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PubMed2006

The effect of a primary care intervention on management of patients with diabetes and hypertension: a pre-post intervention chart audit.

BACKGROUND: A principal goal in enhancing primary care in Canada is to increase emphasis on health promotion, disease prevention and the management of chronic diseases in the primary care setting. To achieve this goal in Nova Scotia, collaborative practice teams with a nurse practitioner and at least one physician were established, and both alternative funding arrangements for physicians and an information system were implemented. This study reports on the impact of this primary healthcare reform initiative on the quality of process-of-care, self-care and proxy measures for specific health outcomes for patients with diabetes and hypertension. METHODS: A pre- (April 1, 1999-March 31, 2000) post- (April 1, 2001-March 31, 2002) intervention audit of consenting patients was conducted at the four sites participating in the Strengthening Primary Care Initiative. Two hundred and eleven charts of patients with diabetes and 541 charts of patients with hypertension were audited. Process-of-care, targeted health outcomes, patient education and self-care items were measured for patients with diabetes. Process-of-care and outcome measures related to clinical management, blood pressure, lifestyle modifications and laboratory investigations were measured for patients with hypertension. Frequencies and proportions were calculated. McNemar's test was used to compare paired data pre- and postintervention. RESULTS: The percentage of patients with diabetes who achieved target blood pressure control rose from 20.4 to 28.5%. Annual screening for retinopathy increased from 33.8 to 41.9% and nephropathy from 61.7 to 71.3%. The percentage of patients monitoring blood glucose levels at home increased from 61.5% to 69.1%. HYPERTENSION: The percentage of patients with hypertension who had their blood pressure checked at least twice a year dropped from 89.1% to 85.0%; however, more patients achieved target systolic (rising from 40.6 to 55.3%) and diastolic (from 77.9 to 85.3%) blood pressure readings. Body mass index was recorded and moderate exercise prescribed to more patients. The percentage of patients with recorded fasting blood glucose levels (from 37.7 to 67.1%) and lipid profiles (from 62.6 to 69.1%) was markedly higher. CONCLUSION: Overall patient care related to diabetes and hypertension was either maintained or improved over the course of the initiative.

Adult↗
PubMed2001

Collaborative writing: the effects of metacognitive prompting and structured peer interaction.

BACKGROUND: The structured system for peer assisted learning in writing named Paired Writing (Topping, 1995) incorporates both metacognitive prompting and scaffolding for the interactive process. AIM: This study sought to evaluate the relative contribution of these two components to student gain in quality of writing and attitudes to writing, while controlling for amount of writing practice and teacher effects. SAMPLE: Participants were 28 ten- and eleven-year-old students forming a problematic mixed ability class. METHODS: All received training in Paired Writing and its inherent metacognitive prompting. Students matched by gender and pre-test writing scores were assigned randomly to Interaction or No Interaction conditions. In the Interaction condition, the more able writers became 'tutors' for the less able. In the No Interaction condition, the more able writers acted as controls for the tutors and the less able as controls for the tutees. Over six weeks, the paired writers produced five pieces of personal writing collaboratively, while children in the No Interaction condition did so alone. RESULTS: On pre- and post-project analyses of the quality of individual writing, all groups showed statistically significant improvements in writing. However, the pre-post gains of the children who wrote interactively were significantly greater than those of the lone writers. There was some evidence that the paired writers also had more positive self-esteem as writers. CONCLUSION: The operation and durability of the Paired Writing system are discussed.

Child↗
PubMed2006

The effectiveness of computerized cognitive behavioural therapy in routine care.

OBJECTIVES AND DESIGN: The efficacy of a Computerized Cognitive Behavioural Therapy (CCBT) package, Beating the Blues, has been demonstrated in a large randomized controlled trial. The current study tests the generalizability of this finding in a naturalistic non-randomized trial. METHOD: 219 patients with anxiety and/or depression were recruited to receive CCBT in routine care. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and Work and Social Adjustment scale (WSA) were administered pre-treatment, immediately on completing treatment and at 6 months post-treatment. Single-item self-report measures of anxiety and depression were also collected during each treatment session. RESULTS: Completer and intention-to-treat analysis demonstrated statistically and clinically significant improvements on the CORE-OM, WSA and in self-reported anxiety and depression. Intention-to-treat analysis indicated an average 0.29-point drop on the CORE-OM, equating to an uncontrolled pre-post effect size of 0.50. Research completers achieved an average 0.61-point drop equating to an uncontrolled pre-post size of 1.00 on the same measure. Where data was available (18%), these benefits were maintained at week 32 (6 months follow-up). CONCLUSION: CCBT can be an effective first line tool within a stepped care framework for the management of common mental health problems.

