Evaluation of a New Zealand campaign towards reduction of intoxication on licensed premises

Reducing intoxication on licensed premises is an important aim of the New Zealand host responsibility programme. A comprehensive programme of evaluation research is detailed, outlining te evaluation, development and ongoing monitoring of a campaign towards reduction of intoxication, based around television advertising. As part of stakeholder interviews, managers of licensed premises identified that they found reducing intoxication a difficult issue to deal with and they were hindered by the lack of drinker awareness of the legal responsibilities of bar staff. This lack of drinker awareness was confirmed by a subsequent survey. A campaign consisting of television advertising, posters and cards listing signs of intoxication was developed and pretested to ensure it had sufficient appeal and communicated the correct messages. Responses to the campaign was assessed via surveys with the 18-55-year-old target age group and managers of licensed premises. Public awareness that barstaff could not serve intoxicated patrons increased markedly and managers were positive about the campaign. The role of this campaign in relation to other strategies to reduce intoxication is discussed.     

An exploratory randomised controlled trial of a premises-level intervention to reduce alcohol related harm including violence in the United Kingdom

ABSTRACT: BACKGROUND: To assess the feasibility of a randomised controlled trial of a licensed premises intervention to reduce severe intoxication and disorder; to establish effect sizes and identify appropriate approaches to the development and maintenance of a rigorous research design and intervention implementation. METHODS: An exploratory two-armed parallel randomised controlled trial with a nested process evaluation. An audit of risk factors and a tailored action plan for high risk premises, with three month follow up audit and feedback. Thirty-two premises that had experienced at least one assault in the year prior to the intervention were recruited, match paired and randomly allocated to control or intervention group. Police violence data and data from a street survey of study premises' customers, including measures of breath alcohol concentration and surveyor rated customer intoxication, were used to assess effect sizes for a future definitive trial. A nested process evaluation explored implementation barriers and the fidelity of the intervention with key stakeholders and senior staff in intervention premises using semi-structured interviews. RESULTS: The process evaluation indicated implementation barriers and low fidelity, with a reluctance to implement the intervention and to submit to a formal risk audit. Power calculations suggest the intervention effect on violence and subjective intoxication would be raised to significance with a study size of 517 premises. CONCLUSIONS: It is methodologically feasible to conduct randomised controlled trials where licensed premises are the unit of allocation. However, lack of enthusiasm in senior premises staff indicates the need for intervention enforcement, rather than voluntary agreements, and on-going strategies to promote sustainability. Trial registration UKCRN 7090; ISRCTN: 80875696.     

A multidisciplinary primary care team consultation in a socio-economically deprived community: An exploratory randomised controlled trial

Background  

Psychosocial problems in socioeconomically deprived communities are not always amenable to traditional medical approaches. Mothers living in these areas are a particularly vulnerable group. The objective of this study was to evaluate the effectiveness of a lengthened multi-disciplinary team consultation in primary care in reducing anxiety and depression in mothers.     

Blood alcohol levels of patrons leaving licensed premises in Perth,Western Australia

Abstract: We aimed to determine the alcohol consumption, blood alcohol levels (BALs) and subsequent driving of patrons leaving 15 hotels and taverns in Perth, Western Australia. Of the 414 patrons approached by interviewers on Friday and Saturday evenings, 307 (74 per cent) consented to take part. Self-reported alcohol consumption, driving intentions, perceived levels of fitness to drive and demographic information were collected using an interviewer-administered questionnaire. Observations of subsequent driving were recorded and BALs were measured by breath-alcohol meter. The patrons surveyed were predominantly male (76 per cent) and aged between 18 and 35 (87 per cent). Average reported alcohol consumption was 7.6 standard drinks for males and 4.9 drinks for females, around double the daily amount recommended by the National Health and Medical Research Council. Further, 23 per cent of the sample had consumed more than 10 drinks (male) and 6 drinks (female). With respect to BALs, 37 per cent of patrons exceeded the drink-drive limit then in force of 0.087 and 56 per cent exceeded 0.05. Of greater concern, 23 per cent who were over the 0.08 legal limit were subsequently observed to drive even though they had been informed of their BAL and legal status with respect to driving. The results suggest that most young patrons drinking in Perth metropolitan hotels and taverns consume alcohol on such occasions in excess of limits currently recommended by health authorities and attain blood alcohol levels dangerous for driving. This is likely to remain unchanged without public debate as to the responsibility of licensees in serving a potentially harmful psychotropic drug and effective enforcement of liquor licensing laws.     

