977 resultados para STANFORD 3 COMMUNITY
Resumo:
Background: Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis (OA). The most well-known is the disease-specific Stanford Arthritis Self-Management Program (ASMP). While Australian and international clinical guidelines promote the concept of self-management for OA, there is currently little evidence to support the use of the ASMP. Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability. However, previous studies have had methodological shortcomings including the use of outcome measures which do not accurately reflect program goals. Additionally, limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored.
Methods/design: This study is a randomised controlled trial to determine the efficacy (in terms of Health-Related Quality of Life and self-management skills) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.
Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practices within 2 private hospital settings in Victoria, Australia. Participants must be 18 years or over, fluent in English and able to attend ASMP sessions. Exclusion criteria include cognitive dysfunction, previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement.
Eligible, consenting participants will be randomised to an intervention group (who receive the ASMP and an arthritis self-management book) or a control group (who receive the book only). Follow-up will be at 6 weeks, 3 months and 12 months using standardised self-report measures. The primary outcome is Health-Related Quality of Life at 12 months, measured using the Assessment of Quality of Life instrument. Secondary outcome measures include the Health Education Impact Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (pain subscale and total scores), Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool. Cost-utility analyses will be undertaken using administrative records and self-report data. A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP.
Discussion: Using an innovative design combining both quantitative and qualitative components, this project will provide high quality data to facilitate evidence-based recommendations regarding the ASMP.
Resumo:
Background
Recognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children. In this study we examine whether, Best Start, an Australian area-based initiative to improve child health was effective in improving access to Maternal and Child Health (MCH) services.
Methods
The study compares access to information, parental confidence and annual 3.5 year Ages and Stages visiting rates before (2001/02) and after (2004/05) the introduction of Best Start. Access to information and parental confidence were measured in surveys of parents with 3 year old children. There were 1666 surveys in the first wave and 1838 surveys in the second wave. The analysis of visiting rates for the 3.5 year Ages and Stages visit included all eligible Victorian children. Best Start sites included 1,739 eligible children in 2001/02 and 1437 eligible children in 2004/05. The comparable figures in the rest of the state were and 45, 497 and 45, 953 respectively.
Results
There was a significant increase in attendance at the 3.5 year Ages and Stages visit in 2004/05 compared to 2001/02 in all areas. However the increase in attendance was significantly greater at Best Start sites than the rest of the state. Access to information and parental confidence improved over the course of the intervention in Best Start sites with MCH projects compared to other Best Start sites.
Conclusion
These results suggest that community-based initiatives in disadvantaged areas may improve parents' access to child health information, improve their confidence and increase MCH service use. These outcomes suggest such programmes could potentially contribute to strategies to reduce child health inequalities.
Resumo:
Psychosocial precursors and correlates of parent-reported internalizing behavior trajectories across the age span of 3–15 years were explored using a community-based cohort of Australian children. Six internalizing trajectories had previously been identified for both girls (N = 810) and boys (N = 874) in this sample, comprising stable low, high, decreasing, and increasing pathways. Infancy and toddler temperamental traits (inhibition/shyness, irritability), behavior problems, and parent–child relationship difficulties constituted significant risks for subsequent problematic internalizing profiles. Several gender-specific trends were evident, with temperamental reactivity and shyness, less optimal parenting, and peer difficulties more salient for girls on increasing trajectories whereas externalizing problems were more prominent among boys on increasing trajectories. Factors associated with recovery from elevated symptoms included higher levels of social competence, better parent and peer relations, and more positive school adjustment. Findings suggest that individual characteristics and relationship experiences may be involved in the development and course of internalizing problems.
Resumo:
Purpose : This study examined whether a community-based progressive resistance strength training programme could improve muscle strength and functional activity in a group of adults with cerebral palsy with high support needs.
Method : Using a single group pre-post clinical design, 10 adults (7 males, 3 females; mean age 47.8 SD 5.7 years) with cerebral palsy and high support needs completed 4 weeks of introduction and familiarization, followed by a 10-week progressive resistance strength training programme in a community gymnasium. Participants were measured for muscle strength, locomotion speed and timed sit-to-stand.
Results : After establishment of a stable baseline from weeks 2 to 5 with no systematic change and a high degree of association ( r > 0.86), participants increased leg strength by 22.0% ( p = 0.02), arm strength by 17.2% ( p = 0.01) and improved performance of sit-to-stand ( p = 0.02) during the 10-week strength training intervention.
