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1.
Time to delivery: Transfers for threatened preterm labour and prelabour rupture of membranes in Western Australia
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Jade Hollingworth MBBS BSc Rachel Pietsch MBBS BSc Mathias Epee‐Bekima MD MRCOG FRANZCOG Elizabeth Nathan M.Biostat 《The Australian journal of rural health》2018,26(1):42-47
Objective
To describe the outcomes of patients transferred to King Edward Memorial Hospital (KEMH) with signs of labour at preterm gestations.Design
A retrospective observational study of the 69 cases transferred to KEMH during 2015.Setting
Patient transfers from all locations across Western Australia (WA) to the sole tertiary perinatal centre in Perth.Participants
Pregnant women within WA with threatened or actual preterm labour (PTL) or preterm prelabour rupture of membranes (PPROM) between 23 and 32 weeks gestation.Main outcome measures
The occurrence of delivery during the admission and time‐to‐delivery as well as length of admission and association between clinical factors and time‐to‐delivery.Results
The percentage of the study population delivered during the admission following transfer was 72.5%. Eighty‐six per cent of those who delivered did so within 72 hours of transfer. The median time from transfer to delivery was 1 day. Sixty‐three per cent of those who did not deliver during the admission progressed to 36 weeks gestation. Patients transferred with PPROM were less likely to deliver during the admission compared to those with uterine activity (50% versus 19.6%, P = 0.007) and nulliparas were more likely to deliver (93.5% versus 55.3%, P < 0.001).Conclusion
The majority of women transferred with signs of PTL progress to delivery during the same admission with the highest risk of delivery being the first 72 hours following transfer. If the pregnancy is ongoing at 72 hours, there is a reasonable chance of progression to late preterm gestation supporting the return of woman to their place of origin for antenatal care following discharge. 相似文献2.
3.
The use of haematopoietic stem cell transplantation in Fanconi anaemia patients: a survey of decision making among families in the US and Canada
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Sadie P. Hutson PhD RN WHNP BC Paul K. J. Han MD MA MPH Jada G. Hamilton PhD MPH Sean C. Rife MA Mohamad M. Al‐Rahawan MD MPH Richard P. Moser PhD Seth P. Duty RN BSN Sheeba Anand MPH Blanche P. Alter MD MPH 《Health expectations》2015,18(5):929-941
Background
Fanconi anaemia (FA) is a rare genetic disorder associated with bone marrow failure (BMF), congenital anomalies and cancer susceptibility. Stem cell transplantation (SCT) offers a potential cure for BMF or leukaemia, but incurs substantial risks. Little is known about factors influencing SCT decision making.Objective
The study objective was to explore factors influencing patients' with FA and family members' decision making about SCT.Design
Using a mixed‐methods exploratory design, we surveyed US and Canadian patients with FA and family members who were offered SCT.Main variables studied
Closed‐ended survey items measured respondents' beliefs about the necessity, risks and concerns regarding SCT; multivariable logistic regression was used to examine the association between these factors and the decision to undergo SCT. Open‐ended survey items measured respondents' perceptions of factors important to the SCT decision; qualitative analysis was used to identify emergent themes.Results
The decision to undergo SCT was significantly associated with greater perceived necessity (OR = 2.81, P = 0.004) and lower concern about harms of SCT (OR = 0.31, P = 0.03). Qualitative analysis revealed a perceived lack of choice among respondents regarding the use of SCT, which was related to physician influence and respondent concerns about patients' quality of life.Conclusions
Overall, study results emphasize the importance of the delicate interplay between provider recommendation of a medical procedure and patient/parental perceptions and decision making. Findings can help providers understand the need to acknowledge family members' perceptions of SCT decision making and offer a comprehensive discussion of the necessity, risks, benefits and potential outcomes. 相似文献4.
5.
Aileen Chou PT DPT Joshua K. Johnson DPT PhD Daniel B. Jones PhD Tracey Euloth MPT Beth A. Matcho PT Andrew Bilderback MS Janet K. Freburger PT PhD 《Health services research》2023,58(Z1):51-62
Objective
To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission.Data Sources
EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017–February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019–July 2021).Study Design
We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted.Data Extraction
We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay.Principal Findings
In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI −0.57, −0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β = 0.01; 95% CI −0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI −0.88, −0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA.Conclusions
Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments. 相似文献6.
