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Ferede A, Abera Wordofa M, Belachew T. Behavior change intervention to sustain iodide salt utilization in households in Ethiopia and study of the effect of iodine status on the growth of young children: community trial. PeerJ 2024; 12:e16849. [PMID: 38549782 PMCID: PMC10977086 DOI: 10.7717/peerj.16849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/07/2024] [Indexed: 04/02/2024] Open
Abstract
Background Monitoring systems in a broad range of countries are a notable effort to eliminate iodine deficiency disorders (IDDs). This study aimed to gather data on the amount of iodide present in table salt and how household consumption patterns affect children's iodine status and its effect on their growth. Methods A single treatment arm community trial study design was designed. Lower community units (LCUs) were chosen at random from districts assigned either intervention or control. From a list of LCUs, 834 mothers and their paired children were chosen randomly. Urine and table salt samples were collected and examined in the national food and nutrition laboratory. The deference between arms was determined using a t test, and the generalized estimating equation (GEE) was used to forecast parameters. Results The mean iodide content in the table salt samples of 164 (98.1%) was 45.3 ppm and a standard deviation (SD) of 14.87, which were above or equal to the recommended parts per million (ppm). Between the baseline survey and the end-line survey, the mean urine iodine concentration (UIC) was 107.7 µg/L (+/- 8.64 SD) and 260.9 µg/L (+/- 149 SD). Children's urine iodine excretion (UIE) had inadequate iodine in 127 (15.2%) children at the beginning of the study, but only 11 (2.6%) of the intervention group still had inadequate iodine at the end. The childrens' mean height (Ht) was 83.1 cm (+/-10 SD) at baseline and 136.4 cm (+/-14 SD) at the end of the survey. Mothers knew a lot (72%) about adding iodized salt to food at the end of cooking, and 183 (21.9%) of them did so regularly and purposefully. A total of 40.5% of children in the intervention group had stunted growth at baseline, which decreased to 15.1% at the end of the study but increased in the control group to 51.1%. The mean difference (MD) of urine iodine concentration (UIC) between intervention and control groups was 97.56 µg/L, with a standard error (SE) of 9.83 (p = 0.001). The end-line Ht of children in the intervention group was increased by 7.93 cm (β = 7.93, p = 0.005) compared to the control group. Conclusions Our research has shown that mothers who embraced healthy eating habits had perceived improvements in both the iodine status and height growth of their children. In addition to managing and using iodine salt, it has also introduced options for other healthy eating habits that will also play a significant role in their children's future development. This sort of knowledge transfer intervention is essential for the sustainability of society's health. Therefore, this trial's implications revealed that the intervention group's iodine status and growth could essentially be improved while the control group continued to experience negative effects. Trial registration ClinicalTrials.gov Identifier: NCT048460 1.
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Affiliation(s)
- Abebe Ferede
- Department of Public Health, Arsi University, Asella, Ethiopia
| | | | - Tefera Belachew
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
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Pisinger C, Toxværd CG, Rasmussen M. Are financial incentives more effective than health campaigns to quit smoking? A community-randomised smoking cessation trial in Denmark. Prev Med 2022; 154:106865. [PMID: 34740676 DOI: 10.1016/j.ypmed.2021.106865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022]
Abstract
The aim of this community-randomised smoking cessation (SC) trial was to investigate both recruitment and SC-rates in three municipalities offering financial incentives (FIM) to smokers who stop smoking when attending a municipal SC-program and compare these with three municipalities investing in a campaign (CAM) that should encourage smokers to use the SC-program. Furthermore, in a non-randomised matched control design we investigated whether there was a difference in recruitment and SC-rates in the three FIM and the three CAM, comparing each with three matched control municipalities (MCM). Each municipality received approx. $16,000. The FIM rewarded persons who were abstinent when attending the municipal SC-program. The CAM spent the money on a campaign recruiting smokers to the SC-program. Two of three FIM were only partly active in recruiting smokers in the intervention year 2018. An intention-to-treat (ITT) approach was used in analyses. Complete case analyses and multiple imputation were used to address loss to follow-up. No difference in recruitment was found between the CAM and the FIM (p = 0.954), in adjusted analyses. In ITT analyses, FIM achieved significantly higher odds of validated abstinence from smoking at one-year follow-up (OR (95%CI): 1.63(1.1-2.4)), but not of self-reported continuous abstinence after six months than CAM. Compared with no intervention, campaigns increased the recruitment of smokers to the SC-program while financial incentives increased six months abstinence rates. In a randomised trial, no difference was demonstrated in the effect of financial incentives and campaigns to recruit smokers to a SC-program and financial incentives seemed superior to help smokers staying smoke-free for a year. TRIAL REGISTRATION: ClinicalTrials.Gov ID: NCT03849092.
