One-year Intervention Program Research Articles

A Qualitative Study Examining Parental Involvement in Youth Sports over a One-Year Intervention Program.

The purpose of this 12-month intervention program was to examine parent–child relationship changes within the sports context. A qualitative interpretative phenomenological analysis was used for the study design. Ten families consented to in-depth interviews. The participants were 10 youth sport parents who had one child each aged 5–6 years. The intervention program involved the participation of all the parents and children. The program integrated psychological, educational, and sports skills into pre-organized sports training sessions. The study results revealed that the intervention program had a positive impact on the parent–child relationship in the sports context. Additionally, the study results suggest that parental involvement in the intervention program positively affected parent–child attachment, the quality of interpersonal relationships between the parent and the child, and effective parenting strategies. Future intervention programs should include both parent and children dyads.

Role of lifestyle intervention programme in regulating brain derived neurotrophic factor in obese children with metabolic syndrome components

Brain derived neurotrophic factor (BDNF) is a neurotrophin probably concerned in the pathophysiology of obesity and metabolic syndrome (MS) in adults. The aim was to explore serum BDNF relationship with metabolic syndrome components before and after one-year of the lifestyle intervention program in obese children. Forty obese children and forty age and gender-matched lean controls were studied. Anthropometric parameters, blood pressure, fasting blood glucose, serum insulin, lipid profile, insulin resistance (HOMA-IR), and serum BDNF, before and after one year of diet control and physical activity were measured. At baseline, fasting glucose, insulin, HOMA-IR, cholesterol, LDL, triglycerides were significantly higher in obese children relative to controls (P=0.00). Serum BDNF concentration was significantly lower in obese children than in lean controls (P=0.00), and its mean concentration of the subjects with MS was significantly lower than those without MS, and control group (P< 0.001). Linear regression analysis suggested that high waist: hip ratio, body adiposity index, fat percentage, diastolic BP, fasting blood glucose, LDL and HOMA-IR are good predictors for decreased serum BDNF concentration in obese children. After one-year intervention program, the obese group showed a significant increase in serum BDNF, and HDL, paralleled by a significant decline in fasting glucose, insulin, HOMA-IR, cholesterol, LDL, triglycerides as compared to the baseline (P =0.00). Serum BDNF was lower in obese children than in lean controls, and seemed to be linked with the metabolic syndrome components. One-year lifestyle intervention program succeeded to enhance BDNF serum concentration in these children.

The effect of alterations in foot centre of pressure on lower body kinematics during the five-iron golf swing

ABSTRACT The research aimed to evaluate the effects of an intervention aimed at altering pressure towards the medial aspect of the foot relating to stability mechanisms associated with the golf swing. We hypothesised that by altering the position of the foot pressure, the lower body stabilisation would improve which in turn would enhance weight distribution and underpinning lower body joint kinematics. Eight professional golf association (PGA) golf coaches performed five golf swings, recorded using a nine-camera motion analysis system synchronised with two force platforms. Following verbal intervention, they performed further five swings. One participant returned following a one-year intervention programme and performed five additional golf swings to provide a longitudinal case study analysis. Golf performance was unchanged evidenced by the velocity and angle of the club at ball impact (BI), although the one-year intervention significantly changed the percentage of weight experienced at each foot in the final 9% of downswing, which provided an even weight distribution at BI. This is a highly relevant finding as it indicates that the foot centre of pressure was central to the base of support and in-line with the centre of mass (CoM), indicating significantly increased stability when the CoM is near maximal acceleration.

Genetic predisposition score predicts the increases of knee strength and muscle mass after one-year exercise in healthy elderly.

This study aims to identify a genetic predisposition score from a set of candidate gene variants that predicts the response to a one-year exercise intervention. 200 participants (aged 60-83 years) were randomly assigned to a fitness (FIT), whole-body vibration (WBV) and control group. Participants in the exercise (FIT and WBV) groups performed a one-year intervention program. Whole-body skeletal muscle mass (SMM) and isometric knee extension strength (PTIM60) were measured before and after the intervention. A set of 170 muscle-related single nucleotide polymorphisms (SNPs) were genotyped. Stepwise regression analysis was applied to select significantly contributing SNPs for baseline and relative change parameters. A data-driven genetic predisposition score (GPS) was calculated by adding up predisposing alleles for each of the phenotypes. GPS was calculated based on 4 to 8 SNPs which were significantly related to the corresponding phenotypes. These SNPs belong to genes that are involved in myoblast differentiation, muscle and bone growth, myofiber contraction, cytokines and DNA methylation. GPS was related to baseline PTIM60 and relative changes of SMM and PTIM60 in the exercise groups, explaining the variance of the corresponding parameter by 3.2%, 14% and 27%, respectively. Adding one increasing allele in the GPS increased baseline PTIM60 by 4.73 Nm, and exercise-induced relative changes of SMM and PTIM60 by 1.78% and 3.86% respectively. The identified genetic predisposition scores were positively related to baseline knee extension strength and muscle adaptations to exercise in healthy elderly. These findings provide supportive genetic explanations for high and low responders in exercise-induced muscle adaptations.