Conclusions : This study adds to the accumulating evidence that strength training can be beneficial for people with cerebral palsy by demonstrating benefits for adults with cerebral palsy and high support needs who are subject to decline in physical function associated with the ageing process.
Resumo:
Objective : To describe time adolescents spend using electronic media (television, computer, video games, and telephone); and to examine associations between self-reported health/well-being and daily time spent using electronic media overall and each type of electronic media.
Methods : Design–Cross-sectional data from the third (2005) wave of the Health of Young Victorians Study, an Australian school-based population study. Outcome Measures–Global health, health-related quality of life (HRQoL; KIDSCREEN), health status (Pediatric Quality of Life Inventory 4.0; PedsQL), depression/anxiety (Kessler-10), and behavior problems (Strengths and Difficulties Questionnaire). Exposure Measures–Duration of electronic media use averaged over 1 to 4 days recalled with the Multimedia Activity Recall for Children and Adolescents (MARCA) computerized time-use diary. Analysis–Linear and logistic regression; adjusted for demographic variables and body mass index z score.
Results : A total of 925 adolescents (mean ± standard deviation age, 16.1 ± 1.2 years) spent, on average, 3 hours 16 minutes per day using electronic media (television, 128 minutes per day; video games, 35; computers, 19; telephone, 13). High overall electronic media use was associated with poorer behavior, health status, and HRQoL. Associations with duration of specific media exposures were mixed; there was a favorable association between computer use (typing/Internet) and psychological distress, whereas high video game use was associated with poorer health status, HRQoL, global health, and depression/anxiety. Television and telephone durations were not associated with any outcome measure.
Conclusions : Despite television's associations with obesity, time spent in other forms of media use appear more strongly related to adolescent health and well-being. This study supports efforts to reduce high video game use and further exploration of the role of computers in health enhancement.
Resumo:
OBJECTIVE--The purpose of this study Was to determine whether beneficial effects on glycemic control of an initial laboratory-supervised resistance training program could be sustained through a community center-based maintenance program.
RESEARCH DESIGN AND METHODS--We studied 57 overweight (BMI [greater than or equal to] 27 kg/[m.sup.2]) sedentary men and women aged 40-80 years with established (>6 months) type 2 diabetes. Initially, all participants attended a twice-weekly 2-month supervised resistance training program conducted in the exercise laboratory. Thereafter, participants undertook a resistance training maintenance program (2 times/week) for 12 months and were randomly assigned to carry this out either in a community fitness and recreation center (center) or in their domestic environment (home). Glycemic control ([HbA.sub.1c] [A1C]) was assessed at 0, 2, and 14 months.
RESULTS--Pooling data from the two groups for the 2-month supervised resistance training program showed that compared with baseline, mean A1C fell by -0.4% [95% CI -0.6 to -0.2]. Within-group comparisons showed that A1C remained lower than baseline values at 14 months in the center group (-0.4% [-0.7 to -0.03]) but not in the home group (-0.1% [-0.4 to 0.3]). However, no between-group differences were observed at each time point. Changes in A1C during the maintenance period were positively associated with exercise adherence in the center group only.
CONCLUSIONS--Center-based but not home-based resistance training was associated with the maintenance of modestly improved glycemic control from baseline, which was proportional to program adherence. Our findings emphasize the need to develop and test behavioral methods to promote healthy lifestyles including increased physical activity in adults with type 2 diabetes.
Resumo:
Objective: To investigate the relative importance of methicillin resistant Staphylococcus aureus (MRSA) in the community in Melbourne by describing circulating S. aureus strains and infection characteristics.
Methods: Patients with any community-onset S. aureus infection were identified via clinical specimens submitted to a community-based pathology service in 2006. The referring doctors confirmed community onset and defined site and severity of each infection. Patient isolates were characterised by antibiotic resistance subtype and presence of the Panton-Valentine leukocidin gene (pvl).
Results: Between April and September 2006, 2,094 S. aureus isolates were processed. Of these, 133 (6.4%) were multiresistant MRSA (mMRSA) and 110 (5.3%) were resistant to less than 3 non-betalactam antibiotics (non-multiresistant MRSA or nmMRSA). We followed-up all nmMRSA (34) and mMRSA (15) confirmed community-onset infections, and a random subset of eligible patients with MSSA infections (57), for whom clinical data were available from referring doctors (82% response).
