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PubMed2001

Interventions for smoking cessation in hospitalised patients.

BACKGROUND: An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited. Providing smoking cessation services during hospitalisation may help more people to attempt and sustain a quit attempt. OBJECTIVES: To determine the effectiveness of interventions for smoking cessation in hospitalised patients. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group register, CINAHL and the Smoking and Health database for studies of interventions for smoking cessation in hospitalised patients. SELECTION CRITERIA: Randomised and quasi-randomised trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking conducted with hospitalised patients who were current smokers or recent quitters. We excluded studies of patients admitted for psychiatric disorders or substance abuse, those that did not report abstinence rates and those with follow-up of less than six months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently for each paper, with disagreements resolved by consensus. MAIN RESULTS: Intensive intervention (inpatient contact plus follow-up for at least one month) was associated with a significantly higher quit rate compared to control (Peto Odds Ratio 1.82, 95% CI 1.49-2.22). There was insufficient evidence to judge the effect of interventions delivered only during the hospital stay. Although the interventions increased quit rates irrespective of whether nicotine replacement therapy was used, the results for nicotine replacement therapy (NRT) were compatible with other data indicating that it increases quit rates. There was no strong evidence that clinical diagnosis affected the likelihood of quitting. REVIEWER'S CONCLUSIONS: High intensity behavioural interventions that include at least one month of follow-up contact are effective in promoting smoking cessation in hospitalised patients. The findings of the review were compatible with research in other settings showing that NRT increases quit rates.

Hospitalization↗
PubMed2000

Interventions for helping patients to follow prescriptions for medications.

BACKGROUND BACKGROUND: Efforts to assist patients with adherence to prescribed, self-administered medications might improve the benefits and efficiency of health care. OBJECTIVES OBJECTIVE: To update an ongoing review summarising the results of randomised controlled trials (RCTs) of interventions to help patients follow prescriptions for medications, focusing on trials that measured both adherence and clinical outcomes. SEARCH STRATEGY: Computerised searches to July 1998 in MEDLINE, CINAHL, The Cochrane Library, International Pharmaceutical Abstracts (IPA), PsychInfo, Sociofile, and HSTAR; bibliographies in articles on patient adherence; articles in the reviewers' personal collections; and contact with authors. SELECTION CRITERIA: Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. DATA COLLECTION AND ANALYSIS: Information on study design features, interventions and controls, and findings were extracted by one reviewer (PM) and a research assistant and confirmed by two of the other reviewers. The studies were too disparate to warrant meta-analysis. MAIN RESULTS: For short-term treatments, one study, of counselling and written information, showed an effect on adherence and clinical outcome. Ten of 19 interventions for long-term treatments reported in 17 RCTs were associated with improvements in adherence, but only nine interventions led to improvements in treatment outcomes. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, counselling, reminders, self-monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. Two studies showed that telling patients about adverse effects of treatment did not affect their adherence. REVIEWER'S CONCLUSIONS: The full benefits of medications cannot be realised at currently achievable levels of adherence. Current methods of improving adherence for chronic health problems are mostly complex and not very effective. More studies of innovative approaches to assist patients to follow medication prescriptions are needed.

Drug Prescriptions↗
PubMed2000

Interventions for preventing tobacco sales to minors.

