Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “interventions”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,099 records · Page 61Linked to original sources
PubMed2002

Long-term effects of a collaborative care intervention in persistently depressed primary care patients.

OBJECTIVE: A previous study described the effect of a collaborative care intervention on improving adherence to antidepressant medications and depressive and functional outcomes of patients with persistent depressive symptoms 8 weeks after the primary care physician initiated treatment. This paper examined the 28-month effect of this intervention on adherence, depressive symptoms, functioning, and health care costs. DESIGN: Randomized trial of stepped collaborative care intervention versus usual care. SETTING: HMO in Seattle, Wash. PATIENTS: Patients with major depression were stratified into severe and moderate depression groups prior to randomization. INTERVENTIONS: A multifaceted intervention targeting patient, physician, and process of care, using collaborative management by a psychiatrist and a primary care physician. MEASURES AND MAIN RESULTS: The collaborative care intervention was associated with continued improvement in depressive symptoms at 28 months in patients in the moderate-severity group (F1,87 = 8.65; P =.004), but not in patients in the high-severity group (F1,51 = 0.02; P =.88) Improvements in the intervention group in antidepressant adherence were found to occur for the first 6 months (chi2(1) = 8.23; P <.01) and second 6-month period (chi2(1) = 5.98; P <.05) after randomization in the high-severity group and for 6 months after randomization in the moderate-severity group(chi2(1) = 6.10; P <.05). There were no significant differences in total ambulatory costs between intervention and control patients over the 28-month period (F1,180 = 0.77; P =.40). CONCLUSIONS: A collaborative care intervention was associated with sustained improvement in depressive outcomes without additional health care costs in approximately two thirds of primary care patients with persistent depressive symptoms.

Adult↗
PubMed2001

A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients.

OBJECTIVES: To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients. DESIGN: Longitudinal prospective before/after design (sequential design). SETTING: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium. PARTICIPANTS: 60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12). INTERVENTION: (1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol. MEASUREMENTS: All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively. RESULTS: Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P =.82), duration of delirium was shorter (P =.03) and severity of delirium was less (P =.0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive. CONCLUSIONS: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.

Activities of Daily Living↗
PubMed2003

Preventing falls in community-dwelling frail older people using a home intervention team (HIT): results from the randomized Falls-HIT trial.

OBJECTIVES: To evaluate the effect of an intervention by a multidisciplinary team to reduce falls in older people's homes. DESIGN: Randomized, controlled trial with follow-up of subjects for 1 year. SETTING: University-affiliated geriatric hospital and older patients' homes. PARTICIPANTS: Three hundred sixty subjects (mean age +/- standard deviation = 81.5 +/- 6.4) admitted from home to a geriatric hospital and showing functional decline, especially in mobility. INTERVENTION: The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a diagnostic home visit and home intervention or a comprehensive geriatric assessment with recommendations and usual care at home. The home intervention included a diagnostic home visit, assessing the home for environmental hazards, advice about possible changes, offer of facilities for any necessary home modifications, and training in the use of technical and mobility aids. An additional home visit was made after 3 months to reinforce the recommendations. After 12 months of follow-up, a home visit was made to all study participants. MEASUREMENTS: Number of falls, type of recommended home modifications, and compliance with recommendations. RESULTS: After 1 year, there were 163 falls in the intervention group and 204 falls in the control group. The intervention group had 31% fewer falls than the control group (incidence rate ratio (IRR) = 0.69, 95% confidence interval (CI) = 0.51-0.97). The intervention was most effective in a subgroup of participants who reported having had two or more falls during the year before recruitment into the study. In this subgroup, the proportion of frequent fallers and the rate of falls was significantly reduced for the intervention group compared with the control group (21 vs 36 subjects with recurrent falls, P =.009; IRR = 0.63, 95% CI = 0.43-0.94). The compliance rate varied with the type of change recommended from 83% to 33% after 12 months of follow-up. CONCLUSION: Home intervention based on home visits to assess the home for environmental hazards, providing information about possible changes, facilitating any necessary modifications, and training in the use of technical and mobility aids was effective in a selected group of frail older subjects with a history of recurrent falling.

Accidental Falls↗
PubMed2004

Effectiveness of a disease management programme for patients with type 2 diabetes mellitus and albuminuria in primary care - the PROSIT project (Proteinuria Screening and Intervention).

