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Beynon F, Langet H, Bohle LF, Awasthi S, Ndiaye O, Machoki M’Imunya J, Masanja H, Horton S, Ba M, Cicconi S, Emmanuel-Fabula M, Faye PM, Glass TR, Keitel K, Kumar D, Kumar G, Levine GA, Matata L, Mhalu G, Miheso A, Mjungu D, Njiri F, Reus E, Ruffo M, Schär F, Sharma K, Storey HL, Masanja I, Wyss K, D’Acremont V. The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms. Glob Health Action 2024; 17:2326253. [PMID: 38683158 PMCID: PMC11060010 DOI: 10.1080/16549716.2024.2326253] [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: 08/03/2023] [Accepted: 02/25/2024] [Indexed: 05/01/2024] Open
Abstract
Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal. Devices are implemented with guidance and training, mentorship, and community engagement. Sociodemographic and clinical data are collected from caregivers and records of enrolled sick children aged 0-59 months at study facilities, with phone follow-up on Day 7 (and Day 28 in the RCT). The primary outcomes assessed for the RCT are severe complications (mortality and secondary hospitalisations) by Day 7 and primary hospitalisations (within 24 hours and with referral); and, for the pre-post study, referrals and antibiotic. Secondary outcomes on other aspects of health status, hypoxaemia, referral, follow-up and antimicrobial prescription are also evaluated. In all countries, embedded mixed-method studies further evaluate the effects of the intervention on care and care processes, implementation, cost and cost-effectiveness. Pilot and baseline studies started mid-2021, RCT and post-intervention mid-2022, with anticipated completion mid-2023 and first results late-2023. Study approval has been granted by all relevant institutional review boards, national and WHO ethical review committees. Findings will be shared with communities, healthcare providers, Ministries of Health and other local, national and international stakeholders to facilitate evidence-based decision-making on scale-up.Study registration: NCT04910750 and NCT05065320.
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Affiliation(s)
- Fenella Beynon
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Hélène Langet
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Leah F. Bohle
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Shally Awasthi
- Department of Paediatrics, King George’s Medical University, Lucknow, India
| | - Ousmane Ndiaye
- Faculté de médecine, Université Cheikh Anta Diop, Dakar, Senegal
| | | | | | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | | | - Silvia Cicconi
- Faculty of Science, University of Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | - Papa Moctar Faye
- Faculté de médecine, Université Cheikh Anta Diop, Dakar, Senegal
| | - Tracy R. Glass
- Faculty of Science, University of Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Kristina Keitel
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Division of Pediatric Emergency Medicine, Department of Pediatrics,Inselspital, University of Bern, Bern, Switzerland
| | - Divas Kumar
- Department of Paediatrics, King George’s Medical University, Lucknow, India
| | - Gaurav Kumar
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Gillian A. Levine
- Faculty of Science, University of Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Lena Matata
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Grace Mhalu
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | - Francis Njiri
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Elisabeth Reus
- Faculty of Science, University of Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | - Fabian Schär
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | | | | | - Irene Masanja
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Valérie D’Acremont
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Digital Global Health Department, Centre for Primary Care and PublicHealth (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - TIMCI Collaborator Group
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
- Department of Paediatrics, King George’s Medical University, Lucknow, India
- Faculté de médecine, Université Cheikh Anta Diop, Dakar, Senegal
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
- Directorate, Ifakara Health Institute, Dar es Salaam, Tanzania
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- PATH
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Division of Pediatric Emergency Medicine, Department of Pediatrics,Inselspital, University of Bern, Bern, Switzerland
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Digital Global Health Department, Centre for Primary Care and PublicHealth (Unisanté), University of Lausanne, Lausanne, Switzerland
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Richards DA, Bollen J, Jones B, Melendez-Torres GJ, Hulme C, Cockcroft E, Cook H, Cooper J, Creanor S, Cruickshank S, Dawe P, Doris F, Iles-Smith H, Kent M, Logan P, O'Connell A, Onysk J, Owens R, Quinn L, Rafferty AM, Romanczuk L, Russell AM, Shepherd M, Singh SJ, Sugg HVR, Coon JT, Tooze S, Warren FC, Whale B, Wootton S. Evaluation of a COVID-19 fundamental nursing care guideline versus usual care: The COVID-NURSE cluster randomized controlled trial. J Adv Nurs 2024; 80:2137-2152. [PMID: 37986547 DOI: 10.1111/jan.15959] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
AIM To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID-19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health-related quality of life and cost-effectiveness. DESIGN Parallel two-arm, cluster-level randomized controlled trial. METHODS Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID-19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient-reported co-primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention-to-treat analyses. RESULTS We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570-572 (98.1%-98.5%) patient participants in 14 clusters. We found no evidence of between-group differences on any patient, nurse or economic outcomes. We found between-group differences over time, in favour of the intervention, for three of our five co-primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the 'other' ethnicity subgroup. CONCLUSION We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non-white British patients' experience of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. IMPACT Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non-white British patients' experience of care. REPORTING METHOD CONSORT and CONSERVE. PATIENT OR PUBLIC CONTRIBUTION Patients with experience of hospitalization with COVID-19 were involved in guideline development and writing, trial management and interpretation of findings.
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Affiliation(s)
- David A Richards
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jess Bollen
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ben Jones
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Claire Hulme
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Emma Cockcroft
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Heather Cook
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Joanne Cooper
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Siobhan Creanor
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Phoebe Dawe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Faye Doris
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Merryn Kent
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Pip Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Abby O'Connell
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jakub Onysk
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Rosie Owens
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Lynne Quinn
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, Kings College University London, London, UK
| | | | | | - Maggie Shepherd
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Holly V R Sugg
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Susannah Tooze
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Bethany Whale
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Stephen Wootton
- Institute of Human Nutrition, University of Southampton, Southampton, UK
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Koch R, Rösel I, Polanc A, Thies C, Sundmacher L, Eigentler T, Martus P, Joos S. TELEDerm: Implementing store-and-forward teledermatology consultations in general practice: Results of a cluster randomized trial. J Telemed Telecare 2024; 30:647-660. [PMID: 35578544 DOI: 10.1177/1357633x221089133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices. METHODS Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices. RESULTS The primary analysis revealed no significant difference in referral rates (relative risk = 1.02; 95% confidence interval = 0.911-1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates. CONCLUSIONS While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.
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Affiliation(s)
- Roland Koch
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Inka Rösel
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Polanc
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Christian Thies
- School of Informatics, Reutlingen University, Reutlingen, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich, München, Germany
| | - Thomas Eigentler
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital Tübingen, Tübingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
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Said L, Gubbels JS, Kremers SPJ. Response to Commentary: Effect evaluation of Sahtak bi Sahnak, a Lebanese secondary school-based nutrition intervention: a cluster randomised trial. Front Nutr 2024; 11:1396571. [PMID: 38737512 PMCID: PMC11085242 DOI: 10.3389/fnut.2024.1396571] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/03/2024] [Indexed: 05/14/2024] Open
Affiliation(s)
- Liliane Said
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
| | - Jessica S. Gubbels
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
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5
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Coulter RW, Mahal IK, Lin CA, Schneider SK, Mathias AS, Baral K, Miller E, Abebe KZ. Providing Lesbian, Gay, Bisexual, Transgender, Nonbinary, and Queer Adolescents With Nurturance, Trustworthiness, and Safety: Protocol for Pilot Cluster Randomized Controlled Trial Design. JMIR Res Protoc 2024; 13:e55210. [PMID: 38502156 PMCID: PMC10988370 DOI: 10.2196/55210] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Sexual and gender minority youths (lesbian, gay, bisexual, transgender, nonbinary, and queer individuals) face elevated risks of substance use (eg, alcohol and tobacco) and mental health issues (eg, depressive symptoms and suicidality) compared to their cisgender heterosexual peers. These inequities are hypothesized to be reduced by building supportive high school environments via the training of school staff. An intervention that trains school staff to better understand and support sexual and gender minority youths and engage in positive bystander behaviors that protect them from bullying exposure may reduce disparities in drug and alcohol use among them. Experts, school staff, and sexual and gender minority youths developed Providing LGBTQ+ Adolescents with Nurturance, Trustworthiness, and Safety (PLANTS), a web-based intervention to train school staff on how to support, affirm, and protect sexual and gender minority youths. OBJECTIVE This paper describes the design of the PLANTS pilot trial primarily aimed at assessing its acceptability, usability, appropriateness, and feasibility. We hypothesize PLANTS will have high acceptability, usability, appropriateness, and feasibility as rated by the school staff. Secondary objectives focus on implementation, safety, and pre-post changes in high school staff outcomes, including self-efficacy and skills (eg, active-empathic listening and bullying intervention). Exploratory objectives focus on the impact of PLANTS on student health outcomes. METHODS In a 2-arm cluster randomized controlled trial, high schools in Massachusetts are allocated to PLANTS or an active comparator group (publicly available sexual and gender minority youths resources or training). High school staff complete pretest and posttest surveys containing validated scales. Primary outcomes are validated measures of acceptability, usability, appropriateness, and feasibility of the intervention completed by staff during posttest surveys. To test our primary hypotheses for each outcome, we will calculate means and 95% CIs and P values using 1-sample 2-sided t tests against a priori thresholds or benchmarks of success. Secondary outcomes include staff's active-empathetic listening skills, self-efficacy for working with sexual and gender minority youths, bystander intervention behaviors for bullying and cyberbullying, and self-efficacy for PLANTS' change objectives completed during pretest and posttest staff surveys. Staff can also complete a posttest interview guided by the Information-Motivation-Behavior model and Consolidated Framework for Implementation Research. Exploratory outcomes include student-level data collected via the 2021 and 2023 MetroWest Adolescent Health Surveys, a health behavior surveillance system in 30 Massachusetts schools. RESULTS School enrollment began in May 2023 and participant enrollment began in June 2023. Data collection is expected to be completed by February 2024. CONCLUSIONS This pilot trial will yield important information about the PLANTS intervention and provide necessary information to conduct a fully powered trial of the efficacy of PLANTS for reducing the deleterious health inequities experienced by sexual and gender minority youths. TRIAL REGISTRATION ClinicalTrials.gov NCT05897827; https://clinicaltrials.gov/study/NCT05897827. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55210.
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Affiliation(s)
- Robert Ws Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Isabella Kaur Mahal
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Clarisse A Lin
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Aaryn S Mathias
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Karuna Baral
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth Miller
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Kaleab Z Abebe
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Olde Engberink RHG. Salt Intake: Reduce or Substitute? J Am Coll Cardiol 2024; 83:723-725. [PMID: 38355241 DOI: 10.1016/j.jacc.2023.12.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Rik H G Olde Engberink
- Amsterdam UMC location University of Amsterdam, Nephrology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, the Netherlands.
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Larsen TB, Urke HB, Kristensen SM, Mathisen FKS. Caring Climate and Support, Mental Health, and Academic Adjustment: Effects from a Cluster Randomized Controlled Trial in Upper Secondary Schools in Norway. Int J Environ Res Public Health 2023; 20:7033. [PMID: 37998264 PMCID: PMC10671492 DOI: 10.3390/ijerph20227033] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
This cluster randomized controlled trial (RCT) examined the effect of a three year follow up of a multi-tier intervention aiming at improving the psychosocial environment in upper secondary schools in Norway. Two intervention conditions were tested: a universal single-tier intervention focused on improving the psychosocial school climate, the dream school program (DSP), and a multi-tier intervention combining the DSP with a targeted measure, the mental health support team (MHST). A total of 2203 students responded to the baseline survey. Of the 2203 pupils, 1884 responded to the first follow-up survey (year 1), 1287 pupils to the second (year 2), and 756 pupils to the third (year 3). The direct and indirect effects on school completion were analyzed using a multi-level linear mixed model. The results showed no significant effects of either the DSP or the DSP and MHST in combination on support, the school climate, mental health, or academic adjustment. We found no significant effect of the interventions on the proportion who had completed school or were in training (the three groups varied between 76.6% and 77.8%). Future similar studies should be attentive to the potential challenges of implementing RCTs in the school setting. Furthermore, the long-term effects of school interventions on the constructs included in this study could be difficult to capture due to the complexity of the phenomena. The implications of these findings are discussed.
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Affiliation(s)
- Torill Bogsnes Larsen
- Department of Health Promotion and Development, University of Bergen, 5009 Bergen, Norway; (H.B.U.); (S.M.K.); (F.K.S.M.)
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8
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Lin Y, Ren C, Liao M, Kang D, Li C, Jiao K, Wang L, Yan Y, Li Y, Wu T, Cheng C, Zhao Z, Xu Z, Tang W, Tucker JD, Ma W. Digital, Crowdsourced, Multilevel Intervention to Promote HIV Testing Among Men Who Have Sex With Men: Cluster Randomized Controlled Trial. J Med Internet Res 2023; 25:e46890. [PMID: 37902831 PMCID: PMC10644183 DOI: 10.2196/46890] [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: 03/01/2023] [Revised: 07/19/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Despite great efforts in HIV prevention worldwide, HIV testing uptake among men who have sex with men (MSM) remains suboptimal. The effectiveness of digital, crowdsourced, multilevel interventions in improving HIV testing is still unclear. OBJECTIVE The aim of this study was to evaluate the effect of a digital, crowdsourced, multilevel intervention in improving HIV testing uptake among MSM in China. METHODS We conducted a 2-arm cluster randomized controlled trial among MSM in 11 cities in Shandong province, China, from August 2019 to April 2020. Participants were men who were HIV seronegative or had unknown serum status, had anal sex with a man in the past 12 months, and had not been tested for HIV in the past 3 months. Participants were recruited through a gay dating app and community-based organizations from preselected cities; these cities were matched into 5 blocks (2 clusters per block) and further randomly assigned (1:1) to receive a digital, crowdsourced, multilevel intervention (intervention arm) or routine intervention (control arm). The digital multilevel intervention was developed through crowdsourced open calls tailored for MSM, consisting of digital intervention images and videos, the strategy of providing HIV self-testing services through digital tools, and peer-moderated discussion within WeChat groups. The primary outcome was self-reported HIV testing uptake in the previous 3 months. An intention-to-treat approach was used to examine the cluster-level effect of the intervention in the 12-month study period using generalized linear mixed models and the individual-level effect using linear mixed models. RESULTS A total of 935 MSM were enrolled (404 intervention participants and 531 controls); 751 participants (80.3%) completed at least one follow-up survey. Most participants were younger than 30 years (n=601, 64.3%), single (n=681, 72.8%), had a college degree or higher (n=629, 67.3%), and had an HIV testing history (n=785, 84%). Overall, the proportion of testing for HIV in the past 3 months at the 3-, 6-, 9-, and 12-month follow-ups was higher in the intervention arm (139/279, 49.8%; 148/266, 55.6%; 189/263, 71.9%; and 171/266, 64.3%, respectively) than the control arm (183/418, 43.8%; 178/408, 43.6%; 206/403, 51.1%; and 182/397, 48.4%, respectively), with statistically significant differences at the 6-, 9-, and 12-month follow-ups. At the cluster level, the proportion of participants who had tested for HIV increased 11.62% (95% CI 0.74%-22.5%; P=.04) with the intervention. At the individual level, participants in the intervention arm had 69% higher odds for testing for HIV in the past 3 months compared with control participants, but the result was not statistically significant (risk ratio 1.69, 95% CI 0.87-3.27; P=.11). CONCLUSIONS The intervention effectively improved HIV testing uptake among Chinese MSM. Our findings highlight that digital, crowdsourced, multilevel interventions should be made more widely available for HIV prevention and other public health issues. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900024350; http://www.chictr.org.cn/showproj.aspx?proj=36718. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-020-04860-8.