Jinjiao Wang PhD RN Jenny Y. Shen MD Yeates Conwell MD Eric J. Podsiadly BA Thomas V. Caprio MD MPH MS Kobi Nathan PharmD Fang Yu PhD RN GNP-BC FGSA FAAN Erika E. Ramsdale MD Donna M. Fick PhD FAAN Amanda S. Mixon MD MS MSPH Sandra F. Simmons PhD 《Health services research》2023,58(Z1):123-138
Objective
To assess how age-friendly deprescribing trials are regarding intervention design and outcome assessment. Reduced use of potentially inappropriate medications (PIMs) can be addressed by deprescribing—a systematic process of discontinuing and/or reducing the use of PIMs. The 4Ms—“Medication”, “Mentation”, “Mobility”, and “What Matters Most” to the person—can be used to guide assessment of age-friendliness of deprescribing trials.Data Source
Published literature.Study Design
Scoping review.Data Extraction Methods
The literature was identified using keywords related to deprescribing and polypharmacy in PubMed, EMBASE, Web of Science, ProQuest, CINAHL, and Cochrane and snowballing. Study characteristics were extracted and evaluated for consideration of 4Ms.Principal Findings
Thirty-seven of the 564 trials identified met the review eligibility criteria. Intervention design: “Medication” was considered in the intervention design of all trials; “Mentation” was considered in eight trials; “Mobility” (n = 2) and “What Matters Most” (n = 6) were less often considered in the design of intervention. Most trials targeted providers without specifying how matters important to older adults and their families were aligned with deprescribing decisions. Outcome assessment: “Medication” was the most commonly assessed outcome (n = 33), followed by “Mobility” (n = 13) and “Mentation” (n = 10) outcomes, with no study examining “What Matters Most” outcomes.Conclusions
“Mentation” and “Mobility”, and “What Matters Most” have been considered to varying degrees in deprescribing trials, limiting the potential of deprescribing evidence to contribute to improved clinical practice in building an age-friendly health care system. 相似文献7.
8.
Patient and public perspectives of community pharmacies in the United Kingdom: A systematic review
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Ali M. K. Hindi BPharm MSc Ellen I. Schafheutle PhD MRes MSc FFRPS Sally Jacobs BSc PhD 《Health expectations》2018,21(2):409-428
Background
The United Kingdom has been at the forefront of enhancing pharmacist roles and community pharmacy services, particularly over the past decade. However, patient and public awareness of community pharmacy services has been limited.Objective
To identify and synthesize the research literature pertaining to patient and public perspectives on: existing community pharmacy services, extended pharmacist roles and strategies to raise awareness of community pharmacy services.Search strategy
Systematic search of 8 electronic databases; hand searching of relevant journals, reference lists and conference proceedings.Inclusion criteria
UK studies investigating patient or public views on community pharmacy services or pharmacist roles from 2005 to 2016.Data extraction and synthesis
Data were extracted into a grid and subjected to narrative synthesis following thematic analysis.Main results
From the 3260 unique papers identified, 30 studies were included. Manual searching identified 4 additional studies. Designs using questionnaires (n = 14, 41%), semi‐structured interviews (n = 8, 24%) and focus groups (n = 6, 18%) made up the greatest proportion of studies. Most of the studies (n = 28, 82%) were published from 2010 onwards and covered perceptions of specific community pharmacy services (n = 31). Using a critical appraisal checklist, the overall quality of studies was deemed acceptable. Findings were grouped into 2 main themes “public cognizance” and “attitudes towards services” each with 4 subthemes.Discussion and conclusions
Patients and the public appeared to view services as beneficial. Successful integration of extended pharmacy services requires pharmacists’ clinical skills to be recognized by patients and physicians. Future research should explore different approaches to increase awareness. 相似文献9.