Aims. To evaluate the structured PROSIT(R) disease management programme for high-risk diabetic patients in primary care with respect to the cardio-vascular risk profile and mortality. Subjects and Methods. Retrospectively 55 albuminuric Type 2 diabetic patients included into the PROSIT(R) programme from 1994 to 1999 (intervention group: age 66.6 +/- 10.5 years, known duration of diabetes 8.9 +/- 6.5 years) were compared with 58 albuminuric patients not participating in the PROSIT(R) programme (control group: age 68.5 +/- 10.4 years, known duration of diabetes 8.5 +/- 6.7 years). Within PROSIT(R) a structured multifactorial intervention programme was applied. The main characteristics of this intervention were strict follow-ups of the patient's risk profile every three months and the use of quality management methods (definition of target values, structured documentation, central data feedback with diagnostic and therapeutic recommendations based on European guidelines). The cardio-vascular risk profile, therapeutic intervention, and secondary diabetic complications were compared between both groups in 1994 and 1999. Results. In the period from 1994 to 1999 the intervention group showed a significant improvement in the vascular risk profile, while the control group did not. In 1999 the mean arterial blood pressure was significantly lower compared to the control group (115 +/- 13 mm Hg vs. 125 +/- 16 mm Hg, p < 0.05). The HbA1c improved only in the intervention group and in 1999 it was significantly lower than in the control group (7.0 +/- 1.3 % vs. 8.4 +/- 1.8 %, p < 0.01). Moreover, the occurrence of clinical endpoints in the intervention group could be reduced: Both the mortalitly rate (14.5 % vs. 34.5 %, p < 0.05) and the rate of new myocardial infarctions (6 % vs. 20 %, p < 0.05) of the intervention group were significantly lower. Conclusions. Participation of albuminuric Type 2 diabetic patients and their physicians in a structured intervention programme showed positive effects on the cardio-vascular risk profile and endpoints compared with a group of non-participating patients and physicians.

Aged↗
PubMed2006

[Economic evaluation of angiographic interventions including a whole-radiology in- and outpatient care].

PURPOSE: To determine the economic efficiency of a whole-radiology in- and outpatient treatment with angiographic interventions performed as the main or sole therapy. MATERIALS AND METHODS: The calculations represent the data of a university radiology department, including the following angiographic interventions (neuroradiology not considered): Vascular intervention (PTA, stent implantation) of kidneys and extremities, recanalization of hemodialysis access, chemoembolization, diagnostic arterioportal liver CT, port implantation, varicocele embolization, PTCD, percutaneous implantation of biliary stent. First, the different angiographic interventions are categorized with reference to the German DRG system 2005. Considering the example of a university hospital, the individual cost of each intervention is calculated and correlated with reimbursements by G-DRG2005 and so-called "ambulant operation" (EBM200plus). With these data, profits and losses are calculated for both in- and outpatient care. RESULTS: Radiologic interventions of inpatients yield a profit in the majority of cases. With a base rate of 2900 euros, the profits in our university hospital range between - 872 euros and + 3411 euros (mean: + 1348 euros). On the other hand, those angiographic interventions suitable for "ambulant operation" generate average profits of + 372 euros, if only direct costs are considered. The data of outpatient radiological interventions average between 381 euros up to 1612 euros lower than compared with profits obtained from in patient care. CONCLUSION: Once an angiographic intervention represents the major or sole therapy, German radiologists are advised to operate out- and inpatient care by themselves. In Germany, the G-DRG-system and EBM enable radiology departments to generate considerable proceeds for their hospitals and, secondly, to yield a valuable add-on profit for their own department budget, which then is partly detached from the inflexible conventional reimbursement of radiological services.

Angiography↗
PubMedDate not supplied

Self-care and quality of life in patients with advanced heart failure: the effect of a supportive educational intervention.

