality of postgraduate General Surgery training programs given by Chilean universities, the satisfaction of students and their preferences after finishing the training period. A survey with multiple choice and Likert type questions was designed and applied to 77 surgery residents, corresponding to 59% of all residents of general surgery specialization programs of Chilean universities. Fifty five per cent of residents financed with their own resources the specialization program. Thirty nine percent disagreed partially or totally with the objectives and rotations of programs. The opportunity to perform surgical interventions and the support by teachers was well evaluated. However, 23% revealed teacher maltreatment. Fifty six percent performed research activities, 73% expected to continue training in a derived specialty and 69% was satisfied with the training program. Residents considered that the quality and dedication of professors and financing of programs are issues that must be improved. The opportunity to perform surgical interventions, obtaining a salary for their work and teacher support is considered of utmost importance.

A Pilot Study of a Creative Bonding Intervention to Promote Nursing Students' Attitudes towards Taking Care of Older People

PubMed Central

Lamet, Ann R.; Sonshine, Rosanne; Walsh, Sandra M.; Molnar, David; Rafalko, Sharon

2011-01-01

Although numbers of older people are increasing, nursing students have negative attitudes towards older people and do not plan to care for them following graduation. Multiple strategies have been implemented to reverse students' attitudes with mixed results. The purpose of this pilot quasi-experimental study was to test a Creative-Bonding Intervention (CBI) with students implementing art activities with older people to promote students' willingness to take care of them. Using a self-transcendence conceptual framework, control (n = 56) and experimental (n = 14) student groups were pre- and post-tested on attitudes toward older people, self-transcendence, and willingness to serve. The CBI improved attitudes towards older people with negative attitudes significantly changed (P = .008) but with no significant differences on self-transcendence and willingness to serve. However, willingness to serve results approached significance (P = .08). The willingness measure (one question) should be expanded. Curricula changes that incorporate creative activities such as the CBI with larger and equal numbers in student groups and longitudinal follow up to determine long-term results after graduation are suggested. PMID:21994833

Development and evaluation of the See Me Smoke-Free multi-behavioral mHealth app for women smokers.

PubMed

Gordon, Judith S; Armin, Julie; D Hingle, Melanie; Giacobbi, Peter; Cunningham, James K; Johnson, Thienne; Abbate, Kristopher; Howe, Carol L; Roe, Denise J

2017-06-01

Women face particular challenges when quitting smoking, especially those with weight concerns. A multi-behavioral smoking cessation intervention addressing these concerns and incorporating guided imagery may assist women to engage in healthy lifestyle behaviors. An mHealth app can easily disseminate such an intervention. The goals of this pilot study were to develop and test the feasibility and potential of the See Me Smoke-Free ™ mHealth app to address smoking, diet, and physical activity among women smokers. We used pragmatic, direct-to-consumer methods to develop and test program content, functionality, and the user interface and conduct a pre-/post-test, 90-day pilot study. We enrolled 151 participants. Attrition was 52%, leaving 73 participants. At 90 days, 47% of participants reported 7-day abstinence and significant increases in physical activity and fruit consumption. Recruitment methods worked well, but similar to other mHealth studies, we experienced high attrition. This study suggests that a guided imagery mHealth app has the potential to address multiple behaviors. Future research should consider different methods to improve retention and assess efficacy.

An In Situ One-Pot Synthetic Approach towards Multivariate Zirconium MOFs.

PubMed

Sun, Yujia; Sun, Lixian; Feng, Dawei; Zhou, Hong-Cai

2016-05-23

Chemically highly stable MOFs incorporating multiple functionalities are of great interest for applications under harsh environments. Herein, we presented a facile one-pot synthetic strategy to incorporate multiple functionalities into stable Zr-MOFs from mixed ligands of different geometry and connectivity. Via our strategy, tetratopic tetrakis(4-carboxyphenyl)porphyrin (TCPP) ligands were successfully integrated into UiO-66 while maintaining the crystal structure, morphology, and ultrahigh chemical stability of UiO-66. The amount of incorporated TCPP is controllable. Through various combinations of BDC derivatives and TCPP, 49 MOFs with multiple functionalities were obtained. Among them, MOFs modified with FeTCPPCl were demonstrated to be catalytically active for the oxidation of ABTS. We anticipate our strategy to provide a facile route to introduce multiple functionalities into stable Zr-MOFs for a wide variety of potential applications. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Early Intervention for Children at Risk for Reading Disabilities: The Impact of Grade at Intervention and Individual Differences on Intervention Outcomes

ERIC Educational Resources Information Center

Lovett, Maureen W.; Frijters, Jan C.; Wolf, Maryanne; Steinbach, Karen A.; Sevcik, Rose A.; Morris, Robin D.

2017-01-01

Across multiple schools and sites, the impact of grade-at-intervention was evaluated for children at risk or meeting criteria for reading disabilities. A multiple-component reading intervention with demonstrated efficacy was offered to small groups of children in 1st, 2nd, or 3rd grade. In a quasi-experimental design, 172 children received the…

Connect for Health: Design of a Clinical-Community Childhood Obesity Intervention Testing Best Practices of Positive Outliers

PubMed Central

Taveras, Elsie M.; Marshall, Richard; Sharifi, Mona; Avalon, Earlene; Fiechtner, Lauren; Horan, Christine; Orav, John; Price, Sarah N.; Sequist, Thomas; Slater, Daniel

2016-01-01

Background The Connect for Health study is designed to assess whether a novel approach to care delivery that leverages clinical and community resources and addresses socio-contextual factors will improve body mass index (BMI) and family-centered, obesity-related outcomes of interest to parents and children. The intervention is informed by clinical, community, parent, and youth stakeholders and incorporates successful strategies and best practices learned from ‘positive outlier” families, i.e., those who have succeeded in changing their health behaviors and improve their BMI in the context of adverse built and social environments. Design Two-arm, randomized controlled trial with measures at baseline and 12 months after randomization. Participants 2-12 year old children with overweight or obesity (BMI≥ 85th percentile) and their parents/guardians recruited from 6 pediatric practices in eastern Massachusetts. Intervention Children randomized to the intervention arm receive a contextually-tailored intervention delivered by trained health coaches who use advanced geographic information system tools to characterize children's environments and neighborhood resources. Health coaches link families to community-level resources and use multiple support modalities including text messages and virtual visits to support families over a one-year intervention period. The control group receives enhanced pediatric care plus non-tailored health coaching. Main Outcome Measures Lower age-associated increase in BMI over a 1-year period. The main parent- and child-reported outcome is improved health-related quality of life. Conclusions The Connect for Health study seeks to support families in leveraging clinical and community resources to improve obesity-related outcomes that are most important to parents and children. PMID:26427562

Pulmonary Physical Therapy Techniques to Enhance Survival in Amyotrophic Lateral Sclerosis: A Systematic Review.

PubMed

Macpherson, Chelsea E; Bassile, Clare C

2016-07-01

Respiratory insufficiency is the primary cause of morbidity and mortality in individuals with amyotrophic lateral sclerosis (ALS). Although mechanical interventions are effective in prolonging survival through respiratory support, pulmonary physical therapy interventions are being investigated. The purpose of this systematic review was to examine the effectiveness of pulmonary physical therapy interventions across the progressive stages of ALS. Six databases were searched for articles from inception to December 2014 investigating pulmonary physical therapy interventions in the ALS population. The search strategy followed Cochrane Collaboration guidelines with replication per database. Effect sizes (ES) were calculated for primary outcome measures: forced vital capacity (FVC) and peak cough expiratory flow (PCEF). Seven studies met inclusion criteria. Four studies used control groups whereas the remainder used repeated measures. With the exception of diaphragmatic breathing, pulmonary physical therapy interventions were effective in improving multiple respiratory outcome measures in this population. Inspiratory muscle training (IMT) was shown to prolong respiratory muscle strength with a strong effect size (ES = 1.48) for FVC. In addition, mean length of survival increased by 12 months. Lung volume recruitment training (LVRT) strongly enhanced immediate cough efficacy with improved FVC (ES = 1.02) and PCEF (ES = 1.82). Manually assisted cough (MAC) only improved PCEF by a small amount (ES = 0.15, bulbar ALS; ES = 0.16, classical ALS groups). Specific pulmonary physical therapy interventions (IMT, LVRT, and MAC) have effectiveness in improving respiratory outcome measures and increasing survival. These should be routinely incorporated into the comprehensive management of individuals with ALS. More rigorous methodological investigations should be performed to replicate these findings.Video abstract available with brief technique demonstration of IMT and LVRT (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A136).

Cueing, demand fading, and positive reinforcement to establish self-feeding and oral consumption in a child with chronic food refusal.

PubMed

Luiselli, J K

2000-07-01

A 3-year-old child with multiple medical disorders and chronic food refusal was treated successfully using a program that incorporated antecedent control procedures combined with positive reinforcement. The antecedent manipulations included visual cueing of a criterion number of self-feeding responses that were required during meals to receive reinforcement and a gradual increase in the imposed criterion (demand fading) that was based on improved frequency of oral consumption. As evaluated in a changing criterion design, the child learned to feed himself as an outcome of treatment. One year following intervention, he was consuming a variety of foods and had gained weight. Advantages of antecedent control methods for the treatment of chronic food refusal are discussed.

Perceptions of Family Among Low-Income Patients With Diabetes in a Text-Based Mobile Health Intervention.

PubMed

Burner, Elizabeth R E; Menchine, Michael D; Kubicek, Katrina; Robles, Marisela; Kagawa Singer, Marjorie; Arora, Sanjay

2018-04-01

Diabetes disproportionately affects the US Latino population, due to socioeconomic pressures, genetics, reduced access to care and cultural practices. While efforts to improve self-care through interventions incorporating family are highly rated by Latinos, family can be both supportive and obstructive. To develop effective interventions, this role needs clarification. We conducted group interviews in Spanish and English with 24 participants with diabetes from a mobile health diabetes self-care intervention. We imported transcripts into Dedoose, a qualitative computer analysis program and analyzed them with a modified grounded theory technique. Utilizing an iterative process, we reexamined transcripts with new codes derived in each round of analysis until saturation was reached. We employed techniques to improve trustworthiness (co-coding, member checking). Broad categorical themes arose from the initial codes and were developed into a conceptual model of barriers to and strategies for diabetes management. Family and family responsibilities emerged as both a supportive and obstructive force for diabetes self-care. While the desire to care for family motivated patients, food at family gatherings and pressure from managing multiple family responsibilities contributed to poor diet choices. Yet, some patients believed their diabetes caused their immediate family to make healthier choices. Among these predominantly Latino patients, family and family responsibilities were key motivators as well as obstacles to self-care, particularly regarding nutrition. Finding the ideal design for social support mHealth-based interventions will require careful study and creation of culturally based programs to match the needs of specific populations, and may require educating family members to provide effective social support.

Adaptive Intervention Design in Mobile Health: Intervention Design and Development in the Cell Phone Intervention for You (CITY) Trial

PubMed Central

Lin, Pao-Hwa; Intille, Stephen; Bennett, Gary; Bosworth, Hayden B; Corsino, Leonor; Voils, Corrine; Grambow, Steven; Lazenka, Tony; Batch, Bryan C; Tyson, Crystal; Svetkey, Laura P

2015-01-01

Background/Aims The obesity epidemic has spread to young adults, and obesity is a significant risk factor for cardiovascular disease. The prominence and increasing functionality of mobile phones may provide an opportunity to deliver longitudinal and scalable weight management interventions in young adults. The aim of this manuscript is to describe the design and development of the intervention tested in the Cell Phone Intervention for You (CITY) study and to highlight the importance of adaptive intervention design (AID) that made it possible. The CITY study was an NHLBI-sponsored, controlled 24-month randomized clinical trial (RCT) comparing two active interventions to a usual-care control group. Participants were 365 overweight or obese (BMI ≥ 25 kg/m2) young adults. Methods Both active interventions were designed based on social cognitive theory and incorporated techniques for behavioral self-management and motivational enhancement. Initial intervention development occurred during a 1-year formative phase utilizing focus groups and iterative, participatory design. During the intervention testing, AID, where an intervention is updated or extended throughout a trial while assuring the delivery of exactly the same intervention to each cohort, was employed. The AID strategy distributed technical work and allowed introduction of novel components in phases intended to help promote and sustain participant engagement. AID was made possible by exploiting the mobile phone's remote data capabilities so that adoption of particular application components could be continuously monitored and components subsequently added or updated remotely. Results The cellphone intervention was delivered almost entirely via cell phone and was always-present, proactive, and interactive – providing passive and active reminders, frequent opportunities for knowledge dissemination, and multiple tools for self-tracking and receiving tailored feedback. The intervention changed over two years to promote and sustain engagement. The personal coaching intervention, alternatively, was primarily personal coaching with trained coaches based on a proven intervention, enhanced with a mobile application, but where all interaction with the technology was participant-initiated. Conclusions The complexity and length of the technology-based RCT created challenges in engagement and technology adaptation, which were generally discovered using novel remote monitoring technology and addressed using the AID. Investigators should plan to develop tools and procedures that explicitly support continuous remote monitoring of interventions to support AID in long-term, technology-based studies, as well as developing the interventions themselves. PMID:26229119

Potential Benefits of Incorporating Peer-to-Peer Interactions Into Digital Interventions for Psychotic Disorders: A Systematic Review.

PubMed

Biagianti, Bruno; Quraishi, Sophia H; Schlosser, Danielle A

2018-04-01

Peer-to-peer interactions and support groups mitigate experiences of social isolation and loneliness often reported by individuals with psychotic disorders. Online peer-to-peer communication can promote broader use of this form of social support. Peer-to-peer interactions occur naturally on social media platforms, but they can negatively affect mental health. Recent digital interventions for persons with psychotic disorders have harnessed the principles of social media to incorporate peer-to-peer communication. This review examined the feasibility, acceptability, and preliminary efficacy of recent digital interventions in order to identify strategies to maximize benefits of online peer-to-peer communication for persons with psychotic disorders. An electronic database search of PubMed, EMBASE, PsycINFO, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database was conducted in February 2017 and yielded a total of 1,015 results. Eight publications that reported data from six independent trials and five interventions were reviewed. The technology supporting peer-to-peer communication varied greatly across studies, from online forums to embedded social networking. When peer-to-peer interactions were moderated by facilitators, retention, engagement, acceptability, and efficacy were higher than for interventions with no facilitators. Individuals with psychotic disorders were actively engaged with moderated peer-to-peer communication and showed improvements in perceived social support. Studies involving service users in intervention design showed higher rates of acceptability. Individuals with psychotic disorders value and benefit from digital interventions that include moderated peer-to-peer interactions. Incorporating peer-to-peer communication into digital interventions for this population may increase compliance with other evidence-based therapies by producing more acceptable and engaging online environments.

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.

Transforming the Morbidity and Mortality Conference to Promote Safety and Quality in a PICU.

PubMed

Cifra, Christina L; Bembea, Melania M; Fackler, James C; Miller, Marlene R

2016-01-01

Determine the effectiveness of a structured systems-oriented morbidity and mortality conference in improving the process of reviewing and responding to adverse events in a PICU. Prospective time series analysis before and after implementation of a systems-oriented morbidity and mortality conference. Single tertiary referral PICU in Baltimore, MD. Thirty-three patients discussed before and 31 patients after implementation of a systems-oriented morbidity and mortality conference over a total of 20 morbidity and mortality conferences, from April 2013 to March 2014. Systems-oriented morbidity and mortality conference incorporating elements of medical incident analysis. There was a significant increase in meeting attendance (mean, 12 vs 31 attendees per morbidity and mortality conference; p < 0.001) after the systems-oriented morbidity and mortality conference was instituted. There was no significant difference in the mean number of cases suggested (4.2 vs 4.6) or discussed (3.3 vs 3.1) per morbidity and mortality conference. There was also no significant difference in the mean number of adverse events identified per morbidity and mortality conference (3.4 vs 4.3). However, there was an increase in the proportion of cases discussed using a standard case review tool, but this did not reach statistical significance (27% vs 45%; p = 0.231). Nevertheless, we observed a significant increase in the mean number of quality improvement interventions suggested (2.4 vs 5.6; p < 0.001) and implemented (1.7 vs 4.4; p < 0.001) per morbidity and mortality conference. All adverse event categories identified had corresponding interventions suggested after the systems-oriented morbidity and mortality conference was instituted compared with before (80% vs 100%). Intervention-to-adverse event ratios per category were also higher (mean, 0.6 vs 1.5). A structured systems-oriented PICU morbidity and mortality conference incorporating elements of medical incident analysis improves the process of reviewing and responding to adverse events by significantly increasing quality improvement interventions suggested and implemented. Future work would involve testing locally adapted versions of the systems-oriented morbidity and mortality conference in multiple inpatient settings.

Preliminary evaluation of a telephone-based smoking cessation intervention in the lung cancer screening setting: A randomized clinical trial.

PubMed

Taylor, Kathryn L; Hagerman, Charlotte J; Luta, George; Bellini, Paula G; Stanton, Cassandra; Abrams, David B; Kramer, Jenna A; Anderson, Eric; Regis, Shawn; McKee, Andrea; McKee, Brady; Niaura, Ray; Harper, Harry; Ramsaier, Michael

2017-06-01

Incorporating effective smoking cessation interventions into lung cancer screening (LCS) programs will be essential to realizing the full benefit of screening. We conducted a pilot randomized trial to determine the feasibility and efficacy of a telephone-counseling (TC) smoking cessation intervention vs. usual care (UC) in the LCS setting. In collaboration with 3 geographically diverse LCS programs, we enrolled current smokers (61.5% participation rate) who were: registered to undergo LCS, 50-77 years old, and had a 20+ pack-year smoking history. Eligibility was not based on readiness to quit. Participants completed pre-LCS (T0) and post-LCS (T1) telephone assessments, were randomized to TC (N=46) vs. UC (N=46), and completed a final 3-month telephone assessment (T2). Both study arms received a list of evidence-based cessation resources. TC participants also received up to 6 brief counseling calls with a trained cessation counselor. Counseling calls incorporated motivational interviewing and utilized the screening result as a motivator for quitting. The outcome was biochemically verified 7-day point prevalence cessation at 3-months post-randomization. Participants (56.5% female) were 60.2 (SD=5.4) years old and reported 47.1 (SD=22.2) pack years; 30% were ready to stop smoking in the next 30 days. TC participants completed an average of 4.4 (SD=2.3) sessions. Using intent-to-treat analyses, biochemically verified quit rates were 17.4% (TC) vs. 4.3% (UC), p<.05. This study provides preliminary evidence that telephone-based cessation counseling is feasible and efficacious in the LCS setting. As millions of current smokers are now eligible for lung cancer screening, this setting represents an important opportunity to exert a large public health impact on cessation among smokers who are at very high risk for multiple tobacco-related diseases. If this evidence-based, brief, and scalable intervention is replicated, TC could help to improve the overall cost-effectiveness of LCS. NCT02267096, https://clinicaltrials.gov. Copyright © 2017 Elsevier B.V. All rights reserved.

Facilitating Vocabulary Acquisition of Children with Cochlear Implants Using Electronic Storybooks

ERIC Educational Resources Information Center

Messier, Jane; Wood, Carla

2015-01-01

The present intervention study explored the word learning of 18 children with cochlear implants in response to E-book instruction. Capitalizing on the multimedia options available in electronic storybooks, the intervention incorporated videos and definitions to provide a vocabulary intervention that includes evidence-based teaching strategies. The…

Adapting Homework for an Older Adult Client with Cognitive Impairment

ERIC Educational Resources Information Center

Coon, David W.; Thompson, Larry W.; Gallagher-Thompson, Dolores

2007-01-01

There is growing evidence that psychosocial treatments incorporating behavioral intervention strategies can be effective in the treatment of depression in older adults with cognitive impairment. However, less work with such cases has focused on the use of cognitive interventions in tandem with these behavioral intervention strategies. This case…

Proposed variations of the stepped-wedge design can be used to accommodate multiple interventions.

PubMed

Lyons, Vivian H; Li, Lingyu; Hughes, James P; Rowhani-Rahbar, Ali

2017-06-01

Stepped-wedge design (SWD) cluster-randomized trials have traditionally been used for evaluating a single intervention. We aimed to explore design variants suitable for evaluating multiple interventions in an SWD trial. We identified four specific variants of the traditional SWD that would allow two interventions to be conducted within a single cluster-randomized trial: concurrent, replacement, supplementation, and factorial SWDs. These variants were chosen to flexibly accommodate study characteristics that limit a one-size-fits-all approach for multiple interventions. In the concurrent SWD, each cluster receives only one intervention, unlike the other variants. The replacement SWD supports two interventions that will not or cannot be used at the same time. The supplementation SWD is appropriate when the second intervention requires the presence of the first intervention, and the factorial SWD supports the evaluation of intervention interactions. The precision for estimating intervention effects varies across the four variants. Selection of the appropriate design variant should be driven by the research question while considering the trade-off between the number of steps, number of clusters, restrictions for concurrent implementation of the interventions, lingering effects of each intervention, and precision of the intervention effect estimates. Copyright © 2017 Elsevier Inc. All rights reserved.

What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care.

PubMed

Sinnott, Carol; Hugh, Sheena Mc; Boyce, Maria B; Bradley, Colin P

2015-03-01

Using clinical guidelines in the management of patients with multimorbidity can lead to the prescription of multiple and sometimes conflicting medications. To explore how GPs make decisions when prescribing for multimorbid patients, with a view to informing intervention design. In-depth qualitative interviews incorporating chart-stimulated recall with purposively sampled GPs in the Republic of Ireland. Grounded theory analysis with iterative theory development. Twenty GPs were interviewed about 51 multimorbid cases. In these cases, GPs integrated information from multiple sources including the patient, specialists, and evidence-based medicine. Difficulties arose when recommendations or preferences conflicted, to which GPs responded by 'satisficing': accepting care that they deemed satisfactory and sufficient for a particular patient. Satisficing was manifest as relaxing targets for disease control, negotiating compromise with the patient, or making 'best guesses' about the most appropriate course of action to take. In multimorbid patients perceived as stable, GPs preferred to 'maintain the status quo' rather than rationalise medications, even in cases with significant polypharmacy. Proactive changes in medications were facilitated by continuity of care, sufficient consultation time, and open lines of communication with the patient, other healthcare professionals, and other GPs. GPs respond to conflicts in the management of multimorbid patients by making compromises between patient-centred and evidence-based care. These findings will be used to inform interventions that aim to care in multimorbidity. © British Journal of General Practice 2015.

Evidence basis for integrated management of mineral metabolism in patients with end-stage renal disease.

PubMed

Scialla, Julia J

2018-07-01

Treatment of mineral metabolism is a mainstay of dialysis care including some of its most widely used and costly pharmaceuticals. Although many mineral metabolites are associated with increased risk of mortality, cardiovascular disease, and other morbidities, few clinical trials are available to guide therapy and most focus on single drug approaches. In practice, providers manage many aspects of mineral metabolism simultaneously in integrated treatment approaches that incorporate multiple agents and changes in the dialysis prescription. The present review discusses the rationale and existing evidence for evaluating integrated, as opposed to single drug, approaches in mineral metabolism. Drugs used to treat mineral metabolism have numerous, and sometimes, opposing effects on biochemical risk factors, such as fibroblast growth factor 23 (FGF23), calcium, and phosphorus. Although vitamin D sterols raise these risk markers when lowering parathyroid hormone (PTH), calcimimetics lower them. Trials demonstrate that combined approaches best 'normalize' the mineral metabolism axis in end-stage renal disease (ESRD). Observations embedded within major trials of calcimimetics reveal that adjustment of calcium-based binders and dialysate calcium is a common approach to adverse effects of these drugs with some initial, but inconclusive, evidence that these co-interventions may impact outcomes. The multiple, and often opposing, biochemical effects of many mineral metabolism drugs provides a strong rationale for studying integrated management strategies that consider combinations of drugs and co-interventions as a whole. This remains a current gap in the field with opportunities for clinical trials.

A virtual reality patient simulation system for teaching emergency response skills to U.S. Navy medical providers.

PubMed

Freeman, K M; Thompson, S F; Allely, E B; Sobel, A L; Stansfield, S A; Pugh, W M

2001-01-01

Rapid and effective medical intervention in response to civil and military-related disasters is crucial for saving lives and limiting long-term disability. Inexperienced providers may suffer in performance when faced with limited supplies and the demands of stabilizing casualties not generally encountered in the comparatively resource-rich hospital setting. Head trauma and multiple injury cases are particularly complex to diagnose and treat, requiring the integration and processing of complex multimodal data. In this project, collaborators adapted and merged existing technologies to produce a flexible, modular patient simulation system with both three-dimensional virtual reality and two-dimensional flat screen user interfaces for teaching cognitive assessment and treatment skills. This experiential, problem-based training approach engages the user in a stress-filled, high fidelity world, providing multiple learning opportunities within a compressed period of time and without risk. The system simulates both the dynamic state of the patient and the results of user intervention, enabling trainees to watch the virtual patient deteriorate or stabilize as a result of their decision-making speed and accuracy. Systems can be deployed to the field enabling trainees to practice repeatedly until their skills are mastered and to maintain those skills once acquired. This paper describes the technologies and the process used to develop the trainers, the clinical algorithms, and the incorporation of teaching points. We also characterize aspects of the actual simulation exercise through the lens of the trainee.

Cognitive and Behavioral Resilience Among Young Gay and Bisexual Men Living with HIV.

PubMed

Hussen, Sophia A; Harper, Gary W; Rodgers, Caryn R R; van den Berg, Jacob J; Dowshen, Nadia; Hightow-Weidman, Lisa B

2017-08-01

HIV/AIDS disproportionately affects young gay, bisexual, and other men who have sex with men (Y-GBMSM). Resilience remains understudied among Y-GBMSM living with HIV, but represents a potentially important framework for improving HIV-related outcomes in this population. We sought to explore cognitive and behavioral dimensions of resilience and their correlates among Y-GBMSM to gain insights to inform future interventions. Our study sample consisted of 200 Y-GBMSM living with HIV enrolled in a multisite study of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Participants completed a one-time, self-administered structured questionnaire, including validated scales capturing a range of cognitive, behavioral, demographic, and psychosocial data. Utilizing these data, we examined cognitive and behavioral dimensions of resilience and their potential psychosocial correlates using linear regression modeling. Multiple regression analyses demonstrated that education, stigma, social support, ethnic identity, internalized homonegativity, and behavioral resilience were statistically significant predictors of cognitive resilience (P < 0.001, R 2  = 0.678). Social support satisfaction and cognitive resilience were significant predictors of behavioral resilience (P < 0.001, R 2  = 0.141). Our findings point to potential strategies for incorporating resilience-promoting features into future interventions to support Y-GBMSM living with HIV. Specifically, strengths-based interventions in this population should seek to enhance social support, promote positive identity development, and encourage education. Future research can also seek to utilize and refine our measures of resilience among youth.

Multiple Health Behavior Change Research: An Introduction and Overview

PubMed Central

Prochaska, Judith J.; Spring, Bonnie; Nigg, Claudio R.

2008-01-01

In 2002, the Society of Behavioral Medicine’s special interest group on Multiple Health Behavior Change was formed. The group focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions. However, there exists surprisingly little understanding of some very basic principles concerning multiple health behavior change (MHBC) research. This paper presents the rationale and need for MHBC research and interventions, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area. The prospects of MHBC for the health of individuals and populations are considerable. PMID:18319098

Information technology for the treatment of diabetes: improving outcomes and controlling costs.

PubMed

Wyne, Kathleen

2008-03-01

Diabetes in particular presents an ideal opportunity for the incorporation of information technology (IT) in the provision of care. The disease is highly prevalent in managed care populations, is frequently associated with comorbid conditions, and requires multiple medications in its management. Furthermore, effective diabetes care involves the monitoring of several measures of disease control, such as hemoglobin A1c (A1c) and lipid levels, by several different levels of providers, such as physicians, nurse practitioners, physician assistants, pharmacists, and dieticians. All of these factors combined make diabetes an opportune disease state for a case study of the implementation of health information technology (HIT) in managed care. To review practical applications of HIT for improving the delivery of care in diabetes management. Between 1990 and 2002, the incidence of type 2 diabetes increased by 61% in the United States. The total costs associated with diabetes have been increasing since the late 1970s as well, with a more dramatic rise over the last 10 years. In fact, the total cost of diabetes in the United States will approach $200 billion per year by the year 2020. In order to improve diabetes management efforts nation wide, the goal of glucose lowering therapy has been recommended to lower the hemoglobin A1c (A1c) to < 7% and keep it below that level long term. Other measures beyond A1c levels have also been identified as being important components to effective diabetes management and incorporated into national treatment recommendations, providing an ideal opportunity for the incorporation of HIT interventions. These interventions have been aimed at 3 different groups of stakeholders in managed care: payers, providers, and patients. While uncontrolled diabetes remains a major concern in managed care from both a health and a cost perspective, implementation of information technology enabled diabetes management (ITDM) has demonstrated significant potential for improving processes of care, preventing the development of diabetic complications, and generating cost savings. ITDM improves the synthesis of information, the delivery of knowledge, and the efficiency of communication, allowing for coordination of care across delivery teams. Of the existing technologies targeting providers, patients, and payers, provider centered interventions, such as diabetes registries currently show the most potential for benefit in improving outcomes and reducing costs.

Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: randomized controlled pilot trial.

PubMed

Lappalainen, Päivi; Kaipainen, Kirsikka; Lappalainen, Raimo; Hoffrén, Henna; Myllymäki, Tero; Kinnunen, Marja-Liisa; Mattila, Elina; Happonen, Antti P; Rusko, Heikki; Korhonen, Ilkka

2013-01-09

Work-related stress is a significant problem for both people and organizations. It may lead to mental illnesses such as anxiety and depression, resulting in increased work absences and disabilities. Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training. The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems. P4Well is a novel intervention which combines modern psychotherapy (the cognitive behavioral therapy and the acceptance and commitment therapy) with personal health technologies to deliver the intervention via multiple channels, includinggroup meetings, Internet/Web portal, mobile phone applications, and personal monitoring devices. This pilot study design was a small-scale randomized controlled trial that compared the P4Well intervention with a waiting list control group. In addition to personal health technologies for self-assessment, the intervention consisted of 3 psychologist-assisted group meetings. Self-assessed psychological measures through questionnaires were collected offline pre- and post-intervention, and 6 months after the intervention for the intervention group. Acceptance and usage of technology tools were measured with user experience questionnaires and usage logs. A total of 24 subjects were randomized: 11 participants were followed up in the intervention group (1 was lost to follow-up) and 12 participants did not receive any intervention (control group). Depressive and psychological symptoms decreased and self-rated health and working ability increased. All participants reported they had benefited from the intervention. All technology tools had active users and 10/11 participants used at least 1 tool actively. Physiological measurements with personal feedback were considered the most useful intervention component. Our results confirm the feasibility of the intervention and suggest that it had positive effects on psychological symptoms, self-rated health, and self-rated working ability. The intervention seemed to have a positive impact on certain aspects of burnout and job strain, such as cynicism and over-commitment. Future studies need to investigate the effectiveness, benefits, and possible problems of psychological interventions which incorporate new technologies. The Finnish Funding Agency for Technology and Innovation (TEKES), Project number 40011/08.

Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City

PubMed Central

2014-01-01

Background Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. Methods We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children’s height and weight and parents reported children’s diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. Results 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. Conclusions Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. Trial registration ClinicalTrials.gov NCT01539070. Comisión Nacional de Investigación Científica del IMSS: 2009-785-120. PMID:24649831

Prevention interventions for human immunodeficiency virus in drug-using women with a history of partner violence

PubMed Central

Stockman, Jamila K; Ludwig-Barron, Natasha; Hoffman, Monica A; Ulibarri, Monica D; Dyer, Typhanye V Penniman

2012-01-01

The intersecting epidemics of human immunodeficiency virus (HIV) and partner violence disproportionately affect women who use drugs. Despite accumulating evidence throughout the world linking these epidemics, HIV prevention efforts focused on these synergistic issues as well as underlying determinants that contribute to the HIV risk environment (eg, housing instability, incarceration, policing practices, survival sex) are lacking. This article highlights selected behavior change theories and biomedical approaches that have been used or could be applied in HIV prevention interventions for drug-using women with histories of partner violence and in existing HIV prevention interventions for drug-using women that have been gender-focused while integrating histories of partner violence and/or relationship power dynamics. To date, there is a paucity of HIV prevention interventions designed for drug-using women (both in and outside of drug treatment programs) with histories of partner violence. Of the few that exist, they have been theory-driven, culture-specific, and address certain aspects of gender-based inequalities (eg, gender-specific norms, relationship power and control, partner violence through assessment of personal risk and safety planning). However, no single intervention has addressed all of these issues. Moreover, HIV prevention interventions for drug-using women with histories of partner violence are not widespread and do not address multiple components of the risk environment. Efficacious interventions should target individuals, men, couples, and social networks. There is also a critical need for the development of culturally tailored combination HIV prevention interventions that not only incorporate evidence-based behavioral and biomedical approaches (eg, microbicides, pre-exposure prophylaxis, female-initiated barrier methods) but also take into account the risk environment at the physical, social, economic and political levels. Ultimately, this approach will have a significant impact on reducing HIV infections among drug-using women with histories of partner violence. PMID:24500422

Prevention interventions for human immunodeficiency virus in drug-using women with a history of partner violence.

PubMed

Stockman, Jamila K; Ludwig-Barron, Natasha; Hoffman, Monica A; Ulibarri, Monica D; Dyer, Typhanye V Penniman

2012-01-01

The intersecting epidemics of human immunodeficiency virus (HIV) and partner violence disproportionately affect women who use drugs. Despite accumulating evidence throughout the world linking these epidemics, HIV prevention efforts focused on these synergistic issues as well as underlying determinants that contribute to the HIV risk environment (eg, housing instability, incarceration, policing practices, survival sex) are lacking. This article highlights selected behavior change theories and biomedical approaches that have been used or could be applied in HIV prevention interventions for drug-using women with histories of partner violence and in existing HIV prevention interventions for drug-using women that have been gender-focused while integrating histories of partner violence and/or relationship power dynamics. To date, there is a paucity of HIV prevention interventions designed for drug-using women (both in and outside of drug treatment programs) with histories of partner violence. Of the few that exist, they have been theory-driven, culture-specific, and address certain aspects of gender-based inequalities (eg, gender-specific norms, relationship power and control, partner violence through assessment of personal risk and safety planning). However, no single intervention has addressed all of these issues. Moreover, HIV prevention interventions for drug-using women with histories of partner violence are not widespread and do not address multiple components of the risk environment. Efficacious interventions should target individuals, men, couples, and social networks. There is also a critical need for the development of culturally tailored combination HIV prevention interventions that not only incorporate evidence-based behavioral and biomedical approaches (eg, microbicides, pre-exposure prophylaxis, female-initiated barrier methods) but also take into account the risk environment at the physical, social, economic and political levels. Ultimately, this approach will have a significant impact on reducing HIV infections among drug-using women with histories of partner violence.

Improving medical records filing in a municipal hospital in Ghana.

PubMed

Teviu, E A A; Aikins, M; Abdulai, T I; Sackey, S; Boni, P; Afari, E; Wurapa, F

2012-09-01

Medical records are kept in the interest of both the patient and clinician. Proper filing of patient's medical records ensures easy retrieval and contributes to decreased patient waiting time at the hospital and continuity of care. This paper reports on an intervention study to address the issue of misfiling and multiple patient folders in a health facility. Intervention study. Municipal Hospital, Goaso, Asunafo North District, Brong Ahafo Region, Ghana. Methods employed for data collection were records review, direct observation and tracking of folders. Interventions instituted were staff durbars, advocacy and communication, consultations, in-service trainings, procurement and monitoring. Factors contributing to issuance of multiple folders and misfiling were determined. Proportion of multiple folders was estimated. Results revealed direct and indirect factors contributing to issuance of multiple patient folders and misfiling. Interventions and monitoring reduce acquisition of numerous medical folders per patient and misfiling. After the intervention, there was significant reduction in the use of multiple folders (i.e., overall 97% reduction) and a high usage of single patient medical folders (i.e., 99%). In conclusion, a defined medical records filing system with adequate training, logistics and regular monitoring and supervision minimises issuance of multiple folders and misfiling.

Incorporating prosocial behavior to promote physical activity in older adults: Rationale and design of the Program for Active Aging and Community Engagement (PACE)☆, ☆☆

PubMed Central

Foy, Capri G.; Vitolins, Mara Z.; Case, L. Douglas; Harris, Susan J.; Massa-Fanale, Carol; Hopley, Richard J.; Gardner, Leah; Rudiger, Nicole; Yamamoto, Kathryn; Swain, Brittany; Goff, David C.; Danhauer, Suzanne C.; Booth, Deborah; Gaspari, Jamie

2014-01-01

Despite the benefits of regular physical activity among older adults, physical activity rates are low in this population. The Program for Active Aging and Community Engagement (PACE) is an ongoing randomized controlled trial designed to compare the effects of two interventions on physical activity at 12 months among older adults. A total of 300 men and women aged 55 years or older will be randomized into either a healthy aging (HA) control intervention (n = 150), which is largely based upon educational sessions, or a prosocial behavior physical activity (PBPA) intervention (n = 150), which incorporates structured physical activity sessions, cognitive-behavioral counseling, and opportunities to earn food for donation to a regional food bank based on weekly physical activity and volunteering. The PBPA intervention is delivered at a local YMCA, and a regional grocery store chain donates the food to the food bank. Data will be collected at baseline, 3, 6, and 12 months. The primary outcome is physical activity as assessed by the Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire at 12 months. Secondary outcomes include physical function and health-related quality of life. If successful, the PACE study will demonstrate that prosocial behavior and volunteerism may be efficaciously incorporated into interventions and will provide evidence for a novel motivating factor for physical activity. PMID:23876672

Incorporating prosocial behavior to promote physical activity in older adults: rationale and design of the Program for Active Aging and Community Engagement (PACE).

PubMed

Foy, Capri G; Vitolins, Mara Z; Case, L Douglas; Harris, Susan J; Massa-Fanale, Carol; Hopley, Richard J; Gardner, Leah; Rudiger, Nicole; Yamamoto, Kathryn; Swain, Brittany; Goff, David C; Danhauer, Suzanne C; Booth, Deborah; Gaspari, Jamie

2013-09-01

Despite the benefits of regular physical activity among older adults, physical activity rates are low in this population. The Program for Active Aging and Community Engagement (PACE) is an ongoing randomized controlled trial designed to compare the effects of two interventions on physical activity at 12 months among older adults. A total of 300 men and women aged 55 years or older will be randomized into either a healthy aging (HA) control intervention (n = 150), which is largely based upon educational sessions, or a prosocial behavior physical activity (PBPA) intervention (n = 150), which incorporates structured physical activity sessions, cognitive-behavioral counseling, and opportunities to earn food for donation to a regional food bank based on weekly physical activity and volunteering. The PBPA intervention is delivered at a local YMCA, and a regional grocery store chain donates the food to the food bank. Data will be collected at baseline, 3, 6, and 12 months. The primary outcome is physical activity as assessed by the Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire at 12 months. Secondary outcomes include physical function and health-related quality of life. If successful, the PACE study will demonstrate that prosocial behavior and volunteerism may be efficaciously incorporated into interventions and will provide evidence for a novel motivating factor for physical activity. © 2013.

People with multiple unhealthy lifestyles are less likely to consult primary healthcare

PubMed Central

2014-01-01

Background Behavioural interventions are often implemented within primary healthcare settings to prevent type 2 diabetes and other lifestyle-related diseases. Although smoking, alcohol consumption, physical inactivity and poor diet are associated with poorer health that may lead a person to consult a general practitioner (GP), previous work has shown that unhealthy lifestyles cluster among low socioeconomic groups who are less likely to seek primary healthcare. Therefore, it is uncertain whether behavioural interventions in primary healthcare are reaching those in most need. This study investigated patterns of GP consultations in relation to the clustering of unhealthy lifestyles among a large sample of adults aged 45 years and older in New South Wales, Australia. Methods A total of 267,153 adults participated in the 45 and Up Study between 2006 and 2009, comprising 10% of the equivalent demographic in the state of New South Wales, Australia (response rate: 18%). All consultations with GPs within 6 months prior and post survey completion were identified (with many respondents attending multiple GPs) via linkage to Medicare Australia data. An index of unhealthy lifestyles was constructed from self-report data on adherence to published guidelines on smoking, alcohol consumption, diet and physical activity. Logistic and zero-truncated negative binomial regression models were used to analyse: (i) whether or not a person had at least one GP consultation within the study period; (ii) the count of GP consultations attended by each participant who visited a GP at least once. Analyses were adjusted for measures of health status, socioeconomic circumstances and other confounders. Results After adjustment, participants scoring 7 unhealthy lifestyles were 24% more likely than persons scoring 0 unhealthy lifestyles not to have attended any GP consultation in the 12-month time period. Among those who attended at least one consultation, those with 7 unhealthy lifestyles reported 7% fewer consultations than persons with 0 unhealthy lifestyles. No effect modification was observed. Conclusion To optimise the prevention of lifestyle-related diseases, interventions for positive behavioural change need to incorporate non-primary healthcare settings in order to reach people with multiple unhealthy lifestyles. PMID:24965672

People with multiple unhealthy lifestyles are less likely to consult primary healthcare.

PubMed

Feng, Xiaoqi; Girosi, Federico; McRae, Ian S

2014-06-26

Behavioural interventions are often implemented within primary healthcare settings to prevent type 2 diabetes and other lifestyle-related diseases. Although smoking, alcohol consumption, physical inactivity and poor diet are associated with poorer health that may lead a person to consult a general practitioner (GP), previous work has shown that unhealthy lifestyles cluster among low socioeconomic groups who are less likely to seek primary healthcare. Therefore, it is uncertain whether behavioural interventions in primary healthcare are reaching those in most need. This study investigated patterns of GP consultations in relation to the clustering of unhealthy lifestyles among a large sample of adults aged 45 years and older in New South Wales, Australia. A total of 267,153 adults participated in the 45 and Up Study between 2006 and 2009, comprising 10% of the equivalent demographic in the state of New South Wales, Australia (response rate: 18%). All consultations with GPs within 6 months prior and post survey completion were identified (with many respondents attending multiple GPs) via linkage to Medicare Australia data. An index of unhealthy lifestyles was constructed from self-report data on adherence to published guidelines on smoking, alcohol consumption, diet and physical activity. Logistic and zero-truncated negative binomial regression models were used to analyse: (i) whether or not a person had at least one GP consultation within the study period; (ii) the count of GP consultations attended by each participant who visited a GP at least once. Analyses were adjusted for measures of health status, socioeconomic circumstances and other confounders. After adjustment, participants scoring 7 unhealthy lifestyles were 24% more likely than persons scoring 0 unhealthy lifestyles not to have attended any GP consultation in the 12-month time period. Among those who attended at least one consultation, those with 7 unhealthy lifestyles reported 7% fewer consultations than persons with 0 unhealthy lifestyles. No effect modification was observed. To optimise the prevention of lifestyle-related diseases, interventions for positive behavioural change need to incorporate non-primary healthcare settings in order to reach people with multiple unhealthy lifestyles.

Adaptive intervention design in mobile health: Intervention design and development in the Cell Phone Intervention for You trial.

PubMed

Lin, Pao-Hwa; Intille, Stephen; Bennett, Gary; Bosworth, Hayden B; Corsino, Leonor; Voils, Corrine; Grambow, Steven; Lazenka, Tony; Batch, Bryan C; Tyson, Crystal; Svetkey, Laura P

2015-12-01

The obesity epidemic has spread to young adults, and obesity is a significant risk factor for cardiovascular disease. The prominence and increasing functionality of mobile phones may provide an opportunity to deliver longitudinal and scalable weight management interventions in young adults. The aim of this article is to describe the design and development of the intervention tested in the Cell Phone Intervention for You study and to highlight the importance of adaptive intervention design that made it possible. The Cell Phone Intervention for You study was a National Heart, Lung, and Blood Institute-sponsored, controlled, 24-month randomized clinical trial comparing two active interventions to a usual-care control group. Participants were 365 overweight or obese (body mass index≥25 kg/m2) young adults. Both active interventions were designed based on social cognitive theory and incorporated techniques for behavioral self-management and motivational enhancement. Initial intervention development occurred during a 1-year formative phase utilizing focus groups and iterative, participatory design. During the intervention testing, adaptive intervention design, where an intervention is updated or extended throughout a trial while assuring the delivery of exactly the same intervention to each cohort, was employed. The adaptive intervention design strategy distributed technical work and allowed introduction of novel components in phases intended to help promote and sustain participant engagement. Adaptive intervention design was made possible by exploiting the mobile phone's remote data capabilities so that adoption of particular application components could be continuously monitored and components subsequently added or updated remotely. The cell phone intervention was delivered almost entirely via cell phone and was always-present, proactive, and interactive-providing passive and active reminders, frequent opportunities for knowledge dissemination, and multiple tools for self-tracking and receiving tailored feedback. The intervention changed over 2 years to promote and sustain engagement. The personal coaching intervention, alternatively, was primarily personal coaching with trained coaches based on a proven intervention, enhanced with a mobile application, but where all interactions with the technology were participant-initiated. The complexity and length of the technology-based randomized clinical trial created challenges in engagement and technology adaptation, which were generally discovered using novel remote monitoring technology and addressed using the adaptive intervention design. Investigators should plan to develop tools and procedures that explicitly support continuous remote monitoring of interventions to support adaptive intervention design in long-term, technology-based studies, as well as developing the interventions themselves. © The Author(s) 2015.

