Efficacy of a Sun Protection Workbook for Kidney Transplant Recipients: A Randomized Controlled Trial of a Culturally Sensitive Educational Intervention

PubMed Central

Robinson, June K.; Guevara, Yanina; Gaber, Rikki; Clayman, Marla L.; Kwasny, Mary J.; Friedewald, John J.; Gordon, Elisa J.

2014-01-01

A culturally sensitive educational intervention that encouraged sun protection behaviors among kidney transplant recipients was developed and the short-term efficacy was evaluated. Non-Hispanic White, Hispanic/Latino, and non-Hispanic Black patients, who received a transplant 2–24 months prior to the study, were randomized into two study groups: intervention versus standard of care. Electronic reminders tailored to the weather conditions were sent every two weeks by text message or email. Self-reported surveys and biologic measurements were obtained prior to the intervention and six weeks later. Among the 101 study participants, there was a statistically significant increase in knowledge, recognition of personal risk of developing skin cancer, willingness to change sun protection behavior, and self-reported performance of sun protection in participants receiving the intervention in comparison with those receiving standard of care (p <0.05). The pigment darkening of the sun–exposed forearm and sun damage of the forearm and sunburns/ skin irritation from the sun were significantly less in participants receiving the intervention (p <0.05). Providing sun protection education at the beginning of summer with reminders tailored to weather conditions helped KTRs adopt sun protection practices. This sun protection program for KTRs may be incorporated into the care provided by the nephrologist or transplant surgeon. PMID:25395386

Brief Intervention for Drug Abusing Adolescents in a School Setting: Outcomes and Mediating Factors

PubMed Central

Winters, Ken C.; Fahnhorst, Tamara; Botzet, Andria; Lee, Susanne; Lalone, Britani

2011-01-01

This randomized controlled trial evaluated the use of two brief intervention conditions for adolescents (aged 12–18 years) who have been identified in a school setting as abusing alcohol and other drugs. Adolescents and their parent (N = 315) were randomly assigned to receive either a 2-session adolescent only (BI-A), 2-session adolescent and additional parent session (BI-AP), or assessment only control condition (CON). Interventions were manually guided and delivered in a school setting by trained counselors. Adolescents and parents were assessed at intake and at 6 months following the completion of the intervention. Analyses of relative (change from intake to 6-months) and absolute (status at 6-months) outcome variables indicated that for the most part, adolescents in the BI-A and BI-AP conditions showed significantly more reductions in drug use behaviors compared to the CON group. Also, youth receiving the BI-AP condition showed significantly better outcomes compared to the BI-A group on several variables. Problem-solving skills and utilization of additional counseling services mediated outcome. The value of a school-based brief intervention for students is discussed. PMID:22000326

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.

Added benefits: Reduced depressive symptom levels among African-American female adolescents participating in an HIV prevention intervention

PubMed Central

Brown, Jennifer L.; Sales, Jessica M.; Swartzendruber, Andrea L.; Eriksen, Michael D.; DiClemente, Ralph J.; Rose, Eve S.

2014-01-01

Background Adolescents experience elevated depressive symptoms which health promotion interventions may reduce. Purpose This study investigated whether HIV prevention trial participation decreased depressive symptoms among African-American female adolescents. Methods Adolescents (N=701; M age = 17.6) first received a group-delivered HIV prevention intervention and then either 12 sexual health (intervention condition) or 12 general health (comparison condition) phone counseling contacts over 24 months. ACASI assessments were conducted at baseline, and at 6-, 12-, 18-, and 24-months post-baseline. Linear generalized estimating equations were used to detect percent relative change in depressive symptoms. Results Participants reported a 2.7% decrease in depressive symptoms (p = 0.001) at each assessment. Intervention participants endorsed an additional 3.6% decrease in depressive symptoms (p = 0.058). Conclusions Trial participation was associated with reduced depressive symptomatology, particularly among those receiving personalized sexual health counseling. HIV prevention interventions may benefit from incorporating additional content to address adolescents’ mental health needs. PMID:24366521

Finding the minimal intervention needed for sustained mammography adherence.

PubMed

Gierisch, Jennifer M; DeFrank, Jessica T; Bowling, J Michael; Rimer, Barbara K; Matuszewski, Jeanine M; Farrell, David; Skinner, Celette Sugg

2010-10-01

Regular adherence to mammography screening saves lives, yet few women receive regular mammograms. RCT. Participants were recruited through a state employee health plan. All were women aged 40-75 years and had recent mammograms prior to enrollment (n=3547). Data were collected from 2004 to 2009. Trial tested efficacy of a two-step adaptively-designed intervention to increase mammography adherence over 4 years. The first intervention step consisted of three reminder types: enhanced usual care reminders (EUCR); enhanced letter reminders (ELR); both delivered by mail, and automated telephone reminders (ATR). After delivery of reminders, women who became off-schedule in any of the 4 years received a second step of supplemental interventions. Three supplemental intervention arms contained priming letters and telephone counseling: barriers only (BarriCall); barriers plus positive consequences of getting mammograms (BarriConCall+); and barriers plus negative consequences of not getting mammograms (BarriConCall-). Average cumulative number of days non-adherent to mammography over 4 years based on annual screening guidelines (analyses conducted in 2009). All reminders performed equally well in reducing number of days of non-adherence. Women randomized to receive supplemental interventions had significantly fewer days of non-adherence compared to women who received EUCR (p=0.0003). BarrConCall+ and BarrConCall- conditions did not significantly differ in days non-adherent compared to women in the barriers-only condition (BarriCon). The minimal intervention needed for sustained mammography use is a combination of a reminder followed by a priming letter and barrier-specific telephone counseling for women who become off-schedule. Additional costs associated with supplemental interventions should be considered by organizations deciding which interventions to use. NCT01148875. Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

A pilot evaluation of a social media literacy intervention to reduce risk factors for eating disorders.

PubMed

McLean, Siân A; Wertheim, Eleanor H; Masters, Jennifer; Paxton, Susan J

2017-07-01

This pilot study investigated the effectiveness of a social media literacy intervention for adolescent girls on risk factors for eating disorders. A quasi-experimental pre- to post-test design comparing intervention and control conditions was used. Participants were 101 adolescent girls (M age  = 13.13, SD = 0.33) who were allocated to receive three social media literacy intervention lessons (n = 64) or to receive classes as usual (n = 37). Self-report assessments of eating disorder risk factors were completed one week prior to, and one week following the intervention. Significant group by time interaction effects revealed improvements in the intervention condition relative to the control condition for body image (body esteem-weight; d = .19), disordered eating (dietary restraint; d = .26) and media literacy (realism scepticism; d = .32). The outcomes of this pilot study suggest that social media literacy is a potentially useful approach for prevention of risk for eating disorders in adolescent girls in the current social media environment of heightened vulnerability. Replication of this research with larger, randomized controlled trials, and longer follow-up is needed. © 2017 Wiley Periodicals, Inc.

Pilot evaluation of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Food-O-Meter, a computer-tailored nutrition advice for adolescents: a study in six European cities.

PubMed

Maes, Lea; Cook, Tina Louisa; Ottovaere, Charlene; Matthijs, Christophe; Moreno, Luis A; Kersting, Mathilde; Papadaki, Alina; Manios, Yannis; Dietrich, Sabine; Hallström, Lena; Haerens, Leen; De Bourdeaudhuij, Ilse; Vereecken, Carine

2011-07-01

To investigate the feasibility and impact of the Food-O-Meter, an Internet-based computer-tailored nutrition intervention in adolescents. Participants in the intervention condition received the computer-tailored advice at baseline and at 1 month, those in the control condition received standardised advice. Effects were evaluated at 1 month (n 621) and at 3 months (n 558) using multi-level modelling. Secondary schools in six European cities. Adolescents accessed the intervention in the school computer room under the supervision of teachers. Classes with students aged 12-17 years in the schools participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) cross-sectional study were randomised into intervention and control schools. In most participating centres the intervention was feasible and generally well appreciated, especially by girls. Technical problems and lack of motivation of the teachers hindered implementation in some centres. Overweight adolescents had higher scores for reading and using the advice than normal weight adolescents. After 1 month adolescents receiving the standardised advice reported an increase in fat intake, while fat intake in the intervention condition was stable (F = 4·82, P < 0·05). After 3 months, there was a trend in the total group for an intervention effect of the tailored advice on fat intake (F = 2·80, P < 0·10). In the overweight group there was a clear positive effect (F = 5·76, P < 0·05). The Food-O-Meter should be developed further. The results were modest but clear for percentage energy from fat, specifically in the overweight group. Adaptations based on new research are needed to enhance the reliability and effectiveness of the intervention.

Longitudinal Intervention Effects on Parenting of the Aventuras para Niños Study

PubMed Central

Ayala, Guadalupe X.; Elder, John P.; Campbell, Nadia R.; Arredondo, Elva; Baquero, Barbara; Crespo, Noe C.; Slymen, Donald J.

2010-01-01

Background Parenting interventions have achieved changes in factors associated with childhood obesity but few have tested the effects on multiple parental influences. Purpose This study examined the efficacy of an intervention aimed at improving several dimensions of parenting related to childhood obesity. Design 2×2 factorial study design Setting/Participants In 2003, thirteen Southern California schools were randomized to one of four conditions: micro-environment only, macro-environment only, micro-plus-macro–environment, and no treatment control condition. Participants included 811 predominantly Mexican immigrant/Mexican-American mothers with children in grades kindergarten through second grade. Intervention In both micro conditions, participants received monthly home visits by a promotora over a 7-month period plus monthly mailed newsletters. Main outcome measures In 2008, intervention effects were examined on: (1) parenting strategies including limit setting, monitoring, discipline, control, and reinforcement related to children’s diet and physical activity; (2) parental support for physical activity; (3) parent-mediated family behaviors such as family meals eaten together and TV watching during family dinners; and (4) perceived barriers and other parent cognitions related to children’s eating and activity. Results At the 2-year follow-up, significant improvements were observed in three of five parenting strategies, parental support, and two of four parent-mediated family behaviors among parents receiving the micro intervention (i.e., those who received promotora visits and monthly newsletters), as compared with those in the macro-only and control conditions. Conclusions Aspects of parenting related to children’s risk for obesity and related health outcomes are modifiable with the support of a promotora and print media. PMID:20117571

Balance--a pragmatic randomized controlled trial of an online intensive self-help alcohol intervention.

PubMed

Brendryen, Håvar; Lund, Ingunn Olea; Johansen, Ayna Beate; Riksheim, Marianne; Nesvåg, Sverre; Duckert, Fanny

2014-02-01

To compare a brief versus a brief plus intensive self-help version of 'Balance', a fully automated online alcohol intervention, on self-reported alcohol consumption. A pragmatic randomized controlled trial. Participants in both conditions received an online single session screening procedure including personalized normative feedback. The control group also received an online booklet about the effects of alcohol. The treatment group received the online multi-session follow-up program, Balance. Online study in Norway. At-risk drinkers were recruited by internet advertisements and assigned randomly to one of the two conditions (n = 244). The primary outcome was self-reported alcohol consumption the previous week measured 6 months after screening. Regression analysis, using baseline carried forward imputation (intent-to-treat), with baseline variables as covariates, showed that intervention significantly affected alcohol consumption at 6 months (B = 2.96; 95% confidence interval = 0.02-5.90; P = 0.049). Participants in the intensive self-help group drank an average of three fewer standard alcohol units compared with participants in the brief self-help group. The online Balance intervention, added to a brief online screening intervention, may aid reduction in alcohol consumption compared with the screening intervention and an educational booklet. © 2013 Society for the Study of Addiction.

Conduct Problems and Peer Rejection in Childhood: A Randomized Trial of the Making Choices and Strong Families Programs

ERIC Educational Resources Information Center

Fraser, Mark W.; Day, Steven H.; Galinsky, Maeda J.; Hodges, Vanessa G.; Smokowski, Paul R.

2004-01-01

This article discusses the effectiveness of a multicomponent intervention designed to disrupt developmental processes associated with conduct problems and peer rejection in childhood. Compared with 41 children randomized to a wait list control condition, 45 children in an intervention condition received a social skills training program. At the…

The Effectiveness of a Web-Based Computer-Tailored Intervention on Workplace Sitting: A Randomized Controlled Trial.

PubMed

De Cocker, Katrien; De Bourdeaudhuij, Ilse; Cardon, Greet; Vandelanotte, Corneel

2016-05-31

Effective interventions to influence workplace sitting are needed, as office-based workers demonstrate high levels of continued sitting, and sitting too much is associated with adverse health effects. Therefore, we developed a theory-driven, Web-based, interactive, computer-tailored intervention aimed at reducing and interrupting sitting at work. The objective of our study was to investigate the effects of this intervention on objectively measured sitting time, standing time, and breaks from sitting, as well as self-reported context-specific sitting among Flemish employees in a field-based approach. Employees (n=213) participated in a 3-group randomized controlled trial that assessed outcomes at baseline, 1-month follow-up, and 3-month follow-up through self-reports. A subsample (n=122) were willing to wear an activity monitor (activPAL) from Monday to Friday. The tailored group received an automated Web-based, computer-tailored intervention including personalized feedback and tips on how to reduce or interrupt workplace sitting. The generic group received an automated Web-based generic advice with tips. The control group was a wait-list control condition, initially receiving no intervention. Intervention effects were tested with repeated-measures multivariate analysis of variance. The tailored intervention was successful in decreasing self-reported total workday sitting (time × group: P<.001), sitting at work (time × group: P<.001), and leisure time sitting (time × group: P=.03), and in increasing objectively measured breaks at work (time × group: P=.07); this was not the case in the other conditions. The changes in self-reported total nonworkday sitting, sitting during transport, television viewing, and personal computer use, objectively measured total sitting time, and sitting and standing time at work did not differ between conditions. Our results point out the significance of computer tailoring for sedentary behavior and its potential use in public health promotion, as the effects of the tailored condition were superior to the generic and control conditions. Clinicaltrials.gov NCT02672215; http://clinicaltrials.gov/ct2/show/NCT02672215 (Archived by WebCite at http://www.webcitation.org/6glPFBLWv).

The Effectiveness of a Web-Based Computer-Tailored Intervention on Workplace Sitting: A Randomized Controlled Trial

PubMed Central

De Bourdeaudhuij, Ilse; Cardon, Greet; Vandelanotte, Corneel

2016-01-01

Background Effective interventions to influence workplace sitting are needed, as office-based workers demonstrate high levels of continued sitting, and sitting too much is associated with adverse health effects. Therefore, we developed a theory-driven, Web-based, interactive, computer-tailored intervention aimed at reducing and interrupting sitting at work. Objective The objective of our study was to investigate the effects of this intervention on objectively measured sitting time, standing time, and breaks from sitting, as well as self-reported context-specific sitting among Flemish employees in a field-based approach. Methods Employees (n=213) participated in a 3-group randomized controlled trial that assessed outcomes at baseline, 1-month follow-up, and 3-month follow-up through self-reports. A subsample (n=122) were willing to wear an activity monitor (activPAL) from Monday to Friday. The tailored group received an automated Web-based, computer-tailored intervention including personalized feedback and tips on how to reduce or interrupt workplace sitting. The generic group received an automated Web-based generic advice with tips. The control group was a wait-list control condition, initially receiving no intervention. Intervention effects were tested with repeated-measures multivariate analysis of variance. Results The tailored intervention was successful in decreasing self-reported total workday sitting (time × group: P<.001), sitting at work (time × group: P<.001), and leisure time sitting (time × group: P=.03), and in increasing objectively measured breaks at work (time × group: P=.07); this was not the case in the other conditions. The changes in self-reported total nonworkday sitting, sitting during transport, television viewing, and personal computer use, objectively measured total sitting time, and sitting and standing time at work did not differ between conditions. Conclusions Our results point out the significance of computer tailoring for sedentary behavior and its potential use in public health promotion, as the effects of the tailored condition were superior to the generic and control conditions. Trial Registration Clinicaltrials.gov NCT02672215; http://clinicaltrials.gov/ct2/show/NCT02672215 (Archived by WebCite at http://www.webcitation.org/6glPFBLWv) PMID:27245789

Effect of a Health Belief Model-based nursing intervention on Chinese patients with moderate to severe chronic obstructive pulmonary disease: a randomised controlled trial.

PubMed

Wang, Ying; Zang, Xiao-Ying; Bai, Jinbing; Liu, Su-Yan; Zhao, Yue; Zhang, Qing

2014-05-01

To test the effect of a Health Belief Model-based nursing intervention on healthcare outcomes in Chinese patients with moderate to severe COPD. The Health Belief Model (HBM) has been internationally validated in a variety of chronic conditions. However, nursing intervention based on the HBM is less explored in Chinese patients with COPD. A randomised controlled trial. Enrolled patients were randomly assigned to the intervention and control groups. Patients in the intervention group received a 20- to 30-minute HBM-based nursing intervention every 2 days during the hospitalisation period after disease conditions were stable, with additional follow-ups after discharge. Patients in the control group received routine nursing care. Patients had significantly increased scores of health belief and self-efficacy after receiving the HBM-based nursing intervention. After receiving the 3-month follow-up, patients in the intervention group had significantly higher mean total scores in the Health Belief Scale and the COPD Self-Efficacy Scale, as well as in all the subscales, than those in the control group except the perceived disease seriousness. Results showed that the value of FEV1 /FVC ratio had a significant difference between study groups before and after the intervention. Results also indicated that mean scores of the Dyspnea Scale, 6-minute walking distance and ADL were significantly different between the groups and between the study time-points. Among patients with moderate to severe COPD, nursing intervention based on the HBM can enhance their health belief and self-efficacy towards the disease management, decrease dyspnoea and improve exercise tolerance and ADL. Nurses can use the HBM-based intervention to enhance patients' health belief and self-efficacy towards the management of COPD, and subsequently benefit healthcare outcomes. © 2013 John Wiley & Sons Ltd.

A web-based computer-tailored smoking prevention programme for primary school children: intervention design and study protocol

PubMed Central

2012-01-01

Background Although the number of smokers has declined in the last decade, smoking is still a major health problem among youngsters and adolescents. For this reason, there is a need for effective smoking prevention programmes targeting primary school children. A web-based computer-tailored feedback programme may be an effective intervention to stimulate youngsters not to start smoking, and increase their knowledge about the adverse effects of smoking and their attitudes and self-efficacy regarding non-smoking. Methods & design This paper describes the development and evaluation protocol of a web-based out-of-school smoking prevention programme for primary school children (age 10-13 years) entitled ‘Fun without Smokes’. It is a transformation of a postal mailed intervention to a web-based intervention. Besides this transformation the effects of prompts will be examined. This web-based intervention will be evaluated in a 2-year cluster randomised controlled trial (c-RCT) with three study arms. An intervention and intervention + prompt condition will be evaluated for effects on smoking behaviour, compared with a no information control condition. Information about pupils’ smoking status and other factors related to smoking will be obtained using a web-based questionnaire. After completing the questionnaire pupils in both intervention conditions will receive three computer-tailored feedback letters in their personal e-mail box. Attitudes, social influences and self-efficacy expectations will be the content of these personalised feedback letters. Pupils in the intervention + prompt condition will - in addition to the personalised feedback letters - receive e-mail and SMS messages prompting them to revisit the ‘Fun without Smokes’ website. The main outcome measures will be ever smoking and the utilisation of the ‘Fun without Smokes’ website. Measurements will be carried out at baseline, 12 months and 24 months of follow-up. Discussion The present study protocol describes the purpose, intervention design and study protocol of ‘Fun without Smokes’. Expectations are that pupils receiving tailored advice will be less likely to smoke after 24 months in contrast to pupils in the control condition. Furthermore, tailored feedback letters and prompting is expected to be more effective than providing tailored feedback letters only. Trial registration Dutch Trial Register NTR3116 PMID:22490110

A Cognitive Behavioral Smoking Abstinence Intervention for Adults with Chronic Pain: A Randomized Controlled Pilot Trial

PubMed Central

Hooten, W. Michael; Townsend, Cynthia O.; Hays, J. Taylor; Ebnet, Kaye L.; Gauvin, Thomas R.; Gehin, Jessica M.; Laures, Heidi J.; Patten, Christi A.; Warner, David O.

2015-01-01

Current evidence suggests it may be difficult for patients with chronic pain to quit smoking and, based on previous formative work, a 7-session individual and group-based cognitive behavioral (CB) intervention was developed. The primary aim of this randomized controlled pilot trial was to test the hypothesis that abstinence at month 6 would be greater among patients with chronic pain who received the CB intervention compared to a control condition. Upon admission to a 3-week interdisciplinary pain treatment (IPT) program, patients were randomized to receive the CB intervention (n = 30) or the control condition (n = 30). The 7-day point prevalence of self-reported smoking status was assessed at week 3 (upon completion of the 3-week IPT program) and at month 6 in an intent-to-treat analysis. At week 3, 30% (n=9) of patients in the CB condition were abstinent from smoking compared to 10% (n=3) in the control group (P=.104). At month 6, 20% (n=6) of patients who received the CB intervention were abstinent compared to none in the control group (P=.024). At week 3, a significant group by time interaction effect was found where the CB patients experienced greater improvements in self-efficacy from baseline compared to the control group (P=.002). A greater proportion of patients randomized to the CB group completed the IPT program (P=.052). The findings of this pilot trial suggest that integration of a CB-based smoking abstinence intervention into ongoing pain therapy may be an effective treatment for smokers with chronic pain. PMID:24333035

Increasing Treatment Seeking Among At-Risk Service Members Returning from Warzones

DTIC Science & Technology

2017-03-01

treatment among at-risk service members. Hypothesis 1a: Participants receiving the cognitive -behavioral (CB) intervention will have significant...Participants assigned to the treatment condition are presented an individualized cognitive -behavioral (CB) intervention. The CB intervention takes 45-60... cognitive -behavioral intervention 6 3. OVERALL PROJECT SUMMARY Recruitment for this trial began on March 2, 2013. We aimed to recruit

Psychosocial Treatment for Recurrent Genital Herpes.

ERIC Educational Resources Information Center

Longo, David J.; And Others

1988-01-01

Assigned 21 individuals with recurrent genital herpes to psychosocial intervention, social support, or waiting-list control conditions. Those receiving psychosocial intervention (herpes simplex virus information, relaxation training, stress management instructions, and an imagery technique) reported significantly greater reductions in herpes…

Effects of Individualized and Standardized Interventions on Middle School Students With Reading Disabilities

PubMed Central

VAUGHN, SHARON; WEXLER, JADE; ROBERTS, GREG; BARTH, AMY A.; CIRINO, PAUL T.; ROMAIN, MELISSA A.; FRANCIS, DAVID; FLETCHER, JACK; DENTON, CAROLYN A.

2011-01-01

This study reports the effectiveness of a year-long, small-group, tertiary (Tier 3) intervention that examined 2 empirically derived but conceptually different treatments and a comparison condition. The researchers had randomly assigned all students to treatment or comparison conditions. The participants were seventh- and eighth-grade students from the previous year who received an intervention and did not meet exit criteria. The researchers assigned them to one of two treatments: standardized (n = 69) or individualized (n = 71) for 50 min a day, in group sizes of 5, for the entire school year. Comparison students received no researcher-provided intervention (n = 42). The researchers used multigroup modeling with nested comparisons to evaluate the statistical significance of Time 3 estimates. Students in both treatments outperformed the comparison students on assessments of decoding, fluency, and comprehension. Intervention type did not moderate the pattern of effects, although students in the standardized treatment had a small advantage over individualized students on word attack. This study provides a framework from which to refine further interventions for older students with reading disabilities. PMID:23125463

Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care: The LINKAGE Clinical Trial.

PubMed

Weisner, Constance M; Chi, Felicia W; Lu, Yun; Ross, Thekla B; Wood, Sabrina B; Hinman, Agatha; Pating, David; Satre, Derek; Sterling, Stacy A

2016-08-01

Research has shown that higher activation and engagement with health care is associated with better self-management. To our knowledge, the linkage intervention (LINKAGE) is the first to engage patients receiving addiction treatment with health care using the electronic health record and a patient activation approach. To examine the effects of an intervention aiming to link patients receiving addiction treatment with health care. A nonrandomized clinical trial evaluating the LINKAGE intervention vs usual care by applying an alternating 3-month off-and-on design over 30 months. Participants were recruited from an outpatient addiction treatment clinic in a large health system between April 7, 2011, and October 2, 2013. Six group-based, manual-guided sessions on patient engagement in health care and the use of health information technology resources in the electronic health record, as well as facilitated communication with physicians, vs usual care. Primary outcomes, measured at 6 months after enrollment, were patient activation (by interview using the Patient Activation Measure), patient engagement in health care (by interview and electronic health record), and alcohol, drug, and depression outcomes (by interview using the Addiction Severity Index for alcohol and drug outcomes and Patient Health Questionnaire (PHQ) for depression). A total of 503 patients were recruited and assigned to the LINKAGE (n = 252) or usual care (n = 251) conditions, with no differences in baseline characteristics between conditions. The mean (SD) age of the patients was 42.5 (11.8) years, 31.0% (n = 156) were female, and 455 (90.5%) completed the 6-month interview. Compared with usual care participants, LINKAGE participants showed an increase in the mean number of log-in days (incidence rate ratio, 1.53; 95% CI, 1.19-1.97; P = .001). Similar results were found across types of patient portal use (communicating by email, viewing laboratory test results and information, and obtaining medical advice). LINKAGE participants were more likely to talk with their physicians about addiction problems (odds ratio, 2.30; 95% CI, 1.52-3.49; P < .001). Although 6-month abstinence rates were high for both conditions (≥70.0% for both) and depression symptoms improved (the proportion with scores ≥15 on the 9-item PHQ dropped from 15.1% [38 of 252] to 8.0% [18 of 225] among LINKAGE participants), there were no differences between conditions. Those who received all intervention components had significantly better alcohol and other drug outcomes than those who received fewer intervention components. Findings support the feasibility and effectiveness of the LINKAGE intervention in helping patients receiving addiction treatment engage in health care and increase communication with their physicians. The intervention did not affect short-term abstinence or depression outcomes. Understanding if the LINKAGE intervention helps prevent relapse and manage long-term recovery will be important. clinicaltrials.gov Identifier: NCT01621711.

Mindfulness-based prevention for eating disorders: A school-based cluster randomized controlled study.

PubMed

Atkinson, Melissa J; Wade, Tracey D

2015-11-01

Successful prevention of eating disorders represents an important goal due to damaging long-term impacts on health and well-being, modest treatment outcomes, and low treatment seeking among individuals at risk. Mindfulness-based approaches have received early support in the treatment of eating disorders, but have not been evaluated as a prevention strategy. This study aimed to assess the feasibility, acceptability, and efficacy of a novel mindfulness-based intervention for reducing the risk of eating disorders among adolescent females, under both optimal (trained facilitator) and task-shifted (non-expert facilitator) conditions. A school-based cluster randomized controlled trial was conducted in which 19 classes of adolescent girls (N = 347) were allocated to a three-session mindfulness-based intervention, dissonance-based intervention, or classes as usual control. A subset of classes (N = 156) receiving expert facilitation were analyzed separately as a proxy for delivery under optimal conditions. Task-shifted facilitation showed no significant intervention effects across outcomes. Under optimal facilitation, students receiving mindfulness demonstrated significant reductions in weight and shape concern, dietary restraint, thin-ideal internalization, eating disorder symptoms, and psychosocial impairment relative to control by 6-month follow-up. Students receiving dissonance showed significant reductions in socio-cultural pressures. There were no statistically significant differences between the two interventions. Moderate intervention acceptability was reported by both students and teaching staff. Findings show promise for the application of mindfulness in the prevention of eating disorders; however, further work is required to increase both impact and acceptability, and to enable successful outcomes when delivered by less expert providers. © 2015 Wiley Periodicals, Inc.

Guided self-help interventions for mental health disorders in children with neurological conditions: study protocol for a pilot randomised controlled trial.

PubMed

Bennett, Sophie; Heyman, Isobel; Coughtrey, Anna; Simmonds, Jess; Varadkar, Sophia; Stephenson, Terence; DeJong, Margaret; Shafran, Roz

2016-11-04

Rates of mental health disorders are significantly greater in children with physical illnesses than in physically well children. Children with neurological conditions, such as epilepsy, are known to have particularly high rates of mental health disorders. Despite this, mental health problems in children with neurological conditions have remained under-recognised and under-treated in clinical settings. Evidence-based guided self-help interventions are efficacious in reducing symptoms of mental health disorders in children, but their efficacy in reducing symptoms of common mental health disorders in children with neurological conditions has not been investigated. We aim to pilot a guided self-help intervention for the treatment of mental health disorders in children with neurological conditions. A pilot randomised controlled trial with 18 patients with neurological conditions and mental health disorders will be conducted. Participants attending specialist neurology clinics at a National UK Children's Hospital will be randomised to receive guided self-help for common mental health disorders or to a 12-week waiting list control. Participants in the treatment group will receive 10 sessions of guided self-help delivered over the telephone. The waiting list control group will receive the intervention after a waiting period of 12 weeks. The primary outcome measure is reduction in symptoms of mental health disorders. Exclusion criteria are limited to those at significant risk of harm to self or others, the presence of primary mental health disorder other than anxiety, depression or disruptive behaviour (e.g. psychosis, eating disorder, obsessive-compulsive disorder) or intellectual disability at a level meaning potential participants would be unable to access the intervention. The study has ethical approval from the Camden and Islington NHS Research Ethics Committee, registration number 14.LO.1353. Results will be disseminated to patients, the wider public, clinicians and researchers through publication in journals and presentation at conferences. This is the first study to investigate guided self-help interventions for mental health problems in children with neurological conditions, a group which is currently under-represented in mental health research. The intervention is modular and adapted from an empirically supported cognitive behavioural treatment. The generalisability and broad inclusion criteria are strengths but may also lead to some weaknesses. Current Controlled Trials: ISRCTN21184717 . Registered on 25 September 2015.

A Pilot Randomized Controlled Trial of an Internet-Based Alcohol Intervention in a Workplace Setting.

PubMed

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

2017-10-01

The aim of this study was to compare the effectiveness of a brief and an intensive self-help alcohol intervention and to assess the feasibility of recruiting to such interventions in a workplace setting. Employees who screened positive for hazardous drinking (n = 85) received online personalized normative feedback and were randomly assigned to one out of two conditions: either they received an e-booklet about the effects of alcohol or they received a self-help intervention comprising 62 web-based, fully automated, and interactive sessions, plus reminder e-mails, and mobile phone text messages (Short Message Service). Two months after baseline, the responders in the intensive condition drank an average of five to six drinks less per week compared to the responders in the brief condition (B = 5.68, 95% CI = 0.48-10.87, P = .03). There was no significant difference between conditions, using baseline observation carried forward imputation (B = 2.96, 95% CI = -0.50-6.42, P = .09). Six months after baseline, no significant difference was found, neither based on complete cases nor intent-to-treat (B = 1.07, 95% CI = -1.29-3.44, P = .37). Challenges with recruitment are thoroughly reported. The study supports the feasibility and the safety of use for both brief and intensive Internet-based self-help in an occupational setting. The study may inform future trials, but due to recruitment problems and low statistical power, the findings are inconclusive in terms of the intensive program being more effective than brief intervention alone. ClinicalTrials.gov Identifier: NCT01931618.

Skills methods to prevent smoking.

PubMed

Schinke, S P; Gilchrist, L D; Schilling, R F; Snow, W H; Bobo, J K

1986-01-01

School health educators have devoted much attention to cigarette smoking. Recent years have seen the testing of interventions to prevent smoking. To date, controlled studies have not evaluated the added value of skills methods for preventing smoking. This article describes such an evaluation with sixth-grade students from two schools. Subjects were pretested and randomly assigned to receive conventional health education methods or to receive skills intervention. Both conditions included films, peer testimonials, discussions, and homework. Health education condition subjects additionally participated in oral quizzes, games, and debates. Skills condition subjects additionally learned problem-solving, self-instruction, and interpersonal communication methods. At postintervention, skills condition subjects, more than health education condition subjects, had better scores on measures of smoking-related knowledge, attitudes, and intentions. In addition, reported cigarette use, validated by biochemical data collection, was lower in the skills condition than in the health education condition at all postintervention measurements, including a 24-month follow-up. The article discusses the strengths, limits, and implications of the study for other smoking prevention efforts in schools.

An Online Drug Abuse Prevention Program for Adolescent Girls: Posttest and 1-Year Outcomes.

PubMed

Schwinn, Traci M; Schinke, Steven P; Hopkins, Jessica; Keller, Bryan; Liu, Xiang

2018-03-01

Early adolescent girls' rates of drug use have matched, and in some instances, surpassed boys' rates. Though girls and boys share risk factors for drug use, girls also have gender-specific risks. Tailored interventions to prevent girls' drug use are warranted. This study developed and tested a web-based, drug abuse prevention program for adolescent girls. The nationwide sample of 13- and 14-year-old girls (N = 788) was recruited via Facebook ads. Enrolled girls were randomly assigned to the intervention or control condition. All girls completed pretest measures online. Following pretest, intervention girls interacted with the 9-session, gender-specific prevention program online. The program aimed to reduce girls' drug use and associated risk factors by improving their cognitive and behavioral skills around such areas as coping with stress, managing mood, maintaining a healthy body image, and refusing drug use offers. Girls in both conditions again completed measures at posttest and 1-year follow-up. At posttest, and compared to girls in the control condition, girls who received the intervention smoked fewer cigarettes and reported higher self-esteem, goal setting, media literacy, and self-efficacy. At 1-year follow-up, and compared to girls in the control condition, girls who received the intervention reported engaging in less binge drinking and cigarette smoking; girls assigned to the intervention condition also had higher alcohol, cigarette, and marijuana refusal skills, coping skills, and media literacy and lower rates of peer drug use. This study's findings support the use of tailored, online drug abuse prevention programming for early adolescent girls.

Reductions in HIV risk-associated sexual behaviors among black male adolescents: effects of an AIDS prevention intervention.

PubMed Central

Jemmott, J B; Jemmott, L S; Fong, G T

1992-01-01

BACKGROUND. The number of reported cases of acquired immune deficiency syndrome (AIDS) is increasing disproportionately among Blacks in the United States. The relatively high incidence of sexually transmitted diseases among Black adolescents suggest the need for AIDS prevention programs to reduce their risk of sexually transmitted human immunodeficiency virus (HIV) infection. METHODS. Black male adolescents (n = 157) were randomly assigned to receive an AIDS risk reduction intervention aimed at increasing AIDS-related knowledge and weakening problematic attitudes toward risky sexual behavior, or to receive a control intervention on career opportunities. RESULTS. The adolescents who received the AIDS intervention subsequently had greater AIDS knowledge, less favorable attitudes toward risky sexual behavior, and lower intentions to engage in such behavior than did those in the control condition. Follow-up data collected 3 months later revealed that the adolescents who had received the AIDS intervention reported fewer occasions of coitus, fewer coital partners, greater use of condoms, and a lower incidence of heterosexual anal intercourse than did the other adolescents. CONCLUSIONS. These results suggest that interventions that increase knowledge about AIDS and change attitudes toward risky sexual behavior may have salutary effects on Black adolescents' risk of HIV infection. PMID:1536352

Randomized controlled trial of a mobile phone intervention for improving adherence to naltrexone for alcohol use disorders.

PubMed

Stoner, Susan A; Arenella, Pamela B; Hendershot, Christian S

2015-01-01

Naltrexone is a front-line treatment for alcohol use disorders, but its efficacy is limited by poor medication adherence. This randomized controlled trial evaluated whether a mobile health intervention could improve naltrexone adherence. Treatment-seeking participants with an alcohol use disorder (N = 76) were randomized to intervention and control conditions. All participants received naltrexone (50 mg/day) with a medication event monitoring system (MEMS) and a prepaid smartphone, and received a daily text message querying medication side effects, alcohol use, and craving. Those in the intervention arm received additional medication reminders and adherence assessment via text message. The primary outcome, proportion of participants with adequate adherence (defined as ≥80% of prescribed doses taken through Week 8), did not differ between groups in intent-to-treat analyses (p = .34). Mean adherence at study midpoint (Week 4) was 83% in the intervention condition and 77% in the control condition (p = .35). Survival analysis found that the intervention group sustained adequate adherence significantly longer (M = 19 days [95% CI = 0.0-44.0]) than those in the control group (M = 3 days [95% CI = 0.0-8.1]) during the first month of treatment (p = .04). Medication adherence did not predict drinking outcomes. These results suggest that in the context of daily monitoring and assessment via cell phone, additional text message reminders do not further improve medication adherence. Although this initial trial does not provide support for the efficacy of text messaging to improve adherence to pharmacotherapy for alcohol use disorders, additional trials with larger samples and alternate designs are warranted. ClinicalTrials.gov: NCT01349985.

Effects of a 12 week self-managed stretching program among Korean-Chinese female migrant workers in Korea: a randomized trial.

PubMed

Lee, Hyeonkyeong; Chae, Duckhee; Wilbur, JoEllen; Miller, Arlene; Lee, Kyongeun; Jin, Hwaeun

2014-04-01

The purpose of this study was to assess the efficacy of a 12 week, self-managed, community-based stretching program on musculoskeletal fitness, musculoskeletal symptoms, and acculturative stress, in Korean-Chinese female migrant workers in Korea. This was a randomized controlled trial with random assignment of eligible full-time Korean-Chinese female migrant workers to a stretching exercise intervention (n=40) or an enhanced stretching exercise intervention (n=40) condition. Both conditions received a 6 min stretching exercise program that included an orientation and three work-related musculoskeletal disorder (WMSD) educational classes. Between educational classes, the enhanced stretching exercise condition also received mobile phone text messaging and telephone counseling to increase self-efficacy (confidence in overcoming barriers) and provide social support. Flexibility, muscle strength, musculoskeletal symptoms, and acculturative stress were assessed at baseline and 12 weeks. Significant increase in flexibility was noted for both conditions, but acculturative stress was significantly reduced only in the standard intervention condition. Muscle strength and WMSD symptoms had no significant changes at the 12 week follow up in both conditions. The 12 week, self-managed, community-based, stretching exercise program was effective to increase flexibility. The standard stretching intervention without any enhancements may be a more cost-effective way to increase flexibility. Longitudinal studies, however, are needed to see if the long-term effects are greater in the enhanced intervention for the migrant worker population. © 2013 The Authors. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.

Assessing the impact of a school-based latrine cleaning and handwashing program on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial

PubMed Central

Caruso, Bethany A.; Freeman, Matthew C.; Garn, Joshua V.; Dreibelbis, Robert; Saboori, Shadi; Muga, Richard; Rheingans, Richard

2016-01-01

Improving school water, sanitation and hygiene (WASH) conditions has been shown to be effective in reducing pupil absence and illness. However, the benefit of sanitation and hygiene promotion improvements at school may depend on the conditions of the latrines and availability of consumables. We employed a three-arm, cluster-randomized trial to determine if a low-cost, policy-relevant, environmental-level latrine cleaning intervention could a) improve latrine cleanliness, b) increase latrine use, and c) reduce absenteeism. We assessed absence via periodical roll-call among 17,564 pupils in 60 schools that previously received WASH Improvements as part of the SWASH+ project. Latrine conditions and use were also assessed using structured observation. Latrine cleanliness increased significantly during the post-intervention period among schools receiving the latrine-cleaning package compared to controls. Handwashing with soap increased as well in intervention schools relative to controls. We found no difference in latrine use and absence across arms. The additive impact of cleaning may not have been strong enough to impact absence above and beyond reductions attributable to the original WASH infrastructure improvements and basic hygiene education the schools previously received. Improving latrine conditions is important for the dignity and well being of pupils, and investments and strategies are necessary to ensure school sanitation environments are clean and pupil-friendly. PMID:25055716

[Thermolabile drugs: pharmacist intervention as a guarantee of cold chain maintenance].

PubMed

Ricote-Lobera, I; Santos-Mena, B; Fraile-Gil, S; Ortiz-Martín, B; Hidalgo-Correas, F J; García-Díaz, B

2014-05-01

To determine whether pharmacist is able to guarantee cold chain maintenance of thermolabile drugs during transport using the available information in the reception process and to compare these results with those obtained in a subsequent intervention phase, in which the manufacturing laboratories were contacted. Intervention study, prospective and comparative"before-after". It was analyzed the storage conditions during transport of all thermolabile drugs received in a 400-bed hospital for 3 months, excluding those from clinical trials. The intervention allowed to ensure cold chain maintenance in 76,5% (n = 488) of received drugs, representing an increase of 41,8% (IC 95% 36,7-46,6%; p < 0,001) compared with the percentage obtained before the intervention. The pharmacist isn't able to ensure the cold chain maintenance of received thermolabile drugs without temperature monitoring device (64,6%). Reports requested from laboratories allowed to increase significantly that percentage. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

PNF 2.0? Initial evidence that gamification can increase the efficacy of brief, web-based personalized normative feedback alcohol interventions.

PubMed

Boyle, Sarah C; Earle, Andrew M; LaBrie, Joseph W; Smith, Daniel J

2017-04-01

Gamified interventions exploit the motivational characteristics of a game in order to provide prevention information and promote behavior change. Despite the modest effect sizes observed in increasingly popular web-based personalized normative feedback (PNF) alcohol interventions for college students, previous research has yet to consider how gamification might be used to enhance efficacy. This study examines whether a novel, gamified PNF intervention format, which includes a point-based reward system, the element of chance, and personal icons to visually represent users, is more effective in reducing short-term alcohol use than the standard web-based style of PNF currently used on college campuses. Two-hundred and thirty-seven college students were randomly assigned to receive either a standard brief, web-based PNF alcohol intervention or the same alcohol intervention components delivered within a Facebook-connected social game called CampusGANDR (Gamified Alcohol Norm Discovery and Readjustment). In both study conditions participants answered identical questions about their perceptions of peer drinking norms and own drinking and then received the same PNF slides. Two weeks following PNF delivery, participants again reported their perceptions of peers' alcohol use and own drinking. Students in the CampusGANDR condition reported significantly reduced peer drinking norms and alcohol use at the two-week follow-up relative to students who received identical PNF delivered by standard online survey. Further, a mediation model demonstrated that this effect was driven by larger reductions in perceived drinking norms among participants assigned to receive CampusGANDR, relative to control. As web-based PNF is becoming an increasingly universal prevention strategy, findings from this study suggest gamification may represent one method by which intervention efficacy could be substantially improved. The potential methodological and economic benefits associated with gamified PNF interventions are emphasized and directions for future research are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

PNF 2.0? Initial Evidence that Gamification Can Increase the Efficacy of Brief, Web-based Personalized Normative Feedback Alcohol Interventions

PubMed Central

Boyle, Sarah C.; Earle, Andrew M.; LaBrie, Joseph W.; Smith, Daniel J.

2017-01-01

Gamified interventions exploit the motivational characteristics of a game in order to provide prevention information and promote behavior change. Despite the modest effect sizes observed in increasingly popular web-based personalized normative feedback (PNF) alcohol interventions for college students, previous research has yet to consider how gamification might be used to enhance efficacy. This study examines whether a novel, gamified PNF intervention format, which includes a point-based reward system, the element of chance, and personal icons to visually represent users, is more effective in reducing short-term alcohol use than the standard web-based style of PNF currently used on college campuses. Two-hundred and thirty-seven college students were randomly assigned to receive either a standard brief, web-based PNF alcohol intervention or the same alcohol intervention components delivered within a Facebook-connected social game called CampusGANDR (Gamified Alcohol Norm Discovery and Readjustment). In both study conditions participants answered identical questions about their perceptions of peer drinking norms and own drinking and then received the same PNF slides. Two weeks following PNF delivery, participants again reported their perceptions of peers’ alcohol use and own drinking. Students in the CampusGANDR condition reported significantly reduced peer drinking norms and alcohol use at the two-week follow-up relative to students who received identical PNF delivered by standard online survey. Further, a mediation model demonstrated that this effect was driven by larger reductions in perceived drinking norms among participants assigned to receive CampusGANDR, relative to control. As web-based PNF is becoming an increasingly universal prevention strategy, findings from this study suggest gamification may represent one method by which intervention efficacy could be substantially improved. The potential methodological and economic benefits associated with gamified PNF interventions are emphasized and directions for future research are discussed. PMID:27978426

Bidirectional Effects between Parenting and Aggressive Child Behavior in the Context of a Preventive Intervention.

PubMed

Te Brinke, Lysanne W; Deković, Maja; Stoltz, Sabine E M J; Cillessen, Antonius H N

2017-07-01

Over time, developmental theories and empirical studies have gradually started to adopt a bidirectional viewpoint. The area of intervention research is, however, lagging behind in this respect. This longitudinal study examined whether bidirectional associations between (changes in) parenting and (changes in) aggressive child behavior over time differed in three conditions: a child intervention condition, a child + parent intervention condition and a control condition. Participants were 267 children (74 % boys, 26 % girls) with elevated levels of aggression, their mothers and their teachers. Reactive aggression, proactive aggression and perceived parenting were measured at four measurement times from pretest to one-year after intervention termination. Results showed that associations between aggressive child behavior and perceived parenting are different in an intervention context, compared to a general developmental context. Aggressive behavior and perceived parenting were unrelated over time for children who did not receive an intervention. In an intervention context, however, decreases in aggressive child behavior were related to increases in perceived positive parenting and decreases in perceived overreactivity. These findings underscore the importance of addressing child-driven processes in interventions aimed at children, but also in interventions aimed at both children and their parents.

Estimation of eye lens doses received by pediatric interventional cardiologists.

PubMed

Alejo, L; Koren, C; Ferrer, C; Corredoira, E; Serrada, A

2015-09-01

Maximum Hp(0.07) dose to the eye lens received in a year by the pediatric interventional cardiologists has been estimated. Optically stimulated luminescence dosimeters were placed on the eyes of an anthropomorphic phantom, whose position in the room simulates the most common irradiation conditions. Maximum workload was considered with data collected from procedures performed in the Hospital. None of the maximum values obtained exceed the dose limit of 20 mSv recommended by ICRP. Copyright © 2015 Elsevier Ltd. All rights reserved.

Study protocol for a self-controlled cluster randomised trial of the Alert Program to improve self-regulation and executive function in Australian Aboriginal children with fetal alcohol spectrum disorder

PubMed Central

Fitzpatrick, James P; Mazzucchelli, Trevor G; Symons, Martyn; Carmichael Olson, Heather; Jirikowic, Tracy; Cross, Donna; Wright, Edie; Adams, Emma; Carter, Maureen; Bruce, Kaashifah; Latimer, Jane

2018-01-01

Introduction While research highlights the benefits of early diagnosis and intervention for children with fetal alcohol spectrum disorders (FASD), there are limited data documenting effective interventions for Australian children living in remote communities. Methods and analysis This self-controlled cluster randomised trial is evaluating the effectiveness of an 8-week Alert Program school curriculum for improving self-regulation and executive function in children living in remote Australian Aboriginal communities. Children in grades 1–6 attending any of the eight participating schools across the Fitzroy Valley in remote North-West Australia (N ≈ 363) were invited to participate. Each school was assigned to one of four clusters with clusters randomly assigned to receive the intervention at one of four time points. Clusters two, three and four had extended control conditions where students received regular schooling before later receiving the intervention. Trained classroom teachers delivered the Alert Program to students in discrete, weekly, 1-hour lessons. Student outcomes were assessed at three time points. For the intervention condition, data collection occurred 2 weeks immediately before and after the intervention, with a follow-up 8 weeks later. For control conditions in clusters two to four, the control data collection matched that of the data collection for the intervention condition in the preceding cluster. The primary outcome is change in self-regulation. FASD diagnoses will be determined via medical record review after the completion of data collection. The results will be analysed using generalised linear mixed modelling and reported in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines. Ethics and dissemination Ethical approval was obtained from the University of Western Australia (WA) (RA/4/1/7234), WA Aboriginal Health Ethics Committee (601) and WA Country Health Service (2015:04). The Kimberley Aboriginal Health Planning Forum Research Sub-Committee and WA Department of Education also provided approval. The results will be disseminated through peer-reviewed journals, conference presentations, the media and at forums. Trial registration number ACTRN12615000733572; Pre-results. PMID:29581212

The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.

PubMed

Kalsi, T; Babic-Illman, G; Ross, P J; Maisey, N R; Hughes, S; Fields, P; Martin, F C; Wang, Y; Harari, D

2015-04-28

Although comorbidities are identified in routine oncology practice, intervention plans for the coexisting needs of older people receiving chemotherapy are rarely made. This study evaluates the impact of geriatrician-delivered comprehensive geriatric assessment (CGA) interventions on chemotherapy toxicity and tolerance for older people with cancer. Comparative study of two cohorts of older patients (aged 70+ years) undergoing chemotherapy in a London Hospital. The observational control group (N=70, October 2010-July 2012) received standard oncology care. The intervention group (N=65, September 2011-February 2013) underwent risk stratification using a patient-completed screening questionnaire and high-risk patients received CGA. Impact of CGA interventions on chemotherapy tolerance outcomes and grade 3+ toxicity rate were evaluated. Outcomes were adjusted for age, comorbidity, metastatic disease and initial dose reductions. Intervention participants undergoing CGA received mean of 6.2±2.6 (range 0-15) CGA intervention plans each. They were more likely to complete cancer treatment as planned (odds ratio (OR) 4.14 (95% CI: 1.50-11.42), P=0.006) and fewer required treatment modifications (OR 0.34 (95% CI: 0.16-0.73), P=0.006). Overall grade 3+ toxicity rate was 43.8% in the intervention group and 52.9% in the control (P=0.292). Geriatrician-led CGA interventions were associated with improved chemotherapy tolerance. Standard oncology care should shift towards modifying coexisting conditions to optimise chemotherapy outcomes for older people.

Fostering adolescents' value beliefs for mathematics with a relevance intervention in the classroom.

PubMed

Gaspard, Hanna; Dicke, Anna-Lena; Flunger, Barbara; Brisson, Brigitte Maria; Häfner, Isabelle; Nagengast, Benjamin; Trautwein, Ulrich

2015-09-01

Interventions targeting students' perceived relevance of the learning content have been shown to effectively promote student motivation within science classes (e.g., Hulleman & Harackiewicz, 2009). Yet, further research is warranted to understand better how such interventions should be designed in order to be successfully implemented in the classroom setting. A cluster randomized controlled study was conducted to test whether ninth-grade students' value beliefs for mathematics (i.e., intrinsic value, attainment value, utility value, and cost) could be fostered with relevance interventions in the classroom. Eighty-two classrooms were randomly assigned to 1 of 2 experimental conditions or a waiting control condition. Both experimental groups received a 90-min intervention within the classroom on the relevance of mathematics, consisting of a psychoeducational presentation and relevance-inducing tasks (either writing a text or evaluating interview quotations). Intervention effects were evaluated via self-reports of 1,916 participating students 6 weeks and 5 months after the intervention in the classroom. Both intervention conditions fostered more positive value beliefs among students at both time points. Compared with the control condition, classes in the quotations condition reported higher utility value, attainment value, and intrinsic value, and classes in the text condition reported higher utility value. Thus, stronger effects on students' value beliefs were found for the quotations condition than for the text condition. When assessing intervention effects separately for females and males, some evidence for stronger effects for females than for males was found. (c) 2015 APA, all rights reserved).

Efficacy of a family intervention program for prevention of hospitalization in patients with schizophrenia. A naturalistic multicenter controlled and randomized study in Spain.

PubMed

Mayoral, Fermín; Berrozpe, Adela; de la Higuera, Jesús; Martinez-Jambrina, Juan José; de Dios Luna, Juan; Torres-Gonzalez, Francisco

2015-01-01

According to most relevant guidelines, family psycho-educational interventions are considered to be one the most effective psychosocial treatments for people with schizophrenia. The main outcome measure in controlled and randomized studies has been prevention of relapses and admissions, and encouragement of compliance, although some questions remain about its applicability and results in clinical practice. The aim of study was to evaluate the efficacy and implementation of a single family psychoeducational intervention in 'real' conditions for people diagnosed with schizophrenia. A total of 88 families were randomized in two groups. The family intervention group received a 12 months psychoeducational treatment, and the other group followed normal standard treatment. Assessments were made at baseline, at 12 and at 18 months. The main outcome measure was hospitalization, and secondary outcome measures were clinical condition (BPRS-E) and social disability (DAS-II). A total of 71 patients finished the study (34 family intervention group and 37 control group). Patients who received family intervention reduced the risk of hospitalization by 40% (P = .4018; 95%CI: 0.1833-0.6204). Symptomatology improved significantly at 12 months (P = .4018; 95%CI: 0.1833-0.6204), but not at 18 months (P = .4018; 95%CI: 0.1833-0.6204). Social disability was significantly reduced in the family intervention group at 12 months and 18 months. Family psychoeducational intervention reduces hospitalization risk and improves clinical condition and social functioning of people with schizophrenia. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

A Preliminary Randomized Controlled Trial of a Behavioral Exercise Intervention for Smoking Cessation

PubMed Central

Bloom, Erika Litvin; Strong, David R.; Riebe, Deborah; Marcus, Bess H.; Desaulniers, Julie; Fokas, Kathryn; Brown, Richard A.

2014-01-01

Introduction: Previous exercise intervention studies for smoking cessation have been challenged by a number of methodological limitations that confound the potential efficacy of aerobic exercise for smoking cessation. Methods: The preliminary efficacy of a behavioral exercise intervention that incorporated features designed to address prior limitations was tested in a randomized controlled trial (RCT). Sixty-one smokers (65.6% female, mean age = 47.3 years, smoked a mean of 19.7 cigarettes/day) were randomized to receive either a 12-week exercise intervention or a 12-week health education contact control. Participants in both conditions received an 8-week telephone-delivered, standard smoking cessation protocol (with the transdermal nicotine patch). Follow-ups were conducted at the end of treatment (EOT), 6- and 12-month timepoints. Results: There were no differences between conditions with respect to the number of weekly exercise or health education sessions attended (9.3±2.8 vs. 9.3±3.0, respectively). While not statistically significant, participants in the exercise condition demonstrated higher verified abstinence rates (EOT: 40% vs. 22.6%, odds ratio [OR] = 2.28; 6- and 12-month follow-ups: 26.7% vs. 12.9%, OR = 2.46). Irrespective of treatment condition, higher levels of moderate-to-vigorous exercise were associated with lower levels of depressive symptoms during the intervention. Conclusions: The results of this small RCT point toward the benefit of a behavioral exercise intervention designed to address previous methodological limitations for smoking cessation. Given the potential public health impact of the demonstrated efficacy of exercise for smoking cessation, the continued development and optimization of exercise interventions for smokers through larger RCTs merits pursuit. PMID:24812023

Efficacy of Visual-Acoustic Biofeedback Intervention for Residual Rhotic Errors: A Single-Subject Randomization Study

ERIC Educational Resources Information Center

Byun, Tara McAllister

2017-01-01

Purpose: This study documented the efficacy of visual-acoustic biofeedback intervention for residual rhotic errors, relative to a comparison condition involving traditional articulatory treatment. All participants received both treatments in a single-subject experimental design featuring alternating treatments with blocked randomization of…

Lessons Learned Through the Implementation of an eHealth Physical Activity Gaming Intervention with High School Youth.

PubMed

Pope, Lizzy; Garnett, Bernice; Dibble, Marguerite

2018-04-01

To encourage high school students to meet physical activity goals using a newly developed game, and to document the feasibility, benefits, and challenges of using an electronic gaming application to promote physical activity in high school students. Working with youth and game designers an electronic game, Camp Conquer, was developed to motivate high school students to meet physical activity goals. One-hundred-five high school students were recruited to participate in a 12-week pilot test of the game and randomly assigned to a Game Condition or Control Condition. Students in both conditions received a FitBit to track their activity, and participants in the Game Condition received access to Camp Conquer. Number of steps and active minutes each day were tracked for all participants. FitBit use, game logins, and qualitative feedback from researchers, school personnel, and participants were used to determine intervention engagement. The majority of study participants did not consistently wear their FitBit or engage with the gaming intervention. Numerous design challenges and barriers to successful implementation such as the randomized design, absence of a true school-based champion, ease of use, and game glitches were identified. Developing games is an exciting technique for motivating the completion of a variety of health behaviors. Although the present intervention was not successful in increasing physical activity in high school students, important lessons were learned regarding how to best structure a gaming intervention for the high school population.

Walking Works Wonders: a tailored workplace intervention evaluated over 24 months.

PubMed

Haslam, Cheryl; Kazi, Aadil; Duncan, Myanna; Clemes, Stacy; Twumasi, Ricardo

2018-06-22

This article presents longitudinal data from 1120 participants across 10 worksites enrolled in Walking Works Wonders, a tailored intervention designed to increase physical activity and reduce sedentary behaviour. The intervention was evaluated over 2 years, using a quasi-experimental design comprising 3 conditions: tailored information; standard information and control. This study explored the impact of the intervention on objective measures (BMI, %Fat, waist circumference, blood pressure and heart rate) and self-reported measures of physical activity, sedentary behaviour, physical and psychological health. Interventions tailored to employees' stage of change significantly reduced BMI and waist circumference compared to standard and control conditions. Employees who received either a standard or tailored intervention demonstrated significantly higher work ability, organizational commitment, job motivation, job satisfaction, and a reduction in intention to quit the organization. The results suggest that adopting a tailored approach to interventions.

Using Songs to Strengthen Reading Fluency

ERIC Educational Resources Information Center

Patel, Pooja; Laud, Leslie E.

2007-01-01

This study evaluated the use of songs with lyrics to increase the reading fluency rates of three middle school students. In the first condition, students heard fluent reading modeled, read regular passages repeatedly and then received feedback on accuracy, phrasing and expression. After that, students received the same intervention, except that…

Educational interventions in peritoneal dialysis: a narrative review of the literature.

PubMed

Schaepe, Christiane; Bergjan, Manuela

2015-04-01

To review the current literature on educational interventions used in peritoneal dialysis (PD). Educational interventions have become increasingly relevant because they play a key role in helping individuals to actively participate in their therapy and to manage their chronic condition. The paper will focus on two areas: (a) educational interventions for individuals living with PD and (b) educational interventions for PD nurses. A narrative review of primary research. Electronic searches of the MEDLINE, CINAHL, EMBASE, ERIC and Cochrane Library (2006-2013) databases were undertaken using terms such as peritoneal dialysis, insertive training, curriculum, nursing education, train the trainer, coach the coach, tutor the tutor, and patient education were used. All studies were reviewed by two researchers. Titles and abstracts of 555 studies were screened and read. Full text articles retrieved were further screened against the inclusion and exclusion criteria. Relevant data on the educational interventions for people receiving PD and nurse training programs were extracted and synthesized narratively. Eighteen articles met the inclusion criteria. Most of them focused on educational intervention programs for people undergoing PD. Findings on the link between the PD trainer's background and peritonitis rates among individuals undergoing PD are inconsistent. PD learners should be taught self-management skills as well as technical skills. They might also benefit from receiving decision-making aids. Older people, people with co-morbidities and people with low educational status need more time to acquire self-care skills and are more likely to develop peritonitis. Home visits have the potential to improve learning outcomes. Re-training needs should be assessed and fulfilled as appropriate. Case and disease management programs have been shown to have positive outcomes for individuals receiving PD. Educational interventions for PD remain an under-researched area, despite the potential they have to make this type of therapy more successful. Further research on education and training for people receiving PD and for PD nurses is needed. In the meantime, educational interventions used for other chronic conditions could provide guidance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Establishing books as conditioned reinforcers for preschool children as a function of an observational intervention.

PubMed

Singer-Dudek, Jessica; Oblak, Mara; Greer, R Douglas

2011-01-01

We tested the effects of an observational intervention (Greer & Singer-Dudek, 2008) on establishing children's books as conditioned reinforcers using a delayed multiple baseline design. Three preschool students with mild language and developmental delays served as the participants. Prior to the intervention, books did not function as reinforcers for any of the participants. The observational intervention consisted of a situation in which the participant observed a confederate being presented with access to books contingent on correct responses and the participant received nothing for correct responses. After several sessions of this treatment, the previously neutral books acquired reinforcing properties for maintenance and acquisition responses for all three participants.

ESTABLISHING BOOKS AS CONDITIONED REINFORCERS FOR PRESCHOOL CHILDREN AS A FUNCTION OF AN OBSERVATIONAL INTERVENTION

PubMed Central

Singer-Dudek, Jessica; Oblak, Mara; Greer, R. Douglas

2011-01-01

We tested the effects of an observational intervention (Greer & Singer-Dudek, 2008) on establishing children's books as conditioned reinforcers using a delayed multiple baseline design. Three preschool students with mild language and developmental delays served as the participants. Prior to the intervention, books did not function as reinforcers for any of the participants. The observational intervention consisted of a situation in which the participant observed a confederate being presented with access to books contingent on correct responses and the participant received nothing for correct responses. After several sessions of this treatment, the previously neutral books acquired reinforcing properties for maintenance and acquisition responses for all three participants. PMID:21941376

Economic evaluation of a web-based tailored lifestyle intervention for adults: findings regarding cost-effectiveness and cost-utility from a randomized controlled trial.

PubMed

Schulz, Daniela N; Smit, Eline S; Stanczyk, Nicola E; Kremers, Stef P J; de Vries, Hein; Evers, Silvia M A A

2014-03-20

Different studies have reported the effectiveness of Web-based computer-tailored lifestyle interventions, but economic evaluations of these interventions are scarce. The objective was to assess the cost-effectiveness and cost-utility of a sequential and a simultaneous Web-based computer-tailored lifestyle intervention for adults compared to a control group. The economic evaluation, conducted from a societal perspective, was part of a 2-year randomized controlled trial including 3 study groups. All groups received personalized health risk appraisals based on the guidelines for physical activity, fruit intake, vegetable intake, alcohol consumption, and smoking. Additionally, respondents in the sequential condition received personal advice about one lifestyle behavior in the first year and a second behavior in the second year; respondents in the simultaneous condition received personal advice about all unhealthy behaviors in both years. During a period of 24 months, health care use, medication use, absenteeism from work, and quality of life (EQ-5D-3L) were assessed every 3 months using Web-based questionnaires. Demographics were assessed at baseline, and lifestyle behaviors were assessed at both baseline and after 24 months. Cost-effectiveness and cost-utility analyses were performed based on the outcome measures lifestyle factor (the number of guidelines respondents adhered to) and quality of life, respectively. We accounted for uncertainty by using bootstrapping techniques and sensitivity analyses. A total of 1733 respondents were included in the analyses. From a willingness to pay of €4594 per additional guideline met, the sequential intervention (n=552) was likely to be the most cost-effective, whereas from a willingness to pay of €10,850, the simultaneous intervention (n=517) was likely to be most cost-effective. The control condition (n=664) appeared to be preferred with regard to quality of life. Both the sequential and the simultaneous lifestyle interventions were likely to be cost-effective when it concerned the lifestyle factor, whereas the control condition was when it concerned quality of life. However, there is no accepted cutoff point for the willingness to pay per gain in lifestyle behaviors, making it impossible to draw firm conclusions. Further economic evaluations of lifestyle interventions are needed. Dutch Trial Register NTR2168; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2168 (Archived by WebCite at http://www.webcitation.org/6MbUqttYB).

Effectiveness of a Smoking Cessation Intervention in Dutch Pharmacies and General Practices

ERIC Educational Resources Information Center

Hoving, Ciska; Mudde, Aart N.; Dijk, Froukje; de Vries, Hein

2010-01-01

Purpose: The purpose of this paper is to test the effectiveness of a computer-tailored smoking cessation intervention, distributed through 75 Dutch general practices (GP) and 65 pharmacies (PH) in a randomised control trial. Design/methodology/approach: Respondents receive a tailored letter or a thank you letter (control condition). Main outcome…

Classroom Management Intervention: The Effects of Training and Mentoring on the Inductee Teacher's Behavior.

ERIC Educational Resources Information Center

Stallion, Brenda K.; Zimpher, Nancy L.

1991-01-01

Study assessed a classroom management program embedded in a mentor and beginning teacher induction program. Researchers assigned mentor/beginning teacher pairs to treatment conditions. Some pairs completed a midyear classroom management intervention workshop. Trained teachers received higher ratings than untrained ones. The presence of mentors did…

Early elementary school intervention to reduce conduct problems: a randomized trial with Hispanic and non-Hispanic children.

PubMed

Barrera, Manuel; Biglan, Anthony; Taylor, Ted K; Gunn, Barbara K; Smolkowski, Keith; Black, Carol; Ary, Dennis V; Fowler, Rollen C

2002-06-01

Children's aggressive behavior and reading difficulties during early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address both of these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. European American (n = 116) and Hispanic (n = 168) children from 3 communities who were selected for aggressiveness or reading difficulties were randomly assigned to an intervention or no-intervention control condition. Intervention families received parent training, and their children received social behavior interventions and supplementary reading instruction over a 2-year period. At the end of intervention, playground observations showed that treated children displayed less negative social behavior than controls. At the end of a 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. The study's limitations and implications for prevention are discussed.

Using memories to motivate future behaviour: an experimental exercise intervention.

PubMed

Biondolillo, Mathew J; Pillemer, David B

2015-01-01

This study tested a novel memory-based experimental intervention to increase exercise activity. Undergraduate students completed a two-part online survey ostensibly regarding college activity choices. At Time 1, they completed questionnaires that included assessments of exercise-related attitudes, motivation and self-reported behaviours. Next, they described a memory of a positive or negative experience that would increase their motivation to exercise; students in a control condition did not receive a memory prompt. Finally, they rated their intentions to exercise in the future. Eight days following Time 1, students received a Time 2 survey that included an assessment of their self-reported exercise during the prior week. Students in the positive memory condition reported higher levels of subsequent exercise than those in the control condition; students in the negative memory condition reported intermediate levels of exercise. Activating a positive motivational memory had a significant effect on students' self-reported exercise activity even after controlling for prior attitudes, motivation and exercise activity.

Workplace Triple P: A controlled evaluation of a parenting intervention for working parents.

PubMed

Sanders, Matthew R; Stallman, Helen M; McHale, Mala

2011-08-01

This paper examined the effects of a parenting intervention targeting working parents called Workplace Triple P. The intervention targeted both parenting and work factors, focusing on key transition times (e.g., from home to work) and trained parents to more effectively manage these transitions. One-hundred-and-twenty-one working parents with children ranging in age from 1-16 years were randomly assigned to either a Workplace Triple P condition (WPTP) or to a waitlist control condition (WLC). Results showed that parents who had received the intervention reported significantly lower levels on measures of personal distress and dysfunctional parenting; and higher levels of work commitment, work satisfaction, and self-efficacy. Implications for the delivery of parenting interventions as employee assistance programs are discussed along with how such interventions can enhance work and family life.

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

PubMed

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

2014-09-01

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

The effects and interactions of student, teacher, and setting variables on reading outcomes for kindergartners receiving supplemental reading intervention.

PubMed

Hagan-Burke, Shanna; Coyne, Michael D; Kwok, Oi-Man; Simmons, Deborah C; Kim, Minjung; Simmons, Leslie E; Skidmore, Susan T; Hernandez, Caitlin L; McSparran Ruby, Maureen

2013-01-01

This exploratory study examined the influences of student, teacher, and setting characteristics on kindergarteners' early reading outcomes and investigated whether those relations were moderated by type of intervention. Participants included 206 kindergarteners identified as at risk for reading difficulties and randomly assigned to one of two supplemental interventions: (a) an experimental explicit, systematic, code-based program or (b) their schools' typical kindergarten reading intervention. Results from separate multilevel structural equation models indicated that among student variables, entry-level alphabet knowledge was positively associated with phonemic and decoding outcomes in both conditions. Entry-level rapid automatized naming also positively influenced decoding outcomes in both conditions. However, its effect on phonemic outcomes was statistically significant only among children in the typical practice comparison condition. Regarding teacher variables, the quality of instruction was associated with significantly higher decoding outcomes in the typical reading intervention condition but had no statistically significant influence on phonemic outcomes in either condition. Among setting variables, instruction in smaller group sizes was associated with better phonemic outcomes in the comparison condition but had no statistically significant influence on outcomes of children in the intervention group. Mode of delivery (i.e., pullout vs. in class) had no statistically significant influence on either outcome variable.

An analysis of maintenance following functional communication training.

PubMed Central

Durand, V M; Carr, E G

1992-01-01

The multiple and long-term effects of functional communication training relative to a common reductive procedure (time-out from positive reinforcement) were evaluated. Twelve children participated in a functional analysis of their challenging behaviors (Study 1), which implicated adult attention as a maintaining variable. The children were then matched for chronological age, mental age, and language age and assigned to two groups. One group received functional communication training as an intervention for their challenging behavior, and the second group received time-out as a contrast. Both interventions were initially successful (Study 2), but durable results were achieved only with the group that received functional communication training across different stimulus conditions (Study 3). Students whose challenging behaviors were previously reduced with time-out resumed these behaviors in the presence of naive teachers unaware of the children's intervention history. The value of teaching communicative responses to promote maintenance is discussed as it relates to the concept of functional equivalence. PMID:1478902

Improving parenting in families referred for child maltreatment: a randomized controlled trial examining effects of Project Support.

PubMed

Jouriles, Ernest N; McDonald, Renee; Rosenfield, David; Norwood, William D; Spiller, Laura; Stephens, Nanette; Corbitt-Shindler, Deborah; Ehrensaft, Miriam

2010-06-01

Project Support is an intervention designed to decrease coercive patterns of aggressive discipline and increase positive parenting. This research evaluates Project Support in a sample of families reported to Children's Protective Services (CPS) for allegations of physical abuse or neglect; 35 families with a child between 3- and 8-years-old participated. In all families, CPS allowed the children to remain in the family home while the family received services. Families were randomly assigned to receive either Project Support or services as usual, which were provided by CPS or CPS-contracted service providers. To evaluate intervention effects, a multimethod, multi-informant assessment strategy was used that included data from mothers' reports, direct observation of parents' behavior, and review of CPS records for re-referrals for child maltreatment. Families who received Project Support services showed greater decreases than families who received services as usual in the following areas: mothers' perceived inability to manage childrearing responsibilities, mothers' reports of harsh parenting, and observations of ineffective parenting practices. Only 5.9% of families in the Project Support condition had a subsequent referral to CPS for child maltreatment, compared with 27.7% of families in the comparison condition. The results suggest that Project Support may be a promising intervention for reducing child maltreatment among families in which it has occurred. (c) 2010 APA, all rights reserved.

Using the Precaution Adoption Process Model to Describe a Disaster Preparedness Intervention among Low-Income Latinos

ERIC Educational Resources Information Center

Glik, Deborah C.; Eisenman, David P.; Zhou, Qiong; Tseng, Chi-Hong; Asch, Steven M.

2014-01-01

Only 40-50% of households in the United States are currently disaster prepared. In this intervention study, respondent-driven sampling was used to select a sample (n = 187) of low income, Latino residents of Los Angeles County, randomly assigned into two treatment conditions: (i) household preparedness education received through…

A Systemic Approach to Implementing Response to Intervention in Three Colorado High Schools

ERIC Educational Resources Information Center

Duffy, Helen; Scala, Jenny

2012-01-01

The National High School Center continues to receive inquiries about how to support high school implementation of response to intervention (RTI). Given the National High School Center's previous work on the topic, the authors wanted to better understand the conditions that contribute to or inhibit implementation of tiered frameworks in high…

Effects of a web-based tailored multiple-lifestyle intervention for adults: a two-year randomized controlled trial comparing sequential and simultaneous delivery modes.

PubMed

Schulz, Daniela N; Kremers, Stef P J; Vandelanotte, Corneel; van Adrichem, Mathieu J G; Schneider, Francine; Candel, Math J J M; de Vries, Hein

2014-01-27

Web-based computer-tailored interventions for multiple health behaviors can have a significant public health impact. Yet, few randomized controlled trials have tested this assumption. The objective of this paper was to test the effects of a sequential and simultaneous Web-based tailored intervention on multiple lifestyle behaviors. A randomized controlled trial was conducted with 3 tailoring conditions (ie, sequential, simultaneous, and control conditions) in the Netherlands in 2009-2012. Follow-up measurements took place after 12 and 24 months. The intervention content was based on the I-Change model. In a health risk appraisal, all respondents (N=5055) received feedback on their lifestyle behaviors that indicated whether they complied with the Dutch guidelines for physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking. Participants in the sequential (n=1736) and simultaneous (n=1638) conditions received tailored motivational feedback to change unhealthy behaviors one at a time (sequential) or all at the same time (simultaneous). Mixed model analyses were performed as primary analyses; regression analyses were done as sensitivity analyses. An overall risk score was used as outcome measure, then effects on the 5 individual lifestyle behaviors were assessed and a process evaluation was performed regarding exposure to and appreciation of the intervention. Both tailoring strategies were associated with small self-reported behavioral changes. The sequential condition had the most significant effects compared to the control condition after 12 months (T1, effect size=0.28). After 24 months (T2), the simultaneous condition was most effective (effect size=0.18). All 5 individual lifestyle behaviors changed over time, but few effects differed significantly between the conditions. At both follow-ups, the sequential condition had significant changes in smoking abstinence compared to the simultaneous condition (T1 effect size=0.31; T2 effect size=0.41). The sequential condition was more effective in decreasing alcohol consumption than the control condition at 24 months (effect size=0.27). Change was predicted by the amount of exposure to the intervention (total visiting time: beta=-.06; P=.01; total number of visits: beta=-.11; P<.001). Both interventions were appreciated well by respondents without significant differences between conditions. Although evidence was found for the effectiveness of both programs, no simple conclusive finding could be drawn about which intervention mode was more effective. The best kind of intervention may depend on the behavior that is targeted or on personal preferences and motivation. Further research is needed to identify moderators of intervention effectiveness. The results need to be interpreted in view of the high and selective dropout rates, multiple comparisons, and modest effect sizes. However, a large number of people were reached at low cost and behavioral change was achieved after 2 years. Nederlands Trial Register: NTR 2168; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2168 (Archived by WebCite at http://www.webcitation.org/6MbUqttYB).

A causal model for longitudinal randomised trials with time-dependent non-compliance

PubMed Central

Becque, Taeko; White, Ian R; Haggard, Mark

2015-01-01

In the presence of non-compliance, conventional analysis by intention-to-treat provides an unbiased comparison of treatment policies but typically under-estimates treatment efficacy. With all-or-nothing compliance, efficacy may be specified as the complier-average causal effect (CACE), where compliers are those who receive intervention if and only if randomised to it. We extend the CACE approach to model longitudinal data with time-dependent non-compliance, focusing on the situation in which those randomised to control may receive treatment and allowing treatment effects to vary arbitrarily over time. Defining compliance type to be the time of surgical intervention if randomised to control, so that compliers are patients who would not have received treatment at all if they had been randomised to control, we construct a causal model for the multivariate outcome conditional on compliance type and randomised arm. This model is applied to the trial of alternative regimens for glue ear treatment evaluating surgical interventions in childhood ear disease, where outcomes are measured over five time points, and receipt of surgical intervention in the control arm may occur at any time. We fit the models using Markov chain Monte Carlo methods to obtain estimates of the CACE at successive times after receiving the intervention. In this trial, over a half of those randomised to control eventually receive intervention. We find that surgery is more beneficial than control at 6months, with a small but non-significant beneficial effect at 12months. © 2015 The Authors. Statistics in Medicine Published by JohnWiley & Sons Ltd. PMID:25778798

The Effects of Local Vibration on Balance, Power, and Self-Reported Pain After Exercise.

PubMed

Custer, Lisa; Peer, Kimberly S; Miller, Lauren

2017-05-01

Muscle fatigue and acute muscle soreness occur after exercise. Application of a local vibration intervention may reduce the consequences of fatigue and soreness. To examine the effects of a local vibration intervention after a bout of exercise on balance, power, and self-reported pain. Single-blind crossover study. Laboratory. 19 healthy, moderately active subjects. After a 30-min bout of full-body exercise, subjects received either an active or a sham vibration intervention. The active vibration intervention was performed bilaterally over the muscle bellies of the triceps surae, quadriceps, hamstrings, and gluteals. At least 1 wk later, subjects repeated the bout, receiving the other vibration intervention. Static balance, dynamic balance, power, and self-reported pain were measured at baseline, after the vibration intervention, and 24 h postexercise. After the bout of exercise, subjects had reduced static and dynamic balance and increased self-reported pain regardless of vibration intervention. There were no differences between outcome measures between the active and sham vibration conditions. The local vibration intervention did not affect balance, power, or self-reported pain.

The effect of wet cupping on quality of life of adult patients with chronic medical conditions in King Abdulaziz University Hospital.

PubMed

Al Jaouni, Soad K; El-Fiky, Eman A; Mourad, Samiha A; Ibrahim, Nahla Khamis; Kaki, Abdullah M; Rohaiem, Sawsan M; Qari, Mohamad H; Tabsh, Laila M; Aljawhari, Adel A

2017-01-01

To assess the effect of wet cupping on health-related quality of life (HRQOL) of adult patients with chronic medical conditions, who were referred to the Cupping Clinic of King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. Methods: A controlled, quasi-experimental study design was carried out among 629 patients referred for cupping from the KAUH Specialty Clinics, during the period from January to December 2014. Patients in the intervention group (309 patients) completed a pre-test included WHO quality of life-BREF, received one wet-cupping session, and filled-out the post-test (1 month later). Patients in the control group (320 patients) completed the pre-test during their enrollment in the study and post-test one month later. Both groups received their ordinary treatment. Descriptive and inferential statistics were performed.  Results: Pain was the most common cause for cupping referral. After cupping intervention, the mean scores of most of the HRQOL domains, especially the physical domain, improved significantly among patients in the intervention group. The mean total score of physical HRQOL domain was 61.6 ± 13.6 before cupping, and reached 69.7 ± 12.6 after intervention (paired t-test=11.3, p=0.000). Improvements in HRQOL were noticed for almost all types of pain and other medical conditions.  Conclusion: There are promising effects in favor of using wet cupping for improving HRQOL of patients with chronic conditions. Cupping is recommended as a complementary treatment modality for chronic medical conditions, especially pain.

The effect of wet cupping on quality of life of adult patients with chronic medical conditions in King Abdulaziz University Hospital

PubMed Central

Jaouni, Soad K. Al; El-Fiky, Eman A.; Mourad, Samiha A.; Ibrahim, Nahla Khamis; Kaki, Abdullah M.; Rohaiem, Sawsan M.; Qari, Mohamad H.; Tabsh, Laila M.; Aljawhari, Adel A.

2017-01-01

Objectives: To assess the effect of wet cupping on health-related quality of life (HRQOL) of adult patients with chronic medical conditions, who were referred to the Cupping Clinic of King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. Methods: A controlled, quasi-experimental study design was carried out among 629 patients referred for cupping from the KAUH Specialty Clinics, during the period from January to December 2014. Patients in the intervention group (309 patients) completed a pre-test included WHO quality of life-BREF, received one wet-cupping session, and filled-out the post-test (1 month later). Patients in the control group (320 patients) completed the pre-test during their enrollment in the study and post-test one month later. Both groups received their ordinary treatment. Descriptive and inferential statistics were performed. Results: Pain was the most common cause for cupping referral. After cupping intervention, the mean scores of most of the HRQOL domains, especially the physical domain, improved significantly among patients in the intervention group. The mean total score of physical HRQOL domain was 61.6 ± 13.6 before cupping, and reached 69.7 ± 12.6 after intervention (paired t-test=11.3, p=0.000). Improvements in HRQOL were noticed for almost all types of pain and other medical conditions. Conclusion: There are promising effects in favor of using wet cupping for improving HRQOL of patients with chronic conditions. Cupping is recommended as a complementary treatment modality for chronic medical conditions, especially pain. PMID:28042631

Effects of promotional materials on vending sales of low-fat items in teachers' lounges.

PubMed

Fiske, Amy; Cullen, Karen Weber

2004-01-01

This study examined the impact of an environmental intervention in the form of promotional materials and increased availability of low-fat items on vending machine sales. Ten vending machines were selected and randomly assigned to one of three conditions: control, or one of two experimental conditions. Vending machines in the two intervention conditions received three additional low-fat selections. Low-fat items were promoted at two levels: labels (intervention I), and labels plus signs (intervention II). The number of individual items sold and the total revenue generated was recorded weekly for each machine for 4 weeks. Use of promotional materials resulted in a small, but not significant, increase in the number of low-fat items sold, although machine sales were not significantly impacted by the change in product selection. Results of this study, although not statistically significant, suggest that environmental change may be a realistic means of positively influencing consumer behavior.

Intervention outcomes among HIV-affected families over 18 months.

PubMed

Rotheram-Borus, Mary Jane; Rice, Eric; Comulada, W Scott; Best, Karin; Elia, Carla; Peters, Katherine; Li, Li; Green, Sara; Valladares, Ena

2012-07-01

We evaluate the efficacy of a family-based intervention over time among HIV-affected families. Mothers living with HIV (MLH; n = 339) in Los Angeles and their school-aged children were randomized to either an intervention or control condition and followed for 18 months. MLH and their children in the intervention received 16 cognitive-behavioral, small-group sessions designed to help them maintain physical and mental health, parent while ill, address HIV-related stressors, and reduce HIV-transmission behaviors. At recruitment, MLH reported few problem behaviors related to physical health, mental health, or sexual or drug transmission acts. Compared to MLH in the control condition, intervention MLH were significantly more likely to monitor their own CD4 cell counts and their children were more likely to decrease alcohol and drug use. Most MLH and their children had relatively healthy family relationships. Family-based HIV interventions should be limited to MLH who are experiencing substantial problems.

Assessing the impact of a school-based latrine cleaning and handwashing program on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial.

PubMed

Caruso, Bethany A; Freeman, Matthew C; Garn, Joshua V; Dreibelbis, Robert; Saboori, Shadi; Muga, Richard; Rheingans, Richard

2014-10-01

Improving school water, sanitation and hygiene (WASH) conditions reduces pupil absence and illness. However, these benefits may depend on the conditions of the latrines and availability of consumables. We sought to determine whether a low-cost, policy-relevant, environmental-level latrine cleaning intervention could improve latrine cleanliness, increase its use and reduce absenteeism. In a three-arm, cluster-randomized trial we assessed absence via periodical roll-call among 17 564 pupils in 60 schools that had previously received WASH improvements as part of the SWASH+ project. Latrine conditions and use were also assessed using structured observation. Latrine cleanliness increased significantly during the post-intervention period among schools receiving the latrine cleaning package compared to controls, as did handwashing with soap. We found no difference in latrine use and absence across arms. The additive impact of cleaning may not have been strong enough to impact absence above and beyond reductions attributable to the original WASH infrastructure improvements and basic hygiene education the schools previously received. Improving latrine conditions is important for the dignity and well-being of pupils, and investments and strategies are necessary to ensure that school toilets are clean and pupil-friendly. © 2014 John Wiley & Sons Ltd.

Program Completion of a Web-Based Tailored Lifestyle Intervention for Adults: Differences between a Sequential and a Simultaneous Approach

PubMed Central

Schneider, Francine; de Vries, Hein; van Osch, Liesbeth ADM; van Nierop, Peter WM; Kremers, Stef PJ

2012-01-01

Background Unhealthy lifestyle behaviors often co-occur and are related to chronic diseases. One effective method to change multiple lifestyle behaviors is web-based computer tailoring. Dropout from Internet interventions, however, is rather high, and it is challenging to retain participants in web-based tailored programs, especially programs targeting multiple behaviors. To date, it is unknown how much information people can handle in one session while taking part in a multiple behavior change intervention, which could be presented either sequentially (one behavior at a time) or simultaneously (all behaviors at once). Objectives The first objective was to compare dropout rates of 2 computer-tailored interventions: a sequential and a simultaneous strategy. The second objective was to assess which personal characteristics are associated with completion rates of the 2 interventions. Methods Using an RCT design, demographics, health status, physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking were self-assessed through web-based questionnaires among 3473 adults, recruited through Regional Health Authorities in the Netherlands in the autumn of 2009. First, a health risk appraisal was offered, indicating whether respondents were meeting the 5 national health guidelines. Second, psychosocial determinants of the lifestyle behaviors were assessed and personal advice was provided, about one or more lifestyle behaviors. Results Our findings indicate a high non-completion rate for both types of intervention (71.0%; n = 2167), with more incompletes in the simultaneous intervention (77.1%; n = 1169) than in the sequential intervention (65.0%; n = 998). In both conditions, discontinuation was predicted by a lower age (sequential condition: OR = 1.04; P < .001; CI = 1.02-1.05; simultaneous condition: OR = 1.04; P < .001; CI = 1.02-1.05) and an unhealthy lifestyle (sequential condition: OR = 0.86; P = .01; CI = 0.76-0.97; simultaneous condition: OR = 0.49; P < .001; CI = 0.42-0.58). In the sequential intervention, being male (OR = 1.27; P = .04; CI = 1.01-1.59) also predicted dropout. When respondents failed to adhere to at least 2 of the guidelines, those receiving the simultaneous intervention were more inclined to drop out than were those receiving the sequential intervention. Conclusion Possible reasons for the higher dropout rate in our simultaneous intervention may be the amount of time required and information overload. Strategies to optimize program completion as well as continued use of computer-tailored interventions should be studied. Trial Registration Dutch Trial Register NTR2168 PMID:22403770

Program completion of a web-based tailored lifestyle intervention for adults: differences between a sequential and a simultaneous approach.

