79,302 research outputs found

    Enhanced motivational interviewing for reducing weight and increasing physical activity in adults with high cardiovascular risk: the MOVE IT three-arm RCT.

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    BACKGROUND: Motivational interviewing (MI) enhanced with behaviour change techniques (BCTs) and deployed by health trainers targeting multiple risk factors for cardiovascular disease (CVD) may be more effective than interventions targeting a single risk factor. OBJECTIVES: The clinical effectiveness and cost-effectiveness of an enhanced lifestyle motivational interviewing intervention for patients at high risk of CVD in group settings versus individual settings and usual care (UC) in reducing weight and increasing physical activity (PA) were tested. DESIGN: This was a three-arm, single-blind, parallel randomised controlled trial. SETTING: A total of 135 general practices across all 12 South London Clinical Commissioning Groups were recruited. PARTICIPANTS: A total of 1742 participants aged 40-74 years with a ≥ 20.0% risk of a CVD event in the following 10 years were randomised. INTERVENTIONS: The intervention was designed to integrate MI and cognitive-behavioural therapy (CBT), delivered by trained healthy lifestyle facilitators in 10 sessions over 1 year, in group or individual format. The control group received UC. RANDOMISATION: Simple randomisation was used with computer-generated randomisation blocks. In each block, 10 participants were randomised to the group, individual or UC arm in a 4 : 3 : 3 ratio. Researchers were blind to the allocation. MAIN OUTCOME MEASURES: The primary outcomes are change in weight (kg) from baseline and change in PA (average number of steps per day over 1 week) from baseline at the 24-month follow-up, with an interim follow-up at 12 months. An economic evaluation estimates the relative cost-effectiveness of each intervention. Secondary outcomes include changes in low-density lipoprotein cholesterol and CVD risk score. RESULTS: The mean age of participants was 69.75 years (standard deviation 4.11 years), 85.5% were male and 89.4% were white. At the 24-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA [mean 70.05 steps, 95% confidence interval (CI) -288 to 147.9 steps, and mean 7.24 steps, 95% CI -224.01 to 238.5 steps, respectively] or in reducing weight (mean -0.03 kg, 95% CI -0.49 to 0.44 kg, and mean -0.42 kg, 95% CI -0.93 to 0.09 kg, respectively). At the 12-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA (mean 131.1 steps, 95% CI -85.28 to 347.48 steps, and mean 210.22 steps, 95% CI -19.46 to 439.91 steps, respectively), but there were reductions in weight for the group and individual intervention arms compared with UC (mean -0.52 kg, 95% CI -0.90 to -0.13 kg, and mean -0.55 kg, 95% CI -0.95 to -0.14 kg, respectively). The group intervention arm was not more effective than the individual intervention arm in improving outcomes at either follow-up point. The group and individual interventions were not cost-effective. CONCLUSIONS: Enhanced MI, in group or individual formats, targeted at members of the general population with high CVD risk is not effective in reducing weight or increasing PA compared with UC. Future work should focus on ensuring objective evidence of high competency in BCTs, identifying those with modifiable factors for CVD risk and improving engagement of patients and primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN84864870. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 69. See the NIHR Journals Library website for further project information. This research was part-funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London

    An evaluation of a multi-site community pharmacy based chronic obstructive pulmonary disease support service

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    Background Chronic obstructive pulmonary disease (COPD) is a progressive chronic condition which can be effectively managed by smoking cessation, optimising prescribed therapy and providing treatment to prevent chest infections from causing hospitalisation. The government agenda in the UK is for community pharmacists to become involved in chronic disease management and COPD is one area where they are ideally located to provide a comprehensive service. Objective To evaluate the effect of a community pharmacy based COPD service on patient outcomes. Method Patients in one UK location were recruited over a 3 month period to receive a community pharmacy based COPD support service consisting of signposting to or provision of smoking cessation service, therapy optimisation, and recommendation to obtain a rescue pack containing steroid and antibiotic to prevent hospitalisation as a result of chest infection. Data was collected over a six month period for all recruited patients. Appropriate clinical outcomes, patient reported medication adherence, quality of life and NHS resource utilisation were measured. Key findings 306 patients accessed the service and full data to enable comparison before and after was available for 137. Significant improvements in patient reported adherence, utilisation of rescue packs, quality of life and a reduction in routine GP visits were identified. The intervention cost was estimated to be off-set by reductions in the use of other NHS services (GP and A&E visits and hospital admissions). Conclusion Results suggest that the service improved patient medicine taking behaviours and that it was cost-effective

    Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial

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    Objective To evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking.Design Randomised controlled trial.Setting Five general practices in Hertfordshire, England.Participants 561 current smokers aged over 35.Intervention All participants were offered spirometric assessment of lung function. Participants in intervention group received their results in terms of "lung age" (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services.Main outcome measures The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease.Results Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at 280 pound ((euro) 365, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants.Conclusion Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.Trial registration National Research Register N0096173751

    The Development of a Common Investment Appraisal for Urban Transport Projects.