The Acceptability of Incorporating a Youth Smoking Prevention Intervention in the Pediatric Emergency Department

PubMed Central

Mahabee-Gittens, E. Melinda; Chen, Chen; Huang, Bin; Gordon, Judith

2014-01-01

The pediatric emergency department (PED) is under-utilized as a setting in which to provide tobacco prevention interventions for at-risk children. We sought to determine the acceptability and feasibility of incorporating a brief, parental tobacco prevention intervention to 520 parents during the PED visit. Mean age (SD) of parents and children was 38.6 (7.1) and 11.5 (1.1), respectively; 47% of children were female; 45% were African American; 36% of parents had an annual income less than $25,000; 28.8% of parents were current smokers. Over 90% of parents said the intervention provided “useful” and “easy to understand” information and 97% of practitioners said it did not “interfere with clinical care.” Given the high prevalence of parental smoking in the PED, there is a high likelihood that their children will initiate smoking in the future. Thus, the use of the PED as a venue to providing tobacco prevention interventions warrants further evaluation. PMID:24858886

The Shared Decision Making Frontier: a Feasibility and Usability Study for Managing Non-Critical Chronic Illness by Combining Behavioural & Decision Theory with Online Technology.

PubMed

Russell, Amina; Van Woensel, William; Abidi, Samina Raza

2015-01-01

The objective of this study is to determine if shared decisions for managing non-critical chronic illness, made through an online biomedical technology intervention, us feasible and usable. The technology intervention incorporates behavioural and decision theories to increase patient engagement, and ultimately long term adherence to health behaviour change. We devised the iheart web intervention as a "proof of concept" in five phases. The implementation incorporates the Vaadin web application framework, Drools, EclipseLink and a MySQL database. Two-thirds of the study participants favoured the technology intervention, based on Likert-scale questions from a post-study questionnaire. Qualitative analysis of think aloud feedback, video screen captures and open-ended questions from the post-study questionnaire uncovered six main areas or themes for improvement. We conclude that online shared decisions for managing a non-critical chronic illness are feasible and usable through the iheart web intervention.

Dual lumen transducer probes for real-time 3-D interventional cardiac ultrasound.

PubMed

Lee, Warren; Idriss, Salim F; Wolf, Patrick D; Smith, Stephen W

2003-09-01

We have developed dual lumen probes incorporating a forward-viewing matrix array transducer with an integrated working lumen for delivery of tools in real-time 3-D (RT3-D) interventional echocardiography. The probes are of 14 Fr and 22 Fr sizes, with 112 channel 2-D arrays operating at 5 MHz. We obtained images of cardiac anatomy and simultaneous interventional device delivery with an in vivo sheep model, including: manipulation of a 0.36-mm diameter guidewire into the coronary sinus, guidance of a transseptal puncture using a 1.2-mm diameter Brockenbrough needle, and guidance of a right ventricular biopsy using 3 Fr biopsy forceps. We have also incorporated the 22 Fr probe within a 6-mm surgical trocar to obtain apical four-chamber ultrasound (US) scans from a subcostal position. Combining the imaging catheter with a working lumen in a single device may simplify cardiac interventional procedures by allowing clinicians to easily visualize cardiac structures and simultaneously direct interventional tools in a RT3-D image.

Incorporation of multiple cloud layers for ultraviolet radiation modeling studies

NASA Technical Reports Server (NTRS)

Charache, Darryl H.; Abreu, Vincent J.; Kuhn, William R.; Skinner, Wilbert R.

1994-01-01

Cloud data sets compiled from surface observations were used to develop an algorithm for incorporating multiple cloud layers into a multiple-scattering radiative transfer model. Aerosol extinction and ozone data sets were also incorporated to estimate the seasonally averaged ultraviolet (UV) flux reaching the surface of the Earth in the Detroit, Michigan, region for the years 1979-1991, corresponding to Total Ozone Mapping Spectrometer (TOMS) version 6 ozone observations. The calculated UV spectrum was convolved with an erythema action spectrum to estimate the effective biological exposure for erythema. Calculations show that decreasing the total column density of ozone by 1% leads to an increase in erythemal exposure by approximately 1.1-1.3%, in good agreement with previous studies. A comparison of the UV radiation budget at the surface between a single cloud layer method and a multiple cloud layer method presented here is discussed, along with limitations of each technique. With improved parameterization of cloud properties, and as knowledge of biological effects of UV exposure increase, inclusion of multiple cloud layers may be important in accurately determining the biologically effective UV budget at the surface of the Earth.

Economic Evaluation as a Component of Quality Effectiveness Research: Methodological and Practical Benefits

ERIC Educational Resources Information Center

Olsson, Tina M.

2012-01-01

Background: As research moves from questions of efficacy (can an intervention work) to questions of effectiveness (does an intervention work in practice), questions of efficiency (what are the costs and consequences of the intervention) become increasingly important. The incorporation of economic evaluation into the planning and execution of…

The Importance and Role of Intracluster Correlations in Planning Cluster Trials

PubMed Central

Preisser, John S.; Reboussin, Beth A.; Song, Eun-Young; Wolfson, Mark

2008-01-01

There is increasing recognition of the critical role of intracluster correlations of health behavior outcomes in cluster intervention trials. This study examines the estimation, reporting, and use of intracluster correlations in planning cluster trials. We use an estimating equations approach to estimate the intracluster correlations corresponding to the multiple-time-point nested cross-sectional design. Sample size formulae incorporating 2 types of intracluster correlations are examined for the purpose of planning future trials. The traditional intracluster correlation is the correlation among individuals within the same community at a specific time point. A second type is the correlation among individuals within the same community at different time points. For a “time × condition” analysis of a pretest–posttest nested cross-sectional trial design, we show that statistical power considerations based upon a posttest-only design generally are not an adequate substitute for sample size calculations that incorporate both types of intracluster correlations. Estimation, reporting, and use of intracluster correlations are illustrated for several dichotomous measures related to underage drinking collected as part of a large nonrandomized trial to enforce underage drinking laws in the United States from 1998 to 2004. PMID:17879427

A nursing-specific model of EPR documentation: organizational and professional requirements.

PubMed

von Krogh, Gunn; Nåden, Dagfinn

2008-01-01

To present the Norwegian documentation KPO model (quality assurance, problem solving, and caring). To present the requirements and multiple electronic patient record (EPR) functions the model is designed to address. The model's professional substance, a conceptual framework for nursing practice is developed by examining, reorganizing, and completing existing frameworks. The model's methodology, an information management system, is developed using an expert group. Both model elements were clinically tested over a period of 1 year. The model is designed for nursing documentation in step with statutory, organizational, and professional requirements. Complete documentation is arranged for by incorporating the Nursing Minimum Data Set. A systematic and comprehensive documentation is arranged for by establishing categories as provided in the model's framework domains. Consistent documentation is arranged for by incorporating NANDA-I Nursing Diagnoses, Nursing Intervention Classification, and Nursing Outcome Classification. The model can be used as a tool in cooperation with vendors to ensure the interests of the nursing profession is met when developing EPR solutions in healthcare. The model can provide clinicians with a framework for documentation in step with legal and organizational requirements and at the same time retain the ability to record all aspects of clinical nursing.

Proposed variations of the stepped-wedge design can be used to accommodate multiple interventions

PubMed Central

Lyons, Vivian H; Li, Lingyu; Hughes, James P; Rowhani-Rahbar, Ali

2018-01-01

Objective Stepped wedge design (SWD) cluster randomized trials have traditionally been used for evaluating a single intervention. We aimed to explore design variants suitable for evaluating multiple interventions in a SWD trial. Study Design and Setting We identified four specific variants of the traditional SWD that would allow two interventions to be conducted within a single cluster randomized trial: Concurrent, Replacement, Supplementation and Factorial SWDs. These variants were chosen to flexibly accommodate study characteristics that limit a one-size-fits-all approach for multiple interventions. Results In the Concurrent SWD, each cluster receives only one intervention, unlike the other variants. The Replacement SWD supports two interventions that will not or cannot be employed at the same time. The Supplementation SWD is appropriate when the second intervention requires the presence of the first intervention, and the Factorial SWD supports the evaluation of intervention interactions. The precision for estimating intervention effects varies across the four variants. Conclusion Selection of the appropriate design variant should be driven by the research question while considering the trade-off between the number of steps, number of clusters, restrictions for concurrent implementation of the interventions, lingering effects of each intervention, and precision of the intervention effect estimates. PMID:28412466

Influence of an injury reduction program on injury and fitness outcomes among soldiers

PubMed Central

Knapik, J; Bullock, S; Canada, S; Toney, E; Wells, J; Hoedebecke, E; Jones, B

2004-01-01

Objective: This study evaluated the influence of a multiple injury control intervention on injury and physical fitness outcomes among soldiers attending United States Army Ordnance School Advanced Individual Training. Methods: The study design was quasiexperimental involving a historical control group (n = 2559) that was compared to a multiple intervention group (n = 1283). Interventions in the multiple intervention group included modified physical training, injury education, and a unit based injury surveillance system (UBISS). The management responsible for training independently formed an Injury Control Advisory Committee that examined surveillance reports from the UBISS and recommended changes to training. On arrival at school, individual soldiers completed a demographics and lifestyle questionnaire and took an army physical fitness test (APFT: push-ups, sit-ups, and two mile run). Injuries among soldiers were tracked by a clinic based injury surveillance system that was separate from the UBISS. Soldiers completed a final APFT eight weeks after arrival at school. Results: Cox regression (survival analysis) was used to examine differences in time to the first injury while controlling for group differences in demographics, lifestyle characteristics, and physical fitness. The adjusted relative risk of a time loss injury was 1.5 (95% confidence interval 1.2 to 1.8) times higher in the historical control men and 1.8 (95% confidence interval 1.1 to 2.8) times higher in the historical control women compared with the multiple intervention men and women, respectively. After correcting for the lower initial fitness of the multiple intervention group, there were no significant differences between the multiple intervention and historical control groups in terms of improvements in push-ups, sit-ups, or two mile run performance. Conclusions: This multiple intervention program contributed to a reduction in injuries while improvements in physical fitness were similar to a traditional physical training program previously used at the school. PMID:14760025

Increasing Retention of Adult Learners in Telecourses through the Incorporation of Learning-Centered Instructional Strategies and the Use of Multiple Modalities for Content Delivery and Interaction.

ERIC Educational Resources Information Center

Nelson, Lin M.

A project was undertaken to increase retention in a health education telecourse by incorporating a competency-based orientation to distance learning and learner-centered instructional strategies into the telecourse, and by using multiple media for content delivery and interaction. A general orientation to distance learning was developed that…

Speech and Language Therapists' Approaches to Communication Intervention with Children and Adults with Profound and Multiple Learning Disability

ERIC Educational Resources Information Center

Goldbart, Juliet; Chadwick, Darren; Buell, Susan

2014-01-01

Background: People with profound intellectual and multiple disabilities (PMLD) have communication impairments as one defining characteristic. Aims: To explore speech and language therapists' (SLTs) decision making in communication interventions for people with PMLD, in terms of the intervention approaches used, the factors informing the decisions…

Brief Alcohol Interventions and Multiple Risk Factors in Primary Care

ERIC Educational Resources Information Center

Funderburk, Jennifer S.; Maisto, Stephen A.; Sugarman, Dawn E.

2007-01-01

Early identification and intervention of harmful/hazardous drinking in primary care are U.S. healthcare priorities. Traditionally, research has focused on designing interventions for patients in primary care who report hazardous/harmful alcohol use, even though it is likely for a patient to be at risk for multiple problems. This article has three…

Pediatric magnet ingestions: the dark side of the force.

PubMed

Brown, Julie C; Otjen, Jeffrey P; Drugas, George T

2014-05-01

Pediatric magnet ingestions are increasing. Commercial availability of rare-earth magnets poses a serious health risk. This study defines incidence, characteristics, and management of ingestions over time. Cases were identified by searching radiology reports from June 2002 to December 2012 at a children's hospital and verified by chart and imaging review. Relative risk (RR) regressions determined changes in incidence and interventions over time. In all, 98% of ingestions occurred since 2006; 57% involved multiple magnets. Median age was 8 years (range 0 to 18); 0% of single and 56% of multiple ingestions required intervention. Compared with 2007 to 2009, ingestions increased from 2010 to 2012 (RR = 1.9, 95% confidence interval 1.2 to 3.0). Intervention proportion was unchanged (RR = .94, 95% confidence interval .4 to 2.2). Small spherical magnets comprised 26.8% of ingestions since 2010; 86% involved multiple magnets and 47% required intervention. Pediatric magnet ingestions and interventions have increased. Multiple ingestions prompt more imaging and surgical interventions. Magnet safety standards are needed to decrease risk to children. Copyright © 2014 Elsevier Inc. All rights reserved.

Men's Preferences for Physical Activity Interventions: An Exploratory Study Using a Factorial Survey Design Created With R Software.

PubMed

Chatfield, Sheryl L; Gamble, Abigail; Hallam, Jeffrey S

2018-03-01

Effective exercise interventions are needed to improve quality of life and decrease the impact of chronic disease. Researchers suggest males have been underrepresented in exercise intervention studies, resulting in less understanding of their exercise practices. Findings from preference survey methods suggest reasonable association between preference and behavior. The purpose of the research described in this article was to use factorial survey, a preference method, to identify the characteristics of exercise interventions most likely to appeal to male participants, so preferences might be incorporated into future intervention research. The research was guided by the framework of Bandura's social cognitive theory, such that variations in individual, environmental, and behavioral factors were incorporated into vignettes. Participants included 53 adult male nonadministrative staff and contract employees at a public university in the Southeastern United States, who each scored 8 vignettes resulting in 423 observations. Multilevel models were used to assess the influence of the factors. Participants scored vignettes that included exercising with a single partner, playing basketball, and exercising in the evening higher than vignettes with other options. Qualitative analysis of an open response item identified additional alternatives in group size, participant desire for coaching support, and interest in programs that incorporate a range of activity alternatives. Findings from this research were consistent with elements of social cognitive theory as applied to health promotion. Factorial surveys potentially provide a resource effective means of identifying participants' preferences for use when planning interventions. The addition of a single qualitative item helped clarify and expand findings from statistical analysis.

Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).

PubMed

McPheeters, Melissa L; Kripalani, Sunil; Peterson, Neeraja B; Idowu, Rachel T; Jerome, Rebecca N; Potter, Shannon A; Andrews, Jeffrey C

2012-08-01

This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or diabetes. Overall, QI interventions were not shown to reduce disparities. Most studies have focused on racial or ethnic disparities, with some targeted interventions demonstrating greater effect in racial minorities--specifically, supporting individuals in tracking their blood pressure at home to reduce blood pressure and collaborative care to improve depression care. In one study, the effect of a language-concordant breast cancer screening intervention was helpful in promoting mammography in Spanish-speaking women. For some depression care outcomes, the collaborative care model was more effective in less-educated individuals than in those with more education and in women than in men. The literature on QI interventions generally and their ability to improve health and health care is large. Whether those interventions are effective at reducing disparities remains unclear. This report should not be construed to assess the general effectiveness of QI in the health care setting; rather, QI has not been shown specifically to reduce known disparities in health care or health outcomes. In a few instances, some increased effect is seen in disadvantaged populations; these studies should be replicated and the interventions studied further as having potential to address disparities.

Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings

PubMed Central

Kuntz, Jennifer L.; Safford, Monika M.; Singh, Jasvinder A.; Phansalkar, Shobha; Slight, Sarah P.; Her, Qoua Liang; Lapointe, Nancy Allen; Mathews, Robin; O’Brien, Emily; Brinkman, William B.; Hommel, Kevin; Farmer, Kevin C.; Klinger, Elissa; Maniam, Nivethietha; Sobko, Heather J.; Bailey, Stacy C.; Cho, Insook; Rumptz, Maureen H.; Vandermeer, Meredith L.; Hornbrook, Mark C.

2018-01-01

Objective Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. Methods We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. Results We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. Conclusions We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. Practice Implications Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate. PMID:25264309

75 FR 17737 - Industrial Economics, Incorporated; Transfer of Data

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

... ENVIRONMENTAL PROTECTION AGENCY [EPA-HQ-OPP-2010-0194; FRL-8820-2] Industrial Economics... (CBI) by the submitter, will be transferred to Industrial Economics, Incorporated in accordance with 40 CFR 2.307(h)(3) and 2.308(i)(2). Industrial Economics, Incorporated has been awarded multiple...

A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol

PubMed Central

2013-01-01

Background Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care. Methods Using a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions. Discussion As a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have incorporated stakeholder input and tailored components of the interventions to meet the specific needs of the involved clinics and communities. Results from this study will provide knowledge about how integrated multi-level interventions can improve hypertension care and reduce disparities. Trial Registration ClinicalTrials.gov NCT01566864 PMID:23734703

Incorporating Prototyping and Iteration into Intervention Development: A Case Study of a Dining Hall-Based Intervention

ERIC Educational Resources Information Center

McClain, Arianna D.; Hekler, Eric B.; Gardner, Christopher D.

2013-01-01

Background: Previous research from the fields of computer science and engineering highlight the importance of an iterative design process (IDP) to create more creative and effective solutions. Objective: This study describes IDP as a new method for developing health behavior interventions and evaluates the effectiveness of a dining hall--based…

The Impact of Project-Based Learning on Improving Student Learning Outcomes of Sustainability Concepts in Transportation Engineering Courses

ERIC Educational Resources Information Center

Fini, Elham H.; Awadallah, Faisal; Parast, Mahour M.; Abu-Lebdeh, Taher

2018-01-01

This paper describes an intervention to enhance students' learning by involving students in brainstorming activities about sustainability concepts and their implications in transportation engineering. The paper discusses the process of incorporating the intervention into a transportation course, as well as the impact of this intervention on…

Religiosity and Spiritual Engagement in Two American Indian Populations

PubMed Central

Garroutte, Eva M.; Beals, Janette; Keane, Ellen M.; Kaufman, Carol; Spicer, Paul; Henderson, Jeff; Henderson, Patricia N.; Mitchell, Christina M.; Manson, Spero M.

2015-01-01

Social scientific investigation into the religiospiritual characteristics of American Indians rarely includes analysis of quantitative data. After reviewing information from ethnographic and autobiographical sources, we present analyses of data from a large, population-based sample of two tribes (n = 3,084). We examine salience of belief in three traditions: aboriginal, Christian, and Native American Church. We then investigate patterns in sociodemographic subgroups, determining the significant correlates of salience with other variables controlled. Finally, we examine frequency with which respondents assign high salience to only one tradition (exclusivity) or multiple traditions (nonexclusivity), again investigating subgroup variations. This first detailed, statistical portrait of American Indian religious and spiritual lives links work on tribal ethnic identity to theoretical work on America’s “religious marketplace.” Results may also inform social/behavioral interventions that incorporate religiospiritual elements. PMID:26582963

What Can Baby See? Vision Tests and Interventions for Infants with Multiple Disabilities. [Videotape].

ERIC Educational Resources Information Center

Chen, Deborah

This videotape explains common vision tests used with infants with multiple disabilities, shows how to gather information from parents on their children's use of vision, and demonstrates selected early intervention strategies for encouraging infants and young children with multiple disabilities to use their vision in functional ways. The videotape…

Research as intervention? Exploring the health and well-being of children and youth facing global adversity through participatory visual methods.

PubMed

D'Amico, Miranda; Denov, Myriam; Khan, Fatima; Linds, Warren; Akesson, Bree

2016-01-01

Global health research typically relies on the translation of knowledge (from health professionals to the community) and the dissemination of knowledge (from research results to the wider public). However, Greenhalgh and Wieringa [2011. Is it time to drop the 'knowledge translation' metaphor? A critical literature review. Journal of the Royal Society of Medicine, 104(12), 501-509. doi: 10.1258/jrsm.2011.110285 ] suggest 'that while "translation" is a widely used metaphor in medicine, it constrains how we conceptualize and study the link between knowledge and practice' (p. 501). Often the knowledge garnered from such research projects comes from health professionals rather than reflecting the lived experiences of people and communities. Likewise, there has been a gap in 'translating' and 'disseminating' the results of participatory action research projects to policymakers and medical practitioners. This paper will look at how using participatory visual methodologies in global health research with children and youth facing global adversity incorporates the multiple functions of their lived realities so that research becomes a means of intervention. Drawing from a literature review of participatory visual methods as media, content and processes of global health research, this paper raises practical, theoretical, and ethical questions that arise from research as intervention. The paper concludes by exploring what lessons emerge when participatory visual methodologies are integrated into global health research with children and youth facing global adversity.

Treatment of Cognitive Impairment in Multiple Sclerosis

PubMed Central

Pierson, Susan H.; Griffith, Nathan

2006-01-01

Cognitive impairment in multiple sclerosis is an increasingly recognized entity. This article reviews the cognitive impairment of multiple sclerosis, its prevalence, its relationship to different types of multiple sclerosis, and its contribution to long-term functional prognosis. The discussion also focuses on the key elements of cognitive dysfunction in multiple sclerosis which distinguish it from other forms of cognitive impairment. Therapeutic interventions potentially effective for the cognitive impairment of multiple sclerosis are reviewed including the effects of disease modifying therapies and the use of physical and cognitive interventions. PMID:16720960

Worksite Environmental Interventions for Obesity Prevention and Control: Evidence from Group Randomized Trials.

PubMed

Fernandez, Isabel Diana; Becerra, Adan; Chin, Nancy P

2014-06-01

Worksites provide multiple advantages to prevent and treat obesity and to test environmental interventions to tackle its multiple causal factors. We present a literature review of group-randomized and non-randomized trials that tested worksite environmental, multiple component interventions for obesity prevention and control paying particular attention to the conduct of formative research prior to intervention development. The evidence on environmental interventions on measures of obesity appears to be strong since most of the studies have a low (4/8) and unclear (2/8) risk of bias. Among the studies reviewed whose potential risk of bias was low, the magnitude of the effect was modest and sometimes in the unexpected direction. None of the four studies describing an explicit formative research stage with clear integration of findings into the intervention was able to demonstrate an effect on the main outcome of interest. We present alternative explanation for the findings and recommendations for future research.

Effect of Almond Supplementation on Glycemia and Cardiovascular Risk Factors in Asian Indians in North India with Type 2 Diabetes Mellitus: A 24-Week Study.

PubMed

Gulati, Seema; Misra, Anoop; Pandey, Ravindra M

2017-03-01

Type 2 diabetes (T2D) statistics have reached menacing proportions in India. Appropriate dietary intervention, as part of healthy lifestyle, is imperative to curb further spread of this disease. This pre-post intervention study was conducted in New Delhi, India, to investigate the effects of daily consumption of almonds for 24 weeks in T2D subjects, specifically on measures of glycemia and cardiovascular disease (CVD) risk factors. In this study, the 24-week intervention period was preceded by a control diet and exercise run-in period of 3 weeks. Raw almonds (20% of energy intake) were provided to the patients for consumption along with diet and physical activity counseling. Patients were assessed for anthropometry, blood pressure, measures of glycemia (fasting blood glucose, glycosylated hemoglobin), lipids [total cholesterol (TC), triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, lipoprotein(a)], surrogate marker of atherosclerosis (Pulse wave velocity), and marker of inflammation (high sensitivity C-reactive protein [hs-CRP]) at baseline and after the intervention period. Statistically significant improvement in mean values for various parameters post intervention was as follows: waist circumference (P < 0.03), waist-to-height ratio (P < 0.005), TC (P < 0.002), serum triglycerides (P < 0.004), low-density lipoprotein cholesterol (P < 0.01), glycosylated hemoglobin (P < 0.04), and hs-CRP (P < 0.01). A trend toward improvement in pulse wave velocity (P < 0.06) was also observed. The study findings illustrate that incorporation of almonds in a well-balanced healthy diet leads to multiple beneficial effects on glycemic and CVDs risk factors in Asian Indian patients with T2D.

Perceptions of Adolescents With Cancer Related to a Pain Management App and Its Evaluation: Qualitative Study Nested Within a Multicenter Pilot Feasibility Study

PubMed Central

Stevens, Bonnie J; Nathan, Paul C; Seto, Emily; Cafazzo, Joseph A; Johnston, Donna L; Hum, Vanessa; Stinson, Jennifer N

2018-01-01

Background Pain in adolescents with cancer is common and negatively impacts health-related quality of life. The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain management support, was developed to enhance pain management using a phased approach (ie, systematic review, consensus conference and vetting, iterative usability testing cycles). A 28-day Pain Squad+ pilot was conducted with 40 adolescents with cancer to evaluate the feasibility of implementing the app in a future clinical trial and to obtain estimates of treatment effect. Objective The objective of our nested qualitative study was to elucidate the perceptions of adolescents with cancer to determine the acceptability and perceived helpfulness of Pain Squad+, suggestions for app improvement, and satisfaction with the pilot study protocol. Methods Post pilot study participation, telephone-based, semistructured, and audio-recorded exit interviews were conducted with 20 adolescents with cancer (12-18 years). All interviews were transcribed and independently coded by 2 study team members. Content analysis was conducted to identify data categories and overarching themes. Results Five major themes comprising multiple categories and codes emerged. These themes focused on the acceptability of the intervention, acceptability of the study, the perceived active ingredients of the intervention, the suitability of the intervention to adolescents’ lives, and recommendations for intervention improvement. Conclusions Overall, Pain Squad+ and the pilot study protocol were acceptable to adolescents with cancer. Suggestions for intervention and study improvements will be incorporated into the design of a future randomized clinical trial (RCT) aimed at assessing the effectiveness of Pain Squad+ on adolescents with cancer health outcomes. PMID:29625951

The role of social cognitive theory in farm-to-school-related activities: implications for child nutrition.

PubMed

Berlin, Linda; Norris, Kimberly; Kolodinsky, Jane; Nelson, Abbie

2013-08-01

Farm-to-school (FTS) programs are gaining attention for many reasons, one of which is the recognition that they could help stem the increase in childhood overweight and obesity. Most FTS programs that have been evaluated have increased students' selection or intake of fruits and vegetables following the incorporation of FTS components. However, the wide range of activities that are typically part of FTS programs make it difficult to pinpoint which components have the greatest potential to improve students' health behaviors. Within the field of nutrition education, theory-based interventions that target the key underlying factors influencing health behavior offer the most promise. We review existing research on dietary health impacts and implications of 3 key FTS-related activities and explore the component activities of FTS in terms of their potential to address the key constructs of social cognitive theory (SCT)--which is a current best practice in the field of nutrition--suggesting that FTS programs incorporating a diverse set of activities appear to be most promising. We find that components of FTS programs incorporate many of the key theoretical constructs in SCT, and show that FTS programs have great potential to facilitate movement toward desired dietary changes. However, it is unlikely that a set of activities in any one current FTS program addresses multiple constructs of the theory in a systematic manner. More intentional inclusion of diverse activities would likely be beneficial. Future research can test these assertions. © 2013, American School Health Association.

Physical Rehabilitation Interventions in Nonambulatory People with Multiple Sclerosis: A Systematic Review

ERIC Educational Resources Information Center

Toomey, Elaine; Coote, Susan B.

2012-01-01

There is an expanding body of research on exercise intervention for multidisciplinary rehabilitation of people with multiple sclerosis (PwMS). Most of this research focuses on people with mild/moderate MS who are ambulatory. As the costs of care increases with increasing disability, it is important to evaluate the evidence for interventions in…

Therapeutic Interventions in the Netherlands and Belgium in Support of People with Profound Intellectual and Multiple Disabilities

ERIC Educational Resources Information Center

Vlaskamp, Carla; Nakken, Han

2008-01-01

For several reasons, people with profound and multiple disabilities may be offered a variety of therapeutic interventions. Thus far, researchers have shown a limited interest in providing an empirical base for these interventions. Research is needed on the theoretical rationale (if any), the supposed "modus operandi" and the claimed…

Implementation of a two-part unit-based multiple intervention: moving evidence-based practice into action.

PubMed

Rashotte, Judy; Thomas, Margot; Grégoire, Diane; Ledoux, Sheila

2008-06-01

This study examined the impact of a 2-part unit-based multiple intervention on the use by pediatric critical care nurses of best practice guidelines for pressure-ulcer prevention. A total of 23 nurses participated in a repeated-measures design pre- and post-intervention to address 2 questions: Is there a difference in nurses' evidence-based practices following implementation of an educational intervention only versus implementation of both an educational and an innovative intervention? Are the changes sustained 6 months after completion of the intervention? A significant change occurred in the implementation of 2 of 11 recommended practices following both interventions: assessment of risk of pressure ulcers using an age-appropriate tool (p < or = 0.001), and the documentation of same (p < or = 0.001). These changes may have been sustained. The findings bring to light the real challenges encountered when attempting to implement and evaluate multiple knowledge translation strategies associated with complex best practice guidelines in clinical practice.

'First 1000 days' health interventions in low- and middle-income countries: alignment of South African policies with high-quality evidence.

PubMed

English, René; Peer, Nazia; Honikman, Simone; Tugendhaft, Aviva; Hofman, Karen J

2017-01-01

In South Africa (SA), despite adoption of international strategies and approaches, maternal, neonatal and child (MNC) morbidity and mortality rates have not sufficiently declined. To conduct an umbrella review (UR) that identifies interventions in low- and middle-income countries, with a high-quality evidence base, that improve MNC morbidity and mortality outcomes within the first 1000 days of life; and to assess the incorporation of the evidence into local strategies, guidelines and documents. We included publications about women and children in the first 1000 days of life; healthcare professionals and community members. Comparators were those who did not receive the intervention. Interventions were pharmacological and non-pharmacological. Outcomes were MNC morbidity and mortality. Authors conducted English language electronic and manual searches (2000-2013). The quality of systematic reviews and meta-analyses (SRs/MAs) were reviewed. Interventions were ranked according to level of evidence; and then aligned with SA strategies, policies and guidelines. A tool to extract data was developed and used by two authors who independently extracted data. Summary measures from MAs or summaries of SRs were reviewed and the specificities of the various interventions listed. A search of all local high-level documents was done and these were assessed to determine the specificities of the recommendations and their alignment to the evidence. In total, 19 interventions presented in 32 SRs were identified. Overall, SA's policymakers have sufficiently included high-quality evidence-based interventions into local policies. However, optimal period of birth spacing (two to five years) is not explicitly promoted nor was ante- and postnatal depression adequately incorporated. Antenatal care visits should be increased from four to about eight according to the evidence. Incorporation of existing evidence into policies can be strengthened in SA. The UR methods are useful to inform policymaking and identify research gaps. RESPONSIBLE EDITOR Nawi Ng, Umeå University, Sweden.

‘First 1000 days’ health interventions in low- and middle-income countries: alignment of South African policies with high-quality evidence

PubMed Central

English, René; Peer, Nazia; Honikman, Simone; Tugendhaft, Aviva; Hofman, Karen J

2017-01-01

ABSTRACT Background: In South Africa (SA), despite adoption of international strategies and approaches, maternal, neonatal and child (MNC) morbidity and mortality rates have not sufficiently declined. Objectives: To conduct an umbrella review (UR) that identifies interventions in low- and middle-income countries, with a high-quality evidence base, that improve MNC morbidity and mortality outcomes within the first 1000 days of life; and to assess the incorporation of the evidence into local strategies, guidelines and documents. Methods: We included publications about women and children in the first 1000 days of life; healthcare professionals and community members. Comparators were those who did not receive the intervention. Interventions were pharmacological and non-pharmacological. Outcomes were MNC morbidity and mortality. Authors conducted English language electronic and manual searches (2000–2013). The quality of systematic reviews and meta-analyses (SRs/MAs) were reviewed. Interventions were ranked according to level of evidence; and then aligned with SA strategies, policies and guidelines. A tool to extract data was developed and used by two authors who independently extracted data. Summary measures from MAs or summaries of SRs were reviewed and the specificities of the various interventions listed. A search of all local high-level documents was done and these were assessed to determine the specificities of the recommendations and their alignment to the evidence. Results: In total, 19 interventions presented in 32 SRs were identified. Overall, SA’s policymakers have sufficiently included high-quality evidence-based interventions into local policies. However, optimal period of birth spacing (two to five years) is not explicitly promoted nor was ante- and postnatal depression adequately incorporated. Antenatal care visits should be increased from four to about eight according to the evidence. Conclusion: Incorporation of existing evidence into policies can be strengthened in SA. The UR methods are useful to inform policymaking and identify research gaps. RESPONSIBLE EDITOR Nawi Ng, Umeå University, Sweden PMID:28715934

The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: a systematic review and meta-analysis.

PubMed

Sangelaji, Bahram; Smith, Catherin M; Paul, Lorna; Sampath, Kesava Kovanur; Treharne, Gareth J; Hale, Leigh Anne

2016-06-01

A systematic review and meta-analysis was conducted to illustrate whether people with multiple sclerosis engage in more physical activity following behaviour change interventions. MEDLINE, CINAHL, PubMed, Web of Sciences, Cochrane Library, SCOPUS, EMBASE and PEDro were searched from their inception till 30 April 2015. Randomized and clinical controlled trials that used behaviour change interventions to increase physical activity in people with multiple sclerosis were selected, regardless of type or duration of multiple sclerosis or disability severity. Data extraction was conducted by two independent reviewers and the Cochrane Collaboration's recommended method was used to assess the risk of bias of each included study. A total of 19 out of 573 studies were included. Focusing on trials without risk of bias, meta-analysis showed that behaviour change interventions can significantly increase physical activity participation (z = 2.20, p = 0.03, standardised main difference 0.65, 95% confidence interval 0.07 to 1.22, 3 trials, I(2) = 68%) (eight to 12 weeks' duration). Behaviour change interventions did not significantly impact on the physical components of quality of life or fatigue. Behaviour change interventions provided for relatively short duration (eight to 12 weeks) may increase the amount of physical activity people with multiple sclerosis engage in, but appear to have no effect on the physical components of quality of life and fatigue. Further high quality investigations of the efficacy of behaviour change interventions to increase physical activity participation that focus on dose, long-term impact and method of delivery are warranted for people with multiple sclerosis. © The Author(s) 2015.

An omnibus test for family-based association studies with multiple SNPs and multiple phenotypes.

PubMed

Lasky-Su, Jessica; Murphy, Amy; McQueen, Matthew B; Weiss, Scott; Lange, Christoph

2010-06-01

We propose an omnibus family-based association test (MFBAT) that can be applied to multiple markers and multiple phenotypes and that has only one degree of freedom. The proposed test statistic extends current FBAT methodology to incorporate multiple markers as well as multiple phenotypes. Using simulation studies, power estimates for the proposed methodology are compared with the standard methodologies. On the basis of these simulations, we find that MFBAT substantially outperforms other methods, including haplotypic approaches and doing multiple tests with single single-nucleotide polymorphisms (SNPs) and single phenotypes. The practical relevance of the approach is illustrated by an application to asthma in which SNP/phenotype combinations are identified and reach overall significance that would not have been identified using other approaches. This methodology is directly applicable to cases in which there are multiple SNPs, such as candidate gene studies, cases in which there are multiple phenotypes, such as expression data, and cases in which there are multiple phenotypes and genotypes, such as genome-wide association studies that incorporate expression profiles as phenotypes. This program is available in the PBAT analysis package.

Web-Based Physical Activity Intervention for Latina Adolescents: Feasibility, Acceptability, and Potential Efficacy of the Niñas Saludables Study.

PubMed

Larsen, Britta; Benitez, Tanya; Cano, Mayra; Dunsiger, Shira S; Marcus, Bess H; Mendoza-Vasconez, Andrea; Sallis, James F; Zive, Michelle

2018-05-09

Physical activity is markedly low in Latina adolescents, yet few physical activity interventions have been attempted in this population. Web-based interventions can incorporate theory-based components, be appealing to adolescents, and have potential for low-cost dissemination. This study aimed to assess the feasibility, acceptability, and potential efficacy of a Web-based physical activity intervention for Latina adolescents in a single-arm pilot trial. A total of 21 Latina adolescents (aged 12-18 years) who could read and write in English and were underactive (<90 min/week) participated in a 12-week, theory-informed Web-based physical activity intervention. The intervention website was modified from a previous Web-based intervention for Latina adults. Web content was individually tailored based on the responses to monthly questionnaires. Feasibility was measured by recruitment, retention, and adherence/engagement, and acceptability was measured by satisfaction surveys. Physical activity was measured at baseline and follow-up (12 weeks) using the 7-day physical activity recall (PAR) interview and accelerometers. Baseline activity as measured by the 7-day PAR and accelerometers was 24.7 (SD 26.11) and 24.8 (SD 38.3) min/week, respectively. At 12 weeks, 19 participants (90%, 19/21) returned. Adherence and engagement with materials were low, but 72% (15/21) of the participants indicated that they were satisfied with the intervention. Activity at 12 weeks increased by 58.8 (SD 11.33) min/week measured by the 7-day PAR (P<.001). Accelerometer-measured activity did not increase. Activities reported at follow-up were more varied than at baseline, including some activities measured poorly by accelerometers (eg, biking and swimming). Participants suggested simplifying the website and incorporating other technologies. Good retention and increases in self-reported activity suggest a promising approach to delivering a physical activity intervention to Latina adolescents. Incorporating other technologies, such as smartphone apps, could make the intervention more engaging, acceptable, and effective. ©Britta Larsen, Tanya Benitez, Mayra Cano, Shira S Dunsiger, Bess H Marcus, Andrea Mendoza-Vasconez, James F Sallis, Michelle Zive. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.05.2018.

Polymedication Electronic Monitoring System (POEMS) - a new technology for measuring adherence.

PubMed

Arnet, Isabelle; Walter, Philipp N; Hersberger, Kurt E

2013-01-01

Reliable and precise measurement of patient adherence to medications is feasible by incorporating a microcircuitry into pharmaceutical packages of various designs, such that the maneuvers needed to remove a dose of drug are detected, time-stamped, and stored. The principle is called "electronic medication event monitoring" but is currently limited to the monitoring of a single drug therapy. Our aims were introducing a new technology; a clear, self-adhesive polymer film, with printed loops of conductive wires that can be affixed to multidrug punch cards for the electronic adherence monitoring of multiple medication regimens (Polymedication Electronic Monitoring System, POEMS), and illustrating potential benefits for patient care. We present a preliminary report with one patient experience. Our illustrative case was supplied with a pre-filled 7-day multiple medication punch card with unit-of-use doses for specific times of the day (six pills in the morning cavity, two pills in the evening cavity, and one pill in case of insomnia in the bedtime cavity), with the new electronic film affixed on it. The intake times over 1 week were extremely skewed (median intake hours at 2:00 pm for the morning doses and at 6:40 pm for the evening doses). After an intervention aimed at optimizing the timing adherence, the morning and evening intake hours became more balanced, with 42.3% of correct dosing intervals (±3 h) for drugs with twice daily intake (vs. 0% before the intervention). The electronic monitoring of the entire therapy revealed an intake pattern that would have remained undiscovered with any other device and allowed a personalized intervention to correct an inadequate medication intake behavior. POEMS may guide health professionals when they need to optimize a pharmacotherapy because of suspected insufficient adherence. Further, knowing the intake pattern of the entire pharmacotherapy can elucidate unreached clinical outcome, drug-drug interactions, and drug resistance. In the near future, one could imagine that medication adherence data over the entire therapy plan would be available as soon as the electronic wires are activated, so that a failure to take medication could be detected immediately and intervention could be taken if appropriate.

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions.

PubMed

Shemilt, Ian; Mugford, Miranda; Drummond, Michael; Eisenstein, Eric; Mallender, Jacqueline; McDaid, David; Vale, Luke; Walker, Damian

2006-11-15

Provision of evidence on costs alongside evidence on the effects of interventions can enhance the relevance of systematic reviews to decision-making. However, patterns of use of economics methods alongside systematic review remain unclear. Reviews of evidence on the effects of interventions are published by both the Cochrane and Campbell Collaborations. Although it is not a requirement that Cochrane or Campbell Reviews should consider economic aspects of interventions, many do. This study aims to explore and describe approaches to incorporating economics methods in a selection of Cochrane systematic reviews in the area of health promotion and public health, to help inform development of methodological guidance on economics for reviewers. The Cochrane Database of Systematic Reviews was searched using a search strategy for potential economic evaluation studies. We included current Cochrane reviews and review protocols retrieved using the search that are also identified as relevant to health promotion or public health topics. A reviewer extracted data which describe the economics components of included reviews. Extracted data were summarised in tables and analysed qualitatively. Twenty-one completed Cochrane reviews and seven review protocols met inclusion criteria. None incorporate formal economic evaluation methods. Ten completed reviews explicitly aim to incorporate economics studies and data. There is a lack of transparent reporting of methods underpinning the incorporation of economics studies and data. Some reviews are likely to exclude useful economics studies and data due to a failure to incorporate search strategies tailored to the retrieval of such data or use of key specialist databases, and application of inclusion criteria designed for effectiveness studies. There is a need for consistency and transparency in the reporting and conduct of the economics components of Cochrane reviews, as well as regular dialogue between Cochrane reviewers and economists to develop increased capacity for economic analyses alongside such reviews. Use of applicable economics methods in Cochrane reviews can help provide the international context within which economics data can be interpreted and assessed as a preliminary to full economic evaluation.

Moving electronic medical records upstream: incorporating social determinants of health.

PubMed

Gottlieb, Laura M; Tirozzi, Karen J; Manchanda, Rishi; Burns, Abby R; Sandel, Megan T

2015-02-01

Knowledge of the biological pathways and mechanisms connecting social factors with health has increased exponentially over the past 25 years, yet in most clinical settings, screening and intervention around social determinants of health are not part of standard clinical care. Electronic medical records provide new opportunities for assessing and managing social needs in clinical settings, particularly those serving vulnerable populations. To illustrate the feasibility of capturing information and promoting interventions related to social determinants of health in electronic medical records. Three case studies were examined in which electronic medical records have been used to collect data and address social determinants of health in clinical settings. From these case studies, we identified multiple functions that electronic medical records can perform to facilitate the integration of social determinants of health into clinical systems, including screening, triaging, referring, tracking, and data sharing. If barriers related to incentives, training, and privacy can be overcome, electronic medical record systems can improve the integration of social determinants of health into healthcare delivery systems. More evidence is needed to evaluate the impact of such integration on health care outcomes before widespread adoption can be recommended. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Neonatal Vaccination: Challenges and Intervention Strategies.

PubMed

Morris, Matthew C; Surendran, Naveen

2016-01-01

While vaccines have been tremendously successful in reducing the incidence of serious infectious diseases, newborns remain particularly vulnerable in the first few months of their life to life-threatening infections. A number of challenges exist to neonatal vaccination. However, recent advances in the understanding of neonatal immunology offer insights to overcome many of those challenges. This review will present an overview of the features of neonatal immunity which make vaccination difficult, survey the mechanisms of action of available vaccine adjuvants with respect to the unique features of neonatal immunity, and propose a possible mechanism contributing to the inability of neonates to generate protective immune responses to vaccines. We surveyed recent published findings on the challenges to neonatal vaccination and possible intervention strategies including the use of novel vaccine adjuvants to develop efficacious neonatal vaccines. Challenges in the vaccination of neonates include interference from maternal antibody and excessive skewing towards Th2 immunity, which can be counteracted by the use of proper adjuvants. Synergistic stimulation of multiple Toll-like receptors by incorporating well-defined agonist-adjuvant combinations to vaccines is a promising strategy to ensure a protective vaccine response in neonates. © 2016 S. Karger AG, Basel.

Care at home of the patient with advanced multiple sclerosis--part 2.

PubMed

Reitman, Nancy Clayton

2010-05-01

Clinicians caring for patients with advanced MS have choices of different options and approaches. Whatever path is chosen, interventions must incorporate the wishes and capabilities of the patient and be supported by the care team, usually led by the nurse. As the work of the great psychologist Abraham Maslow has shown, in his famous "hierarchy of needs," the basic levels of needs must be met before the highest self-actualization can be accomplished (Maslow, 1943). This is equally true in the nursing care of very ill patients, as authors Zalenski and Raspa write: "The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) self-actualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence."(Zalenski & Raspa, 2006, p.1120).

Family influence: key to fruit and vegetable consumption among fourth- and fifth-grade students.

PubMed

Gross, Susan M; Pollock, Elizabeth Davenport; Braun, Bonnie

2010-01-01

To assess social and familial environmental influences on fruit and vegetable (FV) consumption of fourth- and fifth-graders living in a culturally diverse, urban setting. In 2006, students from 9 fourth- and fifth-grade classrooms from a public school in the Washington-Baltimore Metropolitan Region were recruited as part of the Food Stamp Nutrition Education's initiative to increase FV consumption among school-aged children in low-income schools. This intervention was conducted in partnership with the school. Ninety-three fourth- and fifth-grade students and their parents. The average daily FV consumption of elementary school students was the dependent variable. Home engagement (eg, student participation in menu planning and food selection at home), parental modeling, school environment, peer influences, and individual characteristics were the independent variables. Multiple regression analysis. Family and home environment factors explained more than 50% of the variance in students' FV consumption. Interventions designed to influence school-aged children's FV consumption should target family members and consider incorporating strategies to reach families and promote meal planning activities with the children in their homes. Copyright 2010 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.

Motor rehabilitation in stroke and traumatic brain injury: stimulating and intense.

PubMed

Breceda, Erika Y; Dromerick, Alexander W

2013-12-01

The purpose of this review is to provide an update on the latest neurorehabilitation literature for motor recovery in stroke and traumatic brain injury to assist clinical decision making and assessing future research directions. The emerging approach to motor restoration is now multimodal. It engages the traditional multidisciplinary rehabilitation team, but incorporates highly structured activity-based therapies, pharmacology, brain stimulation and robotics. Clinical trial data support selective serotonin reuptake inhibitors and amantadine to assist motor recovery poststroke and traumatic brain injury, respectively. Similarly, there is continued support for intensity as a key factor in activity-based therapies, across skilled and nonskilled interventions. Aerobic training appears to have multiple benefits; increasing the capacity to meet the demands of hemiparetic gait improves endurance for activities of daily living while promoting cognition and mood. At this time, the primary benefit of robotic therapy lies in the delivery of highly intense and repetitive motor practice. Both transcranial direct current and magnetic stimulation therapies are in early stages, but have promise in motor and language restoration. Advancements in neurorehabilitation have shifted treatment away from nonspecific activity regimens and amphetamines. As the body of knowledge grows, evidence-based practice using interventions targeted at specific subgroups becomes progressively more feasible.

