Showing papers on "Psychological intervention published in 2001"
Book•
01 Aug 2001
TL;DR: It is made evident that the neuroscience of mental health-a term that encompasses studies extending from molecular events to psychological, behavioral, and societal phenomena-has emerged as one of the most exciting arenas of scientific activity and human inquiry.
Abstract: The past century has witnessed extraordinary progress in our improvement of the public health through medical sciencea nd ambitious, often innovative, approachest o health care services.P revious Surgeons General reports have saluted our gains while continuing to set ever higher benchmarks for the public health. Through much of this era of great challenge and greater achievement, however, concerns regarding mental illness and mental health too often were relegated to the rear of our national consciousness. Tragic and devastating disorders such as schizophrenia, depression and bipolar disorder, Alzheimer’s disease, the mental and behavioral disorders suffered by children, and a range of other mental disorders affect nearly one in five Americans in any year, yet continue too frequently to be spoken of in whispers and shame. Fortunately, leaders in the mental health field-fiercely dedicated advocates, scientists, government officials, and consumers-have been insistent that mental health flow in the mainstream of health. I agree and issue this report in that spirit. This report makes evident that the neuroscience of mental health-a term that encompasses studies extending from molecular events to psychological, behavioral, and societal phenomena-has emerged as one of the most exciting arenas of scientific activity and human inquiry. We recognize that the brain is the integrator of thought, emotion, behavior, and health. Indeed, one of the foremost contributions of contemporary mental health research is the extent to which it has mended the destructive split between “mental’ and “physical” health.
2,592 citations
01 Jan 2001
TL;DR: This Supplement documents that the science base on racial and ethnic minority mental health is inadequate; the best available research indicates that these groups have less access to and avail-ability of care, and tend to receive poorer quality mental health services.
Abstract: Mental health is fundamental to health, according to Mental Health: A Report of the Surgeon General, the first Surgeon General’s report ever to focus exclusively on mental health. That report of two years ago urged Americans to view mental health as paramount to personal well-being, family relationships, and successful contributions to society. It documented the disabling nature of mental illnesses, showcased the strong science base behind effective treatments, and recommended that people seek help for mental health problems or disorders. The first mental health report also acknowledged that all Americans do not share equally in the hope for recovery from mental illnesses. This is especially true of members of racial and ethnic minority groups. That awareness galvanized me to ask for a supplemental report on the nature and extent of disparities in mental health care for racial and ethnic minorities and on promising directions for the elimination of these disparities. This Supplement documents that the science base on racial and ethnic minority mental health is inadequate; the best available research, however, indicates that these groups have less access to and avail-ability of care, and tend to receive poorer quality mental health services. These disparities leave minority communities with a greater disability burden from unmet mental health needs. A hallmark of this Supplement is its emphasis on the role that cultural factors play in mental health. The cultures from which people hail affect all aspects of mental health and illness, including the types of stresses they confront, whether they seek help, what types of help they seek, what symptoms and concerns they bring to clinical attention, and what types of coping styles and social supports they possess. Likewise, the cultures of clinicians and service systems influence the nature of mental health services.
2,329 citations
TL;DR: Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term, and further research is needed to assess the effectiveness on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.
Abstract: OBJECTIVE —To systematically review the effectiveness of self-management training in type 2 diabetes. RESEARCH DESIGN AND METHODS —MEDLINE, Educational Resources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization. RESULTS —A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up ( CONCLUSIONS —Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.
1,886 citations
TL;DR: Every country can and should begin now to improve its efforts to treat people with mental illness, and 10 recommendations on how governments can strengthen their country’s mental health care are concluded.
