Observed Intervention Effects Research Articles

A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention.

Primary prevention targets development of overweight in individuals with healthy weight and is a great challenge. This paper summarizes the main findings of a working group of the Danish Council on Health and Disease Prevention that reviewed the literature on primary prevention of overweight and obesity among children and adolescents. The results were presented in a Danish report, in which a 2019 Cochrane review on childhood obesity prevention was complemented by searches in PubMed to include all relevant subsequent studies published from January 2018 until March 2020. In this paper, the review was updated until June 2023. Numerous childhood overweight prevention interventions have been developed during the past decades, primarily targeting diet and/or physical activity. Several of these interventions showed positive effects on diet and physical activity level but did not show effects on risk of developing overweight. The evidence foundation is inconsistent as four out of five interventions did not show positive effects. Previously observed intervention effects may not reflect excessive weight gain prevention among children with healthy weight but rather bodyweight reduction among those with overweight or obesity. We do not have sufficient knowledge about how to prevent children with healthy weight from developing overweight, and creative solutions are urgently needed.

Novel mathematical modeling approach finds Fortasyn Connect affects memory through reducing hippocampal atrophy in the LipiDiDiet trial

AbstractBackgroundLipiDiDiet is a 6‐year, randomized, double‐blind, placebo‐controlled intervention in 311 individuals with prodromal Alzheimer’s disease (AD)/mild cognitive impairment receiving the specific multinutrient combination Fortasyn Connect (Souvenaid) or a calorie‐matched placebo control once daily.1 AD is characterized by neurodegeneration including significant synapse loss, and the hippocampal formation is particularly vulnerable in the early stages of AD. Results over the first 2 and 3 years of intervention showed that Fortasyn Connect reduced hippocampal atrophy and slowed decline on clinical and other measures related to cognition, function, and disease progression.2,3 Here, possible mechanistic pathways through which the intervention may affect the risk of disease progression are being explored post‐hoc.MethodA new type of multivariate joint model was applied to the 3‐year LipiDiDiet clinical trial data in which the longitudinal outcomes MRI hippocampal volume (HCV) and neuropsychological test battery (NTB)‐memory are allowed to be associated with disease progression and dropout, and affect each other directly. Specifically, for each longitudinal outcome a linear mixed‐effects model is used to estimate its trajectory, where, for the second longitudinal outcome, the linear predictor of the first outcome is included as time‐varying covariate. Results are compared for both pathways (HCV and NTB‐memory and vice versa), and with results of existing multivariate joint models that have the form of so‐called parallel mediator models (i.e. longitudinal outcomes are merely allowed to be correlated but not to influence each other causally).ResultComparing the models, we observed a strong association between changes in NTB‐memory and disease progression and no direct treatment effect on NTB‐memory. Notably, there was a strong direct treatment effect for HCV changes, together with a direct effect of HCV on disease progression. Moreover, indirect effects of HCV changes on disease progression were mediated through NTB‐memory.ConclusionThis new multivariate joint model is useful in modeling possible mechanistic pathways. Overall results from application to the 3‐year data suggest that the observed intervention effects of Fortasyn Connect are partly mediated through reduction of hippocampal atrophy both directly and indirectly via NTB‐memory, in addition to yet to be defined other/complementary pathways. 1 Funding includes EU‐JPND. 2Lancet Neurol. 2017;16:965‐975. 3Alz & Dementia. 2021;17:29‐40.

Observed intervention effects for mortality in randomised clinical trials: a methodological study protocol

IntroductionIt is essential to choose a realistic anticipated intervention effect when calculating a sample size for a randomised clinical trial. Unfortunately, anticipated intervention effects are often inflated, when compared with...

