scholarly journals Effects of 1 y of free school fruit on intake of fruits, vegetables, and unhealthy snacks: 14 y later

2018 ◽  
Vol 108 (6) ◽  
pp. 1309-1315 ◽  
Author(s):  
Tonje Holte Stea ◽  
Ingrid Marie Hovdenak ◽  
Jannike Rønnestad ◽  
Kjersti Rennestraum ◽  
Frøydis Nordgård Vik ◽  
...  
Keyword(s):  
Fruits And Vegetables ◽  
Intervention Group ◽  
Baseline Survey ◽  
Control Group ◽  
Intervention Period ◽  
Long Term Effects ◽  
Intervention Effects ◽  
Sample Mean ◽  
Unhealthy Snacks

ABSTRACT Background There are not many studies evaluating the long-term effects of fruit and vegetable interventions. Objective We examined the effects of 1 y of free fruit in elementary school on long-term consumption of fruit, vegetables, and unhealthy snacks, according to sex and educational attainment, 14 y after the intervention period. Design In 2001, the baseline survey of the longitudinal cohort, Fruits and Vegetables Make the Marks (FVMM), included 1950 children (mean age: 11.8 y) attending 38 randomly drawn elementary schools from 2 counties in Norway. In the following 10 mo, 9 schools served as intervention schools by participating in the Norwegian School Fruit Program for free, whereas 29 schools served as control schools. A follow-up survey conducted in 2016 included 982 participants (50%) from the original study sample (mean age: 26.5 y). The consumption of fruit and vegetables was measured by a 24-h recall (portions per day), and the consumption of unhealthy snacks was measured by food-frequency questions (portions per week). Linear mixed models were performed to test possible intervention effects on the consumption of fruit, vegetables, and unhealthy snacks 14 y after the intervention period. Results No overall intervention effects after 14 y due to the free-fruit scheme on the consumption of fruit, vegetables, and unhealthy snacks were observed, but significant interactions showed a sustained higher frequency of fruit consumption among females in the intervention group compared with the control group [mean difference (MD): 0.38 portions/d; P = 0.023] and that this effect was only significant among less-educated females (MD: 0.73 portions/d; P = 0.043). No significant long-term intervention effects were observed in the consumption of fruit among highly educated females and males nor in the consumption of vegetables or unhealthy snacks. Conclusion Results from the present study indicate that receiving free fruit at school for 1 y may have positive long-term effects for females without higher education.

Impact of a New Parent Behavioral-Schema Training on Children with ADHD: A Pragmatic Control Trial

2020 ◽  
pp. 108705472095971
Author(s):  
Maly Solan ◽  
Anat Brunstein Klomek ◽  
Galia Ankori ◽  
Asheda Bloch ◽  
Alan Apter ◽  
...  
Keyword(s):  
Intervention Group ◽  
Future Research ◽  
Control Group ◽  
Growth Curve Analysis ◽  
Long Term Effects ◽  
Hyperactivity Disorder ◽  
Behavioral Program ◽  
Symptom Relapse ◽  
Therapy Strategies

Objectives: To examine whether adding schema therapy strategies to the conventional parent behavioral program prevents symptom relapse in children with attention deficit hyperactivity disorder (ADHD). Method: The intervention was designed as an adaptive pragmatic control trial. The parent behavioral training and schema-enhanced parent behavior therapy (SPBT) protocols were delivered to the control group (40 parents of 23 children) and experimental group (97 parents of 54 children), respectively. Participants were assessed at baseline, mid-treatment, and termination. Parents and teachers indicated the severity of ADHD and comorbid symptoms through their responses to standardized questionnaires designed for this purpose. Results: A nested growth curve analysis demonstrated that participants in the schema-enhanced intervention group had a lower risk of symptom relapse than the control group. Conclusion: Participation in the SPBT program significantly reduced relapse rates by the end of the intervention. Future research may determine the long-term effects of the treatment.

