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Spiga F, Davies AL, Tomlinson E, Moore TH, Dawson S, Breheny K, Savović J, Gao Y, Phillips SM, Hillier-Brown F, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database Syst Rev 2024; 5:CD015328. [PMID: 38763517 PMCID: PMC11102828 DOI: 10.1002/14651858.cd015328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well-being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta-analyses. One hundred forty-six studies were based in high-income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty-six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non-industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short-term follow-up (mean difference (MD) 0, 95% confidence interval (CI) -0.10 to 0.10; 5 studies, 2107 participants; low-certainty evidence) and at medium-term follow-up (MD -0.01, 95% CI -0.15 to 0.12; 9 studies, 6815 participants; low-certainty evidence) or zBMI at long-term follow-up (MD -0.05, 95% CI -0.10 to 0.01; 7 studies, 5285 participants; low-certainty evidence). Dietary interventions, compared with control, probably have little to no effect on BMI at long-term follow-up (MD -0.17, 95% CI -0.48 to 0.13; 2 studies, 945 participants; moderate-certainty evidence) and zBMI at short- or medium-term follow-up (MD -0.06, 95% CI -0.13 to 0.01; 8 studies, 3695 participants; MD -0.04, 95% CI -0.10 to 0.02; 9 studies, 7048 participants; moderate-certainty evidence). Five studies (1913 participants; very low-certainty evidence) reported data on serious adverse events: one reported serious adverse events (e.g. allergy, behavioural problems and abdominal discomfort) that may have occurred as a result of the intervention; four reported no effect. Activity interventions versus control Activity interventions, compared with control, may have little to no effect on BMI and zBMI at short-term or long-term follow-up (BMI short-term: MD -0.02, 95% CI -0.17 to 0.13; 14 studies, 4069 participants; zBMI short-term: MD -0.02, 95% CI -0.07 to 0.02; 6 studies, 3580 participants; low-certainty evidence; BMI long-term: MD -0.07, 95% CI -0.24 to 0.10; 8 studies, 8302 participants; zBMI long-term: MD -0.02, 95% CI -0.09 to 0.04; 6 studies, 6940 participants; low-certainty evidence). Activity interventions likely result in a slight reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.18 to -0.05; 16 studies, 21,286 participants; zBMI: MD -0.05, 95% CI -0.09 to -0.02; 13 studies, 20,600 participants; moderate-certainty evidence). Eleven studies (21,278 participants; low-certainty evidence) reported data on serious adverse events; one study reported two minor ankle sprains and one study reported the incident rate of adverse events (e.g. musculoskeletal injuries) that may have occurred as a result of the intervention; nine studies reported no effect. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, may result in a slight reduction in BMI and zBMI at short-term follow-up (BMI: MD -0.11, 95% CI -0.21 to -0.01; 27 studies, 16,066 participants; zBMI: MD -0.03, 95% CI -0.06 to 0.00; 26 studies, 12,784 participants; low-certainty evidence) and likely result in a reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.21 to 0.00; 21 studies, 17,547 participants; zBMI: MD -0.05, 95% CI -0.07 to -0.02; 24 studies, 20,998 participants; moderate-certainty evidence). Dietary and activity interventions compared with control may result in little to no difference in BMI and zBMI at long-term follow-up (BMI: MD 0.03, 95% CI -0.11 to 0.16; 16 studies, 22,098 participants; zBMI: MD -0.02, 95% CI -0.06 to 0.01; 22 studies, 23,594 participants; low-certainty evidence). Nineteen studies (27,882 participants; low-certainty evidence) reported data on serious adverse events: four studies reported occurrence of serious adverse events (e.g. injuries, low levels of extreme dieting behaviour); 15 studies reported no effect. Heterogeneity was apparent in the results for all outcomes at the three follow-up times, which could not be explained by the main setting of the interventions (school, home, school and home, other), country income status (high-income versus non-high-income), participants' socioeconomic status (low versus mixed) and duration of the intervention. Most studies excluded children with a mental or physical disability. AUTHORS' CONCLUSIONS The body of evidence in this review demonstrates that a range of school-based 'activity' interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term, but not at long-term follow-up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. We identified a dearth of evidence for home and community-based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Sophie M Phillips
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Child Health and Physical Activity Laboratory, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre and Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Spiga F, Tomlinson E, Davies AL, Moore TH, Dawson S, Breheny K, Savović J, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 12 to 18 years old. Cochrane Database Syst Rev 2024; 5:CD015330. [PMID: 38763518 PMCID: PMC11102824 DOI: 10.1002/14651858.cd015330.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America, Australia, most of Europe, and the Gulf region. Interventions that aim to prevent obesity involve strategies that promote healthy diets or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective, and numerous new studies have been published over the last five years since the previous version of this Cochrane Review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in adolescents by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in adolescents (mean age 12 years and above but less than 19 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were BMI, zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 74 studies (83,407 participants); 54 studies (46,358 participants) were included in meta-analyses. Sixty studies were based in high-income countries. The main setting for intervention delivery was schools (57 studies), followed by home (nine studies), the community (five studies) and a primary care setting (three studies). Fifty-one interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over 28 months. Sixty-two studies declared non-industry funding; five were funded in part by industry. Dietary interventions versus control The evidence is very uncertain about the effects of dietary interventions on body mass index (BMI) at short-term follow-up (mean difference (MD) -0.18, 95% confidence interval (CI) -0.41 to 0.06; 3 studies, 605 participants), medium-term follow-up (MD -0.65, 95% CI -1.18 to -0.11; 3 studies, 900 participants), and standardised BMI (zBMI) at long-term follow-up (MD -0.14, 95% CI -0.38 to 0.10; 2 studies, 1089 participants); all very low-certainty evidence. Compared with control, dietary interventions may have little to no effect on BMI at long-term follow-up (MD -0.30, 95% CI -1.67 to 1.07; 1 study, 44 participants); zBMI at short-term (MD -0.06, 95% CI -0.12 to 0.01; 5 studies, 3154 participants); and zBMI at medium-term (MD 0.02, 95% CI -0.17 to 0.21; 1 study, 112 participants) follow-up; all low-certainty evidence. Dietary interventions may have little to no effect on serious adverse events (two studies, 377 participants; low-certainty evidence). Activity interventions versus control Compared with control, activity interventions do not reduce BMI at short-term follow-up (MD -0.64, 95% CI -1.86 to 0.58; 6 studies, 1780 participants; low-certainty evidence) and probably do not reduce zBMI at medium- (MD 0, 95% CI -0.04 to 0.05; 6 studies, 5335 participants) or long-term (MD -0.05, 95% CI -0.12 to 0.02; 1 study, 985 participants) follow-up; both moderate-certainty evidence. Activity interventions do not reduce zBMI at short-term follow-up (MD 0.02, 95% CI -0.01 to 0.05; 7 studies, 4718 participants; high-certainty evidence), but may reduce BMI slightly at medium-term (MD -0.32, 95% CI -0.53 to -0.11; 3 studies, 2143 participants) and long-term (MD -0.28, 95% CI -0.51 to -0.05; 1 study, 985 participants) follow-up; both low-certainty evidence. Seven studies (5428 participants; low-certainty evidence) reported data on serious adverse events: two reported injuries relating to the exercise component of the intervention and five reported no effect of intervention on reported serious adverse events. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, do not reduce BMI at short-term follow-up (MD 0.03, 95% CI -0.07 to 0.13; 11 studies, 3429 participants; high-certainty evidence), and probably do not reduce BMI at medium-term (MD 0.01, 95% CI -0.09 to 0.11; 8 studies, 5612 participants; moderate-certainty evidence) or long-term (MD 0.06, 95% CI -0.04 to 0.16; 6 studies, 8736 participants; moderate-certainty evidence) follow-up. They may have little to no effect on zBMI in the short term, but the evidence is very uncertain (MD -0.09, 95% CI -0.2 to 0.02; 3 studies, 515 participants; very low-certainty evidence), and they may not reduce zBMI at medium-term (MD -0.05, 95% CI -0.1 to 0.01; 6 studies, 3511 participants; low-certainty evidence) or long-term (MD -0.02, 95% CI -0.05 to 0.01; 7 studies, 8430 participants; low-certainty evidence) follow-up. Four studies (2394 participants) reported data on serious adverse events (very low-certainty evidence): one reported an increase in weight concern in a few adolescents and three reported no effect. AUTHORS' CONCLUSIONS The evidence demonstrates that dietary interventions may have little to no effect on obesity in adolescents. There is low-certainty evidence that activity interventions may have a small beneficial effect on BMI at medium- and long-term follow-up. Diet plus activity interventions may result in little to no difference. Importantly, this updated review also suggests that interventions to prevent obesity in this age group may result in little to no difference in serious adverse effects. Limitations of the evidence include inconsistent results across studies, lack of methodological rigour in some studies and small sample sizes. Further research is justified to investigate the effects of diet and activity interventions to prevent childhood obesity in community settings, and in young people with disabilities, since very few ongoing studies are likely to address these. Further randomised trials to address the remaining uncertainty about the effects of diet, activity interventions, or both, to prevent childhood obesity in schools (ideally with zBMI as the measured outcome) would need to have larger samples.