Showing papers in "Public Health Research in 2015"

Sexual health promotion for young people delivered via digital media: a scoping review

Abstract: Background: Young people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies. Objectives: To summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media. Design: Literature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK. Results: There are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia. Conclusions: IDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.

Football Fans in Training (FFIT): a randomised controlled trial of a gender-sensitised weight loss and healthy living programme for men – end of study report

Abstract: Funding Scottish Government and The Football Pools funded the delivery of FFIT. National Institute for Health Research Public Health Research programme funded the evaluation and will be published in full in Public Health Research; Vol. 3, No. 2. See the NIHR Journals Library website for further project information.

Can community-based peer support promote health literacy and reduce inequalities? A realist review

Abstract: Background Community-based peer support (CBPS) has been proposed as a potentially promising approach to improve health literacy (HL) and reduce health inequalities. Peer support, however, is described as a public health intervention in search of a theory, and as yet there are no systematic reviews exploring why or how peer support works to improve HL. Objective To undertake a participatory realist synthesis to develop a better understanding of the potential for CBPS to promote better HL and reduce health inequalities. Data sources Qualitative evidence syntheses, conceptual reviews and primary studies evaluating peer-support programmes; related studies that informed theoretical or contextual elements of the studies of interest were included. We conducted searches covering 1975 to October 2011 across Scopus, Global Health (including MEDLINE), ProQuest Dissertations & Theses database (PQDT) [including the Education Resources Information Center (ERIC) and Social Work Abstracts], The King’s Fund Database and Web of Knowledge, and the Institute of Development Studies supplementary strategies were used for the identification of grey literature. We developed a new approach to searching called ‘cluster searching’, which uses a variety of search techniques to identify papers or other research outputs that relate to a single study. Study eligibility criteria Studies written in English describing CBPS research/evaluation, and related papers describing theory, were included. Study appraisal and synthesis methods Studies were selected on the basis of relevance in the first instance. We first analysed within-programme articulation of theory and appraised for coherence. Cross-programme analysis was used to configure relationships among context, mechanisms and outcomes. Patterns were then identified and compared with theories relevant to HL and health inequalities to produce a middle-range theory. Results The synthesis indicated that organisations, researchers and health professionals that adopt an authoritarian design for peer-support programmes risk limiting the ability of peer supporters (PSs) to exercise autonomy and use their experiential knowledge to deliver culturally tailored support. Conversely, when organisations take a negotiated approach to codesigning programmes, PSs are enabled to establish meaningful relationships with people in socially vulnerable groups. CBPS is facilitated when organisations prioritise the importance of assessing community needs; investigate root causes of poor health and well-being; allow adequate time for development of relationships and connections; value experiential cultural knowledge; and share power and control during all stages of design and implementation. The theory now needs to be empirically tested via further primary research. Limitations Analysis and synthesis were challenged by a lack of explicit links between peer support for marginalised groups and health inequalities; explicitly stated programme theory; inconsistent reporting of context and mechanism; poor reporting of intermediate process outcomes; and the use of theories aimed at individual-level behaviour change for community-based interventions. Conclusions Peer-support programmes have the potential to improve HL and reduce health inequalities but potential is dependent upon the surrounding equity context. More explicit empirical research is needed, which establishes clearer links between peer-supported HL and health inequalities. Study registration This study is registered as PROSPERO CRD42012002297. Funding The National Institute for Health Research Public Health Research programme.

How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews

Abstract: Background: Tackling obesity is one of the major contemporary public health policy challenges and is vital in terms of addressing health inequalities. Objectives: To systematically review the effectiveness of interventions (individual, community and societal) in reducing socioeconomic inequalities in obesity among (1) children aged 0–18 years (including prenatal) and (2) adults aged ≥18 years, in any setting, in any country, and (3) to establish how such interventions are organised, implemented and delivered. Data sources: Nine electronic databases including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and NHS Economic Evaluation Database were searched from database start date to 10 October 2011 (child review) and to 11 October 2012 (adult review). We did not exclude papers on the basis of language, country or publication date. We supplemented these searches with website and grey literature searches. Review methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Experimental studies and observational studies with a duration of at least 12 weeks were included. The reviews considered strategies that might reduce existing inequalities in the prevalence of obesity [i.e. effective targeted interventions or universal interventions that work more effectively in low socioeconomic status (SES) groups] as well as those interventions that might prevent the development of inequalities in obesity (i.e. universal interventions that work equally along the SES gradient). Interventions that involved drugs or surgery and laboratory-based studies were excluded from the reviews. The initial screening of titles and abstracts was conducted by one reviewer with a random 10% of the sample checked by a second reviewer. Data extraction was conducted by one reviewer and independently checked by a second reviewer. The methodological quality of the included studies was appraised independently by two reviewers. Meta-analysis and narrative synthesis were conducted focusing on the ‘best-available’ evidence for each intervention type (defined in terms of study design and quality). Results: Of 56,967 papers of inequalities in obesity in children, 76 studies (85 papers) were included, and of 70,730 papers of inequalities in obesity in adults, 103 studies (103 papers) were included. These studies suggested that interventions that aim to prevent, reduce or manage obesity do not increase inequalities. For children, there was most evidence of effectiveness for targeted school-delivered, environmental and empowerment interventions. For adults, there was most evidence of effectiveness for primary care-delivered tailored weight loss and community-based weight loss interventions, at least in the short term among low-income women. There were few studies of appropriate design that could be included on societal-level interventions, a clear limitation of the evidence base found. Limitations: The reviews located few evaluations of societal-level interventions and this was probably because they included only experimental study designs. The quality assessment tool, although described as a tool for public health interventions, seemed to favour those that followed a more clinical model. The implementation tool was practical but enabled only a brief summary of implementation factors to be made. Most of the studies synthesised in the reviews were from outside the UK and related to women. Conclusions: The reviews have found some evidence of interventions with the potential to reduce SES inequalities in obesity and that obesity management interventions do not increase health inequalities. More experimental studies of the effectiveness and cost-effectiveness of interventions (particularly at the societal level) to reduce inequalities in obesity, particularly among adolescents and adult men in the UK, are needed. Study registration: The studies are registered as PROSPERO CRD42011001740 and CRD42013003612. Funding: The National Institute for Health Research Public Health Research programme.

Hazardous Ingredients in Cosmetics and Personal Care Products and Health Concern: A Review

Abstract: Increasing demand of cosmetics all over the world from teen to adult has increased awareness related to safety issue. The objective of this paper is to indicate the ingredients that possess health effect that can be found in cosmetics and personal care products. The ingredient was segmented to three parts which are preservatives, fragrances and heavy metal impurities. The related paper was reviewed in terms of the chemicals that commonly identified in the cosmetic and personal care product. This paper also highlighted the health risk possesses by such ingredients in the products. From the papers reviews, many chemicals remained arguable in term of safety and its presence in the products. The chemicals are either added for it intentional purposes or appears unintentionally due to the nature of chemical itself or due to the manufacturing processes. It is suggested that consumers aware over the ingredients used in their cosmetic and personal care products and the side effects it possesses.

A cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of a school-based cognitive–behavioural therapy programme (FRIENDS) in the reduction of anxiety and improvement in mood in children aged 9/10 years

Abstract: Background Anxiety in children is common, impairs everyday functioning and increases the risk of severe mental health disorders in adulthood, yet few children with anxiety are identified and referred for treatment. Objective To investigate the clinical effectiveness and cost-effectiveness of a universal school-based preventative programme (FRIENDS) in reducing symptoms of anxiety and low mood. Design Cluster randomised controlled trial. Schools (n = 41) were randomly assigned after recruitment on a 1 : 1 : 1 basis to health-led FRIENDS, school-led FRIENDS and usual school provision. Setting Primary schools in three local education authorities in the south-west of England. Participants Children (n = 1362) aged 9–10 years attending school and participating in personal, social and health education (PSHE). Interventions The FRIENDS programme is a cognitive–behavioural therapy programme that develops skills to counter the cognitive, emotional and behavioural aspects of anxiety. The FRIENDS programme was led by either a trained member of the school or a health leader external to the school and was delivered over 9 consecutive weeks. The comparison group received usual school PSHE lessons. Interventions were delivered in the academic year September 2011–July 2012. Main outcome measures Clinical effectiveness assessed by child report of symptoms of anxiety (Revised Child Anxiety and Depression Scale, RCADS); cost-effectiveness based on RCADS and quality-adjusted life-years (Child Health Utility 9 Dimensions, CHU-9D) between baseline and 6 months; process evaluation, evaluation of reach and attrition and qualitative feedback from children, school staff and parents. Results At 12 months there was a difference in the adjusted mean RCADS scores for health-led FRIENDS compared with school-led FRIENDS [–3.91, 95% confidence interval (CI) –6.48 to –1.35] and for health-led FRIENDS compared with usual school provision (–2.66, 95% CI –5.22 to –0.09). At 24 months we were able to assess only 43.6% of our cohort. There were few differences in baseline characteristics between completers and non-completers. Child-reported anxiety in all three groups had reduced by 24 months and there were no longer any group effects. There were no between-group effects for any parent- or child-completed secondary outcomes at 12 or 24 months. The cost of the FRIENDS programme was £52–56 per child. We found no evidence that the FRIENDS programme was cost-effective over a 6-month period; however, our subgroup for the economic analysis differed significantly from our main trial cohort. Conclusions Although greater reductions in anxiety were noted at 12 months when the FRIENDS programme was delivered by health leaders, these additional benefits were not maintained at 24 months. Children’s anxiety levels improved irrespective of the intervention that they received. Our economic evaluation and 24-month assessment had significant shortcomings. However, the universal delivery of specific anxiety prevention programmes will result in additional costs that may be beyond the finances available to most schools. Future work should identify the active ingredients and potential moderators of universal anxiety programmes to determine whether programme length can be reduced, short-term effectiveness maintained and cost-effectiveness improved. At present, our results find limited evidence to support the universal provision of specific anxiety prevention programmes in UK primary schools.

The impact on health inequalities of approaches to community engagement in the New Deal for Communities regeneration initiative: a mixed-methods evaluation

Abstract: Background This study was set in 39 neighbourhoods involved in a government-funded regeneration programme called New Deal for Communities (NDC) that began in 1998. We tested whether or not different approaches to engage residents in decision-making in these areas had different social and health impacts. Methods First, NDC approaches to community engagement (CE) were grouped into four types. We then assessed the impact of these types and whether or not their cost-effectiveness could be calculated. We used existing data from surveys and from NHS and government sources. New data were collected from interviews with residents of NDC areas and former staff. We have also made these data publicly available so that other researchers can assess impacts over a longer time period. Results The four CE types included an empowering resident-led approach (type A), in which residents had a lot of control over decisions, and an instrumental professional-led approach (type D), in which CE was more often used to promote the priorities of public sector organisations. Type B was initially empowering but over time became instrumental and type C balanced empowerment and instrumental approaches from the beginning. There were few statistically significant differences in health and social impacts by CE type. However, when there were statistically significant differences, the results suggest that type A, and to a lesser extent, types B and C approaches may have had better outcomes than the type D approach in relation to levels of participation and trust between residents, control or influence over decisions, social cohesion and mental health. NDC areas with a type D approach were the only ones where residents’ ‘sense of control’ deteriorated over time. Residents of these areas were less likely to feel that the NDC had improved their area and to experience improvements in mental health. However, some aspects of cohesion and trust improved in type D areas. The findings of our economic analyses are mixed. It was difficult to cost engagement activities, measures of effectiveness were not robust and relating costs that could be calculated to specific measures of effectiveness was difficult. There were almost as many negative as positive scores, making the calculation of cost-effectiveness an arbitrary exercise. Conclusions Our results are consistent with a theory that the greater the levels of control that residents have over decisions affecting their lives the more likely there are to be positive impacts. It is plausible that an empowerment approach to CE would help build trust and community cohesion, and that having a greater influence over NDC decisions could lead to more people feeling that the NDC initiative had improved an area. Conversely, our results are also consistent with a theoretical position which suggests that instrumental approaches, which try to engage residents in agendas that are not theirs, will have relatively little positive impact and that community cohesion and well-being may be undermined. The study has not produced firm evidence on the effectiveness of different approaches to CE. However, the findings do suggest that programmes involving CE will be more likely to have positive impacts if the approaches to CE are experienced as more empowering and less instrumental (i.e. less focused on the agendas of external agencies). Future methodological research is needed to develop better measures of empowerment at the collective level and more robust approaches to empowerment on health and well-being at the population level. Funding The National Institute for Health Research Public Health Research programme.

Preventing domestic abuse for children and young people (PEACH): a mixed knowledge scoping review

