Education-only Group Research Articles

Long-Term Blood Pressure Trends After a Remote Hypertension Intervention: A Secondary Analysis of the Digital Care Transformation: Remotely Delivered Hypertension Management Program.

Hypertension is a major cardiovascular risk factor, yet traditional care often results in suboptimal blood pressure (BP) control at the population level. We implemented a remote hypertension management program that monitored home BP and titrated medications per algorithm. This study assessed the program's long-term effects by examining participants' office BP up to 42 months post-enrollment. Participants of the remote hypertension program were categorized into 4 groups: (1) enrolled-maintenance (achieved goal home BP of ≤130/80 mm Hg), (2) enrolled-early exit (left before achieving goal BP), (3) education-only (lifestyle modifications and medications compliance), and (4) white coat hypertension group (high office BP but normal home BP). Office BP readings of participants were collected up to 42 months post-enrollment. A linear mixed-effects regression model estimated mean BP levels and studied factors associated with above-goal systolic BP in the maintenance group. Office BP readings from 3601 participants (mean age, 61±11 years; 57% female; 60% white; 52% atherosclerotic cardiovascular disease) were extracted from electronic health records and analyzed. All groups sustained office BP below their qualifying values (P<0.001) over 42 months. In the maintenance group, 89.7% of participants maintained systolic BP at goal, compared with 63.5% in the early exit group, 69.4% in the education-only group, and 90.7% in the white coat hypertension group. Age >50 years was associated with above-goal systolic BP in the maintenance group. Participants who achieved BP control through the remote hypertension program maintained goal systolic BP in 90% of cases up to 42 months post-enrollment. These findings highlight the long-term benefits of remote, intensive management programs for effective hypertension control.

The effects of alfalfa powder combined with health education on patients with dyslipidemia: A randomized controlled trial

BackgroundCardiovascular diseases (CVDs) remain the leading cause of global mortality, with dyslipidemia recognized as a significant risk factor. Dyslipidemia, characterized by elevated levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), is associated with an increased lifetime risk of CVD. Although alfalfa’s cholesterol-lowering effects have been demonstrated in animal models, clinical trial data supporting its efficacy in human dyslipidemia treatment are limited. MethodsA randomized controlled trial was conducted from September 20, 2021, to January 12, 2023, involving patients diagnosed with dyslipidemia. Approved by the China Ethics Committee of Registering Clinical Trials, the study included multiple sites in China. Eligible participants were adults aged 18 years or older, meeting criteria from the Chinese Guidelines for the Prevention and Treatment of Adult Blood Lipid Disorders. Participants were randomly assigned to either a health education-only group or a combined alfalfa powder supplementation and health education group for a three-month intervention period. ResultsA total of 160 eligible patients were enrolled and randomized into two groups: the Alfalfa group (n = 80) and the Education group (n = 80). The intervention resulted in significant improvements in key lipid parameters in the Alfalfa group, including reductions in TC, LDL-C, and Apo A1 levels. Although changes in HDL-C levels were not significantly different between the groups, the Alfalfa group exhibited a larger increase. Serum lipid metabolomics analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS) indicated that the combined intervention did not significantly alter the overall blood lipid metabolome but identified fifteen regulated differential metabolites, with the glycerophospholipid metabolism pathway significantly affecting lipid metabolism levels. ConclusionSupplementation with alfalfa powder combined with health education significantly reduced TC, LDL-C, and Apo A1 levels in patients with dyslipidemia. KEGG pathway analysis suggests an association between the glycerophospholipid metabolism pathway and dyslipidemia. Further research is warranted to validate these findings and explore the underlying mechanisms.

Implementation of a Pharmacist-Driven Aspirin Deprescribing Protocol Among Older Veterans in a Primary Care Setting.

