Effectiveness of two tobacco cessation methods among TB patients

BACKGROUND: Tobacco and TB are the world´s two greatest public health problems. Exposure to tobacco has been shown to be associated with higher risk of acquiring TB and adverse outcomes such as relapse and TB mortality.OBJECTIVE: To assess and compare self-reported tobacco quit status and biochemically verified cotinine levels among TB patients at different time intervals among two study groups.METHODS: A cluster, randomised controlled trial was conducted on TB patients attending DOTS centres in Delhi, India, who reported using tobacco in any form. Participants were assigned into one of two treatment groups. Centres were randomly assigned to two intervention groups: 1) integrated intervention using behavioural counselling with nicotine replacement therapy (NRT) gum, and 2) intervention using behavioural counselling alone (50 each in intervention and control group). The subjects were followed at Week 1, Month 1, Month 3 and Month 6 for tobacco cessation.RESULTS: At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting tobacco than those who received the conventional TB treatment alone (78.7% vs. 57.8%; P < 0.03).CONCLUSION: DOTS with tobacco use dependence treatment was successful in our study in helping TB patients to quit tobacco dependence and should therefore be offered to every tobacco user.

Multilevel Determinants of Integrated Service Delivery for Intimate Partner Violence and Mental Health in Humanitarian Settings

Inter-agency guidelines recommend that survivors of intimate partner violence in humanitarian settings receive multisectoral services consistent with a survivor-centered approach. Providing integrated services across sectors is challenging, and aspirations often fall short in practice. In this study, we explore factors that influence the implementation of a multisectoral, integrated intervention intended to reduce psychological distress and intimate partner violence in Nyarugusu Refugee Camp, Tanzania. We analyzed data from a desk review of donor, legal, and policy documents; a gender-based violence services mapping conducted through 15 interviews and 6 focus group discussions; and a qualitative process evaluation with 29 stakeholders involved in the implementation of the integrated psychosocial program. We identified the challenges of implementing a multisectoral, integrated intervention for refugee survivors of intimate partner violence at the structural, inter-institutional, intra-institutional, and in social and interpersonal levels. Key determinants of successful implementation included the legal context, financing, inter-agency coordination, engagement and ownership, and the ability to manage competing priorities. Implementing a multisectoral, integrated response for survivors of intimate partner violence is complex and influenced by interrelated factors from policy and financing to institutional and stakeholder engagement. Further investment in identifying strategies to overcome the existing challenges of implementing multisectoral approaches that align with global guidelines is needed to effectively address the burden of intimate partner violence in humanitarian settings.

Environmental and Economic Impact of Retrofitting Techniques to Prevent Out-of-Plane Failure Modes of Unreinforced Masonry Buildings

This paper presents an innovative methodology to assess the economic and environmental impact of integrated interventions, namely solutions that improve both structural and energy performance of existing masonry buildings, preventing out-of-plane modes and increasing their energy efficiency. The procedure allows the assessment of the environmental and the economic normalized costs of each integrated intervention, considering seismic and energy-saving indicators. In addition, the work introduces in relative or absolute terms two original indicators, associated with seismic displacement and thermal transmittance. The iso-cost curves so derived are thus a powerful tool to compare alternative solutions, aiming to identify the most advantageous one. In fact, iso-cost curves can be used with a twofold objective: to determine the optimal integrated intervention associated with a given economic/environmental impact, or, as an alternative, to derive the pairs of seismic and energy performance indicators associated with a given budget. The analysis of a somehow relevant case study reveals that small energy savings could imply excessive environmental impacts, disproportionally increasing the carbon footprint characterizing each intervention. Iso-cost curves in terms of absolute indicators are more suitable for assessing the effects of varying acceleration demands on a given building, while iso-cost curves in terms of relative indicators are more readable to consider a plurality of cases, located in different sites. The promising results confirm the effectiveness of the proposed method, stimulating further studies.

An Integrated Approach to Improve Seismic and Energetic Behaviour of RC Framed Buildings Using Timber Panels

In the present paper, an integrated intervention system applicable to concrete-framed buildings is presented. The purpose of the intervention is to improve both the seismic and the energetic behaviour of such buildings using cross-laminated timber (CLT) panels. Two alternative intervention configurations with different levels of invasiveness are described. Considering a double-wythe masonry-infilled frame, the most invasive configuration consists in the replacement of the external masonry wythe with the CLT panel, while the least invasive configuration consists in the arrangement of the CLT panel from the outside without removing the wythes. The technical details and implementation procedures were studied, considering functionality and disturbance to occupants. An isolated one-storey-one-bay frame was used as a reference for the seismic and thermal analyses. Subsequently, the two intervention configurations were applied to a case-study building by identifying two alternative intervention strategies. The obtained results showed that the proposed integrated intervention approach can significantly reduce both the seismic vulnerability and the energy consumption of concrete buildings.

