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Barbagelata M, Morganti W, Seminerio E, Camurri A, Ghisio S, Loro M, Puleo G, Dijk B, Nolasco I, Costantini C, Cera A, Senesi B, Ferrari N, Canepa C, Custodero C, Pilotto A. Resilience improvement through a multicomponent physical and cognitive intervention for older people: the DanzArTe emotional well-being technology project. Aging Clin Exp Res 2024; 36:72. [PMID: 38488883 PMCID: PMC10942916 DOI: 10.1007/s40520-023-02678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/08/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Resilience is a crucial component of successful aging. However, which interventions might increase resilience in older adults is yet unclear. AIMS This study aims to assess the feasibility and the physical and psychological effects of a technology-based multicomponent dance movement intervention that includes physical, cognitive, and sensory activation in older people living in community-dwelling and nursing home. METHODS DanzArTe program consists of four sessions on a weekly basis, using a technological platform that integrates visual and auditory contents in real time. 122 participants (mean age = 76.3 ± 8.8 years, 91 females = 74.6%) from seven nursing homes and community-dwelling subjects were assessed, before and after the intervention, with the Resilience Scale-14 items (RES-14), the Multidimensional Prognostic Index (MPI), the Psychological General Well-Being Index (PGWBI-S), and the Client Satisfaction Questionnaire-8 (CSQ-8). Mann-Whitney and Wilcoxon signed-ranks tests were used for statistical analyses. RESULTS At baseline significant differences in MPI and RES-14 between community-dwelling and nursing home residents were observed (p < 0.001 for both analyses). After the intervention, resilience significantly increased in total sample (RES-14 mean T1 = 74.6 Vs. T2 = 75.7) and in the nursing home residents (RES-14 mean T1 = 68.1 Vs. T2 = 71.8). All participants showed high overall satisfaction for DanzArTe program (CSQ-8 mean = 23.9 ± 4.4). No differences in MPI and PGWBI-S were observed. DISCUSSION DanzArTe was a feasible intervention and high appreciated by all older adults. Nursing home residents revealed improvements in resilience after DanzArTe program. CONCLUSION The DanzArTe technology-based multi-component intervention may improve resilience in older people living in nursing homes.
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Affiliation(s)
- Marina Barbagelata
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy.
| | - Wanda Morganti
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Emanuele Seminerio
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Antonio Camurri
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Simone Ghisio
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Mara Loro
- Foundation "Fondazione Piemonte dal Vivo", Turin, Italy
| | - Gianluca Puleo
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Babette Dijk
- Ligurian Health Agency, Memory Clinic, Chiavari, Italy
| | | | | | - Andrea Cera
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Barbara Senesi
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Nicola Ferrari
- Department of Italianistics, Romanistics, Antiquities, Arts and Performing Arts, University of Genova, Genoa, Italy
| | - Corrado Canepa
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Alberto Pilotto
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
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Freeman SC, Saeedi E, Ordóñez-Mena JM, Nevill CR, Hartmann-Boyce J, Caldwell DM, Welton NJ, Cooper NJ, Sutton AJ. Data visualisation approaches for component network meta-analysis: visualising the data structure. BMC Med Res Methodol 2023; 23:208. [PMID: 37715126 PMCID: PMC10502971 DOI: 10.1186/s12874-023-02026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Health and social care interventions are often complex and can be decomposed into multiple components. Multicomponent interventions are often evaluated in randomised controlled trials. Across trials, interventions often have components in common which are given alongside other components which differ across trials. Multicomponent interventions can be synthesised using component NMA (CNMA). CNMA is limited by the structure of the available evidence, but it is not always straightforward to visualise such complex evidence networks. The aim of this paper is to develop tools to visualise the structure of complex evidence networks to support CNMA. METHODS We performed a citation review of two key CNMA methods papers to identify existing published CNMA analyses and reviewed how they graphically represent intervention complexity and comparisons across trials. Building on identified shortcomings of existing visualisation approaches, we propose three approaches to standardise visualising the data structure and/or availability of data: CNMA-UpSet plot, CNMA heat map, CNMA-circle plot. We use a motivating example to illustrate these plots. RESULTS We identified 34 articles reporting CNMAs. A network diagram was the most common plot type used to visualise the data structure for CNMA (26/34 papers), but was unable to express the complex data structures and large number of components and potential combinations of components associated with CNMA. Therefore, we focused visualisation development around representing the data structure of a CNMA more completely. The CNMA-UpSet plot presents arm-level data and is suitable for networks with large numbers of components or combinations of components. Heat maps can be utilised to inform decisions about which pairwise interactions to consider for inclusion in a CNMA model. The CNMA-circle plot visualises the combinations of components which differ between trial arms and offers flexibility in presenting additional information such as the number of patients experiencing the outcome of interest in each arm. CONCLUSIONS As CNMA becomes more widely used for the evaluation of multicomponent interventions, the novel CNMA-specific visualisations presented in this paper, which improve on the limitations of existing visualisations, will be important to aid understanding of the complex data structure and facilitate interpretation of the CNMA results.
