• The acceptability of iterative reconstruction algorithms in head CT: An assessment of sinogram affirmed iterative reconstruction (SAFIRE) vs. filtered back projection (FBP) using phantoms

      Harris, Matine; Huckle, John; Anthony, Denis; Charnock, Paul; University of Leeds (Elsevier, 2017-05-31)
      Computed tomography (CT) is the primary imaging investigation for many neurologic conditions with a proportion of patients incurring cumulative doses. Iterative reconstruction (IR) allows dose optimization, but head CT presents unique image quality complexities and may lead to strong reader preferences. OBJECTIVES: This study evaluates the relationships between image quality metrics, image texture, and applied radiation dose within the context of IR head CT protocol optimization in the simulated patient setting. A secondary objective was to determine the influence of optimized protocols on diagnostic confidence using a custom phantom. METHODS AND SETTING: A three-phase phantom study was performed to characterize reconstruction methods at the local reference standard and a range of exposures. CT numbers and pixel noise were quantified supplemented by noise uniformity, noise power spectrum, contrast-to-noise ratio (CNR), high- and low-contrast resolution. Reviewers scored optimized protocol images based on established reporting criteria. RESULTS: Increasing strengths of IR resulted in lower pixel noise, lower noise variance, and increased CNR. At the reference standard, the image noise was reduced by 1.5 standard deviation and CNR increased by 2.0. Image quality was maintained at </=24% relative dose reduction. With the exception of image sharpness, there were no significant differences between grading for IR and filtered back projection reconstructions. CONCLUSIONS: IR has the potential to influence pixel noise, CNR, and noise variance (image texture); however, systematically optimized IR protocols can maintain the image quality of filtered back projection. This work has guided local application and acceptance of lower dose head CT protocols.
    • Alcohol health literacy in young adults with Type 1 diabetes and its impact on diabetes management.

      Barnard, K. D.; Dyson, P.; Sinclair, J. M. A.; Lawton, J.; Anthony, Denis; Cranston, M.; Holt, R. I. G.; University of Leeds; Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK; OCDEM; University of Oxford; OCDEM Churchill Hospital; Oxford UK; et al. (Wiley, 2014-05-13)
      AIMS: To investigate the knowledge of alcohol and carbohydrate content of commonly consumed alcoholic drinks among young adults with Type 1 diabetes and to explore alcohol consumption while identifying diabetes self-management strategies used to minimize alcohol-associated risk. METHOD: We conducted an open-access, multiple-choice web survey to investigate knowledge of alcohol and carbohydrate content of typical alcoholic drinks using images. Respondents to the survey also recorded their current alcohol consumption and diabetes self-management strategies when drinking. RESULTS: A total of 547 people aged 18-30 years responded to the survey (341 women; 192 men; mean (sd) age 24.5 (3.7) years), of whom 365 (66.7%) drank alcohol. In all, 84 (32.9%) women and 31 (22.6%) men scored higher than the cut-off score for increased-risk drinking. Knowledge accuracy of alcohol units was poor: only 7.3% (n = 40) correctly identified the alcohol content of six or more out of 10 drinks. Knowledge of carbohydrate content was also poor: no respondent correctly identified the carbohydrate content of six or more out of 10 drinks. Various and inconsistent strategies to minimize alcohol-associated risk were reported. CONCLUSIONS: Alcohol consumption was common among the survey respondents, but knowledge of alcohol and carbohydrate content was poor. Greater alcohol-related health literacy is required to minimize alcohol-associated risk. Further research should help develop effective strategies to improve health literacy and support safe drinking for young adults with Type 1 diabetes.
    • An exploratory study to identify risk factors for the development of capecitabine-induced palmar plantar erythrodysesthesia (PPE).

