Effectiveness of a Training Program in Reducing Infections in Toddlers Attending Day Care Centers

Abstract

We compared four methods of control selection to assess the effect of using infants with malformations as controls in case-control studies of birth defects. We identified cases and controls using data from the Slone Epidemiology Unit Births Defect Study for the years 1976-1992. Cases were defined as infants with cleft lip and palate and no other malformations (N = 494). Controls (N = 8356) were chosen from infants with other malformations, excluding other oral cleft conditions or syndromes associated with clefts. Maternal smoking during the first 13 weeks of pregnancy was the exposure of interest. We then assessed the measures of association resulting from using controls with varying restrictions. When we excluded all defects potentially associated with maternal smoking (based on reports in the literature), the crude odds ratio for smoking and oral cleft risk was 1.6 (1.3-1.9). When we eliminated all defect groups with a smoking prevalence that was one or more standard deviations above or below the total control group mean, the odds ratio was 1.5 (1.2-1.8); with controls restricted to infants with Mendelian-inherited disorders (with presumably no causal effect of smoking), the odds ratio was 1.6 (1.1-2.7); and when selection was unrestricted, the crude odds ratio was 1.5 (1.2-1.8). When used selectively, infants with malformations other than the anomaly of interest can be a suitable source of controls.

Prevención de infecciones respiratorias en jardines maternales: recomendaciones y revisión sistemática de la evidencia

“…[20][21][22][23][24][25][26][27] No se encontraron estudios que hayan analizado el efecto de una medida única, sino que, los trabajos hallados corresponden a estudios sobre el efecto de programas de capacitación e implementación de varias medidas simultáneamente.…”

An Observational Study of Antibiotic Prescribing Behavior and the Hawthorne Effect

“…Previous investigations demonstrating significant Hawthorne effects on study outcomes have usually been designed to improve performance or outcomes and the study participants were aware of the outcomes being measured (De Amici et al 2000;Arborelius and Timka 1990;Carabin et al 1999;Grufferman 1999). It has been suggested that the Hawthorne effect may have a significant impact only when there is a perceived demand for improved performance or outcomes (Arborelius and Timka 1990).…”

“…However, some studies have found that simply monitoring a particular outcome can change study participant behavior if they know the investigators are interested in that outcome (De Amici et al 2000). For example, Carabin et al (1999) found that having day care workers record the number of children absent because of diarrheal illness over a nine-month period decreased the coliform bacterial counts on the hands of the classroom teachers and children (one of several outcomes that were monitored). De Amici et al informed patients in the preoperative period that they were part of a research study and would thus be closely monitored postoperatively for complications and pain levels (De Amici et al 2000).…”

“…In fact, several interventions aimed at improving physician performance have deliberately included physician feedback and goal-setting as components of successful quality improvement interventions (Davis et al 1995;Greco and Eisenberg 1993;Lohr, Brook, and Kaufman 1980). For studies examining physician performance but not including such factors, measuring the Hawthorne effect is necessary to isolate the true effects of the intervention itself.Previous investigations demonstrating significant Hawthorne effects on study outcomes have usually been designed to improve performance or outcomes and the study participants were aware of the outcomes being measured (De Amici et al 2000;Arborelius and Timka 1990;Carabin et al 1999;Grufferman 1999). It has been suggested that the Hawthorne effect may have a significant impact only when there is a perceived demand for improved performance or outcomes (Arborelius and Timka 1990).…”

Personal exposure assessment studies may suffer from exposure-relevant selection bias

“…Personal exposure measurements are often considered as gold standard, since individual activities and exposures in different microenvironments (home, workplace, outdoors, traffic ) are taken into account ( Wallace and Ott, 1982;Wallace et al, 1989;Williams, 1992;Wallace, 1993;Ott and Roberts, 1998 ). However, assessing personal exposures is demanding for participants and, subsequently, such studies are prone to selective non-response and modified time ± activity patterns during measurements (``Hawthorne effect'') (Robinson, 1988;Boudet et al, 1997;Carabin et al, 1999;Grufferman, 1999 ). Such bias is of particular relevance in two fields of application: on the one hand, exposure assessment is a key element of risk assessment (Samet et al, 1998 ).…”