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Pegado A, Alvarez MJ, Roberto MS. The role of behaviour-change theory in sleep interventions with emerging adults (aged 18-29 years): a systematic review and meta-analysis. J Sleep Res 2023; 32:e13877. [PMID: 36922157 DOI: 10.1111/jsr.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023]
Abstract
Previous systematic reviews and meta-analysis of sleep interventions with young adults have not reached consensus on what contributes to their efficacy. Behaviour-change theories may influence the efficacy of interventions; hence, the aim of this research was to investigate the role of such theories in sleep interventions with this population. Six electronic databases and reference lists were searched (April-May 2021) for published sleep behaviour-change interventions with emerging adults (aged 18-29 years) that used control groups. A selection of 20 studies fulfilled the inclusion criteria, but only six were based on behaviour-change theories. Meta-analysis was run with eight studies, as the others had a high risk of bias or did not present the necessary data to calculate Hedges' g. The estimation of a random effects model for the studies showed a small effect in the sleep quality of the participants in the experimental group (g = -0.26; 95% confidence interval -0.42 to -0.09), with low levels of heterogeneity (I2 = 21%), and a small 95% prediction interval (-0.59 to 0.08). Although we could not examine theory or any other moderators of the effect, a qualitative analysis of the behaviour-change techniques present in the interventions leads us to hypothesise that there is not a direct link between behaviour-change techniques and the success of the intervention. Other characteristics of the interventions may be linked to their variable levels of efficacy and should be investigated in the future, as for now there are no answers as to what the key is for successful sleep interventions.
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Affiliation(s)
- Ana Pegado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Maria-João Alvarez
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Magda Sofia Roberto
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
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2
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Vallis M. Behaviour Change to Promote Diabetes Outcomes: Getting More From What We Have Through Dissemination and Scalability. Can J Diabetes 2023; 47:85-89. [PMID: 36184369 DOI: 10.1016/j.jcjd.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/03/2022] [Accepted: 08/28/2022] [Indexed: 01/31/2023]
Abstract
The potential benefits of advanced medical treatments (pharmacotherapies) and technologies (diagnostics, devices and apps) are unrealized due to lack of sustained behaviour change in individuals living with type 2 diabetes. The lack of scale-up of effective health behaviour change interventions limits health improvement. Identification of mediators of behaviour change (adherence, self-efficacy, intrinsic motivation) can address this limitation by shifting the focus of behaviour change from input (which behaviour change strategy to choose) to output (what can the person adhere to and sustain). Technology and accessing the workplace environment to promote change offer scalable opportunities for facilitating health behaviour change in populations.
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Affiliation(s)
- Michael Vallis
- Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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3
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Hu W, Wang Y, Chen R, Pan T. Application of a Systematic Oral Health Promotion Model for Pregnant Women: A Randomised Controlled Study. Oral Health Prev Dent 2022; 20:413-419. [PMID: 36346336 DOI: 10.3290/j.ohpd.b3555989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To explore the effects of oral health promotion management on the improvement of oral healthcare knowledge, attitudes, and behaviours in pregnant women. MATERIALS AND METHODS This randomised study included pregnant women in Shanghai (China) who were randomly assigned to receive oral-health promotion management (intervention group) or no interventions (control group). The primary outcome for this study was overall oral health. The secondary outcomes included oral health awareness and attitudes, oral health knowledge, oral healthcare behaviours, medical visits, and risk factors. The Fourth National Oral Health Questionnaire was self-administered in this study, and oral examinations included caries and periodontal status. Data consistency was assessed by the Kappa coefficient. RESULTS After intervention, periodontal outcomes in the intervention group had improved statistically significantly, and the proportion of those without periodontal diseases had statistically significantly increased to 14.4% (p < 0.05). In the intervention group, statistically significant improvements were also observed in the number of active caries (p < 0.001), number of filled teeth (p = 0.014), and community periodontal index (CPI) scores (p < 0.001). Overall, after intervention, pregnant women demonstrated comprehension of the importance of children's deciduous teeth, and their knowledge of the importance of good oral health had greatly improved. Further, oral healthcare habits in the intervention group also showed statistically significant improvement: 56.8% established the habit of cleaning the tongue every week (p < 0.05) and 39.6% established the habit of regular oral examination (p < 0.05). CONCLUSION Oral healthcare education and promotion management for pregnant women can effectively improve their oral health, knowledge, attitudes, and behaviours of oral health care.
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4
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Morris M, Halcomb E, Mansourian Y, Bernoth M. Understanding how general practice nurses support adult lifestyle risk reduction: An integrative review. J Adv Nurs 2022; 78:3517-3530. [PMID: 35775138 PMCID: PMC9796034 DOI: 10.1111/jan.15344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 05/18/2022] [Accepted: 06/16/2022] [Indexed: 12/30/2022]
Abstract
AIM To review the literature exploring how general practice nurses support lifestyle risk reduction. DESIGN Integrative literature review. SOURCES CINAHL, Emcare, MEDLINE, Proquest and Scopus were searched for peer-reviewed primary research published in English from 2010 to 2022. METHODS Sixteen papers met the inclusion criteria and were assessed for methodological quality using the Mixed Methods Appraisal Tool. Findings were extracted and thematically analysed. RESULTS Four themes described general practice nurses: (1) Establishing relational connections; (2) Empowering active participation; (3) Engaging mutual motivation and (4) Enabling confident action. General practice nurses used complex interpersonal, risk communication and health coaching skills to build collaborative partnerships that supported patients' self-determination and self-efficacy. While mutual motivation and confidence were reciprocally enabling, gaps in skills, experience and knowledge plus time, resource and role constraints limited general practice nurses' ability to support lifestyle risk reduction. CONCLUSION General practice nurses play a key role in lifestyle risk reduction. Ongoing education, funding, organizational and professional support are needed to enhance their commitment, confidence and capacity. IMPACT What problem did the study address? While general practice nurses play a key role in health promotion and risk reduction, their potential is yet to be fully realized. Research examining methods by which nurses working in general practice support lifestyle risk reduction is limited. What were the main findings? Successful interactions depended on personal, professional, organisational and systemic factors which either enhanced or inhibited relational quality, shared decision-making, mutual commitment, and nurses' confidence and capacity to address lifestyle risks. Targeted professional development and peer mentoring are needed to build proficient practice. Where and on whom will the research have impact? Understanding how general practice nurses support risk reduction can inform policy and identify training and support needs to advance their skills and role. Research exploring synergies between themes may illuminate this process.
