Strengthening families in Head Start: the impact of a parent education programme on the emotional well‐being of Latino families

This study explores the impact of a Head Start add‐on programme, a matrix of services for parents which provides educational and vocational supports, on maternal depression and children’s behaviour in Latino families. We hypothesise that after having completed training, parents who participated in the add‐on programme would have lower levels of reported depression than parents receiving Head Start services alone. It was also hypothesised that decreased levels of reported depression would be related to increases in children’s social skills and reductions in their behaviour problems. Fifty Latino children from a local Head Start programme and their primary caregivers participated in the study. Results indicate that intervention group mothers had significantly lower levels of reported depression when compared to mothers who received regular services. Children’s social skills appeared to increase and their behaviour problems decrease, regardless of whether their parents were involved in self‐sufficiency promoting activities in the programme.     

On estimating treatment effects under non‐compliance in randomized clinical trials: are intent‐to‐treat or instrumental variables analyses perfect solutions?

In this report, we compared four estimators (intent-to-treat, as treated, per protocol, and instrumental variables estimators) that are conventionally considered for treatment effect estimation by simulation under different non-compliance scenarios in typical clinical trial settings. We found that intent-to-treat and instrumental variables estimators are not perfect and can be problematic in some situations although these two estimators carry desirable properties as we assume.     

Are Farm‐to‐School Programs More Common in States With Farm‐to‐School‐Related Laws?

BACKGROUND: Farm‐to‐School programs (FTSPs) connect schools with locally grown food. This article examines whether FTSPs are more common in public elementary schools (ESs) in states with a formal, FTSP law or with a related, locally grown procurement law. METHODS: A pooled, cross‐sectional analysis linked nationally representative samples of 1872 public ESs (across 47 states) for the 2006–2007, 2007–2008, and 2008–2009 school years with state laws effective as of the beginning of September of each year that were collected and analyzed for all states. Multivariate logistic regression models examined the impact of state law on school FTSP participation, controlling for year and school‐level race/ethnicity, region, locale, free‐reduced lunch participation, and school size. RESULTS: The percentage of schools located in a state with a FTSP‐specific law increased from 7.3% to 20.4% over the 3‐year period, while the percentage of schools located in a state with a locally grown procurement law was approximately 30% across all years. The percentage of schools with FTSPs has more than tripled over the last 3 years (from 4.9% to 17.7%). After adjusting for all covariates except year, FTSPs were significantly more likely in states with a FTSP‐specific law (OR = 2.45, 95% CI = 1.28‐4.67); once adjusting for year, the results were marginally significant (OR = 1.72, 95% CI = .91‐3.25). School‐level FTSPs were not related to state locally grown procurement laws. CONCLUSION: Although the percentage of schools with FTSPs is relatively small, these programs are becoming more common, particularly in states with FTSP‐specific laws.     

Cost‐effectiveness analysis based on the number‐needed‐to‐treat: common sense or non‐sense?

This paper explores and critically discusses some of the methodological limitations of using the number-needed-to-treat (NNT) in economic evaluation. We argue that NNT may be a straightforward measure of benefit when the effect of an intervention is immediate, but that serious problems arise when the effect is delay rather than avoidance of an adverse event. In this case, NNT is not a robust or accurate measure of effect, but will vary considerably and inconsistently over time. This weakness will naturally spill over onto any CEA based on NNT. A literature review demonstrated that CEAs based on NNT were all published within the last five years, and that all studies suffered from important limitations. A major weakness of using NNT is the imposed restrictions on the outcome measure, which can only be strictly uni-dimensional and non-generic. Using NNT in economic evaluations is obtained at a cost in terms of both methodological shortcomings, and a reduced ability for such evaluations to serve as a useful tool in decision making processes. The use of NNT in economic evaluations might be better avoided.To every complicated question, there is a simple, straightforward, easy--and probably wrong answer (Occam's Sledgehammer).     

