http://nova.newcastle.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:246 Background. The study aimed to (1) determine the current routine smoking care that smoke-free public hospitals in New South Wales (NSW), Australia, provide to inpatients who are smokers; (2) determine current strategies supporting such care; and (3) examine the association between smoking care provision and hospital characteristics and support strategies. Method. A cross-sectional survey of 169 senior hospital managers was undertaken. Survey items included smoking care practices such as identification of smoking status and provision of nicotine replacement therapy as well as hospital activities such as existence of policies and staff training. Hospital characteristics such as size and geographic location were also collected. Results. Twenty percent of respondents reported provision of minimally 'adequate' smoking care, defined as providing five or more smoking care items to 80% or more of patients. Larger hospitals were significantly less likely to provide adequate smoking care. Nurse training, the existence of signs indicating a smoke-free site and signs indicating location of designated smoking areas were also associated with smoking care provision. The existence of three or more support strategies was associated with smoking care provision. Conclusion. Even in the context of a smoke-free hospital site, the majority of inpatients who are smokers receive inadequate smoking care. Considered investment is required for hospitals to implement strategies to institutionalise the routine provision of appropriate smoking care. (c) 2004 Elsevier Inc. All rights reserved. 2012-03-26T01:01:18.936Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10433 Background: Inadequate fruit and vegetable consumption in childhood increases the risk of developing chronic disease. Despite this, a substantial proportion of children in developed nations, including Australia, do not consume sufficient quantities of fruits and vegetables. Parents are influential in the development of dietary habits of young children but often lack the necessary knowledge and skills to promote healthy eating in their children. The aim of this study is to assess the efficacy of a telephone-based intervention for parents to increase the fruit and vegetable consumption of their 3- to 5-year-old children. Methods/Design: The study, conducted in the Hunter region of New South Wales, Australia, employs a cluster randomised controlled trial design. Two hundred parents from 15 randomly selected preschools will be randomised to receive the intervention, which consists of print resources and four weekly 30-minute telephone support calls delivered by trained telephone interviewers. The calls will assist parents to increase the availability and accessibility of fruit and vegetables in the home, create supportive family eating routines and role-model fruit and vegetable consumption. A further two hundred parents will be randomly allocated to the control group and will receive printed nutrition information only. The primary outcome of the trial will be the change in the child's consumption of fruit and vegetables as measured by the fruit and vegetable subscale of the Children's Dietary Questionnaire. Pre-intervention and post-intervention parent surveys will be administered over the telephone. Baseline surveys will occur one to two weeks prior to intervention delivery, with follow-up data collection calls occurring two, six, 12 and 18 months following baseline data collection. Discussion: If effective, this telephone-based intervention may represent a promising public health strategy to increase fruit and vegetable consumption in childhood and reduce the risk of subsequent chronic disease. Trial registration: Australian Clinical Trials Registry ACTRN12609000820202. 2012-03-19T04:10:11.372Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6993 Levels of hospital smoking cessation care are less than optimal. This study aimed to synthesize the evidence regarding the effectiveness of interventions in increasing smoking cessation care provision in hospitals. A review identified relevant studies published between 1994 and 2006. A description of studies, including methodological quality, was undertaken. Intervention effectiveness in increasing smoking cessation care practices was examined for controlled studies using meta-analysis. Care practices examined were assessment of smoking status; advice to quit; counseling or assistance to quit; advising, offering, or providing nicotine replacement therapy (NRT); and follow-up or referral. Of the 25 identified studies, 18 were U.S. based and in inpatient settings. Of the 10 controlled trials, 4 addressed cardiac patients, 5 measured one smoking cessation care practice, and 9 implemented multistrategic interventions (e.g., combining educational meetings with reminders and written resources). The methodology described in these studies was generally of poor quality. Meta-analysis of controlled trials demonstrated a significant intervention effect for provision of assistance and counseling to quit (pooled risk difference = 16.6, CI = 4.9–28.3) but not for assessment of smoking status, advice to quit, or the provision or discussion of NRT. Statistical heterogeneity was indicated for all smoking cessation care practices. An insufficient number of studies precluded the use of meta-analysis for follow-up or referral for further assistance. Interventions can be effective in increasing the routine provision of hospital smoking cessation care. Future research should use more rigorous study design, examine a broader range of smoking cessation care practices, and focus on hospital-wide intervention implementation. 