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Early Intervention (early + intervention)
Terms modified by Early Intervention Selected AbstractsOutcomes for 236 patients from a 2-year early intervention in psychosis serviceACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009M. A. Turner Objective:, To examine: i) changes in key outcome measures over time in treatment in a representative first-episode psychosis treatment cohort and ii) baseline predictors of service disengagement. Method:, Baseline characteristics of 236 patients were examined for associations with outcomes over time using generalized estimating equation models. The data on disengagement were analysed using logistic regression. Results:, After controlling for admission scores, patients showed consistently improved outcomes while in treatment on functional recovery (unemployment, P < 0.01; HoNOS, P < 0.001; the Quality of Life Scale, P < 0.001; GAF, P < 0.05) but not symptomatology (as assessed by the PANSS and substance abuse). The 64 (33%) who disengaged were more likely to be unemployed (P < 0.01) and have higher HoNOS (P < 0.01) and GAF (P < 0.05) scores at baseline. Conclusion:, This evaluation has shown significant improvements in psychosocial functioning but not psychopathology during treatment at an Early Intervention for Psychosis Service. Despite attempts to retain patients, there is a high rate of treatment discontinuation. [source] Prediction of twelve-month service disengagement from an early intervention in psychosis serviceEARLY INTERVENTION IN PSYCHIATRY, Issue 3 2007Mark Turner Abstract Aim: The aim is to examine disengagement in an early psychosis treatment service and contrast clinical and demographic variables of patients who disengage against those who do not. Methods: Those with termination of treatment, despite therapeutic need within 12 months of entry (disengagers) (n = 57; 24.6%), were compared with those who remained in treatment at 12 months (n = 175) on a range of clinical and demographic variables collected at admission. After testing the difference between proportions, data analysis was conducted using methods of logistic regression. Results: Alcohol and/or cannabis abuse/dependence, initial diagnosisother than mood disorder, long duration of untreated psychosis, lower Positive and Negative Syndrome Scale total symptoms, and lower insight at referral accounted for 27% of variance in patient ,disengagement' within 12 months. Conclusion: A significant proportion of patients with first episode psychosis disengage from treatment within 12 months. Despite a number of factors being associated with disengagement, prediction using admission factors was poor. Early Intervention in Psychosis Services would benefit from increased attention to alcohol and drug problems, trying to reduce the duration of untreated psychosis, improving psychiatric symptoms and increasing insight in all patients to decrease service disengagement. [source] Early Intervention With Almotriptan Improves Sustained Pain-free Response in Acute MigraineHEADACHE, Issue 10 2003Ninan T. Mathew MD Objective.,To determine whether treatment of migraine with almotriptan, when pain intensity is mild, improves 1- and 2-hour pain-free and sustained pain-free rates compared with treatment when pain intensity is moderate or severe. Methods.,This was a post hoc analysis derived from an open-label, multicenter, long-term study of the safety, tolerability, and efficacy of almotriptan 12.5 mg. Patients who met International Headache Society criteria for migraine with or without aura were eligible. Patients were instructed to take a single dose of almotriptan 12.5 mg at the onset of a migraine attack. Rescue medication could be taken if migraine pain had not disappeared at 2 hours. A second dose of almotriptan 12.5 mg could be taken if head pain recurred within 24 hours of the initial dose. Patients reported the intensity of pain at baseline and at 1 and 2 hours postmedication using a 4-point scale: no pain, mild, moderate, or severe pain. They also reported recurrence of pain (return of moderate or severe pain within 2 to 24 hours of taking the study medication) and use of rescue medication. Rescue medication consisted of supplemental analgesics taken for pain relief at 2 to 24 hours postdose. Ergotamines and other 5-HT1B/1D agonists were excluded as rescue medications. Based on these patient-reported end points, sustained pain-free rates, defined as pain-free at 2 hours with no recurrence from 2 to 24 hours and no use of rescue medication, were calculated. Results.,A higher proportion of migraine attacks of mild intensity were pain-free at 1 hour (35.3%) compared with attacks of moderate or severe intensity (7.5%) (P < .001). Two-hour pain-free rates also were significantly higher with mild intensity pain (76.9%) compared to moderate or severe intensity (43.9%) (P < .001). In addition, recurrence rates and use of rescue medication were reduced when attacks were treated during mild pain. Recurrence was 12.9% for mild pain versus 25.0% for moderate or severe pain (P < .001), and use of rescue medication was 9.4% for mild pain versus 17.2% for moderate or severe pain (P < .001). Sustained pain-free rates were nearly twice as high when attacks were treated during mild intensity pain (66.6%) compared with attacks treated during moderate or severe pain (36.6%) (P < .001). Conclusion.,Treatment with almotriptan 12.5 mg during migraine attacks of mild pain intensity improves 1- and 2-hour pain-free and sustained