Tertiary Prevention Interventions Research Articles

Development of a complex tertiary prevention intervention for the transition out of youth homelessness

This paper describes the process of design, development, and implementation of a complex, multi-component, tertiary prevention intervention aimed at stabilizing pathways out of homelessness, the Housing Outreach Project-Collaborative (HOP-C). HOP-C is a multi-organizational, cross-sector, inter-professional collaboration. This process-oriented paper aims to elucidate the rationale for and experience of implementing the three main components of HOP-C: case management, mental health treatment and peer support, as well as the processes that support this wrap-around intervention as a whole. This paper draws on qualitative process-oriented data (i.e. field notes and interviews with staff) collected over the course of the intervention, and integrates perspectives from multiple practitioners involved in this endeavour. Practitioners reported the diversity in the type and intensity of services offered to clients, the building of a close and communicative interprofessional and inter-agency team, as well as the development of broader connectivity between organizations and practitioners as significant strengths of this approach. Challenges and successes in implementation are explored with the intention of providing insight into ways in which other collaborative complex interventions might be approached in the youth homelessness sector.

A Dissemination and Implementation Science Approach to the Epidemic of Opioid Use Disorder in the United States

This review aims to (1) conceptualize the complexity of the opioid use disorder epidemic using a conceptual model grounded in the disease continuum and corresponding levels of prevention and (2) summarize a select set of interventions for the prevention and treatment of opioid use disorder. Epidemiologic data indicate non-medical prescription and illicit opioid use have reached unprecedented levels, fueling an opioid use disorder epidemic in the USA. A problem of this magnitude is rooted in multiple supply- and demand-side drivers, the combined effect of which outweighs current prevention and treatment efforts. Multiple primary, secondary, and tertiary prevention interventions, both evidence-informed and evidence-based, are available to address each point along the disease continuum-non-use, initiation, dependence, addiction, and death. If interventions grounded in the best available evidence are disseminated and implemented across the disease continuum in a coordinated and collaborative manner, public health systems could be increasingly effective in responding to the epidemic.

Content and quality of workplace guidelines developed to prevent mental health problems: results from a systematic review.

Objectives A wide range of guidelines have been developed to prevent work-related mental health problems (MHP), but little is known about the quality of such guidelines. We systematically reviewed the content and quality of workplace guidelines aiming to prevent, detect, and/or manage work-related MHP. Methods We conducted systematic online and database searches (MEDLINE; Web of Science; PsychNET; occupational safety and health databases) to identify guidelines. Eligibility criteria included guidelines recommending primary, secondary, or tertiary preventive interventions to be implemented at the workplace by employers, employees or organizational staff. A minimum of minimum three independent reviewers assessed the quality of guidelines using the Guidelines for Research and Evaluation (AGREE II). Guidelines rated ≥65% with regards to domain I, II, and III were considered to be of good developmental quality. Results Seventeen guidelines were quality assessed. Guidelines mainly targeted employers: eight guidelines recommended primary preventive interventions (eg, reduction of psychosocial hazards by risk management procedures), three recommended tertiary (eg, stay at work or return to work procedures for management), and six recommended a combination of primary, secondary and tertiary interventions (eg, facilitate return to work by increasing mental health literacy of all staff and coordination of sick-listed employees). Four guidelines had developed recommendations of good quality, but the evidence of two guidelines was outdated and studies documenting the effect of implementation were not yet available. Conclusions Few guidelines have been developed with sufficient rigor to help employers prevent or manage work-related MHP and evidence of their effectiveness remains scarce.

Covert incivility: Challenges as a challenge in the nursing academic workplace.

The purpose of this paper is to present a Neuman Systems Model-guided discussion of current knowledge associated with covert incivility in the nursing academic workplace. The Neuman Systems Model provides a multiple discipline, systems perspective of the stressor covert incivility and levels of prevention interventions to counter it. Covert incivility is defined as a stressor that affects individual, group, community, and social systems' intrapersonal, interpersonal, and extrapersonal levels of function. Two prominent examples of expressing covert incivility in academic settings are identified-pluralistic ignorance and passive aggression. The Neuman Systems Model can guide development and testing of primary, secondary, and tertiary prevention interventions targeted to covert incivility in the nursing academic workplace, as well as outcomes of the interventions. The Neuman Systems Model is a useful multiple discipline conceptual model for identification and testing of the effects of covert incivility in the nursing academic workplace.

