Adolescent Patient Text Messaging Through Peer Networks to Increase Youth Access Healthcare and STI Testing (Preprint)

2021 ◽  
Author(s):  
Marguerita Lightfoot ◽  
Joi Jackson-Morgan ◽  
Lance Pollack ◽  
Ayanna Bennett
Keyword(s):  
Text Messaging ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Small Sample Size ◽  
Healthcare Services ◽  
Small Sample ◽  
Text Messages ◽  
Adolescent Medicine ◽  
Post Intervention ◽  
Sti Testing

UNSTRUCTURED Adolescents are disproportionately affected by sexually transmitted infections (STI), including HIV. Many youth with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the healthcare system for other reasons. We examined the feasibility and acceptability of a peer-driven, text messaging strategy to connect youth to STI and HIV services. Using an interrupted time series design consecutive patients at an adolescent medicine clinic were enlisted to send five text messages to peers they believed were sexually active and lived in the clinic's service area. Analyses conducted in 2015 used a generalized linear mixed model. Data were collected from 2013-2014. Of 153 patients approached to participate, 100 agreed to send text messages. Most (55%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results and reported risk behavior increased post intervention, although not statistically significant, likely because of the small sample size. Given low youth uptake of healthcare services and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss youth not connected to school or community programs. The peer-based, text messaging strategy showed promise for both increasing the number of youth accessing health services and finding youth engaging in sexual risk behaviors and most in need of sexual health screening and services.

scholarly journals Brief telephone intervention for caregivers of medically complex patients during COVID-19

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 935-935
Author(s):  
Mary Stevens-Carr ◽  
Kevin Sethi ◽  
Channing Cochran ◽  
Margaret Bencomo-Rivera ◽  
Janice Marceaux
Keyword(s):  
Mixed Model ◽  
Small Sample Size ◽  
Small Sample ◽  
Adult Day Care ◽  
Telephone Intervention ◽  
Post Intervention ◽  
Home Based Primary Care ◽  
Home Based ◽  
Complex Patients ◽  
Mixed Model Anova

Abstract The VA Home Based Primary Care (HBPC) program consists of an interdisciplinary team, including psychology, serving veterans with complex medical conditions who are supported by live-in caregiver(s). HBPC psychologists may work with caregivers to address caregiver stress. Some veterans enrolled in HBPC attend Adult Day Care (ADC) programs, allowing respite for caregivers. At the onset of COVID19 pandemic, ADC centers closed to minimize spread of the virus. The authors identified these caregivers to be at high risk for burnout and sought to develop a protocol to assist these caregivers via telephone and evaluate outcomes. PreCOVID-19 caregiver stress was known via a 4-item Zarit Caregiver Burden annual screening (Bédard et al., 2001). Following ADC closures, caregivers of veterans enrolled in ADC programs were contacted and re-administered the Zarit to determine impact of COVID-19 on caregiver stress. Caregivers of veterans not attending ADC were also contacted for comparison. Contacted caregivers were provided a brief CBT-based intervention via telephone, and post-intervention Zarit screening was administered after two weeks. Ultimately, 4 ADC caregivers and 4 non-ADC caregivers were contacted and provided with services before ADC centers reopened. Statistical analysis via mixed model ANOVA did not yield significant results, likely due to small sample size, although there was a large effect size (η_p^2 =.566). ADC caregivers generally reported increased stress from baseline following ADC closure and reduced stress following provision of intervention. The authors will present caregiver feedback about aspects of telephone intervention that were helpful, and not helpful, as well as authors impression.

scholarly journals Reducing Aggression by Developing Emotional and Inhibitory Control

2021 ◽  
Vol 18 (10) ◽  
pp. 5263
Author(s):  
Miriam Romero-López ◽  
María Carmen Pichardo ◽  
Ana Justicia-Arráez ◽  
Judit Bembibre-Serrano
Keyword(s):  
Psychosocial Development ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Generalized Linear Mixed Model ◽  
Emotional Control ◽  
Control Group ◽  
Post Intervention ◽  
Mixed Model Analysis ◽  
Intervention Measures ◽  
Experimental Group

