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1.
Evaluating the Effect of Comprehensive Intervention on Cerebro-Vascular Function in Population at High Risk of Stroke.
Liu, X, Gu, Y, Zhang, Y, Zhang, Y, Tan, X
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2019;(9):2543-2554
Abstract
BACKGROUND Today there exists few intervention researches on cerebro-vascular function in populations at high risk of stroke in China. METHODS Patients more than 40 years old, with at least 1 of stroke risk factors were recruited from outpatient department in 3 hospitals. A quasi-experimental design was performed by assigning participants into 3 groups: comprehensive intervention group, health education group, and control group. Participants in the control group received no intervention but were informed of risk factors of stroke. For health education group, a health education class was performed. Except to the health education program, participants in the comprehensive intervention group received an additional health life and behavior guidance. RESULTS After the intervention, the Cerebro-Vascular Function Scores (CVFS) had significant differences among 3 groups (F = 5.252, P < 0.05). There was a significant increase in CVFS compared to the control group (P = 0.003, 95%CI: 1.552-8.493). Significantly changes in obesity were observed in comprehensive intervention group before and after the intervention (χ2 = 9.0747, P = 0.0026). The results of logistic regression showed that comprehensive intervention group had a significant decrease in prevalence of obesity (OR = 0.482, 95% CI: 0.242-0.961) compared to the control group. CONCLUSION Health education on stroke in a high-risk population combined with guidance on proper health life and behavior can be effective in preventing stroke.
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2.
Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (the VACOPP Study).
Mustila, T, Raitanen, J, Keskinen, P, Saari, A, Luoto, R
BMC pediatrics. 2013;:80
Abstract
BACKGROUND According to current evidence, the prevention of obesity should start early in life. Even the prenatal environment may expose a child to unhealthy weight gain; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity. Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes. METHODS The study was a non-randomised controlled pragmatic trial aiming to prevent childhood obesity, the setting being municipal maternity health care clinics. The participants (n = 185) were mothers at risk of developing gestational diabetes mellitus and their offspring. The children of the intervention group mothers were born between 2009 and 2010, and children of the control group in 2008. The intervention started between 10-17 gestational weeks and consisted of individual counselling on diet and physical activity by a public health nurse, and two group counselling sessions by a dietician and a physiotherapist. The expectant mothers also received a written information leaflet to motivate them to breastfeed their offspring for at least 6 months. We report the proportion of mothers with pathological glucose tolerance at 26-28 weeks' gestation, the mother's gestational weight gain (GWG) and newborn anthropometry. Infant weight gain from 0 to 12 months of age was assessed as weight-for-length standard deviation scores (SDS) and mixed effect linear regression models. RESULTS Intervention group mothers had fewer pathological oral glucose tolerance test results (14.6% vs. 29.2%; 95% CI 8.9 to 23.0% vs. 20.8 to 39.4%; p-value 0.016) suggesting that the intervention improved gestational glucose tolerance. Mother's GWG, newborn anthropometry or infant weight gain did not differ significantly between the groups. CONCLUSION Since the intervention reduced the prevalence of gestational diabetes mellitus, it may have the potential to diminish obesity risk in offspring. However, results from earlier studies suggest that the possible effect on the offspring's weight gain may manifest only later in childhood. TRIAL REGISTRATION Clinical Trials gov: NCT00970710.
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3.
Improved outcomes in diabetes care for rural African Americans.
Bray, P, Cummings, DM, Morrissey, S, Thompson, D, Holbert, D, Wilson, K, Lukosius, E, Tanenberg, R
Annals of family medicine. 2013;(2):145-50
Abstract
PURPOSE Rural low-income African American patients with diabetes have traditionally poorer clinical outcomes and limited access to state-of-the-art diabetes care. We determined the effectiveness of a redesigned primary care model on patients' glycemic, blood pressure, and lipid level control. METHODS In 3 purposively selected, rural, fee-for-service, primary care practices, African American patients with type 2 diabetes received point-of-care education, coaching, and medication intensification from a diabetes care management team made up of a nurse, pharmacist, and dietitian. In 5 randomly selected control practices matched for practice and patient characteristics, African American patients received usual care. Using univariate and multivariate adjusted models, we evaluated the effects of the intervention on intermediate (median 18 months) and long-term (median 36 months) changes in glycated hemoglobin (hemoglobin A1c) levels, blood pressure, and lipid levels, as well as the proportion of patients meeting target values. RESULTS Among 727 randomly selected rural African American diabetic patients (368 intervention, 359 control), intervention patients had a significantly greater reduction in mean hemoglobin A1c levels at intermediate (-0.5 % vs -0.2%; P <.05) and long-term (-0.5% vs -0.10%; P <.005) follow-up in univariate and multivariate models. The proportion of patients achieving a hemoglobin A1c level of less than 7.5% (68% vs 59%, P <.01) and/or a systolic blood pressure of less than 140 mm Hg (69% vs 57%, P <.01) was also significantly greater in intervention practices in multivariate models. CONCLUSION Redesigning care strategies in rural fee-for-service primary care practices for African American patients with established diabetes results in significantly improved glycemic control relative to usual care.
