To evaluate the effect of a universal, school-based family support programme on body mass index (BMI) of children aged 5-7 years, using pooled data from three trials.
The programme has three to four ...components and is delivered during the first school year. It aims to promote healthy dietary and physical activity behaviours, and secondarily prevent unhealthy weight gain. Three cluster-randomised controlled trials were conducted between 2010 and 2018 in low and mixed socioeconomic status areas in Sweden. Weight and height were measured. Multiple mixed linear regression analysis was performed on the pooled data.
In total, 961 children were included (50% girls, mean age 6.3 years). The post-intervention effect on BMI z-score in all children was small, but in those with obesity at baseline, we observed a significant, clinically relevant, decrease in BMI z-score (-0.21). This was most pronounced in children with a non-Nordic born parent (-0.24). Five to six months after the intervention, decreases were no longer statistically significant.
The intervention resulted in changes in BMI comparable to obesity treatment programmes focusing on behaviour change. However, the effect attenuated with time suggesting the programme should be sustained and evaluated for a longer time.
Abstract
Objectives
To describe characteristics, treatment patterns and persistence in patients with RA treated with tofacitinib, an oral Janus kinase inhibitor, in Canadian clinical practice between ...1 June 2014 and 31 May 2017.
Methods
Data were obtained from the tofacitinib eXel support programme. Baseline demographics and medication history were collected via patient report/special authorization forms; reasons for discontinuation were captured by patient report. Treatment persistence was estimated using Kaplan–Meier methods, with data censored at last follow-up. Cox regression was applied to analyse baseline characteristics associated with treatment discontinuation.
Results
The number of patients with RA enrolled from 2014 to 2017 was 4276; tofacitinib utilization increased during that period, as did the proportion of biologic (b) DMARD-naïve patients prescribed tofacitinib. Of patients who initiated tofacitinib, 1226/3678 (33.3%) discontinued, mostly from lack of efficacy (35.7%) and adverse events (26.9%). Persistence was 62.7% and 49.6% after 1 and 2 years of treatment, respectively. Prior bDMARD experience predicted increased tofacitinib discontinuation (vs bDMARD-naïve, P < 0.001). Increased retention was associated with older age (56–65 years and >65 years vs ⩽45 years; P < 0.05), and time since diagnosis of 15 to <20 years (vs <5 years; P < 0.01). In bDMARD-naïve, post-1 bDMARD, post-2 bDMARD and post-⩾3 bDMARD patients, median survival was >730, 613, 667 and 592 days, respectively.
Conclusion
Since 2014, tofacitinib use in Canadian patients with RA increased, especially among bDMARD-naïve/post-1 bDMARD patients. Median drug survival was ∼2 years. Likelihood of persistence increased for bDMARD-naïve (vs bDMARD-experienced) patients and those aged ⩾56 (vs ⩽45) years.
Introduction Our hospital has chosen a model that goes beyond long-term hospital inpatient care to a community support for people with severe and persisting mental illnesses. This programme is called ...Community Support Programme (CSP) and focuses mainly on connecting patients who are being discharged from long-term hospitalization to a community based rehabilitation service. Objectives To evaluate the effectiveness of the CSP among people with severe and persisting mental illness, as a method to support the positive outcomes and reduce the use of hospital resources after a discharge. Methods This is a retrospect, observational descriptive study. We reviewed 55 cases between 2017 and May of 2021. We analyzed demographic information, diagnosis, duration of stay in the CSP, number of hospitalizations before and after the program, number of emergency visits before and after this program and what kind of community rehabilitation services are connected after the discharge. Results We found 58,2% male and 41,8% female. The main diagnoses were schizophrenia; schizoaffective and bipolar disorder. Before the CSP 85.4% of the patients had been hospitalized, and 76% had attended in a psychiatric emergency unit. After the discharge 36,36% required hospitalization, and 40% visited the psychiatric emergencies units. 54,54% of patients didn’t require hospital resources after their discharge from CSP. Conclusions The results suggest that the CSP helps to avoid hospitalization, reduce the use of hospital resources and drop outs. It helps the transition from hospitalization to a community based rehabilitation service. Disclosure No significant relationships.
Background and aims
Despite the high prevalence and negative effects of hazardous substance use, few young adults enter treatment. Community Reinforcement and Family Training (CRAFT), a support ...programme for concerned significant others of people with substance use disorders, has proved efficacious in promoting treatment entry. The aim of the current trial was to compare the efficacy of CRAFT with an active control for parents of young adults (aged 18–24 years) with hazardous substance use.
Design
This was a randomized controlled superiority trial comparing CRAFT (n = 58) with an active control group receiving manualized counselling (n = 55), with outcome assessments at 6, 12 and 24 weeks (primary end‐point). A sequential design with a stopping rule was added post recruitment commencement.