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Affiliation(s)
- Suzanne C Freeman
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK.
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK.
| | - Elnaz Saeedi
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clareece R Nevill
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola J Cooper
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - Alex J Sutton
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
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Petropoulou M, Rücker G, Weibel S, Kranke P, Schwarzer G. Model selection for component network meta-analysis in connected and disconnected networks: a simulation study. BMC Med Res Methodol 2023; 23:140. [PMID: 37316775 DOI: 10.1186/s12874-023-01959-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/29/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Network meta-analysis (NMA) allows estimating and ranking the effects of several interventions for a clinical condition. Component network meta-analysis (CNMA) is an extension of NMA which considers the individual components of multicomponent interventions. CNMA allows to "reconnect" a disconnected network with common components in subnetworks. An additive CNMA assumes that component effects are additive. This assumption can be relaxed by including interaction terms in the CNMA. METHODS We evaluate a forward model selection strategy for component network meta-analysis to relax the additivity assumption that can be used in connected or disconnected networks. In addition, we describe a procedure to create disconnected networks in order to evaluate the properties of the model selection in connected and disconnected networks. We apply the methods to simulated data and a Cochrane review on interventions for postoperative nausea and vomiting in adults after general anaesthesia. Model performance is compared using average mean squared errors and coverage probabilities. RESULTS CNMA models provide good performance for connected networks and can be an alternative to standard NMA if additivity holds. For disconnected networks, we recommend to use additive CNMA only if strong clinical arguments for additivity exist. CONCLUSIONS CNMA methods are feasible for connected networks but questionable for disconnected networks.
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Affiliation(s)
- Maria Petropoulou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany.
