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At least 1,117 records · Page 62Linked to original sources
PubMed2006

Long-term follow-up of cardiovascular disease risk factors in children after an obesity intervention.

BACKGROUND: Data concerning the long-term improvement of cardiovascular disease (CVD) risk factors after an obesity intervention in children are limited. OBJECTIVE: We studied changes in weight status and CVD risk factors in children in an intervention program and evaluated whether these changes were sustained 1 y after the end of the intervention. DESIGN: We analyzed changes in the SD score (SDS) of body mass index [BMI; in kg/m2 (SDS-BMI)], blood pressure (BP), lipids, and homeostasis model assessment index of insulin resistance (HOMA-IR) over the course of 2 y in 240 obese (BMI > 97th percentile) children aged 6-14 y (x age: 10.4 y; x BMI: 26.9). Of these 240 children, 203 participated in a 1-y intervention program of physical exercise, nutrition education, and behavior therapy. We compared these children with 37 obese children who underwent no intervention and with 12 normal-weight children of the same age and sex. RESULTS: Obese children had significantly (P < 0.05) higher BP, HOMA-IR, and insulin, triacylglycerol, and LDL-cholesterol concentrations and lower HDL-cholesterol concentrations than did normal-weight children. Twenty-nine children dropped out of the intervention. Only in the 126 children who reduced their SDS-BMI did BP (8% and 12% decreases in systolic and diastolic BP, respectively), lipids (12% and 5% decreases in triacylglycerol and LDL cholesterol, respectively; 7% increase in HDL cholesterol), insulin (13% decrease), and HOMA-IR (17% decrease) improve significantly (P < 0.05). Reduction in SDS-BMI and all benefits regarding CVD risk factors were sustained 1 y after the end of the intervention in the children whose SDS-BMI decreased. CONCLUSIONS: Long-term multidisciplinary intervention led to a reduction in SDS-BMI in most of the obese children 1 y after the end of the intervention. Reduction in SDS-BMI was accompanied by an improvement in CVD risk factors.

Adolescent↗
PubMed2002

Effect of a school-based sun-protection intervention on the development of melanocytic nevi in children.

"Kidskin" was a 5-year (1995-1999), school-based intervention trial among first-grade children in Perth, Western Australia. It aimed to assess whether a sun-protection intervention could protect against nevus development on the trunk, face, and arms. Included were a control group, a "moderate intervention" group, and a "high intervention" group. Control schools taught the standard health curriculum, while intervention schools received a specially designed sun-protection curriculum over 4 years. The high intervention group also received program materials over summer vacations when sun exposure was likely to be highest and were offered low-cost sun-protective swimwear. After adjustment for baseline nevus counts and potential confounding, nevus counts on all body sites were slightly lower in both intervention groups relative to the control group at follow-up, although the differences were not statistically significant and the high intervention was no more protective. Children in the moderate and high intervention groups, respectively, had fewer nevi on the back (6%, 95% confidence interval (CI): 0, 12; 4%, 95% CI: -3, 11), chest (boys) (5%, 95% CI: -4, 13; 3%, 95% CI: -8, 14), face (11%, 95% CI: 0, 21; 9%, 95% CI: -6, 21), and arms (8%, 95% CI: -1, 17; 3%, 95% CI: -10, 14).

Child↗
PubMed1997

Peer review and continuous quality improvement of pharmacists' clinical interventions.

A peer-review-based continuous quality improvement (CQI) program for improving pharmacists' clinical interventions at a hospital is described. With the implementation of pharmaceutical care at Detroit Receiving Hospital came the need for a CQI system to validate and improve this type of patient care. A peer-review group (PRG) was formed. The PRG decided to review 60 pharmacist interventions per month for clinical appropriateness, accuracy of entry into the computer, documentation in the medical record by the pharmacist, and implementation if accepted by the physician. Interventions are assigned to individual reviewers, and final decisions on the appropriateness and correctness of the selected interventions are made at periodic PRG meetings. In its first year the PRG met nine times and evaluated 409 interventions; 96% of the interventions were judged clinically appropriate, 62% were accurately entered into the computer, 62% were documented in the medical record by the pharmacist, and 92% were implemented if accepted by the physician. Meetings, additional reviews, and inservice sessions were used to address deficiencies in the interventions; these efforts led to improvements. The clinical appropriateness of documented interventions was included as a medication use indicator in the hospital CQI program. A peer-review-based CQI process allowed a hospital to effectively monitor and improve the quality and documentation of interventions recommended by pharmacists.