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Affiliation(s)
- Yuxi Lin
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ci Ren
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Meizhen Liao
- Institution for AIDS/STD Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Dianmin Kang
- Institution for AIDS/STD Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Chuanxi Li
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kedi Jiao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lin Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yu Yan
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yijun Li
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Taoyu Wu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chunxiao Cheng
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhe Zhao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zece Xu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Weiming Tang
- University of North Carolina Chapel Hill Project-China, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Chapel Hill Project-China, Guangzhou, China
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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9
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Vázquez-González N, Leiva-Fernández J, Cotta-Luque VM, Leiva-Fernández F, Rius-Díaz F, Martos-Crespo F, Martín-Montañez E, Barnestein-Fonseca P. Effectiveness of an educational intervention about inhalation technique in healthcare professionals in primary care: a cluster randomized trial. Front Pharmacol 2023; 14:1266095. [PMID: 37915412 PMCID: PMC10617029 DOI: 10.3389/fphar.2023.1266095] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023] Open
Abstract
Background: Incorrect inhalation technique (IT) is an important issue for chronic obstructive pulmonary disease (COPD) patients and healthcare professionals. Studies in which counseling is carried out with healthcare professionals beforehand so that they can properly educate their patients are required. The objective of the present trial is to assess the improvement in the performance of the IT in subjects with COPD and prescribed inhaled therapy after the implementation of an educational intervention conducted by their general practitioners. Methods: A cluster randomized clinical trial was conducted. A total of 286 COPD patients received scheduled inhalation therapy from 27 general practices in seven primary care centers. A teach-back educational intervention was implemented for both healthcare professionals and patients. The primary outcome of this study was the performance of the correct inhalation technique. It is considered a good technique if all steps in the inhalation data sheet are correctly performed. The secondary outcomes were assessed using forced spirometry, the basal dyspnea index, the Medical Research Council dyspnea scale, St George's Respiratory Questionnaire (SGRQ), and EuroQoL5D-5L for health-related quality of life. A one-year follow-up was conducted using an intention-to-treat analysis. Results: After the intervention, incorrect IT was observed in 92% of professionals and patients, with rates reaching 50% and 69.2%, respectively. The effectiveness in patients was significant, with a number needed to treat of 2.14 (95% CI 1.79-2.66). Factors related to correct IT in patients included the type of intervention, length of intervention (>25 min), good pulmonary function, age (youngest <=65, oldest >83), and less limitation of activity due to dyspnea. There was no relation with the cluster. Conclusion: This study shows the effectiveness of direct inhaler technique training provided by a trained professional on an appropriate timescale (for example, a specific consultation for medication reviews), aiming to help subjects improve their performance using the teach-back method. This could be an encouraging intervention to improve medication adherence and health promotion in people with COPD. Clinical Trial Registration: clinicaltrials.gov, identifier ISRCTN93725230.
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Affiliation(s)
- Noemí Vázquez-González
- Department of Pharmacology and Pediatrics, Faculty of Medicine, University of Malaga. IBIMA Plataforma BIONAND, Malaga, Spain
- Transfusion, Tissues and Cells Centre of Malaga, Andalusian Health Services, Malaga, Spain
| | | | - Víctor M. Cotta-Luque
- Multiprofessional Teaching Unit of Community and Family Care Primary Care District Malaga-Guadalhorce Knowledge Management Unit Malaga-Guadalhorce Health District, Andalusian Health Services, IBIMA Plataforma BIONAND, Malaga, Spain
| | - Francisca Leiva-Fernández
- Multiprofessional Teaching Unit of Community and Family Care Primary Care District Malaga-Guadalhorce Knowledge Management Unit Malaga-Guadalhorce Health District, Andalusian Health Services, IBIMA Plataforma BIONAND, Malaga, Spain
| | - Francisca Rius-Díaz
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Francisco Martos-Crespo
- Department of Pharmacology and Pediatrics, Faculty of Medicine, University of Malaga. IBIMA Plataforma BIONAND, Malaga, Spain
| | - Elisa Martín-Montañez
- Department of Pharmacology and Pediatrics, Faculty of Medicine, University of Malaga. IBIMA Plataforma BIONAND, Malaga, Spain
| | - Pilar Barnestein-Fonseca
- Research Unit, Instituto CUDECA de Estudios e Investigación en Cuidados Paliativos, IBIMA Plataforma BIONAND, Málaga, Spain
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10
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Melbye EL, Bull VH, Hidle KS. Assessment of the SmartJournal Intervention for Improved Oral Care in Nursing Homes: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46926. [PMID: 37801358 PMCID: PMC10589829 DOI: 10.2196/46926] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Poor oral health is common in nursing home residents, and health care professionals report numerous barriers when it comes to the provision of oral care for care-dependent older adults, such as a lack of oral health knowledge and skills, care-resistant behaviors in residents, lack of adequate oral care routines, insufficient systems for documentation of issues related to oral health, a high workload, and unclear responsibilities. An intervention, SmartJournal, has been developed to assist health personnel in preserving older patients' oral health. SmartJournal is a digital tool with three components: (1) documentation of oral hygiene routines; (2) monthly oral health assessment; and (3) education on geriatric oral care. An updated framework for research on complex interventions has been used to guide the various phases in the development of this intervention. This study focuses on the evaluation phase. OBJECTIVE We aim to assess (1) the effectiveness of SmartJournal use in enhancing nursing home caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) whether SmartJournal use results in improved oral health for nursing home residents. METHODS We will use a cluster randomized controlled trial to assess impacts of SmartJournal use as specified under study objectives. Nursing homes located in Rogaland, Norway, will be recruited and randomly assigned to an intervention and a control group. The intervention group will be provided with tablets containing SmartJournal and support from research staff, while the control group will continue with existing oral care routines. Both groups will receive oral hygiene packages. The intervention will last for 12 weeks. Measurements will be performed in both groups at baseline, 3 months, and 9 months and include (1) a survey assessing caregivers' capability, opportunity, motivation, and routines related to oral care; and (2) assessment of oral health status in residents using mucosal-plaque score as a primary outcome measure. Analyses will include descriptive statistics and statistical techniques to look for changes and differences in the study variables within and between the intervention and control groups throughout the study period. Associations between study variables will also be investigated. RESULTS Recruitment of nursing homes for the intervention and control groups was completed in February 2023. Recruitment of individual participants (ie, nursing home residents and caregivers) is ongoing, and baseline measurements are being performed consecutively. Results are expected to be ready for analyses in fall 2024. CONCLUSIONS We aim to assess the effects of SmartJournal use on oral care and oral health in nursing homes. Results from this work may inform further development and implementation of SmartJournal and similar digital tools aiming to enhance health care services offered to care-dependent people. Finally, SmartJournal may have potential as a learning tool in educational programs for nurses and other health care professionals. TRIAL REGISTRATION ClinicalTrials.gov NCT05724043; https://clinicaltrials.gov/study/NCT05724043. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46926.
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Affiliation(s)
| | - Vibeke Hervik Bull
- Research Department, Oral Health Centre of Expertise Rogaland, Stavanger, Norway
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11
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Katena NA, Shamu S, Fana GT, Rusakaniko S. Effects of a Community Health Worker-Led Health Literacy Intervention on Lifestyle Modification Among Patients With Hypertension and Diabetes in the City of Harare, Zimbabwe: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47512. [PMID: 37788044 PMCID: PMC10582805 DOI: 10.2196/47512] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are among the most common noncommunicable diseases in Zimbabwe. These 2 conditions are largely prevented and controlled by lifestyle modifications, such as healthy eating habits, physical activity, and avoiding the use of tobacco and alcohol. OBJECTIVE This study aims to evaluate the effects of a community health worker (CHW)-led health literacy intervention on lifestyle modification among patients with diabetes and hypertension in the City of Harare, Zimbabwe, in terms of (1) adherence to recommended lifestyle changes, (2) blood pressure and blood glucose levels, and (3) medication adherence. METHODS This is a 6-month-long cluster randomized controlled trial, which will be conducted in primary health care clinics in the city of Harare. A total of 14 clinics will be randomly allocated into either the intervention or control group. A total of 680 (49 participants per clinic) adult patients with hypertension and diabetes will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification, which will be delivered by trained CHWs, while those in the control arm will receive usual care. The intervention consists of 4 face-to-face interactive educational sessions and monthly support visits by trained CHWs and will be carried out over a period of 6 months. The primary study outcomes will be blood pressure and blood glucose levels and levels of adherence to the recommended lifestyle modifications. Other outcomes will include adherence to medication. Data management and analysis will be done using Epi Info software, and the data will be analyzed using the intention-to-treat principle. RESULTS Recruitment of study participants commenced on June 1, 2023, and was completed on July 30, 2023. Baseline data are being collected after participants' recruitment, and the final data collection will be completed by January 31, 2024. CONCLUSIONS There is an information dearth regarding the effectiveness of CHW-led interventions for the management and control of hypertension in Zimbabwe. Our study offers an opportunity to show the effectiveness of CHWs in addressing the gaps in the management of hypertension and diabetes. The findings from our study will provide crucial evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource-constrained areas. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47512.
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Affiliation(s)
- Nyaradzai Arster Katena
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shepherd Shamu
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Golden Tafadzwa Fana
- Internal Medicine Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
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12
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Ryan B, Kneebone I, Rose ML, Togher L, Power E, Hoffmann T, Khan A, Simmons-Mackie N, Carragher M, Worrall L. Preventing depression in aphasia: A cluster randomized control trial of the Aphasia Action Success Knowledge (ASK) program. Int J Stroke 2023; 18:996-1004. [PMID: 37154589 PMCID: PMC10507993 DOI: 10.1177/17474930231176718] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Stroke patients with aphasia and their caregivers have higher incidence of depression than those without aphasia. AIMS The objective of the study is to determine whether a tailored intervention program (Action Success Knowledge; ASK) led to better mood and quality of life (QoL) outcomes than an attention control with a 12-month end point at cluster and individual participant level. METHODS A multi-site, pragmatic, two-level single-blind cluster randomized controlled trial compared ASK to an attention control (secondary stroke prevention program). Ten metropolitan and 10 non-metropolitan health regions were randomized. People with aphasia and their family members were recruited within 6 months post-stroke who scored ⩽12 on the Stroke Aphasic Depression Questionnaire Hospital Version-10 at screening. Each arm received manualized intervention over 6-8 weeks followed by monthly telephone calls. Blinded assessments of QoL and depression were taken at 12 months post-onset. RESULTS Twenty clusters (health regions) were randomized. Trained speech pathologists screened 1744 people with aphasia and 373 participants consented to intervention (n = 231 people with aphasia and 142 family members). The attrition rate after consent was 26% with 86 and 85 participants with aphasia in the ASK arm and attention control arm, respectively, receiving intervention. Of those 171 who did receive treatment, only 41 met the prescribed minimum dose. Multilevel mixed effects modeling under the intention-to-treat protocol showed a significant difference on the Stroke and Aphasia Depression Questionnaire-21 (SADQ-21, N = 122, 17 clusters) in favor of the attention control (β = -2.74, 95% confidence interval (CI) = -4.76 to -0.73, p = 0.008). Individual data analysis using a minimal detectable change score for the SADQ-21 showed the difference was not meaningful. CONCLUSION ASK showed no benefit over attention control in improving mood and preventing depression in people with aphasia or their family members.
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Affiliation(s)
- Brooke Ryan
- Discipline of Clinical Psychology, University of Technology Sydney, Ultimo, NSW, Australia
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Ian Kneebone
- Discipline of Clinical Psychology, University of Technology Sydney, Ultimo, NSW, Australia
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
| | - Miranda L. Rose
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Leanne Togher
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- Department of Communication Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Emma Power
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- Speech Pathology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Asaduzzaman Khan
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Marcella Carragher
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Linda Worrall
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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13
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Caldwell S, Flickinger T, Hodges J, Waldman ALD, Garofalini C, Cohn W, Dillingham R, Castel A, Ingersoll K. An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback. JMIR Form Res 2023; 7:e48739. [PMID: 37725419 PMCID: PMC10548330 DOI: 10.2196/48739] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND HIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. OBJECTIVE This study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. METHODS We conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. RESULTS Emerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. CONCLUSIONS Patient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks' efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/37748.
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Affiliation(s)
- Sylvia Caldwell
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, Charlottesville, VA, United States
| | - Tabor Flickinger
- Division of General Medicine, Geriatrics and Palliative Care, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Jacqueline Hodges
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, United States
| | - Ava Lena D Waldman
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, Charlottesville, VA, United States
| | - Chloe Garofalini
- Milken Institute School of Public Health, George Washington University, Washingon, DC, United States
| | - Wendy Cohn
- Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, United States
| | - Amanda Castel
- Milken Institute School of Public Health, George Washington University, Washingon, DC, United States
| | - Karen Ingersoll
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, Charlottesville, VA, United States
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Frimpong JA, Parish C, Feaster DJ, Gooden LK, Matheson T, Haynes L, Linas BP, Assoumou SA, Tross S, Kyle T, Nelson CM, Liguori TK, Toussaint O, Siegel K, Annane D, Metsch LR. A study protocol for Project I-Test: a cluster randomized controlled trial of a practice coaching intervention to increase HIV testing in substance use treatment programs. Res Sq 2023:rs.3.rs-3059783. [PMID: 37461594 PMCID: PMC10350190 DOI: 10.21203/rs.3.rs-3059783/v1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Background People with substance use disorders are vulnerable to acquiring HIV. Testing is fundamental to diagnosis, treatment, and prevention; however, in the past decade, there has been a decline in the number of substance use disorder (SUD) treatment programs offering on-site HIV testing. Fewer than half of SUDs in the United States offer on-site HIV testing. In addition, nearly a quarter of newly diagnosed cases have AIDS at the time of diagnosis. Lack of testing is one of the main reasons that annual HIV incidences have remained constant over time. Integration of HIV testing with testing for HCV, an infection prevalent among persons vulnerable to HIV infection, and in settings where they receive health services, including opioid treatment programs (OTPs), is of great public health importance. Methods/Design In this 3-arm cluster-RCT of opioid use disorders treatment programs, we test the effect of two evidence-based "practice coaching" (PC) interventions on: the provision and sustained implementation of on-site HIV testing, on-site HIV/HCV testing, and linkage to care. Using the National Survey of Substance Abuse Treatment Services data available from SAMHSA, 51 sites are randomly assigned to one of the three conditions: practice coach facilitated structured conversations around implementing change, with provision of resources and documents to support the implementation of (1) HIV testing only, or (2) HIV/HCV testing, and (3) a control condition that provides a package with information only. We collect quantitative (e,g., HIV and HCV testing at six-month-long intervals) and qualitative site data near the time of randomization, and again approximately 7-12 months after randomization. Discussion Innovative and comprehensive approaches that facilitate and promote the adoption and sustainability of HIV and HCV testing in opioid treatment programs are important for addressing and reducing HIV and HCV infection rates. This study is one of the first to test organizational approaches (practice coaching) to increase HIV and HIV/HCV testing and linkage to care among individuals receiving treatment for opioid use disorder. The study may provide valuable insight and knowledge on the multiple levels of intervention that, if integrated, may better position OTPs to improve and sustain testing practices and improve population health. Trial registration ClinicalTrials.gov: NCT03135886. (02 05 2017).