      Law, Annie; Dyson, Sue E.; Anthony, Denis (Wiley, 2015-02)
      Aims: to identify pre-treatment risk factors for the development of Palmar Plantar Erythrodysesthesia in participants receiving capecitabine monotherapy. Specifically the hypothesis that avoidance of activities that cause friction and pressure cause Palmar Plantar Erythrodysesthesia was tested. Background. Previous literature showed contradictory evidence on the subject of predictors of chemotherapy-induced Palmar Plantar Erythrodysesthesia. There is a lack of empirical evidence to support the theory that Palmar Plantar Erythrodysesthesia is caused by damage to the microcapillaries due to everyday activities that cause friction or pressure to the hands or feet. Design. Prospective epidemiological study of risk factors. Methods. Prospective data collection. All patients prior to commencing capecitabine monotherapy between 11 June 2009–31 December 2010, were offered recruitment into the study and followed up for six cycles of treatment (n = 174). Data were collected during semi-structured interviews, from participants’ diaries, physical examination of the hands and feet and review of notes. Data relating to activities that cause friction, pressure or heat were collected. Data were analysed using bivariate (chi-square and independent groups Student’s t) tests where each independent variable was analysed against Palmar Plantar Erythrodysesthesia. Results. The only variables that were associated with an increased risk of Palmar Plantar Erythrodysesthesia were a tendency to have warm hands and pre-existing inflammatory disease. Conclusions. This study gives no support for the hypothesis that avoidance of activities that cause friction and pressure cause Palmar Plantar Erythrodysesthesia.
    • Community Interventions for Health (CIH): A monograph

      Dyson,Pamela; Anthony, Denis; University of Oxford (Oxford Health Alliance, 2015)
      Non communicable disease (NCD), including cardiovascular disease, cancer, diabetes and chronic respiratory diseases, accounted for over 65.5% of deaths in 2010, with more than 80% of these occurring in low and middle income countries (LMIC). Approximately 30% of the deaths in LMIC occur prematurely and are largely preventable. NCD is also associated with increased morbidity and reduced quality of life, and it has been estimated that the global economic impact of NCD could total US$47 trillion over the next twenty years, equivalent to 5% of GDP. The causes of NCD have their roots in three major modifiable risk factors; tobacco use, physical inactivity and unhealthy diet and prevention of NCD by addressing these factors at the community level is fast becoming an area of interest. Most authorities, including the United Nations (UN), the World Health Organisation (WHO) and the US Center for Disease Control and Prevention (CDC) recommend evidence based strategies for lifestyle interventions, but there is limited high grade evidence for population or community based approaches and most of the available evidence is derived from studies conducted in high risk individuals in high income countries. The population approach is inclusive and addresses many factors including health education, structural environmental change, engagement of health providers, transport and education ministries, policy and legislative initiatives and partnerships and coalitions with community organisations. In 2008, the Oxford Health Alliance, a UK registered health charity (No 1117580), began its Community Interventions for Health (CIH) program which was designed to utilise this population approach and which adopted multi factorial, comprehensive strategies for prevention of NCD by addressing modifiable lifestyle risk factor reduction. CIH is an international collaborative study that took place between 2008 2011 in communities in China, India and Mexico and was designed to reduce the risk of NCD by targeting the three main risk factors of tobacco use, physical inactivity and unhealthy diet. The aim of CIH was to evaluate culturally specific strategies to (i) decrease the prevalence of smoking and smokeless tobacco use, (ii) improve diet by increasing intake of fruit and vegetables and reducing use of salt and (iii) increase levels of physical activity in local communities in India, China and Mexico. CIH was conducted over 5 years, and showed that population based strategies to improve health were effective in adults, and had a positive impact on risk factors for NCD by improving dietary intake and ameliorating secular trends for reduced physical activity and increases in overweight and obesity.
    • Community Interventions for Health can support clinicians in advising patients to reduce tobacco use, improve dietary intake and increase physical activity.

