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PubMed2004

Review of intervention studies of families with hospitalized elderly relatives.

PURPOSE: To critique intervention studies of family caregivers in the hospital care for elderly relatives for (a) synthesizing the characteristics of interventions and outcomes, (b) evaluating the effectiveness of the intervention studies, and (c) identifying the strengths and limitations of the intervention studies as a basis for future research. METHODS: An integrated literature review was used to examine nine intervention studies (1983-2003) of adult family caregivers of older family members in the hospital setting. FINDINGS: Although the existing intervention studies have provided a solid base for further study of family care for hospitalized elders, the analysis indicated the following limitations of the existing literature: (a) lack of a clearly defined theoretical framework to guide the interventions and selection of study variables, (b) lack of comparison groups and observation of interventions, and (c) limitations with generalizability of findings. CONCLUSIONS: Nine intervention studies of family caregivers in the hospital care of elderly patients age 60 years or above were found that were conducted in the past 10 years. Although progress has been made in family caregiving of hospitalized elders, future research should include outcomes based on well-defined theoretical frameworks, control of confounding variables, and samples from diverse populations.

Adaptation, Psychological↗
PubMedDate not supplied

A nurse-managed smoking cessation intervention during pregnancy.

OBJECTIVE: To evaluate the effectiveness of a nurse-managed smoking cessation intervention in an outpatient setting among pregnant women who smoked. DESIGN: Prospective; control group participants' cessation rates were assessed 6-12 weeks after clinic contact. They were compared to cessation rates for subsequent intervention participants 6-12 weeks after receiving a nurse-managed smoking cessation intervention. SETTING/PARTICIPANTS: One hundred seventy-eight women who were daily smokers, during their first visit after confirmation of pregnancy at a teaching hospital prenatal clinic. INTERVENTION: Fifteen-minute individualized intervention delivered by an advanced-practice nurse, combined with a telephone contact by an advanced-practice nurse 7-10 days after the clinic visit. MAIN OUTCOME MEASURES: Self-report of smoking, confirmed by saliva cotinine. RESULTS: Intervention group participants had a self-reported abstinence rate of 19% compared with 0% among control group participants. The cotinine-validated abstinence rate for the intervention group was 15.5%, compared with 0% in the control group. African Americans were more likely to quit, compared with white participants who received the intervention. CONCLUSION: A nurse-managed intervention combined with a telephone contact may be an effective strategy for intervening with pregnant smokers, especially African Americans.

Adolescent↗
PubMed2002

Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat.

OBJECTIVE: To assess the effectiveness of tailored interventions to implement guidelines for urinary tract infections in women and sore throat. DESIGN: Unblinded, cluster randomised pretest-post-test trial. SETTING: 142 general practices in Norway. PARTICIPANTS: 72 practices received interventions to implement guidelines for urinary tract infection and 70 practices received interventions to implement guidelines for sore throat, serving as controls for each other. 59 practices in the urinary tract infection group and 61 practices in the sore throat group completed the study. Outcomes were measured in 16 939 consultations for sore throat and 9887 consultations for urinary tract infection. INTERVENTIONS: Interventions were developed to overcome identified barriers to implementing the guidelines. The main components of the tailored interventions were patient educational material, computer based decision support and reminders, an increase in the fee for telephone consultations, and interactive courses for general practitioners and practice assistants. MAIN OUTCOME MEASURES: Changes in rates of use of antibiotics, laboratory tests, and telephone consultations. RESULTS: Patients in the sore throat group were 3% less likely to receive antibiotics after the intervention. Women with symptoms of urinary tract infection in the intervention group were 5.1% less likely to have a laboratory test ordered. No significant differences were found between the groups for the other outcomes. Large variation was found across the included practices in the rates of antibiotic prescription, use of laboratory tests and telephone consultations, and in the extent of change for all three outcome measures. CONCLUSIONS: Passively delivered, complex interventions targeted at identified barriers to change had little effect in changing practice.