Setting
The study took place in two outpatient clinics for young adults in Stockholm, Sweden, and subsequently via video‐conference due to COVID‐19.
Participants
Between October 2018 and May 2021, 113 participants (92% female) who were parents of young adults (87% male) were recruited. Recruitment was discontinued when 70% of the planned sample had been recruited, following an interim analysis of the primary outcome showing no difference between conditions.
Intervention and comparator
Participants were randomized (ratio 1 : 1) to eight manual‐based individual CRAFT sessions or five individual manual‐based counselling sessions + one voluntary psychoeducative group session, delivered over maximum 14 weeks.
Measurements
The primary outcome measure was the rate of young adult entry in substance use treatment during the trial period (24 weeks).
Findings
At the 24 weeks follow‐up, 19 (33%) of CRAFT participants and 17 (31%) of counselling participants had reported young adult treatment entry, with no difference between conditions (odds ratio CRAFT versus counselling 0.84, 95% confidence interval = 0.35; 1.99, P = 0.700). Both conditions reported clinically relevant reductions in young adult substance use, but no change in participants’ levels of depression, anxiety or stress.
Conclusions
This trial showed no statistically significant evidence that Community Reinforcement and Family Training (CRAFT), a support programme for concerned significant others of people with substance use disorders, is more efficacious than manual‐based counselling regarding treatment entry for young adults.
Adherence is a critical factor for optimal clinical outcomes in multiple sclerosis (MS) treatment. This study investigated the adherence and clinical outcomes of MS patients treated with subcutaneous ...(sc) interferon (IFN) (β)-1a, an established immunomodulatory treatment for relapsing MS. The benefits of a patient support programme (PSP) were also studied.
This phase-IV prospective, observational multicentre study enrolled patients with relapsing MS who were treated with sc IFN β-1a for 24 months was conducted at 53 centres across 17 countries. The primary endpoint was adherence to sc IFN β-1a treatment, as assessed using Morisky Green Levine Medication Adherence Scale (MGLS) scores at 24 months. The MGLS is a self-reported diagnostic tool to address medication non-adherence, with a score ranging from 0 to 4, with 0 representing high adherence, 1-2 representing medium adherence, and 3-4 representing low adherence. Other endpoints included time to study and treatment discontinuation over 24 months, the proportion of relapse-free patients, and Expanded Disability Status Scale (EDSS) progression (defined as ≥1.0 point increase sustained for 3 months) at 24 months. A subgroup analysis was performed for endpoints based on patients assigned to PSP (yes/no-PSP versus non-PSP subgroup).
Of the 577 patients enrolled, 408 had evaluable MGLS scores at 24 months. A total of 336 (58.2%; 95% confidence interval CI: 54.1-62.3%) patients reported high adherence, 57 (9.9%; 95% CIs: 7.6-12.7%) reported medium adherence, and 15 (2.6%; 95% CI: 1.5-4.3%) reported low adherence at 24 months. The PSP subgroup reported higher adherence (n = 206; 65.8%) than the non-PSP subgroup (n = 130; 56.5%). By 24 months, 52.2% of the patients were relapse-free and 17.2% patients experienced ≥1 relapse. Expanded Disability Status Scale progression was observed in 12.3% of patients. Over the 24-month period, 30.8% of the patients discontinued treatment, and the most common reasons for treatment discontinuation were adverse events (AEs, 10.4%), being lost to followup (7.1%), and a lack of efficacy (5.5%). Overall, 39.6% patients experienced ≥1 AE, which ranged from mild to moderate.
The study demonstrated high adherence to sc IFN β-1a treatment with an added benefit of PSP participation. More than half of the patients remained relapse-free over a 24-month period. No new safety concerns to sc IFN β-1a treatment were observed.
https://clinicaltrials.gov/study/NCT02921035, NCT02921035.
The death of a parent is a life-changing event, and different programmes are developed to support children. This study explored how parental bereaved adolescents were included and (inter)acted in a ...Swedish support programme. The conducted ethnographic field study included six adolescents, their parents, and eight volunteers. The empirical material was thematically analysed through a theoretical lens inspired by Bourdieu. Three themes emerged: ‘Different strategies for adolescents’ inclusion in the programme,’ ‘Medico-psychological understanding of grief and suffering,’ and ‘Reproduction of the logic of the school.’ Adolescents were included in the programme through different strategies, where adults functioned as gatekeepers. The programme reproduced the school logic and was based on a medico-psychological grief/bereavement understanding. Volunteers had pedagogic authority and concomitant symbolic power, ruling adolescents to do what they must do in the meetings, silently socialising them into the medical logic. The adolescents only interacted and communicated with each other during breaks.