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Papaioannou D, Hamer-Kiwacz S, Mooney C, Cooper C, O'Cathain A, Sprange K, Moody G. Recording harms in randomized controlled trials of behavior change interventions: a scoping review and map of the evidence. J Clin Epidemiol 2024; 169:111275. [PMID: 38336177 DOI: 10.1016/j.jclinepi.2024.111275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Randomized controlled trials evaluate diverse interventions. This can include medical interventions such as drugs or surgical procedures, or behavior change interventions (BCIs) that aim to change a habit, belief, or attitude to improve health, for example, healthy eating, psychological wellbeing. Harms are often recorded poorly or inconsistently within randomized controlled trials of BCIs. This scoping review aimed to collate and describe literature on categories, definitions, and mechanisms of harms from BCIs; methods of identifying plausible harms; and recommendations for recording harms. STUDY DESIGN AND SETTING A scoping review was conducted. Three databases (MEDLINE, PsycINFO, and CINAHL) were searched. Reference list checking and citation searching were performed. Articles were included if they discussed (1) interventions that aimed to modify behavior, (2) categories or mechanisms of harms, and (3) methods or recommendations for recording harms. All research designs were included. One reviewer reviewed titles, abstracts, and full texts; queries were checked with another reviewer. Data were extracted and synthesized descriptively by one reviewer and checked by another reviewer. A thematic map was constructed to summarize the review findings. Harms described from specific BCIs were identified, and examples were selected and summarized. RESULTS The review included 37 articles. Nineteen of 37 articles contributed to a thematic review. Three articles described categories of harms; categories of harm included physical, psychological, group and social interactions, cultural, equity, opportunity cost, environmental, and economic. Seven articles included mechanisms or underlying factors for harms including feelings of failure leading to shame or stigma, and group interventions enabling knowledge exchange on unhealthy behaviors. Twelve articles provided recommendations for recording harms, including taking a proportionate approach by focusing on the most plausible and important harms, collecting different perspectives on whether harms had occurred (eg, caregivers and family members), and using qualitative research methods to identify harms. One article described a three-step method to identify plausible harms from an intervention, and six articles supported aspects of the method. Eighteen of 37 articles contributed to a review which collated harms arising from specific interventions, for example, a peer support intervention in inflammatory bowel disease caused distressing conversations which might lead to anxiety and confrontation with a possible negative future. CONCLUSION BCIs can cause harm. This review identified categories and proposed mechanisms of harms, as well as methods and recommendations for identifying and recording harms in BCIs for inclusion in forthcoming recommendations.
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Affiliation(s)
- Diana Papaioannou
- Clinical Trials Research Unit, Division of Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Sienna Hamer-Kiwacz
- Clinical Trials Research Unit, Division of Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Cara Mooney
- Clinical Trials Research Unit, Division of Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, Division of Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Alicia O'Cathain
- Health and Care Research Unit, Division of Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Gwenllian Moody
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
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Hoefle-Bénard J, Salloch S. Mass drug administration for neglected tropical disease control and elimination: a systematic review of ethical reasons. BMJ Glob Health 2024; 9:e013439. [PMID: 38485140 PMCID: PMC10941120 DOI: 10.1136/bmjgh-2023-013439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/25/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are a diverse group of debilitating diseases and conditions afflicting more than one billion people in impoverished communities. Control of these diseases is crucial to achieve Sustainable Development Goal 3 and the pledge to 'leave no one behind'. Relying on large-scale delivery of wide-spectrum drugs to individuals in at-risk communities irrespective of their health status, mass drug administration is a core strategy for tackling half of the NTDs targeted by the latest WHO roadmap (2021-2030). However, ethical challenges surround its implementation and long-term impact. This systematic review aims to give a comprehensive picture of the variety of ethical reasons for and against mass drug administration for NTD control and elimination, facilitating further debate in ethics and policy. METHODS PubMed and Web of Science Core Collection were searched for all relevant publications. Of the 486 retrieved records, 60 met the inclusion criteria for qualitative analysis. Ethical reasons discussing the topic at hand were extracted from full texts and synthesised through the Kuckartz method of qualitative content analysis. RESULTS Data extraction revealed 61 ethical reasons, of which 20 (32.7%) had positive, 13 (21.3%) had ambivalent and 28 (45.9%) had negative implications regarding mass drug administration for NTDs. The health benefits and cost-effectiveness of the measure were extensively highlighted. However, equity, autonomy and sustainability emerged as the domains with the most pressing ethical concerns. Many issues related to implementation are yet to be adequately addressed in policy documents. CONCLUSIONS This is the first systematic review of ethical reasons pertaining to mass drug administration for NTD control and elimination. Due to the diversity of included studies, no general recommendations can be made. Instead, context-specific strategies seem necessary. Alternative approaches tackling socioecological determinants of ill health are needed for long-term sustainability. Future research could benefit from contributions of non-Western philosophies and perspectives by local researchers.
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Affiliation(s)
- Juliette Hoefle-Bénard
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Sabine Salloch
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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Sánchez-Carracedo D. Obesity stigma and its impact on health: A narrative review. ENDOCRINOL DIAB NUTR 2022; 69:868-877. [PMID: 36446710 DOI: 10.1016/j.endien.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/29/2021] [Indexed: 06/16/2023]
Abstract
Weight stigma and weight bias are pervasive in our society and are based on wrong assumption that obesity derives basically from a lack self-discipline and personal responsibility, obviating recent evidence showing that obesity is a prevalent, complex, progressive, and relapsing chronic disease that results from the interaction between behavioural, environmental, genetic, and metabolic factors. This narrative review provides an overview of recent research on this problem, mainly focused on the negative impact of weigh stigma on health. Overall, recent evidence shows that weight stigma can contribute to worsening obesity-related problems and creating additional barriers to effective obesity care and prevention. In addition, a brief description of some of the most important international initiatives to address the weight stigma is provided.
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Affiliation(s)
- David Sánchez-Carracedo
- Unidad de Conductas Relacionadas con la Alimentación y el Peso, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona Campus de la UAB, Bellaterra, Barcelona, Spain.
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Tarasuk V, McIntyre L. Reconsidering Food Prescription Programs in Relation to Household Food Insecurity. J Nutr 2022; 152:2315-2316. [PMID: 36774097 DOI: 10.1093/jn/nxac175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Valerie Tarasuk
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Lynn McIntyre
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Backhouse T, Ruston A, Killett A, Ward R, Rose-Hunt J, Mioshi E. Risks and risk mitigation in homecare for people with dementia-A two-sided matter: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2037-2056. [PMID: 35703588 DOI: 10.1111/hsc.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/18/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
Policy guidance promotes supporting people to live in their own homes for as long as possible with support from homecare services. People living with dementia who need such support can experience a range of physical and cognitive difficulties, which can increase the risks associated with homecare for this group. We aimed to examine risk and safety issues for people with dementia and their homecare workers and risk mitigation practices adopted by homecare workers to address identified risks. We searched MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, ASSIA and Cochrane Central Register of Controlled Trials databases 5 March 2021. Included studies focussed on homecare for people with dementia and had a risk or safety feature reported. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal tools. Two authors assessed articles for potential eligibility and quality. A narrative synthesis combines the findings. The search identified 2259 records; 27 articles, relating to 21 studies, met the eligibility criteria. The review identified first-order risks that homecare workers in the studies sought to address. Two types of risk mitigation actions were reported: harmful interventions and beneficial interventions. Actions adopted to reduce risks produced intended benefits but also unintended consequences, creating second-order risks to both clients with dementia and homecare workers, placing them at greater risk. Risk mitigation interventions should be person-centred, the responsibility of all relevant professions, and planned to minimise the creation of unintended risks.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Annmarie Ruston
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Renée Ward
- Older Persons' Services, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Julia Rose-Hunt
- Dementia Intensive Support Team East, Norfolk and Suffolk Foundation Trust, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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Feijen-de Jong EI, Warmelink JC, van der Stouwe RA, Dalmaijer M, Jansen DEMC. Interventions for vulnerable pregnant women: Factors influencing culturally appropriate implementation according to health professionals: A qualitative study. PLoS One 2022; 17:e0272249. [PMID: 35921311 PMCID: PMC9348690 DOI: 10.1371/journal.pone.0272249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Proper implementation of interventions by health professionals has a critical effect on their effectiveness and the quality of care provided, especially in the case of vulnerable pregnant women. It is important, therefore, to assess the implementation of interventions in care settings to serve as input to improve implementation. Objective The aim of this study is to identify factors that influence the implementation of interventions for vulnerable pregnant women in the North of the Netherlands from the perspective of health professionals. In this region, an intergenerational transfer of poverty is apparent, leading to many health problems and the transfer of unhealthy lifestyles and the associated diseases to subsequent generations. Methods We used a qualitative research design. Semi-structured interviews with 39 health professionals were conducted between February 2019 and April 2020. To analyse the findings, the MIDI (Measurement Instrument for Determinants of Innovations) was used, an instrument designed to identify what determinants influence the actual use of a new or existing innovation. Results We found two themes that influence the implementation of interventions: 1. The attitude of health professionals towards vulnerable pregnant women: stereotyped remarks and words expressing the homogenization of vulnerable pregnant women. 2. A theme related to the MIDI determinants, under which we added six determinants. Conclusion Our research showed that many factors influence the implementation of interventions for vulnerable pregnant women, making the optimal implementation of interventions very complex. We highlight the need to challenge stereotypical views and attitudes towards specific groups in order to provide relation-centred care, which is extremely important to provide culturally appropriate care. Health professionals need to reflect on their own significant influence on access to and the use of care by vulnerable groups. They hold the key to creating partnerships with women to obtain the best health for mothers and their babies.
