Promotion of children's early psychosocial development through primary health care services. Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries Myofeedback training and intensive muscular strength training to decrease pain and improve work ability among female workers on long-term sick leave with neck pain: a randomized controlled trial Workplace strength training prevents deterioration of work ability among workers with chronic pain and work disability: a randomized controlled trial. The Effects of Physical Activity on Health and Quality of Life in Adolescent Cancer Survivors: A Systematic Review Regenerate: assessing the feasibility of a strength-training program to enhance the physical and mental health of chronic post stroke patients with depression. Resource factors for mental health resilience in early childhood: An analysis with multiple methodologies The effects of strength training on strength and health-related quality of life in older adult women. The role of case management within a community support system: Partnership with psychosocial rehabilitation Dietary phytochemical intake from foods and health outcomes: a systematic review protocol and preliminary scoping Mapping scores from the Strengths and Difficulties Questionnaire (SDQ) to preference-based utility values Improvements of muscle strength predicted benefits in HRQOL and postural balance in women with fibromyalgia: an 8-month randomized controlled trial. [The effect of a health maintenance program on physical function and mental health of the elderly in nursing homes]. A multi-site randomised controlled trial of evidence-based supported employment for adults with severe and persistent mental illness. Outcomes of a Character Strengths-Based Intervention on Self-Esteem and Self-Efficacy of Psychiatrically Hospitalized Youths. The Exercising Together project: design and recruitment for a randomized, controlled trial to determine the benefits of partnered strength training for couples coping with prostate cancer. Methods used to evaluate the quality of evidence underlying the National Kidney Foundation-Dialysis Outcomes Quality Initiative Clinical Practice Guidelines: description, findings, and implications. A Randomized Controlled Clinical Trial of the Strength at Home Men's Program for Partner Violence in Military Veterans. Health enhancing strength training in nonagenarians (STRONG): rationale, design and methods Rating the strength of scientific evidence: relevance for quality improvement programs. Systematic Review: Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease: The State of the Evidence Obesity in children. Part 2: Prevention and management Systematic reviews in public health: old chestnuts and new challenges.
The paper presents the study design of the development and organisation of an EU/WHO multicentre study on the promotion of children 's early psychosocial development through primary health care services . The aim of the programme is to develop training for primary health care workers ( PHCWs ) that improves their ability to assess factors relevant to psychosocial development and gives them preventive approaches to foster that development , building on families ' strengths . The focus is on the period from conception to the end of the second year of the child 's ' life . Two main components are the training of the PHCWs and the semi-structured interviews that guide the workers in practice . The training has content and structure that is feasible within primary health care re sources working in collaboration with mental health services . The programme is evaluated in terms of ( a ) the impact of training on both the PHCWs ' knowledge and attitudes with regard to infant behaviour and development , and on practice as assessed by the delivery of the semi-structured interview ; and ( b ) the effect of the intervention on maternal well-being , infant language development and behavior , home environment and mother-infant interaction . The programme is taking place in Cyprus , Greece , the Federal Republic of Yugoslavia , Portugal , Slovenia and Turkey People living with HIV ( PLWH ) experience greater psychological distress than the general population . Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms , quality of life , and HIV care engagement . However , little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries ( LMICs ) , where the large majority of PLWH reside . This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these setting s. A systematic search strategy was undertaken to identify peer- review ed published papers of intervention trials addressing negative psychological states or disorders ( e.g. depression , anxiety ) among PLWH in LMIC setting s. Search results were assessed against pre-established inclusion and exclusion criteria . Data from papers meeting criteria were extracted for synthesis . Twenty-six papers , published between 2000 and 2014 , describing 22 unique interventions were identified . Trials were implemented in sub-Saharan Africa ( n = 13 ) , Asia ( n = 7 ) , and the Middle East ( n = 2 ) , and addressed mental health using a variety of approaches , including cognitive-behavioral ( n = 18 ) , family-level ( n = 2 ) , and pharmacological ( n = 2 ) treatments . Four r and omized controlled trials reported significant intervention effects in mental health outcomes , and 11 preliminary studies demonstrated promising findings . Among the limited mental health intervention trials with PLWH in LMICs , few demonstrated efficacy .  