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Affiliation(s)
- Maksi Morris
- School of Nursing, Paramedicine and Healthcare Sciences, Faculty of ScienceCharles Sturt UniversityWagga WaggaNSWAustralia
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of Wollongong, Illawarra Health & Medical Research InstituteWollongongNSWAustralia
| | - Yazdan Mansourian
- School of Information and Communication Studies, Faculty of Arts and EducationCharles Sturt UniversityWagga WaggaNSWAustralia
| | - Maree Bernoth
- School of Nursing, Paramedicine and Healthcare Sciences, Faculty of ScienceCharles Sturt UniversityWagga WaggaNSWAustralia
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5
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Sheridan W, Da Silva AS, Leca BM, Ostarijas E, Patel AG, Aylwin SJ, Vincent RP, Panagiotopoulos S, El-Hasani S, le Roux CW, Miras AD, Cardozo L, Dimitriadis GK. Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis. Clin Obes 2021; 11:e12450. [PMID: 33955687 DOI: 10.1111/cob.12450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Women with obesity are at risk of pelvic floor dysfunction with a 3-fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index ≥30 kg/m2 should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta-analysis will assess this recommendation to aid in the counselling of women with obesity-related urinary incontinence (UI). Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov, and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence. Thirty-three studies and their outcomes were meta-analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI-20, SMD -0.774 (95% CI [-1.236, -0.312]). This systematic review and meta-analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity-related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomized control trials assessing the effect of bariatric surgery on women with obesity-related UI are needed to confirm this study's findings.
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Affiliation(s)
- William Sheridan
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Ana Sofia Da Silva
- Department of Urogynaecology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Bianca M Leca
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Eduard Ostarijas
- Institute for Translational Medicine, University of Pecs Medical School, Pécs, Hungary
| | - Ameet G Patel
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Simon Jb Aylwin
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Royce P Vincent
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Spyros Panagiotopoulos
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Shamsi El-Hasani
- Minimal Access and Bariatric Unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Orpington, UK
| | - Carel W le Roux
- Diabetes Complication Research Centre, School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Belfield, Ireland
| | - Alexander D Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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Abstract
Mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and the penalties or costs for non-compliance are proportionate. I describe an algorithm for justified mandatory vaccination. Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. I argue that under conditions of risk or perceived risk of a novel vaccination, a system of payment for risk in vaccination may be superior. I defend a payment model against various objections, including that it constitutes coercion and undermines solidarity. I argue that payment can be in cash or in kind, and opportunity for altruistic vaccinations can be preserved by offering people who have been vaccinated the opportunity to donate any cash payment back to the health service.
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Affiliation(s)
- Julian Savulescu
- Faculty of Philosophy, University of Oxford, Oxford, UK
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
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7
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Riemer S, Heritier C, Windschnurer I, Pratsch L, Arhant C, Affenzeller N. A Review on Mitigating Fear and Aggression in Dogs and Cats in a Veterinary Setting. Animals (Basel) 2021; 11:ani11010158. [PMID: 33445559 PMCID: PMC7826566 DOI: 10.3390/ani11010158] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary The majority of dogs and cats are fearful during veterinary visits, and some individuals may show aggression as a result. We review ways to avoid negative experiences and promote positive emotions in animals visiting the veterinarian. Whenever an animal is in the practice, the veterinary team should endeavour to make the visit as pleasant as possible, by using non-threatening body language and by creating positive associations. High-value food (unless an animal needs to be fasted) or toys should be used generously throughout the visit. In the interaction with the animals, low-stress handling methods, brief pauses and adjusting the procedure based on the animal’s body language help them to feel secure. Distractions can be used to minimise perceived pain such as from injections. If a known painful area needs to be treated, pain killers are advised. For animals that are very fearful, several medication options are available that can be given prior to the veterinary visit to help them with their fears. With reward-based training, animals can learn to accept veterinary procedures. A stress-free veterinary visit benefits all involved parties—the animals, their owners, as well as the veterinary team. Abstract A high proportion of dogs and cats are fearful during veterinary visits, which in some cases may escalate into aggression. Here, we discuss factors that contribute to negative emotions in a veterinary setting and how these can be addressed. We briefly summarise the available evidence for the interventions discussed. The set-up of the waiting area (e.g., spatial dividers; elevated places for cat carriers), tailoring the examination and the treatment to the individual, considerate handling (minimal restraint when possible, avoiding leaning over or cornering animals) and offering high-value food or toys throughout the visit can promote security and, ideally, positive associations. Desensitisation and counterconditioning are highly recommended, both to prevent and address existing negative emotions. Short-term pain from injections can be minimised by using tactile and cognitive distractions and topical analgesics, which are also indicated for painful procedures such as ear cleanings. Recommendations for handling fearful animals to minimise aggressive responses are discussed. However, anxiolytics or sedation should be used whenever there is a risk of traumatising an animal or for safety reasons. Stress-reducing measures can decrease fear and stress in patients and consequently their owners, thus strengthening the relationship with the clients as well as increasing the professional satisfaction of veterinary staff.