Developing and testing a brief clinic‐based lung cancer screening decision aid for primary care settings
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Karen Kane McDonnell PhD RN OCN Scott M. Strayer MD MPH Erica Sercy MSPH Callie Campbell BA Daniela B. Friedman PhD Kathleen B. Cartmell PhD MPH Jan M. Eberth PhD 《Health expectations》2018,21(4):796-804
Background
Cancer screening‐related decisions require patients to evaluate complex medical information in short time frames, often with primary care providers (PCPs) they do not know. PCPs play an essential role in facilitating comprehensive shared decision making (SDM).Objective
To develop and test a decision aid (DA) and SDM strategy for PCPs and high‐risk patients.Design
The DA was tested with 20 dyads. Each dyad consisted of one PCP and one patient eligible for screening. A prospective, one‐group, mixed‐method study design measured fidelity, patient values, screening intention, acceptability and satisfaction.Results
Four PCPs and 20 patients were recruited from an urban academic medical centre. Most patients were female (n = 14, 70%), most had completed high school (n = 15, 75%), and their average age was 65 years old. Half were African American. Patients and PCPs rated the DA as helpful, easy to read and use and acceptable in terms of time frame (observed t = 11.6 minutes, SD 2.7). Most patients (n = 16, 80%) indicated their intent to be screened. PCPs recommended screening for most patients (n = 17, 85%).Conclusions
Evidence supports the value of lung cancer screening with LDCT for select high‐risk patients. Guidelines endorse engaging patients and their PCPs in SDM discussions. Our findings suggest that using a brief, interactive, plain‐language, culturally sensitive, theory‐based DA and SDM strategy is feasible, acceptable and may be essential to effectively translate and sustain the adoption of LDCT screening recommendations into the clinic setting. 相似文献10.
Objective
To illustrate the association between the sociodemographic characteristics of hospital markets and the geographic patterns of Medicare hospital value-based purchasing (HVBP) scores.Data Sources and Study Setting
This is a secondary analysis of United States hospitals with a HVBP Total Performance Score (TPS) for 2019 in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare database (4/2021 release) and American Community Survey (ACS) data for 2015–2019.Study Design
This is a cross-sectional study using spatial multivariable autoregressive models with HVBP TPS and component domain scores as dependent variables and hospital market demographics as the independent variables.Data Collection/Extraction Methods
We calculated hospital market demographics using ZIP code level data from the ACS, weighted the 2019 CMS inpatient Hospital Service Area file.Principal Findings
Spatial autoregressive models using eight nearest neighbors with diversity index, race and ethnicity distribution, families in poverty, unemployment, and lack of health insurance among residents ages 19–64 years provided the best model fit. Diversity index had the highest statistically significant contribution to lower TPS (ß = −12.79, p < 0.0001), followed by the percent of the population coded to “non-Hispanic, some other race” (ß = −2.59, p < 0.0023), and the percent of families in poverty (ß = −0.26, p < 0.0001). Percent of the population was non-Hispanic American Indian/Alaskan Native (ß = 0.35, p < 0.0001) and percent non-Hispanic Asian (ß = 0.12, p < 0.02071) were associated with higher TPS. Lower predicted TPS was observed in large urban cities throughout the US as well as in states throughout the Southeastern US. Similar geographic patterns were observed for the predicted Patient Safety, Person and Community Engagement, and Efficiency and Cost Reduction domain scores but are not for predicted Clinical Outcomes scores.Conclusions
The lower predicted scores seen in cities and in the Southeastern region potentially reflect an inherent—that is, structural—association between market sociodemographics and HVBP scores. 相似文献11.
Lindsay N. Avolio Tyler J. S. Smith Ana Navas-Acien Kate Kruczynski Nora Pisanic Pranay R. Randad Barbara Detrick Rebecca C. Fry Alexander van Geen Walter Goessler Ruth A. Karron Sabra L. Klein Elizabeth L. Ogburn Marsha Wills-Karp Kelsey Alland Kaniz Ayesha Brian Dyer Md. Tanvir Islam Habibat A. Oguntade Md. Hafizur Rahman Hasmot Ali Rezwanul Haque Saijuddin Shaikh Kerry J. Schulze A. K. M. Muraduzzaman A. S. M. Alamgir Meerjady S. Flora Keith P. West Jr. Alain B. Labrique Christopher D. Heaney for the JiVitA Maternal Child Health Nutrition Research Project 《Paediatric and perinatal epidemiology》2023,37(2):165-178
Background
Arsenic exposure and micronutrient deficiencies may alter immune reactivity to influenza vaccination in pregnant women, transplacental transfer of maternal antibodies to the foetus, and maternal and infant acute morbidity.Objectives
The Pregnancy, Arsenic, and Immune Response (PAIR) Study was designed to assess whether arsenic exposure and micronutrient deficiencies alter maternal and newborn immunity and acute morbidity following maternal seasonal influenza vaccination during pregnancy.Population
The PAIR Study recruited pregnant women across a large rural study area in Gaibandha District, northern Bangladesh, 2018–2019.Design
