Men with chronic occupational stress benefit from behavioural/psycho-educational group training: a randomized, prospective, controlled trial

BACKGROUND: Overworking is one of the most frequent stressors. The purpose of this study was to determine the effectiveness of behavioural/psycho-educational group training in men who are chronically stressed from overworking. METHOD: Of 72 male subjects, 36 were randomly assigned to training for 8 weeks and another 36 formed the control group, which received a placebo intervention. Primary outcome measures were systolic blood pressure, salivary cortisol concentration upon awakening, and self-reported changes on the scales of the Trier Inventory for the Assessment of Chronic Stress (TICS), the State-Trait Anger Expression Inventory (STAXI) and the 36-item Short Form Health Survey (SF-36). RESULTS: A significant reduction in mean values was observed in daily systolic blood pressure and salivary cortisol concentration on all the TICS and most of the STAXI and SF-36 scales. CONCLUSIONS: Behavioural/psycho-educational group training appears to be effective in the treatment of men suffering from chronic stress due to overworking.     

Evaluation of a Cognitive–Behavioral Pain Management Program for Children with Chronic Abdominal Pain: A Randomized Controlled Study

Background

Chronic abdominal pain (CAP) in childhood is widely prevalent and has adverse effects on mental health and quality of life. Earlier research emphasized the positive effects of psychological intervention on pain symptoms. This study describes the results of a cognitive–behavioral pain management program for children with CAP. The newly developed cognitive–behavioral group program, “Stop the pain with Happy-Pingu,” includes six sessions for the children and one meeting for the parents.

Purpose

We hypothesized that the training would significantly reduce pain symptoms (frequency, duration, intensity, and pain-related impairment) and increase health-related quality of life compared to wait-list controls, with improvement seen both at the end of treatment and at a 3-month follow-up.

Method

In all, 29 children were randomized into two groups: 15 in the intervention group (IG) and 14 as the wait-list controls (WLC). An intent-to-treat analysis was performed using two-factorial multivariate analyses of variance with repeated measures.

Results

Children in the IG experienced both a reduction in pain (primary outcome) and an improvement in health-related quality of life (secondary outcome) as compared to the WLC. The effect sizes ranged from medium to high.

Conclusion

Cognitive–behavioral methods seem to be appropriate for treating children with CAP.     

Treating oppositional defiant disorder in primary care: a comparison of three models

OBJECTIVE: To determine if a nurse-led or psychologist-led parent-training program was more successful than a minimal intervention in treating early childhood Oppositional Defiant Disorder (ODD) in pediatric primary care. METHODS: Twenty-four practices were randomized to conditions in which parents of 117, 3- to 6.11-year-olds with ODD received the 12-session Webster-Stratton Incredible Years program led by primary care nurses or clinical psychologists, or to a minimal intervention group in which parents received only the companion book to the treatment program. RESULTS: There was improvement across posttreatment and 12-month follow-up for all groups, but no overall treatment group effects. There was a dose effect, with a reliable, clinically significant gain after seven sessions on the Eyberg intensity scale, and nine sessions on the Child Behavior Checklist externalizing scale. CONCLUSIONS: There is little advantage to the therapist-led treatment over bibliotherapy unless parents attend a significant number of sessions.     

Short- and Long-Term Effects of CBT-I in Groups for School-Age Children Suffering From Chronic Insomnia: The KiSS-Program

Objective/Background: This intervention study evaluates the short- and long-term effects of cognitive behavior therapy for insomnia (CBT-I) in groups for school-age children and their parents, named the KiSS-program. CBT-I was implemented in three sessions for children and three sessions for parents. Participants and Methods: All in all, 112 children with chronic childhood insomnia were randomly assigned to a wait-list (WL) control or treatment condition. Results: According to subjective measures as well as objective wrist actigraphy, children in the CBT-I condition reported greater improvements in sleep behavior immediately after the treatment compared to the WL group. Improvements in sleep behavior after CBT-I persisted over the 3-, 6-, and 12-month follow-up assessments. Conclusions: The present study is the first randomized controlled trial that provides evidence for the long-term effectiveness of CBT-I in treating school-age children with chronic insomnia.     

