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Objective:This study evaluated a simple environmental intervention called ‘Water Schools’ in Lower Austria providing free refillable water bottles and educational material.Design:Non-randomised controlled cluster trial with three measurements: at baseline (T0), after the intervention at 9 months (T1) and after 1-year follow-up (T2).Setting:Half-day elementary schools in Lower Austria (Austria).Participants:Third-grade pupils from twenty-two schools in the intervention group (IG) and thirty-two schools in the control group (CG) participated in the study. Data were analysed for 569 to 598 pupils in the IG and for 545 to 613 in the CG, depending on the time of measurement.Results:The consumption of tap water increased in the IG from baseline to T1 and then decreased again at T2, but this was similar in the CG (no statistically significant difference in the time trend between the IG and CG). Similar results were seen for tap water consumption in the mornings. The proportion of children who only drank tap water on school mornings increased significantly from baseline to T1 in the IG compared to the CG (P = 0·020). No difference in the changes over time occurred between the groups for the proportion of pupils drinking approximately one bottle of tap water during school mornings.Conclusions:Not only the children in the IG but also those in the CG drank more tap water after 1 school year than at the beginning. The measurement of drinking habits in the CG may have been intervention enough to bring about changes or to initiate projects.

ZusammenfassungEvidenzbasierung stellt auch im öffentlichen Gesundheitswesen eine zentrale Anforderung dar. 5 allgemeine Prinzipien gelten in der evidenzbasierten Medizin wie in der evidenzbasierten Public Health (EBPH). Sie umfassen Systematik, Transparenz im Umgang mit Unsicherheit, Integration und Partizipation, Umgang mit Interessenkonflikten sowie einen strukturierten, reflektierten Prozess. Dieser Artikel hat das Ziel, ein gemeinsames Verständnis von evidenzbasierter Public Health zu fördern.Mit einer systematischen Literaturrecherche zu Perspektiven der Evidenzbasierung in Public Health wurde das internationale Verständnis von EBPH beleuchtet. So wurden 20 englischsprachige und eine deutschsprachige Quelle identifiziert und einer Inhaltsanalyse unterzogen. Über die allgemeinen Prinzipien hinausgehende Charakteristika dieser Perspektiven befassen sich mit Aspekten der Bevölkerungsorientierung, dem zugrunde liegenden Verständnis von Evidenz, zu beteiligenden Disziplinen und Interessengruppen sowie relevanten Kriterien und notwendigen Kompetenzen für eine Umsetzung von Evidenzbasierung.Darauf aufbauend und unter Berücksichtigung methodischer Entwicklungen im Umgang mit Komplexität lassen sich 4 spezifische Umsetzungsfaktoren der EBPH ableiten. Sie umfassen Theorie, Interdisziplinarität, Kontextabhängigkeit und Komplexität sowie allgemeine gesellschaftliche Aspekte.Die praktische Umsetzung von EBPH erfordert personelle und finanzielle Ressourcen sowie Kompetenzen – unter anderem für die Durchführung systematischer Übersichtsarbeiten zur Wirksamkeit von Maßnahmen unter Alltagsbedingungen, für die wissenschaftliche Betrachtung weiterer relevanter Fragestellungen sowie für die Etablierung transparenter Prozesse zur Formulierung von Empfehlungen.

This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To identify, appraise, and synthesise qualitative studies that explore the perceptions and experiences of healthcare managers or policy‐makers, healthcare providers and clients with general health checks . To identify how stakeholders understand, name, describe, and experience influencing factors relevant to the commissioning, delivery and uptake of general health checks. To supplement and contextualise the findings and conclusions of the Cochrane effectiveness review on general health checks (Krogsbøll 2019), providing an enhanced understanding of why general health checks are widely available.

Objective To summarize the evidence on the effectiveness of soil remediation to prevent or reduce lead exposure. Methods We systematically searched MEDLINE, the Agricultural & Environmental Science Database, Web of Science, and Scopus from 1980 to February 15, 2021. We also performed reference list checking, hand-searched websites, and contacted experts. Eligible studies evaluated the effect of soil remediation to prevent or reduce lead exposure in humans of any age. We screened all records dually; one investigator performed the data extraction; a second checked for completeness and accuracy. Two investigators independently rated the risk of bias of included studies and graded the certainty of evidence. We synthesized findings narratively. Results We identified 6614 potentially relevant publications, all focused on children, of which five studies (six records) fulfilled our prespecified inclusion criteria. The number of evaluated participants ranged from 31 to 1425, with follow-up periods of 11 months to one year. The primary soil remediation method was the replacement of the upper layer with clean soil. Outcomes were limited to blood lead levels (BLL), dust lead levels, and soil lead levels. The largest study, a controlled before– after study (n = 1425) reported favorable effects of soil remediation compared to no intervention. This finding was consistent with results from two cross-sectional studies and one uncontrolled before–after study. One year post-remediation, the mean reduction in BLL was 2.1 μg/dL (p, Graphical abstract Unlabelled Image, Highlights • Lead exposure from contaminated soil is an important public health issue, concerning both children and adults. • Soil remediation alone or in combination with other interventions appears to reduce the blood lead levels in children. • The effect of soil remediation on health outcomes, in high lead exposure areas or in low/middle-income countries is unclear.

