Alcohol assessment and feedback by email for university students: main findings from a randomised controlled trial.

BACKGROUND: Brief interventions can be efficacious in changing alcohol consumption and increasingly take advantage of the internet to reach high-risk populations such as students. AIMS: To evaluate the effectiveness of a brief online intervention, controlling for the possible effects of the research process. METHOD: A three-arm parallel groups design was used to explore the magnitude of the feedback and assessment component effects. The three groups were: alcohol assessment and feedback (group 1); alcohol assessment only without feedback (group 2); and no contact, and thus neither assessment nor feedback (group 3). Outcomes were evaluated after 3 months via an invitation to participate in a brief cross-sectional lifestyle survey. The study was undertaken in two universities randomising the email addresses of all 14 910 students (the AMADEUS-1 study, trial registration: ISRCTN28328154). RESULTS: Overall, 52% (n = 7809) of students completed follow-up, with small differences in attrition between the three groups. For each of the two primary outcomes, there was one statistically significant difference between groups, with group 1 having 3.7% fewer risky drinkers at follow-up than group 3 (P = 0.006) and group 2 scoring 0.16 points lower than group 3 on the three alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) (P = 0.039). CONCLUSIONS: This study provides some evidence of population-level benefit attained through intervening with individual students

Alcohol assessment & feedback by e-mail for university student hazardous and harmful drinkers: study protocol for the AMADEUS-2 randomised controlled trial.

BACKGROUND: Alcohol is responsible for a large and growing proportion of the global burden of disease, as well as being the cause of social problems. Brief interventions are one component of comprehensive policy measures necessary to reduce these harms. Brief interventions increasingly take advantage of the Internet to reach large numbers of high risk groups such as students. The research literature on the efficacy and effectiveness of online interventions is developing rapidly. Although many studies show benefits in the form of reduced consumption, other intervention studies show no effects, for reasons that are unclear. Sweden became the first country in the world to implement a national system in which all university students are offered a brief online intervention via an e-mail. METHODS/DESIGN: This randomized controlled trial (RCT) aims to evaluate the effectiveness of this national system comprising a brief online intervention among university students who are hazardous and harmful drinkers. This study employs a conventional RCT design in which screening to determine eligibility precedes random allocation to immediate or delayed access to online intervention. The online intervention evaluated comprises three main components; assessment, normative feedback and advice on reducing drinking. Screening is confined to a single question in order to minimise assessment reactivity and to prevent contamination. Outcomes will be evaluated after 2 months, with total weekly alcohol consumption being the primary outcome measure. Invitations to participate are provided by e-mail to approximately 55,000 students in 9 Swedish universities. DISCUSSION: This RCT evaluates routine service provision in Swedish universities via a delay in offer of intervention to the control group. It evaluates effects in the key population for whom this intervention has been designed. Study findings will inform the further development of the national service provision. TRIAL REGISTRATION: ISRCTN02335307

Different Methods of Early Identification of Risky Drinking: A Review of Clinical Signs

Aims: To review the literature on detection of risky drinking to compare early identification based on everyday clinical encounters with systematic screening. We also reviewed specific clinical signs that have been suggested to be used as indicators of risky drinking. Methods: A literature review was performed in PubMed and CINAHL of articles up to November 2010. Results: Systematic screening and semi-systematic methods in various forms detected more risky drinkers than non-systematic identification during clinical encounter, but there was a lack of studies comparing the various means of identifying risky drinking. It may be too early to completely rule out the possibility of using non-systematic methods as an effective strategy to identify risky drinking. The earliest signs of risky drinking suggested in the literature are psychological distress and social problems. Conclusion: From a public health perspective, there is a lack of evidence that non-systematic or semi-systematic methods can substitute systematic screening in terms of numbers of risky drinkers detected. If early signs are going to be used to identify risky drinkers, or those to be screened for risky drinking, more focus should be on psychological and social signs because they appear earlier than somatic signs.This is a pre-copy-editing, author-produced PDF of an article accepted for publication in ALCOHOL AND ALCOHOLISM following peer review. The definitive publisher-authenticated version Hanna K Reinholdz, Preben Bendtsen and Fredrik Spak, Different Methods of Early Identification of Risky Drinking: A Review of Clinical Signs, 2011, ALCOHOL AND ALCOHOLISM, (46), 3, 283-291. is available online at: http://dx.doi.org/10.1093/alcalc/agr021 Copyright: Oxford University Press http://www.oxfordjournals.org

Measuring health-related quality of life in patients with chronic obstructive pulmonary disease in a routine hospital setting: Feasibility and perceived value

BACKGROUND: Assessment of health-related quality of life is so far mainly used in specific research settings and not widely accepted in the routine care of patients. Lack of trust in accuracy and reliability and lack of knowledge concerning the questionnaires used, methods, terminology, are just some of the perceived barriers for a more widespread dissemination of these instruments into routine health care. The present study was undertaken in order to test the feasibility of a computerised system for collecting and analysing health-related quality of life in a routine clinical setting and to examine the thoughts and attitudes among physicians concerning the value of these measurements. METHODS: Seventy-four patients with chronic pulmonary lung disease were asked to assess their health-related quality of life with a computerised version of the SF-36 questionnaire before a regular the visit to a physician. The results were immediately available for the physician during the consultation for comparison of information given by the patients and the physician's evaluation of the patients overall health status. A focus group interview with the physicians was performed before and after the implementation of routine measurements of health-related quality of life. RESULTS: The systematic assessment concept worked satisfactorily. All patients approached agreed to participate and completed the assessment on the touch screen computer. A weak correlation was found between patients' self-rated health and pulmonary function and between physicians' evaluation and pulmonary function. The physicians appreciated the SF-36 assessments and the value of the patients' perspective although only a few could pinpoint new clinical decisions based upon this new information. CONCLUSION: Physicians' clinical evaluation and patients' self-rating of health status offer unique and important information that are complementary

Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial

Alcohol; Intervencions breus; Sistema sanitariAlcohol; Intervenciones breves; Sistema sanitarioAlcohol; Brief interventions, Primary healthcareBackground: The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers. Methods/design: In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling. Discussion: Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.The research leading to these results or outcomes has received funding from the European Community’s Seventh Framework Program (FP7/2007-2013), under Grant Agreement nº 259268 – Optimizing delivery of healthcare intervention (ODHIN). Radboud University Nijmegen Medical Centre received co-funding from The Netherlands Organisation for Health Research and Development (ZonMW, Prevention Program), under Grant Agreement nº 200310017

Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial

Alcohol screening; Brief intervention; Referral to electronic brief adviceDetección de alcohol; Intervención breve; Remisión a asesoramiento breve electrónicoDetecció d'alcoholèmia; Intervenció breu; Derivació a assessorament breu electrònicObjectives: The objective of the present study was toexplore whether the possibility of offering facilitatedaccess to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increasedthe proportion of consulting adults who were screenedand given brief advice. Design: The study was a 12-week implementationstudy. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands,Poland and Sweden) were asked to screen adults whoattended the PHCU for risky drinking. Setting: A total of 120 primary healthcare centresfrom 5 jurisdictions in Europe. Participants: 746 individual providers (generalpractitioners, nurses or other professionals)participated in the study. Primary outcome: Change in the proportion ofpatients screened and referred to eBI comparing abaseline 4-week preimplementation period with a12-week implementation period. Results: The possibility of referring patients to the eBIwas not found to be associated with any increase in theproportion of patients screened. However, it wasassociated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole(p<0.05), mainly driven by a significant increase in briefintervention rates in England from 87% to 96%(p<0.01). The study indicated that staff displayed a lowlevel of engagement in this new technology. Staffcontinued to offer face-to-face advice to a largerproportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among thereferred patients; on average, 18% of the patientslogged on to the website with a mean log-on rate acrossthe different countries between 0.58% and 36.95%. Conclusions: Referral to eBI takes nearly as muchtime as brief oral advice and might require moreintroduction and training before staff are comfortablewith referring to eBIThe research leading to these results or outcomes has receivedfunding from the European Union’s Seventh Framework Programme forResearch, Technological Development and Demonstration under grantagreement no. 259268—Optimizing Delivery of Health Care Interventions(ODHIN)

Untersuchung von Katalysatoren auf Gold/TiO2-Basis und optoelektronischen Halbleitern mittels Transmissionselektronenmikroskopie und Tomographie

Gold, usually known for its inertness, can be prepared as a nanoporous bulk material showing catalytic properties. A particular advantage of this catalytic material is the stable monolithic structure, combining mechanical strength, thermal and electrical conductivity and a reproducible porosity due to self-organization during the preparation. Important structural properties are the pore size and the size of the gold ligaments. TEM (transmission electron microscopy) is a powerful tool to obtain information on these properties. Additionally, the functionalization of the nanoporous gold with TiO2 particles was investigated. For the application in catalysis of CO-oxidation, the gold can be coated with TiO2 in order to enhance catalytic activity. Furthermore semiconductor heterostructures were investigated. II-VI-based microcavities grown by molecular beam epitaxy designed for emission in the blue spectral region have been comprehensively characterized by transmission electron microscopy in bright field, dark field and scanning mode. Moreover the STEM signal for InP based semiconductors was simulated

Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial

Brief interventions; Risky drinking; Primary healthcareIntervenciones breves; Bebedores de riesgo; Atención primariaIntervencions breus; Bevedors de risc; Atenció primàriaBackground: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. Methods: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Results: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. Conclusions: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners’ attitudes, their actual behaviour and care improvement strategies to enhance implementation science.The research leading to these results or outcomes has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 259268 – Optimizing delivery of healthcare intervention (ODHIN)

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study

Detecció d'alcoholèmia; Intervenció breu; Actitud del personal sanitariDetección de alcoholemia; Intervención breve; Actitud del personal sanitarioAlcoholism detection; Brief intervention; Attitude of Health PersonnelAims: To determine the relation between existing levels of alcohol screening and brief interventionrates infive European jurisdictions and role security and therapeutic commitment by the participat-ing primary healthcare professionals. Methods: Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psy-chologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities aspart of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Pro-blems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. Results: The only significant but small relationship was found between role security and screeningrate in a multilevel logistic regression analysis adjusted for occupation of the provider, number ofeligible patients and the random effects of jurisdictions and primary health care units (PHCU). Nosignificant relationship was found between role security and brief intervention rate nor betweentherapeutic commitment and screening rate/brief intervention rate. The proportion of patientsscreened varied across jurisdictions between 2 and 10%. Conclusion: Thefindings show that the studied factors (role security and therapeutic commitment)are not of great importance for alcohol screening and BI rates. Given the fact that screening and briefintervention implementation rate has not changed much in the last decade in spite of increased pol-icy emphasis, training initiatives and more research being published, this raises a question aboutwhat else is needed to enhance implementation.Radboud university medical centre received co-funding from The NetherlandsOrganization for Health Research and Development (ZonMW, Prevention Pro-gramme), under Grant Agreement n° 200310017—ODHIN—Optimizing de-livery of healthcare interventions in the Netherlands, according to Art.II.17 ofthe FP7 EC Grant Agreement. Pomeranian Medical University in Szczecin re-ceived co-funding regarding presented research from the Polish sciencefinancialresources in the years 2012–2014 allocated to conduct the international co-funded project ODHIN