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Affiliation(s)
- Stefanie Riemer
- Companion Animal Behaviour Group, Division of Animal Welfare, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland
- Correspondence:
| | | | - Ines Windschnurer
- Institute of Animal Welfare Science, University of Veterinary Medicine Vienna (Vetmeduni Vienna), 1210 Vienna, Austria; (I.W.); (C.A.)
| | - Lydia Pratsch
- Veterinary Behaviour Consultant, 1200 Vienna, Austria;
| | - Christine Arhant
- Institute of Animal Welfare Science, University of Veterinary Medicine Vienna (Vetmeduni Vienna), 1210 Vienna, Austria; (I.W.); (C.A.)
| | - Nadja Affenzeller
- Department of Companion Animals, Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine Vienna (Vetmeduni Vienna), 1210 Vienna, Austria;
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Shah S, Malik F, Senturia KD, Lind C, Chalmers K, Yi-Frazier J, Pihoker C, Wright D. Ethically incentivising healthy behaviours: views of parents and adolescents with type 1 diabetes. J Med Ethics 2020; 47:medethics-2020-106428. [PMID: 33288647 DOI: 10.1136/medethics-2020-106428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/26/2020] [Accepted: 10/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND To assess ethical concerns associated with participation in a financial incentive (FI) programme to help adolescents with type 1 diabetes improve diabetes self-management. METHODS Focus groups with 46 adolescents with type 1 diabetes ages 12-17 and 38 of their parents were conducted in the Seattle, Washington metropolitan area. Semistructured focus group guides addressed ethical concerns related to the use of FI to promote change in diabetes self-management. Qualitative data were analysed and emergent themes identified. RESULTS We identified three themes related to the ethical issues adolescents and parents anticipated with FI programme participation. First, FI programmes may variably change pressure and conflict in different families in ways that are not necessarily problematic. Second, the pressure to share FIs in some families and how FI payments are structured may lead to unfairness in some cases. Third, some adolescents may be likely to fabricate information in any circumstances, not simply because of FIs, but this could compromise the integrity of FI programmes relying on measures that cannot be externally verified. CONCLUSIONS Many adolescents with type 1 diabetes and their parents see positive potential of FIs to help adolescents improve their self-management. However, ethical concerns about unfairness, potentially harmful increases in conflict/pressure and dishonesty should be addressed in the design and evaluation of FI programmes.
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Affiliation(s)
- Seema Shah
- Advanced General Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Faisal Malik
- Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington, Seattle, Washington, USA
| | | | - Cara Lind
- Seattle Children's Research Institute, Seattle, Washington, USA
| | | | - Joyce Yi-Frazier
- Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington, Seattle, Washington, USA
| | - Catherine Pihoker
- Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington, Seattle, Washington, USA
| | - Davene Wright
- Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, United States
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Kim J, Kassels AC, Costin NI, Schmidt H. Remote monitoring of medication adherence and patient and industry responsibilities in a learning health system. J Med Ethics 2020; 46:386-391. [PMID: 32366704 DOI: 10.1136/medethics-2019-105667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 06/11/2023]
Abstract
A learning health system (LHS) seeks to establish a closer connection between clinical care and research and establishes new responsibilities for healthcare providers as well as patients. A new set of technological approaches in medication adherence monitoring can potentially yield valuable data within an LHS, and raises the question of the scope and limitations of patients' responsibilities to use them. We argue here that, in principle, it is plausible to suggest that patients have a prima facie obligation to use novel adherence monitors. However, the strength of the obligations depends considerably on the extent to which data that adherence monitors generate are, in fact, used to further the goals of LHSs. The way in which data ownership is structured in the USA poses a considerable challenge here, while the European Union framework offers a more promising alternative.
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Affiliation(s)
- Junhewk Kim
- Dental Education Research Center, College of Dentistry, Yonsei University, Seoul, Seodaemun-gu, Republic of Korea
| | - Austin Connor Kassels
- Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nathaniel Isaac Costin
- Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, New Jersey, USA
| | - Harald Schmidt
- Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sharma A, Jain M, Nahar VK, Sharma M. Determining predictors of change in sugar sweetened beverage consumption behaviour among university students in India. Int J Adolesc Med Health 2020; 34:ijamh-2019-0078. [PMID: 31981451 DOI: 10.1515/ijamh-2019-0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/11/2019] [Indexed: 01/09/2023]
Abstract
Background Consumption of sugar sweetened beverages (SSBs) is a significant risk behaviour that leads to the development of several chronic diseases. The present study aimed to predict the SSB consumption behaviour among Indian university students by utilising a multi theory model (MTM) of health behaviour change. Methods In a cross-sectional design, a validated 37-item self-report questionnaire was administered to 267 participants from a mid-size university in the National Capital Region (NCR) of India. Stepwise multiple regressions were used to determine predictors of change in initiation and sustenance of SSB consumption behaviour. For stepwise multiple regression, the a priori criteria of probability of F to enter the predictor in the model was set as less than or equal to 0.05 and for removing the predictor as greater than or equal to 0.10. Results The model was able to predict 16.7% variance in behavioural initiation through the constructs of participatory dialogue and behavioural confidence, and 30.2% variance in sustenance through emotional transformation and change in social environment. Participatory dialogue and behavioural confidence were predictors of behaviour initiation; and emotional transformation, and change in social environment were predictors of behaviour sustenance for SSB consumption behaviour change. Conclusion The study provided a pathway for design of interventions for SSB intake reduction in Indian university students. Interventions should be designed using participatory dialogue and behavioural confidence initiation, and emotional transformation and change in social environment for sustenance of change in SSB consumption in this population.
