Effectiveness Of Different Approaches Research Articles

College student reactions to health warning labels: Sociodemographic and psychosocial factors related to perceived effectiveness of different approaches

Objective To examine factors associated with perceiving different types of pictorial cigarette health warning labels as most effective in motivating smokers to quit or preventing smoking initiation among college students. Method We administered an online survey to 24,055 students attending six Southeast colleges in Fall, 2010. We obtained complete data for the current analyses from 2600. Results Current smoking prevalence was 23.5%. The largest majority (78.6%) consistently rated gruesome images as most effective, 19.5% rated testimonial images as most effective, and only a small proportion rated either standard (1.6%) or human suffering images (0.3%) as most effective. Subsequent analyses focused on differences between those endorsing gruesome images or testimonials as most effective. Factors related to ranking testimonials versus gruesome images as most effective included being female (p < 0.01), White (p < 0.01), and nonsmokers (p = 0.04), lower perceived smoking prevalence (p < 0.01), and greater receptivity to laws/restrictions around smoking (p < 0.01) and tobacco marketing (p = 0.01). Among smokers, factors related to ranking testimonials as most effective versus gruesome images included being female (p = 0.03), being White (p = 0.03), higher autonomous motivation (p = 0.03), and greater extrinsic self-efficacy (p = 0.02). Conclusions Understanding factors related to perceived effectiveness of different pictorial warnings among subpopulations should inform health warning labels released by the FDA.

What can we learn from car sharing experiences in the UK?

Car sharing has become synonymous with sustainable transport planning across the UK, but to date there is limited evidence on the effectiveness of different approaches in different settings and contexts. Research undertaken by Integrated Transport Planning Ltd in 2010 on behalf of the Yorkshire and Humber Rural Affairs and Rural Transport Forums has examined the extent, reach and coverage of current car sharing schemes in the Yorkshire and Humber region, with the aim of assessing their potential for improving access to employment, training and key services for people in areas of geographic isolation. The research shows that car sharing has the potential to play a far greater role in transport strategy without the need for significant investment. The paper combines the 2010 research findings with a review of earlier research and explores the contribution that car sharing can play in reducing carbon emissions and improving access to services.

Lateral preference and schizotypy revisited: Comparison of handedness measurement and classification methods

A sample of 256 undergraduate students was administered five schizotypy scales and a lateral preference questionnaire consisting of 41 handedness items, in order to examine the effect of different approaches to the measurement and classification of handedness on the relationship between schizotypy and lateral preference. The extended handedness questionnaire included the 12 items of Annett's handedness questionnaire, the 10 items of Oldfield's (1971) Edinburgh Handedness Inventory, the 19 items of the lateral preference questionnaire used by Kelley and Coursey (1992a), and additional items from Steenhuis and Bryden's (1989) 32-item Waterloo Handedness Inventory, allowing the examination and comparison of a variety of handedness classification schemes and the computation of several continuous measures of handedness, and comparison of their relationships to schizotypy. Different approaches to the measurement and classification of handedness yielded somewhat different findings concerning the relationship to schizotypy, which also varied depending on gender and the schizotypy measure involved. Among males, higher schizotypy scores were associated with more dextral lateral preference, whereas among females higher schizotypy was associated with mixed right-handedness.

Analyzing the effect of different approaches of penalized relationship in multistage selection schemes1

The aim of this study was to extend optimum contribution selection to more realistic breeding schemes with multistage selection. It seems that if the last selection stage accounts for the relationship of the selected animals, then previous selection stages also account for this relationship. An extreme example was considered here: the preselection of dairy bulls that enter a progeny testing scheme. First the penalty on the average relationship in selection step 1 is assumed the same as in step 2. Thereafter, situations with different penalties on the average relationship in the 2 selection steps were analyzed. The simulation started with the generation of prior EBV, which were sampled from a truncated normal distribution. Possible candidates for further progeny testing were selected and progeny test EBV were simulated, where the progeny test was based on 100 daughters per young bull. In situations with greater accuracy of prior EBV, high trait heritability and prior EBV were available for 2,000 bulls; the results were similar for both approaches, independent of family size. However, in a situation with low accuracy of prior EBV and low trait heritability it could be observed that with increasing penalty on the average relationship, correction for relationship in stage 1 yielded in a similar genetic level compared with selecting only for high prior EBV. If the number of bulls with prior EBV increased from 2,000 to 4,000, an increasing penalty on an average relationship gave an improved genetic level. A further improvement of the results with respect to genetic level and average relationship could be observed by increasing the penalty on an average relationship in selection step 1 above that in selection step 2. Overall, this study showed that it is beneficial to use a penalty on an average relationship already for the selection of bulls that enter the progeny test. In case optimum contribution was applied with a constraint on the average relationship in stage 2, this constraint may be translated into a penalty on the average relationship, and the current results suggested that the optimal penalty in selection stage 1 should be twice that of stage 2.