The effects of CLIL on oral comprehension and production: a longitudinal case study

ABSTRACTThis article reports on the outcomes of a longitudinal case study to gauge the impact of content and language integrated learning (CLIL) on two of the least researched language skills: oral comprehension and production. It worked with 24 students in the fourth grade of Compulsory Secondary Education in a public school in Andalusia (southern Spain) over the course of a year and a half in order to measure the impact of CLIL on oral comprehension and production skills after a one-year intervention programme (post-test) and to determine whether its effects pervade after a six-month period (second post-test), when these same students are in Baccalaureate. The results reveal that, contrary to what has traditionally been sustained in bilingual education, it was productive, as opposed to receptive, oral skills which were more positively affected by CLIL in the medium- and long term. The outcomes also provide interesting data on what aspects of oral competence are particularly amenable to being taught through CLIL (e.g. more cognitively complex listening activities) and which need to de developed over a longer time span in order to be significantly improved (e.g. pronunciation and fluency).

Abstract P322: Goals for Cardiometabolic Risk Factors are Still Not Being Attained in the Long Term After Stroke or Transient Ischaemic Attack

Introduction: Clinical guidelines for patients with stroke or TIA have focused on modification of lifestyle and treatment to achieve cardometabolic risk factor goals. However, there is limited evidence on effective attainment of these goals in this high-risk population. Hypothesis: We hypothesised that a one-year intervention program will improve the attainment of cardiometabolic risk factor goals in community-dwelling survivors of stroke or TIA. Methods: Shared Team Approach between Nurses and Doctors For Improved Risk Factor Management (STANDFIRM) trial is an on-going prospective, randomised controlled trial of risk factor management in people with stroke or TIA. Patients hospitalised for stroke/TIA, and aged ≥18 years, were provided an intervention comprising an individualised, evidence-based secondary prevention program, including nurse education visits, and management plan with specialist oversight. The study outcome was attainment of blood pressure, blood cholesterol, blood sugar, body composition, kidney function goals, and smoking cessation at 12 months, based on guideline recommendations. We assessed whether lifestyle or other factors were associated with achieving an increased number of goals. Data collection comprised surveys, anthropometric and biochemical measurements. Differences in the proportion of patients meeting the set goals at baseline and 12 months were determined using McNemar’s chi-square test. The association between baseline factors and goal attainment was determined using multivariable linear regression. Results: Between January 2010 and November 2013, 233 patients (66% male, median age 69 years, 77% ischaemic stroke) were recruited into the intervention arm of the trial. Between baseline and 12 months, there was no difference in the proportion of patients achieving each of the set goals. Overall, only 14 patients (3%) achieved all six measured goals. A total of 90 patients (34%) met ≥4 goals, 89 (34%) met 3 goals, and 84 (32%) met ≤2 goals. In multivariable analyses, factors independently associated with achieving more goals included being female (OR 1.70, 95% CI 1.27, 2.20), having vocational or higher education (OR 1.37, 95% CI 1.05, 1.80), and lower salt intake at baseline (OR 0.98, 95% CI 0.97, 1.00). Conclusion: The 12-month intervention did not have an impact on the attainment of cardiometabolic goals in patients with stroke or TIA. With few individual factors identified, further investigation of system-level factors is warranted to ascertain factors that could facilitate improved risk factor management in patients with stroke or TIA.