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Affiliation(s)
- Jemima A Frimpong
- Jemima A. Frimpong, New York University Abu Dhabi, PO BOX 129188, Saadiyat Island, Abu Dhabi, UAE
| | - Carrigan Parish
- Columbia University, Department of Sociomedical Sciences Miami Research Center, 1120 NW 14 Street Room 1030, Miami, FL 33136
| | - Daniel J Feaster
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th Street, Room 1059, Miami, FL 33136
| | - Lauren K Gooden
- Columbia University, Department of Sociomedical Sciences Miami Research Center, 1120 NW 14 Street Room 1030, Miami, FL 33136
| | - Tim Matheson
- San Francisco Dept of Public Health (SFDPH), 25 Van Ness Avenue; Suite 500, San Francisco, CA 94102
| | - Louise Haynes
- Medical University of South Carolina, 67 President Street, Charleston, SC 29425
| | - Benjamin P Linas
- Boston Medical Center, Crosstown Building, 801 Massachusetts Ave office 2007, Boston, MA, 02118
| | | | - Susan Tross
- HIV Center For Clinical and Behavioral Studies, NYS Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, N.Y. 10032
| | - Tiffany Kyle
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th Street, Room 1064, Miami, FL 33136
| | - C Mindy Nelson
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th Street, Room 1064, Miami, FL 33136
| | - Terri K Liguori
- Columbia University, Department of Sociomedical Sciences Miami Research Center, 1120 NW 14 Street Room 1031, Miami, FL 33136
| | - Oliene Toussaint
- Columbia University, Department of Sociomedical Sciences Miami Research Center, 1120 NW 14 Street Room 1031, Miami, FL 33136
| | - Karolynn Siegel
- Columbia University, Department of Sociomedical Sciences, 722 West 168 Street, NY, NY 10032
| | - Debra Annane
- Health Foundation of South Florida, 2 South Biscayne Blvd., Suite 1710, Miami, FL 33131
| | - Lisa R Metsch
- Columbia University, Department of Sociomedical Sciences and Columbia School of General Studies, 2970 Broadway, 612 Lewisohn Hall, New York, NY 10026
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15
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Broese J, van der Kleij RM, Verschuur EM, Kerstjens HA, Bronkhorst EM, Engels Y, Chavannes NH. The effect of an integrated palliative care intervention on quality of life and acute healthcare use in patients with COPD: Results of the COMPASSION cluster randomized controlled trial. Palliat Med 2023; 37:844-855. [PMID: 37002561 DOI: 10.1177/02692163231165106] [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] [Indexed: 05/30/2023]
Abstract
BACKGROUND COPD causes high morbidity and mortality, emphasizing the need for palliative care. AIM To assess the effectiveness of palliative care in patients with COPD. DESIGN Cluster randomized controlled trial (COMPASSION study; Netherlands Trial Register (NTR): NL7644, 07-04-2019). Healthcare providers within the intervention group were trained to implement palliative care components into routine COPD care. Patients completed questionnaires at baseline, after 3 and 6 months; medical records were assessed after 12 months. The primary outcome was quality of life (FACIT-Pal). Secondary outcomes were anxiety, depression, spiritual well-being, satisfaction with care, acute healthcare use, documentation of life-sustaining treatment preferences and place of death. Generalized linear mixed modelling was used for analyses. SETTING Eight hospital regions in the Netherlands. PARTICIPANTS Patients hospitalized for an acute exacerbation of COPD and positive ProPal-COPD score. RESULTS Of 222 patients included, 106 responded to the questionnaire at 6 months. Thirty-six of 98 intervention patients (36.7%) received the intervention. Intention-to-treat-analysis showed no effect on the primary outcome (adjusted difference: 1.09; 95% confidence interval: -5.44 to 7.60). In the intervention group, fewer intensive care admissions for COPD took place (adjusted odds ratio: 0.21; 95% confidence interval: 0.03-0.81) and strong indications were found for fewer hospitalizations (adjusted incidence rate ratio: 0.69; 95% confidence interval: 0.46-1.03). CONCLUSIONS We found no evidence that palliative care improves quality of life in patients with COPD. However, it can potentially reduce acute healthcare use. The consequences of the COVID-19 pandemic led to suboptimal implementation and insufficient power, and may have affected some of our findings.
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Affiliation(s)
- Johanna Broese
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- Lung Alliance Netherlands, Amersfoort, The Netherlands
| | - Rianne Mjj van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Huib Am Kerstjens
- Department of Respiratory Medicine and Tuberculosis, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - Ewald M Bronkhorst
- Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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Veinot TC, Gillespie B, Argentina M, Bragg-Gresham J, Chatoth D, Collins Damron K, Heung M, Krein S, Wingard R, Zheng K, Saran R. Enhancing the Cardiovascular Safety of Hemodialysis Care Using Multimodal Provider Education and Patient Activation Interventions: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46187. [PMID: 37079365 PMCID: PMC10160944 DOI: 10.2196/46187] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care. OBJECTIVE This study aims to evaluate the independent and comparative effectiveness of 2 interventions-one directed at hemodialysis providers and another for patients-in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions. METHODS This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality. RESULTS This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School's institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024. CONCLUSIONS The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46187.
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Affiliation(s)
- Tiffany Christine Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Brenda Gillespie
- Department of Biostatistics, Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI, United States
| | | | - Jennifer Bragg-Gresham
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Michael Heung
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
| | - Sarah Krein
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States
- Veterans Affairs Center for Clinical Management Research, US Department of Veterans Affairs, Ann Arbor, MI, United States
| | | | - Kai Zheng
- School of Information and Computer Sciences, University of California Irvine, Irvine, CA, United States
| | - Rajiv Saran
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, United States
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Gagnon-Dufresne MC, Azevedo Dantas M, Abreu Silva K, Souza dos Anjos J, Pessoa Carneiro Barbosa D, Porto Rosa R, de Luca W, Zahreddine M, Caprara A, Ridde V, Zinszer K. Social Media and the Influence of Fake News on Global Health Interventions: Implications for a Study on Dengue in Brazil. Int J Environ Res Public Health 2023; 20:5299. [PMID: 37047915 PMCID: PMC10093785 DOI: 10.3390/ijerph20075299] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Social media usage is growing globally, with an exponential increase in low- and middle-income countries. Social media changes the ways in which information-sharing occurs, intensifying the population's exposure to misinformation, including fake news. This has important repercussions for global health. The spread of fake news can undermine the implementation of evidence-based interventions and weaken the credibility of scientific expertise. This is particularly worrisome in countries, such as Brazil, in a sociopolitical context characterized by a lack of popular trust in public institutions. In this project report, we describe our experience with the spread of fake news through the social media platform WhatsApp during the implementation of a cluster randomized controlled trial aimed at reducing dengue incidence in children in Fortaleza (Brazil). During initial visits to selected clusters, the research team was met with resistance. Then, soon after data collection started, fake news began circulating about the study. As a result, the research team developed strategies to dispel suspicion and further promote the study. However, the climate of violence and mistrust, coupled with the COVID-19 pandemic, forced the interruption of the study in 2019. The lessons learned from our experience in Fortaleza can be useful to other researchers and practitioners implementing large-scale interventions in this era of health-related misinformation.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, QC H3N 1X9, Canada
- Center for Public Health Research, Montreal, QC H3C 3J7, Canada
| | | | | | - Jean Souza dos Anjos
- Center for Humanities, Ceará State University, Fortaleza 60020-181, CE, Brazil
- Center for Applied Social Studies, Ceará State University, Fortaleza 60714-903, CE, Brazil
| | | | - Rebeca Porto Rosa
- Center for Health Sciences, Ceará State University, Fortaleza 60714-903, CE, Brazil
| | - William de Luca
- Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, QC H3N 1X9, Canada
| | | | - Andrea Caprara
- Center for Health Sciences, Ceará State University, Fortaleza 60714-903, CE, Brazil
| | - Valéry Ridde
- Population and Development Center, French National Research Institute for Sustainable Development, University of Paris, 75006 Paris, France
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, QC H3N 1X9, Canada
- Center for Public Health Research, Montreal, QC H3C 3J7, Canada
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18
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Suresh N, Kutty VR, Kumar KN, Sarma PS, Vijayan AA, Aljuaid M, Shahid D, Thankappan KR. Effectiveness of an oral health education intervention among 6-12-year-old children: A cluster randomized controlled trial. Community Dent Health 2023. [PMID: 36853187 DOI: 10.1922/cdh_00164suresh06] [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] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/03/2022] [Indexed: 03/01/2023]
Abstract
OBJECTIVES Literature on the effectiveness of theory-based oral health education on the oral hygiene of children is limited. We aimed to determine the effectiveness of an health behaviour theory-based school oral health education intervention on 1) oral hygiene and 2) oral health-related knowledge, attitude and practices among 6-12-year-old children in Kerala, India. METHODS Cluster randomized controlled trial. Sixteen class divisions (clusters) were randomized into intervention and control groups of 225 and 228 children respectively. Primary and secondary outcomes were plaque score as measured using the simplified oral hygiene index (OHI-S) and oral health-related knowledge, attitude and practices respectively. The intervention group received structured oral health education classes for three months and materials including pamphlets. Children in the control group were not given the classes or materials. RESULTS Post-intervention OHI-S scores in the intervention group and control groups were 1.65 and 2.17 respectively (difference = -0.52, 95%CI -0.86, -0.18). All the secondary outcomes improved in the intervention group compared to the control group. CONCLUSIONS The intervention improved the oral hygiene status, oral health-related knowledge, attitude and practices of the children. Longer term follow-up and economic appraisal are needed to help policymakers plan and develop OHEI based on health behaviour theories.
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Affiliation(s)
- N Suresh
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - V R Kutty
- Research Director, Amala Research Centre, India
| | - K N Kumar
- Dental Public Health, Azeezia Dental College, India
| | - P S Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - A A Vijayan
- Dentistry, Mount Zion Medical College, India
| | - M Aljuaid
- Health Administration, College of Business Administration, Saudi Arabia
| | - D Shahid
- Master program, Hult International Business School, USA
| | - K R Thankappan
- Public Health and Community Medicine, Central University of Kerala, India
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Li Y, Xiao QL, Li M, Zhang Y, Chen M, Jiang CH, Kang SR, Zhang Y, Huang J, Jiang H. Community-based intervention via WeChat official account to improve parental health literacy among primary caregivers of children aged 0 to 3 years: Protocol for a cluster randomized controlled trial. Front Public Health 2023; 10:1039394. [PMID: 36684867 PMCID: PMC9853903 DOI: 10.3389/fpubh.2022.1039394] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Background Parental health literacy is an important determinant of children's health, especially during the critical window of early development in the first 3 years. As the information communication technology develops, health education via social media is widely used to deliver health information. However, few studies have explored the effect of intervention via social media on parental health literacy. Objective This study aims to determine whether a WeChat official account-based health intervention can improve parental health literacy of primary caregivers of children aged 0 to 3 years in Minhang District, Shanghai, China. Methods The cluster randomized controlled trial includes all 13 community health centers (CHCs) in Minhang District, Shanghai. We take each CHCs as a cluster in the randomization. The CHCs are randomly allocated to the intervention or the control group through random sequence generation. Ninety primary caregivers of children aged 0 to 2 years will be recruited from each CHC, 1170 in total. Caregivers in the intervention group will be provided with a series of video clips and online reading material links on scientific parenting via a WeChat account. Caregivers in the control group will receive printed educational materials with similar contents to the intervention group. All the participants will access routine child health care and be followed up for 9 months. Online assessment of health literacy will be conducted for both groups before and after the intervention. The primary outcome is the change in the total scores of parental health literacy using a validated instrument. The data of secondary outcomes, such as exclusive breastfeeding in the first 6 months, anthropometric measurements, and disease conditions, will be extracted from routine health care records. Generalized linear mixed model (GLMM) will be used for data analyses. Discussion Compared with traditional health education, health intervention via WeChat official account could be a feasible and effective solution to improve parental health literacy. Trial registration This trial is registered with the Chinese Clinical Trial Registry (ChiCTR): (#ChiCTR2000031711) on April 07, 2020.
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Affiliation(s)
- Yun Li
- Department of Child Health Care, Shanghai Minhang Maternal and Child Health Care Hospital, Shanghai, China
| | - Qiu-Li Xiao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Mu Li
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
- China Studies Centre, The University of Sydney, Sydney, NSW, Australia
| | - Yue Zhang
- Department of Child Health Care, Shanghai Minhang Maternal and Child Health Care Hospital, Shanghai, China
| | - Min Chen
- Department of Child Health Care, Shanghai Minhang Maternal and Child Health Care Hospital, Shanghai, China
| | - Chun-Hua Jiang
- Department of Child Health Care, Shanghai Minhang Maternal and Child Health Care Hospital, Shanghai, China
| | - Shu-Rong Kang
- Department of Child Health Care, Shanghai Minhang Maternal and Child Health Care Hospital, Shanghai, China
| | - Ying Zhang
- Department of Child Health Care, Shanghai Minhang Maternal and Child Health Care Hospital, Shanghai, China
| | - Jun Huang
- Department of Child Health Care, Shanghai Minhang Maternal and Child Health Care Hospital, Shanghai, China
| | - Hong Jiang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China
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20
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McElfish PA, Felix HC, Bursac Z, Rowland B, Yeary KHK, Long CR, Selig JP, Kaholokula JK, Riklon S. A Cluster Randomized Controlled Trial Comparing Diabetes Prevention Program Interventions for Overweight/Obese Marshallese Adults. Inquiry 2023; 60:469580231152051. [PMID: 36799349 PMCID: PMC9940234 DOI: 10.1177/00469580231152051] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023]
Abstract
This study compared the effectiveness of two Diabetes Prevention Program (DPP) interventions on weight loss among overweight and obese Marshallese adults. The study was a two-arm cluster randomized controlled trial conducted in 30 churches in Arkansas and Oklahoma. Marshallese adults with a body mass index ≥25 kg/m2 were eligible for the study. The study sample included 380 participants. Participants received either a faith-based adaptation of the DPP or a family-focused adaptation of the DPP, each delivered over 24 weeks. The primary outcome was weight change from baseline. Secondary outcomes included changes in Hemoglobin A1c, blood pressure, dietary intake, family support for healthy behaviors, and physical activity. Outcomes were examined longitudinally using general linear mixed effects regression models, adjusting for baseline outcomes, sociodemographic covariates, and clustering of participants within churches. Reductions in weight were small for both groups. Overall, only 7.1% of all participants lost 5% or more of their baseline body weight. There were no significant differences in weight loss between the 2 arms at 6 months (P = .3599) or at 12 months (P = .3207). Significant differences in systolic and diastolic blood pressure were found between the 2 arms at 6 months (P = .0293; P = .0068, respectively). Significant within-arm changes were found for sugar-sweetened beverage consumption and family support for both arms at both follow-ups. Both interventions achieved a modest weight loss. While even modest weight loss can be clinically significant, future research is needed to identify chronic disease prevention interventions that can successfully reduce weight for this at-risk population.
