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Health Care Interventions (health + care_intervention)
Selected AbstractsOmega-3 polyunsaturated acids and cardiovascular disease: notable ethnic differences or unfulfilled promise?JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 10 2010J. V. PATEL Summary., The consumption of long chain omega-3 polyunsaturated acids (PUFA) is considered to protect against cardiovascular disease and promote longevity following a heart attack. Historically, research in this area was fuelled by compelling reports of the cardiovascular benefits of omega-3 PUFA in select populations and cultures. More recent studies, in wider populations, suggest discordant findings: differences that are difficult to reconcile as the mechanism of action of omega-3 PUFA are poorly understood. As such, the use of this ,natural treatment' for cardiovascular disease is increasingly controversial, and potentially one of unfulfilled promise. To what extent does ethnicity influence the impact that omega-3 PUFA have on cardiovascular disease and its associated complications? We were interested to review the benefits of omega-3 PUFA in the management of cardiovascular risk amongst diverse ethnic groups. Using a systematic review of literature relating to omega-3 PUFA and cardiovascular disease, we found ethnicity to be a factor that accounts for inconsistency between studies. Some of the effects of omega-3 PUFA are limited to cultures with a very high omega-3 intake, and in turn, ethnicity moderates the efficiency with which PUFA are derived from the diet. Moreover, omega-3 PUFA are an important health care intervention in the current climate of globalization, where supplementation is likely to give protection to cultural groups undergoing dietary transition. Future epidemiological research into the efficacy of omega-3 PUFA in cardiovascular disease should consider the influence of ethnicity. [source] Development of the International Classification of Mental Health Care (ICMHC)ACTA PSYCHIATRICA SCANDINAVICA, Issue 2000A. De Jong Objective: Evaluations of the process of providing mental health care have been hampered because a tool to systematically describe the interventions actually provided by the services was lacking. In this paper the development of such a tool (the International Classification of Mental Health Care; ICMHC) is described. Method: Subsequent versions of the ICMHC were developed, using comments from experts in 24 WHO field centres and results from a number of field trials. In the final version 10 Modalities of Care can be used to describe Modules of Care, using the Level of Specialization scale. The inter-rater reliability of this version was evaluated by the Italian research team, using data from 43 services. Results: Reliability ranged from excellent for nine modalities to reasonably good for the remaining modality. Conclusion: In the context of evaluation studies, the ICMHC can be used to describe systematically mental health care interventions. [source] Risk and protective behaviours of bisexual minority women: a qualitative analysisINTERNATIONAL NURSING REVIEW, Issue 2 2005J. D. Champion phd Background, Public health messages urging women to seek health care services such as sexually transmitted diseases (STD) and cervical cancer screening or family planning services fail to address women who have sex with women (WSW). This negligence may have led to a false sense of security amongst WSW concerning sexual risk behaviour. Research has shown that WSW engaged in more high-risk sexual behaviours than heterosexual women. WSW has been identified as an important vector in the spread of STDs in all populations because of bisexuality. To prevent and reduce transmission of STDs amongst WSW, perceptions of risk for STD amongst WSW need to be understood so that effective interventions may be developed. Aim, To describe the relationship between sexual risk and protective behaviour and STD transmission amongst bisexual minority women with a history of STD. Methods, Life history methods were used to interview 23 African-American bisexual women with a history of STD. Findings, Various themes unfolded during analysis of the patient interviews, including bisexual women's perceptions of STD risk, the context of sexual relationships with women and STD prevention, screening, and treatment practices. Conclusions, The contexts of sexual relationships including multiple or concurrent partner relationships with both men and women placed these women at high risk for STD. Regardless of the type of relationship or belief it is possible to get an STD, protection was often not used. These circumstances identify an extremely high-risk population of women with need for more extensive research to identify strategies for health care interventions. [source] At what degree of belief in a research hypothesis is a trial in humans justified?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2002Benjamin Djulbegovic MD Abstract Rationale, aims and objectives,Randomized controlled trials (RCTs) have emerged as the most reliable method of assessing the effects of health care interventions in clinical medicine. However, RCTs should be undertaken only if there is substantial uncertainty about which of the trial treatments would benefit a patient most. The purpose of this study is to determine the degree of uncertainty in a research hypothesis before it can empirically be tested in an RCT. Methods,We integrated arguments from three independent lines of research , on ethics, principles of the design and conduct of clinical trials, and medical decision making , to develop a decision model to help solve the dilemma of under which circumstances innovative treatments should be tested in an RCT. Results,We showed that RCTs are the preferable option to resolve uncertainties about competing treatment alternatives whenever we desire reliable, undisputed, high-quality evidence with a low likelihood of false-positive or false-negative results. Conclusions When the expected benefit : risk ratio of a new treatment is small, an RCT is justified to resolve uncertainties over a wide range of prior belief (e.g. 10,90%) in the accuracy of the research hypothesis. Randomized controlled trials represent the best means for resolving uncertainties about health care interventions. [source] Use of marketing to disseminate brief alcohol intervention to general practitioners: promoting health care interventions to health promotersJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2000Catherine A. Lock BSc MA Abstract Health research findings are of little benefit to patients or society if they do not reach the audience they are intended to influence. Thus, a dissemination strategy is needed to target new findings at its user group and encourage a process of consideration and adoption or rejection. Social marketing techniques can be utilized to aid successful