Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis

IMPORTANCE

Delirium, an acute disorder with high morbidity and mortality, is often preventable through multicomponent nonpharmacological strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies to date.

OBJECTIVE

To evaluate available evidence on multicomponent nonpharmacological delirium interventions in reducing incident delirium and preventing poor outcomes associated with delirium.

DATA SOURCES

PubMed, Google Scholar, ScienceDirect, and the Cochrane Database of Systematic Reviews from January 1, 1999, to December 31, 2013.

STUDY SELECTION

Studies examining the following outcomes were included: delirium incidence, falls, length of stay, rate of discharge to a long-term care institution (institutionalization), and change in functional or cognitive status.

DATA EXTRACTION AND SYNTHESIS

Two experienced physician reviewers independently and blindly abstracted data on outcome measures using a standardized approach. The reviewers conducted quality ratings based on the Cochrane risk-of-bias criteria for each study.

MAIN OUTCOMES AND MEASURES

We identified 14 interventional studies. The results for outcomes of delirium incidence, falls, length of stay, and institutionalization were pooled for the meta-analysis, but heterogeneity limited our meta-analysis of the results for change in functional or cognitive status. Overall, 11 studies demonstrated significant reductions in delirium incidence (odds ratio [OR], 0.47; 95% CI, 0.38-0.58). Four randomized or matched trials reduced delirium incidence by 44% (OR, 0.56; 95% CI, 0.42-0.76). The rate of falls decreased significantly among intervention patients in 4 studies (OR, 0.38; 95% CI, 0.25-0.60); in 2 randomized or matched trials, the rate of falls was reduced by 64% (OR, 0.36; 95% CI, 0.22-0.61). Length of stay and institutionalization also trended toward decreases in the intervention groups, with a mean difference of -0.16 (95% CI, -0.97 to 0.64) day shorter and the odds of institutionalization 5% lower (OR, 0.95; 95% CI, 0.71-1.26). Among higher-quality randomized or matched trials, length of stay trended -0.33 (95% CI, -1.38 to 0.72) day shorter, and the odds of institutionalization trended 6% lower (OR, 0.94; 95% CI, 0.69-1.30).

CONCLUSIONS AND RELEVANCE

Multicomponent nonpharmacological delirium prevention interventions are effective in reducing delirium incidence and preventing falls, with a trend toward decreasing length of stay and avoiding institutionalization. Given the current focus on prevention of hospital-based complications and improved cost-effectiveness of care, this meta-analysis supports the use of these interventions to advance acute care for older persons.

Effectiveness of multicomponent interventions on incidence of delirium in hospitalized older patients with hip fracture: a systematic review

ABSTRACTBackground:Delirium is the most frequent complication among the hospitalized elderly with hip fracture. Although, delirium is associated with longer hospital stay, higher mortality rates, worse functional outcomes, and higher institutionalization rates yet health service planners have hugely ignored its existence. This review aims to identify the effectiveness of multicomponent interventions to prevent delirium in hospitalized elderly patients with hip fracture.

METHODS

This review includes experimental, non-experimental, and observational studies. Electronic searches were conducted in MEDLINE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Embase, and Web of science.

RESULTS

After inclusion and exclusion criteria were applied, nine full text articles were included in the review. The studies reported the following effect on delirium: We pooled data regarding incidence of delirium from the three RCTs. The effect was in favor of the intervention group (odds ratio 0.64, 95% CI 0.46-0.87). All three RCTs reported that duration of delirium was shorter in the intervention group than in the usual care group (mean 2.9 vs. 3.1 days, median 3 vs. 4 days, median 5.0 vs. 10.2 days). Four other studies reported on the duration of delirium with Milisen and colleagues reported shorter duration of delirium within the intervention group. Four studies reported on severity of delirium with two research groups reporting significant results.

CONCLUSION

Early engagement of multidisciplinary staff who addresses the risk factors of delirium as soon as the patient presents to the acute care environment is the key element of a successful delirium prevention program. Once delirium had developed, the multicomponent interventions did not appear to make a difference to the duration or severity of delirium.

