Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial.

OBJECTIVE: To test the effect of a multidimensional lifestyle intervention on aerobic fitness and adiposity in predominantly migrant preschool children. DESIGN: Cluster randomised controlled single blinded trial (Ballabeina study) over one school year; randomisation was performed after stratification for linguistic region. SETTING: 40 preschool classes in areas with a high migrant population in the German and French speaking regions of Switzerland. PARTICIPANTS: 652 of the 727 preschool children had informed consent and were present for baseline measures (mean age 5.1 years (SD 0.7), 72% migrants of multicultural origins). No children withdrew, but 26 moved away. INTERVENTION: The multidimensional culturally tailored lifestyle intervention included a physical activity programme, lessons on nutrition, media use (use of television and computers), and sleep and adaptation of the built environment of the preschool class. It lasted from August 2008 to June 2009. MAIN OUTCOME MEASURES: Primary outcomes were aerobic fitness (20 m shuttle run test) and body mass index (BMI). Secondary outcomes included motor agility, balance, percentage body fat, waist circumference, physical activity, eating habits, media use, sleep, psychological health, and cognitive abilities. RESULTS: Compared with controls, children in the intervention group had an increase in aerobic fitness at the end of the intervention (adjusted mean difference: 0.32 stages (95% confidence interval 0.07 to 0.57; P=0.01) but no difference in BMI (-0.07 kg/m(2), -0.19 to 0.06; P=0.31). Relative to controls, children in the intervention group had beneficial effects in motor agility (-0.54 s, -0.90 to -0.17; P=0.004), percentage body fat (-1.1%, -2.0 to -0.2; P=0.02), and waist circumference (-1.0 cm, -1.6 to -0.4; P=0.001). There were also significant benefits in the intervention group in reported physical activity, media use, and eating habits, but not in the remaining secondary outcomes. CONCLUSIONS: A multidimensional intervention increased aerobic fitness and reduced body fat but not BMI in predominantly migrant preschool children.

Effects of a lifestyle intervention on adiposity and fitness in overweight or low fit preschoolers (Ballabeina).

OBJECTIVE: Overweight (OW) and low fit children represent cardiovascular high-risk groups. A multidimensional school-based lifestyle intervention performed in 652 preschoolers reduced skinfold thickness and waist circumference, and improved fitness, but did not affect BMI. The objective of this study is to examine whether the intervention was equally effective in OW (≥90th national percentile) and/or low fit (lowest sex- and age-adjusted quartile of aerobic fitness) children compared to their normal weight and normal fit counterparts. DESIGN AND METHODS: Cluster randomized controlled single blinded trial, conducted in 2008/09 in 40 randomly selected preschool classes in Switzerland. The intervention included a playful physical activity program and lessons on nutrition, media use and sleeps. Primary outcomes were BMI and aerobic fitness; secondary outcomes included sum of four skinfolds, waist circumference and motor agility. Modification of intervention effects by BMI-group and fitness-group was tested by interaction terms. RESULTS: Compared to their counterparts, OW children (n = 130) had more beneficial effects on waist circumference (p for interaction = 0.001) and low fit children (n = 154) more beneficial effects on all adiposity outcomes (p for interaction ≤0.03). The intervention effects on both fitness outcomes were not modified by BMI- or fitness-group (all p for interaction ≥0.2). Average intervention effect sizes for BMI were -0.12, -0.05, -0.26 and -0.02 kg/m(2) and for aerobic fitness were 0.40, 0.30, 0.12 and 0.36 stages for OW, normal weight, low fit and normal fit children, respectively. Conclusions: This multidimensional intervention was equally and for some adiposity measures even more effective in high-risk preschoolers and represents a promising option for these children.

Effet de la participation au projet TRANSITION sur l’engagement et le rendement scolaires des jeunes ayant un TDAH à la fin de la première année du secondaire

Le TDAH persiste jusqu’à l’âge adulte dans la majorité des cas. Les jeunes ayant un TDAH sont plus à risque de sous-performance et de décrochage scolaires. Ils présentent également des déficits organisationnels, tel qu’une difficulté à planifier et compléter leurs devoirs. Sans interventions appropriées, ils sont à risque de difficultés importantes au secondaire. La présente étude vise à évaluer l’effet d’une intervention multimodale, Projet TRANSITION, sur l’engagement et le rendement scolaires des jeunes ayant un TDAH. L’échantillon était composé de 47 familles, réparties aléatoirement entre un groupe participant à l’intervention et un groupe contrôle. A la fin de secondaire 1, les jeunes ayant participé ou non à l’intervention ne se distinguent pas quant à la qualité de leur engagement scolaire (cognitif, affectif, comportemental). À la fin du secondaire 1, il n’y a pas de différence significative entre les groupes au niveau des difficultés en lecture ou mathématiques rapportées par le jeune ou le parent, de l’écart à la moyenne de la classe selon le bulletin, et du rendement scolaire par rapport aux autres élèves de leur classe rapporté par le jeune. Cependant, les parents perçoivent que les jeunes ayant participé à l’intervention présentent un meilleur rendement scolaire par rapport aux autres élèves de leur classe en comparaison aux jeunes du groupe contrôle.