Comforting Children and Families Who Grieve: Incorporating Spiritual Support

ERIC Educational Resources Information Center

Jerome, Annette

2011-01-01

Based on specific school and community tragedies, this article reviews difficult situations and how students' spiritual and religious beliefs were incorporated into school-based grief interventions. Suggestions are made to strengthen this often untapped resource, encouraging school-based mental health professionals to consult with community…

Multiple Intravenous Infusions Phase 2b: Laboratory Study

PubMed Central

Pinkney, Sonia; Fan, Mark; Chan, Katherine; Koczmara, Christine; Colvin, Christopher; Sasangohar, Farzan; Masino, Caterina; Easty, Anthony; Trbovich, Patricia

2014-01-01

Background Administering multiple intravenous (IV) infusions to a single patient via infusion pump occurs routinely in health care, but there has been little empirical research examining the risks associated with this practice or ways to mitigate those risks. Objectives To identify the risks associated with multiple IV infusions and assess the impact of interventions on nurses’ ability to safely administer them. Data Sources and Review Methods Forty nurses completed infusion-related tasks in a simulated adult intensive care unit, with and without interventions (i.e., repeated-measures design). Results Errors were observed in completing common tasks associated with the administration of multiple IV infusions, including the following (all values from baseline, which was current practice): setting up and programming multiple primary continuous IV infusions (e.g., 11.7% programming errors) identifying IV infusions (e.g., 7.7% line-tracing errors) managing dead volume (e.g., 96.0% flush rate errors following IV syringe dose administration) setting up a secondary intermittent IV infusion (e.g., 11.3% secondary clamp errors) administering an IV pump bolus (e.g., 11.5% programming errors) Of 10 interventions tested, 6 (1 practice, 3 technology, and 2 educational) significantly decreased or even eliminated errors compared to baseline. Limitations The simulation of an adult intensive care unit at 1 hospital limited the ability to generalize results. The study results were representative of nurses who received training in the interventions but had little experience using them. The longitudinal effects of the interventions were not studied. Conclusions Administering and managing multiple IV infusions is a complex and risk-prone activity. However, when a patient requires multiple IV infusions, targeted interventions can reduce identified risks. A combination of standardized practice, technology improvements, and targeted education is required. PMID:26316919

Evaluation of a residential Kundalini yoga lifestyle pilot program for addiction in India.

PubMed

Khalsa, Sat Bir S; Khalsa, Gurucharan S; Khalsa, Hargopal K; Khalsa, Mukta K

2008-01-01

Previously reported substance abuse interventions incorporating meditation and spiritual approaches are believed to provide their benefit through modulation of both psychological and pyschosocial factors. A 90-day residential group pilot treatment program for substance abuse that incorporated a comprehensive array of yoga, meditation, spiritual and mind-body techniques was conducted in Amritsar, India. Subjects showed improvements on a number of psychological self-report questionnaires including the Behavior and Symptom Identification Scale and the Quality of Recovery Index. Application of comprehensive spiritual lifestyle interventions may prove effective in treating substance abuse, particularly in populations receptive to such approaches.

Knowledge, Attitudes and Practice Relating to Hazardous Alcohol Use across the Continuum of Care in a Community Healthcare Centre

ERIC Educational Resources Information Center

Kishore, Vimal; Lynch, Sara; Pichon, Jamilia; Theall, Katherine; Johnson, Sandy; Roberson, Emily; Hinton, Susan

2011-01-01

Alcohol screening and intervention in community health settings places a great time demand on practitioners. Thus, implementation of practitioner-delivered intervention is challenging. Aims: The aim of this study was to assess the feasibility of incorporating a brief alcohol intervention into daily practices of a community health care centre by…

Effects of an Employer-Based Intervention on Employment Outcomes for Youth with Significant Support Needs Due to Autism

ERIC Educational Resources Information Center

Wehman, Paul; Schall, Carol M.; McDonough, Jennifer; Graham, Carolyn; Brooke, Valerie; Riehle, J. Erin; Brooke, Alissa; Ham, Whitney; Lau, Stephanie; Allen, Jaclyn; Avellone, Lauren

2017-01-01

The purpose of this study was to develop and investigate an employer-based 9-month intervention for high school youth with autism spectrum disorder to learn job skills and acquire employment. The intervention modified a program titled Project SEARCH and incorporated the use of applied behavior analysis to develop Project SEARCH plus Autism…

Results from a preliminary study to develop the quality adjustments for quality adjusted life year values for Trinidad and Tobago.

PubMed

Bailey, H

2013-07-01

No country can afford to provide all necessary healthcare for its citizens, so prioritization among interventions must feature in all health systems. Resources in health should be allocated among interventions/facilities/patients in such a way as to be in line with the objectives of the health system. To achieve this, resource allocation decisions must be informed by the relative contributions that prospective interventions will make to societal health and to costs. Internationally, the EQ-5D based quality adjusted life year (QALY) now dominates this kind of analysis. This paper reports on a pilot study to develop an EQ-5D-3L value set for Trinidad and Tobago based on a protocol that avoids some of the issues that are associated with other approaches to developing such value sets such as the complex elicitation tasks that respondents must carry out, and the large respondent samples required for collecting multiple valuation subset values using blocked designs. An orthogonal discrete choice experiment design was used to elicit a set of choices from a sample of respondents. The choice data were analysed using mixed multinomial logistic regression to produce an internally valid model that predicts well. This paper marks an important milestone in the development of health resource allocation in the Caribbean. It sets out the importance of incorporating the impact of health interventions to inform health resource allocation decisions, describes the elicitation and analysis methods used in the pilot and provides an illustration of the use of the EQ-5D value set.

Translational toxicology: a developmental focus for integrated research strategies.

PubMed

Hughes, Claude; Waters, Michael; Allen, David; Obasanjo, Iyabo

2013-09-30

Given that toxicology studies the potential adverse effects of environmental exposures on various forms of life and that clinical toxicology typically focuses on human health effects, what can and should the relatively new term of "translational toxicology" be taken to mean? Our assertion is that the core concept of translational toxicology must incorporate existing principles of toxicology and epidemiology, but be driven by the aim of developing safe and effective interventions beyond simple reduction or avoidance of exposure to prevent, mitigate or reverse adverse human health effects of exposures.The field of toxicology has now reached a point where advances in multiple areas of biomedical research and information technologies empower us to make fundamental transitions in directly impacting human health. Translational toxicology must encompass four action elements as follows: 1) Assessing human exposures in critical windows across the lifespan; 2) Defining modes of action and relevance of data from animal models; 3) Use of mathematical models to develop plausible predictions as the basis for: 4) Protective and restorative human health interventions. The discussion focuses on the critical window of in-utero development. Exposure assessment, basic toxicology and development of certain categories of mathematical models are not new areas of research; however overtly integrating these in order to conceive, assess and validate effective interventions to mitigate or reverse adverse effects of environmental exposures is our novel opportunity. This is what we should do in translational toxicology so that we have a portfolio of interventional options to improve human health that include both minimizing exposures and specific preventative/restorative/mitigative therapeutics.

Could habits hold the key to weight loss maintenance? A narrative review.

PubMed

Cleo, G; Isenring, E; Thomas, R; Glasziou, P

2017-10-01

Despite the significance placed on lifestyle interventions for obesity management, most weight loss is followed by weight regain. Psychological concepts of habitual behaviour and automaticity have been suggested as plausible explanations for this overwhelming lack of long-term weight loss success. Interventions that focus on changing an individual's behaviour are not usually successful at changing an individual's habits because they do not incorporate the strategies required to break unhealthy habits and/or form new healthy habits. A narrative review was conducted and describes the theory behind habit formation in relation to weight regain. The review evaluated the effectiveness of using habits as tools to maintain weight loss. Three specific habit-based weight loss programmes are described: '10 Top Tips', 'Do Something Different' and 'Transforming Your Life'. Participants in these interventions achieved significant weight loss compared to a control group or other conventional interventions. Habit-based interventions show promising results in sustaining behaviour change. Weight loss maintenance may benefit from incorporating habit-focused strategies and should be investigated further. © 2017 The British Dietetic Association Ltd.

Design, operation, and safety of single-room interventional MRI suites: practical experience from two centers.

PubMed

White, Mark J; Thornton, John S; Hawkes, David J; Hill, Derek L G; Kitchen, Neil; Mancini, Laura; McEvoy, Andrew W; Razavi, Reza; Wilson, Sally; Yousry, Tarek; Keevil, Stephen F

2015-01-01

The design and operation of a facility in which a magnetic resonance imaging (MRI) scanner is incorporated into a room used for surgical or endovascular cardiac interventions presents several challenges. MR safety must be maintained in the presence of a much wider variety of equipment than is found in a diagnostic unit, and of staff unfamiliar with the MRI environment, without compromising the safety and practicality of the interventional procedure. Both the MR-guided cardiac interventional unit at Kings College London and the intraoperative imaging suite at the National Hospital for Neurology and Neurosurgery are single-room interventional facilities incorporating 1.5 T cylindrical-bore MRI scanners. The two units employ similar strategies to maintain MR safety, both in original design and day-to-day operational workflows, and between them over a decade of incident-free practice has been accumulated. This article outlines these strategies, highlighting both similarities and differences between the units, as well as some lessons learned and resulting procedural changes made in both units since installation. © 2014 Wiley Periodicals, Inc.

A strategic approach to the unfinished fortification agenda: feasibility, costs, and cost-effectiveness analysis of fortification programs in 48 countries.

PubMed

Fiedler, John L; Macdonald, Barbara

2009-12-01

Food fortification is a promising strategy for combating micronutrient deficiencies, which plague one-third of the world's population. Which foods to fortify, with which micronutrients, and in which countries remain essential questions that to date have not been addressed at the global level. To provide a tool for international agencies to identify and organize the next phase of the unfinished global fortification agenda by prioritizing roughly 250 potential interventions in 48 priority countries. By explicitly defining the structure and operations of the fortification interventions in a detailed and transparent manner, and incorporating a substantial amount of country-specific data, the study also provides a potentially useful starting point for policy discussions in each of the 48 countries, which--it is hoped--will help to catalyze the development of public-private partnerships and accelerate the introduction of fortification and reduction of micronutrient deficiencies. Forty-eight high-priority countries were identified, and the feasibility of fortifying vegetable oil and sugar with vitamin A and fortifying wheat flour and maize flour with two alternative multiple micronutrient formulations was assessed. One hundred twenty-two country-, food-, and fortification formulation-specific interventions were assessed to be feasible, and the costs of each intervention were estimated. Assuming a 30% reduction in the micronutrient deficiencies of the persons consuming the food, the number of disability-adjusted life years (DALYs) saved by each of the programs was estimated. The cost per DALY saved was calculated for each of the 122 interventions, and the interventions were rank-ordered by cost-effectiveness. It is estimated that the 60 most cost-effective interventions would carry a 10-year price tag of US$1 billion and have costs per DALY saved ranging from US$1 to US$134. The single "best bet" intervention--i.e., the most cost-effective intervention--in each of the 48 countries was identified. This study provides a detailed, transparent, evidence-based approach to defining and estimating the costs and cost-effectiveness of the unfinished global fortification agenda in the 48 priority countries. Other considerations in designing a strategic approach to the unfinished global fortification agenda are also discussed.

Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project.

PubMed

Zgierska, Aleksandra E; Vidaver, Regina M; Smith, Paul; Ales, Mary W; Nisbet, Kate; Boss, Deanne; Tuan, Wen-Jan; Hahn, David L

2018-06-05

Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project. A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine drug testing, depression and opioid misuse risk screening, and standardized documentation of the chronic pain diagnosis and treatment plan. The project team drew upon existing guidelines, feedback from end-users, experts and health system leadership to develop a robust QI intervention, targeting clinic-level implementation of policy-directed practices. The resulting multi-pronged QI intervention included clinic-wide and individual clinician-level educational interventions. The QI intervention will augment the health system's "routine rollout" method, consisting of a single educational presentation to clinicians in group settings and a separate presentation for staff. A stepped-wedge design will enable 9 primary care clinics to receive the intervention and assessment of within-clinic and between-clinic changes in adherence to the policy items measured by clinic-level electronic health record-based measures and process measures of the experience with the intervention. Developing methods for a health system-tailored QI intervention required a multi-step process to incorporate end-user feedback and account for the needs of targeted clinic team members. Delivery of such tailored QI interventions has the potential to enhance uptake of opioid therapy management policies in primary care. Results from this study are anticipated to elucidate the relative value of such QI activities.

The Implementation and Evaluation of Health Promotion Services and Programs to Improve Cultural Competency: A Systematic Scoping Review.

PubMed

Jongen, Crystal Sky; McCalman, Janya; Bainbridge, Roxanne Gwendalyn

2017-01-01

Cultural competency is a multifaceted intervention approach, which needs to be implemented at various levels of health-care systems to improve quality of care for culturally and ethnically diverse populations. One level of health care where cultural competency is required is in the provision of health promotion services and programs targeted to diverse patient groups who experience health-care and health inequalities. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes. This scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia, and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched. Overall, 64 studies on cultural competency interventions were found, with 22 being health promotion programs and services. A process of thematic analysis was utilized to identify key intervention strategies and outcomes reported in the literature. The review identified three overarching strategies utilized in health promotion services and programs to improve cultural competency: community-focused strategies, culturally focused strategies, and language-focused strategies. Studies took different approaches to delivering culturally competent health interventions, with the majority incorporating multiple strategies from each overarching category. There were various intermediate health-care and health outcomes reported across the included studies. Most commonly reported were positive reports of patient satisfaction, patient/participant service access, and program/study retention rates. The health outcome results indicate positive potential of health promotion services and programs to improve cultural competency to impact cardiovascular disease and mental health outcomes. However, due to measurement and study quality issues, it is difficult to determine the extent of the impacts. Examined together, these intervention strategies and outcomes provide a framework that can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency. While there is evidence indicating the effectiveness of such health promotion interventions in improving intermediate and health outcomes, further attention is needed to issues of measurement and study quality.

Annual Research Review: Building a science of personalized intervention for youth mental health.

PubMed

Ng, Mei Yi; Weisz, John R

2016-03-01

Within the past decade, health care service and research priorities have shifted from evidence-based medicine to personalized medicine. In mental health care, a similar shift to personalized intervention may boost the effectiveness and clinical utility of empirically supported therapies (ESTs). The emerging science of personalized intervention will need to encompass evidence-based methods for determining which problems to target and in which order, selecting treatments and deciding whether and how to combine them, and informing ongoing clinical decision-making through monitoring of treatment response throughout episodes of care. We review efforts to develop these methods, drawing primarily from psychotherapy research with youths. Then we propose strategies for building a science of personalized intervention in youth mental health. The growing evidence base for personalizing interventions includes research on therapies adapted for specific subgroups; treatments targeting youths' environments; modular therapies; sequential, multiple assignment, randomized trials; measurement feedback systems; meta-analyses comparing treatments for specific patient characteristics; data-mining decision trees; and individualized metrics. The science of personalized intervention presents questions that can be addressed in several ways. First, to evaluate and organize personalized interventions, we propose modifying the system used to evaluate and organize ESTs. Second, to help personalizing research keep pace with practice needs, we propose exploiting existing randomized trial data to inform personalizing approaches, prioritizing the personalizing approaches likely to have the greatest impact, conducting more idiographic research, and studying tailoring strategies in usual care. Third, to encourage clinicians' use of personalized intervention research to inform their practice, we propose expanding outlets for research summaries and case studies, developing heuristic frameworks that incorporate personalizing approaches into practice, and integrating personalizing approaches into service delivery systems. Finally, to build a richer understanding of how and why treatments work for particular individuals, we propose accelerating research to identify mediators within and across RCTs, to isolate mechanisms of change, and to inform the shift from diagnoses to psychopathological processes. This ambitious agenda for personalized intervention science, although challenging, could markedly alter the nature of mental health care and the benefit provided to youths and families. © 2015 Association for Child and Adolescent Mental Health.

Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care.

PubMed

Ricci-Cabello, Ignacio; Olry de Labry-Lima, Antonio; Bolívar-Muñoz, Julia; Pastor-Moreno, Guadalupe; Bermudez-Tamayo, Clara; Ruiz-Pérez, Isabel; Quesada-Jiménez, Fermín; Moratalla-López, Enrique; Domínguez-Martín, Susana; de los Ríos-Álvarez, Ana M; Cruz-Vela, Pilar; Prados-Quel, Miguel A; López-De Hierro, José A

2013-10-23

In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study. The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level. The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients. Clinical Trials U.S. National Institutes of Health, NCT01849731.

Additional considerations are required when preparing a protocol for a systematic review with multiple interventions.

PubMed

Chaimani, Anna; Caldwell, Deborah M; Li, Tianjing; Higgins, Julian P T; Salanti, Georgia

2017-03-01

The number of systematic reviews that aim to compare multiple interventions using network meta-analysis is increasing. In this study, we highlight aspects of a standard systematic review protocol that may need modification when multiple interventions are to be compared. We take the protocol format suggested by Cochrane for a standard systematic review as our reference and compare the considerations for a pairwise review with those required for a valid comparison of multiple interventions. We suggest new sections for protocols of systematic reviews including network meta-analyses with a focus on how to evaluate their assumptions. We provide example text from published protocols to exemplify the considerations. Standard systematic review protocols for pairwise meta-analyses need extensions to accommodate the increased complexity of network meta-analysis. Our suggested modifications are widely applicable to both Cochrane and non-Cochrane systematic reviews involving network meta-analyses. Copyright © 2017 Elsevier Inc. All rights reserved.

Supporting First-Grade Writers Who Fail to Learn: Multiple Single-Case Evaluation of a Response to Intervention Approach

ERIC Educational Resources Information Center

Arrimada, María; Torrance, Mark; Fidalgo, Raquel

2018-01-01

We report a multiple-baseline single-case study, based in the response to intervention framework, evaluating transcription-only and transcription-and-planning interventions for young, struggling writers. In a baseline phase, 8 classes of Spanish children at the start of their first year of primary (elementary) education completed short, probe…

Correlates of Adherence to a Telephone-Based Multiple Health Behavior Change Cancer Preventive Intervention for Teens: The Healthy for Life Program (HELP)

ERIC Educational Resources Information Center

Mays, Darren; Peshkin, Beth N.; Sharff, McKane E.; Walker, Leslie R.; Abraham, Anisha A.; Hawkins, Kirsten B.; Tercyak, Kenneth P.

2012-01-01

This study examined factors associated with teens' adherence to a multiple health behavior cancer preventive intervention. Analyses identified predictors of trial enrollment, run-in completion, and adherence (intervention initiation, number of sessions completed). Of 104 teens screened, 73% (n = 76) were trial eligible. White teens were more…

Understanding the Contribution of Family History to Colorectal Cancer Risk and Its Clinical Implications: A State-of-the-Science Review

PubMed Central

Lowery, Jan T; Ahnen, Dennis J; Schroy, Paul C.; Hampel, Heather; Baxter, Nancy; Boland, C. Richard; Burt, Randall W; Butterly, Lynn; Doerr, Megan; Doroshenk, Mary; Feero, W. Gregory; Henrikson, Nora; Ladabaum, Uri; Lieberman, David; McFarland, Elizabeth G; Peterson, Susan K; Raymond, Martha; Samadder, N. Jewel; Syngal, Sapna; Weber, Thomas K.; Zauber, Ann G; Smith, Robert

2017-01-01

Background Persons with a family history (FH) of colorectal cancer (CRC) or adenomas that are not due to known hereditary syndromes have increased risk for CRC. Understanding these risks, screening recommendations and screening behaviors can inform strategies to reduce CRC burden in these families. Methods A comprehensive review of literature published within the past 10 years was conducted to assess what is known about cancer risk, screening guidelines, adherence and barriers to screening and effective interventions in persons with FH of CRC, and to identify FH tools used to identify these individuals and inform care. Results Existing data show that having one affected first-degree relative (FDR) increases CRC risk by 2-fold, and risk increases with multiple affected FDRs and younger age at diagnosis. There was variability in screening recommendations across consensus guidelines. Screening adherence was <50% and lower in persons under age 50. Having a provider’s recommendation, multiple affected relatives and family encouragement facilitated screening; insufficient collection of FH, low knowledge of guidelines, and poor family communication were important barriers. Effective interventions incorporated strategies for overcoming barriers but these have not been tested broadly in clinical settings. Conclusions Four strategies for reducing CRC in persons with familial risk are suggested: 1) improve how we collect and utilize cancer FH, 2) establish consensus for screening guidelines by FH, 3) enhance provider-patient knowledge of guidelines and communication about CRC risk, 4) encourage survivors to promote screening within their families, and partner with existing screening programs to expand reach to high-risk groups. PMID:27258162

Systematic Review: The Effectiveness of Interventions to Reduce Falls and Improve Balance in Adults With Multiple Sclerosis.

PubMed

Gunn, Hilary; Markevics, Sophie; Haas, Bernhard; Marsden, Jonathan; Freeman, Jennifer

2015-10-01

To evaluate the effectiveness of interventions in reducing falls and/or improving balance as a falls risk in multiple sclerosis (MS). Computer-based and manual searches included the following medical subject heading keywords: "Multiple Sclerosis AND accidental falls" OR "Multiple Sclerosis AND postural balance" OR "Multiple Sclerosis AND exercise" OR "Multiple Sclerosis AND physical/physio therapy" NOT animals. All literature published to November 2014 with available full-text details were included. Studies were reviewed against the PICO (participants, interventions, comparisons, outcomes) selection criteria: P, adults with MS; I, falls management/balance rehabilitation interventions; C, randomized/quasi-randomized studies comparing intervention with usual care or placebo control; O, falls outcomes and measures of balance. Fifteen articles of the original 529 search results were included. Two reviewers independently extracted data and assessed methodological quality using the Cochrane Risk of Bias tool. Random-effects meta-analysis indicated a small decrease in falls risk (risk ratio, .74), although the 95% confidence interval (CI) crossed 1 (95% CI, .12-4.38). The pooled standardized mean difference (SMD) for balance outcomes was .55 (95% CI, .35-.74). SMD varied significantly between exercise subgroupings; gait, balance, and functional training interventions yielded the greatest pooled effect size (ES) (SMD=.82; 95% CI, 0.55-1.10). There was a moderate positive correlation between program volume (min/wk) and ES (Cohen's d) (r=.70, P=.009), and a moderate negative correlation between program duration in weeks and ES (r=-.62, P=.03). Variations in interventions and outcomes and methodological limitations mean that results must be viewed with caution. This review suggests that balance may improve through exercise interventions, but that the magnitude of the improvements achieved in existing programs may not be sufficient to impact falls outcomes. Supporting participants to achieve an appropriate intensity of practice of highly challenging balance activities appears to be critical to maximizing effectiveness. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of motivational intervention with significant others for patients with alcohol misuse.

PubMed

Shepard, Donald S; Lwin, Aung K; Barnett, Nancy P; Mastroleo, Nadine; Colby, Suzanne M; Gwaltney, Chad; Monti, Peter M

2016-05-01

To estimate the incremental cost, cost-effectiveness and benefit-cost ratio of incorporating a significant other (SO) into motivational intervention for alcohol misuse. We obtained economic data from the one year with the intervention in full operation for patients in a recent randomized trial. The underlying trial took place at a major urban hospital in the United States. The trial randomized 406 (68.7% male) eligible hazardous drinkers (196 during the economic study) admitted to the emergency department or trauma unit. The motivational interview condition consisted of one in-person session featuring personalized normative feedback. The significant other motivational interview condition comprised one joint session with the participant and SO in which the SO's perspective and support were elicited. We ascertained activities across 445 representative time segments through work sampling (including staff idle time), calculated the incremental cost in per patient of incorporating an SO, expressed the results in 2014 US$, incorporated quality and mortality effects from a closely related trial and derived the cost per quality-adjusted life-year (QALY) gained. From a health system perspective, the incremental cost per patient of adding an SO was $341.09 [95% confidence interval (CI) = $244.44-437.74]. The incremental cost per year per hazardous drinker averted was $3623 (CI = $1777-22,709), the cost per QALY gained $32,200 (CI = $15,800-201,700), and the benefit-cost ratio was 4.73 (95% CI = 0.7-9.66). If adding an SO into the intervention strategy were concentrated during the hours with highest risk or in a trauma unit, it would become even more cost-beneficial. Using criteria established by the World Health Organization (cost-effectiveness below the country's gross domestic product per capita), incorporating a significant other into a patient's motivational intervention for alcohol misuse is highly cost-effective. © 2015 Society for the Study of Addiction.

Identifying and understanding the concerns of business: a systematic approach to the development of the Australian WorkHealth Program - Arthritis.

PubMed

Reavley, Nicola; Livingston, Jenni; Buchbinder, Rachelle; Osborne, Richard

2012-07-01

The aim of the Australian WorkHealth Program - Arthritis was to develop and test an education program designed to minimise risk of arthritis and prevent or reduce absenteeism and presenteeism. The objective of the current study was to use a wide-ranging, multifaceted and interactive approach to engage with stakeholders in order to inform the content and delivery of the intervention. Methods used to inform program design included a concept mapping workshop, interviews, surveys, a steering committee and an industry advisory group. Engaging with a wide range of stakeholders in multiple ways early in program development allowed for the comparison and verification of data to obtain a better overall picture of the needs of participants. It also offered the opportunity to share 'ownership' of the program with stakeholders by generating a program that was tailored to their ethos and needs. The stakeholder engagement process was instrumental in building commitment to the program and establishing an overarching model of action. Interview and survey data indicated that awareness of arthritis was low and musculoskeletal disorders more generally were of greater concern. It was agreed that programs should be relevant, evidence-based, involve senior management education, incorporate a business case, and involve tailored implementation and marketing strategies. The qualitative preparatory phase as well as all the engagement work was key to informing program design. The approach taken in this study has the potential to inform a wide range of workplace interventions. Engaging with a wide range of stakeholders in multiple ways from program inception allowed for the comparison and verification of information to permit the generation of a model of intervention that had the highest possible chance of success. It offered the opportunity to not only define program content and implementation processes, but to build genuine 'ownership' of the program.

Combining stepped-care approaches with behavioral reinforcement to motivate employment in opioid-dependent outpatients.

PubMed

Kidorf, Michael; Neufeld, Karin; Brooner, Robert K

2004-01-01

Employment is associated with improved treatment outcome for opioid-dependent outpatients receiving methadone (e.g., Platt, 1995). Opioid-dependent individuals typically enter treatment unemployed and many remain unemployed despite reductions in heroin use. Additional interventions are needed to motivate employment seeking behaviors and outcome. This article reports on a promising approach to reduce the chronic unemployment commonplace in treatment-seeking, opioid-dependent patients--a "stepped care" service delivery intervention that incorporates multiple behavioral reinforcements to motivate patient participation in and adherence to the treatment plan. This therapeutic approach (Motivated Stepped Care--MSC; Brooner and Kidorf (2002) was refined and modified to motivate and support a range of positive treatment behaviors and outcomes in patients with opioid-dependence (Kidorf et al. 1999), including job-seeking and acquisition. Patients who are unemployed after one year of treatment are systematically advanced to more intensive steps of weekly counseling and remain there until employment is attained. Those who remain unemployed despite exposure to at least 4 weeks of counseling at the highest step of care (Step 3, which is 9 h weekly of counseling) are started on a methadone taper in preparation for discharge, which is reversible upon attaining a job. This article describes the MSC approach and presents rates of employment for patients who were judged capable of working (n = 228). A review of medical and billing records during August--September 2002 revealed that the great majority of these patients were employed (93%), usually in full-time positions. Employment was associated with less frequent advancement to higher intensities of weekly counseling because of drug use. Further, multiple indices of improved employment stability and functioning, including months of work, hours of work, and annualized salary, were associated with better drug use outcomes. These data suggest that the MSC intervention is an effective platform for motivating and supporting both job seeking and employment in patients with chronic and severe substance use disorder.

Participatory Research: New Approaches to the Research to Practice Dilemma.

ERIC Educational Resources Information Center

Meyer, Luanna H.; Park, Hyun-Sook; Grenot-Scheyer, Marquita; Schwartz, Ilene; Harry, Beth

1998-01-01

This article presents a rationale for incorporating elements of participatory research approaches into intervention research intended to improve practice. After an overview of the research-to-practice problem, it illustrates how the incorporation of participatory research approaches applied to various decision points can enhance the construction…

The Incorporation of Animal-Assisted Interventions in Social Work Education

ERIC Educational Resources Information Center

Tedeschi, Philip; Fitchett, Jennifer; Molidor, Christian E.

2005-01-01

Successful social work practice requires orientation to diverse social and cultural characteristics which structure the framework for our communities and families. This paper explores the necessity of incorporating the connection between people and non-human relationships in our understanding of social support systems. Specifically, we examine our…

Incorporating spirituality in psychosocial group intervention for women undergoing in vitro fertilization: a prospective randomized controlled study.

PubMed

Chan, Celia H Y; Chan, Cecilia L W; Ng, Ernest H Y; Ho, P C; Chan, Timothy H Y; Lee, G L; Hui, W H C

2012-12-01

This study examined the efficacy of a group intervention, the Integrative Body-Mind-Spirit (I-BMS) intervention, which aims at improving the psychosocial and spiritual well-being of Chinese women undergoing their first IVF treatment cycle. The I-BMS intervention facilitates the search of meaning of life in the context of family and childbearing, as well as the letting go of high IVF expectations. A randomized controlled study of 339 women undergoing first IVF treatment cycle in a local Hong Kong hospital was conducted (intervention: n= 172; no-intervention control: n= 167). Assessments of anxiety, perceived importance of childbearing, and spiritual well-being were made at randomization (T(0) ), on the day starting ovarian stimulations (T(1)), and on the day undertaking embryo transfer (T(2)). Comparing T(0) and T(2), interaction analyses showed women who had received the intervention reported lower levels of physical distress, anxiety, and disorientation. They reported being more tranquil and satisfied with their marriage, and saw childbearing as less important compared to women in the control group. These findings suggest that I-BMS intervention was successful at improving the psychosocial and spiritual well-being of women undergoing their first IVF treatment cycle. This study highlights the importance of providing integrative fertility treatment that incorporates psychosocial and spiritual dimensions. ©2011 The British Psychological Society.

Multilevel Analysis of Multiple-Baseline Data Evaluating Precision Teaching as an Intervention for Improving Fluency in Foundational Reading Skills for at Risk Readers

ERIC Educational Resources Information Center

Brosnan, Julie; Moeyaert, Mariola; Brooks Newsome, Kendra; Healy, Olive; Heyvaert, Mieke; Onghena, Patrick; Van den Noortgate, Wim

2018-01-01

In this article, multiple-baseline across participants designs were used to evaluate the impact of a precision teaching (PT) program, within a Tier 2 Response to Intervention framework, targeting fluency in foundational reading skills with at risk kindergarten readers. Thirteen multiple-baseline design experiments that included participation from…

Experiential Interventions for Clients with Genital Herpes.

ERIC Educational Resources Information Center

Cummings, Anne L.

1999-01-01

Explores potential benefits of incorporating concepts and interventions from experimental therapy to help clients with psychosocial difficulties in learning to live with genital herpes. Recommends experimental counseling of two-chair dialog, empty chair, and metaphor for helping clients with emotional sequelae of genital herpes. Presents case…

Psycho-Spiritual Integrative Therapy: Psychological Intervention for Women with Breast Cancer

ERIC Educational Resources Information Center

Corwin, Diana; Wall, Kathleen; Koopman, Cheryl

2012-01-01

Women with breast cancer frequently report psychological distress throughout the treatment process. Patients have several empirically supported options for group psychotherapy while undergoing breast cancer treatment. However, few interventions have been developed that incorporate spirituality into psychotherapy, despite indications that patients…

Safety in Aquaculture

ERIC Educational Resources Information Center

Durborow, Robert M.; Myers, Melvin L.

2016-01-01

In this article, occupational safety interventions for agriculture-related jobs, specifically in aquaculture, are reviewed. Maintaining quality of life and avoiding economic loss are two areas in which aquaculturists can benefit by incorporating safety protocols and interventions on their farms. The information in this article is based on farm…

A Contextualized Approach to Faith-Based HIV Risk Reduction for African American Women.

PubMed

Stewart, Jennifer M; Rogers, Christopher K; Bellinger, Dawn; Thompson, Keitra

2016-07-01

HIV/AIDS has a devastating impact on African Americans, particularly women and young adults. We sought to characterize risks, barriers, and content and delivery needs for a faith-based intervention to reduce HIV risk among African American women ages 18 to 25. In a convergent parallel mixed methods study, we conducted four focus groups (n = 38) and surveyed 71 young adult women. Data were collected across four African American churches for a total of 109 participants. We found the majority of women in this sample were engaged in behaviors that put them at risk for contracting HIV, struggled with religiously based barriers and matters of sexuality, and had a desire to incorporate their intimate relationships, parenting, and financial burdens into faith-based HIV risk-reduction interventions. Incorporating additional social context-related factors into HIV risk-reduction interventions for young African American women is critical to adapting and developing HIV interventions to reduce risk among young adult women in faith settings. © The Author(s) 2016.

The role of analogy-guided learning experiences in enhancing students' clinical decision-making skills.

PubMed

Edelen, Bonnie Gilbert; Bell, Alexandra Alice

2011-08-01

The purpose of this study was to address the need for effective educational interventions to promote students' clinical decision making (CDM) within clinical practice environments. Researchers used a quasi-experimental, non-equivalent groups, posttest-only design to assess differences in CDM ability between intervention group students who participated in analogy-guided learning activities and control group students who participated in traditional activities. For the intervention, analogy-guided learning activities were incorporated into weekly group discussions, reflective journal writing, and questioning with clinical faculty. The researcher-designed Assessment of Clinical Decision Making Rubric was used to assess indicators of CDM ability in all students' reflective journal entries. Results indicated that the intervention group demonstrated significantly higher levels of CDM ability in their journals compared with the control group (ES(sm) = 0.52). Recommendations provide nurse educators with strategies to maximize students' development of CDM ability, better preparing students for the demands they face when they enter the profession. Copyright 2011, SLACK Incorporated.

Value-based medicine: evidence-based medicine and beyond.

PubMed

Brown, Gary C; Brown, Melissa M; Sharma, Sanjay

2003-09-01

Value-based medicine is the practice of medicine emphasizing the value received from an intervention. Value is measured by objectively quantifying: 1) the improvement in quality of life and/or 2) the improvement in length of life conferred by an intervention. Evidence-based medicine often measures the improvement gained in length of life, but generally ignores the importance of quality of life improvement or loss. Value-based medicine incorporates the best features of evidence-based medicine and takes evidence-based data to a higher level by incorporating the quality of life perceptions of patients with a disease in concerning the value of an intervention. Inherent in value-based medicine are the costs associated with an intervention. The resources expended for the value gained in value-based medicine is measured with cost-utility analysis in terms of the US dollars/QALY (money spent per quality-adjusted life-year gained). A review of the current status and the likely future of value-based medicine is addressed herein.

Low-Cost, Scalable Classroom-Based Approach to Promoting Physical Activity in Preschool Children

PubMed Central

McCrady-Spitzer, Shelly K; Sagdalen, Vanessa; Manohar, Chinmay U; Levine, James A

2017-01-01

Background This study examined the impact of short activity breaks in preschool children. The hypotheses were that preschool children receiving three five-minute activity breaks per day would increase (a) school time physical activity and (b) education scores compared to a control group not receiving the intervention. Methods For 8 weeks, the Intervention Group (n = 13) incorporated three 5-minute activity breaks into their classroom time while the Control Group (n = 12) did not incorporate the activity breaks. Physical activity was measured using a triaxial accelerometer. Education was assessed using standardized methods. Findings After 8 weeks, the preschool children in the Intervention Group increased their school time physical activity from 11,641 ± (SD) 1,368 Acceleration Units (AU)/ hour to 16,058 ± 2,253 AU/hour (P < 0.001). The children in the control group did not increase their physical activity (11,379 ± 2,427 cf 11,624 ± 2,441; ns). Students in the Intervention Group improved their education scores more than students in the control group (18 ± 12 cf 8 ± 7 points, P = 0.01); Letter Recognition improved in particular (9 ± 6 cf 2 ± 4 points, P = 0.001). Conclusions The incorporation of three 5-minute activity breaks was associated with increased school time physical activity and improved learning. PMID:28936491

Assisting persons with multiple disabilities to move through simple occupational activities with automatic prompting.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Groeneweg, Jop

2008-01-01

The present study assessed the possibility of assisting four persons with multiple disabilities to move through and perform simple occupational activities arranged within a room with the help of automatic prompting. The study involved two multiple probe designs across participants. The first multiple probe concerned the two participants with blindness or minimal vision and deafness, who received air blowing as a prompt. The second multiple probe concerned the two participants with blindness and typical hearing who received a voice calling as a prompt. Initially, all participants had baseline sessions. Then intervention started with the first participant of each dyad. When their performance was consolidated, new baseline and intervention occurred with the second participant of each dyad. Finally, all four participants were exposed to a second intervention phase, in which the number of activities per session doubled (i.e., from 8 to 16). Data showed that all four participants: (a) learned to move across and perform the activities available with the help of automatic prompting and (b) remained highly successful through the second intervention phase when the sessions were extended. Implications of the findings are discussed.

Comparing biomarkers as principal surrogate endpoints.

PubMed

Huang, Ying; Gilbert, Peter B

2011-12-01

Recently a new definition of surrogate endpoint, the "principal surrogate," was proposed based on causal associations between treatment effects on the biomarker and on the clinical endpoint. Despite its appealing interpretation, limited research has been conducted to evaluate principal surrogates, and existing methods focus on risk models that consider a single biomarker. How to compare principal surrogate value of biomarkers or general risk models that consider multiple biomarkers remains an open research question. We propose to characterize a marker or risk model's principal surrogate value based on the distribution of risk difference between interventions. In addition, we propose a novel summary measure (the standardized total gain) that can be used to compare markers and to assess the incremental value of a new marker. We develop a semiparametric estimated-likelihood method to estimate the joint surrogate value of multiple biomarkers. This method accommodates two-phase sampling of biomarkers and is more widely applicable than existing nonparametric methods by incorporating continuous baseline covariates to predict the biomarker(s), and is more robust than existing parametric methods by leaving the error distribution of markers unspecified. The methodology is illustrated using a simulated example set and a real data set in the context of HIV vaccine trials. © 2011, The International Biometric Society.

Cognition in multiple sclerosis

PubMed Central

Benedict, Ralph; Enzinger, Christian; Filippi, Massimo; Geurts, Jeroen J.; Hamalainen, Paivi; Hulst, Hanneke; Inglese, Matilde; Leavitt, Victoria M.; Rocca, Maria A.; Rosti-Otajarvi, Eija M.; Rao, Stephen

2018-01-01

Cognitive decline is recognized as a prevalent and debilitating symptom of multiple sclerosis (MS), especially deficits in episodic memory and processing speed. The field aims to (1) incorporate cognitive assessment into standard clinical care and clinical trials, (2) utilize state-of-the-art neuroimaging to more thoroughly understand neural bases of cognitive deficits, and (3) develop effective, evidence-based, clinically feasible interventions to prevent or treat cognitive dysfunction, which are lacking. There are obstacles to these goals. Our group of MS researchers and clinicians with varied expertise took stock of the current state of the field, and we identify several important practical and theoretical challenges, including key knowledge gaps and methodologic limitations related to (1) understanding and measurement of cognitive deficits, (2) neuroimaging of neural bases and correlates of deficits, and (3) development of effective treatments. This is not a comprehensive review of the extensive literature, but instead a statement of guidelines and priorities for the field. For instance, we provide recommendations for improving the scientific basis and methodologic rigor for cognitive rehabilitation research. Toward this end, we call for multidisciplinary collaborations toward development of biologically based theoretical models of cognition capable of empirical validation and evidence-based refinement, providing the scientific context for effective treatment discovery. PMID:29343470

A counterfactual p-value approach for benefit-risk assessment in clinical trials.

PubMed

Zeng, Donglin; Chen, Ming-Hui; Ibrahim, Joseph G; Wei, Rachel; Ding, Beiying; Ke, Chunlei; Jiang, Qi

2015-01-01

Clinical trials generally allow various efficacy and safety outcomes to be collected for health interventions. Benefit-risk assessment is an important issue when evaluating a new drug. Currently, there is a lack of standardized and validated benefit-risk assessment approaches in drug development due to various challenges. To quantify benefits and risks, we propose a counterfactual p-value (CP) approach. Our approach considers a spectrum of weights for weighting benefit-risk values and computes the extreme probabilities of observing the weighted benefit-risk value in one treatment group as if patients were treated in the other treatment group. The proposed approach is applicable to single benefit and single risk outcome as well as multiple benefit and risk outcomes assessment. In addition, the prior information in the weight schemes relevant to the importance of outcomes can be incorporated in the approach. The proposed CPs plot is intuitive with a visualized weight pattern. The average area under CP and preferred probability over time are used for overall treatment comparison and a bootstrap approach is applied for statistical inference. We assess the proposed approach using simulated data with multiple efficacy and safety endpoints and compare its performance with a stochastic multi-criteria acceptability analysis approach.

Important ingredients for health adaptive information systems.

PubMed

Senathirajah, Yalini; Bakken, Suzanne

2011-01-01

Healthcare information systems frequently do not truly meet clinician needs, due to the complexity, variability, and rapid change in medical contexts. Recently the internet world has been transformed by approaches commonly termed 'Web 2.0'. This paper proposes a Web 2.0 model for a healthcare adaptive architecture. The vision includes creating modular, user-composable systems which aim to make all necessary information from multiple internal and external sources available via a platform, for the user to use, arrange, recombine, author, and share at will, using rich interfaces where advisable. Clinicians can create a set of 'widgets' and 'views' which can transform data, reflect their domain knowledge and cater to their needs, using simple drag and drop interfaces without the intervention of programmers. We have built an example system, MedWISE, embodying the user-facing parts of the model. This approach to HIS is expected to have several advantages, including greater suitability to user needs (reflecting clinician rather than programmer concepts and priorities), incorporation of multiple information sources, agile reconfiguration to meet emerging situations and new treatment deployment, capture of user domain expertise and tacit knowledge, efficiencies due to workflow and human-computer interaction improvements, and greater user acceptance.

Pilot of a computer-based brief multiple-health behavior intervention for college students.

PubMed

Moore, Michele J; Werch, Chudley E; Bian, Hui

2012-01-01

Given the documented multiple health risks college students engage in, and the dearth of effective programs addressing them, the authors developed a computer-based brief multiple-health behavior intervention. This study reports immediate outcomes and feasibility of a pilot of this program. Two hundred students attending a midsized university participated. Participants were randomly assigned to the intervention or control program, both delivered via computer. Immediate feedback was collected with the computer program. Results indicate that the intervention had an early positive impact on alcohol and cigarette use intentions, as well as related constructs underlying the Behavior-Image Model specific to each of the 3 substances measured. Based on the implementation process, the program proved to be feasible to use and acceptable to the population. Results support the potential efficacy of the intervention to positively impact behavioral intentions and linkages between health promoting and damaging behaviors among college students.

Two men with multiple disabilities carry out an assembly work activity with the support of a technology system.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Oliva, Doretta; Campodonico, Francesca

2013-10-01

To assess whether two persons with multiple disabilities could learn a work activity (i.e., assembling trolley wheels) with the support of a technology system. After an initial baseline, the study compared the effects of intervention sessions relying on the technology system (which called the participants to the different workstations and provided feedback and final stimulation) with the effects of intervention sessions carried out without technology. The two types of intervention sessions were conducted according to an alternating treatments design. Eventually, only intervention sessions relying on the technology system were used. Both participants managed to assemble wheels independently during intervention sessions relying on the technology system while they failed during sessions without the system. Their performance was strengthened during the final part of the study, in which only sessions with the system occurred. Technology may be critical in helping persons with multiple disabilities manage multi-step work activities.

Predictors of the physical impact of Multiple Sclerosis following community-based, exercise trial.

PubMed

Kehoe, M; Saunders, J; Jakeman, P; Coote, S

2015-04-01

Studies evaluating exercise interventions in people with multiple sclerosis (PwMS) demonstrate small to medium positive effects and large variability on a number of outcome measures. No study to date has tried to explain this variability. This paper presents a novel exploration of data examining the predictors of outcome for PwMS with minimal gait impairment following a randomised, controlled trial evaluating community-based exercise interventions (N = 242). The primary variable was the physical component of the Multiple Sclerosis Impact Scale-29, version 2 (MSIS-29, v2) after a 10-week, controlled intervention period. Predictors were identified a priori and were measured at baseline. Multiple linear regression was conducted. Four models are presented lower MSIS-29, v2 scores after the intervention period were best predicted by a lower baseline MSIS-29,v2, a lower baseline Modified Fatigue Impact Score (physical subscale), randomisation to an exercise intervention, a longer baseline walking distance measured by the Six Minute Walk Test and female gender. This model explained 57.4% of the variance (F (5, 211) = 59.24, p < 0.01). These results suggest that fatigue and walking distance at baseline contribute significantly to predicting MSIS-29, v29 (physical component) after intervention, and thus should be the focus of intervention and assessment. Exercise is an important contributor to minimising the physical impact of MS, and gender-specific interventions may be warranted. © The Author(s), 2014.

A systematic review of integrated use of disease-management interventions in asthma and COPD.

PubMed

Lemmens, Karin M M; Nieboer, Anna P; Huijsman, Robbert

2009-05-01

The effectiveness of multiple interventions in asthma and chronic obstructive pulmonary disease (COPD) is unclear. To examine the effectiveness of multiple interventions as compared to single interventions or usual care on health outcomes and health care utilisation within the context of integrated disease management in asthma and COPD. MEDLINE and the Cochrane Library (1995-May 2008) were searched for controlled trials. Two reviewers independently extracted data and assessed study quality. Meta-analyses were performed on quality of life and health care utilisation data. Furthermore, the effects of multiple interventions versus single interventions and usual care were assessed qualitatively. Of the 36 studies included, 17 targeted double interventions (patient-related and organisational interventions); 19 studies performed triple interventions (patient-related, professional-directed and organisational interventions). They were heterogeneous in terms of (combinations of) interventions, outcomes measured, study design and setting. Pooled data showed that studied disease management programmes significantly improved quality of life on several domains. Patients within triple intervention programmes had less chance of at least one hospital admission compared with usual care. No significant effects were found in number of emergency department visits. Qualitative analyses revealed positive trends on process improvements and satisfaction. Inconclusive results were reported on symptoms; no effects were found in lung function. In spite of the heterogeneity of disease management studies in asthma and COPD care, this review showed promising improvements in quality of life and reductions in hospitalisations, especially for triple intervention programmes.