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Affiliation(s)
- Esther I. Feijen-de Jong
- Midwifery Science AVAG Section, Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Midwifery Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam/Groningen, Groningen, The Netherlands
- * E-mail:
| | - J. Catja Warmelink
- Midwifery Science AVAG Section, Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Midwifery Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam/Groningen, Groningen, The Netherlands
| | - Relinde A. van der Stouwe
- Midwifery Science AVAG Section, Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Midwifery Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam/Groningen, Groningen, The Netherlands
| | - Maria Dalmaijer
- Midwifery Science AVAG Section, Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Midwifery Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam/Groningen, Groningen, The Netherlands
| | - Danielle E. M. C. Jansen
- Midwifery Science AVAG Section, Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Midwifery Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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Moore THM, Tomlinson E, Spiga F, Higgins JPT, Gao Y, Caldwell DM, Nobles J, Dawson S, Ijaz S, Savovic J, Hodder RK, Wolfenden L, Jago R, Phillips S, Hillier-Brown F, Summerbell CD. Interventions to prevent obesity in children aged 12 to 18 years old. Hippokratia 2022. [DOI: 10.1002/14651858.cd015330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Theresa HM Moore
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Francesca Spiga
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Julian PT Higgins
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- NIHR Bristol Biomedical Research Centre; University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol; Bristol UK
| | - Yang Gao
- Department of Sport, Physical Education and Health; Hong Kong Baptist University; Kowloon Hong Kong
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - James Nobles
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Jelena Savovic
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Rebecca K Hodder
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
| | - Luke Wolfenden
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
| | - Russell Jago
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- NIHR Bristol Biomedical Research Centre; University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol; Bristol UK
- Centre for Exercise, Nutrition & Health Sciences; School for Policy Studies, University of Bristol; Bristol UK
| | - Sophie Phillips
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
- Department of Sport and Exercise Science; Durham University; Durham UK
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
- Human Nutrition Research Centre and Population Health Sciences Institute; University of Newcastle; Newcastle UK
| | - Carolyn D Summerbell
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
- Department of Sport and Exercise Science; Durham University; Durham UK
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10
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Moore THM, Tomlinson E, Spiga F, Higgins JPT, Gao Y, Caldwell DM, Nobles J, Dawson S, Ijaz S, Savovic J, Hodder RK, Wolfenden L, Jago R, Phillips S, Hillier-Brown F, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Hippokratia 2022. [DOI: 10.1002/14651858.cd015328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Theresa HM Moore
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Francesca Spiga
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Julian PT Higgins
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol; Bristol UK
| | - Yang Gao
- Department of Sport, Physical Education and Health; Hong Kong Baptist University; Kowloon Hong Kong
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - James Nobles
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- Population Health Sciences, Bristol Medical School, University of Bristol; Bristol UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- Population Health Sciences, Bristol Medical School, University of Bristol; Bristol UK
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Jelena Savovic
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Rebecca K Hodder
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
| | - Luke Wolfenden
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
| | - Russell Jago
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol; Bristol UK
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies; University of Bristol; Bristol UK
| | - Sophie Phillips
- Department of Sport and Exercise Science; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
- Human Nutrition Research Centre and Population Health Sciences Institute; University of Newcastle; Newcastle UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
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11
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Feijen-de Jong EI, Dalmaijer M, van der Stouwe RA, Jansen DEMC, Warmelink JC. Experiences and needs of women in vulnerable situations receiving additional interventions in maternity care: a qualitative study. BMC Pregnancy Childbirth 2022; 22:536. [PMID: 35780118 PMCID: PMC9250178 DOI: 10.1186/s12884-022-04847-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tailoring an intervention to the needs and wishes of pregnant women in vulnerable situations (e.g., socioeconomic disadvantages) can reduce the risk of adverse outcomes and empower these women. A relatively high percentage of pregnant women in the North of the Netherlands are considered vulnerable to adverse pregnancy outcomes because of their low socioeconomic status and the intergenerational transmission of poverty. In order to improve perinatal and maternal health, next to standard prenatal care, various interventions for pregnant women in vulnerable situations have been developed. We do not know to what extent these additional interventions suit the needs of (pregnant) women. Therefore, the aim of this study is to gain insight into the experiences and needs of women in vulnerable situations who receive additional maternity care interventions in the Northern Netherlands. METHODS Qualitative research was performed. We used a phenomenological framework, which is geared towards understanding people's experiences in the context of their everyday lives. In-depth semi-structured interviews were conducted with 17 pregnant women in vulnerable situations living in the Northern Netherlands. A thematic analysis was carried out. RESULTS We found three themes that reflect the experiences and needs of pregnant women in vulnerable situations in relation to the intervention they receive. These themes relate to the care provided by health professionals, to the impact of being offered an intervention, and to practical issues related to receiving an additional intervention. We found that the needs of pregnant women in vulnerable situations who received an additional maternity care intervention varied. This variation in needs was mainly related to practical issues. Women also expressed common needs, namely the desire to have control over their situation, the wish to receive tailor-made information about the intervention, and the wish for the intervention to be specifically tailored to their circumstances. CONCLUSIONS Living in vulnerable situations and being offered additional care evoked diverse reactions and emotions from pregnant women. We recommend that health professionals ensure open and clear communication with women, that they ensure continuity of care and relationship-centered care, and that they become aware of the process of stigmatization of women in vulnerable situations.
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Affiliation(s)
- Esther I Feijen-de Jong
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands. .,Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (location Vumc), Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands. .,Midwifery Academy Amsterdam/Groningen, Dirk Huizingastraat 3-5, 9713, GL, Groningen, The Netherlands.
| | - Maria Dalmaijer
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands.,Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (location Vumc), Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam/Groningen, Dirk Huizingastraat 3-5, 9713, GL, Groningen, The Netherlands
| | - Relinde A van der Stouwe
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands.,Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (location Vumc), Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam/Groningen, Dirk Huizingastraat 3-5, 9713, GL, Groningen, The Netherlands
| | - Danielle E M C Jansen
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands.,Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (location Vumc), Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - J Catja Warmelink
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands.,Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (location Vumc), Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam/Groningen, Dirk Huizingastraat 3-5, 9713, GL, Groningen, The Netherlands
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12
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Brownson RC, Shelton RC, Geng EH, Glasgow RE. Revisiting concepts of evidence in implementation science. Implement Sci 2022; 17:26. [PMID: 35413917 PMCID: PMC9004065 DOI: 10.1186/s13012-022-01201-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background Evidence, in multiple forms, is a foundation of implementation science. For public health and clinical practice, evidence includes the following: type 1 evidence on etiology and burden; type 2 evidence on effectiveness of interventions; and type 3: evidence on dissemination and implementation (D&I) within context. To support a vision for development and use of evidence in D&I science that is more comprehensive and equitable (particularly for type 3 evidence), this article aims to clarify concepts of evidence, summarize ongoing debates about evidence, and provide a set of recommendations and tools/resources for addressing the “how-to” in filling evidence gaps most critical to advancing implementation science. Main text Because current conceptualizations of evidence have been relatively narrow and insufficiently characterized in our opinion, we identify and discuss challenges and debates about the uses, usefulness, and gaps in evidence for implementation science. A set of questions is proposed to assist in determining when evidence is sufficient for dissemination and implementation. Intersecting gaps include the need to (1) reconsider how the evidence base is determined, (2) improve understanding of contextual effects on implementation, (3) sharpen the focus on health equity in how we approach and build the evidence-base, (4) conduct more policy implementation research and evaluation, and (5) learn from audience and stakeholder perspectives. We offer 15 recommendations to assist in filling these gaps and describe a set of tools for enhancing the evidence most needed in implementation science. Conclusions To address our recommendations, we see capacity as a necessary ingredient to shift the field’s approach to evidence. Capacity includes the “push” for implementation science where researchers are trained to develop and evaluate evidence which should be useful and feasible for implementers and reflect community or stakeholder priorities. Equally important, there has been inadequate training and too little emphasis on the “pull” for implementation science (e.g., training implementers, practice-based research). We suggest that funders and reviewers of research should adopt and support a more robust definition of evidence. By critically examining the evolving nature of evidence, implementation science can better fulfill its vision of facilitating widespread and equitable adoption, delivery, and sustainment of scientific advances.
