General Health Education Research Articles

The impact of aerobic exercise combined and computer cognitive training on cognitive function in patients with mild cognitive impairment

Objective To investigate the changes of cognitive function in patients with mild cognitive impairment after aerobic exercise combined and computer cognitive training. Methods Four hundred and twenty patients were divided into two groups by random digits table method. The control group(200 cases) received general health education and rehabilitation training. The intervention group(220 cases) received aerobic exercise combined and computer cognitive training. The patients were assessed with Montreal Cognitive Assessment (MoCA) to evaluate their cognition before training, as well as after training. Results After intervention, the scores of the MoCA total score, naming, attention, language, memory, and orientation in the intervention group were 24.12 ± 2.18, 2.77 ± 0.42, 5.05 ± 0.88, 2.75 ± 0.56, 3.18 ± 0.91, 4.68 ± 0.87, the control group were 21.13 ± 2.13, 2.45 ± 0.56, 4.71 ± 1.10, 2.35 ± 0.69, 2.43 ± 0.81, 4.48 ± 0.96. There were statistically significant differences between the two groups (t=-11.278~-0.543, P 0.05). Conclusions The application of aerobic exercise combined and computer cognitive training could improve the cognitive function. Key words: Mild cognitive impairment; Aerobic exercise; Cognitive function; Computerized cognitive training

Identifying Unrecognized Hearing Loss

Identifying Unrecognized Hearing Loss

The effects of an empowerment-based self-management intervention on empowerment level, psychological distress, and quality of life in patients with poorly controlled type 2 diabetes: A randomized controlled trial

BackgroundThere is considerable interest in advocating empowerment in diabetes care. Health professionals, however, often fail to realize empowerment in clinical practice, especially in patients with poorly controlled type 2 diabetes. ObjectivesTo evaluate the effectiveness of an empowerment-based intervention on empowerment level, psychological distress, and quality of life among patients with poorly controlled type 2 diabetes. DesignAn analysis of secondary outcomes of a prospective multi-center, randomized, parallel, investigator-blinded controlled trial. MethodsA total of 242 adult patients with poorly controlled type 2 diabetes [Hemoglobin A1c (HbA1c)≥ 58 mmol/mol in the recent six months] were randomly allocated to either intervention (n = 121) or attentional control (n = 121) groups. The design of the intervention was based on the Empowerment Process Model. The intervention group received a 6-week empowerment-based transitional care program, with significant emphasis on establishing personally meaningful goals, facilitating collaborative partnership and shared decision-making, resolving life-disease conflicts via situational reflection. Participants in the attentional control group received two general health education classes and post-discharge social calls on top of routine care. Outcomes of interest include empowerment level, diabetes distress, and quality of life. Participants were invited to complete a set of questionnaires before randomization, one-week, and three-month post-intervention. Statistical analyses were performed using the generalized estimating equations based on the intention-to-treat principle. ResultsComparing with the attention control group, participants in the intervention group showed significant improvements on empowerment level [(β= 0.163; 95% confidence interval (CI): 0.011 to 0.316, p = 0.036) at one-week post-intervention and (β= 0.176; 95% CI: 0.020 to 0.331, p = 0.027) at three-month post-intervention, respectively]. This group of patients also displayed significant reduction in terms of emotional-distress (β= −0.424, 95% CI: −0.798 to −0.049, p = 0.027) and regimen-distress (β= −0.397, 95% CI: −0.702 to −0.091, p = 0.011) at three-month post-intervention and physician-related distress (β= −0.236, 95% CI: −0.466 to −0.006, p = 0.044) at one-week post-intervention. Significant improvement in quality of life (β= 4.151, 95% CI: 1.291, 7.012, p = 0.004) at three-month post-intervention was also observed in the intervention group. ConclusionsFindings provide empirical evidence for the values of an empowerment-based intervention program for patients with poorly controlled type 2 diabetes in increasing the empowerment level and perceived quality of life and reducing diabetes distress. Long-term effects of the intervention and its underlying mechanisms need further investigation.

