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PubMed2007

SunSafe in the Middle School Years: a community-wide intervention to change early-adolescent sun protection.

OBJECTIVE: Rising rates of skin cancer associated with early-life sun exposure make it important to improve adolescent sun-protection practices. Our study objective was to determine if a multicomponent community-wide intervention could alter the decline in sun protection that begins in early adolescence. METHODS: A randomized, controlled trial was conducted in 10 communities to assess the impact of the SunSafe in the Middle School Years program. The intervention sought to (1) educate and activate adults and peers to role model and actively promote sun-protection practices and (2) create a pro-sun protection community environment. It targeted school personnel, athletic coaches, lifeguards, and clinicians and enlisted teens as peer advocates. Annual observations of cross-sectional samples of teens at community beach/pool sites were used to assess the impact of 1 and 2 years of intervention exposure compared to grade-matched controls. The outcome was percent of body surface protected by sunscreen, clothing, or shade. RESULTS: Observers determined the sun protection level of 1927 adolescents entering 6th to 8th grades. After 2 years of intervention exposure, adolescents at the beach/pool in intervention communities were significantly better protected than those in control communities. Over 2 years, the percent of body surface area protected declined by 23% in the control arm but only 8% in intervention arm. After intervention, the average percent of body surface protected at intervention sites (66.1%) was significantly greater than control sites (56.8%). Teens in intervention communities reported sun-protection advice from more adult sources, were more likely to use sunscreen, and applied it more thoroughly than control-site teens. CONCLUSIONS: Our multicomponent model addressing adolescent sun protection shows the power of engaging teens and adults from across the community as role models and educators. This new ecological approach shows promise in changing adolescent sun protection behaviors and reducing skin cancer risks.

Adolescent↗
PubMed2006

Brief intervention for alcohol use by pregnant women.

OBJECTIVES: We examined the efficacy of brief intervention as a technique to help pregnant women achieve abstinence from alcohol. A second aim was to assess newborn outcomes as a function of brief intervention. METHODS: Two hundred fifty-five pregnant women who were participants in the Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children and who reported drinking alcohol were assigned to an assessment-only or a brief intervention condition and followed to their third trimester of pregnancy. Brief intervention consisted of 10- to 15-minute sessions of counseling by a nutritionist, who used a scripted manual to guide the intervention. Newborn outcomes of gestation, birth-weight, birth length, and viability were assessed. RESULTS: Women in the brief intervention condition were 5 times more likely to report abstinence after intervention compared with women in the assessment-only condition. Newborns whose mothers received brief intervention had higher birthweights and birth lengths, and fetal mortality rates were 3 times lower (0.9%) compared with newborns in the assessment-only (2.9%) condition. CONCLUSIONS: The success of brief intervention conducted in a community setting by nonmedical professionals has significant implications for national public health policies.

Black or African American↗
PubMed2007

Documentation of pharmacists' interventions in an emergency department and associated cost avoidance.

PURPOSE: An analysis was conducted of pharmacist interventions and resuscitation experiences, including pharmacist participation in a hospital emergency department (ED), and the potential cost avoidance associated with the interventions made by the pharmacists. METHODS: All pharmacists working in the ED prospectively documented the pharmacist interventions that were accepted by physicians and nursing staff and entered into a spreadsheet on a weekly basis, between September 1, 2003, and December 31, 2003. Intervention categories included the provision of drug information; recommendations for dosage adjustment, formulary interchange, initiation of medications, alternative drug therapy, discontinuation of drug therapy, changes in medication therapy due to allergy notification, drug therapy duplication prevention, or changes in the route of drug administration; questions from nursing staff; order clarifications; drug compatibility issues; patient information; toxicology; and drug interaction identification. Intervention data were analyzed and the likelihood of harm was scored; interventions were classified and analyzed by calculating average cost, probability of harm, and potential cost avoidance. RESULTS: During the study, 2150 pharmacist interventions were documented. Pharmacists participated in the care of 1042 patients triaged to the resuscitation area of the ED. Cost avoidance during the study was determined to be 1,029,776 dollars. CONCLUSION: The most commonly documented interventions made by pharmacists involved in the care of patients visiting the ED included provision of drug information, dosage adjustment recommendations, responses to questions from nursing staff, formulary interchanges, and suggestions regarding initiation of drug therapy. The potential cost avoidance attributable to the pharmacist interventions during the study period was over 1 million dollars.

