Contribution of formative research to design an environmental program for obesity prevention in schools in Mexico City.

OBJECTIVE: This paper describes the methods and key findings of formative research conducted to design a school-based program for obesity prevention. MATERIALS AND METHODS: Formative research was based on the ecological model and the principles of social marketing. A mixed method approach was used. Qualitative (direct observation, indepth interviews, focus group discussions and photo-voice) and quantitative (closed ended surveys, checklists, anthropometry) methods were employed. RESULTS: Formative research key findings, including barriers by levels of the ecological model, were used for designing a program including environmental strategies to discourage the consumption of energy dense foods and sugar beverages. CONCLUSION: Formative research was fundamental to developing a context specific obesity prevention program in schools that seeks environment modification and behavior change.

A review of health equity considerations in cochrane reviews of lifestyle interventions for cardiovascular health in adults.

OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of global disease burden and rising health-care costs. Systematic reviews (SRs) rigorously evaluate evidence on health interventions' effects and guide personal, clinical, and policy decision-making. Health equity is the absence of avoidable and unfair differences in health between groups within a population. Assessing equity in lifestyle interventions for cardiovascular health is important due to persisting health inequities in CVD burden and access to interventions. We aim to explore how health equity considerations are addressed in Cochrane SRs of lifestyle interventions for cardiovascular health. STUDY DESIGN AND SETTING: This is a methodological review of Cochrane SRs of lifestyle interventions for cardiovascular health using the PROGRESS-Plus framework. PROGRESS-Plus stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital, while "Plus" stands for additional factors associated with discrimination and exclusion such as age, disability, and comorbidity. Using predefined selection criteria, two authors independently screened all Cochrane reviews published in the Cochrane Database of Systematic Reviews (CDSR) between August 2017 and December 2022. PROGRESS-Plus factors in the SRs were sought in the Summary of Findings (SoF) table, Methods/Inclusion criteria, Methods/Subgroup analyses, Results/Included studies, Results/Subgroup analyses, and Discussion/Overall completeness and applicability of evidence. RESULTS: We included 36 SRs published by 10 Cochrane groups, addressing 11 health conditions with mostly dietary and exercise interventions. The most common PROGRESS-Plus factors assessed were gender/sex, age, and comorbidity. PROGRESS-Plus factors were most addressed in the inclusion criteria (64%), the discussion (75%), and the included studies (92%) sections of the SRs. Only 33% of SoF tables referenced PROGRESS-Plus. Sixty-nine percent of the included SRs planned for subgroup analyses across one or more PROGRESS-Plus factors, but only 43% of SRs conducted subgroup analyses, suggesting limited reporting of PROGRESS-Plus factors in primary studies. CONCLUSION: Equity factors are not sufficiently addressed in Cochrane reviews of lifestyle interventions for cardiovascular health. Low reporting of PROGRESS-Plus factors in implications for practice and research sections of Cochrane SRs limit equity-focused guidance for current clinical practice, public health interventions, and future research.

Centering Racial Health Equity in Systematic Reviews Paper 6: Engaging racially and ethnically diverse stakeholders in evidence syntheses.

OBJECTIVE: To inform methods for centering racial health equity in syntheses, we explored 1) how syntheses that assess health-related interventions and explicitly address racial health inequities have engaged interest holders and 2) guidance for engaging racially and ethnically diverse interest holders. STUDY DESIGN AND SETTING: We systematically identified evidence syntheses (searches limited to January 1, 2020, through January 25, 2023) and guidance documents (no search date limits) for this overview. From syntheses we extracted data on engagement rationale and processes and extracted approaches suggested from guidance documents. We summarized findings qualitatively. RESULTS: Twenty-nine of the 157 (18%) eligible syntheses reported using engagement. Syntheses typically lacked robust detail on why and how to use and structure engagement and outcomes/effects of engagement, though syntheses involving Indigenous populations typically included more detail. When reported, engagement typically occurred in early and later synthesis phases. We did not identify guidance documents that specifically intended to provide guidance for engaging racially/ethnically diverse individuals in syntheses; some related guidance described broader equity considerations or engagement in general. CONCLUSION: This review highlights gaps in understanding of the use of engagement in racial health equity-focused syntheses and in guidance specifically addressing engaging racially and ethnically diverse populations. Syntheses and guidance materials we identified reported limited data addressing the whys, hows, and whats (i.e., rationale for, approaches to, resources needed and effects of) of engagement, and we lack information for understanding whether engagement makes a difference to the conduct and findings of syntheses and when and how engagement of specific populations may contribute to centering racial health equity. A more informed understanding of these issues, facilitated by prospective and retrospective descriptions of engagement of diverse interest holders, may help advance actionable guidance and reviews.

