The primary prevention of anxiety disorders

2020 ◽  
pp. 948-960
Author(s):  
Aliza Werner-Seidler ◽  
Jennifer L. Hudson ◽  
Helen Christensen
Keyword(s):  
Anxiety Disorder ◽  
Primary Prevention ◽  
Scale Up ◽  
Population Level ◽  
Implementation Barriers ◽  
Cognitive Behavioural ◽  
Post Test ◽  
Prevention Programmes ◽  
Programme Content ◽  
The Impact

This chapter describes the nature of primary prevention of anxiety and reports on evidence for its effectiveness. The chapter first defines prevention before reporting results of a systematic review of randomized controlled trials designed to prevent anxiety. A review of existing trials and associated effect sizes suggests that prevention programmes can be effective in preventing anxiety disorder incidence and symptoms in multiple settings (schools, workplaces, community) across the lifespan. The median effect size at post-test across all studies was 0.21, and 0.25 specifically for cognitive behavioural prevention programmes. Key elements common to prevention programmes are then discussed, including a consideration of programme content and personnel delivering the intervention. Key implementation barriers are raised, together with suggestions for how these might be overcome in order to scale up and offer prevention at a population level. The chapter concludes with a consideration of the impact these programmes could have on anxiety disorder incidence.

scholarly journals Revisiting: “A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: does helping babies breathe training save lives?”

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara Berkelhamer ◽  
Nalini Singhal
Keyword(s):  
Neonatal Mortality ◽  
Low Cost ◽  
Scale Up ◽  
Neonatal Resuscitation ◽  
Population Level ◽  
Helping Babies Breathe ◽  
Birth Attendants ◽  
Resuscitation Training ◽  
Facility Birth ◽  
The Impact

Abstract Background Helping Babies Breathe (HBB) is a low cost, skills-based neonatal resuscitation education program designed specifically for use in low resource settings. Studies from Tanzania, India and Nepal have demonstrated that HBB training results in decreased rates of fresh still birth and/or neonatal mortality. However, less is known regarding the impact of training on neonatal mortality at a population level. Bellad et al. utilized (BMC Pregnancy Childbirth. 2016;16 (1):222) utilized population based registries to evaluate outcomes before and after training of facility birth attendants. Their study entitled “A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: Does Helping Babies Breathe training save lives?” suggested facility based training was not associated with consistent improvements in neonatal mortality on a population level. Discussion Combining outcomes from three diverse settings may have under-estimated the impact of HBB training. We remain concerned that the modest benefits observed in the Kenyan site were lost with compiling of data. Summary The statement that HBB “was not associated with consistent improvements in mortality” may lead to the mistaken conclusion that improvements in neonatal mortality were not seen, when in fact, they were in selected cohorts. With numerous studies demonstrating potential for reduced neonatal mortality as a result of HBB training, we encourage interpretation of these findings in the context of local care.

scholarly journals Striving for population-level conservation: integrating physiology across the biological hierarchy

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Elizabeth M Ames ◽  
Meaghan R Gade ◽  
Chelsey L Nieman ◽  
James R Wright ◽  
Christopher M Tonra ◽  
...  
Keyword(s):  
Interspecific Interactions ◽  
Scale Up ◽  
Population Level ◽  
Physiological Measures ◽  
Population Declines ◽  
Future Studies ◽  
Conservation Implications ◽  
Ecosystem Level ◽  
Biological Hierarchy ◽  
The Impact