Hospital Bed Capacity, 300 to 499↗
PubMed1997

Cost savings and avoidance from clinical interventions.

A method that lets a pharmacy department collect data on cost savings and avoidance achieved through pharmacist interventions is described. The pharmacist intervention program at an 849-bed institution is based on the pharmacist's evaluation of the patient, the disease or condition, and the appropriateness of the drug therapy selected. The pharmacist records the recommendation, the rationale, and the intervention outcome, and the data are entered into the medication order-entry system. An assigned code indicates the potential severity of consequences had the intervention not been made. The information is forwarded to the clinical interventions and financial assessment committee (CLIFAC) for analysis of cost savings and potential cost avoidance. To calculate savings, CLIFAC determines the drug acquisition and relevant laboratory costs that would have been charged, as well as the cost of a change in therapy. A method was developed that allows CLIFAC to use hospital-specific diagnosis-related-group data to determine potential cost avoidance as a function of hospital days prevented. From July 1994 through April 1995, 4648 interventions were documented by the 50-member inpatient and ambulatory care pharmacist staff and evaluated and quantified. Of these interventions, 87% were accepted by the medical staff. The accepted interventions represent a net therapy cost saving of $487,833, as well as a cost avoidance of $158,563 achieved by prevention of a potential net 371.9 additional hospital days. A pharmacy department's financial assessment committee evaluated pharmacist interventions by determining changes in the cost of therapy and estimating potential changes in the length of stay.

Cost Savings↗
PubMed2003

Documenting pharmacist interventions on an intranet.

The process of developing and implementing an intranet Web site for clinical intervention documentation is described. An inpatient pharmacy department initiated an organizationwide effort to improve documentation of interventions by pharmacists at its seven hospitals to achieve real-time capture of meaningful benchmarking data. Standardization of intervention types would allow the health system to contrast and compare medication use, process improvement, and patient care initiatives among its hospitals. After completing a needs assessment and reviewing current methodologies, a computerized tracking tool was developed in-house and integrated with the organization's intranet. Representatives from all hospitals agreed on content and functionality requirements for the Web site. The site was completed and activated in February 2002. Before this Web site was established, the most documented intervention types were Renal Adjustment and Clarify Dose, with a daily average of four and three, respectively. After site activation, daily averages for Renal Adjustment remained unchanged, but Clarify Dose is now documented nine times per day. Drug Information and i.v.-to-p.o. intervention types, which previously averaged less than one intervention per day, are now documented an average of four times daily. Approximately 91% of staff pharmacists are using this site. Future plans for this site include enhanced accessibility to the site with wireless personal digital assistants. The design and implementation of an intranet Web site to document pharmacists' interventions doubled the rate of intervention documentation and standardized the intervention types among hospitals in the health system.

California↗
PubMed2006

An intervention program for university students who have parents with alcohol problems: a randomized controlled trial.

AIM: To study the effects of alcohol and coping intervention among University students who have parents with alcohol problems. METHODS: A total of 82 university students (56 women and 22 men, average age 25) with at least one parent with alcohol problems were included. The students were randomly assigned to one of three programs: (i) alcohol intervention program, (ii) coping intervention program, and (iii) combination program. All programs were manual based and individually implemented during two 2-h sessions, 4 weeks apart. This assessment contained both a face-to-face interview and six self-completion questionnaires; AUDIT, SIP, EBAC, coping with parents' abuse questionnaire, SCL-90 and ISSI. Follow-up interviews were conducted after 1 year. RESULTS: All participants finished the baseline assessment, accepted and completed the intervention, while 95% of the students completed the 12-month follow-up assessment. The two groups that received alcohol intervention improved their drinking pattern significantly more than the group that did not receive alcohol intervention [change of standardized scores -0.27 (CI -0.53 to -0.03)]. The groups receiving coping intervention did not differ from the group not receiving coping intervention concerning their ability to cope with their parents' alcohol problems. Nor did they differ regarding changes in their own mental health or in their social interaction capacity. CONCLUSION: The intervention improved drinking patterns in adult children of alcoholics.