Mental health interventions for PLWH in LMICs must be further developed and adapted for re source -limited setting s to improve effectiveness The theoretical framework is that muscle tension in the neck is related to insufficient muscular rest and is a risk factor for chronic pain and reduced work ability . Promoting muscle strength and muscle rest may increase work ability and reduce neck pain . Objectives To test whether myofeedback training or intensive strength training leads to decreased pain and increased work ability in women on long-term sick leave . Methods This is a r and omized controlled trial of two 1-month interventions with myofeedback or muscular strength training in the home environment . Female human service organization workers ( n = 60 ) on long-term ( > 60 days ) sick leave and with chronic neck pain were followed with self-reported and laboratory-observed data of health , pain , muscular activation , and work ability , at baseline , immediately after the intervention and 3 months after baseline . Results For both intervention groups , pain was lowered over time compared with the control group . Decreased pain and muscular activity was associated with increased self-rated work ability and with laboratory-observed work ability at 3-month follow-up . Decreased pain was also associated with increased self-rated work ability at 1-month follow-up . Muscular strength training was associated with increased self-rated work ability and mental health . Myofeedback was associated with increased observed work ability and self- rated vitality . Conclusions The two interventions showed positive results , suggesting that they could be developed for use in health care practice to address pain and work ability . The intensive muscular strength training program , which is both easy to conduct at home and easy to coach , was associated with increased work ability OBJECTIVE Imbalance between work dem and s and individual re sources can lead to musculoskeletal disorders and reduced work ability . The aim of this study was to evaluate the effect of two contrasting interventions on work ability among slaughterhouse workers with chronic pain and work disability . METHODS Sixty-six slaughterhouse workers with upper-limb chronic pain and work disability were r and omly allocated to 10 weeks of either strength training for the shoulder , arm , and h and muscles ( 3 times per week , 10 minutes per session ) or ergonomic training ( usual care control group ) from September to December 2012 . The outcome measure was the change from baseline to 10-week follow-up in the work ability index ( WAI ) . RESULTS A priori hypothesis testing showed a group × time interaction for WAI ( P<0.05 ) . Compared with the ergonomic training group , WAI increased 2.3 [ 95 % confidence interval ( 95 % CI ) 0.9 - 3.7 ] in the strength training group corresponding to a moderate effect size ( Cohen 's d 0.52 ) . Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in the ergonomic group . Of the 7 items of WAI , item 2 ( work ability in relation to the dem and s of the job ) and item 7 ( mental re sources ) increased following strength training compared with ergonomic training ( P<0.05 ) . CONCLUSIONS Implementation of strength training at the workplace prevents deterioration of work ability among manual workers with chronic pain and disability exposed to forceful and repetitive job tasks . Thus , strength training performed at the workplace may in fact be regarded as a complex biopsychosocial intervention modality that reaches further than the specific physiological benefits of training per se Background There are numerous published controlled trials assessing the safety and the benefits of physical activity ( PA ) for child and adult cancer survivors . However , trials exclusively comprised of adolescent cancer survivors aged 13 - 19 years , who may experience different health and quality of life ( QOL ) effects as a function of their developmental status , are lacking . Rather , some trials have included both adolescent and child cancer survivors together . Objective The aim of this systematic review was to synthesize the findings from r and omized controlled trails ( RCTs ) and controlled clinical trials ( CCTs ) investigating the effects of PA on health and QOL outcomes in sample s comprised of > 50 % adolescent cancer survivors to summarize the current state of evidence , identify knowledge gaps , and highlight areas in need of additional research within this population . Methods Using a search strategy developed for this review , 10 electronic data bases were search ed for RCTs and CCTs that reported on the effects of PA on at least 1 health and /or QOL outcome in sample s comprised of > 50 % adolescent cancer survivors . Results From the 2249 articles identified , 2 CCTs met the predetermined eligibility criteria and were included in this review . Combined , 28 adolescents ( of 41 participants ) who were receiving active treatment participated in the 2 studies review ed . A total of 4 health and QOL outcomes ( ie , bone mass , fatigue , grip strength , QOL ) were assessed pre- and post-PA intervention . Conclusions On the basis of the 2 studies review ed , PA appears to be safe and feasible .  PA also shows promise to mitigate reductions in bone mass and might be a viable strategy to improve fatigue , grip strength , and QOL . High- quality controlled trials with larger sample s exclusively comprised of adolescent cancer survivors that assess a wide range of outcomes are needed to determine the effects of PA on health and QOL outcomes in this population OBJECTIVE The Regenerate pilot study explored whether a 10-week , community-based progressive resistance training ( PRT ) program could reduce depressive symptoms in depressed chronic stroke survivors . METHODS Participants were screened for depressive status using the PHQ-9 and confirmed by psychiatric assessment . Eligible people ( n = 45 ) were r and omised to PRT or a waiting-list comparison group .  