Abstract The field of conservation physiology strives to achieve conservation goals by revealing physiological mechanisms that drive population declines in the face of human-induced rapid environmental change (HIREC) and has informed many successful conservation actions. However, many studies still struggle to explicitly link individual physiological measures to impacts across the biological hierarchy (to population and ecosystem levels) and instead rely on a ‘black box’ of assumptions to scale up results for conservation implications. Here, we highlight some examples of studies that were successful in scaling beyond the individual level, including two case studies of well-researched species, and using other studies we highlight challenges and future opportunities to increase the impact of research by scaling up the biological hierarchy. We first examine studies that use individual physiological measures to scale up to population-level impacts and discuss several emerging fields that have made significant steps toward addressing the gap between individual-based and demographic studies, such as macrophysiology and landscape physiology. Next, we examine how future studies can scale from population or species-level to community- and ecosystem-level impacts and discuss avenues of research that can lead to conservation implications at the ecosystem level, such as abiotic gradients and interspecific interactions. In the process, we review methods that researchers can use to make links across the biological hierarchy, including crossing disciplinary boundaries, collaboration and data sharing, spatial modelling and incorporating multiple markers (e.g. physiological, behavioural or demographic) into their research. We recommend future studies incorporating tools that consider the diversity of ‘landscapes’ experienced by animals at higher levels of the biological hierarchy, will make more effective contributions to conservation and management decisions.

scholarly journals Scale-up of prevention programmes: sustained state-wide use of programme delivery software is explained by normalised self-organised adoption and non-adoption

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Eileen Goldberg ◽  
Kathleen Conte ◽  
Victoria Loblay ◽  
Sisse Groen ◽  
Lina Persson ◽  
...  
Keyword(s):  
Collective Action ◽  
Scale Up ◽  
Implementation Process ◽  
Population Level ◽  
Normalisation Process Theory ◽  
Top Down ◽  
Prevention Programmes ◽  
Self Organisation ◽  
Technology Users ◽  
Programme Delivery

Abstract Background Population-level health promotion is often conceived as a tension between “top-down” and “bottom-up” strategy and action. We report behind-the-scenes insights from Australia’s largest ever investment in the “top-down” approach, the $45m state-wide scale-up of two childhood obesity programmes. We used Normalisation Process Theory (NPT) as a template to interpret the organisational embedding of the purpose-built software designed to facilitate the initiative. The use of the technology was mandatory for evaluation, i.e. for reporting the proportion of schools and childcare centres which complied with recommended health practices (the implementation targets). Additionally, the software was recommended as a device to guide the implementation process. We set out to study its use in practice. Methods Short-term, high-intensity ethnography with all 14 programme delivery teams across New South Wales was conducted, cross-sectionally, 4 years after scale-up began. The four key mechanisms of NPT (coherence/sensemaking, cognitive participation/engagement, collective action and reflexive monitoring) were used to describe the ways the technology had normalised (embedded). Results Some teams and practitioners embraced how the software offered a way of working systematically with sites to encourage uptake of recommended practices, while others rejected it as a form of “mechanisation”. Conscious choices had to be made at an individual and team level about the practice style offered by the technology—thus prompting personal sensemaking, re-organisation of work, awareness of choices by others and reflexivity about professional values. Local organisational arrangements allowed technology users to enter data and assist the work of non-users—collective action that legitimised opposite behaviours. Thus, the technology and the programme delivery style it represented were normalised by pathways of adoption and non-adoption. Normalised use and non-use were accepted and different choices made by local programme managers were respected. State-wide, implementation targets are being reported as met. Conclusion We observed a form of self-organisation where individual practitioners and teams are finding their own place in a new system, consistent with complexity-based understandings of fostering scale-up in health care. Self-organisation could be facilitated with further cross-team interaction to continuously renew and revise sensemaking processes and support diverse adoption choices across different contexts.

scholarly journals Effect and feasibility of district level scale up of maternal, newborn and child health interventions in Pakistan: a quasi-experimental study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036293
Author(s):  
Zahid Ali Memon ◽  
Shah Muhammad ◽  
Sajid Soofi ◽  
Nimra Khan ◽  
Nadia Akseer ◽  
...  
Keyword(s):  
Child Health ◽  
Scale Up ◽  
Case Fatality ◽  
Population Level ◽  
Evidence Based ◽  
High Burden ◽  
Newborn And Child Health ◽  
The Impact ◽  
And Child Health

