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This study examined the effect of a job aidsfocused intervention on quality of facility-based postnatal counseling, and whether increased communication improved in-hospital newborn care and maternal knowledge of home practices and danger signs requiring urgent care. Ensuring mothers and newborns receive essential postnatal services, including health counseling, is integral to their survival. Yet, quality of clinic-based postnatal services is often low, and evidence on effective improvement strategies is scarce. Using a pre-post randomized design, data were drawn from direct observations and interviews with 411 mother-newborn pairs. Multi-level regression models with difference-in-differences analyses estimated the intervention's relative effect, adjusting for changes in the comparison arm. The mean percent of recommended messages provided to recently-delivered women significantly improved in the intervention arm as compared to the control (difference-in-differences [[[DELTA].sub.i] - [[DELTA].sub.c]] +30.9, 95% confidence interval (CI) 19.3, 42.5), and the proportion of newborns thermally protected within the first hour ([[DELTA].sub.i] - [[DELTA].sub.c] +33.7, 95% CI 19.0, 48.4) and delayed for bathing ([[DELTA].sub.i] - [[DELTA].sub.c] +23.9, 95% CI 9.4, 38.4) significantly increased. No significant changes were observed in early breastfeeding ([[DELTA].sub.i] - [[DELTA].sub.c] +6.8, 95% CI -2.8, 16.4) which was nearly universal. Omitting traditional umbilical cord substances rose slightly, but was insignificant ([[DELTA].sub.i] - [[DELTA].sub.c] +8.5, 95% CI -2.8, 19.9). The proportion of mothers with correct knowledge of maternal ([[DELTA].sub.i] - [[DELTA].sub.c] +27.8, 95% CI 11.0, 44.6) and newborn ([[DELTA].sub.i] - [[DELTA].sub.c] +40.3, 95% CI 22.2, 58.4) danger signs grew substantially, as did awareness of several home-care practices ([[DELTA].sub.i] - [[DELTA].sub.c] +26.0, 95% CI 7.7, 44.3). Counseling job aids can improve the quality of postnatal services. However, achieving reduction goals in maternal and neonatal mortality will likely require more comprehensive approaches to link enhanced facility services with community-based initiatives. Keywords Postnatal care * Job aids * Counseling * Maternal * Newborn * Quality improvement, Introduction The postnatal period, or the time immediately after birth up to the first 6 weeks of life, is a time of high mortality risk for women and newborns. Each [...]

Smoking cessation interventions for cardiac patients need improvement given their weak effects on long-term abstinence rates and low compliance by nurses to implementation. This study tested the effectiveness of two smoking cessation interventions against usual care in cardiac patients, and conditional effects for patients' motivation to quit and socio-economic status (SES). An experimental study was conducted from 2009 to 2012 for which Dutch cardiac patient smokers were assigned to: usual care (UC; n = 245), telephone counseling (TC; n = 223) or face-to-face counseling (FC; n = 157). The three groups were comparable at baseline and had smoked on average 21 cigarettes a day before hospitalization. After six months, interviews occurred to assess self-reported smoking status. Patients in the TC and FC group had significantly higher smoking abstinence rates than patients in the UC group (p ≤ 0.05 at all times). Regression analysis further revealed significant conditional effects of the interventions on smoking abstinence in patients with lower SES, with a larger effect for TC than FC when compared to UC. These findings suggest that intensive counseling is effective in increasing short-term abstinence rates, particularly in patients with lower SES. Future studies need to investigate how patients with higher SES can profit equally from these type of interventions. Keywords Coronary heart disease * Smoking cessation * Telephone counseling * Face-to-face counseling * Socio-economic status * Effectiveness study, Background Smoking cessation is the single most effective action for secondary prevention of coronary heart disease (CHD). It significantly reduces the risk of mortality, re-hospitalization and reoccurrence after a coronary [...]

Our goal was to investigate the factor structure of a risk assessment tool utilized by suicide hotlines and to determine the predictive validity of the obtained factors in predicting subsequent suicidal behavior. We conducted an Exploratory Factor Analysis (EFA), an EFA in a Confirmatory Factor Analysis (EFA/CFA) framework, anda CFA on independent subsamples derived from a total sample of 1,085. Similar to previous studies, we found consistent evidence for a two-factor solution, with one factor representing a more pernicious form of suicide risk (i.e., Resolved Plans and Preparations; RPP) and one factor representing milder suicidal ideation (i.e., Suicidal Desire and Ideation; SDI). The RPP factor trended toward being more predictive of suicidal ideation at follow-up than the SDI factor. DOI: 10.1002/jclp.20717

Achieving long-term adherence to a dietary pattern is a challenge in many studies investigating the relationship between diet and disease. The Women's Healthy Eating and Living Study was a multi-institutional randomized trial in 3088 women at risk for breast cancer recurrence. At baseline, the average participant followed a healthy dietary pattern of 7 vegetable and fruit servings, 21 g/d of fiber, and 28.7% energy from fat, although fat intake increased over the enrollment period. Using primarily telephone counseling, the intervention group was encouraged to substantially increase intakes of vegetables, fruits, and fiber while decreasing fat intake. Sets of 24-h dietary recalls were completed on 90% of eligible participants at 1 y and 86% at 4 y. Using a conservative imputation analysis, at 1 y, the intervention group consumed 38% more vegetable servings (100% when including juice) than the comparison group, 20% more fruit, 38% more fiber, 50% more legumes, and 30% more whole grain foods, with a 20% lower intake of energy from fat. At 4 y, the between-group differences were 65% for vegetables (including juice), 25% fruit, 30% fiber, 40% legumes, 30% whole grain foods, and 13% lower intake of energy from fat. The intervention effect on fat intake was similar for early vs. late enrollees. Plasma carotenoid concentrations on a random 28% sample validated self-reported vegetable and fruit intake, with a between-group difference of 66% at 1 y and over 40% at 4 y. This large change will allow testing of hypotheses on the role of dietary change in preventing additional breast cancer events.

