Effects of a community intervention to reduce the serving of alcohol to intoxicated patrons

Aims To assess the effects of an alcohol prevention programme to reduce the serving of alcoholic beverages to intoxicated clients on licensed premises. Research design A controlled pre‐ (2004) and post‐intervention study (2006) design. Intervention A community‐based programme combining law enforcement, responsible beverage service training, information campaigns and policy initiatives in one Finnish town (Jyväskylä). Participants and measurements A male actor pretended to be clearly under the influence of alcohol and tried to buy a pint of beer at licensed premises. For the baseline measurement, every bar and nightclub was visited in the intervention and the control areas (94 licensed premises in total). Post‐intervention data were gathered with the same principles (100 licensed premises in total). A researcher observed every visit and documented the results. Results In the post‐intervention study there was a statistically significant increase in refusals to serve denials alcohol to the actor in the intervention area (from 23% to 42% of the licensed premises) compared to refusals in the control area (from 36% to 27% of the licensed premises). Conclusion Previous research has documented that multi‐component community‐based interventions can have a significant impact on over‐serving of alcohol when training and house policies are combined with effective law enforcement. The present findings also demonstrate that comprehensive Responsible Beverage Service (RBS) interventions applied at a local community level can be effective in decreasing service to intoxicated clients in a Nordic context.     

Trial of an intervention to reduce passive smoking in infancy

We tested a health education intervention program to reduce passive smoking in infancy. The aim was to develop an instrument for study of tobacco smoke exposure and childhood respiratory illness. One hundred and eighty-four women who had smoked during pregnancy were allocated by month of delivery to an intervention group, to a minimal contact group, or to a follow-up only comparison group. Exposure to smoke was assessed 3 months later by questionnaire and by measurement of cotinine in samples of maternal and infant urine. There was a reduction in maternal smoking associated with contact with research staff, but this was not statistically significant. There were no differences between the groups in the exposure of infants to tobacco smoke. Reasons for this finding may include the timing of the intervention, the heterogeneity of the target group, and the manner in which information was presented on health risks caused by parental smoking.     

Saturday opening of alcohol retail shops in Sweden: an experiment in two phases

AIM: In February 2000, a trial started with Saturday opening of alcohol retail shops in certain parts of Sweden (phase I), and in July 2001, Saturday opening was extended to the whole country (phase II). The aim of this study is to assess the impact of phase II, and to probe previous results regarding phase I. DESIGN: Prior to February 2000, all alcohol monopoly outlets were closed on Saturdays. After this date, stores in an experimental area (six counties) were open on Saturdays. In the control area (seven counties) the shops remained closed. To prevent biases due to trade leakage, the experimental and control areas were separated by a buffer area (seven counties). Because continuous evaluations of the trial did not reveal any negative consequences, the Saturday opening was implemented in the whole of Sweden after 17 months. DATA AND METHODS: The outcome measures included alcohol sales and indicators of assaults and drunk driving. The pre-intervention period covered the time period January 1995-January 2000, phase I of the post-intervention period February 2000-June 2001 (17 months), and phase II July 2001-July 2002 (13 months). The effects of the two phases were estimated through analyses of monthly data (auto-regressive integrated moving-average (ARIMA) modelling) depicting how sales and harm rates evolved in the experimental area compared to the control area during phase I as well as during phase II. RESULTS: The analysis uncovered a statistically significant increase in alcohol sales of 3.7% during phase I, and about the same increase during phase II (3.6%). There were no significant changes in any of the assault indicators, neither during phase I nor during phase II. There was a statistically significant increase in drunk driving (12%) during phase I, but no change during phase II. The analyses suggested that the increase during phase I was mainly due to a change in the surveillance strategy of the police. CONCLUSIONS: The results lend support to the public health perspective in that the increased accessibility to alcohol rendered by Saturday opening also seems to have increased consumption. On the other hand, we could not detect any increase in alcohol-related harm. The question of whether this may be due to insufficient statistical power is discussed, together with some other methodological complications that were highlighted by the study.     