Background Recent cardiovascular guideline updates recommend against the use of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older people. However, aspirin use remains common in this population. Objective To implement and evaluate the benefit of a pharmacist-driven aspirin deprescribing protocol compared with primary care provider (PCP) education-only in a primary care setting. Methods This prospective, cohort project targeted deprescribing for patients prescribed aspirin for primary prevention of ASCVD. Patients were included if they received primary care services at the Milwaukee Veterans Health Administration Medical Center (VHA) and were 70 years of age or older. Criteria for exclusion were aspirin obtained outside the VHA system, aspirin prescribed for a non-ASCVD-related condition, and/or a history of ASCVD. Active deprescribing by pharmacists and PCP education took place in the intervention group with PCP education only in the standard-of-care group. The primary outcome was the proportion of patients who had aspirin deprescribed in each group. Secondary outcomes included patient acceptability of the intervention and barriers to implementation. Results A total of 520 patients were prescribed aspirin in the intervention group versus 417 in the education-only group. Sixty-five patients met intervention criteria and were contacted for aspirin deprescribing. The pharmacist-led active deprescribing group led to a higher rate of aspirin deprescriptions versus the education-only group (54% vs 18%; P = 0.0001) for patients who met criteria. Conclusion A pharmacist-led aspirin deprescribing protocol within a primary care setting significantly decreased the number of aspirin prescriptions compared with PCP education only.

A randomized clinical trial to support adherence regimens in children with epilepsy: Examining potential mechanisms of change

ObjectiveA family-tailored education and problem-solving intervention, Supporting Treatment Adherence Regimens (STAR), was developed to address the adherence challenges common in youth with epilepsy and their families. Randomized clinical trial (RCT) results indicated a 21% adherence improvement in the STAR group compared with an education-only (EO) group 12-months post-intervention. The current study examined group differences (STAR vs. EO) in epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning over time and whether these factors mediated group differences in adherence at 12-months post-intervention. MethodsTwo-hundred children (ages 2–12) with epilepsy and their caregivers were included as RCT participants. Children with new-onset epilepsy and adherence <95% were randomized to receive either the STAR (n = 27) or EO (n = 29) intervention. Caregivers completed questionnaires assessing outcomes of interest at baseline, midpoint of the intervention, post-intervention, and 3-, 6-, and 12-month follow-ups. Regression-based analyses of covariance and longitudinal mixed effect linear models were conducted. ResultsResults generally revealed no significant group differences across outcomes of interest at post-intervention or over time. However, one significant model did emerge for social problem-solving skills (b = −1.74, p = 0.04), such that these scores were initially higher in the STAR group compared to the EO group, then decreased slightly in the STAR group over time while remaining stable in the EO group. None of these factors mediated group differences in adherence at 12-months post-intervention. ConclusionFuture research should examine other potential mechanisms of treatment change after adherence interventions, such as STAR. Nonsignificant findings can inform the development of future study designs and intervention efforts.

Effectiveness of a foot self-management intervention that utilized commercially available infrared thermometers: Mixed methods research incorporating a pilot RCT

ObjectiveTo evaluate the effectiveness of a foot self-management strategy that utilized a commercially-available infrared thermometer (CAIT) for prevention of diabetic foot ulcers. Research Design and MethodsIn this six-month pilot randomized controlled trial, Phase 2 of a three-phase mixed methods research study, 62 participants were randomized to a thermometer and education group (n = 34) and an education-only group (n = 26). Both groups received foot care education and were assessed by a certified orthotist. All participants recorded their number of steps and recorded a foot assessment in a logbook daily. The thermometer and education group also recorded their daily temperature assessment. A temperature difference of >4° Fahrenheit (F) between the two feet prompted participants to rest their feet. Participants were directed to see their healthcare provider if the temperature difference did not decrease to below 4° F in two days. Phase 3 of the study explored the Phase 2 results to understand the findings further. ResultsThe strategy improved foot assessment and action: the thermometer and education group had significantly more days with any assessment completed than the education-only group (150.98/180 vs. 119.84/180, p = 0.02). Phase 3 findings showed that the thermometer engaged participants, prompted action, and offered reassurance regarding foot health. ConclusionsA CAIT is a tool that could support foot self-management and may offer several benefits, such as promoting and providing structure for a foot assessment and direction for action. Clinical trial reg noNCT0306776 clinicaltrials.gov.

Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE): A randomized trial to improve post myocardial infarction management

ObjectiveWe evaluated the impact of a low intensity web-based and intensive nurse-administered intervention to reduce systolic blood pressure (SBP) among patients with prior MI. MethodsSecondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE) was a three-arm trial. Patients were randomized to 1) post-MI education-only; 2) nurse-administered telephone program; or 3) web-based interactive tool. The study was conducted 2009–2013. ResultsParticipants (n = 415) had a mean age of 61 years (standard deviation [SD], 11). Relative to the education-only group, the 12-month differential improvement in SBP was − 3.97 and − 3.27 mmHg for nurse-administered telephone and web-based groups, respectively. Neither were statistically significant. Post hoc exploratory subgroup analyses found participants who received a higher dose (>12 encounters) in the nurse-administered telephone intervention (n = 60; 46%) had an 8.8 mmHg (95% CI, 0.69, 16.89; p = 0.03) differential SBP improvement versus low dose (<11 encounters; n = 71; 54%). For the web-based intervention, those who had higher dose (n = 73; 53%; >1 web encounter) experienced a 2.3 mmHg (95% CI, −10.74, 6.14; p = 0.59) differential SBP improvement versus low dose (n = 65; 47%). ConclusionsThe main effects were not statistically significant. Practical ImplicationsCompleting the full dose of the intervention may be essential to experience the intervention effect. Clinical Trial RegistrationThe unique identifier is NCT00901277 (http://www.clinicaltrials.gov/ct2/show/NCT00901277?term=NCT00901277&rank=1).

Evaluation of parental education using biomechanical visualization to increase child restraint use in China

IntroductionDespite demonstrated effectiveness of child restraint system (CRS), its use in China is extremely low due to the lack of national legislation requiring the use of CRS, as well as lack of child passenger safety knowledge among caregivers. Implementing an effective intervention is urgently needed to promote the use of CRS. In this study, we primarily evaluated the effectiveness of biomechanical visualization delivered in the context of CRS education to promote CRS use. MethodsWe conducted a cluster randomised controlled trial to test the effects of educational intervention programs on increased use of CRS. Participants included caregivers from 8 pre-schools located in two cities (i.e., Chaozhou and Shantou) in China. Following a baseline survey, 8 pre-schools were randomly assigned into 1 of 4 groups with 2 schools in each group: 1) CRS education-only, 2) CRS education with behavioral skill training, 3) CRS education with biomechanical visualization, and 4) control. The primary outcome was CRS use, and the secondary outcomes included scores of child passenger safety-related knowledge and CRS use-related attitudes. The effect of the intervention was assessed among caregivers at two time points: baseline preintervention and 6 months postintervention. ResultsMore than 70% caregivers had never used CRS at baseline. No statistically significant between-group differences CRS use were observed at baseline preintervention (34.2%, 25.4%, 29.6% and 21.9%, respectively, P = 0.18). However, compared to the control group, odds of CRS non-use was significantly lower in caregivers assigned to the CRS education with biomechanical visualization (adjusted odd ratio (AOR) = 0.11, 95% confidence interval (CI) = 0.07–0.17), CRS education with behavioral skill training (AOR = 0.15, 95%CI = 0.10–0.24) and CRS education-only (AOR = 0.26, 95%CI = 0.17–0.41) groups, respectively. Statistically significant differences were also observed in the secondary outcomes postintervention across groups. Specifically, the CRS education with biomechanical visualization and CRS education with behavioral skill training groups had higher mean knowledge change scores than the CRS education-only group (3.3 ± 1.5 vs. 2.9 ± 2.2, p = 0.035 and 3.2 ± 1.9 vs. 2.9 ± 2.2, p = 0.039, respectively). We also observed a significantly higher increase in the attitudes scores in the CRS education with biomechanical visualization group compared with the CRS education-only group (4.7 ± 2.1 vs. 3.5 ± 2.8,p = 0.026). ConclusionsThis study shows that both biomechanical visualization and behavioral skill training supplements to education improved understanding of CRS knowledge compared to education only, and all three strategies led to increased CRS use. Importantly, CRS education with biomechanical visualization was shown to be more effective than CRS education alone in improving caregiver’s knowledge and attitudes. The use of biomechanical visualization may be an effective supplement to traditional education programs.

