Effect of a Universal Anxiety Prevention Programme (FRIENDS) on Children's Academic Performance: Results from a Randomised Controlled Trial

ERIC Educational Resources Information Center

Skryabina, Elena; Taylor, Gordon; Stallard, Paul

2016-01-01

Background: Evaluations of school-based anxiety prevention programmes have reported improvements in psychological functioning although little is known about their effect upon educational outcomes. Methods: One thousand three hundred and sixty-two children from 40 primary schools in England took part in the randomised controlled trial, Preventing…

Aggressive strategic planning for oral health in Kuwait: a decade of post-war successes.

PubMed

Morris, R E; Gillespie, G M; Al Za'abi, F; Al Rashed, B; Al Mahmeed, B E

2008-01-01

Strategic planning and implementation of oral health care and disease prevention programmes after the 1990/91 Gulf war are discussed. The key concept was to develop access to care and disease prevention for all Kuwaiti children in government kindergarten/primary schools and to eliminate emphasis on extractions and restorations. Resources were restored to pre-war levels and then increased. Prevention programmes for 150 000 children were established. Prevention funds increased from 7% to 20% of the oral health budget. Prevention-based dentists increased from 9.7% to 28.0% of staff. Rising caries trends were stabilized or reduced by up to 36.8%. Percentage of caries-free primary dentition in children increased up to 37.6%, permanent dentition up to 27.0%. A dentistry school was established.

Cluster randomised controlled trial of 'whole school' child maltreatment prevention programme in primary schools in Northern Ireland: study protocol for Keeping Safe.

PubMed

McElearney, Aisling; Brennan-Wilson, Aoibheann; Murphy, Christina; Stephenson, Phyllis; Bunting, Brendan

2018-05-03

Child maltreatment has a pervasive, detrimental impact on children's wellbeing. Despite a growing focus on prevention through school based education, few programmes adopt a whole- school approach, are multi-component, seek to address all forms of maltreatment, or indeed have been robustly evaluated. This paper describes a cluster randomised controlled trial designed to evaluate a school based child maltreatment prevention programme: 'Keeping Safe' in primary schools in Northern Ireland. The intervention has been designed by a non-profit agency. Programme resources include 63 lessons taught incrementally to children between four and 11 years old, and is premised on three core themes: healthy relationships, my body, and being safe. There are programme resources to engage parents and to build the capacity and skills of school staff. A cluster Randomised Controlled Trial (RCT) will be conducted with children in 80 schools over a two-year period. The unit of randomisation is the school. Schools will be allocated to intervention or wait-list control groups using a computer-generated list. Data will be collected at three time points: baseline, end of year one, and end of year two of programme implementation. Primary outcomes will include: children's understanding of key programme concepts, self-efficacy to keep safe in situations of maltreatment, anxiety arising from programme participation, and disclosure of maltreatment. Secondary outcomes include teachers' comfort and confidence in teaching the programme and parents' confidence in talking to their children about programme concepts. This RCT will address gaps in current practice and evidence regarding school based child maltreatment prevention programmes. This includes the use of a whole- school approach and multi-component programme that addresses all maltreatment concepts, a two-year period of programme implementation, and the tracking of outcomes for children, parents, and teachers. Methodologically, it will extend our understanding and learning in: capturing sensitive outcome data from young children, adapting and using standardised measures with children of different ages, the use of school level administrative data on staff reports/children's disclosure of maltreatment as behavioural outcomes, and the conduct of complex trials within the busy school environment. ClinicalTrials.gov: NCT02961010 (Retrospectively registered 8 November 2016).

Let’s prevent diabetes: study protocol for a cluster randomised controlled trial of an educational intervention in a multi-ethnic UK population with screen detected impaired glucose regulation

PubMed Central

2012-01-01

Background The prevention of type 2 diabetes is a globally recognised health care priority, but there is a lack of rigorous research investigating optimal methods of translating diabetes prevention programmes, based on the promotion of a healthy lifestyle, into routine primary care. The aim of the study is to establish whether a pragmatic structured education programme targeting lifestyle and behaviour change in conjunction with motivational maintenance via the telephone can reduce the incidence of type 2 diabetes in people with impaired glucose regulation (a composite of impaired glucose tolerance and/or impaired fasting glucose) identified through a validated risk score screening programme in primary care. Design Cluster randomised controlled trial undertaken at the level of primary care practices. Follow-up will be conducted at 12, 24 and 36 months. The primary outcome is the incidence of type 2 diabetes. Secondary outcomes include changes in HbA1c, blood glucose levels, cardiovascular risk, the presence of the Metabolic Syndrome and the cost-effectiveness of the intervention. Methods The study consists of screening and intervention phases within 44 general practices coordinated from a single academic research centre. Those at high risk of impaired glucose regulation or type 2 diabetes are identified using a risk score and invited for screening using a 75 g-oral glucose tolerance test. Those with screen detected impaired glucose regulation will be invited to take part in the trial. Practices will be randomised to standard care or the intensive arm. Participants from intensive arm practices will receive a structured education programme with motivational maintenance via the telephone and annual refresher sessions. The study will run from 2009–2014. Discussion This study will provide new evidence surrounding the long-term effectiveness of a diabetes prevention programme conducted within routine primary care in the United Kingdom. Trial registration Clinicaltrials.gov NCT00677937 PMID:22607160

Qualitative study on the impact of falling in frail older persons and family caregivers: foundations for an intervention to prevent falls.

PubMed

Faes, Miriam C; Reelick, Miriam F; Joosten-Weyn Banningh, Liesbeth W; Gier, Maartje de; Esselink, Rianne A; Olde Rikkert, Marcel G

2010-09-01

The primary aim of this study was to explore the impact of falling for frail community-dwelling older persons with and without cognitive impairments who have experienced a recent fall and their primary family caregivers. The secondary aim was to define components for a future fall prevention programme. Grounded theory interview study, with 10 patients (three cognitively unimpaired, four with mild cognitive impairment and three with dementia) and 10 caregivers. All patients described a fear of falling and social withdrawal. Caregivers reported a fear of their care recipient (CR) falling. Most patients were unable to name a cause for the falls. Patients rejected the ideas that falling is preventable and that the fear of falling can be reduced. Some caregivers rated the consequences of their CRs' cognitive problems as more burdensome than their falls and believed that a prevention programme would not be useful because of the CRs' cognitive impairment, physical problems, age and personalities. Falling has major physical and emotional consequences for patients and caregivers. A fall prevention programme should focus on reducing the consequences of falling and on promoting self-efficacy and activity. The causes of falls should be discussed. The programme should include dyads of patients and caregivers because caregivers are highly involved and also suffer from anxiety. Before beginning such a programme, providers should transform negative expectations about the programme into positive ones. Finally, caregivers must learn how to deal with the consequences of their CRs' falling as well as their cognitive impairment.

[Development and implementation of a state-wide "train the trainer" model of the school-based prevention programme "Join the Healthy Boat - Primary School"].

PubMed

Wartha, O; Koch, B; Kobel, S; Drenowatz, C; Kettner, S; Schreiber, A; Wirt, T; Kesztyüs, D; Steinacker, J M

2014-10-01

This paper shows how a state-wide health-promotion intervention at primary schools can be implemented by considering the example of the programme "Join the Healthy Boat - Primary School". Additionally, it is illustrated how quality control throughout the whole process can be incorporated. To operate long-term and target-group orientated in the whole state of Baden-Württemberg, the school-based prevention programme "Join the Healthy Boat" uses a "train the trainer" model. The trainers are teachers who were instructed by the project team. In the school year 2009/10, these trainers offered quadrinominal training courses for further teachers. Every urban and rural district is covered by 1 trainer. The trainers evaluated the 6 preparatory training courses they had been given using questionnaires. The following 4 training courses the trainers offered to the teachers were reviewed by the trainers as well as the teachers using questionnaires, too. Additionally, at the end of the school year 2009/10, the teachers completed a questionnaire about their satisfaction regarding the programme itself and the work with the trainer. During the school year 2009/10, 453 teachers were trained by 32 trainers. According to indications on the questionnaires about the preparatory training courses, all trainers felt themselves "very well" or "well" prepared for their task. The teachers evaluated the expertise of the respective trainer, the quality of the training courses and the satisfaction with the programme itself throughout highly. Based on the excellent results of the process evaluation and the programme's wide coverage, an adoption of a "train the trainer" model seems worthwhile for other school-based prevention programmes, as well. © Georg Thieme Verlag KG Stuttgart · New York.

Effects of Training Programme on HIV/AIDS Prevention among Primary Health Care Workers in Oyo State, Nigeria

ERIC Educational Resources Information Center

Ajuwon, Ademola; Funmilayo, Fawole; Oladepo, Oladimeji; Osungbade, Kayode; Asuzu, Michael

2008-01-01

Purpose: The purpose of this paper is to train primary health care workers to be trainers and implementers of community-based AIDS prevention activities in Oyo State, Nigeria, by describing an evaluation of the project. Design/methodology/approach: A total of 148 primary health care workers recruited from the 33 local government areas (LGA) of the…

Suicide index reduction in Slovenia: the impact of primary care provision.

PubMed

Beškovnik, Lucija; Juričič, Nuša Konec; Svab, Vesna

2011-03-01

Background Education of primary care providers about diagnosis and treatment of depression and anxiety is an evidence-based suicide prevention measure.Aim To analyse suicide index, mental health epidemiological data and primary care provision in Slovenian regions and to identify examples of good suicide prevention practices in different Slovenian regions.Methods Analysis of existent epidemiological data on mental health in Slovenia.Results Anxiety and depression are the most common complaints in a representative sample of the Slovene population. The number of suicides in Slovenia had been dropping in the period from 2002 to 2006 and was again slowly rising in 2008. The number of visits to family physicians' practices because of mental health problems is low in comparison to other European countries, which might be attributed also to the high workload of family physicians. Suicide prevention programmes follow the example of the Suicide Prevention Project in the central-east region of Slovenia. This programme is based on education of primary care providers and the general public about recognition and treatment of depression in line with international guidelines.Conclusions The differentiation of causes for suicide reduction needs further research, as well as urgent improvement in the accessibility of primary care teams in Slovenia.

Suicide index reduction in Slovenia: the impact of primary care provision

PubMed Central

2011-01-01

Background Education of primary care providers about diagnosis and treatment of depression and anxiety is an evidence-based suicide prevention measure. Aim To analyse suicide index, mental health epidemiological data and primary care provision in Slovenian regions and to identify examples of good suicide prevention practices in different Slovenian regions. Methods Analysis of existent epidemiological data on mental health in Slovenia. Results Anxiety and depression are the most common complaints in a representative sample of the Slovene population. The number of suicides in Slovenia had been dropping in the period from 2002 to 2006 and was again slowly rising in 2008. The number of visits to family physicians' practices because of mental health problems is low in comparison to other European countries, which might be attributed also to the high workload of family physicians. Suicide prevention programmes follow the example of the Suicide Prevention Project in the central-east region of Slovenia. This programme is based on education of primary care providers and the general public about recognition and treatment of depression in line with international guidelines. Conclusions The differentiation of causes for suicide reduction needs further research, as well as urgent improvement in the accessibility of primary care teams in Slovenia. PMID:22479292

Child, Teacher and Parent Perceptions of the FRIENDS Classroom-Based Universal Anxiety Prevention Programme: A Qualitative Study.

PubMed

Skryabina, Elena; Morris, Joanna; Byrne, Danielle; Harkin, Nicola; Rook, Sarah; Stallard, Paul

2016-01-01

School-based mental health prevention programmes can be effective but their adoption within schools will depend on their social acceptability. We report a qualitative evaluation summarising the views of children (115), parents (20) and school staff (47) about a universal school-based anxiety prevention programme FRIENDS. This study was conducted as part of a large scale randomised controlled trial ( n  = 1362) involving 40 schools in the UK providing primary education to children aged 7-11. Reported overall experience of the programme was very positive, with all three major components of the cognitive behaviour therapy programme (emotional, cognitive, and behavioural) being accepted well and understood by children. The programme was considered to be enjoyable and valuable in teaching children important skills, particularly emotional regulation and coping. Children provided examples of using the skills learned during FRIENDS to manage their emotions and solve problems. However, teachers were concerned that the programme overlapped with the current school curriculum, required additional time and almost half were unable to identify any tangible changes in the children's behaviour. Whilst this paper provides evidence to support the social validity of the FRIENDS anxiety prevention programme, the concerns raised by teachers question the longer-term sustainability of the programme.

[Prevention of neural tube defects. An important health and social problem].

PubMed

Czochańska, J; Lech, M

1998-01-01

Central neural system congenital malformations in the form of neural tube defects (ntd) belong to the most common diseases leading to very serious childrens' disability and mortality. As it has been calculated, the number of children affected with ntd, delivered in Poland every year is in the range of 800-1150. Children with encephalocele participate in this number in app. 50%. As it has been found, morbidity and mortality caused by the ntd remain high and stable in Poland for the last 20 years. In the view of very limited possibilities of the treatment offered by health services, prophylactic measures remain the best methods for limitation of the problem. The primary prevention of ntd was discovered in late seventies. It has been found that folic acid added to the diet of women in the reproductive age reduced number of children born with ntd by 70%. Authors present the Programme of Primary Prevention of ntd in Poland. This Programme has been incorporated in the National Programme of Health for the Nation 1996-2005.

We have the programme, what next? Planning the implementation of an injury prevention programme

PubMed Central

Donaldson, Alex; Lloyd, David G; Gabbe, Belinda J; Cook, Jill

2017-01-01

Background and aim The impact of any injury prevention programme is a function of the programme and its implementation. However, real world implementation of injury prevention programmes is challenging. Lower limb injuries (LLIs) are common in community Australian football (community-AF) and it is likely that many could be prevented by implementing exercise-based warm-up programmes for players. This paper describes a systematic, evidence-informed approach used to develop the implementation plan for a LLI prevention programme in community-AF in Victoria, Australia. Methods An ecological approach, using Step 5 of the Intervention Mapping health promotion programme planning protocol, was taken. Results An implementation advisory group was established to ensure the implementation plan and associated strategies were relevant to the local context. Coaches were identified as the primary programme adopters and implementers within an ecological system including players, other coaches, first-aid providers, and club and league administrators. Social Cognitive Theory was used to identify likely determinants of programme reach, adoption and implementation among coaches (eg, knowledge, beliefs, skills and environment). Diffusion of Innovations theory, the Implementation Drivers framework and available research evidence were used to identify potential implementation strategies including the use of multiple communication channels, programme resources, coach education and mentoring. Conclusions A strategic evidence-informed approach to implementing interventions will help maximise their population impact. The approach to implementation planning described in this study relied on an effective researcher-practitioner partnership and active engagement of stakeholders. The identified implementation strategies were informed by theory, evidence and an in-depth understanding of the implementation context. PMID:26787739

The preventive effect of the bounding exercise programme on hamstring injuries in amateur soccer players: the design of a randomized controlled trial.

PubMed

Van de Hoef, S; Huisstede, B M A; Brink, M S; de Vries, N; Goedhart, E A; Backx, F J G

2017-08-22

Hamstring injuries are the most common muscle injury in amateur and professional soccer. Most hamstring injuries occur in the late swing phase, when the hamstring undergoes a stretch-shortening cycle and the hamstring does a significant amount of eccentric work. The incidence of these injuries has not decreased despite there being effective injury prevention programmes focusing on improving eccentric hamstring strength. As this might be because of poor compliance, a more functional injury prevention exercise programme that focuses on the stretch-shortening cycle might facilitate compliance. In this study, a bounding exercise programme consisting of functional plyometric exercises is being evaluated. A cluster-randomized controlled trial (RCT). Male amateur soccer teams (players aged 18-45 years) have been randomly allocated to intervention and control groups. Both groups are continuing regular soccer training and the intervention group is additionally performing a 12-week bounding exercise programme (BEP), consisting of a gradual build up and maintenance programme for the entire soccer season. The primary outcome is hamstring injury incidence. Secondary outcome is compliance with the BEP during the soccer season and 3 months thereafter. Despite effective hamstring injury prevention programmes, the incidence of these injuries remains high in soccer. As poor compliance with these programmes may be an issue, a new plyometric exercise programme may encourage long-term compliance and is expected to enhance sprinting and jumping performance besides preventing hamstring injuries. NTR6129 . Retrospectively registered on 1 November 2016.

Preliminary evaluation of STRIDE programme in primary schools of Malaysia.

PubMed

Hanjeet, K; Wan Rozita, W M; How, T B; Santhana Raj, L; Baharudin, Omar

2007-12-01

The Students' Resilience and Interpersonal Skills Development Education (STRIDE) is a preventive drug education programme. The rational of this programme is that preventive drug education has to begin early in age, before the development of social attitudes and behaviour of students. A pre and a post intervention surveys were performed to evaluate the impact of this programme. Nine schools from three states were identified to participate in the intervention. These schools were selected based on their locations in high-drug-use areas (where the prevalence of drug use exceeds 0.5% of the student population). The new intervention curriculum was put into practice for three months in the nine schools. The overall scores obtained by each respondent to assess their knowledge on drugs and its implications were analysed. The results showed that the programme made a positive impact from the pre to post intervention programme by using the Wilcoxon Signed Rank Test (p < 0.05). A high percentage of the questions showed significant evidence through the McNemar matched pair Chi-Squared test with Bonferonni correction that there were positive shifts in the answers by comparing the pre and post intervention results (p < 0.05). Recommendations have been discussed with the Ministry of Education to integrate this programme into the national primary school curriculum.

"Stay away from them until you're old enough to make a decision": tobacco company testimony about youth smoking initiation.

PubMed

Wakefield, Melanie; McLeod, Kim; Perry, Cheryl L

2006-12-01

To determine common themes used by US tobacco industry witnesses pertaining to youth smoking initiation during litigation in the United States. Qualitative thematic analysis of transcripts from 29 tobacco litigation cases dating from 1992 to 2002. Youth smoking is portrayed by the tobacco industry as a source of great concern to them. Youth smoking prevention programmes developed by US tobacco companies are supposedly intended to delay decision-making about smoking until age 18, when individuals are then seen to be of an age where they are able to "choose to smoke". Tobacco industry media campaigns, youth access, community and school-based programmes are predicated on peer influence, parental factors, and commercial access being the primary influences on youth smoking uptake, rather than tobacco marketing, inaccurate risk appraisal, price and other factors known to influence youth smoking. Despite substantial financial investment in tobacco industry programmes, their witnesses were able to describe only weak evaluation methods, being preoccupied with measures of message comprehension, programme reach and uptake, and the associated costs of their efforts, rather than any evaluation designed to assess effects on youth smoking behaviour. Stated concerns about youth smoking and youth smoking prevention programmes are put forward in litigation as evidence that the tobacco industry is "serious" about tackling youth smoking, and serve as a primary strategy to improve the tobacco industry's public image. The tobacco industry's evaluation of the effectiveness of their youth smoking prevention programmes is demonstrably insufficient under current public health evaluation standards. Public health and welfare agencies should avoid engagement with tobacco industry-sponsored programmes.

Determinants of participation in a fall assessment and prevention programme among elderly fallers in Hong Kong: prospective cohort study.

PubMed

Wong, Eliza L Y; Woo, Jean; Cheung, Annie W L; Yeung, Pui-Yi

2011-04-01

The study was undertaken to estimate the uptake rate of a fall prevention programme among older fallers and explore related factors. Fall injuries are a major cause nationally of the loss of independence in old age, but they are preventable. Acceptance of fall prevention programmes is therefore important to reduce the risk of falling. Patients aged ≥60 attending the Department of Accident & Emergency of a regional hospital in Hong Kong between 2006 and 2007 were recruited. The study included a baseline interview, focus group interview and a cross-sectional 1-year follow-up telephone survey to assess uptake and its related factors. A total 68% of 1194 older people attended the fall programme. Factors associated with programme participation included the perception of fall as being preventable [OR=3.47, 95% CI (1.59-7.56)] or recoverable [OR=1.73, 95% CI (1.06-2.82)], a safe outside environment; absence of chronic illness, and ability to walk without aids. Old-age people, those living in old-age homes and of lower education level were less likely to join the programme. Older people with the selected characteristics were less likely to attend the fall prevention programme, thus were less likely to benefit from them. Support from family/carers may be an important element in participation. In a nursing context, in primary care practice, all of these factors should be taken into account in any future development of a fall prevention programme in Hong Kong of this nature. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

The role of mental health in primary prevention of sexual and gender-based violence.

PubMed

Gevers, Aník; Dartnall, Elizabeth

2014-01-01

In this short communication, we assert that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV). However, we found that most research and practice to date has focused on the role of mental health post-violence, and SGBV primary prevention is relying on public health models that do not explicitly include mental health. Yet, key concepts, processes, and competencies in the mental health field appear essential to successful SGBV primary prevention. For example, empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial. Furthermore, competencies such as rapport building, group processing, emotional nurturing, modelling, and the prevention of vicarious trauma among staff are important for the successful implementation of SGBV primary prevention programmes. SGBV primary prevention work would benefit from increased collaboration with mental health professionals and integration of key mental health concepts, processes, and skills in SGBV research.

Developing a culturally tailored stroke prevention walking programme for Korean immigrant seniors: a focus group study.

PubMed

Choi, Sarah E; Kwon, Ivy; Chang, Emiley; Araiza, Daniel; Thorpe, Carol Lee; Sarkisian, Catherine A

2016-12-01

To gain better understanding of (i) beliefs and knowledge about stroke; (ii) attitudes about walking for stroke prevention; and (iii) barriers and facilitators to walking among Korean seniors for the cultural tailoring of a stroke prevention walking programme. Physical inactivity is a major risk factor for stroke. Korean immigrant seniors are one of the most sedentary ethnic groups in the United States. An explorative study using focus group data. Twenty-nine Korean immigrant seniors (64-90 years of age) who had been told by a doctor at least once that their blood pressure was elevated participated in 3 focus groups. Each focus group consisted of 8-11 participants. Focus group audiotapes were transcribed and analysed using standard content analysis methods. Participants identified physical and psychological imbalances (e.g. too much work and stress) as the primary causes of stroke. Restoring 'balance' was identified as a powerful means of stroke prevention. A subset of participants expressed that prevention may be beyond human control. Overall, participants acknowledged the importance of walking for stroke prevention, but described barriers such as lack of personal motivation and unsafe environment. Many participants believed that providing opportunities for socialisation while walking and combining walking with health information sessions would facilitate participation in and maintenance of a walking programme. Korean immigrant seniors believe strongly that imbalance is a primary cause of stroke. Restoring balance as a way to prevent stroke is culturally special among Koreans and provides a conceptual base in culturally tailoring our stroke prevention walking intervention for Korean immigrant seniors. A stroke prevention walking programme for Korean immigrant seniors may have greater impact by addressing beliefs about stroke causes and prevention such as physical and psychological imbalances and the importance of maintaining emotional well-being. © 2016 John Wiley & Sons Ltd.

Rational Emotive Behavior Based on Academic Procrastination Prevention: Training Programme of Effectiveness

ERIC Educational Resources Information Center

Düsmez, Ihsan; Barut, Yasar

2016-01-01

The research is an experimental study which has experimental and control groups, and based on pre-test, post-test, monitoring test model. Research group consists of second and third grade students of Primary School Education and Psychological Counseling undergraduate programmes in Giresun University Faculty of Educational Sciences. The research…

Preventing childhood obesity in Asia: an overview of intervention programmes.

PubMed

Uijtdewilligen, L; Waters, C N; Müller-Riemenschneider, F; Lim, Y W

2016-11-01

The rapid economic growth in Asia in the past few decades has contributed to the global increase in childhood obesity prevalence. Yet, little is known about obesity prevention efforts in this region. This systematic review provides an overview of child obesity prevention programmes in Asia. Searches were performed in six electronic databases. Out of 4,234 studies, 17 were included, among them 11 controlled trials (of which five were randomized). Only one study was published before 2007. Identified studies were predominantly conducted in China and Thailand and targeted primary school children in a school setting. Most studies implemented different programmes, frequently targeting behavioural modification through nutrition/health education lectures and/or physical activity sessions. Programme effects related to obesity outcome measures were mixed. Most substantial effects were found for outcomes such as improved health knowledge and/or favourable lifestyle practices. The relatively small number of relevant publications in Asia highlights the need for scientific evaluations of existing and future programmes. This will help ensure the implementation and dissemination of evidence-based approaches that have been proven to be effective in the Asian context. Targeting preschool settings and applying a comprehensive multisectoral approach may increase the effectiveness and sustainability of childhood obesity prevention programmes. © 2016 World Obesity.

The health farm concept in the primary prevention of coronary artery disease.

PubMed

Ahmad, A M

1995-12-01

The purpose of the study is as a preliminary outline of the effectiveness of initiating high-risk individuals into the Health Farm concept in the primary prevention of coronary artery disease (CAD). Thirty-five (35) Army personnel, all male, with risk-factors for CAD were brought together on a Health Farm concept to go through a predesigned ten-day Farm programme comprising CAD risk-assessment, comprehensive medical examination, relevant blood chemistry analysis, physical fitness evaluation, individualised weekly exercise routine, physical fitness workouts, individualised diet, lectures, group discussion and individual counselling. Description of the participants (as measurements of various relevant parameters) are made at the start and as participant-achievement. The results show general participant-compliance to the programme which was reflected by significant changes in weight (p < 0.005), percentile VO2Max (p < 0.005), percentile push-ups (p < 0.005) and girth-difference (p < 0.005). The study showed that the Health Farm concept is effective in initiating high-risk individuals into lifestyles conducive to the primary prevention of CAD. Sustained results towards primary prevention of CAD can be expected with compliance to a long-term follow-up that has been identified and to which participants have been made aware of. Other previous intervention studies are briefly discussed.

Effectiveness of an implementation optimisation intervention aimed at increasing parent engagement in HENRY, a childhood obesity prevention programme - the Optimising Family Engagement in HENRY (OFTEN) trial: study protocol for a randomised controlled trial.

PubMed

Bryant, Maria; Burton, Wendy; Cundill, Bonnie; Farrin, Amanda J; Nixon, Jane; Stevens, June; Roberts, Kim; Foy, Robbie; Rutter, Harry; Hartley, Suzanne; Tubeuf, Sandy; Collinson, Michelle; Brown, Julia

2017-01-24

Family-based interventions to prevent childhood obesity depend upon parents' taking action to improve diet and other lifestyle behaviours in their families. Programmes that attract and retain high numbers of parents provide an enhanced opportunity to improve public health and are also likely to be more cost-effective than those that do not. We have developed a theory-informed optimisation intervention to promote parent engagement within an existing childhood obesity prevention group programme, HENRY (Health Exercise Nutrition for the Really Young). Here, we describe a proposal to evaluate the effectiveness of this optimisation intervention in regard to the engagement of parents and cost-effectiveness. The Optimising Family Engagement in HENRY (OFTEN) trial is a cluster randomised controlled trial being conducted across 24 local authorities (approximately 144 children's centres) which currently deliver HENRY programmes. The primary outcome will be parental enrolment and attendance at the HENRY programme, assessed using routinely collected process data. Cost-effectiveness will be presented in terms of primary outcomes using acceptability curves and through eliciting the willingness to pay for the optimisation from HENRY commissioners. Secondary outcomes include the longitudinal impact of the optimisation, parent-reported infant intake of fruits and vegetables (as a proxy to compliance) and other parent-reported family habits and lifestyle. This innovative trial will provide evidence on the implementation of a theory-informed optimisation intervention to promote parent engagement in HENRY, a community-based childhood obesity prevention programme. The findings will be generalisable to other interventions delivered to parents in other community-based environments. This research meets the expressed needs of commissioners, children's centres and parents to optimise the potential impact that HENRY has on obesity prevention. A subsequent cluster randomised controlled pilot trial is planned to determine the practicality of undertaking a definitive trial to robustly evaluate the effectiveness and cost-effectiveness of the optimised intervention on childhood obesity prevention. ClinicalTrials.gov identifier: NCT02675699 . Registered on 4 February 2016.

Adoption of the Good Behaviour Game: An Evidence-Based Intervention for the Prevention of Behaviour Problems

ERIC Educational Resources Information Center

Dijkman, Marieke A. M.; Harting, Janneke; van der Wal, Marcel F.

2015-01-01

Background and objective: The Good Behaviour Game (GBG) has been shown to be effective in preventing childhood disruptive behaviours and their long-term unfavourable health-related outcomes. Like many other evidence-based preventive health programmes, however, its current use in Dutch primary schools is limited, and knowledge of the factors…

Implementation of the DP-TRANSFERS project in Catalonia: A translational method to improve diabetes screening and prevention in primary care.

PubMed

Costa-Pinel, Bernardo; Mestre-Miravet, Santiago; Barrio-Torrell, Francisco; Cabré-Vila, Joan-Josep; Cos-Claramunt, Xavier; Aguilar-Sanz, Sofía; Solé-Brichs, Claustre; Castell-Abat, Conxa; Arija-Val, Victoria; Lindström, Jaana

2018-01-01

The DE-PLAN-CAT project (Diabetes in Europe-Prevention using lifestyle, physical activity and nutritional intervention-Catalonia) has shown that an intensive lifestyle intervention is feasible in the primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention-Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible. A multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45-75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation. The programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively). A large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities.

Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes

PubMed Central

Roberts, Samantha; Barry, Eleanor; Craig, Dawn; Airoldi, Mara; Bevan, Gwyn; Greenhalgh, Trisha

2017-01-01

Objective Explore the cost-effectiveness of lifestyle interventions and metformin in reducing subsequent incidence of type 2 diabetes, both alone and in combination with a screening programme to identify high-risk individuals. Design Systematic review of economic evaluations. Data sources and eligibility criteria Database searches (Embase, Medline, PreMedline, NHS EED) and citation tracking identified economic evaluations of lifestyle interventions or metformin alone or in combination with screening programmes in people at high risk of developing diabetes. The International Society for Pharmaco-economics and Outcomes Research’s Questionnaire to Assess Relevance and Credibility of Modelling Studies for Informing Healthcare Decision Making was used to assess study quality. Results 27 studies were included; all had evaluated lifestyle interventions and 12 also evaluated metformin. Primary studies exhibited considerable heterogeneity in definitions of pre-diabetes and intensity and duration of lifestyle programmes. Lifestyle programmes and metformin appeared to be cost effective in preventing diabetes in high-risk individuals (median incremental cost-effectiveness ratios of £7490/quality-adjusted life-year (QALY) and £8428/QALY, respectively) but economic estimates varied widely between studies. Intervention-only programmes were in general more cost effective than programmes that also included a screening component. The longer the period evaluated, the more cost-effective interventions appeared. In the few studies that evaluated other economic considerations, budget impact of prevention programmes was moderate (0.13%–0.2% of total healthcare budget), financial payoffs were delayed (by 9–14 years) and impact on incident cases of diabetes was limited (0.1%–1.6% reduction). There was insufficient evidence to answer the question of (1) whether lifestyle programmes are more cost effective than metformin or (2) whether low-intensity lifestyle interventions are more cost effective than the more intensive lifestyle programmes that were tested in trials. Conclusions The economics of preventing diabetes are complex. There is some evidence that diabetes prevention programmes are cost effective, but the evidence base to date provides few clear answers regarding design of prevention programmes because of differences in denominator populations, definitions, interventions and modelling assumptions. PMID:29146638

GP-delivered secondary prevention cardiovascular disease programme; early predictors of likelihood of patient non-adherence.

PubMed

Fitzpatrick, Patricia; Lonergan, Moira; Collins, Claire; Daly, Leslie

2010-12-01

The aim of this study was to determine how routinely recorded data could predict early the likelihood of patient non-adherence to a primary care-delivered secondary prevention programme for established coronary heart disease (CHD), with patients with CHD (10,851) invited to attend four times per year. Non-adherence was defined as attending no more than three GP visits ever. The study sample was selected to allow a possible two-year recorded follow-up period in which patients could take up invitations. Administrative recordings of visit dates and intervals between visits, baseline results of key parameters and early changes were examined using logistic regression to determine independent predictors of non-adherence. Longer interval between early visits, no family history of CHD, smoking and being outside target for exercise at baseline were independently associated with non-adherence. Early identification by GPs of those who fail to attend on time or who defer appointments, in addition to persistence of lifestyle factors unchanged by a prior serious cardiac event should serve as a warning sign that targeted interventions to maintain adherence in primary care-delivered secondary prevention programmes are necessary.

Cost-effectiveness models for dental caries prevention programmes among Chilean schoolchildren.

PubMed

Mariño, R; Fajardo, J; Morgan, M

2012-12-01

This study aims to estimate the cost-effectiveness from a societal perspective of seven dental caries prevention programmes among schoolchildren in Chile: three community-based programmes: water-fluoridation, salt-fluoridation and dental sealants; and four school-based programmes: milk-fluoridation; fluoridated mouthrinses (FMR); APF-Gel, and supervised toothbrushing with fluoride toothpaste. Standard cost-effectiveness analysis methods were used. The costs associated with implementing and operating each programme, using a societal perspective, were identified and estimated. The comparator was non-intervention. Health outcomes were measured as dental caries averted over a 6-year period. Costs were estimated as direct treatment costs, programmes costs and costs of productivity losses as a result of each dental caries prevention programme. Incremental cost-effectiveness ratios were calculated for each programme. Sensitivity analyses were conducted over key parameters. Primary cost-effectiveness analysis (discounted) indicated that four programmes showed net social savings by the DMFT averted. These savings encompassed a range of values per diseased tooth averted; US$16.21 (salt-fluoridation), US$14.89 (community water fluoridation); US$14.78 (milk fluoridation); and US$8.63 (FMR). Individual programmes using an APF-Gel application, dental sealants, and supervised tooth brushing using fluoridated toothpaste, represent costs for the society per diseased tooth averted of US$21.30, US$11.56 and US$8.55, respectively. Based on cost required to prevent one carious tooth among schoolchildren, salt fluoridation was the most cost-effective, with APF-Gel ranking as least cost-effective. Findings confirm that most community/school-based dental caries interventions are cost-effective uses of society's financial resources. The models used are conservative and likely to underestimate the real benefits of each intervention.

Prevention of groin injuries in sports: a systematic review with meta-analysis of randomised controlled trials.

PubMed

Esteve, E; Rathleff, M S; Bagur-Calafat, C; Urrútia, G; Thorborg, K

2015-06-01

Groin injuries are common in football and ice hockey, and previous groin injury is a strong risk factor for future groin injuries, which calls for primary prevention. The aim of this systematic review was to evaluate the effect of specific groin-injury prevention programmes in sports. A comprehensive search was performed in May 2014 yielding 1747 potentially relevant references. Two independent assessors evaluated randomised controlled trials for inclusion, extracted data and performed quality assessments using Cochrane's risk of bias tool. Quantitative analyses were performed in Review Manager 5.3. Seven trials were included: six on football players (four male and two female populations) and one on male handball players. In total there were 4191 participants with a total of 157 injuries. The primary analysis, including all participants, did not show a significant reduction in the number of groin injuries after completing a groin injury prevention programme (relative risk (RR) 0.81; 95% CI 0.60 to 1.09). Subgroup analysis based on type of sports, gender and type of prevention programme showed similar non-significant estimates with RR ranging from 0.48 to 0.81. Meta-analysis revealed a potential clinically meaningful groin injury reduction of 19%, even though no statistical significant reduction in sport-related groin injuries could be documented. PROSPERO registration ID CRD42014009614. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effectiveness of the population-based Check your health preventive programme conducted in primary care with 4 years follow-up [the CORE trial]: study protocol for a randomised controlled trial.

PubMed

Maindal, Helle Terkildsen; Støvring, Henrik; Sandbaek, Annelli

2014-08-29

The periodic health check-up has been a fundamental part of routine medical practice for decades, despite a lack of consensus regarding its value in health promotion and disease prevention. A large-scale Danish population-based preventive programme 'Check your health' was developed based on available evidence of screening and successive accepted treatment, prevention for diseases and health promotion, and is closely aligned with the current health care system.The objective of the 'Check your health' [CORE] trial is to investigate effectiveness on health outcomes of a preventive health check offered at a population-level to all individuals aged 30-49 years, and to establish the cost-effectiveness. The trial will be conducted as a pragmatic household-cluster randomised controlled trial involving 10,505 individuals. All individuals within a well-defined geographical area in the Central Denmark Region, Denmark (DK) were randomised to be offered a preventive health check (Intervention group, n = 5250) or to maintain routine access to healthcare until a delayed intervention (Comparison group, n = 5255). The programme consists of a health examination which yields an individual risk profile, and according to this participants are assigned to one of the following interventions: (a) referral to a health promoting consultation in general practice, (b) behavioural programmes at the local Health Centre, or (c) no need for follow-up.The primary outcomes at 4 years follow-up are: ten-year-risk of fatal cardiovascular event (Heart-SCORE model), physical activity level (self-report and cardiorespiratory fitness), quality of life (SF12), sick leave and labour market attachment. Cost-effectiveness will be evaluated according to life years gained, direct costs and total health costs. Intention to treat analysis will be performed. Results from the largest Danish health check programme conducted within the current healthcare system, spanning the sectors which share responsibility for the individual, will provide a scientific basis to be used in the development of systems to optimise population health in the 21st century. The trial has registered at ClinicalTrials.gov with an ID: NCT02028195 (7. March 2014).

[Nurse involvement in primary care: it is the key to improve the outcomes in primary and secondary prevention?].

PubMed

Scardi, Sabino; Gori, Pierpaolo; Umari, Paolo

2010-06-01

Difficulties in management of risk factors, lifestyle and medications adherence to achieve secondary prevention of ischemic heart disease were described. Many studies indicate that the benefit of cardiac rehabilitation therapy after acute coronary events is only partially maintained during the following year. Thereafter, new strategies of medical care are needed to improve the long-term outcomes in coronary patients. Nurse co-ordinated, multidisciplinary cardiac rehabilitative programme could help patients to improve their lifestyle, to control their risk factors and to achieve their therapeutic goals for secondary prevention of ischemic heart disease.

Health Education in Primary Schools: The Effects of an Educational Programme on the Representations of HIV/AIDS in Children

ERIC Educational Resources Information Center

Berger, Dominique; Jourdan, Didier; Barnoin, Judith

2006-01-01

Health education is a part of the primary school science curriculum in France. Teachers often consider sexuality education and sexually transmitted diseases prevention as a topic they cannot teach without the help of partners. This paper is an account of a research carried out to study the representations of primary school pupils (Key Stage 2,…

[Memorandum prevention research - research areas and methods].

PubMed

Walter, U; Nöcker, G; Plaumann, M; Linden, S; Pott, E; Koch, U; Pawils, S; Altgeld, T; Dierks, M L; Frahsa, A; Jahn, I; Krauth, C; Pomp, M; Rehaag, R; Robra, B P; Süß, W; Töppich, J; Trojan, A; von Unger, H; Wildner, M; Wright, M

2012-10-01

From 2004 to 2012, the German Ministry of Education and Research (BMBF) established its first funding programme for the promotion of prevention research. 60 projects on primary prevention and health promotion and the meta-project entitled "Cooperation for Sustainable Prevention Research" (KNP) received BMBF grants under this programme during this period. The experience and knowledge gained and recommendations arising from the research funded under this programme are compiled in memorandum format. The "Memorandum on Prevention Research - Research Areas and Methods" highlights 5 research areas that are considered to be especially relevant from the perspective of the involved scientists and practice partners.The promotion of structural development and sustainability enhancement in disease prevention and health promotion are central areas that should branch out from existing nuclei of crystallization. Improving the health competence of the population and of specific subpopulations is another major area. Research in these areas should contribute to the development of theoretical concepts and to the empirical testing of these concepts. The transfer of knowledge for effective use of developed disease prevention and health promotion programmes and measures is still a scarcely researched area. Among other things, studies of the transfer of programmes from one context to another, analyses of the coop-eration between politics and science, and the continued theoretical and conceptual development of transfer research are needed. Long-term data on the effects of intervention studies are also needed for proper evaluation of sustainability. The latter dem-onstrates the importance of method development in disease prevention and health promotion research as an area that should receive separate funding and support. This research should include, in particular, studies of the efficacy of complex interventions, health economic analyses, and participative health research. © Georg Thieme Verlag KG Stuttgart · New York.

HIV prevention in Latin America: reaching youth in Colombia.

PubMed

Perez, F; Dabis, F

2003-02-01

The aim of this paper is to describe and evaluate a school-based peer education programme on HIV primary prevention implemented in urban marginal districts of three cities of Colombia from 1997 to 1999. Its main objective was to promote risk awareness and safe sexual behaviours among urban youth populations. Methodology included the collection of baseline information through qualitative methods (focus groups and in-depth interviews), a knowledge, attitudes and practices (KAP) survey, a health education intervention, and post-intervention data collection. Direct beneficiaries were adolescents 10 to 19 years of age, and secondary school teachers of 6th to 9th grades. Main strategies used were peer education and classroom sessions conducted by trained teachers. Short-term results suggest that the programme had a positive effect on knowledge and attitudes related to HIV/AIDS (as the mean knowledge summary indicator among adolescents and secondary school teachers increased 24% and 21%, respectively). The main outcome has been the development of a sex education programme, emphasizing the role of schools in the promotion of sexual and reproductive health. Mass education by a combination of interventions and events at school level, backed up by effective interpersonal communication such as peer education, classroom teaching and community actions are effective primary prevention strategies for HIV sexual transmission and should be more extensively considered.

Implementing a Cancer Fast-track Programme between primary and specialised care in Catalonia (Spain): a mixed methods study

PubMed Central

Prades, J; Espinàs, J A; Font, R; Argimon, J M; Borràs, J M

2011-01-01

Background: The Cancer Fast-track Programme's aim was to reduce the time that elapsed between well-founded suspicion of breast, colorectal and lung cancer and the start of initial treatment in Catalonia (Spain). We sought to analyse its implementation and overall effectiveness. Methods: A quantitative analysis of the programme was performed using data generated by the hospitals on the basis of seven fast-track monitoring indicators for the period 2006–2009. In addition, we conducted a qualitative study, based on 83 semistructured interviews with primary and specialised health professionals and health administrators, to obtain their perception of the programme's implementation. Results: About half of all new patients with breast, lung or colorectal cancer were diagnosed via the fast track, though the cancer detection rate declined across the period. Mean time from detection of suspected cancer in primary care to start of initial treatment was 32 days for breast, 30 for colorectal and 37 for lung cancer (2009). Professionals associated with the implementation of the programme showed that general practitioners faced with suspicion of cancer had changed their conduct with the aim of preventing lags. Furthermore, hospitals were found to have pursued three specific implementation strategies (top-down, consensus-based and participatory), which made for the cohesion and sustainability of the circuits. Conclusion: The programme has contributed to speeding up diagnostic assessment and treatment of patients with suspicion of cancer, and to clarifying the patient pathway between primary and specialised care. PMID:21829194

Shaping Estonian Primary School Pupils' Values by Using Bullying-Prevention Methods

ERIC Educational Resources Information Center

Piht, Sirje; Talts, Leida; Nigulas, Sigrit

2016-01-01

The purpose of this article is to identify to what extent using the methodology of the programme "Bullying-free school", initiated in the Kingdom of Denmark in 2007 and implemented in schools in Estonia since 2013, has supported the development of ethical values in primary school pupils. The methodology focuses on four value attitudes:…

The Friendly Schools Friendly Families Programme: Three-Year Bullying Behaviour Outcomes in Primary School Children

ERIC Educational Resources Information Center

Cross, Donna; Waters, Stacey; Pearce, Natasha; Shaw, Therese; Hall, Margaret; Erceg, Erin; Burns, Sharyn; Roberts, Clare; Hamilton, Greg

2012-01-01

Purpose: This three-year group randomized controlled trial assessed whether a multi-age, multi-level bullying prevention and intervention with staff capacity building, can reduce bullying among primary school children. Methods: This study comprised two intervention and one comparison conditions. Student self-report data were collected from 2552…

Preparing nursing students for the future: Development and implementation of an Australian Bachelor of Nursing programme with a community health focus.

PubMed

Cooper, Simon; Cant, Robyn; Browning, Mark; Robinson, Eddie

2014-01-01

This paper focuses on changes in the educational preparation of undergraduate nurses in line with contemporary primary and preventative healthcare models. We evaluated a new Australian nursing and community care degree programme using focus groups with 38 students in their first years of study, and quantitative performance data (regarding entry, performance and course attrition). Four main themes were identified related to students' course experience: 'I think community health should be an elective'; 'Focus on relevance to practice'; 'Teaching by non-nursing academics' and 'Access to support during transition to university.' Overall pass rates were 94% (first year) and 97% (second year) with a low 11% attrition rate. We conclude that based on prior experiences and stereotypical views, students may be ambivalent about the inclusion of primary and preventative care models which nevertheless are essential to enhance practice and to prepare the future nursing workforce.

Alcohol-Specific Parenting within a Cluster-Randomized Effectiveness Trial of a Swedish Primary Prevention Program

ERIC Educational Resources Information Center

Strandberg, Anna K.; Bodin, Maria C.

2011-01-01

Purpose: Within the framework of an ongoing cluster-randomized effectiveness trial of a parental prevention program, the aim of the present study is to investigate attitudes towards under-age drinking and use of program components, i.e. alcohol-specific parenting behaviors, in parents who did and did not take part in the programme.…

Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials

PubMed Central

DiCenso, Alba; Guyatt, Gordon; Willan, A; Griffith, L

2002-01-01

Objective To review the effectiveness of primary prevention strategies aimed at delaying sexual intercourse, improving use of birth control, and reducing incidence of unintended pregnancy in adolescents. Data sources 12 electronic bibliographic databases, 10 key journals, citations of relevant articles, and contact with authors. Study selection 26 trials described in 22 published and unpublished reports that randomised adolescents to an intervention or a control group (alternate intervention or nothing). Data extraction Two independent reviewers assessed methodological quality and abstracted data. Data synthesis The interventions did not delay initiation of sexual intercourse in young women (pooled odds ratio 1.12; 95% confidence interval 0.96 to 1.30) or young men (0.99; 0.84 to 1.16); did not improve use of birth control by young women at every intercourse (0.95; 0.69 to 1.30) or at last intercourse (1.05; 0.50 to 2.19) or by young men at every intercourse (0.90; 0.70 to 1.16) or at last intercourse (1.25; 0.99 to 1.59); and did not reduce pregnancy rates in young women (1.04; 0.78 to 1.40). Four abstinence programmes and one school based sex education programme were associated with an increase in number of pregnancies among partners of young male participants (1.54; 1.03 to 2.29). There were significantly fewer pregnancies in young women who received a multifaceted programme (0.41; 0.20 to 0.83), though baseline differences in this study favoured the intervention. Conclusions Primary prevention strategies evaluated to date do not delay the initiation of sexual intercourse, improve use of birth control among young men and women, or reduce the number of pregnancies in young women. What is already known on this topicUnintended pregnancies among adolescents pose a considerable problem for the young parents, the child, and societyWhat this study addsPrimary prevention strategies evaluated to date do not delay the initiation of sexual intercourse or improve use of birth control among adolescentsPrimary prevention strategies have not reduced the rate of pregnancies in adolescent womenMeta-analysis of five studies, four of which evaluated abstinence programmes, has shown an increase in pregnancies in partners of male participants PMID:12065267

Gender-informed, psychoeducational programme for couples to prevent postnatal common mental disorders among primiparous women: cluster randomised controlled trial.

PubMed

Fisher, Jane; Rowe, Heather; Wynter, Karen; Tran, Thach; Lorgelly, Paula; Amir, Lisa H; Proimos, Jenny; Ranasinha, Sanjeeva; Hiscock, Harriet; Bayer, Jordana; Cann, Warren

2016-03-07

Interventions to prevent postpartum common mental disorders (PCMD) among unselected populations of women have had limited success. The aim was to determine whether What Were We Thinking (WWWT) a gender-informed, psychoeducational programme for couples and babies can prevent PCMD among primiparous women 6 months postpartum. Cluster-randomised controlled trial. 48 Maternal and Child Health Centres (MCHCs) from 6 Local Government Areas in Melbourne, Australia were allocated randomly to usual care (24) or usual care plus WWWT (24). English-speaking primiparous women receiving primary care at trial MCHCs were recruited to the intervention (204) and control (196) conditions. Of these, 187 (91.7%) and 177 (90.3%) provided complete data. WWWT is a manualised programme comprising primary care from a trained nurse, print materials and a face-to-face seminar. Data sources were standardised and study-specific measures collected in blinded computer-assisted telephone interviews at 6 and 26 weeks postpartum. The primary outcome was PCMD assessed by Composite International Diagnostic Interviews and Patient Health Questionnaire (PHQ) Depression and Generalised Anxiety Disorder modules. In intention-to-treat analyses the adjusted OR (AOR) of PCMD in the intervention compared to the usual care group was 0.78 (95% CI 0.38 to 1.63, ns), but mild to moderate anxiety symptoms (AOR 0.58, 95% CI 0.35 to 0.97) and poor self-rated health (AOR 0.46, 95% CI 0.22 to 0.97) were significantly lower. In a per protocol analysis, comparing the full (three component) intervention and usual care groups, the AOR of PCMD was 0.36, (95% CI 0.14 to 0.95). The WWWT seminar was appraised as salient, comprehensible and useful by >85% participants. No harms were detected. WWWT is readily integrated into primary care, enables inclusion of fathers and addresses modifiable risks for PCMD directly. The full intervention appears a promising programme for preventing PCMD, optimising family functioning, and as the first component of a stepped approach to mental healthcare. ACTRN12613000506796; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Making a success of providing NHS Health Checks in community pharmacies across the Tees Valley: a qualitative study

PubMed Central

2011-01-01

Background In England and Wales, the Department of Health introduced a primary prevention programme, NHS Health Checks, to provide screening for cardiovascular risk amongst people aged 40-74. The aim of this programme is to offer treatment and advice to those identified with an increased risk of cardiovascular diseases (CVD). The North East of England has some of the highest rates of CVD in the UK and prevention is therefore a priority. NHS Tees funded this programme of work under the local branding of Healthy Heart Checks (HHC). These were initially implemented principally through GP practices from October 2008 but, in order to mitigate the possibility that some hard to reach communities would be reluctant to engage with some primary care settings, plans were also developed to deliver the programme through workplace settings and through community pharmacies. This paper reports specifically on the findings from the evaluation in respect of the setting up of HHCs in community pharmacies and aims to offer some lessons for other service settings where this option is seen as a way of providing low threshold services which will minimise inequalities in intervention uptake. Methods In assessing the community pharmacy component of HHCs, a selection of staff having direct involvement in the process was invited to take part in the evaluation. Interviews were carried out with representatives from community pharmacy, staff members from the commissioning Primary Care Trusts and with Local Pharmaceutical Committee members. Results Evaluation and analysis identified challenges which should be anticipated and addressed in initiating HHC in community pharmacies. These have been categorised into four main themes for discussion in this paper: (1) establishing and maintaining pharmacy Healthy Heart Checks, (2) overcoming IT barriers, (3) developing confident, competent staff and (4) ensuring volume and through flow in pharmacy. Conclusions Delivering NHS health checks through community pharmacies can be a complex process, requiring meticulous planning, and may incur higher than expected costs. Findings from our evaluation provide insight into possible barriers to setting up services in pharmacies which may help other commissioning bodies when considering community pharmacy as a location for primary prevention interventions in future. PMID:21929809

Stepped-care to prevent depression and anxiety in visually impaired older adults--design of a randomised controlled trial.

PubMed

van der Aa, Hilde P A; van Rens, Ger H M B; Comijs, Hannie C; Bosmans, Judith E; Margrain, Tom H; van Nispen, Ruth M A

2013-08-09

Subthreshold depression and anxiety are common in the growing population of visually impaired older adults and increase the risk of full-blown depressive or anxiety disorders. Adequate treatment may prevent the development of depression or anxiety in this high risk group. A stepped-care programme was developed based on other effective interventions and focus groups with professionals and patient representatives of three low vision rehabilitation organisations in The Netherlands and Belgium. The final programme consists of four steps: 1) watchful waiting, 2) guided self-help, 3) problem solving treatment, 4) referral to general practitioner. The (cost-)effectiveness of this programme is evaluated in a randomised controlled trial. Patients (N = 230) are randomly assigned to either a treatment group (stepped-care) or a control group (usual care). The primary outcome is the incidence of depressive and anxiety disorders, measured with the Mini International Neuropsychiatric Interview (MINI). Preventive interventions for depression and anxiety have received little attention in the field of low vision. A stepped-care programme that focuses on both depression and anxiety has never been investigated in visually impaired older adults before. If the intervention is shown to be effective, this study will result in an evidence based treatment programme to prevent depression or anxiety in patients from low vision rehabilitation organisations. The pragmatic design of the study greatly enhances the generalisability of the results. However, a possible limitation is the difficulty to investigate the contribution of each individual step. Identifier: NTR3296.

Implementation of the DP-TRANSFERS project in Catalonia: A translational method to improve diabetes screening and prevention in primary care

PubMed Central

Barrio-Torrell, Francisco; Cos-Claramunt, Xavier; Aguilar-Sanz, Sofía; Solé-Brichs, Claustre; Castell-Abat, Conxa; Arija-Val, Victoria; Lindström, Jaana

2018-01-01

Background The DE-PLAN-CAT project (Diabetes in Europe–Prevention using lifestyle, physical activity and nutritional intervention–Catalonia) has shown that an intensive lifestyle intervention is feasible in the primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention–Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible. Methods A multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45–75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation. Results The programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively). Conclusions A large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities. PMID:29543842

Neuromuscular exercises prevent severe knee injury in adolescent team handball players.

PubMed

Achenbach, Leonard; Krutsch, Volker; Weber, Johannes; Nerlich, Michael; Luig, Patrick; Loose, Oliver; Angele, Peter; Krutsch, Werner

2017-10-20

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players. Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury. Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01-0.90), p = 0.019. Other injuries to the lower extremities showed no significant difference between the two groups. Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study

PubMed Central

Whitford, David L; Hickey, Anne; Horgan, Frances; O'Sullivan, Bernadette; McGee, Hannah; O'Neill, Desmond

2009-01-01

Background Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. Methods Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. Results Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. Conclusion General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care. PMID:19402908

Management of children exposed to Mycobacterium tuberculosis: a public health evaluation in West Java, Indonesia.

PubMed

Rutherford, Merrin E; Ruslami, Rovina; Anselmo, Melissa; Alisjahbana, Bachti; Yulianti, Neti; Sampurno, Hedy; van Crevel, Reinout; Hill, Philip C

2013-12-01

To investigate qualitatively and quantitatively the performance of a programme for managing the child contacts of adult tuberculosis patients in Indonesia. A public health evaluation framework was used to assess gaps in a child contact management programme at a lung clinic. Targets for programme performance indicators were derived from established programme indicator targets, the scientific literature and expert opinion. Compliance with tuberculosis screening, the initiation of isoniazid preventive therapy in children younger than 5 years, the accuracy of tuberculosis diagnosis and adherence to preventive therapy were assessed in 755 child contacts in two cohorts. In addition, 22 primary caregivers and 34 clinic staff were interviewed to evaluate knowledge and acceptance of child contact management. The cost to caregivers was recorded. Gaps between observed and target indicator values were quantified. THE GAPS BETWEEN OBSERVED AND TARGET PERFORMANCE INDICATORS WERE: 82% for screening compliance; 64 to 100% for diagnostic accuracy, 50% for the initiation of preventive therapy, 54% for adherence to therapy and 50% for costs. Many staff did not have adequate knowledge of, or an appropriate attitude towards, child contact management, especially regarding isoniazid preventive therapy. Caregivers had good knowledge of screening but not of preventive therapy and had difficulty travelling to the clinic and paying costs. The study identified widespread gaps in the performance of a child contact management system in Indonesia, all of which appear amenable to intervention. The public health evaluation framework used could be applied in other settings where child contact management is failing.

Preventing substance misuse: study protocol for a randomised controlled trial of the Strengthening Families Programme 10–14 UK (SFP 10–14 UK)

PubMed Central

2014-01-01

Background Prevention of alcohol, drug and tobacco misuse by young people is a key public health priority. There is a need to develop the evidence base through rigorous evaluations of innovative approaches to substance misuse prevention. The Strengthening Families Programme 10–14 is a universal family-based alcohol, drugs and tobacco prevention programme, which has achieved promising results in US trials, and which now requires cross-cultural assessment. This paper therefore describes the protocol for a randomised controlled trial of the UK version of the Strengthening Families Programme 10–14 (SFP 10–14 UK). Methods/Design The trial comprises a pragmatic cluster randomised controlled effectiveness trial with families as the unit of randomisation, with embedded process and economic evaluations. Participating families will be randomised to one of two treatment groups - usual care with full access to existing services (control group), or usual care plus SFP 10–14 UK (intervention group). The trial has two primary outcomes - the number of occasions that young people report having drunk alcohol in the last 30 days, and drunkenness during the last 30 days, both dichotomised as ‘never’ and ‘1-2 times or more’. The main follow-up is at 2 years past baseline, and short-term and intermediate outcomes are also measured at 9 and 15 months. Discussion The results from this trial will provide evidence on the effectiveness and cost-effectiveness of an innovative universal family-based substance misuse prevention programme in a UK context. Trial registration Current Controlled Trials ISRCTN63550893. PMID:24438460

Health promotion interventions to prevent early childhood human influenza at the household level: a realist review to identify implications for programmes in Hong Kong.

PubMed

Lam, Winsome; Dawson, Angela; Fowler, Cathrine

2015-04-01

To identify factors affecting the delivery of health promotion interventions to prevent early childhood human influenza at the household level. Yearly, influenza epidemics seriously affect all age groups, particularly those with weakened immune systems, including children. Influenza is transmitted easily from person to person through droplet and direct contact. Maintaining personal hygiene, avoiding close contact with the infected person and proper hand washing are recommended as the most effective means of preventing the transmission of influenza. However, it is not clear what programme-related mechanisms and contexts are crucial to the successful delivery of interventions in the home. This study systematically reviewed published research studies to identify factors influencing the effective delivery of health promotion programmes targeting influenza in a household. Realist review. A realist review methodology was selected to examine what interventions are effective in preventing and managing influenza at the household level and in what circumstances. A structured search of the peer-reviewed primary research literature was undertaken using a defined search protocol. Eight studies were retrieved for the analysis. Mechanisms impacting on intervention delivery were identified, including timing of implementation, programme reach, organisational and healthcare worker involvement, mode and place of delivery, contact with infected person, health practice compliance and sustainability at home. These findings suggest contextual factors that could be identified through ecological approaches to health promotion that are crucial for policymakers to consider when designing interventions. The active involvement of community nurses through an integrated household visiting programme may help to better deliver family-based health promotion interventions to prevent illnesses such as influenza in children. © 2014 John Wiley & Sons Ltd.

Early interventions for youths at high risk for bipolar disorder: a developmental approach.

PubMed

Benarous, Xavier; Consoli, Angèle; Milhiet, Vanessa; Cohen, David

2016-03-01

In recent decades, ongoing research programmes on primary prevention and early identification of bipolar disorder (BD) have been developed. The aim of this article is to review the principal forms of evidence that support preventive interventions for BD in children and adolescents and the main challenges associated with these programmes. We performed a literature review of the main computerised databases (MEDLINE, PUBMED) and a manual search of the literature relevant to prospective and retrospective studies of prodromal symptoms, premorbid stages, risk factors, and early intervention programmes for BD. Genetic and environmental risk factors of BD were identified. Most of the algorithms used to measure the risk of developing BD and the early interventions programmes focused on the familial risk. The prodromal signs varied greatly and were age dependent. During adolescence, depressive episodes associated with genetic or environmental risk factors predicted the onset of hypomanic/manic episodes over subsequent years. In prepubertal children, the lack of specificity of clinical markers and difficulties in mood assessment were seen as impeding preventive interventions at these ages. Despite encouraging results, biomarkers have not thus far been sufficiently validated in youth samples to serve as screening tools for prevention. Additional longitudinal studies in youths at high risk of developing BD should include repeated measures of putative biomarkers. Staging models have been developed as an integrative approach to specify the individual level of risk based on clinical (e.g. prodromal symptoms and familial history of BD) and non-clinical (e.g. biomarkers and neuroimaging) data. However, there is still a lack of empirically validated studies that measure the benefits of using these models to design preventive intervention programmes.

A review of interventions to prevent Type 2 Diabetes after Gestational Diabetes.

PubMed

Peacock, Ann S; Bogossian, Fiona; McIntyre, H David; Wilkinson, Shelley

2014-12-01

Gestational Diabetes Mellitus (GDM) during pregnancy is a risk factor for the development of Type 2 Diabetes (T2DM) within 15 years, and prevention programmes have been problematic. The aim of the study is to identify effective strategies and programmes to decrease the risk of T2DM in women who experience GDM, the barriers to participation, and the opportunities for midwives to assist women in prevention. English language, peer reviewed and professional literature published between 1998 and 2013 were searched. A systematic review of the literature was undertaken, included studies were then appraised for quality and finally findings of the studies were thematically analysed. This review identified that there are interventions that are effective, however most lifestyle changes are difficult to translate into everyday life. As the incidence of GDM is expected to rise, midwives' role in promoting long-term health behaviours requires further review. Women need to overcome barriers and be supported in making the behavioural changes necessary to prevent T2DM following GDM. Midwives as the primary carers for women in pregnancy and childbirth are ideally positioned to educate women and engage them in lifestyle and behaviour programmes that prevent the onset of Type 2 Diabetes. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Rationale and design of the DP-TRANSFERS project: diabetes prevention-transferring findings from European research to society in Catalonia.

PubMed

Costa, Bernardo; Castell, Conxa; Cos, Xavier; Solé, Claustre; Mestre, Santiago; Canela, Marta; Boquet, Antoni; Cabré, Joan-Josep; Barrio, Francisco; Flores-Mateo, Gemma; Ferrer-Vidal, Daniel; Lindström, Jaana

2016-04-27

Compelling evidence has been accumulated to support the effectiveness of intensive lifestyle intervention in delaying progression to Type 2 diabetes even in people identified as being at high risk determined by the Finnish diabetes risk score. The DE-PLAN-CAT project (diabetes in Europe-prevention using lifestyle, physical activity and nutritional intervention-Catalonia) evidenced that intensive lifestyle intervention was feasible and cost-effective on a short scale in real-life primary care settings, at least over 4 years. However, transferring such lifestyle interventions to society remains the major challenge of research in the field of diabetes prevention. The derived DP-TRANSFERS (diabetes prevention-transferring findings from European research to society) is a large scale national programme aimed at translating a tailored lifestyle intervention to the maximum of primary care centres where feasible through a core proposal agreed with all the partners. The method is built upon a 3-step (screening, intervention and follow-up) real-life, community-wide structure on the basis of a dual intensity lifestyle intervention (basic and continuity modules) and supported by a 4-channel transfer strategy (institutional relationships, facilitators' workshops, collaborative groupware and programme WEB page). Participation will initially cover nine health departments (7 million inhabitants) through nine coordinating centres located in metropolitan (3.2 million), semi-urban (2.9 million) and rural (0.9 million) areas from which it is expected accessing 25 % of all primary care settings, equivalent to 90 associated centres (1.6-1.8 million people) with an estimate of 0.32 million participants aged 45-75 years at high risk of future development of diabetes. To ascertain sustainability, effect, satisfaction and quality of the translation programme statistical analyses will be performed from both the entire population (facilitators and participants) and a stratified representative sample obtained by collecting data from at least 920 participants. The DP-TRANSFERS will use a strategy of approach to society consistent with the impact of the disease and the fast accessibility provided by primary care settings in Catalonia. Both the widespread effect of the lifestyle intervention and the translational process itself could be assessed.

[The role of health education in preventive medicine strategy of the Mexican Institute of Social Security].

PubMed

Rodríguez Véliz, A M

1982-01-01

This article presents the Mexican Institute for Social Security (IMSS) created in 1943 and describes its main features, its programmes and the role played by health education inside the programmes. It ends by explaining the present situation concerning health education and the changes which are presently envisaged. During its first twenty years, the IMSS promoted preventive medicine and trained health personnel. Since 1979 it has concerned itself mainly with some 10 million peasants and marginal groups. In the frame of a national development programme, a vaccination and detection campaign were implemented and the distribution system of potable water was extended. Mexico with a population of 73 million has the dual characteristics of a developed and a developing country (70 per cent of its population is urban, 30 per cent rural). The overcrowded cities contrast with the isolated rural areas where sanitary conditions are poor and life difficult. The main causes of mortality, in 1978, were: -in the towns: car accidents, cardiovascular diseases and suicide; -in rural areas, acute respiratory infections and intestinal infections. The 1978 Alma Ata international conference on primary health care and the meeting of Ministers of health convened in 1980 by the Pan American Health Organization endorsed the IMSS programmes which emphasize prevention, promote health education and community participation. The cost of preventive measures being cheaper than treatment, 203 million pesos were saved and allocated to the expansion of programmes. Systematic immunization has resulted in a sharp decline of diphteria, polio, rabies, typhoid, pertussis and measles. Early detection of tumours of cervix uteri has saved many lives.

Stepped-care to prevent depression and anxiety in visually impaired older adults – design of a randomised controlled trial

PubMed Central

2013-01-01

Background Subthreshold depression and anxiety are common in the growing population of visually impaired older adults and increase the risk of full-blown depressive or anxiety disorders. Adequate treatment may prevent the development of depression or anxiety in this high risk group. Method/design A stepped-care programme was developed based on other effective interventions and focus groups with professionals and patient representatives of three low vision rehabilitation organisations in the Netherlands and Belgium. The final programme consists of four steps: 1) watchful waiting, 2) guided self-help, 3) problem solving treatment, 4) referral to general practitioner. The (cost-)effectiveness of this programme is evaluated in a randomised controlled trial. Patients (N = 230) are randomly assigned to either a treatment group (stepped-care) or a control group (usual care). The primary outcome is the incidence of depressive and anxiety disorders, measured with the Mini International Neuropsychiatric Interview (MINI). Discussion Preventive interventions for depression and anxiety have received little attention in the field of low vision. A stepped-care programme that focuses on both depression and anxiety has never been investigated in visually impaired older adults before. If the intervention is shown to be effective, this study will result in an evidence based treatment programme to prevent depression or anxiety in patients from low vision rehabilitation organisations. The pragmatic design of the study greatly enhances the generalisability of the results. However, a possible limitation is the difficulty to investigate the contribution of each individual step. Trial registration Identifier: NTR3296 PMID:23937975

The potential impact of a prophylactic vaccine for human papillomavirus on the current cervical screening programme in Hong Kong.

PubMed

Koljonen, Paul A

2007-08-01

To review and summarise current controversies in cervical screening in Hong Kong and discuss the potential impact of prophylactic human papillomavirus vaccination. Literature search of Medline to December 2006, the Hong Kong Cancer Registry, and Centre of Disease Control. Key words search terms were: 'human papillomavirus', 'vaccine', 'cervical cancer', 'screening programme', and 'Hong Kong'. Original articles, review papers, books, and the worldwide web. Cervical cancer is one of the most common cancers in Hong Kong, and can be prevented if detected at its pre-cancerous stage. Despite the huge disease burden this imposes on our society and robust advocacy by the academic sector, an appropriate screening programme is still not in place. Existence of a vaccine that could potentially reduce the costs of universal screening should prompt our government to re-consider subsidising such a programme. While a combined screening-vaccination programme may be more cost-effective than screening alone, the vaccine is still costly, and the government must consider all the pros and cons. The new human papillomavirus vaccine, combined with an organised screening programme, is probably a more cost-effective way of preventing morbidity and mortality due to cervical cancer than the current programme in Hong Kong. More research and cost-effectiveness analyses are needed to decide on the ideal ages for primary vaccination and the requirement for booster shots.

Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care.

PubMed

Westerlund, Anna; Garvare, Rickard; Nyström, Monica E; Eurenius, Eva; Lindkvist, Marie; Ivarsson, Anneli

2017-03-01

Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed. This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them. A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used. Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors. Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices. Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness. © 2016 Nordic College of Caring Science.

Programme costing of a physical activity programme in primary prevention: should the costs of health asset assessment and participatory programme development count?

PubMed

Wolfenstetter, Silke B; Schweikert, Bernd; John, Jürgen

2012-01-01

This analysis aims to discuss the implications of the "health asset concept", introduced by the WHO, and the "investment for health model" requiring a "participatory approach" of cooperative programme development applied on a physical activity programme for socially disadvantaged women and to demonstrate the related costing issues as well as the relevant decision context. The costs of programme implementation amounted to €48,700. Adding the costs for developing the programme design of €48,800 results in total costs of €97,500; adding on top of that the costs of asset assessment running to €35,600 would total €133,100. These four different cost figures match four different types of potentially relevant decisions contexts. Depending on the decision context the total costs, and hence the incremental cost-effectiveness ratio of a health promotion intervention, could differ considerably. Therefore, a detailed cost assessment and the identification of the decision context are of crucial importance.

Effect of Structured Teaching Programme on Knowledge of School Teachers regarding First Aid Management in Selected Schools of Bangalore.

PubMed

De, Piyali

2014-01-01

Safe childhood is the foundation of a good future. Children face different kinds of accidents at school premises while playing. Prevention of these accidents and their management is essential. A study was therefore conducted among school teachers at Anekal Taluk, Bangalore to make them aware about different accidents of children at school premises and their first aid management. The sample consisted of 30 primary and higher primary school teachers selected by convenience sampling technique. The analysis showed that improvement of knowledge occurred after administering structured teaching programme (STP) on first aid management. Nursing professionals can benefit from the study result at the area of community, administration, research and education.

A community-based Falls Management Exercise Programme (FaME) improves balance, walking speed and reduced fear of falling.

PubMed

Yeung, Pui Yee; Chan, Wayne; Woo, Jean

2015-04-01

Although effective community falls prevention programmes for the older persons have been described, challenges remain in translating proven interventions into daily practice. To evaluate the efficacy, feasibility and acceptability of a falls prevention programme that can be integrated into daily activities in a group of community-dwelling older adults with risk of falling. A cohort study with intervention and comparison groups was designed to evaluate a 36-week group-based falls prevention exercise programme (FaME) in the community setting. Participants were aged 60 years or older, had fallen in the past 12 months, had fear of falling with avoidance of activities or had deficits in balance control. Primary outcome measures included assessment of balance control and mobility; secondary outcome measures included level of physical activity, assessment of fear of falling and health-related quality of life. There were 48 and 51 participants in the intervention and comparison groups, respectively. There were improvements in measurements of balance, walking speed and self-efficacy. The drop out rate was low (14.6% and 3.9% from the intervention and comparison groups, respectively). Overall compliance in the intervention group was 79%. Factors that motivated continued participation include the regular and long-term nature of the programme helping to reinforce their exercise habits, the simplicity of movements and friendliness of the group. The FaME programme improves balance, walking speed and reduces fear of falling. It could be widely promoted and integrated into regular health and social activities in community settings.

Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Together (KAT) Programme

PubMed Central

2011-01-01

Background Alcohol misuse by young people is an important public health issue, and has led to the development of a range of prevention interventions. Evidence concerning the most effective approaches to intervention design and implementation is limited. Parental involvement in school-based interventions is important, but many programmes fail to recruit large numbers of parents. This paper reports findings from an exploratory evaluation of a new alcohol misuse prevention programme - Kids, Adults Together (KAT), which comprised a classroom component, engagement with parents through a fun evening for families with children aged 9-11 years, and a DVD. The evaluation aimed to establish the programme's theoretical basis, explore implementation processes and acceptability, and identify plausible precursors of the intended long-term outcomes. Methods Documentary analysis and interviews with key personnel examined the programme's development. Classroom preparation and KAT family events in two schools were observed. Focus groups with children, and interviews with parents who attended KAT family events were held immediately after programme delivery, and again after three months. Interviews with head teachers and with teachers who delivered the classroom preparation were conducted. Follow-up interviews with programme personnel were undertaken. Questionnaires were sent to parents of all children involved in classroom preparation. Results KAT achieved high levels of acceptability and involvement among both children and parents. Main perceived impacts of the programme were increased pro-social communication within families (including discussions about harmful parental alcohol consumption), heightened knowledge and awareness of the effects of alcohol consumption and key legal and health issues, and changes in parental drinking behaviours. Conclusions KAT demonstrated promise as a prevention intervention, primarily through its impact on knowledge and communication processes within families, and its ability to engage with large numbers of parents. A key programme mechanism was the classroom preparation's facilitation of parental involvement in the family fun evening. The programme also incorporated features identified in the literature as likely to increase effectiveness, including a focus on harm reduction, interactive delivery, and targeting primary-school-age children. Further research is needed to test and develop programme theory through implementation in different school contexts, and to examine potential longer-term impacts, and the feasibility of large scale delivery. PMID:22004185

Management of children exposed to Mycobacterium tuberculosis: a public health evaluation in West Java, Indonesia

PubMed Central

Ruslami, Rovina; Anselmo, Melissa; Alisjahbana, Bachti; Yulianti, Neti; Sampurno, Hedy; van Crevel, Reinout; Hill, Philip C

2013-01-01

Abstract Objective To investigate qualitatively and quantitatively the performance of a programme for managing the child contacts of adult tuberculosis patients in Indonesia. Methods A public health evaluation framework was used to assess gaps in a child contact management programme at a lung clinic. Targets for programme performance indicators were derived from established programme indicator targets, the scientific literature and expert opinion. Compliance with tuberculosis screening, the initiation of isoniazid preventive therapy in children younger than 5 years, the accuracy of tuberculosis diagnosis and adherence to preventive therapy were assessed in 755 child contacts in two cohorts. In addition, 22 primary caregivers and 34 clinic staff were interviewed to evaluate knowledge and acceptance of child contact management. The cost to caregivers was recorded. Gaps between observed and target indicator values were quantified. Findings The gaps between observed and target performance indicators were: 82% for screening compliance; 64 to 100% for diagnostic accuracy, 50% for the initiation of preventive therapy, 54% for adherence to therapy and 50% for costs. Many staff did not have adequate knowledge of, or an appropriate attitude towards, child contact management, especially regarding isoniazid preventive therapy. Caregivers had good knowledge of screening but not of preventive therapy and had difficulty travelling to the clinic and paying costs. Conclusion The study identified widespread gaps in the performance of a child contact management system in Indonesia, all of which appear amenable to intervention. The public health evaluation framework used could be applied in other settings where child contact management is failing. PMID:24347732

Preventing running-related injuries using evidence-based online advice: the design of a randomised-controlled trial

PubMed Central

de Vos, Robert-Jan; van Ochten, John M; Verhaar, Jan AN; Davis, Irene S; Bindels, Patrick JE; Bierma-Zeinstra, Sita MA; van Middelkoop, Marienke

2017-01-01

Introduction Running-related injuries (RRIs) are frequent and can lead to cessation of health promoting activities. Several risk factors for RRIs have been identified. However, no successful injury prevention programme has been developed so far. Therefore, the aim of the present study is to investigate the effect of an evidence-based online injury prevention programme on the number of RRIs. Methods and analysis The INSPIRE trial is a randomised-controlled trial with a 3-month follow-up. Both novice and more experienced runners, aged 18 years and older, who register for a running event (distances 5 km up to 42.195 km) will be asked to participate in this study. After completing the baseline questionnaire, participants will be randomised into either the intervention group or control group. Participants in the intervention group will get access to the online injury prevention programme. This prevention programme consists of information on evidence-based risk factors and advices to reduce the injury risk. The primary outcome measure is the number of self-reported RRIs in the time frame between registration for a running event and 1 month after the running event. Secondary outcome measures include the running days missed due to injuries, absence of work or school due to injuries, and the injury location. Ethics and dissemination An exemption for a comprehensive application is obtained by the Medical Ethical Committee of the Erasmus University Medical Centre Rotterdam, Netherlands. The results of the study will be published in peer-reviewed journals and presented on international congresses. Trial registration number NTR5998. Pre-results PMID:28761721

Can we reduce preventable heart failure readmissions in patients enrolled in a Disease Management Programme?

PubMed

Phelan, D; Smyth, L; Ryder, M; Murphy, N; O'Loughlin, C; Conlon, C; Ledwidge, M; McDonald, K

2009-06-01

Disease Management Programmes (DMPs) are successful in reducing hospital readmissions in heart failure (HF). However, there remain a number of patients enrolled in a DMP who are readmitted with HF. The primary aim of the study was to determine the proportion of preventable readmissions (PR). The secondary aim was to recognise patient characteristics which would identify certain patients at risk of having a PR. A retrospective chart search was performed on patients readmitted over a 1-year period. 38.5% of readmissions were classified as PR. None of these patients made prior contact with the DMP. Admission levels of BNP, potassium, urea and creatinine were significantly lower in the PR group. DMP have proven benefits in reducing hospital readmission nonetheless a significant proportion of these readmissions are preventable. Further work is required to prospectively analyse why these patients fail to contact the DMP.

Economic Evaluation and Transferability of Physical Activity Programmes in Primary Prevention: A Systematic Review

PubMed Central

Wolfenstetter, Silke B.; Wenig, Christina M.

2010-01-01

This systematic review aims to assess the characteristics of, and the clinical and economic evidence provided by, economic evaluations of primary preventive physical exercise interventions, and to analyse their transferability to Germany using recommended checklists. Fifteen economic evaluations from seven different countries met eligibility criteria, with seven of the fifteen providing high economic evidence in the special country context. Most of the identified studies conclude that the investigated intervention provide good value for money compared with alternatives. However, this review shows a high variability of the costing methods between the studies, which limits comparability, generalisability and transferability of the results. PMID:20617050

Primary Prevention of Congenital Anomalies: Special Focus on Environmental Chemicals and other Toxicants, Maternal Health and Health Services and Infectious Diseases.