Effect of a lifestyle intervention on adiposity and fitness in socially disadvantaged subgroups of preschoolers: a cluster-randomized trial (Ballabeina).

OBJECTIVE: A multidimensional lifestyle intervention performed in 652 preschoolers (72% of migrant, 38% of low educational level (EL) parents) reduced body fat, but not BMI and improved fitness. The objective of this study is to examine whether the intervention was equally effective in children of migrant and/or low EL parents.¦METHODS: Cluster-randomized controlled single blinded trial, conducted in 2008/09 in 40 randomly selected preschools in Switzerland. The culturally tailored intervention consisted of a physical activity program and lessons on nutrition, media use and sleep. Primary outcomes included BMI and aerobic fitness. Secondary outcomes included %body fat, waist circumference and motor agility.¦RESULTS: Children of migrant parents benefitted similarly from the intervention compared to their counterparts (p for interaction≥ 0.09). However, children of low EL parents benefitted less, although these differences did not reach statistical significance (p for interaction≥ 0.06). Average intervention effect sizes for BMI were -0.10, -0.05, -0.11 and 0.04 kg/m(2) and for aerobic fitness were 0.55, 0.20, 0.37 and -0.05 stages for children of non-migrant, migrant, middle/high EL and low EL parents, respectively.¦CONCLUSIONS: This intervention was similarly effective among preschoolers of migrant parents compared to their counterparts, while children of low EL parents benefitted less.

Efficacy of in-hospital multidimensional interventions of secondary prevention after acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND: Secondary prevention programs for patients experiencing an acute coronary syndrome have been shown to be effective in the outpatient setting. The efficacy of in-hospital prevention interventions administered soon after acute cardiac events is unclear. We performed a systematic review and meta-analysis to determine whether in-hospital, patient-level interventions targeting multiple cardiovascular risk factors reduce all-cause mortality after an acute coronary syndrome. METHODS AND RESULTS: Using a prespecified search strategy, we included controlled clinical trials and before-after studies of secondary prevention interventions with at least a patient-level component (ie, education, counseling, or patient-specific order sets) initiated in hospital with outcomes of mortality, readmission, or reinfarction rates in acute coronary syndrome patients. We classified the interventions as patient-level interventions with or without associated healthcare provider-level interventions and/or system-level interventions. Twenty-six studies met our inclusion criteria. The summary estimate of 14 studies revealed a relative risk of all-cause mortality of 0.79 (95% CI, 0.69 to 0.92; n=37,585) at 1 year. However, the apparent benefit depended on study design and level of intervention. The before-after studies suggested reduced mortality (relative risk [RR], 0.77; 95% CI, 0.66 to 0.90; n=3680 deaths), whereas the RR was 0.96 (95% CI, 0.64 to 1.44; n=99 deaths) among the controlled clinical trials. Only interventions including a provider- or system-level intervention suggested reduced mortality compared with patient-level-only interventions. CONCLUSIONS: The evidence for in-hospital, patient-level interventions for secondary prevention is promising but not definitive because only before-after studies suggest a significant reduction in mortality. Future research should formally test which components of interventions provide the greatest benefit.

Efficacity of in-hospital multidimensional interventions of secondary prevention after acute coronary syndrome : a systematic review and meta-analysis