Prospective, longitudinal pregnancy and birth cohort.Methods
We conducted home visits to enrol pregnant women in the late first or early second trimester (11–17 weeks of gestational age). Women received a quadrivalent seasonal inactivated influenza vaccine at enrolment. Follow-up included up to 13 visits between enrolment and 3 months postpartum. Arsenic was measured in drinking water and maternal urine. Micronutrient deficiencies were assessed using plasma biomarkers. Vaccine-specific antibody titres were measured in maternal and infant serum. Weekly telephone surveillance ascertained acute morbidity symptoms in women and infants.Preliminary Results
We enrolled 784 pregnant women between October 2018 and March 2019. Of 784 women who enrolled, 736 (93.9%) delivered live births and 551 (70.3%) completed follow-up visits to 3 months postpartum. Arsenic was detected (≥0.02 μg/L) in 99.7% of water specimens collected from participants at enrolment. The medians (interquartile ranges) of water and urinary arsenic at enrolment were 5.1 (0.5, 25.1) μg/L and 33.1 (19.6, 56.5) μg/L, respectively. Water and urinary arsenic were strongly correlated (Spearman's ⍴ = 0.72) among women with water arsenic ≥ median but weakly correlated (⍴ = 0.17) among women with water arsenic < median.Conclusions
The PAIR Study is well positioned to examine the effects of low-moderate arsenic exposure and micronutrient deficiencies on immune outcomes in women and infants. Registration : NCT03930017. 相似文献12.
Olöf Birna Kristjansdottir PhD Una Stenberg PhD Jelena Mirkovic PhD Tonje Krogseth RN Tone Marte Ljoså PhD Kurt C. Stange PhD Cornelia M. Ruland PhD 《Health expectations》2018,21(4):787-795
Background
Self‐management of chronic illness can be highly demanding and people need to mobilize their personal strengths to live well with their condition. More knowledge is needed about how people with chronic illness perceive and use their personal strengths as a basis for better integrating empowering person‐centred approaches into health care.Objective
To explore what people with chronic illness describe as their strengths relevant to their health and well‐being.Setting and Participants
Thirty‐nine participants (11 men) from 4 outpatient self‐management programmes were recruited to individual or group interviews. Participants included patients with chronic respiratory disease (n = 7), chronic pain (n = 18) and morbid obesity (n = 14). Interviews were analysed using content analysis.Results
A number of personal strengths were reported and categorized into 3 domains: (i) Internal strengths, (ii) External strengths and (iii) Self‐management strategies. Internal strengths included being persistent, having a positive outlook, being kind and caring, experiencing positive emotions, being kind towards oneself, reconciling oneself with the situation, having courage and having knowledge and insight. External strengths included support from family, friends, peers and health‐care providers. Self‐management strategies included being active, planning and prioritizing, reducing stress, goal setting and seeking knowledge and help.Discussion and Conclusion
The study provides insights into personal strengths as reported by people with chronic illness. The results complement prior findings on strengths in people with health challenges and can aid in incorporating person‐centred approaches into health care. 相似文献13.
Reliability and validity of the Korean‐language version of the Communication Function Classification System in children with cerebral palsy
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Purpose
The Communication Function Classification System (CFCS) and Viking Speech Scale (VSS) are useful systems for describing the broad communication function and speech intelligibility, respectively, of children with cerebral palsy (CP). The aims of this study were to determine the reliability and validity of the Korean version of the CFCS and also to investigate the association between the CFCS and the VSS and other functional classifications for children with CP.Materials and methods
Participants were 50 children with CP (33 males, 17 females; mean age 7.2 years, range 4–16 years) recruited from a rehabilitation hospital. We analysed the interrater and intrarater reliabilities of the Korean version of the CFCS and VSS between parents, a physiatrist, and a speech–language pathologist (SLP). The social function domain of the Paediatric Evaluation of Disability Inventory was assessed to examine the concurrent validity of the CFCS and VSS.Results
The intrarater reliabilities of the CFCS and VSS were excellent in a physiatrist (? = 0.92, ? = 0.94, respectively) and an SLP (? = 0.98, ? = 0.98) and very good in parents (? = 0.87, ? = 0.89). The interrater reliability of the CFCS and VSS was very good between the physiatrist and SLP (? = 0.87, ? = 0.89) and good between parents and the SLP (? = 0.63, ? = 0.78) and between parents and the physiatrist (? = 0.61, ? = 0.76). The CFCS and VSS were strongly related with the social function domain of Paediatric Evaluation of Disability Inventory. In addition, we found very strong associations between the VSS and CFCS.Conclusions
The Korean version of the CFCS is a valid and reliable tool to classify communication ability and is strongly associated with the VSS, a reliable tool to classify speech intelligibility. 相似文献14.