Adolescent↗
PubMed2004

Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial.

OBJECTIVES: To assess the effectiveness of a multiple intervention aimed at reducing antibiotic prescription rates for symptoms of the respiratory tract in primary care. DESIGN: Randomised controlled trial. SUBJECTS: Twelve peer review groups including 100 general practitioners with their collaborating pharmacists in the region of Utrecht, Netherlands. INTERVENTION: The intervention consisted of group education meetings, with a consensus procedure on indication for and type of antibiotics and with training in communication skills; monitoring and feedback on prescribing behaviour; group education for assistants of general practitioners and pharmacists; and education material for patients. The control group did not receive any of these elements. MAIN OUTCOME MEASURES: Antibiotic prescription rates for acute symptoms of the respiratory tract and patients' satisfaction. RESULTS: 89 general practitioners completed the study (89%). At baseline, prescription rates for antibiotics for respiratory tract symptoms did not differ between intervention and control group (27% v 29%, respectively). After nine months, the prescription rates in the intervention group fell to 23%, whereas the control group's rose to 37% (mean difference in change -12%, 95% confidence interval -18.9% to -4.0%). Multilevel analysis confirmed the results of the unadjusted analysis (intervention effect -10.7%, -20.3% to -1.0%). Patients' satisfaction was high and did not differ in the two groups at baseline or after the intervention. CONCLUSIONS: A multiple intervention reduced prescribing rates of antibiotics for respiratory tract symptoms while maintaining a high degree of satisfaction among patients. Further research should focus on the sustainability and cost effectiveness of this intervention.

Adult↗
PubMed2004

Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke.

OBJECTIVE: To evaluate an occupational therapy intervention to improve outdoor mobility after stroke. DESIGN: Randomised controlled trial. SETTING: General practice registers, social services departments, a primary care rehabilitation service, and a geriatric day hospital. PARTICIPANTS: 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months: 86 were allocated to the intervention group and 82 to the control group. INTERVENTIONS: Leaflets describing local transport services for disabled people (control group) and leaflets with assessment and up to seven intervention sessions by an occupational therapist (intervention group). MAIN OUTCOME MEASURES: Responses to postal questionnaires at four and 10 months: primary outcome measure was response to whether participant got out of the house as much as he or she would like, and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale, Nottingham leisure questionnaire, and general health questionnaire. RESULTS: Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months (relative risk 1.72, 95% confidence interval 1.25 to 2.37) and 10 months (1.74, 1.24 to 2.44). The treatment group reported more journeys outdoors in the month before assessment at both four months (median 37 in intervention group, 14 in control group: P < 0.01) and 10 months (median 42 in intervention group, 14 in control group: P < 0.01). At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group, but there were no significant differences in the other secondary outcomes. No significant differences were observed in these measures at 10 months. CONCLUSION: A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke.

Activities of Daily Living↗
PubMed2006

Tackling alcohol related violence in city centres: effect of emergency medicine and police intervention.

OBJECTIVES: To identify correlates of alcohol related assault injury in the city centre of a European capital city, with particular reference to emergency department (ED) and police interventions, and number and capacity of licensed premises. METHODS: Assaults resulting in ED treatment were studied using a longitudinal controlled intervention, a three stage design during a three year period of rapid expansion in the night-time economy, when ED initiated targeted police interventions were delivered. A controlled ED intervention targeted at high risk night-clubs was carried out. Main outcome measure was ED treatment after assault in licensed premises and the street. RESULTS: Targeted police intervention was associated with substantial reductions in assaults in licensed premises but unexpected increases in street assault were also observed (34% overall: 105% in the principal entertainment thoroughfare). Combined police/ED intervention was associated with a significantly greater reduction compared with police intervention alone (OR = 0.61, 95% CI 0.40 to 0.91). Street assault correlated significantly with numbers and capacity of premises. Risk of assault was 50% greater in and around licensed premises in the city centre compared with those in the suburbs, although dispersion of violence to more licensed premises was not observed. CONCLUSIONS: Marked decreases in licensed premises assaults resulting from targeted policing were enhanced by the intervention of ED and maxillofacial consultants. Capacity of licensed premises was a major predictor of assaults in the city centre street in which they are clustered. City centre assault injury prevention can be achieved through police/ED interventions targeted at high risk licensed premises, which should also target the streets around which these premises are clustered.