PubMed

Taruscio, Domenica; Baldi, Francesca; Carbone, Pietro; Neville, Amanda J; Rezza, Giovanni; Rizzo, Caterina; Mantovani, Alberto

2017-01-01

Congenital anomalies (CA) represent an important fraction of rare diseases, due to the critical role of non-genetic factors in their pathogenesis. CA are the main group of rare diseases in which primary prevention measures will have a beneficial impact. Indeed, since 2013 the European Union has endorsed a body of evidence-based recommendations for CA primary prevention; the recommendations aim at facilitating the inclusion of primary prevention actions the National Rare Disease Plans of EU Member States and encompass different public health fields, from environment through to maternal diseases and lifestyles.The chapter overviews and discusses the assessment of main risk factors for CA, such as environmental toxicants, maternal health and lifestyles and infections, with a special attention to issues that are emerging or need more knowledge.Overall, the availability of CA registries is important for estimating the health burden of CA, identifying possible hotspots, assessing the impact of interventions and addressing further, fit-to-purpose research.The integration of relevant public health actions that are already in place (e.g., control of noxious chemicals, vaccination programmes, public health services addressing chronic maternal conditions) can increase the affordability and sustainability of CA primary prevention. In developing countries with less primary prevention in place and limited overall resources, a first recognition phase may be pivotal in order to identify priority targets. In the meanwhile, policy makers should be made aware that primary prevention of RD supports publicly endorsed societal values like the knowledge-based promotion of health, empowerment, equity and social inclusiveness.

Community-based prevention of hepatitis-B-related liver cancer: Australian insights

PubMed Central

Kansil, Melanie Q; Porwal, Mamta; Penman, Andrew G; George, Jacob

2014-01-01

Abstract Problem Although most primary hepatocellular cancers (HCCs) are attributable to chronic viral hepatitis and largely preventable, such cancers remain a leading cause of cancer-related mortality wherever chronic hepatitis B is endemic. Approach Many HCCs could be prevented by increasing awareness and knowledge of hepatitis B, optimizing the monitoring of chronic hepatitis B and using antiviral treatments – but there are gaps in the implementation of such strategies. Local setting The “B Positive” programme, based in Sydney, Australia, is designed to improve hepatitis-B-related health outcomes among immigrants from countries with endemic hepatitis B. The programme offers information about disease screening, vaccination and treatment options, as well as optimized access to care. Relevant changes The B Positive programme has been informed by economic modelling. The programme offers culturally tailored education on chronic hepatitis B to target communities and their health practitioners and regular follow-up through a population-based registry of cases. Lessons learnt As the costs of screening for chronic hepatitis B and follow-up are relatively low and less than one in every four cases may require antiviral drugs, optimizing access to treatment seems an appropriate and cost-effective management option. The identification and accurate staging of cases and the judicious use of antiviral medications are predicated upon an informed and educated health workforce. As establishing community trust is a lengthy process, delaying the implementation of programmes against chronic hepatitis B until antiviral drugs become cheaper is unwarranted. PMID:24839327

Control programme for cystic echinococcosis in Uruguay.

PubMed

Irabedra, Pilar; Ferreira, Ciro; Sayes, Julio; Elola, Susana; Rodríguez, Miriam; Morel, Noelia; Segura, Sebastian; Santos, Estela Dos; Guisantes, Jorge A

2016-05-24

Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community's participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.

A National Health Service Hospital's cardiac rehabilitation programme: a qualitative analysis of provision.

PubMed

O'Driscoll, Jamie M; Shave, Robert; Cushion, Christopher J

2007-10-01

This paper reports a study examining the effectiveness of a London National Health Service Trust Hospital's cardiac rehabilitation programme, from the perspectives of healthcare professionals and patients. Cardiovascular disease is the world's leading cause of death and disability. Substantial research has reported that, following a cardiac event, cardiac rehabilitation can promote recovery, improve exercise capacity and patient health, reduce various coronary artery disease risk factors and subsequently reduce hospitalization costs. Despite these findings and the introduction of the National Service Framework for Coronary Heart Disease, there is wide variation in the practice, management and organization of cardiac rehabilitation services. A purposeful sample of three postmyocardial infarction patients registered on the selected hospital's cardiac rehabilitation programme, coupled with 11 healthcare professionals were selected. The patients acted as individual case studies. The authors followed all three patients through phase III of their cardiac rehabilitation programme. The research attempted to explore the roles and procedures of a London hospital's cardiac rehabilitation programme through an interpretative framework involving qualitative research methods. Participant observation and in-depth semi-structured interviews were the instruments used to collect data. Whilst the healthcare professionals were enthusiastic about coronary heart disease prevention, the London NHS trust hospital's cardiac rehabilitation programme had several barriers, which reduced the programme's success and prevented it from achieving National Service Framework targets. The barriers were complex and mainly included service-related factors, such as lack of professional training, weak communication between primary and secondary care and confused roles and identities. Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation and secondary prevention programme development, such as communication and role and identity perceptions in a multi-professional working environment and the need to develop a formal training programme for cardiac rehabilitation healthcare professionals. The results of this study highlight the need for increased investment, improved planning and the introduction of a comprehensive training programme for healthcare practitioners in cardiac rehabilitation. Implementation of these actions may reduce many of the service limitations and barriers that currently surround cardiac rehabilitation programmes.

Optimising secondary prevention in the acute period following a TIA of ischaemic origin.

PubMed

Heron, Neil

2016-01-01

Transient ischaemic attacks (TIAs) are highly prevalent conditions, with at least 46 000 people per year in the UK having a TIA for the first time. TIAs are a warning that the patient is at risk of further vascular events and the 90-day risk of vascular events following a TIA, excluding events within the first week after diagnosis when the risk is highest, can be as high as 18%. Immediate assessment of patients with TIA, either at accident and emergency, general practice and/or TIA clinics, is therefore required to address secondary prevention and prevent further vascular events. This article addresses the need for optimising secondary prevention in the acute period following a TIA of ischaemic origin to reduce the risk of further vascular events as per recent Cochrane review advice and presents a novel project, Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE), to do this. One novel way to tackle vascular risk factors and promote secondary prevention in patients with TIA could be to adapt a cardiac rehabilitation programme for these patients. SPRITE, a feasibility and pilot study (ClinicalTrials.gov Identifier: NCT02712385) funded by the National Institute for Health Research, is attempting to adapt a home-based cardiac rehabilitation programme, 'The Healthy Brain Rehabilitation Manual', for use in the acute period following a TIA. The use of cardiac rehabilitation programmes post-TIA requires further research, particularly within the primary care setting.

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.

Cluster randomised control trial for cricket injury prevention programme (CIPP): a protocol paper.

PubMed

Soomro, Najeebullah; Chua, Nina; Freeston, Jonathan; Ferdinands, Rene E D; Sanders, Ross

2017-09-28

Injury prevention programmes (IPPs) are effective in reducing injuries among adolescent team sports. However, there is no validated cricket-specific IPP despite the high incidence of musculoskeletal injuries among amateur cricketers. To evaluate whether a cricket injury prevention programme (CIPP) as a pretraining warm-up or post-training cool-down can reduce injury rates in amateur cricket players. CIPP is a cluster randomised controlled trial which includes 36 male amateur club teams having cricket players aged 14-40 years to be randomly assigned to three study arms: warm-up, cool-down and control (n=12 teams, 136 players in each arm). The intervention groups will perform 15 min CIPP either as a pretraining warm-up or a post-training cool-down. The primary outcome measure will be injury incidence per 1000 player hours and the secondary outcome measures will be whether IPP as a warm-up is better than IPP as a cool-down, and the adherence to the intervention. ACTRN 1261700047039. © 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.

Programmes for advance distribution of misoprostol to prevent post-partum haemorrhage: a rapid literature review of factors affecting implementation.

PubMed

Smith, Helen J; Colvin, Christopher J; Richards, Esther; Roberson, Jeffrey; Sharma, Geeta; Thapa, Kusum; Gülmezoglu, A Metin

2016-02-01

Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synthesizes current knowledge about the barriers and facilitators affecting implementation of advance community distribution of misoprostol to prevent PPH, where misoprostol may be self-administered or administered by an LHW.We searched for and summarized available empirical evidence, and collected primary data from programme stakeholders about their experiences of programme implementation.We present key outcomes and features of advanced distribution programmes that are in operation or have been piloted globally. We categorized factors influencing implementation into those that operate at the health system level, factors related to the community and policy context and those factors more closely connected to the end user.Debates around advance distribution have centred on the potential risks and benefits of making misoprostol available to pregnant women and community members during pregnancy for administration in the home. However, the risks of advance distribution appear manageable and the benefits of self-administration, especially for women who have little chance of expert care for PPH, are considerable. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

School Psychology and School-Based Child and Family Interventions in Singapore

ERIC Educational Resources Information Center

Chong, Wan Har; Lee, Boon Ooi; Tan, Soo Yin; Wong, Shyh Shin; Yeo, Lay See

2013-01-01

This article presents an overview of the range of primary, secondary, and tertiary interventions based on the Singapore Education Ministry-developed whole-school framework for pupil management and support. At the preventive level, a range of school-wide programmes are implemented to provide learning, emotional, and behavioural support for…

Primary prevention of childhood obesity through counselling sessions at Swedish child health centres: design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised trial.

PubMed

Döring, Nora; Hansson, Lena M; Andersson, Elina Scheers; Bohman, Benjamin; Westin, Maria; Magnusson, Margaretha; Larsson, Christel; Sundblom, Elinor; Willmer, Mikaela; Blennow, Margareta; Heitmann, Berit L; Forsberg, Lars; Wallin, Sanna; Tynelius, Per; Ghaderi, Ata; Rasmussen, Finn

2014-04-09

Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children's body mass index and waist circumference at four years. Secondary outcomes are children's and mothers' eating habits (assessed by a food frequency questionnaire), and children's and mothers' physical activity (measured by accelerometer and a validated questionnaire), and mothers' body mass index and waist circumference. The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control group, before they reached 10 months of age). The food frequency questionnaire showed acceptable relative validity when compared with an 8-day food diary. We are not aware of any previous RCT, concerned with the primary prevention of childhood obesity through sessions at CHC that addresses healthy eating habits and physical activity in the context of a routine child health services programme. ISRCTN16991919.

Effects of a community-oriented obesity prevention programme on indicators of body fatness in preschool and primary school children. Main results from the IDEFICS study.

PubMed

De Henauw, S; Huybrechts, I; De Bourdeaudhuij, I; Bammann, K; Barba, G; Lissner, L; Mårild, S; Molnár, D; Moreno, L A; Pigeot, I; Tornaritis, M; Veidebaum, T; Verbestel, V; Ahrens, W

2015-12-01

Childhood obesity is a major public health concern but evidence-based approaches to tackle this epidemic sustainably are still lacking. The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme. Here, we report on the effects of the IDEFICS intervention on indicators of body fatness. The intervention modules addressed the community, school and parental level, focusing on diet, physical activity and stress-related lifestyle factors. A cohort of 16,228 children aged 2-9.9 years - about 2000 per country - was equally divided over intervention and control regions. (Participating countries were Sweden, Germany, Estonia, Hungary, Cyprus, Italy, Spain and Belgium.) We compared the prevalence of overweight/obesity and mean values of body mass index z-score, per cent body fat and waist-to-height ratio over 2 years of follow-up. Mixed models adjusting for age and socioeconomic status of the parents and with an additional random effect for country accounted for the clustered study design. The prevalence of overweight and obesity increased in both the intervention and control group from 18.0% at baseline to 22.9% at follow-up in the control group and from 19.0% to 23.6% in the intervention group. The difference in changes between control and intervention was not statistically significant. For the cohort as a whole, the changes in indicators of body fatness did not show any clinically relevant differences between the intervention and control groups. Changes in favour of intervention treatment in some indicators were counterbalanced by changes in favour of the control group in some other indicators. Over the 2-year-observation period, the IDEFICS primary prevention programme for childhood obesity has not been successful in reducing the prevalence of overweight and obesity nor in improving indicators of body fatness in the target population as a whole. © 2015 World Obesity.

Programme Costing of a Physical Activity Programme in Primary Prevention: Should the Costs of Health Asset Assessment and Participatory Programme Development Count?

PubMed Central

Wolfenstetter, Silke B.; Schweikert, Bernd; John, Jürgen

2012-01-01

This analysis aims to discuss the implications of the “health asset concept”, introduced by the WHO, and the “investment for health model” requiring a “participatory approach” of cooperative programme development applied on a physical activity programme for socially disadvantaged women and to demonstrate the related costing issues as well as the relevant decision context. The costs of programme implementation amounted to €48,700. Adding the costs for developing the programme design of €48,800 results in total costs of €97,500; adding on top of that the costs of asset assessment running to €35,600 would total €133,100. These four different cost figures match four different types of potentially relevant decisions contexts. Depending on the decision context the total costs, and hence the incremental cost-effectiveness ratio of a health promotion intervention, could differ considerably. Therefore, a detailed cost assessment and the identification of the decision context are of crucial importance. PMID:22536517

The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial.

PubMed

Barker, Anna; Brand, Caroline; Haines, Terry; Hill, Keith; Brauer, Sandy; Jolley, Damien; Botti, Mari; Cumming, Robert; Livingston, Patricia M; Sherrington, Cathie; Zavarsek, Silva; Morello, Renata; Kamar, Jeannette

2011-08-01

In-hospital fall-related injuries are a source of personal harm, preventable hospitalisation costs, and access block through increased length of stay. Despite increased fall prevention awareness and activity over the last decade, rates of reported fall-related fractures in hospitals appear not to have decreased. This cluster randomised controlled trial (RCT) aims to determine the efficacy of the 6-PACK programme for preventing fall-related injuries, and its generalisability to other acute hospitals. 24 acute medical and surgical wards from six to eight hospitals throughout Australia will be recruited for the study. Wards will be matched by type and fall-related injury rates, then randomly allocated to the 6-PACK intervention (12 wards) or usual care control group (12 wards). The 6-PACK programme includes a nine-item fall risk assessment and six nursing interventions: 'falls alert' sign; supervision of patients in the bathroom; ensuring patient's walking aids are within reach; establishment of a toileting regime; use of a low-low bed; and use of bed/chair alarm. Intervention wards will be supported by a structured implementation strategy. The primary outcomes are fall and fall-related injury rates 12 months following 6-PACK implementation. This study will involve approximately 16,000 patients, and as such is planned to be the largest hospital fall prevention RCT to be undertaken and the first to be powered for the important outcome of fall-related injuries. If effective, there is potential to implement the programme widely as part of daily patient care in acute hospital wards where fall-related injuries are a problem.

The prevention of tobacco-related disease.

PubMed

Raw, M; McNeill, A

1994-11-01

The key components of a strategy to prevent tobacco-related disease are outlined. These measures aim to increase the cessation of tobacco use and reduce its uptake. Components are wide-ranging, including a taxation policy, a ban on advertising and promotion, a comprehensive health promotion programme including advice from primary health care professionals and the development of campaigning skills, particularly by the medical profession. The prevention of tobacco-related disease has moved into the domain of campaigners and lobbyists at political, economic and international levels. The key target is countering the activities, especially the unethical trade practices, of the wealthy and powerful tobacco industry.

Rationale and design of the PREDICE project: cost-effectiveness of type 2 diabetes prevention among high-risk Spanish individuals following lifestyle intervention in real-life primary care setting.

PubMed

Costa, Bernardo; Cabré, Joan J; Sagarra, Ramon; Solà-Morales, Oriol; Barrio, Francisco; Piñol, Josep L; Cos, Xavier; Bolíbar, Bonaventura; Castell, Conxa; Kissimova-Skarbek, Katarzyna; Tuomilehto, Jaakko

2011-08-04

Type 2 diabetes is an important preventable disease and a growing public health problem. Based on information provided by clinical trials, we know that Type 2 diabetes can be prevented or delayed by lifestyle intervention. In view of translating the findings of diabetes prevention research into real-life it is necessary to carry out community-based evaluations so as to learn about the feasibility and effectiveness of locally designed and implemented programmes. The aim of this project was to assess the effectiveness of an active real-life primary care strategy in high-risk individuals for developing diabetes, and then evaluate its efficiency. Cost-Effectiveness analysis of the DE-PLAN (Diabetes in Europe - Prevention using Lifestyle, physical Activity and Nutritional intervention) project when applied to a Mediterranean population in Catalonia (DE-PLAN-CAT). Multicenter, longitudinal cohort assessment (4 years) conducted in 18 primary health-care centres (Catalan Health Institute). Individuals without diabetes aged 45-75 years were screened using the Finnish Diabetes Risk Score - FINDRISC - questionnaire and a 2-h oral glucose tolerance test. All high risk tested individuals were invited to participate in either a usual care intervention (information on diet and cardiovascular health without individualized programme), or the intensive DE-PLAN educational program (individualized or group) periodically reinforced. Oral glucose tolerance test was repeated yearly to determine diabetes incidence. Besides measuring the accumulated incidence of diabetes, information was collected on economic impact of the interventions in both cohorts (using direct and indirect cost questionnaires) and information on utility measures (Quality Adjusted Life Years). A cost-utility and a cost-effectiveness analysis will be performed and data will be modelled to predict long-term cost-effectiveness. The project was intended to evidence that a substantial reduction in Type 2 diabetes incidence can be obtained at a reasonable cost-effectiveness ratio in real-life primary health care setting by an intensive lifestyle intervention. As far as we know, the DE-PLAN-CAT/PREDICE project represents the first assessment of long-term effectiveness and cost-effectiveness of a public healthcare strategy to prevent diabetes within a European primary care setting.

A new evidence-based model for weight management in primary care: the Counterweight Programme.

PubMed

Laws, Rachel

2004-06-01

Obesity has become a global epidemic, and a major preventable cause of morbidity and mortality. Management strategies and treatment protocols are however poorly developed and evaluated. The aim of the Counterweight Programme is to develop an evidence-based model for the management of obesity in primary care. The Counterweight Programme is based on the theoretical model of Evidence-Based Quality Assessment aimed at improving the management of obese adults (18-75 years) in primary care. The model consists of four phases: (1) practice audit and needs assessment, (2) practice support and training, (3) practice nurse-led patient intervention, and (4) evaluation. Patient intervention consisted of screening and treatment pathways incorporating evidence-based approaches, including patient-centred goal setting, prescribed eating plans, a group programme, physical activity and behavioural approaches, anti-obesity medication and weight maintenance strategies. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation. Eighty practices were recruited of which 18 practices were randomized to act as controls and receive deferred intervention 2 years after the initial audit. By February 2004, 58 of the 62 (93.5%) intervention practices had been trained to run the intervention programme, 47 (75.8%) practices were active in implementing the model and 1256 patients had been recruited (74% female, 26% male, mean age 50.6 years, SD 14). At baseline, 75% of patients had at one or more co-morbidity, and the mean body mass index (BMI) was 36.9 kg/m(2) (SD 5.4). Of the 1256 patients recruited, 91% received one of the core lifestyle interventions in the first 12 months. For all patients followed up at 12 months, 34% achieved a clinical meaningful weight loss of 5% or more. A total of 51% of patients were classed as compliant in that they attended the required level of appointments in 3, 6, and 12 months. For fully compliant patients, weight loss improved with 43% achieving a weight loss of 5% or more at 12 months. The Counterweight Programme is an evidence-based weight management model which is feasible to implement in primary care.

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

PubMed

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

2016-12-01

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

Effect of a universal anxiety prevention programme (FRIENDS) on children's academic performance: results from a randomised controlled trial.

PubMed

Skryabina, Elena; Taylor, Gordon; Stallard, Paul

2016-11-01

Evaluations of school-based anxiety prevention programmes have reported improvements in psychological functioning although little is known about their effect upon educational outcomes. One thousand three hundred and sixty-two children from 40 primary schools in England took part in the randomised controlled trial, Preventing Anxiety in Children through Education in Schools. The trial investigated the effectiveness of a universal school-based cognitive behaviour therapy prevention programme, FRIENDS, delivered by health care staff or school staff compared with usual personal, social, health and education (PSHE) lessons. Self-report psychological outcomes and educational attainment on national standardised attainment tests in reading, writing and maths were collected 12 months postintervention. Analysis was performed at individual level using multivariable mixed effect models controlling for gender, type of intervention and school effect. Registered trial: ISRCTN: 23563048. At 12 months, anxiety reduced in the health-led FRIENDS group compared to school-led FRIENDS and PSHE. There were no between-group differences in academic performance regardless of gender, deprivation, ethnicity and additional educational needs. School-based mental health interventions should assess psychological and educational outcomes. Further research should directly compare the effects of interventions led by health and school staff. © 2016 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

What Do We Know about School Mental Health Promotion Programmes for Children and Youth?

ERIC Educational Resources Information Center

O'Mara, Linda; Lind, Candace

2013-01-01

There are numerous studies of school mental health promotion and primary prevention and many reviews of these studies; however, no clear consensus statement has emerged regarding school mental health promotion other than that child mental health is an important area that should be addressed in schools. This integrative review seeks to address this…

School Area Road Safety Assessment and Improvements (SARSAI) programme reduces road traffic injuries among children in Tanzania.

PubMed

Poswayo, Ayikai; Kalolo, Simon; Rabonovitz, Katheryn; Witte, Jeffrey; Guerrero, Alejandro

2018-05-19

To determine the impact of a paediatric road traffic injury (RTI) prevention programme in urban Sub-Saharan Africa. Dares Salaam, Republic of Tanzania. Household surveys were conducted in catchment areas around 18 primary schools in Dar es Salaam, Republic of Tanzania; the catchment areas were divided into control and intervention groups. Collected data included basic demographic information on all school-aged household members and whether or not they had been involved in an RTI in the previous 12 months, and, if so, what the characteristics of that RTI were. Based on these findings, a separate road safety engineering site analysis and consultation with the communities and other stakeholders, an injury-prevention programme was developed and implemented, consisting of infrastructure enhancements and a site-specific educational programme. The programme was initially implemented at the intervention schools. After 1 year, data were collected in the same manner. The control group received the same intervention after follow-up data were collected. Data were collected on 12 957 school-aged children in the baseline period and 13 555 school-aged children in the post-intervention period, in both the control and intervention communities. There was a statistically significant reduction in RTIs in the intervention group and a non-significant increase in RTI in the control group. The greatest reduction was in motorcycle-pedestrian RTI, private vehicle-pedestrian RTI and morning RTI. The programme demonstrated a significant reduction in paediatric RTI after its implementation, in very specific ways. This study demonstrates that for a reasonable investment, scientifically driven injury-prevention programmes are feasible in resource-limited settings with high paediatric RTI rates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

VIP in construction: systematic development and evaluation of a multifaceted health programme aiming to improve physical activity levels and dietary patterns among construction workers

PubMed Central

2012-01-01

Background The prevalence of both overweight and musculoskeletal disorders (MSD) in the construction industry is high. Many interventions in the occupational setting aim at the prevention and reduction of these health problems, but it is still unclear how these programmes should be designed. To determine the effectiveness of interventions on these health outcomes randomised controlled trials (RCTs) are needed. The aim of this study is to systematically develop a tailored intervention for prevention and reduction of overweight and MSD among construction workers and to describe the evaluation study regarding its (cost-)effectiveness. Methods/Design The Intervention Mapping (IM) protocol was applied to develop and implement a tailored programme aimed at the prevention and reduction of overweight and MSD. The (cost-) effectiveness of the intervention programme will be evaluated using an RCT. Furthermore, a process evaluation will be conducted. The research population will consist of blue collar workers of a large construction company in the Netherlands. Intervention The intervention programme will be aimed at improving (vigorous) physical activity levels and healthy dietary behaviour and will consist of tailored information, face-to-face and telephone counselling, training instruction (a fitness "card" to be used for exercises), and materials designed for the intervention (overview of the company health promoting facilities, waist circumference measuring tape, pedometer, BMI card, calorie guide, recipes, and knowledge test). Main study parameters/endpoints The intervention effect on body weight and waist circumference (primary outcome measures), as well as on lifestyle behaviour, MSD, fitness, CVD risk indicators, and work-related outcomes (i.e. productivity, sick leave) (secondary outcome measures) will be assessed. Discussion The development of the VIP in construction intervention led to a health programme tailored to the needs of construction workers. This programme, if proven effective, can be directly implemented. Trial registration Netherlands Trial Register (NTR): NTR2095 PMID:22289212

The effectiveness of a preconditioning programme on preventing running-related injuries in novice runners: a randomised controlled trial.

PubMed

Bredeweg, Steef W; Zijlstra, Sjouke; Bessem, Bram; Buist, Ida

2012-09-01

There is no consensus on the aetiology and prevention of running-related injuries in runners. Preconditioning studies among different athlete populations show positive effects on the incidence of sports injuries. A 4-week preconditioning programme in novice runners will reduce the incidence of running-related injuries. Randomised controlled clinical trial; level of evidence, 1. Novice runners (N=432) prepared for a four-mile recreational running event. Participants were allocated to the 4-week preconditioning (PRECON) group (N=211) or the control group (N=221). The PRECON group started a 4-week training programme, prior to the running programme, with walking and hopping exercises. After the 4-week period both groups started a 9-week running programme. In both groups information was registered on running exposure and running-related injuries (RRIs) using an internet-based running log. Primary outcome measure was RRIs per 100 runners. An RRI was defined as any musculoskeletal complaint of the lower extremity or lower back causing restriction of running for at least a week. The incidence of RRIs was 15.2% in the PRECON group and 16.8% in the control group. The difference in RRIs between the groups was not significant (χ(2)=0.161, df=1, p=0.69). This prospective study demonstrated that a 4-week PRECON programme with walking and hopping exercises had no influence on the incidence of RRIs in novice runners.

A qualitative evaluation to explore the suitability, feasibility and acceptability of using a 'celebration card' intervention in primary care to improve the uptake of childhood vaccinations.

PubMed

Lwembe, Saumu; Green, Stuart A; Tanna, Nuttan; Connor, Jane; Valler, Colin; Barnes, Ruth

2016-07-30

Childhood vaccination remains a primary mechanism for reducing the burden of infectious disease. In the United Kingdom, as in many countries, a sustained effort is required to ensure that vaccination targets are met to afford protection to the whole population from vaccine preventable disease. The Celebrate and Protect programme is a collaborative partnership developed to improve the uptake of childhood vaccination across a number of boroughs within London through the use of a celebration card to encourage attendance for vaccination and enhance relationships between general practices and the parents/carers of children. This study was undertaken to assess the suitability, feasibility and acceptability of the Celebrate and Protect programme across nine boroughs in London. Data were collected either from telephone interviews (n = 24) or from focus groups (n = 31). A total of 55 key informants were included in the study, representing strategic, commissioning or policy leads, healthcare professionals and primary care teams delivering vaccinations and parents/carers of children under five. The analysis of data identified that whilst parents/carers saw the celebration card positively this raised the issue of 'vaccine hesitancy' and the lack of information that parents/carers have to make informed decisions about vaccination. Similarly, healthcare professionals viewed the programme positively and felt that it was deliverable within existing resources although they raised wider questions about on-going sustainability and about quantitative data collection. In relation to the collaboration between primary care and a pharmaceutical company in developing the Celebrate and Protect programme, it was generally felt that, provided appropriate governance is in place, it was a pragmatic approach in which the benefits outweighed any perceived disadvantages. The Celebrate and Protect programme was seen as an innovative collaborative programme to engage with parents and carers of children in order to improve relationships between service users and providers and subsequently increase vaccination uptake. The analysis demonstrates that that the celebration card is suitable for its purpose, acceptable to both healthcare professionals and to parents/carers of children and the Celebrate and Protect programme has been able to deliver its aims. Whilst the delivery of the 'celebration card' intervention in primary met its objectives there are some outstanding issues in terms of the sustainability of the initiative and the ability to demonstrate quantitative improvements in vaccination uptake rates.

Cost-effectiveness of a pragmatic structured education intervention for the prevention of type 2 diabetes: economic evaluation of data from the Let's Prevent Diabetes cluster-randomised controlled trial

PubMed Central

Ahrabian, D; Davies, M J; Khunti, K; Yates, T; Gray, A M

2017-01-01

Objectives Prevention of type 2 diabetes mellitus (TD2M) is a priority for healthcare systems. We estimated the cost-effectiveness compared with standard care of a structured education programme (Let's Prevent) targeting lifestyle and behaviour change to prevent progression to T2DM in people with prediabetes. Design Cost-effectiveness analysis alongside randomised controlled trial. Setting 44 general practices in Leicestershire, England. Participants 880 participants with prediabetes randomised to receive either standard care or a 6-hour group structured education programme with follow-up sessions in a primary care setting. Main outcome measure Incremental cost utility from the UK National Health Service (NHS) perspective. Quality of life and resource use measured from baseline and during the 36 months follow-up using the EuroQoL EQ-5D and 15D instruments and an economic questionnaire. Outcomes measured using quality-adjusted life years (QALYs) and healthcare costs calculated in 2012–2013 prices. Results After accounting for clustering and missing data, the intervention group was found to have a net gain of 0.046 (95% CI −0.0171 to 0.109) QALYs over 3 years, adjusted for baseline utility, at an additional cost of £168 (95% CI −395 to 732) per patient compared with the standard care group. The incremental cost-effectiveness ratio is £3643/QALY with an 86% probability of being cost-effective at a willingness to pay threshold of £20 000/QALY. Conclusions The education programme had higher costs and higher quality of life compared with the standard care group. The Let's Prevent programme is very likely to be cost-effective at a willingness to pay threshold of £20 000/QALY gained. Trial registration number ISRCTN80605705. PMID:28069625

Cost-effectiveness of a pragmatic structured education intervention for the prevention of type 2 diabetes: economic evaluation of data from the Let's Prevent Diabetes cluster-randomised controlled trial.

PubMed

Leal, J; Ahrabian, D; Davies, M J; Gray, L J; Khunti, K; Yates, T; Gray, A M

2017-01-09

Prevention of type 2 diabetes mellitus (TD2M) is a priority for healthcare systems. We estimated the cost-effectiveness compared with standard care of a structured education programme (Let's Prevent) targeting lifestyle and behaviour change to prevent progression to T2DM in people with prediabetes. Cost-effectiveness analysis alongside randomised controlled trial. 44 general practices in Leicestershire, England. 880 participants with prediabetes randomised to receive either standard care or a 6-hour group structured education programme with follow-up sessions in a primary care setting. Incremental cost utility from the UK National Health Service (NHS) perspective. Quality of life and resource use measured from baseline and during the 36 months follow-up using the EuroQoL EQ-5D and 15D instruments and an economic questionnaire. Outcomes measured using quality-adjusted life years (QALYs) and healthcare costs calculated in 2012-2013 prices. After accounting for clustering and missing data, the intervention group was found to have a net gain of 0.046 (95% CI -0.0171 to 0.109) QALYs over 3 years, adjusted for baseline utility, at an additional cost of £168 (95% CI -395 to 732) per patient compared with the standard care group. The incremental cost-effectiveness ratio is £3643/QALY with an 86% probability of being cost-effective at a willingness to pay threshold of £20 000/QALY. The education programme had higher costs and higher quality of life compared with the standard care group. The Let's Prevent programme is very likely to be cost-effective at a willingness to pay threshold of £20 000/QALY gained. ISRCTN80605705. 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/.

The Italian National Health Service expenditure on workplace prevention and safety (2006-2013): a national-level analysis.

PubMed

Signorelli, C; Riccò, M; Odone, A

2016-01-01

The World Health Organization (WHO) stated that countries' health policies should give high priority to primary prevention of occupational health hazards. Scant data are available on health expenditure on workplace prevention and safety services and on its impact on occupational health outcomes in Italy and in other European countries. objective of the present study was to systematically retrieve, analyse and critically appraise the available national-level data on public health expenditure on workplace prevention and safety services as well as to correlate them with occupational health outcomes. National-level data on total public health expenditure on prevention services, its share spent on workplace prevention and safety services as well as on number of workers receiving appropriate health surveillance were derived from the national public health expenditure monitoring system over a 8-year study period (2006-2013). An analytic approach was adopted to explore the association between health expenditure and occupational health services supply. The Italian National Health Service spends almost € 5 billion per year on preventive care, of which 13.3% are spent on workplace prevention and safety programmes (€ 645 million, € 10.6 per capita). There is wide heterogeneity between Italian regions. Our findings are useful for health systems and policies analysis, national and international comparisons as well as for health policy makers to plan, implement and monitor occupational health prevention programmes.

Horizontal schools-based health programme in rural Kenya.

PubMed

Bogie, James; Eder, Ben; Magnus, Dan; Amonje, Onguko David; Gant, Martina

2017-09-01

Primary school children in low-income countries are at risk of many diseases and poor health affects attendance, cognition and ability to learn. Developing school health and nutrition strategies has been extensively highlighted as a global priority, with a particular focus on complex programme design. However, such programmes are relatively untested in low-income settings. We implemented a complex school health and nutrition programme in two schools in Western Kenya over 3 years. There were numerous elements covering health policy, skills-based health education, infrastructure and disease prevention. A local non-governmental organisation, with involvement from local government and the community, performed programme implementation. Height-for-age, weight-for-age,height-for-weight, anaemia prevalence, academic performance and school attendance were the primary outcome measures. The programme improved nutrition, academic performance and anaemia prevalence. The number of underweight children fell from 20% to 11% (OR 0.51 95% CI 0.39 to 0.68 p=<0.01) and stunting prevalence fell from 29.9% to 20% (OR 0.59 95% CI 0.50 to 0.68 p=<0.01). Academic performance improved with a 74% reduction in odds of failing assessments (OR 0.26 95% CI 0.22 to 0.29 p=<0.01). Anaemia prevalence fell from 17.2% to 11%. The programme showed an increase in low body mass index prevalence and no effect on school attendance, the reasons for which are unclear. These results are encouraging and demonstrate that complex schools health programmes can lead to positive gains in health, nutrition and importantly academic performance. There is a need for further evaluation of comprehensive school health interventions in poor communities. © 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.

Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: a qualitative process evaluation

PubMed Central

Hill, Anne-Marie; McPhail, Steven M; Francis-Coad, Jacqueline; Waldron, Nicholas; Etherton-Beer, Christopher; Flicker, Leon; Ingram, Katharine; Haines, Terry P

2015-01-01

Objectives Falls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators’ perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education. Design A qualitative exploratory study. Methods Data were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework. Results Falls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours. Conclusions Individualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment. PMID:26656027

Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial

PubMed Central

James, Janet; Thomas, Peter; Cavan, David; Kerr, David

2004-01-01

Objective To determine if a school based educational programme aimed at reducing consumption of carbonated drinks can prevent excessive weight gain in children. Design Cluster randomised controlled trial. Setting Six primary schools in southwest England. Participants 644 children aged 7-11 years. Intervention Focused educational programme on nutrition over one school year. Main outcome measures Drink consumption and number of overweight and obese children. Results Consumption of carbonated drinks over three days decreased by 0.6 glasses (average glass size 250 ml) in the intervention group but increased by 0.2 glasses in the control group (mean difference 0.7, 95% confidence interval 0.1 to 1.3). At 12 months the percentage of overweight and obese children increased in the control group by 7.5%, compared with a decrease in the intervention group of 0.2% (mean difference 7.7%, 2.2% to 13.1%). Conclusion A targeted, school based education programme produced a modest reduction in the number of carbonated drinks consumed, which was associated with a reduction in the number of overweight and obese children. PMID:15107313

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

Rationale for the prevention of oral diseases in primary health care: an international collaborative study in oral health education.

PubMed

Bourgeois, Denis M; Phantumvanit, Prathip; Llodra, Juan Carlos; Horn, Virginie; Carlile, Monica; Eiselé, Jean-Luc

2014-10-01

Ensuring that members of society are healthy and reaching their full potential requires the prevention of oral diseases through the promotion of oral health and well-being. The present article identifies the best policy conditions of effective public health and primary care integration and the actors who promote and sustain these efforts. In this review, arguments and recommendations are provided to introduce an oral health collaborative promotion programme called Live.Learn.Laugh. phase 2, arising from an unique partnership between FDI World Dental Federation, the global company Unilever plc and an international network of National Dental Associations, health-care centres, schools and educators populations. © 2014 FDI World Dental Federation.

Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial.

PubMed

Giordano, Alessandro; Bonometti, Gian Pietro; Vanoglio, Fabio; Paneroni, Mara; Bernocchi, Palmira; Comini, Laura; Giordano, Amerigo

2016-12-07

Fall incidents are the third cause of chronic disablement in elderly according to the World Health Organization (WHO). Recent meta-analyses shows that a multifactorial falls risk assessment and management programmes are effective in all older population studied. However, the application of these programmes may not be the same in all National health care setting and, consequently, needs to be evaluated by cost-effectiveness studies before to plan this intervention in regular care. In Italy structured collaboration between hospital staff and primary care is generally lacking and the role of Information and Communication Technologies (ICT) in a fall prevention programme at home has never been explored. This will be a two-group randomised controlled trial aiming to evaluate the effects of a home-based intervention programme delivered by a multidisciplinary health team. The home tele-management programme, previously adopted in our Institute for chronic patients, will be proposed to elderly people affected by chronic diseases at high risk of falling at hospital discharge. The programme will involve the hospital staff and will be managed thanks to the collaboration between hospital and primary care setting. Patients will be followed for 6 months after hospital discharge. A nurse-tutor telephone support and tele-exercise will characterize the intervention programme. People in the control group will receive usual care. The main outcome measure of the study will be the percentage of patients sustaining a fall during the 6-months follow-up period. An economic evaluation will be performed from a societal perspective and will involve calculating cost-effectiveness and cost utility ratios. To date, no adequately powered studies have investigated the effect of the Information and Communication Technologies (ICT) in a home fall prevention program. We aim the program will be feasible in terms of intensity and characteristics, but particularly in terms of patient and provider compliance. The results of the economic evaluation could provide information about the cost-effectiveness of the intervention and the effects on quality of life. In case of shown effectiveness and cost effectiveness, the program could be implemented into health services settings. ClinicalTrials.gov ( NCT02487589 ).

Increased sexual abstinence among in-school adolescents as a result of school health education in Soroti district, Uganda.

PubMed

Shuey, D A; Babishangire, B B; Omiat, S; Bagarukayo, H

1999-06-01

A school health education programme in primary schools aimed at AIDS prevention in Soroti district of Uganda emphasized improved access to information, improved peer interaction and improved quality of performance of the existing school health education system. A cross-sectional sample of students, average age 14 years, in their final year of primary school was surveyed before and after 2 years of interventions. The percentage of students who stated they had been sexually active fell from 42.9% (123 of 287) to 11.1% (31 of 280) in the intervention group, while no significant change was recorded in a control group. The changes remained significant when segregated by gender or rural and urban location. Students in the intervention group tended to speak to peers and teachers more often about sexual matters. Increases in reasons given by students for abstaining from sex over the study period occurred in those reasons associated with a rational decision-making model rather than a punishment model. A primary school health education programme which emphasizes social interaction methods can be effective in increasing sexual abstinence among school-going adolescents in Uganda. The programme does not have to be expensive and can be implemented with staff present in most districts in the region.

Assessing the role of prevention partnerships in STD prevention: a review of comprehensive STD prevention systems progress reports.

PubMed

Hogben, Matthew; Hood, Julia; Collins, Dayne; McFarlane, Mary

2013-11-01

Systematic analysis of STD programme data contributes to a national portrait of sexually transmitted disease (STD) prevention activities, including research and evaluation specifically designed to optimise programme efficiency and impact. We analysed the narrative of the 2009 annual progress reports of the US Comprehensive STD Prevention Systems cooperative agreement for 58 STD programmes, concentrating on programme characteristics and partnerships. Programmes described 516 unique partnerships with a median of seven organisations cited per STD programme. Non-profit organisations (including service providers) were most frequently cited. Higher gonorrhoea morbidity was associated with reporting more partnerships; budget problems were associated with reporting fewer. Challenges to engaging in partnerships included budget constraints, staff turnover and low interest. Data provide a source of information for judging progress in programme collaboration and for informing a sustained programme-focused research and evaluation agenda.

Articulating A Rights-Based Approach to HIV Treatment and Prevention Interventions

PubMed Central

Barr, David; Amon, Joseph J; Clayton, Michaela

2011-01-01

Since the beginning of the epidemic, the protection of human rights has been an integral component in the response to Human Immunodeficiency Virus (HIV). The high degree of stigma and discrimination associated with acquired immune deficiency syndrome (AIDS) has made human rights protection not only a priority to ensure the rights of people living with and at-risk for HIV, but to address public health goals as well. Advances in understanding the impact of antiretroviral treatment on HIV prevention provide exciting opportunities and even a paradigm shift in terms of AIDS prevention. However, this potential cannot be reached unless the advancement of human rights is a primary component of treatment and prevention programme and policy development. The use of antiretroviral treatment as prevention reinforces the value of basic principles related to the dignity and agency of people living with HIV to participate in the design and implementation of programmes, to be informed and to make informed decisions about their health and lives, to be protected from harm, and to have opportunities to seek redress and accountability for abuses. The possibility of using HIV treatment as a prevention tool means that now, more than ever, legal reform and community empowerment and mobilisation are necessary to realize the rights and health of people affected by HIV. PMID:21999775

Articulating a rights-based approach to HIV treatment and prevention interventions.

PubMed

Barr, David; Amon, Joseph J; Clayton, Michaela

2011-09-01

Since the beginning of the epidemic, the protection of human rights has been an integral component in the response to Human Immunodeficiency Virus (HIV). The high degree of stigma and discrimination associated with acquired immune deficiency syndrome (AIDS) has made human rights protection not only a priority to ensure the rights of people living with and at-risk for HIV, but to address public health goals as well. Advances in understanding the impact of antiretroviral treatment on HIV prevention provide exciting opportunities and even a paradigm shift in terms of AIDS prevention. However, this potential cannot be reached unless the advancement of human rights is a primary component of treatment and prevention programme and policy development. The use of antiretroviral treatment as prevention reinforces the value of basic principles related to the dignity and agency of people living with HIV to participate in the design and implementation of programmes, to be informed and to make informed decisions about their health and lives, to be protected from harm, and to have opportunities to seek redress and accountability for abuses. The possibility of using HIV treatment as a prevention tool means that now, more than ever, legal reform and community empowerment and mobilisation are necessary to realize the rights and health of people affected by HIV.

Using Bullying Incident Density to Evaluate the Olweus Bullying Prevention Programme

ERIC Educational Resources Information Center

Black, Sally A.; Jackson, Ericka

2007-01-01

Bullying negatively impacts the mental and physical health of student victims, bullies and bystanders. The Olweus Bullying Prevention Programme is an internationally recognized school based programme demonstrated effective in research. The purpose of this study was to determine if the Bullying Prevention Programme was effective for urban youth…

NHS Diabetes Prevention Programme in England: formative evaluation of the programme in early phase implementation.

PubMed

Penn, Linda; Rodrigues, Angela; Haste, Anna; Marques, Marta M; Budig, Kirsten; Sainsbury, Kirby; Bell, Ruth; Araújo-Soares, Vera; White, Martin; Summerbell, Carolyn; Goyder, Elizabeth; Brennan, Alan; Adamson, Ashley J; Sniehotta, Falko F

2018-02-21

Evaluation of the demonstrator phase and first wave roll-out of the National Health Service (NHS) Diabetes Prevention Programme (DPP) in England. To examine: (1) intervention design, provision and fidelity assessment procedures; (2) risk assessment and recruitment pathways and (3) data collection for monitoring and evaluation. To provide recommendations informing decision makers on programme quality, improvements and future evaluation. We reviewed programme documents, mapping against the NHS DPP specification and National Institute for Health and Care Excellence (NICE) public health guideline: Type 2 diabetes (T2D) prevention in people at high risk (PH38), conducted qualitative research using individual interviews and focus group discussions with stakeholders and examined recruitment, fidelity and data collection procedures. Seven NHS DPP demonstrator sites and, subsequently, 27 first wave areas across England. Intensive behavioural intervention with weight loss, diet and physical activity goals. The national programme specifies at least 13 sessions over 9 months, delivered face to face to groups of 15-20 adults with non-diabetic hyperglycaemia, mainly recruited from primary care and NHS Health Checks. Participants for qualitative research were purposively sampled to provide a spread of stakeholder experience. Documents for review were provided via the NHS DPP Management Group. The NHS DPP specification reflected current evidence with a clear framework for service provision. Providers, with national capacity to deliver, supplied intervention plans compliant with this framework. Stakeholders highlighted limitations in fidelity assessment and recruitment and retention challenges, especially in reach and equity, that could adversely impact on implementation. Risk assessment for first wave eligibility differed from NICE guidance. The NHS DPP provides an evidence-based behavioural intervention for prevention of T2D in adults at high risk, with capacity to deliver nationally. Framework specification allows for balance between consistency and contextual variation in intervention delivery, with session details devolved to providers. Limitations in fidelity assurance, data collection procedures and recruitment issues could adversely impact on intervention effectiveness and restrict evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

NHS Diabetes Prevention Programme in England: formative evaluation of the programme in early phase implementation

PubMed Central

Penn, Linda; Rodrigues, Angela; Haste, Anna; Marques, Marta M; Budig, Kirsten; Sainsbury, Kirby; Bell, Ruth; Araújo-Soares, Vera; White, Martin; Summerbell, Carolyn; Goyder, Elizabeth; Brennan, Alan; Adamson, Ashley J; Sniehotta, Falko F

2018-01-01

Objectives Evaluation of the demonstrator phase and first wave roll-out of the National Health Service (NHS) Diabetes Prevention Programme (DPP) in England. To examine: (1) intervention design, provision and fidelity assessment procedures; (2) risk assessment and recruitment pathways and (3) data collection for monitoring and evaluation. To provide recommendations informing decision makers on programme quality, improvements and future evaluation. Design We reviewed programme documents, mapping against the NHS DPP specification and National Institute for Health and Care Excellence (NICE) public health guideline: Type 2 diabetes (T2D) prevention in people at high risk (PH38), conducted qualitative research using individual interviews and focus group discussions with stakeholders and examined recruitment, fidelity and data collection procedures. Setting Seven NHS DPP demonstrator sites and, subsequently, 27 first wave areas across England. Interventions Intensive behavioural intervention with weight loss, diet and physical activity goals. The national programme specifies at least 13 sessions over 9 months, delivered face to face to groups of 15–20 adults with non-diabetic hyperglycaemia, mainly recruited from primary care and NHS Health Checks. Participants Participants for qualitative research were purposively sampled to provide a spread of stakeholder experience. Documents for review were provided via the NHS DPP Management Group. Findings The NHS DPP specification reflected current evidence with a clear framework for service provision. Providers, with national capacity to deliver, supplied intervention plans compliant with this framework. Stakeholders highlighted limitations in fidelity assessment and recruitment and retention challenges, especially in reach and equity, that could adversely impact on implementation. Risk assessment for first wave eligibility differed from NICE guidance. Conclusions The NHS DPP provides an evidence-based behavioural intervention for prevention of T2D in adults at high risk, with capacity to deliver nationally. Framework specification allows for balance between consistency and contextual variation in intervention delivery, with session details devolved to providers. Limitations in fidelity assurance, data collection procedures and recruitment issues could adversely impact on intervention effectiveness and restrict evaluation. PMID:29467134

Healthcare Programmes for Truck Drivers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

PubMed Central

Lalla-Edward, Samanta Tresha; Fobosi, Siyabulela Christopher; Hankins, Catherine; Case, Kelsey; Venter, W. D. Francois; Gomez, Gabriela

2016-01-01

Background Truck drivers have unique health needs, and by virtue of their continuous travel, experience difficulty in accessing healthcare. Currently, planning for effective care is hindered by lack of knowledge about their health needs and about the impact of on-going programmes on this population’s health outcomes. We reviewed healthcare programmes implemented for sub-Saharan African truck drivers, assessed the evaluation methods, and examined impact on health outcomes. Methods We searched scientific and institutional databases, and online search engines to include all publications describing a healthcare programme in sub-Saharan Africa where the main clients were truck drivers. We consulted experts and organisations working with mobile populations to identify unpublished reports. Forest plots of impact and outcome indicators with unadjusted risk ratios and 95% confidence intervals were created to map the impact of these programmes. We performed a subgroup analysis by type of indicator using a random-effects model to assess between-study heterogeneity. We conducted a sensitivity analysis to examine both the summary effect estimate chosen (risk difference vs. risk ratio) and model to summarise results (fixed vs. random effects). Results Thirty-seven publications describing 22 healthcare programmes across 30 countries were included from 5,599 unique records. All programmes had an HIV-prevention focus with only three expanding their services to cover conditions other primary healthcare services. Twelve programmes were evaluated and most evaluations assessed changes in input, output, and outcome indicators. Absence of comparison groups, preventing attribution of the effect observed to the programme and lack of biologically confirmed outcomes were the main limitations. Four programmes estimated a quantitative change in HIV prevalence or reported STI incidence, with mixed results, and one provided anecdotal evidence of changes in AIDS-related mortality and social norms. Most programmes showed positive changes in risk behaviours, knowledge, and attitudes. Our conclusions were robust in sensitivity analyses. Conclusion Diverse healthcare programmes tailored to the needs of truck drivers implemented in 30 sub-Saharan African countries have shown potential benefits. However, information gaps about availability of services and their effects impede further planning and implementation of effective healthcare programmes for truck drivers. PMID:27333301

Reducing child abuse amongst adolescents in low- and middle-income countries: A pre-post trial in South Africa.

PubMed

Cluver, Lucie; Meinck, Franziska; Yakubovich, Alexa; Doubt, Jenny; Redfern, Alice; Ward, Catherine; Salah, Nasteha; De Stone, Sachin; Petersen, Tshiamo; Mpimpilashe, Phelisa; Romero, Rocio Herrero; Ncobo, Lulu; Lachman, Jamie; Tsoanyane, Sibongile; Shenderovich, Yulia; Loening, Heidi; Byrne, Jasmina; Sherr, Lorraine; Kaplan, Lauren; Gardner, Frances

2016-07-13

No known studies have tested the effectiveness of child abuse prevention programmes for adolescents in low- or middle-income countries. 'Parenting for Lifelong Health' ( http://tiny.cc/whoPLH ) is a collaborative project to develop and rigorously test abuse-prevention parenting programmes for free use in low-resource contexts. Research aims of this first pre-post trial in South Africa were: i) to identify indicative effects of the programme on child abuse and related outcomes; ii) to investigate programme safety for testing in a future randomised trial, and iii) to identify potential adaptations. Two hundred thirty participants (adolescents and their primary caregivers) were recruited from schools, welfare services and community-sampling in rural, high-poverty South Africa (no exclusion criteria). All participated in a 12-week parenting programme, implemented by local NGO childcare workers to ensure real-world external validity. Standardised pre-post measures with adolescents and caregivers were used, and paired t-tests were conducted for primary outcomes: abuse (physical, emotional abuse and neglect), adolescent behaviour problems and parenting (positive and involved parenting, poor monitoring and inconsistent discipline), and secondary outcomes: mental health, social support and substance use. Participants reported high levels of socio-economic deprivation, e.g. 60 % of adolescents had either an HIV-positive caregiver or were orphaned by AIDS, and 50 % of caregivers experienced intimate partner violence. i) indicative effects: Primary outcomes comparing pre-test and post-test assessments showed reductions reported by adolescents and caregivers in child abuse (adolescent report 63.0 % pre-test to 29.5 % post-test, caregiver report 75.5 % pre-test to 36.5 % post-test, both p < 0.001) poor monitoring/inconsistent discipline (p < .001), adolescent delinquency/aggressive behaviour (both p < .001), and improvements in positive/involved parenting (p < .01 adolescent report, p < .001 caregiver report). Secondary outcomes showed improved social support (p < .001 adolescent and caregiver reports), reduced parental and adolescent depression (both p < .001), parenting stress (p < .001 caregiver report) and caregiver substance use (p < .002 caregiver report). There were no changes in adolescent substance use. No negative effects were detected. ii) Programme acceptability and attendance was high. There was unanticipated programme diffusion within some study villages, with families initiating parenting groups in churches, and diffusion through school assemblies and religious sermons. iii) potential adaptations identified included the need to strengthen components on adolescent substance use and to consider how to support spontaneous programme diffusion with fidelity. The programme showed no signs of harm and initial evidence of reductions in child abuse and improved caregiver and adolescent outcomes. It showed high acceptability and unexpected community-level diffusion. Findings indicate needs for adaptations, and suitability for the next research step of more rigorous testing in randomised trials, using cluster randomization to allow for diffusion effects.

Study Protocol: The Norfolk Diabetes Prevention Study [NDPS]: a 46 month multi - centre, randomised, controlled parallel group trial of a lifestyle intervention [with or without additional support from lay lifestyle mentors with Type 2 diabetes] to prevent transition to Type 2 diabetes in high risk groups with non - diabetic hyperglycaemia, or impaired fasting glucose.

PubMed

Pascale, Melanie; Murray, Nikki; Bachmann, Max; Barton, Garry; Clark, Allan; Howe, Amanda; Greaves, Colin; Sampson, Mike

2017-01-06

This 7 year NIHR programme [2011-2018] tests the primary hypothesis that the NDPS diet and physical activity intervention will reduce the risk of transition to type 2 diabetes (T2DM) in groups at high risk of Type 2 diabetes. The NDPS programme recognizes the need to reduce intervention costs through group delivery and the use of lay mentors with T2DM, the realities of normal primary care, and the complexity of the current glycaemic categorisation of T2DM risk. NDPS identifies people at highest risk of T2DM on the databases of 135 general practices in the East of England for further screening with ab fasting plasma glucose and glycosylated haemoglobin [HbA1c]. Those with an elevated fasting plasma glucose [impaired fasting glucose or IFG] with or without an elevated HbA1c [non -diabetic hyperglycaemia; NDH] are randomised into three treatment arms: a control arm receiving no trial intervention, an arm receiving an intensive bespoke group-based diet and physical activity intervention, and an arm receiving the same intervention with enhanced support from people with T2DM trained as diabetes prevention mentors [DPM]. The primary end point is cumulative transition rates to T2DM between the two intervention groups, and between each intervention group and the control group at 46 months. Participants with screen detected T2DM are randomized into an equivalent prospective controlled trial with the same intervention and control arms with glycaemic control [HbA1c] at 46 months as the primary end point. Participants with NDH and a normal fasting plasma glucose are randomised into an equivalent prospective controlled intervention trial with follow up for 40 months. The intervention comprises six education sessions for the first 12 weeks and then up to 15 maintenance sessions until intervention end, all delivered in groups, with additional support from a DPM in one treatment arm. The NDPS programme reports in 2018 and will provide trial outcome data for a group delivered diabetes prevention intervention, supported by lay mentors with T2DM, with intervention in multiple at risk glycaemic categories, and that takes into account the realities of normal clinical practice. ISRCTN34805606 (Retrospectively registered 16.3.16).

A systematic review of education programmes to prevent concussion in rugby union.

PubMed

Fraas, Michael R; Burchiel, Jessica

2016-11-01

There is a high incidence of concussion sustained by athletes participating in rugby union, many of which go unreported. A lack of sufficient knowledge about concussion injuries may explain athletes' failure to report. Several rugby union-playing countries have developed injury education and prevention programmes to address this issue. The aim of the current review was to systematically assess the content and level of evidence on concussion education/prevention programmes in rugby union and to make recommendations for the quality, strength, and consistency of this evidence. We searched PubMed, PsycInfo, MEDLINE, SPORTDiscuss, Webofscience, and conducted a manual search for articles. Ten articles were included for review. Of these, six focused on the BokSmart injury prevention programme in South Africa, two focused on the RugbySmart injury prevention programme in New Zealand, one was an analysis of prevention programmes, and one was a systematic review of rugby injury prevention strategies. Despite the initiative to develop concussion education and prevention programmes, there is little evidence to support the effectiveness of such programmes. There is evidence to support education of coaches and referees. In addition, there is scant evidence to suggest that education and rule changes may have the benefit of changing athlete behaviours resulting in a reduction in catastrophic injury.

The GoodNight study--online CBT for insomnia for the indicated prevention of depression: study protocol for a randomised controlled trial.

PubMed

Gosling, John A; Glozier, Nick; Griffiths, Kathleen; Ritterband, Lee; Thorndike, Frances; Mackinnon, Andrew; Hehir, Kanupriya Kalia; Bennett, Anthony; Bennett, Kylie; Christensen, Helen

2014-02-13

Cognitive Behaviour Therapy for Insomnia (CBT-I) delivered through the Internet is effective as a treatment in reducing insomnia in individuals seeking help for insomnia. CBT-I also lowers levels of depression in this group. However, it is not known if targeting insomnia using CBT-I will lower depressive symptoms, and thus reduce the risk of major depressive episode onset, in those specifically at risk for depression. Therefore, this study aims to examine whether Internet delivery of fully automated self-help CBT-I designed to reduce insomnia will prevent depression. A sample of 1,600 community-dwelling adults (aged 18-64), who screen positive for both subclinical levels of depressive symptoms and insomnia, will be recruited via various media and randomised to either a 9-week online insomnia treatment programme, Sleep Healthy Using The internet (SHUTi), or an online attention-matched control group (HealthWatch). The primary outcome variable will be depression symptom levels at the 6-month post-intervention on the Patient Heath Questionnaire-9 (PHQ-9). A secondary outcome will be onset of major depressive episodes assessed at the 6-month post-intervention using 'current' and 'time from intervention' criteria from the Mini International Neuropsychiatric Interview. This trial is the first randomised controlled trial of an Internet-based insomnia intervention as an indicated preventative programme for depression. If effective, online provision of a depression prevention programme will facilitate dissemination. Australian New Zealand Clinical Trials Registry (ANZCTR), Registration number: ACTRN12611000121965.

Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care.

PubMed

Turner, D A; Paul, S; Stone, M A; Juarez-Garcia, A; Squire, I; Khunti, K

2008-12-01

To determine if a disease management programme for patients with coronary heart disease and heart failure represents an efficient use of health services resources. We carried out an economic evaluation alongside a cluster randomised control trial of 1163 patients with coronary heart disease and chronic heart failure in 20 primary care practices in the United Kingdom. Practices were randomised to either a control group, where patients received standard general practice care, or an intervention group where patients had access to a specialist nurse-led disease management programme. We estimated costs in both groups for coronary heart disease-related resource use. The main outcome measure used in the economic evaluation was quality adjusted life years (QALY) measured using the EuroQol. The disease management programme was associated with an increase in the QALY measured of 0.03 per year and an increase in the total NHS costs of 425 pounds (540 euros), of this only 83 pounds was directly associated with the provision of the nurse clinics. The clinics generated additional QALY at an incremental cost of 13 pounds 158 per QALY compared to the control group. The use of a nurse-led disease management programme is associated with increased costs in other coronary heart disease-related services as well as for the costs of the clinics. They are also associated with improvements in health. Even in the short term these disease management programmes may represent a cost-effective service, as additional QALY are generated at an acceptable extra cost.

Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial.

PubMed

Khunti, Kamlesh; Stone, Margaret; Paul, Sanjoy; Baines, Jan; Gisborne, Louise; Farooqi, Azhar; Luan, Xiujie; Squire, Iain

2007-11-01

To evaluate the effect of a disease management programme for patients with coronary heart disease (CHD) and chronic heart failure (CHF) in primary care. A cluster randomised controlled trial of 1316 patients with CHD and CHF from 20 primary care practices in the UK was carried out. Care in the intervention practices was delivered by specialist nurses trained in the management of patients with CHD and CHF. Usual care was delivered by the primary healthcare team in the control practices. At follow up, significantly more patients with a history of myocardial infarction in the intervention group were prescribed a beta-blocker compared to the control group (adjusted OR 1.43, 95% CI 1.19 to 1.99). Significantly more patients with CHD in the intervention group had adequate management of their blood pressure (<140/85 mm Hg) (OR 1.61, 95% CI 1.22 to 2.13) and their cholesterol (<5 mmol/l) (OR 1.58, 95% CI 1.05 to 2.37) compared to those in the control group. Significantly more patients with an unconfirmed diagnosis of CHF had a diagnosis of left ventricular systolic dysfunction confirmed (OR 4.69, 95% CI 1.88 to 11.66) or excluded (OR 3.80, 95% CI 1.50 to 9.64) in the intervention group compared to the control group. There were significant improvements in some quality-of-life measures in patients with CHD in the intervention group. Disease management programmes can lead to improvements in the care of patients with CHD and presumed CHF in primary care.

FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide—a narrative review

PubMed Central

Bizzini, Mario; Dvorak, Jiri

2015-01-01

In 2009, FIFA promoted and disseminated the FIFA 11+ injury prevention programme worldwide. Developed and studied by the FIFA Medical Assessment and Research Centre (F-MARC), the programme was based on a randomised controlled study and one countrywide campaign in amateur football that significantly reduced injuries and healthcare costs. Since the FIFA 11+ launch, key publications have confirmed the preventive effects of the programme and have evaluated its performance effects in female as well as male amateur football players. Furthermore, implementation strategies of this prevention programme have also been studied. The goal of this narrative review was to summarise the available scientific evidence about the FIFA 11+ programme. While FIFA continues to disseminate and implement FIFA 11+ among its Member Associations, adaptations of the injury prevention programme for children and referees have been developed and are currently being evaluated. PMID:25878073

Perception of stress and quality of life in overweight and obese people--implications for preventive consultancies in primary care.

PubMed

Metz, Ulrike; Welke, Justus; Esch, Tobias; Renneberg, Babette; Braun, Vittoria; Heintze, Christoph

2009-01-01

The increasing prevalence of obesity requires especially primary health care providers to act. General Practitioners (GP) in particular have the opportunity to motivate patients in early risk stages to follow weight reduction programmes before manifestation of associated diseases. In order to conduct preventive consultancies it is necessary to explore the individual physical and mental health status of patients. Aim of this study was to examine quality of life and perceived level of stress in overweight and obese patients treated in primary care. 123 patients, following a health Check up realized by their GP, rated self- reported questionnaires regarding quality of life and perceived level of stress (SF-12, PSS). Following descriptive analysis, differences in dependent variables related to BMI, sex and age were tested using ANOVA and regression analysis (SPSSv15.0). Restrictions in all parameters of mental health for overweight and obese patients in primary care were shown. Especially patients with a BMI above 30 kg/m2 reported a decreased level of quality of life. Health care providers should be aware of cumulative restrictions in mental health of their overweight patients. The findings provide essential implications for all health care professionals in primary care doing preventive consultancies with obese clients.

The role of primary healthcare professionals in oral cancer prevention and detection.

PubMed

Macpherson, L M D; McCann, M F; Gibson, J; Binnie, V I; Stephen, K W

2003-09-13

To investigate current knowledge, examination habits and preventive practices of primary healthcare professionals in Scotland, with respect to oral cancer, and to determine any relevant training needs. Primary care. Questionnaires were sent to a random sample of 357 general medical practitioners (GMPs) and 331 dental practitioners throughout Scotland. Additionally, focus group research and interviews were conducted amongst primary healthcare team members. Whilst 58% of dental respondents reported examining regularly for signs of oral cancer, GMPs examined patients' mouths usually in response to a complaint of soreness. The majority of GMPs (85%) and dentists (63%) indicated that they felt less than confident in detecting oral cancer, with over 70% of GMPs identifying lack of training as an important barrier. Many practitioners were unclear concerning the relative importance of the presence of potentially malignant lesions in the oral cavity. A high proportion of the GMPs indicated that they should have a major role to play in oral cancer detection (66%) but many felt strongly that this should be primarily the remit of the dental team. The study revealed a need for continuing education programmes for primary care practitioners in oral cancer-related activities. This should aim to improve diagnostic skills and seek to increase practitioners' participation in preventive activities.

Changes in Saturday outpatient volume and billings after introducing the Saturday incentive programme to clinics in South Korea: a longitudinal cohort study using claims data from 2012 to 2014.

PubMed

Ha, Hyun Ji; Han, Kyu-Tae; Kim, Sun Jung; Sohn, Tae Yong; Jeon, Byungyool; Park, Eun-Cheol

2016-06-09

In October 2013, the South Korean government introduced an incentive programme to increase the availability of Saturday treatment at clinics, hoping to increase the role of primary care providers as gatekeepers to medical care. To the best of our knowledge, no one has yet investigated this programme's effect on overall outpatient care. Our study aims to analyse the change in Saturday outpatient volume and billings in clinics that adopted the Saturday incentive programme. Our study used 3 types of data from the period October 2012 to March 2014: National Health Insurance Service (NHIS) claims data, hospital evaluation data and medical institution data. These data consisted of 66 825 881 outpatient cases from 2837 clinics. Introducing the Saturday incentive programme. We performed a multilevel analysis that adjusted for clinic-level and outpatient-level variables to examine the difference in the percentage of Saturday outpatient volume and billings after introducing the Saturday incentive programme. The percentages of Saturday outpatient volume and billings were higher after introducing the programme (outpatient volume: β=2.065, p<0.001; outpatient billings: β=3.518, p<0.001). In addition, outpatient volume and billings on Friday and Saturday increased after introducing the programme, while those on weekdays, excluding Friday, decreased. Our findings suggest that the Saturday incentive programme has affected clinic outpatient care and is a worthwhile health policy in terms of promoting primary care. Thus, it may improve healthcare accessibility and quality of care, and prevent inappropriate usage such as emergency room visits by providing patients with weekend clinic hours. 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/

Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis.

PubMed

Murphy, Edel; Vellinga, Akke; Byrne, Molly; Cupples, Margaret E; Murphy, Andrew W; Buckley, Brian; Smith, Susan M

2015-07-01

Ischaemic heart disease (IHD) is the most common cause of death worldwide. To determine the long-term impact of organisational interventions for secondary prevention of IHD. Systematic review and meta-analysis of studies from CENTRAL, MEDLINE(®), Embase, and CINAHL published January 2007 to January 2013. Searches were conducted for randomised controlled trials of patients with established IHD, with long-term follow-up, of cardiac secondary prevention programmes targeting organisational change in primary care or community settings. A random-effects model was used and risk ratios were calculated. Five studies were included with 4005 participants. Meta-analysis of four studies with mortality data at 4.7-6 years showed that organisational interventions were associated with approximately 20% reduced mortality, with a risk ratio (RR) for all-cause mortality of 0.79 (95% confidence interval [CI] = 0.66 to 0.93), and a RR for cardiac-related mortality of 0.74 (95% CI = 0.58 to 0.94). Two studies reported mortality data at 10 years. Analysis of these data showed no significant differences between groups. There were insufficient data to conduct a meta-analysis on the effect of interventions on hospital admissions. Additional analyses showed no significant association between organisational interventions and risk factor management or appropriate prescribing at 4.7-6 years. Cardiac secondary prevention programmes targeting organisational change are associated with a reduced risk of death for at least 4-6 years. There is insufficient evidence to conclude whether this beneficial effect is maintained indefinitely. © British Journal of General Practice 2015.

Comparison of the caries-protective effect of fluoride varnish with treatment as usual in nursery school attendees receiving preventive oral health support through the Childsmile oral health improvement programme - the Protecting Teeth@3 Study: a randomised controlled trial.

PubMed

Wright, William; Turner, Stephen; Anopa, Yulia; McIntosh, Emma; Wu, Olivia; Conway, David I; Macpherson, Lorna M D; McMahon, Alex D

2015-12-18

The Scottish Government set out its policy on addressing the poor oral health of Scottish children in 2005. This led to the establishment of Childsmile, a national programme designed to improve the oral health of children in Scotland. One element of the programme promotes daily tooth brushing in all nurseries in Scotland (Childsmile Core). A second targeted component (Childsmile Nursery) offers twice-yearly application of fluoride varnish to children attending nurseries in deprived areas. Studies suggest that fluoride varnish application can reduce caries in both adult and child populations. This trial aims to explore the effectiveness and cost-effectiveness of additional preventive value fluoride varnish application compared to Childsmile Core. The Protecting Teeth@3 Study is an ongoing 2 year parallel group randomised treatment as usual controlled trial. Three-year-old children attending the ante pre-school year are randomised (1:1) to the intervention arm (fluoride varnish & treatment as usual) or the control arm (treatment as usual). Children in the intervention arm will have Duraphat® fluoride varnish painted on the primary tooth surfaces and will continue to receive treatment as usual: the core Childsmile Nursery intervention. Children in the treatment as usual arm will receive the same series of contacts, without the application of varnish and will also continue with the Childsmile Core intervention. Interventions are undertaken by Childsmile trained extended duty dental nurses at six-monthly intervals. Participants receive a baseline dental inspection in nursery and an endpoint inspection in Primary 1 at the age of 5 years old. We will use primary and secondary outcome measures to compare the effectiveness of Duraphat® fluoride varnish plus treatment as usual with treatment as usual only in preventing any further dental decay. We will also undertake a full economic evaluation of the trial. This study is registered at ClinicalTrials.gov. Number: NCT01674933 (24 August 2012).

A systematic review of technology-based interventions for unintentional injury prevention education and behaviour change.

PubMed

Omaki, Elise; Rizzutti, Nicholas; Shields, Wendy; Zhu, Jeffrey; McDonald, Eileen; Stevens, Martha W; Gielen, Andrea

2017-04-01

The aims of this literature review are to (1) summarise how computer and mobile technology-based health behaviour change applications have been evaluated in unintentional injury prevention, (2) describe how these successes can be applied to injury-prevention programmes in the future and (3) identify research gaps. Studies included in this systematic review were education and behaviour change intervention trials and programme evaluations in which the intervention was delivered by either a computer or mobile technology and addressed an unintentional injury prevention topic. Articles were limited to those published in English and after 1990. Among the 44 technology-based injury-prevention studies included in this review, 16 studies evaluated locally hosted software programmes, 4 studies offered kiosk-based programmes, 11 evaluated remotely hosted internet programmes, 2 studies used mobile technology or portable devices and 11 studies evaluated virtual-reality interventions. Locally hosted software programmes and remotely hosted internet programmes consistently increased knowledge and behaviours. Kiosk programmes showed evidence of modest knowledge and behaviour gains. Both programmes using mobile technology improved behaviours. Virtual-reality programmes consistently improved behaviours, but there were little gains in knowledge. No studies evaluated text-messaging programmes dedicated to injury prevention. There is much potential for computer-based programmes to be used for injury-prevention behaviour change. The reviewed studies provide evidence that computer-based communication is effective in conveying information and influencing how participants think about an injury topic and adopt safety behaviours. 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/.

A programme to increase appropriate usage of benzathine penicillin for management of streptococcal pharyngitis and rheumatic heart disease in Zambia.

PubMed

Long, Aidan; Lungu, Joyce Chipili; Machila, Elizabeth; Schwaninger, Sherri; Spector, Jonathan; Tadmor, Brigitta; Fishman, Mark; Mayosi, Bongani M; Musuku, John

Rheumatic heart disease is highly prevalent and associated with substantial morbidity and mortality in many resource-poor areas of the world, including sub-Saharan Africa. Primary and secondary prophylaxis with penicillin has been shown to significantly improve outcomes and is recognised to be the standard of care, with intra-muscular benzathine penicillin G recommended as the preferred agent by many technical experts. However, ensuring compliance with therapy has proven to be challenging. As part of a public-private partnership initiative in Zambia, we conducted an educational and access-to-medicine programme aimed at increasing appropriate use of benzathine penicillin for the prevention and management of rheumatic heart disease, according to national guidelines. The programme was informed early on by identification of potential barriers to the administration of injectable penicillin, which included concern by health workers about allergic events. We describe this programme and report initial signs of success, as indicated by increased use of benzathine penicillin. We propose that a similar approach may have benefits in rheumatic heart disease programmes in other endemic regions.

The effects of a three-year smoking prevention programme in secondary schools in Helsinki.

PubMed

Vartiainen, Erkki; Pennanen, Marjaana; Haukkala, Ari; Dijk, Froukje; Lehtovuori, Riku; De Vries, Hein

2007-06-01

This study evaluates the effects of a 3-year smoking prevention programme in secondary schools in Helsinki. The study is part of the European Smoking prevention Framework Approach (ESFA), in which Denmark, Finland, the Netherlands, Portugal, Spain and the UK participated. A total of 27 secondary schools in Finland participated in the programme (n = 1821). Schools were randomised into experimental (13) and control groups (14). The programme included 14 information lessons about smoking and refusal skills training. The 3-year smoking prevention programme was also integrated into the standard curriculum. The community-element of the programme included parents, parish confirmation camps and dentists. The schools in the experimental group received the prevention programme and the schools in the control group received the standard health education curriculum. Among baseline never smokers (60.8%), the programme had a significant effect on the onset of weekly smoking in the experimental group [OR = 0.63 (0.45-0.90) P = 0.009] when compared with the control group. Being female, doing poorly at school, having parents and best friends who smoke and more pocket money to spend compared with others were associated with an increased likelihood of daily and weekly smoking onset. These predictors did not have an interaction effect with the experimental condition. This study shows that a school- and community-based smoking prevention programme can prevent smoking onset among adolescents.

Improving access to primary mental health care for Australian children.

PubMed

Bassilios, Bridget; Nicholas, Angela; Reifels, Lennart; King, Kylie; Spittal, Matthew J; Fletcher, Justine; Pirkis, Jane

2016-11-01

This study examines the uptake by children aged predominantly 0-11 years of an Australian primary mental health service - the Access to Allied Psychological Services programme - which began in 2001. In particular, it considers access to, and use of, the child component of Access to Allied Psychological Services, the Child Mental Health Service, introduced in 2010. Using routinely collected programme data from a national minimum dataset and regional population data, we conducted descriptive and regression analysis to examine programme uptake, predictors of service reach and consumer- and treatment-based characteristics of service. Between 2003 and 2013, 18,631 referrals for children were made and 75,178 sessions were scheduled via Access to Allied Psychological Services, over 50% of which were via the Child Mental Health Service in its first 3 years of operation. The rate of referrals for children to the Child Mental Health Service was associated with the rate of Access to Allied Psychological Services referrals for consumers aged 12+ years. The Child Mental Health Service has increased services provided within the Access to Allied Psychological Services programme for children with emotional and behavioural issues and their families, and is potentially filling a service gap in the area of prevention and early intervention for children who have significant levels of need but are unable to access other mental health services. Our findings are policy-relevant for other developed countries with a similar primary mental health care system that are considering means of improving service access by children. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Implementation of Adolescent Family-Based Substance Use Prevention Programmes in Health Care Settings: Comparisons across Conditions and Programmes

ERIC Educational Resources Information Center

Aalborg, Annette E.; Miller, Brenda A.; Husson, Gail; Byrnes, Hilary F.; Bauman, Karl E.; Spoth, Richard L.

2012-01-01

Objective: To examine factors that influence the effectiveness and quality of implementation of evidence-based family-focused adolescent substance use prevention programmes delivered in health care settings and to assess the effects of programme choice versus programme assignment on programme delivery. Design: Strengthening Families Program: For…

Primary and secondary prevention of breast cancer.

PubMed

Kolak, Agnieszka; Kamińska, Marzena; Sygit, Katarzyna; Budny, Agnieszka; Surdyka, Dariusz; Kukiełka-Budny, Bożena; Burdan, Franciszek

2017-12-23

Breast cancer is the most common cancer among women and is the second cancer frequently occurring worldwide of newly-diagnosed cancers. There is much evidence showing the influence of life style and environmental factors on the development of mammary gland cancer (high-fat diet, alcohol consumption, lack of physical exercise), the elimination of which (primary prevention) may contribute to a decrease in morbidity and mortality. Secondary prevention, comprising diagnostic tests (e.g. mammography, ultrasonography, magnetic resonance imaging, breast self-examination, as well as modern and more precise imaging methods) help the early detection of tumours or lesions predisposing to tumours. The aim of this study paper is to review current knowledge and reports regarding primary and secondary prevention of breast cancer. It is estimated that nearly 70% of malign tumours are caused by environmental factors, whereas in breast cancer this percentage reaches 90-95%. There are national programmes established in many countries to fight cancer, where both types of prevention are stressed as serving to decrease morbidity and mortality due to cancers. Cancer prevention is currently playing a key role in the fight against the disease. Behaviour modification, as well as greater awareness among women regarding breast cancer, may significantly contribute towards reducing the incidence of this cancer. Another important aspect is the number of women undergoing diagnostic tests, which still remains at an unsatisfactory level.

Essential health care package for children--the 'Fit for School' program in the Philippines.

PubMed

Monse, Bella; Naliponguit, Ella; Belizario, Vincente; Benzian, Habib; van Helderman, Wim Palenstein

2010-04-01

High prevalence of poverty diseases such as diarrhoea, respiratory tract infection, parasitic infections and dental caries among children in the developing world calls for a return to primary health care principles with a focus on prevention. The 'Fit for School' program in the Philippines is based on international recommendations and offers a feasible, low-cost and realistic strategy using the principles of health promotion outlined in the Ottawa Charter. The cornerstone of the programme is the use of school structures for the implementation of preventive health strategies. 'Fit for School' consists of simple, evidence-based interventions like hand washing with soap, tooth brushing with fluoride toothpaste and other high impact interventions such as bi-annual de-worming as a routine school activity for all children visiting public elementary schools. The programme has been successfully rolled-out in the Philippines covering 630,000 children in 22 provinces and it is planned to reach 6 million children in the next three years. The programme is a partnership project between the Philippine Department of Education and the Local Government Units with support for capacity development activities from the German Development Cooperation and GlaxoSmithKline.

Organizational capacity for chronic disease prevention: a survey of Canadian public health organizations.