Hear here: children with hearing loss learn words by listening.

PubMed

Lew, Joyce; Purcell, Alison A; Doble, Maree; Lim, Lynne H

2014-10-01

Early use of hearing devices and family participation in auditory-verbal therapy has been associated with age-appropriate verbal communication outcomes for children with hearing loss. However, there continues to be great variability in outcomes across different oral intervention programmes and little consensus on how therapists should prioritise goals at each therapy session for positive clinical outcomes. This pilot intervention study aimed to determine whether therapy goals that concentrate on teaching preschool children with hearing loss how to distinguish between words in a structured listening programme is effective, and whether gains in speech perception skills impact on vocabulary and speech development without them having to be worked on directly in therapy. A multiple baseline across subjects design was used in this within-subject controlled study. 3 children aged between 2:6 and 3:1 with moderate-severe to severe-profound hearing loss were recruited for a 6-week intervention programme. Each participant commenced at different stages of the 10-staged listening programme depending on their individual listening skills at recruitment. Speech development and vocabulary assessments were conducted before and after the training programme in addition to speech perception assessments and probes conducted throughout the intervention programme. All participants made gains in speech perception skills as well as vocabulary and speech development. Speech perception skills acquired were noted to be maintained a week after intervention. In addition, all participants were able to generalise speech perception skills learnt to words that had not been used in the intervention programme. This pilot study found that therapy directed at listening alone is promising and that it may have positive impact on speech and vocabulary development without these goals having to be incorporated into a therapy programme. Although a larger study is necessary for more conclusive findings, the results from this preliminary study are promising in support of emphasise on listening skills within auditory-verbal therapy programmes. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

Evidence-Based mHealth Chronic Disease Mobile App Intervention Design: Development of a Framework.

PubMed

Wilhide Iii, Calvin C; Peeples, Malinda M; Anthony Kouyaté, Robin C

2016-02-16

Mobile technology offers new capabilities that can help to drive important aspects of chronic disease management at both an individual and population level, including the ability to deliver real-time interventions that can be connected to a health care team. A framework that supports both development and evaluation is needed to understand the aspects of mHealth that work for specific diseases, populations, and in the achievement of specific outcomes in real-world settings. This framework should incorporate design structure and process, which are important to translate clinical and behavioral evidence, user interface, experience design and technical capabilities into scalable, replicable, and evidence-based mobile health (mHealth) solutions to drive outcomes. The purpose of this paper is to discuss the identification and development of an app intervention design framework, and its subsequent refinement through development of various types of mHealth apps for chronic disease. The process of developing the framework was conducted between June 2012 and June 2014. Informed by clinical guidelines, standards of care, clinical practice recommendations, evidence-based research, best practices, and translated by subject matter experts, a framework for mobile app design was developed and the refinement of the framework across seven chronic disease states and three different product types is described. The result was the development of the Chronic Disease mHealth App Intervention Design Framework. This framework allowed for the integration of clinical and behavioral evidence for intervention and feature design. The application to different diseases and implementation models guided the design of mHealth solutions for varying levels of chronic disease management. The framework and its design elements enable replicable product development for mHealth apps and may provide a foundation for the digital health industry to systematically expand mobile health interventions and validate their effectiveness across multiple implementation settings and chronic diseases.

Family economic strengthening and mental health functioning of caregivers for AIDS-affected children in rural Uganda.

PubMed

Wang, Julia Shu-Huah; Ssewamala, Fred M; Han, Chang-Keun

In sub-Saharan Africa, many extended families assume the role of caregivers for children orphaned by AIDS (AIDS-affected children). The economic and psychological stress ensued from caregiving duties often predispose caregivers to poor mental health outcomes. Yet, very few studies exist on effective interventions to support these caregivers. Using data from a randomized controlled trial called Suubi-Maka ( N = 346), this paper examines whether a family economic strengthening intervention among families caring for AIDS-affected children (ages 12-14) in Uganda would improve the primary caregivers' mental health functioning. The Suubi-Maka study comprised of a control condition ( n = 167) receiving usual care for AIDS-affected children, and a treatment condition ( n = 179) receiving a family economic strengthening intervention, including matched savings accounts, and financial planning and management training to incentivize families to save money for education and/or family-level income generating projects. This paper uses data from baseline/pre-intervention (wave 1) interviews with caregivers and 12-month post-intervention initiation (wave 2). The caregiver's mental health measure adapted from previous studies in sub- Saharan Africa had an internal consistency of .88 at wave 1 and .90 at wave 2. At baseline, the two study groups did not significantly differ on caregiver's mental health functioning. However, at 12-month follow-up, multiple regression analysis located significant differences between the two study groups on mental health functioning. Specifically, following the intervention, caregivers in the treatment condition reported positive improvements on their mental health functioning, especially in the symptom areas of obsession-compulsion, interpersonal sensitivity, hostility, and psychoticism. Findings point to a need for programs and policies aimed at supporting caregivers of AIDS-affected children to begin to consider incorporating family-level economic strengthening components in their usual care protocols, especially in low-resource countries of sub-Saharan Africa. Economic empowerment programming may help enhance the well-being of caregivers and their families.

Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners.

PubMed

Paul, Christine L; Piterman, Leon; Shaw, Jonathan E; Kirby, Catherine; Forshaw, Kristy L; Robinson, Jennifer; Thepwongsa, Isaraporn; Sanson-Fisher, Robert W

2017-03-23

In Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control. Trial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period. Eleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued. There is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented. Australian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976 . Retrospectively registered on 31 May 2011.

Family economic strengthening and mental health functioning of caregivers for AIDS-affected children in rural Uganda

PubMed Central

Wang, Julia Shu-Huah; Ssewamala, Fred M.; Han, Chang-Keun

2015-01-01

In sub-Saharan Africa, many extended families assume the role of caregivers for children orphaned by AIDS (AIDS-affected children). The economic and psychological stress ensued from caregiving duties often predispose caregivers to poor mental health outcomes. Yet, very few studies exist on effective interventions to support these caregivers. Using data from a randomized controlled trial called Suubi-Maka (N = 346), this paper examines whether a family economic strengthening intervention among families caring for AIDS-affected children (ages 12–14) in Uganda would improve the primary caregivers’ mental health functioning. The Suubi-Maka study comprised of a control condition (n = 167) receiving usual care for AIDS-affected children, and a treatment condition (n = 179) receiving a family economic strengthening intervention, including matched savings accounts, and financial planning and management training to incentivize families to save money for education and/or family-level income generating projects. This paper uses data from baseline/pre-intervention (wave 1) interviews with caregivers and 12-month post-intervention initiation (wave 2). The caregiver’s mental health measure adapted from previous studies in sub- Saharan Africa had an internal consistency of .88 at wave 1 and .90 at wave 2. At baseline, the two study groups did not significantly differ on caregiver’s mental health functioning. However, at 12-month follow-up, multiple regression analysis located significant differences between the two study groups on mental health functioning. Specifically, following the intervention, caregivers in the treatment condition reported positive improvements on their mental health functioning, especially in the symptom areas of obsession–compulsion, interpersonal sensitivity, hostility, and psychoticism. Findings point to a need for programs and policies aimed at supporting caregivers of AIDS-affected children to begin to consider incorporating family-level economic strengthening components in their usual care protocols, especially in low-resource countries of sub-Saharan Africa. Economic empowerment programming may help enhance the well-being of caregivers and their families. PMID:26246846

Evidence-Based mHealth Chronic Disease Mobile App Intervention Design: Development of a Framework

PubMed Central

Peeples, Malinda M; Anthony Kouyaté, Robin C

2016-01-01

Background Mobile technology offers new capabilities that can help to drive important aspects of chronic disease management at both an individual and population level, including the ability to deliver real-time interventions that can be connected to a health care team. A framework that supports both development and evaluation is needed to understand the aspects of mHealth that work for specific diseases, populations, and in the achievement of specific outcomes in real-world settings. This framework should incorporate design structure and process, which are important to translate clinical and behavioral evidence, user interface, experience design and technical capabilities into scalable, replicable, and evidence-based mobile health (mHealth) solutions to drive outcomes. Objective The purpose of this paper is to discuss the identification and development of an app intervention design framework, and its subsequent refinement through development of various types of mHealth apps for chronic disease. Methods The process of developing the framework was conducted between June 2012 and June 2014. Informed by clinical guidelines, standards of care, clinical practice recommendations, evidence-based research, best practices, and translated by subject matter experts, a framework for mobile app design was developed and the refinement of the framework across seven chronic disease states and three different product types is described. Results The result was the development of the Chronic Disease mHealth App Intervention Design Framework. This framework allowed for the integration of clinical and behavioral evidence for intervention and feature design. The application to different diseases and implementation models guided the design of mHealth solutions for varying levels of chronic disease management. Conclusions The framework and its design elements enable replicable product development for mHealth apps and may provide a foundation for the digital health industry to systematically expand mobile health interventions and validate their effectiveness across multiple implementation settings and chronic diseases. PMID:26883135

Visualizing Syllables: Real-Time Computerized Feedback within a Speech-Language Intervention

ERIC Educational Resources Information Center

DeThorne, Laura; Aparicio Betancourt, Mariana; Karahalios, Karrie; Halle, Jim; Bogue, Ellen

2015-01-01

Computerized technologies now offer unprecedented opportunities to provide real-time visual feedback to facilitate children's speech-language development. We employed a mixed-method design to examine the effectiveness of two speech-language interventions aimed at facilitating children's multisyllabic productions: one incorporated a novel…

Directed Consultation, the SEALS Model, and Teachers' Classroom Management

ERIC Educational Resources Information Center

Motoca, Luci M.; Farmer, Thomas W.; Hamm, Jill V.; Byun, Soo-yong; Lee, David L.; Brooks, Debbie S.; Rucker, Nkecha; Moohr, Michele M.

2014-01-01

Directed consultation is presented as a professional development framework to guide and support teachers in the implementation of evidence-based interventions that involve contextual and process-oriented approaches designed to be incorporated into daily classroom management. This approach consists of four components: pre-intervention observations…

Universal Interventions for Students with ADHD--and All Students

ERIC Educational Resources Information Center

Zelenka, Valerie

2017-01-01

This article describes effective classroom intervention strategies for students experiencing symptoms of attention-deficit/hyperactivity disorder (ADHD), regardless of the severity and whether the student has a diagnosis of ADHD. These suggestions incorporate the universal design for learning (UDL) framework. This framework does not limit…

Effectiveness of Community-Based Early Intervention Based on Pivotal Response Treatment

ERIC Educational Resources Information Center

Smith, Isabel M.; Flanagan, Helen E.; Garon, Nancy; Bryson, Susan E.

2015-01-01

Preschoolers (n = 118) with autism spectrum disorder (ASD) participated in this prospective effectiveness study of an early intervention program. Treatment entailed parent training and therapist-implemented components, incorporating Pivotal Response Treatment and Positive Behaviour Support. Standardized ability and behavioural measures were…

Implementation of national guidelines, incorporated within structured diabetes and hypertension records at primary level care in Cape Town, South Africa: a randomised controlled trial.

PubMed

Steyn, Krisela; Lombard, Carl; Gwebushe, Nomonde; Fourie, Jean M; Everett-Murphy, Katherine; Zwarenstein, Merrick; Levitt, Naomi S

2013-09-25

Many clinical management guidelines for chronic diseases have been published, but they have not been put into practice by busy clinicians at primary care levels. This study evaluates the implementation of national guidelines incorporated within a structured diabetes and hypertension clinical record (SR) in Cape Town in a randomised controlled trial (RCT). Eighteen public sector community health centres (CHC) were randomly selected and allocated as intervention or control CHC. At each clinic, 25 patients with diabetes and 35 patients with hypertension were enrolled at baseline. Questionnaires were completed, blood samples were collected, blood pressure (BP) and anthropometric measures were taken and patient records were audited. SR with clinical guideline prompts were introduced at the intervention clinics after training doctors in their use and suggestions to incorporate them in regular patient records. Contact was maintained during the year of intervention with the clinic staff. A follow-up survey was conducted 1 year later to assess BP and HbA1c, and the patient records were examined to ascertain the extent of use of the SR in the intervention clinics. In-depth interviews were conducted with doctors and nurses to record their response to the intervention. The intervention evaluated in this RCT had no impact on either diabetes or hypertension control. In the intervention clinics, less than 60% of the patient folders contained the SR and when present was seldom used. Although the staff were well disposed to the research team, their workload prohibited them from undertaking a true evaluation of the SR, and overall they did not perceive the SR as supporting their current process of patient care. No benefit to diabetes of hypertension care by introducing and availability of the staff in the use of the SR was shown in this RCT. The process measures suggest that the SR was not widely used by the healthcare provided in the primary care clinics.

Integrated package approach in delivering interventions during immunisation campaigns in a complex environment in Papua New Guinea: a case study.

PubMed

Vince, John David; Datta, Siddhartha Sankar; Toikilik, Steven; Lagani, William

2014-08-06

Papua New Guinea's difficult and varied topography, poor transport infrastructure, changing dynamics of population and economy in recent times and understaffed and poorly financed health service present major challenges for successful delivery of vaccination and other preventative health interventions to both the rural majority and urban populations, thereby posing risks for vaccine preventable disease outbreaks in the country. The country has struggled to meet the vaccination coverage targets required for the eradication of poliomyelitis and elimination of measles. Escalation of inter and intra country migration resulting from major industrial developments, particularly in extraction industries, has substantially increased the risk of infectious disease importation. This case study documents the evolution of immunisation programmes since the introduction of supplementary immunisation activities (SIAs). Single antigen SIAs have advantages and disadvantages. In situations in which the delivery of preventative health interventions is difficult, it is likely that the cost benefit is greater for multiple than for single intervention. The lessons learned from the conduct of single antigen SIAs can be effectively used for programmes delivering multiple SIA antigens, routine immunisations, and other health interventions. This paper describes a successful and cost effective multiple intervention programme in Papua New Guinea. The review of the last SIA in Papua New Guinea showed relatively high coverage of all the interventions and demonstrated the operational feasibility of delivering multiple interventions in resource constrained settings. Studies in other developing countries such as Lesotho and Ethiopia have also successfully integrated health interventions with SIA. In settings such as Papua New Guinea there is a strong case for integrating supplementary immunisation activity with routine immunisation and other health interventions through a comprehensive outreach programme. Copyright © 2014 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

Paired peer learning through engineering education outreach

NASA Astrophysics Data System (ADS)

Fogg-Rogers, Laura; Lewis, Fay; Edmonds, Juliet

2017-01-01

Undergraduate education incorporating active learning and vicarious experience through education outreach presents a critical opportunity to influence future engineering teaching and practice capabilities. Engineering education outreach activities have been shown to have multiple benefits; increasing interest and engagement with science and engineering for school children, providing teachers with expert contributions to engineering subject knowledge, and developing professional generic skills for engineers such as communication and teamwork. This pilot intervention paired 10 pre-service teachers and 11 student engineers to enact engineering outreach in primary schools, reaching 269 children. A longitudinal mixed methods design was employed to measure change in attitudes and Education Outreach Self-Efficacy in student engineers; alongside attitudes, Teaching Engineering Self-Efficacy and Engineering Subject Knowledge Confidence in pre-service teachers. Highly significant improvements were noted in the pre-service teachers' confidence and self-efficacy, while both the teachers and engineers qualitatively described benefits arising from the paired peer mentor model.

The effects of old, new and emerging medicines on metabolic aberrations in PCOS

PubMed Central

Bargiota, Alexandra

2012-01-01

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age that is associated with significant adverse short- and long-term health consequences. Multiple metabolic aberrations, such as insulin resistance (IR) and hyperinsulinaemia, high incidence of impaired glucose tolerance, visceral obesity, inflammation and endothelial dysfunction, hypertension and dyslipidemia are associated with the syndrome. Assessing the metabolic aberrations and their long term health impact in women with PCOS is challenging and becomes more important as therapeutic interventions currently available for the management of PCOS are not fully able to deal with all these consequences. Current therapeutic management of PCOS has incorporated new treatments resulting from the better understanding of the pathophysiology of the syndrome. The aim of this review is to summarize the effect of old, new and emerging therapies used in the management of PCOS, on the metabolic aberrations of PCOS PMID:23148192

Developing a tool to support diagnostic delivery of dementia.

PubMed

Bennett, Claire E; De Boos, Danielle; Moghaddam, Nima G

2018-01-01

It is increasingly recognised that there are challenges affecting the current delivery of dementia diagnoses. Steps are required to address this. Current good practice guidelines provide insufficient direction and interventions from other healthcare settings do not appear to fully translate to dementia care settings. This project has taken a sequential two-phase design to developing a tool specific to dementia diagnostic delivery. Interviews with 14 participants explored good diagnostic delivery. Thematic analysis produced key themes (overcoming barriers, navigation of multiple journeys and completing overt and covert tasks) that were used to inform the design of a tool for use by clinicians, patients and companions. The tool was evaluated for acceptability in focused group discussions with 13 participants, which indicated a desire to use the tool and that it could encourage good practice. Adaptations were highlighted and incorporated to improve acceptability. Future research is now required to further evaluate the tool.

Understanding nurses' decisions to treat pain in nursing home residents with dementia.

PubMed

Gilmore-Bykovskyi, Andrea L; Bowers, Barbara J

2013-04-01

Nursing home (NH) residents with dementia continue to receive inadequate pain treatment. The purpose of this qualitative study was to examine how nurses make decisions to pharmacologically treat pain in NH residents with dementia. Using Grounded Dimensional Analysis, 15 in-depth interviews were conducted with 13 nurses from four skilled nursing facilities in Wisconsin. Nurses experienced varying levels of certainty regarding suspected pain in response to particular resident characteristics and whether pain was perceived as visible/obvious or nonvisible/not obvious. Nurses felt highly uncertain about pain in residents with dementia. Suspected pain in residents with dementia was nearly always conceptualized as a change in behavior to which nurses responded by trialing multiple interventions in attempts to return the resident to baseline, which despite current recommendations, did not include pain relief trials. Residents with dementia were described as being at greatest risk for experiencing underassessment, undertreatment, and delayed treatment for pain Copyright 2013, SLACK Incorporated.

Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners

PubMed Central

Springer, Andrew E.; Evans, Alexandra E.

2016-01-01

Conducting a health needs assessment is an important if not essential first step for health promotion planning. This paper explores how health needs assessments may be further strengthened for health promotion planning via an assessment of environmental assets rooted in the multiple environments (policy, information, social and physical environments) that shape health and behavior. Guided by a behavioral-ecological perspective- one that seeks to identify environmental assets that can influence health behavior, and an implementation science perspective- one that seeks to interweave health promotion strategies into existing environmental assets, we present a basic framework for assessing environmental assets and review examples from the literature to illustrate the incorporation of environmental assets into health program design. Health promotion practitioners and researchers implicitly identify and apply environmental assets in the design and implementation of health promotion interventions;this paper provides foundation for greater intentionality in assessing environmental assets for health promotion planning. PMID:27579254

Social inclusion/exclusion as matters of social (in)justice: a call for nursing action.

PubMed

Yanicki, Sharon M; Kushner, Kaysi E; Reutter, Linda

2015-06-01

Social inclusion/exclusion involves just/unjust social relations and social structures enabling or constraining opportunities for participation and health. In this paper, social inclusion/exclusion is explored as a dialectic. Three discourses--discourses on recognition, capabilities, and equality and citizenship--are identified within Canadian literature. Each discourse highlights a different view of the injustices leading to social exclusion and the conditions supporting inclusion and social justice. An Integrated Framework for Social Justice that incorporates the three discourses is developed and used to critique the dominant focus on distributive justice within foundational Canadian nursing documents. We propose a broader conceptualization of social (in)justice that includes both relational and structural dimensions. Opportunities for multilevel interventions to promote social justice are identified. This framework is congruent with nursing's moral imperative to promote health equity and with the multiple roles played by nurses to promote social justice in everyday practice. © 2014 John Wiley & Sons Ltd.

Investigation of Matlab® as platform in navigation and control of an Automatic Guided Vehicle utilising an omnivision sensor.

PubMed

Kotze, Ben; Jordaan, Gerrit

2014-08-25

Automatic Guided Vehicles (AGVs) are navigated utilising multiple types of sensors for detecting the environment. In this investigation such sensors are replaced and/or minimized by the use of a single omnidirectional camera picture stream. An area of interest is extracted, and by using image processing the vehicle is navigated on a set path. Reconfigurability is added to the route layout by signs incorporated in the navigation process. The result is the possible manipulation of a number of AGVs, each on its own designated colour-signed path. This route is reconfigurable by the operator with no programming alteration or intervention. A low resolution camera and a Matlab® software development platform are utilised. The use of Matlab® lends itself to speedy evaluation and implementation of image processing options on the AGV, but its functioning in such an environment needs to be assessed.

Aging in Community: Developing a More Holistic Approach to Enhance Older Adults' Well-Being.

PubMed

Davitt, Joan K; Madigan, Elizabeth A; Rantz, Marilyn; Skemp, Lisa

2016-01-01

Public health advances have contributed to increased longevity; however, individuals are more likely to live longer with multiple chronic conditions. The existing health care system primarily focuses on treating disease rather than addressing well-being as a holistic construct that includes physical, social, and environmental components. The current commentary emphasizes the importance of supporting healthy active aging and aging in community. The barriers to aging in community and the state of the intervention science in response to this problem are discussed, and recommendations for future research are provided. Active aging is more than managing illness or care transitions-it promotes engagement, participation, dignity, self-fulfillment, self-determination, and support for older adults. To support aging in community and healthy active aging, a paradigm shift is needed in how the well-being of older adults is thought about and supported. Copyright 2016, SLACK Incorporated.

Factors that influence attitudes and sexual behavior among constituency youth workers in Oshana Region, Namibia.

PubMed

Lawoyin, Olusheyi O; Kanthula, Ruth M

2010-03-01

This survey was carried out to assess attitudes and behaviour among youth within four constituencies in Oshana region, Namibia and to understand to how certain social and cultural factors inform attitudes and influence sexual behaviour among the population of young people surveyed. Using a structured questionnaire, data were collected from a random sample of eighty young men and women between the ages of 15-30 years from four constituencies in Oshana region. Survey outcomes revealed attitudes and certain factors that are linked to sexual risk behaviour such as multiple sexual partnerships. Outcomes also reveal an influence of established socio-cultural norms on gender dynamics within relationships and a culture of reserve around discussions of sex and sexuality among young people. Stakeholder interventions should be directed towards incorporating approaches that address these factors as part of efforts to curb the incidence of HIV among young people in Namibia.

Sexual sensation seeking, transactional sex, and rural African American cocaine users

PubMed Central

Gullette, Donna; Booth, Brenda M.; Wright, Patricia B.; Montgomery, Brooke E. E.; Stewart, Katharine E.

2014-01-01

The purpose of this study was to explore correlates of sexual sensation seeking (SSS) in a sample of rural African American cocaine users. Respondent-driven sampling was used to recruit 251 participants from two impoverished rural counties in eastern Arkansas. Consistent with previous investigations, SSS scores were associated with being younger, being male, having more sexual partners, and having more unprotected sexual encounters in the previous 30 days. Multiple regression revealed SSS was correlated with number of oral sex acts, transactional sex (exchanging sex for food, shelter, drugs, money, or other commodities), and Addiction Severity Index (ASI) drug composite. SSS continues to demonstrate a strong association with sexual risk behaviors in diverse populations, including vulnerable groups like this community. Interventions to reduce unsafe sexual behaviors among high-risk groups, including drug users and individuals who engage in transactional sex, should incorporate approaches that include high sensation seekers' needs for novelty and variety. PMID:24070647

Investigation of Matlab® as Platform in Navigation and Control of an Automatic Guided Vehicle Utilising an Omnivision Sensor

PubMed Central

Kotze, Ben; Jordaan, Gerrit

2014-01-01

Automatic Guided Vehicles (AGVs) are navigated utilising multiple types of sensors for detecting the environment. In this investigation such sensors are replaced and/or minimized by the use of a single omnidirectional camera picture stream. An area of interest is extracted, and by using image processing the vehicle is navigated on a set path. Reconfigurability is added to the route layout by signs incorporated in the navigation process. The result is the possible manipulation of a number of AGVs, each on its own designated colour-signed path. This route is reconfigurable by the operator with no programming alteration or intervention. A low resolution camera and a Matlab® software development platform are utilised. The use of Matlab® lends itself to speedy evaluation and implementation of image processing options on the AGV, but its functioning in such an environment needs to be assessed. PMID:25157548

Carpal valgus in llamas and alpacas: Retrospective evaluation of patient characteristics, radiographic features and outcomes following surgical treatment

PubMed Central

Hunter, Barbara; Duesterdieck-Zellmer, Katja F.; Huber, Michael J.; Parker, Jill E.; Semevolos, Stacy A.

2014-01-01

This study evaluated outcomes of surgical treatment for carpal valgus in New World camelids and correlated successful outcome (absence of carpal valgus determined by a veterinarian) with patient characteristics and radiographic features. Univariable and multivariable analyses of retrospective case data in 19 camelids (33 limbs) treated for carpal valgus between 1987 and 2010 revealed that procedures incorporating a distal radial transphyseal bridge were more likely (P = 0.03) to result in success after a single surgical procedure. A greater degree of angulation (> 19°, P = 0.02) and younger age at surgery (< 4 months, P = 0.03) were associated with unsuccessful outcome. Overall, 74% of limbs straightened, 15% overcorrected, and 11% had persistent valgus following surgical intervention. To straighten, 22% of limbs required multiple procedures, not including implant removal. According to owners, valgus returned following implant removal in 4 limbs that had straightened after surgery. PMID:25477542

Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners.

PubMed

Springer, Andrew E; Evans, Alexandra E

2016-01-01

Conducting a health needs assessment is an important if not essential first step for health promotion planning. This paper explores how health needs assessments may be further strengthened for health promotion planning via an assessment of environmental assets rooted in the multiple environments (policy, information, social and physical environments) that shape health and behavior. Guided by a behavioral-ecological perspective- one that seeks to identify environmental assets that can influence health behavior, and an implementation science perspective- one that seeks to interweave health promotion strategies into existing environmental assets, we present a basic framework for assessing environmental assets and review examples from the literature to illustrate the incorporation of environmental assets into health program design. Health promotion practitioners and researchers implicitly identify and apply environmental assets in the design and implementation of health promotion interventions;this paper provides foundation for greater intentionality in assessing environmental assets for health promotion planning.

Evidence based selection of probiotic strains to promote astronaut health or alleviate symptoms of illness on long duration spaceflight missions.

PubMed

Douglas, G L; Voorhies, A A

2017-10-13

Spaceflight impacts multiple aspects of human physiology, which will require non-invasive countermeasures as mission length and distance from Earth increases and the capability for external medical intervention decreases. Studies on Earth have shown that probiotics have the potential to improve some of the conditions that have manifested during spaceflight, such as gastrointestinal distress, dermatitis, and respiratory infections. The constraints and risks of spaceflight make it imperative that probiotics are carefully selected based on their strain-specific benefits, doses, delivery mechanisms, and relevance to likely crew conditions prior to evaluation in astronauts. This review focuses on probiotics that have been incorporated into healthy human gastrointestinal microbiomes and associated clinically with improvements in inflammatory state or alleviation of symptoms of crew-relevant illness. These studies provide an evidence base for probiotic selection with the greatest potential to support crew health and well-being in spaceflight.

Use of health economics in the development of a national radon control strategy in Ireland.

PubMed

Pollard, D; Fenton, D

2014-07-01

A health economics evaluation of different radon intervention strategies was undertaken including the incorporation of prevention into new buildings, the incorporation of potential remedial measures into new buildings and remediation of existing buildings. The analysis shows that (1) the incorporation of prevention into new houses at the time of construction is generally more cost effective than remediation of existing houses and (2) that the cost effectiveness of programmes aimed at encouraging householders to test and remediate their houses may be poor if they are not undertaken within the context of coherent radon reduction strategy. The results of this evaluation were used to identify the most cost-effective radon interventions in an Irish context in support of the development of a National Radon Control Strategy. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Associations between Adolescents' Perceptions of Alcohol Norms and Alcohol Behaviors: Incorporating Within-School Variability

ERIC Educational Resources Information Center

François, Amir; Lindstrom Johnson, Sarah; Waasdorp, Tracy E.; Parker, Elizabeth M.; Bradshaw, Catherine P.

2017-01-01

Background: Social norm interventions have been implemented in schools to address concerns of alcohol use among high school students; however, research in this area has not incorporated measures of variability that may better reflect the complexity of social influences. Purpose: To examine the association between perceived alcohol norms, the…

Incorporating Choice and Preferred Activities into Classwide Instruction

ERIC Educational Resources Information Center

Kern, Lee; State, Talida M.

2009-01-01

It is often said that the best intervention strategies prevent problem behaviors from starting in the first place. Two preventative strategies that teachers can use are choice making and incorporating preferred activities into classwide instruction. Not only do these strategies avoid problem behaviors, but teachers also find them easy to use in…

Incorporating walking or cycling into car journeys to and from work: The role of individual, workplace and environmental characteristics

PubMed Central

Panter, Jenna; Desousa, Carol; Ogilvie, David

2013-01-01

Objective Small increases in walking or cycling for transport could contribute to population health improvement. We explore the individual, workplace and environmental characteristics associated with the incorporation of walking and cycling into car journeys. Methods In 2009, participants from the Commuting and Health in Cambridge study (UK) reported transport modes used on the commute in the last week as well as individual, workplace and environmental characteristics. Logistic regression was used to assess the explanatory variables associated with incorporating walking or cycling into car commuting journeys. Results 31% of car commuters (n = 419, mean age 43.3 years, SD 0.3) regularly incorporated walking or cycling into their commute. Those without access to car parking at work (OR: 26.0, 95% CI:11.8 to 57.2) and who reported most supportive environments for walking and cycling en route to work (highest versus lowest tertile, OR: 2.7, 95% CI 1.4 to 5.5) were more likely to incorporate walking or cycling into their car journeys. Conclusions Interventions that provide pleasant and convenient routes, limit or charge for workplace car parking and provide free off-site car parking may encourage car commuters to incorporate walking and cycling into car journeys. The effects of such interventions remain to be evaluated. PMID:23375993

Incorporating walking or cycling into car journeys to and from work: the role of individual, workplace and environmental characteristics.

PubMed

Panter, Jenna; Desousa, Carol; Ogilvie, David

2013-03-01

Small increases in walking or cycling for transport could contribute to population health improvement. We explore the individual, workplace and environmental characteristics associated with the incorporation of walking and cycling into car journeys. In 2009, participants from the Commuting and Health in Cambridge study (UK) reported transport modes used on the commute in the last week as well as individual, workplace and environmental characteristics. Logistic regression was used to assess the explanatory variables associated with incorporating walking or cycling into car commuting journeys. 31% of car commuters (n=419, mean age 43.3 years, SD 0.3) regularly incorporated walking or cycling into their commute. Those without access to car parking at work (OR: 26.0, 95% CI:11.8 to 57.2) and who reported most supportive environments for walking and cycling en route to work (highest versus lowest tertile, OR: 2.7, 95% CI 1.4 to 5.5) were more likely to incorporate walking or cycling into their car journeys. Interventions that provide pleasant and convenient routes, limit or charge for workplace car parking and provide free off-site car parking may encourage car commuters to incorporate walking and cycling into car journeys. The effects of such interventions remain to be evaluated. Copyright © 2013 Elsevier Inc. All rights reserved.

Incorporating genomics into breast and prostate cancer screening: assessing the implications

PubMed Central

Chowdhury, Susmita; Dent, Tom; Pashayan, Nora; Hall, Alison; Lyratzopoulos, Georgios; Hallowell, Nina; Hall, Per; Pharoah, Paul; Burton, Hilary

2013-01-01

Individual risk prediction and stratification based on polygenic profiling may be useful in disease prevention. Risk-stratified population screening based on multiple factors including a polygenic risk profile has the potential to be more efficient than age-stratified screening. In this article, we summarize the implications of personalized screening for breast and prostate cancers. We report the opinions of multidisciplinary international experts who have explored the scientific, ethical, and logistical aspects of stratified screening. We have identified (i) the need to recognize the benefits and harms of personalized screening as compared with existing screening methods, (ii) that the use of genetic data highlights complex ethical issues including discrimination against high-risk individuals by insurers and employers and patient autonomy in relation to genetic testing of minors, (iii) the need for transparency and clear communication about risk scores, about harms and benefits, and about reasons for inclusion and exclusion from the risk-based screening process, and (iv) the need to develop new professional competences and to assess cost-effectiveness and acceptability of stratified screening programs before implementation. We conclude that health professionals and stakeholders need to consider the implications of incorporating genetic information in intervention strategies for health-care planning in the future. Genet Med 2013:15(6):423–432 PMID:23412607

Increasing the frequency of physical activity very brief advice for cancer patients. Development of an intervention using the behaviour change wheel.

PubMed

Webb, J; Foster, J; Poulter, E

2016-04-01

Being physically active has multiple benefits for cancer patients. Despite this only 23% are active to the national recommendations and 31% are completely inactive. A cancer diagnosis offers a teachable moment in which patients might be more receptive to lifestyle changes. Nurses are well placed to offer physical activity advice, however, only 9% of UK nurses involved in cancer care talk to all cancer patients about physical activity. A change in the behaviour of nurses is needed to routinely deliver physical activity advice to cancer patients. As recommended by the Medical Research Council, behavioural change interventions should be evidenced-based and use a relevant and coherent theoretical framework to stand the best chance of success. This paper presents a case study on the development of an intervention to improve the frequency of delivery of very brief advice (VBA) on physical activity by nurses to cancer patients, using the Behaviour Change Wheel (BCW). The eight composite steps outlined by the BCW guided the intervention development process. An iterative approach was taken involving key stakeholders (n = 45), with four iterations completed in total. This was not defined a priori but emerged during the development process. A 60 min training intervention, delivered in either a face-to-face or online setting, with follow-up at eight weeks, was designed to improve the capability, opportunity and motivation of nurses to deliver VBA on physical activity to people living with cancer. This intervention incorporates seven behaviour change techniques of goal setting coupled with commitment; instructions on how to perform the behaviour; salience of the consequences of delivering VBA; a demonstration on how to give VBA, all delivered via a credible source with objects added to the environment to support behavioural change. The BCW is a time consuming process, however, it provides a useful and comprehensive framework for intervention development and greater control over intervention replication and evaluation. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Discordances originated by multiple meta-analyses on interventions for myocardial infarction: a systematic review.

PubMed

Lucenteforte, Ersilia; Moja, Lorenzo; Pecoraro, Valentina; Conti, Andrea A; Conti, Antonio; Crudeli, Elena; Galli, Alessio; Gensini, Gian Franco; Minnelli, Martina; Mugelli, Alessandro; Proietti, Riccardo; Shtylla, Jonida; D'Amico, Roberto; Parmelli, Elena; Virgili, Gianni

2015-03-01

To clarify the impact of multiple (covering the same population, intervention, control, and outcomes) systematic reviews (SRs) on interventions for myocardial infarction (MI). Clinical Evidence (BMJ Group) sections and related search strategies regarding MI were used to identify multiple SRs published between 1997 and 2007. Multiple SRs were classified as discordant if they featured conflicting results or interpretation of them. Thirty-six SRs (23.5% of 153 on the treatment or prevention of MI) were classified as multiple and grouped in 16 clusters [ie, at least two SRs with the same PICO (population, condition/disease, intervention, control) and at least one common outcome] exploring angioplasty, angiotensin-converting enzyme inhibitors, anticoagulants, antiplatelets, β-blockers, and stents. Complete agreement on statistically significant differences between interventions was found in 7 of 10 clusters with a shared composite outcome. Agreement was reduced when single outcomes were considered. Despite substantial variation and limited agreement in reporting of major outcomes, SRs agreed in their conclusions on the superiority of either the intervention or control in 14 of 16 clusters. Sources of minor discrepancies were found in terms of study and outcome selection, subgroup analyses, and interpretation of findings. Multiple SRs agreed in their qualitative conclusions but not on reporting and on analyses of hard outcomes. Discordance on significance of treatment effects was due to a combination of variation in design with inclusion of different studies and lack of precision for single hard outcomes compared with a composite outcome. Such inconsistencies among SRs could potentially slow the translation of SRs' results to clinical and public health decision making and suggest the need for a broader methodological and clinical agreement on their design. Copyright © 2015 Elsevier Inc. All rights reserved.

[Adoption of new technologies by health services: the challenge of analyzing relevant factors].

PubMed

Trindade, Evelinda

2008-05-01

The exponential increase in the incorporation of health technologies has been considered a key factor in increased expenditures by the health sector. Such decisions involve multiple levels and stakeholders. Decentralization has multiplied the decision-making levels, with numerous difficult choices and limited resources. The interrelationship between stakeholders is complex, in creative systems with multiple determinants and confounders. The current review discusses the interaction between the factors influencing the decisions to incorporate technologies by health services, and proposes a structure for their analysis. The application and intensity of these factors in decision-making and the incorporation of products and programs by health services shapes the installed capacity of local and regional networks and modifies the health system. Empirical observation of decision-making and technology incorporation in Brazilian health services poses an important challenge. The structured recognition and measurement of these variables can assist proactive planning of health services.

Effects of a school-based intensive intervention on systemic inflammation and disease risk in Mexican-American children

USDA-ARS?s Scientific Manuscript database

Childhood obesity is associated with an increased risk for cardiovascular disease and type 2 Diabetes mellitus. Systemic inflammation is thought to mediate this relationship. We have previously demonstrated that an intervention designed specifically for Mexican-American children that incorporates bo...

Participant Perceptions of an Individualised Physical Activity Anti-Smoking Intervention

ERIC Educational Resources Information Center

Hanlon, Clare; Morris, Tony; O'Sullivan, Grant Anthony

2018-01-01

Purpose: The purpose of this paper is to explore a health program comprising the individual experiences, successes and setbacks of adults in an individually tailored, community-based smoking intervention and physical activity program. The program incorporated physical activity consultation (PAC) and phone support from the well-established Quit…

Model for Improvement of Learning Using Topographic Mapping.

ERIC Educational Resources Information Center

Andrews, David B.

The paper develops a method for learning improvement which incorporates the learner in the development of the learning/instructional strategy. To this end, a rate limiting model using topographical brain mapping as an educational intervention is presented. It is suggested that such intervention programs focus on those factors which are…

R.U. Ready?: Peer Education and Bystander Intervention Sexual Assault Programming

ERIC Educational Resources Information Center

Schweer, Jen Luettel; Heather, Katie; Kay, Kathryn; Stewart, K. Leigh; Kovach, Laura

2012-01-01

R.U. Ready? at Georgetown University is an annual sexual assault awareness event that incorporates peer education and resources with opportunities for students, staff, and faculty to dialogue about providing bystander intervention throughout the campus community. Beyond dialogue, participants learn about student activism and the resources and…

A novel process for integrating patient stories into patient education interventions: incorporating lessons from theater arts.

PubMed

Fix, Gemmae M; Houston, Thomas K; Barker, Anna M; Wexler, Laura; Cook, Natasha; Volkman, Julie E; Bokhour, Barbara G

2012-09-01

Patient narratives, or stories, are an effective means of educating patients because they increase personal relevance and may reduce counter-arguing. However, such stories must seamlessly combine evidenced-based health information while being true to real patient experiences. The purpose of this paper is to describe the process of developing an educational intervention using African-American patients' success stories controlling hypertension. We identified a process to address stories development challenges. (1) To help identify story tellers, we conducted a literature review and subsequently streamlined the process of storyteller identification through screening and telephone interviews. (2) To better elicit stories, we consulted with experts in storytelling and incorporated principles from theater. (3) To select stories, we used intervention mapping to map the intervention to theory and key clinical concepts, and also engaged members of the target community to ensure scientific criteria and maintain authenticity. Using personal narratives as intervention requires weaving together science, theory and clinically sound content, while still being true to the art of storytelling. Through a careful process of identifying storytellers and story selection and drawing upon theater arts, creating stories for intervention can be streamlined while meeting the goals of authenticity and scientific soundness. Published by Elsevier Ireland Ltd.

STATISTICAL METHODOLOGY FOR THE SIMULTANEOUS ANALYSIS OF MULTIPLE TYPES OF OUTCOMES IN NONLINEAR THRESHOLD MODELS.

EPA Science Inventory

Multiple outcomes are often measured on each experimental unit in toxicology experiments. These multiple observations typically imply the existence of correlation between endpoints, and a statistical analysis that incorporates it may result in improved inference. When both disc...

Sociodemographic and social contextual predictors of multiple health behavior change: data from the Healthy Directions-Small Business study.

PubMed

Harley, Amy E; Sapp, Amy L; Li, Yi; Marino, Miguel; Quintiliani, Lisa M; Sorensen, Glorian

2013-03-01

Multiple modifiable health behaviors contribute to the chronic diseases that are the leading causes of death in the USA. Disparities for meeting recommended health behavior guidelines exist across occupational classes and socioeconomic levels. The purpose of this paper was to investigate sociodemographic and social contextual predictors of multiple health behavior change in a worksite intervention. We analyzed data on four diet and exercise variables from an intervention trial with worksite-level randomization. Eight hundred forty-one employees had complete data from baseline (response rate = 84 %) and follow-up surveys (response rate = 77 %). Multilevel logistic regression estimated associations between least absolute shrinkage and selection operator-selected sociodemographic and social contextual predictor variables and the multiple health behavior change outcome (changing 2+ versus 0 behaviors). Gender, being married/partnered, and perceived discrimination were significantly associated with multiple health behavior change. Sociodemographic and social contextual factors predict multiple health behavior change and could inform the design and delivery of worksite interventions targeting multiple health behaviors.

Nutritional supplements for people being treated for active tuberculosis.

PubMed

Abba, Katharine; Sudarsanam, Thambu D; Grobler, Liesl; Volmink, Jimmy

2008-10-08

Tuberculosis is a serious infection affecting mainly the lungs. It may contribute to nutritional deficiencies which in turn may delay recovery by depressing immune functions. Nutritional supplements might therefore promote recovery in people being treated for tuberculosis. To assess the provision of oral nutritional supplements to promote the recovery of people being treated with antituberculous drug therapy for active tuberculosis. We searched the Cochrane Infectious Disease Group Specialized Register (June 2008), CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE (June 2008), EMBASE (June 2008), LILACS (June 2008), mRCT (June 2008), the Indian Journal of Tuberculosis (1983 to June 2008), and checked the reference lists of all included studies. Randomized controlled trials comparing any oral nutritional supplement given for at least four weeks with no nutritional intervention, placebo, or dietary advice only for people being treated for active tuberculosis. Two authors independently selected trials, extracted data, and assessed risk of bias. We calculated risk ratios (RR) for dichotomous variables and mean differences (MD) for continuous variables, with 95% confidence intervals (CI). We pooled data from trials with similar interventions and outcomes. Twelve trials (3393 participants) were included. Five trials had adequate allocation concealment. Interventions included a high energy supplement, high cholesterol diet, vitamin D, vitamin A, zinc, arginine, multiple micronutrient supplements, combined multiple micronutrient supplements and zinc, combined vitamin A and zinc, and combined vitamin A and selenium. The following supplements were associated with increased body weight at follow up: high energy supplements (MD 1.73 kg, 95% CI 0.81 to 2.65; 34 participants, 1 trial); multiple micronutrients plus additional zinc (MD 2.37 kg, 95% CI 2.21 to 2.53; 192 participants, 1 trial); and vitamin A plus zinc (MD 3.10 kg, 95% CI 0.74 to 5.46; 80 participants, 1 trial). There was no evidence that any supplement affected the number of deaths or number of participants with sputum test positive results at the end of treatment. There is limited evidence that high energy supplements and some combinations of zinc with other micronutrients may help people with tuberculosis to gain weight. There is not enough evidence to assess the effect of other combinations of nutrients. A number of relevant trials are in progress, and, where appropriate, the results will be incorporated into future updates of this review.

Promoting high school students' conceptual understandings of the particulate nature of matter through multiple representations

NASA Astrophysics Data System (ADS)

Adadan, Emine

This study mainly explored the efficacy of the two instructional interventions, namely Reform-Based Teaching with Multiple Representations (RBTw/MR) and Reform-Based Teaching (RBT) on stimulating change in students' conceptual understandings of the particulate nature of matter (PNM) and maintaining those scientific understandings constructed during the instruction over a three-month period. In this context, this study also examined the RBTw/MR and RBT students' types of conceptual understandings of the PNM before, immediately after and three-months after the interventions. This study was conducted in two introductory level chemistry classes of a suburban high school. The participants of the study included a total of 42 students who were enrolled in one of the two classes of the chemistry teacher who taught both of the classes. Both the RBTw/MR and the RBT group students were engaged in the same activities with the same sequence of experiences. However, the RBTw/MR instruction differed from the RBT instruction in terms of the frequency of using the multiple representations in relationship to the macroscopic phenomenon and the likely actions that occur at the submicroscopic level. A quasi-experimental control group research design with a pretest, posttest, and delayed posttest was employed by incorporating qualitative data collection and analysis methods. In order to assess students' conceptual understanding of the PNM, the open-ended questionnaire, namely Nature of Matter Diagnostic Questions, was administered to both groups just before, immediately after and three months after the instructional interventions. Fifteen of the 42 students were also interviewed following the posttest. The results of the study revealed the positive short- and long-term learning impacts on the RBTw/MR students' conceptual understandings of the PNM. Before the instruction, a majority of students in both groups (82.6%, RBTw/MR; 73.7%, RBT) held nonscientific types of conceptual understandings of the PNM. Immediately following the instruction, 52.1% of the RBTw/MR students held the types of conceptual understandings of either scientific or scientific fragments. Three months after the instruction, 34.8% of the RBTw/MR students held onto their scientific conceptual understandings of the PNM, only 15.8% of the RBT students' conceptual understandings of the PNM differed from their initial type of conceptual understandings.