Community based yoga classes for type 2 diabetes: an exploratory randomised controlled trial

Background  

Yoga is a popular therapy for diabetes but its efficacy is contested. The aim of this study was to explore the feasibility of researching community based yoga classes in Type 2 diabetes with a view to informing the design of a definitive, multi-centre trial     

An investigation of medical student reactions to feedback: a randomised controlled trial

BACKGROUND: Medical educators have indicated that feedback is one of the main catalysts required for performance improvement. However, medical students appear to be persistently dissatisfied with the feedback that they receive. The purpose of this study was to evaluate learning outcomes and perceptions in students who received feedback compared to those who received general compliments. METHODS: All subjects received identical instruction on two-handed surgical knot-tying. Group 1 received specific, constructive feedback on how to improve their knot-tying skill. Group 2 received only general compliments. Performance was videotaped before and after instruction and after feedback. Subjects completed the study by indicating their global level of satisfaction. Three faculty evaluators observed and scored blinded videotapes of each performance. Intra-observer agreement among expert ratings of performance was calculated using 2-way random effects intraclass correlation (ICC) methods. Satisfaction scores and performance scores were compared using paired samples t-tests and independent samples t-tests. RESULTS: Performance data from 33 subjects were analysed. Inter-rater reliability exceeded 0.8 for ratings of pre-test, pre-intervention and post-intervention performances. The average performance of students who received specific feedback improved (21.98 versus 15.87, P<0.001), whereas there was no significant change in the performance score in the group who received only compliments (17.00 versus 15.39, P=0.181) The average satisfaction rating in the group that received compliments was significantly higher than the group that received feedback (6.00 versus 5.00, P=0.005). DISCUSSION: Student satisfaction is not an accurate measure of the quality of feedback. It appears that satisfaction ratings respond to praise more than feedback, while learning is more a function of feedback.     

Occupation-focused interventions for well older people: An exploratory randomized controlled trial

Abstract

Objective: The aim of this exploratory randomised controlled trial (RCT) was to evaluate three different occupation-focused interventions for well older people by estimating effect sizes for leisure engagement and ability in activities of daily living (ADL) and thereby identifying the most effective interventions. Methods: One hundred and seventy seven persons, 77–82 years old, living alone and without home help, were randomized to a control group (CG), an individual intervention (IG), an activity group (AG), and a one-meeting discussion group (DG). All interventions focused on occupational engagement and how persons can cope with age-related activity restrictions in order to enhance occupational engagement. Data were collected by blinded research assistants at baseline, three, and 12 months. Ordinal outcome data were converted, using Rasch measurement methods, to linear measures of leisure engagement and ADL ability. Standardized between-group effect sizes, Cohen’s d, were calculated. Results: While all groups showed a decline in leisure engagement and ADL over time, the IG and the DG were somewhat effective in minimizing the decline at both three and 12 months. However, the effect sizes were small. Conclusions: The findings indicate that occupation-focused interventions intended to minimize a decline in leisure engagement and ADL were sufficiently promising to warrant their further research.     

Prevalence and acceptability of public health initiatives in licensed premises

OBJECTIVES: To determine the prevalence and acceptability of public health initiatives in licensed premises. METHODS: Licensees/managers of all 333 licensed premises in the Hunter Region of NSW were interviewed to assess the practice of, and interest in undertaking public health initiatives relating to: responsible service of alcohol; environmental tobacco smoke; healthy-food choices; skin, breast and cervical cancer prevention; and the prevention of HIV/AIDS. RESULTS: Ninety eight percent of contacted premises participated in the study. Approximately two-thirds of premises reported having a responsible service of alcohol policy and training their staff in responsible service. One third of premises reported the provision of healthy food choices and smoke-free areas. Initiatives concerned with the prevention of cancer and HIV/AIDS were practised by less than 25% of premises. Between 41% and 85% of premises expressed an interest in undertaking all but two initiatives. Almost all interested premises accepted the offer of resources to facilitate adoption of public health initiatives. CONCLUSIONS: The study suggests that licensed premises are already involved in a number of public health initiatives, and that they appear willing to consider the introduction of a wide range of such initiatives. IMPLICATIONS: The prevalence of public health initiatives in licensed premises, and the extent of interest expressed by licensees/managers in undertaking such initiatives suggests that both a need and an opportunity exist for public health and other agencies to be more actively involved in disseminating appropriate services in this setting.     

