Multi-strategy Interventions Research Articles

RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice

BackgroundMany people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies.MethodsDesign3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. Setting: primary care general practices in southeast Queensland, Australia. Population: adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. Intervention: RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. Outcome measures: the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. Secondary outcomes: at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. Sample size: 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity).DiscussionThe RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients.Trial registrationANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.

Depression and Alcohol Use Disorder Co-Morbidity among Undergraduate Students in University of Port Harcourt, Nigeria

Background: Vulnerable developmental stage is encountered by university undergraduate students, where substantial changes happen in their body, brain, environment and socialization. This may result to increased vulnerability to develop addiction, alcohol use disorder and mental health disorders. Alcohol use disorderand Depression both pose problems in public health.
 Objectives: To determine the prevalence and the socio-demographic correlates of alcohol use disorder and depression co-morbidity among undergraduate.
 Methods: A cross-sectional study was conducted in the Lulu Briggs Health Centre of the University of Port Harcourt. Systematic sampling technique was used to recruit 420 respondents.Validated tools of Alcohol Use disorder Identification Inventory (AUDIT) and Patient Health Questionnaire (PHQ-9)were used to obtain information on depression and alcohol use disorder respectively from each of the respondent.
 Results: The mean age of the respondents was 23.59 (±5.2) years. A total of128 (30.5%) had alcohol use disorder, 205 (48.8%) had depression, and 22.4% (n=94) had co-morbid depression and alcohol use disorder. There was no significant relationship between socio-demographic findings and co-morbidity of depression and alcohol use disorder.
 Conclusion: About 2 in10 undergraduates experience co-morbidity of depression and alcohol use disorder. Multi-strategy interventions comprising ofpolicyand educationaltactics to address these problems are advocated.

Population- and Community-Based Interventions to Prevent Suicide.

Background: Suicide is estimated to account for 1.4% of deaths worldwide, making it among the leading causes of premature death. Public health approaches to reduce suicide have the potential to reach individuals across the spectrum of suicide risk. Aims: To review the effectiveness of newer community-based or population-level suicide prevention strategies. Methods: We conducted a systematic review of literature published from January 2010 to November 2020 to evaluate the effectiveness of community- and population-level interventions. The US Center for Disease Control framework was used for grouping studies by strategy. Results: We included 56 publications that described 47 unique studies. Interventions that reduce access to lethal means, implement organizational policies and culture in police workplace settings, and involve community screening for depression may reduce suicide deaths. It is unclear if other interventions such as public awareness and education campaigns, crisis lines, and gatekeeper training prevent suicide. Evidence was inconsistent for community-based, multistrategy interventions. The most promising multistrategy intervention was the European Alliance Against Depression. Limitations: Most eligible studies were observational and many lacked concurrent control groups or adjustment for confounding variables. Conclusions: Community-based interventions that may reduce suicide deaths include reducing access to lethal means, implementing organizational policies in workplace settings, screening for depression, and the multistrategy European Alliance Against Depression Program. Evidence was unclear, inconsistent, or lacking regarding the impact of many other single- or multistrategy interventions on suicide deaths.

Predictors of cancer-related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy.

Breast cancer is the most common diagnosis and the leading cause of cancer death among women worldwide and ranks first among Asian and Taiwanese women. Cancer-related fatigue (CRF) affects patients' functioning significantly. The aim of this study was to examine changes in cancer-related fatigue (CRF) and related factors among women with breast cancer undergoing a single chemotherapy, and to identify predictors of CRF's change over the course of the chemotherapy cycle. Four self-report questionnaires were administered to assess CRF, sleep quality, depression and anxiety, and symptom distress. Heart rate variability (HRV) was assessed to evaluate autonomic nervous system activation related to CRF. Data were collected four times: (1) before initiation of the single chemotherapy cycle (T0), (2) after completion of the single cycle (T1), (3) 1week post-chemo (T2), and (4) 3weeks post-chemo (T3). Repeated measurement of variance and generalized estimating equations (GEE) were conducted to estimate the trajectories and predictors. One-hundred women with breast cancer (mean age 50.4 ± 9.42) participated. CRF (F=7.46), sleep quality (F=2.74), symptom distress (F=9.99), anxiety (F=5.72), and depression (F=4.14) varied significantly over the single cycle of chemotherapy (p < .001), which the trajectories showed exacerbating at T2. HRV indicated a higher variation only on the day of injection (T0, T1). Results of the GEE revealed that anxiety, depression, and symptom distress were predictors of CRF's change over the single cycle of chemotherapy. CRF worsens at 1week after a chemotherapy injection among Taiwanese women with breast cancer. Based on the risk predictors in CRF that included anxiety, depression, and symptom distress, multistrategy CRF-alleviating interventions should be provided prior to chemotherapy and targeted at the most disturbed period, that is, 1week after injection.

