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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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The effectiveness of a coordinated preventive care approach for healthy ageing (UHCE) among older persons in five European cities: A pre-post controlled trial.
Franse, CB, van Grieken, A, Alhambra-Borrás, T, Valía-Cotanda, E, van Staveren, R, Rentoumis, T, Markaki, A, Bilajac, L, Marchesi, VV, Rukavina, T, et al
International journal of nursing studies. 2018;:153-162
Abstract
BACKGROUND Older persons often have multiple health and social problems and need a variety of health services. A coordinated preventive approach that integrates the provision of health and social care services could promote healthy ageing. Such an approach can be organised differently, depending on the availability and organizational structures in the local context. Therefore, it is important to evaluate the effectiveness of a coordinated preventive care approach in various European settings. OBJECTIVES This study explored the effects of a coordinated preventive health and social care approach on the lifestyle, health and quality of life of community-dwelling older persons in five European cities. DESIGN International multi-center pre-post controlled trial. SETTING Community settings in cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. PARTICIPANTS 1844 community-dwelling older persons (mean age = 79.5; SD = 5.6). METHODS The Urban Health Centres Europe (UHCE) approach consisted of a preventive multidimensional health assessment and, if a person was at-risk, coordinated care-pathways targeted at fall risk, appropriate medication use, loneliness and frailty. Intervention and control sites were chosen based on their location in distinct neighbourhoods in the participating cities. Persons in the catchment area of the intervention sites 'the intervention group' received the UHCE approach and persons in catchment areas of the control sites 'the control group' received care as usual. A questionnaire and two measurements were taken at baseline and at one-year follow-up to assess healthy lifestyle, fall risk, appropriate medication use, loneliness level, frailty, level of independence, health-related quality of life and care use. To evaluate differences in outcomes between intervention group and control group for the total study population, for those who received follow-up care-pathways and for each city separately (multilevel) logistic and linear regression analyses were used. RESULTS Persons in the intervention group had less recurrent falls (OR = 0.65, 95% CI = 0.48; 0.88) and lower frailty (B=-0.43, 95% CI= -0.65 to -0.22) at follow-up compared with persons in the control group. Physical health-related quality of life and mental well-being was better (B = 0.95; 95% CI = 0.14-1.76; and B = 1.50; 95% CI = 0.15-2.84 respectively). The effects of the UHCE approach were stronger in the subgroup of persons (53.6%) enrolled in care-pathways. CONCLUSIONS Our study found promising but minor effects for the use of a coordinated preventive health and social care approach for the promotion of healthy ageing of older persons. Future studies should further evaluate effects of coordinated preventive health and social care aimed at healthy ageing. TRIAL REGISTRATION ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.
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Design of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study.
Taveras, EM, Blaine, RE, Davison, KK, Gortmaker, S, Anand, S, Falbe, J, Kwass, JA, Perkins, M, Giles, C, Criss, S, et al
Childhood obesity (Print). 2015;(1):11-22
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Abstract
BACKGROUND Childhood obesity is highly prevalent, is associated with both short- and long-term adverse outcomes, disproportionately affects racial/ethnic minority and economically deprived children, and represents a major threat to public health. Among the most promising approaches for its prevention and management are multilevel, multisector strategies. METHODS/DESIGN The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study was a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2-12 years in two selected cities in Massachusetts. Building on the Obesity Chronic Care Model, MA-CORD expanded a state public health department community-level obesity prevention initiative that incorporated evidence-based interventions in primary healthcare, the Women, Infants, and Children program, early care and education, schools/afterschool programs, as well as community-wide programs to improve food, beverage, physical activity (PA), and messaging environments. The study used a combination of pre- and post-time series and quasi-experimental designs to examine the extent to which the intervention resulted in changes in BMI, individual-level lifestyle behaviors, satisfaction with healthcare services, and quality of life among children, as well as changes in health policies, programs, and environments in the two intervention cities, compared to a comparison city. The intervention period was 2 years. CONCLUSIONS MA-CORD will determine the extent to which a multisetting, multilevel intervention that integrates activities in primary care with broader public health interventions in schools, early care and education, and the community at large can improve children's dietary and PA behaviors and ultimately reduce obesity in low-income children.
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Preventing weight gain and obesity: indirect effects of the family check-up in early childhood.
