Intervention Subjects Research Articles

Interventions to Mitigate Fatigue Induced by Physical Work: A Systematic Review of Research Quality and Levels of Evidence for Intervention Efficacy.

We present a literature review on workplace physical fatigue interventions, focusing on evaluating the methodological quality and strength of evidence. Physical fatigue is a recognized workplace problem, with negative effects on performance and health-related complaints. Although many studies have focused on the mechanisms and consequences of fatigue, few have considered the effectiveness of interventions to mitigate fatigue. A systematic review of the workplace safety literature for controlled trials of physical fatigue interventions was conducted. Data on intervention type, subject characteristics, targeted tasks and body locations, outcome measures, and study design were extracted. The methodological quality for each study was evaluated using the PEDro scale, and the level of evidence was based on quality, amount, and consistency. Forty-five controlled trials were reviewed, examining 18 interventions. We categorized those interventions into individual-focused (N = 28 studies, nine interventions), workplace-focused (N = 12 studies, five interventions), and multiple interventions (N = 5 studies, four interventions). We identified moderate evidence for interventions related to assistive devices and task variation. There was moderate evidence supporting no fatigue attenuation for the garment change category of interventions. The interventions in the remaining categories had limited to minimal evidence of efficacy. The heterogeneity of the included trials precludes the determination of effect size. This review showed a lack of high levels of evidence for the effectiveness of most physical fatigue interventions. Due to a lack of high levels of evidence for any category of reviewed physical fatigue interventions, further high-quality studies are needed to establish the efficacy of others.

Impact of a Patient-Centered Behavioral Economics Intervention on Hypertension Control in a Highly Disadvantaged Population: a Randomized Trial.

Uncontrolled hypertension contributes to disparities in cardiovascular outcomes. Patient intervention strategies informed by behavioral economics and social psychology could improve blood pressure (BP) control in disadvantaged minority populations. To assess the impact on BP control of an intervention combining short-term financial incentives with promotion of intrinsic motivation among highly disadvantaged patients. Randomized controlled trial. Two hundred seven adults (98% African American or Latino) aged 18 or older with uncontrolled hypertension attending Federally Qualified Health Centers. Six-month intervention, combining financial incentives for measuring home BP, recording medication use, BP improvement, and achieving target BP values with counseling linking hypertension control efforts to participants' personal reasons to stay healthy. Primary outcomes: percentage achieving systolic BP (SBP) < 140mmHg, percentage achieving diastolic BP (DBP) < 90mmHg, and changes in SBP and DBP, all after 6months. Priority secondary outcomes were SBP < 140mmHg, DBP < 90mmHg, and BP change at 12months, 6months after the intervention ended. After 6months, rates of achieving target BP values for intervention and control subjects respectively was 57.1% vs. 40.2% for SBP < 140mmHg (adjusted odds ratio (AOR) 2.53 (1.13-5.70)), 79.8% vs 70.1% for DBP < 90mmHg (AOR 2.50 (0.84-7.44)), and 53.6% vs 40.2% for achieving both targets (AOR 2.04 (0.92-4.52)). However, at 12months, the groups did not differ significantly in these 3 measures: 39.5% vs 35.0% for SBP (AOR 1.20 (0.51-2.83)), 68.4% vs 75.0% for DBP (AOR 0.70 (0.24-2.09)), and 35.5% vs 33.8% for both (AOR 1.03 (0.44-2.42)). Change in absolute SBP and DBP did not differ significantly between the groups at 6 or 12months. Exploratory post hoc analysis revealed intervention benefit only occurred among individuals whose providers intensified their regimens, but not among those with intensification but no intervention. The intervention achieved short-term improvement in SBP control in a highly disadvantaged population. Despite attempts to enhance intrinsic motivation, the effect was not sustained after incentives were withdrawn. Future research should evaluate combined patient/provider strategies to enhance such interventions and sustain their benefit. NCT01402453; http://clinicaltrials.gov/show/NCT01402453.

