Confidence Intervals Permit, but Do Not Guarantee, Better Inference than Statistical Significance Testing

A statistically significant result, and a non-significant result may differ little, although significance status may tempt an interpretation of difference. Two studies are reported that compared interpretation of such results presented using null hypothesis significance testing (NHST), or confidence intervals (CIs). Authors of articles published in psychology, behavioral neuroscience, and medical journals were asked, via email, to interpret two fictitious studies that found similar results, one statistically significant, and the other non-significant. Responses from 330 authors varied greatly, but interpretation was generally poor, whether results were presented as CIs or using NHST. However, when interpreting CIs respondents who mentioned NHST were 60% likely to conclude, unjustifiably, the two results conflicted, whereas those who interpreted CIs without reference to NHST were 95% likely to conclude, justifiably, the two results were consistent. Findings were generally similar for all three disciplines. An email survey of academic psychologists confirmed that CIs elicit better interpretations if NHST is not invoked. Improved statistical inference can result from encouragement of meta-analytic thinking and use of CIs but, for full benefit, such highly desirable statistical reform requires also that researchers interpret CIs without recourse to NHST

Eff ectiveness of a rural sanitation programme on diarrhoea,soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial

Background A third of the 2·5 billion people worldwide without access to improved sanitation live in India, as do two-thirds of the 1·1 billion practising open defecation and a quarter of the 1·5 million who die annually from diarrhoeal diseases. We aimed to assess the eff ectiveness of a rural sanitation intervention, within the context of the Government of India’s Total Sanitation Campaign, to prevent diarrhoea, soil-transmitted helminth infection, and child malnutrition. Methods We did a cluster-randomised controlled trial between May 20, 2010, and Dec 22, 2013, in 100 rural villages in Odisha, India. Households within villages were eligible if they had a child younger than 4 years or a pregnant woman. Villages were randomly assigned (1:1), with a computer-generated sequence, to undergo latrine promotion and construction or to receive no intervention (control). Randomisation was stratifi ed by administrative block to ensure an equal number of intervention and control villages in each block. Masking of participants was not possible because of the nature of the intervention. However, households were not told explicitly that the purpose of enrolment was to study the eff ect of a trial intervention, and the surveillance team was diff erent from the intervention team. The primary endpoint was 7-day prevalence of reported diarrhoea in children younger than 5 years. We did intention-to-treat and per-protocol analyses. This trial is registered with ClinicalTrials.gov, number NCT01214785. Findings We randomly assigned 50 villages to the intervention group and 50 villages to the control group. There were 4586 households (24 969 individuals) in intervention villages and 4894 households (25 982 individuals) in control villages. The intervention increased mean village-level latrine coverage from 9% of households to 63%, compared with an increase from 8% to 12% in control villages. Health surveillance data were obtained from 1437 households with children younger than 5 years in the intervention group (1919 children younger than 5 years), and from 1465 households (1916 children younger than 5 years) in the control group. 7-day prevalence of reported diarrhoea in children younger than 5 years was 8·8% in the intervention group and 9·1% in the control group (period prevalence ratio 0·97, 95% CI 0·83–1·12). 162 participants died in the intervention group (11 children younger than 5 years) and 151 died in the control group (13 children younger than 5 years). Interpretation Increased latrine coverage is generally believed to be eff ective for reducing exposure to faecal pathogens and preventing disease; however, our results show that this outcome cannot be assumed. As eff orts to improve sanitation are being undertaken worldwide, approaches should not only meet international coverage targets, but should also be implemented in a way that achieves uptake, reduces exposure, and delivers genuine health gains. Funding Bill & Melinda Gates Foundation, International Initiative for Impact Evaluation (3ie), and Department for International Development-backed SHARE Research Consortium at the London School of Hygiene & Tropical Medicin

Setting priorities for humanitarian water, sanitation and hygiene research: a meeting report

