scholarly journals Pragmatic pilot cluster randomised control trial of a school-based peer-led anti-smoking intervention for 13-14 year olds in Malaysia

2017 ◽  
Vol 117 (6) ◽  
pp. 599-616 ◽  
Author(s):  
Elniee Melson ◽  
Christopher Bridle ◽  
Wolfgang Markham
Keyword(s):  
Usual Care ◽  
Pilot Trial ◽  
Randomised Control Trial ◽  
Content Type ◽  
Smoking Intervention ◽  
School Based ◽  
Intervention Acceptability ◽  
Before And After ◽  
Training Post

Purpose The purpose of this paper is to report the process evaluation of a pilot randomised control trial of an anti-smoking intervention for Malaysian 13-14-year olds, conducted in 2011/2012. It was hypothesised that trained peer supporters would promote non-smoking among classmates through informal conversations. Design/methodology/approach Smoking-related baseline and follow-up questionnaires were administered, seven months apart, to Form 1 students (n=2,118) attending eight schools across two districts in Sabah (Kota Kinabalu; Keningau). Concealed stratified randomisation assigned two schools per district to the control and intervention arms. Control schools received usual care. Intervention schools received usual care and the peer supporter intervention. Peer supporters completed smoking-related knowledge and attitudes questionnaires before and after peer supporter training and peer supporter training evaluation questionnaires. They also discussed the peer supporter training and role in focus groups immediately following training (n=4) and three months later (n=3), and additionally, recorded post-training anti-smoking activity in diaries. Findings The pilot trial found that student recruitment was high (baseline students matched at follow-up n=1,681 (79 per cent of class-registered students). More boys (n=38) than girls (n=35) attended peer supporter training. Post-training, most peer supporters had improved smoking-related knowledge (n=55; 75 per cent) and attitudes (n=57; 78 per cent) and returned diaries (n=49; 67 per cent). Some focus group boys reported they were reluctant peer supporters and/or found resisting smoking difficult. Practical implications Future trials would benefit from outlined modifications to peer supporter selection, recruitment and training and additionally, assessments of context and intervention acceptability and reach. Originality/value Trials of complex public health interventions are scarce in economically developing countries.

Socio-economic differences in smoking among adolescents in a school-based smoking intervention: The X:IT II study

2021 ◽  
pp. 140349482110076
Author(s):  
Lotus S. Bast ◽  
Lisbeth Lund ◽  
Stine G. LauemØller ◽  
Simone G. Kjeld ◽  
Pernille Due ◽  
...  
Keyword(s):  
Preventive Intervention ◽  
First Year ◽  
Difference In Difference ◽  
Current Smoking ◽  
Smoking Intervention ◽  
School Time ◽  
School Based ◽  
Inequality In Health ◽  
Baseline Response

Aims: Socio-economic inequalities in health behaviour may be influenced by health interventions. We examined whether the X:IT II intervention, aiming at preventing smoking in adolescence, was equally effective among students from different occupational social classes (OSC). Methods: We used data from the multi-component school-based smoking preventive intervention X:IT II, targeting 13- to 15-year-olds in Denmark. The intervention was tested in 46 schools with 2307 eligible students at baseline (response rate=86.6%) and had three main intervention components: smoke-free school time, smoke-free curriculum and parental involvement. We used a difference-in-difference design and estimated the change in current smoking after the first year of implementation in high versus low OSC. Analyses were based on available cases ( N=1190) and imputation of missing data at follow-up ( N=1967). Results: We found that 1% of the students from high OSC and 4.9% from low OSC were smokers at baseline (imputed data), and 8.2% of the students from high OSC and 12.2% from low OSC were smokers at follow-up. Difference-in-difference estimates were close to zero, indicating no differential trajectory. Conclusions: As intended, the X:IT II intervention, designed to apply equally to students from all socio-economic groups, did not seem to create different trajectories in current smoking among adolescents in high and low socio-economic groups. To diminish social inequality in health, future studies should carefully consider the ability to affect all socio-economic groups equally, or even to appeal mainly to participants from lower socio-economic groups, as they are often the ones most in need of intervention.