dissemination of research findings and to speed the process by which new information reaches practice. Principles of social marketing include manipulating the marketing mix of product, price, place and promotion. This paper describes the development of a marketing approach and the outcomes from a trial evaluating the effectiveness and cost-effectiveness of manipulating promotional strategies to disseminate actively a screening and brief alcohol intervention (SBI) programme to general practitioners (GPs). The promotional strategies consisted of postal marketing, telemarketing and personal marketing. The study took place in general practices across the Northern and Yorkshire Regional Health Authority. Of the 614 GPs eligible for the study, one per practice, 321 (52%) took the programme and of those available to use it for 3 months (315), 128 (41%) actively considered doing so, 73 (23%) actually went on to use it. Analysis of the specific impact of the three different promotional strategies revealed that while personal marketing was the most effective overall dissemination and implementation strategy, telemarketing was more cost-effective. The findings of our work show that using a marketing approach is promising for conveying research findings to GPs and in particular a focus on promotional strategies can facilitate high levels of uptake and consideration in this target group. [source] Hormone replacement therapy and cardiovascular disease: increased risks of venous thromboembolism and stroke, and no protection from coronary heart diseaseJOURNAL OF INTERNAL MEDICINE, Issue 5 2004G. D. O. Lowe Abstract. Hormone replacement therapy (HRT) was increasingly promoted over the last 40 years to improve quality of life, and to reduce the risks of osteoporotic fractures and coronary heart disease (CHD). In recent years, observational studies, randomized trials and systematic reviews of such trials have shown that HRT does not reduce, but actually increases cardiovascular risk. HRT increases the relative risks of venous thromboembolism (twofold), and of fatal or disabling stroke (by 50%); whilst increasing the early risk of myocardial infarction and having no protective effect against CHD on longer term use. Possible mechanisms for these increased cardiovascular risks include down-regulation of several inhibitory pathways of blood coagulation, resulting in increased coagulation activation, which promotes venous and arterial thrombosis. The implications for prescription are discussed, as are lessons for future evaluation of health care interventions. [source] Statistical issues in the assessment of health outcomes in children: a methodological reviewJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 4 2009Gillian A. Lancaster Summary., The lack of outcome measures that are validated for use on children limits the effectiveness and generalizability of paediatric health care interventions. Statistical epidemiology is a broad concept encompassing a wide range of useful techniques for use in child health outcome assessment and development. However, the range of techniques that are available is often confusing and prohibits their adoption. In the paper an overview of methodology is provided within the paediatric context. It is demonstrated that in many cases assessment can be performed relatively straightforwardly by using standard statistical techniques, although sometimes more sophisticated techniques are required. Examples of both physiological and questionnaire-based outcomes are given. The usefulness of these techniques is highlighted for achieving specific objectives and ultimately for achieving methodological rigour in clinical outcome studies that are performed in the paediatric population. [source] Models for potentially biased evidence in meta-analysis using empirically based priorsJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2009N. J. Welton Summary., We present models for the combined analysis of evidence from randomized controlled trials categorized as being at either low or high risk of bias due to a flaw in their conduct. We formulate a bias model that incorporates between-study and between-meta-analysis heterogeneity in bias, and uncertainty in overall mean bias. We obtain algebraic expressions for the posterior distribution of the bias-adjusted treatment effect, which provide limiting values for the information that can be obtained from studies at high risk of bias. The parameters of the bias model can be estimated from collections of previously published meta-analyses. We explore alternative models for such data, and alternative methods for introducing prior information on the bias parameters into a new meta-analysis. Results from an illustrative example show that the bias-adjusted treatment effect estimates are sensitive to the way in which the meta-epidemiological data are modelled, but that using point estimates for bias parameters provides an adequate approximation to using a full joint prior distribution. A sensitivity analysis shows that the gain in precision from including studies at high risk of bias is likely to be low, however numerous or large their size, and that little is gained by incorporating such studies, unless the information from studies at low risk of bias is limited. We discuss approaches that might increase the value of including studies at high risk of bias, and the acceptability of the methods in the evaluation of health care interventions. [source] Hearing aid fitting in adults: results of a cost-effectiveness studyCLINICAL OTOLARYNGOLOGY, Issue 4 2000L.J.C. Anteunis For The Sihi Study Group Objective. Despite its high prevalence (, 20% in adults) and the adverse impact on daily life, hearing impairment is a neglected problem. Despite the fact that <,25% of the hearing-impaired seek help and acquire hearing aids in the Netherlands, hearing aid provision and rules for reimbursment are questioned. This is the reason for a cost-effectiveness study. Materials and methods. Self-reported hearing disability and its impact on quality of life was studied in 60 first-time-users, followed prospectively for 16 weeks after hearing aid fitting. They reported significant benefits in hearing ability, experienced an increased number and quality of social contacts and improved self-assessed personal health. Integrating the positive and negative effects of the intervention in a gain in quality of life, a utility value was obtained. Multiplying this utility value by the number of years the effect is expected to last, yielded Quality Adjusted Life Years. Results. In an economic evaluation, based on a model of tracing and referral and costs per QALY, hearing aid fitting in hearing-impaired adults was compared to the effectiveness of other health care interventions and, as a result, placed near the top of a QALY league table. Conclusions. Hearing aid fitting is a very cost-effective intervention. [source] | ||||||||||