PubMed

Schulz, Daniela N; Schneider, Francine; de Vries, Hein; van Osch, Liesbeth A D M; van Nierop, Peter W M; Kremers, Stef P J

2012-03-08

Unhealthy lifestyle behaviors often co-occur and are related to chronic diseases. One effective method to change multiple lifestyle behaviors is web-based computer tailoring. Dropout from Internet interventions, however, is rather high, and it is challenging to retain participants in web-based tailored programs, especially programs targeting multiple behaviors. To date, it is unknown how much information people can handle in one session while taking part in a multiple behavior change intervention, which could be presented either sequentially (one behavior at a time) or simultaneously (all behaviors at once). The first objective was to compare dropout rates of 2 computer-tailored interventions: a sequential and a simultaneous strategy. The second objective was to assess which personal characteristics are associated with completion rates of the 2 interventions. Using an RCT design, demographics, health status, physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking were self-assessed through web-based questionnaires among 3473 adults, recruited through Regional Health Authorities in the Netherlands in the autumn of 2009. First, a health risk appraisal was offered, indicating whether respondents were meeting the 5 national health guidelines. Second, psychosocial determinants of the lifestyle behaviors were assessed and personal advice was provided, about one or more lifestyle behaviors. Our findings indicate a high non-completion rate for both types of intervention (71.0%; n = 2167), with more incompletes in the simultaneous intervention (77.1%; n = 1169) than in the sequential intervention (65.0%; n = 998). In both conditions, discontinuation was predicted by a lower age (sequential condition: OR = 1.04; P < .001; CI = 1.02-1.05; simultaneous condition: OR = 1.04; P < .001; CI = 1.02-1.05) and an unhealthy lifestyle (sequential condition: OR = 0.86; P = .01; CI = 0.76-0.97; simultaneous condition: OR = 0.49; P < .001; CI = 0.42-0.58). In the sequential intervention, being male (OR = 1.27; P = .04; CI = 1.01-1.59) also predicted dropout. When respondents failed to adhere to at least 2 of the guidelines, those receiving the simultaneous intervention were more inclined to drop out than were those receiving the sequential intervention. Possible reasons for the higher dropout rate in our simultaneous intervention may be the amount of time required and information overload. Strategies to optimize program completion as well as continued use of computer-tailored interventions should be studied. Dutch Trial Register NTR2168.

Efficacy of a Telephone-Delivered Sexually Transmitted Infection/Human Immunodeficiency Virus Prevention Maintenance Intervention for Adolescents A Randomized Clinical Trial

PubMed Central

DiClemente, Ralph J.; Wingood, Gina M.; Sales, Jessica M.; Brown, Jennifer L.; Rose, Eve S.; Davis, Teaniese L.; Lang, Delia L.; Caliendo, Angela; Hardin, James W.

2015-01-01

IMPORTANCE Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy. OBJECTIVE To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up. DESIGN, SETTING, AND PARTICIPANTS In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment. INTERVENTIONS Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health. MAIN OUTCOMES AND MEASURES The primary outcomes were percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments. RESULTS During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95%CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95%CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95%CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95%CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95%CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = −0.61; 95%CI, −0.98 to −0.24; P < .001). CONCLUSIONS AND RELEVANCE Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00279799 PMID:25155070

A preliminary randomized controlled trial of a behavioral exercise intervention for smoking cessation.

PubMed

Abrantes, Ana M; Bloom, Erika Litvin; Strong, David R; Riebe, Deborah; Marcus, Bess H; Desaulniers, Julie; Fokas, Kathryn; Brown, Richard A

2014-08-01

Previous exercise intervention studies for smoking cessation have been challenged by a number of methodological limitations that confound the potential efficacy of aerobic exercise for smoking cessation. The preliminary efficacy of a behavioral exercise intervention that incorporated features designed to address prior limitations was tested in a randomized controlled trial (RCT). Sixty-one smokers (65.6% female, mean age = 47.3 years, smoked a mean of 19.7 cigarettes/day) were randomized to receive either a 12-week exercise intervention or a 12-week health education contact control. Participants in both conditions received an 8-week telephone-delivered, standard smoking cessation protocol (with the transdermal nicotine patch). Follow-ups were conducted at the end of treatment (EOT), 6- and 12-month timepoints. There were no differences between conditions with respect to the number of weekly exercise or health education sessions attended (9.3±2.8 vs. 9.3±3.0, respectively). While not statistically significant, participants in the exercise condition demonstrated higher verified abstinence rates (EOT: 40% vs. 22.6%, odds ratio [OR] = 2.28; 6- and 12-month follow-ups: 26.7% vs. 12.9%, OR = 2.46). Irrespective of treatment condition, higher levels of moderate-to-vigorous exercise were associated with lower levels of depressive symptoms during the intervention. The results of this small RCT point toward the benefit of a behavioral exercise intervention designed to address previous methodological limitations for smoking cessation. Given the potential public health impact of the demonstrated efficacy of exercise for smoking cessation, the continued development and optimization of exercise interventions for smokers through larger RCTs merits pursuit. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessing the effects of a complementary parent intervention and prior exposure to a preadolescent program of HIV risk reduction for mid-adolescents.

PubMed

Stanton, Bonita; Wang, Bo; Deveaux, Lynette; Lunn, Sonja; Rolle, Glenda; Li, Xiaoming; Braithwaite, Nanika; Dinaj-Koci, Veronica; Marshall, Sharon; Gomez, Perry

2015-03-01

We (1) evaluated the impact of an evidence-based HIV prevention program with and without a parent component among mid-adolescents living in the Caribbean and (2) determined the effect of prior receipt of a related intervention during preadolescence on intervention response. A randomized, controlled 4-cell trial of a 10-session, theory-based HIV prevention intervention involving 2564 Bahamian grade-10 youths (some of whom had received a comparable intervention in grade 6) was conducted (2008-2011). Randomization occurred at the level of the classroom with follow-up at 6, 12, and 18 months after intervention. The 3 experimental conditions all included the youths' curriculum and either a youth-parent intervention emphasizing adolescent-parent communication, a parent-only goal-setting intervention, or no parent intervention. An intervention delivered to mid-adolescents in combination with a parent-adolescent sexual-risk communication intervention increased HIV/AIDS knowledge, condom-use skills, and self-efficacy and had a marginal effect on consistent condom use. Regardless of prior exposure to a similar intervention as preadolescents, youths benefited from receipt of the intervention. Preadolescents and mid-adolescents in HIV-affected countries should receive HIV prevention interventions that include parental participation.

Racial and Ethnic Differences in the Delivery of the Resources for Enhancing Alzheimer's Caregiver Health II Intervention.

PubMed

Graham-Phillips, Anita; Roth, David L; Huang, Jin; Dilworth-Anderson, Peggye; Gitlin, Laura N

2016-08-01

To determine whether there are racial and ethnicity group differences in Resources for Enhancing Alzheimer's Caregiver Health (REACH II) intervention delivery. Randomized controlled trial. Community-based intervention delivered at five sites across the United States. Family caregivers of persons with dementia who were randomized to the active intervention condition (N = 323). Nine in-home sessions (90 minutes each) and three telephone sessions (30 minutes each) were intended to be delivered and designed to reduce caregiver burden and depression, improve caregiver self-care and social support, and help caregivers manage behavior problems in persons with dementia. Interventionists recorded the type of intervention (home or telephone), start and stop times, and whether specific intervention content modules (e.g., stress management, social support) were administered in each session. Overall, REACH II intervention delivery was high, with more than 80% of randomized caregivers completing at least five in-home sessions and receiving eight or more hours of intervention contact, but black caregivers completed fewer in-home sessions (mean 6.98) than Hispanics (mean 7.84) or whites (mean 8.25) and received less total intervention contact time (mean 683 minutes) than Hispanics (mean 842 minutes) or whites (mean 798 minutes). No significant differences in exposure to content according to race or ethnicity were found after controlling for demographic covariates. Blacks in REACH II received significantly less intervention contact. Similar multicomponent interventions should examine whether there are systematic differences in intervention delivery across specific demographic subgroups and explore implications for treatment outcomes. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Does understanding relational terminology mediate effects of intervention on compare word problems?

PubMed

Schumacher, Robin F; Fuchs, Lynn S

2012-04-01

The purpose of this study was to assess whether understanding relational terminology (i.e., more, less, and fewer) mediates the effects of intervention on compare word problems. Second-grade classrooms (N=31) were randomly assigned to one of three conditions: researcher-designed word-problem intervention, researcher-designed calculation intervention, or business-as-usual (teacher-designed) control. Students in word-problem intervention classrooms received instruction on the compare problem type, which included a focus on understanding relational terminology within compare word problems. Analyses, which accounted for variance associated with classroom clustering, indicated that (a) compared with the calculation intervention and business-as-usual conditions, word-problem intervention significantly increased performance on all three subtypes of compare problems and on understanding relational terminology, and (b) the intervention effect was fully mediated by students' understanding of relational terminology for one subtype of compare problems and partially mediated by students' understanding of relational terminology for the other two subtypes. Copyright © 2011 Elsevier Inc. All rights reserved.

mHealth or eHealth? Efficacy, Use, and Appreciation of a Web-Based Computer-Tailored Physical Activity Intervention for Dutch Adults: A Randomized Controlled Trial.

PubMed

Gomez Quiñonez, Stefanie; Walthouwer, Michel Jean Louis; Schulz, Daniela Nadine; de Vries, Hein

2016-11-09

Until a few years ago, Web-based computer-tailored interventions were almost exclusively delivered via computer (eHealth). However, nowadays, interventions delivered via mobile phones (mHealth) are an interesting alternative for health promotion, as they may more easily reach people 24/7. The first aim of this study was to compare the efficacy of an mHealth and an eHealth version of a Web-based computer-tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions. We collected data among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks, and after 6 months). We recruited participants from a Dutch online research panel and randomly assigned them to 1 of 3 conditions: eHealth (n=138), mHealth (n=108), or control condition (n=127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. We used analysis of variance and linear regression analyses to examine differences between the 2 study groups and the control group with regard to efficacy, use, and appreciation. Participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B=8.48, df=2, P=.03, Cohen d=0.27). We found a small effect size favoring the eHealth condition over the control group (B=6.13, df=2, P=.09, Cohen d=0.21). The eHealth condition had lower dropout rates (117/138, 84.8%) than the mHealth condition (81/108, 75.0%) and the control group (91/127, 71.7%). Furthermore, in terms of usability and appreciation, the eHealth condition outperformed the mHealth condition with regard to participants receiving (t 182 =3.07, P=.002) and reading the feedback messages (t 181 =2.34, P=.02), as well as the clarity of the messages (t 181 =1.99, P=.049). We tested 2 Web-based computer-tailored physical activity intervention versions (mHealth and eHealth) against a control condition with regard to efficacy, use, usability, and appreciation. The overall effect was mainly caused by the more effective eHealth intervention. The mHealth app was rated inferior to the eHealth version with regard to usability and appreciation. More research is needed to assess how both methods can complement each other. Netherlands Trial Register: NTR4503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4503 (Archived by WebCite at http://www.webcitation.org/6lEi1x40s). ©Stefanie Gomez Quiñonez, Michel Jean Louis Walthouwer, Daniela Nadine Schulz, Hein de Vries. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.11.2016.

Treatment adherence in a lay health adviser intervention to treat tobacco dependence.

PubMed

Hood, N E; Ferketich, A K; Paskett, E D; Wewers, M E

2013-02-01

Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in an LHA intervention with 147 Ohio Appalachian female daily smokers. Participants were randomly selected from clinics and randomized to the intervention condition of a randomized controlled trial. Overall, 75.5% of participants received all seven planned LHA visits, 29.3% used patches for >7 weeks and approximately half received high average ratings on participant responsiveness. Depressive symptoms and low nicotine dependence were associated with lower patch adherence while high poverty-to-income ratio was associated with high responsiveness. Compared with those with fewer visits, participants who received all visits were more likely to be abstinent (22.5 versus 2.8%, P=0.026) or have attempted quitting (85.0 versus 47.4%, P=0.009) at 3 months. High participant responsiveness was associated with 12-month abstinence. LHA interventions should focus on improving adherence to nicotine patches and managing depression because it is an independent risk factor for low adherence.

An Internet-based intervention for eating disorders consisting of automated computer-tailored feedback with or without supplemented frequent or infrequent support from a coach: study protocol for a randomized controlled trial.

PubMed

Aardoom, Jiska J; Dingemans, Alexandra E; Spinhoven, Philip; Hakkaart-van Roijen, Leona; Van Furth, Eric F

2013-10-17

Several Internet-based interventions for eating disorders have shown their effectiveness. Still, there is a need to refine such interventions given that most existing programs seem to be limited by their static 'one-size-fits-all' approach. 'Featback', an Internet-based intervention for symptoms of eating disorders provides a more individualized approach. It consists of several components (psychoeducation, a fully automated monitoring and feedback system, and support from a coach), which can be matched to participants' needs and preferences. Until now, it is unclear whether online self-help interventions for eating disorders with support are more effective than those without. The aims of the current study are i) to examine the relative effectiveness of (the different components of) Featback; ii) to examine predictors, moderators and mediators of intervention responses; iii) to report on practical experiences with Featback; and iv) to examine the cost-effectiveness of Featback. Individuals aged 16 years or older, with mild to severe eating disorder symptoms will be randomized to one of the four study conditions. In condition one, participants receive the basic version of Featback, consisting of psychoeducation and a fully automated monitoring and feedback system. In conditions two and three, participants receive the basic version of Featback supplemented with the possibility of infrequent (weekly) or frequent (three times a week) e-mail, chat, or Skype support from a coach, respectively. The fourth condition is a waiting list control condition. Participants are assessed at baseline, post-intervention (8 weeks), and at 3- and 6-month follow-up (the latter except for participants in the waiting list control condition). Primary outcome measures are disordered eating behaviors and attitudes. Secondary outcome measures are (eating disorder-related) quality of life, self-stigma of seeking help, self-esteem, mastery and support, symptoms of depression and anxiety, repetitive negative thinking, motivation to change, user satisfaction, compliance, and help-seeking attitudes and behaviors. This study aims to provide more insight into the (cost-) effectiveness of Internet-based interventions for eating disorders, particularly those with and without professional support, as well as different levels of support. NTR3646.

Intervention-engagement and its role in the effectiveness of stage-matched interventions promoting physical exercise.

PubMed

Richert, Jana; Lippke, Sonia; Ziegelmann, Jochen P

2011-01-01

Intervention-engagement has received little attention in sports medicine as well as research and promotion of physical exercise. The construct is important, however, in the understanding of why interventions work. This study aimed at shedding more light on the interplay of engagement and the subsequent effectiveness of physical exercise interventions. A three-stage model differentiating among nonintenders, intenders, and actors informed the intervention design in this study. In an Internet-based randomized controlled trial (RCT) with two measurement points, N = 326 participants received a stage-matched, stage-mismatched, or control treatment. Assessed variables were goal setting, planning, behavior, and intervention-engagement. It was found that regarding goal setting, nonintenders in the stage-matched intervention and those who engaged highly in the stage-matched intervention improved significantly over time. Regarding planning, intenders in the matched condition as well as all actors increased their levels over time. Regarding behavior, nonintenders and intenders having engaged highly in the intervention improved more than those having engaged little. In order to help nonintenders progress on their way toward goal behavior, it is necessary that they engage highly in a stage-matched intervention. Implications for exercise promotion are that interventions should also aim at increasing participants' intervention-engagement.

The effect on teen driving outcomes of the Checkpoints Program in a state-wide trial.

PubMed

Simons-Morton, Bruce G; L Hartos, Jessica; Leaf, William A; Preusser, David F

2006-09-01

Crash rates among teenagers are highly elevated during the first months of licensure. Parent-imposed driving restrictions on initial driving privileges can reduce exposure to high-risk driving conditions, thus reducing crash risk while teens' driving proficiency develops. This report describes the effect of the Checkpoints Program on driving limits and outcomes. Connecticut teens who obtained a learners permit over a 9-month period were recruited, providing a final sample of 3743 who obtained driver licenses. Families were randomized to the intervention or comparison condition. Intervention families received by mail a series of persuasive communications related to high-risk teen driving and a parent-teen driving agreement, while comparison families received on the same schedule general information on driving and vehicle maintenance. Relative to the comparison group, teens and parents in the Checkpoints Program reported significantly greater limits on high-risk teen driving conditions at licensure, 3-, and 6-months post-licensure; and intervention teens reported significantly less risky driving at each reporting period. By the 12-month follow up teens in the intervention group were significantly less likely than those in the comparison group to have had a traffic violation. However, no treatment group effect was found for crashes. This is the first study to report significant effects on teen driving behavior and performance of education designed to increase parental-imposed teen driving limits.

A pilot randomized controlled trial of a depression and disease management program delivered by phone.

PubMed

Aburizik, Arwa; Dindo, Lilian; Kaboli, Peter; Charlton, Mary; Dawn, Klein; Turvey, Carolyn

2013-11-01

Depression in medically ill patients occurs at twice the rate found in the general population. Though pharmacologic and psychotherapeutic interventions for depression are effective, response to treatment and access to care are barriers for this population. A multidimensional telehealth intervention was designed to focus on these barriers by delivering a phone based intervention that addressed managing one's illness and coping emotionally. Veterans with diabetes, hypertension, or chronic pain and depressive symptoms were randomized to one of three conditions: Usual Care (n=23), Illness Management Only (n=31), or Combined Psychotherapy and Illness Management (n=29). Those randomized to the Combined or Illness Management Only intervention group received 10 phone visits. Veterans in the Combined group received all aspects of the illness management program plus a manualized depression intervention. Subjects completed assessments at baseline, week 5, and 10 to test the main hypothesis that veterans in the Combined condition would have a greater decline in depressive symptoms. The Combined intervention yielded a significant decline in depressive symptoms when compared with Usual Care. However, the there was no significant difference between the Combined and Illness Management Only groups. This is a pilot study with a small sample size relative to a standard randomized controlled trial in psychotherapy. This telephone-based intervention succeeded in reducing depressive symptoms in veterans with chronic illness. It adds to the building evidence base for providing phone-delivered mental health services. © 2013 Elsevier B.V. All rights reserved.

A Cluster Randomized Trial to Promote Healthy Menu Items for Children: The Kids’ Choice Restaurant Program

PubMed Central

Ayala, Guadalupe X.; Castro, Iana A.; Pickrel, Julie L.; Lin, Shih-Fan; Williams, Christine B.; Madanat, Hala; Jun, Hee-Jin; Zive, Michelle

2017-01-01

Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants. PMID:29194392

A Cluster Randomized Trial to Promote Healthy Menu Items for Children: The Kids' Choice Restaurant Program.

PubMed

Ayala, Guadalupe X; Castro, Iana A; Pickrel, Julie L; Lin, Shih-Fan; Williams, Christine B; Madanat, Hala; Jun, Hee-Jin; Zive, Michelle

2017-12-01

Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants.

Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation

PubMed Central

Sung, Lillian; Robinson, Paula; Treister, Nathaniel; Baggott, Tina; Gibson, Paul; Tissing, Wim; Wiernikowski, John; Brinklow, Jennifer; Dupuis, L Lee

2017-01-01

Purpose To develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0–18 years) receiving treatment for cancer or undergoing haematopoietic stem cell transplantation (HSCT). Methods The Mucositis Prevention Guideline Development Group was interdisciplinary and included internationally recognised experts in paediatric mucositis. For the evidence review, we included randomised controlled trials (RCTs) conducted in either children or adults evaluating the following interventions selected according to prespecified criteria: cryotherapy, low level light therapy (LLLT) and keratinocyte growth factor (KGF). We also examined RCTs of any intervention conducted in children. For all systematic reviews, we synthesised the occurrence of severe oral mucositis. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to describe quality of evidence and strength of recommendations. Results We suggest cryotherapy or LLLT may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis. We also suggest KGF may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis. However, KGF use merits caution as there is a lack of efficacy and toxicity data in children, and a lack of long-term follow-up data in paediatric cancers. No other interventions were recommended for oral mucositis prevention in children. Conclusions All three specific interventions evaluated in this clinical practice guideline were associated with a weak recommendation for use. There may be important organisational and cost barriers to the adoption of LLLT and KGF. Considerations for implementation and key research gaps are highlighted. PMID:25818385

Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation.

PubMed

Sung, Lillian; Robinson, Paula; Treister, Nathaniel; Baggott, Tina; Gibson, Paul; Tissing, Wim; Wiernikowski, John; Brinklow, Jennifer; Dupuis, L Lee

2017-03-01

To develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0-18 years) receiving treatment for cancer or undergoing haematopoietic stem cell transplantation (HSCT). The Mucositis Prevention Guideline Development Group was interdisciplinary and included internationally recognised experts in paediatric mucositis. For the evidence review, we included randomised controlled trials (RCTs) conducted in either children or adults evaluating the following interventions selected according to prespecified criteria: cryotherapy, low level light therapy (LLLT) and keratinocyte growth factor (KGF). We also examined RCTs of any intervention conducted in children. For all systematic reviews, we synthesised the occurrence of severe oral mucositis. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to describe quality of evidence and strength of recommendations. We suggest cryotherapy or LLLT may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis. We also suggest KGF may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis. However, KGF use merits caution as there is a lack of efficacy and toxicity data in children, and a lack of long-term follow-up data in paediatric cancers. No other interventions were recommended for oral mucositis prevention in children. All three specific interventions evaluated in this clinical practice guideline were associated with a weak recommendation for use. There may be important organisational and cost barriers to the adoption of LLLT and KGF. Considerations for implementation and key research gaps are highlighted. 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/.

Assessing impact and sustainability of health, water, and sanitation interventions in Bolivia six years post-project.

PubMed

Eder, Clara; Schooley, Janine; Fullerton, Judith; Murguia, Jose

2012-07-01

To assess the impact and sustainability of health, water, and sanitation interventions in Bolivia six years post-project. A mixed-method (qualitative-quantitative) study was conducted in 14 rural intervention and control communities in Bolivia in November 2008, six years after the completion of interventions designed to improve knowledge and practices related to maternal and child health and nutrition, community water systems, and household water and sanitation facilities. The degree to which participants had sustained the community and household practices promoted by the interventions was a particular focus. Community site visits were made to evaluate the status (functional condition) and sustainability (state of maintenance and repair) of community and household water and sanitation infrastructure. Key informant interviews and focus group discussions were conducted to assess knowledge and practices, and perceptions about the value of the interventions to the community. Six years post-project, participants remained committed to sustaining the practices promoted in the interventions. The average rating for the functional condition of community water systems was 42% higher than the average rating in control communities. In addition, more than two-thirds of households continued to practice selected maternal and child health behaviors promoted by the interventions (compared to less than half of the households in the control communities). Communities that received integrated investments (development and health) seemed to sustain the practices promoted in the interventions better than communities that received assistance in only one of the two sectors. Infrastructure for community water systems and household water and sanitation facilities was better built and maintained, and selected maternal and child health behaviors practiced more frequently, in intervention communities versus control communities.

Social Norms Information Enhances the Efficacy of an Appearance-based Sun Protection Intervention

PubMed Central

Kulik, James A; Butler, Heather; Gerrard, Meg; Gibbons, Frederick X; Mahler, Heike

2008-01-01

This experiment examined whether the efficacy of an appearance-based sun protection intervention could be enhanced by the addition of social norms information. Southern California college students (N=125, predominantly female) were randomly assigned to either an appearance-based sun protection intervention-that consisted of a photograph depicting underlying sun damage to their skin (UV photo) and information about photoaging or to a control condition. Those assigned to the intervention were further randomized to receive information about what one should do to prevent photoaging (injunctive norms information), information about the number of their peers who currently use regular sun protection (descriptive norms information), both injunctive and descriptive norms information, or neither type of norms information. The results demonstrated that those who received the UV Photo/photoaging information intervention expressed greater sun protection intentions and subsequently reported greater sun protection behaviors than did controls. Further, the addition of both injunctive and descriptive norms information increased self-reported sun protection behaviors during the subsequent month. PMID:18448221

Randomized Multilevel Intervention to Improve Outcomes of Residents in Nursing Homes in Need of Improvement

PubMed Central

Rantz, Marilyn J.; Nahm, Helen E.; Zwygart-Stauffacher, Mary; Hicks, Lanis; Mehr, David; Flesner, Marcia; Petroski, Gregory F.; Madsen, Richard W.; Scott-Cawiezell, Jill

2012-01-01

Purpose A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Intervention facilities (n=29) received a two-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (n=29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. Design and Methods Randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living (ADL). It was hypothesized that following the intervention, experimental facilities would have better resident outcomes, higher quality of care, higher staff retention, more organizational attributes of improved working conditions than control facilities, similar staffing and staff mix, and lower total and direct care costs. Results The intervention did improve quality of care (p=0.02); there were improvements in pressure ulcers (p=0.05), weight loss (p=0.05). Staff retention, organizational working conditions, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. Implications Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. PMID:21816681

Effects of a Web-Based Tailored Multiple-Lifestyle Intervention for Adults: A Two-Year Randomized Controlled Trial Comparing Sequential and Simultaneous Delivery Modes

PubMed Central

Kremers, Stef PJ; Vandelanotte, Corneel; van Adrichem, Mathieu JG; Schneider, Francine; Candel, Math JJM; de Vries, Hein

2014-01-01

Background Web-based computer-tailored interventions for multiple health behaviors can have a significant public health impact. Yet, few randomized controlled trials have tested this assumption. Objective The objective of this paper was to test the effects of a sequential and simultaneous Web-based tailored intervention on multiple lifestyle behaviors. Methods A randomized controlled trial was conducted with 3 tailoring conditions (ie, sequential, simultaneous, and control conditions) in the Netherlands in 2009-2012. Follow-up measurements took place after 12 and 24 months. The intervention content was based on the I-Change model. In a health risk appraisal, all respondents (N=5055) received feedback on their lifestyle behaviors that indicated whether they complied with the Dutch guidelines for physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking. Participants in the sequential (n=1736) and simultaneous (n=1638) conditions received tailored motivational feedback to change unhealthy behaviors one at a time (sequential) or all at the same time (simultaneous). Mixed model analyses were performed as primary analyses; regression analyses were done as sensitivity analyses. An overall risk score was used as outcome measure, then effects on the 5 individual lifestyle behaviors were assessed and a process evaluation was performed regarding exposure to and appreciation of the intervention. Results Both tailoring strategies were associated with small self-reported behavioral changes. The sequential condition had the most significant effects compared to the control condition after 12 months (T1, effect size=0.28). After 24 months (T2), the simultaneous condition was most effective (effect size=0.18). All 5 individual lifestyle behaviors changed over time, but few effects differed significantly between the conditions. At both follow-ups, the sequential condition had significant changes in smoking abstinence compared to the simultaneous condition (T1 effect size=0.31; T2 effect size=0.41). The sequential condition was more effective in decreasing alcohol consumption than the control condition at 24 months (effect size=0.27). Change was predicted by the amount of exposure to the intervention (total visiting time: beta=–.06; P=.01; total number of visits: beta=–.11; P<.001). Both interventions were appreciated well by respondents without significant differences between conditions. Conclusions Although evidence was found for the effectiveness of both programs, no simple conclusive finding could be drawn about which intervention mode was more effective. The best kind of intervention may depend on the behavior that is targeted or on personal preferences and motivation. Further research is needed to identify moderators of intervention effectiveness. The results need to be interpreted in view of the high and selective dropout rates, multiple comparisons, and modest effect sizes. However, a large number of people were reached at low cost and behavioral change was achieved after 2 years. Trial Registration Nederlands Trial Register: NTR 2168; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2168 (Archived by WebCite at http://www.webcitation.org/6MbUqttYB). PMID:24472854

Development and evaluation of a computerized intervention for low distress tolerance and its effect on performance on a neutralization task.

PubMed

Macatee, Richard J; Cougle, Jesse R

2015-09-01

A growing body of research has linked high distress intolerance (DI) to obsessions, but not other OCD symptom domains. However, existing research is correlational. Experimental studies are needed, but brief methods for reducing DI are lacking. To address these gaps in the literature, a brief, computerized intervention aimed at reducing DI was developed to determine if changing DI affected obsessional phenomena. Individuals reporting high DI were randomized to a treatment or waitlist control group (N = 53). Individuals in the treatment group received the DI treatment (i.e., a 2 h computerized intervention) over two weeks, and then underwent a post-assessment in which DI and obsession-relevant phenomena were measured. Individuals in the control group only received the post-assessment. Analyses revealed a greater reduction in self-reported DI on one measure and smaller decreases in behavioral DI in the intervention condition relative to the waitlist condition, as well as lower in-vivo urges to neutralize an intrusive thought; however, anxious reactivity to the intrusion and neutralization behavior were not affected. Further, bootstrapping analyses revealed that reductions in DI mediated the effect of the intervention on neutralization urges. A clinical sample and placebo control condition were not used. These results provide experimental evidence for the role of DI in obsessional phenomena, specifically in affecting urges to neutralize intrusions, findings consistent with negative reinforcement models of DI. Further, results revealed that DI can be reduced with a brief, computerized intervention, which has important implications for future experimental research and treatment development. Copyright © 2015 Elsevier Ltd. All rights reserved.

Family Treatment for Bipolar Disorder: Family Impairment by Treatment Interactions

PubMed Central

Miller, Ivan W.; Keitner, Gabor I.; Ryan, Christine E.; Uebelacker, Lisa A.; Johnson, Sheri L.; Solomon, David A.

2010-01-01

Objective There is a clear need for psychosocial treatments to supplement pharmacotherapy for bipolar disorder. In this study, the efficacy of 2 forms of adjunctive family intervention were compared to pharmacotherapy alone. In addition to evaluating overall differences between treatments, a chief goal was to examine whether family impairment levels moderated the effects of family intervention on outcome. Method Ninety-two patients diagnosed with bipolar I disorder (according to DSM-III-R) were randomly assigned to receive (1) pharmacotherapy alone, (2) family therapy + pharmacotherapy, or (3) multi-family psychoeducational group + pharmacotherapy. Treatments and assessments continued for up to 28 months. Primary outcome measures were number of episodes per year and percentage of time symptomatic throughout the entire follow-up period. The study was conducted from September 1992 through March 1999. Results No significant main effects were found for treatment condition. Thus, for the total sample, the addition of a family intervention did not improve outcome. However, there were significant treatment condition by family impairment interactions (p < .05). In patients from families with high levels of impairment, the addition of a family intervention (family therapy or psychoeducational group) resulted in a significantly improved course of illness, particularly the number of depressive episodes (p <.01) and proportion of time spent in a depressive episode (p <.01). These effects were relatively large (Cohen d = 0.7–1.0), with patients receiving either family intervention having roughly half the number of depressive episodes and amount of time spent depressed as those receiving pharmacotherapy alone. In contrast, for patients from low-impairment families, the addition of a family intervention did not improve course of illness. Conclusions Our findings build on previous literature suggesting the importance of treatment matching within the mood disorders and suggest that the utility of adding family interventions for bipolar patients and their families may depend upon the family’s level of impairment. PMID:18363424

Mobile diabetes intervention study: testing a personalized treatment/behavioral communication intervention for blood glucose control.

PubMed

Quinn, Charlene C; Gruber-Baldini, Ann L; Shardell, Michelle; Weed, Kelly; Clough, Suzanne S; Peeples, Malinda; Terrin, Michael; Bronich-Hall, Lauren; Barr, Erik; Lender, Dan

2009-07-01

National data find glycemic control is within target (A1c<7.0%) for 37% of patients with diabetes, and only 7% meet recommended glycemic, lipid, and blood pressure goals. To compare active interventions and usual care for glucose control in a randomized clinical trial (RCT) among persons with diabetes cared for by primary care physicians (PCPs) over the course of 1 year. Physician practices (n=36) in 4 geographic areas are randomly assigned to 1 of 4 study groups. The intervention is a diabetes communication system, using mobile phones and patient/physician portals to allow patient-specific treatment and communication. All physicians receive American Diabetes Association (ADA) Guidelines for diabetes care. Patients with poor diabetes control (A1c> or =7.5%) at baseline (n=260) are enrolled in study groups based on PCP randomization. All study patients receive blood glucose (BG) meters and a year's supply of testing materials. Patients in three treatment groups select one of two mobile phone models, receive one-year unlimited mobile phone data and service plan, register on the web-based individual patient portal and receive study treatment phone software based on study assignment. Control group patients receive usual care from their PCP. The primary outcome is mean change in A1c over a 12-month intervention period. Traditional methods of disease management have not achieved adequate control for BG and other conditions important to persons with diabetes. Tools to improve communication between patients and PCPs may improve patient outcomes and be satisfactory to patients and physicians. This RCT is ongoing.

Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study.

PubMed

Linzer, Mark; Poplau, Sara; Brown, Roger; Grossman, Ellie; Varkey, Anita; Yale, Steven; Williams, Eric S; Hicks, Lanis; Wallock, Jill; Kohnhorst, Diane; Barbouche, Michael

2017-01-01

While primary care work conditions are associated with adverse clinician outcomes, little is known about the effect of work condition interventions on quality or safety. A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City. Primary care clinicians and their diabetic and hypertensive patients. Quality improvement projects to improve communication between providers, workflow design, and chronic disease management. Intervention clinics received brief summaries of their clinician and patient outcome data at baseline. We measured work conditions and clinician and patient outcomes both at baseline and 6-12 months post-intervention. Multilevel regression analyses assessed the impact of work condition changes on outcomes. Subgroup analyses assessed impact by intervention category. There were no significant differences in error reduction (19 % vs. 11 %, OR of improvement 1.84, 95 % CI 0.70, 4.82, p = 0.21) or quality of care improvement (19 % improved vs. 44 %, OR 0.62, 95 % CI 0.58, 1.21, p = 0.42) between intervention and control clinics. The conceptual model linking work conditions, provider outcomes, and error reduction showed significant relationships between work conditions and provider outcomes (p ≤ 0.001) and a trend toward a reduced error rate in providers with lower burnout (OR 1.44, 95 % CI 0.94, 2.23, p = 0.09). Few quality metrics, short time span, fewer clinicians recruited than anticipated. Work-life interventions improving clinician satisfaction and well-being do not necessarily reduce errors or improve quality. Longer, more focused interventions may be needed to produce meaningful improvements in patient care. ClinicalTrials.gov # NCT02542995.

Evaluation of an HIV/STD Sexual Risk-Reduction Intervention for Pregnant African American Adolescents Attending a Prenatal Clinic in an Urban Public Hospital: Preliminary Evidence of Efficacy

PubMed Central

Diclemente, R.J.; Wingood, G. M.; Rose, E.; Sales, J. M.; Crosby, R.A.

2009-01-01

Study Objective To evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents. Design A randomized controlled trial. Participants completed baseline and follow-up assessments. Setting An urban public hospital in the Southeastern U.S. Participants Pregnant African-American adolescents (N=170), 14-20 years of age, attending a prenatal clinic. Intervention Intervention participants received two 4-hour group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hour session on healthy nutrition. Main Outcome Measures Consistent condom use. Results Intervention participants reported greater condom use at last intercourse (AOR = 3.9, P = .05) and consistent condom use (AOR = 7.9, P = .05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex. Conclusion Interventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators. PMID:19643646

To Wait in Tier 1 or Intervene Immediately: A Randomized Experiment Examining First Grade Response to Intervention (RTI) in Reading.

PubMed

Al Otaiba, Stephanie; Connor, Carol M; Folsom, Jessica S; Wanzek, Jeanne; Greulich, Luana; Schatschneider, Christopher; Wagner, Richard K

2014-10-01

This randomized controlled experiment compared the efficacy of two Response to Intervention (RTI) models - Typical RTI and Dynamic RTI - and included 34 first-grade classrooms ( n = 522 students) across 10 socio-economically and culturally diverse schools. Typical RTI was designed to follow the two-stage RTI decision rules that wait to assess response to Tier 1 in many districts, whereas Dynamic RTI provided Tier 2 or Tier 3 interventions immediately according to students' initial screening results. Interventions were identical across conditions except for when intervention began. Reading assessments included letter-sound, word, and passage reading, and teacher-reported severity of reading difficulties. An intent-to-treat analysis using multi-level modeling indicated an overall effect favoring the Dynamic RTI condition ( d = .36); growth curve analyses demonstrated that students in Dynamic RTI showed an immediate score advantage, and effects accumulated across the year. Analyses of standard score outcomes confirmed that students in the Dynamic condition who received Tier 2 and Tier 3 ended the study with significantly higher reading performance than students in the Typical condition. Implications for RTI implementation practice and for future research are discussed.

To Wait in Tier 1 or Intervene Immediately: A Randomized Experiment Examining First Grade Response to Intervention (RTI) in Reading

PubMed Central

Al Otaiba, Stephanie; Connor, Carol M.; Folsom, Jessica S.; Wanzek, Jeanne; Greulich, Luana; Schatschneider, Christopher; Wagner, Richard K.

2014-01-01

This randomized controlled experiment compared the efficacy of two Response to Intervention (RTI) models – Typical RTI and Dynamic RTI - and included 34 first-grade classrooms (n = 522 students) across 10 socio-economically and culturally diverse schools. Typical RTI was designed to follow the two-stage RTI decision rules that wait to assess response to Tier 1 in many districts, whereas Dynamic RTI provided Tier 2 or Tier 3 interventions immediately according to students’ initial screening results. Interventions were identical across conditions except for when intervention began. Reading assessments included letter-sound, word, and passage reading, and teacher-reported severity of reading difficulties. An intent-to-treat analysis using multi-level modeling indicated an overall effect favoring the Dynamic RTI condition (d = .36); growth curve analyses demonstrated that students in Dynamic RTI showed an immediate score advantage, and effects accumulated across the year. Analyses of standard score outcomes confirmed that students in the Dynamic condition who received Tier 2 and Tier 3 ended the study with significantly higher reading performance than students in the Typical condition. Implications for RTI implementation practice and for future research are discussed. PMID:25530622

Salmonella internalization in mung bean sprouts and pre- and postharvest intervention methods in a hydroponic system.

PubMed

Ge, Chongtao; Rymut, Susan; Lee, Cheonghoon; Lee, Jiyoung

2014-05-01

Mung bean sprouts, typically consumed raw or minimally cooked, are often contaminated with pathogens. Internalized pathogens pose a high risk because conventional sanitization methods are ineffective for their inactivation. The studies were performed (i) to understand the potential of internalization of Salmonella in mung bean sprouts under conditions where the irrigation water was contaminated and (ii) to determine if pre- and postharvest intervention methods are effective in inactivating the internalized pathogen. Mung bean sprouts were grown hydroponically and exposed to green fluorescence protein-tagged Salmonella Typhimurium through maturity. One experimental set received contaminated water daily, while other sets received contaminated water on a single day at different times. For preharvest intervention, irrigation water was exposed to UV, and for postharvest intervention-contaminated sprouts were subjected to a chlorine wash and UV light. Harvested samples were disinfected with ethanol and AgNO3 to differentiate surface-associate pathogens from the internalized ones. The internalized Salmonella Typhimurium in each set was quantified using the plate count method. Internalized Salmonella Typhimurium was detected at levels of 2.0 to 5.1 log CFU/g under all conditions. Continuous exposure to contaminated water during the entire period generated significantly higher levels of Salmonella Typhimurium internalization than sets receiving contaminated water for only a single day (P < 0.05). Preintervention methods lowered the level of internalized Salmonella by 1.84 log CFU/g (P < 0.05), whereas postintervention methods were ineffective in eliminating internalized pathogens. Preintervention did not completely inactivate bacteria in sprouts and demonstrated that the remaining Salmonella Typhimurium in water became more resistant to UV. Because postharvest intervention methods are ineffective, proper procedures for maintaining clean irrigation water must be followed throughout production in a hydroponic system.

Promoting response variability and stimulus generalization in martial arts training.

PubMed Central

Harding, Jay W; Wacker, David P; Berg, Wendy K; Rick, Gary; Lee, John F

2004-01-01

The effects of reinforcement and extinction on response variability and stimulus generalization in the punching and kicking techniques of 2 martial arts students were evaluated across drill and sparring conditions. During both conditions, the students were asked to demonstrate different techniques in response to an instructor's punching attack. During baseline, the students received no feedback on their responses in either condition. During the intervention phase, the students received differential reinforcement in the form of instructor feedback for each different punching or kicking technique they performed during a session of the drill condition, but no reinforcement was provided for techniques in the sparring condition. Results showed that both students increased the number of different techniques they performed when reinforcement and extinction procedures were conducted during the drill condition, and that this increase in response variability generalized to the sparring condition. PMID:15293637

The Onset of STI Diagnosis through Age 30: Results from the Seattle Social Development Project Intervention

PubMed Central

Hill, Karl G.; Bailey, Jennifer A.; Hawkins, J. David; Catalano, Richard F.; Kosterman, Rick; Oesterle, Sabrina; Abbott, Robert D.

2013-01-01

Objectives To examine (1) whether onset of sexually transmitted infections (STI) through age 30 differed for youths who received a social developmental intervention during elementary grades compared to those in the control condition; (2) potential social-developmental mediators of this intervention; and (3) the extent to which these results differed by ethnicity. Design A nonrandomized controlled trial followed participants to age 30, 18 years after the intervention ended. Three intervention conditions were compared: a full intervention group, assigned to intervention in grades 1 through 6; a late intervention group, assigned to intervention in grades 5 and 6 only; and a no-treatment control group. Setting Eighteen public elementary schools serving diverse neighborhoods including high-crime neighborhoods of Seattle. Analysis Sample 608 participants in three intervention conditions interviewed from age 10 through 30. Interventions Teacher training in classroom instruction and management, child social and emotional skill development, and parent workshops. Outcome Cumulative onset of participant report of STI diagnosis. Intervention Mechanisms Adolescent family environment, bonding to school, antisocial peer affiliation, early sex initiation, alcohol use, cigarette use, and marijuana use were tested. Analysis and Results Complementary log-log survival analysis found significantly lower odds of STI onset for the full intervention compared to the control condition. The lowering of STI onset risk was significantly greater for African Americans and Asian Americans compared to European Americans. Family environment, school bonding and delayed initiation of sexual behavior mediated the relationship between treatment and STI hazard. Conclusions A universal intervention for urban elementary school children, focused on classroom management and instruction, children’s social competence, and parenting practices may reduce the onset of STI through age 30, especially for African Americans. PMID:23539433

The onset of STI diagnosis through age 30: results from the Seattle Social Development Project Intervention.

PubMed

Hill, Karl G; Bailey, Jennifer A; Hawkins, J David; Catalano, Richard F; Kosterman, Rick; Oesterle, Sabrina; Abbott, Robert D

2014-02-01

The objectives of this study were to examine (1) whether the onset of sexually transmitted infections (STI) through age 30 differed for youths who received a social developmental intervention during elementary grades compared to those in the control condition; (2) potential social-developmental mediators of this intervention; and (3) the extent to which these results differed by ethnicity. A nonrandomized controlled trial followed participants to age 30, 18 years after the intervention ended. Three intervention conditions were compared: a full-intervention group, assigned to intervention in grades 1 through 6; a late intervention group, assigned to intervention in grades 5 and 6 only; and a no-treatment control group. Eighteen public elementary schools serving diverse neighborhoods including high-crime neighborhoods of Seattle are the setting of the study. Six hundred eight participants in three intervention conditions were interviewed from age 10 through 30. Interventions include teacher training in classroom instruction and management, child social and emotional skill development, and parent workshops. Outcome is the cumulative onset of participant report of STI diagnosis. Adolescent family environment, bonding to school, antisocial peer affiliation, early sex initiation, alcohol use, cigarette use, and marijuana use were tested as potential intervention mechanisms. Complementary log-log survival analysis found significantly lower odds of STI onset for the full-intervention compared to the control condition. The lowering of STI onset risk was significantly greater for African Americans and Asian Americans compared to European Americans. Family environment, school bonding, and delayed initiation of sexual behavior mediated the relationship between treatment and STI hazard. A universal intervention for urban elementary school children, focused on classroom management and instruction, children's social competence, and parenting practices may reduce the onset of STI through age 30, especially for African Americans.

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

PubMed

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

2014-11-01

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

Optimizing the Scientific Yield from a Randomized Controlled Trial (RCT): Evaluating Two Behavioral Interventions and Assessment Reactivity with a Single Trial

PubMed Central

Carey, Michael P.; Senn, Theresa E.; Coury-Doniger, Patricia; Urban, Marguerite A.; Vanable, Peter A.; Carey, Kate B.

2013-01-01

Randomized controlled trials (RCTs) remain the gold standard for evaluating intervention efficacy but are often costly. To optimize their scientific yield, RCTs can be designed to investigate multiple research questions. This paper describes an RCT that used a modified Solomon four-group design to simultaneously evaluate two, theoretically-guided, health promotion interventions as well as assessment reactivity. Recruited participants (N = 1010; 56% male; 69% African American) were randomly assigned to one of four conditions formed by crossing two intervention conditions (i.e., general health promotion vs. sexual risk reduction intervention) with two assessment conditions (i.e., general health vs. sexual health survey). After completing their assigned baseline assessment, participants received the assigned intervention, and returned for follow-ups at 3, 6, 9, and 12 months. In this report, we summarize baseline data, which show high levels of sexual risk behavior; alcohol, marijuana, and tobacco use; and fast food consumption. Sexual risk behaviors and substance use were correlated. Participants reported high satisfaction with both interventions but ratings for the sexual risk reduction intervention were higher. Planned follow-up sessions, and subsequent analyses, will assess changes in health behaviors including sexual risk behaviors. This study design demonstrates one way to optimize the scientific yield of an RCT. PMID:23816489

Female sex workers use power over their day-to-day lives to meet the condition of a conditional cash transfer intervention to incentivize safe sex.

PubMed

Cooper, Jan E; Dow, William H; de Walque, Damien; Keller, Ann C; McCoy, Sandra I; Fernald, Lia C H; Balampama, Marianna P; Kalolella, Admirabilis; Packel, Laura J; Wechsberg, Wendee M; Ozer, Emily J

2017-05-01

Female Sex Workers are a core population in the HIV epidemic, and interventions such as conditional cash transfers (CCTs), effective in other health domains, are a promising new approach to reduce the spread of HIV. Here we investigate how a population of Tanzanian female sex workers, though constrained in many ways, experience and use their power in the context of a CCT intervention that incentivizes safe sex. We analyzed 20 qualitative in-depth interviews with female sex workers enrolled in a randomized-controlled CCT program, the RESPECT II pilot, and found that while such women have limited choices, they do have substantial power over their work logistics that they leveraged to meet the conditions of the CCT and receive the cash award. It was through these decisions over work logistics, such as reducing the number of workdays and clients, that the CCT intervention had its greatest impact on modifying female sex workers' behavior. Copyright © 2017. Published by Elsevier Ltd.

Using brothel leadership to promote condom use among brothel-based female sex workers in Abuja, Nigeria: study protocol for a cluster randomized pilot trial.

PubMed

Okafor, Uchenna; Crutzen, Rik; Okekearu, Ifeanyi; Adebajo, Sylvia; Uzoh, Adaora; Awo, Egbe Aneotah; Chima, Chukwuemeka; Agwagwa, Ogechukwu; van den Borne, Bart

2017-01-01

The HIV prevalence among female populations involved in sex work in Nigeria has heightened interest in HIV prevention programming for this sub-population with brothel-based female sex workers (BB FSWs) having a prevalence of 27.4%, six times higher than the prevalence in the general population. The clusters in the randomized pilot trial will be brothels and female sex workers (FSWs) residing in the brothels will be the participants of the study. The participants will receive free condom distribution as well as HIV prevention messages on condom use and negotiation skills to increase self-efficacy in handling social and gender power plays within their environment. Twelve brothels will be randomized into experimental and control conditions with a minimum total sample size of 200 participants. Recruitment of participants will be carried out from within the brothels. The control condition will receive a standard intervention consisting of a minimum of six interactive sessions with peer educators (PE) engaging their peers through group discussions and one on one interaction using pre-designed HIV prevention messages. The experimental condition will receive the standard intervention as well as interactive sessions with the brothel leadership (chairladies and brothel managers) to facilitate consistent condom use and appropriate condom use policies, conditions, and messaging. Both interventions will be delivered over a maximum period of 16 weeks, and male and female condoms will be distributed during the intervention. Quantitative assessments will be carried out at baseline and at 16 weeks follow-up, and the pilot findings will inform feasibility of and sample size estimation for a phase III trial. The primary outcomes measured are recruitment rate attrition rate and adherence to the intervention. Consistent condom use outcomes by FSWs within the brothel with all partner types and enhanced self-efficacy for condom negotiation with all partner types will be the primary outcomes for the main study, and the feasibility of their measurement will be determined in this pilot trial. The manuscript describes the protocol for a pilot study to determine the feasibility of a behavioral intervention to improve consistent condom use among BB FSWs. The results of this pilot will inform a larger intervention for HIV prevention for this target group in Nigeria. The Institutional Review Board (IRB) of the Institute of Human Virology, Nigeria; Protocol Number NHREC/10/15/2014a-026.

Systematic review of control groups in nutrition education intervention research.

PubMed

Byrd-Bredbenner, Carol; Wu, FanFan; Spaccarotella, Kim; Quick, Virginia; Martin-Biggers, Jennifer; Zhang, Yingting

2017-07-11

Well-designed research trials are critical for determining the efficacy and effectiveness of nutrition education interventions. To determine whether behavioral and/or cognition changes can be attributed to an intervention, the experimental design must include a control or comparison condition against which outcomes from the experimental group can be compared. Despite the impact different types of control groups can have on study outcomes, the treatment provided to participants in the control condition has received limited attention in the literature. A systematic review of control groups in nutrition education interventions was conducted to better understand how control conditions are described in peer-reviewed journal articles compared with experimental conditions. To be included in the systematic review, articles had to be indexed in CINAHL, PubMed, PsycINFO, WoS, and/or ERIC and report primary research findings of controlled nutrition education intervention trials conducted in the United States with free-living consumer populations and published in English between January 2005 and December 2015. Key elements extracted during data collection included treatment provided to the experimental and control groups (e.g., overall intervention content, tailoring methods, delivery mode, format, duration, setting, and session descriptions, and procedures for standardizing, fidelity of implementation, and blinding); rationale for control group type selected; sample size and attrition; and theoretical foundation. The search yielded 43 publications; about one-third of these had an inactive control condition, which is considered a weak study design. Nearly two-thirds of reviewed studies had an active control condition considered a stronger research design; however, many failed to report one or more key elements of the intervention, especially for the control condition. None of the experimental and control group treatments were sufficiently detailed to permit replication of the nutrition education interventions studied. Findings advocate for improved intervention study design and more complete reporting of nutrition education interventions.

Reductions in Hard Drug Use Among Homeless Youth Receiving a Strength-Based Outreach Intervention: Comparing the Long-Term Effects of Shelter Linkage Versus Drop-in Center Linkage.

PubMed

Guo, Xiamei; Slesnick, Natasha

2017-06-07

The current study sought to test hard drug use outcomes for youth receiving a strengths-based outreach and advocacy intervention that linked youth to either a shelter or a drop-in center. Homeless youth (14-24 years old) were engaged by research assistants (RAs) at soup kitchens, parks, libraries, and other locations that homeless youth were known to frequent. Youth were randomly assigned to receive six months of advocacy that focused on linking youth to a drop-in center (n = 40) or to a crisis shelter (n = 39). Follow-up assessments were conducted at 3, 6, and 9 months post-baseline. Hard drug use over time was the main outcome. Intervention condition and service connection were used as predictors for the baseline level and the slope of change in hard drug use over time. Data analysis was conducted with Bernoulli Hierarchical Generalized Linear Modeling in HLM7. The current study found that those who were in the drop-in linkage condition exhibited a greater reduction in their odds of using hard drugs during the follow-up points than their counterparts in the shelter linkage condition. And finally, those who utilized services more often during the follow-ups were those who exhibited less hard drug use at baseline and less reduction in their odds of using hard drugs. This study suggests that drop-in centers, which are often characterized by low-demand programming and few behavioral restrictions, are effective for addressing hard drug use among homeless youth.

Randomized controlled trial of the Valencia model of waking hypnosis plus CBT for pain, fatigue, and sleep management in patients with cancer and cancer survivors.

PubMed

Mendoza, M E; Capafons, A; Gralow, J R; Syrjala, K L; Suárez-Rodríguez, J M; Fann, J R; Jensen, M P

2017-11-01

This study evaluated the efficacy of an intervention combining the Valencia model of waking hypnosis with cognitive-behavioral therapy (VMWH-CBT) in managing cancer-related pain, fatigue, and sleep problems in individuals with active cancer or who were post-treatment survivors. We hypothesized that four sessions of VMWH-CBT would result in greater improvement in participants' symptoms than four sessions of an education control intervention. Additionally, we examined the effects on several secondary outcome domains that are associated with increases in these symptoms (depression, pain interference, pain catastrophizing, and cancer treatment distress). The study design was a randomized controlled crossover clinical trial comparing the VMWH-CBT intervention with education control. Participants (N = 44) received four sessions of both treatments, in a counterbalanced order (n = 22 per order condition). Participants were 89% female (N = 39) with mean age of 61 years (SD = 12.2). They reported significantly greater improvement after receiving the active treatment relative to the control condition in all the outcome measures. Treatment gains were maintained at 3-month follow-up. This study supports the beneficial effects of the VMWH-CBT intervention relative to a control condition and that treatment gains remain stable. VMWH-CBT-trained clinicians should be accessible for managing symptoms both during and after cancer treatment, though the findings need to be replicated in larger samples of cancer survivors. Copyright © 2016 John Wiley & Sons, Ltd.

Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): A cluster randomised trial protocol

PubMed Central

2010-01-01

Background Variability between clinical practice guideline recommendations and actual clinical practice exists in many areas of health care. A 2004 systematic review examining the effectiveness of guideline implementation interventions concluded there was a lack of evidence to support decisions about effective interventions to promote the uptake of guidelines. Further, the review recommended the use of theory in the development of implementation interventions. A clinical practice guideline for the management of acute low-back pain has been developed in Australia (2003). Acute low-back pain is a common condition, has a high burden, and there is some indication of an evidence-practice gap in the allied health setting. This provides an opportunity to develop and test a theory-based implementation intervention which, if effective, may provide benefits for patients with this condition. Aims This study aims to estimate the effectiveness of a theory-based intervention to increase allied health practitioners' (physiotherapists and chiropractors in Victoria, Australia) compliance with a clinical practice guideline for acute non-specific low back pain (LBP), compared with providing practitioners with a printed copy of the guideline. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of acute non-specific LBP patients who are either referred for or receive an x-ray, and improving mean level of disability for patients three months post-onset of acute LBP. Methods The design of the study is a cluster randomised trial. Restricted randomisation was used to randomise 210 practices (clusters) to an intervention or control group. Practitioners in the control group received a printed copy of the guideline. Practitioners in the intervention group received a theory-based intervention developed to address prospectively identified barriers to practitioner compliance with the guideline. The intervention primarily consisted of an educational symposium. Patients aged 18 years or older who visit a participating practitioner for acute non-specific LBP of less than three months duration over a two-week data collection period, three months post the intervention symposia, are eligible for inclusion. Sample size calculations are based on recruiting between 15 to 40 patients per practice. Outcome assessors will be blinded to group allocation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12609001022257 (date registered 25th November 2009) PMID:21067614

The Differential Impact of User-Fee Exemption Compared to Conditional Cash Transfers on Safe Deliveries in Nepal.

PubMed

Pradhan, Elina; Fan, Victoria Y

2017-08-01

To assess the differential impact of a copayment exemption compared to a cash incentive on increasing skilled birth attendance (i.e., birth attended by a skilled health worker) in Nepal. This study used data on 8,785 children born between July 2005 and December 2008, obtained from the nationally representative Demographic and Health Surveys, 2006 and 2011. Twenty-five districts received both the policy interventions, and the remaining 50 control districts received only the cash incentive. We employed a difference-in-differences model to compare children born in districts with both interventions to those in districts with conditional cash transfers only. Average marginal effects of the difference-in-difference coefficient on skilled birth attendance measures are estimated. Skilled birth attendance in districts with both interventions was no higher on average than in districts with only the cash incentive. In areas with adequate road networks, however, significantly higher skilled birth attendance was observed in districts with both interventions compared to those with only the cash incentive. The added incentive of the user-fee exemption did not significantly increase skilled birth attendance relative to the presence of the cash incentive. User-fee exemptions may not be effective in areas with inadequate road infrastructure. © Health Research and Educational Trust.

Implementation of a community-based secondhand smoke reduction intervention for caregivers of urban children with asthma: process evaluation, successes and challenges

PubMed Central

Blaakman, Susan; Tremblay, Paul J.; Halterman, Jill S.; Fagnano, Maria; Borrelli, Belinda

2013-01-01

Many children, including those with asthma, remain exposed to secondhand smoke. This manuscript evaluates the process of implementing a secondhand smoke reduction counseling intervention using motivational interviewing (MI) for caregivers of urban children with asthma, including reach, dose delivered, dose received and fidelity. Challenges, strategies and successes in applying MI are highlighted. Data for 140 children (3–10 years) enrolled in the School Based Asthma Therapy trial, randomized to the treatment condition and living with one or more smoker, were analyzed. Summary statistics describe the sample, process measures related to intervention implementation, and primary caregiver (PCG) satisfaction with the intervention. The full intervention was completed by 79% of PCGs, but only 17% of other smoking caregivers. Nearly all (98%) PCGs were satisfied with the care study nurses provided and felt the program might be helpful to others. Despite challenges, this intervention was feasible and well received reaching caregivers who were not actively seeking treatment for smoking cessation or secondhand smoke reduction. Anticipating the strategies required to implement such an intervention may help promote participant engagement and retention to enhance the program’s ultimate success. PMID:22717938

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

PubMed

Kwan, Matthew; Faulkner, Guy; Bray, Steven

2013-04-29

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

How can parents get involved in preschool? Barriers and engagement in education by ethnic minority parents of children attending Head Start.

PubMed

Mendez, Julia L

2010-01-01

An intervention was developed to promote parent involvement with ethnic minority families of children attending Head Start preschool programs. Two hundred eighty-eight predominantly African American families from a small southern city were included in this study. Parent satisfaction with the program was high, yet engagement was less than optimal. Some effects were found for the program, despite low levels of participation. Ethnic minority parents who received the intervention increased the frequency of reading to their child as compared with parents in a comparison group who did not receive the program. The quality of the parent-teacher relationship was significantly correlated with parental participation in the intervention. Program participation and the parent-teacher relationship were correlated with higher levels of children's school readiness abilities. Children in the intervention condition showed stronger end-of-year receptive vocabulary and parent-rated social competence as compared with children who did not receive treatment. This research documents the challenges involved in engaging parents in prevention programs. Strategies for maximizing the benefits of preschool for ethnic minority families and their children are discussed. (c) 2009 APA, all rights reserved.

Treatment response to the RENEW weight loss intervention in schizophrenia: Impact of intervention setting

PubMed Central

Brown, Catana; Goetz, Jeannine; Hamera, Edna; Gajewski, Byron

2014-01-01

Background Individuals with serious mental illness have high rates of obesity and a need for specialized weight loss intervention programs. This study examines the efficacy of the RENEW weight loss intervention and examines the impact of the intervention setting on outcomes. Method 136 individuals with serious mental illness from 4 different settings were randomly assigned to receive the RENEW weight loss intervention or a control condition of treatment as usual. The RENEW intervention is a one year program that includes an intensive, maintenance and intermittent supports phase. Results The intervention group experienced a modest weight loss of 4.8 lbs at 3 months, 4.1 lbs at 6 months and a slight weight gain of 1.5 lbs at 12 months. The control group gained a total of 6.2 lbs at 12 months. However when settings were examined separately the responder sites had a weight loss of 9.4 lbs at 3 months, 10.9 lbs at 6 months and 7 lbs at 12 months. Discussion These results suggest that the settings in which individuals receive services may act as a support or hindrance toward response to weight loss interventions. The concept of the obesogenic environment deserves further examination as a factor in the success of weight loss programs. PMID:25261884

Treatment response to the RENEW weight loss intervention in schizophrenia: impact of intervention setting.

PubMed

Brown, Catana; Goetz, Jeannine; Hamera, Edna; Gajewski, Byron

2014-11-01

Individuals with serious mental illness have high rates of obesity and a need for specialized weight loss intervention programs. This study examines the efficacy of the RENEW weight loss intervention and examines the impact of the intervention setting on outcomes. 136 individuals with serious mental illness from 4 different settings were randomly assigned to receive the RENEW weight loss intervention or a control condition of treatment as usual. The RENEW intervention is a one year program that includes an intensive, maintenance and intermittent supports phase. The intervention group experienced a modest weight loss of 4.8 lbs at 3 months, 4.1 lbs at 6 months and a slight weight gain of 1.5 lbs at 12 months. The control group gained a total of 6.2 lbs at 12 months. However when settings were examined separately the responder sites had a weight loss of 9.4 lbs at 3 months, 10.9 lbs at 6 months and 7 lbs at 12 months. These results suggest that the settings in which individuals receive services may act as a support or hindrance toward response to weight loss interventions. The concept of the obesogenic environment deserves further examination as a factor in the success of weight loss programs. Copyright © 2014 Elsevier B.V. All rights reserved.

Increasing Physical Activity Efficiently: An Experimental Pilot Study of a Website and Mobile Phone Intervention

PubMed Central

Vittersø, Joar; Svendsen, Gunnvald Bendix

2014-01-01

The main objective of this pilot study was to test the effectiveness of an online, interactive physical activity intervention that also incorporated gaming components. The intervention design included an activity planner, progress monitoring, and gamification components and used SMS text as a secondary delivery channel and feedback to improve engagement in the intervention content. Healthy adults (n = 21) recruited through ads in local newspapers (age 35–73) were randomized to the intervention or the control condition. Both groups reported physical activity using daily report forms in four registration weeks during the three-month study: only the experiment condition received access to the intervention. Analyses showed that the intervention group had significantly more minutes of physical activity in weeks five and nine. We also found a difference in the intensity of exercise in week five. Although the intervention group reported more minutes of physical activity at higher intensity levels, we were not able to find a significant effect at the end of the study period. In conclusion, this study adds to the research on the effectiveness of using the Internet and SMS text messages for delivering physical activity interventions and supports gamification as a viable intervention tool. PMID:24963290

Unmet basic needs and health intervention effectiveness in low-income populations.

PubMed

Kreuter, Matthew W; McQueen, Amy; Boyum, Sonia; Fu, Qiang

2016-10-01

In the face of unmet basic needs, low SES adults are less likely to obtain needed preventive health services. The study objective was to understand how these hardships may cluster and how the effectiveness of different health-focused interventions might vary across vulnerable population sub-groups with different basic needs profiles. From June 2010-2012, a random sample of low-income adult callers to Missouri 2-1-1 completed a cancer risk assessment and received up to 3 health referrals for needed services (mammography, pap testing, colonoscopy, HPV vaccination, smoking cessation and smoke-free home policies). Participants received either a verbal referral only (N=365), verbal referral+tailored print reminder (N=372), or verbal referral+navigator (N=353). Participants reported their unmet basic needs at baseline and contacts with health referrals at 1-month post-intervention. We examined latent classes of unmet basic needs using SAS. Logistic regression examined the association between latent classes and contacting a health referral, by intervention condition. A 3 class solution best fit the data. For participants with relatively more unmet needs (C2) and those with money needs (C3), the navigator intervention was more effective than the tailored or verbal referral only conditions in leading to health referrals contacts. For participants with fewer unmet basic needs (C1), the tailored intervention was as effective as the navigator intervention. The distribution and nature of unmet basic needs in this sample of low-income adults was heterogeneous, and those with the greatest needs benefitted most from a more intensive navigator intervention in helping them seek needed preventive health services. Copyright © 2016 Elsevier Inc. All rights reserved.

Outcomes from a randomized controlled trial of a multi-component alcohol use preventive intervention for urban youth: project northland Chicago.

PubMed

Komro, Kelli A; Perry, Cheryl L; Veblen-Mortenson, Sara; Farbakhsh, Kian; Toomey, Traci L; Stigler, Melissa H; Jones-Webb, Rhonda; Kugler, Kari C; Pasch, Keryn E; Williams, Carolyn L

2008-04-01

The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings. Sixty-one public schools in Chicago were recruited to participate, were grouped into neighborhood study units and assigned randomly to intervention or 'delayed program' control condition. The study sample (n = 5812 students) was primarily African American, Hispanic and low-income. Students, beginning in sixth grade (age 12 years), received 3 years of intervention strategies (curricula, family interventions, youth-led community service projects, community organizing). Students participated in yearly classroom-based surveys to measure their alcohol use and related risk and protective factors. Additional evaluation components included a parent survey, a community leader survey and alcohol purchase attempts. Overall, the intervention, compared with a control condition receiving 'prevention as usual', was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e. related risk and protective factors). There was a non-significant trend (P = 0.066) that suggested the ability to purchase alcohol by young-appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance. Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana and tobacco use combined (P = 0.01), with alcohol use alone approaching statistical significance (P = 0.06). Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.

Advancing Scientific Reasoning in Upper Elementary Classrooms: Direct Instruction Versus Task Structuring

NASA Astrophysics Data System (ADS)

Lazonder, Ard W.; Wiskerke-Drost, Sjanou

2015-02-01

Several studies found that direct instruction and task structuring can effectively promote children's ability to design unconfounded experiments. The present study examined whether the impact of these interventions extends to other scientific reasoning skills by comparing the inquiry activities of 55 fifth-graders randomly assigned to one of three conditions. Children in the control condition investigated a four-variable inquiry task without additional support. Performance of this task in the direct instruction condition was preceded by a short training in experimental design, whereas children in the task structuring condition, who did not receive the introductory training, were given a version of the task that addressed the four variables one at a time. Analysis of children's experimentation behavior confirmed that direct instruction and task structuring are equally effective and superior to unguided inquiry. Both interventions also evoked more determinate predictions and valid inferences. These findings demonstrate that the effect of short-term interventions designed to promote unconfounded experimentation extends beyond the control of variables.

Examining the Efficacy of a Multitiered Intervention for At-Risk Readers in Grade 1

ERIC Educational Resources Information Center

Smith, Jean Louise M.; Nelson, Nancy J.; Fien, Hank; Smolkowski, Keith; Kosty, Derek; Baker, Scott K.

2016-01-01

This study reports the results of a cluster RCT evaluating the impact of Enhanced Core Reading Instruction on reading achievement of grade 1 at-risk readers. Forty-four elementary schools, blocked by district, were randomly assigned to condition. In both conditions, at-risk readers received 90 minutes of whole-group instruction (Tier 1) plus an…

A school-based, peer leadership physical activity intervention for 6th graders: feasibility and results of a pilot study.

PubMed

Barr-Anderson, Daheia J; Laska, Melissa N; Veblen-Mortenson, Sara; Farbakhsh, Kian; Dudovitz, Bonnie; Story, Mary

2012-05-01

The aim of this study was to promote physical activity in 6th graders by developing and testing the feasibility of an enhanced Presidential Active Lifestyle Award (PALA) program comprised of a peer leadership component and innovative exercise resource toolkit including DVDs. A racially/ethnically diverse sample of students received the standard PALA program (2 control schools, n = 61) or enhanced PALA+Peers program (2 intervention schools, n = 87) during 2006-2007 academic year. Compared with the control condition, the intervention was successful in increasing moderate physical activity in all students (P = .02) and moderate and hard physical activity among girls (P = .03 and P = .04, respectively). Teachers and students reported a high level of satisfaction and receptivity with the intervention. All teachers thought the DVDs were well-received, and 87% of students reported that they would recommend the enhanced program to peers. Coupling peer leadership and DVDs that promote physical activity may be an effective way to increase youth physical activity.

Comparing Two Inquiry Professional Development Interventions in Science on Primary Students' Questioning and Other Inquiry Behaviours

NASA Astrophysics Data System (ADS)

Nichols, Kim; Burgh, Gilbert; Kennedy, Callie

2017-02-01

Developing students' skills to pose and respond to questions and actively engage in inquiry behaviours enables students to problem solve and critically engage with learning and society. The aim of this study was to analyse the impact of providing teachers with an intervention in inquiry pedagogy alongside inquiry science curriculum in comparison to an intervention in non-inquiry pedagogy alongside inquiry science curriculum on student questioning and other inquiry behaviours. Teacher participants in the comparison condition received training in four inquiry-based science units and in collaborative strategic reading. The experimental group, the community of inquiry (COI) condition, received training in facilitating a COI in addition to training in the same four inquiry-based science units. This study involved 227 students and 18 teachers in 9 primary schools across Brisbane, Australia. The teachers were randomly allocated by school to one of the two conditions. The study followed the students across years 6 and 7 and students' discourse during small group activities was recorded, transcribed and coded for verbal inquiry behaviours. In the second year of the study, students in the COI condition demonstrated a significantly higher frequency of procedural and substantive higher-order thinking questions and other inquiry behaviours than those in the comparison condition. Implementing a COI within an inquiry science curriculum develops students' questioning and science inquiry behaviours and allows teachers to foster inquiry skills predicated by the Australian Science Curriculum. Provision of inquiry science curriculum resources alone is not sufficient to promote the questioning and other verbal inquiry behaviours predicated by the Australian Science Curriculum.

Using Behavioral Economic Theory to Increase Use of Effective Contraceptives among Opioid-maintained Women at Risk of Unintended Pregnancy

PubMed Central

Heil, Sarah H.; Hand, Dennis J.; Sigmon, Stacey C.; Badger, Gary J.; Meyer, Marjorie C.; Higgins, Stephen T.

2016-01-01

Objective An unsettling aspect of the US opioid epidemic is the high rate of in utero exposure, especially since most of these pregnancies are unintended, due in part to low rates of effective contraceptive use among opioid-using women. This study tested an intervention informed by behavioral economic theory and aimed at promoting effective contraceptive use among opioid-maintained women at risk of unintended pregnancy in the Burlington, VT area between 2011–2013. Methods Thirty-one women were assigned (initial 5 consecutively, subsequent 26 randomly) to either usual care or an experimental intervention. Participants in usual care received condoms, a dose of emergency contraception, and referral to local providers. Participants in the experimental condition received usual care plus the World Health Organization’s contraception initiation protocol, including free prescription contraceptives, and financial incentives for attending 13 follow-up visits over 6 months to help manage side effects and other issues. Results Significantly more women in the experimental vs. usual care control conditions initiated prescription contraceptive use (100% vs. 29%) and reported prescription contraceptive use at 1-month (63% vs. 13%), 3-month (88% vs. 20%), and 6-month (94% vs. 13%) assessments. None of the experimental condition participants became pregnant during the 6-month protocol vs. three women (20%) in the control condition. Conclusions These results provide the first experimental evidence supporting the efficacy of an intervention for increasing prescription contraceptive use among opioid-maintained women at risk of unintended pregnancy. PMID:27346756

The impact of early psychosocial intervention on self-efficacy of care recipient/carer dyads living with early stage dementia - A mixed methods study.

PubMed

Stockwell-Smith, G; Moyle, W; Kellett, U

2018-05-13

To evaluate the effect of a targeted community-based psychosocial intervention on self-efficacy outcomes for care recipient/carer dyads living with early-stage dementia. There is increasing interest in the role of self-efficacy and self-management structures in determining positive outcomes for people with dementia. The assumption is that care recipient/carer dyads who receive early support to identify and adjust to dementia related changes will cope better in the long-term. An explanatory sequential mixed-method design was employed. Primarily quantitative with qualitative data providing a supportive secondary role to expand on and illuminate the quantitative findings. 88 dyads were recruited and allocated on a regional basis to an intervention or control group. Intervention group dyads received the Early Diagnosis Dyadic Intervention. Control group dyads received two information manuals. Quantitative data were collected at three time-points. Qualitative data were collected via evaluation questionnaires and semi-structured interviews. Intervention structure, content and delivery were acceptable to the dyads but few quantitative self-efficacy findings reached statistical significance. Improvements in self-efficacy were evident in the post-intervention evaluation qualitative responses where dyads expressed greater confidence in identifying and accessing community support. There is an urgent need for effective psychosocial interventions to help reduce the impact of dementia symptoms on patients, carers and society. This study makes an important contribution to our understanding of the capacity of psychosocial interventions to improve self-efficacy outcomes for care recipient/carer dyads with early-stage dementia while also illustrating the challenges associated with measuring self-efficacy in the early stages of the condition. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Effectiveness of a two-phase cognitive rehabilitation intervention for severely impaired schizophrenia patients.

PubMed

Silverstein, Steven M; Hatashita-Wong, Michi; Solak, Beth Anne; Uhlhaas, Peter; Landa, Yulia; Wilkniss, Sandra M; Goicochea, Claudia; Carpiniello, Kelly; Schenkel, Lindsay S; Savitz, Adam; Smith, Thomas E

2005-06-01

Several small-N, uncontrolled reports have demonstrated that the behavioral technique of attention shaping has significantly increased attention span among severely ill schizophrenia patients. In this study, we evaluated the effectiveness of using an individually administered intervention for improving sustained attention, Attention Process Training (APT), followed by an attention-shaping procedure within the context of an ongoing skills training group. Patients were randomly assigned to receive either the APT and attention-shaping sequence (n = 18) or equivalent hours of treatment in the same intensive behavioral rehabilitation program (n = 13). Results indicated dramatic improvements in attentiveness in the cognitive rehabilitation condition compared with the control condition, which demonstrated essentially no change in attentiveness over the 12 weeks of treatment. The attention-shaping intervention appeared to account for the majority of the effect. In contrast to the observational data, performance on neuropsychological tests was unaffected by the cognitive interventions. This two-phase intervention demonstrated effectiveness in promoting attentive behavior among chronic schizophrenia patients with severe attentional impairment.

The pediatric residency training on tobacco project: four-year parent outcome findings.

PubMed

Hymowitz, Norman; Pyle, Sara A; Haddock, C Keith; Schwab, Joseph V

2008-08-01

To assess parent behavioral change and perception of resident intervention on tobacco. In a long-term study of the efficacy of training pediatric residents to address tobacco conducted at the New Jersey Medical School, sixteen pediatric training programs were assigned randomly to either special or standard training conditions. Parent surveys were administered in the fall of 2001 and 2005 in order to assess the effects of resident intervention on parent behavior, as well as parent perceptions of resident intervention. The percent of parents who smoke at sites associated with the special training condition, but not of those at sites associated with standard training, who reported that residents advised them to stop smoking, offered to help them quit, and provided quit smoking materials increased significantly from baseline to year 4. The percent of parents in the special training condition who reported quitting smoking in the past year also increased, although the increase was not statistically significant. A majority of the parents associated with each training condition reported receiving intervention for second hand smoke (SHS). For each training condition, the level of intervention to prevent exposure of infants and children to SHS exposure was similar at baseline and year 4, as was the percent of parents who reported having a smoke-free household. The results support the efficacy of the special training program and underscore the importance of preparing pediatric residents to address tobacco.

Current Issues and Priorities in Childhood Nutrition, Growth, and Infections123

PubMed Central

Salam, Rehana A; Das, Jai K; Bhutta, Zulfiqar A

2015-01-01

Forty-five percent of the 6.6 million under-5 deaths in 2012 were attributable to infectious disease, of which pneumonia and diarrhea were the leading causes. Despite the close interrelation between these infections and nutrition conditions, key nutrition interventions for prevention of childhood diarrhea and pneumonia have not received deserved attention, especially in low- and middle-income countries. Several interventions and strategies can effectively address these issues but are not available to those in need. This article discusses in detail the burden and trends of global under-5 mortality, infections, and nutrition conditions; etiology and associated risk factors; biological plausibility and the interrelation between infections, nutrition, and growth; and existing interventions and strategies to reduce major childhood infections and improve nutrition and growth and implications. PMID:25833888

Optimizing the scientific yield from a randomized controlled trial (RCT): evaluating two behavioral interventions and assessment reactivity with a single trial.

PubMed

Carey, Michael P; Senn, Theresa E; Coury-Doniger, Patricia; Urban, Marguerite A; Vanable, Peter A; Carey, Kate B

2013-09-01

Randomized controlled trials (RCTs) remain the gold standard for evaluating intervention efficacy but are often costly. To optimize their scientific yield, RCTs can be designed to investigate multiple research questions. This paper describes an RCT that used a modified Solomon four-group design to simultaneously evaluate two, theoretically-guided, health promotion interventions as well as assessment reactivity. Recruited participants (N = 1010; 56% male; 69% African American) were randomly assigned to one of four conditions formed by crossing two intervention conditions (i.e., general health promotion vs. sexual risk reduction intervention) with two assessment conditions (i.e., general health vs. sexual health survey). After completing their assigned baseline assessment, participants received the assigned intervention, and returned for follow-ups at 3, 6, 9, and 12 months. In this report, we summarize baseline data, which show high levels of sexual risk behavior; alcohol, marijuana, and tobacco use; and fast food consumption. Sexual risk behaviors and substance use were correlated. Participants reported high satisfaction with both interventions but ratings for the sexual risk reduction intervention were higher. Planned follow-up sessions, and subsequent analyses, will assess changes in health behaviors including sexual risk behaviors. This study design demonstrates one way to optimize the scientific yield of an RCT. © 2013 Elsevier Inc. All rights reserved.

Do Early Literacy Skills in Children's First Language Promote Development of Skills in Their Second Language? An Experimental Evaluation of Transfer

PubMed Central

Goodrich, J. Marc; Lonigan, Christopher J.; Farver, JoAnn M.

2013-01-01

The purpose of this study was to evaluate the cross-language transfer of the emergent literacy skills of preschoolers who were Spanish-speaking language minority children in the context of an experimental intervention study. Ninety-four children were randomly assigned to either a control condition (High/Scope preschool curriculum) or to receive small-group pull-out instruction (Literacy Express Preschool Curriculum) in English or initially in Spanish and transitioning to English. We examined whether children's initial skills in one language moderated the impact of the intervention on those same skills in the other language at posttest. Results demonstrated that, for children in the English-only intervention condition, initial Spanish receptive vocabulary and elision skills moderated the impact of the intervention on English receptive vocabulary and elision skills at posttest, respectively. For children in the transitional intervention condition, initial English definitional vocabulary and elision skills moderated the impact of the intervention on Spanish definitional vocabulary and elision skills at posttest, respectively. Results for the vocabulary interactions, as well as the elision interaction for the English-only intervention group comparisons, supported the notion of transfer of specific linguistic information across languages. Results for elision interaction for the transitional intervention group comparisons supported language-independent transfer. Implications for the theory of cross-language transfer of emergent literacy skills are discussed. PMID:24019555

Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial.

PubMed

Baird, Sarah J; Garfein, Richard S; McIntosh, Craig T; Ozler, Berk

2012-04-07

Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women. We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women. In this cluster randomised trial, never-married women aged 13-22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and randomly assigned with computer-generated random numbers by enumeration area (1:1) to receive cash payments (intervention group) or nothing (control group). Intervention enumeration areas were further randomly assigned with computer-generated random numbers to conditional (school attendance required to receive payment) and unconditional (no requirements to receive payment) groups. Participants in both intervention groups were randomly assigned by a lottery to receive monthly payments ranging from US$1 to $5, while their parents were independently assigned with computer-generated random numbers to receive $4-10. Behavioural risk assessments were done at baseline and 12 months; serology was tested at 18 months. Participants were not masked to treatment status but counsellors doing the serologic testing were. The primary outcomes were prevalence of HIV and herpes simplex virus 2 (HSV-2) at 18 months and were assessed by intention-to-treat analyses. The trial is registered, number NCT01333826. 88 enumeration areas were assigned to receive the intervention and 88 as controls. For the 1289 individuals enrolled in school at baseline with complete interview and biomarker data, weighted HIV prevalence at 18 month follow-up was 1·2% (seven of 490 participants) in the combined intervention group versus 3·0% (17 of 799 participants) in the control group (adjusted odds ratio [OR] 0·36, 95% CI 0·14-0·91); weighted HSV-2 prevalence was 0·7% (five of 488 participants) versus 3·0% (27 of 796 participants; adjusted OR 0·24, 0·09-0·65). In the intervention group, we noted no difference between conditional versus unconditional intervention groups for weighted HIV prevalence (3/235 [1%] vs 4/255 [2%]) or weighted HSV-2 prevalence (4/233 [1%] vs 1/255 [<1%]). For individuals who had already dropped out of school at baseline, we detected no significant difference between intervention and control groups for weighted HIV prevalence (23/210 [10%] vs 17/207 [8%]) or weighted HSV-2 prevalence (17/211 [8%] vs 17/208 [8%]). Cash transfer programmes can reduce HIV and HSV-2 infections in adolescent schoolgirls in low-income settings. Structural interventions that do not directly target sexual behaviour change can be important components of HIV prevention strategies. Global Development Network, Bill & Melinda Gates Foundation, National Bureau of Economic Research Africa Project, World Bank's Research Support Budget, and several World Bank trust funds (Gender Action Plan, Knowledge for Change Program, and Spanish Impact Evaluation fund). Copyright © 2012 Elsevier Ltd. All rights reserved.

Culturally appropriate education intervention on biospecimen research participation among Chinese Americans.

PubMed

Gao, Wanzhen; Ma, Grace X; Tan, Yin; Fang, Carolyn; Weaver, Joellen; Jin, Ming; Lai, Philip; Godwin, Andrew K

2014-03-01

Chinese Americans are at increased risk for hepatitis B virus (HBV) infection. To reduce or eliminate disparities in HBV-related infection rates, participation in scientific investigations of HBV risk and treatment, including biospecimen sampling, is important. However, Asian Americans have low rates of participation in biospecimen research, and little is known about how educational interventions affect knowledge and participation in HBV-related biospecimen research. Eight Chinese community-based organizations participated in a quasi-experimental, two-group design with education assessments at pre- and postworkshop and a 3-month follow-up. Four sites were randomly assigned to receive the intervention (n = 175) and four sites to receive general health education (control; n = 240). Participant knowledge about biospecimen research increased from pre- to posteducation in the intervention but not in the control condition. Of intervention participants, 83.4% (146/175) donated one tube of blood for future HBV biospecimen research, and 50.9% (89/175) donated another tube of blood for HBV testing. In contrast, only 1.1% of participants in the control condition reported donating a blood sample at follow-up assessment. The intervention program significantly increased knowledge of and participation in HBV biospecimen research among Chinese Americans. Community-based participatory research (CBPR) methods featured active support by community leaders, a culturally specific curriculum, and convenient, immediate access to blood sampling, which resulted in high donation rates. HBV-related morbidity and mortality is an urgent problem faced by Chinese Americans. CBPR provides a model for engaging communities in early detection, vaccination, and treatment that can reduce this health threat. ©2014 AACR.

The relative role of cognitive and emotional reactions in mediating the effects of a social comparison sun protection intervention.

PubMed

Mahler, Heike I M

2018-02-01

This experiment examined the cognitive and emotional impact of two social comparison-based sun protection interventions in a sample of Southern California college students (N = 223). One of the interventions employed comparison UV photos of peers who had either much more (downward social comparison) or much less (upward social comparison) skin damage than did participants themselves. The second intervention consisted of descriptive norms information suggesting that a large majority of the participants' peer group regularly protect their skin from the sun. Participants were randomly assigned to one of eight conditions in a 4 (Social Comparison Information: no photo vs. no comparison photos vs. upward comparison photos vs. downward comparison photos) × 2 (Descriptive Norms Information: Received vs. not received) design. Emotional reactions (e.g. worry, embarrassment, relief) and sun-related cognitive reactions (perceived susceptibility, sun protection intentions) were assessed immediately. Sun protection behaviours were assessed in a surprise telephone follow-up five weeks following the intervention. The results demonstrated that the combination of seeing photos of peers who had very little sun damage and learning that a majority of one's peers engage in regular sun protection resulted in reliably greater subsequent sun protection than all other conditions. Further, there was relatively direct evidence that both negative emotional reactions and sun protection intentions mediated this effect. These findings add to the growing literature suggesting the importance of thoroughly examining the role of emotions in health behaviour decisions. Both theory and intervention efficacy would benefit from a better understanding of the relative role of cognitions and emotions in behaviour change.

Online Personalized Normative Alcohol Feedback for Parents of First Year College Students

PubMed Central

Napper, Lucy E.; LaBrie, Joseph W.; Earle, Andrew

2016-01-01

This study examined the efficacy of a personalized normative feedback (PNF) alcohol intervention for parents of students transitioning into college. A sample of 399 parent-student dyads were recruited to take part in the intervention during the summer prior to matriculation. Parents were randomly assigned to receive either normative feedback regarding student drinking and other college parents’ alcohol-related communication or general college health norm information. Students completed measures of alcohol use, alcohol consequences, and parent-child alcohol-specific communication both 1- and 6-months after matriculation. The results indicated that in comparison to the control condition parents who received PNF reported immediate changes in their perceptions of other parents’ behaviors; however, these changes in parent perceived norms did not translate into long-term changes in student drinking behaviors or parent-child communication. Findings highlight the need to consider content beyond normative feedback for parent based alcohol intervention. PMID:27819429

Promoting Fitness and Safety in Elementary Students: A Randomized Control Study of the Michigan Model for Health.

PubMed

O'Neill, James M; Clark, Jeffrey K; Jones, James A

2016-07-01

In elementary grades, comprehensive health education curricula have demonstrated effectiveness in addressing singular health issues. The Michigan Model for Health (MMH) was implemented and evaluated to determine its impact on nutrition, physical fitness, and safety knowledge and skills. Schools (N = 52) were randomly assigned to intervention and control conditions. Participants received MMH with 24 lessons in grade 4 and 28 more lessons in grade 5 including material focusing on nutrition, physical fitness, and safety attitudes and skills. The 40-minute lessons were taught by the classroom teacher who received curriculum training and provided feedback on implementation fidelity. Self-report survey data were collected from the fourth-grade students (N = 1983) prior to the intervention, immediately after the intervention, and 6 weeks after the intervention, with the same data collection schedule repeated in fifth grade. Analysis of the scales was conducted using a mixed-model approach. Students who received the curriculum had better nutrition, physical activity, and safety skills than the control-group students. Intervention students also reported higher consumption of fruits; however, no difference was reported for other types of food consumption. The effectiveness of the MMH in promoting fitness and safety supports the call for integrated strategies that begin in elementary grades, target multiple risk behaviors, and result in practical and financial benefits to schools. © 2016, American School Health Association.