Objective: Interactive voice response (IVR) systems allow respondents to report information privately using the telephone keypad and appear to enhance reports of sensitive behaviors like problem drinking. They hold promise for telehealth applications with problem drinkers who will not seek clinical care, but IVR feasibility and data quality using such community samples have not been well studied across lengthy reporting periods in relation to established retrospective measures that are less costly and burdensome. These issues were evaluated using recently resolved, untreated problem drinkers who are targets for telehealth interventions. Method: Problem drinkers recruited from the community (24 men, 20 women) engaged in IVR self-monitoring (SM) for up to 128 days after initial resolution when the risk of relapse was high. Participants reported daily drinking, money spent on alcohol, and life-event occurrences. An expanded Timeline Followback (TLFB) interview and life-events assessment were completed after the IVR SM interval and covered the same time period. Results: IVR and TLFB reports showed excellent agreement for summary measures of drinking and money spent on alcohol, but IVR reports were higher on several measures. Most, but not all, individuals showed good agreement for reports of day-to-day drinking practices. Reports of life events were less convergent across reporting methods. Conclusions: The findings further established the use of IVR SM with problem drinkers, including assessment of behavioral economic variables, and extended its use to community settings, which offer opportunities to reach the majority who do not seek clinical services., AUTOMATED DATA COLLECTION SYSTEMS that allow respondents to enter information privately appear to enhance reporting of complex and sensitive information about substance use and other risk behaviors. Studies that compared [...]

Pharmacological interventions for smoking cessation are typically evaluated using volunteer samples (efficacy trials) but should also be evaluated in population-based trials (effectiveness trials). Nicotine replacement therapy (NRT) alone and in combination with behavioral interventions was evaluated on a population of smokers from a New England Veterans Affairs Medical Center. Telephone interviews were completed with 3,239 smokers, and 2,054 agreed to participate (64%). Participants were randomly assigned to one of four conditions: stage-matched manuals (MAN); NRT plus manuals (NRT + MAN); expert system plus NRT and manuals (EXP + NRT + MAN); and automated counseling plus NRT, manuals, and expert system (TEL + EXP + NRT + MAN). Assessments were completed at baseline, 10, 20, and 30 months. The point prevalence cessation rates at final follow-up (30 months) were MAN, 20.3% NRT + MAN, 19.3%; EXP + NRT + MAN, 17.6%; and TEL + EXP + NRT + MAN, 19.9%. Stage-matched manuals provided cessation rates comparable with previous studies. The addition of NRT, expert system interventions, and automated telephone counseling failed to produce a further increase in intervention effectiveness. Keywords: effectiveness trial, expert system, nicotine replacement therapy, smoking cessation, telecommunications

Objective: To identify which smoking cessation interventions provide the most efficient use of health care resources at a population level. Methods: Effectiveness data were obtained from a review of the international literature. Costs and effects of smoking cessation interventions were estimated from the perspective of the Australian Government. Treatment costs and effects were modelled using incremental cost-effectiveness ratios. Assumptions regarding effectiveness, resource use and costs were tested by sensitivity analysis. Results: From the population perspective, telephone counselling appeared to be the most cost-effective intervention. Adding proactive forms of telephone counselling increased the effectiveness of pharmacotherapies at a low incremental cost and, therefore, this could be a highly cost-effective strategy. Bupropion appeared to be more cost effective than nicotine replacement therapy (NRT). Combined bupropion and NRT did not appear to be cost effective. Conclusions: General practitioners should be encouraged to refer patients to telephone quit lines and if prescribing pharmacotherapy consider the addition of telephone counselling. Implications: The results support greater investment in proactive forms of telephone counselling and more formal integration of pharmacotherapies with proactive telephone counselling services as cost-effective strategies for reducing population-level smoking rates.

The main objective was to compare usual primary care for depression with two intervention programs namely, telephone care management and telephone care management plus telephone psychotherapy. Three-group randomized controlled trial with allocation concealment and blinded outcome assessment were conducted between November 2000 and May 2002.

Every year millions of Americans attempt to stop smoking cigarettes, but only a fraction are successful in maintaining their newly acquired nonsmoking status [1,2]. What distinguishes those who are successful […]

The effect of a smokers' hotline as an adjunct to self-help manuals was examined. Subjects were 1,813 smokers recruited from a 10-county rural and small urban area. Counties were matched on demographic characteristics and assigned to a manual only or manual plus hotline condition. Subjects were followed over an 18-month period. Hotline services included taped messages and access to paraprofessional counselors. Results show a consistent, significant hotline effect across outcome measures and follow-up periods. This effect emerged either as a main effect for the hotline or as an interaction with enrollment method such that a significant hotline effect emerged for subjects who enrolled through face-to-face methods. These findings indicate the effectiveness of the hotline in enhancing self-help quit rates.

Calls to a community help line for children were analyzed for developmental and gender trends in support-seeking during middle childhood. Results indicated that between the ages of 10 and 11 the nature of help-seeking by callers changed, with a shift toward more informational support-seeking and concern regarding interpersonal problems. This shift was particularly dramatic for girls. Gender differences in the type of support sought (informational vs. instrumental) were slight. Parallels with other studies of stress and coping in children are drawn.