Physically active families – de‐bunking the myth? A qualitative study of family participation in physical activity

Background The benefits of physical activity for reducing obesity and related chronic diseases are well known. The need for more family‐based interventions to increase physical activity is frequently cited in the literature; however, little is known about if and how families are physically active together, and what factors might influence family‐based participation in regular physical activity. This study examined the types of activities (physical and sedentary) engaged in as a family and explored parents' perceptions of the importance, frequency, nature and barriers to family physical activity. Methods Semi‐structured telephone interviews were conducted with 30 parents (26 female, four male) of 10‐ to 11‐year‐old schoolchildren who attended either low, middle or high socio‐economic status schools in Bristol, UK. Interviews were transcribed verbatim, anonymized and analysed using conventional content analysis. Results The majority of parents rated family engagement in physical activity as important, and identified benefits such as increased parent–child communication, spending time together, enjoyment, enhanced mental health, weight control and physical fitness. Despite these benefits most parents reported their families did little or no physical activity together as a family unit during the week, and any activities performed together were usually sedentary in nature. They reported increased family physical activity on the weekends but rarely including the full family unit simultaneously. Parents in two‐parent households commonly paired off with one or more children because of complexities of schedules. Commonly reported barriers were busy lifestyles, diverse ages and interests of children and adults, bad weather, and lack of access to facilities, transportation and money to support activities. Conclusions Family‐based interventions might be more effective if they are designed to accommodate the complex demands and needs of two‐parent and single‐parent families and provide affordable, diverse activities appealing to a wide range of interests.     

Self‐selection bias in eating disorders outcomes research: Does treatment response of underweight research participants and non‐participants differ?

Observational treatment studies provide a valuable alternative to RCTs but are often criticized due to potential self‐selection biases. Studies comparing those who do and do not participate in research on eating disorder treatment are scarce, but necessary to evaluate the impact of self‐selection bias on outcomes. All consecutive underweight adult first admissions (N = 392) to an integrated inpatient (IP)‐partial hospital (PH) behavioral specialty program were invited to participate in a longitudinal study of eating disorder treatment. Demographic and hospital course data were collected on participants (n = 234) and non‐participants (n = 158). Participants and non‐participants had similar BMI at admission, lengths of stay, and weight gain rates. Participants were less likely than non‐participants to end treatment prematurely from IP and were discharged at a higher BMI; the effect size was small. Few differences in hospital course were observed between participants and non‐participants. Although participants were more likely to transition to PH and were discharged at a higher BMI, completion of step‐down to PH within this integrated IP‐PH program rather than research participation status at admission was a better indicator of discharge BMI, which remains the strongest predictor of long‐term weight‐maintenance in eating disorders.     

When does quality‐adjusting life‐years matter in cost‐effectiveness analysis?

PURPOSE: This paper investigates the impact of quality-of-life adjustment on cost-effectiveness analyses, by comparing ratios from published studies that have reported both incremental costs per (unadjusted) life-year and per quality-adjusted life-year for the same intervention. METHODS: A systematic literature search identified 228 original cost-utility analyses published prior to 1998. Sixty-three of these analyses (173 ratio pairs) reported both cost/LY and cost/QALY ratios for the same intervention, from which we calculated medians and means, the difference between ratios (cost/LY minus cost/QALY) and between reciprocals of the ratios, and cost/LY as a percentage of the corresponding cost/QALY ratio. We also compared the ratios using rank-order correlation, and assessed the frequency with which quality-adjustment resulted in a ratio crossing the widely used cost-effectiveness thresholds of 20, 000 US dollars, 50,000 US dollars, and 100,000 US dollars/QALY or LY. RESULTS: The mean ratios were 69,100 US dollars/LY and 103,100 US dollars/QALY, with corresponding medians of 24,600 US dollars/LY and 20,400 US dollars/QALY. The mean difference between ratios was approximately -34,300 US dollars (median difference: 1300 US dollars), with 60% of ratio pairs differing by 10,000 US dollars/year or less. Mean difference between reciprocals was 59 (QA)LYs per million dollars (median: 2.1). The Spearman rank-order correlation between ratio types was 0.86 (p<0.001). Quality-adjustment led to a ratio moving either above or below 50,000 US dollars/LY (or QALY) in 8% of ratio pairs, and across 100,000 US dollars in 6% of cases. CONCLUSIONS: In a sizable fraction of cost-utility analyses, quality adjusting did not substantially alter the estimated cost-effectiveness of an intervention, suggesting that sensitivity analyses using ad hoc adjustments or 'off-the-shelf' utility weights may be sufficient for many analyses. The collection of preference weight data should be subjected to the same scrutiny as other data inputs to cost-effectiveness analyses, and should only be under-taken if the value of this information is likely to be greater than the cost of obtaining it.     