Implementation of Response to Intervention (RtI) Model in Spain: an example of a collaboration between Canarian universities and the department of education of the Canary Islands.

PubMed

Jiménez, Juan E; Rodríguez, Cristina; Crespo, Patricia; González, Desirée; Artiles, Ceferino; Alfonso, Miguel

2010-11-01

The purpose of this study was to examine the effectiveness of second tier intervention at-risk readers within the context of a Response to Intervention approach. The study was conducted in the Canary Islands (Spain), directed by research team ¨Dificultades de Aprendizaje, Psicolingüística y Nuevas Tecnologías¨ (DEA&NT) from University of La Laguna, and supported by the Government of the Canary Islands. A sample of 1.123 Spanish children from fourteen schools districts were given the Spanish adaptation of The Hong Kong Specific Learning Difficulties Behavior Checklist and children who scored at or above the 75th percentile on the test were classified as "at risk" for early reading difficulties. Half of the students were randomly assigned to a project-based intervention condition where they received small group supplementary intervention for 30 minutes daily using the Prevención de las Dificultades Específicas de Aprendizaje (PREDEA) curriculum from mid to late December and continued until mid June. The other half received whatever remedial services were available at their schools. Results indicated that children who received the PREDEA curriculum had higher scores on the Early Grade Reading Assessment Test (EGRA) on initial sound identification, listening comprehension, letter sound knowledge and oral reading fluency compared to the control group.

Physical activity and adolescents: an exploratory randomized controlled trial investigating the influence of affective and instrumental text messages.

PubMed

Sirriyeh, Reema; Lawton, Rebecca; Ward, Jane

2010-11-01

The present study attempts to develop and pilot the feasibility and efficacy of a novel intervention using affective messages as a strategy to increase physical activity (PA) levels in adolescents. Design An exploratory pilot randomized control trial was used to compare behaviour change over 2 weeks. A modified form of the International Physical Activity Questionnaire was used to assess PA behaviour. A total of 120 adolescents (16-19 years) from 4 sixth forms in West Yorkshire completed the field-based study. Participants were randomly assigned to one of three experimental conditions, or the control condition (N=28). Participants in experimental conditions received 1 short messaging service (SMS) text message per day over the 2 weeks, which included manipulations of either affective beliefs (enjoyable/unenjoyable; N=31), instrumental beliefs (beneficial/harmful; N=30), or a combination of these (N=31). Control participants received one SMS text message per week. Outcomes were measured at baseline and at the end of the 2 week intervention. PA levels increased by the equivalent of 31.5  minutes of moderate (four metabolic equivalent) activity per week during the study. Main effects of condition (p=.049), and current physical activity level (p=.002) were identified, along with a significant interaction between condition and current activity level (p=.006). However, when the sample was split at baseline into active and inactive participants, a main effect of condition remained for inactive participants only (p=.001). Post hoc analysis revealed that inactive participants who received messages targeting affective beliefs increased their activity levels significantly more than the instrumental (p=.012), combined (p=.002), and control groups (p=.018). Strategies based on affective associations may be more effective for increasing PA levels in inactive individuals.

Combined Training of One Cognitive and One Metacognitive Strategy Improves Academic Writing Skills.

PubMed

Wischgoll, Anke

2016-01-01

Academic writing is a challenging task. Expert writers apply various writing skills as they anticipate the reader's view of their text while paying attention to structure and content. Research in the high school setting shows that the acquisition of writing skills can be supported by single-strategy training. However, research in higher education is scarce. We tested whether the development of academic writing skills can also be effectively supported by training single strategies or even combined strategies. As metacognition is an important skill for advanced and adult learners, we focused in this study on the benefit of combined cognitive strategies with and without a metacognitive strategy. An experiment including three conditions was conducted (N = 60 German-speaking psychology undergraduates, M = 22.8, SD = 4.4), which lasted for three hours. Each group received a modeling intervention of a basic cognitive strategy on the application of text structure knowledge. Two groups received an additional modeling intervention with either a cognitive strategy treatment on text summarization or a metacognitive strategy treatment on self-monitoring the writing process. One group received no further strategy treatment. Prior knowledge and learning outcomes were measured with a specially developed test on academic writing skills. In addition, all participants wrote an abstract of an empirical article. We found that learners who received the additional self-monitoring strategy intervention benefited significantly more in terms of acquisition of academic writing skills and the quality of their texts than learners who did not receive this intervention. Thus, the results underline the importance of self-monitoring strategies in academic writing. Implications and further research opportunities are discussed.

Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee.

PubMed

Courtney, Carol A; Steffen, Alana D; Fernández-de-Las-Peñas, César; Kim, John; Chmell, Samuel J

2016-03-01

An experimental laboratory study with a repeated-measures crossover design. Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways. Impaired conditioned pain modulation (CPM) has been found experimentally in persons with knee and hip osteoarthritis, indicating impaired inhibition of central nociceptive pathways. We hypothesized increased effectiveness of CPM following application of joint mobilization, determined via measures of deep tissue hyperalgesia. To examine the effect of joint mobilization on impaired CPM. An examination of 40 individuals with moderate/severe knee osteoarthritis identified 29 (73%) with impaired CPM. The subjects were randomized to receive 6 minutes of knee joint mobilization (intervention) or manual cutaneous input only, 1 week apart. Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the hand at baseline, postintervention, and post-CPM testing. Further, vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing. Joint mobilization, but not cutaneous input intervention, resulted in a global increase in pressure pain threshold, indicated by diminished hyperalgesic responses to pressure stimulus. Further, CPM was significantly enhanced following joint mobilization. Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention, but not at the contralateral knee. Resting pain was also significantly lower following the joint intervention. Conditioned pain modulation was enhanced following joint mobilization, demonstrated by a global decrease in deep tissue pressure sensitivity. Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis.

Promoting language and social communication development in babies through an early storybook reading intervention.

PubMed

Brown, Michelle I; Westerveld, Marleen F; Trembath, David; Gillon, Gail T

2017-12-15

This study examined the effectiveness of low- and high-intensity early storybook reading (ESR) intervention workshops delivered to parents for promoting their babies language and social communication development. These workshops educated parents on how to provide a stimulating home reading environment and engage in parent-child interactions during ESR. Parent-child dyads (n = 32); child age: 3-12 months, were assigned into two intervention conditions: low and high intensity (LI versus HI) groups. Both groups received the same ESR strategies; however, the HI group received additional intervention time, demonstrations and support. Outcome measures were assessed pre-intervention, one and three months post-intervention and when the child turned 2 years of age. A significant time-group interaction with increased performance in the HI group was observed for language scores immediately post-intervention (p = 0.007) and at 2-years-of-age (p = 0.022). Significantly higher broader social communication scores were associated with the HI group at each of the time points (p = 0.018, p = 0.001 and p = 0.021, respectively). Simple main effect revealed that both groups demonstrated a significant improvement in language, broader social communication and home reading practices scores. ESR intervention workshops may promote language and broader social communication skills. The HI ESR intervention workshop was associated with significantly higher language and broader social communication scores.

One-Year Outcomes and Mediators of a Brief Intervention for Drug Abusing Adolescents

PubMed Central

Winters, Ken C.; Lee, Susanne; Botzet, Andria; Fahnhorst, Tamara; Nicholson, Ali

2014-01-01

Two manually-guided brief interventions were evaluated with a randomized controlled trial. Adolescents (aged 13-17 years) suspected of abusing alcohol and other drugs and their parent were randomly assigned to receive either a 2-session adolescent only (BI-A), 2-session adolescent and additional parent session (BI-AP), or assessment only control condition (CON). Adolescents were identified in a school setting and the intervention was delivered by trained counselors. Outcome analyses (N=284; 90% of those enrolled) of relative change (from intake to 12-months) and absolute status (at 12-months) revealed a general pattern of reductions in drug use behaviors, particularly with the cannabis outcome measures, in both active conditions (BI-A and BI-AP). Students in the control condition showed worse outcome compared to the BI-A and BI-AP groups. Among the four mediating variables measured at 6-months, use of additional services, motivation to change and parenting practices had significant influences on 12-month outcome; problem solving skills approached significance as a mediator. The potential value of a brief intervention for drug abusing adolescents is discussed. PMID:24955669

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.

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

Comparing a motivational and a self-regulatory intervention to adopt an oral self-care regimen: a two-sequential randomized crossover trial.

PubMed

Lhakhang, Pempa; Gholami, Maryam; Knoll, Nina; Schwarzer, Ralf

2015-01-01

A sequential intervention to facilitate the adoption and maintenance of dental flossing was conducted among 205 students in India, aged 18-26 years. Two experimental groups received different treatment sequences and were observed at three assessment points, 34 days apart. One group received first a motivational intervention (intention, outcome expectancies, and risk perception, followed by a self-regulatory intervention (planning, self-efficacy, and action control). The second group received the same intervention in the opposite order. Both intervention sequences yielded gains in terms of flossing, planning, self-efficacy, and action control. However, at Time 2, those who had received the self-regulatory intervention first, were superior to their counterparts who had received the motivational intervention first. At Time 3, differences vanished as everyone had then received both interventions. Thus, findings highlight the benefits of a self-regulatory compared to a mere motivational intervention.

A Noninferiority Trial of a Problem-Solving Intervention for Hospice Caregivers: In Person versus Videophone

PubMed Central

Parker Oliver, Debra; Wittenberg-Lyles, Elaine; Washington, Karla; Doorenbos, Ardith; Rue, Tessa; Berry, Donna

2012-01-01

Abstract Purpose of the study Problem-solving therapy (PST) has been found effective when delivered to informal caregivers of patients with various conditions. In hospice, however, its translation to practice is impeded by the increased resources needed for its delivery. The study purpose was to compare the effectiveness of a PST intervention delivered face-to-face with one delivered via videophone to hospice primary caregivers. Design and methods The study design was a randomized noninferiority trial with two groups, Group 1 in which caregivers received PST face-to-face, and Group 2 in which caregivers received PST via videophone. Family hospice caregivers were recruited from two urban hospice agencies and received the PST intervention (in three visits for Group 1 or three video-calls in Group 2) in an approximate period of 20 days after hospice admission. Standard caregiver demographic data were collected. Psychometric instruments administered to caregivers at baseline and at study completion included the CQLI-R (Caregiver Quality of Life Index–Revised), the STAI (State-Trait Anxiety Inventory), and the PSI (Problem-Solving Inventory). Results One hundred twenty-six caregivers were recruited in the study; 77 were randomly assigned to Group 1 and 49 to Group 2. PST delivered via video was not inferior to face-to-face delivery. The observed changes in scores were similar for each group. Caregiver quality of life improved and state anxiety decreased under both conditions. Conclusions The delivery of PST via videophone was not inferior to face-to-face. Audiovisual feedback captured by technology may be sufficient, providing a solution to the geographic barriers that often inhibit the delivery of these types of interventions to older adults in hospice. PMID:22536989

The Falls In Care Home study: a feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes

PubMed Central

Walker, Gemma M; Armstrong, Sarah; Gordon, Adam L; Gladman, John; Robertson, Kate; Ward, Marie; Conroy, Simon; Arnold, Gail; Darby, Janet; Frowd, Nadia; Williams, Wynne; Knowles, Sue; Logan, Pip A

2015-01-01

Objective: To explore the feasibility of implementing and evaluating the Guide to Action Care Home fall prevention intervention. Design: Two-centre, cluster feasibility randomized controlled trial and process evaluation. Setting: Purposive sample of six diverse old age/learning disability, long stay care homes in Nottinghamshire, UK. Subjects: Residents aged over 50 years, who had fallen at least once in the past year, not bed-bound, hoist-dependent or terminally ill. Interventions: Intervention homes (n = 3) received Guide to Action Care Home fall prevention intervention training and support. Control homes (n = 3) received usual care. Outcomes: Recruitment, attrition, baseline and six-month outcome completion, contamination and intervention fidelity, compliance, tolerability, acceptance and impact. Results: A total of 81 of 145 (56%) care homes expressed participatory interest. Six of 22 letter respondent homes (27%) participated. The expected resident recruitment target was achieved by 76% (52/68). Ten (19%) residents did not complete follow-up (seven died, three moved). In intervention homes 36/114 (32%) staff attended training. Two of three (75%) care homes received protocol compliant training. Staff valued the training, but advised greater management involvement to improve intervention implementation. Fall risks were assessed, actioned and recorded in care records. Of 115 recorded falls, 533/570 (93%) of details were complete. Six-month resident fall rates were 1.9 and 4.0 per year for intervention and control homes, respectively. Conclusions: The Guide to Action Care Home is implementable under trial conditions. Recruitment and follow-up rates indicate that a definitive trial can be completed. Falls (primary outcome) can be ascertained reliably from care records. PMID:26385358

Effectiveness of a Combined Web-Based and Ecological Momentary Intervention for Incoming First-Year University Students: Protocol for a 3-Arm Randomized Controlled Trial.

PubMed

Riordan, Benjamin C; Moradi, Saleh; Carey, Kate B; Conner, Tamlin S; Jang, Kyungho; Reid, Kelly E; Scarf, Damian

2018-05-15

Alcohol use among university students is common, and those who drink often choose to drink heavily (ie, 4 or more drinks per session for women or 5 or more for men). Web-based interventions (WBIs), in which students complete assessments and receive personalized feedback about their alcohol use, and ecological momentary interventions (EMIs), which use mobile devices as a method of delivering intervention information, are 2 methods that have had some success in reducing alcohol use among university students. The aim of this study was to investigate the effectiveness of a combined WBI and EMI intervention to reduce alcohol use among university students. The study is a 3-arm randomized controlled trial. Participants will be randomized into either a WBI+EMI condition, a WBI-only condition, or an assessment-only control. Our sample will consist of first-year university students, recruited through 5 residential colleges at the University of Otago, New Zealand. All participants will complete an online survey at baseline (ie, before Orientation Week); those in the WBI-only and WBI+EMI conditions will immediately receive personalized feedback (ie, the WBI), whereas participants in the assessment-only condition will receive no feedback. In addition, participants randomized into the WBI+EMI, but not those in the WBI-only or assessment-only groups, will receive 8 Orientation Week (2 per day on nights with large social events) and 6 academic year EMIs (delivered fortnightly). Participants in all conditions will complete brief surveys at the end of the first and second semester and report their weekend alcohol use fortnightly throughout each semester via ecological momentary assessments. The primary hypothesis is that participants in the WBI+EMI group will consume significantly fewer drinks during weekends in their first semester at university compared with WBI-only and assessment-only groups. Secondary hypotheses are that, when compared with the WBI-only and assessment-only groups, the WBI+EMI group will report consuming fewer drinks during Orientation Week, report experiencing fewer negative alcohol-related consequences after first semester, and report lower Alcohol Use Disorder Identification Test-Consumption scores following their first semester. This study adds to a growing body of work investigating the utility of WBIs and EMIs in curbing alcohol consumption. In addition, the study will help to inform policy approaches aimed at curbing alcohol consumption and alcohol-related harm in university students. Australian New Zealand Clinical Trials Registry ACTRN12618000015246; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374104&isReview=true (Archived by WebCite at http://www.webcitation.org/6z9jRLTz6). RR1-10.2196/10164. ©Benjamin C Riordan, Saleh Moradi, Kate B Carey, Tamlin S Conner, Kyungho Jang, Kelly E Reid, Damian Scarf. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 15.05.2018.

Web-Based Fully Automated Self-Help With Different Levels of Therapist Support for Individuals With Eating Disorder Symptoms: A Randomized Controlled Trial.

PubMed

Aardoom, Jiska J; Dingemans, Alexandra E; Spinhoven, Philip; van Ginkel, Joost R; de Rooij, Mark; van Furth, Eric F

2016-06-17

Despite the disabling nature of eating disorders (EDs), many individuals with ED symptoms do not receive appropriate mental health care. Internet-based interventions have potential to reduce the unmet needs by providing easily accessible health care services. This study aimed to investigate the effectiveness of an Internet-based intervention for individuals with ED symptoms, called "Featback." In addition, the added value of different intensities of therapist support was investigated. Participants (N=354) were aged 16 years or older with self-reported ED symptoms, including symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder. Participants were recruited via the website of Featback and the website of a Dutch pro-recovery-focused e-community for young women with ED problems. Participants were randomized to: (1) Featback, consisting of psychoeducation and a fully automated self-monitoring and feedback system, (2) Featback supplemented with low-intensity (weekly) digital therapist support, (3) Featback supplemented with high-intensity (3 times a week) digital therapist support, and (4) a waiting list control condition. Internet-administered self-report questionnaires were completed at baseline, post-intervention (ie, 8 weeks after baseline), and at 3- and 6-month follow-up. The primary outcome measure was ED psychopathology. Secondary outcome measures were symptoms of depression and anxiety, perseverative thinking, and ED-related quality of life. Statistical analyses were conducted according to an intent-to-treat approach using linear mixed models. The 3 Featback conditions were superior to a waiting list in reducing bulimic psychopathology (d=-0.16, 95% confidence interval (CI)=-0.31 to -0.01), symptoms of depression and anxiety (d=-0.28, 95% CI=-0.45 to -0.11), and perseverative thinking (d=-0.28, 95% CI=-0.45 to -0.11). No added value of therapist support was found in terms of symptom reduction although participants who received therapist support were significantly more satisfied with the intervention than those who did not receive supplemental therapist support. No significant differences between the Featback conditions supplemented with low- and high-intensity therapist support were found regarding the effectiveness and satisfaction with the intervention. The fully automated Internet-based self-monitoring and feedback intervention Featback was effective in reducing ED and comorbid psychopathology. Supplemental therapist support enhanced satisfaction with the intervention but did not increase its effectiveness. Automated interventions such as Featback can provide widely disseminable and easily accessible care. Such interventions could be incorporated within a stepped-care approach in the treatment of EDs and help to bridge the gap between mental disorders and mental health care services. Netherlands Trial Registry: NTR3646; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3646 (Archived by WebCite at http://www.webcitation.org/6fgHTGKHE).

Diabetes quality improvement in Department of Veterans Affairs Ambulatory Care Clinics: a group-randomized clinical trial.

PubMed

Reiber, Gayle E; Au, David; McDonell, Mary; Fihn, Stephan D

2004-05-01

To conduct a group-randomized clinical trial to determine whether regular feedback to primary care providers of synthesized information on patients' health, function, and satisfaction would demonstrate improved outcomes for their patients with diabetes. Patients in General Internal Medicine Clinics Department of Veterans Affairs (VA) Medical Centers were randomized into seven intervention or control firms. Patient self-reported information was collected by mail on general health, diabetes, and up to five other chronic conditions. Patients with diabetes received the Seattle Diabetes Questionnaire, the 36-item Medical Outcomes Study short form (SF-36), and a validated patient satisfaction questionnaire at regular intervals. Data from self-report, clinical, pharmacy, and laboratory sources were synthesized into patient-specific feedback reports that intervention providers received before patients' visits. The timely delivery to primary care providers of state-of-the-art patient-feedback reports that identified patient issues and areas for improvement did not result in significant improvements in patient outcomes between the intervention and control firms. Outcomes in diabetic patients whose providers received synthesized patient data before visits were no better than in those receiving care from control firms. Future studies may benefit from substantial involvement in patients discussing, problem solving, and goal setting in addition to use of timely synthesized patient data.

Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial.

PubMed

Bøtker, Hans Erik; Kharbanda, Rajesh; Schmidt, Michael R; Bøttcher, Morten; Kaltoft, Anne K; Terkelsen, Christian J; Munk, Kim; Andersen, Niels H; Hansen, Troels M; Trautner, Sven; Lassen, Jens Flensted; Christiansen, Evald Høj; Krusell, Lars R; Kristensen, Steen D; Thuesen, Leif; Nielsen, Søren S; Rehling, Michael; Sørensen, Henrik Toft; Redington, Andrew N; Nielsen, Torsten T

2010-02-27

Remote ischaemic preconditioning attenuates cardiac injury at elective surgery and angioplasty. We tested the hypothesis that remote ischaemic conditioning during evolving ST-elevation myocardial infarction, and done before primary percutaneous coronary intervention, increases myocardial salvage. 333 consecutive adult patients with a suspected first acute myocardial infarction were randomly assigned in a 1:1 ratio by computerised block randomisation to receive primary percutaneous coronary intervention with (n=166 patients) versus without (n=167) remote conditioning (intermittent arm ischaemia through four cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff). Allocation was concealed with opaque sealed envelopes. Patients received remote conditioning during transport to hospital, and primary percutaneous coronary intervention in hospital. The primary endpoint was myocardial salvage index at 30 days after primary percutaneous coronary intervention, measured by myocardial perfusion imaging as the proportion of the area at risk salvaged by treatment; analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00435266. 82 patients were excluded on arrival at hospital because they did not meet inclusion criteria, 32 were lost to follow-up, and 77 did not complete the follow-up with data for salvage index. Median salvage index was 0.75 (IQR 0.50-0.93, n=73) in the remote conditioning group versus 0.55 (0.35-0.88, n=69) in the control group, with median difference of 0.10 (95% CI 0.01-0.22; p=0.0333); mean salvage index was 0.69 (SD 0.27) versus 0.57 (0.26), with mean difference of 0.12 (95% CI 0.01-0.21; p=0.0333). Major adverse coronary events were death (n=3 per group), reinfarction (n=1 per group), and heart failure (n=3 per group). Remote ischaemic conditioning before hospital admission increases myocardial salvage, and has a favourable safety profile. Our findings merit a larger trial to establish the effect of remote conditioning on clinical outcomes. Fondation Leducq. Copyright 2010 Elsevier Ltd. All rights reserved.

Promoting action control and coping planning to improve hand hygiene.

PubMed

Reyes Fernández, Benjamín; Lippke, Sonia; Knoll, Nina; Blanca Moya, Emanuel; Schwarzer, Ralf

2015-09-25

We examined a brief educational intervention addressing hand hygiene self-regulatory mechanisms, and evaluated which psychological mechanisms may lead to hand hygiene behaviours. Two hundred forty two students (mean age = 21 years, SD = 3.9) received either an experimental (n = 149) or a control condition on action control and planning (n = 93). Hand hygiene, coping planning, and action control were measured at baseline and six weeks later. By applying repeated measures ANOVA, we compared the experimental condition addressing planning to perform hand hygiene with a control condition. Additionally, working mechanisms were evaluated by means of mediation analysis. The intervention had an effect on action control, as reflected by a time by treatment interaction. The direct effect of the intervention on behaviour was, however, non-significant. Changes in action control led to changes in coping planning. These social-cognitive changes mediated the effect of intervention on behaviour, after controlling for gender, baseline behaviour, and classroom membership. In spite of the associations between the intervention and self-regulatory strategies, no direct effect was found of the intervention on behaviour. Further research on how to increase hand sanitizing, involving enviromental characteristics, is required. The intervention led only indirectly to an improvement of hand hygiene via changes in self-regulatory factors. Results indicate the importance of promoting action control and coping planning to initiate changes in hand hygienic behaviours.

[Nutritional status and physical condition of adolescent football players after consuming fishmeal as a nutritional complement].

PubMed

Accinelli-Tanaka, Roberto; López-Oropeza, Lidia

2013-03-01

The objective of the study is to identify the changes in the nutritional parameters and the physical condition of teenage players after eating fishmeal as a nutritional complement. For this purpose, a quasi-experimental study, blinded for investigators, was conducted, involving 100 teenage football players, divided in two groups, homogeneous in terms of all study parameters, one of which received fishmeal for four months. After evaluating the nutritional status and physical condition, before and after the intervention, no change was found in the nutritional and anthropometric status or laboratory results, or in the physical condition. However, those who received fishmeal did report a change in their hemoglobin and hematocrit levels in comparison to the control group. In conclusion, the consumption of fishmeal did not lead to changes in the nutritional status or the physical condition of teenage football players.

Essential health care among Mexican indigenous people in a universal coverage context.

PubMed

Servan-Mori, Edson; Pelcastre-Villafuerte, Blanca; Heredia-Pi, Ileana; Montoya-Rodríguez, Arain

2014-01-01

To analyze the influence of indigenous condition on essential health care among Mexican children, older people and women in reproductive age. The influence of indigenous condition on the probability of receiving medical care due to acute respiratory infection (ARI) and acute diarrheal disease (ADD), vaccination coverage; and antenatal care (ANC) was analyzed using the 2012 National Health Survey and non-experimental matching methods. Indigenous condition does not influence per-se vaccination coverage (in < 1 year), probability of attention of ARI's and ADD's as well as, timely, frequent, and quality ANC. Being indigenous and older adult increases 9% the probability of receiving a fulfilled vaccination schedule. Unfavorable structural conditions in which Mexican indigenous live constitutes the persistent mechanisms of their health vulnerability. Public policy should consider this level of intervention, in a way that intensive and focalized health strategies contribute to improve their health condition and life.

Marketing depression care management to employers: design of a randomized controlled trial.

PubMed

Rost, Kathryn M; Marshall, Donna

2010-03-16

Randomized trials demonstrate that depression care management can improve clinical and work outcomes sufficiently for selected employers to realize a return on investment. Employers can now purchase depression products that provide depression care management, defined as employee screening, education, monitoring, and clinician feedback for all depressed employees. We developed an intervention to encourage employers to purchase a depression product that offers the type, intensity, and duration of care management shown to improve clinical and work outcomes. In a randomized controlled trial conducted with 360 employers of 30 regional business coalitions, the research team proposes to compare the impact of a value-based marketing intervention to usual-care marketing on employer purchase of depression products. The study will also identify mediators and organizational-level moderators of intervention impact. Employers randomized to the value-based condition receive a presentation encouraging them to purchase depression products scientifically shown to benefit the employee and the employer. Employers randomized to the usual-care condition receive a presentation encouraging them to monitor and improve quality indicators for outpatient depression treatment. Because previous research demonstrates that the usual-care intervention will have little to no impact on employer purchasing, depression product purchasing rates in the usual-care condition capture vendor efforts to market depression products to employers in both conditions while the value-based intervention is being conducted. Employers in both conditions are also provided free technical assistance to undertake the actions each presentation encourages. The research team will use intent-to-treat models of all available data to evaluate intervention impact on the purchase of depression products using a cumulative incidence analysis of 12- and 24-month data. By addressing the 'value to whom?' question, the study advances knowledge about one of the most pivotal problems in the translation of evidence-based care to 'real world' settings: whether purchasers can be influenced to buy healthcare products on the basis of value and not exclusively on the basis of cost. If value-based marketing increases depression product purchase rates over usual care, this study will provide encouragement to market new healthcare products on the basis of the product's value to the purchaser as well as the recipient of care. NCT01013220.

Marketing depression care management to employers: design of a randomized controlled trial

PubMed Central

2010-01-01

Background Randomized trials demonstrate that depression care management can improve clinical and work outcomes sufficiently for selected employers to realize a return on investment. Employers can now purchase depression products that provide depression care management, defined as employee screening, education, monitoring, and clinician feedback for all depressed employees. We developed an intervention to encourage employers to purchase a depression product that offers the type, intensity, and duration of care management shown to improve clinical and work outcomes. Methods In a randomized controlled trial conducted with 360 employers of 30 regional business coalitions, the research team proposes to compare the impact of a value-based marketing intervention to usual-care marketing on employer purchase of depression products. The study will also identify mediators and organizational-level moderators of intervention impact. Employers randomized to the value-based condition receive a presentation encouraging them to purchase depression products scientifically shown to benefit the employee and the employer. Employers randomized to the usual-care condition receive a presentation encouraging them to monitor and improve quality indicators for outpatient depression treatment. Because previous research demonstrates that the usual-care intervention will have little to no impact on employer purchasing, depression product purchasing rates in the usual-care condition capture vendor efforts to market depression products to employers in both conditions while the value-based intervention is being conducted. Employers in both conditions are also provided free technical assistance to undertake the actions each presentation encourages. The research team will use intent-to-treat models of all available data to evaluate intervention impact on the purchase of depression products using a cumulative incidence analysis of 12- and 24-month data. Discussion By addressing the 'value to whom?' question, the study advances knowledge about one of the most pivotal problems in the translation of evidence-based care to 'real world' settings: whether purchasers can be influenced to buy healthcare products on the basis of value and not exclusively on the basis of cost. If value-based marketing increases depression product purchase rates over usual care, this study will provide encouragement to market new healthcare products on the basis of the product's value to the purchaser as well as the recipient of care. Trial Registration Clinical Trials Registration Number: NCT01013220 PMID:20233448

Using mHealth Technology in a Self-Management Intervention to Promote Physical Activity Among Adults With Chronic Disabling Conditions: Randomized Controlled Trial.

PubMed

Plow, Matthew; Golding, Meghan

2017-12-01

Physical activity is considered a comprehensive approach for managing limitations in physical function among adults with chronic disabling conditions. However, adults with chronic disabling conditions often face many barriers to engaging in physical activity. A strategy to promote physical activity among adults with chronic disabling conditions is to encourage the use of mobile health (mHealth) apps. The objective of this pilot study was to examine the potential benefits of using commercially available mHealth apps in a self-management intervention among 46 adults with musculoskeletal or neurological conditions. Participants were randomized to one of 3 intervention groups: (1) mHealth-based self-management intervention, (2) paper-based self-management intervention, and (3) contact-control intervention. Participants in all 3 groups met in person once and received 3 follow-up phone calls with a trained graduate assistant. Participants in the mHealth-based and paper-based groups received a computer tablet or a paper diary, respectively, to facilitate goal setting, self-monitoring, and action planning. Participants in the contact-control group received information on healthy behaviors without being taught skills to change behaviors. The following outcomes were measured at baseline and at the 7th week: physical activity (Physical Activity and Disability Survey-revised), psychosocial factors (self-efficacy, self-regulation, and social support), and physical function (Patient Report Outcomes Measurement Information System, 6-min walk test, 1-min chair stands, and 1-min arm curls). Repeated-measures multivariate analysis of variance (MANOVA) indicated significant differences between groups in physical activity levels (Wilks λ=0.71, F 6,76 =2.34, P=.04). Both the mHealth-based and paper-based groups had large effect size increases in planned exercise and leisure-time physical activity compared with the contact-control group (Cohen d=1.20 and d=0.82, respectively). Repeated-measures MANOVA indicated nonsignificant differences between groups in psychosocial factors (Wilks λ=0.85, F 6,76 =1.10, P=.37). However, both the mHealth-based and paper-based groups had moderate effect size improvements in self-efficacy (d=0.48 and d=0.75, respectively) and self-regulation (d=0.59 and d=0.43, respectively) compared with the contact-control group. Repeated-measures MANOVA indicated nonsignificant differences between groups in physical function (Wilks λ=0.94, F 8,66 =0.27, P=.97). There were small and nonsignificant changes between the mHealth-based and paper-based groups with regard to most outcomes. However, the mHealth-based group had moderate effect size increases (d=0.47) in planned exercise and leisure-time physical activity compared with the paper-based group. We found that using commercially available mHealth apps in a self-management intervention shows promise in promoting physical activity among adults with musculoskeletal and neurological conditions. Further research is needed to identify the best ways of using commercially available mobile apps in self-management interventions. Clinicaltrials.gov NCT02833311; https://clinicaltrials.gov/ct2/show/NCT02833311 (Archived by WebCite at http://www.webcitation.org/6vDVSAw1w). ©Matthew Plow, Meghan Golding. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 01.12.2017.

Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System: a Cross-Sectional Study.

PubMed

Jasuja, Guneet K; Bhasin, Shalender; Reisman, Joel I; Hanlon, Joseph T; Miller, Donald R; Morreale, Anthony P; Pogach, Leonard M; Cunningham, Francesca E; Park, Angela; Berlowitz, Dan R; Rose, Adam J

2017-03-01

There has been concern about the growing off-label use of testosterone. Understanding the context within which testosterone is prescribed may contribute to interventions to improve prescribing. To evaluate patient characteristics associated with receipt of testosterone. Cross-sectional. A national cohort of male patients, who had received at least one outpatient prescription within the Veterans Affairs (VA) system during Fiscal Year 2008- Fiscal Year 2012. The study sample consisted of 682,915 non-HIV male patients, of whom 132,764 had received testosterone and a random 10% sample, 550,151, had not. Conditions and medications associated with testosterone prescription. Only 6.3% of men who received testosterone from the VA during the study period had a disorder of the testis, pituitary or hypothalamus associated with male hypogonadism. Among patients without a diagnosed disorder of hypogonadism, the use of opioids and obesity were the strongest predictors of testosterone prescription. Patients receiving >100 mg/equivalents of oral morphine daily (adjusted odds ratio = 5.75, p < 0.001) and those with body mass index (BMI) >40 kg/m 2 (adjusted odds ratio = 3.01, p < 0.001) were more likely to receive testosterone than non-opioid users and men with BMI <25 kg/m 2 . Certain demographics (age 40-54, White race), comorbid conditions (sleep apnea, depression, and diabetes), and medications (antidepressants, systemic corticosteroids) also predicted a higher likelihood of testosterone receipt, all with an adjusted odds ratio less than 2 (p < 0.001). In the VA, 93.7% of men receiving testosterone did not have a diagnosed condition of the testes, pituitary, or hypothalamus. The strongest predictors of testosterone receipt (e.g., obesity, receipt of opioids), which though are associated with unapproved, off-label use, may be valid reasons for therapy. Interventions should aim to increase the proportion of testosterone recipients who have a valid indication.

It’s Your Game. Keep It Real: Delaying Sexual Behavior with an Effective Middle School Program

PubMed Central

Tortolero, Susan R.; Markham, Christine M.; Peskin, Melissa Fleschler; Shegog, Ross; Addy, Robert C.; Escobar-Chaves, S. Liliana; Baumler, Elizabeth R.

2009-01-01

Purpose This study tested the effects of a theory-based middle-school HIV, STI, and pregnancy prevention program, It’s Your Game: Keep it Real (IYG), in delaying sexual behavior. We hypothesized that the IYG intervention would decrease the number of adolescents who initiated sexual activity by the 9th grade compared to those in the comparison schools. Methods The target population was English-speaking middle schoolers from a large urban predominantly African American and Hispanic school district in Southeast Texas. Ten middle schools were randomly assigned either to receive the intervention or to the comparison condition. Seventh-grade students were recruited and followed through 9th grade. The IYG intervention comprises 12 seventh-grade and 12 eighth-grade lessons that integrate group-based classroom activities with computer-based instruction and personal journaling. Ninth-grade follow-up surveys were completed by 907 students (92% of the defined cohort). The primary hypothesis tested was that the intervention would decrease the number of adolescents who initiated sexual activity by the 9th grade compared to those in the comparison schools. Results Almost one-third (29.9%, n=509) of those in the comparison condition initiated sex by 9th grade compared to almost one-quarter (23.4%, n=308) of those in the intervention condition. After adjusting for covariates, students in the comparison condition were 1.29 times more likely to initiate sex by the 9th grade than those in the intervention condition. Conclusions A theory-driven multi-component, curriculum-based intervention can delay sexual initiation up to 24 months; can have impact on specific types of sexual behavior such as initiation of oral and anal sex; and may be especially effective with females. Future research must explore the generalizabilty of these results. PMID:20113923

A Process Evaluation of an Efficacious Family-Based Intervention to Promote Healthy Eating: The Entre Familia: Reflejos de Salud Study.

PubMed

Schmied, Emily; Parada, Humberto; Horton, Lucy; Ibarra, Leticia; Ayala, Guadalupe

2015-10-01

Entre Familia: Reflejos de Salud was a successful family-based randomized controlled trial designed to improve dietary behaviors and intake among U.S. Latino families, specifically fruit and vegetable intake. The novel intervention design merged a community health worker (promotora) model with an entertainment-education component. This process evaluation examined intervention implementation and assessed relationships between implementation factors and dietary change. Participants included 180 mothers randomized to an intervention condition. Process evaluation measures were obtained from participant interviews and promotora notes and included fidelity, dose delivered (i.e., minutes of promotora in-person contact with families, number of promotora home visits), and dose received (i.e., participant use of and satisfaction with intervention materials). Outcome variables included changes in vegetable intake and the use of behavioral strategies to increase dietary fiber and decrease dietary fat intake. Participant satisfaction was high, and fidelity was achieved; 87.5% of families received the planned number of promotora home visits. In the multivariable model, satisfaction with intervention materials predicted more frequent use of strategies to increase dietary fiber (p ≤ .01). Trends suggested that keeping families in the prescribed intervention timeline and obtaining support from other social network members through sharing of program materials may improve changes. Study findings elucidate the relationship between specific intervention processes and dietary changes. © 2015 Society for Public Health Education.

Home-based smoking prevention program Smoke-free Kids on smoking-related cognitions: Secondary outcomes from a cluster randomized controlled trial.

PubMed

Hiemstra, Marieke; Engels, Rutger C M E; van Schayck, Onno C P; Otten, Roy

2016-01-01

The home-based smoking prevention programme 'Smoke-free Kids' did not have an effect on primary outcome smoking initiation. A possible explanation may be that the programme has a delayed effect. The aim of this study was to evaluate the effects on the development of important precursors of smoking: smoking-related cognitions. We used a cluster randomised controlled trial in 9- to 11-year-old children and their mothers. The intervention condition received five activity modules, including a communication sheet for mothers, by mail at four-week intervals. The control condition received a fact-based programme. Secondary outcomes were attitudes, self-efficacy and social norms. Latent growth curves analyses were used to calculate the development of cognitions over time. Subsequently, path modelling was used to estimate the programme effects on the initial level and growth of each cognition. Analyses were performed on 1398 never-smoking children at baseline. Results showed that for children in the intervention condition, perceived maternal norms increased less strongly as compared to the control condition (β = -.10, p = .03). No effects were found for the other cognitions. Based on the limited effects, we do not assume that the programme will have a delayed effect on smoking behaviour later during adolescence.

Short-term effects of a home-based smoking prevention program on antismoking socialization and smoking-related cognitions: a cluster randomized controlled trial.

PubMed

Hiemstra, Marieke; Ringlever, Linda; Otten, Roy; van Schayck, Onno C P; Engels, Rutger C M E

2013-01-01

This study aims to evaluate the short-term effects of a home-based smoking prevention program called 'Smoke-free Kids' on antismoking socialization and smoking-related cognitions and the moderating role of parental smoking. A cluster randomized controlled trial was carried out using one intervention condition compared with a control condition. A total of 1,398 never-smoking children (mean age 10.11 years, SD 0.78) participated. Intention-to-treat and completers-only analyses were performed. Participants in the intervention condition (n=728) received 5 activity modules by mail at 4-week intervals. Modules included communication sheets for their mothers. Participants in the control condition (n=750) received a fact-based intervention only. The main outcomes were the frequency and quality of communication, nonsmoking agreement, house rules, availability of cigarettes, perceived maternal influence, anticipated maternal reactions, attitude, self-efficacy and social norms. Significant effects of the program were found for frequency of communication (B=0.11, p<0.001), nonsmoking agreement (B=0.07, p<0.01), perceived maternal influences (B=0.09, p<0.05), self-efficacy (B=-0.09, p<0.05) and social norms of friends (B=-0.08, p=0.05) and best friends (B=-0.11, p<0.05). Parental smoking had no moderating effect. The Smoke-free Kids program shows promising short-term effects on antismoking socialization and cognitions. Long-term follow-up on the effects of smoking behavior are needed. Copyright © 2012 S. Karger AG, Basel.

Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda.

PubMed

Mutamba, Byamah B; Kane, Jeremy C; de Jong, Joop T V M; Okello, James; Musisi, Seggane; Kohrt, Brandon A

2018-02-15

Despite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma. A non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention. Caregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10-0.62] and 6 months (RR 0.33, 95% CI 0.11-0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers. IPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.

A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial

PubMed Central

Mahtani, Shireen; Rapee, Ronald M; Nicolas, Claire; Lawrence, Katherine A; Mackinnon, Andrew; Jorm, Anthony F

2018-01-01

Background Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. Objective This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms. Methods A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent’s strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children’s Anxiety Scale (anxiety symptoms). Results Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions. Conclusions The fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents’ risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents’ mental health. Trial Registration Australia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj) PMID:29351895

Enhancing cancer patient well-being with a nonpharmacological, heritage-focused intervention.

PubMed

Thomson, Linda J; Ander, Erica E; Menon, Usha; Lanceley, Anne; Chatterjee, Helen J

2012-11-01

Nonpharmacological, arts-focused interventions in health care have demonstrated considerable improvements in cancer patient well-being, although there is a little clinically robust, empirical evidence to demonstrate the value of heritage-focused practices. This study examined the effectiveness of a novel, nonpharmacological, heritage-focused intervention with adult female inpatients receiving cancer treatment in oncology wards of a large, central London hospital. In the tactile experimental condition, participants handled and discussed a selection of museum objects with a facilitator, whereas in the visual control condition, participants discussed photographs of the same objects. Sessions were conducted on a one-to-one basis at patients' bedsides and lasted about half an hour. Quantitative measures of psychological well-being with proven reliability and validity were used in a pretest/post-test control group, quasi-experimental design. Levels of positive emotion, well-being, and happiness were significantly enhanced in the experimental condition compared with the control condition for both oncology and nononcology patients. Findings indicate a future role for heritage-focused practices in enhancing health care environments. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Policing behaviors, safe injection self-efficacy, and intervening on injection risks: Moderated mediation results from a randomized trial.

PubMed

Pitpitan, Eileen V; Patterson, Thomas L; Abramovitz, Daniela; Vera, Alicia; Martinez, Gustavo; Staines, Hugo; Strathdee, Steffanie A

2016-01-01

We aim to use conditional or moderated mediation to simultaneously test how and for whom an injection risk intervention was efficacious at reducing receptive needle sharing among female sex workers who inject drugs (FSWs-IDUs) in Mexico. Secondary analysis of data from a randomized trial. A total of 300 FSW-IDUs participated in Mujer Mas Segura in Ciudad Juarez, Mexico, and were randomized to an interactive injection risk intervention or a didactic injection risk intervention. We measured safe injection self-efficacy as the hypothesized mediator and policing behaviors (being arrested and syringe confiscation) as hypothesized moderators. In total, 213 women provided complete data for the current analyses. Conditional (moderated) mediation showed that the intervention affected receptive needle sharing through safe injection self-efficacy among women who experienced syringe confiscation. On average, police syringe confiscation was associated with lower safe injection self-efficacy (p = .04). Among those who experienced syringe confiscation, those who received the interactive (vs. didactic) intervention reported higher self-efficacy, which in turn predicted lower receptive needle sharing (p = .04). Whereas syringe confiscation by the police negatively affected safe injection self-efficacy and ultimately injection risk behavior, our interactive intervention helped to "buffer" this negative impact of police behavior on risky injection practices. The theory-based, active skills building elements included in the interactive condition, which were absent from the didactic condition, helped participants' self-efficacy for safer injection in the face of syringe confiscation. (c) 2015 APA, all rights reserved).

Policing Behaviors, Safe Injection Self-Efficacy, and Intervening on Injection Risks: Moderated Mediation Results from a Randomized Trial

PubMed Central

Pitpitan, Eileen V.; Patterson, Thomas L.; Abramovitz, Daniela; Vera, Alicia; Martinez, Gustavo; Staines, Hugo; Strathdee, Steffanie A.

2015-01-01

Objective We aim to use conditional, or moderated mediation to simultaneously test how and for whom an injection risk intervention was efficacious at reducing receptive needle sharing among female sex workers who inject drugs (FSWs-IDUs) in Mexico. Methods Secondary analysis of data from a randomized trial. A total of 300 FSW-IDUs participated in Mujer Mas Segura in Ciudad Juarez, Mexico and were randomized to an interactive injection risk intervention or a didactic injection risk intervention. We measured safe injection self-efficacy as the hypothesized mediator, and policing behaviors (being arrested and syringe confiscation) as hypothesized moderators. 213 women provided complete data for the current analyses. Results Conditional (moderated) mediation showed that the intervention affected receptive needle sharing through safe injection self-efficacy among women who experienced syringe confiscation. On average, police syringe confiscation was associated with lower safe injection self-efficacy (p = 0.04). Among those who experienced syringe confiscation, those who received the interactive (vs. didactic) intervention reported higher self-efficacy, which in turn predicted lower receptive needle sharing (p = 0.04). Conclusions Whereas syringe confiscation by the police negatively impacted safe injection self-efficacy and ultimately injection risk behavior, our interactive intervention helped to “buffer” this negative impact of police behavior on risky injection practices. The theory-based, active skills building elements included in the interactive condition, which were absent from the didactic condition, helped participants’ self-efficacy for safer injection in the face of syringe confiscation. PMID:26120851

Use of email and telephone prompts to increase self-monitoring in a Web-based intervention: randomized controlled trial.

PubMed

Greaney, Mary L; Sprunck-Harrild, Kim; Bennett, Gary G; Puleo, Elaine; Haines, Jess; Viswanath, K Vish; Emmons, Karen M

2012-07-27

Self-monitoring is a key behavior change mechanism associated with sustained health behavior change. Although Web-based interventions can offer user-friendly approaches for self-monitoring, engagement with these tools is suboptimal. Increased use could encourage, promote, and sustain behavior change. To determine whether email prompts or email plus telephone prompts increase self-monitoring of behaviors on a website created for a multiple cancer risk reduction program. We recruited and enrolled participants (N = 100) in a Web-based intervention during a primary care well visit at an urban primary care health center. The frequency of daily self-monitoring was tracked on the study website. Participants who tracked at least one behavior 3 or more times during week 1 were classified as meeting the tracking threshold and were assigned to the observation-only group (OO, n = 14). This group was followed but did not receive prompts. Participants who did not meet the threshold during week 1 were randomly assigned to one of 2 prompting conditions: automated assistance (AA, n = 36) or automated assistance + calls (AAC, n = 50). During prompting periods (weeks 2-3), participants in the AA and AAC conditions received daily automated emails that encouraged tracking and two tailored self-monitoring reports (end of week 2, end of week 3) that provided feedback on tracking frequency. Individuals in the AAC condition also received two technical assistance calls from trained study staff. Frequency of self-monitoring was tracked from week 2 through week 17. Self-monitoring rates increased in both intervention conditions during prompting and declined when prompting ceased. Over the 16 weeks of observation, there was a significant between-group difference in the percentage who met the self-monitoring threshold each week, with better maintenance in the AAC than in the AA condition (P < .001). Self-monitoring rates were greater in the OO group than in either the AA or AAC condition (P < .001). Prompting can increase self-monitoring rates. The decrease in self-monitoring after the promoting period suggests that additional reminder prompts would be useful. The use of technical assistance calls appeared to have a greater effect in promoting self-monitoring at a therapeutic threshold than email reminders and the tailored self-monitoring reports alone. ClinicalTrials.gov NCT01415492; http://clinicaltrials.gov/ct2/show/NCT01415492 (Archived by WebCite at http://www.webcitation.org/68LOXOMe2).

A social network-based intervention stimulating peer influence on children's self-reported water consumption: A randomized control trial.

PubMed

Smit, Crystal R; de Leeuw, Rebecca N H; Bevelander, Kirsten E; Burk, William J; Buijzen, Moniek

2016-08-01

The current pilot study examined the effectiveness of a social network-based intervention using peer influence on self-reported water consumption. A total of 210 children (52% girls; M age = 10.75 ± SD = 0.80) were randomly assigned to either the intervention (n = 106; 52% girls) or control condition (n = 104; 52% girls). In the intervention condition, the most influential children in each classroom were trained to promote water consumption among their peers for eight weeks. The schools in the control condition did not receive any intervention. Water consumption, sugar-sweetened beverage (SSB) consumption, and intentions to drink more water in the near future were assessed by self-report measures before and immediately after the intervention. A repeated measure MANCOVA showed a significant multivariate interaction effect between condition and time (V = 0.07, F(3, 204) = 5.18, p = 0.002, pη(2) = 0.07) on the dependent variables. Further examination revealed significant univariate interaction effects between condition and time on water (p = 0.021) and SSB consumption (p = 0.015) as well as water drinking intentions (p = 0.049). Posthoc analyses showed that children in the intervention condition reported a significant increase in their water consumption (p = 0.018) and a decrease in their SSB consumption (p < 0.001) over time, compared to the control condition (p-values > 0.05). The children who were exposed to the intervention did not report a change in their water drinking intentions over time (p = 0.576) whereas the nonexposed children decreased their intentions (p = 0.026). These findings show promise for a social network-based intervention using peer influence to positively alter consumption behaviors. This RCT was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12614001179628). Study procedures were approved by the Ethics Committee of the Faculty of Social Sciences at Radboud University (ECSW2014-1003-203). Copyright © 2016 Elsevier Ltd. All rights reserved.

Provider Communication, Prompts, and Feedback to Improve HPV Vaccination Rates in Resident Clinics.

PubMed

Rand, Cynthia M; Schaffer, Stanley J; Dhepyasuwan, Nui; Blumkin, Aaron; Albertin, Christina; Serwint, Janet R; Darden, Paul M; Humiston, Sharon G; Mann, Keith J; Stratbucker, William; Szilagyi, Peter G

2018-04-01

Human papillomavirus (HPV) vaccination rates lag behind vaccination rates for other adolescent vaccines; a bundled intervention may improve HPV vaccination rates. Our objective is to evaluate the impact of quality improvement (QI) training plus a bundled practice-based intervention (provider prompts plus communication skills training plus performance feedback) on improving HPV vaccinations in pediatric resident continuity clinics. Staff and providers in 8 resident clinics participated in a 12-month QI study. The intervention included training to strengthen provider communication about the HPV vaccine. Clinics also implemented provider prompts, received monthly performance feedback, and participated in learning collaborative calls. The primary outcome measure was eligible visits with vaccination divided by vaccine-eligible visits (captured HPV vaccination opportunities). Practices performed chart audits that were fed into monthly performance feedback on captured HPV vaccination opportunities. We used conditional logistic regression (conditioning on practice) to assess captured vaccination opportunities, with the time period of the study (before and after the QI intervention) as the independent variable. Overall, captured opportunities for HPV vaccination increased by 16.4 percentage points, from 46.9% to 63.3%. Special cause was demonstrated by centerline shift, with 8 consecutive points above the preintervention mean. On adjusted analyses, patients were more likely to receive a vaccine during, versus before, the intervention (odds ratio: 1.87; 95% confidence interval: 1.54-2.28). Captured HPV vaccination rates improved at both well-child and other visits (by 11.7 and 13.0 percentage points, respectively). A bundled intervention of provider prompts and training in communication skills plus performance feedback increased captured opportunities for HPV vaccination. Copyright © 2018 by the American Academy of Pediatrics.

Improved self-confidence was a mechanism of action in two geriatric trials evaluating physical interventions.

PubMed

Peduzzi, Peter; Guo, Zhenchao; Marottoli, Richard A; Gill, Thomas M; Araujo, Katy; Allore, Heather G

2007-01-01

To evaluate the mechanisms of action in two successful geriatric clinical trials that tested multicomponent physical conditioning programs and to determine whether the pathways for overall benefit were through improvement in physical ability and/or self-confidence. PREHAB and DRIVER were conducted by the Yale Pepper Center. PREHAB participants received an individualized program that focused on the impairments present (standardly tailored design); DRIVER participants received the entire intervention (global design). PREHAB enrolled 188 community-living persons, aged 75 years or older, who were physically frail but ambulatory; DRIVER enrolled 178 drivers aged 70 years or older with physical impairments associated with poor driving performance. The primary outcome for PREHAB was a disability score and for DRIVER it was a driving score; potential mediators were measures of physical ability and self-confidence. In PREHAB, pathways for the intervention were established through improvement in physical ability and self-confidence. In DRIVER, there was some evidence for a pathway through improved driving self-confidence but not through physical ability; however, the intervention effect was largely unexplained. Multicomponent physical interventions may operate through psychological mechanisms, and these mechanisms should be anticipated in trial designs so that the component effects can be suitably evaluated.

How to Improve Adolescent Stress Responses: Insights From Integrating Implicit Theories of Personality and Biopsychosocial Models.

PubMed

Yeager, David S; Lee, Hae Yeon; Jamieson, Jeremy P

2016-08-01

This research integrated implicit theories of personality and the biopsychosocial model of challenge and threat, hypothesizing that adolescents would be more likely to conclude that they can meet the demands of an evaluative social situation when they were taught that people have the potential to change their socially relevant traits. In Study 1 (N = 60), high school students were assigned to an incremental-theory-of-personality or a control condition and then given a social-stress task. Relative to control participants, incremental-theory participants exhibited improved stress appraisals, more adaptive neuroendocrine and cardiovascular responses, and better performance outcomes. In Study 2 (N = 205), we used a daily-diary intervention to test high school students' stress reactivity outside the laboratory. Threat appraisals (Days 5-9 after intervention) and neuroendocrine responses (Days 8 and 9 after intervention only) were unrelated to the intensity of daily stressors when adolescents received the incremental-theory intervention. Students who received the intervention also had better grades over freshman year than those who did not. These findings offer new avenues for improving theories of adolescent stress and coping. © The Author(s) 2016.

Smoking relapse-prevention intervention for cancer patients: Study design and baseline data from the surviving SmokeFree randomized controlled trial.

PubMed

Díaz, Diana B; Brandon, Thomas H; Sutton, Steven K; Meltzer, Lauren R; Hoehn, Hannah J; Meade, Cathy D; Jacobsen, Paul B; McCaffrey, Judith C; Haura, Eric B; Lin, Hui-Yi; Simmons, Vani N

2016-09-01

Continued smoking after a cancer diagnosis contributes to several negative health outcomes. Although many cancer patients attempt to quit smoking, high smoking relapse rates have been observed. This highlights the need for a targeted, evidence-based smoking-relapse prevention intervention. The design, method, and baseline characteristics of a randomized controlled trial assessing the efficacy of a self-help smoking-relapse prevention intervention are presented. Cancer patients who had recently quit smoking were randomized to one of two conditions. The Usual Care (UC) group received the institution's standard of care. The smoking relapse-prevention intervention (SRP) group received standard of care, plus 8 relapse-prevention booklets mailed over a 3month period, and a targeted educational DVD developed specifically for cancer patients. Four hundred and fourteen participants were enrolled and completed a baseline survey. Primary outcomes will be self-reported smoking status at 6 and 12-months after baseline. Biochemical verification of smoking status was completed for a subsample. If found to be efficacious, this low-cost intervention could be easily disseminated with significant potential for reducing the risk of negative cancer outcomes associated with continued smoking. Copyright © 2016 Elsevier Inc. All rights reserved.

Readiness to Change as a Mediator of the Effect of a Brief Motivational Intervention on Posttreatment Alcohol-Related Consequences of Injured Emergency Department Hazardous Drinkers

PubMed Central

Stein, L. A. R.; Minugh, P. Allison; Longabaugh, Richard; Wirtz, Philip; Baird, Janette; Nirenberg, Ted D.; Woolard, Robert F.; Carty, Kathy; Lee, Christina; Mello, Michael; Becker, Bruce; Gogineni, Aruna

2009-01-01

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population. PMID:19586135

Brief online interventions targeting risk and protective factors for increased and problematic alcohol use among American college students studying abroad

PubMed Central

Pedersen, Eric R.; Neighbors, Clayton; Atkins, David C.; Lee, Christine M.; Larimer, Mary E.

2016-01-01

Research documents increased and problematic alcohol use during study abroad experiences for college students yet no research documents effective preventive programs with these students. The present randomized controlled trial was designed to prevent increased and problematic alcohol use abroad by correcting misperceptions of peer drinking norms abroad and by promoting positive and healthy adjustment into the host culture (i.e., sojourner adjustment) through brief online personalized feedback interventions. A sample of 343 study abroad college students was randomly assigned to one of four conditions including a personalized normative feedback intervention (PNF), a sojourner adjustment feedback intervention (SAF), a combined PNF + SAF intervention, and an assessment-only control condition. Generalized estimated equation analyses accounting for baseline drinking and consequences revealed an intervention effect for PNF that was mitigated by baseline drinking level, such that PNF was best for those with lighter baseline drinking, but heavier baseline drinkers receiving PNF alone or PNF + SAF drank comparatively similar or more heavily abroad to those in the control condition. However, PNF + SAF condition participants with greater baseline levels of consequences reported comparatively less consequences abroad than their control participants. Thus, PNF alone may be helpful for lighter drinkers at predeparture and the addition of SAF to PNF may help prevent consequences abroad for those reporting more consequences prior to departure abroad. This research represents an important first step in designing and implementing efficacious interventions with at-risk study abroad college students, for which no current empirically-based programs exist. PMID:28080092

Brief online interventions targeting risk and protective factors for increased and problematic alcohol use among American college students studying abroad.

PubMed

Pedersen, Eric R; Neighbors, Clayton; Atkins, David C; Lee, Christine M; Larimer, Mary E

2017-03-01

Research documents increased and problematic alcohol use during study abroad experiences for college students yet no research documents effective preventive programs with these students. The present randomized controlled trial was designed to prevent increased and problematic alcohol use abroad by correcting misperceptions of peer drinking norms abroad and by promoting positive and healthy adjustment into the host culture (i.e., sojourner adjustment) through brief online personalized feedback interventions. A sample of 343 study abroad college students was randomly assigned to 1 of 4 conditions including a personalized normative feedback intervention (PNF), a sojourner adjustment feedback intervention (SAF), a combined PNF + SAF intervention, and an assessment-only control condition. Generalized estimated equation analyses accounting for baseline drinking and consequences revealed an intervention effect for PNF that was mitigated by baseline drinking level, such that PNF was best for those with lighter baseline drinking, but heavier baseline drinkers receiving PNF alone or PNF + SAF drank comparatively similar or more heavily abroad to those in the control condition. However, PNF + SAF condition participants with greater baseline levels of consequences reported comparatively less consequences abroad than their control participants. Thus, PNF alone may be helpful for lighter drinkers at predeparture and the addition of SAF to PNF may help prevent consequences abroad for those reporting more consequences prior to departure abroad. This research represents an important first step in designing and implementing efficacious interventions with at-risk study abroad college students, for which no current empirically based programs exist. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Varied Practice in Laparoscopy Training: Beneficial Learning Stimulation or Cognitive Overload?

PubMed

Spruit, Edward N; Kleijweg, Luca; Band, Guido P H; Hamming, Jaap F

2016-01-01

Determining the optimal design for surgical skills training is an ongoing research endeavor. In education literature, varied practice is listed as a positive intervention to improve acquisition of knowledge and motor skills. In the current study we tested the effectiveness of a varied practice intervention during laparoscopy training. Twenty-four trainees (control group) without prior experience received a 3 weeks laparoscopic skills training utilizing four basic and one advanced training task. Twenty-eight trainees (experimental group) received the same training with a random training task schedule, more frequent task switching and inverted viewing conditions on the four basic training tasks, but not the advanced task. Results showed inferior performance of the experimental group on the four basic laparoscopy tasks during training, at the end of training and at a 2 months retention session. We assume the inverted viewing conditions have led to the deterioration of learning in the experimental group because no significant differences were found between groups on the only task that had not been practiced under inverted viewing conditions; the advanced laparoscopic task. Potential moderating effects of inter-task similarity, task complexity, and trainee characteristics are discussed.

Varied Practice in Laparoscopy Training: Beneficial Learning Stimulation or Cognitive Overload?

PubMed Central

Spruit, Edward N.; Kleijweg, Luca; Band, Guido P. H.; Hamming, Jaap F.

2016-01-01

Determining the optimal design for surgical skills training is an ongoing research endeavor. In education literature, varied practice is listed as a positive intervention to improve acquisition of knowledge and motor skills. In the current study we tested the effectiveness of a varied practice intervention during laparoscopy training. Twenty-four trainees (control group) without prior experience received a 3 weeks laparoscopic skills training utilizing four basic and one advanced training task. Twenty-eight trainees (experimental group) received the same training with a random training task schedule, more frequent task switching and inverted viewing conditions on the four basic training tasks, but not the advanced task. Results showed inferior performance of the experimental group on the four basic laparoscopy tasks during training, at the end of training and at a 2 months retention session. We assume the inverted viewing conditions have led to the deterioration of learning in the experimental group because no significant differences were found between groups on the only task that had not been practiced under inverted viewing conditions; the advanced laparoscopic task. Potential moderating effects of inter-task similarity, task complexity, and trainee characteristics are discussed. PMID:27242599

Examining Maternal Weight Gain During Contingency-Management Treatment for Smoking Cessation Among Pregnant Women

PubMed Central

Washio, Yukiko; Higgins, Stephen T.; Heil, Sarah H.; Badger, Gary J.; Skelly, Joan; Bernstein, Ira M.; Solomon, Laura J.; Higgins, Tara M.; Lynch, Mary Ellen; Hanson, Jennifer D.

2010-01-01

Excessive maternal weight gain during pregnancy can result in serious adverse maternal and neonatal health consequences making it an important outcome to monitor in developing smoking-cessation interventions for pregnant women. Maternal weight gain was investigated in the present study with 154 pregnant participants in controlled trials investigating the efficacy of contingency management (CM) for smoking cessation. Women were assigned to either an abstinence-contingent condition wherein they earned vouchers exchangeable for retail items by abstaining from smoking or to a control condition where they received comparable vouchers independent of smoking status. Mean percent of negative smoking status tests throughout antepartum was greater in the incentive than control condition (45.2±4.6 vs. 15.5±2.4, p < .001) as was late-pregnancy point-prevalence abstinence (36% vs. 8%, p < .001) but maternal weight gain did not differ significantly between treatment conditions (15.0 ± 0.8 kg vs. 15.0 ± 0.9 kg, p = .97). In a comparison of women classified by smoking status rather than treatment condition, a greater percent of negative smoking status tests predicted significantly more weight gain (0.34 kg per 10% increase in negative tests), an effect that appeared to be attributable to women with greater abstinence having larger infants. This study shows no evidence of excessive maternal weight gain among pregnant women receiving a CM intervention for smoking cessation. PMID:20870365

Interventions Delivered in Clinical Settings are Effective in Reducing Risk of HIV Transmission Among People Living with HIV: Results from the Health Resources and Services Administration (HRSA)’s Special Projects of National Significance Initiative

PubMed Central

Shade, Starley B.; Rose, Carol Dawson; Koester, Kimberly; Maiorana, Andre; Malitz, Faye E.; Bie, Jennifer; Kang-Dufour, Mi-Suk; Morin, Stephen F.

2010-01-01

To support expanded prevention services for people living with HIV, the US Health Resources and Services Administration (HRSA) sponsored a 5-year initiative to test whether interventions delivered in clinical settings were effective in reducing HIV transmission risk among HIV-infected patients. Across 13 demonstration sites, patients were randomized to one of four conditions. All interventions were associated with reduced unprotected vaginal and/or anal intercourse with persons of HIV-uninfected or unknown status among the 3,556 participating patients. Compared to the standard of care, patients assigned to receive interventions from medical care providers reported a significant decrease in risk after 12 months of participation. Patients receiving prevention services from health educators, social workers or paraprofessional HIV-infected peers reported significant reduction in risk at 6 months, but not at 12 months. While clinics have a choice of effective models for implementing prevention programs for their HIV-infected patients, medical provider-delivered methods are comparatively robust. PMID:20229132

A school-based, peer leadership physical activity intervention for 6th graders

PubMed Central

Barr-Anderson, Daheia J.; Laska, Melissa N.; Veblen-Mortenson, Sara; Dudovitz, Bonnie; Farbarksh, Kian; Story, Mary

2012-01-01

Background The aim of this study was to promote physical activity in 6th graders by developing and testing the feasibility of an enhanced Presidential Active Lifestyle Award (PALA) program comprised of a peer leadership component and innovative exercise resource toolkit including DVDs. Method A racially/ethnically diverse sample of students received the standard PALA program (2 control schools, n=61) or enhanced PALA+Peers program (2 intervention schools, n=87) during 2006–2007 academic year. Results Compared to the control condition, the intervention was successful in increasing moderate physical activity in all students (p=0.02) and moderate and hard physical activity among girls (p=0.03 and p=0.04, respectively). Teachers and students reported a high level of satisfaction and receptivity with the intervention. All teachers thought the DVDs were well-received, and 87% of students reported that they would recommend the enhanced program to peers. Conclusion Coupling peer leadership and DVDs that promote physical activity may be an effective way to increase youth physical activity. PMID:21945980

Combined Training of One Cognitive and One Metacognitive Strategy Improves Academic Writing Skills

PubMed Central

Wischgoll, Anke

2016-01-01

Academic writing is a challenging task. Expert writers apply various writing skills as they anticipate the reader’s view of their text while paying attention to structure and content. Research in the high school setting shows that the acquisition of writing skills can be supported by single-strategy training. However, research in higher education is scarce. We tested whether the development of academic writing skills can also be effectively supported by training single strategies or even combined strategies. As metacognition is an important skill for advanced and adult learners, we focused in this study on the benefit of combined cognitive strategies with and without a metacognitive strategy. An experiment including three conditions was conducted (N = 60 German-speaking psychology undergraduates, M = 22.8, SD = 4.4), which lasted for three hours. Each group received a modeling intervention of a basic cognitive strategy on the application of text structure knowledge. Two groups received an additional modeling intervention with either a cognitive strategy treatment on text summarization or a metacognitive strategy treatment on self-monitoring the writing process. One group received no further strategy treatment. Prior knowledge and learning outcomes were measured with a specially developed test on academic writing skills. In addition, all participants wrote an abstract of an empirical article. We found that learners who received the additional self-monitoring strategy intervention benefited significantly more in terms of acquisition of academic writing skills and the quality of their texts than learners who did not receive this intervention. Thus, the results underline the importance of self-monitoring strategies in academic writing. Implications and further research opportunities are discussed. PMID:26941671

Randomized controlled trial of physical activity, cognition, and walking in multiple sclerosis.

PubMed

Sandroff, Brian M; Klaren, Rachel E; Pilutti, Lara A; Dlugonski, Deirdre; Benedict, Ralph H B; Motl, Robert W

2014-02-01

The present study adopted a randomized controlled trial design and examined the effect of a physical activity behavioral intervention on cognitive and walking performance among persons with MS who have mild or moderate disability status. A total of 82 MS patients were randomly allocated into intervention or wait-list control conditions. The intervention condition received a theory-based program for increasing physical activity behavior that was delivered via the Internet, and one-on-one video chat sessions with a behavior-change coach. Participants completed self-report measures of physical activity and disability status, and underwent the oral Symbol Digit Modalities Test (SDMT) and 6-minute walk (6MW) test before and after the 6-month period. Analysis using mixed-model ANOVA indicated a significant time × condition × disability group interaction on SDMT scores (p = 0.02, partial-η (2) = 0.08), such that persons with mild disability in the intervention condition demonstrated a clinically meaningful improvement in SDMT scores (~6 point change). There was a further significant time × condition interaction on 6MW distance (p = 0.02, partial-η (2) = 0.07), such that those in the intervention condition demonstrated an increase in 6MW distance relative to those in the control group. The current study supports physical activity as a promising tool for managing cognitive impairment and impaired walking performance in persons with MS, and suggests that physical activity might have specific effects on cognition and non-specific effects on walking performance in this population.

Catheter-related bloodstream infections

PubMed Central

Gahlot, Rupam; Nigam, Chaitanya; Kumar, Vikas; Yadav, Ghanshyam; Anupurba, Shampa

2014-01-01

Central-venous-catheter-related bloodstream infections (CRBSIs) are an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. Consequences depend on associated organisms, underlying pre-morbid conditions, timeliness, and appropriateness of the treatment/interventions received. We have summarized risk factors, pathogenesis, etiology, diagnosis, and management of CRBSI in this review. PMID:25024944

Babies Living Safe & Smokefree: randomized controlled trial of a multilevel multimodal behavioral intervention to reduce low-income children's tobacco smoke exposure.

PubMed

Collins, Bradley N; Lepore, Stephen J

2017-03-14

Addressing children's tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations. This trial uses a randomized two-group design with three measurement points: baseline, 3-month and 12-month follow-up. The primary outcome is bioverified child TSE; the secondary outcome is bioverified maternal quit status. Smoking mothers of children less than 6 years old are recruited from WIC clinics. All participants receive WIC system-level intervention based on the "Ask, Advise, Refer (AAR)" best practices guidelines for pediatrics clinics. It includes training all WIC staff about the importance of maternal tobacco control; and detailing clinics with AAR intervention prompts in routine work flow to remind WIC nutrition counselors to ask all mothers about child TSE, advise about TSE harms and benefits of protection, and refer smokers to cessation services. After receiving the system intervention, mothers are randomized to receive 3 months of additional treatment or an attention control intervention: (1) The multimodal behavioral intervention (MBI) treatment includes telephone counseling sessions about child TSE reduction and smoking cessation, provision of nicotine replacement therapy, a mobile app to support cessation efforts, and multimedia text messages about TSE and smoking cessation; (2) The attention control intervention offers equivalent contact as the MBI and includes nutrition-focused telephone counseling, mobile app, and multimedia text messages about improving nutrition. The control condition also receives a referral to the state smoking cessation quitline. This study tests an innovative community-based, multilevel and integrated multimodal approach to reducing child TSE in a vulnerable, low-income population. The approach is sustainable and has potential for wide reach because WIC can integrate the tobacco intervention prompts into routine workflow and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines. Clinicaltrials.gov NCT02602288 . Registered 9 November 2015.

The Primary Prevention of PTSD in Firefighters: Preliminary Results of an RCT with 12-Month Follow-Up.

PubMed

Skeffington, Petra M; Rees, Clare S; Mazzucchelli, Trevor G; Kane, Robert T

2016-01-01

To develop and evaluate an evidence-based and theory driven program for the primary prevention of Post-traumatic Stress Disorder (PTSD). A pre-intervention / post-intervention / follow up control group design with clustered random allocation of participants to groups was used. The "control" group received "Training as Usual" (TAU). Participants were 45 career recruits within the recruit school at the Department of Fire and Emergency Services (DFES) in Western Australia. The intervention group received a four-hour resilience training intervention (Mental Agility and Psychological Strength training) as part of their recruit training school curriculum. Data was collected at baseline and at 6- and 12-months post intervention. We found no evidence that the intervention was effective in the primary prevention of mental health issues, nor did we find any significant impact of MAPS training on social support or coping strategies. A significant difference across conditions in trauma knowledge is indicative of some impact of the MAPS program. While the key hypotheses were not supported, this study is the first randomised control trial investigating the primary prevention of PTSD. Practical barriers around the implementation of this program, including constraints within the recruit school, may inform the design and implementation of similar programs in the future. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615001362583.

The role of screening, brief intervention, and referral to treatment in the perinatal period.

PubMed

Wright, Tricia E; Terplan, Mishka; Ondersma, Steven J; Boyce, Cheryl; Yonkers, Kimberly; Chang, Grace; Creanga, Andreea A

2016-11-01

Substance use during pregnancy is at least as common as many of the medical conditions screened for and managed during pregnancy. While harmful and costly, it is often ignored or managed poorly. Screening, brief intervention, and referral to treatment is an evidence-based approach to manage substance use. In September 2012, the US Centers for Disease Control and Prevention convened an Expert Meeting on Perinatal Illicit Drug Abuse to help address key issues around drug use in pregnancy in the United States. This article reflects the formal conclusions of the expert panel that discussed the use of screening, brief intervention, and referral to treatment during pregnancy. Screening for substance use during pregnancy should be universal. It allows stratification of women into zones of risk given their pattern of use. Low-risk women should receive brief advice, those classified as moderate risk should receive a brief intervention, whereas those who are high risk need referral to specialty care. A brief intervention is a patient-centered form of counseling using the principles of motivational interviewing. Screening, brief intervention, and referral to treatment has the potential to reduce the burden of substance use in pregnancy and should be integrated into prenatal care. Copyright © 2016 Elsevier Inc. All rights reserved.

Use of topical petroleum jelly for prevention of sepsis in very low-birthweight infants: a prospective, randomised controlled trial.

PubMed

AlKharfy, Turki; Ba-Abbad, Rubana; Hadi, Anjum; AlFaleh, Khalid

2014-08-01

Emollient therapy is used frequently to prevent nosocomial infection in the management of preterm infants, despite a lack of adequate evidence of its efficacy. To assess the efficacy of prophylactic whole-body application of pure preservative-free topical petroleum jelly on the incidence of nosocomial sepsis in very low-birthweight (VLBW) infants. A prospective, randomised controlled trial of the application of topical petroleum jelly was conducted. Infants weighing <1250 g at birth and with a gestational age of ≤32 weeks were included. The intervention group received twice-daily topical therapy of 2 g/kg pure, preservative-free topical petroleum jelly until the completion of 34 weeks of gestation. The control group received no topical petroleum jelly treatment. The primary outcome was the incidence of late-onset sepsis during hospitalisation. Other data collected included the pattern of temperature control, weight changes, fluid requirements, serum bilirubin level, electrolyte imbalance and skin condition. Thirty-five infants in the intervention group and 39 in the control group were recruited. Birthweight, gestational age, gender and perinatal variables were comparable in the two groups. There was a trend towards an increased incidence of culture-proven nosocomial sepsis in the intervention group - 19 episodes (54%) in the intervention group vs 16 (41%) in the control group, and an increased rate of NEC - 20% in the intervention group vs 8% in the control group. The intervention group had better skin condition throughout their stay and the incubator ambient temperature was lower in the intervention group in the 1st week of life. The fluid balance of the infants in the intervention group was better, as reflected by their mean (SD) shorter time to regain birthweight [12 (5) vs 14 (6) days], and there were fewer episodes of hypernatraemia in the 1st week of life, although none of these reached statistical significance. However, there was a significantly lower mean (SD) level of maximum hyperbilirubinaemia [157 (40) vs 182 (46) mmol/L, P = 0·02) in the intervention group. Although prophylactic topical application of pure, preservative-free petroleum jelly brought substantial improvement of skin condition and temperature control, it was associated with a trend towards an increased rate of nosocomial sepsis.

A randomized clinical trial of self-help intervention for smoking cessation: research design, interventions, and baseline data.

PubMed

Unrod, Marina; Simmons, Vani N; Sutton, Steven K; Meltzer, Lauren R; Harrell, Paul T; Meade, Cathy D; Craig, Benjamin M; Lee, Ji-Hyun; Brandon, Thomas H

2014-07-01

Tobacco smoking is the leading preventable cause of mortality and morbidity. Although behavioral counseling combined with pharmacotherapy is the most effective approach to aiding smoking cessation, intensive treatments are rarely chosen by smokers, citing inconvenience. In contrast, minimal self-help interventions have the potential for greater reach, with demonstrated efficacy for relapse prevention, but not for smoking cessation. This paper summarizes the design and methods used for a randomized controlled trial to assess the efficacy of a minimal self-help smoking cessation intervention that consists of a set of booklets delivered across time. Baseline participant recruitment data are also presented. Daily smokers were recruited nationally via multimedia advertisements and randomized to one of three conditions. The Usual Care (UC) group received a standard smoking-cessation booklet. The Standard Repeated Mailings (SRM) group received 8 booklets mailed over a 12-month period. The Intensive Repeated Mailings (IRM) group received 10 booklets and additional supplemental materials mailed monthly over 18months. A total of 2641 smokers were screened, 2349 were randomized, and 1874 provided data for analyses. Primary outcomes will be self-reported abstinence at 6-month intervals up to 30months. If the self-help booklets are efficacious, this minimal, low cost intervention can be widely disseminated and, hence, has the potential for significant public health impact with respect to reduction in smoking-related illness and mortality. Copyright © 2014 Elsevier Inc. All rights reserved.

A randomized trial comparison of the effects of verbal and pictorial naturalistic communication strategies on spoken language for young children with autism.

PubMed

Schreibman, Laura; Stahmer, Aubyn C

2014-05-01

Presently there is no consensus on the specific behavioral treatment of choice for targeting language in young nonverbal children with autism. This randomized clinical trial compared the effectiveness of a verbally-based intervention, Pivotal Response Training (PRT) to a pictorially-based behavioral intervention, the Picture Exchange Communication System (PECS) on the acquisition of spoken language by young (2-4 years), nonverbal or minimally verbal (≤9 words) children with autism. Thirty-nine children were randomly assigned to either the PRT or PECS condition. Participants received on average 247 h of intervention across 23 weeks. Dependent measures included overall communication, expressive vocabulary, pictorial communication and parent satisfaction. Children in both intervention groups demonstrated increases in spoken language skills, with no significant difference between the two conditions. Seventy-eight percent of all children exited the program with more than 10 functional words. Parents were very satisfied with both programs but indicated PECS was more difficult to implement.

Feasibility, Acceptability, and Preliminary Efficacy of an Online HIV Prevention Program for Diverse Young Men who have Sex with Men: The Keep It Up! Intervention

PubMed Central

Mustanski, Brian; Garofalo, Robert; Monahan, Colleen; Gratzer, Beau; Andrews, Rebecca

2013-01-01

Young men who have sex with men (YMSM) are disproportionately infected with HIV/AIDS and there are few prevention programs with published efficacy for this population. This study evaluated the feasibility, acceptability, and preliminary efficacy of an online, interactive, and highly engaging HIV prevention program called Keep It Up! The intervention was designed to be delivered to diverse YMSM upon receiving an HIV negative text result, with the goal for them to “Keep It Up” and stay negative. In a randomized clinical trial, the intervention was compared to an online didactic HIV knowledge condition. The study sample included 102 sexually active YMSM. Participants reported completing online modules in settings that were private and not distracting. Mixed methods data showed intervention participants felt the program was valuable and acceptable. Compared to the control condition, participants in the intervention arm had a 44 % lower rate of unprotected anal sex acts at the 12-week follow-up (p < 0.05). PMID:23673793

Fatigue during breast cancer radiotherapy: an initial randomized study of cognitive-behavioral therapy plus hypnosis.

PubMed

Montgomery, Guy H; Kangas, Maria; David, Daniel; Hallquist, Michael N; Green, Sheryl; Bovbjerg, Dana H; Schnur, Julie B

2009-05-01

The study purpose was to test the effectiveness of a psychological intervention combining cognitive-behavioral therapy and hypnosis (CBTH) to treat radiotherapy-related fatigue. Women (n = 42) scheduled for breast cancer radiotherapy were randomly assigned to receive standard medical care (SMC) (n = 20) or a CBTH intervention (n = 22) in addition to SMC. Participants assigned to receive CBTH met individually with a clinical psychologist. CBTH participants received training in hypnosis and CBT. Participants assigned to the SMC control condition did not meet with a study psychologist. Fatigue was measured on a weekly basis by using the fatigue subscale of the Functional Assessment of Chronic Illness Therapy (FACIT) and daily using visual analogue scales. Multilevel modeling indicated that for weekly FACIT fatigue data, there was a significant effect of the CBTH intervention on the rate of change in fatigue (p < .05), such that on average, CBTH participants' fatigue did not increase over the course of treatment, whereas control group participants' fatigue increased linearly. Daily data corroborated the analyses of weekly data. The results suggest that CBTH is an effective means for controlling and potentially preventing fatigue in breast cancer radiotherapy patients.

Prompting technologies: A comparison of time-based and context-aware transition-based prompting

PubMed Central

Robertson, Kayela; Rosasco, Cody; Feuz, Kyle; Schmitter-Edgecombe, Maureen; Cook, Diane

2016-01-01

BACKGROUND While advancements in technology have encouraged the development of novel prompting systems to support cognitive interventions, little research has evaluated the best time to deliver prompts, which may impact the effectiveness of these interventions. OBJECTIVE This study examined whether transition-based context prompting (prompting an individual during task transitions) is more effective than traditional fixed time-based prompting. METHODS Participants were 42 healthy adults who completed 12 different everyday activities, each lasting 1–7 minutes, in an experimental smart home testbed and received prompts to record the completed activities from an electronic memory notebook. Half of the participants were delivered prompts during activity transitions, while the other half received prompts every 5 minutes. Participants also completed Likert-scale ratings regarding their perceptions of the prompting system. RESULTS Results revealed that participants in the transition-based context prompting condition responded to the first prompt more frequently and rated the system as more convenient, natural, and appropriate compared to participants in the time-based condition. CONCLUSIONS Our findings suggest that prompting during activity transitions produces higher adherence to the first prompt and more positive perceptions of the prompting system. This is an important finding given the benefits of prompting technology and the possibility of improving cognitive interventions by using context-aware transition prompting. PMID:26409520

Lumbopelvic Core Stabilization Exercise and Pain Modulation Among Individuals with Chronic Nonspecific Low Back Pain.

PubMed

Paungmali, Aatit; Joseph, Leonard H; Sitilertpisan, Patraporn; Pirunsan, Ubon; Uthaikhup, Sureeporn

2017-11-01

Lumbopelvic stabilization training (LPST) may provide therapeutic benefits on pain modulation in chronic nonspecific low back pain conditions. This study aimed to examine the effects of LPST on pain threshold and pain intensity in comparison with the passive automated cycling intervention and control intervention among patients with chronic nonspecific low back pain. A within-subject, repeated-measures, crossover randomized controlled design was conducted among 25 participants (7 males and 18 females) with chronic nonspecific low back pain. All the participants received 3 different types of experimental interventions, which included LPST, the passive automated cycling intervention, and the control intervention randomly, with 48 hours between the sessions. The pressure pain threshold (PPT), hot-cold pain threshold, and pain intensity were estimated before and after the interventions. Repeated-measures analysis of variance showed that LPST provided therapeutic effects as it improved the PPT beyond the placebo and control interventions (P < 0.01). The pain intensity under the LPST condition was significantly better than that under the passive automated cycling intervention and controlled intervention (P < 0.001). Heat pain threshold under the LPST condition also showed a significant trend of improvement beyond the control (P < 0.05), but no significant effects on cold pain threshold were evident. Lumbopelvic stabilization training may provide therapeutic effects by inducing pain modulation through an improvement in the pain threshold and reduction in pain intensity. LPST may be considered as part of the management programs for treatment of chronic low back pain. © 2017 World Institute of Pain.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) in a Polish Emergency Department: Three-Month Outcomes of a Randomized, Controlled Clinical Trial*

PubMed Central

Cherpitel, Cheryl J.; Moskalewicz, Jacek; Swiatkiewicz, Grazyna; Ye, Yu; Bond, Jason

2009-01-01

Objective: A randomized, controlled trial of screening, brief intervention, and referral to treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers was conducted in an emergency department (ED) in Sosnowiec, Poland, among patients ages 18 years and older. Method: Data were collected over a 23-week period, from 4:00 pm to midnight, and resulted in 446 patients being recruited into the study (90% of those who screened positive) and randomized to three conditions following a two-stage process: screened only (n = 147), assessed (n = 152), and received intervention (n = 147). Patients in the assessment (85%) and intervention (83%) conditions were blindly reassessed at 3 months via a telephone interview. Results: At 3-month follow-up, both groups showed significant decreases in the proportion who were positive for at-risk drinking, the primary outcome variable. Both groups also showed significant decreases in drinking days per week, drinks per drinking day, maximum drinks per occasion, and negative consequences of drinking. Using analysis of covariance to control for baseline measures and demographic characteristics, no difference in outcome measures was found between intervention and assessment conditions. Subgroup analysis found some significant interactions between intervention and secondary outcomes. Conclusions: Although the main findings were similar to those from other brief-intervention studies in Western cultures, findings here also suggest that intervention may have differential benefits for specific subgroups of patients in the ED, an area of research that may warrant additional study of brief intervention in the ED setting. PMID:19895777

Neurofeedback and cognitive attention training for children with attention-deficit hyperactivity disorder in schools.

PubMed

Steiner, Naomi J; Frenette, Elizabeth C; Rene, Kirsten M; Brennan, Robert T; Perrin, Ellen C

2014-01-01

To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder (ADHD). Children in second and fourth grade with a diagnosis of ADHD (n = 104) were randomly assigned to neurofeedback (NF) (n = 34), cognitive training (CT) (n = 34), or control (n = 36) conditions. A 2-point growth model assessed change from pre-post intervention on parent reports (Conners 3-Parent [Conners 3-P]; Behavior Rating Inventory of Executive Function [BRIEF] rating scale), teacher reports (Swanson, Kotkin, Agler, M-Flynn and Pelham scale [SKAMP]; Conners 3-Teacher [Conners 3-T]), and systematic classroom observations (Behavioral Observation of Students in Schools [BOSS]). Paired t tests and an analysis of covariance assessed change in medication. Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention, Executive Functioning and Global Index, on all BRIEF summary indices, and on BOSS motor/verbal off-task behavior. Children who received CT showed no improvement compared to the control condition. Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning, all BRIEF summary indices, SKAMP Attention, and Conners 3-T Inattention subscales. Stimulant medication dosage in methylphenidate equivalencies significantly increased for children in the CT (8.54 mg) and control (7.05 mg) conditions but not for those in the NF condition (0.29 mg). Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions. Thus, NF is a promising attention training treatment intervention for children with ADHD.

An Examination of the Efficacy of a Multitiered Intervention on Early Reading Outcomes for First Grade Students at Risk for Reading Difficulties.

PubMed

Fien, Hank; Smith, Jean Louise M; Smolkowski, Keith; Baker, Scott K; Nelson, Nancy J; Chaparro, Erin

2015-01-01

This article presents findings of an efficacy trial examining the effect of a multitiered instruction and intervention model on first grade at-risk students' reading outcomes. Schools (N = 16) were randomly assigned to the treatment or control condition. In the fall of Grade 1, students were assigned to an instructional tier on the basis of Stanford Achievement Test-10th Edition scores (31st percentile and above = Tier 1; from the 10th to the 30th percentile = Tier 2). In both conditions, students identified as at risk (i.e., Tier 2; n = 267) received 90 min of whole group instruction (Tier 1) and an additional 30 min of daily small group intervention (Tier 2). In the treatment condition, teachers were trained to enhance core reading instruction by making instruction more explicit and increasing practice opportunities for students in Tier 1. In addition, at-risk readers were provided an additional 30-min daily small group intervention with content that was highly aligned with the Tier 1 core reading program. Results indicate significant, positive effects of the intervention on students' decoding and first semester fluent reading and potentially positive effects on reading comprehension and total reading achievement. © Hammill Institute on Disabilities 2014.

