Center-based Intervention Research Articles

Wearable EEG Neurofeedback Based-on Machine Learning Algorithms for Children with Autism: A Randomized, Placebo-controlled Study.

Behavioral interventions have been shown to ameliorate the electroencephalogram (EEG) dynamics underlying the behavioral symptoms of autism spectrum disorder (ASD), while studies have also demonstrated that mirror neuron mu rhythm-based EEG neurofeedback training improves the behavioral functioning of individuals with ASD. This study aimed to test the effects of a wearable mu rhythm neurofeedback training system based on machine learning algorithms for children with autism. A randomized, placebo-controlled study was carried out on 60 participants aged 3 to 6 years who were diagnosed with autism, at two center-based intervention sites. The neurofeedback group received active mu rhythm neurofeedback training, while the control group received a sham neurofeedback training. Other behavioral intervention programs were similar between the two groups. After 60 sessions of treatment, both groups showed significant improvements in several domains including language, social and problem behavior. The neurofeedback group showed significantly greater improvements in expressive language (P=0.013) and cognitive awareness (including joint attention, P=0.003) than did the placebo-controlled group. Artificial intelligence-powered wearable EEG neurofeedback, as a type of brain-computer interface application, is a promising assistive technology that can provide targeted intervention for the core brain mechanisms underlying ASD symptoms.

¡Miranos! An 8-Month Comprehensive Preschool Obesity Prevention Program in Low-Income Latino Children: Effects on Children's Gross Motor Development.

Organized childcare is an ideal setting to promote gross motor development in young children from low-income minority families. A three-group clustered randomized controlled trial was conducted in Head Start centers serving low-income Latino children to evaluate the impact of an 8-month comprehensive obesity-prevention intervention on children's percentile scores for locomotive skills (LS pctl) and ball skills (BS pctl), and general motor quotient (GMQ). Trained Head Start staff delivered the center-based intervention (CBI) to modify center physical activity and nutrition policies, staff practices, and child behaviors, while the home-based intervention (HBI) offered training and support to parents for obesity prevention at home. Participants were 3-year-old children (n = 310; 87% Latino; 58% female) enrolled in Head Start centers in South Texas. Twelve centers were randomized (1:1:1 ratio) to receive CBI, CBI and HBI (CBI + HBI), or control treatment. Posttest data were collected from 79.1% of participants. All gross motor development measures improved significantly for children in CBI compared to the control, while children in CBI + HBI only showed improvement for GMQ (p = 0.09) and LS pctl (p < 0.001) compared to the control. A comprehensive and culturally competent intervention targeting childcare centers and children's homes was effective at improving children's gross motor development and reducing disparities in child development.

Comparison Of Toddler Physical Activity Measured By Direct Observation And Accelerometer During A Center-based Intervention

Comparison Of Toddler Physical Activity Measured By Direct Observation And Accelerometer During A Center-based Intervention

Effects of Active Video Game Interventions on Physical Health and Development Among Healthy Preschool Children

Early physical activity (PA) interventions during preschool ages are necessary and critical to cultivate healthy movement behaviors for healthy growth and development. The increasing obesity rate among children is a major public health concern globally, which is largely due to poor adherence to participating in regular PA. Active video game (AVG) interventions have been increasingly used in promoting PA. The narrative review synthesized current literature regarding the effect of AVG interventions on physical health and development indicators among healthy preschoolers. A systematic review was performed in Academic Search Premier, CINAHL, ERIC, PubMed, SPORT Discus, and Web of Science, following the PRISMA guidelines. A total of seven experimental studies were included; two were home-based interventions and five were center-based interventions. Three studies confirmed AVG interventions had a positive effect on the targeted outcomes: fruit and vegetable acceptance, execution function, and perceived competence. All other studies found partially positive effects on PA levels, motor skill competence, fundamental movement skills, or cognitive flexibility. The available evidence suggests that AVGs could be a promising channel to promote PA outcomes that contribute to physical health and development in preschoolers. The results underline advantages and usages of AVG interventions in preschoolers although evidence provided limited robustness. There is a paucity of studies that investigated the effect of AVG PA interventions on physical health and development in healthy preschoolers. Future studies are needed to replicate findings and test feasibility and efficacy of AVG PA interventions.