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark; University of Copenhagen, Faculty of Health Sciences, Department of Public Health, Denmark; Danish Heart Foundation, Copenhagen, Denmark.
| | - Cecilie Goltermann Toxværd
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark.
| | - Mette Rasmussen
- WHO-CC, Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, The Capital Region of Denmark, Denmark; Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden.
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Röding D, Soellner R, Reder M, Birgel V, Kleiner C, Stolz M, Groeger-Roth F, Krauth C, Walter U. Study protocol: a non-randomised community trial to evaluate the effectiveness of the communities that care prevention system in Germany. BMC Public Health 2021; 21:1927. [PMID: 34688273 PMCID: PMC8541816 DOI: 10.1186/s12889-021-11935-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Communities That Care (CTC) prevention planning and implementation system trains communities throughout a five-phase cycle to (1) build capacity for prevention, (2) adopt science-based prevention, (3) assess the prevention needs of adolescents living in the community, (4) select, and (5) implement evidence-based programs according to their needs. After CTC proved to be effective and cost-effective in the U.S., it is being used by an increasing number of communities in Germany. The aim of this study is to evaluate the effectiveness and cost-effectiveness of CTC in Germany. METHODS Communities in CTC-phases 1 to 3 (n = 21) and individually-matched comparison communities (n = 21) were recruited for a non-randomised trial. To assess long-term outcomes, (1) a cohort of 5th Grade students will be surveyed biennially concerning behaviours (antisocial behaviour and substance use) and well-being as well as risk and protective factors. Additionally, (2) biennial cross-sectional surveys will be conducted in 6th, 8th, 10th, and 11th Grade in each community. To assess short-term outcomes, a cohort of ten key informants per community will be surveyed biennially concerning adoption of science-based prevention, collaboration, community support and community norms. (4) In a cross-sectional design, all ongoing prevention programs and activities in the communities will be assessed biennially and data will be collected about costs, implementation and other characteristics of the programs and activities. (5) To monitor the CTC implementation, the members of the local CTC-boards will be surveyed annually (cross-sectional design) about team functioning and coalition capacity. Data analysis will include general and generalised mixed models to assess the average treatment effect of CTC. Mediation analyses will be performed to test the logical model, e.g., adoption of science-based prevention as a mediator for the effectiveness of the CTC approach. DISCUSSION This is the first controlled study to evaluate the effectiveness of a comprehensive community prevention approach in Germany. Evaluating the effectiveness of CTC in Germany is an important prerequisite for further diffusion of the CTC approach. TRIAL REGISTRATION This study was registered with German Clinical Trial Register: DRKS00022819 on Aug 18, 2021.
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Affiliation(s)
- Dominik Röding
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany.