Internationally comparable assessments of implementation outcomes are a prerequisite for the accurate and useful exchange of implementation science results. We translated the English versions of the acceptability of intervention measure (AIM), the intervention appropriateness measure (IAM), and the feasibility of intervention measure (FIM) into German following recent guidelines. We tested the structural validity, the internal consistency (Cronbach’s α), and the construct validity (known-groups validity) in a hypothetical situation study of secondary school teachers (n1 = 142) and the structural validity and the internal consistency in a pilot field study of primary school teachers participating in a school health promotion project (n2 = 61). The hypothesized three-factor solution (acceptability, appropriateness, and feasibility) revealed the best model fit in the hypothetical situation study (CFI = 0.97; RMSEA = 0.08). The second study tended to support these results (CFI = 0.99; RMSEA = 0.05) only when the error terms of two items from different constructs were allowed to correlate with each other (“seems like a good match” [IAM] and “seems possible” [FIM]). Furthermore, the intercorrelations between the three factors were higher in the pilot field study than in the hypothetical vignette study (0.71–0.86 vs. 0.06–0.35). The instruments’ internal consistency proved to be high in both studies (Cronbach’s α: 0.91–0.97). We gathered positive evidence for the known-groups validity, as participants who received different stimuli before answering the instruments rated them statistically significantly different. Our study showed that the German versions of the instruments could successfully be applied in health promotion research. We suggest using the four items per instrument rather than an abbreviated version and discuss recommendations for the instruments’ application.

An evidence-based approach is considered a central requirement in the public health system. Five general principles apply in evidence-based medicine as well as in evidence-based public health (EBPH). These comprise a systematic approach, transparency in relation to uncertainty, integration and participation, management of conflicts of interest, and a structured, reflective process. This article aims to promote a common understanding of what taking an evidence-based approach entails in the field of public health.We explored the international understanding of EBPH through systematic literature searches of definitions, concepts, and models regarding an evidence-based approach in public health. In this manner, 20 English sources and one German source were identified and examined using content analysis. Beyond the above-described general principles, characteristics of these perspectives are concerned with a population orientation, the underlying concept of evidence, disciplines, and stakeholder groups to be involved in the process, as well as relevant criteria and necessary competencies for implementing an evidence-based approach.Based on this, and taking into account methodological developments to address complexity, four specific implementation factors of EBPH can be derived. These include theory, interdisciplinarity, context-sensitivity, and complexity as well as general societal aspects.The practical implementation of EBPH requires human and financial resources as well as competencies - among others, for conducting systematic reviews of the effectiveness of measures, examining other relevant questions in a scientific manner, and establishing transparent processes to formulate recommendations.Evidenzbasierung stellt auch im öffentlichen Gesundheitswesen eine zentrale Anforderung dar. 5 allgemeine Prinzipien gelten in der evidenzbasierten Medizin wie in der evidenzbasierten Public Health (EBPH). Sie umfassen Systematik, Transparenz im Umgang mit Unsicherheit, Integration und Partizipation, Umgang mit Interessenkonflikten sowie einen strukturierten, reflektierten Prozess. Dieser Artikel hat das Ziel, ein gemeinsames Verständnis von evidenzbasierter Public Health zu fördern.Mit einer systematischen Literaturrecherche zu Perspektiven der Evidenzbasierung in Public Health wurde das internationale Verständnis von EBPH beleuchtet. So wurden 20 englischsprachige und eine deutschsprachige Quelle identifiziert und einer Inhaltsanalyse unterzogen. Über die allgemeinen Prinzipien hinausgehende Charakteristika dieser Perspektiven befassen sich mit Aspekten der Bevölkerungsorientierung, dem zugrunde liegenden Verständnis von Evidenz, zu beteiligenden Disziplinen und Interessengruppen sowie relevanten Kriterien und notwendigen Kompetenzen für eine Umsetzung von Evidenzbasierung.Darauf aufbauend und unter Berücksichtigung methodischer Entwicklungen im Umgang mit Komplexität lassen sich 4 spezifische Umsetzungsfaktoren der EBPH ableiten. Sie umfassen Theorie, Interdisziplinarität, Kontextabhängigkeit und Komplexität sowie allgemeine gesellschaftliche Aspekte.Die praktische Umsetzung von EBPH erfordert personelle und finanzielle Ressourcen sowie Kompetenzen – unter anderem für die Durchführung systematischer Übersichtsarbeiten zur Wirksamkeit von Maßnahmen unter Alltagsbedingungen, für die wissenschaftliche Betrachtung weiterer relevanter Fragestellungen sowie für die Etablierung transparenter Prozesse zur Formulierung von Empfehlungen.