scholarly journals Cessation from Smoking Improves Innate Host Defense and Clearance of Experimentally Inoculated NasalStaphylococcus aureus

2018 ◽  
Vol 86 (4) ◽  
Author(s):  
Amy L. Cole ◽  
Mary Schmidt-Owens ◽  
Ashley C. Beavis ◽  
Christine F. Chong ◽  
Patrick M. Tarwater ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Interleukin 1 ◽  
Nasal Carriage ◽  
The United States ◽  
Content Type ◽  
Time Period ◽  
Serious Infections ◽  
Before And After ◽  
Enhanced Expression

ABSTRACTStaphylococcus aureusnasal carriage is transient in most humans and usually benign, but dissemination ofS. aureusto extranasal sites causes the majority of clinical infections, andS. aureusis a major cause of serious infections in the United States. A better understanding of innate nasal decolonization mechanisms is urgently needed, as are relevant models for studyingS. aureusclearance. Here, we screened a population of healthy smokers for nasalS. aureuscarriage and compared the participants' abilities to clear experimentally applied nasalS. aureusbefore and after completion of a smoking cessation program. We determined that cigarette smoking increases the mean nasalS. aureusload (2.6 × 104CFU/swab) compared to the load observed in healthy nonsmokers (1.7 × 103CFU/swab) and might increase the rate ofS. aureusnasal carriage in otherwise-healthy adults: 22 of 99 smokers carriedS. aureusat the screening visit, while only 4 of 30 nonsmokers screened positive during the same time period. Only 6 of 19 experimental inoculation studies in active smokers resulted inS. aureusclearance within the month of follow-up, while in the cessation group, 6 of 9 subjects cleared nasalS. aureusand carriage duration averaged 21 ± 4 days. Smoking cessation associated with enhanced expression ofS. aureus-associated interleukin-1β (IL-1β) and granulocyte colony-stimulating factor (G-CSF) in nasal fluids. Participants who failed to clearS. aureusexhibited a higher nasalS. aureusload and elevated nasal interleukin-1 receptor antagonist (IL-1RA) expression at the preexperiment study visits. We conclude that smokers exhibit higherS. aureusloads than nonsmokers and that innate immune pathways, including G-CSF expression and signaling through the IL-1 axis, are important mediators of nasalS. aureusclearance.

scholarly journals Project ImPACT for Toddlers: Pilot outcomes of a community adaptation of an intervention for autism risk

Autism ◽  
2019 ◽  
Vol 24 (3) ◽  
pp. 617-632 ◽  
Author(s):  
Aubyn C Stahmer ◽  
Sarah R Rieth ◽  
Kelsey S Dickson ◽  
Josh Feder ◽  
Marilee Burgeson ◽  
...  
Keyword(s):  
Usual Care ◽  
Pilot Trial ◽  
Autism Spectrum ◽  
Community Based ◽  
Family Outcomes ◽  
Project Impact ◽  
Part C ◽  
Parent Child Interactions ◽  
Quasi Experimental

This study reports child and family outcomes from a community-based, quasi-experimental pilot trial of Project ImPACT for Toddlers that is a parent-mediated, naturalistic, developmental behavioral intervention for children with or at-risk for autism spectrum disorder developed through a research–community partnership. Community early interventionists delivered either Project ImPACT for Toddlers ( n = 10) or Usual Care ( n = 9) to families based on Part C assigned provider. Twenty-five families participated, with children averaging 22.76 months old ( SD = 5.06). Family and child measures were collected at intake, after 3 months of service, and after a 3-month follow-up. Results indicate significantly greater improvements in positive parent–child interactions for Project ImPACT for Toddlers than usual care families, as well as large, but non-significant, effect sizes for Project ImPACT for Toddlers families in children’s social and communication skills.

scholarly journals Exploratory trial of a school-based alcohol prevention intervention with a family component

2016 ◽  
Vol 116 (4) ◽  
pp. 410-431 ◽  
Author(s):  
Jeremy Segrott ◽  
Heather Rothwell ◽  
Ilaria Pignatelli ◽  
Rebecca Playle ◽  
Gillian Hewitt ◽  
...  
Keyword(s):  
Primary School ◽  
Family Communication ◽  
Alcohol Misuse ◽  
School Age Children ◽  
Effectiveness Trial ◽  
Content Type ◽  
Exploratory Trial ◽  
School Based ◽  
Primary School Age

