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Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial
Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme.
Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886).
Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42–0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42–0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7–19], control 10 days [6–18]).
Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units.
State Health Research Advisory Council, Department of Health, Government of Western Australia.
Journal Article
Using Smartphone-Based Psychoeducation to Reduce Postnatal Depression Among First-Time Mothers: Randomized Controlled Trial
Smartphone-based psychoeducation interventions may be a low-cost, user-friendly alternative to resource-consuming, face-to-face antenatal classes to educate expectant mothers.
This study aimed to empirically examine whether such an intervention would lead to reduced postnatal depression, anxiety, or stress and result in a better health-related quality of life.
A single-blind randomized controlled trial was conducted in Hong Kong. All first-time expectant mothers with less than 24 weeks of gestation remaining and attending the antenatal clinic at a public hospital were included. Participants were assigned to the intervention group or the control group by drawing lots. The lots, presented in sealed opaque envelopes, were randomly designated as \"intervention\" or \"control\" by stratified randomization. The intervention, a psychoeducational mobile app, was provided in addition to the treatment as usual (TAU) services from the hospital. Follow up with participants took place at 4 weeks postpartum. The primary outcome was the difference in the levels of antenatal and postnatal depression, assessed by the Edinburgh Postnatal Depression Scale (EPDS). The intention-to-treat approach was employed in the analyses.
The final sample was 660 expectant mothers (n
=330 and n
=330). The mean difference in EPDS scores between the two groups was -0.65 (95% CI -1.29 to 0.00; P=.049) after adjusting for confounding factors. Associations were found between participation in the intervention and reduced depression, and attendance in TAU classes and increased stress levels.
The smartphone-based intervention plus TAU services was effective in reducing postnatal depression at 4 weeks postpartum compared with a control condition of TAU only, making this a cost-effective alternative to TAU education for expectant mothers. Limitations of the study included the short postpartum period after which the follow-up assessment was conducted and the inclusion of first-time mothers rather than all mothers.
HKU Clinical Trials Registry HKUCTR-2024; http://www.hkuctr.com/Study/Show/ 34f62a2f6d594273a290491827206384.
Journal Article
Effect of Diabetes Education Through Pattern Management on Self-Care and Self-Efficacy in Patients with Type 2 Diabetes
This study investigated the effect of applying a customized diabetes education program through pattern management (PM), using continuous glucose monitoring system (CGMS) results, on individual self-care behaviors and self-efficacy in patients with type 2 diabetes mellitus. Patients with type 2 diabetes who had never received diabetes education, enrolled from March to September 2017, were sequentially assigned to either PM education or control groups. In the PM education group, the CGMS test was first conducted one week before diabetes education and repeated three times by PM in order to obtain data on self-care behaviors and self-efficacy. These results were then compared before and after education at three and six months. The control group received the traditional diabetes education. Self-efficacy showed statistically significant interactions between the two groups over time, indicating a significant difference in the degree of self-efficacy between the PM education and control groups. Diabetes education by PM using CGMS result analysis improved life habits with a positive influence on self-care behaviors and self-efficacy for diabetes management. Further studies are needed to further develop and apply individual diabetes education programs in order to sustain the effects of self-care behaviors and self-efficacy in patients with diabetes who experience a decrease in self-efficacy after three months of education.
Journal Article
Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial
BACKGROUND: Family meal frequency has been shown to be strongly associated with better dietary intake; however, associations with weight status have been mixed. Family meals-focused randomized controlled trials with weight outcomes have not been previously conducted. Therefore, this study purpose was to describe weight-related outcomes of the HOME Plus study, the first family meals-focused randomized controlled trial to prevent excess weight gain among youth. METHODS: Families (n = 160 8-12-year-old children and their parents/guardians) were randomized to intervention (n = 81) or control (n = 79) groups. Data were collected at baseline (2011–2012), post-intervention (12-months post-baseline) and follow-up (21-months post-baseline). The intervention included ten monthly group sessions (nutrition education; hands-on meal and snack planning, preparation, and skill development; screen time reductions) and five motivational, goal-setting phone calls. The main outcome was child body mass index (BMI) z-score. RESULTS: General linear models, adjusted for baseline values and demographics, showed no significant treatment group differences in BMI z-scores at post-intervention or follow-up; however, a promising reduction in excess weight gain was observed. Post-hoc stratification by pubertal onset indicated prepubescent children in the intervention group had significantly lower BMI z-scores than their control group counterparts. CONCLUSIONS: The study used a strong theoretical framework, rigorous design, quality measurement and a program with high fidelity to test a family meals-focused obesity prevention intervention. It showed a modest decrease in excess weight gain. The significant intervention effect among prepubescent children suggests the intervention may be more efficacious among relatively young children, although more research with appropriately powered samples are needed to replicate this finding. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01538615. Registered 01/17/2012.
Journal Article
First-Destination Outcomes for 2015–2018 Public Health Graduates: Focus on Employment
Objectives. To improve understanding of the future public health workforce by analyzing first-destination employment outcomes of public health graduates. Methods. We assessed graduate outcomes for those graduating in 2015–2018 using descriptive statistics and the Pearson χ 2 test. Results. In our analysis of data on 53 463 graduates, we found that 73% were employed; 15% enrolled in further education; 5% entered a fellowship, internship, residency, volunteer, or service program; and 6% were not employed. Employed graduates went to work in health care (27%), corporations (24%), academia (19%), government (17%), nonprofit (12%), and other sectors (1%). In 2018, 9% of bachelor’s, 4% of master’s, and 2% of doctoral graduates were not employed but seeking employment. Conclusions. Today’s public health graduates are successful in finding employment in various sectors. This new workforce may expand public health’s reach and lead to healthier communities overall. Public Health Implications. With predicted shortages in the governmental public health workforce and expanding hiring because of COVID-19, policymakers need to work to ensure the supply of public health graduates meets the demands of the workforce.