The PRT program included two high intensity sessions/week for 10 weeks at a community-based gymnasium . Depressive status , physical and mental health and quality of life were measured at baseline , 10 weeks and 6 months . Muscle strength was assessed using 1 repetition maximum ( 1-RM ) for upper and lower limbs . RESULTS The participants ' median age was 69 years : 27 were male . The intervention group had lower depression scores than the comparison group at all time points . At 6-month follow-up , there was a trend for PRT participants to be more likely to be no longer depressed than the comparison group , but the difference was not significant after adjusting for baseline scores . There were modest improvements in health and wellbeing over time , but many scores were lower than reported in non-depressed people . Intervention participants demonstrated significant improvements in strength . Program adherence was good : on average 75 % of the 10-week program was completed . CONCLUSIONS The intervention appeared to be feasible within a community-based setting . To optimize stroke recovery and improve the quality of life of stroke survivors , health professionals should continue to focus on helping survivors ' mental health recovery as well their physical rehabilitation Background Given that relatively little is known about the development of resilience in early childhood , this longitudinal study aim ed to identify preschool re source factors associated with young children ’s mental health resilience to family adversity . Methods A community sample of 474 young Australian children was assessed in preschool ( mean age 4.59 years , 49 % male ) , and again two years later after their transition into formal schooling . At each assessment , st and ard question naires were used to obtain ratings from both parents and teachers about the quality of children ’s relationships with parents and teachers , children ’s self-concept and self-control , mental health ( Strengths and Difficulties Question naire ) , and family adversities ( including stressful life events and socioeconomic disadvantage ) . Results Greater exposure to cumulative family adversities was associated with both greater teacher- and parent-reported child mental health difficulties two years later . Multiple method ologies for operationalizing resilience were used to identify re sources associated with resilient mental health outcomes . Higher quality child – parent and child-teacher relationships , and greater child self-concept and self-control were associated with resilient mental health outcomes . With the exception of child-teacher relationships , these re sources were also prospect i ve antecedents of subsequent resilient mental health outcomes in children with no pre-existing mental health difficulties . Child – parent relationships and child self-concept generally had promotive effects , being equally beneficial for children facing both low- and high-adversity . Child self-control demonstrated a small protective effect on teacher-reported outcomes , with greater self-control conferring greater protection to children under conditions of high-adversity . Conclusions Findings suggest that early intervention and prevention strategies that focus on fostering child-adult relationship quality , self-concept , and self-control in young children may help build children ’s mental health and their resilience to family adversities The short-term effects of an accessible exercise intervention on the strength and health-related quality of life ( HRQOL ) among older adult women were evaluated . We conducted an 8-week resistance training intervention utilizing elastic b and s in 62 community-dwelling women with a mean age of 68 years . Participants were r and omly assigned to either an exercise or a control group . Pre- and postintervention assessment s included strength tests and HRQOL . Results revealed significant increases in three major muscles compared to the control group . However , there were no significant changes on either mental or physical health functioning . The elastic b and s provide older adult women with an inexpensive , practical exercise program that effectively increases strength within 8 weeks but may have little effect on self-reported HRQOL The Strengths model of team case management was assessed relative to an existing high quality psychosocial rehabilitation program that informally provided many services typical of case management ( e.g. , service linkage , monitoring , and consumer advocacy ) . The experimental evaluation triangulated consumer and family member responses with mental health professional reports and consumer records of hospitalization and crisis center contacts . An analysis of data from these four sources revealed that one year after full program implementation , consumers who received case management in conjunction with psychosocial rehabilitation functioned at a higher level of competency and experienced significantly lower psychiatric symptomatology than consumers who received only psychosocial rehabilitation . Implication s for the successful integration of case management into an existing community support program are discussed Introduction Dietary phytochemicals are found in plant-based foods such as fruits , vegetables