S. Hirayama K. Terasawa R. Rabeler T. Hirayama T. Inoue Y. Tatsumi M. Purpura R. Jäger 《Journal of human nutrition and dietetics》2014,27(Z2):284-291
Background
Attention‐deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioural disorder of childhood, affecting 3–5% of school‐age children. The present study investigated whether the supplementation of soy‐derived phosphatidylserine (PS), a naturally occurring phospholipid, improves ADHD symptoms in children.Methods
Thirty six children, aged 4–14 years, who had not previously received any drug treatment related to ADHD, received placebo (n = 17) or 200 mg day–1 PS (n = 19) for 2 months in a randomised, double‐blind manner. Main outcome measures included: (i) ADHD symptoms based on DSM‐IV‐TR; (ii) short‐term auditory memory and working memory using the Digit Span Test of the Wechsler Intelligence Scale for Children; and (iii) mental performance to visual stimuli (GO/NO GO task).Results
PS supplementation resulted in significant improvements in: (i) ADHD (P < 0.01), AD (P < 0.01) and HD (P < 0.01); (ii) short‐term auditory memory (P < 0.05); and (iii) inattention (differentiation and reverse differentiation, P < 0.05) and inattention and impulsivity (P < 0.05). No significant differences were observed in other measurements and in the placebo group. PS was well‐tolerated and showed no adverse effects.Conclusions
PS significantly improved ADHD symptoms and short‐term auditory memory in children. PS supplementation might be a safe and natural nutritional strategy for improving mental performance in young children suffering from ADHD. 相似文献15.
Sissel Jessen Weissert Ellen Margrethe Mikkelsen Bjarke H. Jacobsen Elizabeth E. Hatch Amelia K. Wesselink Lauren A. Wise Kenneth J. Rothman Henrik T. Sørensen Anne Sofie Dam Laursen 《Paediatric and perinatal epidemiology》2023,37(1):57-68
Background
Little is known about potential health effects of eating organic food in relation to reproduction.Objective
We examined associations between organic food consumption and fecundability.Methods
Data were derived from a preconception cohort study of Danish couples trying to conceive (SnartForældre.dk, SF). Participants completed a baseline questionnaire on socio-demographics, anthropometrics and lifestyle and a validated food-frequency questionnaire, which included questions on proportions of organic food consumed within six food groups. Participants were followed up with bimonthly questionnaires for up to 12 months or until pregnancy. Analyses were restricted to 2061 participants attempting pregnancy for ≤6 cycles at enrollment and 1303 with <3 cycles. Fecundability ratios (FRs) and 95% confidence intervals (CI) were estimated by proportional probabilities regression models adjusted for potential confounders including age, lifestyle and socioeconomic factors. Associations were examined for vegetables, fruits, cereals, dairy products, eggs and meat, separately, and for the overall pattern of organic food consumption (organic sum score).Results
The final analytic sample comprised 2069 participants. In the full cohort, organic food consumption was not meaningfully associated with fecundability. Among participants <3 cycles of pregnancy attempt at study entry (n = 1303), the FR was 1.11 (95% CI 0.93, 1.33) for the category ‘less than half’, for ‘more than half’ the FR was 1.17 (95% CI 0.99, 1.38) and for ‘almost everything’ the FR was 1.12 (95% CI 0.97, 1.28).Conclusion
Higher consumption of organic foods was not meaningfully associated with fecundability, although slightly greater fecundability was seen among participants with <3 cycles of pregnancy attempt time. 相似文献16.