Purpose – Involvement of parents/carers may increase effectiveness of primary school-based alcohol-misuse prevention projects through strengthening family-based protective factors, but rates of parental engagement are typically low. This paper reports findings from an exploratory trial of a school-based prevention intervention – Kids, Adults Together (KAT), based on the Social Development Model, which aimed to promote pro-social family communication in order to prevent alcohol misuse, and incorporated strategies to engage parents/carers. The purpose of this paper is to assess the feasibility and value of conducting an effectiveness trial of KAT. Design/methodology/approach – The study was a parallel-group cluster randomised exploratory trial with an embedded process evaluation. The study took place in south Wales, UK, and involved nine primary schools, 367 pupils in Years 5/6 (aged 9-11 years) and their parents/carers and teachers. Questionnaires were completed by pupils at baseline and four month follow-up, and by parents at six month follow-up. Findings – Overall KAT was delivered with good fidelity, but two of five intervention schools withdrew from the study without completing implementation. In total, 50 per cent of eligible parents participated in the intervention, and KAT had good acceptability among pupils, parents and teachers. However, a number of “progression to effectiveness trial” criteria were not met. Intermediate outcomes on family communication (hypothesised to prevent alcohol misuse) showed insufficient evidence of an intervention effect. Difficulties were encountered in identifying age appropriate outcome measures for primary school-age children, particularly in relation to family communication processes. The study was unable to find comprehensive methodological guidance on exploratory trials. Research limitations/implications – It would not be appropriate to conduct an effectiveness trial as key progression criteria relating to intervention and trial feasibility were not met. There is a need for new measures of family communication which are suitable for primary school-age children, and more guidance on the design and conduct of exploratory/feasibility trials. Originality/value – KAT achieved high rates of parental involvement, and its theoretical framework and processes could be adapted by other interventions which experience difficulties with recruitment of parents/carers.

Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors

2005 ◽  
Vol 2 (3) ◽  
pp. 243-248 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee
Keyword(s):  
Pain Relief ◽  
Percutaneous Vertebroplasty ◽  
Invasive Procedure ◽  
Spinal Tumors ◽  
Percutaneous Injection ◽  
Content Type ◽  
Spinal Stabilization ◽  
Before And After ◽  
Fine Print

Object. Vertebroplasty involves the percutaneous injection of polymethylmethacrylate into collapsed vertebral bodies due to hemangioma, osteoporosis, or malignant tumor. The purpose of this study was to evaluate the merits and efficacy of percutaneous vertebroplasty (PVP) combined with radiotherapy in treating patients with osteolytic metastatic spinal tumors (OMSTs). Methods. Twenty-eight patients with OMSTs underwent PVP for the treatment of 72 vertebrae after administration of a local anesthetic or induction of general anesthesia for pain relief and spinal stabilization. Radiotherapy for suppressing tumor or inducing pain relief was performed immediately after PVP in 22 patients. Pain levels were assessed before and after the procedure by using a visual analog scale (VAS), and follow-up assessment was conducted at 1, 3, 6, and 9 months. On postoperative Day 3, marked-to-complete VAS score—based pain relief was achieved in 13 patients (48%) and moderate relief was demonstrated in 11 (41%). The mean VAS pain score was reduced from 8.2 to 3, and major complications were absent in all cases. Follow-up plain radiography was performed to assess vertebral column stability. Neither additional vertebral collapse in the treated vertebrae nor neurological deterioration was observed. Conclusions. Percutaneous vertebroplasty is a minimally invasive procedure and, when combined with radiotherapy, seems to be effective in providing pain relief and stabilization in patients with OMSTs.