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Affiliation(s)
- Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Holly C. Felix
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zoran Bursac
- Florida International University, Miami, FL, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | | | - James P. Selig
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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21
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Shima A, Tanaka H, Okamura T, Nishikawa T, Morino A, Godai K, Tatsumi Y, Kawahara M, Kiyohara M, Kawatsu Y, Kimura T, Miyamatsu N. Offering on-site mammography in workplaces improved screening rates: Cluster randomized controlled trial. J Occup Health 2023; 65:e12389. [PMID: 36823700 PMCID: PMC9950350 DOI: 10.1002/1348-9585.12389] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/17/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES Despite evidence of breast cancer screening efficacy, the screening rate has remained less than 50% in Japan. This study aimed to evaluate the effect of an environmental approach offering on-site mammography in workplaces. METHODS Supermarket stores were randomly assigned into two groups, the intervention group (leaflet and mammography) and the control group (leaflet). From May to July 2018, participants in the intervention group were given a leaflet informing them of the subsidies for breast cancer screening and offered the opportunity to have mammography in their workplaces. Participants in the control group were given the same leaflet, but had to arrange their own screening outside the workplace. The primary outcome was the breast cancer screening rate in 2018. The odds ratio (OR) and 95% confidence interval (CI) for having screening in the intervention group compared with the control group were estimated using multilevel logistic regression. RESULTS We analyzed data from 1624 participants (mean age 53 years) from 25 supermarket stores (intervention: 8 stores, control: 17 stores). Among participants who had not attended screening in the previous year, the screening rate was 7% in the control group and 53% in the intervention group, with an adjusted OR (95% CI) of 14.22 (8.97-22.54). The effect was greater in those who had never attended screening before. CONCLUSION In a worksite-based cluster randomized controlled trial in Japanese supermarket stores, an environmental approach offering mammography in workplaces substantially increased the breast cancer screening rate within 1 year (UMIN000030465).
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Affiliation(s)
- Azusa Shima
- Department of Clinical NursingShiga University of Medical ScienceShigaJapan
- Occupational Health Care Office, Heiwado Co.ShigaJapan
| | | | - Tomonori Okamura
- Department of Preventive Medicine and Public HealthKeio University School of MedicineTokyoJapan
| | - Tomofumi Nishikawa
- Department of Health and NutritionKyoto Koka Women's UniversityKyotoJapan
| | - Ayumi Morino
- Department of Clinical NursingShiga University of Medical ScienceShigaJapan
- Occupational Health Care Office, Heiwado Co.ShigaJapan
| | - Kayo Godai
- Department of Health Promotion ScienceOsaka University Graduate School of MedicineOsakaJapan
| | - Yukako Tatsumi
- Department of Hygiene and Public HealthTeikyo University School of MedicineTokyoJapan
| | - Mizuki Kawahara
- Department of Clinical NursingShiga University of Medical ScienceShigaJapan
| | - Maiko Kiyohara
- Department of Clinical NursingShiga University of Medical ScienceShigaJapan
| | | | - Takashi Kimura
- General Incorporated Foundation Kinki Health Administration CenterShigaJapan
| | - Naomi Miyamatsu
- Department of Clinical NursingShiga University of Medical ScienceShigaJapan
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Parvin K, Talukder A, Mamun MA, Kalra S, Laterra A, Naved RT. A cluster randomized controlled trial for measuring the impact of a social norm intervention addressing child marriage in Pirgacha in Rangpur district of Bangladesh: study protocol for evaluation of the Tipping Point Initiative. Glob Health Action 2022; 15:2057644. [PMID: 35441566 PMCID: PMC9037192 DOI: 10.1080/16549716.2022.2057644] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Child Marriage (CM) is one of the major developmental concerns in Bangladesh, reporting one of the highest rates of CM (59%) globally. To date, interventions to address CM in Bangladesh have failed to seriously engage with social norms that are important contributors to CM. This paper describes the evaluation design of the Tipping Point Initiative that aims to reduce CM through social norm change and increasing adolescent girls’ agency to voice their rights. The Tipping Point Initiative evaluation trial employs a mixed method design. The quantitative component includes a three-arm Cluster Randomized Controlled Trial design, where Arm 1 receives Tipping Point Program (TPP); Arm 2 receives Tipping Point Program Plus (TPP+), a social norms-enhanced version of TPP; and Arm 3 is the Control. The trial covers 51 clusters (villages) in Pirgacha, in Rangpur district, randomized into three study arms (17 per arms). From each cluster, a cohort of 25 adolescent girls aged 12–<16 years were selected randomly for participation in the survey and intervention. Further, a cross-section of adults (six males and six females) were randomly selected from each cluster for survey. Qualitative baseline data were collected from two purposively selected intervention villages in each intervention arm. Thirty In-Depth Interviews, eight Key Informant Interviews and 16 Focus Group Discussion were conducted with adolescent girls, boys, adult women and men. Same strategies have been followed at endline. The intervention was implemented from April 2019 to December 2020. The endline was conducted 10 months after the end of intervention. Intention-to-treat analysis approach will be used for impact assessment. Both narrative analysis and Grounded Theory approach will be employed in analysing qualitative data. The learnings are expected to inform programs and policies regarding what works and does not work to address CM in such social norms intervention in Bangladesh.
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Affiliation(s)
- Kausar Parvin
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Aloka Talukder
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Mahfuz Al Mamun
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
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Cho SJ, Preacher KJ, Yaremych HE, Naveiras M, Fuchs D, Fuchs LS. Modelling multilevel nonlinear treatment-by-covariate interactions in cluster randomized controlled trials using a generalized additive mixed model. Br J Math Stat Psychol 2022; 75:493-521. [PMID: 35312188 DOI: 10.1111/bmsp.12265] [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] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
A cluster randomized controlled trial (C-RCT) is common in educational intervention studies. Multilevel modelling (MLM) is a dominant analytic method to evaluate treatment effects in a C-RCT. In most MLM applications intended to detect an interaction effect, a single interaction effect (called a conflated effect) is considered instead of level-specific interaction effects in a multilevel design (called unconflated multilevel interaction effects), and the linear interaction effect is modelled. In this paper we present a generalized additive mixed model (GAMM) that allows an unconflated multilevel interaction to be estimated without assuming a prespecified form of the interaction. R code is provided to estimate the model parameters using maximum likelihood estimation and to visualize the nonlinear treatment-by-covariate interaction. The usefulness of the model is illustrated using instructional intervention data from a C-RCT. Results of simulation studies showed that the GAMM outperformed an alternative approach to recover an unconflated logistic multilevel interaction. In addition, the parameter recovery of the GAMM was relatively satisfactory in multilevel designs found in educational intervention studies, except when the number of clusters, cluster sizes, and intraclass correlations were small. When modelling a linear multilevel treatment-by-covariate interaction in the presence of a nonlinear effect, biased estimates (such as overestimated standard errors and overestimated random effect variances) and incorrect predictions of the unconflated multilevel interaction were found.
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Affiliation(s)
- Sun-Joo Cho
- Vanderbilt University, Nashville, Tennessee, USA
| | | | | | | | | | - Lynn S Fuchs
- Vanderbilt University, Nashville, Tennessee, USA
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Takaesu Y, Aoki Y, Tomo Y, Tsuboi T, Ishii M, Imamura Y, Tachimori H, Watanabe K. Implementation of a shared decision-making training program for clinicians based on the major depressive disorder guidelines in Japan: A multi-center cluster randomized trial. Front Psychiatry 2022; 13:967750. [PMID: 36032228 PMCID: PMC9413755 DOI: 10.3389/fpsyt.2022.967750] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although shared treatment decision-making with patients requires attention, it is not widely implemented, particularly in the field of psychiatry. The aim of this study was to assess whether a shared decision-making (SDM) training program for clinicians based on the major depressive disorder (MDD) guidelines improved the perceived involvement of the decision process for patients with MDD. Methods A multi-center cluster-randomized controlled intervention of a clinician training program based on the Japanese MDD guidelines using related decision aids compared to usual care was conducted among 56 clinicians from 23 institutions. A total of 124 patients with MDD were enrolled in this study. The primary outcomes were the scores of the Shared Decision Making-Questionnaire-9 (SDM-Q-9) and Decision Conflict Scale (DCS) after the first visit to the outpatient clinics. The secondary outcomes were patients' satisfaction, quality of life, trust in clinicians, and depressive symptoms. Additionally, we evaluated all the observed outcomes at the first and third months of follow-up. Results The scores of the SDM-Q-9 in the SDM training program group were significantly higher than those in the control group at the first visit. However, no significant difference in the DCS scores was found between the two groups. There was no intervention effect for secondary outcomes and the outcomes at the first- and third-month follow-up visits. Conclusion The clinician training program based on the Japanese MDD guidelines can be useful for implementation of SDM. Additional research is needed to confirm the efficacy of this SDM training program. Clinical trial registration [https://www.umin.ac.jp/], identifier [UMIN000034397].
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Affiliation(s)
- Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yumi Aoki
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
- Psychiatric and Mental Health Nursing, St. Luke’s International University, Tokyo, Japan
| | - Yui Tomo
- Department of Clinical Data Science, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Miho Ishii
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
- Senzoku Stress Coping Support Office, Tokyo, Japan
| | - Yayoi Imamura
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Hisateru Tachimori
- Department of Clinical Data Science, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
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Selmouni F, Guy M, Muwonge R, Nassiri A, Lucas E, Basu P, Sauvaget C. Effectiveness of Artificial Intelligence-Assisted Decision-making to Improve Vulnerable Women's Participation in Cervical Cancer Screening in France: Protocol for a Cluster Randomized Controlled Trial (AppDate-You). JMIR Res Protoc 2022; 11:e39288. [PMID: 35771872 PMCID: PMC9382552 DOI: 10.2196/39288] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The French organized population-based cervical cancer screening (CCS) program transitioned from a cytology-based to a human papillomavirus (HPV)-based screening strategy in August 2020. HPV testing is offered every 5 years, starting at the age of 30 years. In the new program, women are invited to undergo an HPV test at a gynecologist's, primary care physician's, or midwife's office, a private clinic or health center, family planning center, or hospital. HPV self-sampling (HPVss) was also made available as an additional approach. However, French studies reported that less than 20% of noncompliant women performed vaginal self-sampling when a kit was sent to their home. Women with lower income and educational levels participate less in CCS. Lack of information about the disease and the benefits of CCS were reported as one of the major barriers among noncompliant women. This barrier could be addressed by overcoming disparities in HPV- and cervical cancer-related knowledge and perceptions about CCS. OBJECTIVE This study aimed to assess the effectiveness of a chatbot-based decision aid to improve women's participation in the HPVss detection-based CCS care pathway. METHODS AppDate-You is a 2-arm cluster randomized controlled trial (cRCT) nested within the French organized CCS program. Eligible women are those aged 30-65 years who have not been screened for CC for more than 4 years and live in the disadvantaged clusters in the Occitanie Region, France. In total, 32 clusters will be allocated to the intervention and control arms, 16 in each arm (approximately 4000 women). Eligible women living in randomly selected disadvantaged clusters will be identified using the Regional Cancer Screening Coordinating Centre of Occitanie (CRCDC-OC) database. Women in the experimental group will receive screening reminder letters and HPVss kits, combined with access to a chatbot-based decision aid tailored to women with lower education attainment. Women in the control group will receive the reminder letters and HPVss kits (standard of care). The CRCDC-OC database will be used to check trial progress and assess the intervention's impact. The trial has 2 primary outcomes: (1) the proportion of screening participation within 12 months among women recalled for CCS and (2) the proportion of HPVss-positive women who are "well-managed" as stipulated in the French guidelines. RESULTS To date, the AppDate-You study group is preparing and developing the chatbot-based decision aid (intervention). The cRCT will be conducted once the decision aid has been completed and validated. Recruitment of women is expected to begin in January 2023. CONCLUSIONS This study is the first to evaluate the impact of a chatbot-based decision aid to promote the CCS program and increase its performance. The study results will inform policy makers and health professionals as well as the research community. TRIAL REGISTRATION ClinicalTrials.gov NCT05286034; https://clinicaltrials.gov/ct2/show/NCT05286034. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/39288.
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Affiliation(s)
- Farida Selmouni
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Marine Guy
- Regional Cancer Screening Coordinating Centre of Occitanie, Carcassonne, France
| | - Richard Muwonge
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Abdelhak Nassiri
- Faculty of Law, Economics, Management and Economic and Social Administration, University of Western Brittany, Brest, France
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Catherine Sauvaget
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
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Liu T, Wang C, Sun J, Chen W, Meng L, Li J, Cao M, Liu Q, Chen C. The Effects of an Integrated Exercise Intervention on the Attenuation of Frailty in Elderly Nursing Homes: A Cluster Randomized Controlled Trial. J Nutr Health Aging 2022; 26:222-229. [PMID: 35297463 DOI: 10.1007/s12603-022-1745-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The frail elderly have an increased risk of frailty because of reduced physical activity, cognitive ability and quality of life. This study aims to evaluate the effects of integrated exercise intervention on the attenuation of frailty in elderly nursing home residents. DESIGN This study was a cluster randomized controlled trial. SETTING AND PARTICIPANTS 146 elderly frailty people from 8 elderly nursing homes in Harbin, China, were randomly assigned into the intervention group and control group after obtaining their informed consent. INTERVENTION The intervention group performed integrated exercise interventions for 12 months, while the control group only continued with their daily activities. MEASUREMENTS Sociodemographic, health-related data, frailty levels, gait parameters, cognition, and quality of life were evaluated. RESULTS The mean age of participants was 80.74± 2.89 years, and 70.37% (n=95) were female. The Difference-in-difference regression showed that, compared with the control group, phenotypic frailty score (β3 =-1.40, p < 0.001) and stride time (β3 = -0.38, p <0.001) decreased significantly in the intervention group, stride velocity (β3 = 0.24, p < 0.001), step length (β3 = 0.08, p <0.001), cadence (β3 = 17.79, p < 0.001), MMSE total score (β3 = 1.90, p < 0.001) and QOL total score (β3 = 11.84, p < 0.001) increased significantly in the intervention group. CONCLUSION The integrated exercise intervention can effectively improve the attenuation of frailty, gait parameters, cognitive function, and quality of life in elderly nursing homes. We can use the findings of this study as a reference for the design of activities for the elderly nursing home residents, to provide them with appropriate exercises, improve their physical functions, and improve or delay their frailty level, which is principally important for developing countries in east Asia where rehabilitation resources are generally scarce.