Adult↗
PubMed2004

[The effect of aroma inhalation method on stress responses of nursing students].

PURPOSE: The purpose of this study is to identify the effect of aroma inhalation on stress responses (physical symptoms, levels of anxiety, perceived stresses)of nursing students. METHOD: This study was a quasi-experimental research using a non-equivalent pre-post design and was conducted from June 1 to June 5, 2002. The subjects consisted of 77 junior nursing students who were divided into 39 experimental group members and 38 control group members. A pretest and Post-test were conducted to measure body symptoms, the level of anxiety, and the level of perceived stress. In the experimental group, aromas were given using an aroma lamp, lavender, peppermint, rosemary and Clary-Sage. In the control group, the treatment was not administered. RESULT: As a result of administering aroma inhalation to nursing students, their physical symptoms decreased, their anxiety scores were low, and their perceived stress scores were low, showing that aroma inhalation could be a very effective stress management method. CONCLUSION: Nursing educators should play an important role in contributing to college students' physical and psychological health by helping enhance their recognition of stress management and effectively relieving their stress using essential oils.

Aromatherapy↗
PubMed2000

Outcomes monitoring and the testing of new psychiatric treatments: work therapy in the treatment of chronic post-traumatic stress disorder.

OBJECTIVE: To evaluate the effectiveness of a work therapy intervention, the Department of Veterans Affairs (VA) Compensated Work Therapy program (CWT), in the treatment of patients suffering from chronic war-related post-traumatic stress disorder (PTSD); and to demonstrate methods for using outcomes monitoring data to screen previously untested treatments. DATA SOURCES/STUDY SETTING: Baseline and four-month follow-up questionnaires administered to 3,076 veterans treated in 52 specialized VA inpatient programs for treatment of PTSD at facilities that also had CWT programs. Altogether 78 (2.5 percent) of these patients participated in CWT during the four months after discharge. STUDY DESIGN: The study used a pre-post nonequivalent control group design. DATA COLLECTION/EXTRACTION METHODS: Questionnaires documented PTSD symptoms, violent behavior, alcohol and drug use, employment status, and medical status at the time of program entry and four months after discharge from the hospital to the community. Administrative databases were used to identify participants in the CWT program. Propensity scores were used to match CWT participants and other patients, and hierarchical linear modeling was used to evaluate differences in outcomes between treatment groups on seven outcomes. PRINCIPAL FINDINGS: The propensity scaling method created groups that were not significantly different on any measure. No greater improvement was observed among CWT participants than among other patients on any of seven outcome measures. CONCLUSIONS: Substantively this study suggests that work therapy, as currently practiced in VA, is not an effective intervention, at least in the short term, for chronic, war-related PTSD. Methodologically it illustrates the use of outcomes monitoring data to screen previously untested treatments and the use of propensity scoring and hierarchical linear modeling to adjust for selection biases in observational studies.

Chronic Disease↗
PubMedDate not supplied

The association between prenatal and or post natal growth disorder and lipid profile in adolescents aged 12 - 15 years old in Tanjungsari Subdistrict, Sumedang, West Java.

