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PubMed2004

[Interventional cardiology in Lithuania: current status and perspectives].

The objective of the article is to evaluate current status of interventional cardiology in Lithuania, to compare these data with the results of interventional cardiology of other European countries and to discuss about perspectives of interventional cardiology in Lithuania. A detailed questionnaire of interventional cardiology of European Society of Cardiology was used for analysis of Lithuanian interventional cardiology data of 2000-2002. Lithuanian interventional cardiologists in 2000-2002 annually performed respectively 1535, 1666 and 2085 coronary angiographies, 500, 532 and 632 PTCA, 120, 133 and 193 stenting procedures per 1000000 inhabitants. According to morbidity of heart diseases in Lithuania and the rate of interventional procedures in Europe, in 2004 more than 9000 coronary angiographies should be performed, 3000 percutaneous transluminal coronary angioplast procedures, and 2000 coronary stent implantations in Lithuania. Achievement of such results would be possible, if the State Sickness Fund and the Ministry of Health would pay more attention to financial problems of interventional cardiology in Lithuania. In conclusion, it can be stated that there are good perspectives for Lithuanian cardiologists to achieve mean European level of interventional procedures in the nearest future.

Angioplasty, Balloon, Coronary↗
PubMed2004

[An evaluation of effects of intervention on maternal and child health in the rural areas of China].

OBJECTIVE: To evaluate the impact of training maternal and child health care providers in the rural areas of China on improvement of health care to pregnant and puerperal women. METHODS: The data originated from the Reproductive Health/Family Planning Project implemented by the State Family Planning Commission and the Ministry of Health from 1998 to 2002, which covered 32 counties in 22 provinces of China. A quasi-experimental design was used. 6 counties were selected from 32 project counties as the intervention group, while 6 non-project counties were taken as the control group with the condition similar to that of the selected project counties in respect to their number of population and economic level. The subjects of the study were mothers with child under 3 years. A total of 348 mothers were interviewed using a structured questionnaire by strictly trained surveyors. It was focused on prenatal care and postpartum follow-up in the survey. INTERVENTION: According to the plan of the project, all maternal and child health care providers at the grass-root level were given a 2-week theoretical training, and some of them were assigned to hospitals where they were gievn a 1-month clinical skills training. RESULTS: With regard to prenatal care, the mothers in intervention group received more prenatal care than those in control group (mean number of obstetric visits: 6.64 vs 5.64, P<0.05). The number of items of examination taken in intervention group was more than that in control group (6.71 versus 5.67, P<0.05). The proportion of the mothers in intervention group who were told that they must visit doctors if they felt uncomfortable in pregnant period, was higher than that in control group (P<0.05). 8 symptoms or signs that possibly occur in pregnant period were listed; in this connection, the mothers in intervention group knew more than those in control group (3.43 vs 2.09, P<0.05). In the postpartum follow-up, more mothers in the intervention group were examined by the doctors. The proportion of mothers who were informed of contraceptive methods was higher in intervention group than in control group (94% vs 78.5%, P<0.05). The descending rate of maternal mortality rate in the intervention areas was much higher than that in the control areas. CONCLUSION: The training of maternal and child health care providers had a significant impact on improving their service skills and quality; consequently, the women covered by their service could receive better maternal and child health care. This indicates that the Reproductive Health/Family Planning Project implemented in the rural areas of China is successful.

Adult↗
PubMed2004

Representing public health nursing intervention concepts with HHCC and NIC.

PURPOSE: It is imperative that public health nurses define their services and provide evidence supporting the effectiveness of interventions. The purpose of this paper is to examine the ex-tent to which two standardized nursing terminologies--Home Health Care Classification (HHCC) and Nursing Interventions Classification (NIC)--represent public health nursing practice according to core public health function in Public Health Nursing Intervention model. METHODS: First, we divided all HHCC and NIC interventions into intervention focus levels: individual/family-focused, community-focused, and system-focused. Second, we categorized HHCC and NIC interventions according to core public health functions: assessment, policy development, and assurance and the categories of interventions in the PHI Model. RESULTS: We identified HHCC and NIC Nursing interventions that represented public health nursing concepts across core public health functions and categories of the PHI model. Analysis of the findings demonstrated that HHCC and NIC have terms for the concepts in the PHI model. CONCLUSION: Although HHCC and NIC cover many concepts in public health nursing practice, additional research is needed to extend these terminologies and to evaluate other standardized terminologies that can reflect more comprehensively public health nursing interventions.