and grains and may be categorised in a nested hierarchical manner with many hundred individual phytochemicals identified to date . To associate phytochemical intakes with positive health outcomes , a fundamental step is to accurately estimate the dietary phytochemical intake from foods reported . The purpose of this systematic review protocol is to describe the process to be undertaken to summarise the evidence for food-based dietary phytochemical intakes and health outcomes for adults . Methods and analysis The review will be undertaken following the PRISMA guidelines and the Cochrane H and book for Systematic Review s of Interventions using the Review Manager software . Phytochemical subclasses ( phenolic acids , flavanols , etc ) will be used to search for relevant studies using the Web of Science and Scopus scientific data bases . The retrieved studies will be screened based on inclusion of natural whole food items and health outcomes . Phytochemical studies related to cardiovascular disease , cancer , overweight , glucose tolerance , digestive , reproductive , macular and bone health and mental disorders , fatigue and immunity will be examined based on prior scoping . The evidence will be aggregated by the food types and health outcomes . Comparison of differences in the outcomes for r and omised controlled trials and observational studies will be undertaken . The strength of the review lies in its focus on whole food items and health conditions rather than one type of phytochemical related to one single health condition . Subgroup and sensitivity analyses will be conducted where an adequate number of publications are found per phytochemical subclass . Dissemination By comparing the outcomes from experimental and observational studies , the review will determine whether the overall conclusions related to the phytochemical subclasses are the same between study types for the identified health conditions . This is useful to public health policymakers and health professionals alike . Trial registration number # CRD42014015610 Abstract Purpose Quality of life mapping methods such as “ Transfer to Utility ” can be used to translate scores on disease-specific measures to utility values , when traditional utility measurement methods ( e.g. st and ard gamble , time trade-off , preference-based multi-attribute instruments ) have not been used . The aim of this study was to generate preliminary ordinary least squares ( OLS ) regression-based algorithms to transform scores from the Strengths and Difficulties Question naires ( SDQ ) , a widely used measure of mental health in children and adolescents , to utility values obtained using the preference-based Child Health Utility ( CHU9D ) instrument . Methods Two hundred caregivers of children receiving community mental health services completed the  SDQ and CHU9D  during a telephone interview . Two OLS regressions were run with the CHU9D utility value as the dependent variable and SDQ subscales as predictors . Result ing algorithms were vali date d by comparing predicted and observed group mean utility values in r and omly selected sub sample s. Results Preliminary validation was obtained for two algorithms , utilising five and three subscales of the SDQ , respectively . Root mean square error values ( .124 ) for both models suggested poor fit at an individual level , but both algorithms performed well in predicting mean group observed utility values . Conclusion This research generated algorithms for translating SDQ scores to utility values and providing research ers with an additional tool for conducting health economic evaluations with child and adolescent mental health data OBJECTIVE To evaluate whether changes in muscle strength due to 32 weeks of supervised aquatic training predicted improvements on health-related quality of life ( HRQOL ) . METHODS Thirty women with FM aged 50.8 + /- 8.7 years were r and omly assigned to an experimental group ( n = 15 ) , performing 3 weekly sessions of 60 min of warm-water exercise ; or to a control group ( n = 15 ) . HRQOL was evaluated using the Short Form 36 Health Survey ( SF-36 ) . Maximal unilateral isokinetic strength was measured at 60 degrees/s and 210 degrees/s in the knee extensors and flexors in concentric action and at 60 degrees/s in knee extensors eccentric action . Postural balance was evaluated using the one-leg stance , eyes closed . RESULTS After 32 weeks of water exercise therapy , statistically significant improvements occurred in concentric knee flexors and extensors strength at 60 degrees/s , in eccentric knee extensors and in postural balance . The treatment led to additional improvements in physical function , role physical problems , body pain , general health , vitality , role emotional problems and mental health dimensions of SF-36 . Gains in the concentric knee flexors strength predicted improvements in role of physical problems , whereas those in concentric knee extensors did the same for mental health and role emotional problems . Gains in eccentric knee extensors strength predicted improvements in postural balance . CONCLUSIONS A long-lasting exercise therapy in warm water produced relevant gains in muscle strength at low velocities of movements , some of which predicted improvements in physical problems , emotional problems , mental health and balance . TRIAL REGISTRATION International St and ard R and omized Controlled Trial Number IS RCT N53367487 , information available in http://www.controlled-trials.com/IS RCT N53367487 PURPOSE The purpose of this study was to determine the effects of a Health Maintenance