Abstract: Background: A range of interventions that aim to prevent domestic abuse has been developed for children and young people in the general population. While these have been widely implemented, few have been rigorously evaluated. This study aimed to discover what was known about these interventions for children and what worked for whom in which settings. Review methods: This mixed knowledge review was informed by realist principles and comprised four overlapping phases: an online mapping survey to identify current provision; a systematic review of the existing literature; a review of the UK ‘grey’ literature; and consultation with young people and experts. Information from these four sources of evidence informed analysis of costs and benefits. Results: The evidence for interventions achieving changes in knowledge and attitudes was stronger than that for behavioural change. Shifting social norms in the peer group emerged as a key mechanism of change. Media campaigns act to influence the wider social climate within which more targeted interventions are received, and they are also a source for programme materials. While most interventions are delivered in secondary schools, they are increasingly targeted at younger children. The review emphasised the importance of a school’s ‘readiness’ to introduce preventative interventions which need to be supported across all aspects of school life. Involving young people in the design and delivery of programmes increases authenticity and this emerged as a key ingredient in achieving impact. Longer interventions delivered by appropriately trained staff appeared likely to be more effective. Teachers emerged as well placed to embed interventions in schools but they require training and support from those with specialist knowledge in domestic abuse. There was evidence that small groups of students who were at higher risk might have accounted for some results regarding effectiveness and that programme effectiveness may vary for certain subgroups. Increasingly, boys are being identified as a target for change. The study identified a need for interventions for disabled children and children and young people from black, Asian, minority ethnic and refugee groups and a particular lack of materials designed for lesbian, gay, bisexual and transgender young people. Limitations: Very little evidence was identified on costs and cost-effectiveness. Few studies showed an effect at the level of significance set for the review. Where it did exist, the effect size was small, except in respect of improved knowledge. The inability to calculate a response rate for the mapping survey, which used a snowballing approach, limits the ability to generalise from it. Conclusions: While it is appropriate to continue to deliver interventions to whole populations of children and young people, effectiveness appeared to be influenced by high-risk children and young people, who should be directed to additional support. Programmes also need to make provision to manage any resulting disclosures. Interventions appear to be context specific, and so those already being widely delivered in the UK and which are likely to be acceptable should be robustly tested. Funding: The National Institute for Health Research Public Health Research programme.

What is the effect of reduced street lighting on crime and road traffic injuries at night? A mixed-methods study

Abstract: Background Some local authorities have reduced street lighting at night to save energy, but little is known about impacts on public health or about public concerns about impacts on well-being. Aim To evaluate the effect of reduced street lighting on crime and road traffic injuries. Design A mixed-methods study comprising a rapid appraisal, a controlled interrupted time series analysis and a cost–benefit analysis (CBA). Setting England and Wales. Target population Residents and workers in eight case study areas; road traffic casualties and victims of crime. Interventions evaluated Switch-off (i.e. lights permanently turned off), part-night lighting (e.g. lights switched off between 12 a.m. and 6 a.m.), dimming lights and white lights/light-emitting diodes (LEDs). Outcomes Public views about implications on well-being; road traffic injury data (STATS19: http://data.gov.uk/dataset/road-accidents-safety-data) obtained for the period 2000–13; crime data (Police.uk: data.police.uk) obtained for the period December 2010–December 2013. Detailed crime data were obtained from one police force for a methodological study of the spatial level at which Police.uk data are valid for analysis. Statistical methods Road traffic collisions were analysed at street segment level. Regression models were used to estimate changes in daytime and night-time collision rates associated with lighting interventions. The ratio of night-time and daytime changes was considered the best estimate of change in night-time collisions following each lighting intervention. Police.uk crime data were found to be reliable when analysed at middle super output area (MSOA) level. For crime, the analysis used the proportion of total km of road in each MSOA with each lighting intervention. Regression models controlled for yearly and monthly trends and were fitted in each geographical region and police force. Effect estimates were pooled in random-effects meta-analyses. Results Public concerns centred on personal security, road safety, crime, fear of crime, sleep quality and being able to see the night sky. Street lighting reductions went largely unnoticed or had only marginal impacts on well-being, but for a minority of people switch-off and part-night lighting elicited concerns about fear of the dark, modernity and local governance. Street lighting data were obtained from 62 local authorities. There was no evidence that reduced street lighting was associated with road traffic collisions at night. There was significant heterogeneity in the estimated effects on crime at police force level. Overall, there was no evidence that reduced street lighting was associated with crime. There was weak evidence for a reduction in crime associated with dimming [rate ratio (RR) 0.84, 95% confidence interval (CI) 0.70 to 1.02] and white light (RR 0.89, 95% CI 0.77 to 1.03). The CBA suggests that part-night lighting may represent a net benefit to local authorities. Limitations The study did not account for the impacts of other safety/crime prevention initiatives (e.g. improved road markings; closed-circuit television), and so associations may be partly attributable to these initiatives. The CBA was unable to include potentially important impacts such as fear of crime and reduced mobility. Conclusion This study found little evidence of harmful effects of switch-off, part-night lighting, dimming or changes to white light/LEDs on levels of road traffic collisions or crime in England and Wales. However, the public were also concerned about other health outcomes. Research is needed to understand how lighting affects opportunities for crime prevention and how these vary by context. Research is needed also on other public health impacts of light at night. Funding The National Institute for Health Research Public Health Research programme.

Prevalence of HIV among Pregnant Women in Rumubiakani, Port Harcourt, Nigeria

Abstract: This study is aimed at determining the prevalence of HIV among pregnant women in Rumubiakani, Port Harcourt, Rivers State, Nigeria. The purpose of the study was explained to the pregnant women attending Antenatal clinic (ANC) in Obio Cottage Hospital, Rumubiakani. Those who consented to the study were given questionnaire. Blood samples were also collected from 200 pregnant women and screened for antibodies to HIV using Determine HIV-1/2 and Stat Pak HIV-1/2 rapid strips. The overall prevalence of HIV was found to be 3.0% (n=6). Of which 4(66.7%) were due to infection by HIV -1 while 2(33.3%) were due to infection by HIV-2. Higher prevalence of 8.3% was found among age-groups 20-29 years compared to 1.3% recorded among >30 years. Participant who had never had any form of formal education had the highest prevalence of HIV (3(4.0%)) while those who had only primary level of education had zero prevalence (0(0.0%)). Those who attested to having gone through secondary and tertiary levels of education had 1(2.5%) and 2(3.3%) prevalence respectively. Higher prevalence was found among adults 3(4.0%), illiterates 3(4.0%), traders 3(15.0%), singles 4(3.3%) and free thinkers 3(10.7%). HIV seropositivity significantly associated with behavioral variables such as had sex for commercial purpose before (8.3%), no HIV screening (7.1%), no awareness of non-sexual route of HIV transmission (4.7%), no condom use (4.2%) and no awareness of management of HIV symptoms (4.2%). Also 200(100.0%) of the participants acknowledged being aware of the existence of HIV. All (100.0%) agreed that to have sex with an infected partner could transmit the virus. However, 58.0% acknowledged being tested for HIV before. Sixty-eight percent (68.0%) of the participants were aware of other routes of transmission of the virus aside sex; they admitted sharing sharp unsterilized objects such as razor blades could be a risk factor. Forty percent (40.0%) of participants admitted they knew how to manage symptoms of the infection and 32.0% were aware of HIV window period. This study has further confirmed the presence of HIV among pregnant women in Port Harcourt, Rivers State, Nigeria.

Socio-Cultural Determinants of Contraceptives Use Among Adolescents in Northern Ghana

Abstract: Adolescent in both rural and urban areas in developing nations are often underserved by family planning service providers. This limits the knowledge level of young men and women about contraceptive methods. The purpose of this study was to examine what determines contraceptive use among adolescents. Data collection spans January to December 2013 with 400 adolescent men and women of reproductive age as study respondents in the Yendi Municipality of Northern Region of Ghana. The data collection tool was questionnaire and focus group discussion. SPSS version 20 was used in the analysis. It was found that most adolescents would use contraceptives if they did not want to get pregnant or if they want to continue with their education. Overall, the desired family size was lower among all the adolescents. It was observed that once a teenage woman has had a child; contraceptive use prevalence rises to a level comparable to that of women in their twenties. The paper recommends that the family planning officers should give more attention to adolescents. Successful side-effect management and proper education in family planning could increase contraceptive use among adolescents.