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13
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Biallas RL, Rehfuess E, Stratil JM. Adverse and other unintended consequences of setting-based interventions to prevent illicit drug use: A systematic review of reviews. J Public Health Res 2022. [DOI: 10.1177/22799036221103362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article explores adverse and unintended consequences (AUCs) of setting-based public health interventions to prevent illicit drug use, including the mechanisms leading to these AUCs. Additionally, the reporting of AUCs in systematic reviews was assessed. Therefore, we conducted a systematic review of reviews and searched four big databases were searched. We included systematic reviews concerned with setting-based interventions to prevent illicit drug use. We used AMSTAR 2 to rate the overall confidence of the results presented in the reviews. Data on study characteristics, types and mechanisms of AUCs were extracted. An a priori categorisation of consequences drew on the WHO-INTEGRATE framework, and the categorisation of mechanisms on the Behaviour Change Wheel. For reviews reporting AUCs, the same information was also retrieved from relevant primary studies. Findings were synthesised narratively and in tables. Finally, we included 72 reviews, of which 18 reported on AUCs. From these, 11 primary studies were identified. Most of the reviews and primary studies were conducted in educational settings. The most prevalent AUCs reported in systematic reviews and primary studies were paradoxical health effects (i.e. increase of drug use). Potential mechanisms discussed primarily focussed on the change though social norms and practices. Changes of knowledge and perception were also mentioned. Concluding, the identified reviews and primary studies paid insufficient attention to AUCs of public health interventions to prevent illicit drug use. Where reported, it was mostly as an afterthought and narrowly framed as health related. No mentions of potential broader social consequences were found.
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Affiliation(s)
- Renke L Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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14
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Alexander SA, Shareck M. Widening the gap? Unintended consequences of health promotion measures for young people during COVID-19 lockdown. Health Promot Int 2021; 36:1783-1794. [PMID: 33604653 PMCID: PMC7928856 DOI: 10.1093/heapro/daab015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
During the first wave of the COVID-19 pandemic, global measures preventing the spread of the new coronavirus required most of the population to lockdown at home. This sudden halt to collective life meant that non-essential services were closed and many health promoting activities (i.e. physical activity, school) were stopped in their tracks. To curb the negative health impacts of lockdown measures, activities adapting to this new reality were urgently developed. One form of activity promoted indoor physical activity to prevent the adverse physical and psychological effects of the lockdown. Another form of activity included the rapid development of online learning tools to keep children and youth engaged academically while not attending school. While these health promoting efforts were meant to benefit the general population, we argue that these interventions may have unintended consequences and inadvertently increase health inequalities affecting marginalized youth in particular, as they may not reap the same benefits, both social and physical, from the interventions promoting at-home physical activities or distance learning measures. We elaborate on several interventions and their possible unintended consequences for marginalized youth and suggest several strategies that may mitigate their impact.
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Affiliation(s)
- Stephanie A Alexander
- Fondation d’entreprise MGEN pour la santé publique, 3 square Max Hymans, 75748 Paris Cedex 15
| | - Martine Shareck
- Département des Sciences de la Santé Communautaire, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e Avenue Nord Sherbrooke, J1H 5N4 Québec, Canada
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Haldane V, Jung AS, De Foo C, Bonk M, Jamieson M, Wu S, Verma M, Abdalla SM, Singh S, Nordström A, Legido-Quigley H. Strengthening the basics: public health responses to prevent the next pandemic. BMJ 2021; 375:e067510. [PMID: 34840134 PMCID: PMC8624065 DOI: 10.1136/bmj-2021-067510] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | | | - Chuan De Foo
- Saw Swee Hock School of Public Health, Singapore
| | - Mathias Bonk
- Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Monica Verma
- Saw Swee Hock School of Public Health, Singapore
| | - Salma M Abdalla
- Independent Panel for Pandemic Preparedness and Response Secretariat
- School of Public Health, Boston University, USA
| | - Sudhvir Singh
- Independent Panel for Pandemic Preparedness and Response Secretariat
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Anders Nordström
- Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine, UK
- Saw Swee Hock School of Public Health, Singapore
- Independent Panel for Pandemic Preparedness and Response Secretariat
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Baker T, Rock M, Bondo K, van der Meer F, Kutz S. 11 years of regular access to subsidized veterinary services is associated with improved dog health and welfare in remote northern communities. Prev Vet Med 2021; 196:105471. [PMID: 34509773 DOI: 10.1016/j.prevetmed.2021.105471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022]
Abstract
Access to veterinary services can have positive impacts on animal health and welfare, and on human mental and physical health and well-being; however, many communities worldwide lack access to such services. At their request, the 5 communities of the Sahtu Settlement Area, Northwest Territories, Canada, have received annual access to preventive veterinary services through the University of Calgary's Northern Community Health Rotation since 2008. To determine the reach of the program, we conducted a dog census in 2017. We then conducted a chart review of 11 years of dog medical records from 2008 to 2018 to evaluate how the reach of the program, the uptake of veterinary services, and dog population demographics, health and welfare measures changed over the duration of the program. In the chart review, we used either multi-level logistic regression or generalized linear models, to determine how seven variables, including age, sex, breed, body condition, deworming, vaccination, and sterilization status upon clinic entry, changed over the course of program delivery. Our results suggest that program reach, veterinary service uptake, and dog demographic, health and welfare measures improved over time. We observed high rabies vaccination coverage in some communities (48 %-83 % of the dog population) and moderate overall sterilization status (25 %-56 % of the dog population) with female dog sterilization more common than male (75 % of dogs leaving the 2017 clinics, compared to 43 %). Several dog demographic, health, and welfare measures, including age, body condition, and vaccination, deworming, and sterilization status, were significantly better in later years of the program (all p < 0.001). Differences among communities, both in dog population numbers from the 2017 census (40-89 dogs) and in the uptake of veterinary services in 2017 (48 %-83 % of the dog population), were notable. Vaccination uptake was directly related to clinic attendance, but sterilization was impacted by additional factors, including community members' acceptance of the procedure. Some unintended consequences were noted, however, including the potential effect of sterilization on the availability of traditional dog breeds in the communities. Overall, our study findings demonstrate that subsidized veterinary services provided over a regular and extended period of time benefit animal population demographics, health and welfare, and could have positive impacts on human well-being. The framework of community collaboration and long-term commitment developed through this program serves as a model for achieving common health goals among communities in need and veterinary service providers.
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Affiliation(s)
- Tessa Baker
- Department of Ecosystem and Public Health, University of Calgary Faculty of Veterinary Medicine, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Melanie Rock
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
| | - Kristin Bondo
- Department of Ecosystem and Public Health, University of Calgary Faculty of Veterinary Medicine, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
| | - Frank van der Meer
- Department of Ecosystem and Public Health, University of Calgary Faculty of Veterinary Medicine, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
| | - Susan Kutz
- Department of Ecosystem and Public Health, University of Calgary Faculty of Veterinary Medicine, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
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Rudolph KE, Gimbrone C, Díaz I. Helped into Harm: Mediation of a Housing Voucher Intervention on Mental Health and Substance Use in Boys. Epidemiology 2021; 32:336-346. [PMID: 33783392 PMCID: PMC8015202 DOI: 10.1097/ede.0000000000001334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interventions can have harmful effects among subgroups they intend to help. The Moving To Opportunity experiment, in which families were randomized to receive a Section 8 housing voucher, was one example. Voucher receipt generally resulted in better long-term mental health and lower substance use and risk behavior outcomes among adolescent girls, but resulted in worse outcomes among adolescent boys. Reasons for this discrepancy and the unintended harmful health effects for boys are unclear. We used mediation analysis to estimate processes through which voucher receipt was hypothesized to affect adolescent mental health and substance use. METHODS We used longitudinal data (10-15 years) on boys enrolled in Moving To Opportunity. We estimated interventional (also known as stochastic) indirect effects of voucher receipt on mental health and substance use outcomes through mediators capturing aspects of the school environment, neighborhood poverty, and instability of the social environment. We also estimated interventional direct effects not operating through these mediators. We used a robust, efficient, nonparametric substitution estimator in the targeted minimum loss-based framework. RESULTS Housing voucher receipt increased long-term risk of any diagnostic statistical manual disorder, any mood disorder, any externalizing disorder, and cigarette smoking among boys. The majority (between 69% and 90%) of the total negative long-term effects could be explained by indirect effects through the mediators considered. CONCLUSIONS This evidence suggests that, even though the intervention had the desired effects on neighborhood poverty and the school environment, these "positives" ultimately negatively impacted the long-term mental health and behaviors of boys.