Early rehabilitation after hospital admission for road trauma using an in-reach multidisciplinary team: a randomised controlled trial

2017 ◽  
Vol 31 (9) ◽  
pp. 1189-1200 ◽  
Author(s):  
Jane Wu ◽  
Steven G Faux ◽  
John Estell ◽  
Stephen Wilson ◽  
Ian Harris ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Usual Care ◽  
Intervention Group ◽  
Psychological Status ◽  
Randomised Control Trial ◽  
Control Group ◽  
Rehabilitation Team ◽  
Secondary Outcomes ◽  
The Impact

Objective: To investigate the impact of an in-reach rehabilitation team for patients admitted after road trauma. Design: Randomised control trial of usual care versus early involvement of in-reach rehabilitation team. Telephone follow-up was conducted by a blind assessor at three months for those with minor/moderate injuries and six months for serious/severe injuries. Setting: Four participating trauma services in New South Wales, Australia. Subjects: A total of 214 patients admitted during 2012-2015 with a length of stay of at least five days. Intervention: Provision of rehabilitation services in parallel with ward based therapy using an in-reach team for the intervention group. The control group could still access the ward based therapy (usual care). Main measures: The primary outcome was acute length of stay. Secondary outcomes included percentage requiring inpatient rehabilitation, function (Functional Independence Measure and Timed Up and Go Test), psychological status (Depression Anxiety and Stress Score 21), pain (Orebro Musculoskeletal Pain Questionnaire) and quality of life (Short Form-12 v2). Results: Median length of stay in acute care was 13 days (IQR 8-21). The intervention group, compared to the control group, received more physiotherapy and occupational therapy sessions (median number of sessions 16.0 versus 11.5, P=0.003). However, acute length of stay did not differ between the intervention and control groups (median 15 vs 12 days, P=0.37). There were no significant differences observed in the secondary outcomes at hospital discharge and follow-up. Conclusion: No additional benefit was found from the routine use of acute rehabilitation teams for trauma patients over and above usual care.

Disease Activity and Adverse Events in Patients with ANCA-Associated Vasculitides Undergoing Long-Term Dialysis

2021 ◽  
Vol 16 (11) ◽  
pp. 1665-1675
Author(s):  
Maëlis Kauffmann ◽  
Mickaël Bobot ◽  
Thomas Robert ◽  
Stéphane Burtey ◽  
Grégoire Couvrat-Desvergnes ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Cardiovascular Events ◽  
Survival Rates ◽  
National Health System ◽  
Dialysis Initiation ◽  
Content Type ◽  
Before And After ◽  
Kidney Impairment

Background and objectivesKidney impairment of ANCA-associated vasculitides can lead to kidney failure. Patients with kidney failure may suffer from vasculitis relapses but are also at high risk of infections and cardiovascular events, which questions the maintenance of immunosuppressive therapy.Design, setting, participants, & measurementsPatients with ANCA-associated vasculitides initiating long-term dialysis between 2008 and 2012 in France registered in the national Renal Epidemiology and Information Network registry and paired with the National Health System database were included. We analyzed the proportion of patients in remission off immunosuppression over time and overall and event-free survival on dialysis (considering transplantation as a competing risk). We compared the incidence of vasculitis relapses, serious infections, cardiovascular events, and cancers before and after dialysis initiation.ResultsIn total, 229 patients were included: 142 with granulomatous polyangiitis and 87 with microscopic polyangiitis. Mean follow-up after dialysis initiation was 4.6±2.7 years; 82 patients received a kidney transplant. The proportion of patients in remission off immunosuppression increased from 23% at dialysis initiation to 62% after 5 years. Overall survival rates on dialysis were 86%, 69%, and 62% at 1, 3, and 5 years, respectively. Main causes of death were infections (35%) and cardiovascular events (26%) but not vasculitis flares (6%). The incidence of vasculitis relapses decreased from 57 to seven episodes per 100 person-years before and after dialysis initiation (P=0.05). Overall, during follow-up, 45% of patients experienced a serious infection and 45% had a cardiovascular event, whereas 13% experienced a vasculitis relapse.ConclusionsThe proportion of patients with ANCA-associated vasculitis in remission off immunosuppression increases with time spent on dialysis. In this cohort, patients were far less likely to relapse from their vasculitis than to display serious infectious or cardiovascular events.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_11_08_CJN03190321.mp3