Adaptation, Psychological↗
PubMed2006

Reducing friday alcohol consumption among moderate, women drinkers: evaluation of a brief evidence-based intervention.

AIMS: A randomized controlled trial was used to evaluate a brief research-based intervention designed to promote drinking within recommended limits on Fridays and Saturdays among moderate drinkers. METHODS: The two-page, leaflet-like intervention included persuasive communication targeting motivational and volitional antecedents of behaviour as specified by an extended theory of planned behaviour (TPB) and implementation intention theory. Participants were randomly allocated to a control group (TPB questionnaire only) or to a group receiving the TPB questionnaire plus leaflet-like intervention. Cognitions and drinking behaviour were measured immediately before the intervention and at 8-weeks follow-up. The pre-intervention questionnaire was distributed to 573 participants of whom 347 (61%) responded at follow-up. RESULTS: Significantly greater reduction in risky drinking on Fridays was observed among women (but not men) in the intervention group at 8-weeks follow-up. No other post-intervention differences were found. CONCLUSIONS: A low-cost, readily-produced, written intervention focusing on recommended daily limits reduced risky drinking amongst women on Fridays. Further work on similar interventions is warranted.

Adult↗
PubMed2000

Physicians' attitudes towards prevention: importance of intervention-specific barriers and physicians' health habits.

BACKGROUND: Several studies have explored physicians' attitudes towards prevention and barriers to the delivery of preventive health interventions. However, the relative importance of these previously identified barriers, both in general terms and in the context of a number of specific preventive interventions, has not been identified. Certain barriers may only pertain to a subset of preventive interventions. OBJECTIVES: We aimed to determine the relative importance of identified barriers to preventive interventions and to explore the association between physicians' characteristics and their attitudes towards prevention. METHODS: We conducted a cross-sectional survey of 496 of the 686 (72.3% response rate) generalist physicians from three Swiss cantons through a questionnaire asking physicians to rate the general importance of eight preventive health strategies and the relative importance of seven commonly cited barriers in relation to each specific preventive health strategy. RESULTS: The proportion of physicians rating each preventive intervention as being important varied from 76% for colorectal cancer screening to 100% for blood pressure control. Lack of time and lack of patient interest were generally considered to be important barriers by 41% and 44% of physicians, respectively, but the importance of these two barriers tended to be specifically higher for counselling-based interventions. Lack of training was most notably a barrier to counselling about alcohol and nutrition. Four characteristics of physicians predicted negative attitudes toward alcohol and smoking counselling: consumption of more than three alcoholic drinks per day [odds ratio (OR) = 8.4], sedentary lifestyle (OR = 3.4), lack of national certification (OR = 2.2) and lack of awareness of their own blood pressure (OR = 2.0). CONCLUSIONS: The relative importance of specific barriers varies across preventive interventions. This points to a need for tailored practice interventions targeting the specific barriers that impede a given preventive service. The negative influence of physicians' own health behaviours indicates a need for associated population-based interventions that reduce the prevalence of high-risk behaviours in the population as a whole.

Attitude of Health Personnel↗
PubMed2003

Integrating theory, basic research, and intervention: two case studies from caregiving research.

PURPOSE: The premise of this article is that interventions should be based explicitly on theory and basic research findings. Although there appears to be general agreement with that assertion, the connections among theory, research, and intervention in the field of gerontology are often tenuous or nonexistent. In this article, we argue for better integration of these three domains, providing two case studies from the Cornell Roybal Center that illustrate the positive role theory and research can play in intervention designs and broader applicability of findings. DESIGN AND METHODS: Study 1 involved a social support intervention for persons making the transition to becoming a family caregiver. Study 2 was an organizational intervention designed to improve interpersonal relationships and increase mutual support between family caregivers and staff in nursing homes. RESULTS: Several benefits emerged as a result of creating theoretically grounded and research-based interventions, including guidance for innovative intervention design and the production of findings that inform both basic research and intervention. IMPLICATIONS: A much closer link between theory and basic research and intervention studies is indicated, suggesting that current federal support of translational research initiatives is justified and worthy of expansion.