pain-free responses. [source] Onset of Depression in Elderly Persons After Hip Fracture: Implications for Prevention and Early Intervention of Late-Life DepressionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2007Eric J. Lenze MD OBJECTIVES: To identify predictors of onset of major depressive disorder (MDD) and of depressive symptoms in subjects who suffered a hip fracture. DESIGN: Prospective naturalistic study. SETTING: University of Pittsburgh Medical Center,Shadyside, a large urban hospital in Pittsburgh, Pennsylvannia. PARTICIPANTS: One hundred twenty-six elderly patients who received surgical fixation for hip fracture and who were not experiencing a major depressive episode at the time of the fracture; severely cognitively impaired persons were excluded. MEASUREMENTS: Subjects were evaluated at the time of hospital discharge using a battery of clinical measures (including apathy measured using the Apathy Evaluation Scale (AES), delirium, cognitive measures, social support, and disability level). Depression was assessed at the end of the surgical stay, 2 weeks later, and then monthly for 6 months, using the Hamilton Rating Scale for Depression (Ham-D) to evaluate symptomatology and the Primary Care Evaluation of Mental Disorders to evaluate diagnosis of MDD. RESULTS: Eighteen of 126 subjects (14.3%) developed MDD after hip fracture. Of these, 11 developed MDD by the end of the hospitalization, and seven developed MDD between 2 and 10 weeks later. Logistic regression showed that baseline apathy score, as measured using the AES, was the only clinical measure associated with the development of MDD (odds ratio=1.09, 95% confidence interval=1.03,1.16, P=.003); 46.2% of those with high AES scores developed MDD, versus 10.9% of those with lower scores. In contrast, cognitive variables, delirium, disability after hip fracture, and other factors related to the fracture (e.g., fracture type) were not associated with MDD. A repeated-measures analysis with Ham-D over time as a dependent variable generally confirmed these findings; depressive symptoms were highest immediately after the fracture, and apathy and delirium scores were associated with higher depressive symptom levels. CONCLUSION: The onset of MDD is common after hip fracture, and the greatest period of risk is immediately after the fracture. Individuals with clinical evidence of apathy are at high risk for developing MDD, and evaluation and close follow-up of such individuals is warranted. However, further research is needed to examine other candidate variables (e.g., clinical measures or biomarkers) to model adequately the risk for MDD after hip fracture and other disabling medical events. [source] Early Intervention in an International PerspectiveJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 1 2006Michael J. Guralnick Abstract, The importance and potential value of a worldwide commitment to provide comprehensive early intervention services for children at risk for or with identified intellectual disabilities are considered in the context of this special issue on early intervention. Further refinement of policies and advances in effective practices will result through the application of relevant research findings, through the development and implementation of comprehensive professional training programs, and through model program development with corresponding efforts to bring programs to scale. Articles in this special issue are discussed as representing major early intervention themes in the international community. [source] A Cost Utility Analysis of Interdisciplinary Early Intervention Versus Treatment as Usual For High-Risk Acute Low Back Pain PatientsPAIN PRACTICE, Issue 5 2010Mark D. Rogerson PhD Abstract Chronic pain is a costly and debilitating condition that has proven difficult to treat, solely with medical interventions, due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study utilized a cost utility analysis to evaluate effectiveness and associated costs of interdisciplinary early intervention for individuals with acute low back pain that was identified as high-risk for becoming chronic. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years, and associated medical and employment costs were gathered for 1 year. Results indicated that subjects improved significantly from pretreatment to 1-year follow-up, and that the early intervention group reported fewer health-care visits and missed workdays than the treatment as usual group. The majority of 1,000 bootstrapped samples demonstrated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. The early intervention treatment was the preferred option in over 85% of samples within an established range of acceptable costs. These results are encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted early treatment. [source] Identifying Combinations of Cancer Markers for Further Study as Triggers of Early InterventionBIOMETRICS, Issue 4 2000Stuart G. Baker Summary. In many long-term clinical trials or cohort studies, investigators repeatedly collect and store tissue or serum specimens and later test specimens from cancer cases and a random sample of controls for potential markers for cancer. An important question is what combination, if any, of the molecular markers should be studied in a future trial as a trigger for early intervention. To answer this question, we summarized the performance of various combinations using Receiver Operating Characteristic (ROC) curves, which plot true versus false positive rates. To construct the