Operation Frontline: assessment of longer-term curriculum effectiveness, evaluation strategies, and follow-up methods

OBJECTIVES: To determine the effectiveness of a traditional pretest versus a retrospective pretest, the stability of self-reported behavior changes at 3 or 6 months post-class series, and the most effective method for longer-term follow-up assessment of Operation Frontline's Eating Right class series. DESIGN: Longitudinal study; subjects surveyed at some combination of traditional pretest, retrospective pretest/posttest after the last class, and at 3 or 6 months. SETTING: Communities in the metropolitan Denver area. PARTICIPANTS: Of the 53 participants, 90% were women, 70% were of Hispanic descent, 49% were between the ages of 20 and 29, and 64% had at least a twelfth-grade education or General Educational Development diploma. MAIN OUTCOME MEASURES: Contrast results from a traditional pretest with a retrospective pretest; assess temporal stability of self-reported behavior changes; and contrast response rates for multiple follow-up methods (mail, telephone, or reunion class). ANALYSIS: Item and scale scores were compared across various time points using repeated-measures analysis of variance. RESULTS: No significant differences were found for 6 of 7 variables between the traditional pretests and retrospective pretests. Most self-reported behavior changes were retained at 3 and 6 months post-class. Mail had the best response rate (62%) for this limited-resource population. CONCLUSIONS AND IMPLICATIONS: The maintenance of behavior changes at 3 or 6 months post-intervention supports the effectiveness of the Eating Right series. Mail follow-up achieved higher response rates than telephone. The lack of significant differences (except 1 variable) between the traditional pretest and the retrospective pretests does not support the retrospective pretest as being more accurate. However, the retrospective pretest may be more desirable for educators, as it eliminates the need to test participants twice.     

Empirical observations on longer-term use of incentives for weight loss

Behavioral economic-based interventions are emerging as powerful tools to help individuals accomplish their own goals, including weight loss. Deposit contract incentive systems give participants the opportunity to put their money down toward losing weight, which they forfeit if they fail to lose weight; lottery incentive systems enable participants to win money if they attain weight loss goals. In this paper, we pool data from two prior studies to examine a variety of issues that unpublished data from those studies allow us to address. First, examining data from the deposit contract treatments in greater depth, we investigate factors affecting deposit frequency and size, and discuss possible ways of increasing deposits. Next, we compare the effectiveness of both deposit contract and lottery interventions as a function of participant demographic characteristics. These observations may help to guide the design of future, longer-term, behavioral economic-based interventions.     

精索静脉高位结扎术中同时结扎精索内动脉的临床初步评估

目的初步评估精索内动静脉同时结扎对睾丸生精功能及血浆睾酮水平的影响,对精索内静脉结扎术是否保留精索内动脉问题进行探讨。方法将精索静脉结扎术中同时行精索内动静脉结扎的病例与保留精索内动脉的病例进行临床对照研究。结果两组病例术前术后自身对照:精子密度、活率、畸形率三项指标均有明显改善(P<0.01),两病例组间对照:术前和术后三项指标均无显著性差异(P>0.05);两病例组间及术前和术后对照,血浆睾酮测定结果均无显著性差异(P>0.05)。精索内动脉保留组手术时间则明显较结扎组延长(P<0.01)。结论精索静脉高位结扎术中同时结扎精索内动脉对睾丸的生精功能及血浆睾酮水平无明显影响,因此在精索内动脉分离困难时应考虑同时结扎精索内动静脉。     

Investigating the longer-term health consequences of work-related injuries among youth

PURPOSE: To investigate the longer-term health consequences of work injuries among youth aged 15-24 years using a population-based, longitudinal study (1991-2001) of merged health care and workers' compensation records. METHODS: A group-based modeling approach was used (1) to identify unique trajectories of health care use defined by general practitioner visits among the study sample stratified by gender, and (2) to determine the injury factors that predict a youth's membership in a trajectory, adjusted for sociodemographic factors. RESULTS: Four long-term trajectories of health care use were identified among young injured workers, for both males and females. Similar trajectories were observed among a comparison, noninjured sample but the magnitude of health care use was consistently higher among the injured worker cohort, especially for females (attributable to general practitioner [GP] visits for symptoms, signs and ill-defined diagnoses), and a notable "spike" in health care use occurred in the year immediately after a work injury for both males and females that was not observed in the comparison population during the matched year (attributable to GP visits for musculoskeletal and injury diagnoses). For males, the type of work injury mattered with an increased odds of belonging to the higher health care trajectories associated with a musculoskeletal injury (odds ratio [OR] = 1.57, 95% CI = .76, 3.23; and OR = 1.61, 95% CI 1.08, 2.41 for the postinjury trajectories), adjusted for age, occupation, socioeconomic status, and geographic location. CONCLUSION: Persistent use of health care services may represent a cumulative burden of morbidity over the life course as a result of a work-related injury in general among young women and as a result of musculoskeletal injuries in particular among males.     