Women's understanding of economic abuse in North-Western Tanzania.

Introduction:Economic abuse is a form of intimate partner violence that still lacks a clear conceptualization and therefore is often overlooked next to physical, sexual and psychological abuse. While existing categorizations recognize economic intimate partner violence as economic control, economic exploitation and employment sabotage, current measurements of economic abuse rarely capture all its forms, and the issue has not been widely explored in low- and middle-income country settings.Methods:We conducted in-depth interviews with 18 women in Mwanza, Tanzania to understand local perceptions and experiences of economic intimate partner violence. We used a thematic analysis approach.Results:Our study illustrates the complexity of economic abuse as a unique form of intimate partner violence, with women experiencing economic exploitation, employment sabotage, economic control and male economic irresponsibility. Gender norms and expectations actively played a key role in furthering abusive economic behaviour as women attempted to generate their own income and participate in financial decisions. Women’s constructs and reactions to economic abuse diverged sharply from the traditional marital expectations of dutifully accepting male control and the men being the main breadwinners in the family. Despite it being widespread, women did not find economic abuse acceptable.Conclusion:The results highlight that economic abuse is a complex issue and that more research on the pathways and manifestations of economic abuse globally would be beneficial. Existing measurement tools should be widened to address all dimensions of economic abuse. Addressing economic abuse will require multi-strategy interventions, working at the individual and community-level to address gender roles and masculinity norms, working with both men and women.

Assessing the Effectiveness of Cancer Screening Interventions Targeting Appalachian Populations: A Systematic Review.

Appalachian residents have higher cancer prevalence and invasive cancer incidence in almost all cancer types relative to non-Appalachian residents. Public health interventions have been carried out to increase preventive cancer screening participation. However, no studies have evaluated the effectiveness of existing interventions targeting cancer screening uptake in this high-risk population. The main objective of this study is to assess the effectiveness of interventions aimed at increasing uptake and/or continuing participation in screened cancers (breast, cervical, colorectal, lung, and prostate) in Appalachia. We conducted a systematic review of electronic databases and gray literature using a combination of MeSH and free-text search terms related to breast, cervical, colorectal, lung, and prostate cancer; mass screening; health promotion; and Appalachia. We identified 3,014 articles of which 15 articles were included. We assessed methodological quality using validated tools and analyzed findings using narrative synthesis. Fifteen studies reported uptake and/or continued participation in screening interventions; these focused on cervical (n = 7), colorectal (n = 5), breast (n = 2), and lung (n = 1) cancers in Appalachia. Interventions included diverse components: mass media campaigns, community outreach events, community health workers, interpersonal counseling, and educational materials. We found that multi-strategy interventions had higher screening uptake relative to interventions employing 1 intervention strategy. Studies that targeted noncompliant populations and leveraged existing community-based organization partnerships had a substantial increase in screening participation versus others. There is an urgent need for further research and implementation of effective cancer prevention and screening interventions to reduce disparities in cancer morbidity and mortality in Appalachian populations.

Are primary/elementary school-based interventions effective in preventing/ameliorating excess weight gain? A systematic review of systematic reviews.

This systematic review of systematic reviews addresses a current gap in evidence by synthesizing findings relating to weight management interventions set entirely in primary/elementary schools targeting, diet, and/or physical activity as key strategies. Eight databases were searched for systematic reviews of trials of school-based interventions targeting children aged 4 to 12 years that looked at biometric and behavioral outcomes. From the 10 selected systematic reviews, we found that interventions designed to promote physical activity or reduce sedentary behavior were most effective for weight loss. Interventions designed to improve diet and nutrition had a small effect on behavioral and cognitive outcomes, and these outcomes could be enhanced through the use of experiential learning. The most effective interventions involved a range of stakeholders in the development process and included parents and families in implementation. This systematic review of systematic reviews offers evidence-based guidance for the development and implementation of multistrategy weight-management interventions in primary/elementary schools.

