Individual Programs Research Articles

Piloting a patient navigation programme for individuals living with dementia, their care partners and members of the care team: protocol for a mixed-methods evaluation

IntroductionInternationally, the number of individuals living with dementia continues to rise. Individuals living with dementia, their care partners and their care team face many barriers and challenges to accessing dementia...

Adherence to home visit protocol in the nutritional care program for individuals with special dietary needs

Adherence to home visit protocol in the nutritional care program for individuals with special dietary needs

Lifetime Cost-Effectiveness of Structured Education and Exercise Therapy for Knee Osteoarthritis in Australia.

Structured education and exercise therapy programs have been proposed to reduce reliance on total knee replacement (TKR) surgery and improve health care sustainability. The long-term cost-effectiveness of these programs is unclear. To estimate the lifetime cost-effectiveness of implementing a national structured education and exercise therapy program for individuals with knee osteoarthritis with the option for future TKR compared with usual care (TKR for all). This economic evaluation used a life table model in combination with a Markov model to compare costs and health outcomes of a national education and exercise therapy program vs usual care in the Australian health care system. Subgroup, deterministic, and probabilistic sensitivity analyses were completed. A hypothetical cohort of adults aged 45 to 84 years who would undergo TKR was created. Structured education and exercise therapy intervention provided by physiotherapists. The comparator was usual care where all people undergo TKR without accessing the program in the first year. Incremental net monetary benefit (INMB), with an incremental cost-effectiveness ratio threshold of 28 033 Australian dollars (A$) per quality-adjusted life-year (QALY) gained, was calculated from a health care perspective. Transition probabilities, costs, and utilities were estimated from national registries and a randomized clinical trial. The hypothetical cohort included 61 394 individuals (53.9% female; 93.6% aged ≥55 years). Implementation of an education and exercise therapy program resulted in a lifetime cost savings of A$498 307 942 (US $339 922 227), or A$7970 (US $5537) per individual, and resulted in fewer QALYs (0.43 per individual) compared with usual care. At a population level, education and exercise therapy was not cost-effective at the lifetime horizon (INMB, -A$4090 [-US $2841]). Subgroup analysis revealed that the intervention was cost-effective only for the first 9 years and over a lifetime only in individuals with no or mild pain at baseline (INMB, A$11 [US $8]). Results were robust to uncertainty around model inputs. In this economic evaluation of structured education and exercise therapy compared with usual care, the intervention was not cost-effective over the lifetime for all patients but was for the first 9 years and for those with minimal pain. These findings point to opportunities to invest early cost savings in additional care or prevention, including targeted implementation to specific subgroups.

Physical and mental health trajectories: A longitudinal SF-36 analysis in Alpha-1 antitrypsin deficiency-associated COPD

BackgroundThe Short Form 36-Item Health Survey (SF-36) is a health-related quality of life (HRQoL) measure validated in people with chronic obstructive pulmonary disease (COPD). While physical health is often more impaired than mental health in people with COPD, research on alpha-1 antitrypsin deficiency (AATD)-associated COPD is limited. This longitudinal study examines changes in physical and mental health in individuals with AATD and associated factors. MethodsAnalyses included participants of AlphaNet, a disease management program for individuals with AATD-associated lung disease who are prescribed augmentation therapy. Norm-based SF-36 scores for mental and physical component summaries (MCS and PCS) and 8 scales were analyzed. Linear mixed models evaluated mean changes in SF-36 scores over time. ResultsThe study included 2165 participants (mean age 56.9 ± 10.0 years, 47.0 % female). At enrollment, mean PCS score was 37.5 ± 9.6, and mean MCS score was 51.9 ± 10.5. Mean mMRC dyspnea score was 2.3 ± 1.3; 54.6 % had ≥2 exacerbations annually, and 46.5 % used oxygen regularly. Average follow-up was 6.6 ± 3.2 years. The HRQoL remained stable; MCS improved by 0.16 points/year (p < 0.0001), while the PCS score declined by 0.49 points/year (p < 0.0001). Subscales followed similar trends. ConclusionsAt baseline, mental HRQoL scores were higher than physical HRQoL scores, indicating better mental health than physical health in this cohort with AATD-associated lung disease. Stable HRQoL with a slight improvement in mental scores over time and a small decrease in physical scores may be a unique feature of this cohort. Further studies are needed to correlate these findings with disease-specific instruments and patient physiology.