The majority of isolates were from skin infections (99/106), but drainage was performed in less than one third of cases (29/99). Antibiotics were prescribed for 89% (95%CI: 82, 94) of infections. The isolates were resistant to the prescribed antibiotic 100% of the time for mMRSA infections and 80% for nmMRSA. Those with infections caused by MRSA had on average one additional visit to their doctor compared with MSSA infections.
Ten nmMRSA clones were identified, including one new pvl positive nmMRSA. Of the 29 nmMRSA isolates, 14 were pvl positive (48%; 95%CIs: 30%, 66%) compared with 16% of MSSA and 0% mMRSA.
Patients with an infection caused by pvl positive strains (23) were younger ((mean age 23 years (95%CI: 16, 30) compared with the 55 years (95%CI: 50, 61)). Infection site also varied with presence of pvl; more pvl positive infections were found in the axilla (17.9% compared with 0%) and head and neck (35.7% compared with 8.2%), and less for the leg or foot (21.4% compared with 55.7%).
Conclusions: We estimate that 3.5% of community-onset S. aureus infections in Melbourne in 2006 were caused by MRSA, and 70 to 90% of patients with MRSA infections were treated initially with antibiotics to which their isolate was resistant. pvl positive isolates of S. aureus were associated with younger age and axillary or head and neck infections.
Resumo:
Community-based interventions are an important component of obesity prevention efforts. The literature provides little guidance on priority-setting for obesity prevention in communities, especially for socially and culturally diverse populations. This paper reports on the process of developing prioritized, community-participatory action plans for obesity prevention projects in children and adolescents using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. We combined stakeholder engagement processes, the ANGELO Framework (scans for environmental barriers, targeted behaviours, gaps in skills and knowledge) and workshops with key stakeholders to create action plans for six diverse obesity prevention projects in Australia (n = 3), New Zealand, Fiji and Tonga from 2002 to 2005. Some sites included sociocultural contextual analyses in the environmental scans. Target groups were under-5-year-olds (Australia), 4–12-year-olds (Australia) and 13–18-year-olds (all four countries). Over 120 potential behavioural, knowledge, skill and environmental elements were identified for prioritization leading into each 2-day workshop. Many elements were common across the diverse cultural communities; however, several unique sociocultural elements emerged in some cultural groups which informed their action plans. Youth were actively engaged in adolescent projects, allowing their needs to be incorporated into the action plans initiating the process of ownership. A common structure for the action plan promoted efficiencies in the process while allowing for community creativity and innovation. The ANGELO is a flexible and efficient way of achieving an agreed plan for obesity prevention with diverse communities. It is responsive to community needs, combines local and international knowledge and creates stakeholder ownership of the action plan.
Resumo:
Box-Ironbark forests occur on the inland hills of the Great Dividing Range in Australia, from western Victoria to southern Queensland. These dry, open forests are characteristically dominated by Eucalyptus species such as Red Ironbark E. tricarpa, Mugga Ironbark E. sideroxylon and Grey Box E. microcarpa. Within these forests, several Eucalyptus species are a major source of nectar for the blossom-feeding birds and marsupials that form a distinctive component of the fauna. In Victoria, approximately 83% of the original pre - European forests of the Box-Ironbark region have been cleared, and the remaining fragmented forests have been heavily exploited for gold and timber. This exploitation has lead to a change in the structure of these forests, from one dominated by large 80-100 cm diameter, widely -spaced trees to mostly small (≥40 cm DBH), more densely - spaced trees. This thesis examines the flowering ecology of seven Eucalyptus species within a Box-Ironbark community. These species are characteristic of Victorian Box-Ironbark forests; River Red Gum E. camaldulensis, Yellow Gum E. leucoxylon, Red Stringybark E. macrorhyncha, Yellow Box E. melliodora, Grey Box E. microcarpa, Red Box E. polyanthemos and Red Ironbark E. tricarpa. Specifically, the topics examined in this thesis are: (1) the floral character traits of species, and the extent to which these traits can be associated with syndromes of bird or insect pollination; (2) the timing, frequency, duration, intensity, and synchrony of flowering of populations and individual trees; (3) the factors that may explain variation in flowering patterns of individual trees through examination of the relationships between flowering and tree-specific factors of individually marked trees; (4) the influence of tree size on the flowering patterns of individually marked trees, and (5) the spatial and temporal distribution of the floral resources of a dominant species, E. tricarpa. The results are discussed in relation to the evolutionary processes that may have lead to the flowering patterns, and the likely effects of these flowering patterns on blossom-feeding fauna of the Box-Ironbark region. Flowering observations were made for approximately 100 individually marked trees for each species (a total of 754 trees). The flower cover of each tree was assessed at a mean interval of 22 (+ 0.6) days for three years; 1997, 1998 and 1999. The seven species of eucalypt each had characteristic flowering seasons, the timing of which was similar each year. In particular, the timing of peak flowering intensity was consistent between years. Other spatial and temporal aspects of flowering patterns for each