Poor reporting quality of observational studies in children with non-syndromic cleft palate makes evidence synthesis difficult

Objective To assess the reporting quality of observational studies included in a systematic review of the management of chronic otitis media with effusion in children with non-syndromic cleft lip and palate using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Methods Medline, CINAHL, Scopus and Embase, were searched for studies comparing the use of ventilation tubes to surveillance. Two reviewers screened potential eligible articles, extracted data independently and assessed reporting quality using the STROBE checklist. Results The median compliance rate with individual STROBE items was low at 25% (range:0-100%) with 11 of the 22 items not reported in any of the studies. Items reported inconsistently pertained to potential sources of bias, sample size calculations, how loss to follow-up was addressed and management of missing data. Conclusion The development of this systematic review highlights the inadequate reporting standards in this field. Differences in the way the outcomes are defined, reported, and measured leads to variability in the observed intervention effects and difficulty in interpreting the true effect size. Future researchers are encouraged to use STROBE guidelines for the design and reporting of observational studies in this field.

Adoption and maintenance of physical activity: Mediation analysis of a psychological intervention.

To analyze the cognitive mediation processes of an effective psychological group-based intervention promoting physical activity (based on motivational and volitional theories; MoVo-LISA) and to test for different underlying intervention mechanisms in the adoption and maintenance phase of physical activity behavior change. In an RCT, N = 202 patients with coronary heart disease were randomly allocated to the group-based MoVo-LISA intervention or a control group (treatment-as-usual). Primary outcome was physical activity (in minutes per week, significant group differences: posttreatment: d = 1.03; 12-months follow-up: d = .57). Potential mediator variables were self-efficacy, outcome expectations, intention strength, self-concordance, action planning and barrier management. A mediation analysis of longitudinal data in SPSS AMOS v.24 was conducted. The intervention was successful in modifying most of the examined cognitive variables in the adoption and/or the maintenance phase, with exception of self-concordance. Intention strength and self-concordance were significant predictors of behavior change in both phases. Findings suggest that the observed intervention effects on physical activity behavior were only partially mediated through the motivational variables self-efficacy and outcome expectation. The results contribute to opening "the black box" of processes behind an intervention and show that intervention effects of MoVo-LISA are partially mediated through the specified cognitive variables. The relevance of motivational variables (intention strength and self-concordance) in the adoption and maintenance phases is highlighted in this study and leads to relevant intervention design implications. Nevertheless, the differentiation of the two phases might help to improve intervention programs through a stronger focus on those cognitive parameters that are critical at a certain point in the behavior change process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effects of a Multilevel Resilience-Based Intervention on Mental Health for Children Affected by Parental HIV: A Cluster Randomized Controlled Trial.

The present study aimed to examine the efficacy of the Child-Caregiver-Advocacy Resilience (ChildCARE) intervention, a multilevel resilience-based psychosocial intervention, on mental health outcomes, including depressive symptoms, school anxiety, and loneliness, among children affected by parental HIV in central China. Seven hundred and ninety children (51.6% boys, 6-17 years of age) affected by parental HIV were randomly assigned by cluster to a control group or one of three intervention groups designed to test the three conditions of the ChildCARE intervention (child-only, child + caregiver, child + caregiver + community). Linear mixed-effects modeling was performed to test the intervention effect at 6, 12, and 18 months. The intervention did not yield significant changes in mental health outcomes in the child-only group at any follow-ups, whereas significant reductions in depressive symptoms and loneliness were observed in the child + caregiver group at 12 months. The observed intervention effects were not sustained at 18 months. Also, children who received the additional community component that, was implemented after 12 months did not show larger improvements in mental health outcomes than the control group at 18 months. Lastly, older children (i.e., ≥12 years) were found to benefit more from the intervention than their younger counterparts (i.e., <12 years). Overall, the findings provide some support for the promise of multilevel resilience-based interventions in improving mental health of children affected by parental HIV, but more research is needed to further determine whether multilevel resilience-based interventions can yield sustained effects on mental health.

Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: a controlled interrupted time series analysis

BackgroundRestricting advertising of products with high fat, salt, and sugar (HFSS) content has been recommended as a tool to tackle obesity, but the impact on purchases is unknown. This study evaluates the impact of outdoor HFSS advertising restrictions, implemented across the London transport network in February, 2019, on HFSS purchases. MethodsTake-home food and drink purchase data (n=5 089 988) from 1970 households (London [intervention] n=977; North of England [control] n=993) from the Kantar Fast Moving Consumer Goods panel were analysed with a controlled interrupted time series design. We estimated average weekly household purchases of energy and nutrients from HFSS products in the postintervention period (Feb 25 to Dec 29, 2019) compared with a counterfactual constructed from the control and preintervention (June 18, 2018, to Feb 24, 2019) series. The London School of Hygiene & Tropical Medicine ethics committee approved the study (16297/RR/11721), and written informed consent was obtained from participants. FindingsAfter adjustment for confounders, average weekly household purchase of energy was reduced by 6·8% (1015·4 kcal, 95% CI 473·6–1557·2) compared with the counterfactual. Reductions in purchases of fat (57·4 g, 95% CI 21·7–93·0), saturated fat (26·4 g, 12·5–40·4) and sugar (85·5 g, 46·7–124·3) from HFSS products were also observed. When stratified by product category, we found a 19·4% reduction in energy purchased from chocolate and confectionery (317·9 kcal, 95% CI 200·0–435·8), along with reductions in fat (13·1 g, 95% CI 7·5–18·8), saturated fat (8·7 g, 5·7–11·7), sugar (41·4 g, 27·4–55·4), and salt (0·2 g, 0·1–0·2) purchased. InterpretationTo our knowledge, this was the first UK study to examine the impact of outdoor HFSS advertising restrictions on food and drink purchases. Our findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products. However, the sustainability of the observed effects is unclear. Confounding due to other events occurring at the same time as the intervention in either the intervention or control group cannot be ruled out. However, observed intervention effects were greater among frequent public transport users, and were specific to the week the advertising restrictions were introduced. FundingNational Institute for Health Research School for Public Health Research (grant number PD-SPH-2015).

Improving well-being and behavior in adolescents utilizing a school-based positive psychology intervention

ABSTRACT This study is a multi-component Positive Psychology Intervention (PPI) with the goal of improving daily happiness and classroom behavior in a sample at-risk high-school students. PPIs have increasingly been used in school settings to enhance student well-being, student success, and to increase positive affect. The current study utilized a multiple baseline design, across five adolescents, to examine whether a manualized PPI implemented in individual school-based counseling sessions with at-risk high-school students, would lead to increased happiness, improved classroom behavior, and life satisfaction, measured through a Daily Happiness survey, the Direct Behavior Rating (DBR), General Happiness Scale, Brief Multidimensional Students’ Life Satisfaction Scale, and the Student Life Satisfaction Scale. Results demonstrated high variability in the data and an overall null effect of the intervention on the two dependent variables of daily happiness and classroom behavior. Limitations included individual impacts of outside factors on student reports and behavior. Due to the small scale of the study and lack of observed intervention effects, more research is needed to draw conclusions about the application of the intervention. However, social validity data revealed that school-based mental health professionals may still consider this intervention to teach students strategies to improve life satisfaction.

Effects of 20-year infancy-onset dietary counselling on cardiometabolic risk factors in the Special Turku Coronary Risk Factor Intervention Project (STRIP): 6-year post-intervention follow-up