Conceptions, Norms, and Values in the Work of Child Protective Services with Families at Risk: An Analysis of Social Workers\u2019 Diaries

Since the conceptions, norms, and values that govern the work of child protection are elusive, they are rarely discussed in the research. This study is based on diaries maintained by three social workers in relation to 15 families that were the subject of interventions by the child protective services in Sweden. All of the mothers in the 15 families had been diagnosed with mental health problems. The diaries include both significant events within the families and the social workers’ own feelings and perceptions about their work. This article discusses four themes: the Janus face of child protective services, clienthood and its conditions, child protective services and good or bad parenting, and the fathers. The results show that the families were subjected to extensive discipline. The diaries also expressed strong value judgements regarding how children should be raised. The parents’ desires and wishes were redefined by the social workers, making the parents powerless. The fathers were marginalized, which meant that an important resource within the families was lost. The parents reacted to this exercise of power in part by trying to escape it and in part by adapting to it. In summary, the desire to help was in some cases transformed into an abusive exercise of power.

Prehabilitation to Improve Positioning Reproducibility in Patients Undergoing Pelvic Radiation Therapy

Reproducible patient positioning is essential for precision in radiation therapy (RT) delivery. However, a retrospective review of pre-treatment imaging demonstrated variability in daily patient set-up. We tested the hypothesis that a structured daily pre-treatment stretching regimen is both feasible and effective for minimizing variability in positioning, as measured by sacral slope angles (SSA). After obtaining IRB approval, we had 8 female patients undergoing pelvic radiotherapy perform a structured daily hip exercise regimen (extension and external rotation) immediately prior to both simulation and daily treatment, throughout the RT course. The control group of 20 patients (17 female and 3 male) had usual care. SSA measurements on daily pre-treatment imaging were compared to SSA measurements from the simulation CT for 5 weeks. The extent of SSA variability between two groups and over time was analyzed using a linear mixed model. The same two readers independently measured SSA of all subjects, comparing SSA on the day of simulation to SSA measured on each day of RT. The average variation in SSA among the intervention subjects was 0.913° (±0.582°), with a range among subjects of 0.57°-1.3°. The average variation for the control subjects was 2.27° (±1.43°), with range among subjects of 1.22° - 5.09°. The difference between the two groups was statistically significant (p=0.002). There was a statistically significant SSA variation between groups at each week of treatment (Week (wk) 1: p = 0.007, wk 2: p = 0.008, wk 3: p = 0.01, wk 4: p = 0.005, wk 5: p = 0.008). There was no significant variation among the intervention subjects between week 1 and later weeks (wk 2: p = 0.88, wk 3: p = 0.74, wk 4: p = 0.97, wk 5: p = 0.40), whereas subjects in the control group demonstrated significant SSA variation between week 1 and the fourth week of therapy (wk 2: p = 0.87, wk 3: p = 0.92, wk 4: p = 0.02, wk 5: p = 0.22). There were no reported adverse effects of the stretching regimen. We demonstrated a significant decrease in the variability of SSA by implementing a simple pre-treatment stretching program, whereas control subjects exhibited an increasing variability of SSA over the course of treatment. We conclude that there is a potential benefit for prehabilitation during pelvic RT. A larger clinical trial is required to determine whether a pre-treatment stretching program would result in clinical benefit.

High prevalence of malnutrition among hospitalized patients in a tertiary care hospital by using malnutrition universal screening tool

EnBackgroundEstimating the prevalence of malnutrition among the hospitalized patients is challenging. Malnutrition is associated with a variety of poor outcomes including long hospital stay and mortality as well as increased hospital costs.AimThe study aims to assess the risk of malnutrition in hospitalized patients and to identify the main factors and clinical parameters associated with the risk of malnutrition.Materials and methodsThe researchers conducted a cohort study to screen for the risk of malnutrition following hospital admission in a population of adult patients recently admitted to a tertiary care hospital in Egypt using the malnutrition universal screening tool (MUST) and simplified nutritional appetite questionnaire and to assess the effect of malnutrition on duration of hospital stay.ResultsThe study included 1000 patients with a mean age of 49±13.7 years. The median duration of hospitalization was 5 (4–7) days, with a range of 2–30 days. All those included in the study presented a risk for malnutrition (1.0% medium risk and 99.0% high risk). High risk malnutrition was most common among those with diabetes (P=0.001) and renal problems (P=0.03), and in patients who had been admitted for longer hospital stay (P=0.037). A statistically positive correlation was seen between the age of the patients (P=0.031, r=−0.031), length of stay (P=0.353, r<0.001), and MUST score. However, there was a statistically significant negative weak correlation between simplified nutritional appetite questionnaire (appetite) (P=0.003, r=−0.094), BMI (P<0.001, r=−0.120), albumin (P<0.001, r=−0.117), and MUST score. Malnourished patients had a longer hospital stay than those who are well nourished (P=0.002).ConclusionWe have identified an overall malnutrition risk of 100% among the hospitalized patients and ascertained that malnutrition is a risk of prolonged length of hospital stay. MUST questionnaire should be implemented to screen and early recognize the malnourished hospitalized subjects for better intervention.

