In a Manila hospital, 204 mothers were randomized into three groups: two intervention groups receiving home-based counseling visits, one of them (n=68) by counselors trained to use a locally developed, two-tiered program of breastfeeding counseling, and the other by counselors trained in general childcare (n=67), were compared with a control group of mothers (n=69) who did not receive any counseling. All infants were scheduled for seven visits to the hospital for follow-up. During hospital visits, maternal and infant body measurements were made and an independent interviewer asked the mothers individually to recall how the infant had been fed. One study physician, blind to participant groups, was consulted at all scheduled and unscheduled infant visits. At six months, 44% of the breastfeeding-counseled mothers, 7% of the childcare-counseled mothers and none of the mothers in the control group were exclusively breastfeeding. Twenty- four mothers breastfed exclusively during the first six months, of whom 22 received breastfeeding counseling and 2 had no breastfeeding counseling. Among 24 infants who were exclusively breastfed from birth to six months there were no episodes of diarrhea. All infants had gained in weight, length and head circumference. Mean maternal weight loss at six months was similar whether her breastfeeding was exclusive or partial. The reasons why mothers without breastfeeding counseling introduced non-breast milk feeding before six months reflected lack of knowledge and support. Breastfeeding support during the first six months focusing on how to prevent and solve breastfeeding problems, particularly during the first two weeks, will enable mothers to choose to breastfeed exclusively up to six months. This study has provided fundamental evidence of successful intervention by breastfeeding counseling to achieve six months of exclusive breastfeeding among term, low-birthweight infants. The locally developed training program in breastfeeding counseling, which successfully prepared volunteers to counsel mothers at home, could be incorporated into primary health care in the Philippines. Mothers who received breastfeeding counseling appreciated how this helped them to achieve their breastfeeding goals for the first six months. Improved breastfeeding practices as a result of breastfeeding counseling provided infants with protection from diarrhea and respiratory infections, contributing to their health and development.

Purpose: To assess the role of photobiomodulation on bone healing around dental implants. Materials and Methods: 72 patients requiring 76 dental implants were included. All patients received dental implant(s.) Treatment group had also to apply LED to surgical sites. ISQ of implants was measured following implant placement and at 1, 2, 4, and 8 weeks postoperatively. Radiographs were taken after insertion and at 8 weeks postoperatively. Data were analyzed using SPSS and Stata. Results: Treatment group showed an increase in ISQ values over the follow-up period compared to control (p < 0.001). Primary effect of LED on ISQ values was seen over the first 2 weeks (p < 0.05). Treatment group showed less decrease in crestal bone height at 8 weeks (p = 0.05). Conclusions: Data suggest that photobiomodulation will allow for a continuous increase in ISQ value and may reduce crestal bone resorption following implant placement.

Purpose: To assess the role of photobiomodulation on bone healing around dental implants. Materials and Methods: 72 patients requiring 76 dental implants were included. All patients received dental implant(s.) Treatment group had also to apply LED to surgical sites. ISQ of implants was measured following implant placement and at 1, 2, 4, and 8 weeks postoperatively. Radiographs were taken after insertion and at 8 weeks postoperatively. Data were analyzed using SPSS and Stata. Results: Treatment group showed an increase in ISQ values over the follow-up period compared to control (p < 0.001). Primary effect of LED on ISQ values was seen over the first 2 weeks (p < 0.05). Treatment group showed less decrease in crestal bone height at 8 weeks (p = 0.05). Conclusions: Data suggest that photobiomodulation will allow for a continuous increase in ISQ value and may reduce crestal bone resorption following implant placement.

The purpose of this randomized controlled study was to investigate the effect of internet- administered guided self-help for women suffering from psychological problems following traumatic childbirth. The eight-week treatment program consisted of written chapters based on cognitive behavioral therapy. 56 participants were randomly assigned to a treatment group (n = 28) or a waiting list group (n = 28).The results showed that post-traumatic symptoms decreased as a result of the treatment, with large within-group effects measured by both the Traumatic Event Scale (TES) (d = 1.33) and the Impact of Event Scale-Revised (IES-R) (d = 1.3). The difference between the groups was only significant when measured by the IES-R in which case the between-group effect was large (d = 0.97). The proportion of the participants who showed clinically significant improvement was considerably greater in the treatment group than in the waiting list group. For other measured outcomes, the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and the Quality of Life Inventory (QOLI), the difference between the groups were not significant,however the treatment group showed significant improvements between pre-and post measurements on all accounts.LAURA is most likely the first study to examine the treatment of psychological problems following traumatic childbirth. The results are promising and overall show that internet-administered cognitive behavioral therapy reduces post-traumatic symptoms following a traumatic childbirth, indicating a decrease in symptoms of anxiety and depression, and an improvement in quality of life.