| | - Renate Soellner
- University of Hildesheim, Institute for Psychology, Hildesheim, Germany
| | - Maren Reder
- University of Hildesheim, Institute for Psychology, Hildesheim, Germany
| | - Vera Birgel
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
| | - Constantin Kleiner
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
| | - Maike Stolz
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
| | | | - Christian Krauth
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
| | - Ulla Walter
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
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Alayadi H, Bernabé E, Sabbah W. Effectiveness of School Dental Screening to Reduce Untreated Caries: A Cluster-Randomized Controlled Trial. Caries Res 2021; 55:577-584. [PMID: 34551412 DOI: 10.1159/000519770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022] Open
Abstract
The aim of the study was to evaluate the effectiveness of dental screening plus referral to a specific treating facility (intervention arm) against screening plus advice letter to see a dentist (traditional screening, and control arm) on changes in untreated caries among primary schoolchildren. A cluster-randomized, assessor-blinded, controlled trial was conducted in 16 public schools in Riyadh city, Saudi Arabia. Children aged 6-11 years without any compromising medical condition were eligible for inclusion. Children were examined for dental caries at baseline and 12 months later. Parents reported their socio-demographic characteristics and their child use of dental services at baseline and follow-up. Differences in the number of decayed primary and permanent teeth between trial arms were assessed using 3-level mixed-effects models to account for the clustering of children within schools and baseline demographic differences between arms. Data from 1,098 children (537 in the intervention and 561 in the control arm) were analysed. In the mixed-effect model, no differences in the increment of decayed primary and permanent teeth were found between the intervention and control arms (rate ratio: 0.88; 95% CI: 0.53-1.06). No differences between arms were found in the proportion of children visiting the dentist either (secondary outcome). The findings of this trial provided no support for the effect of post-screening referral to a specific dental hospital, compared to traditional screening, on changes in untreated dental caries among primary schoolchildren.
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Affiliation(s)
- Haya Alayadi
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
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Morgan PJ, Rayward AT, Young MD, Pollock ER, Eather N, Barnes AT, Kennedy SL, Saunders KL, Drew RJ, Lubans DR. Establishing Effectiveness of a Community-based, Physical Activity Program for Fathers and Daughters: A Randomized Controlled Trial. Ann Behav Med 2021; 56:698-711. [PMID: 34231846 PMCID: PMC9274990 DOI: 10.1093/abm/kaab056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background The ‘Dads And Daughters Exercising and Empowered’ (DADEE) program significantly improved physical activity levels of fathers and their daughters in an efficacy trial. However, the effectiveness of interventions when delivered in real-world settings needs to be established. Purpose To evaluate the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators. Methods We conducted a two-arm RCT, (baseline and 3-months post-intervention assessments), in Newcastle, Australia. In 2016, 155 fathers (27–60 years) and 189 primary-school-aged daughters (4–12 years) (n = 344) were randomly allocated to the intervention (78 fathers, 95 daughters) or waitlist-control (77 fathers, 94 daughters) groups. Trained facilitators delivered the 9-week DADEE program (weekly sessions plus home-based tasks). Primary outcomes were fathers’ and daughters’ physical activity (steps/day). Secondary outcomes included screen-time, weight status, daughters’ fundamental movement skill (FMS) proficiency, perceived sports competence, and fathers’ parenting practices. Effects were assessed using linear mixed models. Results Primary outcome follow-up data were collected from 88% of fathers and 89% of daughters. Significant group-by-time differences in mean daily steps were found for fathers’ (adjusted difference = +1,638; 95% CI: 833, 2,443, d = 0.7) and daughters’ (adjusted difference = +1,023 steps/day; 95% CI: 259, 1,787; d = 0.4) physical activity. Significant effects were observed for daughters’ screen-time, FMS, and some parenting practices. No significant effects were identified for weight status, or fathers’screen-time or self-reported MVPA. Program attendance, satisfaction and fidelity were very high. Conclusion This study established the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators. Importantly, the findings were comparable to those of the efficacy RCT delivered by the research team. To maximize public health benefits, a larger-scale dissemination of the program appears warranted. Trial Registration Australian New Zealand Clinical Trial Registry: ACTRN12616001270404 Human Research Ethics Committee: H-2014-0330
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Affiliation(s)
- Philip J Morgan
