Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings:A systematic review and meta-analysis

OBJECTIVE: To undertake a systematic review and meta-analysis to establish the effectiveness of handwashing in reducing absence and/or the spread of respiratory tract (RT) and/or gastrointestinal (GI) infection among school-aged children and/or staff in educational settings. DESIGN: Randomised-controlled trials (RCTs). SETTING: Schools and other settings with a formal educational component in any country. PATIENTS: Children aged 3–11 years, and/or staff working with them. INTERVENTION: Interventions with a hand hygiene component. MAIN OUTCOME MEASURES: Incidence of RT or GI infections or symptoms related to such infections; absenteeism; laboratory results of RT and/or GI infections. RESULTS: Eighteen cluster RCTs were identified; 13 school-based, 5 in child day care facilities or preschools. Studies were heterogeneous and had significant quality issues including small numbers of clusters and participants and inadequate randomisation. Individual study results suggest interventions may reduce children's absence, RT infection incidence and symptoms, and laboratory confirmed influenza-like illness. Evidence of impact on GI infection or symptoms was equivocal. CONCLUSIONS: Studies are generally not well executed or reported. Despite updating existing systematic reviews and identifying new studies, evidence of the effect of hand hygiene interventions on infection incidence in educational settings is mostly equivocal but they may decrease RT infection among children. These results update and add to knowledge about this crucial public health issue in key settings with a vulnerable population. More robust, well reported cluster RCTs which learn from existing studies, are required

Is the uptake, engagement, and effectiveness of exclusively mobile interventions for the promotion of weight-related behaviors equal for all? A systematic review

Mobile health interventions are promising behavior change tools. However, there is a concern that they may benefit some populations less than others and thus widen inequalities in health. This systematic review investigated differences in uptake of, engagement with, and effectiveness of mobile interventions for weight-related behaviors (i.e., diet, physical activity, and sedentary behavior) based on a range of inequality indicators including age, gender, race/ethnicity, and socioeconomic status. The protocol was registered on PROSPERO (CRD42020192473). Six databases (CINAHL, EMBASE, ProQuest, PsycINFO, Pubmed, and Web of Science) were searched from inception to July 2021. Publications were eligible for inclusion if they reported the results of an exclusively mobile intervention and examined outcomes by at least one inequality indicator. Sixteen publications reporting on 13 studies were included with most reporting on multiple behaviors and inequality indicators. Uptake was investigated in one study with no differences reported by the inequality indicators studied. Studies investigating engagement (n = 7) reported differences by age (n = 1), gender (n = 3), ethnicity (n = 2), and education (n = 2), while those investigating effectiveness (n = 9) reported differences by age (n = 3), gender (n = 5), education (n = 2), occupation (n = 1), and geographical location (n = 1). Given the limited number of studies and their inconsistent findings, evidence of the presence of a digital divide in mobile interventions targeting weight-related behaviors is inconclusive. Therefore, we recommend that inequality indicators are specifically addressed, analyzed, and reported when evaluating mobile interventions

A comprehensive review of reviews of school-based interventions to improve sexual-health

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Objective: To systematically review systematic reviews of school-based sexual-health and relationship Education (SHRE) programmes and, thereby, identify interventions and intervention components that promote reductions in risky sexual behaviour among young people. Methods: Electronic bibliographies were searched systematically to identify systematic reviews of school-based interventions targeting sexual-health. Results were summarised using a narrative synthesis. Results: Thirty seven systematic reviews (summarizing 224 primary RCTs) met our inclusion and quality assessment criteria. In general, these reviews analysed distinct sets of primary studies, and no comprehensive review of available primary studies was identified. Interventions were categorized into 5 types that segment this review literature. Unfortunately, many reviews reported weak and inconsistent evidence of behaviour change. Nonetheless, integration of review findings generated a list of 32 design, content, and implementation characteristics that may enhance effectiveness of school-based, sexual-health interventions. Abstinence-only interventions were found to be ineffective in promoting positive changes in sexual behaviour. By contrast, comprehensive interventions, those specifically targeting HIV prevention, and school-based clinics were found to be effective in improving knowledge and changing attitudes, behaviours and health-relevant outcomes. Conclusions: School-based interventions targeting risky sexual behaviour can be effective. Particular design, content and implementation characteristics appear to be associated with greater effectiveness. We recommend consideration of these characteristics by designers of school-based sexual-health interventions.This study was funded as part of National Institute of Health Research’s School for Public Health Research (NIHR SPHR) project with additional support from the NIHR Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula (PenCLAHRC). The views expressed are those of the author(s) and not necessarily those of 2 the NHS, the NIHR or the Department of Health. Author order represents extent of contribution. Funding statement The School for Public Health Research and the Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula is funded by the National Institute for Health Research (NIHR). SPHR is a partnership between the Universities of Sheffield, Bristol, Cambridge, Exeter, UCL; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse; The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities

Critical Health Literacy in a Pandemic: A Cluster Analysis Among German University Students.