Diets of minority ethnic groups in the UK: influence on chronic disease risk and implications for prevention

Summary Introduction 1Definitions of ethnic groups and demographics of minority ethnic groups in the UK ○ 1.1 Definitions of ‘ethnic groups’ and ‘ethnicity’ ○ 1.2 Demographics and characteristics of minority ethnic groups in the UK – Countries of origin – Age/sex distribution and life expectancy – Geographical distribution and size of household – Religious beliefs – Education and employment patterns Key points 2Overview of the health profile and dietary habits of minority ethnic groups in the UK ○ 2.1 Available surveys ○ 2.2 Overview of the health profiles among adults from minority ethnic groups – Overall health – Cardiovascular disease (CVD) – Coronary heart disease (CHD) – Stroke – Type 2 diabetes – Obesity ○ 2.3 Possible causes of increased disease risk among minority ethnic groups ○ 2.4 Smoking, drinking and physical activity habits ○ 2.5 Dietary habits and nutritional status ○ 2.6 Overview of the health profiles and dietary and health behaviour patterns of children from minority ethnic groups – Overall health – Diet and health behaviour patterns ○ 2.7 Gaps in data availability Key points 3Factors affecting food choice – Income and socio-economic status – Food availability and access – Awareness of healthy eating – Religious beliefs – Food beliefs – Time and cooking skills – Generation and gender Key points 4Traditional diets of minority ethnic groups ○ 4.1 Overview of traditional diets of minority ethic groups – South Asians – African-Caribbeans – Chinese ○ 4.2 Dietary acculturation ○ 4.3 Nutritional composition of ethnic-style cuisine Key points 5Nutritional interventions and health promotion among minority ethnic groups ○ 5.1 Effective nutritional interventions ○ 5.2 Health promotion interventions to prevent problems associated with fasting ○ 5.3 Priorities for nutritional interventions and health promotion ○ 5.4 Using behaviour change models ○ 5.5 Current community initiatives ○ 5.6 Catering for institutionalised individuals ○ 5.7 Recommendations for future research, policy and practice Key points 6Conclusion • Acknowledgements • References Summary According to the latest census, non-white minority ethnic groups made up 7.9% of the UK's population in 2001. The largest of these groups were South Asians, Black African-Caribbeans and Chinese. Studies have shown that some minority ethnic groups are more likely to experience poorer health outcomes compared with the mainstream population. These include higher rates of cardiovascular disease (CVD), type 2 diabetes and obesity. The differences in health outcomes may reflect interactions between diet and other health behaviours, genetic predisposition and developmental programming, all of which vary across different groups. As is the case for the rest of the population, the dietary habits of minority ethnic groups are affected by a wide variety of factors, but acquiring a better understanding of these can help health professionals and educationalists to recognise the needs of these groups and help them to make healthier food choices. Unfortunately, to date, there have been few tailored, well-designed and evaluated nutritional interventions in the UK targeting minority ethnic population groups. Further needs assessment and better evaluation of nutritional interventions have been recommended to enhance the understanding of the effectiveness of different approaches amongst minority ethnic groups. This briefing paper will provide an overview of the health profile, dietary habits and other health behaviours of the three largest non-white minority ethnic groups in the UK, explore the factors affecting their food choices, provide a summary of their traditional diets and review the evidence base to identify the factors that support successful nutrition interventions in these groups.