Explanatory factors of the accreditation of the General Graduation Exam (EGEL) in students of the Bachelor of Science in Education, UABC, Mexico

Research on variables related to academic performance is becoming increasingly important in universities; with special interest the study of those factors that may be subject of intervention for the improvement of the academic performance of their students (Davis &amp; Thomas, 1999). The purpose of the study, among others, was to identify the main factors associated with the accreditation of the students of the Bachelor's Degree in Educational Sciences in a standardized test called the General Graduation Exit Examination in a Mexican public university. The sample was made up of 272 supporting students; Descriptive analyzes were carried out, chi-square (X2) and a logistic regression model was generated. The main results show that the age of the supporters, the schooling of the mother and the average in the Degree are the factors that most relate to the accreditation of the exam. The study presents empirical evidences that can be useful for the obtaining of more favorable results of the students in this type of standardized evaluations and for the decision making for the improvement of the educational processes in the university.

Embryo donation: Survey of in-vitro fertilization (IVF) patients and randomized trial of complimentary counseling.

DesignThis study surveyed patients with stored frozen embryos and developed and tested an intervention through a randomized trial to support subjects to consider embryo disposition options (EDOs), especially donation for family building.MethodsBased on a review of literature on EDOs, the authors developed and mailed a 2-page anonymous survey to 1,053 patients in Massachusetts (USA) to elicit their feelings about their stored embryos. Target patients had embryos cryopreserved for ≥1 year and had not indicated an EDO. Survey respondents were next randomized between usual care (control arm) or an offer of complimentary counseling and educational support regarding EDOs. These counseling sessions were conducted by a licensed mental health professional specializing in infertility treatment.ResultsDespite telephone reminders, only 21.3% of patients responded, likely reflecting most patients’ reluctance to address EDOs. Respondents endorsed an average of 2 of the 5 EDOs, with the following percentages supporting each option: store for future attempts (82%), continue storage (79%), donate to research (29%), discard (14%), and donate for family building (13%). When asked their opinions towards embryo donation to another couple, 78% of patients agreed that donation is a way to help another couple, 48% would consider embryo donation to another family if they had a better understanding of the process, and 38% would be willing to consider donation if they were not going to use the embryos themselves, but 73% expressed discomfort with donation. In the randomized trial, 7.8% of intervention subjects (n = 8) obtained counseling sessions compared to 0.0% (none) of usual care subjects (p = 0.0069). Counseling participants valued not only discussing EDOs, but also assistance in expressing their feelings and differences with their partners.ConclusionImprovement in counseling rates over the control arm suggests that free professional counseling is a small, but likely effective, step towards deciding on an EDO.ClinicalTrials.gov Identifier: NCT01883934 (Frozen embryo donation study).

Effects of Balint group intervention on occupational burnout of primary care physicians

Objective To examine the effects of participating in Balint group (PBG) for reducing occupational burnout among primary care physicians (PCPs). Methods In this randomized controlled trial, 240 PCPs were randomly assigned to PBG (n=70) and control group (n=240) in propotion of 1∶2.Subjects of PBG received Balint group intervention for one year, while control group received natural observation.Maslach Burnout Inventory (MBI) was used to assess the severity of occupational burnout. Results At baseline all three subscales of MBI had no significant difference between PBG and cotrol group(P>0.05). After the intervention, PBG had statistically lower subscale scores in emotional exhaustion ((20.1±8.3) vs (22.6±8.7), t=1.993, P=0.048) and depersonalization ((6.8±4.9) vs (10.8±5.2), t=5.355, P<0.001) than the control group, while had statistically higher score in personal accomplishment subscale((38.3±7.5) vs (34.6±7.7), t=3.311, P=0.001) than the control group. Conclusions PBG is effective in reducing occupational burnout among PCPs. Key words: Primary health care doctors; Balint group; Randomized controlled study; Occupational burnout