Predicting Family and Child Physical Activity across Six-Months of a Family-Based Intervention: An Application of Theory of Planned Behaviour, Planning and Habit

ABSTRACT Family-based physical activity (PA) interventions have proven effective in modifying PA; yet, the underlying mechanisms are currently unclear. In this study, we follow-up upon prior trial data that showed changes to child moderate-to-vigorous PA (MVPA) as a result of a family education+planning intervention compared to an education-only condition. We examined parents’ perceived family PA frequency, family PA social cognitions, and family PA habit over 26 weeks between the two conditions. One hundred and two parents (of children aged 6 to 12 yrs), were recruited through advertisements and randomized to either the planning + education condition (n = 52) or an education-only condition (n = 50). Self-reported family PA, and measures of theory of planned behaviour, planning intention, and habit were completed by the contact parent at baseline, six-week, 13-week, and 26-week time-periods. The education+planning intervention increased planning intention (p <.01) and family PA (p =.06) compared to the© education-only group. The effect of condition on the putative mediators did not explain these changes (all 95% CIs crossed 0), and family PA was associated with child MVPA only at 13 weeks (p <.01). Intervention 20 assignment had a small indirect effect on family PA (favouring©the education+planning group) via Habit. Perceived behavioural©control and habit were consistent predictors of family PA (p <.05), but not PA intention or planning intention (p >.05). The planning+education intervention showed improved family PA and planning intention, yet null mediation results suggest that other variables from the family system (e.g., child motivation, other parent’s motivation and plans) are likely needed to fully understand the intervention effects. The promotion of perceived behavioural control and habit to assist in family PA is recommended for future research in this population.

Peer Support Added to Diabetes Education Improves Metabolic Control and Quality of Life in Mayan Adults Living With Type 2 Diabetes: A Randomized Controlled Trial

BackgroundYucatán, located in the southern region of Mexico, is the state with the country’s highest prevalence of uncontrolled diabetes. Because of its particular cultural and socioeconomic characteristics, the residents of Yucatán face unique health-care challenges. The objective of our study was to evaluate the effect of peer support added to a diabetes education program on glycemic control and diabetes-related quality of life when compared with a conventional diabetes education program in patients with type 2 diabetes in a Mayan community in Mexico. MethodsIn March 2015, a total of 58 participants with a previous diagnosis of type 2 diabetes who were recruited from community health centres in Komchén were randomly assigned in equal numbers to 1 of 2 groups: 1) a peer support and diabetes self-management education group (PSEG) or 2) a conventional diabetes self-management education-only group. The primary outcomes of interest were glycated hemoglobin (A1C) values and diabetes-related quality of life. The majority of subjects were bilingual (Mayan and Spanish speakers), female and middle aged, and had a low level of formal education and high baseline A1C (mean, 8.7%). ResultsWhereas both groups showed significant improvements from baseline to study end in absolute levels of A1C, the PSEG group had a more pronounced clinical improvement, but no statistical improvement, in A1C compared with the conventional diabetes self-management education-only group. PSEG participants exhibited statistically significant improvement in diabetes-related quality of life at 8 months. ConclusionsOur study demonstrates the benefits of peer-support education above and beyond the impact of diabetes self-management education on diabetes-related quality of life in an underserved Mayan community in Mexico.

Physical activity in children at risk of postthrombotic sequelae: a pilot randomized controlled trial

AbstractIncreased physical activity is protective against worsening of postthrombotic syndrome (PTS) in adults. We assessed patient eligibility, consent, adherence, and retention rates in a pilot trial of prescribed physical activity following venous thromboembolism (VTE) in children. Secondary objectives were to describe the within-subject changes in PTS, quality of life, and coagulation biomarkers before and after the intervention in each group. We enrolled and randomized patients between 7 and 21 years of age to the physical activity group or the standard care (education-only) group in a 1:1 allocation ratio. The physical activity group wore a Fitbit for 4 weeks to determine habitual activity and then increased activity over an 8-week “active” period, followed by a 4-week “do-as-you-wish” period. Two hundred thirty-five children were diagnosed with VTE; 111 patients were screened, of whom 40 (36%) met study eligibility criteria. Of these, 23 (57%) consented to participate and were randomized (Fitbit,11; standard group, 12). The trial was of greater interest to overweight and obese children, as they comprised 83% of consented patients. Only 33% adhered to the activity prescription, and 65% (15/23) completed the trial. The PTS scores (P = .001) improved in the physical activity group compared with the education-only group. It is feasible to enroll and randomize pediatric VTE patients to a prescribed physical activity regimen 3 months following VTE. Metrics for adherence to enhanced physical activity and retention were not met. These results provide the rationale to explore low adherence and retention rates before moving forward with a larger trial of exercise training following VTE. This trial was registered at www.clinicaltrials.gov as #NCT03075761.

