Multifaceted Intervention Program Research Articles

초고령자의 삶의 만족도와 우울에 영향을 미치는 라이프스타일 요인: 고령화연구패널조사(KLoSA) 분석

Objective: This study examined the correlation between life satisfaction, depression, and lifestyle (physical activity, eating habits, participation frequency, and participation diversity) among the oldest-old in Korea, and analyzed lifestyle factors that affect life satisfaction and depression. Methods: The independent variables analyzed in this study were physical activity, regular eating habits, participation frequency, and participation diversity as lifestyle factors, and dependent variables were life satisfaction and depression. For analysis, correlation analysis and multiple regression analysis were performed through SPSS. Results: As a result of multiple regression analysis, it was confirmed that participation frequency (t = 6.262, p < 0.001) and regular diet (t = 4.627, p < 0.001) had statistical significance as factors influencing life satisfaction, and depression was identified as a factor influencing participation frequency (t = 6.540, p < 0.001) and regular diet (t = 4.061, p < 0.001), which had statistical significance. Conclusion: This study identified lifestyle factors affecting life satisfaction and depression among the oldest-old in Korea. Therefore, based on the results of this study, a lifestyle-based multifaceted intervention program is needed to improve life satisfaction and depression in the oldest-old in Korea.

689. Significant Improvement in Hand Hygiene Compliance and Decline in Clostridioides difficile Infections with Implementation of Infection Prevention Interventions

Abstract Background Per CDC, C. difficile is an urgent microbial threat. Despite use of CDC diagnostic criteria, 2-step testing protocol and antimicrobial stewardship interventions limiting broad spectrum antimicrobial use, we witnessed an increase in infections in 2022, therefore, additional interventions were implemented. Methods A multifaceted QI intervention program to improve IPC (infection prevention and control) practices was implemented in July 2022 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Interventions included: auditing and real time observations for health care personnel (HCP) hand hygiene compliance; monitoring soap/sanitizer usage; educational interventions including posters posted throughout the hospital emphasizing hand hygiene, “A clean in and clean out” approach and contact precautions reminders posted in patient rooms/nursing stations, weekly nursing huddles focused on nursing and ancillary staff education, provider counseling and continued coaching. Pre-intervention period (P1: 1/10/2021- 6/30/2022) was compared with Intervention period (P2: 07/01/2022-3/31/2023) for hand hygiene compliance and C. difficile infection rates. Results Overall adequate hand hygiene compliance rates for all health care personnel (HCP) increased from 71% during P1 to 85% during P2 (P< 0.05). All categories of HCP showed a significant improvement in hand hygiene compliance from P1 to P2, with rates for physicians increasing from 74% to 92% (p< 0.05), nurses from 68% to 94% (p< 0.001); nurse practitioners/physician assistants from 75% to 90% (p< 0.05), ancillary staff (chaplain, medical technicians, social workers) from 60% to 89% (p< 0.01)]. Hand hygiene product use increased significantly and soap usage alone increased from 45% to 75% in P2 (p< 0.05). C. difficile infections declined significantly from a mean of 1.9 infections per 1000 patient days during P1 to 0.5 infections per 1000 patient days during P2 (p< 0.001); SIR (Standardized infection ratio) decreased from 1.14 during P1 to 0.4 during P2 (p< 0.01). No C. difficile related mortality was observed. Conclusion With implementation of multifaceted IPC interventions, significantly improved hand hygiene rates and a significant decline in C. difficile infections were observed. Disclosures All Authors: No reported disclosures

Aspects of Program Engagement in an Online Physical Activity Intervention and Baseline Predictors of Engagement.

Participant engagement in an online physical activity (PA) intervention is described and baseline factors related to engagement are identified. Longitudinal Study Within Randomized Controlled Trial. Online/Internet. Primary care patients (21-70years). ActiveGOALS was a 3-month, self-directed online PA intervention (15 total lessons, remote coaching support, and a body-worn step-counter). Engagement was measured across six outcomes related to lesson completion (total number and time to complete), coach contact, and behavior tracking (PA, sedentary). Self-reported baseline factors were examined from seven domains (confidence, environment, health, health care, demographic, lifestyle, and quality of life). General linear and nonlinear mixed models were used to examine relationships between baseline factors and engagement outcomes within and across all domains. Seventy-nine participants were included in the sample (77.2% female; 74.7% white non-Hispanic). Program engagement was high (58.2% completed all lessons; PA was tracked ≥3 times/week for 11.3 ± 4.0weeks on average). Average time between completed lessons (days) was longer than expected and participants only contacted their coach about 1 of every 3weeks. Individual predictors related to health, health care, demographics, lifestyle, and quality of life were significantly related to engagement. Examining multiple aspects of engagement and a large number of potential predictors of engagement is likely needed to determine facilitators and barriers for high engagement in multi-faceted online intervention programs.

