Health programs in faith-based organizations: are they effective?

OBJECTIVES: We examined the published literature on health programs in faith-based organizations to determine the effectiveness of these programs. METHODS: We conducted a systematic literature review of articles describing faith-based health activities. Articles (n = 386) were screened for eligibility (n = 105), whether a faith-based health program was described (n = 53), and whether program effects were reported (28). RESULTS: Most programs focused on primary prevention (50.9%), general health maintenance (25.5%), cardiovascular health (20.7%), or cancer (18.9%). Significant effects reported included reductions in cholesterol and blood pressure levels, weight, and disease symptoms and increases in the use of mammography and breast self-examination. CONCLUSIONS: Faith-based programs can improve health outcomes. Means are needed for increasing the frequency with which such programs are evaluated and the results of these evaluations are disseminated.     

Immunization promotion activities: are they effective in encouraging mothers to immunize their children?

Mass media communication is an important strategy for increasing parental uptake and to promote community participation when large-scale immunization activities are carried out. In Mexico, the National Vaccination Council (CONAVA) launches three immunization campaigns every year accompanied by three vaccination promotion campaigns. This study was conducted to assess whether communication activities to promote CONAVA's Second National Health Week (SNHW) were effective in providing information to mothers about the importance of immunizing their children under five years of age and in prompting them to seek immunization services. A probability sample of mothers living in the metropolitan area of Mexico City and having at least one child under five years old was selected for the study. Four outcome variables were defined as measuring the impact of the campaign: (1) mothers' knowledge about the SNHW; (2) mothers' comprehension indicating how well they understood the campaign messages (aware, partly aware and unaware); (3) mothers' motivation, i.e. whether or not they sought out immunizations for their children under the age of five and (4) mothers' opinion of how well they liked the messages. A total of 935 mothers were interviewed; 88.2% knew about the SNHW, 64.3% were aware that the campaign aimed to provide immunizations, and most held a favorable opinion about the messages. Among aware mothers, 87.5% of their children received immunizations. In this group 72.1% were prompted by the information in the campaign to seek immunizations for their children while 27.9% had to be personally invited to participate in the campaign. The latter occurred either when health workers or volunteers visited mothers in their homes or by soliciting mothers' participation as they visited or passed by immunization health posts. In the unaware mothers group, 72.7% of their children received immunizations; 62.5% of the mothers took their children because of information they received through the campaign while 37.5% had to be personally invited to immunize their children. Mothers with better socioeconomic status were more aware of the campaign, but a high percentage of them did not seek immunizations, while mothers with middle and lower socioeconomic status were motivated to immunize their children through the campaign. Promotion activities and messages communicated through the mass media were appropriate to inform and motivate mothers to seek immunization services for their children.     

Stage-based lifestyle interventions in primary care: are they effective?

BACKGROUND: To systematically review the literature concerning the effect of stages-of-change-based interventions in primary care on smoking, physical activity, and dietary behavior. METHODS: An extensive search (until July 2002) was performed using the following inclusion criteria: (1) (randomized) controlled trial (RCT/CT), (2) intervention initiated in primary care, (3) and intervention aimed at changing smoking, physical activity, or dietary behavior, and stages-of-change-based outcomes, and (4) behavioral outcomes. Methodologic quality was assessed, and conclusions on the effectiveness at short-, medium-, and long-term follow-up were based on a rating system of five levels of evidence. Odds ratios were calculated when methodologically appropriate. RESULTS: A total of 29 trials were selected for inclusion. Thirteen studies included a physical activity intervention, 14 aimed at smoking cessation, and five included a dietary intervention. Overall methodologic quality was good. No evidence was found for an effect on stages of change and actual levels of physical activity. Based on the strength of the evidence, limited to no evidence was found for an effect on stages of change for smoking and smoking quit rates. Odds ratios for quitting smoking showed a positive trend. Strong evidence was found for an effect on fat intake at short- and long-term follow-up. Limited evidence was found for an effect on stages of change for fat intake at short-term follow-up. CONCLUSIONS: The scientific evidence for the effect of stages-of-change-based lifestyle interventions in primary care is limited. Limiting aspects in the stages-of-change concept with respect to complex behaviors as physical activity and dietary behavior are discussed.     

Bleeding complications in patients with acute coronary syndromes: are they important and how can we prevent them?

Progress in antithrombotic medications and revascularization procedures has helped to reduce mortality in patients with acute coronary syndromes (ACS). However, these therapies can significantly increase the risk of bleeding. Bleeding complications are important clinical outcomes in patients with ACS. Data from numerous randomized controlled trials and large registries have demonstrated that bleeding is independently associated with a significantly higher risk of mortality in patients with ACS. Furthermore, bleeding complications are associated with an increased risk of recurrent ischemic events. The challenge of preventing bleeding complications while obtaining the optimal antithrombotic benefits of ACS management requires careful consideration of factors associated with patients, pharmacotherapy, and interventional procedures. Clinicians should be able to risk stratify patients for bleeding events just as they would do for recurrent ischemic events in ACS.     

HIV and STDS: how are they linked?

