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Jáuregui A, Pacheco-Miranda S, Argumedo-García G, Marrón-Ponce JA, G.-Olvera A, Vargas-Meza J, Ayvar-Gama YY, Velázquez D, David Quezada A, Bonvecchio-Arenas A. Comprehensive evaluation of Salud Escolar a health school program in Mexico: Rationale, design and methods. Prev Med Rep 2022; 25:101662. [PMID: 35127349 PMCID: PMC8800016 DOI: 10.1016/j.pmedr.2021.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/04/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022] Open
Abstract
The prevalence of obesity and overweight in Mexican children and adolescents is high (greater than 30%) and lifestyle behaviors are far from achieving health recommendations. Salud Escolar is a complex cross-sectoral multi-level policy-based program in Mexico aiming to support schoolchildren healthy behaviors. We describe the rationale, design and methods for the comprehensive evaluation of Salud Escolar during its first phase of implementation. Using a mixed-methods approach and the logic model of Salud Escolar as a guide, a comprehensive evaluation involving 3 types of evaluations was designed: 1) A design evaluation before program implementation, to determine the consistency between the design of Salud Escolar and the problem to be addressed (i.e., childhood obesity), 2) An implementation evaluation to assess potential execution bottlenecks, and 3) An outcomes evaluation, to measure short-term (i.e., knowledge, attitudes and practices related to healthy eating, drinking plain water and doing regular physical activity) and intermediate outcomes (i.e., fruit and vegetable intake, water consumption and daily moderate to vigorous physical activity). This evaluation will provide essential knowledge about program design and implementation processes, which are vital for drawing robust conclusions about the effectiveness of the program. Results and lessons learned from this comprehensive evaluation will provide evidence to improve Salud Escolar program and facilitate its upscaling process and may provide relevant information for school-based programs in other places sharing socio-contextual conditions.
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Key Words
- BMI, Body mass index
- GEE, Generalized Estimating Equations
- HR, Hour
- IS, Implementation Science
- ISAT, ISCOLE School Audit Tool
- LMIC, Low-Middle Income Countries
- MIR, Results Indicators Matrix
- MVPA, Moderate-to-vigorous physical activity
- Obesity
- PA, Physical activity
- Program evaluation
- SOFIT, System for Observing Fitness Time
- SSBs, Sugar sweetened beverages
- School-based intervention
- Schoolchildren
- TRM, Terms of Reference Model
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Affiliation(s)
- Alejandra Jáuregui
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Selene Pacheco-Miranda
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Gabriela Argumedo-García
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Joaquín A Marrón-Ponce
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Armando G.-Olvera
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Jorge Vargas-Meza
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Ylenia Yatziri Ayvar-Gama
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Daniel Velázquez
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Amado David Quezada
- Center for Evaluation and Surveys, Research National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Anabelle Bonvecchio-Arenas
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
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Cole EF, DeGrazia T, Sun Y, Liu Y, Feldman RJ. Assessing Disease Outcome Measures in Bullous Pemphigoid on Standard-Of-Care Therapies. JID Innov 2021; 1:100050. [PMID: 34909747 DOI: 10.1016/j.xjidi.2021.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/21/2022] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering disease resulting in pruritus and cutaneous blistering. Longitudinal studies characterizing the disease course of patients with BP on conventional therapy are lacking. We sought to characterize the changes in disease activity and pruritus of patients with BP on standard-of-care treatments. We conducted a retrospective cohort study on patients with BP on standard-of-care therapy. Generalized Estimating Equations were used to estimate the mean and standard errors for Bullous Pemphigoid Disease Activity Index (BPDAI) total activity score, BPDAI pruritus component score, and anti-BP180 autoantibody levels (BP180) over time. A total of 80 patients with BP showed consistent reductions in BPDAI total activity score and BPDAI pruritus component score, with a nadir at 4 months. BP180 decreased over time, with the largest reductions at 6 and 9 months. Median partial/complete remission was at 6.7 months, with relapses at a median time of 15.9 months. Receiving operating characteristic analysis determined an optimal BPDAI total activity score cutoff of 3.3 to discriminate partial/complete remission incidence (area under the curve = 0.895, sensitivity = 0.844, specificity = 0.78). In conclusion, in patients with BP on standard-of-care therapy, a natural course of BPDAI total activity score and BPDAI pruritus component score over time was comprehensively projected. BPDAI ≤ 3.3 was associated with partial/complete remission. These results provide reference data to guide future clinical trial design for BP.