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Affiliation(s)
- Ankur Sharma
- Department of Public Health Dentistry, Manav Rachna Dental College, Faridabad, India
| | - Meena Jain
- Department of Public Health Dentistry, Manav Rachna Dental College, Delhi-Surajkund Road, Faridabad, India, Phone: +91 74286 72266
| | - Vinayak K Nahar
- School of Medicine, Department of Dermatology, University of Mississippi Medical Center Jackson, Mississippi, United States of America.,School of Medicine/John D. Bower School of Population Health,, Department of Preventive Medicine, University of Mississippi Medical Center, Mississippi, United States of America
| | - Manoj Sharma
- Behavioral and Environmental Health, Jackson State University, Jackson, MS, USA
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Bosselmann L, Fangauf SV, Herbeck Belnap B, Chavanon ML, Nagel J, Neitzel C, Schertz A, Hummers E, Wachter R, Herrmann-Lingen C. Blended collaborative care in the secondary prevention of coronary heart disease improves risk factor control: Results of a randomised feasibility study. Eur J Cardiovasc Nurs 2019; 19:134-141. [PMID: 31564125 DOI: 10.1177/1474515119880062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Risk factor control is essential in limiting the progression of coronary heart disease, but the necessary active patient involvement is often difficult to realise, especially in patients suffering psychosocial risk factors (e.g. distress). Blended collaborative care has been shown as an effective treatment addition, in which a (non-physician) care manager supports patients in implementing and sustaining lifestyle changes, follows-up on patients, and integrates care across providers, targeting both, somatic and psychosocial risk factors. AIMS The aim of this study was to test the feasibility, acceptance and effect of a six-month blended collaborative care intervention in Germany. METHODS For our randomised controlled pilot study with a crossover design we recruited coronary heart disease patients with ⩾1 insufficiently controlled cardiac risk factors and randomised them to either immediate blended collaborative care intervention (immediate intervention group, n=20) or waiting control (waiting control group, n=20). RESULTS Participation rate in the intervention phase was 67% (n=40), and participants reported high satisfaction (M=1.63, standard deviation=0.69; scale 1 (very high) to 5 (very low)). The number of risk factors decreased significantly from baseline to six months in the immediate intervention group (t(60)=3.07, p=0.003), but not in the waiting control group t(60)=-0.29, p=0.77). Similarly, at the end of their intervention following the six-month waiting period, the waiting control group also showed a significant reduction of risk factors (t(60)=3.88, p<0.001). CONCLUSION This study shows that blended collaborative care can be a feasible, accepted and effective addition to standard medical care in the secondary prevention of coronary heart disease in the German healthcare system.
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Affiliation(s)
- Lena Bosselmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany
| | - Stella V Fangauf
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany.,German Center for Cardiovascular Research (DZHK), Germany
| | - Birgit Herbeck Belnap
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany.,Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, USA
| | | | - Jonas Nagel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany.,German Center for Cardiovascular Research (DZHK), Germany
| | - Claudia Neitzel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany
| | - Anna Schertz
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany
| | - Eva Hummers
- Department of General Practice, University of Göttingen Medical Center, Germany
| | - Rolf Wachter
- German Center for Cardiovascular Research (DZHK), Germany.,Clinic and Policlinic for Cardiology, University Hospital Leipzig, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany.,German Center for Cardiovascular Research (DZHK), Germany
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12
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Anderson AS, Craigie AM, Gallant S, McAdam C, Macaskill EJ, Mutrie N, Neilson AR, O'Carroll RE, Rauchhaus P, Sattar N, Stead M, Treweek S. Randomised controlled trial to assess the impact of a lifestyle intervention (ActWELL) in women invited to NHS breast screening. BMJ Open 2018; 8:e024136. [PMID: 30413516 PMCID: PMC6231585 DOI: 10.1136/bmjopen-2018-024136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In Scotland, the incidence of breast cancer is predicted to rise significantly in the next few decades and while there are measures to support reductions in morbidity and mortality, the breast cancer community is currently exploring preventative opportunities including supporting weight management programmes in postmenopausal women. This study aims to assess the effectiveness and cost-effectiveness of a theory-based, community delivered, minimal contact, weight management (diet, physical activity and behaviour change techniques) programme (ActWELL) in women with a body mass index (BMI) >25 kg/m2 attending routine breast cancer screening appointments. METHODS AND ANALYSIS The study will be a four-centre, 1:1 parallel group randomised controlled trial of a 12-month weight management intervention initiated in breast cancer screening centres, delivered by trained Breast Cancer Now lifestyle coaches in community settings. The intervention programme involves two intervention meetings with coaches plus (up to) nine telephone contacts over 12 months. The programme will focus on personalised diet (including alcoholic and sugary drinks) and physical activity habits. Behaviour change techniques include self-monitoring, goal setting, implementation intentions, action and coping plans. The study has a sample size of 414 women with a BMI >25 kg/m2 attending routine National Health Service breast cancer screening appointments. Measures will be taken at baseline, 12 weeks and at 12-month follow-up, complemented by qualitative interviews exploring perceived acceptability and impact on habitual behaviours. The two co-primary outcomes are mean change in measured body weight and change in physical activity between groups to 12 months. Secondary outcomes are changes in eating habits, alcohol intake, sedentary time, quality of life, waist circumference, lipid, haemoglobin A1c and insulin profiles, blood pressure and cost-effectiveness of the intervention. ETHICS AND DISSEMINATION The protocol has been approved by East of Scotland Research Ethics Committee (17/ES/0073). All participants provide written informed consent. Dissemination will be through peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN11057518; Pre-results.
