A text message intervention to support women's physical and mental health after breast cancer treatments (EMPOWER-SMS): a randomised controlled trial protocol.

BACKGROUND: Breast cancer is the most common cancer diagnosed in women worldwide. In developed countries, 80-90% of women will survive five years after diagnosis but the transition from hospital-based care to health self-management and self-efficacy can be difficult. Text messaging programs offer a simple and proven way to provide support to people with chronic diseases. This study aims to test the effectiveness of a text message support program at improving women's health self-efficacy, and physical and mental health outcomes after breast cancer treatments compared to usual care at 6-months and to understand the barriers and enablers to widespread implementation. METHODS: Single-blind randomised control trial (RCT; N = 160) comparing a text message support intervention to usual care in women with breast cancer (recruited from a large tertiary referral hospital in Sydney, Australia). The intervention group will receive a six-month text message support program, which consists of semi-personalised, supportive, lifestyle-focused text messages (4 messages/week) in addition to usual care. The control group will receive usual care without the text message program. Outcomes will be assessed at 6-months. The primary outcome is change in self-efficacy for managing chronic disease. Secondary outcomes include change in clinical outcomes (body mass index), lifestyle outcomes (physical activity levels, dietary behaviours), mood (depression and anxiety scales), quality of life, satisfaction with, and usefulness of the intervention. Analyses will be performed on the principle of intention-to-treat to examine differences between intervention and control groups. DISCUSSION: This study will test if a scalable and cost-effective text-messaging intervention is effective at improving women's health self-efficacy, as well as physical and mental health outcomes. Moreover, this study will provide essential preliminary data to bolster a large multicentre RCT to helpsupport breast cancer survivors throughout recovery and beyond. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12618002020268 , 17 December 2018.

Communicative actions, women's degree of social connectedness and child mortality in rural Bangladesh.

BACKGROUND: Child deaths are decreasing throughout South East Asia, yet the rate remains high and is a cause of considerable anguish. In Bangladesh, there is also a great deal of variation in child mortality between different regions. METHOD: Reported in this paper is the analysis of a survey of 613 Bangladeshi women who live in six rural villages and have reported on their experience of child death. Factors obtained from an interview based questionnaire were investigated to ascertain their association with child death. Multilevel Poison regression models were developed to relate these factors to the number and proportion of child deaths to children ever born while allowing for variation between the villages. RESULTS: It was found that communicative action, especially women's power as the degree of social connectedness, is important in reducing child mortality. Also important in reducing child mortality is the level of women's education. No evidence could be found of sex preference when comparing male and female child deaths.

The determinants of first and subsequent births in urban and rural areas of Bangladesh.

PIP: This study identifies the determinants of the probability of having subsequent births among rural and urban women in Bangladesh. Data were obtained from the 1989 Bangladesh Fertility Survey among a 2-stage sample of 11,905 ever-married women aged 10-49 years. 8466 lived in rural areas; 3439 lived in urban areas. Analysis relied on tabular analysis, nonparametric survival analysis, and Cox proportional hazard regression models. The dependent variable is birth intervals in single months at different parities up to 144 months. Explanatory variables are demographic, socioeconomic, cultural, and decision-making ones and period effects. Findings reveal that different factors affected first births and higher order births. The subsequent births to women in rural areas were affected by more factors. Some variables consistently affected all subsequent births, while others had other impacts. For example, education increased the risk of having a first birth, but decreased the risk of subsequent births. Husband's education was a significant factor in first births and insignificant in higher order births. The period effect was significant for all births. Findings confirm that fertility is recent and stronger in urban areas and will continue to decline. Greater urbanization is likely to lower fertility. Risk of subsequent births was related to work experience. Religion was significant in higher order births in rural areas, but it was insignificant in urban areas. Residence in Dhaka resulted in a lower risk of a first birth compared with Chittagong region. Rural regions had lower risk of higher order births than Chittagong region. Son preference was not a significant factor.^ieng

An investigation into the relationships between area social characteristics and road accident casualties.

