Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools

BACKGROUND: Preschools are often focal points for the spread of illness among young children. The objective of this preschool intervention trial was to determine whether a hygiene program can promote handwashing and thereby reduce illness absenteeism. METHODS: This cluster randomized trial included 40 Jerusalem preschools with 1029 children for 6 baseline days and 66 study days, yielding 73,779 child days. The main outcomes were rates of handwashing and illness absenteeism. The intervention included an educational program and environmental changes. A simultaneous subtrial was run to test a home component. RESULTS: This multi-site intervention program produced sustained behavioral and environmental changes over a 6-month period. An approximately threefold increase in handwashing with soap was observed among preschool children exposed to the intervention. Neither the preschool nor the home intervention program reduced illness absenteeism or overall absenteeism. CONCLUSIONS: This trial illuminates the potential of the preschool as a promising venue for health promotion activities leading to sustained behavioral change, yet suggests the need for enhanced approaches for reducing illness absenteeism.     

Effect of a school-based intervention to promote healthy lifestyles in 7–11 year old children

Background  

Physical inactivity is recognised as a public health concern within children and interventions to increase physical activity are needed. The purpose of this research was to evaluate the effect of a school-based healthy lifestyles intervention on physical activity, fruit and vegetable consumption, body composition, knowledge, and psychological variables.     

Weaknesses and strengths in assessing early childhood programmes: an assessment of an early childhood Spanish trilingual programme in two‐ to three‐year‐old children

This article gives an account of the results from an assessment of an early childhood education programme, conducted over the course of two academic years (1999–2000 and 2000–2001), in a centre in northeastern Spain. The purpose of the assessment was to discover how a particular educational programme contributed to the short‐term competency levels of children aged from two to three years old. The programme’s curriculum encompassed different areas of development, including physical exercise and motor movement and social and linguistic development, using a unique teaching methodology that exposes the children to three different languages at the same time. The article includes a discussion of the weaknesses and strengths in implementing evaluation in early childhood education programmes, and concludes with some guiding principles that may prove useful in the evaluation of the appropriateness of any given assessment method used within an early childhood educational programme.     

An impact and feasibility evaluation of a six-week (nine hour) active play intervention on fathers’ engagement with their preschool children: a feasibility study

Research has demonstrated the benefits of father involvement with their children and a link between uninvolved fatherhood and societal problems. Children's Centres (n?=?15) received 6?×?90-minute active play sessions designed to foster 6 aspects of parental engagement. Fathers’ engagement and attitudes to child physical activity were measured pre- and post-intervention via questionnaire. Acceptability of the intervention was explored through participant and staff focus groups. Results showed no effect on overall time fathers spent with their child during the week (t (36)?=?0.178, p?=?0.860) and the weekend (t (36)?=?1.166, p?=?0.252). Qualitative results demonstrated the sessions provided opportunities for fathers to spend quality time with their children. Parenting self-efficacy increased across the subscale control, t (36)?=??2.97, p?=?0.04. Fathers increased awareness of their role in motivating their child to play (z?=??2.46, p?=?0.01). Further longitudinal research is recommended.     

Food choices of young African-American and Latino adolescents: where do parents fit in?

To gain insight into parents' perceptions of the food preferences of their young adolescents, and their negotiating and decision-making strategies around food purchasing and meals, four focus groups were held with 32 African-American parents and three focus groups with 14 Spanish-dominant, first-generation immigrant Latina mothers. Most participants were of low socioeconomic status and were single parents. Many African-American parents emphasized children's growing appetites and preferences for fast food. Many reported making weekday dinner decisions jointly with the child or allowing the child to eat a lunch-like alternative, and allowing serve-yourself meals on weekends. A few prepared traditional ethnic foods. Latina parents reported that their children liked ethnic foods and fast/junk foods. They emphasized buying foods their children wanted, making no eating restrictions, and preparing traditional ethnic dinners without alternatives. African-American and Latina parents displayed concern over whether to place restrictions on young adolescents' eating. Further research is needed on the ways in which socioeconomic inequalities compound barriers to healthful eating, with particular attention to low income and immigrant populations.     