The objective of this study is to measure the effectiveness of a program on improving inhibitory and emotional control among children. In addition, it is assessed whether the improvement of these skills has an effect on the reduction of aggressive behavior in pre-school children. The participants were 100 children, 50 belonging to the control group and 50 to the experimental group, aged between 5 and 6 years. Pre-intervention and post-intervention measures of inhibitory and emotional control (BRIEF-P) and aggression (BASC) were taken. A Generalized Linear Mixed Model analysis (GLMM) was performed and found that children in the experimental group scored higher on inhibitory and emotional control compared to their peers in the control group. In addition, these improvements have an effect on the decrease in aggressiveness. In conclusion, preventive research should have among its priorities the design of such program given their implications for psychosocial development.

scholarly journals Immunological Effects of an Add-On Physical Exercise Therapy in Depressed Adolescents and Its Interplay with Depression Severity

2021 ◽  
Vol 18 (12) ◽  
pp. 6527
Author(s):  
Heidrun Lioba Wunram ◽  
Max Oberste ◽  
Stefanie Hamacher ◽  
Susanne Neufang ◽  
Nils Grote ◽  
...  
Keyword(s):  
Exercise Therapy ◽  
Depressive Disorders ◽  
Small Sample Size ◽  
Small Sample ◽  
Whole Body ◽  
Control Treatment ◽  
Depression Severity ◽  
Post Intervention ◽  
Positive Effects ◽  
Tnf Α

Background: Pro-inflammatory cytokines (PICs) have gained attention in the pathophysiology and treatment of depressive disorders. At the same time, the therapeutic effect of physical activity seems to work via immunomodulatory pathways. The interventional study “Mood Vibes” analyzed the influence of exercise on depression severity (primary endpoint) in depressive adolescents; the influence of PICs on the clinical outcome was analyzed as a secondary endpoint. Methods: Clinically diagnosed depressed adolescents (N = 64; 28.1% male; mean age = 15.9; mean BMI = 24.6) were included and participated either in Whole Body Vibration (WBV) (n = 21) or bicycle ergometer training (n = 20) in addition to treatment-as-usual (TAU). Patients in the control treatment group received TAU only (n = 23). The PICs (interleukin-6—IL-6 and tumor necrosis factor-α—TNF-α) were analyzed before intervention, after 6 weeks of training (t1), and 8 weeks post-intervention (t2). The effects of the treatment on depression severity were rated by self-rating “Depression Inventory for Children and Adolescents” (DIKJ). Results: Basal IL-6 decreased in all groups from t0 to t1, but it increased again in WBV and controls at t2. TNF-α diminished in ergometer and controls from baseline to t1. PIC levels showed no correlation with depression severity at baseline. The influence on DIKJ scores over time was significant for IL-6 in the WBV group (p = 0.008). Sex had an impact on TNF-α (p < 0.001), with higher concentrations in male patients. Higher body mass index was associated with higher IL-6 concentrations over all measurement points (p < 0.001). Conclusions: The positive effects of an intensive add-on exercise therapy on adolescent depression seem to be partly influenced by immunomodulation. A small sample size and non-randomized controls are limitations of this study.

Abstract 248: Initiation and Assessment of Timekeeping Roles During In-Hospital Cardiac Arrests to Track Rhythm Checks and Epinephrine Dosing

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Conor Crowley ◽  
Peter Clardy ◽  
Jessica McCannon ◽  
Rebecca Logiudice
Keyword(s):  
Small Sample Size ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Sample ◽  
Post Intervention ◽  
Epinephrine Administration ◽  
Team Members ◽  
Minute Post ◽  
Chaotic Nature ◽  
Strongly Agree