RAPPORT DE SYNTHÈSE : Contexte Les programmes de prévention cardiovasculaire secondaire après un événement coronarien aigu ont pu démontrer leur efficacité dans le contexte des soins ambulatoires. L'hospitalisation pour une maladie aiguë peut être considérée comme un «instant charnière», particulièrement adapté à un changement de comportement de santé et où des interventions de prévention secondaire, telle l'éducation du patient, pourraient être particulièrement efficaces. De plus, la prescription de médicaments de prévention cardiovasculaire durant l'hospitalisation semble augmenter la proportion des patients traités selon les recommandations sur le long terme. Récemment, plusieurs études ont évalué l'efficacité de programmes de prévention ayant pour but l'éducation des patients et/ou une augmentation du taux de prescription de médicaments prouvés efficaces par les médecins en charge. L'article faisant l'objet du travail de thèse synthétise la littérature existante concernant l'efficacité en termes de mortalité des interventions multidimensionnelles de prévention cardiovasculaire après un syndrome coronarien aigu, débutées à l'hôpital, centrées sur le patient et ciblant plusieurs facteurs de risque cardiovasculaire. MÉTHODE ET RÉSULTATS : En utilisant une stratégie de recherche définie à l'avance, nous avons inclus des essais cliniques avec groupe contrôle et des études avant-après, débutées à l'hôpital et qui incluaient des résultats cliniques de suivi en terme de mortalité, de taux de réadmission et/ou de récidive de syndrome coronarien aigu. Nous avons catégorisé les études selon qu'elles ciblaient les patients (par exemple une intervention d'éducation aux patients par des infirmières), les soignants (par exemple des cours destinés aux médecins-assistants pour leur enseigner comment prodiguer des interventions éducatives) ou le système de soins (par exemple la mise en place d'itinéraires cliniques au niveau de l'institution). Globalement, les interventions rapportées dans les 14 études répondant aux critères montraient une réduction du risque relatif (RR) de mortalité après un an (RR= 0.79; 95% intervalle de confiance (IC), 0.69-0.92; n=37'585). Cependant, le bénéfice semblait dépendre du type d'étude et du niveau d'intervention. Les études avant-après suggéraient une réduction du risque de mortalité (RR, 0.77; 95% IC, 0.66-0.90; n=3680 décès), tandis que le RR était de 0.96 (95% IC, 0.64-1.44; n=99 décès) pour les études cliniques contrôlées. Seules les études avant-après et les études ciblant les soignants et le système, en plus de cibler les patients, semblaient montrer un bénéfice en termes de mortalité à une année. CONCLUSIONS ET PERSPECTIVES : Les preuves d'efficacité des interventions de prévention secondaires débutées à l'hôpital, ciblant le patient, sont prometteuses, mais pas définitives. En effet, seules les études avant-après montrent un bénéfice en termes de mortalité. Les recherches futures dans ce domaine devraient tester formellement quels éléments des interventions amènent le plus de bénéfices pour les patients.

Matrix Mind : on managerial reframing in multidimensional problem solving

Det är inte ovanligt att man i organisationer ställs inför problem som inte kan hanteras inom befintlig organisationsstruktur. Skälen kan vara att frågorna har många – ibland konflikterande – dimensioner och perspektiv som samtidigt måste beaktas. I den här avhandlingen studeras vilka tankemönster och föreställningar som fanns när grupper av chefer försökte lösa komplexa problem, som inte hade en naturlig organisatorisk hemvist och hur de omsatte dessa tankemönster i handling. Vad kännetecknade det ledarskap som utövades under problemlösningsprocessen? Avhandlingens empiri hämtas från ledarutvecklingsprogram i två internationellt verksamma företag i Sverige, och omfattar 14 verkliga affärsproblem i dessa företag och den process varigenom de löstes. De 14 seminarierna utgör exempel på hur mångdimensionella frågeställningar framgångsrikt hanteras utanför den befintliga organisationsstrukturen. Studien ger, genom att adressera frågor kring tankesätt och ledningsprocesser, en djupare förståelse för förutsättningarna för detta, och lyfter särskilt fram betydelsen av ett ledarskap som inbegriper begreppen intervention, förmåga och omtolkning. Som ett samlat begrepp introduceras bilden att utöva ledarskapet utifrån ett matrix mind. Att påverka strukturer (i vid mening) och därigenom de förmågor som utvecklas, är del i detta ledarskap. Det sker genom interventioner (ingrepp som påverkar relationer i t ex en grupp) och baserades i den aktuella empirin på uppfattningar om värdet av problematisering, erfarenhetsutbyte och av ett språk, som både beskriver och anger inriktning för aktiviteter. Interventioner i strukturer (och till dem knutna processer) beskriver dock bara delvis detta ledarskap. Att leda med ett matrix mind innefattar också ett nyfiket och kreativt förhållningssätt, och att utifrån detta leda omtolkning av problem. I empirin finns flera exempel på detta. Avhandlingen avser att ge ett bidrag inom såväl organisations- som ledarskapsteori.

La réceptivité chez les adolescents agresseurs sexuels participant à une intervention de groupe basé sur la prévention de la récidive

Rapport de stage présenté à la Faculté des études supérieures en vue de l’obtention de la Maîtrise (M.Sc.) en criminologie

Response to intervention : are the emperor's clothes really new?.

