Revising the Logic Model Behind Health Care's Social Care Investments.

Policy Points This article summarizes recent evidence on how increased awareness of patients' social conditions in the health care sector may influence health and health care utilization outcomes. Using this evidence, we propose a more expansive logic model to explain the impacts of social care programs and inform future social care program investments and evaluations.

Healthy lifestyle interventions within the curriculum in school-age children: systematic review and meta-analysis.

Childhood obesity is a major public health challenge. Previous research has identified the impact of school-based interventions for preventing and treating obesity; we hypothesized that when curricular changes are integrated, results could be exponentiated. This study aimed to systematically review and conduct a meta-analysis of the published literature analyzing information about school-based interventions inserted in the curriculum. The Cochrane Handbook methodology was followed. An electronic search was conducted in five databases, with a specific design strategy per database. Randomized controlled trials or quasi-experimental studies of children with nutrition and physical activity (PA) interventions inserted into the school curricula were included. The risk of bias was assessed with the Risk of Bias tool. The mean differences were pooled using a fixed-effects model for the meta-analysis. The certainty of the evidence was evaluated according to the guidelines of the Grading of the Recommendations, Assessment, Development, and Evaluations working group (Protocol ID: CRD42021270557). After the screening and selection process, 12 studies were included. The interventions identified, based on the school curricula, include classroom activities and homework, among others. A meta-analysis with five intervention groups presented an overall mean difference of -0.14 body mass index (BMI) Z-score (95% CI: -0.25, -0.03) after this intervention with high certainty of the evidence. This systematic review and meta-analysis suggest that nutrition and PA lessons inserted into the curricula and supported with additional activities (i.e. homework, workshops, etc.) could increase nutrition knowledge and improve attitudes toward fruit, vegetables, and water consumption, and BMI Z-score reduction.

Diagnostic accuracy of blood biomarkers and non-invasive scores for the diagnosis of NAFLD and NASH: Systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVES: Fatty liver disease is an important public health problem. Early diagnosis is critical to lower its rate of progression to irreversible/terminal stages. This study aimed to evaluate the accuracy of non-invasive prediction scores for fatty liver disease (NAFLD and NASH) diagnosis in adults. MATERIALS AND METHODS: A search was conducted in 10 databases, a qualitative synthesis of 45 studies, and quantitative analysis of the six most common scores. There were 23 risk scores found for NAFLD diagnosis and 32 for NASH diagnosis. The most used were Fatty Liver Index (FLI), aspartate aminotransferase (AST) to Platelet Ratio Index, Fibrosis-4 Index (FIB-4), AST/alanine aminotransferase (ALT) ratio, BARD score, and NAFLD fibrosis score (NFS). RESULTS: The results from the meta-analysis for FLI: Area under the curve (AUC) of 0.76 (95% Confidence Interval [CI] 0.73, 0.80), sensitivity 0.67 (CI 95% 0.62, 0.72) and specificity 0.78 (CI 95% 0.74, 0.83). The AST to Platelet Ratio Index: AUC 0.83 (CI 95% 0.80, 0.86), sensitivity 0.45 (95% CI 0.29, 0.62), and specificity of 0.89 (95% CI 0.83, 0.92). The NFS: AUC of 0.82 (CI 95% 0.78, 0.85), sensitivity 0.30 (CI 95% 0.27, 0.33) and specificity 0.96 (CI 95% 0.95,0.96). CONCLUSIONS: The FLI for NAFLD and AST to Platelet Ratio Index for NASH were the risk scores with the highest prognostic value in the included studies. Further research is needed for the application of new diagnostic risk scores for NAFLD and NASH.

Risk Prediction Score for Chronic Kidney Disease in Healthy Adults and Adults With Type 2 Diabetes: Systematic Review.