The 153-327 million new cases of treatable sexually transmitted diseases (STDs) each year are a critical health problem and are increasingly associated with transmission of HIV infections. There is strong epidemiological evidence that STDs (especially HIV-1 and genital ulcer diseases such as syphilis, herpes, and chancroid) increase a person's ability to transmit or acquire an HIV infection. In addition, HIV may alter the clinical presentation, natural history, diagnosis, and responsiveness to therapy of STDs; and STDs may alter the natural history of HIV infection by inducing immunosuppression, by chronic immune stimulation, or by direct viral interactions. Most reports on HIV infection and syphilis document neurological manifestation of syphilis in HIV-1 infected individuals. HIV-1 may modify an individual's response to syphilis infection, producing more persistent and higher RPR titres, increasing the likelihood of losing reactivity to treponemal tests correlating with advanced HIV disease, and increasing biological false-positive reactions. HIV also appears to reduce the responsiveness of chancroid to standard therapy, especially single-dose therapy, thus requiring multiple-dose therapy over 5-7 days. Herpes simplex viral infections are more frequent and severe in HIV-infected individuals, but dosage adjusted acyclovir therapy is effective in most patients. Gonorrhea does not appear to be affected by the presence of HIV infection, except that HIV-infected women may be more susceptible to cervical gonococcal infection and pelvic inflammatory disease. The clinical presentation of human papilloma virus, however, is altered by HIV infection as is the rate of recurrence and the responsiveness to standard therapy. Because of the recognition of the interaction of HIV and STDs, STD control is now recognized as an essential component of HIV prevention programs. Parallel prevention campaigns, such as condom promotion, could reduce both.     

Parasites in nosocomial diarrhoea: are they underestimated?

Nosocomial diarrhoea, defined as diarrhoea occurring more than 72 h after hospital admission, is reported to account for <1% of endemic nosocomial infections and 17% of epidemic nosocomial infections. The yield of diagnoses from stool cultures in nosocomial diarrhoea is low, and information regarding the role of parasites is limited. We conducted a study to determine the responsible bacterial and parasitological pathogens from nosocomial diarrhoea cases in our 2000-bed tertiary care facility over a 16-month period. Of 226 patients, Clostridium difficile toxins A or B were present in 5.5%, giardia cysts and/or trophozoites in 4.4%, Blastocytis hominis in 4.4% and Cryptosporidium sp. in 0.5% of samples. In conclusion, parasites should be sought in nosocomial diarrhoea in endemic areas.     

HIV and STDs: how are they linked?

I write in response to Dr. Gina Dallabeta's article with this title (HIV and STDs: How Are They Linked?). Prospective studies in sub-Saharan Africa have established the following: 1. Seropositive commercial sex workers have a higher prevalence of genital ulcer disease (GUD) and positive serology for syphilis. 2. Seropositive men with chancroid more frequently have a history of prior GUD. 3. Seronegative men with a history of recent contact with a commercial sex worker are more likely to seroconvert if they have GUD than urethritis. GUD increases the infectiousness of HIV. Similarly, there is increased susceptibility to the virus in cases of genital chlamydial infection and Trichomonas vaginalis. The mechanisms are basically two--mechanical and biological. Mechanically, the raw area resulting from the STD provides a portal of entry for the virus. Biologically, activated lymphocytes and macrophages enhance HIV shedding and increase the susceptibility of the individual to HIV.     

Realist methods in medical education research: what are they and what can they contribute?

Medical Education 2012: 46: 89–96 Context Education is a complex intervention which produces different outcomes in different circumstances. Education researchers have long recognised the need to supplement experimental studies of efficacy with a broader range of study designs that will help to unpack the ‘how’ and ‘why’ questions and illuminate the many, varied and interdependent mechanisms by which interventions may work (or fail to work) in different contexts. Methods One promising approach is realist evaluation, which seeks to establish what works, for whom, in what circumstances, in what respects, to what extent, and why. This paper introduces the realist approach and explains why it is particularly suited to education research. It gives a brief introduction to the philosophical assumptions underlying realist methods and outlines key principles of realist evaluation (designed for empirical studies) and realist review (the application of realist methods to secondary research). Discussion The paper warns that realist approaches are not a panacea and lists the circumstances in which they are likely to be particularly useful.     

Weight control counselling in children: is it effective?

This study evaluates the results of weight control/obesity counselling in the outpatient nutrition clinic of a children's hospital. Using a retrospective design, 96 randomly selected patients referred to the clinic were followed for up to four years using their hospital charts or through information obtained from the referring physician on current weights and heights. At initial assessment, 87 of 96 (91%) children were classified as obese or severely obese at greater than 120% of their Ideal Body Weight (IBW); eight other children would be classified as overweight and one child was within normal weight for height. Forty-nine referrals (51%) did not return for a follow-up visit after the initial assessment; weights were available on 18 (37%). On follow-up of 65 patients; 8% of patients achieved an IBW; a further 34% lost weight; 46% gained weight; and 12% maintained their weight. There was no difference in weight gain or loss by amount of participation in the program or by age or gender. We conclude that the weight control/obesity counselling program in our hospital is ineffective. A multidisciplinary program, based on a nutrition education theory and which includes an evaluation framework and addresses reasons for attrition and family needs, should be developed.     

Violence and mass media: are laws and regulations effective?

In Germany, there are several laws and legal and administrative regulations restricting presentation and propagation of violence in mass media. They have proven to be partly effective. Whilst control and supervision of public media is feasible, the containment of what is distributed over the internet proves to be very difficult. It is well recognized that laws and regulations can be only one part of protection for children and youngsters; school, kindergarten and above all the parents must be educated and held responsible for creating media competence in children and adolescents.