Impact of ¡Míranos! on parent-reported home-based healthy energy balance-related behaviors in low-income Latino preschool children: a clustered randomized controlled trial

BackgroundWidespread establishment of home-based healthy energy balance-related behaviors (EBRBs), like diet, physical activity, sedentary behavior, screen time, and sleep, among low-income preschool-aged children could curb the childhood obesity epidemic. We examined the effect of an 8-month multicomponent intervention on changes in EBRBs among preschool children enrolled in 12 Head Start centers.MethodsThe Head Start (HS) centers were randomly assigned to one of three treatment arms: center-based intervention group (CBI), center-based plus home-based intervention group (CBI + HBI), or control. Before and following the intervention, parents of 3-year-olds enrolled in participating HS centers completed questionnaires about their child’s at-home EBRBs. Adult-facilitated physical activity (PA) was measured by an index based on questions assessing the child’s level of PA participation at home, with or facilitated by an adult. Fruit, vegetable, and added sugar intake were measured via a short food frequency questionnaire, and sleep time and screen time were measured using 7-day logs. A linear mixed effects model examined the intervention’s effect on post-intervention changes in PA, intake of fruit, vegetable, and added sugar, sleep time, and screen time from baseline to post-intervention.ResultsA total of 325 parents participated in the study (CBI n = 101; CBI + HBI n = 101; and control n = 123). Compared to control children, CBI and CBI + HBI parents reported decreases in children’s intake of added sugar from sugar-sweetened beverages. Both CBI and CBI + HBI parents also reported smaller increases in children’s average weekday screen time relative to controls. In addition, CBI + HBI parents reported CBI + HBI parents reported increases in children’s adult-facilitated PA, fruit and vegetable intake, and daily sleep time during weekdays (excluding weekends) and the total week from baseline to post-intervention, while children in the CBI increased sleep time over the total week compared to the children in the control group.ConclusionsParent engagement strengthened the improvement in parent-reported EBRBs at home in young children participating in an evidence-based obesity prevention program in a childcare setting. Future studies should investigate equity-related contextual factors that influence the impact of obesity prevention in health-disparity populations.Trial registrationClinicalTrials.gov, NCT03590834. Registered July 18, 2018, https://clinicaltrials.gov/ct2/show/NCT03590834

Implementation and modification of an organizational-level intervention: a prospective analysis

BackgroundModifications to interventions can jeopardize intervention outcomes. Pre-existing perceived barriers and facilitators to the intervention arising in the implementation preparation phase may help explain why modifications to the intervention may occur during the implementation phase. This two-site comparative case study describes modifications made to a complex organizational-level intervention and examines how known implementation science factors may have enabled such changes to occur.MethodsNorthwestern Medicine’sTM Hispanic Kidney Transplant Program (HKTP) is a culturally competent transplant center-based intervention designed to reduce disparities in living donor kidney transplantation among Hispanics. In-depth qualitative interviews and discussions were longitudinally conducted with transplant stakeholders (i.e., physicians, administrators, clinicians) at two kidney transplant programs with large Hispanic populations during implementation preparation and implementation phases. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis, and Stirman’s Framework for Reporting Adaptations and Modifications-Expanded (FRAME) guided modification classification.ResultsAcross sites, 57 stakeholders participated in an interview, group discussion, and/or learning collaborative discussion. Site-B made more modifications than Site-A (n = 29 versus n = 18). Sites differed in the proportions of delaying/skipping (Site-A 50% versus Site-B 28%) and adding (Site-A 11% versus Site-B 28%) but had comparable substituting (Site-A 17% versus Site-B 17%) and tweaking (Site-A 17% versus Site-B 14%) modification types. Across sites, the transplant team consistently initiated the most modifications (Site-A 66%; Site-B 62%). While individuals initiated slightly more modifications at Site-B (21% versus Site-A 17%), institutions instigated proportionately slightly more modifications at Site-A (17% versus Site-B 10%). CFIR inner setting factors (i.e., structural characteristics, culture, available resources, implementation climate) that prominently emerged during the implementation preparation phase explained similarities and differences in sites’ modification numbers, types, and agents in the implementation phase.ConclusionOrganizations implementing a culturally competent care intervention made modifications. CFIR inner setting factors emerging in the implementation preparation phase largely explained similarities and differences in study sites’ modifications. Identifying factors contributing to modifications may help institutions become better prepared to implement an intervention by addressing known factors in advance, which may foster greater fidelity leading to desired outcomes.Trial registrationClinicalTrials.govNCT03276390. We registered the study retrospectively on 9-7-17.

