Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance.

The purpose of this study was to investigate the effectiveness, dynamics, and consequences of a health education intervention designed to increase patient question asking during the patient's medical visit. Data were collected at a Baltimore family and community health center which provides outpatient services to a low income, predominantly black and female population. The majority of the study participants were, in addition, elderly and chronically ill. A total of 294 patients and 3 providers took part in the study. The study design included random assignment of patients to experimental and placebo groups with two non-equivalent (non-randomized) control groups. Findings included: (1) The experimental group patients asked more direct questions and fewer indirect questions than did placebo group patients. (2) The experimental group patient-provider interaction was characterized by negative affect, anxiety, and anger, while the placebo group patient-provider interaction was characterized as mutually sympathetic. (3) The experimental group patients were less satisfied with care received in the clinic on the day of their visit than were placebo patients. (4) The experimental group patients demonstrated higher appointment-keeping ratios (an average number of appointments kept divided by an average number of appointments made) during a four-month prospective monitoring period.     

提高男性避孕节育知识知晓率和避孕套使用率的干预性试验

目的:提高已婚男性对计划生育及生殖健康知识的知晓程度,促进男性避孕套的使用。方法:根据基线调查和集体访谈所提供的信息,制定并实施干预计划,在试点厂开展包括专家讲座、咨询服务、宣传折页发放、知识竞赛等内容的干预活动。干预试验结束后,进行终点调查。资料经审核校对后用SAS软件包分析处理。结果:干预后①试点厂男性对男用避孕方法中的体外排精、绝育知晓率极显著高于对照厂(P<0.01),对女用避孕方法中的口服避孕药、绝育、安全期避孕知晓率极显著高于对照厂(P<0.01),宫内节育器、皮下埋植剂、杀精剂、紧急避孕法知晓率,试点厂显著高于对照厂(P<0.05);②试点厂男性知道避孕方法种类的比例极显著高于对照厂(P<0.01);③试点厂男性已生育对象避孕套使用比例显著高于对照厂(P<0.05),试点厂男性已生育对象最后一次性生活使用避孕套的比例极显著高于对照厂(P<0.01);④试点厂男性了解现用避孕方法的避孕原理和优缺点的比例增加。结论:鼓励和推动男性参与的干预项目是成功的,通过开展宣传教育等多种形式的干预活动,提高了男性对计划生育及生殖健康知识的知晓程度以及参与计划生育的意识和责任感,并促进了男性避孕套的使用。     

Effects of home visits by home nurses to elderly people with health problems: design of a randomised clinical trial in the Netherlands [ISRCTN92017183]

BACKGROUND: Preventive home visits to elderly people by public health nurses aim to maintain or improve the functional status of elderly and reduce the use of institutional care services. A number of trials that investigated the effects of home visits show positive results, but others do not. The outcomes can depend on differences in characteristics of the intervention programme, but also on the selection of the target population. A risk group approach seems promising, but further evidence is needed. We decided to carry out a study to investigate the effects in a population of elderly with (perceived) poor health rather than the general population. Also, we test whether nurses who are qualified at a lower professional level (home nurses instead of public health nurses) are able to obtain convincing effects. The results of this study will contribute to the discussion on effective public health strategies for the aged. METHODS/DESIGN: The study is carried out as a parallel group randomised trial. To screen eligible participants, we sent a postal questionnaire to 4901 elderly people (70-84 years) living at home in a town in the south of the Netherlands. After applying inclusion criteria (e.g., self-reported poor health status) and exclusion criteria (e.g., those who already receive home nursing care), we selected 330 participants. They entered the randomisation procedure; 160 were allocated to the intervention group and 170 to the control group. The intervention consists of (at least) 8 systematic home visits over an 18 months period. Experienced home nurses from the local home care organisation carry out the visits. The control group receives usual care. Effects on health status are measured by means of postal questionnaires after 12 months, 18 months (the end of the intervention period) and after 24 months (the end of 6-months follow-up), and face-to-face interviews after 18 months. Data on mortality and service use are continuously registered during 24 months. A cost-benefit analysis is included. The design and setting of the study, the selection of eligible participants and the study interventions are described in this article. Other included items are: the primary and secondary outcome measures, the statistical analysis and the economic evaluation.     