Prevalence of abnormal thyroid function test in adults attending primary care setting in the year 2022 in the Kingdom of Bahrain

ABSTRACT Background: Thyroid disease is known to be one of the most common endocrine diseases globally and has serious health implications if left untreated. Objective: This study aimed to gain a better understanding of common thyroid diseases and to explore the associated risk factors in the Kingdom of Bahrain. Methods: A case-control study was carried out after obtaining all thyroid stimulating hormone (TSH) results done in a primary healthcare setting from January 1, 2022 to December 31, 2022 from the Health Information Department. In total, 500 participants were randomly selected from each group: the abnormal thyroid test group (cases) and the normal thyroid test group (controls). Participants were interviewed using a structured list of associated risk factors with the following sections: sociodemographic characteristics, comorbidities, family history of thyroid disease, BMI, previous radiation therapy, and certain medications. Results: The prevalence of abnormal thyroid tests was found to be 11%. Cases were categorized into four groups: hyperthyroidism (26.4%), hypothyroidism (64.6%), hyperthyroidism (4.5%), and subclinical hypothyroidism 13 (4.5%). The results showed significant differences between case and control in the following risk factors: female sex, increasing age, BMI, dyslipidemia, family history of thyroid disease, and previous radiation therapy (P = &lt;0.05). Conclusion: In summary, the high prevalence of abnormal thyroid results highlights the need for an organized national screening program for individuals at average risk for developing thyroid disease.

Effects of group-based versus individual physical exercise programs for knee osteoarthritis: A systematic review and meta-analysis

Background: Knee osteoarthritis (OA) is the most common joint disease worldwide and is associated with a high rate of disability and poor quality of life. However, little is known about the therapeutic effects of group-based versus individual-based physical exercise protocols. Objective: To investigate the effects of individual versus group-based physical exercises on pain intensity and functional outcomes in people with knee OA. Methods: MEDLINE/PubMed, Cochrane, EMBASE, and PEDro databases were searched from the earliest date available to July 2023. Study quality was evaluated using the PEDro scale. Mean difference (MD), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated using a random effect model. Results: Six studies, with 763 patients, met the study criteria. Group-based physical exercises improved pain intensity (VAS 0-100) MD -17.2 (95% CI: -22.2 to -12.3), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale MD -0.54 (95% CI: -1.0 to -0.08), WOMAC function subscale MD -2.1 (95% CI: -4.1 to -0.08) compared to individual modality. No significant difference regarding muscle strength and exercise tolerance was found for participants in the group-based physical exercises compared with individual physical ones. Conclusion: Group-based physical exercise was more successful in reducing pain intensity and functional impairment in patients with knee OA than individual exercise programs. Both group-based and individual physical exercise programs enhanced muscle strength and 6-minute walk distance.

Academy NExT: New and Exciting Transitions—A Residential Summer Program for Individuals With Disabilities

Academy New and Exciting Transitions (NExT) was developed to serve participants who have an Individualized Education Program or 504 ages 15–21 in a residential program grounded in high-interest activities that include vocational and technical programs. The focus of the summer program was to develop communication, interview skills, and career exploration across a wide variety of vocational and technical careers that required minimal to substantial postsecondary training. Academy NExT is part of preemployment transition activities funded through a collaborative effort with Vocational Rehabilitation Services and the Workforce Innovation Opportunity Act. The article presents an overview of the program and outcomes based on qualitative findings.

Community Connector Pilot – Review Of A Non-Clinical Programme Within An Integrated Care Programme For Older Persons Team