Resumen tomado de la publicaci??n

The multidimensional measurement of the positive symptoms of psychosis

The measures most frequently used to assess psychotic symptoms fail to reflect important dimensions. The Psychotic Symptom Rating Scale (PSYRATS) aims to capture the multidimensional nature of auditory hallucinations and delusions. Individuals (N = 276) who had recently relapsed with positive symptoms completed the auditory hallucinations and delusions PSYRATS scales. These scores were compared with the relevant items from the SAPS and PANSS, and with measures of current mood. Total scores and distribution of items of the PSYRATS scales are presented and correlated with other measures. Positive symptom items from the SAPS and PANSS reflected the more objective aspects of PSYRATS ratings of auditory hallucinations and delusions (frequency and conviction) but were relatively poor at measuring distress. A major strength of the PSYRATS scales is the specific measurement of the distress dimension of symptoms, which is a key target of psychological intervention. It is advised that the PSYRATS should not be used as a total score alone, whilst further research is needed to clarify the best use of potential subscales. Copyright (c) 2007 John Wiley & Sons, Ltd.

Confiabilidade e pontuação mínima relacionada à intervenção analgésica de uma escala multidimensional para avaliação de dor pós-operatória em gatos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Refinement and partial validation of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in horses

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Validez y confiabilidad de la versión en español de la escala multidimensional de la UNESP-Botucatu para evaluar el dolor postoperatorio en gatos

This study focused on the validation of the Spanish version of the UNESP-Botucatu multidimensional composite pain scale to assess postoperative pain in cats. The original scale in Portuguese was translated into Spanish by two independent translators, and summarised in one version by a third individual. The summarised version was back-translated and minor adjustments were made. The scale was reviewed by three anesthesiologists with Spanish as their first language, and the final version was submitted to psychometric testing. Thirty cats undergoing ovariohysterectomy were video recorded during the perioperative period. Six observers from different spanish speaking countries, who had Spanish as the first language watched the videos and determined the pain scores using the Spanish version of the scale, identifying the cats that should receive analgesics. Videos were reanalysed in a different order about 2 months after the first assessment. The sensitivity to change, content and construct validity were established by the significant change in pain scores in response to surgery and analgesics. The agreement between the evaluations of the 'gold standard'(researcher that developed the scale) and the other observers confirmed the criterion validity. Inter- and intra-rater reliability, evaluated by intra-class correlation coefficient, ranged from good to very good for all scale items. The cut-off point for rescue analgesia identified by Receiver Operating Characteristic curve was > 7 with 92% of sensitivity and 91% of specificity. The Spanish version of the UNESP-Botucatu multidimensional composite pain scale is interpretable (has an optimal analgesic intervention score), valid and reliable instrument for assessing acute pain in cats undergoing ovariohysterectomy.

Class-specific metrics for multidimensional data projection applied to CBIR

Content-based image retrieval is still a challenging issue due to the inherent complexity of images and choice of the most discriminant descriptors. Recent developments in the field have introduced multidimensional projections to burst accuracy in the retrieval process, but many issues such as introduction of pattern recognition tasks and deeper user intervention to assist the process of choosing the most discriminant features still remain unaddressed. In this paper, we present a novel framework to CBIR that combines pattern recognition tasks, class-specific metrics, and multidimensional projection to devise an effective and interactive image retrieval system. User interaction plays an essential role in the computation of the final multidimensional projection from which image retrieval will be attained. Results have shown that the proposed approach outperforms existing methods, turning out to be a very attractive alternative for managing image data sets.

Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Multidimensional preventive home visit programs aim at maintaining health and autonomy of older adults and preventing disability and subsequent nursing home admission, but results of randomized controlled trials (RCTs) have been inconsistent. Our objective was to systematically review RCTs examining the effect of home visit programs on mortality, nursing home admissions, and functional status decline. METHODS: Data sources were MEDLINE, EMBASE, Cochrane CENTRAL database, and references. Studies were reviewed to identify RCTs that compared outcome data of older participants in preventive home visit programs with control group outcome data. Publications reporting 21 trials were included. Data on study population, intervention characteristics, outcomes, and trial quality were double-extracted. We conducted random effects meta-analyses. RESULTS: Pooled effects estimates revealed statistically nonsignificant favorable, and heterogeneous effects on mortality (odds ratio [OR] 0.92, 95% confidence interval [CI], 0.80-1.05), functional status decline (OR 0.89, 95% CI, 0.77-1.03), and nursing home admission (OR 0.86, 95% CI, 0.68-1.10). A beneficial effect on mortality was seen in younger study populations (OR 0.74, 95% CI, 0.58-0.94) but not in older populations (OR 1.14, 95% CI, 0.90-1.43). Functional decline was reduced in programs including a clinical examination in the initial assessment (OR 0.64, 95% CI, 0.48-0.87) but not in other trials (OR 1.00, 95% CI, 0.88-1.14). There was no single factor explaining the heterogenous effects of trials on nursing home admissions. CONCLUSION: Multidimensional preventive home visits have the potential to reduce disability burden among older adults when based on multidimensional assessment with clinical examination. Effects on nursing home admissions are heterogeneous and likely depend on multiple factors including population factors, program characteristics, and health care setting.