Estimates of Insulin Secretory Function in Apparently Healthy Volunteers Vary as a Function of How the Relevant Variables Are Quantified

Several surrogate estimates have been used to define relationships between insulin action and pancreatic β-cell function in healthy individuals. Because it is unclear how conclusions about insulin secretory function depend on specific estimates used, we evaluated the effect of different approaches to measurement of insulin action and secretion on observations of pancreatic β-cell function in individuals whose fasting plasma glucose (FPG) was <7.0 mmol/L (126 mg/dL). We determined 2 indices of insulin secretion [homeostasis model assessment of β-cell function (HOMA-β) and daylong insulin response to mixed meals], insulin action [homeostasis model assessment of insulin resistance (HOMA-IR) and steady-state plasma glucose (SSPG) concentration during the insulin suppression test], and degree of glycemia [fasting plasma glucose (FPG) and daylong glucose response to mixed meals] in 285 individuals with FPG <7.0 mmol/L. We compared the relationship between the 2 measures of insulin secretion as a function of the measures of insulin action and degree of glycemia. Assessment of insulin secretion varied dramatically as a function of which of the 2 methods was used and which measure of insulin resistance or glycemia served as the independent variable. For example, the correlation between insulin secretion (HOMA-β) and insulin resistance varied from an r value of 0.74 (when HOMA-IR was used) to 0.22 (when SSPG concentration was used). Conclusions about β-cell function in nondiabetic individuals depend on the measurements used to assess insulin action and insulin secretion. Viewing estimates of insulin secretion in relationship to measures of insulin resistance and/or degree of glycemia does not mean that an unequivocal measure of pancreatic β-cell function has been obtained.

Homeopathy for Depression - DEP-HOM: study protocol for a randomized, partially double-blind, placebo controlled, four armed study

BackgroundHomeopathy is often sought by patients with depression. In classical homeopathy, the treatment consists of two main elements: the case history and the prescription of an individually selected homeopathic remedy. Previous data suggest that individualized homeopathic Q-potencies were not inferior to the antidepressant fluoxetine in a sample of patients with moderate to severe depression. However, the question remains whether individualized homeopathic Q-potencies and/or the type of the homeopathic case history have a specific therapeutical effect in acute depression as this has not yet been investigated. The study aims to assess the two components of individualized homeopathic treatment for acute depression, i.e., to investigate the specific effect of individualized Q-potencies versus placebo and to investigate the effect of different approaches to the homeopathic case history.Methods/DesignA randomized, partially double-blind, placebo-controlled, four-armed trial using a 2 × 2 factorial design with a six-week study duration per patient will be performed. 228 patients diagnosed with major depression (moderate episode) by a psychiatrist will be included. The primary endpoint is the total score on the 17-item Hamilton Depression Rating Scale after six weeks. Secondary end points are: Hamilton Depression Rating Scale total score after two and four weeks; response and remission rates, Beck Depression inventory total score, quality of life and safety at two, four and six weeks. Statistical analyses will be by intention-to-treat. The main endpoint will be analysed by a two-factorial analysis of covariance. Within this model generalized estimation equations will be used to estimate differences between verum and placebo, and between both types of case history.DiscussionFor the first time this study evaluates both the specific effect of homeopathic medicines and of a homeopathic case taking in patients with depression. It is an attempt to deal with the challenges of homeopathic research and the results might be useful information in the current discussion about the evidence on homeopathyTrial registrationClinicalTrials.gov: NCT01178255

Spatial interpolation of hourly rainfall – effect of additional information, variogram inference and storm properties

Abstract. Hydrological modelling of floods relies on precipitation data with a high resolution in space and time. A reliable spatial representation of short time step rainfall is often difficult to achieve due to a low network density. In this study hourly precipitation was spatially interpolated with the multivariate geostatistical method kriging with external drift (KED) using additional information from topography, rainfall data from the denser daily networks and weather radar data. Investigations were carried out for several flood events in the time period between 2000 and 2005 caused by different meteorological conditions. The 125 km radius around the radar station Ummendorf in northern Germany covered the overall study region. One objective was to assess the effect of different approaches for estimation of semivariograms on the interpolation performance of short time step rainfall. Another objective was the refined application of the method kriging with external drift. Special attention was not only given to find the most relevant additional information, but also to combine the additional information in the best possible way. A multi-step interpolation procedure was applied to better consider sub-regions without rainfall. The impact of different semivariogram types on the interpolation performance was low. While it varied over the events, an averaged semivariogram was sufficient overall. Weather radar data were the most valuable additional information for KED for convective summer events. For interpolation of stratiform winter events using daily rainfall as additional information was sufficient. The application of the multi-step procedure significantly helped to improve the representation of fractional precipitation coverage.