The sustained and generalized effects of multifaceted treatment on unsignalized pedestrian crossings

IntroductionOne method of improving pedestrian safety is through a multifaceted intervention program to enhance awareness and enforcement of pedestrian right-of-way laws, which has been shown to significantly improve driver behavior toward pedestrians at unsignalized crosswalks. An intervention using this approach was performed in Saint Paul, Minnesota in 2018. However, the sustainability of the intervention's positive effects on yielding, as well as the potential contributing role of police enforcement and infrastructure such as crosswalk markings, are not as well understood. MethodsThe present study provides a reassessment of driver yielding to pedestrians at unsignalized crosswalks in Saint Paul three years after the original intervention, as well as a comparison with unsignalized crosswalks in neighboring Minneapolis, the latter of which has not received any form of high visibility enforcement. The methodology employed the use of staged crossings and natural pedestrian observations at selected unsignalized crosswalk sites. ResultsAn analysis of driver yielding found that there was a sustained improvement in driver yielding in the reassessment period at generalized non-treated sites in Saint Paul in the final phase of the 2018 intervention, compared to the original baseline pre-treatment measures. Second, comparisons between Minneapolis baseline and original 2018 Saint Paul baseline showed significantly higher yielding averages for Saint Paul, which had prior iterations of high visibility enforcement. ConclusionsThe present research indicates long-term benefits to employing a multi-method intervention to improve pedestrian safety at unsignalized crosswalks and suggests there are moderate benefits to including high visibility enforcement as a component of these programs.

Strengthening COVID-19 pandemic response coordination through public health emergency operations centres (PHEOC) in Africa: Review of a multi-faceted knowledge management and sharing approach, 2020-2021.

The coronavirus disease 2019 (COVID-19) pandemic disrupted health security program implementation and incremental gains achieved after the West African Ebola outbreak in 2016 across Africa. Following cancellation of in-person events, a multi-faceted intervention program was established in May 2020 by Africa Centres for Disease Control and Prevention (Africa CDC), the World Health Organisation, and partners to strengthen national COVID-19 response coordination through public health emergency operations centres (PHEOC) utilizing continuous learning, mentorship, and networking. We present the lessons learned and reflection points. A multi-partner program coordination group was established to facilitate interventions' delivery including webinars and virtual community of practice (COP). We retrieved data from Africa CDC's program repository, synthesised major findings and describe these per thematic area. The virtual COP recorded 1,968 members and approximately 300 engagements in its initial three months. Fifty-six webinar sessions were held, providing 97 cumulative learning hours to 12,715 unique participants. Zoom data showed a return rate of 85%; 67% of webinar attendees were from Africa, and about 26 interactions occurred between participants and facilitators per session. Of 4,084 (44%) participants responding to post-session surveys, over 95% rated the topics as being relevant to their work and contributing to improving their understanding of PHEOC operationalisation. In addition, 95% agreed that the simplicity of the training delivery encouraged a greater number of public health staff to participate and spread lessons from it to their own networks. This just-in-time, progressively adaptive multi-faceted learning and knowledge management approach in Africa, with a consequential global audience at the peak of the COVID-19 pandemic, served its intended audience, had a high number of participants from Africa and received greatly satisfactory feedback.

Improvements in musculoskeletal symptoms, mental workload and mental fatigue: Effects of a multicomponent ergonomic intervention among call center workers

