BackgroundProgrammes based on the World Health Organization’s Health Promoting Schools framework (HPS) have been implemented in several countries but for evidence-based policy-making more research is required to determine the effectiveness of the HPS approach.MethodsWe conducted a cluster randomised controlled trial. The units of randomisation were primary school classes recruited in May 2010. Eligible participants were Year 3 primary school classes in Lower Austria that had not participated in a similar programme during the last two years. After baseline assessment in September 2010, 53 classes from 45 primary schools in Lower Austria were randomly assigned to an intervention (n = 26 classes, 432 children) or waiting control arm (n = 27 classes, 493 children aged 8.7 years +/- 4 months). Over the course of 1.5 academic years, participating teachers received on-the-job training (20 h) and two workshops (8 h) to promote health related behaviour in students such as physical activity during the school day and to improve the quality of regular physical education classes. We assessed 15 outcomes grouped into five categories: Emotional and Social Experience in School, Physical Activity, Well-being, and Attention Performance measured by validated and standardised questionnaire and Motor Skills measured by validated and standardised motoric and coordination tests in the school gym. The primary outcome was Classroom Climate and part of the outcomecategory Emotional and Social Experience in School. The final assessment took place in April 2012. All assessors were blinded to the allocation of classes. Multilevel growth modelling was used to investigate programme effectiveness.ResultsWe could not detect any statistically significant differences between groups for the outcomecategories Emotional and Social Experience in school (p = 0.22 to 0.78), Physical Activity, Well-being, and Attention Performance. Significant differences between groups were limited to the outcomecategory Motor Skills (Complex Reaction Ability, Spatial Orientation Skills, Coordination with Precision) which were higher in the intervention group (P < .05).ConclusionsDespite small statistically significant differences in Motor Skills, our study could not detect any clinically relevant improvements in the Emotional and Social Experience at School (including the primary outcome ClassroomClimate), Physical Activity, Well-being, Motor Skills and Attention Performance of students.Trial registrationGerman register of clinical studies: DRKS00000622. Retrospectively registered: 03.12.2010. Approved by the Ethics Committee of Lower Austria (GS4-EK-4/107-2010).

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

Zusammenfassung. Ziel der vorliegenden Arbeit war die Klärung der Bedingungen des Studienabbruchs mit Hilfe von Cox-Regressionsanalysen, Strukturgleichungsmodellen und Mehrebenen-Analysen. Die Daten stammen von Studierenden der Universität Linz, die in ihrem letzten Schuljahr an Studienberatungstests und drei bis siebzehn Semester später an einer Befragung zu ihren Studienerfahrungen teilgenommen haben. In Ergänzung dazu konnten Zeitreihen von Prüfungsergebnissen analysiert werden. Niedrige Schul- und Testleistungen, inkongruente Interessen und niedrige Werte in Selbstkontrolle und Belastbarkeit hatten erwartungsgemäß während des Studiums weniger effiziente Arbeitshaltungen, unzulängliche Prüfungsleistungen (schlechten Notendurchschnitt und geringe Anzahl von Prüfungen pro Semester), Unzufriedenheit mit dem Verlauf des Studiums und schließlich (sehr oft) Studienabbruch zur Folge. Als ein Weg zur Reduzierung des Drop-out-Risikos wird neben Verbesserungen in der Studienorganisation ein weiterer Ausbau der Studienwahlberatung empfohlen.

BackgroundHealth promotion programs can only lead to improvements in health outcomes if they are effectively implemented. However, most studies assessing implementation success focus on only one condition, although more conditions influence this process. Therefore, evidence is scarce on what conditions play a role in successful implementation and how they interact. Hence, we aimed to identify which combinations of teacher and implementation process characteristics affected the emotional and social school experience (SCE) of pupils participating in a school-based health promotion program.MethodsThis study was part of an effectiveness and process evaluation including 24 intervention and 27 control classes. We used fuzzy-set qualitative comparative analysis (fsQCA) to identify combinations of conditions that were associated with either an increase or no increase in the outcome SCE in comparison to the control group at 20 months post intervention. We deductively selected five conditions based on the Consolidated Framework for Implementation Research: teachers’ perceived self-efficacy, teachers’ expectations of the benefits of the intervention, teachers’ previous knowledge about the intervention, dosage of physical activity breaks, and quality of the implementation.ResultsWe identified five different pathways that led to no increase in the pupils’ outcome (parameters of fit: consistency 94%, coverage 66%). The combination of an unsatisfying quality of implementing the intervention and a low previous knowledge about the intervention showed the highest empirical relevance. Similarly, fewer physical activity breaks in combination with other conditions impeded the program’s success. Furthermore, we identified two different pathways characterizing ways to success (consistency: 81%, coverage: 52%). The most relevant combination was good quality implementation of physical activity breaks, implemented by teachers with a high self-efficacy, and a good previous knowledge about the intervention.ConclusionsQCA has potential for an in-depth analysis of complex interventions as it can rely on small to medium sample sizes and analyze pathways to success and non-success separately. The investigated program can be improved by considering the following suggestions: The quality of the implementation process should be monitored during the implementation phase, and regular feedback loops and learning opportunities for teachers should accompany a program. Clear recommendations regarding the dosage should be established.Trial registrationGerman register of clinical studies: DRKS00000622. Retrospectively registered: December 3, 2010, (http://www.drks.de/drks_web/setLocale_EN.do). Approved by the Ethics Committee of Lower Austria (GS4-EK-4/107–2010).Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6284-x) contains supplementary material, which is available to authorized users.