Evaluation of Internet-Based Interventions on Waist Circumference Reduction: A Meta-Analysis

BackgroundInternet-based interventions are more cost-effective than conventional interventions and can provide immediate, easy-to-access, and individually tailored support for behavior change. Waist circumference is a strong predictor of an increased risk for a host of diseases, such as hypertension, diabetes, and dyslipidemia, independent of body mass index. To date, no study has examined the effect of Internet-based lifestyle interventions on waist circumference change.ObjectiveThis study aimed to systematically review the effect of Internet-based interventions on waist circumference change among adults.MethodsThis meta-analysis reviewed randomized controlled trials (N=31 trials and 8442 participants) that used the Internet as a main intervention approach and reported changes in waist circumference.ResultsInternet-based interventions showed a significant reduction in waist circumference (mean change –2.99 cm, 95% CI −3.68 to −2.30, I²=93.3%) and significantly better effects on waist circumference loss (mean loss 2.38 cm, 95% CI 1.61-3.25, I²=97.2%) than minimal interventions such as information-only groups. Meta-regression results showed that baseline waist circumference, gender, and the presence of social support in the intervention were significantly associated with waist circumference reduction.ConclusionsInternet-based interventions have a significant and promising effect on waist circumference change. Incorporating social support into an Internet-based intervention appears to be useful in reducing waist circumference. Considerable heterogeneity exists among the effects of Internet-based interventions. The design of an intervention may have a significant impact on the effectiveness of the intervention.     

Improving remote lifestyle intervention studies in children: Participant and caregiver feedback of the smart heart study

ObjectivesWe sought to describe and analyze the quantitative and qualitative feedback obtained from participants and their caregivers of the Smart Heart study, a successful 12-month lifestyle intervention for children with overweight or obesity and congenital heart disease that provided remote lifestyle counseling, to improve future lifestyle interventions in children.MethodsThirty-six participants and caregivers were polled using a standard program evaluation questionnaire at the end of the intervention. Feedback was compiled into themes, and facilitators and barriers to program success were identified.ResultsThere was a high level of satisfaction with the intervention and staff interactions as well as a low perceived burden of participation. There were also specific concerns, including mixed impressions regarding technology usage and a less impressive indication of actual impactful behavior change.ConclusionsThe study identified five themes, and corresponding facilitators and barriers to participant compliance, from the Smart Heart intervention feedback and offered suggestions for improving future lifestyle behavioral intervention study designs in children.Practice implicationsRemote smartphone counseling is effective and efficient. It is recommended that the counseling messages are specific, the counseling schedule is patient-centric, patient burden is limited, methods with immediate patient feedback are used and family is included when feasible.     

Are worksite interventions effective in increasing physical activity? A systematic review and meta-analysis

Abstract

Worksite interventions have the potential to reach a broad and captive audience and overcome one of the most widely cited barriers to increasing physical activity (PA), namely, a lack of time. A systematic review and random effects, meta-analysis assessed the effectiveness of worksite interventions to enhance PA. Thirty-seven intervention evaluations reporting 55 unique interventions met our inclusion criteria. Results indicate that, overall, worksite interventions have small, positive effects on PA and this effect is smaller when fitness, as opposed to self-report, outcome measures are reported (ds = 0.15 versus 0.23). Worksite interventions targeting PA specifically as opposed to general lifestyle change were found to be more effective whether evaluated in terms of increased fitness (0.29 versus 0.08) or increased self-reported PA (0.27 versus 0.14). Those promoting walking as opposed to other forms of PA were also more effective (0.54 versus 0.16). Interventions providing individually tailored information or instructions were not found to be more effective, but there was evidence that specific goal setting and goal review techniques may enhance fitness gains.     

Interventions for alcohol-related offending by women: a systematic review

Treatment programmes specifically for women offenders are under-developed. A systematic review of studies that could inform interventions for alcohol-related offending by women is reported. Three questions were addressed: 1) What is the most up to date knowledge of ‘what works’ with females who commit alcohol-related offences? 2) What are the identifiable risk-needs factors for non-alcohol dependent women who commit offences involving alcohol misuse? 3) Are there differences between male and female alcohol-related offending? Four studies addressed the effectiveness of psychosocial interventions; three addressed identifiable risk-needs; and 19 addressed differences between male and female offenders' alcohol-related offending. Heterogeneity of these studies precluded meta-analyses, and so a narrative synthesis method was used. There is insufficient evidence to answer the question of what treatment works with women who commit alcohol-related offences. Drunk-driving is most widely studied, and women offenders appear to have more psychosocial problems than men. Alcohol increases the likelihood of violence for both men and women, and, while the mechanisms whereby alcohol increases the likelihood of violence are likely the same in men and women, the effect may be moderated by gender-associated issues. Again, women offenders appear to have more psychosocial problems than men. Implications for developing interventions are discussed.     

