Value of a small control group for estimating intervention effectiveness: results from simulations of immunization effectiveness studies

Explaining the changes in procrastination in an ACT-based course - psychological flexibility and time and effort management as mediators

Introduction

The aim of our study is to explore the relationship between procrastination, time management skills and psychological flexibility and the changes in them during an Acceptance and Commitment therapy (ACT)-based course that included time management training. We also explored the effects of time management skills and psychological flexibility on procrastination. The study used an experimental design in an ACT-based well-being course that included time management training.

Methods

The participants were 109 students taking the course and 27 waiting list students. Analyses were conducted with Pearson correlation, mixed ANOVA and causal mediation analysis.

Results and discussion

Our results show that time management skills, psychological flexibility and procrastination were related to each other, and all changed during the course. In addition, change in both time management and psychological flexibility had an impact on the change in procrastination during the course. The results show that both time management and psychological flexibility influence the change in procrastination during an ACT-based course.

Sheds for life: health and wellbeing outcomes of a tailored community-based health promotion initiative for men’s sheds in Ireland

Background

Gender is increasingly recognised as a critical factor in designing community-based health promotion programmes. Men’s Sheds (‘Sheds’) are community-based informal environments that represent a safe space in which to engage cohorts of hard-to-reach (HTR) men in health promotion. Sheds for Life (SFL), the first structured health promotion initiative evaluated globally in Sheds, is a 10-week initiative co-designed with Shed Members (Shedders) and delivered directly in the Shed setting in Ireland. This research describes the health and wellbeing outcomes experienced by SFL participants.

Methods

Purposive sampling was used to recruit a diverse representation of Shedders (n = 421) participating in SFL alongside a wait list control (n = 86). Questionnaires assessing constructs of health and wellbeing were administered one-to-one in Sheds at baseline, 3, 6 and 12 months. Descriptive data for health outcomes were generated for each time point and assessed for significant changes using inferential testing, while considering COVID-19 impact.

Results

Outcomes related to subjective wellbeing, mental wellbeing, physical activity, social capital and healthy eating significantly increased post SFL (p < 0.05). Mental wellbeing scores (SWEMWBS) post SFL remained significantly higher than baseline despite COVID-19 impact (p < 0.05). Binary logistic regression indicated that the odds of a meaningful SWEMWBS change was significantly higher for shedders that had lower SWEMWBS (OR 0.804), less loneliness (OR 0.638) and lived alone (OR 0.456) at baseline. Shedders with lower SWEMBWS had higher odds of experiencing positive changes in life satisfaction (OR 0.911) and trust (OR 0.928), while Shedders who lived alone had also higher odds of experience positive changes in healthy eating (OR 0.481). Finally, inactive Shedders at baseline had higher odds of experiencing increased levels of physical activity (OR 0.582).

Conclusions

Findings suggest that the inclusive, community-based SFL model is effective in engaging Shedders and facilitating positive and sustained changes in health and wellbeing outcomes. Using gender-specific approaches in the informal and safe environment of the Shed are effective in engaging men in structured health and wellbeing initiatives, particularly those who may be more vulnerable, isolated or lonely.

Trial registration

This study has been retrospectively registered with the ‘International Standard Randomised Controlled Trial Number’ registry (ISRCTN79921361) as of 05/03/2021.

An Economic Evaluation of 'Sheds for Life': A Community-Based Men's Health Initiative for Men's Sheds in Ireland

Men’s Sheds (‘Sheds’) attract a diverse cohort of men and, as such, have been identified as spaces with the potential to engage marginalized subpopulations with more structured health promotion. ‘Sheds for Life’ is a 10-week men’s health initiative for Sheds in Ireland and the first structured health promotion initiative formally evaluated in Sheds. Cost is an important implementation outcome in the evaluation of Sheds for Life when operating in an environment where budgets are limited. Therefore, an economic evaluation is critical to highlight cost-effectiveness for decision makers who determine sustainability. This is the first study to evaluate the cost-effectiveness of health endeavors in Sheds. All costs from pre-implementation to maintenance phases were gathered, and questionnaires incorporating the SF-6D were administered to participants (n = 421) at baseline, 3, 6, and 12 months. Then, utility scores were generated to determine quality-adjusted life years (QALYS). Results demonstrate that the intervention group experienced an average 3.3% gain in QALYS from baseline to 3 months and a further 2% gain from 3 months to 6 months at an estimated cost per QALY of €15,724. These findings highlight that Sheds for Life is a cost-effective initiative that effectively engages and enhances the well-being of Shed members.