PubMed

Hanusaik, Nancy; O'Loughlin, Jennifer L; Kishchuk, Natalie; Paradis, Gilles; Cameron, Roy

2010-04-01

There are no national data on levels of organizational capacity within the Canadian public health system to reduce the burden of chronic disease. Cross-sectional data were collected in a national survey (October 2004 to April 2005) of all 216 national, provincial and regional-level organizations engaged in chronic disease prevention through primary prevention or healthy lifestyle promotion. Levels of organizational capacity (defined as skills and resources to implement chronic disease prevention programmes), potential determinants of organizational capacity and involvement in chronic disease prevention programming were compared in western, central and eastern Canada and across three types of organizations (formal public health organizations, non-governmental organizations and grouped organizations). Forty percent of organizations were located in Central Canada. Approximately 50% were formal public health organizations. Levels of skill and involvement were highest for activities that addressed tobacco control and healthy eating; lowest for stress management, social determinants of health and programme evaluation. The few notable differences in skill levels by provincial grouping favoured Central Canada. Resource adequacy was rated low across the country; but was lowest in eastern Canada and among formal public health organizations. Determinants of organizational capacity (organizational supports and partnerships) were highest in central Canada and among grouped organizations. These data provide an evidence base to identify strengths and gaps in organizational capacity and involvement in chronic disease prevention programming in the organizations that comprise the Canadian public health system.

FRESH AIR: an implementation research project funded through Horizon 2020 exploring the prevention, diagnosis and treatment of chronic respiratory diseases in low-resource settings.

PubMed

Cragg, Liza; Williams, Siân; Chavannes, Niels H

2016-06-30

This protocol describes FRESH AIR, an implementation science project exploring how to improve the prevention, diagnosis and treatment of chronic lung diseases in contexts with limited healthcare resources. It consists of inter-related studies that take place in four countries that are part of the International Primary Care Respiratory Group's (IPCRG) global network: Uganda, the Kyrgyz Republic, Vietnam and Greece. The project has been funded by the European Commission Horizon 2020 research programme and runs from October 2015 until September 2018.

Drug prevention programmes for young people: where have we been and where should we be going?

PubMed

Midford, Richard

2010-10-01

Substance use by young people has long been a concern of western society, but opinion is mixed as to which prevention approach offers the greatest benefit, and whether indeed there is any benefit at all. This paper reviews the nature of prevention programmes, the research evidence that underpins these programmes and the prevention objectives against which effectiveness is measured. The aim of this is to create better understanding of the elements that maximize programme effectiveness, what can be achieved by prevention programmes and how programmes can be improved. There is a range of prevention approaches for which there is evidence of effectiveness. Some are classroom-based; some focus upon parenting; some have substantial whole-of-school and community elements; and some target risk and protective factors in early childhood. All, however, are based substantially on the social influence model. In an attempt to improve practice lists of effective programmes have been developed, but there are concerns about the science behind selection. On balance, there is consistent evidence that social influence prevention programmes do have a small, positive effect on drug use, but this then raises the question as to whether harm, rather than use, would be the more worthwhile target for prevention. Prevention that seeks to reduce harm has been demonstrably effective, but has found little support in some jurisdictions. Research has created a progressively better understanding of how to optimize programme effectiveness and what can be achieved realistically by even the most effective programmes. However, further research is required to identify which, if any, particular approach offers greater promise. The effectiveness of harm reduction should be compared with more traditional abstinence and the additional effects of whole of school, parent and community elements need to be measured more accurately. Contemporary social influence prevention programmes are flawed, but the approach is still the best way of influencing drug use behaviour in young people as a whole. Evidence-based refinement is the best option for greater benefit. © 2009 The Author, Addiction © 2009 Society for the Study of Addiction.

Preventing lower extremity injury in elite orienteerers: study protocol for a randomised controlled trial

PubMed Central

Halvarsson, Bodil

2018-01-01

Background The high physical load associated with running through uneven terrain contributes toorienteerers being exposed to high injury risk, where the majority of injuries are located in the lower extremities. Specific training programmes have been effective at reducing injury risk in sports. Yet no trial has been conducted in elite orienteering. The aim of this study is to investigate the effectiveness of a specific training programme in preventing lower extremity injury in adult elite orienteerers. Study design Randomised controlled trial (RCT). Methods Seventy-two Swedish elite orienteerers, aged 18–40 years, are allocated to an intervention or control group. The intervention group performs four specific exercises, with three difficult levels intensified every second week over the first 4 weeks, targeting strength, flexibility and coordination of the lower extremity. The exercises are completed four times a week (10 min per session) in conjunction with normal training over 14 weeks. Injury data are collected every second week using a valid injury questionnaire distributed by text messages over 14 weeks. The primary outcome is number of substantial injuries in the lower extremity. The secondary outcomes are incidence of ankle sprains and the average substantial injury prevalence across 14 weeks. Discussion Due to high injury risk and lack of injury prevention trials in orienteering, an RCT investigating the effect of a specific exercise programme in preventing lower extremity injury is warranted. The results of this trial will be beneficial to orienteerers, clubs and federations, and increase our understanding on how lower extremity injuries can be prevented in a physically challenging sport. Trial registration number NCT03408925. PMID:29707231

Prevention of fall-related injuries in 7-year-old to 12-year-old children: a cluster randomised controlled trial.

PubMed

Nauta, Joske; Knol, Dirk L; Adriaensens, Lize; Klein Wolt, Karin; van Mechelen, Willem; Verhagen, Evert A L M

2013-09-01

To counteract the recently observed increase in forearm fractures in children worldwide, an educational programme to improve fall skills was developed. In this 8-week programme children learned basic martial arts falling techniques in their physical education classes. In this study, the effectiveness of this educational programme to improve fall skills was evaluated. A cluster randomised controlled trial was conducted in 33 primary schools. The intervention group received the educational programme to improve falling skills during their physical education (PE) classes whereas the control group received their regular PE curriculum. At baseline (October 2009) and follow-up (May 2010), a questionnaire was completed by the children about their physical activity behaviours. Furthermore, fall-related injuries were registered continuously during an entire school-year. A total of 36 incident injuries was reported in the intervention group, equalling an injury incidence density (IID) of 0.14 fall-related injuries per 1000 h of physical activity (95% CI 0.09 to 0.18). In contrast, 96 injuries were reported by the control group corresponding to an IID of 0.26 (95% CI 0.21 to 0.32). However, because intracluster correlation was high (ICC=0.46), differences in injury incidence were not statistically significant. When activity level was taken into account, a trend was shown suggesting that the 'falling is a sport' programme was effective in decreasing falling-related injury risk, but only in the least active children. Although results did not reach significance because of strong clustering effects, a trend was found suggesting that a school-based educational programme to improve falling skills may be more beneficial for the prevention of falling-related injuries in children with low levels of habitual physical activity.

Effectiveness of the 'Healthy School and Drugs' prevention programme on adolescents' substance use: a randomized clustered trial.

PubMed

Malmberg, Monique; Kleinjan, Marloes; Overbeek, Geertjan; Vermulst, Ad; Monshouwer, Karin; Lammers, Jeroen; Vollebergh, Wilma A M; Engels, Rutger C M E

2014-06-01

To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. Randomized clustered trial with two intervention conditions (i.e. e-learning and integral). General population of 11-15-year-old adolescents in the Netherlands. A total of 3784 students of 23 Dutch secondary schools. Structured digital questionnaires were administered pre-intervention and at 32 months follow-up. The primary outcome measures were new incidences of alcohol (life-time and 1-month prevalence), tobacco (life-time and 1-month prevalence) and marijuana use (life-time prevalence). Main effect analyses showed no programme effects on incidences of alcohol consumption (life-time prevalence: e-learning condition: B = 0.102, P = 0.549; integral condition: B = -0.157, P = 0.351; 1-month prevalence: e-learning condition: B = 0.191, P = 0.288; integral condition: B = -0.140, P = 0.445), tobacco consumption (life-time prevalence: e-learning condition: B = 0.164, P = 0.444; integral condition: B = 0.160, P = 0.119; 1-month prevalence: e-learning condition: B = 0.088, P = 0.746; integral condition: B = 0.261, P = 0.093), or marijuana consumption (life-time prevalence: e-learning condition: B = 0.070, P = 0.732; integral condition: B = 0.186, P = 0.214). The non-significant impact of the Healthy School and Drugs programme (a Dutch school-based prevention programme for early adolescents) on incidences of alcohol, tobacco and marijuana use indicates that the programme is either ineffective or implemented inadequately. © 2014 Society for the Study of Addiction.

Neurodevelopmental Impairment among Infants Born to Mothers Infected with Human Immunodeficiency Virus and Uninfected Mothers from Three Peri-Urban Primary Care Clinics in Harare, Zimbabwe

ERIC Educational Resources Information Center

Kandawasvika, Gwendoline Q.; Ogundipe, Enitan; Gumbo, Felicity Z.; Kurewa, Edith N.; Mapingure, Munyaradzi P.; Stray-Pedersen, Babill

2011-01-01

Aim: The aim of this article is to document the risk of neurodevelopmental impairment (NDI) among infants enrolled in a programme for the prevention of mother-to-child transmission of HIV (human immunodeficiency virus) in Zimbabwe using the Bayley Infant Neurodevelopmental Screener (BINS). Method: We prospectively followed up infants at three…

[Evaluation of the implementation of the FAPACAN programme to prevent cancer behavioral risk in primary care users in the North of Spain].

PubMed

López González, M Luisa; Fernández Carreira, Jose Manuel; López González, Santiago; del Olivo del Valle Gómez, M; García Casas, Juan Bautista; Cueto Espinar, Antonio

2003-01-01

The evaluation of the process is an essential condition to correctly measure the impact of educational interventions on behaviour, its psychosocial determinants and the state of change, in the context of health promotion. The aim was to evaluate the quality of the implementation of the FAPACAN Programme, designed to prevent behavioural risk of cancer in Primary Care, and to improve its psychosocial determinants in the A.S.E. Model and the state of change according to Prochaska and DiClemente Theory. The quality of implementation was measured by means of a visit to the health centre, by filling in a checklist 'in situ', and a phone survey with the patient. Centralisation and association measures were found (Pearson and Spearman's coefficient). A multiple regression model was obtained with the score made by the patient (range of 0 to 8) and the covariables: gender, age, level of education, locality and family history of cancer. The quality scores obtained oscillate between 72% and 81% of optimum quality. Significant differences were found owing to the administrator (better with fewer years of exercise) and the patient (better with higher level of study). In general, the quality of implementation was more than sufficient, in spite of the poor provision by the health system.

Oral cancer prevention and control--the approach of the World Health Organization.

PubMed

Petersen, Poul Erik

2009-01-01

Cancer is one of the most common causes of morbidity and mortality today. It is estimated that around 43% of cancer deaths are due to tobacco use, unhealthy diets, alcohol consumption, inactive lifestyles and infection. Low-income and disadvantaged groups are generally more exposed to avoidable risk factors such as environmental carcinogens, alcohol, infectious agents, and tobacco use. These groups also have less access to the health services and health education that would empower them to make decisions to protect and improve their own health. Oro-pharyngeal cancer is significant component of the global burden of cancer. Tobacco and alcohol are regarded as the major risk factors for oral cancer. The population-attributable risks of smoking and alcohol consumption have been estimated to 80% for males, 61% for females, and 74% overall. The evidence that smokeless tobacco causes oral cancer was confirmed recently by the International Agency for Research on Cancer. Studies have shown that heavy intake of alcoholic beverages is associated with nutrient deficiency, which appears to contribute independently to oral carcinogenesis. Oral cancer is preventable through risk factors intervention. Prevention of HIV infection will also reduce the incidence of HIV/AIDS-related cancers such as Kaposi sarcoma and lymphoma. The WHO Global Oral Health Programme is committed to work for country capacity building in oral cancer prevention, inter-country exchange of information and experiences from integrated approaches in prevention and health promotion, and the development of global surveillance systems for oral cancer and risk factors. The WHO Global Oral Health Programme has established a global surveillance system of oral cavity cancer in order to assess risk factors and to help the planning of effective national intervention programmes. Epidemiological data on oral cancer (ICD-10: C00-C08) incidence and mortality are stored in the Global Oral Health Data Bank. In 2007, the World Health Assembly (WHA) passed a resolution on oral health for the first time in 25 years, which also considers oral cancer prevention. The resolution WHA60 A16 URGES Member states--To take steps to ensure that prevention of oral cancer is an integral part of national cancer-control programmes, and to involve oral-health professionals or primary health care personnel with relevant training in oral health in detection, early diagnosis and treatment;--The WHO Global Oral Health Programme will use this statement as the lead for its work for oral cancer control www.who.int/oral_health.

Lifetime cost effectiveness of a through-school nutrition and physical programme: Project Energize.

PubMed

Rush, Elaine; Obolonkin, Victor; McLennan, Stephanie; Graham, David; Harris, James D; Mernagh, Paul; Weston, Adéle R

2014-01-01

Project Energize, a multicomponent through-school physical activity and nutrition programme, is delivered to all primary school children in the Waikato region. The programme aim is to improve the overall health and reduce the rate of weight gain of all Waikato primary school children. An existing economic model was used to extrapolate the programme effects, initial costs, lifetime health treatment cost structures, quality-adjusted-life-years gained and increased life expectancy to the general and Māori child population of New Zealand. In March 2011, a sample of 2474 younger (7.58 ± 0.57 years, mean ± SD) and 2330 older (10.30 ± 0.51 years) children (36% Māori) attending Energize schools had body mass index measured and compared using mixed effect modelling with unEnergized comparison children from 2004 and 2006 from the same region. In 2011 the median body mass index reduction compared with the comparison younger children was -0.504 (90% CI -0.435 to -0.663) kg/m(2) and in the older children -0.551 (-0.456 to -0.789) kg/m(2). In 2010 there were 42,067 children attending Energize schools and in the same year NZ$1,891,175 was spent to deliver the programme; a cost of $44.96/child/year. Compared to the comparison children the increment in cost/quality-adjusted-life-year gained was $30,438 for the younger and $24,690 for the older children, and lower for Māori (younger $28,241, older $22,151) and for the middle socioeconomic status schools ($23,211, $17,891). Project Energize would improve quality and length of life and when compared with other obesity prevention programmes previously assessed with this model, it would be relatively cost-effective from the health treatment payer's perspective.

The polio-eradication programme and issues of the end game.

PubMed

Minor, Philip D

2012-03-01

Poliovirus causes paralytic poliomyelitis, an ancient disease of humans that became a major public-health issue in the 20th century. The primary site of infection is the gut, where virus replication is entirely harmless; the two very effective vaccines developed in the 1950s (oral polio vaccine, or OPV, and inactivated polio vaccine, or IPV) induce humoral immunity, which prevents viraemic spread and disease. The success of vaccination in middle-income and developing countries encouraged the World Health Organization to commit itself to an eradication programme, which has made great advances. The features of the infection, including its largely silent nature and the ability of the live vaccine (OPV) to evolve and change in vaccine recipients and their contacts, make eradication particularly challenging. Understanding the pathogenesis and virology of the infection is of major significance as the programme reaches its conclusion.

The use of cluster sampling to determine aid needs in Grozny, Chechnya in 1995.

PubMed

Drysdale, S; Howarth, J; Powell, V; Healing, T

2000-09-01

War broke out in Chechnya in November 1994 following a three-year economic blockade. It caused widespread destruction in the capital Grozny. In April 1995 Medical Relief International--or Merlin, a British medical non-governmental organisation (NGO)--began a programme to provide medical supplies, support health centres, control communicable disease and promote preventive health-care in Grozny. In July 1995 the agency undertook a city-wide needs assessment using a modification of the cluster sampling technique developed by the Expanded Programme on Immunisation. This showed that most people had enough drinking-water, food and fuel but that provision of medical care was inadequate. The survey allowed Merlin to redirect resources earmarked for a clean water programme towards health education and improving primary health-care services. It also showed that rapid assessment by a statistically satisfactory method is both possible and useful in such a situation.

Addressing non-communicable diseases in Malaysia: an integrative process of systems and community

PubMed Central

2014-01-01

The prevalence of non-communicable diseases (NCDs) and NCD risk factors in Malaysia have risen substantially in the last two decades. The Malaysian Ministry of Health responded by implementing, “The National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2010-2014”, and the “NCD Prevention 1Malaysia” (NCDP-1M) programme. This paper outlines the primary health system context in which the NCDP-1M is framed. We also discuss the role of community in facilitating the integration of this programme, and outline some of the key challenges in addressing the sustainability of the plan over the next few years. The paper thus provides an analysis of an integration of a programme that involved a multi-sectoral approach with the view to contributing to a broader discourse on the development of responsive health systems. PMID:25080846

[The general criteria and recommendations for the elaboration of programs for the early detection of breast cancer and cervical cancer in Spain. The Working Group for the Early Detection of Breast Cancer and Cervical Cancer].

PubMed

Ascunze Elizaga, N; González Enríquez, J; González Navarro, A; Herranz Fernández, C; Marqués Bravo, A; Martín Pérez, J

1993-01-01

Cancer screening and primary prevention of cancer are effective strategies to reduce cancer morbidity and mortality. The experience gained in several European countries about breast and cervical cancer has been growing in the last decades. This fact facilitates the adoption of the most convenient strategies to implement screening programmes in Spain. The Spanish Ministry of Health and Consumer Affairs set up a work group of experts and health managers to make recommendations and to define the basic criteria to take into account when planning and implementing these programmes. The article describes those recommendations as well as the priorities to be established regarding the target population, and the strategies to increase efficiency of those programmes. Recommendations were made according with scientific evidences and the current situation and resources in Spain.

The GoodNight study—online CBT for insomnia for the indicated prevention of depression: study protocol for a randomised controlled trial

PubMed Central

2014-01-01

Background Cognitive Behaviour Therapy for Insomnia (CBT-I) delivered through the Internet is effective as a treatment in reducing insomnia in individuals seeking help for insomnia. CBT-I also lowers levels of depression in this group. However, it is not known if targeting insomnia using CBT-I will lower depressive symptoms, and thus reduce the risk of major depressive episode onset, in those specifically at risk for depression. Therefore, this study aims to examine whether Internet delivery of fully automated self-help CBT-I designed to reduce insomnia will prevent depression. Method/design A sample of 1,600 community-dwelling adults (aged 18–64), who screen positive for both subclinical levels of depressive symptoms and insomnia, will be recruited via various media and randomised to either a 9-week online insomnia treatment programme, Sleep Healthy Using The internet (SHUTi), or an online attention-matched control group (HealthWatch). The primary outcome variable will be depression symptom levels at the 6-month post-intervention on the Patient Heath Questionnaire-9 (PHQ-9). A secondary outcome will be onset of major depressive episodes assessed at the 6-month post-intervention using ‘current’ and ‘time from intervention’ criteria from the Mini International Neuropsychiatric Interview. Discussion This trial is the first randomised controlled trial of an Internet-based insomnia intervention as an indicated preventative programme for depression. If effective, online provision of a depression prevention programme will facilitate dissemination. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), Registration number: ACTRN12611000121965. PMID:24524214

Preventing diabetes blindness: cost effectiveness of a screening programme using digital non-mydriatic fundus photography for diabetic retinopathy in a primary health care setting in South Africa.

PubMed

Khan, Taskeen; Bertram, Melanie Y; Jina, Ruxana; Mash, Bob; Levitt, Naomi; Hofman, Karen

2013-08-01

South Africa like many other developing countries is experiencing an epidemiologic transition with a marked increase in the non-communicable disease (NCD) burden. Diabetic retinopathy is the most common cause of incidental blindness in adults. A screening programme using a mobile fundal camera in a primary care setting has been shown to be effective in the country. Information on affordability and cost is essential for policymakers to consider its adoption. Economic evaluation is the comparative analysis of competing alternative interventions in terms of costs and consequences. A cost effectiveness analysis was done using actual costs from the primary care screening programme. A total of 14,541 patients were screened in three primary healthcare facilities in the Western Cape. Photographs were taken by a trained technician with supervision by an ophthalmic nurse. The photographs were then read by a medical officer with ophthalmic experience. A cost effective ratio of $1206 per blindness case averted was obtained. This included costs for screening and treating an individual. The cost just to screen a patient for retinopathy was $22. The costs of screening and treating all incident cases of blindness due to diabetes in South Africa would be 168,000,000 ZAR ($19,310,344) per annum. Non mydriatic digital fundoscopy is a cost effective measure in the screening and diagnosis of diabetic retinopathy in a primary care setting in South Africa. The major savings in the long term are a result of avoiding government disability grant for people who suffer loss of vision. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa.

PubMed

Andersson, Neil; Cockcroft, Anne; Shea, Bev

2008-12-01

Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of child sexual abuse. A sizeable literature now links GBV and HIV infection.Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviours.GBV perpetrators are at risk of HIV infection, as their victims have often been victimised before and have a high risk of infection. Including perpetrators and victims, perhaps one third of the southern African population is involved in the GBV-HIV dynamic.A randomised controlled trial of income enhancement and gender training reduced GBV and HIV risk behaviours, and a trial of a learning programme reported a non-significant reduction in HIV incidence and reduction of male risk behaviours (primary prevention). Interventions among survivors of GBV can reduce their HIV risk (secondary prevention). Various strategies can reduce spread of HIV from infected GBV survivors (tertiary prevention). Dealing with GBV could have an important effect on the HIV epidemic.A policy shift is necessary. HIV prevention policy should recognise the direct and indirect implications of GBV for HIV prevention, the importance of perpetrator dynamics, and that reduction of GBV should be part of HIV prevention programmes. Effective interventions are likely to include a structural component, and a GBV awareness component.

Does a fall prevention educational programme improve knowledge and change exercise prescribing behaviour in health and exercise professionals? A study protocol for a randomised controlled trial.

PubMed

Tiedemann, A; Sturnieks, D L; Hill, A-M; Lovitt, L; Clemson, L; Lord, S R; Harvey, L; Sherrington, C

2014-11-19

Falling in older age is a serious and costly problem. At least one in three older people fall annually. Although exercise is recognised as an effective fall prevention intervention, low numbers of older people engage in suitable programmes. Health and exercise professionals play a crucial role in addressing fall risk in older adults. This trial aims to evaluate the effect of participation in a fall prevention educational programme, compared with a wait-list control group, on health and exercise professionals' knowledge about fall prevention and the effect on fall prevention exercise prescription behaviour and confidence to prescribe the exercises to older people. A randomised controlled trial involving 220 consenting health and exercise professionals will be conducted. Participants will be individually randomised to an intervention group (n=110) to receive an educational workshop plus access to internet-based support resources, or a wait-list control group (n=110). The two primary outcomes, measured 3 months after randomisation, are: (1) knowledge about fall prevention and (2) self-perceived change in fall prevention exercise prescription behaviour. Secondary outcomes include: (1) participants' confidence to prescribe fall prevention exercises; (2) the proportion of people aged 60+ years seen by trial participants in the past month who were prescribed fall prevention exercise; and (3) the proportion of fall prevention exercises prescribed by participants to older people in the past month that comply with evidence-based guidelines. Outcomes will be measured with a self-report questionnaire designed specifically for the trial. The trial protocol was approved by the Human Research Ethics Committee, The University of Sydney, Australia. Trial results will be disseminated via peer reviewed journals, presentations at international conferences and participants' newsletters. Trial protocol was registered with the Australian and New Zealand Clinical Trials Registry (Number ACTRN12614000224628) on 3 March 2014. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

AIDS Prevention and Control: Invited Presentations and Papers from the World Summit of Ministers of Health on Programmes for AIDS Prevention (London, England, January 26-28, 1988).

ERIC Educational Resources Information Center

World Health Organization, Geneva (Switzerland).

Papers from the World Summit of Ministers of Health on Programmes for AIDS Prevention in this book include: (1) "Global AIDS: Epidemiology, Impact, Projections, Global Strategy," (Jonathan Mann); (2) "Modes of Transmission: The Basis for Prevention Strategies," (Donald Acheson); (3) "National AIDS Information Programme in…

A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme.

PubMed

Donaldson, Alex; Callaghan, Aisling; Bizzini, Mario; Jowett, Andrew; Keyzer, Patrick; Nicholson, Matthew

2018-01-20

Understanding the barriers to programme use is important to facilitate implementation of injury prevention programmes in real-word settings. This study investigated the barriers to coaches of adolescent female soccer teams, in Victoria, Australia, implementing the evidence-based FIFA 11+ injury prevention programme. Concept mapping with data collected from 19 soccer coaches and administrators. Brainstorming generated 65 statements as barriers to 11+ implementation. After the statements were synthesised and edited, participants sorted 59 statements into groups (mean, 6.2 groups; range, 3-10 groups). Multidimensional scaling and hierarchical cluster analysis identified a six-cluster solution: Lack of 11+ knowledge among coaches (15 statements), Lack of player enjoyment and engagement (14), Lack of link to football-related goals (11), Lack of facilities and resources (8), Lack of leadership (6) and Lack of time at training (5). Statements in the 'Lack of 11+ knowledge among coaches' cluster received the highest mean importance (3.67 out of 5) and feasibility for the Football Federation to address (3.20) rating. Statements in the 'Lack of facilities and resources' cluster received the lowest mean importance rating (2.23), while statements in the 'Lack of time at training' cluster received the lowest mean feasibility rating (2.19). A multistrategy, ecological approach to implementing the 11+-with specific attention paid to improving coach knowledge about the 11+ and how to implement it, linking the 11+ to the primary goal of soccer training, and organisational leadership-is required to improve the uptake of the 11+ among the targeted coaches. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A physiotherapy-directed occupational health programme for Austrian school teachers: a cluster randomised pilot study.

PubMed

Figl-Hertlein, A; Horsak, B; Dean, E; Schöny, W; Stamm, T

2014-03-01

Although physiotherapists have long advocated workplace health, school teachers have not traditionally been a focus of study by these professionals. However, classroom teaching contributes to a range of occupational health issues related to general health as well as ergonomics that can be prevented or addressed by physiotherapists. To undertake a pilot study to explore the potential effects of a physiotherapy-directed occupational health programme individualised for school teachers, develop study methodology and gather preliminary data to establish a 'proof of concept' to inform future studies. Cluster randomised pilot study using a convenience sample. Eight Austrian regional secondary schools. Schools and their teachers were recruited and allocated to an intervention group (IG, n=26 teachers) or a control group (CG, n=43 teachers). Teachers were eligible to participate if they reported no health issues that compromised their classroom responsibilities. The IG participated in an individualised physiotherapy-directed occupational health programme (six 30-minute sessions) related to ergonomics and stress management conducted over a 5-month semester. The CG had a pseudo-intervention of one oral education session. Primary outcomes included scores from the physical and mental components and health transition item of the Short-Form-36 Health Survey questionnaire (SF-36), and emotional well-being and resistance to stress items from the work-related behaviour and experience patterns questionnaire. Data were collected before and after one semester. The primary outcome measure, the SF-36 physical component score, showed a reduction in the CG and no change in the IG, meaning that the CG deteriorated over the study semester while the IG did not show any change. A physiotherapy-directed occupational health programme may prevent deterioration of physical health of school teachers in one semester (proof of concept). This pilot study provided valuable information to inform the design of replication and extension studies related to this work. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten Up randomised controlled trial.

PubMed

Jolly, Kate; Lewis, Amanda; Beach, Jane; Denley, John; Adab, Peymane; Deeks, Jonathan J; Daley, Amanda; Aveyard, Paul

2011-11-03

To assess the effectiveness of a range of weight management programmes in terms of weight loss. Eight arm randomised controlled trial. Primary care trust in Birmingham, England. 740 obese or overweight men and women with a comorbid disorder identified from general practice records. Weight loss programmes of 12 weeks' duration: Weight Watchers; Slimming World; Rosemary Conley; group based, dietetics led programme; general practice one to one counselling; pharmacy led one to one counselling; choice of any of the six programmes. The comparator group was provided with 12 vouchers enabling free entrance to a local leisure (fitness) centre. The primary outcome was weight loss at programme end (12 weeks). Secondary outcomes were weight loss at one year, self reported physical activity, and percentage weight loss at programme end and one year. Follow-up data were available for 658 (88.9%) participants at programme end and 522 (70.5%) at one year. All programmes achieved significant weight loss from baseline to programme end (range 1.37 kg (general practice) to 4.43 kg (Weight Watchers)), and all except general practice and pharmacy provision resulted in significant weight loss at one year. At one year, only the Weight Watchers group had significantly greater weight loss than did the comparator group (2.5 (95% confidence interval 0.8 to 4.2) kg greater loss,). The commercial programmes achieved significantly greater weight loss than did the primary care programmes at programme end (mean difference 2.3 (1.3 to 3.4) kg). The primary care programmes were the most costly to provide. Participants allocated to the choice arm did not have better outcomes than those randomly allocated to a programme. Commercially provided weight management services are more effective and cheaper than primary care based services led by specially trained staff, which are ineffective. Trial registration Current Controlled Trials ISRCTN25072883.

A randomised controlled trial of aerobic exercise after transient ischaemic attack or minor stroke to prevent cognitive decline: the MoveIT study protocol.

PubMed

Boss, H M; Van Schaik, S M; Deijle, I A; de Melker, E C; van den Berg, B T J; Scherder, E J A; Bosboom, W M J; Weinstein, H C; Van den Berg-Vos, R M

2014-12-31

Patients with transient ischaemic attack (TIA) or stroke are at risk for cognitive impairment and dementia. Currently, there is no known effective strategy to prevent this cognitive decline. Increasing evidence exists that physical exercise is beneficial for cognitive function. However, in patients with TIA or stroke who are at risk of cognitive impairment and dementia, only a few trials have been conducted. In this study, we aim to investigate whether a physical exercise programme (MoveIT) can prevent cognitive decline in patients in the acute phase after a TIA or minor ischaemic stroke. A single-blinded randomised controlled trial will be conducted to investigate the effect of an aerobic exercise programme on cognition compared with usual care. 120 adult patients with a TIA or minor ischaemic stroke less than 1 month ago will be randomly allocated to an exercise programme consisting of a 12-week aerobic exercise programme and regular follow-up visits to a specialised physiotherapist during the period of 1 year or to usual care. Outcome measures will be assessed at the baseline, and at the 1-year and 2-year follow-up. The primary outcome is cognitive functioning measured with the Montreal Cognitive Assessment (MoCA) test and with additional neuropsychological tests. Secondary outcomes include maximal exercise capacity, self-reported physical activity and measures of secondary prevention. The study received ethical approval from the VU University Amsterdam Ethics committee (2011/383). The results of this study will be published in peer-reviewed journals and presented at international conferences. We will also disseminate the main results to our participants in a letter. The Nederlands Trial Register NTR3884. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

‘A morass of considerations’: exploring attitudes towards ethnicity-based haemoglobinopathy-carrier screening in primary care

PubMed Central

Henneman, L; de Jonge, A; van El, C G; van Tuyl, L H; Cornel, M C; Lagro-Janssen, A L M

2013-01-01

Background. The Netherlands does not have a national haemoglobinopathy (HbP)-carrier screening programme aimed at facilitating informed reproductive choice. HbP-carrier testing for those at risk is at best offered on the basis of anaemia. Registration of ethnicity has proved controversial and may complicate the introduction of a screening programme if based on ethnicity. However, other factors may also play a role. Objective. To explore perceived barriers and attitudes among GPs and midwives regarding the registration of ethnicity and ethnicity-based HbP-carrier screening. Methods. Six focus groups in Dutch primary care, with a total of 37 GPs (n = 9) and midwives (n = 28) were conducted, transcribed and content analysed using Atlas-ti. Results. Both GPs and midwives struggled with correctly identifying ethnicities at risk for HbP. Ethical concerns regarding privacy seemed to originate from World War II experiences, when ethnic and religious registration facilitated deportation of Jewish citizens, coupled with the political climate at the time focus groups were held. Some respondents thought the ethnicity question might undermine the relationship with their clients. Software programmes prevented GPs from registering ethnicity of patients at risk. Financial implications for patients were also a concern. Despite this, respondents seemed positive about screening and were familiar with identifying ethnicity and used this for individual patient care. Conclusions. Although health professionals are generally positive about screening, ethical, financial and practical issues surrounding ethnicity-based HbP-carrier screening need to be clarified before introducing such a programme. Primary care professionals can be targeted through professional organizations but they need national policy support. PMID:23629736

The management of work-related asthma guidelines: a broader perspective.

PubMed

Baur, Xaver; Aasen, Tor Brøvig; Burge, P Sherwood; Heederik, Dick; Henneberger, Paul K; Maestrelli, Piero; Schlünssen, Vivi; Vandenplas, Olivier; Wilken, Dennis

2012-06-01

The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden. Several hundred occupational agents, mainly allergens but also irritants and substances with unknown pathological mechanisms, have been identified as causing work-related asthma. The essential message of these guidelines is that the management of work-related asthma can be considerably optimised based on the present knowledge of causes, risk factors, pathomechanisms, and realistic and effective interventions. To reach this goal we urgently require greatly intensified primary preventive measures and improved case management. There is now a substantial body of evidence supporting the implementation of comprehensive medical surveillance programmes for workers at risk. Those workers who fail surveillance programmes need to be referred to a clinician who can confirm or exclude an occupational cause. Once work-related asthma is confirmed, a revised risk assessment in the workplace is needed to prevent further cases. These new guidelines confirm and extend already existing statements and recommendations. We hope that these guidelines will initiate the much-needed research that is required to fill the gaps in our knowledge and to initiate substantial improvements in preventative measures.

Learning about What Constitutes Effective Training from a Pilot Programme to Improve Music Education in Primary Schools

ERIC Educational Resources Information Center

Rogers, Lynne; Hallam, Susan; Creech, Andrea; Preti, Costanza

2008-01-01

The new primary strategy in England has raised the profile of foundation subjects, including music, yet many primary school teachers lack skills and confidence in their ability to teach music. This research explores a year-long programme of training across 16 primary schools in England that sought to improve music education. The programme involved…

Public health in New York City, 2002-2007: confronting epidemics of the modern era.

PubMed

Frieden, Thomas R; Bassett, Mary T; Thorpe, Lorna E; Farley, Thomas A

2008-10-01

Long after the leading causes of death in the United States shifted from infectious diseases to chronic diseases, many public health agencies have not established effective policies and programmes to prevent current health problems. Starting in 2002, the New York City health department, an agency with a long history of innovation, undertook initiatives to address chronic disease prevention and control, as well as to modernize methods to address persistent health problems. All the initiatives relied on an expansive use of epidemiology; actions to prevent disease were based on policy change to create health-promoting environments as well as engagement with the health care system to improve its focus on prevention. Examples of policy-based initiatives are: a multi-component tobacco control programme that included a tax increase, a comprehensive smoke-free air law, hard-hitting anti-tobacco advertising and cessation services; elimination of trans fats from restaurants and a mandate that restaurants post-calorie information on menu boards. Examples of health care initiatives are public health 'detailing' to primary care providers, creation of a city-wide diabetes registry and development of a public health-oriented electronic health record. The infrastructure needed by local health departments to prevent chronic diseases and other modern health problems includes strong information technology systems, skillful epidemiology, expertise in communications using modern media, policy-making authority and, most importantly, political support.

Secondary prevention at 360°: the important role of diagnostic imaging.

PubMed

Ciarrapico, Anna Micaela; Manenti, Guglielmo; Pistolese, Chiara; Fabiano, Sebastiano; Fiori, Roberto; Romagnoli, Andrea; Sergiacomi, Gianluigi; Stefanini, Matteo; Simonetti, Giovanni

2015-06-01

The aim of this paper is to underline the importance of the role of general practitioners (GPs) in distributing vital information about prevention to citizens, to highlight the importance of the so-called voluntary prevention programmes, both for conditions for which no organised screening programmes exist and for those for which they do exist but may well be obsolete or inefficient. Nowadays, voluntary prevention is made more effective thanks to the new sophisticated diagnostic technologies applied worldwide by diagnostic imaging. Epidemiological data about the incidence and causes of death among the Italian population have shown that screening programmes should be aimed first at fighting the following diseases: prostatic carcinoma, lung cancer, colorectal carcinoma, breast cancer, cardiovascular disease, cerebrovascular disease, aortic and peripheral vascular disease. GPs do not generally give good or adequate instructions concerning voluntary prevention programmes; GPs may not even be aware of this type of prevention which could represent a valuable option together with the existing mass screening programmes. Therefore, in the following analysis, we aim to outline the correct diagnostic pathway for the prevention of diseases having the highest incidence in our country and which represent the most frequent causes of death. If used correctly, these screening programmes may contribute to the success of secondary prevention, limiting the use of tertiary prevention and thus producing savings for the Italian National Health System.

Systematic review of the use of data from national childhood obesity surveillance programmes in primary care: a conceptual synthesis.

PubMed

Henderson, E J; Ells, L J; Rubin, G P; Hunter, D J

2015-11-01

This study reviewed the use in primary care of national surveillance data for children to determine the data's potential utility to inform policy and practice decisions on how to prevent and treat childhood obesity. We reviewed the 28 countries identified by the World Obesity Federation as having high-quality comparable body mass index data for children. Literature published from any period up to December 2013 was included. Peer review literature was searched using Web of Science (Core Collection, MEDLINE). Grey literature was searched using the Internet by country name, programme name and national health and government websites. We included studies that (i) use national surveillance obesity data in primary care, or (ii) explore practitioner or parent perspectives about the use of such data. The main uses of national surveillance data in primary care were to identify and recruit obese children and their parents to participate in school and general practice-based research and/or interventions, and to inform families of children's measurements. Findings indicate a need for school staff and practitioners to receive additional training and support to sensitively communicate with families. Translation of these findings into policy and practice could help to improve current uses of national child obesity surveillance data in primary care. © 2015 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity.

How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?—a scoping review

PubMed Central

Francis, Linda; Dunt, David; Cadilhac, Dominique A

2016-01-01

Objectives Programmes to address chronic disease are a focus of governments worldwide. Despite growth in ‘implementation science’, there is a paucity of knowledge regarding the best means to measure sustainability. The aim of this review was to summarise current practice for measuring sustainability outcomes of chronic disease health programmes, providing guidance for programme planners and future directions for the academic field. Settings A scoping review of the literature spanning 1985–2015 was conducted using MEDLINE, CINAHL, PsychINFO and The Cochrane Library limited to English language and adults. Main search terms included chronic disease, acute care, sustainability, institutionalisation and health planning. A descriptive synthesis was required. Settings included primary care, hospitals, mental health centres and community health. Participants Programmes included preventing or managing chronic conditions including diabetes, heart disease, depression, respiratory disease, cancer, obesity, dental hygiene and multiple chronic diseases. Primary and secondary outcome measures Outcome measures included clarifying a sustainability definition, types of methodologies used, timelines for assessment, criteria levels to determine outcomes and how methodology varies between intervention types. Results Among 153 abstracts retrieved, 87 were retained for full article review and 42 included in the qualitative synthesis. Five definitions for sustainability outcome were identified with ‘maintenance of programme activities’ most frequent. Achieving sustainability was dependent on inter-relationships between various organisational and social contexts supporting a broad scale approach to evaluation. An increasing trend in use of mixed methods designs over multiple time points to determine sustainability outcomes was found. Conclusions Despite the importance and investment in chronic disease programmes, few studies are undertaken to measure sustainability. Methods to evaluate sustainability are diverse with some emerging patterns in measurement found. Use of mixed methods approaches over multiple time points may serve to better guide measurement of sustainability. Consensus on aspects of standardised measurement would promote the future possibility of meta-analytic syntheses. PMID:27246000

Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study.

PubMed

Woringer, Maria; Cecil, Elizabeth; Watt, Hillary; Chang, Kiara; Hamid, Fozia; Khunti, Kamlesh; Dubois, Elizabeth; Evason, Julie; Majeed, Azeem; Soljak, Michael

2017-06-14

Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England's National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups. Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively. Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p < 0.05) than the general population. Screened populations in 29 of 38 LAs were significantly more deprived (p < 0.05). No statistically significant difference among ethnic minority groups was observed between LAs. Nonetheless some LAs - namely Leicester, Thurrock, Sutton, South Tyneside, Portsmouth and Gateshead were very successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p < 0.001) and mean proportion of 40-49 and 50-59 year olds was 9.98% and 3.58% higher (p < 0.0001 and p < 0.01 respectively) than the general population across 38 LAs. Community-based outreach providers effectively reach under-served groups by delivering preventive CVD services to younger, more deprived populations, and a representative proportion of ethnic minority groups. If the programme is successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities therein.

Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis.

PubMed

Pappas, Evangelos; Nightingale, Elizabeth J; Simic, Milena; Ford, Kevin R; Hewett, Timothy E; Myer, Gregory D

2015-05-01

Some injury prevention programmes aim to reduce the risk of ACL rupture. Although the most common athletic task leading to ACL rupture is cutting, there is currently no consensus on how injury prevention programmes influence cutting task biomechanics. To systematically review and synthesise the scientific literature regarding the influence of injury prevention programme exercises on cutting task biomechanics. The three largest databases (Medline, EMBASE and CINAHL) were searched for studies that investigated the effect of injury prevention programmes on cutting task biomechanics. When possible meta-analyses were performed. Seven studies met the inclusion criteria. Across all studies, a total of 100 participants received exercises that are part of ACL injury prevention programmes and 76 participants served in control groups. Most studies evaluated variables associated with the quadriceps dominance theory. The meta-analysis revealed decreased lateral hamstrings electromyography activity (p ≤ 0.05) while single studies revealed decreased quadriceps and increased medial hamstrings activity and decreased peak knee flexion moment. Findings from single studies reported that ACL injury prevention exercises reduce neuromuscular deficits (knee valgus moment, lateral trunk leaning) associated with the ligament and trunk dominance theories, respectively. The programmes we analysed appear most effective when they emphasise individualised biomechanical technique correction and target postpubertal women. The exercises used in injury prevention programmes have the potential to improve cutting task biomechanics by ameliorating neuromuscular deficits linked to ACL rupture, especially when they emphasise individualised biomechanical technique correction and target postpubertal female athletes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Lost in translation? Theory, policy and practice in systems-based environmental approaches to obesity prevention in the Healthy Towns programme in England.

PubMed

Sautkina, Elena; Goodwin, Denise; Jones, Andy; Ogilvie, David; Petticrew, Mark; White, Martin; Cummins, Steven

2014-09-01

This paper explores how system-wide approaches to obesity prevention were 'theorised' and translated into practice in the 'Healthy Towns' programme implemented in nine areas in England. Semi-structured interviews with 20 informants, purposively selected to represent national and local programme development, management and delivery were undertaken. Results suggest that informants articulated a theoretical understanding of a system-wide approach to obesity prevention, but simplifying this complex task in the context of uncertainty over programme aims and objectives, and absence of a clear direction from the central government, resulted in local programmes relying on traditional multi-component approaches to programme delivery. The development of clear, practical guidance on implementation should form a central part of future system-wide approaches to obesity prevention. Copyright © 2014 Elsevier Ltd. All rights reserved.

School-based secondary prevention programmes for preventing violence.

PubMed

Mytton, J; DiGuiseppi, C; Gough, D; Taylor, R; Logan, S

2006-07-19

Early aggressive behaviour is a risk factor for later violence and criminal behaviour. Despite over 20 years of violence prevention interventions being delivered in the school setting, questions remain regarding the effectiveness of different interventions for children exhibiting aggressive behaviour. To examine the effect of school based violence prevention programmes for children identified as aggressive or at risk of being aggressive. We searched CENTRAL, Cochrane Injuries Group specialised register, MEDLINE, EMBASE, other specialised databases and reference lists of articles. We also contacted authors and organisations to identify any further studies. We included trials meeting the following criteria; 1) participants were randomly assigned to intervention and control groups; 2) outcome data were collected concurrently; 3) participants comprised children in mandatory education identified as exhibiting, or at risk of, aggressive behaviour; 4) interventions designed to reduce aggression, violence, bullying, conflict or anger; 5) school based interventions; 6) outcomes included aggressive behaviour, school and agency responses to acts of aggression, or violent injuries. Data were collected on design, participants, interventions, outcomes and indicators of study quality. Results of any intervention to no intervention were compared immediately post-intervention and at 12 months using meta-analysis where appropriate. Of 56 trials identified, none reported data on violent injuries. Aggressive behaviour was significantly reduced in intervention groups compared to no intervention groups immediately post intervention in 34 trials with data, (Standardised Mean Difference (SMD) = -0.41; 95% confidence interval (CI) -0.56 to -0.26). This effect was maintained in the seven studies reporting 12 month follow-up (SMD = -0.40, (95% CI -0.73 to -0.06)). School or agency disciplinary actions in response to aggressive behaviour were reduced in intervention groups for nine trials with data, SMD = -0.48; 95% CI -1.16 to 0.19, although this difference may have been due to chance and was not maintained, based on two studies reporting follow-up to two to four months (SMD = 0.03; 95% CI -0.42 to 0.47). Subgroup analyses suggested that interventions designed to improve relationship or social skills may be more effective than interventions designed to teach skills of non-response to provocative situations, but that benefits were similar when delivered to children in primary versus secondary school, and to groups of mixed sex versus boys alone. School-based secondary prevention programmes to reduce aggressive behaviour appear to produce improvements in behaviour greater than would have been expected by chance. Benefits can be achieved in both primary and secondary school age groups and in both mixed sex groups and boys-only groups. Further research is required to establish whether such programmes reduce the incidence of violent injuries or if the benefits identified can be maintained beyond 12 months.

Literacy and motivation for the prevention and control of hypertension among female community health volunteers: a qualitative study from Nepal.

PubMed

Neupane, Dinesh; Mclachlan, Craig S; Gautam, Rupesh; Mishra, Shiva Raj; Thorlund, Michael; Schlütter, Mette; Kallestrup, Per

2015-01-01

The prevalence of hypertension is increasing in Nepal. Thus, there is a need for a programme to improve primary healthcare. One possibility is to assign prevention, diagnosis, and treatment of hypertension to female community health volunteers (FCHVs). To assess literacy and motivation to be involved in a hypertension prevention and control programme in Nepal among FCHVs. Five focus group discussions (FGDs) were conducted with a total of 69 FCHVs in Lekhnath municipality, Kaski district, Nepal. Seven themes were developed on the basis of data collection: 1) knowledge about hypertension; 2) risk factors of hypertension; 3) prevention and control of hypertension; 4) access to treatment for hypertension in the community; 5) learning about blood pressure measurement; 6) ability to raise blood pressure awareness in the community; 7) possible challenges for their future involvement. Data were analysed using the thematic analysis approach. FCHVs have some knowledge about diagnosis, risk factors, and complications of hypertension. General unanimity was observed in the understanding that hypertension and risk factors needed to be addressed. The willingness of FCHVs to contribute to prevention, control, and management was strong, and they were confident that with some basic training they could obtain skills in hypertension management. Despite limited knowledge about hypertension, FCHVs expressed willingness and readiness to be trained in hypertension management. This study supports the possibility of involving FCHVs in prevention and control of hypertension in Nepal.

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.

Cardiovascular risk factors in multi-ethnic middle school students: the HEALTHY primary prevention trial.

PubMed

Willi, S M; Hirst, K; Jago, R; Buse, J; Kaufman, F; El Ghormli, L; Bassin, S; Elliot, D; Hale, D E

2012-06-01

The objective of this study was to examine the effects of an integrated, multi-component, school-based intervention programme on cardiovascular disease (CVD) risk factors among a multi-ethnic cohort of middle school students. HEALTHY was a cluster randomized, controlled, primary prevention trial. Middle school was the unit of randomization and intervention. Half of the schools were assigned to an intervention programme consisting of changes in the total school food environment and physical education classes, enhanced by educational outreach and behaviour change activities and promoted by a social marketing campaign consisting of reinforcing messages and images. Outcome data reported (anthropometrics, blood pressure and fasting lipid levels) were collected on a cohort of students enrolled at the start of 6th grade (∼11-12 years old) and followed to end of 8th grade (∼13-14 years old). Forty-two middle schools were enrolled at seven field centres; 4363 students provided both informed consent and CVD data at baseline and end of study. The sample was 52.7% female, 54.5% Hispanic, 17.6% non-Hispanic Black, 19.4% non-Hispanic White and 8.5% other racial/ethnic combinations, and 49.6% were categorized as overweight or obese (body mass index ≥ 85th percentile) at baseline. A significant intervention effect was detected in the prevalence of hypertension in non-Hispanic Black and White males. The intervention produced no significant changes in lipid levels. The prevalence of some CVD risk factors is high in minority middle school youth, particularly males. A multi-component, school-based programme achieved only modest reductions in these risk factors; however, promising findings occurred in non-Hispanic Black and White males with hypertension. © 2012 The Authors. Pediatric Obesity © 2012 International Association for the Study of Obesity.

Home visiting programmes for the prevention of child maltreatment: cost-effectiveness of 33 programmes.

PubMed

Dalziel, Kim; Segal, Leonie

2012-09-01

There is a body of published research on the effectiveness of home visiting for the prevention of child maltreatment, but little in the peer reviewed literature on cost-effectiveness or value to society. The authors sought to determine the cost-effectiveness of alternative home visiting programmes to inform policy. All trials reporting child maltreatment outcomes were identified through systematic review. Information on programme effectiveness and components were taken from identified studies, to which 2010 Australian unit costs were applied. Lifetime cost offsets associated with maltreatment were derived from a recent Australian study. Cost-effectiveness results were estimated as programme cost per case of maltreatment prevented and net benefit estimated by incorporating downstream cost savings. Sensitivity analyses were conducted. 33 home visiting programmes were evaluated and cost-effectiveness estimates derived for the 25 programmes not dominated. The incremental cost of home visiting compared to usual care ranged from A$1800 to A$30 000 (US$1800-US$30 000) per family. Cost-effectiveness estimates ranged from A$22 000 per case of maltreatment prevented to several million. Seven of the 22 programmes (32%) of at least adequate quality were cost saving when including lifetime cost offsets. There is great variation in the cost-effectiveness of home visiting programmes for the prevention of maltreatment. The most cost-effective programmes use professional home visitors in a multi-disciplinary team, target high risk populations and include more than just home visiting. Home visiting programmes must be carefully selected and well targeted if net social benefits are to be realised.

[Participant structure and economic benefit of prevention bonus programmes in company health insurance funds].

PubMed

Friedrichs, M; Friedel, H; Bödeker, W

2009-10-01

This study investigates differences in sex, age, and educational level between participants and non-participants of prevention bonus programmes. The differences in the utilisation of drugs, hospital care, and sickness absence before the start of the programmes between these groups are also shown. Finally the economic benefit of the health insurance funds attributed to these programmes is estimated. Data from some 5.2 million insured subjects of 74 company health insurance funds in Germany were linked to information on enrollment into a prevention bonus programme anonymously. In a descriptive analysis the differences in the sociodemographic patterns between both groups are shown as well as the differences in costs to the health insurances in the three sectors mentioned above. The benefit to the health insurance funds is estimated by means of an analysis of covariance. Prevention bonus programmes yields an annual benefit of at least 129 euro per participant. Men aged 40 and older and women aged 30 and older are more likely to opt into such a programme. The same is true for persons with a higher educational level. There are only few differences in health-care utilisation between the participants and non-participants of the programmes before enrollment. Only 1.4% of all insured persons participated in the programmes. There is at least a short-term gain to both involved parties: the insured and the health insurance funds. The programmes are not dominated by deadweight effects. Long-term effects and effectiveness of prevention bonus programmes still have to be investigated. Copyright Georg Thieme Verlag KG Stuttgart . New York.

Learning to Teach Geography for Primary Education: Results of an Experimental Programme

ERIC Educational Resources Information Center

Blankman, Marian; Schoonenboom, Judith; van der Schee, Joop; Boogaard, Marianne; Volman, Monique

2016-01-01

Students training to become primary school teachers appear to have little awareness of the core concepts of geography (teaching). To ensure that future primary school teachers are able to develop their pupils' geographical awareness, a six weeks programme was developed. The characteristics of this programme -- named Consciously Teaching Geography…

The Effects of a Professional Development Programme on Primary School Teachers' Perceptions of Physical Education

ERIC Educational Resources Information Center

Harris, Jo; Cale, Lorraine; Musson, Hayley

2011-01-01

The impact of a professional development programme on primary school teachers' perceptions of physical education was investigated. Primary school teachers from five local education authorities in England provided data for the study via pre-course audits, course evaluations immediately following the programme, and focus groups and individual…

Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study)

PubMed Central

Pallan, Miranda J; Lancashire, Emma R; Hemming, Karla; Frew, Emma; Barrett, Tim; Bhopal, Raj; Cade, Janet E; Canaway, Alastair; Clarke, Joanne L; Daley, Amanda; Deeks, Jonathan J; Duda, Joan L; Ekelund, Ulf; Gill, Paramjit; Griffin, Tania; McGee, Eleanor; Hurley, Kiya; Martin, James; Parry, Jayne; Passmore, Sandra; Cheng, K K

2018-01-01

Abstract Objective To assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity. Design Cluster randomised controlled trial. Setting UK primary schools from the West Midlands. Participants 200 schools were randomly selected from all state run primary schools within 35 miles of the study centre (n=980), oversampling those with high minority ethnic populations. These schools were randomly ordered and sequentially invited to participate. 144 eligible schools were approached to achieve the target recruitment of 54 schools. After baseline measurements 1467 year 1 pupils aged 5 and 6 years (control: 28 schools, 778 pupils) were randomised, using a blocked balancing algorithm. 53 schools remained in the trial and data on 1287 (87.7%) and 1169 (79.7%) pupils were available at first follow-up (15 month) and second follow-up (30 month), respectively. Interventions The 12 month intervention encouraged healthy eating and physical activity, including a daily additional 30 minute school time physical activity opportunity, a six week interactive skill based programme in conjunction with Aston Villa football club, signposting of local family physical activity opportunities through mail-outs every six months, and termly school led family workshops on healthy cooking skills. Main outcome measures The protocol defined primary outcomes, assessed blind to allocation, were between arm difference in body mass index (BMI) z score at 15 and 30 months. Secondary outcomes were further anthropometric, dietary, physical activity, and psychological measurements, and difference in BMI z score at 39 months in a subset. Results Data for primary outcome analyses were: baseline, 54 schools: 1392 pupils (732 controls); first follow-up (15 months post-baseline), 53 schools: 1249 pupils (675 controls); second follow-up (30 months post-baseline), 53 schools: 1145 pupils (621 controls). The mean BMI z score was non-significantly lower in the intervention arm compared with the control arm at 15 months (mean difference −0.075 (95% confidence interval −0.183 to 0.033, P=0.18) in the baseline adjusted models. At 30 months the mean difference was −0.027 (−0.137 to 0.083, P=0.63). There was no statistically significant difference between groups for other anthropometric, dietary, physical activity, or psychological measurements (including assessment of harm). Conclusions The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments. Trial registration Current Controlled Trials ISRCTN97000586. PMID:29437667

Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study).

PubMed

Adab, Peymane; Pallan, Miranda J; Lancashire, Emma R; Hemming, Karla; Frew, Emma; Barrett, Tim; Bhopal, Raj; Cade, Janet E; Canaway, Alastair; Clarke, Joanne L; Daley, Amanda; Deeks, Jonathan J; Duda, Joan L; Ekelund, Ulf; Gill, Paramjit; Griffin, Tania; McGee, Eleanor; Hurley, Kiya; Martin, James; Parry, Jayne; Passmore, Sandra; Cheng, K K

2018-02-07

To assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity. Cluster randomised controlled trial. UK primary schools from the West Midlands. 200 schools were randomly selected from all state run primary schools within 35 miles of the study centre (n=980), oversampling those with high minority ethnic populations. These schools were randomly ordered and sequentially invited to participate. 144 eligible schools were approached to achieve the target recruitment of 54 schools. After baseline measurements 1467 year 1 pupils aged 5 and 6 years (control: 28 schools, 778 pupils) were randomised, using a blocked balancing algorithm. 53 schools remained in the trial and data on 1287 (87.7%) and 1169 (79.7%) pupils were available at first follow-up (15 month) and second follow-up (30 month), respectively. The 12 month intervention encouraged healthy eating and physical activity, including a daily additional 30 minute school time physical activity opportunity, a six week interactive skill based programme in conjunction with Aston Villa football club, signposting of local family physical activity opportunities through mail-outs every six months, and termly school led family workshops on healthy cooking skills. The protocol defined primary outcomes, assessed blind to allocation, were between arm difference in body mass index (BMI) z score at 15 and 30 months. Secondary outcomes were further anthropometric, dietary, physical activity, and psychological measurements, and difference in BMI z score at 39 months in a subset. Data for primary outcome analyses were: baseline, 54 schools: 1392 pupils (732 controls); first follow-up (15 months post-baseline), 53 schools: 1249 pupils (675 controls); second follow-up (30 months post-baseline), 53 schools: 1145 pupils (621 controls). The mean BMI z score was non-significantly lower in the intervention arm compared with the control arm at 15 months (mean difference -0.075 (95% confidence interval -0.183 to 0.033, P=0.18) in the baseline adjusted models. At 30 months the mean difference was -0.027 (-0.137 to 0.083, P=0.63). There was no statistically significant difference between groups for other anthropometric, dietary, physical activity, or psychological measurements (including assessment of harm). The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments. Current Controlled Trials ISRCTN97000586. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The CASE Programme Implemented Across the Primary and Secondary School Transition in Ireland

NASA Astrophysics Data System (ADS)

McCormack, Lorraine; Finlayson, Odilla E.; McCloughlin, Thomas J. J.

2014-11-01

In the Irish education system, there is little continuity between the primary and secondary education systems. The transfer between these systems is particularly problematic in the area of science. In order to alleviate some of these problems, as well as to enhance the cognitive development of students, the Cognitive Acceleration through Science Education programme was adapted for use and implemented across the primary-secondary school transition in Ireland. The programme was delivered in a variety of ways across the two levels, including the teacher and researcher teaching the programmes individually and team-teaching arrangements. The results on cognitive development measures showed that the students who were taught the programme in primary and secondary school made significant gains, when compared to the non-intervention group. There were also gains evident for students who only received one part of the programme (i.e. in either primary or secondary school). The greater gains, in terms of effect size, were evident at secondary school. The rationale, methodology and results are detailed in this paper.

Healthwise South Africa: Cultural Adaptation of a School-Based Risk Prevention Programme

ERIC Educational Resources Information Center

Wegner, L.; Flisher, A. J.; Caldwell, L. L.; Vergnani, T.; Smith, E. A.

2008-01-01

There is a need for effective prevention programmes aimed at reducing risk behaviour among South African adolescents. HealthWise South Africa is a school-based programme designed to reduce sexual and substance use risk behaviour, and promote positive use of leisure time among high-school learners (students). Based on successful programmes in the…

Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner's surgery: Study protocol of a single arm trial preparing an RCT [ISRCTN58562962

PubMed Central

2009-01-01

Background Physical activity programmes can help to prevent functional decline in the elderly. Until now, such programmes use to target either on healthy community-dwelling seniors or on elderly living in special residences or care institutions. Sedentary or frail people, however, are difficult to reach when they live in their own homes. The general practitioner's (GP) practice offers a unique opportunity to acquire these people for participation in activity programmes. We conceptualised a multidimensional home-based exercise programme that shall be delivered to the target group through cooperation between GPs and exercise therapists. In order to prepare a randomised controlled trial (RCT), a feasibility study is being conducted. Methods The study is designed as a single arm interventional trial. We plan to recruit 90 patients aged 70 years and above through their GPs. The intervention lasts 12 weeks and consists of physical activity counselling, a home-exercise programme, and exercise consultations provided by an exercise therapist in the GP's practice and via telephone. The exercise programme consists of two main components: 1. a combination of home-exercises to improve strength, flexibility and balance, 2. walking for exercise to improve aerobic capacity. Primary outcome measures are: appraisal by GP, undesirable events, drop-outs, adherence. Secondary outcome measures are: effects (a. motor tests: timed-up-and-go, chair rising, grip strength, tandem stand, tandem walk, sit-and-reach; b. telephone interview: PRISCUS-Physical Activity Questionnaire, Short Form-8 Health Survey, three month recall of frequency of falls, Falls Efficacy Scale), appraisal by participant, exercise performance, focus group discussion. Data analyses will focus on: 1. decision-making concerning the conduction of a RCT, 2. estimation of the effects of the programme, detection of shortcomings and identification of subgroups with contrary results, 3. feedback to participants and to GPs. Conclusion A new cooperation between GPs and exercise therapists to approach community-dwelling seniors and to deliver a home-exercise programme is object of research with regard to feasibility and acceptance. In case of success, an RCT should examine the effects of the programme. A future implementation within primary medical care may take advantage from the flexibility of the programme. Trial registration Current Controlled Trials ISRCTN58562962. PMID:19686587

Additional Language Teaching within the International Baccalaureate Primary Years Programme: A Comparative Study

ERIC Educational Resources Information Center

Lebreton, Marlène

2014-01-01

The International Baccalaureate Primary Years Programme supports the learning of languages and cultures, but the role of the additional language within this programme is often unclear. There remains a great variability in schools regarding the frequency of lessons and the way that the additional language is taught within the Primary Years…

Healthy eating, activity and obesity prevention: a qualitative study of parent and child perceptions in Australia.

PubMed

Hesketh, K; Waters, E; Green, J; Salmon, L; Williams, J

2005-03-01

Preventative health strategies incorporating the views of target participants have improved the likelihood of success. This qualitative study aimed to elicit child and parent views regarding social and environmental barriers to healthy eating, physical activity and child obesity prevention programmes, acceptable foci, and appropriate modes of delivery. To obtain views across a range of social circumstances three demographically diverse primary schools in Victoria, Australia were selected. Children in Grades 2 (aged 7-8 years) and 5 (aged 10-11 years) participated in focus groups of three to six children. Groups were semi-structured using photo-based activities to initiate discussion. Focus groups with established parent groups were also conducted. Comments were recorded, collated, and themes extracted using grounded theory. 119 children and 17 parents participated. Nine themes emerged: information and awareness, contradiction between knowledge and behaviour, lifestyle balance, local environment, barriers to a healthy lifestyle, contradictory messages, myths, roles of the school and family, and timing and content of prevention strategies for childhood obesity. In conclusion, awareness of food 'healthiness' was high however perceptions of the 'healthiness' of some sedentary activities that are otherwise of benefit (e.g. reading) were uncertain. The contradictions in messages children receive were reported to be a barrier to a healthy lifestyle. Parent recommendations regarding the timing and content of childhood obesity prevention strategies were consistent with quantitative research. Contradictions in the explicit and implicit messages children receive around diet and physical activity need to be prevented. Consistent promotion of healthy food and activity choices across settings is core to population prevention programmes for childhood obesity.

Estimating unbiased economies of scale of HIV prevention projects: a case study of Avahan.

PubMed

Lépine, Aurélia; Vassall, Anna; Chandrashekar, Sudha; Blanc, Elodie; Le Nestour, Alexis

2015-04-01

Governments and donors are investing considerable resources on HIV prevention in order to scale up these services rapidly. Given the current economic climate, providers of HIV prevention services increasingly need to demonstrate that these investments offer good 'value for money'. One of the primary routes to achieve efficiency is to take advantage of economies of scale (a reduction in the average cost of a health service as provision scales-up), yet empirical evidence on economies of scale is scarce. Methodologically, the estimation of economies of scale is hampered by several statistical issues preventing causal inference and thus making the estimation of economies of scale complex. In order to estimate unbiased economies of scale when scaling up HIV prevention services, we apply our analysis to one of the few HIV prevention programmes globally delivered at a large scale: the Indian Avahan initiative. We costed the project by collecting data from the 138 Avahan NGOs and the supporting partners in the first four years of its scale-up, between 2004 and 2007. We develop a parsimonious empirical model and apply a system Generalized Method of Moments (GMM) and fixed-effects Instrumental Variable (IV) estimators to estimate unbiased economies of scale. At the programme level, we find that, after controlling for the endogeneity of scale, the scale-up of Avahan has generated high economies of scale. Our findings suggest that average cost reductions per person reached are achievable when scaling-up HIV prevention in low and middle income countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

The impact of a home-based walking programme on falls in older people: the Easy Steps randomised controlled trial.

PubMed

Voukelatos, Alexander; Merom, Dafna; Sherrington, Catherine; Rissel, Chris; Cumming, Robert G; Lord, Stephen R

2015-05-01

walking is the most popular form of exercise in older people but the impact of walking on falls is unclear. This study investigated the impact of a 48-week walking programme on falls in older people. three hundred and eighty-six physically inactive people aged 65+ years living in the community were randomised into an intervention or control group. The intervention group received a self-paced, 48-week walking programme that involved three mailed printed manuals and telephone coaching. Coinciding with the walking programme manual control group participants received health information unrelated to falls. Monthly falls calendars were used to monitor falls (primary outcome) over 48 weeks. Secondary outcomes were self-reported quality of life, falls efficacy, exercise and walking levels. Mobility, leg strength and choice stepping reaction time were measured in a sub-sample (n = 178) of participants. there was no difference in fall rates between the intervention and control groups in the follow-up period (IRR = 0.88, 95% CI: 0.60-1.29). By the end of the study, intervention group participants spent significantly more time exercising in general, and specifically walking for exercise (median 1.69 versus 0.75 h/week, P < 0.001). our finding that a walking programme is ineffective in preventing falls supports previous research and questions the suitability of recommending walking as a fall prevention strategy for older people. Walking, however, increases physical activity levels in previously inactive older people. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

HIV testing in Europe: Evaluating the impact, added value, relevance and usability of the European Centre for Disease Prevention and Control (ECDC)'s 2010 HIV testing guidance.

PubMed

Sullivan, Ann K; Sperle, Ida; Raben, Dorthe; Amato-Gauci, Andrew J; Lundgren, Jens Dilling; Yazdanpanah, Yazdan; Jakobsen, Stine Finne; Tavoschi, Lara

2017-11-01

An evaluation of the 2010 ECDC guidance on HIV testing, conducted in October 2015-January 2016, assessed its impact, added value, relevance and usability and the need for updated guidance. Data sources were two surveys: one for the primary target audience (health policymakers and decision makers, national programme managers and ECDC official contact points in the European Union/European Economic Area (EU/EEA) countries and one for a broader target audience (clinicians, civil society organisations and international public health agencies); two moderated focus group discussions  (17 participants each); webpage access data; a literature citation review; and an expert consultation (18 participants) to discuss the evaluation findings. Twenty-three of 28 primary target audience and 31 of 51 broader target audience respondents indicated the guidance was the most relevant when compared with other international guidance. Primary target audience respondents in 11 of 23 countries reported that they had used the guidance in development, monitoring and/or evaluation of their national HIV testing policy, guidelines, programme and/or strategy, and 29 of 51 of the broader target audience respondents reported having used the guidance in their work. Both the primary and broader target audience considered it important or very important to have an EU/EEA-level HIV testing guidance (23/28 and 46/51, respectively). The guidance has been widely used to develop policies, guidelines, programmes and strategies in the EU/EEA and should be regularly updated due to continuous developments in the field in order to continue to serve as an important reference guidance in the region.

HIV testing in Europe: Evaluating the impact, added value, relevance and usability of the European Centre for Disease Prevention and Control (ECDC)’s 2010 HIV testing guidance

PubMed Central

Sullivan, Ann K; Sperle, Ida; Raben, Dorthe; Amato-Gauci, Andrew J; Lundgren, Jens Dilling; Yazdanpanah, Yazdan; Jakobsen, Stine Finne; Tavoschi, Lara

2017-01-01

Background: An evaluation of the 2010 ECDC guidance on HIV testing, conducted in October 2015–January 2016, assessed its impact, added value, relevance and usability and the need for updated guidance. Methods: Data sources were two surveys: one for the primary target audience (health policymakers and decision makers, national programme managers and ECDC official contact points in the European Union/European Economic Area (EU/EEA) countries and one for a broader target audience (clinicians, civil society organisations and international public health agencies); two moderated focus group discussions  (17 participants each); webpage access data; a literature citation review; and an expert consultation (18 participants) to discuss the evaluation findings. Results: Twenty-three of 28 primary target audience and 31 of 51 broader target audience respondents indicated the guidance was the most relevant when compared with other international guidance. Primary target audience respondents in 11 of 23 countries reported that they had used the guidance in development, monitoring and/or evaluation of their national HIV testing policy, guidelines, programme and/or strategy, and 29 of 51 of the broader target audience respondents reported having used the guidance in their work. Both the primary and broader target audience considered it important or very important to have an EU/EEA-level HIV testing guidance (23/28 and 46/51, respectively). Conclusion: The guidance has been widely used to develop policies, guidelines, programmes and strategies in the EU/EEA and should be regularly updated due to continuous developments in the field in order to continue to serve as an important reference guidance in the region. PMID:29208158

Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean.

PubMed

Kelly, J A; Somlai, A M; Benotsch, E G; Amirkhanian, Y A; Fernandez, M I; Stevenson, L Y; Sitzler, C A; McAuliffe, T L; Brown, K D; Opgenorth, K M

2006-01-01

This study assessed the programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in 75 countries in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. Multiple databases and expert recommendations were used to identify one major HIV-prevention NGO in the capital or a large city in each country, and in-depth interviews were conducted with each NGO Director. Most NGOs are carrying out their programmes with minimal funding and few regularly employed personnel. Most are highly dependent on international donors, but reliance on small grants with short funding periods limits programme development capacity. HIV-prevention activities varied by region, with African NGOs most likely to use peer education and community awareness events; Eastern European NGOs most likely to offer needle exchange; Latin American NGOs to have resource centres and offer risk reduction programmes; and Caribbean organizations to use mass education approaches. Across regions, NGOs most often targeted the general public and youth, although specialized at-risk groups were the additional focus of attention in some regions. Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers to new HIV-prevention programmes. NGOs are critical service providers. However, their funding, programmes, and resource capacities must be strengthened if NGOs are to realize their full potential in HIV prevention.

Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean

PubMed Central

KELLY, J. A.; SOMLAI, A. M.; BENOTSCH, E. G.; AMIRKHANIAN, Y. A.; FERNANDEZ, M. I.; STEVENSON, L. Y.; SITZLER, C. A.; MCAULIFFE, T. L.; BROWN, K. D.; OPGENORTH, K. M.

2008-01-01

This study assessed the programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in 75 countries in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. Multiple databases and expert recommendations were used to identify one major HIV-prevention NGO in the capital or a large city in each country, and in-depth interviews were conducted with each NGO Director. Most NGOs are carrying out their programmes with minimal funding and few regularly employed personnel. Most are highly dependent on international donors, but reliance on small grants with short funding periods limits programme development capacity. HIV-prevention activities varied by region, with African NGOs most likely to use peer education and community awareness events; Eastern European NGOs most likely to offer needle exchange; Latin American NGOs to have resource centres and offer risk reduction programmes; and Caribbean organizations to use mass education approaches. Across regions, NGOs most often targeted the general public and youth, although specialized at-risk groups were the additional focus of attention in some regions. Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers to new HIV-prevention programmes. NGOs are critical service providers. However, their funding, programmes, and resource capacities must be strengthened if NGOs are to realize their full potential in HIV prevention. PMID:16282071

The management of cardiovascular disease in the Netherlands: analysis of different programmes

PubMed Central

Cramm, Jane M.; Tsiachristas, Apostolos; Walters, Bethany H.; Adams, Samantha A.; Bal, Roland; Huijsman, Robbert; Rutten-Van Mölken, Maureen P.M.H.; Nieboer, Anna P.

2013-01-01

Background Disease management programmes are increasingly used to improve the efficacy and effectiveness of chronic care delivery. But, disease management programme development and implementation is a complex undertaking that requires effective decision-making. Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability. Methods To increase our understanding of the choices that primary healthcare practices face when implementing such programmes and to stimulate successful implementation and sustainability, we compared the early implementation of eight cardiovascular disease management programmes initiated and managed by healthcare practices in various regions of the Netherlands. Using a mixed-methods design, we identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management level, healthcare utilisation costs, development costs and health-related quality of life. Results Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable implementation of cardiovascular disease management programmes, although development costs of the individual programmes varied considerably in relation to the length of the development period. The large number of professionals involved in combination with duration of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new care pathways did not directly contribute to higher costs, delays in implementation indirectly did. Conclusions Developing and implementing cardiovascular disease management programmes is time-consuming and challenging. Multidisciplinary, patient-centred care demands multifaceted changes in routine care. As care pathways become more complex, they also become more expensive. Better preparedness and training can prevent unnecessary delays during the implementation period and are crucial to reducing costs. PMID:24167456

The management of cardiovascular disease in the Netherlands: analysis of different programmes.

PubMed

Cramm, Jane M; Tsiachristas, Apostolos; Walters, Bethany H; Adams, Samantha A; Bal, Roland; Huijsman, Robbert; Rutten-Van Mölken, Maureen P M H; Nieboer, Anna P

2013-01-01

Disease management programmes are increasingly used to improve the efficacy and effectiveness of chronic care delivery. But, disease management programme development and implementation is a complex undertaking that requires effective decision-making. Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability. To increase our understanding of the choices that primary healthcare practices face when implementing such programmes and to stimulate successful implementation and sustainability, we compared the early implementation of eight cardiovascular disease management programmes initiated and managed by healthcare practices in various regions of the Netherlands. Using a mixed-methods design, we identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management level, healthcare utilisation costs, development costs and health-related quality of life. Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable implementation of cardiovascular disease management programmes, although development costs of the individual programmes varied considerably in relation to the length of the development period. The large number of professionals involved in combination with duration of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new care pathways did not directly contribute to higher costs, delays in implementation indirectly did. Developing and implementing cardiovascular disease management programmes is time-consuming and challenging. Multidisciplinary, patient-centred care demands multifaceted changes in routine care. As care pathways become more complex, they also become more expensive. Better preparedness and training can prevent unnecessary delays during the implementation period and are crucial to reducing costs.

Effectiveness of an NGO primary health care programme in rural Bangladesh: evidence from the management information system.

PubMed

Mercer, Alec; Khan, Mobarak Hossain; Daulatuzzaman, Muhammad; Reid, Joanna

2004-07-01

This paper considers evidence of the effectiveness of a non-governmental organization (NGO) primary health care programme in rural Bangladesh. It is based on data from the programme's management information system reported by 27 partner NGOs from 1996-2002. The data indicate relatively high coverage has been achieved for reproductive and child health services, as well as lower infant and child mortality. On the basis of a crude indicator of socio-economic status, the programme is poverty-focused. There is good service coverage among the poorest one-third and others, and the infant and child mortality differential has been eliminated over recent years. A rapid decline in infant mortality among the poorest from 1999-2002 reflects a reduction in neonatal mortality of about 50%. Allowing for some under-reporting and possible misclassification of deaths to the stillbirths category, neonatal mortality is relatively low in the NGO areas. The lower child and maternal mortality for the NGO areas combined, compared with estimates for Bangladesh in recent years, may at least in part be due to high coverage of reproductive and child health services. Other development programmes implemented by many of the NGOs could also have contributed. Despite the limited resources available, and the lower infant and child mortality already achieved, there appears to be scope for further prevention of deaths, particularly those due to birth asphyxia, acute respiratory infection, diarrhoeal disease and accidents. Maternal mortality in the NGO areas was lower in 2000-02 than the most recent estimate for Bangladesh. Further reduction is likely to depend on improved access to qualified community midwives and essential obstetric care at government referral facilities.

The feasibility of using a parenting programme for the prevention of unintentional home injuries in the under-fives: a cluster randomised controlled trial.

PubMed

Mytton, Julie; Ingram, Jenny; Manns, Sarah; Stevens, Tony; Mulvaney, Caroline; Blair, Peter; Powell, Jane; Potter, Barbara; Towner, Elizabeth; Emond, Alan; Deave, Toity; Thomas, James; Kendrick, Denise; Stewart-Brown, Sarah

2014-01-01

Unintentional injury is the leading cause of preventable death of children over the age of 1 year in the UK and a major cause of attendance at emergency departments. Children having one injury are at increased risk of further injuries. Parenting programmes can reduce injuries in preschool children if delivered in the home and on a one-to-one basis. It is not known if group-based programmes delivered outside the home are effective. To develop (1) a parenting programme to prevent recurrent unintentional home injuries in preschool children and (2) a tool for parents to report unintentional home injuries occurring to their preschool children. To assess the feasibility of delivering and evaluating the parenting programme through a cluster randomised controlled trial, specifically to (1) assess methods for the recruitment and retention of parents; (2) determine the training, equipment and facilities needed for the delivery of the programme; (3) establish appropriate primary and secondary outcome measures and methods for their collection; (4) determine how 'normal care' in a comparison arm should be defined; and (5) determine the resource utilisation and costing data that would need to be collected for the cost-effectiveness component of a future trial; and (6) produce estimates of effect sizes to inform sample size estimation for a main trial. Feasibility multicentre, cluster, randomised, unblinded trial. Eight children's centres in Bristol and Nottingham, UK. Ninety-six parents of preschool children who had sustained an unintentional injury requiring medical attention in the previous 12 months. The First-aid Advice and Safety Training (FAST) parent programme, comprising parenting support and skills combined with first aid and home safety advice. Parent-reported medically attended injuries in the index child and any preschool siblings sustained during a 6-month period of observation. An 8-week parenting programme was produced, designed with participant-friendly, incrementally progressive content. A slimline, month-to-a-view injury calendar, spiral bound and suitable for hanging on a wall, was designed for parents to record injuries occurring to their preschool children during the 6-month period of observed time. Fifty-one parents were recruited (40 meeting eligibility criteria plus 11 following 'open invite' to participate); 15 parents completed the FAST parent programme and 49 provided data at baseline and during follow-up. Completion of the programme was significantly greater for participants using the 'open invite' approach (85%) than for those recruited using the original eligibility criteria (31%). Prototype resource use checklists, unit costs and total costs were developed for phases 0, 1 and 2 of the study for use in a future trial. This feasibility study has developed an innovative injury prevention intervention and a tool to record parent-reported injuries in preschool children. It was not feasible to recruit parents of children who had sustained a recent injury, or to ask health visitor teams to identify potential participants and to deliver the programme. A trial should target all families attending children's centres in disadvantaged areas. The intervention could be delivered by a health professional supported by a member of the children's centre team in a community setting. Current Controlled Trials ISRCTN03605270. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 3. See the NIHR Journals Library website for further project information.