Multi-Component Intervention Program on Habitual Physical Activity Parameters and Cognitive Function in Patients with Mild Cognitive Impairment: A Randomized Controlled Trial

Age-related dementia refers to a state in which someone experiences multiple cognitive function impairment due to degenerative brain disease, and which causes difficulties in their daily life or social life. Dementia is the most common and serious obstacle in later life. Early intervention in the case of patients who are in the mild cognitive impairment (MCI) stage among the high-risk group can maintain and improve their cognitive function. The purpose of the current trial is aimed at investigating the association between a multi-component (exercise with cognitive) intervention program and habitual physical activity parameters on cognitive functions in MCI patients. Neuropsychological cognitive and depression assessments were performed by neuropsychologists according to normalized methods, including the Korean mini-mental State examination (K-MMSE) and modified Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog) and cognitive assessment tool (attention, processing speed), and the Korean version of the geriatric depression scale (SGDS-K), both at baseline and at a 12 weeks follow-up. The 12-week multi-component intervention improved cognitive function and habitual physical activity parameters in patients with MCI relative to controls. A multi-component intervention program for patients with MCI is considered to be an effective method of dementia prevention by improving global (ADAS-Cog) and frontal (trail-making test, digit symbol substitution test) cognition and habitual physical activity parameters such as moderate to vigorous physical activity and step count. In addition, it is important to encourage habitual physical activities to ensure that exercise intervention strategies are carried out at the duration and intensity required for improving physical and cognitive wellbeing and obtaining health benefits.

The Behavioral Wellness in Pregnancy study: a randomized controlled trial of a multi-component intervention to promote appropriate weight gain

BACKGROUND

Adequate weight gain during pregnancy is important to both maternal and fetal outcomes. To date, randomized controlled trials have not been effective at increasing the proportion of women meeting gestational weight-gain guidelines.

OBJECTIVES

The aim of this study was to determine whether a multi-component behavioral intervention with a Registered Dietitian Nutritionist significantly improves the proportion of women who adhere to the 2009 Institute of Medicine weight-gain guidelines.

METHODS

Participants were randomly assigned to usual care (UC; n = 24) or intervention (n = 23) between 8 and 14 weeks of gestation. The intervention included a minimum of 6 one-on-one counseling sessions over ∼30 wk focusing on healthy diet and physical activity (PA) goals. In addition to the face-to-face visits, weekly communication via email supported healthy eating, PA, and appropriate weight gain. Gestational weight gain, PA, and diet were assessed at 8-14, 26-28, and 34-36 weeks of gestation; weight retention was measured 2 mo postpartum.

RESULTS

The proportion of women meeting the guidelines was significantly greater in those receiving the intervention than UC (60.8% compared with 25.0%, OR: 4.7; 95% CI: 1.3, 16.2; P = 0.019). Furthermore, 36.4% of the intervention women were at or below their prepregnancy weight at 2 mo postpartum compared with 12.5% in the UC group (P = 0.05).

CONCLUSIONS

A multi-component behavioral intervention improved adherence to the 2009 Institute of Medicine weight-gain guidelines. This trial was registered with clinicaltrials.gov as NCT02168647.

Impact and process evaluation of a co-designed 'Move More, Sit Less' intervention in a public sector workplace

BACKGROUND

High levels of sitting are associated with increased risk of adverse health outcomes, including chronic disease. Extensive sitting at work is common, hence organisations should provide options to employees to reduce prolonged sitting.

OBJECTIVE

To assess the efficacy and acceptability of a co-designed intervention to increase standing and reduce sitting in a public-sector office.

METHODS

Forty-six adults participated in the quasi-experimental study (30 intervention; 16 control). The intervention involved providing sit-stand desks, prompts, workshops, and information emails to assist behavior change. Participants wore a thigh-mounted Actigraph GT3X+ for five working days and responded to an online questionnaire at baseline (BL), 6 (T1) and 13 weeks (T2) post intervention.

RESULTS

Inclinometer-measured proportion of time standing increased in the intervention group from 14% (baseline) to 28% (T1) and 27% (T2) (67 minutes more standing over an 8-hour workday). Intervention participants reduced sitting time from 79% (BL) to 63% (T1 and T2), (80 minutes less sitting over an 8-hour workday). The control group showed no changes. The program was highly recommended (94%), and perceived to support behavior change (81%).