BACKGROUND: Laws restricting sales of tobacco products to minors exist in many countries, but young people may still purchase cigarettes easily. OBJECTIVES: The review assesses the effects of interventions to reduce underage access to tobacco by deterring shopkeepers from making illegal sales. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction group trials register and Medline. Date of the most recent searches: July 1999. SELECTION CRITERIA: We included controlled trials and uncontrolled studies with pre- and post intervention assessment of interventions to change retailers' behaviour. The outcomes were changes in retailer compliance with legislation (assessed by test purchasing), changes in young people's smoking behaviour, and perceived ease of access to tobacco products. DATA COLLECTION AND ANALYSIS: Studies were prescreened for relevance by one person and assessed for inclusion by two people independently. Data from included studies were extracted by one person and checked by a second. Study designs and types of intervention were heterogeneous so results were synthesised narratively, with greater weight given to controlled studies. MAIN RESULTS: We identified 27 studies of which 13 were controlled. Giving retailers information was less effective in reducing illegal sales than active enforcement and/or multicomponent educational strategies. No strategy achieved complete, sustained compliance. In three controlled trials, there was little effect of intervention on youth perceptions of access or prevalence of smoking. REVIEWER'S CONCLUSIONS: Interventions with retailers can lead to large decreases in the number of outlets selling tobacco to youths. However, few of the communities studied in this review achieved sustained levels of high compliance. This may explain why there is limited evidence for an effect of intervention on youth perception of ease of access to tobacco, and on smoking behaviour.

Adolescent↗
PubMed2002

Interaction and intervention modeling: predicting and extrapolating the impact of multiple interventions.

PURPOSE: Methods called interaction and intervention modeling are presented. Interaction modeling examines the interactions between variables as the basis for predicting the impact of multiple variables on a target population and on populations with difference distributions of risk factors. Intervention modeling incorporates these interactions and aims to extrapolate the impact of multiple interventions to new populations. The aim is to develop methods that will be useful for modeling and comparing intervention strategies using existing data and standard statistical methods. METHODS: Traditional hypothesis testing methods used for randomized clinical trials and cohort studies and extrapolating the results to new populations are compared with interaction and intervention modeling methods. Interaction and intervention modeling utilizes the same data as the traditional approach but examines the impact of multiple simultaneous interactions and allows extrapolation of the results to populations with different prevalences and distributions of risk factors. An example using real data demonstrates the potential of interaction and intervention modeling to predict the impact of multiple interacting variables and to compare the impact of alternative interventions. RESULTS: The methods outlined take into account the impact of the magnitude of the relative risks, prevalence of risk factors, and interaction of risk variables when predicting the impact on a new population or extrapolating the results of one or more interventions on a new population. Traditional methods that do not take into account interactions are shown to produce different conclusions from the intervention modeling approach that incorporates interactions. The impact of the intervention modeling approach compared with the traditional approach will be quite variable depending on the prevalence of the risk factors and their extent of interaction. CONCLUSIONS: Studies designed to test a hypothesis treat most variables as potential confounding variables adjusting for their impact and their interactions as part of the analysis using traditional regression methods. Interaction and intervention modeling focuses on the interactions themselves and allows comparison of the effectiveness of alternative interventions.

Clinical Trials as Topic↗
PubMed2001

Surgical interventions for treating distal radial fractures in adults.

BACKGROUND: Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis. OBJECTIVES: To determine when, and if so what type of, surgical intervention is the most appropriate treatment for fractures of the distal radius in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group's specialised register, Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 2000), MEDLINE, EMBASE, CINAHL, the National Research Register (Issues 2 to 4, 2000) and bibliographies of trial reports. The full search was concluded in December 2000. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials involving skeletally mature patients with a fracture of the distal radius, which compared surgical treatment with conservative treatment, different types of surgical intervention or the duration of immobilisation after surgery. The main categories of surgical intervention were external fixation, percutaneous pinning, open reduction and internal fixation, and the insertion of bone scaffolding materials. DATA COLLECTION AND ANALYSIS: All trials, meeting the selection criteria, were independently assessed by both reviewers for methodological quality. Data were extracted for anatomical, functional and clinical outcomes (including complications). The trials were grouped into categories relating to the main comparisons and types of surgical intervention. Despite clear heterogeneity in the characteristics of comparable trials, pooling of data was undertaken where possible and appropriate. MAIN RESULTS: Forty four trials, examining 23 treatment comparisons, met the inclusion criteria of this review. These involved a total of 3193 mainly female and older patients with generally displaced, often comminuted and potentially or evidently unstable fractures. Half of the trials compared surgery with plaster cast immobilisation. Summarising the outcomes was hampered by the variation between the studies in participant characteristics, interventions, quality of trial methodology and reporting, and methods of outcome measurement. Surgical methods were usually associated with better anatomical appearance after fracture healing, but there was inadequate evidence to confirm that these had resulted in better functional and clinical outcomes for the patients. REVIEWER'S CONCLUSIONS: The 44 randomised trials do not provide robust evidence for most of the decisions necessary in the management of these fractures. Although, in particular, there is some evidence to support the use of external fixation or percutaneous pinning, their precise role and methods are not established. It is also unclear whether surgical intervention of most fracture types will produce consistently better long-term outcomes. There is a need for good quality evidence for the surgical management of these fractures.