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Affiliation(s)
- Kara E. Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Catherine Gimbrone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Iván Díaz
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Bogale B, Mørkrid K, Abbas E, Abu Ward I, Anaya F, Ghanem B, Hijaz T, Isbeih M, Issawi S, A. S. Nazzal Z, E. Qaddomi S, Frøen JF. The effect of a digital targeted client communication intervention on pregnant women's worries and satisfaction with antenatal care in Palestine-A cluster randomized controlled trial. PLoS One 2021; 16:e0249713. [PMID: 33891597 PMCID: PMC8064599 DOI: 10.1371/journal.pone.0249713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background The eRegCom cluster randomized controlled trial assesses the effectiveness of targeted client communication (TCC) via short message service (SMS) to pregnant women, from a digital maternal and child health registry (eRegistry) in Palestine, on improving attendance and quality of care. In this paper, we assess whether this TCC intervention could also have unintended consequences on pregnant women’s worries, and their satisfaction with antenatal care (ANC). Methods We interviewed a sub-sample of Arabic-speaking women attending ANC at public primary healthcare clinics, randomized to either the TCC intervention or no TCC (control) in the eRegCom trial, who were in 38 weeks of gestation and had a phone number registered in the eRegistry. Trained female data collectors interviewed women by phone from 67 intervention and 64 control clusters, after securing informed oral consent. The Arabic interview guide, pilot-tested prior to the data collection, included close-ended questions to capture the woman’s socio-demographic status, agreement questions about their satisfaction with ANC services, and the 13-item Cambridge Worry Scale (CWS). We employed a non-inferiority study design and an intention-to-treat analysis approach. Results A total of 454 women, 239 from the TCC intervention and 215 from the control arm participated in this sub-study. The mean and standard deviation of the CWS were 1.8 (1.9) for the intervention and 2.0 (1.9) for the control arm. The difference in mean between the intervention and control arms was -0.16 (95% CI: -0.31 to -0.01) after adjusting for clustering, which was below the predefined non-inferiority margin of 0.3. Women in both groups were equally satisfied with the ANC services they received. Conclusion The TCC intervention via SMS did not increase pregnancy-related worries among recipients. There was no difference in women’s satisfaction with the ANC services between intervention and control arms.
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Affiliation(s)
- Binyam Bogale
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
| | - Eatimad Abbas
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Itimad Abu Ward
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Firas Anaya
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Buthaina Ghanem
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | | | - Mervett Isbeih
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Sally Issawi
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Zaher A. S. Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sharif E. Qaddomi
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - J. Frederik Frøen
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
- * E-mail:
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19
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Shimizu R, Rodwin AH, Munson MR. A Systematic Review of Psychosocial Nutrition Interventions for Young Adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:316-335. [PMID: 33640278 DOI: 10.1016/j.jneb.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Few have examined the effects of psychosocial nutrition interventions targeting young adults, a population with low fruit and vegetable (FV) consumption. This study investigated the impact of nutrition interventions with psychosocial content on improving young adult FV intake. METHOD This registered systematic review was guided by the Preferred Reported Items for Systematic Reviews and Meta-Analyses. RESULTS Searches on CINAHL, Embase, Medline PubMed, Ovid-Medline, PsychInfo, and Web of Science identified 4,113 records. Twenty-four randomized controlled trials were extracted. Eighteen studies found significant between-group differences in fruit and/or vegetable intake. Young adults with low income and racial-ethnic subgroups were underrepresented. A typology emerged as an organizing framework from the psychosocial intervention content. Interventions were anticipatory, socially engaged, a hybrid (anticipatory and socially engaged), or exposure-based. Studies also reported unintended consequences. DISCUSSION Significant between-group differences were mostly reported by anticipatory, socially engaged, or hybrid interventions, aligning with young adult developmental needs through detailed planning, goal-setting tasks, and/or addressing social norms. Interventions with insignificant differences lacked engagement and adequate exposure. IMPLICATIONS FOR RESEARCH AND PRACTICE Demographically inclusive studies are imperative in addressing dietary disparities by socioeconomic status. A typology of interventions emphasizing content rather than theories or treatment strategies widens opportunities for interdisciplinary collaboration. More research is needed to mitigate unintended consequences (boomerang effects) in which FV intake decreased postintervention or participants disengaged in activities intended to increase FV intake.
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Affiliation(s)
- Rei Shimizu
- Silver School of Social Work, New York University, New York, NY.
| | - Aaron H Rodwin
- Silver School of Social Work, New York University, New York, NY
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20
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Papaioannou D, Cooper C, Mooney C, Glover R, Coates E. Adverse event recording failed to reflect potential harms: a review of trial protocols of behavioral, lifestyle and psychological therapy interventions. J Clin Epidemiol 2021; 136:64-76. [PMID: 33684508 DOI: 10.1016/j.jclinepi.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/07/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To explore how potential harms are assessed in trials of behavioral, lifestyle and psychological therapy interventions. STUDY DESIGN AND SETTING This study was a review of protocols from the National Institute of Health Research Health Technology Assessment and Public Health Research programmes. Protocols were included if the study was a randomized controlled trial and the intervention intended to change lifestyle or behavior to improve health or improve psychological outcomes. RESULTS 95 of 151 protocols planned to record adverse events (AEs). Definitions of AEs were often not given and varied widely. Serious AEs were mostly defined using standards originally devised for pharmacological trials. Twenty-two protocols listed expected AEs. Few protocols described assessment of causation between AEs and intervention. Examples of useful AE recording practice were identified. CONCLUSION Monitoring and recording AEs in behavioral intervention trials was variable and frequently based on reporting guidelines for pharmacological trials. This may mean potential harms are being missed. Future trials should consider: 1) Potential harms posed by the intervention 2) How to define serious AEs 3) What are expected AEs. Further research to achieve consensus on AE recording is required, including identification of core adverse outcomes in clinical areas or caused by interventions.
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Affiliation(s)
- Diana Papaioannou
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Cara Mooney
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Rachel Glover
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Elizabeth Coates
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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21
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Howes EM, Harden SM, Cox HK, Hedrick VE. Communicating About Weight in Dietetics Practice: Recommendations for Reduction of Weight Bias and Stigma. J Acad Nutr Diet 2021; 121:1669-1674. [PMID: 33589383 DOI: 10.1016/j.jand.2021.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/18/2022]
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22
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Turcotte-Tremblay AM, Gali Gali IA, Ridde V. The unintended consequences of COVID-19 mitigation measures matter: practical guidance for investigating them. BMC Med Res Methodol 2021; 21:28. [PMID: 33568054 PMCID: PMC7873511 DOI: 10.1186/s12874-020-01200-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/21/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND COVID-19 has led to the adoption of unprecedented mitigation measures which could trigger many unintended consequences. These unintended consequences can be far-reaching and just as important as the intended ones. The World Health Organization identified the assessment of unintended consequences of COVID-19 mitigation measures as a top priority. Thus far, however, their systematic assessment has been neglected due to the inattention of researchers as well as the lack of training and practical tools. MAIN TEXT Over six years our team has gained extensive experience conducting research on the unintended consequences of complex health interventions. Through a reflexive process, we developed insights that can be useful for researchers in this area. Our analysis is based on key literature and lessons learned reflexively in conducting multi-site and multi-method studies on unintended consequences. Here we present practical guidance for researchers wishing to assess the unintended consequences of COVID-19 mitigation measures. To ensure resource allocation, protocols should include research questions regarding unintended consequences at the outset. Social science theories and frameworks are available to help assess unintended consequences. To determine which changes are unintended, researchers must first understand the intervention theory. To facilitate data collection, researchers can begin by forecasting potential unintended consequences through literature reviews and discussions with stakeholders. Including desirable and neutral unintended consequences in the scope of study can help minimize the negative bias reported in the literature. Exploratory methods can be powerful tools to capture data on the unintended consequences that were unforeseen by researchers. We recommend researchers cast a wide net by inquiring about different aspects of the mitigation measures. Some unintended consequences may only be observable in subsequent years, so longitudinal approaches may be useful. An equity lens is necessary to assess how mitigation measures may unintentionally increase disparities. Finally, stakeholders can help validate the classification of consequences as intended or unintended. CONCLUSION Studying the unintended consequences of COVID-19 mitigation measures is not only possible but also necessary to assess their overall value. The practical guidance presented will help program planners and evaluators gain a more comprehensive understanding of unintended consequences to refine mitigation measures.
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Affiliation(s)
- Anne-Marie Turcotte-Tremblay
- School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada.