Abstract Background A Community Connector is a specialist Social Prescriber for older individuals who often present with complex medical needs and are referred directly by an Integrated Care team. The programme is a collaborative model between this team and a respective community host organisation. Integrated Care, as part of the Sláintecare Programme, places a stronger emphasis on social supports and person-centredness as key elements in healthcare (Goodwin, 2013). Methods Referrals are received approximately two to three weeks prior to discharge from the Integrated Care team which allows for relevant feedback from the Community Connector to this team. A coaching approach is utilised as a way of exploring each participant’s individual priorities and their expressed interests and goals in order to enhance their awareness of resources and supports in their own community and their subsequent readiness to engage. This process involves co-creating a personalised wellbeing plan with each individual which can act as the basis for a joint learning journey together. Results On referrals received to the programme, ongoing data is recorded regarding the number of individuals participating, the activities undertaken and the outcomes affecting the wellbeing of participants. Social isolation is a key reason for referral among this cohort in addition to cognitive stimulation, reengagement in social outlets and carer stress. Programme participants continue to be referred to a range of community activities, programmes and supports. Preliminary findings show an increase in community connectedness in regard to individuals’ increased knowledge and subsequent participation in local activities. Conclusion Key qualitative and quantitative data are the basis for initial and ongoing evaluation of the programme. These include recording any reflections and challenges which then act as key learning tools in delivering a unique person-centred programme for older individuals.

Development And Content Validation Of Lower Limb Task-Oriented Exercise Program For Individuals With Sub-Acute Stroke

Development And Content Validation Of Lower Limb Task-Oriented Exercise Program For Individuals With Sub-Acute Stroke

CDC Program Evaluation Framework, 2024.

Program evaluation is a critical tool for understanding and improving organizational activities and systems. This report updates the 1999 CDC Framework for Program Evaluation in Public Health (CDC. Framework for program evaluation in public health. MMWR Recomm Rep 1999;48[No. RR-11];1-40) by integrating major advancements in the fields of evaluation and public health, lessons learned from practical applications of the original framework, and current Federal agency policies and practices. A practical, nonprescriptive tool, the updated 2024 framework is designed to summarize and organize essential elements of program evaluation, and can be applied at any level from individual programs to broader systems by novices and experts for planning and implementing an evaluation. Although many of the key aspects from the 1999 framework remain, certain key differences exist. For example, this updated framework also includes six steps that describe the general process of evaluation planning and implementation, but some content and step names have changed (e.g., the first step has been renamed Assess context). The standards for high-quality evaluation remain central to the framework, although they have been updated to the five Federal evaluation standards. The most substantial change from the 1999 framework is the addition of three cross-cutting actions that are core tenets to incorporate within each evaluation step: engage collaboratively, advance equity, and learn from and use insights. The 2024 framework provides a guide for designing and conducting evaluation across many topics within and outside of public health that anyone involved in program evaluation efforts can use alone or in conjunction with other evaluation approaches, tools, or methods to build evidence, understand programs, and refine evidence-based decision-making to improve all program outcomes.

Comparative Analysis of Independent Reviewer-Rated and Self-Rated Fidelity Scores in Individual Placement and Support Programs: Repeated Cross-Sectional Surveys.

Fidelity assessments can contribute to maintaining the adherence to the individual placement and support (IPS) model, which enhances vocational outcomes for individuals with mental illness worldwide. While independent reviews are standard, self-assessments could broaden the implementation of IPS. This study aimed to evaluate reviewer-rated and self-rated fidelity assessments using the Japanese version of the Individualized Supported Employment Fidelity Scale (JiSEF), and to compare the two assessment methods in terms of their correlations with employment outcomes in Japan. Over the 3-year research period, fidelity assessments were conducted by independent reviewers and trained program staff members across 26 programs, totaling 58 assessments. Analyses involved kappa statistics for item-level comparison, the intra-class correlation coefficient (ICC) and paired t-testfor the overall fidelity scores, and Pearson's correlations to examine the relationship between the fidelity scores and program-level employment outcomes. Most individual JiSEF items demonstrated fair to good reliability between reviewer-rated and self-rated assessments. The ICC for the overall JiSEF scores between the two assessment methods was 0.756, yet the distribution of self-rated scores was more scattered compared with that of reviewer-rated scores. The mean total scores from self-assessments were significantly lower than those from reviewer assessments (t = 2.072, P = 0.043). While both sets of scores correlated significantly with employment rates (r = 0.640, P < 0.001 for reviewer assessments; r = 0.325, P = 0.013 for self-assessments), the correlation was stronger for reviewer ratings (z = 2.207,P = 0.027). Self-rated fidelity assessments offer several benefits. However, since independent reviews had a more normal distribution and higher correlation with employment outcome, they should remain the priority in fidelity assessments within the Japanese IPS framework.