Program on physical functions and mental health of the elderly in nursing homes . METHOD Sixty elderly(over 65 years old ) in a r and omized control study participated in a 16-week group-based intervention including functional exercises and health education . The participants were divided into 3 groups(Health Maintenance Program Group , Supportive Music Exercise Group , and Control Group ) of 20 elderly each . Data was collected from Dec. 1st , 2005 to Mar. 30th , 2006 . Physical function of lower body strength was assessed using a 30-second chair test , flexibility was assessed using a sit- and -reach test , and static balance was assessed by the ability to balance on one leg with open and closed eyes . Depression was assessed using the Korean Form of the Geriatric Depression Scale and self esteem was assessed using Rosenberg 's Self Esteem Question naire . Data was analyzed by Chi-square test , One-way ANOVA , and Repeated measure two factor analysis . RESULTS A Health Maintenance Program significantly increased muscle strength , flexibility and static balance , but depression and self-esteem scores were not significantly changed . CONCLUSION Findings demonstrated that a Health Maintenance Program was more effective on physical function than mental health of the elderly in nursing homes BACKGROUND / AIM The Individual Placement and Support ( IPS ) approach is an evidence -based form of supported employment for people with severe and persistent mental illness . This approach is not yet widely available in Australia even though there is mounting evidence of its generalisability outside the USA . One previous Australian r and omised controlled trial found that IPS is effective for young people with first episode psychosis . The aim of the current trial was to assess the effectiveness of evidence -based supported employment when implemented for Australian adult consumers of public mental health services by utilising existing service systems . METHODS A four-site r and omised control trial design ( n = 208 ) was conducted in Brisbane ( two sites ) , Townsville and Cairns . The intervention consisted of an IPS supported employment service hosted by a community mental health team . The control condition was delivered at each site by mental health teams referring consumers to other disability employment services in the local area . RESULTS At 12 months , those in the IPS condition had 2.4 times greater odds of commencing employment than those in the control condition ( 42.5 % vs. 23.5 % ) . The conditions did not differ on secondary employment outcomes including job duration , hours worked , or job diversity . Attrition was higher than expected in both conditions with 28.4 % completing the baseline interview but taking no further part in the study . CONCLUSION The results support previous international findings that IPS-supported employment is more effective than non-integrated supported employment . IPS can be successfully implemented this way in Australia , but with a loss of effect strength compared to previous USA trials OBJECTIVE Mental health treatment approaches based on character strengths can be used to complement the traditional focus on functional impairment . The study tested use of a character strengths-based intervention to enhance the self-esteem and self-efficacy of psychiatrically hospitalized youths . METHODS Eighty-one hospitalized adolescents were r and omly assigned to intervention or comparison groups . The intervention used the Values in Action Inventory of Strengths for Youth to discover character strengths and incorporate them into coping skills . Self-efficacy and self-esteem were measured at baseline , postintervention , two weeks , and three months . RESULTS Self-esteem and self-efficacy initially increased in both groups , but only the intervention group showed sustained improvement . The intervention was associated with increased self-efficacy at two weeks and increased self-efficacy and self-esteem at three months . CONCLUSIONS A brief , easily administered character strengths-based intervention may be an adjunctive tool in the treatment of psychiatrically hospitalized youths Prostate cancer can threaten quality of life for the patient and his spouse and the quality of his marital relationship . The purpose of our study is to evaluate the effects of " Exercising Together " - a partnered strength training program for married couples coping with prostate cancer - on the physical and emotional health of  prostate cancer survivors ( PCS ) and their spouses and on marital quality . We are conducting a 6-month r and omized controlled trial with two groups : 1 ) Exercising Together - a progressive , supervised strength training program and 2 ) a usual care control condition . The primary aims of this exploratory study are to : 1 ) Determine the effect of partnered strength training on physical and emotional health ( muscle strength , physical function , body composition and self-report physical and mental health ) in PCS , 2 ) Determine the effect of partnered strength training on physical and emotional health in spouses and 3 ) Explore the effect of partnered strength training on marital quality ( incongruence , communication , relationship quality , intimacy ) of the PCS and spouse . Target accrual has been met in this study with 64 couples enrolled and r and omized to exercise ( n=32 ) or usual care ( n=32 ) groups . This study is the first to examine the feasibility of this exercise format in both the chronically ill patient and spouse and explore benefits at the individual and couple level This report describes