Primordial and primary prevention is the cornerstone for cardiometabolic health. In the randomised, controlled Special Turku Coronary Risk Factor Intervention Project (STRIP; n=1116), a 20-year dietary counselling intervention was given to children biannually from infancy, and cardiometabolic health benefits had been observed among the participants in the intervention group. Here, we report on the key results of the first follow-up done 6 years after the end of the intervention, at age 26 years. The randomised controlled STRIP study recruited children at age 5 months from well-baby clinics in Turku, Finland, and randomly assigned them to either an intervention or control group; group allocation was unmasked. The intervention introduced participants to a heart-healthy diet, characterised by low proportional intake of saturated fat and cholesterol, by dietary counselling and nutrition education sessions to parents and children from the age of 7 months to 20 years. Children in the control group received only the basic health education given at Finnish well-baby clinics and school health care. We assessed diet, lifestyle, and cardiometabolic risk factor data, including blood pressure, anthropometry, serum biochemistry (lipids, apolipoproteins, glucose, and insulin), and homoeostatic model assessment of insulin resistance (HOMA-IR) in the participants at age 26 years. 1116 children were included in the original STRIP study, of whom 551 provided data at the age 26 years follow-up, and data for 507 participants were analysed (243 in the intervention group and 264 in the control group). At follow-up, those who had been in the intervention group had slightly lower mean intake of saturated fat as a proportion of total energy intake than the control group (13·0% [SD 3·3] vs 13·7% [3·6], p=0·049). A higher proportion of participants in the intervention group achieved the targeted monounsaturated and polyunsaturated fat to saturated fat ratio of more than 2:1 than the control group (78 [39%] of 200 vs 70 [30%] of 235; risk ratio [RR] 1·16 [95% CI 1·01-1·33]; p=0·035). A higher proportion of intervention group participants met the ideal total cholesterol concentration of less than 5·17 mmol/L (194 [81%] of 240 vs 187 [72%] of 261; RR 1·45 [1·05-2·01], p=0·024) and optimal LDL cholesterol concentration of less than 3·0 mmol/L (166 [69%] of 240 vs 158 [61%] of 251; RR 1·30 [1·03-1·66], p=0·031). Those who received the intervention had lower glucose (5·00 mmol/L [SD 0·43] vs 5·07 mmol/L [0·46], p=0·040) and HOMA-IR (median 1·44 [IQR 1·09-1·91] vs 1·62 [1·22-2·09], p=0·037) than the participants in the control group. Previously observed intervention effects during the 20-year counselling were largely maintained into adulthood 6 years after the withdrawal of the intervention. Dietary counselling introduced in infancy thus provided a sustained benefit to diet quality and cardiometabolic risk factor levels. Academy of Finland, Juho Vainio Foundation, Finnish Foundation for Cardiovascular Research, Finnish Ministry of Education and Culture, Finnish Cultural Foundation, Sigrid Jusélius Foundation, Special Governmental grants for Health Sciences Research (Turku University Hospital), Yrjö Jahnsson Foundation, Finnish Medical Foundation, and Turku University Foundation.

Engagement in mHealth behavioral interventions for HIV prevention and care: making sense of the metrics.

Engagement is the primary metric by which researchers can assess whether participants in a mHealth intervention used and interacted with the intervention's content as intended over a pre-specified period to result in behavior change. Paradata, defined as the process data documenting users' access, participation, and navigation through a mHealth intervention, have been associated with differential treatment outcomes in mHealth interventions. Within behavioral mHealth interventions, there has been an increase in the number of studies addressing the HIV prevention and care continuum in recent years, yet few have presented engagement metrics or examined how these data could inform design modifications, promote continued engagement, and supplement primary intervention efficacy and scale-up efforts. We review common paradata metrics in mHealth interventions (e.g., amount, frequency, duration and depth of use), using case studies from four technology-driven HIV interventions to illustrate their utility in evaluating mHealth behavioral interventions for HIV prevention and care. Across the four case studies, participants' ages ranged between 15 and 30 years and included a racially and ethnically diverse sample of youth. The four case studies had different approaches for engaging young men who have sex with men: a tailored brief intervention, an interactive modular program, a daily tool to monitor and self-regulate treatment adherence, and an online platform promoting social engagement and social support. Each focused on key outcomes across the HIV prevention and care continuum [e.g., safer sex behaviors, HIV testing, antiretroviral therapy (ART) adherence] and collected paradata metrics systematically. Across the four interventions, paradata was utilized to identify patterns of use, create user profiles, and determine a minimum engagement threshold for future randomized trials based on initial pilot trial data. Evidence of treatment differences based on paradata analyses were also observed in between-arm and within-arm analyses, indicating that intervention exposure and dosage might influence the strength of the observed intervention effects. Paradata reflecting participants' engagement with intervention content was used to suggest modifications to intervention design and navigation, to understand what theoretically-driven content participants chose to engage with in an intervention, and to illustrate how engagement was linked to HIV-related outcomes. Paradata monitoring and reporting can enhance the rigor of mHealth trials. Metrics of engagement must be systematically collected, analyzed and interpreted to meaningfully understand a mHealth intervention's efficacy. Future mHealth trials should work to identify suitable engagement metrics during intervention development, ensure their collection throughout the trial, and evaluate their impact on trial outcomes.

