The Effectiveness of Anxiety Interventions for Young Children: A Meta-Analytic Review.

Anxiety symptoms and disorders are prevalent and impairing in young children and these symptoms often persist and worsen over time, indicating the need for efficacious interventions for this age group. The purpose of this study was to evaluate the effectiveness of psychosocial interventions targeting anxiety in younger children and to assess the potential moderators of outcome. The effect sizes from 24 trials were assessed based on a random effect model. The mean weighted effect size was found to be significant and moderate in magnitude. Moderators, including level of intervention, intervention approach, rater, and level of training of the provider/program facilitator, are assessed and discussed. Overall, the findings indicate that anxiety interventions are effective in reducing anxiety in young children, and targeted trials show particularly strong promise.

[Adapting clinical practice guidelines to a regional oncology network: the Piedmont experience]. / Adattamento di linee guida cliniche e organizzative alla Rete oncologica regionale: l'esperienza del Piemonte.

OBJECTIVE: To develop a method for adapting the best available cancer practice guidelines (CPGs) to the regional oncology network in Piedmont (NW of Italy, with about 4.3 million residents). METHODS: Four CPG were developed by multidisciplinary working groups, involving local opinion leaders, coordinated by the same team (including epidemiologists and health economists). The major features of these guidelines were: (a) to cover all the phases ofthe disease (from diagnosis to palliative care); (b) to satisfy common standards for evidence based guidelines; (c) to be coherent with the local health organization and resource availability. In the first three CPGs, regarding common cancers (colon-rectum, breast, lung), recommendations were graded according to the underlying level of evidence, from A to C, and treatment was organized by specialty. In the last guideline, regarding a rare condition (soft tissue sarcomas, STS), a grading system reflecting also the clinical importance of the decision was adopted and treatment recommendations were organized by clinical scenarios. In each guideline, some implementation tools, including a set of process and outcome indicators for audit monitoring, were provided. RESULTS: The four CPGs have been published between 2001 and 2004. The number ofrecommendations ranged between 38 (STS) and 103 (colon-rectum), with some differences in the distribution by specialty and grading. The CPGs have been disseminated through the oncology network and local health coordinators have been involved in the implementation. The impact of the CPGs is being evaluated by different approaches (analyses of administrative data, sample surveys and user's interviews). CONCLUSIONS: To adapt evidence based guidelines to a specific regional health organization is feasible and may be usefil for diseases requiring a multidisciplinary approach and continuity of care.

Baseline findings of the Italian multicenter randomized controlled trial of "once-only sigmoidoscopy"--SCORE.

BACKGROUND: A single sigmoidoscopy examination at around age 60 years has been proposed as a cost-effective strategy to prevent colorectal cancer. A multicenter randomized controlled trial, the SCORE trial, is in progress in Italy to estimate the impact of this strategy on colorectal cancer incidence and mortality and the duration of the protective effect. We present the baseline screening outcomes. METHODS: A questionnaire was mailed to a random sample of 236 568 people aged 55-64 years to assess their eligibility for and interest in screening. Those reporting a history of colorectal cancer, adenomas, inflammatory bowel disease, recent colorectal endoscopy, or two first-degree relatives with colorectal cancer were excluded. Eligible, interested respondents were assigned randomly to the control group (no further contact) or the intervention group (invitation to undergo sigmoidoscopy). Screenees with colorectal cancer, polyps larger than 5 mm, three or more adenomas, adenomas 5 mm or smaller with a villous component of more than 20%, or severe dysplasia were referred for colonoscopy. RESULTS: Of the 56 532 respondents (23.9% of those invited), 34 292 were enrolled and 17 148 were assigned to the screening group. Of those, 9999 attended and 9911 were actually examined by sigmoidoscopy. Distal adenomas were detected in 1070 subjects (10.8%). Proximal adenomas were detected in 116 of 747 (15.5%) subjects without cancer at sigmoidoscopy who then underwent colonoscopy. A total of 54 subjects was found to have colorectal cancer, a rate of 5.4 per 1000 (54% of which were Dukes' A). The procedures were relatively safe, with two perforations (one in 9911 sigmoidoscopy exams and one in 775 colonoscopies) and one hemorrhage requiring hospitalization after polypectomy during colonoscopy. The pain associated with sigmoidoscopy was described as mild or less than expected by 83.3% of the screenees. CONCLUSION: Sigmoidoscopy screening is generally acceptable to recipients and safe. The high yield of advanced adenomas is consistent with the projected impact of sigmoidoscopy screening on colorectal cancer incidence.