Brief report: family-based group intervention for young siblings of children with chronic illness and developmental disability

OBJECTIVE: To evaluate the impact of a family-based group intervention for young siblings of children with chronic illness and developmental disability (CI/DD). METHODS: Forty-three healthy siblings (ages 4-7 years) of children with CI/DD and their parents participated in an intervention designed to address sibling challenges that cut across types of diagnostic conditions. The intervention consisted of six sessions of collateral and integrated sibling-parent groups. Measures of sibling knowledge, sibling sense of connectedness with other children in similar family circumstances, and sibling global functioning were collected before and after intervention. A subsample of 17 families completed a 3-month follow-up. RESULTS: Siblings' knowledge of the child's disorder and sibling connectedness increased significantly from pre- to posttreatment for both boys and girls, regardless of the nature of the brother or sister's condition. Sibling perceptions of self-competence increased from pre- to posttreatment, whereas parent reports of sibling behavioral functioning remained within the normal range. Improvements in sibling knowledge and connectedness maintained at follow-up. Parent satisfaction with the program was high. CONCLUSIONS: Results support more controlled evaluations of family-based intervention to improve young sibling adaptation to CI/DD.     

Evaluation of a prevention program to address body focus and negative affect among children

The current study evaluated a program to improve the body image and positive and negative affect of children. Participants were 368 children aged 8-12 years. The results demonstrated that boys placed more importance on and were less satisfied with their muscles; girls were less satisfied with their weight and the importance of weight increased with increasing age. Children with a large BMI were less satisfied with their weight. Boys in the intervention group showed reduced levels of negative affect over time. Further research is required to develop prevention and intervention programs to lower the effects of body dissatisfaction and negative affect among children.     

A randomized controlled trial of a brief educational and psychological intervention for patients presenting to a cardiac clinic with palpitation

BACKGROUND: We sought to determine whether a brief psycho-educational intervention reduced disability in patients with benign palpitation. METHOD: In a pragmatic randomized controlled trial within a cardiology clinic at a district general hospital, 80 consecutive patients diagnosed as having benign palpitation--either palpitation due to awareness of extrasystoles or sinus rhythm--with associated distress or disability were randomized to an intervention group (usual care plus nurse-delivered intervention based on cognitive-behavioural principles) or to a control group (usual care). Principal outcome was difference in proportion of participants with good or excellent researcher-rated activity levels at 3 months. Subsidiary outcomes were self-rated symptoms, distress and disability, researcher-rated unmet treatment needs. RESULTS: The principal outcome showed a statistically and clinically significant benefit for the intervention group, with a number needed to treat of 3 (95% CIs 2 to 7). All but one subsidiary outcomes also showed a difference in favour of the intervention group, and several differences reached statistical significance. Significantly more of the control group had unmet treatment needs at 3 months. CONCLUSIONS: A brief, nurse-delivered, psycho-educational intervention, was an effective treatment for benign palpitation. Further evaluation, including assessment of cost-effectiveness, is needed. The findings have application to the care of patients presenting with other types of 'unexplained' medical symptoms.     

Effects of a self-management educational program for the control of childhood asthma

The objective of the present study was to evaluate the effects of a self-management educational program on 29 children between 6 and 14 years old and their parents implemented in an office setting in Venezuela. Children were randomly assigned to experimental and control group. Children's asthma knowledge, self-management abilities, index morbidity, parents' asthma knowledge and management abilities were measured. The program consisted of six sessions of information giving and cognitive-behavioral strategies for the children, and two talks and an informative brochure for the parents. Results of t tests indicate that the experimental group experienced a statistical significant effects on children's asthma knowledge (P < 0.001) and practice of self-management abilities (P < 0.000) and in parents' knowledge (P < 0.008) compared to the control group. The educational Self-management program had a significant impact on the Morbidity Index of the study group at post-test (P < 0.05). Younger children benefited more from the program compared to older ones (P < 0.09). Children's age is highlighted as a critical variable in designing asthma educational programs. Results suggest the effectiveness on these programs independently of the cultural context.     

Effects of an attachment-based intervention on daily cortisol moderated by dopamine receptor D4: a randomized control trial on 1- to 3-year-olds screened for externalizing behavior

The effect of the Video-Feedback Intervention to Promote Positive Parenting and Sensitive Discipline (VIPP-SD) on daily cortisol production was tested in a randomized controlled trial with 130 families with 1- to 3-year-old children screened for their relatively high levels of externalizing behavior. Six 1.5-hr intervention sessions focusing on maternal sensitivity and discipline were conducted with individual families at their homes. Children in the intervention group showed lower cortisol levels, with a moderating role of the dopamine receptor D4 (DRD4) VNTR exon III polymorphism. The VIPP-SD program proved to be effective in decreasing daily cortisol production in children with the DRD4 7-repeat allele, but not in children without the DRD4 7-repeat allele. Our findings indicate that children are differentially susceptible to intervention effects dependent on the presence of the 7-repeat DRD4 allele.     