scholarly journals Effect of a free healthy school meal on fruit, vegetables and unhealthy snacks intake in Norwegian 10- to 12-year-old children

2020 ◽  
Author(s):  
Frøydis Nordgård Vik ◽  
Kaia Elisabeth Paulsen Heslien ◽  
Wendy Van Lippevelde ◽  
Nina Cecilie Øverby
Keyword(s):  
School Children ◽  
Intervention Group ◽  
Dietary Guidelines ◽  
Fruit And Vegetables ◽  
Control Group ◽  
Intervention Effects ◽  
School Meal ◽  
Weekly Intake ◽  
One Year ◽  
Unhealthy Snacks

Abstract Background Norwegian children have a lower intake of fruit, vegetables, and a higher intake of unhealthy snacks compared to dietary guidelines. Such dietary inadequacies may be detrimental for their current and future health. Schools are favorable settings to establish healthy eating practices. Still, no school meal arrangement is provided in Norway, and most children typically bring packed lunches from home. The aim of this study was to investigate whether serving a free healthy school meal for one year resulted in a higher intake of fruit and vegetables and a lower intake of unhealthy snacks in total among 10-12-year-olds in Norway.Methods The School Meal Project in Southern Norway was a non-randomized trial in two elementary schools in rural areas in the school year 2014/2015. The study sample consisted of 10- to 12-year-old children; an intervention group (N=55) and a control group (N=109) resulting in a total of 164 school children at baseline. A food frequency questionnaire was completed by the children at baseline, at five months follow-up and after one year to assess fruit, vegetable and snacks intake. Multiple linear regression analyses were performed to assess intervention effects on overall intake of fruit and vegetables and unhealthy snacks.Results Serving of a free healthy school meal for one year resulted in a higher weekly intake of vegetables on sandwiches in the intervention group compared to the control group, adjusted for baseline intake (B: 1.11 (95% CI: .38, 1.85)) at the end of the intervention. No other significant intervention effects were found for the remaining fruit and vegetables measures. Serving of a free healthy school meal did not result in a lower weekly intake of unhealthy snacks (i.e. potato chips, candy and sugar sweetened beverages) in the intervention group compared to the control group.Conclusions A free healthy school meal resulted in a higher weekly intake of vegetables on sandwiches but did not significantly change any other investigated dietary behaviors. However, given the inadequate intake of vegetables among children and that even moderate improvements have public health relevance, a free healthy school meal for all school children could be beneficial.

scholarly journals Effect of a free healthy school meal on fruit, vegetables and unhealthy snacks intake in Norwegian 10- to 12-year-old children

2020 ◽  
Author(s):  
Frøydis Nordgård Vik ◽  
Kaia Elisabeth Paulsen Heslien ◽  
Wendy Van Lippevelde ◽  
Nina Cecilie Øverby
Keyword(s):  
School Children ◽  
Intervention Group ◽  
Dietary Guidelines ◽  
Fruit And Vegetables ◽  
Control Group ◽  
Intervention Effects ◽  
School Meal ◽  
Weekly Intake ◽  
One Year ◽  
Unhealthy Snacks