Youth and adolescent social work education. Analysis of the impact of the Bologna plan on university study programs in Europe

ABSTRACTThe process of developing the European Higher Education Area (EHEA) that was initiated after the Bologna Declaration in 1999 led to the harmonization of European university systems and a profound modernization of university. Social work education has been no exception in this regard. Focusing on youth as a group subject to intervention and addressed through documents and references from the International Federation of Social Workers (IFSW), from the European Social Work Research Association (ESWRA), in specialized literature and through social services, we consider it important to analyse how young social work students are trained in order to work with young people. It should be noted that they are young to all intents and purposes once they complete their studies, thus implying they face the same problems as their target intervention subjects. For this reason, we have undertaken a cross-country comparison between undergraduate study programs that provide training in youth from 16 European universities, namely Spain, Cyprus, Czech Republic, Germany, Italy, Portugal, United Kingdom, Netherlands, Poland, and the Slovak Republic. The data obtained leads to the following paradox: the relevance of young people as a field of action does not match the creation of study programs and specific courses on the problems young people face and how to tackle them.

Emotional Coping Through Solution Focused Counselling Therapy: Case Study of Psychological Distressed Women

&#x0D; &#x0D; &#x0D; The aim of this paper was to explore the emotional coping of psychological distressed women who had undergone counselling session based on Solution Focused Therapy Module. Six (6) working women were selected as subjects based on the criteria such as currently working and have had experience symptoms of psychological distress such as anxiety and depression for the past four weeks. The subject’s levels of psychological distress were measured using the Kessler psychological distress scale (K10). In this study, qualitative case study method had been done to get in depth understand of the emotional coping styles among the subjects. The pre and post interviews had been conducted with all the subjects to explore how they cope emotionally with the psychological distress before and after the intervention. Finding of this research explained that subjects had a different style of emotional coping before and after the intervention. The subjects agreed that their type of emotions influenced the level of psychological distress. Before the intervention, subjects experienced negatives emotions that influenced them to have negative styles of emotional coping such as withdrawal, over thinking, problem avoidance and crying. After the intervention subjects experienced positive emotions that made them to be calmer and relax, they also felt better and able to think of the solutions to their problems. Thus, they need to be able to control their emotion prior to reducing the level of psychological distress. Subjects also have different coping mechanism before and after the intervention due to their age differences and maturity level.&#x0D; &#x0D; &#x0D;

Impact of lunch provision on anthropometry, hemoglobin, and micronutrient status of female Cambodian garment workers: exploratory randomized controlled trial

BackgroundLunch provision is expected to improve the nutritional status of Cambodian garment workers. The objective of this study is to evaluate the effects of a model lunch provision through a canteen on anthropometry, hemoglobin, and micronutrient status in female garment workers in Cambodia.MethodsThis exploratory randomized controlled trial was implemented at a garment factory in Phnom Penh, Cambodia. Female workers (nulliparous, non-pregnant) were recruited and randomly allocated into an intervention arm (workday’s lunch provision) and a control arm. Served lunch sets (~ 700 kcal on average) included diverse local dishes. Anthropometry (body mass index, weight, triceps skinfold thickness, and mid-upper arm muscle circumference), as well as hemoglobin, serum ferritin and soluble transferrin receptor, serum retinol binding protein, and serum folate concentrations were assessed at baseline and after 5 months of lunch provision. A general linear model with adjustments for baseline values was used to estimate intervention effects for each outcome variable.ResultsTwo hundred twenty-three women were recruited (n = 112 control and n = 111 intervention). 172 (n = 86 in each arm) completed the study. Baseline prevalence of underweight, anemia, depleted iron stores, and marginal iron stores, were 31, 24, 21, and 50%, respectively. Subjects were not affected by frank vitamin A or folate deficiency, whereas 30% showed a marginal folate status. Overall, mean changes in anthropometric variables, hemoglobin, and retinol binding protein were marginal and not significant among intervention subjects. Mean folate concentration increased insignificantly by + 1.1 ng/mL (− 0.02, 2.2) (p = 0.054). On the other hand, mean ferritin decreased by − 6.6 μg/L (− 11.9, − 1.3) (p = 0.015). Subgroup analysis prompts that effects are differently pronounced according to the baseline status of workers.ConclusionsFindings indicate that model lunch sets provided a beneficial amount of dietary folate, but need to be revisited for iron content and/or iron bioavailability. It is believed that distinct positive effects on anthropometry, hemoglobin, and micronutrient status can solely be expected in malnourished individuals. The authors suggest that similar larger trials, which include sets adapted to the concrete needs of workers affected by underweight, anemia and/or definite micronutrient deficiencies, should be performed.Trial registrationThe trial was registered at the German Clinical Trials Register (9 January 2015, Identifier: DRKS00007666).

