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PubMed1998

Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial.

OBJECTIVE: To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain. DESIGN: A double-blind prospective randomized controlled trial. SETTING: Physical therapy outpatient department, tertiary care. PATIENTS: Ninety-three low back pain patients were randomly assigned to either a standard exercise program (n = 49) or a combined exercise and motivation program (n = 44). INTERVENTIONS: Patients were prescribed 10 physical therapy sessions and were advised to continue exercising after treatment termination. The motivation program consisted of five compliance-enhancing interventions. Follow-up assessments were performed at 3 1/2 weeks, 4 months, and 12 months. MAIN OUTCOME MEASURES: Disability (low back outcome score), pain intensity, physical impairment (modified Waddell score, fingertip-to-floor distance, abdominal muscle strength), working ability, motivation, and compliance. RESULTS: The patients in the motivation group were significantly more likely to attend their exercise therapy appointments (p = .0005). Four and 12 months after study entry there was a significant difference in favor of the motivation group with regard to the disability score (p = .004) and pain intensity (p < or = .026). At 4 months, there was a significant advantage for the motivation group in the fingertip-to-floor distance (p = .01) and in abdominal muscle strength (p = .018). No significant differences were found in motivation scores, self-reported compliance with long-term exercise, and modified Waddell score. In terms of working ability, there was a trend favoring the combined exercise and motivation program. CONCLUSION: The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.

Abdominal Muscles↗
PubMed2000

Verifying drug abuse prevention program effects using reciprocal best friend reports.

Considerable research suggests that social influences-based drug abuse prevention programming has produced the most consistently successful preventive effects. However, a common criticism of this literature is that most prevention intervention studies rely solely on self-reported substance use. The purpose of this study was to assess the effects of normative education, arguably the most successful component of social influence based prevention programs, on alcohol and cigarette consumption using both self- and reciprocal best friend reports of substance use. Analyses of subsamples of data from 11,995 students participating in the Adolescent Alcohol Prevention Trial revealed that normative education significantly delayed the onset of alcohol use across the eighth, ninth, and tenth grades among public school students. A similar but somewhat less robust pattern was found for cigarette use. These results suggest that self-report bias does not account for previous findings and demonstrate rather convincingly that normative education is an effective drug prevention strategy for public school settings.

Adolescent↗
PubMedDate not supplied

Health risk changes with a low-cost individualized health promotion program: effects at up to 30 months.

BACKGROUND AND PURPOSE: Health promotion programs are increasingly important components of health care in an era of predominantly chronic illness preceded by identified health risk behaviors. We report a large and relatively long experience with a low-cost intervention delivered through the mail and using sequential time-oriented risk appraisal and personalized recommendations, each six months, together with self-management materials. METHODS: We performed a prospective, longitudinal, observational study of 103,937 consecutive program participants observed for at least six months and up to 30 months. The primary study endpoint is overall health risk score, with secondary analysis of individual risk behaviors. A concurrent comparison group utilizes the initial scores of new participants by calendar time over the study period. RESULTS: Strong overall positive effects were observed, with improvement in computed health risk scores over 18 months of 14.7% (p less than .0001) in those 65 and over and 18.4% (p<.0001) in those under 65. At 30 months, improvement was 18.8% (p less than .0001) and 25.7% (p less than .0001), respectively. There was improvement in self-report scores for all targeted health risk behaviors, except for pounds over ideal weight, including smoking; dietary fat, salt, and fiber; alcohol; exercise; cholesterol; and reported stress. There was progressive improvement approximating 5% each six-month period. Results were consistent across age groups 16-35, 36-50, 51-65, and over 65 and over different educational level. Results could not be accounted for by sequential changes in initial health habits of participants over time. DISCUSSION: (ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Supplemental Food Program: effects on health and pregnancy outcome.

To determine the effect of participation in the Special Supplemental Food Program for Women, Infants, and Children on use of health care, health-related practices, health knowledge, and pregnancy outcome, a total of 519 pregnant women were interviewed during public health department clinics in six Alabama counties. Of the sample, 341 women were participants in the WIC program and were therefore at nutritional risk; 178 were control subjects (nonparticipants) who were not at nutritional risk. There were no significant differences in pregnancy outcome between the two groups. In fact, mean birth weight was identical (7.13 lb), and mean weight gain for WIC participants was 25.8 lb, compared to 24.9 for controls. Other findings were less positive, however. Utilization patterns and health-related practices differed little between groups. There was no significant difference in the percentage of women planning to nurse. Significantly more WIC participants had discussed nursing, but significantly fewer felt they knew how to nurse. WIC is effective in overcoming nutritional risk and improving pregnancy outcome, but its educational component needs to be strengthened.