An Online Social Network to Increase Walking in Dog Owners: A Randomized Trial

PubMed Central

Schneider, Kristin L.; Murphy, Deirdra; Ferrara, Cynthia; Oleski, Jessica; Panza, Emily; Savage, Clara; Gada, Kimberly; Bozzella, Brianne; Olendzki, Effie; Kern, Daniel; Lemon, Stephenie C.

2014-01-01

PURPOSE Encouraging dog walking may increase physical activity in dog owners. This cluster randomized controlled trial investigated whether a social networking website (Meetup™) could be used to deliver a multi-component dog walking intervention to increase physical activity. METHODS Sedentary dog owners (n=102) participated. Eight neighborhoods were randomly assigned to the Meetup condition (Meetup) or a condition where participants received monthly emails with content from the American Heart Association on increasing physical activity (AHA). The Meetup intervention was delivered over 6 months and consisted of newsletters, dog walks, community events and an activity monitor. The primary outcome was steps; secondary outcomes included social support for walking, sense of community, perceived dog walking outcomes, barriers to dog walking and feasibility of the intervention. RESULTS Mixed model analyses examined change from baseline to post-intervention (6 months) and whether change in outcomes differed by condition. Daily steps increased over time (p=0.04, d=0.28), with no differences by condition. The time x condition interaction was significant for the perceived outcomes of dog walking (p=0.04, d=0.40), such that the Meetup condition reported an increase in the perceived positive outcomes of dog walking, whereas the AHA condition did not. Social support, sense of community and dog walking barriers did not significantly change. Meetup logins averaged 58.38 per week (SD=11.62). Within two months of the intervention ending, organization of the Meetup groups transitioned from study staff to Meetup members. CONCLUSION Results suggest that a Meetup group is feasible for increasing physical activity in dog owners. Further research is needed to understand how to increase participation in the Meetup group and facilitate greater connection among dog owners. PMID:25003777

RelAte: pilot study of the effects of a mealtime intervention on social cognitive factors and energy intake among older adults living alone.

PubMed

McHugh Power, Joanna E; Lee, Olga; Aspell, Niamh; McCormack, Emma; Loftus, Michelle; Connolly, Leona; Lawlor, Brian; Brennan, Sabina

2016-11-01

Mealtime interventions typically focus on institutionalised older adults, but we wanted to investigate whether they may also be effective among those living independently. Using a randomised controlled trial design, we assessed the effects of a novel mealtime intervention on self-efficacy, food enjoyment and energy intake. A total of 100 adults living alone aged over 60 years were randomised to the treatment or control conditions: all received a guidebook on nutrition and culinary skills. Treatment group participants received a weekly visit from a trained volunteer who prepared and shared a meal with them. Participants in the treatment group showed improvements relative to those in the control group at borderline significance (P=0·054) for self-efficacy and at significance for food enjoyment. Significant improvements were observed in female participants in the treatment but not in the control group in energy intake (although following corrections for multiple comparisons, only the effect on food enjoyment remained significant). These findings will inform the design of future complex interventions. For this type of intervention to be successful, more focus has to be placed on making interventions more personalised, potentially according to sex. Findings are important for nutritional sciences as they indicate that, in order to improve energy intake and food enjoyment among older adults, multimodal nutritional interventions including social components may be successful.

Can a print-based intervention increase screening for first degree relatives of people with colorectal cancer? A randomised controlled trial.

PubMed

Carey, Mariko; Sanson-Fisher, Robert; Macrae, Finlay; Cameron, Emilie; Hill, David; D'Este, Catherine; Simmons, Jody; Doran, Christopher

2016-12-01

To test the effectiveness of a targeted print-based intervention to improve screening adherence in first degree relatives of people with colorectal cancer (CRC). People with CRC and their adult first degree relatives were identified through a population-based cancer registry and randomly allocated as a family unit to the intervention or control condition. The control group received general information about CRC screening. The intervention group received printed advice regarding screening that was targeted to their risk level. Screening adherence was assessed at baseline and at 12 months via self report. 752 (25%) index cases and 574 (34%) eligible first degree relatives consented to take part in the trial and completed baseline interviews. At 12 months, 58% of first degree relatives in the control group and 61% in the intervention group were adherent to screening guidelines (mixed effects logistic regression group by time interaction effect =2.7; 95%CI=1.2-5.9; P=0.013). Subgroup analysis indicated that the intervention was only effective for those with the lowest risk. Provision of personalised risk information may have a modest effect on adherence to CRC screening recommendations among first degree relatives of people diagnosed with CRC. Improved strategies for identifying and engaging first degree relatives are needed to maximise the population impact of the intervention. © 2016 The Authors.

The Effects of a Brief Acceptance-based Behavior Therapy vs. Traditional Cognitive Behavior Therapy for Public Speaking Anxiety: Differential Effects on Performance and Verbal Working Memory

NASA Astrophysics Data System (ADS)

Glassman, Lisa Hayley

Individuals with public speaking phobia experience fear and avoidance that can cause extreme distress, impaired speaking performance, and associated problems in psychosocial functioning. Most extant interventions for public speaking phobia focus on the reduction of anxiety and avoidance, but neglect performance. Additionally, very little is known about the relationship between verbal working memory and social performance under conditions of high anxiety. The current study compared the efficacy of two cognitive behavioral treatments, traditional Cognitive Behavioral Therapy (tCBT) and acceptance-based behavior therapy (ABBT), in enhancing public speaking performance via coping with anxiety. Verbal working memory performance, as measured by the backwards digit span (BDS), was measured to explore the relationships between treatment type, anxiety, performance, and verbal working memory. We randomized 30 individuals with high public speaking anxiety to a 90-minute ABBT or tCBT intervention. As this pilot study was underpowered, results are examined in terms of effect sizes as well as statistical significance. Assessments took place at pre and post-intervention and included self-rated and objective anxiety measurements, a behavioral assessment, ABBT and tCBT process measures, and backwards digit span verbal working memory tests. In order to examine verbal working memory during different levels of anxiety and performance pressure, we gave each participant a backwards digit span task three times during each assessment: once under calm conditions, then again while experiencing anticipatory anxiety, and finally under conditions of acute social performance anxiety in front of an audience. Participants were asked to give a video-recorded speech in front of the audience at pre- and post-intervention to examine speech performance. Results indicated that all participants experienced a very large and statistically significant decrease in anxiety (both during the speech and BDS), as well as an improvement in speech performance regardless of intervention received. While not statistically significant, participants who received an acceptance-based intervention exhibited larger improvements in observer-rated speech performance at post-treatment in comparison to tCBT (F (1,21) = 1.91, p =.18, etap2 = .08) such that individuals in the ABBT condition exhibited a considerably greater improvement in observer-rated speech performance than those in the tCBT condition. There was no differential impact of treatment condition on subjective speech anxiety or working memory task performance. Potential mediators and moderators of treatment were also examined. Results provide support for a brief 90-minute intervention for public speaking anxiety, but more research is needed in a study with a larger sample to fully understand the relationship between ABBT strategies and improvements in behavioral performance.

Randomised controlled trial of a text messaging intervention for reducing processed meat consumption: The mediating roles of anticipated regret and intention.

PubMed

Carfora, V; Caso, D; Conner, M

2017-10-01

The present study aimed to extend the literature on text messaging interventions involved in promoting healthy eating behaviours. The theoretical framework was the Theory of Planned Behaviour (TPB). A randomized controlled trial was used to test the impact of daily text messages compared to no message (groups) for reducing processed meat consumption (PMC) over a 2 week period, testing the sequential mediation role of anticipated regret and intention on the relationship between groups and PMC reduction. PMC and TPB variables were assessed both at Time 1 and Time 2. Participants were Italian undergraduates (at Time 1 N = 124) randomly allocated to control and message condition groups. Undergraduates in the message condition group received a daily SMS, which focused on anticipated regret and urged them to self-monitor PMC. Participants in the control group did not receive any message. Those who completed all measures at both time points were included in the analyses (N = 112). Findings showed that a daily messaging intervention, controlling for participants' past behaviour, reduced self-reported consumption of PMC. Mediation analyses indicated partial serial mediation via anticipated regret and intentions. The current study provided support for the efficacy of a daily messaging intervention targeting anticipated regret and encouraging self-monitoring in decreasing PMC. Outcomes showed the important mediating role of anticipated regret and intentions for reducing PMC. Copyright © 2017 Elsevier Ltd. All rights reserved.

Engaging parents of children with and without asthma in smoking-specific parenting: results from a 3-year Randomized Controlled Trial evaluation.

PubMed

Ringlever, Linda; Hiemstra, Marieke; C M E Engels, Rutger; C P van Schayck, Onno; Otten, Roy

2016-12-01

The present study evaluated long-term effects of a home-based smoking prevention program targeting smoking-specific parenting in families with children with and without asthma. A total of 1398 non-smoking children (mean age 10.1) participated, of which 197 (14.1%) were diagnosed with asthma. Families were blinded to group assignment. The intervention group (n = 684) received booklets with assignments that actively encouraged parents to engage in smoking-specific parenting strategies. Control families (n = 714) received booklets containing basic information about youth smoking. Latent growth curve modeling was used to calculate intercepts and slopes to examine whether there was change in the different parenting aspects over the study period. Regression analyses were used to examine whether a possible change was different for intervention and control condition families with and without a child with asthma. For those smoking-specific parenting aspects that changed over time, families in the intervention and control condition increased similarly. Families with a child with asthma did not engage in parenting at higher levels due to the intervention program than parents of non-asthmatic children. This prevention program did not affect smoking-specific parenting in the Netherlands. Future prevention research could focus on other risk factors for smoking initiation among adolescents with asthma. Netherlands Trial Register NTR1465. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

The Power of Visualization: Back to the Future for Pain Management in Fibromyalgia Syndrome.

PubMed

Molinari, Guadalupe; García-Palacios, Azucena; Enrique, Ángel; Roca, Pablo; Fernández-Llanio Comella, Nagore; Botella, Cristina

2017-12-26

Previous studies have demonstrated the effects of positive psychological factors on pain adjustment. Specifically, optimism has been linked to better physical functioning and less psychological distress. Until recently, these beneficial effects have mostly been examined in correlational studies or laboratory settings. The aim of this study was to test the efficacy of the Best Possible Self intervention using information and communication technologies with fibromyalgia patients. Seventy-one patients were randomly allocated to the Best Possible Self intervention or a Daily Activities control condition. The Best Possible Self intervention used an interactive multimedia system with the support of an Internet platform to practice the guided imagery exercise online. Intent-to-treat analyses showed that, compared with the control condition, Best Possible Self patients showed significant improvements in depression, positive affect, and self-efficacy at postintervention. Moreover, at three-month follow-up, patients who received the intervention improved their optimism and negative affect significantly more than participants in the control condition. This study shows how a technology-supported intervention aimed at augmenting positive affect and promoting positive functioning works in the case of fibromyalgia, expanding the intervention's efficacy data in clinical populations and adding knowledge about the role that positive psychological factors play in pain experience. Moreover, it demonstrates the specific effects of the Best Possible Self intervention in order to incorporate this exercise in pain treatment protocols. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Confident body, confident child: A randomized controlled trial evaluation of a parenting resource for promoting healthy body image and eating patterns in 2- to 6-year old children.

PubMed

Hart, Laura M; Damiano, Stephanie R; Paxton, Susan J

2016-05-01

Body image and eating patterns develop in early childhood and are influenced by the family environment. This research evaluated Confident Body, Confident Child (CBCC), an intervention for parents of 2- to 6-year-old children, designed to promote body satisfaction, healthy eating, and weight management in early childhood. A randomized controlled trial compared four groups: (A) received the CBCC resource pack and a workshop, (B) received the CBCC resource pack only, (C) received a nutrition-only resource and (D) received no interventions until all questionnaires were completed (i.e., functioned as waitlist control). Measures of parenting variables relevant to child body image and eating patterns, parent-report of child weight, and evaluation questions about the resource, were implemented pre- and post-intervention. At 6-weeks post-intervention, the CBCC resource was associated with significant reductions in parents' intentions to use behaviors that increase the risk of negative body attitudes or unhealthy eating in their children, in parents' use of feeding practices associated with childhood overweight, and in television watching during family meals. Significant increases in parents' intentions to use positive behaviors and knowledge of child body image and healthy eating patterns were also found. Superior results were found for the CBCC resource + workshop condition, suggesting it is the preferred delivery method. CBCC positively impacts parenting variables associated with childhood risk for body dissatisfaction, unhealthy eating and weight. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:458-472). © 2016 Wiley Periodicals, Inc.

A Mood Management Intervention in an Internet Stop Smoking Randomized Controlled Trial Does Not Prevent Depression: A Cautionary Tale

PubMed Central

Schueller, Stephen M.; Pérez-Stable, Eliseo J.; Muñoz, Ricardo F.

2014-01-01

Smoking and depression are related, and mood management interventions included in smoking cessation interventions can increase smoking abstinence rates. Could a mood management intervention embedded in an Internet-based smoking cessation intervention prevent major depressive episodes? Spanish- and English-speaking smokers (N = 17,430) from 191 countries were randomized to one of four online self-help intervention conditions (two with mood management). We analyzed preventive effects among those participants without a major depressive episode at baseline. The mood management intervention did not reduce the incidence of major depressive episodes in the following 12 months. However, we found a mood management by depression risk interaction (OR = 1.77, p = .004), such that high-risk participants who received the mood management intervention had an increased occurrence of major depressive episodes (32.8% vs. 26.6%), but not low-risk participants (11.6% vs. 10.8%). Further research on whether mood management interventions may have deleterious effects on subsets of smokers appears warranted. PMID:25525565

Brief Intervention in the Emergency Department Among Mexican-Origin Young Adults at the US-Mexico Border: Outcomes of a Randomized Controlled Clinical Trial Using Promotores.

PubMed

Cherpitel, Cheryl J; Ye, Yu; Bond, Jason; Woolard, Robert; Villalobos, Susana; Bernstein, Judith; Bernstein, Edward; Ramos, Rebeca

2016-03-01

A randomized controlled trial of brief intervention (BI), for drinking and related problems, using peer health promotion advocates (promotores), was conducted among at-risk and alcohol-dependent Mexican-origin young adult emergency department (ED) patients, aged 18-30. Six hundred and ninety-eight patients were randomized to: screened only (n = 78), assessed (n = 310) and intervention (n = 310). Primary outcomes were at-risk drinking and Rapid Alcohol Problems Screen (RAPS4) scores. Secondary outcomes were drinking days per week, drinks per drinking day, maximum drinks in a day and negative consequences of drinking. At 3- and 12-month follow-up the intervention condition showed significantly lower values or trends on all outcome variables compared to the assessed condition, with the exception of the RAPS4 score; e.g. at-risk drinking days dropped from 2.9 to 1.7 at 3 months for the assessed condition and from 3.2 to 1.2 for the intervention condition. Using random effects modeling controlling for demographics and baseline values, the intervention condition showed significantly greater improvement in all consumption measures at 12 months, but not in the RAPS4 or negative consequences of drinking. Improvements in outcomes were significantly more evident for non-injured patients, those reporting drinking prior to the event, and those lower on risk taking disposition. At 12-month follow-up this study demonstrated significantly improved drinking outcomes for Mexican-origin young adults in the ED who received a BI delivered by promotores compared to those who did not. ClinicalTrials.gov. NCT02056535. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

"Everybody brush!": protocol for a parallel-group randomized controlled trial of a family-focused primary prevention program with distribution of oral hygiene products and education to increase frequency of toothbrushing.

PubMed

Cunha-Cruz, Joana; Milgrom, Peter; Shirtcliff, R Michael; Huebner, Colleen E; Ludwig, Sharity; Allen, Gary; Scott, JoAnna

2015-05-22

Twice daily toothbrushing with fluoridated toothpaste is the most widely advocated preventive strategy for dental caries (tooth decay) and is recommended by professional dental associations. Not all parents, children, or adolescents follow this recommendation. This protocol describes the methods for the implementation and evaluation of a quality improvement health promotion program. The objective of the study is to show a theory-informed, evidence-based program to improve twice daily toothbrushing and oral health-related quality of life that may reduce dental caries, dental treatment need, and costs. The design is a parallel-group, pragmatic randomized controlled trial. Families of Medicaid-insured children and adolescents within a large dental care organization in central Oregon will participate in the trial (n=21,743). Families will be assigned to one of three groups: a test intervention, an active control, or a passive control condition. The intervention aims to address barriers and support for twice-daily toothbrushing. Families in the test condition will receive toothpaste and toothbrushes by mail for all family members every three months. In addition, they will receive education and social support to encourage toothbrushing via postcards, recorded telephone messages, and an optional participant-initiated telephone helpline. Families in the active control condition will receive the kit of supplies by mail, but no additional instructional information or telephone support. Families assigned to the passive control will be on a waiting list. The primary outcomes are restorative dental care received and, only for children younger than 36 months old at baseline, the frequency of twice-daily toothbrushing. Data will be collected through dental claims records and, for children younger than 36 months old at baseline, parent interviews and clinical exams. Enrollment of participants and baseline interviews have been completed. Final results are expected in early summer, 2017. If proven effective, this simple intervention can be sustained by the dental care organization and replicated by other organizations and government. ClinicalTrials.gov NCT02327507; http://clinicaltrials.gov/ct2/show/NCT02327507 (Archived by WebCite at http://www.webcitation.org/6YCIxJSor).

Mind-Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review.

PubMed

Burnett-Zeigler, Inger; Schuette, Stephanie; Victorson, David; Wisner, Katherine L

2016-02-01

Mind-body approaches are commonly used to treat a variety of chronic health conditions, including depression and anxiety. A substantial proportion of individuals with depression and anxiety disorders do not receive conventional treatment; disadvantaged individuals are especially unlikely to receive treatment. Mind-body approaches offer a potentially more accessible and acceptable alternative to conventional mental health treatment for disadvantaged individuals, who may not otherwise receive mental health treatment. This review examines evidence for the efficacy of mind-body interventions for mental health symptoms among disadvantaged populations. While rates of utilization were relatively lower for racial/ethnic minorities, evidence suggests that significant proportions of racial/ethnic minorities are using complementary health approaches as health treatments, especially prayer/healers and natural or herbal remedies. This review of studies on the efficacy of mind-body interventions among disadvantaged populations found evidence for the efficacy of mind-body approaches for several mental and physical health symptoms, functioning, self-care, and overall quality of life.

Web-Based Fully Automated Self-Help With Different Levels of Therapist Support for Individuals With Eating Disorder Symptoms: A Randomized Controlled Trial

PubMed Central

Dingemans, Alexandra E; Spinhoven, Philip; van Ginkel, Joost R; de Rooij, Mark; van Furth, Eric F

2016-01-01

Background Despite the disabling nature of eating disorders (EDs), many individuals with ED symptoms do not receive appropriate mental health care. Internet-based interventions have potential to reduce the unmet needs by providing easily accessible health care services. Objective This study aimed to investigate the effectiveness of an Internet-based intervention for individuals with ED symptoms, called “Featback.” In addition, the added value of different intensities of therapist support was investigated. Methods Participants (N=354) were aged 16 years or older with self-reported ED symptoms, including symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder. Participants were recruited via the website of Featback and the website of a Dutch pro-recovery–focused e-community for young women with ED problems. Participants were randomized to: (1) Featback, consisting of psychoeducation and a fully automated self-monitoring and feedback system, (2) Featback supplemented with low-intensity (weekly) digital therapist support, (3) Featback supplemented with high-intensity (3 times a week) digital therapist support, and (4) a waiting list control condition. Internet-administered self-report questionnaires were completed at baseline, post-intervention (ie, 8 weeks after baseline), and at 3- and 6-month follow-up. The primary outcome measure was ED psychopathology. Secondary outcome measures were symptoms of depression and anxiety, perseverative thinking, and ED-related quality of life. Statistical analyses were conducted according to an intent-to-treat approach using linear mixed models. Results The 3 Featback conditions were superior to a waiting list in reducing bulimic psychopathology (d=−0.16, 95% confidence interval (CI)=−0.31 to −0.01), symptoms of depression and anxiety (d=−0.28, 95% CI=−0.45 to −0.11), and perseverative thinking (d=−0.28, 95% CI=−0.45 to −0.11). No added value of therapist support was found in terms of symptom reduction although participants who received therapist support were significantly more satisfied with the intervention than those who did not receive supplemental therapist support. No significant differences between the Featback conditions supplemented with low- and high-intensity therapist support were found regarding the effectiveness and satisfaction with the intervention. Conclusions The fully automated Internet-based self-monitoring and feedback intervention Featback was effective in reducing ED and comorbid psychopathology. Supplemental therapist support enhanced satisfaction with the intervention but did not increase its effectiveness. Automated interventions such as Featback can provide widely disseminable and easily accessible care. Such interventions could be incorporated within a stepped-care approach in the treatment of EDs and help to bridge the gap between mental disorders and mental health care services. Trial Registration Netherlands Trial Registry: NTR3646; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3646 (Archived by WebCite at http://www.webcitation.org/6fgHTGKHE) PMID:27317358

'I just wanted someone to tell me it wasn't all in my mind and do something for me': Qualitative exploration of acceptability of a CBT based intervention to manage chronic orofacial pain.

PubMed

Goldthorpe, J; Peters, S; Lovell, K; McGowan, L; Aggarwal, V

2016-05-13

Introduction Evidence suggests that psychosocial management may produce improved outcomes for patients suffering from chronic orofacial pain (COFP), when symptoms cannot be attributed to pathology. A complex intervention, based on cognitive behavioural therapy (CBT) was developed by a multi-disciplinary team, using evidence synthesis. An important element of developing and evaluating complex interventions is to establish acceptability to stakeholders; therefore qualitative interviews with patients were carried out.Objectives To explore levels of acceptability of a complex intervention to manage COFP.Method Semi-structured interviews were carried out with 17 participants who had been referred to the intervention. Thematic analysis was used to identify emerging issues and themes from the data.Results Themes relating to processes of engagement with the intervention emerged. Important processes were: identification with the intervention; feeling believed and understood; obtaining a plausible explanation for symptoms; degree of perceived effort required to engage; acceptance of having a long-term condition; and receiving demonstrative, positive feedback.Conclusion Patients presenting with unexplained COFP in a secondary care setting are able to accept a CBT based intervention to manage their condition. Findings may offer guidance for dentists who are not used to referring patients to psychosocial interventions and inform the way dentists communicate the nature of unexplained symptoms to patients.

Effects of music therapy on drug avoidance self-efficacy in patients on a detoxification unit: a three-group randomized effectiveness study.

PubMed

Silverman, Michael J

2014-01-01

Self-efficacy is a component of Bandura's social cognitive theory and can lead to abstinence and a reduction of relapse potential for people who have substance abuse disorders. To date, no music therapy researcher has utilized this theoretical model to address abstinence and reduce the likelihood of relapse in people who have addictions. The purpose of this study was to determine the effects of music therapy on drug avoidance self-efficacy in a randomized three-group wait-list control design with patients on a detoxification unit. Participants (N = 131) were cluster randomized to one of three single-session conditions: music therapy, verbal therapy, or wait-list control. Music therapy participants received a group lyric analysis intervention, verbal therapy participants received a group talk therapy session, and wait-list control participants eventually received a group recreational music therapy intervention. Although there was no significant between-group difference in drug avoidance self-efficacy, participants in the music therapy condition tended to have the highest mean drug avoidance self-efficacy scores. Posttest written comments supported the use of both music therapy and verbal therapy sessions. Two music therapy participants specifically noted that their initial skepticism had dissipated after receiving music therapy. Despite a lack of significant differences, the theoretical support of self-efficacy for substance abuse rehabilitation suggests that this may be an area of continued clinical focus and empirical investigation. Clinical anecdotes, limitations of the study, and suggestions for future research are provided.

Comparing four service delivery models for adolescent girls and young women through the ‘Girl Power’ study: protocol for a multisite quasi-experimental cohort study

PubMed Central

Rosenberg, Nora E; Pettifor, Audrey E; Myers, Laura; Phanga, Twambilile; Marcus, Rebecca; Madlingozi, Nomtha; Vansia, Dhrutika; Masters, Avril; Maseko, Bertha; Mtwisha, Lulu; Kachigamba, Annie; Tang, Jennifer; Hosseinipour, Mina C; Bekker, Linda-Gail

2017-01-01

Introduction In sub-Saharan Africa, adolescent girls and young women (AGYW) face a range of sexual and reproductive health (SRH) challenges. Clinical, behavioural and structural interventions have each reduced these risks and improved health outcomes. However, combinations of these interventions have not been compared with each other or with no intervention at all. The ‘Girl Power’ study is designed to systematically make these comparisons. Methods and analysis Four comparable health facilities in Malawi and South Africa (n=8) were selected and assigned to one of the following models of care: (1) Standard of care: AGYW can receive family planning, HIV testing and counselling (HTC), and sexually transmitted infection (STI) syndromic management in three separate locations with three separate queues with the general population. No youth-friendly spaces, clinical modifications or trainings are offered, (2) Youth-Friendly Health Services (YFHS): AGYW are meant to receive integrated family planning, HTC and STI services in dedicated youth spaces with youth-friendly modifications and providers trained in YFHS, (3) YFHS+behavioural intervention (BI): In addition to YFHS, AGYW can attend 12 monthly theory-driven, facilitator-led, interactive sessions on health, finance and relationships, (4) YFHS+BI+conditional cash transfer (CCT): in addition to YFHS and BI, AGYW receive up to 12 CCTs conditional on monthly BI session attendance. At each clinic, 250 AGYW 15–24 years old (n=2000 total) will be consented, enrolled and followed for 1 year. Each participant will complete a behavioural survey at enrolment, 6 months and 12 months . All clinical, behavioural and CCT services will be captured. Outcomes of interest include uptake of each package element and reduction in HIV risk behaviours. A qualitative substudy will be conducted. Ethics/dissemination This study has received ethical approval from the University of North Carolina Institutional Review Board, the University of Cape Town Human Research Ethics Committee and Malawi’s National Health Sciences Research Committee. Study plans, processes and findings will be disseminated to stakeholders, in peer-reviewed journals and at conferences. PMID:29247104

Evaluating the effectiveness and efficacy of unguided internet-based self-help intervention for the prevention of depression: a randomized controlled trial.

PubMed

Lintvedt, Ove K; Griffiths, Kathleen M; Sørensen, Kristian; Østvik, Andreas R; Wang, Catharina E A; Eisemann, Martin; Waterloo, Knut

2013-01-01

The Internet has the potential to increase the capacity and accessibility of mental health services. This study aimed to investigate whether an unguided Internet-based self-help intervention delivered without human support or guidance can reduce symptoms of depression in young people at risk of depression. The study also aimed to explore the usage of such sites in a real-life setting, to estimate the effects of the intervention for those who received a meaningful intervention dose and to evaluate user satisfaction. Young adults were recruited by means of a screening survey sent to all students at the University of Tromsø. Of those responding to the survey, 163 students (mean age 28.2 years) with elevated psychological distress were recruited to the trial and randomized to an Internet intervention condition or the waiting list control group. The Internet condition comprised a depression information website and a self-help Web application delivering automated cognitive behavioural therapy. The participants in the waiting list condition were free to access formal or informal help as usual. Two-thirds of the users who completed the trial initially reported an unmet need for help. The findings demonstrated that an unguided intervention was effective in reducing symptoms of depression and negative thoughts and in increasing depression literacy in young adults. Significant improvements were found at 2-month follow up. Internet-based interventions can be effective without tracking and thus constitute a minimal cost intervention for reaching a large number of people. User satisfaction among participants was high. Copyright © 2011 John Wiley & Sons, Ltd.

Improving International-Level Chess Players' Performance with an Acceptance-Based Protocol: Preliminary Findings

ERIC Educational Resources Information Center

Ruiz, Francisco J.; Luciano, Carmen

2012-01-01

This study compared an individual, 4-hr intervention based on acceptance and commitment therapy (ACT) versus a no-contact control condition in improving the performance of international-level chess players. Five participants received the brief ACT protocol, with each matched to another chess player with similar characteristics in the control…

Increasing Math Milieu Teaching by Varying Levels of Consultation Support: An Example of Analyzing Intervention Strength

ERIC Educational Resources Information Center

Marsicano, Richard T.; Morrison, Julie Q.; Moomaw, Sally C.; Fite, Nathan M.; Kluesener, Courtney M.

2015-01-01

The current study used a single-case design to examine two performance feedback conditions varying in intensity on the frequency of naturalistic math instruction in preschool classrooms during non-instructional times (transition, lunch, free play). Three Head Start teachers received professional development that combined information on four…

Getting better at chronic care in remote communities: study protocol for a pragmatic cluster randomised controlled of community based management.

PubMed

Schmidt, Barbara; Wenitong, Mark; Esterman, Adrian; Hoy, Wendy; Segal, Leonie; Taylor, Sean; Preece, Cilla; Sticpewich, Alex; McDermott, Robyn

2012-11-21

Prevalence and incidence of diabetes and other common comorbid conditions (hypertension, coronary heart disease, renal disease and chronic lung disease) are extremely high among Indigenous Australians. Recent measures to improve quality of preventive care in Indigenous community settings, while apparently successful at increasing screening and routine check-up rates, have shown only modest or little improvements in appropriate care such as the introduction of insulin and other scaled-up drug regimens in line with evidence-based guidelines, together with support for risk factor reduction. A new strategy is required to ensure high quality integrated family-centred care is available locally, with continuity and cultural safety, by community-based care coordinators with appropriate system supports. The trial design is open parallel cluster randomised controlled trial. The objective of this pragmatic trial is to test the effectiveness of a model of health service delivery that facilitates integrated community-based, intensive chronic condition management, compared with usual care, in rural and remote Indigenous primary health care services in north Queensland. Participants are Indigenous adults (aged 18-65 years) with poorly controlled diabetes (HbA1c>=8.5) and at least one other chronic condition. The intervention is to employ an Indigenous Health Worker to case manage the care of a maximum caseload of 30 participants. The Indigenous Health Workers receive intensive clinical training initially, and throughout the study, to ensure they are competent to coordinate care for people with chronic conditions. The Indigenous Health Workers, supported by the local primary health care (PHC) team and an Indigenous Clinical Support Team, will manage care, including coordinating access to multidisciplinary team care based on best practice standards. Allocation by cluster to the intervention and control groups is by simple randomisation after participant enrolment. Participants in the control group will receive usual care, and will be wait-listed to receive a revised model of the intervention informed by the data analysis. The primary outcome is reduction in HbA1c measured at 18 months. Implementation fidelity will be monitored and a qualitative investigation (methods to be determined) will aim to identify elements of the model which may influence health outcomes for Indigenous people with chronic conditions. This pragmatic trial will test a culturally-sound family-centred model of care with supported case management by IHWs to improve outcomes for people with complex chronic care needs. This trial is now in the intervention phase. Australian New Zealand Clinical Trials Registry ACTR12610000812099.

Effects of speech and print feedback on spelling performance of a child with cerebral palsy using a speech generating device.

PubMed

Raghavendra, Parimala; Oaten, Rebecca

2007-09-01

The aim of the study was to investigate the effectiveness of three feedback conditions, using a speech-generating device, on spelling performance of Tom, an 11-year-old boy with cerebral palsy and complex communication needs. Tom was taught to spell 12 words under three feedback conditions. In the SPEECH condition, he received only speech feedback from the device and in the PRINT condition he received only the orthographic feedback on the display of the device. In the SPEECH-PRINT condition, Tom received both speech output and orthographic feedback. An adapted alternating treatment design was used to investigate the effects of the three-feedback conditions. To strengthen the reliability and increase the internal validity of the findings, an intrasubject direct replication was carried out using the same procedure, but teaching 12 different spelling words to Tom. Tom reached criterion with the PRINT feedback condition first, followed by SPEECH and SPEECH-PRINT conditions simultaneously for the first 12 words, and the same order for the second set of 12 words. Overall, the PRINT condition was most efficient for Tom. The results are discussed in terms of evidence for learning style preferences within spelling instruction for a child with complex communication needs. Furthermore, the implications for targeting intervention to optimise spelling achievement amongst this group are considered.

A Comparison of Performance Feedback Procedures on Teachers' Treatment Implementation Integrity and Students' Inappropriate Behavior in Special Education Classrooms

PubMed Central

DiGennaro, Florence D; Martens, Brian K; Kleinmann, Ava E

2007-01-01

This study examined the extent to which treatment integrity of 4 special education teachers was affected by goal setting, performance feedback regarding student or teacher performance, and a meeting cancellation contingency. Teachers were trained to implement function-based treatment packages to address student problem behavior. In one condition, teachers set a goal for student behavior and received daily written feedback about student performance. In a second condition, teachers received daily written feedback about student performance as well as their own accuracy in implementing the intervention and would be able to avoid meeting with a consultant to practice missed steps by implementing the intervention with 100% integrity. This latter package increased treatment integrity the most above baseline levels. Higher levels of treatment integrity were significantly correlated with lower levels of student problem behavior for 3 of the 4 teacher–student dyads. Three of the 4 teachers also rated both feedback procedures as highly acceptable. Implications for increasing and maintaining treatment integrity by teachers via a consultation model are discussed. PMID:17970259

Multimedia decision support intervention: a promising approach to enhance the intention to complete an advance directive among hospitalized adults.

PubMed

Hickman, Ronald L; Lipson, Amy R; Pinto, Melissa D; Pignatiello, Grant

2014-04-01

We examined the acceptability and initial efficacy of a multimedia decision support (MDS) intervention to improve intention to complete an advanced directive (AD) among hospitalized adults following an episode of critical illness. We used comparative quasi-experimental posttest only design. Forty-nine hospitalized adults, recovering from a critical illness, received either MDS or AD educational brochure. Demographic characteristics and self-report measures of AD knowledge were captured at baseline and used as covariates. Helpfulness of the intervention (acceptability) and the outcome variable, intention to complete an AD decision, were assessed after exposure to the MDS intervention or educational brochure (information-only control condition). The MDS was a more acceptable form of education compared to a brochure. After adjusting for covariates, participants exposed to the MDS intervention were 24.7 times more likely to intend to complete an AD compared to those who were assigned to the information-only control condition. This pilot study establishes the acceptability and initial efficacy of the MDS intervention among individuals with critical illness, who are at high risk for hospital readmission life-sustaining treatment. This study illuminates a teachable moment in which patients are more receptive to interventions to complete an AD. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

The Effectiveness of a Nurse-Led Cognitive-Behavioral Therapy on the Quality of Life, Self-Esteem and Mood Among Filipino Patients Living With Heart Failure: a Randomized Controlled Trial.

PubMed

Cajanding, Ruff Joseph Macale

2016-08-01

The diagnosis and complications associated with heart failure (HF) have been very well established to adversely impact an individual's physical and psychosocial well-being, and interventions such as cognitive-behavioral techniques have demonstrated potential positive benefits among patients with HF. However, the effects of such interventions among Filipino HF patients have not been studied. This study aimed to determine the effectiveness of a nurse-led cognitive-behavioral intervention program on the quality of life, self-esteem and mood among Filipino patients with HF. A randomized control two-group design with repeated measures and collected data before and after the intervention was used in this study. Participants were assigned to either the control (n=48) or the intervention group (n=52). Control group participants received traditional care. Intervention participants underwent a 12-week nurse-led cognitive-behavioral intervention program focusing on patient education, self-monitoring, skills training, cognitive restructuring and spiritual development. Measures of quality of life, self-esteem and mood were obtained at baseline and after the intervention. At baseline, participants in both groups have poor quality of life, low self-esteem, and moderate depressive symptom scores. After the 12-week intervention period, participants in the intervention group had significant improvement in their quality of life, self-esteem and mood scores compared with those who received only standard care. Nurse-led cognitive-behavioral intervention is an effective strategy in improving the quality of life, self-esteem and mood among Filipino patients living with HF. It is recommended that this intervention be incorporated in the optimal care of patients with this cardiac condition. Copyright © 2015 Elsevier Inc. All rights reserved.

Feasibility trial of a scalable psychological intervention for women affected by urban adversity and gender-based violence in Nairobi.

PubMed

Dawson, Katie S; Schafer, Alison; Anjuri, Dorothy; Ndogoni, Lincoln; Musyoki, Caroline; Sijbrandij, Marit; van Ommeren, Mark; Bryant, Richard A

2016-11-18

Living in conditions of chronic adversity renders many women more vulnerable to experiencing gender-based violence (GBV). In addition to GBV's physical and social consequences, the psychological effects can be pervasive. Access to evidence-based psychological interventions that seek to support the mental health of women affected by such adversity is rare in low- and middle-income countries. The current study evaluates a brief evidence-informed psychological intervention developed by the World Health Organization for adults impacted by adversity (Problem Management Plus; PM+). A feasibility randomised control trial (RCT) was conducted to inform a fully powered trial. Community health workers delivered the intervention to 70 women residing in three peri-urban settings in Nairobi, Kenya. Women, among whom 80% were survivors of GBV (N = 56), were randomised to receive five sessions of either PM+ (n = 35) by community health workers or enhanced treatment as usual (ETAU; n = 35). PM+ was not associated with any adverse events. Although the study was not powered to identify effects and accordingly did not identify effects on the primary outcome measure of general psychological distress, women survivors of adversity, including GBV, who received PM+ displayed greater reductions in posttraumatic stress disorder symptoms following treatment than those receiving ETAU. This feasibility study suggests that PM+ delivered by lay health workers is an acceptable and safe intervention to reach women experiencing common mental disorders and be inclusive for those affected by GBV and can be studied in a RCT in this setting. The study sets the stage for a fully powered, definitive controlled trial to assess this potentially effective intervention. ACTRN12614001291673 , 10/12/2014, retrospectively registered during the recruitment phase.

A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors.

PubMed

Bloss, Cinnamon S; Wineinger, Nathan E; Peters, Melissa; Boeldt, Debra L; Ariniello, Lauren; Kim, Ju Young; Sheard, Judith; Komatireddy, Ravi; Barrett, Paddy; Topol, Eric J

2016-01-01

Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers-some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program-making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group.

A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

PubMed Central

Peters, Melissa; Boeldt, Debra L.; Ariniello, Lauren; Kim, Ju Young; Sheard, Judith; Komatireddy, Ravi; Barrett, Paddy

2016-01-01

Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers–some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program–making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group. PMID:26788432

A study protocol to investigate the management of depression and challenging behaviors associated with dementia in aged care settings.

PubMed

McCabe, Marita P; Mellor, David; Davison, Tanya E; Karantzas, Gery; von Treuer, Kathryn; O'Connor, Daniel W

2013-09-19

The high occurrence and under-treatment of clinical depression and behavioral and psychological symptoms of dementia (BPSD) within aged care settings is concerning, yet training programs aimed at improving the detection and management of these problems have generally been ineffective. This article presents a study protocol to evaluate a training intervention for facility managers/registered nurses working in aged care facilities that focuses on organisational processes and culture as well as knowledge, skills and self-efficacy. A Randomised Control Trial (RCT) will be implemented across 18 aged care facilities (divided into three conditions). Participants will be senior registered nurses and personal care attendants employed in the aged care facility. The first condition will receive the training program (Staff as Change Agents - Enhancing and Sustaining Mental Health in Aged Care), the second condition will receive the training program and clinical support, and the third condition will receive no intervention. Pre-, post-, 6-month and 12-month follow-up measures of staff and residents will be used to demonstrate how upskilling clinical leaders using our transformational training approach, as well as the use of a structured screening, referral and monitoring protocol, can address the mental health needs of older people in residential care. The expected outcome of this study is the validation of an evidence-based training program to improve the management of depression and BPSD among older people in residential care settings by establishing routine practices related to mental health. This relatively brief but highly focussed training package will be readily rolled out to a larger number of residential care facilities at a relatively low cost. Australia and New Zealand Clinical Trials Register (ANZCTR): The Universal Trial Number (UTN) is U1111-1141-0109.

Targeting children's dietary behaviors in a family intervention: 'Entre familia: reflejos de salud'.

PubMed

Horton, Lucy A; Parada, Humberto; Slymen, Donald J; Arredondo, Elva; Ibarra, Leticia; Ayala, Guadalupe X

2013-01-01

This intervention sought to promote healthy eating with the ultimate goal of reducing childhood obesity risk. Three hundred and sixty-one Latino families living on the US-Mexico border with at least one child between 7-13 years of age were eligible to participate. Families randomly assigned to the four-month intervention received 14 contacts with a promotora (community health worker), consisting of 11 home visits and three telephone calls; the control condition was a delayed treatment intervention. Children reported on their dietary intake at baseline, immediately post-intervention and at the six month follow-up visit. The intervention reduced weekly consumption of fast food (p<0.05). A dose-response relationship was observed such that for every seven hours of promotora contact, monthly variety of fruits (p<0.01) and vegetables (p<0.01) increased by one. No other intervention effects were observed. Family-based interventions can improve children's eating habits, with the amount of contact with the promotora being key to success.

Effect of Economic Assets on Sexual Risk-Taking Intentions Among Orphaned Adolescents in Uganda

PubMed Central

Han, Chang-Keun; Neilands, Torsten B.; Ismayilova, Leyla; Sperber, Elizabeth

2010-01-01

Objectives. We examined the effect of economic assets on sexual risk-taking intentions among school-going AIDS-orphaned adolescents in rural Uganda. Methods. AIDS-orphaned adolescents from 15 comparable schools were randomly assigned to control (n = 133) or treatment (n = 127) conditions. Treatment participants received child savings accounts, workshops, and mentorship. This economic intervention was in addition to the traditional care and support services for school-going orphaned adolescents (counseling and school supplies) provided to both treatment and control groups. Adolescents in the treatment condition were compared with adolescents in the control condition at baseline and at 10 months after the intervention. Results. After control for sociodemographic factors, child-caregiver/parental communication, and peer pressure, adolescents in the economic intervention group reported a significant reduction in sexual risk-taking intentions compared with adolescents in the control condition. Conclusions. The findings indicate that in Uganda, a country devastated by poverty and disease (including HIV/AIDS), having access to economic assets plays an important role in influencing adolescents' sexual risk-taking intentions. These findings have implications for the care and support of orphaned adolescents, especially in poor African countries devastated by poverty and sexually transmitted diseases. PMID:20075323

Promoting mental health and preventing substance abuse and violence in elementary students: a randomized control study of the Michigan Model for Health.

PubMed

O'neill, James M; Clark, Jeffrey K; Jones, James A

2011-06-01

In elementary grades, comprehensive health education curricula mostly have demonstrated effectiveness in addressing singular health issues. The Michigan Model for Health (MMH) was implemented and evaluated to determine its impact on multiple health issues, including social and emotional skills, prosocial behavior, and drug use and aggression. Schools (N = 52) were randomly assigned to intervention and control conditions. Participants received 24 lessons in grade 4 (over 12 weeks) and 28 more lessons in grade 5 (over 14 weeks), including material focusing on social and emotional health, interpersonal communication, social pressure resistance skills, drug use prevention, and conflict resolution skills. The 40-minute lessons were taught by the classroom or health teacher who received curriculum training and provided feedback on implementation fidelity. Self-report survey data were collected from the fourth-grade students (n = 2512) prior to the intervention, immediately after the intervention, and 6 weeks after the intervention, with the same data collection schedule repeated in fifth grade. Students who received the curriculum had better interpersonal communication skills, social and emotional skills, and drug refusal skills than the control group students. Intervention students also reported lower intentions to use alcohol and tobacco, less alcohol and tobacco use initiated during the study and in the past 30 days, and reduced levels of aggression. The effectiveness of the MMH in promoting mental health and preventing drug use and aggression supports the call for integrated strategies that begin in elementary grades, target multiple risk behaviors, and result in practical and financial benefits to schools. © 2011, American School Health Association.

A Cluster Randomized Controlled Trial of an Adolescent HIV Prevention Program among Bahamian Youth: Effect at 12 Months Post-Intervention

PubMed Central

Chen, Xinguang; Lunn, Sonya; Deveaux, Lynette; Li, Xioaming; Brathwaite, Nanika; Cottrell, Lesley; Stanton, Bonita

2014-01-01

Background Behavioral interventions based on the Protection Motivation Theory (PMT) have been demonstrated to reduce HIV risk behavior among mid- and older adolescents in different settings across the globe but have not been evaluated among Caribbean nations and have received limited evaluation among pre-adolescents. Objective To determine 1) the effectiveness among pre-adolescents in The Bahamas of a PMT-based HIV prevention program “Focus on Youth in the Caribbean” (FOYC) and 2) the role of the targeted PMT constructs in intervention effect. Methods 1,360 sixth grade youth (10-11 years of age) from 15 urban schools in New Providence, The Bahamas were randomized by school to receive either FOYC or a control condition. Data collected at baseline, six and 12 months post intervention were analyzed. A five-step scheme was used to assess sexual behavior progression, ranging from “1” = “a virgin without intention to have sex” to” 5″ = “having sex without a condom”. Group-based trajectory analysis was utilized in assessing the program effect. Results Two sexual behavior progression patterns were detected: slow progressors and quick progressors. Receiving FOYC reduced the likelihood for adolescents to become quick progressors (adjusted OR = 0.77, 95% CI: 0.64-1.00). The observed effectiveness was especially impacted by a subset of the targeted PMT constructs. Conclusion FOYC effectively delays sexual risk among Bahamian pre-adolescents. The group-based trajectory analysis provides an analytical approach for assessing interventions among adolescents with low rates and diverse progression patterns of sexual activity. PMID:19116781

Effectiveness of two different behavioral modification techniques among 5-7-year-old children: A randomized controlled trial.

PubMed

Vishwakarma, Aruna Prashanth; Bondarde, Prashant Arjun; Patil, Sudha Bhimangouda; Dodamani, Arun Suresh; Vishwakarma, Prashanth Yachrappa; Mujawar, Shoeb A

2017-01-01

Dental fear is a common, essential, and inevitable emotion that appears as a response to the stressful situation, which raises children's anxiety level, resulting in reduced demand for pediatric dental care. (1) To compare and evaluate the effectiveness of customized tell-play-do (TPD) technique with live modeling for behavior management of children. (2) To compare the behavioral modification techniques in managing the children during their dental visits. Ninety-eight children aged 5-7 years were enrolled in the study and randomly allocated into two groups. Phase I: first visit. Group I - children were conditioned to receive various dental procedures using live modeling followed by oral prophylaxis. Group II - TPD technique was introduced with customized playing dental objects followed by oral prophylaxis. Phase II: second visit. After 7 days interval, all the study subjects were subjected to rotary restorative treatment. Heart rate, Facial Image Scale (FIS), and Venham-6-point index were used before intervention, after intervention, and during dental procedure to quantify the anxious behavior. All 98 children after intervention underwent oral prophylaxis on first visit and rotary restorative treatment on second visit. The average pulse rate, FIS, and Venham scale scores were significantly lower among children who received TPD intervention when compared to those who received live modeling intervention. Unpaired t-test at 5% level of significance was considered as statistical significance. TPD is effective in reducing children's fear and anxiety about dental treatment, children enjoy playing with customized dental object. Thus, to promote adaptive behavior, TPD could be an alternate behavioral modification technique during pediatric dentistry.

Guided self-help cognitive behavioral intervention for VoicEs (GiVE): study protocol for a pilot randomized controlled trial.

PubMed

Hazell, Cassie M; Hayward, Mark; Cavanagh, Kate; Jones, Anna-Marie; Strauss, Clara

2016-07-26

Cognitive behavior therapy for psychosis (CBTp) is an effective intervention for people who hear distressing voices (auditory hallucinations). However, there continues to be a problem of poor access to CBTp. Constraints on health care funding require this problem to be addressed without a substantial increase in funding. One solution is to develop guided self-help forms of CBTp to improve access, and a symptom-specific focus on, for example, distressing voices (auditory verbal hallucinations) has the potential to enhance effectiveness. We term this cognitive behavior therapy for distressing voices (CBTv). This trial is an external pilot randomized controlled trial comparing the effects of 12-week guided self-help CBTv (with eight therapist support sessions) with a wait list control condition. Informed consent will be obtained from each participant. Half of the 30 participants will be randomized to receive guided self-help CBTv immediately; the remaining half will receive the intervention after a 12-week delay. All participants will continue with their usual treatment throughout the study. Outcomes will be assessed using questionnaires completed at baseline and 12 weeks postrandomization. Interviews will be offered to all those who receive therapy immediately to explore their experiences with the intervention. The outcomes of this trial, both quantitative and qualitative, will inform the design of a definitive randomized controlled trial of guided self-help CBTv. If this intervention is effective, it could help to increase access to CBT for those who hear distressing voices. ISRCTN registration number  ISRCTN77762753 . Registered on 23 July 2015.

Effectiveness of telerehabilitation programme following surgery in shoulder impingement syndrome (SIS): study protocol for a randomized controlled non-inferiority trial.

PubMed

Pastora-Bernal, Jose-Manuel; Martín-Valero, Rocío; Barón-López, Francisco Javier; García-Gómez, Oscar

2017-02-23

Shoulder pain is common in society, with high prevalence in the general population. Shoulder impingement syndrome (SIS) is the most frequent cause. Patients suffer pain, muscle weakness and loss of movement in the affected joint. Initial treatment is predominantly conservative. The surgical option has high success rates and is often used when conservative strategy fails. Traditional physiotherapy and post-operative exercises are needed for the recovery of joint range, muscle strength, stability and functionality. Telerehabilitation programmes have shown positive results in some orthopaedic conditions after surgery. Customized telerehabilitation intervention programmes should be developed to recover shoulder function after SIS surgery. The objective of this study is to evaluate the feasibility and effectiveness of a telerehabilitation intervention compared with usual care in patients after subacromial decompression surgery. We will compare an intervention group receiving videoconferences and a telerehabilitation programme to a control group receiving traditional physiotherapy intervention in a single-blind, randomized controlled non-inferiority trial study design. Through this study, we will further develop our preliminary data set and practical experience with the telerehabilitation programmes to evaluate their effectiveness and compare this with traditional intervention. We will also explore patient satisfaction and cost-effectiveness. Patient enrolment is ongoing. ClinicalTrials.gov, NCT02909920 . 14 September 2016.

Does a booster intervention augment the preventive effects of an abbreviated version of the coping power program for aggressive children?

PubMed

Lochman, John E; Baden, Rachel E; Boxmeyer, Caroline L; Powell, Nicole P; Qu, Lixin; Salekin, Karen L; Windle, Michel

2014-01-01

Booster interventions have been presumed to be important methods for maintaining the effects of evidence-based programs for children with behavioral problems, but there has been remarkably little empirical attention to this assumption. The present study examines the effect of a child-oriented booster preventive intervention with children who had previously received an abbreviated version (24 child sessions, 10 parent sessions) of the Coping Power targeted prevention program. Two hundred and forty-one children (152 boys, 89 girls) were screened as having moderate to high levels of aggressive behavior in 4th grade, then half were randomly assigned to receive the abbreviated Coping Power program in 5th grade, and half of the preventive intervention children were then randomly assigned to a Booster condition in 6th grade. The Booster sessions consisted of brief monthly individual contacts, and were primarily with the children. Five assessments across 4 years were collected from teachers, providing a three-year follow-up for all children who participated in the project. Results indicated that the abbreviated Coping Power program (one-third shorter than the full intervention) had long-term effects in reducing children's externalizing problem behaviors, proactive and reactive aggression, impulsivity traits and callous-unemotional traits. The Booster intervention did not augment these prevention effects. These findings indicate that a briefer and more readily disseminated form of an evidence-based targeted preventive intervention was effective. The findings have potential implications for policy and guidelines about possible intervention length and booster interventions.

Does a Booster Intervention Augment the Preventive Effects of an Abbreviated Version of the Coping Power Program for Aggressive Children?

PubMed Central

Lochman, John E.; Baden, Rachel E.; Boxmeyer, Caroline L.; Powell, Nicole P.; Qu, Lixin; Salekin, Karen L.; Windle, Michel

2013-01-01

Booster interventions have been presumed to be important methods for maintaining the effects of evidence-based programs for children with behavioral problems, but there has been remarkably little empirical attention to this assumption. The present study examines the effect of a child-oriented booster preventive intervention with children who had previously received an abbreviated version (24 child sessions, 10 parent sessions) of the Coping Power targeted prevention program. Two hundred and forty-one children (152 boys, 89 girls) were screened as having moderate to high levels of aggressive behavior in 4th grade, then half were randomly assigned to receive the abbreviated Coping Power program in 5th grade, and half of the preventive intervention children were then randomly assigned to a Booster condition in 6th grade. The Booster sessions consisted of brief monthly individual contacts, and were primarily with the children. Five assessments across four years were collected from teachers, providing a three-year follow-up for all children who participated in the project. Results indicated that the abbreviated Coping Power program (one-third shorter than the full intervention) had long-term effects in reducing children’s externalizing problem behaviors, proactive and reactive aggression, impulsivity traits and callous-unemotional traits. The Booster intervention did not augment these prevention effects. These findings indicate that a briefer and more readily disseminated form of an evidence-based targeted preventive intervention was effective. The findings have potential implications for policy and guidelines about possible intervention length and booster interventions. PMID:23417235

Metacognitive executive function training for young children with ADHD: a proof-of-concept study.

PubMed

Tamm, Leanne; Nakonezny, Paul A

2015-09-01

Executive functions (EF) are impaired in children with attention-deficit/hyperactivity disorder (ADHD). It may be especially critical for interventions to target EF in early childhood given the developmental progression of EF deficits that may contribute to later functional impairments. This proof-of-concept study examined the initial efficacy of an intervention program on EF and ADHD. We also examined child performance on three neurocognitive tasks assessing cognitive flexibility, auditory/visual attention, and sustained/selective attention. Children with ADHD (ages 3-7) and their parents were randomized to receive an intervention targeting metacognitive EF deficits (n = 13) or to a waitlist control condition (n = 12). Linear model analysis of covariance compared groups on parent EF ratings, blinded clinician ratings of ADHD symptoms and improvement, and child performance on neurocognitive measures. Children who received the intervention significantly improved on parent ratings of attention shifting and emotion regulation in addition to clinician ratings of inattention. Moderate effect sizes showed additional intervention effects on parent ratings of inhibition, memory, and planning, and clinician ratings of hyperactivity/impulsivity and overall improvement. Small effect sizes were observed for improvement on child neurocognitive measures. Although replication with a larger sample and an active control group is needed, EF training with a metacognitive focus is a potentially promising intervention for young children with ADHD.

The Primary Prevention of PTSD in Firefighters: Preliminary Results of an RCT with 12-Month Follow-Up

PubMed Central

Rees, Clare S.; Mazzucchelli, Trevor G.; Kane, Robert T.

2016-01-01

Aim To develop and evaluate an evidence-based and theory driven program for the primary prevention of Post-traumatic Stress Disorder (PTSD). Design A pre-intervention / post-intervention / follow up control group design with clustered random allocation of participants to groups was used. The “control” group received “Training as Usual” (TAU). Method Participants were 45 career recruits within the recruit school at the Department of Fire and Emergency Services (DFES) in Western Australia. The intervention group received a four-hour resilience training intervention (Mental Agility and Psychological Strength training) as part of their recruit training school curriculum. Data was collected at baseline and at 6- and 12-months post intervention. Results We found no evidence that the intervention was effective in the primary prevention of mental health issues, nor did we find any significant impact of MAPS training on social support or coping strategies. A significant difference across conditions in trauma knowledge is indicative of some impact of the MAPS program. Conclusion While the key hypotheses were not supported, this study is the first randomised control trial investigating the primary prevention of PTSD. Practical barriers around the implementation of this program, including constraints within the recruit school, may inform the design and implementation of similar programs in the future. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615001362583 PMID:27382968

Immediate effect of couple relationship education on low-satisfaction couples: a randomized clinical trial plus an uncontrolled trial replication.

PubMed

Kim Halford, W; Pepping, Christopher A; Hilpert, Peter; Bodenmann, Guy; Wilson, Keithia L; Busby, Dean; Larson, Jeffry; Holman, Thomas

2015-05-01

Couple relationship education (RE) usually is conceived of as relationship enhancement for currently satisfied couples, with a goal of helping couples sustain satisfaction. However, RE also might be useful as a brief, accessible intervention for couples with low satisfaction. Two studies were conducted that tested whether couples with low relationship satisfaction show meaningful gains after RE. Study 1 was a three-condition randomized controlled trial in which 182 couples were randomly assigned to RELATE with Couple CARE (RCC), a flexible delivery education program for couples, or one of two control conditions. Couples with initially low satisfaction receiving RCC showed a moderate increase in relationship satisfaction (d=0.50) relative to the control. In contrast, couples initially high in satisfaction showed little change and there was no difference between RCC and the control conditions. Study 2 was an uncontrolled trial of the Couple Coping Enhancement Training (CCET) administered to 119 couples. Couples receiving CCET that had initially low satisfaction showed a moderate increase in satisfaction (g=.44), whereas initially highly satisfied couples showed no change. Brief relationship education can assist somewhat distressed couples to enhance satisfaction, and has potential as a cost-effective way of enhancing the reach of couple interventions. Copyright © 2015. Published by Elsevier Ltd.

Motivational interviewing in a Web-based physical activity intervention with an avatar: randomized controlled trial.

PubMed

Friederichs, Stijn; Bolman, Catherine; Oenema, Anke; Guyaux, Janneke; Lechner, Lilian

2014-02-13

Developing Web-based physical activity (PA) interventions based on motivational interviewing (MI) could increase the availability and reach of MI techniques for PA promotion. Integrating an avatar in such an intervention could lead to more positive appreciation and higher efficacy of the intervention, compared to an intervention that is purely text-based. The present study aims to determine whether a Web-based PA intervention based on MI with an avatar results in more positive appreciation and higher effectiveness of the intervention, when compared to an intervention that is purely text-based. A three-arm randomized controlled trial was conducted, containing the following research conditions: (1) a Web-based PA intervention based on MI with an avatar, (2) a content-identical intervention without an avatar, and (3) a control condition that received no intervention. Measurements included PA behavior and process variables, measured at baseline, directly following the intervention and 1 month post intervention. Both interventions significantly increased self-reported PA at 1 month, compared to the control condition (beta(AVATARvsCONTROL)=.39, P=.011; beta(TEXTvsCONTROL)=.44, P=.006). No distinctions were found regarding intervention effect on PA between both interventions. Similarly, the results of the process evaluation did not indicate any significant differences between both interventions. Due to the limited relational skills of the avatar in this study, it probably did not succeed in forming a stronger relationship with the user, over and above text alone. The findings suggest that avatars that do not strengthen the social relationship with the user do not enhance the intervention impact. Future research should determine whether Web-based PA interventions based on MI could benefit from inclusion of a virtual coach capable of more complex relational skills than used in the current study, such as responding in gesture to the user's state and input. Dutch Trial Register trial number: NTR3147; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3147 (Archived by WebCite at http://www.webcitation.org/6NCbwdUJX).

An Economic Evaluation of a Video- and Text-Based Computer-Tailored Intervention for Smoking Cessation: A Cost-Effectiveness and Cost-Utility Analysis of a Randomized Controlled Trial

PubMed Central

Stanczyk, Nicola E.; Smit, Eline S.; Schulz, Daniela N.; de Vries, Hein; Bolman, Catherine; Muris, Jean W. M.; Evers, Silvia M. A. A.

2014-01-01

Background Although evidence exists for the effectiveness of web-based smoking cessation interventions, information about the cost-effectiveness of these interventions is limited. Objective The study investigated the cost-effectiveness and cost-utility of two web-based computer-tailored (CT) smoking cessation interventions (video- vs. text-based CT) compared to a control condition that received general text-based advice. Methods In a randomized controlled trial, respondents were allocated to the video-based condition (N = 670), the text-based condition (N = 708) or the control condition (N = 721). Societal costs, smoking status, and quality-adjusted life years (QALYs; EQ-5D-3L) were assessed at baseline, six-and twelve-month follow-up. The incremental costs per abstinent respondent and per QALYs gained were calculated. To account for uncertainty, bootstrapping techniques and sensitivity analyses were carried out. Results No significant differences were found in the three conditions regarding demographics, baseline values of outcomes and societal costs over the three months prior to baseline. Analyses using prolonged abstinence as outcome measure indicated that from a willingness to pay of €1,500, the video-based intervention was likely to be the most cost-effective treatment, whereas from a willingness to pay of €50,400, the text-based intervention was likely to be the most cost-effective. With regard to cost-utilities, when quality of life was used as outcome measure, the control condition had the highest probability of being the most preferable treatment. Sensitivity analyses yielded comparable results. Conclusion The video-based CT smoking cessation intervention was the most cost-effective treatment for smoking abstinence after twelve months, varying the willingness to pay per abstinent respondent from €0 up to €80,000. With regard to cost-utility, the control condition seemed to be the most preferable treatment. Probably, more time will be required to assess changes in quality of life. Future studies with longer follow-up periods are needed to investigate whether cost-utility results regarding quality of life may change in the long run. Trial Registration Nederlands Trial Register NTR3102 PMID:25310007

An economic evaluation of a video- and text-based computer-tailored intervention for smoking cessation: a cost-effectiveness and cost-utility analysis of a randomized controlled trial.

PubMed

Stanczyk, Nicola E; Smit, Eline S; Schulz, Daniela N; de Vries, Hein; Bolman, Catherine; Muris, Jean W M; Evers, Silvia M A A

2014-01-01

Although evidence exists for the effectiveness of web-based smoking cessation interventions, information about the cost-effectiveness of these interventions is limited. The study investigated the cost-effectiveness and cost-utility of two web-based computer-tailored (CT) smoking cessation interventions (video- vs. text-based CT) compared to a control condition that received general text-based advice. In a randomized controlled trial, respondents were allocated to the video-based condition (N = 670), the text-based condition (N = 708) or the control condition (N = 721). Societal costs, smoking status, and quality-adjusted life years (QALYs; EQ-5D-3L) were assessed at baseline, six-and twelve-month follow-up. The incremental costs per abstinent respondent and per QALYs gained were calculated. To account for uncertainty, bootstrapping techniques and sensitivity analyses were carried out. No significant differences were found in the three conditions regarding demographics, baseline values of outcomes and societal costs over the three months prior to baseline. Analyses using prolonged abstinence as outcome measure indicated that from a willingness to pay of €1,500, the video-based intervention was likely to be the most cost-effective treatment, whereas from a willingness to pay of €50,400, the text-based intervention was likely to be the most cost-effective. With regard to cost-utilities, when quality of life was used as outcome measure, the control condition had the highest probability of being the most preferable treatment. Sensitivity analyses yielded comparable results. The video-based CT smoking cessation intervention was the most cost-effective treatment for smoking abstinence after twelve months, varying the willingness to pay per abstinent respondent from €0 up to €80,000. With regard to cost-utility, the control condition seemed to be the most preferable treatment. Probably, more time will be required to assess changes in quality of life. Future studies with longer follow-up periods are needed to investigate whether cost-utility results regarding quality of life may change in the long run. Nederlands Trial Register NTR3102.

Can conditional cash transfers improve the uptake of nutrition interventions and household food security? Evidence from Odisha’s Mamata scheme

PubMed Central

2017-01-01

There is considerable global evidence on the effectiveness of cash transfers in improving health and nutrition outcomes; however, the evidence from South Asia, particularly India, is limited. In the context of India where more than a third of children are undernourished, and where there is considerable under-utilization of health and nutrition interventions, it is opportune to investigate the impact of cash transfer programs on the use of interventions. We study one conditional cash transfer program, Mamata scheme, implemented in the state of Odisha, in India that targeted pregnant and lactating women. Using survey data on 1161 households from three districts in the state of Odisha, we examine the effect of the scheme on eight outcomes: 1) pregnancy registration; 2) receipt of antenatal services; 3) receipt of iron and folic acid (IFA) tablets; 4) exposure to counseling during pregnancy; 5) exposure to postnatal counseling; 6) exclusive breastfeeding; 7) full immunization; and 8) household food security. We conduct regression analyses and correct for endogeneity using nearest-neighbor matching and inverse-probability weighting models. We find that the receipt of payments from the Mamata scheme is associated with a 5 percentage point (pp) increase in the likelihood of receiving antenatal services, a 10 pp increase in the likelihood of receiving IFA tablets, and a decline of 0.84 on the Household Food Insecurity Access Scale. These results provide the first quantitative estimates of effects associated with the Mamata scheme, which can inform the design of government policies related to conditional cash transfers. PMID:29228022

Effectiveness of Motivational Incentives for Adolescent Marijuana Users in a School-Based Intervention.

PubMed

Stewart, David G; Felleman, Benjamin I; Arger, Christopher A

2015-11-01

This study examined whether adolescents receiving Motivational Interviewing (MI) intervention have different outcomes compared to those receiving Motivational Incentives (Motivational Interviewing combined with Contingency Management; MI+CM). A total of 136 adolescents (from a parent study of 220 adolescents) with problematic substance use were recruited from 8 high schools in Washington State, where they completed either 8-weeks of MI or MI+CM. Frequency of marijuana use was assessed at baseline, at the end-of-treatment, and at 16-week follow-up. A balanced and matched sample was created using propensity scores, then analyzed using Hierarchical Linear Modeling (HLM). Multilevel regression analyses revealed that adolescents who received MI+CM exhibited a greater reduction in use across time (p<.05). Reductions at the end-of-treatment were greater for the MI+CM condition (Cohen's d=-.82) compared to MI alone (Cohen's d=-.33), but did not differ at 16-week follow-up. Adolescents receiving MI+CM showed significantly fewer negative consequences of marijuana use at the end-of-treatment (t1, 124=2.26, p<.05), higher use of coping strategies (t1, 124=3.01, p<.01), and increased likelihood to attend additional treatment for substance use (χ2 1, 124=4.12 p<.05), though hypothesized improvements in motivation and school attendance were not found. Use of coping strategies at the end-of-treatment had a significant indirect effect on the relationship between the intervention condition and marijuana use at the end-of-treatment (F3, 121=10.20, R2=.20, p<.01). These results suggest that the inclusion of contingencies into adolescent marijuana treatment decreases the end-of-treatment frequency of marijuana use and related consequences while increasing the use of coping strategies and the pursuit of additional treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Optimizing timing and dosage: does parent type moderate the effects of variations of a parent-based intervention to reduce college student drinking?

PubMed

Varvil-Weld, Lindsey; Scaglione, Nichole; Cleveland, Michael J; Mallett, Kimberly A; Turrisi, Rob; Abar, Caitlin C

2014-02-01

Research on parent-based interventions (PBIs) to reduce college student drinking has explored the optimal timing of delivery and dosage. The present study extended this work by examining the effectiveness of three different PBI conditions on student drinking outcomes as a function of parenting types and students' pre-college drinking patterns. Four hypotheses were evaluated (early intervention, increased dosage, invariant, and treatment matching risk). A random sample of 1,900 college students and their parents was randomized to four conditions: (1) pre-college matriculation, (2) pre-college matriculation plus booster, (3) post-college matriculation, or (4) control, and was assessed at baseline (summer prior to college) and 5-month follow-up. Baseline parent type was assessed using latent profile analysis (positive, pro-alcohol, positive, anti-alcohol, negative mother, and negative father). Student drinking patterns were classified at baseline and follow-up and included: non-drinker, weekend light drinker, weekend heavy episodic drinker, and heavy drinker. Consistent with the treatment matching risk hypothesis, results indicated parent type moderated the effects of intervention condition such that receiving the intervention prior to college was associated with lower likelihood of being in a higher-risk drinking pattern at follow-up for students with positive, anti-alcohol, or negative father parent types. The findings are discussed with respect to optimal delivery and dosage of parent-based interventions for college student drinking.

Optimizing Timing and Dosage: Does Parent Type Moderate the Effects of Variations of a Parent-Based Intervention to Reduce College Student Drinking?

PubMed Central

Varvil-Weld, Lindsey; Scaglione, Nichole; Cleveland, Michael J.; Mallett, Kimberly A.; Turrisi, Rob; Abar, Caitlin C.

2013-01-01

Research on parent-based interventions (PBIs) to reduce college student drinking has explored the optimal timing of delivery and dosage. The present study extended this work by examining the effectiveness of three different PBI conditions on student drinking outcomes as a function of parenting types and students' pre-college drinking patterns. Four hypotheses were evaluated (early intervention, increased dosage, invariant, and treatment matching risk). A random sample of 1900 college students and their parents was randomized to four conditions: 1) pre-college matriculation, 2) pre-college matriculation plus booster, 3) post-college matriculation, or 4) control, and was assessed at baseline (summer prior to college) and 5-month follow-up. Baseline parent type was assessed using latent profile analysis (positive, pro-alcohol, positive, anti-alcohol, negative mother and negative father). Student drinking patterns were classified at baseline and follow up and included: non-drinker, weekend light drinker, weekend heavy episodic drinker, and heavy drinker. Consistent with the treatment matching risk hypothesis, results indicated parent type moderated the effects of intervention condition such that receiving the intervention prior to college was associated with lower likelihood of being in a higher-risk drinking pattern at follow up for students with positive, anti-alcohol or negative father parent types. The findings are discussed with respect to optimal delivery and dosage of parent-based interventions for college student drinking. PMID:23404668

The Impact of a Comprehensive Microfinance Intervention on Depression Levels of AIDS-Orphaned Children in Uganda. *

PubMed Central

Ssewamala, Fred M.; Neilands, Torsten B.; Waldfogel, Jane; Ismayilova, Leyla

2011-01-01

Purpose By adversely affecting family functioning and stability, poverty constitutes an important risk factor for children’s poor mental health functioning. This study examines the impact of a comprehensive microfinance intervention, designed to reduce the risk of poverty, on depression among AIDS-orphaned youth. Methods Children from 15 comparable primary schools in Rakai District of Uganda, one of those hardest hit by HIVAIDS in the country, were randomly assigned to control (n=148) or treatment (n=138) conditions. Children in the treatment condition received a comprehensive microfinance intervention comprising of matched savings accounts, financial management workshops, and mentorship. This was in addition to traditional services provided for all school-going orphaned adolescents (counseling and school supplies). Data were collected at wave 1 (baseline), wave 2 (10-months postintervention), and wave 3 (20-months post-intervention). We used multilevel growth models to examine the trajectory of depression in treatment and control conditions, measured using Children’s Depression Inventory (Kovacs). Results Children in the treatment group exhibited a significant decrease in depression whereas their control group counterparts showed no change in depression. Conclusion The findings indicate that over and above traditional psychosocial approaches used to address mental health functioning among orphaned children in sub-Saharan Africa, incorporating poverty alleviation-focused approaches, such as this comprehensive microfinance intervention, has the potential to improve psychosocial functioning of these children. PMID:22443837

Psychological Outcomes After a Sexual Assault Video Intervention: A Randomized Trial.

PubMed

Miller, Katherine E; Cranston, Christopher C; Davis, Joanne L; Newman, Elana; Resnick, Heidi

2015-01-01

Sexual assault survivors are at risk for a number of mental and physical health problems, including posttraumatic stress disorder and anxiety. Unfortunately, few seek physical or mental health services after a sexual assault (Price, Davidson, Ruggiero, Acierno, & Resnick, 2014). Mitigating the impact of sexual assault via early interventions is a growing and important area of research. This study adds to this literature by replicating and expanding previous studies (e.g., Resnick, Acierno, Amstadter, Self-Brown, & Kilpatrick, 2007) examining the efficacy of a brief video-based intervention that provides psychoeducation and modeling of coping strategies to survivors at the time of a sexual assault nurse examination. Female sexual assault survivors receiving forensic examinations were randomized to standard care or to the video intervention condition (N = 164). The participants completed mental health assessments 2 weeks (n = 69) and 2 months (n = 74) after the examination. Analyses of covariance revealed that women in the video condition had significantly fewer anxiety symptoms at the follow-up assessments. In addition, of those participants in the video condition, survivors reporting no previous sexual assault history reported significantly fewer posttraumatic stress symptoms 2 weeks after the examination than those with a prior assault history. Forensic nurses have the unique opportunity to intervene immediately after a sexual assault. This brief video intervention is a cost-effective tool to aid with that process.

A randomized controlled trial of a smoking cessation self-help intervention for dual users of tobacco cigarettes and E-cigarettes: Intervention development and research design.

PubMed

Meltzer, Lauren R; Simmons, Vani N; Sutton, Steven K; Drobes, David J; Quinn, Gwendolyn P; Meade, Cathy D; Unrod, Marina; Brandon, Karen O; Harrell, Paul T; Eissenberg, Thomas; Bullen, Christopher R; Brandon, Thomas H

2017-09-01

Electronic Nicotine Delivery Systems, also called electronic cigarettes or e-cigarettes, have been available for over a decade and use has been increasing dramatically. The primary reported reasons for use are to aid smoking cessation or reduction, yet a significant proportion appear to be long-term users of both products ("dual users"). Dual users may be motivated to quit smoking and might benefit from a behavioral intervention for smoking cessation. This paper describes the intervention development, as well as the design, methods, and data analysis plans for an ongoing randomized controlled trial (RCT). Formative research and learner verification were conducted to create a usable, understandable, and acceptable self-help intervention targeting dual users. The efficacy is being tested in an RCT with current dual users (N=2900) recruited nationally and randomized to one of three conditions. The Assessment Only (ASSESS) group only completes assessments. The Generic Self-Help (GENERIC) group receives non-targeted smoking cessation booklets and supplemental materials sent monthly over 18months. The e-cigarette Targeted Self-Help (eTARGET) group receives the newly developed intervention (targeted booklets and supplemental materials) sent over the same period. All participants complete self-report surveys every 3months over 2years. The primary study outcome is self-reported 7-day point prevalence abstinence. Cost-effectiveness metrics for the GENERIC and eTARGET interventions will also be calculated. Copyright © 2017 Elsevier Inc. All rights reserved.

The importance of knowing the home conditions of patients receiving long-term oxygen therapy.

PubMed

Godoy, Ilda; Tanni, Suzana Erico; Hernández, Carme; Godoy, Irma

2012-01-01

Long-term oxygen therapy (LTOT) is one of the main treatments for patients with chronic obstructive pulmonary disease. Patients receiving LTOT may have less than optimal home conditions and this may interfere with treatment. The objective of this study was, through home visits, to identify the characteristics of patients receiving LTOT and to develop knowledge regarding the home environments of these patients. Ninety-seven patients with a mean age of 69 plus or minus 10.5 years were evaluated. This study was a cross-sectional descriptive analysis. Data were collected during an initial home visit, using a questionnaire standardized for the study. The results were analyzed retrospectively. Seventy-five percent of the patients had chronic obstructive pulmonary disease, and 11% were active smokers. The patients' mean pulse oximetry values were 85.9% plus or minus 4.7% on room air and 92% plus or minus 3.9% on the prescribed flow of oxygen. Most of the patients did not use the treatment as prescribed and most used a humidifier. The extension hose had a mean length of 5 plus or minus 3.9 m (range, 1.5-16 m). In the year prior to the visit, 26% of the patients received emergency medical care because of respiratory problems. Few patients reported engaging in leisure activities. The home visit allowed us to identify problems and interventions that could improve the way LTOT is used. The most common interventions related to smoking cessation, concentrator maintenance and cleaning, use of a humidifier, and adjustments of the length of the connector hose. Therefore, the home visit is a very important tool in providing comprehensive care to patients receiving LTOT, especially those who show lack of adequate progress and those who show uncertainty about the treatment method.

Transcranial direct current stimulation over left inferior frontal cortex improves speech fluency in adults who stutter.

PubMed

Chesters, Jennifer; Möttönen, Riikka; Watkins, Kate E

2018-04-01

See Crinion (doi:10.1093/brain/awy075) for a scientific commentary on this article.Stuttering is a neurodevelopmental condition affecting 5% of children, and persisting in 1% of adults. Promoting lasting fluency improvement in adults who stutter is a particular challenge. Novel interventions to improve outcomes are of value, therefore. Previous work in patients with acquired motor and language disorders reported enhanced benefits of behavioural therapies when paired with transcranial direct current stimulation. Here, we report the results of the first trial investigating whether transcranial direct current stimulation can improve speech fluency in adults who stutter. We predicted that applying anodal stimulation to the left inferior frontal cortex during speech production with temporary fluency inducers would result in longer-lasting fluency improvements. Thirty male adults who stutter completed a randomized, double-blind, controlled trial of anodal transcranial direct current stimulation over left inferior frontal cortex. Fifteen participants received 20 min of 1-mA stimulation on five consecutive days while speech fluency was temporarily induced using choral and metronome-timed speech. The other 15 participants received the same speech fluency intervention with sham stimulation. Speech fluency during reading and conversation was assessed at baseline, before and after the stimulation on each day of the 5-day intervention, and at 1 and 6 weeks after the end of the intervention. Anodal stimulation combined with speech fluency training significantly reduced the percentage of disfluent speech measured 1 week after the intervention compared with fluency intervention alone. At 6 weeks after the intervention, this improvement was maintained during reading but not during conversation. Outcome scores at both post-intervention time points on a clinical assessment tool (the Stuttering Severity Instrument, version 4) also showed significant improvement in the group receiving transcranial direct current stimulation compared with the sham group, in whom fluency was unchanged from baseline. We conclude that transcranial direct current stimulation combined with behavioural fluency intervention can improve fluency in adults who stutter. Transcranial direct current stimulation thereby offers a potentially useful adjunct to future speech therapy interventions for this population, for whom fluency therapy outcomes are currently limited.

Preliminary Effectiveness Study of Coping Power Program for Aggressive Children in Pakistan.

PubMed

Mushtaq, Asia; Lochman, John E; Tariq, Pervaiz N; Sabih, Fazaila

2017-10-01

Aggression is a characteristic feature of many psychiatric disorders. To address the scarceness for evidence-based interventions for behavioral problems in Pakistan, we evaluated the effectiveness of culturally adapted version of Coping Power Program. The purpose of the study was to determine the extent to which Coping Power Program is capable of reducing aggressive behavior and improving competent behavior, when delivered in a different culture, i.e., Pakistan. With randomized control trial (RCT) of pre- and post-testing, 112 fourth grade boys were allocated to Coping Power intervention condition and waitlist control condition. The intervention group showed significant reduction in aggression at post assessment, in comparison to control group. Boys who received Coping Power intervention also showed improvements in behavior, social skills, and social cognitive processes, with better anger control and problem solving strategies, in comparison to the control group. The results of the study provide preliminary evidence, supporting the effectiveness of Coping Power Program for Pakistani children. Despite its limitations, the results of this study are promising and suggest that Coping Power is an effective intervention to reduce behavioral problems and promote healthy and positive behaviors in children, even when implemented in different contexts with greater potential for violence exposure.

Supported Employment for the Reintegration of Disability Pensioners with Mental Illnesses: A Randomized Controlled Trial.

PubMed

Viering, Sandra; Jäger, Matthias; Bärtsch, Bettina; Nordt, Carlos; Rössler, Wulf; Warnke, Ingeborg; Kawohl, Wolfram

2015-01-01

Work is beneficial for the recovery from mental illness. Although the approach of individual placement and support (IPS) has been shown to be effective in Europe, it has not yet been widely implemented in European health care systems. The aim of this randomized controlled trial was to assess the effectiveness of IPS for disability pensioners with mental illnesses new on disability benefits in Switzerland. In the study at hand, 250 participants were randomly assigned to either the control or the intervention group. The participants in the intervention group received job coaching according to IPS during 2 years. The control group received no structured support. Both groups were interviewed at baseline and followed up every 6 months (baseline, 6, 12, 16, 18, 24 months) for 2 years. Primary outcome was to obtain a job in the competitive employment. IPS was more effective for the reintegration into the competitive employment market for disability pensioners than the control condition. Thirty-two percent of the participants of the intervention group and 12% of the control group obtained new jobs in the competitive employment. IPS is also effective for the reintegration into competitive employment of people with mental illness receiving disability pensions.

Using Problem-solving Therapy to Improve Problem-solving Orientation, Problem-solving Skills and Quality of Life in Older Hemodialysis Patients.

PubMed

Erdley-Kass, Shiloh D; Kass, Darrin S; Gellis, Zvi D; Bogner, Hillary A; Berger, Andrea; Perkins, Robert M

2017-08-24

To determine the effectiveness of Problem-Solving Therapy (PST) in older hemodialysis (HD) patients by assessing changes in health-related quality of life and problem-solving skills. 33 HD patients in an outpatient hemodialysis center without active medical and psychiatric illness were enrolled. The intervention group (n = 15) received PST from a licensed social worker for 6 weeks, whereas the control group (n = 18) received usual care treatment. In comparison to the control group, patients receiving PST intervention reported improved perceptions of mental health, were more likely to view their problems with a positive orientation and were more likely to use functional problem-solving methods. Furthermore, this group was also more likely to view their overall health, activity limits, social activities and ability to accomplish desired tasks with a more positive mindset. The results demonstrate that PST may positively impact mental health components of quality of life and problem-solving coping among older HD patients. PST is an effective, efficient, and easy to implement intervention that can benefit problem-solving abilities and mental health-related quality of life in older HD patients. In turn, this will help patients manage their daily living activities related to their medical condition and reduce daily stressors.

Effects of a Web-Based Computer-Tailored Game to Reduce Binge Drinking Among Dutch Adolescents: A Cluster Randomized Controlled Trial

PubMed Central

Crutzen, Rik; Mercken, Liesbeth; Candel, Math; de Vries, Hein

2016-01-01

Background Binge drinking among Dutch adolescents is among the highest in Europe. Few interventions so far have focused on adolescents aged 15 to 19 years. Because binge drinking increases significantly during those years, it is important to develop binge drinking prevention programs for this group. Web-based computer-tailored interventions can be an effective tool for reducing this behavior in adolescents. Embedding the computer-tailored intervention in a serious game may make it more attractive to adolescents. Objective The aim was to assess whether a Web-based computer-tailored intervention is effective in reducing binge drinking in Dutch adolescents aged 15 to 19 years. Secondary outcomes were reduction in excessive drinking and overall consumption during the previous week. Personal characteristics associated with program adherence were also investigated. Methods A cluster randomized controlled trial was conducted among 34 Dutch schools. Each school was randomized into either an experimental (n=1622) or a control (n=1027) condition. Baseline assessment took place in January and February 2014. At baseline, demographic variables and alcohol use were assessed. Follow-up assessment of alcohol use took place 4 months later (May and June 2014). After the baseline assessment, participants in the experimental condition started with the intervention consisting of a game about alcohol in which computer-tailored feedback regarding motivational characteristics was embedded. Participants in the control condition only received the baseline questionnaire. Both groups received the 4-month follow-up questionnaire. Effects of the intervention were assessed using logistic regression mixed models analyses for binge and excessive drinking and linear regression mixed models analyses for weekly consumption. Factors associated with intervention adherence in the experimental condition were explored by means of a linear regression model. Results In total, 2649 adolescents participated in the baseline assessment. At follow-up, 824 (31.11%) adolescents returned. The intervention was effective in reducing binge drinking among adolescents aged 15 years (P=.03) and those aged 16 years when they participated in at least 2 intervention sessions (P=.04). Interaction effects between excessive drinking and educational level (P=.08) and between weekly consumption and age (P=.09) were found; however, in-depth analyses revealed no significant subgroup effects for both interaction effects. Additional analyses revealed that prolonged use of the intervention was associated with stronger effects for binge drinking. Yet, overall adherence to the intervention was low. Analyses revealed that being Protestant, female, younger, a nonbinge drinker, and having a higher educational background were associated with adherence. Conclusions The intervention was effective for adolescents aged 15 and 16 years concerning binge drinking. Prevention messages may be more effective for those at the start of their drinking career, whereas other methods may be needed for those with a longer history of alcohol consumption. Despite using game elements, intervention completion was low. Trial Registration Dutch Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by WebCite® at http://www.webcitation.org/6eSJD3FiY) PMID:26842694

Effects of a Web-Based Computer-Tailored Game to Reduce Binge Drinking Among Dutch Adolescents: A Cluster Randomized Controlled Trial.

PubMed

Jander, Astrid; Crutzen, Rik; Mercken, Liesbeth; Candel, Math; de Vries, Hein

2016-02-03

Binge drinking among Dutch adolescents is among the highest in Europe. Few interventions so far have focused on adolescents aged 15 to 19 years. Because binge drinking increases significantly during those years, it is important to develop binge drinking prevention programs for this group. Web-based computer-tailored interventions can be an effective tool for reducing this behavior in adolescents. Embedding the computer-tailored intervention in a serious game may make it more attractive to adolescents. The aim was to assess whether a Web-based computer-tailored intervention is effective in reducing binge drinking in Dutch adolescents aged 15 to 19 years. Secondary outcomes were reduction in excessive drinking and overall consumption during the previous week. Personal characteristics associated with program adherence were also investigated. A cluster randomized controlled trial was conducted among 34 Dutch schools. Each school was randomized into either an experimental (n=1622) or a control (n=1027) condition. Baseline assessment took place in January and February 2014. At baseline, demographic variables and alcohol use were assessed. Follow-up assessment of alcohol use took place 4 months later (May and June 2014). After the baseline assessment, participants in the experimental condition started with the intervention consisting of a game about alcohol in which computer-tailored feedback regarding motivational characteristics was embedded. Participants in the control condition only received the baseline questionnaire. Both groups received the 4-month follow-up questionnaire. Effects of the intervention were assessed using logistic regression mixed models analyses for binge and excessive drinking and linear regression mixed models analyses for weekly consumption. Factors associated with intervention adherence in the experimental condition were explored by means of a linear regression model. In total, 2649 adolescents participated in the baseline assessment. At follow-up, 824 (31.11%) adolescents returned. The intervention was effective in reducing binge drinking among adolescents aged 15 years (P=.03) and those aged 16 years when they participated in at least 2 intervention sessions (P=.04). Interaction effects between excessive drinking and educational level (P=.08) and between weekly consumption and age (P=.09) were found; however, in-depth analyses revealed no significant subgroup effects for both interaction effects. Additional analyses revealed that prolonged use of the intervention was associated with stronger effects for binge drinking. Yet, overall adherence to the intervention was low. Analyses revealed that being Protestant, female, younger, a nonbinge drinker, and having a higher educational background were associated with adherence. The intervention was effective for adolescents aged 15 and 16 years concerning binge drinking. Prevention messages may be more effective for those at the start of their drinking career, whereas other methods may be needed for those with a longer history of alcohol consumption. Despite using game elements, intervention completion was low. Dutch Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by WebCite® at http://www.webcitation.org/6eSJD3FiY).