Intervention of childhood and adolescents obesity in Shantou city

The purpose of this study was to evaluate the effects of multicomponent school based intervention constituted of diet modification, regular exercise and psychosocial consultation on body status in overweight and obese children and adolescents. And to come up with an appropriate intervention protocol for controlling children and adolescents obesity in Shantou city. Two schools were randomised to intervention group and control group respectively. A total of 41 students enrolled were diagnosed as overweight or obese. Twenty-six students of the intervention group completed the one-year intervention programme consisted of diet modification, regular exercise and psychological consultation except two of them were transferred to another school. The differences of BMI, anthropometric measures, metabolic profile and the scores of questionnaire and the scale were compared to evaluate the effects of the intervention programme. After one-year intervention, it observed in the intervention group that BMI-Z score, WHR and WHtR had significant improvements, and there was a nonsignificant trend (P=0.053) for a decrease in BMI-P. Fasting plasma glucose, cholesterol (CH) and low-density-lipoprotein cholesterol (LDL-C) levels in the intervention group showed nonsignificant trend for a decrease (PFPG=0.084, PCH=0.057, PLDLC=0.098), compared with a significant increase of triglycerides (TG) and LDL-C levels in the control group (PTG=0.041, PLDL-C=0.038). There were some positive dietary, physical activity, or sedentary behaviour changes found in the students of the intervention group as the scores of the questionnaire got significant improvement (P=0.04). Our one-year multicomponent school-based intervention programme did have positive effects to some extents on health state and lifestyle behaviour of overweight and obese children and adolescents, which indicated that it is feasible and important to implement such a school-based intervention programme in Shantou city.

Cost-effectiveness of a one-year coaching program for healthy physical activity in early rheumatoid arthritis

Purpose: To describe cost-effectiveness of the Physical Activity in Rheumatoid Arthritis (PARA) study intervention. Method: Costs were collected and estimated retrospectively. Cost-effectiveness was calculated based on the intervention cost per patient with respect to change in health status (EuroQol global visual analog scale – EQ-VAS and EuroQol – EQ-5D) and activity limitation (Health assessment questionnaire – HAQ) using cost-effectiveness- and cost-minimization analyses. Results: Total cost of the one-year intervention program was estimated to be €67 317 or €716 per participant. Estimated difference in total societal cost between the intervention (IG) and control (CG) was €580 per participant. Incremental cost-effectiveness ratio (ICER) for one point (1/100) of improvement in EQ-VAS was estimated to be €116. By offering the intervention to more affected participants in the IG compared to less affected participants, 15.5 extra points of improvement in EQ-VAS and 0.13 points of improvement on HAQ were gained at the same cost. “Ordinary physiotherapy” was most cost-effective with regard to EQ-5D. Conclusions: The intervention resulted in improved effect in health status for the IG with a cost of €116 per extra point in VAS. The intervention was cost-effective if targeted towards a subgroup of more affected patients when evaluating the effect using VAS and HAQ.Implications for RehabilitationThe physical activity coaching intervention resulted in an improved effect on VAS for the intervention group, to a higher cost.In order to maximize cost-effectiveness, this type of physical activity coaching intervention should be targeted towards patients largely affected by their RA.The intervention is cost-effective from the patients’ point of view, but not from that of the general population.

An outpatient antibacterial stewardship intervention during the journey to JCI accreditation

BackgroundAntibacterial overuse, misuse and resistance have become a major global threat. The Joint Commission International (JCI) accreditation standards include quality improvement and patient safety, which is exemplified by antimicrobial stewardship. There are currently few reports on interventions to improve the quality of outpatient antibacterial prescribing.MethodsA before-after intervention study, aiming at antibacterial use in outpatients, was performed in a university-affiliated hospital with 2.8 million outpatient visits annually during the journey to JCI accreditation (March of 2012 - March of 2013). Comprehensive intervention measures included formulary adjustment, classification management, motivational, information technological, educational and organizational measures. A defined daily dose (DDD) methodology was applied. Pharmacoeconomic data and drug-related problems (DRPs) were statistically compared between the two phases.ResultsThe variety of antibacterials available in outpatient pharmacy decreased from 38 to 16. The proportion of antibacterial prescriptions significantly decreased (12.7% versus 9.9%, P < 0.01). The proportion of prescriptions containing the restricted antibacterials was 30.4% in the second phase, significantly lower than the value of 44.7% in the first phase (P < 0.01). The overall proportion of oral versus all antibacterial prescriptions increased (94.0% to 100%, P < 0.01) when measured as defined daily doses. Statistically significant increases in relative percentage of DDDs of oral antibacterials (i.e., DDDs of individual oral antibacterial divided by the sum of DDDs of all antibacterials) were observed with moxifloxacin, levofloxacin, cefuroxime axetil, ornidazole, clindamycin palmitate, cefaclor, amoxicillin and clarithromycin. Occurrence rate of DRPs decreased from 13.6% to 4.0% (P < 0.01), with a larger decrease seen in surgical clinics (surgical: 19.5% versus 5.6%; internal medicine: 8.4% versus 2.8%, P < 0.01). The total expenditure on antibacterials for outpatients decreased by 34.7% and the intervention program saved about 6 million Chinese Yuan Renminbi (CNY) annually.ConclusionThe one-year intervention program on outpatient antibacterial use during the journey to JCI accreditation reduced the expenditure on antibacterials, improved the appropriateness of antibacterial prescriptions. Quality improvements need integrated multifaceted intervention measures and long-term adherence to the antibiotic stewardship. Approach of i.v. to oral antibacterial switch, classification management, and motivational measures may play the most efficient role in changing antibacterial prescription practices.