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4.
Fitwits: preparing residency-based physicians to discuss childhood obesity with preteens.
Wislo, VM, McGaffey, A, Scopaz, KA, D'Amico, FJ, Jewell, IK, Bridges, MW, Hogan, L, Hughes, K
Clinical pediatrics. 2013;(12):1107-17
Abstract
OBJECTIVE To evaluate the Fitwits MD office tool and games for obesity discussions with 9- to 12-year-olds. METHODS A nonrandomized intervention study using pre- and posttest assessments in 2 residency programs compared 31 control group and 55 intervention physicians (34 previously trained, 21 newly trained to use Fitwits). Surveys addressed comfort and competence regarding: obesity prevention and treatment, nutrition, exercise, portion size, body mass index (BMI), and the term "obesity." We surveyed all groups at baseline and 5 months (post 1) and new trainees 3 months later (post 2). RESULTS In post 1, prior trainees reported significantly increased comfort and competence for discussing obesity prevention, portion size, BMI, and "obesity." In post 2, new trainees reported significantly increased comfort and competence discussing obesity prevention and treatment, portion size, and BMI. CONCLUSIONS Experience using Fitwits improved residency-based physician comfort and competence in obesity prevention and treatment, portion size, BMI, and "obesity" discussions with preadolescents.
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5.
Impact of anthropometric measurements in clinical practice.
Kiisk, L, Kaarma, H, Ots-Rosenberg, M
Collegium antropologicum. 2012;(4):1325-33
Abstract
Anthropometry helps to assess nutritional status which is an important determinant of clinical outcome in many patients, including the number of those suffering from chronic kidney disease (CKD). Weight gain after successful kidney transplantation is a well-known phenomenon, therefore we hypothesized that intensive counseling, based of menu analysis by a dietitian of CKD patients with a kidney transplant, can prevent the significant body weight (BW) gain after the transplant operation. The aim of the investigation was to study long-term anthropometrical, biochemical and dual-energy densitometry changes in the kidney transplant patients, to study correlations between the studied parameters and to compare those with the follow-up data. The prospective long-term study was carried out in 28 clinically stable renal transplant patients. Control groups consisted both transplant patients (47 patients), receiving ordinary nutritional counseling, and of healthy population subjects (342). Anthropometry and biochemistry were studied in patients twice: the first follow-up (FU1) data were collected 1.3 +/- 0.2 years, and the second follow-up (FU2) data were collected 2.7 +/- 0.3 years after the transplant. Significant BW gain was found only in renal transplant male patients (FU1 vs. FU2, p < 0.001) but not in females. The mean weight gain in control group patients was significant both in the male and female groups. In males, the mean C-reactive protein was significantly correlated with different body circumferences. But, in females, no clear associations were found. In females, significant correlation was found between mean body weight, body mass index and triglycerides. We conclude that the use of anthropometry in clinical practice, together with intensive and individual counseling by a dietitian, should be regular in the kidney transplant patients' population to prevent overweight. Monitoring of the dynamics of anthropometrical and biochemical parameters are clinically relevant in the post-transplant period together with densitometry.
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6.
Enhancing memory in late-life depression: the effects of a combined psychoeducation and cognitive training program.
Naismith, SL, Diamond, K, Carter, PE, Norrie, LM, Redoblado-Hodge, MA, Lewis, SJ, Hickie, IB
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. 2011;(3):240-8
Abstract
OBJECTIVE To evaluate the efficacy of a multifactorial cognitive training (CT) program for older people with a lifetime history of depressive disorder. METHODS This was a single-blinded waitlist control design. The study was conducted in the Healthy Brain Ageing Clinic, a specialist outpatient clinic at the Brain & Mind Research Institute, Sydney, Australia. Forty-one participants (mean age = 64.8 years, sd = 8.5) with a lifetime history of major depression were included. They were stabilized on medication and had depressive symptoms in the normal to mild range. The intervention encompassed both psychoeducation and CT. Each component was 1-hour in duration and was delivered in a group format over a 10-week period. Psychoeducation was multifactorial, was delivered by health professionals and targeted cognitive strategies, as well depression, anxiety, sleep, vascular risk factors, diet and exercise. CT was computer-based and was conducted by Clinical Neuropsychologists. Baseline and follow-up neuropsychological assessments were conducted by Psychologists who were blinded to group allocation. The primary outcome was memory whilst secondary outcomes included other aspects of cognition and disability. RESULTS CT was associated with significant improvements in visual and verbal memory corresponding to medium to large effect sizes. CONCLUSION CT may be a viable secondary prevention technique for late-life depression, a group who are at risk of further cognitive decline and progression to dementia.