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Affiliation(s)
- T Liu
- Chen Chen, PhD. Department of the Ward 5 of Acupuncture and Moxibustion, the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, No. 144, Gogol Road, Harbin City 150040, Heilongjiang Province, China. Telephone: +0451-87093470;
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Becquey E, Diop L, Awonon J, Diatta AD, Ganaba R, Pedehombga A, Gelli A. A Poultry Value Chain Intervention Promoting Diversified Diets Has Limited Impact on Maternal and Child Diet Adequacy during the Lean Season in a Cluster Randomized Controlled Trial. J Nutr 2022; 152:1336-1346. [PMID: 35170739 PMCID: PMC9071289 DOI: 10.1093/jn/nxac034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Soutenir l'Exploitation Familiale pour Lancer l'Élevage des Volailles et Valoriser l'Économie Rurale (SELEVER) is a nutrition- and gender-sensitive poultry value chain project designed and implemented by international nongovernmental organization Tanager, which consists of poultry market facilitation and behavior change activities aiming at increasing poultry production and improving diets without free inputs transfer. OBJECTIVES The study aimed at assessing the impact of SELEVER on diets of women and children during the lean season. METHODS Within a cluster randomized controlled trial, 45 communes were assigned to 1 of 3 arms, including 1) SELEVER interventions, 2) SELEVER with an intensive hygiene and sanitation component (SELEVER + WASH), and 3) a control group without intervention. Two rounds of survey were conducted 2 y apart during the lean season. Primary dietary outcomes were the probability of adequacy (PA) of iron, zinc, and vitamin A intakes; mean PA of 11 micronutrients and individual dietary diversity score collected through quantitative 24-h recall in longitudinal samples of women and index children (2-4 y old) in 1054 households; and minimum acceptable diet in the repeated cross-sectional sample of their younger sibling aged 6-23 mo. Impacts were assessed by intention-to-treat ANCOVA. RESULTS Relative to control, SELEVER interventions (groups 1 + 2) increased the PA of iron intakes in women by 1.8 percentage points (pp) (P = 0.030). We found no further impact on primary outcomes, although egg consumption increased in index children (+0.73 pp, P = 0.010; +0.69 kcal/d, P = 0.036). Across the 3 groups, we observed negative effects of SELEVER on the PA of zinc intakes in women relative to SELEVER + WASH (-4.1 pp, P = 0.038) and on a variety of secondary dietary outcomes relative to both other groups. The study was registered on the ISCRCTN registry (ISRCTN16686478). CONCLUSIONS Information-only-based value chain interventions may not have meaningful positive effects on diets of women and children in the lean season in settings with largely inadequate diets. We found suggestive evidence that synergies between intervention components may have introduced heterogeneity in effects on diet.
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Affiliation(s)
| | - Loty Diop
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Josue Awonon
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Ampa D Diatta
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | | | | | - Aulo Gelli
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
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Rahul A, Chintha S, Anish TS, Prajitha KC, Indu PS. Effectiveness of a Non-pharmacological Intervention to Control Diabetes Mellitus in a Primary Care Setting in Kerala: A Cluster-Randomized Controlled Trial. Front Public Health 2021; 9:747065. [PMID: 34869163 PMCID: PMC8636158 DOI: 10.3389/fpubh.2021.747065] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite being the first Indian state with a dedicated Non-Communicable Disease (NCD) program, glycemic control among a large proportion of patients is low in Kerala. This study tries to find evidence for a standardized non-pharmacological strategy delivered through Junior Public Health Nurses (JPHNs) in achieving and maintaining glycemic control among diabetic patients registered with NCD clinics of primary health care settings. Design: A cluster randomized controlled trial was conducted among adult patients with Diabetes Mellitus attending NCD clinics of primary care settings of South Kerala, India. JPHNs of the intervention group received additional module-based training while standard management continued in the control group. Sequence generation was done by random permuted blocks method and a cluster of 12 patients was selected from each of the 11 settings by computer-generated random numbers. Patients were followed up for 6 months with monthly monitoring of Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PPBS), blood pressure, Body Mass Index (BMI), and health-related behaviors. Knowledge and skills/practice of JPHNs were also evaluated. Analysis of Covariance was done to study the final outcome adjusting for the baseline values and a model for glycemic control was predicted using multilevel modeling. Results: We analyzed 72 participants in the intervention group and 60 participants in the control group according to the intention-to-treat principle. The intervention was associated with a significant reduction in FBS (p < 0.001) and PPBS (p < 0.001) adjusting for the baseline values. The achievement of glycemic control was 1.5 (95% CI: 1.05-2.3) times better with intervention and they showed a better trend of maintenance of glycemic control (FBS, p = 0.003 and PPBS, p = 0.039). Adjusting for clustering and the baseline values, the intervention showed a significant effect on FBS (B = -3.1, SE = 0.57; p < 0.001) and PPBS (B = -0.81, SE = 0.3; p < 0.001) with time. Drug adherence score (p < 0.001), hours of physical activity (p < 0.001), BMI (p = 0.002), fruit intake (p = 0.004), and green leafy vegetable intake (p = 0.01) were the major predictors of FBS control. The practice/skills score of the JPHNs significantly improved with intervention (p < 0.001) adjusting for baseline values. Conclusion: A well-designed health worker intervention package incorporated into the existing health system can translate into attitude change and skill development in the health workers which can reflect in the improvement of glycemic control among the patients. Trial registration: [URL: http://www.ctri.nic.in], identifier [CTRI/2017/11/010622].
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Affiliation(s)
- Arya Rahul
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, India
| | - Sujatha Chintha
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, India
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Buøen ES, Lekhal R, Lydersen S, Berg-Nielsen TS, Drugli MB. Promoting the Quality of Teacher-Toddler Interactions: A Randomized Controlled Trial of "Thrive by Three" In-Service Professional Development in 187 Norwegian Toddler Classrooms. Front Psychol 2021; 12:778777. [PMID: 34867691 PMCID: PMC8637887 DOI: 10.3389/fpsyg.2021.778777] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
The effectiveness of the Thrive by Three intervention, a 10-month, multicomponent, in-service professional development model to promote the quality of caregiver-toddler interactions (i.e., process quality), was tested utilizing a clustered randomized controlled design. Eighty childcare centers with 187 toddler classrooms in Norway were randomly assigned to either the Thrive by Three intervention group (n=87) or a usual-activity wait list control group (n=100). Interactional quality was assessed with the Toddler version of the Classroom Assessment Scoring System (CLASS-Toddler) at three timepoints: pre-, mid-, and post-intervention. There were significant group differences in change in quality during the intervention period in both CLASS domains, Emotional and Behavioral Support (EBS), and Engaged Support for Learning (ESL), with greater overall differences in the ESL domain. Quality increased in the intervention groups, but quality decreased in the control group from baseline to post-intervention. There were significant group differences in quality at baseline. The Thrive by Three intervention had a positive effect on teacher-toddler interactions in both the EBS and ESL domains. Results need to be replicated preferably in more diverse samples. Clinical Trial Registration:ClinicalTrials.gov #NCT03879733.
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Affiliation(s)
- Elisabet Solheim Buøen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.,Department of Communication and Culture, Norwegian Business School, Oslo, Norway
| | - Ratib Lekhal
- Department of Communication and Culture, Norwegian Business School, Oslo, Norway.,Department of Education, University of Oslo, Oslo, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Science, Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Turid Suzanne Berg-Nielsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Science, Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - May Britt Drugli
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Science, Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Centre of the Study of Educational Practice, Inland Norway University of Applied Sciences, Hamar, Norway
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Hendrickse J, Yeaton WH. An Empirical Validation of the Regression Point Displacement Design Using Within-Study Comparison Logic: Emerging Possibilities and Cautions. Eval Rev 2021; 45:279-308. [PMID: 34979824 DOI: 10.1177/0193841x211064420] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The regression point displacement (RPD) design is a quasi-experiment (QE) that aims to control many threats to internal validity. Though it has existed for several decades, RPD has only recently begun to answer applied research questions in lieu of stronger QEs. OBJECTIVES Our primary objective was to implement within-study comparison (WSC) logic to create RPD replicates and to determine conditions under which RPD might provide estimates comparable to those found in validating experiments. RESEARCH DESIGN We utilize three randomized controlled trials (two cluster-level, one individual-level), artificially decomposing or creating cluster structures, to create multiple RPDs. We compare results in each RPD treatment group to a fixed set of control groups to gauge the congruence of these repeated RPD realizations with results found in these three RCTs. RESULTS RPD's performance was uneven. Using multiple criteria, we found that RPDs successfully predicted the direction of the RCT's intervention effect but inconsistently fell within the .10 SD threshold. A scant 13% of RPD results were statistically significant at either the .05 or .01 alpha-level. RPD results were within the 95% confidence interval of RCTs around half the time, and false negative rates were substantially higher than false positive rates. CONCLUSIONS RPD consistently underestimates treatment effects in validating RCTs. We analyze reasons for this insensitivity and offer practical suggestions to improve the chances RPD will correctly identify favorable results. We note that the synthetic, "decomposition of cluster RCTs," WSC design represents a prototype for evaluating other QEs.
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Affiliation(s)
- Joshua Hendrickse
- School of Communication, 7823Florida State University, Tallahassee, FL, USA
| | - William H Yeaton
- School of Education, 7823Florida State University, Tallahassee, FL, USA
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Catho G, Centemero NS, Waldispühl Suter B, Vernaz N, Portela J, Da Silva S, Valotti R, Coray V, Pagnamenta F, Ranzani A, Piuz MF, Elzi L, Meyer R, Bernasconi E, Huttner BD. How to Develop and Implement a Computerized Decision Support System Integrated for Antimicrobial Stewardship? Experiences From Two Swiss Hospital Systems. Front Digit Health 2021; 2:583390. [PMID: 34713055 PMCID: PMC8521958 DOI: 10.3389/fdgth.2020.583390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/14/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Computerized decision support systems (CDSS) provide new opportunities for automating antimicrobial stewardship (AMS) interventions and integrating them in routine healthcare. CDSS are recommended as part of AMS programs by international guidelines but few have been implemented so far. In the context of the publicly funded COMPuterized Antibiotic Stewardship Study (COMPASS), we developed and implemented two CDSSs for antimicrobial prescriptions integrated into the in-house electronic health records of two public hospitals in Switzerland. Developing and implementing such systems was a unique opportunity for learning during which we faced several challenges. In this narrative review we describe key lessons learned. Recommendations: (1) During the initial planning and development stage, start by drafting the CDSS as an algorithm and use a standardized format to communicate clearly the desired functionalities of the tool to all stakeholders. (2) Set up a multidisciplinary team bringing together Information Technologies (IT) specialists with development expertise, clinicians familiar with “real-life” processes in the wards and if possible, involve collaborators having knowledge in both areas. (3) When designing the CDSS, make the underlying decision-making process transparent for physicians and start simple and make sure to find the right balance between force and persuasion to ensure adoption by end-users. (4) Correctly assess the clinical and economic impact of your tool, therefore try to use standardized terminologies and limit the use of free text for analysis purpose. (5) At the implementation stage, plan usability testing early, develop an appropriate training plan suitable to end users' skills and time-constraints and think ahead of additional challenges related to the study design that may occur (such as a cluster randomized trial). Stay also tuned to react quickly during the intervention phase. (6) Finally, during the assessment stage plan ahead maintenance, adaptation and related financial challenges and stay connected with institutional partners to leverage potential synergies with other informatics projects.
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Affiliation(s)
- Gaud Catho
- Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolo S Centemero
- Division of Clinical Informatics, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Nathalie Vernaz
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Medical Direction, Geneva University Hospital, Geneva, Switzerland
| | - Javier Portela
- Division of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Serge Da Silva
- Division of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Roberta Valotti
- Division of Infectious Diseases, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Valentina Coray
- Division of Clinical Informatics, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Francesco Pagnamenta
- Division of Clinical Informatics, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Alice Ranzani
- Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Marie-Françoise Piuz
- Division of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Luigia Elzi
- Division of Informatics, Geneva University Hospital, Geneva, Switzerland
| | - Rodolphe Meyer
- Division of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Benedikt D Huttner
- Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Livanou M, Lane R. Assessing the Feasibility of a Multicenter Transition Intervention Model Across Adolescent Secure Services in England (MOVING FORWARD): Protocol for a Feasibility Cluster Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e29273. [PMID: 34677140 PMCID: PMC8571693 DOI: 10.2196/29273] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young people moving from adolescent secure inpatient units to adult care in the United Kingdom have multiple and complex needs and are more likely to experience poor transition outcomes. Poorly managed transitions can lead to enduring use and dependency on mental health services. However, there is a lack of knowledge about the feasibility of transitional care models. OBJECTIVE This paper presents the protocol for a study that aims to test a feasibility cluster randomized controlled trial for young people transitioning from adolescent secure services to adult-oriented settings. The overarching aim of the MOVING FORWARD study is to provide a preliminary estimate of the effectiveness and cost-effectiveness of a new transition intervention model and to inform a future full-scale cluster randomized controlled trial. METHODS The design of the study is a 3-arm feasibility cluster randomized controlled trial comparing the MOVING FORWARD intervention against standard transition preparation conducted at 6 adolescent secure services, of which 4 units will receive the intervention and 2 will serve as controls. Eligible young people between 17-19 years, their parents/carers, and key workers will be invited to participate. Young people and parents/carers will be allocated to two conditions (young people alone and young people with a parent/carer) and will receive 4 transition preparation workshops across 6 months. Six adolescent secure hospitals will be randomly allocated, stratified by area and service type. Data will be collected at 3 time points: baseline (T0), 6-12 months postintervention (T1), and 18-24 months postbaseline (T2). Primary and secondary outcomes will be based on assessment measures and interviews conducted at T1 and T2. RESULTS A total of 13 young people and 17 staff members have contributed to the intervention design through online advisory groups on the design of the study and important themes for transition. We have also consulted members of the public (a steering group) including 2 young people who have transitioned to the community and 2 parents/carers. Common identified themes included appropriateness of module content and support during delayed transitions. The content of the intervention will be finalized during the first 6 months of the study. Participants will be recruited over the course of 6 months. An intraclass correlation coefficient will be calculated to inform the power of the sample size for a further large-scale trial. With a sample size of 50, we will be able to estimate a dropout rate of 80% (95% CI -11% to 11%). CONCLUSIONS This research will provide practitioners and policy makers with an evidence-based framework of how training and familiarization with the prospective transitions can yield positive outcomes. This study will test whether a psychosocial intervention can be implemented in adolescent secure hospitals. The results will identify barriers and facilitators to the proposed intervention and will enable services to reflect on the quality of transitional care delivery. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/29273.
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Affiliation(s)
- Maria Livanou
- Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University, Kingston Upon Thames, United Kingdom
| | - Rebecca Lane
- Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University, Kingston Upon Thames, United Kingdom
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Eninger L, Ferrer-Wreder L, Eichas K, Olsson TM, Hau HG, Allodi MW, Smedler AC, Sedem M, Gull IC, Herkner B. A Cluster Randomized Trial of Promoting Alternative Thinking Strategies (PATHS ®) With Swedish Preschool Children. Front Psychol 2021; 12:695288. [PMID: 34326800 PMCID: PMC8313762 DOI: 10.3389/fpsyg.2021.695288] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/21/2021] [Indexed: 12/04/2022] Open
Abstract
The preschool edition of Promoting Alternative THinking Strategies (PATHS®) is a school-based, teacher implemented universal intervention developed in the United States designed to promote social emotional competence (SEC) in children as a foundation for improved mental health. PATHS is delivered as a curriculum and it is based on theories and research regarding SEC, brain development, and optimal school environments. A majority of children in Sweden attend preschool, which is government-subsidized and follows a national curriculum focusing on both academic and social emotional learning. However, there is not so much focus on formal instruction nor manual-based lessons. The purpose of this study was to assess the short-term (pre- to post-test) effects of PATHS in the Swedish preschool setting. Using a two-wave cluster randomized trial with multi-method and informant assessment (N = 285 4 and 5-year-old Swedish children; n = 145 wait-list control; n = 140 intervention; K = 26 preschools; k = 13 intervention; k = 13 control) we assessed changes in child emotional knowledge, emotional awareness, social problem solving, prosocial play, inhibitory control, and working memory using structural equation modeling (SEM). We included schools with at least one classroom of 4–5-year-old children from three municipalities. We excluded open preschools, parent cooperative preschools, and family day homes. After random assignment, schools were informed of condition assignment. Research team members were not blind to assignment. We hypothesized that relative to children in control schools, children in intervention schools would evidence improvements in social emotional competence as well as other outcomes. Children in PATHS, relative to children in the control, evidenced improvements in working memory and prosocial play, but also showed an increase in hyperactive behaviors. Girls in PATHS, relative to girls in the control, showed improvement in emotional knowledge and reduced anxiety. These results are considered in light of efforts to promote positive development and mental health. The trial registration number at ClinicalTrials.gov is NCT04512157. Main funding was from Swedish Council for Working Life and Social Research, the Swedish Research Council, Formas, and VINNOVA (dnr: 259-2012-71).