      Anthony, Denis; Dyson, Pamela A; Lv, Jun; Thankappan, Kavumpurathu Raman; Champgane, Beatriz; Matthews, David R; University of Leeds; University of Oxford; Sree Chitra Tirunal Institute for Medical Sciences and Technology; International American Heart Organisation; et al. (Wiley, 2016-07-25)
      AIMS AND OBJECTIVES: To increase clinical interventions to reduce modifiable risk factors for noncommunicable disease in low- and middle-income countries. BACKGROUND: Noncommunicable disease is the leading cause of death in the world and is common in low- and middle-income countries. Risk factors for noncommunicable disease are modifiable and health professionals are in an unique position to intervene and influence them. DESIGN: Clinical interventions were used as part of the Community Interventions for Health programme, a nonrandomised, controlled study undertaken in three communities - one each in China, India and Mexico. METHODS: All clinicians in intervention and control areas of the study were invited to complete surveys. A total of 2280 completed surveys at baseline and 2501 at follow-up. Culturally appropriate interventions to reduce tobacco use, improve dietary intake and increase physical activity were delivered in the intervention areas. RESULTS: Clinicians in the intervention group felt more prepared to advise smoking cessation and improvement of diet. They were more likely to test serum cholesterol and blood pressure, but less likely to take measurements of height, hip, waist and skin-fold thickness. There were more resources available to clinicians in the intervention group and they used counselling more and complementary medicine less than those in the control group. CONCLUSIONS: Community interventions which have been shown to have a positive effect in the community and workplace also change clinical practice. RELEVANCE TO CLINICAL PRACTICE: Community interventions make clinicians, including nurses, more likely to feel prepared to offer advice and more likely to use counselling. This would be expected to reduce risk factors in patients.
    • A comparison of the performance of the Braden Q and the Glamorgan paediatric pressure ulcer risk assessment scales in general and intensive care paediatric and neonatal units.

      Willock, Jane; Habiballah, Laila; Long, Deborah; Palmer, Kelli; Anthony, Denis; University of Leeds; University of Oxford (Elsevier, 2016-03-15)
      Aims To compare the predictive ability of two risk assessment scales used in children. Background There are several risk assessment scales (RASs) employed in paediatric settings but most have been modified from adult scales such as the Braden Q whereas the Glamorgan was an example of a scale designed for children. Methods Using incidence data from 513 paediatric hospital admissions, receiver operating characteristic (ROC) was employed to compare the two scales. The area under the curve (AUC) was the outcome of interest. Results The two scales were similar in this population in terms of area under the curve. Neonatal and paediatric intensive care were similar in terms of AUC for both scales but in general paediatric wards the Braden Q may be superior in predicting risk. Conclusion Either scale could be used if the predictive ability was the outcome of interest. The scales appear to work well with neonatal, paediatric intensive care and general children’s wards. However the Glamorgan scale is probably preferred by childrens’ nurses as it is easy to use and designed for use in children. There is some suggestion that while the two scales are similar in intensive care, for general paediatrics the Braden Q may be the better scale.
    • Conflict management styles used by nurses in Jordan

      Al-Hamdan, Zaid; Norrie, Peter; Anthony, Denis; University of Leeds; Jordan University of Science and Technology, Jordan; De Montfort University, Leicester; Assistant Professor, Faculty of Nursing, Jordan University of Science and Technology, Jordan; Principal Lecturer and Senior Research Fellow, School of Nursing and Midwifery, De Montfort University, UK; Professor of Nursing, School of Nursing and Midwifery, De Montfort University, UK (Sage, 2014-02-01)
      The aim of this study is to investigate the conflict management styles used by nurse managers in Jordan. There are five main styles which nurse managers use to deal with conflict. At present research into their utilisation is dominated by reports from Western countries. This research is the second to investigate their use by nurses in an Arab country and it illustrates both similarities and differences with this earlier work, allowing an initial profile to be constructed which may be applicable to the larger Arab world of health care. Cross sectional quantitative survey of nurse managers in Jordan. The Rahim Organisation Conflict Inventory (ROCI II) questionnaire was completed by 350 (83% response).The nurse managers were most likely to use an integrating style of conflict management, followed in rank order by comprising, obliging, dominating and avoiding. A tentative model of the styles which nurse managers in Arab countries use to manage conflict is proposed, which suggests that these managers are likely to provide stable workplaces.
    • Development of NURSE education in Saudi Arabia, Jordan and Ghana: From undergraduate to doctoral programmes