Home Care Services↗
PubMed2004

[Weight-control intervention in overweight subjects at high risk of cardiovascular disease: a trial of a public health practical training program in a medical school].

OBJECTIVE: To evaluate the effectiveness of a weight-control intervention for overweight subjects at high risk of cardiovascular disease (CVD) at a worksite conducted by medical students as a public health practical training program. METHODS: A total of 45 men and women who were obese (BMI > or = 24.0 kg/m2) and found to be hypertensive (SBP > or = 140 mmHg or DBP > or = 90 mmHg) or suffering from hypercholesterolemia (total serum cholesterol > or = 220 mg/dl) in an annual health check up in November 2001 were invited to participate in a weight-control intervention program. Eight individuals agreed (intervention group) and other sixteen control subjects whose sex and age (+/- 3 years) were matched to the intervention subjects were selected. The duration of the program was three months (from July to October 2002) and a 2 kg weight reduction in that period was set as the goal. The baseline survey consisted of a dietary questionnaire and a health quiz. Subjects had two counseling sessions and received four personal letters in the three months. A semi-quantitative food frequent questionnaire, a photograph method (Diet Agent Service, Matsushita Electric Works, Ltd.) and three day food records were conducted for dietary surveys. Changes in bodyweight, BMI, blood pressure, and serum total cholesterol concentration from November 2001 to November 2002 were compared between the intervention and control groups. Food group intakes and nutrient intakes were compared between weight reduction achievers and non-achievers. RESULTS: Mean bodyweight changes from November 2001 to November 2002 were -2.3 kg (SD 3.3 kg) for the intervention group and +0.3 kg (SD 1.5 kg) for the control group, the difference being significant (p = 0.013). For the intervention group mean bodyweight change from July to October 2002 was -1.5 kg (SD 2.4 kg). For total serum cholesterol, the mean changes were -32.1 mg/dl vs. +0.5 mg/dl (p = 0.005), for SBP -9.5 mmHg vs. +4.7 mmHg (p = 0.083) and for DBP -2.8 mmHg vs. +1.4 mmHg (p = 0.438). These were thought to be consequences of weight-control intervention. From dietary surveys, weight reduction achievers increased fish intake and decreased fats, snacks and sweets. Those who answered the health quiz more correctly demonstrated more reduction of bodyweight. CONCLUSIONS: Effectiveness of a weight-control intervention for reduction of CVD risk factors was found in the present public health practical training program for medical students. Dietary advice based on various dietary surveys was indicated to be effective in the weight-control program. A population strategy to distribute health information appeared necessary for effective health education programs for high-risk subjects.

Cardiovascular Diseases↗
PubMed2005

Using focus groups of older African Americans and Latinos with diabetes to modify a self-care empowerment intervention.

OBJECTIVE: To make cultural and age-specific modifications to a self-care empowerment intervention. DESIGN: Focus groups with self-administered surveys. SETTING: Two public health diabetes and geriatrics clinic and two senior centers in and around South Los Angeles. PARTICIPANTS: African Americans and Latinos aged > or = 55 years with diabetes (N=79), and two groups of health educators (N=16). MAIN OUTCOME MEASURES: After describing the proposed intervention, the focus group facilitators asked participants: 1) whether the community of interest would be interested in the proposed empowerment intervention; 2) why or why not; and 3) how the intervention could be modified to better address the concerns of the study community of interest. All groups were audiotaped, transcribed, and (when appropriate) translated into English. Three independent investigators read all transcripts and completed standardized coding forms for each transcript. In addition, at the end of each focus group, all participants completed a self-administered written survey asking them to rate aspects of the proposed intervention. RESULTS: Older African Americans and Latinos endorsed the intervention but desired an expanded dietary educational component and identified disability as an important missing content area. Participants rejected the use of an audio learning tool and did not believe that matching group-facilitator sociodemographic characteristics was important as long as facilitators demonstrated cultural competency. CONCLUSIONS: These findings illustrate a model of participatory research in which researchers and community members work together to develop an empowerment intervention that will meet community needs and will have greater cultural appropriateness. Modifying the intervention in accordance with these findings should enhance the relevance and impact of the self-care intervention.

