Identifying well-connected opinion leaders for informal health promotion: the example of the ASSIST smoking prevention program

Methods used to select opinion leaders for informal behavior change interventions vary, affecting the role they adopt and the outcomes of interventions. The development of successful identification methods requires evidence that these methods achieve their aims. This study explored whether the “whole community” nomination process used in the ASSIST smoking prevention program successfully identified “peer supporters” who were well placed within their school social networks to diffuse an antismoking message to their peers. Data were collected in the United Kingdom during A Stop Smoking in Schools Trial. Behavioral data were provided at baseline and post intervention by all students. Social network data were provided post intervention by students in four control and six intervention schools. Centrality measures calculated using UCINET demonstrate that the ASSIST nomination process successfully identified peer supporters who were more socially connected than others in their year and who had social connections across the entire year group including the program’s target group. The results indicate that three simple questions can identify individuals who are held in high esteem by their year group and who also have the interpersonal networks required of opinion leaders to successfully disseminate smoke-free messages through their social networks. This approach could be used in other informal health promotion initiatives

Risk Of Hypoglycemia Among T1dm Individuals Who Exercise Regularly

ABSTRACT Objective: Exercise training and sport activity are important for good health among those with type 1 diabetes mellitus (T1DM); however, fear of hypoglycemia is a clear barrier to participation. We examined both the main demographic and exercise training risk profiles for exercise-associated and nocturnal hypoglycemia, including indicators of unawareness. Mode of insulin delivery, whether multiple daily injections (MDI) via pen or continuous subcutaneous insulin infusion (CSII) via pump, was an important consideration. Research Design: Our study was based on data from an internet-based survey in the Netherlands that attracted T1DM participants who engage in routine exercise or sport activity. Results: The majority of survey participants reported experiencing hypoglycemia either sometimes (67.9%) or regularly (18.5%) during or after exercise, while 74% reported experience of nocturnal hypoglycemia. In contrast, only a very small number of survey participants reported complete unawareness surrounding symptom severity (\u3c 4%). Overall, regular exercise-associated hypoglycemia predicted the report of nocturnal hypoglycemia (OR= 14.44; P \u3c 0.001). Significant demographic predictors specific for exercise-associated hypoglycemia were sex, age, and number of years of exercise with T1DM (P \u3c0.05). Nocturnal hypoglycemia was influenced by duration of diagnosis and daily basal insulin dose requirements (P \u3c 0.05). Mode of insulin delivery (pen/pump) significantly influenced both exercise-associated (P= 0.002) and nocturnal (P= 0.042) hypoglycemic outcomes, depending on exercise type (endurance/non-endurance). Specifically, pump use, in the context of non-endurance exercise, was associated with high risk for both forms of hypoglycemia. Conclusions: While hypoglycemia is prevalent in individuals with T1DM who exercise regularly, hypoglycemia unawareness is not. Given that baseline insulin requirements were broadly tied to the above risk profiles, we conclude that exercise regimens to improve overall insulin sensitivity may be crucial to mitigating risk for hypoglycemic outcomes

Improving mechanical and neuromuscular deficits following anterior cruciate ligament reconstruction

Despite consistent resolution of knee laxity and return to physical activity following ACL reconstruction, a growing body of evidence implicates impaired weight acceptance strategies as frequent primary drivers in a host of poor long-term outcomes. Most egregiously, the majority of the people with ACL reconstruction will show radiographic evidence of knee osteoarthritis within 15 years of surgery. Abnormal compression of the knee joint due to impaired knee flexion during weight acceptance is exacerbated by a tendency toward concomitant co-contraction of the knee musculature. Despite a plethora of proposed training paradigms, performance deficits after ACL reconstruction prove particularly resistant to enduring change. The studies included in this dissertation examine the mechanical and neuromuscular impairments in weight acceptance during landing from a jump that underlie the limitations to success following ACL reconstruction. A path toward improving functional recovery by treating impairments in landing is suggested and a novel training approach is tested. First, a cross-sectional study examines both the impaired patterns of neuromuscular recruitment in people who have returned to sporting activity following ACL reconstruction and their relationship to mechanics in landing. A pre-test/post-test laboratory study further examines the relationship between imposed changes in landing mechanics and co-contraction between the hamstrings and the quadriceps musculature. Clarification of neuromuscular activation and coordination impairments allows development of specific treatment techniques. To address limitations in current practice, a new device, the Bodyweight Reduction Instrument to Deliver Graded Exercise (BRIDGE), is validated in a third study, in which the effects of body weight support on the mechanics of repetitive single leg hopping are tested. The use of the BRIDGE is then described in a clinical case study. Finally, a randomized clinical trial determines whether high volume jump training with reduced loading intensity via body weight support will preferentially enhance motor learning for improved coordination of the neuromuscular system during high demand tasks such as single leg landing. This dissertation thereby advances the science of rehabilitation to more effectively target mechanical and neuromuscular impairments that devastatingly contribute to the risk of re-injury and early onset osteoarthritis following ACL reconstruction