CONCLUSIONS

This Move More, Sit Less intervention appears to be efficacious and acceptable. Future interventions should be co-designed to ensure culturally appropriate components and higher acceptability.

Gaelic4Girls-The Effectiveness of a 10-Week Multicomponent Community Sports-Based Physical Activity Intervention for 8 to 12-Year-Old Girls

Girls are less active than boys throughout childhood and adolescence, with limited research focusing on female community sports-based programs. This study aims to assess the effectiveness of a multi-component, community sports-based intervention for increasing girl's physical activity (PA) levels, fundamental movement skill (FMS) proficiency, and psychological wellbeing, as relative to a second treatment group (the traditionally delivered national comparative program), and a third control group. One hundred and twenty female-only participants (mean age = 10.75 ± 1.44 years), aged 8 to 12 years old from three Ladies Gaelic Football (LGF) community sports clubs (rural and suburban) were allocated to one of three conditions: (1) Intervention Group 1 (n = 43) received a novel, specifically tailored, research-informed Gaelic4Girls (G4G) intervention; (2) Intervention Group 2 (n = 44) used the traditionally delivered, national G4G program, as run by the Ladies Gaelic Football (LGF) Association of Ireland; and (3) Control Group 3 (n = 33) received no G4G intervention (group 1 or 2) conditions and were expected to carry out their usual LGF community sports activities. Primary outcome measurements (at both pre- and 10-week follow up) examining the effectiveness of the G4G intervention included (1) PA, (2) FMS and (3) Psychological correlates (enjoyment levels, self-efficacy, peer and parental support). Following a two (pre to post) by three (intervention group 1, intervention group 2, and control group 3) mixed-model ANOVA, it was highlighted that intervention group 1 significantly increased in PA (p = 0.003), FMS proficiency (p = 0.005) and several psychological correlates of PA (p ≤ 0.005). The findings demonstrate that the 10-week, specifically tailored, research-informed G4G intervention is a feasible and efficacious program, leading to a positive effect on the physical and psychological wellbeing of pre-adolescent Irish girls, relative to the traditionally delivered national G4G comparative program and control group conditions.

Investigation of ward fidelity to a multicomponent delirium prevention intervention during a multicentre, pragmatic, cluster randomised, controlled feasibility trial

BACKGROUND

delirium is a frequent complication of hospital admission for older people and can be reduced by multicomponent interventions, but implementation and delivery of such interventions is challenging.

OBJECTIVE

to investigate fidelity to the prevention of delirium system of care within a multicentre, pragmatic, cluster randomised, controlled feasibility trial.

SETTING

five care of older people and three orthopaedic trauma wards in eight hospitals in England and Wales.

DATA COLLECTION

research nurse observations of ward practice; case note reviews and examination of documentation.

ASSESSMENT

10 health care professionals with experience in older people's care assessed the fidelity to 21 essential implementation components within four domains: intervention installation (five items; maximum score = 5); intervention delivery (12 items; maximum score = 48); intervention coverage (three items; maximum score = 16); and duration of delivery (one item; maximum score = 1).

RESULTS

the mean score (range) for each domain was: installation 4.5 (3.5-5); delivery 32.6 (range 27.3-38.3); coverage 7.9 (range 4.2-10.1); and duration 0.38 (0-1). Of the 10 delirium risk factors, infection, nutrition, hypoxia and pain were the most and cognitive impairment, sensory impairment and multiple medications the least consistently addressed. Overall fidelity to the intervention was assessed as high (≥80%) in two wards, medium (51-79%) in five wards and low (≤50%) in one ward.

CONCLUSION

the trial was designed as a pragmatic evaluation, and the findings of medium intervention fidelity are likely to be generalisable to delirium prevention in routine care and provide an important context to interpret the trial outcomes.

A 'novel' multi-component approach to promote physical activity among older cancer survivors: a pilot randomized controlled trial

BACKGROUND

Physical activity (PA) provides many benefits for recovery from cancer treatments. Many older (65+ years) cancer survivors which comprise the majority of the cancer survivor population, do not meet recommended PA guidelines. This study explored the feasibility and acceptability of using audiobooks as part of a 12-week multi-component intervention to increase steps/day, light and moderate-to-vigorous intensity PA among older survivors.