Call center workers are highly susceptible to work-related musculoskeletal disorders (WRMSDs) as well as mental stress. Nonetheless, there has been a surprising paucity in the body of the research regarding interventions among call center workers. The purpose of this paper is to investigate the effectiveness of a multicomponent ergonomic intervention program on mental workload, mental fatigue and WRMSDs of call center employees. A non-randomized interventional study with a single group pretest-posttest design was conducted among 84 call center workers of a private telecommunication company in the city of Tehran, Iran. At the baseline, data regarding WRMSDs prevalence, mental workload and mental fatigue were collected by means of standard Nordic, NASA-TLX and SOFI questionnaires, respectively. Then, subjects participated in a multifaceted intervention program including comprehensive office ergonomic training, work layout improvement, supervised on-site face to face visits, and provision of quality break time encompassing regular exercise program. Follow-up assessment was carried out after 6 months. After the intervention, prevalence of WMSDs in the neck (10%, P = 0.022), lower back (8.4%, P = 0.04), and knees (9.5%, P = 0.02) decreased significantly, while improvements in other body areas remained insignificant. Results also showed a significant decrease in overall score of mental demand (P = 0.000) as well as three of its subscales including performance (P = 0.02), effort (P = 0.001), and frustration (P = 0.025). Additionally, positive effect of the intervention was also observable on overall mental fatigue of call center workers (P = 0.016). As for its subscales, Lack of energy was reported to decrease meaningfully (P = 0.007) while lack of motivation did not change significantly (P = 0.240). Although the primary focus of many ergonomic interventions has remained to measure physical outcomes of the work place, our findings show that multicomponent interventions are indeed capable of boosting cognitive aspects of the work as well. The future studies should consider investigating such outcomes.

Impact of a 12-month multifaceted neurological physiotherapy intervention on gross motor function in women with Rett syndrome.

Rett syndrome is a rare genetic neurological syndrome that affects mostly females. The syndrome leads to severe impairments impacting all areas of the affected persons' life, including speech, mobility, eating, and breathing impairments. The most distinct symptoms include stereotyped hand movements, ataxia, and atrophy of the lower limbs, and signs of autism. According to the principle of convenience sampling, the quantitative research included five females diagnosed with Rett syndrome subject to their personalized goal oriented neurological physiotherapy. Changes in gross motor function were assessed by the Gross Motor Function Measure 88 and Rett syndrome Gross Motor Scale. It was found that the 12-month multifaceted neurological physiotherapy intervention had statistically significant improvements in both Gross Motor Function Measure 88 (p = 0.005) and Rett syndrome Gross Motor Scale (p = 0.012). Despite positive improvements, the absence of control group made it difficult for a comparative evaluation to determine what interventions had the best possible outcomes. The quantitative research demonstrates neuro-developmental treatment sessions, hippotherapy, hydrotherapy, physical therapy, a walking program, endurance exercises, active-assisted exercises, and coordination exercises, had a significant impact on improving gross motor function status. Current multifaceted intervention program leads to good improvement of gross motor skills above what can be expected from late motor deterioration.

A multilayered ergonomic intervention program on reducing musculoskeletal disorders in an industrial complex: A dynamic participatory approach

Work-related musculoskeletal disorders (WMSDs) are closely identified with common complaints in different workplaces. This study aimed to implement an intervention program through which ergonomic measures were dynamically localized in industry. An interventional study, including three basic layers, namely, training workshops, participatory ergonomics (PE), and workstation redesign was fulfilled in an Iranian steel manufacturing complex from 2017 to 2020. A steering committee (SC) was formed following several meetings held for clarification of the project to the management team. The SC members then attended four organized workshops managed by an ergonomics specialist. Afterwards, the basics of ergonomics were transferred to action groups. After developing ergonomic assessment tools, the ergonomic problems were prioritized and numerous positive changes were made by the action groups. The findings of the tailored checklists revealed a load of WMSDs risk factors. All the three layers of the program were implemented as initiated. Ergonomics training workshops were then held and significant differences were observed between the participants' pre/posttest mean scores in all workshops (p < 0.001). Moreover, PE measures were exercised at all levels of the organization inducing enthusiastic motivation of the workforce to consider ergonomic requirements in the workplace. Consequently, the workers' innovative ideas and the managerial support yielded diverse workstation redesigns due to a growth in either the workers' ergonomics awareness or participatory culture grounding. A multilayered ergonomic intervention was implemented in this study. In conclusion, a multifaceted long-term follow-up intervention program could be applied to enhance workers’ health status and to raise system productivity.

Design and implementation of a multifaceted injury prevention intervention in Bedouin children in southern Israel

BackgroundChild injury is prevalent in the Bedouin community of southern Israel, with higher injury rates compared with the general population. Bedouin children aged 0–4 were twice as likely as children...

Evaluation of an intervention to reduce child injury in Bedouin communities in Southern Israel

BackgroundChild injury is particularly prevalent in low socioeconomic populations and minorities. In Israel, Bedouin children exhibit high rates of injuries and death. A multifaceted community intervention to reduce injury in...