Trato digno de enfermería durante 2010-2015 en el sistema nacional de indicadores de calidad

En este trabajo se presenta el comportamiento del indicador de trato digno de enfermería durante el periodo 2010 a 2015 en el Sistema Nacional de Indicadores de Calidad en Salud, con el objetivo de describir la percepción de la calidad de la atención recibida por los usuarios de los servicios de salud, así como identificar las variables de este indicador que representen un mayor reto para el profesional de enfermería. La información analizada se obtuvo del portal de internet de la Dirección General de Calidad y Educación en Salud. Los resultados indican que durante el periodo 2010-2011 no se cumplió con el estándar de calificación mínima de 95% esperada por el cumplimiento de los criterios establecidos para este indicador. Los criterios limitantes fueron porcentaje de pacientes a los cuales la enfermera (o): a) lo saluda en forma amable, b) se presenta, y c) se dirige por su nombre. De 2012 a 2015 se cumplió con el estándar, lo cual sugiere que la medición de este indicador ha permitido detectar áreas de oportunidad e implementar estrategias de mejora continua, por otro lado también indica el enfoque ético y humanístico en la atención que caracteriza la profesión de enfermería.

"My Surgical Success": Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery-A Pilot Randomized Controlled Clinical Trial.

ObjectiveThis study aims to assess the feasibility of digital perioperative behavioral pain medicine intervention in breast cancer surgery and evaluate its impact on pain catastrophizing, pain, and opioid cessation after surgery.Design and SettingA randomized controlled clinical trial was conducted at Stanford University (Palo Alto, CA, USA) comparing a digital behavioral pain medicine intervention (“My Surgical Success” [MSS]) with digital general health education (HE).ParticipantsA convenience sample of 127 participants were randomized to treatment group. The analytic sample was 68 patients (N = 36 MSS, N = 32 HE).Main OutcomesThe primary outcome was feasibility and acceptability of a digital behavioral pain medicine intervention (80% threshold for acceptability items). Secondary outcomes were pain catastrophizing, past seven-day average pain intensity, and time to opioid cessation after surgery for patients who initiated opioid use.ResultsThe attrition rate for MSS intervention (44%) was notably higher than for HE controls (18%), but it was lower than typical attrition rates for e-health interventions (60–80%). Despite greater attrition for MSS, feasibility was demonstrated for the 56% of MSS engagers, and the 80% threshold for acceptability was met. We observed a floor effect for baseline pain catastrophizing, and no significant group differences were found for postsurgical pain catastrophizing or pain intensity. MSS was associated with 86% increased odds of opioid cessation within the 12-week study period relative to HE controls (hazard ratio = 1.86, 95% confidence interval = 1.12–3.10, P = 0.016).ConclusionsFifty-six percent of patients assigned to MSS engaged with the online platform and reported high satisfaction. MSS was associated with significantly accelerated opioid cessation after surgery (five-day difference) with no difference in pain report relative to controls. Perioperative digital behavioral pain medicine may be a low-cost, accessible adjunct that could promote opioid cessation after breast cancer surgery.

Exploring Disparities in Influenza Immunization for Older Women.