Risk of persistent cranial nerve injury after carotid endarterectomy

2004 ◽  
Vol 101 (3) ◽  
pp. 445-448 ◽  
Author(s):  
Edwin J. Cunningham ◽  
Rick Bond ◽  
Marc R. Mayberg ◽  
Charles P. Warlow ◽  
Peter M. Rothwell
Keyword(s):  
Carotid Endarterectomy ◽  
Nerve Injury ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Content Type ◽  
Before And After ◽  
Cranial Nerve Injury ◽  
Cranial Nerve Injuries ◽  
Fine Print

Object. Cranial nerve injuries, particularly motor nerve injuries, following carotid endarterectomy (CEA) can be disabling and therefore patients should be given reliable information about the risks of sustaining such injuries. The reported frequency of cranial nerve injury in the published literature ranges from 3 to 23%, and there have been few series in which patients were routinely examined before and after surgery by a neurologist. Methods. The authors investigated the risk of cranial nerve injuries in patients who underwent CEA in the European Carotid Surgery Trial (ECST), the largest series of patients undergoing CEA in which neurological assessment was performed before and after surgery. Cranial nerve injury was assessed and recorded in every patient and persisting deficits were identified on follow-up examination at 4 months and 1 year after randomization. Risk factors for cranial nerve injury were examined by performing univariate and multivariate analyses. There were 88 motor cranial nerve injuries among the 1739 patients undergoing CEA (5.1% of patients; 95% confidence interval [CI] 4.1–6.2). In 23 patients, the deficit had resolved by hospital discharge, leaving 3.7% of patients (95% CI 2.9–4.7) with a residual cranial nerve injury: 27 hypoglossal, 17 marginal mandibular, 17 recurrent laryngeal, one accessory nerve, and three Horner syndrome. In only nine patients (0.5%; 95% CI 0.24–0.98) the deficit was still present at the 4-month follow-up examination; however, none of the persisting deficits resolved during the subsequent follow up. Only duration of operation longer than 2 hours was independently associated with an increased risk of cranial nerve injury (hazard ratio 1.56, p < 0.0001). Conclusions. The risk of motor cranial nerve injury persisting beyond hospital discharge after CEA is approximately 4%. The vast majority of neurological deficits resolve over the next few months, however, and permanent deficits are rare. Nevertheless, the risk of cranial nerve injury should be communicated to patients before they undergo surgery.

Evaluating neuropsychologically informed rehabilitation training for staff within a high secure intellectual disability service

2020 ◽  
Vol 11 (2) ◽  
pp. 61-73
Author(s):  
Phyllis Annesley ◽  
Zoe Hamilton ◽  
Roisin Galway ◽  
Samantha Akiens ◽  
Rachel Hicks ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Thematic Analysis ◽  
Challenging Behaviour ◽  
Content Type ◽  
Staff Members ◽  
Training Post ◽  
People With Intellectual Disabilities ◽  
Day Services ◽  
One Year

Purpose Neuropsychologically informed rehabilitation (NIR) is one approach to supporting people with intellectual disabilities, cognitive impairment and challenging behaviour. This study aims to evaluate a five-day training course in NIR for staff working with adult male offenders with intellectual disabilities in a high secure hospital. The impacts on both the staff who undertook the training and the patients with challenging behaviour were explored. Design/methodology/approach Participants were psychology, nursing and day services staff and male patients. The staff completed a post-training questionnaire and three measures at pre-NIR training, post-NIR training and one-year follow-up. Patients completed four questionnaire measures within the same periods. Findings NIR training was positively evaluated by staff. Staff members’ perceived efficacy in working with challenging behaviour significantly increased post-training which was maintained at follow-up. Thematic analysis showed that the training staff members built their confidence, knowledge and skills. Because of these being high to start with, the study could not evidence statistically significant changes in these. Thematic analysis yielded two main themes, namely, benefits and quality of training, each with their own subthemes. The impacts of the training on patients were difficult to assess related to various factors. Research limitations/implications The knowledge and confidence measures used were limited in scope with an experienced staff group and required development. Practical implications NIR training could assist staff in other secure and community settings in working with people with intellectual disabilities and challenging behaviours. Originality/value This study positively contributes to an area that requires more research.

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