Smith, JD, Montaño, Z, Dishion, TJ, Shaw, DS, Wilson, MN
Prevention science : the official journal of the Society for Prevention Research. 2015;(3):408-19
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The early signs of obesity are observable in early childhood. Although the most promising prevention approaches are family-centered, few relevant early prevention programs exist. This study evaluated the effects of an evidence-based, home-visiting intervention, the Family Check-Up (FCU), on the trajectory of children's weight gain. The FCU was designed to prevent the development of behavior problems by improving family management practices; children's weight has not been an explicit target. On the basis of previous research and conceptual models, we hypothesized that intervention effects on parenting practices, specifically caregivers' use of positive behavior support (PBS) strategies in toddlerhood, would mediate improvements in children's weight trajectories. A total of 731 indigent caregiver-child dyads from a multisite randomized intervention trial were examined. Observational assessment of parenting and mealtime behaviors occurred from age 2-5 years. The child's body mass index (BMI) was assessed yearly from age 5-9.5 years. Path analysis with a latent growth model revealed a significant indirect effect of the FCU on the trajectory of BMI in later childhood. Improvements in caregivers' PBS in toddlerhood, which was related to the nutritional quality of the meals caregivers served to the child during the mealtime task, served as the intervening process. Furthermore, findings indicate that the FCU prevents progression to overweight and obese status amongst at-risk children. These study results add to existing evidence that has demonstrated that family-based interventions aimed at improving general family management skills are effective at preventing weight gain. Future directions are discussed.
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Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial.
Meropol, SB, Schiltz, NK, Sattar, A, Stange, KC, Nevar, AH, Davey, C, Ferretti, GA, Howell, DE, Strosaker, R, Vavrek, P, et al
Pediatrics. 2014;(6):e1664-75
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OBJECTIVE Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. METHODS In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need. CONCLUSIONS Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.
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The challenge of cardiovascular prevention in primary care: implications of a European observational study in 8928 patients at different risk levels.
Ludt, S, Wensing, M, Campbell, SM, Ose, D, van Lieshout, J, Rochon, J, Uhlmann, L, Szecsenyi, J
European journal of preventive cardiology. 2014;(2):203-13
Abstract
BACKGROUND Cardiovascular prevention can be provided to patients at different risk levels. The aim of this study was to compare the quality of cardiovascular prevention provided in European primary care between patients with diagnosed coronary heart disease (CHD) and individuals at high risk due to known risk factors but not labelled with a diagnosis of cardiovascular disease (CVD). Additionally, we aimed to identify individual and practice factors to predict risk factor control. METHODS An international cross-sectional study was conducted in 10 European countries. Clinical record data were abstracted for quality indicators for 8928 patients in 10 countries and patient questionnaires were completed by 7846 patients in nine countries. Information about 320 general practices was assessed using practice questionnaires and interviews. Hierarchical multilevel modelling was used for analyses. RESULTS Recording of risk factors and advice was higher in the CHD than in the high-risk group. Risk factor control was better in the CHD group: uncontrolled levels of blood pressure (34.2 vs. 49.3%; p < 0.001), cholesterol (32.4 vs. 64.5%; p < 0.001). Predictors of risk factor control were medication adherence (RR 0.97; p = 0.007) and health-related quality of life (RR 0.86; p = 0.005). Being at high risk (RR 1.42; p < 0.001), being single (RR 1.12; p < 0.001), and having lower educational level (RR 1.09; p < 0.001) were associated with poorer risk factor control. Practice factors were not associated with outcomes. CONCLUSIONS Strategies to improve guidelines adherence in cardiovascular prevention may be stronger focused on individuals at risk before CVD is diagnosed and require organizational and political support to reinforce general practices.
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'Be active, eat right', evaluation of an overweight prevention protocol among 5-year-old children: design of a cluster randomised controlled trial.
Veldhuis, L, Struijk, MK, Kroeze, W, Oenema, A, Renders, CM, Bulk-Bunschoten, AM, Hirasing, RA, Raat, H
BMC public health. 2009;:177
Abstract
BACKGROUND The prevalence of overweight and obesity in children has at least doubled in the past 25 years with a major impact on health. In 2005 a prevention protocol was developed applicable within Youth Health Care. This study aims to assess the effects of this protocol on prevalence of overweight and health behaviour among children. METHODS AND DESIGN A cluster randomised controlled trial is conducted among 5-year-old children included by 44 Youth Health Care teams randomised within 9 Municipal Health Services. The teams are randomly allocated to the intervention or control group. The teams measure the weight and height of all children. When a child in the intervention group is detected with overweight according to the international age and gender specific cut-off points of BMI, the prevention protocol is applied. According to this protocol parents of overweight children are invited for up to three counselling sessions during which they receive personal advice about a healthy lifestyle, and are motivated for and assisted in behavioural change.The primary outcome measures are Body Mass Index and waist circumference of the children. Parents will complete questionnaires to assess secondary outcome measures: levels of overweight inducing/reducing behaviours (i.e. being physically active, having breakfast, drinking sweet beverages and watching television/playing computer games), parenting styles, parenting practices, and attitudes of parents regarding these behaviours, health-related quality of life of the children, and possible negative side effects of the prevention protocol. Data will be collected at baseline (when the children are aged 5 years), and after 12 and 24 months of follow-up. Additionally, a process and a cost-effectiveness evaluation will be conducted. DISCUSSION In this study called 'Be active, eat right' we evaluate an overweight prevention protocol for use in the setting of Youth Health Care. It is hypothesized that the use of this protocol will result in a healthier lifestyle of the children and an improved BMI and waist circumference. TRIAL REGISTRATION Current Controlled Trials ISRCTN04965410.
