Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study

Background

There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this.

Methods

An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate.

Results

A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who received the conventional TB treatment alone (77.5% vs. 8.7%; p < 0.001). Furthermore, at the end of TB treatment (6 months or later), there were significantly higher rates of treatment default (15.2% vs. 2.5%; p = 0.019) and treatment failure (6.5% vs. 0%; p = 0.019) in the DOTS group than in the SCIDOTS group.

Conclusion

This study provides evidence that connecting TB-tobacco treatment strategy is significant among TB patients who are smokers. The findings suggest that the integrated approach may be beneficial and confer advantages on short-term outcomes and possibly on future lung health of TB patients who quit smoking. This study may have important implications on health policy and clinical practice related to TB management among tobacco users.     

Mentoring and Facilitating Professional Engagement as Quality Enhancement Strategies: An Overview and Evaluation of the Family Child Care Partnerships Program

Background

The importance of professional development training for individuals tasked with providing quality early child care is widely accepted. However, research assessing the impact of specific, long-term professional development programs on changes in caregiver behavior is largely absent, as is research about the processes and mechanisms of such training efforts that produce changes in child care practices.

Objective

We specify the underlying activities and processes of a mentor–delivered quality enhancement and professional development program, Family Child Care Partnerships (FCCP), and present the results of two studies using implementation data to examine program effectiveness as measured by mentors’ observational assessments of the global quality of caregiving practices and providers’ self-reported professional engagement.

Methods

Study 1 consisted of 365 family child care providers who were invited to participate in FCCP. Study 2 was a subsample of Study 1 and consisted of 109 providers. We used latent difference score modeling to examine changes in global child care quality from program entry to program departure and bivariate associations among changes in quality and professional engagement.

Results

Significant increases were found between pre- and post-enrollment assessments of caregiving quality and professional engagement. Increases in professional engagement were associated with increases in quality.

Conclusions

Findings are discussed in the context of the limited information available to guide quality improvement and professional development in family child care and in light of recommendations that the early childhood care and education field develop methods of training that embed knowledge and skills development in practice.     

Money ABC – Ein Programm für Grundschulkinder zur frühzeitigen Prävention von Verschuldung

Background

This paper reports on the development and evaluation of a prevention program to avoid indebtedness at an early stage of child development. The program, which was conceptualized for 4th graders, focuses on the improvement of financial knowledge and life-skills. It contains four modules related to financial knowledge and the improvement of delay of gratification, self-esteem, and resistance against influences of peers and media.

Aims

The program is expected to improve the financial knowledge of elementary school children. Moreover, the resources of the children are improved to enhance life-skills, which are expected to work against tendencies of becoming indebted.

Materials and methods

The program effects were evaluated with a sample of 199 children from three elementary schools. The training group consisted of 96 children, while 103 children served as the control group. The training group participated in a prevention program with three 90-min lessons.

Results and conclusion

It was shown that financial knowledge and resistance against influences of peers and media could be significantly improved in the training group. No substantial improvements were indicated for self-esteem and delay of gratification. The results are discussed with respect to program enhancements and possibilities to use the program in practice.     

A Study on the Role of Mobile Phone Communication in Tuberculosis DOTS Treatment

Background:

Every year, a lot of Tuberculosis (TB) patients undergo Directly Observed Treatment Short-course (DOTS) in Salem city, one of the high TB districts in South India. Mobile phone usage among these patients and health workers is common. Mobile phone communication has a great potential in TB treatment.

Objectives:

To analyze the mobile phone usage and its effectiveness in TB DOTS treatment.

Materials and Methods:

A cross-sectional survey with 150 TB patients was followed by a focus group discussion with treatment supervisors, DOTS providers, and health workers.

Results:

Majority of patients use mobile phones to make calls to health workers to clarify their doubts on side effects, food, and symptoms of the disease. TB treatment supervisors effectively use mobile phones to counsel patients to adhere to the treatment regimen. Patients see mobile phones as a useful communication tool in TB treatment though they prefer direct interpersonal communication with health workers. Though the mobile ownership is 68% among the TB patients, many of them are not able to send text messages or read messages in English.

Conclusion:

Mobile phone possession and usage is high among the patients. Patients need to be trained to use mobile phone features such as alarm, voice mail, and interactive voice response. Incentives like free talk time and short message service (SMS) will encourage patients to communicate frequently with health workers, thereby, increasing the chances of better adherence to DOTS. SMS could be made available in the regional languages.     