Poor Birth Size a Badge of Low Birth Weight Accompanying Less Antenatal Care in Bangladesh with Substantial Divisional Variation: Evidence from BDHS - 2011

Abstract: In spite of having a pretty good progress in maternal and child health, low birth weight is still a serious public health issue for Bangladesh. The prime concern of this study was to crosscheck the eventual influence of antenatal care on poor birth size, a substitution of low birth weight and to explore the divisional variation along with its individual role on poor birth size. A nationally representative data, Bangladesh Demographic and Health Survey (BDHS) 2011 was used for this purpose. Sample size for this study was 7324 children from the different parts of the country born within last five years preceding the survey and all of them were the last child. Logistic regression analysis was applied to examine the influence of ANC on poor birth size as well as other relevant variables such as mother’s level of education, house hold income, division, age of mother at birth, birth order, sex of child, place of residence, media exposure etc. A total of 17.5% children had poor birth size (reported as “very small” or “smaller than average” by mothers) at the time of birth. The result of the analysis shows that ANC is negatively and significantly associated with poor birth size after controlling for all other potential factors. Four or more times ANC visited mothers, compared to no ANC visited mothers, have 26% lower risks of having poor birth size babies (p=0.002). Highest frequency (23%) of poor birth size was found at South-eastern part of Bangladesh which is Chittagong division and lowest frequency (10.1%) was observed in both Barisal and Khulna division. In comparison to Dhaka division, mothers living at Sylhet or Chittagong division have 42% or 35% higher risk of having poor birth size babies respectively(p=0.003 or p=0.001). As per current study it is well documented that provision of adequate antenatal care and proper utilization of it can effectively reduce poor birth size, eventually low birth weight in Bangladesh and divisional variation is also prominent in Bangladesh.

Preventing alcohol misuse in young people: an exploratory cluster randomised controlled trial of the Kids, Adults Together (KAT) programme

Abstract: Alcohol misuse has high personal, social and economic costs, and misuse by young people is of particular concern. Schools have been identified as having an important role in the delivery of alcohol misuse prevention interventions. Researchers compared primary schools which ran the Kids, Adults Together (KAT) programme with schools which did not run the programme (control group). KAT aims to prevent misuse of alcohol by encouraging children and parents to talk about alcohol before children grow up and start drinking. It comprises classroom work about the effects of drinking alcohol, a family event and an educational digital versatile disc (DVD). The best way to find out if KAT can prevent alcohol misuse is to conduct a randomised controlled trial (RCT) lasting 2 or more years, comparing a large number of schools running KAT with an equal number of schools which continue with their normal curriculum. This study assessed whether or not a RCT would be useful and practicable. Many schools invited to take part did not reply or declined. The research, lasting 14 months, involved nine schools and investigated whether or not (1) schools could run KAT successfully; (2) the research methods which would be used in a RCT were suitable and acceptable for children, parents and schools; and (3) how likely it was that KAT would increase family communication if we measured this in a RCT. All four control-group schools completed the study and there was positive feedback from the three schools which ran KAT, where large numbers of parents and children participated. Two schools which should have run KAT withdrew. Most children completed questionnaires for the research but some of the questions were too hard for 9- to 11-year-olds. Few parents took part in interviews and KAT did not appear to increase family communication. It is not appropriate to conduct a RCT of KAT because (1) we need to develop better questionnaires first; (2) the programme did not appear to increase family communication; (3) KAT’s impact on alcohol misuse could be small, meaning that a RCT would be very expensive; and (4) we need to test how practicable it would be for a RCT to do follow-up questionnaires with children after they had moved to secondary schools.

Preschoolers in the Playground: a pilot cluster randomised controlled trial of a physical activity intervention for children aged 18 months to 4 years

Abstract: Background The preschool years are considered critical for establishing healthy lifestyle behaviours such as physical activity. Levels of physical activity track through childhood into adulthood and establishing habitual physical activity early in life is therefore vital. Time spent outdoors is associated with greater physical activity and playground interventions have been shown to increase physical activity in school-aged children. There are few preschool, playground-based interventions and these have given inconclusive results. A report published by the UK’s Chief Medical Officer (CMO) highlighted the need for new interventions to promote movement in the early years (0–5 years). Objectives This study aimed to undertake a pilot cluster randomised controlled trial (RCT) of an outdoor playground-based physical activity intervention for parents and their children aged from 18 months to 4 years (Preschoolers in the Playground or PiP) and to assess the feasibility of conducting a full-scale cluster RCT. Design The study was a two-armed pilot cluster RCT with economic and qualitative evaluations. Participants were randomised on a 1 : 1 basis to the PiP intervention (n = 83) or usual practice (control; n = 81). Setting Bradford, West Yorkshire, UK. Participants Children aged from 18 months to 4 years. Intervention The PiP intervention is grounded in behavioural theory (social cognitive theory) and is in accordance with CMO guidance for physical activity in the early years. It is informed by existing literature and data collected from focus groups with parents. The intervention was delivered in primary school playgrounds. Six 30-minute PiP sessions per week were available for 30 weeks; families were encouraged to come to three a week. The 10-week initiation phase was facilitated by a member of school staff and the maintenance phase was unsupervised. Main outcome measures Recruitment and retention of schools and families to the trial were the main outcome measures. The acceptability of trial procedures and the intervention, the feasibility of collecting health outcome data and the fidelity of the implementation of the intervention were also evaluated. A preliminary assessment of cost-effectiveness and a sample size calculation for a full trial were conducted. Results In total, 37% of schools and 48% of parents approached agreed to take part. Levels of retention were good at 10 and 52 weeks’ follow-up (82.3% and 83.5% respectively). Both the trial procedures and the intervention were acceptable. However, attendance was low during the autumn and winter/spring initiation phases but somewhat better in the summer initiation phase. Attendance was poor throughout all maintenance phases. The accelerometry protocol for measuring physical activity requires modification. The fidelity of intervention implementation was good (81% adherence). The intervention was borderline cost-effective. A sample size of 600 children from 38 schools is required for a full trial. Conclusion A full RCT of the PiP intervention is feasible. The PiP intervention requires some modification, for example running the intervention during the summer term only, but was found to be acceptable to schools and families. Trial registration Current Controlled Trials ISRCTN54165860. Funding This project was funded by the NIHR Public Health Research programme and will be published in full in Public Health Research; Vol. 3, No. 5. See the NIHR Journals Library website for further project information.