Aged↗
PubMed1998

The cost-effectiveness of forty health interventions in Guinea.

Addressing diseases of a high burden with the most cost-effective interventions could do much to reduce disease in the population. We conducted a cost-effectiveness analysis of 40 health interventions in Guinea, a low-income country in sub-Saharan Africa, using local data. Interventions were selected from treatment protocols at health centres, first referral hospitals and national programmes in Guinea, based upon consultation with health care providers and government plans. For each intervention, we calculated the costs (comprising labour, drugs, supplies, equipment, and overhead) in relation to years of life saved, discounted at 3%. The results show that the per capita costs and effectiveness of any intervention vary considerably. Average costs show no clear pattern by level of care, but effectiveness is generally highest for curative hospital interventions. Several interventions have a cost-effectiveness of US$100 per year of life saved (LYS) or less, and address more than 5% of total years of life lost. These include health centre interventions such as: treatment of childhood pneumonia ($3/LYS); rehydration therapy for diarrhoea ($7/LYS); integrated management of childhood pneumonia, malaria and diarrhoea ($8/LYS); short-course treatment of tuberculosis ($12/LYS); treatment of childhood malaria ($13/LYS), and childhood vaccination ($25/LYS). Outreach programmes for impregnated bed nets against malaria cost $43/LYS. Maternal and perinatal diseases, have slightly less cost-effective interventions: integrated family planning, prenatal and delivery care at health centres ($109/LYS) or outreach programmes to provide prenatal and delivery care ($283/LYS). A minimum package of health services would cost approximately $13 per capita, and would address a large proportion (69%) of major causes of premature mortality. This minimum package would cost about three times the current public spending on health, suggesting that health spending needs to rise to achieve good health outcomes.

Cost-Benefit Analysis↗
PubMed2006

Worksite intervention effects on physical health: a randomized controlled trial.

Overweight and physical inactivity are risk factors for increased disease burden and health care expenditure. Well-designed studies are still needed to determine the treatment efficacy of worksite interventions targeting such risk factors. This randomized controlled trial was conducted at one of Australia's casinos in 2002-2003, to investigate the effects of a comprehensive exercise and lifestyle intervention on physical fitness. Only 6.4% of the workforce expressed interest in being study participants. Seventy-three employees (aged 32 +/- 8 years, 51% overweight/obese, 73% shift workers and 52% women) were recruited and randomized to treatment or wait-list control groups for 24 weeks, 44 of whom completed the intervention. Components of the intervention include supervised moderate-to-high intensity exercise including combined aerobic (at least 20 min duration 3 days/week) and weight-training (for an estimated 30 min completed 2-3 days/week), and dietary/health education (delivered via group seminars, one-on-one counselling and literature through the provision of a worksite manual). ANCOVA, by intention-to-treat and of study completers, found significant between-group differences in the mean waist circumference and predicted maximal oxygen uptake (VO2max), favouring the intervention, but effects were concentrated in one subject. For study completers, between-group differences in the mean waist circumference (82.3 +/- 9.2 versus 90.5 +/- 17.8 cm, p = 0.01) and predicted VO2max (47 versus 41 ml/kg/min, p < 0.001) remained significant without the outlier, favouring the intervention. Higher intervention compliance predicted greater improvements in physical fitness. No significant effects on body mass or body mass index were found. This worksite intervention significantly improved waist circumference and aerobic fitness in healthy but sedentary employees, most of whom were shift workers. Worksite interventions have the potential to counter the increasing burden of overweight and obesity, particularly visceral adiposity, as well as physical inactivity; however, substantial barriers to adoption/adherence need to be overcome for greater feasibility and impact on employee physical health.

Adult↗
PubMed2006

A controlled trial of a school-based environmental intervention to improve physical activity in Dutch children: JUMP-in, kids in motion.