ROC curves, we proposed a new class of nonparametric algorithms which extends the ROC paradigm to multiple tests. We fit various combinations of markers to a training sample and evaluated the performance in a test sample using a target region based on a utility function. We applied the methodology to the following markers for prostate cancer, the last value of total prostate-specific antigen (PSA), the last ratio of total to free PSA, the last slope of total PSA, and the last slope of the ratio. In the test sample, the ROC curve for last total PSA was slightly closer to the target region than the ROC curve for a combination of four markers. In a separate validation sample, the ROC curve for last total PSA intersected the target region in 77% of bootstrap replications, indicating some promise for further study. We also discussed sample size calculations. [source] School,Based Early Intervention and Later Child Maltreatment in the Chicago Longitudinal StudyCHILD DEVELOPMENT, Issue 1 2003Arthur J. Reynolds Investigated were the effects of participation in the Title I Child,Parent Centers (CPC) on substantiated reports of child maltreatment for 1,408 children (93% of whom are African American) in the Chicago Longitudinal Study. The CPCs provide child education and family support services in high,poverty areas. After adjusting for preprogram maltreatment and background factors, 913 preschool participants had significantly lower rates of court petitions of maltreatment by age 17 than 495 children of the same age who participated in alternative kindergarten interventions (5.0% vs. 10.5%, a 52% reduction). Participation for 4 to 6 years was significantly associated with lower rates of maltreatment (3.6% vs. 6.9%, a 33% reduction). Findings based on child protective service records (as well as combined protective service and court records) were similar. Preschool length, family risk, and school poverty were associated with lower rates of maltreatment. Parental involvement in school and school mobility were significant mediators of intervention effects. [source] Early Intervention for Trauma: Current Status and Future DirectionsCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 2 2002Brett T. Litz Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma. [source] Early intervention in patients at ultra high risk of psychosis: benefits and risksACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009M. B. De Koning Objective:, Prediction of transition to psychosis in the prodromal phase of schizophrenia has raised interest in intervention prior to the onset of frank psychosis. The aim of this review was to examine whether interventions in the prodromal phase have a favourable benefit/risk ratio. Method:, A literature search in PubMed, EMBASE and PsycINFO was performed. Results:, Three randomized clinical trials with antipsychotic medication and/or cognitive behavioural therapy as clinical intervention suggested a positive effect at the end of treatment, but no significant differences were found at the end of follow-up periods from 1 to 4 years. Naturalistic studies present a hypothesis about a possible preventive effect of antidepressive medication. The results of eight other studies are more difficult to interpret. Side-effects of antipsychotic medication and non-adherence with medication are essential problems. Conclusion:, At the present time, the data concerning the benefits and risks do not justify prodromal intervention as standard clinical practice. [source] International Diabetes Federation: a consensus on Type 2 diabetes preventionDIABETIC MEDICINE, Issue 5 2007K. G. M. M. Alberti Abstract Aims, Early intervention and avoidance or delay of progression to Type 2 diabetes is of enormous benefit to patients in terms of increasing life expectancy and quality of life, and potentially in economic terms for society and health-care payers. To address the growing impact of Type 2 diabetes the International Diabetes Federation (IDF) Taskforce on Prevention and Epidemiology convened a consensus workshop in 2006. The primary goal of the workshop and this document was the prevention of Type 2 diabetes in both the developed and developing world. A second aim was to reduce the risk of cardiovascular disease in people who are identified as being at a higher risk of Type 2 diabetes. The IDF plan for prevention of Type 2 diabetes is based on controlling modifiable risk factors and can be divided into two target groups: ,,People at high risk of developing Type 2 diabetes ,,The entire population. Conclusions, In planning national measures for the prevention of Type 2 diabetes, both groups should be targeted simultaneously with lifestyle modification the primary goal through a stepwise approach. In addition, it is important that all activities are tailored to the specific local situation. Further information on the prevention of diabetes can be found on the IDF website: http://www.idf.org/prevention. [source] Early detection and intervention in first-episode schizophrenia: a critical reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2001T. K. Larsen Objective: To review the literature on early intervention in psychosis and to evaluate relevant studies. Method: Early intervention was defined as intervention in the prodromal phase (primary prevention) and intervention after the onset of psychosis, i.e. shortening of duration of untreated psychosis (DUP) (secondary prevention). Results: We found few studies aimed at early intervention, but many papers discussing the idea at