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Affiliation(s)
- Lilianne Eninger
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Kyle Eichas
- Department of Psychological Sciences, Tarleton State University, Stephenville, TX, United States
| | - Tina M Olsson
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Ginner Hau
- Department of Special Education, Stockholm University, Stockholm, Sweden
| | | | | | - Mina Sedem
- Department of Special Education, Stockholm University, Stockholm, Sweden
| | | | - Birgitta Herkner
- Department of Special Education, Stockholm University, Stockholm, Sweden
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Tang ACY, Lee RLT. Effects of a group mindfulness-based cognitive programme on smartphone addictive symptoms and resilience among adolescents: study protocol of a cluster-randomized controlled trial. BMC Nurs 2021; 20:86. [PMID: 34090443 PMCID: PMC8180053 DOI: 10.1186/s12912-021-00611-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Smartphone addiction in adolescent is a significant global health issue since the last decade. Evidence has shown that the uncontrolled use of smartphone would lead to undesirable impact on their growth and development. However, evidence-based interventions to manage adolescents’ smartphone addictive behaviors is lacking. The proposed study aims to examine the effect of a group mindfulness-based cognitive programme(MBCP) on resilience, smartphone behavior and addictive symptoms in young adolescents. Methods It is an open-label, parallel-group, cluster-randomized controlled trial with repeated measurement analysis. Four primary schools in Hong Kong will be recruited and randomly allocated in a ratio of 1:1 to the intervention/control group. A convenience sample of 240 class level 5 primary school students, 60 from each school, will be recruited. Participants in the intervention group will receive a 12-week MBCP which comprises 90-minute supervised practice at school and daily home practice. Resilience will be measured by Connor-Davidson Resilience Scale – 25 (Chinese version); smartphone behavior will be represented by time spent/day using the smartphone and types of functions used; addictive symptoms will be measured by Smartphone Addiction Scale-Short Version (Chinese Version). Baseline assessment(T0) will be conducted before the intervention starts. Post-tests will be conducted in weeks 4, 8, 12 of the intervention, and 3 months follow-up. Intention-to-Treat analysis will be applied to the variables. Generalized Estimating Equation model will be used to compare differences in resilience scores, smartphone behavior and addiction scores between and within groups, adjusted for socio-demographic factors. P < 0.05 with two-tailed test will be regarded as significance. Discussion It is expected that adolescents will demonstrate better resilience and lesser smartphone addictive symptoms after joining the MBCP. The study will be the first provided empirical evidence to support the promising application of MBCP to manage smartphone use among adolescents. It introduces community stakeholders including community nurses a non-invasive and simple-to-administer intervention to tackle problematic smartphone use among adolescent clients. Trial registration Chinese Clinical Trial Registry, ChiCTR2000033273, Registered on 26 May 2020.
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Affiliation(s)
| | - Regina Lai Tong Lee
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, 2308, Callaghan, New South Wales, Australia
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Bhattarai N, Price CI, McMeekin P, Javanbakht M, Vale L, Ford GA, Shaw L. Cost-effectiveness of an enhanced Paramedic Acute Stroke Treatment Assessment (PASTA) during emergency stroke care: Economic results from a pragmatic cluster randomized trial. Int J Stroke 2021; 17:282-290. [PMID: 33724103 PMCID: PMC8864331 DOI: 10.1177/17474930211006302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/25/2022]
Abstract
Background The Paramedic Acute Stroke Treatment Assessment (PASTA) trial evaluated an
enhanced emergency care pathway which aimed to facilitate thrombolysis in
hospital. A pre-planned health economic evaluation was included. The main
results showed no statistical evidence of a difference in either
thrombolysis volume (primary outcome) or 90-day dependency. However,
counter-intuitive findings were observed with the intervention group showing
fewer thrombolysis treatments but less dependency. Aims Cost-effectiveness of the PASTA intervention was examined relative to
standard care. Methods A within trial cost-utility analysis estimated mean costs and
quality-adjusted life years over 90 days’ time horizon. Costs were derived
from resource utilization data for individual trial participants.
Quality-adjusted life years were calculated by mapping modified Rankin scale
scores to EQ-5D-3L utility tariffs. A post-hoc subgroup analysis examined
cost-effectiveness when trial hospitals were divided into compliant and
non-compliant with recommendations for a stroke specialist thrombolysis
rota. Results The trial enrolled 1214 patients: 500 PASTA and 714 standard care. There was
no evidence of a quality-adjusted life year difference between groups [0·007
(95% CI: −0·003 to 0·018)] but costs were lower in the PASTA group [−£1473
(95% CI: −£2736 to −£219)]. There was over 97.5% chance that the PASTA
pathway would be considered cost-effective. There was no evidence of a
difference in costs at seven thrombolysis rota compliant hospitals but costs
at eight non-complaint hospitals costs were lower in PASTA with more
dominant cost-effectiveness. Conclusions Analyses indicate that the PASTA pathway may be considered cost-effective,
particularly if deployed in areas where stroke specialist availability is
limited. Trial Registration: ISRCTN12418919 www.isrctn.com/ISRCTN12418919
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Affiliation(s)
- Nawaraj Bhattarai
- Health Economics Group, Population Health Sciences Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Peter McMeekin
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Mehdi Javanbakht
- Health Economics Group, Population Health Sciences Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, 5994Newcastle University, Newcastle upon Tyne, UK.,Medical Sciences Division, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, 5994Newcastle University, Newcastle upon Tyne, UK
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Schröder K, Öberg B, Enthoven P, Hedevik H, Fors M, Abbott A. Effectiveness and Quality of Implementing a Best Practice Model of Care for Low Back Pain (BetterBack) Compared with Routine Care in Physiotherapy: A Hybrid Type 2 Trial. J Clin Med 2021; 10:1230. [PMID: 33809640 DOI: 10.3390/jcm10061230] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/21/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022] Open
Abstract
Low back pain (LBP) occurs in all ages and first-line treatment by physiotherapists is common. The main aim of the current study was to evaluate the effectiveness of implementing a best practice model of care for LBP (intervention group—BetterBack☺ MoC) compared to routine physiotherapy care (control group) regarding longitudinal patient reported outcomes. The BetterBack☺ MoC contains clinical guideline recommendations and support tools to facilitate clinician adherence to guidelines. A secondary exploratory aim was to compare patient outcomes based on the fidelity of fulfilling a clinical practice quality index regarding physiotherapist care. A stepped cluster randomized design nested patients with LBP in the three clusters which were allocated to control (n = 203) or intervention (n = 264). Patient reported measures were collected at baseline, 3, 6 and 12 months and analyzed with mixed model regression. The primary outcome was between-group changes from baseline to 3 months for pain intensity and disability. Implementation of the BetterBack☺ MoC did not show any between-group differences in the primary outcomes compared with routine care. However, the intervention group showed significantly higher satisfaction at 3 months and clinically meaningful greater improvement in LBP illness perception at 3 months and quality of life at 3 and 6 months but not in patient enablement and global impression of change compared with the control group. Physiotherapists’ care that adhered to all clinical practice quality indices resulted in an improvement of most patient reported outcomes with a clinically meaningful greater improved LBP illness perception at 3 months and quality of life at 3 and 6 months, significantly greater improvement in LBP illness perception, pain and satisfaction at 3 and 6 months and significantly better enablement at all time points as well as better global improvement outcomes at 3 months compared with non-adherent care. This highlights the importance of clinical guideline based primary care for improving patient reported LBP outcomes.
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Watson SI, Girling A, Hemming K. Design and analysis of three-arm parallel cluster randomized trials with small numbers of clusters. Stat Med 2021; 40:1133-1146. [PMID: 33258219 DOI: 10.1002/sim.8828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/19/2022]
Abstract
In this article, we review and evaluate a number of methods used in the design and analysis of small three-arm parallel cluster randomized trials. We conduct a simulation-based study to evaluate restricted randomization methods including covariate-constrained randomization and a novel method for matched-group cluster randomization. We also evaluate the appropriate modelling of the data and small sample inferential methods for a variety of treatment effects relevant to three-arm trials. Our results indicate that small-sample corrections are required for high (0.05) but not low (0.001) values of the intraclass correlation coefficient and their performance can depend on trial design, number of clusters, and the nature of the hypothesis being tested. The Satterthwaite correction generally performed best at an ICC of 0.05 with a nominal type I error rate for single-period trials, and in trials with repeated measures type I error rates were between 0.04 and 0.06. Restricted randomization methods produce little benefit in trials with repeated measures but in trials with single post-intervention design can provide relatively large gains in power when compared to the most unbalanced possible allocations. Matched-group randomization improves power but is not as effective as covariate-constrained randomization. For model-based analysis, adjusting for fewer covariates than were used in a restricted randomization process under any design can produce non-nominal type I error rates and reductions in power. Where comparisons to two-arm cluster trials are possible, the performance of the methods is qualitatively very similar.
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Affiliation(s)
- Samuel I Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alan Girling
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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38
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Xu C, Dong Z, Zhang P, Chang G, Xiang Q, Zhang M, Zhou J, Qiao C, Yang Q, Qin Y, Lou P. Effect of group cognitive behavioural therapy on psychological stress and blood glucose in people with type 2 diabetes mellitus: A community-based cluster randomized controlled trial in China. Diabet Med 2021; 38:e14491. [PMID: 33296541 DOI: 10.1111/dme.14491] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether group cognitive behavioural therapy (GCBT) delivered by general practitioners reduces anxiety and depression and improves glycaemic levels in adults with type 2 diabetes mellitus. METHODS We conducted a community-based cluster randomized controlled trial in adults with type 2 diabetes mellitus from 48 communities in China. Participants received either GCBT plus usual care (UC) or UC only. General practitioners were trained in GCBT before intervention in the intervention group. The primary outcome was glycated haemoglobin (HbA1c ) concentration. Outcome data were collected from all participants at baseline, 2 months, 6 months and 1 year. The secondary outcomes were depression (Patient Health Questionnaire-9; PHQ-9) and anxiety (General Anxiety Disorder questionnaire; GAD-7). RESULTS The GCBT group showed greater improvement in GAD-7 and PHQ-9 scores, respectively, than the UC group after 2 months post-baseline (T = -6.46, p < 0.0001; T = -5.29, p < 0.001), 6 months (T = -4.58, p < 0.001; T = -4.37, p < 0.001) and 1 year post-intervention (T = -3.91, p < 0.001; T = -3.57, p < 0.001). There was no difference in HbA1c values between the GCBT and UC groups at 2 months while the values were lower in the GCBT group at 6 months and 1 year (T = -6.83, p < 0.001; T = -4.93, p < 0.001, respectively). Subgroup analysis indicated a long-term effect of GCBT only for mild and moderate anxiety and mild depression groups. Similarly, HbA1c values reduced only in the mild and moderate anxiety and the mild depression groups. CONCLUSIONS General practitioners can deliver GCBT interventions. GCBT plus UC is superior to UC for reducing mild/moderate anxiety and depression, and improving glycaemic levels. TRIAL REGISTRATION Chinese clinical trials registration (ChiCTR-IOP-16008045).
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Affiliation(s)
- Chunrong Xu
- Department of Endocrinology, Xuzhou Third People's Hospital, Xuzhou, Jiangsu, China
| | - Zongmei Dong
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, Jiangsu, China
| | - Pan Zhang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, Jiangsu, China
| | - Guiqiu Chang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, Jiangsu, China
| | - Quanyong Xiang
- Department of Non-communicable Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Ming Zhang
- Department of Endocrinology, Xuzhou Third People's Hospital, Xuzhou, Jiangsu, China
| | - Jinyi Zhou
- Department of Non-communicable Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Cheng Qiao
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, Jiangsu, China
| | - Qing Yang
- Department of Endocrinology, Xuzhou Third People's Hospital, Xuzhou, Jiangsu, China
| | - Yu Qin
- Department of Non-communicable Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Peian Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, Jiangsu, China
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Díaz-Caneja CM, Martín-Babarro J, Abregú-Crespo R, Huete-Diego MÁ, Giménez-Dasí M, Serrano-Marugán I, Arango C. Efficacy of a Web-Enabled, School-Based, Preventative Intervention to Reduce Bullying and Improve Mental Health in Children and Adolescents: Study Protocol for a Cluster Randomized Controlled Trial. Front Pediatr 2021; 9:628984. [PMID: 33981651 PMCID: PMC8107271 DOI: 10.3389/fped.2021.628984] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: Bullying is a major preventable risk factor for mental disorders. Available evidence suggests school-based interventions reduce bullying prevalence rates. This study aims to test the efficacy of a web-enabled, school-based, multicomponent anti-bullying intervention to prevent school bullying and to assess its effects on mental health and quality of life. Methods and analysis: Cluster randomized controlled trial conducted in 20 publicly funded primary and secondary schools in Madrid, Spain. Schools are randomly allocated to either the intervention arm (n = 10) or conventional practices arm (n = 10). The web-enabled intervention (LINKlusive) lasts ~12 weeks and consists of three main components: (i) an online training program for teachers and parents, (ii) a web-guided educational program for students, focusing on promoting respect for diversity, empathy, and social skill development, and (iii) a web-guided, teacher-delivered, targeted intervention program for bullying situations identified based on peer-support strategies and individual intervention for those involved (i.e., bullying victims and perpetrators). The primary objective is to compare differences between peer-reported bullying victimization in the intervention and control arms at the end of the intervention. Secondary outcome measures are additional measures of bullying victimization and perpetration, mental health symptoms, self-esteem, and quality of life. A follow-up assessment is conducted 1 year after the end of the intervention. Treatment effects will be tested using multilevel mixed models, adjusting for school-, classroom-, and student-related covariates. Considering the increased bullying rates in children with special educational needs, a specific subgroup analysis will test the efficacy of the intervention on bullying prevalence, mental health, and quality of life in this particularly vulnerable population. Ethics and Dissemination: The Deontology Commission of the School of Psychology, Universidad Complutense in Madrid, Spain reviewed the study protocol and granted ethical approval on 21st January 2019. The results of the trial will be disseminated in relevant peer-reviewed journals and at conferences in the field. Trial Registration Number: ISRCTN15719015.