Increasing Employees' Health by Workplace Physical Activity Counseling: The Mediating Role of Step-Based Physical Activity Behavior Change.

This study evaluated the effects of a 3-month workplace physical activity (PA) intervention on employees' health-related fitness and well-being. Moreover, mediational pathways were examined. A longitudinal, quasi-experimental trial was evaluated in Belgian employees. The intervention group (IG: n = 246) received 3-months individualized, tailored PA counseling, consisting of face-to-face counseling and follow-up e-mail and telephone contacts. The reference group (n = 54) received no PA counseling. Outcome measures (assessed at baseline, 3mo [short term], and 9mo [long term]) included body composition, cardiorespiratory fitness, well-being, and step-based PA. With no changes in the reference group, the IG showed short-term improvements in body mass index (-0.24kg/m2, P < .001), body fat (-0.88%, P < .001), waist circumference (-1.47cm, P < .001), and muscle percentage (+0.47%, P < .001). Moreover, with respect to cardiorespiratory fitness, IG participants improved on perceived exertion, both in the short term (-0.91, P < .001) and long term (-0.83, P < .001). Furthermore, perceived physical well-being increased in the IG, both in the short term (+0.57, P < .001) and long term (+0.57, P < .001). The observed intervention effects on body composition, perceived exertion, and well-being were mediated by (increases in) step-based PA. Workplace PA counseling programs have the potential to enhance employees' health-related fitness and well-being. Importantly, step-based PA behavior change was found to contribute to the postintervention improvements.

Unsolicited Reporting to Prescribers of Opioid Analgesics by a State Prescription Drug Monitoring Program: An Observational Study with Matched Comparison Group

State prescription drug monitoring programs (PDMPs) can help detect individuals with multiple provider episodes (MPEs; also referred to as doctor/pharmacy shopping), an indicator of prescription drug abuse and/or diversion. Although unsolicited reporting by PDMPs to prescribers of opioid analgesics is thought to be an important practice in reducing MPEs and the potential harm associated with them, evidence of its effectiveness is mixed. This exploratory research evaluates the impact of unsolicited reports sent by Massachusetts' PDMP to the prescribers of persons with MPEs. Individuals with MPEs were identified from PDMP records between January 2010 and July 2011 as individuals having Schedule II prescriptions (at least one prescription being an opioid) from four or more distinct prescribers and four or more distinct pharmacies within six months. Based on available MA-PDMP resources, an unsolicited report containing the patient's 12-month prescription history was sent to prescribers of a subset of patients who met the MPE threshold; a comparison group closely matched on demographics and baseline prescription history, whose prescribers were not sent a report, was generated using propensity score matching. The prescription history of each group was examined for 12 months before and after the intervention. There were eighty-four patients (intervention group) whose prescribers received an unsolicited report and 504 matched patients (comparison group) whose prescribers were not sent a report. Regression analyses indicated significantly greater decreases in the number of Schedule II opioid prescriptions (P < 0.01), number of prescribers visited (P < 0.01), number of pharmacies used (P < 0.01), dosage units (P < 0.01), total days' supply (P < 0.01), total morphine milligram equivalents (MME; P < 0.01), and average daily MME (P < 0.05) for the intervention group relative to the comparison group. A post hoc analysis suggested that the observed intervention effects were greater for individuals with an average daily dose of less than 100 MMEs. This study suggests that PDMP unsolicited reporting to prescribers can help reduce risk measures in patients' prescription histories, which may improve health outcomes for patients receiving opioid analgesics from multiple providers.

Challenges of Prolonged Follow-up and Temporal Imbalance in Pragmatic Trials: Analysis of the ENCOURAGE Trial.