METHODS

Twenty older cancer survivors (95% female, mean age = 71.55 years, 90% White, 85% overweight/obese, 75% breast cancer survivors, mean 1.96 years since treatment completion) were randomized into one of the two study groups (Audiobook Group, n = 12, Comparison Group, n = 8). Both study groups were provided a tailored step goal program over the 12-week intervention; weekly step increases were based on a percent increase from baseline. Participant self-monitored their steps using a Fitbit Charge 2. In addition, the Audiobook group were encouraged to listen to audiobooks (downloaded onto a smartphone device via an app available at no cost from the local library) during PA to add enjoyment and increase PA. Regression analyses on steps/day, light and moderate-to-vigorous PA/week and sedentary time/week as assessed by the Actigraph were conducted, after adjusting for Actigraph wear time. Data from the post-intervention questionnaire were summarized.

RESULTS

Overall, majority of participants (89%) stated they were very satisfied with their participation and 100% reported that they were able to maintain their activity upon study completion. Retention rates were high. At post-intervention, there were significant differences favoring the Audiobook group for steps/day and moderate-to-vigorous PA/week. No significant group differences were found for minutes of light intensity PA/week and sedentary time/week.

CONCLUSION

Piloting the implementation of a sustainable, innovative intervention among older survivors to increase their PA has significance for this group of survivors.

Improving access to a multi-component intervention for caregivers and people with dementia

Due to the increasing social and economic costs of dementia, there are urgent calls to develop accessible and sustainable care for people with dementia and their caregivers. Multi-component non-pharmacological interventions (NPIs) appear effective in improving or maintaining daily functioning and well-being, but are typically labour-intensive for health care professionals, thus hindering access. The current study aimed to explore the feasibility and acceptability of a novel approach to widen access to NPI by involving caregivers to present part of the intervention and with staff from local support organizations instructed to train the caregivers. Trainers and caregivers were shown to comply with training instructions and the direct intervention costs were low. Feedback from trainers and caregivers was positive and well-being ratings from people with dementia and caregivers remained stable over time and caregivers' sense of competence improved. The findings suggest that involving caregivers and trained non-professionals to provide the intervention is feasible and acceptable and could be a cost-effective solution to improve access to care.

Facilitators and barriers to a dietitian-implemented blended care weight-loss intervention (SMARTsize): a qualitative study

BACKGROUND

Dietitians play an important role in the intervention and prevention of being overweight and obesity. More and more blended care interventions are being implemented. The present study aimed to evaluate the delivery by Dutch dietitians of a multicomponent, evidence-based weight-loss programme (SMARTsize), including counselling for relapse prevention. The aim of this qualitative study was to identify facilitators and barriers to the delivery of SMARTsize.

METHODS

Nine semi-structured interviews were conducted with 10 dietitians who participated in a larger implementation study. Each interview was recorded and transcribed verbatim. Determinants of theory of implementation, including characteristics of the user, the innovation, organisational context and setting, and innovation strategy guided interviews and analysis. Data were coded and analysed using the framework approach.

RESULTS

According to dietitians, the SMARTsize intervention had a positive influence on patients. The main implementation facilitators were the availability of implementation materials, such as a manual, training in relapse prevention and social support from other dietitians. The main barriers to implementation were organisation and financial reimbursement of cooking classes, the belief that patients need more individual counselling in the starting phase, and the unsuitability for people with low levels of health literacy.

CONCLUSIONS

Most dietitians considered that implementation of the SMARTsize intervention consisting of e-health, written information and cooking classes and face-to-face counselling is challenging but feasible. Further development of the SMARTsize intervention and implementation tools is needed to lower experienced barriers. It is also recommended that a version of the intervention to be developed that is suitable for patients with lower levels of health literacy.

Cognitive stimulation and activities of daily living for individuals with mild-to-moderate dementia: A scoping review

Introduction

Dementia is a progressive syndrome that interferes with the individual's ability to perform activities of daily living (ADL). Cognitive stimulation (CS) is a non-pharmacological approach aimed to mitigate the impact of dementia symptoms. While CS has been shown to provide benefits for cognition and quality of life, the evidence supporting its use in improving ADL outcomes is reduced. The aim of this review was to chart what is known from the literature about the use of CS in improving ADL outcomes.