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Luchenski SA, Dawes J, Aldridge RW, Stevenson F, Tariq S, Hewett N, Hayward AC. Hospital-based preventative interventions for people experiencing homelessness in high-income countries: A systematic review. EClinicalMedicine 2022; 54:101657. [PMID: 36311895 PMCID: PMC9597099 DOI: 10.1016/j.eclinm.2022.101657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND People experiencing homelessness have significant unmet needs and high rates of unplanned care. We aimed to describe preventative interventions, defined in their broadest sense, for people experiencing homelessness in a hospital context. Secondary aims included mapping outcomes and assessing intervention effectiveness. METHODS We searched online databases (MEDLINE, Embase, PsycINFO, HMIC, CINAHL, Web of Science, Cochrane Library) from 1999-2019 and conducted backward and forward citation searches to 31 December 2020 (PROSPERO CRD42019154036). We included quantitative studies in emergency and inpatient settings measuring health or social outcomes for adults experiencing homelessness in high income countries. We assessed rigour using the "Quality Assessment Tool for Quantitative Studies" and summarised findings using descriptive quantitative methods, a binomial test, a Harvest Plot, and narrative synthesis. We used PRISMA and SWiM reporting guidelines. FINDINGS Twenty-eight studies identified eight intervention types: care coordination (n=18); advocacy, support, and outreach (n=13); social welfare assistance (n=13); discharge planning (n=12); homelessness identification (n=6); psychological therapy and treatment (n=6); infectious disease prevention (n=5); and screening, treatment, and referrals (n=5). The evidence strength was weak (n=16) to moderate (n=10), with two high quality randomised controlled trials. We identified six outcome categories with potential benefits observed for psychosocial outcomes, including housing (11/13 studies, 95%CI=54.6-98.1%, p=0.023), healthcare use (14/17, 56.6-96.2%, p=0.013), and healthcare costs (8/8, 63.1-100%, p=0.008). Benefits were less likely for health outcomes (4/5, 28.3-99.5%, p=0.375), integration with onward care (2/4, 6.8-93.2%, p=1.000), and feasibility/acceptability (5/6, 35.9-99.6%, p=0.219), but confidence intervals were very wide. We observed no harms. Most studies showing potential benefits were multi-component interventions. INTERPRETATION Hospital-based preventative interventions for people experiencing homelessness are potentially beneficial, but more rigorous research is needed. In the context of high needs and extreme inequities, policymakers and healthcare providers may consider implementing multi-component preventative interventions. FUNDING SL is supported by an NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2016-02-042). JD is supported by an NIHR School of Public Health Research Pre-doctoral Fellowship (NU-004252). RWA is supported by a Wellcome Clinical Research Career Development Fellowship (206602).
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Affiliation(s)
- Serena A. Luchenski
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London WC1E 7HT, United Kingdom
- Corresponding author.
| | - Joanna Dawes
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London WC1E 7HT, United Kingdom
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute for Health Informatics, University College London, 255 Euston Road, London NW1 2DA, United Kingdom
| | - Fiona Stevenson
- Department of Primary Care and Population Health, Institute of Epidemiology and Healthcare, University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Shema Tariq
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, United Kingdom
| | - Nigel Hewett
- Pathway, 4th Floor, East, 250 Euston Rd, London NW1 2PG, United Kingdom
| | - Andrew C. Hayward
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London WC1E 7HT, United Kingdom
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Subramanian S, Tangka FKL, Hoover S, DeGroff A. Integrated interventions and supporting activities to increase uptake of multiple cancer screenings: conceptual framework, determinants of implementation success, measurement challenges, and research priorities. Implement Sci Commun 2022; 3:105. [PMID: 36199098 PMCID: PMC9532830 DOI: 10.1186/s43058-022-00353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/19/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Screening for colorectal, breast, and cervical cancer has been shown to reduce mortality; however, not all men and women are screened in the USA. Further, there are disparities in screening uptake by people from racial and ethnic minority groups, people with low income, people who lack health insurance, and those who lack access to care. The Centers for Disease Control and Prevention funds two programs-the Colorectal Cancer Control Program and the National Breast and Cervical Cancer Early Detection Program-to help increase cancer screenings among groups that have been economically and socially marginalized. The goal of this manuscript is to describe how programs and their partners integrate evidence-based interventions (e.g., patient reminders) and supporting activities (e.g., practice facilitation to optimize electronic medical records) across colorectal, breast, and cervical cancer screenings, and we suggest research areas based on implementation science. METHODS We conducted an exploratory assessment using qualitative and quantitative data to describe implementation of integrated interventions and supporting activities for cancer screening. We conducted 10 site visits and follow-up telephone interviews with health systems and their partners to inform the integration processes. We developed a conceptual model to describe the integration processes and reviewed screening recommendations of the United States Preventive Services Task Force to illustrate challenges in integration. To identify factors important in program implementation, we asked program implementers to rank domains and constructs of the Consolidated Framework for Implementation Research. RESULTS Health systems integrated interventions for all screenings across single and multiple levels. Although potentially efficient, there were challenges due to differing eligibility of screenings by age, gender, frequency, and location of services. Program implementers ranked complexity, cost, implementation climate, and engagement of appropriate staff in implementation among the most important factors to success. CONCLUSION Integrating interventions and supporting activities to increase uptake of cancer screenings could be an effective and efficient approach, but we currently do not have the evidence to recommend widescale adoption. Detailed multilevel measures related to process, screening, and implementation outcomes, and cost are required to evaluate integrated programs. Systematic studies can help to ascertain the benefits of integrating interventions and supporting activities for multiple cancer screenings, and we suggest research areas that might address current gaps in the literature.