Effectiveness of capacity building interventions relevant to public health practice: a systematic review

BackgroundThis systematic review assessed the effectiveness of capacity building interventions relevant to public health practice. The aim is to inform and improve capacity building interventions.MethodsFour strategies were used: 1) electronic database searching; 2) reference lists of included papers; 3) key informant consultation; and 4) grey literature searching. Inclusion (e.g., published in English) and exclusion criteria (e.g., non-English language papers published earlier than 2005) are outlined with included papers focusing on capacity building, learning plans, or professional development plans within public health and related settings, such as non-governmental organizations, government, or community-based organizations relating to public health or healthcare. Outcomes of interest included changes in knowledge, skill or confidence (self-efficacy), changes in practice (application or intent), and perceived support or supportive environments, with outcomes reported at the individual, organizational or systems level(s). Quality assessment of all included papers was completed.ResultsFourteen papers were included in this review. These papers reported on six intervention types: 1) internet-based instruction, 2) training and workshops, 3) technical assistance, 4) education using self-directed learning, 5) communities of practice, and 6) multi-strategy interventions. The available literature showed improvements in one or more capacity-building outcomes of interest, mainly in terms of individual-level outcomes. The available literature was moderate in quality and showed a range of methodological issues.ConclusionsThere is evidence to inform capacity building programming and how interventions can be selected to optimize impact. Organizations should carefully consider methods for analysis of capacity building interventions offered; specifically, through which mechanisms, to whom, and for which purpose. Capacity-building interventions can enhance knowledge, skill, self-efficacy (including confidence), changes in practice or policies, behaviour change, application, and system-level capacity. However in applying available evidence, organizations should consider the outcomes of highest priority, selecting intervention(s) effective for the outcome(s) of interest. Examples are given for selecting intervention(s) to match priorities and context, knowing effectiveness evidence is only one consideration in decision making. Future evaluations should: extend beyond the individual level, assess outcomes at organizational and systems levels, include objective measures of effect, assess baseline conditions, and evaluate features most critical to the success of interventions.

The association between levels of alcohol consumption and mental health problems and academic performance among young university students.

PurposeMental health problems and harmful alcohol consumption have been found to be high among young university students compared to the general population in Australia. This research aimed to investigate the association between levels of drinking and mental health problems and academic performance among university students aged 18 to 24 years.MethodsThis study used a quantitative cross-sectional design using data that were collected in 2014 as part of the Youth Alcohol Project (YAP). Participants were randomly drawn from a cross sectional sample of 6000 undergraduate students. Included in the study were only students who were within the age of 18–24, undergraduate, and internally enrolled at the main campus. A total of 2518 undergraduate students aged 18 to 24 years who were enrolled internally at Curtin University Bentley campus were randomly recruited. Data were collected through an online survey. Students were invited to participate in the study through their student email address. The email invitations coincided with the release of semester results to increase the likelihood of students accessing their emails. A further 628 students were randomly recruited through face to face intercept survey during the campus market days. Data were collected by trained research assistants. Validated instruments were used to collected data on levels of alcohol consumption, mental health, and academic performance.ResultsA considerable proportion of participants (44%) reported consuming alcohol at hazardous or harmful levels. Multiple logistic regression analysis showed that students who were consuming alcohol at hazardous levels were 1.2 times more likely to report psychological distress than those with lower levels of alcohol consumption (aOR 1.2, 95% CI: 1.1–1.5). In addition, being late for class (aOR 1.7, 95% CI:1.1–2.4), missing classes (aOR = 2.6, 95% CI: 1.9–2.6), inability to concentrate in class (aOR = 2.6, 95% CI: 1.9–3.4), and inability to complete assignments (aOR = 3.5, 95% CI 2.0–6.0) independently predicted for moderate or hazardous alcohol consumption.ConclusionThe study shows that a considerable proportion of undergraduate students at university consume alcohol at hazardous or harmful levels. In addition, high levels of alcohol consumption are associated with poor academic performance and mental health outcomes among students. The results of the study warrant multi-strategy interventions that focus on policy, organisational, educational, environmental and economic strategies that will help to reduce alcohol related harms among university students.

Is There an Association between Social Connectedness, Social Identity, Alcohol Consumption and Mental Health among Young University Students?