While women obtain most recommended preventive health interventions more often than men, evidence is mixed regarding influenza vaccination for older adults. Therefore, we evaluated sex differences in influenza vaccination among older adults. Nationally representative cross-sectional survey. United States. A total of 1 252 705 adults, aged 65 years and older, responding to 2013 to 2017 Medicare Consumer Assessment of Healthcare Providers and Systems surveys. The dependent variable was Healthcare Effectiveness Data and Information Set self-reported influenza immunization. The primary predictor was sex. Covariates included general health status, education, race/ethnicity, and Medicare Advantage (MA; managed care) vs Fee-for-Service (FFS) coverage. After adjusting for health status and other sociodemographic factors, women's immunization was 2% lower than men's immunization in MA, with no significant overall sex difference in FFS. Women were immunized less often than men in 95% of MA health plans, with the largest gaps in low-immunizing plans. Further analyses revealed variation in sex differences by health status, education, and race/ethnicity in both MA and FFS. Notably in MA, women in poor health were immunized less often than men in similar health (-4%; P < .001). Black women were immunized much less often than black men in both MA and FFS (-5%; P < .001 for each). Hispanic women were immunized less often than Hispanic men in MA (-4%; P < .001) but not within FFS. Women in MA experience small disparities overall in influenza immunization, with larger disparities for black and Hispanic women. Providers and MA plans should increase efforts to recommend and monitor immunization for older women, especially black and Hispanic women and those in poor health. Given the potential to reduce morbidity and mortality, equitable access to a critical preventive health service, such as influenza immunization, is crucial for all older adults.

The influence of information-based health education WeChat platformon on the cognition, attitude and behavior of pelvic floor muscle training of puerperal

Objective To study the application effect of information-based health education WeChat platform on the cognition, attitude and behavior of pelvic floor muscle training (pelvic floor muscle training, PFMT) of puerpera, in order to provide an effective intervention method and scientific basis to improve the compliance level of PFMT. Methods Full-term birth 329 cases of vaginal delivery have been chosen from August to September in 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. They were divided into 3 groups: control group, audio group, video group by computer random digital table method. The number of the cases of the corresponding groups were 108,113, 108 cases. Control group was given general postpartum health education, audio group and video group were given continuation of voice remind audio guide and continuation of voice remind video guide respectively from postpartum 1 week to 7 weeks. The compliance level of PFMT of the three groups would be evaluated before and after the intervention. Results The KAP(Knowledge, Altitude and Practice, KAP) scores of PFMT of control group, audio group and video group were 9.0(7.0,10.0), 11.0(8.0,12.0), 12.0 (11.0,13.0) points, respectively. There were significant differences between the video group and the control group, between the video group and the audio group and between the audio group and the control group (Z =-4.302, -10.233, -6.429, P<0.01). Comparison of the PFMT scores before and after the three groups, there was a visibility significant statistical difference in KAP scores (Z =-5.596, -11.762. -15.061, P< 0.01). Conclusions The maternals' knowledge level and physical activity level of PFMT are relatively low. Health care workers should enhance their knowledge about PFMT and improve their understanding of PFMT. WeChat platform to continue voice remind audio guide and continue voice remind video guide way of health education, could improve the KAP level of maternal PFMT and adherence. The KAP level of video guide health education is superior to the audio guide way of health education, which has clinical significance, and is worth popularizing. Key words: Healthy education; Stress urinary incontinence; Informatization; Knowledge, altitude and practice

Effect of Cognitive Behavioral Therapy on Improving the Cognitive Function in Major and Minor Depression.

The aim of this study was to investigate the effectiveness of cognitive behavioral therapy (CBT) on improving the cognitive function in minor depression (MiD) and major depression (MaD). The study will constitute a placebo-controlled single-blind parallel-group randomized controlled trial. The selected participants will be randomly allocated into one of two parallel groups with a 1:1 ratio: the CBT-based group and the general health education group. CBT significantly alleviated depressive symptoms of MiD and MaD at 12 weeks (p < 0.001), and the treatment effect was maintained for at least 12 months (p < 0.001). Interestingly, CBT significantly promotes more cognitive function of MiD and partial cognitive function of MaD at 12 weeks in the intervention group than in the control group (p < 0.01). CBT can alleviate depressive symptoms of both minor and MaDs. The effectiveness of CBT is different on improving the cognitive function in MiD and MaD.

Community-Based Cervical Cancer Education: Changes in Knowledge and Beliefs Among Vietnamese American Women.