Journal Article
Advancing the global public health agenda for NAFLD: a consensus statement
Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics — from epidemiology, awareness, care and treatment to public health policies and leadership — that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease with a substantial burden worldwide. In this Consensus Statement, a global multidisciplinary group of experts develop consensus statements and recommendations addressing a broad range of topics on NAFLD to raise awareness and spur action.
Journal Article
Enhancing Coverage of Second Booster Dose of DPT Vaccine Coverage With Parental Education: A Cluster Randomized Approach
Objectives
To assess the effect of a single clinic-based educational intervention session on parents of children aged 4.5 to 5.5 years on improving the coverage of a second booster dose of the DPT vaccine. The secondary objective was to assess the coverage of second booster dose of the DPT vaccine among children aged > 6 years and to learn about the reasons behind such dropouts, if any.
Methods
The study was conducted in two phases. In the first phase, a cross-sectional study was conducted among children aged > 6 years who were attending the pediatric OPD or IPD to determine the coverage of the second booster dose of DPT vaccine and possible reasons for dropout. This was followed by a clustered randomized trial evaluating the effect of an educational intervention (clinic-based, single session) among parents of children aged 4.5 to 5.5 years for improving second DPT booster coverage.
Results
A total of 384 children were enrolled in the first phase, of which 233 (60.68%) were vaccinated. Subgroup analysis showed significant differences in the vaccine coverage between children from tribal-dominant and non-tribal-dominant districts (45.10% vs 63.06%,
P
= 0.01). Educational intervention resulted in higher vaccination coverage (77.24%) compared to 71.43% in the control arm (
P
= 0.300)
Conclusions
The current study showed low coverage for second booster of DPT vaccine. With educational intervention, the target immunization coverage could be attained early which has implications for reducing childhood morbidity due to vaccine-preventable diseases.
Journal Article
Jamie's Ministry of Food: Quasi-Experimental Evaluation of Immediate and Sustained Impacts of a Cooking Skills Program in Australia
To evaluate the immediate and sustained effectiveness of the first Jamie's Ministry of Food Program in Australia on individuals' cooking confidence and positive cooking/eating behaviours.
A quasi- experimental repeated measures design was used incorporating a wait-list control group. A questionnaire was developed and administered at baseline (T1), immediately post program (T2) and 6 months post completion (T3) for participants allocated to the intervention group, while wait -list controls completed it 10 weeks prior to program commencement (T1) and just before program commencement (T2). The questionnaire measured: participants' confidence to cook, the frequency of cooking from basic ingredients, and consumption of vegetables, vegetables with the main meal, fruit, ready-made meals and takeaway. Analysis used a linear mixed model approach for repeated measures using all available data to determine mean differences within and between groups over time.
All adult participants (≥18 years) who registered and subsequently participated in the program in Ipswich, Queensland, between late November 2011- December 2013, were invited to participate.
In the intervention group: 694 completed T1, 383 completed T1 and T2 and 214 completed T1, T2 and T3 assessments. In the wait-list group: 237 completed T1 and 149 completed T1 and T2 assessments. Statistically significant increases within the intervention group (P<0.001) and significant group*time interaction effects (P<0.001) were found in all cooking confidence measures between T1 and T2 as well as cooking from basic ingredients, frequency of eating vegetables with the main meal and daily vegetable intake (0.52 serves/day increase). Statistically significant increases at T2 were sustained at 6 months post program in the intervention group.
Jamie's Ministry of Food Program, Australia improved individuals' cooking confidence and cooking/eating behaviours contributing to a healthier diet and is a promising community-based strategy to influence diet quality.
Journal Article
Sleep Education Improves the Sleep Duration of Adolescents: A Randomized Controlled Pilot Study
Purpose:
To determine the feasibility and pilot a sleep education program in New Zealand high school students.
Methods:
A parallel, two-arm randomized controlled pilot trial was conducted. High school students (13 to 16 years) were randomly allocated to either a classroom-based sleep education program intervention (n = 15) or to a usual curriculum control group (n = 14). The sleep education program involved four 50-minute classroom-based education sessions with interactive groups. Students completed a 7-day sleep diary, a sleep questionnaire (including sleep hygiene, knowledge and problems) at baseline, post-intervention (4 weeks) and 10 weeks follow-up.
Results:
An overall treatment effect was observed for weekend sleep duration (
F
1,24
= 5.21, p = 0.03). Participants in the intervention group slept longer during weekend nights at 5 weeks (1:37 h:min, p = 0.01) and 10 weeks: (1:32 h:min, p = 0.03) compared to those in the control group. No differences were found between groups for sleep duration on weekday nights. No significant differences were observed between groups for any of the secondary outcomes (sleep hygiene, sleep problems, or sleep knowledge).
Conclusions:
A sleep education program appears to increase weekend sleep duration in the short term. Although this program was feasible, most schools are under time and resource pressure, thus alternative methods of delivery should be assessed for feasibility and efficacy. Larger trials of longer duration are needed to confirm these findings and determine the sustained effect of sleep education on sleep behavior and its impact on health and psychosocial outcomes.
Commentary:
A commentary on this article appears in this issue on page 793.
Citation:
Kira G, Maddison R, Hull M, Blunden S, Olds T. Sleep education improves the sleep duration of adolescents: a randomized controlled pilot study.
J Clin Sleep Med
2014;10(7):787–792.
Journal Article