Prevalence and Response to Occupational Hazards among Nursing Students in Gaza Strip, Palestine: The Role of Personal Protective Equipment and Safety Regulations

Abstract: Although nursing students are more prone to occupational hazards and injuries in the course of their clinical training activities, they have not been the primary focus of any published study of exposure incidents in Gaza strip, Palestine. The aim of this study was to describe the prevalence of exposure to occupational hazards among nursing students and to determine the degree to which occupational safety and health control strategies are applied. A cross sectional descriptive study was conducted at the faculty of nursing in the Islamic University of Gaza, Palestine. The results from 114 respondents showed that 44.3% were exposed to at least one of the occupational hazards. Exposure to psychological hazards was the highest (56.6%) followed by accidental hazards (44%), chemical hazards (43.9%), and biological hazards (39.8%), while the lowest was the physical hazards (39.3%). Needle-stick injuries when using sharp devices were reported by 45.5% of the students. About 67% were exposed to verbal or physical abuse while 43.0% were exposed to the x-rays and other types of radio-graphical procedures. Irritation of skin, eyes and nose was quite prevalent among students (48%) due to exposure to hazardous chemical substances. Although most of the participants (97.4%) were fully aware of using Personal Protective Equipment and safety regulations, only 25% were actually compliant. In conclusion, most of the nursing students were exposed to at least one of the five occupational hazards. It is important therefore to continuously encourage behavioral changes, promotion of safety measures and application of occupational health services to minimize workplace-induced injuries.

Employer schemes to encourage walking to work: feasibility study incorporating an exploratory randomised controlled trial

Abstract: Background Physical inactivity increases the risk of many chronic diseases, including coronary heart disease, type 2 diabetes, obesity and some cancers. Increasing physical activity levels, particularly among the most sedentary, is an important aim of current public health policy in the UK. An opportunity for working adults to increase physical activity levels may be through walking during the daily commute. Objectives To build on existing knowledge and resources to develop an employer-led scheme to increase walking to work; to test the feasibility of implementing and evaluating the intervention; and to explore other requirements of a full-scale trial. Design Feasibility study incorporating phase 1 resource review, focus groups with employees and interviews with employers in three workplaces (one small, one medium and one large); and phase 2 exploratory cluster randomised controlled trial (RCT) including process and economic evaluations. Setting Workplaces (eight small, five medium and four large) in Bristol. Participants One hundred and eighty-seven employees (89 male and 98 female) at baseline. Interventions Walk to Work promoters were recruited and trained about the health, social, economic and environmental benefits of walking to work and how to identify and promote safe walking routes for employees. They were given resource packs based on nine key behaviour change techniques. The role of the Walk to Work promoter was to encourage participating employees in their workplace to walk to work; to help to identify walking routes; to encourage goal setting; and to provide additional encouragement through four contacts over the following 10 weeks (face to face, e-mail or telephone, as appropriate). Main outcome measures Recruitment and retention rates; sample size calculation and estimation of the intracluster correlation coefficient (ICC); acceptability of the intervention and evaluation methods; and estimation of costs. Results Workplace and employee recruitment appeared to be restricted by the initial requirement to identify employees living within 2 miles of the workplace. Once recruited, no workplace withdrew from the study between baseline and 1-year follow-up. It proved feasible to recruit and train workplace Walk to Work promoters. The response rate was 132 (71%) at 1-year follow-up. Although the study was not powered to measure effectiveness, accelerometer data suggest that overall physical activity and moderate to vigorous physical activity (MVPA) were higher in the intervention arm than in the control arm at 1-year follow-up. The ICC was estimated at 0.12 (95% confidence interval 0.00 to 0.30). Based on an average cluster size of eight, an ICC of 0.15 and attrition of 25%, a total sample size of 678 would have 80% power with 5% significance to detect a 15% increase in mean MVPA. The average cost of the intervention was estimated at £441 per workplace. Activity levels were similar in the intervention and control arms at baseline. Conclusions The intervention and evaluation were feasible, and acceptable to participants. There was sufficient evidence of promise to justify a full-scale trial incorporating lessons learned during the feasibility study. Future work: an application is being submitted for a follow-on full-scale cluster RCT. Trial registration Current Controlled Trials ISRCTN72882329. Funding This project was funded by the NIHR Public Health Research programme and will be published in full in Public Health Research; Vol. 3, No. 4. See the NIHR Journals Library website for further project information. The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

Analysis of lower limb movement to determine the effect of manipulating the appearance of stairs to improve safety: a linked series of laboratory-based, repeated measures studies

Abstract: Background: Falls on stairs are a common and dangerous problem for older people. This series of studies evaluated whether or not selected changes to the appearance of stairs could make them safer for older people to negotiate. Objectives: To determine the effect of (1) a step edge highlighter and its position and (2) an optimised horizontal–vertical (H–V) visual illusion placed on a step riser on gait safety during stair descent and ascent. Design: A series of studies using a repeated measures, laboratory-based design, investigating gait control and safety in independently mobile older people. Setting: The University of Bradford Vision and Mobility Laboratory. Participants: Fit and healthy older people aged 60 years of age or more, independently mobile, reasonably active and with normal healthy eyes and corrected vision. Interventions: A step edge highlighter in a variety of offsets from the stair edge and an optimised H–V visual illusion placed on the stair riser. The H–V illusion was provided on a staircase by horizontal step edge highlighters on the tread edges and vertical stripes on the step risers. Main outcome measures: Gait parameters that are important for safe stepping in ascent and descent, measured using three-dimensional lower limb segmental kinematic data.

Effect of Exposure to Cement Dust on Pulmonary Function among Cement Plants Workers in the Middle Governorate, Gaza- Palestine

Abstract: This study was conducted to investigate the level of PM air pollution in cement plants, and their impacts on respiratory system health and pulmonary function for cement plants workers. Case-control study was conducted on all cement plants at Middle Gaza Governorates. 100 individuals participated, case (exposed) and control (non exposed) groups contain 50, 50 respectively. All participants were subjected to questionnaire, lung function measuring by electronic spirometery. The findings of this study showed that an average particulate matter from 106.3 to 143.3, which is about more than 4 times higher than the particulate matter (PM2.5) existing standard of 35 μg/m3 also an average particulate matter from 615 to 656, which is about more than 4 times higher than the particulate matter (PM10) existing standard of 150 μg/m3. As well as, it showed clear links between PM exposure and respiratory health and pulmonary function. Cough, dyspnea and sputum buildup were more common among the exposed group, Furthermore, the mean of FEV1/ FVC (%) for control group is significantly greater than that for FEV1/ FVC (%) for case group. Among other recommendations, this paper infers that Environmental and engineering control of cement dust emissions, protective techniques, procedures, measures and equipment and periodic medical examinations.