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Affiliation(s)
- Annie S Anderson
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Angela Mary Craigie
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Stephanie Gallant
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Chloe McAdam
- Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - E Jane Macaskill
- Department of Breast Surgery, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Ronan E O'Carroll
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, Tayside Medical Sciences Centre, Ninewells Hospital and Medical School, Dundee, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Martine Stead
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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13
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Levy N. Nudges to reason: not guilty. J Med Ethics 2018; 44:723. [PMID: 29151057 PMCID: PMC6173810 DOI: 10.1136/medethics-2017-104639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Neil Levy
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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14
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Soril LJJ, Noseworthy TW, Dowsett LE, Memedovich K, Holitzki HM, Lorenzetti DL, Stelfox HT, Zygun DA, Clement FM. Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis. BMJ Open 2018; 8:e019912. [PMID: 29776919 PMCID: PMC5961610 DOI: 10.1136/bmjopen-2017-019912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To assess the impact of behaviour modification interventions to promote restrictive red blood cell (RBC) transfusion practices. DESIGN Systematic review and meta-analysis. SETTING, PARTICIPANTS, INTERVENTIONS Seven electronic databases were searched to January 2018. Published randomised controlled trials (RCTs) or non-randomised studies examining an intervention to modify healthcare providers' RBC transfusion practice in any healthcare setting were included. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the proportion of patients transfused. Secondary outcomes included the proportion of inappropriate transfusions, RBC units transfused per patient, in-hospital mortality, length of stay (LOS), pretransfusion haemoglobin and healthcare costs. Meta-analysis was conducted using a random-effects model and meta-regression was performed in cases of heterogeneity. Publication bias was assessed by Begg's funnel plot. RESULTS Eighty-four low to moderate quality studies were included: 3 were RCTs and 81 were non-randomised studies. Thirty-one studies evaluated a single intervention, 44 examined a multimodal intervention. The comparator in all studies was standard of care or historical control. In 33 non-randomised studies, use of an intervention was associated with reduced odds of transfusion (OR 0.63 (95% CI 0.56 to 0.71)), odds of inappropriate transfusion (OR 0.46 (95% CI 0.36 to 0.59)), RBC units/patient weighted mean difference (WMD: -0.50 units (95% CI -0.85 to -0.16)), LOS (WMD: -1.14 days (95% CI -2.12 to -0.16)) and pretransfusion haemoglobin (-0.28 g/dL (95% CI -0.48 to -0.08)). There was no difference in odds of mortality (OR 0.90 (95% CI 0.80 to 1.02)). Protocol/algorithm and multimodal interventions were associated with the greatest decreases in the primary outcome. There was high heterogeneity among estimates and evidence for publication bias. CONCLUSIONS The literature examining the impact of interventions on RBC transfusions is extensive, although most studies are non-randomised. Despite this, pooled analysis of 33 studies revealed improvement in the primary outcome. Future work needs to shift from asking, 'does it work?' to 'what works best and at what cost?' PROSPERO REGISTRATION NUMBER CRD42015024757.
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Affiliation(s)
- Lesley J J Soril
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Thomas W Noseworthy
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Laura E Dowsett
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Katherine Memedovich
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Hannah M Holitzki
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - David A Zygun
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Critical Care Medicine, Alberta Health Services and Faculty of Medicine and Dentistry, University of Alberta, Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
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15
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Beukes EW, Manchaiah V, Valien TE, Baguley DM, Allen PM, Andersson G. Positive experiences related to living with tinnitus: A cross-sectional survey. Clin Otolaryngol 2017; 43:489-495. [PMID: 28994194 DOI: 10.1111/coa.13002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to gain insights related to positive experiences reported by adults with tinnitus living in the United Kingdom. DESIGN A cross-sectional survey design was used in a sample of adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus. SETTING The study was UK wide and data collection was online. PARTICIPANTS Participants consisted of 240 adults (137 males, 103 females), with an average age of 48.16 years and average tinnitus duration of 11.52 years (SD: 11.88). MAIN OUTCOME MEASURES Tinnitus severity was measured by means of the Tinnitus Functional Index. To evaluate the secondary effects of tinnitus, the Insomnia Severity Index, the Hearing Handicap Inventory for Adults-Screening Version and the Cognitive Failures Questionnaires were administered. Positive experiences related to tinnitus were explored using an open-ended question format. RESULTS Around a third of participants (32.5%) reported positive experiences associated with tinnitus. The number of positive responses ranged from one to eight responses per participant, although there were fewer participants with more than one positive response. The predominant themes concerned for (i) coping; (ii) personal development; (iii) support, and to a lesser extent (iv) outlook. Younger participants, those with a lower hearing disability and those with fewer cognitive failures were more likely to report positive experiences associated with having tinnitus. CONCLUSIONS This study has identified that personal development and a positive outlook are possible despite experiencing tinnitus. Ways to facilitate positive experiences related to tinnitus should be promoted, as these may reduce the negative consequences associated with tinnitus. The most prevalent positive theme was the ability to cope with tinnitus. Positive experiences were also drawn from having clinical and other support networks. This highlights the importance of providing tinnitus interventions that can assist people in coping with tinnitus, particularly to those less likely to relate tinnitus to any positive experiences. Those most likely to be helped include those who are older with greater cognitive difficulties and a greater hearing disability.
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Affiliation(s)
- E W Beukes
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK
| | - V Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.,Linnaeus Centre HEAD, Swedish Institute for Disability Research, Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden.,Audiology India, Mysore, India.,Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India
| | - T E Valien
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
| | - D M Baguley
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK.,National Institute for Health Research, Nottingham Biomedical Research Centre, Ropewalk House, The Ropewalk, Nottingham, UK.,Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - P M Allen
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK.,Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - G Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden
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16
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Långh U, Hammar M, Klintwall L, Bölte S. Allegiance and knowledge levels of professionals working with early intensive behavioural intervention in autism. Early Interv Psychiatry 2017; 11:444-450. [PMID: 27060473 DOI: 10.1111/eip.12335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/24/2015] [Accepted: 02/18/2016] [Indexed: 11/28/2022]
Abstract
AIM Early intensive behavioural intervention (EIBI) for children with autism spectrum disorder (ASD) is often delivered using a community model. Behaviour modification experts train and supervise non-experts (e.g. preschool personnel) to teach children according to applied behaviour analysis principles in their natural environment. Several factors predict EIBI outcomes in ASD, for example, knowledge of EIBI and EIBI allegiance among trainers. The aim of the present study was to survey levels of knowledge about and allegiance towards EIBI. METHODS Formal knowledge of EIBI and EIBI allegiance was surveyed in supervised preschool staff conducting EIBI (n = 33), preschool staff not involved in EIBI (n = 26), behaviour modification experts (n = 60), school staff (n = 25) and parents of children with ASD (n = 150) [N = 294]. A 27-item (15 knowledge and 12 allegiance questions) online questionnaire was collected. RESULTS Supervised preschool staff conducting EIBI had more knowledge than preschool staff not using EIBI, but they were not more allegiant. Compared with behaviour modification experts, the supervised EIBI preschool staff group showed markedly less knowledge and allegiance. CONCLUSIONS Findings indicate potential for improvement regarding formal knowledge levels of preschool staff delivering EIBI to children with ASD in real-world settings. In addition, fostering EIBI allegiance might be prioritized when teaching EIBI among non-experts. Broadly increased EIBI knowledge levels among all preschool teachers should be achieved by adding behaviour modification techniques to common university curricula in preschool education. Allegiance of preschool personnel might be accomplished by EIBI supervisors meeting skepticism in practice with conveyance of evidence-based principles and discussions of ethical issues.
