PulsE
Quarterly eBulletin of public health and health services systematic reviews
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PulsE is a quarterly eBulletin that provides information about newly published systematic reviews of public health and health services interventions. The reviews are drawn from a range of open access sources and are selected for inclusion in the eBulletin because of their relevance to local health policy priorities. More information about the development of PulsE is available here.
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Issue 11 - February 2010
New Reviews
Falls prevention in nursing homes and hospitals
Falls incidence in nursing care facilities is reported to be about three times greater than in the community, and such falls are associated with considerable morbidity and mortality. This Cochrane review aimed to assess the effectiveness of programs designed to reduce the incidence of falls in older people in nursing homes and hospitals. Data were drawn from 41 randomised trials involving over 25,000 participants. In nursing care facilities, supervised exercise interventions were not associated with a reduced rate or risk of falling, but Vitamin D supplementation reduced the rate of falls by 28%. While multi-factorial interventions overall did not impact on the rate or risk of falls, multi-factorial interventions that were provided by a multidisciplinary team and which included an exercise component were associated with a 40% reduction in the rate of falls. In hospitals, supervised exercise interventions reduced the risk of falling by 56%. Pooled data also showed a significant effect of multi-factorial interventions, which reduced fall rates by 31% and reduced the risk of falls by 27%.
Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database of Systematic Reviews 2010, Issue 1. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005465/frame.html
Interventions for promoting physical activity among European teenagers
Adolescence is characterised by a significant decline in the time spent in physical activity, and most teenagers in Europe do not achieve levels of activity recommended in public health guidelines. This review aimed to summarise the effectiveness of interventions to promote physical activity among European teenagers. The review includes data from 20 interventions conducted with teenagers (average age 10 to 19 years) in Europe since 1990 and published since 1995. In total, 13 interventions were found to impact positively on the level of physical activity of teenagers. Most of the interventions (n= 11) which were successful in improving activity levels were conducted in a school setting; however, these improvements were not sustained beyond the short term and were largely confined to school-related (as opposed to leisure time) activity. There was promising evidence that involvement of parents and peers in school-based programs is effective. In general, interventions targeting more than one health behaviour appeared to be less effective than those focused on physical activity alone.
De Meester F, van Lenthe FJ, Spittaels H, Lien N, De Bourdeaudhuij I. Interventions for promoting physical activity among European teenagers: a systematic review. International Journal of Behavioral Nutrition and Physical Activity 2009;6:82. http://www.ijbnpa.org/content/6/1/82
School-based programs to reduce bullying
School bullying can have serious short- and long-term effects on children’s physical and mental health. This review, published by the Campbell Collaboration, aimed to assess the effectiveness of school-based anti-bullying programs in reducing school bullying. The review includes findings from 89 reports of 53 major program evaluations conducted in developed countries. Analysis of pooled data suggested that school-based anti-bullying programs were often effective: on average, bullying decreased by 20-23% and victimization fell by 17-20%. The most important program elements that were associated with a decrease in both bullying and victimization were: information sessions for parents and/or parent-teacher meetings; disciplinary methods; longer duration of the program for children and teachers; and greater intensity of the program for children and teachers. Programs inspired by the work of Norwegian researcher Dan Olweus were most effective. Anti-bullying programs appeared to work better with older children (aged 11 years or older), in larger-scale studies, in Norway specifically, and in Europe more generally. The authors recommend the development of an international system of accrediting anti-bullying programs.
Farrington DP, Ttofi MM. School-based programs to reduce bullying and victimization. Campbell Systematic Reviews 2009:6. http://campbellcollaboration.org/lib/download/718/
Addressing social disadvantage to reduce teenage pregnancy
Teenage pregnancy is associated with a wide range of subsequent adverse health and social outcomes which are independent of pre-existing social, economic, and health problems. Traditional approaches to reducing teenage pregnancy rates (e.g. sex education) have been shown to be ineffective on their own. This review therefore aimed to determine whether interventions that address the social disadvantage associated with early parenthood are effective in reducing teenage conception. Data were drawn from six controlled trials and five qualitative studies. The review found that early childhood interventions (which aim to promote cognitive and social development through preschool education, parent training, and social skills training) and youth development programs (which aim to promote self esteem, positive aspirations, and a sense of purpose through vocational, educational, volunteering, and life skills work) were associated with a 39% reduction in teenage pregnancy rates among young women. Analysis of the qualitative studies revealed three major themes relating to teenage pregnancy: dislike of school; poor material circumstances and unhappy childhood; and low expectations and aspirations for the future. The authors argue that this review provides a small but reliable evidence base supporting the value of early childhood and youth development programs for reducing unintended teenage pregnancy rates.