The epidemic of major sexually transmitted diseases in Shanghai, China, 2009-2018.

Acquired immune deficiency syndrome (AIDS), hepatitis B virus (HBV), hepatitis C virus (HCV), gonorrhea and syphilis are the major sexually transmitted diseases (STDs) in the world, which are the focus of epidemic prevention and control in China. The epidemiological trend analysis of STDs in Shanghai could reflect the epidemic situation of these diseases in high-income areas of China, providing a reference for how to control their epidemic. Although the overall incidence rate of infectious diseases levelled off after 2009, Shanghai still faces many new obstacles in the fight against STDs. Without effective prevention and control strategies for high-risk behaviors, such as active sexual activity without protection, for key susceptible populations, there may be a more serious epidemic of STDs in the future. Given these situations, strategies for controlling STDs in Shanghai should be more targeted with the development of epidemics, focusing on the following key areas for future work: i) attaching importance to health education; ii) strengthening epidemic surveillance; and iii) developing Community Health Service Centers (CHSC) as intervention subjects.

Text messaging support for patients with diabetes or coronary artery disease (SupportMe): protocol for a pragmatic randomised controlled trial

IntroductionLow-cost interventions providing self-management support are needed for people with coronary artery disease (CAD) and diabetes. Mobile phone text messaging provides a potential vehicle for this. The SupportMe Trial aims...

1719-P: Plasma Glucose Response to Oral Dexamethasone Predicts Incident Prediabetes in Normoglycemic Offspring of Parents with Type 2 Diabetes

Background: Dexamethasone (dex) challenge was used historically to diagnose chemical diabetes. Here we determined its utility in predicting prediabetes in a biracial cohort. Methods: We studied 190 euglycemic subjects with parental type 2 diabetes. After a baseline 75-gram OGTT, subjects ingested 2 mg dex at 10 PM and returned at 8AM for measurement of plasma cortisol and glucose. Subjects were followed quarterly for incident prediabetes for 5 years. Serial assessments included OGTT, insulin secretion (IVGTT), and insulin sensitivity (euglycemic clamp). Results: Table 1 shows baseline characteristics and response to dex. Progressors to prediabetes had a higher glycemic response to dex than nonprogressors (&amp;lt;0.0001). In a regression model, post-dex fasting glucose level remained a significant predictor of Incident prediabetes after controlling for age, weight, waist, and baseline glucose (P&amp;lt;0.001). From ROC analysis, fasting plasma glucose ≥110 mg/dL after dex predicted incident prediabetes with 80% sensitivity and 60% specificity. Conclusion: Glycemic response to 2mg dex predicts incident prediabetes and could be useful for stratification and selection of high-risk subjects for lifestyle intervention. Table 1: Baseline demographic and glucoregulatory characteristics of subjects who developed prediabetes compared to those who remained normoglycemic. Disclosure E. Nyenwe: None. N.A. Umekwe: None. D.J. James: None. F. Ariganjoye: None. J.Y. Wan: None. S. Dagogo-Jack: Board Member; Self; Jana Care Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Sanofi-Aventis. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Stock/Shareholder; Self; Dance Biopharm Holdings Inc. Funding American Diabetes Association (7-07-MN-13 to S.D-J.); National Institutes of Health

Effect of lifestyle focused text messaging on risk factor modification in patients with diabetes and coronary heart disease: A sub-analysis of the TEXT ME study