Role of patient and public participation in health technology assessment and coverage decisions

Health technology assessment (HTA) has become an integral part of decision-making on the coverage of new health technologies in most health systems in the developed world. In recent years, pressure to involve patients and members of the public in HTA has grown. In this article, we summarize findings from peer-reviewed and ‘gray’ literature, and discussions with key informants to determine potential roles for patients and the public in HTA and coverage decision-making. We also summarize existing roles for both groups in jurisdictions. Although there appears to be a general view that involvement of patients and the public is highly desirable, research offering insights into the effectiveness of different approaches to accomplish this is scarce. Nonetheless, many of the HTA agencies in developed countries have established some mechanism for seeking input from patients or the public in their processes.

Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients.

Background:Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. Little is known regarding the effect of different approaches on the incidence of PDPH.Objectives:In this study we aimed to compare the incidence of PDPH in the case of median and paramedian approaches in patients undergoing spinal anesthesia for orthopedic operations.Patients and Methods:Patients scheduled for orthopedic surgery under spinal anesthesia between 2007 and 2008 were studied in a double-blinded randomized controlled trial. The patients were randomized to receive spinal anesthesia by either a median (n = 75) or paramedian (n = 75) approach through a 25-gauge Crawford needle. No premedication was given, and all patients received 500 mL of normal saline intravenously and 4 mL of 0.5% isobaric Marcaine 30 minutes prior to surgery in both approaches.Results:Fifteen patients (10%) developed PDPH. There was no significant difference in the incidence of PDPH in both groups, with 7 (9.3%) patients in the median approach group versus 8 (10.7%) in the paramedian approach group developing typical PDPH (P = 0.875). However, a significant difference in PDPH incidence (P = 0.041) was observed between females (9; 16.7%) and males (6; 6.3%).Conclusions:There is no difference between median and paramedian approaches with respect to PDPH incidence; the paramedian approach is therefore recommended, especially for older patients with degenerative changes in the spine and intervertebral spaces and those who cannot take the proper position. Moreover, the rate of PDPH was found to be significantly higher in females than in males.

Multimedia education programme for patients with a stoma: effectiveness evaluation

This paper is a report of an evaluation of the effectiveness of a multimedia education program in relation to stoma knowledge, self-care attitudes and behaviour with patients with a stoma in the postoperative period. Multimedia education programmes not only give patients with useful information in the absence of health professionals, but can also augment information given in traditional clinical practice. However, the literature on the effectiveness of different approaches to stoma education is limited. A randomized experimental study design was used. Participants were recruited from a surgical unit in a large hospital in Taiwan. A total of 102 patients with a stoma were randomly assigned to either the multimedia education programme (n=46) or a conventional stoma education programme (n=56) with a follow-up of 1 week. Outcome variables measured were levels of self-care knowledge, attitudes towards self-care and self-care behaviour. Patients who received the multimedia education programme improved their overall self-care knowledge, attitudes and behaviour statistically significantly when compared with those who received the conventional stoma education programme. Although further, longer-term follow-up will be useful, this study demonstrates that multimedia packages can enhance patient involvement in their stoma care and can augment stoma education - particularly in resource challenged healthcare environments.