Passive versus active service delivery: Comparing the effects of two parenting interventions on early cognitive development in rural China.

We present the results of a cluster-randomized controlled trial that evaluates the effects of a free, center-based parenting intervention on early cognitive development and parenting practices in 100 rural villages in China. We then compare these effects to a previous trial of a home-based intervention conducted in the same region, using the same parenting curriculum and public service system, accounting for potential differences between the studies. We find that the center-based intervention did not have a significant impact on child development outcomes, but did lead to increases in the material investments, time investments, and parenting skills of caregivers. The average impact of the center-based intervention on child skills and investments in children was significantly smaller than the home-visiting intervention. Analysis of the possible mechanisms suggests that the difference in effects was driven primarily by different patterns of selection into program participation.

Effects of a Web-based Intervention on Cardiovascular and Physical Health of Korean Older Adults During the Pandemic

During the lockdown, 97.5% of Korean senior centers in South Korea were closed to prevent the spread of the coronavirus disease 2019 (COVID-19). The threat of the COVID-19 presented the need for alternative interventions for Korean older adults to maintain cardiovascular and physical health. Korean senior centers implemented web-based interventions to provide physical health services, but their effectiveness was not yet assessed. Thus, our study aimed to identify the effects of a web-based intervention using a smartwatch and mobile app in older adults when compared to center-based intervention during the pandemic. This study collected 117 Korean older adults (≥ 60) who participated in the 12-week web-based and center-based physical interventions using a smartwatch and mobile app. This quasi-experimental study was conducted between August and December in 2020. We analyzed the pre-posttest of cardiovascular and physical health across two intervention types. Our regression results indicated that participants in the 12-week web-based intervention reported better cardiovascular (systolic blood pressure: b = -13.77, p < .001; cholesterol: b = -11.71, p < .05) and physical health (muscular function: b = 2.99, p < .001; body balance: b = -1.31, p < .001; cardiopulmonary endurance: b = 33.33, p < .001) than those in center-based intervention at posttest. The findings imply a web-based intervention is likely to become an innovative therapeutic strategy for older adults' health to respond to the rapidly changing social service systems amid the pandemic.

Effectiveness of exercise intervention on fall-related fractures in older adults: a systematic review and meta-analysis of randomized controlled trials

BackgroundExercise intervention can significantly improve physical function and bone strength; however, the effect of exercise on fall-related fractures in older adults remains controversial. This study aimed to assess the effectiveness of exercise intervention on fall-related fractures in older adults by conducting a meta-analysis of randomized controlled trials (RCTs).MethodsPubMed, EMBASE, and Cochrane databases were systematically searched for RCTs through November 24, 2019 to investigate the effectiveness of exercise intervention on fall-related fractures in older adults. Pooled relative risk (RR) with 95% confidence interval (CI) was calculated using the random-effects model. Sensitivity, subgroup, and publication bias analyses were also conducted.ResultsA total of 7704 older adults and 428 fall-related fracture events from 20 RCTs were selected for the final meta-analysis. The follow-up duration across included trials ranged from 6.0 months to 7.0 years. The pooled RR suggested that exercise intervention was associated with a reduced fall-related fracture risk in older adults (RR: 0.74; 95% CI: 0.59–0.92; P = 0.007; I2 = 12.6%). The pooled conclusion was robust and not affected by any individual trial. Subgroup analysis revealed that the significant effect of exercise intervention on fall-related fractures was mainly detected when the study reported results from both male and female subjects, when it did not report the baseline body mass index, when individuals received both home- and center-based interventions, when the follow-up duration was > 1.0 year, and when it was a high-quality study.ConclusionsRegular exercise intervention could prevent fall-related fractures in older adults. Further large-scale RCTs should be conducted to assess the effectiveness of different exercise programs on fall-related fractures at various sites.