Cost Control↗
PubMed1986

The drug treatment of mild hypertension in the Multiple Risk Factor Intervention Trial. A review.

The Multiple Risk Factor Intervention Trial was a long term study on the benefit of lowering risk factors for coronary heart disease mortality in middle-aged men. Study participants were randomised to either 'special intervention' or 'usual care'. Intensive intervention for special intervention men involved cholesterol lowering dietary advice, behaviour modification for cigarette smoking and a stepped care pharmacological approach to lower blood pressure. Overall, at 6 years, there was a 7.1% lower coronary heart disease mortality in special intervention compared with usual care men, a statistically non-significant difference (Confidence Interval +25 to -15%). Subgroup analysis revealed that special intervention men who were hypertensive at baseline and who had resting ECG abnormalities experienced a higher coronary heart disease mortality than the comparable usual care group. Within group Cox regression analysis, with coronary heart disease mortality as the dependent variable, revealed an interaction between diuretic use and resting ECG abnormalities in special intervention men. Additional analyses of clinics revealed a higher special intervention/usual care mortality in those clinics that used mainly hydrochlorothiazide in special intervention hypertensives. Results of the Multiple Risk Factor Intervention Trial raise important questions concerning the treatment of mild hypertension, and the clinical significance of metabolic alterations of antihypertensive drugs.

Adult↗
PubMed1994

The effectiveness of psychological interventions in competitive sport.

The use of psychological interventions in competitive sport to enhance performance has become increasingly popular. However, the effectiveness of these interventions has been questioned by some sports psychologists. In general, educationally-based psychological interventions have produced significant increases in performance. Specifically, it was found that 38 of the 45 studies examined (85%) had found positive performance effects, although causality could only be inferred in 20 of these studies. These interventions could be classified as relaxation-based, cognitive, cognitive-behavioural or behavioural in nature. Although general support was provided for the effectiveness of psychological interventions in competitive sports, a number of methodological shortcomings limit the application of the findings. For example, future intervention research in competitive sport should employ more detailed manipulation checks, include follow-up assessments beyond a mere post-test, include placebo-control groups to control for expectancy effects and include more diverse samples. In addition to the empirical intervention research, recent research employing qualitative methodologies has greatly added to our understanding of the types of interventions and what type of sport psychology consultants most positively affect performance enhancement, as well as the personal growth of athletes. Continued quantitative and qualitative research needs to be conducted so that a better understanding is gained of how to conduct psychological interventions with athletes that will enhance performance as well as personal growth.

Behavior Therapy↗
PubMed2006

An evaluation of cost sharing to finance a diet and physical activity intervention to prevent diabetes.

OBJECTIVE: The Diabetes Prevention Program (DPP) lifestyle intervention is a cost-effective strategy to prevent type 2 diabetes, but it is unclear how this intervention could be financed. We explored whether this intervention could be offered in a way that allows return on investment for private health insurers while remaining attractive for consumers, employers, and Medicare. RESEARCH DESIGN AND METHODS: We used the DPP and other published reports to build a Markov simulation model to estimate the lifetime progression of disease, costs, and quality of life for adults with impaired glucose tolerance. The model assumed a health-payer perspective and compared DPP lifestyle and placebo interventions. Primary outcomes included cumulative incidence of diabetes, direct medical costs, quality-adjusted life-years (QALYs), and cost per QALY gained. RESULTS: Compared with placebo, providing the lifestyle intervention at age 50 years could prevent 37% of new cases of diabetes before age 65, at a cost of $1,288 per QALY gained. A private payer could reimburse $655 (24%) of the $2,715 in total discounted intervention costs during the first 3 intervention years and still recover all of these costs in the form of medical costs avoided. If Medicare paid up to $2,136 in intervention costs over the 15-year period before participants reached age 65, it could recover those costs in the form of future medical costs avoided beginning at age 65. CONCLUSIONS: Cost-sharing strategies to offer the DPP lifestyle intervention for eligible people between ages 50 and 64 could provide financial return on investment for private payers and long-term benefits for Medicare.

Aged↗
PubMed1996

Effects of a brief office-based intervention to facilitate diabetes dietary self-management.