Tobacco use prevalence, knowledge and attitudes, and tobacco cessation training among medical students: results of a pilot study of Global Health Professions Students Survey (GHPSS) in Italy

Aim

The aims of this study were to examine tobacco use prevalence, knowledge and attitudes, and tobacco cessation training among students attending Italian medical schools using the Global Health Professions Student Survey approach and to identify possible factors associated with smoking status.

Subjects and Methods

A multicentre cross-sectional pilot study was carried out in five Italian Schools of Medicine from March to April 2009. Questionnaires were administered in anonymous, voluntary and self-administered form to third year students attending medical schools. The outcome measure was ??being a current smoker??. A logistic regression was used to evaluate possible factors associated with smoking status.

Results

The prevalence of current smokers was 31.4%. More than half considered health professionals as models for patients, and around 90% thought health professionals have a role in giving advice or information about smoking cessation. Only 5.8% of responders had received smoking cessation training during medical school. Medical students who considered healthcare professionals as behavioural models had lower likelihood of smoking (OR?=?0.52).

Conclusions

Given the high prevalence of smokers among medical students and the poorness of smoking cessation programmes, it is important to create tobacco control training programmes addressed to healthcare students.     

Public preferences for government spending in Canada

Introduction

Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor.

Methodology

A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India.

Results

Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear.

Conclusion

Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.     

Tuberculosis in the era of infection with the human immunodeficiency virus: assessment and comparison of community knowledge of both infections in rural Uganda

Background

In Uganda, despite a significant public health burden of tuberculosis (TB) in the context of high human immunodeficiency virus (HIV) prevalence, little is known about community knowledge of TB. The purpose of this study was to assess and compare knowledge about TB and HIV in the general population of western Uganda and to examine common knowledge gaps and misconceptions.

Methods

We implemented a multi-stage survey design to randomly survey 360 participants from one district in western Uganda. Weighted summary knowledge scores for TB and HIV were calculated and multiple linear regression (with knowledge score as the dependant variable) was used to determine significant predictors. Six focus group discussions were conducted to supplement survey findings.

Results

Mean (SD) HIV knowledge score was 58 (12) and TB knowledge score was 33 (15), both scores out of 100. The TB knowledge score was statistically significantly (p?<?0.001) lower. Multivariate regression models included age, sex, marital status, education, residence, and having a friend with HIV/TB as independent variables. TB knowledge was predicted by rural residence (coefficient?=??6.27, 95% CI: -11.7 to ?0.8), and age ≥45 years (coefficient?=?7.45, 95% CI: 0.3-14.6). HIV knowledge was only predicted by higher education (coefficient?=?0.94, 95%CI: 0.3-1.6). Focus group participants mentioned various beliefs in the aetiology of TB including sharing cups, alcohol consumption, smoking, air pollution, and HIV. Some respondents believed that TB was not curable.

Conclusion

TB knowledge is low and many misconceptions about TB exist: these should be targeted through health education programs. Both TB and HIV-infection knowledge gaps could be better addressed through an integrated health education program on both infections, whereby TB program managers include HIV information and vice versa.

     

Predictors of Home-Based Child Care Providers’ Participation in Professional Development Workshops and Coaching

Background

Little is known about factors that influence home-based child care providers’ participation in professional development. Factors that predict participation in activities that are designed to promote the utilization and maintenance of skills taught are of particular interest.

Objective

Our aim was to examine factors in the home-based child care context that might influence participation in professional development, including demographic variables, working conditions, preintervention skills and training, perceptions of workshop usefulness, and interpersonal factors such as job-related stress and depressive symptoms.

Methods

In this exploratory study, we examined predictors of participation among 67 home-based child care providers in Oregon, USA, who took part in the intervention group of a randomized efficacy study on a multiphase professional development program to promote preschoolers’ positive social development.

Results

Latent class analysis of participation resulted in three distinct groups: those who participated in the initial three workshops (WS), those who participated in workshops plus maintenance activities (consultation and a booster session, WS+), and those with little to no participation (NP). The NP group was too small to include in further analysis. A multivariate logistic regression model with child care provider education, number of preschool-age children enrolled in care, child-to-caregiver ratio, and self-reported stress included as predictors significantly improved classification in the WS+ group compared to the WS group.

Conclusions

These findings offer a preliminary look at the unique factors influencing home-based child care providers’ participation in extended professional development. Relevancy of content to child care providers’ situations appears to be important.     