Adult↗
PubMed1998

The DIET study: long-term outcomes of a cognitive-behavioral weight-control intervention in independent-living elders. Dietary Intervention: Evaluation of Technology.

OBJECTIVE: To describe the long-term outcomes of a cognitive-behavioral weight-control intervention implemented in a community-based sample of independent-living, older adults. DESIGN: A quasi-experimental design was used to compare an intervention community with a wait-listed control community. Comparisons between the communities were made at 40 weeks (J Am Diet Assoc. 1994;94:37-42). The controlled trial ended at 40 weeks; then both communities received 2 years of intervention. Two-year data from both communities were combined and are presented in this article. Three-year outcome data from the initial intervention community were available and are also presented. SUBJECTS: A total of 247 overweight (> 4.5 kg of age-adjusted weight), older (mean age = 71 years) adults in 2 independent-living retirement communities participated in the study. INTERVENTION: The Dietary Intervention: Evaluation of Technology (DIET) study consisted of an intensive 10-week psychoeducational approach focused on lifestyle change, followed by a less intensive 2-year phase focusing on relapse prevention and maintenance of lifestyle changes. OUTCOME MEASURES: Physiologic and behavioral variables were analyzed at baseline and at 2 years after baseline. This article reports the combined 2-year outcome data from both retirement communities. Results of an additional follow-up 1 year after intervention was withdrawn are reported for the initial intervention community. STATISTICAL ANALYSIS: A within-subjects repeated measures analysis of variance design was used to test for significant changes in weight and lipid values over time. RESULTS: At 2 years, 70% of those who started the intervention remained actively enrolled. This group showed significant decreases in body mass index (-1.2, P < .001) and glucose level (-0.80 mmol/L, P < .001). Although high-density lipoprotein cholesterol (HDL-C) levels had increased at 40 weeks after baseline, this was not maintained at 2 years. At the 3-year follow-up, changes in body mass index and glucose level were maintained. APPLICATIONS/CONCLUSIONS: The purpose of this article was to describe the long-term outcomes of a community-based weight-reduction intervention for older adults. The findings may be of interest to clinicians who design community or worksite weight-reduction programs. Although the intervention was designed to be a low-intensity program, attrition over the length of the study was still problematic. Nevertheless, our follow-up study indicates that this intervention was efficacious in maintaining reductions in weight and glucose levels for overweight older adults for 3 years.

Activities of Daily Living↗
PubMed2002

Patients with acute coronary syndromes without persistent ST elevation undergoing percutaneous coronary intervention benefit most from early intervention with protection by a glycoprotein IIb/IIIa receptor blocker.