Exploring the effectiveness of couples interventions for adults living with a chronic physical illness: A systematic review

ObjectivePartners have a significant role in a person’s ability to adjust to a chronic physical illness, which warrants their inclusion in couples interventions. However to deliver more specific, tailored support it is necessary to explore which types of couples interventions are most effective across certain chronic illness populations and outcomes.MethodsFive databases were searched using selected terms. Thirty-five articles met the eligibility criteria for inclusion.ResultsThe majority of studies were from the US, and most interventions targeted cancer populations. Couples interventions fell into two categories according to therapeutic approach; Cognitive Behavioural Skills Training (CBST) and Relationship Counselling (RC). When compared with a patient-only intervention or controls, CBST interventions effectively targeted behavioural, physical/somatic and cognitive outcomes, while RC more effectively targeted interpersonal outcomes.ConclusionCouples interventions can be more effective than patient-only interventions or controls across various patient and partner outcomes. Couples interventions tend to favour a skills-based or a relationship-based approach, which strongly influences the types outcomes effectively targeted.Practice implicationsOur findings suggest it could be therapeutically useful to integrate these two approaches to more holistically support couples living with chronic illness. We also identify the need to target understudied illness groups and ethnicities.     

Structural organization of mammalian copper-containing amine oxidase genes

Objective

To evaluate the evidence regarding the disease concept of histamine intolerance as a state of inadequate histamine inactivation.

Methods

Keyword-based systematic screening of the scientific literature and of public websites focusing on diagnostic and therapeutic procedures.

Results

Histamine intolerance is commonly diagnosed based solely on subjective reporting of symptoms instead of following systematic diagnostic procedures based on objective laboratory and physical parameters. The only effective long-term therapy is avoidance of histamine-containing food.

Conclusions

The concept of histamine intolerance as a metabolic disease is in need of more experimental and clinical evidence and affected patients will benefit from a clear, evidence-based diagnostic and therapeutic regime.

     

Promoting physical activity in persons with type 2 diabetes mellitus: A systematic review of systematic reviews

ObjectiveThere is a large amount of studies about interventions for promoting physical activity (PA) in persons with type 2 diabetes (T2D) as well as several systematic reviews referring to these studies. The objective of this contribution is to provide a systematic review of these systematic reviews.MethodPubMed, PsychInfo and the Cochrane Library were searched for systematic reviews and/or meta-analyses regarding interventions for promoting PA in persons with T2D. The individual reviews and the relationships between the reviews were analysed.ResultsEighteen reviews were included. Seventeen of these reviews contained references to included trials, amounting to 113 trials in total. Five of the reviews addressed PA interventions in general; six addressed specific devices for delivering the intervention; five addressed specific approaches for giving the participants feedback about their outcomes; and two addressed specific therapeutic approaches. Only 14 cross-references were found.ConclusionGiving feedback about outcomes and helping people to integrate PA in their daily lives seem to be the most effective intervention components. Basing intervention development on theories seems helpful.Practical implicationsInterventions should give feedback about outcomes and help to integrate PA in daily life. Intervention development should be theory-based.     

Improving patient knowledge of palliative care: A randomized controlled intervention study

ObjectivesTo determine if laypersons’ knowledge about palliative care can improve with a brief education intervention.Methods152 adults were recruited to participate in a web-based randomized intervention trial that followed a 2 (content) × 2 (format) between-subjects design. Groups received either a video intervention, an information page intervention, a video control, or an information page control. An ANCOVA with contrast coding of two factors was utilized to assess if knowledge, as measured by the Palliative Care Knowledge Scale (PaCKS), increased post intervention.ResultsThere was a significant difference between intervention group means and control group means on PaCKS scores from T1 to T2 F(1, 139) = 11.10, p = 0.00, η_p² = 0.074. There was no significant difference in PaCKS change scores between the video intervention and information page intervention.ConclusionsThis study demonstrates that an information page and a brief video can improve knowledge of palliative care in laypersons.Practice implicationsSelf-administered educational interventions could be made available in diverse settings in order to reach patients and their families who may benefit from but are unaware of palliative care. Interventions more intensive than the one tested in this study might result in even more significant improvements in knowledge.     