Abstract: As I write these words in mid October I reflect on the way in which we have, during the past 4 weeks, expressed our shared grief in understanding, sympathy, and support for those affected by posttraumatic stress. We are reminded of the extraordinary ability of humans tocopewithextremesofemotion,tohelp each other, and to handle fear, pain, and loss. We work together to preserve our mental health. We see nothing wrong, or mysterious, in our coping mechanisms. But we do not expect people to have to cope alone, in isolation. We understandtheneedforhelpandguidance. As health care professionals, we know that mental illness is not a personal failure. If there is failure, it is in the way society in general and the health sector in particular have responded to people with mental and neurological disorders. By separating mental health care from physical health care—and often separating those who have mental illness from society—the health care profession has reinforced stigma, making successful treatment much harder. I see this as a time of opportunity for change, and I agree strongly with an earlier JOURNAL article by US Surgeon General David Satcher ( JAMA. 2001; 285:1697). Every country can and should begin now to improve its efforts to treat people with mental illness. A recent WHO global survey of mental health policy issues, Atlas of Mental HealthResources in theWorld2001 (http:// www.who.int/mental health/Publication Pages/Pubs 2001.html), found that 40% of the 185 countries surveyed have no national mental health policy, 30% have no programs to improve mental health conditions, and 25% have no specific mental health legislation. Well over one third (37%) of the countries have no community care facilities. The global toll of mental illness and neurological disorders is staggering. Neuropsychiatric disorders account for 31% of the disability in the world— and they affect rich and poor nations and individuals alike. According to the World Health Report 2001, Mental Health: New Understanding, New Hope (http://www.who.int/whr/), 450 million people have a mental or neurological disorder. Of these, 121 million have depression and 50 million have epilepsy. Every year, 1 million people commit suicide and 10 million to 20 million attempt suicide. A great deal of this suffering is unnecessary. We know, for instance, that 60% of those with major depression can fully recover if treated. However, in both industrialized and developing countries, less than 25% of those affected receive treatment, for reasons that include stigma, discrimination, scarce resources, lack of skills in primary health care, and deficient public health policies. The treatment gap is similar or greater for many other easily treatable mental and neurological disorders. Because people do not get the care they need, these disorders impose a range of social and economic costs on individuals, households, employers, and society, ranging from the cost of care to the cost of lost productivity. Solutions based on scientific evidence are available and affordable. Through recent advances in neuroscience, neuroimaging, genetics, and behavioral sciences, we know more about brain functioning and behavior than ever before. Breakthroughs in therapy and medication have occurred. In the World Health Report 2001, WHO summarizes current knowledge about mental and neurological disorders: the global burden, current level of care, latest knowledge about causes and treatment, and ongoing efforts to reform mental health care. The report concludes with 10 recommendations on how governments can strengthen their country’s mental health care: • provide treatment for mental disorders within primary care; • ensure that psychotropic drugs are available; • replace large custodial hospitals with community care facilities backed by general hospital psychiatric beds and home care support; • launch public awareness campaigns to overcome stigma and discrimination; • involve communities, families, and consumers in decision making on policies and services; • establish national policies, programs, and legislation; • train mental health professionals; • link mental health with other social sectors; • monitor community mental health; and • support more research. The report outlines three scenarios to help guide countries and population groups, depending on the resources available and the current status of mental health care in each country. Regarding treatment, for example, if even the poorest countries could ensure that the five most needed psychotropic drugs were available in all health care settings, we could ease the suffering of millions of people. If many middle-income countries could use the experiences of others as a guide and initiate pilot projects for community care, parts of or entire custodial institutions could be shut down, and the financial savings could strengthen further community care activities. If some of the richest countries could review their health care financing rules to ensure parity between mental and physical health problems, a major obstacle to treatment could be removed. We need to speed up and strengthen care for the mentally ill. —Gro Harlem Brundtland, MD, MPH Director-General World Health Organization FROM THE WORLD HEALTH ORGANIZATION
1,683 citations
12 Jan 2001
TL;DR: This work focuses on the part of the literature concerned with the role of psychology in the treatment of health and illness in the context of the family and the literature on social psychology in general.