BACKGROUND: Many patients with acute coronary syndromes are offered percutaneous coronary intervention. However, the appropriate indications for, and optimal timing of, such procedures are uncertain. We analysed timing of intervention and associated events (death and myocardial infarction) in the PURSUIT trial in which 9461 patients received a platelet glycoprotein IIb/IIIa inhibitor, eptifibatide, or placebo for 72 h. Other treatment was left to the investigators. 2430 patients underwent percutaneous coronary intervention within 30 days. Four groups were distinguished, who underwent percutaneous coronary intervention on day 1; on days 2 or 3; at 4 to 7 days; or between 8 until 30 days, for eptifibatide- and placebo-treated patients. RESULTS: The four groups treated with placebo demonstrated total 30-day events of 15.9% for day 1 percutaneous coronary intervention, 17.7%, 15.0% and 18.2%, respectively, for successive intervals of later intervention. Later intervention was associated with more pre-procedural events (2.2% to 13.7%, P=0.001) which was balanced by a decrease in procedure-related events (12.1 to 3.1%, P=0.001), while the overall 30-day event rates were similar. Eptifibatide-treated patients with percutaneous coronary intervention on day 1 had the lowest rate of 30-day events (9.2%, P<0.05 vs other groups). In this group, pre-procedural risk was only 0.3%, while percutaneous coronary intervention on eptifibatide treatment was associated with low procedural risk (7.2%). The total 30-day event rate for later percutaneous coronary intervention in patients receiving eptifibatide was 14.0 on days 2 and 3, 15.0% for days 4 to 7 and 17.4% for days 7 to 30, respectively. CONCLUSION: Patients treated with a platelet glycoprotein IIb/IIIa receptor blocker, and early percutaneous coronary intervention (within 24 h) had the lowest event rate in this post hoc analysis. Thus 'watchful waiting' may not be the optimal strategy. Rather an early invasive strategy with percutaneous coronary intervention under protection of a platelet glycoprotein IIb/IIIa receptor blocker should be considered in selected patients. Randomized trials are warranted to verify this issue.

Acute Disease↗
PubMed1999

Nursing interventions to decrease bleeding at the femoral access site after percutaneous coronary intervention. SANDBAG Nursing Coordinators. Standards of Angioplasty Nursing Techniques to Diminish Bleeding Around the Groin.

BACKGROUND: This trial is the first prospective, multicenter clinical nursing trial conducted to measure the effect of nursing interventions on bleeding at the femoral access site after percutaneous coronary intervention with or without a potent antiplatelet agent given along with heparin and aspirin. OBJECTIVE: To measure the relationship between nursing interventions and complications at the arterial access site in patients undergoing percutaneous coronary interventions and to recommend a standard of care to minimize bleeding complications. METHODS: In a descriptive, correlational 4010-patient study, nursing care interventions after coronary procedures were measured. Observed standards of care were assessed, and regression techniques were used to evaluate nursing interventions and the effect of the interventions on bleeding at the access site after percutaneous coronary procedures. RESULTS: Several significant correlations between nursing interventions and the occurrences of moderate to severe bleeding at the access site were found; however, most interventions had little effect. The most significant factors in decreasing complications at the access site were early removal of the arterial sheath, the type of pressure mechanism used to achieve arterial hemostasis, staffing allocation, and the person and method used to remove the sheath. CONCLUSION: Many nursing interventions after percutaneous coronary intervention have become routine in the absence of clinical outcome data. Most nursing interventions aimed at decreasing bleeding at the vascular access site increase nursing workload but do not significantly affect bleeding in the groin. These results underscore the importance of continued clinical research studies to validate nursing practice on the basis of patients' outcomes.

Angioplasty, Balloon, Coronary↗
PubMed1999

Early intervention promotes intellectual development of premature infants: a preliminary report. Early Intervention of Premature Infants Cooperative Research Group.