Inclusive Universities. Exploring the well-being of university students with special needs in Albania

Aim. The purpose of this study is to explore the issue of the inclusion of university students with special needs (USSN) in universities and their social well-being, based on the case of the Faculty of Social Sciences at the University of Tirana in the Republic of Albania. Methods. The methodology used is based on the combination of secondary sources, with primary ones, provided through the interview of the academic and administrative staff, parents and students. Results. The study highlighted that in the Republic of Albania important positive steps have been taken in improving the legislation of Higher Education regarding the inclusion of UUUUSSN in universities. This has been successfully adapted to the Unaiversity Statute of the University of Tirana. Also, the study highlighted that even from the infrastructural aspect, some opportunities have been created for USSN in this faculty, but they are still insufficient. The lack of protocols and individual programmes for the treatment of USSN is a necessity. Regardless of these shortcomings and some people’s skepticism about the participation of USSN in university education, a friendly climate is created in this faculty, in function of the social well-being of USSN. Conclusions. As a conclusion, the adaptation of the philosophy of inclusion in concrete practices is met with numerous challenges. Regarding the creation of a friendly climate in function of the social welfare of USNS, the case of the Faculty of Social Sciences at the University of Tirana constitutes a positive model, which should be promoted.

Functional and subjective outcomes after surgical management of complex elbow dislocations: a retrospective study.

Dislocations of the elbow are the second most frequent upper-body injury after shoulder dislocations, comprising 11-28% of all elbow injuries. Complex elbow dislocations pose challenging management due to the involvement of critical stabilizing structures. This study aimed to investigate functional and subjective outcomes (MEPS, DASH, Oxford score) in 44 patients with complex elbow dislocations who underwent surgery between 2018 and 2020, with subgroup analysis focusing on gender and age differences. A retrospective analysis was conducted on patients treated at C.T.O. Hospital, Turin, for complex elbow dislocations between January 2018 and December 2020. Surgical approaches included radial head synthesis, coronoid fixation, ligamentous repair, and ulnar nerve management. Postoperatively, patients followed a standardized or individualized program. Data analysis involved t-tests to assess score differences between subgroups. Among the 44 analyzed patients, the mean age was 48years, and the mean follow-up time was 29months. Various types of complex dislocations were identified, with radial head and coronoid fractures classified accordingly. Surgical approaches included multiple methods of reduction and synthesis. While most patients adhered to postoperative programs, subsequent reoperations were conducted in 11% of cases. Scores did not significantly differ between genders, although a trend toward better DASH scores in males was observed. Younger patients showed better, though not statistically significant, outcomes in mobility and functional measures. This study underscores the importance of pre-operative assessment for positive surgical outcomes in complex elbow dislocations. Additionally, findings suggest that younger age may correlate with slightly better functional outcomes. Despite limitations such as retrospective design and sample size, the study enhances our understanding of complex dislocation outcomes and provides valuable insights for future interventions.

Comparison of On-Campus and Off-Campus Summer Training on Strength Performance of College Football Players

The purpose of this study was to assess changes in one-repetition (1RM) strength performances during summer training in college football players who remained on-campus and those who did not. NCAA Division II players (n = 85, weight = 102.2 ± 22.8 kg) self-selected to stay on-campus for 90% of the summer (ES, n = 14), 50% of the summer (PS, n = 24), and 0% of the summer (NS, n = 47). 1RM for bench press (BP) and squat (SQ) were performed at the beginning of summer and prior to fall training camp. Each player received individualized resistance training programs throughout the summer based on pre-test maximal strength measurements. Comparison of post-training BP improvement scores indicated significantly greater gain (p&lt;0.01) for ES and PS (10.5 ± 8.5 kg and 8.0 ± 6.2 kg, respectively) than for NS (1.5 ± 5.1 kg). Post-training gain scores for SQ indicated ES (39.4 ± 30.6 kg) was significantly greater than PS (22.7 ± 18.8 kg) which was significantly greater than NS (1.7 ± 10.7 kg). Whether due to more consistent routine of training and/or greater motivation, resistance training under the supervision of a strength and conditioning specialist during the summer produced significantly greater improvements in both BP and SQ for those athletes who remained on-campus compared to those players who left campus for the entire summer.