High Protein Intake Among Preschoolers in Childcare in a Region at Elevated Risk for Obesity.

To compare diet quality of convenience samples of children 2-3 and 4-5years attending 11 of 75 childcare centers in Hays County, Texas to a nationally representative sample, as part of a needs assessment to inform a childcare center-based intervention. Parents completed 24-h recalls of their child's diet in 2014. Usual dietary intake of the regional and age-matched sample from the National Health and Nutrition Examination Survey (2011-2014) was estimated using the National Cancer Institute method. Diet quality was assessed using the Healthy Eating Index. Quantile regression and t-tests compared nutrient intake and Healthy Eating Index scores between the two samples. Children ages 2-3 and 4-5years in the regional sample (n = 124) consumed a higher percent of calories from protein (19%) than children in the national sample (n = 1613; 14%, P < .0.0001). In the regional sample, 21% of children 2-3years consumed protein in excess of the AMDR compared to fewer than 1% of children in the national sample. Assessing regional diet while planning health outreach is important. Among children in childcare in this community, high protein intake may contribute to weight disparity. Workshops with childcare center staff to address center policies, environments, and parent outreach could address replacing some high-protein foods with other nutrient-rich foods.

Study protocol for a cluster randomized controlled trial to test \u201c\xa1M\xedranos! Look at Us, We Are Healthy!\u201d \u2013 an early childhood obesity prevention program

BackgroundOne in three Head Start children is either overweight or obese. We will test the efficacy of an early childhood obesity prevention program, “¡Míranos! Look at Us, We Are Healthy!” (¡Míranos!), which promotes healthy growth and targets multiple energy balance-related behaviors in predominantly Latino children in Head Start. The ¡Míranos! intervention includes center-based (policy changes, staff development, gross motor program, and nutrition education) and home-based (parent engagement/education and home visits) interventions to address key enablers and barriers in obesity prevention in childcare. In partnership with Head Start, we have demonstrated the feasibility and acceptability of the proposed interventions to influence energy balance-related behaviors favorably in Head Start children.MethodsUsing a three-arm cluster randomized controlled design, 12 Head Start centers will be randomly assigned in equal number to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) comparison. The interventions will be delivered by trained Head Start staff during the academic year. A total of 444 3-year-old children (52% females; n = 37 per center at baseline) in two cohorts will be enrolled in the study and followed prospectively 1 year post-intervention. Data collection will be conducted at baseline, immediately post-intervention, and at the one-year follow-up and will include height, weight, physical activity (PA) and sedentary behaviors, sleep duration and screen time, gross motor development, dietary intake and food and activity preferences. Information on family background, parental weight, PA- and nutrition-related practices and behaviors, PA and nutrition policy and environment at center and home, intervention program costs, and treatment fidelity will also be collected.DiscussionWith endorsement and collaboration of two local Head Start administrators, ¡Míranos!, as a culturally tailored obesity prevention program, is poised to provide evidence of efficacy and cost-effectiveness of a policy and environmental approach to prevent early onset of obesity in low-income Latino preschool children. ¡Míranos! can be disseminated to various organized childcare settings, as it is built on the Head Start program and its infrastructure, which set a gold standard for early childhood education, as well as current PA and nutrition recommendations for preschool children.Trial registrationClinicalTrials.Gov (NCT03590834) July 18, 2018.

Effectiveness of early care and education center-based interventions for improving cardiovascular fitness in early childhood: A systematic review and meta-analysis.