Was limitiert schulische Tabakprävention?

Background

The school is seen as an important setting for tobacco prevention. What limitates the success of school-based preventive measures?

Instruments and methods

In a naturalistic-controlled cohort study, N?=?1359 students in fifth or sixth grade from college preparatory (“Gymnasium”), secondary modern (“Realschule”) or comprehensive secondary schools (“Gesamtschule”) participated in the universal educational program “Not smoking is cool!” (NiC). They were surveyed before the program as well as three and nine months after with standardized instruments on tobacco intake, academic achievements, and social behavior.

Results

NiC is effective in “Gymnasium” fifth-/sixth graders but shows, as expected, small effect sizes. The percentage of new smokers increased more strongly in the “Gymnasium” control than in the “Gymnasium” intervention group. Pre-existing tobacco intake, academic achievements and behavioral difficulties influenced NiC’s effectiveness regardless of school type.

Conclusions

Significant limitations on the effectiveness of a school-based tobacco prevention program in fifth-/sixth graders exist. These are risk factors that are not addressed by the intervention measure. NiC should be informed by selective and/or behaviour-based prevention program content when conducted in the less academically oriented secondary schools.     

A bibliometric analysis of toxicology research productivity in Middle Eastern Arab countries during a 10-year period (2003–2012)

Background

The key to universal coverage in tuberculosis (TB) management lies in community participation and empowerment of the population. Social infrastructure development generates social capital and addresses the crucial social determinants of TB, thereby improving program performance. Recently, there has been renewed interest in the concept of social infrastructure development for TB control in developing countries. This study aims to revive this concept and highlight the fact that documentation on ways to operationalize urban TB control is required from a holistic development perspective. Further, it explains how development of social infrastructure impacts health and development outcomes, especially with respect to TB in urban settings.

Methods

A wide range of published Government records pertaining to social development parameters and TB program surveillance, between 2001 and 2011 in Delhi, were studied. Social infrastructure development parameters like human development index along with other indicators reflecting patient profile and habitation in urban settings were selected as social determinants of TB. These include adult literacy rates, per capita income, net migration rates, percentage growth in slum population, and percentage of urban population living in one-room dwelling units. The impact of the Revised National Tuberculosis Control Program on TB incidence was assessed as an annual decline in new TB cases notified under the program. Univariate linear regression was employed to examine the interrelationship between social development parameters and TB program outcomes.

Results

The decade saw a significant growth in most of the social development parameters in the State. TB program performance showed 46% increment in lives saved among all types of TB cases per 100,000 population. The 7% reduction in new TB case notifications from the year 2001 to 2011, translates to a logarithmic decline of 5.4 new TB cases per 100,000 population. Except per capita income, literacy, and net migration rates, other social determinants showed significant correlation with decline in new TB cases per 100,000 population.

Conclusions

Social infrastructure development leads to social capital generation which engenders positive growth in TB program outcomes. Strategies which promote social infrastructure development should find adequate weightage in the overall policy framework for urban TB control in developing countries.     

Bewegung zur Prävention von Demenz

Background

Dementia diseases pose a global health problem. Recent studies show that physical activity can slow cognitive decline and delay the onset of dementia. In Germany there is a lack of evidence-based physical activity programs for preventing dementia.

Goals

The intervention study GESTALT investigated if and how an evidence-based physical activity program for preventing dementia could be implemented into the daily routines of prevention providers. The focus of this article is on the efficacy of the physical activity program regarding the cognitive and physical performance of the participants (65–75 years), as well as on the increase and retention of physical activity.

Methods

GESTALT included a multimodal exercise program and accompanying telephone support.

Results

GESTALT was successfully implemented by the prevention providers, and was well accepted by the participants. 60?% of the participants were practicing additional physical activity by the time of follow-up. There were improvements in cognitive performance with respect to short-term and working memory. Some participants met only a few risk factors for dementia.

Conclusions

The successful implementation suggests continuation and dissemination of GESTALT. In order to reach more people who have never engaged in physical activity and meet more risk factors for dementia, refined recruitment strategies are needed.     

Gesundheitsförderung bei Auszubildenden

Background

Because of their age and the entry into working life, trainees are in a phase of change. As health-related behaviours also consolidate in this part of life, sensitization for corresponding topics can contribute to health promotion of the future employees in the long term.

Methods

This study examines nutritional behaviour and physical activity as well as the general self-effectiveness expectations of trainees of a major company of the metal industry who participated in a health promotion program over an 11-month period. The participants’ satisfaction with the program was evaluated. In addition, health-related data of 51 male trainees were collected by a questionnaire.

