Violent offending : the efficacy of a unitary and transtheoretical intervention

Examines "best practice" in reducing recidivism. Compares two interventions for violent offenders, and examines whether their different theoretical orientations (unitary or transtheoretical) affected program efficiency. Although the transtheoretical intervention was more efficacious, insufficient adherence to best practice principles within implementation of both programs significantly impinged upon program success.

Assessing the legitimacy of humanitarian intervention : purpose, authority and means

This study looked at military deployments that seek to promote human rights, including operations in Somalia, Rwanda and Kosovo. While a legitimate humanitarian purpose and international authority for these missions can be demonstrated, finding the appropriate means of action - or how to best conduct the operation - remains very difficult, ensuring similar future missions will remain controversial.

Constructing a Malaysian early intervention programme for children with disabilities

This case study of a parent-initiated community project called Wings Melaka has helped improve provision of early intervention services to Malaysian children with disabilities, and their families, by making contributions specifically to the workplace at Wings Melaka, and more generally, to the much-neglected field of early intervention in Malaysia.

Evaluation of an early intervention program for childhood conduct problems

Treatment outcomes of an early intervention program for childhood conduct problems were evaluated. Results provided support for the longitudinal effectiveness of the program in reducing conduct problems, social difficulties, and psychosocial impairment for young primary school aged children. Children's experience and expression of anger also reduced across the program's duration. The portfolio presents four case studies whose results provide further support for Exposure and Response Prevention (ERP) as an effective and clinically useful treatment for paediatric OCD in everyday clinical contexts.

Evaluation of an internet-based psychological intervention for the treatment of erectile dysfunction

Recent research on the treatment of erectile dysfunction (ED) has focused on medical interventions, in particular oral medications. The current study examined the effectiveness of an internet-based psychological intervention for this condition. In total, 31 men (12 in treatment group, 19 in control group) completed the program. The results demonstrated that men who completed the program reported improved erectile functioning and sexual relationship satisfaction and quality. The implications of these findings for the treatment of ED are discussed.

Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan

Background/Purpose

Hepatocellular carcinoma (HCC) has been the leading cause of cancer death in Taiwan since the 1980s. A two-stage screening intervention was introduced in 1996 and has been implemented in a limited number of hospitals. The present study assessed the costs and health outcomes associated with the introduction of screening intervention, from the perspective of the Taiwanese government. The cost-effectiveness analysis aimed to assist informed decision making by the health authority in Taiwan.
Methods

A two-phase economic model, 1-year decision analysis and a 60-year Markov simulation, was developed to conceptualize the screening intervention within current practice, and was compared with opportunistic screening alone. Incremental analyses were conducted to compare the incremental costs and outcomes associated with the introduction of the intervention. Sensitivity analyses were performed to investigate the uncertainties that surrounded the model.
Results

The Markov model simulation demonstrated an incremental cost-effectiveness ratio (ICER) of NT$498,000 (US$15,600) per life-year saved, with a 5% discount rate. An ICER of NT$402,000 (US$12,600) per quality-adjusted life-year was achieved by applying utility weights. Sensitivity analysis showed that excess mortality reduction of HCC by screening and HCC incidence rates were the most influential factors on the ICERs. Scenario analysis also indicated that expansion of the HCC screening intervention by focusing on regular monitoring of the high-risk individuals could achieve a more favorable result.
Conclusion

Screening the population of high-risk individuals for HCC with the two-stage screening intervention in Taiwan is considered potentially cost-effective compared with opportunistic screening in the target population of an HCC endemic area.

Attracting women to computing : a framework for evaluating intervention programmes

The lack of women in the computing industry in Australia, and in many western countries, is a problem that has been recognised by academics, the industry and governments. Over the last 20 years there have been many attempts to redress this gender imbalance via intervention programs aimed at increasing female participation in computing education and ultimately the computing profession. However statistics show no improvement in the rate of participation of females in this industry and anecdotal evidence suggests that these intervention programmes have not been as successful or effective as was anticipated. Evaluation could determine the effectiveness of such programmes yet only limited evaluations appear in the literature about intervention programmes established to encourage females in computing. This research sought to investigate how these types of intervention programmes should be evaluated.

Reducing obesity in early childhood : results from romp & chomp, an Australian community-wide intervention program

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.

Evaluation of a community pharmacy-based intervention for improving patient adherence to antihypertensives: a randomised controlled trial

Background
The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy (HAPPY).

Methods/Design
The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense®). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data.

Discussion
To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention.

Trial Registration
Australian New Zealand Clinical Trial Registry ACTRN12609000705280

Twelve-month effects of a playground intervention on children's morning and lunchtime recess physical activity levels

Background: Recess is an opportunity for children to engage in daily physical activity. The aim of this study was to investigate the 12-month effects of a playground intervention on children’s moderate-to-vigorous (MVPA) and vigorous physical activity (VPA) during morning and lunchtime recess.

Methods: Four hundred and seventy children (232 boys, 238 girls) from 26 elementary schools participated in the study. Fifteen schools redesigned the playground environment using playground markings and physical structures. Eleven schools served as socioeconomic matched controls. Physical activity levels were quantified using heart rate and accelerometry at baseline, 6 months, and 12 months post-intervention. A 3-level (time, pupil, and school) multilevel analysis was used to determine the effects of the intervention across time on MVPA and VPA.

Results: Positive yet nonsignificant intervention effects were found for MVPA and VPA during morning and lunchtime recess. Intervention children were more active during recess than control children. Interactions revealed that the intervention effect was stronger at 6 months than 12 months post-intervention.

Conclusions: A playground markings and physical structures intervention had a positive effect on intervention children’s morning and lunchtime MVPA and VPA when assessed using heart rate and accelerometry, but this effect is strongest 6-months post-intervention and decreased between 6 months and 12 months.

Children's physical activity levels during school recess : a quasi-experimental intervention study

Background : Recess provides a daily opportunity for children to engage in moderate-to-vigorous (MVPA) and vigorous physical activity (VPA). Limited research has investigated the effects of recess-based interventions on physical activity using large sample sizes whilst investigating variables that may influence the intervention effect. The aim of the study was to investigate the short-term effects of a playground markings and physical structures intervention on recess physical activity. A secondary aim was to investigate the effects of covariates on the intervention.

Methods : 150 boys and 147 girls were randomly selected from 26 elementary schools to wear uni-axial accelerometers that quantified physical activity every 5 seconds during recess. Fifteen schools located in deprived areas in one large urban city in England received funding through a national initiative to redesign the playground environment. Eleven schools served as matched socioeconomic controls. Data were collected at baseline and 6-weeks following playground intervention. Recess MVPA and VPA levels adjusted for pupil- and school-level covariates (baseline physical activity, age, gender, recess length, body mass index) were analysed using multilevel analyses.

Results : Positive but non-significant intervention effects were found for MVPA and VPA when confounding variables were added to the model. Gender was a significant predictor of recess physical activity, with boys engaging in more MVPA and VPA than girls. Significant interactions for MVPA revealed that the intervention effect was stronger for younger elementary aged school children compared to older children, and the intervention effect increased as daily recess duration increased.

Conclusion : The playground redesign intervention resulted in small but non-significant increases in children's recess physical activity when school and pupil level variables were added to the analyses. Changing the playground environment produced a stronger intervention effect for younger children, and longer daily recess duration enabled children to engage in more MVPA following the intervention. This study concludes that the process of increasing recess physical activity is complex when school and pupil-level covariates are considered, though they should be taken into account when investigating the effects of playground intervention studies on children's physical activity during recess.