Introducing a quality improvement programme to primary healthcare teams

PubMed Central

Hearnshaw, H.; Reddish, S.; Carlyle, D.; Baker, R.; Robertson, N.

1998-01-01

OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes. PMID:10339022

Can Education Innovations Be Sustained after the End of Donor Funding? The Case of a Reading Intervention Programme in Zambia

ERIC Educational Resources Information Center

Kombe, Charity Lengwe Meki Kombe; Herman, Chaya

2017-01-01

This article explores the sustainability of donor-supported innovations in the education sector. Accordingly, a case study was conducted of a programme (Primary Reading Programme) implemented in Zambian primary schools which was intended to improve literacy levels. The programme was initially supported by the Department for International…

[How do Prevention Projects Reach their Target Groups? Results of a Survey with Prevention Projects].

PubMed

Brand, T; Böttcher, S; Jahn, I

2015-12-01

 The aim of this study was to assess methods used to access target groups in prevention projects funded within the prevention research framework by the German Federal Ministry of Education and Research.  A survey with prevention projects was conducted. Access strategies, communication channels, incentives, programme reach, and successful practical recruitment strategies were explored.  38 out of 60 projects took part in the survey. Most projects accessed their target group within structured settings (e. g., child day-care centers, schools, workplaces). Multiple communication channels and incentives were used, with written information and monetary incentives being used most frequently. Only few projects were able to report their programme reach adequately; programme reach was highest for programmes accessing the target groups in structured settings. The respondents viewed active recruitment via personal communication with the target group and key persons in the settings as the most successful strategy.  The paper provides an overview on recruitment strategies used in current preven-tion projects. More systematic research on programme reach is necessary. © Georg Thieme Verlag KG Stuttgart · New York.

"Mathematics in the Workplace": A Pilot Enrichment Programme for Mathematically Talented Primary Students in Hong Kong

ERIC Educational Resources Information Center

Kwan, Anderson C. K.; Yuen, Mantak

2013-01-01

The authors report on the implementation of an enrichment programme titled "Mathematics in the Workplace" for mathematically talented students, aged 8 to 12 years, who were studying in Primary 3 to Primary 6 classes in Hong Kong. The aim of the pilot programme was to enable gifted learners to make connections between mathematics and its…

Influence of Retraining Programme on Self-Esteem of Primary School Teachers in Ebonyi State of Nigeria

ERIC Educational Resources Information Center

Igbo, Janet N.; Eze, Justina U.; Eskay, M.; Onu, V. C.; Omeje, J.

2012-01-01

This study investigated the influence of retraining programme on self-esteem of primary school teachers in Ebonyi State of Nigeria. The study was guided by one research question and a null hypothesis. A purposively selected sample of 775 primary school teachers who attended capacity building retraining programme provided the data collected using…

Primary Science Curriculum Development in Africa--Strategies, Problems and Prospects with Particular Reference to the African Primary Science Programme.

ERIC Educational Resources Information Center

Bajah, Sam Tunde

1981-01-01

The African Primary Science Programme (APSP) was one of the three major projects in Africa sponsored by Educational Services Incorporated (ESI), later the Educational Development Center (EDC), Newton, Massachusetts. The problems of introducing this programme in the anglophone African States and its implications for science education are discussed.…

Optics outreach in Irish context

NASA Astrophysics Data System (ADS)

McHugh, Emer; Smith, Arlene

2009-06-01

The Applied Optics Group, National University of Ireland Galway is a research centre involved in programmes that cover a wide variety of topics in applied optics and imaging science, including smart optics, adaptive optics, optical scattering and propagation, and engineering optics. The Group have also developed significant outreach programmes both in Primary and Post-Primary schools. It is recognised that there is a need for innovation in Science Education in Ireland and we are committed to working extensively with schools. The main aim of these outreach programmes is to increase awareness and interest in science with students and enhance the communication skills of the researchers working in the Group. The education outreach team works closely with the relevant teachers in both Primary and Post-Primary schools to design and develop learning initiatives to match the needs of the target group of students. The learning programmes are usually delivered in the participating schools during normal class time by a team of Applied Optics specialists. We are involved in running these programmes in both Primary and Post-Primary schools where the programmes are tailored to the curriculum and concentrating on optics and light. The students may also visit the Groups research centre where presentations and laboratory tours are arranged.

[Prevention among migrants: Participation, migrant sensitive strategies and programme characteristics].

PubMed

Brand, T; Kleer, D; Samkange-Zeeb, F; Zeeb, Hajo

2015-06-01

Health promotion and prevention can contribute to a long, healthy life in populations both with and without migrant background. This paper provides an overview on migrant participation in prevention programmes in Germany. Furthermore, we describe migrant sensitive prevention strategies and characteristics of prevention programmes for migrants in Germany. With regard to participation in prevention programmes, lower vaccination rates are found among children and adolescents who migrated to Germany after birth. Among adults with a migrant background, we found lower participation in general health check-ups, oral health check-ups, cancer screening programs and influenza vaccination. Migrant sensitive prevention strategies address the visual style of the material, a target group specific risk communication, language requirements, a systematic involvement of the target group, and the recognition of deeply rooted sociocultural practices and beliefs. On analyzing a large database on prevention programs in Germany, we found only a few programmes that were exclusively targeted to migrant groups (0.6%). In 16.6% of the programs migrants were addressed as the target group among others. Compared to general population programs, programs for migrants were more often exclusively directed towards girls or women. Moreover, programs for migrants used community-based approaches more often and addressed different age groups. Although information on migrant participation in prevention programs and utilization of migrant sensitive strategies is still incomplete, we can assume that there is a need for diversity-oriented, migrant sensitive prevention.

Coaches' perspectives on implementing an evidence-informed injury prevention programme in junior community netball.

PubMed

Saunders, N; Otago, L; Romiti, M; Donaldson, A; White, P; Finch, Cf

2010-12-01

For effective sports injury prevention, information is needed about the implementation context for interventions. This study describes coaches' feedback on the implementation of an evidence-informed injury prevention programme in community junior netball using coaches' perceptions and the RE-AIM framework. A lower-limb injury prevention programme (Down to Earth; D2E), for teaching safe-landing techniques, was delivered to 31 coaches from 31 junior community netball teams in a 1-h workshop. Coaches then delivered a 6-week programme at team training sessions starting in the week before the competition season commenced. 65% of coaches completed a feedback survey 17 weeks after they had delivered the programme. Most (88%) coaches believed that D2E improved their players' ability to perform correct landing techniques in games and that players had retained these improvements over the season. The majority (83%) indicated that an improvement in player athletic attributes was the greatest advantage of D2E, followed by a reduction in injury risk. Identified barriers to implementing D2E were running out of time and very young players finding the drills too difficult. Coaches reported that they needed more ideas for training drills that could be incorporated into their programmes and believed that their own coaching training did not adequately prepare them to implement an injury prevention programme. Although coaches believed that D2E was effective in developing correct landing techniques, some modifications are needed to make it more suitable for younger players and coach education by accreditation courses could be improved to support the implementation of injury prevention programmes.

Effects of a suicide prevention programme for hospitalised patients with mental illness in South Korea.

PubMed

Jun, Won Hee; Lee, Eun Ju; Park, Jeong Soon

2014-07-01

To investigate the effects of a suicide prevention programme on the levels of depression, self-esteem, suicidal ideation and spirituality in patients with mental illness. Instances of suicide have significant correlations with depression, low self-esteem, suicidal ideation and a low level of spirituality in the victims. Therefore, addressing depression, low self-esteem and suicidal ideation as suicide risk factors and increasing levels of spirituality can constitute an effective programme to prevent suicide among patients with mental illness. The study was a quasi-experimental study with a nonequivalent control group, nonsynchronised design. The study sample consisted of 45 patients with mental illness who had been admitted to the psychiatric unit in a university hospital in South Korea. The patients were assigned to control and experimental groups of 23 and 22 members, respectively. The suicide prevention programme was conducted with the experimental group over four weeks and included eight sessions (two per week). The control group received only routine treatments in the hospital. The experimental group that participated in the programme had significantly decreased mean scores for depression and suicidal ideation compared with the control group. However, there were no significant differences in the mean scores for self-esteem and spirituality between the groups. The suicide prevention programme might be usefully applied as a nursing intervention for patients hospitalised in psychiatric wards or clinics where the goals are to decrease depression and suicidal ideation. Typical treatments for hospitalised patients with mental illness are not enough to prevent suicide. Intervention for suicide prevention needs to apply an integrated approach. The suicide prevention programme using an integrated approach is more effective in reducing depression and suicidal ideation in patients with mental illness than applying routine treatments in the hospital. © 2013 John Wiley & Sons Ltd.

Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey.

PubMed

Soban, Lynn M; Kim, Linda; Yuan, Anita H; Miltner, Rebecca S

2017-09-01

To describe the presence and operationalisation of organisational strategies to support implementation of pressure ulcer prevention programmes across acute care hospitals in a large, integrated health-care system. Comprehensive pressure ulcer programmes include nursing interventions such as use of a risk assessment tool and organisational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programmes. Data were collected by an e-mail survey to all chief nursing officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarise survey responses and evaluate relationships between some variables. Organisational strategies that support implementation of a pressure ulcer prevention programme (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalised within individual hospitals. Organisational strategies to support implementation of pressure ulcer preventive programmes are often not optimally operationalised to achieve consistent, sustainable performance. The results of the present study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Youth, Terrorism and Education: Britain's Prevent Programme

ERIC Educational Resources Information Center

Thomas, Paul

2016-01-01

Since the 7/7 bombings of July 2005, Britain has experienced a domestic terror threat posed by a small minority of young Muslims. In response, Britain has initiated "Prevent," a preventative counter-terrorism programme. Building on previous, general critiques of Prevent, this article outlines and critically discusses the ways in which…

Cognitive and physical resources are important in order to complete a geriatric fall prevention programme.

PubMed

Kirchhoff, Marianne; Damgaard, Kirsten

2016-01-01

It is well documented that falls may be prevented, but effectiveness in reducing the risk of falling depends on the uptake of and the adherence to preventive actions. 65+-year-old fallers identified by screening for fall risk were offered referral to a geriatric fall clinic together with fallers referred from general practitioners (GPs). They were assessed to identify individual risk factors for falling, and appropriate interventions were planned, including exercise classes. A total of 811 persons were identified by screening, 342 of whom accepted referral. Furthermore, 176 were referred from GPs. Only 402 of 518 fallers attended the clinic. A total of 65 dropped out by their own request, 29 stopped because they became seriously ill or died. Another 62 patients were discharged before fulfilling the programme as they were unable to participate due to physical or cognitive problems. Indicators of cessation were cognitive or physical weakness. Geriatric fall prevention is resource-consuming both in terms of staff needed and with respect to demands made on the patients, and the frailest part of the fall population cannot comply. It is necessary to differentiate fall prevention services for the population of elderly fallers as interventions in primary healthcare have been shown to be more effective among the most frail elderly fallers. The project received funding from the Danish Ministry of the Interior and Health and from The Fund for Scientific Work in the Geriatric Field within the former Copenhagen Hospital Corporation. not relevant.

Cost-Effectiveness of School-Based Prevention of Cannabis Use.

PubMed

Deogan, Charlotte; Zarabi, Natalie; Stenström, Nils; Högberg, Pi; Skärstrand, Eva; Manrique-Garcia, Edison; Neovius, Kristian; Månsdotter, Anna

2015-10-01

Cannabis is the most frequently used illicit drug globally. Despite increasing evidence that cannabis use is associated with adverse health effects, the knowledge on preventative strategies is still limited. This study stemmed from a systematic review of effective prevention in which school-based programmes were identified as promising. The primary objective was to evaluate the cost effectiveness of Project ALERT (Adolescent, Learning, Experiences, Resistance, and Training), compared with ordinary ATOD (Alcohol, Tobacco, and Other Drug) education, among Swedish students in the eighth grade of compulsory school. The cost-effectiveness analysis was performed from the societal perspective with quality-adjusted life-years (QALYs) as an outcome (willingness-to-pay threshold €50,000) and follow-up periods from 1 year to a lifetime, considering a discounting rate of 3%, and with costs inflated to 2013 levels. A Markov model was constructed on the basis of the 'states' of single use, regular use, daily use and use of other illicit drugs, which were associated with 'complications' of psychosis, schizophrenia, traffic accidents, depression and amotivational syndrome. Health and cost consequences were linked to both states and complications. The programme was cost saving on the basis of evidence from the USA (ratio 1:1.1), and was cost effective (incremental cost-effectiveness ratio €22,384 per QALY) after reasonable adjustment for the Swedish context and with 20 years of follow-up. When the target group was restricted to boys who were neither studying nor working/doing work experience, the programme was cost effective after 9 years and cost saving (ratio 1:3.2) after 20 years. School-based prevention such as Project ALERT has the potential to be cost effective and to be cost saving if implemented in deprived areas. In the light of the shifting landscape regarding legalization of cannabis, it seems rational to continue the health economic analysis of prevention initiated here.

A police education programme to integrate occupational safety and HIV prevention: protocol for a modified stepped-wedge study design with parallel prospective cohorts to assess behavioural outcomes

PubMed Central

Strathdee, Steffanie A; Arredondo, Jaime; Rocha, Teresita; Abramovitz, Daniela; Rolon, Maria Luisa; Patiño Mandujano, Efrain; Rangel, Maria Gudelia; Olivarria, Horcasitas Omar; Gaines, Tommi; Patterson, Thomas L; Beletsky, Leo

2015-01-01

Introduction Policing practices are key drivers of HIV among people who inject drugs (PWID). This paper describes the protocol for the first study to prospectively examine the impact of a police education programme (PEP) to align law enforcement and HIV prevention. PEPs incorporating HIV prevention (including harm reduction programmes like syringe exchange) have been successfully piloted in several countries but were limited to brief pre–post assessments; the impact of PEPs on policing behaviours and occupational safety is unknown. Objectives Proyecto ESCUDO (SHIELD) aims to evaluate the efficacy of the PEP on uptake of occupational safety procedures, as assessed through the incidence of needle stick injuries (NSIs) (primary outcome) and changes in knowledge of transmission, prevention and treatment of HIV and viral hepatitis; attitudes towards PWID, adverse behaviours that interfere with HIV prevention and protective behaviours (secondary outcomes). Methods/analysis ESCUDO is a hybrid type I design that simultaneously tests an intervention and an implementation strategy. Using a modified stepped-wedge design involving all active duty street-level police officers in Tijuana (N=∼1200), we will administer one 3 h PEP course to groups of 20–50 officers until the entire force is trained. NSI incidence and geocoded arrest data will be assessed from department-wide de-identified data. Of the consenting police officers, a subcohort (N=500) will be randomly sampled from each class to undergo pre-PEP and post-PEP surveys with a semiannual follow-up for 2 years to assess self-reported NSIs, attitudes and behaviour changes. The impact on PWIDs will be externally validated through a parallel cohort of Tijuana PWIDs. Ethics/dissemination Research ethics approval was obtained from the USA and Mexico. Findings will be disseminated through open access to protocol materials through the Law Enforcement and HIV Network. Trial registration number NCT02444403. PMID:26260350

6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial

PubMed Central

Morello, Renata T; Wolfe, Rory; Brand, Caroline A; Haines, Terry P; Hill, Keith D; Brauer, Sandra G; Botti, Mari; Cumming, Robert G; Livingston, Patricia M; Sherrington, Catherine; Zavarsek, Silva; Lindley, Richard I; Kamar, Jeannette

2016-01-01

Objective To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. Design Cluster randomised controlled trial. Setting Six Australian hospitals. Participants All patients admitted to 24 acute wards during the trial period. Interventions Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: “falls alert” sign, supervision of patients in the bathroom, ensuring patients’ walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. Main outcome measures The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. Results During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients’ characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. Conclusions Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12611000332921. PMID:26813674

A pressure ulcer prevention programme specially designed for nursing homes: does it work?

PubMed

Kwong, Enid W-Y; Lau, Ada T-Y; Lee, Rainbow L-P; Kwan, Rick Y-C

2011-10-01

The aim of this study was to evaluate a pressure ulcer prevention programme for nursing homes to ascertain the feasibility of its implementation, impact on care staff and outcomes for pressure ulcer knowledge and skills and pressure ulcer reduction. No pressure ulcer prevention protocol for long-term care settings has been established to date. The first author of this study thus developed a pressure ulcer prevention programme for nursing homes. A quasi-experimental pretest and post-test design was adopted. Forty-one non-licensed care providers and eleven nurses from a government-subsidised nursing home voluntarily participated in the study. Knowledge and skills of the non-licensed care providers were assessed before, immediately after and six weeks after the training course, and pressure ulcer prevalence and incidence were recorded before and during the protocol implementation. At the end of the programme implementation, focus group interviews with the subjects were conducted to explore their views on the programme. A statistically significant improvement in knowledge and skills scores amongst non-licensed care providers was noted. Pressure ulcer prevalence and incidence rates dropped from 9-2·5% and 2·5-0·8%, respectively, after programme implementation. The focus group findings indicated that the programme enhanced the motivation of non-licensed care providers to improve their performance of pressure ulcer prevention care and increased communication and cooperation amongst care staff, but use of the modified Braden scale was considered by nurses to increase their workload. A pressure ulcer prevention programme for nursing homes, which was feasible and acceptable, with positive impact and outcome in a nursing home was empirically developed. The study findings can be employed to modify the programme and its outcomes for an evaluation of effectiveness of the programme through a randomised controlled trial. © 2011 Blackwell Publishing Ltd.

Men's perspectives on fall risk and fall prevention following participation in a group-based programme conducted at Men's Sheds, Australia.

PubMed

Liddle, Jeannine L M; Lovarini, Meryl; Clemson, Lindy M; Jang, Haeyoung; Willis, Karen; Lord, Stephen R; Sherrington, Catherine

2017-05-01

Research on older men's views regarding fall prevention is limited. The purpose of this qualitative study was to explore the experiences and perspectives of older men regarding fall risk and prevention so that fall prevention programmes can better engage older men. Eleven men who had taken part in a group-based fall prevention programme called Stepping On conducted at Men's Sheds in Sydney, Australia, participated in semi-structured interviews during June and July 2015 which were audio-recorded and transcribed. Data were coded and analysed using constant comparative methods. Over-arching theoretical categories were developed into a conceptual framework linking programme context and content with effects of programme participation on men. Men's Sheds facilitated participation in the programme by being inclusive, male-friendly places, where Stepping On was programmed into regular activities and was conducted in an enjoyable, supportive atmosphere. Programme content challenged participants to think differently about themselves and their personal fall risk, and provided practical options to address fall risk. Two major themes were identified: adjusting the mindset where men adopted a more cautious mindset paying greater attention to potential fall risks, being careful, concentrating and slowing down; and changing the ways where men acted purposefully on environmental hazards at home and incorporated fall prevention exercises into their routine schedules. Practitioners can engage and support older men to address falls by better understanding men's perspectives on personal fall risk and motivations for action. © 2016 John Wiley & Sons Ltd.

The cervical cancer prevention programme in Costa Rica

PubMed Central

Rojas, Ileana Quirós

2015-01-01

Cervical and uterine cancer continues to be an important issue for women around the world, although neoplasia has the greatest demonstrated potential for prevention. Costa Rica has achieved important advances in the reduction of the incidence and mortality of these cancers since the last century. This is the result of a series of policies, programmes, and plans, not only at the level of the health care system, but also in other areas. Increased access for women to care in health centres, fundamentally at the primary level, has been vital, as has ensuring the quality of cytology readings and access to diagnosis and treatment for precursor lesions for in situ and invasive cancers. Despite all of these achievements, there are still challenges to be overcome, which are widespread in many countries in Latin America and the Caribbean. It is important to learn from the experiences of other countries in order to improve women’s health not only as a health objective, but also as an ethical imperative to promote the exercise of women’s rights to life and health. PMID:26557876

Integrating GDM management in public health: Pakistan perspective.

PubMed

Riaz, Musarrat; Basit, Abdul

2016-09-01

Pakistan is a developing country with diverse social, economic and cultural dimensions along with limited resources. Non communicable diseases (NCDS) including diabetes are highly prevalent compromising the already challenged health care system. Gestational diabetes mellitus (GDM) with its associated maternal and foetal complications is increasing with rapidly changing lifestyle pattern. Since Pakistan has limited resources and other health issues compete strongly with gestational diabetes initiatives, the most feasible strategy will be the horizontal integration. This will work with the existing primary health care system integrating NCD control programmes with Maternal and Child health (MCH) programmes. Utilizing the existing health care system is the only implementable cost effective strategy. Antenatal screening and treatment of GDM alone is not sufficient but Post-partum screening (PPS) of women with GDM is an important strategy for prevention of diabetes as the conversion rates of GDM to type 2 diabetes are high. Furthermore, instead of perceiving GDM as a temporary reversible clinical entity, it should be considered as a trans-generational prevention of diabetes that needs to be addressed as a public health issue in order to improve maternal and foetal health.

Reducing HIV infection in people who inject drugs is impossible without targeting recently-infected subjects

PubMed Central

Vasylyeva, Tetyana I.; Friedman, Samuel R.; Lourenco, Jose; Gupta, Sunetra; Hatzakis, Angelos; Pybus, Oliver G.; Katzourakis, Aris; Smyrnov, Pavlo; Karamitros, Timokratis; Paraskevis, Dimitrios; Magiorkinis, Gkikas

2016-01-01

Objective: Although our understanding of viral transmission among people who inject drugs (PWID) has improved, we still know little about when and how many times each injector transmits HIV throughout the duration of infection. We describe HIV dynamics in PWID to evaluate which preventive strategies can be efficient. Design: Due to the notably scarce interventions, HIV-1 spread explosively in Russia and Ukraine in 1990s. By studying this epidemic between 1995 and 2005, we characterized naturally occurring transmission dynamics of HIV among PWID. Method: We combined publicly available HIV pol and env sequences with prevalence estimates from Russia and Ukraine under an evolutionary epidemiology framework to characterize HIV transmissibility between PWID. We then constructed compartmental models to simulate HIV spread among PWID. Results: In the absence of interventions, each injector transmits on average to 10 others. Half of the transmissions take place within 1 month after primary infection, suggesting that the epidemic will expand even after blocking all the post–first month transmissions. Primary prevention can realistically target the first month of infection, and we show that it is very efficient to control the spread of HIV-1 in PWID. Treating acutely infected on top of primary prevention is notably effective. Conclusion: As a large proportion of transmissions among PWID occur within 1 month after infection, reducing and delaying transmissions through scale-up of harm reduction programmes should always form the backbone of HIV control strategies in PWID. Growing PWID populations in the developing world, where primary prevention is scarce, constitutes a public health time bomb. PMID:27824626

Child oral health concerns amongst parents and primary care givers in a Sure Start local programme.

PubMed

Daly, B; Clarke, W; McEvoy, W; Periam, K; Zoitopoulos, L

2010-09-01

To conduct an oral health promotion needs assessment amongst parents and primary care givers of pre-school children in a South East London Sure Start Local Programme (SSLP). To explore the oral health concerns and oral health literacy with regard to children's oral health amongst parents and primary care givers in a South East London SSLP. A qualitative study using four in-depth focus groups with a purposive sample of 20 participants. Data were analysed using the framework method. The SSLP was identified as an important source of information, support and social interaction for participants. Participants rated the informal networks of the programme as equally authoritative as other formal sources of information. Oral health concerns included: introducing healthy eating, establishing tooth brushing, teething and access to dental care. While participants had adequate knowledge of how to prevent oral disease they cited many barriers to acting on their knowledge which included: parents' tiredness, lack of confidence in parenting skills, confusing information, widespread availability of sugary foods and drinks, and lack of local child friendly dentists. Parenting skills and the social support provided by the SSLP appeared to be integral to the introduction of positive oral health behaviours. SSLPs were seen as a trusted source of support and information for carers of pre-school children. Integration of oral health promotion into SSLPs has the potential to tap into early interventions which tackle the wider support needs of carers of pre-school children while also supporting the development of positive oral health behaviours.

A bird's eye view of PMTCT coverage at two regional hospitals and their referral clinics in a resource-limited setting.

PubMed

Moodley, Dhayendre; Srikewal, Jyothi; Msweli, Lindiwe; Maharaj, Niren R

2011-02-01

While countries strengthen their health information systems, local health managers require alternative strategies to monitor their prevention of mother-to-child transmission (PMTCT) programmes to improve coverage and service delivery. To demonstrate the use of a postpartum audit to establish PMTCT coverage and programme deficiencies at hospitals and multiple primary health care facilities. A cross-sectional hospital-based medical chart audit of pregnant women admitted in labour to their regional hospital. Their antenatal hand-held medical records were added to a hospital-issued maternity chart that was used to record further obstetric and perinatal management during their hospital stay. Women recuperating in the postnatal wards up to 48 hours after delivery at two hospitals in KwaZulu-Natal participated. Data included their antenatal attendance, access to HIV counselling and testing (HCT), and access to nevirapine (NVP) for PMTCT. Fifty-three clinics were indirectly evaluated as a result of the postpartum audit. All clinics provided HCT and the average HIV testing rate was 91% (range 40 - 100); 15% (N = 8) of these clinics with HIV testing rates of < 80% were identified. The median frequency of NVP dispensing at 53 clinics was 87% (interquartile range 67 - 100); among these 30% (N = 16) with NVP dispensing frequencies of < 80% were identified. An exit survey by trained nurses at a maternity hospital can provide health services management with a quick estimate of antenatal and PMTCT coverage of multiple primary health facilities in a specified catchment area. Challenges in the PMTCT programme at primary health clinic and hospital levels were highlighted.

Association between community characteristics and implementation of community programmes and policies addressing childhood obesity: the Healthy Communities Study.

PubMed

Schultz, J A; Collie-Akers, V L; Fawcett, S B; Strauss, W J; Nagaraja, J; Landgraf, A J; McIver, K L; Weber, S A; Arteaga, S S; Nebeling, L C; Rauzon, S M

2018-06-19

Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity. The objective of this study is to investigate associations between community characteristics and the intensity of community policies and programmes to prevent childhood obesity documented in the Healthy Communities Study that engaged a diverse sample of US communities. Programmes and policies were documented in 130 communities across the USA, reporting over 9000 different community programmes and policies to prevent obesity among children ages 4-15. We examined associations between community characteristics and the intensity of community programmes and policies implemented (i.e. their amount and reach, duration and strength of change strategy). Community characteristics explain 25% of the variability in the intensity of community programmes and policies implemented in communities. Particular characteristics - urbanicity, region, being a large county and the per cent of African-Americans in a community - contributed to more (over 18% of the 25%) of the observed variability. © 2018 World Obesity Federation.

Trialling a shaken baby syndrome prevention programme in the Auckland District Health Board.

PubMed

Kelly, Patrick; Wilson, Kati; Mowjood, Aqeela; Friedman, Joshua; Reed, Peter

2016-02-19

To describe and evaluate a shaken baby prevention programme trialled in the Auckland District Health Board from January 2010, to December 2011. Development and implementation of the programme, telephone survey of a sample of caregivers and written survey of a sample of providers. At least 2,592 caregivers received the trial programme. 150 (6%) were surveyed by telephone a median of 6 weeks later. 128 (85%) remembered at least one key message, unprompted; most commonly "It's OK to walk away" (94/150, 63%). When asked, 92% had made a plan for what to do when frustrated and 63% had shared the information with others. Only 98/150 (65%) watched the programme DVD. Many said they already knew about the risks of shaking a baby, but still found the programme highly relevant. Thirty-one nurses were surveyed. There was a high degree of agreement that the programme was relevant. Barriers to programme delivery included time, workload and the documentation required. A shaken baby prevention programme adapted to New Zealand can be introduced in a District Health Board and is acceptable to caregivers and health professionals. Further research is needed to evaluate the content, mode of delivery and effectiveness of this programme.

Measles: effect of a two-dose vaccination programme in Catalonia, Spain.

PubMed Central

Godoy, P.; Domínguez, A.; Salleras, L.

1999-01-01

The study reports incidences of measles in Catalonia, Spain, as detected by surveillance, and analyses the specific characteristics of the outbreaks reported for the period 1986-95. Incidences per 100,000 inhabitants were calculated for the period 1971-95. The following variables were studied: year of presentation, number of cases, median age, transmission setting, cases with a record of vaccination and preventable cases. Associations between variables were determined using odds ratios (OR). The incidence of measles declined from 306.3 cases in 1971 to 30.9 in 1995. A total of 50 outbreaks were investigated. The outbreaks that occurred in the last two years of the study had a higher likelihood of having a transmission setting other than primary school (OR = 3.9); a median case age > 10 years (OR = 7.2); and fewer than 6 cases (OR = 2.3). The characteristics of recent outbreaks, marked by a rise both in transmission outside the primary-school setting and in median age, indicate the need for the introduction of a specific vaccination programme at the end of adolescence in addition to control of school-related outbreaks. PMID:10083711

Affordability of programmes to prevent spontaneous preterm birth in Austria: a budget impact analysis.

PubMed

Zechmeister-Koss, Ingrid; Piso, Brigitte

2014-02-01

Preterm birth is a rising health problem in Europe generally, and in Austria specifically. Decision makers require objective information on the effects and costs of measures to prevent preterm birth. We undertook a budget impact analysis from a public payer perspective and for a 1-year and 5-year time horizon for five prevention approaches to reduce preterm birth. These were cervix screening + progesterone application, progesterone injection, smoking cessation, fish oil supplementation and infection screening. We analysed affordability in terms of programme costs and potential cost savings. Programme costs range from below €50 000 (cervix screening in high-risk pregnancy) to €500 000 (universal infection screening). The lowest health effects have been shown for smoking cessation programmes (-10 preterm births per year), whereas infection screening demonstrated the largest effect (-230 preterm births per year). In the base-case analysis, all programmes are potentially cost saving (-€500 000 to -€13 million per year). In the sensitivity analyses, preterm birth costs, target group size and (partly) unit costs of programme components have an influence on potential cost savings. However, except for two programmes, the results are robust concerning an overall economic net benefit of the programmes analysed compared with no programme. The study is mainly limited by the quality of some cost data and choice of the reference scenario. When considering potential cost savings, the five prevention programmes analysed seem affordable, with cervix screening and infection screening likely being the most promising in Austria.

An assessment of oral cancer curricula in dental hygiene programmes: implications for cancer control.

PubMed

Thacker, K K; Kaste, L M; Homsi, K D; LeHew, C W

2016-11-01

To assess oral cancer prevention and early detection curricula in Illinois associate-degree dental hygiene programmes and highlight global health applications. An email invitation was sent to each Illinois associate-degree granting dental hygiene programme's oral cancer contact to participate in a survey via a SurveyMonkey™ link to a 21-item questionnaire. Questions elicited background information on each programme and inquired about curriculum and methods used for teaching oral cancer prevention and early detection. Eight of the 12 (67%) programmes responded. Three (37.5%) reported having a specific oral cancer curriculum. Five (62.5%) require students to perform examinations for signs and symptoms of oral cancer at each clinic visit. Variations exist across the programmes in the number of patients each student sees annually and the number of oral cancer examinations each student performs before graduation. Seven programmes (87.5%) conduct early detection screening in community settings. All programmes included risk assessment associated with tobacco. All other risk factors measured were treated inconsistently. Significant differences in training and experience were reported across Illinois dental hygiene programmes. Training is neither standardized nor uniformly comprehensive. Students' preparation for delivering prevention and early detection services to their patients could be strengthened to ensure competence including reflection of risk factors and behaviours in a global context. Regular review of curricular guidelines and programme content would help dental hygienists meet the expectations of the Crete Declaration on Oral Cancer Prevention. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Reducing drug related deaths: a pre-implementation assessment of knowledge,barriers and enablers for naloxone distribution through general practice

PubMed Central

2014-01-01

Background The Scottish Naloxone Programme aims to reduce Scotland’s high number of drug-related deaths (DRDs) caused by opiate overdose. It is currently implemented through specialist drug services but General Practitioners (GPs) are likely to have contact with drug using patients and their families and are therefore in an ideal position to direct them to naloxone schemes, or provide it themselves. This research gathered baseline data on GP’s knowledge of and willingness to be involved in DRD prevention, including naloxone administration, prior to the implementation of primary care based delivery. Methods Mixed methods were used comprising a quantitative, postal survey and qualitative telephone interviews. A questionnaire was sent to 500 GPs across Scotland. An initial mailing was followed by a reminder. A shortened questionnaire containing seven key questions was posted as a final reminder. Telephone interviews were conducted with 17 GPs covering a range of demographic characteristics and drug user experience. Results A response rate of 55% (240/439) was achieved. There was some awareness of the naloxone programme but little involvement (3.3%), 9% currently provided routine overdose prevention, there was little involvement in displaying overdose prevention information (<20%). Knowledge of DRD risk was mixed. There was tentative willingness to be involved in naloxone prescribing with half of respondents willing to provide this to drug users or friends/family. However half were uncertain GP based naloxone provision was essential to reduce DRDs. Factors enabling naloxone distribution were: evidence of effectiveness, appropriate training, and adding to the local formulary. Interviewees had limited awareness of what naloxone distribution in primary care may involve and considered naloxone supply as a specialist service rather than a core GP role. Wider attitudinal barriers to involvement with this group were expressed. Conclusions There was poor awareness of the Scottish National Naloxone Programme in participants. Results indicated GPs did not currently feel sufficiently skilled or knowledgeable to be involved in naloxone provision. Appropriate training was identified as a key requirement. PMID:24428947

Effectiveness of a universal parental support programme to promote healthy dietary habits and physical activity and to prevent overweight and obesity in 6-year-old children: the Healthy School Start Study, a cluster-randomised controlled trial.

PubMed

Nyberg, Gisela; Sundblom, Elinor; Norman, Åsa; Bohman, Benjamin; Hagberg, Jan; Elinder, Liselotte Schäfer

2015-01-01

To develop and evaluate the effectiveness of a parental support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in Swedish children. A cluster-randomised controlled trial was carried out in areas with low to medium socio-economic status. Participants were six-year-old children (n = 243) and their parents. Fourteen pre-school classes were randomly assigned to intervention (n = 7) and control groups (n = 7). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary and physical activity habits and parental self-efficacy through a questionnaire. Body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 6-months follow-up. Group differences were examined using analysis of covariance and Poisson regression, adjusted for gender and baseline values. There was no significant intervention effect in the primary outcome physical activity. Sub-group analyses showed a significant gender-group interaction in total physical activity (TPA), with girls in the intervention group demonstrating higher TPA during weekends (p = 0.04), as well as in sedentary time, with boys showing more sedentary time in the intervention group (p = 0.03). There was a significantly higher vegetable intake (0.26 servings) in the intervention group compared to the control group (p = 0.003). At follow-up, sub-group analyses showed a sustained effect for boys. The intervention did not affect the prevalence of overweight or obesity. It is possible to influence vegetable intake in children and girls' physical activity through a parental support programme. The programme needs to be intensified in order to increase effectiveness and sustain the effects long-term. These findings are an important contribution to the further development of evidence-based parental support programmes to prevent overweight and obesity in children. Controlled-trials.com ISRCTN32750699.

Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: A process evaluation

PubMed Central

Bleijlevens, Michel HC; Hendriks, Marike RC; van Haastregt, Jolanda CM; van Rossum, Erik; Kempen, Gertrudis IJM; Diederiks, Joseph PM; Crebolder, Harry FJM; van Eijk, Jacques ThM

2008-01-01

Background Falls are a major health threat to older community-living people, and initiatives to prevent falls should be a public health priority. We evaluated a Dutch version of a successful British fall prevention programme. Results of this Dutch study showed no effects on falls or daily functioning. In parallel to the effect evaluation, we carried out a detailed process evaluation to assess the feasibility of our multidisciplinary fall prevention programme. The present study reports on the results of this process evaluation. Methods Our fall prevention programme comprised a medical and occupational-therapy assessment, resulting in recommendations and/or referrals to other services if indicated. We used self-administered questionnaires, structured telephone interviews, structured recording forms, structured face-to-face interviews and a plenary group discussion to collect data from participants allocated to the intervention group (n = 166) and from all practitioners who performed the assessments (n = 8). The following outcomes were assessed: the extent to which the multidisciplinary fall prevention programme was performed according to protocol, the nature of the recommendations and referrals provided to the participants, participants' self-reported compliance and participants' and practitioners' opinions about the programme. Results Both participants and practitioners judged the programme to be feasible. The programme was largely performed according to protocol. The number of referrals and recommendations ensuing from the medical assessment was relatively small. Participants' self-reported compliance as regards contacting their GP to be informed of the recommendations and/or referrals was low to moderate. However, self-reported compliance with such referrals and recommendations was reasonable to good. A large majority of participants reported they had benefited from the programme. Conclusion The results of the present study show that the programme was feasible for both practitioners and participants. Main factors that seem to be responsible for the lack of effectiveness are the relatively low number of referrals and recommendations ensuing from the medical assessments and participants' low compliance as regards contacting their GP about the results of the medical assessment. We do not recommend implementing the programme in its present form in regular care. Trial registration ISRCTN64716113 PMID:18816381

Exploiting the potential of vector control for disease prevention.

PubMed

Townson, H; Nathan, M B; Zaim, M; Guillet, P; Manga, L; Bos, R; Kindhauser, M

2005-12-01

Although vector control has proven highly effective in preventing disease transmission, it is not being used to its full potential, thereby depriving disadvantaged populations of the benefits of well tried and tested methods. Following the discovery of synthetic residual insecticides in the 1940s, large-scale programmes succeeded in bringing many of the important vector-borne diseases under control. By the late 1960s, most vector-borne diseases--with the exception of malaria in Africa--were no longer considered to be of primary public health importance. The result was that control programmes lapsed, resources dwindled, and specialists in vector control disappeared from public health units. Within two decades, many important vector-borne diseases had re-emerged or spread to new areas. The time has come to restore vector control to its key role in the prevention of disease transmission, albeit with an increased emphasis on multiple measures, whether pesticide-based or involving environmental modification, and with a strengthened managerial and operational capacity. Integrated vector management provides a sound conceptual framework for deployment of cost-effective and sustainable methods of vector control. This approach allows for full consideration of the complex determinants of disease transmission, including local disease ecology, the role of human activity in increasing risks of disease transmission, and the socioeconomic conditions of affected communities.

Exploiting the potential of vector control for disease prevention.

PubMed Central

Townson, H.; Nathan, M. B.; Zaim, M.; Guillet, P.; Manga, L.; Bos, R.; Kindhauser, M.

2005-01-01

Although vector control has proven highly effective in preventing disease transmission, it is not being used to its full potential, thereby depriving disadvantaged populations of the benefits of well tried and tested methods. Following the discovery of synthetic residual insecticides in the 1940s, large-scale programmes succeeded in bringing many of the important vector-borne diseases under control. By the late 1960s, most vector-borne diseases--with the exception of malaria in Africa--were no longer considered to be of primary public health importance. The result was that control programmes lapsed, resources dwindled, and specialists in vector control disappeared from public health units. Within two decades, many important vector-borne diseases had re-emerged or spread to new areas. The time has come to restore vector control to its key role in the prevention of disease transmission, albeit with an increased emphasis on multiple measures, whether pesticide-based or involving environmental modification, and with a strengthened managerial and operational capacity. Integrated vector management provides a sound conceptual framework for deployment of cost-effective and sustainable methods of vector control. This approach allows for full consideration of the complex determinants of disease transmission, including local disease ecology, the role of human activity in increasing risks of disease transmission, and the socioeconomic conditions of affected communities. PMID:16462987

An evidence-based shared decision making programme on the prevention of myocardial infarction in type 2 diabetes: protocol of a randomised-controlled trial.

PubMed

Buhse, Susanne; Heller, Tabitha; Kasper, Jürgen; Mühlhauser, Ingrid; Müller, Ulrich Alfons; Lehmann, Thomas; Lenz, Matthias

2013-10-19

Lack of patient involvement in decision making has been suggested as one reason for limited treatment success. Concepts such as shared decision making may contribute to high quality healthcare by supporting patients to make informed decisions together with their physicians.A multi-component shared decision making programme on the prevention of heart attack in type 2 diabetes has been developed. It aims at improving the quality of decision-making by providing evidence-based patient information, enhancing patients' knowledge, and supporting them to actively participate in decision-making. In this study the efficacy of the programme is evaluated in the setting of a diabetes clinic. A single blinded randomised-controlled trial is conducted to compare the shared decision making programme with a control-intervention. The intervention consists of an evidence-based patient decision aid on the prevention of myocardial infarction and a corresponding counselling module provided by diabetes educators. Similar in duration and structure, the control-intervention targets nutrition, sports, and stress coping. A total of 154 patients between 40 and 69 years of age with type 2 diabetes and no previous diagnosis of ischaemic heart disease or stroke are enrolled and allocated either to the intervention or the control-intervention. Primary outcome measure is the patients' knowledge on benefits and harms of heart attack prevention captured by a standardised knowledge test. Key secondary outcome measure is the achievement of treatment goals prioritised by the individual patient. Treatment goals refer to statin taking, HbA1c-, blood pressure levels and smoking status. Outcomes are assessed directly after the counselling and at 6 months follow-up. Analyses will be carried out on intention-to-treat basis. Concurrent qualitative methods are used to explore intervention fidelity and to gain insight into implementation processes. Interventions to facilitate evidence-based shared decision making represent an innovative approach in diabetes care. The results of this study will provide information on the efficacy of such a concept in the setting of a diabetes clinic in Germany. ISRCTN84636255.

Economic and health efficiency of education funding policy.

PubMed

Curtin, T R; Nelson, E A

1999-06-01

Public spending programmes to reduce poverty, expand primary education and improve the economic status of women are recommended priorities of aid agencies and are now gradually being reflected in third world governments' policies, in response to aid conditions imposed by the World Bank and OECD countries. However outcomes fall short of aspiration. This paper shows that donors' lending policies, especially those restricting public spending on education to the primary level, (1) perpetuate poverty, (2) minimise socio-economic impact of public health programmes and (3) prevent significant improvement in the economic status of women. These effects are the result of fundamental flaws in donors' education policy model. Evidence is presented to show that health status in developing countries will be significantly enhanced by increasing the proportion of the population which has at least post-primary education. Heads of households with just primary education have much the same probability of experiencing poverty and high mortality of their children as those with no education at all. Aid donors' policies, which require governments of developing countries to limit public funding of education to the primary level, have their roots in what is contended here to be an erroneous interpretation of human capital theory. This interpretation focuses only on the declining marginal internal rates of return on public investments in successive levels of schooling and ignores the opposite message of the increasing marginal net present values of those investments. Cars do not travel fastest in their lowest gear despite its fastest acceleration, life's long journey is not most comfortable for those with only primary schooling.

Critical Thinking Tendencies among Teacher Candidates

ERIC Educational Resources Information Center

Genc, Salih Zeki

2008-01-01

The study aims to determine critical thinking tendencies among teacher candidates. 720 students from primary school teaching department (Primary School Teaching Programme, Science Teaching Programme and Pre-School Teaching Programme) form the sample of the study. When the gender and age distributions were investigated, 253 candidates are males and…

Vertical and horizontal integration of knowledge and skills - a working model.

PubMed

Snyman, W D; Kroon, J

2005-02-01

The new integrated outcomes-based curriculum for dentistry was introduced at the University of Pretoria in 1997. The first participants graduated at the end of 2001. Educational principles that underpin the new innovative dental curriculum include vertical and horizontal integration, problem-oriented learning, student-centred learning, a holistic attitude to patient care and the promotion of oral health. The aim of this research project was to develop and assay a model to facilitate vertical integration of knowledge and skills thereby justifying the above mentioned action. The learning methodology proposed for the specific outcome of the Odontology module, namely the diagnosis of dental caries and the design of a primary preventive programme, included problem-solving as the driving force for the facilitation of vertical and horizontal integration, and an instructional design for the integration of the basic knowledge and clinical skills into a single learning programme. The paper describes the methodology of problem-oriented learning as applied in this study together with the detail of the programme. The consensus of those teachers who represent the basic and clinical sciences and who participate in this learning programme is that this model is practical and can assist vertical as well as horizontal integration of knowledge.

Prioritising prevention: implementation of IGT Care Call, a telephone based service for people at risk of developing type 2 diabetes.

PubMed

Savas, Linda Ann; Grady, Katherine; Cotterill, Sarah; Summers, Lucinda; Boaden, Ruth; Gibson, J Martin

2015-02-01

To design, deliver and evaluate IGT Care Call, a telephone service providing a 6 month lifestyle education programme for people with impaired glucose tolerance (IGT). An observational study of IGT Care Call, a programme providing motivational support and education using electronic scripts. The service was delivered to 55 participants, all of whom completed the course (an information pack and at least five telephone calls over 6 months). Clinical measurements were undertaken in General Practice at baseline, on completion of the programme and one year later. Among the 40 participants for whom we have complete data available, one year after discharge, participants showed improvements in fasting plasma glucose (0.29 mmol/l, 95% CI 0.07 to 0.51), weight (2.81 kg, 95% CI 1.20 to 4.42) and BMI (1.06 kg/m(2), 95% CI 0.49 to 1.63). All differences were statistically significant (p < 0.01). Whilst an uncontrolled observational study with a small sample size, this pilot suggests IGT Care Call may be effective in promoting positive and sustained lifestyle changes to prevent type 2 diabetes, which warrants further investigation. A telephone method of service delivery was acceptable, convenient and may have improved self confidence in how to reduce risk of type 2 diabetes. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers.

PubMed

Thiam, Sylla; Kimotho, Victoria; Gatonga, Patrick

2013-10-03

Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness.

Addressing sexual health behaviour during emerging adulthood: a critical review of the literature.

PubMed

Alexander, Kamila A; Jemmott, Loretta S; Teitelman, Anne M; D'Antonio, Patricia

2015-01-01

In this critical literature review, we examine evidence-based interventions that target sexual behaviours of 18- to 25-year-old emerging adult women. Nurses and clinicians implement theory-driven research programmes for young women with increased risk of HIV/AIDS and sexually transmitted infections. Strategies to decrease transmission of HIV and sexually transmitted infections are rigorously evaluated and promoted by public health agencies such as the United States Centers for Disease Control and Prevention. While many interventions demonstrate episodic reductions in sexual risk behaviours and infection transmission, there is little evidence they build sustainable skills and behaviours. Programmes may not attend to contextual and affective influences on sexual behaviour change. Discursive paper. We conducted a conceptually based literature review and critical analysis of the Centers for Disease Control and Prevention's best-evidence and good-evidence HIV behavioural interventions. In this review, we examined three contextual and affective influences on the sexual health of emerging adult women: (1) developmental age, (2) reproduction and pregnancy desires and (3) sexual security or emotional responses accompanying relationship experiences. Our analyses revealed intervention programmes paid little attention to ways age, desires for pregnancy or emotional factors influence sexual decisions. Some programmes included 18- to 25-year-olds, but they made up small percentages of the sample and did not attend to unique emerging adult experiences. Second, primary focus on infection prevention overshadowed participant desires for pregnancy. Third, few interventions considered emotional mechanisms derived from relationship experiences involved in sexual decision-making. Growing evidence demonstrates sexual health interventions may be more effective if augmented to attend to contextual and affective influences on relationship risks and decision-making. Modifying currently accepted strategies may enhance sustainability of sexual health-promoting behaviours. This study provides nurses and public health educators with recommendations for broadening the content of sexual health promotion intervention programming. © 2014 John Wiley & Sons Ltd.

Evaluation of RugbySmart: a rugby union community injury prevention programme.

PubMed

Gianotti, Simon M; Quarrie, Ken L; Hume, Patria A

2009-05-01

RugbySmart, a rugby union injury prevention programme, was launched in New Zealand in 2001. It was compulsory for all coaches and referees to complete RugbySmart requirements annually in order to continue coaching or refereeing. After 5 years of implementation the programme partners, Accident Compensation Corporation and New Zealand Rugby Union, evaluated RugbySmart to determine its effectiveness in reducing injuries. The purpose was to evaluate the effect of RugbySmart on reducing injury rates per 100,000 players and resulting injury prevention behaviours. The RugbySmart programme was associated with a decrease in injury claims per 100,000 players in most areas the programme targeted; the programme had negligible impact on non-targeted injury sites. The decrease in injury claims numbers was supported by results from the player behaviour surveys pre- and post-RugbySmart. There was an increase in safe behaviour in the contact situations of tackle, scrum and ruck technique.

The costs of scaling up HIV prevention for high risk groups: lessons learned from the Avahan Programme in India.

PubMed

Chandrashekar, Sudhashree; Guinness, Lorna; Pickles, Michael; Shetty, Govindraj Y; Alary, Michel; Vickerman, Peter; Vassall, Anna

2014-01-01

The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond. Prospective costing study. This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$ 2011. Mean total unit costs (2004-08) per person reached at least once a year and per monthly contact were US$ 235(56-1864) and US$ 82(12-969) respectively. 35% of the cost was incurred by NGOs, 30% at the state level SLP and 35% at the national programme level. The proportion of total costs by activity were 34% for expertise enhancement, 37% for programme management (including support and supervision), 22% for core HIV prevention activities (outreach and STI services) and 7% for community mobilisation and enabling environment activities. Total unit cost per person reached fell sharply as the programme expanded due to declining unit costs above the service level (from US$ 477 per person reached in 2004 to US$ 145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached. Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities.

The Costs of Scaling Up HIV Prevention for High Risk Groups: Lessons Learned from the Avahan Programme in India

PubMed Central

Chandrashekar, Sudhashree; Guinness, Lorna; Pickles, Michael; Shetty, Govindraj Y.; Alary, Michel; Vickerman, Peter; Vassall, Anna

2014-01-01

Objective The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond. Design Prospective costing study. Methods This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$ 2011. Results Mean total unit costs (2004–08) per person reached at least once a year and per monthly contact were US$ 235(56–1864) and US$ 82(12–969) respectively. 35% of the cost was incurred by NGOs, 30% at the state level SLP and 35% at the national programme level. The proportion of total costs by activity were 34% for expertise enhancement, 37% for programme management (including support and supervision), 22% for core HIV prevention activities (outreach and STI services) and 7% for community mobilisation and enabling environment activities. Total unit cost per person reached fell sharply as the programme expanded due to declining unit costs above the service level (from US$ 477 per person reached in 2004 to US$ 145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached. Conclusions Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities. PMID:25203052

Learning globally to enhance local practice: an international programme in primary care & family health.

PubMed

Godoy-Ruiz, Paula; Rodas, Jamie; Talbot, Yves; Rouleau, Katherine

2016-09-01

In a global context of growing health inequities, international learning experiences have become a popular strategy for equipping health professionals with skills, knowledge, and competencies required to work with the populations they serve. This study sought to analyse the Chilean Interprofessional Programme in Primary Health Care (CIPPHC), a 5 week international learning experience funded by the Ministry of Health in Chile targeted at Chilean primary care providers and delivered in Toronto by the Department of Family and Community Medicine at the University of Toronto. The study focused on three cohorts of students (2010-2012). Anonymous programme evaluations were analysed and semi-structured interviews conducted with programme alumni. Simple descriptive statistics were gathered from the evaluations and the interviews were analysed via thematic content analysis. The majority of participants reported high levels of satisfaction with the training programme, knowledge gain, particularly in the areas of the Canadian model of primary care, and found the materials delivered to be applicable to their local context. The CIPPHC has proven to be a successful educational initiative and provides valuable lessons for other academic centres in developing international interprofessional training programmes for primary care health care providers.

Stakeholders' perceptions of programme sustainability: findings from a community-based fall prevention programme.

PubMed

Hanson, H M; Salmoni, A W

2011-08-01

Sustainability of health promotion and injury prevention programmes is a goal of practitioners and an increasingly common requirement of funding bodies. However, less is known about the views held by individual stakeholders involved in such programmes regarding their perceptions of facilitators and barriers to achieving sustainability. This paper aims to share the perceptions of programme sustainability held by key stakeholders involved in a community-based fall prevention programme in three Ontario demonstration communities in Canada. A qualitative case study research design. A holistic multiple case study method was employed. In total, 45 stakeholders involved in various aspects of the project participated from three demonstration sites. Stakeholders' perceptions were gathered on the individual actions they took in an effort to promote sustainability, and the barriers they perceived as preventing or limiting sustainability. Stakeholders reported taking a number of actions to aid programme sustainability, with some actions deemed to be more functional in aiding sustainability than others. Common actions reported by stakeholders included partnership formation, networking and increasing community capacity. Stakeholders also perceived a number of barriers to achieving sustainability, including insufficient human and financial resources, lack of co-ordination and buy-in, heavy reliance on volunteers and an inability to mobilize physicians. Stakeholders' perceptions of sustainability were used to develop recommendations for sustainability for both communities and funding bodies. The views and experiences shared by the stakeholders in this project can serve as lessons learnt to aid in the sustainability of other health promotion and injury prevention programmes in the future. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Health as a target: South Africa's destabilization of Mozambique.

PubMed

Cliff, J; Noormahomed, A R

1988-01-01

Since 1982 attacks on the health services have been an integral part of South African destabilization of Mozambique. After independence in 1975, Mozambique began successfully to implement a primary health care policy. By attacking primary health care units, kidnapping and killing health workers and destroying transport, a South African supported rebel movement has attempted to undermine this policy. The combined effects of the negative economic consequences of the war, the forced displacement of over a million people and the destruction and disruption of health services have worsened the health of the Mozambican people. Preventive programmes have been severely disrupted. Effects on health include an increase in mortality rates, famine and infectious disease epidemics. Similarities exist between this war and the low intensity conflict in Nicaragua. Given the intensity of the onslaught, the primary health care system has proved remarkably resistant to destruction.

Evaluation of a Peer-Led Smoking Prevention Programme for Romanian Adolescents

ERIC Educational Resources Information Center

Lotrean, L. M.; Dijk, F.; Mesters, I.; Ionut, C.; De Vries, H.

2010-01-01

The goal of this study was to assess the effects of a school-based smoking prevention programme that used both a video and peer-led discussion groups among Romanian junior high school students aged 13-14 years. The programme embraced the social influence approach and concentrated on enhancing self-efficacy and the acquisition of cigarette refusal…

Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions.

PubMed

Solberg, Hilde Strøm; Steinsbekk, Aslak; Solbjør, Marit; Granbo, Randi; Garåsen, Helge

2014-11-08

Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users' and health professionals' perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why. Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method. The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes. The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients' every-day life situations. The user informants' perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring approach should be applied in the development of the health professionals' competence in practice. The effect of a self-management support programme based on the core characteristics found in this study needs to be evaluated.

Evaluation of a nurse-led dementia education and knowledge translation programme in primary care: A cluster randomized controlled trial.

PubMed

Wang, Yao; Xiao, Lily Dongxia; Ullah, Shahid; He, Guo-Ping; De Bellis, Anita

2017-02-01

The lack of dementia education programmes for health professionals in primary care is one of the major factors contributing to the unmet demand for dementia care services. To determine the effectiveness of a nurse-led dementia education and knowledge translation programme for health professionals in primary care; participants' satisfaction with the programme; and to understand participants' perceptions of and experiences in the programme. A cluster randomized controlled trial was used as the main methodology to evaluate health professionals' knowledge, attitudes and care approach. Focus groups were used at the end of the project to understand health professionals' perceptions of and experiences in the programme. Fourteen community health service centres in a province in China participated in the study. Seven centres were randomly assigned to the intervention or control group respectively and 85 health professionals in each group completed the programme. A train-the-trainer model was used to implement a dementia education and knowledge translation programme. Outcome variables were measured at baseline, on the completion of the programme and at 3-month follow-up. A mixed effect linear regression model was applied to compare the significant differences of outcome measures over time between the two groups. Focus groups were guided by four semi-structured questions and analysed using content analysis. Findings revealed significant effects of the education and knowledge translation programme on participants' knowledge, attitudes and a person-centred care approach. Focus groups confirmed that the programme had a positive impact on dementia care practice. A dementia education and knowledge translation programme for health professionals in primary care has positive effects on their knowledge, attitudes, care approach and care practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fetal alcohol syndrome (FAS) primary prevention through fas diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS.

PubMed

Astley, S J; Bailey, D; Talbot, C; Clarren, S K

2000-01-01

A 5-year, fetal alcohol syndrome (FAS) primary prevention study was conducted in Washington State to: (1) assess the feasibility of using a FAS diagnostic and prevention clinic as a centre for identifying and targeting primary prevention intervention to high-risk women; (2) generate a comprehensive, lifetime profile of these women; (3) identify factors that have enhanced and/or hindered their ability to achieve abstinence. The results of this study are presented in two parts. Objective 1 is summarized in the preceding paper and objectives 2 and 3 are summarized here. Comprehensive interviews were conducted with 80 women, who had given birth to a child diagnosed with FAS, to document their sociodemographics, reproductive and family planning history, social and healthcare utilization patterns, adverse social experiences, social support network, alcohol use and treatment history, mental health, and intelligence quotient (IQ). These high-risk women were diverse in racial, educational and economic backgrounds, were often victims of abuse, and challenged by mental health issues. Despite their rather harsh psychosocial profile, many demonstrated the ability to overcome their alcohol dependence over time. Relative to the women who had not achieved abstinence, the women who had achieved abstinence had significantly higher IQs, higher household incomes, larger more satisfactory social support networks, were more likely to report a religious affiliation, and were more likely to be receiving mental health treatment for their mental health disorders. The rate of unintended pregnancies and alcohol-exposed pregnancies was substantial. Key barriers to achieving effective family planning were maternal alcohol and drug use, lack of access to birth control and lack of support by their partner to use birth control. A FAS diagnostic and prevention clinic can be used to identify women at high risk for producing children damaged by prenatal alcohol exposure. Primary prevention programmes targeted to this population could lead to measurable reductions in the incidence of FAS.

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.

What Do Primary Students Say about School-Based Social Work Programmes?

ERIC Educational Resources Information Center

Testa, Doris

2014-01-01

This article focuses on primary school children's experiences of school-based social work programmes. These students, aged between 6 and 11, and drawn from a student population comprising 28 different cultural backgrounds and from low socio-economic backgrounds, participated in a case study that researched a school-based social work programme, the…

[Evaluation of a workplace health promotion program].

PubMed

Forette, Françoise; Brieu, Marie-Anne; Lemasson, Hervé; Salord, Jean-Claude; Le Pen, Claude

2014-01-01

Some studies suggest that a workplace prevention programme could reduce health inequalities related to education level and improve the health status of the employees. The objective of the study was to demonstrate the advantages for a company to implement a health prevention programme in the workplace in order to: 1-improve health literacy 2 - change health-related behaviours 3-improve the company image. A "before - after" methodology was used in a population of 2153 employees of three companies. Three areas of prevention were considered: nutrition, physical activity and prevention of back pain. The successive steps of the EBS programme included general communication, group workshops and individual coaching. Data collection was carried out using anonymous questionnaires sent by e-mail. A global assessment was performed based on the companies' pooled data, with separate analysis according to the steps of the programme. The programme mobilized employees with participation rates ranging from 25% to 45.5%. After completion of the full programme, 77.5% of respondents reported an improvement of their health knowledge versus 50.3% of those who only received general communication. Behavioural modification was observed, especially in the fields of nutrition and back pain.. EBS can be considered to be a vector of the company image for almost 7 out of 10 employees. A health prevention education programme provided by the company in the workplace mobilizes employees and contributes to improvement of health knowledge and behaviour change. All approaches tested were important and applicable to various types of companies or workers.

Prevention and management of non-communicable disease: the IOC consensus statement, Lausanne 2013.

PubMed

Matheson, Gordon O; Klügl, Martin; Engebretsen, Lars; Bendiksen, Fredrik; Blair, Steven N; Börjesson, Mats; Budgett, Richard; Derman, Wayne; Erdener, Ugur; Ioannidis, John P A; Khan, Karim M; Martinez, Rodrigo; Van Mechelen, Willem; Mountjoy, Margo; Sallis, Robert E; Schwellnus, Martin; Shultz, Rebecca; Soligard, Torbjørn; Steffen, Kathrin; Sundberg, Carl Johan; Weiler, Richard; Ljungqvist, Arne

2013-11-01

Morbidity and mortality from preventable, non-communicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology and design thinking. The purpose of this paper is to summarise the results of a consensus meeting on NCD prevention sponsored by the IOC in April 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within healthcare systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: (1) Focus on behavioural change as the core component of all clinical programmes for the prevention and management of chronic disease. (2) Establish actual centres to design, implement, study and improve preventive programmes for chronic disease. (3) Use human-centred design in the creation of prevention programmes with an inclination to action, rapid prototyping and multiple iterations. (4) Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programmes for the prevention and treatment of chronic disease focused on physical activity, diet and lifestyle. (5) Mobilise resources and leverage networks to scale and distribute programmes of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programmes within healthcare. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad hoc Working Group charged with the responsibility of moving this agenda forward.

A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive–behavioural programme with integrated coaching for anxious adults in primary care

PubMed Central

Szigethy, Eva; Solano, Francis; Wallace, Meredith; Perry, Dina L; Morrell, Lauren; Scott, Kathryn; Bell, Megan Jones

2018-01-01

Introduction Generalised anxiety disorder (GAD) and subclinical GAD are highly prevalent in primary care. Unmanaged anxiety worsens quality of life in patients seen in primary care practices and leads to increased medical utilisation and costs. Programmes that teach patients cognitive–behavioural therapy (CBT) techniques have been shown to improve anxiety and to prevent the evolution of anxiety symptoms to disorders, but access and engagement have hampered integration of CBT into medical settings. Methods and analysis This pragmatic study takes place in University of Pittsburgh Medical Center primary care practices to evaluate a coach-supported mobile cognitive– behavioural programme (Lantern) on anxiety symptoms and quality of life. Clinics were non-randomly assigned to either enhanced treatment as usual or Lantern. All clinics provide electronic screening for anxiety and, within clinics assigned to Lantern, patients meeting a threshold level of mild anxiety (ie, >5 on Generalised Anxiety Disorder 7-Item Questionnaire (GAD-7)) are referred to Lantern. The first study phase is aimed at establishing feasibility, acceptability and effectiveness. The second phase focuses on long-term impact on psychosocial outcomes, healthcare utilisation and clinic/provider adoption/sustainable implementation using a propensity score matched parallel group study design. Primary outcomes are changes in anxiety symptoms (GAD-7) and quality of life (Short-Form Health Survey) between baseline and 6-month follow-ups, comparing control and intervention. Secondary outcomes include provider and patient satisfaction, patient engagement, durability of changes in anxiety symptoms and quality of life over 12 months and the impact of Lantern on healthcare utilisation over 12 months. Patients from control sites will be matched to the patients who use the mobile app. Ethics and dissemination Ethics and human subject research approval were obtained. A data safety monitoring board is overseeing trial data and ethics. Results will be communicated to participating primary care practices, published and presented at clinical and scientific conferences. Trial registration number NCT03035019. PMID:29331971

A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive-behavioural programme with integrated coaching for anxious adults in primary care.

PubMed

Szigethy, Eva; Solano, Francis; Wallace, Meredith; Perry, Dina L; Morrell, Lauren; Scott, Kathryn; Bell, Megan Jones; Oser, Megan

2018-01-13

Generalised anxiety disorder (GAD) and subclinical GAD are highly prevalent in primary care. Unmanaged anxiety worsens quality of life in patients seen in primary care practices and leads to increased medical utilisation and costs. Programmes that teach patients cognitive-behavioural therapy (CBT) techniques have been shown to improve anxiety and to prevent the evolution of anxiety symptoms to disorders, but access and engagement have hampered integration of CBT into medical settings. This pragmatic study takes place in University of Pittsburgh Medical Center primary care practices to evaluate a coach-supported mobile cognitive- behavioural programme (Lantern) on anxiety symptoms and quality of life. Clinics were non-randomly assigned to either enhanced treatment as usual or Lantern. All clinics provide electronic screening for anxiety and, within clinics assigned to Lantern, patients meeting a threshold level of mild anxiety (ie, >5 on Generalised Anxiety Disorder 7-Item Questionnaire (GAD-7)) are referred to Lantern. The first study phase is aimed at establishing feasibility, acceptability and effectiveness. The second phase focuses on long-term impact on psychosocial outcomes, healthcare utilisation and clinic/provider adoption/sustainable implementation using a propensity score matched parallel group study design. Primary outcomes are changes in anxiety symptoms (GAD-7) and quality of life (Short-Form Health Survey) between baseline and 6-month follow-ups, comparing control and intervention. Secondary outcomes include provider and patient satisfaction, patient engagement, durability of changes in anxiety symptoms and quality of life over 12 months and the impact of Lantern on healthcare utilisation over 12 months. Patients from control sites will be matched to the patients who use the mobile app. Ethics and human subject research approval were obtained. A data safety monitoring board is overseeing trial data and ethics. Results will be communicated to participating primary care practices, published and presented at clinical and scientific conferences. NCT03035019. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effectiveness of information campaigns.

PubMed

Breitbart, E W; Greinert, R; Volkmer, B

2006-09-01

Skin cancer represents the most common type of cancer in the white population worldwide and the incidence has dramatically increased during the last decades. UV-radiation is believed to be the most important risk factor responsible for this trend. The prominent role of UV-radiation renders skin cancer most suitable for primary prevention, because the main risk factor can easily be avoided by sticking to simple rules for the behaviour in the sun or under artificial UV (e.g. sunbeds). Since UV-exposure cannot and should not be avoided totally especially due to the beneficial health effects of UV-irradiation like Vitamin D(3)-production, recommendations and information for the public should be as clear and as weighted as possible, through adequate messages, such as: "Love the sun and protect your skin". For that purpose the Association of Dermatological Prevention in Germany (ADP) developed the period of life programme (POLP) that defines certain age-specific target groups, with the aim to give well adapted prevention messages to the population during lifetime. Evaluation of primary prevention campaigns in Germany showed that due to continuous intervention programs during the last 16 years changes in the "sun-behaviour" of the population have been achieved leading to a reduced but sufficient exposure to solar UV-irradiation. This will then contribute to the aim of decreasing morbidity and mortality of skin cancer.

The effect of an active implementation of a disease management programme for chronic obstructive pulmonary disease on healthcare utilization - a cluster-randomised controlled trial

PubMed Central

2013-01-01

Background The growing population living with chronic conditions calls for efficient healthcare-planning and effective care. Implementing disease-management-programmes is one option for responding to this demand. Knowledge is scarce about the effect of implementation processes and their effect on patients; only few studies have reported the effectiveness of disease-management-programmes targeting patients with chronic obstructive pulmonary disease (COPD). The objective of this paper was to determine the effect on healthcare-utilization of an active implementation model for a disease-management-programme for patients with one of the major multimorbidity diseases, COPD. Methods The standard implementation of a new disease-management-programme for COPD was ongoing during the study-period from November 2008 to November 2010 in the Central Denmark Region. We wanted to test a strategy using Breakthrough Series, academic detailing and lists of patients with COPD. It targeted GPs and three hospitals serving approx. 60,000 inhabitants aged 35 or older and included interventions directed at professionals, organisations and patients. The study was a non-blinded block- and cluster-randomised controlled trial with GP-practices as the unit of randomisation. In Ringkoebing-Skjern Municipality, Denmark, 16 GP-practices involving 38 GPs were randomised to either the intervention-group or the control-group. A comparable neighbouring municipality acted as an external-control-group which included nine GP-practices with 25 GPs. An algorithm based on health-registry-data on lung-related contacts to the healthcare-system identified 2,736 patients who were alive at the end of the study-period. The population included in this study counted 1,372 (69.2%) patients who responded to the baseline questionnaire and confirmed their COPD diagnosis; 458 (33.4%) patients were from the intervention-group, 376 (27.4%) from the control-group and 538(39.2%) from the external-control-group. The primary outcome was adherence to the disease-management-programme measured at patient-level by use of specific services from general practice. Secondary outcomes were use of out-of-hours-services, outpatient-clinic, and emergency-department and hospital-admissions. Results The intervention practices provided more planned preventive consultations, additional preventive consultations and spirometries than non-intervention practices. A comparison of the development in the intervention practices with the development in the control-practices showed that the intervention resulted in more planned preventive-consultations, fewer conventional consultations and fewer patients admitted without a lung-related-diagnosis. Conclusions Use of the active implementation model for the disease-management-programme for COPD changed the healthcare utilization in accordance with the programme. Trial registration Clinicaltrials.gov identifier: NCT01228708. PMID:24090189

The effect of an active implementation of a disease management programme for chronic obstructive pulmonary disease on healthcare utilization--a cluster-randomised controlled trial.

PubMed

Smidth, Margrethe; Christensen, Morten Bondo; Fenger-Grøn, Morten; Olesen, Frede; Vedsted, Peter

2013-10-03

The growing population living with chronic conditions calls for efficient healthcare-planning and effective care. Implementing disease-management-programmes is one option for responding to this demand. Knowledge is scarce about the effect of implementation processes and their effect on patients; only few studies have reported the effectiveness of disease-management-programmes targeting patients with chronic obstructive pulmonary disease (COPD). The objective of this paper was to determine the effect on healthcare-utilization of an active implementation model for a disease-management-programme for patients with one of the major multimorbidity diseases, COPD. The standard implementation of a new disease-management-programme for COPD was ongoing during the study-period from November 2008 to November 2010 in the Central Denmark Region. We wanted to test a strategy using Breakthrough Series, academic detailing and lists of patients with COPD. It targeted GPs and three hospitals serving approx. 60,000 inhabitants aged 35 or older and included interventions directed at professionals, organisations and patients. The study was a non-blinded block- and cluster-randomised controlled trial with GP-practices as the unit of randomisation. In Ringkoebing-Skjern Municipality, Denmark, 16 GP-practices involving 38 GPs were randomised to either the intervention-group or the control-group. A comparable neighbouring municipality acted as an external-control-group which included nine GP-practices with 25 GPs. An algorithm based on health-registry-data on lung-related contacts to the healthcare-system identified 2,736 patients who were alive at the end of the study-period. The population included in this study counted 1,372 (69.2%) patients who responded to the baseline questionnaire and confirmed their COPD diagnosis; 458 (33.4%) patients were from the intervention-group, 376 (27.4%) from the control-group and 538(39.2%) from the external-control-group. The primary outcome was adherence to the disease-management-programme measured at patient-level by use of specific services from general practice. Secondary outcomes were use of out-of-hours-services, outpatient-clinic, and emergency-department and hospital-admissions. The intervention practices provided more planned preventive consultations, additional preventive consultations and spirometries than non-intervention practices. A comparison of the development in the intervention practices with the development in the control-practices showed that the intervention resulted in more planned preventive-consultations, fewer conventional consultations and fewer patients admitted without a lung-related-diagnosis. Use of the active implementation model for the disease-management-programme for COPD changed the healthcare utilization in accordance with the programme. Clinicaltrials.gov identifier: NCT01228708.

What do community football players think about different exercise-training programmes? Implications for the delivery of lower limb injury prevention programmes

PubMed Central

Finch, Caroline F; Doyle, Tim LA; Dempsey, Alasdair R; Elliott, Bruce C; Twomey, Dara M; White, Peta E; Diamantopoulou, Kathy; Young, Warren; Lloyd, David G

2014-01-01

Background Players are the targeted end-users and beneficiaries of exercise-training programmes implemented during coach-led training sessions, and the success of programmes depends upon their active participation. Two variants of an exercise-training programme were incorporated into the regular training schedules of 40 community Australian Football teams, over two seasons. One variant replicated common training practices, while the second was an evidence-based programme to alter biomechanical and neuromuscular factors related to risk of knee injuries. This paper describes the structure of the implemented programmes and compares players’ end-of-season views about the programme variants. Methods This study was nested within a larger group-clustered randomised controlled trial of the effectiveness of two exercise-training programmes (control and neuromuscular control (NMC)) for preventing knee injuries. A post-season self-report survey, derived from Health Belief Model constructs, included questions to obtain players’ views about the benefits and physical challenges of the programme in which they participated. Results Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit. Suggestions from players about potential improvements to the training programme and its future implementation included reducing duration, increasing range of drills/exercises and promoting its injury prevention and other benefits to players. Conclusions Players provide valuable feedback about the content and focus of implemented exercise-training programmes, that will directly inform the delivery of similar, or more successful, programmes in the future. PMID:24047571

Young Women's Lived Experience of Participating in a Positive Youth Development Programme: The "Teens & Toddlers" Pregnancy Prevention Intervention

ERIC Educational Resources Information Center

Sorhaindo, Annik; Mitchell, Kirstin; Fletcher, Adam; Jessiman, Patricia; Keogh, Peter; Bonell, Chris

2016-01-01

Purpose: Evaluation of the Teens & Toddlers (T&T) positive youth development (PYD) and teenage pregnancy prevention programme suggested that the intervention had minimal effectiveness partly due to its unclear theory of change. The purpose of this paper is to examine the lived experiences of young women participating in the programme to…

Diagnostic inertia in obesity and the impact on cardiovascular risk in primary care: a cross-sectional study

PubMed Central

Martínez-St John, Damian RJ; Palazón-Bru, Antonio; Gil-Guillén, Vicente F; Sepehri, Armina; Navarro-Cremades, Felipe; Ramírez-Prado, Dolores; Orozco-Beltrán, Domingo; Carratalá-Munuera, Concepción; Cortés, Ernesto; Rizo-Baeza, María M

2015-01-01

Background Prevalence of diagnostic inertia (DI), defined as a failure to diagnose disease, has not been analysed in patients with obesity. Aim To quantify DI for cardiovascular risk factors (CVRF) in patients with obesity, and determine its association with the cardiovascular risk score. Design and setting Cross-sectional study of people ≥40 years attending a preventive programme in primary healthcare centres in Spain in 2003–2004. Method All patients with obesity attending during the first 6 months of the preventive programme were analysed. Participants had to be free of CVD (myocardial ischaemia or stroke) and aged 40–65 years; the criteria used to measure SCORE (Systematic COronary Risk Evaluation). Three subgroups of patients with obesity with no personal history of CVRF but with poor control of risk factors were established. Outcome variable was DI, defined as poor control of risk factors and no action taken by the physician. Secondary variables were diabetes, fasting blood glucose (FBG), body mass index (BMI), and SCORE. Adjusted odds ratios (OR) was determined using multivariate logistic regression models. Results Of 8687 patients with obesity in the programme, 6230 fulfilled SCORE criteria. Prevalence of DI in the three subgroups was: hypertension, 1275/1816 (70.2%) patients affected (95% CI = 68.1 to 72.3%); diabetes, 335/359 (93.3%) patients affected (95% CI = 90.7 to 95.9%); dyslipidaemia subgroup, 1796/3341 (53.8%) patients affected (95% CI = 52.1 to 55.4%. Factors associated with DI for each subgroup were: for hypertension, absence of diabetes, higher BMI, and greater cardiovascular risk; for dyslipidaemia, diabetes, higher BMI, and greater cardiovascular risk (SCORE); and for diabetes, lower FBG levels, lower BMI, and greater cardiovascular risk. Conclusion This study quantified DI in patients with obesity and determined that it was associated with a greater cardiovascular risk. PMID:26120135

Effectiveness of Senior Dance on risk factors for falls in older adults (DanSE): a study protocol for a randomised controlled trial

PubMed Central

Franco, Marcia R; Sherrington, Catherine; Tiedemann, Anne; Pereira, Leani S; Perracini, Monica R; Faria, Claudia R S; Pinto, Rafael Z; Pastre, Carlos M

2016-01-01

Introduction Strong evidence shows that exercise is effective to improve fall risk factors among older people. However, older people's participation and adherence to exercise programmes is suboptimal. Type of exercise and apathy are reported to be barriers to exercise participation, suggesting that new effective interventions are needed. The primary aim of this randomised controlled trial is to investigate the effect of Senior Dance plus brief education for falls prevention on balance among people aged 60 years or over, compared with a control group receiving only brief education. Methods and analysis This single-blind randomised controlled trial will involve 82 community-dwelling older people aged 60 years or over who are cognitively intact. Participants allocated to the intervention group will attend a single educational class on strategies to prevent falls, and will participate in a 12-week, twice-weekly group-based programme of Senior Dance. The Senior Dance consists of different choreographies, which include rhythmic and simple movements with rhythmic folk songs. Participants allocated to the control group will attend the same educational class that intervention group participants will receive, and will be instructed not to take part in any regular exercise programme. The primary outcome will be single-leg stance with eyes closed. Secondary outcomes include: Short Physical Performance Battery, Falls Efficacy Scale, Trail Making Test and the Montreal Cognitive Assessment. Continuous outcomes will be reported using mean (SD) or median (IQR), depending on the distribution of the data. The linear regression approach to analysis of covariance will be used to compare the mean effect between groups. All patients will be included in the analyses following an intention-to-treat approach. Ethics and dissemination Ethics approval has been granted by the Human Ethics Committee of the São Paulo State University (CAAE 48665215.9.0000.5402). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences. Trial registration number NCT02603523, Pre-results. PMID:28039296

Interobserver agreement between primary graders and an expert grader in the Bristol and Weston diabetic retinopathy screening programme: a quality assurance audit.