Method

A scoping review of the use of CS in improving ADL outcomes for individuals with mild-to-moderate dementia was conducted, following a scoping review methodological framework. Eight databases were searched, including all articles published up until June 2022.

Findings

A three-step search strategy yielded 788 results. Following screening and review, 36 papers met the inclusion criteria for this review. Studies were charted and discussed in the areas of (1) cognitive stimulation therapy; (2) group CS programmes; (3) multi-component CS interventions; (4) individual CS programmes and (5) other types of CS.

Conclusion

The review identified a range of CS programmes from across 13 countries worldwide. Multi-component CS interventions involving ADL-focused activities reported the most benefits for ADL outcomes.

The effect of a multi-component school-based social network intervention on children's body mass index: a four-arm intervention study

Methods: Four schools were randomly allocated to one of four conditions: a social network intervention using influence agents focusing on water consumption, physical activity, a combination of the two, or a passive control condition. Participants included a total of 201 6- to-11-year-old children (53.7% girls; Mage = 8.51, SDage = 0.93). At baseline, 149 (76.0%) participants had a healthy weight, 29 (14.8%) had overweight and 18 (9.2%) had obesity.

Results: Linear mixed effect models indicated that a multi-component school-based social network intervention targeting both water consumption and physical activity was most effective in decreasing children's zBMI.

Conclusion: This study suggests that schools can contribute to the intervention of childhood obesity-even without involving the parents-by targeting both children's water consumption and physical activity through influential peers, but more research is needed to identify mechanisms of change.

HEPPI: a randomized controlled trial of the efficacy of a cognitive-emotional intervention for homebound older adults

OBJECTIVES

This randomized controlled trial aimed to assess the efficacy of the Homebound Elderly People Psychotherapeutic Intervention (HEPPI), a home-delivered cognitive-emotional intervention, among the homebound older population presenting with mild cognitive impairment and depressive or anxiety symptoms.

METHODS

Participants were randomly assigned either to the intervention group or the treatment-as-usual group and completed baseline, post-intervention, and three-month follow-up assessments. Changes in episodic memory and symptoms of depression and anxiety were the primary outcomes. Secondary outcomes included changes in global cognition, attentional control, subjective memory complaints, functional status, and quality of life. Data were analyzed on an intention-to-treat basis employing a linear mixed models approach. ClinicalTrials.gov identifier: NCT05499767.

RESULTS

Compared with the treatment-as-usual group, the HEPPI group reported significant immediate improvement in cognition, mood, and daily functional performance. Positive effects of HEPPI were maintained over the follow-up phase only in depressive symptomatology, perceived incapacity to perform advanced instrumental activities of daily living, and self-reported emotional ability. A significant impact of the intervention on the subjective memory complaints level was observed only three months after the intervention.

CONCLUSIONS

This study suggests that HEPPI may be a promising home-delivered cognitive-emotional intervention to help homebound older adults improve their mental health.

Development and Cultural Adaptation of a Computer-Delivered and Multi-Component Alcohol Reduction Intervention for Russian Women Living with HIV and HCV

Background:

There is elevated prevalence of problem drinking among Russian women living with HIV and HCV co-infection. This paper describes the development and cultural adaptation of a multi-component alcohol reduction intervention incorporating a brief, computer-delivered module for Russian women living with HIV and HCV co-infection.

Methods:

The format and content of the intervention were adapted to be linguistic-, cultural-, and gender-appropriate using the ADAPT-ITT framework. A computer-delivered module and brief clinician-delivered individual and telephone sessions were developed.

Results:

We describe the theoretical foundations of the intervention, the cultural adaptation of the intervention, and overview the content of the intervention’s multiple components.

Discussion:

Interventions to reduce alcohol use that can be integrated within Russian HIV treatment centers are urgently needed. If efficacious, the culturally-adapted intervention offers the promise of a cost-effective, easily disseminated intervention approach for Russian women living with HIV/HCV co-infection engaging in problematic alcohol use.

