A Feasibility Study of A Home-Based Program to Promote Perceived Adequate Milk

Objective The purpose of this study was to evaluate the feasibility of a home-based educational skill building program to support exclusive breastfeeding for mothers in the early postpartum period. Specific aims were to: (1) evaluate the effectiveness of the study’s recruitment strategy, comparing the use of an intermediary with a direct approach, (2) examine intervention fidelity, (3) examine program adherence, and (4) assess the acceptability of the intervention to participants. Design and Sample A mixed methods within-group, three-occasion descriptive design, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. Intervention The program was implemented during three, 60-90 minute educational training sessions in the home, delivered at 6, 13, and 27 days postpartum. Results Mothers who adhered to the intervention protocol correctly attributed their infant’s crying behavior to factors other than the adequacy of the mother’s milk supply. All participants were recruited through direct approach. The program was delivered as planned with high fidelity, a high retention rate, and with a high rate of acceptability. Conclusions A fully scripted, at-home, nurse-delivered educational skill building program can be delivered with efficiency to breastfeeding mothers with full-term singleton infants; intervention fidelity, retention, and acceptability were high.

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Feasibility study of the Home-based Exercises for Responsible Sex (HERS) intervention to promote correct and consistent condom use among young women

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00885-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Nicola Knights ◽

Nicole Stone ◽

Tom Nadarzynski ◽

Katherine Brown ◽

Katie Newby ◽

...

Keyword(s):

Condom Use ◽

Feasibility Study ◽

Young Women ◽

Self Efficacy ◽

Repeated Measures ◽

Recruitment Strategy ◽

Consistent Condom ◽

Post Intervention ◽

Study Objective ◽

Home Based

Abstract Background Male condoms are effective in preventing common sexually transmitted infections (STIs) and unintended pregnancy, if used correctly and consistently. However, condom use errors and problems are common and young people report negative experiences, such as reduced pleasure. The Kinsey Institute Home-Based Exercises for Responsible Sex (KIHERS) is a novel condom promotion intervention for young women, which aims to reduce condom errors and problems, increase self-efficacy and improve attitudes towards condoms, using a pleasure-focussed approach. The study objective was to test the operability, viability and acceptability of an adapted version of the KIHERS intervention with young women aged 16–25 years in the United Kingdom (UK) (Home-Based Exercises for Responsible Sex-UK (HERS-UK). Methods A repeated-measures single-arm design was used, with a baseline (T1) and two follow-up assessments (T2 and T3), conducted 4 weeks and 8 weeks post intervention over a 3-month period. Participants were provided a condom kit containing different condoms and lubricants and were asked to experiment with condoms alone using a dildo and/or with a sexual partner. Ten process evaluation interviews were conducted post intervention. Results Fifty-five young women received the intervention; 36 (65%) completed T2 and 33 (60%) completed T3. Condom use errors and problems decreased, self-efficacy increased and attitudes towards condoms improved significantly. The proportion of participants who reported using a condom for intercourse in the past 4 weeks increased from T1 (20; 47%) to T2 (27; 87%) and T3 (23; 77%) and using lubricant with a condom for intercourse increased from T1 (6; 30%) to T2 (13; 48%)) and T3 (16; 70%). However, motivation to use condoms did not change. Cronbach’s alpha scores indicated good internal consistency of measures used. Qualitative data provided strong evidence for the acceptability of the intervention. Conclusions HERS-UK was implemented as intended and the recruitment strategy was successful within a college/university setting. This feasibility study provided an early indication of the potential effectiveness and acceptability of the intervention, and the benefits of using a pleasure-focussed approach with young women. Measures used captured change in outcome variables and were deemed fit for purpose. Future research should explore cost-effectiveness of this intervention, in a large-scale controlled trial using a diverse sample and targeting young women most at risk of STIs.