Black or African American↗
PubMed1992

Interventions related to pain.

A two-round Delphi survey was completed by pain experts to achieve consensus on 10 selected pain interventions and associated activities characteristic of each intervention. Consistently high scores were obtained by the raters for each intervention and activity, with most activities perceived as critical to the intervention. Interventions with more specific activities were rated highest by the expert judges. Expert feedback indicates the complexity of establishing a list of activities for selected interventions when dealing with pain of various types, with different causes and for different patient populations. The expert raters clearly see assessment and evaluation activities as part of the intervention strategies for each intervention. Further research is needed to validate the interventions and activities with nurse experts from varying clinical specialty areas in the practice setting.

Delphi Technique↗
PubMed2005

[Stage progression of dental patients following brief interventions for smoking cessation].

PURPOSE: Potential effects of brief intervention for smoking cessation were evaluated by examination of stage progression with respect to quitting the habit in dental patients. METHODS: Stage progression was retrospectively evaluated in 25 patients undergoing brief interventions since April 2001 at a university dental hospital. Stage of cessation was requested prior to and following interventions (June to December 2003) according to the modification method of Prochaska's model. Brief interventions were conducted by indication of effects of smoking in the mouth and on dental treatment at each visit. Cessation techniques were explained in instances where subjects displayed an interest in smoking cessation. RESULTS: The intervals between dental visits varied (1-6 months). Prior to intervention, numbers of patients in the pre-contemplation, contemplation and preparation stages were 15, 5 and 5, respectively; this changed to 6, 2 and 1, respectively, following intervention, with 16 participants attempting smoking cessation, and 9 reporting continued abstinence. Stage progression was noted in 18 subjects. In the remaining 7 patients, 6 in the pre-contemplation and 1 in the contemplation stage, no change was registered. More than half of the patients (11/20) who had not prepared for cessation prior to intervention and all patients (5/5) in the preparation period reported smoking cessation following the brief interventions. CONCLUSION: Brief interventions in dental practice can induce smoking cessation in patients.

Aged↗
PubMed2006

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial.

AIM: To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management. DESIGN OF STUDY: Randomised controlled trial. SETTING: Twenty-six intervention and 23 control primary care practices in the Netherlands. METHOD: Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later. RESULTS: Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant. CONCLUSION: The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument.

Family Practice↗
PubMed1990

Four years' experience with a clinical intervention program: cost avoidance and impact of a clinical coordinator.

Four years of data are reported on the drug cost avoidance and the net cost savings associated with a clinical pharmacy intervention program. In 1986 the pharmacy department at a 324-bed nonprofit community medical center began a clinical intervention program by adding one full-time equivalent for providing clinical services. A new clinical pharmacist position was created in 1988. A reorganization in 1989 resulted in further increases in staffing, including the creation of a clinical coordinator position to oversee the intervention program, and in administrative time. Staff pharmacists self-report a broad range of interventions on a clinical documentation form. During the period 1986-1989, monthly data on the number of types of interventions recommended, the percentage of recommendations accepted by the medical staff, and drug cost avoidance were tabulated. Cost avoidance was calculated by subtracting the cost of therapy ordered by the physician from the cost of therapy initiated as a result of the intervention. Net drug cost savings were calculated by subtracting from cost avoidance the cost of pharmacist time required for performing the interventions. The average number of interventions per month ranged from 170 in 1986 to 292 in 1990. During an 18-month period before the clinical coordinator was added, average monthly cost avoidance and net savings were $4932 and $3739, respectively. Average monthly cost avoidance increased to $6244 and savings to $4644 in a 12-month period after the clinical coordinator was added. A four-year study of a clinical intervention program showed that the dollar value and impact outlasted the initial success expected for such programs.