•Defining the role of SUMP national programmes.•Key factors that are critical to the success of SUMP development.•Challenges related to SUMP development in complex multilevel governance ...contexts.•Degree of support provided by the programmes.
Sustainable Urban Mobility Plans (SUMPs) are a new approach to local transport planning strongly promoted by the European Commission and increasingly adopted around Europe. They exist, however, in a largely national legal and financial framework, one which varies greatly between countries. In recent years many countries have developed national programmes to support the development of SUMPs within their national framework.
The paper explains the role of SUMP national supporting programmes by relating them to key factors that are critical to the success of SUMP development. It also seeks to understand how the national programmes that exist are improving; challenges related to development of SUMPs in complex multilevel governance contexts; and the degree of support provided by the programmes within this context.
To answer these questions a two-stage methodology was used. The first element was a questionnaire survey focused on the existence and state of national SUMP programmes in several EU/EEA member states or regions. The second element was interviews with SUMP experts in four countries selected to represent the experienced, the new and active, and the new but less active, in terms of their activity with SUMP national programmes.
The results show that the national SUMP supporting programmes in the countries surveyed and interviewed do not fully address the factors which have been identified as being critical to the success of SUMP development and implementation. The overall picture of national SUMP supporting frameworks is one where most of such frameworks are still in the early stages of development. On the other hand, the relatively small impact of the national SUMP supporting programme was seen as less of a barrier to SUMP implementation in most of the countries than lack of funds and public opposition to contentious transport measures.
The European Higher Education area has as one of its axes of development the promotion of quality in universities. Within this framework, the assessment of the quality of the teaching staff is highly ...recommended. With this aim the Teaching Evaluation Support Programme (DOCENTIA) promoted by Spanish National Agency for Quality Assessment and Accreditation (ANECA) is designed to satisfy the needs of the higher education system for a model and procedures to guarantee the quality of the teaching activity while fostering its development and recognition. Currently, more than 90% of the Spanish universities participate in this program, throughout its different phases. This paper presents this program, explains how it is being implemented at the Universitat Politècnica de València (UPV, Spain), and provides the proposed amendments by the evaluation commission during the follow-up verification phase that must be justified and solved during the monitoring phase, which is currently in progress, to obtain the certification.
Universal Health Coverage (UHC), initiative from the World Health Organization (WHO), is a means to provide the human right to health by providing essential health services to everyone, enabling ...disease prevention, treatment, rehabilitation, and palliative care. In line with the WHO recommendations, the UHC was first introduced in Pakistan in Khyber Pakhtunkhwa (KP) province under the name ‘Sehat Sahulat Programme’ (SSP), literally ‘Health Facility Program’ in 2015. The provincial Government in Punjab approved a similar initiative in Punjab, the largest province (by population) of the country, and the program was later rolled out in Islamabad Capital Territory (ICT), Azad and Jammu Kashmir (AJK), Gilgit Baltistan (GB), Sindh, and Baluchistan provinces leaping into the nation-wide coverage. This article provides a current overview of the UHC initiative in Pakistan, analyses its progress in appraising key milestones, and makes recommendations to achieve a robust universal health coverage across Pakistan.
MEETINGDEM investigated whether the Dutch Meeting Centres Support Programme (MCSP) could be implemented in Italy, Poland, and the UK with comparable benefits. This paper reports on the impact on ...people living with dementia attending pilot Meeting Centres in the 3 countries.
Nine pilot Meeting Centres (MCs) participated (Italy-5, Poland-2, UK-2). Effectiveness of MCSP was compared with Usual Care (UC) on outcomes measuring behavioural and psychological symptoms (NPI), depression (CSDD), and quality of life (DQoL, QOL-AD), analysed by ANCOVAs in a 6-month pre-test/post-test controlled trial.
Pre/post data were collected for 85 people with dementia and 93 carers (MCSP) and 74 people with dementia /carer dyads' receiving UC. MCSP showed significant positive effects for DQoL Self-esteem (F = 4.8, P = 0.03); Positive Affect (F = 14.93, P < 0.00); Feelings of Belonging (F = 7.77, P = 0.01) with medium and large effect sizes. Higher attendance levels correlated with greater neuropsychiatric symptom reduction (rho = 0.24, P = 0.03) and a greater increase in feelings of support (rho = 0.36, P = 0.001).
MCSPs showed significant wellbeing and health benefits compared with UC, building on the evidence of effectiveness from the Netherlands. In addition to the previously reported successful implementation of MCSP in Italy, Poland, and the UK, these findings suggest that further international dissemination of MCSP is recommended.
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