Improving hypertension control among excessive alcohol drinkers: a randomised controlled trial in France. The WALPA Group.

OBJECTIVES--To improve blood pressure control among hypertensive ( > 140/90 mmHg) excessive alcohol drinkers. DESIGN--Fourteen worksite physicians were randomised onto an intervention group and a control group. The intervention was based on training the worksite physicians and follow up of those hypertensive subjects defined as excessive drinkers. Follow up was based on self monitoring of alcohol consumption by the subject, in view of the results of their gamma glutamyl transferase (GGT) activity determination. SETTING--Fourteen workplaces in France - mainly in the industrial sector. SUBJECTS--Altogether 15 301 subjects were screened by the 14 physicians: 129 of these were included in the study. MAIN OUTCOME MEASURES--This was the difference between the initial systolic blood pressure (SBP) and the SBP one year later (delta BP). Secondary criteria were the difference between the initial and final diastolic blood pressure (delta DBP) and delta BP at two years; antihypertensive treatment; state alcohol consumption (delta AC); delta GGT; and body mass index (delta BMI). RESULTS--The decrease in SBP levels was significantly larger in the intervention group than in the control group: at one year, delta SBP values were -11.9 (15.6) mmHg and -4.6 (13.8) respectively (p < 0.05). This benefit was still observed after two years of follow up (-13.8 (17.4) mmHg v -7.5 (14.2) mmHg (p < 0.05)). No difference was observed in DBP. The percentage of treated subjects did not differ between groups. At one year, delta AC was larger in the intervention group (-2.8 (5.2) U/d) than in the control group (-1.6 (3.4) (p < 0.1)). delta GGT and delta BMI did not differ between the two groups. A weak positive correlation was observed between delta AC and delta SBP (r = 0.16). CONCLUSION--An intervention aimed at the hypertensive excessive drinkers in a working population was found to be effective in reducing SBP on a long term basis (two years). The mechanisms of reduction in alcohol consumption and improved drug compliance cannot be ascertained in this pragmatic study. From a public health point of view, reducing the excess cardiovascular risk among a "hard to reach" population seems feasible with a strategy specifically designed for this high risk group.     

Public opinion on alcohol service at licensed premises: a population survey in Stockholm, Sweden 1999-2000

OBJECTIVE: In 1996, a community alcohol-prevention program focusing on licensed premises was initiated in Stockholm, Sweden. As a part of this initiative, a study has been conducted to investigate the public opinion in Stockholm on different strategies to reduce problems related to alcohol service at licensed premises. METHOD: A random sample of 1000 people resident in Stockholm County, within the age-group 18-65 years was selected. A postal questionnaire was sent out during the time-period November 1999 and January 2000 (response rate 59%). The questionnaire included questions on background factors, and support for various strategies to reduce intoxication and to prevent violence at licensed premises. The impact of each background factor on level of support for each strategy was analyzed using logistic regression. RESULTS: We found an overall strong support for licensed premises to practice responsible beverage service to reduce intoxication, whereas strategies to reduce availability (e.g., increased alcohol price, reduced open hours) were unpopular. The level of support differed by background factor. Frequent alcohol consumers, men, young people (< or =30 years), and frequent visitors to licensed premises, were less supportive. CONCLUSION: There is strong popular support for licensed premises to practice responsible beverage service and for stricter enforcement of existing legislation by local authorities.     