Abstract: T.A. Revenson, Introduction. Part 1. Overarching Frameworks and Paradigms. H. Leventhal, S. Bodnar-Deren, J.Y. Breland, J. Hash-Converse, L.A. Phillips, E.A. Leventhal, L.D. Cameron, Modeling Health and Illness Behavior: The Approach of the Common Sense Model. J.R. Jennings, V. Egizio, How Psychophysiology Contributes to Health Psychology. A. Luegey Dougall, A. Baum, Stress, Health and Illness. M.F. Scheier, C.S. Carver, G.H. Armstrong, Behavioral Self-regulation, Health and Illness. K. Glanz, M.C. Kegler, Processes of Health Behavior Change. L.S. Aiken, M.A. Gerend, K.M. Jackson, K.W. Ranby, Subjective Risk and Health Protective Behavior: Prevention and Early Detection. Part 2. Cross-cutting Issues. D. Turk, H.D. Wilson, K.S. Swanson, Psychological and Physiological Bases of Chronic Pain. J. Smyth, J.W. Pennebaker, D. Arigo, What are the Health Effects of Disclosure? T.A. Revenson, S.J. Lepore, Coping in Social Context. M.A. Hoyt, A. Stanton, Adjustment to Chronic Illness. S.I. McClelland, Measuring Sexual Quality of Life: Ten Recommendations for Health Psychologists. J Dunbar-Jacob, E. Schlenk, M. McCall, Patient Adherence to Treatment Regimens. L.M. Martire, R. Schulz, Caregiving and Care-receiving in Later Life: Health Effects and Promising Interventions. Part 3. Risk and Protective Factors. N.E. Grunberg, S. Shafer Berger, A.K. Starosciak, Tobacco Use: Psychology, Neurobiology, and Clinical Implication. R. Wing, S. Phelan, Obesity. G. Brassington, E.B. Hekler, Z. Cohen, A.C. King, Health Enhancing Physical Activity. T.W. Smith, L.C. Gallo, S. Shivpuri, A.L. Brewer, Personality and Health: Current Issues and Emerging Perspectives. C. Park, Meaning, Spirituality, and Growth: Protective and Resilience Factors in Health and Illness. C. Dunkel Schetter, M. Lobel, Pregnancy and Birth Outcomes: A Multi-level Analysis of Prenatal Maternal Stress and Birth Weight. T. Wills, M.G. Ainette, Social Networks and Social Support. M.A. Alderfer, C.M. Stanley, Health and Illness in the Context of the Family. Part 4. Macro-level and Structural Influences on Health. V.S. Helgeson, Gender and Health: A Social Psychological Perspective. J.M. Ruiz, C.C. Prather, P. Steffen, Socioeconomic Status and Health. E. Brondolo, S. Lackey, E. Love, Race and Health: Racial Disparities in Hypertension and Links Between Racism and Health. I.H. Meyer, The Health of Sexual Minorities. I. Siegler, M.F. Elias, H.B. Bosworth, Aging and Health. Part 5. Applications of Health Psychology. J.D. Betensky, R.J. Contrada, D.C. Glass, Psychosocial Factors in Cardiovascular Disease: Emotional States, Conditions, and Attributes. S.P. Newman, S.P. Hirani, J. Stygall, T. Fteropoulli, Treatment in Cardiovascular Disease. N. Schneiderman, K. Orth-Gomer, Randomized Clinical Trials: Psychosocial-behavioral Interventions for Cardiovascular Disease. L.A. Faul, P.B. Jacobsen, Psychosocial Interventions for People with Cancer. A.L. Marsland, E.A. Bachen, S. Cohen, Stress, Immunity and Susceptibility to Upper Respiratory Infectious Disease. S. Danoff-Burg, A.H. Seawell, Psychological Processes in Rheumatic Disease. M.H. Antoni, A.W. Carrico, Psychological and Bio-behavioral Processes in HIV Disease. V. Mays, R.M. Maas, J. Ricks, S.D. Cochran, HIV and African American Women in the U.S. South: A Social Determinants Approach to Population-level HIV Prevention and Intervention Efforts.
1,208 citations
Book•
01 Jan 2001
TL;DR: Rethinking Risk Assessment as discussed by the authors is a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence.
Abstract: Rethinking Risk Assessment tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence.
1,060 citations
TL;DR: Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care.
Abstract: OBJECTIVE —To review the effectiveness of interventions targeted at health care professionals and/or the structure of care in order to improve the management of diabetes in primary care, outpatient, and community settings. RESEARCH DESIGN AND METHODS —A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed. Standard search methods of the Cochrane Effective Practice and Organization of Care Group were used. RESULTS —A total of 41 studies met the inclusion criteria. The studies identified were heterogeneous in terms of interventions, participants, settings, and reported outcomes. In all studies, the interventions were multifaceted. The interventions were targeted at health care professionals only in 12 studies, at the organization of care only in 9 studies, and at both in 20 studies. Complex professional interventions improved the process of care, but the effect on patient outcomes remained less clear because such outcomes were rarely assessed. Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures. Complex interventions in which patient education was added and/or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care. CONCLUSIONS —Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care. The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care.
