Interventions for Families of Individuals with Schizophrenia

Recent best practice guidelines recommend the provision of psychosocial family interventions for families of adults with schizophrenia. This article delineates the various family interventions and the empirical base of these interventions. These interventions include psychoeducation, family education, family consultation, and family support and advocacy groups. Although the provision of these interventions incur additional costs, they also have the potential for financial savings as a result of decreasing mental health service utilisation and improving outcomes for both the families and their ill relatives.The article concludes with recommendations for providers and organisations to improve effective relationships with families of adults with schizophrenia. Providers and organisations need to understand the needs of families, become knowledgeable about interventions for families and direct families to appropriate resources if they are unable to provide the family intervention themselves.     

Advancing novel HIV prevention intervention research with MSM--meeting report

HIV continues to exact an enormous toll on society and to disproportionately affect gay and bisexual men and other men who have sex with men (MSM). Innovative prevention interventions are needed to reverse this trend. In August 2009, the U.S. National Institute of Mental Health and the Centers for Disease Control and Prevention convened a meeting of scientists, community representatives, advocates, and federal partners to discuss innovative prevention-intervention science. The meeting was structured to maximize discussion of (1) healthy sex interventions, (2) community and structural interventions, (3) integrated biomedical and behavioral interventions, and (4) interventions to improve uptake of HIV testing. Presentations and discussion focused on research gaps in designing risk-reducing and sexual health-promoting interventions for MSM, including interventions to address mental health, substance use, disclosure, and stigma. This article summarizes the meeting proceedings, highlights key points, and outlines future directions.     

Targeting smokers with low readiness to change with tailored and nontailored self-help materials

BACKGROUND: Few smoking cessation self-help materials are available for smokers who are not planning to quit. However, computer-tailored interventions can be designed specifically for these smokers. METHODS: In a large randomized field trial (N = 843), two different tailored smoking cessation self-help interventions (multiple tailoring and single tailoring) and one standardized smoking cessation self-help guide were compared with a no-information control group and with each other. The contents of the tailored interventions were adapted to individuals' self-reported stage of change, outcome expectations, self-efficacy levels, and smoking behavior. RESULTS: The primary outcome measure was forward stage transition. The standardized self-help guide had no effect. Among smokers who were not planning to quit within the next 5 years the multiple-tailored intervention was more effective than the single-tailored intervention. This pattern was supported by the cognitive changes caused by the interventions. Among smokers who were planning to quit within the next 5 years but not within the next 6 months, none of the self-help materials had any effect. CONCLUSION: The present results show that the self-help material currently available in the Netherlands, the standardized self-help guide, was not effective among smokers with low readiness to change. However, computer-generated tailored interventions seem a promising means of communicating information on smoking and smoking cessation to these smokers.     

Cost-effectiveness analysis with risk aversion

This paper discusses why, in a medical context, the standard assumption of a risk-neutral social planner is inappropriate and develops a framework for conducting cost-effectiveness (CE) analysis when social planners are risk-averse. This framework demonstrates that if new medical interventions are variance increasing (decreasing), the risk-neutral approach will approve (reject) projects that should be rejected (accepted). This methodology is applied to two medical interventions that have been previously evaluated and considered cost-effective in the published literature. Since both conclusions assumed risk neutrality we determine the level of societal risk-aversion that would be necessary to reject these new interventions and compare these levels to previous estimates of risk-aversion in the economics literature. We find that for reasonable values of the risk-aversion parameter, only one of the two interventions should be approved. It is our recommendation that the cut-off risk aversion parameter (the level of risk-aversion above which a project would be rejected) should become a standard reported figure in future CE studies.     

A Systematic Review of Disability Management Interventions with Economic Evaluations

Introduction We present the results of a systematic literature review of disability management interventions to answer the question: “what is the credible evidence that incremental investment in disability management interventions is worth undertaking?” Methods We identified studies through searches in journal databases and requests to content experts. After assessing the quality of studies that met content requirements, we employed a best-evidence synthesis approach. Studies were stratified across several dimensions for evidence synthesis, with industry as the core stratification criterion. Results We identified 17 disability management interventions with economic analyses, of which eight were of high or medium quality. We found strong evidence supporting the economic merits of multi-sector disability management interventions, but could not make a positive statement about the remaining five industry clusters with studies. For stratification by intervention components, we found moderate evidence for interventions that included an education component, moderate evidence for those with physiotherapy, limited evidence for those with a behavioural component, and moderate evidence for those with a work/vocational rehabilitation component. For stratification by intervention features, we found moderate evidence for interventions that included a work accommodation offer, contact between health care provider and workplace, early contact with worker by workplace, ergonomic work site visits, and interventions with a return-to-work coordinator. Conclusions We found credible evidence supporting the financial benefits of disability management interventions for one industry cluster and several intervention components and features.     