Alcohol Drinking↗
PubMed2005

Systematic review of multidisciplinary interventions in heart failure.

OBJECTIVE: To determine the impact of multidisciplinary interventions on hospital admission and mortality in heart failure. DESIGN: Systematic review. Thirteen databases were searched and reference lists from included trials and related reviews were checked. Trial authors were contacted if further information was required. SETTING: Randomised controlled trials conducted in both hospital and community settings. PATIENTS: Trials were included if all, or a defined subgroup of patients, had a diagnosis of heart failure. INTERVENTIONS: Multidisciplinary interventions were defined as those in which heart failure management was the responsibility of a multidisciplinary team including medical input plus one or more of the following: specialist nurse, pharmacist, dietician, or social worker. Interventions were separated into four mutually exclusive groups: provision of home visits; home physiological monitoring or televideo link; telephone follow up but no home visits; and hospital or clinic interventions alone. Pharmaceutical and exercise based interventions were excluded. MAIN OUTCOME MEASURES: All cause hospital admission, all cause mortality, and heart failure hospital admission. RESULTS: 74 trials were identified, of which 30 contained relevant data for inclusion in meta-analyses. Multidisciplinary interventions reduced all cause admission (relative risk (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95, p = 0.002), although significant heterogeneity was found (p = 0.002). All cause mortality was also reduced (RR 0.79, 95% CI 0.69 to 0.92, p = 0.002) as was heart failure admission (RR 0.70, 95% CI 0.61 to 0.81, p < 0.001). These results varied little with sensitivity analyses. CONCLUSION: Multidisciplinary interventions for heart failure reduce both hospital admission and all cause mortality. The most effective interventions were delivered at least partly in the home.

Cardiac Output, Low↗
PubMed2026

Interventions to improve school attendance: a systematic review and meta-analysis of evidence from randomised controlled trials.

BACKGROUND: Poor school attendance adversely affects youth behaviour and health trajectories. We reviewed and synthesised the evidence from randomised controlled trials (RCTs) on interventions to improve school attendance. METHODS: This systematic review and meta-analysis updates the Education Endowment Foundation (EEF) 2022 review on attendance interventions. We synthesised RCT data to inform recommendations. We searched ERIC (via EBSCOhost), PsycINFO, Web of Science and Google Scholar for publications 1 January 2020-16 October 2024 to identify attendance interventions delivered to students, parents/guardians or school staff. We also extracted and analysed RCTs identified in the EEF review. Two reviewers independently extracted data from published articles and assessed risk of bias and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation, GRADE assessment). We synthesised and meta-analysed data per our protocol (PROSPERO: CRD42024610037). RESULTS: We screened 9366 titles and abstracts and included 61 articles (2000-2024): 43 articles published 2020-2024 plus 18 articles from the previous review (2000-2020), reporting 57 trials of 54 interventions. Pooled mean difference and 95% CIs for days of school attended was 0.63 (-0.34 to 1.61), I2=64.0%, low certainty, for mentoring interventions and 0.43 (0.10 to 0.76), I2=91.9%, moderate certainty, for parental engagement interventions. Other intervention areas including targeted approaches, behavioural programmes and social-emotional interventions had smaller, heterogeneous evidence bases. Risk of bias was moderate-to-low in most trials. CONCLUSION: A large range of interventions exist to address the diverse causes of school absence. Parental engagement demonstrated a small positive effect on attendance, particularly among younger age groups. Most trials were from the USA; implementation and evaluation in other countries will inform effectiveness.