Self-management among community-dwelling people with chronic conditions: Adapting evidence-based group programs using intervention mapping

ObjectiveSelf-management is a core theme within chronic care and several evidence-based interventions (EBIs) exist to promote self-management ability. However, these interventions cannot be adapted in a mere copy-paste manner. The current study describes and demonstrates a planned approach in adapting EBI’s in order to promote self-management in community-dwelling people with chronic conditions.MethodsWe used Intervention Mapping (IM) to increase the intervention’s fit with a new context. IM helps researchers to take decisions about whether and what to adapt, while maintaining the working ingredients of existing EBI’s.ResultsWe present a case study in which we used IM to adapt EBI’s to the Flemish primary care context to promote self-management in people with one or more chronic disease. We present the reader with a contextual analysis, intervention aims, and content, sequence and scope of the resulting intervention.ConclusionIM provides an excellent framework in providing detailed guidance on intervention adaption to a new context, while preserving the essential working ingredients of EBI’s.Practice ImplicationsThe case study is exemplary for public health researchers and practitioners as a planned approach to seek and find EBI’s, and to make adaptations.     

Effectiveness of caregiver non-pharmacological interventions for behavioural and psychological symptoms of dementia: An updated meta-analysis

BackgroundThe behavioural and psychological symptoms of dementia (BPSD) have significant negative effects on the health of both patients with dementia and their caregivers. However, the reported effectiveness of non-pharmacological interventions targeting caregivers of patients with dementia for BPSD is inconsistent.MethodsWe systematically searched the databases PubMed, PsycINFO, CINAHL, Embase, Cochrane Library and four Chinese databases from 2010 through April 2021. The Standardised mean difference (SMD) was calculated using random-effects models. Risk of bias in individual studies was assessed using Cochrane Collaboration’s tool, and the certainty of evidence was assessed using the five GRADE criteria.ResultsThirty-one randomised controlled trials (RCTs) involving 3501 dyads were included. The meta-analysis indicated that non-pharmacological interventions showed small but significant effects on both BPSD in patients with dementia (SMD = -0.14; 95% CI, -0.22 to -0.06; P = 0.001) and caregiver reactions to BPSD (SMD = -0.16; 95% CI, -0.25 to -0.07; P = 0.001). The effect sizes of BPSD in patients at follow-up (SMD = -0.24; 95% CI, -0.38 to -0.09; P = 0.002) were larger than those at post-test. Tailored interventions were associated with more substantial reductions in BPSD in patients (SMD = -0.24; 95% CI, -0.37 to -0.11; P < 0.001) than standardised interventions (SMD = -0.07; 95% CI, -0.18 to 0.04; P = 0.218).ConclusionsNon-pharmacological interventions targeting caregivers have the potential to reduce BPSD in patients with dementia and improve caregiver negative reactions to BPSD. Moreover, tailored interventions seemed to be more effective in reducing BPSD, and more significant improvements in BPSD may be observed in long-term follow-up.     

Program Use and Outcome Change in a Web-Based Trauma Intervention: Individual and Social Factors