Can Women Facilitate Men’s Prostate Cancer Screening Informed Decision-Making? The M-PACT Trial

The M-PACT study compared an all-male with a mixed-sex intervention to increase informed decision-making for prostate cancer screening among African-American men in church settings. We recruited 262 men in 18 churches randomized to the two intervention approaches. Trained and certified lay peer community health advisors in each church led a series of four men’s health workshops on informed decision-making for prostate cancer screening. African-American male workshop participants completed baseline, post-workshop, and 12-month follow-up surveys. Contrary to our expectations, including women in the workshops did not result in increased intervention efficacy for the informed decision-making outcomes as both groups showed significant improvement over time in several study outcomes including stage of decision-making for prostate cancer screening, preference for role in decision-making, prostate cancer knowledge, and self-reports of prostate specific antigen testing. Finally, men who attended multiple workshops had better informed decision-making outcomes on several indicators. The current findings suggest mixed results from including women in this men’s health educational intervention. Future work should consider optimal ways of providing family support for African-American men’s health promotion.     

Capturing intervention effects over time: reanalysis of a critical time intervention for homeless mentally ill men

OBJECTIVES: We analyzed whether a method for identifying latent trajectories--latent class growth analysis (LCGA)--was useful for understanding outcomes for individuals subject to an intervention. METHODS: We used LCGA to reanalyze data from a published study of mentally ill homeless men in a critical time intervention (CTI) program. In that study, 96 men leaving a shelter's on-site psychiatric program were randomly assigned to experimental and control groups. The former received CTI services and the latter usual services. Each individual's housing circumstances were observed for 18 months after program initiation. Our outcome measure was monthly homelessness: a person was considered homeless in a month if he was homeless for even 1 night that month. RESULTS: Four latent classes were found among the control group, but just 3 among the experimental group. Control, but not experimental, group individuals showed a small class of chronically homeless men. The size of the never-homeless class was 19 percentage points larger for the experimental than for the control group. J- and inverted-U-shaped patterns were also found among both groups, but with important differences in timing of patterns. CONCLUSIONS: Our results reveal effects not apparent in the original analysis, suggesting that latent class growth models improve intervention evaluation.     

Pre-randomisation in study designs: getting past the taboo

In October 2006 the Dutch Ministry of Health, Welfare and Sport announced that the use of pre-randomisation in study designs is admissible and not in conflict with the Dutch Medical Research in Human Subjects Act. With pre-randomisation, the conventional sequence of obtaining informed consent followed by randomisation is reversed. According to the original pre-randomisation design (Zelen design), participants are randomised before they are asked to consent; after randomisation, only participants in the experimental group are asked to consent to treatment and effect measurement. In the past, pre-randomisation has seldom been used, and when it was, it was often under the wrong circumstances. Awareness regarding the ethical, legal and methodological objections to pre-randomisation is increasing. About a decade ago, we illustrated the applicability and acceptability of pre-randomisation by means of a fictitious heroin provision trial. In general, pre-randomisation is justified if valid evaluation of the effects of an intervention is impossible using a conventional randomised design, e.g., if knowledge of the intervention may lead to non-compliance or drop-out in the control group, or when the intervention is an educational programme. Other requirements for pre-randomisation include the following: the study has a clinically relevant objective, it is likely that the study will lead to important new insights, the informed consent procedure bears no potential harm to participants, at least standard care is offered to participants in the control group, and the approval of an independent research ethics committee is obtained.     

The stepped wedge design

Not all questions concerning therapeutic effects in medical research can be answered satisfactorily by standard trials. The stepped wedge cluster design is a special form of randomised study in which an intervention at group level is implemented in stages. The design can be used in situations where randomization at the patient level is inappropriate or impossible and where a stepped implementation of the experimental intervention is important for ethical, logistic or financial reasons. The time before the experimental intervention is introduced in a cluster is used as control period. The statistical analysis of cluster trials should account for the fact that individuals within clusters may show many similarities. Ethical aspects of stepped wedge design should be considered carefully, especially when obtaining individual informed consent is not possible.     