a more general level. We identified no studies that prove that intervention in the prodromal phase is possible without a high risk for treating false positives. We identified some studies aimed at reducing DUP, but the results are ambiguous and, until now, no follow-up data showing a positive effect on prognosis have been presented. Conclusion: Early intervention in psychosis is a difficult and important challenge for the psychiatric health services. At the time being reduction of DUP seems to be the most promising strategy. Intervention in the prodromal phase is more ethically and conceptually problematic. [source] Early intervention with second-generation antipsychotics in first-episode psychosis: results of an 8-week naturalistic studyEARLY INTERVENTION IN PSYCHIATRY, Issue 1 2010Richard C. Josiassen Abstract Objective: The objective was to compare short-term effectiveness of aripiprazole with three other second-generation antipsychotics (SGAs) in the treatment of first-episode psychosis. Method: In a naturalistic, ,single-blind' design, 60 subjects experiencing their first psychotic episode were treated for 8 weeks with aripiprazole (n = 19), risperidone (n = 16), olanzapine (n = 14) or quetiapine (n = 11). Medication and dosing decisions were made by treating psychiatrists, constrained to once-a-day dosing, low initial doses and no clozapine. Weekly ratings were obtained using the Positive and Negative Syndrome Scale (PANSS), Simpson-Angus Rating Scale and Barnes Akathasia Rating Scale. Weight and vital signs were also collected weekly. Results: The group presented with severe psychotic symptoms (mean baseline PANSS total score of 105.2), which were reduced rapidly (P < 0.0005). The between-group and group by time interaction terms were non-significant. Similar reductions were seen across all PANSS sub-scales. At Week 1 the mean PANSS Activation Scale score was reduced more with olanzapine than in the other groups (P < 0.002). Few instances of extrapyramidal symptoms occurred; all were sporadic and did not require treatment. Group body weight increased by 7.3% over the study. Vital signs remained unchanged. Conclusions: Early intervention with low doses of four SGAs led to rapid symptom reduction in first-episode psychotic patients with severe psychopathology. Although no clear medication advantages were observed in the short term, longer duration studies with larger samples will be required for determining efficacy, rates of compliance, relapse prevention and diminished incidence of extrapyramidal signs and symptoms. [source] The rationale for early intervention in schizophrenia and related disordersEARLY INTERVENTION IN PSYCHIATRY, Issue 2009Merete Nordentoft Abstract Aim: To examine the rationale and evidence supporting an early intervention approach in schizophrenia. Methods: A selective literature review was conducted. Results: During the onset of schizophrenia, there is often a significant delay between the emergence of psychotic symptoms and the initiation of treatment. The average duration of untreated psychosis is around 1,2 years. During this period, brain function may continue to deteriorate and social networks can be irreversibly damaged. Studies have consistently linked longer duration of untreated psychosis with poorer outcomes and this relationship holds even after controlling for the potential confounding variable of premorbid functioning. In Norway, the early Treatment and Intervention in PSychosis study demonstrated that duration of untreated psychosis is amenable to intervention with the combination of educational campaigns and specialized early detection units substantially decreasing the period from onset of symptoms to treatment initiation. Furthermore, recent evidence from the randomized controlled OPUS and the Lambeth Early Onset trial studies have linked phase-specific early interventions to improved outcomes spanning symptoms, adherence to treatment, comorbid drug abuse, relapse and readmission. Some benefits persist after cessation of the intervention. Conclusions: Early intervention in schizophrenia is justified to reduce the negative personal and social impact of prolonged periods of untreated symptoms. Furthermore, phase-specific interventions are associated with improved outcomes, at least in the short term. Further research is needed to establish the optimum duration of such programmes. [source] Early intervention and suicide preventionEARLY INTERVENTION IN PSYCHIATRY, Issue 3 2008Jo Robinson No abstract is available for this article. [source] Early intervention with difficult to engage, ,high-risk' youth: evaluating an intensive outreach approach in youth mental healthEARLY INTERVENTION IN PSYCHIATRY, Issue 3 2008Carsten Schley Abstract Background: Although intensive outreach (IO) models such as assertive community treatment and intensive case management have a strong evidence base in adult psychiatry, their effectiveness in the early intervention sector is unknown. Aim: To explore client characteristics and treatment effects in a group of difficult to engage, ,high-risk' young people, seen by the Intensive Mobile Youth Outreach Service (IMYOS, ORYGEN Youth Heath) in Western Metropolitan Melbourne. Methods: The clinical files of 47 clients were audited, targeting demographic and treatment outcome data prior to and during IMYOS involvement. Results: Clients typically presented with traumatic childhoods, disrupted education, repeated treatment dropout, poor mental health and ,high-risk' behaviours. Results showed a significant