IntroductionPakistan has a high burden of maternal, newborn and child morbidity and mortality. Several factors including weak scale-up of evidence-based interventions within the existing health system; lack of community awareness regarding health conditions; and poverty contribute to poor outcomes. Deaths and morbidity are largely preventable if a combination of community and facility-based interventions are rolled out at scale.Methods and analysisUmeed-e-Nau (UeN) (New Hope) project aims is to improve maternal, newborn and child health (MNCH) in eight high-burden districts of Pakistan by scaling up of evidence-based interventions. The project will assess interventions focused on, first, improving the quality of MNCH care at primary level and secondary level. Second, interventions targeting demand generation such as community mobilisation, creating awareness of healthy practices and expanding coverage of outreach services will be evaluated. Third, we will also evaluate interventions targeting the improvement in quality of routine health information and promotion of use of the data for decision-making. Hypothesis of the project is that roll out of evidence-based interventions at scale will lead to at least 20% reduction in perinatal mortality and 30% decrease in diarrhoea and pneumonia case fatality in the target districts whereas two intervention groups will serve as internal controls. Monitoring and evaluation of the programme will be undertaken through conducting periodical population level surveys and quality of care assessments. Descriptive and multivariate analytical methods will be used for assessing the association between different factors, and difference in difference estimates will be used to assess the impact of the intervention on outcomes.Ethics and disseminationThe ethics approval was obtained from the Aga Khan University Ethics Review Committee. The findings of the project will be shared with relevant stakeholders and disseminated through open access peer-reviewed journal articles.Trial registration numberNCT04184544; Pre-results.

scholarly journals Looking beyond the Lamppost: Population-Level Primary Prevention of Breast Cancer

2020 ◽  
Vol 17 (23) ◽  
pp. 8720
Author(s):  
Gabriella M. McLoughlin ◽  
Eric M. Wiedenman ◽  
Sarah Gehlert ◽  
Ross C. Brownson
Keyword(s):  
Breast Cancer ◽  
Primary Prevention ◽  
Population Health ◽  
Population Level ◽  
Future Research ◽  
Dissemination And Implementation ◽  
Factors Influencing ◽  
Policies And Programs ◽  
The Impact ◽  
Prevention Of Breast Cancer

Although innovative and impactful interventions are necessary for the primary prevention of breast cancer, the factors influencing program adoption, implementation, and sustainment are key, yet remain poorly understood. Insufficient attention has been paid to the primary prevention of breast cancer in state and national cancer plans, limiting the impact of evidence-based interventions on population health. This commentary highlights the state of primary prevention of breast cancer and gaps in the current literature. As a way to enhance the reach and adoption of cancer prevention policies and programs, the utility of dissemination and implementation (D&I) science is highlighted. Examples of how D&I could be applied to study policies and programs for chronic disease prevention are described, in addition to needs for future research. Through application of D&I science and a strong focus on health equity, a clearer understanding of contextual factors influencing the success of prevention programs will be achieved, ultimately impacting population health.

scholarly journals The future of a partially effective HIV vaccine: assessing limitations at the population level

2019 ◽  
Author(s):  
Christian Selinger ◽  
Dobromir T. Dimitrov ◽  
Philip Welkhoff ◽  
Anna Bershteyn
Keyword(s):  
Scale Up ◽  
Population Level ◽  
Cost Effective ◽  
Hiv Vaccine ◽  
Generation Vaccine ◽  
Vaccine Impact ◽  
The One ◽  
Time Required ◽  
The Impact ◽  
Roll Out