Meta-analyses of small numbers of trials often agree with longer-term results

Objective

Many systematic reviews include only a few studies. It is unclear whether recommendations based on these will be correct in the longer term; hence, this article explores whether meta-analyses give reliable results after only a few studies.

Study Design and Setting

Cumulative meta-analysis of data from 65 meta-analyses from 18 Cochrane systematic reviews was carried out. Various measures of closeness to the pooled estimate from all trials after three and five trials were included. Changes during the accumulation of evidence were noted.

Results

The 95% confidence interval included the final estimate in 72% of meta-analyses after three studies and in 83% after five studies. It took a median of four (interquartile range: 1.25-6) studies to get within 10% of the final point estimate. Agreement between the results at three and five studies and the final estimate was not predicted by the number of participants, the number of events, τ², or I². Estimates could still change substantially after many trials were included.

Conclusion

Many of the conclusions drawn from systematic reviews with small numbers of included studies will be correct in the long run, but it is not possible to predict which ones.     

Very-low-energy diets and morbidity: a systematic review of longer-term evidence

Evidence from the literature supports the safe use of very-low-energy diets (VLED) for up to 3 months in supervised conditions for patients who fail to meet a target weight loss using a standard low-fat, reduced-energy approach. There is, however, a need for longer-term outcomes on obesity and associated morbidities following a VLED. The present systematic review aims to investigate longer-term outcomes from studies using VLED, with a minimum duration of 12 months, published between January 2000 and December 2010. Studies conducted in both children and adults, with a mean/median BMI of ≥?28?kg/m2 were included. PubMed, MEDLINE, Web of Science and Science Direct were searched. Reference lists of studies and reviews were manually searched. Weight loss or prevention of weight gain and morbidities were the main outcomes assessed. A total of thirty-two out of 894 articles met the inclusion criteria. The duration of the studies ranged from 12 months to 5 years. Periods of VLED ranged from 25?d to 9 months. Several studies incorporated aspects of behaviour therapy, exercise, low-fat diets, low-carbohydrate diets or medication. Current evidence demonstrates significant weight loss and improvements in blood pressure, waist circumference and lipid profile in the longer term following a VLED. Interpretation of the results, however, was restricted and conclusions with which to guide best practice are limited due to heterogeneity between the studies. The present review clearly identifies the need for more evidence and standardised studies to assess the longer-term benefits from weight loss achieved using VLED.     

The perilous journey of nutrition evaluation.

Program evaluation in the area of nutrition has been both insufficient and deficient. A 1976 to 1977 survey of nutrition programs throughout the world being conducted as part of a Harvard Institute for International Development Project revealed that of 140 programs surveyed only 23% reported having analyzed nutritional status data and only 15% indicated they had analyzed their programs' cost data. Nutrition evaluation faces a series of impediments to its successful implementation, and these evaluation barriers fall into 4 main categories: technical; financial; psychological; and political. The nature of malnutrition, the imperfections in the measuring instruments, the sophistication requirements of evaluation design as well as the ambiguity of the data collected have combined to present a technical barrier to evaluation. The scarcity of funds traditionally available to mount nutrition programs has made program administrators stingy when contemplating evaluation budgets. Regarding the psychological, evaluations are threatening, and people fear them. Few nutritional programs are totally insulated from politics. Their emergence is based not primarily on realizing nutritional needs but on achieving political ends. These barriers go far in explaining the relative neglect of nutrition evaluation, yet they are not insurmountable. There are 5 basic questions that the task of nutrition evaluation must address: why do it; for whom; by whom; when; and how. An attempt is made to answer each of these questions in detail. Evaluation is important to good planning which is critical to effective implementation. Effective implementation is a prerequisite to improving the nutritional well being of the population. Evaluation can and should serve many potential users. There appears to be 7 potential main user groups: national planners; funders; sectoral planners; program managers; field workers; beneficiaries; and researchers. The question of who should carry out the evaluations will depend on 3 main factors: technical requirements; objectivity; and resource availability. The evaluation information system should be mounted as an ongoing mechanism which produces various flows and forms of data at various times depending on end user needs. In terms of the how question the effort is made to present a framework within which such techniques can be applied to evaluate nutrition programs. The framework has 3 components: target group definition; costing procedures; and performance indicators.