Into a SEIFA SES cul‐de‐sac?

Use of the Australian Bureau of Statistics' SEIFA scores has almost become an automatic practice in area-based research on socio-economic status (SES) correlates of health inequalities in Australia in recent years. This article questions the wisdom of this emerging heavy, often singular, reliance on the SEIFA indexes for representing a real socio-economic condition. It is argued that improvements in our understanding of the social and economic processes that produce health inequalities will not occur unless we move beyond SEIFA's broad brush. Data for New England Area Health local government areas are used to support the argument.     

Meta‐analysis of Gaussian individual patient data: Two‐stage or not two‐stage?

Quantitative evidence synthesis through meta‐analysis is central to evidence‐based medicine. For well‐documented reasons, the meta‐analysis of individual patient data is held in higher regard than aggregate data. With access to individual patient data, the analysis is not restricted to a “two‐stage” approach (combining estimates and standard errors) but can estimate parameters of interest by fitting a single model to all of the data, a so‐called “one‐stage” analysis. There has been debate about the merits of one‐ and two‐stage analysis. Arguments for one‐stage analysis have typically noted that a wider range of models can be fitted and overall estimates may be more precise. The two‐stage side has emphasised that the models that can be fitted in two stages are sufficient to answer the relevant questions, with less scope for mistakes because there are fewer modelling choices to be made in the two‐stage approach. For Gaussian data, we consider the statistical arguments for flexibility and precision in small‐sample settings. Regarding flexibility, several of the models that can be fitted only in one stage may not be of serious interest to most meta‐analysis practitioners. Regarding precision, we consider fixed‐ and random‐effects meta‐analysis and see that, for a model making certain assumptions, the number of stages used to fit this model is irrelevant; the precision will be approximately equal. Meta‐analysts should choose modelling assumptions carefully. Sometimes relevant models can only be fitted in one stage. Otherwise, meta‐analysts are free to use whichever procedure is most convenient to fit the identified model.     

Contenants et contaminants en nutrition parentérale : l’aluminium,un revenant ?

Aluminium is a well-known potentially hazardous contaminant in parenteral preparation for dialysis or drug delivery. The main objective of the study is to assess aluminium exposure from chronic parenteral nutrition supply. The specific objectives of the study were (i) to assess aluminium concentration in parenteral nutrition compounds (n = 26) and in hospital-made parenteral nutrition mixture (n = 56), (ii) to compare aluminium concentration in nutrition products to the maximum allowable concentration (i.e. 25 μg/L), and finally (iii) to compare the daily rate infused per kilogram of weight to the limit value recommended by American Society of Parenteral and Enteral Nutrition (i.e. 2 μg.kg^?1 per day). Aluminium content, assessed by atomic absorption spectrophotometry, was determined in parenteral nutrition compounds and in hospital-made parenteral nutrition admixtures to clinically stable patients undergoing total or partial parenteral nutrition. Aluminium concentration in fourteen parenteral nutrition compounds and all parenteral nutrition admixtures excessed 25 μg/L. Furthermore, two thirds of patients were exposed to a rate of aluminium significantly upper than that recommended by the American Society of Parenteral and Enteral Nutrition (i.e. 2 μg.kg^-1 per day). This study shows that parenteral nutrition compounds and parenteral nutrition admixtures were overloaded in aluminium. A monograph specifying acceptable aluminium content of parenteral nutrition products seems necessary for further redaction of European pharmaceutical norm or guidance.