Modelling stillbirth mortality reduction with the Lives Saved Tool

Background

The worldwide burden of stillbirths is large, with an estimated 2.6 million babies stillborn in 2015 including 1.3 million dying during labour. The Every Newborn Action Plan set a stillbirth target of ≤12 per 1000 in all countries by 2030. Planning tools will be essential as countries set policy and plan investment to scale up interventions to meet this target. This paper summarises the approach taken for modelling the impact of scaling-up health interventions on stillbirths in the Lives Saved tool (LiST), and potential future refinements.

Methods

The specific application to stillbirths of the general method for modelling the impact of interventions in LiST is described. The evidence for the effectiveness of potential interventions to reduce stillbirths are reviewed and the assumptions of the affected fraction of stillbirths who could potentially benefit from these interventions are presented. The current assumptions and their effects on stillbirth reduction are described and potential future improvements discussed.

Results

High quality evidence are not available for all parameters in the LiST stillbirth model. Cause-specific mortality data is not available for stillbirths, therefore stillbirths are modelled in LiST using an attributable fraction approach by timing of stillbirths (antepartum/ intrapartum). Of 35 potential interventions to reduce stillbirths identified, eight interventions are currently modelled in LiST. These include childbirth care, induction for prolonged pregnancy, multiple micronutrient and balanced energy supplementation, malaria prevention and detection and management of hypertensive disorders of pregnancy, diabetes and syphilis. For three of the interventions, childbirth care, detection and management of hypertensive disorders of pregnancy, and diabetes the estimate of effectiveness is based on expert opinion through a Delphi process. Only for malaria is coverage information available, with coverage estimated using expert opinion for all other interventions. Going forward, potential improvements identified include improving of effectiveness and coverage estimates for included interventions and addition of further interventions.

Conclusions

Known effective interventions have the potential to reduce stillbirths and can be modelled using the LiST tool. Data for stillbirths are improving. Going forward the LiST tool should seek, where possible, to incorporate these improving data, and to continually be refined to provide an increasingly reliable tool for policy and programming purposes.

     

Occupational therapists' assessments of adults with long-term pain: the Swedish experience

The purposes of this study were to describe the needs for occupational therapy among people of working age with long-term pain, and to describe treatment interventions based on these assessments. Occupational therapists working in primary health care and/or with special interest in pain management (n=109) assessed 113 people aged 18-58 years with long-term pain with the Occupational Therapy Needs Assessment--Pain (OTNA--P) questionnaire. The occupational therapists recommended treatment interventions where appropriate. The results generated categories of needs that have implications for interventions: 1) need for patient education, 2) needs due to limitations in activity performance, 3) needs due to patient's discouragement, 4) need as a result of patient's dependency and 5) needs related to work. The suggested interventions focused on increased knowledge of how to handle daily occupations, mainly categorized as education and stress management' and behavioural' interventions. Significant correlations were found between the assessed needs and the suggested interventions. The results of this study could assist in developing guidelines for practitioners working in occupational therapy pain management programmes. It is recommended that further research is done on the effectiveness of occupational therapy interventions with patients with long-term pain.     

Social Work Practice with Pre- and Post-Liver Transplant Patients

SUMMARY

This paper describes a retrospective, practice-based research study of social work interventions with liver transplant candidates and recipients. This study is based on a retrospective chart review conducted to examine psychosocial risk factors, interventions and medical outcomes. Psychosocial interventions provided to patients and families before and after transplant will be described as well as their relationship to medical outcomes. Research Findings and practice implications will be discussed.     

早期心理干预对肺结核咯血病人焦虑情绪的影响观察

目的探讨早期心理干预对肺结核咯血病人焦虑情绪的影响。方法将98例病人随机分为实验组与对照组,每组各49例,2组病人在住院期间均接受常规护理,而试验组增加护理干预。并分别采用Zung的焦虑自评量表（SAS）测量病人焦虑情绪。结果早期心理干预前实验组和对照组患者的中、重度焦虑程度比较,差异无统计学意义（P〉0.05）;早期心理干预后实验组和对照组患者的中、重度焦虑程度比较,差异有统计学意义（P〈0.05）。结论早期心理干预可以减轻或消除病人焦虑情绪,提高病人生活质量。     

Are differences in exposure to a multicomponent school-based intervention associated with varying dietary outcomes in adolescents?

Multicomponent interventions are recommended for health behavior change among adolescents. However, it is difficult to disentangle the effects of multiple intervention components. This article reports outcomes associated with varying levels of exposure to a school-based nutrition intervention. Teens Eating for Energy and Nutrition at School (TEENS). Four incremental exposures were possible: (1) control group, (2) school environment interventions only, (3) classroom plus environment interventions, and (4) peer leaders plus classroom plus environment interventions. Pattems suggesting dose response were observed, with peer leaders reporting the largest increases in fruit, vegetable, and lower fat food consumption. Students exposed to classroom plus environment interventions also improved, whereas students exposed only to school environment interventions showed trends toward choosing lower fat foods and declining fruit intake and no change in vegetable intake. Control students' choices remained stable. Future studies may investigate mechanisms for peer leaders' changes, maximizing curriculum effectiveness, and improving environmental interventions.     