This systematic review and meta-analysis examined the literature on early care and education center (ECEC)-based physical activity interventions to identify ecologic environmental factors that improve cardiovascular fitness (CVF) in preschool-aged children. Data sources included PubMed, Web of Science, Cochrane Library Trials, CINHAL, Science Direct, PsychINFO and SPORTDiscus. Peer-reviewed publications of studies that met the following criteria were eligible for inclusion: (1) mean age of participants between two and a half and five and a half years old enrolled in a pre-primary school; (2) randomized controlled trials or quasi-experimental interventions with a control group; (3) interventions occurring before, during, or immediately after school; (4) use of an objective measure or field-based estimate of CVF; (5) enrolled apparently healthy children. In June of 2018, titles (n = 1197) were reviewed for inclusion into the study and 74 abstracts/full texts were assessed for eligibility. Ten articles met all eligibility criteria and were included in the final review. A random effects meta-analysis suggested a moderate-to-large effect size for ECEC-based interventions to increase CVF (g = 0.75; 95%CI [0.40–1.11]). Interventions that included three or more ecologic environments (g = 0.79 [0.34–1.25]) were more effective than interventions occurring at the individual level (g = 0.67 [0.12–1.22]). Study quality was moderate, and (mean ± SD) 17.9 ± 4.3 (63.9%) of 28 checklist items were reported. Preliminary evidence suggests that ECEC-based interventions to increase CVF are highly effective at improving preschool children's exercise test scores. Although ECEC-based interventions show promise, the small number of studies included in this review limits confidence in these findings. Review registered at PROSPERO CRD42018099115.

Interventions for developmental delays in children born to HIV-infected mothers: a systematic review

ABSTRACTChildren born to HIV-infected mothers have worse developmental outcomes compared to HIV-unexposed children. However, little is known about interventions to improve developmental outcomes in this population. This study systematically reviews the literature on interventions to improve development in children born to HIV-infected mothers. We systematically searched the following electronic bibliographic databases: Ovid MEDLINE, Embase, PsycINFO, Education Resources Information Center, and the Cochrane Database of Systematic Reviews. Studies were selected on the basis of defined inclusion criteria and excluded if antiretroviral medication was the only intervention. Titles, abstracts, and full texts were assessed by 2 independent reviewers. Data were collected on characteristics of the study design, intervention, and developmental outcomes measured. Risk of bias and strength of evidence were assessed on all included articles. Our search resulted in 11,218 records. After our initial review, 43 records were appraised in their entirety and 9 studies met all inclusion criteria. Six were performed in sub-Saharan Africa, while the remaining 3 were performed in the United States. Eight were randomized-controlled trials and one was a retrospective chart review. Four studies focused on caregiver-training, 2 studied massage therapy, and the remaining studies focused on maternal vitamin supplementation, video-based cognitive therapy, or center-based interventions. Massage therapy had the most consistent improvements in the domains measured, while caregiver training and cognitive therapy interventions had limited benefits. The center-based intervention showed no benefit. Only 3 studies had a low risk of bias, and 4 studies had good strength of evidence. Most studies found some benefit. However, these findings are limited by the quality of the study designs, small sample size, and heterogeneity of the interventions and assessments used to measure outcomes. There is a critical need for the creation of evidence-based interventions to promote development in this vulnerable population.

Listening to Music Improves Language Skills in Children Prenatally Exposed to Cocaine

The effectiveness of listening to music, as an intervention to improve language skills, was tested with young children prenatally exposed to cocaine. In addition to the prenatal exposure to cocaine, these children often share family experiences such as substance abuse, poverty, and mental illness that are prevalent in chronically stressed families in which abuse and trauma are likely to occur. In the current study 62 children, between the ages of 17 and 30 months, who were receiving a center-based intervention program, participated in a 16-week music-based trial. The trial consisted of listening to music 5 days a week for 16 weeks. During the first week music listening sessions were 50-minutes and during the subsequent 15 weeks the daily listening sessions were 10 minutes. Participants were randomly assigned to three groups: a filtered music group that listened to vocal music filtered to emphasize frequencies within the bandwidth of spontaneous human speech, an unfiltered music group that listened to the same vocal music in its original unaltered form, and a control group that only received the standard early intervention services provided by the preschool. Outcomes were evaluated with assessments for expressive and receptive language skills. Results document that children, who listened to either the filtered or unaltered music, showed greater gains on language skills than the control group. The findings suggest that providing scheduled times to listen to vocal music similar to a mother singing a lullaby would provide a simple cost-effective language intervention. Keywords: language skills; music therapy; prenatal cocaine exposure; children; Polyvagal Theory.