      Anthony, Denis; Alosaimi, Dalyal; Dyson, Sue E.; Saleh, Mohammad; Korsah, Kwadwo; University of Derby; King Saud University, Saudi Arabia; University of Ghana, Ghana; University of Jordan, Jordan (Elseiver, 2020-08-18)
      Doctoral programmes in nursing have a long history in the US where traditional research based PhDs and more clinically based doctoral programmes are common. In the rest of the world PhDs are better accepted though professional doctorates with a thesis component are common in the UK. In countries with newly established or planned doctoral programmes in nursing the research PhD seems the degree of choice. Here we discuss developments in Jordan, Saudi Arabia and Ghana. This study used official documents, strategic plans, curriculum developments and other documentary evidence from Saudi Arabia, Jordan and Ghana. We compared doctoral programmes and development with other countries by reference to the literature. We offer the example of public health and non-communicable diseases in particular as one area where doctorally trained nurses applying international standards in collaboration internationally may be of benefit.
    • Digital interventions to promote self-management in people with osteoarthritis: systematic review and meta-analysis - Study protocol

      Safari, Reza; Jackson, Jessica; Dhadda, Buk; Watkins, Merryl; Sheffield, David; Anthony, Denis; Ward, Derek; University of Derby; NHS Southern Derbyshire; Lincolnshire County Council (National Health Service (NHS), 2018-05-11)
      The proposed research is a systematic review and meta-analysis of available randomised controlled trials of digital interventions to promote self-management in people with osteoarthritis. The effects of self-management programs, on patient outcomes such as pain, disability, function and quality of life will be analysed in direct pairwise meta-analysis. The health service outcomes and cost effectiveness data will also be extracted if reported in the papers and will be synthesised narratively.
    • Evaluating clinical placements in Saudi Arabia with the CLES+T scale

      Anthony, Denis; Al-Anazi, Norah; Alosaimi, Dalyal; Pandaan, Isabelita; Dyson, Sue E.; University of Derby (Elsevier, 2019-07-09)
      The clinical learning environment and supervision (CLES) tool has been enhanced with an additional sub-scale for measuring the quality of nurse teacher’s involvement to form the CLES+T scale. It has been widely used in many countries to evaluate clinical placements. Here we report data from Saudi Arabia. The CLES+T was employed to measure satisfaction among student nurses concerning their clinical learning environment. Linear regression was used to determine relationships of various variables to the outcomes of total CLES+T score and those of its subscales. Students were generally satisfied with their placements. For female students the number of visits of the nurse tutor was positively associated with most subscales and with the total score. For males, who had fewer visits of nurse tutor, there was no such association. Nurse tutor visits are positive in terms of clinical placement evaluation by female student nurses. Saudi nursing students are generally similar to students in other international studies in terms of their appraisal of clinical placements.
    • An exploratory study to identify risk factors for the development of capecitabine-induced Palmar Plantar Erythrodysesthesia (PPE)