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Affiliation(s)
- Ulrika Långh
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.,Autism Center for Young Children, Habilitation and Health, Stockholm County Council, Stockholm, Sweden
| | - Martin Hammar
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.,Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Lars Klintwall
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Behavioural Science, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Sven Bölte
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.,Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
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17
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Lloyd JKF. Minimising Stress for Patients in the Veterinary Hospital: Why It Is Important and What Can Be Done about It. Vet Sci 2017; 4:vetsci4020022. [PMID: 29056681 PMCID: PMC5606596 DOI: 10.3390/vetsci4020022] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/12/2017] [Accepted: 03/18/2017] [Indexed: 12/23/2022] Open
Abstract
Minimising stress for patients should always be a priority in the veterinary hospital. However, this is often overlooked. While a "no stress" environment is not possible, understanding how to create a "low stress" (sometimes called "fear-free") environment and how to handle animals in a less stressful manner benefits patients, staff and the hospital alike. Many veterinary practitioners believe creating a low stress environment is too hard and too time consuming, but this need not be the case. With some simple approaches, minimising patient, and hence staff, stress is achievable in all veterinary practices. This article provides a background on why minimising stress is important and outlines some practical steps that can be taken by staff to minimise stress for presenting and hospitalised patients. Useful resources on recognising signs of stress in dogs and cats, handling, restraint, behaviour modification, medications, and hospital design are provided.
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Affiliation(s)
- Janice K F Lloyd
- College of Public Health, Medicine and Veterinary Science, James Cook University, Townsville, QLD 4811, Australia.
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18
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Kelli HM, Witbrodt B, Shah A. THE FUTURE OF MOBILE HEALTH APPLICATIONS AND DEVICES IN CARDIOVASCULAR HEALTH. Euro Med J Innov 2017; 2017:92-97. [PMID: 28191545 PMCID: PMC5298843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mobile health (mHealth) is the utilisation of mobile technologies in healthcare and has particular relevance in improving lifestyle behaviours which may ultimately reduce cardiovascular disease risk. Various intervention studies for example integrate self-monitoring of diet and physical activity with text messaging systems to improve intermediate outcomes. Currently the future progress of mHealth technologies in formal diagnostic and therapeutic roles is pending and includes the need to validate and standardise accelerometer and heart rate data from various devices. Data also needs to be integrated from such devices into the medical record system to facilitate communication between providers and patients. Although short-term behaviour changes have been found with technologies such as Fitbit® (Fitbit, Inc., San Francisco, California, USA), whether such technologies/interventions lead to sustained behaviour change and reduced risk of myocardial infarction and death remains to be seen.
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Affiliation(s)
- Heval Mohamed Kelli
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley Witbrodt
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amit Shah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University; Department of Medicine, Division of Cardiology, Emory University School of Medicine; Staff Physician, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
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19
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Wollesen B, Menzel J, Lex H, Mattes K. The BASE-Program-A Multidimensional Approach for Health Promotion in Companies. Healthcare (Basel) 2016; 4:E91. [PMID: 27941643 DOI: 10.3390/healthcare4040091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/16/2016] [Accepted: 12/05/2016] [Indexed: 11/17/2022] Open
Abstract
Multidimensional assessments for conducting interventions are needed to achieve positive health effects within companies. BASE is an acronym, consisting of B = "Bedarfsbestimmung" (requirements); A = "Arbeitsplatzorganisation" (organisation of work); S = "Schulung des belastungsverträglichen Alltagshandelns" (coaching preventive behaviour at work); E = "Eigenverantwortung und Selbstwirksamkeit" (self-responsibility and self-efficacy). It is a prevention program designed to avoid and reduce work-related musculoskeletal diseases. It was developed to support prevention strategies within companies. It comprises aspects of health protection, ergonomics, exercise and self-efficacy. A comprehensive assessment will identify strain e.g., musculoskeletal discomforts due to body positions or psychological stress. Moreover, the general health status, preferences and barriers for participating in health promotion programs are evaluated. This analysis leads to practical and goal-oriented recommendations and interventions which suit the needs of companies and employees. These are executed onsite in real workplace situations and involve the introduction of first-hand experience in behavioural change. Therefore, this practical approach enhances the employees' acceptance and self-efficacy for health promotion. This can result in long-term health promoting behaviour. This article presents the outcome and sustainability effects of BASE in three different application fields (logistic, industrial and office workers).