the approach the National Kidney Foundation-Dialysis Outcomes Quality Initiative ( NKF-DOQI ) used to assess the strength of published evidence pertinent to individual NKF-DOQI Clinical Practice Guidelines , as well as the relationship between that approach and methods used by the US Preventive Services Task Force , the Cochrane Collaboration , and the Agency for Health Care Policy and Research to rate the quality and /or strength of evidence . We also present the results of an analysis of the strength of evidence underlying the NKF-DOQI Guidelines showing that one can not infer the quality of evidence reported in a study ( rated either on a 0-to-1 scale or categorically as excellent , very good , good , fair , or poor ) simply by knowing the type of study design used ( r and omized trial , nonr and omized trial , natural experiment , cohort study , cross-sectional study , case-control study , case report ) . Issues related to assessment of the strength of evidence underlying a practice guideline opposed to that reported in an individual study are highlighted OBJECTIVE We evaluated the efficacy of the Strength at Home Men 's Program ( SAH-M ) , a trauma-informed group intervention based on a social information processing model to end intimate partner violence ( IPV ) use in a sample of veterans/service members and their partners . To date , no r and omized controlled trial has supported the efficacy of an IPV intervention in this population . METHOD Participants included 135 male veterans/service members and 111 female partners . Recruitment was conducted from February 2010 through August 2013 , and participation occurred within 2 Department of Veterans Affairs hospitals . Male participants completed an initial assessment that included diagnostic interviews and measures of physical and psychological IPV using the Revised Conflict Tactics Scales and were r and omly assigned to an enhanced treatment as usual ( ETAU ) condition or SAH-M. Those r and omized to SAH-M were enrolled in this 12-week group immediately after baseline . Those r and omized to ETAU received clinical referrals and re sources for mental health treatment and IPV services . All male participants were reassessed 3 and 6 months after baseline . Female partners completed phone assessment s at the same intervals that were focused both on IPV and on the provision of safety information and clinical referrals . RESULTS Primary analyses using hierarchical linear modeling indicated significant time-by-condition effects such that SAH-M participants compared with ETAU participants evidence d greater reductions in physical and psychological IPV use ( β = -0.135 [ SE = 0.061 ] , P = .029 ; β = -0.304 [ SE = 0.135 ] , P = .026 ; respectively ) . Additional analyses of a measure that disaggregated forms of psychological IPV showed that SAH-M , relative to ETAU , reduced controlling behaviors involving isolation and monitoring of the partner ( β = -0.072 [ SE = 0.027 ] , P = .010 ) . CONCLUSIONS Results provide support for the efficacy of SAH-M in reducing and ending IPV in male veterans and service members . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT01435512 Background The Health Enhancing Strength Training in Nonagenarians ( STRONG ) is a r and omised control trial to assess the effectiveness of an aerobic and strength training program for improving muscle strength , functional capacity and quality of life in nonagenarians . Methods Sixty ( 51 women ) nonagenarians ( age range : 90–102 years ) who live in a geriatric nursing home will be r and omly assigned to either a usual care ( control ) group ( n = 30 ) or an intervention ( training ) group ( n = 30 ) . Participants allocated in the usual care group will receive general physical activity guidelines and participants allocated in the intervention group will also enrol in three weekly non-consecutive individualized training sessions ( ~45–50 min each ) during 8 weeks . The exercise program will consist of muscular strength [ with a special focus on leg press at 30 % ( start of the program ) to 70 % 1 repetition maximum ( end ) ] and aerobic exercises ( cycle-ergometry during 3–5 to 15 minutes at 12–14 points in the rate of perceived exertion scale ) . Results Results from STRONG will help to better underst and the potential of regular physical activity for improving the well-being of the oldest population groups . Conclusion The increase in life expectancy together with the dramatic decrease in birth rates in industrialized countries calls the attention to health care systems and public health policymakers to focus attention on promoting healthy lifestyle in the highest sector of the population pyramid . Our study attempts to improve functional capacity and QOL of nonagenarians by implementing an individualised aerobic and strength training program in a geriatric residential care . Results from STRONG will help to better underst and the potential of regular physical activity for improving the well being even in persons aged 90 years or over . Trail Registration Clinical Trials.gov ID : OBJECTIVE To summarize an extensive review of systems for grading the quality of research articles and rating the strength of bodies of evidence , and to highlight for health professionals and decision-makers concerned with quality measurement and improvement the available " best practice s " tools by which these steps can be accomplished . DESIGN Drawing on an extensive review of checklists , question naires , and other tools in the field of evidence -based practice , this paper discusses clinical , management , and policy rationale s