Social connectedness has been identified as a protective factor for a range of health issues however the literature is not conclusive. The high prevalence of hazardous alcohol consumption and mental health problems among university students along with the potential for the university as a setting for health promotion prompted this study. The study aims to explore the association between levels of alcohol consumption, mental health, social connectedness and social identity among university students. Online data were collected from a random sample of university undergraduate students (n = 2506) aged 18 - 24 years old. Outcomes were measured using the Alcohol Use Disorders Identification Test (AUDIT), the Kessler Psychological Distress Scale, Social Connectedness Scale, Social Identity Scale and measures of paid employment and study (hours), and participation in sports and other clubs. The majority of students had consumed alcohol in the last 12 months (87%). Of these students 38% reported to drink at hazardous levels (AUDIT ≥ 8). When all factors were considered: gender, living arrangements, being a domestic student, hours spent at work, participation in university and community sport, higher levels of psychological distress, higher levels of social connectedness, and lower levels of social identity were significant predictors of hazardous alcohol consumption. The finding highlights the need for the inclusion of integrated, multi-strategy health promotion interventions on campus. Further exploration of the associations between social connectedness and social identity as influences of health behaviors will better inform the development of targeted strategies for specific groups.

A Systematic Review of the Impact of Multi-Strategy Nutrition Education Programs on Health and Nutrition of Adolescents

ObjectiveTo update evidence on the impact of multi-strategy nutrition education interventions on adolescents' health and nutrition outcomes and behaviors. DesignSystematic review of randomized controlled studies of multi-strategy interventions encompassing nutrition education published from 2000 to 2014 guided by the Preferred Reported Items for Systematic Reviews and Meta-analyses statement. SettingSecondary schools in developed countries. ParticipantsAdolescents aged 10–18 years. Main Outcome MeasuresAnthropometric and dietary intake. AnalysisSystematic search of 7,009 unduplicated articles and review of 11 studies (13 articles) meeting inclusion criteria using qualitative comparison. ResultsFour studies reported significant changes in anthropometric measures and 9 showed significant changes in dietary intake. Type of nutrition education varied. Components of the interventions that showed statistically significant changes in anthropometric and dietary intake included facilitation of the programs by school staff and teachers, parental involvement, and using theoretical models to guide the intervention's development. Changes in canteens, food supply, and vending machines were associated with significant changes in dietary intake. Conclusions and ImplicationsMulti-strategy interventions can have significant impacts on nutrition of adolescents when the nutrition education is theoretically based and facilitated by school staff in conjunction with parents and families, and includes changes to the school food environment.

What are the risk factors for HIV in men who have sex with men in Ho Chi Minh City, Vietnam?- A cross-sectional study

BackgroundThe number of people living with HIV (PLWH) in Vietnam was estimated to rise from 156,802 in 2009 to 256,000 in 2014. Although the number of new HIV reported cases has decreased by roughly 14,000 cases per year from 2010 to 2013 a concerning increase in HIV prevalence has been identified among men who have sex with men (MSM) from 1.7 % in 2005 to 2.4 % in 2013. There are signs of increased HIV (+) prevalence among MSM in a number of cities/provinces, especially in the two largest cities, Ho Chi Minh City (HCMC) and Hanoi. HCMC is the country’s major “hot spot” for HIV/AIDS, with over a third of the total national AIDS patients. This paper is based on a secondary analysis of Integrated Biological and Behavioural Surveillance (IBBS) data collected in Vietnam in 2009 to examine the research question “Do behavioural risk factors contribute to HIV infection among the MSM population in HCMC?”.MethodsA cross-sectional design was employed to sample males aged over 15 from communities in HCMC, who reported having any types of sex with another man at least once during the last 12 months. Participants (399) were recruited using the respondent driven sampling (RDS) method and provided both biological data (specimens) and behavioural data collected through a questionnaire survey.ResultsThe study found high HIV prevalence (14.8 %) among the MSM sample from HCMC. Multivariate analysis found age and level of formal education completed, to be significantly associated with HIV infection. MSM aged over 25 were more likely to be HIV (+) than the younger group (OR = 7.82, 95 %CI = 3.37–18.16, p < 0.001); as were participants who had low educational (OR = 2.74, p < 0.05) and medium educational levels (OR = 2.68, p < 0.05). In addition, those participants who had anal sex with male partners (OR = 2.7, p < 0.05) and whose sexual partners injected drugs (OR = 2.24, p < 0.05) and who felt at risk of HIV infection (OR = 2.42, p < 0.01) had a higher risk of HIV infection.ConclusionsThe high proportion of HIV (+) MSM in our sample from HCMC indicates that we need a better understanding of MSM behaviour patterns, risk practices and social networks as well as improved HIV prevention and control measures. More targeted and relevant HIV prevention programs for older and less educated MSM are urgently needed to address the key risk factors we have identified. MSM engaging in drug-related risk behaviours require multi-strategy HIV interventions relating to both sex and drug behaviour among MSM and their partners who engage in drug use. Further work is needed to identify locations and strategies where these high-risk individuals can be accessed as well as to reduce barriers related to social discrimination and stigma. Targeting high risk individuals and groups should supplement existing efforts aimed at the MSM population in HCMC.

