Effects of a school-based prevention programme on smoking in early adolescence: a 6-month follow-up of the ‘Eigenständig werden’ cluster randomised trial

BackgroundLittle is know about whether the effects of community engagement interventions for child survival in low-income and middle-income settings are sustained. Seasonal variation and secular trend may blur the data. Neonatal mortality was reduced in a cluster-randomised trial in Vietnam where laywomen facilitated groups composed of local stakeholders employing a problem-solving approach for 3 years. In this analysis, we aim at disentangling the secular trend, the seasonal variation and the effect of the intervention on neonatal mortality during and after the trial.MethodsIn Quang Ninh province, 44 communes were allocated to intervention and 46 to control. Births and neonatal deaths were assessed in a baseline survey in 2005, monitored during the trial in 2008–2011 and followed up by a survey in 2014. Time series analyses were performed on monthly neonatal mortality data.ResultsThere were 30 187 live births and 480 neonatal deaths. The intervention reduced the neonatal mortality from 19.1 to 11.6 per 1000 live births. The reduction was sustained 3 years after the trial. The control areas reached a similar level at the time of follow-up. Time series decomposition analysis revealed a downward trend in the intervention areas during the trial that was not found in the control areas. Neonatal mortality peaked in the hot and wet summers.ConclusionsA community engagement intervention resulted in a lower neonatal mortality rate that was sustained but not further reduced after the end of the trial. When decomposing time series of neonatal mortality, a clear downward trend was demonstrated in intervention but not in control areas.Trial registration numberISRCTN44599712, Post-results.

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Impact of a school-based water, sanitation and hygiene programme on children’s independent handwashing and toothbrushing habits: a cluster-randomised trial

International Journal of Public Health ◽

10.1007/s00038-020-01514-z ◽

2020 ◽

Vol 65 (9) ◽

pp. 1699-1709

Author(s):

Denise Duijster ◽

Helen Buxton ◽

Habib Benzian ◽

Jed Dimaisip-Nabuab ◽

Bella Monse ◽

...

Keyword(s):

Primary Schools ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Monday Morning ◽

Daily Group ◽

School Based ◽

Cluster Randomised ◽

Sanitation And Hygiene ◽

Filipino Children ◽

And Control

Abstract Objectives To explore whether a school-based water, sanitation and hygiene programme, which includes group hygiene activities, contributes to the formation of independent handwashing and toothbrushing habits among Filipino children. Methods In this cluster-randomised trial, twenty primary schools were randomly allocated to the intervention or control arm. Intervention schools received group handwashing facilities and implemented daily group handwashing and toothbrushing activities. A soap use to toilet event ratio was calculated to measure children’s independent handwashing behaviour after toilet use, and dental plaque accumulation on Monday morning was measured as a proxy indicator for children’s independent toothbrushing behaviour at home. Results Four months after implementation, handwashing and toothbrushing behaviours did not significantly differ between intervention and control schools. The mean soap use in intervention schools and control schools was 0.41 g and 0.30 g per toilet event, respectively (p = 0.637). Compared to baseline, mean plaque scores reduced by 4.2% and 3.5% in intervention and control schools, respectively (p = 0.857). Conclusions Although health benefits have been established, school-based group handwashing and toothbrushing may not be sufficient to increase children’s uptake of independent hygiene behaviours.

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Policy-oriented, school-based physical activity intervention to prevent childhood obesity in China (the health legacy project of the second Summer Youth Olympic Games): a cluster randomised trial

The Lancet Diabetes & Endocrinology ◽

10.1016/s2213-8587(16)30364-3 ◽

2016 ◽

Vol 4 ◽

pp. S9 ◽

Cited By ~ 3

Author(s):

Fei Xu ◽

Zhiyong Wang ◽

Qing Ye ◽

Lap Ah Tse ◽

Hong Xue ◽

...

Keyword(s):

Physical Activity ◽

Childhood Obesity ◽

Olympic Games ◽

Physical Activity Intervention ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

School Based ◽

Cluster Randomised

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Precommitting to choose wisely about low-value services: a stepped wedge cluster randomised trial

BMJ Quality & Safety ◽

10.1136/bmjqs-2017-006699 ◽

2017 ◽

Vol 27 (5) ◽

pp. 355-364 ◽

Cited By ~ 14

Author(s):

Jeffrey Todd Kullgren ◽

Erin Krupka ◽

Abigail Schachter ◽

Ariel Linden ◽

Jacquelyn Miller ◽

...