AbstractObjectivesMathematical models have unanimously predicted that a first-generation HIV vaccine would be useful and cost-effective to roll out, but that its overall impact would be insufficient to reverse the epidemic. Here, we explore what factors contribute most to limiting the impact of such a vaccine.MethodsRanging from a theoretical ideal to a more realistic regimen, mirroring the one used in the currently ongoing trial in South Africa (HVTN 702), we model a nested hierarchy of vaccine attributes such as speed of roll-out, efficacy, and retention of booster doses.ResultsThe predominant reasons leading to a substantial loss of vaccine impact on the HIV epidemic are the time required to scale up mass vaccination, limited durability and waning of efficacy.ConclusionsA partially effective HIV vaccine will be a critical milestone for the development of a highly effective, durable, and scalable next-generation vaccine. Accelerated development, expedited vaccine availability, and improved immunogenicity are the main attributes of a vaccine that could dramatically reverse the course of the epidemic in highly endemic countries.

scholarly journals Linking light-dependent life history traits with population dynamics for Prochlorococcus and cyanophage

2019 ◽  
Author(s):  
David Demory ◽  
Riyue Liu ◽  
Yue Chen ◽  
Fangxin Zhao ◽  
Ashley Coenen ◽  
...  
Keyword(s):  
Population Dynamics ◽  
Life History ◽  
Life History Traits ◽  
Scale Up ◽  
Population Level ◽  
Cellular Growth ◽  
Diurnal Rhythms ◽  
Cell Infection ◽  
Infection Dynamics ◽  
The Impact

Prochlorococcus grow in diurnal rhythms driven by diel cycles. Their ecology depends on light, nutrients, and top-down mortality processes including lysis by viruses. Cyanophage, viruses that infect cyanobacteria, are also impacted by light. For example, extracellular viability and intra-cell infection kinetics of some cyanophage vary between light and dark conditions. Nonetheless, it remains unclear if light-dependent viral life history traits scale-up to influence population-level dynamics. Here we examined the impact of diel-forcing on both cellular- and population-scale dynamics in multiple Prochlorococcus-phage systems. To do so, we developed a light-driven population model including both cellular growth and viral infection dynamics. We then tested the model against measurements of experimental infection dynamics with diel forcing to examine the extent to which population level changes in both viral and host abundances could be explained by light-dependent life history traits. Model-data integration reveals that light-dependent adsorption can improve fits to population dynamics for some virus-host pairs. However, light-dependent variation alone does not fully explain realized host and virus population dynamics. Instead, we show evidence of a previously unrecognized lysis saturation at relatively high virus to cell ratios. Altogether, our study represents a quantitative approach to integrate mechanistic models to reconcile Prochlorococcus-virus dynamics spanning cellular to population scales.

Effectiveness of cognitive behavioural group therapy for social anxiety disorder: long-term benefits and aftercare

2019 ◽  
Vol 47 (5) ◽  
pp. 501-513 ◽  
Author(s):  
Ciara Fogarty ◽  
David Hevey ◽  
Odhrán McCarthy
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Group Therapy ◽  
Social Anxiety Disorder ◽  
Support Group ◽  
Anxiety And Depression ◽  
Cognitive Behavioural ◽  
The Impact

AbstractBackground:Empirical research demonstrates the short- to medium-term efficacy and effectiveness of cognitive behavioural group therapy (CBGT) for social anxiety disorder (SAD). Little is known about the durability of gains beyond 1 year following treatment in real-life clinical settings. Literature regarding the impact of aftercare programs as an adjunct to CBGT treatment on SAD is scarce.Aims:To evaluate the long-term effectiveness of CBGT for SAD in a community sample and to explore the relationship between long-term treatment outcomes and aftercare support group attendance.Method:A longitudinal cohort design evaluated changes in standardized psychological measures assessing aspects of SAD, anxiety and depression. Questionnaires were completed before the program (time 1, N = 457), after the program (time 2, n = 369) and at an average of 4.6 years follow-up (time 3, n = 138).Results:Large treatment effect sizes at post-intervention were maintained at long-term follow-up on measures of SAD, anxiety and depression. There was no statistically significant relationship between frequency of attendance at an aftercare support group and degree of improvement from post-treatment severity on any measure.Conclusions:CBGT is an effective intervention in the long-term in a routine clinical setting and should be considered a viable treatment option for SAD. Recommendations for future research, treatment implications and study limitations are considered.

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