ИСПРАВЛЕНИЕ И РЕСОЦИАЛИЗАЦИЯ: К ВОПРОСУ О КОНЦЕПТУАЛЬНОЙ ЯСНОСТИ

The article analyzes the problems of correction and re-socialization of convicts and former convicts. According to the author, many issues of correction and re-socialization remain open, there is a lack of conceptual clarity in understanding these processes. The conclusion is proposed for discussion that in the process of re-socialization of convicts and former convicts, two stages can be distinguished – social readaptation and internalization. It is proved that social readaptation as an adaptation of convicts and persons who have served their sentences to new or restored norms and values, social roles can be expressed in obtaining general or additional education, vocational training, advanced training, involvement in paid work, development of mutual assistance among convicts, restoration and (or) development of ties with relatives, friends, colleagues, etc. It is noted that at the second independent stage of re-socialization, the acquired experience, values are reinteriorized with the help of other people, social institutions: they are assimilated, incorporated into the inner world of individuals, turning into a kind of reflex. The article substantiates the position that the process of re-socialization should be implemented through individual social rehabilitation programs and act in accordance with international acts as a way to achieve the main goal – the reintegration of convicts into society. It is concluded that the focus of penal enforcement policy should not be on absolute theories with ideas of retribution, which represent «the criminal as a rational agent weighing the costs and benefits of crime,» but on correctional concepts that see the criminal as a person amenable to correction and in need of support and treatment.

Impaired Social Attention and Cognitive Empathy in a Paediatric Sample of Children with Symptoms of Anxiety.

Impairments in social cognition, in particular empathy, have been associated with childhood psychopathology, though previous investigations have yielded inconsistent results. Measures of social attention can reveal processes involved in responses to emotional stimuli and highlight deficits in empathy, or emotional biases in those with anxiety. The current study examined symptoms of anxiety, cognitive and affective empathy scores, and eye-gaze patterns in a pediatric sample of children (n = 178; 51-98 months-old) referred by their teachers for emerging psychopathology symptoms at school. We used eye-tracking metrics to capture gaze patterns during a dynamic video task designed to elicit empathic responses. Anxiety symptomology was reported by parents using the Screen for Child Anxiety Related Disorders scale (SCARED). Associations between eye-tracking variables, cognitive and affective empathy, and anxiety scores were analysed dimensionally in accordance with the Research and Domain Criteria (RDoC) framework. Higher levels of anxiety were associated with lower cognitive empathy and shorter first and total fixation durations to the eyes, across emotions (happiness, sadness, fear). No such associations were found between affective empathy and anxiety. Hierarchical multiple regression analyses revealed that across emotion conditions, first fixation duration negatively predicted anxiety scores. Our results indicate that children high in anxiety display cognitive empathy impairments and shorter attention to the eyes. These findings could inform early intervention programs for individuals at risk of developing anxiety disorders, as educating those high in anxiety on ways to identify emotions in others through changes in social attention could help to reduce anxiety.

대학생의 5성격유형, 불안, 우울이 회복탄력성에 미치는 영향 요인

Objectives The purpose of this study is to understand the Big 5 personality factor in individual factors and anxiety and depression in psychological factor on resilience of university students. Methods Data were collected throughs self-report questionnaires between November 17 and to December 22. Participants were comprised of a convenience sample of 198 college students. Collected data were analyzed by frequency and percentage, mean and standard deviation, t-test, ANOVA, Pearson's correlation, and Multiple regression by SPSS/WIN 25.0. Results The resilience of research subjects was higher than the moderate level, and in the score of each area, the optimism and perseverance were the highest. Resilience according to general characteristics showed statistically significant differences depending on gender, satisfaction with major, club activities, regular exercise, perceived physical health, perceived mental health, Daily internet use time and Daily smartphone use time. Agreeableness and Resilience had negative correlations between Openness, anxiety, depression and Resilience. The Openness, satisfaction with major, Agreeableness, Conscientiousness, perceived physical health, perceived mental health, depression and Neuroticism had effects on Resilience. Conclusions In order to increase the resilience of college students it would be necessary to enhance the manage in physical, mental health it would be necessary to enhance the Satisfaction in major, improve the Openness, Agreeableness, Conscientiousness. In order to improve these factors, intervention in individual counseling programs that take personality factors into account will also be necessary.