Results

Significant results can be seen in the decrease of consumed portions of “extras” (soft drinks, snacks, chocolate) per day and in a significant increase of general self-effectiveness expectations. There were no changes relating to the intake of fruits, vegetables, whole-grain bread, fast food or physical activity. Overall, the program received highly positive feedback. The trainees acquired health-related knowledge skills. The majority of the trainees could be motivated to continue their occupation with the topics discussed and now has the intention to change some aspects of health-related behaviour in their daily routine.

Conclusion

The program has not shown direct and sudden effects on health behaviour in all of the investigated health-related topics. However, the early sensitization of the participants of corresponding topics as well as the increase in general self-effectiveness expectations might probably contribute to long-term health promotion of young employees.

     

Ressourcenst?rkendes Training f��r angehende und berufst?tige Lehrkr?fte an berufsbildenden Schulen

Background

Due to altered educational and socialization conditions, schools have to face new pedagogical/didactic and socially educative tasks which highlight possibilities as well as limits of pedagogical actions. They also impose a great burden on the personal competence and the expertise of teachers.

Aim

The aim of this paper was to develop an effective, preventive health care program, which contributes to an improvement in educational quality and which prepares teachers for working with vocational preparation year students or BVJ students (to be explained in a footnote).

Results

The evaluation of the tested instruction course providing increased resources for practicing teachers at vocational schools with the collaboration of teacher training students showed a high level of acceptance on the part of the participants. Significantly positive training effects could be attested with regard to the growth of knowledge, the increase of confidence, the assessment of expected personal effectiveness, and the time management of the participants.

Conclusion

The results confirm that the course training offers a primary preventive health benefit ensuring healthy and proficient teaching and learning throughout one??s working life.     

Clinical care for sexual assault survivors multimedia training: a mixed-methods study of effect on healthcare providers’ attitudes,knowledge, confidence,and practice in humanitarian settings

Background

Sexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, STIs, HIV, psychological trauma, and social stigma. In response, the International Rescue Committee developed a multimedia training tool to encourage competent, compassionate, and confidential clinical care for sexual assault survivors in low-resource settings. This study evaluated the effect of the training on healthcare providers’ attitudes, knowledge, confidence, and practices in four countries.

Methods

Using a mixed-methods approach, we surveyed a purposive sample of 106 healthcare providers before and 3 months after training to measure attitudes, knowledge, and confidence. In-depth interviews with 40 providers elaborated on survey findings. Medical record audits were conducted in 35 health facilities before and 3 months after the intervention to measure healthcare providers’ practice. Quantitative and qualitative data underwent statistical and thematic analysis.

Results

While negative attitudes, including blaming and disbelieving women who report sexual assault, did not significantly decrease among healthcare providers after training, respect for patient rights to self-determination and non-discrimination increased from 76% to 91% (p?<?.01) and 74% to 81% (p?<?.05) respectively. Healthcare providers’ knowledge and confidence in clinical care for sexual assault survivors increased from 49% to 62% (p?<?.001) and 58% to 73% (p?<?.001) respectively following training. Provider practice improved following training as demonstrated by a documented increase in eligible survivors receiving emergency contraception from 50% to 82% (p?<?.01), HIV post-exposure prophylaxis from 42% to 92% (p?<?.001), and STI prophylaxis and treatment from 45% to 96% (p?<?.01).

Conclusions

Although beliefs about sexual assault are hard to change, training can improve healthcare providers’ respect for patient rights and knowledge and confidence in direct patient care, resulting in more competent and compassionate clinical care for sexual assault survivors.

     

Pediatric Primary Care Providers’ Relationships with Mental Health Care Providers: Survey Results

Background

As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental health providers would differ in their care of patients with mental health concerns when compared to PPCPs not in such relationships.

Objective

To explore differences between PPCPs who have relationships with mental health care providers and those who do not with regard to their care of children with mental health concerns.

Methods

Seventy-two PPCPs completed a mailed survey addressing topics such as comfort levels diagnosing and managing patients with behavioral health disorders, perceived barriers to care, activity related to prescribing psychotropic medications, and availability of consultation with mental health specialists. More than one-third (19 providers) of providers reported no specialized training in behavioral pediatrics and nearly 45 % (32 providers) indicated having a relationship or partnership with a mental health specialist.