OBJECTIVE: The goal of this study was to determine the effects of a supportive educational nursing intervention on self-care abilities, self-care behavior, and quality of life of patients with advanced heart failure. DESIGN: The study design was an experimental, random assignment. SETTING: The study was located at the University Hospital in Maastricht, The Netherlands. PATIENTS: The study included 179 patients (mean age 73 years, 58% men, New York Heart Association classification III and IV) admitted to a university hospital with symptoms of heart failure. OUTCOME MEASURES: Outcome measures included self-care abilities (Appraisal of Self-care Agency Scale), self-care behavior (Heart Failure Self-care Behavior Scale), 3 dimensions of quality of life (functional capabilities, symptoms, and psychosocial adjustment to illness), and overall well-being (Cantril's ladder of life). INTERVENTION: The intervention patients received systematic education and support by a nurse in the hospital and at home. Control patients received routine care. RESULTS: Self-care abilities did not change as a result of the intervention, but the self-care behavior in the intervention group was higher than the self-care behavior in the control group during follow-up. The effect of the supportive educational intervention on quality of life was limited. The 3 dimensions of quality of life improved after hospitalization in both groups, with no differences between intervention and control group as measured at each follow-up measurement. However, there was a trend indicating differences between the 2 groups in decrease in symptom frequency and symptom distress during the 9 months of follow-up. CONCLUSION: A supportive educational nursing intervention is effective in improving self-care behavior in patients with advanced (New York Heart Association class III-IV) heart failure; however, a more intensive intervention is needed to show effectiveness in improving quality of life.

Adaptation, Psychological↗
PubMed1999

Do workplace interventions prevent low-back disorders? If so, why?: a methodologic commentary.

The demand for workplace interventions to prevent low-back disorders has increased in recent years. At the same time, a crisis in the literature has become apparent: there are conflicting reports on whether or not these interventions work. With the aim of understanding the reason for the dissension in the literature, six studies were selected for close examination. These were studies of interventions based on differing principles, i.e. a change in organizational ethos to promote back safety, back belt use, the introduction of ergonomic devices, and back-strengthening exercises. If the studies are taken at face value, any of the interventions, regardless of type, has a tremendous effect. Methodological problems inherent in these studies may provide a clue to why essentially different interventions were found to be consistently successful. Study design quality has long been noted to exert a particular influence on the evaluation of outcomes: the quality of the study design is often inversely related to reported outcomes. Of the six studies selected for examination, four did not include a contemporaneous control group, five did not randomly assign subjects to test and control groups, and none included a placebo group. Given these research designs, variables other than those tested by the studies may have produced the reported results. These variables include 'beliefs of the intervention providers' and 'coalescence of the work group', both of which are discussed. Two approaches, the pragmatic and the explanatory, may be used to study workplace interventions to prevent low-back disorders. Most of the examined studies are pragmatically oriented. Having dealt with study design problems expeditiously, these studies may be characterized as more immediately responsive to the demand to evaluate workplace interventions than explanatory studies. On the other hand, explanatory studies, most notably associated with randomized clinical trials in medicine, are more rigorous. Enough pragmatically oriented studies have been conducted to suggest that workplace interventions may have an effect on low-back disorders. More conclusive explanatory studies may now be conducted.

Accidents, Occupational↗
PubMedDate not supplied

HIV/AIDS among probationers: an assessment of risk and results from a brief intervention.

A number of studies have examined HIV risk behaviors in prisoner populations, but relatively few have examined such behaviors in probationer populations. Since probationers have more opportunities to engage in risk behaviors than do prisoners, the potential importance of HIV interventions with probationers becomes readily apparent. This article examines a sample representative of the supervised probationer population in Delaware. The sample respondents received a baseline interview, then were randomly selected to receive either an enhanced version of NIDA standard HIV Intervention or a Focused Intervention based on a cognitive thought-mapping model. Intervention boosters were offered at two follow-up intervals in the following three months, and respondents were reinterviewed at six months. The data at baseline suggest that probationers in Delaware have levels of injection drug use, other serious drug use, and rates of risky sexual behaviors that approach those observed in prison populations. The interventions' effectiveness in changing attitudes and behaviors at the six-month interview was then examined. The data support the conclusion that brief interventions can significantly impact both drug use and sexual risk behaviors among probationers. However, there do not appear to be significant improvements for those receiving the more intensive Focused Intervention, as compared to those who receive the enhanced Standard Intervention. Further work will consider what components in programs and characteristics in clients should be considered in selecting the most appropriate interventions for probationers.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Intervention among frequent attenders of the out-of-hours service: a stratified cluster randomized controlled trial.