reduction in risk to self and others between referral and discharge, and significantly lower admissions rates and inpatient days compared with the 9 months prior to referral. Conclusions: IO might be an effective early intervention strategy to minimize risk of harm and decrease hospitalization in young people. However, conclusions are provisional as there was no control group included in this study. Further study is required, perhaps with a waiting list control. [source] Early intervention in psychiatry for poorly resourced countriesEARLY INTERVENTION IN PSYCHIATRY, Issue 3 2007Helen Herrman [source] The cost-effectiveness of consistent and early intervention of harm reduction for injecting drug users in BangladeshADDICTION, Issue 2 2010Lorna Guinness ABSTRACT Aims To assess the cost-effectiveness of the CARE-SHAKTI harm reduction intervention for injecting drug users (IDUs) over a 3-year period, the impact on the cost-effectiveness of stopping after 3 years and how the cost-effectiveness might vary with baseline human immunodeficiency virus (HIV) prevalence. Design Economic cost data were collected from the study site and combined with impact estimates derived from a dynamic mathematical model. Setting Dhaka, Bangladesh, where the HIV prevalence has remained low despite high-risk sexual and injecting behaviours, and growing HIV epidemics in neighbouring countries. Findings The cost per HIV infection prevented over the first 3 years was US$110.4 (33.1,182.3). The incremental cost-effectiveness of continuing the intervention for a further year, relative to stopping at the end of year 3, is US$97 if behaviour returns to pre-intervention patterns. When baseline IDU HIV prevalence is increased to 40%, the number of HIV infections averted is halved for the 3-year period and the cost per HIV infection prevented doubles to US$228. Conclusions The analysis confirms that harm reduction activities are cost-effective. Early intervention is more cost-effective than delaying activities, although this should not preclude later intervention. Starting harm reduction activities when IDU HIV prevalence reaches as high as 40% is still cost-effective. Continuing harm reduction activities once a project has matured is vital to sustaining its impact and cost-effectiveness. [source] First-episode psychosis: A literature reviewINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 2 2008Simone I. Reed ABSTRACT:, This paper reports on a literature review of the impacts of first-episode psychosis on both the patient and their family and carers. The discussion focuses on the effects on the patient experiencing psychotic symptoms for the first time, including disruption to their environment, social connectedness, and future plans. Patients experiencing these symptoms can experience fear, distress, and isolation. Many of these patients are also at greater risk to themselves and others. The family and carers witnessing this psychosis may experience fear, guilt, and often carry the emotional and physical burden of care. Early intervention and treatment are crucial to potentially achieving better clinical outcomes, and to alleviating the psychological impact on patients and their families. The nurse's role in the treatment of the patient experiencing first-episode psychosis is to facilitate early intervention through recognition of symptoms and ongoing assessment, work to reduce a patient's risks, manage treatments, and work with the patient to reduce the risk of relapse. [source] Older caregivers' coping strategies and sense of coherence in relation to quality of lifeJOURNAL OF ADVANCED NURSING, Issue 6 2007Anna Kristensson Ekwall Abstract Aim., This paper reports a study to investigate coping strategies and sense of coherence in relation to gender, the extent of care, caregiving activities and health-related quality of life in a population-based sample of caregivers aged 75 and over. Background., Caring for another person can be stressful both emotionally, and caregiver burden may affect quality of life in a negative way for the carer. Caregivers' experience of burden may depend on for example, the behaviour of the person cared for, their own health and their sense of coherence. Older people take a great part of caregiving responsibility and thus understanding of their strain and coping is required. Methods., A postal survey was carried out in 2001 with 171 informal caregivers, aged 75 or older. The response rate was 47%. The questionnaire included the Short-Form 12, Carer's Assessment of Managing Index, and Sense of Coherence instrument. Results., Almost 70% of caregivers provided help every day. Higher health-related quality of life was predicted by using self-sustaining coping strategies and by high sense of coherence. Poor economic situation and demanding social and practical support predicted low scores. Conclusion., These findings could help identify those at risk of low quality of life due to caregiving, dysfunctional coping or lack of information about care. Early intervention, including education about alternative coping strategies and practical information, might allow caregivers better possibilities to continue caring with less negative effects on their lives. [source] Efficacy of a standardized echinacea preparation (EchinilinTM) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trialJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2004V. Goel PhD Summary Background:, Recently, echinacea has regained popularity as one of the treatments chosen most commonly by