School-based mindfulness intervention for stress reduction in adolescents: Design and methodology of an open-label, parallel group, randomized controlled trial.

PubMed

Johnstone, Jeanette M; Roake, Chelsea; Sheikh, Ifrah; Mole, Ashlie; Nigg, Joel T; Oken, Barry

2016-12-15

Adolescents are in a high-risk period developmentally, in terms of susceptibility to stress. A mindfulness intervention represents a potentially useful strategy for developing cognitive and emotion regulation skills associated with successful stress coping. Mindfulness strategies have been used successfully for emotional coping in adults, but are not as well studied in youth. This article details a novel proposal for the design of an 8-week randomized study to evaluate a high school-based mindfulness curriculum delivered as part of a two semester health class. A wellness education intervention is proposed as an active control, along with a waitlist control condition. All students enrolled in a sophomore (10 th grade) health class at a private suburban high school will be invited to participate ( n = 300). Pre-test assessments will be obtained by youth report, parent ratings, and on-site behavioral testing. The assessments will evaluate baseline stress, mood, emotional coping, controlled attention, and working memory. Participants, divided into 13 classrooms, will be randomized into one of three conditions, by classroom: A mindfulness intervention, an active control (wellness education), and a passive control (waitlist). Waitlisted participants will receive one of the interventions in the following term. Intervention groups will meet weekly for 8 weeks during regularly scheduled health classes. Immediate post-tests will be conducted, followed by a 60-day post-test. It is hypothesized that the mindfulness intervention will outperform the other conditions with regard to the adolescents' mood, attention and response to stress.

A Mixed-Method Efficacy and Fidelity Study of Check and Connect

ERIC Educational Resources Information Center

Powers, Kristin; Hagans, Kristi; Linn, Megan

2017-01-01

The effectiveness of the Check and Connect dropout prevention program was examined, over the course of 2.5 years, with 54 middle school students from diverse backgrounds experiencing one or more conditions of risk for dropout. Participants were randomly assigned to receive the Check and Connect intervention or business as usual (i.e., control) in…

Youth Characteristics Associated with Intensity of Service Use in a School-Based Mental Health Intervention

ERIC Educational Resources Information Center

Burnett-Zeigler, Inger; Lyons, John S.

2012-01-01

Several epidemiological studies have reported that large numbers of children and adolescents suffer from diagnosable psychiatric conditions, however most of them do not receive treatment. The schools are a key setting where youth with mental health problems are identified and linked to treatment. In this study we examine the demographic and…

Randomized Controlled Trial for Behavioral Smoking and Weight Control Treatment: Effect of Concurrent Versus Sequential Intervention.

ERIC Educational Resources Information Center

Spring, Bonnie; Pagoto, Sherry; Pingitore, Regina; Doran, Neal; Schneider, Kristin; Hedeker, Don

2004-01-01

The authors compared simultaneous versus sequential approaches to multiple health behavior change in diet, exercise, and cigarette smoking. Female regular smokers (N = 315) randomized to 3 conditions received 16 weeks of behavioral smoking treatment, quit smoking at Week 5, and were followed for 9 months after quit date. Weight management was…

Preventing family transmission of anxiety: Feasibility RCT of a brief intervention for parents.

PubMed

Cartwright-Hatton, Sam; Ewing, Donna; Dash, Suzanne; Hughes, Zoe; Thompson, Ellen J; Hazell, Cassie M; Field, Andy P; Startup, Helen

2018-03-25

Children of anxious parents are at high risk of anxiety disorders themselves. The evidence suggests that this is due to environmental rather than genetic factors. However, we currently do little to reduce this risk of transmission. There is evidence that supporting parenting in those with mental health difficulties can ameliorate this risk. Therefore, the objective of this study was to test the feasibility of a new one-session, group-based, preventive parenting intervention for parents with anxiety disorders. Feasibility Randomized Controlled Trial. A total of 100 parents with anxiety disorders, recruited from adult mental health services in England (and child aged 3-9 years), were randomized to receive the new intervention (a 1-day, group workshop), or to treatment as usual. Children's anxiety disorder and anxiety symptoms were assessed to 12 months by outcome assessors who were blind to group allocation. Exploratory analyses were conducted on an intention to treat basis, as far as possible. A total of 51 participants were randomized to the intervention condition and 49 to the control condition (82% and 80% followed to 12 months, respectively). The attendance rate was 59%, and the intervention was highly acceptable to parents who received it. The RCT was feasible, and 12-month follow-up attrition rates were low. Children whose parents were in the control condition were 16.5% more likely to have an anxiety disorder at follow-up than those in the intervention group. No adverse events were reported. An inexpensive, light-touch, psycho-educational intervention may be useful in breaking the intergenerational cycle of transmission of anxiety disorders. A substantive trial is warranted. Anxiety disorders run in families, but we currently do little to help anxious parents to raise confident children. A brief group workshop was highly acceptable to such parents and was very inexpensive to run. Children of parents who took part in the brief intervention were 16.5% less likely to have an anxiety disorder, 1 year later, than children whose parents were in the control group. This was a feasibility study, and while it showed that both the intervention and the research were feasible, the study needs replicating with a much larger sample. Many parents faced barriers to attending the workshop, and future efforts should focus on widening accessibility. We were unable to obtain sufficient self-report data from children, so the outcomes are based on parent report only. © 2018 The British Psychological Society.

From Value Assessment to Value Cocreation: Informing Clinical Decision-Making with Medical Claims Data.

PubMed

Thompson, Steven; Varvel, Stephen; Sasinowski, Maciek; Burke, James P

2016-09-01

Big data and advances in analytical processes represent an opportunity for the healthcare industry to make better evidence-based decisions on the value generated by various tests, procedures, and interventions. Value-based reimbursement is the process of identifying and compensating healthcare providers based on whether their services improve quality of care without increasing cost of care or maintain quality of care while decreasing costs. In this article, we motivate and illustrate the potential opportunities for payers and providers to collaborate and evaluate the clinical and economic efficacy of different healthcare services. We conduct a case study of a firm that offers advanced biomarker and disease state management services for cardiovascular and cardiometabolic conditions. A value-based analysis that comprised a retrospective case/control cohort design was conducted, and claims data for over 7000 subjects who received these services were compared to a matched control cohort. Study subjects were commercial and Medicare Advantage enrollees with evidence of CHD, diabetes, or a related condition. Analysis of medical claims data showed a lower proportion of patients who received biomarker testing and disease state management services experienced a MI (p < 0.01) or diabetic complications (p < 0.001). No significant increase in cost of care was found between the two cohorts. Our results illustrate the opportunity healthcare payers such as Medicare and commercial insurance companies have in terms of identifying value-creating healthcare interventions. However, payers and providers also need to pursue system integration efforts to further automate the identification and dissemination of clinically and economically efficacious treatment plans to ensure at-risk patients receive the treatments and interventions that will benefit them the most.

Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

PubMed

Morales-Asencio, Jose M; Kaknani-Uttumchandani, Shakira; Cuevas-Fernández-Gallego, Magdalena; Palacios-Gómez, Leopoldo; Gutiérrez-Sequera, José L; Silvano-Arranz, Agustina; Batres-Sicilia, Juan Pedro; Delgado-Romero, Ascensión; Cejudo-Lopez, Ángela; Trabado-Herrera, Manuel; García-Lara, Esteban L; Martin-Santos, Francisco J; Morilla-Herrera, Juan C

2015-10-01

Complex chronic diseases are a challenge for the current configuration of health services. Case management is a service frequently provided for people with chronic conditions, and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers and services used. The study was divided into three phases, covering the detection of information needs, the design and its implementation in the health care system, using literature review and expert consensus methods to select variables that would be included in the registry. A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. A web-based registry with modular and layered architecture was designed. The framework follows a pattern based on the model-view-controller approach. In its first 6 months after the implementation, 102 case managers have introduced an average number of 6.49 patients each one. The registry permits a complete and in-depth analysis of the characteristics of the patients who receive case management, the interventions delivered and some major outcomes as mortality, readmissions or adverse events. © 2015 John Wiley & Sons, Ltd.

Effects of Small-Group Tutoring with and without Validated Classroom Instruction on At-Risk Students' Math Problem Solving: Are Two Tiers of Prevention Better Than One?

PubMed

Fuchs, Lynn S; Fuchs, Douglas; Craddock, Caitlin; Hollenbeck, Kurstin N; Hamlett, Carol L; Schatschneider, Christopher

2008-01-01

The purpose of this study was to assess the effects of small-group tutoring with and without validated classroom instruction on at-risk (AR) students' math problem solving. Stratifying within schools, 119 3(rd)-grade classes were randomly assigned to conventional or validated problem-solving instruction (Hot Math [schema-broadening instruction]). Students identified as AR (n = 243) were randomly assigned, within classroom conditions, to receive Hot Math tutoring or not. Students were tested on problem-solving and math applications measures before and after 16 weeks of intervention. Analyses of variance, which accounted for the nested structure of the data, revealed the tutored students who received validated classroom instruction achieved better than tutored students who received conventional classroom instruction (ES = 1.34). However, the advantage for tutoring over no tutoring was similar whether or not students received validated or conventional classroom instruction (ESs = 1.18 and 1.13). Tutoring, not validated classroom instruction reduced the prevalence of math difficulty. Implications for responsiveness-to-intervention prevention models and for enhancing math problem-solving instruction are discussed.

Effects of Small-Group Tutoring with and without Validated Classroom Instruction on At-Risk Students' Math Problem Solving: Are Two Tiers of Prevention Better Than One?

PubMed Central

Fuchs, Lynn S.; Fuchs, Douglas; Craddock, Caitlin; Hollenbeck, Kurstin N.; Hamlett, Carol L.; Schatschneider, Christopher

2008-01-01

The purpose of this study was to assess the effects of small-group tutoring with and without validated classroom instruction on at-risk (AR) students' math problem solving. Stratifying within schools, 119 3rd-grade classes were randomly assigned to conventional or validated problem-solving instruction (Hot Math [schema-broadening instruction]). Students identified as AR (n = 243) were randomly assigned, within classroom conditions, to receive Hot Math tutoring or not. Students were tested on problem-solving and math applications measures before and after 16 weeks of intervention. Analyses of variance, which accounted for the nested structure of the data, revealed the tutored students who received validated classroom instruction achieved better than tutored students who received conventional classroom instruction (ES = 1.34). However, the advantage for tutoring over no tutoring was similar whether or not students received validated or conventional classroom instruction (ESs = 1.18 and 1.13). Tutoring, not validated classroom instruction reduced the prevalence of math difficulty. Implications for responsiveness-to-intervention prevention models and for enhancing math problem-solving instruction are discussed. PMID:19122881

Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial

PubMed Central

Anderson, Peter; Coulton, Simon; Kaner, Eileen; Bendtsen, Preben; Kłoda, Karolina; Reynolds, Jillian; Segura, Lidia; Wojnar, Marcin; Mierzecki, Artur; Deluca, Paolo; Newbury-Birch, Dorothy; Parkinson, Kathryn; Okulicz-Kozaryn, Katarzyna; Drummond, Colin; Gual, Antoni

2017-01-01

PURPOSE We aimed to test whether 3 strategies—training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice—have a longer-term effect on primary care clinicians’ delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) tool. METHODS We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention—screening and, if screen-positive, advice—at 9 months. RESULTS Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03–1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention. CONCLUSIONS Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months. PMID:28694269

A randomized trial of the effect of prayer on depression and anxiety.

PubMed

Boelens, Peter A; Reeves, Roy R; Replogle, William H; Koenig, Harold G

2009-01-01

To investigate the effect of direct contact person-to-person prayer on depression, anxiety, positive emotions, and salivary cortisol levels. Cross-over clinical trial with depression or anxiety conducted in an office setting. Following randomization to the prayer intervention or control groups, subjects (95% women) completed Hamilton Rating Scales for Depression and Anxiety, Life Orientation Test, Daily Spiritual Experiences Scale, and underwent measurement of cortisol levels. Individuals in the direct person-to-person prayer contact intervention group received six weekly 1-hour prayer sessions while those in the control group received none. Rating scales and cortisol levels were repeated for both groups after completion of the prayer sessions, and a month later. ANOVAs were used to compare pre- and post-prayer measures for each group. At the completion of the trial, participants receiving the prayer intervention showed significant improvement of depression and anxiety, as well as increases of daily spiritual experiences and optimism compared to controls (p < 0.01 in all cases). Subjects in the prayer group maintained these significant improvements (p < 0.01 in all cases) for a duration of at least 1 month after the final prayer session. Participants in the control group did not show significant changes during the study. Cortisol levels did not differ significantly between intervention and control groups, or between pre- and post-prayer conditions. Direct contact person-to-person prayer may be useful as an adjunct to standard medical care for patients with depression and anxiety. Further research in this area is indicated.

Designs for Testing Group-Based Interventions with Limited Numbers of Social Units: The Dynamic Wait-Listed and Regression Point Displacement Designs.

PubMed

Wyman, Peter A; Henry, David; Knoblauch, Shannon; Brown, C Hendricks

2015-10-01

The dynamic wait-listed design (DWLD) and regression point displacement design (RPDD) address several challenges in evaluating group-based interventions when there is a limited number of groups. Both DWLD and RPDD utilize efficiencies that increase statistical power and can enhance balance between community needs and research priorities. The DWLD blocks on more time units than traditional wait-listed designs, thereby increasing the proportion of a study period during which intervention and control conditions can be compared, and can also improve logistics of implementing intervention across multiple sites and strengthen fidelity. We discuss DWLDs in the larger context of roll-out randomized designs and compare it with its cousin the Stepped Wedge design. The RPDD uses archival data on the population of settings from which intervention unit(s) are selected to create expected posttest scores for units receiving intervention, to which actual posttest scores are compared. High pretest-posttest correlations give the RPDD statistical power for assessing intervention impact even when one or a few settings receive intervention. RPDD works best when archival data are available over a number of years prior to and following intervention. If intervention units were not randomly selected, propensity scores can be used to control for non-random selection factors. Examples are provided of the DWLD and RPDD used to evaluate, respectively, suicide prevention training (QPR) in 32 schools and a violence prevention program (CeaseFire) in two Chicago police districts over a 10-year period. How DWLD and RPDD address common threats to internal and external validity, as well as their limitations, are discussed.

Designs for testing group-based interventions with limited numbers of social units: The dynamic wait-listed and regression point displacement designs

PubMed Central

Wyman, Peter A.; Brown, C. Hendricks

2015-01-01

The dynamic wait-listed design (DWLD) and regression point displacement design (RPDD) address several challenges in evaluating group-based interventions when there is a limited number of groups. Both DWLD and RPDD utilize efficiencies that increase statistical power and can enhance balance between community needs and research priorities. The DWLD blocks on more time units than traditional wait-listed designs, thereby increasing the proportion of a study period during which intervention and control conditions can be compared, and can also improve logistics of implementing intervention across multiple sites and strengthen fidelity. We discuss DWLDs in the larger context of roll-out randomized designs and compare it with its cousin the Stepped Wedge design. The RPDD uses archival data on the population of settings from which intervention unit(s) are selected to create expected posttest scores for units receiving intervention, to which actual posttest scores are compared. High pretest-posttest correlations give the RPDD statistical power for assessing intervention impact even when one or a few settings receive intervention. RPDD works best when archival data are available over a number of years prior to and following intervention. If intervention units were not randomly selected, propensity scores can be used to control for nonrandom selection factors. Examples are provided of the DWLD and RPDD used to evaluate, respectively, suicide prevention training (QPR) in 32 schools and a violence prevention program (CeaseFire) in 2 Chicago police districts over a 10-year period. How DWLD and RPDD address common threats to internal and external validity, as well as their limitations, are discussed. PMID:25481512

Using standardized patients to evaluate hospital-based intervention outcomes.

PubMed

Li, Li; Lin, Chunqing; Guan, Jihui

2014-06-01

The standardized patient approach has proved to be an effective training tool for medical educators. This article explains the process of employing standardized patients in an HIV stigma reduction intervention in healthcare settings in China. The study was conducted in 40 hospitals in two provinces of China. One year after the stigma reduction intervention, standardized patients made unannounced visits to participating hospitals, randomly approached service providers on duty and presented symptoms related to HIV and disclosed HIV-positive test results. After each visit, the standardized patients evaluated their providers' attitudes and behaviours using a structured checklist. Standardized patients also took open-ended observation notes about their experience and the evaluation process. Seven standardized patients conducted a total of 217 assessments (108 from 20 hospitals in the intervention condition; 109 from 20 hospitals in the control condition). Based on a comparative analysis, the intervention hospitals received a better rating than the control hospitals in terms of general impression and universal precaution compliance as well as a lower score on stigmatizing attitudes and behaviours toward the standardized patients. Standardized patients are a useful supplement to traditional self-report assessments, particularly for measuring intervention outcomes that are sensitive or prone to social desirability. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2013; all rights reserved.

Retraining automatic action tendencies changes alcoholic patients' approach bias for alcohol and improves treatment outcome.

PubMed

Wiers, Reinout W; Eberl, Carolin; Rinck, Mike; Becker, Eni S; Lindenmeyer, Johannes

2011-04-01

This study tested the effects of a new cognitive-bias modification (CBM) intervention that targeted an approach bias for alcohol in 214 alcoholic inpatients. Patients were assigned to one of two experimental conditions, in which they were explicitly or implicitly trained to make avoidance movements (pushing a joystick) in response to alcohol pictures, or to one of two control conditions, in which they received no training or sham training. Four brief sessions of experimental CBM preceded regular inpatient treatment. In the experimental conditions only, patients' approach bias changed into an avoidance bias for alcohol. This effect generalized to untrained pictures in the task used in the CBM and to an Implicit Association Test, in which alcohol and soft-drink words were categorized with approach and avoidance words. Patients in the experimental conditions showed better treatment outcomes a year later. These findings indicate that a short intervention can change alcoholics' automatic approach bias for alcohol and may improve treatment outcome.

Evaluation of a cognitive remediation intervention for college students with psychiatric conditions.

PubMed

Mullen, Michelle G; Thompson, Judy L; Murphy, Ann A; Malenczak, Derek; Giacobbe, Giovanna; Karyczak, Sean; Holloway, Katherine E; Twamley, Elizabeth W; Silverstein, Steven M; Gill, Kenneth J

2017-03-01

Given the poor educational outcomes associated with psychiatric conditions, we developed Focused Academic Strength Training (FAST), a 12-week strategy-focused cognitive remediation intervention designed to improve academic functioning among college students with psychiatric conditions. Here we report initial results from a randomized controlled trial of FAST. Seventy-two college students with mood, anxiety, and/or psychotic disorders were randomized to receive FAST or services as usual and were assessed at baseline and 4 months (posttreatment). Repeated-measures analyses of variance indicated FAST-associated improvements in self-reported cognitive strategy use (p < .001), self-efficacy (p = .001), and academic difficulties (p = .025). There were no significant treatment-related improvements in neuropsychological performance. FAST may lead to an increase in self-efficacy and cognitive strategy use, as well as a reduction in academic difficulties among students with psychiatric conditions. Future analyses with follow-up data through 12 months will address the potential of FAST to improve academic functioning among this population. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Using actigraphy feedback to improve sleep in soldiers: an exploratory trial.

PubMed

Adler, Amy B; Gunia, Brian C; Bliese, Paul D; Kim, Paul Y; LoPresti, Matthew L

2017-04-01

The objective of this study was to assess the impact of wearing an actigraph and receiving personalized feedback on the sleep of a high-risk occupational group: United States soldiers recently returned from a combat deployment. Following a baseline survey with a full sample, a subsample of soldiers wore an actigraph, received feedback, and completed a brief survey. Two months later, the full sample completed a follow-up survey. The actigraph intervention involved wearing an actigraph for 3 weeks and then receiving a personalized report about sleep patterns and an algorithm-based estimate of cognitive functioning derived from individual sleep patterns. Propensity score matching with a genetic search algorithm revealed that subjects in the actigraph condition (n=43) reported fewer sleep problems (t value = -2.55, P<.01) and getting more sleep hours (t value =1.97, P<.05) at follow-up than those in a matched comparison condition (n=43, weighted). There were no significant differences in functioning, somatic symptoms, and mental health outcomes (posttraumatic stress disorder symptoms and depression). A significant interaction indicated that the actigraph had a more beneficial effect on those with more somatic symptoms at baseline but not those with more sleep problems. Most participants rated the personalized report as helpful. Actigraphs combined with personalized reports may offer a useful, simple intervention to improve the sleep patterns of large, high-risk occupational groups. Published by Elsevier Inc.

Community psychiatric nurse caseloads and the 'worried well': misspent time vital work?

PubMed

Bowers, L

1997-11-01

Community psychiatric nurses (CPNs) in the United Kingdom are being repeatedly urged to focus their attention upon those with serious and enduring psychotic illnesses, and to withdraw from working with the 'worried well' in the primary health care setting. In view of this pressure, it is important to discover the nature of community psychiatric nurses' non-psychotic caseloads. The aim of this study was to describe these cases, what precipitated their referral, what problems they suffered from, what effects these problems had upon their lives and what kinds of therapeutic interventions they were receiving. A random sample was drawn of non-psychotic CPN patients. The community psychiatric nurses then received a structured interview about the history, care and treatment of these patients. These patients did not, in general, suffer from minor, self-limiting conditions. They typically had had 5 years of contact with psychiatric services, and their psychiatric symptoms blighted their occupational, social and personal lives. Their condition caused significant carer burden, and there was frequently a risk of suicide. The CPNs case-managed a complex combination of interventions for these patients, of which psychotherapeutic methods were only one part. The findings show that community psychiatric nurses have a valid role to play in the care of those with non-psychotic mental disorders, and should continue to receive the opportunity, and appropriate training, to do so.

Drinking outcomes following drink refusal skills training: differential effects for African American and non-Hispanic White clients.

PubMed

Witkiewitz, Katie; Villarroel, Nadia Aracelliz; Hartzler, Bryan; Donovan, Dennis M

2011-03-01

Determining whether a particular treatment works for specific groups of people can help tailor dissemination of evidence-based alcohol treatments. It has been proposed that individuals from different racial groups might have better outcomes in treatments that are sensitive to sociocultural issues that impact alcohol use among these groups. The current study was a secondary analysis of data from the combined behavioral intervention (CBI) condition of the COMBINE study. Those randomly assigned to CBI (n = 776) had the opportunity to receive up to 9 skills training modules, which were chosen by the therapist. The goal of the current study was to determine whether receiving 1 of the CBI modules, drink refusal and social pressure skills training, predicted differential outcomes among African American clients. Results indicated that African American clients who received the drink refusal skills training module (n = 25) had significantly fewer heavy drinking days (d = 0.79) 1 year following treatment than African Americans clients who did not receive the module (n = 35). African American clients who received the module also had significantly fewer heavy drinking days (d = 0.86) than non-Hispanic White clients who received the module (n = 241). Good clinical outcomes at 1 year posttreatment were observed among 80% of African Americans who received the module, compared with 54% of African Americans who did not receive the module and 52% of non-Hispanic White clients who did receive the module. Although small sample size limits interpretation, findings provide preliminary evidence supporting the inclusion of drink refusal skills training as part of alcohol interventions for African American clients.

Motivating Low Socioeconomic Status Smokers to Accept Evidence-Based Smoking Cessation Treatment: A Brief Intervention for the Community Agency Setting

PubMed Central

Reeder, Kevin M.; TerBeek, Erin G.; Fiore, Michael C.; Baker, Timothy B.

2015-01-01

Introduction: Individuals of low socioeconomic status (SES), smoke at very high rates but make fewer and less successful quit attempts than do other smokers. Low-SES smokers have specific beliefs about smoking and quitting that may serve as barriers to making quit attempts. The purpose of this study was to test the impact of a brief intervention addressing these beliefs on making calls to a telephone quit line. Methods: Of 522 smokers entering the study at 5 Wisconsin Salvation Army (SA) sites, 102 expressed motivation to quit and served as a comparison group. The remaining 420 smokers were not motivated to quit and were randomly assigned to 1 of 3 conditions: an intervention group who received brief counseling focused on cessation goals and beliefs, an attention-control group, and a low contact control group. The primary outcome was the rate at which smokers made a call to the Wisconsin tobacco quit line (WTQL) during their SA visit. Secondary outcome measures included motivational variables, stage of change, changes in beliefs about smoking and quitting, and self-reported abstinence. Results: Unmotivated participants in the intervention condition called the WTQL at a significantly higher rate (12.2%) than did those in the 2 control conditions (2.2% and 1.4%) (p < .01) and approached the rate of calling by participants who were initially motivated to quit (15.7%). Intervention condition participants also showed improved motivation to quit and stage of change. Conclusions: A brief, targeted motivational intervention focusing on cessation goals and beliefs increased the initiation of an evidence-based tobacco cessation treatment by low-SES smokers. PMID:26180226

Brief training in mindfulness meditation reduces symptoms in patients with a chronic or recurrent lifetime history of depression: A randomized controlled study.

PubMed

Winnebeck, Emilia; Fissler, Maria; Gärtner, Matti; Chadwick, Paul; Barnhofer, Thorsten

2017-12-01

Training in mindfulness has been introduced to the treatment of depression as a means of relapse prevention. However, given its buffering effects on maladaptive responses to negative mood, mindfulness training would be expected to be particularly helpful in those who are currently suffering from symptoms. This study investigated whether a brief and targeted mindfulness-based intervention can reduce symptoms in acutely depressed patients. Seventy-four patients with a chronic or recurrent lifetime history were randomly allocated to receive either a brief mindfulness-based intervention (MBI) encompassing three individual sessions and regular home practice or a control condition that combined psycho-educational components and regular rest periods using the same format as the MBI. Self-reported severity of symptoms, mindfulness in every day life, ruminative tendencies and cognitive reactivity were assessed before and after intervention. Treatment completers in the MBI condition showed pronounced and significantly stronger reductions in symptoms than those in the control condition. In the MBI group only, patients showed significant increases in mindfulness, and significant reductions in ruminative tendencies and cognitive reactivity. Brief targeted mindfulness interventions can help to reduce symptoms and buffer maladaptive responses to negative mood in acutely depressed patients with chronic or recurrent lifetime history. Copyright © 2017 Elsevier Ltd. All rights reserved.

Long-term effectiveness of cognitive-behavioural self-help intervention for nightmares.

PubMed

Lancee, Jaap; Spoormaker, Victor I; van den Bout, Jan

2011-09-01

Nightmares are a prevalent disorder leading to daily impairments. Two cognitive-behavioural self-help interventions--imagery rehearsal and exposure--recently showed short-term efficacy compared to a waiting-list and a group that recorded their nightmares. This paper reports the long-term results of the imagery rehearsal (n=103) and exposure (n=95) interventions. Participants were assigned randomly to a condition after completing baseline measurements; they received a 6-week self-help intervention and completed questionnaires 4, 16 and 42 weeks after end of treatment. Initial effects on nightmare measures were almost completely sustained after 42 weeks (d=0.50-0.70); no differences were found between exposure and imagery rehearsal therapy. These results suggest that nightmares should be targeted specifically and that an internet-delivered self-help intervention seems to be a good first option in a stepped-care model. © 2010 European Sleep Research Society.

Counseling African Americans to Control Hypertension: cluster-randomized clinical trial main effects.

PubMed

Ogedegbe, Gbenga; Tobin, Jonathan N; Fernandez, Senaida; Cassells, Andrea; Diaz-Gloster, Marleny; Khalida, Chamanara; Pickering, Thomas; Schwartz, Joseph E

2014-05-20

Data are limited on the implementation of evidence-based multilevel interventions targeted at blood pressure (BP) control in hypertensive blacks who receive care in low-resource primary care practices. Counseling African Americans to Control Hypertension is a cluster-randomized clinical trial in which 30 community health centers were randomly assigned to the intervention condition (IC) or usual care (UC). Patients at the IC sites received patient education, home BP monitoring, and monthly lifestyle counseling, whereas physicians attended monthly hypertension case rounds and received feedback on their patients' home BP readings and chart audits. Patients and physicians at the UC sites received printed patient education material and hypertension treatment guidelines, respectively. The primary outcome was BP control, and secondary outcomes were mean changes in systolic and diastolic BPs at 12 months, assessed with an automated BP device. A total of 1059 patients (mean age, 56 years; 28% men, 59% obese, and 36% with diabetes mellitus) were enrolled. The BP control rate was similar in both groups (IC=49.3% versus UC=44.5%; odds ratio, 1.21 [95% confidence interval, 0.90-1.63]; P=0.21). In prespecified subgroup analyses, the intervention was associated with greater BP control in patients without diabetes mellitus (IC=54.0% versus UC=44.7%; odds ratio, 1.45 [confidence interval, 1.02-2.06]); and small-sized community health centers (IC=51.1% versus UC=39.6%; odds ratio, 1.45 [confidence interval, 1.04-2.45]). A practice-based, multicomponent intervention was no better than UC in improving BP control among hypertensive blacks. Future research on the implementation of behavioral modification strategies for hypertension control in low-resource settings should focus on the development of more efficient and tailored interventions in this high-risk population. http://www.clinicaltrials.gov. Unique identifier: NCT00233220. © 2014 American Heart Association, Inc.

Closing tobacco-related disparities: Using community organizations to increase consumer demand.

PubMed

Christiansen, Bruce A; Brooks, Marva; Keller, Paula A; Theobald, Wendy E; Fiore, Michael C

2010-03-01

Individuals living in poverty are more likely to smoke, and they suffer disproportionately from tobacco use. Strategies used to deliver tobacco-cessation interventions often fail to reach smokers living in poverty. Providing tobacco interventions to smokers when they present to community organizations is a potential strategy, but the acceptability and effectiveness of such interventions is unknown. In this 2007 pilot study, 295 smokers seeking emergency assistance from the Salvation Army in Wisconsin were randomly assigned to either a very brief (30-second) smoking intervention condition or to a control no-intervention condition. All participants completed a follow-up survey at the end of their visit assessing their satisfaction with the community agency, interest in quitting, and motivation to quit. This brief intervention increased the likelihood that smokers would seek help when they decided to quit (61% vs 44%, p<0.05) but did not affect intention to quit in the next 6 months or perceived difficulty of quitting. The intervention was well received by both participants and Salvation Army staff. Smokers in this pilot study found it acceptable to have their smoking addressed when seeking services from a community agency. Such interventions may need to be more intense than the one used in this study in order to achieve the goal of increased motivation to quit. Community agencies should consider including brief tobacco-dependence interventions as a secondary mission to improve their clients' health. 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Using a web-based game to prevent posttraumatic stress in children following medical events: design of a randomized controlled trial.

PubMed

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

2013-01-01

Medical events including acute illness and injury are among the most common potentially traumatic experiences for children. Despite the scope of the problem, only limited resources are available for prevention of posttraumatic stress symptoms (PTSS) after pediatric medical events. Web-based programs provide a low-cost, accessible means to reach a wide range of families and show promise in related areas of child mental health. To describe the design of a randomized controlled trial that will evaluate feasibility and estimate preliminary efficacy of Coping Coach, a web-based preventive intervention to prevent or reduce PTSS after acute pediatric medical events. Seventy children and their parents will be randomly assigned to either an intervention or a waitlist control condition. Inclusion criteria require that children are aged 8-12 years, have experienced a medical event, have access to Internet and telephone, and have sufficient competency in the English language to complete measures and understand the intervention. Participants will complete baseline measures and will then be randomized to the intervention or waitlist control condition. Children in the intervention condition will complete module 1 (Feelings Identification) in the hospital and will be instructed on how to complete modules 2 (Appraisals) and 3 (Avoidance) online. Follow-up assessments will be conducted via telephone at 6, 12, and 18 weeks after the baseline assessment. Following the 12-week assessment, children in the waitlist control condition will receive instructions for completing the intervention. Primary study outcomes include data on intervention feasibility and outcomes (child appraisals, coping, PTSS and health-related quality of life). Results will provide data on the feasibility of the implementation of the Coping Coach intervention and study procedures as well as estimations of efficacy to determine sample size for a larger study. Potential strengths and limitations of this design are discussed.

Using a web-based game to prevent posttraumatic stress in children following medical events: design of a randomized controlled trial

PubMed Central

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

2013-01-01

Background Medical events including acute illness and injury are among the most common potentially traumatic experiences for children. Despite the scope of the problem, only limited resources are available for prevention of posttraumatic stress symptoms (PTSS) after pediatric medical events. Web-based programs provide a low-cost, accessible means to reach a wide range of families and show promise in related areas of child mental health. Objectives To describe the design of a randomized controlled trial that will evaluate feasibility and estimate preliminary efficacy of Coping Coach, a web-based preventive intervention to prevent or reduce PTSS after acute pediatric medical events. Method Seventy children and their parents will be randomly assigned to either an intervention or a waitlist control condition. Inclusion criteria require that children are aged 8–12 years, have experienced a medical event, have access to Internet and telephone, and have sufficient competency in the English language to complete measures and understand the intervention. Participants will complete baseline measures and will then be randomized to the intervention or waitlist control condition. Children in the intervention condition will complete module 1 (Feelings Identification) in the hospital and will be instructed on how to complete modules 2 (Appraisals) and 3 (Avoidance) online. Follow-up assessments will be conducted via telephone at 6, 12, and 18 weeks after the baseline assessment. Following the 12-week assessment, children in the waitlist control condition will receive instructions for completing the intervention. Results Primary study outcomes include data on intervention feasibility and outcomes (child appraisals, coping, PTSS and health-related quality of life). Discussion Results will provide data on the feasibility of the implementation of the Coping Coach intervention and study procedures as well as estimations of efficacy to determine sample size for a larger study. Potential strengths and limitations of this design are discussed. PMID:23898396

Effects of Promotion and Compunction Interventions on Real Intergroup Interactions: Promotion Helps but High Compunction Hurts

PubMed Central

Greenland, Katy; Xenias, Dimitrios; Maio, Gregory R.

2017-01-01

HIGHLIGHTS  We show the promotion intervention has positive effects during intergroup contact, but that high levels of compunction can have negative effects. Intergroup contact is probably the longest standing and most comprehensively researched intervention to reduce discrimination. It is also part of ordinary social experience, and a key context in which discrimination is played out. In this paper, we explore two additional interventions which are also designed to reduce discrimination, but which have not yet been applied to real intergroup interactions. The promotion intervention encourages participants to relax and enjoy an interaction, while the compunction intervention motivates participants to avoid discrimination. Across two studies, we tested the separate effects of promotion (Study 1) and then compunction (Study 2) on participants' interactions with a confederate whom they believed to have a history of schizophrenia. In Study 1, participants received either a promotion intervention to “relax and have an enjoyable dialogue” or no intervention (control; n = 67). In Study 2, participants completed a Single-Category Implicit Attitude Test before being told that they were high in prejudice (high compunction condition) or low in prejudice (low compunction condition; n = 62). Results indicated that promotion was associated with broadly positive effects: participants reported more positive experience of the interaction (enjoyment and interest in a future interaction), and more positive evaluations of their contact partner (increased friendliness and reduced stereotyping). There were no effects on participants' reported intergroup anxiety. In contrast, high compunction had broadly negative effects: participants reported more negative experiences of the interaction and more negative evaluations of their contact partner (using the same dependent measures outlined above). In addition, participants in the high compunction condition reported increased intergroup anxiety and increased self-anxiety (anxiety around thinking or doing something that is prejudiced). Participants in the high compunction condition also reported reduced expectancies of self-efficacy (i.e., they were less confident that they would be able to make a good impression). PMID:28439248

Online peer support interventions for chronic conditions: a scoping review protocol.

PubMed

Munce, Sarah Elizabeth Patricia; Shepherd, John; Perrier, Laure; Allin, Sonya; Sweet, Shane N; Tomasone, Jennifer R; Nelson, Michelle L A; Guilcher, Sara J T; Hossain, Saima; Jaglal, Susan

2017-09-24

Peer support is receiving increasing attention as both an effective and cost-effective intervention method to support the self-management of chronic health conditions. Given that an increasing proportion of Canadians have internet access and the increasing implementation of web-based interventions, online peer support interventions are a promising option to address the burden of chronic diseases. Thus, the specific research question of this scoping review is the following: What is known from the existing literature about the key characteristics of online peer support interventions for adults with chronic conditions? METHODS AND ANALYSIS: We will use the methodological frameworks used by Arksey and O'Malley as well as Levac and colleagues for the current scoping review. To be eligible for inclusion, studies must report on adults (≥18 years of age) with one of the Public Health Agency of Canada chronic conditions or HIV/AIDS. We will limit our review to peer support interventions delivered through online formats. All study designs will be included. Only studies published from 2012 onwards will be included to ensure relevance to the current healthcare context and feasibility. Furthermore, only English language studies will be included. Studies will be identified by searching a variety of databases. Two reviewers will independently screen the titles and abstracts identified by the literature search for inclusion (ie, level 1 screening), the full text articles (ie, level 2 screening) and then perform data abstraction. Abstracted data will include study characteristics, participant population, key characteristics of the intervention and outcomes collected. This review will identify the key features of online peer support interventions and could assist in the future development of other online peer support programmes so that effective and sustainable programmes can be developed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effects of Promotion and Compunction Interventions on Real Intergroup Interactions: Promotion Helps but High Compunction Hurts.

PubMed

Greenland, Katy; Xenias, Dimitrios; Maio, Gregory R

2017-01-01

HIGHLIGHTS   We show the promotion intervention has positive effects during intergroup contact, but that high levels of compunction can have negative effects. Intergroup contact is probably the longest standing and most comprehensively researched intervention to reduce discrimination. It is also part of ordinary social experience, and a key context in which discrimination is played out. In this paper, we explore two additional interventions which are also designed to reduce discrimination, but which have not yet been applied to real intergroup interactions. The promotion intervention encourages participants to relax and enjoy an interaction, while the compunction intervention motivates participants to avoid discrimination. Across two studies, we tested the separate effects of promotion (Study 1) and then compunction (Study 2) on participants' interactions with a confederate whom they believed to have a history of schizophrenia. In Study 1, participants received either a promotion intervention to "relax and have an enjoyable dialogue" or no intervention (control; n = 67). In Study 2, participants completed a Single-Category Implicit Attitude Test before being told that they were high in prejudice (high compunction condition) or low in prejudice (low compunction condition; n = 62). Results indicated that promotion was associated with broadly positive effects: participants reported more positive experience of the interaction (enjoyment and interest in a future interaction), and more positive evaluations of their contact partner (increased friendliness and reduced stereotyping). There were no effects on participants' reported intergroup anxiety. In contrast, high compunction had broadly negative effects: participants reported more negative experiences of the interaction and more negative evaluations of their contact partner (using the same dependent measures outlined above). In addition, participants in the high compunction condition reported increased intergroup anxiety and increased self-anxiety (anxiety around thinking or doing something that is prejudiced). Participants in the high compunction condition also reported reduced expectancies of self-efficacy (i.e., they were less confident that they would be able to make a good impression).

Cognitive-Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis.

PubMed

Smitherman, Todd A; Kuka, Alexander J; Calhoun, Anne H; Walters, A Brooke Pellegrino; Davis-Martin, Rachel E; Ambrose, Carrie E; Rains, Jeanetta C; Houle, Timothy T

2018-05-06

Insomnia is frequently comorbid with chronic migraine, and small trials suggest that cognitive-behavioral treatment of insomnia (CBTi) may reduce migraine frequency. This study endeavored to provide a quantitative synthesis of existing CBTi trials for adults with chronic migraine using Bayesian statistical methods, given their utility in combining prior knowledge with sequentially gathered data. Completer analyses of 2 randomized trials comparing CBTi to a sham control intervention (Calhoun and Ford, 2007; Smitherman et al, 2016) were used to quantify the effects of a brief course of treatment on headache frequency. Change in headache frequency from baseline to the primary endpoint (6-8 weeks posttreatment) was regressed on group status using a Gaussian linear model with each study specified in the order of completion. To estimate the combined effect, posterior distributions from the Calhoun and Ford study were used as informative priors for conditioning on the Smitherman et al data. In a combined analysis of these prior studies, monthly headache frequency of the treatment group decreased by 6.2 days (95%CrI: -9.7 to -2.7) more than the control group, supporting an interpretation that there is a 97.5% chance that the treatment intervention is at least 2.7 days better than the control intervention. The analysis supports the hypothesis that at least for those who complete treatment, there is high probability that individuals who receive CBTi experience greater headache reduction than those who receive a control intervention equated for therapist time and out-of-session skills practice. Cognitive-behavioral interventions for comorbid insomnia hold promise for reducing headache frequency among those with chronic migraine. These findings add to a small but growing body of literature that migraineurs with comorbid conditions often respond well to behavioral interventions, and that targeting comorbidities may improve migraine itself. © 2018 American Headache Society.

Moms in motion: a group-mediated cognitive-behavioral physical activity intervention.

PubMed

Cramp, Anita G; Brawley, Lawrence R

2006-08-22

When examining the prevalence of physical inactivity by gender and age, women over the age of 25 are at an increased risk for sedentary behavior. Childbearing and motherhood have been explored as one possible explanation for this increased risk. Post natal exercise studies to date demonstrate promising physical and psychological outcomes, however few physical activity interventions have been theory-driven and tailored to post natal exercise initiates. The purpose of this study was to compare the effects of a group-mediated cognitive behavioral intervention based upon social-cognitive theory and group dynamics (GMCB) to a standard care postnatal exercise program (SE). A randomized, two-arm intervention design was used. Fifty-seven post natal women were randomized to one of two conditions: (1) a standard exercise treatment (SE) and (2) a standard exercise treatment plus group-mediated cognitive behavioral intervention (GMCB). Participants in both conditions participated in a four-week intensive phase where participants received standard exercise training. In addition, GMCB participants received self-regulatory behavioral skills training via six group-mediated counseling sessions. Following the intensive phase, participants engaged in a four-week home-based phase of self-structured exercise. Measures of physical activity, barrier efficacy, and proximal outcome expectations were administered and data were analyzed using ANCOVA procedures. ANCOVA of change scores for frequency, minutes, and volume of physical activity revealed significant treatment effects over the intensive and home-based phases (p's < 0.01). In addition, ANCOVA of change in mean barrier efficacy and proximal outcome expectations at the conclusion of the intensive phase demonstrated that GMCB participants increased their initial level of barrier efficacy and outcome expectations while SE participants decreased (p < 0.05). While both exercise programs resulted in improvements to exercise participation, the GMCB intervention produced greater improvement in overall physical activity, barrier efficacy and proximal outcome expectations.

Receipt of HIV/STD prevention counseling by HIV-infected adults receiving medical care in the United States.

PubMed

Mizuno, Yuko; Zhu, Julia; Crepaz, Nicole; Beer, Linda; Purcell, David W; Johnson, Christopher H; Valverde, Eduardo E; Skarbinski, Jacek

2014-01-28

Guidelines recommend risk-reduction counseling by HIV providers to all HIV-infected persons. Among HIV-infected adults receiving medical care in the United States, we estimated prevalence of exposure to three types of HIV/sexually transmitted disease (STD) risk-reduction interventions and described the characteristics of persons who received these interventions. Data were from the Medical Monitoring Project (MMP), a supplemental HIV surveillance system designed to produce nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States. Descriptive analyses were conducted to estimate the exposure to each type of HIV/STD risk-reduction intervention. Bivariate and multivariable analyses were conducted to assess associations between the selected correlates with each exposure variable. About 44% of participants reported a one-on-one conversation with a healthcare provider about HIV/STD prevention, 30% with a prevention program worker, 16% reported participation in a small group risk-reduction intervention, and 52% reported receiving at least one of the three interventions in the past 12 months. Minority race/ethnicity, low income, and risky sexual behavior consistently predicted greater intervention exposure. However, 39% of persons who reported risky sex did not receive any HIV/STD risk-reduction interventions. HIV-infected persons in care with fewer resources or those who engaged in risk behaviors were more likely to receive HIV/STD risk-reduction interventions. However, less than half of HIV-infected persons in care received HIV/STD prevention counseling from their provider, an intervention that has been shown to be effective and is supported by guidelines.

[A group cognitive behavioral intervention for people registered in supported employment programs: CBT-SE].

PubMed

Lecomte, T; Corbière, M; Lysaker, P H

2014-06-01

Supported employment programs are highly effective in helping people with severe mental illness obtain competitive jobs quickly. However, job tenure is often a problem for many. Of the various obstacles to job tenure documented, dysfunctional beliefs regarding the workplace and one's own abilities has been proposed as a therapeutic target. The purpose of this article is threefold: (1) to describe the development and the content of a novel group cognitive behavioral intervention designed to increase job tenure for people receiving supported employment services; (2) to present the feasibility and acceptability of the intervention; and (3) to investigate some preliminary data regarding employment outcomes. A group CBT intervention offered during 8 sessions over the course of one month, in order to respect the rapid job search principle of IPS (individual placement and support), was developed. The content was tailored to facilitate the learning of skills specific to the workplace, such as recognizing and managing one's stressors at work, determining and modifying dysfunctional thoughts (e.g. not jumping to conclusions, finding alternatives, seeking facts), overcoming obstacles (e.g. problem solving), improving one's self-esteem as a worker (recognizing strengths and qualities), dealing with criticism, using positive assertiveness, finding coping strategies (for symptoms and stress) to use at work, negotiating work accommodations and overcoming stigma. A trial is currently underway, with half the participants receiving supported employment as well as CBT-SE and the other half receiving only supported employment. A subsample of the first 24 participants having completed the 12-month follow-up were used for the analyses, including 12 having received at least 3 sessions out of the 8 group sessions and 12 receiving only supported employment. Feasibility and acceptability were determined by the group therapists' feedback, the participants' feedback as well as attendance to group sessions. The work outcomes looked at with the preliminary sample only included the 12-month follow-up and involved: obtaining a competitive job, number of hours worked per week as well as number of weeks worked at the same job (>24hours). In terms of feasibility and acceptability, therapists and participants all mentioned appreciating the group, finding it useful and helpful, some even mentioning feeling grateful to have had the opportunity to receive the intervention. The only negative feedback received pertained to the frequency of the meetings, which could be brought down to one meeting per week of two hours instead of two one-hour sessions per week. Participation was very good, with the average number of sessions attended being of 6/8. In terms of work outcomes, 50 % of all participants in both conditions found competitive work. Out of those working competitively, the number of participants working more than 24hours per week at the 12-month follow-up was higher in the CBT-SE group compared to the control condition (75 % vs. 50 %). Similarly, there was a trend towards the number of consecutive weeks worked at the same job being slightly superior at the 12-month follow-up for those who had received the CBT-SE intervention (22.5 weeks vs. 18.3 weeks). The preliminary results support previous studies where on average 50 % of people registered in supported employment programs obtain competitive work. We confirmed that the intervention was feasible and acceptable. Preliminary data suggest that the CBT-SE intervention might help people with severe mental illness use skills and gain the needed confidence enabling them to work longer hours and consecutive weeks. These results should be considered with caution given that only 24 participants were looked at whereas the final sample size will be of 160 participants. Nonetheless, these preliminary results are promising. Furthermore, additional information regarding the impact of the CBT-SE intervention on the capacity to overcome obstacles at work, self-esteem as a worker, as well as other work-related variables have been collected but have not been investigated here. Once the study is completed, the results should enlighten us regarding the usefulness of offering CBT-SE not only in terms of work outcomes but also in improving various psychosocial domains linked to workplace satisfaction. Copyright © 2014. Published by Elsevier Masson SAS.

The effect of educational interventions with siblings of hospitalized children.

PubMed

Gursky, Barbara

2007-10-01

Research has demonstrated that siblings of chronically ill children can experience significant emotional and behavior changes; however, few studies have looked at the specific impact of pediatric hospitalization on the nonhospitalized child. Studies also indicate that children who receive age-appropriate information are better equipped to handle the stress and anxiety often associated with hospitalization.This study explored whether siblings of hospitalized children who received educational interventions had lower anxiety levels compared to siblings who did not receive interventions. A pretest-posttest experimental design was used with 50 subjects, ages 6-17 years, recruited from a children's hospital within a university medical center. Subjects were matched according to age, sex, and race, with 25 siblings each in the experimental and control groups. Siblings assigned to the experimental group received interventions from a standardized educational intervention protocol developed by the researcher. Interventions focused on teaching the sibling about hospitalization, illness or injury, and treatment for the patient, based on cognitive stages of development. All interventions were conducted by child life specialists on staff at the hospital with extensive training and experience in preparation and procedural teaching. Results shows that siblings who received educational interventions had significantly lower anxiety levels after interventions, compared to siblings who did not receive interventions. These findings have significant impact on children's health care and supporting family needs when a child is hospitalized.

An online social network to increase walking in dog owners: a randomized trial.

PubMed

Schneider, Kristin L; Murphy, Deirdra; Ferrara, Cynthia; Oleski, Jessica; Panza, Emily; Savage, Clara; Gada, Kimberly; Bozzella, Brianne; Olendzki, Effie; Kern, Daniel; Lemon, Stephenie C

2015-03-01

Encouraging dog walking may increase physical activity in dog owners. This cluster-randomized controlled trial investigated whether a social networking Web site (Meetup™) could be used to deliver a multicomponent dog walking intervention to increase physical activity. Sedentary dog owners (n = 102) participated. Eight neighborhoods were randomly assigned to the Meetup™ condition (Meetup™) or a condition where participants received monthly e-mails with content from the American Heart Association regarding increasing physical activity. The Meetup™ intervention was delivered over 6 months and consisted of newsletters, dog walks, community events, and an activity monitor. The primary outcome was steps; secondary outcomes included social support for walking, sense of community, perceived dog walking outcomes, barriers to dog walking, and feasibility of the intervention. Mixed-model analyses examined change from baseline to postintervention (6 months) and whether change in outcomes differed by condition. Daily steps increased over time (P = 0.04, d = 0.28), with no differences by condition. The time-condition interaction was significant for the perceived outcomes of dog walking (P = 0.04, d = 0.40), such that the Meetup™ condition reported an increase in the perceived positive outcomes of dog walking, whereas the American Heart Association condition did not. Social support, sense of community, and dog walking barriers did not significantly change. Meetup™ logins averaged 58.38 per week (SD, 11.62). Within 2 months of the intervention ending, organization of the Meetup™ groups transitioned from the study staff to Meetup™ members. Results suggest that a Meetup™ group is feasible for increasing physical activity in dog owners. Further research is needed to understand how to increase participation in the Meetup™ group and facilitate greater connection among dog owners.

Effect of Chlorella Ingestion on Oxidative Stress and Fatigue Symptoms in Healthy Men.

PubMed

Okada, Hirotaka; Yoshida, Noriko; Kakuma, Tatsuyuki; Toyomasu, Kouji

2018-05-21

We examined the effects of dietary chlorella ingestion on oxidative stress and fatigue symptoms in healthy men under resting and fatigue conditions. We conducted a double-blind, parallel-arm controlled study. Twenty-seven healthy male volunteers (mean age, 35.4±10.4 years) were randomly divided into the chlorella and placebo groups, and received chlorella (6 g/day) and lactose as placebo (7.2 g/day), respectively, for 4 weeks. To simulate mild fatigue, subjects underwent exercise (40% of the heart rate reserve) for 30 minutes. Fatigue was measured using the visual analog scale of fatigue (F-VAS) pre- and post-exercise. Serum antioxidant capacity (AC), malondialdehyde levels, and other indices of oxidative stress were measured pre- and post-exercise. All measurements were repeated after the intervention period and the results were compared with baseline measurements. Under resting conditions, AC significantly increased after the intervention period in the chlorella group, but not in the placebo group. Malondialdehyde levels after the intervention period were significantly lower in the chlorella group than in the placebo group. There were no significant differences in any of the oxidative-stress indices measured pre- and post-exercise, either before or after intervention, in either group. F-VAS significantly increased after exercise at all measurement time-points in both groups, except after the intervention period in the chlorella group. Under fatigue conditions, there were no significant differences in oxidative stress indices between the groups. Our results suggest that chlorella ingestion has the potential to relieve oxidative stress and enhance tolerance for fatigue under resting conditions.

Does occasional cannabis use impact anxiety and depression treatment outcomes?: Results from a randomized effectiveness trial.

PubMed

Bricker, Jonathan B; Russo, Joan; Stein, Murray B; Sherbourne, Cathy; Craske, Michelle; Schraufnagel, Trevor J; Roy-Byrne, Peter

2007-01-01

This study investigated the extent to which occasional cannabis use moderated anxiety and depression outcomes in the Collaborative Care for Anxiety and Panic (CCAP) study, a combined cognitive-behavioral therapy (CBT) and pharmacotherapy randomized effectiveness trial. Participants were 232 adults from six university-based primary care outpatient clinics in three West Coast cities randomized to receive either the CCAP intervention or the usual care condition. Results showed significant (P<.01) evidence of an interaction between treatment group (CCAP vs. usual care) and cannabis use status (monthly vs. less than monthly) for depressive symptoms, but not for panic disorder or social phobia symptoms (all P>.05). Monthly cannabis users' depressive symptoms improved in the CCAP intervention just as much as those who used cannabis less than monthly, whereas monthly users receiving usual care had significantly more depressive symptoms than those using less than monthly. A combined CBT and medication treatment intervention may be a promising approach for the treatment of depression among occasional cannabis users. (c) 2006 Wiley-Liss, Inc.

Importance of intervening in the preconception period to impact pregnancy outcomes.

PubMed

Dean, Sohni V; Imam, Ayesha M; Lassi, Zohra S; Bhutta, Zulfiqar A

2013-01-01

Preconception care that begins in adolescence and is provided before and between pregnancies has the potential to impact 136 million women who give birth each year and ensure that newborns receive the healthiest start possible. Providing simple interventions before pregnancy can prevent a significant proportion of maternal and neonatal mortality and morbidity. Interventions to promote adolescent health and prevent teenage pregnancies, encourage contraceptive use and appropriate birth spacing, optimize weight and micronutrient status, and screen for and manage chronic conditions have proven efficacy. These interventions must now be scaled up to maximize delivery. Women who receive preconception care are more likely to adopt healthy behaviors, and therefore have better pregnancy outcomes. Preconception care is particularly effective when men are involved and care is provided in the community setting. All healthcare providers can and should begin to provide preconception care to all adolescent girls, women and couples of reproductive age by asking them if they wish to become pregnant or are actively trying to prevent pregnancy. Copyright © 2013 Nestec Ltd., Vevey/S. Karger AG, Basel.

Long-term effects of food supplementation and psychosocial intervention on the physical growth of Colombian infants at risk of malnutrition.

PubMed

Super, C M; Herrera, M G; Mora, J O

1990-02-01

280 Colombian infants at risk of malnutrition were randomly assigned to 1 of 4 experimental groups formed by the presence/absence of 2 interventions: (1) food supplementation for the entire family, from mid-pregnancy until the target child was 3 years old, and (2) a twice-weekly home-visiting program to promote cognitive development, from birth until age 3. All families received free medical care and were studied prospectively. At 3 years of age, children who had received food supplementation averaged 2.6 cm and 642 grams larger than controls. Home visiting and supplementation together reduced the number of children with severe growth retardation. 3 years after intervention (age 6), supplementation effects remained. Children in the home visit condition had become larger than controls, by 1.7 cm and 448 grams. The interactive effect to reduce stunting was marginally significant at this age, and the overall distribution of scores was improved. Other results suggest that changes in family functioning as well as biological mechanisms account for the observed pattern of results.

Positive psychology interventions for patients with heart disease: a preliminary randomized trial

PubMed Central

Nikrahan, Gholam Reza; Suarez, Laura; Asgari, Karim; Beach, Scott R.; Celano, Christopher M.; Kalantari, Mehrdad; Abedi, Mohammad Reza; Etesampour, Ali; Abbas, Rezaei; Huffman, Jeff C.

2016-01-01

Objective Positive psychological characteristics have been linked to superior cardiac outcomes. Accordingly, in this exploratory study, we assessed positive psychology interventions in patients who had recently undergone a procedure to treat cardiovascular disease. Method Participants were randomly assigned to receive one of three different six-week face-to-face interventions or a wait-list control condition. We assessed intervention feasibility and compared changes in psychological outcome measures post-intervention (7 weeks) and at follow-up (15 weeks) between intervention and control participants. Across the interventions, 74% of assigned sessions were completed. Results When comparing outcomes between interventions and control participants (N=55 total), there were no between-group differences post-intervention, but at follow-up intervention participants had greater improvements in happiness (β=14.43, 95% confidence interval [CI]=8.66–20.2, p<.001), depression (β=−3.87, 95% CI=−7.72 to 0.02, p=.049), and hope (β=7.12, 95% CI=1.25–13.00, p=.017), with moderate-large effect sizes. Efficacy of the three interventions was similar. Conclusions Future studies are needed to identify an optimal positive psychology intervention for cardiac patients. PMID:27137709

Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant.

PubMed

Waterman, Amy D; Robbins, Mark L; Paiva, Andrea L; Peipert, John D; Kynard-Amerson, Crystal S; Goalby, Christina J; Davis, LaShara A; Thein, Jessica L; Schenk, Emily A; Baldwin, Kari A; Skelton, Stacy L; Amoyal, Nicole R; Brick, Leslie A

2014-10-14

Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients' knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention. Nine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients' transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach. At the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings. ClinicalTrials.gov, number NCT02181114.

Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients.

PubMed

Wåhlin, Charlotte; Ekberg, Kerstin; Persson, Jan; Bernfort, Lars; Öberg, Birgitta

2013-03-01

To describe the types of intervention offered, to investigate the relationship between the type of intervention given, patient-reported usefulness of interventions and the effect on self-reported work ability in a cohort of sick-listed patients with musculoskeletal disorders (MSD) or mental disorders (MD). A prospective cohort study was performed including 810 newly sick-listed patients (MSD 62 % and MD 38 %). The baseline questionnaire included sociodemographic characteristics and measures of work ability. The 3-month follow-up questionnaire included measures of work ability, type of intervention received, and judgment of usefulness. Twenty-five percent received medical intervention modalities (MI) only, 45 % received a combination of medical and rehabilitative intervention modalities (CRI) and 31 % received work-related interventions combined with medical or rehabilitative intervention modalities (WI). Behavioural treatments were more common for patients with MD compared with MSD and exercise therapy were more common for patients with MSD. The most prevalent workplace interventions were adjustment of work tasks or the work environment. Among patients with MD, WI was found to be useful and improved work ability significantly more compared with only MI or CRI. For patients with MSD, no significant differences in improved work ability were found between interventions. Patients with MD who received a combination of work-related and clinical interventions reported best usefulness and best improvement in work ability. There was no difference in improvements in work ability between rehabilitation methods in the MSD group. There seems to be a gap between scientific evidence and praxis behaviour in the rehabilitation process. Unimodal rehabilitation was widely applied in the early rehabilitation process, a multimodal treatment approach was rare and only one-third received work-related interventions. It remains a challenge to understand who needs what type of intervention.

Lifestyle Triple P: a parenting intervention for childhood obesity.

PubMed

Gerards, Sanne M P L; Dagnelie, Pieter C; Jansen, Maria W J; van der Goot, Lidy O H M; de Vries, Nanne K; Sanders, Matthew R; Kremers, Stef P J

2012-04-03

Reversing the obesity epidemic requires the development and evaluation of childhood obesity intervention programs. Lifestyle Triple P is a parent-focused group program that addresses three topics: nutrition, physical activity, and positive parenting. Australian research has established the efficacy of Lifestyle Triple P, which aims to prevent excessive weight gain in overweight and obese children. The aim of the current randomized controlled trial is to assess the effectiveness of the Lifestyle Triple P intervention when applied to Dutch parents of overweight and obese children aged 4-8 years. This effectiveness study is called GO4fit. Parents of overweight and obese children are being randomized to either the intervention or the control group. Those assigned to the intervention condition receive the 14-week Lifestyle Triple P intervention, in which they learn a range of nutritional, physical activity and positive parenting strategies. Parents in the control group receive two brochures, web-based tailored advice, and suggestions for exercises to increase active playing at home. Measurements are taken at baseline, directly after the intervention, and at one year follow-up. Primary outcome measure is the children's body composition, operationalized as BMI z-score, waist circumference, and fat mass (biceps and triceps skinfolds). Secondary outcome measures are children's dietary behavior and physical activity level, parenting practices, parental feeding style, parenting style, parental self-efficacy, and body composition of family members (parents and siblings). Our intervention is characterized by a focus on changing general parenting styles, in addition to focusing on changing specific parenting practices, as obesity interventions typically do. Strengths of the current study are the randomized design, the long-term follow-up, and the broad range of both self-reported and objectively measured outcomes. Current Controlled Trials NTR 2555 MEC AZM/UM: NL 31988.068.10 / MEC 10-3-052.

Erythrocyte membrane fatty acids in multiple sclerosis patients and hot-nature dietary intervention with co-supplemented hemp-seed and evening-primrose oils.

PubMed

Rezapour-Firouzi, Soheila; Arefhosseini, Seyed Rafie; Ebrahimi-Mamaghani, Mehrangiz; Farhoudi, Mehdi; Baradaran, Behzad; Ali, Torbati Mohammad; Zamani, Fatemeh

2013-01-01

The risk of developing multiple sclerosis (MS) is associated with increased dietary intake of saturated fatty acids. For many years it has been suspected that this disease might be associated with an imbalance between unsaturated and saturated fatty acids. We determined erythrocyte membrane fatty acids levels in Hot nature dietary intervention with co-supplemented hemp seed and evening primrose oils in multiple sclerosis patients. To determine the erythrocyte membrane fatty acids levels and correlate it with expanded disability status scale (EDSS) at baseline after 6 months intervention in MS patients by gas chromatography, in this double blind, randomized trial, 100 RRMS patients with EDSS<6 were allocated into three groups: "Group A" that received co-supplemented hemp seed and evening primrose oils with advised Hot nature diet. "Group B" received olive oil and "Group C" received the co-supplemented oils. The results showed that the mean follow-up was 180 ± 2.9SD days (N=65, 23 M and 42 F aged 34.25 ± 8.07 years with disease duration of 6.80 ± 4.33 years). There was no significant difference in the study parameters at baseline. After 6 months, EDSS, Immunological parameters and the erythrocyte cell membrane with regard to specific fatty acids showed improvement in the group A and C, whereas there was worsening condition for the group B after the intervention. We concluded that Hot-nature dietary intervention with co-supplemented hemp seed and evening primrose oils caused an increase PUFAs in MS patients and improvement in the erythrocyte membrane fatty acids composition. This could be an indication of restored plasma stores, and a reflection of disease severity reduction.

Non-surgical treatment of hip osteoarthritis. Hip school, with or without the addition of manual therapy, in comparison to a minimal control intervention: Protocol for a three-armed randomized clinical trial

PubMed Central

2011-01-01

Background Hip osteoarthritis is a common and chronic condition resulting in pain, functional disability and reduced quality of life. In the early stages of the disease, a combination of non-pharmacological and pharmacological treatment is recommended. There is evidence from several trials that exercise therapy is effective. In addition, single trials suggest that patient education in the form of a hip school is a promising intervention and that manual therapy is superior to exercise. Methods/Design This is a randomized clinical trial. Patients with clinical and radiological hip osteoarthritis, 40-80 years of age, and without indication for hip surgery were randomized into 3 groups. The active intervention groups A and B received six weeks of hip school, taught by a physiotherapist, for a total of 5 sessions. In addition, group B received manual therapy consisting of joint manipulation and soft-tissue therapy twice a week for six weeks. Group C received a self-care information leaflet containing advice on "live as usual" and stretching exercises from the hip school. The primary time point for assessing relative effectiveness is at the end of the six weeks intervention period with follow-ups after three and 12 months. Primary outcome measure is pain measured on an eleven-point numeric rating scale. Secondary outcome measures are the hip dysfunction and osteoarthritis outcome score, patient's global perceived effect, patient specific functional scale, general quality of life and hip range of motion. Discussion To our knowledge this is the first randomized clinical trial comparing a patient education program with or without the addition of manual therapy to a minimal intervention for patients with hip osteoarthritis. Trial registration ClinicalTrials NCT01039337 PMID:21542914

Non-surgical treatment of hip osteoarthritis. Hip school, with or without the addition of manual therapy, in comparison to a minimal control intervention: protocol for a three-armed randomized clinical trial.

PubMed

Poulsen, Erik; Christensen, Henrik W; Roos, Ewa M; Vach, Werner; Overgaard, Søren; Hartvigsen, Jan

2011-05-04

Hip osteoarthritis is a common and chronic condition resulting in pain, functional disability and reduced quality of life. In the early stages of the disease, a combination of non-pharmacological and pharmacological treatment is recommended. There is evidence from several trials that exercise therapy is effective. In addition, single trials suggest that patient education in the form of a hip school is a promising intervention and that manual therapy is superior to exercise. This is a randomized clinical trial. Patients with clinical and radiological hip osteoarthritis, 40-80 years of age, and without indication for hip surgery were randomized into 3 groups. The active intervention groups A and B received six weeks of hip school, taught by a physiotherapist, for a total of 5 sessions. In addition, group B received manual therapy consisting of joint manipulation and soft-tissue therapy twice a week for six weeks. Group C received a self-care information leaflet containing advice on "live as usual" and stretching exercises from the hip school. The primary time point for assessing relative effectiveness is at the end of the six weeks intervention period with follow-ups after three and 12 months.Primary outcome measure is pain measured on an eleven-point numeric rating scale. Secondary outcome measures are the hip dysfunction and osteoarthritis outcome score, patient's global perceived effect, patient specific functional scale, general quality of life and hip range of motion. To our knowledge this is the first randomized clinical trial comparing a patient education program with or without the addition of manual therapy to a minimal intervention for patients with hip osteoarthritis. ClinicalTrials NCT01039337.

Comparing motivational, self-regulatory and habitual processes in a computer-tailored physical activity intervention in hospital employees - protocol for the PATHS randomised controlled trial.

PubMed

Kwasnicka, Dominika; Vandelanotte, Corneel; Rebar, Amanda; Gardner, Benjamin; Short, Camille; Duncan, Mitch; Crook, Dawn; Hagger, Martin S

2017-05-26

Most people do not engage in sufficient physical activity to confer health benefits and to reduce risk of chronic disease. Healthcare professionals frequently provide guidance on physical activity, but often do not meet guideline levels of physical activity themselves. The main objective of this study is to develop and test the efficacy of a tailored intervention to increase healthcare professionals' physical activity participation and quality of life, and to reduce work-related stress and absenteeism. This is the first study to compare the additive effects of three forms of a tailored intervention using different techniques from behavioural theory, which differ according to their focus on motivational, self-regulatory and/or habitual processes. Healthcare professionals (N = 192) will be recruited from four hospitals in Perth, Western Australia, via email lists, leaflets, and posters to participate in the four group randomised controlled trial. Participants will be randomised to one of four conditions: (1) education only (non-tailored information only), (2) education plus intervention components to enhance motivation, (3) education plus components to enhance motivation and self-regulation, and (4) education plus components to enhance motivation, self-regulation and habit formation. All intervention groups will receive a computer-tailored intervention administered via a web-based platform and will receive supporting text-messages containing tailored information, prompts and feedback relevant to each condition. All outcomes will be assessed at baseline, and at 3-month follow-up. The primary outcome assessed in this study is physical activity measured using activity monitors. Secondary outcomes include: quality of life, stress, anxiety, sleep, and absenteeism. Website engagement, retention, preferences and intervention fidelity will also be evaluated as well as potential mediators and moderators of intervention effect. This is the first study to examine a tailored, technology-supported intervention aiming to increase physical activity in healthcare professionals. The study will evaluate whether including additional theory-based behaviour change techniques aimed at promoting motivation, self-regulation and habit will lead to increased physical activity participation relative to information alone. The online platform developed in this study has potential to deliver efficient, scalable and personally-relevant intervention that can be translated to other occupational settings. Australian New-Zealand Clinical Trial Registry: ACTRN12616000462482, submitted 29/03/2016, prospectively registered 8/04/2016.

Patient navigation and financial incentives to promote smoking cessation in an underserved primary care population: A randomized controlled trial protocol.

PubMed

Quintiliani, Lisa M; Russinova, Zlatka L; Bloch, Philippe P; Truong, Ve; Xuan, Ziming; Pbert, Lori; Lasser, Karen E

2015-11-01

Despite the high risk of tobacco-related morbidity and mortality among low-income persons, few studies have connected low-income smokers to evidence-based treatments. We will examine a smoking cessation intervention integrated into primary care. To begin, we completed qualitative formative research to refine an intervention utilizing the services of a patient navigator trained to promote smoking cessation. Next, we will conduct a randomized controlled trial combining two interventions: patient navigation and financial incentives. The goal of the intervention is to promote smoking cessation among patients who receive primary care in a large urban safety-net hospital. Our intervention will encourage patients to utilize existing smoking cessation resources (e.g., quit lines, smoking cessation groups, discussing smoking cessation with their primary care providers). To test our intervention, we will conduct a randomized controlled trial, randomizing 352 patients to the intervention condition (patient navigation and financial incentives) or an enhanced traditional care control condition. We will perform follow-up at 6, 12, and 18 months following the start of the intervention. Evaluation of the intervention will target several implementation variables: reach (participation rate and representativeness), effectiveness (smoking cessation at 12 months [primary outcome]), unintended consequences (e.g., purchase of illicit substances with incentive money), adoption (use of intervention across primary care suites), implementation (delivery of intervention), and maintenance (smoking cessation after conclusion of intervention). Improving the implementation of smoking cessation interventions in primary care settings serving large underserved populations could have substantial public health impact, reducing cancer-related morbidity/mortality and associated health disparities. Copyright © 2015 Elsevier Inc. All rights reserved.

[The quantitative changes of bioelements (Ca, Zn, Mg, Cu, Mn) in crystalline lenses under the influence of hypodynamic stress and zinc].

PubMed

Kusleika, Saulius

2002-01-01

The aim of the study was to investigate and estimate quantitative changes of bioelements (Ca, Zn, Mg, Cu, Mn) in the lenses on the influence of hypodynamic stress and zinc (Zn). Hypodynamic stress of 48 days duration was provoked for Chinchilla rabbits (n = 20) by placing them in metal hutches. Every day (48 days) 10 rabbits, which had intervention received 0.3 mg/kg body wt. doses of Zn (in form of Zn acetate). The rabbits (n = 10) of the control group, which had no intervention were kept in vivarium conditions. Concentration of bioelements in the lenses of rabbits was detected by atomic absorption spectrophotometry 503 "Perkin-Elmer" (USA). The investigation revealed that hypodynamic stress of 48 days duration caused the increase in amount of Ca, Zn, Mn in lenses as compared with that in control rabbits and in rabbits receiving Zn. The concentration of bioelements (Ca, Zn, Mg, Cu, Mn) in lenses of rabbits receiving Zn in case of hypodynamic stress did not change significantly.

Evaluation of a Self-Management Program for Gastroesophageal Reflux Disease in China.

PubMed

Xu, Wenhong; Sun, Changxian; Lin, Zheng; Lin, Lin; Wang, Meifeng; Zhang, Hongjie; Song, Yulei

2016-01-01

Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible.

Protocol for: Sheffield Obesity Trial (SHOT): a randomised controlled trial of exercise therapy and mental health outcomes in obese adolescents [ISRCNT83888112].

PubMed

Daley, Amanda J; Copeland, Robert J; Wright, Neil P; Wales, Jerry K H

2005-10-31

While obesity is known to have many physiological consequences, the psychopathology of this condition has not featured prominently in the literature. Cross-sectional studies have indicated that obese children have increased odds of experiencing poor quality of life and mental health. However, very limited trial evidence has examined the efficacy of exercise therapy for enhancing mental health outcomes in obese children, and the Sheffield Obesity Trial (SHOT) will provide evidence of the efficacy of supervised exercise therapy in obese young people aged 11-16 years versus usual care and an attention-control intervention. SHOT is a randomised controlled trial where obese young people are randomised to receive; (1) exercise therapy, (2) attention-control intervention (involving body-conditioning exercises and games that do not involve aerobic activity), or (3) usual care. The exercise therapy and attention-control sessions will take place three times per week for eight weeks and a six-week home programme will follow this. Ninety adolescents aged between 11-16 years referred from a children's hospital for evaluation of obesity or via community advertisements will need to complete the study. Participants will be recruited according to the following criteria: (1) clinically obese and aged 11-16 years (Body Mass Index Centile > 98th UK standard) (2) no medical condition that would restrict ability to be active three times per week for eight weeks and (3) not diagnosed with insulin dependent diabetes or receiving oral steroids. Assessments of outcomes will take place at baseline, as well as four (intervention midpoint) and eight weeks (end of intervention) from baseline. Participants will be reassessed on outcome measures five and seven months from baseline. The primary endpoint is physical self-perceptions. Secondary outcomes include physical activity, self-perceptions, depression, affect, aerobic fitness and BMI.

Risk Factors for Anticipatory Grief in Family Members of Terminally Ill Veterans Receiving Palliative Care Services.

PubMed

Burke, Laurie A; Clark, Karen A; Ali, Khatidja S; Gibson, Benjamin W; Smigelsky, Melissa A; Neimeyer, Robert A

2015-01-01

Anticipatory grief is the process associated with grieving the loss of loved ones in advance of their inevitable death. Because anticipatory grief has been associated with a variety of outcomes, risk factors for this condition deserve closer consideration. Fifty-seven family members of terminally ill, hospice-eligible veterans receiving palliative care services completed measures assessing psychosocial factors and conditions. Elevated anticipatory grief was found in families characterized by relational dependency, lower education, and poor grief-specific support, who also experienced discomfort with closeness and intimacy, neuroticism, spiritual crisis, and an inability to make sense of the loss. Thus, in this sample, anticipatory grief appears to be part of a cluster of factors and associated distress that call for early monitoring and possible intervention.

A Randomized Controlled Study of a Group Intervention Program to Enhance Mental Health of Children of Illegal Migrant Workers

ERIC Educational Resources Information Center

Meir, Yael; Slone, Michelle; Levis, Mira

2014-01-01

Background: The social-ecological environment of undocumented children of migrant workers includes varying levels of risk factors. Growing up in these conditions compromises children's development on all levels. Many of these children are in need of psychotherapy, however, due to limited resources, only a few of them receive mental health aid.…

Pilot Intervention to Increase Physical Activity among Sedentary Urban Middle School Girls: A Two-Group Pretest-Posttest Quasi-Experimental Design

ERIC Educational Resources Information Center

Robbins, Lorraine B.; Pfeiffer, Karin A.; Maier, Kimberly S.; Lo, Yun-Jia; Wesolek, Stacey M.

2012-01-01

The primary purpose of the study was to determine whether girls in one school receiving nurse counseling plus an after-school physical activity club showed greater improvement in physical activity, cardiovascular fitness, and body composition than girls assigned to an attention control condition in another school (N = 69). Linear regressions…

Feasibility study design and methods for a home-based, square-stepping exercise program among older adults with multiple sclerosis: The SSE-MS project.

PubMed

Sebastião, Emerson; McAuley, Edward; Shigematsu, Ryosuke; Motl, Robert W

2017-09-01

We propose a randomized controlled trial (RCT) examining the feasibility of square-stepping exercise (SSE) delivered as a home-based program for older adults with multiple sclerosis (MS). We will assess feasibility in the four domains of process, resources, management and scientific outcomes. The trial will recruit older adults (aged 60 years and older) with mild-to-moderate MS-related disability who will be randomized into intervention or attention control conditions. Participants will complete assessments before and after completion of the conditions delivered over a 12-week period. Participants in the intervention group will have biweekly meetings with an exercise trainer in the Exercise Neuroscience Research Laboratory and receive verbal and visual instruction on step patterns for the SSE program. Participants will receive a mat for home-based practice of the step patterns, an instruction manual, and a logbook and pedometer for monitoring compliance. Compliance will be further monitored through weekly scheduled Skype calls. This feasibility study will inform future phase II and III RCTs that determine the actual efficacy and effectiveness of a home-based exercise program for older adults with MS.

A randomized controlled trial testing a social network intervention to promote physical activity among adolescents.

PubMed

van Woudenberg, Thabo J; Bevelander, Kirsten E; Burk, William J; Smit, Crystal R; Buijs, Laura; Buijzen, Moniek

2018-04-23

The current study examined the effectiveness of a social network intervention to promote physical activity among adolescents. Social network interventions utilize peer influence to change behavior by identifying the most influential individuals within social networks (i.e., influence agents), and training them to promote the target behavior. A total of 190 adolescents (46.32% boys; M age = 12.17, age range: 11-14 years) were randomly allocated to either the intervention or control condition. In the intervention condition, the most influential adolescents (based on peer nominations of classmates) in each classroom were trained to promote physical activity among their classmates. Participants received a research smartphone to complete questionnaires and an accelerometer to measure physical activity (steps per day) at baseline, and during the intervention one month later. A multilevel model tested the effectiveness of the intervention, controlling for clustering of data within participants and days. No intervention effect was observed, b = .04, SE = .10, p = .66. This was one of the first studies to test whether physical activity in adolescents could be promoted via influence agents, and the first social network intervention to use smartphones to do so. Important lessons and implications are discussed concerning the selection criterion of the influence agents, the use of smartphones in social network intervention, and the rigorous analyses used to control for confounding factors. Dutch Trial Registry (NTR): NTR6173 . Registered 5 October 2016 Study procedures were approved by the Ethics Committee of the Radboud University (ECSW2014-100614-222).

Body Image in Primary Schools: A pilot evaluation of a primary school intervention program designed by teachers to improve children's body satisfaction.

PubMed

Halliwell, Emma; Yager, Zali; Paraskeva, Nicole; Diedrichs, Phillippa C; Smith, Hilary; White, Paul

2016-12-01

Body Image in the Primary School (Hutchinson & Calland, 2011) is a body image curriculum that is widely available but has not yet been evaluated. This study evaluates a set of 6 of the 49 available lessons from this curriculum. Seventy-four girls and 70 boys aged 9-10 were recruited from four primary schools in the UK. Schools were randomly allocated into the intervention condition, where students received 6hours of body image lessons, or to lessons as normal. Body esteem was significantly higher among girls in the intervention group, compared to the control group, immediately post intervention, and at 3-month follow-up. Moreover, girls with lowest levels of body esteem at baseline reported the largest gains. Internalization was significantly lower among boys in the control group compared to the intervention group at 3-month follow-up. The pattern of results among the control group raises interesting issues for intervention evaluation. Copyright © 2016. Published by Elsevier Ltd.

An empirical assessment of implementation, adaptation, and tailoring: the evaluation of CDC's National Diffusion of VOICES/VOCES.

PubMed

Harshbarger, Camilla; Simmons, Gretchen; Coelho, Helen; Sloop, Kira; Collins, Charles

2006-08-01

The Centers for Disease Control and Prevention (CDC), through its Diffusion of Effective Behavioral Interventions (DEBI) program, trained over 260 agencies on VOICES/VOCES between August 2003 and April 2005. ORC Macro conducted interviews with agency staff 3 months after receiving VOICES/VOCES training. This article discusses the diffusion of VOICES/VOCES; agencies' adoption, adaptation, and implementation of this intervention; and needs for ongoing proactive technical assistance (TA) for agencies to successfully integrate behavioral interventions into their programs. The vastmajority of agencies implemented VOICES/VOCES with fidelity to the core elements, and agencies successfully adapted the intervention to make it more appealing to target populations. TA is needed for interventions to be successfully adapted and implemented with fidelity to the core elements, and to ensure program sustainability. More effective interventions of short duration and minimum complexity to easily match with existing resources and conditions of agency capacity among HIV prevention providers in the community are needed.

Virtual reality intervention for older women with breast cancer.

PubMed

Schneider, Susan M; Ellis, Mathew; Coombs, William T; Shonkwiler, Erin L; Folsom, Linda C

2003-06-01

This study examined the effects of a virtual reality distraction intervention on chemotherapy-related symptom distress levels in 16 women aged 50 and older. A cross-over design was used to answer the following research questions: (1) Is virtual reality an effective distraction intervention for reducing chemotherapy-related symptom distress levels in older women with breast cancer? (2) Does virtual reality have a lasting effect? Chemotherapy treatments are intensive and difficult to endure. One way to cope with chemotherapy-related symptom distress is through the use of distraction. For this study, a head-mounted display (Sony PC Glasstron PLM - S700) was used to display encompassing images and block competing stimuli during chemotherapy infusions. The Symptom Distress Scale (SDS), Revised Piper Fatigue Scale (PFS), and the State Anxiety Inventory (SAI) were used to measure symptom distress. For two matched chemotherapy treatments, one pre-test and two post-test measures were employed. Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and received no distraction intervention (control condition) during an alternate chemotherapy treatment. Analysis using paired t-tests demonstrated a significant decrease in the SAI (p = 0.10) scores immediately following chemotherapy treatments when participants used VR. No significant changes were found in SDS or PFS values. There was a consistent trend toward improved symptoms on all measures 48 h following completion of chemotherapy. Evaluation of the intervention indicated that women thought the head mounted device was easy to use, they experienced no cybersickness, and 100% would use VR again.

Positive Psychology Interventions for Patients With Heart Disease: A Preliminary Randomized Trial.

PubMed

Nikrahan, Gholam Reza; Suarez, Laura; Asgari, Karim; Beach, Scott R; Celano, Christopher M; Kalantari, Mehrdad; Abedi, Mohammad Reza; Etesampour, Ali; Abbas, Rezaei; Huffman, Jeff C

2016-01-01

Positive psychologic characteristics have been linked to superior cardiac outcomes. Accordingly, in this exploratory study, we assessed positive psychology interventions in patients who had recently undergone a procedure to treat cardiovascular disease. Participants were randomly assigned to receive 1 of 3 different 6-week face-to-face interventions or a wait-list control condition. We assessed intervention feasibility and compared changes in psychologic outcome measures postintervention (7wk) and at follow-up (15wk) between intervention and control participants. Across the interventions, 74% of assigned sessions were completed. When comparing outcomes between interventions and control participants (N = 55 total), there were no between-group differences post-intervention, but at follow-up intervention participants had greater improvements in happiness (β = 14.43, 95% CI: 8.66-20.2, p < 0.001), depression (β = -3.87, 95% CI: -7.72 to 0.02, p = 0.049), and hope (β = 7.12, 95% CI: 1.25-13.00, p =0.017), with moderate-large effect sizes. Efficacy of the 3 interventions was similar. Future studies are needed to identify an optimal positive psychology intervention for cardiac patients. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Feasibility of a Cognitive-Behavioral and Environmental Intervention for Sleep-Wake Difficulties in Community-Dwelling Cancer Patients Receiving Palliative Care.

PubMed

Bernatchez, Marie Solange; Savard, Josée; Savard, Marie-Hélène; Aubin, Michèle

2018-05-14

High rates of sleep-wake difficulties have been found in patients with cancer receiving palliative care. Pharmacotherapy is the most frequently used treatment option to manage these difficulties despite numerous adverse effects and the absence of empirical evidence of its efficacy and innocuity in palliative care. This pilot study aimed to assess the feasibility and acceptability of a cognitive-behavioral and environmental intervention (CBT-E) to improve insomnia and hypersomnolence in patients with a poor functioning level and to collect preliminary data on its effects. Six patients with cancer receiving palliative care (Eastern Cooperative Oncology Group score 2-3), who had insomnia and/or hypersomnolence, received 1 CBT-E individual session at home. They applied the strategies for 3 weeks. Patients completed the Insomnia Severity Index, the Epworth Sleepiness Scale, a daily sleep diary, and a 24-hour actigraphic recording (7 days) at pretreatment and posttreatment, in addition to a semistructured interview (posttreatment). Participants found strategies easy to apply most of the time, and none was rated as impossible to use because of their health condition. However, their adherence and satisfaction toward CBT-E were highly variable. Results on the effects of CBT-E were heterogeneous, but improvements were observed in patients with a persistent insomnia disorder. The CBT-E protocol tested among this highly selected sample was fairly well received and suggested positive outcomes in some patients, particularly those with an insomnia complaint alone. Efforts should be pursued to adapt CBT-E and develop other nonpharmacological interventions, in order to provide an alternative to pharmacotherapy for sleep-wake difficulties in this population.

Effects of a new sports companion on received social support and physical exercise: an intervention study.

PubMed

Rackow, Pamela; Scholz, Urte; Hornung, Rainer

2014-11-01

The role of social support in physical exercise is well documented. However, the majority of studies that investigate the associations between social support and physical exercise target perceived instead of received social support. Moreover, most studies investigate the effects of received social support using a descriptive correlational design. Thus, our study aimed at investigating the effects of received social support by conducting an intervention study. Participants were randomly assigned to an intervention (n = 118) or control group (n = 102). The intervention comprised regularly exercising with a new sports companion for eight weeks. To investigate the time course of physical exercise and received social support, growth curve modelling was employed. Generally, both groups were able to improve their physical exercise. However, the control group tended to decrease again during the final point of measurement. Received social support, however, decreased slightly in the control group, but remained stable in the intervention group. The intervention was suitable to sustain received social support for physical exercise across a two-month interval. Overall, these findings highlight the importance of further investigating social support for physical exercise applying an experimental approach. © 2014 The International Association of Applied Psychology.