A systematic mapping review of interventions to improve adolescent mental health literacy, attitudes and behaviours

AIM

The onset of mental illness is most common in adolescence, therefore mental health promotion efforts frequently target this age group. Evaluation literature in this area is largely segmented into specific domains in terms of settings, countries, and/or groups of young people, but an overall understanding and comparison across these areas is lacking. The current review aims to provide such an overview of interventions/programs which attempt to improve adolescents' mental health literacy, attitudes/stigma and behaviours.

METHODS

A systematic mapping review synthesized the strengths and weaknesses of published interventions/programs to improve mental health outcomes in youth. Ten databases and grey literature sources were searched, and results were categorized according to sample, location/setting, type of information presented, delivery and testing procedures, mental health outcome/s evaluated, and limitations.

RESULTS

One hundred and forty articles met the inclusion criteria; 126 were original records and 14 were reviews. Mental health literacy and attitudes/stigma were examined most frequently, and studies were predominantly conducted in school-based environments and high income economies. Intervention/program effectiveness varied across outcome/s measured, setting, and control group usage, with mental health literacy exhibiting the most positive changes overall. Common limitations included no long-term follow up or control group inclusion.

CONCLUSIONS

Despite generally positive changes seen throughout studies in this area, effectiveness differed across a range of methodological domains. Most research is conducted in schools and higher income economies, but the lack of investigation in other contexts (i.e., internet or community) or lower income countries suggests our understanding in this area is constrained.

Evaluating a Sport-Based Mental Health Literacy Intervention in Australian Amateur Sporting Adolescents

Youth amateur sporting environments present an untapped, under-researched, and potentially vital avenue for targeted mental health intervention programs. This study evaluates such an intervention in 12 sporting clubs, comprising of 330 Australian youth aged 12-15 years (M = 13.73, SD = 0.79). Mental health literacy, help-seeking intentions, and help-seeking behaviors were measured throughout the season using a repeated-measures experimental-control design. Multilevel modelling revealed the intervention successfully improved mental health literacy and help-seeking intentions in particular cohorts, such as youth scoring low in these constructs pre-intervention and youth who had not previously received the intervention. This study demonstrates the efficacy of interventions to effect positive change in amateur sporting youth, highlighting a convenient method to improve mental health in young people.

Reducing Young Schoolchildren's Intake of Sugar-Rich Food and Drinks: Study Protocol and Intervention Design for "Are You Too Sweet?" A Multicomponent 3.5-Month Cluster Randomised Family-Based Intervention Study

A high consumption of sugar-rich discretionary food and drinks has several health implications, which have been traced from childhood into adulthood. Parents act as primary mediators shaping children's dietary habits, and interventions that engage parents have shown to result in positive outcomes. Further, collaboration with local school health nurses and dentists provides an effective structural frame to support behaviour change and anchor new initiatives. The multicomponent 3.5-month cluster randomised family-focused intervention "Are you too Sweet?" aims to evaluate the effectiveness of communicating new Danish guidelines for sugar-rich discretionary food and drinks for school starters (5-7 years). This paper describes the development, outcomes and process evaluation of the intervention that includes three main components: extended dialogue during a school health nurse consultation, a box with home-use materials, and a social media platform to facilitate interaction among participants. Children (n = 160) and their parents were scheduled for a baseline interview at six different schools. The intervention was developed to increase self-efficacy, knowledge about guidelines, observational learning and reduce impediments for behavioural change. The desired primary outcome was a reduction in intake of sugar-rich food measured through a 7-day dietary record. The results contribute to the evidence on effective health promotion strategies.