- Department and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA, 02115, USA.
| | | | - Valéry Ridde
- IRD (French Institute for Research on Sustainable Development), CEPED, Université de Paris, 45 Rue des Saints-Pères, 75006, Paris, France
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23
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Taylor J, Forgeron P, Vandyk A, Finley A, Lightfoot S. Pediatric Health Outcome Evaluation in Low-and Middle-Income Countries: A Scoping Review of NGO Practice. Glob Pediatr Health 2021; 8:2333794X21991011. [PMID: 33614849 PMCID: PMC7868502 DOI: 10.1177/2333794x21991011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objective. The purpose of this study was to explore the research on the delivery and evaluation of pediatric health services by non-governmental organizations in low-and middle-income countries to better understand how they contribute to positive and sustainable health outcomes. Methods. A scoping review was completed using a 2-step study selection procedure. Results. Of the 5742 studies, 17 met criteria, including quantitative and mixed method designs, representing 10 different non-governmental organizations with programs in 33 low-and middle-income countries. Health outcomes were reported 89 times across the studies. A total of 56 different outcomes were identified in total, of which 24 were positive, 27 were negative, and 5 were unchanged. Conclusions. Widespread variation between non-governmental organizations exist, however, comprehensive pediatric health outcome evaluation is growing. Further emphasis should be given to adolescent specific research and robust measurement of quality of life.
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Affiliation(s)
| | | | | | - Allen Finley
- Dalhousie University & IWK Health Centre, Halifax, NS, Canada
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24
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Dmitrieva A, Stepanov V, Svyrydova K, Lukash IG, Doltu S, Golichenko M, Kalivoshko V, Khanyukov E, Kosmukhamedova Z, Torkunov O, Zagrebelnyi O. More evidence or stronger political will: exploring the feasibility of needle and syringe programs in Ukrainian prisons. Harm Reduct J 2021; 18:10. [PMID: 33468162 PMCID: PMC7814436 DOI: 10.1186/s12954-020-00459-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2007, the World Health Organization (WHO) recommended for prison authorities to introduce prison needle and syringe programs (PNSP) if they have any evidence that injecting drug use is taking place in prisons. This article presents descriptive evidence that injecting drug use takes place in Ukrainian prisons, it discusses how (denial of) access to injection equipment is regulated in the current system and what changes should be considered in order to implement PNSP. BACKGROUND Ukrainian prisons still live by the laws and policies adopted in the Soviet Union. Besides laws and regulations, these legacies are replicated through the organization and infrastructure of the prison's physical space, and through "carceral collectivism" as a specific form of living and behaving. Inviolability of the prison order over time helps the prison staff to normalize and routinely rationalize punishment enforcement as a power "over" prisoners, but not a power "for" achieving a specific goal. METHODS The Participatory Action Research approach was used as a way of involving different actors in the study's working group and research process. The data were gathered through 160 semi-structured interviews with prison health care workers, guards, people who inject drugs (PWID) who served one or several terms and other informants. RESULTS The "expertise" in drug use among prisoners demonstrated by prison staff tells us two things-they admit that injecting use takes place in prisons, and that the surveillance of prisoner behavior has been carried out constantly since the very beginning as a core function of control. The communal living conditions and prison collectivism may not only produce and reproduce a criminal subculture but, using the same mechanisms, produce and reproduce drug use in prison. The "political will" incorporated into prison laws and policies is essential for the revision of outdated legacies and making PNSP implementation feasible. CONCLUSION PNSP implementation is not just a question of having evidence of injecting drug use in the hands of prison authorities. For PNSP to be feasible in the prison environment, there is a need for specific changes to transition from one historical period and political leadership to another. And, thus, to make PNSP work requires making power work for change, and not just for reproducing the power itself.
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Affiliation(s)
| | - Vladimir Stepanov
- Support, Research and Development Center, Kyiv, Ukraine
- Doctoral School at National University of “Kyiv-Mohyla Academy” (NaUKMA), Kyiv, Ukraine
| | | | - Ievgeniia-Galyna Lukash
- Support, Research and Development Center, Kyiv, Ukraine
- Doctoral School at National University of “Kyiv-Mohyla Academy” (NaUKMA), Kyiv, Ukraine
| | - Svetlana Doltu
- Council for Preventing and Eliminating Discrimination and Ensuring Equality, Chisinau, Republic of Moldova
- Council for the Prevention of Torture (National Preventive Mechanism), Chisinau, Republic of Moldova
| | | | | | - Evgeniy Khanyukov
- Global Fund and PATH Projects in State Penitentiary Service, Kyiv, Ukraine
| | - Zhannat Kosmukhamedova
- Regional Programme Office for the Eastern Europe United Nations Office on Drugs and Crime, Kyiv, Ukraine
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25
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Pitt AL, Goldhaber-Fiebert JD, Brandeau ML. Public Health Interventions with Harms and Benefits: A Graphical Framework for Evaluating Tradeoffs. Med Decis Making 2020; 40:978-989. [PMID: 32996356 PMCID: PMC8056742 DOI: 10.1177/0272989x20960458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Evaluations of public health interventions typically report benefits and harms aggregated over the population. However, benefits and harms are not always evenly distributed. Examining disaggregated outcomes enables decision makers to consider health benefits and harms accruing to both intended intervention recipients and others in the population. METHODS We provide a graphical framework for categorizing and comparing public health interventions that examines the distribution of benefit and harm between and within population subgroups for a single intervention and compares distributions of harm and benefit for multiple interventions. We demonstrate the framework through a case study of a hypothetical increase in the price of meat (5%, 10%, 25%, or 50%) that, via elasticity of demand, reduces consumption and consequently reduces body mass index. We examine how inequalities in benefits and harms (measured by quality-adjusted life-years) are distributed across a population of white and black males and females. RESULTS A 50% meat price increase would yield the greatest net benefit to the population. However, because of reduced consumption among low-weight individuals, black males would bear disproportionate harm relative to the benefit they receive. With increasing meat price, the distribution of harm relative to benefit becomes less "internal" to those receiving benefit and more "distributed" to those not receiving commensurate benefit. When we segment the population by sex only, this result does not hold. CONCLUSIONS Disaggregating harms and benefits to understand their differential impact on subgroups can strongly affect which decision alternative is deemed optimal, as can the approach to segmenting the population. Our framework provides a useful tool for illuminating key tradeoffs relevant to harm-averse decision makers and those concerned with both equity and efficiency.
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Affiliation(s)
- Allison L Pitt
- Department of Management Science and Engineering, Stanford University, Stanford, CA
| | - Jeremy D Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA
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26
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Carrere J, Reyes A, Oliveras L, Fernández A, Peralta A, Novoa AM, Pérez K, Borrell C. The effects of cohousing model on people's health and wellbeing: a scoping review. Public Health Rev 2020; 41:22. [PMID: 33042597 PMCID: PMC7539375 DOI: 10.1186/s40985-020-00138-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Housing is a social determinant of health. Extensive research has highlighted its adverse effects on health. However, less is known about the effects of cohousing typology on health, which has the potential to create lively social networks and healthy communities and environments. We report the findings of a scoping study designed to gather and synthesise all known evidence on the relationship between cohousing and wellbeing and health. Method Using the scoping review method, we conducted a literature review in PubMed, ProQuest, Scopus, Web of Science, Science Direct and JSTOR in May 2019 and selected articles published from 1960 onwards, with no geographical limit and no design restrictions. Retrieved articles underwent three sequential screening phases. The results were described through a narrative synthesis of the evidence. Results Of the 2560 articles identified, we selected 25 full-text articles analysing 77 experiences. All of them were conducted in high-income countries. Ten studies analysed the impact of cohousing on physical and mental health or quality of life and wellbeing. Eight of the 10 studies found a positive association. In addition, 22 studies analysed one or more psychosocial determinants of health (such as social support, sense of community and physical, emotional and economic security) and most found a positive association. Through these determinants, quality of life, wellbeing and health could be improved. However, the quality of the evidence was low. Discussion The cohousing model could enhance health and wellbeing mediated by psychosocial determinants of health. However, extreme caution should be exercised in drawing any conclusions due to the dearth of data identified and the designs used in the included studies, with most being cross-sectional or qualitative studies, which precluded causal-based interpretations. Because housing is a major social determinant of health, more evidence is needed on the impact of this model on health through both psychosocial and material pathways.
