DVD training for depression identification and treatment in older adults: a two-group, randomized, wait-list control study.

OBJECTIVE. To test the effectiveness of an educational intervention aimed at improving mental health knowledge and skills in occupational therapists working with older rehabilitation patients. METHOD. The DVD-format educational intervention was evaluated using a two-group randomized wait-list control design. Occupational therapists (n = 75) completed a 32-item knowledge questionnaire at three time points. Patient charts were reviewed (n = 960) at 3 months before and 3 and 6 months after DVD training to evaluate clinical practice change. RESULTS. A two-way analysis of variance showed knowledge scores increased significantly for both groups after DVD training. A significant Group × Time interaction and significant main effects for time and group were found. Chart review data also showed significant increases in desired clinical behaviors in both groups after training. The greatest single item of clinical practice change was use of a standardized depression screen. CONCLUSION. DVD-based training can significantly improve mental health practice.

An asset-based community initiative to reduce television viewing in New York state.

BACKGROUND: Childhood obesity is an epidemic. Addressing this problem will require the input of many sectors and change in many behaviors. The "community" must be part of the solution, and the solution must be constructed on existing assets that lend strength to positive environmental change. OBJECTIVE: To catalyze an established asset-based community partnership to support efforts to reduce television viewing time by developing and providing alternative activities as part of a broader, 3-year study to reduce childhood obesity among preschool-aged children in rural, upstate New York. METHOD: Asset mapping was utilized to compile an inventory of individual and community strengths upon which a partnership could be established. Facilitated focus group sessions were conducted to better understand childcare environmental policies and practices, and to guide changes conducive to health and fitness. Planning meetings and targeted outreach brought key stakeholders together for a community-participatory initiative to support positive environmental change. RESULTS.: The partnership planned and initiated an array of after-school and weekend community activities for preschool-aged children and their families in the weeks preceding, during, and following a designated 'TV Turn-off' week in April, 2004 and March, 2005. CONCLUSION: Methods of asset-based community development are an effective way to engage community participation in public health initiatives.

Incidence and distribution of lower extremity deep vein thrombosis in rehabilitation patients: implications for screening.

Patients admitted to in-patient rehabilitation programs have an increased risk for developing deep venous thrombosis (DVT). However, the utility of screening for lower extremity DVT using duplex ultrasound in this high-risk population is not well characterized. The purpose of this study is to identify whether or not screening lower-extremity duplex exams are indicated in this high-risk population. Screening lower extremity duplex exams were performed on all patients admitted to the rehabilitation center at Mt. Sinai Hospital over a 3-year period. Charts were reviewed for patient age, gender, diagnosis, date of screening and follow-up duplex exams, presence and location of venous thrombosis at each duplex exam, history of anticoagulation, and medical DVT prophylaxis. The presence of DVT at screening, the location of DVT along the lower extremity, and the outcome of calf DVT were analyzed in terms of gender, underlying diagnosis, and history of DVT prophylaxis. Lower extremity DVT was detected in 34% of patients. Twenty-three percent of patients had isolated calf vein thrombosis. Men were more likely than women to have DVT. Calf DVTs progressed in 3% of patients over an average follow-up of 2 weeks. The presence of DVT, its location along the lower extremity, and the outcome of calf vein DVT had no significant relationship to underlying diagnosis or history of prophylaxis. Screening duplex exams to detect lower extremity DVT in rehabilitation patients is useful. Screening altered management in 26% of patients, prompting either anticoagulation or repeat duplex exam.

An intervention to reduce television viewing by preschool children.

BACKGROUND: Television viewing has been associated with increased violence in play and higher rates of obesity. Although there are interventions to reduce television viewing by school-aged children, there are none for younger children. OBJECTIVE: To develop and evaluate an intervention to reduce television viewing by preschool children. DESIGN: Randomized controlled trial conducted in 16 preschool and/or day care centers in rural upstate New York. PATIENTS: Children aged 2.6 through 5.5 years. INTERVENTION: Children attending intervention centers received a 7-session program designed to reduce television viewing as part of a health promotion curriculum, whereas children attending the control centers received a safety and injury prevention program. OUTCOME MEASUREMENTS: Change in parent-reported child television/video viewing and measured growth variables. RESULTS: Before the intervention, the intervention and control groups viewed 11.9 and 14.0 h/wk of television/videos, respectively. Afterward, children in the intervention group decreased their television/video viewing 3.1 h/wk, whereas children in the control group increased their viewing by 1.6 h/wk, for an adjusted difference between the groups of -4.7 h/wk (95% confidence interval, -8.4 to -1.0 h/wk; P =.02). The percentage of children watching television/videos more than 2 h/d also decreased significantly from 33% to 18% among the intervention group, compared with an increase of 41% to 47% among the control group, for a difference of -21.5% (95% confidence interval, -42.5% to -0.5%; P =.046). There were no statistically significant differences in children's growth between groups. CONCLUSIONS: This study is the first to show that a preschool-based intervention can lead to reductions in young children's television/video viewing. Further research is needed to determine the long-term effects associated with reductions in young children's television viewing.