2012-01-30T05:04:18.959Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6994 Aims, design and intervention: Smoking care provision to in-patients is important in assisting smoking cessation and for management of nicotine withdrawal. Limited studies have reported the effectiveness of interventions designed to increase the hospital-wide provision of such care. A quasi-experimental matched-pair trial, involving two intervention and two control hospitals in NSW, Australia, investigated whether a multi-strategic intervention increased hospital-wide smoking care provision. Participants and measurements: Patient surveys (n = 274-347 per experimental condition), medical notes audits (n = 181-228) and health professional surveys (n = 229-302) were used to collect outcome data at baseline and follow-up. Findings: Significantly greater increases in intervention hospitals compared to control hospitals were found for patient-reported offer of nicotine replacement therapy (NRT) (intervention 34% versus control 12%), provision of NRT (16% versus 4%) and provision of written resources (11% versus 2%), and for the recording in medical notes of smoking management discussion (13% versus 3%), offer of NRT (24% versus 3%) and provision of NRT (21% versus 5%). Intervention group health professionals reported significantly greater increases in the mean estimate of patients who: had their smoking management discussed (30% versus 17%); were offered or provided with NRT (30% versus 18%); were asked their intention to smoke post-discharge (22% versus 10%); and were provided with discharge NRT (21% versus 4%). Conclusions Implementation of a multi-strategic intervention is effective in increasing hospital smoking care delivery, particularly the provision of NRT. Research is required to identify methods to increase further the delivery of this and other forms of smoking care. 2012-01-30T05:04:18.699Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8283 Issue addressed: To describe the demographic and health-related characteristics (physical activity, self-reported health status, quality of life and falls history) of older people who enrol in a team-based game, Lifeball, and examine associations between continuation and participant characteristics. Reasons for stopping, participants' perceptions of the game and changes in health-related characteristics over 12 months were examined. Methods: Telephone surveys were conducted with a cohort of Lifeball players at: baseline, soon after commencing playing and 12 months later. Results: At baseline, participants were aged 40 to 96 years (mean 67). Most were female (84%), in good to excellent health (86%) and reported being sufficiently (> 150 minutes per week) physically active (69%). Almost half (43%) were still playing 12 months later (continuers). Continuers were more likely to perceive Lifeball had helped them to: feel fitter and healthier (91%); improve their social life (73%); and be more active (53%). No significant changes in continuers' physical activity, self-reported health status and quality of life measures were reported. The main reason for stopping playing was illness/injury unrelated to Lifeball. Conclusions: Lifeball mainly appealed to healthy, active older people. 2011-07-18T02:20:16.607Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8113 The provision of smoking cessation care to surgical patients before admission can reduce post-operative complications and encourage long-term smoking cessation. Our aim was to show how a comprehensive computer-based smoking cessation intervention, developed to enhance smoking cessation care to surgical patients, addresses barriers to care provision. Consultations with preoperative clinic staff and reviews of the scientific literature were conducted and identified the following barriers to the provision of effective smoking cessation care: a lack of organisational support, perceived patient objection, a lack of systems to identify smokers, a lack of staff time and skill, perceived inability to change care practices, a perceived lack of efficacy of cessation care and the cost of providing care. Based on positive findings of a pilot trial, a comprehensive computer-based smoking cessation intervention was implemented in a preoperative clinic. Data from previous evaluations of the intervention were used to assess the extent to which the intervention addressed clinician barriers to care. The computer-based intervention was found to provide a means to accurately and systematically identify smokers; it required little clinical staff time or skill; it was considered an acceptable form of care by staff and patients; it was effective in encouraging patient cessation and it was inexpensive to deliver relative to other surgical costs. Furthermore, the computer-based intervention continues to operate in the preoperative clinic in the absence of ongoing research support. The implementation of such a model of care should be considered by clinical services interested in reducing the smoking related morbidity and mortality of patients. 