AIM: to investigate association between growth disorders in pre and post natal period and abnormal lipid profile in adolescents aged 12 -15 years old in Tanjungsari population. METHODS: a cohort study was conducted in 3350 children who were born in 1988-1990 in Tanjungsari Subdistrict, Sumedang, West Java. A complete anthropometric data since their birth were collected from October 2002-February 2003. INCLUSION CRITERIA: Children who had birth weight in the range of +/- 3 of standard deviation (SD). Post natal growth disorder based on Z score of height according to age group and height changes at the age of 0-12 months and 12-36 months. SGA criteria were determined based on cross tabulation between weight and birth length at birth. Study subjects were divided into control group, groups of pre natal, post natal and pre-postnatal growth disorder. All subjects were checked for lipid profiles. Statistical calculation used analysis of variance, t test and logistic regression. 312 subjects were included in this study, 73 were in control group, 90 subjects in postnatal, 96 subjects were in pre natal and 53 subjects were in pre-post natal growth disorder group. RESULTS: this study has not shown significant difference in risk factor of having abnormal lipid profile between normal control group and growth disorder group except for those in prenatal growth disorder group with RR = 2.375 (p = 0.014). CONCLUSION: the post natal growth disorder had not influenced lipid profile in adolescents with SGA. Recent BMI was an additional risk factor for pre-post natal growth disorder group.

Adolescent↗
PubMed1997

The effects of high-volt pulsed current electrical stimulation on delayed-onset muscle soreness.

OBJECTIVE: We investigated three 30-minute high-volt pulsed current electrical stimulation (HVPC) treatments of 125 pps to reduce pain, restore range of motion (ROM), and recover strength loss associated with delayed-onset muscle soreness (DOMS). DESIGN AND SETTING: Randomized, masked comparison of three 30-minute treatment and sham HVPC regimens over a 48-hour period. SUBJECTS: Twenty-eight college students. MEASUREMENTS: Subjects performed concentric and eccentric knee extensions with the right leg to induce muscle soreness. Assessments were made before and after the exercise bout and each treatment at 24, 48, and 72 hours postexercise. RESULTS: Three separate 2 x 3 x 2 ANOVAs were used to determine significant differences (p < .05) between days, treatments, and pre-post treatment effects and significant interaction among these variables. Scheffe post hoc tests showed no significant reduction in pain perception or improvement in loss of function at 24, 48, and 72 hours postexercise. Mean pain perception assessments (0 = no pain, 10 = severe pain) for the HVPC group were 2.9, 4.5, and 3.5 and for the sham group 3.8, 4.8, and 3.5). Mean ROM losses for the HVPC group were 9.0 degrees , 22.3 degrees , and 26.2 degrees , and for the sham group were 9.5 degrees , 23.1 degrees , and 23.0 degrees . Mean strength losses (1RM) for the HVPC group were 25.9, 25.7, and 20.8 lbs and for the sham group were 22.3, 22.3, and 13.8 lbs. CONCLUSIONS: HVPC as we studied it was ineffective in providing lasting pain reduction and at reducing ROM and strength losses associated with DOMS.

Journal Article↗
PubMed1989

Influence of body hair removal on physiological responses during breaststroke swimming.

Nine male collegiate swimmers (EXP) were studied 8 d before (PRE) and 1 d after (POST) shaving the hair from their arms, legs, and exposed trunk. A control group (CON, N = 4) of their teammates was also tested at these times but did not remove body hair. In PRE and POST, distance per stroke (SL), VO2, heart rate (HR), and post-swim blood lactate concentration (BL) were measured during a 365.8 m breaststroke swim at approximately 90% effort. Subjects also performed a tethered breaststroke swim with retarding forces of 6.27, 7.75, and 9.26 kg. The EXP group experienced a significant (P less than 0.05) reduction in BL (mean +/- SE: 8.48 +/- 0.78 to 6.74 +/- 0.74 mmol.l-1), a decreased VO2 (3.60 +/- 0.15 to 3.27 +/- 0.14 l.min-1), an increase in SL (2.07 +/- 0.08 to 2.31 +/- 0.10 m.stroke-1), and an insignificant (P = 0.08) decline in HR (174 +/- 5 to 168 +/- 4 beats.min-1) during the free swim. The CON group showed no changes in BL, SL, or HR. During the tethered swim, there were no significant PRE-POST differences in VO2, HR, or BL for either group. In a separate group of swimmers (nine who shaved body hair and nine controls), removing body hair significantly reduced the rate of velocity decay during a prone glide after a maximal underwater leg push-off. It is concluded that removing body hair reduces active drag, thereby decreasing the physiological cost of swimming.

Adult↗
PubMedDate not supplied

Sustained effects of educating retailers to reduce cigarette sales to minors.