Hypertension and Its Risk Factors - A Cross Sectional Study in an Urban Population of a North Indian District

Abstract: Background: Non communicable diseases are on the rise at an alarming rate among adult population both in developed and developing world. Among the various risk factors for non communicable diseases hypertension is a significant risk factor in cardiovascular diseases. The study aimed to assess various risk factors and their association with hypertension. Materials and Methods: A Cross sectional community based study was conducted in an urban population aged 30 yrs and above in an urban locality of Jammu district of J&K. Every alternate house was visited thus covering 50% of total houses. Standard oral questionnaire, predesigned and pretested was used to obtain information on risk factors for hypertension. Results: Among the risk factors studied for hypertension age, sex, educational status, BMI, alcohol intake and physical inactivity were found to be statistically significant, while no significant association could be found with non vegetarian diet and extra salt intake. Conclusions: Advancing age, male sex, higher BMI, alcohol consumption and physical inactivity were found to be important risk factors for hypertension.

Knowledge and Practice of Hand Washing among Caregivers of Under-Five Children in a Rural Nigerian Community

Abstract: Hand washing is a very important public health tool in disease control. The control of some of the leading causes of under-five morbidity and mortality is greatly enhanced when mothers and other care-givers adopt appropriate hand washing practices. The study was done to assess the knowledge and practice of hand washing by mothers and caregivers of children less than five years with a view to recommending ways of enhancing the practice in rural communities. This was a cross-sectional survey using a cluster sampling technique. A sample of 513 mothers and care givers was drawn from selected quarters in Usugbenu-Irrua and studied with interviewer-administered questionnaires. A scoring system designed by the research team was used to assess the knowledge of respondents. The mean age of mothers interviewed was 31.6 (±9.2) years. Over two-third (70.6%) of them had good knowledge of hand washing. Fifty-six percent reported regular washing of hands at critical moments; hand washing was highest after defecation (79.6%). There was no statistically significant relationship between the knowledge and practice of hand washing (df=1, X 2 = 2.796, p = 0.094). The commonest reasons given for not washing hands regularly were: being too busy (19%) and non-availability of soaps (17.7%) and water (13.5%).The findings showed that though there is a gap between knowledge and practice of hand washing, it is not statistically significant. The study indicates that other factors beyond knowledge may be responsible for poor hand washing behaviour.

Pilot study of a randomised trial of a guided e-learning health promotion intervention for managers based on management standards for the improvement of employee well-being and reduction of sickness absence: the GEM (Guided E-learning for Managers) study

Abstract: Background Psychosocial work environments influence employee well-being. There is a need for an evaluation of organisational-level interventions to modify psychosocial working conditions and hence employee well-being. Objective To test the acceptability of the trial and the intervention, the feasibility of recruitment and adherence to and likely effectiveness of the intervention within separate clusters of an organisation. Design Mixed methods: pilot cluster randomised controlled trial and qualitative study (in-depth interviews, focus group and observation). Participants Employees and managers of a NHS trust. Inclusion criteria were the availability of sickness absence data and work internet access. Employees on long-term sick leave and short-term contracts and those with a notified pregnancy were excluded. Intervention E-learning program for managers based on management standards over 10 weeks, guided by a facilitator and accompanied by face-to-face meetings. Three clusters were randomly allocated to receive the guided e-learning intervention; a fourth cluster acted as a control. Main outcome measures Recruitment and participation of employees and managers; acceptability of the intervention and trial; employee subjective well-being using the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS); and feasibility of collecting sickness absence data. Results In total, 424 employees out of 649 approached were recruited and 41 managers out of 49 were recruited from the three intervention clusters. Of those consenting, 350 [83%, 95% confidence interval (CI) 79% to 86%] employees completed the baseline assessment and 291 (69%, 95% CI 64% to 73%) completed the follow-up questionnaires. Sickness absence data were available from human resources for 393 (93%, 95% CI 90% to 95%) consenting employees. In total, 21 managers adhered to the intervention, completing at least three of the six modules. WEMWBS scores fell slightly in all groups, from 50.4 to 49.0 in the control group and from 51.0 to 49.9 in the intervention group. The overall intervention effect was 0.5 (95% CI –3.2 to 4.2). The fall in WEMWBS score was significantly less among employees whose managers adhered to the intervention than among those employees whose managers did not (–0.7 vs. 1.6, with an adjusted difference of 1.6, 95% CI 0.1 to 3.2). The intervention and trial were acceptable to managers, although our study raises questions about the widely used concept of ‘acceptability’. Managers reported insufficient time to engage with the intervention and lack of senior management ‘buy-in’. It was thought that the intervention needed better integration into organisational processes and practice. Conclusions The mixed-methods approach proved valuable in illuminating reasons for the trial findings, for unpacking processes of implementation and for understanding the influence of study context. We conclude from the results of our pilot study that further mixed-methods research evaluating the intervention and study design is needed. We found that it is feasible to carry out an economic evaluation of the intervention. We plan a further mixed-methods study to re-evaluate the intervention boosted with additional elements to encourage manager engagement and behaviour change in private and public sector organisations with greater organisational commitment. Study registration Current Controlled Trials ISRCTN58661009. Funding This project was funded by the NIHR Public Health Research programme and will be published in full in Public Health Research; Vol. 3, No. 9. See the NIHR Journals Library website for further project information.

Moderating Effects of Oral Health Behaviors on the Relation Between Daily Stress and Oral Health Status in Korean Adolescents

Abstract: Objective: The purpose of this study was to investigate moderating effects of oral health behaviors between daily stress and oral health status among Korean adolescents. Methods: A total of 3,900 adolescent data from 'Korean Survey on the Health of Youth and Children in 2010' were used in this study. The hierarchical multiple regression analyses was used to examine the moderating effects between daily stress and oral health status adjusting for control variables. Results: We found that adolescents who less daily stress, had experience dental clinic, and higher frequency of brushing their teeth after lunch were good in their oral health status. Adolescents’s oral health behaviors(experience of visiting dental clinic and frequency of brushing teeth after lunch) moderated negative effects of daily stress on oral health status. Conclusion: The results of this study suggest implications for practical intervention on oral health and psychological stress, confirming that oral health behaviors are a component that maintains and boost the oral health among adolescents.

Medication Errors in Neonatal Care Units

Abstract: Background: Medication errors are common in the neonatal intensive care units. Aim: this current study aimed to describe the medication errors seen in the NICU, types, rates and prevention. Method: This current study was a prospective study of medication errors in two NICUs (Abu El rish El Monira NICU and Sayed Galal NICU). The study consisted of three phases; pre intervention phase, interevention phase and post intervention phase. Residents and nurses were interviewed to further investigate the weak points in the drug use process and possible causes of errors .This was followed by a data show presentation for the NICU staff to show the most common errors seen in the pre intervention phase, Intervention phase and post intervention phase to explore ideas for elimination of these medication errors at the NICU. Results: In the pre intervention phase: From total of 700 prescribing orders evaluated, 522 prescribing error were detected in the two NICUs (74.5%). The administration errors detected in the two NICUs were 488 (69.7%). Conclusions: Medication errors are common in NICUs. Fortunately, actual harm to an infant is rare. Continuous monitoring, frequent training and educational courses and presence of clinical pharmacist in the NICU will contribute to eliminate the medication errors in NICUs.