Effectiveness of secondary and tertiary prevention for violence against women in low and low-middle income countries: a systematic review

BackgroundViolence against women (VAW) is a major problem worldwide, with one in three women experiencing violence in their lifetime. While interventions to prevent violence (primary prevention) are extremely important, they can take many years. This review focuses on secondary and tertiary prevention interventions that address the needs of survivors of violence and aim to prevent recurrence. This review also focuses on studies taking place in low and low-middle income countries, where rates of VAW are highest.MethodsSearches of peer-reviewed and grey literature took place from March–June 2016 through databases (Embase, CINAHL, WHO Global Index Medicus, Medline, PsychINFO, Web of Science, Cochrane Library, Applied Social Sciences Index and s and Sociological s) and by consulting experts in the field. Only primary research was eligible for inclusion and studies had to focus on secondary or tertiary prevention for survivors of VAW in low or low-middle income countries. All study designs were eligible, as long as the study examined client-related outcome measures (e.g., incidence of violence, health outcomes or client satisfaction). Data were extracted and quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and a qualitative quality assessment tool developed by Mays and Pope. Due to the low number of results and heterogeneity of the study populations and outcomes, a narrative synthesis was conducted and evidence was summarized.ResultsOne thousand two hundred fifteen studies were identified through the search strategy and 22 of these met the eligibility criteria. Overall, the evidence for interventions is weak and study limitations prevent definitive conclusions on what works. There is some evidence that interventions targeting alcohol use, both among perpetrators and survivors, may be effective at reducing VAW through secondary prevention, and that psychotherapy might be effective for survivors of non-partner sexual violence through tertiary prevention. Finally, some evidence exists for crisis centres increasing survivors’ access to services (through both secondary and tertiary prevention), however, assessment of their impact on future VAW are needed.ConclusionsThough some interventions for survivors of VAW have shown evidence of effectiveness, further research is needed, especially high-quality studies with quantitative outcome data.

Eliminating Health Disparities through Action on the Social Determinants of Health: A Systematic Review of Home Visiting in the United States, 2005-2015.

The purpose of this systematic literature review was to synthesize the results of transdisciplinary interventions designed with a home visit component in experimental and quasi-experimental studies having representative samples of racial and ethnic minorities. The design of this systematic review was adapted to include both experimental and quasi-experimental quantitative studies. The predetermined inclusion criteria were studies (a) having an experimental or quasi-experimental quantitative design, (b) having a home visit as a research component, (c) including a prevention research intervention strategy targeting health and/or safety issues, (d) conducted in the United States, (e) having representation (at least 30% in the total sample size) of one or more racial/ethnic minority, (f) available in full text,and (g) published in a peer-reviewed journal between January, 2005 and December, 2015. Thirty-nine articles were included in the review. There were 20 primary prevention, 5 secondary prevention, and 14 tertiary prevention intervention studies. Community and home visitation interventions by nurses can provide an effective means for mitigating social determinants of health by empowering people at risk for health disparities to avoid injury, maintain health, and prevent and manage existing disease.

Incidence and predictors for cardiovascular disease in Chinese patients with type 2 diabetes mellitus – a population-based retrospective cohort study

AimsThis study aimed to estimate the 5-year incidence rate of cardiovascular disease (CVD) and determine predictive factors of new CVD in Chinese patients with type 2 diabetes mellitus (T2DM). MethodsA retrospective cohort study was conducted on 115,470 T2DM patients aged ≥18years without any history of CVD. Cox Proportional Hazard regression stratified by gender was performed to explore predictive factors of CVD. ResultsFor 5.3years median follow-up, the overall incidence rate of CVD per 1,000 person–years was 17.2 (95% CI: 16.9–17.6), without significant gender difference. Predictors of higher risk of CVD were older age, current smoking, longer duration of T2DM, more severe stage of chronic kidney disease, anti-hypertensive and oral anti-diabetic drugs needed, and higher body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), total cholesterol/high-density lipoprotein-cholesterol ratio (TC/HDL-C ratio) and urine albumin/creatinine ratio (ACR). Lipid-lowering agents needed in men, and ex-smoking and higher hemoglobin A1c (HbA1c) in female were the additional predictive factors of increased CVD risk. ConclusionsSmoking, BMI, HbA1c, SBP, DBP, TC/HDL-C ratio and ACR were found to be modifiable risk factors of new CVD in Chinese T2DM patients, which should be targeted as tertiary preventive interventions. The lack of association between HbA1c and CVD in men found in this study deserves further investigation.