Adolescent↗
PubMed1996

Analysis of prevention program effectiveness with clustered data using generalized estimating equations.

Experimental studies of prevention programs often randomize clusters of individuals rather than individuals to treatment conditions. When the correlation among individuals within clusters is not accounted for in statistical analysis, the standard errors are biased, potentially resulting in misleading conclusions about the significance of treatment effects. This study demonstrates the generalized estimating equations (GEE) method, focusing specifically on the GEE-independent method, to control for within-cluster correlation in regression models with either continuous or binary outcomes. The GEE-independent method yields consistent and robust variance estimates. Data from project DARE, a youth substance abuse prevention program, are used for illustration.

Adolescent↗
PubMed2001

A cognitive-behavioral return-to-work program: effects on pain patients with a history of long-term versus short-term sick leave.

A cognitive-behavioral return-to-work focused program was evaluated in a randomized controlled design, and the effects were compared between two groups of women with musculoskeletal pain. One group of patients (n=36) had a history of long-term sick leave (>12 months) at the start of the program and the other (n=36) had a history of short-term sick leave (2-6 months). The outpatient treatment program, conducted by a psychologist, included 12 sessions with the primary aim to help the patients return-to-work. The treatment first included teaching of coping strategies such as applied relaxation, stress management, graded activity training and pacing. Thereafter the patients were taught how to manage difficulties at their return-to-work and how to generalize coping strategies to different risk factors at their work places. The control condition received treatment-as-usual. The results showed that the cognitive-behavioral return-to-work program was more effective than the treatment-as-usual control condition in reducing the number of days on sick leave for patients on short-term sick leave, but not for patients on long-term sick leave. The treatment program also helped the patients on short-term sick leave to increase their ability to control and decrease pain and to increase their general activity level compared to the control condition. These results underscore the need for an early return-to-work focused rehabilitation to prevent long-term sick leave and disability.

Absenteeism↗
PubMed2001

Primary care-based physical activity programs: effectiveness in sedentary older patients with osteoarthritis symptoms.

OBJECTIVE: This study examined, in a group of older patients, (a) the effectiveness of an invitation to participate in a program providing individualized physical activity advice in a primary care setting and (b) the changes in self-reported physical activity and symptoms in patients with osteoarthritis (OA). METHODS: Healthy, sedentary community-dwelling men and women aged 60 years or more were invited to participate. Following random allocation, the intervention group received individualized physical activity advice at baseline and at 3, 6, and 12 months followup. RESULTS: Of the 299 people who satisfied the study's inclusion criteria, a subgroup of 69 people reported pain and stiffness of the hip or knee at baseline. These patients reported increases in frequency and time of walking and vigorous exercise (all P < 0.001), with no change to OA symptom scores (pain and stiffness), and a small decline in physical functioning was reported at 12 months followup in the control group only (P = 0.027). At the 12-month followup more intervention participants than control participants (P = 0.013) reported a greater intention to exercise. CONCLUSIONS: An offer of primary care-based physical activity advice, with an emphasis on the benefits for general health (rather than "treatment" for OA), will attract individuals with OA symptoms. Although the present study was unable to demonstrate intervention-control group differences for the majority of outcomes, intention to exercise did appear to be positively influenced.

Age Factors↗
PubMed2000

Reducing substance dependence in elderly people: the side effects program.

OBJECTIVES: To reduce benzodiazepine, narcotic and total prescription medication use in community-dwelling elderly people with suspected substance dependence. METHODS: A community-based substance dependence program for seniors was established, and referrals were accepted from a wide variety of sources (self-referral, families, emergency departments, family physicians, community agencies, etc). The service typically included several home visits by a nurse and/or social worker trained in recognizing and treating substance dependence in the elderly, medical assessment by a geriatrician and generation of a client-directed treatment plan. Treatment plans included individual and family counselling, recommendations regarding medication changes and involvement in a peer support/education group. Medication use, health care utilization, functional status, cognition and depression scales were collected before and six months after intervention. RESULTS: Of the 95 elderly patients with substance dependence that were seen over a period of 12 months, 55 agreed to participate in the program. Substance dependence included alcohol dependence in 23 participants, benzodiazepine dependence in 20 participants, narcotic dependence in six participants and mixed dependence in six participants. Involvement in the program was associated with significant reductions in depression scale scores (P=0.02), number of daily prescription medications (P=0.002), benzodiazepine use (P=0.01), narcotic use (P=0.04) and number of acute hospitalizations (P=0.001). No significant changes were noted in cognition, functional status, total prescription costs, office visits or emergency room visits. CONCLUSIONS: A community-based sub- stance dependence program for elderly people may significantly reduce narcotic, benzodiazepine and prescription medication use in this population. Further studies are needed to determine the cost effectiveness of such programs.