End‐of‐life decision‐making in Belgium,Denmark, Sweden and Switzerland: does place of death make a difference?

OBJECTIVE: To examine differences in end-of-life decision-making in patients dying at home, in a hospital or in a care home. DESIGN: A death certificate study: certifying physicians from representative samples of death certificates, taken between June 2001 and February 2002, were sent questionnaires on the end-of-life decision-making preceding the patient's death. SETTING: Four European countries: Belgium (Flanders), Denmark, Sweden, and Switzerland (German-speaking part). MAIN OUTCOME MEASURES: The incidence of and communication in different end-of-life decisions: physician-assisted death, alleviation of pain/symptoms with a possible life-shortening effect, and non-treatment decisions. RESULTS: Response rates ranged from 59% in Belgium to 69% in Switzerland. The total number of deaths studied was 12 492. Among all non-sudden deaths the incidence of several end-of-life decisions varied by place of death. Physician-assisted death occurred relatively more often at home (0.3-5.1%); non-treatment decisions generally occurred more often in hospitals (22.4-41.3%), although they were also frequently taken in care homes in Belgium (26.0%) and Switzerland (43.1%). Continuous deep sedation, in particular without the administration of food and fluids, was more likely to occur in hospitals. At home, end-of-life decisions were usually more often discussed with patients. The incidence of discussion with other caregivers was generally relatively low at home compared with in hospitals or care homes. CONCLUSION: The results suggest the possibility that end-of-life decision-making is related to the care setting where people die. The study results seem to call for the development of good end-of-life care options and end-of-life communication guidelines in all settings.     

Does participation in a population-based dietary intervention scheme have a lasting impact on fruit intake in young children?

BACKGROUND: The National Schools Fruit Scheme (NSFS) is intended to improve fruit intake in young children by providing free daily fruit at school. METHODS: We used a parentally completed questionnaire for three consecutive years to study fruit intake in young children before, during and after participation in the NSFS compared with a control region. RESULTS: In 2003, 2004 and 2005, a total of 224, 220 and 179 schools, respectively, were studied with responses from 5,606, 5,111 and 3,382 children for each survey. Between 2003 and 2004, individual fruit consumption in the intervention region increased by more (from a median of 7.5 to 14.0 pieces/week) than in the control region (from a median of 9.2-11.0 pieces/week), resulting in a difference (P < 0.001) between the two regions in 2004. However, after ceasing to be eligible for the NSFS, fruit intake in children in the intervention region fell to a median of 12 pieces per week, lower than that in the control region (median value of 14 pieces per week, P = 0.02). CONCLUSIONS: School-based fruit distribution schemes providing free fruit at school appear to be an effective means of increasing dietary fruit intake in young children, including those who live in relatively socio-economically deprived areas. However, this approach does not influence fruit intake after the provision of free fruit ends, so schemes may need to be sustained to provide the maximum benefit to young children.     

How active are we? Levels of routine physical activity in children and adults

The accurate measurement of physical activity is fraught with problems in adults, but more especially in children because they have more complex and multi-dimensional activity patterns. In addition, the results of different studies are often difficult to interpret and compare, because of the diversity of methodological approaches, differences in data analysis and reporting, and the adoption of varying definitions of what constitutes an appropriate level of activity. Furthermore, inactivity is seldom quantified directly. Although there exists an extensive literature documenting the health benefits of regular physical activity in adults, activity-health relationships in children are not clear-cut. Current recommendations reinforce the concept of health-related activity, accumulating 30 min moderate-intensity exercise on at least 5 d/week (adults) and 1 h moderate-intensity exercise/d (children). Evidence suggests a high prevalence of inactivity in adults, but whether or not inactivity is increasing cannot be assessed currently. Similarly, no definite conclusions are justified about either the levels of physical activity of children, or whether these are sufficient to maintain and promote health. Data to support the belief that activity levels in childhood track into adulthood are weak. Inactivity is associated with an increased risk of weight gain and obesity, but causality remains to be established. In children there is strong evidence to demonstrate a dose response relationship between the prevalence and incidence of obesity and time spent viewing television. Future research should focus on refining methodology for physical activity assessment to make it more sensitive to the different dimensions and contexts of activity in different age-groups.     