The invisibility of men in South African violence prevention policy: national prioritization, male vulnerability, and framing prevention

BackgroundSouth Africa has a significant violence problem. The exposure of girls and women to interpersonal violence is widespread, and the victimization of men, especially to severe and homicidal forms of aggression, is of considerable concern, with male homicide eight times the global rate. In the last two decades, there have been a plethora of South African policies to promote safety. However, indications suggest that the policy response to violence is not coherently formulated, comprehensive, or evenly implemented.ObjectiveThis study examines selected South African national legislative instruments in terms of their framing and definition of violence and its typology, vulnerable populations, and prevention.DesignThis study comprises a directed content analysis of selected legislative documents from South African ministries mandated to prevent violence and its consequences or tasked with the prevention of key contributors to violence. Documents were selected using an electronic keyword search method and analyzed independently by two researchers.ResultsThe legislative documents recognized the high levels of violence, confirmed the prioritization of selected vulnerable groups, especially women, children, disabled persons, and rural populations, and above all drew on criminological perspectives to emphasize tertiary prevention interventions. There is a policy focus on the protection and support of victims and the prosecution of perpetrators, but near absent recognition of men as victims.ConclusionsThere is a need to broaden the policy framework from primarily criminological and prosecutorial perspectives to include public health contributions. It is likewise important to enlarge the conceptions of vulnerability to include men alongside other vulnerable groups. These measures are important for shaping and resourcing prevention decisions and strengthening primary prevention approaches to violence.

Multi-level preventive care for Type 2 diabetes

Type 2 Diabetes Mellitus (T2DM) accounts for 4.6 million deaths globally and for 11% of the global health expenditure (IDF, 2012). Several different primary, secondary, and tertiary preventive interventions promise better health outcomes and cost savings. Such interventions are typically studied in isolation. This paper proposes a compartmental mathematical model for T2DM that comprehends the interactions of multiple preventive interventions for various stages of T2DM, population dynamics, and the ensuing levels of clinical indicators, costs and utilities of disease states. We use the model to optimize portfolios of interventions for a multi-level preventive care program (using data from a population with high T2DM prevalence such as the UAE) and give insights about different ways in which interventions can be beneficial (such as for screening or for averting new cases). We demonstrate that the cost effectiveness with a classical discounted net present value perspective does not imply cost effectiveness for long-run planning, and that joint optimization of a portfolio of interventions can have benefits relative to the sequential optimization of interventions individually. Thus, accounting for long-run demographics and the interaction of interventions may be a useful extension to traditional cost-utility analyses when designing preventive care policies.

Social Support, Nutrition Intake, and Physical Activity in Cancer Survivors

To examine depressive symptoms, hope, social support, and quality of life in relation to fruit and vegetable (FV) intake and physical activity (PA) among cancer survivors diagnosed within the past 4 years. In 2010, participants were recruited from a southeastern US cancer center and completed a mail-based survey (response rate 22.7%) assessing these psychosocial factors, FV intake, and PA. Among 128 participants, 72% consumed ≥5 FV/ day; 77.8% walked for exercise ≥4 times/week. Controlling for sociodemographics, consuming ≥5 FV/day was associated with greater significant other social support (p = .004); walking for exercise ≥4 times/week was associated with greater friend support (p = .003). These findings can inform tertiary cancer prevention interventions.

The impact of chronic disease self-management programs: healthcare savings through a community-based intervention

BackgroundAmong the most studied evidence-based programs, the Chronic Disease Self-Management Program (CDSMP) has been shown to help participants improve their health behaviors, health outcomes, and reduce healthcare utilization. However, there is a lack of information on how CDSMP, when nationally disseminated, impacts healthcare utilization and averts healthcare costs. The purposes of this study were to: 1) document reductions in healthcare utilization among national CDSMP participants; 2) calculate potential cost savings associated with emergency room (ER) visits and hospitalizations; and 3) extrapolate the cost savings estimation to the American adults.MethodsThe national study of CDSMP surveyed 1,170 community-dwelling CDSMP participants at baseline, 6 months, and 12 months from 22 organizations in 17 states. The procedure used to estimate potential cost savings included: 1) examining the pattern of healthcare utilization among CDSMP participants from self-reported healthcare utilization assessed at baseline, 6 months, and 12 months; 2) calculating age-adjusted average costs for persons using the 2010 Medical Expenditure Panel Survey; 3) calculating costs saved from reductions in healthcare utilization; 4) estimating per participant program costs; 5) computing potential cost savings by deducting program costs from estimated healthcare savings; and 6) extrapolating savings to national populations using Census data combined with national health statistics.ResultsFindings from analyses showed significant reductions in ER visits (5%) at both the 6-month and 12-month assessments as well as hospitalizations (3%) at 6 months among national CDSMP participants. This equates to potential net savings of $364 per participant and a national savings of $3.3 billion if 5% of adults with one or more chronic conditions were reached.ConclusionsFindings emphasize the value of public health tertiary prevention interventions and the need for policies to support widespread adoption of CDSMP.