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Abstract
INTRODUCTION This study aimed to examine how improving infant sleep impacted the emotional well-being of mothers. METHODS The participants were 80 mothers of infants aged 6-12 months; they attended a primary care medical clinic in Adelaide, Australia, for assistance with infant sleep problems. Behavioural intervention consisted of a 45-minute consultation, where verbal and written information describing sleep physiology and strategies to improve infant sleep was provided. Mothers were followed up 2-6 weeks later. Mothers rated their confidence (C), pleasure (P) and frustration (F) on a scale from 0 to 10, and completed the Depression Anxiety Stress Scale 21 at each consultation. The number of night-time awakenings and time taken to see an improvement in infant sleep were also reported. RESULTS There was a significant increase in the C and P scores, and a significant decrease in the F scores (all p < 0.001). The mean total CPF score increased significantly from 14 to 25 (maximum score = 30). There was also a significant decrease in depression, anxiety and stress in the mothers (all p < 0.001). The mean number of maximum night awakenings also decreased significantly, from 4.9 to 0.5 (p < 0.001). The mean time taken to see improved infant sleep, as reported by the mothers, was 2.8 nights. CONCLUSION A single consultation using a behavioural strategy to improve infant sleep was effective in improving infant sleep and in increasing maternal emotional well-being. In particular, the scores for 'pleasure in being a mother' increased dramatically.
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Affiliation(s)
- Brian Symon
- University of Adelaide, Kensington Park, Australia.,Kensington Park Medical Practice, Kensington Park, Australia
| | - Georgina E Crichton
- Kensington Park Medical Practice, Kensington Park, Australia.,Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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21
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Abstract
This paper addresses: 1) Situations where human behaviour is involved in relation to antibiotics, focusing on providers and consumers; 2) Theories about human behaviour and factors influencing behaviour in relation to antibiotics; 3) How behaviour in relation to antibiotics can change; and, 4) Antibiotic mainstreaming as an approach to facilitate changes in human behaviour as regards antibiotics. Influencing human behaviour in relation to antibiotics is a complex process which includes factors like knowledge, attitudes, social norms, socio-economic conditions, peer pressure, experiences, and bio-physical and socio-behavioural environment. Further, key concepts are often perceived in different ways by different individuals. While designing and implementing projects or programmes for behavioural change with respect to antibiotics for professionals or consumers it is helpful to consider theories or models of behaviour change, e.g. the 'stages of change model', including pre-contemplation, contemplation, preparation, action, and maintenance. People in different stages of change are susceptible to different behaviour modification strategies. Application of marketing principles to 'global good', so-called 'social marketing', to improve 'welfare of the individual and society' is gaining increased attention in public health. In conclusion, just providing correct knowledge is not sufficient although it is a pre-requisite for behaviour modification in the desired direction. We can never change the behaviour of any other human, but we can facilitate for others to change their own behaviour. One possibility is to implement 'antibiotic mainstreaming' as a potentially effective way for behaviour modification, i.e. to address consequences for maintaining effective antibiotics in all activities and decisions in society.
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Affiliation(s)
- Cecilia Stålsby Lundborg
- Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ashok J. Tamhankar
- Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Indian Initiative for Management of Antibiotic Resistance (IIMAR), Department of Environmental Medicine, R.D. Gardi Medical College, Ujjain, India
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Geisinger ML, Geurs NC, Bain JL, Kaur M, Vassilopoulos PJ, Cliver SP, Hauth JC, Reddy MS. Oral health education and therapy reduces gingivitis during pregnancy. J Clin Periodontol 2013; 41:141-8. [PMID: 24164645 DOI: 10.1111/jcpe.12188] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pregnant women demonstrate increases in gingivitis despite similar plaque levels to non-pregnant counterparts. AIM To evaluate an intensive protocol aimed at reducing gingivitis in pregnant women and provide pilot data for large-scale randomized controlled trials investigating oral hygiene measures to reduce pregnancy gingivitis and alter maternity outcomes. MATERIALS AND METHODS One hundred and twenty participants between 16 and 24 weeks gestation with Gingival Index (GI) scores ≥2 at ≥50% of tooth sites were enrolled. Plaque index (PI), gingival inflammation (GI), probing depth (PD), and clinical attachment levels (CAL) were recorded at baseline and 8 weeks. Dental prophylaxis was performed at baseline and oral hygiene instructions at baseline, 4 and 8 weeks. Pregnancy outcomes were recorded at parturition. Mixed-model analysis of variance was used to compare clinical measurements at baseline and 8 weeks. RESULTS Statistically significant reductions in PI, GI, PD, and CAL occurred over the study period. Mean whole mouth PI and GI scores decreased approximately 50% and the percentage of sites with PI and GI ≥2 decreased from 40% to 17% and 53% to 21.8%, respectively. Mean decreases in whole mouth PD and CAL of 0.45 and 0.24 mm, respectively, were seen. CONCLUSIONS Intensive oral hygiene regimen decreased gingivitis in pregnant patients.
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Affiliation(s)
- Maria L Geisinger
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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Kisely S, Crowe E, Lawrence D, White A, Connor J. A time series analysis of presentations to Queensland health facilities for alcohol-related conditions, following the increase in 'alcopops' tax. Australas Psychiatry 2013; 21:383-8. [PMID: 23671225 DOI: 10.1177/1039856213486307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In response to concerns about the health consequences of high-risk drinking by young people, the Australian Government increased the tax on pre-mixed alcoholic beverages ('alcopops') favoured by this demographic. We measured changes in admissions for alcohol-related harm to health throughout Queensland, before and after the tax increase in April 2008. METHODS We used data from the Queensland Trauma Register, Hospitals Admitted Patients Data Collection, and the Emergency Department Information System to calculate alcohol-related admission rates per 100,000 people, for 15 - 29 year-olds. We analysed data over 3 years (April 2006 - April 2009), using interrupted time-series analyses. This covered 2 years before, and 1 year after, the tax increase. We investigated both mental and behavioural consequences (via F10 codes), and intentional/unintentional injuries (S and T codes). RESULTS We fitted an auto-regressive integrated moving average (ARIMA) model, to test for any changes following the increased tax. There was no decrease in alcohol-related admissions in 15 - 29 year-olds. We found similar results for males and females, as well as definitions of alcohol-related harms that were narrow (F10 codes only) and broad (F10, S and T codes). CONCLUSIONS The increased tax on 'alcopops' was not associated with any reduction in hospital admissions for alcohol-related harms in Queensland 15 - 29 year-olds.
