RESUMO
Objective To investigate the number and distribution of un-repaired cleft lip/palate patients in Gansu province. Methods A census was conducted by staff members of the health system and Population and Family Planning Committee (PFPC) in Gansu province. Standardized -Questionnaires were administered to collect demographic, domestic and diagnosis-related information. Results In 2008, the total number of un-repaired cleft lip/palate patients was 4675,with a detection rate of 1.84/10 000 in Gansu province. Rates of detection were higher in males (2.11/10 000), young age group(4.86/10 000), rural areas(2.23/10 000),poor counties(2.19/10 000)than in females(1.43/10 000), medium (0,97/10 000)/old age group(0.68/10 000), township areas (0.62/10 000), or richer counties (1.35/10 000). Among all the cities and prefectures of Gansu,Baiyin city (2.7/10 000) had the highest while Jinchang city (0.7/10 000) had the lowest prevalence rates. Conclusion Un-repaired cleft lip/palate had been a disease burden to Gansu province,especially in the rural area and poorer counties.
RESUMO
In this article, two research cases are employed to show the rationale of the stepped-wedge design, under what situations that such a design is desirable, and how it can be implemented. Stepped-wedge design seems to suit to randomized controlled trials in which the entire study population will receive intervention programs as they would "provide more advantages than harm". When intervention can not be given to all the targets simultaneously due to limited resources, this design is particularly useful. The stepped-wedge design is also relevant when there is a hope to detect or control the time trend effect on the effectiveness of the intervention strategy. On the other hand, however, this design requires longer trial duration and presents a number of statistical challenges. Hence, careful planning and monitoring are essential to ensure that a robust evaluation is undertaken.