consumers with the expectation that it will reduce the severity and duration of the common cold. However, the results from a limited number of clinical trials for this application have thus far been inconclusive. This incongruity may be the result of investigators utilizing poorly standardized echinacea products, likely devoid of sufficient quantities of active constituents necessary to exert a definitive clinical effect. Therefore, a formulation containing alkamides, cichoric acid, and polysaccharides at concentrations of 0·25, 2·5, and 25 mg/mL, respectively, was prepared from freshly harvested Echinacea purpurea plants (commercially available as Echinilin, Natural Factors Nutritional Products, Inc., Vancouver, BC, Canada). The objective of this study was to test the efficacy of this highly standardized formulation in reducing the severity and duration of symptoms of a naturally acquired common cold. Methods:, In a randomized, double-blind, placebo-controlled trial, 282 subjects aged 18,65 years with a history of two or more colds in the previous year, but otherwise in good health, were recruited. The subjects were randomized to receive either echinacea or placebo. They were instructed to start the echinacea or placebo at the onset of the first symptom related to a cold, consuming 10 doses the first day and four doses per day on subsequent days for 7 days. Severity of symptoms (10-point scale: 0, minimum; 9, maximum) and dosing were recorded daily. A nurse examined the subjects on the mornings of days 3 and 8 of their cold. Results:, A total of 128 subjects contracted a common cold (59 echinacea, 69 placebo). The total daily symptom scores were found to be 23·1% lower in the echinacea group than in placebo in those who followed all elements of the study protocol (P < 0·01). Throughout the treatment period, the response rate to treatments was greater in the echinacea group. A few adverse event profiles were observed in both groups. Conclusions:, Early intervention with a standardized formulation of echinacea resulted in reduced symptom severity in subjects with naturally acquired upper respiratory tract infection. Further studies with larger patient populations appear to be warranted. [source] Annotation: Early intervention and prevention of self-injurious behaviour exhibited by young children with developmental disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2008D. M. Richman Abstract The ontogeny of self-injurious behaviour exhibited by young children with developmental delays or disabilities is due to a complex interaction between neurobiological and environmental variables. In this manuscript, the literature on emerging self-injury in the developmental disability population is reviewed with a focus on an operant conceptual model of how topographies of self-injurious behaviour can change structurally and become sensitive to various environmental consequences. Results of previous studies are reviewed in terms of extending our research focus from a reactive model of assessment and treatment of well-established cases of self-injury to an early intervention and prevention model. [source] Early intervention in psychosis: a rural perspectiveJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2007M. KELLY rmn dip ma Over the past decade, there has been great interest in both the development and delivery of early intervention in psychosis services in the United Kingdom, supported by national policy and a Policy Implementation Guide (PIG). Despite this, the PIG fails to distinguish the delivery of early intervention services to different population groups. The paper aims to augment available literature with the range of complex issues that practitioners may face when working in rural settings and link this to the development of early intervention services in rural communities. This paper will also outline some of the fundamental factors that challenge delivery of early intervention to individuals with a first episode of psychosis and their families in rural communities. Important key areas for consideration will be highlighted for both the planning and delivery of early intervention to rural communities. [source] Long-term outcome of oral language and phonological awareness intervention with socially disadvantaged preschoolers: the impact on language and literacyJOURNAL OF RESEARCH IN READING, Issue 3 2010Caroline Henning Early intervention aims to prevent poor literacy outcomes associated with social disadvantage. This study examined whether the short-term positive effect of a preschool classroom-based oral language and phonological awareness (PA) programme was maintained and transferred to literacy 2 years later. The vocabulary knowledge, grammatical skill, auditory comprehension and reading comprehension of 54 6,7-year-old Australian children who attended school in a low-socioeconomic area were measured. Children's PA abilities were also assessed and are reported elsewhere. There were no significant differences between children who had received intervention in preschool and those who had not, with the entire cohort performing below the average range of the general population. The findings indicated that while generating short-term positive effects, intervention in preschool did not enhance socially disadvantaged children's language and literacy achievement in the long term. [source] Early intervention of recent onset mild persistent asthma in children aged under 11 yrs: the Steroid Treatment As Regular Therapy in early asthma (START) trialPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 2006Yu-Zhi Chen Inhaled corticosteroids are known to be effective in persistent asthma, but their long-term effect in mild persistent disease of recent onset, which is particularly relevant in children, requires clarification. The objective of this study was to determine the long-term efficacy of regular inhaled low-dose budesonide in children aged <11 yrs with mild persistent asthma with onset within 2 yrs of enrollment. Children aged 5,10 yrs formed part of the population of the inhaled Steroid Treatment As Regular Therapy in early asthma (START) study, and they were randomized in a double-blind manner to treatment with once daily budesonide 200 ,g or placebo via TurbuhalerTM in addition to usual clinical care and other asthma medication. The double-blind treatment phase continued for 3 yrs. Of the 1974 children, 1000 in the budesonide group and 974 in the placebo group, were analyzed for efficacy. Addition of once-daily budesonide to usual care was associated with a significant increase in the time to first severe asthma-related event (SARE) and significantly reduced risk of SARE over 3 yrs. The hazard ratio relative to usual care (placebo) was 0.60 (95% confidence interval: 0.40,0.90; p = 0.012), with a relative risk reduction of 40%. Children receiving budesonide also needed significantly less intervention with other inhaled corticosteroids (12.3% vs. 22.5% over 3 yrs; p < 0.01), with trends towards decreased usage of oral/systemic corticosteroids and inhaled short-acting ,2 -agonists. Budesonide treatment also had a significant beneficial effect on lung function relative to placebo. In conclusion, early intervention adding once-daily budesonide to usual care in children with mild, persistent asthma of recent onset reduces the long-term risk and frequency of SAREs and improves lung function compared with usual care alone. [source] Early intervention in CF: How to monitor the effectPEDIATRIC PULMONOLOGY, Issue 11 2007Giora Weiser MD Abstract Early and aggressive therapy already at the stage when no apparent signs of significant lung disease are detectable, may delay the development and progression of cystic fibrosis (CF). Identification of markers for early pulmonary disease in CF is crucial to monitor adherence to preventive therapy and determine its success. Currently several surrogate markers are available that are used in both the decision making and evaluation of the timing and success of early intervention namely, pulmonary function tests (PFT), microbial cultures, imaging techniques, inflammatory markers, serological markers, and several general signs such as exacerbation rate and nutritional status. This review will present the current status and discuss the significance of their application as well as their limitations for patients with CF and no apparent pulmonary disease. 2007;42:1002,1007. © 2007 Wiley-Liss, Inc. [source] Predictors of breast cancer-related distress following mammography screening in younger women on a family history breast screening programmePSYCHO-ONCOLOGY, Issue 12 2008K. Brain Abstract Objective: This longitudinal study investigated pre-screening factors that predicted breast cancer-specific distress among 1286 women who were undergoing annual mammography screening as part of a UK programme for younger women (i.e., under 50) with a family history of breast cancer. Methods: Women completed questionnaires one month prior to screening, and one and six months after receiving screening results. Factors measured were breast cancer worry, perceived risk, cognitive appraisals, coping, dispositional optimism, and background variables relating to screening history and family history. Results: Pre-screening cancer worry was the most important predictor of subsequent worry, explaining 56/61% and 54/57% of the variance at one and six months follow-up, respectively. Other salient pre-screening predictors included high perceived risk of breast cancer, appraisals of high relevance and threat associated with the family history, and low perceived ability to cope emotionally. Women who had previously been part of the screening programme and those with a relative who had recently died from breast cancer were also vulnerable to longer-term distress. A false positive screening result, pessimistic personality, and coping efforts relating to religion and substance use predicted outcomes of screening at one month follow-up, but were not predictive in the longer-term. Conclusion: Early intervention to ameliorate high levels of cancer-related distress and negative appraisals would benefit some women as they progress through the familial breast screening programme. Copyright © 2008 John Wiley & Sons, Ltd. [source] Systematic review of early vs deferred hormonal treatment of locally advanced prostate cancer: a meta-analysis of randomized controlled trialsBJU INTERNATIONAL, Issue 6 2007Gregory Boustead OBJECTIVE To compare the effectiveness of hormonal treatment (luteinizing hormone-releasing hormone agonists and/or antiandrogens) as an early or as a deferred intervention for patients with locally advanced prostate cancer (LAPC), as radiotherapy is currently the standard treatment for LAPC, with hormonal treatment considered a reserve option. METHODS We systematically reviewed randomized controlled trials (RCTs) in patients with LAPC treated with standard care (radical prostatectomy, radiotherapy, and/or watchful waiting) or standard care plus hormonal treatment. Outcomes assessed were mortality and objective