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Process evaluation of a randomised pilot trial of home-based rehabilitation compared to usual care in patients with heart failure with preserved ejection fraction and their caregiver’s

10.21203/rs.3.rs-17265/v4 ◽

2020 ◽

Author(s):

Karen Smith ◽

Chim Lang ◽

Jenny Wingham ◽

Julia Frost ◽

Colin Greaves ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Rehabilitation ◽

Process Evaluation ◽

Treatment Options ◽

Pilot Trial ◽

Qualitative Assessment ◽

Intervention Fidelity ◽

Preserved Ejection Fraction ◽

Home Based

Abstract Background: Whilst almost 50 percent of heart failure (HF) patients have preserved ejection fraction (HFpEF), evidence-based treatment options for this patient group remain limited. However, there is growing evidence of the potential value of exercise-based cardiac rehabilitation. This study reports the process evaluation of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention for HFpEF patients and their caregivers conducted as part of the REACH-HFpEF pilot trial. Methods: Process evaluation sub-study parallel to a single centre (Tayside, Scotland) randomised controlled pilot trial with qualitative assessment of both intervention fidelity delivery and HFpEF patients’ and caregivers’ experiences. The REACH-HF intervention consisted of self-help manual for patients and caregivers, facilitated over 12 weeks by trained healthcare professionals. Interviews were conducted following completion of intervention in a purposeful sample of 15 HFpEF patients and seven caregivers.Results: Qualitative information from the facilitator interactions and interviews identified three key themes for patients and caregivers: (1) understanding their condition, (2) emotional consequences of HF, and (3) responses to the REACH-HF intervention. Fidelity analysis found the interventions to be delivered adequately with scope for improvement in caregiver engagement. The differing professional backgrounds of REACH-HF facilitators in this study demonstrate the possibility of delivery of the intervention by healthcare staff with expertise in HF, cardiac rehabilitation or both. .Conclusions: The REACH-HF home-based facilitated intervention for HFpEF appears to be a feasible and a well-accepted model for the delivery of rehabilitation, with the potential to address key unmet needs of patients and their caregivers who are often excluded from HF and current cardiac rehabilitation programmes. Results of this study will inform a recently funded full multicentre randomised clinical trial.Trial registration: ISRCTN78539530 (date registration 7th July 2015) http://www.isrctn.com/ISRCTN78539530

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Program targets young adults with home-based skill building

The Brown University Child & Adolescent Psychopharmacology Update ◽

10.1002/cpu.30104 ◽

2016 ◽

Vol 18 (2) ◽

pp. 6-6

Keyword(s):

Young Adults ◽

Home Based ◽

Skill Building

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New Mechanical Fat Separation Technique: Adjustable Regenerative Adipose-tissue Transfer (ARAT) and Mechanical Stromal Cell Transfer (MEST)

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojaa035 ◽

2020 ◽

Vol 2 (4) ◽

Cited By ~ 1

Author(s):

H Eray Copcu ◽

Sule Oztan

Keyword(s):

Adipose Tissue ◽

Stromal Cells ◽

Stromal Cell ◽

Retention Rate ◽

High Rate ◽

Cell Transfer ◽

Fat Tissue ◽

Cell Counts ◽

Tissue Transfer ◽

Regenerative Cells

Abstract Background Adipose tissue is not only a very important source of filler but also the body’s greatest source of regenerative cells. Objectives In this study, adipose tissue was cut to the desired dimensions using ultra-sharp blade systems to avoid excessive blunt pressure and applied to various anatomical areas—a procedure known as adjustable regenerative adipose-tissue transfer (ARAT). Mechanical stromal cell transfer (MEST) of regenerative cells from fat tissue was also examined. Methods ARAT, MEST, or a combination of these was applied in the facial area of a total of 24 patients who were followed for at least 24 months. The integrity of the fat tissue cut with different diameter blades is shown histopathologically. The number and viability of the stromal cells obtained were evaluated and secretome analyses were performed. Patient and surgeon satisfaction were assessed with a visual analog scale. Results With the ARAT technique, the desired size fat grafts were obtained between 4000- and 200-micron diameters and applied at varying depths to different aesthetic units of the face, and a guide was developed. In MEST, stromal cells were obtained from 100 mL of condensed fat using different indication-based protocols with 93% mean viability and cell counts of 28.66 to 88.88 × 106. Conclusions There are 2 main complications in fat grafting: visibility in thin skin and a low retention rate. The ARAT technique can be used to prevent these 2 complications. MEST, on the other hand, obtains a high rate of fat and viable stromal cells without applying excessive blunt pressure. Level of Evidence: 4