Clinical pharmacist assisted thromboprophylactic optimization in general surgical patients

Practice of prophylaxis against venous thromboembolism (VTE) following surgical procedures has been in the scenario for about half a century. Despite the surging evidence regarding the clinical and economic efficacy, the practice remains underutilized. The study was aimed at optimizing the prophylactic practices for prevention of VTE in the general surgical patients in a tertiary care hospital using a pharmacist assisted multi-strategy intervention. The prospective quasi-experimental study was conducted in general surgical department of a tertiary care hospital in Kerala. The initial audit phase was targeted at assessing the prevailing prophylactic practices and its adequacy in relation to American College of Chest Physicians (ACCP) guidelines. This was followed by an educational phase where physicians were provided the feedback and institutional protocol. The third phase involved intervention through patient risk stratification and prophylactic recommendation by pharmacist concomitantly with reaudit. The overall non-compliance to the therapy decreased from 52% in the control phase to 20% in the intervention phase with P = 0.0009. The partial compliance to therapy reduced from 40% in the control phase to 32% in the intervention phase with P = 0.4047. Total compliance to therapy increased from 8% in the control to 48% in the intervention stage and the difference was found to be significant with P < 0.0001. The study was effective in increasing the overall compliance to the ACCP 9th guidelines by 40% and the average duration by 1.61 days. Clinical pharmacist assisted multi-strategy interventions were effective in enhancing the appropriateness of the prophylaxis as per the ACCP recommendations. Les recommandations concernant la prévention du thrombo-embolisme veineux (VTE) postopératoire datent d’un demi-siècle. Malgré l’évidence de l’efficacité clinique et économique, les recommandations restent encore parfois peu ou mal utilisées. L’étude a visé à optimiser les pratiques de prévention du VTE chez les patients hospitalisés en chirurgie générale dans un hôpital de soin possédant des pharmaciens cliniciens. L’étude quasi expérimentale éventuelle a été conduite dans le département de chirurgie générale d’un hôpital du Kerala. La phase initiale a été un audit des pratiques prophylactiques existantes et leur adéquation avec les directives cliniques de l’American College of Chest Physicians (ACCP). Ceci a été suivi par une phase éducative où les pharmaciens cliniciens ont présenté le résultat d’audit aux médecins avec un protocole institutionnel. La troisième phase a impliqué une intervention des pharmaciens selon le profil de risque du patient avec un rappel de la recommandation prophylactique et dans la foulée un nouvel audit. Le non-respect global à la thérapie a diminué de 52 % dans la phase de contrôle à 20 % dans la phase d’intervention (p = 0,0009). La conformité partielle aux directives cliniques a été réduite de 40 % pour la phase de contrôle jusqu’à 32 % pour la phase d’intervention (p = 0,4047). La conformité totale aux directives cliniques s’est accrue significativement de 8 % pour le contrôle jusqu’à 48 % pour l’étape d’intervention (p < 0,0001). La stratégie utilisée s’est avérée efficace pour améliorer la conformité globale aux 9es directives ACCP (+ 40 %) et la durée moyenne à 1,61 jours. Les interventions du pharmacien clinicien se sont avérées efficaces pour assurer le respect des directives cliniques de l’ACCP.