OBJECTIVE: To investigate whether the number of frequent attenders (FA) contacts with the out-of-hours service can be reduced by deploying a combination of intervention strategies. DESIGN: A stratified cluster randomized controlled trial, each cluster containing a general practice and all its listed patients. SETTING: The out-of-hours service in the county of Northern Jutland (490,000 inhabitants), Denmark. INTERVENTIONS: The following intervention strategies were deployed: predisposition, individual instruction, economic incitement, continuing medical education meetings, feedback/reminder, and patient-mediated intervention. SUBJECTS: An intervention group of 3500 patients and a control group of 4635 patients. MAIN OUTCOME MEASURES: Absolute and relative fall in the number of contacts with the out-of-hours service per patient after 6 and 12 months. RESULTS: Analysed by group, intervention patients saw a more pronounced decline in the number of contacts than controls, except for two outcomes. However, this difference was only significant after 12 months. For women aged 17-66 years with 5-9 contacts during the previous 12 months, the decrease was significantly more pronounced in the intervention group for all outcomes (p=0.004-0.042). However, for the rest of the subgroups the effect varied more, and in several cases it was more distinct in the control group. CONCLUSION: The data collected point towards an effect of intervention on the use of out-of-hours services even if the responses obtained were not uniform and unequivocal. However, one has to consider the problems of multiple comparisons and in conclusion no convincing effect of the intervention was found.

Adolescent↗
PubMed2000

Development of schoolchildren's smoking habits: questionnaire studies in intervention and control groups.

The objective of the present study was to describe the development of smoking from the sixth grade (age 12) to the eighth (age 14), for girls and for boys, and to study the effect of a simple anti-smoking intervention carried out in the sixth grade. All the roughly 2000 schoolchildren in Kronoberg County, born in 1982, completed an annual anonymous classroom questionnaire on smoking habits in the years 1994-96. In 1994, there were two visits, each lasting 80 min, by a campaigner from A Non-Smoking Generation to the 59 schools which opted for intervention, and no visits to the 21 schools which declined intervention. Before the intervention there were no differences in the frequency of smokers between the intervention group and the control group. In 2 y the proportion of smokers then rose among the girls from 1% to 12% and among the boys from 2% to 7%. Two years after the intervention, the proportion of smokers in the intervention group was approximately two-thirds of that in the control group. When the statistical analysis was based on the individual pupils, the difference between the two groups was statistically significant, but if the schools were used as the unit of analysis, the result was non-significant. Even a small-scale intervention may have an effect on the development of smoking among schoolchildren, but other preventive measures in the schools probably also contributed to the positive development of smoking in the intervention group.

Adolescent↗
PubMed2000

Cost-effectiveness of an HIV risk reduction intervention for adults with severe mental illness.

Small-group HIV prevention interventions that focus on individual behavioural change have been shown to be especially effective in reducing HIV risk among persons with severe mental illness. Because economic resources to fund HIV prevention efforts are limited, health departments, community planning groups and other key decision-makers need reliable information on the cost and cost-effectiveness (not solely on effectiveness) of different HIV prevention interventions. This study used an economic evaluation technique known as cost-utility analysis to assess the cost-effectiveness of three related cognitive-behavioural HIV risk reduction interventions: a single-session, one-on-one intervention; a multi-session small-group intervention; and a multi-session small-group intervention that taught participants to act as safer sex advocates to their peers. For men, all three interventions were cost-effective, but advocacy training was the most cost-effective of the three. For women, only the single-session intervention was cost-effective. The gender differences observed here highlight the importance of focusing on gender issues when delivering HIV prevention interventions to men and women who are severely mentally ill.

Adult↗
PubMed2003

Development of a structured generic drug intervention model for public health purposes: a brief application of motivational interviewing with young people.

Brief applications of Motivational Interviewing (MI) emerged around 15 years ago to target problematic alcohol and other drug use. Interventions which specifically target illicit drug use, young people, or which are delivered in settings other than health-care services have, however, been relatively slow to develop. The needs of young people for interventions distinct from those offered to adults are considered, as a precursor to an outline of the structure of a newly adapted intervention targeting drug use in general among young people. Based upon earlier topic-based approaches developed by Rollnick et al. this intervention is innovative in simultaneously targeting a range of drugs in pursuit of secondary prevention objectives, while also seeking to manifest the spirit of MI. The intervention consists of a single-session face-to-face conversation of up to 60 minutes duration. Data are presented which describe the development and conduct of this intervention during the course of an efficacy trial, with promising efficacy data themselves reported elsewhere. Observations are made on intervention delivery and consideration is given to implications for further novel targeting of young people and within the field of addiction interventions more generally. [McCambridge J, Strang J. Development of a structured generic drug intervention model for public health purposes: a brief application of motivational interviewing with young people.

Adolescent↗
PubMedDate not supplied

Metaphonological skills of children with phonological disorders before and after phonological and metaphonological intervention.