Interventions to promote physical activity are important in preventing children from becoming overweight. Many projects have been developed but only a few showed (moderate) effects. JUMP-in is a systematically developed primary-school-based intervention that focuses on the use of theory, environmental changes, parental influences and cooperation with multi-level parties in intervention development. The effects of JUMP-in were evaluated with a quasi-experimental pre-test/post-test research design. In total, 510 children from Grades 4, 5 and 6 of four intervention schools and two control schools in Amsterdam were followed for an intervention period of one school year. Changes in physical activity as well as in the social cognitive determinants were assessed using self-reports. In addition, a process evaluation has been executed. The results show that JUMP-in was effective in influencing physical activity, especially among children from Grade 6. Children in the control group decreased their level of physical activity considerably, while activity levels in intervention children from Grade 6 remained stable. The intervention effects could not be explained by changes in the measured social cognitive determinants. In contrast, process information illuminated differences in intervention effects between the participating schools. The results from the JUMP-in study show the importance of intervention designs that focus on a theory-based mix of relevant environmental and social cognitive factors.

Child↗
PubMed2000

The Western Australian School Health Project: comparing the effects of intervention intensity on organizational support for school health promotion.

The aim of this study was to evaluate changes in school health promotion practice related to two levels of intervention in the Western Australian School Health (WASH) Project: (1) a low-intensity intervention involving a single mail-out of WASH Project resources, and (2) a high-intensity intervention involving training, planning time and expert support. The schools involved in the study were divided into three groups. Treatment group 1 received the high-intensity intervention, treatment group 2 received the low-intensity intervention and a comparison group received no intervention. Two scales were developed to assess change, i.e. a school organizational scale (Chronbach's alpha = 0.76) and a health promotion activity scale (Chronbach's alpha = 0.79). The results indicate that a high-intensity intervention, such as the WASH Project, which provides training to a critical mass of school community members from each school, ongoing access to an expert in the field, as well as dedicated planning time, is able to increase the comprehensiveness and quality of health strategic planning by schools. Furthermore, the results suggest that a low-intensity mail-out intervention is no more successful in initiating change that providing no intervention at all.

Adolescent↗
PubMed2006

Evaluation of a 2-year physical activity and healthy eating intervention in middle school children.

The aim of the present study was to evaluate the effects of a middle school physical activity and healthy eating intervention, including an environmental and computer-tailored component, and to investigate the effects of parental involvement. A random sample of 15 schools with seventh and eight graders was randomly assigned to one of three conditions: (i) intervention with parental involvement, (ii) intervention alone and (iii) control group. In 10 schools, an intervention, combining environmental changes with computer-tailored feedback, was implemented over 2 school years. In five intervention schools, increased parental support was added. Physical activity was measured with questionnaires in the total sample and with accelerometers in a sub-sample of children. Fat intake, fruit, water and soft drink consumption were measured using food-frequency questionnaires. Results showed significant positive intervention effects on physical activity in both genders and on fat intake in girls. Parental involvement did not increase intervention effects. It can be concluded that physical activity and eating behaviours of middle school children can be improved by school-based strategies combining environmental and personal interventions. The use of personalized computer-tailored interventions seems to be a promising tool for targeting adolescents but needs to be further explored.

Adolescent↗
PubMed1993

Community-based intervention: the Coronary Risk Factor Study (CORIS).

The Coronary Risk Factor Study (CORIS) examined the feasibility and effectiveness of a multifactorial community intervention programme to reduce coronary heart disease (CHD) risk factor levels. Three Afrikaner communities were surveyed before and after a 4-year intervention in two of the communities, the third serving as a control (C). Intervention was primarily by small mass media (low-intensity intervention, LII) or by small mass media plus interpersonal intervention to high-risk individuals (high-intensity intervention, HII). After allowing for change in C, significant net reductions in blood pressure, smoking, and risk score were obtained in LII and HII alike. Though the total cholesterol (TC) fell by 10-12%, there was no net reduction in favour of the intervention communities. However, LII and HII resulted in significant increases in high-density lipoprotein cholesterol (HDL-C) levels and HDL-C/TC ratios in comparison to C. Overall, the LII community fared almost as well as the HII community, and high-risk individuals did not show a greater change in risk factors than others. We conclude that community-based intervention works, and that in these particular communities a media-based health education programme was more cost-effective than one which adds a greater degree of interpersonal intervention.

Adolescent↗
PubMed2003

Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis.