Maintenance of Increased Childhood Influenza Vaccination Rates 1 Year After an Intervention in Primary Care Practices

ObjectiveInfluenza vaccination rates among some groups of children remain below the Healthy People 2020 goal of 70%. Multistrategy interventions to increase childhood influenza vaccination have not been evaluated recently. MethodsTwenty pediatric and family medicine practices were randomly assigned to receive the intervention in either year 1 or year 2. This study focuses on influenza vaccine uptake in the 10 year 1 intervention sites during intervention and the following maintenance year. The intervention included the 4 Pillars Immunization Toolkit—a practice improvement toolkit, early delivery of donated vaccine for disadvantaged children, staff education, and feedback on progress. During the maintenance year, practices were not assisted or contacted, except to complete follow-up surveys. Student's t tests assessed vaccine uptake of children aged 6 months to 18 years, and multilevel regression modeling in repeated measures determined variables related to the likelihood of vaccination. ResultsInfluenza vaccine uptake increased 12.4 percentage points (PP; P < .01) during active intervention and uptake was sustained (+0.4 PP; P > .05) during maintenance, for an average change of 12.7 PP over all sites, increasing from 42.2% at baseline to 54.9% (P < .001) during maintenance. In regression modeling that controlled for age, race, and insurance, likelihood of vaccination was greater during intervention than baseline (odds ratio 1.47; 95% confidence interval 1.44–1.50; P < .001) and greater during maintenance than baseline (odds ratio 1.50; 95% confidence interval 1.47–1.54; P < .001). ConclusionsIn primary care practices, a multistrategy intervention that included the 4 Pillars Immunization Toolkit, early delivery of vaccine, and feedback was associated with significant improvements in childhood influenza vaccination rates that were maintained 1 year after active intervention.

Mindful M&amp;M’s

Disruptive behavior problems are the primary reason for referral of preschool-aged children to mental health care settings and significantly interfere with social and academic functioning. Furthermore, when left untreated, disruptive behavior disorder may persist and cause impairments in social, academic, and occupational functioning in later developmental stages. Parent-based training programs are effective in ameliorating many symptoms of disruptive behavior disorders, but often neglect other child factors associated with disruptive behavior, such as deficits in emotion regulation. Mindfulness training may be an effective method for addressing these individual-level contributing factors underlying the child’s disruptive behavior. At present, treatment outcome research on the efficacy of mindfulness training among preschool-aged children with disruptive behavior problems is highly limited. This case study examined the implementation of a two-part treatment consisting of a four-session parent-training program as well as four sessions of targeted mindfulness training for a preschool-aged child with disruptive behavior disorder. Treatment outcome data revealed significant gains, including improvements in emotion regulation and decreases in level of aggression, defiance, and sleep problems. Treatment gains were maintained at 6-month follow-up, along with further decreases in aggression, defiance, inattention, and hyperactivity, which resulted in no clinical-level symptoms at 6-months post-treatment. This case study demonstrates the potential efficacy of multi-strategy interventions for preschool-aged children with disruptive behavior problems and highlights mindfulness training as a promising adjunct to family-based interventions.

Childhood Obesity Prevention Interventions in Childcare Settings: Systematic Review of Randomized and Nonrandomized Controlled Trials

Childcare settings are an opportune location for early intervention programs seeking to prevent childhood obesity. This article reports on a systematic review of controlled trials of obesity prevention interventions in childcare settings. The review was limited to English language articles published in PubMed, Web of Science, and Education Resources Information Center (ERIC) between January 2000 and April 2012. childhood obesity prevention interventions in childcare settings using controlled designs that reported adiposity and behavior outcomes. no interventions, non-childcare settings, clinical weight loss programs, non-English publications. Publications were identified by key word search. Two authors reviewed eligible studies to extract study information and study results. Qualitative synthesis was conducted, including tabulation of information and a narrative summary. Fifteen studies met the eligibility criteria. Seven studies reported improvements in adiposity. Six of the 13 interventions with dietary components reported improved intake or eating behaviors. Eight of the 12 interventions with physical activity components reported improved activity levels or physical fitness. Evidence was mixed for all outcomes. Results should be interpreted cautiously given the high variability in study designs and interventions. Further research needs long-term follow-up, multistrategy interventions that include changes in the nutrition and physical activity environment, reporting of cost data, and consideration of sustainability.