This study investigated the relationships between the phonological and metaphonological skills of 19 children aged 3-5 years with moderate to severe phonological disorders, and the effects of intervention on the children's awareness skills. Seven tasks were used which required children to produce alliterations and rhymes, to segment sentences, disyllabic and monosyllabic words, and to change the names of objects. Children's metaphonological skills were tested (a) before intervention, (b) following phonological intervention and (c) following phonological plus metaphonological intervention. Evaluation of children's segmental and syllable/wordshape profiles before intervention indicated that children with larger phonetic inventories and better word and syllable shapes tended to have higher metaphonology task scores. Individual variation, however, suggested that children's overall phonological profiles rather than particular characteristics of their speech were more important for good metaphonological task performance. Children's phonological awareness skills were also related to their morphosyntactic production skills. Intervention outcomes indicated that both phonological and metaphonological intervention may result in a significant increase in children's metaphonological task performance. It was further observed that children with more moderate phonological disorders and good morphosyntactic production skills tended to improve on the metaphonological tasks after phonological intervention alone. Children with more severe phonological and morphosyntactic disorders tended to increase their task performance only after phonological plus metaphonological intervention.

Child, Preschool↗
PubMed2006

Evaluation of an intervention designed to enhance involvement of older patients in their own care.

OBJECTIVE: To implement a programme for involvement of older patients aged 70+ in general practice, and to detect quality changes after its implementation. METHODS: The study was performed in 11 European countries as an uncontrolled before-and-after study, in which a number of GPs and patients answered a questionnaire before and after receiving an intervention. The intervention was aimed at motivating, instructing and facilitating GPs and older patients to increase patient involvement during consultation by use of a specially designed consultation leaflet. RESULTS: Valid data from seven countries exist. There was a total of 765 patients and 70 GPs in the pre-intervention phase, and 564 patients and 49 GPs in the post-intervention phase. In the post-intervention group, 43% of the patients thought that the consultation leaflet had improved the consultation and 62% of the GPs found it to be useful. There were no significant differences between pre- and post-intervention patient perceptions of the level of involvement, evaluations of consultations and perceptions of feeling enabled to deal with their health situation. CONCLUSION: Quality of consultations as measured by patient satisfaction and patient enablement did not improve as a result of the intervention, but nearly half of the patients and two thirds of the GPs found the intervention to be useful. Unselected use of this intervention on all patients cannot be advised without further studies on possible effects. Future studies should focus on the applicability and benefits of the methods for special patient groups.

Adult↗
PubMed2006

Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania: development of a theory- and evidence-based intervention programme.

AIMS: Action to prevent the spread of HIV among young people in Sub-Saharan Africa is needed urgently. In order to be effective, such action should be theory and evidence based and carefully adapted to local cultures and contexts. The present article describes the organization, theoretical basis, and methodological approach of a project that aims at developing and evaluating school-based interventions targeting adolescents aged 12-14 years. METHODS: Researchers from European and African universities have developed interventions that were conducted in three sites: Cape Town and Polokwane (South Africa) and Dar es Salaam (Tanzania). In each site the interventions were evaluated through large-scale field experiments with intervention schools and delayed intervention schools and with baseline and two follow-up data collections. Minimum sample sizes were estimated for each site based on local data and taking into account that the unit of allocation was schools and not individual students (the design effect). During the formative phase as well as within the field experiments, qualitative studies were also conducted. DISCUSSION: The interventions were developed consistent with the Intervention Mapping approach, and the theoretical framework was based on a modified version of the Theory of Planned Behaviour. The limitations of Western social cognition models were recognized, and the theoretical framework has therefore been expanded in two directions: towards integrating cultural processes and towards taking societal factors and constraints into account. CONCLUSION: The project will throw light on the application of social cognition models as well as the usefulness of the Intervention Mapping approach to intervention development in sub-Saharan Africa.

Adolescent↗
PubMed2002

An evaluation model for psychoeducational interventions using interactive multimedia.