OBJECTIVE: There is a pressing need for brief practical interventions that address diabetes management. Using a randomized design, we evaluated a medical office-based intervention focused on behavioral issues relevant to dietary self-management. RESEARCH DESIGN AND METHODS: There were 206 adult diabetes patients randomized to usual care or brief intervention, which consisted of touchscreen computer-assisted assessment to provide immediate feedback on key barriers to dietary self-management, and goal setting and problem-solving counseling for patients. Follow-up components to the single session intervention included phone calls and interactive video or videotape instruction as needed. RESULTS: Multivariate analyses of covariance revealed that the brief intervention produced greater improvements than usual care on a number of measures of dietary behavior (e.g., fewer calories from saturated fat, fewer high-fat eating habits and behaviors) at the 3-month follow-up. There were also significant differences favoring intervention on changes in serum cholesterol levels and patient satisfaction but not on glycosylated hemoglobin. The intervention effects were relatively robust across a variety of patient characteristics, the two participating physicians, and intervention staff members. CONCLUSIONS: If the long-term results are equally positive and generalize to other setting, this intervention could provide a prototype for a feasible cost-effective way to integrate patient views and behavioral management into office-based care for diabetes.

Adult↗
PubMed1997

Effects of an intervention by a diabetes team in hospitalized patients with diabetes.

OBJECTIVE: Hospitalized patients with diabetes have a prolonged length of stay in the hospital. We conducted a controlled prospective randomized feasibility study of the effects of a diabetes team (a diabetes nurse educator and an endocrinologist) on the length of stay and other outcomes of hospitalization in these patients. RESEARCH DESIGN AND METHODS: A total of 179 hospitalized patients with diabetes were randomly assigned to receive usual care supplemented with (85 patients) or without (94 control patients) a diabetes team intervention. Outcome measures included the length of stay, blood glucose control, and rates of readmission. RESULTS: For the primary diagnosis of diabetes, the median length of stay was 5.5 days (95% CI 4-8 days) for patients who received diabetes team intervention and 7.5 days (5-11 days) for the control patients (NS). For the secondary diagnosis of diabetes, the median length of stay was 10.0 days (8-13 days) in the intervention group and 10.5 days (8-13 days) in the control group (NS). One month after the team intervention was initiated, 75% of patients in the intervention group were in good glycemic control, compared with 46% in the control group. Readmissions at 3 months after discharge included 13 (15%) patients from the intervention group and 30 (32%) patients in the control group (P = 0.01). CONCLUSIONS: Randomized controlled prospective trials of clinical interventions in hospitalized patients with diabetes are feasible. Diabetes team intervention appears to reduce the hospital length of stay and to improve glycemic control. Team intervention significantly reduces the rate of recurrent hospitalization.

Adolescent↗
PubMed2002

Strong in body and spirit: lifestyle intervention for Native American adults with diabetes in New Mexico.

OBJECTIVE: To determine the effects of a culturally appropriate diabetes lifestyle intervention for Native Americans on risk factors for complications of diabetes. RESEARCH DESIGN AND METHODS: A nonrandomized, community-based diabetes intervention trial was conducted in three Native American sites in New Mexico from 1993-1997. Participants were assigned to intervention or control based on community of residence. Intervention sessions were held approximately 6 weeks apart over approximately 10 months. The intervention was delivered in site A in family and friends (FF) groups (n = 32); site B received the same intervention in one-on-one (OO) appointments (n = 39); and site C received usual medical care (UC) (n = 33) (total participants, n = 104). Primary change in HbA(1c) level was assessed at 1 year. RESULTS: Adjusted mean change in HbA(1c) value varied significantly across the three arms at 1 year (P = 0.05). The UC arm showed a statistically significant increase in adjusted mean HbA(1c) change (1.2%, P = 0.001), whereas both intervention arms showed a small nonsignificant (P > 0.05) increase in the adjusted mean change (0.5% and 0.2% for FF and OO arms, respectively). The increase was statistically significantly smaller in the combined intervention arms (0.4%) compared with the UC arm (1.2%, P = 0.02). CONCLUSIONS: Lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time.

Adult↗
PubMed2004

Improvements in patient-reported outcomes associated with an intervention to enhance quality of care for rural patients with type 2 diabetes: results of a controlled trial.