species, including the percentage of trees that flowered, frequency of flowering, intensity of flowering and duration of flowering, displayed significant variation between years, between forest stands (sites) and between individual trees within sites. All seven species displayed similar trends in flowering phenology over the study, such that 1997 was a relatively 'poor' flowering year, 1998 a 'good' year and 1999 an 'average' year in this study area. The floral character traits and flowering seasons of the seven Eucalyptus species suggest that each species has traits that can be broadly associated with particular pollinator types. Differences between species in floral traits were most apparent between 'summer' and 'winter' flowering species. Winter - flowering species displayed pollination syndromes associated with bird pollination and summer -flowering species displayed syndromes more associated with insect pollination. Winter - flowering E. tricarpa and E. leucoxylon flowers, for example, were significantly larger, and contained significantly greater volumes of nectar, than those of the summer flowering species, such as E. camaldulensis and E. melliodom. An examination of environmental and tree-specific factors was undertaken to investigate relationships between flowering patterns of individually marked trees of E. microcarpa and E. tricarpa and a range of measures that may influence the observed patterns. A positive association with tree-size was the most consistent explanatory variable for variation between trees in the frequency and intensity of flowering. Competition from near-neighbours, tree health and the number of shrubs within the canopy area were also explanatory variables. The relationship between tree size and flowering phenology was further examined by using the marked trees of all seven species, selected to represent five size-classes. Larger trees (≥40 cm DBH) flowered more frequently, more intensely, and for a greater duration than smaller trees. Larger trees provide more abundant floral resources than smaller trees because they have more flowers per unit area of canopy, they have larger canopies in which more flowers can be supported, and they provide a greater abundance of floral resources over the duration of the flowering season. Heterogeneity in the distribution of floral resources was further highlighted by the study of flowering patterns of E. tricarpa at several spatial and temporal scales. A total of approximately 5,500 trees of different size classes were sampled for flower cover along transects in major forest blocks at each of five sample dates. The abundance of flowers varied between forest blocks, between transects and among tree size - classes. Nectar volumes in flowers of E. tricarpa were sampled. The volume of nectar varied significantly among flowers, between trees, and between forest stands. Mean nectar volume per flower was similar on each sample date. The study of large numbers of individual trees for each of seven species was useful in obtaining quantitative data on flowering patterns of species' populations and individual trees. The timing of flowering for a species is likely to be a result of evolutionary selective forces tempered by environmental conditions. The seven species' populations showed a similar pattern in the frequency and intensity of flowering between years (e.g. 1998 was a 'good' year for most species) suggesting that there is some underlying environmental influence acting on these aspects of flowering. For individual trees, the timing of flowering may be influenced by tree-specific factors that affect the ability of each tree to access soil moisture and nutrients. In turn, local weather patterns, edaphic and biotic associations are likely to influence the available soil moisture. The relationships between the timing of flowering and environmental conditions are likely to be complex. There was no evidence that competition for pollinators has a strong selective influence on the timing of flowering. However, as there is year-round flowering in this community, particular types of pollinators may be differentiated along a temporal gradient (e.g. insects in summer, birds in winter). This type of differentiation may have resulted in the co-evolution of floral traits and pollinator types, with flowers displaying adaptations that match the morphologies and energy requirements of the most abundant pollinators in any particular season. Spatial variation in flowering patterns was evident at several levels. This is likely to occur because of variation in climate, weather patterns, soil types, degrees of disturbance and biotic associations, which vary across the Box-Ironbark region. There was no consistency among sites between years in flowering patterns suggesting that factors affecting flowering at this level are complex. Blossom-feeding animals are confronted with a highly spatially and temporally patchy resource. This patchiness has been increased with human exploitation of these forests leading to a much greater abundance of small trees and fewer large trees. Blossom-feeding birds are likely to respond to this variation in different ways, depending upon diet-breadth, mobility and morphological and behavioural characteristics. Future conservation of the blossom-feeding fauna of Box-Ironbark forests would benefit from the retention of a greater number of large trees, the protection and enhancement of existing remnants, and revegetation with key species, such as E. leucoxylon, E. microcarpa and E. tricarpa. The selective clearing of summer flowering species, which occur on the more fertile areas, may have negatively affected the year-round abundance and distribution of floral resources. The unpredictability of the spatial distribution of flowering patches within the region means that all remnants are likely to be important foraging areas in some years.