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[Cardiovascular risk reduction: impact of an international project].
Colle, B, Brusaferro, S, ,
Annali di igiene : medicina preventiva e di comunita. 2008;(3 Suppl 1):43-8
Abstract
The Euroaction project, promoted by European Society of Cardiology, aims to determine whether a nurse co-ordinated, multidisciplinary, family based preventive cardiology programme could help more patients and their families achieve the recommended European lifestyle, risk factor and therapeutic goals for cardiovascular disease prevention. EUROACTION was evaluated in a paired cluster randomized controlled trial, and the primary care branch included 6 European countries. Consecutive patients > 50 years and < 80 years, with no history of cardiovascular disease, were prospectively identified by the general practitioners with one of the following: (i) high total cardiovascular risk (HeartScore > or = 5% over 10 years, either now or when projected to age 60 years) and on no medical treatment for blood pressure, lipids or diabetes; (ii) on treatment with anti-hypertensive and/or lipid-lowering drug therapies started in the last year but with no diabetes; (iii) diagnosed with diabetes mellitus (treated by diet alone or with oral hypoglycaemic drug therapy and/or insulin) within the last three years in both intervention and usual care practices. All eligible high risk individuals and their partners were then invited by the nurse for an assessment of their lifestyle, risk factors and therapeutic management as soon as possible after identification. In the primary care intervention branch 1019 patients have been enrolled with no differences by sex and mean age 62, while in the control branch 1005 patients were recruited with mean age 63, female were 43%. The main results show that Intervention group (I) had a statistically significant improvement compared to Usual Care (UC) in the assumption of recommended quantity of fruit and vegetables (78.4% I vs 38.8% UC p=0.005), in the weight loss (weight loss > al 5% in subjects with BMI > 25 kg/m2) (16.5% I vs 6.8% UC p=0.005), in blood pressure control both in people specifically treated with drugs and untreated (respectively 52% I vs 35% UC p=0.04 and 65% Ivs 45% UC p=0.02), in reaching the European target for total cholesterol (Total Cholesterol < 5.0 mmol/l) during the study year (from 21.9% to 35.8% (I) absolute increase 12.7% (p=0.025) vs from 33% to 32.2% (UC)). No significant differences were found about change of smoking habits. The experimented intervention model based on a multidisciplinary approach and nurses leaded showed a good one year impact in reducing cardiovascular risk factors in high risk people. This model should be further tested in local contexts.
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Healthy steps in an integrated delivery system: child and parent outcomes at 30 months.
Johnston, BD, Huebner, CE, Anderson, ML, Tyll, LT, Thompson, RS
Archives of pediatrics & adolescent medicine. 2006;(8):793-800
Abstract
OBJECTIVE To test the effects of the Healthy Steps for Young Children program (HS) (which supports parents managing children's developmental and behavioral issues)-with and without a prenatal component-on child health and development, parenting practices, and parental well-being. DESIGN A concurrent comparison with clinic-level assignment to intervention or usual care status. Nested in the intervention arm, a randomized trial compared HS with and without a prenatal component. SETTING Five primary care clinics in an integrated delivery system in the Pacific Northwest. PARTICIPANTS A consecutive sample of 439 pregnant women (80% of eligible) were enrolled. Follow-up data were obtained for 78% when the child was 30 months old. Intervention Families in intervention clinics received HS services, including developmental and behavioral advice and risk factor screening. In addition, those randomized to prenatal services received 3 home visits during pregnancy. MAIN OUTCOME MEASURES Assessed by telephone interview in the 3 domains of child health and development, parenting practices, and parental well-being. RESULTS Intervention was associated with positive outcomes in timely well-child care, immunization rates, breastfeeding, television viewing, injury prevention, and discipline strategies. Prenatal initiation of services was associated with larger expressive vocabularies at age 24 months. Mothers who received the intervention reported more depressive symptoms, but there was no increase in the proportion with clinically significant depression. CONCLUSIONS For members of an integrated delivery system, the HS intervention was associated with positive effects on children's health and parenting practices. There was little evidence of any additional benefit of HS services initiated during the prenatal period.