Low cervical cancer screening rates among Vietnamese American women have been attributed, in part, to inadequate knowledge about cervical cancer and health beliefs that hinder screening. A community-based educational program was developed to improve knowledge and attitudes toward cervical cancer screening in this underserved population. It was hypothesized that the program would result in increases in knowledge, as well as enhanced health beliefs and self-efficacy toward obtaining cervical cancer screening. Using a group-randomized design, 1488 women from 30 Vietnamese community-based organizations were assigned to either the intervention (n = 816) or control (n = 672) conditions. The intervention group received cervical cancer education delivered by bilingual community health educators. Intervention content addressed individual beliefs and expectancies regarding cervical cancer screening (e.g., perceived risk of developing cervical cancer; perceived benefits and barriers to screening; social and cultural norms regarding screening). The control group received general health education, including information about cancer screening. Knowledge and health beliefs were assessed at baseline and post-intervention. Among women in the intervention group, overall knowledge about cervical cancer and screening guidelines increased from pre- to post-program (30% vs. 88%, p < 0.001), perceived benefits of screening increased (3.50 vs. 4.49, p < 0.001), and perceived barriers to screening decreased (3.13 vs. 2.25, p < 0.001). Changes in knowledge and health beliefs were not observed among women in the control group. A community-based educational program can help increase knowledge about cervical cancer and screening, promote positive changes in women's beliefs about the benefits of cervical cancer screening, and reduce perceived barriers to screening. Such programs may play an important role in addressing health disparities and informing underserved populations about recommended screening tests.

Provision of Sexually Transmitted Infection Services in a Mobile Clinic Reveals High Unmet Need in Remote Areas of South Africa: A Cross-sectional Study.

The burden of sexually transmitted infections (STIs) in areas of sub-Saharan Africa with poor access to health care services is not well documented. In remote areas of South Africa, we investigated the prevalence of STIs and approaches to providing STI services through a mobile clinic. We recruited 251 adult women visiting a mobile clinic that normally provides general health education and screening services, but not STI care. Clinical and sexual history was obtained and vaginal specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium infection and for Candida albicans and bacterial vaginosis. Laboratory test was positive for 133 (53%) of 251 women for at least 1 STI: C. trachomatis was observed in 52 (21%) women, N. gonorrhoeae in 39 (16%) women, T. vaginalis in 81 (32%) women and M. genitalium in 21 (8%) women. Eighty-one (32%) women met the criteria for vaginal discharge syndrome, of which 58% (47/81) would have been treated accurately. Among asymptomatic women 84 (49%) of 170 were diagnosed with an STI but untreated under the syndromic approach. We could not identify factors associated with asymptomatic STI infection. There is a high unmet need for STI care in rural South African settings with poor access to health care services. Provision of STI services in a mobile clinic using the syndromic management approach provides a useful approach, but would have to be enhanced by targeted diagnostics to successfully address the burden of infection.

Developing community-based health education strategies with family history: Assessing the association between community resident family history and interest in health education.

Family history (FH) is an underutilized genetically informative tool that can influence disease prevention and treatment. It is unclear how FH fits into the development of community-based health education. This study examines the role that FH plays in perceived threat and health education related to mental and chronic physical conditions in the context of the health belief model. Data were collected from 1,048 adult participants aged 18-90 years. Approximately 76% of participants indicated African-American race/ethnicity and 35% had less than high school level education. Self-report data were collected on FH of four disorders: anxiety, depression, diabetes, and high blood pressure. Interest in receiving information regarding prevention as well as future testing efforts was assessed broadly. A series of logistic regressions examined the association between FH for each of the disorders and interest in receiving information on (1) prevention of diseases in general and (2) testing for diseases in general. These associations were also analyzed after accounting for the influence of perceived threat of conditions. Interest in receiving general health education was significantly associated with FH of depression (OR = 2.72, 95% CI = 1.74-4.25), anxiety (OR = 2.26, 95% CI = 1.45-3.22), and high blood pressure (OR = 2.54, 95% CI = 1.05-6.12). After adjustment for perceived threat, the magnitude of these associations was reduced substantially. The associations between perceived threat and either interest in receiving information on disease testing or receiving general health education were strong and significant across all conditions (OR = 2.11-3.74). These results provide evidence that perceived threat mediates the association between FH and engagement with health education. Currently available health education programs may benefit from considering the role of FH in an individual's motivation for participation in health education activities alongside other factors.