OBJECTIVE: To evaluate the effect of early intervention on the intellectual development of the premature infants. METHODS: Premature infants at gestational age of 28-36.9 weeks were randomly divided into two groups: intervention and conventional care groups. Normal newborn infants during the same period were included in the control group (routine care). Up to March 1996, 156 cases were over the age 1.5-2 years (corrected age), 52 in the intervention group, 51 in the conventional care group and 53 in the normal control group. Parents were taught to carry out the 0-2 year intervention program, which included motor, cognitive, speech development and social behavior. Every three months, height, weight and head circumference were measured. At the age of one and a half and two years, all infants in the three groups received infant development tests of Child Development Center of China (CDCC) scale. The examiner did not know which infant had received intervention. RESULTS: There was no significant difference in biological factors among the two premature groups and in cultural and social factors among the three groups. Intelligence tests at the age of one and a half and two years showed that the average mental development index (MDI) in the intervention group was 13.8 and 14.6 higher than those in the conventional care group and the differences were significant. The psychomotor development index (PDI) was 5.2 and 4.7 higher but the differences were not significant. The MDI and PDI in the intervention group and normal control were quite close, but at two years, the MDI and PDI in the intervention group were 5.7 and 7.3 higher than those in the normal control and the differences were significant (P < 0.05). Compared with the normal control, the MDI in conventional care group at one and a half and two years of age were 11.5 and 8.9 lower. The difference was very significant. There were four cases of mental retardation, whose mental development index (MDI) was less then 70 in the conventional care group, but none in the intervention group. CONCLUSIONS: Early intervention can promote intellectual development of the premature infants and may be beneficial to the prevention of mental retardation. Early and intensive intervention can produce better results. Bringing parent's initiative into full play through deepening their understanding of the importance of early intervention is the key to success.

Child Development↗
PubMed1990

Mortality rates after 10.5 years for participants in the Multiple Risk Factor Intervention Trial. Findings related to a priori hypotheses of the trial. The Multiple Risk Factor Intervention Trial Research Group.

The Multiple Risk Factor Intervention Trial was a primary prevention trial to test the effect of multifactor intervention on coronary heart disease mortality in high-risk men who were randomly assigned to special intervention (n = 6428) or to their usual sources of health care (n = 6438). As previously reported, after 6 to 8 years of intervention, mortality from coronary heart disease and from all causes did not differ significantly between men assigned to special intervention and men assigned to their usual sources of health care. This report describes the mortality findings after 10.5 years (an average of 3.8 years after the end of intervention). Mortality rates were lower for men who received special intervention than for men who received their usual care by 10.6% for coronary heart disease and by 7.7% for all causes. Differences in mortality rates were substantially larger after the end of intervention than observed to that point. Differences in mortality rates after 10.5 years were primarily due to a 24% reduction in the death rate from acute myocardial infarction in men receiving special intervention compared with men receiving their usual care. As before, mortality differences between special intervention and usual care varied according to the presence of resting electrocardiographic abnormalities. These data suggest that multiple risk factor intervention confers a mortality benefit in middle-aged men over a period of about 10 years.

Adult↗
PubMed2000

Interventions for preventing ankle ligament injuries.

BACKGROUND: Some sports, for example basketball and soccer, have a very high incidence of ankle injuries, mainly sprains. This contributes to ankle sprains being one of the most commonly treated injuries. OBJECTIVES: To assess the effects of interventions used for the prevention of ankle ligament injuries or sprains in physically active individuals from adolescence to middle age. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE (1966 to July 1996), EMBASE (1980 to September 1996), CINAHL (1982 to June 1996), and bibliographies of study reports. We also contacted colleagues and some trialists. Date of the most recent search: March 1997. SELECTION CRITERIA: Randomised or quasi-randomised trials of interventions for the prevention of ankle sprains in physically active individuals from adolescence to middle age were included provided ankle sprains were recorded. Interventions include use of modified footwear and associated supports, adapted training programmes and health education. DATA COLLECTION AND ANALYSIS: At least four reviewers independently assessed methodological quality and extracted data. Wherever possible, results of outcome measures were pooled and sub-grouped by history of previous sprain. MAIN RESULTS: Five randomised trials with data for 3954 participants were included. All trials involved young, active, mostly male adults participating in high-risk, usually sporting, activities. With the exception of ankle disc training, all prophylactic interventions entailed the application of an external ankle support in the form of a semi-rigid orthosis, air-cast brace or high top shoes. There was a significant reduction in the number of ankle sprains in people allocated external ankle support (Peto odds ratio 0.49; 95% confidence interval 0.37 to 0.66). This reduction was greater for those with a previous history of ankle sprain, but still possible for those without prior sprain. There was no apparent difference in the degree of severity of the ankle sprain prevented nor any change to the incidence of other leg injuries. The protective effect of 'high-top' shoes remains to be established. There was limited evidence for reduction in ankle sprain for those with previous ankle sprains who did ankle disc training exercises. REVIEWER'S CONCLUSIONS: This review provides good evidence for the beneficial effect of ankle supports in the form of semi-rigid orthoses or air-cast braces to prevent ankle sprain during high-risk sporting activities (e.g. soccer, basketball). Participants with a history of previous sprain can be advised that wearing such supports may reduce the risk of incurring a future sprain. However, any potential prophylactic effect should be balanced against the baseline risk of the activity, the supply and cost of the particular device, and for some, the possible or perceived loss of performance. Further research is indicated principally to investigate other prophylactic interventions and general applicability.