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Randomised Trial ◽

Choosing Wisely ◽

Cluster Randomised Trial ◽

Low Back ◽

Stepped Wedge ◽

Intervention Period ◽

Cluster Randomised

BackgroundLittle is known about how to discourage clinicians from ordering low-value services. Our objective was to test whether clinicians committing their future selves (ie, precommitting) to follow Choosing Wisely recommendations with decision supports could decrease potentially low-value orders.MethodsWe conducted a 12-month stepped wedge cluster randomised trial among 45 primary care physicians and advanced practice providers in six adult primary care clinics of a US community group practice.Clinicians were invited to precommit to Choosing Wisely recommendations against imaging for uncomplicated low back pain, imaging for uncomplicated headaches and unnecessary antibiotics for acute sinusitis. Clinicians who precommitted received 1–6 months of point-of-care precommitment reminders as well as patient education handouts and weekly emails with resources to support communication about low-value services.The primary outcome was the difference between control and intervention period percentages of visits with potentially low-value orders. Secondary outcomes were differences between control and intervention period percentages of visits with possible alternate orders, and differences between control and 3-month postintervention follow-up period percentages of visits with potentially low-value orders.ResultsThe intervention was not associated with a change in the percentage of visits with potentially low-value orders overall, for headaches or for acute sinusitis, but was associated with a 1.7% overall increase in alternate orders (p=0.01). For low back pain, the intervention was associated with a 1.2% decrease in the percentage of visits with potentially low-value orders (p=0.001) and a 1.9% increase in the percentage of visits with alternate orders (p=0.007). No changes were sustained in follow-up.ConclusionClinician precommitment to follow Choosing Wisely recommendations was associated with a small, unsustained decrease in potentially low-value orders for only one of three targeted conditions and may have increased alternate orders.Trial registration numberNCT02247050; Pre-results.

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Effectiveness of delivering integrated COPD care at public healthcare facilities: a cluster randomised trial in Pakistan

BJGP Open ◽

10.3399/bjgpopen18x101634 ◽

2019 ◽

Vol 3 (1) ◽

pp. bjgpopen18X101634

Author(s):

Muhammad Amir Khan ◽

Nida Khan ◽

John D Walley ◽

Muhammad Ahmar Khan ◽

Joseph Hicks ◽

...

Keyword(s):

Public Health ◽

Primary Outcome ◽

Clinical Care ◽

Randomised Trial ◽

Health Facilities ◽

Cluster Randomised Trial ◽

Public Healthcare ◽

Public Health Facilities ◽

Cluster Randomised

BackgroundIn Pakistan chronic obstructive pulmonary disease (COPD) prevalence is 2.1% in adults aged >40 years. Despite being a health policy focus, integrated COPD care has remained neglected, with wide variation in practice.AimTo assess whether enhanced care at public health facilities resulted in better control of COPD, treatment adherence, and smoking cessation.Design & settingA two-arm cluster randomised controlled trial was undertaken in 30 public health facilities (23 primary and 7 secondary), across three districts of Punjab, between October 2014–December 2016. Both arms had enhanced diagnosis and patient recording processes. Intervention facilities also had clinical care guides; drugs for COPD; patient education flipcharts; associated staff training; and mobile phone follow-up.MethodFacilities were randomised in a 1:1 ratio (sealed envelope independent lottery method), and 159 intervention and 154 control patients were recruited. The eligibility criteria were as follows: diagnosed with COPD, aged ≥18 years, and living in the catchment area. The primary outcome was change in BODE (Body mass index, airway Obstruction, Dyspnoea, Exercise capacity) index score from baseline to final follow-up visit. Staff and patients were not blinded.ResultsSix-month primary outcomes were available for 147/159 (92.5%) intervention and 141/154 (91.6%) control participants (all clusters). The primary outcome results cluster-level analysis were as follows: mean intervention outcome = -1.67 (95% confidence intervals [CI] = -2.18 to -1.16); mean control outcome = -0.66 (95% CI = -1.09 to -0.22); and covariate-adjusted mean intervention–control difference = -0.96 (95% CI = -1.49 to -0.44; P = 0.001).ConclusionThe findings of this trial and a separate process evaluation study support the scaling of this integrated COPD care package at primary and secondary level public health facilities in Pakistan and similar settings.

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