Exercise intervention in the management of urinary incontinence in older women in villages in Bangladesh: a cluster randomised trial

Group exercise-based programmes for urinary incontinence appear to be promising low-cost interventions for women in developing countries, but no evidence exists to support whether they could be implemented or effective in such populations. We aimed to evaluate whether a group intervention that comprised pelvic floor muscle training, mobility exercises, and bladder education would be more effective than education alone, and report changes between villages (ie, clusters) rather than between individual participants. In this cluster randomised trial, we recruited women from 16 pairs of villages in Bangladesh, with each pair comprising similar villages from the same sub-district. Women aged 60-75 years were interviewed to establish eligibility. Women were eligible if they had current urinary incontinence, and were excluded if they had a third degree or higher uterine prolapse, if they were unable to walk or stand without help, or if they had insufficient intellectual capacity to understand questions and follow instructions. The villages were randomly assigned within each pair to either exercise plus education or education-only intervention by use of a random number generator from a fixed seed. Women were excluded after consenting if they lived too far from the centre of the village. The exercise intervention was a physiotherapist-led group exercise class that was held twice weekly for 12 weeks, with home exercises between classes and to 24 weeks. Both groups received bladder-health education. Participants were followed up for 24 weeks. A 3-day continence record was collected at recruitment and every 4 weeks up until 24 weeks. This record involved the participant tying a knot in ribbons worn under the clothing each time they had an episode of urinary leakage. The primary outcome was change in number of knots (recorded leakage episodes) from recruitment to 24 weeks. Safety was assessed in all participants in the exercise intervention group. The trial is registered at ClinicalTrials.gov, number NCT02453100. Between Aug 22, 2015, and July 2, 2018, of 3577 women aged 60-75 years identified, 1003 were eligible, of whom 625 consented to participate (n=335 exercise plus education villages, and n=290 in education-only villages). Of these consenting women, 46 were excluded (n=37 exercise plus education, n=9 education only) because they lived too far from the centre of the village. At week 24, 283 (95%) of 298 in the exercise plus education group and 274 (98%) of 281 in the education-only group completed a 3-day continence record. The estimate of change in number of leakage episodes between baseline and 24 weeks was -7·7 (95% CI -10·6 to -4·8) at the village level in an unadjusted model, and -6·64 (-7·95 to -5·33) in a random-effects model accounting for cluster randomisation. No adverse events were reported. A structured group-exercise intervention has the potential to manage urinary incontinence in older women in communities largely outside the reach of pharmaceutical or surgical interventions. Canadian Institutes for Health Research.

A randomised feasibility study to investigate the impact of education and the addition of prompts on the sedentary behaviour of office workers