1,019 citations
01 Jan 2001
TL;DR: A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed as mentioned in this paper.
Abstract: OBJECTIVE
To review the effectiveness of interventions targeted at health care professionals and/or the structure of care in order to improve the management of diabetes in primary care, outpatient, and community settings.
RESEARCH DESIGN AND METHODS
A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed. Standard search methods of the Cochrane Effective Practice and Organization of Care Group were used.
RESULTS
A total of 41 studies met the inclusion criteria. The studies identified were heterogeneous in terms of interventions, participants, settings, and reported outcomes. In all studies, the interventions were multifaceted. The interventions were targeted at health care professionals only in 12 studies, at the organization of care only in 9 studies, and at both in 20 studies. Complex professional interventions improved the process of care, but the effect on patient outcomes remained less clear because such outcomes were rarely assessed. Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures. Complex interventions in which patient education was added and/or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care.
CONCLUSIONS
Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care. The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care.
968 citations
TL;DR: Cognitive-behavioral interventions are more effective than the other intervention types and are most pronounced on the following outcome categories: complaints, psychologic resources and responses, and perceived quality of work life.
Abstract: In this quantitative meta-analysis is sought to determine the effectiveness of occupational stress-reducing interventions and the populations for which such interventions are most beneficial. 48 experimental studies were included in the analysis. Four intervention types were distinguished: cognitive-behavioural interventions, relaxation techniques, multimodal programs, and organisation-focused interventions. A small but significant overall effect was found. A moderate effect was found for cognitive-behavioural interventions and multimodal interventions, and a small effect was found for relaxation techniques. The effect size for organization-focused interventions was nonsignificant. Effects were most pronounced on the following outcome categories: complaints, psychologic resources and responses, and perceived quality of work life. The conclusion of the study was that stress management interventions are effective. Cognitive-behavioural interventions are more effective than the other intervention types.
918 citations
TL;DR: This review identifies and describes 34 universal and targeted interventions that have demonstrated positive outcomes under rigorous evaluation and makes recommendations based on these characteristics for policy and practice in school- and communitybased prevention of childhood psychopathology.
Abstract: The authors reviewed scores of primary prevention programs to identify preventive interventions that had undergone quasi-experimental or randomized trials and been found to reduce symptoms of psychopathology (aggression, depression, or anxiety) or factors commonly associated with an increased risk for later mental disorders. In this review, the authors identify and describe 34 universal and targeted interventions that have demonstrated positive outcomes under rigorous evaluation. The authors go on to examine common characteristics of successful prevention programs and make recommendations based on these characteristics for policy and practice in school- and communitybased prevention of childhood psychopathology.
814 citations
Book•
28 Mar 2001TL;DR: Psychology of Physical Activity is a comprehensive account of psychological knowledge about physical activity covering motivation and the psychological factors associated with activity or inactivity; the feel-good factor.
Abstract: Psychology of Physical Activity is a comprehensive account of our psychological knowledge about physical activity covering: motivation and the psychological factors associated with activity or inactivity; the feel-good factor: the psychological outcomes of exercising, including mental health illness and clinical populations; interventions and applied practice in the psychology of physical activity; current trends and future directions in research and practice. This textbook is essential for students of sport and exercise science, exercise physiology, health psychology, occupational therapy and physical education.
TL;DR: High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons and recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.
Abstract: OBJECTIVES: This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV. METHODS: We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. RESULTS: HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. CONCLUSIONS: High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.
TL;DR: In this paper, social competence is particularly salient for students who are classified into one of the high-incidence disability groups such as specific learning disabilities, mental retardation, emotional disturbance, or attention deficit/hyperactivity disorder.
Abstract: Social competence is particularly salient for students who are classified into one of the high-incidence disability groups such as specific learning disabilities, mental retardation, emotional disturbance, or attention deficit/hyperactivity disorder. Among the most popular of the instructional approaches for these students has been social skills training (SST). Various meta-analyses of the literature suggest that SST has not produced large, socially important, long-term, or generalized changes in social competence of students with high-incidence disabilities. Probable explanations for the weak effects in some meta-analyses are discussed and specific recommendations are offered for designing and producing more effective SST interventions.
