Families Matter in Long-Term Care: Results of a Group-Randomized Trial.
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ABSTRACT:
SUBMITTER: Zimmerman S
PROVIDER: S-EPMC4167776 | biostudies-literature | 2013
REPOSITORIES: biostudies-literature
Publications
Families Matter in Long-Term Care: Results of a Group-Randomized Trial.
Zimmerman Sheryl S Cohen Lauren W LW Reed David D Gwyther Lisa P LP Washington Tiffany T Cagle John G JG Sloane Philip D PD Preisser John S JS
Seniors housing & care journal 20130101 1
This group-randomized trial implemented and evaluated an intervention to reduce staff burden and improve family and resident outcomes by helping families create meaningful roles for themselves in residential care/assisted living and nursing homes. Across 24 sites, families (<i>N</i> = 490) and staff (<i>N</i> = 397) provided data over six months about family involvement, family and staff well-being and attitudes, and resident quality of life. Intervention subjects participated in workshops and c ...[more]
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Project description:Severe neglect in early life is associated with compromises in brain development and associated behavioral functioning. Although early intervention has been shown to support more normative trajectories of brain development, specific improvements in the white matter pathways that underlie emotional and cognitive development are unknown.To examine associations among neglect in early life, early intervention, and the microstructural integrity of white matter pathways in middle childhood.The Bucharest Early Intervention Project is a randomized clinical trial of high-quality foster care as an intervention for institutionally reared children in Bucharest, Romania, from 2000 through the present. During infancy, children were randomly selected to remain in an institution or to be placed in foster care. Those who remained in institutions experienced neglect, including social, emotional, linguistic, and cognitive impoverishment. Developmental trajectories of these children were compared with a group of sociodemographically matched children reared in biological families at baseline and several points throughout development. At approximately 8 years of age, 69 of the original 136 children underwent structural magnetic resonance imaging scans.Four estimates of white matter integrity (fractional anisotropy [FA] and mean [MD], radial [RD], and axial [AD] diffusivity) for 48 white matter tracts throughout the brain were obtained through diffusion tensor imaging.Significant associations emerged between neglect in early life and microstructural integrity of the body of the corpus callosum (FA, ? = 0.01 [P =?.01]; RD, ? =?-0.02 [P =?.005]; MD, ? =?-0.01 [P =?.02]) and tracts involved in limbic circuitry (fornix crus [AD, ? = 0.02 (P =?.046)] and cingulum [RD, ? =?-0.01 (P =?.02); MD, ? =?-0.01 (P =?.049)]), frontostriatal circuitry (anterior [AD, ? =?-0.01 (P =?.02)] and superior [AD, ? =?-0.02 (P =?.02); MD, ? =?-0.01 (P =?.03)] corona radiata and external capsule [right FA, ? = 0.01 (P =?.03); left FA, ? = 0.01 (P =?.03); RD, ? =?-0.01 (P =?.01); MD, ? =?-0.01 (P =?.03)]), and sensory processing (medial lemniscus [AD, ? =?-0.02 (P =?.045); MD, ? =?-0.01 (P =?.04)] and retrolenticular internal capsule [FA, ? =?-0.01 (P =?.002); RD, ? = 0.01 (P =?.003); MD, ? = 0.01 (P =?.04)]). Follow-up analyses revealed that early intervention promoted more normative white matter development among previously neglected children who entered foster care.Results suggest that removal from conditions of neglect in early life and entry into a high-quality family environment can support more normative trajectories of white matter growth. Our findings have implications for public health and policy efforts designed to promote normative brain development among vulnerable children.clinicaltrials.gov Identifier: NCT00747396.
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Project description:OBJECTIVE:Meaning-centered group psychotherapy for cancer survivors (MCGP-CS) is an effective intervention to improve personal meaning, psychological well-being, and depressive symptoms until 6 months after the intervention. In this study, the long-term effects of MCGP-CS (i.e., at 1- and 2-year follow-up) on meaning, psychological well-being and posttraumatic growth were assessed, in comparison to supportive group psychotherapy (SGP) and care as usual (CAU). METHODS:Cancer survivors (n = 170) were randomized into MCGP-CS, SGP, or CAU. Assessments were scheduled at baseline, 1 week, 3 months, 6 months, 1 year, and 2 years postintervention. Outcome measures were the Personal Meaning Profile, Ryff's Scales of Psychological Well-Being (SPWB), the Posttraumatic Growth Inventory, and their subscales. Linear mixed models (LMM) were used and results were both reported on an intention-to-treat (ITT) basis, as well as for intervention completers only. RESULTS:LMM and post hoc analyses with Bonferroni correction revealed that MCGP-CS participants reported more improvement on positive relations (subscale of SPWB) than CAU participants of 2-year postintervention (ITT analysis, Cohen's d = .82). Completers also reported more personal growth (subscale of SPWB) after MCGP-CS than after SGP 1-year postintervention (Cohen's d = .94). No long-term effects were found on the other outcome measures. CONCLUSIONS:In the 2 years after MCGP-CS, the short-term significant effects on personal meaning and most positive effects related to psychological well-being faded. However, MCGP-CS had a long-term positive effect on positive relations with others and on survivors' sense of personal growth. TRIAL REGISTRATION:Netherlands Trial Register: NTR3571.
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Project description:BackgroundAlthough the majority of Ghanaian women receive antenatal care (ANC), many exhibit low health literacy by misinterpreting and incorrectly operationalizing ANC messages, leading to poor maternal and newborn health outcomes. Prior research in low-resource settings has found group antenatal care (G-ANC) feasible for women and providers. This study aims to determine the effect of G-ANC on increasing maternal health literacy. We hypothesized that pregnant women randomized into G-ANC would exhibit a greater increase in maternal health literacy than women in routine, individual ANC.MethodsA 5-year cluster randomized controlled trial was conducted in 14 rural and peri-urban health facilities in the Eastern Region of Ghana. Facilities were paired based on patient volume and average gestational age at ANC enrollment and then randomized into intervention (G-ANC) vs. control (routine, individual ANC); 1761 pregnant women were recruited. Data collection occurred at baseline (T0) and post-birth (T2) using the Maternal Health Literacy scale, a 12-item composite scale to assess maternal health literacy. Logistic regression compared changes in health literacy from T0 to T2.ResultsOverall, women in both the intervention and control groups improved their health literacy scores over time (p < 0.0001). Women in the intervention group scored significantly higher on 3 individual items and on overall composite scores (p < 0.0001) and were more likely to attend 8 or more ANC visits.ConclusionWhile health literacy scores improved for all women attending ANC, women randomized into G-ANC exhibited greater improvement in overall health literacy post-birth compared to those receiving routine individual care. Life-saving information provided during ANC must be presented in an understandable format to prevent women and newborns from dying of preventable causes.Trial registryEthical approval for the study was obtained from the Institutional Review Boards of the University of Michigan (HUM#00161464) and the Ghana Health Service (GHS-ERC: 016/04/19).
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