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Affiliation(s)
- Sujha Subramanian
- grid.62562.350000000100301493RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Florence K. L. Tangka
- grid.416781.d0000 0001 2186 5810Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sonja Hoover
- grid.62562.350000000100301493RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Amy DeGroff
- grid.416781.d0000 0001 2186 5810Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
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Sharma KP, DeGroff A, Hohl SD, Maxwell AE, Escoffery NC, Sabatino SA, Joseph DA. Multi-component interventions and change in screening rates in primary care clinics in the Colorectal Cancer Control Program. Prev Med Rep 2022; 29:101904. [PMID: 35864930 PMCID: PMC9294188 DOI: 10.1016/j.pmedr.2022.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/06/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Evidence-based interventions (EBIs) in clinics increase colorectal cancer screening. Even more effective are multi-component interventions (MCIs) vs a single strategy. We examined the effectiveness of MCIs in CDC’s Colorectal Cancer Control Program. Combination of 3–4 EBIs or 2–3 strategies led to significant increase in screening. Some MCIs led up to 7.2 percentage points annual increases.
Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Implementation of evidence-based interventions (EBIs) increases CRC screening. The purpose of this analysis is to determine which combinations of EBIs or strategies led to increases in clinic-level screening rates among clinics participating in CDC’s Colorectal Cancer Control Program (CRCCP). Data were collected from CRCCP clinics between 2015 and 2018 and the analysis was conducted in 2020. The outcome variable was the annual change in clinic level CRC screening rate in percentage points. We used first difference (FD) estimator of linear panel data regression model to estimate the associations of outcome with independent variables, which include different combinations of EBIs and intervention strategies. The study sample included 486 unique clinics with 1156 clinic years of total observations. The average baseline screening rate was 41 % with average annual increase of 4.6 percentage points. Only two out of six combinations of any two EBIs were associated with increases in screening rate (largest was 6.5 percentage points, P < 0.001). Any combinations involving three EBIs or all four EBIs were significantly associated with the outcome with largest increase of 7.2 percentage points (P < 0.001). All interventions involving 2–3 strategies led to increases in rate with largest increase associated with the combination of increasing community demand and access (6.1 percentage points, P < 0.001). Clinics implementing combinations of these EBIs, particularly those including three or more EBIs, often were more likely to have impact on screening rate change than those implementing none.