for rating strength of evidence in a quality improvement context , and documents best practice s methods for these tasks . RESULTS After review of 121 systems for grading the quality of articles , 19 systems , mostly STUDY DESIGN specific , met a priori scientific st and ards for grading systematic review s , r and omized controlled trials , observational studies , and diagnostic tests ; eight systems ( of 40 review ed ) met similar st and ards for rating the overall strength of evidence . All can be used as is or adapted for particular types of evidence reports or systematic review s. CONCLUSIONS Formally grading study quality and rating overall strength of evidence , using sound instruments and procedures , can produce reasonable levels of confidence about the science base for parts of quality improvement programs . With such information , health care professionals and administrators concerned with quality improvement can underst and better the level of science ( versus only clinical consensus or opinion ) that supports practice guidelines , review criteria , and assessment s that feed into quality assurance and improvement programs . New systems are appearing and research is needed to confirm the conceptual and practical underpinnings of these grading and rating systems , but the need for those developing systematic review s , practice guidelines , and quality or audit criteria to underst and and undertake these steps is becoming increasingly clear Purpose : The purpose of the present review was to assess the quality of evidence in the literature regarding the specific benefits of inspiratory muscle training ( IMT ) with an emphasis on training intensity and the relationships between changes in inspiratory muscle function and other clinical outcome measures . Methods : Articles were found by search ing CINAHL , PubMed , Medline via First Search , and ProQuest data bases . Articles used in the review were r and omized trials of IMT vs. sham IMT or no intervention  , published in English in a peer‐ review ed journal , included patients with chronic obstructive pulmonary disease ( COPD ) , and specified the intensity of training . The quality of the studies was evaluated by 2 independent review ers using the method ological rigor scale described by Medlicott and Harris as well as Sackett 's levels of evidence . Fifteen articles met the inclusion criteria and were used in this review . Results : Consistent improvements in maximal inspiratory pressures ( ranging from ‐11 to ‐30 cm H2O ) and inspiratory muscle endurance were found . Improvements in dyspnea and health‐related quality of life were also observed . Inspiratory muscle training may result in improved exercise tolerance as measured using walking tests . High‐intensity IMT result ed in improved training efficiency with respect to inspiratory muscle strength , but evidence of the effect of high‐intensity IMT on other clinical outcomes is lacking . Conclusion : Despite research spanning decades , there are numerous limitations in the literature regarding IMT . IMT appears to improve dyspnea , waking test distance , and health‐related quality of life in individuals with COPD , but it is not clear whether this improvement is mediated through improved inspiratory muscle strength and endurance . This review discussed several considerations critical to the design of future trials # # # # Summary points In the first part of this article we described how obesity in children is measured , its prevalence , whether children should be screened , and the risk factors for and consequences of obesity.1 In this part we review the current evidence on the prevention and management of childhood obesity . # # # # Sources and selection criteria This review draws on the Foresight report , guidance from the National Institute for Health and Clinical Excellence and the Australian National Health Medical Research Council , and Cochrane review . In April 2008 we search ed the Cochrane Library data base of review s and the Centre for Review s and Dissemination data bases using the search term “ obesity ” . We also conducted a Medline search ( ( Child$ or paediatric or pediatric or adolescent ) and ( Obes$ or overweight ) ) limited to 1 January 2005 to 6 May 2008 and “ review articles ” ; this identified 1105 articles . We read the abstract s of these articles and retrieved relevant papers . We also used articles from our own bibliographies collected over the past 10 years . The evidence to support the measurement , prevention , and management of obesity in children is still relatively weak , with few r and omised controlled trials or systematic review s. The strength of evidence is developing and the up date d Cochrane review that will be published in 2009 The Bulletin ’s editorial team has decided to encourage systematic review s. This is an important decision and is to be welcomed . However it is possible that it will not be received positively by all . Some may feel that systematic review s are not suitable for answering wider public health questions , and that the new section will simply result in the publication of systematic review s addressing narrowly focused , clinical questions with a focus on r and omized controlled trials alone.1 There is no reason why this should be so , and there are far too many examples of systematic review s of non- clinical interventions ( including government policies ) , which include non-r and omized studies , to list.2 Systematic review s of qualitative research are also becoming more common.3 Nonetheless misconceptions about the scope and flexibility of systematic