Administrative Personnel↗
PubMed1990

The Mother-Infant Transaction Program. The content and implications of an intervention for the mothers of low-birthweight infants.

A brief, economic neonatal intervention based on the transactional model of development and influenced predominantly by the conceptual design of the Neonatal Behavioral Assessment Scale was implemented in an intensive care nursery with the mothers of a group of low-birthweight infants. The development of the intervention group was compared with that of a similar group of low-birthweight infants who did not receive the intervention and contrasted with that of a group of normal-birthweight infants. The intervention had a significant effect on maternal adjustment and perception of the infant at 6 months. No significant effect on infant cognitive development was apparent until 36 months (that is, 31 months after the intervention had ceased). The intervention effect was even more significant at 48 months. It appeared that the two low-birthweight groups had progressively diverged after 12 months, the intervention group rising until it approximated the normal-birthweight group in cognitive development, whereas the low-birthweight control group deteriorated. The economical nature of the MITP, its unique (although delayed) benefits, and the apparent durability of the intervention effect, suggest that this intervention program has important theoretical and practical implications and potentially far-reaching applications.

Child Development↗
PubMed1990

Comparative effectiveness of individual and group interventions to support family caregivers.

The comparative effectiveness of individual and group interventions in supporting family caregivers of frail older people was examined. An individual intervention produced more positive effects on caregiver psychological functioning and well-being than did a group intervention, whereas a group intervention produced greater improvements in caregivers' social supports. Participants in both interventions experienced significant improvements in coping with caregiving stress. Process differences are proposed as an explanation for the differential effects of the two intervention modalities. Psychological issues respond best to individual intervention, and social support issues respond best to group intervention. Therefore, the most appropriate type of intervention might be determined by the types of problems and issues specific to an individual caregiver.

Counseling↗
PubMed1989

Effect of a pharmacist's and a nurse's interventions on cost of drug therapy in a medical intensive-care unit.

The effect of interventions by a pharmacist and a nurse on the cost of drug therapy in a medical intensive-care unit (ICU) was determined. A pharmacist taught cost-avoidance concepts related to medication use to a senior member of the nursing staff. The pharmacist and the nurse documented during a 91-day period all interventions that resulted in a discontinuation or change in drug therapy or involved nonformulary drug requests or serum drug concentration determinations. Costs that were avoided or added as a result of these interventions were determined using drug acquisition costs and (for interventions involving i.v. therapy) the cost of related supplies. Costs were calculated for both the initial 24-hour period after each intervention and the expected duration of therapy. The 345 interventions of the pharmacist and the nurse represented $6,383 in 24-hour cost avoidance and $23,993 in total cost avoidance. The majority of interventions resulted in discontinuation of medications or changes in drug dosage; most of those interventions involved antimicrobial agents. Other frequent interventions involved changes in route of administration and the interchange of therapeutic alternates. A pharmacist and a nurse had a positive impact on the cost of drug therapy in a medical ICU.

Baltimore↗
PubMed1987

Interventions in preschools to increase the use of safety restraints by preschool children.

Despite the proven safety value of wearing vehicle safety restraints, people continue to travel without this protection. Legislation requiring the use of safety restraints has been implemented in several countries, including Australia, in an attempt to improve rates of restraint use. In Australia, legislation dramatically increased rates of adult restraint use, yet the rate of restraint use by children remains comparatively low. One of the main reasons for parents not restraining their child is the child's dislike of wearing a restraint, with resultant disruptive behavior. This study compared two interventions implemented within preschools: a coercive intervention aimed at parents and an educational intervention aimed at preschool children. Measures of restraint use were made by direct observation at preschools prior to intervention and again immediately following the 2-week interventions. The safety restraint use of children in the control and coercive intervention groups did not change significantly as a result of intervention. Restraint use of children in the educational intervention group increased 15 percentage points from 60.6% to 75.0%: a significant increase of 25%. This novel intervention approach holds promise as a means of increasing preschool children's use of safety restraints.