TL;DR: The authors discuss common concerns about the use of evidence-based practices, such as whether ethical values have a role in shaping such practices and how to deal with clinical situations for which no scientific evidence exists.
Abstract: The authors describe the rationale for implementing evidence-based practices in routine mental health service settings. Evidence-based practices are interventions for which there is scientific evidence consistently showing that they improve client outcomes. Despite extensive evidence and agreement on effective mental health practices for persons with severe mental illness, research shows that routine mental health programs do not provide evidence-based practices to the great majority of their clients with these illnesses. The authors define the differences between evidence-based practices and related concepts, such as guidelines and algorithms. They discuss common concerns about the use of evidence-based practices, such as whether ethical values have a role in shaping such practices and how to deal with clinical situations for which no scientific evidence exists.
TL;DR: In this article, the authors present the results of systematic reviews of the effectiveness and economic efficiency of selected population-based interventions to reduce alcohol-impaired driving, using changes in alcohol-related crashes as the primary outcome measure.
TL;DR: Bargaining with reading habit is no need as what will be given by this psychology of physical activity determinants well being and interventions, how can you bargain with the thing that has many benefits for you?
Abstract: Bargaining with reading habit is no need. Reading is not kind of something sold that you can take or not. It is a thing that will change your life to life better. It is the thing that will give you many things around the world and this universe, in the real world and here after. As what will be given by this psychology of physical activity determinants well being and interventions, how can you bargain with the thing that has many benefits for you?
TL;DR: The authors describe the critical components of effective programs, which include a comprehensive, long-term, staged approach to recovery; assertive outreach; motivational interventions; provision of help to clients in acquiring skills and supports to manage both illnesses and to pursue functional goals; and cultural sensitivity and competence.
Abstract: After 20 years of development and research, dual diagnosis services for clients with severe mental illness are emerging as an evidence-based practice. Effective dual diagnosis programs combine mental health and substance abuse interventions that are tailored for the complex needs of clients with comorbid disorders. The authors describe the critical components of effective programs, which include a comprehensive, long-term, staged approach to recovery; assertive outreach; motivational interventions; provision of help to clients in acquiring skills and supports to manage both illnesses and to pursue functional goals; and cultural sensitivity and competence. Many state mental health systems are implementing dual diagnosis services, but high-quality services are rare. The authors provide an overview of the numerous barriers to implementation and describe implementation strategies to overcome the barriers. Current approaches to implementing dual diagnosis programs involve organizational and financing changes a...
TL;DR: In this article, the authors examined terminology, background, developmental aspects and myths about bullying, and four bullying interventions were summarized and reviewed, and the main findings indicate everyone must shoulder the responsibility of putting an end to bullying behaviour.
Abstract: Bullying is a problem which is receiving increasing attention worldwide. Researchers in several countries have already devised and implemented bullying intervention/prevention programs on a nation-wide basis. Data from large-scale trials of comprehensive, school-wide programs indicate that when used as a long-term ongoing solution rather than a 'quick fix' in crisis situations, bullying behaviour can be reduced significantly. This article examines terminology, background, developmental aspects and myths about bullying. Psychosocial characteristics of and implications for bullies and victims are discussed. Four bullying interventions are summarized and reviewed, and the main findings indicate everyone must shoulder the responsibility of putting an end to bullying behaviour.
TL;DR: This bulletin describes state-of-the-art universal and selective prevention programs designed to promote parent and teacher competencies and to prevent conduct problems and indicated interventions designed for children who already have been diagnosed with oppositional defiant disorder and/or conduct disorder.
Abstract: This bulletin describes state-of-the-art universal and selective prevention programs designed to promote parent and teacher competencies and to prevent conduct problems. In addition, it describes indicated interventions designed for children who already have been diagnosed with oppositional defiant disorder and/or conduct disorder. Emphasis is placed on empirically supported programs that have identified key malleable risk factors in children, families, and schools, which have been shown in longitudinal research to be related to later development of substance abuse, delinquency, and violence. We have targeted preschool and primary grade children, ages 0–8 years, in this review because research suggests that the most effective interventions can nip in the bud risk behaviors in the early years, before antisocial behaviors become crystallized. Guidelines for selecting effective interventions are provided.