Background:\ud \ud Overweight and obesity are increasing worldwide and are considered to be a major public health issue of the 21st century. Introducing taxation of the fat content in foods is considered a potentially powerful policy tool to reduce consumption of foods high in fat or saturated fat, or both.\ud \ud Objectives:\ud \ud To assess the effects of taxation of the fat content in food on consumption of total fat and saturated fat, energy intake, overweight, obesity, and other adverse health outcomes in the general population.\ud \ud Search methods:\ud \ud We searched CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Embase, and 15 other databases and trial registers on 12 September 2019. We handsearched the reference lists of all records of included studies, searched websites of international organizations and institutions (14 October 2019), and contacted review advisory group members to identify planned, ongoing, or unpublished studies (26 February 2020).\ud \ud Selection criteria:\ud \ud In line with Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria, we included the following study types: randomized controlled trials (RCTs), cluster‐randomized controlled trials (cRCTs), non‐randomized controlled trials (nRCTs), controlled before‐after (CBA) studies, and interrupted time series studies. We included studies that evaluated the effects of taxes on the fat content in foods. Such a tax could be expressed as sales, excise, or special value added tax (VAT) on the final product or an intermediary product. Eligible interventions were taxation at any level, with no restriction on the duration or the implementation level (i.e. local, regional, national, or multinational). Eligible study populations were children (zero to 17 years) and adults (18 years or older) from any country and setting. We excluded studies that focused on specific subgroups only (e.g. people receiving pharmaceutical intervention; people undergoing a surgical intervention; ill people who are overweight or obese as a side effect, such as those with thyroiditis and depression; and people with chronic illness). Primary outcomes were total fat consumption, consumption of saturated fat, energy intake through fat, energy intake through saturated fat, total energy intake, and incidence/prevalence of overweight or obesity. We did not exclude studies based on country, setting, comparison, or population.\ud \ud Data collection and analysis:\ud \ud We used standard Cochrane methods for all phases of the review. Risk of bias of the included studies was assessed using the criteria of Cochrane’s ‘Risk of bias’ tool and the EPOC Group’s guidance. Results of the review are summarized narratively and the certainty of the evidence was assessed using the GRADE approach. These steps were done by two review authors, independently.\ud \ud Main results:\ud \ud We identified 23,281 records from searching electronic databases and 1173 records from other sources, leading to a total of 24,454 records. Two studies met the criteria for inclusion in the review. Both included studies investigated the effect the Danish tax on saturated fat contained in selected food items between 2011 and 2012. Both studies used an interrupted time series design. Neither included study had a parallel control group from another geographic area. The included studies investigated an unbalanced panel of approximately 2000 households in Denmark and the sales data from a specific Danish supermarket chain (1293 stores). Therefore, the included studies did not address individual participants, and no restriction regarding age, sex, and socioeconomic characteristics were defined. We judged the overall risk of bias of the two included studies as unclear.\ud \ud For the outcome total consumption of fat, a reduction of 41.8 grams per week per person in a household (P < 0.001) was estimated. For the consumption of saturated fat, one study reported a reduction of 4.2% from minced beef sales, a reduction of 5.8% from cream sales, and an increase of 0.5% to sour cream sales (no measures of statistical precision were reported for these estimates). These estimates are based on a restricted number of food types and derived from sales data; they do not measure individual intake. Moreover, these estimates do not account for other relevant sources of fat intake (e.g. packaged or processed food) or other food outlets (e.g. restaurants or cafeterias); hence, we judged the evidence on the effect of taxation on total fat consumption or saturated fat consumption to be very uncertain. We did not identify evidence on the effect of the intervention on energy intake or the incidence or prevalence of overweight or obesity.\ud \ud Authors' conclusions:\ud \ud Given the very low quality of the evidence currently available, we are unable to reliably establish whether a tax on total fat or saturated fat is effective or ineffective in reducing consumption of total fat or saturated fat. There is currently no evidence on the effect of a tax on total fat or saturated fat on total energy intake or energy intake through saturated fat or total fat, or preventing the incidence or reducing the prevalence of overweight or obesity.

Background Decision-makers increasingly request rapid answers to clinical or public health questions. To save time, personnel, and financial resources, rapid reviews streamline the methodological steps of the systematic review process. We aimed to explore the validity of a rapid review approach that combines a substantially abbreviated literature search with a single-reviewer screening of abstracts and full texts using three case studies. Methods We used a convenience sample of three ongoing Cochrane reviews as reference standards. Two reviews addressed oncological topics and one addressed a public health topic. For each of the three topics, three reviewers screened the literature independently. Our primary outcome was the change in conclusions between the rapid reviews and the respective Cochrane reviews. In case the rapid approach missed studies, we recalculated the meta-analyses for the main outcomes and asked Cochrane review authors if the new body of evidence would change their original conclusion compared with the reference standards. Additionally, we assessed the sensitivity of the rapid review approach compared with the results of the original Cochrane reviews. Results For the two oncological topics (case studies 1 and 2), the three rapid reviews each yielded the same conclusions as the Cochrane reviews. However, the authors would have had less certainty about their conclusion in case study 2. For case study 3, the public health topic, only one of the three rapid reviews led to the same conclusion as the Cochrane review. The other two rapid reviews provided insufficient information for the authors to draw conclusions. Using the rapid review approach, the sensitivity was 100% (3 of 3) for case study 1. For case study 2, the three rapid reviews identified 40% (4 of 10), 50% (5 of 10), and 60% (6 of 10) of the included studies, respectively; for case study 3, the respective numbers were 38% (8 of 21), 43% (9 of 21), and 48% (10 of 21). Conclusions Within the limitations of these case studies, a rapid review approach that combines abbreviated literature searches with single-reviewer screening may be feasible for focused clinical questions. For complex public health topics, sensitivity seems to be insufficient.