A Community-Based, Participatory, Multi-Component Intervention Increased Sales of Healthy Foods in Local Supermarkets-The Health and Local Community Project (SoL)

Project SoL was a 19-month (September 2012 to April 2014) community-based multi-component intervention based on the supersetting approach that was designed to promote healthier eating and physical activity among children and their families. The aim of this study was to examine the effects of a multi-component intervention (level 1) and a mass media intervention alone (level 2) compared to a control area (level 3) on food sales. The design was quasi-experimental. Weekly sales data for all Coop supermarkets in the intervention and control areas were analysed via longitudinal linear mixed-effects analyses. Significant increases in the sales of fish (total) (29%; p = 0.003), canned fish (31%; p = 0.025) and oatmeal (31%; p = 0.003) were found for the level 1 intervention area compared to the control area. In the level 2 intervention area, significant increases in the sales of vegetables (total) (17%; p = 0.038), fresh vegetables (20%; p = 0.01), dried fruit (51%; p = 0.022), oatmeal (19%; p = 0.008) and wholegrain pasta (58%; p = 0.0007) were found compared to the control area. The sales of canned fish increased by 30% in the level 1 area compared to the level 2 area (p = 0.025). This study demonstrated significant increases in the sales of healthy foods, both in the areas with multi-component and mass media interventions alone compared to the control area.

Effects of Virtual Reality Physical and Cognitive Training Intervention On Cognitive Abilities of Elders with Mild Cognitive Impairment

Background

Virtual reality (VR) technology has become increasingly used for assessment and intervention in the neuroscience field.

Objective

We aimed to investigate the effects of a VR Training System, named VRADA (VR Exercise App for Dementia and Alzheimer's Patients), on the cognitive functioning of older people with mild cognitive impairment (MCI).

Methods

In this intervention study, 122 older adults with MCI were randomly assigned to five groups (the VRADA group (n = 28), a bike group (n = 11), a physical exercise group (n = 24), a mixed group (physical and cognitive exercise) (n = 31), and a non-contact control group (n = 28). The VRADA group underwent 32 physical and cognitive training sessions, performed 2 or 3 times weekly for 12 weeks in the VR environment. All participants had detailed neuropsychological assessments before and after intervention.

Results

A series of linear regression models revealed that the VRADA group showed improvement or no deterioration in cognitive decline in global cognitive function (MMSE), verbal memory (Rey Auditory Verbal Learning Test and WAIS forward test), and executive functions, mental flexibility (Trail Making Test B).

Conclusions

This interventionstudy indicates that the VRADA system improves the cognitive function of elders with MCI.

An Evaluation of the Impact of a Multicomponent Stop Smoking Intervention in an Irish Prison

The disproportionately high prevalence of tobacco use among prisoners remains an important public health issue. While Ireland has well-established legislative bans on smoking in public places, these do not apply in prisons. This study evaluates a multi-component tobacco control intervention in a medium security prison for adult males in Ireland. A stop-smoking intervention, targeting staff and prisoners, was designed, implemented, and evaluated with a before-and-after study. Analysis was conducted using McNemar’s test for paired binary data, Wilcoxon signed rank test for ordinal data, and paired T-tests for continuous normal data. Pre-intervention, 44.3% (n = 58) of the study population were current smokers, consisting of 60.7% of prisoners (n = 51) and 15.9% of staff (n = 7). Post-intervention, 45.1% of prisoners (n = 23/51) and 100% of staff (n = 7/7) who identified as current smokers pre-intervention reported abstinence from smoking. Among non-smokers, the proportion reporting being exposed to someone else’s cigarette smoke while being a resident or working in the unit decreased from 69.4% (n = 50/72) pre-intervention to 27.8% (n = 20/72) post-intervention (p < 0.001). This multicomponent intervention resulted in high abstinence rates, had high acceptability among both staff and prisoners, and was associated with wider health benefits across the prison setting.

Evaluation of OPTIMISE (Online Programme to Tackle Individual's Meat Intake Through Self-regulation): Cohort Study

BACKGROUND

There is an urgent need to reduce society's meat consumption to help mitigate climate change and reduce noncommunicable diseases.

OBJECTIVE

This study aimed to investigate changes in meat intake after participation in an online, multicomponent, self-regulation intervention.

