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The comparative archaeology of complex societies
\"Eleven leading archeologists describe their research on ancient empires, states, and chiefdoms using a comparative perspective. By making comparisons among sites, regions, and artifacts, these scholars produce new understanding of diverse specific cases, from the towering ruins of Angkor to the houses of Inca peasants. The reader learns about the political strategies of kings and chiefs, the daily choices of ordinary households, and the creative ways in which ancient peoples built their cities and shaped their landscapes. In the process, these chapters illustrate how to do comparative analysis using archeological data\"-- Provided by publisher.
Book
Strengthening the community support group to improve maternal and neonatal health seeking behaviors: A cluster-randomized controlled trial in Satkhira District, Bangladesh
Although achieved development goals on maternal and child health, in the era of Sustainable Development Goals (SDGs), Bangladesh still needs to promote skilled attendance at birth as well as a continuum of care for mothers and babies. How to implement effective interventions by strengthening the community health system also remains as a crucial policy issue. The objective of the proposed study is to evaluate the impact of a community-based intervention as part of a bilateral development aid project on utilization of maternal and neonatal care provided by skilled providers and qualified facilities.
A cluster randomized trial was conducted in Kalaroa Upazila of Satkhira District. Community Clinics (CCs) in the study setting were randomly allocated to either intervention or control. We recruited all eligible women covered by CC catchment areas who gave a birth during the past 12 months of data collection at the baseline and end-line surveys. In the intervention areas, three Community Support Groups (CSGs) were developed in each of the CC areas. The members of CSG were trained to identify pregnant women, educate community people on pregnancy related danger signs, and encourage them for utilization of skilled services in the community and health facilities. The primary outcomes were the utilization of services for antenatal care, delivery, postnatal care and sick newborns. Difference-in-Difference (DID) analysis was performed to identify the changes by the intervention with adjustment of cluster effects by generalized mixed effects regression models.
The major indicators of the utilization of maternal and neonatal care among pregnant women with different wealth status showed significant improvement after the intervention. The impacts of the intervention were in particular significant among the women of 2nd and 3rd quintiles of household wealth status. The use of CCs increased after the intervention and private hospitals / clinics served as the major health providers. The study also identified increased practices of cesarean section.
The success of the intervention suggests a potential of the government efforts to strengthen the community support system for promotion of safe motherhood. The intervention helps to identify and remove existing and emerging barriers that lie between women and healthcare providers for safe motherhood and continuum of care.
UMIN Clinical Trial Registry UMIN000031789.
Journal Article
The organization ecology of interest communities : assessment and agenda
\"The organization ecology approach to the study of interest representation and lobbying is now almost two decades old, and a substantial body of theoretical and empirical work in both the United States and Europe has developed using this approach. Critically assessing this body of work, this collection summarises the origins and development of this research program, grounding it more firmly in the larger literature on organization ecology. It provides critical assessments of this literature from those working outside of its theoretical and empirical confines to respond to those critics and to outline an agenda for research for the future using the organization ecology approach to interest representation. The contributions to the book provide a review of the research program for those using organization ecology to study interest representation, outlines how it contributes to the larger body of work on both interest representation and organization ecology, and encourages future research on interest representation from a community-level perspective. \"-- Provided by publisher.
Book
Improving engagement with healthcare in hepatitis C: a randomised controlled trial of a peer support intervention
Background
Peer support can enable patient engagement with healthcare services, particularly for marginalised populations. In this randomised controlled trial, the efficacy of a peer support intervention at promoting successful engagement with clinical services for chronic hepatitis C was assessed.
Methods
In London, UK, potential participants were approached through outreach services for problematic drug use and homelessness. Individuals positive for hepatitis C virus (HCV) after confirmatory testing were randomised using an online service to the intervention (peer support) or standard of care. The primary outcome of interest was successful engagement with clinical hepatitis services. The study was non-blinded. Absolute differences were calculated using a generalised linear model and the results compared to logistic regression.
Results
Three hundred sixty-four individuals consented to participate. One hundred one had chronic hepatitis C and were randomised, 63 to receive the intervention (peer support). A successful outcome was achieved by 23 individuals in this arm (36.5%) and seven (18.4%) receiving the standard of care, giving an absolute increase of 18.1% (95% confidence interval 1.0–35.2%,
p
value = 0.04). This was mirrored in the logistic regression (odds ratio 2.55 (0.97–6.70),
p
= 0.06). No serious adverse events were reported.
Conclusions
Peer support can improve the engagement of patients with chronic HCV with healthcare services.
Trial registration
ISRCTN24707359
. Registered 19th October 2012.
Journal Article
Feasibility and impact of a patient support group care model on diabetes and hypertension care in informal settlements in Nairobi, Kenya: a quasi-experimental study
A support group care model including self-financing is a promising strategy to improve care for patients with diabetes or hypertension in resource-constrained settings.
We investigated the uptake, feasibility, and impact of a self-financing patient support group care model on cardiometabolic parameters among adult patients with uncontrolled diabetes or hypertension in informal settlements in Nairobi, Kenya.