Accident Prevention↗
PubMed1995

Effectiveness of physician-based interventions with problem drinkers: a review.

OBJECTIVE: To review the results of randomized controlled trials on the effectiveness of brief physician interventions with problem drinkers. DATA SOURCES: The MEDLINE and EMBASE databases were searched for articles published from 1966 and 1972 respectively, with the terms "problem/controlled/responsible/moderate/risk/drink"; "advice/drink"; "physician, nurse, general practitioner"; and "random." Forty-three articles were identified in the EMBASE search and 112 articles in the MEDLINE search. STUDY SELECTION: All trials examining the effectiveness of interventions by physicians in reducing alcohol consumption among problem drinkers attending a health-care facility were reviewed. Trials involving subjects attending an alcohol treatment clinic and those involving interventions delivered solely by nonphysicians were excluded. Eleven trials met the final selection criteria. DATA EXTRACTION: For each article, two of the authors independently assigned a score from 0 to 2 on a number of criteria for validity and generalizability. DATA SYNTHESIS: The four trials with the highest validity scores showed that men in the intervention groups reduced their weekly alcohol consumption by five to seven standard drinks more than the men in the control groups. Results for women were inconsistent. No convincing evidence of declines in alcohol-related morbidity among men or women was found. CONCLUSIONS: The trials support the use of brief interventions by physicians for patients with drinking problems. Although further studies are needed to determine their effect on morbidity and mortality, the public health impact of such interventions is potentially enormous. Further research is needed to determine which patients are best suited for brief interventions, the optimal intensity of treatment and which components of brief interventions are most effective. Research is also needed to establish which strategies are effective in inducing physicians to use brief interventions.

Alcohol Drinking↗
PubMedDate not supplied

Cancer control planning and establishment of priorities for intervention by a state health department.

A number of data sources routinely available to State health departments were analyzed as part of a State health department cancer control planning effort. This planning effort consisted of seven steps; the most challenging one was the establishment of priorities for cancer control interventions. Using data from available sources, however, a framework for prioritizing potential cancer control interventions as well as choosing a geographic area in which to implement selected interventions was developed. Factors considered in this framework for setting intervention priorities included the magnitude of the problem; the existence of scientific consensus regarding the efficacy of intervention techniques; the availability of data needed to plan, implement, and evaluate an intervention; the availability of resources within communities to implement an intervention; and the existence of public demand for the intervention. The development and use of this cancer control planning model and framework for setting cancer control intervention priorities in New York State are described in this paper. In using this planning model and framework for setting priorities, quantitative elements were found to be most necessary to define problems, but qualitative elements were most crucial for decision making.

Decision Making, Organizational↗
PubMed1994

Family-based intervention improves maternal psychological well-being and feeding interaction of preterm infants.

OBJECTIVE: To determine the efficacy of an individualized, family-based intervention with preterm infants and their families. DESIGN: Randomized, repeated measures intervention outcome study. SETTING: Level III neonatal intensive care nursery. PATIENTS: Random sample of 34 preterm infants < or = 1500 g and their families. INTERVENTIONS: Individualized, family-based intervention during the hospitalization and transition to home addressed problems identified by parents in four domains including: infant behavior and characteristics, family organization and functioning, caregiving environment, and home discharge and community resources. MEASUREMENTS AND MAIN RESULTS: Standardized questionnaires were administered at baseline and discharge to mothers, and predischarge bottle-feeding interactions were videotaped and coded by two blinded observers. Results were in favor of intervention (Int) versus control (Con) mothers (baseline; discharge) (P < .05) on the Parental Stressor Scale Sights and Sounds subscale (Int 2.4 +/- 1.0; 2.0 +/- 0.8 vs Con 2.4 +/- 0.9; 2.6 +/- 0.8); Child's Appearance and Behavior subscale (Int 2.8 +/- 1.0; 2.5 +/- 1.1 vs Con 2.8 +/- 0.8; 3.1 +/- 0.6); and Total Stressor Score (Int 93.9 +/- 36.6; 72.3 +/- 41.8 vs Con 87.5 +/- 26.7; 87.8 +/- 26.2). On the Beck Depression Inventory, intervention mothers had significant decreases in depressive symptoms (39%; 11%) vs control mothers (31%; 44%). Maternal self-esteem in both groups improved over time. There were no significant group differences in family environment. During feeding interactions, intervention infants grimaced (P < .001) and gagged (P < .05) less than controls. Intervention mothers less frequently interrupted feedings (P < .001); less frequently stimulated infant sucking (P < .01); smiled more (P < .001); vocalized more (P < .01); demonstrated greater sensitivity to infant behavior (P < .001), better quality of physical contact (P < .001), and more positive affect (P < .01). CONCLUSIONS: Individualized, family-based intervention appears to reduce maternal stress and depression, and to enhance early mother-infant feeding interactions. Further research is needed to determine whether these short-term beneficial effects persist beyond the newborn period.