Training effect of family caregivers for disabled elderly people based on the online care knowledge and skill system

Objective To explore the application effect of online learning platform on the training of family caregivers of disabled elderly people. Methods From September 2017 to March 2018, the family caregivers of 90 disabled elderly people in a district of Changsha were selected by convenience sampling method, and divided into control group and observation group by random number table method, with 45 cases in each group. During the study period, the caregivers of the control group received general health education. The caregivers in the intervention group received online training on the self-developed online learning platform under the guidance of the researchers for months. Before and after the training, the family caregivers were investigated using the Family Caregivers Care Ability Scale and the Care Knowledge Assessment Questionnaire. Results Before the training, there was no statistically significant difference in average score of care knowledge, and the total score and the five dimensions' scores of the Family Caregivers Care Ability Scale between the two groups (P > 0.05) . After training, the score of the care knowledge in the intervention group was (82.2±15.2) , which was higher than that in the control group (64.2±17.2) , and the difference was statistically significant (t=5.260, P<0.01) . After training, the score of Family Caregivers Care Ability Scale in the intervention group was (13.90±4.52) , which was lower than that in the control group (16.57±3.25) , and the difference was statistically significant (t=3.217, P<0.01) . The scores of the four dimension of the scale, including adjusting the role of caregiver, meeting need and providing assistance, dealing with personal mood, adjusting life in order to meet the needs to take care of elderly in the intervention gorup were lower than those in the control group, and the differences were statistically significant (P<0.05) . Conclusions The training based on the online care knowledge and skill system for disability elderly can improve the family caregivers of nursing knowledge level and ability to take care of the elderly. Key words: Aged; Health education; Education, remote; Computer communication network; Home nursing (non-professional); Disabled elderly; Family caregivers

A Preexperimental Study to Assess the Impact of an Interdisciplinary Educational Intervention on Nurses' Knowledge of Perinatal and Infant Oral Health Care.

Objective:The objective of this study was to assess the impact of an interdisciplinary educational intervention on the knowledge of nursing practitioners regarding perinatal and infant oral health (PIOH) care.Materials and Methods:This was a preexperimental study conducted among nursing practitioners in Lagos, Nigeria. Participants received hands-on training and didactic lectures, which included dental caries etiology and risk factors; oral hygiene and dietary education; teething and its management; dental trauma and its prevention; nonnutritive habits; screening, referrals, and counseling; and fluoride varnish application. Knowledge of the trainees was assessed using pre- and posttest questionnaires. Level of statistical significance was set at P < 0.05.Results:Overall, 110 nurses participated in the study with a mean age of 40.9 ± 10.8 years; 106 (96.4%) were females. Approximately 88% of the participants had not received formal training on PIOH. The baseline mean scores of the participants’ knowledge on oral hygiene, teething, trauma, caries, and oral habits were 4.31 ± 1.9, 9.84 ± 2.6, 2.59 ± 1.7, 4.24 ± 1.8, and 1.45 ± 0.6, respectively; this increased significantly (P < 0.001) following the educational intervention with posttest mean scores as 7.58 ± 0.8, 11.79 ± 1.3, 4.34 ± 1.9, 6.19 ± 1.8, and 1.82 ± 0.4 and six-month evaluation scores as 6.21 ± 1.8,7 10.27 ± 3.1, 4.39 ± 1.5, 5.91 ± 1.8, and 1.79 ± 0.5, respectively. Overall posttest (31.4 ± 4.2) and six-month (28.6 ± 6.2) knowledge scores were significantly higher than the pretest values (22.4 ± 4.8, P < 0.001). At the six-month post-intervention survey, 84% of the nurses reported inclusion of PIOH education in their routine general health education sessions.Conclusion:There was a positive impact of the educational intervention as evidenced by an increase in the knowledge of the nurses on PIOH care and the inclusion of PIOH education in their general health education. A slight decline between posttest and six-month evaluation scores indicates a need for continuous education and evaluation.