BackgroundInsight into user adherence to Web-based intervention programs and into its relationship to intervention effect is needed.ObjectiveThe objective of this study was to examine use of a Web-based self-help intervention program, the Chinese version of My Trauma Recovery (CMTR), among Chinese traumatized individuals, and to investigate the relationship between program use and user characteristics before the intervention and change in outcomes after the intervention and at 3-months’ follow-up.MethodsThe sample consisted of 56 urban survivors of different trauma types and 90 rural survivors of the 2008 Sichuan earthquake, who used the CMTR in 1 month on their own or guided by volunteers in a counseling center. Predictors were demographics (sex, age, highest education, marital status, and annual family income), health problems (trauma duration, posttraumatic symptoms, and depression), psychological factors (coping self-efficacy), and social factors (social functioning impairment and social support). Program use was assessed by general program usage (eg, number of visiting days) and program adherence (eg, webpages completed in modules). Outcome measures were the Posttraumatic Diagnostic Scale (PDS), Symptom Checklist 90-Depression (SCL-D), Trauma Coping Self-Efficacy scale (CSE), Crisis Support Scale (CSS), and Social Functioning Impairment questionnaire (SFI) adopted from the CMTR.Results(1) Program use: rural participants had a larger total number of visiting days (F_1,144=40.50, P<.001) and visited more program modules in 1 month (χ²₃=73.67, P<.001) than urban participants. (2) Predictors and program use: total number of visiting days was correlated with CSS at pretest (r=.22, P=.009), and total number of completed webpages was associated with SFI at pretest (r=.19, P=.02). Number of webpages completed in modules was correlated with all demographic, disease severity, psychological, and social factors at pretest. (3) Program use and outcomes change: in general, use of the triggers and self-talk modules showed a consistent positive association with improvement in PDS, SCL-D, SFI, and CSE. The relaxation module was associated with positive change in PDS, but with negative change in CSS and SFI. The professional help module was associated with positive change in SCL-D, but its use on the first day was associated with negative change in CSS and CSE. The unhelpful coping module was associated with negative change in SFI. The mastery tools module showed a consistent association with negative change in PDS and SCL-D.ConclusionsThese findings suggest that both individual (eg, demographic, health problems, psychological) and social factors (eg, social functioning, social support) should be considered when delivering Web-based interventions, particularly in collectivist cultures. Specific program adherence indicators (eg, webpages completed in each module, activity types completed), rather than general program usage indicators (eg, total number or time of visiting), should be developed to examine the effectiveness of various program modules or elements.

Clinical Trial

Australian New Zealand Clinical Trials Registry: ACTRN12611000951954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343399 (Archived by WebCite at http://www.webcitation.org/6G7WyNODk)     

Long-term outcomes of percutaneous coronary interventions within coronary artery bypass grafts

IntroductionThe long-term outcomes of percutaneous coronary interventions (PCIs) within coronary artery bypasses are still poor as compared to those within native coronary arteries. Thus, we aimed to assess predictors of long-term clinical outcomes after PCIs of coronary bypasses.Material and methodsWe enrolled 194 patients after PCIs of coronary artery bypasses at the mean age of 69.5 ±8.3 years (73.2% male). The primary study endpoint was a combination of target-vessel revascularization (TVR), target-lesion revascularization (TLR), myocardial infarction (MI), stroke, coronary artery bypass grafting (CABG) and death. The mean follow-up was 964 ±799.1 days and was completed among 156 patients. Multivariate analysis was used to assess determinants of study endpoints during follow-up. Moreover, we compared survival curves according to the type of PCI and presence of anti-embolic protection.ResultsThe primary endpoint of the study occurred in 59.7% of patients after the mean time of 669.6 ±598.7 days. The TVR occurred in 37.9% of individuals, TLR in 24.2%, MI in 26.3%, stroke in 4.2%, CABG in 2.1% and death in 30.5% of patients. In Cox multivariate analysis, PCI of two or more bypasses (p < 0.01), post-dilatation (p < 0.05) and no-reflow (p < 0.05) were the independent determinants of the primary study endpoint. No significant impact of anti-embolic protection devices on long-term outcomes was observed.ConclusionsPercutaneous coronary interventions of two or more bypasses, post-dilatation and no-reflow are predictors of worse outcome in patients undergoing PCI within coronary artery bypass grafts.     

Perspectives of Colombian medicine students about their formation on breaking bad news: A cross-sectional study

IntroductionMedical schools are responsible for breaking bad news training, which should be focused on the students; therefore, the purpose of this study is to identify undergraduate medical students’ perceptions regarding the best way to train them.MethodsCross-sectional anonymous survey applied between 438 >18-years-old Colombian medicine students.ResultsThe students feel unprepared to breaking bad news; even without formal training, they believe they are better at breaking bad news as they advance in their training due to their observation of other clinicians and their personal experiences. A higher proportion of male students consider themselves empathetic than female students, but advanced male students report more frequently that their empathic capacity has decreased throughout their career more frequently than female students of the same academic level.DiscussionThis information will allow the medical school to modify the curriculum to offer proper training to its students.ConclusionVery few students have received formal training regarding this topic, and most of them are interested in training.     