AimsThere is potential to provide public health interventions through text messaging for patients with Type 2 diabetes mellitus (T2DM). Our objective was to ascertain if lifestyle focused text messaging addressing cardiovascular risk factors in patients with coronary heart disease (CHD) and T2DM, was more effective than usual care. MethodsThis is a secondary analysis of the TEXT ME study, a randomised clinical trial of a 6-month text messaging intervention in patients with coronary heart disease. The measured outcomes include cholesterol, blood pressure (BP), body mass index (BMI), HbA1c, waist/hip circumference and smoking status. Our objective was to ascertain if lifestyle focused text messaging in patients with T2DM was more effective than usual care, and to determine if the intervention was more effective in patients with T2DM compared to those without. Results229 participants in the TEXT ME study had T2DM (32%), 111 participants in the intervention group and 118 in the control group. At 6 months, the mean difference in systolic BP was −7.6 mmHg (95%CI −11.8, −3.37, p = 0.0003) and diastolic BP −3.7 mmHg (95%CI −6.12, −1.24, p = 0.0032). The mean difference in low density lipoprotein in the intervention arm, compared to the control arm, was −0.05 mmol/L (95%CI −0.27, 0.18, p = 0.813), and in triglycerides was −0.29 mmol/L (95%CI −0.59, 0.01, p = 0.035) respectively. The mean difference in BMI was −0.89 kg/m2 (95%CI −2.74, 0.95, p < 0.0001) in the intervention group, waist circumference −3.98 cm (95%CI −8.57, 0.61, p < 0.0001) and hip circumference −3.26 cm (95%CI −7.67, 1.16, p = 0.0006). Intervention subjects with diabetes were less likely to be smokers at 6 months. The mean difference in HbA1c between the control and intervention group was not significant (p = 0.126). The intervention was as effective in patients with diabetes, compared to those without. ConclusionAmong patients with coronary heart disease with T2DM, lifestyle-focused text messaging resulted in significant risk factor reduction.

Population Policy as a Means for Bio-Politics: The Cases of Romania and China

After the discovery of “population” in modern society, domination over the body has been enacted by a set of interventions which are called regulatory control, or bio-politics by Michel Foucault. From the eighteenth century onwards, bio-politics has involved any kind of intervention which acts as means for forming the population according to the wills of those with power. This has led to an era of bio-politics in which fertility in particular has become regulated in accordance with political economy. Hence the body, especially the female body, has been reduced to an economic object by detaching her identity, personal aspirations and desires. In turn, sexuality becomes a subject of economic interventions through pronatalist and/or antinatalist politics. In either way, those interventions should be methodologically regarded as instruments of bio-politics. This paper specifically focuses on pronatalist and antinatalist politics as bio-political instruments in the well-known Romanian case and the Chinese case by drawing upon the Foucauldian perspective of bio-politics.

The Effectiveness of Roy’s Adaptation Model for Patients with Chronic Kidney Disease Undergoing Pre-Dialysis in Indonesia

Introduction: Patients with chronic kidney disease (CKD) undergoing pre-dialysis requires a good self-management to control low protein intake and maintain kidney function. Adaptation to the existing stimulus through coping and adjustment mechanisms is important to maintaining good kidney function. However, few studies applied nursing theory based to guide intervention in helping the adaptation of patient CKD with their condition. The purpose of this study is to evaluate the effectiveness of Roy’s adaptation model towards physiological and psychological adaptation response among patients with CKD undergoing pre-dialysis.Methods: This study was conducted using a quasi-experiment to patients with CKD pre-dialysis, age over 18 years old. We modified Roy’s adaptation model for patients with CKD undergoing pre-dialysis.Results: A total of 70 subjects agreed to join the study, 38 subjects in intervention and 32 subjects in the control group. The mean of eGFR ranged from 26.3 to 26.6 mL/min/1.73 m2. We found that Roy’s adaptation model has significantly improved drinking behavior, reduce protein intake, blood creatinine, and psychosocial adaptation response after the intervention.Conclusion: These study findings suggested that Roy’s adaptation model is effective to help patients with CKD undergoing pre-dialysis improve their behavior and maintain kidneyfunction . Model dissemination, advocacy to related units, and application in nursing care in patients with chronic kidney disease pre-dialysis are necessary.

Effect of Health Coaching Delivered by a Respiratory Therapist or Nurse on Self-Management Abilities in Severe COPD: Analysis of a Large Randomized Study.