Decreasing Fear of Falling in Chronic Stroke Survivors Through Cognitive Behavior Therapy and Task-Oriented Training.

Background and Purpose- Research has shown that balance training is effective for reducing the fear of falling in individuals with a history of stroke. In this study, we evaluated (1) whether cognitive behavior therapy could augment the beneficial effects of task-oriented balance training (TOBT) in reducing the fear of falling in chronic stroke survivors and (2) whether it could, in turn, reduce fear-avoidance behavior and improve related health outcomes. Methods- Eighty-nine cognitively intact subjects with mildly impaired balance ability were randomized into the following 2 groups that underwent 90-minutes interventions 2 days per week for 8 weeks: (1) cognitive behavior therapy + TOBT or (2) general health education + TOBT (control). The primary outcome was the fear of falling, and the secondary outcomes were fear-avoidance behavior, balance, fall risk, independent daily living, community integration, and health-related quality of life. The outcomes were assessed at baseline, after 4 and 8 weeks of intervention, and 3 and 12 months after completing the intervention. Results- Eighty-two subjects completed the intervention and follow-up assessments. From postintervention to 12 months after completing the intervention, the cognitive behavior therapy + TOBT participants reported greater reduction in the fear of falling and fear-avoidance behavior and greater improvements in balance and independent daily living than the general health education + TOBT participants. Conclusions- Cognitive behavior therapy should be considered as an adjuvant therapy to standard physiotherapy for cognitively intact individuals with a history of stroke. Clinical Trial Registration- URL: https://clinicaltrials.gov. Unique identifier: NCT02937532.

Testing a behavioral intervention to improve adherence to adjuvant endocrine therapy (AET)

Adjuvant endocrine therapy (AET) is used to prevent recurrence and reduce mortality for women with hormone receptor positive breast cancer. Poor adherence to AET is a significant problem and contributes to increased medical costs and mortality. A variety of problematic symptoms associated with AET are related to non-adherence and early discontinuation of treatment. The goal of this study is to test a novel, telephone-based coping skills training that teaches patients adherence skills and techniques for coping with problematic symptoms (CST-AET). Adherence to AET will be assessed in real-time for 18 months using wireless smart pill bottles. Symptom interference (i.e., pain, vasomotor symptoms, sleep problems, vaginal dryness) and cost-effectiveness of the intervention protocol will be examined as secondary outcomes. Participants (N = 400) will be recruited from a tertiary care medical center or community clinics in medically underserved or rural areas. Participants will be randomized to receive CST-AET or a general health education intervention (comparison condition). CST-AET includes ten nurse-delivered calls delivered over 6 months. CST-AET provides systematic training in coping skills for managing symptoms that interfere with adherence. Interactive voice messaging provides reinforcement for skills use and adherence that is tailored based on real-time adherence data from the wireless smart pill bottles. Given the high rates of non-adherence and recent recommendations that women remain on AET for 10 years, we describe a timely trial. If effective, the CST-AET protocol may not only reduce the burden of AET use but also lead to cost-effective changes in clinical care and improve breast cancer outcomes.Trials registration: ClinicalTrials.gov, NCT02707471, registered 3/3/2016.