CHILD↗
PubMed1998

Comparison between two districts of the effects of an air pollution intervention on bronchial responsiveness in primary school children in Hong Kong.

STUDY OBJECTIVE: This study examined the impact on children's respiratory health of a government air quality intervention that restricted the sulphur content of fuels to 0.5% from July 1990 onwards. DESIGN/SETTING/PARTICIPANTS: This study examined the changes, one and two years after the introduction of the intervention, in airway hyperreactivity of non-asthmatic and non-wheezing, primary 4, 5, and 6, school children aged 9-12 years living in a polluted district compared with those in a less polluted district. Bronchial hyperreactivity (BHR)(a 20% decrease in FEV1 provoked by a cumulative dose of histamine less than 7.8 mumol) and bronchial reactivity slope (BR slope) (percentage change in logarithmic scale in FEV1 per unit dose of histamine) were used to estimate responses to a histamine challenge. The between districts differences after the intervention were studied to assess the effectiveness of the intervention. MAIN RESULTS: In cohorts, comparing measurements made before the intervention and one year afterwards, both BHR and BR slope declined from 29% to 16% (p = 0.026) and from 48 to 39 (p = 0.075) respectively in the polluted district; and from 21% to 10% (p = 0.001) and 42 to 36 (p > 0.100) in the less polluted district. Comparing measurements made in 1991 (one year after intervention) with those in 1992 (two years after intervention), only the polluted district showed a significant decline from 28% to 12% (p = 0.016) and from 46 to 35 (p = 0.014), for BHR and BR slope respectively, with a greater decline in both responses (p = 0.018 and 0.073) than in the less polluted district. CONCLUSION: Bronchial hyperresponsiveness tests can be used to support the evaluation of an air quality intervention. The demonstrated reduction in bronchial hyperresponsiveness is an indication of the effectiveness of the intervention.

Air Pollutants↗
PubMed2001

Cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of two primary care interventions aimed at improving attendance for breast screening.

OBJECTIVES: To examine the effectiveness and cost-effectiveness of two interventions based in primary care aimed at increasing uptake of breast screening. SETTING: 24 General practices with low uptake in the second round of screening (below 60%) in north west London and the West Midlands, UK. Participants were all women registered with these practices and eligible for screening in the third round. METHODS: Pragmatic factorial cluster randomised controlled trial, with practices randomised to a systematic intervention (general practitioner letter), an opportunistic intervention (flag in women's notes prompting discussion by health professionals), neither intervention, or both. Outcome measures were attendance for screening 6 months after the practices had been screened and cost-effectiveness of the interventions. RESULTS: 6,133 Women were included: 1,721 control; 1,818 letter; 1,232 flag; 1,362 both interventions. Attendance data were obtained for 5,732 (93%) women. The two interventions independently increased breast screening uptake in a logistic regression model adjusted for clustering, with the flag (odds ratio (OR) 1.43, 95% confidence interval (95% CI) 1.14 to 1.79; p=0.0019) marginally more effective than the letter (OR 1.31, 95% CI 1.05 to 1.64; p=0.015). Health service costs per additional attendance were 26 pounds (letter) and 41 pounds (flag). CONCLUSIONS: Although both interventions increased attendance for breast screening, the letter was the more cost-effective. Any decision to implement both interventions rather than just the letter will depend on whether the additional (41 pounds) costs are judged worthwhile in terms of the gains in breast screening uptake.

Breast Neoplasms↗
PubMed2004

Reducing absenteeism in hospital cleaning staff: pilot of a theory based intervention.