This paper reports on the analysis of a data base created by merging road casualty information and census data for the former Lothian region in Scotland. The data base was established by assigning resident postcodes to each casualty record and relating these postcodes to the census data for the relevant census output area. Initially, consideration was given to the relationship between casualty frequencies and the distance of the accidents from the zones of residence. As might be anticipated, the casualty frequencies were higher nearer to the zones of residence, possibly due to higher exposure. Subsequently, the relationships between casualty rates and social deprivation indicators for the casualties' zone of residence were investigated. In general it was found that the casualty rates amongst residents from areas classified as relatively deprived were significantly higher than those from relatively affluent areas.

Factors affecting the most recent fertility rates in urban-rural Bangladesh.

This paper reports on a study which has been undertaken using data from the 1989 Bangladesh Fertility Survey (BFS) to determine the significance of influences on the probability of birth in the year preceding the survey. In the survey a total of 11905 ever-married women of reproductive age were asked a battery of questions relating to fertility aspects of women. Variables selected in this study were grouped into demographic, socio-economic, cultural and decision-making variables. Findings from the study indicate that the mother's age, whether contraception has ever been used, the death of a child at any time, whether the woman has ever worked, religion, region of residence, and female independence are the important covariates for explaining recent fertility in Bangladesh. Models are developed for the probabilities of a woman giving birth in urban and rural areas, dependent on her demographic and socio-economic conditions. Also developed are models for contraceptive use in urban-rural Bangladesh. This modelling contributes to a better understanding of fertility changes in Bangladesh and the differentials between urban and rural fertility. It is indicated that a continued fertility decline is likely.

Urban and rural fertility in Bangladesh: a causal approach.

Fertility models are constructed from the 1989 Bangladesh Fertility Survey (BFS) employing path analysis. These models are developed and interpreted for urban and rural situations. As a proxy for fertility, the number of children ever born is used, and age, religion, age at marriage, parental childhood residence, and education are considered as explanatory variables. The contribution that these variables give to explaining the 1989 Bangladeshi fertility is compared to the explanatory variables that Ahmed (1981) found suitable for Bangladeshi fertility in 1975. We find that in 1989, compared to 1975, childhood background and education of the mother and age at marriage exert a greater influence on urban fertility, and religion no longer has a significant effect. In the rural case, the effect of religion on fertility has increased since 1975, as has education and age at marriage.

PIP: Path analysis was used to determine the influence of socioeconomic and demographic variables on fertility. Data was obtained from the 1989 Bangladesh Fertility Survey (BFS) on 11,905 ever married women: 8466 rural women and 3439 urban women. Findings were compared with Ahmed's analysis of 1975 BFS data. The number of children ever born (CEB) was examined in terms of the influences of age, religion, childhood place of residence, and educational background. In the urban model CEB was significantly influenced by women's age, education, and childhood background. Religion indirectly influenced CEB through women's age at marriage and education. Women's age did not indirectly significantly influence CEB. In the rural model CEB was directly and significantly influenced by women education, marriage age, religion, and age. Education had a smaller influence in the rural setting and indirectly influenced marriage age but to a lesser extent than in an urban setting. In the rural setting women's age did have an indirect affect on fertility through educational status. Childhood background influenced the education of women in rural areas. In the rural setting age and religion had stronger impacts than in urban areas. In urban areas the indirect influence of age on women's education was stronger. The findings suggest that urbanization is an appropriate explanation for fertility decline in that it reduced fertility and increased educational levels. Between 1975 and 1989 religion had a diminished affect on urban fertility, and women's education and marriage age increased in their impact on fertility over time. In rural areas religion's impact increased over the 14-year period, but women's education and marriage age decreased the impact of increased religious influence.

The use of sigmoids in modelling and forecasting human populations.

"The aim of this paper is to present a review that might justify giving further consideration to the use of sigmoids in contemporary population modelling and forecasting. To do this a brief account is given of the historical development of these models, pointing out why demographers have viewed these trend models with scepticism. Most of the paper is devoted to showing that, despite these criticisms, sigmoid-based trend models are useful practical tools for the demographer." Examples using data for various countries are presented.