“Everybody Brush!”: Protocol for a Parallel-Group Randomized Controlled Trial of a Family-Focused Primary Prevention Program With Distribution of Oral Hygiene Products and Education to Increase Frequency of Toothbrushing

PubMed Central

2015-01-01

Background Twice daily toothbrushing with fluoridated toothpaste is the most widely advocated preventive strategy for dental caries (tooth decay) and is recommended by professional dental associations. Not all parents, children, or adolescents follow this recommendation. This protocol describes the methods for the implementation and evaluation of a quality improvement health promotion program. Objective The objective of the study is to show a theory-informed, evidence-based program to improve twice daily toothbrushing and oral health-related quality of life that may reduce dental caries, dental treatment need, and costs. Methods The design is a parallel-group, pragmatic randomized controlled trial. Families of Medicaid-insured children and adolescents within a large dental care organization in central Oregon will participate in the trial (n=21,743). Families will be assigned to one of three groups: a test intervention, an active control, or a passive control condition. The intervention aims to address barriers and support for twice-daily toothbrushing. Families in the test condition will receive toothpaste and toothbrushes by mail for all family members every three months. In addition, they will receive education and social support to encourage toothbrushing via postcards, recorded telephone messages, and an optional participant-initiated telephone helpline. Families in the active control condition will receive the kit of supplies by mail, but no additional instructional information or telephone support. Families assigned to the passive control will be on a waiting list. The primary outcomes are restorative dental care received and, only for children younger than 36 months old at baseline, the frequency of twice-daily toothbrushing. Data will be collected through dental claims records and, for children younger than 36 months old at baseline, parent interviews and clinical exams. Results Enrollment of participants and baseline interviews have been completed. Final results are expected in early summer, 2017. Conclusions If proven effective, this simple intervention can be sustained by the dental care organization and replicated by other organizations and government. Trial Registration Trial Registration: ClinicalTrials.gov NCT02327507; http://clinicaltrials.gov/ct2/show/NCT02327507 (Archived by WebCite at http://www.webcitation.org/6YCIxJSor). PMID:26002091

Prevention of postnatal distress or depression: an evaluation of an intervention at preparation for parenthood classes.

PubMed

Matthey, Stephen; Kavanagh, David J; Howie, Pauline; Barnett, Bryanne; Charles, Margaret

2004-04-01

To determine the effectiveness of a psychosocial intervention, provided to expectant couples in routine antenatal classes, on the postpartum psychosocial adjustment of women and men. A 3*3 between subjects randomised control design was utilised. The two factors were condition and self-esteem. Preparation for Parenthood programs were randomly allocated to one of three conditions: usual service ('control'), experimental ('empathy'), or non-specific control ('baby-play'). The latter condition controlled for the non-specific effects of the intervention, these being: the provision of an extra class; asking couples to consider the early postpartum weeks; and receiving booster information after the antenatal class, and again shortly after the birth. Women and men were categorised into three levels of self-esteem, as measured antenatally: low, medium and high. 268 participants were recruited antenatally. Interview data and self-report information was collected from 202 of these women at 6 weeks postpartum, and 180 women at 6 months postpartum. The intervention consisted of a session focusing on psychosocial issues related to becoming first-time parents. Participants discussed possible postpartum concerns in separate gender groups for part of the session, and then discussed these issues with their partners. Hypothetical scenarios depicting stressful situations in the early postpartum weeks for women and men were discussed, with solutions that parents have found useful given to the participants. In the non-specific control condition, the session focused on the importance of play with a baby, with videotapes and discussion around how parents can play with infants. At 6 weeks postpartum there was a significant interaction effect between condition and self-esteem on maternal adjustment. Women with low self-esteem, who had received the intervention, were significantly better adjusted on measures of mood and sense of competence than low-self-esteem women in either of the two control conditions. There were no main or interaction effects by 6 months postpartum. The beneficial effect at 6 weeks was related to partners of these women being more aware of how the mother was feeling, and with women reporting greater satisfaction with the sharing of home and baby tasks. There were no significant main or interaction effects for men at either time point, other than men with low self-esteem reporting poorer adjustment. This brief and inexpensive intervention was effective in reducing postpartum distress in some first-time mothers at 6 weeks postpartum. The effectiveness of this intervention was related to an increased level of awareness in the men as to how their partners were experiencing the early postpartum weeks. That the effect was only evident for women who, antenatally, reported being low in self-esteem, is an important advance in our knowledge of the effectiveness of such prevention programs. No previous studies have investigated the differential effectiveness of such programs depending upon the woman's level of self-esteem, and this finding indicates that future work should measure this variable. These findings should be understood in the context that the population sampled were those attending preparation for parenthood classes, and thus different interventions will be needed for couples who do not attend such classes. This brief psychosocial intervention can be readily applied to antenatal classes routinely conducted in hospitals or the community.

Self-Administered Computer Therapy for Apraxia of Speech: Two-Period Randomized Control Trial With Crossover.

PubMed

Varley, Rosemary; Cowell, Patricia E; Dyson, Lucy; Inglis, Lesley; Roper, Abigail; Whiteside, Sandra P

2016-03-01

There is currently little evidence on effective interventions for poststroke apraxia of speech. We report outcomes of a trial of self-administered computer therapy for apraxia of speech. Effects of speech intervention on naming and repetition of treated and untreated words were compared with those of a visuospatial sham program. The study used a parallel-group, 2-period, crossover design, with participants receiving 2 interventions. Fifty participants with chronic and stable apraxia of speech were randomly allocated to 1 of 2 order conditions: speech-first condition versus sham-first condition. Period 1 design was equivalent to a randomized controlled trial. We report results for this period and profile the effect of the period 2 crossover. Period 1 results revealed significant improvement in naming and repetition only in the speech-first group. The sham-first group displayed improvement in speech production after speech intervention in period 2. Significant improvement of treated words was found in both naming and repetition, with little generalization to structurally similar and dissimilar untreated words. Speech gains were largely maintained after withdrawal of intervention. There was a significant relationship between treatment dose and response. However, average self-administered dose was modest for both groups. Future software design would benefit from incorporation of social and gaming components to boost motivation. Single-word production can be improved in chronic apraxia of speech with behavioral intervention. Self-administered computerized therapy is a promising method for delivering high-intensity speech/language rehabilitation. URL: http://orcid.org/0000-0002-1278-0601. Unique identifier: ISRCTN88245643. © 2016 American Heart Association, Inc.

Pilot test of an emotional education intervention component for sexual risk reduction.

PubMed

Ferrer, Rebecca A; Fisher, Jeffrey D; Buck, Ross; Amico, K Rivet

2011-09-01

Emotions are key predictors of sexual risk behavior but have been largely ignored in theory-based intervention development. The present study aims to evaluate whether the addition of an emotional education intervention component to a traditional social-cognitive safer sex intervention increases intervention efficacy, compared with both a social-cognitive only intervention and a no intervention control condition. Young adults were randomized in small groups to receive the social-cognitive-emotional (SCE) intervention, the social-cognitive (SC) intervention, or standard of care. Analyses of data from 176 participants indicated that intervention arms reported similar increased condom use compared with the no intervention control arm at 3 months' postintervention (β = .06, p = .41, d = 0.08). However, at 6 months' postintervention, individuals in the SCE intervention arm reported increased condom use compared with both the SC intervention (β = .27, p = .04, d = 0.38) and control arms (β = .37, p < .01; d = 0.56), demonstrating preliminary evidence that the addition of an emotional education component may facilitate sustained behavior change. An emotional education intervention module has the potential to facilitate sustained behavior change at delayed follow-up. Additional research is necessary to replicate findings in a larger sample and to determine the mediators of emotional education intervention efficacy.

Yo Puedo--a conditional cash transfer and life skills intervention to promote adolescent sexual health: results of a randomized feasibility study in san francisco.

PubMed

Minnis, Alexandra M; vanDommelen-Gonzalez, Evan; Luecke, Ellen; Dow, William; Bautista-Arredondo, Sergio; Padian, Nancy S

2014-07-01

We designed and evaluated for feasibility an intervention-Yo Puedo-that addresses social network influences and socioeconomic opportunities in a neighborhood with substantial gang exposure and early childbearing. Yo Puedo combined conditional cash transfers for completion of educational and reproductive health wellness goals with life skills sessions, and targeted youth 16-21 years of age and same-aged members of their social network. We conducted a two-arm study with social networks randomized to the intervention or a standard services control arm. We evaluated intervention uptake, adherence, and safety; and assessed evidence of effects on behavioral outcomes associated with unintended pregnancy and sexually transmitted infection risk. A total of 72 social networks composed of 162 youth enrolled, with 92% retention over 6 months. Seventy-two percent of youth randomized to the intervention participated in intervention activities: 53% received at least one conditional cash transfer payment and 66% came to at least one life skills session. We found no evidence that cash payments financed illicit or high-risk behavior. At 6 months, compared with controls, intervention participants had a lower odds of hanging out on the street frequently (odds ratio [OR], .54; p = .10) and a lower odds of reporting that their close friends had been incarcerated (OR, .6; p = .12). They reported less regular alcohol use (OR, .54; p = .04) and a lower odds of having sex (OR, .50; p = .04). The feasibility evaluation of Yo Puedo demonstrated its promise; a larger evaluation of effects on pregnancy and sustained behavioral changes is warranted. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Automated outreach to increase primary adherence to cholesterol-lowering medications.

PubMed

Derose, Stephen F; Green, Kelley; Marrett, Elizabeth; Tunceli, Kaan; Cheetham, T Craig; Chiu, Vicki Y; Harrison, Teresa N; Reynolds, Kristi; Vansomphone, Southida S; Scott, Ronald D

2013-01-14

Primary nonadherence occurs when new prescriptions are not dispensed. Little is known about how to reduce primary nonadherence. We performed a randomized controlled trial to evaluate an automated system to decrease primary nonadherence to statins for lowering cholesterol. Adult members of Kaiser Permanente Southern California with no history of statin use within the past year who did not fill a statin prescription after 1 to 2 weeks were passively enrolled. The intervention group received automated telephone calls followed 1 week later by letters for continued nonadherence; the control group received no outreach. The primary outcome was a statin dispensed up to 2 weeks after delivery of the letter. Secondary outcomes included refills at intervals up to 1 year. Intervention effectiveness was determined by intent-to-treat analysis and Fisher exact test. Subgroups were examined using logistic regression. There were 2606 participants in the intervention group and 2610 in the control group. Statins were dispensed to 42.3% of intervention participants and 26.0% of control participants (absolute difference, 16.3%; P < .001). The relative risk for the intervention vs control group was 1.63 (95% CI, 1.50-1.76). Intervention effectiveness varied slightly by age (P = .045) but was effective across all age strata. Differences in the frequency of statin dispensations persisted up to 1 year (P < .001). The intervention was effective in reducing primary nonadherence to statin medications. Because of low marginal costs for outreach, this strategy appears feasible for reducing primary nonadherence. This approach may generalize well to other medications and chronic conditions.

Modeling Dynamic Food Choice Processes to Understand Dietary Intervention Effects.

PubMed

Marcum, Christopher Steven; Goldring, Megan R; McBride, Colleen M; Persky, Susan

2018-02-17

Meal construction is largely governed by nonconscious and habit-based processes that can be represented as a collection of in dividual, micro-level food choices that eventually give rise to a final plate. Despite this, dietary behavior intervention research rarely captures these micro-level food choice processes, instead measuring outcomes at aggregated levels. This is due in part to a dearth of analytic techniques to model these dynamic time-series events. The current article addresses this limitation by applying a generalization of the relational event framework to model micro-level food choice behavior following an educational intervention. Relational event modeling was used to model the food choices that 221 mothers made for their child following receipt of an information-based intervention. Participants were randomized to receive either (a) control information; (b) childhood obesity risk information; (c) childhood obesity risk information plus a personalized family history-based risk estimate for their child. Participants then made food choices for their child in a virtual reality-based food buffet simulation. Micro-level aspects of the built environment, such as the ordering of each food in the buffet, were influential. Other dynamic processes such as choice inertia also influenced food selection. Among participants receiving the strongest intervention condition, choice inertia decreased and the overall rate of food selection increased. Modeling food selection processes can elucidate the points at which interventions exert their influence. Researchers can leverage these findings to gain insight into nonconscious and uncontrollable aspects of food selection that influence dietary outcomes, which can ultimately improve the design of dietary interventions.

Two-year follow-up of an adolescent behavioral weight control intervention.

PubMed

Lloyd-Richardson, Elizabeth E; Jelalian, Elissa; Sato, Amy F; Hart, Chantelle N; Mehlenbeck, Robyn; Wing, Rena R

2012-08-01

This study examined the 24-month outcomes of a randomized controlled trial of a group-based behavioral weight control (BWC) program combined with either activity-based peer intervention or aerobic exercise. At baseline, 118 obese adolescents (68% female; BMI = 31.41 ± 3.33) ages 13 to 16 years (mean = 14.33; SD = 1.02) were randomized to receive 1 of 2 weight loss interventions. Both interventions received the same 16-week group-based cognitive-behavioral treatment, combined with either aerobic exercise or peer-based adventure therapy. Eighty-nine adolescents (75% of original sample) completed the 24-month follow-up. Anthropometric and psychosocial measures were obtained at baseline, at the end of the 16-week intervention, and at 12 and 24 months following randomization. An intent-to-treat mixed factor analysis of variance indicated a significant effect for time on both percent over 50th percentile BMI for age and gender and standardized BMI score, with no differences by intervention group. Post hoc comparisons showed a significant decrease in percent overweight at 4 months (end of treatment), which was maintained at both 12- and 24-month follow-up visits. Significant improvements on several dimensions of self-concept were noted, with significant effects on physical appearance self-concept that were maintained through 24 months. Both BWC conditions were effective at maintaining reductions in adolescent obesity and improvements in physical appearance self-concept through 24-month follow-up. This study is one of the first to document long-term outcomes of BWC intervention among adolescents.

School-based intervention for childhood disruptive behavior in disadvantaged settings: a randomized controlled trial with and without active teacher support.

PubMed

Liber, Juliette M; De Boo, Gerly M; Huizenga, Hilde; Prins, Pier J M

2013-12-01

In this randomized controlled trial, we investigated the effectiveness of a school-based targeted intervention program for disruptive behavior. A child-focused cognitive behavioral therapy (CBT) program was introduced at schools in disadvantaged settings and with active teacher support (ATS) versus educational teacher support (ETS) (CBT + ATS vs. CBT + ETS). Screening (n = 1,929) and assessment (n = 224) led to the inclusion of 173 children ages 8-12 years from 17 elementary schools. Most of the children were boys (n = 136, 79%) of low or low-to-middle class socioeconomic status (87%); the sample was ethnically diverse (63% of non-Western origin). Children received CBT + ATS (n = 29) or CBT + ETS (n = 41) or were entered into a waitlist control condition (n = 103) to be treated afterward (CBT + ATS, n = 39, and CBT + ETS, n = 64). Effect sizes (ES), clinical significance (reliable change), and the results of multilevel modeling are reported. Ninety-seven percent of children completed treatment. Teachers and parents reported positive posttreatment effects (mean ES = .31) for CBT compared with the waitlist control condition on disruptive behavior. Multilevel modeling showed similar results. Clinical significance was modest. Changes had remained stable or had increased at 3-months follow-up (mean ES = .39). No consistent effect of teacher condition was found at posttreatment; however, at follow-up, children who received ETS fared significantly better. This study shows that a school-based CBT program is beneficial for difficult-to-reach children with disruptive behavior: The completion rate was remarkably high, ESs (mean ES = .31) matched those of previous studies with targeted intervention, and effects were maintained or had increased at follow-up.

Alcohol Interventions Among Underage Drinkers in the ED: A Randomized Controlled Trial.

PubMed

Cunningham, Rebecca M; Chermack, Stephen T; Ehrlich, Peter F; Carter, Patrick M; Booth, Brenda M; Blow, Frederic C; Barry, Kristen L; Walton, Maureen A

2015-10-01

This study examined the efficacy of emergency department (ED)-based brief interventions (BIs), delivered by a computer or therapist, with and without a post-ED session, on alcohol consumption and consequences over 12 months. Patients (ages 14-20 years) screening positive for risky drinking were randomized to: BI (n = 277), therapist BI (n = 278), or control (n = 281). After the 3-month follow-up, participants were randomized to receive a post-ED BI session or control. Incorporating motivational interviewing, the BIs addressed alcohol consumption and consequences, including driving under the influence (DUI), and alcohol-related injury, as well as other concomitant drug use. The computer BI was an offline, Facebook-styled program. Among 4389 patients screened, 1054 patients reported risky drinking and 836 were enrolled in the randomized controlled trial. Regression models examined the main effects of the intervention conditions (versus control) and the interaction effects (ED condition × post-ED condition) on primary outcomes. The therapist and computer BIs significantly reduced consumption at 3 months, consequences at 3 and 12 months, and prescription drug use at 12 months; the computer BI reduced the frequency of DUI at 12 months; and the therapist BI reduced the frequency of alcohol-related injury at 12 months. The post-ED session reduced alcohol consequences at 6 months, benefiting those who had not received a BI in the ED. A single-session BI, delivered by a computer or therapist in the ED, shows promise for underage drinkers. Findings for the fully automated stand-alone computer BI are particularly appealing given the ease of future implementation. Copyright © 2015 by the American Academy of Pediatrics.

Comparing four service delivery models for adolescent girls and young women through the 'Girl Power' study: protocol for a multisite quasi-experimental cohort study.

PubMed

Rosenberg, Nora E; Pettifor, Audrey E; Myers, Laura; Phanga, Twambilile; Marcus, Rebecca; Bhushan, Nivedita Latha; Madlingozi, Nomtha; Vansia, Dhrutika; Masters, Avril; Maseko, Bertha; Mtwisha, Lulu; Kachigamba, Annie; Tang, Jennifer; Hosseinipour, Mina C; Bekker, Linda-Gail

2017-12-14

In sub-Saharan Africa, adolescent girls and young women (AGYW) face a range of sexual and reproductive health (SRH) challenges. Clinical, behavioural and structural interventions have each reduced these risks and improved health outcomes. However, combinations of these interventions have not been compared with each other or with no intervention at all. The 'Girl Power' study is designed to systematically make these comparisons. Four comparable health facilities in Malawi and South Africa (n=8) were selected and assigned to one of the following models of care: (1) Standard of care : AGYW can receive family planning, HIV testing and counselling (HTC), and sexually transmitted infection (STI) syndromic management in three separate locations with three separate queues with the general population. No youth-friendly spaces, clinical modifications or trainings are offered, (2) Youth-Friendly Health Services (YFHS) : AGYW are meant to receive integrated family planning, HTC and STI services in dedicated youth spaces with youth-friendly modifications and providers trained in YFHS, (3) YFHS+behavioural intervention (BI) : In addition to YFHS, AGYW can attend 12 monthly theory-driven, facilitator-led, interactive sessions on health, finance and relationships, (4) YFHS+BI+conditional cash transfer (CCT) : in addition to YFHS and BI, AGYW receive up to 12 CCTs conditional on monthly BI session attendance.At each clinic, 250 AGYW 15-24 years old (n=2000 total) will be consented, enrolled and followed for 1 year. Each participant will complete a behavioural survey at enrolment, 6 months and 12 months . All clinical, behavioural and CCT services will be captured. Outcomes of interest include uptake of each package element and reduction in HIV risk behaviours. A qualitative substudy will be conducted. This study has received ethical approval from the University of North Carolina Institutional Review Board, the University of Cape Town Human Research Ethics Committee and Malawi's National Health Sciences Research Committee. Study plans, processes and findings will be disseminated to stakeholders, in peer-reviewed journals and at conferences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Alcohol-related and mental health care for patients with unhealthy alcohol use and posttraumatic stress disorder in a National Veterans Affairs cohort.

PubMed

Chen, Jessica A; Owens, Mandy D; Browne, Kendall C; Williams, Emily C

2018-02-01

Unhealthy alcohol use and posttraumatic stress disorder (PTSD) frequently co-occur. Patients with both conditions have poorer functioning and worse treatment adherence compared to those with either condition alone. Therefore, it is possible that PTSD, when co-occurring with unhealthy alcohol use, may influence receipt of evidence-based alcohol-related care and mental health care. We evaluated receipt of interventions for unhealthy alcohol use and receipt of mental health follow-up care among patients screening positive for unhealthy alcohol use with and without PTSD in a national sample from the Veterans Health Administration (VA). National clinical and administrative data from VA's electronic medical record were used to identify all patients who screened positive for unhealthy alcohol use (AUDIT-C score≥5) between 10/1/09-5/30/13. Unadjusted and adjusted Poisson regression models were fit to estimate the relative rate and prevalence of receipt of: brief interventions (advice to reduce or abstain from drinking≤14days after positive screening), specialty addictions treatment for alcohol use disorder (AUD; documented visit≤365days after positive screening), pharmacotherapy for AUD (filled prescription≤365days after positive screening), and mental health care ≤14days after positive screening for patients with and without PTSD (documented with ICD-9 CM codes). In secondary analyses, we tested effect modification by both severity of unhealthy alcohol use and age. Among 830,825 patients who screened positive for unhealthy alcohol use, 140,388 (16.9%) had documented PTSD. Of the full sample, 71.6% received brief interventions, 10.3% received specialty AUD treatment, 3.1% received pharmacotherapy for AUD, and 24.0% received mental health care. PTSD was associated with increased likelihood of receiving all types of care. Adjusted relative rates were 1.04 (95% CI 1.03-1.05) for brief interventions, 1.06 (1.05-1.08) for specialty AUD treatment, 1.35 (1.31-1.39) for AUD pharmacotherapy, and 1.82 (1.80-1.84) for mental health care. Alcohol use severity modified effects of PTSD for specialty AUD treatment, AUD pharmacotherapy, and mental health care such that effects were maintained at lower severity but attenuated among patients with severe unhealthy alcohol use. Age modified all effects with the strength of the association between PTSD and care outcomes being strongest for younger (18-29years) and older veterans (65+ years) and weaker or non-significant for middle-aged veterans (30-44 and 45-64years). In this large national sample of patients with unhealthy alcohol use, PTSD was associated with increased likelihood of receiving alcohol-related and mental health care. PTSD does not appear to be a barrier to care among VA patients with unhealthy alcohol use. Published by Elsevier Inc.

Custom-Molded Foot-Orthosis Intervention and Multisegment Medial Foot Kinematics During Walking

PubMed Central

Cobb, Stephen C.; Tis, Laurie L.; Johnson, Jeffrey T.; Wang, Yong “Tai”; Geil, Mark D.

2011-01-01

Context: Foot-orthosis (FO) intervention to prevent and treat numerous lower extremity injuries is widely accepted clinically. However, the results of quantitative gait analyses have been equivocal. The foot models used, participants receiving intervention, and orthoses used might contribute to the variability. Objective: To investigate the effect of a custom-molded FO intervention on multisegment medial foot kinematics during walking in participants with low-mobile foot posture. Design: Crossover study. Setting: University biomechanics and ergonomics laboratory. Patients or Other Participants: Sixteen participants with low-mobile foot posture (7 men, 9 women) were assigned randomly to 1 of 2 FO groups. Interventions : After a 2-week period to break in the FOs, individuals participated in a gait analysis that consisted of 5 successful walking trials (1.3 to 1.4 m/s) during no-FO and FO conditions. Main Outcome Measure(s): Three-dimensional displacements during 4 subphases of stance (loading response, mid-stance, terminal stance, preswing) were computed for each multisegment foot model articulation. Results: Repeated-measures analyses of variance (ANOVAs) revealed that rearfoot complex dorsiflexion displacement during midstance was greater in the FO than the no-FO condition (F1,14 = 5.24, P = .04, partial η2 = 0.27). Terminal stance repeated-measures ANOVA results revealed insert-by-insert condition interactions for the first metatarsophalangeal joint complex (F1,14 = 7.87, P = .01, partial η2 = 0.36). However, additional follow-up analysis did not reveal differences between the no-FO and FO conditions for the balanced traditional orthosis (F1,14 = 4.32, P = .08, partial η2 = 0.38) or full-contact orthosis (F1,14 = 4.10, P = .08, partial η2 = 0.37). Conclusions: Greater rearfoot complex dorsiflexion during midstance associated with FO intervention may represent improved foot kinematics in people with low-mobile foot postures. Furthermore, FO intervention might partially correct dys-functional kinematic patterns associated with low-mobile foot postures. PMID:21944067

RCT Testing Bystander Effectiveness to Reduce Violence.

PubMed

Coker, Ann L; Bush, Heather M; Cook-Craig, Patricia G; DeGue, Sarah A; Clear, Emily R; Brancato, Candace J; Fisher, Bonnie S; Recktenwald, Eileen A

2017-05-01

Bystander-based programs have shown promise to reduce interpersonal violence at colleges, yet limited rigorous evaluations have addressed bystander intervention effectiveness in high schools. This study evaluated the Green Dot bystander intervention to reduce sexual violence and related forms of interpersonal violence in 26 high schools over 5 years. A cluster RCT was conducted. Kentucky high schools were randomized to intervention or control (wait list) conditions. Green Dot-trained educators conducted schoolwide presentations and recruited student popular opinion leaders to receive bystander training in intervention schools beginning in Year 1. The primary outcome was sexual violence perpetration, and related forms of interpersonal violence victimization and perpetration were also measured using anonymous student surveys collected at baseline and annually from 2010 to 2014. Because the school was the unit of analysis, violence measures were aggregated by school and year and school-level counts were provided. A total of 89,707 students completed surveys. The primary, as randomized, analyses conducted in 2014-2016 included linear mixed models and generalized estimating equations to examine the condition-time interaction on violence outcomes. Slopes of school-level totals of sexual violence perpetration (condition-time, p<0.001) and victimization (condition-time, p<0.001) were different over time. During Years 3-4, when Green Dot was fully implemented, the mean number of sexual violent events prevented by the intervention was 120 in Intervention Year 3 and 88 in Year 4. For Year 3, prevalence rate ratios for sexual violence perpetration in the intervention relative to control schools were 0.83 (95% CI=0.70, 0.99) in Year 3 and 0.79 (95% CI=0.67, 0.94) in Year 4. Similar patterns were observed for sexual violence victimization, sexual harassment, stalking, and dating violence perpetration and victimization. Implementation of Green Dot in Kentucky high schools significantly decreased not only sexual violence perpetration but also other forms of interpersonal violence perpetration and victimization. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

"Active Team" a social and gamified app-based physical activity intervention: randomised controlled trial study protocol.

PubMed

Edney, Sarah; Plotnikoff, Ronald; Vandelanotte, Corneel; Olds, Tim; De Bourdeaudhuij, Ilse; Ryan, Jillian; Maher, Carol

2017-11-02

Physical inactivity is a leading preventable cause of chronic disease and premature death globally, yet over half of the adult Australian population is inactive. To address this, web-based physical activity interventions, which have the potential to reach large numbers of users at low costs, have received considerable attention. To fully realise the potential of such interventions, there is a need to further increase their appeal to boost engagement and retention, and sustain intervention effects over longer periods of time. This randomised controlled trial aims to evaluate the efficacy of a gamified physical activity intervention that connects users to each other via Facebook and is delivered via a mobile app. The study is a three-group, cluster-RCT. Four hundred and forty (440) inactive Australian adults who use Facebook at least weekly will be recruited in clusters of three to eight existing Facebook friends. Participant clusters will be randomly allocated to one of three conditions: (1) waitlist control condition, (2) basic experimental condition (pedometer plus basic app with no social and gamification features), or (3) socially-enhanced experimental condition (pedometer plus app with social and gamification features). Participants will undertake assessments at baseline, three and nine months. The primary outcome is change in total daily minutes of moderate-to-vigorous physical activity at three months measured objectively using GENEActive accelerometers [Activeinsights Ltd., UK]. Secondary outcomes include self-reported physical activity, depression and anxiety, wellbeing, quality of life, social-cognitive theory constructs and app usage and engagement. The current study will incorporate novel social and gamification elements in order to examine whether the inclusion of these components increases the efficacy of app-based physical activity interventions. The findings will be used to guide the development and increase the effectiveness of future health behaviour interventions. This trial was registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12617000113358 , date of registration 23 January, 2017).

Evaluation of Yoga for Preventing Adolescent Substance Use Risk Factors in a Middle School Setting: A Preliminary Group-Randomized Controlled Trial

PubMed Central

LoRusso, Amanda; Shin, Sunny H.; Khalsa, Sat Bir S.

2016-01-01

Adolescence is a key developmental period for preventing substance use initiation, however prevention programs solely providing educational information about the dangers of substance use rarely change adolescent substance use behaviors. Recent research suggests that mind–body practices such as yoga may have beneficial effects on several substance use risk factors, and that these practices may serve as promising interventions for preventing adolescent substance use. The primary aim of the present study was to test the efficacy of yoga for reducing substance use risk factors during early adolescence. Seventh-grade students in a public school were randomly assigned by classroom to receive either a 32-session yoga intervention (n = 117) in place of their regular physical education classes or to continue with physical-education-as-usual (n = 94). Participants (63.2 % female; 53.6 % White) completed pre- and post-intervention questionnaires assessing emotional self-regulation, perceived stress, mood impairment, impulsivity, substance use willingness, and actual substance use. Participants also completed questionnaires at 6-months and 1-year post-intervention. Results revealed that participants in the control condition were significantly more willing to try smoking cigarettes immediately post-intervention than participants in the yoga condition. Immediate pre- to post-intervention differences did not emerge for the remaining outcomes. However, long-term follow-up analyses revealed a pattern of delayed effects in which females in the yoga condition, and males in the control condition, demonstrated improvements in emotional self-control. The findings suggest that school-based yoga may have beneficial effects with regard to preventing males' and females' willingness to smoke cigarettes, as well as improving emotional self-control in females. However additional research is required, particularly with regard to the potential long-term effects of mind–body interventions in school settings. The present study contributes to the literature on adolescence by examining school-based yoga as a novel prevention program for substance use risk factors. PMID:27246653

Evaluation of Yoga for Preventing Adolescent Substance Use Risk Factors in a Middle School Setting: A Preliminary Group-Randomized Controlled Trial.

PubMed

Butzer, Bethany; LoRusso, Amanda; Shin, Sunny H; Khalsa, Sat Bir S

2017-03-01

Adolescence is a key developmental period for preventing substance use initiation, however prevention programs solely providing educational information about the dangers of substance use rarely change adolescent substance use behaviors. Recent research suggests that mind-body practices such as yoga may have beneficial effects on several substance use risk factors, and that these practices may serve as promising interventions for preventing adolescent substance use. The primary aim of the present study was to test the efficacy of yoga for reducing substance use risk factors during early adolescence. Seventh-grade students in a public school were randomly assigned by classroom to receive either a 32-session yoga intervention (n = 117) in place of their regular physical education classes or to continue with physical-education-as-usual (n = 94). Participants (63.2 % female; 53.6 % White) completed pre- and post-intervention questionnaires assessing emotional self-regulation, perceived stress, mood impairment, impulsivity, substance use willingness, and actual substance use. Participants also completed questionnaires at 6-months and 1-year post-intervention. Results revealed that participants in the control condition were significantly more willing to try smoking cigarettes immediately post-intervention than participants in the yoga condition. Immediate pre- to post-intervention differences did not emerge for the remaining outcomes. However, long-term follow-up analyses revealed a pattern of delayed effects in which females in the yoga condition, and males in the control condition, demonstrated improvements in emotional self-control. The findings suggest that school-based yoga may have beneficial effects with regard to preventing males' and females' willingness to smoke cigarettes, as well as improving emotional self-control in females. However additional research is required, particularly with regard to the potential long-term effects of mind-body interventions in school settings. The present study contributes to the literature on adolescence by examining school-based yoga as a novel prevention program for substance use risk factors.

Targeted Messages Increase Dairy Consumption in Adults: a Randomized Controlled Trial.

PubMed

Jung, Mary E; Latimer-Cheung, Amy E; Bourne, Jessica E; Martin Ginis, Kathleen A

2017-02-01

Dairy consumption amongst North Americans aged 30-50 has been declining. Targeted messages have been identified as a cost-efficient method through which to increase health-enhancing behavior, such as dairy intake. The aim of this study is to assess the utility of targeted, framed, efficacy-enhancing messages on calcium consumption from dairy in adults aged 30-50 in a randomized controlled trial. Seven hundred and thirty-two individuals (463 women, 269 men; M age  = 40.57 years) were randomly assigned to one of five message conditions: (1) gain-framed (GF), (2) loss-framed (LF), (3) self-regulatory efficacy-enhancing (SRE), (4) GF plus SRE (GF + SRE), or (5) LF plus SRE (LF + SRE). Conditions were separate for men and women. Each condition received an emailed message on four consecutive days. Calcium intake from dairy, self-regulatory efficacy, outcome expectations, and outcome value were measured at baseline, 1 and 4 weeks following the intervention. Calcium intake from dairy significantly increased from baseline to week 1 post-intervention in all conditions (p < .001). A significant message condition x time interaction (p = .04) revealed that increases seen in the LF + SRE condition were maintained at week 4. All social cognitive constructs increased following the intervention (ps < .01). Self-regulatory efficacy (β = .28, p < .01) and outcome expectations (β = .19, p < .01) were significant predictors of subsequent calcium intake (week 4) from dairy. Taken together, it appears as though ensuring message content is targeted to the specific population's beliefs and motives is of importance when developing behavioral change intervention material.

Functional analysis and intervention for perseverative verbal behaviour of an older adult with traumatic brain injury.

PubMed

Quearry, Amy Garcia; Lundervold, Duane A

2016-01-01

A functional analysis of behaviour was conducted to determine the controlling variables related to the perseverative verbal behaviour (PBV) of a 60-year-old female with a long-standing traumatic brain injury receiving educational assistance. Functional analyses (FA) of antecedent and consequent conditions related to PCB were conducted to determine controlling influence of: (a) content of verbal interaction and, (b) social reinforcement. After isolating the controlling variables, the functioned-based intervention was implemented in 60 minute tutoring sessions. A reversal condition was used to demonstrate experimental control of the behavior during tutoring sessions. PVB which occurred in the context of tutoring for an undergraduate course significantly interfered with the delivery of instruction. Multiple replications of the functional relation between social reinforcement and PVB duration was demonstrated using an A-B-A-B reversal design during functional analysis and tutoring conditions. PVB markedly declined, but did not extinguish over the course of weekly tutoring (extinction) sessions, most likely due to 'bootleg reinforcement' occurring in other situations. Results indicate that perseverative verbal behaviour following closed head injury may be strongly influenced by the social contingencies operating in various contexts and is amenable to applied behaviour analysis interventions.

Step Care treatment for smoking cessation

PubMed Central

Ebbert, Jon O.; Little, Melissa A.; Klesges, Robert C.; Bursac, Zoran; Johnson, Karen C.; Thomas, Fridtjof; Vander Weg, Mark W.

2017-01-01

Abstract We compared the effectiveness of a ‘stepped care’ approach with increasing treatment intensity (‘Step Care’) to one with repeated treatments (‘Recycle’) among cigarette smokers interested in quitting smoking. Step 1 of the Step Care intervention consisted of a single counseling session, nicotine patch for six weeks and telephonic contact. For smokers not achieving tobacco abstinence 6 months after randomization with Step 1, the intensity of the intervention increased to four counseling sessions, bupropion sustained-release, nine telephone calls and three mailings (Step 2). For those not achieving tobacco abstinence 12 months after randomization, smokers received six behavioral counseling sessions, nicotine patch and nicotine gum, nine telephone calls and three mailings (Step 3). The Recycle participants received one session of health behavior counseling, six weeks of the nicotine patch and a telephone call at each step. 270 cigarette smokers were randomized. At 24 months after randomization using an intention to treat analysis, no statistically significant difference was observed in prolonged smoking abstinence between the Step Care and Recycle condition (16.9% versus 9.4%; adjusted OR = 1.88; 95% CI 0.88–4.01; P =0.10). Additional research is needed to explore whether a stepped care intervention increases long-term smoking abstinence rates compared with repeating the same intervention. PMID:28158558

Development of a school-based program for adolescents at-risk for depression in India: results from a pilot study.

PubMed

Singhal, Meghna; Manjula, M; Vijay Sagar, K John

2014-08-01

A majority of adolescents in India, who are at risk for depression, do not receive treatment or receive it when the psychopathology has become entrenched and chronic. The present pilot study was an endeavor to assess the felt needs of adolescents vis-à-vis the difficulties and stressors experienced by them. For this purpose, 300 students across three schools were screened using standardized measures. Another objective of the study was to develop and test a school-based Coping Skills Program to address adolescents at-risk for depression. Schools were sequentially assigned to intervention or control conditions; students of index (n=13) and control (n=6) groups were assessed at baseline, post-intervention, and 3 months follow-up. At post-intervention for the index group, all outcomes measures except coping skills-including depressive symptoms, negative cognitions, academic stress, and social problem-solving-showed change in the expected direction, this difference assuming significance at follow-up. The program was rated positively by students using anonymous feedback and there was low to nil perceived stigmatization. Results are discussed in the context of need for such intervention programs in India, and future scope of research involving larger samples. Copyright © 2014 Elsevier B.V. All rights reserved.

Elementary school children's science learning from school field trips

NASA Astrophysics Data System (ADS)

Glick, Marilyn Petty

This research examines the impact of classroom anchoring activities on elementary school students' science learning from a school field trip. Although there is prior research demonstrating that students can learn science from school field trips, most of this research is descriptive in nature and does not examine the conditions that enhance or facilitate such learning. The current study draws upon research in psychology and education to create an intervention that is designed to enhance what students learn from school science field trips. The intervention comprises of a set of "anchoring" activities that include: (1) Orientation to context, (2) Discussion to activate prior knowledge and generate questions, (3) Use of field notebooks during the field trip to record observations and answer questions generated prior to field trip, (4) Post-visit discussion of what was learned. The effects of the intervention are examined by comparing two groups of students: an intervention group which receives anchoring classroom activities related to their field trip and an equivalent control group which visits the same field trip site for the same duration but does not receive any anchoring classroom activities. Learning of target concepts in both groups was compared using objective pre and posttests. Additionally, a subset of students in each group were interviewed to obtain more detailed descriptive data on what children learned through their field trip.

Effects of a co-financed interdisciplinary collaboration model in primary health care on service utilisation among patients with musculoskeletal disorders.

PubMed

Hultberg, Eva-Lisa; Lönnroth, Knut; Allebeck, Peter

2007-01-01

In 1994 Sweden introduced a trial legislation allowing co-financing between authorities. The legislation aimed to stimulate new ways of collaboration between health and social care providers. One of the specific objectives was to make management of patients with conditions requiring multidisciplinary care more efficient and reduce costs. This study aims to assess if there were any differences in management of patients with musculoskeletal disorders at health centres applying the trial legislation compared to health centre with conventional care with regards to health services utilisation, health care interventions received, and costs. A comparative prospective study was conducted. Consecutive patients aged 16-64 with musculoskeletal disorders attending the health care centres with (n=107) and without (n=31) co-financing model were interviewed at inclusion and after 6 and 12 months. Number of contacts with professionals and interventions received were registered. Patients at the intervention centres had significantly more contact with physiotherapists and physicians than the controls. Contacts with other services such as social insurance office, social services office or hospitals did not differ significantly between the groups. Costs were higher for the interventions centres. The findings do not suggest that the trial legislation reduced health care utilisation or costs for patients with musculoskeletal disorders.

The Efficacy of a Web-Based Screening and Brief Intervention for Reducing Alcohol Consumption Among Japanese Problem Drinkers: Protocol for a Single-Blind Randomized Controlled Trial.

PubMed

Hamamura, Toshitaka; Suganuma, Shinichiro; Takano, Ayumi; Matsumoto, Toshihiko; Shimoyama, Haruhiko

2018-05-30

The literature shows that computer-delivered interventions with personalized normative feedback can reduce problem drinking for up to 6 months in the West. Meanwhile, no studies have been conducted to examine the effects of such interventions among Japanese problem drinkers. Possible moderators associated with effectiveness of the intervention need to be also explored. The purpose of this study is to conduct a trial and examine the efficacy of a brief intervention with personal normative feedback and psychoeducation on several measures of alcohol consumption among Japanese problem drinkers. Additionally, this study will examine whether the level of alcohol use disorder and beliefs about the physical and psychological outcomes of drinking moderate the effect of the intervention on outcome measures. This study will conduct a single-blind, 2-armed randomized controlled trial. Japanese adults with an Alcohol Use Disorder Identification Test score of 8 or higher will be enrolled in the trial. Participants allocated to the intervention group will receive the intervention immediately after the baseline measurements, and participants allocated to the waitlist group will receive the intervention at the end of the trial. Outcome measures include drinking quantity, drinking frequency, and alcohol-related consequences. Follow-up assessment will take place at 1 month, 2 months, and 6 months following the baseline measurement. The authors will not know the group allocation during trial. The authors will plan to collect a sample of 600 participants. Mixed-effect analyses of variance will be used to examine the main effects of condition, the main effects of time, and the interaction effects between condition and time on outcome variables. Enrollment for the trial began on January 6, 2018 and data are expected to be available by August 2018. This study will contribute to the literature by demonstrating the efficacy of Web-based screenings and brief interventions among Japanese problem drinkers and indicating several possible moderators between the intervention and outcomes. This type of Web-based brief intervention has the possibility of being implemented in Japanese schools and workplaces as a prevention tool. UMIN Clinical Trials Registry R000034388; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000034388 (Archived by WebCite at http://www.webcitation.org/6xmOoTfTI). RR1-10.2196/10650. ©Toshitaka Hamamura, Shinichiro Suganuma, Ayumi Takano, Toshihiko Matsumoto, Haruhiko Shimoyama. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 30.05.2018.

The effectiveness of bibliotherapy in alleviating tinnitus-related distress.

PubMed

Malouff, John M; Noble, William; Schutte, Nicola S; Bhullar, Navjot

2010-03-01

The present study examined the efficacy of bibliotherapy in assisting individuals experiencing distress related to tinnitus. One hundred sixty-two tinnitus sufferers from Australia participated in a study designed to examine the effectiveness of a cognitive-behaviorally based self-help book in reducing distress. To maximize the ecological validity of the findings, we excluded no individuals interested in treatment for tinnitus-related distress. The experimental condition lost 35% of participants at postassessment, compared to 10% in the control group. In an analysis of participants who completed postintervention assessment, those assigned to the intervention condition, who received a tinnitus self-help book, showed significantly less tinnitus-related distress and general distress 2 months later compared to those assigned to the waiting list control condition. The intervention group's reduction in tinnitus-related distress and general distress from preintervention to postintervention 2 months later was significant, and these participants maintained a significant reduction in distress on follow-up 4 months after they received the tinnitus self-help book. A long-term follow-up of all participants, who at that time had received the book at least a year previously, showed a significant reduction in tinnitus distress. Although these group differences and pre-post changes were significant, effect sizes were small. Intention-to-treat analyses showed no significant effect for between-groups analyses, but did show a significant effect for the 1-year follow-up pre-post analysis. Information on the effectiveness of using a self-help book, without therapist assistance, in alleviating distress is important, as bibliotherapy can provide inexpensive treatment that is not bound by time or place. Copyright 2010 Elsevier Inc. All rights reserved.

Increasing young adults' condom use intentions and behaviour through changing chlamydia risk and coping appraisals: study protocol for a cluster randomised controlled trial of efficacy.

PubMed

Newby, Katie V; French, David P; Brown, Katherine E; Lecky, Donna M

2013-05-30

Chlamydia is the most commonly diagnosed sexually transmitted infection (STI) in England and has serious public health consequences. Young people carry a disproportionate burden of infection. A number of social cognition models identify risk appraisal as a primary motivator of behaviour suggesting that changing risk appraisals for STIs may be an effective strategy in motivating protective behaviour. Meta-analytic evidence indicates that the relationship between risk appraisal and health behaviour is small, but studies examining this relationship have been criticised for their many conceptual and methodological weaknesses. The effect of risk appraisal on health behaviour may therefore be of larger size. The proposed study aims to examine the efficacy of an intervention to increase condom use intentions and behaviour amongst young people through changing chlamydia risk and coping appraisals. Coping appraisal is targeted to avoid the intervention being counterproductive amongst recipients who do not feel able to perform the behaviour required to reduce the threat. An experimental design with follow-up, a conditional measure of risk appraisal, and analysis which controls for past behaviour, enable the relationship between risk appraisal and protective behaviour to be accurately assessed. The proposed study is a two-arm cluster randomised controlled trial using a waiting-list control design to test the efficacy of the intervention compared to a control group. Participants will be school pupils aged 13-16 years old recruited from approximately ten secondary schools. Schools will be randomised into each arm. Participants will receive their usual teaching on STIs but those in the intervention condition will additionally receive a single-session sex education lesson on chlamydia. Measures will be taken at baseline, post-intervention and at follow-up three months later. The primary outcome measure is intention to use condoms with casual sexual partners. As far as the authors are aware, this is the first controlled trial testing the efficacy of an intervention to increase condom use intentions and behaviour through changing chlamydia risk appraisals. It is one of few experimental studies to accurately test the relationship between risk appraisal and precautionary sexual behaviour using a conditional measure of risk appraisal and controlling for past behaviour.

Addressing critical gaps in the treatment of eating disorders.

PubMed

Kazdin, Alan E; Fitzsimmons-Craft, Ellen E; Wilfley, Denise E

2017-03-01

Remarkable progress has been made in developing psychosocial interventions for eating disorders and other mental disorders. Two priorities in providing treatment consist of addressing the research-practice gap and the treatment gap. The research-practice gap pertains to the dissemination of evidence-based treatments from controlled settings to routine clinical care. Closing the gap between what is known about effective treatment and what is actually provided to patients who receive care is crucial in improving mental health care, particularly for conditions such as eating disorders. The treatment gap pertains to extending treatments in ways that will reach the large number of people in need of clinical care who currently receive nothing. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services for eating disorders and other mental health problems do not receive treatment. This article discusses the approaches required to better ensure: (1) that more people who are receiving treatment obtain high-quality, evidence-based care, using such strategies as train-the-trainer, web-centered training, best-buy interventions, electronic support tools, higher-level support and policy; and (2) that a higher proportion of those who are currently underserved receive treatment, using such strategies as task shifting and disruptive innovations, including treatment delivery via telemedicine, the Internet, and mobile apps. © 2017 Wiley Periodicals, Inc.

An online psychological intervention can improve the sexual satisfaction of men following treatment for localized prostate cancer: outcomes of a Randomised Controlled Trial evaluating My Road Ahead.

PubMed

Wootten, Addie C; Meyer, Denny; Abbott, Jo-Anne M; Chisholm, Katherine; Austin, David W; Klein, Britt; McCabe, Marita; Murphy, Declan G; Costello, Anthony J

2017-07-01

Prostate cancer treatment often results in significant psycho-sexual challenges for men following treatment; however, many men report difficulty in accessing appropriate care. A randomized controlled trial was undertaken to assess the efficacy of a 10-week self-guided online psychological intervention called My Road Ahead (MRA) for men with localized prostate cancer in improving sexual satisfaction. Participants were randomized to 1 of 3 conditions MRA alone or MRA plus online forum, or forum access alone. Pre, post, and follow-up assessments of overall sexual satisfaction were conducted. Mixed models and structural equation modeling were used to analyze the data. One hundred forty-two men (mean age 61 y; SD = 7) participated. The majority of participants had undergone radical prostatectomy (88%) and all men had received treatment for localized prostate cancer. Significant differences were obtained for the 3 groups (P = .026) and a significant improvement in total sexual satisfaction was observed only for participants who were allocated to MRA + forum with a large effect size (P = .004, partial η 2  = 0.256). Structural equation modeling indicated that increases in sexual function, masculine self-esteem, and sexual confidence contributed significantly to overall sexual satisfaction for the MRA + forum plus forum condition. This study is the first, to our knowledge, that has evaluated a self-guided online psychological intervention tailored to the specific needs of men with prostate cancer. The findings indicate the potential for MRA to deliver support that men may not otherwise receive and also highlight the importance of psychological intervention to facilitate improved sexual outcomes. Copyright © 2016 John Wiley & Sons, Ltd.

Applying a Family-Level Economic Strengthening Intervention to Improve Education and Health-Related Outcomes of School-Going AIDS-Orphaned Children: Lessons from a Randomized Experiment in Southern Uganda.

PubMed

Ssewamala, Fred M; Karimli, Leyla; Torsten, Neilands; Wang, Julia Shu-Huah; Han, Chang-Keun; Ilic, Vilma; Nabunya, Proscovia

2016-01-01

Children comprise the largest proportion of the population in sub-Saharan Africa. Of these, millions are orphaned. Orphanhood increases the likelihood of growing up in poverty, dropping out of school, and becoming infected with HIV. Therefore, programs aimed at securing a healthy developmental trajectory for these orphaned children are desperately needed. We conducted a two-arm cluster-randomized controlled trial to evaluate the effectiveness of a family-level economic strengthening intervention with regard to school attendance, school grades, and self-esteem in AIDS-orphaned adolescents aged 12-16 years from 10 public rural primary schools in southern Uganda. Children were randomly assigned to receive usual care (counseling, school uniforms, school lunch, notebooks, and textbooks), "bolstered" with mentorship from a near-peer (control condition, n = 167), or to receive bolstered usual care plus a family-level economic strengthening intervention in the form of a matched Child Savings Account (Suubi-Maka treatment arm, n = 179). The two groups did not differ at baseline, but 24 months later, children in the Suubi-Maka treatment arm reported significantly better educational outcomes, lower levels of hopelessness, and higher levels of self-concept compared to participants in the control condition. Our study contributes to the ongoing debate on how to address the developmental impacts of the increasing numbers of orphaned and vulnerable children and adolescents in sub-Saharan Africa, especially those affected by HIV/AIDS. Our findings indicate that innovative family-level economic strengthening programs, over and above bolstered usual care that includes psychosocial interventions for young people, may have positive developmental impacts related to education, health, and psychosocial functioning.

A randomized controlled trial testing an Internet delivered cost-benefit approach to weight loss maintenance.

PubMed

Leahey, Tricia M; Fava, Joseph L; Seiden, Andrew; Fernandes, Denise; Doyle, Caroline; Kent, Kimberly; La Rue, Molly; Mitchell, Marc; Wing, Rena R

2016-11-01

Weight loss maintenance is a significant challenge in obesity treatment. During maintenance the "costs" of adhering to weight management behaviors may outweigh the "benefits." This study examined the efficacy of a novel approach to weight loss maintenance based on modifying the cost-benefit ratio. Individuals who achieved a 5% weight loss (N=75) were randomized to one of three, 10-month maintenance interventions. All interventions were delivered primarily via the Internet. The Standard arm received traditional weight maintenance strategies. To increase benefits, or rewards, for maintenance behaviors, the two cost-benefit intervention conditions received weekly monetary rewards for self-monitoring and social reinforcement via e-coaching. To decrease behavioral costs (boredom) and increase novelty, participants in the cost-benefit conditions also monitored different evidence-based behaviors every two weeks (e.g., Weeks 1 & 2: steps; Week 3 & 4: red foods). The primary difference between the cost-benefit interventions was type of e-coach providing social reinforcement: Professional (CB Pro) or Peer (CB Peer). Study procedures took place in Providence, RI from 2013 to 2014. Retention was 99%. There were significant group differences in weight regain (p=.01). The Standard arm gained 3.5±5.7kg. In contrast, participants in CB Pro and CB Peer lost an additional 1.8±7.0kg and 0.5±6.4kg, respectively. These results suggest that an Internet delivered cost-benefit approach to weight loss maintenance may be effective for long-term weight control. In addition, using peer coaches to provide reinforcement may be a particularly economic alternative to professionals. These data are promising and provide support for a larger, longer trial. Copyright © 2016 Elsevier Inc. All rights reserved.

A randomized controlled trial testing an Internet delivered cost-benefit approach to weight loss maintenance

PubMed Central

Leahey, Tricia M.; Fava, Joseph L.; Seiden, Andrew; Fernandes, Denise; Doyle, Caroline; Kent, Kimberly; La Rue, Molly; Mitchell, Marc; Wing, Rena R.

2016-01-01

Weight loss maintenance is a significant challenge in obesity treatment. During maintenance the “costs” of adhering to weight management behaviors may outweigh the “benefits.” This study examined the efficacy of a novel approach to weight loss maintenance based on modifying the cost-benefit ratio. Individuals who achieved a 5% weight loss (N=75) were randomized to one of three, 10-month maintenance interventions. All interventions were delivered primarily via the Internet. The Standard arm received traditional weight maintenance strategies. To increase benefits, or rewards, for maintenance behaviors, the two cost-benefit intervention conditions received weekly monetary rewards for self-monitoring and social reinforcement via e-coaching. To decrease behavioral costs (boredom) and increase novelty, participants in the cost-benefit conditions also monitored different evidence-based behaviors every two weeks (e.g., Weeks 1 & 2: steps; Week 3 & 4: red foods). The primary difference between the cost-benefit interventions was type of e-coach providing social reinforcement: Professional (CB Pro) or Peer (CB Peer). Study procedures took place in Providence, RI from 2013–2014. Retention was 99%. There were significant group differences in weight regain (p=.01). The Standard arm gained 3.5±5.7kg. In contrast, participants in CB Pro and CB Peer lost an additional 1.8±7.0kg and 0.5±6.4kg, respectively. These results suggest that an Internet delivered cost-benefit approach to weight loss maintenance may be effective for long-term weight control. In addition, using peer coaches to provide reinforcement may be a particularly economic alternative to professionals. These data are promising and provide support for a larger, longer trial. Clinicaltrials.gov Identifier NCT01760486 PMID:27095323

Applying a Family-Level Economic Strengthening Intervention to Improve Education and Health-Related Outcomes of School-going AIDS-Orphaned Children: Lessons from a Randomized Experiment in Southern Uganda

PubMed Central

Ssewamala, Fred M.; Leyla, Karimli; Neilands, Torsten; Julia Shu-Huah, Wang; Chang-Keun, Han; Vilma, Ilic; Proscovia, Nabunya

2015-01-01

Children comprise the largest proportion of the population in sub-Saharan Africa. Of these, millions are orphaned. Orphanhood increases the likelihood of growing up in poverty, dropping out of school, and becoming infected with HIV. Therefore, programs aimed at securing a healthy developmental trajectory for these orphaned children are desperately needed. We conducted a two-arm cluster-randomized controlled trial to evaluate the effectiveness of a family-level economic strengthening intervention with regard to school-attendance, school grades, and self-esteem in AIDS-orphaned adolescents aged 12–16 years from 10 public rural primary schools in southern Uganda. Children were randomly assigned to receive usual care (counseling, school uniforms, school lunch, notebooks and textbooks), “bolstered” with mentorship from a near-peer (control condition, n=167), or to receive bolstered usual care plus a family-level economic strengthening intervention in the form of a matched Child Savings Account (Suubi-Maka treatment arm, n = 179). The two groups did not differ at baseline, but 24-months later, children in the Suubi-Maka treatment arm reported significantly better educational outcomes, lower levels of hopelessness, and higher levels of self-concept compared to participants in the control condition. Our study contributes to the ongoing debate on how to address the developmental impacts of the increasing numbers of orphaned, and vulnerable children and adolescents in sub-Saharan Africa, especially those affected by HIV/AIDS. Our findings indicate that innovative family-level economic strengthening programs, over and above bolstered usual care that includes psychosocial interventions for young people, may have positive developmental impacts related to education, health, and psychosocial functioning. PMID:26228480

Does Stepping Stones Triple P plus Acceptance and Commitment Therapy improve parent, couple, and family adjustment following paediatric acquired brain injury? A randomised controlled trial.

PubMed

Brown, Felicity L; Whittingham, Koa; Boyd, Roslyn N; McKinlay, Lynne; Sofronoff, Kate

2015-10-01

To evaluate the efficacy of a behavioural family intervention, Stepping Stones Triple P (SSTP), combined with an Acceptance and Commitment Therapy (ACT) workshop in improving parent, family and couple outcomes following paediatric acquired brain injury (ABI). Fifty-nine parents (90% mothers) of children (mean age 7 years; 35 males, 24 females) with ABI. Participants were randomly assigned to a treatment (10-week group SSTP and ACT program) or a care-as-usual (CAU) control condition (10 weeks). Those in the CAU condition received the treatment after the waitlist period. Self-report measures of parent psychological distress, parent psychological flexibility, parenting confidence, family functioning, and couple relationship, assessed at: pre-intervention, post-intervention, and 6-months post-intervention. Post-intervention, the treatment group showed significant, small to medium improvements relative to the CAU group (at the p < .05 level) on parent psychological distress, parent psychological flexibility, parent confidence in managing behaviours, family adjustment,and number of disagreements between parents. Most improvements were maintained at 6-months. Parent skills training and ACT may be efficacious in improving parent, family, and couple outcomes in families of children with an ABI. Copyright © 2015 Elsevier Ltd. All rights reserved.

An investigation of emotion recognition training to reduce symptoms of social anxiety in adolescence.

PubMed

Rawdon, Caroline; Murphy, Daria; Motyer, Gillian; Munafò, Marcus R; Penton-Voak, Ian; Fitzgerald, Amanda

2018-05-01

This study aimed to examine the effect of emotion recognition training on social anxiety symptoms among adolescents, aged 15-18 years. The study included a screening session, which identified participants who scored above a cut-off on a self-report measure of social anxiety for enrolment into a randomized controlled trial (Clinical Trials ID: NCT02550379). Participants were randomized to an intervention condition designed to increase the perception of happiness over disgust in ambiguous facial expressions or a sham intervention control condition, and completed self-report measures of social anxiety, fear of negative evaluation, anxiety-related disorders, and depressive symptoms. The intervention group demonstrated a strong shift in the balance point at which they perceived happiness over disgust in ambiguous facial expressions. This increase in positive perception was not associated with any changes in the primary outcome of social anxiety; however, some evidence of improvement in symptomatology was observed on one of a number of secondary outcomes. Those in the intervention group had lower depression symptoms at 2-week follow-up, compared to those in the control group who received the sham intervention training. Potential reasons for why the shift in balance point measurement was not associated with a concurrent shift in symptoms of social anxiety are discussed. Copyright © 2018 Elsevier B.V. All rights reserved.

A non-randomized [corrected] controlled trial of the active music engagement (AME) intervention on children with cancer.

PubMed

Robb, Sheri L; Clair, Alicia A; Watanabe, Masayo; Monahan, Patrick O; Azzouz, Faouzi; Stouffer, Janice W; Ebberts, Allison; Darsie, Emily; Whitmer, Courtney; Walker, Joey; Nelson, Kirsten; Hanson-Abromeit, Deanna; Lane, Deforia; Hannan, Ann

2008-07-01

Coping theorists argue that environmental factors affect how children perceive and respond to stressful events such as cancer. However, few studies have investigated how particular interventions can change coping behaviors. The active music engagement (AME) intervention was designed to counter stressful qualities of the in-patient hospital environment by introducing three forms of environmental support. The purpose of this multi-site randomized controlled trial was to determine the efficacy of the AME intervention on three coping-related behaviors (i.e. positive facial affect, active engagement, and initiation). Eighty-three participants, ages 4-7, were randomly assigned to one of three conditions: AME (n = 27), music listening (ML; n = 28), or audio storybooks (ASB; n = 28). Conditions were videotaped to facilitate behavioral data collection using time-sampling procedures. After adjusting for baseline differences, repeated measure analyses indicated that AME participants had a significantly higher frequency of coping-related behaviors compared with ML or ASB. Positive facial affect and active engagement were significantly higher during AME compared with ML and ASB (p<0.0001). Initiation was significantly higher during AME than ASB (p<0.05). This study supports the use of the AME intervention to encourage coping-related behaviors in hospitalized children aged 4-7 receiving cancer treatment. (c) 2007 John Wiley & Sons, Ltd.

The effects of a psychological intervention directed at optimizing immune function: study protocol for a randomized controlled trial.

PubMed

Schakel, Lemmy; Veldhuijzen, Dieuwke S; van Middendorp, Henriët; Prins, Corine; Joosten, Simone A; Ottenhoff, Tom H M; Visser, Leo G; Evers, Andrea W M

2017-05-26

Previous research has provided evidence for the link between psychological processes and psychophysiological health outcomes. Psychological interventions, such as face-to-face or online cognitive behavioral therapy (CBT) and serious games aimed at improving health, have shown promising results in promoting health outcomes. Few studies so far, however, have examined whether Internet-based CBT combined with serious gaming elements is effective in modulating health outcomes. Moreover, studies often did not incorporate psychophysiological or immunological challenges in order to gain insight into physiological responses to real-life challenges after psychological interventions. The overall aim of this study is to investigate the effects of a psychological intervention on self-reported and physiological health outcomes in response to immune and psychophysiological challenges. In a randomized controlled trial, 60 healthy men are randomly assigned to either an experimental condition, receiving guided Internet-based (e-health) CBT combined with health-related serious gaming elements for 6 weeks, or a control condition receiving no intervention. After the psychological intervention, self-reported vitality is measured, and participants are given an immunological challenge in the form of a Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccination. One day after the vaccination, participants are asked to perform several psychophysiological tasks in order to explore the effects of the psychological intervention on participants' stress response following the immune challenge. To assess the delayed effects of vaccination on self-reported and physiological health outcomes, a follow-up visit is planned 4 weeks later. Total study duration is approximately 14 weeks. The primary outcome measure is self-reported vitality measured directly after the intervention. Secondary outcome measures include inflammatory and endocrine markers, as well as psychophysiological measures of heart rate and skin conductance in response to the psychophysiological tasks after the BCG vaccination. The innovative design features of this study - e.g., combining guided e-health CBT with health-related serious gaming elements and incorporating immunological and psychophysiological challenges - will provide valuable information on the effects of a psychological intervention on both self-reported and physiological health outcomes. This study will offer further insights into the mechanisms underlying the link between psychological factors and health outcomes and is anticipated to contribute to the optimization of health care strategies. Nederlands Trial Register, NTR5610 . Registered on 4 January 2016.

Girls on the move program to increase physical activity participation.

PubMed

Robbins, Lorraine B; Gretebeck, Kimberlee A; Kazanis, Anamaria S; Pender, Nola J

2006-01-01

Because physical inactivity poses serious health risks, interventions are urgently needed to reverse the increasingly sedentary lifestyles of adolescent girls. The aim of this study was to determine the feasibility of "Girls on the Move," an individually tailored computerized physical activity (PA) program plus nurse counseling intervention, in increasing PA. A pretest-posttest control group design was used with 77 racially diverse sedentary girls in Grades 6, 7, and 8 from two middle schools. Each of the instructional grades was randomly assigned to either an intervention or control condition. After completing computerized questionnaires, each girl in the control group received a handout listing the PA recommendations. To encourage PA, each girl in the intervention group received computerized, individually tailored feedback messages based on her responses to the questionnaires, individual counseling from the school's pediatric nurse practitioner (PNP), and telephone calls and mailings from a trained research assistant. At 12 weeks, girls in both groups responded to the questionnaires. No differences in self-reported PA emerged between the intervention and control groups at Weeks 1 (baseline) and 12 (postintervention). Repeated measures ANOVA showed a significant interaction between group and time for social support for PA, F(1, 69) = 5.73, p = .019, indicating that the intervention group had significantly greater social support across time than did the control group. From baseline to postintervention, social support increased for the intervention group but decreased for the control group. Reasons for the lack of significant differences between the groups on the PA measures were cited. Important information that could inform subsequent studies that test interventions to increase youth PA was acquired from conducting this study. Future efforts to increase PA participation might include this approach for enhancing social support for PA.

Cognitive Rehabilitation in Alzheimer's Disease: A Controlled Intervention Trial.

PubMed

Brueggen, Katharina; Kasper, Elisabeth; Ochmann, Sina; Pfaff, Henrike; Webel, Steffi; Schneider, Wolfgang; Teipel, Stefan

2017-01-01

Cognitive Rehabilitation for Alzheimer's disease (AD) is an integrative multimodal intervention. It aims to maintain autonomy and quality of life by enhancing the patients' abilities to compensate for decreased cognitive functioning. We evaluated the feasibility of a group-based Cognitive Rehabilitation approach in mild AD dementia and assessed its effect on activities of daily living (ADL). We included 16 patients with AD dementia in a controlled partial-randomized design. We adapted the manual-guided Cognitive Rehabilitation program (CORDIAL) to a group setting. Over the course of three months, one group received the Cognitive Rehabilitation intervention (n = 8), while the other group received a standardized Cognitive Training as an active control condition (n = 8). ADL-competence was measured as primary outcome. The secondary outcome parameters included cognitive abilities related to daily living, functional cognitive state, and non-cognitive domains, e.g., quality of life. For each scale, we assessed the interaction effect 'intervention by time', i.e., from pre-to post-intervention. We found no significant interaction effect of intervention by time on the primary outcome ADL-competence. The interaction effect was significant for quality of life (Cohen's d: -1.43), showing an increase in the intervention group compared with the control group. Our study demonstrates the feasibility of a group-based Cognitive Rehabilitation program for patients with mild AD dementia. The Cognitive Rehabilitation showed no significant effect on ADL, possibly reflecting a lack of transfer between the therapy setting and real life. However, the group setting enhanced communication skills and coping mechanisms. Effects on ADL may not have reached statistical significance due to a limited sample size. Furthermore, future studies might use an extended duration of the intervention and integrate caregivers to a greater extent to increase transfer to activities of daily living.

Hazard perception skills of young drivers with Attention Deficit Hyperactivity Disorder (ADHD) can be improved with computer based driver training: An exploratory randomised controlled trial.

PubMed

Bruce, C R; Unsworth, C A; Dillon, M P; Tay, R; Falkmer, T; Bird, P; Carey, L M

2017-12-01

Young drivers with Attention Deficit Hyperactivity Disorder (ADHD) are at higher risk of road traffic injuries than their peers. Increased risk correlates with poor hazard perception skill. Few studies have investigated hazard perception training using computer technology with this group of drivers. *Determine the presence and magnitude of the between-group and within- subject change in hazard perception skills in young drivers with ADHD who receive Drive Smart training. *Determine whether training-facilitated change in hazard perception is maintained over time. This was a feasibility study, randomised control trial conducted in Australia. The design included a delayed treatment for the control group. Twenty-five drivers with a diagnosis of ADHD were randomised to the Immediate Intervention or Delayed Intervention group.The Immediate Intervention group received a training session using a computer application entitled Drive Smart. The Delayed Intervention group watched a documentary video initially (control condition), followed by the Drive Smart computer training session. The participant's hazard perception skill was measured using the Hazard Perception Test (HPT). After adjusting for baseline scores, there was a significant betweengroup difference in post-intervention HPT change scores in favour of the Immediate Intervention group. The magnitude of the effect was large. There was no significant within-group delayed intervention effect. A significant maintenance effect was found at 6-week follow-up for the Immediate Intervention group. The hazard perception skills of participants improved following training with large effect size and some maintenance of gain. A multimodal approach to training is indicated to facilitate maintenance. A full-scale trial is feasible. Copyright © 2017 Elsevier Ltd. All rights reserved.

Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial - Cell Phone Intervention for You (CITY).

PubMed

Batch, Bryan C; Tyson, Crystal; Bagwell, Jacqueline; Corsino, Leonor; Intille, Stephen; Lin, Pao-Hwa; Lazenka, Tony; Bennett, Gary; Bosworth, Hayden B; Voils, Corrine; Grambow, Steven; Sutton, Aziza; Bordogna, Rachel; Pangborn, Matthew; Schwager, Jenifer; Pilewski, Kate; Caccia, Carla; Burroughs, Jasmine; Svetkey, Laura P

2014-03-01

The obesity epidemic has spread to young adults, leading to significant public health implications later in adulthood. Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic. Few weight loss trials have been conducted in young adults. It is unclear what weight loss strategies are beneficial in this population. To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You (CITY) study, which is a single center, randomized three-arm trial that compares the impact on weight loss of 1) a behavioral intervention that is delivered almost entirely via cell phone technology (Cell Phone group); and 2) a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone (Personal Coaching group), each compared to 3) a usual care, advice-only control condition. A total of 365 community-dwelling overweight/obese adults aged 18-35 years were randomized to receive one of these three interventions for 24 months in parallel group design. Study personnel assessing outcomes were blinded to group assignment. The primary outcome is weight change at 24 [corrected] months. We hypothesize that each active intervention will cause more weight loss than the usual care condition. Study completion is anticipated in 2014. If effective, implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults through promotion of weight loss. ClinicalTrial.gov: NCT01092364. Published by Elsevier Inc.

Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial – Cell phone Intervention for You (CITY)

PubMed Central

Batch, Bryan C.; Tyson, Crystal; Bagwell, Jacqueline; Corsino, Leonor; Intille, Stephen; Lin, Pao-Hwa; Lazenka, Tony; Bennett, Gary; Bosworth, Hayden B.; Voils, Corrine; Grambow, Steven; Sutton, Aziza; Bordogna, Rachel; Pangborn, Matthew; Schwager, Jenifer; Pilewski, Kate; Caccia, Carla; Burroughs, Jasmine; Svetkey, Laura P.

2014-01-01

Background The obesity epidemic has spread to young adults, leading to significant public health implications later in adulthood. Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic. Few weight loss trials have been conducted in young adults. It is unclear what weight loss strategies are beneficial in this population. Purpose To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You (CITY) study, which is a single center, randomized three-arm trial that compares the impact on weight loss of 1) a behavioral intervention that is delivered almost entirely via cell phone technology (Cell Phone group); and 2) a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone (Personal Coaching group), each compared to; 3) a usual care, advice-only control condition. Methods A total of 365 community-dwelling overweight/obese adults aged 18–35 years were randomized to receive one of these three interventions for 24 months in parallel group design. Study personnel assessing outcomes were blinded to group assignment. The primary outcome is weight change at 12 months. We hypothesize that each active intervention will cause more weight loss than the usual care condition. Study completion is anticipated in 2014. Conclusions If effective, implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults through promotion of weight loss. PMID:24462568

Non-pharmacological sleep interventions for youth with chronic health conditions: a critical review of the methodological quality of the evidence.

PubMed

Brown, Cary A; Kuo, Melissa; Phillips, Leah; Berry, Robyn; Tan, Maria

2013-07-01

Restorative sleep is clearly linked with well-being in youth with chronic health conditions. This review addresses the methodological quality of non-pharmacological sleep intervention (NPSI) research for youth with chronic health conditions. The Guidelines for Critical Review (GCR) and the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) were used in the review. The search yielded 31 behavioural and 10 non-behavioural NPSI for review. Most studies had less than 10 participants. Autism spectrum disorders, attention deficit/hyperactivity disorders, down syndrome, intellectual disabilities, and visual impairments were the conditions that most studies focused upon. The global EPHPP scores indicated most reviewed studies were of weak quality. Only 7 studies were rated as moderate, none were strong. Studies rated as weak quality frequently had recruitment issues; non-blinded participants/parents and/or researchers; and used outcome measures without sound psychometric properties. Little conclusive evidence exists for NPSIs in this population. However, NPSIs are widely used and these preliminary studies demonstrate promising outcomes. There have not been any published reports of negative outcomes that would preclude application of the different NPSIs on a case-by-case basis guided by clinical judgement. These findings support the need for more rigorous, applied research. • Methodological Quality of Sleep Research • Disordered sleep (DS) in youth with chronic health conditions is pervasive and is important to rehabilitation therapists because DS contributes to significant functional problems across psychological, physical and emotional domains. • Rehabilitation therapists and other healthcare providers receive little education about disordered sleep and are largely unaware of the range of assessment and non-pharmacological intervention strategies that exist. An evidence-based website of pediatric sleep resources can be found at http://www.SleepRight.ualberta.ca • The current research on non-pharmacological sleep interventions (NPSI) for youth with health conditions is methodologically weak. However, consistently positive outcomes reported in the literature demonstrate that pragmatic interventions such as bright light therapy, activity, massage and behavioral interventions are promising areas. No studies found reasons that a trail of a NPSI matched to the youth's context and condition should not attempted. More rigorous clinically relevant study of pragmatic non-pharmacological interventions appropriate for therapists' and parents' needs is required.

Living with tics: reduced impairment and improved quality of life for youth with chronic tic disorders.

PubMed

McGuire, Joseph F; Arnold, Elysse; Park, Jennifer M; Nadeau, Joshua M; Lewin, Adam B; Murphy, Tanya K; Storch, Eric A

2015-02-28

Pharmacological and behavioral interventions have focused on reducing tic severity to alleviate tic-related impairment for youth with chronic tic disorders (CTDs), with no existing intervention focused on the adverse psychosocial consequences of tics. This study examined the preliminary efficacy of a modularized cognitive behavioral intervention ("Living with Tics", LWT) in reducing tic-related impairment and improving quality of life relative to a waitlist control of equal duration. Twenty-four youth (ages 7-17 years) with Tourette Disorder or Chronic Motor Tic Disorder and psychosocial impairment participated. A treatment-blind evaluator conducted all pre- and post-treatment clinician-rated measures. Youth were randomly assigned to receive the LWT intervention (n=12) or a 10-week waitlist (n=12). The LWT intervention consisted of up to 10 weekly sessions targeted at reducing tic-related impairment and developing skills to manage psychosocial consequences of tics. Youth in the LWT condition experienced significantly reduced clinician-rated tic-impairment, and improved child-rated quality of life. Ten youth (83%) in the LWT group were classified as treatment responders compared to four youth in the waitlist condition (33%). Treatment gains were maintained at one-month follow-up. Findings provide preliminary data that the LWT intervention reduces tic-related impairment and improves quality of life for youth with CTDs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Living with Tics: Reduced Impairment and Improved Quality of Life for Youth with Chronic Tic Disorders

PubMed Central

McGuire, Joseph F.; Arnold, Elysse; Park, Jennifer M.; Nadeau, Joshua M.; Lewin, Adam B.; Murphy, Tanya K.; Storch, Eric A.

2014-01-01

Pharmacological and behavioral interventions have focused on reducing tic severity to alleviate tic-related impairment for youth with chronic tic disorders (CTDs), with no existing intervention focused on the adverse psychosocial consequences of tics. This study examined the preliminary efficacy of a modularized cognitive behavioral intervention ("Living with Tics", LWT) in reducing tic-related impairment and improving quality of life relative to a waitlist control of equal duration. Twenty-four youth (ages 7–17 years) with Tourette Disorder or Chronic Motor Tic Disorder and psychosocial impairment participated. A treatment-blind evaluator conducted all pre- and post-treatment clinician-rated measures. Youth were randomly assigned to receive the LWT intervention (n=12) or a 10-week waitlist (n=12). The LWT intervention consisted of up to 10 weekly sessions targeted at reducing tic-related impairment and developing skills to manage psychosocial consequences of tics. Youth in the LWT condition experienced significantly reduced clinician-rated tic-impairment, and improved child-rated quality of life. Ten youth (83%) in the LWT group were classified as treatment responders compared to four youth in the waitlist condition (33%). Treatment gains were maintained at one-month follow-up. Findings provide preliminary data that the LWT intervention reduces tic-related impairment and improves quality of life for youth with CTDs. PMID:25500348

A randomized controlled trial of a peer co-led dissonance-based eating disorder prevention program for gay men.

PubMed

Brown, Tiffany A; Keel, Pamela K

2015-11-01

Gay males have increased risk for eating disorders compared to heterosexual males, establishing a need to develop and empirically evaluate programs to reduce risk for this population. The present study investigated the acceptability and efficacy of a cognitive dissonance-based (DB) intervention (The PRIDE Body Project(©)) in reducing eating disorder risk factors among gay males in a university-based setting. Eighty-seven gay males were randomized to either a 2-session DB intervention (n = 47) or a waitlist control condition (n = 40). Participants completed eating disorder risk factor assessments pre-intervention, post-intervention, and at 4-week follow-up, and those receiving the intervention completed post-treatment acceptability measures. Acceptability ratings were highly favorable. Regarding efficacy, the DB condition was associated with significantly greater decreases in body dissatisfaction, drive for muscularity, self-objectification, partner-objectification, body-ideal internalization, dietary restraint, and bulimic symptoms compared to waitlist control from pre- to post-intervention. Improvements in the DB group were maintained at 4-week follow-up, with the exception of body-ideal internalization. Body-ideal internalization mediated treatment effects on bulimic symptoms. Results support the acceptability and efficacy of The PRIDE Body Project(©) and provide support for theoretical models of eating pathology in gay men. Copyright © 2015 Elsevier Ltd. All rights reserved.

Being Human: A Qualitative Interview Study Exploring Why a Telehealth Intervention for Management of Chronic Conditions Had a Modest Effect.

PubMed

O'Cathain, Alicia; Drabble, Sarah J; Foster, Alexis; Horspool, Kimberley; Edwards, Louisa; Thomas, Clare; Salisbury, Chris

2016-06-30

Evidence of benefit for telehealth for chronic conditions is mixed. Two linked randomized controlled trials tested the Healthlines Service for 2 chronic conditions: depression and high risk of cardiovascular disease (CVD). This new telehealth service consisted of regular telephone calls from nonclinical, trained health advisers who followed standardized scripts generated by interactive software. Advisors facilitated self-management by supporting participants to use Web-based resources and helped to optimize medication, improve treatment adherence, and encourage healthier lifestyles. Participants were recruited from primary care. The trials identified moderate (for depression) or partial (for CVD risk) effectiveness of the Healthlines Service. An embedded qualitative study was undertaken to help explain the results of the 2 trials by exploring mechanisms of action, context, and implementation of the intervention. Qualitative interview study of 21 staff providing usual health care or involved in the intervention and 24 patients receiving the intervention. Interviewees described improved outcomes in some patients, which they attributed to the intervention, describing how components of the model on which the intervention was based helped to achieve benefits. Implementation of the intervention occurred largely as planned. However, contextual issues in patients' lives and some problems with implementation may have reduced the size of effect of the intervention. For depression, patients' lives and preferences affected engagement with the intervention: these largely working-age patients had busy and complex lives, which affected their ability to engage, and some patients preferred a therapist-based approach to the cognitive behavioral therapy on offer. For CVD risk, patients' motivations adversely affected the intervention whereby some patients joined the trial for general health improvement or from altruism, rather than motivation to make lifestyle changes to address their specific risk factors. Implementation was not optimal in the early part of the CVD risk trial owing to technical difficulties and the need to adapt the intervention for use in practice. For both conditions, enthusiastic and motivated staff offering continuity of intervention delivery tailored to individual patients' needs were identified as important for patient engagement with telehealth; this was not delivered consistently, particularly in the early stages of the trials. Finally, there was a lack of active engagement from primary care. The conceptual model was supported and could be used to develop further telehealth interventions for chronic conditions. It may be possible to increase the effectiveness of this, and similar interventions, by attending to the human as well as the technical aspects of telehealth: offering it to patients actively wanting the intervention, ensuring continuity of delivery by enthusiastic and motivated staff, and encouraging active engagement from primary care staff.

Using Participant Data to Extend the Evidence Base for Intensive Behavioral Intervention for Children with Autism

ERIC Educational Resources Information Center

Eldevik, Sigmund; Hastings, Richard P.; Hughes, J. Carl; Jahr, Erik; Eikeseth, Svein; Cross, Scott

2010-01-01

We gathered individual participant data from 16 group design studies on behavioral intervention for children with autism. In these studies, 309 children received behavioral intervention, 39 received comparison interventions, and 105 were in a control group. More children who underwent behavioral intervention achieved reliable change in IQ (29.8%)…

Evaluating the components of an emergent literacy intervention for preschool children at risk for reading difficulties

PubMed Central

Lonigan, Christopher J.; Purpura, David J.; Wilson, Shauna B.; Walker, Patricia M.; Clancy-Menchetti, Jeanine

2013-01-01

Many preschool children are at risk for reading problems because of inadequate emergent literacy skills. Evidence supports the effectiveness of interventions to promote these skills, but questions remain about which intervention components work and whether combining intervention components will result in larger gains. In this study, 324 preschoolers (mean age = 54.32 months, SD = 5.88) from low-income backgrounds (46% girls and 54% boys; 82% African American, 14% White, and 4% other) were randomized to combinations of meaning-focused (dialogic reading or shared reading) and code-focused (phonological awareness, letter knowledge, or both) interventions or a control group. Interventions had statistically significant positive impacts only on measures of their respective skill domains. Combinations of interventions did not enhance outcomes across domains, indicating instructional needs in all areas of weakness for young children at risk for later reading difficulties. Less time for each intervention in the combined phonological awareness and letter knowledge intervention conditions, however, did not result in reduced effects relative to nearly twice as much time for each intervention when children received either only the phonological awareness intervention or only the letter knowledge intervention. This finding suggests that a relatively compact code-focused intervention can address the needs of children with weaknesses in both domains. PMID:23073367

Effects of Plantar Flexor Muscle Static Stretching Alone and Combined With Massage on Postural Balance.

PubMed

Hemmati, Ladan; Rojhani-Shirazi, Zahra; Ebrahimi, Samaneh

2016-10-01

To evaluate and compare the effects of stretching and combined therapy (stretching and massage) on postural balance in people aged 50 to 65 years. Twenty-three subjects participated in this nonrandomized clinical trial study. Each participant randomly received plantar flexor muscle stretching (3 cycles of 45 seconds with a 30-second recovery period between cycles) alone and in combination with deep stroking massage (an interval of at least 30 minutes separated the two interventions). The data were recorded with a force platform immediately after each condition with eyes open and closed. The center of pressure displacement and velocity along the mediolateral and anteroposterior axes were calculated under each condition. The data were analyzed with multiple-pair t-tests. The center of pressure displacement and velocity along the mediolateral axis increased after both stretching and the combined intervention. There were significant differences in both values between participants in the stretching and combined interventions (p<0.05). Plantar flexor muscle stretching (for 45 seconds) combined with deep stroking massage may have more detrimental effects on postural balance than stretching alone because each intervention can intensify the effects of the other.

Randomized controlled trial of a computer-based module to improve contraceptive method choice.

PubMed

Garbers, Samantha; Meserve, Allison; Kottke, Melissa; Hatcher, Robert; Ventura, Alicia; Chiasson, Mary Ann

2012-10-01

Unintended pregnancy is common in the United States, and interventions are needed to improve contraceptive use among women at higher risk of unintended pregnancy, including Latinas and women with low educational attainment. A three-arm randomized controlled trial was conducted at two family planning sites serving low-income, predominantly Latina populations. The trial tested the efficacy of a computer-based contraceptive assessment module in increasing the proportion of patients choosing an effective method of contraception (<10 pregnancies/100 women per year, typical use). Participants were randomized to complete the module and receive tailored health materials, to complete the module and receive generic health materials, or to a control condition. In intent-to-treat analyses adjusted for recruitment site (n=2231), family planning patients who used the module were significantly more likely to choose an effective contraceptive method: 75% among those who received tailored materials [odds ratio (OR)=1.56; 95% confidence interval (CI): 1.23-1.98] and 78% among those who received generic materials (OR=1.74; 95% CI: 1.35-2.25), compared to 65% among control arm participants. The findings support prior research suggesting that patient-centered interventions can positively influence contraceptive method choice. Copyright © 2012 Elsevier Inc. All rights reserved.

Economic Evaluation of a Patient-Directed Music Intervention for ICU Patients Receiving Mechanical Ventilatory Support.

PubMed

Chlan, Linda L; Heiderscheit, Annette; Skaar, Debra J; Neidecker, Marjorie V

2018-05-04

Music intervention has been shown to reduce anxiety and sedative exposure among mechanically ventilated patients. Whether music intervention reduces ICU costs is not known. The aim of this study was to examine ICU costs for patients receiving a patient-directed music intervention compared with patients who received usual ICU care. A cost-effectiveness analysis from the hospital perspective was conducted to determine if patient-directed music intervention was cost-effective in improving patient-reported anxiety. Cost savings were also evaluated. One-way and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. Midwestern ICUs. Adult ICU patients from a parent clinical trial receiving mechanical ventilatory support. Patients receiving the experimental patient-directed music intervention received a MP3 player, noise-canceling headphones, and music tailored to individual preferences by a music therapist. The base case cost-effectiveness analysis estimated patient-directed music intervention reduced anxiety by 19 points on the Visual Analogue Scale-Anxiety with a reduction in cost of $2,322/patient compared with usual ICU care, resulting in patient-directed music dominance. The probabilistic cost-effectiveness analysis found that average patient-directed music intervention costs were $2,155 less than usual ICU care and projected that cost saving is achieved in 70% of 1,000 iterations. Based on break-even analyses, cost saving is achieved if the per-patient cost of patient-directed music intervention remains below $2,651, a value eight times the base case of $329. Patient-directed music intervention is cost-effective for reducing anxiety in mechanically ventilated ICU patients.

The role of tobacco outlet density in a smoking cessation intervention for urban youth.

PubMed

Mennis, Jeremy; Mason, Michael; Way, Thomas; Zaharakis, Nikola

2016-03-01

This study investigates the role of tobacco outlet density in a randomized controlled trial of a text messaging-based smoking cessation intervention conducted among a sample of 187 primarily African American youth in a midsize U.S. city. A moderated mediation model was used to test whether the indirect effect of residential tobacco outlet density on future smoking was mediated by the intention to smoke, and whether this indirect effect differed between adolescents who received the intervention and those who did not. Results indicated that tobacco outlet density is associated with intention to smoke, which predicts future smoking, and that the indirect effect of tobacco outlet density on future smoking is moderated by the intervention. Tobacco outlet density and the intervention can be viewed as competing forces on future smoking behavior, where higher tobacco outlet density acts to mitigate the sensitivity of an adolescent to the intervention's intended effect. Smoking cessation interventions applied to youth should consider tobacco outlet density as a contextual condition that can influence treatment outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Preconceptional motivational interviewing interventions to reduce alcohol-exposed pregnancy risk.