      Law, Annie; Dyson, Sue E.; Anthony, Denis; De Montfort University; University Hospitals of Leicester NHS Trust; UK; Middlesex University; UK; University of Leeds; UK (Wiley., 2015-02-20)
      AIMS: To identify pre-treatment risk factors for the development of Palmar Plantar Erythrodysesthesia in participants receiving capecitabine monotherapy. Specifically the hypothesis that avoidance of activities that cause friction and pressure cause Palmar Plantar Erythrodysesthesia was tested. BACKGROUND: Previous literature showed contradictory evidence on the subject of predictors of chemotherapy-induced Palmar Plantar Erythrodysesthesia. There is a lack of empirical evidence to support the theory that Palmar Plantar Erythrodysesthesia is caused by damage to the microcapillaries due to everyday activities that cause friction or pressure to the hands or feet. DESIGN: Prospective epidemiological study of risk factors. METHODS: Prospective data collection. All patients prior to commencing capecitabine monotherapy between 11 June 2009-31 December 2010, were offered recruitment into the study and followed up for six cycles of treatment (n = 174). Data were collected during semi-structured interviews, from participants' diaries, physical examination of the hands and feet and review of notes. Data relating to activities that cause friction, pressure or heat were collected. Data were analysed using bivariate (chi-square and independent groups Student's t) tests where each independent variable was analysed against Palmar Plantar Erythrodysesthesia. RESULTS: The only variables that were associated with an increased risk of Palmar Plantar Erythrodysesthesia were a tendency to have warm hands and pre-existing inflammatory disease. CONCLUSIONS: This study gives no support for the hypothesis that avoidance of activities that cause friction and pressure cause Palmar Plantar Erythrodysesthesia.
    • Increased knowledge of the effects of smoking and second-hand smoke encourages smoke-free homes.

      Fenton, Brenda; Thankappan, Kavumpurathu Raman; Champagne, Beatriz; Lv, Jun; Anthony, Denis; University of Leeds; Director, Community-based Research and Evaluation, MATRIX Public Health Solutions Inc., USA; Professor, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, India; Executive Director, InterAmerican Heart Foundation, USA; Associate Professor, Department of Epidemiology &amp; Biostatistics, School of Public Health, Peking University Health Science Center, China; et al. (Sage, 2014-04-15)
      Objective: To establish the drivers for smoke-free homes among current daily smokers. Design: A cross-sectional study employing interviews (adults) and self-completed surveys (schoolchildren). Sample: Children aged 12 and 14 in schools in four cities in China, India, Mexico and England.Adults in the community. Measurements: Knowledge, attitude, beliefs and behaviour relevant to second-hand smoke in home. Intervention: None. Results: A total of 8994 adults and 14,756 children were surveyed. Knowledge of some of the effects of tobacco is high, but other effects are poorly understood in all cities.
    • Metabolic syndrome among type 2 diabetic patients in Sub-Saharan African countries: A systematic review and meta-analysis.

      Shiferaw, Wondimeneh Shibabaw; Akalu, Tadesse Yirga; Gedefaw, Mihretie; Anthony, Denis; Kassie, Ayelign Mengesha; Misganaw Kebede, Worku; Mulugeta, Henok; Dessie, Getenet; Aynalem, Yared Asmare; Debre Berhan University, Ethiopia; et al. (Elseveir, 2020-07-23)
      PubMed, Web of Science, African Journals Online, Google Scholar, Scopus, and Wiley Online Library databases from inception to April 27, 2020 were searched to identify relevant studies. The I2 statistic was used to check heterogeneity across the included studies. DerSimonian and Laird random-effects model was applied to estimate pooled effect size, and 95% confidence interval across studies. A funnel plot and Egger's regression test were used to determine the presence of publication bias. Sensitivity analysis was deployed to determine the effect of a single study on the overall estimation. All statistical analyses were done using STATA™ Version 14 software.
    • Nurses' knowledge and practice of pressure ulcer prevention and treatment: an observational study