Physical activity to prevent obesity in young children: cluster randomised controlled trial

Physical activity to prevent obesity in young children: cluster randomised controlled trial . Reilly , J. J. , Kelly , L. , Montgomery , C. , Williamson , A. , Fisher , A. , McColl , J. H. , Lo Conte , R. , Paton , J. Y. & Grant , S. ( 2006 ) British Medical Journal , 333 , 1041 DOI: 10.1136/bmj.38979.623773.55.     

An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients

Background: Perioperative oral supplementation has been shown to reduce post‐operative complications. However, the use of preoperative standard oral supplements in a cohort of colorectal cancer patients has not been evaluated. The present study examined whether preoperative supplements are beneficial in this group. Methods: In a randomised controlled trial, patients were assigned to receive 400 mL of oral supplement and dietary advice or dietary advice alone. Primary outcome was the number of post‐operative complications. One hundred and twenty‐five patients were recruited (59 randomised to the intervention group and 66 to the control group) and nine were excluded. Results: In the intervention group, 24 (44%) patients had a complication compared to 26 (42%) in the control group (P = 0.780). In the intervention and control groups, there were eight (15%) and 16 (25%) surgical site infections, respectively (P = 0.140) and seven (13%) and 11 (17%) chest infections, respectively (P = 0.470). Subgroup analysis for hypothesis generation included 83 (71%) weight‐losing patients, where there was a significant reduction in surgical site infections using the Buzby definition (P = 0.034), although this was not the case for the Centre for Disease Control definition (P = 0.052). Conclusions: There was no evidence that preoperative supplements were beneficial in reducing the number of complications, although there may be some benefit for surgical site infections in selected weight‐losing preoperative patients.     

Parenting intervention in Sure Start services for children at risk of developing conduct disorder: pragmatic randomised controlled trial

Parenting intervention in Sure Start services for children at risk of developing conduct disorder: pragmatic randomised controlled trial . Hutchings J , Bywater T , Daley D , Gardner F , Whitaker C , Jones K , Eames C , Edwards RT . ( 2007 ) British Medical Journal , 334 , 678 – 682 . doi: 10.1136/bmj.39126.620799.55     

Advice to eat fish and mood: a randomised controlled trial in men with angina

People with high intake of fish have lower reported rates of depression and a small trial in psychiatric patients suggested that fish oil supplements reduced episodes of depression and mania. As part of a factorial trial of interventions to reduce mortality in angina 452 men were randomised to advice to eat more fatty fish or no fish advice. Maxepa fish oil capsules were supplied to men who found the fish unpalatable. Fish intake and mood were assessed at baseline and six months. Most men (83%) had mood assessed using the Derogatis Stress Profile at baseline and follow-up. Self reported intake of fish was higher in the fish advice group at six months. There was, however, no difference in depression or anxiety in those allocated to receive fish advice. After controlling for baseline mood, the difference in depression score between those randomised to fish advice and those not was 1.29 (95% CI -0.29 to 2.88) and the difference in anxiety was 0.82 (95% CI -0.57 to 2.22) with positive differences indicating more depression or anxiety in those allocated to the fish arm. This trial provides no evidence that increased fatty fish intake in people without depressive symptoms has any substantial effect on mood.     

Interventions with retailers to reduce cigarette sales to minors: a randomised controlled trial

Abstract: We aimed to determine the relative effectiveness of an education intervention and a threat–of–enforcement intervention in reducing sales of cigarettes to under–age youth by randomly allocating 300 retailers in a nonmetropolitan region of New South Wales to: a control group with no intervention; a minimal–intervention group, which received an educational letter; and a maximal–intervention group, which received a threat of enforcement followed by a visit from a public health officer. Retailers were checked for compliance at pretest and post–test, six months apart, by twelve 18–yearolds who were judged by independent raters to look younger. The retailers were surveyed by telephone at both times for knowledge, attitudes and self–reported sales practices. Neither intervention achieved significant improvements for the two key behavioural outcomes: requiring proof of age and display of a warning sign. Neither was there an intervention effect on knowledge about the law. The greatest improvement in the proportion of retailers who believed that the legal age should be 18 or over was in the minimal–intervention group, and both intervention groups were less likely than the control group at post–test to think that it was acceptable to sell to a person who was nearly 18. There was poor overall compliance with the revised legislation at pre–test. The finding of a pretest–to–post–test improvement but no differential intervention effect highlights the methodological difficulties of such research. The interventions may, however, have been pardy successful in modifying the attitudes of retailers. (Aust N Z J Public Health 1997; 21: 590–6)     