Recent systematic reviews have highlighted a paucity of rigorous evidence to guide water, sanitation and hygiene (WASH) interventions in humanitarian crises. In June 2017, the Research for Health in Humanitarian Crises (R2HC) programme of Elhra, convened a meeting of representatives from international response agencies, research institutions and donor organisations active in the field of humanitarian WASH to identify research priorities, discuss challenges conducting research and to establish next steps. Topics including cholera transmission, menstrual hygiene management, and acute undernutrition were identified as research priorities. Several international response agencies have existing research programmes; however, a more cohesive and coordinated effort in the WASH sector would likely advance this field of research. This report shares the conclusions of that meeting and proposes a research agenda with the aim of strengthening humanitarian WASH policy and practice

Effectiveness of a brief school-based body image intervention 'Dove Confident Me: Single Session' when delivered by teachers and researchers: Results from a cluster randomised controlled trial

© 2015 The Authors. This study evaluated a 90-min single session school-based body image intervention (Dove Confident Me: Single Session), and investigated if delivery could be task-shifted to teachers. British adolescents (N = 1707; 11-13 years; 50.83% girls) participated in a cluster randomised controlled trial [lessons as usual control; intervention teacher-led (TL); intervention researcher-led (RL)]. Body image, risk factors, and psychosocial and disordered eating outcomes were assessed 1-week pre-intervention, immediate post-intervention, and 4-9.5 weeks follow-up. Multilevel mixed-models showed post-intervention improvements for intervention students relative to control in body esteem (TL; girls only), negative affect (TL), dietary restraint (TL; girls only), eating disorder symptoms (TL), and life engagement (TL; RL). Awareness of sociocultural pressures increased at post-intervention (TL). Effects were small-medium in size (ds 0.19-0.76) and were not maintained at follow-up. There were no significant differences between conditions at post or follow-up on body satisfaction, appearance comparisons, teasing, appearance conversations and self-esteem. The intervention had short-term benefits for girls' body image and dietary restraint, and for eating disorder symptoms and some psychosocial outcomes among girls and boys. A multi-session version of the intervention is likely to be necessary for sustained improvements. Teachers can deliver this intervention effectively with minimal training, indicating broader scale dissemination is feasible. Trial registration: ISRCTN16782819

What primary health care services should residents of rural and remote Australia be able to access? A systematic review of "core" primary health care services.

BACKGROUND: There are significant health status inequalities in Australia between those people living in rural and remote locations and people living in metropolitan centres. Since almost ninety percent of the population use some form of primary health care service annually, a logical initial step in reducing the disparity in health status is to improve access to health care by specifying those primary health care services that should be considered as "core" and therefore readily available to all Australians regardless of where they live. A systematic review was undertaken to define these "core" services.Using the question "What primary health care services should residents of rural and remote Australia be able to access?", the objective of this paper is to delineate those primary health care core services that should be readily available to all regardless of geography. METHOD: A systematic review of peer-reviewed literature from established databases was undertaken. Relevant websites were also searched for grey literature. Key informants were accessed to identify other relevant reference material. All papers were assessed by at least two assessors according to agreed inclusion criteria. RESULTS: Data were extracted from 19 papers (7 papers from the peer-reviewed database search and 12 from other grey sources) which met the inclusion criteria. The 19 papers demonstrated substantial variability in both the number and nature of core services. Given this variation, the specification or synthesis of a universal set of core services proved to be a complex and arguably contentious task. Nonetheless, the different primary health care dimensions that should be met through the provision of core services were developed. In addition, the process of identifying core services provided important insights about the need to deliver these services in ways that are "fit-for-purpose" in widely differing geographic contexts. CONCLUSIONS: Defining a suite of core primary health care services is a difficult process. Such a suite should be fit-for-purpose, relevant to the context, and its development should be methodologically clear, appropriate, and evidence-based. The value of identifying core PHC services to both consumers and providers for service planning and monitoring and consequent health outcomes is paramount

THE SITUATED HINTERLANDS OF ONLINE GAMING PRACTICES

Previous work has established the existence and research interest of a “digital hinterland” (Rogerson, Gibbs & Smith, 2017) – online practices that support and frame people’s engagement with a hobby. In this paper, we extend the notion of the hinterland from digital-only practices to consider how online-gaming practices are framed by engagement in activities held in material spaces. Looking at the esports bar spectatorship experience, we describe how attendance substantiates and supports fans’ relationship with their fandom and with other fans. We draw on existing literature about esports experiences, practices of offline gaming hobbyists, and sports and media tourism, to show that shared time and place, attendance, and their contribution to an individual’s gaming capital (Consalvo, 2007; Walsh & Apperley, 2009) are important elements of this situated hinterland