Adolescent↗
PubMed2001

Alarm interventions for nocturnal enuresis in children.

BACKGROUND: Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs to the children can be great. OBJECTIVES: To assess the effects of alarm interventions on nocturnal enuresis in children, and to compare alarms with other interventions. SEARCH STRATEGY: The following electronic databases were searched: MEDLINE to June 1997; AMED; ASSIA; BIDS; BIOSIS Previews (1985-1996); CINAHL; DHSS Data; EMBASE (1974 to June 1997); PsycLIT and SIGLE. Organisations, manufacturers, researchers and health professionals concerned with enuresis were contacted for information. The reference sections of obtained studies were also checked for further trials. Date of the most recent search: July 1997. SELECTION CRITERIA: All randomised trials of alarm interventions for nocturnal enuresis in children were included in the review. Trials were eligible for inclusion if: children were randomised to alarm treatment compared with controls, other behavioural methods or drugs for nocturnal bedwetting; participants with organic causes for their bedwetting were excluded; and baseline assessments of the level of bedwetting were reported. Trials focused solely on daytime wetting were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the quality of the eligible trials, and extracted data. MAIN RESULTS: Twenty two randomised trials met the inclusion criteria, involving 1125 children who received treatment with alarms. The quality of many of the trials was poor, and many comparisons were addressed only by single trials. Children treated with alarms were significantly more likely than untreated controls to become dry during treatment (RR for failing to achieve 14 dry nights 0.27, 95% CI 0.19 to 0.39) and failing to remain dry (RR 0.58, 95%CI 0.46 to 0.74). There was insufficient evidence to judge whether one type of alarm is better than another and whether alarms alone were as good as or better than other behavioural interventions alone or as a supplement to alarm treatment. Desmopressin or tricyclics seem as effective as alarms while on treatment. There was limited evidence to suggest that the relapse rate might be lower after stopping alarm treatment than after desmopressin (RR 0.11, 95% CI 0.02 to 0.78). REVIEWER'S CONCLUSIONS: Alarm interventions are an effective treatment for nocturnal bedwetting in children. Desmopressin and tricyclics appeared as effective while on treatment, but this effect was not sustained after treatment stopped, and alarms may be more effective in the long term. Comparisons between drug and behavioural treatments are needed, and should include relapse rates after treatment is finished.

Case-Control Studies↗
PubMed2004

Low energy reporting may increase in intervention participants enrolled in dietary intervention trials.