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Enhancing Engagement of Citizen Scientists to Monitor Precipitation Phase

Frontiers in Earth Science ◽

10.3389/feart.2021.617594 ◽

2021 ◽

Vol 9 ◽

Author(s):

Monica M. Arienzo ◽

Meghan Collins ◽

Keith S. Jennings

Keyword(s):

Citizen Science ◽

Land Surface ◽

Retention Rate ◽

Text Message ◽

Recruitment Strategy ◽

Temperature Threshold ◽

Land Surface Models ◽

Air Temperatures ◽

Surface Models ◽

Precipitation Phase

Recent literature has highlighted how citizen science approaches can engage volunteers, expand scientific literacy, and accomplish targeted research objectives. However, there is limited information on how specific recruitment, retention, and engagement strategies enhance scientific outcomes. To help fill this important information gap, we detail the use of various approaches to engage citizen scientists in the collection of precipitation phase data (rain, snow, or mixed). In our study region, the Sierra Nevada and Central Basin and Range of California and Nevada near Lake Tahoe, a marked amount of annual precipitation falls near freezing. At these air temperatures, weather forecasts, land surface models, and satellites all have difficulty correctly predicting and observing precipitation phase, making visual observations the most accurate approach. From January to May 2020, citizen scientists submitted timestamped, geotagged observations of precipitation phase through the Citizen Science Tahoe mobile phone application. Our recruitment strategy included messaging to winter, weather, and outdoor enthusiasts combined with amplification through regional groups, which resulted in over 199 citizen scientists making 1,003 ground-based observations of rain, snow, and mixed precipitation. We enhanced engagement and retention by targeting specific storms in the region through text message alerts that also allowed for questions, clarifications, and training opportunities. We saw a high retention rate (88%) and a marked increase in the number of observations following alerts. For quality control of the data, we combined various meteorological datasets and compared to the citizen science observations. We found that 96.5% of submitted data passed our quality control protocol, which enabled us to evaluate rain-snow partitioning patterns. Snow was the dominant form of precipitation at air temperatures below and slightly above freezing, with both ecoregions expressing a 50% rain-snow air temperature threshold of 4.2°C, a warmer value than what would be incorporated into most land surface models. Thus, the use of a lower air temperature threshold in these areas would produce inaccuracies in event-based rain-snow proportions. Overall, our high retention rate, data quality, and rain-snow analysis were supported by the recruitment strategy, text message communication, and simplicity of the survey design. We suggest other citizen science projects may follow the approaches detailed herein to achieve their scientific objectives.

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Non-disclosure of tuberculosis diagnosis by patients to their household members in south western Uganda

10.1101/622597 ◽

2019 ◽

Author(s):

Miria Nyangoma ◽

Francis Bajunirwe ◽

Daniel Atwine

Keyword(s):