review s still surface occasionally and it never fails to surprise me when I stumble across one of these hoary old chestnuts . If it really were true that systematic review s were only for simple , individual-level interventions , systematic review ers working in public health would be very concerned . After all , public health problems require us to draw on complex sets of qualitative as well as quantitative evidence ; and some policy interventions have never been subjected to r and omized controlled trials ( RCTs ) but have been evaluated using other approaches ; everything from controlled and uncontrolled before- and -after studies , to time series analyses , to qualitative methods . In such cases , systematic review s that focused on RCTs alone would have little to say and we would end up producing many “ empty review s ” , which contain no studies at all . These would be undoubtedly quicker to do and quicker to read than the typical systematic review , but would be of limited use for making policy . However this is not the case . In public health we already have a wealth of review s that prioritize RCTs where they are available , but which draw upon a range of other evidence where they are appropriate to answering the review question .2 Take , as an example , transport policies , an important social determinant of health.4 Public health decision-makers have been interested in the effects on health of building new roads for decades , but there has never been a r and omized controlled trial , for obvious reasons . Yet it would make no sense to cl aim that there is no evidence to be review ed ; rather , there have been many controlled and uncontrolled studies that have examined the effects of new roads on respiratory symptoms , injuries , community severance , disturbance and a variety of other outcomes of public health importance . These studies have in fact been systematic ally review ed.5 Many other examples of review s of complex interventions that impact on public health could be given , which appear on the Cochrane Data base and elsewhere,6,7 and such review s are the main focus of the recently-established Cochrane Public Health Review Group . It is also worth noting that both the Cochrane and Campbell Collaboration include increasing numbers of review s that are relevant to low- and middle- income countries,8 though there is a particular need for more systematic review s that consider the effects on equity of the interventions that they include.9 Currently systematic review s have a “ utilitarian bias ” – they tend to be concerned more with the effects on population s and average effects than with distributional effects and impacts in disadvantaged subgroups . It is to be hoped that systematic review s su bmi tted to the Bulletin will routinely consider the effects of interventions on health inequities . The Cochrane Health Equity Field ( http://equity.cochrane.org/en/index.html ) was set up explicitly to further this agenda , to encourage systematic review authors to explicitly assess the effects of interventions not only on the whole population , but on the disadvantaged . So where does this leave non- systematic review s ? Should every review be a systematic review ? This is a difficult question to answer in a short editorial . My own view is that not all review s need to be systematic review s ; there is still a place for review papers that provide a broad overview , and that discuss a range of evidence and make a contribution to wider debates about what might work in particular setting s. However , while such discussion s help place evidence in context and suggest how it may be used , they should not be confused with the evidence -based conclusions of a transparent , scientific review , which systematic ally attempts to find all the relevant evidence , appraises its strengths and limitations in a transparent fashion , and draws that evidence together in such a way that the more robust studies are given greater weight . Finally , the challenges are many . Evidence on interventions to improve public health is in short supply , particularly evidence on social determinants . Systematic review ers therefore face a real challenge in making best use of the sometimes poor , often sparse and usually heterogeneous evidence available to them . It is easy to set narrow inclusion criteria for a review and then sift through the evidence before concluding that there is n’t enough – and what there is , is n’t very good anyway . Such “ evidential nihilism ” is probably not helpful to decision-makers , and public health systematic review ers need to continue to develop new methods and better frameworks within which different types of research evidence can be integrated to inform decision-making . Publishing systematic review s in the Bulletin should give an added impetus to this ongoing work .
The Client Assessment of Strengths , Interests and Goals ( CASIG ) had the strongest psychometric evidence .
The SAW and CASIG assessment s can be tentatively recommended within clinical practice , although the evidence for all strengths assessment s is currently limited .
These categories form the basis of an empirically based definition of strengths that could be used as a conceptual foundation for new clinical assessment
Strengths assessment s focus on the individual 's talents , abilities , re sources , and strengths .
No systematic review of strengths assessment s for use within mental health population s has been published .
The aims of this study were to describe and evaluate strengths assessment s  for use within mental health services .