Realism in evidence based medicine: interpreting the randomised controlled trial

Realism is emerging as a paradigm for research and explanation in the natural and social sciences. A realist framework is elaborated and applied to the four possible situations that may generate the observations of randomised, controlled trials. It is demonstrated that by using two realist concepts "mechanism" and "context" a number of misinterpretations of such trials from within the dominant empiricist paradigm may be rectified. Evidence based medicine should adopt realism to temper a misleading empiricism, this will involve relegating statistical arguments to their proper subsidiary place and adopting an adequate theory of causation.     

Increasing influenza vaccine uptake in children: A randomised controlled trial

BackgroundInfluenza vaccine is not included in the Hong Kong Government’s universal Childhood Immunisation Programme but eligible children can receive subsidised vaccine through the private sector using the Vaccination Subsidy Scheme (VSS). This study examined whether a simple intervention package can increase influenza vaccine uptake in Hong Kong children.MethodsTwo study samples were enrolled: families of children who had participated in a previous knowledge, attitudes and practices study; and mother-infant pairs recruited from postnatal wards. Control groups received publicly available leaflets about VSS. Intervention groups additionally received: (1) a concise information sheet about influenza and its vaccine; (2) semi-completed forms to utilise the subsidy; (3) contacts of VSS clinics that did not charge above the subsidy; and (4) text message reminders for vaccination. Enrolled mothers were contacted when children were approximately 1 and 2 years old to determine influenza vaccination status of the families and their plan to vaccinate their children. Mothers’ attitudes towards influenza vaccine were assessed at enrolment and at the end of the study.ResultsA total of 833 eligible mother-infant pairs were enrolled from the two samples. The intervention package improved influenza vaccine uptake by 22% at one year and 25% at two years of age. Maternal influenza vaccine uptake in intervention group was higher during this two-year period in those who had never been previously vaccinated. Mothers’ self-efficacy regarding the use of influenza vaccine in her child i.e. belief and confidence in her own ability to make a good decision, was also improved with the intervention.ConclusionsA four-component intervention package could improve influenza vaccine uptake in Hong Kong children and their mothers during the first two years of life and depending on vaccine effectiveness could potentially reduce influenza-associated hospital admissions in children below 2 years old by 13–24%.     

Increasing child pedestrian and cyclist visibility: cluster randomised controlled trial

STUDY OBJECTIVE: Visibility aids have the potential to reduce child pedestrian and cyclist injury but scarce data exist relating to their use or to interventions for increasing visibility aid use among children. This cluster randomised controlled trial was designed to assess the use of free visibility aids one and eight weeks after their provision among primary school children in Nottingham, UK. DESIGN: One class from each of 20 schools representing 377 children aged 7, 8, and 9 years old participated in the trial and were randomly assigned to treatment and control arms. Children in the intervention arm received two visibility aids, namely, a reflective and fluorescent slap wrap (an item that can be worn around an arm or trouser leg and is readily removed), and a reflective durable sticker in addition to educational material on the importance of being seen in the dark. Observers visited schools to observe use of reflective and fluorescent slap wraps, stickers, piping and patches on coats, and bags at baseline and at one and eight weeks after distribution of the visibility aids. The study used random effects logistic regression to calculate odds ratios (OR) and confidence intervals (CI). MAIN RESULT: The results showed that children provided with free visibility aids were significantly more likely to use any visibility aid at one week (adjusted OR 59.5, 95% CI 18.5 to 191.0) and eight weeks (adjusted OR 5.9, 95% CI 3.4 to 10.4) after distribution than children in the control arm. CONCLUSIONS: Providing free visibility aids and an educational booklet on road safety significantly increases use of visibility aids for up to eight weeks during the winter among primary school children. On the basis of an eight week follow up trial in Nottingham of 20 classes of children aged 7 to 9 years old, these results suggest that campaigns providing free visibility aids to primary school children should be encouraged.