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Affiliation(s)
- Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red (CIBER) de Salud Mental (CIBERSAM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier Martín-Babarro
- Department of Research and Psychology in Education, School of Psychology, Universidad Complutense, Madrid, Spain
| | - Renzo Abregú-Crespo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red (CIBER) de Salud Mental (CIBERSAM), School of Medicine, Universidad Complutense, Madrid, Spain.,School of Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Miguel Á Huete-Diego
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red (CIBER) de Salud Mental (CIBERSAM), School of Medicine, Universidad Complutense, Madrid, Spain.,Department of Research and Psychology in Education, School of Psychology, Universidad Complutense, Madrid, Spain
| | - Marta Giménez-Dasí
- Department of Research and Psychology in Education, School of Psychology, Universidad Complutense, Madrid, Spain
| | | | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red (CIBER) de Salud Mental (CIBERSAM), School of Medicine, Universidad Complutense, Madrid, Spain
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40
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Caro-Bautista J, Villa-Estrada F, Gómez-González A, Lupiáñez-Pérez I, Morilla-Herrera JC, Kaknani-Uttumchandani S, García-Mayor S, Morales-Asencio JM. Effectiveness of a Diabetes Education Program based on Tailored interventions and Theory of Planned Behaviour: Cluster randomized controlled trial protocol. J Adv Nurs 2020; 77:427-438. [PMID: 33009844 DOI: 10.1111/jan.14580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/24/2020] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
AIM To measure the Effectiveness of a Diabetes Education Program for people with T2DM, based on Tailored interventions and the Theory of Planned Behaviour. DESIGN Cluster randomized controlled clinical trial. METHODS This multicentre study will be carried out at 30 primary healthcare centres, where 436 persons with Type 2 Diabetes Mellitus (T2DM), aged between 18-75 years, will be recruited. The experimental educational program to be applied is modelled using components obtained from a systematic review and prior qualitative analysis. In addition, a taxonomy of nursing practice is used to standardize the program, based on the Theory of Planned Behaviour as a conceptual model. The intervention will be carried out by community nurses, using ADAPP-Ti® , an application developed with FileMaker Pro v.18. The control group will receive usual care and data will be collected at 6, 12, and 18 months, for both groups. The primary outcome considered will be glycosylated haemoglobin and cardiovascular factors, while the secondary ones will be tobacco consumption, body mass index, barriers to self-care, health-related quality of life, and lifestyle modification. The protocol was approved by the Ethics Committee of the Province of Malaga (Spain) in November 2014. DISCUSSION The degree of metabolic control in T2DM is not always associated with healthy lifestyles and significant levels of medication are often prescribed to achieve clinical objectives. An intervention focused on needs, based on the best available evidence and a solid conceptual framework, might successfully consolidate appropriate self-care behaviour in this population. IMPACT The study will result in the publication of an educational program featuring well-defined interventions and activities that will enable clinicians to tailor health care to the individual's needs and to combat treatment inertia in attending this population.
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Affiliation(s)
- Jorge Caro-Bautista
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Francisca Villa-Estrada
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Alberto Gómez-González
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Inmaculada Lupiáñez-Pérez
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Juan Carlos Morilla-Herrera
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Shakira Kaknani-Uttumchandani
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Silvia García-Mayor
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - José Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
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Guillaumier A, Skelton E, Shakeshaft A, Farrell M, Tzelepis F, Walsberger S, D'Este C, Paul C, Dunlop A, Stirling R, Fowlie C, Kelly P, Oldmeadow C, Palazzi K, Bonevski B. Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster-randomized controlled trial. Addiction 2020; 115:1345-1355. [PMID: 31762105 DOI: 10.1111/add.14911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/13/2019] [Revised: 07/25/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Abstract
AIM Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7-day point prevalence abstinence (PPA) at 8 weeks follow-up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8 weeks and 6.5 months follow-up. DESIGN Cluster-randomized controlled trial, with AOD service as unit of randomization, conducted January 2015-March 2016. SETTING Thirty-two eligible services (provided face-to-face client sessions to ≥ 50 clients/year) in Australia were randomized to control (usual care; n = 15) or intervention (n = 17) groups by an independent blinded biostatistician. PARTICIPANTS Eligible participants (≥ 16 years, current smoker) completed surveys at the service at baseline (n = 896) and telephone follow-up surveys (conducted by blinded assessors) at 8 weeks (n = 471; 53%) and 6.5 months (n = 427; 48%). INTERVENTION Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care. MEASUREMENTS Primary outcome was biochemically verified 7-day PPA at 8-week follow-up. Secondary outcomes included verified and self-reported prolonged abstinence, self-reported 7-day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention-to-treat analyses were performed, assuming missing participants were not abstinent. FINDINGS At 8 weeks, the findings in verified 7-day PPA between groups [2.6 versus 1.8%, odds ratio (OR) = 1.72, 95% confidence interval (CI) = 0.5-5.7, P = 0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8 weeks [incidence rate ratio (IRR) = 0.88, 95% CI = 0.8-0.95, P = 0.001] but were similar at 6.5 months (IRR = 0.96, 95% CI = 0.9-1.02, P = 0.240) follow-up. At both follow-ups the intervention group reported higher rates of NRT use. CONCLUSIONS Integrating smoking cessation treatment into addiction services did not significantly improve short-term abstinence from smoking.
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Affiliation(s)
- Ashleigh Guillaumier
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Eliza Skelton
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Flora Tzelepis
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Local Health District, Hunter New England Population Health, Wallsend, NSW, Australia
| | - Scott Walsberger
- Tobacco Control Unit, Cancer Council NSW, Woolloomooloo, NSW, Australia
| | - Catherine D'Este
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Christine Paul
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Adrian Dunlop
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Newcastle Community Health Centre, Hunter New England Local Health District, Newcastle West, NSW, Australia
| | - Robert Stirling
- Network of Alcohol and other Drugs Agencies, Woolloomooloo, NSW, Australia
| | - Carrie Fowlie
- Alcohol, Tobacco and Other Drug Association ACT, Ainslie, ACT, Australia
| | - Peter Kelly
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | | | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Billie Bonevski
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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42
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James CE, Zuber S, Dupuis-Lozeron E, Abdili L, Gervaise D, Kliegel M. Formal String Instrument Training in a Class Setting Enhances Cognitive and Sensorimotor Development of Primary School Children. Front Neurosci 2020; 14:567. [PMID: 32612501 PMCID: PMC7309442 DOI: 10.3389/fnins.2020.00567] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/06/2019] [Accepted: 05/07/2020] [Indexed: 01/08/2023] Open
Abstract
This cluster randomized controlled trial provides evidence that focused musical instrumental practice, in comparison to traditional sensitization to music, provokes multiple transfer effects in the cognitive and sensorimotor domain. Over the last 2 years of primary school (10-12 years old), 69 children received group music instruction by professional musicians twice a week as part of the regular school curriculum. The intervention group learned to play string instruments, whereas the control group (i.e., peers in parallel classes) was sensitized to music via listening, theory and some practice. Broad benefits manifested in the intervention group as compared to the control group for working memory, attention, processing speed, cognitive flexibility, matrix reasoning, sensorimotor hand function, and bimanual coordination Apparently, learning to play a complex instrument in a dynamic group setting impacts development much stronger than classical sensitization to music. Our results therefore highlight the added value of intensive musical instrumental training in a group setting within the school curriculum. These results encourage general implementation of such training in public primary schools, thus better preparing children for secondary school and for daily living activities.
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Affiliation(s)
- Clara E. James
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
- Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Sascha Zuber
- Department of Psychology, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Swiss National Centre of Competences in Research LIVES–Overcoming Vulnerability: Life Course Perspectives (NCCR Lives), Université de Lausanne, Lausanne, Switzerland
| | - Elise Dupuis-Lozeron
- Clinical Research Centre and Division of Clinical Epidemiology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laura Abdili
- Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Diane Gervaise
- Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Matthias Kliegel
- Department of Psychology, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Swiss National Centre of Competences in Research LIVES–Overcoming Vulnerability: Life Course Perspectives (NCCR Lives), Université de Lausanne, Lausanne, Switzerland
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Theiss-Nyland K, Qadri F, Colin-Jones R, Zaman K, Khanam F, Liu X, Voysey M, Khan A, Hasan N, Ashher F, Farooq YG, Pollard AJ, Clemens JD. Assessing the Impact of a Vi-polysaccharide Conjugate Vaccine in Preventing Typhoid Infection Among Bangladeshi Children: A Protocol for a Phase IIIb Trial. Clin Infect Dis 2020; 68:S74-S82. [PMID: 30845333 PMCID: PMC6405281 DOI: 10.1093/cid/ciy1107] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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] [Indexed: 12/29/2022] Open
Abstract
Background Typhoid fever illnesses are responsible for more than 100 000 deaths worldwide each year. In Bangladesh, typhoid fever is endemic, with incidence rates between 292–395 per 100 000 people annually. While considerable effort has been made to improve access to clean water and sanitation services in the country, there is still a significant annual typhoid burden, which particularly affects children. A typhoid conjugate vaccine (Vi-TCV) was recently prequalified by the World Health Organization and recommended for use, and offers the potential to greatly reduce the typhoid burden in Bangladesh. Methods This study is a double-blind, cluster-randomized, controlled trial of Vi-TCV in a geographically defined area in Dhaka, Bangladesh. At least 32 500 children from 9 months to <16 years of age will be vaccinated and followed for 2 years to assess the effectiveness and safety of Vi-TCV in a real-world setting. All cluster residents will also be followed to measure the indirect effect of Vi-TCV in this community. Ethics and Dissemination This protocol has been approved by the International Centre for Diarrhoeal Disease Research, Bangladesh; a University of Oxford research review; and both ethical review committees. Informed written consent and assent will be obtained before enrollment. Vi-TCV has been shown to be safe and effective in previous, smaller-scale studies. The results of this study will be shared through a series of peer-reviewed journal articles. The findings will also be disseminated to the local government, stakeholders within the community, and the population within which the study was conducted. Conclusions This trial is the largest and only cluster-randomized control trial of Vi-TCV ever conducted, and will describe the effectiveness of Vi-TCV in an endemic population. The results of this trial may provide important evidence to support the introduction of TCVs in countries with a high burden of typhoid. Clinical Trials Registration ISRCTN11643110.
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Affiliation(s)
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Rachel Colin-Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - K Zaman
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Arifuzzaman Khan
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Nazmul Hasan
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Fahim Ashher
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Yama G Farooq
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
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Li X, Duolikun N, Cheng F, Billot L, Jia W, Zhang P. Road to Hierarchical Diabetes Management at Primary Care (ROADMAP) Study in China: Protocol for the Statistical Analysis of a Cluster Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18333. [PMID: 32343257 PMCID: PMC7218607 DOI: 10.2196/18333] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/10/2020] [Accepted: 03/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background As the management of type 2 diabetes remains suboptimal in primary care, the Road to Hierarchical Diabetes Management at Primary Care (ROADMAP) study was designed and conducted in diverse primary care settings to test the effectiveness of a three-tiered diabetes management model of care in China. Objective This paper aims to predetermine the detailed analytical methods for the ROADMAP study before the database lock to reduce potential bias and facilitate transparent analyses. Methods The ROADMAP study adopts a community-based, cluster randomized controlled trial design that compares the effectiveness of a tiered diabetes management model on diabetes control with usual care among patients with diabetes over a 1-year study period. The primary outcome is the control rate of glycated hemoglobin (HbA1c) <7% at 1 year. Secondary outcomes include the control rates of ABC (HbA1c, blood pressure, and low-density lipoprotein cholesterol [LDL-C], individual and combined) and fasting blood glucose, and the change in each outcome. The primary analysis will be the log-binomial regression with generalized estimating equation (GEE), which accounts for the clustering within communities, for binary outcomes and linear regression with GEE for continuous outcomes. For both, the baseline value of the analyzed outcome will be the covariate. The other covariate further adjusted models and the repetitive models after multiple imputation (when more than 10% of observations in HbA1c after 1 year are missing) will be used for sensitivity analysis. Five prespecified subgroup analyses have also been planned to explore the heterogeneity of the intervention effects by adding the subgroup variable and its interaction with the intervention to the primary model. Results This plan has been finalized, approved, and signed off by the principle investigator, co-principle investigator, and lead statisticians as of November 22, 2019, and made public on the institutional website without any knowledge of intervention allocation. Templates for the main figure and tables are presented. Conclusions This statistical analysis protocol was developed for the main results of the ROADMAP study by authors blinded to group allocation and with no access to study data, which will guarantee the transparency and reduce potential bias during statistical analysis. Trial Registration Chinese Clinical Trial Registry ChiCTR-IOC-17011325; https://tinyurl.com/ybpr9xrq International Registered Report Identifier (IRRID) DERR1-10.2196/18333
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Affiliation(s)
- Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Nadila Duolikun
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Fengzhuo Cheng
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Laurent Billot
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Weiping Jia
- Department of Endocrinology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Chinese Diabetes Society, Beijing, China
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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Liao J, Xiao HY, Li XQ, Sun SH, Liu SX, Yang YJ, Xu DR. A Social Group-Based Information-Motivation-Behavior Skill Intervention to Promote Acceptability and Adoption of Wearable Activity Trackers Among Middle-Aged and Older Adults: Cluster Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e14969. [PMID: 32271151 PMCID: PMC7180511 DOI: 10.2196/14969] [Citation(s) in RCA: 6] [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: 06/08/2019] [Revised: 01/03/2020] [Accepted: 02/10/2020] [Indexed: 01/13/2023] Open
Abstract
Background Wearable activity trackers offer potential to optimize behavior and support self-management. To assist older adults in benefiting from mobile technologies, theory-driven deployment strategies are needed to overcome personal, technological, and sociocontextual barriers in technology adoption. Objective To test the effectiveness of a social group–based strategy to improve the acceptability and adoption of activity trackers by middle-aged and older adults. Methods A cluster randomized controlled trial was conducted among 13 groups of middle-aged and older adults (≥45 years) performing group dancing (ie, square dancing) as a form of exercise in Guangzhou from November 2017 to October 2018. These dancing groups were randomized 1:1 into two arms, and both received wrist-worn activity trackers and instructions at the baseline face-to-face assessment. Based on the Information-Motivation-Behavior Skill framework, the intervention arm was also given a tutorial on the purpose of exercise monitoring (Information), encouraged to participate in exercise and share their exercise records with their dancing peers (Motivation), and were further assisted with the use of the activity tracker (Behavior Skill). We examined two process outcomes: acceptability evaluated by a 14-item questionnaire, and adoption assessed by the uploaded step count data. Intention-to-treat analysis was applied, with the treatment effects estimated by multilevel models. Results All dancing groups were followed up for the postintervention reassessment, with 61/69 (88%) participants of the intervention arm (7 groups) and 56/80 (70%) participants of the control arm (6 groups). Participants’ sociodemographic characteristics (mean age 62 years, retired) and health status were comparable between the two arms, except the intervention arm had fewer female participants and lower cognitive test scores. Our intervention significantly increased the participants’ overall acceptability by 6.8 points (95% CI 2.2-11.4), mainly driven by promoted motivation (adjusted group difference 2.0, 95% CI 0.5-3.6), increased usefulness (adjusted group difference 2.5, 95% CI 0.9-4.1), and better perceived ease of use (adjusted group difference 1.2, 95% CI 0.1-2.4), whereas enjoyment and comfort were not increased (adjusted group difference 0.9, 95% CI –0.4-2.3). Higher adoption was also observed among participants in the intervention arm, who were twice as likely to have valid daily step account data than their controlled counterparts (adjusted incidence relative risk [IRR]=2.0, 95% CI 1.2-3.3). The average daily step counts (7803 vs 5653 steps/day for the intervention and control, respectively) were similar between the two arms (adjusted IRR=1.4, 95% CI 0.7-2.5). Conclusions Our social group–based deployment strategy incorporating information, motivation, and behavior skill components effectively promoted acceptability and adoption of activity trackers among community-dwelling middle-aged and older adults. Future studies are needed to examine the long-term effectiveness and apply this social engagement strategy in other group settings or meeting places. Trial Registration Chinese Clinical Trial Registry ChiCTR-IOC-17013185; https://tinyurl.com/vedwc7h.