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Affiliation(s)
- Juli Carrere
- Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), C. Sant Quintí 77, 08041 Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Alexia Reyes
- Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Laura Oliveras
- Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), C. Sant Quintí 77, 08041 Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Anna Fernández
- Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5, Pabellón 11. Planta 0, 28029 Madrid, Spain
| | - Andrés Peralta
- Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain
| | - Ana M Novoa
- Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), C. Sant Quintí 77, 08041 Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5, Pabellón 11. Planta 0, 28029 Madrid, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), C. Sant Quintí 77, 08041 Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5, Pabellón 11. Planta 0, 28029 Madrid, Spain
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Hovden L, Paasche T, Nyanza EC, Bastien S. Water Scarcity and Water Quality: Identifying Potential Unintended Harms and Mitigation Strategies in the Implementation of the Biosand Filter in Rural Tanzania. QUALITATIVE HEALTH RESEARCH 2020; 30:1647-1661. [PMID: 32449474 PMCID: PMC7410274 DOI: 10.1177/1049732320918860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Bottom-up public health interventions are needed which are built on an understanding of community perspectives. Project SHINE is a community-based participatory action research intervention focused on developing sustainable water, sanitation, and hygiene strategies with Maasai pastoralists in Tanzania. The aim of the study is to understand perceptions related to water quality and scarcity as well as to assess the potential of the Biosand Filter as a low-cost, low-tech water treatment option. To avoid unintended harms, the community was engaged in identifying potential harms and mitigation strategies prior to the implementation of the filter.Two in-depth interviews and two group discussions were analyzed using thematic content analysis, while three think tanks were analyzed using directed content analysis. The findings highlight a range of concerns regarding water scarcity and quality. The think tank approach was an effective means of engaging the community in identifying potential unintended harms across four dimensions: the physical, psychosocial, economic, and cultural contexts. In addition, two external themes emerged as salient: political harm and harm by omission.
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Affiliation(s)
| | | | | | - Sheri Bastien
- Norwegian University of Life
Sciences, Ås, Norway
- University of Calgary, Calgary,
Alberta, Canada
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28
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Anne G, Émilie T, Kareen N, Ginette L, Valéry R. Adapting a health equity tool to meet professional needs (Québec, Canada). Health Promot Int 2020; 34:e71-e83. [PMID: 30107463 DOI: 10.1093/heapro/day047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
While numerous tools are available to better incorporate equity into population health actions, they are limited mainly by their lack of adaptation to professional practices and organizational realities. A study was conducted in Québec to identify and understand, from the perspective of future users, conditions that would facilitate use of a tool (Reflex-ISS) targeted at supporting collaborative action to improve consideration of social inequalities in health (SIH) within population health actions. Concept mapping and focus groups were implemented as complementary methods for investigating the conditions. Significant results that emerged were strong participant interest in the tool and the need for resources to better take SIH into account. The conditions for use that were identified referred to the tool itself (user-friendliness and literacy) and to resources for appropriating the tool, competency development, as well as the role and responsibilities of organizations and policies in promoting use of the tool in daily activities and more fundamentally in acting against SIH in general. Models for organizational innovation give an idea of the dimensions that need to be considered to strengthen the integration of equity into organizations and to support the changes in practice that result from using the tool. They provide a reminder that a health equity tool cannot be the cornerstone of an organizational strategy to fight against SIH; rather, it must be incorporated as part of a systemic strategy of professional and organizational development.
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Affiliation(s)
| | | | - Nour Kareen
- Direction de santé publique de la Montérégie, Longueuil, Québec, Canada
| | | | - Ridde Valéry
- IRD (French Institute For Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD.,Université de Montréal Public Health Research Institute (IRSPUM), Québec, Canada
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29
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Alexander SA, Jones CM, Tremblay MC, Beaudet N, Rod MH, Wright MT. Reflexivity in Health Promotion: A Typology for Training. Health Promot Pract 2020; 21:499-509. [PMID: 32285696 PMCID: PMC7298350 DOI: 10.1177/1524839920912407] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Reflexivity has emerged as a key concept in the field of health promotion
(HP). Yet it remains unclear how diverse forms of reflexivity are
specifically relevant to HP concerns, and how these “reflexivities”
are interconnected. We argue that frameworks are needed to support
more systematic integration of reflexivity in HP training and
practice. In this article, we propose a typology of reflexivity in HP
to facilitate the understanding of reflexivity in professional
training. Drawing from key theories and models of reflexivity, this
typology proposes three reflexive positions (ideal-types) with
specific purposes for HP: reflexivity in, on, and underlying action.
This article illustrates our typology’s ideal-types with vignettes
collected from HP actors working with reflexivity in North America and
Europe. We suggest that our typology constitutes a conceptual device
to organize and discuss a variety of experiences of engaging with
reflexivity for HP. We propose the typology may support integrating
reflexivity as a key feature in training a future cadre of health
promoters and as a means for building a responsible HP practice.
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Affiliation(s)
| | | | | | - Nicole Beaudet
- Montreal Health and Social Services Agency, Montreal, Canada
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30
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Guichard A, Hébert C, Nour K, Lafontaine G, Tardieu É, Ridde V. [Adaptation and conditions of use of a health equity tool: The Reflex-ISS tool]. SANTE PUBLIQUE 2019; 30:121-130. [PMID: 30547477 DOI: 10.3917/spub.184.0121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Although actions to reduce social inequalities in health cannot be considered the exclusive responsibility of public health actors, they should at least make sure their interventions account for these inequalities. However, the actors involved in these interventions have few tools to support them in this process. Therefore, building on a study conducted in France, we have adapted, tested, and developed in Quebec a tool intended to help actors take into account social inequalities in health. The article presents the approach that led to the adaptation of the tool to the Quebec context, to describe the tool, and then to discuss some issues for inclusion in professional practices. A participatory and constructive process between researchers, managers and practitioners led to a useful and useable tool. It is composed of five aspects of intervention (planning, implementation, evaluation, sustainability, and empowerment) and 44 items for discussion presented as questions. A user guide, a glossary, and some practical examples accompany the tool. It follows a reflexive and constructive process wherein a third party facilitator can assist actors involved in an intervention to analyze how they take social inequalities in health into account. This assessment can help generate collective recommendations for improvements, which can be monitored over time, to improve consideration of equity in public health interventions. The article concludes on some issues related to its integration into professional practices.
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Bakaki PM, Staley J, Liu R, Dawson N, Golchin N, Horace A, Johnson H, Waldron J, Winterstein A, Kleinman LC, Bolen SD. A transdisciplinary team approach to scoping reviews: the case of pediatric polypharmacy. BMC Med Res Methodol 2018; 18:102. [PMID: 30286720 PMCID: PMC6172739 DOI: 10.1186/s12874-018-0560-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Polypharmacy can be either beneficial or harmful to children. We conducted a scoping review to examine the concept of pediatric polypharmacy: its definition, prevalence, extent and gaps in research. In this manuscript, we report our transdisciplinary scoping review methodology. METHODS After establishing a transdisciplinary team, we iteratively developed standard operating procedures for the study's search strategy, inclusion/exclusion criteria, screening, and data extraction. We searched eight bibliographic databases, screened abstracts and full text articles, and extracted data from included studies using standardized forms. We held regular team meetings and performed ongoing internal validity measurements to maintain consistent and quality outputs. RESULTS With the aid of EPPI Reviewer collaborative software, our transdisciplinary team of nine members performed dual reviews of 363 included studies after dual screening of 4398 abstracts and 1082 full text articles. We achieved overall agreement of 85% and a kappa coefficient of 0.71 (95% CI 0.68-0.74) while screening full text articles. The screening and review processes required about seven hours per extracted study. The two pharmacists, an epidemiologist, a neurologist, and a librarian on the review team provided internal consultation in these key disciplines. A stakeholder group of 10 members with expertise in evidence synthesis, research implementation, pediatrics, mental health, epilepsy, pharmacoepidemiology, and pharmaceutical outcomes were periodically consulted to further characterize pediatric polypharmacy. CONCLUSIONS A transdisciplinary approach to scoping reviews, including internal and external consultation, should be considered when addressing complex cross-disciplinary questions.
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Affiliation(s)
- Paul M Bakaki
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Jennifer Staley
- Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA
| | - Rujia Liu
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Neal Dawson
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - Negar Golchin
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Alexis Horace
- Department of Clinical Sciences, University of Louisiana at Monroe College of Pharmacy, Monroe, LA, USA
| | - Hannah Johnson
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jennifer Waldron
- Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lawrence C Kleinman
- Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA.,The Center for Child Health and Policy at Rainbow, University Hospitals, Cleveland, OH, USA
| | - Shari D Bolen
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.,Center for Health Care Research and Policy, Case Western Reserve University at the MetroHealth System, Cleveland, OH, USA
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Jakobsen SP, Charlotte Overgaard. ‘They’ll be judging us’ a qualitative study of pregnant women's experience of being offered participation in a supportive intervention. Midwifery 2018; 61:81-87. [DOI: 10.1016/j.midw.2018.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 10/18/2022]
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Chi C, Tuepker A, Schoon R, Núñez Mondaca A. Critical evaluation of international health programs: Reframing global health and evaluation. Int J Health Plann Manage 2018; 33:511-523. [PMID: 29314258 DOI: 10.1002/hpm.2483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of that discussion is the need to change norms in program evaluation so that analysis of community ownership, beyond various degrees of "participation," is seen as central to strong evaluation practices. This article challenges mainstream evaluation practices and proposes a framework of Critical Evaluation with 3 levels: upstream evaluation assessing the "who" and "how" of programming decisions; midstream evaluation focusing on the "who" and "how" of selecting program objectives; and downstream evaluation, the focus of current mainstream evaluation, which assesses whether the program achieved its stated objectives. A vital tenet of our framework is that a community possesses the right to determine the path of its health development. A prerequisite of success, regardless of technical outcomes, is that programs must address communities' high priority concerns. Current participatory methods still seldom practice community ownership of program selection because they are vulnerable to funding agencies' predetermined priorities. In addition to critiquing evaluation practices and proposing an alternative framework, we acknowledge likely challenges and propose directions for future research.