disease progression. The meta-analysis used a fixed-effects model. RESULTS Of the 108 trials identified, seven met the inclusion criteria and were of sufficient quality to be included in the analysis. Early intervention with hormonal treatment significantly reduced all-cause mortality compared with deferred treatment (relative risk, RR, 0.86; 95% confidence interval, CI, 0.82,0.91; P < 0.001). Similarly, early vs deferred use of hormonal treatment significantly reduced: prostate cancer- specific mortality (RR 0.72; 95% CI 0.65,0.79); overall progression (RR 0.74; 0.69,0.78); local progression (RR 0.65; 0.57,0.73); and distant progression (RR 0.67; 0.61,0.74; all P < 0.001). Results were robust to changes in inclusion/exclusion criteria and use of a random-effects model for the meta-analyses. Heterogeneity and publication bias had no significant effect on the analyses. CONCLUSIONS Early intervention with hormonal treatment for patients with LAPC provides significantly lower mortality and objective disease progression than deferring their use until standard care has failed. [source] Mothers' awareness of their weight status and concern about their children being overweight: findings from first-time mothers in south-west SydneyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Li Ming Wen Abstract Objective: To assess mothers' awareness of their weight status and to investigate whether this awareness influences mothers' concerns about their child being overweight or obese. Design and setting: An analysis of cross-sectional baseline survey data from the Healthy Beginnings Trial conducted in south-west Sydney, NSW. Participants: A total of 667 first-time mothers at 24-36 weeks of pregnancy or within one month after giving birth, who participated in the Healthy Beginnings Trial. Results: Forty per cent of first-time mothers were overweight (24%) or obese (16%). Of these women 49% considered their weight acceptable and 21% had little or no concern about their child being overweight and obese. Concern about her child's weight was not dependent on the mother's age, marital status, education, employment, ethnicity or weight status. The only factor associated with concern about children being overweight was the mother's awareness of her own weight status. Mothers who were unaware of being overweight were twice as likely to be unconcerned about their children being overweight as those who were aware of their weight status (RR 1.98, 95% CI 1.19 to 3.29, p=0.009). Conclusions: There was a low level of awareness of mothers' own weight status, in particular among mothers who were young and less educated. This could lead to a lack of concern about their child being overweight. Implications: Early interventions to prevent childhood overweight and obesity need to improve mothers' awareness of their own weight status and appropriate concerns about children being overweight or obese. [source] Effects of fully established Sure Start Local Programmes on 3-year-old children and their families living in England: a quasi-experimental observational studyCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2009Richard Reading Effects of fully established Sure Start Local Programmes on 3-year-old children and their families living in England: a quasi-experimental observational study . MelhuishE., BelskyJ., LeylandA. H., BarnesJ. & the National Evaluation of Sure Start Research Team ( 2008 ) The Lancet , 372 , 1641 , 1647 . DOI: 10.1016/S0140-6736(08)61687-6 . Background Sure Start Local Programmes (SSLPs) are area-based interventions to improve services for young children and their families in deprived communities, promote health and development, and reduce inequalities. We therefore investigated whether SSLPs affect the well-being of 3-year-old children and their families. Methods In a quasi-experimental observational study, we compared 5883 3-year-old children and their families from 93 disadvantaged SSLP areas with 1879 3-year-old children and their families from 72 similarly deprived areas in England who took part in the Millennium Cohort Study. We studied 14 outcomes , children's immunizations, accidents, language development, positive and negative social behaviours and independence; parenting risk; home-learning environment; father's involvement; maternal smoking, body-mass index and life satisfaction; family's service use; and mother's rating of area. Findings After we controlled for background factors, we noted beneficial effects associated with the programmes for five of 14 outcomes. Children in the SSLP areas showed better social development than those in the non-SSLP areas, with more positive social behaviour (mean difference 0.45, 95% CI 0.09 to 0.80, P = 0.01) and greater independence (0.32, 0.18 to 0.47, P < 0.0001). Families in SSLP areas showed less negative parenting (,0.90, ,1.11 to ,0.69, P < 0.0001) and provided a better home-learning environment (1.30, 0.75 to 1.86, P < 0.0001). These families used more services for supporting child and family development than those not living in SSLP areas (0.98, 0.86 to 1.09, P < 0.0001). Effects of SSLPs seemed to apply to all subpopulations and SSLP areas. Interpretation Children and their families benefited from living in SSLP areas. The contrast between these and previous findings on the effect of SSLPs might indicate increased exposure to programmes that have become more effective. Early interventions can improve the life chances of young children living in deprived areas. [source] | |||||||||||||||||||||||||||||||||||||||||||