OBJECTIVE: To examine differences in low energy intake reporting between intervention and control groups during a dietary intervention trial. DESIGN: Retrospective data analysis from a subcohort of participants in the Polyp Prevention Trial (PPT), a 4-year, multisite, randomized, controlled dietary intervention trial. Intervention consisted of educational material and counseling sessions supporting a low-fat, high-fiber diet. Baseline and annual demographics, behavioral characteristics, energy intake (EI) based on self-reported 4-day food records, and height and weight of participants were collected at baseline and annually. Basal metabolic rate (BMR) was estimated (using the Schofield equation) to calculate EI/BMR. SUBJECTS: Of the 443 participants (302 male, 141 female) at baseline, 195 (43.3%) were younger than 60 years, and 394 (91%) were white. At Year 4, 383 participants remained: 186 (122 men, 64 women) in the intervention group, and 197 (133 men, 64 women) in the control group. STATISTICAL ANALYSES: Using either paired t tests or analysis of variance, the differences between the means for EI, weight, and EI/BMR were compared at baseline, Year 1, and Year 4 for the participants who remained at Year 4. The Goldberg EI/BMR cutoff value of 1.06 (for plausible EI) identified participants who reported low EI. Linear regression was used to quantify the association of various risk factors to EI/BMR and for multivariate analyses within groups. chi(2) contingency table analysis quantified differences of low energy reporting within groups. RESULTS: At baseline, 46.8% of women and 11.6% of men reported lower than plausible EI. Only men had a significant increase in low energy reporting after randomization. At Year 1, 18.9% of intervention group men reported low EI compared with 9.8% of control group men (P<.05). At Year 4, 23.0% of intervention group men reported low EI compared with 12.8% of control group men (P<.05). CONCLUSIONS/APPLICATIONS: Difference in low EI reporting between intervention and control groups could distort results from dietary intervention trials; interpretation of findings from dietary trials must include this potential bias. Intervention study design should include dietary intake data collection methods that are not subject to such bias (ie, biomarkers and performance criteria) to measure intervention compliance.

Basal Metabolism↗
PubMed2004

Multimicronutrient interventions but not vitamin a or iron interventions alone improve child growth: results of 3 meta-analyses.

Meta-analyses of randomized controlled intervention trials were conducted to assess the effects of vitamin A, iron, and multimicronutrient interventions on the growth of children < 18 y old. A PubMed database search and other methods identified 14 vitamin A, 21 iron, and 5 multimicronutrient intervention studies that met the design criteria. Weighted mean effect sizes and CI were calculated using a random effects model for changes in height and weight. Tests for homogeneity and stratified analyses by predefined characteristics were conducted. Vitamin A interventions had no significant effect on growth; effect sizes were 0.08 (95% CI: -0.20, 0.36) for height and -0.01 (95% CI: -0.24, 0.22) for weight. Iron interventions also had no significant effect on child growth. Overall effect sizes were 0.09 (95% CI: -0.07, 0.24) for height and 0.13 (95% CI: -0.05, 0.30) for weight. The results were similar across categories of age, duration of intervention, mode and dosage of intervention, and baseline anthropometric status. Iron interventions did result in a significant increase in hemoglobin (Hb) concentrations with an effect size of 1.49 (95% CI: 0.46, 2.51). Multimicronutrient interventions had a positive effect on child growth; the effect sizes were 0.28 (95% CI: 0.16, 0.41) for height and 0.28 (95% CI: -0.07, 0.63) for weight. Interventions limited to only vitamin A or iron did not improve child growth. Multimicronutrient interventions, on the other hand, improved linear and possibly ponderal growth in children.

Africa↗
PubMed2003

Effect of 7-year infancy-onset dietary intervention on serum lipoproteins and lipoprotein subclasses in healthy children in the prospective, randomized Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study.

BACKGROUND: We previously showed that low-saturated-fat dietary intervention from infancy until 5 years of age safely and effectively reduced serum cholesterol concentration. We now report how such intervention influenced serum lipids, LDL particle size, and HDL subfractions in children when they reached the age of 7 years. METHODS AND RESULTS: Healthy 7-month-old infants (n=1062) were randomized to the intervention (n=540) and control (n=522) groups. Each year, two individualized counseling sessions were organized to the intervention families. Serum lipid values were measured annually. The intervention boys had 0.20 to 0.39 mmol/L lower serum cholesterol values than the control boys throughout the follow-up (always P<0.05), but the values of the intervention and control girls did not differ. The LDL particle sizes and HDL subfractions were determined in a random subgroup of 96 intervention and 101 control children at the age of 7 years. The mean particle diameter of major LDL peak was 262.6 A in the intervention boys and 258.5 A in the control boys (P=0.05), and 259.2 A in the intervention girls and 261.3 A in the control girls (P=0.30). HDL2 and HDL3 cholesterol concentrations did not differ between the intervention and control children or between the two genders. CONCLUSIONS: The 7-year intervention favorably influenced not only the serum total and LDL cholesterol concentrations but also the LDL particle size in boys. LDL particle size remained unchanged in girls, as did HDL2 and HDL3 concentrations in both genders.