Predictive Model for the Quality of Life of Infertile Men

Purpose: This study explores factors influencing the quality of life of infertile men, and attempts to construct a structural model to predict their quality of life. Methods: Data was collected via questionnaires from 242 infertile male outpatients from 3 infertile clinics at general hospital urologist departments, with the subjects’ confidentiality was ensured. The self-reported questionnaires were collected for 7 months from February to August 2016 in the outpatient centers. The collected data was analyzed using SPSS/WIN 21.0 Program and Mplus 6.0 Program. Results: Hypothesis test of the quality of life as the endogenous variable identified infertility-related stress (β=-0.79, t=-9.41), depression (β=-0.20, t=-2.58), and spirituality (β=0.21, t=2.90) as statistically significant variables. Marital adjustment (β=-0.06, t=-0.69) and social support (β=-0.12, t=-1.79) were not statistically significant. The variables accounted for 84.1% of the variation. Conclusion: The results of the study show that infertility-related stress and depression have negative correlation, and spirituality has a positive correlation with infertile men’s quality of life. As such, there needs to be a development of practical and multi-faceted nursing intervention programs to control infertility-related stress and depression levels so as to sustain infertile men’s quality of life.

The feasibility of a Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: protocol for a non-randomised feasibility study

BackgroundA dementia diagnosis can prevent people from participating in society, leading to a further decline in cognitive, social and physical health. However, it may be possible for people with dementia to continue to live meaningful lives and continue to participate actively in society if a supportive psychosocial environment exists. Resilience theory, which focuses on strengthening personal attributes and external assets in the face of serious challenges, may provide a scaffold on which an inclusive multifaceted psychosocial supportive environment can be built. This protocol paper describes a study to determine the feasibility of conducting a multifaceted complex resilience building psychosocial intervention for people with dementia and their caregivers living in the community.MethodsThis is a non-randomised feasibility study. Ten participants with dementia and their primary caregivers living in the community will be recruited and receive the CREST intervention. The intervention provides (a) a 7-week cognitive stimulation programme followed by an 8-week physical exercise programme for people with dementia and (b) a 6-week educational programme for caregivers. Members of the wider community will be invited to a dementia awareness programme and GP practices to a dementia training workshop. Trained professionals will deliver all intervention components. Outcomes will assess the feasibility and acceptability of all study processes. The feasibility and acceptability of a range of outcomes to be collected in a future definitive trial, including economic measurements, will also be explored. Finally, social marketing will be used to map a route toward stigma change in dementia for use in a subsequent trial. Quantitative feasibility outcome assessments will be completed at baseline and after completion of the 15-week intervention while qualitative data will be collected at recruitment, baseline, during and post-intervention delivery.ConclusionThis feasibility study will provide evidence regarding the feasibility and acceptability of a comprehensive multifaceted psychosocial intervention programme for people with dementia and their caregivers (CREST). The results will be used to inform the development and implementation of a subsequent RCT, should the findings support feasibility.Trial registrationISRCTN25294519 Retrospectively registered 07.10.2019

Evaluating the effectiveness of a multi-faceted inpatient diabetes management program among hospitalised patients with diabetes mellitus

BackgroundDiabetes mellitus (DM) is one of the most common chronic diseases. Individuals with DM are more likely to be hospitalised and stay longer than those without DM. Inpatient hypoglycemia and hyperglycemia, which are associated with adverse outcomes, are common, but can be prevented through hospital quality improvement programs.MethodsWe designed a multi-faceted intervention program with the aim of reducing inpatient hypoglycemia and hyperglycemia. This was implemented over seven phases between September 2013 to January 2016, and covered all the non-critical care wards in a tertiary hospital. The program represented a pragmatic approach that leveraged on existing resources and infrastructure within the hospital. We calculated glucometric outcomes in June to August 2016 and compared them with those in June to August 2013 to assess the overall effectiveness of the program. We used regression models with generalised estimating equations to adjust for potential confounders and account for correlations of repeated outcomes within patients and admissions.ResultsWe observed significant reductions in patient-days affected by hypoglycemia (any glucose reading < 4 mmol/L: OR = 0.71, 95% CI: 0.61 to 0.83, p < 0.001), and hyperglycemia (any glucose reading > 14 mmol/L: OR = 0.84, 95% CI: 0.71 to 0.99, p = 0.041). Similar findings were observed for admission-level hypoglycemia and hyperglycemia. Further analyses suggested that these reductions started to occur four to 6 months post-implementation.ConclusionsOur program was associated with sustained improvements in clinically relevant outcomes. Our described intervention could be feasibly implemented by other secondary and tertiary care hospitals by leveraging on existing infrastructure and work force.