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Affiliation(s)
- Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Hai-Yan Xiao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xue-Qi Li
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shu-Hua Sun
- Division of Health Management, Shayuan Primary Health Care Center, Guangzhou, China
| | - Shi-Xing Liu
- Division of Health Management, Shayuan Primary Health Care Center, Guangzhou, China
| | - Yung-Jen Yang
- Taiwanese Society of Geriatric Psychiatry, Taiwan, China
| | - Dong Roman Xu
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
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Lännerström L, Holmström IK, Wallman T. The effect of a short educational intervention in social insurance medicine: A randomized controlled trial. Nurs Open 2020; 7:523-529. [PMID: 32089848 PMCID: PMC7024614 DOI: 10.1002/nop2.416] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022] Open
Abstract
Aim To evaluate the effect of an educational intervention in social insurance medicine with Registered Nurses. Design Randomized controlled trial. Methods The trial was performed in 20 primary healthcare centres in Central Sweden. The centres were randomly assigned as intervention or control. All Registered Nurses working with telephone nursing at the centres were invited (N = 114); out of these 100 agreed to participate and responded to a questionnaire at the beginning and end of the trial. Fourteen questions in the questionnaire dealt with professional background and were used as exposure variables and were analysed using nominal logistic regression. Results Registered Nurses in the centres randomly assigned for the intervention experienced handling sick leave questions as less problematic after the intervention than those in the control group. This indicated that the intervention was associated with a positive effect. However, due to the rather small study population, the effect was inconclusive.
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Affiliation(s)
- Linda Lännerström
- Department of Public Health and Caring SciencesFamily Medicine and Preventive Medicine SectionUppsala UniversityUppsalaSweden
- Centre for Clinical Research SörmlandUppsala UniversityEskilstunaSweden
| | - Inger K. Holmström
- School of Health, Care and Social WelfareMälardalen UniversityVästeråsSweden
- Department of Public Health and Caring SciencesHealth Services Research SectionUppsala UniversityUppsalaSweden
| | - Thorne Wallman
- Department of Public Health and Caring SciencesFamily Medicine and Preventive Medicine SectionUppsala UniversityUppsalaSweden
- Centre for Clinical Research SörmlandUppsala UniversityEskilstunaSweden
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Al-Jaishi AA, McIntyre CW, Sontrop JM, Dixon SN, Anderson S, Bagga A, Benjamin D, Berry D, Blake PG, Chambers L, Chan PCK, Delbrouck N, Devereaux PJ, Ferreira-Divino LF, Goluch R, Gregor L, Grimshaw JM, Hanson G, Iliescu E, Jain AK, Lok CE, Mustafa RA, Nathoo B, Nesrallah GE, Oliver MJ, Pandeya S, Parmar MS, Perkins D, Presseau J, Rabin E, Sasal J, Shulman T, Sood MM, Steele A, Tam P, Tascona D, Wadehra D, Wald R, Walsh M, Watson P, Wodchis W, Zager P, Zwarenstein M, Garg AX. Major Outcomes With Personalized Dialysate TEMPerature (MyTEMP): Rationale and Design of a Pragmatic, Registry-Based, Cluster Randomized Controlled Trial. Can J Kidney Health Dis 2020; 7:2054358119887988. [PMID: 32076569 PMCID: PMC7003172 DOI: 10.1177/2054358119887988] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/09/2019] [Accepted: 09/23/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Small randomized trials demonstrated that a lower compared with higher dialysate temperature reduced the average drop in intradialytic blood pressure. Some observational studies demonstrated that a lower compared with higher dialysate temperature was associated with a lower risk of all-cause mortality and cardiovascular mortality. There is now the need for a large randomized trial that compares the effect of a low vs high dialysate temperature on major cardiovascular outcomes. OBJECTIVE The purpose of this study is to test the effect of outpatient hemodialysis centers randomized to (1) a personalized temperature-reduced dialysate protocol or (2) a standard-temperature dialysate protocol for 4 years on cardiovascular-related death and hospitalizations. DESIGN The design of the study is a pragmatic, registry-based, open-label, cluster randomized controlled trial. SETTING Hemodialysis centers in Ontario, Canada, were randomized on February 1, 2017, for a trial start date of April 3, 2017, and end date of March 31, 2021. PARTICIPANTS In total, 84 hemodialysis centers will care for approximately 15 500 patients and provide over 4 million dialysis sessions over a 4-year follow-up. INTERVENTION Hemodialysis centers were randomized (1:1) to provide (1) a personalized temperature-reduced dialysate protocol or (2) a standard-temperature dialysate protocol of 36.5°C. For the personalized protocol, nurses set the dialysate temperature between 0.5°C and 0.9°C below the patient's predialysis body temperature for each dialysis session, to a minimum dialysate temperature of 35.5°C. PRIMARY OUTCOME A composite of cardiovascular-related death or major cardiovascular-related hospitalization (a hospital admission with myocardial infarction, congestive heart failure, or ischemic stroke) captured in Ontario health care administrative databases. PLANNED PRIMARY ANALYSIS The primary analysis will follow an intent-to-treat approach. The hazard ratio of time-to-first event will be estimated from a Cox model. Within-center correlation will be considered using a robust sandwich estimator. Observation time will be censored on the trial end date or when patients die from a noncardiovascular event. TRIAL REGISTRATION www.clinicaltrials.gov; identifier: NCT02628366.
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Affiliation(s)
- Ahmed A. Al-Jaishi
- London Health Sciences Centre, ON, Canada
- ICES, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | | | - Jessica M. Sontrop
- London Health Sciences Centre, ON, Canada
- Western University, London, ON, Canada
| | - Stephanie N. Dixon
- London Health Sciences Centre, ON, Canada
- ICES, ON, Canada
- Western University, London, ON, Canada
| | | | | | | | - David Berry
- Sault Area Hospital, Sault Ste. Marie, ON, Canada
| | - Peter G. Blake
- London Health Sciences Centre, ON, Canada
- Western University, London, ON, Canada
| | | | | | | | | | | | | | | | - Jeremy M. Grimshaw
- Ottawa Hospital Research Institute, ON, Canada
- University of Ottawa, ON, Canada
| | | | | | - Arsh K. Jain
- London Health Sciences Centre, ON, Canada
- ICES, ON, Canada
- Western University, London, ON, Canada
| | | | - Reem A. Mustafa
- McMaster University, Hamilton, ON, Canada
- University of Kansas Medical Center, Kansas City, USA
| | | | | | - Matthew J. Oliver
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | | | | | - Justin Presseau
- Ottawa Hospital Research Institute, ON, Canada
- University of Ottawa, ON, Canada
| | - Eli Rabin
- Niagara Health System, St. Catharines, ON, Canada
| | | | | | - Manish M. Sood
- ICES, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
- University of Ottawa, ON, Canada
| | | | - Paul Tam
- Scarborough Health Network, ON, Canada
| | | | | | - Ron Wald
- ICES, ON, Canada
- University of Toronto, ON, Canada
- St. Michael’s Hospital, Toronto, ON, Canada
| | - Michael Walsh
- McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare, Hamilton, ON, Canada
| | - Paul Watson
- Thunder Bay Regional Health Sciences Centre, ON, Canada
| | | | | | | | - Amit X. Garg
- London Health Sciences Centre, ON, Canada
- ICES, ON, Canada
- McMaster University, Hamilton, ON, Canada
- Western University, London, ON, Canada
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Gelli A, Nguyen PH, Santacroce M, Twalibu A, Margolies A, Katundu M. A Community-Based Early Childhood Development Center Platform Promoting Diversified Diets and Food Production Increases the Mean Probability of Adequacy of Intake of Preschoolers in Malawi: A Cluster Randomized Trial. J Nutr 2020; 150:350-355. [PMID: 31616933 DOI: 10.1093/jn/nxz245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/14/2019] [Revised: 07/16/2019] [Accepted: 09/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Young children in Malawi consume low-quality diets lacking micronutrients critical for their development. OBJECTIVE To evaluate the impact of an agriculture and nutrition behavior change communication (BCC) intervention implemented through community-based childcare centers on the nutrient adequacy of diets of children living in food-insecure settings in Malawi. METHODS A cluster randomized trial was undertaken in 60 community-based childcare centers, including 1248 children aged 3-6 y. Nutrient intakes were estimated using interactive, multipass 24-h recall. Dietary adequacy was estimated through the probability of adequacy (PA) and mean probability of adequacy (MPA) of 11 micronutrients. Impacts were assessed by difference-in-difference (DID) estimates, adjusted for geographic clustering and child age and sex. RESULTS Intervention groups were similar for most baseline characteristics. Loss to follow-up was low (7% over a 12-mo period) and participation in the intervention was high (>90% enrollment and 80% attendance during the 5 d before the survey). Positive impacts were found for the PA of several individual micronutrient intakes: vitamin A [DID: 9 percentage points (pp), SE 3 pp], vitamin C (14 pp, SE 3 pp), riboflavin (11 pp, SE 3 pp), zinc (8 pp, SE 3 pp), and for the MPA for the 11 nutrients considered (5 pp, SE 1 pp). These impacts were driven by effects on younger children (aged 3-4 y). CONCLUSIONS Using a preschool platform to implement a nutrition-sensitive BCC intervention is an effective strategy to improve the adequacy of micronutrient intake of preschool children in food-insecure settings. The trial was registered at ISCRCTN as ISCRCTN96497560.
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Affiliation(s)
- Aulo Gelli
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Phuong Hong Nguyen
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Marco Santacroce
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Aisha Twalibu
- Save the Children, International/Malawi, Washington, DC, USA/Zomba, Malawi
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Martinez-Montilla JM, Mercken L, de Vries H, Candel M, Lima-Rodríguez JS, Lima-Serrano M. A Web-Based, Computer-Tailored Intervention to Reduce Alcohol Consumption and Binge Drinking Among Spanish Adolescents: Cluster Randomized Controlled Trial. J Med Internet Res 2020; 22:e15438. [PMID: 32012064 PMCID: PMC7007597 DOI: 10.2196/15438] [Citation(s) in RCA: 6] [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: 07/10/2019] [Revised: 10/04/2019] [Accepted: 10/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background Alcohol consumption, including binge drinking (BD) and heavy episodic drinking (HED), is one of the leading risk factors among Spanish adolescents leading to significant social, health, and economic consequences. Reduction of BD and HED in adolescents can be achieved using Web-based, computer-tailored (CT) interventions, providing highly personalized feedback that is adapted to a person’s individual characteristics and needs. Randomized controlled trials assessing the effects of tailored BD reduction programs among Spanish adolescents are scarce. Objective The aim of this study was to test the effectiveness of the Web-based, CT intervention Alerta Alcohol, aimed at the prevention of BD in Spanish adolescents. As a secondary outcome, effects on HED, weekly consumption, and any consumption were also assessed. The adherence and process evaluation were assessed. Methods A cluster randomized controlled trial conducted among 15 Spanish schools was developed. Each school was randomized into either an experimental condition (EC) (N=742) or a control condition (CC) (N=505). Finally, 351 participants for the EC and 261 for the CC were included in the analysis (N=612). Baseline assessment took place in January and February 2017. Demographic variables and alcohol use were assessed at baseline. Follow-up assessment of alcohol use took place 4 months later in May and June 2017. Participants were compared according to their randomization group (EC versus CC). After the baseline assessment, participants in the EC started the intervention, which consisted of short stories about BD, in which CT feedback was based on the I-Change Model for behavior change. Participants in the CC group only received the baseline questionnaire. Effects of the intervention were assessed using a three-level mixed logistic regression analysis for BD, HED, and any consumption, and a three-level mixed linear regression analysis for weekly consumption. Results In total, 1247 adolescents participated in the baseline assessment and 612 participated in the follow-up assessment; the attrition rate was 50.92%. The intervention was effective in reducing HED among adolescents; the odds of HED in the CC was nine times that in the experimental condition (P=.04). No effects were found for BD, weekly consumption, and any consumption. Process evaluations revealed that the adolescents were satisfied with the program (68.8%), would use the program again (52.9%), and would recommend it to someone else (62.8%). Females and non-binge drinkers showed better responses in the process evaluation. Conclusions Our intervention was effective regarding HED but not regarding BD, weekly consumption, and any consumption. It may be that limiting alcohol consumption to prevent HED was easier in the Spanish context than it was to carry out further steps, such as reducing other patterns of alcohol consumption. Hence, additional actions are needed to accomplish these latter goals, including community approaches and policy actions aimed at denormalizing alcohol consumption among Spanish adolescents. Trial Registration ClinicalTrials.gov NCT03288896; https://clinicaltrials.gov/ct2/show/NCT03288896 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-018-5346-4
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Affiliation(s)
- José Manuel Martinez-Montilla
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.,Department of Health Promotion, Maastricht University, Maastricht, Netherlands.,Care and Public Health Research Institute, Maastricht, Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands.,Care and Public Health Research Institute, Maastricht, Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands.,Care and Public Health Research Institute, Maastricht, Netherlands
| | - Math Candel
- Care and Public Health Research Institute, Maastricht, Netherlands.,Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands
| | | | - Marta Lima-Serrano
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
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Setyowibowo H, Hunfeld JAM, Iskandarsyah A, Yudiana W, Passchier J, Sadarjoen SS, Badudu DF, Suardi DR, Hof EV, Sijbrandij M. A self-help intervention for reducing time to diagnosis in Indonesian women with breast cancer symptoms. Psychooncology 2019; 29:696-702. [PMID: 31852021 PMCID: PMC7217183 DOI: 10.1002/pon.5316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/06/2019] [Accepted: 10/28/2019] [Indexed: 12/26/2022]
Abstract
Objective We investigated the effectiveness of a self‐help intervention named PERANTARA, which aims to improve adherence to diagnostic procedures among women with breast cancer (BC) symptoms to reduce the time to a definitive diagnosis. Methods With a cluster randomized crossover design across four hospitals, PERANTARA and treatment as usual (TAU) or TAU only was provided at successive periods in a randomly determined order. The main outcome was the time between the first medical consultation and the definitive diagnosis. Secondary outcomes were BC knowledge, measured by the Breast Cancer Knowledge Test (BCKT); symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS); quality of life, measured by the World Health Organization Quality of Life‐BREF (WHOQOL‐BREF); and health status, measured by the EQ‐5D‐5L. A linear mixed model analysis was conducted to analyse the outcomes. Results We recruited 132 women with BC symptoms from four hospitals; 67 participants were in the intervention group, and 65 participants were in the control group. PERANTARA reduced the time to definitive diagnosis by 13.3 days (M [SD]: 25.90 [23.20] in the intervention group vs 39.29 [35.10] in the control group; mean difference = −13.26, 95% CI = −24.51 to −2.00, P = .02). No significant difference was found between the groups in BC knowledge, symptoms of anxiety, depression, quality of life, or health status. Conclusions PERANTARA reduced the time to definitive diagnosis among Indonesian women with BC symptoms. Psychoeducation may be an important addition to regular BC care to prevent undue delays in diagnostic procedures.
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Affiliation(s)
- Hari Setyowibowo
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Educational Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Joke A M Hunfeld
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aulia Iskandarsyah
- Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Whisnu Yudiana
- Department of Experimental Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Jan Passchier
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sawitri S Sadarjoen
- Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | | | - Drajat R Suardi
- Department of Surgical Oncology, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Edith Van't Hof
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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