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, New South Wales, Australia
| | - Anna T Rayward
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, New South Wales, Australia
| | - Myles D Young
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Psychology, College of Engineering, Science and Environment, University of Newcastle, New South Wales, Australia
| | - Emma R Pollock
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, New South Wales, Australia
| | - Narelle Eather
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, New South Wales, Australia
| | - Alyce T Barnes
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, New South Wales, Australia
| | - Stevie-Lee Kennedy
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, New South Wales, Australia
| | - Kristen L Saunders
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, New South Wales, Australia
| | - Ryan J Drew
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, New South Wales, Australia
| | - David R Lubans
- Priority Research Centre for Physical Activity and Nutrition, School of Education, Faculty of Education and Arts, University of Newcastle, New South Wales, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, New South Wales, Australia
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Miller TR, Ringwalt CL, Grube JW, Paschall MJ, Fisher DA, Gordon MV. Design and outcome measures for the AB InBev Global Smart Drinking Goals evaluation. Contemp Clin Trials Commun 2019; 16:100458. [PMID: 31650076 DOI: 10.1016/j.conctc.2019.100458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/19/2019] [Accepted: 09/28/2019] [Indexed: 02/02/2023] Open
Abstract
We describe the rationale for and design of an independent evaluation of the Global Smart Drinking Goals (GSDG) program. The primary purpose of this program, supported by the AB InBev Foundation, is to reduce harms associated with alcohol use by 10%. Our evaluation focuses on the effects of prevention strategies sponsored by the Foundation that are being implemented in six city pilots located in as many countries. These strategies are designed to reduce heavy episodic drinking, underage drinking, drink driving, and alcohol-related violence. Each city pilot has been matched with a comparison city in which the GSDG program will not be implemented. In this quasi-experimental community trial, we will assess each city pilot's progress toward reaching its harm reduction goals, relative to its comparison city, by means of annual adult and youth surveys. We will then supplement these analyses with the use of pertinent local archival data, where available. We discuss several challenges related to this evaluation and its quasi-experimental design. These include operating in a fluid and unpredictable environment in regard to the implementation, adaptation, and (on occasion) abandonment of the prevention strategies selected by each city pilot. We also discuss issues concerning our decision to accept funding from the alcohol industry and the measures we have taken to ensure the independence of our evaluation.
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Mohammadi TM, Hajizamani A, Hajizamani HR, Abolghasemi B. Fluoride varnish effect on preventing dental caries in a sample of 3-6 years old children. J Int Oral Health 2015; 7:30-5. [PMID: 25709364 PMCID: PMC4336657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 11/03/2014] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Early childhood caries is one of the most prevalent chronic diseases of children that affect their life and their family in different aspects. Using different types of fluoride is one of the most effective ways for preventing the disease. Fluoride varnish is a topical fluoride product which could use in the community even by non-professional. This study aimed to assess the effect of fluoride varnish on dental caries in a group of children aged 3-6 years old in Kerman kindergarten during 6 month's period. MATERIALS AND METHODS This community interventional study recruited a sample of volunteer children from 12 kindergartens through a cluster sampling. Kindergarten randomly allocated to test and control group after matching. Dental examination was performed in three phases of the study by a trained dentist using criteria of Intentional Caries Detection and Assessment System. Fluoride varnish was applied for test group in the first phase after dental examination and also 3 and 6 months after this phase. Control group has received varnish product just after 3 and 6 months after the first dental exam. Mean decayed, missed and filled teeth (dmft) were compared between and within groups using T-test. RESULTS From 476 children who participated in the study 55% were boys and the 6 years group was the most frequent group with 35% (166). Mean dmft difference was significant between Phase 1 and 2 (P = 0.05) in the test group but there was no significant difference between Phase 2 and 3 (P = 0.07). The difference was not significant between Phase 1 and 2 (P = 0.09) but it was significant between Phase 1 and 3 (P = 0.03) in the control group. CONCLUSION The study results showed a decrease in mean dmft after applying the fluoride varnish which confirms previous studies.