Background Global prevalence of overweight and obesity are alarming. For tackling this public health problem, preventive public health and policy actions are urgently needed. Some countries implemented food taxes in the past and some were subsequently abolished. Some countries, such as Norway, Hungary, Denmark, Bermuda, Dominica, St. Vincent and the Grenadines, and the Navajo Nation (USA), specifically implemented taxes on unprocessed sugar and sugar‐added foods. These taxes on unprocessed sugar and sugar‐added foods are fiscal policy interventions, implemented to decrease their consumption and in turn reduce adverse health‐related, economic and social effects associated with these food products. Objectives To assess the effects of taxation of unprocessed sugar or sugar‐added foods in the general population on the consumption of unprocessed sugar or sugar‐added foods, the prevalence and incidence of overweight and obesity, and the prevalence and incidence of other diet‐related health outcomes. Search methods We searched CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Embase and 15 other databases and trials registers on 12 September 2019. We handsearched the reference list of all records of included studies, searched websites of international organisations and institutions, and contacted review advisory group members to identify planned, ongoing or unpublished studies. Selection criteria We included studies with the following populations: children (0 to 17 years) and adults (18 years or older) from any country and setting. Exclusion applied to studies with specific subgroups, such as people with any disease who were overweight or obese as a side‐effect of the disease. The review included studies with taxes on or artificial increases of selling prices for unprocessed sugar or food products that contain added sugar (e.g. sweets, ice cream, confectionery, and bakery products), or both, as intervention, regardless of the taxation level or price increase. In line with Cochrane Effective Practice and Organisation of Care (EPOC) criteria, we included randomised controlled trials (RCTs), cluster‐randomised controlled trials (cRCTs), non‐randomised controlled trials (nRCTs), controlled before‐after (CBA) studies, and interrupted time series (ITS) studies. We included controlled studies with more than one intervention or control site and ITS studies with a clearly defined intervention time and at least three data points before and three after the intervention. Our primary outcomes were consumption of unprocessed sugar or sugar‐added foods, energy intake, overweight, and obesity. Our secondary outcomes were substitution and diet, expenditure, demand, and other health outcomes. Data collection and analysis Two review authors independently screened all eligible records for inclusion, assessed the risk of bias, and performed data extraction.Two review authors independently assessed the certainty of the evidence using the GRADE approach. Main results We retrieved a total of 24,454 records. After deduplicating records, 18,767 records remained for title and abstract screening. Of 11 potentially relevant studies, we included one ITS study with 40,210 household‐level observations from the Hungarian Household Budget and Living Conditions Survey. The baseline ranged from January 2008 to August 2011, the intervention was implemented on September 2011, and follow‐up was until December 2012 (16 months). The intervention was a tax ‐ the so‐called 'Hungarian public health product tax' ‐ on sugar‐added foods, including selected foods exceeding a specific sugar threshold value. The intervention includes co‐interventions: the taxation of sugar‐sweetened beverages (SSBs) and of foods high in salt or caffeine. The study provides evidence on the effect of taxing foods exceeding a specific sugar threshold value on the consumption of sugar‐added foods. After implementation of the Hungarian public health product tax, the mean consumption of taxed sugar‐added foods (measured in units of kg) decreased by 4.0% (standardised mean difference (SMD) −0.040, 95% confidence interval (CI) −0.07 to −0.01; very low‐certainty evidence). The study was at low risk of bias in terms of performance bias, detection bias and reporting bias, with the shape of effect pre‐specified and the intervention unlikely to have any effect on data collection. The study was at unclear risk of attrition bias and at high risk in terms of other bias and the independence of the intervention. We rated the certainty of the evidence as very low for the primary and secondary outcomes. The Hungarian public health product tax included a tax on sugar‐added foods but did not include a tax on unprocessed sugar. We did not find eligible studies reporting on the taxation of unprocessed sugar. No studies reported on the primary outcomes of consumption of unprocessed sugar, energy intake, overweight, and obesity. No studies reported on the secondary outcomes of substitution and diet, demand, and other health outcomes. No studies reported on differential effects across population subgroups. We could not perform meta‐analyses or pool study results. Authors' conclusions There was very limited evidence and the certainty of the evidence was very low. Despite the reported reduction in consumption of taxed sugar‐added foods, we are uncertain whether taxing unprocessed sugar or sugar‐added foods has an effect on reducing their consumption and preventing obesity or other adverse health outcomes. Further robustly conducted studies are required to draw concrete conclusions on the effectiveness of taxing unprocessed sugar or sugar‐added foods for reducing their consumption and preventing obesity or other adverse health outcomes., Plain language summary Does taxation of unprocessed sugar or foods with added sugar reduce their consumption and prevent obesity or other adverse health outcomes? Why is this review important? As outlined by the World Health Organization, 'globesity' (the rise in overweight and obesity globally) is a major world challenge. A sugar‐rich diet, especially when combined with physical inactivity, may cause overweight and obesity, and other harmful health outcomes. There are direct costs to healthcare services of people being overweight or obese, such as preventing and treating health problems that this causes. There are also costs to society as a whole when people who are ill through being overweight or obese are unable to work. Who will be interested in this review? This review may be of interest to government public health agencies, policy decision‐makers, food retailers, and food industries. This review and subsequent updates of this review may change policy and affect a government's motivation to create a tax on unprocessed sugar and foods with added sugar. It also may motivate food industries to reformulate their products to contain lower levels of added sugar. What question does this review aim to answer? We wanted to know if taxation of unprocessed sugar and foods with added sugar (other than sugar‐sweetened beverages (SSBs)) reduced their consumption, changed people's energy intake, and reduced overweight and obesity. We also wanted to know if taxation changed people's diet and spending, and had an effect on other diet‐related health problems. Which studies were included in the review? We searched for ongoing or published studies up to October 2019. Of a total of 24,454 records retrieved, we identified one 'interrupted time series' (ITS) study meeting our eligibility criteria to assess the impact of a tax on sugar‐added foods (but not unprocessed sugar). The study used data from the Hungarian Household Budget and Living Conditions Survey, with observations from 40,210 households. Evidence from the study included a 'baseline' (the situation before taxation), ranging from January 2008 to August 2011. The Hungarian public health product tax was implemented on September 2011. The duration of the follow‐up period (measuring the effects of taxation) was 16 months. The study was funded by the Scottish Institute for Research in Economics (SIRE) Early Career Engagement Grant. What does the evidence from the review reveal? The included study provided very limited evidence that taxing foods with added sugar reduced their consumption by 4%. We are very uncertain about this evidence because the study did not use the strongest methods, looked at other kinds of taxation as well as taxing foods with added sugar, and may not have correctly classified food types. We are uncertain whether taxing foods with added sugar has an effect on reducing their consumption. The included study did not investigate the effects of taxing unprocessed sugar. What should happen next? Further research is needed to assess the effectiveness of taxing unprocessed sugar or foods with added sugar for reducing their consumption and preventing obesity or other adverse health outcomes. Studies should take place in countries that have implemented these taxes and should look at cost‐effectiveness as well as the health benefits of taxing unprocessed sugar or foods with added sugar as a public health policy for preventing overweight, obesity or other adverse health outcomes. Countries that have implemented these taxes are Bermuda, Dominica, Hungary, India, Norway, the Navajo Nation (USA), and St. Vincent and Grenadines.