Counselors’ Knowledge about HIV Transmission and Prevention

This article presents the results of an online survey study of 80 counselors to explore counselors’ knowledge about Human Immunodeficiency Virus (HIV) transmission, HIV prevention strategies, potentially related factors, and where counselors obtained their knowledge. Results show that approximately 90% of counselors correctly identified knowledge about HIV transmission, 68% correctly identified knowledge about HIV prevention strategies, and 64% reported receiving no education regarding HIV/AIDS in their graduate counseling programs. Implications for counselor training and professional development are discussed

Reducing smoking in adolescents: cost-effectiveness results from the cluster randomized ASSIST (A Stop Smoking In Schools Trial)

Introduction: School-based smoking prevention programmes can be effective, but evidence on cost-effectiveness is lacking. We conducted a cost-effectiveness analysis of a school-based “peer-led” intervention.<p></p> Methods: We evaluated the ASSIST (A Stop Smoking In Schools Trial) programme in a cluster randomized controlled trial. The ASSIST programme trained students to act as peer supporters during informal interactions to encourage their peers not to smoke. Fifty-nine secondary schools in England and Wales were randomized to receive the ASSIST programme or usual smoking education. Ten thousand seven hundred and thirty students aged 12–13 years attended participating schools. Previous work has demonstrated that the ASSIST programme achieved a 2.1% (95% CI = 0%–4.2%) reduction in smoking prevalence. We evaluated the public sector cost, prevalence of weekly smoking, and cost per additional student not smoking at 24 months.<p></p> Results: The ASSIST programme cost of £32 (95% CI = £29.70–£33.80) per student. The incremental cost per student not smoking at 2 years was £1,500 (95% CI = £669–£9,947). Students in intervention schools were less likely to believe that they would be a smoker at age 16 years (odds ratio [OR] = 0.80; 95% CI = 0.66–0.96).<p></p> Conclusions: A peer-led intervention reduced smoking among adolescents at a modest cost. The intervention is cost-effective under realistic assumptions regarding the extent to which reductions in adolescent smoking lead to lower smoking prevalence and/or earlier smoking cessation in adulthood. The annual cost of extending the intervention to Year 8 students in all U.K. schools would be in the region of £38 million and could result in 20,400 fewer adolescent smokers.<p></p&gt

Young people's views about the purpose and composition of research ethics committees:findings from the PEARL qualitative study

BACKGROUND: Avon Longitudinal Study of Parents and Children (ALSPAC) is a birth cohort study within which the Project to Enhance ALSPAC through Record Linkage (PEARL) was established to enrich the ALSPAC resource through linkage between ALSPAC participants and routine sources of health and social data. PEARL incorporated qualitative research to seek the views of young people about data linkage, including their opinions about appropriate safeguards and research governance. In this paper we focus on views expressed about the purpose and composition of research ethics committees. METHODS: Digitally recorded interviews were conducted with 48 participants aged 17–19 years. Participants were asked about whether medical research should be monitored and controlled, their knowledge of research ethics committees, who should sit on these committees and what their role should be. Interview recordings were fully transcribed and anonymised. Thematic analysis was undertaken, assisted by the Framework approach to data management. RESULTS: The majority of interviewees had little or no specific knowledge of ethics committees. Once given basic information about research ethics committees, only three respondents suggested there was no need for such bodies to scrutinise research. The key tasks of ethics committees were identified as monitoring the research process and protecting research participants. The difficulty of balancing the potential to inhibit research against the need to protect research participants was acknowledged. The importance of relevant research and professional expertise was identified but it was also considered important to represent wider public opinion, and to counter the bias potentially associated with self-selection possibly through a selection process similar to ‘jury duty’. CONCLUSIONS: There is a need for more education and public awareness about the role and composition of research ethics committees. Despite an initial lack of knowledge, interviewees were able to contribute their ideas and balance the rights of individuals with the wider benefits from research. The suggestion that public opinion should be represented through random selection similar to jury duty may be worth pursuing in the light of the need to ensure diversity of opinion and establish trust amongst the general public about the use of ‘big data’ for the wider public good