Exploring the Impact of an Arts Exposure Programme for Individuals Experiencing Housing Vulnerability

Participatory art-based activities (e.g. dancing, drumming, painting, singing) are beneficial for individuals experiencing housing vulnerability. Less is known about how receptive arts engagement (e.g. visiting a museum) may or may not be beneficial for similar populations. In a large U. S. Midwestern city, a homelessness services provider partnered with a local arts organisation to develop an arts exposure programme for a group of individuals experiencing housing vulnerability. Using qualitative methods, including observation and focus groups, this study explored the impact of the programme on participants. Findings show most participants had prior and ongoing experiences with and interests in the arts. In focus group discussions, participants reflected on their unique access to the events, experiences of cultural resonance, and new perspectives gained from the events. These findings suggest receptive arts engagement offers similar benefits as participatory arts-based activities, including opportunities for empowerment, critical dialogues around issues of power, oppression, and privilege, and social connection. They also underscore the need for additional research in this area and increased arts accessibility for individuals experiencing housing vulnerability.

Can general exercise training and pelvic floor muscle training be used as an empowering tool among women with endometriosis? Experiences among women with endometriosis participating in the intervention group of a randomized controlled trial

BackgroundThe potential benefit of exercise in alleviating symptoms of endometriosis is unclear. Still, exercise may be used to empower women and manage disease symptoms. The purpose of this study was to explore how regular supervised group- and individual exercise training, including pelvic floor muscle training (PFMT), is experienced among women with endometriosis after participating in a randomized controlled trial (RCT).MethodsAmong 41 women randomized to exercise training for four months, ten women were interviewed about their experiences with exercise training after participation in the trial. The weekly group training was led by women’s health physiotherapists and included individualized and progressive muscular strength training of large muscle groups and the pelvic floor muscles, in addition to endurance-, flexibility, and relaxation training. An individual training program followed the same principles as the group training and was to be performed 3–5 times per week, depending on the level of intensity. PFMT was recommended daily. The women also received a group pain management course emphasizing exercise training as self-management. Using inductive reflexive thematic analysis, responses to the question “Did participation in the study change your view of exercise as part of the treatment for endometriosis?“ were analyzed.ResultsThe women brought forward the importance of knowledge about the benefits of exercise to make informed decisions in disease management. Further, the women described how exercise training was perceived as less frightening and manageable when exposed to various intensities, dosages, and types of exercises in a safe and supportive environment. PFMT was especially brought forward as something new and appreciated, and for some of the women, to be performed on days when their bodies could not handle the general exercise training. They also expressed that the supervised exercise brought an extra dimension of belonging through group participation.ConclusionsIndividualization and regular supervision seem important to empower women with knowledge about exercise training as self-management and to experience exercise training as safe and non-threatening. Further, creating a sense of belonging through group training may improve social support and build active coping strategies that are essential for disease management of endometriosis.Trial registrationNCT05091268 (registered 23.09.2021).

Neurofibromatosis type1 adult surveillance form for Austria.

Neurofibromatosis type1 (NF1) is arare autosomal dominant tumor predisposition syndrome with abirth prevalence of approximately 1in 2000-3000 individuals. Management of both benign and malignant tumors arising in individuals with NF1 is demanding and tumors may be difficult to treat. Both standardized and individual surveillance programs are therefore highly important to prevent morbidity and mortality in patients with NF1. The guidelines for the clinical management of NF1 recently proposed by the European Reference Network for Genetic Tumor Risk Syndromes provide the cornerstone of the present surveillance form and were discussed through three rounds of voting and afinal consensus meeting involving experts from five Austrian and one German clinical NF1 centers for adults and one patient organization representative. Subsequently, 31items within 4categories were integrated into the proposed surveillance form for Austria. All recommendations, unless otherwise specified, pertain to primarily asymptomatic patients in routine follow-up. At healthcare transition from pediatric to adult surveillance or the initial visit in adulthood, we suggest athorough clinical, laboratory and radiological examination to obtain abaseline for future diagnostics. To comply with the general screening recommendations in Austria, we suggest extending the frequency of clinical visits from annual to biennial at 50years of age. In cases of clinical dynamics, early follow-up is recommended to facilitate early detection of potential complications. Particular emphasis should be placed on preventive patient education.