AIMS: To develop, pilot, and evaluate a workplace intervention to reduce sickness absence, based on a demand-control-support model of job strain. METHODS: Changes in the working arrangements of hospital cleaning staff were introduced with the aim of increasing their control over work and the support received at work. The study design was quasi-experimental, with 221 cleaning staff in the intervention group and 91 catering staff in the control group. The dependent variable was the difference in percentage monthly sickness absence between the 12 months preceding and following the intervention. Differences in sickness absence between staff groups for each month after the intervention were compared with differences between staff groups for the equivalent month one year prior to it. RESULTS: There was a significant reduction in the difference in sickness absence rates between the intervention and control group of 2.3% in the six months after the intervention, compared to the six months before. The difference was not maintained at 12 months. CONCLUSIONS: These results suggest that a workplace intervention aimed at increasing control and support at work has a small effect on reducing sickness absence among hospital cleaning staff in the short term. Future research should seek to replicate this effect in larger, experimental studies, analyse postulated mediators of such theory based interventions, and develop interventions that maintain improvement.

Absenteeism↗
PubMed2006

Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis.

OBJECTIVE: To identify and evaluate studies of interventions in primary care aimed at reducing medication related adverse events that result in morbidity, hospital admission, and/or mortality. METHODS: Fourteen electronic databases were systematically searched for published and unpublished data. Bibliographies of retrieved papers were searched and experts and first authors contacted in an attempt to locate additional studies. There were no restrictions on language of publication. All interventions applied in primary care settings which aimed to improve patient safety by reducing adverse events resulting from medication overuse or misuse were considered. Randomised controlled trials, controlled trials, controlled before and after studies, and interrupted time series studies were eligible for inclusion. Study quality assessment and data extraction were undertaken using the Cochrane Effective Practice and Organisation of Care data collection checklist and template. Meta-analysis was performed using a random effects model. RESULTS: 159 studies were initially identified, of which 38 satisfied our inclusion criteria. These were categorised as follows: 17 pharmacist-led interventions (of which 15 reported hospital admissions as an outcome); eight interventions led by other primary healthcare professionals that reported preventable drug related morbidity as an outcome; and 13 complex interventions that included a component of medication review aimed at reducing falls in the elderly (the outcome being falls). Meta-analysis found that pharmacist-led interventions are effective at reducing hospital admissions (OR 0.64 (95% CI 0.43 to 0.96)), but restricting analysis to the randomised controlled trials failed to demonstrate significant benefit (OR 0.92 (95% CI 0.81 to 1.05)). Pooling the results of studies in the other categories did not demonstrate any significant effect. CONCLUSIONS: There is relatively weak evidence to indicate that pharmacist-led medication reviews are effective in reducing hospital admissions. There is currently no evidence for the effectiveness of other interventions which aim at reducing admissions or preventable drug related morbidity. More randomised controlled trials of primary care based pharmacist-led interventions are needed to decide whether or not this intervention is effective in reducing hospital admissions.

Accidental Falls↗
PubMed2004

Intervention to reduce environmental tobacco smoke exposure in Latino children: null effects on hair biomarkers and parent reports.

OBJECTIVE: To evaluate the effectiveness of a lay delivered intervention to reduce Latino children's exposure to environmental tobacco smoke (ETS). The a priori hypothesis was that children living in households that were in the intervention group would have lower exposure over time than measurement only controls. DESIGN: A two group, randomised control trial was conducted. SETTING: Areas of San Diego county with a large Latino population. PARTICIPANTS: 143 Latino parent-child pairs. INTERVENTION: Trained bicultural and bilingual Latina lay community health advisors, or promotoras, conducted problem solving aimed at lowering the target child's exposure to ETS in the household. Six home and telephone sessions were delivered by the promotoras over a four month period. MAIN OUTCOME MEASURES: Outcome measures were collected at baseline, immediately post-intervention, three months post-intervention, and 12 months post-intervention. Four outcomes were considered: (1) parent's paper-and-pencil reports of the child's past month exposure; (2) hair samples from the child analysed for past month nicotine; (3) hair samples from the child analysed for past month cotinine; and (4) per cent confirmed reducers. RESULTS: There were no significant condition-by-time interactions, the term indicative of a differential intervention effect. Significant or near significant time main effects were seen for children's hair cotinine, per cent confirmed reducers, and, in particular, parent reports of exposure. CONCLUSIONS: Applying a lay promotora model to deliver the behavioural problem solving intervention unfortunately was not effective. A likely explanation relates to the difficulty of delivering a relatively complex intervention by lay women untrained in behaviour change theory and research methods.