Motivational interviewing for smoking cessation
Motivational interviewing (MI) is a brief psychotherapeutic intervention intended to increase the likelihood that a person will make an attempt to change their harmful behaviour. The main focus of MI is helping people to explore and resolve their ambivalence about behaviour change. MI has been shown to be effective for treating alcohol and drug addiction, encouraging weight loss, and improving diet and exercise. This review aimed to determine whether MI is also effective for promoting smoking cessation. The review includes data on over 10,000 smokers from 14 trials; the most common approach to MI in these trials was the provision of feedback to the smoker in order to develop discrepancy between smoking and personal goals in a non-threatening manner. Analysis of pooled data indicated that MI was associated with a 27% increase in abstinence compared with brief advice or usual care. MI was more successful when delivered by general practitioners than when facilitated by counsellors or nurses, and sessions lasting longer than 20 minutes appeared to be more effective than shorter sessions. MI delivered over multiple sessions may be slightly more effective than single sessions, but both options were associated with positive outcomes.
Lai DTC, Cahill K, Qin Y, Tang J-L. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2010, Issue 1. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006936/frame.html
Psychosocial interventions for reducing injection and sexual risk behaviour among drug users
This Cochrane review aimed to determine the effectiveness of multi-session psychosocial interventions designed to reduce injection and sexual behaviours associated with greater risk of contracting HIV. Multi-session psychosocial interventions were defined as a program consisting of at least three sessions combining HIV education with training to improve communication skills, assertiveness, and safe sexual and injection risk behaviour. These multi-session programs can be provided in a variety of settings, including methadone maintenance clinics and needle and syringe exchanges. Data were drawn from 35 trials with a total of almost 12,000 participants. Both formal multi-session psychosocial interventions and standard education (i.e. one or two sessions of education and skills training) were associated with reductions in risk behaviour. However, multi-session psychosocial interventions did not appear to be more beneficial than standard education for encouraging safer injecting or sexual risk behaviour. There was some evidence to suggest that people receiving formal drug treatment receive more benefit from multi-session psychosocial interventions than those not engaged in treatment. The authors conclude that, given the relative cost effectiveness of brief educational interventions compared with multi-session programs, standard education interventions should be offered as a treatment option alongside other effective interventions.
Children's views about obesity, body size, shape, and weight
Currently, little is known about children’s perspectives on obesity and body size, shape and weight. This systematic review was commissioned by the Department of Health (England) to examine recent research findings from the UK in which children aged 4-11 years provide views about their own body sizes or about the body sizes of others. The review incorporates findings from 28 UK-based studies. Data were analysed in two ways: (i) common themes from studies in which children were asked open-ended questions were identified; and (ii) children’s responses to forced-choice questions were aggregated. Key findings included:
- Children, unless they were very overweight, often did not see body shape as an immediately relevant issue. Children in general did see body size as an issue for others, and some reported negative feelings around body size.
- Whatever their body size, children did not emphasise the health implications of being overweight. Instead they saw overweight bodies as having problematic social and psychological consequences.
- Children assessed their own and others’ body sizes critically. They described how they compared their bodies over time and with other peoples’ bodies. Very overweight children spontaneously described their own bodies as being a larger size.
- Children’s responses to body fat were almost exclusively negative and were infused with moralistic ideas involving blame, responsibility and due punishment.
- While attitudes to thinness and dieting for weight loss were not always positive, girls, in particular, were aware of social pressures to be thin and were sometimes applying them to themselves.
- Very overweight children and those who are not overweight had very different ideas about children’s control over their body sizes.
- While children identified multiple influences on their body size and discussed some in complex terms, their recommendations for other children seeking to lose weight focused mainly on eating.
- Children emphasised the importance of support for helping them deal with pressures around body size and helping them have a healthy weight.
- Very overweight children identified other barriers and facilitators to attempting weight loss.