Delirium is probably the most common presenting symptom of disease in old age. Delirium, as defined in DSM-IV, is a neuropsychiatric syndrome characterized by disturbance in attention and consciousness, which develops over a short period of time and where the symptoms tend to fluctuate during the course of the day. The overall aim was to increase knowledge about the risk factors and outcome of delirium in old patients with femoral neck fracture and to develop and evaluate a multi-factorial intervention program for prevention and treatment of delirium in these patients. In a prospective study of 101 consecutive patients with a femoral neck fracture, 29.7% were delirious before surgery and another 18.8% developed delirium postoperatively. Of those who were delirious preoperatively all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and seemed to have more postoperative complications, such as infections. Patients with preoperative delirium had a poorer walking ability on discharge compared to patients with postoperative delirium only. In a five-year prospective follow up study 30 out of 78 (38.5%) non-demented patients with a femoral neck fracture developed dementia. Twenty out of 29 (69%) who were delirious postoperatively developed dementia compared to 10 out of 49 (20%) who were not delirious during hospitalization (p&lt;0.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years compared to 17/49 (34.7%) of those who remained lucid postoperatively (p=0.001). A non-randomized multi-factorial intervention study with the aim of preventing and treating delirium among patients with femoral neck fracture (n=49) showed that the incidence of delirium was significantly lower than reported in previously published studies. The incidence of other postoperative complications was also lower and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. A similar multi-factorial intervention program evaluated as a randomized controlled trial including 199 femoral neck fracture patients showed that fewer intervention patients than controls suffered postoperative delirium (56/102, 55% vs. 73/97, 75%, p=0.003). For intervention patients the postoperative delirium was also of shorter duration (5.0±7.1 days vs. 10.2±13.3 days, p=0.009). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p&lt;0.001). Intervention patients suffered from significantly fewer in-hospital complications, such as decubital ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0±17.9 days vs. 38.0±40.6 days, p=0.028). In conclusion, pre- and postoperative delirium is common and seems to be associated with various risk factors, which require different strategies for prevention and treatment. Delirium is also associated with the development of dementia and a higher mortality rate. Multifactorial intervention programs can successfully be implemented and result in the reduction of delirium, fewer complications and shorter hospitalization.

Background: Acceptance and Commitment Therapy (ACT) has shown promise as an effective intervention in the treatment of mental health disorders. In the last decade, the delivery of ACT has expanded to include various formats (e.g. groups, self-help, online and phone apps). Further research is needed to evaluate whether such delivery formats are a viable extension of ACT. Furthermore, the existing evidence base of certain alternative delivery formats have yet to be reviewed. This thesis portfolio sought to contribute to this area of research. Methods: A systematic review of the literature was conducted to investigate the efficacy of group-based interventions for mental health disorders using ACT. Five databases were systematically searched, manual searches were conducted and corresponding authors were contacted. Studies which used a randomised-controlled design, with adult samples and investigated group-based ACT interventions for mental health disorders were included. A meta-analysis of the included studies was conducted for post-intervention and follow-up data. In the empirical study, an ACT manual was trialled using a randomised-controlled design to investigate the efficacy of using ACT in a guided self-help context. Participants with anxiety/depression were randomly assigned to receive either the ACT intervention or treatment as usual (TAU). Those in the ACT group were posted an ACT manual and received two telephone calls. Outcome measures were analysed after the six-week intervention. Results: From the meta-analysis, 18 randomised-controlled trials were identified, 14 of which focussed on anxiety and depression. The findings suggest that ACT-based groups have a large effect on symptom reduction when compared to non-active comparisons at post-treatment and a moderate effect when compared to non-active comparisons at follow-up. Additionally, there was a small effect in favour of ACT when compared to active treatment controls at post-treatment and equivalent effects when comparing ACT to active treatment controls at follow-up. Similar effects were found when separately comparing the 14 studies which focussed primarily on anxiety and depression. The empirical study revealed that guided self-help was found to be no more effective in improving quality of life or reducing psychological distress than the TAU group. However, such results should be interpreted with caution as the small sample size and high attrition rate indicates that further research with larger samples and follow-up are needed before strong conclusions can be made. Conclusions: The findings of this research indicate that group-based ACT interventions may be a suitable alternative delivery format for service providers in the provision of common mental health disorders, particularly anxiety and depression. Further research is needed before any strong conclusions can be made regarding the efficacy of guided self-help for anxiety/depression.