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Affiliation(s)
- Krishna P Sharma
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Sarah D Hohl
- Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, United States
| | - Annette E Maxwell
- Center for Cancer Prevention and Control Research, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, United States
| | - Ngoc Cam Escoffery
- Emory University, Rollins School of Public Health, CDC, Atlanta, GA, United States
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Djenaba A Joseph
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
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Hicklin K, O'Leary MC, Nambiar S, Mayorga ME, Wheeler SB, Davis MM, Richardson LC, Tangka FKL, Lich KH. Assessing the impact of multicomponent interventions on colorectal cancer screening through simulation: What would it take to reach national screening targets in North Carolina? Prev Med 2022; 162:107126. [PMID: 35787844 PMCID: PMC11056941 DOI: 10.1016/j.ypmed.2022.107126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/10/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
Healthy People 2020 and the National Colorectal Cancer Roundtable established colorectal cancer (CRC) screening targets of 70.5% and 80%, respectively. While evidence-based interventions (EBIs) have increased CRC screening, the ability to achieve these targets at the population level remains uncertain. We simulated the impact of multicomponent interventions in North Carolina over 5 years to assess the potential for meeting national screening targets. Each intervention scenario is described as a core EBI with additional components indicated by the "+" symbol: patient navigation for screening colonoscopy (PN-for-Col+), mailed fecal immunochemical testing (MailedFIT+), MailedFIT+ targeted to Medicaid enrollees (MailedFIT + forMd), and provider assessment and feedback (PAF+). Each intervention was simulated with and without Medicaid expansion and at different levels of exposure (i.e., reach) for targeted populations. Outcomes included the percent up-to-date overall and by sociodemographic subgroups and number of CRC cases and deaths averted. Each multicomponent intervention was associated with increased CRC screening and averted both CRC cases and deaths; three had the potential to reach screening targets. PN-for-Col + achieved the 70.5% target with 97% reach after 1 year, and the 80% target with 78% reach after 5 years. MailedFIT+ achieved the 70.5% target with 74% reach after 1 year and 5 years. In the Medicaid population, assuming Medicaid expansion, MailedFIT + forMd reached the 70.5% target after 5 years with 97% reach. This study clarifies the potential for states to reach national CRC screening targets using multicomponent EBIs, but decision-makers also should consider tradeoffs in cost, reach, and ability to reduce disparities when selecting interventions.
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Affiliation(s)
- Karen Hicklin
- Department of Industrial and Systems Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA.
| | - Meghan C O'Leary
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Maria E Mayorga
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA
| | - Stephanie B Wheeler
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melinda M Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA; Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA; School of Public Health, Oregon Health & Science University, Portland State University, Portland, OR, USA
| | | | | | - Kristen Hassmiller Lich
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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de Almeida VBP, Filgueiras AR, Nogueira PCK, Sesso RC, Sawaya AL, Domene SMÁ. The impact of food addiction behaviours on the treatment of overweight students. Br J Nutr 2021; 129:1-8. [PMID: 34657642 DOI: 10.1017/s0007114521004189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The present study evaluated the association of food addiction (FA), the change of the BMI/age z-score and the consumption of ultra-processed foods in overweight students undergoing a 16-month, multicomponent intervention in the school environment. FA was investigated using the Yale Food Addiction Scale for Children, and the dietary assessment was estimated using the semi-quantitative FFQ in overweight 9-11-year-old students (BMI/age z-score ≥ 1) of both sexes at their baseline and after the intervention (n 120). Among the schoolchildren, 33·4 % had FA in at least one of the two assessments. The analysis of mixed-effects models to assess the effect of the intervention and the change of the BMI/age z-score between evaluations showed that the occurrence of FA influenced the maintenance of weight (time#FA, β = 0·30, 95 % CI 0·05, 0·54, P = 0·016). Weight loss was observed only in individuals who did not present FA (BMI/age z-score = -0·3). When evaluating the effect of the intervention and the dietary variables, we verified a reduction in the consumption of sugary milk-based drinks -71·13 kJ (-17 kcal), P = 0·04 only in non-FA students at the end of the study. FA has been identified as an underlying factor with therapeutic relevance, and an enhanced understanding of FA can open new paths for the prevention and management of obesity.