Objectives: In the COVID-19 pandemic, critical health literacy (CHL-P) has been proposed as a means of addressing issues of complexity, uncertainty, and urgency. Our study aimed to identify CHL-P clusters among university students in Germany and to analyze associations with potential determinants. Methods: In May 2020, students at four German universities participated in the COVID-19 International Student Well-Being Study, an online survey that yielded a non-probabilistic sample of N = 5,021. CHL-P, COVID-19-related knowledge, worries, risk perception, and adherence to protective measures were measured in an online questionnaire with self-constructed items. We conducted a cluster analysis of the five CHL-P items and performed logistic regression analyses. Results: Two CHL-P clusters were identified: high vs. moderate CHL-P. Belonging to the high-CHL-P cluster (31.2% of students) was significantly associated with older age, female/other gender, advanced education, higher levels of parental education, and moderate importance placed on education. In addition, higher levels of knowledge, risk perception and worries, and adherence to protective measures were associated with high CHL-P cluster membership. Conclusion: Students would benefit from educational measures that promote CHL-P at German universities

How to select interventions for promoting physical activity in schools? Combining preferences of stakeholders and scientists

Background The failure to scale-up and implement physical activity (PA) interventions in real world contexts, which were previously successful under controlled conditions, may be attributed to the different criteria of stakeholders and scientists in the selection process of available interventions. Therefore, the aim of our study was to investigate and compare the criteria applied by local stakeholders and scientists for selecting amongst suitable school-based PA interventions for implementation. Methods We conducted a three-round repeated survey Delphi study with local stakeholders (n = 7; Bremen, Germany) and international scientific PA experts (n = 6). Independently for both panels, two rounds were utilized to develop a list of criteria and the definitions of criteria, followed by a prioritization of the criteria in the third round. For each panel, a narrative analysis was used to rank-order unique criteria, list the number of scorers for the unique criteria and synthesize criteria into overarching categories. Results The stakeholders developed a list of 53 unique criteria, synthesized into 11 categories with top-ranked criteria being ‘free of costs’, ‘longevity’ and ‘integration into everyday school life’. The scientists listed 35 unique criteria, synthesized into 7 categories with the top-ranked criteria being ‘efficacy’, ‘potential for reach’ and ‘feasibility’. The top ranked unique criteria in the stakeholder panel were distributed over many categories, whereas four out of the top six criteria in the scientist panel were related to ‘evidence’. Conclusions Although stakeholders and scientists identified similar criteria, major differences were disclosed in the prioritization of the criteria. We recommend an early collaboration of stakeholders and scientists in the design, implementation, and evaluation of PA interventions

Determinants promoting and hindering physical activity in primary school children in Germany: a qualitative study with students, teachers and parents

BackgroundDeterminants affecting children’s physical activity (PA) at an early age are of particular interest to develop and strengthen strategies for increasing the levels of children’s PA. A qualitative study was conducted to investigate the views of primary school-aged children, their teachers and parents regarding barriers and facilitators to engage in PA.MethodsFocus groups were conducted separately with primary school children, parents and teachers in a city in Northern Germany between October 2021 and January 2022. The semi- structured focus groups with children and teachers took part in person within school, whereas the focus groups with parents took place online. Data were transcribed verbatim and analysed using thematic analysis. During analysis, the socio-ecological model was identified as useful to map the determinants mentioned and was consequently applied to organize the data.ResultsTeachers (n = 10), parents (n = 18) and children (n = 46) of five primary schools in Germany participated in the focus groups. Participants of the three groups identified similar barriers and facilitators of PA in primary school-aged children, ranging across all four layers of the socio-ecological model. The barriers encountered were the preferences of children for sedentary activities (individual characteristics), the preference of parents to control their child’s actions (microsystem), a lack of financial resources from parents and long sitting times in class (mesosystem), and barriers related to rainy weather and Covid-19 restrictions (exosystem). Facilitators mentioned were the childrens’ natural tendency to be active (individual characteristics), involvement and co-participation of parents or peers in engaging in PA, support provided by teachers and the school (microsystem), living in rural areas, having sufficient facilities and favorable weather conditions (exosystem).ConclusionA range of determinants promoting and hindering PA, ranging across all layers of the socio-ecological model were identified by children, parents and teachers in this study. These determinants need to be kept in mind when developing effective PA intervention programs for primary school-aged children. Future interventions should go beyond individual characteristics to also acknowledge the influence of childrens’ social surrounding, including parents, peers and teachers, and the wider (school) environment

Associations of loneliness with mental health and with social and physical activity among university students in Germany: results of the COVID-19 German student well-being study (C19 GSWS)

IntroductionUniversity students are at high risk for loneliness with a potential negative impact on health. The COVID-19 measures disrupted students’ academic routine and social life, which might have affected their perception of loneliness. This study investigated the prevalence of perceived loneliness among university students in Germany during the COVID-19 pandemic and its associations with mental health, behavioral outcomes, and sociodemographic characteristics.MethodsCOVID-19 German student well-being study (C19 GSWS) collected data from five German universities from October 27th to November 14th, 2021, resulting in a sample of 7,203 respondents. Associations of loneliness with depressive symptoms, anxiety, social and physical activity, as well as sociodemographic characteristics, were analyzed using multivariable logistic regressions.ResultsA total of 20.6% of students reported loneliness. Students with depressive or anxiety symptoms had more than eight- or sixfold odds, respectively, for reporting loneliness (depressive symptoms: OR = 8.29; 95% CI: 7.21–9.52; anxiety: OR = 6.48; 95% CI: 5.65–7.43) compared with students who did not report any symptoms. Students who were less physically active were more likely to experience loneliness compared with students who were more physically active (no moderate physical activity: OR = 1.39; 95% CI: 1.21–1.59; no vigorous physical activity: OR = 1.19; 95% CI: 1.04–1.36). We found no association between loneliness and social activity. However, loneliness was associated with being single (OR = 2.93; 95% CI: 2.55–3.36), living alone (OR = 1.31; 95% CI: 1.13–1.52), or having a temporary residency status in Germany (OR = 2.24; 95% CI: 1.65–3.04).ConclusionOur findings highlight the importance of loneliness as a relevant factor associated with health. Further research is needed to determine potential protective factors to tackle loneliness and to investigate how study conditions at higher education institutions may affect students’ perceived loneliness