A two-group prospective quasi-experimental study was conducted. The outcomes were changes in mean glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index, and waist-hip ratio in control versus intervention communities, assessed 6 months after intervention implementation.
At baseline, 118 patients with diabetes (intervention, 60; control, 58) and 176 with hypertension (intervention, 87; control, 89) were enrolled. At endline, 81 patients with diabetes and 137 with hypertension were surveyed. In the intervention arm, HbA1c decreased from 10.8% to 9.0% (mean difference [95% CI]: -1.7 [-2.4, -0.9]
< 0.001) and in the control arm from 10.6% to 9.9% (-0.9 [-1.5, -0.3]
= 0.005). Difference-in-difference analysis showed a notably greater reduction in HbA1c in the intervention arm (-0.942 [0.463]
< 0.05). In the intervention arm, SBP decreased from 155.0 mmHg to 148.7 mmHg (-6.3 [-11.7, -0.9]
= 0.022) and in the control arm, from 160.1 mmHg to 152.5 mmHg (-7.6 [-12.9, -2.3]
= 0.005). DBP in the intervention arm changed from 99.1 mmHg to 97.9 mmHg (-1.1 [4.2, 1.9]
= 0.462) and in the control arm from 99.7 mmHg to 94.8 mmHg (-4.9 [7.8, -2.0]
= 0.001).
A self-financing patient support group care model is feasible, improves cardiometabolic parameters and can be a strategy to manage diabetes, hypertension, and other chronic diseases in low-resource settings.
Journal Article
The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial
Objective: Supporting patients’ self care could have a major effect on the management of long-term conditions, which has led to worldwide interest in effective self care interventions. In England, self care support is being developed through the “Expert Patients Programme”, which provides lay-led generic courses to improve patients’ self care skills. However, the clinical and cost effectiveness of such courses remains unclear. Methods: Two-arm pragmatic randomised controlled trial design with waiting list control in community settings in England. 629 patients with a wide range of self-defined long-term conditions were studied. The lay-led self care support group involved 6-weekly sessions to teach self care skills. Primary outcomes were self-efficacy, reported energy and routine health services utilisation at 6 months. A cost-effectiveness analysis was also conducted. Results: Patients receiving immediate course access reported considerably greater self-efficacy and energy at 6-month follow-up, but reported no statistically significant reductions in routine health services utilisation over the same time period. The cost-effectiveness analysis showed that patients receiving immediate course access reported considerably greater health related quality of life, and a small reduction in costs. If a quality adjusted life year was valued at £20 000 ($39 191; €30 282), there was a 70% probability that the intervention was cost effective. Conclusions: Lay-led self care support groups are effective in improving self-efficacy and energy levels among patients with long-term conditions, and are likely to be cost effective over 6 months at conventional values of a decision-maker’s willingness to pay. They may be a useful addition to current services in the management of long-term conditions.
Journal Article
Effects of a Social-Network Method for Group Assignment Strategies on Peer-Led Tobacco Prevention Programs in Schools
Objectives. Our study tested the effectiveness of network methods for identifying opinion leaders and for constructing groups. Methods. Three conditions—random, teacher, and network—were randomly assigned to 84 6th-grade classrooms within 16 schools. Pre- and postcurriculum data on mediators of tobacco use were collected from 1961 students. Peer leaders in the network condition were identified by student nominations, and those leaders were matched with the students who nominated them. Results. Students in the network condition relative to the random condition liked the prevention program more and had improved attitudes (β = −0.06; P < .01), improved self-efficacy (β = −0.10; P < .001), and decreased intention to smoke (adjusted odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.38, 0.55). Conclusions. The network method was the most effective way to structure the program. Future programs may refine this technique and use it in other settings.
Journal Article
Twelve-Month Follow-Up of a Randomized Controlled Trial of Internet-Based Guided Self-Help for Parents of Children on Cancer Treatment
A substantial proportion of parents of children on cancer treatment report psychological distress such as symptoms of post-traumatic stress (PTSS), depression, and anxiety. During their child's treatment many parents also experience an economic burden.
The aim of this study was to evaluate the long-term efficacy of Internet-based guided self-help for parents of children on cancer treatment.
This study was a parallel randomized controlled trial comparing a 10-week Internet-based guided self-help program, including weekly support from a therapist via encrypted email, with a wait-list control condition. The intervention was based on cognitive behavior therapy (CBT) and focused on psychoeducation and skills to cope with difficult thoughts and feelings. Primary outcome was self-reported PTSS. Secondary outcomes were self-reported symptoms of depression, anxiety, health care consumption, and sick leave during the past month. Outcomes were assessed pre- and postintervention and at 12-month follow-up. Parents of children on cancer treatment were invited by health care personnel at pediatric oncology centers, and parents meeting the modified symptom criteria on the PCL-C were included in the study. Self-report assessments were provided on the Web.
A total of 58 parents of children on cancer treatment (median months since diagnosis=3) were included in the study (intervention n=31 and control n=27). A total of 18 participants completed the intervention, and 16 participants in each group participated in the 12-month follow-up. Intention-to-treat analyses revealed significant effects in favor of the intervention on the primary outcome PTSS, with large between-group effect sizes at postassessment (d=0.89; 95% CI 0.35-1.43) and at 12-month follow-up (d=0.78; 95% CI 0.25-1.32). Significant effects in favor of the intervention on the secondary outcomes depression and anxiety were also observed. However, there was no evidence for intervention efficacy on health care consumption or sick leave.