Abstract Background: Norwegian children have a lower intake of fruit, vegetables, and a higher intake of unhealthy snacks compared to dietary guidelines. Such dietary inadequacies may be detrimental for their current and future health. Schools are favorable settings to establish healthy eating practices. Still, no school meal arrangement is provided in Norway, and most children typically bring packed lunches from home. The aim of this study was to investigate whether serving a free healthy school meal for one year resulted in a higher intake of fruit and vegetables and a lower intake of unhealthy snacks in total among 10-12-year-olds in Norway.Methods: The School Meal Project in Southern Norway was a non-randomized trial in two elementary schools in rural areas in the school year 2014/2015. The study sample consisted of 10- to 12-year-old children; an intervention group (N=55) and a control group (N=109) resulting in a total of 164 school children at baseline. A food frequency questionnaire was completed by the children at baseline, at five months follow-up and after one year to assess fruit, vegetable and snacks intake. Multiple linear regression analyses were performed to assess intervention effects on overall intake of fruit and vegetables and unhealthy snacks.Results: Serving of a free healthy school meal for one year was associated with a higher weekly intake of vegetables on sandwiches in the intervention group compared to the control group, adjusted for baseline intake (B: 1.11 (95% CI: .38, 1.85)) at the end of the intervention. No other significant intervention effects were found for the remaining fruit and vegetables measures. Serving of a free healthy school meal was not associated with a lower weekly intake of unhealthy snacks (i.e. potato chips, candy, sugar sweetened beverages) in the intervention group compared to the control group. Conclusions: A free healthy school meal was associated with a higher weekly intake of vegetables on sandwiches but did not significantly change any other investigated dietary behaviors. However, given the inadequate intake of vegetables among children and that even moderate improvements have public health relevance, a free healthy school meal for all school children could be beneficial. Trial registration: ISRCTN61703361 Date of registration: December 3rd, 2018 Retrospectively registered

scholarly journals Long-Term Effects of Financial Incentives for General Practitioners on Quality Indicators in the Treatment of Patients With Diabetes Mellitus in Primary Care—A Follow-Up Analysis of a Cluster Randomized Parallel Controlled Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Rahel Meier ◽  
Corinne Chmiel ◽  
Fabio Valeri ◽  
Leander Muheim ◽  
Oliver Senn ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Medical Records ◽  
Financial Incentives ◽  
Controlled Trial ◽  
Intervention Group ◽  
Routine Data ◽  
Control Group ◽  
Long Term Effects ◽  
Patients With Diabetes

Background: The effect of financial incentives on the quality of primary care is of high interest, and so is its sustainability after financial incentives are withdrawn.Objective: To assess both long-term effects and sustainability of financial incentives for general practitioners (GPs) in the treatment of patients with diabetes mellitus based on quality indicators (QIs) calculated from routine data from electronic medical records.Design/Participants: Randomized controlled trial using routine data from electronic medical records of patients with diabetes mellitus of Swiss GPs.Intervention: During the study period of 24 months, all GPs received bimonthly feedback reports with information on their actual treatment as reflected in QIs. In the intervention group, the reports were combined with financial incentives for quality improvement. The incentive was stopped after 12 months.Measurements: Proportion of patients meeting the process QI of annual HbA1c measurements and the clinical QI of blood pressure levels below 140/85 mmHg.Results: A total of 71 GPs from 43 different practices were included along with 3,854 of their patients with diabetes mellitus. Throughout the study, the proportion of patients with annual HbA1c measurements was stable in the intervention group (78.8–78.9%) and decreased slightly in the control group (81.5–80.2%) [odds ratio (OR): 1.21; 95% CI: 1.04–1.42, p < 0.05]. The proportion of patients achieving blood pressure levels below 140/85 mmHg decreased in the control group (51.2–47.2%) and increased in the intervention group (49.7–51.9%) (OR: 1.18; 95% CI: 1.04–1.35, p < 0.05) where it peaked at 54.9% after 18 months and decreased steadily over the last 6 months.Conclusion: After the withdrawal of financial incentives for the GPs after 12 months, some QIs still improved, indicating that 1 year might be too short to observe the full effect of such interventions. The decrease in QI achievement rates after 18 months suggests that the positive effects of time-limited financial incentives eventually wane.

scholarly journals Mediating Effects of Stigma and Depressive Symptoms in a Social Media–Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial

10.2196/27897 ◽  
2021 ◽  
Vol 23 (11) ◽  
pp. e27897
Author(s):  
Yiran Li ◽  
Yan Guo ◽  
Y Alicia Hong ◽  
Chengbo Zeng ◽  
Yu Zeng ◽  
...  
Keyword(s):  
Social Media ◽  
Depressive Symptoms ◽  
Intervention Group ◽  
Control Group ◽  
People Living With Hiv ◽  
Mediating Effects ◽  
Long Term Effects ◽  
Related Stigma ◽  
Living With Hiv