OBJECTIVE: The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve quality of care for rural patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta, Canada. The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers. Clinical and patient-reported outcomes were assessed after 6 months. Patient-reported outcomes included changes in health-related quality of life (Health Utilities Index Mark 3 [HUI3]), satisfaction with care, lifestyle (Diabetes Lifestyle Form), and adherence to self-care activities. Analysis of covariance was used to assess differences over time between the control and intervention regions. RESULTS: A total of 200 intervention and 172 control subjects were included in this analysis. After adjusting for important clinical and demographic differences, a statistically significant and clinically important improvement in the overall HUI3 score was seen at the 6-month follow-up in the intervention region (0.06 [95% CI 0.02-0.10]) compared with the control region (0.01 [-0.04 to 0.04]) (P = 0.03 for the difference between groups). Satisfaction with general medical care (P < 0.001 between groups) and diabetes care (P < 0.001 between groups) increased among patients in the intervention region compared with the control region. Self-efficacy, attitudes, and beliefs about diabetes control all increased in the intervention region when compared with the control region, but adherence to self-care activities did not. CONCLUSIONS: A provider-level intervention directed at improving quality of clinical care for patients with type 2 diabetes also had a favorable impact on overall health-related quality of life, satisfaction with care, and other humanistic outcomes.

Alberta↗
PubMedDate not supplied

[Diffusion of pharmacist interventions within the framework of clinical pharmacy activity in the clinical ward].

BACKGROUND: Computerised physician order entry (CPOE) and the integration of a pharmacist in clinical wards have been shown to prevent medication errors. OBJECTIVES: The objectives were to describe interventions performed by a clinical pharmacist integrated into clinical wards with CPOE, to assess the acceptance of interventions by prescribers, and to describe factors associated with acceptance. METHODS: A 3-week prospective study was conducted in five wards of a 2000-bed French teaching hospital. RESULTS: During pharmacist review of medication orders and participation on physician rounds, six resident pharmacists provided interventions either conveyed orally to prescribers, using the computer system, or combining both methods. There were 221 pharmacist interventions concerning drug-drug interactions (27%), drug monitoring (17%) and computer-related problems (16%). Pharmacist interventions consisted of change of drug choice or dose adjustment (49%), drug monitoring (17%) and administration modality optimisation (14%). Interventions were provided solely via computer systems in 67% of cases. The rate of intervention acceptance was 47.1%. In multivariate analysis, acceptance was significantly associated with oral transmission (odds ratio [OR] = 6.46; 95% confidence interval [95% CI] [1.65-25.24]; p < 0.01), change of drug choice or dose adjustment recommendations (OR = 3.81; 95% CI [1.63-8.86]; p < 0.01) and administration modality optimisation recommendations (OR = 9.51; 95% CI [3.02-29.93]; p < 0.01). CONCLUSION: Communication method and nature of recommendation are factors associated with pharmacist intervention acceptance. CPOE is necessary to develop clinical pharmacy practice. However, only the integration of the pharmacist on the ward can guarantee a high level of acceptance of pharmacist interventions by prescribers.

France↗
PubMed1995

Epidemiological assessment of an intervention trial to increase calcium intake in female college students.

An educational intervention trial to increase calcium (Ca) intake was conducted on female college students taking a dietician course and the efficacy of the trial was assessed by a prospective cohort study. The one hundred and eight 18- or 19-year-old students were divided into two cohorts, i.e., a control group and an intervention group. The educational intervention was given to the intervention group only and both group received 3 surveys, before the intervention (baseline, BL), 1 week after the intervention (WAI), and 1 year after the intervention (YAI). The amount of Ca intake at BL did not differ significantly between the cohorts. The Ca intake of the control group did not change significantly in the 3 surveys. The intervention group significantly increased Ca intake at WAI and maintained a higher level of Ca intake at the time of YAI. These results suggest some efficacy of the educational intervention to increase Ca intake in the female college students.

Adolescent↗
PubMedDate not supplied

Competence-building in adolescents, Part II: Community intervention for survivors of peer suicide.

Nurses often encounter situations in which they are called upon to assist in post-suicide community interventions with teachers, church youth group leaders, and mental health professionals. Controlled studies of interventions to aid adolescents coping with the loss of a peer are lacking. The purpose of this study, conditioned by an unanticipated suicide in an ongoing research study, was to document changes in psychosocial competence of adolescent peer suicide survivors. Following a supportive community intervention, the peer survivor group was compared with a similar group of adolescents who did not experience peer suicide. Both groups were in the control condition of a larger nursing study of social competence-building. The survivor group had significantly greater self-efficacy immediately after the community intervention and 2 months later when contrasted with the comparison group. In addition, the survivor group reported greater social acceptance and job competence immediately after the community intervention. Correlated t-tests showed the survivor group had significant gains in problem-solving appraisal and global self-worth after the community intervention, but significant declines in global self-worth and scholastic competence 2 months after the intervention. The findings support the belief that community interventions are initially worthwhile in helping adolescents to cope with peer suicide, but continued supportive intervention may be needed to offset declines noted over time in areas such as self-worth and academics.