Centering Racial Health Equity in Systematic Reviews Paper 2: Themes from Semi-structured Interviews.

OBJECTIVE: In the context of profound and persistent racial health inequities, we sought to understand how to define racial health equity in the context of systematic reviews and how to staff, conduct, disseminate, sustain, and evaluate systematic reviews that address racial health equity. STUDY DESIGN AND SETTING: The study consisted of virtual, semi-structured interviews followed by structured coding and qualitative analyses using NVivo. RESULTS: Twenty-nine individuals, primarily US-based, including patients, community representatives, systematic reviewers, clinicians, guideline developers, primary researchers, and funders, participated in this study. These interest holders brought up systems of power, injustice, social determinants of health, and intersectionality when conceptualizing racial health equity. They also emphasized including community members with lived experience in review teams. They suggested making changes to systematic review scope, methods, and eligible evidence (such as adapting review methods to include racial health equity considerations in prioritizing topics for reviews, formulating key questions and searches, and specifying outcomes) and broadening evidence to include designs that address implementation and access. Interest holders noted that sustained efforts to center racial health equity in systematic reviews require resources, time, training, and demonstrating value to funders. CONCLUSION: Interest holders identified changes to the funding, staffing, conduct, dissemination, and implementation of systematic reviews to center racial health equity. Action on these steps requires clear standards for success, an evidence base to support transformative changes, and consensus among interest holders on the way forward.

Centering Racial Health Equity in Systematic Reviews-Paper 1: Introduction to the Series.

OBJECTIVE: Systematic reviews hold immense promise as tools to highlight evidence-based practices that can reduce or aim to eliminate racial health disparities. Currently, consensus on centering racial health equity, in systematic reviews and other evidence synthesis products is lacking. Centering racial health equity implies concentrating or focusing attention on health equity in ways that bring attention to the perspectives or needs of groups that are typically marginalized. STUDY DESIGN AND SETTING: This Cochrane US Network team and colleagues, with the guidance of a steering committee, sought to understand the views of varied interest holders through semi-structured interviews, and conducted evidence syntheses addressing (1) definitions of racial health equity, (2) logic models and frameworks to center racial health equity, (3) interventions to reduce racial health inequities, and (4) interest holder engagement in evidence syntheses. Our methods and teams include a primarily American and Canadian lens; however, findings and insights derived from this work are applicable to any region in which racial or ethnic discrimination and disparities in care due to structural causes exist. RESULTS: In this series, we explain why centering racial health equity matters, what gaps exist and may need to be prioritized. The interviews and systematic reviews identified numerous gaps to address racial health equity that require changes not merely to evidence synthesis practices but also to the underlying evidence ecosystem. These changes include increasing representation, establishing foundational guidance (on definitions and causal mechanisms and models, building a substantive evidence base on racial health equity, strengthening methods guidance, disseminating and implementing results, and sustaining new practices). CONCLUSION: Centering racial health equity requires consensus on the part of key interest holders. As part of the next steps in building consensus, the manifold gaps identified by this series of papers need to be prioritized. Given resource constraints, changes in norms around systematic reviews are most likely to occur when evidence-based standards for success are clearly established and the benefits of centering racial health equity are apparent.

Centering Racial Health Equity in Systematic Reviews Paper 3: A Systematic Review of Definitions For "Racial Health Equity" and Related Terms within Health Related Articles.

OBJECTIVE: To systematically evaluate definitions of "racial health equity" and related terms within health-related academic literature. STUDY DESIGN AND SETTING: We systematically evaluated definitions of racial health equity and related terms within health-related academic articles. Articles published in English were included, and no date restrictions were imposed. RESULTS: We found 20 original articles containing relevant definitions out of 1816 retrieved articles, thirteen of which were published from 2020-2023. Themes used in the definitions varied, with racism (n= 12) and quality of healthcare (n= 10) being the most common. Additional themes, including social hierarchy or marginalization, discrimination, justice, unmet social needs, and historical events were used by some definitions. Eleven of the included manuscripts defined race as a social construct. CONCLUSION: This study depicts racial health equity as an emerging concept with limited consensus on racism, quality of health, and social determinants of health as important underlying frameworks. To center equity efforts and actions under a workable and shared vision, we recommend continued discussions regarding underlying meanings of racial health equity concepts and propose establishing a definition that promotes unity across health fields and prevents ambiguity.