Adolescent motor vehicle crash prevention through a trauma center-based intervention program.

Therapy, level IV.

Effects of Theory-Based Behavioral Interventions on Physical Activity Among Overweight and Obese Female Cancer Survivors: A Systematic Review of Randomized Controlled Trials.

Purpose. To determine whether theory-based physical activity (PA) interventions for overweight and obese female cancer survivors lead to increased PA and improved health. Methods. This systematic review examined randomized controlled trials analyzing the impact of theory-based PA interventions on overweight and obese female cancer survivors through December 2016. Searches of 5 electronic databases revealed 10 articles that included 1351 participants who met the inclusion criteria. Results. Participants were primarily non-Hispanic white (74%-100%) breast or endometrial cancer survivors. Intervention characteristics and PA assessment tools varied greatly. Adherence (68%-99%) and retention (79%-100%) were relatively high. Social cognitive theory was utilized as the theoretical construct in 9 of the 10 studies. Home-based interventions led to small improvements in PA (Cohen’s d range = 0.25-0.31), whereas home-based plus center-based interventions led to moderate to large improvements (Cohen’s d range = 0.45-1.02). Only three of the studies assessed psychosocial behavioral processes associated with PA, and the results were mixed. Health-related outcomes included improvements in aerobic fitness (Cohen’s d = 0.32-1.1 in 5 studies), large absolute decreases in waist circumferences (>6 cm in 3 of 5 studies; Cohen’s d = −0.31 to −1.02), and no change in inflammatory biomarkers (in 2 studies). Only one serious adverse event (pelvic stress fracture) was attributed to the interventions. Conclusions. Theory-based PA interventions are safe and feasible for overweight and obese female cancer survivors. Interventions that include a center-based component showed moderate to large effect sizes for PA. Future studies should evaluate behavioral variables and more health-related clinical outcomes.

Distance delivery of a parent-implemented language intervention for young boys with fragile X syndrome.

In addition to significant cognitive delays, boys with fragile X syndrome display phenotypic characteristics that include delays in language, inattention, social anxiety, and escape-maintained challenging behaviors. Despite these challenges, families affected by fragile X syndrome often have limited access to center-based intervention programs. The present study utilized a multiple baseline design across participants to examine the preliminary effectiveness of a 12-week, parent-implemented spoken language intervention for three 5- to 7-year-old boys with fragile X syndrome. The goal of the intervention was to teach the biological mothers of each boy to use a set of verbally responsive language support strategies while participating in shared book reading activities with her child. All aspects of the intervention, including pre- and post-treatment measures, were delivered into the family's home via distance video teleconferencing. Results from this study provide preliminary support for the efficacy of this parent-implemented language intervention approach by demonstrating generalized improvements in both targeted maternal strategy use and measures of child spoken language. The present study expands upon prior language intervention research utilizing distance delivery of services for families affected by fragile X syndrome. Additionally, the study provides early support for the feasibility of collecting pre- and post-treatment assessments at a distance.

Status of cold chain management among health care providers in Qatar: Primary health care center-based intervention study

Objective: The study aimed to measure the status of cold chain management among primary health care professionals at primary healthcare centers (PHCC) in Qatar. Methods: A cross-sectional design with pre-post-intervention study was conducted, and 570 primary health professionals were selected from 21 PHCCs using random sampling. A structured self-administered questionnaire was used to collect data regarding the status of cold chain system of healthcare workers before and after educational intervention. Results: Of the 570 subjects, 492 (86.3%) participated in the post-intervention evaluation. cold chain management, before the intervention six elements were present in all of the PHCCs (100%), eight were present in &gt;80%, another eight were present in 60–80%, while 13 were present in &lt; 60%. These figures improved to 8, 13, 4, and 10, respectively, after the intervention. Conclusion: In Qatar, The current status of cold chain status among primary healthcare workers had significantly improved after intervention. The practices of health professionals were also found to be adequate. Therefore, it is recommended that all health professionals working in PHCCs should receive mandatory cold chain management training to ensure delivery of safe and effective vaccines in Qatar. Keywords: KAP, cold chain, primary health care center, immunization, PHC, Qatar