INTRODUCTION: Chronic kidney disease (CKD) is an important public health problem. In 2017, the global prevalence was estimated at 9.1%. Appropriate tools to predict the risk of developing CKD are necessary to prevent its progression. Type 2 diabetes is a leading cause of CKD; screening the population living with the disease is a cost-effective solution to prevent CKD. The aim of our study was to identify the existing prediction scores and their diagnostic accuracy for detecting CKD in apparently healthy populations and populations with type 2 diabetes. METHODS: We conducted an electronic search in databases, including Medline/PubMed, Embase, Health Evidence, and others. For the inclusion criteria we considered studies with a risk predictive score in healthy populations and populations with type 2 diabetes. We extracted information about the models, variables, and diagnostic accuracy, such as area under the receiver operating characteristic curve (AUC), C statistic, or sensitivity and specificity. RESULTS: We screened 2,359 records and included 13 studies for healthy population, 7 studies for patients with type 2 diabetes, and 1 for both populations. We identified 12 models for patients with type 2 diabetes; the range of C statistic was from 0.56 to 0.81, and the range of AUC was from 0.71 to 0.83. For healthy populations, we identified 36 models with the range of C statistics from 0.65 to 0.91, and the range of AUC from 0.63 to 0.91. CONCLUSION: This review identified models with good discriminatory performance and methodologic quality, but they need more validation in populations other than those studied. This review did not identify risk models with variables comparable between them to enable conducting a meta-analysis.

Association between physical activity and physical and functional performance in non-institutionalized Mexican older adults: a cohort study.

BACKGROUND: Aging is an independent risk factor for deterioration in functional capacity. Some studies have reported that physical activity (PA) improves functional capacity and physical performance among older adults (OA). Thus the objective of the present study was to assess the longitudinal association between PA and functional and physical performance in non-institutionalized OA. METHODS: A longitudinal analysis using data from the Frailty, Dynapenia and Sarcopenia in Mexican adults (FRADYSMEX, by its Spanish acronym) cohort study was conducted. PA was assessed through the Community Healthy Activities Model Program for Seniors (CHAMPS) instrument. Functionality was measured with the Barthel index and the Lawton and Brody scale, while physical performance was measured with the Short Physical Performance Battery (SPPB). To evaluate the association between the level of PA and physical and functional performance as a continuous variable, a linear regression of mixed effects was performed. To assess PA and dependence in basic activities of the daily life (BADL), instrumental activities of the daily life (IADL), and low physical performance (PP), generalized estimation equation models [to compute odds ratios (OR) and 95% confidence intervals (95%CI)] were computed. RESULTS: Older people who performed moderate to vigorous-intensity PA had a lower risk of dependence in IADL (OR = 0.17; 95%CI: 0.10, 0.80) and lower risk of low PP (OR = 0.18; 95%CI: 0.11, 0.58) compared to those in lower categories of PA. CONCLUSIONS: Older adults living in the community who perform PA of moderate to vigorous intensity have a lower risk of dependence in BADL and IADL and have a lower risk of low PP.

Lifestyle Quality Indices and Female Breast Cancer Risk: A Systematic Review and Meta-Analysis.

Breast cancer (BC) poses an important burden of disease, which probably could be reduced by adopting healthy lifestyles like healthy body weight, healthy diet, and physical activity, among others. Many studies have reported that adherence to healthy lifestyles may decrease BC risk. The main objective of this study was to estimate a summary association of studies evaluating a healthy lifestyle index and BC risk. A systematic review and meta-analysis following the Cochrane methodology were carried out. Observational studies, including healthy lifestyle indices and their association with BC, were searched from 4 databases. For the meta-analysis, random-effects model was used to evaluate overall BC risk, BC by molecular subtype and menopausal status. Thirty-one studies were included in the systematic review, and 29 studies in the meta-analysis. When the highest vs. the lowest category to a healthy lifestyle index were compared, the study identified a 20% risk reduction for BC in prospective studies (hazard ratio [HR] 0.80 95% CI: 0.78, 0.83) and an odds ratio (OR) of 0.74 (95% CI: 0.63, 0.86) for retrospective studies. The inverse association remained statistically significant when stratified by menopausal status, except for premenopausal BC in prospective studies. Furthermore, an inverse association was found for molecular subtypes estrogen receptor (ER+)/progesterone receptor (PR+): HR = 0.68 (95%CI: 0.63, 0.73), ER+/PR-: HR = 0.78 (95% CI: 0.67, 0.90) and ER-/PR-: HR = 0.77 (95% CI: 0.64, 0.92). Most studies scored at a low risk of bias and a moderate score for the certainty of the evidence. Adherence to a healthy lifestyle reduces the risk of BC, regardless of its molecular subtypes, which should be considered a priority to generate recommendations for BC prevention at a population level. International prospective register of systematic reviews (PROSPERO) ID: CRD42021267759.