C-A4-01: Providing Care for Cancer Survivors in Integrated Delivery Systems: An Assessment of Current Practices and Future Opportunities

Jessica Chubak, PhD1, Clarissa Hsu, PhD2, Leah Tuzzio, MPH1, Beth Kirlin, BA1 and Larissa Nekhlyudov, MD, MPH3,4 1Group Health; 2Group Health Research Institute; 3Harvard Medical School; 4Harvard Vanguard Medical Associates

Measuring the Impact of Outreach and Enrollment Strategies for Public Health Insurance in California

OBJECTIVE AND STUDY SETTING: To evaluate the effectiveness of different approaches to outreach on public health insurance enrollment in 25 California counties with a Children's Health Initiative. Administrative enrollment databases. The use of eight enrollment strategies were identified in each quarter from 2001 to 2007 for each of 25 counties (county quarter). Strategies were categorized as either technology or nontechnology. New enrollments were obtained for Medi-Cal, Healthy Families, and Healthy Kids. Bivariate and multivariate analyses assessed the link between each strategy and new enrollments rates of children. Methods Surveys of key informants determined whether a specific outreach strategy was used in each quarter. These were linked to new enrollments in each county quarter. Between 2001 and 2007, enrollment grew in all three children's health programs. We controlled for the effects of counties, seasons, and county-specific child poverty rates. There was an increase in enrollment rates of 11 percent in periods when technology-based systems were in use compared with when these approaches were inactive. Non-technology-based approaches, including school-linked approaches, yielded a 12 percent increase in new enrollments rates. Deploying seven to eight strategies yielded 54 percent more new enrollments per 10,000 children compared with periods with none of the specific strategies. National health care reform provides new opportunities to expand coverage to millions of Americans. An investment in technology-based enrollment systems will maximize new enrollments, particularly into Medicaid; nontechnological approaches may help identify harder-to-reach populations. Moreover, incorporating several strategies, whether phased in or implemented simultaneously, will enhance enrollments.

Comparing the Efficiency of Different Approaches to Teach Informatics at Secondary Schools

Each of the 16 federal states of Germany has its own school system and also its own pol- icy to integrate informatics, computer science or ICT into this system. Till present there aren't any tests of students' knowledge on a nation-wide level. Therefore nation-wide or international con- tests currently offer the only opportunities to compare the knowledge of the participating students on a large scale level. By evaluating the overall performance of the students of different federal states, we were able to compare the effectiveness of different approaches of teaching Informatics at secondary schools.

Reduction in elective delivery at

No studies exist that have examined the effectiveness of different approaches to a reduction in elective early term deliveries or the effect of such policies on newborn intensive care admissions and stillbirth rates. We conducted a retrospective cohort study of prospectively collected data and examined outcomes in 27 hospitals before and after implementation of 1 of 3 strategies for the reduction of elective early term deliveries. Elective early term delivery was reduced from 9.6-4.3% of deliveries, and the rate of term neonatal intensive care admissions fell by 16%. We observed no increase in still births. The greatest improvement was seen when elective deliveries at <39 weeks were not allowed by hospital personnel. Physician education and the adoption of policies backed only by peer review are less effective than "hard stop" hospital policies to prevent this practice. A 5% rate of elective early term delivery would be reasonable as a national quality benchmark.

Cross-Sector Partnerships: City Regeneration and Social Justice

In this article, the ability of partnerships to generate goods that enhance the quality-of-life of socially and economically deprived urban communities is explored. Drawing on Rawl’s study on social justice [Rawls, J.: 1971, A Theory of Justice (Harvard University Press, Cambridge)] and Sen’s capabilities approach [Sen, A.: 1992, Inequality Re-Examined (Harvard University Press, Cambridge, MA); 1999, Development as Freedom (Oxford University Press, Oxford); 2009, The Idea of Justice (Ellen Lane, London)], we undertake an ethical evaluation of the effectiveness of different approaches to partnership activity in city neighbourhood regeneration. We focus, in particular, on their impact on the social regeneration of disadvantaged communities. Governance of cross-sector partnerships, built upon negotiated values and strong community voice, may result in a greater sense of procedural justice, as well as improvements to orderliness in local neighbourhoods. However, distributive justice, the accumulation of, and access to, goods that enable greater participation in society, remains largely elusive within neighbourhood partnership activity. We conclude that social provision that deals fairly with the causes of disadvantage by enhancing the capabilities of local communities and increasing social capital is likely to be a more effective and sustainable approach for partnerships, despite being a longer-term and more costly endeavour.

Toilet Training

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Protocol for a mixed methods study investigating the impact of investment in housing, regeneration and neighbourhood renewal on the health and wellbeing of residents: the GoWell programme.