Evaluation of an integrated intervention to reduce psychological distress and intimate partner violence in refugees: Results from the Nguvu cluster randomized feasibility trial

Introduction The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu). Methods We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women’s groups that were randomized to the Nguvu intervention or usual care. Participants from women’s groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in refugee contexts. Results We found that Nguvu was relevant to the needs of refugee women affected by intimate partner violence. We found reductions in some indicators of psychological distress, but did not identify sizeable changes in partner violence over time. Overall, we found that Nguvu was acceptable and feasible. However, challenges to the research protocol included baseline imbalances between study conditions, differential intervention completion related to intimate partner violence histories, differences between Nguvu groups and facilitators, and some indication that Nguvu may be less beneficial for participants with more severe intimate partner violence profiles. Conclusions We found evidence supporting the relevance of Nguvu to refugee women affected by partner violence and psychological distress and moderate evidence supporting the acceptability and feasibility of evaluating and implementing this intervention in a complex refugee setting. A definitive cluster randomized trial requires further adaptations for recruitment and eligibility screening, randomization, and retention. Trial registration ISRCTN65771265, June 27, 2016.

A conceptual analysis of the meaning of comfort at the end-of-life using the Walker and Avant (2014) Framework

Objective The aim of the authors is to clarify the concept of comfort at the end-of-life in order to support understandings of fundamental nursing care needed at this stage of healthcare. Methods The Walker and Avant framework was applied to develop a deeper understanding of the concept of comfort at the end of life. Results Five defining attributes of comfort in the end-of-life were identified and they are having a peaceful home-life environment, trust and consolation, proximity and social-cultural support, alleviation of suffering, and a process of integrated intervention by nurses. Conclusions At the end-of-life patients commonly experience physical, psychological, social-cultural, and environmental discomfort. Patients’ families also encounter significant challenges. However, their comfort needs are often secondary to that of the patient. Additionally, a lack of clarity exists regarding the holistic meaning of comfort at the end-of-life, which can largely be confined to understandings of physical comfort for the patient, with a limited understanding of addressing family/caregivers’ needs. Therefore, this concept analysis may provide some guidance in this regard and also provides support toward a more integrated understanding of the concept.

Sustainability of integrated anaemia prevention activities implemented through non-government organizations and schools, and its effect on haemoglobin status of adolescent girls in urban slums of Pune, in Maharashtra, India

Background: Programmes for the prevention of iron deficiency anaemia among adolescent girls need sustainable inputs for maximum benefits. Aim: To assess the interventions sustained for anaemia prevention implemented through NGOs and schools. Methods: An intervention study followed longitudinally in three phases. Phase I comprised (a) needs assessment of the community and (b) capacity assessment of service providers through a cross-sectional survey in nine slums, through six NGOs and three schools. Based on needs assessment, an integrated intervention for anaemia prevention was provided for adolescent girls ( n = 384) in the community. To ensure sustainability the capacity of stakeholders ( n = 67) was built by providing training in the components of the integrated intervention and establishing linkages with the public health system. Refresher training was conducted during phase II ( n = 69) for reinforcing and strengthening of activities introduced in phase I. In phase II and III continuations of activities by the NGOs and schools that were initiated in phase I were monitored. Sustainability of activities was measured using an index that comprised technical, programmatic, social, and financial indicators. The impact of sustained interventions was assessed by comparing the mean rank haemoglobin concentrations of centres with varying levels of coverage. Results: Scores of sustainability indicators decreased from phase II to phase III. Organizations that showed > 50% coverage showed significantly higher mean rank haemoglobin ( p = < 0.05) during phases II and III. Conclusion: There is a need to identify and address barriers that prevent sustainable interventions for anaemia control.

Effects of an integrated intervention program for alcoholism (IIPA) on learning, memory and quality of life (QOL) in persons with alcohol dependence at the Centre for Addiction Medicine, Bengaluru, India

PurposeThis study aims to examine the effectiveness of an integrated intervention program for alcoholism (IIPA) for improving verbal encoding and memory, visuospatial construction, visual memory and quality of life (QoL) in persons with alcohol dependence.Design/methodology/approachThe sample comprised treatment-seeking alcohol-dependent persons (n = 50), allotted into two groups: (1) the treatment as usual (TAU) group (n = 25) and (2) the treatment group (n = 25)]. The groups were matched on age (±1 year) and education (±1 year). The TAU group received standard pharmacological treatment, psychotherapeutic sessions on relapse prevention and yoga for 18 days, while the treatment group received IIPA sessions in addition to the usual treatment. Auditory verbal learning test, complex figure test and QoL scale were administered at pre- and post-treatment along with screening measures.FindingsThe two groups were comparable on demographic variables, clinical characteristics and outcome measures at baseline. Pre- to post-treatment changes (gain scores) comparison between the treatment and TAU groups revealed a significant difference in verbal encoding, verbal and visual memory, verbal recognition, visuospatial construction and QoL.Research limitations/implicationsThis study suggests that IIPA is effective for improving learning and memory in both modality (verbal and visual) and QoL in persons with alcoholism. The IIPA may help in better treatment recovery.Practical implicationsThe IIPA may help in treatment for alcoholism and may enhance treatment efficacy.Originality/valueIIPA is effective for improving learning and memory in both modalities and QoL in persons with alcohol dependence. The IIPA may help in better treatment recovery.