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    In December 1990 we were invited by Birmingham City Council and Centro to submit a proposal for an introductory study of the development of a common investment appraisal for urban transport projects. Many of the issues had arisen during the Birmingham Integrated Transport Study (BITS) in which we were involved, and in the subsequent assessment of light rail schemes of which we have considerable experience. In subsequent discussion, the objectives were identified as being:- (i) to identify, briefly, the weaknesses with existing appraisal techniques; (ii) to develop proposals for common methods for the social cost-benefit appraisal of both urban road and rail schemes which overcome these weaknesses; (iii) to develop complementary and consistent proposals for common methods of financial appraisal of such projects; (iv) to develop proposals for variants of the methods in (ii) and (iii) which are appropriate to schemes of differing complexity and cost; (v) to consider briefly methods of treating externalities, and performance against other public sector goals, which are consistent with those developed under (ii) to (iv) above; (vi) to recommend work to be done in the second phase of the study (beyond March 1991) on the provision of input to such evaluation methods from strategic and mode-specific models, and on the testing of the proposed evaluation methods. Such issues are particularly topical at present, and we have been able to draw, in our study, on experience of:- (i) evaluation methods developed for BITS and subsequent integrated transport studies (MVA) (ii) evaluation of individual light rail and heavy rail investment projects (ITS,MVA); (iii) the recommendations of AMA in "Changing Gear" (iv) advice to IPPR on appraisal methodology (ITS); (v) submissions to the House of Commons enquiry into "Roads for the Future" (ITS); (vi) advice to the National Audit Office (ITS) (vii) involvement in the SACTRA study of urban road appraisal (MVA, ITS

    Common sense common safety

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    "A report by Lord Young of Graffham to the Prime Minister following a Whitehall‑wide review of the operation of health and safety laws and the growth of the compensation culture" - Cover

    John Chrysostom, rhetoric and Galatians

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    This paper examines the influence of contemporary rhetoric on John Chrysostom’s commentary on Galatians (with some reference to other exegetical works). Because ancient rhetoric developed over time, the primary points of reference are works on rhetorical theory, commentaries on Demosthenes and rhetorical exercises dating to the second century AD and later. It is argued that modern attempts to classify the letter under the three standard classes of oratory are misconceived in terms of ancient theory, but that this is not an obstacle to rhetorical analysis. John’s use of rhetorical concepts in analysing the structure of the letter is illustrated, as is his use of the pattern of counterposition (an objection attributed to an opponent) and solution, both as a compositional device and as an exegetical tool. In his interpretation of Gal. 2.1-10, John argues Paul is unable to deal fully with counterpositions because of the constraints entailed by a covert strategy agreed by the apostles at the Jerusalem consultation. John’s interpretation of the confrontation with Peter at Antioch, according to which Peter pretended to give way to Paul’s opponents in order to give him an opportunity to respond, is shown to be based on the rhetorical concept of figured speech. John’s attention to Paul’s management of the relationship with his addressees is examined. The admiration which John expresses for this and other aspects of Paul’s rhetorical technique is shown to echo, in content and phrasing, similar expressions of admiration in commentaries on Demosthenes originating in contemporary rhetorical schools

    Cyber-crime Science = Crime Science + Information Security

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    Cyber-crime Science is an emerging area of study aiming to prevent cyber-crime by combining security protection techniques from Information Security with empirical research methods used in Crime Science. Information security research has developed techniques for protecting the confidentiality, integrity, and availability of information assets but is less strong on the empirical study of the effectiveness of these techniques. Crime Science studies the effect of crime prevention techniques empirically in the real world, and proposes improvements to these techniques based on this. Combining both approaches, Cyber-crime Science transfers and further develops Information Security techniques to prevent cyber-crime, and empirically studies the effectiveness of these techniques in the real world. In this paper we review the main contributions of Crime Science as of today, illustrate its application to a typical Information Security problem, namely phishing, explore the interdisciplinary structure of Cyber-crime Science, and present an agenda for research in Cyber-crime Science in the form of a set of suggested research questions

    Predicting nitrogen mineralization from soil organic matter - a chimera?

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    Predicting nitrogen (N) mineralization from soil organic matter is difficult because N mineralization is affected by several environmental factors, while being the net outcome of concurrent N processes that produce and consume mineral N. One aim of the present thesis was to study the effects of freezing and thawing on carbon (C) and N mineralization. A second aim was to elucidate if, and how, the quantity and quality of organic matter inputs affect N mineralization from the pool of soil organic matter. C and net N mineralization were determined in soils from the Ultuna Long-Term Soil Organic Matter Experiment exposed to repeated freezing and thawing (temperatures ranging from –5 °C to +5 °C). C, gross and net N mineralization in relation to quantity and quality of organic matter inputs were determined during long-term laboratory incubations at 20 °C. Gross N mineralization rates were estimated using the 15N isotope dilution technique, which is based on several assumptions. The assumption of ‘equilibrium between added and native N’ was tested by using a published data set in a dynamic compartmental model. Freezing and thawing of soils resulted in a flush in C and N mineralization, but the effect was only short-lived. It was concluded that freezing and thawing of soils during late winter and early spring is unlikely to be of importance to crop N availability in spring. Both quantity and quality of organic matter were major determinants of C and gross N mineralization, and these were proportional suggesting that C mineralization may be used as a predictor for gross N mineralization. Preferential use of added N may be a more common occurrence in 15N isotope dilution studies than hitherto thought and the assumption of ‘equilibrium between added and native N’ needs therefore critical evaluation. The data analysis presented in this thesis offers a way to estimate the potential effects of preferential use on gross N mineralization rate estimates. This thesis indicates that studies based on the mechanisms underlying N processes may improve our understanding of the relation between soil organic matter and N mineralization. Further mechanistic studies should therefore be considered in future N research
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