Centering racial health equity in systematic reviews Paper 4: A systematic review on the use of logic models and frameworks for methodological conduct of evidence synthesis.

OBJECTIVE: To identify evidence syntheses of health interventions addressing racial health equity reporting the use of equity-focused frameworks and logic models. STUDY DESIGN AND SETTING: The search strategy included three sources; a search of three bibliographic databases to identify systematic reviews assessing interventions to improve racial health equity, semi-structured interviews with diverse group and a targeted organization website searches (e.g. NIH, USPSTF) to identify relevant logic models and frameworks. The searches were conducted between January 1, 2020, and January 25, 2023. We used a qualitative approach to identify and describe key characteristics of equity-focused logic models and frameworks used in evidence syntheses. RESULTS: Of the 153 racial health equity-focused evidence syntheses identified, 2 explicitly used logic models to describe the intervention mechanism. We identified seven existing health equity frameworks from semi-structured interviews and electronic search of key websites that were categorized by stated purpose as providing guidance for 1) research, 2) health policy, 3) digital healthcare solutions, and 4) clinical preventive services. Two out of 7 frameworks included guidance on integrating frameworks or logic models in evidence synthesis while the majority provided contextual information on how to define or consider race or racism as a structural determinant of health. CONCLUSION: There is limited use of logic models and frameworks in evidence syntheses addressing racial health equity. There is a need for more applied frameworks providing guidance for framing, conducting and interpreting findings of evidence syntheses addressing racial health equity.

Centering Racial Health Equity in Systematic Reviews Paper 5: A Methodological Overview of methods and interventions.

OBJECTIVE: We aim to 1) evaluate the methods used in systematic reviews of interventions focused on racialized populations to improve racial health equity, and 2) examine the types of interventions evaluated for advancing racial health equity in systematic reviews. STUDY DESIGN AND METHODS: We searched MEDLINE, Cochrane and Campbell databases for reviews evaluating interventions focused on racialized populations to mitigate racial health inequities, published from January 2020 to January 2023. RESULTS: We analyzed 157 reviews on racialized populations. Only 22 (14%) reviews addressed racism's role in driving racial health inequities related to the review question. Eleven percent (7) of reviews considered intersectionality when conceptualizing racial inequities. Two-thirds (105, 67%) provided descriptive summaries of included studies rather than synthesizing them. Among those that quantified effect sizes, 54% (21) used biased synthesis methods like vote counting. The most common method assessed was tailoring interventions to meet the needs of racialized populations. Reviews mainly focused on assessing interventions to reduce racial disparities rather than enhancing structural opportunities for racialized populations. CONCLUSIONS: Reviews for racial health equity could be improved by enhancing methodologic quality, defining the role of racism in the question, usingreliable analytical methods, and assessing process and implementation outcomes. More focus is needed on assessing structural interventions to improve opportunities for racialized populations and prioritize these issues in political and social agendas.

Definitions, terminology, and related concepts of "racial health equity": a scoping review protocol.

BACKGROUND: In the USA, access to quality healthcare varies greatly across racial and ethnic groups, resulting in significant health disparities. A new term, "racial health equity" (RHE), is increasingly reported in the medical literature, but there is currently no consensus definition of the term. Additionally, related terms such as "health disparities," "health inequities," and "equality" have been inconsistently used when defining RHE. METHODS: The primary purpose of this scoping review is to investigate the current use and underlying concepts used to define racial health equity. The study will address two key questions: (1) "What terminology and definitions have been used to characterize RHE?" and (2) "What knowledge gaps and challenges are present in the current state of RHE research and theory?" The review will collect and analyze data from three sources: (1) websites from key national and international health organizations, (2) theoretical and narrative published articles, and (3) evidence synthesis studies addressing interventions targeting racial health equity and minority stakeholder engagement. DISCUSSION: Defining "racial health equity" and related terminology is the first step to advancing racial health equity within the USA. This review aims to offer an improved understanding of RHE constructs and definitions, bringing greater unity to national racial health equity research efforts across disciplines. SYSTEMATIC REVIEW REGISTRATION: This protocol is registered with the Open Science Framework at https://osf.io/7pvzq .

Optimized variant calling for estimating kinship.