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Affiliation(s)
| | | | | | - Ricardo Cintra Sesso
- Department of Medicine, Federal University of São Paulo UNIFESP, São Paulo, SP, Brazil
| | - Ana Lydia Sawaya
- Department of Physiology, Federal University of São Paulo UNIFESP, São Paulo, SP, Brazil
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Bastami M, Azadi A. Effects of a Multicomponent Program on Fall Incidence, Fear of Falling, and Quality of Life among Older Adult Nursing Home Residents. Ann Geriatr Med Res 2020; 24:252-258. [PMID: 33171549 PMCID: PMC7781964 DOI: 10.4235/agmr.20.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/24/2020] [Indexed: 11/06/2022] Open
Abstract
Background Falling is one of the most common problems in older adults and can lead to additional health problems. This study aimed to determine the effects of a multicomponent program on fall incidence and quality of life in older adult nursing home residents. Methods This was a quasi-experimental study with a pretest and post-test design. The study population comprised 55 older adults residing in nursing homes. The intervention was a multicomponent program including physical activities, training sessions, and physical environment modifications in nursing homes that was conducted for 8 weeks. The data collection tools included a socio-demographic characteristics form and questionnaires pertaining to the quality of life and fear of falls, which were completed by the participants before and after the intervention. Results The mean age of the participants was 68.48 years, and most (90%) were illiterate. We observed a significant difference between the mean number of falls and the scores for fear of falling before and after the intervention (p<0.001). We also observed a significant difference between the total quality of life scores and all of the related dimensions before and after the intervention, indicating that the quality of life of the older adults had improved after the intervention (p<0.001). Conclusion The results of this study indicated that the multicomponent fall prevention program was effective in improving the quality of life, fall rate, and fear of falling among older residents in nursing homes. Further studies are needed to explore the long-term effects of these interventions.
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Affiliation(s)
- Masoumeh Bastami
- Student Research Committee, Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Arman Azadi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
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Husebo BS, Allore H, Achterberg W, Angeles RC, Ballard C, Bruvik FK, Fæø SE, Gedde MH, Hillestad E, Jacobsen FF, Kirkevold Ø, Kjerstad E, Kjome RLS, Mannseth J, Naik M, Nouchi R, Puaschitz N, Samdal R, Tranvåg O, Tzoulis C, Vahia IV, Vislapuu M, Berge LI. LIVE@Home.Path-innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial. Trials 2020; 21:510. [PMID: 32517727 PMCID: PMC7281688 DOI: 10.1186/s13063-020-04414-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The global health challenge of dementia is exceptional in size, cost and impact. It is the only top ten cause of death that cannot be prevented, cured or substantially slowed, leaving disease management, caregiver support and service innovation as the main targets for reduction of disease burden. Institutionalization of persons with dementia is common in western countries, despite patients preferring to live longer at home, supported by caregivers. Such complex health challenges warrant multicomponent interventions thoroughly implemented in daily clinical practice. This article describes the rationale, development, feasibility testing and implementation process of the LIVE@Home.Path trial. METHODS The LIVE@Home.Path trial is a 2-year, multicenter, mixed-method, stepped-wedge randomized controlled trial, aiming to include 315 dyads of home-dwelling people with dementia and their caregivers, recruited from 3 municipalities in Norway. The stepped-wedge randomization implies that all dyads receive the intervention, but the timing is determined by randomization. The control group constitutes the dyads waiting for the intervention. The multicomponent intervention was developed in collaboration with user-representatives, researchers and stakeholders to meet the requirements from the national Dementia Plan 2020. During the 6-month intervention period, the participants will be allocated to a municipal coordinator, the core feature of the intervention, responsible for regular contact with the dyads to facilitate L: Learning, I: Innovation, V: Volunteering and E: Empowerment (LIVE). The primary outcome is resource utilization. This is measured by the Resource Utilization in Dementia (RUD) instrument and the Relative Stress Scale (RSS), reflecting that resource utilization is more than the actual time required for caring but also how burdensome the task is experienced by the caregiver. DISCUSSION We expect the implementation of LIVE to lead to a pathway for dementia treatment and care which is cost-effective, compared to treatment as usual, and will support high-quality independent living, at home. TRIAL REGISTRATION ClinicalTrials.gov: NCT04043364. Registered on 15 March 2019.