Multifaceted interventions for healthcare-associated infections and rational use of antibiotics in a low-to-middle-income country: Can they be sustained?

Transmission of infection between patients by health workers, and the irrational use of antibiotics are preventable causes for healthcare-associated infections (HAI) and multi-resistant organisms. A previous study implementing a hand hygiene campaign and antibiotic stewardship program significantly reduced these infections. Sustaining such interventions can be challenging. To evaluate whether there was a sustained effect of a multifaceted infection control and antibiotic stewardship program on HAI and antibiotic use 5 years after it began. A prospective evaluation study was conducted over 26 months (from February 2016 to April 2018) in a teaching hospital in Indonesia, 5 years after the implementation of an antibiotic stewardship and infection control program, which was successful when initially evaluated. All children admitted to the pediatric ICU and pediatric wards were observed daily. Assessment of HAI was made based on the criteria from the Centers for Disease Control and Prevention. Assessment of rational antibiotic use was based on the WHO Pocket Book of Hospital Care for Children. Multivariable logistic regression analysis was used to quantify the relationship between the HAI and the multifaceted intervention. We observed an increase in HAIs, from 8.6% (123/1419 patients) in the initial post-intervention period in 2011-2013 to 16.9% (314/1855) in the evaluation study (relative risk (RR) (95% CI) 1.95 (1.60 to 2.37)). After adjusting for potential confounders, we found that an increase in HAI in the evaluation period with adjusted OR 1.94 (95% CI 1.53 to 2.45). Inappropriate antibiotic use also increased, from 20.6% (182 of 882 patients who were prescribed antibiotics) to 48.6% (545/1855) (RR 2.35 (2.04 to 2.71)). Hand hygiene compliance also declined from 62.9% (1125/1789) observed moments requiring hand hygiene to 51% (1526/2993) (RR 3.33 (2.99 to 3.70)). Healthcare-associated infections and irrational use of antibiotics remain significant even after the implementation of a multifaceted infection control intervention and antibiotic stewardship program. There is a need for continuous input, ongoing surveillance and long-term monitoring of these interventions to sustain compliance and effectiveness and address problems as they emerge.

The application of evidence-based bundle approach to reduce surgical site infection in geriatric hip fracture patients: A single centre experience

Introduction: Surgical site infection (SSI) is associated with increased morbidity and mortality, prolongation on length of hospital stay and cost of community healthcare. In 2010 and 2012, our centre experienced an unexpectedly high rate of SSI in geriatric hip fracture patients with hemiarthroplasty done. A multifaceted intervention programme – ‘bundle approach’ – consisting of preoperative microbiological screening, perioperative measures and postoperative wound care was implemented. Method: Preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening was implemented. Intravenous vancomycin was given as prophylactic antibiotic of choice in those patients with positive MRSA screening. All patients will be bathed with chlorhexidine lotion 1 day before operation or on the day of operation. Standardized protocol of surgical site disinfection was implemented: a stringent first stage povidone-iodine disinfection, second stage waterproof extremity draping and sterile plastic sheet wrapping of non-surgical region and third stage ChloraPrep, followed by circumferential iodophor-impregnated plastic adhesive drape (‘Ioban’) covering the hip and thigh region. The surgical wound was dressed with Aquacel adhesive tape after wound closure. Results: The total numbers of infected cases were 17 from 2008 to 2012 and 9 from 2013 to 2018 (first quarter). The rates of infection were 7.02% from 2008 to 2012 and 3.16% from 2013 to 2018 (first quarter). There was a statistically significant reduction in the number of infected cases of hemiarthroplasty after the implementation of bundle approach ( p = 0.0411). Discussion: The bundle approach showed to achieve an effective and sustained decrease in SSI for the geriatric hip fracture patients.

The Effects of Multifaceted Ergonomic Interventions on Musculoskeletal Complaints in Intensive Care Units.

