Long-term Positive Change Research Articles

Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II

ABSTRACTAims: To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP). Method: A consecutive selection of 40 children, ages 4–12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I–II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections. 3D gait analysis, goal-attainment scaling, and body function assessments were performed before and at 3, 12, and 24 months after initial injections. Results: A significant but clinically small long-term improvement in gait was observed. Plantarflexor spasticity was reduced after three months and remained stable, while passive ankle dorsiflexion increased after 3 months but decreased slightly after 12 months. Goal-attainment gradually increased, reached the highest levels at 12 months, and levels were maintained at 24 months. Conclusion: The treatments’ positive effect on spasticity reduction was identified, but did not relate to improvement in gait or goal-attainment. No long-term positive change in passive ankle dorsiflexion was observed. Goal attainment was achieved in all except four children. The clinical significance of the improved gait is unclear. Further studies are recommended to identify predictors for positive treatment outcome.

A randomised controlled trial of an exercise plus behaviour change intervention in people with multiple sclerosis: the step it up study protocol.

BackgroundExercise has consistently yielded short-term, positive effects on health outcomes in people with multiple sclerosis (MS). However, these effects have not been maintained in the long-term. Behaviour change interventions aim to promote long-term positive lifestyle change. This study, namely, “Step it Up” will compare the effect of an exercise plus Social Cognitive Theory (SCT)-based behaviour change intervention with an exercise plus control education intervention on walking mobility among people with MS.Methods/designPeople with a diagnosis of MS who walk independently, score of 0–3 on the Patient Determined Disease Steps, who have not experienced an MS relapse or change in their MS medication in the last 12 weeks and who are physically inactive will be randomised to one of two study conditions. The experimental group will undergo a 10-week exercise plus SCT-based behavioural change intervention. The control group will undergo a 10-week exercise plus education intervention to control for contact. Participants will be assessed at weeks 1, 12, 24 and 36. The primary outcome will be walking mobility. Secondary outcomes will include: aerobic capacity, lower extremity muscle strength, participant adherence to the exercise programme, self-report exercise intensity, self-report enjoyment of exercise, exercise self-efficacy, outcome expectations for exercise, goal-setting for exercise, perceived benefits and barriers to exercise, perceptions of social support, physical and psychological impact of MS and fatigue. A qualitative evaluation of Step it Up will be completed among participants post-intervention.DiscussionThis randomised controlled trial will examine the effectiveness of an exercise plus SCT-based behaviour change intervention on walking mobility among people with MS. To this end, Step it Up will serve to inform future directions of research and clinical practice with regard to sustainable exercise interventions for people with MS.Trial registrationClinicalTrials.gov, NCT02301442

Make do, or mend? EU security provision in complex conflicts: the Democratic Republic of Congo

This article assesses whether the EU contributes to long-term positive change in societies emerging from violent conflict, helping them ‘mend’ or whether it simply encourages societies to ‘make do’ with the status quo. To do so, the article focuses on two of the principles found in the Treaty, peace and justice for human rights violations. It examines how the EU translates the principles of peace and justice into policy and puts them into practice by analyzing EU engagement in peace mediation, transitional justice, and security sector reform in general and through in-depth examination of EU engagement in the Democratic Republic of Congo. It questions the prevailing discourse that greater inter-institutional coherence would improve EU security provision and considers whether and how the EU prioritizes between peace and justice. The article finds that principles may be translated into policy and put into practice, and practice is often ahead of policy. But this is uneven within as well as across the institutions. Greater coherence between principle, policy, and practice, rather than between institutions, would improve EU security provision and enable prioritization. If the EU settles for making do, it undermines its considerable potential to contribute to long-term solutions to complex conflicts.

Against the tide: Recent diversity increase enhances resource use in a coastal ecosystem

Biodiversity losses in marine, terrestrial, and freshwater ecosystems have raised concerns about the maintenance of sustainable ecosystem functions and services (“biodiversity crisis”). A positive diversity—productivity relationship has previously been supported by theoretical models, and by laboratory and field experiments in a variety of ecosystems including unicellular microbial communities. Here we show an increasing biomass yield of aquatic primary producers at the ecosystem scale, paralleled by a long‐term positive biodiversity change, which contrasts with the trend of global biodiversity loss. The implied direct long‐term biodiversity effect on ecosystem functioning was an increase of phytoplankton biomass per unit limiting nutrient by a factor of 1.2 to 1.4. Changes in diversity of microorganisms may have immediate implications for essential ecosystem processes like productivity and biomass yield. Diversity‐driven enhancement of resource use in primary production can lead to increased food web yields, but they also can cause a stoichiometric mismatch between autotrophs and primary consumers. Unveiling the functional roles of planktonic biodiversity therefore has essential implications both for global change and for harvestable marine resources.

Using Organizational Policy to Create a Positive and Supportive Environment: An Example of Women and HIV Prevention

Making meaningful contact with marginalized populations is a challenge that public health practitioners continually face. Vulnerable populations that are targeted in health promotion initiatives are frequent users of community-based organizations, making these agencies an important point of contact. The relationships community-based organizations have with vulnerable populations are under-utilized for developing and disseminating health messages. Using the example of women and HIV prevention, this paper argues that amending policy within community organizations can be an effective method to improve access to health information and resources, and elicit positive change. Furthermore, greater collaboration and knowledge exchange between public health agencies and community service providers will ensure organizations have the capacity to implement evidence-based policies that foster an environment where long-term positive change can occur.