Resumo:
Community Development as a form of practice promotes empowerment and social justice. Its origins lie in people's collective struggle to be heard, recognised and accorded full citizenship in society. It has developed strategies to achieve social change that challenge dominant ways of thinking, policy and resource allocation in society. 'Enterprise culture has its origins in the individualism and competitiveness of capitalism. These essentially neo-liberalist concepts have been remoulded into a radical political program of change sponsored by the state under the guise of new managerialism, competitive tendering and privatization. This research seeks to examine the interface between community development and enterprise culture as a potential site of tension and contestation through an analysis of discourse. The initial task, therefore, was to elaborate the concept of enterprise culture and examine the ways enterprise culture has been manifested in community development. The focus has been on practitioners committed to community development through a qualitative, empirical approach with a view to discerning their views on the relevance and impact of enterprise culture on their work. Community development provides a useful domain for interrogating the infiltration of the concept of the enterprise culture because of its history of opposition and mobilisation. The research seeks to understand the ways in which the forms of enterprise culture as an essentially cultural project are manifested in practice contexts and to analyse the nature of the response to its various manifestations. As a result, it constitutes more than just a critique of any one of these forms, eg, privatisation, tendering out, managerialism, and instead seeks to investigate the degree to which a cultural shift may be occurring towards notions of greater individualism and away from collective notions of responsibility, obligation and citizenship. The research critically analyses the impact of enterprise culture on Australian social policy through the case study of community development practice. The manifestations of enterprise culture are investigated at various levels, with an emphasis on the responses of practitioners. A related aim is to reveal the range of possible responses to the infiltration of the enterprise culture in terms of values, language and practice into community development. Are new forms of practice emerging or is the field being steadily co-opted by government social and educational policy? Finally, the research should enable some future directions to be identified for the field of community development. The findings represent an initial attempt in an Australian context to establish the degree of influence that enterprise culture has had and/or will have on social policy. Chapter 1 examines the concept of enterprise culture and a background to its impact on community development as a domain of practice. The meaning of enterprise culture and its origins will be examined in Chapter 2. Its influence on Australian social policy is then discussed with particular reference to recent changes in Victoria regarding family services. In Chapter 3, the main features of critical discourse analysis are outlined as a framework for subsequent analysis of the links between discourse and hegemony. The work of Fairclough (1992, 1995) is utilised to highlight the relevance of discourse analysis to an examination of the infiltration of ideas associated with enterprise culture into the domain of community development. Chapter 4 provides an overview of the origins and defining characteristics of community development practice. The diverse beginnings and philosophical underpinnings are discussed and the main features of community development outlined in order to establish meanings attached to key concepts such as empowerment and participation. In Chapter 5, the findings of initial interviews with sixteen community development practitioners are discussed in terms of their perceptions of the impact of enterprise culture on their practice and the organisational culture within which they operate. These initial interviews were conducted in November-December 1996. A primary focus of the interviews was to establish the key words in their lexicon of practice and to provide an opportunity for reflection on the relative influence of discourse and practices associated with enterprise culture. A framework for analysing and making sense of the forms of response to enterprise culture is applied to the responses. Four forms of possible response are proposed and discussed in the context of the data. Follow up interviews were conducted in November-December 1997 and the findings of these interviews are discussed in Chapter 6. A particular emphasis in these interviews was on any changes in the lexicon of practice and indications of a change in the impact of discourse and practices associated with enterprise culture. The forms of response suggested in the framework outlined in Chapter 5 are discussed in the light of any movement in the responses of participants in the study. The implications of the findings are discussed in the context of the framework of responses or forms of embrace of enterprise culture analysed in earlier chapters. Finally, in Chapter 7, the potential for community development as a form of practice to transcend or at least accommodate the impact of enterprise culture through strategic forms of embrace is discussed and possible strategies based on the research that may assist in the development of this response are proposed.