PubMed

Patra, S; Gomm, E M W; Macipe, M; Bailey, C

2009-08-01

To assess the quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and to set standards for future interobserver agreement reports. A prospective audit of 213 image sets from six fully trained primary graders in the Bristol and Weston diabetic retinopathy screening programme was carried out over a 4-week period. All the images graded by the primary graders were regraded by an expert grader blinded to the primary grading results and the identity of the primary grader. The interobserver agreement between primary graders and the blinded expert grader and the corresponding Kappa coefficient was determined for overall grading, referable, non-referable and ungradable disease. The audit standard was set at 80% for interobserver agreement with a Kappa coefficient of 0.7. The interobserver agreement bettered the audit standard of 80% in all the categories. The Kappa coefficient was substantial (0.7) for the overall grading results and ranged from moderate to substantial (0.59-0.65) for referable, non-referable and ungradable disease categories. The main recommendation of the audit was to provide refresher training for the primary graders with focus on ungradable disease. The audit demonstrated an acceptable level of quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and provided a standard against which future interobserver agreement can be measured for quality assurance within a screening programme. Diabet. Med. 26, 820-823 (2009).

Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management.

PubMed

Zwerink, Marlies; Effing, Tanja; Kerstjens, Huib A M; van der Valk, Paul; Brusse-Keizer, Marjolein; Zielhuis, Gerhard; van der Palen, Job

2016-01-01

Information regarding cost-effectiveness of community-based exercise programmes in COPD is scarce. Therefore, we have investigated whether a community-based exercise programme is a cost-effective component of self-management for patients with COPD after 2 years of follow-up. All included COPD patients participated in four self-management sessions. Additionally, patients in the COPE-active group participated in an 11-month community-based exercise programme led by physiotherapists. Patients trained 3 times/week for 6 months and two times/week during the subsequent 5 months. In both periods, one of these weekly training sessions was home-based (unsupervised). No formal physiotherapy sessions were offered to COPE-active patients in the second year. A decision analytical model with a 24-month perspective was used to evaluate cost-effectiveness. Incremental cost-effectiveness ratios (ICER) were calculated and cost-effectiveness planes were created. Data of 77 patients participating in the exercise programme and 76 patients in the control group were analysed. The ICER for an additional patient prevented from deteriorating at least 47.5 meters on the ISWT was €6257. The ICER for an additional patient with a clinically relevant improvement (≥ 500 steps/day) in physical activity was €1564, and the ICER for an additional quality-adjusted life year (QALY) was €10 950. Due to a lack of maintenance of beneficial effects on our primary outcome exercise capacity after 2 years of follow-up and higher costs of the programme, the community-based exercise programme cannot be considered cost-effective compared to self-management programmes only. Nevertheless, the ICERs for the secondary outcomes physical activity and QALY are generally considered acceptable.

A review of the evidence for the effectiveness of primary prevention interventions for Hepatitis C among injecting drug users

PubMed Central

Wright, Nat MJ; Tompkins, Charlotte NE

2006-01-01

Background Hepatitis C (HCV) prevalence is most common amongst injecting drug users where up to 98% of the population can be infected despite a low prevalence of HIV. This review considers the evidence for the effectiveness of primary prevention interventions to reduce incidence or prevalence of hepatitis C. Methods Systematic review of the major electronic medical databases: Medline, EMBASE, PsycINFO, CINAHL and the Cochrane Library (Evidence Based Health). Either intervention or observational studies were included if they described an intervention targeting injecting drug using populations with the outcome to reduce either the prevalence or incidence of hepatitis C infection. Results 18 papers were included in the final review from 1007 abstracts. Needle exchange programmes reduce the prevalence of HCV though prevalence remains high. Similarly the effectiveness of methadone maintenance treatment is only marginally effective at reducing HCV incidence. There is limited evidence evaluating either the effectiveness of behavioural interventions, bleach disinfectants, or drug consumption rooms. Conclusion Primary prevention interventions have led to a reduction in HIV incidence, have been less effective at reducing HCV incidence. Global prevalence of HCV remains disturbingly high in injecting drug users. A robust response to the global health problem of HCV will require provision of new interventions. Behavioural interventions; distribution of bleach disinfectant; other injecting paraphernalia alongside sterile needle distribution; and evaluation of drug consumption rooms merit further expansion internationally and research activity to contribute to the emerging evidence base. Whilst the prevalence of HCV remains high, nevertheless many current interventions aimed at primary HCV prevention have been shown to be cost-effective due to their significant positive impact upon prevalence of HIV. PMID:16956393

Independent Thinkers and Learners: A Critical Evaluation of the "Growing Together Schools Programme"

ERIC Educational Resources Information Center

Sharpe, Darren

2014-01-01

This article reports on primary data following an evaluative research project examining an innovative outdoor learning programme in the South East of England with pupils from year six in a primary school. The programme focused on enhancing the skills, experiences and personal attributes of children and young people to cope better with the…

The National Singing Programme for Primary Schools in England: An Initial Baseline Study

ERIC Educational Resources Information Center

Welch, G. F.; Himonides, E.; Papageorgi, I.; Saunders, J.; Rinta, T.; Stewart, C.; Preti, C.; Lani, J.; Vraka, M.; Hill, J.

2009-01-01

The "Sing Up" National Singing Programme for primary schools in England was launched in November 2007 under the UK government's "Music Manifesto". "Sing Up" is a four-year programme whose overall aim is to raise the status of singing and increase opportunities for children throughout the country to enjoy singing as…

School-based primary NCD risk reduction: education and public health perspectives.

PubMed

Bay, Jacquie L; Hipkins, Rosemary; Siddiqi, Kamran; Huque, Rumana; Dixon, Robyn; Shirley, Debra; Tairea, Karen; Yaqona, Delaney; Mason-Jones, Amanda; Vickers, Mark H

2017-04-01

The rising global burden of noncommunicable diseases (NCDs) has heightened awareness of the necessity for primary risk prevention programmes. These aim to facilitate long-term behaviour changes in children and adolescents that can reduce NCD risk factors and disease onset in later-life. School-based programmes designed to improve childhood and adolescent health behaviours and wellbeing contribute to this; however, design and impact assessment of these is complex. These programmes should be multidisciplinary, utilizing both educational and health expertise. Health outcomes may not be evident in the short term, but may occur with learning-related behaviour modifications, highly effective when sustained over a lifetime. Thus assessment must analyse short-term learning and behaviour impacts as well as long-term capability, behaviour and health outcomes.The focus of assessment measures in the health and education sectors differs and often lacks depth in one or other area. Educators generally focus on identifying evidence of learning related to capability, attitude and/or behaviour changes, while public health practitioners typically focus on health measures (e.g. body mass index (BMI), mental health, or risk behaviours).We argue that multidisciplinary approaches incorporating education and health viewpoints clarify issues relating to the potential value of schools as a setting to facilitate primary NCD risk reduction. To demonstrate this, we need to: 1) build stronger understandings of the features of effective learning for behavioural change and the best way to evaluate these, and 2) convincingly correlate these measures with long-term metabolic health indicators by tracking learner behaviour and health over time. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Managing Risk in Producing Concerts and Other Major Campus Events: A Guide for Student Programmers.

ERIC Educational Resources Information Center

German, Carol J.

1999-01-01

Offers suggestions for campus-activities programmers on how to minimize liability for problems with concerts and other student-planned campus events. Discussion covers prevention of monetary loss, breach of contract issues, and preventing personal injuries and property damage. Specific preventive actions and policies are discussed. (MSE)

Early Fatherhood: A Mapping of the Evidence Base Relating to Pregnancy Prevention and Parenting Support

ERIC Educational Resources Information Center

Trivedi, D.; Brooks, F.; Bunn, F.; Graham, M.

2009-01-01

Teenage pregnancy prevention programmes targeted at young women have received considerable attention from researchers and programme developers. However, to date, relatively limited information is available on preventing teenage fatherhood or improving outcomes for young fathers. A notable gap is concerned with understanding the forms of sexual…

Cluster-randomised controlled trial to assess the effectiveness and cost-effectiveness of an obesity prevention programme for Chinese primary school-aged children: the CHIRPY DRAGON study protocol

PubMed Central

Li, Bai; Liu, Wei Jia; Adab, Peymane; Pallan, Miranda; Hemming, Karla; Frew, Emma; Lin, Rong; Martin, James; Liu, Wei; Cheng, Kar Keung

2017-01-01

Introduction Childhood obesity in China has increased more rapidly and over a shorter time period than in other countries. However, there is a paucity of rigorously developed and evaluated prevention interventions. We aim to evaluate the clinical and cost-effectiveness as well as the implementation process of a complex multicomponent intervention developed using the UK Medical Research Council (MRC) framework. This study provides one of the first examples of rigorous development and evaluation of a childhood obesity prevention programme in a non-western population using the MRC methods. Methods and analysis A cluster-randomised controlled trial in 40 primary schools in Guangzhou, China, including children aged 6–7 years at baseline. Schools will be randomly allocated to either the usual practice (n=20) or intervention arm (n=20). The 12-month intervention consists of four components targeting diet and physical activity behaviours in and outside school, with family involvement. The primary objective is to compare the difference in mean body mass index (BMI) z-score between the intervention and control arms at the end of the intervention (starting March/April 2017). A sample size of 1640 pupils recruited from 40 schools is sufficient to detect a difference of 0.17 units in the mean BMI z-score with a power of 80% (ICC=0.01. ICC, intraclass correlation coefficient) and a significance level of 5%. Treatment effects will be tested using a mixed linear model in STATA adjusting for the child baseline BMI z-score and clustering by school. All analyses will be by intention to treat. Secondary analyses will additionally adjust for prespecified school-level and child-level covariates. The incremental cost-effectiveness ratio for the intervention versus usual practice will be ‘cost per quality-adjusted life year (QALY)’. Cost per change in BMI z-score will also be assessed. A range of methods will be used to evaluate intervention implementation, mechanisms of impact and contextual factors. Ethics and dissemination Ethical approval was obtained from the Life and Health Sciences Ethical Review Committee at the University of Birmingham and the Ethical Committee of Guangzhou Centre for Disease Control and Prevention. The primary, secondary, process evaluation and economic evaluation results of the trial will be disseminated through relevant international peer-reviewed journals and conferences. Trial registration number ISRCTN11867516; Pre-results. PMID:29196485

Global burden of dental condition among children in nine countries participating in an international oral health promotion programme, 2012-2013.

PubMed

Bourgeois, Denis M; Llodra, Juan Carlos

2014-10-01

The Live.Learn.Laugh. phase 2 programme is a unique global partnership between FDI World Dental Federation and Unilever Oral Care which aims to provide measurable improvement of oral health on a global scale through encouraging twice-daily brushing with a fluoride toothpaste. It was based on international recommendations using the principles of health promotion within school for the implementation of preventive health strategies. This paper is an overview of the dental caries condition of children from 2012 to 2013 in nine countries included in four World Health Organisation (WHO) regions. A cross-sectional study was conducted in each country before the implementation of health-promotion measures focused on twice-daily toothbrushing with fluoride toothpaste. The sample was based on stratified sampling according to the WHO pathfinder recommendations. From a total of 7,949 children examined, there were 517 children (1-2 years of age), 1,667 preschool children (3-5 years of age) and 5,789 schoolchildren (6-13 years of age). The prevalence and severity of primary dental caries, early childhood caries and temporary dental caries were described using decayed, filled teeth (dft), permanent decayed, missing, filled teeth (DMFT) indices and the significant caries index (SCI). The major findings were a high prevalence of caries, identification of high-risk groups and inequality in the distribution of the severity of dental conditions. Aggregated data from this overview should provide justification for implementing an oral health programme. The main point is the need to retain and expand the community fluoridation programme as an effective preventive measure. At the individual level, the aggregated data identify the need for more targeted efforts to reach children early - especially among specific high-risk groups. © 2014 FDI World Dental Federation.

Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s National Health Service Health Check preventive cardiovascular programme

PubMed Central

Woringer, Maria; Nielsen, Jessica Jones; Zibarras, Lara; Evason, Julie; Harris, Matthew; Majeed, Azeem; Soljak, Michael

2017-01-01

Background The National Health Service (NHS) Health Check is a cardiovascular disease (CVD) risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There is no tool to assess the effectiveness of the programme in communicating CVD risk to patients. Aims The aim of this paper was to develop a questionnaire examining patients’ CVD risk awareness for use in health service research evaluations of the NHS Health Check programme. Methods We developed an 85-item questionnaire to determine patients’ views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items were added. The resulting 65-item questionnaire with satisfactory content validity (content validity indices≥0.80) and face validity was tested on 110 NHS Health Check attendees in primary care in a cross-sectional study between 21 May 2014 and 28 July 2014. Results Following analyses of data, we reduced the questionnaire from 65 to 26 items. The 26-item questionnaire constitutes four scales: Knowledge of CVD Risk and Prevention, Perceived Risk of Heart Attack/Stroke, Perceived Benefits and Intention to Change Behaviour and Healthy Eating Intentions. Perceived Risk (Cronbach’s α=0.85) and Perceived Benefits and Intention to Change Behaviour (Cronbach’s α=0.82) have satisfactory reliability (Cronbach’s α≥0.70). Healthy Eating Intentions (Cronbach’s α=0.56) is below minimum threshold for reliability but acceptable for a three-item scale. Conclusions The resulting questionnaire, with satisfactory reliability and validity, may be used in assessing patients’ awareness of CVD risk among NHS Health Check attendees. PMID:28947435

Addressing sexual health behaviour during emerging adulthood: a critical review of the literature

PubMed Central

Alexander, Kamila A; Jemmott1, Loretta S; Teitelman, Anne M; D’Antonio, Patricia

2016-01-01

Aims and objectives In this critical literature review, we examine evidence-based interventions that target sexual behaviours of 18- to 25-year-old emerging adult women. Background Nurses and clinicians implement theory-driven research programmes for young women with increased risk of HIV/AIDS and sexually transmitted infections. Strategies to decrease transmission of HIV and sexually transmitted infections are rigorously evaluated and promoted by public health agencies such as the United States Centers for Disease Control and Prevention. While many interventions demonstrate episodic reductions in sexual risk behaviours and infection transmission, there is little evidence they build sustainable skills and behaviours. Programmes may not attend to contextual and affective influences on sexual behaviour change. Design Discursive paper. Methods We conducted a conceptually based literature review and critical analysis of the Centers for Disease Control and Prevention’s best-evidence and good-evidence HIV behavioural interventions. In this review, we examined three contextual and affective influences on the sexual health of emerging adult women: (1) developmental age, (2) reproduction and pregnancy desires and (3) sexual security or emotional responses accompanying relationship experiences. Results Our analyses revealed intervention programmes paid little attention to ways age, desires for pregnancy or emotional factors influence sexual decisions. Some programmes included 18- to 25-year-olds, but they made up small percentages of the sample and did not attend to unique emerging adult experiences. Second, primary focus on infection prevention overshadowed participant desires for pregnancy. Third, few interventions considered emotional mechanisms derived from relationship experiences involved in sexual decision-making. Conclusions Growing evidence demonstrates sexual health interventions may be more effective if augmented to attend to contextual and affective influences on relationship risks and decision-making. Modifying currently accepted strategies may enhance sustainability of sexual health-promoting behaviours. PMID:24988875

Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa.

PubMed

Jukes, Matthew; Simmons, Stephanie; Bundy, Donald

2008-12-01

Education has a potentially important role to play in tackling the spread of HIV, but is there evidence that this potential is realized? This analysis combines the results of previous literature reviews and updates them with the findings of recent randomized controlled trials and a discussion of possible mechanisms for the effect of schooling on vulnerability to HIV infection. There is a growing body of evidence that keeping girls in school reduces their risk of contracting HIV. The relationship between educational attainment and HIV has changed over time, with educational attainment now more likely to be associated with a lower risk of HIV infection than earlier in the epidemic. Educational attainment cannot, however, be isolated from other socioeconomic factors as the cause of HIV risk reduction. The findings of this analysis suggest that the equitable expansion of primary and secondary schooling for girls in southern Africa will help reduce their vulnerability to HIV. Evidence of ineffective HIV prevention education in schools underlines the need for careful evidence-based programme design. Despite the challenges, recent provisional evidence suggests that highly targeted programmes promoting realistic options for young adults may lead to safer sexual behaviour. Targeted education programmes have also been successful in changing students' attitudes to people living with HIV and AIDS, which is associated with testing and treatment decisions. This reduction in stigma may be crucial in encouraging the uptake of voluntary counselling and testing, a central strategy in the control of the epidemic. Expansions of carefully designed and evaluated school-based HIV prevention programmes can help to reduce stigma and have the potential to promote safe sexual behaviour.

Translating evidence into policy for cardiovascular disease control in India

PubMed Central

2011-01-01

Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care. PMID:21306620

Preventive home visits to older people in Denmark--why, how, by whom, and when?

PubMed

Vass, M; Avlund, K; Hendriksen, C; Philipson, L; Riis, P

2007-08-01

In Denmark, political decisions improved the implementation of 'preventative thinking' into every-day clinical work. The potential benefits of preventive efforts have been supported by legislative and administrative incentives, and an ongoing effort to remain focused on the benefits of these initiatives towards older people is politically formulated and underlined as part of the new structured municipality reform. Evidence of beneficial effects of health promotion and prevention of disease in old age is well documented. In-home visits with individualised assessments make it possible to reach older persons not normally seen in the health care system. In-home assessment is not just a health check, but also an opportunity to meet individual needs that may be of importance for older people to stay independent. Preventive home visits may be part of an overall culture and strategy to avoid or prevent functional decline. There is an urgent need of an interdisciplinary teamwork and management for such programmes, incorporating flexible cooperation between the primary and secondary health care sector. The value and importance of geriatric and gerontological education is evidence based.

Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world.

PubMed

Engle, Patrice L; Black, Maureen M; Behrman, Jere R; Cabral de Mello, Meena; Gertler, Paul J; Kapiriri, Lydia; Martorell, Reynaldo; Young, Mary Eming

2007-01-20

This paper is the third in the Child Development Series. The first paper showed that more than 200 million children under 5 years of age in developing countries do not reach their developmental potential. The second paper identified four well-documented risks: stunting, iodine deficiency, iron deficiency anaemia, and inadequate cognitive stimulation, plus four potential risks based on epidemiological evidence: maternal depression, violence exposure, environmental contamination, and malaria. This paper assesses strategies to promote child development and to prevent or ameliorate the loss of developmental potential. The most effective early child development programmes provide direct learning experiences to children and families, are targeted toward younger and disadvantaged children, are of longer duration, high quality, and high intensity, and are integrated with family support, health, nutrition, or educational systems and services. Despite convincing evidence, programme coverage is low. To achieve the Millennium Development Goals of reducing poverty and ensuring primary school completion for both girls and boys, governments and civil society should consider expanding high quality, cost-effective early child development programmes.

Evaluation of a tobacco prevention programme among teenagers in Sweden.

PubMed

Hedman, Linnéa; Andersson, Martin; Stridsman, Caroline; Rönmark, Eva

2015-05-14

To study the prevalence of tobacco use among teenagers, to evaluate a tobacco prevention programme and to study factors related to participation in the prevention programme. Population-based prospective cohort study. Within the Obstructive Lung disease in Northern Sweden (OLIN) studies, a cohort study about asthma in schoolchildren started in 2006. All children aged 7-8 years in three municipalities were invited to a questionnaire survey and 2585 (96%) participated. The cohort was followed up at age 11-12 years (n=2612, 95% of invited) and 14-15 years (n=2345, 88% of invited). In 2010, some of the children in the OLIN cohort (n=447) were invited to a local tobacco prevention programme and 224 (50%) chose to participate. At the age of 14-15 years, the prevalence of daily smoking was 3.5%. Factors related to smoking were female sex, having a smoking mother, participation in sports and lower parental socioeconomic status (SES). The prevalence of using snus was 3.3% and risk factors were male sex, having a smoking mother, having a snus-using father and non-participation in the prevention programme. In the prevention programme, the prevalence of tobacco use was significantly lower among the participants compared with the controls in the cohort. Factors related to non-participation were male sex, having a smoking mother, lower parental SES and participation in sports. The prevalence of tobacco use was lower among the participants in the tobacco prevention programme compared with the non-participants as well as with the controls in the cohort. However, the observed benefit of the intervention may be overestimated as participation was biased by selection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Developing Primary Leadership in England: Adopting an Interpretivist Perspective

ERIC Educational Resources Information Center

Zhang, Wei; Brundrett, Mark

2011-01-01

This paper aims to investigate the perceptions of primary school leaders about the efficacy of the National College programmes. The findings from six contextually different primary schools reveal that the programmes were perceived to have exerted the least influence on school leaders' personality change and pupil outcomes because many generalised…

The Outcome of a Preventive Dental Care Programme on the Prevalence of Localized Aggressive Periodontitis in Down's Syndrome Individuals

ERIC Educational Resources Information Center

Zigmond, Maora; Stabholz, A.; Shapira, J.; Bachrach, G.; Chaushu, G.; Becker, A.; Yefenof, E.; Merrick, J.; Chaushu, S.

2006-01-01

Background: Periodontal disease in Down's syndrome (DS) individuals develops earlier and is more rapid and extensive than in age-matched normal individuals. The present study evaluated a group of DS patients, who had been participating in a 10-year preventive dental programme, for the impact of the programme on their periodontal status. Methods:…

Difficulties Experienced in Setting and Achieving Goals by Participants of a Falls Prevention Programme: A Mixed-Methods Evaluation

PubMed Central

Mason, Wendy; Haines, Terry P.

2014-01-01

ABSTRACT Purpose: To evaluate the ability of participants of a falls prevention programme to set and achieve goals. Methods: The study used a prospective longitudinal design and a mixed-methods approach to data collection. Study participants were (1) 220 older adults participating in a 15-week combined exercise and education falls prevention programme and (2) 9 practitioners (3 home-care nurses, 5 community workers, and an exercise physiologist) involved in delivering the programme. Data from goal-setting forms were analyzed, and descriptive statistics were used to determine the number of appropriate goals set and achieved. Data were analyzed according to programme setting (home- or group-based) and whether or not participants were classified as being from a Culturally and Linguistically Diverse (CALD) background in the Australian context. Semi-structured interviews with programme practitioners were thematically analyzed. Results: A total of 144 respondents (n=75 CALD group, n=41 non-CALD group, n=6 CALD home, n=22 non-CALD home) set 178 goals. Only 101 (57%) goals could be evaluated according to achievement, because participants set goals that focused on health state instead of behaviour, set goals not relevant to falls prevention, used inappropriate constructs to measure goal achievement, and either did not review their goals or dropped out of the programme before goal review. Of these 101 goals, 64 were achieved. Practitioners described their own difficulties in understanding the process of setting health behaviour goals along with communication, cultural, and logistic difficulties. Conclusions: Both CALD and non-CALD participants and those participating in both group- and home-based programmes experienced difficulty in setting and achieving goals to facilitate behaviour change for falls prevention. Data suggest that home-based participants had more difficulty in setting goals than their group-based counterparts and, to a lesser extent, that CALD participants experienced more difficulty in setting goals than their non-CALD counterparts. The use of a guided approach to goal setting and the need for more specific practitioner training and follow-up support regarding goal setting in the context of a falls prevention programme should be considered. PMID:25922563

Difficulties experienced in setting and achieving goals by participants of a falls prevention programme: a mixed-methods evaluation.

PubMed

Haas, Romi; Mason, Wendy; Haines, Terry P

2014-01-01

To evaluate the ability of participants of a falls prevention programme to set and achieve goals. The study used a prospective longitudinal design and a mixed-methods approach to data collection. Study participants were (1) 220 older adults participating in a 15-week combined exercise and education falls prevention programme and (2) 9 practitioners (3 home-care nurses, 5 community workers, and an exercise physiologist) involved in delivering the programme. Data from goal-setting forms were analyzed, and descriptive statistics were used to determine the number of appropriate goals set and achieved. Data were analyzed according to programme setting (home- or group-based) and whether or not participants were classified as being from a Culturally and Linguistically Diverse (CALD) background in the Australian context. Semi-structured interviews with programme practitioners were thematically analyzed. A total of 144 respondents (n=75 CALD group, n=41 non-CALD group, n=6 CALD home, n=22 non-CALD home) set 178 goals. Only 101 (57%) goals could be evaluated according to achievement, because participants set goals that focused on health state instead of behaviour, set goals not relevant to falls prevention, used inappropriate constructs to measure goal achievement, and either did not review their goals or dropped out of the programme before goal review. Of these 101 goals, 64 were achieved. Practitioners described their own difficulties in understanding the process of setting health behaviour goals along with communication, cultural, and logistic difficulties. Both CALD and non-CALD participants and those participating in both group- and home-based programmes experienced difficulty in setting and achieving goals to facilitate behaviour change for falls prevention. Data suggest that home-based participants had more difficulty in setting goals than their group-based counterparts and, to a lesser extent, that CALD participants experienced more difficulty in setting goals than their non-CALD counterparts. The use of a guided approach to goal setting and the need for more specific practitioner training and follow-up support regarding goal setting in the context of a falls prevention programme should be considered.

Rationales for home safety promotion in the Iranian primary healthcare system: results from a pilot study.

PubMed

Mohammadi, R; Ekman, R; Svanström, L; Gooya, M M

2006-01-01

To analyse the prerequisites for a nationwide primary healthcare (PHC) home safety promotion programme in Iran. Injury is a major public health problem throughout the world, currently accounting for one-seventh of all premature deaths and disabilities. Within 20 years, it is estimated that the proportion will increase to one-fifth. The present healthcare system in Iran was started in 1979, with a major focus on easy access to services and prevention. The system is based on the 'health house', which is run by community health workers. A survey shows that 36% of injuries occur in the home environment. A pilot phase of the Home Safety Promotion Programme was initiated in 1994, and included safety checking at home for fences, kitchens, drugs and poisons, heaters, electricity, and stairs and ladders. The pilot study covered 478,551 households out of the 12 million (approximately) in Iran. Sixty-nine supervisors were involved individually, assembled into eight focus groups. Household safety increased by 10-20% over the 4 years of the study. The frequency of home visits changed from annual to seasonal, since all participants agreed that there were seasonal differences in safety problems. The supervisors showed a high level of knowledge of injury as a public health problem, and also positive attitudes towards doing something about safety on the basis of a PHC scheme. The role of a surveillance system was highlighted, and it was suggested that such a system should be added to the programme. Based on our preliminary findings, there were reasons to obtain a policy decision concerning a national programme for safety promotion before extending the pilot scheme to the whole country. A national safety programme was decided upon following completion of the pilot study. It includes a home-related-injury surveillance system that is mandatory in rural areas and voluntary in some cities.

The First-aid Advice and Safety Training (FAST) parents programme for the prevention of unintentional injuries in preschool children: a protocol.

PubMed

Mytton, Julie A; Towner, Elizabeth Ml; Kendrick, Denise; Stewart-Brown, Sarah; Emond, Alan; Ingram, Jenny; Blair, Peter S; Powell, Jane; Mulvaney, Caroline; Thomas, James; Deave, Toity; Potter, Barbara

2014-02-01

Unintentional injury is the leading cause of preventable death in children in the UK, and 0-4-year-olds frequently attend emergency departments following injuries in the home. Parenting programmes designed to support parents, promote behaviour change and enhance parent-child relationships have been shown to improve health outcomes in children. It is not known whether group-based parenting programmes have the potential to prevent unintentional injuries in preschool children. A study to develop a group-based parenting programme to prevent unintentional home injuries in preschool children, and assess the feasibility of evaluation through a cluster-randomised controlled trial. The intervention, designed for parents of children who have sustained a medically attended injury, will be developed with two voluntary sector organisations. The feasibility study will assess ability to recruit parents, deliver the programme and follow-up participants. Participants will complete questionnaires at baseline, 3 months and 6 months, and report injuries in their preschool children using a tool designed and validated for this study. Qualitative methods will assess user and deliverer perceptions of the programme. This study will develop the first group-based parenting programme to prevent injuries in preschool children, and design tools for parent-reported injury outcomes. A key challenge will be to recruit parents to participate in a manner that is non-stigmatising, and does not result in feelings of guilt or belief that they are perceived to be a bad parent. The findings will be used to prepare a trial to assess the effectiveness and cost-effectiveness of the intervention.

Congenital heart disease and rheumatic heart disease in Africa: recent advances and current priorities.

PubMed

Zühlke, Liesl; Mirabel, Mariana; Marijon, Eloi

2013-11-01

Africa has one of the highest prevalence of heart diseases in children and young adults, including congenital heart disease (CHD) and rheumatic heart disease (RHD). We present here an extensive review of recent data from the African continent highlighting key studies and information regarding progress in CHD and RHD since 2005. Main findings include evidence that the CHD burden is underestimated mainly due to the poor outcome of African children with CHD. The interest in primary prevention for RHD has been recently re-emphasised, and new data are available regarding echocardiographic screening for subclinical RHD and initiation of secondary prevention. There is an urgent need for comprehensive service frameworks to improve access and level of care and services for patients, educational programmes to reinforce the importance of prevention and early diagnosis and a relevant research agenda focusing on the African context.

Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents.

PubMed

Hetrick, Sarah E; Cox, Georgina R; Witt, Katrina G; Bir, Julliet J; Merry, Sally N

2016-08-09

Depression is common in young people. It has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health. This is an update of a Cochrane review that was last updated in 2011. To determine whether evidence-based psychological interventions (including cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and third wave CBT)) are effective in preventing the onset of depressive disorder in children and adolescents. We searched the specialised register of the Cochrane Common Mental Disorders Group (CCMDCTR to 11 September 2015), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched conference abstracts and reference lists of included trials and reviews, and contacted experts in the field. We included randomised controlled trials of an evidence-based psychological prevention programme compared with any comparison control for young people aged 5 to 19 years, who did not currently meet diagnostic criteria for depression. Two authors independently assessed trials for inclusion and rated their risk of bias. We adjusted sample sizes to take account of cluster designs and multiple comparisons. We contacted trial authors for additional information where needed. We assessed the quality of evidence for the primary outcomes using GRADE. We included 83 trials in this review. The majority of trials (67) were carried out in school settings with eight in colleges or universities, four in clinical settings, three in the community and four in mixed settings. Twenty-nine trials were carried out in unselected populations and 53 in targeted populations.For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), there were 32 trials with 5965 participants and the risk of having a diagnosis of depression was reduced for participants receiving an intervention compared to those receiving no intervention (risk difference (RD) -0.03, 95% confidence interval (CI) -0.05 to -0.01; P value = 0.01). We rated this evidence as moderate quality according to the GRADE criteria. There were 70 trials (73 trial arms) with 13,829 participants that contributed to the analysis for the primary outcome of depression symptoms (self-rated) at the post-intervention time point, with results showing a small but statistically significant effect (standardised mean difference (SMD) -0.21, 95% CI -0.27 to -0.15; P value < 0.0001). This effect persisted to the short-term assessment point (up to three months) (SMD -0.31, 95% CI -0.45 to -0.17; P value < 0.0001; 16 studies; 1558 participants) and medium-term (4 to 12 months) assessment point (SMD -0.12, 95% CI -0.18 to -0.05; P value = 0.0002; 53 studies; 11,913 participants); however, the effect was no longer evident at the long-term follow-up. We rated this evidence as low to moderate quality according to the GRADE criteria.The evidence from this review is unclear with regard to whether the type of population modified the overall effects; there was statistically significant moderation of the overall effect for depression symptoms (P value = 0.0002), but not for depressive disorder (P value = 0.08). For trials implemented in universal populations there was no effect for depression diagnosis (RD -0.01, 95% CI -0.03 to 0.01) and a small effect for depression symptoms (SMD -0.11, 95% CI -0.17 to -0.05). For trials implemented in targeted populations there was a statistically significantly beneficial effect of intervention (depression diagnosis RD -0.04, 95% CI -0.07 to -0.01; depression symptoms SMD -0.32, 95% CI -0.42 to -0.23). Of note were the lack of attention placebo-controlled trials in targeted populations (none for depression diagnosis and four for depression symptoms). Among trials implemented in universal populations a number used an attention placebo comparison in which the intervention consistently showed no effect. Overall the results show small positive benefits of depression prevention, for both the primary outcomes of self-rated depressive symptoms post-intervention and depression diagnosis up to 12 months (but not beyond). Estimates of numbers needed to treat to benefit (NNTB = 11) compare well with other public health interventions. However, the evidence was of moderate to low quality using the GRADE framework and the results were heterogeneous. Prevention programmes delivered to universal populations showed a sobering lack of effect when compared with an attention placebo control. Interventions delivered to targeted populations, particularly those selected on the basis of depression symptoms, had larger effect sizes, but these seldom used an attention placebo comparison and there are practical difficulties inherent in the implementation of targeted programmes. We conclude that there is still not enough evidence to support the implementation of depression prevention programmes.Future research should focus on current gaps in our knowledge. Given the relative lack of evidence for universal interventions compared with attention placebo controls and the poor results from well-conducted effectiveness trials of universal interventions, in our opinion any future such trials should test a depression prevention programme in an indicated targeted population using a credible attention placebo comparison group. Depressive disorder as the primary outcome should be measured over the longer term, as well as clinician-rated depression. Such a trial should consider scalability as well as the potential for the intervention to do harm.

Internet cognitive behavioural therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care.

PubMed

Newby, J M; Mackenzie, A; Williams, A D; McIntyre, K; Watts, S; Wong, N; Andrews, G

2013-12-01

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) have the highest co-morbidity rates within the internalizing disorders cluster, yet no Internet-based cognitive behavioural therapy (iCBT) programme exists for their combined treatment. We designed a six-lesson therapist-assisted iCBT programme for mixed anxiety and depression. Study 1 was a randomized controlled trial (RCT) comparing the iCBT programme (n = 46) versus wait-list control (WLC; n = 53) for patients diagnosed by structured clinical interview with MDD, GAD or co-morbid GAD/MDD. Primary outcome measures were the Patient Health Questionnaire nine-item scale (depression), Generalized Anxiety Disorder seven-item scale (generalized anxiety), Kessler 10-item Psychological Distress scale (distress) and 12-item World Health Organization Disability Assessment Schedule II (disability). The iCBT group was followed up at 3 months post-treatment. In study 2, we investigated the adherence to, and efficacy of the same programme in a primary care setting, where patients (n = 136) completed the programme under the supervision of primary care clinicians. The RCT showed that the iCBT programme was more effective than WLC, with large within- and between-groups effect sizes found (>0.8). Adherence was also high (89%), and gains were maintained at 3-month follow-up. In study 2 in primary care, adherence to the iCBT programme was low (41%), yet effect sizes were large (>0.8). Of the non-completers, 30% experienced benefit. Together, the results show that iCBT is effective and adherence is high in research settings, but there is a problem of adherence when translated into the 'real world'. Future efforts need to be placed on developing improved adherence to iCBT in primary care settings.

Cost-effectiveness in fall prevention for older women.

PubMed

Hektoen, Liv F; Aas, Eline; Lurås, Hilde

2009-08-01

The aim of this study was to estimate the cost-effectiveness of implementing an exercise-based fall prevention programme for home-dwelling women in the > or = 80-year age group in Norway. The impact of the home-based individual exercise programme on the number of falls is based on a New Zealand study. On the basis of the cost estimates and the estimated reduction in the number of falls obtained with the chosen programme, we calculated the incremental costs and the incremental effect of the exercise programme as compared with no prevention. The calculation of the average healthcare cost of falling was based on assumptions regarding the distribution of fall injuries reported in the literature, four constructed representative case histories, assumptions regarding healthcare provision associated with the treatment of the specified cases, and estimated unit costs from Norwegian cost data. We calculated the average healthcare costs per fall for the first year. We found that the reduction in healthcare costs per individual for treating fall-related injuries was 1.85 times higher than the cost of implementing a fall prevention programme. The reduction in healthcare costs more than offset the cost of the prevention programme for women aged > or = 80 years living at home, which indicates that health authorities should increase their focus on prevention. The main intention of this article is to stipulate costs connected to falls among the elderly in a transparent way and visualize the whole cost picture. Cost-effectiveness analysis is a health policy tool that makes politicians and other makers of health policy conscious of this complexity.

Examining the Sustainability of Teacher Learning Following a Year-Long Science Professional Development Programme for Inservice Primary School Teachers

ERIC Educational Resources Information Center

Drits-Esser, Dina; Gess-Newsome, Julie; Stark, Louisa A.

2017-01-01

This two-year, mixed-methods study explored teacher learning during a year-long professional development programme and during the year following the programme. The study examined patterns of change in primary school teachers' inquiry practices, inquiry beliefs and physical science content knowledge during both years as well as the effects of…

Expanding Global Language Education in Public Primary Schools: The National English Programme in Mexico

ERIC Educational Resources Information Center

Sayer, Peter

2015-01-01

The paper examines the recent national programme of English language instruction in the Mexican public primary schools, called the "Programa Nacional de Inglés en Educación Básica" (PNIEB). The programme, initiated in 2009 by the Ministry of Education as part of the national curriculum, represents the largest expansion of English…

The Impact of a Professional Development Programme on Primary Teachers' Classroom Practice and Pupils' Attitudes to Science

ERIC Educational Resources Information Center

Smith, Greg

2015-01-01

This study investigates the relationship, if any, between teacher participation in a targeted professional development programme and changes in participants' instructional practice and their pupils' attitudes to learning primary science. The programme took place over a 2-year period in 15 small rural schools in the West of Ireland. Data sources…

Master of Primary Health Care degree: who wants it and why?

PubMed

Andrews, Abby; Wallis, Katharine A; Goodyear-Smith, Felicity

2016-06-01

INTRODUCTION The Department of General Practice and Primary Health Care at the University of Auckland is considering developing a Master of Primary Health Care (MPHC) programme. Masters level study entails considerable investment of both university and student time and money. AIM To explore the views of potential students and possible employers of future graduates to discover whether there is a market for such a programme and to inform the development of the programme. METHODS Semi-structured interviews were conducted with 30 primary health care stakeholders. Interviews were digitally recorded, transcribed and analysed using a general inductive approach to identify themes. FINDINGS Primary care practitioners might embark on MPHC studies to develop health management and leadership skills, to develop and/or enhance clinical skills, to enhance teaching and research skills, or for reasons of personal interest. Barriers to MPHC study were identified as cost and a lack of funding, time constraints and clinical workload. Study participants favoured inter-professional learning and a flexible delivery format. Pre-existing courses may already satisfy the post-graduate educational needs of primary care practitioners. Masters level study may be superfluous to the needs of the primary care workforce. CONCLUSIONS Any successful MPHC programme would need to provide value for PHC practitioner students and be unique. The postgraduate educational needs of New Zealand primary care practitioners may be already catered for. The international market for a MPHC programme is yet to be explored.

Pre-Exercise Screening and Health Coaching in CHD Secondary Prevention: A Qualitative Study of the Patient Experience

ERIC Educational Resources Information Center

Shaw, R.; Gillies, M.; Barber, J.; MacIntyre, K.; Harkins, C.; Findlay, I. N.; McCloy, K.; Gillie, A.; Scoular, A.; MacIntyre, P. D.

2012-01-01

Secondary prevention programmes can be effective in reducing morbidity and mortality from coronary heart disease (CHD). In particular, UK guidelines, including those from the Department of Health, emphasize physical activity. However, the effects of secondary prevention programmes with an exercise component are moderate and uptake is highly…

Tobacco and oral health--the role of the world health organization.

PubMed

Petersen, Poul Erik

2003-01-01

In addition to several other chronic diseases, tobacco use is a primary cause of many oral diseases and adverse oral conditions. For example, tobacco is a risk factor for oral cancer, periodontal disease, and congenital defects in children whose mothers smoke during pregnancy. The epidemic of tobacco use is one of the greatest threats to global health; sadly the future appears worse because of the globalization of marketing. The World Health Organization (WHO) has strengthened the work for effective control of tobacco use. At the World Health Assembly in May 2003 the Member States agreed on a groundbreaking public health treaty to control tobacco supply and consumption. The treaty covers tobacco taxation, smoking prevention and treatment, illicit trade, advertising, sponsorship and promotion, and product regulation. Oral health professionals and dental associations worldwide should consider this platform for their future work for tobacco prevention since in several countries they play an important role in communication with patients and communities. The WHO Oral Health Programme gives priority to tobacco control in many ways through the development of national and community programmes which incorporates oral health and tobacco issues, tobacco prevention through schools, tobacco risk assessment in countries, and design of modern surveillance systems on risk factors and oral health. Systematic evaluation of coordinated efforts should be carried out at country and inter-country levels.

Monitoring the effectiveness of HIV and STI prevention initiatives in England, Wales, and Northern Ireland: where are we now?

PubMed Central

Brown, A E; Tomkins, S E; Logan, L E; LaMontagne, D S; Munro, H L; Hope, V D; Righarts, A; Blackham, J E; Rice, B D; Chadborn, T R; Tookey, P A; Parry, J V; Delpech, V; Gill, O N; Fenton, K A

2006-01-01

Primary and secondary prevention are essential components of the response to HIV and sexually transmitted infections (STIs). We present findings from nationally implemented HIV/STI prevention interventions. In 2003, of those attending STI clinics at least 64% of men who have sex with men (MSM) and 55% of heterosexuals accepted a confidential HIV test; 88% of all HIV infections in women giving birth in England were diagnosed before delivery; 85% of MSM eligible for hepatitis B vaccination received a first dose of vaccine at their first STI clinic attendance; 74% of STI clinic attendees for emergency appointments, and 20% of those for routine appointments were seen within 48 hours of initiating an appointment; the National Chlamydia Screening Programme in England found a positivity of 10% and 13% among young asymptomatic women and men, respectively. Prevention initiatives have seen recent successes in limiting further HIV/STI transmission. However, more work is required if current levels of transmission are to be reduced. PMID:16461593

Distribution and prevalence of major risk factors of noncommunicable diseases in selected countries: the WHO Inter-Health Programme.

PubMed Central

Berrios, X.; Koponen, T.; Huiguang, T.; Khaltaev, N.; Puska, P.; Nissinen, A.

1997-01-01

The Inter-Health Programme was launched in 1986 by WHO, with the collaboration of a coordination centre (National Public Health Institute, Finland) to control and prevent chronic noncommunicable diseases (CNCDs) among adults. Programmes for action were organized based on the concept that most major CNCDs share common risk factors and that those that are lifestyle related are modifiable through efficient interventions using multifactorial strategies involving community participation and behaviour changes carried out at the primary health care level. Twelve countries from all WHO Regions have joined the programme. A baseline survey was undertaken in all countries with a common protocol, following the criteria and methods employed in the MONICA Project. Altogether 36815 men and women aged 35-64 years were included in the present analysis from the following Inter-Health countries: Chile, China, Cyprus, Finland, Lithuanian SSR, Malta, Mauritius, Russian SFSR, United Republic of Tanzania, and USA. In addition to individual country analysis, centralized analysis was carried out at the Finnish National Public Health Institute and the Department of Community Health, Kuopio University, Finland. Reported here are the mean values of blood pressure, body mass index, and serum total cholesterol as well as specific prevalences of smoking, hypertension, obesity, and hypercholesterolaemia. PMID:9185361

Breast Cancer Screening Programmes across the WHO European Region: Differences among Countries Based on National Income Level.

PubMed

Altobelli, Emma; Rapacchietta, Leonardo; Angeletti, Paolo Matteo; Barbante, Luca; Profeta, Filippo Valerio; Fagnano, Roberto

2017-04-23

Breast cancer (BC) is the most frequent tumour affecting women all over the world. In low- and middle-income countries, where its incidence is expected to rise further, BC seems set to become a public health emergency. The aim of the present study is to provide a systematic review of current BC screening programmes in WHO European Region to identify possible patterns. Multiple correspondence analysis was performed to evaluate the association among: measures of occurrence; GNI level; type of BC screening programme; organization of public information and awareness campaigns regarding primary prevention of modifiable risk factors; type of BC screening services; year of screening institution; screening coverage and data quality. A key difference between High Income (HI) and Low and Middle Income (LMI) States, emerging from the present data, is that in the former screening programmes are well organized, with approved screening centres, the presence of mobile units to increase coverage, the offer of screening tests free of charge; the fairly high quality of occurrence data based on high-quality sources, and the adoption of accurate methods to estimate incidence and mortality. In conclusion, the governments of LMI countries should allocate sufficient resources to increase screening participation and they should improve the accuracy of incidence and mortality rates.

Evaluation of a school-based intervention programme for South African children of divorce.

PubMed

Botha, Cornelius J; Wild, Lauren G

2013-01-01

Parental divorce affects approximately 30 000 South African children annually. This pilot study aimed to evaluate the effectiveness of the Children of Divorce Intervention Programme (CODIP) at two South African schools. CODIP is a preventively oriented group programme which was developed to foster resilience by helping children cope more effectively with possible academic, behavioural, and emotional problems brought about by their parents' divorce. Twenty-five 10- to 14-year-old boys from two primary schools were randomly assigned to 2 experimental groups and 1 delayed intervention control group. The experimental groups attended 12 one-hour weekly sessions; the control group received no intervention until after the study was completed. Children's understanding of divorce related events and social, emotional and behavioural adjustment was assessed one week before the intervention and three months thereafter using a battery of self-rated, teacher-rated and parent-rated questionnaires. One-way ANOVAs indicated no statistically significant decline in children's self-reported problematic beliefs about divorce or total difficulties. However, teachers' and parents' ratings indicated that compared to the control group, the combined experimental groups showed significant improvement in their general behavioural, emotional and social adjustment after programme participation. The results suggest that South African children who experience parental divorce may benefit from participation in CODIP.

[Food and nutrition in primary care in Brazil].

PubMed

Nunes Pereira, Tatiane; Alves Monteiro, Renata; Pacheco Santos, Leonor Maria

To describe food and nutrition actions in primary health care in Brazil. Exploratory review of articles published between 2007 and 2016. Lilacs, PubMed, Scopus and Web of Science databases were consulted. 103 articles were included, mostly published between 2012 and 2016 and developed mainly in the Southeast region of Brazil. The most prevalent research topics were food behaviour or consumption, nutritional status and non-communicable diseases. Most research was led by universities and was focused on diagnosis. Few actions on health promotion, healthy eating, assistance, treatment, integral health care and prevention of diseases related to food and nutrition were found in the review. National interest in food and nutrition has increased, however academic production is still far from the actual needs for providing evidence that impacts health status. More research is needed to describe, propose and evaluate programmes and actions. Therefore, it is essential for closer relationships to be forged between universities, managers and health services in order to identify common interests and to develop research that meets the needs of the area and contribute to planning and improving programmes and actions. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Improving mental health through parenting programmes: block randomised controlled trial

PubMed Central

Patterson, J; Barlow, J; Mockford, C; Klimes, I; Pyper, C; Stewart-Brown, S

2002-01-01

Aims: To assess the effectiveness of a parenting programme, delivered by health visitors in primary care, in improving the mental health of children and their parents among a representative general practice population. Methods: Parents of children aged 2–8 years who scored in the upper 50% on a behaviour inventory were randomised to the Webster-Stratton 10 week parenting programme delivered by trained health visitors, or no intervention. Main outcome measures were the Eyberg Child Behaviour Inventory and the Goodman Strengths and Difficulties Questionnaire to measure child behaviour, and the General Health Questionnaire, Abidin's Parenting Stress Index, and Rosenberg's Self Esteem Scale to measure parents' mental health. These outcomes were measured before and immediately after the intervention, and at six months follow up. Results: The intervention was more effective at improving some aspects of the children's mental health, notably conduct problems, than the no intervention control condition. The Goodman conduct problem score was reduced at immediate and six month follow up, and the Eyberg Child Behaviour Inventory was reduced at six months. The intervention also had a short term impact on social dysfunction among parents. These benefits were seen among families with children scoring in the clinical range for behaviour problems and also among children scoring in the non-clinical (normal) range. Conclusion: This intervention could make a useful contribution to the prevention of child behaviour problems and to mental health promotion in primary care. PMID:12456542

Knowledge level of nurses in Jordan on ventilator-associated pneumonia and preventive measures.

PubMed

Hassan, Zeinab M; Wahsheh, Moayad A

2017-05-01

Ventilator-associated pneumonia is the most prevalent infection in Intensive Care Units, with the highest mortality rate; crude mortality rates may be as high as 20-75%. Many practices such as prevention measures (e.g. hand washing, wearing gloves, suctioning, elevated head of bed between 30° and 45°) have demonstrated an effect of reducing the incidence of this infection. To identify the level of nurses' knowledge of ventilator-associated pneumonia and prevention measures before an educational programme, identify the level of nurses' knowledge on ventilator-associated pneumonia and prevention post an educational programme and identify the reasons for not applying ventilator-associated pneumonia prevention measures among nurses in Jordan. Pre- and post-intervention observational study. Data based on a self-reported questionnaire from 428 nurses who worked in intensive care units were analysed. PowerPoint lectures, videos, printed materials and electronic materials were used in the intervention. Paired t-tests were used to test research questions. More than three-quarters of nurses had a low knowledge level regarding pathophysiology, risk factors and ventilator-associated pneumonia preventative measures. Nurses showed significant improvements in mean scores on the knowledge level of ventilator-associated pneumonia and prevention measures after an educational programme (p < 0.05). The main reasons for not applying prevention measures were the lack of time and no followed protocols in the units. Health education programmes about ventilator-associated pneumonia must be conducted among nurses in Jordan through continuous education. Hospital and nursing administrators should be actively involved in educational programmes and in assuring support for continuing education. Protocol for ventilator-associated pneumonia prevention should be developed based on current evidence-based guidelines. © 2016 British Association of Critical Care Nurses.

The Implementation of a Behavioural Support Programme: Teachers' Perceptions of the Programme and Themselves as Providers

ERIC Educational Resources Information Center

Ingemarson, Maria; Bodin, Maria; Rubenson, Birgitta; Guldbrandsson, Karin

2016-01-01

Purpose: The purpose of this paper is to investigate how teachers received and perceived the school programme Prevention in School (PS), a positive behavioural support programme; how did the teachers perceive the programme characteristics and themselves as providers; and how did this affect programme implementation? Design/methodology/approach:…

How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature.

PubMed

Kok, Maryse C; Kane, Sumit S; Tulloch, Olivia; Ormel, Hermen; Theobald, Sally; Dieleman, Marjolein; Taegtmeyer, Miriam; Broerse, Jacqueline E W; de Koning, Korrie A M

2015-03-07

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs. We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized. Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes. Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance.

Frequency and preventative interventions for non-suicidal self-injury and suicidal behaviour in primary school-age children: a scoping review protocol.

PubMed

Bem, Danai; Connor, Charlotte; Palmer, Colin; Channa, Sunita; Birchwood, Max

2017-07-10

Non-suicidal self-injury (NSSI) and suicidal behaviour have been witnessed in children as young as 6-7 years of age, but while there are many reviews of preventative interventions for NSSI and suicide in adolescents, few have explored its prevalence in younger children and the potential impact of preventative interventions at this stage of life. NSSI and suicidal behaviour are an increasing concern in schools but school-based programmes can improve knowledge, attitudes and help-seeking behaviours and help prevent escalation of NSSI and later suicide. This scoping review will aim to explore the nature and extent of the evidence on the magnitude of NSSI and suicidal behaviour in primary school children, and to examine whether there are any primary school-based interventions available for the prevention of this phenomenon in 5 to 11-year-olds. A scoping review will be conducted using established methodology by Arksey and O'Malley and the Joanna Briggs Institute. Multiple bibliographic and indexing databases and grey literature will be searched using a combination of text words and index terms relating to NSSI, suicide, primary schools, frequency and intervention. Two reviewers will independently screen eligible studies for study selection and extract relevant data from included studies. A narrative summary of evidence will be conducted for all included studies with results presented in tables and/or diagrams. Inductive content analysis will be used to understand any narrative findings within the included studies. Ethical approval is not required for this scoping review. The results of this review will be disseminated though publication in a peer-reviewed journal and presented at relevant 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.

The efficacy of education programme for preventing constipation in women.

PubMed

Ayaz, Sultan; Hisar, Filiz

2014-06-01

This study was performed to evaluate the efficiency of the education programme for prevention of constipation in women. This study was performed as a pre-test-posttest design. Thirty-five women were included who have constipation problem. Data were collected by questionnaire: Constipation Severity Instrument (CSI), Constipation Visual Analogue Scale (CVAS) and Bristol Stool Chart (BSC). Eight home visits were made for each of the women and they were followed up for 3 months. Participants received an individual education programme that included advice on dietary consumption such as pulpy-fibrous nutrient consumption, fluid intake, an exercise regime and counselling about optimal position to defecate. The subscales of 'Colonic Inertia' and 'Pain', and CSI total mean scores and CVAS mean scores were decreased significantly after education programme (P < 0.05). According to the BSC, 71.5% of the women stated their stool form to be 'sausage-shaped, but lumpy' before the education programme, but after the said programme the percentage had dropped to 17.1%. Education programme given to women who had constipation were determined to have been effective in alleviating constipation. Nurses should develop appropriate and effective strategies to help women prevent constipation. © 2013 Wiley Publishing Asia Pty Ltd.

National infection prevention and control programmes: Endorsing quality of care.

PubMed

Stempliuk, Valeska; Ramon-Pardo, Pilar; Holder, Reynaldo

2014-01-01

Core components Health care-associated infections (HAIs) are a major cause of morbidity and mortality. In addition to pain and suffering, HAIs increase the cost of health care and generates indirect costs from loss of productivity for patients and society as a whole. Since 2005, the Pan American Health Organization has provided support to countries for the assessment of their capacities in infection prevention and control (IPC). More than 130 hospitals in 18 countries were found to have poor IPC programmes. However, in the midst of many competing health priorities, IPC programmes are not high on the agenda of ministries of health, and the sustainability of national programmes is not viewed as a key point in making health care systems more consistent and trustworthy. Comprehensive IPC programmes will enable countries to reduce the mobility, mortality and cost of HAIs and improve quality of care. This paper addresses the relevance of national infection prevention and control (NIPC) programmes in promoting, supporting and reinforcing IPC interventions at the level of hospitals. A strong commitment from national health authorities in support of national IPC programmes is crucial to obtaining a steady decrease of HAIs, lowering health costs due to HAIs and ensuring safer care.

Pilot evaluation of an adolescent risk and injury prevention programme incorporating curriculum and school connectedness components.

PubMed

Chapman, R L; Buckley, L; Sheehan, M; Shochet, I M

2013-08-01

School connectedness is an important protective factor for adolescent risk-taking behaviour. This study examined a pilot version of the Skills for Preventing Injury in Youth (SPIY) programme, combining teacher professional development (PD) for increasing school connectedness (connectedness component) with a risk and injury prevention curriculum for early adolescents (curriculum component). A process evaluation was conducted on the connectedness component, involving assessments of programme reach, participant receptiveness and initial use, and a preliminary impact evaluation was conducted on the combined connectedness and curriculum programme. The connectedness component was well received by teacher participants, who saw benefits for both themselves and their students. Classroom observation also showed that teachers who received PD made use of the programme strategies. Grade 8 students who participated in the SPIY programme were less likely to report violent behaviour at 6-month follow-up than were control students, and trends also suggested reduced transport injuries. The results of this research support the use of the combined SPIY connectedness and curriculum components in a large-scale effectiveness trial to assess the impact of the programme on students' connectedness, risk-taking and associated injuries.

Improving outcomes of first‐episode psychosis: an overview

PubMed Central

Fusar‐Poli, Paolo; McGorry, Patrick D.; Kane, John M.

2017-01-01

Outcomes of psychotic disorders are associated with high personal, familiar, societal and clinical burden. There is thus an urgent clinical and societal need for improving those outcomes. Recent advances in research knowledge have opened new opportunities for ameliorating outcomes of psychosis during its early clinical stages. This paper critically reviews these opportunities, summarizing the state‐of‐the‐art knowledge and focusing on recent discoveries and future avenues for first episode research and clinical interventions. Candidate targets for primary universal prevention of psychosis at the population level are discussed. Potentials offered by primary selective prevention in asymptomatic subgroups (stage 0) are presented. Achievements of primary selected prevention in individuals at clinical high risk for psychosis (stage 1) are summarized, along with challenges and limitations of its implementation in clinical practice. Early intervention and secondary prevention strategies at the time of a first episode of psychosis (stage 2) are critically discussed, with a particular focus on minimizing the duration of untreated psychosis, improving treatment response, increasing patients’ satisfaction with treatment, reducing illicit substance abuse and preventing relapses. Early intervention and tertiary prevention strategies at the time of an incomplete recovery (stage 3) are further discussed, in particular with respect to addressing treatment resistance, improving well‐being and social skills with reduction of burden on the family, treatment of comorbid substance use, and prevention of multiple relapses and disease progression. In conclusion, to improve outcomes of a complex, heterogeneous syndrome such as psychosis, it is necessary to globally adopt complex models integrating a clinical staging framework and coordinated specialty care programmes that offer pre‐emptive interventions to high‐risk groups identified across the early stages of the disorder. Only a systematic implementation of these models of care in the national health care systems will render these strategies accessible to the 23 million people worldwide suffering from the most severe psychiatric disorders. PMID:28941089

Spring Fever: Process Evaluation of a Sex and Relationships Education Programme for Primary School Pupils

ERIC Educational Resources Information Center

Newby, Katie V.; Mathieu-Chartier, Sara

2018-01-01

In primary schools in England, programmes of Sex and Relationships Education (SRE) are rare. Provision has been judged as requiring improvement in over one-third of these schools at a time when statutory provision has been mandated by the government. The aim of this study was to examine the early implementation of Spring Fever, a programme of…

Success or Failure of Primary Second/Foreign Language Programmes in Asia: What Do the Data Tell Us?

ERIC Educational Resources Information Center

Baldauf, Richard B., Jr.; Kaplan, Robert B.; Kamwangamalu, Nkonko; Bryant, Pauline

2011-01-01

Primary school second/foreign language (SL/FL) programmes in Asia, as well as in other parts of the world, are becoming more common, with many targeting English as the SL or FL. The pressures for such English language programmes come from top-down notions that in a globalised world English is required for societies to be competitive, especially…

The Effects of an Individualised ICT-Based Music Education Programme on Primary School Students' Musical Competence and Grades

ERIC Educational Resources Information Center

Hernández-Bravo, Juan R.; Cardona-Moltó, M. Cristina; Hernández-Bravo, José A.

2016-01-01

The purpose of this study was to examine the effect of an information and communications technology (ICT)-based individualised music education programme on primary students' musical competence. A 2 × 3 aptitude treatment interaction factorial design was used to assess the impact of the programme as a function of students' musical aptitude (MA)…

Health coaching and pedometers to enhance physical activity and prevent falls in community-dwelling people aged 60 years and over: study protocol for the Coaching for Healthy AGEing (CHAnGE) cluster randomised controlled trial.

PubMed

Tiedemann, Anne; Rissel, Chris; Howard, Kirsten; Tong, Allison; Merom, Dafna; Smith, Stuart; Wickham, James; Bauman, Adrian; Lord, Stephen R; Vogler, Constance; Lindley, Richard I; Simpson, Judy M; Allman-Farinelli, Margaret; Sherrington, Catherine

2016-05-10

Prevention of falls and promotion of physical activity are essential for maximising well-being in older age. However, there is evidence that promoting physical activity among older people without providing fall prevention advice may increase fall rates. This trial aims to establish the impact of a physical activity and fall prevention programme compared with a healthy eating programme on physical activity and falls among people aged 60+ years. This cluster randomised controlled trial will involve 60 groups of community-dwelling people aged 60+ years. Participating groups will be randomised to: (1) a physical activity and fall prevention intervention (30 groups), involving written information, fall risk assessment and prevention advice, a pedometer-based physical activity tracker and telephone-based health coaching; or (2) a healthy eating intervention (30 groups) involving written information and telephone-based dietary coaching. Primary outcomes will be objectively measured physical activity at 12 months post-randomisation and self-reported falls throughout the 12-month trial period. Secondary outcomes include: the proportion of fallers, the proportion of people meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and health and community service use. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will be preplanned, conducted while masked to group allocation, will take into account cluster randomisation, and will use an intention-to-treat approach. Protocol has been approved by the Human Research Ethics Committee at The University of Sydney, Australia (number 2015/517). Results will be disseminated via peer-reviewed journal articles, international conference presentations and participants' newsletters. ACTRN12615001190594. 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/

Effectiveness and micro-costing of the KiVa school-based bullying prevention programme in Wales: study protocol for a pragmatic definitive parallel group cluster randomised controlled trial.

PubMed

Clarkson, Suzy; Axford, Nick; Berry, Vashti; Edwards, Rhiannon Tudor; Bjornstad, Gretchen; Wrigley, Zoe; Charles, Joanna; Hoare, Zoe; Ukoumunne, Obioha C; Matthews, Justin; Hutchings, Judy

2016-02-01

Bullying refers to verbal, physical or psychological aggression repeated over time that is intended to cause harm or distress to the victims who are unable to defend themselves. It is a key public health priority owing to its widespread prevalence in schools and harmful short- and long-term effects on victims' well-being. There is a need to strengthen the evidence base by testing innovative approaches to preventing bullying. KiVa is a school-based bullying prevention programme with universal and indicated elements and an emphasis on changing bystander behaviour. It achieved promising results in a large trial in Finland, and now requires testing in other countries. This paper describes the protocol for a cluster randomised controlled trial (RCT) of KiVa in Wales. The study uses a two-arm waitlist control pragmatic definitive parallel group cluster RCT design with an embedded process evaluation and calculation of unit cost. Participating schools will be randomised a using a 1:1 ratio to KiVa plus usual provision (intervention group) or usual provision only (control group). The trial has one primary outcome, child self-reported victimisation from bullying, dichotomised as 'victimised' (bullied at least twice a month in the last couple of months) versus 'not victimised'. Secondary outcomes are: bullying perpetration; aspects of child social and emotional well-being (including emotional problems, conduct, peer relations, prosocial behaviour); and school attendance. Follow-up is at 12 months post-baseline. Implementation fidelity is measured through teacher-completed lesson records and independent school-wide observation. A micro-costing analysis will determine the costs of implementing KiVa, including recurrent and non-recurrent unit costs. Factors related to the scalability of the programme will be examined in interviews with head teachers and focus groups with key stakeholders in the implementation of school-based bullying interventions. The results from this trial will provide evidence on whether the KiVa programme is transportable from Finland to Wales in terms of effectiveness and implementation. It will provide information about the costs of delivery and generate insights into factors related to the scalability of the programme. Current Controlled Trials ISRCTN23999021 Date 10-6-13.

The impact of active stakeholder involvement on recruitment, retention and engagement of schools, children and their families in the cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP): a school-based intervention to prevent obesity.

PubMed

Lloyd, J; McHugh, C; Minton, J; Eke, H; Wyatt, K

2017-08-14

Recruitment and retention of participants is crucial for statistical power and internal and external validity and participant engagement is essential for behaviour change. However, many school-based interventions focus on programme content rather than the building of supportive relationships with all participants and tend to employ specific standalone strategies, such as incentives, to improve retention. We believe that actively involving stakeholders in both intervention and trial design improves recruitment and retention and increases the chances of creating an effective intervention. The Healthy Lifestyles Programme, HeLP (an obesity prevention programme for children 9-10 years old) was developed using intervention mapping and involved extensive stakeholder involvement in both the design of the trial and the intervention to ensure that: (i) delivery methods were suitably engaging, (ii) deliverers had the necessary skills and qualities to build relationships and (iii) the intervention dovetailed with the National Curriculum. HeLP was a year-long intervention consisting of 4 multi-component phases using a range of delivery methods. We recruited 1324 children from 32 schools from the South West of England to a cluster-randomised controlled trial to determine the effectiveness of HeLP in preventing obesity. The primary outcome was change in body mass index standard deviation score (BMI SDS) at 24 months post randomisation. Secondary outcomes included additional anthropometric and behavioural (physical activity and diet) measures at 18 and 24 months. Anthropometric and behavioural measures were taken in 99%, 96% and 94% of children at baseline, 18 and 24 months, respectively, with no differential follow up between the control and intervention groups at each time point. All children participated in the programme and 92% of children and 77% of parents across the socio-economic spectrum were considered to have actively engaged with HeLP. We attribute our excellent retention and engagement results to the high level of stakeholder involvement in both trial and intervention design, the building of relationships using appropriate personnel and creative delivery methods that are accessible to children and their families across the social spectrum. International Standard Randomised Controlled Trials Register, ISRCTN15811706 . Registered on 1 May 2012.

Second and third year oral health and dental student perceptions of future professional work.

PubMed

Tan, A S; Anderson, V R; Foster Page, L A

2013-11-01

To explore and compare the ways dental and oral health students characterise their future professional work (FPW) at the end of their second and third professional years. Questionnaires were given to a cohort group of 48 dental students and 31 oral health students at the end of their second and third professional years at the University of Otago. Students' characterisations of their FPW were identified using an inductive approach, and the emphasis on each characterisation was confirmed using a 'weighted' table. Dental student response rates were 92% (in 2010) and 85% (in 2011); and oral health student response rates were 100% (in 2011) and 97% (in 2011). Students characterised their FPW in ten broad ways: in reference to treatment-related concerns, patient-related concerns, oral health promotion, oral health education, disease prevention and monitoring, communication, teamwork, maintaining an ideal clinical environment, maintaining a sense of self and improving quality of life. In both years, dental students emphasised treatment-related concerns as central to their FPW and dealing with patient-related concerns as a primary source of difficulty. Oral health students emphasised oral health promotion, oral health education, disease prevention and monitoring and restorative tasks as central to their FPW and dealing with patient-related concerns as a primary source of difficulty. Students' broad perceptions of their FPW changed little as they progressed through their programmes; however, their responses suggested the need for greater attention within their programmes to patient management and teamwork. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Development and preliminary evaluation of a behavioural HIV-prevention programme for teenage girls of Latino descent in the USA.

PubMed

Davidson, Tatiana M; Lopez, Cristina M; Saulson, Raelle; Borkman, April L; Soltis, Kathryn; Ruggiero, Kenneth J; de Arellano, Michael; Wingood, Gina M; Diclemente, Ralph J; Danielson, Carla Kmett

2014-01-01

National data suggests that teenage girls of Latino descent in the USA are disproportionately affected by HIV, with the US Centers for Disease Control and Prevention reporting the rate of new infections being approximately four times higher compared to White women of comparable age . This paper highlights the need for an effective single-sex HIV-prevention programme for teenage girls of Latino descent and describes the development and preliminary evaluation of Chicas Healing, Informing, Living and Empowering (CHILE), a culturally-tailored, HIV-prevention programme exclusively for teenage girls of Latino descent that was adapted from Sisters Informing, Healing, Living and Empowering (SiHLE), an evidence-based HIV- prevention program that is culturally tailored for African American young women. Theatre testing, a pre-testing methodology to assess consumer response to a demonstration of a product, was utilised to evaluate the relevance and utility of the HIV programme as well as opportunities for the integration of cultural constructs. Future directions for the evaluation of CHILE are discussed.

Universal alcohol misuse prevention programmes for children and adolescents: Cochrane systematic reviews.

PubMed

Foxcroft, David R; Tsertsvadze, Alexander

2012-05-01

Alcohol misuse by young people causes significant health and social harm, including death and disability. Therefore, prevention of youth alcohol misuse is a policy aim in many countries. Our aim was to examine the effectiveness of (1) school-based, (2) family-based and (3) multi-component universal alcohol misuse prevention programmes in children and adolescents. Three Cochrane systematic reviews were performed: searches in MEDLINE, EMBASE, PsycINFO, Project CORK and the Cochrane Register of Controlled Trials up to July 2010, including randomised trials evaluating universal alcohol misuse prevention programmes in school, family or multiple settings in youths aged 18 years or younger. Two independent reviewers identified eligible studies and any discrepancies were resolved via discussion. A total of 85 trials were included in the reviews of school (n = 53), family (n = 12) and multi-component (n = 20) programmes. Meta-analysis was not performed due to study heterogeneity. Most studies were conducted in North America. Risk of bias assessment revealed problems related to inappropriate unit of analysis, moderate to high attrition, selective outcome reporting and potential confounding. Certain generic psychosocial and life skills school-based programmes were effective in reducing alcohol use in youth. Most family-based programmes were effective. There was insufficient evidence to conclude that multiple interventions provided additional benefit over single interventions. In these Cochrane reviews, some school, family or multi-component prevention programmes were shown to be effective in reducing alcohol misuse in youths. However, these results warrant a cautious interpretation, since bias and/or contextual factors may have affected the trial results. Further research should replicate the most promising studies identified in these reviews and pay particular attention to content and context factors through rigorous evaluation.

Childhood obesity: nurses' role in addressing the epidemic.

PubMed

Rabbitt, Aifric; Coyne, Imelda

Obesity is a significant long-term health problem that is common among children and adolescents in Western countries. Being overweight or obese (extremely overweight) can contribute to type 2 diabetes in childhood and increase the risk of cardiovascular disease in adulthood. Primary prevention of obesity prevents the development of serious secondary complications in adulthood. Nurses can help parents and children by providing nutritional advice and, through weight management programmes, offer strategies for decreasing caloric intake and increasing physical activity. Nurses' actions should always take a whole-family approach because it is challenging for obese children to alter their dietary or physical habits if not supported by their families. Nurses should work with all members of the multidisciplinary team in addressing childhood obesity as it is a major health issue with long-term mobidities.

Physical Activity and Exercise as a Basic Preventive Measure (Primary Prevention, Prevention after Renal Transplantation).

PubMed

Adámková, Věra; Bělohoubek, Jiří; Adámek, Václav; Juhaňáková, Martina; Pirk, Jan

2015-11-01

Movement is an inseparable part of one's life, and has been a basic everyday activity through the history of mankind. However, a lack of physical activity and availability of food have resulted in a variety of serious health impairments. The 20th century has witnessed a steep rise of mortality from cardiovascular disease, increase in the prevalence of type-2 diabetes mellitus, malignant diseases, and dramatic increase in body weight initially in industrialized nations followed, in the last two decades of the last century, by the populations of third-world countries with all inherent consequences of this phenomenon. Preventive programmes involving physical activity have also been on the list of top priorities of various materials issued by the World Health Organization. Physical activity is one of the simplest non-pharmacological tools in the prevention of a plethora of diseases. The simplest physical activity, even for therapeutic purposes, is walking. We can walk any time, virtually anywhere, so walking is also the least expensive therapeutic option. Copyright© by the National Institute of Public Health, Prague 2015.

The Citizenship Safety Project: a pilot study.

PubMed

Frederick, K; Barlow, J

2006-02-01

The Government White Paper Saving Lives: Our Healthier Nation (1999) provides a clear indication that accidents are a serious public health problem and have been targeted by the Department of Health as a key area for prevention over the next 10 years. School-based injury prevention programmes have been identified as one of the key settings for the implementation of the White Paper's heath promotion strategies. The Citizen Safety Project (CSP) is a peer-delivered injury prevention programme for Year 10 students (14-15 years) and Year 2 pupils (6-7 years). This paper summarizes the findings of a pilot study that assessed the feasibility of implementing the CSP in schools and of conducting a larger study. Working as part of their Personal Social Health Education lessons, 11 pairs (n = 22) of Year 10 students developed a project to take one accident prevention theme of their choice into a primary school to teach small groups of five or six Year 2 pupils (n = 55). A formative evaluation was conducted, based on interviews with Year 2 and Year 10 teachers (n = 2), and the diaries of Year 10 students. Knowledge of accident prevention and risk awareness was measured in Year 2 pupils using the Draw and Write technique, and impact on Year 10 students was measured using self-esteem and locus of control inventories. Using both statistical and thematic analysis the study concludes that the CSP is well accepted, improves knowledge in Year 2 pupils and boosts confidence in Year 10 students, while concurrently achieving key stage attainment targets. Implications of the study are discussed in terms of future research, as are recommendations with regard to modifications to the project.

The Intercultural and Non-Formal Learning Processes of Children in Primary School Exchange Programmes in France and Germany

ERIC Educational Resources Information Center

Melin, Valérie; Wagner, Bernd

2015-01-01

This paper is based on educational anthropology, and presents the initial findings of a three-year international comparative study of primary school children's learning-processes during travel and cross-cultural encounters. A French-German research team investigated and here reports on primary school exchange programmes. Open coding of the…

Developing a diabetes prevention education programme for community health-care workers in Thailand: formative findings.

PubMed

Sranacharoenpong, Kitti; Hanning, Rhona M

2011-10-01

The aim of this study was to investigate barriers to and supports for implementing a diabetes prevention education programme for community health-care workers (CHCWs) in Chiang Mai province, Thailand. The study also aimed to get preliminary input into the design of a tailored diabetes prevention education programme for CHCWs. Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. As access to diabetes prevention programme is limited in Thailand, especially in rural and semi-urban areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective, and sustainable. Health-care professionals (n = 12) selected from health centres within one district participated in in-depth interviews. In addition, screened people at risk for diabetes participated in interviews (n = 8) and focus groups (n = 4 groups, 23 participants). Coded transcripts from audio-taped interviews or focus groups were analysed by hand and using NVivo software. Concept mapping illustrated the findings. Health-care professionals identified potential barriers to programme success as a motivation for regular participation, and lack of health policy support for programme sustainability. Health-care professionals identified opportunities to integrate health promotion and disease prevention into CHCWs' duties. Health-care professionals recommended small-group workshops, hands-on learning activities, case studies, and video presentations that bring knowledge to practice within their cultural context. CHCWs should receive a credit for continuing study. People at risk for diabetes lacked knowledge of nutrition, diabetes risk factors, and resources to access health information. They desired two-way communication with CHCWs. Formative research supports the need for an effective, sustainable programme to support knowledge translation to CHCWs and at-risk populations in the communities they serve. Ultimately, this should support chronic disease prevention in Thailand.

Canaries in the coal mine: Interpersonal violence, gang violence, and violent extremism through a public health prevention lens.

PubMed

Eisenman, David P; Flavahan, Louise

2017-08-01

This paper asks what programmes and policies for preventing violent extremism (also called 'countering violent extremism', or CVE) can learn from the public health violence prevention field. The general answer is that addressing violent extremism within the wider domain of public health violence prevention connects the effort to a relevant field of research, evidence-based policy and programming, and a broader population reach. This answer is reached by examining conceptual alignments between the two fields at both the case-level and the theoretical level. To address extremist violence within the wider reach of violence prevention, having a shared model is seen as a first step. The World Health Organization uses the social-ecological framework for assessing the risk and protective factors for violence and developing effective public-health based programmes. This study illustrates how this model has been used for gang violence prevention and explores overlaps between gang violence prevention and preventing violent extremism. Finally, it provides policy and programme recommendations to align CVE with public health violence prevention.

Exploring weight loss services in primary care and staff views on using a web-based programme.

PubMed

Ware, Lisa J; Williams, Sarah; Bradbury, Katherine; Brant, Catherine; Little, Paul; Hobbs, F D Richard; Yardley, Lucy

2012-01-01

Demand is increasing for primary care to deliver effective weight management services to patients, but research suggests that staff feel inadequately resourced for such a role. Supporting service delivery with a free and effective web-based weight management programme could maximise primary care resource and provide cost-effective support for patients. However, integration of e-health into primary care may face challenges. To explore primary care staff experiences of delivering weight management services and their perceptions of a web-based weight management programme to aid service delivery. Focus groups were conducted with primary care physicians, nurses and healthcare assistants (n = 36) involved in delivering weight loss services. Data were analysed using inductive thematic analysis. Participants thought that primary care should be involved in delivering weight management, especially when weight was aggravating health problems. However, they felt under-resourced to deliver these services and unsure as to the effectiveness of their input, as routine services were not evaluated. Beliefs that current services were ineffective resulted in staff reluctance to allocate more resources. Participants were hopeful that supplementing practice with a web-based weight management programme would enhance patient services and promote service evaluation. Although primary care staff felt they should deliver weight loss services, low levels of faith in the efficacy of current treatments resulted in provision of under-resourced and 'ad hoc' services. Integration of a web-based weight loss programme that promotes service evaluation and provides a cost-effective option for supporting patients may encourage practices to invest more in weight management services.

Integrating an infectious disease programme into the primary health care service: a retrospective analysis of Chagas disease community-based surveillance in Honduras.

PubMed

Hashimoto, Ken; Zúniga, Concepción; Nakamura, Jiro; Hanada, Kyo

2015-03-24

Integration of disease-specific programmes into the primary health care (PHC) service has been attempted mostly in clinically oriented disease control such as HIV/AIDS and tuberculosis but rarely in vector control. Chagas disease is controlled principally by interventions against the triatomine vector. In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection. This paper retrospectively analyses the effects and process of integrating a Chagas disease vector surveillance system into health centres. We evaluated the effects of integration at six pilot sites in western Honduras during 2008-2011 on; surveillance performance; knowledge, attitude and practice in schoolchildren; reports of triatomine bug infestation and institutional response; and seroprevalence among children under 15 years of age. The process of integration of the surveillance system was analysed using the PRECEDE-PROCEED model for health programme planning. The model was employed to systematically determine influential and interactive factors which facilitated the integration process at different levels of the Ministry of Health and the community. Overall surveillance performance improved from 46 to 84 on a 100 point-scale. Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points. Seroprevalence declined from 3.4% to 0.4%. Health centres responded to the community bug reports by insecticide spraying. As key factors, the health centres had potential management capacity and influence over the inhabitants' behaviours and living environment directly and through community health volunteers. The National Chagas Programme played an essential role in facilitating changes with adequate distribution of responsibilities, participatory modelling, training and, evaluation and advocacy. We found that Chagas disease vector surveillance can be integrated into the PHC service. Health centres demonstrated capacity to manage vector surveillance and improve performance, children's awareness, vector report-response and seroprevalence, once tasks were simplified to be performed by trained non-specialists and distributed among the stakeholders. Health systems integration requires health workers to perform beyond their usual responsibilities and acquire management skills. Integration of vector control is feasible and can contribute to strengthening the preventive capacity of the PHC service.