Activities of Daily Living↗
PubMed1994

The U.S. Navy Healthy Back Program: effect on back knowledge among recruits.

This study assessed the immediate effects of the U.S. Navy's Healthy Back Program in changing knowledge about back injury prevention. The prevalence of back problems among incoming recruits and correlates of back pain also were examined. Intervention recruits (n = 1,772) received the Healthy Back Program presentation, then completed a questionnaire. Control subjects (n = 1,658) completed an identical questionnaire but received no presentation. Intervention recruits scored significantly higher on back knowledge (67%) than controls (50%). About 41% of all recruits had experienced a back problem, 27% reported at least one back problem within the past year, and 11% reported back pain during recruit training. Lifting, sports participation, and bending were the leading causes of previous back problems. Better self-reported health and fitness were associated with fewer low back problems.

Adolescent↗
PubMed2002

Stable isotope aided evaluation of community nutrition program: effect of food supplementation schemes on maternal and infant nutritional status.

The supplementation program of the community nutrition project (PNC) launched by the Senegalese Government in order to protect the most vulnerable groups (children and women) was evaluated. Using a stable isotope (deuterium), we assessed the effect of the PNC on breastmilk output, mother's body composition, and baby's growth at three months of lactation. Breastmilk triglycerides, lactose, protein, and zinc were also determined. Mothers who were supplemented more than 60 days during pregnancy showed a significant increase in fat-free mass as compared to those who were supplemented for less than 30 days (p = .03). Breastmilk output was not influenced by the supplementation, but breastmilk lactose, total protein, and zinc contents increased significantly (p < .01) in the supplemented mothers. Growth of the babies of the supplemented mothers was better than that of those whose mothers were not supplemented. It was concluded that the food supplementation had beneficial effects on both mothers' and babies' nutritional status depending on the onset of the supplementation.

Adult↗
PubMed1996

Parental educational program: effectiveness and retention.

55 parents of adolescent children were asked to rate the effectiveness of their communication with their adolescents before and after a 10-wk. parent educational program encouraging authoritative parent-adolescent interactions. Parents reported improved effectiveness of communication from the pre- to post-program assessment times. Retention was compared across groups receiving high and low support in attendance of meetings, but retention did not differ across the two groups.

Adolescent↗
PubMed1998

Premedical program effective in increasing admissions to health professional schools.

The Special Premedical Studies Program (SPSP) has been successful in preparing Aboriginal students in Canada for admission to medicine, dentistry, medical rehabilitation, and pharmacy at the University of Manitoba. The success rate for admission to these faculties is 20%. There is a higher failure rate in the basic years of medical/dental education, but remediation has been 100% successful. Failure rates in the clinical years do not differ from those of the mainstream population. Grade point averages and MCAT scores are given less weight in the special consideration category of application at the University of Manitoba. SPSP students can and do apply to this category. The higher rate of first unsuccessful attempt in the basic years of medical education specifically can be attributed to a variety of factors, including reading skills. Although the numbers are small, we show that there is a correlation between the comprehension score of the Nelson-Denny test and the verbal score of MCAT. But there was no difference on the average between verbal score in MCAT and pass/fail in basic medical years. Students who scored above the 80th percentile on the comprehension portion of the Nelson-Denny test were successful in their first attempt at examinations in medical school.

American Indian or Alaska Native↗
PubMed1992

Health program effectiveness measurement: a case of degenerative disease.

An administrator of a Health Program aiming at the control of a specified disease has a need for a quantitative evaluation of the consequences of the Program's realization. On the population level, Lifetime Lost (LTL) figures calculated for both target and reference populations might be used for this purpose. The LTL methodology provides a user with a new procedure for medical data processing. It allows to estimate the LTL values from mortality data only, without the laborious procedure of registration of the morbidity episodes in target and reference populations. This approach is valid for a special case of degenerative diseases.

Aged↗
PubMed1990

A comparison of single-versus multi-modal exercise programs: effects on aerobic power.

The purpose of this study was to compare the effects of a 10-week single mode (SM) training program (walk/jog) versus a multimode (MM) training program (walk/jog, cycle, arm crank) on peak aerobic power (VO2 peak) during three ergometry modes. Twenty Ss were stratified initially according to gender and then randomly assigned to either of the treatment groups. Seven additional Ss served as controls. Peak VO2 was determined during treadmill running, cycle ergometry and arm crank ergometry prior to and after ten weeks of training. Training for the SM group (N = 9) consisted of walk/jog three days per week for five weeks at approximately 50-60% peak VO2 and an energy cost of approximately 2400 kJ per week, then increased to approximately 3200 kJ for the duration of the study. Training for the MM group (N = 8) was isoenergetic to the SM group. However, the training differed in that subjects exercised one day walk/jog, one day cycling, and one day arm cranking. Controls were tested twice with no treatment between. Post-training VO2 peaks for the three ergometry modes were analyzed with an analysis of covariance, utilizing pre-training scores as a statistical covariate. The post-training SM VO2 was found to be significantly greater than either the MM or C when testing on the treadmill. No other comparison was statistically significant. These data support the concept that a conditioning program can become sufficiently variable so that expected increases in aerobic power are not produced, despite the fact that isoenergetic training is undertaken.(ABSTRACT TRUNCATED AT 250 WORDS)

