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      Developing and evaluating complex interventions: the new Medical Research Council guidance


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          Evaluating complex interventions is complicated. The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance

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          Most cited references15

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          What is missing from descriptions of treatment in trials and reviews?

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            Effect of air-pollution control on death rates in Dublin, Ireland: an intervention study.

            Particulate air pollution episodes have been associated with increased daily death. However, there is little direct evidence that diminished particulate air pollution concentrations would lead to reductions in death rates. We assessed the effect of air pollution controls--ie, the ban on coal sales--on particulate air pollution and death rates in Dublin. Concentrations of air pollution and directly-standardised non-trauma, respiratory, and cardiovascular death rates were compared for 72 months before and after the ban of coal sales in Dublin. The effect of the ban on age-standardised death rates was estimated with an interrupted time-series analysis, adjusting for weather, respiratory epidemics, and death rates in the rest of Ireland. Average black smoke concentrations in Dublin declined by 35.6 mg/m(3) (70%) after the ban on coal sales. Adjusted non-trauma death rates decreased by 5.7% (95% CI 4-7, p<0.0001), respiratory deaths by 15.5% (12-19, p<0.0001), and cardiovascular deaths by 10.3% (8-13, p<0.0001). Respiratory and cardiovascular standardised death rates fell coincident with the ban on coal sales. About 116 fewer respiratory deaths and 243 fewer cardiovascular deaths were seen per year in Dublin after the ban. Reductions in respiratory and cardiovascular death rates in Dublin suggest that control of particulate air pollution could substantially diminish daily death. The net benefit of the reduced death rate was greater than predicted from results of previous time-series studies.
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              The impact of pesticide regulations on suicide in Sri Lanka.

              Between 1950 and 1995 suicide rates in Sri Lanka increased 8-fold to a peak of 47 per 100,000 in 1995. By 2005, rates had halved. We investigated whether Sri Lanka's regulatory controls on the import and sale of pesticides that are particularly toxic to humans were responsible for these changes in the incidence of suicide. Ecological analysis using graphical and descriptive approaches to identify time trends in suicide and risk factors for suicide in Sri Lanka, 1975-2005. Restrictions on the import and sales of WHO Class I toxicity pesticides in 1995 and endosulfan in 1998, coincided with reductions in suicide in both men and women of all ages. 19,769 fewer suicides occurred in 1996-2005 as compared with 1986-95. Secular trends in unemployment, alcohol misuse, divorce, pesticide use and the years associated with Sri Lanka's Civil war did not appear to be associated with these declines. These data indicate that in countries where pesticides are commonly used in acts of self-poisoning, import controls on the most toxic pesticides may have a favourable impact on suicide. In Asia, there are an estimated 300,000 deaths from pesticide self-poisoning annually. National and international policies restricting the sale of pesticides that are most toxic to humans may have a major impact on suicides in the region.

                Author and article information

                Role: programme manager
                Role: professor
                Role: director
                Role: professor
                Role: director
                Role: professor
                BMJ : British Medical Journal
                BMJ Publishing Group Ltd.
                29 September 2008
                : 337
                : a1655
                [1 ]MRC Population Health Sciences Research Network, Glasgow G12 8RZ
                [2 ]Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD
                [3 ]MRC Social and Public Health Sciences Unit, Glasgow G12 8RZ
                [4 ]Centre for Outcomes Research and Effectiveness, University College London, London WC1E 7HB
                [5 ]MRC General Practice Research Framework, London NW1 2ND
                [6 ]Public and Environmental Health Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
                Author notes
                Correspondence to: P Craig peter@ 123456sphsu.mrc.ac.uk
                © BMJ Publishing Group Ltd 2008
                : 23 August 2008
                Research Methods and Reporting



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