OBJECTIVES: To evaluate an intervention to reduce inappropriate use of key antibiotics with interrupted time series analysis. METHODS: The intervention is a policy for appropriate use of Alert Antibiotics (carbapenems, glycopeptides, amphotericin, ciprofloxacin, linezolid, piperacillin-tazobactam and third-generation cephalosporins) implemented through concurrent, patient-specific feedback by clinical pharmacists. Statistical significance and effect size were calculated by segmented regression analysis of interrupted time series of drug use and cost for 2 years before and after the intervention started. RESULTS: Use of Alert Antibiotics increased before the intervention started but decreased steadily for 2 years thereafter. The changes in slope of the time series were 0.27 defined daily doses/100 bed-days per month (95% CI 0.19-0.34) and pound 1908 per month (95% CI pound 1238- pound 2578). The cost of development, dissemination and implementation of the intervention ( pound 20133) was well below the most conservative estimate of the reduction in cost ( pound 133296), which is the lower 95% CI of effect size assuming that cost would not have continued to increase without the intervention. However, if use had continued to increase, the difference between predicted and actual cost of Alert Antibiotics was pound 572448 (95% CI pound 435696- pound 709176) over the 24 months after the intervention started. CONCLUSIONS: Segmented regression analysis of pharmacy stock data is a simple, practical and robust method for measuring the impact of interventions to change prescribing. The Alert Antibiotic Monitoring intervention was associated with significant decreases in total use and cost in the 2 years after the programme was implemented. In our hospital, the value of the data far exceeded the cost of processing and analysis.

Anti-Bacterial Agents↗
PubMed2005

Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study.

OBJECTIVES: To evaluate the impact of an educational intervention on judicious antibiotic prescription for upper respiratory diseases in children. METHODS: A multicentre before-and-after study was conducted in five major community child healthcentres in Israel. Antibiotic prescription data were collected for all visits of patients aged 3 months to 18 years with a diagnosis of acute otitis media, tonsillopharyngitis, sinusitis or upper respiratory tract infection from November 1999 through February 2000 (pre-intervention period) and from November 2000 through February 2001 (post-intervention period). The intervention consisted of a 1 day seminar on the diagnosis and judicious treatment of respiratory tract infections in children according to the recommendations of the Centers of Disease Control and Prevention. The patient files were reviewed for patient characteristics, specific respiratory disease, and specific antibiotics prescribed. The main outcome measures were the rates and appropriateness of antibiotic prescribing for the different respiratory diseases before and after an educational intervention for practising paediatricians. RESULTS: A total of 4580 clinic visits were eligible for analysis in the pre-intervention period and 4364 in the post-intervention period. From the pre- to the post-intervention period, the odds ratio for appropriate antibiotic treatment was 1.8 for acute otitis media (95% CI 1.52-2.11, P < 0.01) and 1.35 for pharyngitis (95% CI 1.13-1.61, P < 0.01). Overall, use of antibiotics for acute otitis media decreased from 93% to 87.4% (P < 0.05), and for upper respiratory tract infection, from 13.8% to 11.5% (P < 0.05). There were no significant changes in these factors for sinusitis. CONCLUSIONS: A targeted educational intervention can improve antibiotic prescription practices for respiratory infections in children and decrease unnecessary antibiotic use. Such studies can also pinpoint areas that require further attention.

Adolescent↗
PubMed2005

Early childhood development interventions and cognitive development of young children in rural Vietnam.

Little is known about the long-term benefits of interventions that aim to promote early childhood development programs. The goal of this research was to determine whether an early childhood development intervention added to a nutrition intervention during preschool ages had lasting effects on the cognitive development of school-age children in communes of Thanh Hoa province in rural Vietnam. The study focused on a total of 313 children aged 6.5-8.5 y (grades 1 and 2 in primary school) in 2 communes that were exposed to nutrition intervention or nutrition and early childhood development (ECD) intervention from 1999 to 2003. Measurements of height and cognitive test scores (Raven's Progressive Matrices Test) were collected from the children; household characteristics were determined by interviews with mothers. Longitudinal analysis was performed by integrating the data with that collected from the same children in past surveys. Significant effects of the ECD intervention compared with the nutrition intervention were detected. The beneficial effect of ECD intervention on the cognitive test scores was large for the most nutritionally challenged children whose height-for-age Z-scores declined or remained in the stunted range. The findings help provide useful insights into the development of an effective integrated model of ECD and nutrition intervention for children in rural Vietnam.

Body Height↗