PP32 Are there Socio-Inequalities Associated With Type 2 Diabetes Care?

BackgroundThere has been increasing research interest in the adverse effects of public health interventions; notably concern that processes in the planning or delivery of an intervention may create or exacerbate...

Rehabilitation and Parkinson’s Disease

Rehabilitation and Parkinson’s Disease

Suicide Attempts: Prevention of Repetition

To present an overview of promising strategies to prevent repetition of suicidal behaviours. This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits and the key words: suicid* or deliberate self-harm and treatment* or therapy or intervention* or management. Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo- a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) (n = 4), (including dialectical behaviour therapy [n = 2]); psychodynamic therapy (n = 2); mixed (CBT plus psychodynamic therapy [n = 1]); and motivational approach and change in therapist (n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples. There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.

Your views and letters

Simmons’ (2010) concept analysis revealed that clinical reasoning can be defined as ‘a complex process that uses formal and informal thinking strategies to gather and analyse patient information, evaluate the significance of this information, and weigh alternative actions’ (p. 1155). Benner et al. (2010) defined clinical reasoning as ‘the ability to reason as a clinical situation changes, taking into account the context and concerns of the patient and family’ (p. 85). They went on to explain, ‘When nurses use clinical reasoning, they capture patients’ trends and trajectories’ (p. 85). Capturing patients’ trends and trajectories can be thought of as clinical reasoning-in-transition, which is a way of thinking that the nurse uses to keep ‘track of the particular patient, how the illness or illnesses are unfolding, and the meaning of the patient’s responses. It requires keeping track of a narrative of what has been tried and what has or has not worked with the patient. [It] requires from the [nurse] a thoughtful stance of attentiveness, respect, curiosity, inquiry and willingness to be ‘pulled up short’ in [his or] her thinking, all framed by the [nurse’s] concern for the good of the patient’ (Benner et al. 2010, p. 55). Clinical reasoning also requires other inputs from the client and additional members of the healthcare team. Neither Simmons nor Benner et al. identified an intellectual context or a structure for clinical reasoning, which limits the value of the concept to the advancement of distinctive nursing knowledge and practice. We offer the Neuman Systems Model (NSM; Neuman & Fawcett 2011) as one intellectual context and structure for clinical reasoning. With regard to an intellectual context, the NSM provides a holistic systems approach for clinical reasoning that helps the nurse see the whole pathway of clinical reasoning from the parts, which are made up of the interactions among the antecedents, attributes, and consequences of the concept of clinical reasoning. Understanding the entire pathway enables the nurse to make subsequent care decisions in a coordinated manner rather than in a piecemeal way. The NSM provides a structure for clinical reasoning by directing the nurse’s attention to the concerns of the individual, family or community client system by focusing on who the client system is, in what environments the client system dwells, and the health status of the client system. In particular, the NSM directs the nurse to assess the client’s and his/her own perceptions of internal and external physiological, psychological, sociocultural, developmental and spiritual stressors that are impinging on the client and the client’s strengths and defenses against noxious stressors. Following assessment, clinical reasoning is used to determine the primary, secondary or tertiary prevention interventions that are needed to retain, attain or maintain client wellness. Other nursing conceptual models provide different contexts and structures for clinical reasoning. We submit that regardless of the conceptual model selected, both an identified context and a specific structure for clinical reasoning are required if clinical reasoning is to be translated from a theoretical analysis to the reality of nursing practice.

Understanding the Development and Prevention of Type 2 Diabetes in Youth (Part 1)

Abstract The prevalence of being at risk of overweight, overweight, pre-diabetes, and type 2 diabetes is increasing in the United States in youth. Primary care providers must understand how the emerging epidemic of type 2 diabetes developed during the past several decades to accurately diagnose it in young patients. Primary, secondary, and tertiary prevention interventions are needed to address the emerging epidemic of type 2 diabetes in youth. Primary prevention involves delaying the development of type 2 diabetes by reducing the prevalence of overweight. Secondary prevention is aimed at preventing those with pre-diabetes from developing diabetes, and tertiary prevention is aimed at preventing the complications of type 2 diabetes.