2011-07-06T02:10:06.739Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7234 Increasing physical activity amongst seniors is important for public health, yet guidance is needed to minimise injury risks. To describe the incidence of falls/injuries in a walking team ball game(Lifeball) designed for seniors, a prospective cohort study was undertaken amongst community dwelling Lifeball participants in Australia. Players completed a telephone survey soon after commencing Lifeball (2004) and 12 months later (2005). Attendance and incident records were audited for the period. Subjects joined a Lifeball group with opportunity to play at least once per week. Baseline was completed by 284 players aged between 40 and 96 years (mean 67 years), with most (83.8%, 238/284) female. Of 263 followed up, the average attendances was 25, with 19.3% attending on fewer than 4 occasions and 14.3% attending 52 or more times. Most (93.9%) reported no injuries requiring medical attention. However, 16 (6.1%) had injuries requiring medical attention and their 27 injuries represent an injury rate of 3.3 per 1000 hours of participation. Twenty participants (7.6%) had a Lifeball fall equating to a fall rate of 2.8 per 1000 hours of participation. Falls in Lifeball were not associated with measured predictors (age, gender, falls history, perceived falls risk or hours played). Incident records showed a trip/stumble involving rushing, walking backwards, or overextending (all against rules) as common falling causes. Lifeball is not ‘risk free’ however due to a lack of comparative data it is difficult to compare injury rate to relevant activities. Prevention of injury should concentrate on enforcing safety rules. 2011-02-21T04:00:18.989Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1604 Background. Evidence suggests that preoperative clinics, like other hospital outpatient clinics and inpatient wards, fail to systematically provide smoking cessation care to patients having planned surgery. Methods. The aim of the study was to assess the efficacy, acceptability, and cost of a multifaceted intervention to facilitate the provision of comprehensive smoking cessation care to patients attending a preoperative clinic. Two hundred ten smoking patients attending a preoperative clinic at a major teaching hospital in Australia took part in the study. One hundred twenty-four patients were randomly assigned to an experimental group and 86 patients to a usual cessation care group. A multifaceted intervention was developed that included the use of opinion leaders, consensus processes, computer-delivered cessation care, computer-generated prompts for care provision by clinic staff, staff training, and performance feedback. Results. Ninety-six percent of experimental group patients received behavioral counseling and tailored self-help material. Experimental group patients were significantly more likely than usual care patients to report receiving brief advice by nursing (79% vs. 47%; P b 0.01) and anaesthetic (60% vs. 39%; P b 0.01) staff. Experimental group patients who were nicotine dependent were also more likely to be offered preoperative nicotine replacement therapy (NRT) (82% vs. 8%; P b 0.01) and be prescribed postoperative NRT (86% vs. 0%; P b 0.01). The multifaceted intervention was found to be acceptable by staff. Conclusion. A multifaceted clinical practice change intervention may be effective in improving the delivery of smoking cessation care to preoperative surgical patients. 2010-04-27T06:28:55.752Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1566 Background: The study aimed to (1) determine the current routine smoking care that smoke-free public hospitals in New South Wales (NSW), Australia, provide to inpatients who are smokers; (2) determine current strategies supporting such care; and (3) examine the association between smoking care provision and hospital characteristics and support strategies. Method: A cross-sectional survey of 169 senior hospital managers was undertaken. Survey items included smoking care practices such as identification of smoking status and provision of nicotine replacement therapy as well as hospital activities such as existence of policies and staff training. Hospital characteristics such as size and geographic location were also collected. Results: Twenty percent of respondents reported provision of minimally ‘adequate’ smoking care, defined as providing five or more smoking care items to 80% or more of patients. Larger hospitals were significantly less likely to provide adequate smoking care. Nurse training, the existence of signs indicating a smoke-free site and signs indicating location of designated smoking areas were also associated with smoking care provision. The existence of three or more support strategies was associated with smoking care provision. Conclusion: Even in the context of a smoke-free hospital site, the majority of inpatients who are smokers receive inadequate smoking care. Considered investment is required for hospitals to implement strategies to institutionalise the routine provision of appropriate smoking care. 2010-04-27T06:27:56.520Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:633 