4 research outputs found
Relationships between children’s behaviour and parents’ work within families of mining and energy workers
We examine the relationships between the working arrangements of mineworkers and behavioural issues in their children, using a large Australian matched-pair dataset of workers and their partners. The findings suggest both that workers’ work conditions, and aspects of safety and security influence aspects of child behaviour, reflecting not least the results of tiredness, emotional exhaustion and sleep interruption. In addition, it appears that child behaviour probably influences the pressure experienced by their parents and hence their attitudes towards aspects of work
2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern
Deciding when to return to sport after injury is complex
and multifactorial—an exercise in risk management.
Return to sport decisions are made every day by
clinicians, athletes and coaches, ideally in a collaborative
way. The purpose of this consensus statement was to
present and synthesise current evidence to make
recommendations for return to sport decision-making,
clinical practice and future research directions related to
returning athletes to sport. A half day meeting was held
in Bern, Switzerland, after the First World Congress in
Sports Physical Therapy. 17 expert clinicians participated.
4 main sections were initially agreed upon, then
participants elected to join 1 of the 4 groups—each
group focused on 1 section of the consensus statement.
Participants in each group discussed and summarised the
key issues for their section before the 17-member group
met again for discussion to reach consensus on the
content of the 4 sections. Return to sport is not a
decision taken in isolation at the end of the recovery and
rehabilitation process. Instead, return to sport should be
viewed as a continuum, paralleled with recovery and
rehabilitation. Biopsychosocial models may help the
clinician make sense of individual factors that may
influence the athlete’s return to sport, and the Strategic
Assessment of Risk and Risk Tolerance framework may
help decision-makers synthesise information to make an
optimal return to sport decision. Research evidence to
support return to sport decisions in clinical practice is
scarce. Future research should focus on a standardised
approach to defining, measuring and reporting return to
sport outcomes, and identifying valuable prognostic
factors for returning to sport
Infographic: 2016 consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern.
2016 Consensus statement on return to spor
An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial
Background
The obesity epidemic has major public health consequences. Expert dietetic and behavioural counselling with intensive follow-up is effective, but resource requirements severely restrict widespread implementation in primary care, where most patients are managed. We aimed to estimate the effectiveness and cost-effectiveness of an internet-based behavioural intervention (POWeR+) combined with brief practice nurse support in primary care.
Methods
We did this pragmatic, parallel-group, randomised controlled trial at 56 primary care practices in central and south England. Eligible adults aged 18 years or older with a BMI of 30 kg/m 2 or more (or ≥28 kg/m 2 with hypertension, hypercholesterolaemia, or diabetes) registered online with POWeR+—a 24 session, web-based, weight management intervention lasting 6 months. After registration, the website automatically randomly assigned patients (1:1:1), via computer-generated random numbers, to receive evidence-based dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to 6 monthly nurse follow-up (control group); web-based intervention and face-to-face nurse support (POWeR+Face-to-face [POWeR+F]; up to seven nurse contacts over 6 months); or web-based intervention and remote nurse support (POWeR+Remote [POWeR+R]; up to five emails or brief phone calls over 6 months). Participants and investigators were masked to group allocation at the point of randomisation; masking of participants was not possible after randomisation. The primary outcome was weight loss averaged over 12 months. We did a secondary analysis of weight to measure maintenance of 5% weight loss at months 6 and 12. We modelled the cost-effectiveness of each intervention. We did analysis by intention to treat, with multiple imputation for missing data. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN21244703.
Findings
Between Jan 30, 2013, and March 20, 2014, 818 participants were randomly assigned to the control group (n=279), the POWeR+F group (n=269), or the POWeR+R group (n=270). Weight loss averaged over 12 months was recorded in 666 (81%) participants. The control group lost almost 3 kg over 12 months (crude mean weight: baseline 104·38 kg [SD 21·11; n=279], 6 months 101·91 kg [19·35; n=136], 12 months 101·74 kg [19·57; n=227]). The primary imputed analysis showed that compared with the control group, patients in the POWeR+F group achieved an additional weight reduction of 1·5 kg (95% CI 0·6–2·4; p=0·001) averaged over 12 months, and patients in the POWeR+R group achieved an additional 1·3 kg (0·34–2·2; p=0·007). 21% of patients in the control group had maintained a clinically important 5% weight reduction at month 12, compared with 29% of patients in the POWeR+F group (risk ratio 1·56, 0·96–2·51; p=0·070) and 32% of patients in the POWeR+R group (1·82, 1·31–2·74; p=0·004). The incremental overall cost to the health service per kg weight lost with the POWeR+ interventions versus the control strategy was £18 (95% CI −129 to 195) for POWeR+F and –£25 (−268 to 157) for POWeR+R; the probability of being cost-effective at a threshold of £100 per kg lost was 88% and 98%, respectively. No adverse events were reported.
Interpretation
Weight loss can be maintained in some individuals by use of novel written material with occasional brief nurse follow-up. However, more people can maintain clinically important weight reductions with a web-based behavioural program and brief remote follow-up, with no increase in health service costs. Future research should assess the extent to which clinically important weight loss can be maintained beyond 1 year.
Funding
Health Technology Assessment Programme of the National Institute for Health Research