Evaluation of the effect of a patient decision aid about vasectomy on the decision-making process: a randomized trial

BackgroundBetween 7% and 10% of men who choose vasectomy as a contraceptive method regret their decision. This study evaluates the effect of a patient decision aid (PtDA) designed to help men decide whether or not to have a vasectomy.Study DesignMen considering vasectomy were randomized to an experimental group that received a full PtDA containing information and values guidance (n=32) or to a control group that received an abridged PtDA containing information only (n=31).ResultsMean Decisional Conflict Scale (DCS) scores before and after the intervention were 2.6±0.4 and 1.9±0.4 in the experimental group and 2.5±0.4 and 1.8±0.4 in the control group (p=.94), respectively. Mean knowledge of vasectomy scores before and after the intervention were 50%±16% and 72%±18% in the experimental group and 55%±18% and 71%±15% in the control group (p=.40), respectively. At baseline, all participants were undecided as to whether to have a vasectomy. After the intervention, 60% of experimental group participants and 53% of control group participants had made a definite decision (p=.58).ConclusionIn men considering vasectomy, both versions of the PtDAs improved the quality of decision-making process to a similar extent. Information alone may be sufficient to support good decision making in these patients.     

Low energy reporting may increase in intervention participants enrolled in dietary intervention trials

OBJECTIVE: To examine differences in low energy intake reporting between intervention and control groups during a dietary intervention trial. DESIGN: Retrospective data analysis from a subcohort of participants in the Polyp Prevention Trial (PPT), a 4-year, multisite, randomized, controlled dietary intervention trial. Intervention consisted of educational material and counseling sessions supporting a low-fat, high-fiber diet. Baseline and annual demographics, behavioral characteristics, energy intake (EI) based on self-reported 4-day food records, and height and weight of participants were collected at baseline and annually. Basal metabolic rate (BMR) was estimated (using the Schofield equation) to calculate EI/BMR. SUBJECTS: Of the 443 participants (302 male, 141 female) at baseline, 195 (43.3%) were younger than 60 years, and 394 (91%) were white. At Year 4, 383 participants remained: 186 (122 men, 64 women) in the intervention group, and 197 (133 men, 64 women) in the control group. STATISTICAL ANALYSES: Using either paired t tests or analysis of variance, the differences between the means for EI, weight, and EI/BMR were compared at baseline, Year 1, and Year 4 for the participants who remained at Year 4. The Goldberg EI/BMR cutoff value of 1.06 (for plausible EI) identified participants who reported low EI. Linear regression was used to quantify the association of various risk factors to EI/BMR and for multivariate analyses within groups. chi(2) contingency table analysis quantified differences of low energy reporting within groups. RESULTS: At baseline, 46.8% of women and 11.6% of men reported lower than plausible EI. Only men had a significant increase in low energy reporting after randomization. At Year 1, 18.9% of intervention group men reported low EI compared with 9.8% of control group men (P<.05). At Year 4, 23.0% of intervention group men reported low EI compared with 12.8% of control group men (P<.05). CONCLUSIONS/APPLICATIONS: Difference in low EI reporting between intervention and control groups could distort results from dietary intervention trials; interpretation of findings from dietary trials must include this potential bias. Intervention study design should include dietary intake data collection methods that are not subject to such bias (ie, biomarkers and performance criteria) to measure intervention compliance.     

Influence of an educational videotape on attitudes toward participating in cohort studies--results of a randomized controlled trial

OBJECTIVE: This study was conducted to examine whether an educational videotape might change peoples' attitudes toward participating in future cohort studies by a prospective randomized controlled trial. METHODS: The participants were recruited from the residents of Kamogawa-city (139 at a health promotion festival, 54 from a nursery care study class, 53 from an elderly class, and 9 individuals who had not attended a health checkup for more than 10 years). All participants were randomized into a control group and an intervention group, and were asked to fill out a questionnaire designed to evaluate attitudes toward participating in future cohort studies. Those in the intervention group, however, were also asked to watch a videotape, produced by the authors to explain the objectives, significance, and security policies of a cohort study planned to be conducted in the same city, before completing the questionnaire. RESULTS: In the intervention group, 44% (54/123) showed a positive attitude to future participation, while the figure was only 25% (31/122) in the control group (Cochran-Mantel-Haenszel chi2: P=0.0025). CONCLUSION: The videotape proved to be a useful tool for informing the general public about the nature of cohort studies and to increasing probable participation.     