Evaluation of Environmental Sampling Methods for Detection of Staphylococcus aureus on Fomites.

Abstract: We evaluated a variety of methods to recover S. aureus from inanimate surfaces. Two contact agar plates and three swab sampling methods were tested on porous and non-porous surfaces and bar soap. The cost and ease of use of each method was also evaluated. S. aureus was recovered using all methods on both porous and non-porous surfaces. S. aureus could not be detected on three of four brands of soap.

All-Wales Licensed Premises Intervention (AWLPI): A randomised controlled trial to reduce alcohol-related violence

Abstract: BackgroundAlcohol-related violence in and in the vicinity of licensed premises continues to place a considerable burden on the United Kingdom’s (UK) health services. Robust interventions targeted at licensed premises are therefore required to reduce the costs of alcohol-related harm. Previous evaluations of interventions in licensed premises have a number of methodological limitations and none have been conducted in the UK. The aim of the trial was to determine the effectiveness of the Safety Management in Licensed Environments intervention designed to reduce alcohol-related violence in licensed premises, delivered by Environmental Health Officers, under their statutory authority to intervene in cases of violence in the workplace.Methods/DesignA national randomised controlled trial, with licensed premises as the unit of allocation. Premises were identified from all 22 Local Authorities in Wales. Eligible premises were those with identifiable violent incidents on premises, using police recorded violence data. Premises were allocated to intervention or control by optimally balancing by Environmental Health Officer capacity in each Local Authority, number of violent incidents in the 12 months leading up to the start of the project and opening hours. The primary outcome measure is the difference in frequency of violence between intervention and control premises over a 12 month follow-up period, based on a recurrent event model. The trial incorporates an embedded process evaluation to assess intervention implementation, fidelity, reach and reception, and to interpret outcome effects, as well as investigate its economic impact.DiscussionThe results of the trial will be applicable to all statutory authorities directly involved with managing violence in the night time economy and will provide the first formal test of Health and Safety policy in this environment. If successful, opportunities for replication and generalisation will be considered.Trial registrationUKCRN 14077; ISRCTN78924818.

Contribution of Socio-Demographic Factors on Antenatal Care in Bangladesh: Modeling Approach

Abstract: Background: Antenatal care (ANC) is essential for both mother and child health well-being. The risk of maternal mortality and morbidity as well as neonatal deaths can be reduced substantially through regular and proper antenatal care taken and delivery under safe and hygienic conditions. An attempt has been made to disclose how many times antenatal care (ANC) was taken by the pregnant mother and to find out the contribution of socio-demographic factors on ANC. Moreover, an effort is concentrated to find out a functional relationship between number of visits of ANC and the respondents. Data and methods: Data and necessary information of 4,921 reproductive women were obtained from the Bangladesh Demographic and Health Survey (BDHS) 2007. Multiple classification analysis (MCA) was used to identify the most important determinants of number of antenatal visit. Furthermore, negative exponential model was also employed here. Results: The results reveal that majority (37.83%) women have not taken any ANC during pregnancy and 15.18%, 12.68%, 11.22% and 6.24%, pregnant women have taken 1, 2, 3 and 4 times of ANC respectively. The result also reveal that only 1.67% pregnant women have taken 10 and above times ANC. MCA results showed that living condition, living place during pregnancy and TT injection before birth have been found to be the first, second and third contributing factors on number of ANC of pregnant mother. The grand mean of MCA result is 3.59 which indicate insufficient dose of ANC of pregnant mothers. Moreover, it is found that distribution of the respondents due to number of visits of ANC follows modified negative exponential model. Conclusions: This study demonstrates the low ANC service utilization. The utilization of the ANC service was influenced by various socio-demographic and health related factors. Hence there is a need to increase the availability and accessibility of health services to all women. Women's overall status (education, living condition, living place during pregnancy and preceding birth interval) need to be considered.

Seropositivity of Canine Distemper Virus (CDV) in Dogs Presenting at Abeokuta, Nigeria

Abstract: Background: Canine distemper (CD) is a highly contagious, multi-systemic, and potentially fatal viral disease that was once recognized as the leading cause of death in dogs. Aims: This study was carried out to detect canine distemper virus (CDV) in plasma and serum samples of vaccinated and unvaccinated dogs in Abeokuta, Nigeria. The usefulness of a commercially available rapid canine distemper virus antigen test kits was also evaluated to determine the seropositivity of CDV in dogs. Methods: Rapid canine distemper virus antigen test kits ® were used to detect the presence of CDV in dogs presented at the Veterinary Teaching Hospital, FUNAAB, Abeokuta, Nigeria. Forty dogs were enrolled in this study. Blood samples were collected from 40 dogs and screened for CDV and evaluation of post-vaccination immunity to CDV. Results: The age range of all the dogs sampled were from 3 months to 10 years. Of the 40 dogs tested, 3(7.5%) were positive for CDV and 37(92.5%) were negative. CDV was only detected in plasma samples and none in serum samples. Among 25(62.5%) dogs with known history of vaccination, 3(12.0%) were positive for CDV. None (0.0%) of the 4(10.0%) unvaccinated dogs and 11(27.5%) with unknown history of vaccination had CDV. Higher prevalence was observed in females (12.5%) than males (4.5%). CDV was only present in Boerboel (33.3%) and Alsatian breeds (5.6%). CDV was also present in apparently healthy dogs (9.7%). Conclusions: This study has further confirms the presence of CDV in 7.5% of the dogs in Abeokuta, Nigeria. The study showed significant association (p< 0.05) with age, sex, breeds, vaccination, health status, sample types and CDV seropositivity. This study further confirms the efficacy of rapid canine distemper virus antigen test kits in the detection of CDV in plasma of dogs.

Determinants of Delivery by Skilled Birth Attendants among Pregnant Women in Makueni County, Kenya

Abstract: Background: Skilled birth attendants (SBAs) can improve outcomes during delivery and postpartum by detecting and managing early complications of pregnancy and labor. The objective of this study was to determine factors associated with SBA utilization among women seeking antenatal care at rural community health units in Makueni, Kenya where less than 37% of women deliver with SBAs. Methods: Pregnant mothers were recruited at antenatal care clinics, enrolled and interviewed at baseline, then followed until delivery and for six weeks post-partum. Sociodemographic characteristics, knowledge and attitudes were compared using Chi square test and independent t tests among those who utilized SBA services and those who did not. Results: From January 2012 to January 2013, 324 pregnant women were interviewed at baseline and again at 6 weeks postpartum, of whom 172 (54%) reported delivery with an SBA. Women with secondary school education and above were 1.8 times more likely to choose skilled attendance at delivery compared to those with less education (Odds ratio (OR) 1.8, 95% confidence interval (CI): 1.02 - 2.60), and women with previous pregnancies were 40% less likely to utilize skilled attendance during delivery compared to nulliparous women (OR 0.6, CI: 0.40 - 0.95). Women with male partners who had greater than a secondary school education were more likely to delivery with an SBA present (OR), and there was a trend for pregnant mothers accompanied by their spouses to the delivery to be more likely to deliver in a health facility when compared to those accompanied by other birth companions (OR 1.4, CI: 0.73 - 2.78). Access to a vehicle as a mode of transport to the place of delivery was strongly associated with increased likelihood of delivery with an SBA (OR 24.1, CI: 14.82 - 42.64). At the postpartum visit, women stated that the amount of money they had spent for skilled delivery was $67 which was significantly higher than the $30 USD reported for unskilled delivery (p = 0.001). Conclusions: Several factors were identified as independently associated with mothers not utilizing skilled care during delivery (education level, parity, transport availability) and the cost of delivery with an SBA was found to be more than double the cost without an SBA Interventions targeting these factors could increase uptake of delivery by SBAs and improve maternal and infant health in rural Kenya and other parts of sub-Saharan Africa.