Introduction: Compliance to ACLS cardiac arrest algorithm is low and associated with worse outcomes from in-hospital cardiac arrests (IHCA). Reasons for non-compliance include reduced communication due to chaotic nature of IHCAs and difficulty timing epinephrine administration and rhythm check intervals. Hypothesis: Delegating two separate code team members for rhythm and epinephrine timing will increase adherence to ACLS algorithm during IHCAs. Methods: This is a pre-post interventional study of IHCAs at a single academic medical center. Two stopwatches were placed on all code carts and two new timekeeping roles were created. Education was provided to staff regarding the alteration of existing code team member roles for the use of stopwatches. Algorithm adherence was analyzed pre and post implementation of timekeeper roles. Deviation from the 2-minute rhythm check or 3-5-minute epinephrine administration was counted as one deviation. Anonymous surveys were delivered to evaluate providers perceived benefits of timekeeper roles for IHCAs. Results: Data from 13 pre intervention IHCAs were compared to 12 IHCAs post intervention. The initial rhythm was PEA/asystole in 69% pre-intervention vs 83% post intervention. Prior to implementation 82 deviations vs. 11 deviations post implementation occurred (p=0.006). The mean time until first dose of epinephrine was administered pre intervention was 2.3 ± 3.3 minutes vs 0.4 ±1 minute post. Pre-implementation ROSC rate was 53.8% vs. 66.7% post intervention. Surveys were delivered to 100% of code team members post intervention, with a 79% response rate. Surveys demonstrate providers felt time keeping roles made it easier to track epinephrine administration and rhythm checks. On a Likert scale, 78% of providers “strongly agree” that the use of timekeeping roles and devices improved code team communication. Conclusion: Two separate timekeeper roles during IHCAs improved algorithm compliance, code team function and communication, and was favored by code team members. Timekeeper roles may be associated with improved rates of ROSC and less time until the first dose of epinephrine is administered. This study is limited by its small sample size, single center and requires validation.

scholarly journals Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Valerie Wing Yu Wong ◽  
Ying Huang ◽  
Wan In Wei ◽  
Samuel Yeung Shan Wong ◽  
Kin On Kwok
Keyword(s):  
Small Sample Size ◽  
Meta Analysis ◽  
Small Sample ◽  
Risk Of Bias ◽  
Source Control ◽  
Resistant Organism ◽  
Routine Practice ◽  
Post Intervention ◽  
Term Care ◽  
Mrsa Colonization

Abstract Background Despite clear evidence of benefits in acute-care hospitals, controversy over the effectiveness of IPC measures for MDROs is perceptible and evidence-based practice has not been established. Objective To investigate the effects of IPC interventions on MDRO colonization and infections in LTCFs. Data sources Ovid MEDLINE, EMBASE, and CINAHL from inception to September 2020. Eligibility criteria Original and peer-reviewed articles examining the post-intervention effects on MDRO colonization and infections in LTCFs. Interventions (i) Horizontal interventions: administrative engagement, barrier precautions, education, environmental cleaning, hand hygiene, performance improvement, and source control; and (ii) vertical intervention: active surveillance plus decolonization. Study appraisal and synthesis We employed a random-effects meta-analysis to estimate the pooled risk ratios (pRRs) for methicillin-resistant Staphylococcus aureus (MRSA) colonization by intervention duration; and conducted subgroup analyses on different intervention components. Study quality was assessed using Cochrane risk of bias tools. Results Of 3877 studies identified, 19 were eligible for inclusion (eight randomized controlled trials (RCTs)). Studies reported outcomes associated with MRSA (15 studies), vancomycin-resistant Enterococci (VRE) (four studies), Clostridium difficile (two studies), and Gram-negative bacteria (GNB) (two studies). Eleven studies were included in the meta-analysis. The pRRs were close to unity regardless of intervention duration (long: RR 0.81 [95% CI 0.60–1.10]; medium: RR 0.81 [95% CI 0.25–2.68]; short: RR 0.95 [95% CI 0.53–1.69]). Vertical interventions in studies with a small sample size showed significant reductions in MRSA colonization while horizontal interventions did not. All studies involving active administrative engagement reported reductions. The risk of bias was high in all but two studies. Conclusions Our meta-analysis did not show any beneficial effects from IPC interventions on MRSA reductions in LTCFs. Our findings highlight that the effectiveness of interventions in these facilities is likely conditional on resource availability—particularly decolonization and barrier precautions, due to their potential adverse events and uncertain effectiveness. Hence, administrative engagement is crucial for all effective IPC programmes. LTCFs should consider a pragmatic approach to reinforce standard precautions as routine practice and implement barrier precautions and decolonization to outbreak responses only.

scholarly journals A power approximation for the Kenward and Roger Wald test in the linear mixed model

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254811
Author(s):  
Sarah M. Kreidler ◽  
Brandy M. Ringham ◽  
Keith E. Muller ◽  
Deborah H. Glueck
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Wald Test ◽  
Small Sample ◽  
Power Calculation ◽  
Wald Statistic ◽  
Power Approximation ◽  
Group Randomized Trial ◽  
Approximate Moments ◽  
Image Position

