Three weight loss competitions were held in business/ industrial settings. One competition was between three banks; the other two were within industries, either between employee teams selected at random or between divisions of the industry. Attrition in the competitions was less than I per cent and weight loss averaged 5.5 kg. Both employees and management reported positive changes in morale and employee/management relations, and both considered the competition important to the success of the program. The costeffectiveness ratio ($2.93 per I per cent reduction in percentage overweight) is the best yet reported. (Am J Public Health 1984; 74:1283-1285 Health promotion at the work site has potential for improving public health,'-2 but in the weight control area, programs have not transferred well from clinical to work settings; the typical worksite program reports nearly double the attrition and half the weight loss found for similar programs in the clinic.3-7 One way to improve these results may be to introduce health promotion competitions to enhance motivation and social support. This paper describes the use of weight loss competitions in three work settings. MethodsThree separate competitions were held in Lycoming County, an area of 119,000 population in north central Pennsylvania. Employees in all participating industries were invited to participate. Subjects less than 10 per cent overweight were excluded from the main analyses.Competition 1 (Three Banks)-A challenge for competition was issued by the presidents of three banks* with a total of 570 employees. In the three banks, 176 employees (31 per cent of the work force) participated in the 12-week program; 112 persons were more than 10 per cent overweight.Competition 2 (Litton)-Fifty-three of 225 employees of a manufacturing firm (Litton Industries) participated in the 13-week program. The participants were assigned randomly to one of three teams within the industry. Participants were weighed weekly by a member of the research team who was not connected with industry. At each weigh-in, the participants received an installment of a behavioral treatment manual8 which emphasized self-monitoring, stimulus control, slowing eating, reinforcement, social support, attitude change, nutrition, and exercise. A large board (4 x 5 ft) was placed in a prominent location in each workplace to show the weekly progress of each team. The boards provided weekly feedback and acted as incentives. Emnployees and management completed a post-program questionnaire to rate several aspects of the program. They rated changes on five-point scales in morale, energy level, employee-management relations, absenteeism, and work performance.Results were analyzed using analyses of variance and covariance with initial weight as the covariate. Chi square analyses were used to evaluate questionnaire responses and correlations were used to test for associations between weight change and questionnaire responses. The covariance analyses yielded the same pattern of results as the analyses o...

Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...

All children in Grades 3 through 12 of one school system completed a survey about health habits and beliefs including smoking and eating habits, perceptions of exercise, weight, and parental involvement in health. The surveys were factor-analyzed within grade and sex, and the overall factors that emerged were Smoking Habits, Family Discussion of Health, Family Thinking About Health, Nutritional Habits, and Health Locus of Control. Analysis of variance of each factor revealed that girls generally reported healthier food habits than did boys. However, girls reported more smoking and less exercise. There are also changes in habits and belief with age; junior high school is a particularly important time for the development of several habits. The findings are discussed in relation to theories of child development and the implications for the content and timing of future health education intervention programs with children.

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