Population-level susceptibility, severity and spread of pandemic influenza: design of, and initial results from, a pre-pandemic and hibernating pandemic phase study using cross-sectional data from the Health Survey for England (HSE)

Abstract: Assessing severity and spread of a novel influenza strain at the start of a pandemic is critical for informing a targeted and proportional response. It requires community-level studies to estimate the burden of infection and disease. Rapidly initiating such studies in a pandemic is difficult. The study aims to establish an efficient system allowing real-time assessment of population susceptibility, spread of infection and clinical attack rates in the event of a pandemic. We developed and appended additional survey questions and specimen collection to the Health Survey for England (HSE) - a large, annual, rolling nationally representative general population survey recruiting throughout the year - to enable rapid population-based surveys of influenza infection and disease during a pandemic. Using these surveys we can assess the spread of the virus geographically, by age and through time. The data generated can also provide denominators for national estimates of case fatality and hospitalisation rates. Phase 1: we compared retrospectively collected HSE illness rates during the first two infection waves of the 2009 pandemic with the Flu Watch study (a prospective community cohort). Monthly and seasonal age-specific rates of illness and proportion vaccinated were compared. Phase 2: we piloted blood specimen and data collection alongside the 2012-13 HSE. We are developing laboratory methods and protocols for real-time serological assays of a novel pandemic influenza virus using these specimens, and automated programmes for analysing and reporting illness and infection rates. Phase 3: during inter-pandemic years, the study enters a holding phase, where it is included in the yearly HSE ethics application and planning procedures, allowing rapid triggering in a pandemic. Phase 4: once retriggered, the study will utilise the methods developed in phase 2 to monitor the severity and spread of the pandemic in real time. Phase 1: the rates of reported illness during the first two waves in the HSE underestimated the community burden as measured by Flu Watch, but the patterns of illness by age and time were broadly comparable. The extent of underestimation was greatest for HSE participants interviewed later in the year compared with those interviewed closer to the pandemic. Vaccine uptake in the HSE study was comparable to independent national estimates and the Flu Watch study. Phases 2 and 3: illness data and serological samples from 2018 participants were collected in the 2012-13 HSE and transferred to the University College London Hospital. In the 2013 HSE and onwards, this project was included in the annual HSE ethics and planning rounds. The HSE's underestimation of illness rates during the first two waves of the pandemic is probably due to recall bias and the limitation of being able to report only one illness when multiple illnesses per season can occur. Changes to the illness questions (reporting only recent illnesses) should help minimise these issues. Additional prospective follow-up could improve measurement of disease incidence. The representative nature of the HSE allows accurate measurements of vaccine uptake. This study is registered as ISRCTN80214280. This project was funded by the NIHR Public Health Research programme and will be published in full in Public Health Research; Vol. 3, No. 6. See the NIHR Journals Library website for further project information. This work was produced by Fragaszy et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence

Abstract: Background Violence in and around premises licensed for the on-site sale and consumption of alcohol continues to burden the NHS with assault-related injuries. Trial design A randomised controlled trial with licensed premises as the unit of allocation, with additional process and cost-effectiveness evaluations. Methods Premises were eligible (n = 837) if they were licensed for on-site sale and consumption of alcohol, were within 1 of the 22 local authorities (LAs) in Wales and had previously experienced violence. Data were analysed using Andersen–Gill recurrent event models in an intention-to-treat analysis. An embedded process evaluation examined intervention implementation, reach, fidelity, dose and receipt. An economic evaluation compared costs of the intervention with benefits. Intervention Premises were randomised to receive a violence-reduction intervention, Safety Management in Licensed Environments (SMILE), which was delivered by an environmental health practitioner (EHP; the agent). SMILE consisted of an initial risk audit to identify known risks of violence, a follow-up audit scheduled to enforce change for premises in which serious risks had been identified, structured advice from EHPs on how risks could be addressed in premises and online materials that provided educational videos and related material. Objective To develop intervention materials that are acceptable and consistent with EHPs’ statutory remit; to determine the effectiveness of the SMILE intervention in reducing violence; to determine reach, fidelity, dose and receipt of the intervention; and to consider intervention cost-effectiveness. Outcome Difference in police-recorded violence between intervention and control premises over a 455-day follow-up period. Randomisation A minimum sample size of 274 licensed premises per arm was required, rounded up to 300 and randomly selected from the eligible population. Licensed premises were randomly assigned by computer to intervention and control arms in a 1 : 1 ratio. Optimal allocation was used, stratified by LA. Premises opening hours, volume of previous violence and LA EHP capacity were used to balance the randomisation. Premises were dropped from the study if they were closed at the time of audit. Results SMILE was delivered with high levels of reach and fidelity but similar levels of dose to all premises, regardless of risk level. Intervention premises (n = 208) showed an increase in police-recorded violence compared with control premises (n = 245), although results are underpowered. An initial risk audit was less effective than normal practice (hazard ratio = 1.34, 95% confidence interval 1.20 to 1.51) and not cost-effective. Almost all eligible intervention premises (98.6%) received the initial risk audit; nearly 40% of intervention practices should have received follow-up visits but fewer than 10% received one. The intervention was acceptable to EHPs and to some premises staff, but less so for smaller independent premises. Conclusions SMILE was associated with an increase in police-recorded violence in intervention premises, compared with control premises. A lack of follow-up enforcement visits suggests implementation failure for what was seen as a key mechanism of action. There are also concerns as to the robustness of police data for targeting and assessing outcome effectiveness, while intervention premises may have received greater attention from statutory agencies and, therefore, the identification of more violence than control premises. Although SMILE had high reach and was feasible and acceptable to EHPs, it was found to be ineffective and associated with increased levels of violence, compared with normal practice and it requires additional work to promote the implementation of follow-up enforcement visits. Future work will aim to better understand the role of intervention dose on outcomes and seek more objective measures of violence for use in similar trials. Trial registration Current Controlled Trials ISRCTN78924818.