Preventing falls in older people: impact of an intervention to reduce environmental hazards in the home

OBJECTIVES: To evaluate the impact of an intervention to reduce fall hazards in the homes of older people. DESIGN: The intervention was administered to the 570 subjects in the experimental arm of a randomized controlled trial, with follow-up of subjects for 1 year. SETTING: Community-based seniors living in Perth, Australia. PARTICIPANTS: People age 70 and older. INTERVENTION: Registered nurses delivered the intervention. It consisted of a home hazard assessment, an educational strategy on general fall hazard reduction and ways to reduce identified home hazards, and the free installation of safety devices: grab rails, nonslip stripping on steps, and double-sided tape for floor rugs and mats. All intervention subjects received the home hazard assessment, and 96% received the educational strategy. Grab rails were installed in 77% of homes, rugs were stabilized in 8%, and nonslip step stripping was installed in 36%. MEASUREMENTS: Hazard prevalence was assessed at baseline in all homes and 11 months later in a random sample of 51 homes. Action taken in response to the intervention was assessed by a self-completed postal questionnaire completed 11 months after the intervention. RESULTS: All homes had at least one fall hazard. The most prevalent were floor rugs and mats (mean of 14 per home), stepovers (Stepovers are structural changes to the height of the floor that were designed to be stepped over rather than stepped upon, for example, the lip of a shower or a bath side.) (mean of seven per home), steps (mean of four per home), and trailing cords (mean of two per home). The intervention was associated with a small but significant reduction in four of the five most prevalent hazards. The mean number of unsafe rugs and mats was reduced by 1.57 per house (95% confidence interval (CI) = 0.91-2.24); the mean number of unsafe steps was reduced by 0.61 per house (95% CI = 0.28-0.94); the mean number of rooms with trailing cords was reduced by 0.43 per house (95% CI = 0.10-0.76); and the mean number of unsafe chairs was reduced by 0.10 per house (95% CI = 0.02-0.18). Safety devices were installed in 81.9% of homes. Advice on modifying specific hazards identified on the home hazard assessment resulted in over 50% of subjects removing hazards of floor rugs and mats, trailing cords, and obstacles. The general education message prompted less activity to reduce these hazards than did the advice on identified hazards. CONCLUSIONS: Fall hazards are ubiquitous in the homes of older people. The intervention resulted in a small reduction in the mean number of hazards per house, with many study subjects taking action but removing only a few hazards. The impact of the intervention in achieving self-reported action to reduce hazards was high.     

Consequences of an intervention to reduce restrictive side rail use in nursing homes

OBJECTIVES: To examine the effect of an advanced practice nurse (APN) intervention on restrictive side rail usage in four nursing homes and with a sample of 251 residents. A secondary question explored the association between restrictive side rail reduction and bed-related falls. DESIGN: Pre- and posttest design. SETTING: Four urban nursing homes. PARTICIPANTS: All nursing home residents present in the nursing home at three time points (n=710, 719, and 707) and a subset of residents (n=251) with restrictive side rail use at baseline. INTERVENTION: APN consultation with individual residents and facility-wide education and consultation. MEASUREMENTS: Direct observation of side rail status, resident and nurse interview for functional status, mobility, cognition, behavioral symptoms, medical record review for demographics and treatment information, and incident reports for fall data. RESULTS: At the institutional level, one of the four nursing homes significantly reduced restrictive side rail use (P=.01). At the individual participant level, 51.4% (n=130) reduced restrictive side rail use. For the group that reduced restrictive side rails, there was a significantly (P<.001) reduced fall rate (-0.053; 95% confidence interval (CI)=-0.083 to -0.024), whereas the group that continued restrictive side rail did not demonstrate a significantly (P=.17) reduced fall rate (-0.013; 95% CI=-0.056-0.030). CONCLUSION: An APN consultation model can safely reduce side rail use. Restrictive side rail reduction does not lead to an increase in bed-related falls. Although side rails serve many purposes, routine use of these devices to restrict voluntary movement and prevent falls is not supported.     