Preventing problem behaviors: Primary, secondary, and tertiary level prevention interventions for young children.

The purpose of this report is to compare changes in social skills, problem behaviors, and academic competence for kindergarten or first grade students identified as being at risk for serious behavior problems who received primary, secondary, or tertiary level preventive interventions. Of the 93 participants in this study, 73% were male; 86% were Caucasian, and 65% were characterized as having externalizing behavior problems. A repeated measures analysis of variance indicated statistically significant differences (p < .01) between the groups based on type of intervention received the Self-Control subscale (e.g., controlling temper, responding appropriately to teasing) of the Social Skills Rating System (Gresham & Elliott, 1990). School-wide Positive Behavior Support is an effective primary prevention intervention, even for young children with serious internalizing or externalizing behavior problems.

Primary Prevention of Intimate Partner Violence for Women’s Health

The aim of this work is to make the case that prevention is essential and that concrete strategies for prevention exist and need to be prioritized. The women’s movement of the late 1960s advocated for a more comprehensive tertiary prevention for intimate partner violence (IPV) (Schechter, 1982) to include law enforcement and legal responses to IPV. The women’s movement also inspired creation of battered women’s shelters and community-based support services for women seeking assistance in coping with IPV or safely leaving a violent relationship. These essential and life-saving services are tertiary prevention because violence has already occurred, and, for many women, the violence has become chronic and health consequences have already occurred. The focus of these tertiary prevention interventions is preventing death or disability not in preventing the violence. More effective and cost-efficient primary and secondary prevention strategies are needed, in addition to adequately funding the necessary tertiary prevention approaches to address the epidemic of IPV. The remainder of this article will be a presentation of the range of primary and secondary prevention strategies that can and, in some cases, are being implemented in the United States and elsewhere. The lists provided are not meant to be exhaustive, but illustrative. Many dedicated individuals and groups have given careful thought to the range of prevention strategies. See Table 1 for an illustrative list of references for these strategies and notes on the focus of the work.

The REACH (Reaching for Excellence in Adolescent Care and Health) project: study design, methods, and population profile.

The REACH Project (Reaching for Excellence in Adolescent Care and Health) was designed as an observational study with the ultimate goal of achieving a better understanding of HIV disease progression and co-morbidity in adolescents and thus improving health care management. A standardized base protocol was developed through the collaborative efforts of the Basic Science and Clinical Science Groups of Adolescent Medicine HIV/AIDS Research Network. With little to no information available on the manifestations or progression of HIV disease in adolescents, the scope of the research objectives of REACH was focused on biomedical outcomes. However, extensive behavioral and psychosocial data were collected to provide necessary context to the biomedical data and to inform future primary, secondary or tertiary prevention interventions. The REACH Project targeted the following objectives: 1.To examine the pathogenesis of HIV infection and its spectrum of disease in adolescents (aged 12 to 18 years at study entry) and to compare them to those described in adults and children. 2.To examine the effect of HIV infection on normal physiologic growth and development in HIV infected adolescents, and in turn, to examine the effect of pubertal maturation on HIV progression. 3.To examine the morbidity associated with co-infections with sexually transmitted infections (STI) that commonly occur in adolescents and to compare these morbidities between HIV infected and HIV uninfected adolescents, with particular attention to the role of cervical maturation as a risk for STI acquisition in female subjects. 4.To examine potential immunologic markers in peripheral blood for disease progression specific to adolescents infected with HIV. 5.To examine the association between cytokine expression in endocervical secretions, STI acquisition, and HIV disease progression in adolescent females. 6.To examine the association between mental health and behavioral patterns and disease progression in adolescents infected with HIV.

Role of secondary stressors in the parental death-child distress relation.

This study examined the psychological consequences and secondary stressors associated with death of a parent. The sample (N = 116) consisted of 26 youths who had lost a parent to homicide, 45 youths who had lost a parent to natural death, and 45 nonbereaved youths. Youngsters completed face-to-face interviews, while their guardians completed measures assessing the children's functioning. Results based on both child and guardian reports indicated that parental death was associated with an increase in secondary stressors, regardless of the mode of death. Findings based on guardian reports also revealed that parental death was related to increased internalizing distress, and that parental death due to homicide was related to increased externalizing distress. Furthermore, secondary stressors mediated the parental death-child distress relation such that parental death led to an increase in stressors, which in turn led to increased child distress. Implications for secondary and tertiary preventive interventions are discussed.