The bases of targeting behavior in health promotion and disease prevention

ObjectiveHealth behaviors shape more than 30% of one’s physical and mental health, as well as overall well-being. Yet, changing behavior is difficult. This paper aims first at operationalizing the concept of health behavior by focusing on its main components and determinants. Second, it gives insights into how to influence health behavior by providing an overview of some of the most commonly used approaches to the design of behavioral interventions.MethodsThis is a position paper that presents a selection of evidence-based theories, models and approaches to understand and address behavior.ResultsA health behavior broadly refers to every individual action affecting health, disease, disability, or mortality. Behavior is shaped by factors within the skin (biological, psychological) and outside the skin (interpersonal, environmental, policy). Behavior change has therefore to be addressed from an ecological perspective. Specifically, behavior change can be influenced by changing capability, opportunity and motivation. Depending on the specific determinants of the behavior at stake, there are numerous approaches that can be taken. The main steps to design interventions are: defining the problem, selecting and analyzing the target audience, setting objectives, designing the intervention, planning and implementing an evaluation.ConclusionBehaviors should not be targeted in isolation but within a socio-ecological approach that accounts for both their individual and environmental determinants.Practice implicationsThis paper provides practitioners with the bases of behavior change. It offers a road-map of the main factors to consider and shows how to address behavior by planning an intervention in all its main steps.     

A scoping review of education and training interventions in Autism Spectrum Disorder

ObjectiveAutism Spectrum Disorder (ASD) is a chronic neurodevelopmental disorder. Living with ASD requires that individuals and parents develop skills in order to cope with daily life. Education interventions are recommended to support them. This study aims to get an overview of education and training interventions in ASD.MethodsA scoping review of international literature was conducted.Results43 articles were analyzed. Four main types of intervention stand out: support groups, parental training; psychoeducation; therapeutic patient education. However, the majority of publications is focused on the parents rather than on individuals living with ASD, and the needs assessments identified focused on general needs rather than educational needs.ConclusionWhile educational interventions for parents and individuals with ASD are now encouraged, considerable heterogeneity is observed. But this variety is not based on a reasoned approach to matching supply and needs. Future studies could focus more on the educational needs of individuals with ASD.Practice implicationsOverview of education and training interventions in ASD help health care providers to better understand the strengths and limitations of their interventions.     

mHealth or eHealth? Efficacy,Use, and Appreciation of a Web-Based Computer-Tailored Physical Activity Intervention for Dutch Adults: A Randomized Controlled Trial

BackgroundUntil a few years ago, Web-based computer-tailored interventions were almost exclusively delivered via computer (eHealth). However, nowadays, interventions delivered via mobile phones (mHealth) are an interesting alternative for health promotion, as they may more easily reach people 24/7.ObjectiveThe first aim of this study was to compare the efficacy of an mHealth and an eHealth version of a Web-based computer-tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions.MethodsWe collected data among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks, and after 6 months). We recruited participants from a Dutch online research panel and randomly assigned them to 1 of 3 conditions: eHealth (n=138), mHealth (n=108), or control condition (n=127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. We used analysis of variance and linear regression analyses to examine differences between the 2 study groups and the control group with regard to efficacy, use, and appreciation.ResultsParticipants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B=8.48, df=2, P=.03, Cohen d=0.27). We found a small effect size favoring the eHealth condition over the control group (B=6.13, df=2, P=.09, Cohen d=0.21). The eHealth condition had lower dropout rates (117/138, 84.8%) than the mHealth condition (81/108, 75.0%) and the control group (91/127, 71.7%). Furthermore, in terms of usability and appreciation, the eHealth condition outperformed the mHealth condition with regard to participants receiving (t₁₈₂=3.07, P=.002) and reading the feedback messages (t₁₈₁=2.34, P=.02), as well as the clarity of the messages (t₁₈₁=1.99, P=.049).ConclusionsWe tested 2 Web-based computer-tailored physical activity intervention versions (mHealth and eHealth) against a control condition with regard to efficacy, use, usability, and appreciation. The overall effect was mainly caused by the more effective eHealth intervention. The mHealth app was rated inferior to the eHealth version with regard to usability and appreciation. More research is needed to assess how both methods can complement each other.

Trial Registration

Netherlands Trial Register: NTR4503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4503 (Archived by WebCite at http://www.webcitation.org/6lEi1x40s)