PubMed

Ingersoll, Karen S; Ceperich, Sherry D; Hettema, Jennifer E; Farrell-Carnahan, Leah; Penberthy, J Kim

2013-04-01

Alcohol exposed pregnancy (AEP) is a leading cause of preventable birth defects. While randomized controlled trials (RCTs) have shown that multi-session motivational interviewing-based interventions reduce AEP risk, a one-session intervention could facilitate broader implementation. The purposes of this study were to: (1) test a one-session motivational AEP prevention intervention for community women and (2) compare outcomes to previous RCTs. Participants at risk for AEP (N=217) were randomized to motivational interviewing+assessment feedback (EARLY), informational video, or informational brochure conditions. Outcomes were drinks per drinking day (DDD), ineffective contraception rate, and AEP risk at 3 and 6 months. All interventions were associated with decreased DDD, ineffective contraception rate, and AEP risk. Participants who received EARLY had larger absolute risk reductions in ineffective contraception and AEP risk, but not DDD. Effect sizes were compared to previous RCTs. The one-session EARLY intervention had less powerful effects than multi-session AEP prevention interventions among community women, but may provide a new option in a continuum of preventive care. Copyright © 2013 Elsevier Inc. All rights reserved.

Trauma rehabilitation for war-affected persons in northern Uganda: a pilot evaluation of the EMPOWER programme.

PubMed

Sonderegger, Robi; Rombouts, Sacha; Ocen, Benson; McKeever, Reyelle Sarah

2011-09-01

OBJECTIVES. This study evaluated the impact of a culturally sensitive cognitive behaviour therapy (CBT)-based intervention (the EMPOWER programme) for war-affected persons in northern Uganda. DESIGN. The study conducted a pilot evaluation with a convenience sample of participants from internally displaced persons (IDPs) camps (i.e., a treatment camp and waitlist control camp). This was done to avoid treatment effects spreading from the intervention to control conditions. METHODS. A total of 202 participants (N= 90 treatment participants and N= 112 control participants) were included as a convenience sample. The Acholi Psychosocial Assessment Instrument (APAI), a culturally appropriate measure of psychosocial functioning, was administered to participants residing in two IDP camps at pre-treatment, post-treatment, and at 3-month follow-up. Participants in the treatment camp received the EMPOWER programme--a culturally sensitive CBT-based intervention teaching emotional resiliency and promoting forgiveness. RESULTS. Participants in the treatment condition reported (a) significantly lower scores on the depression-like syndromes and the anxiety-like syndrome and (b) significantly more prosocial behaviours, than participants in the control condition. CONCLUSIONS. The results of this study provide initial support for the application of structured CBT interventions in war-affected areas, illustrating that the EMPOWER programme could be utilized by humanitarian agencies to address the psychosocial needs of war-affected displaced persons. ©2010 The British Psychological Society.

A pragmatic randomized controlled trial of the Flinders Program of chronic condition management in community health care services.

PubMed

Battersby, Malcolm; Harris, Melanie; Smith, David; Reed, Richard; Woodman, Richard

2015-11-01

To evaluate the Flinders Program in improving self-management in common chronic conditions. To examine properties of the Partners in Health scale (PIH). Participants were randomized to usual care or Flinders Program plus usual care. Self-management competency, quality of life, and other outcomes were measured at baseline, 6 months, and 12 months. Of 231 participants, 172 provided data at 6 months and 61 at 12 months. At 6 months, intention-to-treat outcomes favoured the intervention group for SF-12 physical health (p=0.043). Other pre-determined outcomes did not show significance. At 6 months intervention participants' problem severity scores reduced (p<0.001) and goal achievement scores increased (p<0.001). Only 55% of the intervention group received a Flinders Program, compromising study power. The PIH was associated with other measures at baseline and for change over time. In a pragmatic community trial, the Flinders Program improved quality of life at 6 months. Incomplete in-practice intervention delivery limited trial power. Studies are now needed on improving delivery. The PIH has potential as a generic risk screening tool and predictive measure of change in self-management and chronic condition outcomes over time. Better implementation including service integration is required for improved chronic disease management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Study protocol: a cluster randomized controlled trial to assess the effectiveness of a multi-pronged behavioural intervention to improve use of personal protective equipment among migrant workers exposed to organic solvents in small and medium-sized enterprises.

PubMed

Chen, Wen; Li, Tongyang; Zou, Guanyang; Li, Xudong; Shi, Leiyu; Feng, Shanshan; Shi, Jingrong; Zhou, Fangjing; Han, Siqi; Ling, Li

2016-07-16

In China, most of migrant workers work in the small and medium-sized enterprises (SMEs) and are a vulnerable group for occupational health. Migrant workers are at increased risk of occupational health risks due to poor occupational health behaviours such as the low use of personal protective equipment (PPE). However, there is a lack of solid evidence regarding how to improve the use of PPE among migrant workers in SMEs. The current study will assess the effectiveness of a multi-pronged behavioural intervention designed to promote PPE utilization among migrant workers exposed to organic solvents in SMEs. This is a single blind, three-arm cluster randomized trial with 60 SMEs equally randomized to receive a top-down intervention (i.e. general health education and mHealth intervention provided by researchers) or a comprehensive intervention (which includes both top-down intervention and peer education) or a control condition (participants will not receive the intervention, but study measures will be obtained). Interventions will be conducted at the SMEs level for 6 months and all eligible migrant workers in these SMEs will be enrolled into the trial. The primary outcome is effective use of PPE during the last week. The secondary outcomes are occupational health knowledge and attitude and participation in occupational health check-up. Data will be collected and assessed at baseline; 3 months post baseline and the end of the intervention. This theory- and evidence based intervention will contribute to the limited evidence of behaviour change intervention in improving PPE utilization of migrant workers in SMEs, and provide timely evidence for the development of basic occupational health services in China and elsewhere with similar industrialization contexts. ChiCTR-IOR-15006929 . Registered on 16 August 2015.

The root of the problem: increasing root vegetable intake in preschool children by repeated exposure and flavour flavour learning.

PubMed

Ahern, Sara M; Caton, Samantha J; Blundell, Pam; Hetherington, Marion M

2014-09-01

Children's vegetable consumption falls below current recommendations, highlighting the need to identify strategies that can successfully promote intake. The current study aimed to investigate the effectiveness of flavour-flavour learning as one such strategy for increasing vegetable intake in preschool children. Children (N = 29) aged 15 to 56 months were recruited through participating nurseries. Each received a minimum of six and maximium eight exposures to a root vegetable puree with added apple puree (flavour-flavour learning) alternating with six to eight exposures to another with nothing added (repeated exposure). A third puree acted as a control. Pre- and post-intervention intake measures of the three purees with nothing added were taken to assess change in intake. Follow-up measures took place 1 month (n = 28) and 6 months (n = 10) post-intervention. Intake increased significantly from pre- to post-intervention for all purees (~36 g), with no effect of condition. Magnitude of change was smaller in the control condition. Analysis of follow-up data showed that intake remained significantly higher than baseline 1 month (p < 0.001) and 6 months (p < 0.001) post-intervention for all conditions. Children under 24 months ate consistently more across the intervention than the older children (≥24 m) with no differences found in response to condition. This study confirms previous observations that repeated exposure increases intake of a novel vegetable in young children. Results also suggest that mere exposure (to the food, the experimenters, the procedure) can generalise to other, similar vegetables but the addition of a familiar flavour confers no added advantage above mere exposure. Copyright © 2014 Elsevier Ltd. All rights reserved.

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder.

PubMed

Wagner, Birgit; Nagl, Michaela; Dölemeyer, Ruth; Klinitzke, Grit; Steinig, Jana; Hilbert, Anja; Kersting, Anette

2016-07-01

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n=69) or a wait-list condition (n=70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination-Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d=1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82≤d≤1.11). In the treatment group significant improvement was still observed for all measures 1year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED. Copyright © 2016. Published by Elsevier Ltd.

Social cognitive mediators of the effect of the MobileMums intervention on physical activity.

PubMed

Fjeldsoe, Brianna S; Miller, Yvette D; Marshall, Alison L

2013-07-01

To explore whether improvements in physical activity following the MobileMums intervention were mediated by changes in Social Cognitive Theory (SCT) constructs targeted in the intervention (barrier self efficacy, goal setting skills, outcome expectancy, social support, and perceived environmental opportunity for exercise). This paper also examined if the mediating constructs differed between initial (baseline to 6 weeks) and overall (baseline to 13 weeks) changes in physical activity. Secondary analysis of data from a randomized controlled trial involving 88 postnatal women (<12 months postpartum). Participants were randomized to receive either the 12-week MobileMums intervention or a minimal-contact control condition. Physical activity and proposed mediators were assessed by self-report at baseline, 6 weeks, and 13 weeks. Walking for Exercise frequency was assessed using the Australian Women's Activity Survey and frequency of moderate-to-vigorous physical activity (MVPA) was assessed using a single-item question. Initial improvements in goal-setting skills mediated the relationship between experimental condition and initial changes in MVPA, αβ (95% CI) = 0.23(0.01, 0.59), and Walking for Exercise, αβ (95% CI) = 0.34(0.06, 0.73). Initial improvements in barrier self efficacy mediated the relationship between experimental condition and initial change in MVPA, αβ (95% CI) = 0.36(0.12, 0.65), but not Walking for Exercise. None of the SCT outcomes significantly mediated the relationship between experimental condition and overall (baseline to 13 weeks) change in frequency of MVPA or Walking for Exercise. Future interventions with postnatal women using SCT should target barrier self-efficacy and goal setting skills in order to increase physical activity. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Feasibility study of a peer-facilitated low intensity cognitive-behavioral intervention for mild to moderate depression and anxiety in older adults.

PubMed

Seeley, John R; Manitsas, Tara; Gau, Jeff M

2017-09-01

The majority of older adults experiencing depression and/or anxiety do not receive adequate treatment due to limited access to evidence-based practices. Low intensity cognitive-behavioral intervention has been established as an evidence-based practice with the potential to increase the reach to older adults. The purpose of the current study is to evaluate the feasibility, acceptability, and potential efficacy of a low intensity, peer-supported, cognitive-behavioral intervention for mild to moderate depression and/or anxiety delivered by a local intergovernmental agency serving older adults. Sixty-two older adults (81% female) between 55 and 96 years of age were randomly assigned to either a peer-facilitated cognitive-behavioral bibliotherapy condition (n = 31) or a wait-list control condition (n = 31). The 10-week feasibility trial data indicated that (1) a majority of the participants were highly engaged in the intervention with an average number of 7.3 peer sessions attended and 2.1 workbooks completed, (2) the participants were quite satisfied with the peer mentoring sessions and moderately satisfied with the workbooks, and (3) there were clinically meaningful reductions in depressive symptoms for those assigned to the treatment condition compared to those that were wait-listed (d = .43), though the effect was non-significant (p = .099) due to the small sample size. The evidence for the impact on reducing anxiety symptoms was more equivocal with a non-significant, small effect size favoring the treatment condition. The pilot study provided preliminary evidence for the feasibility, acceptability, and potential efficacy of the peer-facilitated low intensity cognitive-behavioral therapy intervention approach.

Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study.

PubMed

van Dongen, Ellen Ji; Duijzer, Geerke; Jansen, Sophia C; Ter Beek, Josien; Huijg, Johanna M; Leerlooijer, Joanne N; Hiddink, Gerrit J; Feskens, Edith Jm; Haveman-Nies, Annemien

2016-11-01

To investigate (i) how the SLIMMER intervention was delivered and received in Dutch primary health care and (ii) how this could explain intervention effectiveness. A randomised controlled trial was conducted and subjects were randomly allocated to the intervention (10-month combined dietary and physical activity intervention) or the control group. A process evaluation including quantitative and qualitative methods was conducted. Data on process indicators (recruitment, reach, dose received, acceptability, implementation integrity and applicability) were collected via semi-structured interviews with health-care professionals (n 45) and intervention participant questionnaires (n 155). SLIMMER was implemented in Dutch primary health care in twenty-five general practices, eleven dietitians, nine physiotherapist practices and fifteen sports clubs. Subjects at increased risk of developing type 2 diabetes were included. It was possible to recruit the intended high-risk population (response rate 54 %) and the SLIMMER intervention was very well received by both participants and health-care professionals (mean acceptability rating of 82 and 80, respectively). The intervention programme was to a large extent implemented as planned and was applicable in Dutch primary health care. Higher dose received and participant acceptability were related to improved health outcomes and dietary behaviour, but not to physical activity behaviour. The present study showed that it is feasible to implement a diabetes prevention intervention in Dutch primary health care. Higher dose received and participant acceptability were associated with improved health outcomes and dietary behaviour. Using an extensive process evaluation plan to gain insight into how an intervention is delivered and received is a valuable way of identifying intervention components that contribute to implementation integrity and effective prevention of type 2 diabetes in primary health care.

A Randomized Clinical Trial of Cogmed Working Memory Training in School-Age Children with ADHD: A Replication in a Diverse Sample Using a Control Condition

ERIC Educational Resources Information Center

Chacko, A.; Bedard, A. C.; Marks, D. J.; Feirsen, N.; Uderman, J. Z.; Chimiklis, A.; Rajwan, E.; Cornwell, M.; Anderson, L.; Zwilling, A.; Ramon, M.

2014-01-01

Background: Cogmed Working Memory Training (CWMT) has received considerable attention as a promising intervention for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children. At the same time, methodological weaknesses in previous clinical trials call into question reported efficacy of CWMT. In particular, lack of equivalence…

Testing a Dutch web-based tailored lifestyle programme among adults: a study protocol.

PubMed

Schulz, Daniela N; Kremers, Stef Pj; van Osch, Liesbeth Adm; Schneider, Francine; van Adrichem, Mathieu Jg; de Vries, Hein

2011-02-16

Smoking, high alcohol consumption, unhealthy eating habits and physical inactivity often lead to (chronic) diseases, such as cardiovascular diseases and cancer. Tailored online interventions have been proven to be effective in changing health behaviours. The aim of this study is to test and compare the effectiveness of two different tailoring strategies for changing lifestyle compared to a control group using a multiple health behaviour web-based approach. In our Internet-based tailored programme, the five lifestyle behaviours of smoking, alcohol intake, fruit consumption, vegetable consumption, and physical activity are addressed. This randomized controlled trial, conducted among Dutch adults, includes two experimental groups (i.e., a sequential behaviour tailoring condition and a simultaneous behaviour tailoring condition) and a control group. People in the sequential behaviour tailoring condition obtain feedback on whether their lifestyle behaviours meet the Dutch recommendations. Using a step-by-step approach, they are stimulated to continue with a computer tailored module to change only one unhealthy behaviour first. In the course of the study, they can proceed to change a second behaviour. People in the simultaneous behaviour tailoring condition receive computer tailored feedback about all their unhealthy behaviours during their first visit as a stimulation to change all unhealthy behaviours. The experimental groups can re-visit the website and can then receive ipsative feedback (i.e., current scores are compared to previous scores in order to give feedback about potential changes). The (difference in) effectiveness of the different versions of the programme will be tested and compared to a control group, in which respondents only receive a short health risk appraisal. Programme evaluations will assess satisfaction with and appreciation and personal relevance of the intervention among the respondents. Finally, potential subgroup differences pertaining to gender, age and socioeconomic status regarding the behaviour effects and programme evaluation will be assessed. Research regarding multiple behaviour change is in its infancy. We study how to offer multiple behaviour change interventions optimally. Using these results could strengthen the effectiveness of web-based computer-tailoring lifestyle programmes. This study will yield new results about the need for differential lifestyle approaches using Internet-based expert systems and potential differences in subgroups concerning the effectiveness and appreciation. Dutch Trial Register NTR2168.

An assessment of antenatal care among Syrian refugees in Lebanon.

PubMed

Benage, Matthew; Greenough, P Gregg; Vinck, Patrick; Omeira, Nada; Pham, Phuong

2015-01-01

After more than three years of violence in Syria, Lebanon hosts over one million Syrian refugees creating significant public health concerns. Antenatal care delivery to tens of thousands of pregnant Syrian refugee women is critical to preventing maternal and fetal mortality but is not well characterized given the multiple factors obtaining health data in a displaced population. This study describes antenatal care access, the scope of existing antenatal care, and antenatal and family planning behaviors and practice among pregnant Syrian refugees in various living conditions and multiple geographic areas of Lebanon. A field-based survey was conducted between July and October 2013 in 14 main geographic sites of refugee concentration. The assessment evaluated antenatal services among a non-randomized sample of 420 self-identified pregnant Syrian refugee women that included demographics, gestational age, living accommodation, antenatal care coverage, antenatal care content, antenatal health behaviors, antenatal health literacy, and family planning perception and practices. In total, 420 pregnant Syrian refugees living in Lebanon completed the survey. Of these, 82.9% (348) received some antenatal care. Of those with at least one antenatal visit, 222 (63.8%) received care attended by a skilled professional three or more times, 111 (31.9%) 1-2 times, and 15 (4.3%) had never received skilled antenatal care. We assessed antenatal care content defined by blood pressure measurement, and urine and blood sample analyses. Of those who had received any antenatal care, only 31.2% received all three interventions, 18.2% received two out of three, 32.1% received one out of three, and 18.5% received no interventions. Only (41.2%) had an adequate diet of vitamins, minerals, and folic acid. Access, content and health behaviors varied by gestational age, type of accommodation and location in Lebanon. Standards of antenatal care are not being met for pregnant Syrian refugee women in Lebanon. This descriptive analysis of relative frequencies suggests reproductive health providers should focus attention on increasing antenatal care visits, particularly to third trimester and late gestational age patients and to those in less secure sheltering arrangements. With this approach they can improve care content by providing early testing and interventions per accepted guidelines designed to improve pregnancy outcomes.

Randomized Controlled Trial of a Brief Versus Extended Internet Intervention for Problem Drinkers.

PubMed

Cunningham, John A; Shorter, Gillian W; Murphy, Michelle; Kushnir, Vladyslav; Rehm, Jürgen; Hendershot, Christian S

2017-10-01

Brief Internet interventions have been shown to reduce alcohol consumption. This trial intended to compare the effects of one such brief intervention to an extended Internet intervention for problem drinkers. Using online advertising, 490 participants, 18 years or older, were recruited and randomized to receive a brief ( CheckYourDrinking.net ) versus an extended ( AlcoholHelpCentre.net ) Internet intervention and were followed up at 6, 12, and 24 months. The per protocol primary analysis assessed difference between condition at the 12-month follow-up. The follow-up rate at 12 months was 83.3 %. ANCOVAs of the primary (Alcohol Use Disorder Identification Test (AUDIT)-C) and secondary outcome variables (drinks in a typical week, highest number of drinks on one occasion-baseline drinking as covariate) revealed no significant (p > 0.05) differences between the interventions. Similarly, combined analyses of the 6-, 12-, and 24-month follow-up revealed no significant differences between interventions at all time points. The present study does not provide support for the added benefit of an extended Internet intervention for problem drinkers over a brief Internet intervention.

Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study.

PubMed

Chen, Shulin; Conwell, Yeates; Xue, Jiang; Li, Lydia W; Tang, Wan; Bogner, Hillary R; Dong, Hengjin

2018-05-29

Depression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas. The Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person's primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village's Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects' electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention. The COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life. ClinicalTrials.gov ID: NCT01938963 ; First posted: September 10, 2013.

What's Possible for First-Grade At-Risk Literacy Learners Receiving Early Intervention Services

ERIC Educational Resources Information Center

Bufalino, Janet; Wang, Chuang; Gomez-Bellenge, Francisco X.; Zalud, Garreth

2010-01-01

This paper summarizes a study that was conducted on data from children who received a one-on-one intervention called Reading Recovery[R] during the first half of their first-grade year in school. The purpose was to investigate the relationship between accelerated progress children made during and after receiving a Reading Recovery intervention,…

The effects of exposure to feminist ideology on women's body image.

PubMed

Peterson, Rachel D; Tantleff-Dunn, Stacey; Bedwell, Jeffrey S

2006-09-01

Body image disturbance has become a common problem among women and there is a need to focus on creating empirically supported treatments. Psychoeducational interventions have reduced body image dissatisfaction, but their impact is limited because they do not offer women adaptive methods of interpreting the many appearance-related messages they receive. This study examined if exposure to a feminist perspective may provide alternative interpretations of cultural messages, thereby increasing body image satisfaction. Participants were randomly assigned to a feminist or psychoeducational intervention, or a control group. Exposure to the feminist condition resulted in increased self-identification as a feminist and greater appearance satisfaction, and changes in feminist identity were related to positive changes in body image. The findings indicate that exposure to feminist theories may serve as an effective intervention strategy.

A Telephone Intervention for Substance-Using Adult Male Perpetrators of Intimate Partner Violence.

PubMed

Mbilinyi, Lyungai F; Neighbors, Clayton; Walker, Denise D; Roffman, Roger A; Zegree, Joan; Edleson, Jeffrey; O'Rourke, Allison

2011-01-27

OBJECTIVE: To preliminarily evaluate telephone-delivered motivational enhancement therapy (MET) in motivating unadjudicated and nontreatment seeking intimate partner violence (IPV) perpetrators, who also use substances, to self-refer into treatment. METHOD: 124 adult men were recruited via a multimedia marketing campaign and were randomly assigned to the intervention (MET) or comparison group following a baseline assessment. Participants in the MET condition received a personalized feedback report on their IPV and substance-use behaviors, consequences, and social norms beliefs. RESULTS: Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, increasing motivation for treatment seeking, and changing perceived norms for IPV and substance abuse (SA). CONCLUSIONS: Applications for brief MET interventions to facilitate voluntary treatment entry among substance-using IPV perpetrators are discussed.

Counseling African Americans to Control Hypertension (CAATCH) Trial: A Multi-level Intervention to Improve Blood Pressure Control in Hypertensive African Americans

PubMed Central

Ogedegbe, Gbenga; Tobin, Jonathan N.; Fernandez, Senaida; Gerin, William; Diaz-Gloster, Marleny; Cassells, Andrea; Khalida, Chamanara; Pickering, Thomas; Schoenthaler, Antoinette; Ravenell, Joseph

2009-01-01

Background Despite strong evidence of effective interventions targeted at blood pressure (BP) control, there is little evidence on the translation of these approaches to routine clinical practice in care of hypertensive African Americans. The goal of this study is to evaluate the effectiveness of a multi-level, multi-component, evidence-based intervention compared to usual care in improving BP control among hypertensive African Americans who receive care in Community Health Centers (CHCs). The primary outcomes are BP control rate at 12 months; and maintenance of intervention one year after the trial. The secondary outcomes are within-patient change in BP from baseline to 12 months and cost effectiveness of the intervention. Methods and Results Counseling African Americans to Control Hypertension (CAATCH) is a group randomized clinical trial with two conditions: Intervention Condition (IC) and Usual Care (UC). Thirty CHCs were randomly assigned equally to the IC group (N=15) or the UC group (N=15). The intervention is comprised of three components targeted at patients (interactive computerized hypertension education; home BP monitoring; and monthly behavioral counseling on lifestyle modification) and two components targeted at physicians (monthly case rounds based on JNC-7 guidelines; chart audit and provision of feedback on clinical performance and patients’ home BP readings). All outcomes are assessed at quarterly study visits for one year. Chart review is conducted at 24 months to evaluate maintenance of intervention effects and sustainability of the intervention. Conclusions Poor BP control is one of the major reasons for the mortality gap between African Americans and whites. Findings from this study, if successful, will provide salient information needed for translation and dissemination of evidence-based interventions targeted at BP control into clinical practice for this high-risk population. PMID:20031845

A System Dynamics Approach to Modeling the Sensitivity of Inappropriate Emergency Department Utilization

NASA Astrophysics Data System (ADS)

Behr, Joshua G.; Diaz, Rafael

Non-urgent Emergency Department utilization has been attributed with increasing congestion in the flow and treatment of patients and, by extension, conditions the quality of care and profitability of the Emergency Department. Interventions designed to divert populations to more appropriate care may be cautiously received by operations managers due to uncertainty about the impact an adopted intervention may have on the two values of congestion and profitability. System Dynamics (SD) modeling and simulation may be used to measure the sensitivity of these two, often-competing, values of congestion and profitability and, thus, provide an additional layer of information designed to inform strategic decision making.

Influence of Quality of Relationship Between Patient With Melanoma and Partner on Partner-Assisted Skin Examination Education: A Randomized Clinical Trial.

PubMed

Hultgren, Brittney A; Turrisi, Rob; Mallett, Kimberly A; Ackerman, Sarah; Robinson, June K

2016-02-01

Melanoma has a high survival rate if it is detected early. Training patients with early-stage melanoma who are at risk of developing new melanomas to perform skin self-examination (SSE) may improve survival. To examine for whom the intervention works best in a sample composed of dyads of patients with melanoma and skin-check partners who received an SSE intervention vs customary care. For 494 patients with stage 0 to IIB melanoma (mean age, 55 years; 253 [51.2%] females) and their skin-check partners (mean age, 55 years; 280 [56.7%] females), a randomized clinical trial was conducted in ambulatory care dermatologic offices from June 6, 2011, to April 14, 2014. Follow-up assessments were performed at 12 months. Analysis was performed between March 23 and June 25, 2015. Dyads of 494 patients and their partners were randomly assigned to receive the intervention (395 patients) or customary care (control) (99 patients). The main outcome was patient SSE self-efficacy. Partner motivation to assist with SSE and relationship quality (eg, agreeability, activities with partner, and happiness) were assessed for moderation of the influence of the intervention's effect on SSE self-efficacy. Relationship quality, defined by activities with the partner (β = -0.892, SE = 0.432, t = -2.066; P = .001) and happiness (β = -4.586, SE = 2.044, t = -2.24; P = .001), significantly moderated the intervention effects on patients' SSE self-efficacy. In contrast, patient-partner agreeability (β = -0.262, SE = 0.148, t = -1.773; P = .09) and partner motivation (β = -0.328, SE = 1.024, t = -0.320; P = .10) did not significantly moderate the intervention effects on patients' SSE self-efficacy. Differences between the conditions were highest when activities performed with the partner were below average (mean difference, 6.652; P = .001) and when happiness was below average (mean difference, 7.000; P = .001). Although everyone receiving the intervention experienced some benefit, the findings indicate the greatest increases in self-efficacy were observed for those with below-average activities performed with the partner and happiness. The training of patients with melanoma and their partners in early-detection SSE benefited some more than others. Pairs who have low relationship quality, as determined by activities performed with the partner and happiness, may have received the greatest benefits from the training intervention because they were given an activity to perform together. clinicaltrials.gov Identifier: NCT01432860.

A cluster randomized control field trial of the ABRACADABRA web-based reading technology: replication and extension of basic findings

PubMed Central

Piquette, Noella A.; Savage, Robert S.; Abrami, Philip C.

2014-01-01

The present paper reports a cluster randomized control trial evaluation of teaching using ABRACADABRA (ABRA), an evidence-based and web-based literacy intervention (http://abralite.concordia.ca) with 107 kindergarten and 96 grade 1 children in 24 classes (12 intervention 12 control classes) from all 12 elementary schools in one school district in Canada. Children in the intervention condition received 10–12 h of whole class instruction using ABRA between pre- and post-test. Hierarchical linear modeling of post-test results showed significant gains in letter-sound knowledge for intervention classrooms over control classrooms. In addition, medium effect sizes were evident for three of five outcome measures favoring the intervention: letter-sound knowledge (d= +0.66), phonological blending (d = +0.52), and word reading (d = +0.52), over effect sizes for regular teaching. It is concluded that regular teaching with ABRA technology adds significantly to literacy in the early elementary years. PMID:25538663

Association Between Extraversion and Exercise Performance Among Elderly Persons Receiving a Videogame Intervention.

PubMed

Zaitsu, Kosuke; Nishimura, Yuki; Matsuguma, Hiroyuki; Higuchi, Shigekazu

2015-10-01

We examined the effects of an exergame intervention on exercise performance, as well as the influence of players' personality traits on the effects of the intervention. In total, 16 elderly persons (>65 years old) participated in the study for 12 weeks. Participants were required to complete the Big Five Scale. We measured the number of times that the sit-to-stand exercise was performed during the interventions with and without exergames. We compared the average number of times that the sit-to-stand exercise was performed per day in each of the two conditions. The average number of times that exercise was undertaken with exergame use was greater than that without exergame use; however, no significant difference was found. The difference between the average number of times that exercise occurred with and without exergame use was positively correlated with neuroticism, negatively correlated with extraversion, and not associated with conscientiousness. The intervention comprising the use of exergames has a positive motivational influence among less extraverted elderly persons.

Influencing care in acute myocardial infarction: a randomized trial comparing 2 types of intervention.

PubMed

Sauaia, A; Ralston, D; Schluter, W W; Marciniak, T A; Havranek, E P; Dunn, T R

2000-01-01

The purpose of this study was to evaluate performance feedback delivered by on-site presentations compared to mailed feedback on improving acute myocardial infarction (AMI) care. We used a randomized trial including 18 hospitals nested within the Cooperative Cardiovascular Project. Patients comprised AMI Medicare patients admitted before (n = 929, 1994 and 1995) and after intervention (n = 438, 1996). Control hospitals received written feedback by mail. The experimental intervention group received a presentation led by a cardiologist and a quality improvement specialist. We assessed the proportion of patients receiving appropriate AMI care before and after the intervention. Both univariate and multivariate analyses demonstrated no effect of the intervention in increasing the proportion of patients who received reperfusion, aspirin, beta-blockers, or angiotensin-converting enzyme inhibitors. On-site feedback presentations were not associated with a larger improvement in AMI care compared to the mailed feedback. Other interventions, such as opinion leaders and patient-directed interventions, may be necessary in order to improve the care of AMI patients.

Current Proportion of Women Receiving Perinatal Psychosocial or Psychological Intervention in Japan

PubMed Central

Suzuki, Shunji; Kuribayashi, Yasushi; Matsuda, Hideo; Asakawa, Yasuyuki; Sekizawa, Akihiko; Tanaka, Masanobu; Okai, Takashi; Kinoshita, Katsuyuki

2016-01-01

Background In this study, we examined the current status of psychosocial or psychological intervention for women during pregnancy and the postpartum period in Japan. Methods We estimated the number of women receiving perinatal psychosocial or psychological intervention in Japan. On December 2015, we requested 2,462 obstetrical facilities that are members of the Japan Association of Obstetricians and Gynecologists (JAOG) to provide information on women who received psychosocial or psychological intervention during pregnancy, the hospitalization period for childbirth and the puerperal 1 month in 2014. A total of 1,305 (53.0%) of the 2,462 obstetrical facilities responded with valid information on a total of 515,373 women, accounting for approximately 52% of all deliveries that occurred in Japan during the study period. Results The number of women who received psychosocial or psychological intervention during pregnancy, the hospitalization period for childbirth and the puerperal 1 month were 4,843 (0.94%), 4,791 (0.93%) and 3,015 (0.59%), respectively. In total, 8,743 women (1.70%) received psychosocial or psychological intervention in 2014. Conclusion Considering the response rate, the number of women requiring perinatal psychosocial or psychological intervention was estimated to be 16,000 per year in Japan. PMID:27222675

Error affect inoculation for a complex decision-making task.

PubMed

Tabernero, Carmen; Wood, Robert E

2009-05-01

Individuals bring knowledge, implicit theories, and goal orientations to group meetings. Group decisions arise out of the exchange of these orientations. This research explores how a trainee's exploratory and deliberate process (an incremental theory and learning goal orientation) impacts the effectiveness of individual and group decision-making processes. The effectiveness of this training program is compared with another program that included error affect inoculation (EAI). Subjects were 40 Spanish Policemen in a training course. They were distributed in two training conditions for an individual and group decision-making task. In one condition, individuals received the Self-Guided Exploration plus Deliberation Process instructions, which emphasised exploring the options and testing hypotheses. In the other condition, individuals also received instructions based on Error Affect Inoculation (EAI), which emphasised positive affective reactions to errors and mistakes when making decisions. Results show that the quality of decisions increases when the groups share their reasoning. The AIE intervention promotes sharing information, flexible initial viewpoints, and improving the quality of group decisions. Implications and future directions are discussed.

Relationships of Shared Decision Making with Parental Perceptions of Child Mental Health Functioning and Care

PubMed Central

Weller, Bridget; Titus, Courtney

2016-01-01

Experts encourage parents and practitioners to engage in shared decision making (SDM) to provide high quality child mental health care. However, little is known regarding SDM among families of children with common mental health conditions. The objectives of this study were to examine associations between parental report of SDM and parental perceptions of (a) receiving child mental health care and (b) child mental health functioning. We analyzed cross-sectional data on children with a common mental health condition (attention-deficit hyperactivity disorder, oppositional-defiant or conduct disorder, anxiety, or depression) from the 2009/2010 National Survey of Children with Special Healthcare Needs (N = 9,434). The primary independent variable was parent-reported SDM, and the dependent variables were parental perception of (a) their child receiving all needed mental health care (b) their children's impairment in school attendance and extracurricular activity participation, and (c) severity of their children's mental health condition. Multivariate logistic and multinomial regression analyses were conducted. Greater parent-reported SDM was associated with parental perceptions of receiving all needed child mental health care and children not having school or extracurricular impairment. Greater SDM was also associated with perceptions of children having a mild mental health condition compared to children having a moderate or severe condition. Findings provide a basis for future longitudinal and intervention studies to examine the benefit of SDM for improving parental perceptions of the quality of child mental health care and mental health functioning among children with common mental health conditions. PMID:25577238

Relationships of Shared Decision Making with Parental Perceptions of Child Mental Health Functioning and Care.

PubMed

Butler, Ashley M; Weller, Bridget; Titus, Courtney

2015-11-01

Experts encourage parents and practitioners to engage in shared decision making (SDM) to provide high quality child mental health care. However, little is known regarding SDM among families of children with common mental health conditions. The objectives of this study were to examine associations between parental report of SDM and parental perceptions of (a) receiving child mental health care and (b) child mental health functioning. We analyzed cross-sectional data on children with a common mental health condition (attention-deficit hyperactivity disorder, oppositional-defiant or conduct disorder, anxiety, or depression) from the 2009/2010 National Survey of Children with Special Healthcare Needs (N = 9,434). The primary independent variable was parent-reported SDM, and the dependent variables were parental perception of (a) their child receiving all needed mental health care (b) their children's impairment in school attendance and extracurricular activity participation, and (c) severity of their children's mental health condition. Multivariate logistic and multinomial regression analyses were conducted. Greater parent-reported SDM was associated with parental perceptions of receiving all needed child mental health care and children not having school or extracurricular impairment. Greater SDM was also associated with perceptions of children having a mild mental health condition compared to children having a moderate or severe condition. Findings provide a basis for future longitudinal and intervention studies to examine the benefit of SDM for improving parental perceptions of the quality of child mental health care and mental health functioning among children with common mental health conditions.

Virtual Reality Intervention for Older Women with Breast Cancer

PubMed Central

SCHNEIDER, SUSAN M.; ELLIS, MATHEW; COOMBS, WILLIAM T.; SHONKWILER, ERIN L.; FOLSOM, LINDA C.

2013-01-01

This study examined the effects of a virtual reality distraction intervention on chemotherapy-related symptom distress levels in 16 women aged 50 and older. A cross-over design was used to answer the following research questions: (1) Is virtual reality an effective distraction intervention for reducing chemotherapy-related symptom distress levels in older women with breast cancer? (2) Does virtual reality have a lasting effect? Chemotherapy treatments are intensive and difficult to endure. One way to cope with chemotherapy-related symptom distress is through the use of distraction. For this study, a head-mounted display (Sony PC Glasstron PLM—S700) was used to display encompassing images and block competing stimuli during chemotherapy infusions. The Symptom Distress Scale (SDS), Revised Piper Fatigue Scale (PFS), and the State Anxiety Inventory (SAI) were used to measure symptom distress. For two matched chemotherapy treatments, one pre-test and two post-test measures were employed. Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and received no distraction intervention (control condition) during an alternate chemotherapy treatment. Analysis using paired t-tests demonstrated a significant decrease in the SAI (p = 0.10) scores immediately following chemotherapy treatments when participants used VR. No significant changes were found in SDS or PFS values. There was a consistent trend toward improved symptoms on all measures 48 h following completion of chemotherapy. Evaluation of the intervention indicated that women thought the head mounted device was easy to use, they experienced no cybersickness, and 100% would use VR again. PMID:12855087

Effect of Play-based Therapy on Meta-cognitive and Behavioral Aspects of Executive Function: A Randomized, Controlled, Clinical Trial on the Students With Learning Disabilities.

PubMed

Karamali Esmaili, Samaneh; Shafaroodi, Narges; Hassani Mehraban, Afsoon; Parand, Akram; Zarei, Masoume; Akbari-Zardkhaneh, Saeed

2017-01-01

Although the effect of educational methods on executive function (EF) is well known, training this function by a playful method is debatable. The current study aimed at investigating if a play-based intervention is effective on metacognitive and behavioral skills of EF in students with specific learning disabilities. In the current randomized, clinical trial, 49 subjects within the age range of 7 to 11 years with specific learning disabilities were randomly assigned into the intervention (25 subjects; mean age 8.5±1.33 years) and control (24 subjects; mean age 8.7±1.03 years) groups. Subjects in the intervention group received EF group training based on playing activities; subjects in the control group received no intervention. The behavior rating inventory of executive function (BRIEF) was administered to evaluate the behavioral and cognitive aspects of EF. The duration of the intervention was 6 hours per week for 9 weeks. Multivariate analysis of covariance was used to compare mean changes (before and after) in the BRIEF scores between the groups. The assumptions of multivariate analysis of covariance were examined. After controlling pre-test conditions, the intervention and control groups scored significantly differently on both the metacognition (P=0.002; effect size=0.20) and behavior regulation indices (P=0.01; effect size=0.12) of BRIEF. Play-based therapy is effective on the metacognitive and behavioral aspects of EF in students with specific learning disabilities. Professionals can use play-based therapy rather than educational approaches in clinical practice to enhance EF skills.

The feasibility, patterns of use and acceptability of using mobile phone text-messaging to improve treatment adherence and post-treatment review of children with uncomplicated malaria in western Kenya.

PubMed

Otieno, Gabriel; Githinji, Sophie; Jones, Caroline; Snow, Robert W; Talisuna, Ambrose; Zurovac, Dejan

2014-02-03

Trials evaluating the impact of mobile phone text-messaging to support management of acute diseases, such as malaria, are urgently needed in Africa. There has been however a concern about the feasibility of interventions that rely on access to mobile phones among caregivers in rural areas. To assess the feasibility and inform development of an intervention to improve adherence to malaria medications and post-treatment review, mobile phone network, access, ownership and use among caregivers in western Kenya was assessed. A cross-sectional survey based on outpatient exit interviews was undertaken among caregivers of children with malaria at four trial facilities. The main outcomes were proportions of caregivers that have mobile signal at home; have access to mobile phones; are able to read; and use text-messaging. Willingness to receive text-message reminders was also explored. Descriptive analyses were performed. Of 400 interviewed caregivers, the majority were female (93.5%), mothers of the sick children (87.8%) and able to read (97.3%). Only 1.7% of caregivers were without any education. Nearly all (99.8%) reported access to a mobile signal at home. 93.0% (site range: 89-98%) had access to a mobile phone within their household while 73.8% (site range: 66-78%) possessed a personal phone. Among caregivers with mobile phone access, 93.6% (site range: 85-99%) used the phone to receive text-messages. Despite only 19% having electricity at home nearly all (99.7%) caregivers reported that they would be able to have permanent phone access to receive text-messages in the next 28 days. Willingness to receive text-message reminders was nearly universal (99.7%) with 41.7% of caregivers preferring texts in English, 32.3% in Kiswahili and 26.1% in Dholuo. Despite concerns that the feasibility of text-messaging interventions targeting caregivers may be compromised in rural high malaria risk areas in Kenya, very favourable conditions were found with respect to mobile network, access and ownership of phones, use of text-messaging and minimum literacy levels required for successful intervention delivery. Moreover, there was a high willingness of caregivers to receive text-message reminders. Impact evaluations of carefully tailored text-messaging interventions targeting caregivers of children with malaria are timely and justified.

Effect of motor control training on muscle size and football games missed from injury.

PubMed

Hides, Julie A; Stanton, Warren R; Mendis, M Dilani; Gildea, Jan; Sexton, Margot J

2012-06-01

This panel-randomized intervention trial was designed to examine the effect of a motor control training program for elite Australian Football League players with and without low back pain (LBP). The outcome measures included cross-sectional area (CSA) and symmetry of multifidus, quadratus lumborum, and psoas muscles and the change in CSA of the trunk in response to an abdominal drawing-in task. These measures of muscle size and function were performed using magnetic resonance imaging. Availability of players for competition games was used to assess the effect of the intervention on the occurrence of injuries. The motor control program involved performance of voluntary contractions of the multifidus and transversus abdominis muscles while receiving feedback from ultrasound imaging. Because all players were to receive the intervention, the trial was delivered as a stepped-wedge design with three treatment arms (a 15-wk intervention, a 8-wk intervention, and a waitlist control who received a 7-wk intervention toward the end of the playing season). Players participated in a Pilates program when they were not receiving the intervention. The intervention program was associated with an increase in multifidus muscle size relative to results in the control group. The program was also associated with an improved ability to draw-in the abdominal wall. Intervention was commensurate with an increase in availability for games and a high level of perceived benefit. The motor control program delivered to elite footballers was effective, with demonstrated changes in the size and control of the targeted muscles. In this study, footballers who received the intervention early in the season missed fewer games because of injury than those who received it late in the playing season.

The Effect of Nurse Practitioner Co-Management on the Care of Geriatric Conditions

PubMed Central

Reuben, David B.; Ganz, David A.; Roth, Carol P.; McCreath, Heather E.; Ramirez, Karina D.; Wenger, Neil S.

2013-01-01

Background/Objectives The quality of care for geriatric conditions remains poor. The Assessing Care of Vulnerable Elders (ACOVE)-2 model (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage to community resources) improves the quality of care for geriatric conditions when implemented by primary care physicians (PCPs) or by nurse practitioners (NPs) co-managing care with an academic geriatrician. However, it is unclear whether community-based PCP-NP co-management can achieve similar results. Design Case study. Setting Two community-based primary care practices. Participants Patients > 75 years who screened positive for at least one condition: falls, urinary incontinence (UI), dementia, and depression. Intervention The ACOVE-2 model augmented by NP co-management of conditions. Measurements Quality of care by medical record review using ACOVE-3 quality indicators (QIs). Patients receiving co-management were compared with those who received PCP care alone in the same practices. Results Of 1084 screened patients, 658 (61%) screened positive for > 1 condition; 485 of these patients were randomly selected for chart review and triggered a mean of 7 QIs. A NP saw approximately half (49%) for co-management. Overall, patients received 57% of recommended care. Quality scores for all conditions (falls: 80% versus 34%; UI: 66% versus 19%; dementia: 59% versus 38%) except depression (63% versus 60%) were higher for patients seen by a NP. In analyses adjusted for gender, age of patient, number of conditions, site, and a NP estimate of medical management style, NP co-management remained significantly associated with receiving recommended care (p<0.001), as did the NP estimate of medical management style (p=0.02). Conclusion Compared to usual care using the ACOVE-2 model, NP co-management is associated with better quality of care for geriatric conditions in community-based primary care. PMID:23772723

Usefulness of a simple self-administered joint condition assessment sheet to predict the need for orthopaedic intervention in the management of haemophilic arthropathy.

PubMed

Masaoka, T; Amano, K; Takedani, H; Suzuki, T; Otaki, M; Seita, I; Tateiwa, T; Shishido, T; Yamamoto, K; Fukutake, K

2017-03-01

Detecting signs of joint deterioration is important for early effective orthopaedic intervention in managing haemophilic arthropathy. We developed a simple, patient self-administered sheet to evaluate the joint condition, and assessed the predictive ability of this assessment sheet for the need for an orthopaedic intervention. This was a single-centre, cross-sectional study. The association between the score of each of the four items of the assessment sheet (bleeding, swelling, pain and physical impairment) and the results of radiological findings and physical examinations based on Haemophilia Joint Health Score 2.1 was assessed. An optimal scoring system was explored by the area under the curve (AUC). The cut-off value for the need for surgery or physiotherapy was determined using the receiver operating characteristic curve procedure. Forty-two patients were included. The 'physical impairment' item showed the highest correlation coefficient with the results of radiographic and physical examinations (range: 0.57-0.76). The AUC of finally adjusted scoring indicates good ability to discriminate between patients with and without a need for orthopaedic intervention. The positive predictive value was the highest at a cut-off value of 4 points for knees (63.0%) and ankles (70.0%), at 5 points for elbows (66.7%) and the highest predictive accuracy at the cut-off value of 4 points for all the joints. The linear trend of the need for an orthopaedic intervention was observed with an increasing score. The joint condition assessment sheet can help clinicians assess the need for orthopaedic intervention for haemophilic arthropathy in Japanese patients with haemophilia. © 2016 John Wiley & Sons Ltd.

Feasibility, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology Supported Self-Management Intervention for Older Adults with Serious Mental Illness.

PubMed

Fortuna, Karen L; DiMilia, Peter R; Lohman, Matthew C; Bruce, Martha L; Zubritsky, Cynthia D; Halaby, Mitch R; Walker, Robert M; Brooks, Jessica M; Bartels, Stephen J

2018-06-01

To assess the feasibility, acceptability, and preliminary effectiveness of a peer-delivered and technology supported integrated medical and psychiatric self-management intervention for older adults with serious mental illness. Ten older adults with serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder) and medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 60 years and older received the PeerTECH intervention in their homes. Three certified peer specialists were trained to deliver PeerTECH. Data were collected at baseline, one-month, and three-month. The pilot study demonstrated that a three-month, peer-delivered and technology-supported integrated medical and psychiatric self-management intervention ("PeerTECH") was experienced by peer specialists and participants as feasible and acceptable. PeerTECH was associated with statistically significant improvements in psychiatric self-management. In addition, pre/post, non-statistically significant improvements were observed in self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment. This pre/post pilot study demonstrated it is possible to train peers to use technology to deliver an integrated psychiatric and medical self-management intervention in a home-based setting to older adults with serious mental illness with fidelity. These findings provide preliminary evidence that a peer-delivered and technology-supported intervention designed to improve medical and psychiatric self-management is feasible, acceptable, and is potentially associated with improvements in psychiatric self-management, self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment with older adults with serious mental illness and chronic health conditions.

Supporting Adolescent Orphan Girls to Stay in School as HIV Risk Prevention: Evidence From a Randomized Controlled Trial in Zimbabwe

PubMed Central

Cho, Hyunsan; Rusakaniko, Simbarashe; Iritani, Bonita; Mapfumo, John; Halpern, Carolyn

2011-01-01

Objectives. Using a randomized controlled trial in rural eastern Zimbabwe, we tested whether comprehensive support to keep orphan adolescent girls in school could reduce HIV risk. Methods. All orphan girls in grade 6 in 25 primary schools were invited to participate in the study in fall 2007 (n = 329). Primary schools were randomized to condition. All primary schools received a universal daily feeding program; intervention participants received fees, uniforms, and a school-based helper to monitor attendance and resolve problems. We conducted annual surveys and collected additional information on school dropout, marriage, and pregnancy rates. We analyzed data using generalized estimating equations over 3 time points, controlling for school and age at baseline. Results. The intervention reduced school dropout by 82% and marriage by 63% after 2 years. Compared with control participants, the intervention group reported greater school bonding, better future expectations, more equitable gender attitudes, and more concerns about the consequences of sex. Conclusions. We found promising evidence that comprehensive school support may reduce HIV risk for orphan girls. Further study, including assessment of dose response, cost benefit, and HIV and herpes simplex virus 2 biomarker measurement, is warranted. PMID:21493943

Self-administered acupressure for symptom management among Chinese family caregivers with caregiver stress: a randomized, wait-list controlled trial.

PubMed

Tiwari, Agnes; Lao, Lixing; Wang, Amy Xiao-Min; Cheung, Denise Shuk Ting; So, Mike Ka Pui; Yu, Doris Sau Fung; Lum, Terry Yat Sang; Yuk Fung, Helina Yin King; Yeung, Jerry Wing Fai; Zhang, Zhang-Jin

2016-10-28

Caregiving can be stressful, potentially creating physical and psychological strain. Substantial evidence has shown that family caregivers suffer from significant health problems arising from the demands of caregiving. Although there are programs supporting caregivers, there is little evidence regarding their effectiveness. Acupressure is an ancient Chinese healing method designed to restore the flow of Qi (vital energy) by applying external pressure to acupoints. A randomized, wait-list controlled trial was developed to evaluate the effectiveness of a self-administered acupressure intervention on caregiver stress (primary objective) and stress-related symptoms of fatigue, insomnia, depression, and health-related quality of life (secondary objectives) in Chinese caregivers of older family members. Two hundred Chinese participants, aged ≥ 21 years, who are the primary caregivers of an older family member and screen positive for caregiver stress and symptoms of fatigue/insomnia/depression will be recruited from a community setting in Hong Kong. Subjects will be randomized to receive either an immediate treatment condition (self-administered acupressure intervention) or a wait-list control condition. The self-administered acupressure intervention will include (i) an individual learning and practice session twice a week for 2 weeks, (ii) a home follow-up visit once a week for 2 weeks, and (iii) 15-min self-practice twice a day for 6 weeks. The wait-list control group will receive the same acupressure training after the intervention group has completed the intervention. We hypothesize that Chinese family caregivers in the intervention group will have lower levels of caregiver stress, fatigue, insomnia, depression, and higher health-related quality of life after completion of the intervention than participants in the wait-list control group. This study will provide evidence for the effectiveness of self-administered acupressure in reducing stress and improving symptoms of fatigue, insomnia, depression, and health-related quality of life in Chinese family caregivers. The findings will inform the design of interventions to relieve negative health effects of caregiving. Furthermore, the results can raise community awareness and serve as a basis for policymaking, planning, and allocation of resources regarding empowerment of family caregivers for self-care. Current Controlled Trials NCT02526446 . Registered August 10, 2015.

Development of a face-to-face injunctive norms brief motivational intervention for college drinkers and preliminary outcomes

PubMed Central

Prince, Mark A.; Maisto, Stephen A.; Rice, Samara L.; Carey, Kate B.

2015-01-01

Findings are presented from the first randomized clinical trial that compared changes in alcohol consumption and alcohol-related consequences among college student drinkers from baseline to follow-up across four conditions: (a) a new single component injunctive norms brief motivational intervention (IN-BMI) condition, (b) a single component descriptive norms brief motivational intervention (DN-BMI), (c) a Combined IN and DN brief motivational intervention (Combined-BMI), and (d) assessment-only control. DN-BMI focused on the juxtaposition of personal, perceived, and actual alcohol use by typical same-sex students at your university. INBMI focused on the juxtaposition of personal, perceived, and actual attitudes about alcohol related consequences by the typical same-sex student at your university. Exploratory analyses assessed the effect of IN-BMI and DN-BMI on matched (e.g., the effect of DN-BMI on perceived DN) and mismatched norms (e.g., the effect of DN-BMI on perceived IN). IN-BMI resulted in greater decreases in alcohol use and consequences when delivered alone and in conjunction with DN-BMI compared to the control condition. Further, the Combined-BMI condition reported greater reductions in alcohol use but not consequences compared to the DN condition. Receiving IN-BMI either alone or in combination with DN-BMI produced greater changes in IN perceptions than were produced in the control group. Grounded in norms theory, this study examined how college student problem drinking is affected by both IN-BMI and DN-BMI alone and in combination. We conclude that IN-BMI alone or in combination with DN-BMI is able to modify alcohol use and reduce alcohol related consequences. PMID:26478943

The economic effects of supporting tuberculosis-affected households in Peru

PubMed Central

Tovar, Marco A.; Huff, Doug; Boccia, Delia; Montoya, Rosario; Ramos, Eric; Lewis, James J.; Gilman, Robert H.; Evans, Carlton A.

2016-01-01

The End TB Strategy mandates that no tuberculosis (TB)-affected households face catastrophic costs due to TB. However, evidence is limited to evaluate socioeconomic support to achieve this change in policy and practice. The objective of the present study was to investigate the economic effects of a TB-specific socioeconomic intervention. The setting was 32 shantytown communities in Peru. The participants were from households of consecutive TB patients throughout TB treatment administered by the national TB programme. The intervention consisted of social support through household visits and community meetings, and economic support through cash transfers conditional upon TB screening in household contacts, adhering to TB treatment/chemoprophylaxis and engaging with social support. Data were collected to assess TB-affected household costs. Patient interviews were conducted at treatment initiation and then monthly for 6 months. From February 2014 to June 2015, 312 households were recruited, of which 135 were randomised to receive the intervention. Cash transfer total value averaged US$173 (3.5% of TB-affected households' average annual income) and mitigated 20% of households' TB-related costs. Households randomised to receive the intervention were less likely to incur catastrophic costs (30% (95% CI 22–38%) versus 42% (95% CI 34–51%)). The mitigation impact was higher among poorer households. The TB-specific socioeconomic intervention reduced catastrophic costs and was accessible to poorer households. Socioeconomic support and mitigating catastrophic costs are integral to the End TB strategy, and our findings inform implementation of these new policies. PMID:27660507

The economic effects of supporting tuberculosis-affected households in Peru.

PubMed

Wingfield, Tom; Tovar, Marco A; Huff, Doug; Boccia, Delia; Montoya, Rosario; Ramos, Eric; Lewis, James J; Gilman, Robert H; Evans, Carlton A

2016-11-01

The End TB Strategy mandates that no tuberculosis (TB)-affected households face catastrophic costs due to TB. However, evidence is limited to evaluate socioeconomic support to achieve this change in policy and practice. The objective of the present study was to investigate the economic effects of a TB-specific socioeconomic intervention.The setting was 32 shantytown communities in Peru. The participants were from households of consecutive TB patients throughout TB treatment administered by the national TB programme. The intervention consisted of social support through household visits and community meetings, and economic support through cash transfers conditional upon TB screening in household contacts, adhering to TB treatment/chemoprophylaxis and engaging with social support. Data were collected to assess TB-affected household costs. Patient interviews were conducted at treatment initiation and then monthly for 6 months.From February 2014 to June 2015, 312 households were recruited, of which 135 were randomised to receive the intervention. Cash transfer total value averaged US$173 (3.5% of TB-affected households' average annual income) and mitigated 20% of households' TB-related costs. Households randomised to receive the intervention were less likely to incur catastrophic costs (30% (95% CI 22-38%) versus 42% (95% CI 34-51%)). The mitigation impact was higher among poorer households.The TB-specific socioeconomic intervention reduced catastrophic costs and was accessible to poorer households. Socioeconomic support and mitigating catastrophic costs are integral to the End TB strategy, and our findings inform implementation of these new policies. Copyright ©ERS 2016.

Falls Assessment Clinical Trial (FACT): design, interventions, recruitment strategies and participant characteristics.

PubMed

Elley, C Raina; Robertson, M Clare; Kerse, Ngaire M; Garrett, Sue; McKinlay, Eileen; Lawton, Beverley; Moriarty, Helen; Campbell, A John

2007-07-29

Guidelines recommend multifactorial intervention programmes to prevent falls in older adults but there are few randomised controlled trials in a real life health care setting. We describe the rationale, intervention, study design, recruitment strategies and baseline characteristics of participants in a randomised controlled trial of a multifactorial falls prevention programme in primary health care. Participants are patients from 19 primary care practices in Hutt Valley, New Zealand aged 75 years and over who have fallen in the past year and live independently. Two recruitment strategies were used - waiting room screening and practice mail-out. Intervention participants receive a community based nurse assessment of falls and fracture risk factors, home hazards, referral to appropriate community interventions, and strength and balance exercise programme. Control participants receive usual care and social visits. Outcome measures include number of falls and injuries over 12 months, balance, strength, falls efficacy, activities of daily living, quality of life, and physical activity levels. 312 participants were recruited (69% women). Of those who had fallen, 58% of people screened in the practice waiting rooms and 40% when screened by practice letter were willing to participate. Characteristics of participants recruited using the two methods are similar (p > 0.05). Mean age of all participants was 81 years (SD 5). On average participants have 7 medical conditions, take 5.5 medications (29% on psychotropics) with a median of 2 falls (interquartile range 1, 3) in the previous year. The two recruitment strategies and the community based intervention delivery were feasible and successful, identifying a high risk group with multiple falls. Recruitment in the waiting room gave higher response rates but was less efficient than practice mail-out. Testing the effectiveness of an evidence based intervention in a 'real life' setting is important.

Genetics moderate alcohol and intimate partner violence treatment outcomes in a randomized controlled trial of hazardous drinking men in batterer intervention programs: A preliminary investigation.

PubMed

Stuart, Gregory L; McGeary, John; Shorey, Ryan C; Knopik, Valerie S

2016-07-01

We examined whether a cumulative genetic score (CGS) containing MAOA and 5-HTTLPR polymorphisms moderated drinking and intimate partner violence (IPV) treatment outcomes in hazardous drinking men receiving batterer intervention or batterer intervention plus a brief alcohol intervention. We conducted a randomized controlled trial with 97 hazardous drinking men who had a relationship partner and were in batterer intervention programs. Participants were randomized to receive 40 hr of standard batterer program (SBP) or the SBP plus a 90-min alcohol intervention (SBP + BAI). Data were collected at baseline, 3-, 6-, and 12-month follow-up, with follow-up rates of 99.0%, 97.9%, and 93.8%, respectively. Genomic DNA was extracted from saliva. Substance use was measured with the timeline followback interview; IPV was assessed with the Revised Conflict Tactics scales. The primary outcomes were drinks per drinking day (DDD), percentage of days abstinent from alcohol (PDA), frequency of physical IPV, and injuries to partners. Consistent with hypotheses, analyses demonstrated significant treatment condition by CGS interactions for PDA, physical violence, and injuries, but not for DDD. At high levels of the CGS, men in SBP + BAI had greater PDA (B = .16, 95% CI [.04, .27], p = .01), less physical violence perpetration (B = -1.21, 95% CI [-2.21, -.21], p = .02), and fewer injuries to partners (B = -2.37, 95% CI [-3.19, -.82], p = .00) than men in SBP. No differences between the groups in PDA, physical violence, or injuries were observed at low levels of the CGS. Findings demonstrate the potential importance of MAOA and 5-HTTLPR polymorphisms in the treatment of IPV and drinking in men in batterer intervention programs. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Mobile phone messaging for facilitating self-management of long-term illnesses.

PubMed

de Jongh, Thyra; Gurol-Urganci, Ipek; Vodopivec-Jamsek, Vlasta; Car, Josip; Atun, Rifat

2012-12-12

Long-term illnesses affect a significant proportion of the population in developed and developing countries. Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), may present convenient, cost-effective ways of supporting self-management and improving patients' self-efficacy skills through, for instance, medication reminders, therapy adjustments or supportive messages. To assess the effects of mobile phone messaging applications designed to facilitate self-management of long-term illnesses, in terms of impact on health outcomes and patients' capacity to self-manage their condition. Secondary objectives include assessment of: user evaluation of the intervention; health service utilisation and costs; and possible risks and harms associated with the intervention. We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009), EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993 to June 2009) and African Health Anthology (January 1993 to June 2009).We also reviewed grey literature (including trial registers) and reference lists of articles. We included randomised controlled trials (RCTs), quasi-randomised controlled trials (QRCTs), controlled before-after (CBA) studies, or interrupted time series (ITS) studies with at least three time points before and after the intervention. We selected only studies where it was possible to assess the effects of mobile phone messaging independent of other technologies or interventions. Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author. Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by a third. Primary outcomes of interest were health outcomes as a result of the intervention and capacity to self-manage long-term conditions. We also considered patients' and providers' evaluation of the intervention, perceptions of safety, health service utilisation and costs, and potential harms or adverse effects. The included studies were heterogeneous in type of condition addressed, intervention characteristics and outcome measures. Therefore, a meta-analysis to derive an overall effect size for the main outcome categories was not considered justified and findings are presented narratively. We included four randomised controlled trials involving 182 participants.For the primary outcome of health outcomes, including physiological measures, there is moderate quality evidence from two studies involving people with diabetes showing no statistical difference from text messaging interventions compared with usual care or email reminders for glycaemic control (HbA1c), the frequency of diabetic complications, or body weight. There is moderate quality evidence from one study of hypertensive patients that the mean blood pressure and the proportion of patients who achieved blood pressure control were not significantly different in the intervention and control groups, and that there was no statistically significant difference in mean body weight between the groups. There is moderate quality evidence from one study that asthma patients receiving a text messaging intervention experienced greater improvements on peak expiratory flow variability (mean difference (MD) -11.12, 95% confidence interval (CI) -19.56 to -2.68) and the pooled symptom score comprising four items (cough, night symptoms, sleep quality, and maximum tolerated activity) (MD -0.36, 95% CI -0.56 to -0.17) compared with the control group. However, the study found no significant differences between the groups in impact on forced vital capacity or forced expiratory flow in 1 second.For the primary outcome of capacity to self-manage the condition, there is moderate quality evidence from one study that diabetes patients receiving the text messaging intervention demonstrated improved scores on measures of self-management capacity (Self-Efficacy for Diabetes score (MD 6.10, 95% CI 0.45 to 11.75), Diabetes Social Support Interview pooled score (MD 4.39, 95% CI 2.85 to 5.92)), but did not show improved knowledge of diabetes. There is moderate quality evidence from three studies of the effects on treatment compliance. One study showed an increase in hypertensive patients' rates of medication compliance in the intervention group (MD 8.90, 95% CI 0.18 to 17.62) compared with the control group, but in another study there was no statistically significant effect on rates of compliance with peak expiratory flow measurement in asthma patients. Text message prompts for diabetic patients initially also resulted in a higher number of blood glucose results sent back (46.0) than email prompts did (23.5).For the secondary outcome of participants' evaluation of the intervention, there is very low quality evidence from two studies that patients receiving mobile phone messaging support reported perceived improvement in diabetes self-management, wanted to continue receiving messages, and preferred mobile phone messaging to email as a method to access a computerised reminder system.For the secondary outcome of health service utilisation, there is very low quality evidence from two studies. Diabetes patients receiving text messaging support made a comparable number of clinic visits and calls to an emergency hotline as patients without the support. For asthma patients the total number of office visits was higher in the text messaging group, whereas the number of hospital admissions was higher for the control group.Because of the small number of trials included, and the low overall number of participants, for any of the reviewed outcomes the quality of the evidence can at best be considered moderate. We found some, albeit very limited, indications that in certain cases mobile phone messaging interventions may provide benefit in supporting the self-management of long-term illnesses. However, there are significant information gaps regarding the long-term effects, acceptability, costs, and risks of such interventions. Given the enthusiasm with which so-called mHealth interventions are currently being implemented, further research into these issues is needed. 

Is the quality of brief motivational interventions for drug use in primary care associated with subsequent drug use?

PubMed

Palfai, Tibor P; Cheng, Debbie M; Bernstein, Judith A; Palmisano, Joseph; Lloyd-Travaglini, Christine A; Goodness, Tracie; Saitz, Richard

2016-05-01

Although a number of brief intervention approaches for drug use are based on motivational interviewing (MI), relatively little is known about whether the quality of motivational interviewing skills is associated with intervention outcomes. The current study examined whether indices of motivational interviewing skill were associated with subsequent drug use outcomes following two different MI-based brief interventions delivered in primary care; a 15 min Brief Negotiated Interview (BNI) and a 45 min adaptation of motivational interviewing (MOTIV). Audio recordings from 351 participants in a randomized controlled trial for drug use in primary care were coded using the Motivational Interviewing Treatment Integrity Scale, (MITI Version 3.1.1). Separate negative binomial regression analyses, stratified by intervention condition, were used to examine the associations between six MITI skill variables and the number of days that the participant used his/her main drug 6 weeks after study entry. Only one of the MITI variables (% reflections to questions) was significantly associated with the frequency of drug use in the MOTIV condition and this was opposite to the hypothesized direction (global p=0.01, adjusted IRR 1.50, 95%CI: 1.03-2.20 for middle vs. lowest tertile [higher skill, more drug use]. None were significantly associated with drug use in the BNI condition. Secondary analyses similarly failed to find consistent predictors of better drug outcomes. Overall, this study provides little evidence to suggest that the level of MI intervention skills are linked with better drug use outcomes among people who use drugs and receive brief interventions in primary care. Findings should be considered in light of the fact that data from the study are from negative trial of SBI and was limited to primary care patients. Future work should consider alternative ways of examining these process variables (i.e., comparing thresholds of proficient versus non-proficient skills) or considering alternative methods of coding intervention skills. Copyright © 2016 Elsevier Ltd. All rights reserved.

Influence of transcutaneous electrical nerve stimulation conditions on disynaptic reciprocal Ia inhibition and presynaptic inhibition in healthy adults.

PubMed

Takeda, Kazuya; Tanabe, Shigeo; Koyama, Soichiro; Ushiroyama, Kosuke; Naoi, Yuki; Motoya, Ikuo; Sakurai, Hiroaki; Kanada, Yoshikiyo

2017-03-01

This study investigated the influence of stimulus conditions of transcutaneous electrical nerve stimulation (TENS) on disynaptic reciprocal Ia inhibition (RI) and presynaptic inhibition (D1 inhibition) in healthy adults. Eight healthy participants received TENS (stimulus frequencies of 50, 100, and 200 Hz) over the deep peroneal nerve and tibialis anterior (TA) muscle in the resting condition for 30 min. At pre- and post-intervention, the RI from the TA to the soleus (SOL) and D1 inhibition of the SOL alpha motor neuron were assessed by evoked electromyography. The results showed that RI was not changed by TENS at any stimulus frequency condition. Conversely, D1 inhibition was significantly changed by TENS regardless of the stimulus frequency. The present results and previous studies pertaining to RI suggest that the resting condition might strongly influence the lack of pre- vs. post-intervention change in the RI. Regarding the D1 inhibition, the present results suggest that the effect of TENS might be caused by post-tetanic potentiation. The knowledge gained from the present study might contribute to a better understanding of fundamental studies of TENS in healthy adults and its clinical application for stroke survivors.

Physical appearance anxiety impedes the therapeutic effects of video feedback in high socially anxious individuals.

PubMed

Orr, Elizabeth M J; Moscovitch, David A

2014-01-01

Video feedback (VF) interventions effectively reduce social anxiety symptoms and negative self-perception, particularly when they are preceded by cognitive preparation (CP) and followed by cognitive review. In the current study, we re-examined data from a study on the efficacy of a novel VF intervention for individuals high in social anxiety to test the hypothesis that physical appearance anxiety would moderate the effects of VF. Data were analyzed from 68 socially anxious participants who performed an initial public speech, and were randomly assigned to an Elaborated VF condition (VF plus cognitive preparation and cognitive review), a Standard VF condition (VF plus cognitive preparation) or a No VF condition (exposure alone), and then performed a second speech. As hypothesized, when appearance concerns were low, both participants who received Elaborated and Standard VF were significantly less anxious during speech 2 than those in the No VF condition. However, when levels of appearance concern were high, neither Elaborated nor Standard VF reduced anxiety levels during speech 2 beyond the No VF condition. Results from our analog sample suggest the importance of tailoring treatment protocols to accommodate the idiosyncratic concerns of socially anxious patients.

A Pilot Randomized Trial of Text-Messaging for Symptom Awareness and Diabetes Knowledge in Adolescents With Type 1 Diabetes

PubMed Central

Han, Yi; Faulkner, Melissa Spezia; Fritz, Heather; Fadoju, Doris; Muir, Andrew; Abowd, Gregory D.; Head, Lauren; Arriaga, Rosa I.

2015-01-01

Adolescents with type 1 diabetes typically receive clinical care every 3 months. Between visits, diabetes-related issues may not be frequently reflected, learned, and documented by the patients, limiting their self-awareness and knowledge about their condition. We designed a text-messaging system to help resolve this problem. In a pilot, randomized controlled trial with 30 adolescents, we examined the effect of text messages about symptom awareness and diabetes knowledge on glucose control and quality of life. The intervention group that received more text messages between visits had significant improvements in quality of life. PMID:25720675

Nursing Case Management, Peer Coaching, and Hepatitis A and B Vaccine Completion Among Homeless Men Recently Released on Parole: Randomized Clinical Trial

PubMed Central

Nyamathi, Adeline; Salem, Benissa E.; Zhang, Sheldon; Farabee, David; Hall, Betsy; Khalilifard, Farinaz; Leake, Barbara

2015-01-01

Background Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. Objectives The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching and nurse-delivered interventions was compared at 12-month follow up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive peer coaching (PC) intervention condition, with minimal nurse involvement; and a (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Further, we assessed predictors of vaccine completion among this targeted sample. Methods A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HAB vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-squared analysis to compare completion rates across the three levels of intervention. Results Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC) (p =. 78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. Discussion Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole. PMID:25932697

Motivating Low Socioeconomic Status Smokers to Accept Evidence-Based Smoking Cessation Treatment: A Brief Intervention for the Community Agency Setting.

PubMed

Christiansen, Bruce A; Reeder, Kevin M; TerBeek, Erin G; Fiore, Michael C; Baker, Timothy B

2015-08-01

Individuals of low socioeconomic status (SES), smoke at very high rates but make fewer and less successful quit attempts than do other smokers. Low-SES smokers have specific beliefs about smoking and quitting that may serve as barriers to making quit attempts. The purpose of this study was to test the impact of a brief intervention addressing these beliefs on making calls to a telephone quit line. Of 522 smokers entering the study at 5 Wisconsin Salvation Army (SA) sites, 102 expressed motivation to quit and served as a comparison group. The remaining 420 smokers were not motivated to quit and were randomly assigned to 1 of 3 conditions: an intervention group who received brief counseling focused on cessation goals and beliefs, an attention-control group, and a low contact control group. The primary outcome was the rate at which smokers made a call to the Wisconsin tobacco quit line (WTQL) during their SA visit. Secondary outcome measures included motivational variables, stage of change, changes in beliefs about smoking and quitting, and self-reported abstinence. Unmotivated participants in the intervention condition called the WTQL at a significantly higher rate (12.2%) than did those in the 2 control conditions (2.2% and 1.4%) (p < .01) and approached the rate of calling by participants who were initially motivated to quit (15.7%). Intervention condition participants also showed improved motivation to quit and stage of change. A brief, targeted motivational intervention focusing on cessation goals and beliefs increased the initiation of an evidence-based tobacco cessation treatment by low-SES smokers. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial.

PubMed

Nyamathi, Adeline; Salem, Benissa E; Zhang, Sheldon; Farabee, David; Hall, Betsy; Khalilifard, Farinaz; Leake, Barbara

2015-01-01

Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample. A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention. Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.

GET.ON Mood Enhancer: efficacy of Internet-based guided self-help compared to psychoeducation for depression: an investigator-blinded randomised controlled trial

PubMed Central

2014-01-01

Background Major depressive disorder (MDD) imposes a considerable disease burden on individuals and societies. A large number of randomised controlled trials (RCTs) have shown the efficacy of Internet-based guided self-help interventions in reducing symptoms of depression. However, study quality varies considerably. The aim of this study is to evaluate the efficacy of a new Internet-based guided self-help intervention (GET.ON Mood Enhancer) compared to online-based psychoeducation in an investigator-blinded RCT. Methods/design A RCT will be conducted to compare the efficacy of GET.ON Mood Enhancer with an active control condition receiving online psychoeducation on depression (OPD). Both treatment groups will have full access to treatment as usual. Adults with MDD (n = 128) will be recruited and randomised to one of the two conditions. Primary outcome will be observer-rated depressive symptoms (HRSD-24) by independent assessors blind to treatment conditions. Secondary outcomes include changes in self-reported depressive symptom severity, anxiety and quality of life. Additionally, potential negative effects of the treatments will systematically be evaluated on several dimensions (for example, symptom deteriorations, attitudes toward seeking psychological help, relationships and stigmatisation). Assessments will take place at baseline, 6 and 12 weeks after randomisation. Discussion This study evaluates a new Internet-based guided self-help intervention for depression using an active control condition (psychoeducation-control) and an independent, blinded outcome evaluation. This study will further enhance the evidence for Internet-based guided self-help interventions for MDD. Trial registration German Clinical Trial Registration (DRKS): DRKS00005025 PMID:24476555

Effects of the KiVa antibullying program on cyberbullying and cybervictimization frequency among Finnish youth.

PubMed

Williford, Anne; Elledge, L Christian; Boulton, Aaron J; DePaolis, Kathryn J; Little, Todd D; Salmivalli, Christina

2013-01-01

Cyberbullying among school-aged children has received increased attention in recent literature. However, no empirical evidence currently exists on whether existing school-based antibullying programs are effective in targeting the unique aspects of cyberbullying. To address this important gap, the present study investigates the unique effects of the KiVa Antibullying Program on the frequency of cyberbullying and cybervictimization among elementary and middle school youth. Using data from a group randomized controlled trial, multilevel ordinal regression analyses were used to examine differences in the frequencies of cyberbullying and cybervictimization between intervention (N = 9,914) and control students (N = 8,498). The effects of age and gender on frequencies of cyber behaviors were also assessed across conditions. Results revealed a significant intervention effect on the frequency of cybervictimization; KiVa students reported lower frequencies of cybervictimization at posttest than students in a control condition. The effect of condition on the perpetration of cyberbullying was moderated by age. When student age was below the sample mean, KiVa students reported lower frequencies of cyberbullying than students in the control condition. We also found evidence of classroom level variation in cyberbullying and cybervictimization, suggesting cyberbullying is in part a classroom-level phenomenon. KiVa appears to be an efficacious program to address cyber forms of bullying and victimization. We discuss several unique aspects of KiVa that may account for the significant intervention effects. Results suggest that KiVa is an intervention option for schools concerned with reducing cyberbullying behavior and its deleterious effects on children's adjustment.

The Effects of a Brief Acceptance-Based Behavioral Treatment Versus Traditional Cognitive-Behavioral Treatment for Public Speaking Anxiety: An Exploratory Trial Examining Differential Effects on Performance and Neurophysiology.

PubMed

Glassman, Lisa H; Forman, Evan M; Herbert, James D; Bradley, Lauren E; Foster, Elizabeth E; Izzetoglu, Meltem; Ruocco, Anthony C

2016-09-01

Individuals with public speaking anxiety (PSA) experience fear and avoidance that can cause extreme distress, impaired speaking performance, and associated problems in psychosocial functioning. Most extant interventions for PSA emphasize anxiety reduction rather than enhancing behavioral performance. We compared the efficacy of two brief cognitive-behavioral interventions, a traditional cognitive-behavior treatment (tCBT) and an acceptance-based behavior treatment (ABBT), on public speaking performance and anxiety in a clinical sample of persons with PSA. The effects of treatment on prefrontal brain activation were also examined. Participants (n = 21) were randomized to 90 min of an ABBT or a tCBT intervention. Assessments took place at pre- and post-treatment and included self-rated anxiety and observer-rated performance measures, a behavioral assessment, and prefrontal cortical activity measurements using functional near-infrared spectroscopy (fNIRS). Exploratory results indicated that participants in the ABBT condition experienced greater improvements in observer-rated performance relative to those in the tCBT condition, while those in the tCBT condition experienced greater reductions in subjective anxiety levels. Individuals in the ABBT condition also exhibited a trend toward greater treatment-related reductions in blood volume in the left dorsolateral prefrontal cortex relative to those who received tCBT. Overall, these findings preliminarily suggest that acceptance-based treatments may free more cognitive resources in comparison with tCBT, possibly resulting in greater improvements in objectively rated behavioral performances for ABBT interventions. © The Author(s) 2016.

Efficacy of memory rehabilitation therapy: a meta-analysis of TBI and stroke cognitive rehabilitation literature.

PubMed

Elliott, Madison; Parente, Frederick

2014-01-01

To examine the efficacy of cognitive rehabilitation strategies specifically designed to improve memory after traumatic brain injury (TBI) and stroke vs. memory improvement with the passage of time. A meta-analysis was performed on 26 studies of memory retraining and recovery that were published between the years of 1985 and 2013. Effect sizes (ESs) from each study were calculated and converted to Pearson's r and then analysed to assess the overall effect size and the relationship among the ESs, patient demographics and treatment interventions. RESULTS indicated a significant average ES (r = 0.51) in the treatment intervention conditions, as well as a significant average ES (r = 0.31) in the control conditions, in which participants did not receive any treatment. The largest ESs occurred in studies of stroke patients and studies concerning working memory rehabilitation. RESULTS showed that memory rehabilitation was an effective therapeutic intervention, especially for stroke patients and for working memory as a treatment domain. However, the results also indicated that significant memory improvement occurred spontaneously over time.

Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study.

PubMed

Marshall, Jane; Booth, Tracey; Devane, Niamh; Galliers, Julia; Greenwood, Helen; Hilari, Katerina; Talbot, Richard; Wilson, Stephanie; Woolf, Celia

2016-01-01

This study evaluated an intervention for people with aphasia delivered in a novel virtual reality platform called EVA Park. EVA Park contains a number of functional and fantastic locations and allows for interactive communication between multiple users. Twenty people with aphasia had 5 weeks' intervention, during which they received daily language stimulation sessions in EVA Park from a support worker. The study employed a quasi randomised design, which compared a group that received immediate intervention with a waitlist control group. Outcome measures explored the effects of intervention on communication and language skills, communicative confidence and feelings of social isolation. Compliance with the intervention was also explored through attrition and usage data. There was excellent compliance with the intervention, with no participants lost to follow up and most (18/20) receiving at least 88% of the intended treatment dose. Intervention brought about significant gains on a measure of functional communication. Gains were achieved by both groups of participants, once intervention was received, and were well maintained. Changes on the measures of communicative confidence and feelings of social isolation were not achieved. Results are discussed with reference to previous aphasia therapy findings.

Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study

PubMed Central

Marshall, Jane; Booth, Tracey; Devane, Niamh; Galliers, Julia; Greenwood, Helen; Hilari, Katerina; Talbot, Richard; Wilson, Stephanie; Woolf, Celia

2016-01-01

Introduction This study evaluated an intervention for people with aphasia delivered in a novel virtual reality platform called EVA Park. EVA Park contains a number of functional and fantastic locations and allows for interactive communication between multiple users. Twenty people with aphasia had 5 weeks’ intervention, during which they received daily language stimulation sessions in EVA Park from a support worker. The study employed a quasi randomised design, which compared a group that received immediate intervention with a waitlist control group. Outcome measures explored the effects of intervention on communication and language skills, communicative confidence and feelings of social isolation. Compliance with the intervention was also explored through attrition and usage data. Results There was excellent compliance with the intervention, with no participants lost to follow up and most (18/20) receiving at least 88% of the intended treatment dose. Intervention brought about significant gains on a measure of functional communication. Gains were achieved by both groups of participants, once intervention was received, and were well maintained. Changes on the measures of communicative confidence and feelings of social isolation were not achieved. Results are discussed with reference to previous aphasia therapy findings. PMID:27518188

The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment.

PubMed

Ferrer, Alejandra J

2007-01-01

The purpose of this study was to investigate the effects of familiar live music on the anxiety levels of patients undergoing chemotherapy treatment. Randomly selected patients were assigned to experimental (n = 25) and control (n = 25) conditions. Pre and posttests consisted of questionnaires and the recording of the patient's heart rate and blood pressures. Subjects in the experimental group received 20 minutes of familiar live music during their chemotherapy treatment. Subjects in the control group received standard chemotherapy. It was assumed that those patients receiving music intervention would: (a) lower their anxiety levels; (b) experience a decrease in heart rate and blood pressure; (c) improve their levels of negative reactions including fatigue, worry, and fear; and (d) improve their levels of positive reactions including comfort and relaxation. Results of the study showed statistically significant improvement for the experimental group on the measures of anxiety, fear, fatigue, relaxation, and diastolic blood pressure. No significant differences between groups were found for heart rate and systolic blood pressure. Descriptive values indicated that, on average, the experimental group was influenced positively by the music intervention, and participants improved their quality of life while undergoing chemotherapy treatment.

Evaluation of a Self-Management Program for Gastroesophageal Reflux Disease in China

PubMed Central

Xu, Wenhong; Sun, Changxian; Lin, Lin; Wang, Meifeng; Zhang, Hongjie; Song, Yulei

2016-01-01

Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible. PMID:27684637

Improving Mental Health Outcomes of Burmese Migrant and Displaced Children in Thailand: a Community-Based Randomized Controlled Trial of a Parenting and Family Skills Intervention.

PubMed

Annan, Jeannie; Sim, Amanda; Puffer, Eve S; Salhi, Carmel; Betancourt, Theresa S

2017-10-01

The negative effects of displacement and poverty on child mental health are well-known, yet research on prevention interventions in low- and middle-income countries, especially fragile states, remains limited. We examined the effectiveness of a parenting skills intervention on mental health outcomes among Burmese migrant and displaced children living in 20 communities in Thailand. Participants were primary caregivers and children aged 7 to 15 years (n = 479 families). Families were randomly assigned to receive an adapted version of the Strengthening Families Program (n = 240) or a wait-list control condition (n = 239). Assessments were conducted at baseline and 1-month post-intervention for both conditions and at 6 months for treatment group only. One month after the program, children in the treatment condition showed significant reductions in externalizing problems (caregiver effect size (ES) -0.22, p = 0.02; child report ES -0.11, p = 0.02) and child attention problems compared with controls (caregiver report ES -0.23, p = 0.03). There was no significant treatment effect on children's internalizing problems (ES -0.06; p = 0.31). Children reported a significant increase in prosocial protective factors relative to controls (ES 0.20, p < 0.01). Results suggest that an evidence-based parenting skills intervention adapted for a displaced and migrant Burmese population facing high levels of adversity can have positive effects on children's externalizing symptoms and protective psychosocial factors. Clinicaltrials.gov: https://clinicaltrials.gov/show/NCT01829815.

Feasibility of a computerized intervention for offenders with substance use disorders: a research note.

PubMed

Chaple, Michael; Sacks, Stanley; McKendrick, Karen; Marsch, Lisa A; Belenko, Steven; Leukefeld, Carl; Prendergast, Michael; French, Michael

2014-01-01

Despite evidence that treatment is effective in reducing recidivism among inmates with substance use problems, scarce resources mean that few of those in need of treatment actually receive it. Computerized substance abuse interventions could be used to expand access to treatment in prisons without placing an undue burden on resources. The major aim of the study was to compare treatment conditions in terms of their service utilization, skills acquisition, and treatment satisfaction. The study recruited men and women with substance use disorders from 10 prisons in 4 states. In an open label clinical trial, 494 subjects were randomly assigned either to the Experimental condition, a computerized drug treatment intervention, the Therapeutic Education System (TES; n  = 249), or to the Control condition, Standard Care ( n  = 245). Chi-square tests compared groups on categorical variables and independent samples t tests were used for interval level continuous variables. Initial evidence demonstrated: (1) comparable group rates of session attendance and high rates of TES module completion for experimental subjects; (2) comparable group gains in the development of coping skills; and (3) a more favorable view of TES than of Standard Care . Collectively, these results show that a computerized intervention, such as TES, can be implemented successfully in prison. Given the barriers to the delivery of substance abuse treatment typically encountered in correctional settings, computerized interventions have the potential to fill a significant treatment gap and are particularly well suited to inmates with mild to moderate substance use disorders who often are not treated.

Consumer understanding of calorie labeling: a healthy monday e-mail and text message intervention.

PubMed

Abel, Michelle L; Lee, Katherine; Loglisci, Ralph; Righter, Allison; Hipper, Thomas J; Cheskin, Lawrence J

2015-03-01

To assess caloric knowledge of participants and determine if an e-mail and/or text message intervention could increase knowledge of recommended daily caloric intake. Randomized, control trial. Johns Hopkins Hospital Cobblestone Café. The 246 participants reported eating at the Café at least twice/week. Participants randomized to control, e-mail, or text condition. The text and e-mail conditions received a message on four consecutive Mondays stating the recommended daily caloric intake. Knowledge of the government reference value of 2,000 calories. Intention-to-treat analysis was conducted. Multivariate logistic regression examined the effectiveness of text and e-mail messaging for improving knowledge of the government calorie reference value. Baseline awareness of the daily calorie reference value in study population was low. Participants in the text message condition were twice as likely to know the government calorie reference value compared to controls (p = .047, odds ratio = 2.2, 95% confidence interval [1.01, 4.73]). No significant differences were found for the e-mail condition (p = .5). Many people do not know the daily recommended caloric intake. Public education on the government calorie reference value is necessary for menu-labeling interventions to be more effective. Weekly text messaging can serve as an effective modality for delivering calorie information and nutrition education. © 2014 Society for Public Health Education.

A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial.

PubMed

Pichierri, Giuseppe; Murer, Kurt; de Bruin, Eling D

2012-12-14

Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults. This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming. The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults. Thirty-one participants (mean age ± SD: 86.2 ± 4.6 years), residents of two Swiss hostels for the aged, were randomly assigned to either the dance group (n = 15) or the control group (n = 16). The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming. The control group performed only the strength and balance exercises during this period. Outcome measures were foot placement accuracy, gait performance under single and dual task conditions, and falls efficacy. After the intervention between-group comparison revealed significant differences for gait velocity (U = 26, P = .041, r = .45) and for single support time (U = 24, P = .029, r = .48) during the fast walking dual task condition in favor of the dance group. No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy. There was a significant interaction in favor of the dance video game group for improvements in step time. Significant improved fast walking performance under dual task conditions (velocity, double support time, step length) was observed for the dance video game group only. These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program. This trial has been registered under ISRCTN05350123 (www.controlled-trials.com)

Neuro emotional technique effects on brain physiology in cancer patients with traumatic stress symptoms: preliminary findings.