Effective and Scalable Interventions to Reduce Sodium Intake: a Systematic Review and Meta-Analysis.

PURPOSE OF REVIEW: High-sodium intake is a main risk factor for increased blood pressure and cardiovascular disease, the leading cause of death worldwide. Reducing sodium intake at the population level is one of the most cost-effective strategies to address this. The aim of the present systematic review and meta-analysis are to examine data from recent studies that measure the effectiveness and scalability of interventions aimed at reducing sodium intake at both the population and individual level. RECENT FINDINGS: Worldwide, sodium intake is higher than the World Health Organization recommendations. Structural interventions such as mandatory reformulation of foods, food labeling, taxes or subsidies, and communication campaigns have shown to be the most effective in reducing the population's sodium consumption. Interventions in education, particularly those that use a social marketing framework with short duration, food reformulation, and combined strategies, have the potential to decrease sodium intake.

Overview of Systematic Reviews of Health Interventions for the Prevention and Treatment of Overweight and Obesity in Children.

(1) Background: The importance of studying the health interventions used to prevent and treat overweight and obesity in school-aged children is imperative. This overview aimed to summarize systematic reviews that assess the effects of school-based, family, and mixed health interventions for preventing and treating overweight and obesity in school-aged children. (2) Methods: The Cochrane Collaboration methodology and PRISMA statement were followed. A search was conducted using terms adapted to 12 databases. Systematic reviews reporting interventions in children from six to 12 years old with an outcome related to preventing or treating obesity and overweight were included. Studies with pharmacological or surgical interventions and adolescents were excluded. (3) Results: A total of 15,226 registers were identified from databases and citation searching. Of those, ten systematic reviews published between 2013 and 2022 were included. After the overlap, 331 interventions for children between 6 and 12 years old were identified, and 61.6% involved physical activity and nutrition/diet intervention. Multicomponent intervention, combining physical activity with nutrition and behavioral change, school-based plus community-based interventions may be more effective in reducing overweight and obesity in children. (4) Conclusions: Plenty of interventions for childhood overweight and obesity aimed at prevention and treatment were identified, but there is a gap in the methodological quality preventing the establishment of a certain recommendation.

Participatory intervention to improve nutrition and physical activity of school-age children in Mexico.

Obesity is one of the major public health problems of the 21st century, affecting every country in the world. In Mexico, the prevalence of overweight and obesity in children (5 to 11 years) was 35.5%. Childhood obesity is a chronic disease itself; and is associated with other chronic conditions. OBJECTIVE: To assess the effect and feasibility of a participatory intervention to improve nutrition and physical activity within the school environment in children in public elementary schools in Mexico. METHODS: The present study is a cluster trial. The intervention focused on; changes in food offered, training the schools' food service staff, promoting water consumption and physical activity at the community level, implementing healthy spaces inside the school, improving the quality of physical education within schools, among others. The main outcomes will focus on rate of weight gain, time devoted to physical activity, sedentary behaviors, diet quality and response feeding behaviors. We also will assess the time and personnel involved in the intervention development, maintenance, and dissemination. CONCLUSION: Findings from this trial will generate new translational knowledge in Mexico; if the results are positive, this participatory intervention could serve as a basis for designing multidimensional interventions that could be scaled up at the national level.

Effect Of Exercise on Muscle Mass, Fat Mass, Bone Mass, Muscular Strength and Physical Performance in Community Dwelling Older Adults: Systematic Review and Meta-Analysis.