Using the Internet to provide psychological interventions shows promise as an effective mode of delivery for parents reporting an increased level of PTSS and who consider Internet-based interventions as a viable option. Future research should corroborate these findings and also develop and evaluate interventions and policies that may help ameliorate the economic burden that parents may face during their child's treatment for cancer.
Journal Article
Protocol for a partially nested randomized controlled trial to evaluate the effectiveness of the Scleroderma Patient-centered Intervention Network Support Group Leader EDucation (SPIN-SSLED) Program
Background
Some people with rare diseases rely on peer-led support groups for disease-specific education and emotional and practical support. Systemic sclerosis (SSc), or scleroderma, is a rare autoimmune connective tissue disease. Many people with SSc cannot access support groups, and, when support groups exist, they may not be sustained due to challenges that could be addressed via leader training. The Scleroderma Patient-centered Intervention Network (SPIN), along with SSc patient organization partners, developed a training program for SSc patient support group leaders, the Scleroderma Support group Leader EDucation (SPIN-SSLED) Program. We recently completed a feasibility trial in which we successfully delivered the program to two groups of support group leaders who reported a high level of satisfaction with the program and its delivery. The primary objective of the full-scale SPIN-SSLED trial is to evaluate the effect of the program on support group leaders’ self-efficacy for carrying out their leadership role. Secondary objectives include evaluating effects on leader burnout, leader satisfaction (participation efficacy), and emotional distress.
Methods/design
The SPIN-SSLED trial is a pragmatic randomized controlled trial (RCT) in which 180 support group leaders will be randomly allocated to training groups of 6 participants each or to a waitlist control. We will use a partially nested RCT design to reflect dependence between individuals in training groups, but not in the waitlist control. Participants allocated to the training program will receive the 13-module SPIN-SSLED Program, delivered via webinar over the course of 3 months in weekly 60–90-min sessions. The primary outcome is leader self-efficacy, measured by the Scleroderma Support Group Leader Self-efficacy Scale post-intervention. Secondary outcomes are leader self-efficacy at 3 months post-intervention, and leader burnout, volunteer job satisfaction (participation efficacy), and emotional distress post-intervention and at 3 months post-intervention.
Discussion
The SPIN-SSLED trial will test whether a training program for SSc patient support group leaders increases the self-efficacy of group leaders to carry out leadership tasks. The program has the potential to significantly improve the effectiveness and sustainability of existing SSc support groups, to increase the number of available support groups, and to be adapted for other chronic diseases.
Trial registration
ClinicalTrials.gov,
NCT03965780
. Registered on 29 May 2019.
Journal Article
Internet-Based Treatment for Adults with Depressive Symptoms: Randomized Controlled Trial
Many depressed people do not receive help for their symptoms, and there are various barriers that impede help-seeking. The Internet may offer interesting alternatives for reaching and helping people with depression. Depression can be treated effectively with Internet-based cognitive behavioral therapy (CBT), but a short intervention based on problem solving therapy (PST) could constitute a worthwhile alternative to CBT.
In this study we evaluated the effectiveness of Internet-based CBT and Internet-based PST in comparison to a waiting list control group (WL), and we determined the differences between the two treatments.
We conducted a 3-arm randomized controlled trial to compare CBT, PST, and WL. The main inclusion criterion was presence of depressive symptoms (>or= 16 on the Center for Epidemiological Studies Depression scale). CBT and PST consisted of eight and five weekly lessons respectively. Participants were supported by email. Self-report measures of depression, anxiety, and quality of life were completed at pretest and after 5, 8, and 12 weeks.
A total of 263 participants were randomized to the three conditions (CBT: n=88; PST: n=88; WL: n=87). Of the 263 participants, 184 (70%) completed questionnaires after 5 weeks, 173 (66%) after 8 weeks, and 151 (57%) after 12 weeks. Between-group effect sizes for depressive symptoms were 0.54 for CBT after 8 weeks (95% confidence interval (CI): 0.25 - 0.84) and 0.47 for PST after 5 weeks (95% CI: 0.17 - 0.77). These effects were further improved at 12 weeks (CBT: 0.69, 95% CI: 0.41 - 0.98; PST: 0.65, 95% CI: 0.36 - 0.95). For anxiety, effect sizes were also at a medium level. Effect sizes for quality of life were low. The number of participants showing clinically significant change at 12 weeks was significantly higher for CBT (n = 34, 38.6%) and PST (n = 30, 34.1%), compared to WL (n = 0).
Both Internet-based treatments are effective in reducing depressive symptoms, although the effect of PST is realized more quickly.
International Standard Randomized Controlled Trial Number (ISRCTN): 16823487; http://www.controlled-trials.com/ISRCTN16823487/16823487 (Archived by WebCite at http://www.webcitation.org/5cQsOj7xf).
Journal Article