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Affiliation(s)
- Tayebeh Malek Mohammadi
- Associate Professor, Department of Dental Public Health, Research Center of Social Determinants of Health, Institute of Future Health Research, Kerman University of Medical Sciences, Kerman, Iran
| | - Abolghasem Hajizamani
- Assistant Professor, Department of Dental Public Health, Oral and Dental Disease Research Center, Kerman University of Medical Sciences, Kerman, Iran,Correspondence: Dr. Hajizamani A. Department of Dental Public Health, Oral and Dental Disease Research Center, Kerman University of Medical Sciences, Kerman, Iran. Tel: +(0) 983432118071. Fax: +(0) 983412118073.
| | - Hamid Reza Hajizamani
- Dental Student, Department of Dental Public Health, Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Batol Abolghasemi
- Dentist, Department of Dental Public Health, Kerman University of Medical Sciences, Kerman, Iran
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Abdollahi M, Abdollahi Z, Fozouni F, Bondarianzadeh D. Oral Zinc Supplementation Positively Affects Linear Growth, But not Weight, in Children 6-24 Months of Age. Int J Prev Med 2014; 5:280-6. [PMID: 24829711 PMCID: PMC4018636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 05/28/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Childhood zinc deficiency is a common problem in many developing countries where people rely mainly on plant based diets with low zinc contents. Zinc supplementation is one of strategies to combat zinc deficiency and its consequences in children. The aim of this community trial was to examine the effect of zinc supplementation on the linear growth of children 6-24 months of age and to examine the feasibility of its implementation in the context of primary health care (PHC). METHODS Rural community health centers providing maternal and child care in two areas with moderate rates of malnutrition were randomly assigned to intervention and control groups, including 393 and 445 children 6-24 months of age, respectively. Children in both groups received routine iron and multivitamin or vitamin A and D supplements through PHC services. Mothers of children in the intervention group were asked to give a single dose of 5 ml/day zinc sulfate syrup (containing 5 mg elemental zinc) to their children for 3 months while children in the control group did not receive the supplement. RESULTS Anthropometric measurements were performed at baseline and on a monthly basis in both groups. We found a 0.5 cm difference in the height increment in the intervention group as compared with the control (P < 0.001). Zinc supplementation had no effect on weight increment of children. CONCLUSIONS Oral zinc supplementation was found to be both practical and effective in increasing linear growth rate of children less than 2 years of age through PHC.
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Affiliation(s)
- Morteza Abdollahi
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Research, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Abdollahi
- Department of Nutrition, Ministry of Health and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Fozouni
- Department of Nutrition, Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dolly Bondarianzadeh
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Reboussin BA, Preisser JS, Song EY, Wolfson M. Sample size estimation for alternating logistic regressions analysis of multilevel randomized community trials of under-age drinking. J R Stat Soc Ser A Stat Soc 2012; 175:10.1111/j.1467-985X.2011.01003.x. [PMID: 24347839 PMCID: PMC3859441 DOI: 10.1111/j.1467-985x.2011.01003.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Under-age drinking is an enormous public health issue in the USA. Evidence that community level structures may impact on under-age drinking has led to a proliferation of efforts to change the environment surrounding the use of alcohol. Although the focus of these efforts is to reduce drinking by individual youths, environmental interventions are typically implemented at the community level with entire communities randomized to the same intervention condition. A distinct feature of these trials is the tendency of the behaviours of individuals residing in the same community to be more alike than that of others residing in different communities, which is herein called 'clustering'. Statistical analyses and sample size calculations must account for this clustering to avoid type I errors and to ensure an appropriately powered trial. Clustering itself may also be of scientific interest. We consider the alternating logistic regressions procedure within the population-averaged modelling framework to estimate the effect of a law enforcement intervention on the prevalence of under-age drinking behaviours while modelling the clustering at multiple levels, e.g. within communities and within neighbourhoods nested within communities, by using pairwise odds ratios. We then derive sample size formulae for estimating intervention effects when planning a post-test-only or repeated cross-sectional community-randomized trial using the alternating logistic regressions procedure.
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Affiliation(s)
| | - John S Preisser
- University of North Carolina School of Public Health, Chapel Hill, USA
| | - Eun-Young Song
- Wake Forest University School of Medicine, Winston-Salem USA
| | - Mark Wolfson
- Wake Forest University School of Medicine, Winston-Salem USA
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