Arm↗
PubMedDate not supplied

State borad examinaions and associate degree program effectiveness.

Relative effectiveness of the 13 Washington State associate degree (AD) programs was rated by 102 directors of nursing, AD nursing educators, and state board members. When the programs were ranked according to these ratings and the average of the programs' state board examinations, only a small positive relationship was obtained. State board examinations, therefore, should not be used by state and federal agencies as a composite measure of program effectivensss. Instead, the examinations should remain an assessment of th eminimum competency of individuals.

Education, Nursing, Associate↗
PubMed2000

Prevention of falls in the construction industry: evidence for program effectiveness.

OBJECTIVE: The objective of this study was to review the evidence for the effectiveness of different strategies to prevent falls from heights in the construction industry. SEARCH STRATEGY: We used the Cochrane Collaboration search strategy to search the following electronic databases: MEDLINE, EMBASE, NIOSHTIC, PsycINFO and Dissertation Abstracts. The reference lists from each potentially eligible study were checked, and knowledgeable people in the field were contacted for additional leads to published reports. SELECTION CRITERIA: Studies were included if they (1) examined the effectiveness of an intervention to decrease falls from heights to construction workers, (2) included data on one of the outcomes of interest, and (3) included a comparison group. MAIN RESULTS: We identified only three studies for review. An ecologic study found some evidence that regulations with enforcement may decrease falls in construction industry. Two studies on educational efforts suggested that educational programs may decrease falls but methodologic limitations restricted the conclusions that could be drawn. CONCLUSIONS: There are few data to support the effectiveness of current programs to decrease fall-related injuries in the construction industry. Rigorous evaluation of these interventions is indicated.

Accident Prevention↗
PubMed1998

Police perspectives on responding to mentally ill people in crisis: perceptions of program effectiveness.

In this study, we sampled sworn police officers from three law enforcement agencies (n = 452), each of which had different system responses to mentally ill people in crisis. One department relies on field assistance from a mobile mental health crisis team, a second has a team of officers specially trained in crisis intervention and management of mentally ill people in crisis, and a third has a team of in-house social workers to assist in responding to calls. Calls involving mentally ill people in crisis appear to be frequent and are perceived by most of the officers to pose a significant problem for the department; however, most officers reported feeling well prepared to handle these calls. Generally, officers from the jurisdiction with a specialized team of officers rated their program as being highly effective in meeting the needs of mentally ill people in crisis, keeping mentally ill people out of jail, minimizing the amount of time officers spend on these calls, and maintaining community safety. Officers from departments relying on a mobile crisis unit (MCU) and on police-based social workers both rated their programs as being moderately effective on each of these dimensions except for minimizing officer time on these calls where the MCU had significantly lower ratings.

Adult↗
PubMed1995

A breast feeding education and promotion program: effects on knowledge, attitudes, and support for breast feeding.

This study was undertaken to determine the effects of a partner-support, incentive-based educational program on breast feeding knowledge, attitudes and support and to examine the relationship between feeding intentions and feeding behavior among low-income women. Women who expressed a willingness to participate in the intervention were randomly assigned to "intervention" and "usual breast feeding" (control) groups. Sixty-eight primipara women with expected due dates between May and December, 1992, volunteered to participate in the study. Of these, 34 were randomly assigned to each of the two groups. Approximately 81 percent of the women completed the study, leaving n = 29 in the control group and n = 26 in the intervention group. The intervention consisted of special incentives (prizes) for women and their partners to participate in several breast feeding education and promotion activities. Intervention group women and their partners experienced positive changes in breast feeding knowledge and attitudes. Furthermore, the intervention seemed to have influenced more women in the treatment group to breast feed despite their prenatal feeding intentions. In addition, the partners of intervention group women were perceived to be more supportive of breast feeding than control group partners. These findings suggest that incentives, such as donated prizes, can be used to attract lower socioeconomic group women and their partners to breast feeding promotion interventions. Participation in such interventions can produce positive changes in breast feeding knowledge, attitudes, and support, and can have a dramatic effect in promoting breast feeding.

Breast Feeding↗