An intervention trial to postpone aging in competent elderly. Trial of nutritional improvement in the retirement home

The purpose of this study was to evaluate the effectiveness of a comprehensive intervention program in changing dietary habits and nutritional status, for postponing aging in competent elderly. The intervention group (n = 44, 11 men, 33 women, mean age: 74.3 +/- 5.4 years) comprised residents of a retirement home in a suburb of Tokyo. The intervention program, which consisted of 82 lectures and practice sessions focusing mainly on improvement of life styles, was performed between May 1993 and May 1995. In addition, individualized dietary consultations were provided every week during the intervention period. The age and sex matched control group (n = 133, 33 men, 100 women) was randomly selected from participants of the community-based health examination in Tokyo. Changes in dietary habits were measured by a 15-food frequency questionnaire method. As parameters of nutritional status, serum albumin (ALB), total cholesterol (TC), HDL cholesterol (HDL-C) and body mass index (BMI) were simultaneously examined at pre- and post-intervention. The results obtained were as follows: 1) The mean score of Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG Index of Competence) was 11.3 +/- 1.6 in the intervention group, 12.0 +/- 1.6 in the control group, the competent level of functional capacity was equally high in both groups. 2) Food frequencies of meat, fruit, and fat and oil significantly increased in the intervention group. A significant increase in the food frequency of meat was seen in the control group. 3) Significant increases in ALB, HDL-C and BMI were consequently observed in the intervention group, whereas levels of ALB and BMI significantly decreased in the control group. 4) The number of times of participation in the comprehensive intervention program was significantly positively related to the change in ALB between pre- and post-intervention, after adjusted for age, sex, education, TMIG Index of Competence score and ALB level at baseline. These results indicate that the comprehensive intervention program is effective for postponing aging in the competent elderly.     

Change in protein intake in elderly French people living at home after a nutritional information program targeting protein consumption

OBJECTIVE: The purpose of the study was to assess the impact of a nutrition information program targeting protein consumption in elderly people. DESIGN AND INTERVENTION: Participants individually completed a questionnaire on food consumption and answered an attitude questionnaire (first survey period). Half of the participants (message group) participated in an information program targeting protein consumption, whereas the other half (control group) were not given any information. Two weeks after the program, both groups participated in the same surveys again (second survey period). SUBJECTS: Eighty-two healthy subjects (65 to 75 years old) living at home participated in this study. STATISTICAL ANALYSES: A two-way multivariate analysis of variance, paired t tests, and chi2 tests were performed to determine the influence of group (control versus message) and gender on the differences in protein consumption and in attitudes between the first and second survey periods. RESULTS: In the second survey period, the control group participants decreased their protein intake by an average of 0.049 g/lb/day, mainly by a reduction in meat product consumption. Conversely, the message group participants increased their protein intake by 0.041 g/lb/day, with a greater increase for the women (0.059) than the men (0.023 g/lb/day). After the nutrition information program, knowledge, perceived control on health, and belief that sensory perception decreased with age were higher among the message group participants. CONCLUSIONS: Nutrition knowledge and protein intake increased significantly among the message group participants. Thus, it is possible to change dietary practice and knowledge in elderly individuals by information targeting one nutrition message.     