Resumo:
Abstract This thesis set out to achieve the following objectives: (1) To identify the priorities and expectations that the Geelong community has of its public health care system. (2) To determine if there is a common view on the attributes of a just health system. (3) To consider a method of utilising the data in the determination of health care priority setting in Barwon Health. (4) To determine a model of community participation which enables ongoing input into the decision making processes of Barwon Health. The methodology involved a combination of qualitative and quantitative research. The qualitative work involved the use of focus groups that were conducted with 64 members of the Geelong community. The issues raised informed the development of the interview schedule that was the basis of the quantitative study, which surveyed a representative sample of 400 members of the Geelong community. Prior to reporting on this work, the areas of distributive justice, scarcity and community participation in health care were considered. The research found that timely access to public hospitals, emergency care and aged care services were the major priorities; for many people, the cost was less relevant than a quality service. Shorter waiting times and increased staffing levels were strongly supported. Increased taxes were nominated as the best means of financing the health system they sought. Community based services were less relevant than hospital services but health education was supported. An egalitarian approach to resource distribution was favoured although the community was prepared to discriminate in favour of younger people and against older people. There was strong support for the community to be involved in decision making in the public health care system through surveys or focus groups but very little support was given to priorities being determined by politicians, administrators and to a lesser extent, medical professionals.
Resumo:
Summary : Osteoporosis is an increasing burden on individuals and health resources. The Osteoporosis Prevention and Self-Management Course (OPSMC) was designed to assist individuals to prevent and manage osteoporosis; however, it had not been evaluated in an Australian setting. This randomised controlled trial showed that the course increased osteoporosis knowledge.
Introduction and hypothesis : Osteoporosis is a major and growing public health concern. An OPSMC was designed to provide individuals with information and skills to prevent or manage osteoporosis, but its effectiveness has not previously been evaluated. This study aimed to determine whether OPSMC attendance improved osteoporosis knowledge, self-efficacy, self-management skills or behaviour.
Materials and methods : Using a wait list randomised controlled trial design, 198 people (92% female) recruited from the community and aged over 40 (mean age = 63) were randomised into control (n = 95) and intervention (n = 103) groups. The OPSMC consists of four weekly sessions which run for 2 h and are led by two facilitators. The primary outcome were osteoporosis knowledge, health-directed behaviour, self-monitoring and insight and self-efficacy.
Results : The groups were comparable at baseline. At 6-week follow-up, the intervention group showed a significant increase in osteoporosis knowledge compared with the control group; mean change 3.5 (p < 0.001) on a measure of 0–20. The intervention group also demonstrated a larger increase in health-directed behaviour, mean change 0.16 (p < 0.05), on a measure of 0–6.
Conclusion : The results indicate that the OPSMC is an effective intervention for improving understanding of osteoporosis and some aspects of behaviour in the short term.
Resumo:
Background Self-management is seen as a primary mechanism to support the optimization of care for people with chronic diseases such as symptomatic vascular disease. There are no established and evidence-based stroke-specific chronic disease self-management programs. Our aim is to evaluate whether a stroke-specific program is safe and feasible as part of a Phase II randomized-controlled clinical trial.
Methods Stroke survivors are recruited from a variety of sources including: hospital stroke services, local paper advertisements, Stroke South Australia newsletter (volunteer peer support organization), Divisions of General Practice, and community service providers across Adelaide, South Australia. Subjects are invited to participate in a multi-center, single-blind, randomized, controlled trial. Eligible participants are randomized to either;
• standard care,
• standard care plus a six week generic chronic condition self-management group education program, or,
• standard care plus an eight week stroke specific self-management education group program.
Interventions are conducted after discharge from hospital. Participants are assessed at baseline, immediate post intervention and six months.
Study Outcomes The primary outcome measures determine study feasibility and safety, measuring, recruitment, participation, compliance and adverse events.
