***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Rationale There is little evidence for the efficacy of h and washing for prevention of influenza transmission in re source -poor setting s. We tested the impact of intensive h and washing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh . Methods In 2009–10 , we identified index case- patients with influenza-like illness ( fever with cough or sore throat ) who were the only symptomatic person in their household . Household compounds of index case- patients were r and omized to control or intervention ( soap and daily h and washing promotion ) . We conducted daily surveillance and collected oropharyngeal specimens . Secondary attack ratios ( SAR ) were calculated for influenza and ILI in each arm . Among controls , we investigated individual risk factors for ILI among household contacts of index case- patients . Results Among 377 index case- patients , the mean number of days between fever onset and study enrollment was 2.1 ( SD 1.7 ) among the 184 controls and 2.6 ( SD 2.9 ) among 193 intervention case- patients . Influenza infection was confirmed in 20 % of controls and 12 % of intervention index case- patients . The SAR for influenza-like illness among household contacts was 9.5 % among intervention ( 158/1661 ) and 7.7 % among control households ( 115/1498 ) ( SAR ratio 1.24 , 95 % CI 0.92–1.65 ) . The SAR ratio for influenza was 2.40 ( 95 % CI 0.68–8.47 ) . In the control arm , susceptible contacts < 2 years old ( RRadj 5.51 , 95 % CI 3.43–8.85 ) , those living with an index case-patient enrolled ≤24 hours after symptom onset ( RRadj 1.91 , 95 % CI 1.18–3.10 ) , and those who reported multiple daily interactions with the index case-patient ( RRadj 1.94 , 95 % CI 1.71–3.26 ) were at increased risk of influenza-like illness . Discussion H and washing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza . Behavior may not have changed rapidly enough to curb transmission between household members . A reactive approach to reduce household influenza transmission through h and washing promotion may be ineffective in the context of rural Bangladesh . Trial Registration Clinical Trials.gov Please cite this paper as : Simmerman et al. ( 2011 ) Findings from a household r and omized controlled trial of h and washing and face masks to reduce influenza transmission in Bangkok , Thail and . Influenza and Other Respiratory Viruses 5(4 ) , 256–267 Background Evidence is needed on the effectiveness of non‐pharmaceutical interventions ( NPIs ) to reduce influenza transmission . Methodology We studied NPIs in households with a febrile , influenza‐positive child . Households were r and omized to control , h and washing ( HW ) , or h and washing plus paper surgical face masks ( HW + FM ) arms . Study nurses conducted home visits within 24 hours of enrollment and on days 3 , 7 , and 21 . Respiratory swabs and serum were collected from all household members and tested for influenza by RT‐PCR or serology . Principal Findings Between April 2008 and August 2009 , 991 ( 16·5 % ) of 5995 pediatric influenza‐like illness patients tested influenza positive . Four hundred and forty‐two index children with 1147 household members were enrolled , and 221 ( 50·0 % ) were aged < 6 years . Three hundred and ninety‐seven ( 89·8 % ) households reported that the index patient slept in the parents ’ bedroom . The secondary attack rate was 21·5 % , and 56/345 ( 16·3 % ; 95 % CI 12·4–20·2 % ) secondary cases were asymptomatic . H and ‐washing subjects reported 4·7 washing episodes/day , compared to 4·9 times/day in the HW + FM arm and 3·9 times/day in controls ( P = 0·001 ) . The odds ratios ( ORs ) for secondary influenza infection were not significantly different in the HW arm ( OR = 1·20 ; 95 % CI 0·76–1·88 ; P‐0.442 ) , or the HW + FM arm ( OR = 1·16 ; 95 % CI .0·74–1·82 ; P = 0.525 ) . Conclusions Influenza transmission was not reduced by interventions to promote h and washing and face mask use . This may be attributable to transmission that occurred before the intervention , poor facemask compliance , little difference in h and ‐washing frequency between study groups , and shared sleeping arrangements . A prospect i ve study design and a careful analysis of sociocultural factors could improve future NPI studies Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background The economical impact of absenteeism and reduced productivity due to acute infectious respiratory and gastrointestinal disease is normally not in the focus of surveillance systems and may therefore be underestimated . However , large community studies in Europe and USA have shown that communicable diseases have a great impact on morbidity and lead to millions of lost days at work , school and university each year . H and disinfection is acknowledged as key element for infection control , but its effect in open , work place setting s is unclear . Methods Our study involved a prospect i ve , controlled , intervention-control group design to assess the epidemiological and economical impact of alcohol-based h and disinfectants use at work place . Volunteers in public administrations in the municipality of the city of Greifswald were r and omized in two groups . Participants in the intervention group were provided with alcoholic h and disinfection , the control group was unchanged .  