A randomised controlled trial of an active telephone‐based recruitment strategy to increase childcare‐service staff attendance at a physical activity and nutrition training workshop

Centre-based childcare services represent a promising setting to target the prevention of excessive weight gain in preschool-aged children. Staff training is a key component of multi-strategy interventions to improve implementation of effective physical activity and nutrition promoting practices for obesity prevention in childcare services. This randomised controlled trial aimed to examine whether an active telephone-based strategy to invite childcare-service staff to attend a training workshop was effective in increasing the proportion of services with staff attending training, compared with a passive strategy. Services were randomised to an active telephone-based or a passive-recruitment strategy. Those in the active arm received an email invitation and one to three follow-up phone calls, whereas services in the passive arm were informed of the availability of training only via newsletters. The proportion of services with staff attending the training workshop was compared between the two arms. One hundred and twenty-eight services were included in this study. A significantly larger proportion (52%) of services in the active arm compared with those in the passive-strategy arm (3.1%) attended training (d.f.=1, χ2=34.3; P<0.001). An active, telephone-based recruitment strategy significantly increased the proportion of childcare services with staff attending training. Further strategies to improve staff attendance at training need to be identified and implemented. SO WHAT?: Active-recruitment strategies including follow-up telephone calls should be utilised to invite staff to participate in training, in order to maximise the use of training as an implementation strategy for obesity prevention in childcare services.

Smoking-Cessation Interventions in People Living With HIV Infection: A Systematic Review

Tobacco smoking remains a prevalent behavior in people living with HIV infection (PLWHs) and is associated with impaired immune functioning, increased cardiovascular risk, and decreased response to antiretroviral therapy. This review presents a critique and synthesis of evidence on effective smoking-cessation interventions for PLWHs. A comprehensive search identified nine peer-reviewed intervention studies published between 1989 and 2012. The highest likelihood of smoking cessation (range of odds ratios 4.33-5.6) were in two randomized controlled trial interventions using cell phone technology. Clinically significant reductions in systolic blood pressure, weight gain, and increased CD(4+) T-cell count were reported in participants who ceased smoking in three of the nine studies. Overall, multistrategy smoking-cessation interventions, delivered over multiple sessions, were effective. However, the most effective interventions were tailored to the unique individual needs of PLWHs, including assessment of and intervention for polysubstance abuse and mental health issues, as well as the inclusion of access-promoting elements.

Barriers to translating evidence‐based breastfeeding information into practice

There is strong evidence that using breastmilk substitutes disadvantages the infant, mother and community as a whole. There is also increasing evidence regarding the lactation process, breastfeeding inhibitors and enablers, and breastfeeding management options. However, there appears to be a gap between this evidence base and practice with breastfeeding rates being unacceptably low, especially following hospital discharge. This paper discusses barriers to the implementation of breastfeeding best practice using a framework of the research-to-practice pipeline: acceptance, applicable, available and able, acted upon, agreed to and adhered to. As blocks or restrictions to the flow of information or evidence may occur at any point along the pathway, researchers designing interventions to increase breastfeeding rates need to consider using multi-strategy interventions and target collaborative care across professions. Barriers to implementing evidence-based breastfeeding practices are common and wide ranging. These barriers should be considered when developing new breastfeeding services and research programmes.

Economic Violence To Women and Girls

Most studies on gender-based violence (GBV) have focused on its physical, sexual, and psychological manifestations. This paper seeks to draw attention to the types of economic violence experienced by women, and describes its consequences on health and development. Economic violence experienced included limited access to funds and credit; controlling access to health care, employment, education, including agricultural resources; excluding from financial decision making; and discriminatory traditional laws on inheritance, property rights, and use of communal land. At work women experienced receiving unequal remuneration for work done equal in value to the men's, were overworked and underpaid, and used for unpaid work outside the contractual agreement. Some experienced fraud and theft from some men, illegal confiscation of goods for sale, and unlawful closing down of worksites. At home, some were barred from working by partners; while other men totally abandoned family maintenance to the women. Unfortunately, economic violence results in deepening poverty and compromises educational attainment and developmental opportunities for women. It leads to physical violence, promotes sexual exploitation and the risk of contracting HIV infection, maternal morbidity and mortality, and trafficking of women and girls. Economic abuse may continue even after the woman has left the abusive relationship. There is need for further large-scale studies on economic violence to women. Multi-strategy interventions that promote equity between women and men, provide economic opportunities for women, inform them of their rights, reach out to men and change societal beliefs and attitudes that permit exploitative behavior are urgently required.