Despite state laws prohibiting the purchase of tobacco by minors, the ease with which underage youth can purchase cigarettes has been documented nationwide. The public health community as well as policy makers have called for a combination of retailer education and enforcement of laws prohibiting tobacco sales to minors. Enforcement activity may not be feasible in many communities, however, and an educational intervention may be the only option. This paper reports results of a 6-month followup assessment following a face-to-face education intervention with retailers to reduce cigarettes sales to minors in San Diego County, CA. A control-experimental group, pre-post design was employed to study the sustained effects of the program on the illegal sale of cigarettes to minors. A total of 236 stores were visited by minors, ages 14-17 years, with the intent of purchasing cigarettes. Information was collected three times: pre-test, immediately following the intervention, and 6 months after the intervention ended. The groups included a no-treatment control group of 108 stores and an intervention group of 128 that received three educational visits from project staff over a 1-year period. Community education via media and informational presentations was also conducted. As previously reported, a 68-percent pretest sales rate was found for stores overall. Immediately following the intervention, 32 percent of the intervention group and 59 percent of the control group sold cigarettes to minors. These results were maintained 6 months following the conclusion of the intervention. Results are discussed in terms of education versus use of enforcement.

Adolescent↗
PubMed1994

Suicide intervention training evaluation: a preliminary report.

To date, very little work has been done on evaluating training in suicide intervention. This study developed and piloted a comprehensive method for evaluating suicide intervention training by applying three studies of immediate training effects on (a) suicide intervention abilities, (b) attitudes to suicide and suicide intervention, and (c) knowledge about suicide. The focus of the evaluation was a broadly used 2-day suicide intervention training program. Changes in suicide intervention abilities were measured by the Suicide Intervention Response Inventory (SIRI) and by performance in simulated suicide intervention situations, scored with the Suicide Intervention Protocol (SIP). Subjects consisted of 19 workshop participants in a pre-post condition and 17 participants in a post-test only condition. Results indicated significant increases in skills in suicide intervention situations. No significant effects were noted on the SIRI. Results from the attitudes and knowledge studies were very preliminary. They are reported here so that others may become aware of the methodology being used and the status of evaluation of the target program. Implications for further research are discussed.

Adult↗
PubMedDate not supplied

[Evaluation of pipetting systems. III. Micropipette precision in a routine task].

OBJECTIVE: To establish a norm of the precision achievable with a micropipette in an IRMA assay under routine conditions. MATERIAL AND METHODS: A micropipette (Gilson) adjusted to dispense 100 microL was used by a single analyst with experience in its use. In each assay, ten aliquots of radioactive antiprolactin were pipetted in clean tubes (PRE-batch tubes), followed by pipetting of the tubes being processed in the assay, and at the end, a second pipetting of 10 aliquots in clean tubes (POST-batch tubes). The study includes the data of 15 consecutive batches during a seven month period with an overall mean of 283 tubes per batch. The PRE- and POST-tubes were read in a gamma counter (Crystal plus). The mean, SD and CV for PRE, POST and global (PRE+POST) tubes were calculated for each batch. RESULTS: The global CV of the 15 batches ranged from 1.6 to 6.9%, mean of 3.1%. We found no evidence of increased imprecision due to fatigue of the analyst, but surprisingly, we observed that in nine of the 15 batches there was a significant difference in the means of the PRE-tubes vs the POST-tubes (t test) without differences in precision. Thus, part of the global variability is due to what we have called pseudoimprecision (i.e. an increase in CV due to differences in means). In addition, the POST-tubes had higher values in the first 7 batches but the opposite occurred in the last 8 batches (table 2). This shift in the sign of the PRE-POST differences suggests the presence of opposite factors operating in time, i.e. one or more factors increased the volume of pipetting after using the pipette more than 150 times (batches 1-7) whereas other/others decreased it (batches 8-15). CONCLUSIONS: 1. Our first approximation to a norm of micropipetting precision in batches of 200-300 tubes was a CV of 3.1%. 2. This norm was influenced by a problem of pseudoimprecision detected ex-post-facto. 3. Our findings justify continuation studies to detect the pseudoimprecision and evaluate its causes prospectively.

Antibodies↗