Zusammenfassung Cochrane Public Health erstellt systematische Übersichtsarbeiten zu populationsbezogenen Maßnahmen, die sich mit strukturellen und sozialen Einflüssen auf Gesundheit beschäftigen und liefert so eine Basis für evidenzbasierte Entscheidungen im Public Health Bereich. Neben der Unterstützung von Review Prozessen bereitet Cochrane Public Health Europe Ergebnisse neuer Cochrane Public Health Reviews verständlich und auf Deutsch für EntscheidungsträgerInnen und weitere Interessierte auf.

ObjectivesOccupational injuries and diseases are a huge public health problem and cause extensive suffering and loss of productivity. Nevertheless, many occupational health and safety (OHS) guidelines are still not based on the best available evidence. In the last decade, numerous systematic reviews on behavioural, relational and mixed interventions to reduce occupational injuries and diseases have been carried out, but a comprehensive synopsis is yet missing. The aim of this overview of reviews is to provide a comprehensive basis to inform evidence-based decision-making about interventions in the field of OHS.MethodsWe conducted an overview of reviews. We searched MEDLINE (Ovid), the Cochrane Library (Wiley), epistemonikos.org and Scopus (Elsevier) for relevant systematic reviews published between January 2008 and June 2018. Two authors independently screened abstracts and full-text publications and determined the risk of bias of the included systematic reviews with the ROBIS (Risk of Bias in Systematic Reviews) tool.ResultsWe screened 2287 abstracts and 200 full-texts for eligibility. Finally, we included 25 systematic reviews with a low risk of bias for data synthesis and analysis. We identified systematic reviews on the prevention of occupational injuries, musculoskeletal, skin and lung diseases, occupational hearing impairment and interventions without specific target diseases. Several interventions led to consistently positive results on individual diseases; other interventions did not show any effects, or the studies are contradictory. We provide detailed results on all included interventions.DiscussionTo our knowledge, this is the first comprehensive overview of behavioural, relational and mixed interventions and their effectiveness in preventing occupational injuries and diseases. It provides policymakers with an important basis for making evidence-based decisions on interventions in this field.PROSPERO registration numberCRD42018100341

ObjectiveTo summarize the best available evidence regarding the short- and long-term health effects of cow’s milk intake in healthy, full-term infants up to 3 years of age.DesignWe conducted a systematic review and meta-analysis.SettingWe searched MEDLINE (via PubMed), EMBASE and the Cochrane Library between 1960 and July 2013 and manually reviewed reference lists of pertinent articles. Two researchers independently reviewed abstracts and full-text articles and extracted relevant data.SubjectsWe included (randomized/non-randomized) controlled trials and observational studies.ResultsWe included data from twenty-three studies (one randomized controlled trial, four non-randomized controlled trials, eight case–control studies and ten cohort studies) for the evidence synthesis. Pooled results of four studies revealed a higher risk of Fe-deficiency anaemia for infants consuming cow’s milk compared with those consuming follow-on formula (relative risk=3·76; 95 % CI 2·73, 5·19). For type 1 diabetes mellitus, six out of seven case–control studies did not show a difference in the risk of developing this disease based on the age of introduction of cow’s milk. We did not find negative associations for other health effects.ConclusionsCow’s milk consumption in infancy is associated with an increased risk of developing Fe-deficiency anaemia. Limiting cow’s milk consumption may be important to ensure an adequate Fe intake for infants and toddlers. High-quality patient information for caregivers is needed on how infants’ Fe requirements can be met.

The aim of this systematic review was to summarize systematically the existing evidence for the effects of student participation in designing, planning, implementing and/or evaluating school health promotion measures. The focuswas on the effects of participation in school health promotion measures rather than on student involvement at school in general. Participation is a core value for health promotion but empirical evidence of its outcomes is scarce. Wesearched major bibliographic databases (including ASSIA, ERIC, PsycINFO, Scopus, PubMed and the Social Sciences Citation Index). Two reviewers independently decided about inclusion and exclusion of the identified abstracts(n ¼ 5075) and full text articles. Of the 90 full text articles screened, 26 papers met the inclusion criteria. We identified evidence for positive effects, especially for the students themselves, the school as organization, and interactionsand social relations at school. Almost all included studies showed personal effects on students referring to an increased satisfaction, motivation and ownership, an increase in skills, competencies and knowledge, personal development, health-related effects and influence on student perspective.Given that student participation has more been discussed as a value, or ideal of health promotion in schools, these findings documenting its effectiveness are important. However, further research is needed to consider the level orintensity of involvement, different approaches and stages of participation in the health promotion intervention, as well as mediating factors such as gender, socio-cultural background or academic achievement, in a more systematicmanner.