One of the fundamental goals of forensic genetics is sample attribution, i.e., whether an item of evidence can be associated with some person or persons. The most common scenario involves a direct comparison, e.g., between DNA profiles from an evidentiary item and a sample collected from a person of interest. Less common is an indirect comparison in which kinship is used to potentially identify the source of the evidence. Because of the sheer amount of information lost in the hereditary process for comparison purposes, sampling a limited set of loci may not provide enough resolution to accurately resolve a relationship. Instead, whole genome techniques can sample the entirety of the genome or a sufficiently large portion of the genome and as such they may effect better relationship determinations. While relatively common in other areas of study, whole genome techniques have only begun to be explored in the forensic sciences. As such, bioinformatic pipelines are introduced for estimating kinship by massively parallel sequencing of whole genomes using approaches adapted from the medical and population genomic literature. The pipelines are designed to characterize a person's entire genome, not just some set of targeted markers. Two different variant callers are considered, contrasting a classical variant calling algorithm (BCFtools) to a more modern deep convolution neural network (DeepVariant). Two different bioinformatic pipelines specific to each variant caller are introduced and evaluated in a titration series. Filters and thresholds are then optimized specifically for the purposes of estimating kinship as determined by the KING-robust algorithm. With the appropriate filtering and thresholds in place both tools perform similarly, with DeepVariant tending to produce more accurate genotypes, though the resultant types of inaccuracies tended to produce slightly less accurate overall estimates of relatedness.

Study Exploring the Effects of Daily Supplementation with 400 µg of Folic Acid on the Nutritional Status of Folate in Women of Reproductive Age.

BACKGROUND: This investigation determines the nutritional state of serum and red blood cell (RBC) folate concentration and their relation with intake of folate, B6 ,and B12 , with serum vitamin B12 , and with genetic variants after provision of 400 µg/day of folic acid for 3 months to a group of 34 Colombian women of reproductive age. METHODS: We evaluated nutrient intake using 24-hr recall, assessing the levels of serum folate, RBC folate, serum B12 , and homocysteine, as well as determining genetic variants of the enzyme MTHFR (C677T and A1298C) and CßS (844ins68pb). RESULTS: The results show that following intake of 400 µg/day of folic acid, the risk of folate deficiency as seen in regular dietary intake disappears and the nutritional status of this nutrient is increased (p < 0.001). With respect to vitamin B12, the risk of serum deficiency with folic acid consumption increased slightly, and those that were found to be B12 deficient after supplementation also had decreased levels of serum homocysteine. Genetic factors did not influence the nutritional status of folate, although an association was found between the intake of nutrients and biochemical indicators. CONCLUSION: Given the results of our study, subsequent studies evaluating folic acid supplementation should also consider evaluating the status of B12 and B6 , and serum and RBC folate, as they participate interdependently in the cycle of folate and methionine and in homocysteine metabolism.Birth Defects Research 109:564-573, 2017.© 2017 Wiley Periodicals, Inc.

Contribution of formative research to design an environmental program for obesity prevention in schools in Mexico City / Contribución de la investigación formativa para el diseño de un programa para la prevención de obesidad en escuelas de la Ciudad de México

Objective. This paper describes the methods and key findings of formative research conducted to design a school-based program for obesity prevention. Materials and methods. Formative research was based on the ecological model and the principles of social marketing. A mixed method approach was used. Qualitative (direct observation, indepth interviews, focus group discussions and photo-voice) and quantitative (closed ended surveys, checklists, anthropometry) methods were employed. Results. Formative research key findings, including barriers by levels of the ecological model, were used for designing a program including environmental strategies to discourage the consumption of energy dense foods and sugar beverages. Conclusion. Formative research was fundamental to developing a context specific obesity prevention program in schools that seeks environment modification and behavior change.

Objetivo. Describir los aspectos metodológicos y principales resultados de una investigación formativa realizada para diseñar un programa ambiental para la prevención de obesidad en escuelas. Material y métodos. La investigación formativa se basó en el modelo ecológico y los principios del mercadeo social. Se utilizó un enfoque de métodos mixtos: cualitativos (observación directa, entrevistas en profundidad, grupos de discusión y foto-voz) y cuantitativos (cuestionarios cerrados, inventarios de alimentos y bebidas, antropometría). Resultados. Los principales resultados de la investigación formativa, incluyendo las barreras identificadas en los niveles del modelo ecológico, fueron contemplados para el diseño del programa, que incluyó estrategias ambientales para desincentivar el consumo de alimentos de alta densidad energética y bebidas azucaradas. Conclusión. La investigación formativa fue fundamental para diseñar un programa de prevención de obesidad para la modificación del ambiente y cambios de comportamientos, factible y adaptado al contexto de las escuelas públicas de la Ciudad de México.