      Saleh, Mohammad; Papanikolaou, Panos; Nassar, Omayyah; Shaheen, Abeer; Anthony, Denis; The University of Jordan; University of Leeds (Elsevier, 2019-10-25)
      To assess nurses’ knowledge on pressure ulcer (PU) prevention and treatment in Jordan, and the frequency of and factors influencing nurses’ implementation of PU prevention and treatment interventions. Highly educated and experienced nurses can provide effective PU care; however, previous studies highlighted poor knowledge and implementation of PU care. Design: A correlational study examining nurses’ knowledge of PU prevention and frequency of PU preventive actions in Jordanian hospitals. Participants were 377 nurses and 318 patients from 11 hospitals. Data were collected to quantify the frequency of nurses’ implementation of pressure ulcer prevention and treatment interventions for patients suffering from PUs and/or at risk of PU development using a self-reported cross-sectional survey and prospective 8-hour observation. For observed PU prevention while type of hospital and number of beds in units were significant it is not known without further work if this is replicable. For observed PU treatment, linear regression analysis revealed significant negative beta values for more than 50 beds in clinical unit (β=-2.49). The study addressed new factors, facilitating the provision of prevention and treatment strategies to PU development, including type of clinical institution and number of beds in clinical unit.
    • Online research in health

      Anthony, Denis; University of Derby (Sage, 2019-04-30)
      This chapter shows some of the ways to use online resources in health research. It looks not only at internet-based data sources but also more widely at some of the clinical databases to illustrate the advantages and limitations of using these for research. In general, using internet-based resources can be make health research quicker and less labour intensive with rapid access to data and references. It can also provide tools to carry out data collection and analysis. However, researchers may have to learn how to use the tools available and not all health data are available. Some clinical databases are closed systems for reasons of patient confidentiality. These systems may be web-based but are on intranets rather than on the public internet with wider access – such as those that are part of hospital information and support systems (HISS).
    • Prevalence of pressure ulcers in Africa: A systematic review and meta-analysis

      Anthony, Denis; Alosaimi, Dalyal; Korsah, Kwadwo; Safari, Reza; Shiferaw, Wondimeneh Shibabaw; University of Derby; College of Nursing, King Saud University, Saudi Arabia; Institute of Medicine and College of Health Sciences, Debre Berhan University, Ethiopia; School of Nursing and Midwifery, University of Ghana, Ghana (Elsevier, 2021-10-27)
      A recent global review of pressure ulcers contained no studies from Africa. To identify the prevalence and incidence of pressure ulcers in Africa. Bibliographic databases, African specific databases, grey literature. Studies with prevalence or incidence data of pressure ulcers from Africa since the year 2000. Any age, including children, in any setting, specifically including hospital patients from any clinical area but not restricted to hospital settings. Holy score for bias, Joanna Briggs Institute Critical Appraisal Instrument. We followed the PRISMA guideline for systematic reviews. We searched Embase, Medline, Scopus, CINHAL, Google Scholar, specialist African databases and grey literature for studies reporting incidence or prevalence data. Nineteen studies met the inclusion criteria and were included in the study. Point prevalence rates varied from 3.4% to 18.6% for medical/surgical and other general hospital units with a pooled prevalence of 11%, for grades II-IV 5%. For spinal injury units the pooled prevalence was 44%. Restricted to English, French and Arabic. Prevalence of pressure ulcers in Africa reported here is similar to figures from a recent review of prevalence in Europe and two recent global reviews of hospitalised patients. Prevalence of pressure ulcers in spinal cord injury patients is similar to figures from a review of developing countries. The reporting of prevalence is lacking in detail in some studies. Studies using an observational design employing physical examination of patients showed higher prevalence than those relying on other methods such as medical notes or databases. Further prevalence and incidence studies are needed in Africa. Reporting of such studies should ensure items in the “Checklist for Prevalence Studies” from Joanna Briggs Institute (or similar well regarded resources) are addressed and the PICOS model and PRISMA guidelines are employed. Systematic review registration number. Prospero registration number CRD42020180093
    • Prevalence of pressure ulcers in long term care: A global review.