Context, culture and (non-verbal) communication affect handover quality

BackgroundTransfers of care, also known as handovers, remain a substantial patient safety risk. Although research on handovers has been done since the 1980s, the science is incomplete. Surprisingly few interventions...

Is the authoritative parenting model effective in changing oral hygiene behavior in adolescents?

This study examined whether the authoritative parenting model (APM) is more effective than conventional approaches for changing adolescent oral hygiene behavior. A total of 247 adolescents were recruited using a cluster random-sampling method. Subject groups were randomly allocated into an intervention group (APM-based interventions), a Control Group 1 (conventional dental education and behavior modification) or a Control Group 2 (conventional behavior modification). The results were assessed after 3 and 12 months. Oral hygiene level was assessed as percent dental plaque and the ratio of plaque percent change (RPC). At the 3-month follow-up, there were significant differences among the groups; the APM group had the largest decrease in plaque levels (24.5%), Control Group 1 showed a decrease in plaque levels of 15.4% and Control Group 2 showed an increase in plaque levels of 2.8%. At the 12-month follow-up, an improvement was observed in all groups, but there were no statistically significant differences among the groups. In the short term, the intervention based on the APM was more effective in changing adolescent oral hygiene behavior compared with the conventional approaches. The reasons for long-term positive change after discontinued interventions in control groups need to be explored in future studies.

Thinking About Youth Poverty Through the Lenses of Chronic Poverty, Life-Course Poverty and Intergenerational Poverty

Youth poverty is a serious global problem, not least because of the large numbers of youth and children living in absolute poverty in developing countries. In many contexts, youth are relatively likely to experience poverty because of age-based discrimination and the uncertainties and dynamism surrounding the transition from childhood to adulthood. But it is not always the case that youth are disproportionately poor. The relative extent of youth poverty in a given context depends on the interaction of many different factors. This paper draws upon work by the Chronic Poverty Research Centre to argue that the related concepts of chronic poverty, life-course poverty and intergenerational poverty are useful for understanding youth poverty. First, analysis of the causes of chronic poverty can help locate the relative position of different groups of the poor and facilitate policy prioritisation. Second, life-course events (e.g. leaving school, starting work, having children) play a significant role in shaping vulnerability to poverty. These 'life events' are more likely to occur during particular 'life stages', but stage is only partly related to age. Third, it is important to take an intergenerational perspective because poverty experienced in youth is often linked to parental poverty and childhood deprivation, and - like poverty in childhood or old age - can have implications across the life-course of a young person and that of her/his household. At the same time that youth may not always be among the poorest or the most vulnerable, adolescence and young adulthood may be the period, after early childhood, in which anti-poverty interventions have the most potential for long-term positive change. Constructing and analysing developing country panel datasets (quantitative and qualitative) can foster the development of suitable interventions, appropriately timed.

In search of durable positive psychology interventions: Predictors and consequences of long-term positive behavior change

A number of positive psychology interventions have successfully helped people learn skills for improving mood and building personal resources (e.g., psychological resilience and social support). However, little is known about whether intervention activities remain effective in the long term, or whether new resources are maintained after the intervention ends. We address these issues in a 15-month follow-up survey of participants from a loving-kindness meditation intervention. Many participants continued to practice meditation, and they reported more positive emotions (PEs) than those who had stopped meditating or had never meditated. All participants maintained gains in resources made during the initial intervention, whether or not they continued meditating. Continuing meditators did not differ on resources at baseline, but they did show more PE and a more rapid PE response to the intervention. Overall, our results suggest that positive psychology interventions are not just efficacious but of significant value in participants’ real lives.

In search of durable positive psychology interventions: Predictors and consequences of long-term positive behavior change

In search of durable positive psychology interventions: Predictors and consequences of long-term positive behavior change

Using message framing to achieve long-term behavioral changes in persons with diabetes

This study examines how the framing of educational information affects changes in health-related knowledge, attitudes, and behavior. Patients with diabetes viewed either a gain- or a loss-framed informational video about proper foot care and its importance for the prevention of health-threatening problems. The gain-framed messages sustained long-term positive behavioral change. Regression analyses showed that changes in attitudes were predicted by changes in knowledge and that both framing and attitudes were predictors of long-term behavior. This study is important for nurses and certified diabetes educators in that it demonstrates that gain-framed messages are effective in sustaining health-promoting behavior.

Long-term consequences of the Alzheimer's caregiver role: a qualitative analysis.

A qualitative analysis was performed on responses of 51 participants to open-ended questions about the experience of being family caregivers for a loved one affected by Alzheimer's disease. Participants had been in the caregiver role for at least eight years. Results indicated a pattern of adapting successfully or unsuccessfully to the caregiver role, experiencing initial caregiver burden, finding relief in social support when available, and long-term distress or long-term positive change. Memories and feelings were strong about individuals and institutions that had been helpful or indifferent many years earlier as the caregivers struggled to cope with their unplanned predicament.

Therapeutic community dropouts: criminal behavior five years after treatment.

Two hundred and two male dropouts, mainly heroin abusers averaging 3 to 6 years out of treatment, were sampled from the 1970-1971 Phoenix House admissions by race and time in program (less than 1 month to more than 2 years). Criminal justice arrest records were compared between three pre- and all posttreatment years. Percent and rate of arrest declined significantly in followup. Magnitude of reductions was uniform across race and legal status, varied by age, but increased systematically by time in program. Results replicated and extended earlier findings, confirming long-term positive change in criminal behavior associated with length of stay in the therapeutic community.