Results

Those providers who reported relationships indicated greater availability of consultation and communication with psychiatric providers as well as telephone consultation with non-psychiatric mental health providers. All providers were more comfortable assessing as opposed to treating children with disorders, with the exception of attention disorders, which providers were comfortable with both treating and assessing. For all conditions, there was no main effect for partnership.

Conclusion

While partnerships may be associated with greater availability of consultation and communication, for this sample of PPCPs there was no evidence of advantage with respect to diagnosis and management. The paper concludes with a discussion of study limitations, the need for further research, and suggestions for practice.     

Lives saved by tuberculosis control and prospects for achieving the 2015 global target for reducing tuberculosis mortality

Objective

To assess whether the global target of halving tuberculosis (TB) mortality between 1990 and 2015 can be achieved and to conduct the first global assessment of the lives saved by the DOTS/Stop TB Strategy of the World Health Organization (WHO).

Methods

Mortality from TB since 1990 was estimated for 213 countries using established methods endorsed by WHO. Mortality trends were estimated separately for people with and without human immunodeficiency virus (HIV) infection in accordance with the International classification of diseases. Lives saved by the DOTS/Stop TB Strategy were estimated with respect to the performance of TB control in 1995, the year that DOTS was introduced.

Findings

TB mortality among HIV-negative (HIV−) people fell from 30 to 20 per 100 000 population (36%) between 1990 and 2009 and could be halved by 2015. The overall decline (when including HIV-positive [HIV+] people, who comprise 12% of all TB cases) was 19%. Between 1995 and 2009, 49 million TB patients were treated under the DOTS/Stop TB Strategy. This saved 4.6–6.3 million lives, including those of 0.23–0.28 million children and 1.4–1.7 million women of childbearing age. A further 1 million lives could be saved annually by 2015.

Conclusion

Improvements in TB care and control since 1995 have greatly reduced TB mortality, saved millions of lives and brought within reach the global target of halving TB deaths by 2015 relative to 1990. Intensified efforts to reduce deaths among HIV+ TB cases are needed, especially in sub-Saharan Africa.     

Development and process evaluation of a web-based responsible beverage service training program

Background

Responsible beverage service (RBS) training designed to improve the appropriate service of alcohol in commercial establishments is typically delivered in workshops. Recently, Web-based RBS training programs have emerged. This report describes the formative development and subsequent design of an innovative Web-delivered RBS program, and evaluation of the impact of the program on servers’ knowledge, attitudes, and self-efficacy.

Methods

Formative procedures using focus groups and usability testing were used to develop a Web-based RBS training program. Professional alcohol servers (N?=?112) who worked as servers and/or mangers in alcohol service settings were recruited to participate. A pre-post assessment design was used to assess changes associated with using the program.

Results

Participants who used the program showed significant improvements in their RBS knowledge, attitudes, and self-efficacy.

Conclusions

Although the current study did not directly observe and determine impact of the intervention on server behaviors, it demonstrated that the development process incorporating input from a multidisciplinary team in conjunction with feedback from end-users resulted in creation of a Web-based RBS program that was well-received by servers and that changed relevant knowledge, attitudes, and self-efficacy. The results also help to establish a needed evidence base in support of the use of online RBS training, which has been afforded little research attention.

     

Consensus statement on dementia education and training in Europe

Objectives

The aim of the current statement is to agree on: (1) what is the current situation with education and training on dementia in Europe; (2) what are the minimum educational requirements for professionals (neurologists, psychiatrists, primary care providers, nurses, biologists, neuroradiologists, etc.) regarding Alzheimer’s disease and dementia, and (3) how to start a course of action for the future.

Design

In 2005, a simple questionnaire was sent to members of the European Alzheimer’s Disease Consortium (EADC) concerning the education and training on dementia in their countries. Fourteen universities of the respective countries responded to this simple questionnaire. The answers varied, and the conclusion of this effort was that little was done concerning the training of students and health professionals on dementia. In 2008, another more structured and specified questionnaire was sent to professors in different universities of the same countries.

Results

The answers obtained were different from those of the previous questionnaire and demonstrated that it is very difficult to know about training and education in the field of dementia in every European country.

Conclusion

From the data collected, it seems that although in the recent past little had been done concerning training on dementia, nowadays training has been developed in most European countries, and relevant educational projects exist both for medical students and doctors during their specialty training. Our main purpose is to develop training material or develop specific courses to improve the professional knowledge about dementia so that best medical and non-medical practice is implemented.