Cross Sectional Study ◽

Adult Patients ◽

High Rate ◽

Negative Effects ◽

Cross Sectional ◽

Logistic Regression Models ◽

Household Level ◽

Home Based ◽

Household Members ◽

Western Uganda

ABSTRACTBackgroundTuberculosis (TB) non-disclosure by adult patients to all household members is a setback to TB control efforts. It reduces the likelihood that household contacts will seek early TB screening, initiation on preventive or curative treatment, but also hinders the implementation of infection controls and home-based directly observed treatment. Therefore, this study aimed at determining the level of TB non-disclosure, its predictors and effects of disclosure to household members on adult patients at a large regional referral hospital in south-western Uganda.MethodsCross-sectional study. Questionnaires administered to collect patients’ sociodemographic and their TB disclosure data. Non-disclosure was considered if a patient did not reveal their TB diagnosis to all household members within 2 weeks post-treatment initiation. Univariate and multivariate logistic regression models were fitted for predictors of non-disclosure.ResultsEnrolled 62 patients, 74% males, mean age of 32 years, and median of five people per household. Non-disclosure rate was 30.6%. Post-disclosure experiences were positive in 98.3% of patients, while negative experiences suggestive of severe stigma occurred in 24.6% of patients. Being female (OR 6.5, 95% CI: 1.42-29.28) and belonging to Muslim faith (OR 12.4, 95% CI: 1.42-109.05) predicted TB non-disclosure to household members.ConclusionsThere is a high rate of TB non-disclosure to household members by adult patients in rural Uganda, with the highest vulnerability seen among female and Muslim patients. Interventions enhancing TB disclosure at household level while minimizing negative effects of stigma should be developed and prioritized.

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Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

JMIR mhealth and uhealth ◽

10.2196/22080 ◽

2020 ◽

Vol 8 (10) ◽

pp. e22080

Author(s):

HyangHee Kim ◽

Nam-Bin Cho ◽

Jinwon Kim ◽

Kyung Min Kim ◽

Minji Kang ◽

...

Keyword(s):

Older Adults ◽

Intervention Program ◽

Mobile App ◽

Community Dwelling ◽

Tongue Pressure ◽

Main Trial ◽

Home Based ◽

Intervention Protocol ◽

Term Maintenance

Background Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults. Objective The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults. Methods We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention. Results Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed. Conclusions Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted. International Registered Report Identifier (IRRID) RR2-10.2196/19585

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Patterns and prognostic markers for treatment response in generalized epilepsies

Neurology ◽

10.1212/wnl.0000000000010644 ◽

2020 ◽

Vol 95 (18) ◽

pp. e2519-e2528 ◽

Cited By ~ 1

Author(s):

Joanna Gesche ◽

Helle Hjalgrim ◽

Guido Rubboli ◽

Christoph P. Beier

Keyword(s):

Valproic Acid ◽

Side Effects ◽

Treatment Response ◽

Antiepileptic Drugs ◽

Seizure Control ◽

Retention Rate ◽

High Rate ◽

Seizure Freedom ◽

Inverse Association ◽

Acceptable Side

ObjectiveTo determine the pattern of treatment response in patients with idiopathic generalized epilepsy (IGE) and whether routinely assessed clinical and neurophysiological parameters allow predicting response to lamotrigine, levetiracetam, or valproic acid.MethodsIn 328 adult patients with IGE, demographic data, imaging, EEG data, current and prior antiepileptic treatment, treatment outcome, and side effects were analyzed from the patients' medical files and patient interviews.ResultsSeizure freedom with acceptable side effects at the first attempt was achieved in 61 (18.6%) patients. One hundred four (31.7%) patients tried ≥3 antiepileptic drugs before achieving seizure control at the last follow-up. Lamotrigine, levetiracetam, and valproic acid showed differential response rates (39.8% vs 47.5% vs 71.1%) that were most pronounced in patients with juvenile myoclonic epilepsy. The risk of having side effects was higher with valproic acid (23.7%) than with lamotrigine (10.4%) or levetiracetam (20.4%) treatment, contributing to the low retention rate of valproic acid (53.7%). Treatment resistance was associated with established risk factors. Multivariate analyses aiming at identifying clinical indicators for response to specific drugs did not reveal putative biomarkers when corrected for drug resistance.ConclusionDespite a high rate of seizure control, the chance of achieving seizure control and acceptable side effects at first attempt was low due to an inverse association of effectiveness and side effects of the 3 most commonly used drugs. Routinely assessed clinical parameters were not indicative for response to specific drugs.Classification of evidenceThis study provides Class II evidence that for patients with IGE, various clinical factors do not predict a response to specific antiepileptic drugs.

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