Modifying Alcohol Consumption to Reduce Obesity (MACRO): development and feasibility trial of a complex community-based intervention for men

BackgroundObese men who consume alcohol are at a greatly increased risk of liver disease; those who drink > 14 units of alcohol per week have a 19-fold increased risk of dying from liver disease.ObjectivesTo develop an intervention to reduce alcohol consumption in obese men and to assess the feasibility of a randomised controlled trial (RCT) to investigate its effectiveness.Design of the interventionThe intervention was developed using formative research, public involvement and behaviour change theory. It was organised in two phases, comprising a face-to-face session with trained laypeople (study co-ordinators) followed by a series of text messages. Participants explored how alcohol consumption contributed to weight gain, both through direct calorie consumption and through its effect on increasing food consumption, particularly of high-calorie foodstuffs. Men were encouraged to set goals to reduce their alcohol consumption and to make specific plans to do so. The comparator group received an active control in the form of a conventional alcohol brief intervention. Randomisation was carried out using the secure remote web-based system provided by the Tayside Clinical Trials Unit. Randomisation was stratified by the recruitment method and restricted using block sizes of randomly varying lengths. Members of the public were involved in the development of all study methods.SettingMen were recruited from the community, from primary care registers and by time–space sampling (TSS). The intervention was delivered in community settings such as the participant’s home, community centres and libraries.ParticipantsMen aged 35–64 years who had a body mass index (BMI) of > 30 kg/m2 and who drank > 21 units of alcohol per week.ResultsThe screening methods successfully identified participants meeting the entry criteria. Trial recruitment was successful, with 69 men (36 from 419 approached in primary care, and 33 from 470 approached via TSS) recruited and randomised in 3 months. Of the 69 men randomised, 35 were allocated to the intervention group and 34 to the control group. The analysis was conducted on 31 participants from the intervention group and 30 from the control group. The participants covered a wide range of ages and socioeconomic statuses. The average alcohol consumption of the men recruited was 47.2 units per week, more than twice that of the entry criterion (> 21 units per week). Most (78%) engaged in binge drinking (> 8 units in a session) at least weekly. Almost all (95%) exceeded the threshold for a 19-fold increase in the risk of dying from liver disease (BMI of > 30 kg/m2 and > 14 units of alcohol per week). Despite this, they believed that they were at low risk of harm from alcohol, possibly because they seldom suffered acute harms (e.g. hangovers) and made few visits to a general practitioner or hospital.InterventionThe intervention was delivered with high fidelity. A high follow-up rate was achieved (98%) and the outcomes for the full RCT were measured. A process evaluation showed that participants engaged with the main components of the intervention. The acceptability of the study methods was high.ConclusionsThis feasibility study developed a novel intervention and evaluated all of the stages of a RCT that would test the effectiveness of the intervention. The main stages of a trial were completed successfully: recruitment, randomisation, intervention delivery, follow-up and measurement of study outcomes. Most of the men recruited drank very heavily and were also obese. This places them at a very high risk of liver disease, making them a priority for intervention

A review of occupational therapy research and development activity in Scotland, Northern Ireland and Wales

Introduction: A review was undertaken of the College of Occupational Therapists’ 2002 scoping study of occupational therapy research and development activity in Scotland, Northern Ireland and Wales in order to assess the developments in infrastructure supporting occupational therapy research, to highlight opportunities available to occupational therapists and to identify how the College could best support members’ research activities. Method:Within each nation, a literature review and focus group were undertaken. A feature of the research was the opportunity for a student occupational therapist from each country to be involved as co-researcher. Findings: The findings revealed a considerable investment and increase in research capacity developments in all three countries, recognising the need to develop the evidence base to underpin occupational therapy interventions. Barriers to progressing research activity included time and research topic prioritisation, and workplace cultures that did not promote research-related activities. The College of Occupational Therapists was considered to have a key role in influencing policy directions and the launch of the United Kingdom Occupational Therapy Research Foundation was viewed as an opportunity to support occupation-focused research and capacity development. Conclusion: Significant progress reflects the investment in research infrastructure, although further effort is needed to change cultural impacts

Water reuse in a paper reprocessing plant /

Includes appendices.Prepared by School of Civil Engineering & Environmental Science, University of Oklahoma, Norman Okla., and Big Chief Roofing Company, Ardmore, Okla., under grant S-801206.Includes bibliographical references (pages 67-71).Mode of access: Internet