Rees R, Oliver K, Woodman J, Thomas J. Children’s views about obesity, body size, shape and weight: a systematic review. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London; 2009. http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=2463
Home-based versus centre-based cardiac rehabilitation
Cardiac rehabilitation (CR) programs typically provide exercise, education, counselling and support to aid recovery after a cardiac event and prevent further cardiac illness. Many eligible participants find it difficult to attend centre-based CR or are reluctant to take part in group-based classes, prompting the introduction of home-based CR to encourage wider participation. This review, reported in both the Cochrane Database of Systematic Reviews and the British Medical Journal, aimed to determine the effectiveness of home-based cardiac rehabilitation programs compared with supervised centre-based cardiac rehabilitation on mortality and morbidity, health-related quality of life and modifiable cardiac risk factors in patients with coronary heart disease. The review incorporates data from 21 papers reporting on 12 studies with almost 2,000 participants. There was no evidence of a significant difference between centre- or home-based CR in a range of modifiable risk factors, including systolic blood pressure, diastolic blood pressure, total cholesterol, HDL-cholesterol, LDL-cholesterol, or smoking. In terms of clinical events, there was no evidence of any significant differences in mortality or cardiac events. CR setting was also unrelated to exercise capacity and health-related quality of life. In the home based participants, there was some evidence of superior adherence. The authors conclude that home- and centre-based CR appear to be equally effective in improving the clinical and health-related quality of life of participants, which supports the extension of home-based CR programs to enable greater choice among patients.
Taylor RS, Dalal H, Jolly K, Moxham T, Zawada A. Home-based versus centre-based cardiac rehabilitation. Cochrane Database of Systematic Reviews 2010, Issue 1. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD007130/frame.html
Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. Br Med J 2010;340:b5631. http://bmj.com/cgi/content/abstract/340/jan19_4/b5631?papetoc
Forthcoming Reviews
Combined pharmacotherapy and behavioural interventions for smoking cessation (Cochrane Tobacco Addiction Group)
This review aims to evaluate the effect of combining behavioural support and medication to aid smoking cessation, and to identify whether there are different effects depending on intensity of intervention, population treated, levels of compliance or treatment setting. The review will also evaluate the effect of providing more intensive behavioural support to people using medication.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008286/frame.html
Contraceptive services for socially disadvantaged young people (NICE – UK National Institute for Health and Clinical Excellence)
This review will: (a) determine the effectiveness and cost-effectiveness of interventions to encourage young people, especially socially disadvantaged young people, to use contraceptives and contraceptive services; and (b) explore the perceptions, views and beliefs of socially disadvantaged young people and their families about contraception and contraceptive services.
http://www.nice.org.uk/nicemedia/pdf/ContraceptiveServicesFinalScope.pdf
The effectiveness of strategies to change organisational culture to improve healthcare performance (Cochrane Effective Practice and Organisation of Care Group)
This review will aim to determine the effectiveness of strategies to change organisational culture in improving healthcare performance, and to examine the effectiveness of these strategies according to different patterns of organisational culture.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008315/frame.html
Physical activity for improving cognition in older people with mild cognitive impairment (Cochrane Dementia and Cognitive Improvement Group)
The primary objective of this review will be to evaluate and quantify the effectiveness of physical activity interventions in improving cognition in older adults with mild cognitive impairment; the effectiveness of physical activity in improving non-cognitive outcomes will also be explored.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008198/frame.html
Other Resources
New web-based cost conversion tool
In systematic reviews that incorporate evidence on the costs of interventions, cost estimates are often drawn from studies conducted in different countries and/or at different times. To enable end users of reviews to make meaningful comparisons between a range of cost estimates, it is preferable for these estimates to be expressed using a ‘common metric’, which requires their adjustment to a common currency and price year. The CCEMG – EPPI-Centre Cost Converter (v.1.0) is a free web-based tool for adjusting estimates of cost expressed in one currency and price year to a specific target currency and price year. The tool uses a two-stage computation. Stage 1 adjusts the original estimate of cost from the original price year to a target price year, using a Gross Domestic Product deflator index. Stage 2 converts the price-year adjusted cost estimate from the original currency to a target currency, using conversion rates based on Purchasing Power Parities for GDP. The tool was developed by the Campbell & Cochrane Economics Methods Group (CCEMG) and the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre).
http://eppi.ioe.ac.uk/costconversion/default.aspx
Proposed Cochrane food security and nutrition field
In an effort to better understand the underlying causes of food insecurity and contribute towards reducing hunger, under-nutrition and poverty, a group of stakeholders is exploring the possibility of establishing a Cochrane review group focused on food and nutrition. A proposal is currently being developed for discussion and consultation, including with the coordinator and members of the existing nutrition sub-field of the primary health care field.
http://news.cochrane.org/view/item/review_one.jsp?j=1758