Adult↗
PubMed2004

[Interventions to reduce health inequalities].

The objective of this study is to compile, describe and assess interventions to reduce health inequalities developed in Spain by administrations, NGO or other entities. The search was organized in three settings: governmental strategies, interventions, and among the latter, those particularly addressing excluded social groups. Administration actions and policies were investigated through formal surveys addressed to regional governments (17 regions and 2 cities). Production of information by gender and socio-economic level (SEL), plans and programs, as well as interventions was explored. Key informants were consulted and scientific literature was reviewed in order to identify interventions. Médicos del Mundo and Cáritas, two of the main national NGO were consulted. Fourteen administrations responded. In general, health information includes sex analysis, few administrations analyse by gender or SEL and six study inequalities in the general population. Most administrations produce specific information by pathologies (HIV/AIDS.) or social groups (women.). They mention intervention experiences applied to territories or vulnerable groups, evaluated through process indicators. In the period 1995-2002, 722 papers on inequalities in Spain have been published. Among them, 28 are interventions and 9 have been evaluated, mainly with quasi-experimental designs. Large NGO, sometimes with public funding, work with excluded populations through outreach programs. Most Spanish health information does not include yet inequalities analysis, although it is growing steadily. Publication of inequalities studies has increased sharply, but intervention publications are rare and evaluated interventions are extremely scarce. Administrations and NGO work in interventions mainly addressed to excluded populations.

Female↗
PubMed2005

[Effectiveness of advanced group and individual interventions in tackling tobacco dependency in primary care].

OBJECTIVES: To compare the effectiveness of group advanced intervention and individual advanced intervention for smoking management in primary health care; b) to know if in group intervention exists an added positive effect due of the group and, if this is true, to characterize it; and c) to know the advantages and inconvenients that the participants attribute to each intervention. DESIGN: Control clinic trial randomized in individual scale. SETTING: Mallorca primary health centers, Spain. PARTICIPANTS: Smokers >5 packet-year or monoxid carbon levels >15 ppm prepared for give up smoking. People younger than 18 years, people with terminal illness, and mental problems will be excluded. INTERVENTIONS: Candidates will be assigned to: a) group intervention; b) individual intervention; or c) short intervention or control group. Interventions will be done by a nurse and a general practitioner. Depth interview will be done for qualitative study. PRINCIPAL MEASUREMENT: Maintained cessation during 12 months confirmed by expired-air carbon monoxide measurement. SECONDARY MEASUREMENTS: Self-declared cessation and confirmed by expired-air carbon monoxide measurement months 1, 2, 3, 6, and 9, and tobacco reduction if there isn't abandonment. ANALYSIS: Intention treatment. Multilevel analysis will be done to determinate the positive effect added of the group if it's proved that exists. Content analysis for qualitative study. DISCUSSION: Randomization will prevent participants will be treated by their general practitioner o their nurse, this can mean worse results than results obtained in practice.

Female↗
PubMed2006

[Effectiveness of an intervention to improve quality care in reducing cardiovascular risk in hypertense patients].