Can informed choice invitations lead to inequities in intentions to make lifestyle changes among participants in a primary care diabetes screening programme? Evidence from a randomized trial

Objective

To test whether information about benefits and harms of screening for type 2 diabetes increases intentions to make lifestyle changes amongst attenders, predominantly among the socially advantaged and those with a strong future time orientation.

Study design

Planned subgroup analysis of attenders for screening participating in a randomized controlled trial of an informed choice invitation vs a standard invitation to attend for type 2 diabetes screening.

Methods

Potentially eligible participants were identified from practice registers using routine data which were used to calculate risk scores for diabetes for all aged 40–69 years without known type 2 diabetes and area deprivation based on post code. In total, 1272 individuals in the top 25% risk category were randomized to receive one of two invitations to attend their practices for screening: an informed choice invitation or a standard invitation. The subsequent attenders completed self-report measures of future time orientation and deprivation immediately before undergoing a screening test.

Results

Individual-level deprivation demonstrated a significant moderator effect [F (4,635) = 4.32, P = 0.002]: individuals who were high in deprivation had lower intentions to engage in lifestyle change following receipt of the informed choice invitation. However, intentions were not patterned by deprivation when it was assessed at the area-level using the Index of Multiple Deprivation 2007. The hypothesized moderating effect of future time orientation on invitation type was also supported [F(14,613) = 2.46, P = 0.002): individuals low in future time orientation had markedly lower intentions to engage in lifestyle change following receipt of an informed choice invitation compared with a standard invitation for screening.

Conclusion

Efforts to enhance informed choice where the implications of diagnosis are a requirement for lifestyle change may require that the immediate benefits are communicated, and efforts to address the apparent barriers to diabetes self-care are made, if the potential for inequity is to be avoided.     

Predictors of asthma in young children: does reporting source affect our conclusions?

Both the size and statistical significance of sociodemographic and early health risk factors on childhood asthma vary across studies, in part because some studies rely on parents' retrospective reports of health conditions while others are based on medical records. The authors compare predictors of asthma alternately using maternal reports and medical records for the same set of children. Data are from the 1988 National Maternal and Infant Health Survey and 1991 Longitudinal Follow-up, which collected information from birth certificates, medical records, and mothers of a nationally representative, population-based cohort, allowing comparison across data sources for a consistent sample of young children in the United States. Concordance between maternal reports and medical records on asthma is moderate (kappa = 0.48). The authors find considerable discrepancies in both the estimated prevalence of asthma and the distribution across children with different sociodemographic and health characteristics, depending on the source of asthma data. Black race, male gender, and preterm birth are found to be risk factors for asthma regardless of data source. Poverty, large family size, urban residence, maternal smoking, and breastfeeding are significantly associated with asthma based on maternal reports but not medical records. Lower health care utilization among poor, uninsured, and urban children may account for part of the discrepancy.     

Factors associated with routine immunization coverage of children under one year old in Lao People’s Democratic Republic

BackgroundRoutine vaccination is administered free of charge to all children under one year old in Lao People’s Democratic Republic (Lao PDR) and the national goal is to achieve at least 95% coverage with all vaccines included in the national immunization program by 2025. In this study, factors related to the immunization system and characteristics of provinces and districts in Lao PDR were examined to evaluate the association with routine immunization coverage.MethodsCoverage rates for Bacillus Calmette-Guerin (BCG), Diphtheria-Tetanus-Pertussis-Hepatitis B (DTP-HepB), DTP-HepB-Hib (Haemophilus influenzae type B), polio (OPV), and measles (MCV1) vaccines from 2002 to 2014 collected through regular reporting system, were used to identify the immunization coverage trends in Lao PDR. Correlation analysis was performed using immunization coverage, characteristics of provinces or districts (population, population density, and proportion of poor villages and high-risk villages), and factors related to immunization service (including the proportions of the following: villages served by health facility levels, vaccine session types, and presence of well-functioning cold chain equipment). To determine factors associated with low coverage, provinces were categorized based on 80% of DTP-HepB-Hib3 coverage (<80% = low group; ≥80% = high group).ResultsCoverages of BCG, DTP-HepB3, OPV3 and MCV1 increased gradually from 2007 to 2014 (82.2–88.3% in 2014). However, BCG coverage showed the least improvement from 2002 to 2014. The coverage of each vaccine correlated with the coverage of the other vaccines and DTP-HepB-Hib dropout rate in provinces as well as districts. The provinces with low immunization coverage were correlated with higher proportions of poor villages.ConclusionsRoutine immunization coverage has been improving in the last 13 years, but the national goal is not yet reached in Lao PDR. The results of this study suggest that BCG coverage and poor villages should be targeted to improve nationwide coverage.     