Working at intensive care units (ICUs) is considered a risk factor for developing musculoskeletal complaints (MSC). This study was conducted between January 2017 and June 2019 in two ICUs of a university hospital. It was designed as a pre- and post-assessment of the intervention group (IG) (N = 27) compared with a control group (CG) (N = 23) to determine the effects of a multifaceted ergonomics intervention program in reducing MSC. The IG (N: 35) received a multifaceted ergonomic intervention program, which was implemented by an ERGO team over an 18 month period. Four ergonomic interventions were planned as follows: individual level interventions such as training; stretching exercises and motivation meetings; administrative intervention such as a daily 10 min stretching exercises break; engineering interventions such as lifting and usage of auxiliary devices. The CG (N:29) did not receive any intervention. Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used to assess MSC in both groups. At the start of the intervention, both groups were similar concerning the number of visits to doctors due to MSC, the number of sick leave days, and total CMDQ scores (p > 0.05 for all). Two factor repeated ANOVA measures were performed for between-groups and within-group analyses. The mean of the initial CMSDQ total scores in both groups increased significantly in the 18th month (p < 0.001). However, the interaction effect of group and time (between and within factors) was not significant (p = 0.992). Work-related MSC is a common occupational health problem among nurses. This study showed that individual-level interventions are not likely to succeed in eliminating manual patient lifting by nurses. Our results suggested that interventions without administrative measures might have limited success

Factors that Influence Sleep among Residents in Long-Term Care Facilities.

Long-term care residents often experience sleep disturbances as they are vulnerable to a variety of physical, psychosocial, and environmental factors that contribute to sleep disturbances. However, few studies have examined the combined impact of multiple factors on sleep among long-term care residents. This study aimed to identify the factors that influence sleep efficiency and sleep quality based on a modified senescent sleep model. A total of 125 residents were recruited from seven long-term care facilities in South Korea. Sleep patterns and sleep quality were collected using 3-day sleep logs and the Minimal Insomnia Screening Scale for Korean adults (KMISS), respectively. The mean sleep efficiency was 84.6% and the mean score on sleep quality was 15.25. A multiple linear regression analysis showed that greater dependence in activities of daily living (ADL), higher pain, and light at night were related to lower sleep efficiency. Higher pain and fatigue, less activity time, noise and light at night, and lower nighttime staffing levels were related to poorer sleep quality. This study highlights that psychosocial and environmental factors as well as physical factors could influence sleep for long-term care residents. Our findings could be foundational evidence for multi-faceted sleep intervention program development in long-term care settings.

A Mobile App (mHeart) to Detect Medication Nonadherence in the Heart Transplant Population: Validation Study

BackgroundMedication nonadherence in heart transplant recipients (HTxR) is related to graft loss and death. mHeart is a mobile app that uses electronic patient-reported outcome measures (ePROMs) to identify and manage medication nonadherence in the outpatient heart transplant (HTx) population.ObjectiveThe study primarily aimed to validate mHeart to measure medication nonadherence in early stage HTxR by assessing the psychometric properties of ePROMs. The secondary aims were to (1) measure patient satisfaction with the mHeart tool and its usability and (2) explore the impact of a theory-based treatment on medication nonadherence rates to determine its scalability to larger research.MethodsA prospective study was conducted in the outpatient clinic of a tertiary hospital. All consecutive early stage HTxR (<1.5 years from HTx) were included. The ePROM psychometric properties assessed were validity, reliability, responsiveness, interpretability, and burden. ePROMs comprised the 4-item Morisky-Green-Levine questionnaire and an adapted version of the Haynes-Sackett questionnaire. The Simplified Medication Adherence Questionnaire (SMAQ) was also applied on-site. Three consecutive medication nonadherence assessments were performed by a transplant pharmacist. To improve medication nonadherence, theory-based interventions were delivered in a 1-month period. Patient satisfaction was assessed by a semiquantitative Web-based survey at the end of the study.ResultsWe included 31 early stage HTxR (age: mean 54 years, SD 12 years), and 71% (22/31) of them were men. The HTxR were taking a mean 13 (SD 4; range 7-18) drugs per day. A total of 42% (13/31) of patients were unaware of the consequences of medication nonadherence, and 39% (12/31) of patients were nonadherent to immunosuppressive treatment. The content validity measure showed excellent levels of expert panel agreement for the Haynes-Sacket (14/14, 100%) and Morisky-Green-Levine (13/14, 93%) questionnaires. SMAQ and Morisky-Green-Levine ePROMs showed similar measurement domains (convergent validity, phi=0.6, P<.001), which, as expected, differed from Haynes-Sackett ePROMs (divergent validity, phi=0.3, P=.12). Reliability assessment revealed a very strong association between ePROM and on-site PROMs (phi>0.7, P<.001). Reproducibility was moderate (Haynes-Sackett κ=0.6, P<.002) or poor (Morisky-Green-Levine κ=0.3, P=.11) because of unexpected improved medication adherence rates during the test-retest period. According to responsiveness, the theory-based multifaceted intervention program improved medication nonadherence by 16% to 26% (P<.05). A burden analysis showed that ePROMs could potentially overcome traditional on-site limitations (eg, automatic recording of ePROM responses in the hospital information system). The mean score for overall patient satisfaction with the mHeart approach was 9 (SD 2; score range: 0-10). All 100% (29/29) of patients surveyed reported that they would recommend the mHeart platform to other HTxR.ConclusionsePROMs adhered to the quality standards and successfully identified medication nonadherence in the HTx population, supporting their widespread use. The theory-based intervention program showed a promising improvement in medication adherence rates and produced excellent patient satisfaction and usability scores in HTxR.