Quasi-experimental evaluation of a nutritional educational intervention among home support assistants for the elderly

BACKGROUND: The French National Program on Nutrition and Health has defined two specific objectives targeting older persons: (i) to improve their status in calcium and vitamin D and (ii) to prevent undernutrition. Home help provides support in activities of daily living, including meals, to dependent persons. The objective of our study was to evaluate the impact of a nutritional education intervention on knowledge and practices among home support assistants for the elderly. METHODS: Three facilities providing home support in Gironde (France) selected 132 home support assistants to follow an education program and 134 controls. Nutrition training was conducted in the intervention group by a dietician during two half-day sessions in May-June 2004. A non randomized controlled trial design was used for evaluation. Nutritional knowledge (20 questions) and practice (5 questions) of home support assistants were assessed by questionnaire before (April 2004) and after (September 2004) the training period in each group. Satisfaction of the intervention group was also assessed. RESULTS: The intervention group included 101 participants and the control group 106 persons who answered both questionnaires before and after the education program. The intervention group was significantly younger (p < 0.05), less educated (p = 0.01) and had less often participated to previous nutrition training (p < 0.001) than the control group. There was no significant difference between the two groups before intervention for their mean scores of knowledge or practices. The intervention group significantly improved its knowledge score (mean gain 2.5 points, p < 0.001) after the training period, whereas the score remained unchanged in the control group (mean gain 0.5 points, p = 0.06). The impact of the nutritional education was very significant (p < 0.0001) after adjustment for the characteristics which differed between the two groups. The practice scores did not differ significantly after intervention in multivariate analyses. Satisfaction of trained home support assistants was very high. Conclusion: An education program of home support assistants for elderly persons can improve their nutritional knowledge, but this study cannot conclude that the intervention was efficient to improve the nutritional status of older persons.     

Empowering elderly Iranians through a social group work intervention: A trial study to assess the effect of the intervention on participants' quality of life

We designed and ran an empowerment‐oriented social group work intervention to assess whether the intervention could improve the quality of life of older Iranians. The intervention consisted of nine group sessions that focused on capacity building and increasing individual competences, environmental resources and opportunities. Using a randomised controlled trial (RCT), 60 elderly people (30 men and 30 women in the intervention and control groups) from Social Services Centres in Tehran Municipality participated in this study. The WHOQOL‐BREF instrument was used to measure quality of life, comparing before, after and follow‐up measures between the groups and within each group. ANOVA and GEE tests were applied to analyse the data. The results showed significant progress in overall quality of life of the participants, particularly in the domains of physical health, psychological health, social relationships and environmental health. In pretest, there were no significant differences between the groups in terms of quality of life and its domains, but there were significant differences in the post‐ and follow‐up tests. This study provides support for the empowerment‐oriented social group work intervention with Iranian elderly people. This kind of intervention can be a useful model for empowering older people, especially in countries where social support and health services for seniors are not yet freely available.     

A dietary trial with a short-term low-sucrose diet in an Italian population: effects on colorectal mucosal proliferation

Colorectal mucosal proliferation is supposed to predict colon cancer risk. We investigated whether a low-sucrose diet might reduce colorectal mucosal proliferation in a group of patients at higher risk of colorectal cancer after at least two colon adenoma resections. In a pilot phase, 14 patients [12 men and 2 women, 60.3 +/- 5 (SD) yr] were instructed to adopt a low-sucrose diet for one month. Colorectal biopsies were taken twice in the same patients, at the start and the end of the intervention period, and mucosal proliferation was measured by [3H]thymidine uptake in vitro and autoradiography. Although compliance of study participants to dietary modification was high, only a few agreed to two consecutive endoscopies; thus we carried out a randomized study, and 107 patients were assigned to a low-sucrose diet (50 treated patients: 31 men and 19 women, 59.7 +/- 7.5 yr) or instructed to continue their usual diet for one month (55 control patients: 32 men and 23 women, 59.6 +/- 7.7 yr). At the end of this period, colorectal biopsies were obtained. The results of the pilot phase and the randomized study showed that a low-sucrose diet for one-month did not affect proliferation or the distribution of proliferation activity along the crypt. The food-frequency questionnaires indicated that treated patients consumed significantly less sucrose (and fewer total calories) during the dietary modification. Urinary fructose, a measure of dietary sucrose intake, was also reduced at the end of the intervention period. In conclusion, we found no evidence that a low-sucrose diet for one month influences colorectal mucosal proliferation.     