Child↗
PubMed2004

Developmentally appropriate sexual risk reduction interventions for adolescents: rationale, review of interventions, and recommendations for research and practice.

BACKGROUND: Despite awareness of the need to design developmentally appropriate sexual risk reduction interventions for adolescents, limited information exists to identify the aspects of intervention design or content that make an intervention developmentally appropriate. PURPOSE: (a) To clarify the rationale for designing developmentally appropriate interventions, (b) to review randomized controlled trials (RCTs) of adolescent sexual risk reduction interventions, (c) to identify developmentally appropriate strategies, (d) to examine the relationship between developmental appropriateness and sexual risk outcomes, and (e) to provide recommendations for research. METHODS: The authors examined studies (n = 24) published before 2003 that evaluated a risk reduction intervention, sampled adolescents, used an RCT study design, and evaluated sexual behavior outcomes. RESULTS: Content analysis indicated that the interventions tested were often tailored to the cognitive level of adolescents, as indicated by the use of exercises on decision making, goal setting and planning, and concrete explanation of abstract concepts. Interventions also addressed the social influences of risky sex such as peer norms and provided communication skills training. Overall, the interventions tested in RCTs were more effective in delaying the onset of sexual activity than in promoting abstinence among sexually active youth. Interventions with booster sessions were effective in reducing sexual risk behavior. The use of process measures, linked with developmental constructs, was rare. However, improvements in sexual communication skills and perceived norms for safer sex were associated with reductions in sexual risk outcomes. CONCLUSIONS: Developmental transitions during adolescence influence sexual behavior and should be considered when developing and evaluating risk reduction interventions for youth. Future research should assess process measures of key developmental constructs as well as risk behavior and biological outcomes.

Adolescent↗
PubMed2000

Self-help interventions for smoking cessation.

BACKGROUND: Many smokers give up smoking on their own, but provision of materials giving advice and information may assist them and increase the number who quit successfully. OBJECTIVES: The aims of this review were to determine the effectiveness of different forms of self-help materials, compared with no treatment and with other minimal contact strategies; the effectiveness of adjuncts to self-help, such as computer generated feedback, telephone hotlines and pharmacotherapy; and the effectiveness of approaches tailored to the individual compared with non-tailored materials. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register. Date of the most recent search September 1999. SELECTION CRITERIA: We included randomised trials of smoking cessation with follow-up of at least six months, where at least one arm tested a self-help intervention. We defined self-help as structured programming for smokers trying to quit without intensive contact with a therapist. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of subjects, the nature of the self-help materials, the amount of face to face contact given to subjects and to controls, outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates when available. Where appropriate, we performed meta-analysis using a fixed effects model. MAIN RESULTS: We identified forty-five trials. Twenty seven compared self-help materials to no intervention or tested materials as an adjunct to advice. In nine trials in which self-help was compared to no intervention there was a pooled effect which just reached statistical significance (odds ratio 1.23, 95% confidence interval 1.02 to 1.49). There was no evidence of benefit from adding self-help materials to face to face advice, or to nicotine replacement therapy. There was evidence from eight trials using materials which were tailored for the characteristics of individual smokers that such personalised materials were more effective than standard materials (odds ratio 1.41, 95% confidence interval 1.14 to 1.75). Adding follow-up telephone calls from counsellors also appeared to increase quitting (odds ratio 1.62, 95% confidence interval 1.33 to 1.97). One trial of offering access to a hotline also showed an effect. REVIEWER'S CONCLUSIONS: Self-help materials may provide a small increase in quitting compared to no intervention. There is no evidence that they have an additional benefit over other minimal interventions such as advice from a health care professional, or nicotine replacement therapy. There is evidence that materials tailored for individual smokers are more effective.

Behavior Therapy↗