Background Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions. Objective This study aims to explore the intervention mechanisms of a social media–based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period. Methods We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants’ QOL. Results About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported. Conclusions These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media–based interventions that can address HIV-related stigma and alleviate depressive symptoms. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019

scholarly journals Effect of a free healthy school meal on fruit, vegetables and unhealthy snacks intake in Norwegian 10- to 12-year-old children

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Frøydis N. Vik ◽  
Kaia E. P. Heslien ◽  
Wendy Van Lippevelde ◽  
Nina C. Øverby
Keyword(s):  
School Children ◽  
Intervention Group ◽  
Dietary Guidelines ◽  
Fruit And Vegetables ◽  
Control Group ◽  
Intervention Effects ◽  
School Meal ◽  
Weekly Intake ◽  
One Year ◽  
Unhealthy Snacks

Abstract Background Norwegian children have a lower intake of fruit, vegetables, and a higher intake of unhealthy snacks compared to dietary guidelines. Such dietary inadequacies may be detrimental for their current and future health. Schools are favorable settings to establish healthy eating practices. Still, no school meal arrangement is provided in Norway, and most children typically bring packed lunches from home. The aim of this study was to investigate whether serving a free healthy school meal for one year resulted in a higher intake of fruit and vegetables and a lower intake of unhealthy snacks in total among 10–12-year-olds in Norway. Methods The School Meal Project in Southern Norway was a non-randomized trial in two elementary schools in rural areas in the school year 2014/2015. The study sample consisted of 10- to 12-year-old children; an intervention group (N = 55) and a control group (N = 109) resulting in a total of 164 school children at baseline. A food frequency questionnaire was completed by the children at baseline, at five months follow-up and after one year to assess fruit, vegetable, and snacks intake. Multiple linear regression analyses were performed to assess intervention effects on overall intake of fruit and vegetables and unhealthy snacks. Results Serving of a free healthy school meal for one year was associated with a higher weekly intake of vegetables on sandwiches in the intervention group compared to the control group, adjusted for baseline intake (B: 1.11 (95% CI: .38, 1.85)) at the end of the intervention. No other significant intervention effects were found for the remaining fruit and vegetables measures. Serving of a free healthy school meal was not associated with a lower weekly intake of unhealthy snacks (i.e. potato chips, candy, sugar sweetened beverages) in the intervention group compared to the control group. Conclusions A free healthy school meal was associated with a higher weekly intake of vegetables on sandwiches but did not significantly change any other investigated dietary behaviors. However, given the inadequate intake of vegetables among children and that even moderate improvements have public health relevance, a free healthy school meal for all school children could be beneficial. Trial registration ISRCTN61703361. Date of registration: December 3rd, 2018. Retrospectively registered.

Effectiveness of a School-Based Intervention to Empower Children to Cope With Advertising

2020 ◽  
Vol 32 (3) ◽  
pp. 107-118 ◽  
Author(s):  
Esther Rozendaal ◽  
Bernd Figner
Keyword(s):  
Coping Strategies ◽  
Structural Equation ◽  
Coping Behavior ◽  
Intervention Group ◽  
Future Research ◽  
Control Group ◽  
Long Term Effects ◽  
Mixed Effect ◽  
School Based

Abstract. This study tested the effectiveness of a theory-driven, school-based advertising intervention entitled Ad Masters that aimed to stimulate children’s advertising coping behavior in the current media landscape. A cluster randomized controlled trial was completed among 704 children (7–12 years old) in schools. The schools were allocated to either the intervention group ( n = 399) or control group ( n = 305). Both short-term (directly after the intervention) and long-term effects (3 months after the end of the intervention) were measured. Bayesian mixed-effect analyses showed positive short- and long-term effects of the intervention on children’s understanding of advertising’s tactics. Structural equation analysis showed that the intervention-induced changes in children’s understanding of advertising’s tactics were not related to any changes in their use of advertising coping strategies or their advertising susceptibility. No other intervention effects were found. However, structural equation analyses showed that, regardless of the intervention, motivation and ability to use advertising coping strategies are both associated with children’s actual coping behavior. These findings indicate that motivation and ability to effectively use advertising coping strategies are important empowering factors that should be taken into account in future research on children’s advertising coping behavior and in advertising intervention development.