TL;DR: In this article, a meta-analysis was conducted regarding the effect of including relatives in schizophrenia treatment and the main result was that the relapse rate can be reduced by 20 percent if relatives of schizophrenia patients are included in the treatment.
Abstract: Twenty-five intervention studies were meta-analytically examined regarding the effect of including relatives in schizophrenia treatment. The studies investigated family intervention programs to educate relatives and help them cope better with the patient's illness. The patient's relapse rate, measured by either a significant worsening of symptoms or rehospitalization in the first years after hospitalization, served as the main study criterion. The main result of the meta-analysis was that the relapse rate can be reduced by 20 percent if relatives of schizophrenia patients are included in the treatment. If family interventions continued for longer than 3 months, the effect was particularly marked. Furthermore, different types of comprehensive family interventions have similar results. The bifocal approach, which offers psychosocial support to relatives and schizophrenia patients in addition to medical treatment, was clearly superior to the medication-only standard treatment. The effects of family interventions and comprehensive patient interventions were comparable, but the combination did not yield significantly better results than did a treatment approach, which focused on either the patient or the family. This meta-analysis indicates that psychoeducational interventions are essential to schizophrenia treatment.
TL;DR: The authors examined the features of effective school-based prevention of crime, substance use, dropout/nonattendance, and other conduct problems, using meta-analytic techniques.
Abstract: This study examines the features of effective school-based prevention of crime, substance use, dropout/nonattendance, and other conduct problems. It summarizes, using meta-analytic techniques, results from 165 studies of school-based prevention activities that ranged from individual counseling or behavior modification programs through efforts to change the way schools are managed. The results highlight several inadequacies in the existing research for guiding policy and practice, the most notable of which is that many popular school-based prevention approaches have not been well studied to date. The study shows, however, that school-based prevention practices appear to be effective in reducing alcohol and drug use, dropout and nonattendance, and other conduct problems. The size of the average effect for each of the four outcomes was small and there was considerable heterogeneity across studies in the magnitude of effects, even within program type after adjusting for measured method and population differences. Non-cognitive-behavioral counseling, social work, and other therapeutic interventions show consistently negative effects, whereas self-control or social competency promotion instruction that makes use of cognitive-behavioral and behavioral instructional methods show consistently positive effects. Also effective are noninstructional cognitive-behavioral and behavioral methods programs. Environmentally focused interventions appear to be particularly effective for reducing delinquency and drug use.
TL;DR: The RE-AIM ratings suggest that, although often efficacious for those participating, traditional face-to-face intervention modalities will have limited impact if they cannot be delivered consistently to large segments of the target population.
TL;DR: This is an overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity, focused in particular on developing countries, and includes interventions aimed at preventing, detecting or treating any stage along this pathway during pregnancy.
Abstract: This is an overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity, focused in particular on developing countries. It concentrates on the major causes of maternal mortality, and traces their antecedent morbidities and risk factors in pregnancy. It also includes interventions aimed at preventing, detecting or treating any stage along this pathway during pregnancy. This is an updated and expanded version of a review first published by the World Health Organization (WHO) in 1992. The scientific evidence from randomised controlled trials and other types of intervention or observational study on the effectiveness of these interventions is reviewed critically. The sources and quality of available data, and possible biases in their collection or interpretation are considered. As in other areas of maternal health, good-quality evidence is scarce and, just as in many aspects of health care generally, there are interventions in current practice that have not been subjected to rigorous evaluation. A table of antenatal interventions of proven effectiveness in conditions that can lead to maternal mortality or serious morbidity is presented. Interventions for which there is some promising evidence, short of proof, of effectiveness are explored, and the outstanding questions formulated. These are presented in a series of tables with suggestions about the types of study needed to answer them.
TL;DR: Primary analyses revealed that Comb had a significant incremental effect over MedMgt (with a small effect size for this comparison) when categorical indicators of excellent response and when composite outcome measures were used.