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Affiliation(s)
- Steve Kisely
- School of Population Health, University of Queensland, Herston, QLD, Australia.
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Saßmann H, de Hair M, Danne T, Lange K. Reducing stress and supporting positive relations in families of young children with type 1 diabetes: a randomized controlled study for evaluating the effects of the DELFIN parenting program. BMC Pediatr 2012; 12:152. [PMID: 22994843 PMCID: PMC3512538 DOI: 10.1186/1471-2431-12-152] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 09/18/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To assess initial efficacy and feasibility of a structured behavioural group training (DELFIN) for parents of children with diabetes type 1, in order to reduce parenting stress and to improve parenting skills. METHODS A randomized controlled study was conducted between July 2008 and September 2010, at a children's hospital in Hannover with parents of children with type 1 diabetes (2-10 yrs) (intervention group n = 37; control group n = 28). Parenting skills, parents' psychological burden, children's behavioural difficulties and quality of metabolic control were assessed before, 3 months after and 12 months after participating in the training program. RESULTS In the intervention group parenting behaviour in conflict situations improved significantly after 3 months (Z = -3.28; p ≤ 0.001). It remained stable over 12 months (Z = -2.94; p ≤ 0.01). Depression and anxiety scores of parents decreased (Z = -1.93; p ≤ .05; Z = -2.02; p ≤ .05). Even though the outcome in the intervention group was more positive, the differences between both study arms failed to reach statistical significance. Unexpectedly parenting behaviour in the control group improved also (Z = -2.45; p ≤ .05). Anxiety as well as stress scores decreased in this group (Z = -2.02; p ≤ .05 and Z = -2.11; p ≤ .05). In both groups the initial metabolic control was good and without significant differences (A1c 7.2 ± 0.8% vs. 7.1 ± 0.4%; p > 0.5). It remained stable in the DELFIN group (A1c 7.1 ± 0.8%; p > 0.5), but it increased slightly in controls (A1c 7.3 ± 0.5%; Z = -2.79; p = .005). CONCLUSIONS This study has brought first evidence for the efficacy and feasibility of the program. A multicentre study with a larger sample is necessary to confirm these first results.
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Affiliation(s)
- Heike Saßmann
- Hannover Medical School, Medical Psychology OE 5430, Hannover 30625, Germany
| | - Mira de Hair
- Hannover Medical School, Medical Psychology OE 5430, Hannover 30625, Germany
| | - Thomas Danne
- Kinderkrankenhaus auf der Bult, Hannover 30173, Germany
| | - Karin Lange
- Hannover Medical School, Medical Psychology OE 5430, Hannover 30625, Germany
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Sinclair J, Burton A, Ashcroft R, Priebe S. Clinician and service user perceptions of implementing contingency management: a focus group study. Drug Alcohol Depend 2011; 119:56-63. [PMID: 21680110 PMCID: PMC3629561 DOI: 10.1016/j.drugalcdep.2011.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 05/16/2011] [Accepted: 05/16/2011] [Indexed: 12/02/2022]
Abstract
BACKGROUND Contingency management (CM), despite the evidence base for its effectiveness, remains controversial, with sub-optimal implementation. In 2007, UK guidelines recommended the use of CM in publicly funded services, but uptake has also been minimal. Previous surveys of service providers suggest differences in opinions about CM, but to date there has been no published involvement of service users in this debate. METHOD Focus group methodology was used to explore systematically the attitudes, concerns and opinions of staff and service users about the use of CM, in publicly funded substance misuse services, to identify the key areas that may be influential in terms of implementation and outcome. Data were analysed thematically using the constant comparative method. RESULTS 70 staff and service users participated in 9 focus groups. 15 themes of discussion around CM were identified, grouped into four categories: how CM was aligned to the philosophy of substance misuse services; the practicalities of implementation; wider ethical concerns; and how participants perceived the evidence for effectiveness. CONCLUSIONS Robust process evaluation in different treatment systems is needed to define the active components of CM for implementation. Involvement of service users in this process is essential and is likely to provide valuable insights into the mechanism of action of CM and its effectiveness and uptake within complex treatment systems.
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Affiliation(s)
- J.M.A. Sinclair
- University of Southampton School of Medicine, Southampton SO14 3DT, UK,Corresponding author at: University Department of Psychiatry, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, UK. Tel.: +44 2380 718 520; fax: +44 2380 718 533.
| | - A. Burton
- Queen Mary University of London, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK
| | - R. Ashcroft
- Queen Mary University of London, London E1 4NS, UK
| | - S. Priebe
- Queen Mary University of London, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK
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Priebe S, Sinclair J, Burton A, Marougka S, Larsen J, Firn M, Ashcroft R. Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study. J Med Ethics 2010; 36:463-468. [PMID: 20581423 PMCID: PMC2976611 DOI: 10.1136/jme.2009.035071] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 03/31/2010] [Accepted: 04/26/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND Offering financial incentives to achieve medication adherence in patients with severe mental illness is controversial. AIMS To explore the views of different stakeholders on the ethical acceptability of the practice. METHOD Focus group study consisting of 25 groups with different stakeholders. RESULTS Eleven themes dominated the discussions and fell into four categories: (1) 'wider concerns', including the value of medication, source of funding, how patients would use the money, and a presumed government agenda behind the idea; (2) 'problems requiring clear policies', comprising of practicalities and assurance that incentives are only one part of a tool kit; (3) 'challenges for research and experience', including effectiveness, the possibility of perverse incentives, and impact on the therapeutic relationship; (4) 'inherent dilemmas' around fairness and potential coercion. CONCLUSIONS The use of financial incentives is likely to raise similar concerns in most stakeholders, only some of which can be addressed by empirical research and clear policies.
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Affiliation(s)
- Stefan Priebe
- Queen Mary University of London, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London, UK.
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