BackgroundOffice workers have been identified as being at risk of accumulating high amounts of sedentary time in prolonged events during work hours, which has been associated with increased risk of a number of long-term health conditions.There is some evidence that providing advice to stand at regular intervals during the working day, and using computer-based prompts, can reduce sedentary behaviour in office workers. However, evidence of effectiveness, feasibility and acceptability for these types of intervention is currently limited.MethodsA 2-arm, parallel group, cluster-randomised feasibility trial to assess the acceptability of prompts to break up sedentary behaviour was conducted with office workers in a commercial bank (n = 21). Participants were assigned to an education only group (EG) or prompt and education group (PG). Both groups received education on reducing and breaking up sitting at work, and the PG also received hourly prompts, delivered by Microsoft Outlook over 10 weeks, reminding them to stand. Objective measurements of sedentary behaviour were made using activPAL monitors worn at three time points: baseline, in the last 2 weeks of the intervention period and 12 weeks after the intervention. Focus groups were conducted to explore the acceptability of the intervention and the motivations and barriers to changing sedentary behaviour.ResultsRandomly generated, customised prompts, delivered by Microsoft Outlook, with messages about breaking up sitting, proved to be a feasible and acceptable way of delivering prompts to office workers. Participants in both groups reduced their sitting, but changes were not maintained at follow-up. The education session seemed to increase outcome expectations of the benefits of changing sedentary behaviour and promote self-regulation of behaviour in some participants. However, low self-efficacy and a desire to conform to cultural norms were barriers to changing behaviour.ConclusionsPrompts delivered by Microsoft Outlook were a feasible, low-cost way of prompting office workers to break up their sedentary behaviour, although further research is needed to determine whether this has an additional impact on sedentary behaviour, to education alone. The role of cultural norms, and promoting self-efficacy, should be considered in the design of future interventions.Trial registrationThis study was registered retrospectively as a clinical trial on ClinicalTrials.gov (ID no. NCT02609282) on 23 March 2015.

Effects of Combining a Brief Cognitive Intervention with Transcranial Direct Current Stimulation on Pain Tolerance: A Randomized Controlled Pilot Study.

Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laboratory study was to investigate the combination of a brief cognitive restructuring intervention and transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in affecting pain tolerance. Randomized, double-blind, placebo-controlled laboratory pilot. Medical University of South Carolina. A total of 79 healthy adult volunteers. Subjects were randomized into one of six groups: 1) anodal tDCS plus a brief cognitive intervention (BCI); 2) anodal tDCS plus pain education; 3) cathodal tDCS plus BCI; 4) cathodal tDCS plus pain education; 5) sham tDCS plus BCI; and 6) sham tDCS plus pain education. Participants underwent thermal pain tolerance testing pre- and postintervention using the Method of Limits. A significant main effect for time (pre-post intervention) was found, as well as for baseline thermal pain tolerance (covariate) in the model. A significant time × group interaction effect was found on thermal pain tolerance. Each of the five groups that received at least one active intervention outperformed the group receiving sham tDCS and pain education only (i.e., control group), with the exception of the anodal tDCS + education-only group. Cathodal tDCS combined with the BCI produced the largest analgesic effect. Combining cathodal tDCS with BCI yielded the largest analgesic effect of all the conditions tested. Future research might find stronger interactive effects of combined tDCS and a cognitive intervention with larger doses of each intervention. Because this controlled laboratory pilot employed an acute pain analogue and the cognitive intervention did not authentically represent cognitive behavioral therapy per se, the implications of the findings on chronic pain management remain unclear.

Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury: A Randomized, Clinical Trial.

Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov ).

Comparison of Indiana High School Football Injury Rates by Inclusion of the USA Football "Heads Up Football" Player Safety Coach.

Background:In Indiana, high school football coaches are required to complete a coaching education course with material related to concussion awareness, equipment fitting, heat emergency preparedness, and proper technique. Some high schools have also opted to implement a player safety coach (PSC). The PSC, an integral component of USA Football’s Heads Up Football (HUF) program, is a coach whose primary responsibility is to ensure that other coaches are implementing proper tackling and blocking techniques alongside other components of the HUF program.Purpose:To compare injury rates in Indiana high school football teams by their usage of a PSC or online coaching education only.Study Design:Cohort study; Level of evidence, 2.Methods:Athletic trainers (ATs) evaluated and tracked injuries at each practice and game during the 2015 high school football season. Players were drawn from 6 teams in Indiana. The PSC group, which used the PSC component, was comprised of 204 players from 3 teams. The “education only” group (EDU), which utilized coaching education only, was composed of 186 players from 3 teams. Injury rates and injury rate ratios (IRRs) were reported with 95% confidence intervals (CIs).Results:During 25,938 athlete-exposures (AEs), a total of 149 injuries were reported, of which 54 (36.2%) and 95 (63.8%) originated from the PSC and EDU groups, respectively. The practice injury rate was lower in the PSC group than the EDU group (2.99 vs 4.83/1000 AEs; IRR, 0.62; 95% CI, 0.40-0.95). The game injury rate was also lower in the PSC group than the EDU group (11.37 vs 26.37/1000 AEs; IRR, 0.43; 95% CI, 0.25-0.74). When restricted to concussions only, the rate was lower in the PSC group (0.09 vs 0.73/1000 AEs; IRR, 0.12; 95% CI, 0.01-0.94), although only 1 concussion was reported in the PSC group. No differences were found in game concussion rates (0.60 vs 4.39/1000 AEs; IRR, 0.14; 95% CI, 0.02-1.11).Conclusion:Findings support the PSC as an effective method of injury mitigation in high school football. Future research should seek to replicate this study using larger samples from additional states.