Abstract: In 1992, the National Institute of Mental Health and 6 teams of investigators began a multisite clinical trial, the Multimodal Treatment of Attention-Deficit Hyperactivity Disorder (MTA) study. Five hundred seventy-nine children were randomly assigned to either routine community care (CC) or one of three study-delivered treatments, all lasting 14 months. The three MTA treatments-monthly medication management (usually methylphenidate) following weekly titration (MedMgt), intensive behavioral treatment (Beh), and the combination (Comb)-were designed to reflect known best practices within each treatment approach. Children were assessed at four time points in multiple outcome. Results indicated that Comb and MedMgt interventions were substantially superior to Beh and CC interventions for attention-deficit hyperactivity disorder symptoms. For other functioning domains (social skills, academics, parent-child relations, oppositional behavior, anxiety/depression), results suggested slight advantages of Comb over single treatments (MedMgt, Beh) and community care. High quality medication treatment characterized by careful yet adequate dosing, three times daily methylphenidate administration, monthly follow-up visits, and communication with schools conveyed substantial benefits to those children that received it. In contrast to the overall study findings that showed the largest benefits for high quality medication management (regardless of whether given in the MedMgt or Comb group), secondary analyses revealed that Comb had a significant incremental effect over MedMgt (with a small effect size for this comparison) when categorical indicators of excellent response and when composite outcome measures were used. In addition, children with parent-defined comorbid anxiety disorders, particularly those with overlapping disruptive disorder comorbidities, showed preferential benefits to the Beh and Comb interventions. Parental attitudes and disciplinary practices appeared to mediate improved response to the Beh and Comb interventions.
TL;DR: A literature search yielded 83 nonpharmacological intervention studies, which utilized the following categories of interventions: sensory, social contact, behavior therapy, staff training, structured activities, environmental interventions, medical/nursing care interventions, and combination therapies.
Abstract: Inappropriate behaviors are very common in dementia and impose an enormous toll both emotionally and financially. Three main psychosocial theoretical models have generally been utilized to explain inappropriate behaviors in dementia: the "unmet needs" model, a behavioral/learning model, and an environmental vulnerability/reduced stress-threshold model. A literature search yielded 83 nonpharmacological intervention studies, which utilized the following categories of interventions: sensory, social contact (real or simulated), behavior therapy, staff training, structured activities, environmental interventions, medical/nursing care interventions, and combination therapies. The majority are reported to have a positive, albeit not always significant, impact. Better matching of the available interventions to patients' needs and capabilities may result in greater benefits to patients and their caregivers.
TL;DR: To assess the effectiveness of all interventions that have been evaluated for use in the treatment or management of CFS in adults or children, 350 studies initially identified demonstrated mixed results in terms of effectiveness.
Abstract: ContextA variety of interventions have been used in the treatment and management
of chronic fatigue syndrome (CFS). Currently, debate exists among health care
professionals and patients about appropriate strategies for management.ObjectiveTo assess the effectiveness of all interventions that have been evaluated
for use in the treatment or management of CFS in adults or children.Data SourcesNineteen specialist databases were searched from inception to either
January or July 2000 for published or unpublished studies in any language.
The search was updated through October 2000 using PubMed. Other sources included
scanning citations, Internet searching, contacting experts, and online requests
for articles.Study SelectionControlled trials (randomized or nonrandomized) that evaluated interventions
in patients diagnosed as having CFS according to any criteria were included.
Study inclusion was assessed independently by 2 reviewers. Of 350 studies
initially identified, 44 met inclusion criteria, including 36 randomized controlled
trials and 8 controlled trials.Data ExtractionData extraction was conducted by 1 reviewer and checked by a second.
Validity assessment was carried out by 2 reviewers with disagreements resolved
by consensus. A qualitative synthesis was carried out and studies were grouped
according to type of intervention and outcomes assessed.Data SynthesisThe number of participants included in each trial ranged from 12 to
326, with a total of 2801 participants included in the 44 trials combined.
Across the studies, 38 different outcomes were evaluated using about 130 different
scales or types of measurement. Studies were grouped into 6 different categories.
In the behavioral category, graded exercise therapy and cognitive behavioral
therapy showed positive results and also scored highly on the validity assessment.
In the immunological category, both immunoglobulin and hydrocortisone showed
some limited effects but, overall, the evidence was inconclusive. There was
insufficient evidence about effectiveness in the other 4 categories (pharmacological,
supplements, complementary/alternative, and other interventions).ConclusionsOverall, the interventions demonstrated mixed results in terms of effectiveness.