Peer support intervention trials are typically conducted in community-based settings and provide generalizable results. The logistic challenges of community-based trials often result in unplanned temporal imbalances in recruitment and follow-up. When imbalances are present, as in the ENCOURAGE trial, appropriate statistical methods must be used to account for these imbalances. We present the design, conduct, and analysis of the ENCOURAGE trial as a case study of a cluster-randomized, community-based, peer-coaching intervention. Preliminary data analysis included examination of study data for imbalances in participant characteristics at baseline, the presence of both secular and seasonal trends in outcome measures, and imbalances in time from baseline to follow-up. Additional examination suggested the presence of nonlinear trends in the intervention effect. The final analyses adjusted for all identified imbalances with accounting for community clustering by supplementing linear mixed effect models with generalized additive mixed models (GAMM) to examine nonlinear trends. Largely due to the location of participants across a considerable geographic area, temporal imbalances were discovered in recruitment, baseline, and follow-up data collection, along with evidence for both secular and seasonal trends in study outcome measures. Using the standard analytical approach, ENCOURAGE appeared to be a null trial. After incorporating adjustment for these temporal imbalances, linear regression analyses still showed no intervention effect. Upon further analyses using GAMM to consider nonlinear intervention trends, we observed intervention effects that were both significant (P <.05) and nonlinear. In community-based trials, recruitment and follow-up may not occur as planned, and complex temporal imbalance may greatly influence the analysis. Real-world trials should use careful logistic planning and monitoring to avoid temporal imbalance. If imbalance is unavoidable, sophisticated statistical methods may nevertheless extract useful information, although the potential problem of residual confounding due to other unmeasured imbalances must be considered.

Trial sequential analysis may be insufficient to draw firm conclusions regarding statistically significant treatment differences using observed intervention effects: A case study of meta-analyses of multiple myeloma trials

Trial sequential analysis (TSA) has been proposed as a method to assess the risk of random error in cumulative meta-analysis (MA), which increases due to repeated significance testing. The aim of TSA is to assist researchers from wrongly concluding treatment differences in the absence of a benefit (i.e. true versus false positive). Similar to monitoring boundaries applied in individual randomized controlled trials, recent literature has advocated the use of TSA for assessing the conclusiveness of results from MAs to determine the requirement for future studies in case of true positive results. While this may be desirable, we present empirical evidence from a recent systematic review to demonstrate that the use of TSA may lead to a premature declaration of statistically significant treatment difference, when further accumulated evidence suggested otherwise. Using all apparently conclusive MAs in multiple-myeloma, we empirically studied under what thresholds for the risk ratio reduction and power a true positive result becomes false positive. We recommend that the conclusion of significant treatment differences in cumulative MA should be weighed against acceptable thresholds regarding the type I error, power and apriori specified clinically meaningful treatment difference.

Cognitive mediation of intervention effects on physical exercise: Causal models for the adoption and maintenance stage

Objective: To investigate how the effects of a group-based intervention program (MoVo-LISA) on exercise behaviour were mediated by cognitive variables. Different causal models mapping the short-term (adoption) and long-term (maintenance) intervention effects were tested using path analyses. Design: N = 220 in-patients of a rehabilitation clinic were assigned to an usual care or intervention group (quasi-experimental design). Questionnaire-based assessment was conducted at baseline; discharge; and at six weeks, six months and 12 months post discharge. Measures: The potential mediator variables were outcome expectations, self-efficacy, strength of goal intention (intention strength), self-concordance, action planning and barrier management. Results: Observed intervention effects on exercise behaviour (p < 0.05) were mediated by intention strength at the adoption and maintenance stages, by action planning only at the adoption, and by barrier management only at the maintenance stage. Self-efficacy and outcome expectations were only indirectly involved in these mediations by affecting intention strength and self-concordance. Conclusion: This is the first study to track the cognitive mediation processes of intervention effects on exercise behaviour over a long time-period by differentiating the adoption and maintenance stages of behaviour change. The findings emphasise the importance of deconstructing intervention effects (modifiability vs. predictive power of a mediator) to develop more effective interventions.

Evaluation of medical and health economic effectiveness of non-pharmacological secondary prevention of coronary heart disease.