Despite the increased availability of strong analgesics and evidence-based recommendations for pain management, under-treatment of cancer-related pain is still common. Extended-release (ER) opioids, in contrast to immediate-release opioids, provide prolonged analgesia. In this review, we aimed to compare the efficacy and safety of ER opioid analgesics in managing moderate-to-severe pain in patients with cancer. We identified randomized controlled trials (RCTs) and controlled observational studies that compared ER opioids in cancer pain by searching several databases, including MEDLINE, EMBASE and the Cochrane Library. Two independent reviewers screened and evaluated retrieved records to select relevant studies. We dually assessed the risk of bias for included studies and evaluated the overall strength of evidence for six critical outcomes using Grading of Recommendations Assessment, Development and Evaluation level of evidence. A total of three double-blind RCTs (comparative efficacy and adverse events), two non-blinded RCTs and four observational studies (comparative adverse events) were included in this review. All randomized trials and one observational study were of high risk of bias, and three observational studies of unclear risk of bias. The level of evidence for the selected efficacy and safety outcomes was low and very low. We synthesized the findings qualitatively because of the paucity of relevant studies as well as variable study design and quality. This systematic review indicates no substantial differences in efficacy and frequent adverse events among ER opioids for cancer pain. The body of evidence, however, is limited to few comparisons and fraught with methodological shortcomings.

Background The Z0011-study, a landmark randomised controlled trial (RCT) challenged the benefits of complete axillary lymph node dissection (ALND) compared with sentinel lymph node dissection only (SLND) in breast cancer patients with positive sentinel nodes. The study, however, has been criticised for lack of power and low applicability. The aim of this review was to systematically assess the evidence on the comparative benefits and harms of ALND versus SLND for sentinel node positive breast cancer patients. Methods We systematically searched PubMed, Embase, the Cochrane Library, and reference lists of pertinent review articles from January 2006 to August 2011. We dually reviewed the literature and rated the risk of bias of each study. For effectiveness, we included RCTs and observational studies of at least 1year follow-up. In addition, we considered studies conducted in sentinel node-negative women to assess the risk of harms. If data were sufficient, we conducted random effects meta-analysis of outcomes of interest. Results Meta-analysis of three studies with 50,120 patients indicated similar 5-year survival and regional recurrence rates between patients treated with ALND or SLND, although prognostic tumour characteristics varied among the 3 study-populations. Results from 6 studies on more than 11,500 patients reported a higher risk for harms for ALND than SLND. Long-term evidence on pertinent health outcomes is missing. Conclusion The available evidence indicates that for some women with early invasive breast cancer SLND appears to be a justifiable alternative to ALND. Surgeons need to discuss advantages and disadvantages of both approaches with their patients.