Six-month effects of the Groningen active living model (GALM) on physical activity, health and fitness outcomes in sedentary and underactive older adults aged 55-65

OBJECTIVE: To determine the effects on energy expenditure, health and fitness outcomes in sedentary older adults aged 55-65 after 6-month participation in the GALM program. METHODS: In three Dutch communities, subjects from matched neighbourhoods were assigned to an intervention (n = 79) or a waiting-list control group (n = 102). The GALM program consisted of fifteen 60 min sessions once a week emphasising moderate-intensity recreational sports activities. RESULTS: The intervention group showed significant increases in energy expenditure for recreational sports activities, other leisure-time physical activity, health indicators, and perceived and performance-based fitness. Contrary to our expectations, the same increases were found for the control group. Consequently, only significant between-group differences, favouring the intervention group, were obtained for sleep, diastolic blood pressure, perceived fitness score and grip strength. CONCLUSION: The increases in energy expenditure for physical activity from the GALM program, especially for the more intensive recreational sports activities, look promising and are in line with the expected amounts necessary to improve health. Further research is needed to evaluate long-term effects of participation in the GALM program. PRACTICE IMPLICATIONS: These results underline that GALM can be considered successful in stimulating leisure-time physical activity and improving health and fitness in older adults.     

The effects of a community-based literacy program: One-year follow-up findings

Researchers have become increasingly concerned about whether behaviors that have been successfully changed through intervention programs are maintained after completion of the intervention. Project PRIMER (Producing Infant/Mother Ethnic Readers) is a community-based program designed to teach low-income parents techniques for promoting literacy at home. The initial effects of Project PRIMER were that parents who were assigned to the intervention group increased their literacy behaviors significantly more than parents in the control group, and children in the experimental group had significantly higher language production and conceptual development scores than children in the control group. Follow-up data were collected one year after the intervention was completed to determine whether the behaviors modeled to the parents were maintained and whether children in the intervention and control groups still differed in their tests scores. One hundred ninety-four of the 277 participating families were located one year later. Few of the significant differences initially produced were maintained. These results suggest that booster sessions are necessary to maintain changes in both parents and their children. © 1999 John Wiley & Sons, Inc.     

基于社会信息加工模型的团体干预对孤独症谱系障碍儿童社交能力的影响

目的：以社会信息加工(SIP)情绪-认知整合模型为理论依据,设计适用于改善孤独症谱系障碍(ASD)儿童社交能力的团体干预项目,并对其效果进行即时和短期追踪评估。方法：49名4～10岁孤独症谱系障碍(ASD)儿童被随机分为干预组和对照组,两组同时接受常规康复训练,干预组在此基础上给予每周3次,每次1.5小时,共计18次的团体训练,采用《社交反应量表》评估。结果：训练结束后,干预组社交反应后测及追踪测得分均显著低于前测,后测与追踪测差异不显著,对照组三次测量差异均不显著。干预组的社交能力得到提升,各项指标追踪效果能够有效保持,在社交沟通和ASD行为方式上,追踪阶段还有进步。结论：基于SIP情绪-认知整合模型的团体干预项目能够有效改善ASD儿童的社交能力。     

Short-term effects of a group support program and an individual support program for caregivers of stroke patients

Caregivers of stroke patients who live at home experience many problems. There is evidence from the literature that caregivers' situations can be improved by teaching them active coping strategies and by offering them information about the disease. This study investigated the short-term effects of two different interventions both with the same contents, and both aimed at enhancing caregivers' confidence in knowledge, active coping strategies, mental well-being, vitality, social support, assertiveness, and at reducing strain. In addition, we investigated which type of support, i.e. a group program or home visits, had the most positive effects. Caregivers of stroke patients from four regions of the Netherlands were assigned in blocks to a control group or one of the intervention programs. To the group program 130 caregivers were assigned, to the home visits 78 caregivers, and to the control group 49 caregivers. Caregivers were interviewed before entering the program and after completion of the program. Multiple stepwise regression analysis was used to determine the effects of the interventions. In the short-term, both interventions (group program and home visits together) contributed significantly to an increase in confidence in knowledge about patient care, and the use of the active coping strategies 'confronting' and 'seeking social support'. The group program achieved a small increase in seeking social support. When only taking into account those caregivers that followed a substantial part of the program (per protocol group) also a medium effect was found from both interventions on perceived self efficacy. When comparing the group program and the home visits, no significant differences in effects were found. The results of the program are considered encouraging. We recommend implementation of more intervention programs that focus on coping and providing information.     