Adaptation, Psychological↗
PubMedDate not supplied

Impact of a longitudinal community HIV intervention targeting injecting drug users' stage of change for condom and bleach use.

PURPOSE: To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation. DESIGN: Repeated cross-sectional sampling with matched intervention and comparison communities. SETTING: Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution. SUBJECTS: 3081 injecting drug users who were sexually active and/or shared injection equipment. INTERVENTION: Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms. MEASURES: Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners. RESULTS: Toward the end of the study, 77% of injection drug users in the intervention area reported being exposed to the intervention. In the intervention area, rates of condom carrying increased from 10 to 27% (p < .001), and there was an increase from 2.32 to 3.11 in mean stage of change for using condoms with other partners, while stage of change decreased in the comparison area (p < .01). Mean stage of change for using condoms with a main partner also increased in the intervention area, but the difference was not significant after controlling for change in the comparison area. Subjects with recent project exposure had higher stage-of-change scores for using condoms with a main partner (p < .05) and other partners (p < .01) and for cleaning injection equipment with bleach (p < .05). CONCLUSIONS: The results demonstrate the effectiveness of the AIDS Community Demonstration Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.

Adult↗
PubMedDate not supplied

A worksite intervention to enhance social cognitive theory constructs to promote exercise adherence.

UNLABELLED: The results suggest social cognitive theory variables associated with the adoption of exercise are changeable in a brief worksite intervention. Self-regulation techniques and outcome-expectancy value improved, but self-efficacy did not improve for the treatment group. One possible explanation is, the intervention did not adequately address the ability to overcome barriers to exercise faced by participants in the intervention. Another explanation may be the effect of experiencing the barriers to exercise faced by subjects during the first 4 weeks of a self-regulated exercise program. Before engaging in exercise, the participants had a perceived level of confidence to overcome barriers to exercise. Once faced with real barriers to exercise, the subjects may have reevaluated their ability to overcome these barriers. It is interesting that the comparison group reported small decreases in all social cognitive theory variables measured in this study. The comparison group received a program of assessment, instruction, and access to facilities that is common to many worksite-based fitness promotion programs. Clearly, this approach did not have a favorable impact on psychosocial variables associated with exercise adherence. These results may be explained by a reevaluation of beliefs and perceived capabilities to exercise, once faced with the real experiences and barriers related to the adoption of an exercise program. The small decreases in social cognitive theory variables in the comparison group may explain high dropout rates in many fitness center programs and warrant further study. IMPLICATIONS: Health promotion specialists at the worksite need intervention programs that are safe, effective, and efficient for their employees. This intervention was based in the classroom, and no exercise was performed during class. This is appealing to employees who do not have access to shower facilities at the worksite. Moreover, in many interventions, subjects exercise during class and have limited time to learn specific skills to help them adopt and maintain exercise outside the structure of the intervention. Having established favorable changes in social cognitive theory constructs attributable to the intervention, a follow-up study should be conducted to determine the extent to which these changes predict adherence to regular exercise. These studies would establish the causal linkages between social cognitive theory constructs and regular exercise. LIMITATIONS: There were specific limitations, and the results should be interpreted cautiously. The sample size was relatively small, although similar to other exercise intervention research reviewed by Dishman. Another limitation of the sample was no random assignment to treatment or comparison group. The results apply only to the subjects who volunteered for this study. The measure of outcome-expectancy value is the most vulnerable of those used to measure outcome expectations and outcome expectancies. It is possible that the results of the study would be substantially altered if a better measure were available. The data were collected through self-administered questionnaires. It was assumed the subjects would provide accurate information, but reliance on self-reported data introduces potential sources of error.

Adult↗
PubMedDate not supplied

Evaluation of a Wellness-Based Mindfulness Stress Reduction intervention: a controlled trial.