BACKGROUND: Lead exposure is a serious health hazard, especially for children. It is associated with physical, cognitive and neurobehavioural impairment in children. There are many potential sources of lead in the environment, therefore trials have tested many household interventions to prevent or reduce lead exposure. This is an update of a previously published review. OBJECTIVES: To assess the effects of household interventions intended to prevent or reduce further lead exposure in children on improvements in cognitive and neurobehavioural development, reductions in blood lead levels and reductions in household dust lead levels. SEARCH METHODS: In March 2020, we updated our searches of CENTRAL, MEDLINE, Embase, 10 other databases and ClinicalTrials.gov. We also searched Google Scholar, checked the reference lists of relevant studies and contacted experts to identify unpublished studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi‐RCTs of household educational or environmental interventions, or combinations of interventions to prevent lead exposure in children (from birth to 18 years of age), where investigators reported at least one standardised outcome measure. DATA COLLECTION AND ANALYSIS: Two authors independently reviewed all eligible studies for inclusion, assessed risk of bias and extracted data. We contacted trialists to obtain missing information. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 17 studies (three new to this update), involving 3282 children: 16 RCTs (involving 3204 children) and one quasi‐RCT (involving 78 children). Children in all studies were under six years of age. Fifteen studies took place in urban areas of North America, one in Australia and one in China. Most studies were in areas with low socioeconomic status. Girls and boys were equally represented in those studies reporting this information. The duration of the intervention ranged from three months to 24 months in 15 studies, while two studies performed interventions on a single occasion. Follow‐up periods ranged from three months to eight years. Three RCTs were at low risk of bias in all assessed domains. The other 14 studies were at unclear or high risk of bias; for example, we considered two RCTs and one quasi‐RCT at high risk of selection bias and six RCTs at high risk of attrition bias. National or international research grants or governments funded 15 studies, while the other two did not report their funding sources. Education interventions versus no intervention None of the included studies in this comparison assessed effects on cognitive or neurobehavioural outcomes, or adverse events. All studies reported data on blood lead level outcomes. Educational interventions showed there was probably no evidence of a difference in reducing blood lead levels (continuous: mean difference (MD) –0.03, 95% confidence interval (CI) –0.13 to 0.07; I² = 0%; 5 studies, 815 participants; moderate‐certainty evidence; log‐transformed data), or in reducing floor dust levels (MD –0.07, 95% CI –0.37 to 0.24; I² = 0%; 2 studies, 318 participants; moderate‐certainty evidence). Environmental interventions versus no intervention Dust control: one study in this comparison reported data on cognitive and neurobehavioural outcomes, and on adverse events in children. The study showed numerically there may be better neurobehavioural outcomes in children of the intervention group. However, differences were small and the CI included both a beneficial and non‐beneficial effect of the environmental intervention (e.g. mental development (Bayley Scales of Infant Development‐II): MD 0.1, 95% CI –2.1 to 2.4; 1 study, 302 participants; low‐certainty evidence). The same study did not observe any adverse events related to the intervention during the eight‐year follow‐up, but observed two children with adverse events in the control group (1 study, 355 participants; very low‐certainty evidence). Meta‐analysis also found no evidence of effectiveness on blood lead levels (continuous: MD –0.02, 95% CI –0.09 to 0.06; I² = 0%; 4 studies, 565 participants; moderate‐certainty evidence; log‐transformed data). We could not pool the data regarding floor dust levels, but studies reported that there may be no evidence of a difference between the groups (very low‐certainty evidence). Soil abatement: the two studies assessing this environmental intervention only reported on the outcome of 'blood lead level'. One study showed a small effect on blood lead level reduction, while the other study showed no effect. Therefore, we deem the current evidence insufficient to draw conclusions about the effectiveness of soil abatement (very low‐certainty evidence). Combination of educational and environmental interventions versus standard education Studies in this comparison only reported on blood lead levels and dust lead levels. We could not pool the studies in a meta‐analysis due to substantial differences between the studies. Since the studies reported inconsistent results, the evidence is currently insufficient to clarify whether a combination of interventions reduces blood lead levels and floor dust levels (very low‐certainty evidence). AUTHORS' CONCLUSIONS: Based on available evidence, household educational interventions and environmental interventions (namely dust control measures) show no evidence of a difference in reducing blood lead levels in children as a population health measure. The evidence of the effects of environmental interventions on cognitive and neurobehavioural outcomes and adverse events is uncertain too. Further trials are required to establish the most effective intervention for reducing or even preventing further lead exposure. Key elements of these trials should include strategies to reduce multiple sources of lead exposure simultaneously using empirical dust clearance levels. It is also necessary for trials to be carried out in low‐ and middle‐income countries and in differing socioeconomic groups in high‐income countries.

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of taxation of unprocessed sugar or sugar-added foods in the general population on the: consumption of unprocessed sugar or sugar-added foods; prevalence and incidence of overweight and obesity; and prevalence and incidence of diet-related health conditions.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effects of taxation of sugar‐sweetened beverages (SSBs) on SSB consumption, energy intake, overweight, obesity, and other adverse health outcomes in the general population.

PurposeParticipation is a core value for health promoting schools. Student participation at schools is often implemented in various forms of councils. The aims of this article are to summarise the effects of student participation in student councils, to show who benefits most and to discuss characteristics that make student councils effective.Design/methodology/approachThe article is based on a recently conducted systematic literature review. Nearly one third of all included cases were dealing with student participation in the form of student councils. The authors conducted a qualitative analysis of the diverse effects and characteristics of student councils.FindingsEffects of student participation in student councils can be categorised into personal effects on students, effects on interactions and on the school as an organisation. Students actually participating in councils, i.e. the student representatives, benefit most in terms of personal effects (e.g. increasing life skills, self‐esteem, developing democratic skills) and in terms of improvements in peer relationships or student‐adult relationships. All students benefit from improvements in the physical or social environment of the school. The characteristics that potentially make student councils successful concern the council composition, election procedures of representatives, positions and procedures and frequency and timing of council meetings, communication between council and the student body or other actors, the decision‐making power of the council, supportive school context and training of councillors and staff.Originality/valueThis is the first systematic synthesis of research conducted on effects of student participation in student councils. The article discusses the potential of student councils for strengthening the whole‐school approach to health promotion.

Kollektive Partizipation in der Schule ist ein gewinnbringendes jedoch empirisch schwer zu erfassendes Unterfangen. Wenig erstaunlich ist daher, dass bisher nur vereinzelte quantitative Studien vorliegen. Ursachlich dafur scheint ein Mangel an theoretisch fundierten und hinreichend validierten Befragungsinstrumenten, die fur den Einsatz in grosangelegten Kinder- und Jugendstudien geeignet waren. Der folgende Beitrag diskutiert deshalb die psychometrische Qualitat eines eigens zu diesem Zweck entwickelten Messinstruments, das im Rahmen einer Validierungsstudie an insgesamt 266 Wiener Schuler/inne/n zum Einsatz gelangt ist. Die Testergebnisse sprechen fur die Reliabilitat und Validitat der entwickelten Partizipationsskalen. Sie sollten jedoch im Rahmen weiterer Untersuchungen verifiziert werden.