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Affiliation(s)
- Chunhuei Chi
- Center for Global Health, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Anaïs Tuepker
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University/ Portland Veterans Affairs Health Care System, Portland, Oregon, USA
| | - Rebecca Schoon
- Center for Global Health, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA.,Public Health Program, Pacific University, Forest Grove, Oregon, USA
| | - Alicia Núñez Mondaca
- Department of Management and Information Systems, School of Economics and Business, University of Chile, Santiago, Chile
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Lucyk K, McLaren L. Commentary - Is the future of "population/public health" in Canada united or divided? Reflections from within the field. Health Promot Chronic Dis Prev Can 2017; 37:223-227. [PMID: 28703704 PMCID: PMC5650033 DOI: 10.24095/hpcdp.37.7.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION "Are population and public health truly a unified field, or is population health simply attaching itself to public health as a means of gaining credibility?" This commentary was prompted by the above question, which was asked during K. L.'s PhD candidacy exam. In response, K. L. cited recent developments in the field to support her conviction that population and public health (PPH) existed positively as a unified discipline. However, through conversations that ensued over the subsequent weeks and months, we concluded that this issue goes deeper than the existence of departments and organizations labelled "population and public health," and may benefit from debate and discussion, particularly for the incoming generation of PPH scholars. In this commentary, we argue that (1) the PPH label at times implies a coherence of ideas, values and priorities that may not be present; (2) it is important and timely to work towards a more unified PPH; and (3) both challenges to and opportunities for a more unified PPH exist, which we illustrate using the broad areas of research funding, the public health workforce and PPH ethics.
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Affiliation(s)
- Kelsey Lucyk
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lindsay McLaren
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Treloar C, McCredie L, Lloyd AR. The Prison Economy of Needles and Syringes: What Opportunities Exist for Blood Borne Virus Risk Reduction When Prices Are so High? PLoS One 2016; 11:e0162399. [PMID: 27611849 PMCID: PMC5017673 DOI: 10.1371/journal.pone.0162399] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 08/08/2016] [Indexed: 02/04/2023] Open
Abstract
Aim A formal Needle and Syringe Program (NSP) is not provided in Australian prisons. Injecting equipment circulates in prisons as part of an informal and illegal economy. This paper examined how this economy generates blood-borne virus (BBV) risk and risk mitigation opportunities for inmates. Method The HITS-p cohort recruited New South Wales inmates who had reported ever injecting drugs and who had a negative HCV serological test within 12 months prior to enrolment. For this study, qualitative interviews were conducted with 30 participants enrolled in HITS-p. Participants included 10 women and were incarcerated in 12 prisons. Results A needle/syringe was nominated as being typically priced in the ‘inside’ prison economy at $100-$150, with a range of $50-$350. Purchase or hire of equipment was paid for in cash (including transactions that occurred outside prison) and in exchange for drugs and other commodities. A range of other resources was required to enable successful needle/syringe economies, especially relationships with visitors and other prisoners, and violence to ensure payment of debts. Strategies to mitigate BBV risk included retaining one needle/syringe for personal use while hiring out others, keeping drug use (and ownership of equipment) “quiet”, stealing used equipment from the prison health clinic, and manufacture of syringes from other items available in the prison. Conclusions The provision of prison NSP would disrupt the inside economies built around contraband needles/syringes, as well as minimise BBV risk. However, any model of prison NSP should be interrogated for any unanticipated markets that could be generated as a result of its regulatory practices.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
- * E-mail:
| | - Luke McCredie
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Andrew R. Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
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Allen-Scott LK, Buntain B, Hatfield JM, Meisser A, Thomas CJ. Academic Institutions and One Health: Building Capacity for Transdisciplinary Research Approaches to Address Complex Health Issues at the Animal-Human-Ecosystem Interface. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:866-71. [PMID: 25650827 PMCID: PMC4484662 DOI: 10.1097/acm.0000000000000639] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
To improve health at the human, animal, and ecosystem interface, defined as One Health, training of researchers must transcend individual disciplines to develop a new process of collaboration. The transdisciplinary research approach integrates frameworks and methodologies beyond academic disciplines and includes involvement of and input from policy makers and members of the community. The authors argue that there should be a significant shift in academic institutions' research capacity to achieve the added value of a transdisciplinary approach for addressing One Health problems. This Perspective is a call to action for academic institutions to provide the foundations for this salient shift. The authors begin by describing the transdisciplinary approach, propose methods for building transdisciplinary research capacity, and highlight three value propositions that support the case. Examples are provided to illustrate how the transdisciplinary approach to research adds value through improved sustainability of impact, increased cost-effectiveness, and enhanced abilities to mitigate potentially harmful unintended consequences. The authors conclude with three key recommendations for academic institutions: (1) a focus on creating enabling environments for One Health and transdisciplinary research, (2) the development of novel funding structures for transdisciplinary research, and (3) training of "transmitters" using real-world-oriented educational programs that break down research silos through collaboration across disciplines.
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Affiliation(s)
- Lisa K. Allen-Scott
- L.K. Allen-Scott is a graduate student, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Buntain
- B. Buntain is professor, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer M. Hatfield
- J.M. Hatfield is associate professor, Department of Community Health Sciences, and associate dean of global health and international partnerships, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Meisser
- A. Meisser is research associate, Department of Epidemiology and Public Health, Human and Animal Health Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Christopher James Thomas
- C.J. Thomas is university pro-vice chancellor for research, professor of zoology, and Center for Integrated Research in the Rural Environment (CIRRE) chair in ecological modeling, Institute of Biological, Environmental & Rural Sciences, Aberystwyth University, Aberystwyth, Wales, United Kingdom
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Allen-Scott L, Hatfield J, McIntyre L, McLaren L. Operationalizing the ‘population health’ approach to permit consideration and minimization of unintended harms of public health interventions: a malaria control example. CRITICAL PUBLIC HEALTH 2014. [DOI: 10.1080/09581596.2014.980397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lucan SC. Concerning limitations of food-environment research: a narrative review and commentary framed around obesity and diet-related diseases in youth. J Acad Nutr Diet 2014; 115:205-212. [PMID: 25443565 DOI: 10.1016/j.jand.2014.08.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
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Tylka TL, Annunziato RA, Burgard D, Daníelsdóttir S, Shuman E, Davis C, Calogero RM. The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. J Obes 2014; 2014:983495. [PMID: 25147734 PMCID: PMC4132299 DOI: 10.1155/2014/983495] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/31/2014] [Accepted: 06/25/2014] [Indexed: 12/14/2022] Open
Abstract
Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.
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Affiliation(s)
- Tracy L. Tylka
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
| | | | - Deb Burgard
- Psychology Private Practice, Los Altos, CA 94022, USA
| | | | - Ellen Shuman
- Acoria—A Weigh Out Eating Disorder Treatment, Cincinnati, OH 45208, USA
| | - Chad Davis
- Department of Psychology, Fordham University, Bronx, NY 10458, USA
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Premji S. Mobile health in maternal and newborn care: fuzzy logic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6494-503. [PMID: 25003177 PMCID: PMC4078591 DOI: 10.3390/ijerph110606494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Whether mHealth improves maternal and newborn health outcomes remains uncertain as the response is perhaps not true or false but lies somewhere in between when considering unintended harmful consequences. Fuzzy logic, a mathematical approach to computing, extends the traditional binary “true or false” (one or zero) to exemplify this notion of partial truths that lies between completely true and false. The commentary explores health, socio-ecological and environmental consequences–positive, neutral or negative. Of particular significance is the negative influence of mHealth on maternal care-behaviors, which can increase stress reactivity and vulnerability to stress-induced illness across the lifespan of the child and establish pathways for intergenerational transmission of behaviors. A mHealth “fingerprinting” approach is essential to monitor psychosocial, economic, cultural, environmental and physical impact of mHealth intervention and make evidence-informed decision(s) about use of mHealth in maternal and newborn care.
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Affiliation(s)
- Shahirose Premji
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Faculty of Medicine, Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-403-220-4081; Fax: +1-403-284-4803
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