Human immunodeficiency virus (HIV) prevention education in Singapore: challenges for the future.

PubMed

Wong, Mee Lian; Sen, Priya; Wong, Christina M; Tjahjadi, Sylvia; Govender, Mandy; Koh, Ting Ting; Yusof, Zarina; Chew, Ling; Tan, Avin; K, Vijaya

2012-12-01

We reviewed the current human immunodeficiency virus (HIV) prevention education programmes in Singapore, discussed the challenges faced and proposed prevention education interventions for the future. Education programmes on HIV prevention have shown some success as seen by reduced visits to sex workers among the general adult population and a marked increase in condom use among brothel-based sex workers. However, we still face many challenges such as low awareness of HIV preventive strategies and high prevalence of HIV stigma in the general population. Voluntary HIV testing and condom use remain low among the priority groups such as men who have sex with men (MSM) and heterosexual men who buy sex. Casual sex has increased markedly from 1.1% in 1989 to 17.4% in 2007 among heterosexuals in Singapore, with the majority (84%) practising unprotected sex. Sex workers have moved from brothels to entertainment venues where sex work is mostly hidden with lack of access to sexually transmitted infections (STIs)/ HIV prevention education and treatment programmes. Education programmes promoting early voluntary testing is hampered because of poor access, high cost and stigma towards people living with HIV. It remains a challenge to promote abstinence and consistent condom use in casual and steady sexual relationships among heterosexuals and MSM. New ways to promote condom use by using a positive appeal about its pleasure enhancing effects rather than the traditional disease-oriented approach should be explored. Education programmes promoting early voluntary testing and acceptance of HIV-infected persons should be scaled up and integrated into the general preventive health services.

Randomised controlled trial of a web-based programme in sustaining best practice alcohol management practices at community sports clubs: a study protocol

PubMed Central

McFadyen, Tameka; Kingsland, Melanie; Tindall, Jennifer; Rowland, Bosco; Sherker, Shauna; Gillham, Karen; Heaton, Rachael; Clinton-McHarg, Tara; Lecathelinais, Christophe; Brooke, Daisy; Wiggers, John

2018-01-01

Introduction Community-based interventions have been found to effectively increase the implementation of alcohol management practices and reduce excessive alcohol use and alcohol-related harm at sports clubs. However, once implementation support ceases there may be a reduction in such intervention effects. Thus, ongoing contribution to improving the health of the community is diminished; sustaining practice implementation is a key determinant to address this. One possible solution to the strategic and logistical challenges of sustainability involves the use of the web. The primary aim of this study is to assess the effectiveness of a web-based programme in sustaining the implementation of alcohol management practices by community football clubs. The secondary aim is to assess the effectiveness of the programme in preventing excessive alcohol consumption and alcohol-related harm among members of community football clubs. Methods and analysis The study will employ a repeat randomised controlled trial design and be conducted in regional and metropolitan areas within two states of Australia. Community level football clubs who are currently accredited with an existing alcohol management programme (‘Good Sports’) and implementing at least 10 of the 13 core alcohol management practices (eg, not serving alcohol to <18-year-olds) required by the programme will be recruited and randomised to either a web-based sustainability programme or a ‘minimal contact’ programme. The primary outcome measures are the proportion of football clubs implementing ≥10 of the 13 required alcohol management practices and the mean number of those practices being implemented at 3-year follow-up. Secondary outcomes include: the proportion of club members who report risky drinking at their club, the Alcohol Use Disorder Identification Test (AUDIT) score and mean AUDIT score of club members. Outcome data will be collected via observation at the club during a 1-day visit to a home game, conducted by trained research assistants at baseline and follow-up. Ethics and dissemination The study was approved by The University of Newcastle Human Research Ethics Committee (reference: H-2013-0429). Study findings will be disseminated widely through peer-reviewed publications and conference presentations. Trial registration number ACTRN12614000746639; Pre-results. PMID:29362250

The Incorporation of the USA "Science Made Sensible" Programme in South African Primary Schools: A Cross-Cultural Approach to Science Education

ERIC Educational Resources Information Center

de Villiers, Rian; Plantan, Tiffany; Gaines, Michael

2016-01-01

The Science Made Sensible (SMS) programme began as a partnership between the University of Miami (UM), Florida, USA, and some public schools in Miami. In this programme, postgraduate students from UM work with primary school science teachers to engage learners in science through the use of inquiry-based, hands-on activities. Due to the success of…

[Perceived satisfaction and usefulness of suicide prevention information for patients and relatives].

PubMed

Triñanes, Y; Senra-Rivera, C; Seoane-Pesqueira, G; González-García, A; Álvarez-Ariza, M; de-Las-Heras-Liñero, E; Atienza, G

2014-01-01

To assess the satisfaction of persons with suicidal behaviour and their relatives using patient information material included in the Clinical Practice Guidelines on Prevention and Treatment of Suicidal Behaviour. The sample was made up of 57 patients with suicidal ideation or behaviour, and 52 relatives. The participants were recruited through a suicide prevention programme (Programa de intervención intensiva en conducta suicida [PII] - Suicidal Behaviour Intensive Intervention Programme) and a family association (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES] - Galician Federation of Associations of Relatives and Persons with mental diseases). An ad-hoc questionnaire was designed to ascertain the degree of perceived satisfaction and usefulness of using the information included in the guidelines. The descriptive data of the sample is presented, along with an exploratory factorial analysis of the questionnaire that yielded two dimensions, i.e., format and usefulness. Patients scored significantly lower than the relatives in two dimensions; nevertheless, no significant differences were found between the two groups in the level of general satisfaction. The socio-demographic variables did not influence the results. Similarly, no differences were observed between patients with and without history of suicidal behaviour. Participants stressed that Primary Care was the setting best suited for dissemination of this type of information. In general, both patients and relatives displayed a high level of satisfaction with the patient information material assessed. Furnishing information of this type to patients with suicidal ideation and/or behaviour could act as a preventive-educational tool. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: a double-blind randomized controlled trial.

PubMed

Agouropoulos, A; Twetman, S; Pandis, N; Kavvadia, K; Papagiannoulis, L

2014-10-01

To evaluate the effect of biannual fluoride varnish applications in preschool children as an adjunct to school-based oral health promotion and supervised tooth brushing with 1000ppm fluoride toothpaste. 424 preschool children, 2-5 year of age, from 10 different pre schools in Athens were invited to this double-blind randomized controlled trial and 328 children completed the 2-year programme. All children received oral health education with hygiene instructions twice yearly and attended supervised tooth brushing once daily. The test group was treated with fluoride varnish (0.9% diflurosilane) biannually while the control group had placebo applications. The primary endpoints were caries prevalence and increment; secondary outcomes were gingival health, mutans streptococci growth and salivary buffer capacity. The groups were balanced at baseline and no significant differences in caries prevalence or increment were displayed between the groups after 1 and 2 years, respectively. There was a reduced number of new pre-cavitated enamel lesions during the second year of the study (p=0.05) but the decrease was not statistically significant. The secondary endpoints were unaffected by the varnish treatments. Under the present conditions, biannual fluoride varnish applications in preschool children did not show significant caries-preventive benefits when provided as an adjunct to school-based supervised tooth brushing with 1000ppm fluoride toothpaste. In community based, caries prevention programmes, for high caries risk preschool children, a fluoride varnish may add little to caries prevention, when 1000ppm fluoride toothpaste is used daily. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Documentary Analysis of HIV/AIDS Education Interventions in Ghana

ERIC Educational Resources Information Center

Halabi, Saamira; Smith, William; Collins, John; Baker, David; Bedford, Jason

2013-01-01

Objective: While the international donor community has spent millions on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) prevention through educational programmes, the quality of information in educational curricula is rarely analyzed. This study analyzes the content of prevention programmes, focusing on informational…

Early fatherhood: a mapping of the evidence base relating to pregnancy prevention and parenting support.

PubMed

Trivedi, D; Brooks, F; Bunn, F; Graham, M

2009-12-01

Teenage pregnancy prevention programmes targeted at young women have received considerable attention from researchers and programme developers. However, to date, relatively limited information is available on preventing teenage fatherhood or improving outcomes for young fathers. A notable gap is concerned with understanding the forms of sexual health programmes that are most effective from the perspective of young men. We conducted a systematic mapping to identify studies involving young men aimed at preventing teenage pregnancy, improving outcomes for teenage fathers or exploring the perspectives of young men around pregnancy and fatherhood. We searched a wide range of electronic databases from January 1996 to August 2008. Three quantitative and 15 qualitative studies were identified, of which nine were UK based. Key themes related to the inappropriateness of current sexual health promotion to respond to the needs of young men. While young men often possessed very similar ideals to young women, existing programmes were problematic when they negatively stereotyped young men and ineffectively addressed models of masculinity or the difficulties young men may have forming meaningful relationships. Further investigations are required on programme development for young men, particularly on sexual health promotion interventions for 'looked-after' young men and those from unstable childhoods.

Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012.

PubMed

Laitinen, L A; Anttalainen, U; Pietinalho, A; Hämäläinen, P; Koskela, K

2003-04-01

(1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients as possible with sleep apnoea recover, (3) to maintain capacity for work and functional capacity of patients with sleep apnoea, (4) to reduce the percentage of patients with severe sleep apnoea, (5) to decrease the number of sleep apnoea patients requiring hospitalisation and (6) to improve cost effectiveness of prevention and treatment of sleep apnoea. (6) The following means are suggested for achieving the goals: (1) to promote prevention of obesity, weight loss and weight control; (2) to promote securing of nasal respiration in child patients and removal of obstructing redundant soft tissues; (3) to promote the correction of children's malocclusions, (4) to enhance knowledge about risk factors and treatment of sleep apnoea in key groups, (5) to promote early diagnosis and active treatment, (6) to commence rehabilitation early and individually as a part of treatment and (7) to encourage scientific research. (7) On the national level, the occurrence of sleep apnoea can be prevented, for example, by encouraging weight control. The programme gives examples of such measures and appeals to various authorities and voluntary organisations to reinforce their collaboration. Preventive measures should be individualised, and based on due consideration. (8) The efficacy of diagnosing sleep apnoea should be increased. Attention should be paid to the symptoms of risk group patients at different units of the primary and occupational health care. Even mild forms of the disease should be treated appropriately. Diagnosis and treatment of the disease involve cooperation between the primary and specialised health-care sectors. Methods of treatment are (1) treatment of obesity, (2) positional therapy, (3) reduction of the use of medicines impairing the central nervous system, (4) reduction of smoking and the consumption of alcohol, (5) devices affecting the position of the tongue and lower jaw, (6) treatment with Continuous Positive Airway Pressure (CPAP-treatment), (7) surgical methods of treatment and (8) rehabilitation. (9) The hierarchy of referrals in the prevention and treatment of sleep apnoea should be revised to accord a greater role to the primary health-care sector. Good exchanges of information and cooperation between the primary health care and specialised medical-care sectors should be developed. Hospitals districts in cooperation with provincial governments and municipalities should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. (10) Rehabilitation of sleep apnoea should be goal-orientated and cover all forms of rehabilitation: medical, occupational and social. Rehabilitation should prevent the effects caused by the disease. Thus, it is possible to support self-care, increase the patient's resources and improve quality of life. (11) Information and training should be directed primarily towards health-care personnel, patients and their families. Organisations should produce materials for health and patient education as well as organising training events. To support the activities. financing will be needed from organisations such as Finland's Slot Machine Association. The Social Insurance Institution should disseminate information about questions of social security. Regional direction and training will mainly be the responsibilities of hospital districts, provincial governments and local health centres. The media will play an important role in the dissemination in-depth information about prevention and treatment of sleep apnoea.

[Preventable drug-related morbidity: determining valid indicators for primary care in Portugal].

PubMed

Guerreiro, Mara Pereira; Cantrill, Judith A; Martins, Ana Paula

2007-01-01

Preventable drug-related morbidity (PDRM) indicators are operational measures of therapeutic risk management. These clinical indicators, which cover a wide range of drugs, combine process and outcome in the same instrument. They were developed in the US and have been validated for primary care settings in the US, UK and Canada. This study is part of a research programme; it aimed to determine a valid set of PDRM indicators for adult patients in primary care in Portugal. Face validity of 61 US and UK-derived indicators translated to Portuguese was preliminarily determined by means of a postal questionnaire using a purposive sample of four Portuguese pharmacists with different backgrounds. Preliminary content validity of indicators approved in the previous stage was determined by cross-checking each definition of PDRM with standard drug information sources in Portugal. Face and content validity of indicators yielded by preliminary work were then established by a 37 expert panel (20 community pharmacists and 17 general practitioners) using a two-round Delphi survey. Data were analysed using SPSS release 11.5. Nineteen indicators were ruled out in preliminary validation. Changes were made in the content of eight of the remaining 42 indicators; these were related to differences in the drugs being marketed and patterns of drug monitoring between countries. Thirty-five indicators were consensus approved as PDRM for adult patients in Portuguese primary care by the Delphi panel.

Predictors of completing a primary health care diabetes prevention intervention programme in people at high risk of type 2 diabetes: Experiences of the DE-PLAN project.

PubMed

Gilis-Januszewska, Aleksandra; Lindström, Jaana; Barengo, Noël C; Tuomilehto, Jaakko; Schwarz, Peter Eh; Wójtowicz, Ewa; Piwońska-Solska, Beata; Szybiński, Zbigniew; Windak, Adam; Hubalewska-Dydejczyk, Alicja

2018-02-01

It has been shown that real-life implementation studies for the prevention of type 2 diabetes (DM2) performed in different settings and populations can be effective. However, not enough information is available on factors influencing the reach of DM2 prevention programmes. This study examines the predictors of completing an intervention programme targeted at people at high risk of DM2 in Krakow, Poland as part of the DE-PLAN project.A total of 262 middle-aged people, everyday patients of 9 general practitioners' (GP) practices, at high risk of DM2 (Finnish Diabetes Risk Score (FINDRISK) >14) agreed to participate in the lifestyle intervention to prevent DM2. Intervention consisted of 11 lifestyle counseling sessions, organized physical activity sessions followed by motivational phone calls and letters. Measurements were performed at baseline and 1 year after the initiation of the intervention.Seventy percent of the study participants enrolled completed the core curriculum (n = 184), 22% were men. When compared to noncompleters, completers had a healthier baseline diabetes risk profile (P <.05). People who completed the intervention were less frequently employed versus noncompleters (P = .037), less often had hypertension (P = .043), and more frequently consumed vegetables and fruit daily (P = .055).In multiple logistic regression model, employment reduced the likelihood of completing the intervention 2 times (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81). Higher glucose 2 hours after glucose load and hypertension were the independent factors decreasing the chance to participate in the intervention (OR 0.79, 95% 0.69-0.92 and OR 0.52, 95% CI 0.27-0.99, respectively). Daily consumption of vegetables and fruits increased the likelihood of completing the intervention (OR 1.86, 95% 1.01-3.41).In conclusion, people with healthier behavior and risk profile are more predisposed to complete diabetes prevention interventions. Male, those who work and those with a worse health profile, are less likely to participate and complete interventions. Targeted strategies are needed in real-life diabetes prevention interventions to improve male participation and to reach those who are working as well as people with a higher risk profile.

A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial.

PubMed

Elinder, Liselotte Schäfer; Patterson, Emma; Nyberg, Gisela; Norman, Åsa

2018-04-06

Systematic reviews conclude that interventions to prevent overweight and obesity in children obtain stronger effects when parents are involved. Parenting practices and parent-child interactions shape children's health-related behaviours. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent obesity in children through parental support in disadvantaged areas with increased health needs, delivered by teachers and school nurses. This protocol describes the design, outcome and process evaluation of the study. Effectiveness of the intervention is compared to standard care within school health services. The 6-month programme, based on Social Cognitive Theory, consists of four components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents by the school nurse concerning the child; 3) classroom activities for the children by teachers; and 4) a web-based self-test of type-2 diabetes risk by parents. Effects will be studied in a cluster randomised trial including 17 schools and 352 six-year old children. The primary outcome is dietary intake of indicator foods, and secondary outcomes are physical activity, sedentary behaviour and BMI. Outcomes will be measured at baseline, at 6 months directly after the intervention, and at follow-up 18 months post baseline. Statistical analysis will be by mixed-effect regression analysis according to intention to treat and per protocol. Mediation analysis will be performed with parental self-efficacy and parenting practices. Quantitative and qualitative methods will be used to study implementation in terms of dose, fidelity, feasibility and acceptability. The hypothesis is that the programme will be more effective than standard care and feasible to perform in the school context. The programme is in line with the cumulated evidence regarding the prevention of childhood obesity: That schools should be a focal point of prevention efforts, interventions should involve multiple components, and include the home environment. If effective, it will fill a knowledge gap concerning evidence-based health promotion practice within school health services to prevent obesity, and in the long term reduce social inequalities in health. The trial was retrospectively registered on January 4, 2018 and available online at ClinicalTrials.gov : No. NCT03390725 .

The value of theory in programmes to implement clinical guidelines: Insights from a retrospective mixed-methods evaluation of a programme to increase adherence to national guidelines for chronic disease in primary care

PubMed Central

Sheringham, Jessica; Solmi, Francesca; Ariti, Cono; Baim-Lance, Abigail; Morris, Steve; Fulop, Naomi J.

2017-01-01

Background Programmes have had limited success in improving guideline adherence for chronic disease. Use of theory is recommended but is often absent in programmes conducted in ‘real-world’ rather than research settings. Materials and methods This mixed-methods study tested a retrospective theory-based approach to evaluate a ‘real-world’ programme in primary care to improve adherence to national guidelines for chronic obstructive pulmonary disease (COPD). Qualitative data, comprising analysis of documents generated throughout the programme (n>300), in-depth interviews with planners (clinicians, managers and improvement experts involved in devising, planning, and implementing the programme, n = 14) and providers (practice clinicians, n = 14) were used to construct programme theories, experiences of implementation and contextual factors influencing care. Quantitative analyses comprised controlled before-and-after analyses to test ‘early’ and evolved’ programme theories with comparators grounded in each theory. ‘Early’ theory predicted the programme would reduce emergency hospital admissions (EHA). It was tested using national analysis of standardized borough-level EHA rates between programme and comparator boroughs. ‘Evolved’ theory predicted practices with higher programme participation would increase guideline adherence and reduce EHA and costs. It was tested using a difference-in-differences analysis with linked primary and secondary care data to compare changes in diagnosis, management, EHA and costs, over time and by programme participation. Results Contrary to programme planners’ predictions in ‘early’ and ‘evolved’ programme theories, admissions did not change following the programme. However, consistent with ‘evolved’ theory, higher guideline adoption occurred in practices with greater programme participation. Conclusions Retrospectively constructing theories based on the ideas of programme planners can enable evaluators to address some limitations encountered when evaluating programmes without a theoretical base. Prospectively articulating theory aided by existing models and mid-range implementation theories may strengthen guideline adoption efforts by prompting planners to scrutinise implementation methods. Benefits of deriving programme theory, with or without the aid of mid-range implementation theories, however, may be limited when the evidence underpinning guidelines is flawed. PMID:28328942

Training in the prevention of cervical cancer: advantages of e-learning

PubMed Central

Company, Assumpta; Montserrat, Mireia; Bosch, Francesc X; de Sanjosé, Silvia

2015-01-01

Cervical cancer remains the second most common cancer for women worldwide and is the cancer priority in most low- and middle-income countries (LMIC). The development of vaccines against the human papilloma virus (HPV) and the impact of technology both for the detection of HPV and cervical cancer represent milestones and new opportunities in prevention. New internet-based technologies are generating mass access to training programmes. This article presents the methodology for developing an online training programme for the prevention of cervical cancer as well as the results obtained during the four year period wherein the same programme was delivered in Latin America. PMID:26557878

Determinants of willingness to pay taxes for a community-based prevention programme.

PubMed

Lindholm, L A; Rosén, M E; Stenbeck, M E

1997-06-01

Prevention can reduce the risk of disease, but has other consequences as well. Willingness-to-pay (WTP) is one method to analyse these multi-dimensional consequences, if the stated WTP is assumed to be a function of all the expected positive and negative effects perceived. An interview study of a community-based cardiovascular disease prevention programme in northern Sweden shows that expectations regarding reduced mortality in the community and future savings in public health care spending increase the perceived value of the programme. Among personal benefits, decreased disease risk was not positively associated with WTP, while a low level of anxiety was.

Training in the prevention of cervical cancer: advantages of e-learning.

PubMed

Company, Assumpta; Montserrat, Mireia; Bosch, Francesc X; de Sanjosé, Silvia

2015-01-01

Cervical cancer remains the second most common cancer for women worldwide and is the cancer priority in most low- and middle-income countries (LMIC). The development of vaccines against the human papilloma virus (HPV) and the impact of technology both for the detection of HPV and cervical cancer represent milestones and new opportunities in prevention. New internet-based technologies are generating mass access to training programmes. This article presents the methodology for developing an online training programme for the prevention of cervical cancer as well as the results obtained during the four year period wherein the same programme was delivered in Latin America.

E-mentoring for violence and injury prevention: early lessons from a global programme.

PubMed

Wadhwaniya, Shirin; Meddings, David; Gururaj, Gopalkrishna; Ozanne-Smith, Joan; Ameratunga, Shanthi; Hyder, Adnan A

2015-01-01

To address the growing burden of violence and injuries, especially in low- and middle-income countries, in 2007 the World Health Organization launched MENTOR-VIP, a global violence and injury prevention (VIP)-mentoring programme. The programme aims to develop human resource capacity through 12-month mentoring arrangements between individual VIP experts (mentors) and less-experienced injury practitioners (mentees). In this paper, we review the first five years of the programme (2007-2011) using a systems analysis and SWOT (Strengths, Weaknesses, Opportunities and Threats) frameworks, discuss programme findings and make recommendations. A well-defined programme with clear instructions, successful matching of mentorship pairs with similar interests and language, a formal accord agreement, institutional support and effective communication were identified as programme strengths. Overambitious projects, lack of funds and difficulties with communications were identified as programme weaknesses. Mentorship projects that require institutional permissions or resources could be potential threats to the success of mentorship. The study resulted in the four following recommendations to strengthen the programme: (1) institute additional steps in selection and matching mentor-mentee pair; (2) train mentors on e-mentoring; (3) conduct special orientation for mentees to the programme; and (4) maintain effective and open communication throughout the programme.

Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis.

PubMed

Sterne, Jonathan Ac; Bodalia, Pritesh N; Bryden, Peter A; Davies, Philippa A; López-López, Jose A; Okoli, George N; Thom, Howard Hz; Caldwell, Deborah M; Dias, Sofia; Eaton, Diane; Higgins, Julian Pt; Hollingworth, Will; Salisbury, Chris; Savović, Jelena; Sofat, Reecha; Stephens-Boal, Annya; Welton, Nicky J; Hingorani, Aroon D

2017-03-01

Warfarin is effective for stroke prevention in atrial fibrillation (AF), but anticoagulation is underused in clinical care. The risk of venous thromboembolic disease during hospitalisation can be reduced by low-molecular-weight heparin (LMWH): warfarin is the most frequently prescribed anticoagulant for treatment and secondary prevention of venous thromboembolism (VTE). Warfarin-related bleeding is a major reason for hospitalisation for adverse drug effects. Warfarin is cheap but therapeutic monitoring increases treatment costs. Novel oral anticoagulants (NOACs) have more rapid onset and offset of action than warfarin, and more predictable dosing requirements. To determine the best oral anticoagulant/s for prevention of stroke in AF and for primary prevention, treatment and secondary prevention of VTE. Four systematic reviews, network meta-analyses (NMAs) and cost-effectiveness analyses (CEAs) of randomised controlled trials. Hospital (VTE primary prevention and acute treatment) and primary care/anticoagulation clinics (AF and VTE secondary prevention). Patients eligible for anticoagulation with warfarin (stroke prevention in AF, acute treatment or secondary prevention of VTE) or LMWH (primary prevention of VTE). NOACs, warfarin and LMWH, together with other interventions (antiplatelet therapy, placebo) evaluated in the evidence network. Efficacy  Stroke, symptomatic VTE, symptomatic deep-vein thrombosis and symptomatic pulmonary embolism. Safety  Major bleeding, clinically relevant bleeding and intracranial haemorrhage. We also considered myocardial infarction and all-cause mortality and evaluated cost-effectiveness. MEDLINE and PREMEDLINE In-Process & Other Non-Indexed Citations, EMBASE and The Cochrane Library, reference lists of published NMAs and trial registries. We searched MEDLINE and PREMEDLINE In-Process & Other Non-Indexed Citations, EMBASE and The Cochrane Library. The stroke prevention in AF review search was run on the 12 March 2014 and updated on 15 September 2014, and covered the period 2010 to September 2014. The search for the three reviews in VTE was run on the 19 March 2014, updated on 15 September 2014, and covered the period 2008 to September 2014. Two reviewers screened search results, extracted and checked data, and assessed risk of bias. For each outcome we conducted standard meta-analysis and NMA. We evaluated cost-effectiveness using discrete-time Markov models. Apixaban (Eliquis ® , Bristol-Myers Squibb, USA; Pfizer, USA) [5 mg bd (twice daily)] was ranked as among the best interventions for stroke prevention in AF, and had the highest expected net benefit. Edoxaban (Lixiana ® , Daiichi Sankyo, Japan) [60 mg od (once daily)] was ranked second for major bleeding and all-cause mortality. Neither the clinical effectiveness analysis nor the CEA provided strong evidence that NOACs should replace postoperative LMWH in primary prevention of VTE. For acute treatment and secondary prevention of VTE, we found little evidence that NOACs offer an efficacy advantage over warfarin, but the risk of bleeding complications was lower for some NOACs than for warfarin. For a willingness-to-pay threshold of > £5000, apixaban (5 mg bd) had the highest expected net benefit for acute treatment of VTE. Aspirin or no pharmacotherapy were likely to be the most cost-effective interventions for secondary prevention of VTE: our results suggest that it is not cost-effective to prescribe NOACs or warfarin for this indication. NOACs have advantages over warfarin in patients with AF, but we found no strong evidence that they should replace warfarin or LMWH in primary prevention, treatment or secondary prevention of VTE. These relate mainly to shortfalls in the primary data: in particular, there were no head-to-head comparisons between different NOAC drugs. Calculating the expected value of sample information to clarify whether or not it would be justifiable to fund one or more head-to-head trials. This study is registered as PROSPERO CRD42013005324, CRD42013005331 and CRD42013005330. The National Institute for Health Research Health Technology Assessment programme.

Evaluation of a pilot oral health promotion programme 'Keep Smiling': perspectives from GDPs, health champions and school staff.

PubMed

Yusuf, H; Wright, K; Robertson, C

2015-04-24

To evaluate a pilot oral health promotion programme (fluoride varnish and tooth brushing), targeting 3-7-year-olds in primary schools in a deprived area of London. A pilot programme was conducted among five primary schools targeting 3-7-year-old children in a deprived area of London. The programme consisted of a fluoride varnish application and tooth brushing sessions. Outcome (participation rates) and process evaluations were carried out using semi-structured interviews with school staff, health champions and dentists. Overall, 79.2% of the targeted children participated in tooth brushing and 68.6% of children received fluoride varnish. The programme received positive feedback from school staff, dental teams and health champions. It raised awareness of dental health among all stakeholders and provided children with a unique experience, creating a positive image of dental teams. Community engagement and collaboration between health, education and the voluntary sector is feasible and integral in developing oral health promotion programmes aimed at children attending primary schools in a deprived area of London.

[Characteristics of elderly leaders volunteering to participate in a fall prevention programme].

PubMed

Shimanuki, Hideki; Ueki, Shouzoh; Ito, Tunehisa; Honda, Haruhiko; Takato, Jinro; Kasai, Toshiyuki; Sakamoto, Yuzuru; Niino, Naoakira; Haga, Hiroshi

2005-09-01

This study was conducted to assess characteristics of elderly leaders volunteering to participate in a fall prevention programme. We surveyed 1,503 individuals (75 elderly leaders volunteering to participate in a fall prevention programme and 1,428 non-leader elderly) among the elderly population living in a rural community, Miyagi Prefecture. Subjects were aged 70-84 years. The questionnaire covered socio-demographic factors, as well as physical, psychology and social variables. To analyze the characteristics of the elderly leaders volunteering to participate in this programme, the relationships of socio-demographic, physical, psychology and social factors to whether the elderly were leaders in the programme were analyzed using logistic regression. As a result of multiple logistic regression analysis, the characteristics of elderly leaders volunteering to participate in the fall prevention programme were as follows; 1) being male (OR = 0.25, 95%CI 0.14-0.44); 2) young age (OR=0.43, 95%CI 0.25-0.73); 3) having a high intellectual activity (OR = 2.72, 95%CI 1.65-4.48); 4) being well satisfied with their health (OR = 1.45, 95%CI 1.02-2.07), and 5) having a high IKIGAI (OR = 1.06, 95%CI 1.01-1.13). Only elderly individuals capable of high-level intellectual activities can fill the roles of elderly volunteer group leaders discussed in this study.

School-based education programmes for the prevention of unintentional injuries in children and young people.

PubMed

Orton, Elizabeth; Whitehead, Jessica; Mhizha-Murira, Jacqueline; Clarkson, Mandy; Watson, Michael C; Mulvaney, Caroline A; Staniforth, Joy Ul; Bhuchar, Munish; Kendrick, Denise

2016-12-27

Unintentional injuries are the leading cause of death in children aged four to 18 years and are a major cause of ill health. The school setting offers the opportunity to deliver preventive interventions to a large number of children and has been used to address a range of public health problems. However, the effectiveness of the school setting for the prevention of different injury mechanisms in school-aged children is not well understood. To assess the effects of school-based educational programmes for the prevention of injuries in children and evaluate their impact on improving children's safety skills, behaviour and practices, and knowledge, and assess their cost-effectiveness. We ran the most recent searches up to 16 September 2016 for the following electronic databases: Cochrane Injuries Group Specialised Register; Cochrane Central Register of Controlled Trials; Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations; Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R); Embase and Embase Classic (Ovid); ISI Web of Science: Science Citation Index Expanded; ISI Web of Science Conference Proceedings Citation Index-Science; ISI Web of Science: Social Sciences Citation Index; ISI Web of Science: Conference Proceedings Citation Index - Social Sciences & Humanities; and the 14 October 2016 for the following electronic databases: Health Economics Evaluations Database (HEED); Health Technology Assessment Database (HTA); CINAHL Plus (EBSCO); ZETOC; LILACS; PsycINFO; ERIC; Dissertation Abstracts Online; IBSS; BEI; ASSIA; CSA Sociological Abstracts; Injury Prevention Web; SafetyLit; EconLit (US); PAIS; UK Clinical Research Network Study Portfolio; Open Grey; Index to Theses in the UK and Ireland; Bibliomap and TRoPHI. We included randomised controlled trials (RCTs), non-randomised controlled trials (non-RCTs), and controlled before-and-after (CBA) studies that evaluated school-based educational programmes aimed at preventing a range of injury mechanisms. The primary outcome was self-reported or medically attended unintentional (or unspecified intent) injuries and secondary outcomes were observed safety skills, observed behaviour, self-reported behaviour and safety practices, safety knowledge, and health economic outcomes. The control groups received no intervention, a delayed injury-prevention intervention or alternative school-based curricular activities. We included studies that aimed interventions at primary or secondary prevention of injuries from more than one injury mechanism and were delivered, in part or in full, in schools catering for children aged four to 18 years. We used standard methodological procedures expected by Cochrane. Two review authors identified relevant trials from title and abstracts of studies identified in searches and two review authors extracted data from the included studies and assessed risk of bias. We grouped different types of interventions according to the outcome assessed and the injury mechanism targeted. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. The review included 27 studies reported in 30 articles. The studies had 73,557 participants with 12 studies from the US; four from China; two from each of Australia, Canada, the Netherlands and the UK; and one from each of Israel, Greece and Brazil. Thirteen studies were RCTs, six were non-RCTs and eight were CBAs. Of the included studies, 18 provided some element of the intervention in children aged four to 11 years, 17 studies included children aged 11 to 14 years and nine studies included children aged 14 to 18 years.The overall quality of the results was poor, with the all studies assessed as being at high or unclear risks of bias across multiple domains, and varied interventions and data collection methods employed. Interventions comprised information-giving, peer education or were multi-component.Seven studies reported the primary outcome of injury occurrence and only three of these were similar enough to combine in a meta-analysis, with a pooled incidence rate ratio of 0.73 (95% confidence interval (CI) 0.49 to 1.08; 2073 children) and substantial statistical heterogeneity (I 2 = 63%). However, this body of evidence was low certainty, due to concerns over this heterogeneity (inconsistency) and imprecision. This heterogeneity may be explained by the non-RCT study design of one of the studies, as a sensitivity analysis with this study removed found stronger evidence of an effect and no heterogeneity (I 2 = 0%).Two studies report an improvement in safety skills in the intervention group. Likewise, the four studies measuring observed safety behaviour reported an improvement in the intervention group relative to the control. Thirteen out of 19 studies describing self-reported behaviour and safety practices showed improvements, and of the 21 studies assessing changes in safety knowledge, 19 reported an improvement in at least one question domain in the intervention compared to the control group. However, we were unable to pool data for our secondary outcomes, so our conclusions were limited, as they were drawn from highly diverse single studies and the body of evidence was low (safety skills) or very low (behaviour, safety knowledge) certainty. Only one study reported intervention costs but did not undertake a full economic evaluation (very low certainty evidence). There is insufficient evidence to determine whether school-based educational programmes can prevent unintentional injuries. More high-quality studies are needed to evaluate the impact of educational programmes on injury occurrence. There is some weak evidence that such programmes improve safety skills, behaviour/practices and knowledge, although the evidence was of low or very low quality certainty. We found insufficient economic studies to assess cost-effectiveness.

Screening for increased cardiometabolic risk in primary care: a systematic review

PubMed Central

den Engelsen, Corine; Koekkoek, Paula S; Godefrooij, Merijn B; Spigt, Mark G; Rutten, Guy E

2014-01-01

Background Many programmes to detect and prevent cardiovascular disease (CVD) have been performed, but the optimal strategy is not yet clear. Aim To present a systematic review of cardiometabolic screening programmes performed among apparently healthy people (not yet known to have CVD, diabetes, or cardiometabolic risk factors) and mixed populations (apparently healthy people and people diagnosed with risk factor or disease) to define the optimal screening strategy. Design and setting Systematic review of studies performed in primary care in Western countries. Method MEDLINE, Embase, and CINAHL databases were searched for studies screening for increased cardiometabolic risk. Exclusion criteria were studies designed to assess prevalence of risk factors without follow-up or treatment; without involving a GP; when fewer than two risk factors were considered as the primary outcome; and studies constrained to ethnic minorities. Results The search strategy yielded 11 445 hits; 26 met the inclusion criteria. Five studies (1995–2012) were conducted in apparently healthy populations: three used a stepwise method. Response rates varied from 24% to 79%. Twenty-one studies (1967–2012) were performed in mixed populations; one used a stepwise method. Response rates varied from 50% to 75%. Prevalence rates could not be compared because of heterogeneity of used thresholds and eligible populations. Observed time trends were a shift from mixed to apparently healthy populations, increasing use of risk scores, and increasing use of stepwise screening methods. Conclusion The optimal screening strategy in primary care is likely stepwise, in apparently healthy people, with the use of risk scores. Increasing public awareness and actively involving GPs might facilitate screening efficiency and uptake. PMID:25267047

Evaluation of a nationally funded state-based programme to reduce fatal occupational injuries

PubMed Central

Menendez, Cammie Chaumont; Castillo, Dawn; Rosenman, Kenneth; Harrison, Robert; Hendricks, Scott

2015-01-01

Background The Fatality Assessment and Control Evaluation (FACE) programme was established by the National Institute for Occupational Safety and Health to help prevent occupational traumatic fatalities by funding states to conduct targeted fatality investigations within cause-specific focus areas and associated prevention efforts. Purpose To investigate the impact of the state-based FACE programme on two previous focus areas. Methods A longitudinal time-series analysis spanning 22 years compared state fatality rates for occupational falls and electrocutions before and after FACE programme funding with states not receiving FACE programme funding. Lag periods were utilised to allow time for the programme to have an effect, and rates were adjusted for a variety of covariates. Separate analyses were conducted for each injury outcome. Results A reduction in fall fatality rates that was of borderline significance (1-year lag adjRR=0.92 (0.84 to 1.00)) and a non-significant reduction in electrocution fatality rates (3-year lag adjRR=0.92 (0.82 to 1.03)) were observed in states with FACE programme funding, Best-fit models presented two separate lag periods. Conclusions While it is challenging to quantitatively evaluate effectiveness of programmes such as FACE, the data suggest the FACE programme may be effective in preventing occupational injury deaths within its outcome focus areas throughout the state. It is important to look for ways to measure intermediate effects more precisely, as well as ways to maintain effects over time. PMID:22864251

Disabled persons and HIV/AIDS prevention: a case study of deaf and leprosy persons in Nigeria.

PubMed

Enwereji, Ezinna E; Enwereji, Kelechi O

2008-08-01

(i) To investigate factors and conditions that influence HIV/AIDS prevention among leprosy and deaf persons in leprosy settlements in Nigerian; (ii) to examine the extent to which the Government includes leprosy and deaf persons in HIV prevention programmes; (iii) To identify immediate needs of leprosy and deaf patients in settlements (iv) to determine possible areas for improving services so as to explore potential solutions. Total sample of 227 inmates and 34 Health Care Workers were studied in three purposively selected settlements. Two intervention concepts, participatory reservation approach (PRA) and planned action (PLA) were utilized in the study. The concepts enabled researchers to examine factors that influenced provision of HIV/AIDS prevention programmes to inmates in settlements. Data collection instruments were questionnaire and focus group discussions for inmates and interview guides for Health Workers. Data were analysed qualitatively and quantitatively with the help of Stat Pac Gold package. Findings showed that there were no reproductive health and and HIV prevention programmes in the settlements. There was lack of Governments' commitment to fund health programmes and to train Health Workers, as well as rejection, isolation, discrimination and discouragement of HIV/AIDS prevention programmes in settlements. There was poor knowledge of mode of transmission of HIV/AIDS among inmates. About 59 (53.6%) of inmates in Abia, and 60 (51.3%) in Oyo were not interested in voluntary counselling and sex education. Findings showed that inmates in the leprosy settlements were at risk of unprotected sex. About 99 (43.6%) in Oyo and 88 (38.8%) in Abia State, especially those who were single cohabited with opposite sexes to have babies in settlements (p = 003). Number of inmates that had babies in settlements justifies providing sex education, reproductive health and HIV/AIDS prevention programmes. This will assist in reducing HIV/AIDS prevalence among disabled persons in Nigeria.

Beral's 1974 paper: A step towards universal prevention of cervical cancer.

PubMed

Franceschi, Silvia; Vaccarella, Salvatore

2015-12-01

In 1974, Valerie Beral published a landmark paper on the sexually transmitted origin of cervical cancer (CC) using statistics routinely available in the United Kingdom (UK). Among women born between 1902 and 1947, CC mortality rates correlated remarkably well with the incidence rates of gonorrhoea when they were 20 years old and both were highest among women born after 1940. Hence, if CC prevention and treatment had remained unchanged, the youngest generations of women would have experienced a high risk of CC death as they grew older. Fortunately, progress in CC prevention has helped avoid this scenario. The adverse consequences of the "sexual revolution" were greatly mitigated in the UK and other high-resource countries by the implementation of high quality cytology-based CC screening. An age-period-cohort analysis suggests that >30,000 cases or approximately 35% of expected CC cases may have been prevented by screening programmes in the UK between 1983 and 2007 and this percentage has been steadily increasing. In addition, the discovery of the causal role of HPV is reshaping primary and secondary prevention of CC. Cheaper HPV tests are becoming available and HPV-based primary screening may at last facilitate CC screening in low-resource countries. In the long-term, however, HPV vaccination, which has already been adopted by many countries, represents the best hope for preventing CC and overcoming socio-economic differences in CC risk within and across countries. The additional elucidation of HPV cofactors to which Beral has greatly contributed may also help control HPV infection in unvaccinated women. Copyright © 2015 Elsevier Ltd. All rights reserved.

Improving Fine Motor Skills in Young Children: An Intervention Study

ERIC Educational Resources Information Center

Brown, Carol G.

2010-01-01

The aim of this study was to evaluate the effect of the Primary Movement programme on the fine motor skills of children in an early years setting in an area of high social disadvantage. Primary Movement is a programme which can be used as an early intervention technique to help children inhibit persistent primary reflexes that have been shown to…

Integrating mental health into primary care in Sverdlovsk

PubMed Central

2009-01-01

Introduction Mental disorders occur as frequently in Russia as elsewhere, but the common mental disorders, especially depression, have gone largely unrecognised and undiagnosed by policlinic staff and area doctors. Methods This paper describes the impact and sustainability of a multi-component programme to facilitate the integration of mental health into primary care, by situation appraisal, policy dialogue, development of educational materials, provision of a training programme and the publication of standards and good practice guidelines to improve the primary care of mental disorders in the Sverdlovsk region of the Russian Federation. Results The multi-component programme has resulted in sustainable training about common mental disorders, not only of family doctors but also of other cadres and levels of professionals, and it has been well integrated with Sverdlovsk's overall programme of health sector reforms. Conclusion It is possible to facilitate the sustainable integration of mental health into primary care within the Russian context. While careful adaptation will be needed, the approach adopted here may also hold useful lessons for policy makers seeking to integrate mental health within primary care in other contexts and settings. PMID:22477885

Value for money: economic evaluation of two different caries prevention programmes compared with standard care in a randomized controlled trial.

PubMed

Vermaire, J H; van Loveren, C; Brouwer, W B F; Krol, M

2014-01-01

A cost-effectiveness analysis was conducted during a 3-year randomized controlled clinical trial in a general dental practice in the Netherlands in which 230 6-year-old children (± 3 months) were assigned to either regular dental care, an increased professional fluoride application (IPFA) programme or a non-operative caries treatment and prevention (NOCTP) programme. Information on resource use during the 3-year period was documented by the dental nurse at every patient visit, such as treatment time, travel time and travel distance. Caries increment scores (at D3MFS level) were used to assess effectiveness. Cost calculations were performed using bottom-up micro-costing. Incremental cost-effectiveness ratios (ICERs) were expressed as additional average costs per prevented DMFS. The ICERs compared with regular dental care from a health care system perspective and societal perspective were, respectively, EUR 269 and EUR 1,369 per prevented DMFS in the IPFA programme, and EUR 30 and EUR 100 in the NOCTP programme. The largest investments for the NOCTP group were made in the first year of the study; they decreased in the second and equalled the costs of control group in third year of the study. From both medical and economic points of view, the NOCTP strategy may be considered the preferred strategy for caries prevention.

Substantial improvement of primary cardiovascular prevention by a systematic score-based multimodal approach: A randomized trial: The PreFord-Study.

PubMed

Gysan, Detlef Bernd; Millentrup, Stefanie; Albus, Christian; Bjarnason-Wehrens, Birna; Latsch, Joachim; Gohlke, Helmut; Herold, Gerd; Wegscheider, Karl; Heming, Christian; Seyfarth, Melchior; Predel, Hans-Georg

2017-09-01

Trial design Prospective randomized multicentre interventional study. Methods Individual cardiovascular risk assessment in Ford Company, Germany employees ( n = 4.196), using the European Society of Cardiology-Systematic Coronary Risk Evaluation (ESC-SCORE) for classification into three risk groups. Subjects assigned to ESC high-risk group (ESC-SCORE ≥ 5%), without a history of cardiovascular disease were eligible for randomization to a multimodal 15-week intervention programme (INT) or to usual care and followed up for 36 months. Objectives Evaluation of the long-term effects of a risk-adjusted multimodal intervention in high-risk subjects. Primary endpoint: reduction of ESC-SCORE in INT versus usual care. Secondary endpoints: composite of fatal and non-fatal cardiovascular events and time to first cardiovascular event. intention-to-treat and per-protocol analysis. Results Four hundred and forty-seven subjects were randomized to INT ( n = 224) or to usual care ( n = 223). After 36 months ESC-SCORE development favouring INT was observed (INT: 8.70% to 10.03% vs. usual care: 8.49% to 12.09%; p = 0.005; net difference: 18.50%). Moreover, a significant reduction in the composite cardiovascular events was observed: (INT: n = 11 vs. usual care: n = 27). Hazard ratio of intervention versus control was 0.51 (95% confidence interval 0.25-1.03; p = 0.062) in the intention-to-treat analysis and 0.41 (95% confidence interval 0.18-0.90; p = 0.026) in the per-protocol analysis, respectively. No intervention-related adverse events or side-effects were observed. Conclusions Our results demonstrate the efficiency of identifying cardiovascular high-risk subjects by the ESC-SCORE in order to enrol them to a risk adjusted primary prevention programme. This strategy resulted in a significant improvement of ESC-SCORE, as well as a reduction in predefined cardiovascular endpoints in the INT within 36 months. (ISRCTN 23536103.).

[Nationwide Evaluation of the "Parental Folder" and its Utility Value--Insights into the Health and Information Behaviour of Parents].

PubMed

Pawils, S; Busche, W; Schwinn, A; Fillinger, U; Koch, U

2015-09-01

The "parental folder" is meant as a primary prevention programme for children starting at birth with the aim to give access to relevant health knowledge to all parents and to strengthen the parental competence in doctor-parent communication. In a sample of N=1,634 families the effects of the folder were examined in a randomized controlled study in the federal states Rhineland-Palatinate and Saxony. In addition N=103 experts were asked for their valuation of the folder. © Georg Thieme Verlag KG Stuttgart · New York.

A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial.

PubMed

Fernández, Anna; Mendive, Juan M; Conejo-Cerón, Sonia; Moreno-Peral, Patricia; King, Michael; Nazareth, Irwin; Martín-Pérez, Carlos; Fernández-Alonso, Carmen; Rodríguez-Bayón, Antonina; Aiarzaguena, Jose Maria; Montón-Franco, Carmen; Serrano-Blanco, Antoni; Ibañez-Casas, Inmaculada; Rodríguez-Sánchez, Emiliano; Salvador-Carulla, Luis; Garay, Paola Bully; Ballesta-Rodríguez, María Isabel; LaFuente, Pilar; Del Mar Muñoz-García, María; Mínguez-Gonzalo, Pilar; Araujo, Luz; Palao, Diego; Gómez, María Cruz; Zubiaga, Fernando; Navas-Campaña, Desirée; Aranda-Regules, Jose Manuel; Rodriguez-Morejón, Alberto; de Dios Luna, Juan; Bellón, Juan Ángel

2018-02-23

Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months. With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated. ClinicalTrials.gov, NCT01151982. Registered on June 29, 2010.

Knowledge gaps that hamper prevention and control of Mycobacterium avium subspecies paratuberculosis infection.

PubMed

Barkema, H W; Orsel, K; Nielsen, S S; Koets, A P; Rutten, V P M G; Bannantine, J P; Keefe, G P; Kelton, D F; Wells, S J; Whittington, R J; Mackintosh, C G; Manning, E J; Weber, M F; Heuer, C; Forde, T L; Ritter, C; Roche, S; Corbett, C S; Wolf, R; Griebel, P J; Kastelic, J P; De Buck, J

2018-05-01

In the last decades, many regional and country-wide control programmes for Johne's disease (JD) were developed due to associated economic losses, or because of a possible association with Crohn's disease. These control programmes were often not successful, partly because management protocols were not followed, including the introduction of infected replacement cattle, because tests to identify infected animals were unreliable, and uptake by farmers was not high enough because of a perceived low return on investment. In the absence of a cure or effective commercial vaccines, control of JD is currently primarily based on herd management strategies to avoid infection of cattle and restrict within-farm and farm-to-farm transmission. Although JD control programmes have been implemented in most developed countries, lessons learned from JD prevention and control programmes are underreported. Also, JD control programmes are typically evaluated in a limited number of herds and the duration of the study is less than 5 year, making it difficult to adequately assess the efficacy of control programmes. In this manuscript, we identify the most important gaps in knowledge hampering JD prevention and control programmes, including vaccination and diagnostics. Secondly, we discuss directions that research should take to address those knowledge gaps. © 2017 Blackwell Verlag GmbH.

Capitation-Based Financing Hampers the Provision of Preventive Services in Primary Health Care

PubMed Central

Sándor, János; Kósa, Karolina; Papp, Magor; Fürjes, Gergő; Kőrösi, László; Jakovljevic, Mihajlo; Ádány, Róza

2016-01-01

Mortality caused by non-communicable diseases has been extremely high in Hungary, which can largely be attributed to not performed preventive examinations (PEs) at the level of primary health care (PHC). Both structures and financial incentives are lacking, which could support the provision of legally defined PEs. A Model Programme was launched in Hungary in 2012 to adapt the recommendations for PHC of the World Health Organization. A baseline survey was carried out to describe the occurrence of not performed PEs. A sample of 4320 adults representative for Hungary by age and gender was surveyed. Twelve PEs to be performed in PHC as specified by a governmental decree were investigated and quantified. Not performed PEs per person per year with 95% confidence intervals were computed for age, gender, and education strata. The number of not performed PEs for the entire adult population of Hungary was estimated and converted into expenses according to the official reimbursement costs of the National Health Insurance Fund. The rate of service use varied between 16.7 and 70.2%. There was no correlation between the unit price of examinations and service use (r = 0.356; p = 0.267). The rate of not performed PEs was not related to gender, but older age and lower education proved to be risk factors. The total number of not performed PEs was over 17 million in the country. Of the 31 million euros saved by not paying for PEs, the largest share was not spent on those in the lowest educational category. New preventive services offered in the reoriented PHC model program include systematic and scheduled health examination health promotion programs at community settings, risk assessment followed by individual or group care, and/or referral and chronic care. The Model Programme has created a pressure for collaborative work, consultation, and engagement at each level, from the GPs and health mediators up to the decision-making level. It channeled the population into preventive health services shown by the fact that more than 80% of the population in the intervention area has already participated in the health status assessment. PMID:27679797

Capitation-Based Financing Hampers the Provision of Preventive Services in Primary Health Care.

PubMed

Sándor, János; Kósa, Karolina; Papp, Magor; Fürjes, Gergő; Kőrösi, László; Jakovljevic, Mihajlo; Ádány, Róza

2016-01-01

Mortality caused by non-communicable diseases has been extremely high in Hungary, which can largely be attributed to not performed preventive examinations (PEs) at the level of primary health care (PHC). Both structures and financial incentives are lacking, which could support the provision of legally defined PEs. A Model Programme was launched in Hungary in 2012 to adapt the recommendations for PHC of the World Health Organization. A baseline survey was carried out to describe the occurrence of not performed PEs. A sample of 4320 adults representative for Hungary by age and gender was surveyed. Twelve PEs to be performed in PHC as specified by a governmental decree were investigated and quantified. Not performed PEs per person per year with 95% confidence intervals were computed for age, gender, and education strata. The number of not performed PEs for the entire adult population of Hungary was estimated and converted into expenses according to the official reimbursement costs of the National Health Insurance Fund. The rate of service use varied between 16.7 and 70.2%. There was no correlation between the unit price of examinations and service use (r = 0.356; p = 0.267). The rate of not performed PEs was not related to gender, but older age and lower education proved to be risk factors. The total number of not performed PEs was over 17 million in the country. Of the 31 million euros saved by not paying for PEs, the largest share was not spent on those in the lowest educational category. New preventive services offered in the reoriented PHC model program include systematic and scheduled health examination health promotion programs at community settings, risk assessment followed by individual or group care, and/or referral and chronic care. The Model Programme has created a pressure for collaborative work, consultation, and engagement at each level, from the GPs and health mediators up to the decision-making level. It channeled the population into preventive health services shown by the fact that more than 80% of the population in the intervention area has already participated in the health status assessment.

Reducing falls after hospital discharge: a protocol for a randomised controlled trial evaluating an individualised multimodal falls education programme for older adults.

PubMed

Hill, Anne-Marie; Etherton-Beer, Christopher; McPhail, Steven M; Morris, Meg E; Flicker, Leon; Shorr, Ronald; Bulsara, Max; Lee, Den-Ching; Francis-Coad, Jacqueline; Waldron, Nicholas; Boudville, Amanda; Haines, Terry

2017-02-02

Older adults frequently fall after discharge from hospital. Older people may have low self-perceived risk of falls and poor knowledge about falls prevention. The primary aim of the study is to evaluate the effect of providing tailored falls prevention education in addition to usual care on falls rates in older people after discharge from hospital compared to providing a social intervention in addition to usual care. The 'Back to My Best' study is a multisite, single blind, parallel-group randomised controlled trial with blinded outcome assessment and intention-to-treat analysis, adhering to CONSORT guidelines. Patients (n=390) (aged 60 years or older; score more than 7/10 on the Abbreviated Mental Test Score; discharged to community settings) from aged care rehabilitation wards in three hospitals will be recruited and randomly assigned to one of two groups. Participants allocated to the control group shall receive usual care plus a social visit. Participants allocated to the experimental group shall receive usual care and a falls prevention programme incorporating a video, workbook and individualised follow-up from an expert health professional to foster capability and motivation to engage in falls prevention strategies. The primary outcome is falls rates in the first 6 months after discharge, analysed using negative binomial regression with adjustment for participant's length of observation in the study. Secondary outcomes are injurious falls rates, the proportion of people who become fallers, functional status and health-related quality of life. Healthcare resource use will be captured from four sources for 6 months after discharge. The study is powered to detect a 30% relative reduction in the rate of falls (negative binomial incidence ratio 0.70) for a control rate of 0.80 falls per person over 6 months. Results will be presented in peer-reviewed journals and at conferences worldwide. This study is approved by hospital and university Human Research Ethics Committees. ACTRN12615000784516. 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/.

Reducing falls after hospital discharge: a protocol for a randomised controlled trial evaluating an individualised multimodal falls education programme for older adults

PubMed Central

Hill, Anne-Marie; Etherton-Beer, Christopher; McPhail, Steven M; Morris, Meg E; Flicker, Leon; Bulsara, Max; Lee, Den-Ching; Francis-Coad, Jacqueline; Waldron, Nicholas; Boudville, Amanda; Haines, Terry

2017-01-01

Introduction Older adults frequently fall after discharge from hospital. Older people may have low self-perceived risk of falls and poor knowledge about falls prevention. The primary aim of the study is to evaluate the effect of providing tailored falls prevention education in addition to usual care on falls rates in older people after discharge from hospital compared to providing a social intervention in addition to usual care. Methods and analyses The ‘Back to My Best’ study is a multisite, single blind, parallel-group randomised controlled trial with blinded outcome assessment and intention-to-treat analysis, adhering to CONSORT guidelines. Patients (n=390) (aged 60 years or older; score more than 7/10 on the Abbreviated Mental Test Score; discharged to community settings) from aged care rehabilitation wards in three hospitals will be recruited and randomly assigned to one of two groups. Participants allocated to the control group shall receive usual care plus a social visit. Participants allocated to the experimental group shall receive usual care and a falls prevention programme incorporating a video, workbook and individualised follow-up from an expert health professional to foster capability and motivation to engage in falls prevention strategies. The primary outcome is falls rates in the first 6 months after discharge, analysed using negative binomial regression with adjustment for participant's length of observation in the study. Secondary outcomes are injurious falls rates, the proportion of people who become fallers, functional status and health-related quality of life. Healthcare resource use will be captured from four sources for 6 months after discharge. The study is powered to detect a 30% relative reduction in the rate of falls (negative binomial incidence ratio 0.70) for a control rate of 0.80 falls per person over 6 months. Ethics and dissemination Results will be presented in peer-reviewed journals and at conferences worldwide. This study is approved by hospital and university Human Research Ethics Committees. Trial registration number ACTRN12615000784516. PMID:28153933

Evaluation of a computerized cognitive behavioural therapy programme, MindWise (2.0), for adults with mild-to-moderate depression and anxiety.

PubMed

Collins, Sarah; Byrne, Michael; Hawe, James; O'Reilly, Gary

2018-06-01

To investigate the acceptability and utility of a newly developed computerized cognitive behavioural therapy (cCBT) programme, MindWise (2.0), for adults attending Irish primary care psychology services. Adult primary care psychology service users across four rural locations in Ireland were invited to participate in this study. A total of 60 service users participated in the MindWise (2.0) treatment group and compared to 22 people in a comparison waiting list control group. Participants completed pre- and post-intervention outcome measures of anxiety, depression, and work/social functioning. At post-intervention, 25 of 60 people in the MindWise (2.0) condition had fully completed the programme and 19 of 22 people in the waiting list condition provided time 2 data. Relative to those in the control group, the MindWise (2.0) participants reported significantly reduced symptoms of anxiety and no change in depression or work/social functioning. The newly developed cCBT programme, MindWise (2.0), resulted in significant improvements on a measure of anxiety and may address some barriers to accessing more traditional face-to-face mental health services for adults in a primary care setting. Further programme development and related research appears both warranted and needed to lower programme drop-out, establish if gains in anxiety management are maintained over time, and support people in a primary care context with depression. There is a growing evidence base that computerized self-help programmes can assist in a stepped-care approach to adult mental health service provision. These programmes require further development to address issues such as high dropout, the development of equally effective transdiagnostic content, and greater effectiveness in the country of origin. This study evaluated the acceptability and utility of a brief online CBT programme for adults referred due to anxiety or low mood to primary care psychology services in the national health service in Ireland. Results indicate that 42% of people completed the programme and experienced a significant reduction in anxiety but not depression and no improvement in work or social adjustment compared to similar adults on a waiting list for services. This study suggests the programme warrants further development and research and may in time become a useful and suitable intervention within the national health service in Ireland. © 2017 The British Psychological Society.

Developing a programme theory to explain how primary health care teams learn to respond to intimate partner violence: a realist case-study.

PubMed

Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel; Vives-Cases, Carmen; Marchal, Bruno

2015-06-09

Despite the progress made on policies and programmes to strengthen primary health care teams' response to Intimate Partner Violence, the literature shows that encounters between women exposed to IPV and health-care providers are not always satisfactory, and a number of barriers that prevent individual health-care providers from responding to IPV have been identified. We carried out a realist case study, for which we developed and tested a programme theory that seeks to explain how, why and under which circumstances a primary health care team in Spain learned to respond to IPV. A realist case study design was chosen to allow for an in-depth exploration of the linkages between context, intervention, mechanisms and outcomes as they happen in their natural setting. The first author collected data at the primary health care center La Virgen (pseudonym) through the review of documents, observation and interviews with health systems' managers, team members, women patients, and members of external services. The quality of the IPV case management was assessed with the PREMIS tool. This study found that the health care team at La Virgen has managed 1) to engage a number of staff members in actively responding to IPV, 2) to establish good coordination, mutual support and continuous learning processes related to IPV, 3) to establish adequate internal referrals within La Virgen, and 4) to establish good coordination and referral systems with other services. Team and individual level factors have triggered the capacity and interest in creating spaces for team leaning, team work and therapeutic responses to IPV in La Virgen, although individual motivation strongly affected this mechanism. Regional interventions did not trigger individual and/ or team responses but legitimated the workings of motivated professionals. The primary health care team of La Virgen is involved in a continuous learning process, even as participation in the process varies between professionals. This process has been supported, but not caused, by a favourable policy for integration of a health care response to IPV. Specific contextual factors of La Virgen facilitated the uptake of the policy. To some extent, the performance of La Virgen has the potential to shape the IPV learning processes of other primary health care teams in Murcia.

Older people and falls: health status, quality of life, lifestyle, care networks, prevention and views on service use following a recent fall.

PubMed

Roe, Brenda; Howell, Fiona; Riniotis, Konstantinos; Beech, Roger; Crome, Peter; Ong, Bie Nio

2009-08-01

This study has investigated older people's experiences of a recent fall, its impact on their health, lifestyle, quality of life, care networks, prevention and their views on service use. Falls are common in older people and prevalence increases with age. Falls prevention is a major policy and service initiative. An exploratory, qualitative design involving two time points. A convenience sample of 27 older people from two primary care trusts who had a recent fall. Taped semi structured qualitative interviews were conducted and repeated at follow up to detect change over time and repeat falls. Data were collected on their experience of falls, health, activities of living, lifestyle, quality of life, use of services, prevention of falls, informal care and social networks. Content analysis of transcribed interviews identified key themes. The majority of people fell indoors (n = 23), were repeat fallers (n = 22) with more than half alone when they fell (n = 15). For five people it was their first ever fall. Participants in primary care trust 1 had a higher mean age than those in primary care trust 2 and had more injurious falls (n = 12, mean age 87 years vs. n = 15, mean age 81 years). The majority of non-injurious falls went unreported to formal services. Falls can result in a decline in health status, ability to undertake activities of living, lifestyle and quality of life. Local informal care and support networks are as important as formal care for older people at risk of falls or who have fallen. Access to falls prevention programmes and services is limited for people living in more rural communities. Falls prevention initiatives and services should work with local communities, agencies and informal carers to ensure equitable access and provision of information, resources and care to meet the needs of older people at risk or who have fallen.

Effect of an Education Programme for South Asians with Asthma and Their Clinicians: A Cluster Randomised Controlled Trial (OEDIPUS)

PubMed Central

Griffiths, Chris; Bremner, Stephen; Islam, Kamrul; Sohanpal, Ratna; Vidal, Debi-Lee; Dawson, Carolyn; Foster, Gillian; Ramsay, Jean; Feder, Gene; Taylor, Stephanie; Barnes, Neil; Choudhury, Aklak; Packe, Geoff; Bayliss, Elizabeth; Trathen, Duncan; Moss, Philip; Cook, Viv; Livingstone, Anna Eleri; Eldridge, Sandra

2016-01-01

Background People with asthma from ethnic minority groups experience significant morbidity. Culturally-specific interventions to reduce asthma morbidity are rare. We tested the hypothesis that a culturally-specific education programme, adapted from promising theory-based interventions developed in the USA, would reduce unscheduled care for South Asians with asthma in the UK. Methods A cluster randomised controlled trial, set in two east London boroughs. 105 of 107 eligible general practices were randomised to usual care or the education programme. Participants were south Asians with asthma aged 3 years and older with recent unscheduled care. The programme had two components: the Physician Asthma Care Education (PACE) programme and the Chronic Disease Self Management Programme (CDSMP), targeted at clinicians and patients with asthma respectively. Both were culturally adapted for south Asians with asthma. Specialist nurses, and primary care teams from intervention practices were trained using the PACE programme. South Asian participants attended an outpatient appointment; those registered with intervention practices received self-management training from PACE-trained specialist nurses, a follow-up appointment with PACE-trained primary care practices, and an invitation to attend the CDSMP. Patients from control practices received usual care. Primary outcome was unscheduled care. Findings 375 south Asians with asthma from 84 general practices took part, 183 registered with intervention practices and 192 with control practices. Primary outcome data were available for 358/375 (95.5%) of participants. The intervention had no effect on time to first unscheduled attendance for asthma (Adjusted Hazard Ratio AHR = 1.19 95% CI 0.92 to 1.53). Time to first review in primary care was reduced (AHR = 2.22, (1.67 to 2.95). Asthma-related quality of life and self-efficacy were improved at 3 months (adjusted mean difference -2.56, (-3.89 to -1.24); 0.44, (0.05 to 0.82) respectively. Conclusions A multi-component education programme adapted for south Asians with asthma did not reduce unscheduled care but did improve follow-up in primary care, self-efficacy and quality of life. More effective interventions are needed for south Asians with asthma. PMID:28030569

The prevention of diabetes and cardiovascular disease in people with schizophrenia.

PubMed

Holt, R I G

2015-08-01

Primary prevention of diabetes and cardiovascular disease is an important priority for people with schizophrenia. This review aims to identify lifestyle and pharmacological interventions that reduce diabetes and cardiovascular disease in people with schizophrenia. PubMed and other electronic databases were searched to identify relevant articles. Lifestyle interventions that focus on diet and physical activity reduce the incidence of diabetes. Similar programmes in people with schizophrenia have led to significant weight loss and may reasonably be expected to reduce diabetes in the long-term. Metformin may be considered when lifestyle change is not feasible or effective. Lifestyle interventions, particularly smoking cessation, are likely to be effective in reducing cardiovascular disease in people with schizophrenia. Although cardiovascular prevention trials with statins have not been performed in people with schizophrenia, similar reductions in cholesterol has been seen as in the general population and statins should be considered for those at high risk. Traditional cardiovascular risk prediction models perform well in identifying those at high cardiovascular risk, but bespoke prediction models using data from people with schizophrenia perform better. Reducing diabetes and cardiovascular disease requires a coordinated and concerted effort from mental and physical health teams working across primary and secondary care. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

What Determines HIV Prevention Costs at Scale? Evidence from the Avahan Programme in India.

PubMed

Lépine, Aurélia; Chandrashekar, Sudhashree; Shetty, Govindraj; Vickerman, Peter; Bradley, Janet; Alary, Michel; Moses, Stephen; Vassall, Anna

2016-02-01

Expanding essential health services through non-government organisations (NGOs) is a central strategy for achieving universal health coverage in many low-income and middle-income countries. Human immunodeficiency virus (HIV) prevention services for key populations are commonly delivered through NGOs and have been demonstrated to be cost-effective and of substantial global public health importance. However, funding for HIV prevention remains scarce, and there are growing calls internationally to improve the efficiency of HIV prevention programmes as a key strategy to reach global HIV targets. To date, there is limited evidence on the determinants of costs of HIV prevention delivered through NGOs; and thus, policymakers have little guidance in how best to design programmes that are both effective and efficient. We collected economic costs from the Indian Avahan initiative, the largest HIV prevention project conducted globally, during the first 4 years of its implementation. We use a fixed-effect panel estimator and a random-intercept model to investigate the determinants of average cost. We find that programme design choices such as NGO scale, the extent of community involvement, the way in which support is offered to NGOs and how clinical services are organised substantially impact average cost in a grant-based payment setting. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

[Knowledge and use of different support programs in the context of early prevention in relation to family-related psychosocial burden].

PubMed

Eickhorst, Andreas; Schreier, Andrea; Brand, Christian; Lang, Katrin; Liel, Christoph; Renner, Ilona; Neumann, Anna; Sann, Alexandra

2016-10-01

The Federal Initiative for Early Prevention (funded by German ministry BMFSFJ), through the development of specific assistance programmes, supports families that suffer from psychosocial burden. As nationally representative data are missing, the National Centre for Early Prevention carried out a national survey on the psychosocial burden experienced by families with children aged 0-3 years. Ascertainment of the connections between family-related psychosocial burden and knowledge and use of different assistance programmes. Via paediatricians, 8063 parents were recruited to complete a questionnaire on objective burden, subjective experience of burden as well as knowledge and use of assistance programmes. Differences in knowledge and use between educational groups were tested by means of chi-squared tests. Very good knowledge of available assistance programmes and the offer and acceptance of aid by family midwives were subjected to regression analyses. Clear differences in knowledge and use of individual assistance programmes between educational groups were observed. Many programmes are predominantly used by better educated families, although there are exceptions, for example in the case of family midwives. Despite generally small group differences, less-educated families are the proportionally largest user group of family midwives. Furthermore we present average predicted percentages of knowledge and use for specific groups of psychosocially burdened parents as derived from the regression analyses. The results are discussed in the context of barriers to access for individual assistance programmes as well as their match with families' needs in the practice of early prevention.

The impact of economic recession on infection prevention and control.

PubMed

O'Riordan, M; Fitzpatrick, F

2015-04-01

The economic recession that began in 2007 led to austerity measures and public sector cutbacks in many European countries. Reduced resource allocation to infection prevention and control (IPC) programmes is impeding prevention and control of tuberculosis, HIV and vaccine-preventable infections. In addition, higher rates of infectious disease in the community have a significant impact on hospital services, although the extent of this has not been studied. With a focus on quick deficit reduction, preventive services such IPC may be regarded as non-essential. Where a prevention programme succeeds in reducing disease burden to a low level, its very success can undermine the perceived need for the programme. To mitigate the negative effects of recession, we need to: educate our political leaders about the economic benefits of IPC; better quantify the costs of healthcare-associated infection; and evaluate the effects of budget cuts on healthcare outcomes and IPC activities. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Cost effectiveness of brief interventions for reducing alcohol consumption.

PubMed

Wutzke, S E; Shiell, A; Gomel, M K; Conigrave, K M

2001-03-01

The direct costs and health effects of a primary-care-based brief intervention for hazardous alcohol consumption were examined. The total cost of the intervention was calculated from costs associated with: marketing the intervention programme; providing training and support in the use of the intervention materials; physician time required for providing brief advice for 'at-risk' drinkers. The effect of the intervention on health outcomes was expressed in terms of number of life years saved by preventing alcohol-related deaths. This was derived by combining estimates of the impact of the programme if it were implemented nationally with available evidence on the health effects of excess alcohol consumption. Results are based on international trial evidence showing the physical resources required by the intervention and its effectiveness combined with Australian price data. The costs associated with screening and brief advice using the current intervention programme range from Aus$19.14 to Aus$21.50. The marginal costs per additional life year saved were below Aus$1873. The robustness of the model used is supported by an extensive sensitivity analysis. In comparison with existing health promotion strategies the costs and effects of the current intervention are highly encouraging.

Evaluating 5 years' NIMART mentoring in South Africa's HIV treatment programme: Successes, challenges and future needs.

PubMed

Jones, M; Cameron, D

2017-09-22

Task shifting has enabled South Africa (SA) to rapidly expand its HIV treatment programme. This has been achieved by training and mentoring primary-care nurses in nurse initiation and management of antiretroviral therapy (NIMART). Five years into its clinical mentoring programme, the Foundation for Professional Development conducted an evaluation that identified improved knowledge, attitudes and confidence perceived by nurses who received NIMART mentoring. Low completion rates for the Department of Health (DoH) NIMART training process were identified and therefore targeted mentoring was introduced; this increased the percentage of primary nurses eligible for DoH certificates of clinical competence in NIMART from 12%, adding a further 30%. There remain a large number of primary nurses who require mentoring in order to complete the NIMART process. For those who have completed the process, there remains a need for ongoing mentoring as SA's HIV programme evolves, complex cases emerge and primary care undergoes change.

Communication and the electronic health record training: a comparison of three healthcare systems.

PubMed

Lynott, Michelle H; Kooienga, Sarah A; Stewart, Valerie T

2012-01-01

The electronic health record (EHR) used in the examination room, is becoming the primary method of medical data storage in primary care practice in the USA. One of the challenges in using EHRs is maintaining effective patient-provider communication. Many studies have focused on communication in the examination room. Scant research exists on the best methods in educating nurse practitioners and other primary care providers (clinicians). The purpose of this study was to explore various health record training programmes for clinicians. One researcher participated in and observed three health systems' EHR training programmes for ambulatory care providers in the Pacific Northwest. A focused ethnographic approach was used, emphasising patient-provider communication. Only one system had formalised communication training in their class, the other two systems emphasised only the software and data aspects of the EHR. The fact that clinicians are expected to use EHRs in the examination room necessitates the inclusion of communication training in EHR training programmes and/or as a part of primary care nurse practitioner education programmes.

Effect of diet and physical exercise intervention programmes on coronary heart disease risk in smoking and non-smoking men in Sweden.

PubMed Central

Näslund, G K; Fredrikson, M; Hellénius, M L; de Faire, U

1996-01-01

STUDY OBJECTIVE: To investigate differences between smokers and non-smokers in health behaviour, cardiovascular risk factors, coronary heart disease (CHD) risks, health knowledge, health attitudes, and compliance with a CHD prevention programme. DESIGN: Differences between smokers and non-smokers were studied via medical examinations, questionnaires, physical exercise activity logs, and food record sheets. Data were analysed using univariate and multivariate analyses. The five and 10 year CHD risks were assessed using the Framingham CHD risk estimate. SETTING: The Karolinska Hospital, Stockholm, and Sollentuna Primary Health Centre, Sollentuna, Sweden. PARTICIPANTS: The analyses were based on 158 healthy smoking and non-smoking men aged 35-60 years with raised cardiovascular risk factors who enrolled in controlled, randomised six month diet and exercise programmes. MAIN RESULTS: Discriminant analysis suggested that smokers, compared with non-smokers, were characterised by a higher alcohol energy percent, lower HDL cholesterol concentration, lower systolic blood pressure, and a higher plasminogen activator inhibitor-1 (PAI-1) value. Knowledge of the risk factors for CHD was not a discriminating factor. Both smokers and non-smokers increased the exercise taken, improved their diet, and lowered their CHD risk. Before, as well as after the intervention, smokers had a higher CHD risk than non-smokers. CONCLUSIONS: The best CHD prevention action that could be taken by smokers would of course be to quit smoking. Those who cannot stop should be encouraged to improve their diet and increase the amount of physical exercise they take in order to reduce the health hazards of their smoking behaviour. PMID:8762375

The Sector-Wide Approach in Bangladesh Primary Education: A Critical View. CREATE Pathways to Access. Research Monograph No. 57

ERIC Educational Resources Information Center

Ahmed, Manzoor

2011-01-01

This monograph, in the CREATE Pathways to Access series, is about the modality of cooperation and programme management in primary education in Bangladesh, based specifically on the experience of the Second Primary Education Development Programme (PEDP II). It is not intended to be an assessment of PEDP II accomplishments, but key information and a…

Evaluation of an education and activation programme to prevent chronic shoulder complaints: design of an RCT [ISRCTN71777817

PubMed Central

Bruijn, Camiel De; de Bie, Rob; Geraets, Jacques; Goossens, Marielle; Köke, Albère; van den Heuvel, Wim; van der Heijden, Geert; Dinant, Geert-Jan

2005-01-01

Background About half of all newly presented episodes of shoulder complaints (SC) in general practice are reported to last for at least six months. Early interventions aimed at the psychological and social determinants of SC are not common in general practice, although such interventions might prevent the development of chronic SC. The Education and Activation Programme (EAP) consists of an educational part and a time-contingent activation part. The aim of the EAP is to provide patients with the proper cognitions by means of education, and to stimulate adequate behaviour through advice on activities of daily living. Design The article describes the design of a randomised clinical trial (RCT) to evaluate the effectiveness and cost-effectiveness of an EAP in addition to usual care, compared to usual care only, in the prevention of chronic SC after six months. It also describes the analysis of the cost and effect balance. Patients suffering from SC for less than three months are recruited in general practice and through open recruitment. A trained general practitioner or a trained therapist administers the EAP. Primary outcome measures are patient-perceived recovery, measured by self-assessment on a seven-point scale, and functional limitations in activities of daily living. Questionnaires are used to study baseline measures, prognostic measures, process measures and outcome measures. Discussion The inclusion of patients in the study lasted until December 31st 2003. Data collection is to end in June 2004. PMID:15715914

Evaluating the impacts of screening and smoking cessation programmes on lung cancer in a high-burden region of the USA: a simulation modelling study

PubMed Central

Tramontano, Angela C; Sheehan, Deirdre F; McMahon, Pamela M; Dowling, Emily C; Holford, Theodore R; Ryczak, Karen; Lesko, Samuel M; Levy, David T; Kong, Chung Yin

2016-01-01

Objective While the US Preventive Services Task Force has issued recommendations for lung cancer screening, its effectiveness at reducing lung cancer burden may vary at local levels due to regional variations in smoking behaviour. Our objective was to use an existing model to determine the impacts of lung cancer screening alone or in addition to increased smoking cessation in a US region with a relatively high smoking prevalence and lung cancer incidence. Setting Computer-based simulation model. Participants Simulated population of individuals 55 and older based on smoking prevalence and census data from Northeast Pennsylvania. Interventions Hypothetical lung cancer control from 2014 to 2050 through (1) screening with CT, (2) intensified smoking cessation or (3) a combination strategy. Primary and secondary outcome measures Primary outcomes were lung cancer mortality rates. Secondary outcomes included number of people eligible for screening and number of radiation-induced lung cancers. Results Combining lung cancer screening with increased smoking cessation would yield an estimated 8.1% reduction in cumulative lung cancer mortality by 2050. Our model estimated that the number of screening-eligible individuals would progressively decrease over time, indicating declining benefit of a screening-only programme. Lung cancer screening achieved a greater mortality reduction in earlier years, but was later surpassed by smoking cessation. Conclusions Combining smoking cessation programmes with lung cancer screening would provide the most benefit to a population, especially considering the growing proportion of patients ineligible for screening based on current recommendations. PMID:26928026

Prevent: what is pre-criminal space?

PubMed Central

Goldberg, David; Jadhav, Sushrut; Younis, Tarek

2017-01-01

Prevent is a UK-wide programme within the government's anti-terrorism strategy aimed at stopping individuals from supporting or taking part in terrorist activities. NHS England's Prevent Training and Competencies Framework requires health professionals to understand the concept of pre-criminal space. This article examines pre-criminal space, a new term which refers to a period of time during which a person is referred to a specific Prevent-related safeguarding panel, Channel. It is unclear what the concept of pre-criminal space adds to the Prevent programme. The term should be either clarified or removed from the Framework. PMID:28811915

Reading Comprehension: A Computerized Intervention with Primary-age Poor Readers.