Evaluation of a theory-based nutrition intervention for older adults with diabetes mellitus

OBJECTIVE: To evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus. DESIGN: A randomized pretest-posttest control group design was used. SUBJECTS/SETTING: Participants (48 experimental, 50 control) were aged 65 years and older with type 2 diabetes for 1 year or longer; 93 participants (95%) completed the study, conducted in an outpatient setting. INTERVENTION: The intervention included 10 weekly group sessions led by a dietitian. Information processing, learning theory, and Social Cognitive Theory principles were used in program development and evaluation. MAIN OUTCOME MEASURES: Participants' knowledge, outcome expectations (expected results of behavior), self-efficacy, and decision-making skills were assessed. Instrument validity and reliability were established before program evaluation. STATISTICAL ANALYSES PERFORMED: Factor analysis identified underlying factor structures. Analysis of covariance with pretest score as covariate was used to compare groups at posttest. Paired t tests compared results within groups. RESULTS: Two factors were identified for outcome expectations (positive and negative) and for self-efficacy (promoters of and barriers to diabetes management). The experimental group had greater improvement in total knowledge scores (mean +/- standard error of the mean: 7.8+/-0.7) than the control group (0.2+/-0.7) (P < .0001), positive outcome expectations (0.59+/-0.15 vs 0.06+/-0.15, P = .01), promoters of diabetes management (0.83+/-0.12 vs -0.09+/-0.18, P < or = .001) and decision-making skills (5.1+/-0.5 vs 0.3+/-0.5, P < .0001) and greater reduction in barriers to diabetes management (1.1+/-0.16 vs 0.34+/-0.16, P < .01). No significant difference in negative outcome expectations occurred between groups at posttest. APPLICATIONS/CONCLUSIONS: Older adults with diabetes can benefit from nutrition education designed to improve knowledge and skills necessary for diabetes management.     

Postmenopausal hormone therapy and body composition--a substudy of the estrogen plus progestin trial of the Women's Health Initiative

BACKGROUND: It has been suggested that hormone therapy may help counter undesirable changes in body composition in older women. OBJECTIVE: This study was designed to test whether estrogen plus progestin (E+P) therapy favorably affects age-related changes in body composition in postmenopausal women. DESIGN: The substudy was composed of 835 women from the estrogen plus progestin trial of the Women's Health Initiative who were randomly assigned to receive either E+P therapy (n = 437) or placebo (n = 398). The women had a mean age of 63.1 y and, on average, were 13.8 y past menopause. More than 17% of the participants were from an ethnic minority. No significant differences in baseline body composition (measured with dual-energy X-ray absorptiometry) by intervention assignment were observed. RESULTS: After 3 y of intervention, the women who received active E+P therapy lost less lean soft tissue mass (-0.04 kg) than did the women who received placebo (-0.44 kg; P = 0.001). Additionally, the women in the E+P group had less upper-body fat distribution than did the women in the placebo group (change in ratio of trunk to leg fat mass: -0.025 for the E+P group and 0.004 for the placebo group; P = 0.003). A sensitivity analysis, which was conducted on the women who took > or = 80% of the study medication during the intervention period, corroborated the findings from the intent-to-treat analysis. CONCLUSIONS: A 3-y E+P intervention significantly reduced both the loss of lean soft tissue mass and the ratio of trunk to leg fat mass in postmenopausal women. However, the effect sizes were small, and whether these changes in body composition lead to significant health benefits remains to be confirmed.     

Nutrition intervention group program based on preaction-stage-oriented change processes of the Transtheoretical Model promotes long-term reduction in dietary fat intake