PubMed

Monti, Daniel A; Tobia, Anna; Stoner, Marie; Wintering, Nancy; Matthews, Michael; He, Xiao-Song; Doucet, Gaelle; Chervoneva, Inna; Tracy, Joseph I; Newberg, Andrew B

2017-08-01

The purpose of this study was to characterize the neurophysiological and clinical effects that may result from the neuro emotional technique (NET) in patients with traumatic stress symptoms associated with a cancer-related event. We hypothesized that self-regulatory processing of traumatic memories would be observable as physiological changes in key brain areas after undergoing the NET intervention and that these changes would be associated with improvement of traumatic stress symptoms. We enrolled 23 participants with a prior cancer diagnosis who expressed a distressing cancer-related memory that was associated with traumatic stress symptoms of at least 6 months in duration. Participants were randomized to either the NET intervention or a waitlist control condition. To evaluate the primary outcome of neurophysiological effects, all participants received functional magnetic resonance imaging (fMRI) during the auditory presentation of both a neutral stimulus and a description of the specific traumatic event. Pre/post-comparisons were performed between the traumatic and neutral condition, within and between groups. Psychological measures included the Impact of Event Scale (IES), State Trait Anxiety Index (STAI), Brief Symptom Inventory (BSI)-18, and Posttraumatic Cognitions Inventory (PTCI). The initial fMRI scans in both groups showed significant increases in the bilateral parahippocampus and brainstem. After NET, reactivity in the parahippocampus, brainstem, anterior cingulate, and insula was significantly decreased during the traumatic stimulus. Likewise, participants receiving the NET intervention had significant reductions (p < 0.05) compared to the control group in distress as measured by the BSI-18 global severity index, anxiety as measured by the STAI, and traumatic stress as measured by the IES and PTCI. This study is an initial step towards understanding mechanistic features of the NET intervention. Specifically, brain regions involved with traumatic memories and distress such as the brainstem, insula, anterior cingulate gyrus, and parahippocampus had significantly reduced activity after the NET intervention and were associated with clinical improvement of symptoms associated with distressing recollections. This preliminary study suggests that the NET intervention may be effective at reducing emotional distress in patients who suffer from traumatic stress symptoms associated with a cancer-related event.

Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada).

PubMed

McGrath, Patrick J; Sourander, Andre; Lingley-Pottie, Patricia; Ristkari, Terja; Cunningham, Charles; Huttunen, Jukka; Filbert, Katharine; Aromaa, Minna; Corkum, Penny; Hinkka-Yli-Salomäki, Susanna; Kinnunen, Malin; Lampi, Katja; Penttinen, Anne; Sinokki, Atte; Unruh, Anita; Vuorio, Jenni; Watters, Carolyn

2013-10-21

Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent-child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour. This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child's sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization. The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems. ClinicalTrials.gov # NCT01750996.

Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada)

PubMed Central

2013-01-01

Background Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families™ Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent–child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour. Methods/design This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child’s sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization. Discussion The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems. Trial registration ClinicalTrials.gov # NCT01750996 PMID:24139323

Online Versus Face-To-Face Training of Critical Time Intervention: A Matching Cluster Randomized Trial

PubMed Central

Olivet, Jeffrey; Zerger, Suzanne; Greene, R. Neil; Kenney, Rachael R.; Herman, Daniel B.

2017-01-01

This study examined the effectiveness of online education to providers who serve people experiencing homelessness, comparing online and face-to-face training of Critical Time Intervention (CTI), an evidence-based case management model. The authors recruited 184 staff from 19 homeless service agencies to participate in one of two training conditions: (a) Online Training + Community of Practice or (b) Face-to-Face Training + Telephone Consultation. Each group received 24 hours of instruction and support. Through baseline, follow-up, and nine-month post-training surveys, the authors examined satisfaction, knowledge gains, knowledge retention, and readiness to implement CTI. While satisfaction rates were higher among participants in the face-to-face group, the two training conditions produced comparable pre/post knowledge gains. Furthermore, both groups showed increased knowledge retention scores at nine-month follow up, with the online group scoring higher than the face-to-face group. PMID:28919668

An Educational Intervention to Evaluate Nurses' Knowledge of Heart Failure.

PubMed

Sundel, Siobhan; Ea, Emerson E

2018-07-01

Nurses are the main providers of patient education in inpatient and outpatient settings. Unfortunately, nurses may lack knowledge of chronic medical conditions, such as heart failure. The purpose of this one-group pretest-posttest intervention was to determine the effectiveness of teaching intervention on nurses' knowledge of heart failure self-care principles in an ambulatory care setting. The sample consisted of 40 staff nurses in ambulatory care. Nurse participants received a focused education intervention based on knowledge deficits revealed in the pretest and were then resurveyed within 30 days. Nurses were evaluated using the valid and reliable 20-item Nurses Knowledge of Heart Failure Education Principles Survey tool. The results of this project demonstrated that an education intervention on heart failure self-care principles improved nurses' knowledge of heart failure in an ambulatory care setting, which was statistically significant (p < .05). Results suggest that a teaching intervention could improve knowledge of heart failure, which could lead to better patient education and could reduce patient readmission for heart failure. J Contin Educ Nurs. 2018;49(7):315-321. Copyright 2018, SLACK Incorporated.

Tailored message interventions versus typical messages for increasing participation in colorectal cancer screening among a non-adherent population: A randomized controlled trial.

PubMed

Hirai, Kei; Ishikawa, Yoshiki; Fukuyoshi, Jun; Yonekura, Akio; Harada, Kazuhiro; Shibuya, Daisuke; Yamamoto, Seiichiro; Mizota, Yuri; Hamashima, Chisato; Saito, Hiroshi

2016-05-24

The purpose of this study was to examine the effectiveness and cost-efficiency of a tailored message intervention compared with a non-tailored message intervention for increasing colorectal cancer (CRC) screening rates among a non-adherent population, in a community-based client reminder program. After a baseline survey for psychological segmentation, 2140 eligible individuals were randomly assigned either to a group with a tailored matched-message condition (N = 356), a group with a non-tailored unmatched-message condition (N = 355), or to two control groups, one using a typical message with a professional design (N = 717) and one without a professional design (N = 712). The main outcome measure was attendance rates in a community-organized CRC screening program within five months of receiving a print reminder. There was a significant difference in fecal occult blood test (FOBT) attendance rates at follow-up assessments between the tailored matched-message condition (14.0 %) and the control (9.9 %; OR = 1.48, p = 0.026), while there was no significant difference between the unmatched-message condition (11.0 %) and the control (OR = 1.12, p = 0.558), and between the matched-message condition and the unmatched-message condition (OR = 1.32, p = 0.219). The cost of a one-person increase in FOBT screening was 3,740 JPY for the tailored matched-message condition, while it was 2,747 JPY for the control. A tailored-message intervention for segmented individuals designed to increase CRC screening rates in a community-based client reminder program was significantly effective compared to a usual reminder, but not more effective than an unmatched message in a randomized controlled trial, and was not sufficiently effective to highlight its value from a cost perspective. Therefore, the tailored intervention including target segmentation needs to be improved for future implementation in a CRC screening program for a non-adherent population. UMIN Clinical Trials Registry UMIN000004384 . Date of Registration: March 2011.

Acceptability and preliminary feasibility of an internet/CD-ROM-based education and decision program for early-stage prostate cancer patients: randomized pilot study.

PubMed

Diefenbach, Michael A; Mohamed, Nihal E; Butz, Brian P; Bar-Chama, Natan; Stock, Richard; Cesaretti, Jamie; Hassan, Waleed; Samadi, David; Hall, Simon J

2012-01-13

Prostate cancer is the most common cancer affecting men in the United States. Management options for localized disease exist, yet an evidence-based criterion standard for treatment still has to emerge. Although 5-year survival rates approach 98%, all treatment options carry the possibility for significant side effects, such as erectile dysfunction and urinary incontinence. It is therefore recommended that patients be actively involved in the treatment decision process. We have developed an Internet/CD-ROM-based multimedia Prostate Interactive Educational System (PIES) to enhance patients' treatment decision making. PIES virtually mirrors a health center to provide patients with information about prostate cancer and its treatment through an intuitive interface, using videos, animations, graphics, and texts. (1) To examine the acceptability and feasibility of the PIES intervention and to report preliminary outcomes of the program in a pilot trial among patients with a new prostate cancer diagnosis, and (2) to explore the potential impact of tailoring PIES treatment information to participants' information-seeking styles on study outcomes. Participants (n = 72) were patients with newly diagnosed localized prostate cancer who had not made a treatment decision. Patients were randomly assigned to 3 experimental conditions: (1) control condition (providing information through standard National Cancer Institute brochures; 26%), and PIES (2) with tailoring (43%) and (3) without tailoring to a patient's information-seeking style (31%). Questionnaires were administrated before (t1) and immediately after the intervention (t2). Measurements include evaluation and acceptability of the PIES intervention, monitoring/blunting information-seeking style, psychological distress, and decision-related variables (eg, decisional confidence, feeling informed about prostate cancer and treatment, and treatment preference). The PIES program was well accepted by patients and did not interfere with the clinical routine. About 79% of eligible patients (72/91) completed the pre- and post-PIES intervention assessments. Patients in the PIES groups compared with those in the control condition were significantly more likely to report higher levels of confidence in their treatment choices, higher levels of helpfulness of the information they received in making a treatment decision, and that the information they received was emotionally reassuring. Patients in the PIES groups compared with those in the control condition were significantly less likely to need more information about treatment options, were less anxious about their treatment choices, and thought the information they received was clear (P < .05). Tailoring PIES information to information-seeking style was not related to decision-making variables. This pilot study confirms that the implementation of PIES within a clinical practice is feasible and acceptable to patients with a recent diagnosis of prostate cancer. PIES improved key decision-making process variables and reduced the emotional impact of a difficult medical decision.

A qualitative evaluation of occupational therapy-led work rehabilitation for people with inflammatory arthritis: Perspectives of therapists and their line managers.

PubMed

Prior, Yeliz; Amanna, Evangeline A; Bodell, Sarah J; Hammond, Alison

2015-08-01

Occupational therapy-led work rehabilitation for employed people with inflammatory arthritis and work problems was piloted in five hospitals in the United Kingdom. This qualitative study explored the views of participating occupational therapists and their line managers about the work rehabilitation training received and conducting the intervention, with particular focus on the structured interview used, the Work Experience Survey - Rheumatic Conditions. Face-to-face semi-structured interviews were conducted with occupational therapists ( n  = 9), followed by telephone interviews with their line managers ( n  = 2). Interviews were audio-recorded, transcribed verbatim and thematically analysed by three researchers to maximize validity. The main themes emerging from the occupational therapists' interviews were: varying levels of prior knowledge and experience of work rehabilitation, initial concerns about the feasibility of a lengthy work assessment in practice and increased confidence in delivering work rehabilitation as the study progressed. The line managers' interviews generated themes around the positive impact of the work rehabilitation training the occupational therapists received, and changes in their practice. The Work Experience Survey - Rheumatic Conditions was considered a good choice of work assessment which can be implemented in practice. Once therapists had provided the work intervention several times, their confidence and skills increased.

A qualitative evaluation of occupational therapy-led work rehabilitation for people with inflammatory arthritis: Perspectives of therapists and their line managers

PubMed Central

Amanna, Evangeline A; Bodell, Sarah J; Hammond, Alison

2015-01-01

Introduction Occupational therapy-led work rehabilitation for employed people with inflammatory arthritis and work problems was piloted in five hospitals in the United Kingdom. This qualitative study explored the views of participating occupational therapists and their line managers about the work rehabilitation training received and conducting the intervention, with particular focus on the structured interview used, the Work Experience Survey – Rheumatic Conditions. Method Face-to-face semi-structured interviews were conducted with occupational therapists (n = 9), followed by telephone interviews with their line managers (n = 2). Interviews were audio-recorded, transcribed verbatim and thematically analysed by three researchers to maximize validity. Results The main themes emerging from the occupational therapists’ interviews were: varying levels of prior knowledge and experience of work rehabilitation, initial concerns about the feasibility of a lengthy work assessment in practice and increased confidence in delivering work rehabilitation as the study progressed. The line managers’ interviews generated themes around the positive impact of the work rehabilitation training the occupational therapists received, and changes in their practice. Conclusion The Work Experience Survey – Rheumatic Conditions was considered a good choice of work assessment which can be implemented in practice. Once therapists had provided the work intervention several times, their confidence and skills increased. PMID:26321786

Brief Intervention Decreases Drinking Frequency in HIV-Infected, Heavy Drinking Women: Results of a Randomized Controlled Trial

PubMed Central

Chander, Geetanjali; Hutton, Heidi E.; Lau, Bryan; Xu, Xiaoqiang; McCaul, Mary E.

2015-01-01

Objective Hazardous alcohol use by HIV-infected women is associated with poor HIV outcomes and HIV transmission risk behaviors. We examined the effectiveness of brief alcohol intervention (BI) among hazardous drinking women receiving care in an urban, HIV clinic. Methods Women were randomized to a 2-session BI or usual care. Outcomes assessed at baseline, 3, 6 and 12 months included 90-day frequency of any alcohol use and heavy/binge drinking (≥4 drinks per occasion), and average drinks per drinking episode. Secondary outcomes included HIV medication and appointment adherence, HIV1-RNA suppression, and days of unprotected vaginal sex. We examined intervention effectiveness using generalized mixed effect models and quantile regression. Results Of 148 eligible women, 74 were randomized to each arm. In mixed effects models, 90-day drinking frequency decreased among intervention group compared to control, with women in the intervention condition less likely to have a drinking day (OR: 0.42 (95% CI: 0.23–0.75). Heavy/binge drinking days and drinks per drinking day did not differ significantly between groups. Quantile regression demonstrated a decrease in drinking frequency in the middle to upper ranges of the distribution of drinking days and heavy/binge drinking days that differed significantly between intervention and control conditions. At follow-up, the intervention group had significantly fewer episodes of unprotected vaginal sex. No intervention effects were observed for other outcomes. Conclusions Brief alcohol intervention reduces frequency of alcohol use and unprotected vaginal sex among HIV-infected women. More intensive services may be needed to lower drinks per drinking day and enhance care for more severely affected drinkers. PMID:25967270

Effect of short-term hazelnut consumption on DNA damage and oxidized LDL in children and adolescents with primary hyperlipidemia: a randomized controlled trial.

PubMed

Guaraldi, Federica; Deon, Valeria; Del Bo', Cristian; Vendrame, Stefano; Porrini, Marisa; Riso, Patrizia; Guardamagna, Ornella

2018-07-01

Children with primary hyperlipidemia are prone to develop premature atherosclerosis, possibly associated with increased oxidative stress. Nutritional therapy is the primary strategy in the treatment of hyperlipidemia and associated conditions. Dietary interventions with bioactive-rich foods, such as nuts, may contribute to the modulation of both lipid profile and the oxidative/antioxidant status. Our study aimed to assess the impact of a dietary intervention with hazelnuts on selected oxidative stress markers in children and adolescents with primary hyperlipidemia. A single-blind, 8-week, randomized, controlled, three-arm, parallel-group study was performed. Children and adolescents diagnosed with primary hyperlipidemia (n=60) received dietary guidelines and were randomized into three groups: group 1 received hazelnuts with skin (HZN+S), and group 2 hazelnuts without skin (HZN-S), at equivalent doses (15-30 g/day, based on body weight); group 3 (controls) received only dietary recommendations (no nuts). At baseline and after 8 weeks, plasma oxidized low-density lipoprotein (ox-LDL) concentrations, oxidative levels of DNA damage in PBMCs and potential correlation with changes in serum lipids were examined. A reduction of endogenous DNA damage by 18.9%±51.3% (P=.002) and 23.1%±47.9% (P=.007) was observed after HZN+S and HZN-S, respectively. Oxidatively induced DNA strand breaks decreased by 16.0%±38.2% (P=.02) following HZN+S treatment. Ox-LDL levels did not change after HZN+S intervention but positively correlated with total cholesterol and LDL cholesterol. A short-term hazelnut intervention improves cell DNA protection and resistance against oxidative stress but not ox-LDL in hyperlipidemic pediatric patients. The trial was registered at ISRCTN.com, ID no. ISRCTN12261900. Copyright © 2018 Elsevier Inc. All rights reserved.

Fibromyalgia syndrome: prevalence, pharmacological and non-pharmacological interventions in outpatient health care. An analysis of statutory health insurance data.

PubMed

Sauer, Kristin; Kemper, Claudia; Glaeske, Gerd

2011-01-01

Fibromyalgia syndrome (FMS) is a chronic pain condition impacting on quality of life, causing physical and psychological impairment resulting in limited participation in professional and social life. The objective of this study was to assess the prevalence, recommended pharmacological and non-pharmacological interventions of FMS, patients' characteristics and to compare findings to current research. About 1.6 Mio patients of a German statutory health insurance company (GEK) in 2007 were analyzed for: (a) the prevalence of FMS (ICD-10: M79.7); (b) and comorbid depression (ICD-10: F32/33); (c) the recommended pharmacological and non-pharmacological intervention rates; (d) and characteristics of patients associated with being prescribed recommended interventions. The (a) standardized prevalence of FMS in 2007 was 0.05% in men and 0.4% in women. (b) 51.9% of the patients with prevalent FMS had a comorbid depression in 2007 (88.2% female). (c) 66% of FMS patients received the recommended pharmacological treatment, 59% physical therapy, 6.1% cognitive-behavioural therapy and 3.4% a combination of these (multi-component therapy, MCT). (d) One year increase in age was associated with a 3% decrease in the predicted odds of receiving MCT (95%, CI 0.95-0.99). The current data indicate an FMS-prevalence that differs from epidemiological surveys and screenings, probably due to methodological differences. Especially females with comorbid depression are affected. The likelihood of receiving MCT is not associated with gender, but with younger age. Yet, the findings seem to indicate insufficient and inadequate treatment, but FMS warrants more research. Copyright © 2010 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Long-term Effect of Home Nursing Intervention on Cost and Healthcare Utilization for Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study.

PubMed

Matsumura, Takuro; Takarada, Kana; Oki, Yutaro; Fujimoto, Yukari; Kaneko, Hiromi; Ohira, Mineko; Ishikawa, Akira

2015-01-01

The present study aimed to examine the long-term effects of a home nursing intervention on healthcare utilization and costs among patients with chronic obstructive pulmonary disease (COPD). A 3-year retrospective study. Eleven COPD patients who had received home nursing intervention after hospital discharge were enrolled. We retrospectively investigated their healthcare utilization and costs for 1 year before the intervention and during 2 years of the intervention. The number and length of hospitalizations decreased gradually from the pre-intervention period through the second year. The number of hospital and home nursing visits increased from the pre-intervention period through the first and second years. The hospitalization costs were decreased by approximately half from the pre-intervention period through the first year and from the first year through the second year. The total medical cost did not change significantly. Our home nursing intervention decreased the number and length of hospitalizations and the hospitalization costs; however, it did not affect the total medical cost. It is possible that the continuation of home nursing interventions may decrease the number of hospitalizations, number of home nursing visits, and the total medical cost by maintaining the health condition of patients. © 2014 Association of Rehabilitation Nurses.

Efficacy of an Attachment-Based Intervention Model on Health Indices in Children with Chronic Disease and Their Mothers.

PubMed

Dehghani-Arani, Fateme; Besharat, Mohammad Ali; Fitton, Victoria A; Aghamohammadi, Asghar

2018-05-07

Studies have shown significant relationship between health conditions and attachment. This study aimed to examine an attachment-based intervention model named mother-child-disease triangle (MCDT) on health indices in children with chronic disease and their mothers. This randomized trial study included 22 volunteer children aged 12-18 years undergoing medical treatment for a chronic disease and their mothers. After evaluation by 28-form General Health Questionnaire (GHQ-28), inventory of parent and peer attachment (IPPA), 28-form Child Health Questionnaire (CHQ-28) and Illness Perception Questionnaire (IPQ), the mother-child dyads were paired on the basis of IPPA scores. These pairs were then randomly assigned to an experimental or control group. The experimental group received ten 90-min sessions of MCDT over a 7-week period. Meanwhile, the control group received ten simple conversational sessions as a dummy intervention. In accordance with this study's pre-test/post-test design, both groups were evaluated once again after completing their respective treatment. Multivariate analysis of covariance (MANCOVA) showed members of the experimental group to have significantly stronger attachment and better physiological and psychosocial health than those in the control group. These findings suggest that attachment-based interventions can be used to improve the effectiveness of treatment among children with chronic disease and their mothers.

Preliminary Evidence for Feasibility, Use, and Acceptability of Individualized Texting for Adherence Building for Antiretroviral Adherence and Substance Use Assessment among HIV-Infected Methamphetamine Users

PubMed Central

Moore, David J.; Montoya, Jessica L.; Blackstone, Kaitlin; Depp, Colin A.; Atkinson, J. Hampton; TMARC Group, The

2013-01-01

The feasibility, use, and acceptability of text messages to track methamphetamine use and promote antiretroviral treatment (ART) adherence among HIV-infected methamphetamine users was examined. From an ongoing randomized controlled trial, 30-day text response rates of participants assigned to the intervention (individualized texting for adherence building (iTAB), n = 20) were compared to those in the active comparison condition (n = 9). Both groups received daily texts assessing methamphetamine use, and the iTAB group additionally received personalized daily ART adherence reminder texts. Response rate for methamphetamine use texts was 72.9% with methamphetamine use endorsed 14.7% of the time. Text-derived methamphetamine use data was correlated with data from a structured substance use interview covering the same time period (P < 0.05). The iTAB group responded to 69.0% of adherence reminder texts; among those responses, 81.8% endorsed taking ART medication. Standardized feedback questionnaire responses indicated little difficulty with the texts, satisfaction with the study, and beliefs that future text-based interventions would be helpful. Moreover, most participants believed the intervention reduced methamphetamine use and improved adherence. Qualitative feedback regarding the intervention was positive. Future studies will refine and improve iTAB for optimal acceptability and efficacy. This trial is registered with ClinicalTrials.gov NCT01317277. PMID:24078868

Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy.

PubMed

Peterson, Douglas E; Ohrn, Kerstin; Bowen, Joanne; Fliedner, Monica; Lees, Judith; Loprinzi, Charles; Mori, Takehiko; Osaguona, Anthony; Weikel, Dianna S; Elad, Sharon; Lalla, Rajesh V

2013-01-01

This systematic review analyzed the strength of the literature and defined clinical practice guidelines for the use of oral cryotherapy for the prevention and/or treatment of oral mucositis caused by cancer therapy. A systematic review on relevant oral cryotherapy studies indexed prior to 31 December 2010 was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) using OVID/MEDLINE, with publications selected for review based on defined inclusion and exclusion criteria. Findings from the reviewed studies were integrated into guidelines based on the overall level of evidence for each intervention. Guidelines were classified into three types: recommendation, suggestion, or no guideline possible. Twenty-two clinical studies and two meta-analyses were analyzed. Results were compared with the MASCC/ISOO guidelines published in 2007. The recommendation for the use of oral cryotherapy to prevent oral mucositis in patients receiving bolus fluorouracil (5-FU) was maintained, in agreement with the 2007 guidelines. A suggestion for use of oral cryotherapy to prevent oral mucositis in patients receiving high-dose melphalan as conditioning regimen with or without total body irradiation for HCST was revised from the 2007 guidelines. No guideline was possible for any other intervention, due to insufficient evidence. The evidence continues to support the use of oral cryotherapy for prevention of oral mucositis in patients receiving bolus 5-FU chemotherapy or high-dose melphalan. This intervention is consistent with the MASCC/ISOO guidelines published in 2007. The literature is limited by the fact that utilization of a double-blind study design is not feasible. Future studies that compare efficacy of oral cryotherapy with other mucositis agents in patients receiving chemotherapy with relatively short plasma half-lives would be useful.

A novel cognitive intervention for compulsive checking: Targeting maladaptive beliefs about memory.

PubMed

Alcolado, Gillian M; Radomsky, Adam S

2016-12-01

Compulsive checking is one of the most common symptoms of obsessive-compulsive disorder (OCD). Recently it has been proposed that those who check compulsively may believe their memory is poor, rather than having an actual memory impairment. The current study sought to develop and assess a brief cognitive intervention focused on improving maladaptive beliefs about memory, as they pertain to both checking symptoms and memory performance. Participants (N = 24) with a diagnosis of OCD and clinical levels of checking symptomatology were randomly assigned either to receive two weekly 1-hour therapy sessions or to self-monitor during a similar waitlist period. Time spent checking, checking symptoms, maladaptive beliefs about memory, and visuospatial memory were assessed both pre- and post-treatment/waitlist. Results showed that compared to the waitlist condition, individuals in the treatment condition displayed significant decreases in their maladaptive beliefs about memory and checking symptoms from pre- to post-intervention. They also exhibited increased recall performance on a measure of visuospatial memory. Changes in beliefs about memory were predictors of reduced post-intervention checking, but were not predictive of increased post-intervention memory scores. The lack of long term follow-up data and use of a waitlist control leave questions about the stability and specificity of the intervention. Findings provide preliminary evidence that strategies targeting beliefs about memory may be worthy of inclusion in cognitive-behavioural approaches to treating compulsive checking. Copyright © 2015 Elsevier Ltd. All rights reserved.

Explaining physical activity levels from a self-efficacy perspective: the physical activity counseling trial.

PubMed

Blanchard, Chris M; Fortier, Michelle; Sweet, Shane; O'Sullivan, Tracey; Hogg, William; Reid, Robert D; Sigal, Ronald J

2007-01-01

The Physical Activity Counseling (PAC) trial compared the effects of a 13-week primary care physical activity (PA) intervention that incorporated a PA counselor into a health care practice compared to a control condition on PA over a 25-week period and showed group differences in PA were present at 6 and 13 weeks. The main purpose was to examine the mediating effect of 6-week task and barrier self-efficacy on the intervention versus control group/13-week PA relationships. A secondary purpose was to determine whether task and barrier self-efficacy were significantly related to PA throughout the trial for both groups. Participants were primarily sedentary individuals who received a 2- to 4-min PA intervention from their primary care provider, after which they were randomly assigned to the intervention (n = 61) or control condition (n = 59). Self-reported PA and task (barrier) self-efficacy measures were obtained during (i.e., baseline, 6 and 13 weeks) and after (i.e., 19 and 25 weeks) the intervention in both groups. Six-week task and barrier self-efficacy had a small mediating effect. Furthermore, barrier self-efficacy had a significant relationship with PA throughout the trial, whereas the relationship between task self-efficacy and PA became significantly weaker as the trial progressed. PAC interventions among primarily sedentary individuals should be partly based on barrier and task self-efficacy. However, the stability of the task self-efficacy/PA relationship needs further examination.

Anxiety sensitivity risk reduction in smokers: A randomized control trial examining effects on panic

PubMed Central

Schmidt, Norman B.; Raines, Amanda M.; Allan, Nicholas P.; Zvolensky, Michael J.

2016-01-01

Empirical evidence has identified several risk factors for panic psychopathology, including smoking and anxiety sensitivity (AS; the fear of anxiety-related sensations). Smokers with elevated AS are therefore a particularly vulnerable population for panic. Yet, there is little knowledge about how to reduce risk of panic among high AS smokers. The present study prospectively evaluated panic outcomes within the context of a controlled randomized risk reduction program for smokers. Participants (N = 526) included current smokers who all received a state-of-the-art smoking cessation intervention with approximately half randomized to the AS reduction intervention termed Panic-smoking Program (PSP). The primary hypotheses focus on examining the effects of a PSP on panic symptoms in the context of this vulnerable population. Consistent with prediction, there was a significant effect of treatment condition on AS, such that individuals in the PSP condition, compared to those in the control condition, demonstrated greater decreases in AS throughout treatment and the follow-up period. In addition, PSP treatment resulted in lower rates of panic-related symptomatology. Moreover, mediation analyses indicated that reductions in AS resulted in lower panic symptoms. The present study provides the first empirical evidence that brief, targeted psychoeducational interventions can mitigate panic risk among smokers. PMID:26752327

Anxiety sensitivity risk reduction in smokers: A randomized control trial examining effects on panic.

PubMed

Schmidt, Norman B; Raines, Amanda M; Allan, Nicholas P; Zvolensky, Michael J

2016-02-01

Empirical evidence has identified several risk factors for panic psychopathology, including smoking and anxiety sensitivity (AS; the fear of anxiety-related sensations). Smokers with elevated AS are therefore a particularly vulnerable population for panic. Yet, there is little knowledge about how to reduce risk of panic among high AS smokers. The present study prospectively evaluated panic outcomes within the context of a controlled randomized risk reduction program for smokers. Participants (N = 526) included current smokers who all received a state-of-the-art smoking cessation intervention with approximately half randomized to the AS reduction intervention termed Panic-smoking Program (PSP). The primary hypotheses focus on examining the effects of a PSP on panic symptoms in the context of this vulnerable population. Consistent with prediction, there was a significant effect of treatment condition on AS, such that individuals in the PSP condition, compared to those in the control condition, demonstrated greater decreases in AS throughout treatment and the follow-up period. In addition, PSP treatment resulted in lower rates of panic-related symptomatology. Moreover, mediation analyses indicated that reductions in AS resulted in lower panic symptoms. The present study provides the first empirical evidence that brief, targeted psychoeducational interventions can mitigate panic risk among smokers. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Diabetes Manual trial protocol – a cluster randomized controlled trial of a self-management intervention for type 2 diabetes [ISRCTN06315411

PubMed Central

Sturt, Jackie; Hearnshaw, Hilary; Farmer, Andrew; Dale, Jeremy; Eldridge, Sandra

2006-01-01

Background The Diabetes Manual is a type 2 diabetes self-management programme based upon the clinically effective 'Heart Manual'. The 12 week programme is a complex intervention theoretically underpinned by self-efficacy theory. It is a one to one intervention meeting United Kingdom requirements for structured diabetes-education and is delivered within routine primary care. Methods/design In a two-group cluster randomized controlled trial, GP practices are allocated by computer minimisation to an intervention group or a six-month deferred intervention group. We aim to recruit 250 participants from 50 practices across central England. Eligibility criteria are adults able to undertake the programme with type 2 diabetes, not taking insulin, with HbA1c over 8% (first 12 months) and following an agreed protocol change over 7% (months 13 to 18). Following randomisation, intervention nurses receive two-day training and delivered the Diabetes Manual programme to participants. Deferred intervention nurses receive the training following six-month follow-up. Primary outcome is HbA1c with total and HDL cholesterol; blood pressure, body mass index; self-efficacy and quality of life as additional outcomes. Primary analysis is between-group HbA1c differences at 6 months powered to give 80% power to detect a difference in HbA1c of 0.6%. A 12 month cohort analysis will assess maintenance of effect and assess relationship between self-efficacy and outcomes, and a qualitative study is running alongside. Discussion This trial incorporates educational and psychological diabetes interventions into a single programme and assesses both clinical and psychosocial outcomes. The trial will increase our understanding of intervention transferability between conditions, those diabetes related health behaviours that are more or less susceptible to change through efficacy enhancing mechanisms and how this impacts on clinical outcomes. PMID:16846517

The Diabetes Manual trial protocol - a cluster randomized controlled trial of a self-management intervention for type 2 diabetes [ISRCTN06315411].

PubMed

Sturt, Jackie; Hearnshaw, Hilary; Farmer, Andrew; Dale, Jeremy; Eldridge, Sandra

2006-07-17

The Diabetes Manual is a type 2 diabetes self-management programme based upon the clinically effective 'Heart Manual'. The 12 week programme is a complex intervention theoretically underpinned by self-efficacy theory. It is a one to one intervention meeting United Kingdom requirements for structured diabetes-education and is delivered within routine primary care. In a two-group cluster randomized controlled trial, GP practices are allocated by computer minimisation to an intervention group or a six-month deferred intervention group. We aim to recruit 250 participants from 50 practices across central England. Eligibility criteria are adults able to undertake the programme with type 2 diabetes, not taking insulin, with HbA1c over 8% (first 12 months) and following an agreed protocol change over 7% (months 13 to 18). Following randomisation, intervention nurses receive two-day training and delivered the Diabetes Manual programme to participants. Deferred intervention nurses receive the training following six-month follow-up. Primary outcome is HbA1c with total and HDL cholesterol; blood pressure, body mass index; self-efficacy and quality of life as additional outcomes. Primary analysis is between-group HbA1c differences at 6 months powered to give 80% power to detect a difference in HbA1c of 0.6%. A 12 month cohort analysis will assess maintenance of effect and assess relationship between self-efficacy and outcomes, and a qualitative study is running alongside. This trial incorporates educational and psychological diabetes interventions into a single programme and assesses both clinical and psychosocial outcomes. The trial will increase our understanding of intervention transferability between conditions, those diabetes related health behaviours that are more or less susceptible to change through efficacy enhancing mechanisms and how this impacts on clinical outcomes.

Lifestyle Triple P: a parenting intervention for childhood obesity

PubMed Central

2012-01-01

Background Reversing the obesity epidemic requires the development and evaluation of childhood obesity intervention programs. Lifestyle Triple P is a parent-focused group program that addresses three topics: nutrition, physical activity, and positive parenting. Australian research has established the efficacy of Lifestyle Triple P, which aims to prevent excessive weight gain in overweight and obese children. The aim of the current randomized controlled trial is to assess the effectiveness of the Lifestyle Triple P intervention when applied to Dutch parents of overweight and obese children aged 4–8 years. This effectiveness study is called GO4fit. Methods/Design Parents of overweight and obese children are being randomized to either the intervention or the control group. Those assigned to the intervention condition receive the 14-week Lifestyle Triple P intervention, in which they learn a range of nutritional, physical activity and positive parenting strategies. Parents in the control group receive two brochures, web-based tailored advice, and suggestions for exercises to increase active playing at home. Measurements are taken at baseline, directly after the intervention, and at one year follow-up. Primary outcome measure is the children’s body composition, operationalized as BMI z-score, waist circumference, and fat mass (biceps and triceps skinfolds). Secondary outcome measures are children’s dietary behavior and physical activity level, parenting practices, parental feeding style, parenting style, parental self-efficacy, and body composition of family members (parents and siblings). Discussion Our intervention is characterized by a focus on changing general parenting styles, in addition to focusing on changing specific parenting practices, as obesity interventions typically do. Strengths of the current study are the randomized design, the long-term follow-up, and the broad range of both self-reported and objectively measured outcomes. Trial Registration Current Controlled Trials NTR 2555 MEC AzM/UM NL 31988.068.10 / MEC 10-3-052 PMID:22471971

Mass media for smoking cessation in adolescents.

PubMed

Solomon, Laura J; Bunn, Janice Y; Flynn, Brian S; Pirie, Phyllis L; Worden, John K; Ashikaga, Takamaru

2009-08-01

Theory-driven, mass media interventions prevent smoking among youth. This study examined effects of a media campaign on adolescent smoking cessation. Four matched pairs of media markets in four states were randomized to receive or not receive a 3-year television/radio campaign aimed at adolescent smoking cessation based on social cognitive theory. The authors enrolled 2,030 adolescent smokers into the cohort (n = 987 experimental; n = 1,043 comparison) and assessed them via annual telephone surveys for 3 years. Although the condition by time interaction was not significant, the proportion of adolescents smoking in the past month was significantly lower in the experimental than comparison condition at 3-year follow-up when adjusted for baseline smoking status. The media campaign did not impact targeted mediating variables. A media campaign based on social cognitive constructs produced a modest overall effect on smoking prevalence among adolescents, but the role of theory-based constructs is unclear.

Effects of massage on the anxiety of patients receiving percutaneous coronary intervention.

PubMed

Peng, Sanying; Ying, Bie; Chen, Yi; Sun, Xiamei

2015-03-01

This study aimed to explore the effects of massage on the state anxiety of patients receiving percutaneous coronary intervention (PCI). In accordance with the principle of the minimum allocation of imbalance index for comparability, a total of 117 cases that were ready to receive PCI were divided into two groups (59 in the intervention group and 58 in the control group). The patients in the control group received routine care, whereas the patients in the observation group were given massage intervention. The state anxiety, heart rate, and blood pressure of the two groups were observed and compared. Massage treatments reduced the emergency response and level of anxiety of cardiovascular patients before PCI. The post-intervention blood pressure, heart rate, and pain score of the intervention group were significantly better than those of the control group (P<0.05). Health professionals should pay attention to and strengthen the exploration of the effects of reasonable care intervention mode under PCI to promote the physical and mental health of patients, as well as improve their medical care satisfaction.

Baseline Equivalence. WWC Standards Brief

ERIC Educational Resources Information Center

What Works Clearinghouse, 2017

2017-01-01

The What Works Clearinghouse (WWC) uses the term "baseline equivalence" when determining if the intervention group (those that received the intervention of interest) and the comparison group (those that did not receive the intervention) had characteristics that were similar enough ("equivalent") at the start of the study (at…

A Pilot Randomized Controlled Trial of an Integrated In-person and Mobile Phone Delivered Counseling and Text Messaging Intervention to Reduce HIV Transmission Risk among Male Sex Workers in Chennai, India.

PubMed

Mimiaga, Matthew J; Thomas, Beena; Biello, Katie; Johnson, Blake E; Swaminathan, Soumya; Navakodi, Pandiyaraja; Balaguru, S; Dhanalakshmi, A; Closson, Elizabeth F; Menon, Sunil; O'Cleirigh, Conall; Mayer, Kenneth H; Safren, Steven A

2017-11-01

Men who have sex with men (MSM) are at increased risk for HIV infection in India, particularly those who engage in transactional sex with other men (i.e., male sex workers; MSW). Despite the need, HIV prevention efforts for Indian MSW are lacking. As in other settings, MSW in India increasingly rely on the use of mobile phones for sex work solicitation. Integrating mobile phone technology into an HIV prevention intervention for Indian MSW may mitigate some of the challenges associated with face-to face approaches, such as implementation, lack of anonymity, and time consumption, while at the same time proving to be both feasible and useful. This is a pilot randomized controlled trial to examine participant acceptability, feasibility of study procedures, and preliminary efficacy for reducing sexual risk for HIV. MSW (N = 100) were equally randomized to: (1) a behavioral HIV prevention intervention integrating in-person and mobile phone delivered HIV risk reduction counseling, and daily, personalized text or voice messages as motivating "cognitive restructuring" cues for reducing condomless anal sex (CAS); or (2) a standard of care (SOC) comparison condition. Both groups received HIV counseling and testing at baseline and 6-months, and completed ACASI-based, behavioral and psychosocial assessments at baseline, 3, and 6 months. Mixed-effects regression procedures specifying a Poisson distribution and log link with a random intercept and slope for month of follow-up was estimated to assess the intervention effect on the primary outcomes: (1) CAS acts with male clients who paid them for sex, and (2) CAS acts with male non-paying sexual partners-both outcomes assessed over the past month. The intervention was both feasible (98% retention at 6-months) and acceptable (>96% of all intervention sessions attended); all intervention participants rated the intervention as "acceptable" or "very acceptable." A reduction in the reported number of CAS acts with male clients who paid them for sex in the past month was seen in both study conditions. MSW in the intervention condition reported a faster rate of decline in the number of CAS acts with male clients in the past month from the baseline to both the 3-month (B = -1.20; 95% CI -1.68, -0.73; p < 0.0001) and 6-month (B = -2.44; 95% CI -3.35, -1.53; p < 0.00001) assessment visits compared to the SOC condition. Post-hoc contrasts indicated that, at 3 months, participants in the intervention condition reported 1.43 (SD = 0.29) CAS acts with male clients in the past month compared to 4.85 (SD = 0.87) in the control condition (p = 0.0003). Furthermore, at 6 months, the intervention condition participants reported 0.24 (SD = 0.09) CAS acts with male clients in the past month compared to 2.79 (SD = 0.79) in the control condition (p < 0.0001). Findings are encouraging and provide evidence of feasibility and acceptability, and demonstrate initial efficacy (for reducing sexual risk for HIV) of a behavioral HIV prevention intervention for Indian MSW that combines daily, personalized text or voice messages with mobile phone-delivered sexual risk reduction counseling and skills building. Future testing of the intervention in a fully powered randomized controlled efficacy trial is warranted.

Brief interventions to reduce Ecstasy use: a multi-site randomized controlled trial.

PubMed

Norberg, Melissa M; Hides, Leanne; Olivier, Jake; Khawar, Laila; McKetin, Rebecca; Copeland, Jan

2014-11-01

Studies examining the ability of motivational enhancement therapy (MET) to augment education provision among ecstasy users have produced mixed results and none have examined whether treatment fidelity was related to ecstasy use outcomes. The primary objectives of this multi-site, parallel, two-group randomized controlled trial were to determine if a single-session of MET could instill greater commitment to change and reduce ecstasy use and related problems more so than an education-only intervention and whether MET sessions delivered with higher treatment fidelity are associated with better outcomes. The secondary objective was to assess participants' satisfaction with their assigned interventions. Participants (N=174; Mage=23.62) at two Australian universities were allocated randomly to receive a 15-minute educational session on ecstasy use (n=85) or a 50-minute session of MET that included an educational component (n=89). Primary outcomes were assessed at baseline, and then at 4-, 16-, and 24-weeks postbaseline, while the secondary outcome measure was assessed 4-weeks postbaseline by researchers blind to treatment allocation. Overall, the treatment fidelity was acceptable to good in the MET condition. There were no statistical differences at follow-up between the groups on the primary outcomes of ecstasy use, ecstasy-related problems, and commitment to change. Both intervention groups reported a 50% reduction in their ecstasy use and a 20% reduction in the severity of their ecstasy-related problems at the 24-week follow up. Commitment to change slightly improved for both groups (9%-17%). Despite the lack of between-group statistical differences on primary outcomes, participants who received a single session of MET were slightly more satisfied with their intervention than those who received education only. MI fidelity was not associated with ecstasy use outcomes. Given these findings, future research should focus on examining mechanisms of change. Such work may suggest new methods for enhancing outcomes. Australia and New Zealand Clinical Trial Registry: ACTRN12611000136909. Copyright © 2014. Published by Elsevier Ltd.

Relationship and partner moderator variables increase self-efficacy of performing skin self-examination

PubMed Central

Robinson, June K.; Stapleton, Jerod; Turrisi, Rob

2010-01-01

Objective We sought to identify relationship and partner-related moderating variables that influence the effectiveness of both a couples and a solo learning intervention designed to increase skin self-examination behavior in a sample of patients at risk for developing melanoma. Methods Patients received a brief intervention designed to teach skin self-examination skills and were randomly assigned into either a solo learning condition where the intervention was administered to the patient alone (n = 65) or a couple learning condition where the intervention was administered to the patient and patient’s spouse or cohabiting partner (n = 65). The main outcome measure was skin self-examination self-efficacy, which is the strongest mediator of skin self-examination. The relationship moderator variables measured were quality of relationship, partner motivation, and ability to assist in implementation of the intervention. Results When quality of the marital/partner relationship was high, the beneficial effects provided by the partner being included in the skin self-examination skills training were the highest and patients exhibited higher self-efficacy. Similar effects were observed for those with partners who were motivated to implement the intervention, and for those with partners high in ability to provide support. Limitations Study limitations include the need to evaluate whether the effects can be sustained long term and the exclusion of patients with melanoma without partners. Conclusions The amount of beneficial effects gained by the patient from the skin self-examination intervention was influenced by marital/partner relationships. Clinicians may need to consider these relationship and partner characteristics when communicating to patients about skin cancer screening. PMID:18258332

Effects of Three Depression Prevention Interventions on Risk for Depressive Disorder Onset in the Context of Depression Risk Factors

PubMed Central

Rohde, Paul; Stice, Eric; Gau, Jeff M.

2013-01-01

Study aims were to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Adolescents (N = 341) with elevated depressive symptoms were randomized to one of four prevention intervention conditions (cognitive-behavioral group, supportive-expressive group, cognitive-behavioral bibliotherapy, educational brochure control). By 2-year follow-up, 14% showed onset of major/minor depressive disorders. Classification tree analysis (CTA) revealed that negative attributional style was the most important risk factor: youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Results implicate two key pathways to depression involving negative attributional style and elevated depressive symptoms in this population, and suggest that bibliotherapy may offset the risk conveyed by the most important depression risk factor in this sample. PMID:22932745

Reduced substance use as a secondary benefit of an indicated cognitive-behavioral adolescent depression prevention program.

PubMed

Rohde, Paul; Stice, Eric; Gau, Jeff M; Marti, C Nathan

2012-09-01

Our first aim was to test whether a group cognitive-behavioral (CB) depression prevention program reduces substance use escalation over 2-year follow-up relative to two active comparison interventions and a brochure assessment control. Our second aim examined whether reductions in depressive symptoms mediate intervention effects, as posited by the affect-regulation model of substance use. In this indicated prevention trial, 341 high school adolescents at risk for depression because of the presence of elevated depressive symptoms were randomized to a Group CB intervention, group supportive-expressive group intervention, CB bibliotherapy, or educational brochure control condition. Participants in Group CB had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants; no other condition differences were significant. Mediational analyses suggested that reductions in depressive symptoms from baseline to posttest accounted for changes in substance use over 2 years for participants in Group CB relative to brochure control participants but did not mediate effects relative to those receiving bibliotherapy. Results suggest that a secondary benefit of this CB group indicated depression prevention program is lower rates of long-term substance use. Findings supported the hypothesis that, relative to a nonactive comparison condition, reductions in depressive symptoms mediated the effects of Group CB prevention on substance use escalation. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Effects of three depression prevention interventions on risk for depressive disorder onset in the context of depression risk factors.

PubMed

Rohde, Paul; Stice, Eric; Gau, Jeff M

2012-12-01

Study aims were to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Adolescents (N = 341) with elevated depressive symptoms were randomized to one of four prevention intervention conditions (cognitive-behavioral group, supportive-expressive group, cognitive-behavioral bibliotherapy, educational brochure control). By 2-year follow-up, 14% showed onset of major/minor depressive disorders. Classification tree analysis (CTA) revealed that negative attributional style was the most important risk factor: Youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: Those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Results implicate two key pathways to depression involving negative attributional style and elevated depressive symptoms in this population, and suggest that bibliotherapy may offset the risk conveyed by the most important depression risk factor in this sample.

Effects of Contingency Management and Bupropion on Cigarette Smoking in Smokers with Schizophrenia

PubMed Central

Tidey, Jennifer W.; Rohsenow, Damaris J.; Kaplan, Gary B.; Swift, Robert M; Reid, Netesha

2013-01-01

Rationale Individuals with schizophrenia have high smoking-related morbidity and mortality rates and need powerful and innovative smoking cessation interventions. Objectives This proof-of-concept study investigated the feasibility and initial efficacy of combining a contingency management intervention with bupropion to reduce smoking in people with schizophrenia. Methods Using a double-blind, placebo-controlled, between-groups design, 57 non-treatment seeking participants were randomized to receive 300 mg/day bupropion or placebo. One week later, participants were randomized to a contingency management (CM) intervention in which reductions in urinary cotinine levels were reinforced, or a non-contingent reinforcement (NR) condition in which session attendance was reinforced, regardless of cotinine level. Over the 22-day study period, participants visited the laboratory approximately three times per week to provide urine samples for analysis of cotinine levels, to give breath samples for analysis of carbon monoxide (CO) levels, and to report number of cigarettes smoked per day, nicotine withdrawal symptoms, cigarette craving and psychiatric symptoms. Results Cotinine and CO levels significantly decreased during the study period in participants randomized to the CM condition, but not the NR condition. Bupropion did not reduce cotinine levels or increase the efficacy of CM. Cigarette craving and psychiatric symptom levels significantly decreased during the study in all groups. Conclusions The results of this study indicate the efficacy and feasibility of this CM intervention for reducing smoking in individuals with schizophrenia. PMID:21475970

Mindfulness Based Relapse Prevention for Stimulant Dependent Adults: A Pilot Randomized Clinical Trial.

PubMed

Glasner-Edwards, Suzette; Mooney, Larissa J; Ang, Alfonso; Garneau, Hélène Chokron; Hartwell, Emily; Brecht, Mary-Lynn; Rawson, Richard A

2017-02-01

In light of the known associations between stress, negative affect, and relapse, mindfulness strategies hold promise as a means of reducing relapse susceptibility. In a pilot randomized clinical trial, we evaluated the effects of Mindfulness Based Relapse Prevention (MBRP), relative to a health education control condition (HE) among stimulant dependent adults receiving contingency management. All participants received a 12-week contingency management (CM) intervention. Following a 4-week CM-only lead in phase, participants were randomly assigned to concurrently receive MBRP (n=31) or HE (n=32). Stimulant dependent adults age 18 and over. A university based clinical research center. The primary outcomes were stimulant use, measured by urine drug screens weekly during the intervention and at 1-month post-treatment, negative affect, measured by the Beck Depression Inventory and Beck Anxiety Inventory, and psychiatric severity, measured by the Addiction Severity Index. Medium effect sizes favoring MBRP were observed for negative affect and overall psychiatric severity outcomes. Depression severity changed differentially over time as a function of group, with MBRP participants reporting greater reductions through follow-up (p=0.03; Effect Size=0.58). Likewise, the MBRP group evidenced greater declines in psychiatric severity, (p=0.01; Effect Size=0.61 at follow-up). Among those with depressive and anxiety disorders, MBRP was associated with lower odds of stimulant use relative to the control condition (Odds Ratio= 0.78, p=0.03 and OR=0.68, p=0.04). MBRP effectively reduces negative affect and psychiatric impairment, and is particularly effective in reducing stimulant use among stimulant dependent adults with mood and anxiety disorders.

The effectiveness of lifestyle triple P in the Netherlands: a randomized controlled trial.

PubMed

Gerards, Sanne M P L; Dagnelie, Pieter C; Gubbels, Jessica S; van Buuren, Stef; Hamers, Femke J M; Jansen, Maria W J; van der Goot, Odilia H M; de Vries, Nanne K; Sanders, Matthew R; Kremers, Stef P J

2015-01-01

Lifestyle Triple P is a general parenting intervention which focuses on preventing further excessive weight gain in overweight and obese children. The objective of the current study was to assess the effectiveness of the Lifestyle Triple P intervention in the Netherlands. We used a parallel randomized controlled design to test the effectiveness of the intervention. In total, 86 child-parent triads (children 4-8 years old, overweight or obese) were recruited and randomly assigned (allocation ratio 1:1) to the Lifestyle Triple P intervention or the control condition. Parents in the intervention condition received a 14-week intervention consisting of ten 90-minute group sessions and four individual telephone sessions. Primary outcome measure was the children's body composition (BMI z-scores, waist circumference and skinfolds). The research assistant who performed the measurements was blinded for group assignment. Secondary outcome measures were the children's dietary behavior and physical activity level, parenting practices, parental feeding style, parenting style, and parental self-efficacy. Outcome measures were assessed at baseline and 4 months (short-term) and 12 months (long-term) after baseline. Multilevel multiple regression analyses were conducted to determine the effect of the intervention on primary and secondary outcome measures. No intervention effects were found on children's body composition. Analyses of secondary outcomes showed positive short-term intervention effects on children's soft-drink consumption and parental responsibility regarding physical activity, encouragement to eat, psychological control, and efficacy and satisfaction with parenting. Longer-term intervention effects were found on parent's report of children's time spent on sedentary behavior and playing outside, parental monitoring food intake, and responsibility regarding nutrition. Although the Lifestyle Triple P intervention showed positive effects on some parent reported child behaviors and parenting measures, no effects were visible on children's body composition or objectively measured physical activity. Several adjustments of the intervention content are recommended, for example including a booster session. Nederlands Trial Register NTR 2555.

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

PubMed Central

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

2014-01-01

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

A smart-phone intervention to address mental health stigma in the construction industry: A two-arm randomised controlled trial.

PubMed

Milner, A; Law, P C F; Mann, C; Cooper, T; Witt, K; LaMontagne, A D

2018-04-01

High levels of self-stigma are associated with a range of adverse mental health, treatment, and functional outcomes. This prospective study examined the effects of an electronic mental health stigma reduction intervention on self-stigma (self-blame, shame, and help-seeking inhibition) among male construction workers in Australia. Male construction workers (N = 682) were randomly assigned to receive either the intervention condition or the wait list control over a six-week period. Self-stigma was assessed using the Self-Stigma of Depression Scale at post-intervention. We conducted linear regression to assess the effectiveness of the intervention on self-stigma, adjusting for relevant covariates. Self-stigma was relatively low in the sample. The intervention had no significant effect on self-stigma, after adjusting for confounders. There were reductions in stigma in both the intervention and control groups at 6-week follow-up. Process evaluation indicated that participants generally enjoyed the program and felt that it was beneficial to their mental health. These observations underscore the need for further research to elucidate understanding of the experience of self-stigma among employed males.

Effectiveness of a smartphone-based worry-reduction training for stress reduction: A randomized-controlled trial.

PubMed

Versluis, Anke; Verkuil, Bart; Spinhoven, Philip; F Brosschot, Jos

2018-04-03

Perseverative cognition (e.g. worry) and unconscious stress are suggested to be important mediators in the relation between stressors and physiological health. We examined whether a smartphone-based worry-reduction training improved a physiological marker of stress (i.e. increased heart rate variability [HRV]) and unconscious stress. Randomised-controlled trial was conducted with individuals reporting work stress (n = 136). Participants were randomised to the experimental, control or waitlist condition (resp. EC, CC, WL). The EC and CC registered emotions five times daily for four weeks. The EC additionally received a worry-reduction training with mindfulness exercises. Primary outcome was 24-h assessments of HRV measured at pre-, mid- and post-intervention. Secondary outcomes were implicit affect and stress. Effects on heart rate and other psychological outcomes were explored. A total of 118 participants completed the study. No change from pre- to post-intervention was observed for the primary or secondary outcomes. The change over time was not different between conditions. Findings suggest that the training was ineffective for improving HRV or psychological stress. Future studies may focus on alternative smartphone-based stress interventions, as stress levels are high in society. There is need for easy interventions and smartphones offer possibilities for this.

A restaurant-based intervention to promote sales of healthy children's menu items: the Kids' Choice Restaurant Program cluster randomized trial.

PubMed

Ayala, Guadalupe X; Castro, Iana A; Pickrel, Julie L; Williams, Christine B; Lin, Shih-Fan; Madanat, Hala; Jun, Hee-Jin; Zive, Michelle

2016-03-10

Away-from-home eating is an important dietary behavior with implications on diet quality. Thus, it is an important behavior to target to prevent and control childhood obesity and other chronic health conditions. Numerous studies have been conducted to improve children's dietary intake at home, in early care and education, and in schools; however, few studies have sought to modify the restaurant food environment for children. This study adds to this body of research by describing the development and launch of an innovative intervention to promote sales of healthy children's menu items in independent restaurants in Southern California, United States. This is a cluster randomized trial with eight pair-matched restaurants in San Diego, California. Restaurants were randomized to a menu-only versus menu-plus intervention condition. The menu-only intervention condition involves manager/owner collaboration on the addition of pre-determined healthy children's menu items and kitchen manager/owner collaboration to prepare and plate these items and train kitchen staff. The menu-plus intervention condition involves more extensive manager/owner collaboration and kitchen staff training to select, prepare, and plate new healthy children's menu items, and a healthy children's menu campaign that includes marketing materials and server training to promote the items. The primary outcome is sales of healthy children's menu items over an 18-week period. In addition, dining parties consisting of adults with children under 18 years of age are being observed unobtrusively while ordering and then interviewed throughout the 18-week study period to determine the impact of the intervention on ordering behaviors. Manager/owner interviews and restaurant audits provide additional evidence of impact on customers, employees, and the restaurant environment. Our process evaluation assesses dose delivered, dose received, and intervention fidelity. Successful recruitment of the restaurants has been completed, providing evidence that the restaurant industry is open to working on the public health challenge of childhood obesity. Determining whether a restaurant intervention can promote sales of healthy children's menu items will provide evidence for how to create environments that support the healthy choices needed to prevent and control obesity. Despite these strengths, collection of sales data that will allow comprehensive analysis of intervention effects remains a challenge. NCT02511938.

Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment.

PubMed

Maloney, Kathleen; Ward, Abigail; Krenz, Bonnie; Petty, Nora; Bryson, Lindsay; Dolkart, Caitlin; Visser, Theodoor; Le Menach, Arnaud; Scott, Valerie K; Cohen, Justin M; Mtumbuka, Esther; Mkude, Sigsbert

2017-01-03

Tanzania has seen a reduction in the fraction of fevers caused by malaria, likely due in part to scale-up of control measures. While national guidelines require parasite-based diagnosis prior to treatment, it is estimated that more than half of suspected malaria treatment-seeking in Tanzania initiates in the private retail sector, where diagnosis by malaria rapid diagnostic test (RDT) or microscopy is illegal. This pilot study investigated whether the introduction of RDTs into Accredited Drug Dispensing Outlets (ADDOs) under realistic market conditions would improve case management practices. Dispensers from ADDOs in two intervention districts in Tanzania were trained to stock and perform RDTs and monitored quarterly. Each district was assigned a different recommended retail price to evaluate the need for a subsidy. Malaria RDT and artemisinin-based combination therapy (ACT) uptake and availability were measured pre-intervention and 1 year post-intervention through structured surveys of ADDO owners and exiting customers in both intervention districts and one contiguous control district. Descriptive analysis and logistic regression were used to compare the three districts and identify predictive variables for testing. A total of 310 dispensers from 262 ADDOs were trained to stock and perform RDTs. RDT availability in intervention ADDOs increased from 1% (n = 172) to 73% (n = 163) during the study; ACT medicines were available in 75% of 260 pre-intervention and 68% of 254 post-intervention ADDOs. Pre-treatment testing performed within the ADDO increased from 0 to 65% of suspected malaria patients who visited a shop (95% CI 60.8-69.6%) with no difference between intervention districts. Overall parasite-based diagnosis increased from 19 to 74% in intervention districts and from 3 to 18% in the control district. Prior knowledge of RDT availability (aOR = 1.9, p = 0.03) and RDT experience (aOR = 1.9, p = 0.01) were predictors for testing. Adherence data indicated that 75% of malaria positives received ACT, while 3% of negatives received ACT. Trained and supervised ADDO dispensers in rural Tanzania performed and sold RDTs under real market conditions to two-thirds of suspected malaria patients during this one-year pilot. These results support the hypothesis that introducing RDTs into regulated private retail sector settings can improve malaria testing and treatment practices without an RDT subsidy. Trial registration ISRCTN ISRCTN14115509.

Effect of Modified Otago Exercises on Postural Balance, Fear of Falling, and Fall Risk in Older Fallers With Knee Osteoarthritis and Impaired Gait and Balance: A Secondary Analysis.

PubMed

Mat, Sumaiyah; Ng, Chin Teck; Tan, Pey June; Ramli, Norlisah; Fadzli, Farhana; Rozalli, Faizatul Izza; Mazlan, Mazlina; Hill, Keith D; Tan, Maw Pin

2018-03-01

Osteoarthritis (OA) is considered an established risk factor for falls. Published studies evaluating secondary falls prevention strategies among individuals with OA are limited. To evaluate the effect of a personalized home-based exercise program to improve postural balance, fear of falling, and falls risk in older fallers with knee OA and gait and balance problems. Randomized controlled trial. University of Malaya Medical Centre. Fallers who had both radiological OA and a Timed Up and Go (TUG) score of over 13.5 seconds. Postural sway (composite sway) was quantified with the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) under 4 different sensory conditions: eyes open on firm surface, eyes closed on firm surface, eyes open on unstable foam surface, and eyes closed on unstable foam surface. Participants were asked to stand upright and to attempt to hold their position for 10 seconds for each test condition. The average reading for all conditions were calculated. Participants randomized to the intervention arm received a home-based modified Otago Exercise Program (OEP) as part of a multifactorial intervention, whereas control participants received general health advice and conventional treatment. This was a secondary subgroup analysis from an original randomized controlled trial, the Malaysian Falls Assessment and Intervention Trial (MyFAIT) (trial registration number: ISRCTN11674947). Posturography using a long force plate balance platform (Balancemaster, NeuroCom, USA), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the short-form Falls Efficacy Scale-International (short FES-I) were assessed at baseline and 6 months. Results of 41 fallers with radiological evidence of OA and impaired TUG (intervention, 17; control, 24) were available for the final analysis. Between-group analysis revealed significant improvements in the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), Limits of Stability (LOS), and short FES-I scores by the intervention group compared to the control group at 6 months. No significant difference in time to first fall or in fall-free survival between the intervention and control groups was found. Home-based balance and strength exercises benefited older fallers with OA and gait and balance disorders by improving postural control, with no observable trend in reduction of fall recurrence. Our findings will now inform a future, adequately powered, randomized controlled study using fall events as definitive outcomes. I. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

An exploration of decision aid effectiveness: the impact of promoting affective vs. deliberative processing on a health-related decision.

PubMed

Davis, Esther L; McCaffery, Kirsten; Mullan, Barbara; Juraskova, Ilona

2015-12-01

Decision aids (DAs) are non-directive communication tools that help patients make value-consistent health-care decisions. However, most DAs have been developed without an explicit theoretical framework, resulting in a lack of understanding of how DAs achieve outcomes. To investigate the effect of promoting affective vs. deliberative processing on DA effectiveness based on dual-process theory. One hundred and forty-eight female university students participated in a randomized controlled experiment with three conditions: emotion-focused, information-focused and control. Preference-value consistency, knowledge, decisional conflict and satisfaction were compared across the conditions using planned contrast analyses. The intervention comprised two different DAs and instructional manipulations. The emotion-focused condition received a modified DA with affective content and instructions to induce an affective reaction. The information-focused and control conditions received the same DA without the affective content. The information-focused condition received additional instructions to induce deliberative processing. Controlling for the experiment-wise error rate at P < 0.017, the emotion-focused and information-focused conditions had significantly higher decisional satisfaction than the control condition (P < 0.001). The emotion-focused condition did not demonstrate preference-value consistency. There were no significant differences for decisional conflict and knowledge. Results suggest that the promotion of affective processing may hinder value-consistent decision making, while deliberative processing may enhance decisional satisfaction. This investigation of the effect of affective and deliberative processes in DA-supported decision making has implications for the design and use of DAs. DA effectiveness may be enhanced by incorporating a simple instruction to focus on the details of the information. © 2014 John Wiley & Sons Ltd.

Adolescents demonstrate improvement in obesity risk behaviors following completion of Choice, Control, and Change, a curriculum addressing personal agency and autonomous motivation

PubMed Central

Koch, Pamela A.; Lee, Heewon; Calabrese-Barton, A

2010-01-01

Background The rapid increase of obesity and diabetes risk beginning in youth, particularly those from disadvantaged communities, calls for prevention efforts. Objective To examine the impact of a curriculum intervention, Choice, Control, and Change (C3), on the adoption of the energy balance related behaviors of decreasing sweetened drinks, packaged snacks, fast food, and leisure screen time, and increasing water, fruits and vegetables, and physical activity, and on potential psychosocial mediators of the behaviors. Design Ten middle schools in low-income New York City neighborhoods were randomly assigned within matched pairs to either intervention or comparison/ delayed control conditions during the 2007–2008 school year. Participants 562 inner city seventh grade students in the intervention condition, and 574 in the comparison condition. Intervention Students received the 24 C3 lessons that used science inquiry-based investigations to enhance motivation for action, and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action. Main outcome measures Self-report instruments to measure energy balance related behaviors targeted by the curriculum, and potential psychosocial mediators of the behaviors. Analyses ANCOVA with group (intervention/control) as a fixed factor and pre-test as covariate. Results Students in intervention schools compared to the delayed intervention controls reported consumption of significantly fewer sweetened drinks and packaged snacks, smaller sizes of fast food, increased intentional walking for exercise, and decreased leisure screen-time, but showed no increases in their intakes of water, fruits, and vegetables. They showed significant increases in positive outcome expectations about the behaviors, self-efficacy, goal intentions, competence, and autonomy. Conclusions The C3 curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk, indicating that combining inquiry-based science education and behavioral theory is a promising approach. PMID:21111093

Pilot Randomized Controlled Trial of a Mindfulness-Based Group Intervention in Adolescent Girls at Risk for Type 2 Diabetes with Depressive Symptoms

PubMed Central

Shomaker, Lauren B.; Bruggink, Stephanie; Pivarunas, Bernadette; Skoranski, Amanda; Foss, Jillian; Chaffin, Ella; Dalager, Stephanie; Annameier, Shelly; Quaglia, Jordan; Brown, Kirk Warren; Broderick, Patricia; Bell, Christopher

2017-01-01

Objective (1) Evaluate feasibility and acceptability of a mindfulness-based group in adolescent girls at-risk for type 2 diabetes (T2D) with depressive symptoms, and (2) compare efficacy of a mindfulness-based versus cognitive-behavioral group for decreasing depressive symptoms and improving insulin resistance. Design and setting Parallel-group, randomized controlled pilot trial conducted at a university. Participants Thirty-three girls 12-17y with overweight/obesity, family history of diabetes, and elevated depressive symptoms were randomized to a six-week mindfulness-based (n=17) or cognitive-behavioral program (n=16). Interventions Both interventions included six, one-hour weekly group sessions. The mindfulness-based program included guided mindfulness awareness practices. The cognitive-behavioral program involved cognitive restructuring and behavioral activation. Main outcome measures Adolescents were evaluated at baseline, post-intervention, and six-months. Feasibility/acceptability were measured by attendance and program ratings. Depressive symptoms were assessed by validated survey. Insulin resistance was determined from fasting insulin and glucose, and dual energy x-ray absorptiometry was used to assess body composition. Results Most adolescents attended ≥80% sessions (mindfulness:92% versus cognitive-behavioral:87%, p=1.00). Acceptability ratings were strong. At post-treatment and six-months, adolescents in the mindfulness condition had greater decreases in depressive symptoms than adolescents in the cognitive-behavioral condition (ps<.05). Compared to the cognitive-behavioral condition, adolescents in the mindfulness-based intervention also had greater decreases in insulin resistance and fasting insulin at post-treatment, adjusting for fat mass and other covariates (ps<.05). Conclusions A mindfulness-based intervention shows feasibility and acceptability in girls at-risk for T2D with depressive symptoms. Compared to a cognitive-behavioral program, after the intervention, adolescents who received mindfulness showed greater reductions in depressive symptoms and better insulin resistance. PMID:28619307

"PHE in Action": Development and Modeling of an Intervention to Improve Patient Engagement among Older Adults.

PubMed

Menichetti, Julia; Graffigna, Guendalina

2016-01-01

The increasing prevalence of chronic conditions among older adults constitutes a major public health problem. Thus, changes in lifestyles are required to prevent secondary conditions and sustain good care practices. While patient engagement received great attention in the last years as key strategy to solve this issue, to date no interventions exist to sustain the engagement of older chronic patients toward their health management. This study describes the design, development, and optimization of PHEinAction , a theoretically-driven intervention program to increase patient engagement in older chronic populations and consequently to foster healthy changes that can help reduce risks of health problems. The development process followed the UK Medical Research Council's (MRC) guidelines and involved selecting the theoretical base for the intervention, identifying the relevant evidence-based literature, and conducting exploratory research to qualitatively evaluate program's feasibility, acceptability, and comprehension. The result was a user-endorsed intervention designed to improve older patients' engagement in health management based on the theoretical framework of the Patient Health Engagement (PHE) model. The intervention program, which emerged from this process, consisted of 2 monthly face-to-face 1-h sessions delivered by a trained facilitator and one brief telephonic consultation, and aimed to facilitate a range of changes for patient engagement (e.g., motivation to change, health information seeking and use, emotional adjustment, health behaviors planning). PHEinAction is the first example of a theoretically-based patient engagement intervention designed for older chronic targets. The intervention program is based on psychological theory and evidence; it facilitates emotional, psychological, and behavioral processes to support patient engagement and lifestyle change and maintenance. It provides estimates of the extent to which it could help high-risk groups engage in effective health management and informs future trials.

“PHE in Action”: Development and Modeling of an Intervention to Improve Patient Engagement among Older Adults

PubMed Central

Menichetti, Julia; Graffigna, Guendalina

2016-01-01

The increasing prevalence of chronic conditions among older adults constitutes a major public health problem. Thus, changes in lifestyles are required to prevent secondary conditions and sustain good care practices. While patient engagement received great attention in the last years as key strategy to solve this issue, to date no interventions exist to sustain the engagement of older chronic patients toward their health management. This study describes the design, development, and optimization of PHEinAction, a theoretically-driven intervention program to increase patient engagement in older chronic populations and consequently to foster healthy changes that can help reduce risks of health problems. The development process followed the UK Medical Research Council's (MRC) guidelines and involved selecting the theoretical base for the intervention, identifying the relevant evidence-based literature, and conducting exploratory research to qualitatively evaluate program's feasibility, acceptability, and comprehension. The result was a user-endorsed intervention designed to improve older patients' engagement in health management based on the theoretical framework of the Patient Health Engagement (PHE) model. The intervention program, which emerged from this process, consisted of 2 monthly face-to-face 1-h sessions delivered by a trained facilitator and one brief telephonic consultation, and aimed to facilitate a range of changes for patient engagement (e.g., motivation to change, health information seeking and use, emotional adjustment, health behaviors planning). PHEinAction is the first example of a theoretically-based patient engagement intervention designed for older chronic targets. The intervention program is based on psychological theory and evidence; it facilitates emotional, psychological, and behavioral processes to support patient engagement and lifestyle change and maintenance. It provides estimates of the extent to which it could help high-risk groups engage in effective health management and informs future trials. PMID:27695435

Optimizing a positive psychology intervention to promote health behaviors following an acute coronary syndrome: The Positive Emotions after Acute Coronary Events-III (PEACE-III) randomized factorial trial.

PubMed

Celano, Christopher M; Albanese, Ariana M; Millstein, Rachel A; Mastromauro, Carol A; Chung, Wei-Jean; Campbell, Kirsti A; Legler, Sean R; Park, Elyse R; Healy, Brian C; Collins, Linda M; Januzzi, James L; Huffman, Jeff C

2018-04-05

Despite the clear benefits of physical activity and related behaviors on prognosis, most patients suffering an acute coronary syndrome (ACS) remain nonadherent to these behaviors. Deficits in positive psychological constructs (e.g., optimism) are linked to reduced participation in health behaviors, supporting the potential utility of a positive psychology (PP)-based intervention in post-ACS patients. Accordingly, we aimed to identify optimal components of a PP-based intervention to promote post-ACS physical activity. As part of a multiphase optimization strategy, we completed a randomized factorial trial with eight conditions in 128 post-ACS patients to efficiently identify best-performing intervention components. All participants received a PP-based intervention, with conditions varying in duration (presence/absence of booster sessions), intensity (weekly/daily PP exercises), and content (PP alone or combined with motivational interviewing [MI]), allowing three concurrent comparisons within the trial. Study aims included assessments of the overall feasibility, acceptability, and impact of the intervention, along with the primary aim of determining which components were associated with objectively-measured physical activity and self-reported health behavior adherence at 16 weeks, assessed using longitudinal models. The intervention was well-accepted and associated with substantial improvements in behavioral and psychological outcomes. Booster sessions were associated with greater activity to a nearly significant degree (β=8.58, 95% confidence interval= -0.49-17.65, effect size difference=.43; p=.064), MI was associated with overall adherence (β=0.95, 95% confidence interval=0.02-1.87, effect size difference=.39; p=.044), and weekly exercise completion was generally superior to daily. These findings will enable optimization of the PP-based intervention in preparation for a well-powered controlled trial. ClinicalTrials.gov identifier: NCT02754895.

Description of public health nursing nutrition assessment and interventions for home-visited women.

PubMed

Horning, Melissa L; Olsen, Jeanette M; Lell, Shay; Thorson, Diane R; Monsen, Karen A

2018-05-09

The purpose of this manuscript was to describe: Public Health Nurse (PHN) home-visited, female client Nutrition Knowledge (K), Behavior (B), and Status (S); the number and types of nutrition interventions PHNs used with these clients; and the types of clients receiving nutrition interventions. This descriptive study used PHN-generated Omaha System, electronic health record data from January 2012 to July 2015. The analytic sample contains 558 women who received home visits in a rural Midwestern U.S. county that employed universal nutrition assessment for clients. Omaha System data included nutrition KBS scores (from 1 = low to 5 = high) and nutrition interventions delivered. Analyses included descriptive, bivariate, and multivariate analyses (means, frequencies, chi-squares, general linear models). PHNs assessed nutrition KBS scores for 84.1% of clients; average Nutrition Knowledge was 3.4 (SD = 0.7), Behavior 3.7 (SD = 0.8), and Status 4.3 (SD = 1.0). PHNs provided 0-36 nutrition interventions per client. Nutrition intervention patterns were detected by the type of visit clients received. Results suggest home-visited women have room to improve Nutrition KBS and PHNs utilize myriad nutrition interventions. Results also point to opportunities to improve home-visited client care by providing more nutrition interventions, especially to those not receiving interventions, and revising standard care plans to reflect important Case Management nutrition interventions. © 2018 Wiley Periodicals, Inc.

Combination therapy efficacy of catgut embedding acupuncture and diet intervention on interleukin-6 levels and body mass index in obese patients

NASA Astrophysics Data System (ADS)

Tjan, P. M.; Srilestari, A.; Abdurrohim, K.; Kresnawan, T.

2017-08-01

Obesity is a major health problem worldwide, affecting more than 500 million adults with an additional 1.5 billion adults classified as overweight. Acupuncture has been recognized as an adjunctive therapy for obesity, and recent evidence suggests its potential to reduce the inflammatory response in adipose tissue, a condition believed to be responsible for obesity-related health problems. Interleukin-6 (IL-6) has been proposed as an important mediator of the inflammatory response in adipose tissue, but the number of studies addressing the issue is still limited. A double-blind, randomized, placebo-controlled trial was conducted with36 obese patients currently receiving dietary intervention. The patients were randomly allocated into the catgut embedding acupuncture group with diet intervention or the sham (placebo) embedding acupuncture group with diet intervention. Catgut embedding therapy was given twice at CV12 Zhongwan, ST25 Tianshu, CV6 Qihai, and SP6 Sanyinjiao acupoints with two week intervals between procedures. The study endpoints were the IL-6 levels in the blood plasma and body mass index (BMI), measured before and after the intervention. We observed a reduction in the IL-6 levels (mean reduction 0.13 pg/mL, 95% CI: 0.03-0.23) and BMI (mean reduction 0.66, 95% CI 0.43-0.88) in the accupuncture group. The average difference in mean reduction of BMI between the accupuncture and sham groups was 0.34 (95% CI: 0.17-0.52). No difference was found in mean IL-6 reduction between the two groups (95% CI: -0.17 to 0.06). The results suggest that acupoint catgut embedding therapy may help reduce IL-6 levels and BMI in obese patients receiving dietary intervention.

The Effect of a School-Based Transitional Support Intervention Program on Alternative School Youth's Attitudes and Behaviors

ERIC Educational Resources Information Center

Kelchner, Viki P.; Evans, Kathy; Brendell, Kathrene; Allen, Danielle; Miller, Cassandre; Cooper-Haber, Karen

2017-01-01

This investigation examined the potential impact of a school-based youth intervention program on the attitudes and behavioral patterns of at-risk youth. The sample size used in this study was 52; 24 participants received the school-based intervention and 28 participants did not receive the intervention. A two-group pretest-posttest design approach…

Effectiveness and acceptance of a web-based depression intervention during waiting time for outpatient psychotherapy: study protocol for a randomized controlled trial.

PubMed

Grünzig, Sasha-Denise; Baumeister, Harald; Bengel, Jürgen; Ebert, David; Krämer, Lena

2018-05-22

Due to limited resources, waiting periods for psychotherapy are often long and burdening for those in need of treatment and the health care system. In order to bridge the gap between initial contact and the beginning of psychotherapy, web-based interventions can be applied. The implementation of a web-based depression intervention during waiting periods has the potential to reduce depressive symptoms and enhance well-being in depressive individuals waiting for psychotherapy. In a two-arm randomized controlled trial, effectiveness and acceptance of a guided web-based intervention for depressive individuals on a waitlist for psychotherapy are evaluated. Participants are recruited in several German outpatient clinics. All those contacting the outpatient clinics with the wish to enter psychotherapy receive study information and a depression screening. Those adults (age ≥ 18) with depressive symptoms above cut-off (CES-D scale > 22) and internet access are randomized to either intervention condition (treatment as usual and immediate access to the web-based intervention) or waiting control condition (treatment as usual and delayed access to the web-based intervention). At three points of assessment (baseline, post-treatment, 3-months-follow-up) depressive symptoms and secondary outcomes, such as quality of life, attitudes towards psychotherapy and web-based interventions and adverse events are assessed. Additionally, participants' acceptance of the web-based intervention is evaluated, using measures of intervention adherence and satisfaction. This study investigates a relevant setting for the implementation of web-based interventions, potentially improving the provision of psychological health care. The results of this study contribute to the evaluation of innovative and resource-preserving health care models for outpatient psychological treatment. This trial has been registered on 13 February 2017 in the German clinical trials register (DRKS); registration number DRKS00010282 .

Smartphone-based reminder system to promote pelvic floor muscle training for the management of postnatal urinary incontinence: historical control study with propensity score-matched analysis.

PubMed

Kinouchi, Kaori; Ohashi, Kazutomo

2018-01-01

The purpose of this study was to evaluate the efficacy of a smartphone-based reminder system in promoting pelvic floor muscle training (PFMT) to help postpartum women manage urinary incontinence (UI). Forty-nine and 212 postpartum women in the intervention and control groups, respectively, received PFMT guidance using a leaflet and verbal instruction as the standard care at an obstetrics clinic in Japan. Women in the intervention group also received PFMT support using the smartphone-based reminder system between January and August 2014. For analysis, they were compared with historical controls between February 2011 and January 2012, who did not receive such support and were chosen by propensity score matching. The outcomes examined were PFMT adherence and UI prevalence. The former consisted of implementation rate (i.e., the percentage of women who reported performing PFMT during the intervention period), training intensity (i.e., the number of pelvic floor muscle contractions (PFMCs) per day), and training frequency (i.e., the number of days PFMT was performed per week); the latter consisted of self-reported UI prevalence at baseline and at the end of the eight-week intervention period. Propensity score matching resulted in 58 postpartum women ( n  = 29 per group). The intervention group exhibited better PFMT adherence than the control group, in terms of PFMT implementation rate (69 vs. 31%, p  = 0.008), median training intensity (15 vs. 1 PFMC reps/day, p  = 0.006), and training frequency (7 vs. 3 days/week, p  < 0.001). UI prevalence was not different between the groups at baseline, but was significantly reduced in the intervention group at eight weeks (0 vs. 24%, p  = 0.004). Our smartphone-based reminder system appears promising in enhancing PFMT adherence and managing postpartum UI in postpartum women. By enhancing PFMT adherence and improving women's ability to manage the condition, the reminder system could improve the health-related quality of life of postpartum women with UI.

A single-center randomized, controlled trial investigating the efficacy of a mHealth ECG technology intervention to improve the detection of atrial fibrillation: the iHEART study protocol.

PubMed

Hickey, Kathleen T; Hauser, Nicole R; Valente, Laura E; Riga, Teresa C; Frulla, Ashton P; Masterson Creber, Ruth; Whang, William; Garan, Hasan; Jia, Haomiao; Sciacca, Robert R; Wang, Daniel Y

2016-07-16

Atrial fibrillation is a major public health problem and is the most common cardiac arrhythmia, affecting an estimated 2.7 million Americans. The true prevalence of atrial fibrillation is likely underestimated because episodes are often sporadic; therefore, it is challenging to detect and record an occurrence in a "real world" setting. To date, mobile health tools that promote earlier detection and treatment of atrial fibrillation and improvement in self-management behaviors and knowledge have not been evaluated. This study will be the first to address the epidemic problem of atrial fibrillation with a novel approach utilizing advancements in mobile health electrocardiogram technology to empower patients to actively engage in their healthcare and to evaluate impact on quality of life and quality-adjusted life years. Furthermore, sending a daily electrocardiogram transmission, coupled with receiving educational and motivational text messages aimed at promoting self-management and a healthy lifestyle may improve the management of chronic cardiovascular conditions (e.g., hypertension, diabetes, heart failure, etc.). Therefore, we are currently conducting a randomized controlled trial to assess the efficacy of a mobile health intervention, iPhone® Helping Evaluate Atrial fibrillation Rhythm through Technology (iHEART) versus usual cardiac care. The iHEART study is a single center, prospective, randomized controlled trial. A total of 300 participants with a recent history of atrial fibrillation will be enrolled. Participants will be randomized 1:1 to receive the iHEART intervention, receiving an iPhone® equipped with an AliveCor® Mobile ECG and accompanying Kardia application and behavioral altering motivational text messages or usual cardiac care for 6 months. This will be the first study to investigate the utility of a mobile health intervention in a "real world" setting. We will evaluate the ability of the iHEART intervention to improve the detection and treatment of recurrent atrial fibrillation and assess the intervention's impact on improving clinical outcomes, quality of life, quality-adjusted life-years and disease-specific knowledge. NCT02731326 ; Verified April 2016.

Soft Decision Analyzer

NASA Technical Reports Server (NTRS)

Steele, Glen; Lansdowne, Chatwin; Zucha, Joan; Schlensinger, Adam

2013-01-01

The Soft Decision Analyzer (SDA) is an instrument that combines hardware, firmware, and software to perform realtime closed-loop end-to-end statistical analysis of single- or dual- channel serial digital RF communications systems operating in very low signal-to-noise conditions. As an innovation, the unique SDA capabilities allow it to perform analysis of situations where the receiving communication system slips bits due to low signal-to-noise conditions or experiences constellation rotations resulting in channel polarity in versions or channel assignment swaps. SDA s closed-loop detection allows it to instrument a live system and correlate observations with frame, codeword, and packet losses, as well as Quality of Service (QoS) and Quality of Experience (QoE) events. The SDA s abilities are not confined to performing analysis in low signal-to-noise conditions. Its analysis provides in-depth insight of a communication system s receiver performance in a variety of operating conditions. The SDA incorporates two techniques for identifying slips. The first is an examination of content of the received data stream s relation to the transmitted data content and the second is a direct examination of the receiver s recovered clock signals relative to a reference. Both techniques provide benefits in different ways and allow the communication engineer evaluating test results increased confidence and understanding of receiver performance. Direct examination of data contents is performed by two different data techniques, power correlation or a modified Massey correlation, and can be applied to soft decision data widths 1 to 12 bits wide over a correlation depth ranging from 16 to 512 samples. The SDA detects receiver bit slips within a 4 bits window and can handle systems with up to four quadrants (QPSK, SQPSK, and BPSK systems). The SDA continuously monitors correlation results to characterize slips and quadrant change and is capable of performing analysis even when the receiver under test is subjected to conditions where its performance degrades to high error rates (30 percent or beyond). The design incorporates a number of features, such as watchdog triggers that permit the SDA system to recover from large receiver upsets automatically and continue accumulating performance analysis unaided by operator intervention. This accommodates tests that can last in the order of days in order to gain statistical confidence in results and is also useful for capturing snapshots of rare events.

Employment Interventions for Individuals with ASD: The Relative Efficacy of Supported Employment With or Without Prior Project SEARCH Training.

PubMed

Schall, Carol M; Wehman, Paul; Brooke, Valerie; Graham, Carolyn; McDonough, Jennifer; Brooke, Alissa; Ham, Whitney; Rounds, Rachael; Lau, Stephanie; Allen, Jaclyn

2015-12-01

This paper presents findings from a retrospective observational records review study that compares the outcomes associated with implementation of supported employment (SE) with and without prior Project SEARCH with ASD Supports (PS-ASD) on wages earned, time spent in intervention, and job retention. Results suggest that SE resulted in competitive employment for 45 adults with ASD. Twenty-five individuals received prior intervention through PS-ASD while the other 20 individuals received SE only. Individuals in this sample who received PS-ASD required fewer hours of intervention. Additionally, individuals in the PS-ASD group achieved a mean higher wage and had higher retention rates than their peers who received SE only. Further research with a larger sample is needed to confirm these findings.

Multidimensional team-based intervention using musical cues to reduce odds of facility-acquired pressure ulcers in long-term care: a paired randomized intervention study.

PubMed

Yap, Tracey L; Kennerly, Susan M; Simmons, Mark R; Buncher, Charles R; Miller, Elaine; Kim, Jay; Yap, Winston Y

2013-09-01

To test the effectiveness of a pressure ulcer (PU) prevention intervention featuring musical cues to remind all long-term care (LTC) staff (nursing and ancillary) to help every resident move or reposition every 2 hours. Twelve-month paired-facility two-arm (with one-arm crossover) randomized intervention trial. Ten midwestern U.S. LTC facilities. Four treatment facilities received intervention during Months 1 to 12, four comparison facilities received intervention during Months 7 to 12, and two pseudo-control facilities received no intervention. LTC facility residents (N = 1,928). All facility staff received in-person education, video, and handouts, and visiting family members received informational pamphlets on PU prevention and an intervention featuring musical cues. Nurse-led multidisciplinary staff teams presented the cues as prompts for staff and family to reposition residents or remind them to move. Musical selections (with and without lyrics) customized to facility preferences were played daily over the facility intercom or public address system every 2 hours for the 12-hour daytime period. Primary outcome measure was the frequency of new facility-acquired PUs divided by the total number of facility Minimum Data Set (MDS) resident assessments conducted during the study period. Odds of a new PU were lower in intervention facilities (P = .08) for MDS 2.0 assessments and were significantly lower (P = .05) for MDS 3.0. Mean odds ratios suggested intervention facility residents were 45% less likely than comparison facility residents to develop a new PU. Customized musical cues that prompt multidisciplinary staff teams to encourage or enable movement of all residents hold promise for reducing facility-acquired PUs in LTC settings. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

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

NASA Astrophysics Data System (ADS)

Rosenzweig, Emily Quinn

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