PubMed

Horne, Joanna Kathryn

2017-05-01

The current study investigates the effectiveness of a computerized reading comprehension programme on the reading accuracy, reading comprehension and reading rate of primary-age poor readers. There is little published literature relating to computerized reading interventions in UK primary schools, and no previous studies have investigated the Comprehension Booster programme. Thirty-eight children (26 boys and 12 girls; aged 6:7 to 11:0) from two schools in East Yorkshire, UK, took part. Half of the participants (the intervention group) undertook the Comprehension Booster programme for a 6-week period, whilst the other half (the control group) continued with their usual teaching. Significant effects of the intervention were found, with increases in reading accuracy and reading comprehension for the intervention group. It is concluded that computerized reading programmes can be effective in improving reading skills, and these are particularly useful for pupils with reading difficulties in disadvantaged areas, where resources are limited and family support in reading is lower. However, such programmes are not a replacement for good teaching, and regular monitoring of children with reading difficulties is required. Further research is necessary to compare the programme used here to other conventional and computerized intervention programmes, using a larger sample. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

SLIMMER: a randomised controlled trial of diabetes prevention in Dutch primary health care: design and methods for process, effect, and economic evaluation.

PubMed

Duijzer, Geerke; Haveman-Nies, Annemien; Jansen, Sophia C; ter Beek, Josien; Hiddink, Gerrit J; Feskens, Edith J M

2014-06-14

Implementation of interventions in real-life settings requires a comprehensive evaluation approach. The aim of this article is to describe the evaluation design of the SLIMMER diabetes prevention intervention in a Dutch real-life setting. The SLIMMER study is a randomised, controlled intervention study including subjects aged 40 through 70 years with impaired fasting glucose or high risk of diabetes. The 10-month SLIMMER intervention involves a dietary and physical activity intervention, including case management and a maintenance programme. The control group receives usual health care and written information about a healthy lifestyle. A logic model of change is composed to link intervention activities with intervention outcomes in a logical order. Primary outcome is fasting insulin. Measurements are performed at baseline and after 12 and 18 months and cover quality of life, cardio-metabolic risk factors (e.g. glucose tolerance, serum lipids, body fatness, and blood pressure), eating and physical activity behaviour, and behavioural determinants. A process evaluation gives insight in how the intervention was delivered and received by participants and health care professionals. The economic evaluation consists of a cost-effectiveness analysis and a cost-utility analysis. Costs are assessed from both a societal and health care perspective. This study is expected to provide insight in the effectiveness, including its cost-effectiveness, and delivery of the SLIMMER diabetes prevention intervention conducted in Dutch primary health care. Results of this study provide valuable information for primary health care professionals, researchers, and policy makers. The SLIMMER study is registered with ClinicalTrials.gov (NCT02094911) since March 19, 2014.

SLIMMER: a randomised controlled trial of diabetes prevention in Dutch primary health care: design and methods for process, effect, and economic evaluation

PubMed Central

2014-01-01

Background Implementation of interventions in real-life settings requires a comprehensive evaluation approach. The aim of this article is to describe the evaluation design of the SLIMMER diabetes prevention intervention in a Dutch real-life setting. Methods/Design The SLIMMER study is a randomised, controlled intervention study including subjects aged 40 through 70 years with impaired fasting glucose or high risk of diabetes. The 10-month SLIMMER intervention involves a dietary and physical activity intervention, including case management and a maintenance programme. The control group receives usual health care and written information about a healthy lifestyle. A logic model of change is composed to link intervention activities with intervention outcomes in a logical order. Primary outcome is fasting insulin. Measurements are performed at baseline and after 12 and 18 months and cover quality of life, cardio-metabolic risk factors (e.g. glucose tolerance, serum lipids, body fatness, and blood pressure), eating and physical activity behaviour, and behavioural determinants. A process evaluation gives insight in how the intervention was delivered and received by participants and health care professionals. The economic evaluation consists of a cost-effectiveness analysis and a cost-utility analysis. Costs are assessed from both a societal and health care perspective. Discussion This study is expected to provide insight in the effectiveness, including its cost-effectiveness, and delivery of the SLIMMER diabetes prevention intervention conducted in Dutch primary health care. Results of this study provide valuable information for primary health care professionals, researchers, and policy makers. Trial registration The SLIMMER study is registered with ClinicalTrials.gov (NCT02094911) since March 19, 2014. PMID:24928217

Rapid tests for sexually transmitted infections (STIs): the way forward

PubMed Central

Peeling, R W; Holmes, K K; Mabey, D

2006-01-01

In the developing world, laboratory services for sexually transmitted infections (STIs) are either not available, or where limited services are available, patients may not be able to pay for or physically access those services. Despite the existence of national policy for antenatal screening to prevent congenital syphilis and substantial evidence that antenatal screening is cost‐effective, implementation of syphilis screening programmes remains unacceptably low because of lack of screening tools that can be used in primary health care settings. The World Health Organization Sexually Transmitted Diseases Diagnostics Initiative (SDI) has developed the ASSURED criteria as a benchmark to decide if tests address disease control needs: Affordable, Sensitive, Specific, User‐friendly, Rapid and robust, Equipment‐free and Deliverable to end‐users. Rapid syphilis tests that can be used with whole blood approach the ASSURED criteria and can now be deployed in areas where no previous screening has been possible. Although rapid tests for chlamydia and gonorrhoea lack sensitivity, more tests are in development. The way forward for STI diagnostics requires a continuing quest for ASSURED tests, the development of a road map for test introduction, sustainable programmes for quality assurance, and the creation of a robust infrastructure linked to HIV prevention that ensures sustainability of STI control efforts that includes viral STIs. PMID:17151023

Rapid tests for sexually transmitted infections (STIs): the way forward.

PubMed

Peeling, R W; Holmes, K K; Mabey, D; Ronald, A

2006-12-01

In the developing world, laboratory services for sexually transmitted infections (STIs) are either not available, or where limited services are available, patients may not be able to pay for or physically access those services. Despite the existence of national policy for antenatal screening to prevent congenital syphilis and substantial evidence that antenatal screening is cost-effective, implementation of syphilis screening programmes remains unacceptably low because of lack of screening tools that can be used in primary health care settings. The World Health Organization Sexually Transmitted Diseases Diagnostics Initiative (SDI) has developed the ASSURED criteria as a benchmark to decide if tests address disease control needs: Affordable, Sensitive, Specific, User-friendly, Rapid and robust, Equipment-free and Deliverable to end-users. Rapid syphilis tests that can be used with whole blood approach the ASSURED criteria and can now be deployed in areas where no previous screening has been possible. Although rapid tests for chlamydia and gonorrhoea lack sensitivity, more tests are in development. The way forward for STI diagnostics requires a continuing quest for ASSURED tests, the development of a road map for test introduction, sustainable programmes for quality assurance, and the creation of a robust infrastructure linked to HIV prevention that ensures sustainability of STI control efforts that includes viral STIs.

Reducing HIV infection among new injecting drug users in the China-Vietnam Cross Border Project.

PubMed

Des Jarlais, Don C; Kling, Ryan; Hammett, Theodore M; Ngu, Doan; Liu, Wei; Chen, Yi; Binh, Kieu Thanh; Friedmann, Patricia

2007-12-01

To assess an HIV prevention programme for injecting drug users (IDU) in the crossborder area between China and Vietnam. Serial cross-sectional surveys (0, 6, 12, 18, 24 and 36 months) of community-recruited current IDU. The project included peer educator outreach and the large-scale distribution of sterile injection equipment. Serial cross-sectional surveys with HIV testing of community recruited IDU were conducted at baseline (before implementation) and 6, 12, 18, 24 and 36 months post-baseline. HIV prevalence and estimated HIV incidence among new injectors (individuals injecting drugs for < 3 years) in each survey wave were the primary outcome measures. The percentages of new injectors among all subjects declined across each survey waves in both Ning Ming and Lang Son. HIV prevalence and estimated incidence fell by approximately half at the 24-month survey and by approximately three quarters at the 36-month survey in both areas (all P < 0.01). The implementation of large-scale outreach and syringe access programmes was followed by substantial reductions in HIV infection among new injectors, with no evidence of any increase in individuals beginning to inject drugs. This project may serve as a model for large-scale HIV prevention programming for IDU in China, Vietnam, and other developing/transitional countries.

Preventive education and birth order as co-determinants of IQ in disadvantaged 5-year-olds.

PubMed

Boat, B W; Campbell, F A; Ramey, C T

1986-01-01

The effects of preventive education and birth order on IQ scores of 95 economically disadvantaged children at risk for retarded intellectual development were studied. Experimental first- and later-born children participated from birth in a 5-year programme of systematic educational intervention. An equal number of children served as controls and received no systematic intervention. First-borns prevailed as the brighter children in both the educational treatment group and the control group when Wechsler Preschool and Primary Scale of Intelligence (WPPSI) full scale and verbal IQ scores were compared. Furthermore, mothers of first-borns (70% of whom were only-born at age 5) achieved significantly higher WAIS scores than did mothers of later-born children. Results suggest that later-born disadvantaged children are at greatest risk for developmental retardation.

Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services.

PubMed

Wolfenden, Luke; Jones, Jannah; Williams, Christopher M; Finch, Meghan; Wyse, Rebecca J; Kingsland, Melanie; Tzelepis, Flora; Wiggers, John; Williams, Amanda J; Seward, Kirsty; Small, Tameka; Welch, Vivian; Booth, Debbie; Yoong, Sze Lin

2016-10-04

Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to:1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes;2. describe the cost or cost-effectiveness of such strategies;3. describe any adverse effects of such strategies on childcare services, service staff or children;4. examine the effect of such strategies on child diet, physical activity or weight status. We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). We included any study (randomised or non-randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. The review authors independently screened abstracts and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative assessment via meta-analysis. However, we narratively synthesised the trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). We identified 10 trials as eligible and included them in the review. The trials sought to improve the implementation of policies and practices targeting healthy eating (two trials), physical activity (two trials) or both healthy eating and physical activity (six trials). Collectively the implementation strategies tested in the 10 trials included educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing. A total of 1053 childcare services participated across all trials. Of the 10 trials, eight examined implementation strategies versus a usual practice control and two compared alternative implementation strategies. There was considerable study heterogeneity. We judged all studies as having high risk of bias for at least one domain.It is uncertain whether the strategies tested improved the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention. No intervention improved the implementation of all policies and practices targeted by the implementation strategies relative to a comparison group. Of the eight trials that compared an implementation strategy to usual practice or a no intervention control, however, seven reported improvements in the implementation of at least one of the targeted policies or practices relative to control. For these trials the effect on the primary implementation outcome was as follows: among the three trials that reported score-based measures of implementation the scores ranged from 1 to 5.1; across four trials reporting the proportion of staff or services implementing a specific policy or practice this ranged from 0% to 9.5%; and in three trials reporting the time (per day or week) staff or services spent implementing a policy or practice this ranged from 4.3 minutes to 7.7 minutes. The review findings also indicate that is it uncertain whether such interventions improve childcare service staff knowledge or attitudes (two trials), child physical activity (two trials), child weight status (two trials) or child diet (one trial). None of the included trials reported on the cost or cost-effectiveness of the intervention. One trial assessed the adverse effects of a physical activity intervention and found no difference in rates of child injury between groups. For all review outcomes, we rated the quality of the evidence as very low. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used in this review. Current research provides weak and inconsistent evidence of the effectiveness of such strategies in improving the implementation of policies and practices, childcare service staff knowledge or attitudes, or child diet, physical activity or weight status. Further research in the field is required.

Test, episode, and programme sensitivities of screening for colorectal cancer as a public health policy in Finland: experimental design.

PubMed

Malila, Nea; Oivanen, Tiina; Malminiemi, Outi; Hakama, Matti

2008-11-20

To report the sensitivities of the faecal occult blood test, screening episode, and screening programme for colorectal cancer and the benefits of applying a randomised design at the implementation phase of a new public health policy. Experimental design incorporated in public health evaluation using randomisation at individual level in the target population. 161 of the 431 Finnish municipalities in 2004-6. 106 000 adults randomised to screening or control arms. In total, 52 998 adults aged 60-64 in the screening arm received faecal occult blood test kits. Test, episode, and programme sensitivities estimated by the incidence method and corrected for selective attendance and overdiagnosis. The response for screening was high overall (70.8%), and significantly better in women (78.1%) than in men (63.3%). The incidence of cancer in the controls was somewhat higher in men than in women (103 v 93 per 100 000 person years), which was not true for interval cancers (42 v 49 per 100 000 person years). The sensitivity of the faecal occult blood test was 54.6%. Only a few interval cancers were detected among those with positive test results, hence the episode sensitivity of 51.3% was close to the test sensitivity. At the population level the sensitivity of the programme was 37.5%. Although relatively low, the sensitivity of screening for colorectal cancer with the faecal occult blood test in Finland was adequate. An experimental design is a prerequisite for evaluation of such a screening programme because the effectiveness of preventing deaths is likely to be small and results may otherwise remain inconclusive. Thus, screening for colorectal cancer using any primary test modality should be launched in a public health programme with randomisation of the target population at the implementation phase.

Estimating the Cost-Effectiveness of HIV Prevention Programmes in Vietnam, 2006-2010: A Modelling Study

PubMed Central

Pham, Quang Duy; Wilson, David P.; Kerr, Cliff C.; Shattock, Andrew J.; Do, Hoa Mai; Duong, Anh Thuy; Nguyen, Long Thanh; Zhang, Lei

2015-01-01

Introduction Vietnam has been largely reliant on international support in its HIV response. Over 2006-2010, a total of US$480 million was invested in its HIV programmes, more than 70% of which came from international sources. This study investigates the potential epidemiological impacts of these programmes and their cost-effectiveness. Methods We conducted a data synthesis of HIV programming, spending, epidemiological, and clinical outcomes. Counterfactual scenarios were defined based on assumed programme coverage and behaviours had the programmes not been implemented. An epidemiological model, calibrated to reflect the actual epidemiological trends, was used to estimate plausible ranges of programme impacts. The model was then used to estimate the costs per averted infection, death, and disability adjusted life-year (DALY). Results Based on observed prevalence reductions amongst most population groups, and plausible counterfactuals, modelling suggested that antiretroviral therapy (ART) and prevention programmes over 2006-2010 have averted an estimated 50,600 [95% uncertainty bound: 36,300–68,900] new infections and 42,600 [36,100–54,100] deaths, resulting in 401,600 [312,200–496,300] fewer DALYs across all population groups. HIV programmes in Vietnam have cost an estimated US$1,972 [1,447–2,747], US$2,344 [1,843–2,765], and US$248 [201–319] for each averted infection, death, and DALY, respectively. Conclusions Our evaluation suggests that HIV programmes in Vietnam have most likely had benefits that are cost-effective. ART and direct HIV prevention were the most cost-effective interventions in reducing HIV disease burden. PMID:26196290

Effectiveness of a universal school-based programme for preventing depression in Chinese adolescents: a quasi-experimental pilot study.

PubMed

Wong, Paul W C; Fu, King-Wa; Chan, Kim Y K; Chan, Wincy S C; Liu, Patricia M Y; Law, Yik-Wa; Yip, Paul S F

2012-12-15

Evidence of the effectiveness, rather than efficacy, of universal school-based programmes for preventing depression among adolescents is limited. This study examined the effectiveness of a universal depression prevention programme, "The Little Prince is Depressed" (LPD), which adopted the cognitive-behavioural model and aimed to reduce depressive symptoms and enhance protective factors of depression among secondary school students in Hong Kong. A quasi-experimental design was adopted for this pilot study. Thirteen classes were assigned to the intervention or control conditions according to the deliberation of the programme administrator of the four participating schools. Implementation was carried out in two phases, with a professional-led first phase and teacher-led programme second phase. LPD consisted of a 12-week school-based face-to-face programme with psycho-educational lessons and homework assignments. Students completed the programme generally showed positive development in help-seeking attitudes and self-esteem. For students who had more depressive symptoms at pre-assessment, the programme was found to be significant in enhancing cognitive-restructuring skills and support-seeking behaviours. The programme was not, however, found to be statistically significant in reducing depressive symptoms of the participants over the study period. A small sample size, a high attrition rate, and a short follow-up time frame. The LPD programme was successful in building resilience of the students in general and enhancing the cognitive-behavioural skills of students with depressive symptoms. While we did not find sufficient evidence for concluding that the LPD was effective in reducing depressive symptoms, we believe that these results highlight the challenges of implementing evidence-based practices generated from highly controlled environments in real-life settings. Copyright © 2012 Elsevier B.V. All rights reserved.

Development of a training programme for home health care workers to promote preventive activities focused on a healthy lifestyle: an intervention mapping approach.

PubMed

Walters, Maaike E; Dijkstra, Arie; de Winter, Andrea F; Reijneveld, Sijmen A

2015-07-09

Lifestyle is an important aspect in maintaining good health in older adults, and home health care (HHC) workers can play an important role in promoting a healthy lifestyle. However, there is limited evidence in the literature regarding how to develop an effective training programme to improve the physical activity level and fruit and vegetable consumption of older adults within a HHC setting. The aim of this paper is to describe how Intervention Mapping (IM) was used to develop a training programme to promote preventive activities of HHC workers relating to the physical activity and fruit and vegetable intake of older adults living at home. IM, a systematic theory and evidence-based approach was used to develop, implement and evaluate the training programme. This entailed a literature search, a survey, semi-structured interviews and consultation with HHC workers and various field experts, and a pilot training session. The determinants associated with the provision of preventive activities were identified, and an overview was created of those objectives, matching methods and practical applications that could influence these determinants. The performance objectives for the HHC workers were early detection and monitoring, promoting a healthy lifestyle, informing colleagues, continuing allocated preventive activities and referring to other experts and facilities. Findings were translated into a comprehensive training programme for HHC workers focused on motivating older adults to adopt and maintain a healthier lifestyle. IM was a useful tool in the development of a theory-based training programme to promote preventive activities by HHC workers relating to fruit and vegetable intake and physical activity of older adults.

Determining Factors for Cyberbullying Prevention Programmes

ERIC Educational Resources Information Center

Manzuoli, Cristina Hennig; Medina, Liliana Cuesta

2017-01-01

This study reports on the first stages of a larger project to develop an ICT-supported cyberbullying prevention programme that fosters development of children's communication skills for the safe use of social media. To establish baseline data on the incidence and growth of cyberbullying in Bogotá, Colombia, we applied a Revised School Violence…

Who Are the Peer Educators? HIV Prevention in South African Schools

ERIC Educational Resources Information Center

Mason-Jones, Amanda J.; Flisher, Alan J.; Mathews, Catherine

2011-01-01

Characteristics of learners who become peer educators are rarely explored despite the potential relevance to the success of peer education programmes. Fifteen high schools selected to implement peer education HIV prevention programmes in South Africa were recruited. A total of 2339 Grade 10 learners were surveyed and comparisons were made between…

Community Screening for Preschool Child Inhibition to Offer the "Cool Little Kids" Anxiety Prevention Programme

ERIC Educational Resources Information Center

Beatson, Ruth M.; Bayer, Jordana K.; Perry, Alexandra; Mathers, Megan; Hiscock, Harriet; Wake, Melissa; Beesley, Kate; Rapee, Ronald M.

2014-01-01

Temperamental inhibition has been identified as a key risk factor for childhood anxiety and internalizing problems. An efficacious early prevention programme for shy/inhibited children has been developed; however, accurate, efficient and acceptable screening is needed to support wider implementation. We explore community screening options in the…

Preventing Sexual Violence and HIV in Children

PubMed Central

Sommarin, Clara; Kilbane, Theresa; Mercy, James A.; Moloney-Kitts, Michele; Ligiero, Daniela P.

2018-01-01

Background Evidence linking violence against women and HIV has grown, including on the cycle of violence and the links between violence against children and women. To create an effective response to the HIV epidemic, it is key to prevent sexual violence against children and intimate partner violence (IPV) against adolescent girls. Methods Authors analyzed data from national household surveys on violence against children undertaken by governments in Swaziland, Tanzania, Kenya, and Zimbabwe, with support of the Together for Girls initiative, as well as an analysis of evidence on effective programmes. Results Data show that sexual and physical violence in childhood are linked to negative health outcomes, including increased sexual risk taking (eg, inconsistent condom use and increased number of sexual partners), and that girls begin experiencing IPV (emotional, physical, and sexual) during adolescence. Evidence on effective programmes addressing childhood sexual violence is growing. Key interventions focus on increasing knowledge among children and caregivers by addressing attitudes and practices around violence, including dating relationships. Programmes also seek to build awareness of services available for children who experience violence. Discussion Findings include incorporating attention to children into HIV and violence programmes directed to adults; increased coordination and leveraging of resources between these programmes; test transferability of programmes in low- and middle-income countries; and invest in data collection and robust evaluations of interventions to prevent sexual violence and IPV among children. Conclusions This article contributes to a growing body of evidence on the prevention of sexual violence and HIV in children. PMID:24918598

A Synthesis of the Evidence for Managing Stress at Work: A Review of the Reviews Reporting on Anxiety, Depression, and Absenteeism

PubMed Central

Bhui, Kamaldeep S.; Dinos, Sokratis; Stansfeld, Stephen A.; White, Peter D.

2012-01-01

Background. Psychosocial stressors in the workplace are a cause of anxiety and depressive illnesses, suicide and family disruption. Methods. The present review synthesizes the evidence from existing systematic reviews published between 1990 and July 2011. We assessed the effectiveness of individual, organisational and mixed interventions on two outcomes: mental health and absenteeism. Results. In total, 23 systematic reviews included 499 primary studies; there were 11 meta-analyses and 12 narrative reviews. Meta-analytic studies found a greater effect size of individual interventions on individual outcomes. Organisational interventions showed mixed evidence of benefit. Organisational programmes for physical activity showed a reduction in absenteeism. The findings from the meta-analytic reviews were consistent with the findings from the narrative reviews. Specifically, cognitive-behavioural programmes produced larger effects at the individual level compared with other interventions. Some interventions appeared to lead to deterioration in mental health and absenteeism outcomes.Gaps in the literature include studies of organisational outcomes like absenteeism, the influence of specific occupations and size of organisations, and studies of the comparative effectiveness of primary, secondary and tertiary prevention. Conclusions. Individual interventions (like CBT) improve individuals' mental health. Physical activity as an organisational intervention reduces absenteeism. Research needs to target gaps in the evidence. PMID:22496705

A synthesis of the evidence for managing stress at work: a review of the reviews reporting on anxiety, depression, and absenteeism.

PubMed

Bhui, Kamaldeep S; Dinos, Sokratis; Stansfeld, Stephen A; White, Peter D

2012-01-01

Psychosocial stressors in the workplace are a cause of anxiety and depressive illnesses, suicide and family disruption. The present review synthesizes the evidence from existing systematic reviews published between 1990 and July 2011. We assessed the effectiveness of individual, organisational and mixed interventions on two outcomes: mental health and absenteeism. In total, 23 systematic reviews included 499 primary studies; there were 11 meta-analyses and 12 narrative reviews. Meta-analytic studies found a greater effect size of individual interventions on individual outcomes. Organisational interventions showed mixed evidence of benefit. Organisational programmes for physical activity showed a reduction in absenteeism. The findings from the meta-analytic reviews were consistent with the findings from the narrative reviews. Specifically, cognitive-behavioural programmes produced larger effects at the individual level compared with other interventions. Some interventions appeared to lead to deterioration in mental health and absenteeism outcomes.Gaps in the literature include studies of organisational outcomes like absenteeism, the influence of specific occupations and size of organisations, and studies of the comparative effectiveness of primary, secondary and tertiary prevention. Individual interventions (like CBT) improve individuals' mental health. Physical activity as an organisational intervention reduces absenteeism. Research needs to target gaps in the evidence.

HIV-related stigma and universal testing and treatment for HIV prevention and care: design of an implementation science evaluation nested in the HPTN 071 (PopART) cluster-randomized trial in Zambia and South Africa.

PubMed

Hargreaves, James R; Stangl, Anne; Bond, Virginia; Hoddinott, Graeme; Krishnaratne, Shari; Mathema, Hlengani; Moyo, Maureen; Viljoen, Lario; Brady, Laura; Sievwright, Kirsty; Horn, Lyn; Sabapathy, Kalpana; Ayles, Helen; Beyers, Nulda; Bock, Peter; Fidler, Sarah; Griffith, Sam; Seeley, Janet; Hayes, Richard

2016-12-01

Stigma and discrimination related to HIV and key populations at high risk of HIV have the potential to impede the implementation of effective HIV prevention and treatment programmes at scale. Studies measuring the impact of stigma on these programmes are rare. We are conducting an implementation science study of HIV-related stigma in communities and health settings within a large, pragmatic cluster-randomized trial of a universal testing and treatment intervention for HIV prevention in Zambia and South Africa and will assess how stigma affects, and is affected by, implementation of this intervention. A mixed-method evaluation will be nested within HIV prevention trials network (HPTN) 071/PopART (Clinical Trials registration number NCT01900977), a three-arm trial comparing universal door-to-door delivery of HIV testing and referral to prevention and treatment services, accompanied by either an immediate offer of anti-retroviral treatment to people living with HIV regardless of clinical status, or an offer of treatment in-line with national guidelines, with a standard-of-care control arm. The primary outcome of HPTN 071/PopART is HIV incidence measured among a cohort of 52 500 individuals in 21 study clusters. Our evaluation will include integrated quantitative and qualitative data collection and analysis in all trial sites. We will collect quantitative data on indicators of HIV-related stigma over 3 years from large probability samples of community members, health workers and people living with HIV. We will collect qualitative data, including in-depth interviews and observations from members of these same groups sampled purposively. In analysis, we will: (1) compare HIV-related stigma measures between study arms, (2) link data on stigma to measures of the success of implementation of the PopART intervention and (3) explore changes in the dominant drivers and manifestations of stigma in study communities and the health system. HIV-related stigma may impede the successful implementation of HIV prevention and treatment programmes. Using a novel study-design nested within a large, community randomized trial we will evaluate the extent to which HIV-related stigma affects and is affected by the implementation of a comprehensive combination HIV prevention intervention including a universal test and treatment approach. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Post primary school teachers' view point on reproductive health and contraceptive practice among schoolgirls in Port Harcourt, Nigeria.

PubMed

Briggs, L A

1994-10-01

The view point of secondary school teachers on reproductive health, specifically, their attitude towards contraceptive practice among sexually active schoolgirls and general opinion on teenage pregnancy was examined. A sample survey of teachers was conducted in all the registered girls and mixed post primary schools in Port Harcourt. A substantial proportion of teachers were of the opinion that sexually active schoolgirls should not be encouraged to use contraceptives because they damage reproductive organs. A greater proportion (33.8%) of teachers was also of the opinion that schoolgirls should abstain from sex until they are married. This was closely followed by the suggestion that sexually active girls should use contraceptives (20.8%). The majority (48.3%) of teachers, however, advocated a sex education programme in the schools in order to prevent unwanted pregnancy.

Suboptimal management of cardiovascular risk factors in coronary heart disease patients in primary care occurs particularly in women.

PubMed

Driscoll, A; Beauchamp, A; Lyubomirsky, G; Demos, L; McNeil, J; Tonkin, A

2011-10-01

Patients with established coronary heart disease (CHD) are at the highest risk of further events. Despite proven therapies, secondary prevention is often suboptimal. General practitioners (GPs) are in an ideal position to improve secondary prevention. To contrast management of cardiovascular risk factors in patients with established CHD in primary care to those in clinical guidelines and according to gender. GPs throughout Australia were approached to participate in a programme incorporating a disease management software (mdCare) program. Participating practitioners (1258 GPs) recruited individual patients whose cardiovascular risk factor levels were measured. The mdCare programme included 12,509 patients (58% male) diagnosed with CHD. Their mean age was 71.7years (intra-quartile range 66-78) for men and 74years (intra-quartile range 68-80) for women. Low-density-lipoprotein cholesterol was above target levels in 69% (2032) of women compared with 58% (2487) in men (P < 0.0001). There was also a higher proportion of women with total cholesterol above target levels (76%, 3592) compared with men (57%, 3787) (P < 0.0001). In patients who were prescribed lipid-lowering medication, 53% (2504) of men and 72% (2285) of women continued to have a total cholesterol higher than recommended target levels (P < 0.0001). Overall, over half (52%, 6538) had at least five cardiovascular risk factors (55% (2914) in women and 50% (3624) in men, P < 0.0001). This study found less intensive management of cardiovascular risk factors in CHD patients, particularly among women, despite equivalent cardiovascular risk. This study has shown that these patients have multiple risk factors where gender also plays a role. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

Oral health status among children and adolescents in governmental and private schools of the Palestinian Territories.

PubMed

Abuhaloob, Lamis; Petersen, Poul Erik

2018-04-01

Political conflicts in the Palestinian Territories (PT) have resulted in systematic deterioration of socio-economic conditions and health. The World Health Organization (WHO) has emphasised the negative impacts of social crisis on children' oral health and quality of life. To assess the prevalence and trends in dental caries and poor gingival health of schoolchildren in the PT through the scholastic years 1998/1999 to 2012/2013. This is a retrospective study. Prevalence data on dental caries of primary and permanent dentitions among children 6, 12 and 16 years of age were gathered from annual oral health reports of the School Dental Health Programme (SDHP)-Ministry of Health. Caries was recorded according to WHO methods and criteria. Decayed, missing and filled teeth indices for primary (dmft) and permanent (DMFT) teeth were calculated. Gingival health status was examined according to the Community Periodontal Index (scores 1 and 2). Statistical analysis used SPSS. In 2012/2013, dental caries prevalence rates and the index scores among schoolchildren were as follows, respectively: 56.4% and 2.7 dmft at age 6; 42.0% and 1.4 DMFT at age 12; and 38.7% and 1.7 DMFT at age 16. For all age groups, the d/D-component of the caries indices was high. Trends of dental-caries prevalence, caries experience and gingival bleeding were fairly constant over time from 1998/1999. The SDHP was established in order to prevent and control oral diseases among schoolchildren in the PT. The Programme is fairly passive and the survey indicates an urgent need for reorientation of activities towards population-based prevention and health promotion. The application of the WHO Health Promoting Schools concept is highly recommended. © 2017 FDI World Dental Federation.

Interventions to prevent youth violence in Latin America: a systematic review.

PubMed

Atienzo, Erika E; Baxter, Susan K; Kaltenthaler, Eva

2017-01-01

This review aims to summarise evidence on the effectiveness of interventions to prevent youth violence in Latin America. A systematic search on 13 academic databases was conducted to locate studies evaluating a primary or secondary prevention intervention in Latin America. Studies could use any type of quantitative design to assess outcomes related to youth violence. A search of websites, references and citation searching was also carried out. The quality of each study was assessed. Nine studies were identified. Most documented positive effects of the interventions on the perception of youth violence present in the community/school. Evidence was found of a reduction in homicides and juvenile crimes in three studies, two of which evaluated a community-based intervention. There were mixed results for the self-report of participation on violent acts. The majority of the studies lacked of a rigorous design. Most of the interventions had some promising results, including the reduction of homicides within communities. Community-based programmes were the most consistent regarding an effectiveness to prevent violence. However, the evidence for Latin America is still scarce and relies on non-rigorously designed studies.

Preventing progression from gestational diabetes mellitus to diabetes: A thought-filled review.

PubMed

Kasher-Meron, Michal; Grajower, Martin M

2017-10-01

Women with a history of gestational diabetes are at high risk for developing type 2 diabetes mellitus. In studies with long periods of follow-up, diabetes incidence of up to 70% has been reported. The appropriate follow-up of women following a pregnancy complicated by gestational diabetes has not been studied. Published guidelines recommend that obstetrician/gynaecologists, who are often the de facto primary care physicians for these otherwise healthy young women, incorporate glucose monitoring in the post-partum period into their annual examinations. In reality, reported rates of screening have been low. There is also no clear evidence for any beneficial interventions to prevent diabetes in patients with prior history of gestational diabetes. Lifestyle intervention programmes for diabetes prevention among these patients yielded disappointing results. Metformin, pioglitazone, liraglutide, and bariatric surgery are possible options but based on inadequate data. There remains a need for randomized, placebo-controlled studies to evaluate various pharmacologic treatments, with and without lifestyle interventions, to prevent type 2 diabetes mellitus in women with a history of gestational diabetes. Copyright © 2017 John Wiley & Sons, Ltd.

Epidemiology of dental caries in children in the United Arab Emirates.

PubMed

Al-Bluwi, Ghada S M

2014-08-01

Dental caries has a significant impact on the general health and development of children. Understanding caries epidemiology is an essential task for the United Arab Emirates (UAE) policymakers to evaluate preventive programmes and to improve oral health. The purpose of this review is to collect and summarise all data available in the published literature on the epidemiology of dental caries in the UAE in children aged under 13 years. This will provide dental health planners with a comprehensive data summary, which will help in the planning for and evaluation of dental caries prevention programmes. Data were collected from the various published studies in PubMed, Academic Search Complete, Google, and the reference lists in relevant articles. Four keywords were used in the search: 'dental caries,' 'epidemiology,' 'prevalence,' and 'UAE'. All studies conducted in the UAE in general or any single emirate that sheds light on the prevalence of dental caries of children under 13 years were included in this literature review. Studies on early childhood caries and factors associated with dental caries were also included. The review comprises 11 published surveys of childhood caries in UAE. The earliest study was published in 1991 and the most recent was published in 2011. The range of decayed, missing and filled primary teeth (dmft) in UAE children (age between 4 years and 6 years) was 5.1-8.4. For the 12-year-old group the decayed missing and filled permanent teeth (DMFT) ranged from 1.6 to 3.24. Baseline data on oral health and a good understanding of dental caries determinants are necessary for setting appropriate goals and planning for preventive oral health programmes. The current data available on the dmft and DMFT indicate that childhood dental caries is still a serious dental public health problem in the UAE that warrants immediate attention by the government and policy makers. © 2014 FDI World Dental Federation.

Preventing renal and cardiovascular risk by renal function assessment: insights from a cross-sectional study in low-income countries and the USA

PubMed Central

Cravedi, Paolo; Sharma, Sanjib Kumar; Bravo, Rodolfo Flores; Islam, Nazmul; Tchokhonelidze, Irma; Ghimire, Madhav; Pahari, Bishnu; Thapa, Sanjeev; Basnet, Anil; Tataradze, Avtandil; Tinatin, Davitaia; Beglarishvili, Lela; Fwu, Chyng-Wen; Kopp, Jeffrey B; Eggers, Paul; Ene-Iordache, Bogdan; Carminati, Sergio; Perna, Annalisa; Chianca, Antonietta; Couser, William G; Remuzzi, Giuseppe; Perico, Norberto

2012-01-01

Objective To assess the prevalence of microalbuminuria and kidney dysfunction in low-income countries and in the USA. Design Cross-sectional study of screening programmes in five countries. Setting Screening programmes in Nepal, Bolivia, the USA (National Health and Nutrition Examination Survey (NHANES) 2005–2008) Bangladesh and Georgia. Participants General population in Nepal (n=20 811), Bolivia (n=3436) and in the USA (n=4299) and high-risk subjects in Bangladesh (n=1518) and Georgia (n=1549). Primary and secondary outcome measures Estimated glomerular filtration rate (eGFR)<60ml/min/1.73 m2 and microalbuminuria (defined as urinary albumin creatinine ratio values of 30–300 mg/g) were the main outcome measures. The cardiovascular (CV) risk was also evaluated on the basis of demographic, clinical and blood data. Results The prevalence of eGFR<60ml/min/1.73 m2 was 19%, 3.2% and 7% in Nepal, Bolivia and the USA, respectively. In Nepal, 7% of subjects were microalbuminuric compared to 8.6% in the USA. The prevalence of participants with predicted 10-year CV disease (CVD) risk ≥10% was 16.9%, 9.4% and 17% in Nepal, Bolivia and in the USA, respectively. In Bangladesh and Georgia, subjects with eGFR<60 ml/min/1.73 m2 were 8.6% and 4.9%, whereas those with microalbuminuria were 45.4% and 56.5%, respectively. Predicted 10-year CVD risk ≥10% was 25.4% and 25% in Bangladesh and Georgia, respectively. Conclusions Renal abnormalities are common among low-income countries and in the USA. Prevention programmes, particularly focused on those with renal abnormalities, should be established worldwide to prevent CVD and progression to end-stage renal disease. PMID:23002161

[Population impact of a podiatric school health programme].

PubMed

Ramos-Galván, José; Álvarez-Ruiz, Verónica; Tovaruela-Carrión, Natalia; Mahillo-Durán, Ramón; Gago-Reyes, Fernando

2016-01-01

This article presents an overview of the work done over the past 12 years in a collaboration between the school communities at various primary and secondary schools and the practical experience managers working in the Preventive and Community Podiatry area of the Podiatry degree at the University of Seville (Spain). The article presents several strategies, which were carried out in the fields of Foot Health for All and Preventive and Community Podiatry as part of the Hermes Research Group (CTS-601) aimed at promoting general foot health. Foot examinations were conducted in a total of 4,630 school pupils, with foot problems being confirmed in 677 of them. Some 7,145 members of the school community were also helped, with these people being reached through educational activities around foot care. The aim of the initiative was to prevent foot damage among children, which could have a harmful impact on their quality of life as adults. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Shared decision making in preventive care in Switzerland: From theory to action.

PubMed

Selby, Kevin; Auer, Reto; Cornuz, Jacques

2017-06-01

Switzerland with its decentralized, liberal health system and its tradition of direct democracy may be an ideal place for shared decision making (SDM) to take root organically, rather than using top-down regulations seen in other countries. There are now multiple directives and programmes in place to encourage SDM, with the creation of several decision aids and specific training programs in the five Swiss medical schools. There has been an emphasis on preventive care, with the integration of patient preference into an organized colorectal cancer screening program, clear recommendations for prostate cancer screening, and inroads into the primary prevention of cardiovascular disease. Focusing on the experience of the University of Lausanne, we describe multiple approaches being taken to teaching SDM and the local development of decision aids, drawing on international experience but tailored to local needs. Efforts are being made to further involve patients in not only SDM, but also associated research and quality improvement projects. Copyright © 2017. Published by Elsevier GmbH.

Using Soil Seed Banks for Ecological Education in Primary School

ERIC Educational Resources Information Center

Ju, Eun Jeong; Kim, Jae Geun

2011-01-01

In this study, we developed an educational programme using soil seed banks to promote ecological literacy among primary school-aged children. The programme consisted of seven student activities, including sampling and setting soil seed banks around the school, watering, identifying seedlings, and making observations about the plants and their…

Links in the Chain: Bringing Together Literacy and Science

ERIC Educational Resources Information Center

Taylor, Neil; Hansford, Diane; Rizk, Nadya; Taylor, Subhashni

2017-01-01

In Australia, the Federal Government and the Australian Academy of Science have developed a programme entitled "Primary Connections" (primaryconnections.org. au), aimed at supporting the teaching of science in the primary sector. The programme makes strong and explicit links between science and literacy through the use of word walls,…

Mentoring Beginning Teachers in Primary Schools: Research Review

ERIC Educational Resources Information Center

Spooner-Lane, Rebecca

2017-01-01

While mentoring programmes have proven to be successful in reducing attrition and improving teaching ability in beginning teachers, there remains a lack of research delineating the key components of effective mentoring programmes in primary education. This integrative research review examines empirical studies conducted since 2000 on the nature…

The Lifecycle of a South African Non-governmental Organisation: Primary Science Programme, 1983-1999.

ERIC Educational Resources Information Center

Harvey, Stephen; Peacock, Alan

2001-01-01

Traces the lifecycle of the Primary Science Programme (PSP), 1983-99, a representative South African nongovernmental organization. Shows how the social and economic environment shaped PSP development and demise. Highlights tensions between quality versus quantity, subject versus holistic focus, and participatory versus authoritarian management…

Effectiveness of Senior Dance on risk factors for falls in older adults (DanSE): a study protocol for a randomised controlled trial.

PubMed

Franco, Marcia R; Sherrington, Catherine; Tiedemann, Anne; Pereira, Leani S; Perracini, Monica R; Faria, Claudia R S; Pinto, Rafael Z; Pastre, Carlos M

2016-12-30

Strong evidence shows that exercise is effective to improve fall risk factors among older people. However, older people's participation and adherence to exercise programmes is suboptimal. Type of exercise and apathy are reported to be barriers to exercise participation, suggesting that new effective interventions are needed. The primary aim of this randomised controlled trial is to investigate the effect of Senior Dance plus brief education for falls prevention on balance among people aged 60 years or over, compared with a control group receiving only brief education. This single-blind randomised controlled trial will involve 82 community-dwelling older people aged 60 years or over who are cognitively intact. Participants allocated to the intervention group will attend a single educational class on strategies to prevent falls, and will participate in a 12-week, twice-weekly group-based programme of Senior Dance. The Senior Dance consists of different choreographies, which include rhythmic and simple movements with rhythmic folk songs. Participants allocated to the control group will attend the same educational class that intervention group participants will receive, and will be instructed not to take part in any regular exercise programme. The primary outcome will be single-leg stance with eyes closed. Secondary outcomes include: Short Physical Performance Battery, Falls Efficacy Scale, Trail Making Test and the Montreal Cognitive Assessment. Continuous outcomes will be reported using mean (SD) or median (IQR), depending on the distribution of the data. The linear regression approach to analysis of covariance will be used to compare the mean effect between groups. All patients will be included in the analyses following an intention-to-treat approach. Ethics approval has been granted by the Human Ethics Committee of the São Paulo State University (CAAE 48665215.9.0000.5402). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences. NCT02603523, Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls.

PubMed

Irvine, Lisa; Conroy, Simon P; Sach, Tracey; Gladman, John R F; Harwood, Rowan H; Kendrick, Denise; Coupland, Carol; Drummond, Avril; Barton, Garry; Masud, Tahir

2010-11-01

multifactorial falls prevention programmes for older people have been proved to reduce falls. However, evidence of their cost-effectiveness is mixed. economic evaluation alongside pragmatic randomised controlled trial. randomised trial of 364 people aged ≥70, living in the community, recruited via GP and identified as high risk of falling. Both arms received a falls prevention information leaflet. The intervention arm were also offered a (day hospital) multidisciplinary falls prevention programme, including physiotherapy, occupational therapy, nurse, medical review and referral to other specialists. self-reported falls, as collected in 12 monthly diaries. Levels of health resource use associated with the falls prevention programme, screening (both attributed to intervention arm only) and other health-care contacts were monitored. Mean NHS costs and falls per person per year were estimated for both arms, along with the incremental cost-effectiveness ratio (ICER) and cost effectiveness acceptability curve. in the base-case analysis, the mean falls programme cost was £349 per person. This, coupled with higher screening and other health-care costs, resulted in a mean incremental cost of £578 for the intervention arm. The mean falls rate was lower in the intervention arm (2.07 per person/year), compared with the control arm (2.24). The estimated ICER was £3,320 per fall averted. the estimated ICER was £3,320 per fall averted. Future research should focus on adherence to the intervention and an assessment of impact on quality of life.

Education Against Tobacco (EAT): a quasi-experimental prospective evaluation of a programme for preventing smoking in secondary schools delivered by medical students: a study protocol.

PubMed

Brinker, Titus J; Stamm-Balderjahn, Sabine; Seeger, Werner; Groneberg, David A

2014-07-24

A survey conducted by the German Federal Centre for Health Education in 2012 showed that 35.2% of all young adults (18-25 years) and 12.0% of all adolescents (12-17 years) in Germany are regular cigarette smokers. Most smoked their first cigarette in early adolescence. We recently reported a significantly positive short-term effect of a physician-delivered school-based smoking prevention programme on the smoking behaviour of schoolchildren in Germany. However, physician-based programmes are usually very expensive. Therefore, we will evaluate and optimise Education against Tobacco (EAT), a widespread, low-cost programme delivered by about 400 medical students from 16 universities in Germany. A prospective quasi-experimental study design with two measurements at baseline (t1) and 6 months post-intervention (t2) to investigate an intervention in 10-15-year-olds in grades 6-8 at German secondary schools. The intervention programme consists of two 60-min school-based medical-student-delivered modules with (module 1) and without the involvement of patients with tobacco-related diseases and control groups (no intervention). The study questionnaire measuring smoking status (water pipe and cigarette smoking), smoking-related cognitions, and gender, social and cultural aspects was designed and pre-tested in advance. The primary end point is the prevalence of smokers and non-smokers in the two study arms at 6 months after the intervention. The percentage of former smokers and new smokers in the two groups and the measures of smoking behaviour will be studied as secondary outcome measures. In accordance with Good Epidemiologic Practice (GEP) guidelines, the study protocol was submitted for approval by the responsible ethics committee, which decided that the study does not need ethical approval (Goethe University, Frankfurt-Main, Germany). Findings will be disseminated in peer-reviewed journals, at conferences, within our scientific advisory board and through medical students within the EAT project. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Education Against Tobacco (EAT): a quasi-experimental prospective evaluation of a programme for preventing smoking in secondary schools delivered by medical students: a study protocol

PubMed Central

Brinker, Titus J; Stamm-Balderjahn, Sabine; Seeger, Werner; Groneberg, David A

2014-01-01

Introduction A survey conducted by the German Federal Centre for Health Education in 2012 showed that 35.2% of all young adults (18–25 years) and 12.0% of all adolescents (12–17 years) in Germany are regular cigarette smokers. Most smoked their first cigarette in early adolescence. We recently reported a significantly positive short-term effect of a physician-delivered school-based smoking prevention programme on the smoking behaviour of schoolchildren in Germany. However, physician-based programmes are usually very expensive. Therefore, we will evaluate and optimise Education against Tobacco (EAT), a widespread, low-cost programme delivered by about 400 medical students from 16 universities in Germany. Methods and analysis A prospective quasi-experimental study design with two measurements at baseline (t1) and 6 months post-intervention (t2) to investigate an intervention in 10–15-year-olds in grades 6–8 at German secondary schools. The intervention programme consists of two 60-min school-based medical-student-delivered modules with (module 1) and without the involvement of patients with tobacco-related diseases and control groups (no intervention). The study questionnaire measuring smoking status (water pipe and cigarette smoking), smoking-related cognitions, and gender, social and cultural aspects was designed and pre-tested in advance. The primary end point is the prevalence of smokers and non-smokers in the two study arms at 6 months after the intervention. The percentage of former smokers and new smokers in the two groups and the measures of smoking behaviour will be studied as secondary outcome measures. Ethics and dissemination In accordance with Good Epidemiologic Practice (GEP) guidelines, the study protocol was submitted for approval by the responsible ethics committee, which decided that the study does not need ethical approval (Goethe University, Frankfurt-Main, Germany). Findings will be disseminated in peer-reviewed journals, at conferences, within our scientific advisory board and through medical students within the EAT project. PMID:25059969

Universalization of Primary Education in Colombia: The New School Programme. Notes, Comments... No. 191 = Colombie: L'enseignement primaire pour tous le programme "Ecole nouvelle."

ERIC Educational Resources Information Center

Colbert, Vicky; Arboleda, Jairo

For the first time, Colombia is in a position to comply with the article of her constitution which guarantees a primary education to all citizens. The country now has the technical, political and financial conditions necessary to universalize primary education, particularly in rural areas where low coverage and inefficiency of the system have…

Translating guidelines to practice: findings from a multidisciplinary preventive cardiology programme in the west of Ireland.

PubMed

Gibson, Irene; Flaherty, Gerard; Cormican, Sarah; Jones, Jennifer; Kerins, Claire; Walsh, Anne Marie; Costello, Caroline; Windle, Jane; Connolly, Susan; Crowley, James

2014-03-01

The aim of this observational, descriptive study is to evaluate the impact of an intensive, evidence-based preventive cardiology programme on medical and lifestyle risk factors in patients at high risk of developing cardiovascular disease (CVD). Increased CVD risk patients and their family members/partners were invited to attend a 16-week programme consisting of a professional multidisciplinary lifestyle intervention, with appropriate risk factor and therapeutic management in a community setting. Smoking, dietary habits, physical activity levels, waist circumference and body mass index, and medical risk factors were measured at initial assessment, at end of programme, and at 1-year follow up. Adherence to the programme was high, with 375 (87.2%) participants and 181 (84.6%) partners having completed the programme, with 1-year data being obtained from 235 (93.6%) patients and 107 (90.7%) partners. There were statistically significant improvements in both lifestyle (body mass index, waist circumference, physical activity, Mediterranean diet score, fish, fruit, and vegetable consumption, smoking cessation rates), psychosocial (anxiety and depression scales and quality of life indices), and medical risk factors (blood pressure, lipid and glycaemic targets) between baseline and end of programme, with these improvements being sustained at 1-year follow up. These findings demonstrate how a holistic model of CVD prevention can improve cardiovascular risk factors by achieving healthier lifestyles and optimal medical management.

Global policy for improvement of oral health in the 21st century--implications to oral health research of World Health Assembly 2007, World Health Organization.

PubMed

Petersen, Poul Erik

2009-02-01

The World Health Organization (WHO) Global Oral Health Programme has worked hard over the past 5 years to increase the awareness of oral health worldwide as oral health is important component of general health and quality of life. Meanwhile, oral disease is still a major public health problem in high income countries and the burden of oral disease is growing in many low- and middle income countries. In the World Oral Health Report 2003, the WHO Global Oral Health Programme formulated the policies and necessary actions to the continuous improvement of oral health. The strategy is that oral disease prevention and the promotion of oral health needs to be integrated with chronic disease prevention and general health promotion as the risks to health are linked. The World Health Assembly (WHA) and the Executive Board (EB) are supreme governance bodies of WHO and for the first time in 25 years oral health was subject to discussion by those bodies in 2007. At the EB120 and WHA60, the Member States agreed on an action plan for oral health and integrated disease prevention, thereby confirming the approach of the Oral Health Programme. The policy forms the basis for future development or adjustment of oral health programmes at national level. Clinical and public health research has shown that a number of individual, professional and community preventive measures are effective in preventing most oral diseases. However, advances in oral health science have not yet benefited the poor and disadvantaged populations worldwide. The major challenges of the future will be to translate knowledge and experiences in oral disease prevention and health promotion into action programmes. The WHO Global Oral Health Programme invites the international oral health research community to engage further in research capacity building in developing countries, and in strengthening the work so that research is recognized as the foundation of oral heath policy at global level.

Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care.

PubMed

Guiriguet, Carolina; Muñoz-Ortiz, Laura; Burón, Andrea; Rivero, Irene; Grau, Jaume; Vela-Vallespín, Carmen; Vilarrubí, Mercedes; Torres, Miquel; Hernández, Cristina; Méndez-Boo, Leonardo; Toràn, Pere; Caballeria, Llorenç; Macià, Francesc; Castells, Antoni

2016-07-01

Participation rates in colorectal cancer screening are below recommended European targets. To evaluate the effectiveness of an alert in primary care electronic medical records (EMRs) to increase individuals' participation in an organised, population-based colorectal cancer screening programme when compared with usual care. Cluster randomised controlled trial in primary care centres of Barcelona, Spain. Participants were males and females aged 50-69 years, who were invited to the first round of a screening programme based on the faecal immunochemical test (FIT) (n = 41 042), and their primary care professional. The randomisation unit was the physician cluster (n = 130) and patients were blinded to the study group. The control group followed usual care as per the colorectal cancer screening programme. In the intervention group, as well as usual care, an alert to health professionals (cluster level) to promote screening was introduced in the individual's primary care EMR for 1 year. The main outcome was colorectal cancer screening participation at individual participant level. In total, 67 physicians and 21 619 patients (intervention group) and 63 physicians and 19 423 patients (control group) were randomised. In the intention-to-treat analysis screening participation was 44.1% and 42.2% respectively (odds ratio 1.08, 95% confidence interval [CI] = 0.97 to 1.20, P = 0.146). However, in the per-protocol analysis screening uptake in the intervention group showed a statistically significant increase, after adjusting for potential confounders (OR, 1.11; 95% CI = 1.02 to 1.22; P = 0.018). The use of an alert in an individual's primary care EMR is associated with a statistically significant increased uptake of an organised, FIT-based colorectal cancer screening programme in patients attending primary care centres. © British Journal of General Practice 2016.

Development of a questionnaire to evaluate patients' awareness of cardiovascular disease risk in England's National Health Service Health Check preventive cardiovascular programme.

PubMed

Woringer, Maria; Nielsen, Jessica Jones; Zibarras, Lara; Evason, Julie; Kassianos, Angelos P; Harris, Matthew; Majeed, Azeem; Soljak, Michael

2017-09-25

The National Health Service (NHS) Health Check is a cardiovascular disease (CVD) risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There is no tool to assess the effectiveness of the programme in communicating CVD risk to patients. The aim of this paper was to develop a questionnaire examining patients' CVD risk awareness for use in health service research evaluations of the NHS Health Check programme. We developed an 85-item questionnaire to determine patients' views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items were added. The resulting 65-item questionnaire with satisfactory content validity (content validity indices≥0.80) and face validity was tested on 110 NHS Health Check attendees in primary care in a cross-sectional study between 21 May 2014 and 28 July 2014. Following analyses of data, we reduced the questionnaire from 65 to 26 items. The 26-item questionnaire constitutes four scales: Knowledge of CVD Risk and Prevention, Perceived Risk of Heart Attack/Stroke, Perceived Benefits and Intention to Change Behaviour and Healthy Eating Intentions. Perceived Risk (Cronbach's α=0.85) and Perceived Benefits and Intention to Change Behaviour (Cronbach's α=0.82) have satisfactory reliability (Cronbach's α≥0.70). Healthy Eating Intentions (Cronbach's α=0.56) is below minimum threshold for reliability but acceptable for a three-item scale. The resulting questionnaire, with satisfactory reliability and validity, may be used in assessing patients' awareness of CVD risk among NHS Health Check attendees. © 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.

Workplace programmes for HIV and tuberculosis: a systematic review to support development of international guidelines for the health workforce.

PubMed

Yassi, Annalee; O'Hara, Lyndsay M; Lockhart, Karen; Spiegel, Jerry M

2013-01-01

The health service sector has a vital role to play in delivering human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment and care, yet evidence indicates that healthcare workers (HCWs) themselves lack adequate access to HIV and TB services. HCWs are also at increased risk from TB and other infectious diseases at work, and therefore accessing HIV services is particularly important. A systematic review was therefore conducted to inform the development of World Health Organization (WHO) guidelines to improve access to HIV and TB services, and specifically, to assess the evidence regarding providing such services through workplace-based programmes. We identified any study published since 1984 that addressed outcomes of interest as defined through multi-stakeholder consultations, and were related to workplace interventions in (1) the healthcare workplace and (2) any workplace that included HIV and/or TB diagnosis and/or treatment. Interventions focusing solely on primary prevention with no diagnostic or treatment services were excluded, as they were the subject of other guidelines. A minimum of two reviewers independently extracted data and assessed the articles against pre-set selection criteria; studies were also profiled and quality assessed by a minimum of two reviewers. Three studies met these criteria specifically for HCWs; all showed a preponderance of positive benefits, with minimal negative outcome. Seven studies met these criteria regarding workplace HIV and/or TB diagnosis and/or treatment from other sectors, public or private. Again, all showed positive results. The paucity of high-quality evidence in this field of research was itself an important finding, beckoning further research on workplace-based programmes for health workers. Nonetheless, while more well-designed intervention studies are definitely desirable, providing programmes for HCWs to obtain HIV and TB diagnosis and treatment at the workplace is supported by the literature and is consistent with the values of the stakeholders, justifying the WHO-International Labour Organization-UNAIDS guidelines that emerged.

The Brain Games study: protocol for a randomised controlled trial of computerised cognitive training for preventing mental illness in adolescents with high-risk personality styles.

PubMed

Mewton, Louise; Hodge, Antoinette; Gates, Nicola; Visontay, Rachel; Teesson, Maree

2017-09-25

A broad range of mental disorders are now understood as aberrations of normal adolescent brain development. In both adolescents and adults, executive dysfunction has been implicated across a range of mental illnesses, and enhancing executive functioning may prove to be a useful prevention strategy for adolescents at risk for a range of psychopathology. This study will consist of a double-blind, randomised controlled trial with a 12-month follow-up period. Participants will consist of 200 people aged 16-24 years who are at risk for a range of mental disorders based on personality risk factors, but have not experienced a lifetime mental illness as determined by a structured diagnostic interview. Participants will be randomly allocated to either an intervention group who complete an online cognitive training programme specifically targeting executive functioning ability or a control group who complete an online cognitive training programme that has limited executive functioning training potential. Superiority of the executive functioning training programme compared with the control training programme will be assessed at baseline, post-training and at 3-month, 6-month and 12-month follow-up. All assessments will be conducted online. The primary outcome of the study will be general psychopathology as measured by the Strengths and Difficulties Questionnaire. Secondary outcomes will include executive functioning ability, day-to-day functioning and alcohol consumption. All analyses will be undertaken using mixed-model repeated measures analysis of variance with planned contrasts. Ethics approval has been obtained from the University of New South Wales Human Research Ethics Committee (HC15094). Results of the trial immediately post-treatment and at 12 months follow-up will be submitted for publication in peer-reviewed journals. ACTRN12616000127404; Pre-results. © 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.

The Brain Games study: protocol for a randomised controlled trial of computerised cognitive training for preventing mental illness in adolescents with high-risk personality styles

PubMed Central

Mewton, Louise; Hodge, Antoinette; Gates, Nicola; Visontay, Rachel; Teesson, Maree

2017-01-01

Introduction A broad range of mental disorders are now understood as aberrations of normal adolescent brain development. In both adolescents and adults, executive dysfunction has been implicated across a range of mental illnesses, and enhancing executive functioning may prove to be a useful prevention strategy for adolescents at risk for a range of psychopathology. Methods and analysis This study will consist of a double-blind, randomised controlled trial with a 12-month follow-up period. Participants will consist of 200 people aged 16–24 years who are at risk for a range of mental disorders based on personality risk factors, but have not experienced a lifetime mental illness as determined by a structured diagnostic interview. Participants will be randomly allocated to either an intervention group who complete an online cognitive training programme specifically targeting executive functioning ability or a control group who complete an online cognitive training programme that has limited executive functioning training potential. Superiority of the executive functioning training programme compared with the control training programme will be assessed at baseline, post-training and at 3-month, 6-month and 12-month follow-up. All assessments will be conducted online. The primary outcome of the study will be general psychopathology as measured by the Strengths and Difficulties Questionnaire. Secondary outcomes will include executive functioning ability, day-to-day functioning and alcohol consumption. All analyses will be undertaken using mixed-model repeated measures analysis of variance with planned contrasts. Ethics and dissemination Ethics approval has been obtained from the University of New South Wales Human Research Ethics Committee (HC15094). Results of the trial immediately post-treatment and at 12 months follow-up will be submitted for publication in peer-reviewed journals. Trial registration number ACTRN12616000127404; Pre-results. PMID:28951415

Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community

PubMed Central

Wright, J; Harrison, S; McGeorge, M; Patterson, C; Russell, I; Russell, D; Small, N; Taylor, M; Walsh, M; Warren, E; Young, J

2006-01-01

Problem Rapid referral and management of patients with transient ischaemic attacks is a key component in the national strategy for stroke prevention. However, patients with transient ischaemic attacks are poorly identified and undertreated. Design and setting Before and after evaluation of quality improvement programme with controlled comparison in three primary care trusts reflecting diverse populations and organisational structures in an urban district in the North of England. Key measures for improvement The proportion of patients receiving antiplatelet drugs and safe driving advice on referral to a speciality clinic, and the numbers of referrals, adjusted for age, to the specialist clinic before and after the improvement programme. Strategies for change Interviews with patient and professionals to identify gaps and barriers to good practice; development of evidence based guidelines for the management of patients with transient ischaemic attacks; interactive multidisciplinary workshops for each primary care trust with feedback of individual audit results of referral practice; outreach visits to teams who were unable to attend the workshops; referral templates and desktop summaries to provide reminders of the guidelines to clinicians; incorporation of standards into professional contracts. Effects of change A significant improvement occurred in identification and referral of patients with transient ischaemic attacks to specialist clinics, with a 41% increase in referrals from trained practices compared with control practices. There were also significant improvements in the early treatment and safety advice provided to patients before referral. Lessons learnt A strategic approach to effective quality improvement across a diverse health community is feasible and achievable. Careful planning with patient and professional involvement to develop a tailored and multifaceted quality improvement programme to implement evidence based practice can work in very different primary care settings. Key components of the effectiveness of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication, and use of established networks and opinion leaders. PMID:16456203

Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community.

PubMed

Wright, J; Harrison, S; McGeorge, M; Patterson, C; Russell, I; Russell, D; Small, N; Taylor, M; Walsh, M; Warren, E; Young, J

2006-02-01

Rapid referral and management of patients with transient ischaemic attacks is a key component in the national strategy for stroke prevention. However, patients with transient ischaemic attacks are poorly identified and undertreated. Before and after evaluation of quality improvement programme with controlled comparison in three primary care trusts reflecting diverse populations and organisational structures in an urban district in the North of England. The proportion of patients receiving antiplatelet drugs and safe driving advice on referral to a specialty clinic, and the numbers of referrals, adjusted for age, to the specialist clinic before and after the improvement programme. Interviews with patient and professionals to identify gaps and barriers to good practice; development of evidence based guidelines for the management of patients with transient ischaemic attacks; interactive multidisciplinary workshops for each primary care trust with feedback of individual audit results of referral practice; outreach visits to teams who were unable to attend the workshops; referral templates and desktop summaries to provide reminders of the guidelines to clinicians; incorporation of standards into professional contracts. A significant improvement occurred in identification and referral of patients with transient ischaemic attacks to specialist clinics, with a 41% increase in referrals from trained practices compared with control practices. There were also significant improvements in the early treatment and safety advice provided to patients before referral. A strategic approach to effective quality improvement across a diverse health community is feasible and achievable. Careful planning with patient and professional involvement to develop a tailored and multifaceted quality improvement programme to implement evidence based practice can work in very different primary care settings. Key components of the effectiveness of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication, and use of established networks and opinion leaders.

Strengthening of Oral Health Systems: Oral Health through Primary Health Care

PubMed Central

Petersen, Poul Erik

2014-01-01

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. PMID:24525450

Differences in the perceived role of the healthcare provider in delivering vascular health checks: a Q methodology study

PubMed Central

2013-01-01

Background The UK Department of Health introduced the National Health Service (NHS) Health Check Programme in April 2009 in an attempt to improve primary and secondary prevention of cardiovascular disease in the UK population and to reduce health inequalities. Healthcare professionals' attitudes towards giving lifestyle advice will influence how they interact with patients during consultations. We therefore sought to identify the attitudes of primary care healthcare professionals towards the delivery of lifestyle advice in the context of the NHS Health Check Programme. Methods Fifty-two primary care healthcare professionals undertook a Q sort with 36 statements that represented a range of viewpoints about the importance of lifestyle change, medication, giving lifestyle advice in the primary care setting, and the individual, social and material factors that might impact on lifestyle related behaviour change. Sorts were analysed by-person using principal components analysis and varimax rotation. Results Five statistically independent factors (accounts) reflected distinct views on the topic. Account 1 was supportive of initiatives like the NHS Health Check, and emphasised the importance of professionals working collaboratively with patients to facilitate lifestyle change. Account 2 expressed views on the potential overuse of statin medication and placed responsibility for lifestyle change with the patient. Account 3 viewed the healthcare professional role to be one of educator, emphasising the provision of information. Account 4 perceived lifestyle change to be difficult for patients and emphasised the need for healthcare professionals to be role models. Account 5 was inconsistent about the value of lifestyle change, or the role of healthcare professionals in promoting it, a finding that may be due to ambivalence about the health check or to lack of engagement with the Q sort task. We found no strong associations between any of the factors and, gender, role, age or ethnicity. Conclusions Our findings suggest that healthcare professionals hold viewpoints that may influence how they interact with patients during health checks. When implementing programmes like the NHS Health Check, it would be useful to take healthcare professionals’ views into account. Attitudes and beliefs could be explored during training sessions, for example. PMID:24229342

An assessment of the effect of an experimental environmental education programme (Man and Nutrition) on Kuwaiti primary school pupils (Grade Four)

NASA Astrophysics Data System (ADS)

Esmaeel, Yaqoub Y. R.

The educational system in Kuwait is undergoing some fundamental changes, and the need for reform of environmental education has become urgent as a result of the concerns of both the government and the public over environmental issues. It is in such a context that this research was conducted. The research was intended to develop, implement, and evaluate an experimental programme Man and Nutrition for Kuwaiti primary school pupils, aimed at developing a positive environmental achievement, Information about the present status of environmental concepts and environmental education in Kuwait was obtained from preliminary study such as interviews and curriculum analysis. Interviews were conducted in ten different primary schools in four districts in Kuwait, which involved 31 pupils in total, hi addition, information was obtained by analysis of the science curriculum for fourth grade primary schools. The preliminary study was carried out during the period April to October 1998. The results of the preliminary study served to aid the development of an experimental teaching programme. The experimental programme Man and Nutrition consisted of eight lessons printed in two booklets, a teacher's guide and pupil's textbook. The research included a review of the relevant literature examining the development of environmental programmes and activities in a number of countries, which were selected because of their environmental education approaches, and the variety of their environmental conditions. Pilot testing of the teaching programmes was carried out to ascertain the appropriateness of the materials and the data collecting instruments used for the evaluation of the main experimental study. The main study group included 115 pupils in four primary schools and four teachers selected in Kuwait. Data collecting included pre and post-tests and the course evaluation by teachers using semi-structured interviews. Statistical analysis of data obtained was carried out using the SPSS/PC+ computer programme. The major results of this study indicated that: (1) The present science programme of the fourth grade does not sufficiently cover the concepts identified as environmental concepts. (2) The experimental programme was significantly effective in increasing the pupils' knowledge regarding the environmental programme Man and Nutrition. (3) A significant difference in the mean scores was found between boys and girls in the post-achievement test. (4) There was a significant difference in the pupils' mean scores between the educational districts in the post-achievement test. (5) The experimental programme had similar influences on pupils' overall achievement by parents' education. Based upon the above major research results, the study puts forward some practical recommendations regarding the development of a school environmental education programme. Since the study is one of the first of its kind in Kuwait, it also suggests a few possible areas for future research. It is hoped that the research will lead to a worthwhile primary school environmental education.

What Determines HIV Prevention Costs at Scale? Evidence from the Avahan Programme in India

PubMed Central

Chandrashekar, Sudhashree; Shetty, Govindraj; Vickerman, Peter; Bradley, Janet; Alary, Michel; Moses, Stephen; Vassall, Anna

2016-01-01

Abstract Expanding essential health services through non‐government organisations (NGOs) is a central strategy for achieving universal health coverage in many low‐income and middle‐income countries. Human immunodeficiency virus (HIV) prevention services for key populations are commonly delivered through NGOs and have been demonstrated to be cost‐effective and of substantial global public health importance. However, funding for HIV prevention remains scarce, and there are growing calls internationally to improve the efficiency of HIV prevention programmes as a key strategy to reach global HIV targets. To date, there is limited evidence on the determinants of costs of HIV prevention delivered through NGOs; and thus, policymakers have little guidance in how best to design programmes that are both effective and efficient. We collected economic costs from the Indian Avahan initiative, the largest HIV prevention project conducted globally, during the first 4 years of its implementation. We use a fixed‐effect panel estimator and a random‐intercept model to investigate the determinants of average cost. We find that programme design choices such as NGO scale, the extent of community involvement, the way in which support is offered to NGOs and how clinical services are organised substantially impact average cost in a grant‐based payment setting. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd. PMID:26763652

Cost-effectiveness of community screening for glaucoma in rural India: a decision analytical model.

PubMed

John, D; Parikh, R

2018-02-01

Studies in several countries have demonstrated the cost-effectiveness of population-based screening for glaucoma when targeted at high-risk groups such as older adults and with familial history of disease. This study conducts a cost-effective analysis of a hypothetical community screening and subsequent treatment programme in comparison to opportunistic case finding for glaucoma in rural India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in rural areas of India. A decision analytical model was built to model events, costs and treatment pathways with and without a hypothetical screening programme for glaucoma for a rural-based population aged between 40 and 69 years in India. The treatment pathway included both primary open-angle glaucoma and angle-closure disease. The data on costs of screening and treatment were provided by an administrator of a tertiary eye hospital in Eastern India. The probabilities for the screening and treatment pathway were derived from published literature and a glaucoma specialist. The glaucoma prevalence rates were adapted from the Chennai Glaucoma Study findings. An incremental cost-effectiveness ratio value of ₹7292.30 per quality-adjusted life-year was calculated for a community-screening programme for glaucoma in rural India. The community screening for glaucoma would treat an additional 2872 cases and prevent 2190 person-years of blindness over a 10-year period. Community screening for glaucoma in rural India appears to be cost-effective when judged by a ratio of willingness-to-pay thresholds as per WHO-CHOICE guidelines. For community screening to be cost-effective, adequate resources, such as trained medical personnel and equipment would need to be made available. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

The Incredible Years Therapeutic Social and Emotional Skills Programme: A Pilot Study

ERIC Educational Resources Information Center

Hutchings, Judy; Bywater, Tracey; Gridley, Nicole; Whitaker, Christopher J.; Martin-Forbes, Pam; Gruffydd, Stella

2012-01-01

The Incredible Years (IY) universal child Classroom Dinosaur and Teacher Classroom Management programmes are delivered in all 102 primary schools in Gwynedd County, Wales. This article describes a pilot study of the IY Therapeutic (small group) Dinosaur School social and emotional coaching programme, developed as a treatment programme, in one such…

Co-operation, participation and conflicts faced in public health--lessons learned from a long-term prevention programme in Sweden.

PubMed

Brännström, I; Emmelin, M; Dahlgren, L; Johansson, M; Wall, S

1994-09-01

A comprehensive community-based programme for prevention of cardiovascular diseases (CVD) and diabetes was established in 1985 in a small municipality in northern Sweden. A cross-sectional survey to the general public was performed and semi-structured open-ended interviews were taken of actors at different levels. Notes from official records were also included in the study. The aim was to describe and discuss some factors that promote or constrain community participation in health programmes. The results generally confirmed that the right of definition concerning the health programme mainly remained with the health professionals. Community participation was mainly defined by the actors based on the medical and health planning approach and, thereby, as a means to transform health policy plans into reality by transmitting health knowledge and increasing consciousness among the citizens of the need for changing lifestyles. However, participation as a means of identifying problems and demonstrating power relationships and as elements in promoting local democracy was hardly represented among the actors at all. Overall, the CVD health programme was characterized by consensus between the actors. Despite this, debates and arguments about interpretations, social interests, personal conflicts and ideological constraints were observed. However, a majority of the public wanted the CVD preventive programme to continue.

The costs of HIV prevention strategies in developing countries.

PubMed Central

Söderlund, N.; Lavis, J.; Broomberg, J.; Mills, A.

1993-01-01

Since many evaluations of HIV (human immunodeficiency virus) prevention programmes do not include data on costs, a preliminary analysis of the costs and outputs of a sample of HIV prevention projects was attempted. Case studies, representing six broad HIV prevention strategies in developing countries with differing levels of per capita gross domestic product, were sought on the basis of availability of data and potential generalizability. The six prevention strategies studied were mass media campaigns, peer education programmes, sexually transmitted disease treatment, condom social marketing, safe blood provision, and needle exchange/bleach provision programmes. Financial cost data were abstracted from published studies or were obtained directly from project coordinators. Although estimates of cost-effectiveness were not made, calculations of the relative cost per common process measure of output were compared. Condom distribution costs ranged from US$ 0.02 to 0.70 per condom distributed, and costs of strategies involving personal educational input ranged from US$ 0.15 to 12.59 per contact. PMID:8261563

Workplace interventions for common mental disorders: a systematic meta-review.

PubMed

Joyce, S; Modini, M; Christensen, H; Mykletun, A; Bryant, R; Mitchell, P B; Harvey, S B

2016-03-01

Depression and anxiety disorders are the leading cause of sickness absence and long-term work incapacity in most developed countries. The present study aimed to carry out a systematic meta-review examining the effectiveness of workplace mental health interventions, defined as any intervention that a workplace may either initiate or facilitate that aims to prevent, treat or rehabilitate a worker with a diagnosis of depression, anxiety or both. Relevant reviews were identified via a detailed systematic search of academic and grey literature databases. All articles were subjected to a rigorous quality appraisal using the AMSTAR assessment. Of the 5179 articles identified, 140 studies met the inclusion criteria, of which 20 were deemed to be of moderate or high quality. Together, these reviews analysed 481 primary research studies. Moderate evidence was identified for two primary prevention interventions; enhancing employee control and promoting physical activity. Stronger evidence was found for CBT-based stress management although less evidence was found for other secondary prevention interventions, such as counselling. Strong evidence was also found against the routine use of debriefing following trauma. Tertiary interventions with a specific focus on work, such as exposure therapy and CBT-based and problem-focused return-to-work programmes, had a strong evidence base for improving symptomology and a moderate evidence base for improving occupational outcomes. Overall, these findings demonstrate there are empirically supported interventions that workplaces can utilize to aid in the prevention of common mental illness as well as facilitating the recovery of employees diagnosed with depression and/or anxiety.

Parental Support for Teenage Pregnancy Prevention Programmes in South Carolina Public Middle Schools

ERIC Educational Resources Information Center

Rose, India; Prince, Mary; Flynn, Shannon; Kershner, Sarah; Taylor, Doug

2014-01-01

Teenage pregnancy is a major public health issue in the USA; this is especially true in the state of South Carolina (SC). Research shows that well developed, good-quality teenage pregnancy prevention (TPP) programmes can be effective in modifying young people's sexual behaviour. While several quantitative studies have examined parents' perceptions…

Effects of a School-Based Stress Prevention Programme on Adolescents in Different Phases of Behavioural Change

ERIC Educational Resources Information Center

Vierhaus, Marc; Maass, Asja; Fridrici, Mirko; Lohaus, Arnold

2010-01-01

This study examines whether the assumptions of the Transtheoretical Model (TTM) are useful to evaluate the effectiveness of a school-based stress prevention programme in adolescence to promote appropriate coping behaviour. The TTM assumes three consecutive phases in the adoption of behavioural patterns. Progress throughout the phases is promoted…

Secondary prevention lifestyle interventions initiated within 90 days after TIA or 'minor' stroke: a systematic review and meta-analysis of rehabilitation programmes.

PubMed

Heron, Neil; Kee, Frank; Cardwell, Christopher; Tully, Mark A; Donnelly, Michael; Cupples, Margaret E

2017-01-01

Strokes are often preceded by a transient ischaemic attack (TIA) or 'minor' stroke. The immediate period after a TIA/minor stroke is a crucial time to initiate secondary prevention. However, the optimal approach to prevention, including non-pharmacological measures, after TIA is not clear. To systematically review evidence about the effectiveness of delivering secondary prevention, with lifestyle interventions, in comprehensive rehabilitation programmes, initiated within 90 days of a TIA/minor stroke. Also, to categorise the specific behaviour change techniques used. The review identified randomised controlled trials by searching the Cochrane Library, Ovid MEDLINE, Ovid EMBASE, Web of Science, EBSCO CINAHL and Ovid PsycINFO. Two review authors independently screened titles and abstracts for eligibility (programmes initiated within 90 days of event; outcomes reported for TIA/minor stroke) and extracted relevant data from appraised studies; a meta-analysis was used to synthesise the results. A total of 31 potentially eligible papers were identified and four studies, comprising 774 patients post-TIA or minor stroke, met the inclusion criteria; two had poor methodological quality. Individual studies reported increased aerobic capacity but meta-analysis found no significant change in resting and peak systolic blood pressure, resting heart rate, aerobic capacity, falls, or mortality. The main behaviour change techniques were goal setting and instructions about how to perform given behaviours. There is limited evidence of the effectiveness of early post-TIA rehabilitation programmes with preventive lifestyle interventions. Further robust randomised controlled trials of comprehensive rehabilitation programmes that promote secondary prevention and lifestyle modification immediately after a TIA are needed. © British Journal of General Practice 2017.

Practical applications of injury surveillance: a brief 25-year history of the Connecticut Injury Prevention Center.

PubMed

Lapidus, Garry; Borrup, Kevin; DiVietro, Susan; Campbell, Brendan T; Beebe, Rebecca; Grasso, Damion; Rogers, Steven; Joseph, D'Andrea; Banco, Leonard

2016-04-01

The mission of the Connecticut Injury Prevention Center (CIPC), jointly housed in Connecticut Children's Medical Center and Hartford Hospital, is to reduce unintentional injury and violence among Connecticut residents, with a special focus on translating research into injury prevention programmes and policy. The CIPC engages in four core activities: research, education and training, community outreach programmes and public policy. As surveillance is an essential element of injury prevention, the CIPC has developed a robust statewide fatal and non-fatal injury surveillance system that has guided our prior work and continues to inform our current projects. The purpose of this article is to review the projects, programmes, and collaborative relationships that have made the CIPC successful in reducing unintentional injury and violence in Connecticut throughout the course of its 25 years history. Retrospective review of the application of injury surveillance. We believe that the application of our surveillance system can serve as a model for others who wish to engage in collaborative, community-based, data-driven injury prevention programmes in their own communities. 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/

The convergence of American and Nigerian religious conservatism in a biopolitical shaping of Nigeria's HIV/AIDS prevention programmes

PubMed Central

Jappah, Jlateh V.