Development,implementation, and assessment of a pilot workplace intervention to reduce sitting among staff in a UK university department

BackgroundTime spent being sedentary is linked with poor health, independent of physical activity levels. Sitting in the workplace substantially contributes to sedentary time, but research assessing low-cost interventions aimed at reducing sitting in the workplace is scarce. Existing evidence supports the use of multimodal interventions developed using participative approaches. This study aimed to develop, implement, and assess a multimodal, participative, low-cost intervention intended to reduce workplace sitting.MethodsThe intervention, Sit Less ScHARR!, was developed with a focus group of 11 staff from the School of Health and Related Research (ScHARR) in which participative approaches and brainstorming techniques were used. Main components of the intervention included posters and prompts or emails suggesting ways to sit less, use of social media, and management support. All staff (n=317) were invited to take part, of whom 17 participated in all aspects of the assessment, completing 7 day preintervention and postintervention daily logs that recorded time spent sitting. Sit Less ScHARR! was delivered over 4 weeks from July 7 to Aug 3, 2014. Paired t tests were done to determine preintervention and postintervention differences in daily workplace sitting time, although this pilot study aimed to determine an overall magnitude of effect only and was not powered to detect a specific effect size. Qualitative survey data about feasibility and acceptability of the intervention were collected and thematically analysed. The study was approved by the ScHARR Ethics Committee. Focus group participants provided informed consent; for other participants, informed consent was implied by completion of daily logs.FindingsMean baseline sitting time of 440 min/workday was reported with a mean reduction of 26 min/workday post intervention (n=17, 95% CI −2 to 53, p=0·067). Sit Less ScHARR! was well received and perceived to be both acceptable and feasible. Management support was a highlighted strength, whereas meetings where participants were encouraged to walk or stand received mixed feedback.InterpretationThis small pilot study is encouraging with respect to potential outcomes and feasibility of multimodal interventions to reduce sitting in the workplace in UK settings. Assessment of this study provides useful information to support the use of participatory approaches during intervention development and potential for more sustainable low-cost interventions. The findings might not be generalisable since this study was carried out within a health-related academic setting.FundingNone.     

An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects

STUDY OBJECTIVES: To determine whether an educational initiative could decrease rates of ventilator-associated pneumonia in a regional health-care system. SETTING: Two teaching hospitals (one adult, one pediatric) and two community hospitals in an integrated health system. DESIGN: Preintervention and postintervention observational study. PATIENTS: Patients admitted to the four participating hospitals between January 1, 1999, and June 30, 2002, who acquired ventilator-associated pneumonia. INTERVENTION: An educational program for respiratory care practitioners and ICU nurses emphasizing correct practices for the prevention of ventilator-associated pneumonia. The program included a self-study module on risk factors for, and strategies to prevent, ventilator-associated pneumonia and education-based in-services. Fact sheets and posters reinforcing the information were posted throughout the ICU and respiratory care departments. MEASUREMENTS AND RESULTS: Completion rates for the module were calculated by job title at each hospital. Rates of ventilator-associated pneumonia per 1,000 ventilator days were calculated for all hospitals combined and for each hospital separately. Overall 635 of 792 ICU nurses (80.1%) and 215 of 239 respiratory therapists (89.9%) completed the study module. There were 874 episodes of ventilator-associated pneumonia at the four hospitals during the 3.5-year study period out of 129,527 ventilator days. Ventilator-associated pneumonia rates for all four hospitals combined dropped by 46%, from 8.75/1,000 ventilator days in the year prior to the intervention to 4.74/1,000 ventilator days in the 18 months following the intervention (p < 0.001). Statistically significant decreased rates were observed at the pediatric hospital and at two of the three adult hospitals. No change in rates was seen at the community hospital with the lowest rate of study module completion among respiratory therapists (56%). CONCLUSIONS: Educational interventions can be associated with decreased rates of ventilator-associated pneumonia in the ICU setting. The involvement of respiratory therapy staff in addition to ICU nurses is important for the success of educational programs aimed at the prevention of ventilator-associated pneumonia.     

Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial

Aims To evaluate the effectiveness of brief alcohol intervention (BAI) in reducing alcohol use among hazardous drinkers treated in the emergency department (ED) after an injury; in addition it tests whether assessment of alcohol use without BAI is sufficient to reduce hazardous drinking. Design Randomized controlled clinical trial with 12‐month follow‐up conducted between January 2003 and June 2005. Setting Urban academic emergency department (ED) of the Lausanne University Hospital, Lausanne, Switzerland. Participants A total of 5136 consecutive patients attending ED after an injury completed a seven‐item general and a three‐item alcohol screen and 1472 (28.7%) were positive for hazardous drinking according to the National Institute on Alcohol Abuse and Addiction definition; of these 987 (67.1%) were randomized into a BAI group (n = 310) or a control group with screening and assessment (n = 342) or a control group with screening only (n = 335) and then a total of 770 patients (78.0%) completed the 12‐month follow‐up procedures. Intervention A single 10–15‐minute session of standardized BAI conducted by a trained research assistant. Measurements Percentage of participants who have changed to low‐risk drinking at follow‐up. Findings Data obtained at 12 months indicated that similar proportions were low‐risk drinkers in BAI versus control groups with and without assessment (35.6%, 34.0%, 37.0%, respectively, P = 0.71). Data also indicated similar reductions in drinking frequency, quantity, binge drinking frequency and Alcohol Use Disorders Identification Test (AUDIT) scores across groups. All groups reported similar numbers of days hospitalized and numbers of medical consults in the last 12 months. A model including age groups, gender, AUDIT and injury severity scores indicated that BAI had no influence on the main alcohol use outcome. Conclusions This study provides the evidence that a 10–15‐minute BAI does not decrease alcohol use and health resource utilization in hazardous drinkers treated in the ED, and demonstrates that commonly found decreases in hazardous alcohol use in control groups cannot be attributed to the baseline alcohol assessment.     

Physical, subjective, and social availability: their relationship to alcohol consumption in rural and urban areas

The alcohol availability literature indicates that under some conditions, physical availability is positively associated with per capita alcohol consumption. Smart (1980) suggested that at the individual level, subjective and social aspects of availability may mediate and outweigh the influence of physical availability. The study described here examined the simultaneous effects of physical, subjective, and social availability on alcohol consumption. Standardized telephone interviews were conducted with 781 adult drinkers. As hypothesized, physical availability was not a significant multivariate predictor of alcohol consumption for residents of high, medium, and low alcohol outlet density counties in Michigan (USA). Subjective and social availability indicators were significant predictors of alcohol consumption. Similar patterns of results were found in multiple regression analyses for blacks and whites and women and men, although blacks and women consumed less alcohol than did whites and men. The theoretical and practical implications of these results are discussed.     

Gender differences in response to emotional stress: an assessment across subjective, behavioral, and physiological domains and relations to alcohol craving

Background:  Women and men are at risk for different types of stress-related disorders, with women at greater risk for depression and anxiety and men at greater risk for alcohol-use disorders. The present study examines gender differences in emotional and alcohol craving responses to stress that may relate to this gender divergence in disorders.
Method:  Healthy adult social drinkers (27 men, 27 women) were exposed to individually developed and calibrated stressful, alcohol-related, and neutral-relaxing imagery, 1 imagery per session, on separate days and in random order. Subjective emotions, behavioral/bodily responses, cardiovascular arousal [heart rate (HR), blood pressure (BP)], and self-reported alcohol craving were assessed.
Results:  Women reported and displayed greater sadness and anxiety following stress than men and men had greater diastolic BP response than women. No gender differences in alcohol craving, systolic BP or HR were observed. Subjective, behavioral, and cardiovascular measures were correlated in both genders. However, for men, but not women, alcohol craving was associated with greater subjective emotion and behavioral arousal following stress and alcohol cues.
Conclusions:  These data suggest that men and women respond to stress differently, with women experiencing greater sadness and anxiety, while men show a greater integration of reward motivation (craving) and emotional stress systems. These findings have implications for the gender-related divergence in vulnerability for stress-related disorders, with women at greater risk for anxiety and depression than men, and men at greater risk for alcohol-use disorders than women.     