Aucouturier J Isacco L Thivel D Fellmann N Chardigny JM Duclos M Duché P 《Clinical nutrition (Edinburgh, Scotland)》2011,30(6):780-785
Background & aims
Exercise induces adaptations in fat metabolism favourable to the treatment of obesity. However, time interval between meal and exercise alters substrate bioavailability and oxidation during exercise. The aim of this study was therefore to investigate the effect of time interval between food intake and exercise on substrate oxidation rates in obese and lean children.Methods
The metabolic responses to exercise of nine obese children (10.3 ± 1.8 years; %body fat: 36.1 ± 6.1) and seven lean children (9.2 ± 1.6 years; %body fat: 22.2 ± 4.1) were compared 1 h (time interval 1, TI1) and 3 h (TI3) after a standardized breakfast.Results
Despite significantly lower plasma glucose and insulin concentrations and large effect size suggesting a higher plasma FFA availability (lean, 1.43, obese 0.98), fat oxidation was not significantly increased in TI3 compared to TI1 in both lean and obese children. Fat oxidation contributed marginally to energy expenditure during exercise (<20%) in both conditions and groups but was moderately increased during TI3 compared to TI1 in lean children (effect size: 0.54).Conclusions
The low contribution of fat oxidation to energy expenditure during exercise in obese and lean children fed 3 h before exercise questions the efficacy of moderate intensity exercise to favourably affect fat balance. 相似文献17.
K. Simpson D. Keen D. Adams C. Alston‐Knox J. Roberts 《Child: care, health and development》2018,44(1):99-107
Background
Children on the autism spectrum participate less frequently, and in a narrower range of activities, than their nonautistic peers, but little is known about exact participation patterns across contexts or how this is perceived by caregivers. This study aimed to document patterns of participation and caregiver views with regard to frequency and intensity of activities.Method
Caregivers of children on the spectrum aged 5 (n = 90) and 9–10 years (n = 128) completed the Participation and Environment Measure for Children and Youth for home, school, and community. Caregivers reported on frequency of child's participation, level of involvement, and caregivers' desire for change in participation patterns.Results
Item‐level analyses revealed similar patterns of participation across home, school, and community for both cohorts with some small age‐appropriate differences. Caregivers generally desired increased diversity, frequency, and involvement in activities but a decreased use of electronics (computers, games, TV, and DVDs).Conclusion
The possibility of autism‐specific participation patterns could inform future interventions aimed at enhancing social inclusion. This warrants further investigation through multiinformant designs that seek the perspectives of the child and caregivers. 相似文献18.
19.
The impact of social deprivation on the response to a randomised controlled trial of a weight management intervention (BeWEL) for people at increased risk of colorectal cancer
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A. Fisher A. M. Craigie M. Macleod R. J. C. Steele A. S. Anderson 《Journal of human nutrition and dietetics》2018,31(3):306-313
Background
Although 45% of colorectal cancer (CRC) cases may be avoidable through appropriate lifestyle and weight management, health promotion interventions run the risk of widening health inequalities. The BeWEL randomised controlled trial assessed the impact of a diet and activity programme in overweight adults who were diagnosed with a colorectal adenoma, demonstrating a significantly greater weight loss at 12 months in intervention participants than in controls. The present study aimed to compare BeWEL intervention outcomes by participant deprivation status.Methods
The intervention group of the BeWEL trial (n = 163) was classified by the Scottish Index of Multiple Deprivation (SIMD) quintiles into ‘more deprived’ (SIMD 1–2, n = 58) and ‘less deprived’ (SIMD 3–5, n = 105). Socio‐economic and lifestyle variables were compared at baseline to identify potential challenges to intervention adherence in the more deprived. Between group differences at 12 months in primary outcome (change in body weight) and secondary outcomes (cardiovascular risk factors, diet, physical activity, knowledge of CRC risk and psychosocial variables) were assessed by deprivation status.Results
At baseline, education (P = 0.001), income (P < 0.001), spending on physical activity (P = 0.003) and success at previous weight loss attempts (P = 0.007) were significantly lower in the most deprived. At 12 months, no between group differences by deprivation status were detected for changes in primary and main secondary outcomes.Conclusions
Despite potential barriers faced by the more deprived participants, primary and most secondary outcomes were comparable between groups, indicating that this intervention is unlikely to worsen health inequalities and is equally effective across socio‐economic groups. 相似文献20.
No difference in self‐reported frequency of choking between infants introduced to solid foods using a baby‐led weaning or traditional spoon‐feeding approach
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A. Brown 《Journal of human nutrition and dietetics》2018,31(4):496-504