A review of published evaluations of psychoeducational interventions using interactive digital multimedia shows that evaluations typically address only some of the areas that collectively would constitute a comprehensive evaluation. There appears to be a need for an accepted standard for these evaluations, based on a general evaluation model that encompasses all relevant aspects of development, efficacy and use of multimedia interventions. A comprehensive model is proposed which includes special features of multimedia interventions that lead to unique evaluation requirements. The model integrates relevant aspects of program evaluation and clinical trials models in order to provide a unique model that includes all the evaluation domains relevant to digital multimedia interventions. These include evaluation of intervention theory, intervention design strategies, the formative process, intervention efficacy (process and outcome) and contextual issues such as evaluability assessment, reporting and stakeholder issues. The application of individual components of the model is illustrated with reference to problems in the evaluation literature on a particular type of digital multimedia intervention, electroencephalographic biofeedback for Attention-Deficit/Hyperactivity Disorder. The model should be useful for researchers planning evaluations of digital multimedia interventions, especially in the psychoeducational domain. This paper provides a theoretical and evidential background for the evaluation model, and includes a checklist and flowchart for the planning and conduct of the evaluation.

Attention Deficit Disorder with Hyperactivity↗
PubMed2006

Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention.

OBJECTIVE: This study tested the efficacy of an 8-week culturally targeted nutrition and physical activity intervention on body composition. METHODS: A randomized, attention-controlled, two-group trial was conducted in a blackowned commercial gym with a sample of 366 predominantly healthy, obese African American women. A free 1-year membership to the study site gym was provided to participants in both groups. Data were collected at baseline, 2, 6, and 12 months. RESULTS: Sample retention at 1 year was 71%. Between-group longitudinal analysis including only participants with complete data revealed a trend toward weight stability in the intervention group at 2 months compared with controls (+0.05 kg/m(2), p = 0.75; +0.32 kg/m(2), p = 0.08, respectively), disappearing at 12 months (+1.37 kg/m(2), p = 0.0001; +1.02 kg/m(2), p = 0.001, respectively). Within-group analysis demonstrated that intervention and control participants' fitness (1-mile run-walk) improved by 1.9 minutes (p = 0.0001) and 2.3 minutes (p = 0.0001), respectively, at 12 months. Mixed model regression analyses demonstrated a significant main effect of the intervention on fitness (p = 0.0185) and a marginally significant effect on body mass index (BMI) (p = 0.057), at 2 months, disappearing by 6 months. By 12 months, however, the controls exhibited a significant advantage in waist circumference stability compared with intervention participants (+1.1 cm, p = 0.2763; +2.1 cm, p = 0.0002, respectively). CONCLUSIONS: The intervention produced modest short-term improvements in body composition, but the economic incentive of a free 1-year gym membership provided to all participants was a more potent intervention than the education and social support intervention tested. However, longer-term fitness enhancement remains elusive and demands research and policy attention. These findings have policy implications in that employer-/insurer-subsidized gym memberships may require interventions targeting other levels of change (e.g., physical or social/environmental) to foster sustainable fitness improvements.

Adult↗
PubMed1999

A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients.

OBJECTIVE: to prove the effectiveness of geriatric evaluation and management for elderly, hospitalized patients, combined with post-discharge home intervention by an interdisciplinary team. DESIGN: randomized controlled trial with outcome and costs assessed for 12 months after the date of admission. SETTING: university-affiliated geriatric hospital and the homes of elderly patients. SUBJECTS: 545 patients with acute illnesses admitted from home to the geriatric hospital. INTERVENTIONS: patients were randomly assigned to receive either comprehensive geriatric assessment and post-discharge home intervention (intervention), comprehensive geriatric assessment alone (assessment) or usual care. MAIN OUTCOME MEASURES: survival, functional status, rehospitalization, nursing home placement and direct costs over 12 months. RESULTS: the intervention group showed a significant reduction in length of hospital stay (33.49 days vs 40.7 days in the assessment group and 42.7 days in the control group; P < 0.05) and rate of immediate nursing home placement (4.4% vs 7.3% and 8.1%; P < 0.05). There was no difference in survival, acute care hospital readmissions or new admissions to nursing homes but the intervention group had significantly shorter hospital readmissions (22.2 days vs 34.2 days and 35.7 days; P < 0.05) and nursing home placements (114.7 days vs 161.6 days and 170.0 days; P < 0.05). Direct costs were lower in the intervention group [about DM 7000 (US $4000) per person per year]. Functional capacities were significantly better in the intervention group. CONCLUSIONS: comprehensive geriatric assessment in combination with post-discharge home intervention does not improve survival, but does improve functional status and can reduce the length of the initial hospital stay and of subsequent readmissions. It can reduce the rate of immediate nursing home admissions and delay permanent nursing home placement. It may also substantially reduce direct costs of hospitalized patients.

Activities of Daily Living↗