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Affiliation(s)
- Bettina Sandgathe Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
| | - Heather Allore
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Wilco Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Frøydis Kristine Bruvik
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stein Erik Fæø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Vid Specialized University, Bergen, Norway
| | - Marie Hidle Gedde
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Eirin Hillestad
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,The Dignity Centre, Bergen, Norway
| | - Frode Fadnes Jacobsen
- Vid Specialized University, Bergen, Norway.,Centre for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Lillehamner, Norway.,Centre of Old Age Psychiatry Research, Innlandet Hospital Trust, Gjøvik, Norway.,Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | | | - Reidun Lisbeth Skeide Kjome
- Centre for Pharmacy, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Janne Mannseth
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mala Naik
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Rui Nouchi
- Department of Cognitive Health Science, Institute of Development, Aging and Cancer, Tohoku University, Tohoku, Japan
| | - Nathalie Puaschitz
- Centre for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Rune Samdal
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Oscar Tranvåg
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Charalampos Tzoulis
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ipsit Vihang Vahia
- McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Maarja Vislapuu
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Line Iden Berge
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway. .,NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway.
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Guise JM, Chang C, Viswanathan M, Glick S, Treadwell J, Umscheid CA, Whitlock E, Fu R, Berliner E, Paynter R, Anderson J, Motu'apuaka P, Trikalinos T. Agency for Healthcare Research and Quality Evidence-based Practice Center methods for systematically reviewing complex multicomponent health care interventions. J Clin Epidemiol 2014; 67:1181-91. [PMID: 25438663 DOI: 10.1016/j.jclinepi.2014.06.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/12/2014] [Accepted: 06/01/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this Agency for Healthcare Research and Quality Evidence-based Practice Center methods white paper was to outline approaches to conducting systematic reviews of complex multicomponent health care interventions. STUDY DESIGN AND SETTING We performed a literature scan and conducted semistructured interviews with international experts who conduct research or systematic reviews of complex multicomponent interventions (CMCIs) or organizational leaders who implement CMCIs in health care. RESULTS Challenges identified include lack of consistent terminology for such interventions (eg, complex, multicomponent, multidimensional, multifactorial); a wide range of approaches used to frame the review, from grouping interventions by common features to using more theoretical approaches; decisions regarding whether and how to quantitatively analyze the interventions, from holistic to individual component analytic approaches; and incomplete and inconsistent reporting of elements critical to understanding the success and impact of multicomponent interventions, such as methods used for implementation the context in which interventions are implemented. CONCLUSION We provide a framework for the spectrum of conceptual and analytic approaches to synthesizing studies of multicomponent interventions and an initial list of critical reporting elements for such studies. This information is intended to help systematic reviewers understand the options and tradeoffs available for such reviews.
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Affiliation(s)
- Jeanne-Marie Guise
- Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, 3710 SW US Veterans Hospital Road, Mailcode R&D71, Portland, OR 97239, USA.
| | - Christine Chang
- Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA
| | - Meera Viswanathan
- RTI-UNC Evidence-based Practice Center, 3400 E. Cornwallis Rd., Research Triangle Park, NC 27709, USA
| | - Susan Glick
- Blue Cross Blue Shield Evidence-based Practice Center, 225 North Michigan Avenue, Chicago, IL 60601, USA
| | - Jonathan Treadwell
- ECRI-Penn Evidence-based Practice Center, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA
| | - Craig A Umscheid
- ECRI-Penn Evidence-based Practice Center, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA
| | - Evelyn Whitlock
- Kaiser Evidence-based Practice Center, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Rongwei Fu
- Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, 3710 SW US Veterans Hospital Road, Mailcode R&D71, Portland, OR 97239, USA
| | - Elise Berliner
- Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA
| | - Robin Paynter
- Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, 3710 SW US Veterans Hospital Road, Mailcode R&D71, Portland, OR 97239, USA
| | - Johanna Anderson
- Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, 3710 SW US Veterans Hospital Road, Mailcode R&D71, Portland, OR 97239, USA
| | - Pua Motu'apuaka
- Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, 3710 SW US Veterans Hospital Road, Mailcode R&D71, Portland, OR 97239, USA
| | - Tom Trikalinos
- Brown Evidence-based Practice Center, Brown University, 1 Prospect Street, Providence, RI 02912, USA
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