Background Non-communicable diseases (NCDs) are the largest cause of premature death worldwide. Socioeconomic inequalities contribute to a disparity in the burden of NCDs among disadvantaged and advantaged populations in low (LIC), middle (MIC), and high income countries (HIC). We conducted an overview of systematic reviews to systematically and objectively assess the available evidence on socioeconomic inequalities in relation to morbidity and mortality of NCDs and their risk factors. Methods We searched PubMed, The Cochrane Library, EMBASE, SCOPUS, Global Health, and Business Source Complete for relevant systematic reviews published between 2003 and December 2013. Two authors independently screened abstracts and full-text publications and determined the risk of bias of the included systematic reviews. Results We screened 3302 abstracts, 173 full-text publications and ultimately included 22 systematic reviews. Most reviews had major methodological shortcomings; however, our synthesis showed that having low socioeconomic status (SES) and/or living in low and middle income countries (LMIC) increased the risk of developing cardiovascular diseases (CVD), lung and gastric cancer, type 2 diabetes, and chronic obstructive pulmonary disease (COPD). Furthermore, low SES increased the risk of mortality from lung cancer, COPD, and reduced breast cancer survival in HIC. Reviews included here indicated that lower SES is a risk factor for obesity in HIC, but this association varied by SES measure. Early case fatalities of stroke were lower and survival of retinoblastoma was higher in MIC compared to LIC. Conclusions The current evidence supports an association between socioeconomic inequalities and NCDs and risk factors for NCDs. However, this evidence is incomplete and limited by the fairly low methodological quality of the systematic reviews, including shortcomings in the study selection and quality assessment process. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2227-y) contains supplementary material, which is available to authorized users.

Participatory evaluation has been increasingly used in health promotion (HP) and various forms of participatory evaluation have been put into practice. Simultaneously, the concept of participation has become more important for evaluation research in general, which is equally diverse and the subject of various discourses. This study addresses the issue of how the concept of participation has been established in HP evaluation practice. An analytical framework was developed, which served as a basis for a literature review, but can also be used as a general framework for analyzing and planning the scope of participation by various stakeholders within different phases of participatory evaluation. Three dimensions of participation, which refer to decision making (decision power, deliberation) and action processes are distinguished. The results show that only a few articles discussed participatory evaluation processes and participatory (evaluation) research was largely put forth by participatory (action) research in communities. The articles analyzed referred mostly to three stakeholder groups - evaluators, program staff and beneficiaries - and to participation processes in the initial evaluation phases. The application of the framework revealed that decision power seems to be held predominantly by program staff, evaluators seem to be more involved in action processes and beneficiaries in deliberation processes.

ObjectivesTo determine the effectiveness of interventions designed to prevent or reduce publication and related biases.Study Design and SettingWe searched multiple databases and performed manual searches using terms related to publication bias and known interventions against publication bias. We dually reviewed citations and assessed risk of bias. We synthesized results by intervention and outcomes measured and graded the quality of the evidence (QoE).ResultsWe located 38 eligible studies. The use of prospective trial registries (PTR) has increased since 2005 (seven studies, moderate QoE); however, positive outcome-reporting bias is prevalent (14 studies, low QoE), and information in nonmandatory fields is vague (10 studies, low QoE). Disclosure of financial conflict of interest (CoI) is inadequate (five studies, low QoE). Blinding peer reviewers may reduce geographical bias (two studies, very low QoE), and open-access publishing does not discriminate against authors from low-income countries (two studies, very low QoE).ConclusionThe use of PTR and CoI disclosures is increasing; however, the adequacy of their use requires improvement. The effect of open-access publication and blinding of peer reviewers on publication bias is unclear, as is the effect of other interventions such as electronic publication and authors' rights to publish their results.

Background When the nature and direction of research results affect their chances of publication, a distortion of the evidence base – termed publication bias – results. Despite considerable recent efforts to implement measures to reduce the non-publication of trials, publication bias is still a major problem in medical research. The objective of our study was to identify barriers to and facilitators of interventions to prevent or reduce publication bias. Methods We systematically reviewed the scholarly literature and extracted data from articles. Further, we performed semi-structured interviews with stakeholders. We performed an inductive thematic analysis to identify barriers to and facilitators of interventions to counter publication bias. Results The systematic review identified 39 articles. Thirty-four of 89 invited interview partners agreed to be interviewed. We clustered interventions into four categories: prospective trial registration, incentives for reporting in peer-reviewed journals or research reports, public availability of individual patient-level data, and peer-review/editorial processes. Barriers we identified included economic and personal interests, lack of financial resources for a global comprehensive trial registry, and different legal systems. Facilitators identified included: raising awareness of the effects of publication bias, providing incentives to make data publically available, and implementing laws to enforce prospective registration and reporting of clinical trial results. Conclusions Publication bias is a complex problem that reflects the complex system in which it occurs. The cooperation amongst stakeholders to increase public awareness of the problem, better tailoring of incentives to publish, and ultimately legislative regulations have the greatest potential for reducing publication bias. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0551-z) contains supplementary material, which is available to authorized users.

Background Sunlight exposure and high vitamin D status have been hypothesised to reduce the risk of developing dementia. The objective of our research was to determine whether lack of sunlight and hypovitaminosis D over time are associated with dementia. Methods We systematically searched MEDLINE (via PubMed), Cochrane Library, EMBASE, SCOPUS, Web of Science, ICONDA, and reference lists of pertinent review articles from 1990 to October 2015. We conducted random effects meta-analyses of published and unpublished data to evaluate the influence of sunlight exposure or vitamin D as a surrogate marker on dementia risk. Results We could not identify a single study investigating the association between sunlight exposure and dementia risk. Six cohort studies provided data on the effect of serum vitamin D concentration on dementia risk. A meta-analysis of five studies showed a higher risk for persons with serious vitamin D deficiency (