OBJECTIVE: To develop and evaluate the long-term effectiveness of an intervention program, based on preaction-stage-oriented change processes of the Transtheoretical Model of Behavior Change, that could be delivered in a group setting to help participants lower dietary fat intake. DESIGN: An enhanced version of the nonequivalent control group experimental design was used. Entire sections of an undergraduate introductory nutrition science course were assigned to an experimental, pretest/posttest control, or posttest-only control group. Daily fat intake and stage of change of the experimental and pretest/posttest control groups were determined at the pretest and posttest and 1-year later at a follow-up test. Every 1 to 2 weeks during the study, stage of change of the experimental group was assessed. Daily fat intake of the experimental group was assessed at study midpoint. Daily fat intake and stage of change of the posttest-only control group was determined at the posttest. Pretest results were used to place participants of the experimental and pretest/posttest control groups in either the preaction stage (i.e., precontemplation, contemplation, or preparation) or the action/maintenance stage. SUBJECTS/SETTING: The sample consisted of 38, 30, and 42 undergraduate students who were assigned to the experimental, pretest/posttest control, and posttest-only control groups, respectively. INTERVENTION: The experimental group participated in a group-based, dietary fat intake intervention that included a series of 11 lessons taught over a 14-week period. Each lesson was based on 1 or 2 of the preaction-stage-oriented change processes of the Transtheoretical Model. MAIN OUTCOME MEASURES: Data were evaluated to determine the effects of the intervention program on long-term dietary fat reduction and stage of change progression. STATISTICAL ANALYSIS PERFORMED: Analysis of variance, repeated-measures analysis of variance, and paired t tests. RESULTS: For pretest and posttest dietary fat intake scores, stage and time were significant, and there was a significant time-by-stage interaction. Time was significant for pretest and posttest stage scores. Subjects in the preaction-stage experimental group significantly increased their mean stage of change and reduced their fat intake between the pretest and posttest; these changes persisted for 1 year. Pretest/posttest control group participants who began in a preaction stage also significantly increased their mean stage and reduced fat intake by the posttest, but these changes did not endure until the follow-up test. APPLICATIONS/CONCLUSIONS: This intervention program produced an enduring, significant reduction in mean dietary fat consumption and a significant progression in mean stage of change of subjects in the experimental group who were in the preaction stage. It may be appropriate to design group interventions to use preaction stage processes rather than the more traditionally used action and maintenance stages change processes.     

HIV prevention using the operative group approach among men who have sex with men in São Paulo, Brazil

This study aimed to evaluate the operative group as a preventive approach among men who have sex with men that use two public health services in the city of S?o Paulo, Brazil. One hundred volunteers were randomly allocated to two groups (intervention and control, with 50 each). All participants answered questionnaires in two phases: before the intervention and six months after its conclusion. Effect was measured by comparing the groups for the following outcomes: median number of anal sex acts without condoms and responses from the participants to questions about HIV infection. 69 participants completed the study (34 in the prevention group and 35 in the control group). Analysis showed a decrease in the number of unprotected anal sex acts (p = 0.029) and an increase in the number of answers favoring prevention in the intervention group. The results indicate that the study group was responsive to a safer sex operative group intervention. Further research is necessary to evaluate the feasibility of this prevention approach as a public health strategy, including other social groups.     

Knowledge of osteoporosis in a Swedish municipality--a prospective study

BACKGROUND: As a part of the Vadstena Osteoporosis Prevention Project, the knowledge of osteoporosis was examined before the intervention program started, after 5 and 10 years. METHODS: At baseline (in 1989) 15% of the population in two Swedish municipalities was randomly invited to the study. The participants in the study group were invited for examination by forearm bone densitometry and a questionnaire concerning lifestyle and risk factors for osteoporosis and also knowledge of osteoporosis, while the subjects in the control group were examined only by questionnaire. Follow-ups were made in 1994 and in 1999. Meanwhile education about osteoporosis was given to the study group, to the public, and to various professionals in the study community. RESULTS: There was a difference in the level of knowledge between the groups prior to the intervention. The rate of increment did not differ significantly between the groups for the study period. Previous participants had 0.58 higher score than new participants in the study group in 1994 (P = 0.031) and 0.76 higher score in 1999 (P < 0.001) regarding the total number of correct answers. The women in the study group had 0.63 higher score than the men in 1994 (P = 0.016) and 1.03 higher score in 1999 (P < 0.001) regarding the total number of correct answers. CONCLUSION: There was no significant effect of a general intervention program concerning the knowledge of osteoporosis in participants in the intervention area compared to the control area.