GAMBARAN PERANAN PENYULUHAN METODE DEMONSTRASI TERHADAP PENGETAHUAN MENYIKAT GIGI PADA SISWA/I KELAS IV SD 068003 KAYU MANIS PERUMNAS SIMALINGKAR KECAMATAN MEDAN TUNTUNGAN

Brushing teeth is one of the methods to maintain dental hygiene and oral health. It can ward off the incidence of caries. In general, dental and oral health education is obtained from counseling. The group of people that usually becomes the target is elementary school children because the age of 6-14 years is a transition period or the change in permanent teeth (mixed teeth period).In this research, the counseling was the one with demonstration method which was aimed to increase the knowledge of brushing teeth in Grade IV students at SD 068003 Kayu Manis, Perumnas Simalingkar, Medan Tuntungan Subdistrict with 30 students as the samples.The result of the research showed that before the counseling, 18 respondents (60%) were in good criteria in their knowledge of brushing teeth correctly and 11 respondents (36.7%) were in moderate category. After the counseling with demonstration method, all respondents (100%) were in good category.The conclusion was that counseling with demonstration method could improve students’ knowledge of brushing teeth. It is recommended that Grade IV students at SD 068003 brush their teeth properly and correctly.

Effect of Internet-Based Cognitive Behavioral Humanistic and Interpersonal Training vs Internet-Based General Health Education on Adolescent Depression in Primary Care

Although 13-20% of American adolescents experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available. To study whether CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training) reduces the hazard for depression in at-risk adolescents identified in primary care, as compared to a general health education attention control (HE). The Promoting AdolescenT Health (PATH) study compares CATCH-IT and HE in a phase 3 single-blind multicenter randomized attention control trial. Participants were enrolled from 2012 to 2016 and assessed at 2, 6, 12, 18, and 24 months post-randomization. Primary care. Eligible adolescents were 13-18 years with subsyndromal depression and/or history of depression and no current depression diagnosis or treatment. Of 2,250 adolescents screened for eligibility, 446 participants completed the baseline interview and 369 were randomized into CATCH-IT (n=193) and HE (n=176). CATCH-IT is a 20-module (15 adolescent modules, 5 parent modules) online psychoeducation course that includes a parent program, supported by three motivational interviews. Time-to-event for depressive episode; depressive symptoms at 6 months. Mean age was 15.4 years, and 68% were female; 28% had both a past episode and subsyndromal depression; 12% had a past episode only, 59% had subsyndromal depression only, and 1% had borderline subsyndromal depression. The outcome of time-to-event favored CATCH-IT but was not significant with intention-to-treat analyses (N=369; unadjusted HR=0.59; 95% CI 0.27, 1.29; p=0.18; adjusted HR=0.53; 95% CI 0.23, 1.23, p=0.14). Adolescents with higher baseline CES-D10 scores showed a significantly stronger effect of CATCH-IT on time-to-event relative to those with lower baseline scores (p=0.04). For example, for a CES-D10 score of 15 (significant sub-syndromal depression), HR=0.20 (95% CI 0.05, 0.77), compared to CES-D10 of 5 (no sub-syndromal depression), HR=1.44 (95% CI, 0.41, 5.03). In both CATCH-IT and HE groups, depression symptoms declined and functional scores increased. CATCH-IT may be better than HE for preventing depressive episodes for at-risk adolescents with sub-syndromal depression. CATCH-IT may be a scalable approach to prevent depressive episodes in adolescents in primary care.

Study Protocol for a Randomized Controlled Trial of Choral Singing Intervention to Prevent Cognitive Decline in At-Risk Older Adults Living in the Community.

Introduction: This study is a parallel-arm randomized controlled trial evaluating choral singing’s efficacy and underlying mechanisms in preventing cognitive decline in at-risk older participants.Methods: Three-hundred and sixty community-dwelling, non-demented older participants are recruited for a 2-year intervention. Inclusion criteria are self-reported cognitive complaints, early cognitive impairment based on neuropsychological test scores or multiple risk factors of dementia. Participants are randomized to either weekly choral singing sessions or general health education. The primary outcome is cognitive performance, measured by a composite cognitive test score (CCTS). Secondary outcomes include depression, anxiety and neuropsychiatric symptoms; perceived stress; sleep quality and severity of dementia symptoms. Underlying mechanisms are examined using blood- and urine-based biomarkers and neuroimaging.Results: Screening began in July 2016. The first group of participants (n = 93) have been recruited. Intervention and control treatments are ongoing and will end in December 2019.Discussion: An evidence-based singing intervention for dementia prevention holds potential for healthcare savings and societal welfare.Trial Registration: NCT02919748, IRB Approval Number: NUS 2508.