We derive a noncentral F power approximation for the Kenward and Roger test. We use a method of moments approach to form an approximate distribution for the Kenward and Roger scaled Wald statistic, under the alternative. The result depends on the approximate moments of the unscaled Wald statistic. Via Monte Carlo simulation, we demonstrate that the new power approximation is accurate for cluster randomized trials and longitudinal study designs. The method retains accuracy for small sample sizes, even in the presence of missing data. We illustrate the method with a power calculation for an unbalanced group-randomized trial in oral cancer prevention.

scholarly journals Longitudinal Variation of Amino Acid Levels in Human Milk and Their Associations with Infant Gender

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1233 ◽  
Author(s):  
Joris van Sadelhoff ◽  
Bert van de Heijning ◽  
Bernd Stahl ◽  
Sonia Amodio ◽  
Edmond Rings ◽  
...  
Keyword(s):  
Human Milk ◽  
Mixed Model ◽  
Small Sample Size ◽  
Male Infant ◽  
Small Sample ◽  
Functional Roles ◽  
Protein Levels ◽  
Infant Gender ◽  
Amino Acid Levels ◽  
Time Specific

It is discussed that specific amino acids (AAs) have functional roles in early life. Understanding the AA composition in human milk (HM) during lactation assists in specifying these roles. To this end we assessed the levels of free AAs (FAAs), total AAs (free and bound, TAAs) and protein levels in HM in the first 6 months of lactation, and evaluated possible associations with infant gender. HM samples of 25 healthy Dutch mothers participating in the PreventCD study were collected monthly during the first 6 months of lactation. Of the participating mothers, 12 gave birth to a boy and 13 gave birth to a girl. Analyses of the HM samples revealed that levels of free glutamate, glutamine, aspartate, glycine, and serine significantly increased during months 1–3 of lactation, both in absolute sense and relative to TAA levels. Evaluation of gender differences by mixed model analyses revealed an association between female infant gender and higher protein content (p = 0.0465) and TAA content (p = 0.0362) in HM during the first 3 months of lactation. Furthermore, there was a tendency for an association of male infant gender with higher levels of free glutamine (p = 0.0948) in HM during the first 3 months of lactation. These results show that FAA, TAA and protein levels in HM display a time-specific occurrence during lactation. Moreover, although confirmation is necessary in view of the small sample size, this study indicates that the AA composition in HM shows differential effects of the infant’s sex.

scholarly journals Preliminary Support for a Cognitive Remediation Intervention for Women During the Menopausal Transition: A Pilot Study

2021 ◽  
Vol 2 ◽  
Author(s):  
Elena C. Ballantyne ◽  
Jelena P. King ◽  
Sheryl M. Green
Keyword(s):  
Small Sample Size ◽  
Cognitive Remediation ◽  
Small Sample ◽  
Cognitive Test ◽  
Control Group ◽  
Emotional Symptoms ◽  
Depression Anxiety Stress Scale ◽  
Post Intervention ◽  
Clinical Trial Registration ◽  
Cognitive Improvement

Background: Menopause is associated with physical and emotional symptoms, and subjective cognitive concerns that are generally not borne out on objective cognitive measures. This discrepancy suggests that a psychological rather than biological mechanism likely mediates the cognitive concerns of women in menopause. The current study assessed the feasibility and effectiveness of a cognitive remediation intervention with the goal of reducing subjective perceptions of cognitive difficulty during the menopause.Methods: Twenty-seven menopausal women (M age = 53.74, SD = 4.14) completed a 5-week group-based intervention (with a post-group booster) consisting of 2-h weekly sessions. Participants completed pre- and post-intervention measures capturing subjective cognitive ability, mood, anxiety, stress, personality, and objective cognitive tests. The primary variable of interest was self-reported cognitive confidence measured by the Memory and Cognitive Confidence Scale (MACCS).Results: All but one MACCS subscale significantly decreased over the course of treatment (with lower scores associated with higher confidence) and effect sizes ranged from small to large (d = −0.39 to −0.91) with gains maintained at 1-month follow-up. Interestingly, no change in objective cognitive test performance was observed, indicating increases in subjective cognitive confidence in the absence of objective cognitive improvement. There was no change in mood, anxiety, or stress scores. Two-level HLM analyses revealed that those with higher baseline neuroticism, as measured by the NEO Personality Inventory, had smaller decreases in post-group MACCS High Standards subscale relative to those with lower baseline neuroticism (p = 0.027, d = −0.45). Those with higher baseline depression scores on the Depression Anxiety Stress Scale (DASS-21) had a smaller decrease in post-intervention MACCS Total Score relative to those with lower depression ratings.Conclusion: To our knowledge, this is the first feasibility study of its kind targeting perceptions of cognitive impairment during menopause. Although generally well-tolerated, recruitment and scheduling difficulties were flagged as challenges to engagement while a small sample size and lack of control group limit conclusions about efficacy. Providing current results could be replicated with enhanced methods, these results provide support that cognitive remediation is a feasible and credible treatment, and may improve quality of life for women in menopause.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03311880.