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

PubMed

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

2018-05-22

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

Missing an opportunity: the embedded nature of weight management in primary care

PubMed Central

Osunlana, A. M.; Ogunleye, A. A.; Sharma, A. M.; Campbell‐Scherer, D.

2015-01-01

Summary The 5As Team study was designed to create, implement and evaluate a flexible intervention to improve the quality and quantity of weight management visits in primary care. The objective of this portion of the study was to explore how primary care providers incorporate weight management in their practice. 5AsT is a randomized controlled trial (RCT) on the implementation of a 6‐month 5 As Team (5AsT) intervention designed to operationalize the 5As of obesity management in primary care. Data for the qualitative portion of the study presented here included semi‐structured interviews with 29 multidisciplinary team providers and field notes of intervention sessions. Thematic analysis was undertaken. A key pattern that emerged from the data was that healthcare providers usually do not address obesity as a primary focus for a visit. Rather, obesity is embedded in a wide range of primary care encounters for other conditions. Implications were it can take extra time to discuss weight, it can be inappropriate to bring up weight as a topic, and treating risk factors and root causes of obesity have indirect benefits to patient weight management. Our findings have implications for obesity treatment approaches and tools that assume a discreet weight management visit. The embedded nature of obesity management in primary care can be harnessed to leverage multiple opportunities for asking and assessing root causes of obesity, and working longitudinally towards individual health goals. PMID:26303812

Exercise training and immune crosstalk in breast cancer microenvironment: exploring the paradigms of exercise-induced immune modulation and exercise-induced myokines.

PubMed

Goh, Jorming; Niksirat, Negin; Campbell, Kristin L

2014-01-01

Observational research suggests that exercise may reduce the risk of breast cancer and improve survival. One proposed mechanism for the protective effect of aerobic exercise related to cancer risk and outcomes, but has not been examined definitively, is the immune response to aerobic exercise. Two prevailing paradigms are proposed. The first considers the host immune response as modifiable by aerobic exercise training. This exercise-modulated immune-tumor crosstalk in the mammary microenvironment may alter the balance between tumor initiation and progression versus tumor suppression. The second paradigm considers the beneficial role of exercise-induced, skeletal muscle-derived cytokines, termed "myokines". These myokines exert endocrine-like effects on multiple organs, including the mammary glands. In this systematic review, we i) define the role of macrophages and T-cells in breast cancer initiation and progression; ii) address the two paradigms that support exercise-induced immunomodulation; iii) systematically assessed the literature for exercise intervention that assessed biomarkers relevant to both paradigms in human intervention trials of aerobic exercise training, in healthy women and women with breast cancer; iv) incorporated pre-clinical animal studies and non-RCTs for background discussion of putative mechanisms, through which aerobic exercise training modulates the immunological crosstalk, or the myokine-tumor interaction in the tumor microenvironment; and v) speculated on the potential biomarkers and mechanisms that define an exercise-induced, anti-tumor "signature", with a view toward developing relevant biomarkers for future aerobic exercise intervention trials.

The Effects of Gain- versus Loss-Framed Messages Following Health Risk Information on Physical Activity in Individuals With Multiple Sclerosis.

PubMed

Lithopoulos, Alexander; Bassett-Gunter, Rebecca L; Martin Ginis, Kathleen A; Latimer-Cheung, Amy E

2017-06-01

Few people with multiple sclerosis engage in physical activity. Messaging interventions may motivate more physical activity among these individuals. The purpose of this online study was to evaluate an intervention presenting participants with multiple sclerosis (N = 237) with risk information (i.e., information demonstrating people with multiple sclerosis are more likely to experience certain health issues) or no risk information followed by gain- or loss-framed physical activity messages. Participants completed questionnaires on Days 1, 6, and 28 and received information material on Days 2-5. The dependent variables were as follows: physical activity intentions and behavior, response and task efficacy, perceived threat (i.e., perception of threat to health issues relevant to people with multiple sclerosis), and avoidance (i.e., avoiding thinking about/doing something about the health issues presented in the messages). Analyses indicated physical activity and response efficacy increased over time. Also, participants receiving risk information had higher levels of physical activity and perceived threat. However, manipulation checks showed no differences between participants regarding perceptions of risk information or gain/loss-framed messages. Despite the lack of impact of the framing intervention, this study suggests that a brief informational intervention can positively influence physical activity and certain correlates of physical activity among people with multiple sclerosis.

Randomised controlled trial of a 12 week yoga intervention on negative affective states, cardiovascular and cognitive function in post-cardiac rehabilitation patients.

PubMed

Yeung, Alan; Kiat, Hosen; Denniss, A Robert; Cheema, Birinder S; Bensoussan, Alan; Machliss, Bianca; Colagiuri, Ben; Chang, Dennis

2014-10-24

Negative affective states such as anxiety, depression and stress are significant risk factors for cardiovascular disease, particularly in cardiac and post-cardiac rehabilitation populations.Yoga is a balanced practice of physical exercise, breathing control and meditation that can reduce psychosocial symptoms as well as improve cardiovascular and cognitive function. It has the potential to positively affect multiple disease pathways and may prove to be a practical adjunct to cardiac rehabilitation in further reducing cardiac risk factors as well as improving self-efficacy and post-cardiac rehabilitation adherence to healthy lifestyle behaviours. This is a parallel arm, multi-centre, randomised controlled trial that will assess the outcomes of post- phase 2 cardiac rehabilitation patients assigned to a yoga intervention in comparison to a no-treatment wait-list control group. Participants randomised to the yoga group will engage in a 12 week yoga program comprising of two group based sessions and one self-administered home session each week. Group based sessions will be led by an experienced yoga instructor. This will involve teaching beginner students a hatha yoga sequence that incorporates asana (poses and postures), pranayama (breathing control) and meditation. The primary outcomes of this study are negative affective states of anxiety, depression and stress assessed using the Depression Anxiety Stress Scale. Secondary outcomes include measures of quality of life, and cardiovascular and cognitive function. The cardiovascular outcomes will include blood pressure, heart rate, heart rate variability, pulse wave velocity, carotid intima media thickness measurements, lipid/glucose profiles and C-reactive protein assays. Assessments will be conducted prior to (week 0), mid-way through (week 6) and following the intervention period (week 12) as well as at a four week follow-up (week 16). This study will determine the effect of yoga practice on negative affective states, cardiovascular and cognitive function in post-phase 2 cardiac rehabilitation patients. The findings may provide evidence to incorporate yoga into standardised cardiac rehabilitation programs as a practical adjunct to improve the management of psychosocial symptoms associated with cardiovascular events in addition to improving patients' cognitive and cardiovascular functions. ACTRN12612000358842.

Incorporating user perspectives in the design of an online intervention tool for people with visible differences: face IT.

PubMed

Bessell, Alyson; Clarke, Alex; Harcourt, Diana; Moss, Tim P; Rumsey, Nichola

2010-10-01

Individuals with visible differences can experience social anxiety in relation to their appearance. Social skills-based psychosocial interventions have to date shown only limited effectiveness at addressing their concerns. To incorporate user perspectives in the development of an online psychosocial intervention, known as Face IT. Study one consisted of a needs assessment with 12 individuals with a visible difference and six health professionals in order to identify the difficulties experienced by those with visible difference and obtain feedback on the proposed content of Face IT. The findings demonstrated support for the social skills model and the use of an online intervention. Study two consisted of an empirical usability evaluation of Face IT with 14 potential users and 14 health professionals. Based on feedback from the participants, changes were made to the graphics and navigation of the programme. The clinical content has been made more acceptable. The findings indicate support for the importance of social skills-based psychosocial interventions for addressing the needs of those with a visible difference, and have allowed modifications to be made to Face IT ahead of a randomized controlled trial of effectiveness.

Management of Fatigue in Persons with Multiple Sclerosis

PubMed Central

Khan, Fary; Amatya, Bhasker; Galea, Mary

2014-01-01

Fatigue is one of the most common symptoms of multiple sclerosis. Despite advances in pharmacological and non-pharmacological treatment, fatigue continues to be the disabling symptom in persons with MS (pwMS), affecting almost 80% of pwMS. In current practice, both pharmacological and non-pharmacological interventions are used in combination, encompassing a multi-disciplinary approach. The body of research investigating the effect of these interventions is growing. This review systematically evaluated the existing evidence on the effectiveness and safety of different interventions currently applied for the management of fatigue in person with multiple sclerosis in improving patient outcomes, to guide treating clinicians. PMID:25309504

Introducing onsite antenatal syphilis screening in Burkina Faso: implementation and evaluation of a feasibility intervention tailored to a local context.

PubMed

Bocoum, Fadima Yaya; Tarnagda, Grissoum; Bationo, Fabrice; Savadogo, Justin R; Nacro, Sarata; Kouanda, Séni; Zarowsky, Christina

2017-05-30

Although the advantages of introducing point of care testing for syphilis in antenatal care (ANC) are well documented, there is little evidence on how to address structural issues within health systems. A better understanding of how these interventions work in a range of settings and contexts is needed in order to overcome bottlenecks at health system level. To better understand the relationships between implementation and context we developed and implemented an intervention focused on integrating a rapid screening test for syphilis in ANC services in rural primary health care facilities in Burkina Faso. This manuscript describes the intervention and reports on feasibility and acceptability of the intervention, the facilitators and barriers to the implementation of this intervention and the likelihood that point of care test for syphilis will become routinely incorporated in practice. In Kaya Health and Demographic Surveillance System (Kaya HDSS), all 7 primary healthcare facilities were selected for intervention in 2013. A participatory approach was used to design and implement an antenatal syphilis screening intervention. The Normalization Process Model (NPM) proposed by May et al. was adapted in order to identify barriers and facilitators and to explore the likelihood to become routinely incorporated in practice. Registers, Observations (n = 14 ANC 1) of interactions between patients and health workers during ANC and interviews with health workers (n = 14) were our data sources. An intervention that included onsite training, provision of supplies and medicines, quality control and supervision was implemented in 7 health facilities in 2013. Rapid syphilis test and treatment were delivered during ANC within the examination room with no specific additional mechanism regarding staff organization. The perceived barriers were lack of training of all staff, workload, stock-outs of consumables and lack of motivation of staff. Key facilitators included political environment, ease of use of test and acceptability to pregnant women. Onsite testing for antenatal syphilis is a feasible and acceptable intervention in ANC at primary health facility in Burkina Faso. The point-of care test for syphilis is more likely to be acceptable by health workers as routine service and incorporated as a normal practice. The study was retrospectively registered on ClinicalTrials.gov under the Trial Registration Number NCT03156751 .

Multiple health behavior change in adults with or at risk for cancer: a systematic review.

PubMed

Green, Amanda C; Hayman, Laura L; Cooley, Mary E

2015-05-01

To identify components of efficacious interventions for multiple health behavior change (MHBC) in adult cancer survivors or adults at high risk for cancer. A systematic review of MHBC interventions was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Ten studies met inclusion criteria. Most studies changed at least 2 health behaviors. Diet, exercise, and smoking cessation were consistently changed with in-person interventions. Longer duration interventions using phone or mail contact had a positive association with changing diet and exercise. MHBC interventions positively influenced behavior change in adults with cancer and those at high risk for cancer. Future studies should focus on increasing dissemination and implementation of efficacious interventions.

The effects of a multi-component higher-functioning autism anti-stigma program on adolescent boys.

PubMed

Staniland, Jessica J; Byrne, Mitchell K

2013-12-01

A six-session higher-functioning autism anti-stigma program incorporating descriptive, explanatory and directive information was delivered to adolescent boys and the impact upon knowledge, attitudes and behavioural intentions towards peers with autism was evaluated. Participants were seventh-, eighth- and ninth-grade students (N = 395) from regular classes in a mainstream school. Two-eighth-grade classes were randomly allocated to the intervention condition and all remaining students were either allocated to the no-intervention peer or no-intervention non-peer condition. The anti-stigma program improved the knowledge and attitudes, but not the behavioural intentions of participants towards their peers with autism. Knowledge and attitudinal changes were maintained at follow-up. There were no spill-over effects of the program to non-targeted students. These results provide some preliminary evidence for the effectiveness of multi-session anti-stigma programs incorporating combined information for adolescent students in inclusive educational environments.

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.

How Multiple Interventions Influenced Employee Turnover: A Case Study.

ERIC Educational Resources Information Center

Hatcher, Timothy

1999-01-01

A 3-year study of 46 textile industry workers identified causes of employee turnover (supervision, training, organizational communication) using performance analysis. A study of multiple interventions based on the analysis resulted in changes in orientation procedures, organizational leadership, and climate, reducing turnover by 24%. (SK)

Artificial Intelligence-Assisted Online Social Therapy for Youth Mental Health

PubMed Central

D'Alfonso, Simon; Santesteban-Echarri, Olga; Rice, Simon; Wadley, Greg; Lederman, Reeva; Miles, Christopher; Gleeson, John; Alvarez-Jimenez, Mario

2017-01-01

Introduction: Benefits from mental health early interventions may not be sustained over time, and longer-term intervention programs may be required to maintain early clinical gains. However, due to the high intensity of face-to-face early intervention treatments, this may not be feasible. Adjunctive internet-based interventions specifically designed for youth may provide a cost-effective and engaging alternative to prevent loss of intervention benefits. However, until now online interventions have relied on human moderators to deliver therapeutic content. More sophisticated models responsive to user data are critical to inform tailored online therapy. Thus, integration of user experience with a sophisticated and cutting-edge technology to deliver content is necessary to redefine online interventions in youth mental health. This paper discusses the development of the moderated online social therapy (MOST) web application, which provides an interactive social media-based platform for recovery in mental health. We provide an overview of the system's main features and discus our current work regarding the incorporation of advanced computational and artificial intelligence methods to enhance user engagement and improve the discovery and delivery of therapy content. Methods: Our case study is the ongoing Horyzons site (5-year randomized controlled trial for youth recovering from early psychosis), which is powered by MOST. We outline the motivation underlying the project and the web application's foundational features and interface. We discuss system innovations, including the incorporation of pertinent usage patterns as well as identifying certain limitations of the system. This leads to our current motivations and focus on using computational and artificial intelligence methods to enhance user engagement, and to further improve the system with novel mechanisms for the delivery of therapy content to users. In particular, we cover our usage of natural language analysis and chatbot technologies as strategies to tailor interventions and scale up the system. Conclusions: To date, the innovative MOST system has demonstrated viability in a series of clinical research trials. Given the data-driven opportunities afforded by the software system, observed usage patterns, and the aim to deploy it on a greater scale, an important next step in its evolution is the incorporation of advanced and automated content delivery mechanisms. PMID:28626431

Artificial Intelligence-Assisted Online Social Therapy for Youth Mental Health.

PubMed

D'Alfonso, Simon; Santesteban-Echarri, Olga; Rice, Simon; Wadley, Greg; Lederman, Reeva; Miles, Christopher; Gleeson, John; Alvarez-Jimenez, Mario

2017-01-01

Introduction: Benefits from mental health early interventions may not be sustained over time, and longer-term intervention programs may be required to maintain early clinical gains. However, due to the high intensity of face-to-face early intervention treatments, this may not be feasible. Adjunctive internet-based interventions specifically designed for youth may provide a cost-effective and engaging alternative to prevent loss of intervention benefits. However, until now online interventions have relied on human moderators to deliver therapeutic content. More sophisticated models responsive to user data are critical to inform tailored online therapy. Thus, integration of user experience with a sophisticated and cutting-edge technology to deliver content is necessary to redefine online interventions in youth mental health. This paper discusses the development of the moderated online social therapy (MOST) web application, which provides an interactive social media-based platform for recovery in mental health. We provide an overview of the system's main features and discus our current work regarding the incorporation of advanced computational and artificial intelligence methods to enhance user engagement and improve the discovery and delivery of therapy content. Methods: Our case study is the ongoing Horyzons site (5-year randomized controlled trial for youth recovering from early psychosis), which is powered by MOST. We outline the motivation underlying the project and the web application's foundational features and interface. We discuss system innovations, including the incorporation of pertinent usage patterns as well as identifying certain limitations of the system. This leads to our current motivations and focus on using computational and artificial intelligence methods to enhance user engagement, and to further improve the system with novel mechanisms for the delivery of therapy content to users. In particular, we cover our usage of natural language analysis and chatbot technologies as strategies to tailor interventions and scale up the system. Conclusions: To date, the innovative MOST system has demonstrated viability in a series of clinical research trials. Given the data-driven opportunities afforded by the software system, observed usage patterns, and the aim to deploy it on a greater scale, an important next step in its evolution is the incorporation of advanced and automated content delivery mechanisms.

Feasibility and user perception of a fully automated push-based multiple-session alcohol intervention for university students: randomized controlled trial.

PubMed

Bendtsen, Marcus; Bendtsen, Preben

2014-06-23

In recent years, many electronic health behavior interventions have been developed in order to reach individuals with unhealthy behaviors, such as risky drinking. This is especially relevant for university students, many of whom are risky drinkers. This study explored the acceptability and feasibility in a nontreatment-seeking group of university students (including both risk and nonrisk drinkers), of a fully automated, push-based, multiple-session, alcohol intervention, comparing two modes of delivery by randomizing participants to receive the intervention either by SMS text messaging (short message service, SMS) or by email. A total of 5499 students at Luleå University in northern Sweden were invited to participate in a single-session alcohol assessment and feedback intervention; 28.04% (1542/5499) students completed this part of the study. In total, 29.44% (454/1542) of those participating in the single-session intervention accepted to participate further in the extended multiple-session intervention lasting for 4 weeks. The students were randomized to receive the intervention messages via SMS or email. A follow-up questionnaire was sent immediately after the intervention and 52.9% (240/454) responded. No difference was seen regarding satisfaction with the length and frequency of the intervention, regardless of the mode of delivery. Approximately 15% in both the SMS (19/136) and email groups (15/104) would have preferred the other mode of delivery. On the other hand, more students in the SMS group (46/229, 20.1%) stopped participating in the intervention during the 4-week period compared with the email group (10/193, 5.2%). Most students in both groups expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. A striking difference was seen regarding when a message was read; 88.2% (120/136) of the SMS group read the messages within 1 hour in contrast to 45.2% (47/104) in the email group. In addition, 83.1% (113/136) in the SMS group stated that they read all or almost all the messages, compared with only 63.5% (66/104) in the email group. Based on the feedback from the students, an extended, multiple-session, push-based intervention seems to be a feasible option for students interested in additional support after a single-session alcohol intervention. SMS as a mode of delivery seems to have some advantages over email regarding when a message is read and the proportion of messages read. However, more students in the SMS group stopped the intervention than in the email group. Based on these promising findings, further studies comparing the effectiveness of single-session interventions with extended multiple-session interventions delivered separately or in combination are warranted.

"Homelessness and trauma go hand-in-hand": pathways to homelessness among women veterans.

PubMed

Hamilton, Alison B; Poza, Ines; Washington, Donna L

2011-01-01

Veterans comprise a disproportionate fraction of the nation's homeless population, with women veterans up to four times more likely to be homeless than non-veteran women. This paper provides a grounded description of women veterans' pathways into homelessness. Three focus groups were held in Los Angeles, California, with a total of 29 homeless women veterans. Five predominant "roots" (precipitating experiences) initiated pathways toward homelessness: 1) childhood adversity, 2) trauma and/or substance abuse during military service, 3) post-military abuse, adversity, and/or relationship termination, 4) post-military mental health, substance abuse, and/or medical problems, and 5) unemployment. Contextual factors, which promoted development of homelessness in the setting of primary roots, included women veterans' "survivor instinct," lack of social support and resources, sense of isolation, pronounced sense of independence, and barriers to care. These contextual factors also reinforced persistence of the roots of post-military adversity and mental health and substance abuse problems, serving to maintain cycles of chronic homelessness. Collectively, these multiple, interacting roots and contextual factors form a "web of vulnerability" that is a target for action. Multiple points along the pathways to homelessness represent critical junctures for VA and community-based organizations to engage in prevention or intervention efforts on behalf of women veterans. Considering the multiple, interconnected challenges that these women veterans described, solutions to homelessness should address multiple risk factors, include trauma-informed care that acknowledges women veterans' traumatic experiences, and incorporate holistic responses that can contribute to healing and recovery. Published by Elsevier Inc.

A review of interventions to teach a mand repertoire

PubMed Central

Shafer, Esther

1995-01-01

Interventions which teach developmentally disabled persons to make requests and choices are now widely recommended. Recent changes in general approaches to teaching request-making have been noted which are consistent with theory and research concerning mands. Three categories of interventions, incidental teaching, choice making, and the interrupted behavior chain are also examined with regard to theory concerning the mand and establishing operations (EOs). Several of the critical features of EOs, and in particular the momentary aspect of EOs, have not been well incorporated into interventions. Suggestions for improvement of mand interventions are therefore proposed. PMID:22477097

Improving Vector Evaluated Particle Swarm Optimisation Using Multiple Nondominated Leaders

PubMed Central

Lim, Kian Sheng; Buyamin, Salinda; Ahmad, Anita; Shapiai, Mohd Ibrahim; Naim, Faradila; Mubin, Marizan; Kim, Dong Hwa

2014-01-01

The vector evaluated particle swarm optimisation (VEPSO) algorithm was previously improved by incorporating nondominated solutions for solving multiobjective optimisation problems. However, the obtained solutions did not converge close to the Pareto front and also did not distribute evenly over the Pareto front. Therefore, in this study, the concept of multiple nondominated leaders is incorporated to further improve the VEPSO algorithm. Hence, multiple nondominated solutions that are best at a respective objective function are used to guide particles in finding optimal solutions. The improved VEPSO is measured by the number of nondominated solutions found, generational distance, spread, and hypervolume. The results from the conducted experiments show that the proposed VEPSO significantly improved the existing VEPSO algorithms. PMID:24883386

Multiple magnet ingestion: is there a role for early surgical intervention?

PubMed

Salimi, Amrollah; Kooraki, Soheil; Esfahani, Shadi Abdar; Mehdizadeh, Mehrzad

2012-01-01

Children often swallow foreign bodies. Multiple magnet ingestion is rare, but can result in serious complications. This study presents three unique cases of multiple magnet ingestion: one case an 8-year-old boy with multiple magnet ingestion resulting in gastric obstruction and the other two cases with intestinal perforations due to multiple magnet intake. History and physical examination are unreliable in children who swallow multiple magnets. Sometimes radiological findings are not conclusive, whether one magnet is swallowed or more. If magnets are not moved in sequential radiology images, we recommend early surgical intervention before gastrointestinal complications develop. Toy companies, parents, physicians, and radiologists should be warned about the potential complications of such toys.

[Endovascular interventions for multiple trauma].

PubMed

Kinstner, C; Funovics, M

2014-09-01

In recent years interventional radiology has significantly changed the management of injured patients with multiple trauma. Currently nearly all vessels can be reached within a reasonably short time with the help of specially preshaped catheters and guide wires to achieve bleeding control of arterial und venous bleeding. Whereas bleeding control formerly required extensive open surgery, current interventional methods allow temporary vessel occlusion (occlusion balloons), permanent embolization and stenting. In injured patients with multiple trauma preinterventional procedural planning is performed with the help of multidetector computed tomography whenever possible. Interventional radiology not only allows minimization of therapeutic trauma but also a considerably shorter treatment time. Interventional bleeding control has developed into a standard method in the management of vascular trauma of the chest and abdomen as well as in vascular injuries of the upper and lower extremities when open surgical access is associated with increased risk. Additionally, pelvic trauma, vascular trauma of the superior thoracic aperture and parenchymal arterial lacerations of organs that can be at least partially preserved are primarily managed by interventional methods. In an interdisciplinary setting interventional radiology provides a safe and efficient means of rapid bleeding control in nearly all vascular territories in addition to open surgical access.

Incorporating considerations of cost-effectiveness, affordability, and resource implications in guideline development: article 6 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Hill, Suzanne R; Olson, Leslie G; Falck-Ytter, Yngve; Cruz, Alvaro A; Atkins, David; Baumann, Michael; Jaeschke, Roman; Woitalla, Thomas; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that health care recommendations are based on the best available research evidence. This is the sixth of a series of 14 articles prepared to advise guideline developers for respiratory and other diseases on how to achieve this goal. In this article, we focused on integrating cost and resource information in guideline development and formulating recommendations focusing on four key questions. We addressed the following specific questions. (1) When is it important to incorporate costs, and/or resource implications, and/or cost-effectiveness, and/or affordability considerations in guidelines? (2) Which costs and which resource use should be considered in guidelines? (3)What sources of evidence should be used to estimate costs, resource use, and cost-effectiveness? (4) How can cost-effectiveness, resource implications, and affordability be taken into account explicitly? Our work was based on a prior review on this topic and our conclusions are based on available evidence, consideration of what guideline developers are doing, and workshop discussions. Many authorities suggest that there is a need to include explicit consideration of costs, resource use, and affordability during guideline development. Where drug use is at issue, "explicit consideration" may need to involve only noting whether the price (easily determined and usually the main component of "acquisition cost") of a drug is high or low. Complex interventions such as rehabilitation services are to a greater degree setting- and system-dependent. Resources used, and the costs of those resources, will vary among systems, and formal identification by a guideline group of the resource requirements of a complex intervention is essential. A clinical guideline usually contains multiple recommendations, and in some cases there are hundreds. Defining costs and resource use for all of them-especially for multiple settings-is unlikely to be feasible. At present, disaggregated resource utilization accompanied by some cost information seems to be the most promising approach. The method for assigning values to costs, including external or indirect cost (such as time off work), can have a significant impact on the outcome of any economic evaluation. The perspective that the guideline assumes should be made explicit. Standards for evidence for clinical data are usually good-quality trials reporting a relevant endpoint that should be summarized in a systematic review. Like others, we are therefore proposing that the ideal sources of evidence for cost and resource utilization data for guideline development are systematic reviews of randomized controlled trials that report resource utilization, with direct comparisons between the interventions of interest.

Effects of physiotherapy interventions on balance in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Paltamaa, Jaana; Sjögren, Tuulikki; Peurala, Sinikka H; Heinonen, Ari

2012-10-01

To determine the effects of physiotherapy interventions on balance in people with multiple sclerosis. A systematic literature search was conducted in Medline, Cinahl, Embase, PEDro, both electronically and by manual search up to March 2011. Randomized controlled trials of physiotherapy interventions in people with multiple sclerosis, with an outcome measure linked to the International Classification of Functioning, Disability and Health (ICF) category of "Changing and maintaining body position", were included. The quality of studies was determined by the van Tulder criteria. Meta-analyses were performed in subgroups according to the intervention. After screening 233 full-text papers, 11 studies were included in a qualitative analysis and 7 in a meta-analysis. The methodological quality of the studies ranged from poor to moderate. Low evidence was found for the efficacy of specific balance exercises, physical therapy based on an individualized problem-solving approach, and resistance and aerobic exercises on improving balance among ambulatory people with multiple sclerosis. These findings indicate small, but significant, effects of physiotherapy on balance in people with multiple sclerosis who have a mild to moderate level of disability. However, evidence for severely disabled people is lacking, and further research is needed.

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions

PubMed Central

Shemilt, Ian; Mugford, Miranda; Drummond, Michael; Eisenstein, Eric; Mallender, Jacqueline; McDaid, David; Vale, Luke; Walker, Damian

2006-01-01

Background Provision of evidence on costs alongside evidence on the effects of interventions can enhance the relevance of systematic reviews to decision-making. However, patterns of use of economics methods alongside systematic review remain unclear. Reviews of evidence on the effects of interventions are published by both the Cochrane and Campbell Collaborations. Although it is not a requirement that Cochrane or Campbell Reviews should consider economic aspects of interventions, many do. This study aims to explore and describe approaches to incorporating economics methods in a selection of Cochrane systematic reviews in the area of health promotion and public health, to help inform development of methodological guidance on economics for reviewers. Methods The Cochrane Database of Systematic Reviews was searched using a search strategy for potential economic evaluation studies. We included current Cochrane reviews and review protocols retrieved using the search that are also identified as relevant to health promotion or public health topics. A reviewer extracted data which describe the economics components of included reviews. Extracted data were summarised in tables and analysed qualitatively. Results Twenty-one completed Cochrane reviews and seven review protocols met inclusion criteria. None incorporate formal economic evaluation methods. Ten completed reviews explicitly aim to incorporate economics studies and data. There is a lack of transparent reporting of methods underpinning the incorporation of economics studies and data. Some reviews are likely to exclude useful economics studies and data due to a failure to incorporate search strategies tailored to the retrieval of such data or use of key specialist databases, and application of inclusion criteria designed for effectiveness studies. Conclusion There is a need for consistency and transparency in the reporting and conduct of the economics components of Cochrane reviews, as well as regular dialogue between Cochrane reviewers and economists to develop increased capacity for economic analyses alongside such reviews. Use of applicable economics methods in Cochrane reviews can help provide the international context within which economics data can be interpreted and assessed as a preliminary to full economic evaluation. PMID:17107612

Housing interventions and health: Quantifying the impact of indoor particles on mortality and morbidity with disease recovery.

PubMed

Milner, James; Chalabi, Zaid; Vardoulakis, Sotiris; Wilkinson, Paul

2015-08-01

Housing interventions for energy efficiency and greenhouse gas emission reduction have the potential to reduce exposure to indoor air pollution if they are implemented correctly. This work assessed the health impacts of home energy efficiency measures in England and Wales resulting in a reduction in average indoor PM2.5 exposures of 3 μg m(-3). The assessment was performed using a new multistate life table model which allows transition into and between multiple morbid states, including recovery to disease-free status and relapse, with transition rates informed by age- and cause-specific disease prevalence, incidence and mortality data. Such models have not previously included disease recovery. The results demonstrate that incorporation of recovery in the model is necessary for conditions such as asthma which have high incidence in early life but likelihood of recovery in adulthood. The impact assessment of the home energy efficiency intervention showed that the reduction in PM2.5 exposure would be associated with substantial benefits for mortality and morbidity from asthma, coronary heart disease and lung cancer. The overall impact would be an increase in life expectancy of two to three months and approximately 13 million QALYs gained over the 90 year follow-up period. Substantial quality-of-life benefits were also observed, with a decrease in asthma over all age groups and larger benefits due to reduced coronary heart disease and lung cancer, particularly in older age groups. The multistate model with recovery provides important additional information for assessing the impact on health of environmental policies and interventions compared with mortality-only life tables, allowing more realistic representation of diseases with substantial non-mortality burdens. Copyright © 2015 Elsevier Ltd. All rights reserved.

Resistant starch type 4-enriched diet lowered blood cholesterols and improved body composition in a double blind controlled cross-over intervention.

PubMed

Nichenametla, Sailendra N; Weidauer, Lee A; Wey, Howard E; Beare, Tianna M; Specker, Bonny L; Dey, Moul

2014-06-01

A metabolic health crisis is evident as cardiovascular diseases (CVD) remain the leading cause of mortality in the United States. Effects of resistant starch type 4 (RS4), a prebiotic fiber, in comprehensive management of metabolic syndrome (MetS) remain unknown. This study examined the effects of a blinded exchange of RS4-enriched flour (30% v/v) with regular/control flour (CF) diet on multiple MetS comorbidities. In a double blind (participants-investigators), placebo-controlled, cluster cross-over intervention (n = 86, age≥18, 2-12 week interventions, 2-week washout) in the United States, individuals were classified as having MetS (With-MetS) or not (No-MetS) following International Diabetes Federation (IDF)-criteria. RS4 consumption compared with CF resulted in 7.2% (p = 0.002) lower mean total cholesterol, 5.5% (p = 0.04) lower non-HDL, and a 12.8% (p < 0.001) lower HDL cholesterol in the With-MetS group. No-MetS individuals had a 2.6% (p = 0.02) smaller waist circumference and 1.5% (p = 0.03) lower percent body fat following RS4 intervention compared to CF. A small but significant 1% increase in fat-free mass was observed in all participants combined (p = 0.02). No significant effect of RS4 was observed for glycemic variables and blood pressures. RS4 consumption improved dyslipidemia and body composition. Incorporation of RS4 in routine diets could offer an effective strategy for public cardio-metabolic health promotion. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Resistant starch type 4-enriched diet lowered blood cholesterols and improved body composition in a double-blind controlled crossover intervention

PubMed Central

Nichenametla, Sailendra N.; Weidauer, Lee A.; Wey, Howard E.; Beare, Tianna M.; Specker, Bonny L.; Dey, Moul

2014-01-01

A metabolic health crisis is evident as cardiovascular diseases (CVD) remain the leading cause of mortality in the US. Effects of resistant starch type 4 (RS4), a prebiotic fiber, in comprehensive management of metabolic syndrome (MetS) remain unknown. This study examined the effects of a blinded exchange of resistant starch type-4 (RS4)-enriched flour (30% v/v) with regular/control flour (CF) diet on multiple MetS comorbidities. In a double-blind (participants-investigators), placebo-controlled, cluster crossover intervention (n=86, age ≥18, 2–12week interventions, 2week washout) in the US, individuals were classified as having MetS (With-MetS) or not (No-MetS) following International Diabetes Federation (IDF)-criteria. RS4 consumption compared with CF resulted in 7.2% (p=0.002) lower mean total cholesterol (TC), 5.5% (p=0.04) lower non-HDL, and a 12.8% (p<0.001) lower HDL cholesterol in the With-MetS group. No-MetS individuals had a 2.6% (p=0.02) smaller waist circumference and 1.5% (p=0.03) lower percent body fat following RS4 intervention compared to CF. A small but significant 1% increase in fat-free mass was observed in all participants combined (p=0.02). No significant effect of RS4 was observed for glycemic variables and blood pressures. RS4 consumption improved dyslipidemia and body composition. Incorporation of RS4 in routine diets could offer an effective strategy for public metabolic-CVD health promotion. The clinicaltrials.gov-reference NCT01887964. PMID:24478107

A Systematic Review on Promoting Adherence to Antiretroviral Therapy in HIV-infected Patients Using Mobile Phone Technology.

PubMed

Quintana, Yuri; Gonzalez Martorell, Eduardo A; Fahy, Darren; Safran, Charles

2018-04-01

 Adherence to antiretroviral therapy (ART) is paramount to successful long-term suppression of human immunodeficiency virus (HIV). For poorly adherent patients with HIV, barriers to remaining adherent may be overcome by the implementation of targeted interventions delivered via mobile devices. This systematic review is focused specifically on mobile phone technologies to deliver adherence interventions in HIV/acquired immunodeficiency syndrome (AIDS) populations.  This review (PROSPERO #CRD42017065131) systematically extracted data from published literature from five databases on mobile phone interventions to improve adherence to ART for HIV. The reported studies had been conducted between 2007 and 2017. Risk of bias was assessed using the Cochrane method ranking each criterion as low, high, or unclear risk of bias.  Of the 835 articles returned, we identified 26 randomized controlled trials (RCTs), retrospective and prospective cohort trials, or mixed method studies with a comparison group that fit criteria for inclusion. No standard measure of adherence was consistent throughout the examined studies, and assessments by self-report, pill counting, and medication event monitoring system (MEMS) were utilized. The studies reported mixed results, with 17 reporting significant improvements to adherence, 3 reporting improvements without supplying p -values, and 6 reporting no significant change or a reduction in adherence.  The mixed nature of the results exemplifies the need for more comprehensive approaches and larger scale trials to confirm results observed in limited cohort sizes. To better retain satisfactory adherence within the HIV population, and especially in low-resource settings, we recommend that future interventions incorporate multiple strategies: mobile-based reminders, social support structures, and personalized content. Schattauer GmbH Stuttgart.

Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base

PubMed Central

Landis, R. Clive; Brown, Jeremiah R.; Fitzgerald, David; Likosky, Donald S.; Shore-Lesserson, Linda; Baker, Robert A.; Hammon, John W.

2014-01-01

Abstract: A wide range of pharmacological, surgical, and mechanical pump approaches have been studied to attenuate the systemic inflammatory response to cardiopulmonary bypass, yet no systematically based review exists to cover the scope of anti-inflammatory interventions deployed. We therefore conducted an evidence-based review to capture “self-identified” anti-inflammatory interventions among adult cardiopulmonary bypass procedures. To be included, trials had to measure at least one inflammatory mediator and one clinical outcome, specified in the “Outcomes 2010” consensus statement. Ninety-eight papers satisfied inclusion criteria and formed the basis of the review. The review identified 33 different interventions and approaches to attenuate the systemic inflammatory response. However, only a minority of papers (35 of 98 [35.7%]) demonstrated any clinical improvement to one or more of the predefined outcome measures (most frequently myocardial protection or length of intensive care unit stay). No single intervention was supported by strong level A evidence (multiple randomized controlled trials [RCTs] or meta-analysis) for clinical benefit. Interventions at level A evidence included off-pump surgery, minimized circuits, biocompatible circuit coatings, leukocyte filtration, complement C5 inhibition, preoperative aspirin, and corticosteroid prophylaxis. Interventions at level B evidence (single RCT) for minimizing inflammation included nitric oxide donors, C1 esterase inhibition, neutrophil elastase inhibition, propofol, propionyl-L-carnitine, and intensive insulin therapy. A secondary analysis revealed that suppression of at least one inflammatory marker was necessary but not sufficient to confer clinical benefit. The most effective interventions were those that targeted multiple inflammatory pathways. These observations are consistent with a “multiple hit” hypothesis, whereby clinically effective suppression of the systemic inflammatory response requires hitting multiple inflammatory targets simultaneously. Further research is warranted to evaluate if combinations of interventions that target multiple inflammatory pathways are capable of synergistically reducing inflammation and improving outcomes after cardiopulmonary bypass. PMID:26357785

Musculoskeletal physiotherapists' use of psychological interventions: a systematic review of therapists' perceptions and practice.

PubMed

Alexanders, Jenny; Anderson, Anna; Henderson, Sarah

2015-06-01

Research has demonstrated that incorporating psychological interventions within physiotherapy practice has numerous potential benefits. Despite this physiotherapists have reported feeling inadequately trained to confidently use such interventions in their day-to-day practice. To systematically review musculoskeletal physiotherapists' perceptions regarding the use of psychological interventions within physiotherapy practice. Eligible studies were identified through a rigorous search of AMED, CINAHL, EMBASE, MEDLINE and PsychINFO from January 2002 until August 2013. Full text qualitative, quantitative and mixed methodology studies published in English language investigating musculoskeletal physiotherapists' perceptions regarding their use of psychological interventions within physiotherapy practice. Included studies were appraised for risk of bias using the Critical Appraisal Skills Programme qualitative checklist. Meta-analysis was not possible due to study heterogeneity. Six studies, all with a low risk of bias, met the inclusion criteria. These studies highlighted that physiotherapists appreciate the importance of using psychological interventions within their practice, but report inadequate understanding and consequent underutilisation of these interventions. These results should be noted with some degree of caution due to various limitations associated with the included studies and with this review, including the use of a qualitative appraisal tool for mixed methodology/quantitative studies. These findings suggest that musculoskeletal physiotherapists are aware of the potential benefits of incorporating psychological interventions within their practice but feel insufficiently trained to optimise their use of such interventions; hence highlighting a need for further research in this area and a review of physiotherapist training. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

The effectiveness of smoking cessation interventions prior to surgery: a systematic review.

PubMed

Cropley, Mark; Theadom, Alice; Pravettoni, Gabriella; Webb, Gemma

2008-03-01

The objective of this review was to evaluate the effectiveness of smoking cessation interventions prior to surgery and examine smoking cessation rates at 6 months follow-up. The Cochrane Library Database, PsycINFO, EMBASE, Medline, and Cinahl databases were searched using the terms: smok$, smoking cessation, tobacco, cigar$, preop$, operati$, surg$, randomi*ed control$ trial, intervention, program$, cessation, abstinen$, quit. Further articles were obtained from reference lists. The search was limited to articles on adults, written in English and published up to December 2006. Only randomized control trials (RCTs) that incorporated smoking cessation interventions to patients awaiting elective surgery were included. Seven studies met the inclusion criteria. Methodological quality was assessed by all the authors. The findings revealed that short-term quit rates (or a reduction by more than half of normal daily rate) ranged from 18% to 93% in patients receiving a smoking intervention (mean 55%), compared with a range of 2%-65% of controls (mean = 27.7%). Two studies examined smoking status at 6 months but these revealed no significant difference in abstinence rates between patients who had received an intervention and those that had not. Studies that incorporated counseling in addition to nicotine replacement therapy appeared to show greater benefits. It is concluded that smoking cessation interventions prior to surgery are effective in helping patients to quit smoking. However, such effects appear to be short-lived. Future research needs to examine intervention and patient factors to see whether tailoring the smoking cessation intervention specifically to the patient improves overall abstinence rates.

A combined planning and self-efficacy intervention to promote physical activity: a multiple mediation analysis.

PubMed

Koring, Milena; Richert, Jana; Parschau, Linda; Ernsting, Anna; Lippke, Sonia; Schwarzer, Ralf

2012-01-01

Many individuals are motivated to improve their physical activity levels, but often fail to act upon their intention. Interventions fostering volitional strategies, such as action planning, coping planning, and self-efficacy beliefs, can help to translate intentions into behavior. This study examines the effectiveness and the mechanisms of a combined planning and self-efficacy intervention to promote physical activity among motivated individuals. Participants (N = 883) were randomly assigned to the intervention or to a waiting-list control condition. Multivariate analysis of variance revealed that the intervention resulted in significantly more physical activity, higher levels of action planning, coping planning, and volitional self-efficacy beliefs (p < 0.01). In addition, multiple mediation analysis showed that action planning, coping planning, and volitional self-efficacy mediate between the intervention and physical activity. The study shows that the intervention successfully fostered physical activity and unfolds the underlying self-regulatory mechanisms of the intervention's effectiveness.

Co-Occurring Health-Related Behavior Pairs in College Students: Insights for Prioritized and Targeted Interventions

ERIC Educational Resources Information Center

Wells, Katelyn; Makela, Carole; Kennedy, Catherine

2014-01-01

Background: Research on strategies for addressing multiple health-related behaviors (HRBs) in one intervention are needed because resources are sparse and clarification is needed regarding the relationship between multiple HRBs. Purpose: Determine undergraduate students' health behavior co-occurring pairs of smoking cigarettes (SC), alcohol…

Changing Multiple Adolescent Health Behaviors through School-Based Interventions: A Review of the Literature

ERIC Educational Resources Information Center

Busch, Vincent; de Leeuw, Johannes Rob Josephus; de Harder, Alinda; Schrijvers, Augustinus Jacobus Petrus

2013-01-01

Background: In approaches to health promotion in adolescents, unhealthy behaviors are no longer regarded as independent processes, but as interrelated. This article presents a systematic literature review of school-based interventions targeting multiple adolescent behaviors simultaneously. Methods: A systematic literature search was performed…

SOMOS: Evaluation of an HIV Prevention Intervention for Latino Gay Men

ERIC Educational Resources Information Center

Vega, Miriam Y.; Spieldenner, Andrew R.; DeLeon, Dennis; Nieto, Bolivar X.; Stroman, Carolyn A.

2011-01-01

Latino gay men face multiple barriers to human immunodeficiency virus (HIV) prevention, in particular a lack of intervention programs that integrate prevention messages with cultural norms and address issues of social marginalization from multiple communities (gay community and Latino community), homophobia and racism. In order to address these…

Effects of a Comprehensive Function-Based Intervention Applied across Multiple Educational Settings

ERIC Educational Resources Information Center

Gann, Candace J.; Ferro, Jolenea B.; Umbreit, John; Liaupsin, Carl J.

2014-01-01

This study examined the feasibility and effectiveness of a comprehensive function-based intervention applied across multiple inclusive classroom settings. The participant was a middle school student diagnosed with Asperger Syndrome who exhibited chronic off-task behaviors across all academic environments. This study was conducted across two…

Genetic transformation in citrus: Thinking outside the box

USDA-ARS?s Scientific Manuscript database

Conventional breeding methods to incorporate resistance in citrus are very slow, due to extended juvenility from seedling trees and multiple generations needed to incorporate resistance from distant relatives. Use of transgenic methods may provide disease resistance in less time. Published protocols...

Binary variable multiple-model multiple imputation to address missing data mechanism uncertainty: Application to a smoking cessation trial

PubMed Central

Siddique, Juned; Harel, Ofer; Crespi, Catherine M.; Hedeker, Donald

2014-01-01

The true missing data mechanism is never known in practice. We present a method for generating multiple imputations for binary variables that formally incorporates missing data mechanism uncertainty. Imputations are generated from a distribution of imputation models rather than a single model, with the distribution reflecting subjective notions of missing data mechanism uncertainty. Parameter estimates and standard errors are obtained using rules for nested multiple imputation. Using simulation, we investigate the impact of missing data mechanism uncertainty on post-imputation inferences and show that incorporating this uncertainty can increase the coverage of parameter estimates. We apply our method to a longitudinal smoking cessation trial where nonignorably missing data were a concern. Our method provides a simple approach for formalizing subjective notions regarding nonresponse and can be implemented using existing imputation software. PMID:24634315

Rationale and design of a randomized controlled, clinical trial investigating a comprehensive exercise stimulus for improving mobility disability outcomes in persons with multiple sclerosis.