Evaluation of medical and health economic effectiveness of non-pharmacological secondary prevention of coronary heart disease.

Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema

The aim of this study was to evaluate the impact of a twice-weekly strength training intervention on perceptions of body image in 234 breast cancer survivors (112 with lymphedema) who participated in the Physical Activity and Lymphedema (PAL) trial. The study population included two hundred and thirty-four women randomly assigned to twice-weekly strength training or control group that completed the 32-item Body Image and Relationships Scale (BIRS) at baseline and 12 months. Percent change in baseline to 12-month BIRS total and subscale scores, upper and lower body strength, and general quality of life (QOL) were compared by intervention status. A series of multiple linear regression models including indicator variables for subgroups based on age, marital status, race, education, BMI, and strength change were used to examine differential intervention impact by subgroup. Strength and QOL variables were assessed as mediators of the intervention effect on BIRS. Baseline BIRS scores were similar across intervention and lymphedema status. Significantly greater improvement in BIRS total score was observed from baseline to 12 months in treatment vs. control participants (12.0 vs. 2.0%; P < 0.0001). A differential impact of the intervention on the Strength and Health subscale was observed for older women (>50 years old) in the treatment group (P = 0.03). Significantly greater improvement was observed in bench and leg press among treatment group when compared to control group participants, regardless of lymphedema. Observed intervention effects were independent of observed strength and QOL changes. Twice-weekly strength training positively impacted self-perceptions of appearance, health, physical strength, sexuality, relationships, and social functioning. Evidence suggests the intervention was beneficial regardless of prior diagnosis of lymphedema. Strength and QOL improvements did not mediate the observed intervention effects.

Cognitive behavioral stress management effects on mood, social support, and a marker of antiviral immunity are maintained up to 1 year in HIV-infected gay men.

Numerous herpesvirus infections are associated with clinically relevant outcomes as well as an accelerated HIV replication rate and subsequent disease progression. Stress management interventions may improve markers of cellular immune control over latent herpesvirus infections and these changes appear to be mediated by perceptions of increased social support availability. We examined the effects of a group-based cognitive behavioral stress management (CBSM) intervention on distress, dysphoria, perceived social support, and herpesvirus immunoglobulin G (IgG) antibody titers during the 6 to 12 months following the intervention. Of those who were initially randomized, 49 HIV-infected men were followed during the 6- to 12-month period after randomization to either a 10-week CBSM intervention (n = 31) or a modified wait-list control condition (n = 18). Measures of distress, dysphoria, social support, and blood samples for herpesvirus IgG titers were taken at baseline, immediately following CBSM and at 6- to 12-month follow-up. Men in CBSM displayed maintenance of previously observed intervention effects on dysphoria, reliable alliance support, and herpesvirus IgG antibody titers (i.e., Epstein-Barr virus capsid antigen; EBV-VCA). Intervention-related changes in EBV-VCA were unrelated to changes in lymphocyte subsets (i.e., CD4+, CD8+, and CD4+:CD8+) or changes in measures of dysphoria and social support during the investigation period. Data indicate that HIV-infected men participating in a CBSM intervention maintain better psychosocial status and immunologic control of latent EBV infection up to 1 year after its conclusion.

Improving client–provider communication: evaluation of a training program for women, infants and children (WIC) professionals in New York state

Results are presented from evaluation of an intensive 1 day training program to improve the growth monitoring counseling skills of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) providers. The training was framed by the patient-centered approach, and focused on a seven-step technique that emphasized eliciting client perspective on the child’s health and negotiating follow-up strategies. Changes in skill were assessed during audiotaped mock counseling sessions with simulated clients. Observed intervention effects were moderate but encouraging for future training programs. After the training, more providers elicited client perspective, and provider level of engagement in negotiating with the client increased. At post-test providers asked more open-ended questions than at pre-test, and provider-to-client talk ratio decreased. Increases in provider total and competence-related satisfaction paralleled improvements in counseling proficiency. Study results suggest that counseling skills of non-physician health providers can change after a 1 day focused training: providers were more client-centered in their discussions. Limitations and implications of the study are discussed.