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1.  Antenatal iron/folic acid supplements, but not postnatal care, prevents neonatal deaths in Indonesia: analysis of Indonesia Demographic and Health Surveys 2002/2003–2007 (a retrospective cohort study) 
BMJ Open  2012;2(6):e001399.
Objective
This study aimed to assess the contribution of postnatal services to the risk of neonatal mortality, and the relative contributions of antenatal iron/folic acid supplements and postnatal care in preventing neonatal mortality in Indonesia.
Design
Retrospective cohort study.
Setting and participants
Data used in this study were the 2002–2007 Indonesia Demographic and Health Surveys, nationally representative surveys. The pooled data provided survival information of 26 591 most recent live-born infants within the 5-years prior to each interview.
Primary outcomes
Primary outcomes were early neonatal mortality, that is, deaths in the first week, and all neonatal mortality, that is, deaths in the first month of life. Exposures were antenatal iron/folic acid supplementation and postnatal care from days 1 to 7. Potential confounders were community, socio-economic status and birthing characteristics and perinatal healthcare. Cox regression was used to assess the association between study factors and neonatal mortality.
Results
Postnatal care services were not associated with newborn survival. Postnatal care on days 1–7 after birth did not reduce neonatal death (HR=1.00, 95% CI 0.55 to 1.83, p=1.00) and early postnatal care on day 1 was associated with an increased risk of early neonatal death (HR=1.27, 95% CI 0.69 to 2.32, p=0.44) possibly reflecting referral of ill newborns. Early postnatal care on day 1 was not protective for neonatal deaths on days 2–7 whether provided by doctors (HR 3.61, 95% CI 1.54 to 8.45, p<0.01), or by midwives or nurses (HR 1.38, 95% CI 0.53 to 3.57, p=0.512). In mothers who took iron/folic acid supplements during pregnancy, the risk of early neonatal death was reduced by 51% (HR=0.49, 95% CI 0.30 to 0.79, p<0.01).
Conclusions
We found no protective effect of postnatal care against neonatal deaths in Indonesia. However, important reductions in the risk of neonatal death were found for women who reported use of antenatal iron/folic acid supplements during pregnancy.
doi:10.1136/bmjopen-2012-001399
PMCID: PMC3532976  PMID: 23117564
Epidemiology; Perinatology; Public Health
2.  Effect of a school-based peer education intervention on physical activity and sedentary behaviour in Chinese adolescents: a pilot study 
BMJ Open  2012;2(3):e000721.
Objective
To evaluate the effect on physical activity and sedentary behaviour of a pilot school-based peer education programme in urban Beijing, China.
Design
4 junior high schools were matched by school size and randomised to intervention (n=346) and control group (n=336).
Intervention
Trained peer leaders from grade 7 by research staff delivered weekly 40-min lessons to their classmates over four consecutive weeks. Students in control schools received no intervention.
Outcome measures
A validated 7-day youth physical activity questionnaire was used to evaluate physical activity and sedentary behaviours at baseline (September 2010), 3 months (December 2010) and 7 months (May 2011). Generalised linear mixed models were applied to evaluate the effect.
Results
There was a significant decrease in time in sedentary behaviour on weekdays, 20 min/day at 7 months (p=0.020) reported by students in the intervention schools compared with control schools. This reduction was mainly due to a reduction of 14 min/day in computer usage on weekdays (p=0.0009). There were no significant differences in time on other sedentary behaviours, including television and DVD, video game, extracurricular reading, writing, drawing and listening to music, passive commuting and sitting to talk. There was also no significant difference in time in moderate-to-vigorous physical activity between intervention and control group.
Conclusions
Peer education appears to be a promising intervention in reducing sedentary behaviours in adolescents in China. These results need confirmation in a larger study.
Clinical trial registration number
ACTRN12612000417886 at http://ANZCTR.org.au
Article summary
Article focus
To evaluate the effect on physical activity and sedentary behaviour of a pilot school-based peer education programme in grade 7 students in urban Beijing, China.
Key messages
Peer education is a promising intervention to reduce sedentary behaviours in adolescents.
Strengths and limitations of this study
Our intervention is innovative because the peer education programme is theory-based and easy to run by following the peer leader's manual. Peer leaders are trained in a short period of time and then educate their classmates. These features ensure the programme minimally interrupt school activities, cost-effective and feasible for larger scale implementation.
With only two schools in each arm, potential confounders may not have been balanced across treatment groups. Also, physical activity was not objectively measured.
doi:10.1136/bmjopen-2011-000721
PMCID: PMC3358620  PMID: 22586284
3.  Cohort profile: Ho Chi Minh City Youth Cohort—changes in diet, physical activity, sedentary behaviour and relationship with overweight/obesity in adolescents 
BMJ Open  2012;2(1):e000362.
Objectives
The Ho Chi Minh Youth cohort study aimed to assess the change in nutritional status; indicators of adiposity; diet; physical activity and sedentary behaviours; home, neighbourhood and school microenvironments and their complex relationships in adolescents in urban areas of Ho Chi Minh City.
Design
Prospective 5-year cohort.
Setting
Systematic random sampling was used to select 18 schools in urban districts.
Participants
Children were followed up over 5 years with an assessment in each year. Consent, from both adolescents and their parents, was required. At baseline, 759 students were recruited into the cohort, and of these students, 740 remained in the cohort for the first round, 712 for the second round, 630 for the third round and 585 for the last round of follow-up.
Primary and secondary outcome measures
Anthropometric measurements were taken using established guidelines. Six main groups of exposure factors including dietary intake and behaviours, physical activity and sedentary behaviours, family social and physical environment, school environment, socioeconomic status and parental characteristics were measured.
Results
Retention rate was high (77%). Within 5-year period, the prevalence of combined overweight and obesity using International Obesity Task Force cut-off values increased from 14.2% to 21.8%. Time spent on physical activity decreased significantly in the 5-year period from 87 to 50 min/day. Time spent on sedentary behaviours increased in the 5-year period from 512 to 600 min/day.
Conclusions
The complete data analysis of this cohort study will allow a full exploration of the role of environmental and lifestyle behaviours on adolescent overweight and obesity and also identify the factors most strongly associated with excess weight gain and the appearance of overweight and obesity in different age groups of adolescents from this large city in Vietnam.
Article summary
Article focus
The change in nutritional status; indicators of adiposity; diet; physical activity and sedentary behaviours; home, neighbourhood and school microenvironments and their complex relationships in adolescents in urban areas of Ho Chi Minh city.
Key messages
Prevalence of combined overweight/obesity increased from 14.2% to 21.8% in 5-year period.
Time spent on physical activity decreased significantly in the 5-year period from 87 to 50 min/day.
Time spent on sedentary behaviours increased in the 5-year period from 512 to 600 min/day.
Strengths and limitations of this study
This is the first cohort in Vietnam on adolescent obesity.
This study assessed a full set of potential risk factors from dietary intake, physical activity and sedentary behaviours to environmental factors, allowing a wide ranging assessment of the factors related to excess weight gain and overweight and obesity among urban Vietnamese adolescents.
The present longitudinal study revealed changes in anthropometric measurements, physical activity, sedentary behaviour and diet associated with age in both genders.
doi:10.1136/bmjopen-2011-000362
PMCID: PMC3282290  PMID: 22337814

Results 1-3 (3)