scholarly journals A Randomised Controlled Trial Comparing the Effect of E-learning, with a Taught Workshop, on the Knowledge and Search Skills of Health Professionals

2006 ◽  
Vol 1 (3) ◽  
pp. 44 ◽  
Author(s):  
Nicola Pearce-Smith
Keyword(s):  
Randomised Controlled Trial ◽  
Sample Size ◽  
Health Professionals ◽  
Search Strategy ◽  
Small Sample Size ◽  
Controlled Trial ◽  
Small Sample ◽  
Post Intervention ◽  
E Learning ◽  
Randomised Controlled

Objective - The aim of the trial was to establish whether there is a significant difference in terms of knowledge and skills, between self-directed learning using a web-based resource, compared with a classroom based interactive workshop, for teaching health professionals how to search. The outcomes measured were knowledge of databases and study designs, and search skills. Methods - The study design was a randomised controlled trial (RCT). 17 health professionals were randomised into one of two groups – one group (EG) received access to a search-skills web resource, and the other group received a search workshop (WG) taught by a librarian. Participants completed pre- and post-intervention tests involving multiple choice questions and practical searching using clinical scenarios.. Results - 9 WG and 6 EG participants completed both pre-and post-intervention tests. The test results were blindly marked using a score chart developed with two other librarians. For question formulation and devising a search strategy, all participants obtained a score that was the same or better after receiving the intervention (both WG and EG), but statistical analysis showed that the only significant outcomes were for the WG devising a search strategy (p=0.01) and preferring to search using MeSH after receiving the taught workshop (p=0.02). The Mann-Whitney test showed there were no significant differences in any of the outcomes (p>0.05), between the WG and the EG. The statistical analyses must be viewed with caution due to the small sample size. Conclusions - There were no significant differences in knowledge of databases and study design, or search skills, when the WG and the EG were compared. Although many participants obtained a score that was higher post-intervention, only devising a search strategy and preferring to search using MeSH were significant for the WG. The question of whether a taught workshop and an e-learning module are of equal effectiveness in teaching search skills, is an important one for health librarians involved in user education, and was a justifiable topic to propose and conduct research. The fact that the results are mainly inconclusive due to the small sample size is disappointing, but does not diminish the importance of conducting the study.

Mobile-phone text messaging (SMS) for providing oral health education to mothers of preschool children in Belgaum City

2011 ◽  
Vol 17 (8) ◽  
pp. 432-436 ◽  
Author(s):  
Ratika Sharma ◽  
Mamata Hebbal ◽  
Anil V Ankola ◽  
Vikneshan Murugabupathy
Keyword(s):  
Preschool Children ◽  
Oral Health ◽  
Health Education ◽  
Text Messaging ◽  
Effective Means ◽  
Text Message ◽  
Text Messages ◽  
Post Intervention ◽  
Plaque Score ◽  
Oral Health Education

We compared the effectiveness of two media (text messages and pamphlets) in imparting health education to mothers of preschool children. Mothers and their children were randomized into two groups. There were 72 mothers and their children in the pamphlet group and 71 in the text message group. The mothers were given health education by one of the two modes for four weeks. Knowledge, attitude and practices of the mothers were assessed by a questionnaire pre- and post-intervention. Visible plaque scores of their children were also recorded pre- and post-intervention. There were significant improvements in knowledge ( P < 0.001), attitude ( P < 0.001) and practices ( P < 0.001) in both groups. There was also a significant reduction in visible plaque scores ( P < 0.001) in both groups. Text messaging was more effective than pamphlets in improving knowledge, attitude and practices of mothers, but the comparative reduction in plaque score between groups was not significant. Text messaging appears to be an effective means of imparting oral health education.

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