Do superfast broadband and tailored interventions improve use of eHealth and reduce health related travel? Introduction – eHealth has been shown to have promising health outcomes in numerous areas, however many people remain digitally excluded and therefore suffer an inequality in health service provision. Lack of internet infrastructure, personal skills, and service provision have been identified as potential barriers to eHealth but as yet there is no good evidence of the significance of these barriers and the impact of interventions to improve them. This PhD aimed to assess impact on eHealth uptake of three interventions (i) superfast broadband, (ii) a tailored booklet to help participants improve personal internet skills and support, (iii) GP interventions to improve health service provision of eHealth. A subsidiary aim was to assess the impact on miles travelled. Methods - In a cluster quasi-randomised factorial controlled trial, 1388 households from 78 postcodes were sampled in 2013 from the 20088 Cornish postcodes and allocated to the 8 (2X2X2) arms of the study. A unique sampling method was used to prevent contamination between arms. Comparison of ‘eHealth readiness’ and ‘miles travelled’ from baseline to 18-month follow-up between the 8 arms of the study was used to assess the impact of interventions. Interventions were tailored based on responses from the initial baseline survey and designed using aspects of the theory of diffusion of innovations. An overall eHealth Readiness score (0-10) was obtained from a validated self-completed questionnaire combining four sub-scales (Personal, Provision, Support, Economic). The standard deviation of the eHealth Readiness score represents a measure of eHealth inequalities. Findings – No significant differences were shown between each intervention arm of the study, either singly or in combination (all p > .05). eHealth Readiness significantly improved over the 18-month trial period (M=4.36 vs M=4.59, t(235)=4.18 p < .001, CI=0.13-0.35). This increase is evidenced by increases in Personal and Provision scores (t(255)=3.191 p=.002, t(258)=3.410 p=.001). There was no change in eHealth inequality. The proportion of internet users, mobile use and happiness with internet speed also increased. Average travel to GPs did not significantly differ between baseline and follow-up (12.3 vs 13.0, t(251)=.44, p=.66). No correlation was shown between eHealth Readiness and total travel miles to GP practices. Discussion – Individuals within Cornwall became more ready to adopt eHealth services over the 18 months of study, increasing in both their personal ability to use eHealth and their methods of access. This increase did not cause a larger digital divide. However, this increase could not be attributed to any of the three interventions. Further research should focus on making use of the improvement of infrastructure within Cornwall and seek to implement eHealth services. The eHealth readiness of Cornwall should be assessed in a longitudinal study to understand the effects of time of the superfast rollout. Qualitative studies should take place on persons of interest to help design more effective interventions with the aim to achieve a societal drive to sustainable use and adoption of eHealth.  Contribution to knowledge – Previously internet infrastructure has been acknowledged as a barrier to eHealth. This PhD was the first to analyse the impact of a high-speed internet rollout alongside other interventions on eHealth readiness. The methods in this study were unique and provide the basis for further work, both in the creation of a sampling method to reduce contamination between cluster interventions and as the first time a measure of eHealth readiness and eHealth inequality has been used to assess the effectiveness of eHealth interventions.