Background. Evidence suggests that preoperative clinics, like other hospital outpatient clinics and inpatient wards, fail to systematically provide smoking cessation care to patients having planned surgery. Methods. The aim of the study was to assess the efficacy, acceptability, and cost of a multifaceted intervention to facilitate the provision of comprehensive smoking cessation care to patients attending a preoperative clinic. Two hundred ten smoking patients attending a preoperative clinic at a major teaching hospital in Australia took part in the study. One hundred twenty-four patients were randomly assigned to an experimental group and 86 patients to a usual cessation care group. A multifaceted intervention was developed that included the use of opinion leaders, consensus processes, computer-delivered cessation care, computer-generated prompts for care provision by clinic staff, staff training, and performance feedback. Results. Ninety-six percent of experimental group patients received behavioral counseling and tailored self-help material. Experimental group patients were significantly more likely than usual care patients to report receiving brief advice by nursing (79% vs. 47%; P < 0.01) and anaesthetic (60% vs. 39%; P < 0.01) staff. Experimental group patients who were nicotine dependent were also more likely to be offered preoperative nicotine replacement therapy (NRT) (82% vs. 8%; P < 0.01) and be prescribed postoperative NRT (86% vs. 0%; P < 0.01). The multifaceted intervention was found to be acceptable by staff. Conclusion. A multifaceted clinical practice change intervention may be effective in improving the delivery of smoking cessation care to preoperative surgical patients. 2010-04-27T05:37:53.752Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:634 We assessed the efficacy of a comprehensive programme for stopping smoking in 210 smokers scheduled for surgery, before admission and 3 months after attending a pre-operative clinic. Participants were randomly allocated to receive an intervention incorporating nicotine replacement therapy for patients smoking more than 10 cigarettes per day ('dependent smokers'), or to a control group to receive usual care. Dependent smokers allocated to the intervention group were more likely to report abstinence before surgery than those allocated to receive usual-care (63 (73%) vs. 29 (56%), respectively; OR 2.2 (95% CI 1.0-4.8)), and 3 months after attendance (16 (18%) vs. 3 (5%), respectively; OR = 3.9 (95% CI 1.0-21.7). 2010-04-27T05:37:50.382Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4693 The aim of the study was to assess the feasibility, acceptability, and cost of referral of smoking patients to a proactive quitline service for postdischarge cessation support. Participants were recruited from the preoperative clinic of an Australian hospital. Data were collected from project records and a telephone interview with participants 6 months after attending the preoperative clinic. The study found that 64% of the 67 participants accepted an offer of referral to the quitline by preoperative clinic staff. Some 74% of patients referred to the quitline were contacted by the quitline after discharge. Smokers contacted by the quitline and clinic staff referring patients to the quitline generally responded favorably on items assessing the acceptability of the quitline service and the process of referral to the quitline. Referral to the quitline service cost less than US$2 per patient. Referral of patients to a quitline is feasible, was generally considered acceptable by surgical patients and staff, and was inexpensive. 2010-04-27T05:12:25.751Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4477 Issue addressed: The study sought to assess the potential efficacy of a comprehensive smoking cessation intervention for surgical patients. Methods: The study employed a modified historical controlled trial design. Participants were recruited from a preoperative clinic of an Australian hospital in 2003. Patients allocated to the experimental group received a comprehensive smoking cessation intervention incorporating preoperative computerised smoking cessation counselling, tailored self-help material, brief advice from preoperative clinical staff, NRT, telephone counselling, and proactive post-discharge telephone support from a Quitline. Results: At the six month follow-up 12% of 66 usual care control group participants and 25% of 52 experimental group participants reported being abstinent (p=0.07). Conclusions: Comprehensive smoking cessation interventions initiated preoperatively and incorporating post-discharge support from a Quitline may be efficacious in increasing smoking abstinence. 