Pharmacists solving problems in asthma management — experiences from a one-year intervention programme in Finland

Abstract Objective To study the effect of an intervention provided by community pharmacists on detection and resolution of problems in asthma patients' self-management and to study patients' opinions about the perceived usefulness of the pharmacists' input. Method A one-year intervention study was conducted with scheduled visits and follow-ups at baseline, four, eight and 12 months. Study patients (n=28) acted as their own controls. Setting Four communities and community pharmacies in different parts of Finland. Key findings At study baseline, all patients had at least one documented problem, the most commonly reported being problems with medication, side effects, problems with inhalation devices and not using asthma medicines according to the physician's instructions. On average, patients had five “intervention” consultations with the pharmacist during the one-year study. After the intervention, half of the patients reported that their problems had been resolved. The most useful areas of advice were considered by the patients to be instructions about changing asthma medication according to asthma symptoms and management of asthma symptoms. Twenty-five of the 28 patients reported that they were satisfied with the education and counselling provided by pharmacists, a higher number than for physicians or nurses. Conclusion The findings from this small longitudinal study indicate that community pharmacists can improve asthma patients' treatment by consultations during which they identify and address problems in self-management of asthma.

The social meaning of smoking for boys in a residential school for children with emotional and behavioural disorders

IN 1990, a one-year intervention programme was begun in a residential school for boys with emotional and behavioural disorders with the aims of negotiating changes in the school's lax policy on smoking, and reducing the smoking rates amongst the boys, 93 per cent of whom were regular smokers. As part of this programme, a sample of 34 boys aged 12 to 15 years were interviewed on a one-to-one basis using a structured questionnaire to find out about smoking prevalence at school and at home. They were asked what, if anything, would tempt them to reduce or give up their habit. The boys smoked between five and 30 cigarettes per day between Monday and Friday at school, and between five and 40 cigarettes per day at the weekend at home. With one exception, all the boys smoked more cigarettes during the weekend than they did during the week. Three-quarters of the boys said that they had tried to give up smoking, and that a fitness programme was the only thing which would tempt them to try again. This study suggests the importance of the social meaning of smoking for children, and reinforces the idea, established in other research, of the strong link between smoking and identification with peer groups and peer lifestyles.

The ischemic heart disease life stress monitoring program: Possible therapeutic mechanisms

Abstract This paper attempts to identify the therapeutic components responsible for the mortality-reducing impact of the Ischemic Heart Disease Life Stress Monitoring Program. Designed to break the link between stress and illness, this one-year intervention program for patients recovering from myocardial infarctions included monthly telephone monitoring of psychological symptoms of stress and home nursing visits for high stress patients. Nursing interventions were individually tailored for each patient and involved a combination of teaching, support and referral strategies. A randomized controlled trial of the program. involving 453 male patients showed that it reduced stress symptoms and cut one-year mortality rates by 50%. These results are considered in the context of the approaches and outcomes of other educational and support programs for cardiac patients. In addition to sample size two factors appear to differentiate the program from other less successful therapies: patient selection for treatment on the basis of stress scores, and individualized treatment. It is also suggested that stress reduction is not the only plausible mechanism for program impact. Increased compliance with beta-blocking medication may also have been involved. In addition to using larger sample sizes future evaluations of cardiac rehabilitation program should be designed to allow the differentiation of these alternate therapeutic mechanisms.