Cost-Effectiveness of Telephone-Delivered Behavioral Skills Intervention for African-American Adults with Diabetes

Background: To investigate cost differences between intervention arms of a telephone-delivered self-management training for African Americans with diabetes. Methods: This RCT used a 2x2 factorial design, randomizing African American adults with poorly controlled diabetes to: 1) knowledge only, 2) skills training only, 3) combined knowledge and skills training, or 4) control group receiving general health education. The primary outcome for cost effectiveness was glycemic control (HbA1c) at 12-months post-randomization. Costs for healthcare utilization were measured using Medical Expenditure Panel Survey (MEPS) estimates and costs for lost wages were estimated using interval regression. All costs were adjusted to 2012 dollars. Cost utility was quality-adjusted life years (QALYs) estimated via the area under the curve technique using utilities obtained from respondents’ answers to SF-12 questions and mortality estimates based on CDC lifetables. Empirical joint distribution of incremental costs, QALYs, and cost effectiveness acceptability curves were generated using non-parametric bootstrapping. Results: There was no significant difference in cost (p=0.44) or change of QALYs between arms (p=0.36). With no statistically significant difference in cost, the incremental cost effectiveness ratios (ICER) were not significant compared to control, however, the knowledge only arm was $660 less expensive, the behavioral skills arm was $813 more expensive, and the combined arm was $3,630 less expensive than the control arm to achieve a 0.6% decrease in HbA1c. Conclusions: Combined with the clinical findings, these results suggest telephone-delivered education and behavioral skills training is a cost-effective way to improve glycemic control. In particular, the combined knowledge and skills training intervention arm resulted in costs $3,600 lower than the control, and dropped HbA1c by 0.6%, achieving a clinically significant change for lower cost. Disclosure L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc.. C. Dismuke: None. C. Eiler: None. R.J. Walker: None.

Reducing racial/ethnic tobacco cessation disparities via cognitive behavioral therapy: Design of a dualsite randomized controlled trial

Racial/ethnic disparities in tobacco cessation are such that U.S. minorities have greater difficulty quitting compared to White non-Hispanics. Group differences in distress (i.e., perceived stress and depressive symptoms) may contribute to cessation disparities. The allostasis model of health suggests that the toll of chronic stress experienced by racial/ethnic minorities may lead to dysregulation of the physiological stress system and drug use. Previous research suggests that group cognitive behavioral therapy (CBT) for tobacco cessation addresses distress as a modifiable mechanism and has the potential to reduce/eliminate disparities. The present study is a dualsite randomized controlled trial aimed at evaluating the efficacy of group CBT in eliminating racial/ethnic differences in smoking cessation and distress. The study utilizes a [2 (intervention: group CBT or group general health education [GHE]) × 3 (race/ethnicity: African American/Black, Hispanic, White)] factorial design by randomizing 225 adult smokers from the community. Both interventions provide eight counseling sessions and eight weeks of nicotine patch therapy. Assessments occur at the end-of-therapy, and at 3-, 6-, and 12-months. Generalized longitudinal mixed modeling will be used to test our primary abstinence outcome, biochemically-confirmed 7-day point prevalence abstinence at 12-months. We hypothesize that group CBT will reduce or eliminate racial/ethnic differences in perceived stress, depressive symptoms, and smoking cessation compared to group GHE. We also hypothesize that reductions in physiological distress, assessed by salivary cortisol, will mediate racial/ethnic group differences in smoking cessation, particularly among racial/ethnic minorities. This study has implications for eliminating disparities in psychosocial factors related to tobacco use and cessation.Trial registration: Clinicaltrials.govNCT02511236. Registered on July 27, 2015.