All conclusions about effectiveness should be considered together with the
methodological inadequacies of the studies. Interventions which have shown
promising results include cognitive behavioral therapy and graded exercise
therapy. Further research into these and other treatments is required using
standardized outcome measures.
TL;DR: Changes in the health care system have resulted in a shift of cancer care from the in‐patient arena to ambulatory and home settings, and this shift has likewise translated into increased family involvement in the day‐to‐day care of the person with cancer.
Abstract: Changes in the health care system have resulted in a shift of cancer care from the in-patient arena to ambulatory and home settings. This shift has likewise translated into increased family involvement in the day-to-day care of the person with cancer. Cancer patients have multifaceted needs, including disease and treatment monitoring, symptom management, medication administration, emotional support, assistance with personal care, and assistance with instrument care. Family caregivers may be ill prepared to assume these tasks, requiring information on the disease and treatment, as well as instruction in technical and care skills. Moreover, caregiving must be balanced against already established roles and role responsibilities. In addition, family caregivers have their own emotional responses to the patients' diagnosis and prognosis, and may require coaching and emotional support themselves.
The health care system can facilitate positive outcomes by embracing the family caregiver as a partner in the health care team, providing instruction and guidance to the caregiver as he/she assumes this role, and evaluating the home care situation. Research to date has only scratched the surface of testing interventions that meet the needs of the cancer caregiver.
A research agenda is proposed to more fully elucidate the cancer caregiver's experience throughout the illness and treatment trajectory, and identify the means to effecting positive outcomes for the person with cancer, their family caregiver, and the health care system.
TL;DR: This article conducted a comprehensive review of literature and used quantitative methods of meta-analysis to investigate what self-determination interventions have been studied, what groups of individuals with disabilities have been taught self determination, and what levels of outcomes have been achieved using self determination interventions.
Abstract: Self-determination, the combination of skills, knowledge, and beliefs that enable a person to engage in goal-directed, self-regulated, autonomous behavior, has become an important part of special education and related services for people with disabilities. Research on the outcomes of self-determination interventions has been sparse. In this study, we conducted a comprehensive review of literature and used quantitative methods of meta-analysis to investigate what self-determination interventions have been studied, what groups of individuals with disabilities have been taught self-determination, and what levels of outcomes have been achieved using self-determination interventions. Fifty-one studies were identified that intervened to promote one or more components of self-determination; 22 were included in meta-analyses. The median effect size across 100 group intervention comparisons (contained in 9 studies) was 1.38. In contrast, 13 single subject studies included 18 interventions and produced a median per...
TL;DR: An implementation plan for evidence-based practices based on the use of toolkits to promote the consistent delivery of such practices and to address the concerns of mental health authorities (funders), administrators of provider organizations, clinicians, and consumers and their families are described.
Abstract: Extensive empirical research, summarized in several reviews and codified in practice guidelines, recommendations, and algorithms, demonstrates that several pharmacological and psychosocial interventions are effective in improving the lives of persons with severe mental illnesses. Yet the practices validated by research are not widely offered in routine mental health practice settings. As part of an effort to promote the implementation of evidence-based practice, the authors summarize perspectives on how best to change and sustain effective practice from the research literature and from the experiences of administrators, clinicians, family advocates, and services researchers. They describe an implementation plan for evidence-based practices based on the use of toolkits to promote the consistent delivery of such practices. The toolkits will include integrated written material, Web-based resources, training experiences, and consultation opportunities. Special materials will address the concerns of mental hea...
TL;DR: It is suggested that social development interventions through elementary school can have positive long-term effects on school bonding and the importance of long- term follow-up studies of preventive interventions is demonstrated.
Abstract: Bonding to school has been shown to be a protective factor against many problem behaviors. This study examines the effects of intervention during the elementary grades on changes in school bonding from middle school through high school, using hierarchical linear modeling. A full intervention group (Grades 1-6), a late intervention group (interventions in Grades 5 and 6 only), and a control group offered no special intervention were compared. The full intervention group was significantly more bonded to school than the control group at ages 13 and 18. Moreover, the full intervention group showed a curvilinear change in school bonding over time, decreasing to age 16 and then increasing to age 18, whereas bonding to school in both the control and late intervention groups continued to decline from age 13 to age 18. These findings suggest that social development interventions through elementary school can have positive long-term effects on school bonding and demonstrate the importance of long-term follow-up stu...