The Salford Family Intervention Project: Relapse Rates of Schizophrenia at Five and Eight Years

1994 ◽  
Vol 165 (6) ◽  
pp. 829-832 ◽  
Author(s):  
Nicholas Tarrier ◽  
Christine Barrowclough ◽  
Kathleen Porceddu ◽  
Elizabeth Fitzpatrick
Keyword(s):  
Predictive Power ◽  
Expressed Emotion ◽  
Intervention Group ◽  
Family Intervention ◽  
Control Group ◽  
Long Term Effects ◽  
The Family ◽  
Schizophrenic Patients ◽  
Relapse Rates

BackgroundThis study assessed the long-term effects of family intervention on schizophrenic relapse.MethodForty schizophrenic patients who had participated in a family intervention trial and who had not experienced relapse at two years after discharge from the index admission were traced through case notes and hospital records. The percentage of patients experiencing a relapse was estimated for patients in the family intervention group, the high-EE control group, and the low-EE control group, at five years and eight years after discharge.ResultsThere were significantly fewer relapses in the family intervention group than in the high-EE control group at both five years and eight years. The number of relapses in the low-EE control group was lower than in the high-EE control group, but this just failed to reach significance.ConclusionsThe benefit of family intervention and the predictive power of EE are sustained over eight years. Expressed emotion (EE) has remained a remarkably robust predictor of relapse in schizophrenia. Kavanagh (1992) cited 20 out of 23 prospective studies that showed patients who returned to live with high-EE relatives had higher relapse rates over 9–12 months after discharge than did patients returning to live with low-EE relatives. Seventeen of these studies reported this difference to be significant.British Journal of Psychiatry (1994),165, 829–832

scholarly journals Effectiveness of a Behavior Change Technique–Based Smartphone Game to Improve Intrinsic Motivation and Physical Activity Adherence in Patients With Type 2 Diabetes: Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Christoph Höchsmann ◽  
Denis Infanger ◽  
Christopher Klenk ◽  
Karsten Königstein ◽  
Steffen P Walz ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Behavior Change ◽  
Intrinsic Motivation ◽  
Intervention Group ◽  
Control Group ◽  
Intervention Period ◽  
Behavior Change Technique

BACKGROUND Regular physical activity (PA) is an essential component of a successful type 2 diabetes treatment. However, despite the manifest evidence for the numerous health benefits of regular PA, most patients with type 2 diabetes remain inactive, often due to low motivation and lack of PA enjoyment. A recent and promising approach to help overcome these PA barriers and motivate inactive individuals to change their PA behavior is PA-promoting smartphone games. While short-term results of these games are encouraging, the long-term success in effectively changing PA behavior has to date not been confirmed. It is possible that an insufficient incorporation of motivational elements or flaws in gameplay and storyline in these games affect the long-term motivation to play and thereby prevent sustained changes in PA behavior. We aimed to address these design challenges by developing a PA-promoting smartphone game that incorporates established behavior change techniques and specifically targets inactive type 2 diabetes patients. OBJECTIVE To investigate if a self-developed, behavior change technique-based smartphone game designed by an interdisciplinary team is able to motivate inactive individuals with type 2 diabetes for regular use and thereby increase their intrinsic PA motivation. METHODS Thirty-six inactive, overweight type 2 diabetes patients (45-70 years of age) were randomly assigned to either the intervention group or the control group (one-time lifestyle counseling). Participants were instructed to play the smartphone game or to implement the recommendations from the lifestyle counseling autonomously during the 24-week intervention period. Intrinsic PA motivation was assessed with an abridged 12-item version of the Intrinsic Motivation Inventory (IMI) before and after the intervention. In addition, adherence to the game-proposed PA recommendations during the intervention period was assessed in the intervention group via the phone-recorded game usage data. RESULTS Intrinsic PA motivation (IMI total score) increased significantly in the intervention group (+6.4 (SD 4.2; P<.001) points) while it decreased by 1.9 (SD 16.5; P=.623) points in the control group. The adjusted difference between both groups was 8.1 (95% CI 0.9, 15.4; P=.029) points. The subscales “interest/enjoyment” (+2.0 (SD 1.9) points, P<.001) and “perceived competence” (+2.4 (SD 2.4) points, P<.001) likewise increased significantly in the intervention group while they did not change significantly in the control group. The usage data revealed that participants in the intervention group used the game for an average of 131.1 (SD 48.7) minutes of in-game walking and for an average of 15.3 (SD 24.6) minutes of strength training per week. We found a significant positive association between total in-game training (min) and change in IMI total score (beta=0.0028; 95% CI 0.0007-0.0049; P=.01). CONCLUSIONS In inactive individuals with type 2 diabetes, a novel smartphone game incorporating established motivational elements and personalized PA recommendations elicits significant increases in intrinsic PA motivation that are accompanied by de-facto improvements in PA adherence over 24 weeks. CLINICALTRIAL ClinicalTrials.gov NCT02657018; https://clinicaltrials.gov/ct2/show/NCT02657018