METHODS

We conducted a pre-post observational study among adult meat eaters in the United Kingdom who signed up to a website offering support based on self-regulation theory to reduce meat consumption. The program lasted 9 weeks (including a 1-week baseline phase, a 4-week active intervention phase, and a 4-week maintenance phase), comprising self-monitoring, goal setting, action planning, and health and environmental feedback. Meat intake was estimated during weeks 1, 5, and 9 using a 7-day meat frequency questionnaire. We analyzed the change in mean daily meat intake from baseline to week 5 and week 9 among those reporting data using a hierarchical linear mixed model. We assessed changes in attitudes toward meat consumption by questionnaire and considered the acceptability and feasibility of the intervention.

RESULTS

The baseline cohort consisted of 289 participants, of whom 77 were analyzed at week 5 (26.6% of the baseline sample) and 55 at week 9 (71.4% of the week 5 sample). We observed large reductions in meat intake at 5 and 9 weeks: -57 (95% CI -70 to -43) g/day (P<.001) and -49 (95% CI -64 to -34) g/day (P<.001), respectively. Participants' meat-free self-efficacy increased, meat-eating identities moved toward reduced-meat and non-meat-eating identities, and perceptions of meat consumption as the social norm reduced. Participants who completed the study reported high engagement and satisfaction with the intervention.

CONCLUSIONS

Among people motivated to engage, this online self-regulation program may lead to large reductions in meat intake for more than 2 months, with promising signs of a change in meat-eating identity toward more plant-based diets. This digital behavior change intervention could be offered to complement population-level interventions to support reduction of meat consumption.

Perceptions of Portuguese parents about the acceptability of a multicomponent intervention targeted at behavioral inhibition during early childhood

High and stable behavioral inhibition during early childhood is a risk factor for later anxiety disorders. The few available interventions targeted at behavioral inhibition have not yet been implemented in European countries. Evaluating intervention acceptability is essential when introducing interventions in new cultures. This study aimed to explore the perceptions of parents about the acceptability of the multicomponent Turtle Program in Portugal. Participants were 12 parents (from seven families) of children with a positive screening on the Behavioral Inhibition Questionnaire and no diagnoses of developmental disorders/selective mutism. Children's mean age was 55.86 months and most children were female and first-born. Parents and children participated in the eight-sessions Turtle Program. After each session, parents completed weekly satisfaction checklists. Following completion of the full intervention, parents were invited to participate in individual qualitative in-depth interviews. The thematic analysis revealed that both parents perceived the intervention objectives and contents as relevant. Both parents suggested the introduction of follow-up sessions, the discussion of practical experiences, the need to be sensitive to cultural differences in positive language, and the provision of more feedback about children's activities. These findings support prior research on the acceptability and cultural tailoring needed for parenting and child socioemotional learning interventions.

Impact of a Collaboration-Focused Intervention to Prevent Healthcare-Associated Infections Before and During the Coronavirus Disease 2019 Pandemic

BACKGROUND

Nursing home (NH) residents are susceptible to healthcare-associated infections (HAIs). Alignment among NHs, hospitals, and health departments is critical for effective implementation of infection prevention efforts. We tested a collaborative model that engaged hospitals and NHs to reduce infections among NH residents.

METHODS

We recruited 92 NHs and 15 hospitals over four 12-month cohorts (2018-2022). The intervention focused on HAI prevention; practices to reduce infection transmission; and effective communication among hospitals, NHs, and state health departments. NHs submitted data on urinary tract infection, catheter-associated urinary tract infection, Clostridioides difficile infection, methicillin-resistant Staphylococcus aureus infection, catheter use, and urine cultures. Changes in outcomes before and during the coronavirus disease 2019 (COVID-19) pandemic were assessed using multilevel negative binomial regression.

RESULTS

A total of 63 NHs (68%) partnered with 18 hospitals and submitted 2 or more months of outcome data. Forty NHs participated before COVID-19 (contributing to 1 364 492 resident-days, 56 258 device-days), and 23 NHs participated during COVID-19 (566 142 resident-days, 29 568 device-days). While reductions in the incidence of urine cultures (incidence rate ratio [IRR], 0.37; P < .001) and total composite infections (IRR, 0.68; P = .03) were observed before COVID-19, these reductions were not sustained during the pandemic.

CONCLUSIONS

Prior to COVID-19 pandemic, collaboration between NHs and referring regional hospitals with engagement from state health departments led to reductions in NH urine cultures and total infections. Although the pandemic significantly impacted our study, we demonstrate the importance of regional networks in promoting infection prevention in NHs.