Impact on Physical Fitness of the Chinese CHAMPS: A Clustered Randomized Controlled Trial.

Background: School physical activity (PA) policy, physical education curriculum, teacher training, knowledge of physical fitness, and parental support are among the key issues underlying the declining trend of physical fitness in children and adolescents. The Chinese CHAMPS was a multi-faceted intervention program to maximize the opportunities for moderate and vigorous physical activity (MVPA), and increase physical fitness in middle school students. The purpose of the study was to test whether the levels of modification in school physical education policy and curriculum incrementally influenced the changes in cardiorespiratory fitness and other physical fitness outcomes. Methods: This 8-month study was a clustered randomized controlled trial using a 2 × 2 factorial design. The participants were 680 7th grade students (mean age = 12.66 years) enrolled in 12 middle schools that were randomly assigned to one of four treatment conditions: school physical education intervention (SPE), afterschool program intervention (ASP), SPE+ASP, and control. Targeted behaviors of the Chinese CHAMPS were the student’s sedentary behavior and MVPA. The study outcomes were assessed by a test battery of physical fitness at the baseline and posttest. Sedentary behavior and MVPA were measured in randomly selected students using observations and accelerometry. Results: The terms contrasting the pooled effect of SPE, ASP, and SPE+ASP vs. Control, the pooled effect of SPE and SPE+ASP vs. ASP only, and the effect of SPE+ASP vs. ASP on CRF and other physical fitness outcomes were all significant after adjusting for covariates, supporting the study hypothesis. Process evaluation demonstrated high fidelity of the intervention in the targeted students’ behaviors. Conclusions: Chinese CHAMPS demonstrated the impact of varying the amount of MVPA and vigorous physical activity (VPA) on the physical fitness in middle school students in support of the need to increase the opportunity for PA in schools and to introduce high-intensity exercises in school-based PA programs. Modification of school policy, quality of physical education curriculum, and teacher training were important moderators of the improvement in physical fitness. (Trial registration: ChiCTR-IOR-14005388, the Childhood Health; Activity and Motor Performance Study).

Nutrition in contemporary South Africa

In South Africa, both under- and over-nutrition exist. At national level, more than half of the females are either overweight or obese, while children suffer from under-nutrition. Childhood malnutrition starts early in life, with the first two years being the most vulnerable period. Chronic malnutrition (as indicated by the prevalence of stunting) is a bigger problem than acute malnutrition (as indicated by the prevalence of wasting). Stunted children have a higher risk for being overweight. At national level, 33.3% of preschool children are vitamin A deficient, 21.4% are anaemic and 5.0% suffer from iron deficiency anaemia. Prevalence figures for childhood malnutrition differ between and within provinces. South African children consume a maizebased diet that is inadequate in energy and of low nutrient density. Inadequate intake of micronutrients starts during infancy. Strategies to address micronutrient malnutrition include high-dose vitamin A supplementation, food fortification, biofortification and dietary diversification. The availability of a greater variety of nutritious foods at community and household level can be increased through mixed cropping, the introduction of new crops, the promotion of underexploited traditional food crops, and home-gardens. A broad multifaceted comprehensive health intervention programme is needed to address childhood malnutrition.Keywords: nutritional status, adults, children, dietary diversification, South Africa