Treatment for preschool children with interpersonal sexual behavior problems: a pilot study.

This pilot study evaluated a 12-week group treatment program for preschool children with interpersonal sexual behavior problems (SBP; N = 85; 53 completed at least 8 sessions). Many children presented with co-occurring trauma symptoms and disruptive behaviors. In intent-to-treat analysis, a significant linear reduction in SBP due to number of treatment sessions attended was found, an effect that was independent of linear reductions affiliated with elapsed time. Under the assumption that treatment can have an incremental impact, more than one third of the variance was accounted for by treatment effects, with female and older children most favorably impacted. Caregivers reported increase in knowledge, satisfaction, and usefulness of treatment. In addition to replication, future research is needed to examine (a) effects of environment change and time on SBP, (b) stability of treatment effects, and (c) best practices to integrate evidence-based treatments for comorbid conditions.     

Development of a cancer clinical trials multi-media intervention: Clinical Trials: Are they Right for You?

Objective

To describe processes used to develop a multi-media psycho-educational intervention to prepare patients for a discussion about cancer clinical trials (CTs).

Methods

Guided by a Steering Committee, formative research was conducted to develop an informative and engaging tool about cancer CTs. Twenty-three patients and caregivers participated in formative in-depth interviews to elicit information about perceptions of cancer CTs to inform production of a new media product.

Results

Formative research revealed participants had concerns about experimentation, held beliefs that cancer CTs were for patients who had no other treatment options, and wanted a balance of information about pros and cons of CT participation. The value of physicians as credible spokespersons and the use of patients as role-models were supported. Using iterative processes, the production team infused the results into creation of a multimedia psycho-educational intervention titled Clinical Trials: Are they Right for You?

Conclusion

An intervention, developed through an iterative consumer-focused process involving multiple stakeholders and formative research, may result in an engaging informative product.

Practice implications

If found to be efficacious, Clinical Trials: Are they Right for You? is a low-cost and easily disseminated multimedia psycho-educational intervention to assist cancer patients with making an informed decision about cancer CTs.     

Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: An intervention study

BackgroundNursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation.AimThe present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes.Design, setting and participantsAn intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009).MethodsThe nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics.ResultsThe implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions.ConclusionThis study provides evidence that the computerized decision support system and an educational program as implementation strategies had a positive influence on nursing documentation practice.     

The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management?

BACKGROUND: The RE-AIM framework is used as a method of systematically considering the strengths and weaknesses of chronic illness management interventions in order to guide program planning. METHOD: The RE-AIM dimensions of Reach, Efficacy, Adoption, Implementation, and Maintenance are used to rate one-on-one counseling interventions, group sessions, interactive computer-mediated interventions, telephone calls, mail interventions, and health system policies. RESULTS: The RE-AIM ratings suggest that, although often efficacious for those participating, traditional face-to-face intervention modalities will have limited impact if they cannot be delivered consistently to large segments of the target population. Interventions using new information technologies may have greater reach, adoption, implementation, and maintenance, and thereby greater public health impact. Policy changes received high ratings across a variety of RE-AIM dimensions. CONCLUSIONS: Program planners should make decisions regarding implementing and funding health services based on multiple dimensions, rather than only considering efficacy in randomized clinical trials. Doing so may improve the resulting public health impact. Directions for future chronic illness management research related to RE-AIM, and implications for decision making, are described.     

Structured parent education in the management of childhood atopic dermatitis: the Berlin model

Childhood atopic dermatitis (AD) is a common disease with the prevalence rates increasing. Its chronic course with frequent relapses puts a special burden on both children and their parents. To maximise positive long-term outcome in the management of AD it is important to support parents in dealing with the chronic condition of their child in addition to treating symptoms. In the present article, we describe in detail the goals, structure, and content of the Berlin education program for parents of children with AD. The program aims to contribute towards a comprehensive, family-oriented management of childhood AD. Its objective is to improve parent’s self-management skills with regard to their child’s disease and to positively impact the course of the disease as well as the family’s quality of life. Medical, nutritional and psychological issues are covered in six group sessions which are conducted by a multiprofessional team of paediatricians, psychologists and dieticians. Preliminary data show that the program has a desirable effect on aspects of quality of life and coping.