Impact of food support on food security and body weight among HIV antiretroviral therapy recipients in Honduras: a pilot intervention trial

Optimal strategies to improve food security and nutrition for people living with HIV (PLHIV) may differ in settings where overweight and obesity are prevalent and cardiovascular disease risk is a concern. However, no studies among PLHIV have investigated the impact of food support on nutritional outcomes in these settings. We therefore assessed the effect of food support on food insecurity and body weight in a population of PLHIV with high prevalence of overweight and obesity. We implemented a pilot intervention trial in four government-run HIV clinics in Honduras. The trial tested the effect of a monthly household food ration plus nutrition education (n = 203), compared to nutrition education alone (n = 197), over 12 months. Participants were clinic patients receiving antiretroviral therapy (ART). Assessments were obtained at baseline, 6 and 12 months. Primary outcomes for this analysis were food security, using the validated Latin American and Caribbean Food Security Scale and body weight (kg). Thirty-one percent of participants were overweight (22%) or obese (8%) at baseline. At 6 months, the probability of severe food insecurity decreased by 48.3% (p < 0.01) in the food support group, compared to 11.6% in the education-only group (p < 0.01). Among overweight or obese participants, food support led to average weight gain of 1.13 kg (p < 0.01), while nutrition education alone was associated with average weight loss of 0.72 kg (p < 0.10). Nutrition education alone was associated with weight gain among underweight and normal weight participants. Household food support may improve food security but not necessarily nutritional status of ART recipients above and beyond nutrition education. Improving nutritional tailoring of food support and testing the impact of nutrition education should be prioritized for PLHIV in Latin America and similar settings.

A Pelvic Floor Fitness Program for Older Women With Urinary Symptoms: A Feasibility Study

To determine the feasibility of an adapted pelvic fitness and educational program to control urinary incontinence (UI) and overactive bladder (OAB) symptoms in women older than 65 years. Feasibility study. Residential independent-living facilities. Forty-three study subjects, limited to women 65 years and older residing in or using an independent-living facility, who self-reported that they had symptoms of UI or OAB. Study participants volunteered to participate in a 6-week pelvic fitness class. Classes were held at 3 different independent-living sites. Forty-three women in 4 different treatment groups with 9-15 women per group completed the adapted group pelvic fitness and education instruction, which was provided twice a week for 6 weeks. At one site, in addition to the treatment group, an education-only group met; in this group, 14 women received an alternate intervention consisting of only one educational session and a booklet presenting the didactic content without specific muscle isolation or training. In addition to demographics, standardized assessments using validated instruments were obtained before the first class and after the last class, including general health, self-reported bladder function, quality of life, and the timed up-and-go test. Most participants (97%) were white, with a mean age of 83 years (range, 67-95 years). Most participants in the treatment groups (83%) reported symptom improvement. Statistically significant improvements in OAB and bladder symptoms were found after 6 weeks in the treatment groups, based on visual analog scale scores (P = .0058) for bothersomeness of bladder symptoms, the total score of the Urogenital Distress Inventory, Short Form (P ≤ .0001), and the total score of the Incontinence Impact Questionnaire, Short Form (P = .0036). A group pelvic floor fitness program combined with pelvic health education is a promising approach to reduce urinary symptoms and improve the quality of life of older women living with OAB or UI symptoms.