2013-01-01

Nigeria has the largest number of HIV/AIDS cases in West Africa, with 3.3 million people estimated to be living with the disease. The country remains a fragile democratic state and has allocated insufficient resources to combat the spread of HIV/AIDS among its citizens. The preponderance of President's Emergency Plan for AIDS Relief (PEPFAR) dollars, expert knowledge, conservative ideology and activities has shaped the direction of HIV/AIDS sexual-transmission prevention programmes in Nigeria. PEPFAR channels significant resources through Nigerian faith-based organisations (FBOs), and considers these organisations integral for HIV prevention strategies. In many instances, HIV/AIDS prevention programmes managed by FBOs reflect their ideologies of morality and sexuality. There is a convergence of religious ideology concerning morality and HIV infectivity between American and Nigerian conservatives; this produces a fertile ground for the influence and expansion of the conservative activities of PEPFAR in Nigeria. The paper highlights this nexus and draws attention to the biopolitical underpinning of PEPFAR in shaping Nigeria's HIV prevention programmes. The paper further notes both positive and negative effects of PEPFAR activities and attempts by the Obama administration to redirect PEPFAR to a more holistic approach in order to optimise outcomes. PMID:23391163

The convergence of American and Nigerian religious conservatism in a biopolitical shaping of Nigeria's HIV/AIDS prevention programmes.

PubMed

Jappah, Jlateh V

2013-01-01

Nigeria has the largest number of HIV/AIDS cases in West Africa, with 3.3 million people estimated to be living with the disease. The country remains a fragile democratic state and has allocated insufficient resources to combat the spread of HIV/AIDS among its citizens. The preponderance of President's Emergency Plan for AIDS Relief (PEPFAR) dollars, expert knowledge, conservative ideology and activities has shaped the direction of HIV/AIDS sexual-transmission prevention programmes in Nigeria. PEPFAR channels significant resources through Nigerian faith-based organisations (FBOs), and considers these organisations integral for HIV prevention strategies. In many instances, HIV/AIDS prevention programmes managed by FBOs reflect their ideologies of morality and sexuality. There is a convergence of religious ideology concerning morality and HIV infectivity between American and Nigerian conservatives; this produces a fertile ground for the influence and expansion of the conservative activities of PEPFAR in Nigeria. The paper highlights this nexus and draws attention to the biopolitical underpinning of PEPFAR in shaping Nigeria's HIV prevention programmes. The paper further notes both positive and negative effects of PEPFAR activities and attempts by the Obama administration to redirect PEPFAR to a more holistic approach in order to optimise outcomes.

An Evaluation of the Social and Emotional Aspects of Learning (SEAL) Programme: Promoting Positive Behaviour, Effective Learning and Well-Being in Primary School Children

ERIC Educational Resources Information Center

Hallam, Susan

2009-01-01

The Social and Emotional Aspects of Learning programme (SEAL), designed to develop children's social, emotional and behavioural skills in the primary school, was part of the Primary Behaviour and Attendance Pilot funded by the then Department for Education and Skills (DfES) and piloted in 25 Local Authorities in the UK. The data collected in the…

Impact of treatment on hepatitis C virus transmission and incidence in Egypt: A case for treatment as prevention.

PubMed

Ayoub, H H; Abu-Raddad, L J

2017-06-01

Egypt has launched a hepatitis C virus (HCV) treatment programme using direct-acting antivirals (DAAs). Our aim was to assess the impact of five plausible programme scale-up and sustainability scenarios for HCV treatment as prevention in Egypt. We developed and analysed a mathematical model to assess programme impact using epidemiologic, programming and health economics measures. The model was parametrized with current and representative natural history, HCV prevalence and programme data. HCV incidence in Egypt is declining, but will persist at a considerable level for decades unless controlled by interventions. Across the five programme scenarios, 1.75-5.60 million treatments were administered by 2030. Reduction in incidence (annual number of new infections) by 2030 ranged between 29% and 99%, programme-attributed reduction in incidence rate (new infections per susceptible person per year) ranged between 18% and 99%, number of infections averted ranged between 42 393 and 469 599, and chronic infection prevalence reached as low as 2.8%-0.1%. Reduction in incidence rate year by year hovered around 7%-15% in the first decade of the programme in most scenarios. Treatment coverage in 2030 ranged between 24.9% and 98.8%, and number of treatments required to avert one new infection ranged between 9.5 and 12.1. Stipulated targets for HCV by 2030 could not be achieved without scaling-up treatment to 365 000 per year and sustaining it for a decade. In conclusion, DAA scale-up will have an immense and immediate impact on HCV incidence in Egypt. Elimination by 2030 is feasible if sufficient resources are committed to programme scale-up and sustainability. HCV treatment as prevention is a potent and effective prevention approach. © 2017 The Authors. Journal of Viral Hepatitis Published by John Wiley & Sons Ltd.

Outsourcing Physical Education in Primary Schools: Evaluating the Impact of Externally Provided Programmes on Generalist Teachers

ERIC Educational Resources Information Center

Whipp, Peter R.; Hutton, Heidi; Grove, J. Robert; Jackson, Ben

2011-01-01

In place of generalist delivery, externally provided physical activity programmes (EPPAPs) are potentially an effective method for offering primary school students specialist physical education (PE) instruction, as well as providing training for generalist classroom teachers. In the present study, a group of generalist teachers were interviewed…

From Initial Teacher Education through Induction and Beyond: A Longitudinal Study of Primary Teacher Beliefs

ERIC Educational Resources Information Center

Ní Chróinín, Déirdre; O'Sullivan, Mary

2014-01-01

A better understanding of the relationship between beginning teachers' beliefs and the pedagogies of teacher education (TE) programmes that support their learning across time can enhance TE programme effectiveness. This 6-year longitudinal study examined the development and change of beginning primary classroom teachers' (n = 6) beliefs about…

Teacher-Writer Memoirs as Lens for Writing Emotionally in a Primary Teacher Education Programme

ERIC Educational Resources Information Center

Deegan, James G.

2008-01-01

This article examines student teachers' experiences of writing emotionally through the lens of teacher-writer memoirs. The participants were 99 postgraduate student teachers on a sociology of teaching module in an initial primary teacher education programme in the Republic of Ireland. Analysis of journal responses indicated how student teachers…

Effective Practical Work in Primary Science: The Role of Empathy

ERIC Educational Resources Information Center

Abrahams, Ian; Reiss, Michael

2010-01-01

"Getting Practical-Improving practical work in science" is a government-funded programme intended to improve the effectiveness and affective value of practical work in school science in England. In order to evaluate the effectiveness of the programme in terms of achieving its aims, ten primary and twenty secondary schools have been…

Evaluating the Implementation of an Emotional Wellbeing Programme for Primary School Children Using Participatory Approaches

ERIC Educational Resources Information Center

Clarke, Aleisha M.; Sixsmith, Jane; Barry, Margaret M.

2015-01-01

Objective: This paper reports on the use of child participatory approaches to evaluate the implementation and impact of the "Zippy's Friends" emotional wellbeing programme on children in disadvantaged primary schools in Ireland. Design: As part of the overall evaluation study, which comprised a clustered randomised controlled trial,…

Characteristics of suicide hotspots on the Belgian railway network.

PubMed

Debbaut, Kevin; Krysinska, Karolina; Andriessen, Karl

2014-01-01

In 2004, railway suicide accounted for 5.3% of all suicides in Belgium. In 2008, Infrabel (Manager of the Belgian Railway Infrastructure) introduced a railway suicide prevention programme, including identification of suicide hotspots, i.e., areas of the railway network with an elevated incidence of suicide. The study presents an analysis of 43 suicide hotspots based on Infrabel data collected during field visits and semi-structured interviews conducted in mental health facilities in the vicinity of the hotspots. Three major characteristics of the hotspots were accessibility, anonymity, and vicinity of a mental health institution. The interviews identified several risk and protective factors for railway suicide, including the training of staff, introduction of a suicide prevention policy, and the role of the media. In conclusion, a comprehensive railway suicide prevention programme should continuously safeguard and monitor hotspots, and should be embedded in a comprehensive suicide prevention programme in the community.

Evaluating process and clinical outcomes of a primary care mental health integration project in rural Rwanda: a prospective mixed-methods protocol.

PubMed

Smith, Stephanie L; Misago, Claire Nancy; Osrow, Robyn A; Franke, Molly F; Iyamuremye, Jean Damascene; Dusabeyezu, Jeanne D'Arc; Mohand, Achour A; Anatole, Manzi; Kayiteshonga, Yvonne; Raviola, Giuseppe J

2017-02-28

Integrating mental healthcare into primary care can reduce the global burden of mental disorders. Yet data on the effective implementation of real-world task-shared mental health programmes are limited. In 2012, the Rwandan Ministry of Health and the international healthcare organisation Partners in Health collaboratively adapted the Mentoring and Enhanced Supervision at Health Centers (MESH) programme, a successful programme of supported supervision based on task-sharing for HIV/AIDS care, to include care of neuropsychiatric disorders within primary care settings (MESH Mental Health). We propose 1 of the first studies in a rural low-income country to assess the implementation and clinical outcomes of a programme integrating neuropsychiatric care into a public primary care system. A mixed-methods evaluation will be conducted. First, we will conduct a quantitative outcomes evaluation using a pretest and post-test design at 4 purposively selected MESH MH participating health centres. At least 112 consecutive adults with schizophrenia, bipolar disorder, depression or epilepsy will be enrolled. Primary outcomes are symptoms and functioning measured at baseline, 8 weeks and 6 months using clinician-administered scales: the General Health Questionnaire and the brief WHO Disability Assessment Scale. We hypothesise that service users will experience at least a 25% improvement in symptoms and functioning from baseline after MESH MH programme participation. To understand any outcome improvements under the intervention, we will evaluate programme processes using (1) quantitative analyses of routine service utilisation data and supervision checklist data and (2) qualitative semistructured interviews with primary care nurses, service users and family members. This evaluation was approved by the Rwanda National Ethics Committee (Protocol #736/RNEC/2016) and deemed exempt by the Harvard University Institutional Review Board. Results will be submitted for peer-reviewed journal publication, presented at conferences and disseminated to communities served by the programme. 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/.

The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study

PubMed Central

Jackson, Christopher; Steinacher, Arno; Goodman, Anna; Langenberg, Claudia; Griffin, Simon

2018-01-01

Background The National Health Service (NHS) Health Check programme was introduced in 2009 in England to systematically assess all adults in midlife for cardiovascular disease risk factors. However, its current benefit and impact on health inequalities are unknown. It is also unclear whether feasible changes in how it is delivered could result in increased benefits. It is one of the first such programmes in the world. We sought to estimate the health benefits and effect on inequalities of the current NHS Health Check programme and the impact of making feasible changes to its implementation. Methods and findings We developed a microsimulation model to estimate the health benefits (incident ischaemic heart disease, stroke, dementia, and lung cancer) of the NHS Health Check programme in England. We simulated a population of adults in England aged 40–45 years and followed until age 100 years, using data from the Health Survey of England (2009–2012) and the English Longitudinal Study of Aging (1998–2012), to simulate changes in risk factors for simulated individuals over time. We used recent programme data to describe uptake of NHS Health Checks and of 4 associated interventions (statin medication, antihypertensive medication, smoking cessation, and weight management). Estimates of treatment efficacy and adherence were based on trial data. We estimated the benefits of the current NHS Health Check programme compared to a healthcare system without systematic health checks. This counterfactual scenario models the detection and treatment of risk factors that occur within ‘routine’ primary care. We also explored the impact of making feasible changes to implementation of the programme concerning eligibility, uptake of NHS Health Checks, and uptake of treatments offered through the programme. We estimate that the NHS Health Check programme prevents 390 (95% credible interval 290 to 500) premature deaths before 80 years of age and results in an additional 1,370 (95% credible interval 1,100 to 1,690) people being free of disease (ischaemic heart disease, stroke, dementia, and lung cancer) at age 80 years per million people aged 40–45 years at baseline. Over the life of the cohort (i.e., followed from 40–45 years to 100 years), the changes result in an additional 10,000 (95% credible interval 8,200 to 13,000) quality-adjusted life years (QALYs) and an additional 9,000 (6,900 to 11,300) years of life. This equates to approximately 300 fewer premature deaths and 1,000 more people living free of these diseases each year in England. We estimate that the current programme is increasing QALYs by 3.8 days (95% credible interval 3.0–4.7) per head of population and increasing survival by 3.3 days (2.5–4.1) per head of population over the 60 years of follow-up. The current programme has a greater absolute impact on health for those living in the most deprived areas compared to those living in the least deprived areas (4.4 [2.7–6.5] days of additional quality-adjusted life per head of population versus 2.8 [1.7–4.0] days; 5.1 [3.4–7.1] additional days lived per head of population versus 3.3 [2.1–4.5] days). Making feasible changes to the delivery of the existing programme could result in a sizable increase in the benefit. For example, a strategy that combines extending eligibility to those with preexisting hypertension, extending the upper age of eligibility to 79 years, increasing uptake of health checks by 30%, and increasing treatment rates 2.5-fold amongst eligible patients (i.e., ‘maximum potential’ scenario) results in at least a 3-fold increase in benefits compared to the current programme (1,360 premature deaths versus 390; 5,100 people free of 1 of the 4 diseases versus 1,370; 37,000 additional QALYs versus 10,000; 33,000 additional years of life versus 9,000). Ensuring those who are assessed and eligible for statins receive statins is a particularly important strategy to increase benefits. Estimates of overall benefit are based on current incidence and management, and future declines in disease incidence or improvements in treatment could alter the actual benefits observed in the long run. We have focused on the cardiovascular element of the NHS Health Check programme. Some important noncardiovascular health outcomes (e.g., chronic obstructive pulmonary disease [COPD] prevention from smoking cessation and cancer prevention from weight loss) and other parts of the programme (e.g., brief interventions to reduce harmful alcohol consumption) have not been modelled. Conclusions Our model indicates that the current NHS Health Check programme is contributing to improvements in health and reducing health inequalities. Feasible changes in the organisation of the programme could result in more than a 3-fold increase in health benefits. PMID:29509767

The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study.

PubMed

Mytton, Oliver T; Jackson, Christopher; Steinacher, Arno; Goodman, Anna; Langenberg, Claudia; Griffin, Simon; Wareham, Nick; Woodcock, James

2018-03-01

The National Health Service (NHS) Health Check programme was introduced in 2009 in England to systematically assess all adults in midlife for cardiovascular disease risk factors. However, its current benefit and impact on health inequalities are unknown. It is also unclear whether feasible changes in how it is delivered could result in increased benefits. It is one of the first such programmes in the world. We sought to estimate the health benefits and effect on inequalities of the current NHS Health Check programme and the impact of making feasible changes to its implementation. We developed a microsimulation model to estimate the health benefits (incident ischaemic heart disease, stroke, dementia, and lung cancer) of the NHS Health Check programme in England. We simulated a population of adults in England aged 40-45 years and followed until age 100 years, using data from the Health Survey of England (2009-2012) and the English Longitudinal Study of Aging (1998-2012), to simulate changes in risk factors for simulated individuals over time. We used recent programme data to describe uptake of NHS Health Checks and of 4 associated interventions (statin medication, antihypertensive medication, smoking cessation, and weight management). Estimates of treatment efficacy and adherence were based on trial data. We estimated the benefits of the current NHS Health Check programme compared to a healthcare system without systematic health checks. This counterfactual scenario models the detection and treatment of risk factors that occur within 'routine' primary care. We also explored the impact of making feasible changes to implementation of the programme concerning eligibility, uptake of NHS Health Checks, and uptake of treatments offered through the programme. We estimate that the NHS Health Check programme prevents 390 (95% credible interval 290 to 500) premature deaths before 80 years of age and results in an additional 1,370 (95% credible interval 1,100 to 1,690) people being free of disease (ischaemic heart disease, stroke, dementia, and lung cancer) at age 80 years per million people aged 40-45 years at baseline. Over the life of the cohort (i.e., followed from 40-45 years to 100 years), the changes result in an additional 10,000 (95% credible interval 8,200 to 13,000) quality-adjusted life years (QALYs) and an additional 9,000 (6,900 to 11,300) years of life. This equates to approximately 300 fewer premature deaths and 1,000 more people living free of these diseases each year in England. We estimate that the current programme is increasing QALYs by 3.8 days (95% credible interval 3.0-4.7) per head of population and increasing survival by 3.3 days (2.5-4.1) per head of population over the 60 years of follow-up. The current programme has a greater absolute impact on health for those living in the most deprived areas compared to those living in the least deprived areas (4.4 [2.7-6.5] days of additional quality-adjusted life per head of population versus 2.8 [1.7-4.0] days; 5.1 [3.4-7.1] additional days lived per head of population versus 3.3 [2.1-4.5] days). Making feasible changes to the delivery of the existing programme could result in a sizable increase in the benefit. For example, a strategy that combines extending eligibility to those with preexisting hypertension, extending the upper age of eligibility to 79 years, increasing uptake of health checks by 30%, and increasing treatment rates 2.5-fold amongst eligible patients (i.e., 'maximum potential' scenario) results in at least a 3-fold increase in benefits compared to the current programme (1,360 premature deaths versus 390; 5,100 people free of 1 of the 4 diseases versus 1,370; 37,000 additional QALYs versus 10,000; 33,000 additional years of life versus 9,000). Ensuring those who are assessed and eligible for statins receive statins is a particularly important strategy to increase benefits. Estimates of overall benefit are based on current incidence and management, and future declines in disease incidence or improvements in treatment could alter the actual benefits observed in the long run. We have focused on the cardiovascular element of the NHS Health Check programme. Some important noncardiovascular health outcomes (e.g., chronic obstructive pulmonary disease [COPD] prevention from smoking cessation and cancer prevention from weight loss) and other parts of the programme (e.g., brief interventions to reduce harmful alcohol consumption) have not been modelled. Our model indicates that the current NHS Health Check programme is contributing to improvements in health and reducing health inequalities. Feasible changes in the organisation of the programme could result in more than a 3-fold increase in health benefits.

Introducing innovation in a management development programme for a UK primary care organisation.

PubMed

Smith, Paul; Hampson, Libby; Scott, Jonathan; Bower, Karen

2011-01-01

The aim of this paper is to examine the introduction of innovation as part of a management development programme at a primary care organisation, a legal form known as a Primary Care Trust (PCT), in the UK. The paper draws on experience of managing a successful management development programme for a PCT. The report of the case study analyses the key events that took place between 2008 and 2010, from direct observation, surveys, discussion and documentary evidence. The Northern PCT has partnerships with a number of educational providers to deliver their leadership and management development programmes. A close working relationship had developed and the programme is bespoke - hence it is current and of practical use to the UK's National Health Service (NHS). In addition, there are regular meetings, with module leaders gaining a firsthand understanding of the organisation's needs and aspirations. This has resulted in a very focused and personalised offering and a genuine involvement in the programme and individuals concerned. The research was conducted among a relatively small sample, and there is a lack of previous literature evidence to make significant comparisons. The paper identifies key implications for practitioners and educators in this area. This paper is one of few to investigate innovation and improvement in the NHS, and is unique in that it uses the lenses of a management development programme to explore this important, and under-researched, topic.

Medical curricula and preventing childhood obesity: pooling the resources of medical students and primary care to inform curricula.

PubMed

Wylie, Ann; Furmedge, Daniel S; Appleton, Amber; Toop, Helen; Coats, Tom

2009-03-01

The study aimed to firstly provide a small self-selecting group of medical students with the opportunity to explore current approaches and opportunities addressing the prevention of childhood obesity and, secondly, to consider what aspects could be part of the taught curriculum. Medical students in their third and fourth year were invited to self-design special study modules (SSMs) exploring interventions and processes addressing the growing concern about childhood obesity. One student looked at the role of the primary care teams, two looked at community-based opportunities to improve physical activity in urban areas where there is significant deprivation and one student explored the complex role of the media as a social determinant of dietary patterns and sedentary behaviour. Primary care health professionals questioned their role in regard to raising the topic of obesity in the consultation and had limited awareness of current NICE guidelines and local interventions for referral. Local authority physical activity programmes have an important role in preventing and tackling obesity and although the media are regulated, there is limited impact on reducing obesity. Conversely, the influence of the media is complex and enables medical students and teachers to be aware of some of the social determinants influencing health-related behaviour. About a third of UK GP practices have some role in medical undergraduate education. It will therefore be inevitable that students will encounter GPs working with prevention and management of childhood obesity, however limited, and this will increasingly be part of the teaching agenda, whether formal and planned or opportunistic. Curricula could include being familiar with the evidence that informs NICE guidelines, observing these guidelines being implemented and their limitations, awareness of local schemes for referral to prevent or treat obesity and the influence of wider determinants on diet and physical activity behaviour, including the media.

[Care for immigrant patients: facts and professionals' perception in 6 primary health care zones in Navarre].

PubMed

Fuertes Goñi, Maria Carmen; Elizalde, L; De Andrés, M R; García Castellano, P; Urmeneta, S; Uribe, J M; Bustince, P

2010-01-01

To describe utilisation of health care services and motives for consultation in Primary Care in the native and the immigrant population, and compare this with the perception of primary care professionals. Data was collected on health care activity during the year 2006 for all people registered (N=86,966) in the 6 basic health care zones with the highest proportion of immigrants (14.4%) and on the following variables: country of origin, age, sex, year of inscription in the public health service. The health card and OMI-AP programme databases were used. A qualitative methodology of focus groups and in-depth interviews was employed. Seventy-two point four percent of immigrants requested care from the primary care professionals in 2006, of whom 50% proceeded from Ecuador and 70% were between 25 and 44 years old. Eighty-two percent of the natives made consultations and required more referrals to specialised care than the immigrants of the same age group. The most frequent consultation with natives and with immigrants was "acute respiratory infections" (7 to 23% according to age group). The second most frequent with immigrants was "administrative problems". The consultations with immigrants were not related to preventive aspects such as smoking and there were more consultations (p>0.001) for gynaeco-obstetric episodes (10.7%) and those related to work (19%) or psychosomatic problems (8.5%). The perception of the primary care professionals was that the immigrants carry out more consultations than the natives and generate a certain "disorder" in the clinic. Immigrants use healthcare services less than the native population. Nonetheless, this fact is not perceived in this way by the primary care professionals. Fewer preventive activities are carried out with immigrants, who suffer from more labour and psychosomatic problems.

Sport-specific biomechanical responses to an ACL injury prevention programme: A randomised controlled trial.

PubMed

Taylor, Jeffrey B; Ford, Kevin R; Schmitz, Randy J; Ross, Scott E; Ackerman, Terry A; Shultz, Sandra J

2018-04-19

Anterior cruciate ligament (ACL) injury prevention programmes have not been as successful at reducing injury rates in women's basketball as in soccer. This randomised controlled trial (ClinicalTrials.gov #NCT02530333) compared biomechanical adaptations in basketball and soccer players during jump-landing activities after an ACL injury prevention programme. Eighty-seven athletes were cluster randomised into intervention (6-week programme) and control groups. Three-dimensional biomechanical analyses of drop vertical jump (DVJ), double- (SAG-DL) and single-leg (SAG-SL) sagittal, and double- (FRONT-DL) and single-leg (FRONT-SL) frontal plane jump landing tasks were tested before and after the intervention. Peak angles, excursions, and joint moments were analysed using two-way MANCOVAs of post-test scores while controlling for pre-test scores. During SAG-SL the basketball intervention group exhibited increased peak knee abduction angles (p = .004) and excursions (p = .003) compared to the basketball control group (p = .01) and soccer intervention group (p = .01). During FRONT-SL, the basketball intervention group exhibited greater knee flexion excursion after training than the control group (p = .01), but not the soccer intervention group (p = .11). Although women's soccer players exhibit greater improvements in knee abduction kinematics than basketball players, these athletes largely exhibit similar biomechanical adaptations to ACL injury prevention programmes.

Industry sponsored youth smoking prevention programme in Malaysia: a case study in duplicity.

PubMed

Assunta, M; Chapman, S

2004-12-01

To review tobacco company strategies of using youth smoking prevention programmes to counteract the Malaysian government's tobacco control legislation and efforts in conducting research on youth to market to them. Systematic keyword and opportunistic website searches of formerly private internal industry documents. Search terms included Malay, cmtm, jaycees, YAS, and direct marketing; 195 relevant documents were identified for this paper. Industry internal documents reveal that youth anti-smoking programmes were launched to offset the government's tobacco control legislation. The programme was seen as a strategy to lobby key politicians and bureaucrats for support in preventing the passage of legislation. However, the industry continued to conduct research on youth, targeted them in marketing, and considered the teenage market vital for its survival. Promotional activities targeting youth were also carried out such as sports, notably football and motor racing, and entertainment events and cash prizes. Small, affordable packs of cigarettes were crucial to reach new smokers. The tobacco industry in Malaysia engaged in duplicitous conduct in regard to youth. By buying into the youth smoking issue it sought to move higher on the moral playing field and strengthen its relationship with government, while at the same time continuing to market to youth. There is no evidence that industry youth smoking prevention programmes were effective in reducing smoking; however, they were effective in diluting the government's tobacco control legislation.

Industry sponsored youth smoking prevention programme in Malaysia: a case study in duplicity

PubMed Central

Assunta, M; Chapman, S

2004-01-01

Objective: To review tobacco company strategies of using youth smoking prevention programmes to counteract the Malaysian government's tobacco control legislation and efforts in conducting research on youth to market to them. Methods: Systematic keyword and opportunistic website searches of formerly private internal industry documents. Search terms included Malay, cmtm, jaycees, YAS, and direct marketing; 195 relevant documents were identified for this paper. Results: Industry internal documents reveal that youth anti-smoking programmes were launched to offset the government's tobacco control legislation. The programme was seen as a strategy to lobby key politicians and bureaucrats for support in preventing the passage of legislation. However, the industry continued to conduct research on youth, targeted them in marketing, and considered the teenage market vital for its survival. Promotional activities targeting youth were also carried out such as sports, notably football and motor racing, and entertainment events and cash prizes. Small, affordable packs of cigarettes were crucial to reach new smokers. Conclusion: The tobacco industry in Malaysia engaged in duplicitous conduct in regard to youth. By buying into the youth smoking issue it sought to move higher on the moral playing field and strengthen its relationship with government, while at the same time continuing to market to youth. There is no evidence that industry youth smoking prevention programmes were effective in reducing smoking; however, they were effective in diluting the government's tobacco control legislation. PMID:15564218

Results of a coordination and shared clinical information programme between primary care and nephrology.

PubMed

García García, Manuel; Valenzuela Mújica, Mari Pau; Martínez Ocaña, Juan Carlos; Otero López, María del Sol; Ponz Clemente, Esther; López Alba, Thaïs; Gálvez Hernández, Enrique

2011-01-01

The high prevalence of chronic kidney disease (CKD) in the general population has created a need to coordinate specialised nephrology care and primary care. Although several systems have been developed to coordinate this process, published results are scarce and contradictory. To present the results of the application of a coordinated programme between nephrology care and primary care through consultations and a system of shared clinical information to facilitate communication and improve the criteria for referring patients. Elaboration of a coordinated care programme by the primary care management team and the nephrology department, based on the SEN-SEMFYC consensus document and a protocol for the study and management of arterial hypertension (AHT). Explanation and implementation in primary health care units. A directory of specialists’ consultations was created, both in-person and via e-mail. A continuous training programme in kidney disease and arterial hypertension was implemented in the in-person consultation sessions. The programme was progressively implemented over a three-year period (2007-2010) in an area of 426,000 inhabitants with 230 general practitioners. Use of a clinical information system named Salut en Xarxa that allows access to clinical reports, diagnoses, prescriptions, test results and clinical progression. Improved referral criteria between primary care and specialised nephrology service. Improved prioritisation of visits. Progressive increase in referrals denied by specialists (28.5% in 2009), accompanied by an explanatory report including suggestions for patient management. Decrease in first nephrology outpatient visits that have been referred from primary care (15% in 2009). Family doctors were generally satisfied with the improvement in communication and the continuous training programme. The main causes for denying referral requests were: patients >70 years with stage 3 CKD (44.15%); patients <70 years with stage 3a CKD (19.15%); albumin/creatinine ratio <500 mg/g (12.23%); non-secondary, non-refractory, essential AHT (11.17%). The general practitioners included in the programme showed great interest and no complaints were registered. The consultations improve adequacy and prioritisation of nephrology visits, allow for better communication between different levels of the health system, and offer systematic training for general practitioners to improve the management of nephrology patients. This process allows for referring nephrology patients with the most complex profiles to nephrology outpatient clinics.

Effect on motivation, perceived competence, and activation after participation in the ''Ready to Act'' programme for people with screen-detected dysglycaemia: a 1-year randomised controlled trial, Addition-DK.

PubMed

Maindal, Helle Terkildsen; Sandbæk, Annelli; Kirkevold, Marit; Lauritzen, Torsten

2011-05-01

To investigate the reach of the ''Ready to Act'' programme and the 1-year effects on psychological determinants of healthy behaviour: motivation, perceived competence, and activation level. A total of 509 adults with dysglycaemia were recruited from general practioners (GPs) in the intensive arm of the Danish Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION) study, a type 2 diabetes screening programme. The participants were randomised to the ''Ready to Act'' programme added on top of GP care (n = 322) or to GP care (n = 187). The core components of the programme were motivation, action experience, informed decision-making, and social involvement conducted in two one-to-one sessions and eight group-meetings (18 hours). The reach of the programme was measured by the proportion of people who signed up. Outcomes were changes in treatment motivation (Treatment Self-Regulation Questionnaire, TSRQ), perceived competence (Perceived Competence Scale, PCS), and activation in chronic care (Patient Activation Measure, PAM). Effect size was the difference between 1-year changes in the randomisation groups analysed by intention-to-treat. A total of 142 (44%) of 322 signed up and 123 (87%) of these completed. At 1 year, the difference in autonomous motivation for behavioural treatment (TSRQ) between the randomisation groups was 1.0 (95% CI 0.1 to 2.0), and the difference in perceived competence changes in healthy diet (PCS-d) was 1.5 (95% CI 0.2 to 2.7). No differences were observed for activation (PAM) between the groups. Subgroup analysis revealed men to benefit more from the intervention than women. The programme is a promising health-promoting component in prevention and care for people with screen-detected dysglycaemia, as it attracted four of 10 people and had effects on motivation and perceived competence.

Primary School Autonomy in the Context of the Expanding Academies Programme

ERIC Educational Resources Information Center

Boyask, Ruth

2018-01-01

The transnational trend towards school autonomy has been enacted in England through the academies programme. The programme is poised to enter its third phase of expansion in light of government commitment to the conversion of all state-funded schools to academies. This article considers the moral implications of the expansion of the programme that…

Private animal health and welfare standards in quality assurance programmes: a review and proposed framework for critical evaluation.

PubMed

More, S J; Hanlon, A; Marchewka, J; Boyle, L

2017-06-24

In recent years, 'private standards' in animal health and welfare have become increasingly common, and are often incorporated into quality assurance (QA) programmes. Here, we present an overview of the use of private animal health and welfare standards in QA programmes, and propose a generic framework to facilitate critical programme review. Private standards are being developed in direct response to consumer demand for QA, and offer an opportunity for product differentiation and a means to drive consumer choice. Nonetheless, a range of concerns have been raised, relating to the credibility of these standards, their potential as a discriminatory barrier to trade, the multiplicity of private standards that have been developed, the lack of consumer input and compliance costs. There is a need for greater scrutiny of private standards and of associated QA programmes. We propose a framework to clarify the primary programme goal(s) and measureable outputs relevant to animal health and welfare, the primary programme beneficiaries and to determine whether the programme is effective, efficient and transparent. This paper provides a theoretical overview, noting that this framework could be used as a tool directly for programme evaluation, or as a tool to assist with programme development and review. British Veterinary Association.

Domestic Violence and Abuse Prevention Programmes in the Early Years Classroom: A Pastoral, Academic and Financial Priority?

ERIC Educational Resources Information Center

McKee, Bronagh E.; Mason, Sarah

2015-01-01

Prevention programmes underpin every child's right to "feel" safe and to "be" safe from all forms of harm. Delivered in schools across the globe, they aim to equip children with knowledge about safety and the skills to seek help early. By drawing upon international prevalence and impact research, as well as the legal, policy…

Parenting Programmes for Preventing Tobacco, Alcohol or Drugs Misuse in Children Less than 18: A Systematic Review

ERIC Educational Resources Information Center

Petrie, Jane; Bunn, Frances; Byrne, Geraldine

2007-01-01

We conducted a systematic review of controlled studies of parenting programmes to prevent tobacco, alcohol or drug abuse in children less than 18. We searched Cochrane Central Register of Controlled Trials, specialized Register of Cochrane Drugs and Alcohol Group, Pub Med, psych INFO, CINALH and SIGLE. Two reviewers independently screened studies,…

Impact of a District-Wide Diabetes Prevention Programme Involving Health Education for Children and the Community

ERIC Educational Resources Information Center

Sheeladevi, Sethu; Sagar, Jayanthi; Pujari, Siddharth; Rani, Padmaja Kumari

2014-01-01

Objective: To present results from a district-wide diabetes prevention programme involving health education for school children and the local community. Method: The model of health education that was utilized aimed to secure lifestyle changes and the identification of diabetes risk by school children (aged 9-12 years). The children acted as health…

Does Successful School-Based Prevention of Bullying Influence Substance Use among 13- To 16-Year-Olds?

ERIC Educational Resources Information Center

Amundsen, Ellen J.; Ravndal, Edle

2010-01-01

Aim: To test whether the school-based Olweus prevention programme against bullying may have lasting effects on substance use, a hypothesis based on the characteristics of bullies having misconduct behaviour associated with substance use. Methods: The Olweus programme was introduced from grades 7 through 9 in four schools and monitored up to grade…

Romantic Relationships: An Important Context for HIV/STI and Pregnancy Prevention Programmes with Young People

ERIC Educational Resources Information Center

Coyle, Karin K.; Anderson, Pamela M.; Franks, Heather M.; Glassman, Jill; Walker, James D.; Charles, Vignetta Eugenia

2014-01-01

Romantic relationships are central in the lives of young people. This paper uses data on romantic relationships from urban youth in the USA to illustrate how using a relationships perspective in HIV/STI and pregnancy prevention programmes broadens the skills and content covered, and contextualises the learning to enhance relevance and use.…

Teachers' knowledge, attitudes and experience in sexual abuse prevention education in El Salvador.

PubMed

Hurtado, Alicia; Katz, Craig; Ciro, Dianne; Guttfreund, Daniel

2013-01-01

Research on how to prevent child sexual abuse (CSA) in developing nations is practically non-existent. We sought to determine Salvadoran teachers' knowledge, attitudes, experience and barriers to CSA detection and reporting to assess the need for a CSA prevention programme and to assess barriers in conducting such a programme. One hundred teachers completed a questionnaire while they visited the Tin Marin Children's Museum in San Salvador. Nineteen of these teachers also participated in a focus group. We found that 89% of teachers reported at least two signs and symptoms of child abuse. One hundred per cent of teachers agreed that it is their responsibility to teach students about sexual abuse. Unusual for a study of this kind, parental migration was mentioned as making children vulnerable to CSA, and fear of gang violence and retribution was identified as interfering with teachers' ability to protect children. We conclude that Salvadoran teachers were knowledgeable about CSA detection and reporting and would support a programme in which they are trained to speak to their students about this topic. Barriers to reporting child abuse, such as teachers' safety and fear, need to be addressed in future CSA prevention programmes.

Antimicrobial stewardship: English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR).

PubMed

Ashiru-Oredope, Diane; Hopkins, Susan

2013-11-01

The clinical, public health and economic implications of antimicrobial resistance present a major threat to future healthcare. Antimicrobial use is a major driver of resistance, and antimicrobial stewardship programmes are increasingly being advocated as a means of improving the quality of prescribing. However, to increase their impact and assess their success, a better understanding of antimicrobial usage, both in primary and secondary care, and linkage with antimicrobial resistance data are required. In England, national summaries of primary care dispensing data are issued annually by the Health and Social Care Information Centre. However, there is currently no routine public reporting of antimicrobial usage in hospitals. In response to the threat posed by antimicrobial resistance, as highlighted in the Report of the Chief Medical Officer and on the request of the Department of Health, Public Health England has developed a new national programme, the English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR). The programme will bring together the elements of antimicrobial utilization and resistance surveillance in both primary and secondary care settings, alongside the development of quality measures and methods to monitor unintended outcomes of antimicrobial stewardship and both public and professional behaviour interventions. This article reports on the background to the programme development, the current oversight group membership and the public reporting structure.

Costs of dengue prevention and incremental cost of dengue outbreak control in Guantanamo, Cuba.

PubMed

Baly, Alberto; Toledo, Maria E; Rodriguez, Karina; Benitez, Juan R; Rodriguez, Maritza; Boelaert, Marleen; Vanlerberghe, Veerle; Van der Stuyft, Patrick

2012-01-01

To assess the economic cost of routine Aedes aegypti control in an at-risk environment without dengue endemicity and the incremental costs incurred during a sporadic outbreak. The study was conducted in 2006 in the city of Guantanamo, Cuba. We took a societal perspective to calculate costs in months without dengue transmission (January-July) and during an outbreak (August-December). Data sources were bookkeeping records, direct observations and interviews. The total economic cost per inhabitant (p.i.) per month. (p.m.) increased from 2.76 USD in months without dengue transmission to 6.05 USD during an outbreak. In months without transmission, the routine Aedes control programme cost 1.67 USD p.i. p.m. Incremental costs during the outbreak were mainly incurred by the population and the primary/secondary level of the healthcare system, hardly by the vector control programme (1.64, 1.44 and 0.21 UDS increment p.i. p.m., respectively). The total cost for managing a hospitalized suspected dengue case was 296.60 USD (62.0% direct medical, 9.0% direct non-medical and 29.0% indirect costs). In both periods, the main cost drivers for the Aedes control programme, the healthcare system and the community were the value of personnel and volunteer time or productivity losses. Intensive efforts to keep A. aegypti infestation low entail important economic costs for society. When a dengue outbreak does occur eventually, costs increase sharply. In-depth studies should assess which mix of activities and actors could maximize the effectiveness and cost-effectiveness of routine Aedes control and dengue prevention. © 2011 Blackwell Publishing Ltd.

Seven key actions to eradicate rheumatic heart disease in Africa: the Addis Ababa communiqué.

PubMed

Watkins, David; Zuhlke, Liesl; Engel, Mark; Daniels, Rezeen; Francis, Veronica; Shaboodien, Gasnat; Kango, Mabvuto; Abul-Fadl, Azza; Adeoye, Abiodun; Ali, Sulafa; Al-Kebsi, Mohammed; Bode-Thomas, Fidelia; Bukhman, Gene; Damasceno, Albertino; Goshu, Dejuma Yadeta; Elghamrawy, Alaa; Gitura, Bernard; Haileamlak, Abraham; Hailu, Abraha; Hugo-Hamman, Christopher; Justus, Steve; Karthikeyan, Ganesan; Kennedy, Neil; Lwabi, Peter; Mamo, Yoseph; Mntla, Pindile; Sutton, Chris; Mocumbi, Ana Olga; Mondo, Charles; Mtaja, Agnes; Musuku, John; Mucumbitsi, Joseph; Murango, Louis; Nel, George; Ogendo, Stephen; Ogola, Elijah; Ojji, Dike; Olunuga, Taiwo Olabisi; Redi, Mekia Mohammed; Rusingiza, Kamanzi Emmanuel; Sani, Mahmoud; Sheta, Sahar; Shongwe, Steven; van Dam, Joris; Gamra, Habib; Carapetis, Jonathan; Lennon, Diana; Mayosi, Bongani M

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a 'roadmap' of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa. Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseases (NCD), (4) decentralise technical expertise and technology for diagnosing and managing ARF and RHD (including ultrasound of the heart), (5) establish national and regional centres of excellence for essential cardiac surgery for the treatment of affected patients and training of cardiovascular practitioners of the future, (6) initiate national multi-sectoral RHD programmes within NCD control programmes of affected countries, and (7) foster international partnerships with multinational organisations for resource mobilisation, monitoring and evaluation of the programme to end RHD in Africa. This Addis Ababa communiqué has since been endorsed by African Union heads of state, and plans are underway to implement the roadmap in order to end ARF and RHD in Africa in our lifetime.

Reflections on a Primary School Teacher Professional Development Programme on Learning English through Process Drama

ERIC Educational Resources Information Center

To, Lai-wa Dora; Chan, Yuk-lan Phoebe; Lam, Yin Krissy; Tsang, Shuk-kuen Yvonne

2011-01-01

This article documents the authors' reflections on a teacher professional development programme conducted in 38 Hong Kong primary schools on the teaching of English through Process Drama. The authors draw upon the views of school principals, subject panel head teachers, English teachers, students and parents in focus group interviews to examine…

Institutional, Material and Economic Constraints in Languages Education: Unequal Provision of Linguistic Resources in Early Childhood and Primary Settings in Australia

ERIC Educational Resources Information Center

Jones Díaz, Criss

2014-01-01

In Australia, languages education in early childhood and primary education includes three main approaches: transitional, enrichment and full bilingual programmes. This article proposes that transitional and enrichment programmes in Australia are constituted and shaped by competing and contested institutional, material, discursive and economic…

Multimedia Scenario Based Learning Programme for Enhancing the English Language Efficiency among Primary School Students

ERIC Educational Resources Information Center

Tupe, Navnath

2015-01-01

This research was undertaken with a view to assess the deficiencies in English language among Primary School Children and to develop Multimedia Scenario Based Learning Programme (MSBLP) for mastery of English language which required special attention and effective treatment. The experimental study with pre-test, post-test control group design was…

Educational Policies/Programmes' Effect on Attrition Rates in Primary Schools in Nigeria

ERIC Educational Resources Information Center

Duze, Chinelo O.

2012-01-01

This paper examined attrition in primary schools in Nigeria with specific reference and focus on some policies and programmes of Nigeria's educational system with a view to highlighting its possible effect on the attainment of the Education for All (EFA) goals by 2015. It reviewed equal educational opportunity in relation to school environments…

Students' Experiences of Collaborative Creation through Songcrafting in Primary School: Supporting Creative Agency in "School Music" Programmes

ERIC Educational Resources Information Center

Muhonen, Sari

2016-01-01

The study reported in this article investigates students' experiences (n = 41) of their primary school songcrafting, examining the potential to support creative agency within school music education programmes. Songcrafting refers to a collaborative composing practice in which everyone is considered to be a capable creator of melodies and lyrics,…

Challenges for a New Bilingual Program: Implementing the International Baccalaureate Primary Years Programme in Four Colombian Schools

ERIC Educational Resources Information Center

Lochmiller, Chad R.; Lucero, Audrey; Lester, Jessica Nina

2016-01-01

The International Baccalaureate (IB) has expanded in Latin America. Drawing from a larger multi-sited qualitative case study, we examined the challenges associated with the implementation of the IB Primary Years Programme (PYP) in a Colombian and bilingual context. Findings highlight (1) the intersecting nature of challenges associated with the…

Evaluation of a multicomponent programme for the management of musculoskeletal pain and depression in primary care: a cluster-randomised clinical trial (the DROP study).

PubMed

Aragonès, Enric; López-Cortacans, Germán; Caballero, Antonia; Piñol, Josep Ll; Sánchez-Rodríguez, Elisabet; Rambla, Concepció; Tomé-Pires, Catarina; Miró, Jordi

2016-03-16

Chronic musculoskeletal pain and depression are very common in primary care patients. Furthermore, they often appear as comorbid conditions, resulting in additive effect on adverse health outcomes. On the basis of previous studies, we hypothesise that depression and chronic musculoskeletal pain may benefit from an integrated management programme at primary care level. We expect positive effects on both physical and psychological distress of patients. To determine whether a new programme for an integrated approach to chronic musculoskeletal pain and depression leads to better outcomes than usual care. Cluster-randomised controlled trial involving two arms: a) control arm (usual care); and b) intervention arm, where patients participate in a programme for an integrated approach to the pain-depression dyad. Primary care centres in the province of Tarragona, Catalonia, Spain, Participants: We will recruit 330 patients aged 18-80 with moderate or severe musculoskeletal pain (Brief Pain Inventory, average pain subscale ≥5) for at least 3 months, and with criteria for major depression (DSM-IV). A multicomponent programme according to the chronic care model. The main components are care management, optimised antidepressant treatment, and a psychoeducational group action. Blind measurements: The patients will be monitored through blind telephone interviews held at 0, 3, 6 and 12 months. Severity of pain and depressive symptoms, pain and depression treatment response rates, and depression remission rates. The outcomes will be analysed on an intent-to-treat basis and the analysis units will be the individual patients. This analysis will consider the effect of the study design on any potential lack of independence between observations made within the same cluster. The protocol was approved by the Research Ethics Committee of the Jordi Gol Primary Care Research Institute (IDIAP), Barcelona, (P14/142). This project strengthens and improves treatment approaches for a major comorbidity in primary care. The design of the intervention takes into account its applicability under typical primary care conditions, so that if the programme is found to be effective it will be feasible to apply it in a generalised manner. ClinicalTrials.gov: NCT02605278 ; Registered 28 September, 2015.

An integrated structural intervention to reduce vulnerability to HIV and sexually transmitted infections among female sex workers in Karnataka state, south India

PubMed Central

2011-01-01

Background Structural factors are known to affect individual risk and vulnerability to HIV. In the context of an HIV prevention programme for over 60,000 female sex workers (FSWs) in south India, we developed structural interventions involving policy makers, secondary stakeholders (police, government officials, lawyers, media) and primary stakeholders (FSWs themselves). The purpose of the interventions was to address context-specific factors (social inequity, violence and harassment, and stigma and discrimination) contributing to HIV vulnerability. We advocated with government authorities for HIV/AIDS as an economic, social and developmental issue, and solicited political leadership to embed HIV/AIDS issues throughout governmental programmes. We mobilised FSWs and appraised them of their legal rights, and worked with FSWs and people with HIV/AIDS to implement sensitization and awareness training for more than 175 government officials, 13,500 police and 950 journalists. Methods Standardised, routine programme monitoring indicators on service provision, service uptake, and community activities were collected monthly from 18 districts in Karnataka between 2007 and 2009. Daily tracking of news articles concerning HIV/AIDS and FSWs was undertaken manually in selected districts between 2005 and 2008. Results The HIV prevention programme is now operating at scale, with over 60,000 FSWs regularly contacted by peer educators, and over 17,000 FSWs accessing project services for sexually transmitted infections monthly. FSW membership in community-based organisations has increased from 8,000 to 37,000, and over 46,000 FSWs have now been referred for government-sponsored social entitlements. FSWs were supported to redress > 90% of the 4,600 reported incidents of violence and harassment reported between 2007-2009, and monitoring of news stories has shown a 50% increase in the number of positive media reports on HIV/AIDS and FSWs. Conclusions Stigma, discrimination, violence, harassment and social equity issues are critical concerns of FSWs. This report demonstrates that it is possible to address these broader structural factors as part of large-scale HIV prevention programming. Although assessing the impact of the various components of a structural intervention on reducing HIV vulnerability is difficult, addressing the broader structural factors contributing to FSW vulnerability is critical to enable these vulnerable women to become sufficiently empowered to adopt the safer sexual behaviours which are required to respond effectively to the HIV epidemic. PMID:21962115

An integrated structural intervention to reduce vulnerability to HIV and sexually transmitted infections among female sex workers in Karnataka state, south India.

PubMed

Gurnani, Vandana; Beattie, Tara S; Bhattacharjee, Parinita; Mohan, H L; Maddur, Srinath; Washington, Reynold; Isac, Shajy; Ramesh, B M; Moses, Stephen; Blanchard, James F

2011-10-02

Structural factors are known to affect individual risk and vulnerability to HIV. In the context of an HIV prevention programme for over 60,000 female sex workers (FSWs) in south India, we developed structural interventions involving policy makers, secondary stakeholders (police, government officials, lawyers, media) and primary stakeholders (FSWs themselves). The purpose of the interventions was to address context-specific factors (social inequity, violence and harassment, and stigma and discrimination) contributing to HIV vulnerability. We advocated with government authorities for HIV/AIDS as an economic, social and developmental issue, and solicited political leadership to embed HIV/AIDS issues throughout governmental programmes. We mobilised FSWs and appraised them of their legal rights, and worked with FSWs and people with HIV/AIDS to implement sensitization and awareness training for more than 175 government officials, 13,500 police and 950 journalists. Standardised, routine programme monitoring indicators on service provision, service uptake, and community activities were collected monthly from 18 districts in Karnataka between 2007 and 2009. Daily tracking of news articles concerning HIV/AIDS and FSWs was undertaken manually in selected districts between 2005 and 2008. The HIV prevention programme is now operating at scale, with over 60,000 FSWs regularly contacted by peer educators, and over 17,000 FSWs accessing project services for sexually transmitted infections monthly. FSW membership in community-based organisations has increased from 8,000 to 37,000, and over 46,000 FSWs have now been referred for government-sponsored social entitlements. FSWs were supported to redress > 90% of the 4,600 reported incidents of violence and harassment reported between 2007-2009, and monitoring of news stories has shown a 50% increase in the number of positive media reports on HIV/AIDS and FSWs. Stigma, discrimination, violence, harassment and social equity issues are critical concerns of FSWs. This report demonstrates that it is possible to address these broader structural factors as part of large-scale HIV prevention programming. Although assessing the impact of the various components of a structural intervention on reducing HIV vulnerability is difficult, addressing the broader structural factors contributing to FSW vulnerability is critical to enable these vulnerable women to become sufficiently empowered to adopt the safer sexual behaviours which are required to respond effectively to the HIV epidemic.

Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme.

PubMed

Nathwani, Dilip; Sneddon, Jacqueline; Malcolm, William; Wiuff, Camilla; Patton, Andrea; Hurding, Simon; Eastaway, Anne; Seaton, R Andrew; Watson, Emma; Gillies, Elizabeth; Davey, Peter; Bennie, Marion

2011-07-01

In 2008, the Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP) was published by the Scottish Government. One of the key actions was initiation of the Scottish Antimicrobial Prescribing Group (SAPG), hosted within the Scottish Medicines Consortium, to take forward national implementation of the key recommendations of this action plan. The primary objective of SAPG is to co-ordinate and deliver a national framework or programme of work for antimicrobial stewardship. This programme, led by SAPG, is delivered by NHS National Services Scotland (Health Protection Scotland and Information Services Division), NHS Quality Improvement Scotland, and NHS National Education Scotland as well as NHS board Antimicrobial Management Teams. Between 2008 and 2010, SAPG has achieved a number of early successes, which are the subject of this review: (i) through measures to optimise prescribing in hospital and primary care, combined with infection prevention measures, SAPG has contributed significantly to reducing Clostridium difficile infection rates in Scotland; (ii) there has been engagement of all key stakeholders at local and national levels to ensure an integrated approach to antimicrobial stewardship within the wider healthcare-associated infection agenda; (iii) development and implementation of data management systems to support quality improvement; (iv) development of training materials on antimicrobial stewardship for healthcare professionals; and (v) improving clinical management of infections (e.g. community-acquired pneumonia) through quality improvement methodology. The early successes achieved by SAPG demonstrate that this delivery model is effective and provides the leadership and focus required to implement antimicrobial stewardship to improve antimicrobial prescribing and infection management across NHS Scotland. Copyright © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Patients’ Opinions about Knowing Their Risk for Depression and What to Do about It. The PredictD-Qualitative Study

PubMed Central

Bellón, Juan Á.; Moreno-Peral, Patricia; Moreno-Küstner, Berta; Motrico, Emma; Aiarzagüena, José M.; Fernández, Anna; Fernández-Alonso, Carmen; Montón-Franco, Carmen; Rodríguez-Bayón, Antonina; Ballesta-Rodríguez, María Isabel; Rüntel-Geidel, Ariadne; Payo-Gordón, Janire; Serrano-Blanco, Antoni; Oliván-Blázquez, Bárbara; Araujo, Luz; Muñoz-García, María del Mar; King, Michael; Nazareth, Irwin; Amezcua, Manuel

2014-01-01

Background The predictD study developed and validated a risk algorithm for predicting the onset of major depression in primary care. We aimed to explore the opinion of patients about knowing their risk for depression and the values and criteria upon which these opinions are based. Methods A maximum variation sample of patients was taken, stratified by city, age, gender, immigrant status, socio-economic status and lifetime depression. The study participants were 52 patients belonging to 13 urban health centres in seven different cities around Spain. Seven Focus Groups (FGs) were given held with primary care patients, one for each of the seven participating cities. Results The results showed that patients generally welcomed knowing their risk for depression. Furthermore, in light of available evidence several patients proposed potential changes in their lifestyles to prevent depression. Patients generally preferred to ask their General Practitioners (GPs) for advice, though mental health specialists were also mentioned. They suggested that GPs undertake interventions tailored to each patient, from a “patient-centred” approach, with certain communication skills, and giving advice to help patients cope with the knowledge that they are at risk of becoming depressed. Conclusions Patients are pleased to be informed about their risk for depression. We detected certain beliefs, attitudes, values, expectations and behaviour among the patients that were potentially useful for future primary prevention programmes on depression. PMID:24646951

The epidemiology of rheumatic fever in the Tairawhiti/Gisborne region of New Zealand: 1997-2009.

PubMed

Siriett, Victoria; Crengle, Sue; Lennon, Diana; Stonehouse, Mary; Cramp, Geoffrey

2012-11-09

To establish Acute Rheumatic Fever (ARF) rates within the Tairawhiti District Health Board (1997-2009) to identify communities for primary prevention programmes. ARF cases (1997-2009) sought by audit of Gisborne Hospital admissions, penicillin prophylaxis lists and the EpiSurv notifiable disease database. ARF rates (n=44 cases) during 1997 to 2009 (7.6/100,000) with a continuing significant disparity between Maori (n=40, 15.2/100,000) and non-Maori, (n=3, 1.1/100,000). One case was Pacific. This disparity was marked in school-aged children (5-14 years: Maori 59/100,000 vs non-Maori 8/100,000). Over 80% of ARF cases demonstrated heart damage (18% moderate, 20% severe and 8% requiring heart surgery). ARF cases were strongly associated with living and schooling within high deprivation areas Forty ARF cases were enrolled in 13/21 Gisborne schools, 4/18 East Coast schools and 2/17 western rural schools. (No school for 8 cases). When assessed as a percentage of school rolls there were no discernable differences between primary, intermediate and secondary schools. Of the 44 cases, 35 (80%) resided in areas of NZDep06 score 8-10 (most deprived). Very high ARF rates were recorded in the 1960's; the continuing burden of ARF in Maori children indicate a strong requirement for primary prevention strategies. Progress has plateaued in the last 20 years.

Patients' opinions about knowing their risk for depression and what to do about it. The predictD-qualitative study.

PubMed

Bellón, Juan Á; Moreno-Peral, Patricia; Moreno-Küstner, Berta; Motrico, Emma; Aiarzagüena, José M; Fernández, Anna; Fernández-Alonso, Carmen; Montón-Franco, Carmen; Rodríguez-Bayón, Antonina; Ballesta-Rodríguez, María Isabel; Runte-Geidel, Ariadne; Rüntel-Geidel, Ariadne; Payo-Gordón, Janire; Serrano-Blanco, Antoni; Oliván-Blázquez, Bárbara; Araujo, Luz; Muñoz-García, María del Mar; King, Michael; Nazareth, Irwin; Amezcua, Manuel

2014-01-01

The predictD study developed and validated a risk algorithm for predicting the onset of major depression in primary care. We aimed to explore the opinion of patients about knowing their risk for depression and the values and criteria upon which these opinions are based. A maximum variation sample of patients was taken, stratified by city, age, gender, immigrant status, socio-economic status and lifetime depression. The study participants were 52 patients belonging to 13 urban health centres in seven different cities around Spain. Seven Focus Groups (FGs) were given held with primary care patients, one for each of the seven participating cities. The results showed that patients generally welcomed knowing their risk for depression. Furthermore, in light of available evidence several patients proposed potential changes in their lifestyles to prevent depression. Patients generally preferred to ask their General Practitioners (GPs) for advice, though mental health specialists were also mentioned. They suggested that GPs undertake interventions tailored to each patient, from a "patient-centred" approach, with certain communication skills, and giving advice to help patients cope with the knowledge that they are at risk of becoming depressed. Patients are pleased to be informed about their risk for depression. We detected certain beliefs, attitudes, values, expectations and behaviour among the patients that were potentially useful for future primary prevention programmes on depression.

Perspectives of rural health and human service practitioners following suicide prevention training programme in Australia: A thematic analysis.

PubMed

Jones, Martin; Ferguson, Monika; Walsh, Sandra; Martinez, Lee; Marsh, Michael; Cronin, Kathryn; Procter, Nicolas

2018-05-01

There are well-established training programmes available to support health and human services professionals working with people vulnerable to suicide. However, little is known about involving people with lived experience in the delivery of suicide prevention training with communities with increased rates of suicide. The aim of this paper was to report on a formative dialogical evaluation that explored the views of health and human services workers with regard to a suicide prevention training programme in regional (including rural and remote areas) South Australia which included meaningful involvement of a person with lived experience in the development and delivery of the training. In 2015, eight suicide prevention training workshops were conducted with health and human services workers. All 248 participants lived and worked in South Australian regional communities. We interviewed a subsample of 24 participants across eight sites. A thematic analysis of the interviews identified five themes: Coproduction is key, It is okay to ask the question, Caring for my community, I can make a difference and Learning for future training. The overall meta-theme was "Involvement of a person with lived experience in suicide prevention training supports regional communities to look out for people at risk of suicide." This paper highlights the need for suicide prevention training and other workforce development programmes to include lived experience participation as a core component in development and delivery. © 2018 John Wiley & Sons Ltd.

2015-2018 Regional Prevention Plan of Lombardy (Northern Italy) and sedentary prevention: a cross-sectional strategy to develop evidence-based programmes.

PubMed

Coppola, Liliana; Ripamonti, Ennio; Cereda, Danilo; Gelmi, Giusi; Pirrone, Lucia; Rebecchi, Andrea

2016-01-01

Cross-sector, life-course, and setting approaches are identified in the 2015-2018 Regional Prevention Plan (PRP) of Lombardy Region (Northern Italy) as valuable strategies to ensure the efficacy and sustainable prevention of the non-communicable disease (NCDs). The involvement of non-health sectors in health promotion activities represents a suitable strategy to affect on social, economic, and political determinants and to change environmental factors that could cause NCDs. A dialogue among communities, urban planning, and prevention know-how is a prerequisite to develop a system of policies suitable to promote healthy lifestyle in general and, specifically, active lifestyles. The 2015-2018 Lombardy PRP pursues its aims of health promotion and behavioural risk factors for NCDs prevention through programmes that implement their own setting networks (Health Promoting Schools - SPS; Workplace Health Promotion - WHP) and develop new networks. Sedentary lifestyle prevention and active lifestyle promotion are performed through the approach promoted by the Healthy Cities Programme (WHO), encouraging two main processes: 1. creating integrated capacity-building among health and social prevention services, academic research, and local stakeholders on different urban planning and design issues; 2. promoting community empowerment through active citizens participation. Through this process, Lombardy Region aims to orient its services developing evidence-based programmes and enhancing advocacy and mediating capacity skills in order to create a profitable partnership with non-health sectors. This paper reports the main impact data: 26,000 children that reach school by foot thanks to walking buses, 57% of 145 companies joining WHP are involved in promoting physical activity, 18,891 citizens who attend local walking groups.

(Re)politicising and (re)positioning prevention: community mobilisations and AIDS prevention in the new AIDS era.

PubMed

Rolston, Imara Ajani

2016-07-01

An increasing focus on the relationship between AIDS prevalence and socio-economic inequality signals the need for a revaluation of the role of "politics" and "power" in AIDS prevention. This revaluation bears great significance when considering the future trajectories of the AIDS prevention efforts that target highly marginalised populations with high prevalence rates. An emphasis on intersecting forms of inequality has direct implications for the future of AIDS prevention practice. This study explores the experiences of participants, facilitators and local stakeholders applying the United Nations Development Programme (UNDP) Community Capacity Enhancement-Community Conversations (CCE-CC) approach to AIDS prevention in the Eastern Cape province of South Africa. It uses the political narrative analysis of life histories and semi-structured interviews as a means to interrogate the lived experiences of local actors participating in or influenced by this popularised form of community mobilisation used throughout sub-Saharan Africa. Findings suggest the need for a more explicit and intentional valuation for the intersection between the social and political determinants of health in programmes that use community mobilisation as prevention. They also signal a need to critically re-evaluate "community mobilisation" as an AIDS prevention tradition. Intersecting social and political power dynamics play a significant role in both opening up and constraining community mobilisation efforts. This paper proposes the need for a pedagogical turn to "deep organising" and "participatory forms of democracy", as a necessary frontier for programmes working with highly marginalised populations with high prevalence rates. Programmes need to more explicitly support, protect, and advocate for the ability of affected communities to engage in political processes, discourse and long-term organising.

The retinal renin-angiotensin system: implications for therapy in diabetic retinopathy.

PubMed

Sjølie, A K; Chaturvedi, N

2002-08-01

Retinopathy is the most common complication of diabetes, and a leading cause of blindness in people of working age. Optimal blood pressure and metabolic control can reduce the risk of diabetic retinopathy, but are difficult to achieve in clinical practice. In the EUCLID Study, the angiotensin converting enzyme (ACE) inhibitor lisinopril reduced the risk of progression of retinopathy by approximately 50%, and also significantly reduced the risk of progression to proliferative retinopathy. These findings are consistent with extensive evidence that the renin-angiotensin system is expressed in the eye, and that adverse effects of angiotensin II on retinal angiogenesis and function can be inhibited by ACE inhibitors or angiotensin II-receptor blockers. However, in the EUCLID Study retinopathy was not a primary end-point and the study was not sufficiently powered for the eye-related outcomes. Hence, the Diabetic Retinopathy Candesartan Trials (DIRECT) programme has been established to determine whether AT(1)-receptor blockade with candesartan can prevent the incidence and progression of diabetic retinopathy. This programme comprises three studies, involving a total of 4500 patients recruited from about 300 centres worldwide. The patients are normotensive or treated hypertensive individuals, and so the DIRECT programme should assess the potential of an AT(1)-receptor blocker to protect against the pathological changes in the eye following diabetes.

Retreat from Alma Ata? The WHO's report on Task Shifting to community health workers for AIDS care in poor countries.

PubMed

Campbell, C; Scott, K

2011-01-01

This paper examines the potential of community health worker (CHW) programmes, as proposed by the 2008 World Health Organisation (WHO) document Task Shifting to tackle health worker shortages, to contribute to HIV/AIDS prevention and treatment and various Millennium Development Goals in low-income countries. It examines the WHO proposal through a literature review of factors that have facilitated the success of previous CHW experiences. The WHO has taken account of five key lessons learnt from past CHW programmes (the need for strong management, appropriate selection, suitable training, adequate retention structures and good relationships with other healthcare workers). It has, however, neglected to emphasise the importance of a sixth lesson, the 'community embeddedness' of CHWs, found to be of critical importance to the success of past CHW programmes. We have no doubt that the WHO plans will increase the number of workers able to perform medically oriented tasks. However, we argue that without community embeddedness, CHWs will be unable to successfully perform the socially oriented tasks assigned to them by the WHO, such as health education and counselling. We locate the WHO's neglect of community embeddedness within the context of a broader global public health trend away from community-focused primary healthcare towards biomedically focused selective healthcare.

RESPOND--A patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for a multicentre randomised controlled trial.

PubMed

Barker, A L; Cameron, P A; Hill, K D; Flicker, L; Haines, T P; Lowthian, J A; Waldron, N; Arendts, G; Redfern, J; Forbes, A; Brand, C A; Etherton-Beer, C D; Hill, A M; Hunter, P; Nyman, S R; Smit, D

2015-02-01

Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. A RCT at two tertiary referral EDs in Melbourne and Perth, Australia. 528 community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk; live in residential aged care or >50 km from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis; are receiving palliative care or are unable to use a telephone will be excluded. Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year. RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease; however, evidence to support this approach in falls prevention is limited. The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Community-based pilot intervention to tackle childhood obesity: a whole-system approach.

PubMed

Vamos, E P; Lewis, E; Junghans, C; Hrobonova, E; Dunsford, E; Millett, C

2016-11-01

Go-Golborne is a pilot intervention to prevent childhood obesity in the Royal Borough of Kensington and Chelsea between 2014 and 2018. It is a multistrategy approach targeting children aged 0-16 years and their families in all settings where children live, learn and play. This paper describes the methodology and the practical steps in the development of Go-Golborne. The programme uses a quasi-experimental design for the evaluation of changes in weight status using data from the extended National Child Measurement Programme across local schools. For specific behavioural change objectives, baseline self-reported lifestyle measures will be compared against annual follow-up data over the 3-year study period. Qualitative methods will be used to explore the perceptions of stakeholders and participants and organizational change. Go-Golborne aims to mobilize everyone in the community who has a role or interest in shaping the local environment, norms and behaviours across a range of sectors. A community network of local organizations has been established to codesign all programme activities. The Steering Group of Council officers support programme implementation and environmental changes. The programme has identified six specific behaviour change objectives representing the key areas of need in Golborne and all activities in the council and the community target these objectives during specific programme phases. Key components include community capacity building, community-wide social marketing, environment and policy change and evaluation. The programme is currently at the beginning of its implementation phase with activities in the community and council targeting the first behaviour change objective. The pilot aims to test the effectiveness of this approach to support behaviour change and prevent unhealthy weight gain in children using multiple strategies. This programme will inform the development of an intervention model that defines essential programme components, accountability of partner organizations delivering obesity prevention programmes and the effective use of existing assets. Copyright © 2016 The Royal Society for Public Health. All rights reserved.

Preventing deaths and injuries from house fires: an outcome evaluation of a community-based smoke alarm installation programme.

PubMed

Istre, Gregory R; McCoy, Mary A; Moore, Billy J; Roper, Carey; Stephens-Stidham, Shelli; Barnard, Jeffrey J; Carlin, Debra K; Stowe, Martha; Anderson, Ron J

2014-04-01

Few studies have examined the impact of community-based smoke alarm (SA) distribution programmes on the occurrence of house fire-related deaths and injuries (HF-D/I). To determine whether the rate of HF-D/I differed for programme houses that had a SA installed through a community-based programme called Operation Installation, versus non-programme houses in the same census tracts that had not received such a SA. Teams of volunteers and firefighters canvassed houses in 36 high-risk target census tracts in Dallas, TX, between April 2001 and April 2011, and installed lithium-powered SAs in houses where residents were present and gave permission. We then followed incidence of HF-D/I among residents of the 8134 programme houses versus the 24 346 non-programme houses. After a mean of 5.2 years of follow-up, the unadjusted HF-D/I rate was 68% lower among residents of programme houses versus non-programme houses (3.1 vs 9.6 per 100 000 population, respectively; rate ratio, 0.32; 95% CI 0.10 to 0.84). Multivariate analysis including several demographic variables showed that the adjusted HF-D/I rate in programme houses was 63% lower than non-programme houses. The programme was most effective in the first 5 years after SA installation, with declining difference in rates after the 6th year, probably due to SAs becoming non-functional during that time. This collaborative, community-based SA installation programme was effective at preventing deaths and injuries from house fires, but the duration of effectiveness was less than 10 years.

Primary Teachers' Reflections on Inquiry- and Context-Based Science Education

NASA Astrophysics Data System (ADS)

Walan, Susanne; Mc Ewen, Birgitta

2017-04-01

Inquiry- and context-based teaching strategies have been proven to stimulate and motivate students' interests in learning science. In this study, 12 teachers reflected on these strategies after using them in primary schools. The teachers participated in a continuous professional development (CPD) programme. During the programme, they were also introduced to a teaching model from a European project, where inquiry- and context-based education (IC-BaSE) strategies were fused. The research question related to teachers' reflections on these teaching strategies, and whether they found the model to be useful in primary schools after testing it with their students. Data collection was performed during the CPD programme and consisted of audio-recorded group discussions, individual portfolios and field notes collected by researchers. Results showed that compared with using only one instructional strategy, teachers found the new teaching model to be a useful complement. However, their discussions also showed that they did not reflect on choices of strategies or purposes and aims relating to students' understanding, or the content to be taught. Before the CPD programme, teachers discussed the use of inquiry mainly from the aspect that students enjoy practical work. After the programme, they identified additional reasons for using inquiry and discussed the importance of knowing why inquiry is performed. However, to develop teachers' knowledge of instructional strategies as well as purposes for using certain strategies, there is need for further investigations among primary school teachers.

Study protocol of a cluster randomized controlled trial evaluating the efficacy of a comprehensive pressure ulcer prevention programme for private for-profit nursing homes.

PubMed

Kwong, Enid Wai-yung; Lee, Paul Hong; Yeung, Kwan-mo

2016-01-18

Because the demand for government-subsidized nursing homes in Hong Kong outstrips the supply, the number of for-profit private nursing homes has been increasing rapidly. However, the standard of care in such homes is always criticized. Pressure ulcers are a major long-term care issue that is closely associated with the quality of care delivered in nursing home settings. The aim of this study is to evaluate the effectiveness of a pressure ulcer prevention programme for residents in private for-profit nursing homes. This is a two-arm cluster randomized controlled trial with an estimated sample size of 1088 residents and 74 care staff from eight for-profit private nursing homes. Eligible nursing homes will be those classified as category A2 homes in the Enhanced Bought Place Scheme (EBPS), having a capacity of around 130-150 beds, and no structured PU prevention protocol and/or programmes in place. Care staff will be health workers, personal care workers, and nurses who are front-line staff providing direct care to residents. Eight nursing homes will be randomly assigned to either an experimental or control group. The experimental group will be provided with an intensive training programme and will be involved in the implementation of a 16-week pressure ulcer prevention protocol, while the control group will deliver the usual pressure ulcer prevention care. The study outcomes are the pressure ulcer prevention knowledge and skills of the care staff and the prevalence and incidence of pressure ulcers. Data on the knowledge and skills of care staff, and prevalence of pressure ulcer will be collected at the base line, and then at the 8(th) week and at completion of the implementation of the protocol. The assessment of the incidence of pressures will start from before the commencement of the intensive training course to the end of the implementation of the protocol. In view of the negative impact of pressure ulcers, it is important to have an effective and evidence-based pressure ulcer prevention programme to improve preventive care in private for-profit nursing homes. The programme will potentially improve the knowledge and skills of care staff on the prevention of pressure ulcers and also lead to a reduction in the development of pressure ulcers in nursing homes. The Current Controlled Trial is NCT02270385, 18 October 2014.

Mental health consumers' with medical co‐morbidity experience of the transition through tertiary medical services to primary care

PubMed Central

Cranwell, Kate; Polacsek, Meg

2016-01-01

Abstract Medical comorbidity in people with long‐term mental illness is common and often undetected; however, these consumers frequently experience problems accessing and receiving appropriate treatment in public health‐care services. The aim of the present study was to understand the lived experience of mental health consumers with medical comorbidity and their carers transitioning through tertiary medical to primary care services. An interpretative, phenomenological analysis approach was used, and semistructured, video‐recorded, qualitative interviews were used with 12 consumers and four primary caregivers. Four main themes and related subthemes were abstracted from the data, highlighting consumer's and carers’ experience of transition through tertiary medical to primary care services: (i) accessing tertiary services is difficult and time consuming; (ii) contrasting experiences of clinician engagement and support; (iii) lack of continuity between tertiary medical and primary care services; and (iv) Mental Health Hospital Admission Reduction Programme (MH HARP) clinicians facilitating transition. Our findings have implications for organisational change, expanding the role of MH HARP clinicians (whose primary role is to provide consumers with intensive support and care coordination to prevent avoidable tertiary medical hospital use), and the employment of consumer and carer consultants in tertiary medical settings, especially emergency departments. PMID:26735771

The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial

PubMed Central

2012-01-01

Background To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm). Methods This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36. Results Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were −30.09% and −27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended). Conclusion Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn. Trial registration National Medical Research Registration (NMRR) Number: NMRR-08-287-1442 Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370 PMID:23046818

The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial.

PubMed

Selvaraj, Francis Jude; Mohamed, Mafauzy; Omar, Khairani; Nanthan, Sudha; Kusiar, Zainab; Subramaniam, Selvaraj Y; Ali, Norsiah; Karanakaran, Kamalakaran; Ahmad, Fauziah; Low, Wilson H H

2012-10-10

To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm). This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36. Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were -30.09% and -27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended). Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn. National Medical Research Registration (NMRR) Number: NMRR-08-287-1442Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370.

[Better coordination between primary care, community settings and diabetes outpatient clinic for patients with type 2 diabetes].

PubMed

Gjessing, Hans Jørgen; Jørgensen, Ulla Linding; Møller, Charlotte Chrois; Huge, Lis; Dalgaard, Anne Mette; Nielsen, Kristian Wendelboe; Thomsen, Lis; Buch, Martin Sandberg

2014-06-02

Integrated care programmes for patients with type 2 diabetes can be successfully implemented by planning the programmes in coordination between the sectors primary care, community settings and diabetes outpatient clinic, and with involvement of leaders and employees. Our project has resulted in: 1) more patients with type 2 diabetes receiving diabetes management courses, 2) improved diabetes management of primary care, and 3) improved confidence and respect between sectors involved in diabetes care.

Promoting physical activity among older people in primary care using peer mentors.

PubMed

Stevens, Zoe; Barlow, Cate; Iliffe, Steve

2015-04-01

The home-based Otago Exercise Programme has been shown to increase sustained physical-activity levels in older people recruited through primary care, when supported by health professionals. The ProAct65+ trial is testing this programme using volunteer peer mentors to support behaviour change. This qualitative study explored how these peer mentors experienced their role. Ten peer mentors from the ProAct65+ trial were interviewed. Semi-structured interviews were audio-recorded, transcribed verbatim and thematically analysed. Peer mentors reported positive experiences including meeting new people, watching mentees progress, developing friendships and being shown gratitude for their support. Key barriers and facilitators to the mentoring process included the home and telephone as settings for support, geography and making contact with mentees. Findings from this study can help the development of peer mentor programmes in primary care for older people. Future programmes should recruit peer mentors who are local to where mentoring is needed to reduce travel difficulties.

Identifying behavioural determinants for interventions to increase handwashing practices among primary school children in rural Burundi and urban Zimbabwe.

PubMed

Seimetz, Elisabeth; Slekiene, Jurgita; Friedrich, Max N D; Mosler, Hans-Joachim

2017-07-14

This article presents the development of a school handwashing programme in two different sub-Saharan countries that applies the RANAS (risk, attitudes, norms, ability, and self-regulation) systematic approach to behaviour change. Interviews were conducted with 669 children enrolled in 20 primary schools in Burundi and 524 children in 20 primary schools in Zimbabwe. Regression analyses were used to assess the influence of the RANAS behavioural determinants on reported handwashing frequencies. The results revealed that, in both countries, a programme targeting social norms and self-efficacy would be most effective. In Burundi, raising the children's perceived severity of the consequences of contracting diarrhoea, and in Zimbabwe, increasing the children's health knowledge should be part of the programme. The school handwashing programme should create awareness of the benefits of handwashing through educational activities, raise the children's ability and confidence in washing hands at school through infrastructural improvements, and highlight the normality of washing hands at school through events and poster creation.

Evaluating a Pregnancy and STI Prevention Programme in Rural, At-Risk, Middle School Girls in the USA

ERIC Educational Resources Information Center

Hill, Julie C.; Lynne-Landsman, Sarah D.; Graber, Julia A.; Johnson, Kelly J.

2016-01-01

Objective: Young people in urban areas are often the focus of pregnancy and sexually transmitted infection (STI) prevention programmes because of their high risk of unwanted pregnancy and contracting an STI. Young people in rural areas are far less studied but also have a high risk of similar outcomes. This study evaluates Giving Our Girls…

Implementation research: towards universal health coverage with more doctors in Brazil

PubMed Central

Oliveira, Aimê; Trindade, Josélia Souza; Barreto, Ivana CHC; Palmeira, Poliana Araújo; Comes, Yamila; Santos, Felipe OS; Santos, Wallace; Oliveira, João Paulo Alves; Pessoa, Vanira Matos; Shimizu, Helena Eri

2017-01-01

Abstract Objective To evaluate the implementation of a programme to provide primary care physicians for remote and deprived populations in Brazil. Methods The Mais Médicos (More Doctors) programme was launched in July 2013 with public calls to recruit physicians for priority areas. Other strategies were to increase primary care infrastructure investments and to provide more places at medical schools. We conducted a quasi-experimental, before-and-after evaluation of the implementation of the programme in 1708 municipalities with populations living in extreme poverty and in remote border areas. We compared physician density, primary care coverage and avoidable hospitalizations in municipalities enrolled (n = 1450) and not enrolled (n = 258) in the programme. Data extracted from health information systems and Ministry of Health publications were analysed. Findings By September 2015, 4917 physicians had been added to the 16 524 physicians already in place in municipalities with remote and deprived populations. The number of municipalities with ≥ 1.0 physician per 1000 inhabitants doubled from 163 in 2013 to 348 in 2015. Primary care coverage in enrolled municipalities (based on 3000 inhabitants per primary care team) increased from 77.9% in 2012 to 86.3% in 2015. Avoidable hospitalizations in enrolled municipalities decreased from 44.9% in 2012 to 41.2% in 2015, but remained unchanged in control municipalities. We also documented higher infrastructure investments in enrolled municipalities and an increase in the number of medical school places over the study period. Conclusion Other countries having shortages of physicians could benefit from the lessons of Brazil’s programme towards achieving universal right to health. PMID:28250510