The demographic transition makes it necessary to establish new recommendations about the components that are most affected by aging, such as: muscle mass, fat mass, bone mass, muscle strength, and physical performance. Exercise has been identified as a factor that improves those conditions. The aim of this review is to synthetize and analyze the results of exercise interventions on muscle mass, fat mass, bone mass, strength and physical performance in community dwelling older adults (OA). A systematic search was carried out in eleven databases, using validated terms as "aged", "exercise" and others. For the meta-analysis, we differentiated by type of exercise and outcome. Twenty-nine randomized clinical trials were obtained for the review and 24 clinical trials for meta-analysis. This study identified an increase of 1.0 kg (95% Confidence Interval [CI] 0.3 -1.7) in total muscle mass (TMM) and 0.4 kg (95%CI 0.0,0.7) in appendicular muscle mass (AMM); a decrease of -3.7 kg (95% CI -5.8, -1.5) in total fat mass and -3.7% (95%CI -5.8, -1.5) in fat percentage after the resistance exercise intervention by 2-3 times per week. A -3.0% (95%CI -4.6, -1.3) decrease was observed in fat percentage after the aerobic exercise intervention. The quality of the evidence was ranked from high to very low; the risk of bias most common was performance bias and other bias. This study suggests that resistance exercise is the intervention that shows a positive effect on muscle fat mass, and bone mass. More research is needed for other exercise interventions.

Chronic kidney disease risk prediction scores assessment and development in Mexican adult population.

Background: Chronic kidney disease (CKD) is a major public health problem, with considerable growth in prevalence and mortality in recent years. Screening of CKD at primary care is crucial for the implementation of prevention strategies. The aims of this study are to assess CKD risk prediction scores and to develop a risk prediction score for the Mexican adult population. Methods: Data from the Mexican National Health and Nutrition Survey 2016 was utilized and 3463 participants ≥ 20 years old were included. Reduced renal function with Glomerular filtration rate and/or the presence of albuminuria was defined as CKD. Multiple logistic regression models were performed for the creation of a training and validation model. Additionally, several models were validated in our Mexican population. Results: The developed training model included sex, age, body mass index, fast plasma glucose, systolic blood pressure, and triglycerides, as did the validation model. The area under the curve (AUC) was 0.78 (95% CI: 0.72, 0.79) for training model, and 0.76 (95% CI: 0.71, 0.80) in validation model for Mexican adult population. Age, female gender, presence of diabetes and hypertension, elevated systolic and diastolic blood pressure, serum and urinary creatinine, and higher HbA1c were significantly associated with the prevalent chronic kidney disease. Previous CKD risk predictive models were evaluated with a representative sample of the Mexican adult population, their AUC was between 0.61 and 0.78. Conclusion: The designed CKD risk predictive model satisfactorily predicts using simple and common variables in primary medical care. This model could have multiple benefits; such as, the identification of the population at risk, and prevention of CKD.

Overview of systematic reviews of health interventions that aim to prevent and treat overweight and obesity among children.

BACKGROUND: Childhood overweight and obesity is a global public health issue. Although there is evidence of a reduced prevalence in some countries, there is still much controversy about the efficacy of health interventions that aim to prevent and treat obesity in this specific population. The objective of the present study is to develop an overview of systematic reviews (OSRs) that assesses the effects of school-based, family, and multi-component health interventions for the prevention and treatment of obesity, change in physical activity, dietary, and/or hydration behaviors, and change in metabolic risk factors in school-aged children. METHODS: This protocol was developed using the methodology proposed by Cochrane. It outlines a comprehensive search in 12 electronic databases to identify systematic reviews of health interventions, including studies that evaluate and how to prevent and/or treat overweight and/or obesity in children aged 6 to 12 years. The risk of bias of the included Systematic Reviews will be assessed with the ROBIS tool. DISCUSSION: Since the OSRs methodology's purpose is only to harmonize evidence from open access publications, ethical consent is not necessary for the present protocol. In terms of diffusion, a paper will be submitted for publication in a scientific journal to describe the main results obtained through the OSRs. TRIAL REGISTRATION: The present overview of the systematic review protocol has been registered in PROSPERO (ID number 218296).