PubMed

Motl, Robert W; Pilutti, Lara A; Sandroff, Brian M; Klaren, Rachel; Balantrapu, Swathi; McAuley, Edward; Sosnoff, Jacob J; Fernhall, Bo

2013-05-01

This randomized controlled trial (RCT) examines the effect of a comprehensive exercise training stimulus on physiological function and mobility disability (i.e., problems walking) in individuals with multiple sclerosis (MS) who have walking impairment. This trial will recruit 30 persons with MS across central Illinois who have an Expanded Disability Status Scale score between 4.0 and 6.0, and those persons will be randomized into either the intervention or control arm of the study; the participants will not be blinded regarding group assignment. The intervention will incorporate equal amounts of aerobic, resistance, and balance modes of training delivered 3 times/week with a gradual progression of duration and intensity across a 6-month period. The control will involve stretching along with minimal muscle strengthening stimuli and will be delivered on the same frequency and duration. The primary outcomes will be clinical, kinematic, patient-rated, and physiological measures of mobility disability. The secondary outcomes will be measures of physiological function including aerobic capacity, muscle strength, and balance. This study will lay the foundation for the design of a subsequent Phase II or Phase III RCT by (a) providing effect sizes that can be included in a power analysis for sample size estimation and (b) investigating whether aerobic capacity, muscle strength, and balance are possible factors associated with the beneficial effect of exercise training on walking outcomes. Taken as a whole, the proposed study and our subsequent research agenda has the potential for advancing the management of mobility disability using exercise training in the 2nd stage of MS. Copyright © 2013 Elsevier Inc. All rights reserved.

Understanding the contribution of family history to colorectal cancer risk and its clinical implications: A state-of-the-science review.

PubMed

Lowery, Jan T; Ahnen, Dennis J; Schroy, Paul C; Hampel, Heather; Baxter, Nancy; Boland, C Richard; Burt, Randall W; Butterly, Lynn; Doerr, Megan; Doroshenk, Mary; Feero, W Gregory; Henrikson, Nora; Ladabaum, Uri; Lieberman, David; McFarland, Elizabeth G; Peterson, Susan K; Raymond, Martha; Samadder, N Jewel; Syngal, Sapna; Weber, Thomas K; Zauber, Ann G; Smith, Robert

2016-09-01

Persons with a family history (FH) of colorectal cancer (CRC) or adenomas that are not due to known hereditary syndromes have an increased risk for CRC. An understanding of these risks, screening recommendations, and screening behaviors can inform strategies for reducing the CRC burden in these families. A comprehensive review of the literature published within the past 10 years has been performed to assess what is known about cancer risk, screening guidelines, adherence and barriers to screening, and effective interventions in persons with an FH of CRC and to identify FH tools used to identify these individuals and inform care. Existing data show that having 1 affected first-degree relative (FDR) increases the CRC risk 2-fold, and the risk increases with multiple affected FDRs and a younger age at diagnosis. There is variability in screening recommendations across consensus guidelines. Screening adherence is <50% and is lower in persons under the age of 50 years. A provider's recommendation, multiple affected relatives, and family encouragement facilitate screening; insufficient collection of FH, low knowledge of guidelines, and poor family communication are important barriers. Effective interventions incorporate strategies for overcoming barriers, but these have not been broadly tested in clinical settings. Four strategies for reducing CRC in persons with familial risk are suggested: 1) improving the collection and utilization of the FH of cancer, 2) establishing a consensus for screening guidelines by FH, 3) enhancing provider-patient knowledge of guidelines and communication about CRC risk, and 4) encouraging survivors to promote screening within their families and partnering with existing screening programs to expand their reach to high-risk groups. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2633-2645. © 2016 American Cancer Society. © 2016 American Cancer Society.

Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report.

PubMed

Salvatori, Renata; Rowe, Robert H; Osborne, Raine; Beneciuk, Jason M

2014-06-01

Case report. Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.

Incorporating AAC and General Instructional Strategies in Requesting Interventions: A Case Study in Down Syndrome

ERIC Educational Resources Information Center

Lanter, Elizabeth; Russell, Sharon D.; Kuriakose, Annu; Blevins, Kasey E.

2016-01-01

This article provides clinicians and educators a useful conceptualization of general instructional strategies often used to promote the performance of requests in children with developmental disabilities, and which can be applied in interventions that utilize augmentative and alternative communication. A case study illustrates the specialized…

Leveraging Technology to Improve Developmental Mathematics Course Completion: Evaluation of a Large-Scale Intervention

ERIC Educational Resources Information Center

Wladis, Claire; Offenholley, Kathleen; George, Michael

2014-01-01

This study hypothesizes that course passing rates in remedial mathematics classes can be improved through early identification of at-risk students using a department-wide midterm, followed by a mandated set of online intervention assignments incorporating immediate and elaborate feedback for all students identified as "at-risk" by their…

Should We Teach Primary Pupils about Chemical Change?

ERIC Educational Resources Information Center

Papageorgiou, George; Grammaticopoulou, Maria; Johnson, Phil Michael

2010-01-01

Thirty-six pupils from three sixth-grade classes (ages 11/12, n = 75) in Greece were interviewed pre- and post-intervention in a piece of research on explanations of chemical phenomena. Software concerning chemical phenomena was incorporated in a teaching scheme, where the particle theory was used. After a 13 hour intervention, pupils'…

Evaluation of an Anger Therapy Intervention for Incarcerated Adult Males

ERIC Educational Resources Information Center

Vannoy, Steven D.; Hoyt, William T.

2004-01-01

An anger therapy intervention was developed for incarcerated adult males. The therapy was an extension of cognitive-behavioral approaches, incorporating principles and practices drawn from Buddhist psychology. Adult males from a Midwestern low-security prison were randomly assigned to either a treatment group (n= 16) or a waiting list control…

A New Comprehensive Educational Group Program for Older Adults with Cognitive Complaints: Background, Content, and Process Evaluation

ERIC Educational Resources Information Center

Hoogenhout, Esther M.; de Groot, Renate H. M.; Jolles, Jelle

2011-01-01

This paper presents a comprehensive group intervention for older adults with cognitive complaints. It offers psychoeducation about cognitive aging and contextual factors, focuses on skills and compensatory behavior, and incorporates group discussion. The intervention reduced negative emotional reactions towards cognitive functioning in a…

Is More Better? Outcome and Dose of a Universal Drug Prevention Effectiveness Trial

ERIC Educational Resources Information Center

Ferrer-Wreder, Laura; Cadely, Hans Saint-Eloi; Domitrovich, Celene E.; Small, Meg L.; Caldwell, Linda L.; Cleveland, Michael J.

2010-01-01

Two evidence-based interventions, Life Skills Training and TimeWise, were combined in an effectiveness trial. Participants were predominately African American youth (N = 715; M[subscript age] = 12). The study authors provide an empirical demonstration of the implications of incorporating dosage information in intervention outcome analyses. Study…

Outcomes of a School-Based Program for Young Children with Disruptive Behaviors

ERIC Educational Resources Information Center

Plath, Debbie; Croce, Nic; Crofts, Penny; Stuart, Graeme

2016-01-01

This article reports on outcomes of an Australian pilot school-based early intervention program called Got It! (Getting On Track In Time!). Findings contribute to evidence for the effectiveness of interventions for children with early-onset conduct problems. The Got It! program incorporates universal and targeted components for children ages five…

Juvenile Delinquents, the Martial Arts, and Behavior Modification: An Experimental Study for Social Intervention.

ERIC Educational Resources Information Center

Demoulin, Donald F.

Adolescents are particularly open to the influences of interventions that restructure their attitudes and self-concept. This study assesses the influence of martial arts training that incorporates a philosophy of life along with strict discipline. The hypothesis was that such training could positively influence juvenile delinquents and contribute…

Improved Prevention Counseling by HIV Care Providers in a Multisite, Clinic-Based Intervention: Positive STEPs

ERIC Educational Resources Information Center

Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol

2009-01-01

The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV care providers' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…

Dietitians’ Perspectives on Interventions to Enhance Adherence to Dietary Advice for Chronic Diseases in Adults

PubMed Central

DESROCHES, SOPHIE; LAPOINTE, ANNIE; DESCHÊNES, SARAH-MAUDE; BISSONNETTE-MAHEUX, VÉRONIQUE; GRAVEL, KARINE; THIRSK, JAYNE; LÉGARÉ, FRANCE

2016-01-01

Purpose To assess dietitians’ perspectives on the importance and applicability of interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults in the Canadian context. Methods Based on a Cochrane systematic review, we identified 8 promising interventions for enhancing adherence to dietary advice: behavioural contracts, exchange lists, feedback based on self-monitoring, individualized menu suggestions, multiple interventions, portion size awareness, telephone follow-up, and videos. Thirty-two dietitians then completed a 3-round Delphi study by responding to an electronic questionnaire asking them to rate the importance and applicability in their practice of the 8 interventions on a 7-point Likert scale. Results Using a ≥75% level of agreement, 4 interventions showed strong consensus: multiple interventions, feedback based on self-monitoring, portion size awareness, and videos. Among these, the most significant were (means ± SD for importance and applicability, respectively) feedback based on self-monitoring (6.97 ± 0.18 and 6.72 ± 0.46), portion size awareness (6.69 ± 0.54 and 6.75 ± 0.51), and multiple interventions (6.94 ± 0.25 and 6.81 ± 0.40). Conclusions These findings can guide the development of educational training sessions for dietitians to help them provide practice-relevant interventions that will increase the likelihood that patients adhere to their advice regarding prevention and management of chronic diseases. PMID:26280789

Integrated Arrival and Departure Schedule Optimization Under Uncertainty

NASA Technical Reports Server (NTRS)

Xue, Min; Zelinski, Shannon

2014-01-01

In terminal airspace, integrating arrivals and departures with shared waypoints provides the potential of improving operational efficiency by allowing direct routes when possible. Incorporating stochastic evaluation as a post-analysis process of deterministic optimization, and imposing a safety buffer in deterministic optimization, are two ways to learn and alleviate the impact of uncertainty and to avoid unexpected outcomes. This work presents a third and direct way to take uncertainty into consideration during the optimization. The impact of uncertainty was incorporated into cost evaluations when searching for the optimal solutions. The controller intervention count was computed using a heuristic model and served as another stochastic cost besides total delay. Costs under uncertainty were evaluated using Monte Carlo simulations. The Pareto fronts that contain a set of solutions were identified and the trade-off between delays and controller intervention count was shown. Solutions that shared similar delays but had different intervention counts were investigated. The results showed that optimization under uncertainty could identify compromise solutions on Pareto fonts, which is better than deterministic optimization with extra safety buffers. It helps decision-makers reduce controller intervention while achieving low delays.

Eating the elephant whole or in slices: views of participants in a smoking cessation intervention trial on multiple behaviour changes as sequential or concurrent tasks

PubMed Central

2012-01-01

Background This paper explores smoking cessation participants’ perceptions of attempting weight management alongside smoking cessation within the context of a health improvement intervention implemented in Glasgow, Scotland. Methods One hundred and thirty-eight participants were recruited from smoking cessation classes in areas of multiple deprivation in Glasgow and randomised to intervention, receiving dietary advice, or to control groups. The primary outcome of the study was to determine the % change in body weight. Semi-structured interviews were conducted with a purposive sample of 15 intervention and 15 control participants at weeks 6 (during the intervention) and 24 (at the end of the intervention). The current paper, though predominantly qualitative, links perceptions of behaviour modification to % weight change and cessation rates at week 24 thereby enabling a better understanding of the mediators influencing multiple behaviour change. Results Our findings suggest that participants who perceive separate behaviour changes as part of a broader approach to a healthier lifestyle, and hence attempt behaviour changes concurrently, may be at comparative advantage in positively achieving dual outcomes. Conclusions These findings highlight the need to assess participants’ preference for attempting multiple behaviour changes sequentially or simultaneously in addition to assessing their readiness to change. Further testing of this hypothesis is warranted. Trial Registration ISRCTN94961361 PMID:22759785

Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) - Feasibility testing, pilot randomised controlled trial and mixed methods process evaluation.

PubMed

Rahn, A C; Köpke, S; Backhus, I; Kasper, J; Anger, K; Untiedt, B; Alegiani, A; Kleiter, I; Mühlhauser, I; Heesen, C

2018-02-01

Treatment decision-making is complex for people with multiple sclerosis. Profound information on available options is virtually not possible in regular neurologist encounters. The "nurse decision coach model" was developed to redistribute health professionals' tasks in supporting immunotreatment decision-making following the principles of informed shared decision-making. To test the feasibility of a decision coaching programme and recruitment strategies to inform the main trial. Feasibility testing and parallel pilot randomised controlled trial, accompanied by a mixed methods process evaluation. Two German multiple sclerosis university centres. People with suspected or relapsing-remitting multiple sclerosis facing immunotreatment decisions on first line drugs were recruited. Randomisation to the intervention (n = 38) or control group (n = 35) was performed on a daily basis. Quantitative and qualitative process data were collected from people with multiple sclerosis, nurses and physicians. We report on the development and piloting of the decision coaching programme. It comprises a training course for multiple sclerosis nurses and the coaching intervention. The intervention consists of up to three structured nurse-led decision coaching sessions, access to an evidence-based online information platform (DECIMS-Wiki) and a final physician consultation. After feasibility testing, a pilot randomised controlled trial was performed. People with multiple sclerosis were randomised to the intervention or control group. The latter had also access to the DECIMS-Wiki, but received otherwise care as usual. Nurses were not blinded to group assignment, while people with multiple sclerosis and physicians were. The primary outcome was 'informed choice' after six months including the sub-dimensions' risk knowledge (after 14 days), attitude concerning immunotreatment (after physician consultation), and treatment uptake (after six months). Quantitative process evaluation data were collected via questionnaires. Qualitative interviews were performed with all nurses and a convenience sample of nine people with multiple sclerosis. 116 people with multiple sclerosis fulfilled the inclusion criteria and 73 (63%) were included. Groups were comparable at baseline. Data of 51 people with multiple sclerosis (70%) were available for the primary endpoint. In the intervention group 15 of 31 (48%) people with multiple sclerosis achieved an informed choice after six months and 6 of 20 (30%) in the control group. Process evaluation data illustrated a positive response towards the coaching programme as well as good acceptance. The pilot-phase showed promising results concerning acceptability and feasibility of the intervention, which was well perceived by people with multiple sclerosis, most nurses and physicians. Delegating parts of the immunotreatment decision-making process to trained nurses has the potential to increase informed choice and participation as well as effectiveness of patient-physician consultations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Use of programme theory to understand the differential effects of interventions across socio-economic groups in systematic reviews-a systematic methodology review.

PubMed

Maden, Michelle; Cunliffe, Alex; McMahon, Naoimh; Booth, Andrew; Carey, Gina Michelle; Paisley, Suzy; Dickson, Rumona; Gabbay, Mark

2017-12-29

Systematic review guidance recommends the use of programme theory to inform considerations of if and how healthcare interventions may work differently across socio-economic status (SES) groups. This study aimed to address the lack of detail on how reviewers operationalise this in practice. A methodological systematic review was undertaken to assess if, how and the extent to which systematic reviewers operationalise the guidance on the use of programme theory in considerations of socio-economic inequalities in health. Multiple databases were searched from January 2013 to May 2016. Studies were included if they were systematic reviews assessing the effectiveness of an intervention and included data on SES. Two reviewers independently screened all studies, undertook quality assessment and extracted data. A narrative approach to synthesis was adopted. A total of 37 systematic reviews were included, 10 of which were explicit in the use of terminology for 'programme theory'. Twenty-nine studies used programme theory to inform both their a priori assumptions and explain their review findings. Of these, 22 incorporated considerations of both what and how interventions do/do not work in SES groups to both predict and explain their review findings. Thirteen studies acknowledged 24 unique theoretical references to support their assumptions of what or how interventions may have different effects in SES groups. Most reviewers used supplementary evidence to support their considerations of differential effectiveness. The majority of authors outlined a programme theory in the "Introduction" and "Discussion" sections of the review to inform their assumptions or provide explanations of what or how interventions may result in differential effects within or across SES groups. About a third of reviews used programme theory to inform the review analysis and/or synthesis. Few authors used programme theory to inform their inclusion criteria, data extraction or quality assessment. Twenty-one studies tested their a priori programme theory. The use of programme theory to inform considerations of if, what and how interventions lead to differential effects on health in different SES groups in the systematic review process is not yet widely adopted, is used implicitly, is often fragmented and is not implemented in a systematic way.

Chronic Disease Management Strategies of Early Childhood Caries: Support from the Medical and Dental Literature.

PubMed

Edelstein, Burton L; Ng, Man Wai

2015-01-01

An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.

Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program.

PubMed

Fu, Rongwei; Gartlehner, Gerald; Grant, Mark; Shamliyan, Tatyana; Sedrakyan, Art; Wilt, Timothy J; Griffith, Lauren; Oremus, Mark; Raina, Parminder; Ismaila, Afisi; Santaguida, Pasqualina; Lau, Joseph; Trikalinos, Thomas A

2011-11-01

This article is to establish recommendations for conducting quantitative synthesis, or meta-analysis, using study-level data in comparative effectiveness reviews (CERs) for the Evidence-based Practice Center (EPC) program of the Agency for Healthcare Research and Quality. We focused on recurrent issues in the EPC program and the recommendations were developed using group discussion and consensus based on current knowledge in the literature. We first discussed considerations for deciding whether to combine studies, followed by discussions on indirect comparison and incorporation of indirect evidence. Then, we described our recommendations on choosing effect measures and statistical models, giving special attention to combining studies with rare events; and on testing and exploring heterogeneity. Finally, we briefly presented recommendations on combining studies of mixed design and on sensitivity analysis. Quantitative synthesis should be conducted in a transparent and consistent way. Inclusion of multiple alternative interventions in CERs increases the complexity of quantitative synthesis, whereas the basic issues in quantitative synthesis remain crucial considerations in quantitative synthesis for a CER. We will cover more issues in future versions and update and improve recommendations with the accumulation of new research to advance the goal for transparency and consistency. Copyright © 2011 Elsevier Inc. All rights reserved.

Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit.

PubMed

Feldman, Kira; Berall, Anna; Karuza, Jurgis; Senderovich, Helen; Perri, Giulia-Anna; Grossman, Daphna

2016-11-01

Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise. A survey was administered to staff on the unit before and after the intervention of the pain team to understand staff perceptions of pain management. Pre- and post-comparisons of the survey responses were analysed by using t-tests. This study provided some evidence for the success of this interprofessional education initiative through changes in staff confidence with respect to pain management. It also showed that embedding the pain team into the acute care team supported the KT process as an effective method of interprofessional team building. Incorporating the pain team into the acute care unit to provide training and ongoing decision support was a feasible strategy for KT and could be replicated in other clinical settings.

A pilot investigation of the potential for incorporating lifelog technology into executive function rehabilitation for enhanced transfer of self-regulation skills to everyday life.

PubMed

Cuberos-Urbano, Gustavo; Caracuel, Alfonso; Valls-Serrano, Carlos; García-Mochón, Leticia; Gracey, Fergus; Verdejo-García, Antonio

2018-06-01

The objective of the study was to identify the potential target and effect size of goal management training (GMT) enhanced with life-logging technology compared with standard GMT on a range of possible primary outcomes reflecting cognitive and ecological aspects of executive functioning and quality of life. Sixteen patients with acquired brain injury involving executive dysfunction were randomly allocated to one of the two interventions: seven weeks of GMT (n = 8), or seven weeks of GMT+Lifelog (n = 8). Outcome measures included a battery of executive function tests, the Dysexecutive Questionnaire (DEX) and the Quality of Life after Brain Injury scale (QOLIBRI), measured pre- and post-interventions. Within-group changes were assessed with related-samples t-tests and estimation of effect sizes. GMT+Lifelog was associated with significant changes, of medium to large effect size, in response inhibition (Stroop), multitasking (Strategy Application and Multiple Errand tests), DEX Intentionality and Positive Affect subscales and QOLIBRI Daily Life and Autonomy, subscales. GMT alone was associated with significant changes of overall quality of life. It was concluded that GMT+Lifelog holds promise to optimise the impact of GMT on executive dysfunction and quality of life.

Qualitative exporation of relationships with important non-parental adults in the lives of youth in foster care

PubMed Central

Ahrens, Kym R.; DuBois, David Lane; Garrison, Michelle; Spencer, Renee; Richardson, Laura P.; Lozano, Paula

2012-01-01

Foster youth are at risk of poor adult outcomes. Research on the role of mentoring relationships for this population suggests the value of strategies that increase their access to adult sources of support, both while in foster care and as they reach adulthood. We conducted semi-structured, individual qualitative interviews with 23 former foster youth ages 18-25 regarding their relationships with supportive non-parental adults. We sought to identify factors that influence the formation, quality, and duration of these relationships and to develop testable hypotheses for intervention strategies. Findings suggest several themes related to relationship formation with non-parental adults, including barriers (e.g., youth's fears of being hurt) and facilitators (e.g., patience from the adult). Distinct themes were also identified relating to the ongoing development and longevity of these relationships. Youth also described multiple types of support and positive contributions to their development. Proposed intervention strategies include systematic incorporation of important non-parental adults into transition planning, enhanced training and matching procedures within formal mentoring programs, assistance for youth to strengthen their interpersonal awareness and skills, and the targeting of specific periods of need when linking youth to sources of adult support. Recommended research includes the development, pilot-testing, and evaluation of proposed strategies. PMID:22661797

HIV-related stigma and NGO-isation in India: an historico-empirical analysis

PubMed Central

Nambiar, Devaki

2011-01-01

In response to World Bank critiques in 2007, the Indian Ministry of Health and Family Welfare declared that HIV-related stigma was a barrier to the participation of Non-Governmental Organisations (NGOs) in the implementation of HIV prevention Targeted Interventions. Taking a deeper view of HIV-related stigma as an historically inflected process of devaluation, this paper details the history and transformation of NGO involvement in the HIV epidemic from 1986 through economic liberalisation in the 1990s up to the recently concluded National AIDS Control Program (NACP II, 1999-2006). It additionally examines findings from interviews and participant observation of NGO workers (N=24) from four Targeted Intervention NGOs in Delhi funded under NACP II. Analysis reveals that a ‘second wave’ of HIV-related NGO involvement has mushroomed in the past two decades, affording NGO workers multiple pathways to credibility in the Indian response to the epidemic. Contradictions embedded in the overlap of these pathways produce stigma, reflecting ‘adverse incorporation.’ Drawing upon noteworthy exceptions to this trend from the ‘first wave’ of Indian HIV-related NGOs, the paper calls for NGO participation as an explicitly political project of addressing the social inequalities that shape stigma as well as vulnerability to illness writ large. PMID:22150236

Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review

PubMed Central

Brand, Sarah L.; Thompson Coon, Jo; Fleming, Lora E.; Carroll, Lauren; Bethel, Alison; Wyatt, Katrina

2017-01-01

Background Healthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and “burnout” at work than staff in other sectors. There is a growing call for the ‘triple aim’ of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom’s (UK) Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff. Objectives This systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of) these recommendations and determine whether they improve staff health and wellbeing. Methods A comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward) in collective activities to improve physical or mental health or promote healthy behaviours. Results Eleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1) pre-determined (one-size-fits-all) and no choice of activities (two studies); or 2) pre-determined and some choice of activities (one study); 3) A wide choice of a range of activities and some adaptation to local needs (five studies); or, 3) a participatory approach to creating programmes responsive and adaptive to local staff needs that have extensive choice of activities to participate in (three studies). Only five of the interventions included substantial involvement and engagement of leadership and efforts aimed at up-skilling the leadership of staff to support staff health and wellbeing. Incorporation of more of the recommendations did not appear to be related to effectiveness. The heterogeneity of study designs, populations and outcomes excluded a meta-analysis. All studies were deemed by their authors to be at least partly effective. Two studies reported statistically significant improvement in objectively measured physical health (BMI) and eight in subjective mental health. Six studies reported statistically significant positive changes in subjectively assessed health behaviours. Conclusions This systematic review identified 11 studies which incorporate at least one of the Boorman recommendations and provides evidence that whole-system healthy workplace interventions can improve health and wellbeing and promote healthier behaviours in healthcare staff. PMID:29200422

Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review.

PubMed

Brand, Sarah L; Thompson Coon, Jo; Fleming, Lora E; Carroll, Lauren; Bethel, Alison; Wyatt, Katrina

2017-01-01

Healthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and "burnout" at work than staff in other sectors. There is a growing call for the 'triple aim' of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom's (UK) Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff. This systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of) these recommendations and determine whether they improve staff health and wellbeing. A comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward) in collective activities to improve physical or mental health or promote healthy behaviours. Eleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1) pre-determined (one-size-fits-all) and no choice of activities (two studies); or 2) pre-determined and some choice of activities (one study); 3) A wide choice of a range of activities and some adaptation to local needs (five studies); or, 3) a participatory approach to creating programmes responsive and adaptive to local staff needs that have extensive choice of activities to participate in (three studies). Only five of the interventions included substantial involvement and engagement of leadership and efforts aimed at up-skilling the leadership of staff to support staff health and wellbeing. Incorporation of more of the recommendations did not appear to be related to effectiveness. The heterogeneity of study designs, populations and outcomes excluded a meta-analysis. All studies were deemed by their authors to be at least partly effective. Two studies reported statistically significant improvement in objectively measured physical health (BMI) and eight in subjective mental health. Six studies reported statistically significant positive changes in subjectively assessed health behaviours. This systematic review identified 11 studies which incorporate at least one of the Boorman recommendations and provides evidence that whole-system healthy workplace interventions can improve health and wellbeing and promote healthier behaviours in healthcare staff.

Best Practices of Multiple-Time SmartWay Award Winners

EPA Pesticide Factsheets

This EPA presentations focus is on the SmartWay Excellence Awards multiple winners, their best practices in protecting the environment, incorporating sustainability and reducing carbon pollution, along with benefits of being a partner.

MULTIPLE SCALES FOR SUSTAINABLE RESULTS

EPA Science Inventory

This session will highlight recent research that incorporates the use of multiple scales and innovative environmental accounting to better inform decisions that affect sustainability, resilience, and vulnerability at all scales. Effective decision-making involves assessment at mu...

Geospatial optimization of siting large-scale solar projects

USGS Publications Warehouse

Macknick, Jordan; Quinby, Ted; Caulfield, Emmet; Gerritsen, Margot; Diffendorfer, James E.; Haines, Seth S.

2014-01-01

guidelines by being user-driven, transparent, interactive, capable of incorporating multiple criteria, and flexible. This work provides the foundation for a dynamic siting assistance tool that can greatly facilitate siting decisions among multiple stakeholders.

Evidence-based exercise prescription for balance and falls prevention: a current review of the literature.

PubMed

Shubert, Tiffany E

2011-01-01

Falls are the leading cause of emergency department visits, hospital admissions, and unintentional death for older adults. Balance and strength impairments are common falls risk factors for community-dwelling older adults. Though physical therapists commonly treat balance and strength, standardized falls screening has not been fully incorporated into physical therapy practice and there is much variation in the frequency, intensity, and duration of therapy prescribed to achieve optimal results. For community-dwelling older adults, a progressive exercise program that focuses on moderate to high-intensity balance exercises appears to be one of the most effective interventions to prevent falls. For more frail older adults in institutional settings, exercise programs in addition to multifactorial interventions appear to show promise as effective falls prevention interventions. The minimum dose of exercise to protect an older adult against falls is 50 hours. This article describes the current best practices for physical therapists to effectively improve balance and manage falls risk in patients. The unique challenges and opportunities for physical therapists to incorporate evidence-based fall-prevention strategies are discussed. Innovative practice models incorporating evidence-based fall-prevention programs and partnerships with public health and aging service providers to create a continuum of care and achieve the optimal dose of balance training are presented.

Addictive Behavior Interventions Among College Students.

PubMed

Jeffries, Emily R; Lemke, Austin W; Shah, Sonia M; Dean, Kimberlye E; Richter, Ashley A; Buckner, Julia D

2016-12-01

Addictive behaviors among college students are a significant public health concern. This manuscript reviews the past two years of literature on prevention and treatment approaches for college students who engage in addictive behaviors. In-person skills-based interventions and motivational interventions that incorporate personalized feedback are effective in the short-term but little support was found for long-term effects. Although web-based interventions reduced certain addictive behaviors (e.g., alcohol, problematic gambling), in-person interventions that include motivational interviewing components and personalized feedback appear to be more efficacious. Research has largely focused on alcohol and little is known about the utility of interventions for students who use tobacco or illicit substances or who engage in problematic gambling. Research on interventions for these high-risk behaviors is recommended.

Effectiveness of a Multiple Family Group Intervention for Juvenile First Offenders in Reducing Parent Stress

ERIC Educational Resources Information Center

Caldwell, Christopher Les; Horne, Arthur M.; Davidson, Bernard; Quinn, William H.

2007-01-01

Parenting practices are major influences on incidents of juvenile delinquency. Stress experienced by parents of children with behavioral problems is a leading contributor to parenting practices. We investigated the extent to which parental stress was reduced by participation in an established multiple group family intervention, the Family…

Characteristics and correlates of coping with multiple sclerosis: a systematic review.

PubMed

Keramat Kar, Maryam; Whitehead, Lisa; Smith, Catherine M

2017-10-10

The purpose of this systematic review was to examine coping strategies that people with multiple sclerosis use, and to identify factors that influence their coping pattern. This systematic review followed the Joanna Briggs Institute guidelines for synthesizing descriptive quantitative research. The following databases were searched from the inception of databases until December 2016: Ovid (Medline, Embase, CINAHL, and PsycINFO), Science Direct, Web of Science, and Scopus. Manual search was also conducted from the reference lists of retrieved articles. Findings related to the patterns of coping with multiple sclerosis and factors influencing coping with multiple sclerosis were extracted and synthesized. The search of the database yielded 455 articles. After excluding duplicates (n = 341) and studies that did not meet the inclusion criteria (n = 27), 71 studies were included in the full-text review. Following the full-text, a further 21 studies were excluded. Quality appraisal of 50 studies was completed, and 38 studies were included in the review. Synthesis of findings indicated that people with multiple sclerosis use emotional and avoidance coping strategies more than other types of coping, particularly in the early stages of the disease. In comparison to the general population, people with multiple sclerosis were less likely to use active coping strategies and used more avoidance and emotional coping strategies. The pattern of coping with multiple sclerosis was associated with individual, clinical and psychological factors including gender, educational level, clinical course, mood and mental status, attitude, personality traits, and religious beliefs. The findings of this review suggest that considering individual or disease-related factors could help healthcare professionals in identifying those less likely to adapt to multiple sclerosis. This information could also be used to provide client-centered rehabilitation for people living with multiple sclerosis based on their individual responses and perceptions for coping. Implications for rehabilitation Engagement in coping with multiple sclerosis has been associated with individual factors and neuropsychological functions. Considering individual and disease-related factors would allow healthcare professionals to provide more tailored interventions to maintain and master coping with multiple sclerosis. People living with multiple sclerosis should be empowered to appraise and manage ability to cope based on the contextual evidence (individual and clinical condition). Rehabilitation services should move beyond physical management incorporating behavioral aspects for better functioning in living with multiple sclerosis.

Effect of length of time before incorporation on survival of pathogenic bacteria present in livestock wastes applied to agricultural soil.

PubMed

Hutchison, M L; Walters, L D; Moore, A; Crookes, K M; Avery, S M

2004-09-01

In response to reports that the contamination of food can occur during the on-farm primary phase of food production, we report data that describes a possible cost-effective intervention measure. The effect of time before soil incorporation of livestock wastes spread to land on the rate of decline of zoonotic agents present in the waste was investigated. Fresh livestock wastes were inoculated with laboratory-cultured Salmonella, Listeria, and Campylobacter spp. and Escherichia coli O157 before they were spread onto soil. Incorporation of the spread wastes was either immediate, delayed for 1 week, or did not occur at all. Bacterial decline was monitored over time and found to be significantly more rapid for all waste types when they were left on the soil surface. There were no significant differences in initial bacterial decline rates when wastes were spread in summer or winter. Our results indicate that not incorporating contaminated livestock wastes into soil is a potential intervention measure that may help to limit the spread of zoonotic agents further up the food chain. The implications of these findings are discussed in relation to current advice for livestock waste disposal.

Effective strategies to reduce commercial tobacco use in Indigenous communities globally: A systematic review.

PubMed

Minichiello, Alexa; Lefkowitz, Ayla R F; Firestone, Michelle; Smylie, Janet K; Schwartz, Robert

2016-01-11

All over the world, Indigenous populations have remarkably high rates of commercial tobacco use compared to non-Indigenous groups. The high rates of commercial tobacco use in Indigenous populations have led to a variety of health issues and lower life expectancy than the general population. The objectives of this systematic review were to investigate changes in the initiation, consumption and quit rates of commercial tobacco use as well as changes in knowledge, prevalence, community interest, and smoke-free environments in Indigenous populations. We also aimed to understand which interventions had broad reach, what the common elements that supported positive change were and how Aboriginal self-determination was reflected in program implementation. We undertook a systematic review of peer-reviewed publications and grey literature selected from seven databases and 43 electronic sources. We included studies between 1994 and 2015 if they addressed an intervention (including provision of a health service or program, education or training programs) aimed to reduce the use of commercial tobacco use in Indigenous communities globally. Systematic cross-regional canvassing of informants in Canada and internationally with knowledge of Indigenous health and/or tobacco control provided further leads about commercial tobacco reduction interventions. We extracted data on program characteristics, study design and learnings including successes and challenges. In the process of this review, we investigated 73 commercial tobacco control interventions in Indigenous communities globally. These interventions incorporated a myriad of activities to reduce, cease or protect Indigenous peoples from the harms of commercial tobacco use. Interventions were successful in producing positive changes in initiation, consumption and quit rates. Interventions also facilitated increases in the number of smoke-free environments, greater understandings of the harms of commercial tobacco use and a growing community interest in addressing the high rates of commercial tobacco use. Interventions were unable to produce any measured change in prevalence rates. The extent of this research in Indigenous communities globally suggests a growing prioritization and readiness to address the high rates of commercial tobacco use through the use of both comprehensive and tailored interventions. A comprehensive approach that uses multiple activities, the centring of Aboriginal leadership, long term community investments, and the provision of culturally appropriate health materials and activities appear to have an important influence in producing desired change.

Applying evidence from economic evaluations to translate cancer survivorship research into care.

PubMed

de Moor, Janet S; Alfano, Catherine M; Breen, Nancy; Kent, Erin E; Rowland, Julia

2015-09-01

This paper summarizes recommendations stemming from the meeting, Applying Evidence from Economic Evaluations to Translate Cancer Survivorship Research into Care, hosted by the National Cancer Institute. The meeting convened funded investigators, experts in cancer control, survivorship, health economics, and team science to identify the economic and health services data needed to facilitate the dissemination of cancer survivorship interventions into care and how survivorship and health economic investigators can successfully collaborate together and with other stakeholders. Recommendations from the meeting are as follows. First, investigators must engage key stakeholders early in the planning process to understand the outcomes and cost domains on which they base decisions. Second, evaluations of intervention efficacy and value should be conducted using standardized and comparable measures and analytic approaches to enable comparisons across studies. Finally, a health economist should be included during the planning phase of the study so that the economic evaluation is pursued in concert with the survivorship intervention. Economic analyses, from the perspective of key stakeholders, must be incorporated into survivorship intervention research. The results from these analyses should be disseminated in a manner that is transparent, accessible, and comparable across studies. To optimize cancer survivors' health and quality of life, it is essential deliver high-quality and high-value care. Incorporating economic analyses into survivorship intervention research can inform the translation of effective interventions into practice.

Lifestyle Approaches for People With Intellectual Disabilities: A Systematic Multiple Case Analysis.

PubMed

Steenbergen, Henderika Annegien; Van der Schans, Cees P; Van Wijck, Ruud; De Jong, Johan; Waninge, Aly

2017-11-01

Health care organizations supporting individuals with intellectual disabilities (IDs) carry out a range of interventions to support and improve a healthy lifestyle. However, it is difficult to implement an active and healthy lifestyle into daily support. The presence of numerous intervention components, multiple levels of influence, and the explicit use of theory are factors that are considered to be essential for implementation in practice. A comprehensive written lifestyle policy provides for sustainability of a lifestyle approach. It is unknown to what extent these crucial factors for successful implementation are taken into consideration by health care organizations supporting this population. To analyze the intervention components, levels of influence, explicit use of theory, and conditions for sustainability of currently used lifestyle interventions within lifestyle approaches aiming at physical activity and nutrition in health care organizations supporting people with ID. In this descriptive multiple case study of 9 health care organizations, qualitative data of the lifestyle approaches with accompanying interventions and their components were compiled with a newly developed online inventory form. From 9 health care organizations, 59 interventions were included, of which 31% aimed to improve physical activity, 10% nutrition, and 59% a combination of both. Most (49%) interventions aimed at the educational component and less at daily (19%) and generic activities (16%) and the evaluation component (16%). Most interventions targeted individuals with ID and the professionals whereas social levels were underrepresented. Although 52% of the interventions were structurally embedded, only 10 of the 59 interventions were theory-driven. Health care organizations could improve their lifestyle approaches by using an explicit theoretical basis by expanding the current focus of the interventions that primarily concentrate on their clients and professionals toward also targeting the social and external environment as well as the introduction of a written lifestyle policy. This policy should encompass all interventions and should be the responsibility of those in the organization working with individuals with ID. In conclusion, comprehensive, integrated, and theory-driven approaches at multiple levels should be promoted. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

An intervention for parents with AIDS and their adolescent children.

PubMed

Rotheram-Borus, M J; Lee, M B; Gwadz, M; Draimin, B

2001-08-01

This study evaluated an intervention designed to improve behavioral and mental health outcomes among adolescents and their parents with AIDS. Parents with AIDS (n = 307) and their adolescent children (n = 412) were randomly assigned to an intensive intervention or a standard care control condition. Ninety-five percent of subjects were reassessed at least once annually over 2 years. Adolescents in the intensive intervention condition reported significantly lower levels of emotional distress, of multiple problem behaviors, of conduct problems, and of family-related stressors and higher levels of self-esteem than adolescents in the standard care condition. Parents with AIDS in the intervention condition also reported significantly lower levels of emotional distress and multiple problem behaviors. Coping style, levels of disclosure regarding serostatus, and formation of legal custody plans were similar across intervention conditions. Interventions can reduce the long-term impact of parents' HIV status on themselves and their children.

Contact tracing of tuberculosis: a systematic review of transmission modelling studies.

PubMed

Begun, Matt; Newall, Anthony T; Marks, Guy B; Wood, James G

2013-01-01

The WHO recommended intervention of Directly Observed Treatment, Short-course (DOTS) appears to have been less successful than expected in reducing the burden of TB in some high prevalence settings. One strategy for enhancing DOTS is incorporating active case-finding through screening contacts of TB patients as widely used in low-prevalence settings. Predictive models that incorporate population-level effects on transmission provide one means of predicting impacts of such interventions. We aim to identify all TB transmission modelling studies addressing contact tracing and to describe and critically assess their modelling assumptions, parameter choices and relevance to policy. We searched MEDLINE, SCOPUS, COMPENDEX, Google Scholar and Web of Science databases for relevant English language publications up to February 2012. Of the 1285 studies identified, only 5 studies met our inclusion criteria of models of TB transmission dynamics in human populations designed to incorporate contact tracing as an intervention. Detailed implementation of contact processes was only present in two studies, while only one study presented a model for a high prevalence, developing world setting. Some use of relevant data for parameter estimation was made in each study however validation of the predicted impact of interventions was not attempted in any of the studies. Despite a large body of literature on TB transmission modelling, few published studies incorporate contact tracing. There is considerable scope for future analyses to make better use of data and to apply individual based models to facilitate more realistic patterns of infectious contact. Combined with a focus on high burden settings this would greatly increase the potential for models to inform the use of contract tracing as a TB control policy. Our findings highlight the potential for collaborative work between clinicians, epidemiologists and modellers to gather data required to enhance model development and validation and hence better inform future public health policy.

Contact Tracing of Tuberculosis: A Systematic Review of Transmission Modelling Studies

PubMed Central

Begun, Matt; Newall, Anthony T.; Marks, Guy B.; Wood, James G.

2013-01-01

The WHO recommended intervention of Directly Observed Treatment, Short-course (DOTS) appears to have been less successful than expected in reducing the burden of TB in some high prevalence settings. One strategy for enhancing DOTS is incorporating active case-finding through screening contacts of TB patients as widely used in low-prevalence settings. Predictive models that incorporate population-level effects on transmission provide one means of predicting impacts of such interventions. We aim to identify all TB transmission modelling studies addressing contact tracing and to describe and critically assess their modelling assumptions, parameter choices and relevance to policy. We searched MEDLINE, SCOPUS, COMPENDEX, Google Scholar and Web of Science databases for relevant English language publications up to February 2012. Of the 1285 studies identified, only 5 studies met our inclusion criteria of models of TB transmission dynamics in human populations designed to incorporate contact tracing as an intervention. Detailed implementation of contact processes was only present in two studies, while only one study presented a model for a high prevalence, developing world setting. Some use of relevant data for parameter estimation was made in each study however validation of the predicted impact of interventions was not attempted in any of the studies. Despite a large body of literature on TB transmission modelling, few published studies incorporate contact tracing. There is considerable scope for future analyses to make better use of data and to apply individual based models to facilitate more realistic patterns of infectious contact. Combined with a focus on high burden settings this would greatly increase the potential for models to inform the use of contract tracing as a TB control policy. Our findings highlight the potential for collaborative work between clinicians, epidemiologists and modellers to gather data required to enhance model development and validation and hence better inform future public health policy. PMID:24023742

Results of a multi-media multiple behavior obesity prevention program for adolescents.

PubMed

Mauriello, Leanne M; Ciavatta, Mary Margaret H; Paiva, Andrea L; Sherman, Karen J; Castle, Patricia H; Johnson, Janet L; Prochaska, Janice M

2010-12-01

This study reports on effectiveness trial outcomes of Health in Motion, a computer tailored multiple behavior intervention for adolescents. Using school as level of assignment, students (n=1800) from eight high schools in four states (RI, TN, MA, and NY) were stratified and randomly assigned to no treatment or a multi-media intervention for physical activity, fruit and vegetable consumption, and limited TV viewing between 2006 and 2007. Intervention effects on continuous outcomes, on movement to action and maintenance stages, and on stability within action and maintenance stages were evaluated using random effects modeling. Effects were most pronounced for fruit and vegetable consumption and for total risks across all time points and for each behavior immediately post intervention. Co-variation of behavior change occurred within the treatment group, where individuals progressing to action or maintenance for one behavior were 1.4-4.2 times more likely to make similar progress on another behavior. Health in Motion is an innovative, multiple behavior obesity prevention intervention relevant for all adolescents that relies solely on interactive technology to deliver tailored feedback. The outcomes of the effectiveness trial demonstrate both an ability to initiate behavior change across multiple energy balance behaviors simultaneously and feasibility for ease of dissemination. Copyright © 2010 The Institute For Cancer Prevention. Published by Elsevier Inc. All rights reserved.

Clinical findings provide criteria to evaluate priorities of ophthalmologic intervention in conscious multiple trauma patients.

PubMed

Shams-Vahdati, Samad; Gholipour, Changiz; Jalilzadeh-Binazar, Mehran; Moharamzadeh, Payman; Sorkhabi, Rana; Jalilian, Respina

2015-07-01

Multiple trauma patients frequently suffer eye injuries, especially those patients with head traumas. We evaluated the accuracy of physical findings to determine the priorities of emergency ophthalmologic intervention in these patients. This study included all multiple trauma patients with ophthalmic trauma who had a GCS of 15 when they arrived at the emergency department during the period of March, 2008-March, 2009. First, we evaluated the patients according to the criteria of the study. Then, an ophthalmologist evaluated them. From March 2008-March 2009, 306 multiple trauma patients with ocular trauma came to our ED. The sensitivity and accuracy of emergency physicians in diagnosing the priority of ophthalmologic treatment were comparable to an ophthalmologist (measure of agreement in kappa=0.967). The ability of an emergency physician or general surgeon to determine the actual need of early ophthalmologist intervention can improve decision making and saving both time and money. Our study suggests that it is possible to determine according to clinical findings the need of the patient to have ophthalmologic intervention without referring the patient to ophthalmologist examination. Defining specific criteria of ophthalmologic examinations can clarify the necessity of emergency ophthalmologic examination and intervention. Copyright © 2014 Elsevier Ltd. All rights reserved.

CHALLENGES OF PROCESSING BIOLOGICAL DATA FOR INCORPORATION INTO A LAKE EUTROPHICATION MODEL

EPA Science Inventory

A eutrophication model is in development as part of the Lake Michigan Mass Balance Project (LMMBP). Successful development and calibration of this model required the processing and incorporation of extensive biological data. Data were drawn from multiple sources, including nutrie...

Incorporating pest management into the design of multiple goal-oriented cropping systems

USDA-ARS?s Scientific Manuscript database

Suggestions are offered to facilitate efforts to incorporate pest management goals into the design of crop production systems. The scope of research programs should be expanded to ensure broad multidisciplinary cooperation. Inclusion of farmers, production specialists and researchers from discipli...