The Direct Access Colonoscopy Clinic: Improving time to colonoscopy for eligible positive faecal occult blood test patients in Broken Hill NSW

Objective: This pilot project aimed to assess whether the Direct Access Colonoscopy Clinic is an effective and safe model to reduce the time from a positive faecal occult blood test referral to a gastroenterologist-performed colonoscopy, and its effect on meeting the 120-day recommendation. Design: Before/after clinical practice and patient file audit. Setting: Broken Hill Health Service. Participants: De-identified data from all positive faecal occult blood test colonoscopies performed in the Broken Hill Health Service in October 2016-January 2017 (Pre-Direct Access Colonoscopy Clinic) and October 2017-January 2018 (Post-Direct Access Colonoscopy Clinic). Main outcome measures: Variables included referral date, indication, initial appointment date, colonoscopy date, colonoscopy finding, bowel preparation and adverse events. Colonoscopies indicated by positive faecal occult blood test results were the focus. Results: The nurse-consulted Direct Access Colonoscopy Clinic cohort (n = 22) had a significant 139-day reduction from positive faecal occult blood test referral to colonoscopy compared to the Pre-Direct Access Colonoscopy Clinic cohort. All Direct Access Colonoscopy Clinic patients met the new 120-day recommendation for wait-time from referral to colonoscopy. Following the introduction of the Direct Access Colonoscopy Clinic, no immediate adverse events were documented for patients using either the conventional or Direct Access Colonoscopy Clinic pathways. Conclusions: The Direct Access Colonoscopy Clinic offers a safe and effective intervention that reduces wait-time to colonoscopy in eligible patients with positive faecal occult blood test within the recommended 120 days. Further research is recommended, but Direct Access Colonoscopy Clinic has the potential to improve timely access to colonoscopy services and outcomes for all positive faecal occult blood test patients

Dual use of tobacco and cannabis: significant change in use between Prince Edward Island (PEI) and Canadian students (2008/2009 to 2014/2015)

Background Between 2012/2013 and 2014/2015, a significant increase in tobacco and cannabis use occurred among PEI students that did not align with patterns of use in other Canadian provinces. We have not identified why these rates are rising in PEI; however, there are growing concerns about health risks resulting from dual use, given the strong and consistent association between tobacco and cannabis. Methods From 2008/2009 to 2014/2015, the Canadian Student Tobacco Alcohol and Drugs Survey (CSTADS) (formerly the Youth Smoking Survey) collected biennial student substance use data across Canada. In 2014/2015, CSTADS data were collected from 42 094 students in 336 Canadian schools (incl. 2 256 PEI students in 53 schools). Results PEI student tobacco use has risen significantly from 2012/2013 for three indicators (past 30 day use of menthol cigarettes [3.0 to 4.3%]; little cigars or cigarillos [4.3 to 5.4%]; and any tobacco product [13.8 to 16.1%]). In 2014/2015, PEI student tobacco use rates (incl. current smoking, ever tried, and past 30 day use of any tobacco product) were all significantly higher than national rates. In addition, 44.5% of Canadian students (15+) reported ever using cannabis (incl. >90% of current cigarette smokers). Provincially, prevalence of cannabis use (grades 7-12) varied significantly (PEI - 24.8% vs. Canada - 16.5%). Access to cannabis was perceived ´easier´ by students who reported smoking cigarettes. Conclusions This divergent pattern of tobacco and cannabis use in PEI raises alarms. Is there a possible "gateway effect," where use of one substance is increasing the likelihood of another, or, is the change the result of provincial policies/programs being focused on other student risk behaviours? A national call to action on dual use of tobacco and cannabis is needed, which sets clear targets for reducing use, documents the impacts of dual use on health, and creates policies to protect against harm