The aim of this paper was to review the evidence for early-life (from conception to 5 years of age) determinants of obesity. The design is review of published systematic reviews. Data sources included Medline, Embase, Web of Science, Cochrane Library, CINAHL, PsycINFO. Identification of 22 eligible reviews from a database of 12,021 independent publications. Quality of selected reviews assessed using the Assessment of Multiple Systematic Reviews score. Articles published after the reviews were used to confirm results. No review was classified as high quality, 11 as moderate and 11 as low. Factors associated with later overweight and obesity: maternal diabetes, maternal smoking, rapid infant growth, no or short breastfeeding, obesity in infancy, short sleep duration, <30 min of daily physical activity, consumption of sugar-sweetened beverages. Other factors were identified as potentially relevant, although the size of their effect is difficult to estimate. Maternal smoking, breastfeeding, infant size and growth, short sleep duration and television viewing are supported by better-quality reviews. It is difficult to establish a causal association between possible determinants and obesity, and the relative importance of each determinant. Future research should focus on early-life interventions to confirm the role of protective and risk factors and to tackle the high burden obesity represents for present and future generations.

This Campbell Systematic Review examines the effectiveness of different approaches for promoting handwashing and sanitation behaviour change, and factors affecting implementation, in low and middle‐income countries. The review summarises evidence from 42 impact evaluations, and from 28 qualitative studies. Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components. Sanitation and hygiene messaging with a focus on handwashing with soap has an effect after the intervention has ended, but there is little impact on sanitation outcomes. However, these effects are not sustainable in the long term. Using elements of psychosocial theory in a small‐scale handwashing promotion intervention, or adding theory‐based elements such as infrastructure promotion or public commitment to an existing promotional approach, seem promising for handwashing with soap. None of the approaches described have consistent effects on behavioural factors such as knowledge, skills and attitude. There are no consistent effects on health. Plain language summary Community‐based approaches are most effective in promoting changes in hygiene practices, but sustainability is a challengeCommunity‐based approaches to promote handwashing and sanitation efforts seem to work better than social marketing, messaging and interventions based on psychosocial theory. Programs combining hygiene and sanitation measures appears to have a larger impact than either one alone. What is this review about?Diarrhoeal diseases are very common causes of death in low and middle‐income countries. Improved sanitation and hygiene reduce diarrhoea, but adoption remains a challenge.This review assesses the evidence for two questions: (1) how effective are different approaches to promote handwashing and sanitation behaviour change; and (2) what factors influence the implementation of these approaches? What studies are included?Studies of effectiveness had to be impact evaluations using an experimental or quasi‐experimental design and analytical observational studies. Implementation studies used qualitative designs.Forty‐two quantitative studies and 28 qualitative studies met the inclusion criteria. The quantitative studies were conducted in LMICs worldwide, with the majority of the studies in South Asia and Sub‐Saharan Africa. What are the main findings of this review?Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components.Sanitation and hygiene messaging with a focus on hand...

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SummaryThe objective of this study was to analyse interventions for the prevention of overweight and obesity in children under 5 years of age. We carried out a systematic review focusing exclusively on randomized controlled trials (RCTs). Data sources include Medline, Cochrane Library, EMBASE, CINHAL, PsychInfo and Web of Science. Data were extracted from seventeen articles describing seven RCTs identified through electronic search, screening of references in systematic reviews, own files and contact with authors. RCTs were assessed with the Jadad scale. Four trials were carried out in preschool settings, one with an exclusive educational component, two with an exclusive physical activity component and one with both. Two trials were family-based, with education and counselling for parents and children. The remaining trial was carried out in maternity hospitals, with a training intervention on breastfeeding. None of the interventions had an effect in preventing overweight and obesity. The failure to show an effect may be due to the choice of outcomes, the quality of the RCTs, the suboptimal implementation of the interventions, the lack of focus on social and environmental determinants. More rigorous research is needed on interventions and on social and environmental factors that could impact on lifestyle.

Cochrane Database of Systematic Reviews Comparison of di erent human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV-related disease in females and males (Review)