Self-management of patients with COPD has received increasing attention in recent years given its association with improved outcomes. There is a scarcity of feasible interventions that can improve self-management abilities. We recently reported the positive effect of health coaching, started at the time of hospital discharge, on re-hospitalizations and emergency department visits for patients with COPD admitted for an exacerbation. In this substudy, we aimed to investigate the effects of health coaching delivered by a respiratory therapist or a nurse compared with guideline-based usual care on self-management abilities in COPD. Self-management was measured by using the Chronic Respiratory Disease Questionnaire mastery domain and was assessed at baseline, at 6 months, and at 12 months after hospitalization. Two hundred and fifteen subjects hospitalized for a COPD exacerbation were randomized to the intervention or the control. The mean change in the Chronic Respiratory Disease Questionnaire mastery score from baseline to month 6 was Δ0.58 32 ± 1.29 on the intervention arm and Δ0.17 32 ± 1.14 on the control arm (P = .02). Of the intervention subjects, 55% had at least a 0.5-point increase in Chronic Respiratory Disease Questionnaire mastery (minimum clinically important difference) compared with 38% in the control group. Health coaching was an independent predictor of the minimum clinically important difference or greater change in the Chronic Respiratory Disease Questionnaire mastery score at 6 months after initiation of the intervention (odds ratio 1.95, 95% CI 1.01-3.79). The changes in the Chronic Respiratory Disease Questionnaire mastery score at 12 months showed a trend but did not attain statistical significance. Health coaching delivered by a respiratory therapist or a nurse improved self-management abilities when applied to subjects with COPD after hospital discharge for an exacerbation. (ClinicalTrials.gov Identifier: NCT01058486, Mayo IRB 09-004341).

Mood outcomes of a behavioral treatment for urinary incontinence in prostate cancer survivors.

This study aimed to assess whether prostate cancer survivors who received a behavioral intervention to urinary incontinence had experienced a significant mood improvement. One hundred fifty-three prostate cancer survivors with persistent incontinence were included in this secondary data analysis. They were randomly assigned to usual care or interventions that provided pelvic floor muscle exercises and self-management skills. All subjects had measures of anxiety, depression, and anger at baseline, 3months (post-intervention), and 6months (follow-up). Negative binomial regression analysis was performed to examine the group status, daily leakage frequency at 3months, and their interactions at 3months as predictors for mood outcomes at 6months, controlling for demographic and medical variables. The main effect of daily leakage frequency at 3months significantly predicted anxiety at 6months (p < .01). The group main effect on any mood outcomes at 6months was not statistically significant. The interaction between the group and 3-month leakage had a significant effect on anxiety; intervention subjects achieving a significant leakage reduction at 3months exhibited significantly less anxiety at 6months than other subjects (p = .04). Age, employment status, and receiving surgery at baseline were significantly associated with less anxiety, depression, and anger at 6months. Reduced urinary incontinence significantly predicted less anxiety, especially among the intervention subjects. The findings suggest a significant association between a behavioral therapy of urinary incontinence and anxiety reduction in prostate cancer survivors.

A Pilot Randomised Controlled Trial of a Text Messaging Intervention with Customisation Using Linked Data from Wireless Wearable Activity Monitors to Improve Risk Factors Following Gestational Diabetes.

Gestational diabetes (GDM) is a highly prevalent disorder of pregnancy which portends a high risk for future type 2 diabetes. Limited evidence indicates lifestyle intervention prevents the development of diabetes, but most previously studied interventions are resource-intensive. Intervention programs that utilise newer technologies may be scalable at lower cost. This 6-month pilot randomized controlled trial tested the delivery of text messages linked to an activity monitor, adaptive physical activity goal setting, and limited face-to-face counseling, as an intervention to improve rates of post-partum glucose tolerance testing and lifestyle behaviours amongst women following a GDM pregnancy. Sixty subjects were randomised 2:1 intervention vs. control. Compared to control subjects, there were trends for intervention subjects to improve diet, increase physical activity, and lose weight. There was no difference between the groups in the rate of glucose tolerance testing. Only 46 (77%) subjects completed some, and 19 subjects completed all the elements of the final evaluation. Feedback regarding the text messages and activity monitor was highly positive. Overall, results suggest that a text message and activity monitor intervention is feasible for a larger study or even as a potentially scalable population health intervention. However, low completion rates necessitate carefully considered modification of the protocol.