Life Skill Interventions with Homeless Youth,Domestic Violence Victims and Adults with Mental Illness

SUMMARY

This paper presents three exploratory studies of life skills interventions (employment, money management or food/nutrition) with 73 homeless individuals from four shelters and supportive housing programs located in the urban Midwest for youth, victims of domestic violence and adults with mental illness. The Ansell Casey Life Skills Assessment was administered prior to the eight group and individual sessions. Quizzes and posttests indicated clinical change in all groups, with statistical significance in the domestic violence group. The intervention implementation, challenges encountered, and strategies developed for implementing shelter-based interventions are discussed. Recommendations for successfully providing collaborative university-shelter clinical interventions are provided.     

Nutrition interventions for people with disabilities: A scoping review

BackgroundApproximately 19 percent of Americans have a disability. People with disabilities are at greater risk for obesity and poor nutrition, as well as resulting secondary conditions. CDC recommends interventions for this population to address this disparity.ObjectiveThe purpose of this article is to present the results of a scoping review of studies pertaining to community-based nutrition interventions among adults with disabilities.MethodsElectronic databases were searched to discover articles pertaining to community-based nutrition interventions for people with disabilities.ResultsSixteen journal articles published between 2002 and 2012 were reviewed. The reviewed community based nutrition interventions for adults with disabilities showed some success in improving health outcomes.ConclusionsThere is a need for future research, particularly interventions with objective outcome measures and including people with disabilities throughout the development and implementation of programs.     

Moving forward with research on the prevention of violence against workers

OVERVIEW: This article highlights the major issues discussed at the Workplace Violence Intervention Research Workshop convened in April 2000. It includes discussion of impediments to developing research on interventions that address violence against workers, and it suggests directions for establishing a research agenda. To identify potential interventions strategies, the article provides examples to demonstrate the utility of developing interventions described in two distinct conceptual frameworks developed by William Haddon.     

Systematic review of the efficacy of parenting interventions for children with cerebral palsy

This systematic review aims to evaluate the efficacy of parenting interventions (i.e. behavioural family intervention and parent training) with parents of children with cerebral palsy (CP) on child behavioural outcomes and parenting style/skill outcomes. The following databases were searched: Medline (1950-April 2010), PubMed (1951-April 2010), PsycINFO (1840-April 2010), CINAHL (1982-April 2010) and Web of Science (1900-April 2010). No randomized clinical trials of parenting interventions with parents of children with CP were identified. Three studies were identified that involved the examination of a targeted parenting intervention via a pre-post design. Interventions utilized included the implementation of parenting interventions in conjunction with behavioural intervention and oral motor exercises for children with CP and feeding difficulties, the Hanen It Takes Two to Talk programme and a Functional Communication Training programme for parents. All studies found changes in relevant child behavioural outcomes. The studies reviewed suggest that parenting interventions may be an effective intervention for parents of children with CP. However, the current research is limited to pre-post designs of targeted parenting interventions (e.g. parenting interventions focused upon communication). A randomized controlled trial of parenting interventions for families of children with CP is urgently needed to address this paucity in the literature and provide families of children with CP with an evidence-based intervention to address child behavioural and emotional problems as well as parenting challenges.     

A systematic review of networked technologies supporting carers of people with dementia

We conducted a systematic review of the effectiveness of networked ICT interventions in supporting carers of people with dementia. Five bibliographic databases were searched and a total of 1456 abstracts were identified as potentially relevant. From these we identified 15 papers describing five interventions: ComputerLink, AlzOnline, Caring for Others and two studies from the REACH project (TLC and CTIS). The interventions reviewed were multifaceted with elements of networked peer support. Outcomes were inconsistent but suggested that the interventions had moderate effects on improving carer stress and depression. Treatment effects were found to vary with caregiver characteristics such as ethnic groups, formal support and baseline burden. Further evaluation is needed in robust trials with good follow-up.     

白血病大剂量化疗后粒细胞缺乏的护理

目的探讨白血病化疗后粒细胞缺乏期间的护理措施。方法回顾性分析2008年1月至2012年12月在我院就诊的89例白血病患者化疗后粒细胞缺乏期间的护理工作及成效。结果经积极治疗与护理,7～35天后有85例患者粒细胞恢复至正常范围,2例自动出院,2例死于颅内出血。结论在白血病化疗后粒细胞缺乏期间,做好对患者的护理工作,可加快粒细胞的恢复．使患者顺利度过粒细胞缺乏期。