Evaluation of a Community Health Service Center-Based Intervention Program for Managing Chronic Heart Failure.

Although the role of primary care for the management of patients with chronic heart failure (CHF) has been highly recommended, structural involvement of primary care in heart failure (HF) management programs is extremely limited. To examine the feasibility and applicability of two most recommended forms of care delivery mode, home visit and telephone support, for CHF management in the setting of community health service center (CHSC). Prospective study. This study was conducted in two CHSCs in Beijing, China. Care delivery was led by trained general practitioners or community nurses via home visits in one CHSC and telephone support in the other. Data regarding the change in mortality and hospitalization rate during 12 months and self-care level at 6 months were prospectively collected and compared across the intervention groups. A total of 329 patients were included, with 142 in the home visit group and 187 in the telephone support group. Patients in both groups had frequent visits to CHSC (8.1±5.9 in the home visit and 7.7±4.1 in the telephone support group, p=0.45) during the follow-up period. Compared to the telephone support group, patients in the home visit group showed a reduction in all-cause mortality (14.1% versus 20.3%, p=0.14), one or more hospitalizations due to any cause (33.8% versus 44.2%, p=0.12) and one or more hospitalizations due to cardiac cause (17.6% versus 24.6%, p=0.13) in the home visit group. The absolute differences were 6.2% (95% CI: 1.9%, 14.3%), 8.4% (95% CI: 2.1%, 18.9%) and 7.3% (95% CI: 1.5%, 16.1%), respectively, although the results were not statistically significant. After 6 months of intervention, patients in both groups achieved marked improvement in self-care with reference to their own baseline values. Although no statistical difference was observed between the two care delivery approaches regarding the clinical outcomes of interest, given the high participation rates, the acceptable rate of adverse events, frequent CHSC visits and patients' preferences in the current study, it was concluded that CHSC might be the optimal setting for delivering care to CHF patients in China.

Cost Analysis of a Childcare Center-Based Intervention to Prevent Obesity in the Preschool Years

Background: In the United States, 17% of children are considered obese, and the economic burden of obesity and related conditions are concerning. Healthy Caregivers-Healthy Children (HC2) is an early childcare center-based obesity prevention trial among ethnically diverse children and families. Objectives: To better understand the economic impact of early childhood obesity prevention efforts, this study conducted a cost analysis of the HC2 intervention and estimated the potential lifetime cost-savings of HC2 from reducing childhood obesity. Patients and Methods: Economic analyses estimated the direct intervention costs and the projected lifetime medical cost savings from preventing childhood obesity. Cost data were collected using detailed staffing and financial records, from the HC2 study investigators. Resources were organized into four main categories: personnel costs, contractors, supplies and equipment, and miscellaneous expenditures. Costs were estimated separately for the two phases of the intervention: Year 1 and Years 2 - 3. Results: The total cost of HC2 intervention was 206319 $. The average cost per child in Year 1 was 113.90 $. The average cost per child for the booster sessions, in Years 2 and 3 was 29.02 $ per year. Average cost per child throughout the intervention was 172 $. If HC2 generates just a 1% reduction in obesity, lifetime savings would be of approximately 228000 $, with net savings of 21681 $, over the three years of the intervention. The average (per child) net savings across all HC2 participants range from 18 $, if 1% of participants avoid obesity, to 1728 $, if 10% avoid obesity. Conclusions: The HC2 intervention shows potential for generating cost savings. Cost analyses of programs of this type are helpful to policymakers and program planners to allocate resources for obesity prevention programs in school and childcare settings.