Concerns and experiences of women participating in a short‐term AZT intervention feasibility study for prevention of HIV transmission from mother‐to‐child

This paper describes the experiences and concerns of women participating in a short‐term AZT intervention feasibility study to prevent mother‐to‐child HIV transmission at three sites in India. The study used qualitative methods to examine the experiences of 31 women during late pregnancy, delivery and at post‐natal visits. It also elicited the perspectives of 19 healthcare providers. Frequent visits required during late‐pregnancy and the post‐natal period presented concerns for the women in the study. Women's understanding of the long‐term implications of participating in the intervention study was poor, and living with uncertainty about the HIV status of the newborn was a major concern. The provision of psychosocial support is essential in future intervention studies and should be incorporated on an ongoing basis. Networking with women‐centred support groups may be helpful in enabling women to gain the long‐term benefits of this type of intervention.     

Lead dust in Broken Hill homes — a potential hazard for young children?

OBJECTIVE: To determine the potential hazard posed by indoor lead dust to young children in Broken Hill, a silver-lead-zinc mining town in outback Australia, and the degree to which lead flux is influenced by factors such as geographical location, house construction type and condition. METHODS: 116 homes were selected and 93 (80%) studied from 10 localities in Broken Hill during the spring of 1995. Lead flux was measured using 85 mm diameter polystyrene petri dishes. Dishes were placed in four rooms of each house to collect dust over a six-to-eight-week period. Data on the location, condition and construction type of each house were recorded. Multiple linear regression was used to determine predictors of lead flux. Flux data were log transformed for the analysis. RESULTS: Average household lead flux varied nearly seven-fold across districts from a low of 166 (distant from the mines), to a high of 1,104 microg/m2/30-day period (adjacent to the mines). Houses that were 'adequately sealed' had 2.9 times the lead flux, and 'poorly sealed' houses 4.3 times the flux, of 'very well sealed' houses. Construction material did not significantly affect these flux levels, and no statistically significant interactions were found between house condition and location or house type. CONCLUSIONS: Many Broken Hill homes have high levels of lead flux that pose a potential risk to young children. Quantification of this hazard provides useful information for the community that can help focus efforts on actions required to minimise lead dust in the home. IMPLICATIONS: Household dust is a potential source of lead for young children in at-risk communities. Information on lead flux in homes can assist these communities and public health agencies to better understand and deal more effectively with the problem.     

Can the school make a difference? A multilevel analysis of adolescent risk and health behaviour

The main aim of this article is to assess the relationship between the structural and (health) policy variables of the school and characteristics of the individual on the risk and health behaviour of adolescents. Individual and school level effects on seven health-related behaviours are simultaneously estimated, using multilevel modelling. The data are from the Flemish health behaviour in school-aged children study in Belgium. Data are used from 29 Flemish schools in which students (N=3225), school administrators (N=29) and teachers (N=1132) were surveyed with anonymous written questions. The analysis confirms previous findings concerning individual level effects. Although differences between schools in risk and health behaviour were found to originate mainly from differences in pupil characteristics, substantial variation between schools remained with regard to regular smoking, drinking habits and tooth brushing after controlling for individual effects. A wide range of school structure and policy variables were taken into account, but only few of them were found to influence the health and risk behaviour of young people. Moreover, the study could not detect an effect of health promotion policy at school. The analysis therefore only partially confirms the hypothesis that the school has an impact on the health behaviour of young people. The findings demonstrate the need for a more thorough examination of the paths by which schools can influence the health behaviour of their pupils.