The Effect of a Spanish Virtual Pain Coach for Older Adults: A Pilot Study

To pilot test the effects of a virtual pain coach on ambulatory Spanish-speaking older adults with pain from osteoarthritis. A randomized, controlled design was used. Eighteen Spanish-speaking older adults were randomly assigned to the virtual pain coach and pain communication education group, or to the pain communication education-only group. All participants viewed the pain communication videotape. Participants in the virtual pain coach group practiced talking about their osteoarthritis pain with the virtual pain coach. Immediately after the respective intervention, participants had their ambulatory medical visit. Pain intensity and pain interference with activities were measured with the Brief Pain Inventory, and depressive symptoms were measured with the Beck Depression Inventory II at baseline and 1 month later. No significant group difference emerged for pain intensity, pain interference with activities, or depressive symptoms 1 month later. More older adults in the virtual pain coach group reported a change from nonuse to use of opioids at 1 month, 50% vs 0% of the education only group, Fisher's exact test, P = 0.023. Preliminary data indicate that the Spanish virtual pain coach might assist Spanish-speaking older adults to talk with their practitioner about their osteoarthritis pain and obtain opioid treatment changes, but that pain and depressive symptoms continue unchanged 1 month later. Additional refinement and testing is required for the Spanish-speaking virtual pain coach to determine acceptability and outcomes for assisting Spanish-speaking older adults to communicate about their pain with their primary care practitioner.

The Health Education for Lupus Study: A Randomized Controlled Cognitive-Behavioral Intervention Targeting Psychosocial Adjustment and Quality of Life in Adolescent Females With Systemic Lupus Erythematosus

IntroductionTo examine in a randomize controlled feasibility clinical trial the efficacy of a cognitive-behavioral intervention designed to manage pain, enhance disease adjustment and adaptation and improve quality of life among female adolescents with systemic lupus erythematosus. MethodsFemale adolescents (n=53) ranging in age from 12 to 18 years were randomly assigned to 1 of 3 groups including a cognitive-behavioral intervention, an education-only arm and a no-contact control group. Participants were assessed at baseline, postintervention and at 3- and 6-month intervals after completion of the intervention. ResultsNo significant differences were revealed among the 3 treatment arms for any of the dependent measures at any of the assessment points. For the mediator variables, a posthoc secondary analysis did reveal increases in coping skills from baseline to postintervention among the participants in the cognitive-behavioral intervention group compared with both the no-contact control group and the education-only group. ConclusionAlthough no differences were detected in the primary outcome, a possible effect on coping of female adolescents with systemic lupus erythematosus was detected in this feasibility study. Whether the impact of training in the area of coping was of sufficient magnitude to generalize to other areas of functioning, such as adjustment and adaptation, is unclear. Future phase III randomized trials will be needed to assess additional coping models and to evaluate the dose of training and its influence on pain management, adjustment and health-related quality of life.

A Short-Term Physical Activity Randomized Trial in the Lower Mississippi Delta

BackgroundThe purpose of this study was to determine if a short-term pedometer-based intervention results in immediate increases in time spent in moderate-to-vigorous physical activity (MVPA) compared to a minimal educational intervention.MethodsA sample of 43 overweight adults 35 to 64 years of age participated in a one week pedometer-based feasibility trial monitored by accelerometry. Participants were randomized into a one-week education-only group or a group that also wore a pedometer. Accelerometer-measured MVPA was measured over 7 days at baseline and again for 7 days immediately post-intervention.ResultsMinutes of MVPA increased significantly in the overall sample (p = 0.02); however, the effect of adding the pedometer to the education program was not significant (p = 0.89). Mean (±SE) MVPA increased from 12.7±2.4 min/day to 16.2±3.6 min/day in the education-only group and from 13.2±3.3 min/day to 16.3±3.9 min/day in the education+pedometer group. The correlation between change in steps/day and change in MVPA was 0.69 (p<0.0001).ConclusionsThe results of this study suggest that the addition of a pedometer to a short-term education program does not produce added benefits with respect to increasing physical activity in the Lower Mississippi Delta.Trial RegistrationClinicalTrials.gov NCT01264757