We report a systematic review of randomised controlled trials of physical activity promotion in apparently healthy, free living adults (that is, people who were not receiving treatment for any illness and were not in an institution). The aim was to explore evidence of effective promotion of physical activity. MethodsSearches were carried out using Medline, Excerpta Medica, SPORT (Data-Star), and Unicorn from 1966-93. Key words include "exercise", "community", "intervention", and "randomised controlled trial". Searches were also carried out on key authors identified from reviews. Only English language journals were searched. Two hundred and fifty abstracts were identified but only 18 described papers on randomised controlled trials. Additional searching was then carried out using the references from both existing reviews and the papers chosen from the abstracts. A further 37 papers were thus gathered. Each paper was read by two of us (MH and TA) and considered for inclusion.The criteria for inclusion were as follows: * A control group; * Subjects were assigned to control or intervention by randomisation; * Trials testing single factor interventions to increase activity; * Interventions tested on apparently healthy, free living adults; * Exercise behaviour was the dependent variable.The quality of each paper was assessed using a three point scoring system. Each of three areas of potential bias in methodology were scored: (1) the quality of random allocation; (2) results analysed on intention to treat; (3) outcomes assessed without knowledge of assignment of subjects to groups by ran-
Healthcare systems are in the process of reforming themselves to better meet the needs of people with, or at risk of developing, chronic diseases and long term conditions. One goal of these efforts is the coproduction of activated, informed, engaged and motivated patients and citizens. The clinical, public health and financial benefits of achieving such a goal may be dramatic. Motivational Interviewing (MI) is a proven and practical front-line approach which can help deliver this goal whilst also helping to deliver such policy objectives and intermediate outcomes as increased levels of patient centered care, participatory or shared decision making, evidence-based healthcare and improved clinician-patient relationships. Until now, MI has been passively diffusing through the system as a result of the innovation and early uptake by insightful individuals and organizations. If healthcare systems want to breakthrough to higher levels of performance, investment in the conscious and deliberate implementation of MI into front-line settings may prove helpful.
Background & Aims Chronic infection with hepatitis B and C viruses (HBV & HCV) is a major contributor to liver disease and liver‐related mortality in Uzbekistan. There is a need to demonstrate the feasibility of large‐scale simplified testing and treatment to implement a national viral hepatitis elimination program. Methods Thirteen polyclinics were utilized to screen, conduct follow‐up biochemical measures and treat chronic HBV and HCV infection in the general adult population. Task shifting and motivational interviewing training allowed nurses to provide rapid screening and general practitioners (GPs) to treat individuals on‐site. An electronic medical system tracked individuals through the cascade of care. Results The use of rapid tests allowed for screening of 60 769 people for HCV and HBV over 6 months and permitted outdoor testing during the COVID‐19 pandemic along with COVID testing. 13%–14% of individuals were lost to follow‐up after the rapid test, and another 62%–66% failed to come in for their consultation. One stop testing and treatment did not result in a statistically increase in retention and lack of patient awareness of viral hepatitis was identified as a key factor. Despite training, there were large differences between GPs and patients initiating treatment. Conclusions The current study demonstrated the feasibility of large‐scale general population screening and task shifting in low‐ and middle‐income countries. However, such programs need to be proceeded by awareness campaign to minimize loss to follow up. In addition, multiple trainings are needed for GPs to bolster their skills to talk to patients about treatment.
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ObjectivesThe SafeSpace study codesigned and tested a virtual reality (VR) intervention, incorporating relaxation and compassionate mind training to determine acceptability/feasibility in an oncology setting and evaluate impact on physical/psychological well-being and quality of life.DesignA two-phase study. Phase I determined key characteristics using an experienced-based codesign approach. Phase II evaluated the intervention using various measures and qualitative interviews in a mixed methods approach. Descriptive statistics were used to analyse measures data and framework analysis to analyse interviews.SettingA specialist cancer centre, UK.Participants11 in phase I and 21 in phase II. Participants were in cancer treatment, recovery or palliative care.Primary and secondary outcomePrimary outcome: acceptability of the intervention, assessed by >60% uptake of three sessions. Secondary outcomes: impact on psychological well-being using EQ-5D/QLQ-C30, Profile of Mood Scale, Warwick and Edinburgh Mental Well-being Scale, Depression and Anxiety Severity Scale 21, Self-Compassion Scale, Acceptance and Action Questionnaire and a locally developed questionnaire to capture self-compassion post use. Physiological impact was assessed by change in heart rate (HR)/HR variability and electrodermal activity (EDA).ResultsTwenty participants (mean age=48.7 years; SD=16.87); 65% (n=13) completed three sessions. Mental well-being improved following each use and from baseline to after session 3 (VR 1—z=2.846, p≤0.01; VR 2—z=2.501, p≤0.01; VR 3—z=2.492, p≤0.01). There was statistically significant difference in mean scores for EDA at mid-session and post session compared with pre session (F (1.658, 4.973)=13.364, p<0.05). There was statistically significant reduction in stress levels from baseline to post session 3. Participants found the intervention acceptable and highlighted areas for development.ConclusionThe intervention is acceptable and feasible and has shown positive effects on mental well-being/stress in the oncology setting. Larger studies are needed to confirm findings.
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