scholarly journals Study Protocol for Evaluation of an Extended Maintenance Intervention on Life Satisfaction and BMI Among 7–14-Year-Old Children Following a Stay at a Residential Health Camp in Denmark

2021 ◽  
Vol 9 ◽  
Author(s):  
Mette Juul Kristoffersen ◽  
Susan Ishøy Michelsen ◽  
Mette Rasmussen ◽  
Pernille Due ◽  
Lau Caspar Thygesen ◽  
...  
Keyword(s):  
Life Satisfaction ◽  
Study Protocol ◽  
Quantitative Methods ◽  
Intervention Group ◽  
The Other ◽  
Secondary Outcome ◽  
Control Group ◽  
Long Term Effects ◽  
Maintenance Intervention

Background: It is challenging to maintain effects of public health interventions. For residential health camps benefits often disappear as the child returns home. Furthermore, long-term effects are often not measured or reported. This paper presents the study protocol for an evaluation of an extended maintenance intervention offered to children who have completed a 10-week residential health camp at one of the five Danish Christmas Seal Houses (DCSH). The target group of DSCH is 7–14-year-olds with social, mental, and/or overweight issues and the overall aim of the camp is to increase life satisfaction and a healthy lifestyle. The primary aim of this study is to assess the effectiveness of the maintenance intervention on children's life satisfaction (primary outcome) and BMI Z-score (secondary outcome) 1 year after health camp.Methods: The extended maintenance intervention is developed by DCSH and delivered to each child and family individually by an intervention coordinator to help children maintain positive benefits of the health camp on life satisfaction and health behaviors after returning to their homes. Intervention activities target the child and the family. The effect will be tested in a quasi-experimental design: The intervention is offered to half of the children at one of the five DSCH (intervention group, N~144) while the other half and the children at the other four DSCH receive a standard maintenance intervention (control group, N~894). Children will complete questionnaires on life satisfaction measured by an adapted version of the Cantril ladder and height and weight prior to health camp, at the end of health camp, 3 months and 1 year after the end of health camp. To enable per protocol analysis and nuanced interpretation of effect estimates, we will monitor the implementation of the intervention by a process evaluation study among children, parents, and follow up coordinators using qualitative and quantitative methods.Discussion: We present a systematic approach to evaluating practice-based interventions in a research design. The study will provide new knowledge on the effectiveness of individualized maintenance interventions on long-term effects on life satisfaction and weight loss among children.Trial registration: Prospectively registered at Current Controlled Trials ISRCTN 13011465 https://www.isrctn.com/ISRCTN13011465

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