OBJECTIVE: To evaluate the effectiveness of an intervention on health workers, based on quality improvement through reduction of cardiovascular risk in patients with hypertension. DESIGN: Quasi-experimental study. SETTING: Primary care. Two urban health centres. PARTICIPANTS: A thousand hypertense patients selected by stratified random sampling. One centre (500) was assigned to implement a quality improvement intervention, while at the other centre (500) "usual care" procedures were followed (control group). INTERVENTIONS: The quality improvement intervention consisted of a combined program designed for the medical and nursing staff that comprised audit, feedback, training sessions, and implementation of clinical practice guidelines. MAIN MEASUREMENTS: Coronary risk using the Framingham scale and cardiovascular mortality risk using the SCORE project. RESULTS: Absolute coronary risk decreased from 16.94% (95% CI, 15.92-17.66) to 13.81% (95% CI, 13.09-14.52) (P<.001) in the intervention group; whilst there was no significant change in the control group, which dropped from 17.63% (95% CI, 16.68-18.53) to 16.82% (95% CI, 15.91-17.74). The intervention led to a 2.28% point decrease (95% CI, 1.35-3.21) (P<.001) in coronary risk. Cardiovascular mortality risk decreased from 2.48% (95% CI, 2.35-2.62) to 2.19% (95% CI, 2.07-2.31) (P<.001) in the intervention group, with no significant change in the control group, which changed from 2.45% (95% CI, 2.30-2.59) to 2.52% (95% CI, 2.38-2.66). The intervention led to a 0.36% point decrease (95% CI, 0.05-0.73) (P<.001) in cardiovascular mortality risk. CONCLUSIONS: The quality improvement intervention was effective in decreasing coronary risk and cardiovascular mortality risk in patients with hypertension.

Aged↗
PubMed2004

Effects of urban community intervention on 3-year survival and recurrence after first-ever stroke.

BACKGROUND AND PURPOSE: For the past 2 decades, stroke has been a principal cause of death in China, and stroke incidence tends to increase with the increase of stroke-related risk factors. The purpose of this study was to evaluate the effects of urban community-based intervention on 3-year survival and recurrence after first-ever stroke. METHODS: Two communities with a registered population of approximately 50 000 each were selected as either intervention or control communities in Beijing during 1991 to 2000. Comprehensive intervention measures including the management of high-risk population and the health education of whole community population were regularly implemented. Then the influence of community intervention on 3-year survival and recurrence after initial stroke was evaluated. RESULTS: Within 3 years, 41.85% of 736 patients in the intervention community died whereas 40.34% of 818 patients in the control community died. Of 223 cases from the intervention community, 26 (11.66%) had a recurrent stroke within 3 years versus 52 (20.80%) of 250 cases from the control community. The statistical difference was found. Compared with the control community, the death risk of first-ever stroke in the intervention community decreased by 26% (relative risk [RR]=0.74; 95% confidence interval [CI]: 0.61 to 0.89; P=0.002); especially, that of hemorrhagic stroke decreased by 39% (RR=0.61; 95%CI: 0.46 to 0.81; P=0.001). Compared with the control community, the recurrence risk of first-ever stroke from the intervention community decreased by 42% (RR=0.58; 95% CI: 0.34 to 1.00; P=0.048). CONCLUSIONS: Community intervention may be effective and beneficial to the recurrence prevention and survival improvement of stroke, especially hemorrhagic stroke.

Aged↗
PubMed1992

Initial findings on preventive intervention for families with parental affective disorders.

OBJECTIVE: The purpose of this study was to develop a clinician-based cognitive, psychoeducational, preventive intervention for families with parental affective disorder that would be suitable to widespread use, test its feasibility and safety, and define the areas affected by the intervention. The intervention was designed to increase understanding of parental illness and resilience in the children. METHOD: The authors studied the first seven families (14 parents) to receive the intervention. Enrollment criteria included affective disorder during the preceding year in at least one parent, presence of at least one child between the ages of 8 and 14 years who was not psychiatrically ill at the time of participation, and willingness to participate in the research study. The intervention consisted of parent, child, and family sessions. Assessment included semistructured interviews with parents about affective disorders, standard ratings of marital satisfaction and therapeutic alliance, and a recently developed semistructured interview to assess response to the intervention. RESULTS: Overall satisfaction with the intervention was rated moderate to high by parents. No harm was reported. Ten of 14 parent subjects reported five or more behavior and attitude changes that they attributed to the intervention. The most frequent behavior and attitudinal changes reported were increased discussion of the illness and related issues and increased understanding of information about affective illness. CONCLUSIONS: The authors conclude that the intervention is safe and feasible in families with parental affective disorder.

Adult↗