Feasibility and User Perception of a Fully Automated Push-Based Multiple-Session Alcohol Intervention for University Students: Randomized Controlled Trial

PubMed Central

2014-01-01

Background In recent years, many electronic health behavior interventions have been developed in order to reach individuals with unhealthy behaviors, such as risky drinking. This is especially relevant for university students, many of whom are risky drinkers. Objective This study explored the acceptability and feasibility in a nontreatment-seeking group of university students (including both risk and nonrisk drinkers), of a fully automated, push-based, multiple-session, alcohol intervention, comparing two modes of delivery by randomizing participants to receive the intervention either by SMS text messaging (short message service, SMS) or by email. Methods A total of 5499 students at Luleå University in northern Sweden were invited to participate in a single-session alcohol assessment and feedback intervention; 28.04% (1542/5499) students completed this part of the study. In total, 29.44% (454/1542) of those participating in the single-session intervention accepted to participate further in the extended multiple-session intervention lasting for 4 weeks. The students were randomized to receive the intervention messages via SMS or email. A follow-up questionnaire was sent immediately after the intervention and 52.9% (240/454) responded. Results No difference was seen regarding satisfaction with the length and frequency of the intervention, regardless of the mode of delivery. Approximately 15% in both the SMS (19/136) and email groups (15/104) would have preferred the other mode of delivery. On the other hand, more students in the SMS group (46/229, 20.1%) stopped participating in the intervention during the 4-week period compared with the email group (10/193, 5.2%). Most students in both groups expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. A striking difference was seen regarding when a message was read; 88.2% (120/136) of the SMS group read the messages within 1 hour in contrast to 45.2% (47/104) in the email group. In addition, 83.1% (113/136) in the SMS group stated that they read all or almost all the messages, compared with only 63.5% (66/104) in the email group. Conclusions Based on the feedback from the students, an extended, multiple-session, push-based intervention seems to be a feasible option for students interested in additional support after a single-session alcohol intervention. SMS as a mode of delivery seems to have some advantages over email regarding when a message is read and the proportion of messages read. However, more students in the SMS group stopped the intervention than in the email group. Based on these promising findings, further studies comparing the effectiveness of single-session interventions with extended multiple-session interventions delivered separately or in combination are warranted. PMID:25098296

Queer as F**k: Reaching and Engaging Gay Men in Sexual Health Promotion through Social Networking Sites

PubMed Central

Hellard, Margaret; Gold, Judy; Ata, Nadine; Chang, Shanton; Howard, Steve; Asselin, Jason; Ilic, Olivia; Batrouney, Colin; Stoove, Mark

2013-01-01

Background A growing number of health promotion interventions are taking advantage of the popularity and interactivity of new social media platforms to foster and engage communities for health promotion. However, few health promotion interventions using social networking sites (SNS) have been rigorously evaluated. "Queer as F**k"(QAF) began as pilot project in 2010 to deliver sexual health promotion via short "webisodes" on SNS to gay men. Now in its fifth season, QAF is among the few published examples internationally to demonstrate the sexual health promotion potential of SNS. Objective The objective of this evaluation is to assess reach, interactivity, and engagement generated by QAF to inform future health interventions and evaluations using SNS. Methods We undertook a mixed method process evaluation using an uncontrolled longitudinal study design that compared multiple measurements over time to assess changes in reach and engagement. We adapted evaluation methods from the health promotion, information systems, and creative spheres. We incorporated online usage statistics, interviews informed by user diary-scrapbooks, and user focus groups to assess intervention reach and engagement. Results During Series 1-3 (April 2010 to April 2011), 32 webisodes were posted on the QAF Facebook and YouTube pages. These webisodes attracted over 30,000 views; ranging from 124-3092 views per individual episode. By April 2011, the QAF Facebook page had 2929 predominantly male fans. Interview and focus group participants supported the balance of education and entertainment. They endorsed the narrative "soap opera" format as an effective way to deliver sexual health messages in an engaging, informative, and accessible manner that encouraged online peer discussion of sexual health and promoted community engagement. Conclusions QAF offers a successful example of exploiting the reach, interactivity, and engagement potential of SNS; findings from this process evaluation provide a model to inform the delivery and evaluation of future health promotion interventions on SNS. PMID:23391459

Social Media Use and HIV-Related Risk Behaviors in Young Black and Latino Gay and Bi Men and Transgender Individuals in New York City: Implications for Online Interventions.

PubMed

Patel, Viraj V; Masyukova, Mariya; Sutton, Desmond; Horvath, Keith J

2016-04-01

Urban young men who have sex with men (YMSM) and transgender women continue to experience high rates of new HIV infections in the USA, yet most of this population is not reached by current prevention interventions. The rate of Internet and social media use among youth is high. However, continually updated understanding of the associations between social media access and use and HIV risk behaviors is needed to reach and tailor technology-delivered interventions for those most vulnerable to HIV-racially and ethnically diverse urban YMSM and transgender persons. Thus, we conducted an in-person, venue-based cross-sectional survey among young gay, bisexual, and transgender individuals at locations primarily visited by Black and Latino gay and bisexual and transgender individuals in New York City to understand social media use and how it may relate to HIV risk behaviors to inform social media-based interventions. Among 102 primarily Black and Latino gay and bisexual men (75.5 %) and transgender women (19.6 %), over 90 % were under 30 years of age, 18.6 % reported homelessness in the past 6 months, and 10.8 % reported having HIV. All participants used social media, most accessed these platforms most often via a mobile device (67.6 %) and most logged on multiple times per day (87.3 %). Participants used social media to seek sex partners (56.7 %), exchange sex for money or clothes (19.6 %), and exchange sex for drugs (9.8 %). These results confirm prior studies demonstrating the feasibility of using social media platforms to reach at-risk, urban youth. Of particular concern is the association between recent STI and exchanging sex for money/clothes and drugs. Interventions using social media for young, urban minority MSM and transgender populations should incorporate risk reduction modules addressing exchange partners and promote frequent and regular HIV/STI testing.

Queer as F**k: reaching and engaging gay men in sexual health promotion through social networking sites.

PubMed

Pedrana, Alisa; Hellard, Margaret; Gold, Judy; Ata, Nadine; Chang, Shanton; Howard, Steve; Asselin, Jason; Ilic, Olivia; Batrouney, Colin; Stoove, Mark

2013-02-07

A growing number of health promotion interventions are taking advantage of the popularity and interactivity of new social media platforms to foster and engage communities for health promotion. However, few health promotion interventions using social networking sites (SNS) have been rigorously evaluated. "Queer as F**k"(QAF) began as pilot project in 2010 to deliver sexual health promotion via short "webisodes" on SNS to gay men. Now in its fifth season, QAF is among the few published examples internationally to demonstrate the sexual health promotion potential of SNS. The objective of this evaluation is to assess reach, interactivity, and engagement generated by QAF to inform future health interventions and evaluations using SNS. We undertook a mixed method process evaluation using an uncontrolled longitudinal study design that compared multiple measurements over time to assess changes in reach and engagement. We adapted evaluation methods from the health promotion, information systems, and creative spheres. We incorporated online usage statistics, interviews informed by user diary-scrapbooks, and user focus groups to assess intervention reach and engagement. During Series 1-3 (April 2010 to April 2011), 32 webisodes were posted on the QAF Facebook and YouTube pages. These webisodes attracted over 30,000 views; ranging from 124-3092 views per individual episode. By April 2011, the QAF Facebook page had 2929 predominantly male fans. Interview and focus group participants supported the balance of education and entertainment. They endorsed the narrative "soap opera" format as an effective way to deliver sexual health messages in an engaging, informative, and accessible manner that encouraged online peer discussion of sexual health and promoted community engagement. QAF offers a successful example of exploiting the reach, interactivity, and engagement potential of SNS; findings from this process evaluation provide a model to inform the delivery and evaluation of future health promotion interventions on SNS.

TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation.

PubMed

Salisbury, Chris; Thomas, Clare; O'Cathain, Alicia; Rogers, Anne; Pope, Catherine; Yardley, Lucy; Hollinghurst, Sandra; Fahey, Tom; Lewis, Glyn; Large, Shirley; Edwards, Louisa; Rowsell, Alison; Segar, Julia; Brownsell, Simon; Montgomery, Alan A

2015-02-06

To develop a conceptual model for effective use of telehealth in the management of chronic health conditions, and to use this to develop and evaluate an intervention for people with two exemplar conditions: raised cardiovascular disease risk and depression. The model was based on several strands of evidence: a metareview and realist synthesis of quantitative and qualitative evidence on telehealth for chronic conditions; a qualitative study of patients' and health professionals' experience of telehealth; a quantitative survey of patients' interest in using telehealth; and review of existing models of chronic condition management and evidence-based treatment guidelines. Based on these evidence strands, a model was developed and then refined at a stakeholder workshop. Then a telehealth intervention ('Healthlines') was designed by incorporating strategies to address each of the model components. The model also provided a framework for evaluation of this intervention within parallel randomised controlled trials in the two exemplar conditions, and the accompanying process evaluations and economic evaluations. Primary care. The TElehealth in CHronic Disease (TECH) model proposes that attention to four components will offer interventions the best chance of success: (1) engagement of patients and health professionals, (2) effective chronic disease management (including subcomponents of self-management, optimisation of treatment, care coordination), (3) partnership between providers and (4) patient, social and health system context. Key intended outcomes are improved health, access to care, patient experience and cost-effective care. A conceptual model has been developed based on multiple sources of evidence which articulates how telehealth may best provide benefits for patients with chronic health conditions. It can be used to structure the design and evaluation of telehealth programmes which aim to be acceptable to patients and providers, and cost-effective. 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.

Engaged for Change: A Community-Engaged Process for Developing Interventions to Reduce Health Disparities.

PubMed

Rhodes, Scott D; Mann-Jackson, Lilli; Alonzo, Jorge; Simán, Florence M; Vissman, Aaron T; Nall, Jennifer; Abraham, Claire; Aronson, Robert E; Tanner, Amanda E

2017-12-01

The science underlying the development of individual, community, system, and policy interventions designed to reduce health disparities has lagged behind other innovations. Few models, theoretical frameworks, or processes exist to guide intervention development. Our community-engaged research partnership has been developing, implementing, and evaluating efficacious interventions to reduce HIV disparities for over 15 years. Based on our intervention research experiences, we propose a novel 13-step process designed to demystify and guide intervention development. Our intervention development process includes steps such as establishing an intervention team to manage the details of intervention development; assessing community needs, priorities, and assets; generating intervention priorities; evaluating and incorporating theory; developing a conceptual or logic model; crafting activities; honing materials; administering a pilot, noting its process, and gathering feedback from all those involved; and editing the intervention based on what was learned. Here, we outline and describe each of these 13 steps.

Efficacy in Teaching through "Multiple Intelligence" Instructional Strategies

ERIC Educational Resources Information Center

Tamilselvi, B.; Geetha, D.

2015-01-01

Multiple intelligence is the theory that "people are smart in more ways than one has immense implication for educators". Howard Gardner proposed a new view of intelligence that is rapidly being incorporated in school curricula. In his theory of Multiple Intelligences, Gardner expanded the concept of intelligence with such areas as music,…

Symptomatic therapy in multiple sclerosis

PubMed Central

Frohman, Teresa C.; Castro, Wanda; Shah, Anjali; Courtney, Ardith; Ortstadt, Jeffrey; Davis, Scott L.; Logan, Diana; Abraham, Thomas; Abraham, Jaspreet; Remington, Gina; Treadaway, Katherine; Graves, Donna; Hart, John; Stuve, Olaf; Lemack, Gary; Greenberg, Benjamin; Frohman, Elliot M.

2011-01-01

Multiple sclerosis is the most common disabling neurological disease of young adults. The ability to impact the quality of life of patients with multiple sclerosis should not only incorporate therapies that are disease modifying, but should also include a course of action for the global multidisciplinary management focused on quality of life and functional capabilities. PMID:21694806

Glycemic modulation in neuro-oncology: experience and future directions using a modified Atkins diet for high-grade brain tumors

PubMed Central

Strowd, Roy E.; Cervenka, Mackenzie C.; Henry, Bobbie J.; Kossoff, Eric H.; Hartman, Adam L.; Blakeley, Jaishri O.

2015-01-01

Dietary glycemic modulation through high-fat, low-carbohydrate diets, which induce a state of systemic ketosis and alter systemic metabolic signaling, have been incorporated into the clinical management of patients with neurological disease for more than a century. Mounting preclinical evidence supports the antitumor, proapoptotic, and antiangiogenic effects of disrupting glycolytic metabolism through dietary intervention. In recent years, interest in incorporating such novel therapeutic strategies in neuro-oncology has increased. To date, 3 published studies incorporating novel dietary therapies in oncology have been reported, including one phase I study in neuro-oncology, and have set the stage for further study in this field. In this article, we review the biochemical pathways, preclinical data, and early clinical translation of dietary interventions that modulate systemic glycolytic metabolism in the management of primary malignant brain tumors. We introduce the modified Atkins diet (MAD), a novel dietary alternative to the classic ketogenic diet, and discuss the critical issues facing future study. PMID:26649186

NCI collaborates with Multiple Myeloma Research Foundation

Cancer.gov

The National Cancer Institute (NCI) announced a collaboration with the Multiple Myeloma Research Foundation (MMRF) to incorporate MMRF's wealth of genomic and clinical data on the disease into the NCI Genomic Data Commons (GDC), a publicly available datab

Early Socioeconomic Adversity and Young Adult Physical Illness: The Role of Body Mass Index and Depressive Symptoms

PubMed Central

Wickrama, K. A. S.; Kwon, Josephine A.; Oshri, Assaf; Lee, Tae Kyoung

2014-01-01

Purpose The present study investigated the psycho-physiological inter and intra-individual processes that mediate the linkage between childhood/adolescent socioeconomic adversities and adult health outcomes. Specifically, the proposed model examined the roles of youth depressive symptoms and BMI trajectories as mediators that explain the link between early adversity and young adults’ general health and physical illnesses after controlling for gender, race/ethnicity, and earlier general health reports. Methods Using a nationally representative sample of 12,424 from National Longitudinal Study of Adolescent Health (Add Health), this study used growth curve modeling to consider both the severity (initial level) as well as the change over time (deterioration or elevation) as psycho-physiological mediators, thereby acknowledging multiple facets of depressive symptoms and BMI trajectories as psych-physiological mediators of early adversity to adult health. Results Results provide evidence for (a) the influence of early childhood and early adolescent cumulative socioeconomic adversity on both the initial levels and changes over time of depressive symptoms and BMI and (b) the independent influences depressive symptoms and BMI trajectories on the general health and the physical illnesses of young adults Conclusions These findings contribute valuable knowledge to existing research by elucidating how early adversity exerts an enduring long-term influence on physical health problems in young adulthood; further, this information suggests effective intervention and prevention programs should incorporate multiple facets (severity and change over time) of multiple mechanisms (psychological and physiological). PMID:24856408

Exploring Physical Activity Behaviour of Persons with Multiple Sclerosis: A Qualitative Pilot Study

PubMed Central

Resnik, Linda; Allen, Susan

2015-01-01

Purpose Identify facilitators and barriers to physical activity (PA), and explore the utility of Social Cognitive Theory (SCT) and Transactional Model of Stress and Coping (TMSC) in understanding PA behaviour among persons with multiple sclerosis (MS). Methods Thirteen participants from a clinical trial were interviewed and classified as physically active, sometimes active, or inactive based on the Health-Promoting Lifestyle Profile-II. Interviews were analysed using analytical induction, which consisted of coding data into pre-established categories and then exploring similarities and differences between groups. Pre-established coding categories were constructs from SCT (i.e. environment, expectations, self-efficacy, and self-regulation) and TMSC (i.e. stress appraisal and coping style). Results Inactive and active participants differed in their self-regulation skills, self-efficacy, and coping styles. Common barriers to PA included symptoms and the physical and social environment. Facilitators of PA included strong self-regulation skills, confidence to overcome symptoms to engage in PA (i.e. barrier self-efficacy), and positive coping styles. Conclusion Results from this pilot study suggest that PA interventions will need to implement multiple strategies that target self-efficacy, social environment, and coping styles. We found SCT and TMSC useful in understanding PA behaviour among persons with MS; however, a limitation to these theories is that they are not explicit in the relationship between health and cognitions. Future research will need to explore how to incorporate models of health and function into existing behaviour change theories. PMID:19479491

Active Intervention Program Using Dietary Education and Exercise Training for Reducing Obesity in Mexican American Male Children

ERIC Educational Resources Information Center

Lee, Sukho; Misra, Ranjita; Kaster, Elizabeth

2012-01-01

This study evaluated the effectiveness of a 10-week active intervention program (AIP), which incorporates dietary education with exercise training, among 30 healthy Mexican American male children, aged 8-12 years, in Laredo, Texas. Participants were randomly divided into 3 groups: education (EDU), dietary education to participants and parents and…

Positive Psychology Intervention to Alleviate Child Depression and Increase Life Satisfaction: A Randomized Clinical Trial

ERIC Educational Resources Information Center

Kwok, Sylvia Y. C. L.; Gu, Minmin; Kit, Katrina Tong Kai

2016-01-01

Purpose: The study aims to examine the effectiveness of a positive psychology group-based intervention program, incorporating elements of hope and gratitude, in decreasing depression and increasing life satisfaction among primary school students in Hong Kong. Method: A total of 68 children, with the Depression score of Chinese Hospital Anxiety and…

A Profile of Outdoor Adventure Interventions for Young People in Australia

ERIC Educational Resources Information Center

Bowen, Daniel J.; Neill, James T.; Williams, Ian R.; Mak, Anita S.; Allen, Nicholas B.; Olsson, Craig A.

2016-01-01

In this study, we describe characteristics of outdoor adventure interventions (OAIs) that aim to address problem behaviors in young people in Australia. A national online survey was completed by 98 program leaders and 24 program managers. OAIs for youth in Australia are diverse, but typically incorporate several days in the outdoors, during which…

Whole-School Approaches to Incorporating Mindfulness-Based Interventions: Supporting the Capacity for Optimal Functioning in School Settings

ERIC Educational Resources Information Center

Kielty, Michele L.; Gilligan, Tammy D.; Staton, A. Renee

2017-01-01

With any intervention program, involving all stakeholders in a joint effort toward implementation is most likely to lead to success. Whole-school approaches that involve school personnel, students, families, and local communities have been associated with positive, sustained outcomes. For mindfulness training programs to generate the most…

A Mixed-Methods Study of Early Intervention Implementation in the Commonwealth of Pennsylvania: Supports, Services, and Policies for Young Children with Developmental Delays and Disabilities

ERIC Educational Resources Information Center

Mattern, Janet A.

2015-01-01

Participation in high quality early intervention programs is critical for eligible young children who experience atypical development for their future academic success. High quality programs promote access to services, incorporate instructional strategies that encourage children's participation, and advocate public policy that supports…

Using iKidTools™ Software Support Systems to Develop and Implement Self-Monitoring Interventions

ERIC Educational Resources Information Center

Patti, Angela L.; Miller, Kevin J.

2011-01-01

Educational teams often are faced with the task of developing and implementing Behavioral Intervention Plans (BIPs) for students who present challenging and/or disruptive behaviors. This article describes the steps used to develop and implement a self-monitoring BIP that incorporated an innovative software system, iKidTools™. An authentic case…

Professionals' Perceptions of the Role of Literacy in Early Intervention Services

ERIC Educational Resources Information Center

Thatcher, Karen; Fletcher, Kathryn

2008-01-01

The purpose of the current study was to examine therapists' perceptions about literacy in early intervention services. Little effort has been devoted to the incorporation of literacy into therapy services for very young children with special needs. In an attempt to understand how therapy providers view the role of literacy in their services, 168…

The art and science of patient storytelling-harnessing narrative communication for behavioral interventions: the ACCE project.

PubMed

Houston, Thomas K; Cherrington, Andrea; Coley, Heather L; Robinson, Kimberly M; Trobaugh, John A; Williams, Jessica H; Foster, Pamela H; Ford, Daniel E; Gerber, Ben S; Shewchuk, Richard M; Allison, Jeroan J

2011-08-01

Narrative communication is an emerging form of persuasive communication used in health education to solicit actual patient stories. Eliciting a narrative is an open-ended process and may or may not map to desired intervention objectives or underlying behavioral constructs. In addition, incorporating actual, unscripted narratives into multimedia interventions is challenging. The authors evaluated a protocol of editing narratives for a multimedia intervention to promote smoking cessation in the African American community that maintains fidelity to the original message and was related to behavioral constructs from social cognitive theory. The authors used four steps: (a) narrative collection (videotaping), (b) narrative review (rating of content), (c) narrative editing (documentary style), and (d) pilot testing (usability and assessment of transportation). The authors videotaped 50 personal smoking cessation narratives. After coding for presence of theoretical constructs, perceived risks of smoking (present in 53% of narratives) was the most common related behavioral construct. Four narratives were chosen for inclusion in the DVD. Pilot testing showed viewers reported high level of transportation into the narrative. The authors found that some behavioral constructs were rare and difficult to solicit in this population but that the final product was engaging to the viewers. Lessons learned may be useful for other video-based behavioral interventions that incorporate personal narratives.

Unpacking the ‘structural’ in a structural approach for HIV prevention among female sex workers: A case study from China

PubMed Central

Huang, Yingying; Muessig, Kathryn E.; Zhang, Ning; Maman, Suzanne

2015-01-01

Interventions for HIV prevention among female sex workers (FSWs) in China focus on HIV/sexually transmitted infection (STI) and individual behaviour change. An occupational health framework facilitates intervention across an array of health issues FSWs face including HIV/STI, violence, reproductive health, stigma and substance use. Through a case study of a community-based Jiaozhou (JZ) FSW programme, we developed a conceptual framework incorporating global discussions of structural approaches to HIV prevention with the specific social and structural contexts identified among FSWs in China. Based on ethnographic fieldwork between August 2010 and May 2013, we describe the evolution of this programme to its current occupational health focus and unpack the intervention strategies. We describe the critical features of the programme that have fostered success among FSWs including high-quality clinical services provided within a welcoming setting, responsive outreach work through staff and trained FSW peers, interpersonal and community-level engagement aimed at changing the local social and structural environments of sex work and tailored health education materials. This intervention differs from other projects in China by adopting a more holistic approach to FSW health that incorporates social issues. It also demonstrates the feasibility of structural interventions among FSWs even within an environment that has strong anti-prostitution policies. PMID:25742611

Too attractive: the growing problem of magnet ingestions in children.

PubMed

Brown, Julie C; Otjen, Jeffrey P; Drugas, George T

2013-11-01

Small, powerful magnets are increasingly available in toys and other products and pose a health risk. Small spherical neodymium magnets marketed since 2008 are of particular concern. The objective of this study was to determine the incidence, characteristics, and management of single and multiple-magnet ingestions over time. Magnet ingestion cases at a tertiary children's hospital were identified using radiology reports from June 2002 to December 2012. Cases were verified by chart and imaging review. Relative risk regressions were used to determine changes in the incidence of ingestions and interventions over time. Of 56 cases of magnet ingestion, 98% occurred in 2006 or later, and 57% involved multiple magnets. Median age was 8 years (range, 0-18 years). Overall, 21% of single and 88% of multiple ingestions had 2 or more imaging series obtained, whereas no single and 56.3% of multiple ingestions required intervention (25.0% endoscopy, 18.8% surgery, 12.5% both). Magnet ingestions increased in 2010 to 2012 compared with 2007 to 2009 (relative risk, 1.9; 95% confidence interval, 1.2-3.0). Small, spherical magnets likely from magnet sets comprised 27% of ingestions, all ingested 2010 or later: 86% involved multiple magnets, 50% of which required intervention. Excluding these cases, ingestions of other magnets did not increase in 2010 to 2012 compared with 2007 to 2009 (relative risk, 0.94; 95% confidence interval, 0.6-1.4). The incidence of pediatric magnet ingestions and subsequent interventions has increased over time. Multiple-magnet ingestions result in high utilization of radiological imaging and surgical interventions. Recent increases parallel the increased availability of small, spherical magnet sets. Young and at-risk children should not have access to these and other small magnets. Improved regulation and magnet safety standards are needed.

Systematic review of health literacy in Cochrane database studies on paediatric asthma educational interventions: searching beyond rigorous design.

PubMed

Zeni, Mary Beth

2012-03-01

The purpose of this study was to evaluate if paediatric asthma educational intervention studies included in the Cochrane Collaboration database incorporated concepts of health literacy. Inclusion criteria were established to identify review categories in the Cochrane Collaboration database specific to paediatric asthma educational interventions. Articles that met the inclusion criteria were selected from the Cochrane Collaboration database in 2010. The health literacy definition from Healthy People 2010 was used to develop a 4-point a priori rating scale to determine the extent a study reported aspects of health literacy in the development of an educational intervention for parents and/or children. Five Cochrane review categories met the inclusion criteria; 75 studies were rated for health literacy content regarding educational interventions with families and children living with asthma. A priori criteria were used for the rating process. While 52 (69%) studies had no information pertaining to health literacy, 23 (31%) reported an aspect of health literacy. Although all studies maintained the rigorous standards of randomized clinical trials, a model of health literacy was not reported regarding the design and implementation of interventions. While a more comprehensive health literacy model for the development of educational interventions with families and children may have been available after the reviewed studies were conducted, general literacy levels still could have been addressed. The findings indicate a need to incorporate health literacy in the design of client-centred educational interventions and in the selection criteria of relevant Cochrane reviews. Inclusion assures that health literacy is as important as randomization and statistical analyses in the research design of educational interventions and may even assure participation of people with literacy challenges. © 2012 The Author. International Journal of Evidence-Based Healthcare © 2012 The Joanna Briggs Institute.

A systematic review of midwife-led interventions to address post partum post-traumatic stress.

PubMed

Borg Cunen, Nicole; McNeill, Jenny; Murray, Karen

2014-02-01

to systematically identify interventions that midwives could introduce to address post-traumatic stress in women following childbirth. a search strategy was developed and relevant papers were identified from databases including Cinahl, Cochrane Library, EMBASE, Maternity and Infant Care, MEDLINE, PsycINFO, and Web of Science. Key search terms used were post-traumatic stress, post partum, intervention, controlled trial and review. Papers eligible for inclusion were primary studies and reviews of research published from 2002-2012, focusing on interventions which could be implemented by midwives for the prevention and/or management of PTSD. For primary studies, RCTs, controlled clinical trials, and cohort studies with a control group were eligible. Eligible reviews were those with a specified search strategy and inclusion/exclusion criteria. Methodological quality was assessed using recognised frameworks. six primary studies and eight reviews were eligible for inclusion. The majority of included studies or reviews focused on debriefing and/or counselling interventions; however the results were not consistent due to significant variation in methodological quality and use of dissimilar interventions. Two of the reviews considered the general management of post partum PTSD and one broadly covered anxiety during pregnancy and the post partum, incorporating a section on PTSD. The majority of women reported that the opportunity to discuss their childbirth experience was subjectively beneficial. no evidence-based midwifery interventions were identified from this systematic review that can be recommended for introduction into practice to address PTSD. It is recommended that future research in this area should incorporate standardised interventions with similar outcome measures to facilitate synthesis of results. Further research on interventions used in non-maternity populations is needed in order to confirm their usefulness in addressing post partum PTSD. © 2013 Elsevier Ltd. All rights reserved.

Statistical Power in Evaluations That Investigate Effects on Multiple Outcomes: A Guide for Researchers

ERIC Educational Resources Information Center

Porter, Kristin E.

2018-01-01

Researchers are often interested in testing the effectiveness of an intervention on multiple outcomes, for multiple subgroups, at multiple points in time, or across multiple treatment groups. The resulting multiplicity of statistical hypothesis tests can lead to spurious findings of effects. Multiple testing procedures (MTPs) are statistical…

Estimating Statistical Power When Making Adjustments for Multiple Tests

ERIC Educational Resources Information Center

Porter, Kristin E.

2016-01-01

In recent years, there has been increasing focus on the issue of multiple hypotheses testing in education evaluation studies. In these studies, researchers are typically interested in testing the effectiveness of an intervention on multiple outcomes, for multiple subgroups, at multiple points in time or across multiple treatment groups. When…

Effectiveness of Cultural Adaptations of Interventions Aimed at Smoking Cessation, Diet, and/or Physical Activity in Ethnic Minorities. A Systematic Review

PubMed Central

Nierkens, Vera; Hartman, Marieke A.; Nicolaou, Mary; Vissenberg, Charlotte; Beune, Erik J. A. J.; Hosper, Karen; van Valkengoed, Irene G.; Stronks, Karien

2013-01-01

Background The importance of cultural adaptations in behavioral interventions targeting ethnic minorities in high-income societies is widely recognized. Little is known, however, about the effectiveness of specific cultural adaptations in such interventions. Aim To systematically review the effectiveness of specific cultural adaptations in interventions that target smoking cessation, diet, and/or physical activity and to explore features of such adaptations that may account for their effectiveness. Methods Systematic review using MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials registers (1997–2009). Inclusion criteria: a) effectiveness study of a lifestyle intervention targeted to ethnic minority populations living in a high income society; b) interventions included cultural adaptations and a control group that was exposed to the intervention without the cultural adaptation under study; c) primary outcome measures included smoking cessation, diet, or physical activity. Results Out of 44904 hits, we identified 17 studies, all conducted in the United States. In five studies, specific cultural adaptations had a statistically significant effect on primary outcomes. The remaining studies showed no significant effects on primary outcomes, but some presented trends favorable for cultural adaptations. We observed that interventions incorporating a package of cultural adaptations, cultural adaptations that implied higher intensity and those incorporating family values were more likely to report statistically significant effects. Adaptations in smoking cessation interventions seem to be more effective than adaptations in interventions aimed at diet and physical activity. Conclusion This review indicates that culturally targeted behavioral interventions may be more effective if cultural adaptations are implemented as a package of adaptations, the adaptation includes family level, and where the adaptation results in a higher intensity of the intervention. More systematic experiments are needed in which the aim is to gain insight in the best mix of cultural adaptations among diverse populations in various settings, particularly outside the US. PMID:24116000

Effectiveness of cultural adaptations of interventions aimed at smoking cessation, diet, and/or physical activity in ethnic minorities. a systematic review.

PubMed

Nierkens, Vera; Hartman, Marieke A; Nicolaou, Mary; Vissenberg, Charlotte; Beune, Erik J A J; Hosper, Karen; van Valkengoed, Irene G; Stronks, Karien

2013-01-01

The importance of cultural adaptations in behavioral interventions targeting ethnic minorities in high-income societies is widely recognized. Little is known, however, about the effectiveness of specific cultural adaptations in such interventions. To systematically review the effectiveness of specific cultural adaptations in interventions that target smoking cessation, diet, and/or physical activity and to explore features of such adaptations that may account for their effectiveness. Systematic review using MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials registers (1997-2009). a) effectiveness study of a lifestyle intervention targeted to ethnic minority populations living in a high income society; b) interventions included cultural adaptations and a control group that was exposed to the intervention without the cultural adaptation under study; c) primary outcome measures included smoking cessation, diet, or physical activity. Out of 44904 hits, we identified 17 studies, all conducted in the United States. In five studies, specific cultural adaptations had a statistically significant effect on primary outcomes. The remaining studies showed no significant effects on primary outcomes, but some presented trends favorable for cultural adaptations. We observed that interventions incorporating a package of cultural adaptations, cultural adaptations that implied higher intensity and those incorporating family values were more likely to report statistically significant effects. Adaptations in smoking cessation interventions seem to be more effective than adaptations in interventions aimed at diet and physical activity. This review indicates that culturally targeted behavioral interventions may be more effective if cultural adaptations are implemented as a package of adaptations, the adaptation includes family level, and where the adaptation results in a higher intensity of the intervention. More systematic experiments are needed in which the aim is to gain insight in the best mix of cultural adaptations among diverse populations in various settings, particularly outside the US.

Who Benefits from Which Reading Intervention in the Primary Years? Match the Intervention with the Reading Profile

ERIC Educational Resources Information Center

Munro, John

2017-01-01

Reading difficulties may have multiple causes. Effective approaches to reading intervention need to target the specific causes for individual readers. The Early Reading Intervention Knowledge program comprises three intervention pathways: a phonological-phonemic pathway, a phonic-orthographic pathway, and an oral language pathway. This study…

Exploring an Ecological Model of Perceived Usability within a Multi-Tiered Vocabulary Intervention

ERIC Educational Resources Information Center

Neugebauer, Sabina R.; Chafouleas, Sandra M.; Coyne, Michael D.; McCoach, D. Betsy; Briesch, Amy M.

2016-01-01

The present study examines an ecological model for intervention use to explain student vocabulary performance in a multi-tiered intervention setting. A teacher self-report measure composed of factors hypothesized to influence intervention use at multiple levels (i.e., individual, intervention, and system level) was administered to 54 teachers and…

Using Structural Equation Modeling To Fit Models Incorporating Principal Components.

ERIC Educational Resources Information Center

Dolan, Conor; Bechger, Timo; Molenaar, Peter

1999-01-01

Considers models incorporating principal components from the perspectives of structural-equation modeling. These models include the following: (1) the principal-component analysis of patterned matrices; (2) multiple analysis of variance based on principal components; and (3) multigroup principal-components analysis. Discusses fitting these models…

Anti-inflammatory nutritional intervention in patients with relapsing-remitting and primary-progressive multiple sclerosis: A pilot study

PubMed Central

Rossano, Rocco; Larocca, Marilena; Trotta, Vincenzo; Mennella, Ilario; Vitaglione, Paola; Ettorre, Michele; Graverini, Antonio; De Santis, Alessandro; Di Monte, Elisabetta; Coniglio, Maria Gabriella

2016-01-01

The aim of this work was to assess the influence of nutritional intervention on inflammatory status and wellness in people with multiple sclerosis. To this end, in a seven-month pilot study we investigated the effects of a calorie-restricted, semi-vegetarian diet and administration of vitamin D and other dietary supplements (fish oil, lipoic acid, omega-3 polyunsaturated fatty acids, resveratrol and multivitamin complex) in 33 patients with relapsing-remitting multiple sclerosis and 10 patients with primary-progressive multiple sclerosis. At 0/3/6 months, patients had neurological examination, filled questionnaires and underwent anthropometric measurements and biochemical analyses. Serum fatty acids and vitamin D levels were measured as markers of dietary compliance and nutritional efficacy of treatment, whereas serum gelatinase levels were analyzed as markers of inflammatory status. All patients had insufficient levels of vitamin D at baseline, but their values did not ameliorate following a weekly administration of 5000  IU, and rather decreased over time. Conversely, omega-3 polyunsaturated fatty acids increased already after three months, even under dietary restriction only. Co-treatment with interferon-beta in relapsing-remitting multiple sclerosis was irrelevant to vitamin D levels. After six months nutritional treatment, no significant changes in neurological signs were observed in any group. However, serum levels of the activated isoforms of gelatinase matrix metalloproteinase-9 decreased by 59% in primary-progressive multiple sclerosis and by 51% in relapsing-remitting multiple sclerosis patients under nutritional intervention, including dietary supplements. This study indicates that a healthy nutritional intervention is well accepted by people with multiple sclerosis and may ameliorate their physical and inflammatory status. PMID:26785711

Anti-inflammatory nutritional intervention in patients with relapsing-remitting and primary-progressive multiple sclerosis: A pilot study.

PubMed

Riccio, Paolo; Rossano, Rocco; Larocca, Marilena; Trotta, Vincenzo; Mennella, Ilario; Vitaglione, Paola; Ettorre, Michele; Graverini, Antonio; De Santis, Alessandro; Di Monte, Elisabetta; Coniglio, Maria Gabriella

2016-03-01

The aim of this work was to assess the influence of nutritional intervention on inflammatory status and wellness in people with multiple sclerosis. To this end, in a seven-month pilot study we investigated the effects of a calorie-restricted, semi-vegetarian diet and administration of vitamin D and other dietary supplements (fish oil, lipoic acid, omega-3 polyunsaturated fatty acids, resveratrol and multivitamin complex) in 33 patients with relapsing-remitting multiple sclerosis and 10 patients with primary-progressive multiple sclerosis. At 0/3/6 months, patients had neurological examination, filled questionnaires and underwent anthropometric measurements and biochemical analyses. Serum fatty acids and vitamin D levels were measured as markers of dietary compliance and nutritional efficacy of treatment, whereas serum gelatinase levels were analyzed as markers of inflammatory status. All patients had insufficient levels of vitamin D at baseline, but their values did not ameliorate following a weekly administration of 5000  IU, and rather decreased over time. Conversely, omega-3 polyunsaturated fatty acids increased already after three months, even under dietary restriction only. Co-treatment with interferon-beta in relapsing-remitting multiple sclerosis was irrelevant to vitamin D levels. After six months nutritional treatment, no significant changes in neurological signs were observed in any group. However, serum levels of the activated isoforms of gelatinase matrix metalloproteinase-9 decreased by 59% in primary-progressive multiple sclerosis and by 51% in relapsing-remitting multiple sclerosis patients under nutritional intervention, including dietary supplements. This study indicates that a healthy nutritional intervention is well accepted by people with multiple sclerosis and may ameliorate their physical and inflammatory status. © 2016 by the Society for Experimental Biology and Medicine.

Identifying Mechanisms of Change in a Conversation Therapy for Aphasia Using Behaviour Change Theory and Qualitative Methods

ERIC Educational Resources Information Center

Johnson, Fiona M.; Best, Wendy; Beckley, Firle Christina; Maxim, Jane; Beeke, Suzanne

2017-01-01

Background: Conversation therapy for aphasia is a complex intervention comprising multiple components and targeting multiple outcomes. UK Medical Research Council (MRC) guidelines published in 2008 recommend that in addition to measuring the outcomes of complex interventions, evaluation should seek to clarify how such outcomes are produced,…

Motivation and Self-Management Behavior of the Individuals With Chronic Low Back Pain.

PubMed

Jung, Mi Jung; Jeong, Younhee

2016-01-01

Self-management behavior is an important component for successful pain management in individuals with chronic low back pain. Motivation has been considered as an effective way to change behavior. Because there are other physical, social, and psychological factors affecting individuals with pain, it is necessary to identify the main effect of motivation on self-management behavior without the influence of those factors. The purpose of this study was to investigate the effect of motivation on self-management in controlling pain, depression, and social support. We used a nonexperimental, cross-sectional, descriptive design with mediation analysis and included 120 participants' data in the final analysis. We also used hierarchical multiple regression to test the effect of motivation, and multiple regression analysis and Sobel test were used to examine the mediating effect. Motivation itself accounted for 23.4% of the variance in self-management, F(1, 118) = 35.003, p < .001. After controlling covariates, motivation was also a significant factor for self-management. In the mediation analysis, motivation completely mediated the relationship between education and self-management, z = 2.292, p = .021. Motivation is an important part of self-management, and self-management education is not effective without motivation. The results of our study suggest that nurses incorporate motivation in nursing intervention, rather than only giving information.

Health Utilities of Type 2 Diabetes-Related Complications: A Cross-Sectional Study in Sweden

PubMed Central

Kiadaliri, Aliasghar A.; Gerdtham, Ulf-G; Eliasson, Björn; Gudbjörnsdottir, Soffia; Svensson, Ann-Marie; Steen Carlsson, Katarina

2014-01-01

This study estimates health utilities (HU) in Sweden for a range of type 2 diabetes-related complications using EQ-5D and two alternative tariffs (UK and Swedish) from 1757 patients with type 2 diabetes from the Swedish National Diabetes Register (NDR). Ordinary least squares were used for statistical analysis. Lower HU was found for female gender, younger age at diagnosis, higher BMI, and history of complications. Microvascular and macrovascular complications had the most negative effect on HU among women and men, respectively. The greatest decline in HU was associated with kidney disorders (−0.114) using the UK tariff and stroke (−0.059) using the Swedish tariff. Multiple stroke and non-acute ischaemic heart disease had higher negative effect than a single event. With the UK tariff, each year elapsed since the last microvascular/macrovascular complication was associated with 0.013 and 0.007 units higher HU, respectively. We found important heterogeneities in effects of complications on HU in terms of gender, multiple event, and time. The Swedish tariff gave smaller estimates and so may result in less cost-effective interventions than the UK tariff. These results suggest that incorporating subgroup-specific HU in cost-utility analyses might provide more insight for informed decision-making. PMID:24810579

Policy challenges and approaches for the conservation of mangrove forests in Southeast Asia.

PubMed

Friess, Daniel A; Thompson, Benjamin S; Brown, Ben; Amir, A Aldrie; Cameron, Clint; Koldewey, Heather J; Sasmito, Sigit D; Sidik, Frida

2016-10-01

Many drivers of mangrove forest loss operate over large scales and are most effectively addressed by policy interventions. However, conflicting or unclear policy objectives exist at multiple tiers of government, resulting in contradictory management decisions. To address this, we considered four approaches that are being used increasingly or could be deployed in Southeast Asia to ensure sustainable livelihoods and biodiversity conservation. First, a stronger incorporation of mangroves into marine protected areas (that currently focus largely on reefs and fisheries) could resolve some policy conflicts and ensure that mangroves do not fall through a policy gap. Second, examples of community and government comanagement exist, but achieving comanagement at scale will be important in reconciling stakeholders and addressing conflicting policy objectives. Third, private-sector initiatives could protect mangroves through existing and novel mechanisms in degraded areas and areas under future threat. Finally, payments for ecosystem services (PES) hold great promise for mangrove conservation, with carbon PES schemes (known as blue carbon) attracting attention. Although barriers remain to the implementation of PES, the potential to implement them at multiple scales exists. Closing the gap between mangrove conservation policies and action is crucial to the improved protection and management of this imperiled coastal ecosystem and to the livelihoods that depend on them. © 2016 Society for Conservation Biology.

Data-driven model for the assessment of Mycobacterium tuberculosis transmission in evolving demographic structures

PubMed Central

Arregui, Sergio; Marinova, Dessislava; Sanz, Joaquín

2018-01-01

In the case of tuberculosis (TB), the capabilities of epidemic models to produce quantitatively robust forecasts are limited by multiple hindrances. Among these, understanding the complex relationship between disease epidemiology and populations’ age structure has been highlighted as one of the most relevant. TB dynamics depends on age in multiple ways, some of which are traditionally simplified in the literature. That is the case of the heterogeneities in contact intensity among different age strata that are common to all airborne diseases, but still typically neglected in the TB case. Furthermore, while demographic structures of many countries are rapidly aging, demographic dynamics are pervasively ignored when modeling TB spreading. In this work, we present a TB transmission model that incorporates country-specific demographic prospects and empirical contact data around a data-driven description of TB dynamics. Using our model, we find that the inclusion of demographic dynamics is followed by an increase in the burden levels predicted for the next decades in the areas of the world that are most hit by the disease today. Similarly, we show that considering realistic patterns of contacts among individuals in different age strata reshapes the transmission patterns reproduced by the models, a result with potential implications for the design of age-focused epidemiological interventions. PMID:29563223

A systematic review of effective interventions for reducing multiple health risk behaviors in adolescence.

PubMed

Hale, Daniel R; Fitzgerald-Yau, Natasha; Viner, Russell Mark

2014-05-01

We systematically searched 9 biomedical and social science databases (1980-2012) for primary and secondary interventions that prevented or reduced 2 or more adolescent health risk behaviors (tobacco use, alcohol use, illicit drug use, risky sexual behavior, aggressive acts). We identified 44 randomized controlled trials of universal or selective interventions and were effective for multiple health risk behaviors. Most were school based, conducted in the United States, and effective for multiple forms of substance use. Effects were small, in line with findings for other universal prevention programs. In some studies, effects for more than 1 health risk behavior only emerged at long-term follow-up. Integrated prevention programs are feasible and effective and may be more efficient than discrete prevention strategies.

Data to action: using formative research to develop intervention programs to increase physical activity in adolescent girls.

PubMed

Young, Deborah Rohm; Johnson, Carolyn C; Steckler, Allan; Gittelsohn, Joel; Saunders, Ruth P; Saksvig, Brit I; Ribisl, Kurt M; Lytle, Leslie A; McKenzie, Thomas L

2006-02-01

Formative research is used to inform intervention development, but the processes of transmitting results to intervention planners and incorporating information into intervention designs are not well documented. The authors describe how formative research results from the Trial of Activity for Adolescent Girls (TAAG) were transferred to planners to guide intervention development. Methods included providing oral and written reports, prioritizing recommendations, and cross-checking recommendations with intervention objectives and implementation strategies. Formative work influenced the intervention in many ways. For example, results indicated that middle schools offered only coeducational physical education and health education classes, so the TAAG intervention was designed to be appropriate for both sexes, and intervention strategies were developed to directly address girls' stated preferences (e.g., enjoyable activities, opportunity to socialize) and barriers (e.g., lack of skills, fear of injury) for physical activity. The challenges of using formative research for intervention development are discussed.

Jamaican Mothers’ Influences of Adolescent Girls’ Sexual Beliefs and Behaviors

PubMed Central

Hutchinson, M. Katherine; Kahwa, Eulalia; Waldron, Norman; Brown, Cerese Hepburn; Hamilton, Pansy I.; Hewitt, Hermi H.; Aiken, Joyette; Cederbaum, Julie; Alter, Emily; Jemmott, Loretta Sweet

2012-01-01

Purpose The purpose of this study was to identify the ways in which urban Jamaican mothers influence their adolescent daughters’ sexual beliefs and behaviors in order to incorporate them into the design of a family-based human immunodeficiency virus (HIV) risk reduction intervention program. Design Focus groups were conducted with 46 14- to 18-year-old adolescent girls and 30 mothers or female guardians of adolescent girls recruited from community-based organizations in and around Kingston and St. Andrew, Jamaica. Separate focus groups were held with mothers and daughters; each included 6 to 10 participants. Focus group sessions were scripted, led by teams that included trained Jamaican and American facilitators and note-takers, and audio-taped to ensure data accuracy. Data were analyzed using qualitative content analysis. Findings Four major maternal influences were identified: mother-daughter relationship quality, mother-daughter sexual communication, monitoring or supervision, and maternal sexual role modeling. Mothers’ and daughters’ reports were consistent; both groups identified positive and negative influences within each category. Conclusions Some maternal influences were positive and health promoting; others were negative and promoted unsafe sexual activity and risk for HIV and other sexually transmitted infections. These influences were incorporated into the design of a culture-specific family-based HIV risk reduction intervention tailored to the needs of urban Jamaican adolescent girls and their mothers. Clinical Relevance In order to be effective, family-based HIV risk reduction interventions should be theory based and tailored to the target audience. The four maternal influences identified in this formative study were incorporated into the subsequent intervention design. PMID:22339731

Equitable service provision for inclusive education and effective early intervention.

PubMed

Wicks, K M

1998-01-01

This paper illustrates one model of providing an integrated paediatric speech and language therapy service which attempts to meet the demands of both inclusive education and effective early intervention. A move has been made from location-oriented therapy provision to offering children and their families equal opportunities to have appropriate intervention according to need. The model incorporates the philosophy of inclusive education and supports the development of current specialist educational establishments into resource bases of expertise for children with special needs in mainstream schools.

Music therapy as an adjunctive treatment in the management of stress for patients being weaned from mechanical ventilation.