Outpatient Physical Therapists’ Knowledge, Attitudes, and Behaviors Regarding Eating Disorder Screening

Background & Purpose: Approximately 9% of Americans will have an eating disorder in their lifetime1 and these disorders can impact the recovery of patients receiving physical therapy services. Physical therapists (PT) should be aware if a patient has a history of, or current history of an eating disorder or nutritional deficiency as these can negatively impact a patient’s participation and optimal functioning. Minimal research has been performed related to physical therapy and eating disorders. Determining outpatient physical therapists’ knowledge, attitudes, and behaviors towards eating disorders and if they are screening for eating disorders is the first step in furthering research to help bridge the gap in the literature and improve patient care for this population This is a descriptive cross-sectional study investigating outpatient physical therapists’ knowledge, attitudes, and behaviors regarding eating disorder screening as a part of physical therapy practice. Participants: 231 licensed physical therapists working in an outpatient clinic setting. Methods: Researchers created a survey based on current literature on eating disorder screening and three physical therapists reviewed it for clarity. Questions were structured to target three main topics: knowledge, attitudes, and behaviors of physical therapists on eating disorder screening. The electronic survey was created and distributed via employer emails, APTA listservs, and social media. Results: A total of 231 participants with an average age of 35.67 years old (±10.42 years) consented to participate in the study. The majority of the sample population, 63.06%, reported having no education on eating disorders. A total of 83.34% of participants agreed or strongly agreed that screening for eating disorders is within the physical therapists scope of practice. However, only 6.54% of participants routinely screen for eating disorders. Discussion: The vast majority of physical therapists surveyed did not screen patients for eating disorders. However, the majority of participants agreed/strongly agreed that screening for eating disorders is within the PT scope of practice and that they wanted to play a role in helping patients prevent poor eating habits. Educating patients about eating disorders should include providing appropriate resources to patients, whether that is a referral to another medical professional, a hotline/helpline, or general CDC nutritional guidelines. To identify patients with eating disorders screening is the first step. Physical therapists can then give education, refer to other professionals and modify the PT plan of care appropriately.https://digitalcommons.misericordia.edu/research_posters2023/1022/thumbnail.jp

What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent: qualitative study

Objective To examine how much oncologists tell patients about the survival benefit of palliative chemotherapy during consultations at which decisions about treatment are made

Young people's views about consenting to data linkage:findings from the PEARL qualitative study

Abstract Background Electronic administrative data exist in several domains which, if linked, are potentially useful for research. However, benefits from data linkage should be considered alongside risks such as the threat to privacy. Avon Longitudinal Study of Parents and Children (ALSPAC) is a birth cohort study. The Project to Enhance ALSPAC through Record Linkage (PEARL) was established to enrich the ALSPAC resource through linkage between ALSPAC participants and routine sources of health and social data. Qualitative research was incorporated in the PEARL study to examine participants’ views about data linkage and inform approaches to information sharing. This paper focusses on issues of consent. Methods Digitally recorded interviews were conducted with 55 participants aged 17–19 years. Terms and processes relating to consent, anonymization and data linkage were explained to interviewees. Scenarios were used to prompt consideration of linking different sources of data, and whether consent should be requested. Interview recordings were fully transcribed. Thematic analysis was undertaken using the Framework approach. Results Participant views on data linkage appeared to be most influenced by: considerations around the social sensitivity of the research question, and; the possibility of tangible health benefits in the public interest. Some participants appeared unsure about the effectiveness of anonymization, or did not always view effective anonymization as making consent unnecessary. This was related to notions of ownership of personal information and etiquette around asking permission for secondary use. Despite different consent procedures being explained, participants tended to equate consent with ‘opt-in’ consent through which participants are ‘asked’ if their data can be used for a specific study. Participants raising similar concerns came to differing conclusions about whether consent was needed. Views changed when presented with different scenarios, and were sometimes inconsistent. Conclusions Findings from this study question the validity of ‘informed consent’ as a cornerstone of good governance, and the extent to which potential research participants understand different types of consent and what they are consenting, or not consenting, to. Pragmatic, imaginative and flexible approaches are needed if research using data linkage is to successfully realise its potential for public good without undermining public trust in the research process