Respiratory and gastrointestinal symptoms and days of work were recorded based on a monthly question naire over one year . On the whole , 1230 person months were evaluated . Results H and disinfection reduced the number of episodes of illness for the majority of the registered symptoms . This effect became statistically significant for common cold ( OR = 0.35 [ 0.17 - 0.71 ] , p = 0.003 ) , fever ( OR = 0.38 [ 0.14 - 0.99 ] , p = 0.035 ) and coughing ( OR = 0.45 [ 0.22 - 0.91 ] , p = 0.02 ) . Participants in the intervention group reported less days ill for most symptoms assessed , e.g. colds ( 2.07 vs. 2.78 % , p = 0.008 ) , fever ( 0.25 vs. 0.31 % , p = 0.037 ) and cough ( 1.85 vs. 2.00 % , p = 0.024 ) . For diarrhoea , the odds ratio for being absent became statistically significant too ( 0.11 ( CI 0.01 - 0.93 ) . Conclusion H and disinfection can easily be introduced and maintained outside clinical setting s as part of the daily h and hygiene . Therefore it appears as an interesting , cost-efficient method within the scope of company health support programmes . Trial registration numberIS RCT N : IS RCT Background There are sparse data on whether non-pharmaceutical interventions can reduce the spread of influenza . We implemented a study of the feasibility and efficacy of face masks and h and hygiene to reduce influenza transmission among Hong Kong household members . Methodology /Principal Findings We conducted a cluster r and omized controlled trial of households ( composed of at least 3 members ) where an index subject presented with influenza-like-illness of < 48 hours duration . After influenza was confirmed in an index case by the QuickVue Influenza A+B rapid test , the household of the index subject was r and omized to 1 ) control or 2 ) surgical face masks or 3 ) h and hygiene . Households were visited within 36 hours , and 3 , 6 and 9 days later . Nose and throat swabs were collected from index subjects and all household contacts at each home visit and tested by viral culture . The primary outcome measure was laboratory culture confirmed influenza in a household contact ; the secondary outcome was clinical ly diagnosed influenza ( by self-reported symptoms ) . We r and omized 198 households and completed follow up home visits in 128 ; the index cases in 122 of those households had laboratory-confirmed influenza . There were 21 household contacts with laboratory confirmed influenza corresponding to a secondary attack ratio of 6 % . Clinical secondary attack ratios varied from 5 % to 18 % depending on case definitions . The laboratory-based or clinical secondary attack ratios did not significantly differ across the intervention arms . Adherence to interventions was variable . Conclusions / Significance The secondary attack ratios were lower than anticipated , and lower than reported in other countries , perhaps due to differing patterns of susceptibility , lack of significant antigenic drift in circulating influenza virus strains recently , and /or issues related to the symptomatic recruitment design . Lessons learnt from this pilot have informed changes for the main study in 2008 . Trial Registration Clinical Trials.gov NCT00425893 HK Clinical Trials.com The objective of this study was to identify possible hygiene behaviors  associated with the incidence of ILI among adults in Beijing . In January 2011 , we conducted a multi-stage sampling , cross-sectional survey of adults living in Beijing using self-administered anonymous question naires . The main outcome variable was self-reported ILI within the past year . Multivariate logistic regression was used to identify factors associated with self-reported ILI . A total of 13003 participants completed the question naires . 6068 ( 46.7 % ) of all participants reported ILI during the past year . After adjusting for demographic characteristics , the variables significantly associated with a lower likelihood of reporting ILI were regular physical exercise ( OR 0.80 ; 95 % CI 0.74–0.87 ) , optimal h and hygiene ( OR 0.87 ; 95 % CI 0.80–0.94 ) , face mask use when going to hospitals ( OR 0.87 ; 95 % CI 0.80–0.95 ) , and not sharing of towels and h and kerchiefs ( OR 0.68 ; 95 % CI 0.63–0.73 ) . These results highlight that  personal hygiene behaviors  were potential preventive factors against the incidence  of ILI among adults in Beijing , and future interventions to improve personal hygiene behaviors are needed in Beijing BACKGROUND Minimal research has been published evaluating the effectiveness of h and hygiene delivery systems ( ie , rubs , foams , or wipes ) at removing viruses from h and s. The purpose s of this study were to determine the effect of several alcohol-based h and sanitizers in removing influenza A ( H1N1 ) virus , and to compare the effectiveness of foam , gel , and h and wipe products . METHODS H and s of 30 volunteers were inoculated with H1N1 and r and omized to treatment with foam , gel , or h and wipe applied to half of each volunteer 's finger pads . The log(10 ) count of each subject 's treated and untreated finger pads were averaged . Log(10 ) reductions were calculated from these differences and averaged within treatment group . Between-treatment analysis compared changes from the untreated finger pads using analysis of covariance with treatment as a factor and the average log(10 ) untreated finger pads as the covariate . RESULTS Log(10 ) counts on control finger pads were 2.7 - 5.3 log(10 ) of the 50 % infectious dose for tissue culture ( TCID(50)/0.1 mL ) ( mean , 3.8 ± 0.5 log(10 ) TCID(50)/0.1 mL ) , and treated finger pad counts for all test products were 0.5 - 1.9 log(10 ) TCID(50)/0.1 mL ( mean , 0.53 ± 0.17 log(10 ) TCID(50)/0.1 mL ) . Treatments with all products result ed in a significant reduction in viral titers ( > 3 logs ) at their respective exposure times that were statistically comparable . CONCLUSIONS All 3 delivery systems ( foam , gel , and wipe ) produced significantly reduced viral counts on h and BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . R 
    Output:
    
In light of its proven effectiveness in other setting s , there is no compelling evidence to stop using good h and hygiene practice to reduce the risk of influenza infection and transmission in the community setting