Secondary outcomes include:
• positive and active engagement in life measured by the Health Education Impact Questionnaire,
• improvements in quality of life measured by the Assessment of Quality of Life instrument,
• improvements in mood measured by the Irritability, Depression and Anxiety Scale,
• health resource utilization measured by a participant held diary and safety.
Conclusion The results of this study will determine whether a definitive Phase III efficacy trial is justified.
Resumo:
Background: There is growing evidence that community-based interventions can reduce childhood obesity in older children.
Objective: We aimed to determine the effectiveness of the Romp & Chomp intervention in reducing obesity and promoting healthy eating and active play in children aged 0–5 y.
Design: Romp & Chomp was a community-wide, multisetting, multistrategy intervention conducted in Australia from 2004 to 2008. The intervention occurred in a large regional city (Geelong) with a target group of 12,000 children and focused on community capacity building and environmental (political, sociocultural, and physical) changes to increase healthy eating and active play in early-childhood care and educational settings. The evaluation was repeat cross-sectional with a quasiexperimental design and comparison sample. Main outcome measures were body mass index (BMI), standardized BMI (zBMI; according to the Centers for Disease Control and Prevention 2000 reference charts), and prevalence of overweight/obesity and obesity-related behaviors in children aged 2 and 3.5 y.
Results: After the intervention there was a significantly lower mean weight, BMI, and zBMI in the 3.5-y-old subsample and a significantly lower prevalence of overweight/obesity in both the 2- and 3.5-y-old subsamples (by 2.5 and 3.4 percentage points, respectively) than in the comparison sample (a difference of 0.7 percentage points; P < 0.05) compared with baseline values. Intervention child-behavioral data showed a significantly lower intake of packaged snacks (by 0.23 serving), fruit juice (0.52 serving), and cordial (0.43 serving) than that in the comparison sample (all P < 0.05).
Conclusion: A community-wide multisetting, multistrategy intervention in early-childhood settings can reduce childhood obesity and improve young children's diets. This trial was registered with the Australian Clinical Trials Registry at anzctr.org.au as ACTRN12607000374460.
Resumo:
Objective To develop and evaluate the effectiveness of a community behavioural intervention to prevent weight gain and improve health related behaviours in women with young children.
Design Cluster randomised controlled trial.
Setting A community setting in urban Australia.
Participants 250 adult women with a mean age of 40. 39 years (SD 4.77, range 25-51) and a mean body mass index of 27.82 kg/m2 (SD 5.42, range 18-47) were recruited as clusters through 12 primary (elementary) schools. Intervention Schools were randomly assigned to the intervention or the control. Mothers whose schools fell in the intervention group (n=127) attended four interactive group sessions that involved simple health messages, behaviour change strategies, and group discussion, and received monthly support using mobile telephone text messages for 12 months. The control group (n=123)
attended one non-interactive information session based on population dietary and physical activity guidelines.
Main outcome measures The main outcome measures were weight change and difference in weight change between the intervention group and the control group at 12 months. Secondary outcomes were changes in serum concentrations of fasting lipids and glucose, and changes in dietary behaviours, physical activity, and self management behaviours.
Results All analyses were adjusted for baseline values and the possible clustering effect. Women in the control group gained weight over the 12 month study period (0.83 kg, 95% confidence interval (CI) 0.12 to 1.54), whereas those in the intervention group lost weight (−0.20 kg, −0.90 to 0.49). The difference in weight change between the intervention group and the control group at 12 months was −1.13 kg (−2.03 to −0.24 kg; P<0.05) on the basis of observed values and −1.11 kg (−2.17 to −0.04) after multiple imputation to account for possible bias created by missing values. Secondary analyses after multiple imputation showed a difference in the intervention group compared with the control group for total cholesterol concentration (−0.35 mmol/l, −0.70 to −0.001), self management behaviours (diet score 0.18, 0.13 to 0.33; physical activity score 0.24, 0.05 to 0.43), and confidence to control weight (0.40, 0.11 to 0.69). Regular self weighing was associated with weight loss in the intervention group only (−1.98 kg, −3.75 to −0.23).
Conclusions Weight gain in women with young children could be prevented using a low intensity self management intervention delivered in a community setting. Self management of health behaviours improved with the intervention. The response rate of 12%, although comparable with that in other community studies, might limit the ability to generalise to other populations.
Trial registration Australian New Zealand Clinical Trials Registry number ACTRN12608000110381.