Adult↗
PubMedDate not supplied

Preventing perinatal transmission of HIV--costs and effectiveness of a recommended intervention.

OBJECTIVE: To calculate the national costs of reducing perinatal transmission of human immunodeficiency virus through counseling and voluntary testing of pregnant women and zidovudine treatment of infected women and their infants, as recommended by the Public Health Service, and to compare these costs with the savings from reducing the number of pediatric infections. METHOD: The authors analyzed the estimated costs of the intervention and the estimated cost savings from reducing the number of pediatric infections. The outcome measures are the number of infections prevented by the intervention and the net cost (cost of intervention minus the savings from a reduced number of pediatric HIV infections). The base model assumed that intervention participation and outcomes would resemble those found in the AIDS Clinical Trials Group Protocol 076. Assumptions were varied regarding maternal seroprevalence, participation by HIV-infected women, the proportion of infected women who accepted and completed the treatment, and the efficacy of zidovudine to illustrate the effect of these assumptions on infections prevented and net cost. RESULTS: Without the intervention, a perinatal HIV transmission rate of 25% would result in 1750 HIV-infected infants born annually in the United States, with lifetime medical-care costs estimated at $282 million. The cost of the intervention (counseling, testing, and zidovudine treatment) was estimated to be $ 67.6 million. In the base model, the intervention would prevent 656 pediatric HIV infections with a medical care cost saving of $105.6 million. The net cost saving of the intervention was $38.1 million. CONCLUSION: Voluntary HIV screening of pregnant women and ziovudine treatment for infected women and their infants resulted in cost savings under most of the assumptions used in this analysis. These results strongly support implementation of the Public Health Service recommendations for this intervention.

AIDS Serodiagnosis↗
PubMedDate not supplied

HIV sexual risk reduction interventions for women: a review.

AIDS has emerged as a serious public health threat for women. Reducing the risk for HIV infection among sexually active women requires the adoption of preventive strategies that effectively inhibit viral transmission. However, there is a paucity of published literature describing interventions targeted toward women and even fewer published reports evaluating their effectiveness. We conducted a search of HIV prevention interventions for women using the MEDLINE, ERIC and PSYCHLIT on-line computer database for the years January 1984-May 1995 to assess the effectiveness of interventions in increasing condom use during sexual intercourse. Interventions efficacious at increasing condom use applied a social psychological model of behavior to guide the development and implementation of the intervention, used randomized controlled designs to evaluate program efficacy, emphasized gender-related influences, were peer-led, and used multiple intervention sessions. While these findings are promising, methodologic limitations preclude any definitive assessment of programmatic efficacy. One challenge for future studies is to corroborate and extend these findings using rigorous methodologic research designs to evaluate programmatic efficacy, in particular, longer follow-up to assess stability of treatment effects over time. Another challenge is to understand the implications of previous research for the development of more gender-relevant interventions. The urgency of the HIV epidemic demands that the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority. Medical Subject Headings (MeSH): women, HIV/AIDS, interventions, prevention.

Adolescent↗