PURPOSE: To determine if participation in a Wellness-Based Mindfulness Stress Reduction intervention decreases the effect of daily hassles, psychological distress, and medical symptoms. DESIGN: A randomized controlled trial of a stress reduction intervention with a 3-month follow-up. SETTING: A university setting in West Virginia. SUBJECTS: A total of 103 adults, with 59 in the intervention group and 44 in the control group. Eight-five percent of subjects completed the intervention. Fifty-nine percent and 61% of the intervention and control subjects completed the study, respectively. INTERVENTION: The intervention consisted of an 8-week group stress reduction program in which subjects learned, practiced, and applied "mindfulness meditation" to daily life situations. The control group received educational materials and were encouraged to use community resources for stress management. MEASURES: The Daily Stress Inventory assessed the effect of daily hassles, the Revised Hopkins Symptom Checklist measured psychological distress, the Medical Symptom Checklist measured number of medical symptoms, and a Follow-up Questionnaire measured program adherence. RESULTS: Intervention subjects reported significant decreases from baseline in effect of daily hassles (24%), psychological distress, (44%), and medical symptoms (46%) that were maintained at the 3-month follow-up compared to control subjects (repeated measures analysis of variance [ANOVA]; p < .05). CONCLUSIONS: Self-selected community residents can improve their mental and physical health by participating in a stress reduction intervention offered by a university wellness program.

Adult↗
PubMed2000

Safe motherhood intervention studies in Africa: a review.

OBJECTIVE: To review the findings of safe motherhood intervention studies conducted in African settings. DATA SOURCES: Published literature regarding interventions designed to reduce maternal mortality in African settings. STUDY SELECTION: Studies conducted in sub-Saharan Africa to assess the effects of interventions designed to reduce maternal mortality. DATA EXTRACTION: Search of Medline database for the years 1988 to 1998 with additional manual search of references cited in Medline-referenced studies. DATA SYNTHESIS: Few of the 34 intervention studies identified used a double-blind, randomized controlled trial design (4/34), or outcome measures directly related to maternal mortality or maternal health (7/34). Six of the studies produced reasonably convincing evidence of a positive effect on maternal health outcomes. Of these, three showed that changes in delivery practices brought about improved maternal outcomes, two found that a combined intervention consisting of upgrading of emergency obstetric services and community education increased the number of major obstetric complications treated, and one showed that a range of improvements in hospital equipment and management reduced facility-based maternal mortality ratios. No study sought to reduce maternal mortality associated with unsafe termination of pregnancy. CONCLUSIONS: More than a decade after the launching of the Safe Motherhood Initiative, there exists little evidence regarding which interventions will reduce maternal mortality levels in African settings. Intervention studies conducted in Africa have identified several low-tech improvements in emergency obstetric services which improve maternal outcomes and deserve replication and testing in a variety of settings. Further operational research should be conducted to identify and test other promising safe motherhood interventions, in particular interventions designed to reduce the important proportion of maternal mortality associated with unsafe termination of pregnancy.

Africa↗
PubMedDate not supplied

Playfulness in children with and without disability: measurement and intervention.

OBJECTIVE: The differences in playfulness between young children with cerebral palsy and developmental delays and children who are typically developing, and the comparative effects of two interventions (one focused on improving mother-child interaction patterns, the other a neurodevelopmental treatment [NDT] session) on children's playfulness were examined in this study. Reliability and validity of the Test of Playfulness (ToP) also were examined. METHOD: Three trained raters used the ToP to score 38 children, half with cerebral palsy and developmental delays and half typically developing, as they played with their mothers. Mental ages of the children ranged from 3 to 18 months. The mother-child dyads in which the children had cerebral palsy and developmental delays were then randomly assigned to an intervention group. After a 1-hr intervention to improve mother-child interaction, the children were rescored on the ToP. RESULTS: After examination of ToP reliability and validity, children with cerebral palsy and developmental delays were found to score significantly lower on the ToP than their peers who were typically developing. In addition, children whose mothers received an intervention to improve mother-child interactions scored significantly higher on the ToP after intervention than before intervention. However, the gain scores of children whose mothers received the intervention were not significantly higher than those of children who received direct NDT. CONCLUSION: The results suggested that when the shared goal of parents and therapists is to enable children to express their inherent playfulness, intervention to improve parent-child interactions may be more potent than intervention directed at improving the child's developmental skills.

Adult↗