2010-04-27T05:09:46.619Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4924 Hospitals are key settings for the provision of smoking cessation care. Limited data are available that describe the prevalence and type of such care delivered routinely in this setting. We reviewed studies conducted in hospitals and published between 1994 and 2005 that reported levels of smoking care delivery. This review describes the proportion of patients receiving, and the proportion of health professionals providing, various smoking cessation care practices. We used both descriptive and meta-analytic methods. According to the meta-analysis, smoking status was assessed in 60% of patients, 42% were advised or counseled to quit, 14% were provided with or advised to use nicotine replacement therapy (NRT), and 12% received referrals or follow-up. Significantly fewer patients received follow-up or referrals than were assessed for smoking status or received advice or counseling to quit. Some 81% of health professionals reported they assessed smoking status, 70% advised or counseled patients to quit, 13% provided NRT or advised its use, and 39% provided referrals or follow-up. Significantly fewer health professionals advised or prescribed NRT than assessed smoking status or advised or counseled patients to quit. Statistical heterogeneity was indicated for all smoking care practices. Levels of smoking cessation care are less than optimal in hospitals, and the levels of some important care practices are particularly low. Future research should identify effective methods for increasing smoking care provision in this setting. In addition, standardized measures of smoking care should be developed. Hospital organizations should enhance and continue to monitor their delivery of smoking care. 2010-04-27T05:09:23.490Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5427 Background: If public health research does not progress beyond descriptive research to testing the effectiveness of interventions that can provide causal data, its contribution to evidence-based practice will not be realized. This paper examined the number and percentage of public health research publications over three time periods (1987–1988, 1997–1998, 2005–2006) for three preventive health issues: tobacco use, alcohol use, and inadequate physical activity. Methods: A computer-based literature search was conducted, using the Medline and PsycINFO databases. A random sample of 1000 abstracts for each preventive health issue was examined per time period. The abstracts were first categorized as public health or not, and then as data-based or non–data-based public health research. Data-based publications were classified according to research type as measurement-, descriptive/epidemiologic-, or intervention-oriented. Data analysis occurred in 2007. Results: The number of data-based public health research publications examined for each topic ranged between 180 and 346 in 1987–1988, 199 and 322 in 1997–1998, and 302 and 364 in 2005–2006. Despite a significant increase over time in the percentage of intervention publications for tobacco (from 10% in 1987–1988 to 18% in 2005–2006, p=0.008), the majority of publications in all three time periods were descriptive/epidemiologic for all topics (62%–87% in 1987–1988, 64%–85% in 1997–1998, 78%–79% in 2005–2006). There were fewer measurement (3%–7% in 1987–1988, 2%–6% in 1997–1998, 4%–10% in 2005–2006) or intervention publications (9%–31% in 1987–1988, 10%–30% in 1997–1998, 12%–18% in 2005–2006). Conclusions: Descriptive research does not provide optimal evidence for how to reduce preventable illness. Reasons for the lack of measurement and intervention public health research are explored. 2010-04-27T04:48:40.906Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5179 The provision of smoking care, including the management of nicotine withdrawal and assistance with a quitting attempt, is identified as an important part of the overall care of hospitalised patients. Levels of smoking care delivery in hospitals have been less than optimal. Increasing this care across multiple facilities and units within NSW Health represents a significant challenge. This article examines levels of smoking care delivery in NSW hospitals, and research evidence and best practice recommendations to inform potential strategies to increase such care. It also reviews statewide initiatives implemented by NSW Health to enhance the delivery of smoking care and suggests further strategies that could facilitate this. 2010-04-27T04:46:38.431Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5068 Objective: The study aimed to critically appraise the extent and strength of systematic review evidence for, and guideline recommendations regarding hospital smoking cessation interventions. Methods: Systematic reviews of smoking cessation interventions were identified via an electronic search of the Cochrane Library. Metaanalyses from Cochrane reviews were categorised as those that incorporated only studies of hospital based interventions, and those which incorporated interventions which were not hospital based. Smoking cessation guidelines for hospital health professionals were identified via a search of the World Wide Web. Results: The review found that evidence from meta-analyses restricted to hospital studies was insufficient to evaluate a number of specific intervention strategies and at times conflicted with the findings of meta-analyses without such restrictions. The majority of guidelines recommended the provision of brief advice, counseling, nicotine replacement therapy despite the absence of clear supporting evidence. Conclusions: Further hospital-based research addressing specific cessation strategies is required. Furthermore, smoking cessation guidelines for hospital based health professionals should more specifically reflect evidence from this setting. 2010-04-27T04:34:59.579Z ]]>