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7.
Teaching Chilean mothers to massage their full-term infants: effects on maternal breast-feeding and infant weight gain at age 2 and 4 months.
Serrano, MS, Doren, FM, Wilson, L
The Journal of perinatal & neonatal nursing. 2010;(2):172-81
Abstract
The purpose of this study was to evaluate the effects of massage on infant weight gain and exclusive maternal breast-feeding of an intervention that involved teaching mothers to massage their full-term infants. The sample included 100 healthy newborn infants who were receiving primary healthcare at 3 health centers in a low-income neighborhood of Santiago, Chile. The control group included 65 infants and the massage group included 35 infants. During their second well-child clinic visit, clinic nurses provided instruction to massage-group mothers about how to massage their infants, based on the methods of the Baby's First Massage program (http://www.babysfirstmassage.com/Scripts/default.asp). Mothers were encouraged to massage their infants for 10 to 15 minutes at least once a day, starting when their infants were 15 days old. There was no difference in the mean weights of the infants between the massage and control groups at baseline, but at age 2 months, massage group infants weighed significantly more than control-group infants. There were no weight differences between the 2 groups at age 4 months. There were no differences between the 2 groups on the incidence of exclusive maternal breast-feeding at age 2 or 4 months. The findings suggest that teaching mothers to massage their newborn infants may have a beneficial effect on the infant's early weight gain. There is a need for additional studies to evaluate the effect of maternal massage on other health and welfare outcomes for both mothers and infants.
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8.
Promoting health in early-stage dementia: evaluation of a 12-week course.
Buettner, LL, Fitzsimmons, S
Journal of gerontological nursing. 2009;(3):39-49
Abstract
This project tested a 12-week health promotion course for older adults with early-stage dementia. In a quasi-experimental design, participants were assigned by site to intervention group or control group and evaluated at two time points. Mini-Mental State Examination scores, Geriatric Depression Scale scores, health behaviors, plus several measures of psychological well-being were used in this study. In the independent samples t-test analysis, significant positive change was found from pretest to posttest for the treatment group on cognition and depression. A chi square analysis found several significant positive differences in health behaviors for the treatment group.
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9.
Methotrexate information booklet study 2008.
Mohammad, A, Kilcoyne, A, Bond, U, Regan, M, Phelan, M
Clinical and experimental rheumatology. 2009;(4):649-50
Abstract
INTRODUCTION I n order to assess the value of using the methotrexate information booklet, we conducted a single blind prospective controlled trial of the patients attending two rheumatology services. METHODS The active-arm (n=40) used the MTX information booklet for the patients' education and the control-arm (n=38) did not. Patients' interviews were conducted over a 6-month period using an MTX-questionnaire. RESULTS The entire active-arm patients (100%) were taking folic-acid and 32 (80%) knew the reason why they were taking folic-acid vs. [30 (79%) and 10 (26%) in the control-arm]. In the active-arm 35 (88%) knew the reason for their monthly blood tests vs. 18 (47%) in the control-arm. The entire active-arm was aware of the need for contraception use and MTX-side effects vs. 23 (60%) and 15 (40%) in the control-arm respectively. CONCLUSIONS The use of the MTX information booklet in our cohort improved their understanding of the treatment.
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10.
Effect of the diabetes outpatient intensive management programme on glycaemic control for type 2 diabetic patients.
Song, MS, Kim, HS
Journal of clinical nursing. 2007;(7):1367-73
Abstract
AIM: The purpose of this study was to examine the effect of the diabetes outpatient intensive management programme (DOIMP) on glycaemic control over a 12 week follow-up period for type 2 diabetic patients in Korea. BACKGROUND Diabetic complications can be prevented if the glycaemic status of diabetes patients is maintained within a nearly normal range. Patient education is critical in controlling blood glucose levels of patients with diabetes within the optimal range. METHODS DOIMP was composed of multidisciplinary education, complication monitoring and telephone counselling. Twenty-five patients in the intervention group participated in the DOIMP and 24 patients in the control group were briefed on the conventional description of diabetes mellitus by diabetes education nurses. RESULTS Patients in the intervention group had a mean decrease of 2.3%, which those in the control group having a mean decrease 0.4% in glycosylated haemoglobin (HbA(1)c). There was no difference between the two groups in the change in fasting blood glucose (FBG) and two-hour postprandial blood glucose (2-h PBG). The proportion of the patients with HbA(1)c <7% was higher in the intervention group than in the control group at the post-test compare with the pretest. CONCLUSION DOIMP can reduce HbA(1)c in type 2 diabetes patients. RELEVANCE TO CLINICAL PRACTICE These findings indicated that DOIMP could be effective in glycaemic control in type 2 diabetes patients.