Use of an orientation clinic to reduce failed new patient appointments in primary care

Patients who fail to attend initial appointments reduce clinic efficiency. To maximize attendance by newly referred outpatients, we introduced a mandatory group orientation clinic for all new patients and determined its effects on no-show rates. Orientation clinic also provided health care screening and opportunities for patient feedback. The new patient noshow rate for initial provider visits decreased significantly from 45% before institution of orientation clinic to 18% aftewards (P<.0001). The total no-show (patients who failed to attend orientation clinic or an initial provider visit) rate of the postintervention group was 51% (P=.28, compared with before the intervention). This intervention improved the efficiency and minimized the wasted time of our clinicians. Presented at the annual meeting of the Society of General Internal Medicine, San Francisco, Calif, April 1999.     

Use of an automated blood pressure recording device,the BpTRU,to reduce the "white coat effect" in routine practice

BACKGROUND: Patients often exhibit higher blood pressure (BP) readings in the doctor's office, a phenomenon known as the white coat effect. This study examines the presence of a physician in the examining room as a possible factor in provoking a white coat effect. METHODS: Blood pressure measurements taken by an automated BP recording device, the BpTRU (VSM MedTech Ltd., Vancouver, BC, Canada) with the patient alone in the examining room, were compared with the following: (1) BP taken by the patient's family physician; (2) BP taken on the first visit to a hypertension specialist; (3) BP measured by a trained research technician and (4) the mean awake ambulatory BP (ABP). The BpTRU and trained research technician readings were taken outside of the office (treatment) setting in an ABP research unit. RESULTS: Blood pressure readings (mm Hg, mean +/- SEM) taken by the BpTRU (155 +/- 5/88 +/- 2) tended to be lower than for the family physician (166 +/- 4/89 +/- 3) and the hypertension specialist (174 +/- 5/92 +/- 2; P <.001). However, BP taken by the trained research technician (158 +/- 4/90 +/- 2) was similar to the value obtained by the BpTRU. The mean awake ABP was lower (P < 0.01) than the other four BP values. CONCLUSIONS: Use of an automated BP recording device outside of the office (treatment) setting can partly eliminate the white coat effect. A similar finding was observed with readings taken by a trained research technician under similar conditions. Referral of patients to nonoffice settings for automated BP recordings may provide a more accurate estimate of a patient's BP status, with partial elimination of the white coat effect associated with readings taken by a physician.     

The availability of original data and statistics: an improvement in good publication practice

The purpose of this paper is to highlight the aspects of good publication practices, with particular reference to data analysis, and to propose an innovative initiative for improving the quality of scientific information in this field. Several committees within the scientific community provide information and publish guidelines in order to support scientists in the application of good publication practices and to improve quality in medical research. Those guidelines suggest that the possibility of verifying the original data warrants the reliability of the published results by reducing the occurrence of misconduct related to data analysis. The initiative proposed in this article is aimed at making the original data and the statistical reports available to the scientific community together with the actual paper. Such a practice is undoubtedly an improvement in the quality of publication permitting verification of the results as well as allowing for further elaboration of the same data.     

Left ventricular electromechanical mapping: a case study of functional assessment in coronary intervention

Electromechanical mapping is a new diagnostic tool that can be used to identify viable myocardium. In the case reported here, the technique was used before intervention to map areas of viable myocardium; post-intervention mapping showed improved mechanical function of the revascularized areas. Electromechanical mapping offers the potential of assessing left ventricular function in the cardiac catheterization laboratory before and after interventional procedures.     

The role of alcohol providers in prevention: an evaluation of a server intervention programme

Server intervention is a relatively new approach in the attempt to reduce the incidence of drinking and driving. Although a number of evaluations have suggested that the approach may be effective, there have been few comprehensive evaluations of such programmes. The present study utilized process evaluation techniques to assess reactions to a programme developed by the Addiction Research Foundation, and a quasi-experimental design to determine the impact of the programme on the serving practices of servers. Actors portrayed behaviors often faced by servers, and observers rated the reactions of the servers, who were unaware of the simulations, to these situations. The programme appears to have been effective in changing behavior, in that trained servers exhibited less inappropriate responses than did untrained servers. In addition the results suggested that the programme increased servers' knowledge about their obligations and potential strategies for dealing with these situations. The implications of these findings for future implementations of such programmes are discussed.