BackgroundThere is little robust evidence to test the policy assumption that housing-led area regeneration strategies will contribute to health improvement and reduce social inequalities in health. The GoWell Programme has been designed to measure effects on health and wellbeing of multi-faceted regeneration interventions on residents of disadvantaged neighbourhoods in the city of Glasgow, Scotland.Methods/DesignThis mixed methods study focused (initially) on 14 disadvantaged neighbourhoods experiencing regeneration. These were grouped by intervention into 5 categories for comparison. GoWell includes a pre-intervention householder survey (n = 6008) and three follow-up repeat-cross sectional surveys held at two or three year intervals (the main focus of this protocol) conducted alongside a nested longitudinal study of residents from 6 of those areas. Self-reported responses from face-to-face questionnaires are analysed along with various routinely produced ecological data and documentary sources to build a picture of the changes taking place, their cost and impacts on residents and communities. Qualitative methods include interviews and focus groups of residents, housing managers and other stakeholders exploring issues such as the neighbourhood context, potential pathways from regeneration to health, community engagement and empowerment.DiscussionUrban regeneration programmes are 'natural experiments.' They are complex interventions that may impact upon social determinants of population health and wellbeing. Measuring the effects of such interventions is notoriously challenging. GoWell compares the health and wellbeing effects of different approaches to regeneration, generates theory on pathways from regeneration to health and explores the attitudes and responses of residents and other stakeholders to neighbourhood change.

HIV Risk Behavior Before and After HIV Counseling and Testing in Jail: A Pilot Study

Jail incarceration represents an opportunity to deliver HIV counseling and testing (C&T) services to persons at increased risk of infection. However, jails can be chaotic with rapid turnover of detainees. We conducted a pilot study to investigate the feasibility of comparing the effect of different approaches to HIV C&T in jail on subsequent HIV risk behaviors among persons testing HIV negative. Consecutive cohorts of newly incarcerated jail detainees were recruited with 132 subjects completing standard HIV C&T as per jail protocol and 132 subjects completing rapid testing with an individualized counseling session. Risk behavior was assessed and compared at baseline and 6 weeks after jail release. Among the 264 male participants, preincarceration substance use and sexual risk were common. The follow-up visit was completed by 59% of eligible participants. There were no differences in postrelease HIV risk behavior between the 2 arms but there was an overall decrease in risk behavior after jail release for the cohort. In addition, all participants in the rapid arm received rapid HIV test results compared with participants receiving 28% of conventional test results. Jail incarceration represents an important public health opportunity to deliver HIV C&T. This study demonstrated (1) feasibility in delivering rapid HIV testing combined with individualized counseling to jail detainees, (2) improved test result delivery rates, and (3) success with evaluating risk behaviors during the transition from jail to the community. Further research is needed to determine the optimal approach to HIV C&T in jail with the goal of increasing awareness of HIV serostatus and decreasing HIV risk behavior.

Impact of 6‐month Caloric Restriction on Autonomic Nervous System Activity in Healthy, Overweight, Individuals

Caloric restriction (CR) increases maximum lifespan but the mechanisms are unclear. Dominance of the sympathetic nervous system (SNS) over the parasympathetic nervous system (PNS) has been shown to be a strong risk factor for cardiovascular disease. Obesity and aging are associated with increased SNS activity, and weight loss and/or exercise seem to have positive effects on this balance. We therefore evaluated the effect of different approaches of CR on autonomic function in 28 overweight individuals participating in the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial. Participants were randomized to either control, CR: 25% decrease in energy intake, CREX: 12.5% CR + 12.5% increase in energy expenditure, or LCD: low-calorie diet until 15% weight reduction followed by weight maintenance. Autonomic function was assessed by spectral analysis of heart-rate variability (HRV) while fasting and after a meal. Measurements were performed at baseline and 6 months. HR and SNS index decreased and PNS index increased in all intervention groups but reached significance only in CREX. HR and SNS index increased and PNS index decreased in response to the meal in all intervention groups. The results therefore suggest that weight loss improved SNS/PNS balance especially when CR is combined with exercise.