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Lemanska A, Byford RC, Correa A, Cruickshank C, Dearnaley DP, Griffin C, Hall E, de Lusignan S, Faithfull S. Linking CHHiP prostate cancer RCT with GP records: A study proposal to investigate the effect of co-morbidities and medications on long-term symptoms and radiotherapy-related toxicity. Tech Innov Patient Support Radiat Oncol 2017; 2:5-12. [PMID: 32095558 PMCID: PMC7033766 DOI: 10.1016/j.tipsro.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/17/2017] [Accepted: 06/07/2017] [Indexed: 12/25/2022] Open
Abstract
Background Patients receiving cancer treatment often have one or more co-morbid conditions that are treated pharmacologically. Co-morbidities are recorded in clinical trials usually only at baseline. However, co-morbidities evolve and new ones emerge during cancer treatment. The interaction between multi-morbidity and cancer recovery is significant but poorly understood. Purpose To investigate the effect of co-morbidities (e.g. cardiovascular and diabetes) and medications (e.g. statins, antihypertensives, metformin) on radiotherapy-related toxicity and long-term symptoms in order to identify potential risk factors. The possible protective effect of medications such as statins or antihypertensives in reducing radiotherapy-related toxicity will also be explored. Methods Two datasets will be linked. (1) CHHiP (Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy for Prostate Cancer) randomised control trial. CHHiP contains pelvic symptoms and radiation-related toxicity reported by patients and clinicians. (2) GP (General Practice) data from RCGP RSC (Royal College of General Practitioners Research and Surveillance Centre). The GP records of CHHiP patients will be extracted, including cardiovascular co-morbidities, diabetes and prescription medications. Statistical analysis of the combined dataset will be performed in order to investigate the effect. Conclusions Linking two sources of healthcare data is an exciting area of big healthcare data research. With limited data in clinical trials (not all clinical trials collect information on co-morbidities or medications) and limited lengths of follow-up, linking different sources of information is increasingly needed to investigate long-term outcomes. With increasing pressures to collect detailed information in clinical trials (e.g. co-morbidities, medications), linkage to routinely collected data offers the potential to support efficient conduct of clinical trials.
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Key Words
- ANOVA, analysis of variance
- BNF, British National Formulary
- Big data
- CHHiP
- CHHiP, Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy for Prostate Cancer
- Data linkage
- EPIC, Expanded Prostate Cancer Index Composite
- FACT-P, Functional Assessment of Cancer Therapy-Prostate
- GEE, Generalized Estimating Equations
- GP, General Practitioner
- ICD10, International Classification of Disease version 10
- ICR, Institute of Cancer Research
- IMRT, Intensity Modulated Radiotherapy
- LENT/SOMA, Late Effects Normal Tissue Toxicity; subjective, objective, management, and analytic
- Late-effects
- PCa, Prostate cancer
- PROs, Patient Reported Outcomes
- QOL, Quality of life
- RCGP RSC
- RCGP, Royal College of General Practitioners
- RCT, Randomised Control Trial
- REC, Research Ethics Committee
- RSC, Research & Surveillance Centre
- RTOG, Radiation Therapy Oncology Group
- Radiotherapy-related side-effects
- SHA2-512, Secure Hash Algorithm 2 with 512 bit hash values
- UCLA-PCI, University of California, Los Angeles Prostate Cancer Index
- UK, United Kingdom
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Affiliation(s)
- Agnieszka Lemanska
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Rachel C Byford
- Department of Health Care Management and Policy, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ana Correa
- Department of Health Care Management and Policy, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Clare Cruickshank
- The Institute of Cancer Research - Clinical Trials and Statistics Unit, London, UK
| | - David P Dearnaley
- The Institute of Cancer Research and Royal Marsden NHS Trust, London, UK
| | - Clare Griffin
- The Institute of Cancer Research - Clinical Trials and Statistics Unit, London, UK
| | - Emma Hall
- The Institute of Cancer Research - Clinical Trials and Statistics Unit, London, UK
| | - Simon de Lusignan
- Department of Health Care Management and Policy, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sara Faithfull
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Blankers M, van Emmerik A, Richters B, Dekker J. Blended internet care for patients with severe mental illnesses: An open label prospective controlled cohort pilot study. Internet Interv 2016; 5:51-55. [PMID: 30135807 PMCID: PMC6096193 DOI: 10.1016/j.invent.2016.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This paper reports first experiences while providing blended (combined face-to-face and internet-based) flexible assertive community treatment (FACT) to outpatients with severe mental illnesses (SMI). The aim was to compare treatment satisfaction, clinical outcome and quality of life in the short term (3 months) of patients receiving blended FACT with those receiving conventional FACT. METHOD This pilot study was designed as an open label prospective controlled cohort study. 47 SMI patients were found eligible and non-randomly allocated to Blended FACT (n = 25) or to conventional FACT (n = 22). Data were collected at baseline and at a 3-month follow-up. Measures included were the Dutch Mental Health Care Thermometer, Health of the Nation Outcome Scales (HONOS), Manchester Short Assessment of Quality of Life (MANSA), EuroQoL 5 dimensional (EQ5D) and the Mental Health Confidence Scale (MHCS). RESULTS At a three months follow-up, patients reported slightly improved quality of life (EuroQoL 5 dimensional, Wald χ2(1) = 6.80, p = 0.01; MANSA, Wald χ2(1) = 4.02, p = 0.05) and self-efficacy beliefs regarding their mental health problems (MHCS, Wald χ2(1) = 3.71, p = 0.05). HONOS scores did not change over time, Wald χ2(1) = 2.34, p = 0.13. Satisfaction scores were on average between satisfactory - good (BI: M = 7.50, SD = 1.54; CAU: M = 7.53 SD = 0.96; on a 1-10 scale). These results did not differ between the two study groups. CONCLUSION It appears acceptable to patients to provide blended FACT with SMI, with outcomes comparable to face-to-face FACT. A future high quality trial is warranted to establish (cost-)effectiveness of blended FACT.
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Affiliation(s)
- Matthijs Blankers
- Arkin Mental Health Care, Amsterdam, The Netherlands,Trimbos institute, Utrecht, The Netherlands,Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands,Corresponding author at. Arkin Mental Health Care, Department of Research, PO Box 75848, 1070 AV Amsterdam, The Netherlands.
| | - Arnold van Emmerik
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jack Dekker
- Arkin Mental Health Care, Amsterdam, The Netherlands,Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
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