Providing care for a frail older adult who is suffering from dementia has been described as a stressful experience that may erode psychological well-being and physical health of caregivers. The burden and stress is increased when the caregivers are themselves elderly. The present study investigated an 8-week stress-reduction program, Mindfulness-Based Stress Reduction (MBSR), and compared it to a similarly structured, alternative behavioral intervention, Progressive Muscle Relaxation (PMR), to determine if MBSR was as effective or more effective than PMR at reducing subjective burden, symptoms of depression, perceived loneliness or perceived stress among middle-aged and older family caregivers of persons with dementia and other neurocognitive disorders. Twenty-eight participants were randomly assigned to either MBSR or PMR. Self-report and biological measures were collected on five occasions: At the beginning and end of intervention training, and at 8 weeks, 6 months and 1 year following the end of intervention training. In addition to a packet of self-report questionnaires and home-collected salivary cortisol, a laboratory controlled emotional stress test was designed to elicit an emotionally stressful response relevant to caregivers’ experience of caregiving, and facilitate the measurement of stress-related changes in systolic blood pressure and cortisol reactivity. At 1 year post-intervention, the PMR group showed a significantly greater reduction in perceived stress and disruptive patient behaviors. A reduction in emotional reactivity to patient problem behaviors approached significance (p = .08) at 1 year post-intervention for the PMR group. The MBSR group showed significantly greater reductions in self-reported symptoms of depression and perceived isolation from pre- to post-intervention, and those changes remained significant at 8 weeks post-intervention. However, by 1 year post-intervention, interaction effects were non-significant as both groups showed similar decreases in symptoms of depression and perceived isolation. Both groups showed similar decreases in diurnal cortisol, cortisol awakening response, and daily average cortisol (but not laboratory cortisol) from pre- to post-intervention and further decreases at 8 weeks post-intervention, and showed similar reductions in magnitude of change by 1 year post-intervention. This pattern was similar for both groups with systolic blood pressure, showing decreases from pre- to post-intervention, additional decreases at 8 weeks post-intervention, and returning towards baseline by 1 year post-intervention. Both groups also reported similar increases in levels of dispositional mindfulness and self-compassion and similar improvement in overall sleep quality that was sustained at 1 year post-intervention. No changes were seen for perceived burden or loneliness. Significant correlations with amount of daily practice of the instructed stress-reduction approaches were observed for several of the dependent measures from pre- to post-intervention and 8 weeks post-intervention. From pre-intervention to 1 year post-intervention, an overall pattern emerged, where both groups showed similar improvements from pre- to post-intervention, and additional improvements at 8 weeks post-intervention, but displayed a curvilinear reduction in improvements—with some exceptions—and a return towards baseline at 6 months and 1 year post-intervention. In general, reductions in the magnitude of changes observed by 1 year post-intervention remained below baseline levels. Results suggest that both MBSR and relaxation-based interventions may be differentially effective in reducing psychological and physiological indices of chronic stress among older caregivers of relatives with neurocognitive disorders. However, further research, employing wait-list control participants, will be necessary for unambiguous interpretation of the present results.

Please read the abstract in the dissertation. Copyright / Dissertation (MEng)--University of Pretoria, 2010. / Chemical Engineering / unrestricted

Bakgrund: Akupunktur är en gammal behandlingsmetod, beräknad ungefär 4100 år gammal och kommer från Kina. Elektroakupunktur är en något nyare behandlingsmetod där man för ström mellan nålarna. Denna behandlingsmetod används främst av fysioterapeuter. Behandlingarna som fysioterapeuten utför kräver ett vetenskapligt stöd, därför finns ett behov att granska den litteratur som behandlingsmetoden grundas på. Inom forskning och verksamhet använder man olika namn för denna metod, både “electroacupuncture” och “percutaneouselectricalnervestimulation” (PENS). Ryggsmärta är ett vanligt problem bland världens befolkning, det är beräknat att upptill 70% av befolkningen kommer någon gång i sitt liv uppleva ryggssmärta. Det är även beräknat att vara den vanligaste smärtförekomsten. Om elektroakupunktur fungerar mot ländryggssmärta kan terapeuter använda denna behandlingsmetod. Syfte: Syftet med denna studie var att undersöka vilket vetenskapligt stöd det finns för elektroakupunktur som behandlingsmetod vid ländryggssmärta. Metod: En systematisk sökning utfördes i databaserna CinAHL, PubMed, PEDro, Scopus och Web of Science angående elektroakupunktur och ländryggssmärta. Sökorden som användes var “electroacupuncture”, “lowback pain ”, “percuteaneous electricalnervestimulation” och “randomized controlled trial”. Resultat: Sammanlagt 15 RCT – studier inkluderades i denna studie. Sammanlagt 11 av 15 studier fann signifikanta skillnader i resultat. 8 studier behandlade kronisk ländryggssmärta, 4 behandlade diskogena besvär och resterande 3 behandlade andra ryggdiagnoser. Elektroakupunktur har visat ge en smärtlindring vid ländryggssmärta. Konklusion: Samtliga inkluderade studier fann smärtlindring av behandlingen, dock visade inte alla signifikanta skillnader. Det finns även metodologiska brister i den befintliga litteraturen vilket innebär att bör se resultaten kritiskt. Mer forskning inom området behövs.