      Anthony, Denis; Alosoumi, Dalyal; Safari, Reza; University of Derby (Mark Allen Healthcare, 2019)
      To identify the prevalence and incidence of pressure ulcers in people with long term conditions resident in care homes or nursing homes . We followed the PRISMA guideline for systematic reviews however due to funding constraints we do not claim this review to be systematic but it is a narrative review informed by PRISMA. We searched Embase, Medline and CINHAL for observational studies reporting incidence or prevalence data. Data reported relevant head to toe examination of the pressure ulcer in residence of care or nursing homes. Internat and external validity of the included studies were assessed using the checklist devised by Hoy et al (2012). Seventeen studies met the inclusion criteria an included in the study. Some studies gave a full breakdown by grade, some only gave overall figures and some excluded grade I pressure ulcers. However within those constraints certain patterns are clear. Prevalence rates varied from 3.4% to 32.4% and large differences in prevalence in different countries was not explained by methodological differences. While some countries such as Germany, the Netherlands and the USA had robust data some countries such as the UK had none. Pressure ulcers are a common problem in long term care. However there are substantial differences between countries and many countries have no published data.
    • Reducing avoidable pressure ulcers.

      Anthony, Denis; HODGSON, Heather; HORNER, Joanna; University of Leeds (Wounds UK., 2017-04-24)
      Risk assessment scales for pressure ulcers have been in use for over 50 years but there is no evidence that such scales reduce pressure ulcer incidence. Pressure ulcer interventions have been shown to be effective, sometimes alongside risk assessment scales. Care bundles are an example of multifaceted approaches that have been successfully used in a variety of clinical areas including for pressure ulcers. Pressure ulcers were monitored before and after implementation of a new scheme based on an existing care bundle. Avoidable pressure ulcers were significantly reduced following implementation of the scheme.
    • Reducing health risk factors in workplaces of low and middle-income countries.

      Anthony, Denis; Dyson, Pamela A.; Lv, Jun; Thankappan, Kavumpurathu R.; Matthews, David R.; University of Leeds; Healthcare; University of Leeds; Leeds UK; Oxford Centre for Diabetes, Endocrinology & Metabolism; University of Oxford; Oxford UK; School of Public Health; Peking University Health Science Center; Beijing China; Achutha Menon Centre for Health Science Studies; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Trivandrum India; et al. (Wiley., 2015-03-19)
      Objective: To reduce risk factors in workplace settings in low- and middle-income countries. Design and Sample: Workplace interventions were utilized as part of the Community Interventions for Health program, a nonrandomized, controlled study undertaken in three communities in China, India, and Mexico. Exactly, 45 industrial, 82 health and 101 school workplace settings with a target population of 15,726. Two independent cross-sectional surveys of workers were conducted at baseline and follow-up, after 18–24 months of intervention activities. Measures: Culturally appropriate interventions to reduce tobacco use, increase physical activity, and improve dietary intake were delivered in the intervention areas. Results: Exactly, 12,136 adults completed surveys at baseline, and 9,786 at follow-up. In the intervention group, the prevalence of tobacco use reduced significantly in men (-6.0%, p < .001) and the proportion eating five portions of fruit and vegetables daily increased (+6.9%, p < .001) compared with the control group. There were no significant differences between the groups for changes in physical activity or prevalence of overweight. Conclusions: Workplace interventions improved risk factors in China, India, and Mexico.
    • Successful up-scaled population interventions to reduce risk factors for non-communicable disease in adults: results from the International Community Interventions for Health (CIH) Project in China, India and Mexico.

      Dyson, Pamela A; Anthony, Denis; Fenton, Brenda; Stevens, Denise E; Champagne, Beatriz; Li, Li-Ming; Lv, Jun; Ramírez Hernández, Jorge; Thankappan, K R; Matthews, David R; et al. (PLOS, 2015-04-13)
      Non-communicable disease (NCD) is increasing rapidly in low and middle-income countries (LMIC), and is associated with tobacco use, unhealthy diet and physical inactivity. There is little evidence for up-scaled interventions at the population level to reduce risk in LMIC.