PubMed

Hunter, Bryan C; Oliva, Rosemary; Sahler, Olle Jane Z; Gaisser, D'Arcy; Salipante, Diane M; Arezina, Clare H

2010-01-01

This project investigated music therapy (MT) in managing anxiety associated with weaning from mechanical ventilation. The use of sedation to treat anxiety during weaning is problematic because side effects (e.g., respiratory depression) are precisely the symptoms that cause the weaning process to be interrupted and consequently prolonged. Study goals were to determine the feasibility of incorporating MT into the weaning process and to evaluate the efficacy of the intervention, based on levels of anxiety, Days to Wean (DTW), and patient/nurse satisfaction. Adult patients received multiple MT sessions per week while undergoing weaning trials from mechanical ventilation. Feasibility was determined by successful enrollment in the study and nurse survey. Efficacy was evaluated through anxiety, as measured by heart rate, respiratory rate, and patient/nurse survey; DTW; and patient/nurse satisfaction. Nurse surveys reported that MT was successfully incorporated into the milieu and 61 subjects were enrolled. Significant differences in heart rate and respiratory rate were found from the beginning to the end of MT sessions (p < .05 and p < .0001, respectively), indicating a more relaxed state. No significant difference in mean DTW was found between study and control subjects. Patient/nurse satisfaction was high. Music therapy can be used successfully to treat anxiety associated with weaning from mechanical ventilation. Limitations and suggestions for further research are discussed.

The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.

PubMed

Hutton, Brian; Salanti, Georgia; Caldwell, Deborah M; Chaimani, Anna; Schmid, Christopher H; Cameron, Chris; Ioannidis, John P A; Straus, Sharon; Thorlund, Kristian; Jansen, Jeroen P; Mulrow, Cynthia; Catalá-López, Ferrán; Gøtzsche, Peter C; Dickersin, Kay; Boutron, Isabelle; Altman, Douglas G; Moher, David

2015-06-02

The PRISMA statement is a reporting guideline designed to improve the completeness of reporting of systematic reviews and meta-analyses. Authors have used this guideline worldwide to prepare their reviews for publication. In the past, these reports typically compared 2 treatment alternatives. With the evolution of systematic reviews that compare multiple treatments, some of them only indirectly, authors face novel challenges for conducting and reporting their reviews. This extension of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement was developed specifically to improve the reporting of systematic reviews incorporating network meta-analyses. A group of experts participated in a systematic review, Delphi survey, and face-to-face discussion and consensus meeting to establish new checklist items for this extension statement. Current PRISMA items were also clarified. A modified, 32-item PRISMA extension checklist was developed to address what the group considered to be immediately relevant to the reporting of network meta-analyses. This document presents the extension and provides examples of good reporting, as well as elaborations regarding the rationale for new checklist items and the modification of previously existing items from the PRISMA statement. It also highlights educational information related to key considerations in the practice of network meta-analysis. The target audience includes authors and readers of network meta-analyses, as well as journal editors and peer reviewers.

Use of concurrent mixed methods combining concept mapping and focus groups to adapt a health equity tool in Canada.

PubMed

Guichard, Anne; Tardieu, Émilie; Dagenais, Christian; Nour, Kareen; Lafontaine, Ginette; Ridde, Valéry

2017-04-01

The aim of this project was to identify and prioritize a set of conditions to be considered for incorporating a health equity tool into public health practice. Concept mapping and focus groups were implemented as complementary methods to investigate the conditions of use of a health equity tool by public health organizations in Quebec. Using a hybrid integrated research design is a richer way to address the complexity of questions emerging from intervention and planning settings. This approach provides a deeper, operational, and contextualized understanding of research results involving different professional and organizational cultures, and thereby supports the decision-making process. Concept mapping served to identify and prioritize in a limited timeframe the conditions to be considered for incorporation into a health equity tool into public health practices. Focus groups then provided a more refined understanding of the barriers, issues, and facilitating factors surrounding the tools adoption, helped distinguish among participants' perspectives based on functional roles and organizational contexts, and clarified some apparently contradictory results from the concept map. The combined use of these two techniques brought the strengths of each approach to bear, thereby overcoming some of the respective limitations of concept mapping and focus groups. This design is appropriate for investigating targets with multiple levels of complexity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Samoan body and soul: adapting an evidence-based obesity and cancer prevention program.

PubMed

Cassel, Kevin D; Braun, Kathryn; Ka'opua, Lana; Soa, Fuamaila; Nigg, Claudio

2014-12-01

Obesity-associated chronic diseases persist in Samoan populations in the United States. Samoans and African Americans share cultural similarities such as church affiliation, perceptions of weight and body size, and obesity-related health risks. Adapting an effective energy balance intervention originally designed for African Americans--Body and Soul--might be useful in reducing obesity among U.S. Samoans. To determine potential attractiveness and adaptations, we used aspects of grounded theory to analyze key-informant and focus group interviews with 31 purposively selected Samoans in Hawaii. We incorporated participatory features into the research with Samoan community members conducting parts of the study. From interview narratives, we identified relevant themes from Samoan culture, such as "fa'aSamoa", or the Samoan way, and specific energy balance activities to include in an obesity and cancer prevention intervention for U.S.-dwelling Samoans. Our findings describe methods to address health disparities by incorporating culturally appropriate health concepts into existing evidence-based interventions. © The Author(s) 2014.

Samoan Body and Soul: Adapting an Evidence-Based Obesity and Cancer Prevention Program

PubMed Central

Cassel, Kevin D.; Braun, Kathryn; Ka’opua, Lana; Soa, Fuamaila; Nigg, Claudio

2015-01-01

Obesity-associated chronic diseases persist in Samoan populations in the United States. Samoans and African Americans share cultural similarities such as church affiliation, perceptions of weight and body size, and obesity-related health risks. Adapting an effective energy balance intervention originally designed for African Americans—Body and Soul— might be useful in reducing obesity among U.S. Samoans. To determine potential attractiveness and adaptations, we used aspects of grounded theory to analyze key-informant and focus group interviews with 31 purposively selected Samoans in Hawaii. We incorporated participatory features into the research with Samoan community members conducting parts of the study. From interview narratives, we identified relevant themes from Samoan culture, such as fa’aSamoa or the Samoan way, and specific energy balance activities to include in an obesity and cancer prevention intervention for U.S.-dwelling Samoans. Our findings describe methods to address health disparities by incorporating culturally appropriate health concepts into existing evidence-based interventions. PMID:25212854

A sustained release formulation of novel quininib-hyaluronan microneedles inhibits angiogenesis and retinal vascular permeability in vivo.

PubMed

Galvin, Orla; Srivastava, Akshay; Carroll, Oliver; Kulkarni, Rajiv; Dykes, Steve; Vickers, Steven; Dickinson, Keith; Reynolds, Alison L; Kilty, Claire; Redmond, Gareth; Jones, Rob; Cheetham, Sharon; Pandit, Abhay; Kennedy, Breandán N

2016-07-10

Pathologic neovascularisation and ocular permeability are hallmarks of proliferative diabetic retinopathy and age-related macular degeneration. Current pharmacologic interventions targeting VEGF are effective in only 30-60% of patients and require multiple intraocular injections associated with iatrogenic infection. Thus, our goal is to develop novel small molecule drugs that are VEGF-independent are amenable to sustained ocular-release, and which reduce retinal angiogenesis and retinal vascular permeability. Here, the anti-angiogenic drug quininib was formulated into hyaluronan (HA) microneedles whose safety and efficacy was evaluated in vivo. Quininib-HA microneedles were formulated via desolvation from quininib-HA solution and subsequent cross-linking with 4-arm-PEG-amine prior to freeze-drying. Scanning electron microscopy revealed hollow needle-shaped particle ultrastructure, with a zeta potential of -35.5mV determined by electrophoretic light scattering. The incorporation efficiency and pharmacokinetic profile of quininib released in vitro from the microneedles was quantified by HPLC. Quininib incorporation into these microneedles was 90%. In vitro, 20% quininib was released over 4months; or in the presence of increasing concentrations of hyaluronidase, 60% incorporated quininib was released over 4months. Zebrafish hyaloid vasculature assays demonstrated quininib released from these microneedles significantly (p<0.0001) inhibited ocular developmental angiogenesis compared to control. Sustained amelioration of retinal vascular permeability (RVP) was demonstrated using a bespoke cysteinyl leukotriene induced rodent model. Quininib-HA microparticles significantly inhibited RVP in Brown Norway rats one month after administration compared to neat quininib control (p=0.0071). In summary, quininib-HA microneedles allow for sustained release of quininib; are safe in vivo and quininib released from these microneedles effectively inhibits angiogenesis and RVP in vivo. Copyright © 2016 Elsevier B.V. All rights reserved.

Response to Intervention: Is the Sky Falling?

ERIC Educational Resources Information Center

Dougherty Stahl, Katherine A.

2016-01-01

Response to Intervention (RTI) is a multiple tiered system of instructional interventions that may also serve to identify children with Specific Learning Disabilities (particularly in reading and spelling). This article summarizes the findings of Evaluation of Response to Intervention Practices for Elementary School Reading (Balu, Zhu, Doolittle,…

Accounting for equity considerations in cost-effectiveness analysis: a systematic review of rotavirus vaccine in low- and middle-income countries.

PubMed

Boujaoude, Marie-Anne; Mirelman, Andrew J; Dalziel, Kim; Carvalho, Natalie

2018-01-01

Cost-effectiveness analysis (CEA) is frequently used as an input for guiding priority setting in health. However, CEA seldom incorporates information about trade-offs between total health gains and equity impacts of interventions. This study investigates to what extent equity considerations have been taken into account in CEA in low- and middle-income countries (LMICs), using rotavirus vaccination as a case study. Specific equity-related indicators for vaccination were first mapped to the Guidance on Priority Setting in Health Care (GPS-Health) checklist criteria. Economic evaluations of rotavirus vaccine in LMICs identified via a systematic review of the literature were assessed to explore the extent to which equity was considered in the research objectives and analysis, and whether it was reflected in the evaluation results. The mapping process resulted in 18 unique indicators. Under the 'disease and intervention' criteria, severity of illness was incorporated in 75% of the articles, age distribution of the disease in 70%, and presence of comorbidities in 5%. For the 'social groups' criteria, relative coverage reflecting wealth-based coverage inequality was taken into account in 30% of the articles, geographic location in 27%, household income level in 8%, and sex at birth in 5%. For the criteria of 'protection against the financial and social effects of ill health', age weighting was incorporated in 43% of the articles, societal perspective in 58%, caregiver's loss of productivity in 45%, and financial risk protection in 5%. Overall, some articles incorporated the indicators in their model inputs (20%) while the majority (80%) presented results (costs, health outcomes, or incremental cost-effectiveness ratios) differentiated according to the indicators. Critically, less than a fifth (17%) of articles incorporating indicators did so due to an explicit study objective related to capturing equity considerations. Most indicators were increasingly incorporated over time, with a notable exception of age-weighting of DALYs. Integrating equity criteria in CEA can help policy-makers better understand the distributional impact of health interventions. This study illustrates how equity considerations are currently being incorporated within CEA of rotavirus vaccination and highlights the components of equity that have been used in studies in LMICs. Areas for further improvement are identified.

Prevention of sexually transmitted HIV infections through the President's Emergency Plan for AIDS Relief: a history of achievements and lessons learned.

PubMed

Ryan, Caroline A; Conly, Shanti R; Stanton, David L; Hasen, Nina S

2012-08-15

HIV prevention in the President's Emergency Plan for AIDS Relief (PEPFAR) began when both data on HIV prevalence and the toolbox of interventions for prevention of sexual transmission were relatively limited. PEPFAR's early focus was on scaling-up information, education, and communication programs that included messaging on abstinence for youth and faithfulness primarily through nongovernmental organizations, including faith-based organizations. Additional activities included condom promotion, distribution, and social marketing. In epidemics concentrated within key populations, PEPFAR's prevention efforts focused on a minimum package of services including outreach, information, education, and communication programs, STI treatment (where appropriate), and condom promotion and distribution. As more epidemiological data became available and with experience gleaned in these early efforts, the need for tailored and flexible approaches became evident. The next iteration of prevention efforts still emphasized behavioral interventions, but incorporated a sharper focus on key epidemic drivers, especially multiple partners; a data-driven emphasis on high transmission areas and populations, including prevention with people living with HIV; and a more strategic and coordinated approach at the national level. Recently, the paradigm for prevention efforts has shifted yet again. Evidence that biomedical interventions such as male circumcision, treatment for prevention of vertical and horizontal transmission, and treatment itself could lead to declines in incidence has refocused PEPFAR's prevention portfolio. New guidance on sexually transmitted HIV focuses on combination prevention, emphasizing biomedical, behavioral and structural approaches. Landmark speeches by the President and the Secretary of State and new ambitious targets for PEPFAR point toward a new goal: an AIDS-free generation.

Piloting case-based instruction in a didactic clinical immunology course.

PubMed

Hoag, Kathleen; Lillie, Janet; Hoppe, Ruth

2005-01-01

To assess (1) the effect of case-based instructional modules on student critical thinking, class attendance, and satisfaction and (2) student opinion of case formats. University-based upper division course in clinical immunology and serology. The course was taught by the same instructor for two consecutive semesters with the intervention introduced in the second semester. Sixty-seven students experienced the intervention and 56 students were in the baseline cohort. Nine cases were interspersed between lectures during the semester. Each case took one 50-minute class in which students worked in groups of five or six. Student performance on five critical thinking multiple-choice examination questions and percent student attendance on case days versus lecture days were analyzed using the Mann-Whitney test. Student ratings on course evaluations were analyzed using t-test comparing semesters with and without intervention. Student opinion of cases was obtained through surveys and a focus group. Student performance on critical thinking exam questions was similar in the two groups. Student attendance was significantly higher on case days (95.6%) versus lecture days (80.3%; p < 0.0001). Only composite ratings for instructor involvement, student-instructor interaction, and course organization were significantly improved in the semester with cases compared to the semester with lecture only (p < 0.0001 for all indices). Although case studies did not significantly improve student performance on critical thinking questions, they still proved to be a valuable instructional method. Student attendance, student-instructor interaction, and instructor involvement in the course were all positively affected by incorporation of case studies. Discussion of cases also helped to uncover student misconceptions of course material.

A Prototype Educational Model for Hepatobiliary Interventions: Unveiling the Role of Graphic Designers in Medical 3D Printing.

PubMed

Javan, Ramin; Zeman, Merissa N

2018-02-01

In the context of medical three-dimensional (3D) printing, in addition to 3D reconstruction from cross-sectional imaging, graphic design plays a role in developing and/or enhancing 3D-printed models. A custom prototype modular 3D model of the liver was graphically designed depicting segmental anatomy of the parenchyma containing color-coded hepatic vasculature and biliary tree. Subsequently, 3D printing was performed using transparent resin for the surface of the liver and polyamide material to develop hollow internal structures that allow for passage of catheters and wires. A number of concepts were incorporated into the model. A representative mass with surrounding feeding arterial supply was embedded to demonstrate tumor embolization. A straight narrow hollow tract connecting the mass to the surface of the liver, displaying the path of a biopsy device's needle, and the concept of needle "throw" length was designed. A connection between the middle hepatic and right portal veins was created to demonstrate transjugular intrahepatic portosystemic shunt (TIPS) placement. A hollow amorphous structure representing an abscess was created to allow the demonstration of drainage catheter placement with the formation of pigtail tip. Percutaneous biliary drain and cholecystostomy tube placement were also represented. The skills of graphic designers may be utilized in creating highly customized 3D-printed models. A model was developed for the demonstration and simulation of multiple hepatobiliary interventions, for training purposes, patient counseling and consenting, and as a prototype for future development of a functioning interventional phantom.

Modeling spatial segregation and travel cost influences on utilitarian walking: Towards policy intervention

PubMed Central

Yang, Yong; Auchincloss, Amy H.; Rodriguez, Daniel A.; Brown, Daniel G.; Riolo, Rick; Diez-Roux, Ana V.

2015-01-01

We develop an agent-based model of utilitarian walking and use the model to explore spatial and socioeconomic factors affecting adult utilitarian walking and how travel costs as well as various educational interventions aimed at changing attitudes can alter the prevalence of walking and income differentials in walking. The model is validated against US national data. We contrast realistic and extreme parameter values in our model and test effects of changing these parameters across various segregation and pricing scenarios while allowing for interactions between travel choice and place and for behavioral feedbacks. Results suggest that in addition to income differences in the perceived cost of time, the concentration of mixed land use (differential density of residences and businesses) are important determinants of income differences in walking (high income walk less), whereas safety from crime and income segregation on their own do not have large influences on income differences in walking. We also show the difficulty in altering walking behaviors for higher income groups who are insensitive to price and how adding to the cost of driving could increase the income differential in walking particularly in the context of segregation by income and land use. We show that strategies to decrease positive attitudes towards driving can interact synergistically with shifting cost structures to favor walking in increasing the percent of walking trips. Agent-based models, with their ability to capture dynamic processes and incorporate empirical data, are powerful tools to explore the influence on health behavior from multiple factors and test policy interventions. PMID:25733776

An exploration of the mechanisms of change following an integrated group intervention for stuttering, as perceived by school-aged children who stutter (CWS).

PubMed

Caughter, Sarah; Dunsmuir, Sandra

2017-03-01

To explore the process of change and role of resilience following an integrated group intervention for children who stutter (CWS). Using an exploratory multiple case study design, this research sought to identify the most significant changes perceived by seven participants following therapy, the mechanisms of change, and the role of resilience in the process of change. Quantitative measurements of resilience were combined with qualitative analysis of semi-structured interviews. Thematic analysis of qualitative data showed that cognitive and emotional change was a key driver for therapeutic change, enabled by the shared experience of the group and a positive therapeutic environment. These changes were generalised into clients' real-world experiences, facilitated by their support network. Quantitative data demonstrated a statistically reliable positive change in overall Resiliency scores for four participants and reduced impact of stuttering scores on OASES-S for all participants, maintained at 12 month follow-up. This study demonstrates the importance of adopting an integrated approach in therapy for CWS, which incorporates Cognitive Behavioural Therapy (CBT) as a key component, to facilitate change and build resilience. These results are unique to this cohort of CWS and further investigation into the use of CBT and the process of change may be warranted. The reader will be able to (1) describe the integrated intervention used in this study (2) define the most significant change following therapy for the participants involved (3) summarise the key factors that facilitated change during the therapy process (as perceived by the participants). Copyright © 2016 Elsevier Inc. All rights reserved.

Summarizing the incidence of adverse events using volcano plots and time intervals.

PubMed

Zink, Richard C; Wolfinger, Russell D; Mann, Geoffrey

2013-01-01

Adverse event incidence analyses are a critical component for describing the safety profile of any new intervention. The results typically are presented in lengthy summary tables. For therapeutic areas where patients have frequent adverse events, analysis and interpretation are made more difficult by the sheer number and variety of events that occur. Understanding the risk in these instances becomes even more crucial. We describe a space-saving graphical summary that overcomes the limitations of traditional presentations of adverse events and improves interpretability of the safety profile. We present incidence analyses of adverse events graphically using volcano plots to highlight treatment differences. Data from a clinical trial of patients experiencing an aneurysmal subarachnoid hemorrhage are used for illustration. Adjustments for multiplicity are illustrated. Color is used to indicate the treatment with higher incidence; bubble size represents the total number of events that occur in the treatment arms combined. Adjustments for multiple comparisons are displayed in a manner to indicate clearly those events for which the difference between treatment arms is statistically significant. Furthermore, adverse events can be displayed by time intervals, with multiple volcano plots or animation to appreciate changes in adverse event risk over time. Such presentations can emphasize early differences across treatments that may resolve later or highlight events for which treatment differences may become more substantial with longer follow-up. Treatment arms are compared in a pairwise fashion. Volcano plots are space-saving tools that emphasize important differences between the adverse event profiles of two treatment arms. They can incorporate multiplicity adjustments in a manner that is straightforward to interpret and, by using time intervals, can illustrate how adverse event risk changes over the course of a clinical trial.

Novel microbial fuel cell design to operate with different wastewaters simultaneously.

PubMed

Mathuriya, Abhilasha Singh

2016-04-01

A novel single cathode chamber and multiple anode chamber microbial fuel cell design (MAC-MFC) was developed by incorporating multiple anode chambers into a single unit and its performance was checked. During 60 days of operation, performance of MAC-MFC was assessed and compared with standard single anode/cathode chamber microbial fuel cell (SC-MFC). The tests showed that MAC-MFC generated stable and higher power outputs compared with SC-MFC and each anode chamber contributed efficiently. Further, MAC-MFCs were incorporated with different wastewaters in different anode chambers and their behavior in MFC performance was observed. MAC-MFC efficiently treated multiple wastewaters simultaneously at low cost and small space, which claims its candidature for future possible scale-up applications. Copyright © 2015. Published by Elsevier B.V.

Interventions aimed at improving the ability to use everyday technology in work after brain injury.

PubMed

Kassberg, Ann-Charlotte; Prellwitz, Maria; Malinowsky, Camilla; Larsson-Lund, Maria

2016-01-01

The aim of this study was to explore and describe how client-centred occupational therapy interventions may support and improve the ability to use everyday technology (ET) in work tasks in people with acquired brain injury (ABI). A qualitative, descriptive multiple-case study was designed, and occupation-based interventions were provided to three working-age participants with ABI. Multiple sources were used to collect data throughout the three intervention processes, including assessments, field notes, and interviews. The Canadian Occupational Performance Measure and the Management of Everyday Technology Assessment were administered before the interventions, after the interventions and at a follow-up session 2-3 months subsequent to the interventions. The three intervention processes initially consisted of similar actions, but subsequently the actions took on a different focus and intensity for each case. All of the goals in each of the three case processes were achieved, and both perceived and observed abilities to use ET in work tasks improved. Client-centred occupational therapy interventions might have the potential to improve the ability to use ET in work tasks in people with ABI.

Is Computer-Aided Instruction an Effective Tier-One Intervention for Kindergarten Students at Risk for Reading Failure in an Applied Setting?

ERIC Educational Resources Information Center

Kreskey, Donna DeVaughn; Truscott, Stephen D.

2016-01-01

This study investigated the use of computer-aided instruction (CAI) as an intervention for kindergarten students at risk for reading failure. Headsprout Early Reading (Headsprout 2005), a type of CAI, provides internet-based, reading instruction incorporating the critical components of reading instruction cited by the National Reading Panel (NRP…

Incorporating Video Modeling into a School-Based Intervention for Students with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Wilson, Kaitlyn P.

2013-01-01

Purpose: Video modeling is an intervention strategy that has been shown to be effective in improving the social and communication skills of students with autism spectrum disorders, or ASDs. The purpose of this tutorial is to outline empirically supported, step-by-step instructions for the use of video modeling by school-based speech-language…

The Use of Lifestyle and Behavioral Modification Approaches in Obesity Interventions for Black Women: A Literature Review

ERIC Educational Resources Information Center

Walker, Renee E.; Gordon, Melanie

2014-01-01

The alarming obesity prevalence in Black women is well documented yet poorly understood. Obesity interventions for Black women have failed to produce long-term reductions in weight. Recommendations to incorporate a lifestyle and behavioral modification approach have been made to address obesity in this population. The purpose of this article was…

Cultural and Linguistic Alchemy: Mining the Resources of Spanish-Speaking Children and Families Receiving Early Intervention Services

ERIC Educational Resources Information Center

Puig, Victoria I.

2012-01-01

This study was designed to gain insight into how early intervention (EI) services incorporate the cultural and linguistic resources of families and how EI professionals and families build partnerships with each other. Through observation and interview, the author looked deeply at the experiences of a small group of culturally and linguistically…

The Role of the Family in Intervention of Infants at High Risk of Cerebral Palsy: A Systematic Analysis

ERIC Educational Resources Information Center

Dirks, Tineke; Hadders-Algra, Mijna

2011-01-01

During the past two decades, awareness of the role of the family in the child's life has increased and the term "family-centred services" (FCS) has been introduced to facilitate care for children with special needs and their families. It is, however, unclear how various early intervention programmes incorporate family involvement in service…

Effects of Explicit and Non-Explicit Versions of an Early Intervention Program Incorporating Indigenous Culture into Kindergarten Literacy Instruction

ERIC Educational Resources Information Center

MacKay, Leslie D.; McIntosh, Kent

2012-01-01

Low literacy is a challenge facing Indigenous communities across North America and is an identified barrier to school success. Early literacy intervention is an important target to reduce the discrepancies in literacy outcomes. The Moe the Mouse® Speech and Language Development Program (Gardner & Chesterman, 2006) is a cultural curriculum…

Partnership Matters in Health Services Research: A Mixed Methods Study of Practitioners' Involvement in Research and Subsequent Use of Evidence-Based Interventions

ERIC Educational Resources Information Center

Spector, Anya Y.; Pinto, Rogério M.

2017-01-01

Health and social service practitioners have not readily incorporated research-based behavioral interventions in HIV prevention practice due to lack of awareness, lack of training, and challenges translating research findings into practice. Practitioners' involvement in research is associated with their willingness to use research to guide…

Facilitators and Barriers to the Use of iPads as a Therapy Tool: A Canadian Survey of Pediatric Occupational Therapists

ERIC Educational Resources Information Center

Coutinho, Franzina; Bosisio, Marie-Elaine; Brown, Emma J.; Rishikof, Stephanie; Skaf, Elise; Freedin, Erin; Kelly, Shannon; Dahan-Oliel, Noemie

2017-01-01

Technological advancements are leading occupational therapists to alter traditional methods of addressing intervention with clients by incorporating intervention tools like the iPad to enhance rehabilitation and improve participation in the everyday activities of children they engage with as a means of increasing motivation and interest. The use…

Defense Mechanisms: Discussions and Bibliographies; General or Multiple, and Specific.

ERIC Educational Resources Information Center

Pedrini, D. T.; Pedrini, Bonnie C.

This publication considers some Freudian ego mechanisms. The first discussion and bibliography concerns defense mechanisms, in general or in multiple; after which, the discussions and bibliographies concern specific defense mechanisms: denial; displacement, substitution, sublimation; fixation; identification, introjection, incorporation,…

Oral Health Education for Pediatric Nurse Practitioner Students

PubMed Central

Golinveaux, Jay; Gerbert, Barbara; Cheng, Jing; Duderstadt, Karen; Alkon, Abbey; Mullen, Shirin; Lin, Brent; Miller, Arthur; Zhan, Ling

2014-01-01

The aim of this study was to evaluate whether an interdisciplinary, multifaceted oral health education program delivered to pediatric nurse practitioner students at the University of California, San Francisco, would improve their knowledge, confidence, attitudes, and behaviors regarding the provision of oral health assessments, consultations, referrals, and services to young children during well-child visits. Thirty pediatric nurse practitioner students were included in the study. Participants completed a written survey before and after receiving an interdisciplinary educational intervention that included didactic education, simulation exercises, and clinical observation by a pediatric dental resident. Between pre-intervention and post-intervention, a significant improvement was seen in the pediatric nurse practitioners’ knowledge of oral health topics (p<0.001), confidence when providing oral health counseling (p<0.001), and attitudes about including oral health counseling in their examinations (p=0.006). In the post-intervention survey, 83 percent of the subjects reported having incorporated oral examinations into their well-child visits. Our study suggests that providing an interdisciplinary oral health educational program for pediatric nurse practitioner students can improve their knowledge, confidence, attitudes, and behaviors regarding the incorporation of oral health care services during routine well-child visits. PMID:23658403

An augmented cognitive behavioural therapy for treating post-stroke depression: description of a treatment protocol.

PubMed

Kootker, Joyce A; Rasquin, Sascha M C; Smits, Peter; Geurts, Alexander C; van Heugten, Caroline M; Fasotti, Luciano

2015-09-01

Currently, no evidence-based treatment is available for mood problems after stroke. We present a new psychological intervention designed to reduce depressive complaints after stroke. This intervention was based on cognitive behavioural therapy principles and was shown feasible in a pilot study. In order to meet the specific needs of stroke patients (concerning both sensori-motor, cognitive, and behavioural problems), we incorporated motivational interviewing, grief resolution, and psycho-education. We emphasised for each session to take into account the cognitive deficits of the patients (i.e. be concrete, accessible, structured, specific, and repeat information). Moreover, we augmented the psychologist-administered therapy with the contribution of an occupational or movement therapist aimed at facilitating patients' goal-setting and attainment. The intervention consisted of 12 one-hour sessions with a psychologist and three or four one-hour sessions with an occupational or movement therapist. Currently, the effectiveness of the intervention is evaluated in a randomised controlled trial. The proposed psychological treatment protocol is innovative, as it applies cognitive behavioural therapy in a stroke-specific manner; moreover, it supports goal attainment by incorporating occupational or movement therapy sessions. © The Author(s) 2014.

Social Media as a Catalyst for Policy Action and Social Change for Health and Well-Being: Viewpoint.

PubMed

Yeung, Douglas

2018-03-19

This viewpoint paper argues that policy interventions can benefit from the continued use of social media analytics, which can serve as an important complement to traditional social science data collection and analysis. Efforts to improve well-being should provide an opportunity to explore these areas more deeply, and encourage the efforts of those conducting national and local data collection on health to incorporate more of these emerging data sources. Social media remains a relatively untapped source of information to catalyze policy action and social change. However, the diversity of social media platforms and available analysis techniques provides multiple ways to offer insight for policy making and decision making. For instance, social media content can provide timely information about the impact of policy interventions. Social media location information can inform where to deploy resources or disseminate public messaging. Network analysis of social media connections can reveal underserved populations who may be disconnected from public services. Machine learning can help recognize important patterns for disease surveillance or to model population sentiment. To fully realize these potential policy uses, limitations to social media data will need to be overcome, including data reliability and validity, and potential privacy risks. Traditional data collection may not fully capture the upstream factors and systemic relationships that influence health and well-being. Policy actions and social change efforts, such as the Robert Wood Johnson Foundation's effort to advance a culture of health, which are intended to drive change in a network of upstream health drivers, will need to incorporate a broad range of behavioral information, such as health attitudes or physical activity levels. Applying innovative techniques to emerging data has the potential to extract insight from unstructured data or fuse disparate sources of data, such as linking health attitudes that are expressed to health behaviors or broader health and well-being outcomes. ©Douglas Yeung. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.03.2018.

The Implementation of Patient-Reported Outcome Measures in Yoga Therapy.

PubMed

Ross, Alyson; Birdee, Gurjeet; Touchton-Leonard, Katharine; Bevans, Margaret

2016-01-01

Yoga therapists are interested in knowing whether their therapeutic interventions are helpful in improving health and wellbeing in their yoga therapy clients. However, few yoga therapists use standardized, reliable, and valid questionnaires to determine the therapeutic effectiveness of their treatments. Patient-reported outcome (PRO) measures are paper or web-based questionnaires used to assess an individual's perceptions of their symptoms and/or quality of life. In 2004, the National Institutes of Health (NIH) launched the PROMIS ® initiative to standardize and simplify the collection of PROs in research and in clinical practice. The PROMIS ® initiative launched a multicenter cooperative group that collected and reviewed thousands of PROs, then extensively tested them in over 20,000 research participants. The result was a web-based collection of item banks of the best questions or "items" within three domains of interest: physical, mental, and social health. These item banks are housed in the Assessment Center, a free online resource for collecting PROs. 1 Incorporating PROMIS ® outcomes into yoga therapy streamlines and optimizes the collection of PROs by enabling access to reliable and valid questionnaires that are easy to read, simple to complete, and are available in multiple languages as well as in both adult and pediatric versions. The use of standardized PROs may improve yoga therapy implementation in healthcare and accelerate translation of clinical research by allowing yoga therapists to conduct indepth symptom assessments using tools that allow for comparisons to other therapeutic clinical and research interventions. The purpose of this paper is to summarize the development of the NIH PROMIS ® initiative and to provide suggestions for incorporating PRO collection into yoga therapy. Important considerations to consider when implementing PROs into yoga therapy are discussed, including the choice of questionnaires and method of delivery (paper or web-based), frequency of PRO administration, interpretation and management of PRO results, and the management of problematic issues that arise.

The Implementation of Patient-Reported Outcome Measures in Yoga Therapy.

PubMed

Ross, Alyson; Birdee, Gurjeet; Touchton-Leonard, Katharine; Bevans, Margaret

2016-09-01

Yoga therapists are interested in knowing whether their therapeutic interventions are helpful in improving health and wellbeing in their yoga therapy clients. However, few yoga therapists use standardized, reliable, and valid questionnaires to determine the therapeutic effectiveness of their treatments. Patient-reported outcome (PRO) measures are paper or web-based questionnaires used to assess an individual's perceptions of their symptoms and/or quality of life. In 2004, the National Institutes of Health (NIH) launched the PROMIS ® initiative to standardize and simplify the collection of PROs in research and in clinical practice. The PROMIS ® initiative launched a multicenter cooperative group that collected and reviewed thousands of PROs, then extensively tested them in over 20,000 research participants. The result was a web-based collection of item banks of the best questions or "items" within three domains of interest: physical, mental, and social health. These item banks are housed in the Assessment Center, a free online resource for collecting PROs. 1 Incorporating PROMIS ® outcomes into yoga therapy streamlines and optimizes the collection of PROs by enabling access to reliable and valid questionnaires that are easy to read, simple to complete, and are available in multiple languages as well as in both adult and pediatric versions. The use of standardized PROs may improve yoga therapy implementation in healthcare and accelerate translation of clinical research by allowing yoga therapists to conduct indepth symptom assessments using tools that allow for comparisons to other therapeutic clinical and research interventions. The purpose of this paper is to summarize the development of the NIH PROMIS ® initiative and to provide suggestions for incorporating PRO collection into yoga therapy. Important considerations to consider when implementing PROs into yoga therapy are discussed, including the choice of questionnaires and method of delivery (paper or web-based), frequency of PRO administration, interpretation and management of PRO results, and the management of problematic issues that arise.

Social Media as a Catalyst for Policy Action and Social Change for Health and Well-Being: Viewpoint

PubMed Central

2018-01-01

This viewpoint paper argues that policy interventions can benefit from the continued use of social media analytics, which can serve as an important complement to traditional social science data collection and analysis. Efforts to improve well-being should provide an opportunity to explore these areas more deeply, and encourage the efforts of those conducting national and local data collection on health to incorporate more of these emerging data sources. Social media remains a relatively untapped source of information to catalyze policy action and social change. However, the diversity of social media platforms and available analysis techniques provides multiple ways to offer insight for policy making and decision making. For instance, social media content can provide timely information about the impact of policy interventions. Social media location information can inform where to deploy resources or disseminate public messaging. Network analysis of social media connections can reveal underserved populations who may be disconnected from public services. Machine learning can help recognize important patterns for disease surveillance or to model population sentiment. To fully realize these potential policy uses, limitations to social media data will need to be overcome, including data reliability and validity, and potential privacy risks. Traditional data collection may not fully capture the upstream factors and systemic relationships that influence health and well-being. Policy actions and social change efforts, such as the Robert Wood Johnson Foundation’s effort to advance a culture of health, which are intended to drive change in a network of upstream health drivers, will need to incorporate a broad range of behavioral information, such as health attitudes or physical activity levels. Applying innovative techniques to emerging data has the potential to extract insight from unstructured data or fuse disparate sources of data, such as linking health attitudes that are expressed to health behaviors or broader health and well-being outcomes. PMID:29555624

Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women.

PubMed

Gould, Gillian S; Bar-Zeev, Yael; Bovill, Michelle; Atkins, Lou; Gruppetta, Maree; Clarke, Marilyn J; Bonevski, Billie

2017-09-15

Indigenous smoking rates are up to 80% among pregnant women: prevalence among pregnant Australian Indigenous women was 45% in 2014, contributing significantly to the health gap for Indigenous Australians. We aimed to develop an implementation intervention to improve smoking cessation care (SCC) for pregnant Indigenous smokers, an outcome to be achieved by training health providers at Aboriginal Medical Services (AMS) in a culturally competent approach, developed collaboratively with AMS. The Behaviour Change Wheel (BCW), incorporating the COM-B model (capability, opportunity and motivation for behavioural interventions), provided a framework for the development of the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy implementation intervention at provider and patient levels. We identified evidence-practice gaps through (i) systematic literature reviews, (ii) a national survey of clinicians and (iii) a qualitative study of smoking and quitting with Aboriginal mothers. We followed the three stages recommended in Michie et al.'s "Behaviour Change Wheel" guide. Targets identified for health provider behaviour change included the following: capability (psychological capability, knowledge and skills) by training clinicians in pharmacotherapy to assist women to quit; motivation (optimism) by presenting evidence of effectiveness, and positive testimonials from patients and clinicians; and opportunity (environmental context and resources) by promoting a whole-of-service approach and structuring consultations using a flipchart and prompts. Education and training were selected as the main intervention functions. For health providers, the delivery mode was webinar, to accommodate time and location constraints, bringing the training to the services; for patients, face-to-face consultations were supported by a booklet embedded with videos to improve patients' capability, opportunity and motivation. The ICAN QUIT in Pregnancy was an intervention to train health providers at Aboriginal Medical Services in how to implement culturally competent evidence-based practice including counselling and nicotine replacement therapy for pregnant patients who smoke. The BCW aided in scientifically and systematically informing this targeted implementation intervention based on the identified gaps in SCC by health providers. Multiple factors impact at systemic, provider, community and individual levels. This process was therefore important for defining the design and intervention components, prior to a conducting a pilot feasibility trial, then leading on to a full clinical trial.

Restoration of acidic mine spoils with sewage sludge: II measurement of solids applied

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

Stucky, D.J.; Zoeller, A.L.

1980-01-01

Sewage sludge was incorporated in acidic strip mine spoils at rates equivalent to 0, 224, 336, and 448 dry metric tons (dmt)/ha and placed in pots in a greenhouse. Spoil parameters were determined 48 hours after sludge incorporation, Time Planting (P), and five months after orchardgrass (Dactylis glomerata L.) was planted, Time Harvest (H), in the pots. Parameters measured were: pH, organic matter content (OM), cation exchange capacity (CEC), electrical conductivity (EC) and yield. Values for each parameter were significantly different at the two sampling times. Correlation coefficient values were calculated for all parameters versus rates of applied sewage sludgemore » and all parameters versus each other. Multiple regressions were performed, stepwise, for all parameters versus rates of applied sewage sludge. Equations to predict amounts of sewage sludge incorporated in spoils were derived for individual and multiple parameters. Generally, measurements made at Time P achieved the highest correlation coefficient and multiple correlation coefficient values; therefore, the authors concluded data from Time P had the greatest predictability value. The most important value measured to predict rate of applied sewage sludge was pH and some additional accuracy was obtained by including CEC in equation. This experiment indicated that soil properties can be used to estimate amounts of sewage sludge solids required to reclaim acidic mine spoils and to estimate quantities incorporated.« less

The Effects of Mindfulness-Based Intervention on Children's Attention Regulation.

PubMed

Felver, Joshua C; Tipsord, Jessica M; Morris, Maxwell J; Racer, Kristina Hiatt; Dishion, Thomas J

2017-08-01

This article describes results from a randomized clinical trial of a mindfulness-based intervention for parents and children, Mindful Family Stress Reduction, on a behavioral measure of attention in youths, the Attention Network Task (ANT). Forty-one parent-child dyads were randomly assigned to either the mindfulness-based intervention condition or a wait-list control. School-age youths completed the ANT before and after the intervention. Results demonstrate significant, medium-size ( f 2 = -.16) intervention effects to the conflict monitoring subsystem of the ANT such that those in the intervention condition decreased in conflict monitoring more than those in the wait-list control. Youths in the intervention condition also showed improvements in their orienting subsystem scores, compared with controls. Mindfulness-based interventions for youths have potential utility to improve attentional self-regulation, and future research should consider incorporating measures of attention into interventions that use mindfulness training.

Data to Action

PubMed Central

Rohm Young, Deborah; Johnson, Carolyn C.; Steckler, Allan; Gittelsohn, Joel; Saunders, Ruth P.; Saksvig, Brit I.; Ribisl, Kurt M.; Lytle, Leslie A.; McKenzie, Thomas L.

2008-01-01

Formative research is used to inform intervention development, but the processes of transmitting results to intervention planners and incorporating information into intervention designs are not well documented. The authors describe how formative research results from the Trial of Activity for Adolescent Girls (TAAG) were transferred to planners to guide intervention development. Methods included providing oral and written reports, prioritizing recommendations, and cross-checking recommendations with intervention objectives and implementation strategies. Formative work influenced the intervention in many ways. For example, results indicated that middle schools offered only coeducational physical education and health education classes, so the TAAG intervention was designed to be appropriate for both sexes, and intervention strategies were developed to directly address girls’ stated preferences (e.g., enjoyable activities, opportunity to socialize) and barriers (e.g., lack of skills, fear of injury) for physical activity. The challenges of using formative research for intervention development are discussed. PMID:16397162

Influence of behavioral theory on fruit and vegetable intervention effectiveness among children: A meta-analysis

USDA-ARS?s Scientific Manuscript database

The objective of this study was to test the hypotheses that interventions clearly based on theory, multiple theories, or a formal intervention planning process will be more effective in changing fruit and vegetable consumption among children than interventions with no behavioral theoretical foundati...

Is More Better? Outcome and Dose of a Universal Drug Prevention Effectiveness Trial

PubMed Central

Ferrer-Wreder, Laura; Cadely, Hans Saint-Eloi; Domitrovich, Celene E.; Small, Meg L.; Caldwell, Linda L.; Cleveland, Michael J.

2014-01-01

Two evidence-based interventions, Life Skills Training and TimeWise, were combined in an effectiveness trial. Participants were predominately African American youth (N = 715; Mage = 12). The study authors provide an empirical demonstration of the implications of incorporating dosage information in intervention outcome analyses. Study results showed no program-related benefits for drug use. Results indicated intervention-related benefits for assertiveness and anxiety management skills and drug use intentions as well as a reduction in detrimental leisure motivations. High program exposure and lesson coverage tended to be connected to intervention benefits. Study findings also documented ways that dosage information provides insight into interventions and their effects. PMID:21053080

Allowing Students to Administer Their Own Interventions: An Application of the Self-Administered Folding-In Technique

ERIC Educational Resources Information Center

Hulac, David M.; Wickerd, Garry; Vining, Odell

2013-01-01

This study sought to determine the efficacy of a self-administered folding-in technique to help fourth grade students at-risk for math difficulties improve their fluency with multiplication facts. The investigators used a multiple baseline across participants design during a two-phase intervention. While 4 of the 5 students made progress during…

Multiple-Component Remediation for Developmental Reading Disabilities: IQ, Socioeconomic Status, and Race as Factors in Remedial Outcome

ERIC Educational Resources Information Center

Morris, Robin D.; Lovett, Maureen W.; Wolf, Maryanne; Sevcik, Rose A.; Steinbach, Karen A.; Frijters, Jan C.; Shapiro, Marla B.

2012-01-01

Results from a controlled evaluation of remedial reading interventions are reported: 279 young disabled readers were randomly assigned to a program according to a 2 x 2 x 2 factorial design (IQ, socioeconomic status [SES], and race). The effectiveness of two multiple-component intervention programs for children with reading disabilities (PHAB +…

Creating a Common Table: Using Peer Mediated Intervention to Promote Social Communication Skills with At-Risk and Autism Spectrum Disorder Populations

ERIC Educational Resources Information Center

Craig-Unkefer, Lesley; Loncola Walberg, Jennifer

2015-01-01

Identifying an intervention that is effective for multiple populations can be a challenge. Given the potential range of students in an inclusive setting, the need to identify common strategies that promote skill development for multiple populations is essential. Professionals need to identify those strategies that promote skill development that…

Adaptation of a Counseling Intervention to Address Multiple Cancer Risk Factors among Overweight/Obese Latino Smokers

ERIC Educational Resources Information Center

Castro, Yessenia; Fernández, Maria E.; Strong, Larkin L.; Stewart, Diana W.; Krasny, Sarah; Hernandez Robles, Eden; Heredia, Natalia; Spears, Claire A.; Correa-Fernández, Virmarie; Eakin, Elizabeth; Resnicow, Ken; Basen-Engquist, Karen; Wetter, David W.

2015-01-01

More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social…

Four Seventh Grade Students Who Qualify for Academic Intervention Services in Mathematics Learning Multi-Digit Multiplication with the Montessori Checkerboard

ERIC Educational Resources Information Center

Donabella, Mark A.; Rule, Audrey C.

2008-01-01

This article describes the positive impact of Montessori manipulative materials on four seventh grade students who qualified for academic intervention services because of previous low state test scores in mathematics. This mathematics technique for teaching multi-digit multiplication uses a placemat-sized quilt with different color-coded squares…

An Integrated Methodology to Assess Compliance with Delphi Survey Key Components of Yoga Interventions for Musculoskeletal Conditions as Applied in a Systematic Review of Fibromyalgia Studies.

PubMed

Fischer-White, Tamara G; Anderson, Joel G; Taylor, Ann Gill

2016-01-01

The objective of this article was to present a methodology incorporating existing guidelines and tools for systematic reviews and to evaluate the Delphi survey 33 key component recommendations of yoga interventions for musculoskeletal conditions as a tool for a systematic review in fibromyalgia studies. Databases searched included PubMed, Ovid Medline, PsychINFO, the Cochrane Library, CINAHL, ALT HealthWatch, PEDro, and Web of Science. Selected were articles published between November 14, 2004 and November 13, 2014, written in English, reporting original research of yoga interventions for adults with fibromyalgia. Six articles met the inclusion criteria, revealing that three yoga styles ("Relaxing" yoga, Yoga of Awareness, and Hatha yoga) have been assessed in persons with fibromyalgia. Overall, reporting compliance with the 33 key components ranged from 39.4% to 84.8%, with a mean adherence rate of 62.63% ± 17.74. None of the authors used an accepted reporting guideline; specific components of asana, pranayama, relaxation, and mindfulness practices that would have been incorporated into the interventions tested were identified in only 33.33% of the articles reviewed; and none of the articles included detailed, replicable descriptions of the interventions. This systematic review supports the need for comprehensive yoga research guidelines. Findings reveal a lack of reporting of intervention details, the need to report a disease-specific rationale for selection of the particular yoga style used for the intervention, and that a limited number of yoga styles have been investigated in persons with fibromyalgia. Copyright © 2016 Elsevier Inc. All rights reserved.