Short term effects of a weight loss and healthy lifestyle programme for overweight and obese men delivered by German football clubs

Numbers of obese and overweight people continue to grow in Germany as they do worldwide. Men are affected more often but do less about it and few weight loss services attract men in particular. To evaluate the effectiveness of a men-only weight loss programme, Football Fans in Training (FFIT), delivered by football clubs in the German Bundesliga, we did a non-randomized trial with a waiting list control group. Participants' data were collected between January 2017 and July 2018. FFIT is a 12-week, group-based, weight loss programme and was delivered in stadia and facilities of 15 professional German Bundesliga clubs. Inclusion criteria were age 35-65 years, BMI ≥ 28 and waist circumference ≥100 cm. Clubs recruited participants through Social Media, E-Mail and match day advertisement. 477 German male football fans were allocated to the intervention group by order of registration date at their respective clubs. 84 participants on the waiting list were allocated to the control group. Primary outcome was mean difference in weight loss with treatment condition over time as independent variable. We performed a multilevel mixed-effects linear regression analysis. Results were based on Intention-to-treat (ITT) analysis with Multiple Imputation. After 12 weeks, the mean weight loss of the intervention group adjusted for club, course and participants' age was 6.24 kg (95% CI 5.82-6.66) against 0.50 kg (-0.47-1.49) in the comparison group (p < 0.001). The results indicate that Football Fans in Training effectively helped German men to reduce their weight and waist circumference.

Assessment of effectiveness and safety of repeat administration of proinflammatory primed allogeneic mesenchymal stem cells in an equine model of chemically induced osteoarthritis

Background

This study aimed at assessing the effectiveness and safety of repeated administrations of allogeneic bone marrow-derived mesenchymal stem cells (BM-MSCs) primed with tumor necrosis factor (TNF)-α and interferon-γ in an equine model of chemically-induced osteoarthritis. Arthritis was induced in both radio-carpal (RC)-joints by amphotericin-B in 18 ponies, divided into three groups depending on the treatment injected: MSC-naïve (n = 7), MSC-primed (n = 7) and control (n = 4). The study consisted of two phases and used one RC-joint of each animal in each phase, with four months time-lapse, in order to assess two end-points. Clinical, synovial, radiological and ultrasonographic follow-up was performed. At six months, animals were euthanized and both carpi were assessed by magnetic resonance imaging (MRI), gross anatomy, histopathology, histochemistry and gene expression.

Results

Clinical and synovial inflammatory signs were quicker reduced in MSC-treated groups and repeated allogeneic administration did not produce adverse reactions, but MSC-primed group showed slight and transient local inflammation after second injection. Radiology and MRI did not show significant differences between treated and control groups, whereas ultrasonography suggested reduced synovial effusion in MSC-treated groups. Both MSC-treated groups showed enhanced cartilage gross appearance at two compared to six months (MSC-naïve, p < 0.05). Cartilage histopathology did not reveal differences but histochemistry suggested delayed progression of proteoglycan loss in MSC-treated groups. Synovium histopathology indicated decreased inflammation (p < 0.01) in MSC-primed and MSC-naïve at two and six months, respectively. At two months, cartilage from MSC-primed group significantly (p < 0.05) upregulated collagen type II (COL2A1) and transforming growth factor (TGF)-β1 and downregulated cyclooxygenase-2 and interleukin (IL)-1β. At six months, MSC-treatments significantly downregulated TNFα (p < 0.05), plus MSC-primed upregulated (p < 0.05) COL2A1, aggrecan, cartilage oligomeric protein, tissue inhibitor of metalloproteinases-2 and TGF-β1. In synovium, both MSC-treatments decreased (p < 0.01) matrix metalloproteinase-13 expression at two months and MSC-primed also downregulated TNFα (p < 0.05) and IL-1β (p < 0.01).

Conclusions

Both MSC-treatments provided beneficial effects, mostly observed at short-term. Despite no huge differences between MSC-treatments, the findings suggested enhanced anti-inflammatory and regulatory potential of MSC-primed. While further research is needed to better understand these effects and clarify immunogenicity implications, these findings contribute to enlarge the knowledge about MSC therapeutics and how they could be influenced.

Electronic supplementary material

The online version of this article (10.1186/s12917-018-1556-3) contains supplementary material, which is available to authorized users.