RESUMEN
This paper examines the institutional mechanisms supporting the ethical oversight of human participant research conducted by the United Nations (UN). The UN has served an instrumental role in shaping international standards on research ethics, which invariably require ethical oversight of all research studies with human participants. The authors' experiences of conducting research collaboratively with UN agencies, in contrast, have led to concern that the UN frequently sponsors, or participates in, studies with human participants that have not received appropriate ethical oversight. It is argued that the institutional mechanisms in place to prevent research with human participants from being undertaken by the UN without ethical oversight do not, at present, extend substantively beyond the provision of guidelines and online training offered by a minority of UN bodies. The WHO and UNICEF are identified as notable exceptions, having implemented various measures to prevent health research with human participants from being undertaken without ethical oversight. Yet, it is highlighted that the WHO and UNICEF are not the only UN bodies that undertake health research with human participants and there are countless actors under the umbrella of the UN system that are regularly involved in non-health research with human participants. Arguments for the pursuit of the highest standard of ethical oversight by UN bodies are presented. Moving forward, the paper asks the question: is it time for the UN to set the standards for the oversight of ethical oversight?
RESUMEN
BACKGROUND: Older people are vulnerable to sustained high levels of psychosocial distress following a crime. A cognitive behavioural therapy (CBT)-informed psychological therapy, the Victim Improvement Package (VIP) may aid recovery. The VIP trial aims to test the clinical and cost-effectiveness of the VIP for alleviating depressive and anxiety symptoms in older victims of crime. METHODS/DESIGN: People aged 65 years or more who report being a victim of crime will be screened by Metropolitan Police Service Safer Neighbourhood Teams within a month of the crime for distress using the Patient Health Questionnaire-2 and the Generalised Anxiety Disorder-2. Those who screen positive will be signposted to their GP for assistance, and re-screened at 3 months. Participants who screen positive for depression and/or anxiety at re-screening are randomised to a CBT informed VIP added to treatment as usual (TAU) compared to TAU alone. The intervention consists of 10 individual 1-h sessions, delivered weekly by therapists from the mental health charity Mind. The primary outcome measure is the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI), used as a composite measure, assessed at 6 months after the crime (post therapy) with a 9-month post-crime follow-up. Secondary outcome measures include the EQ-5D, and a modified Client Service Receipt Inventory. A total of 226 participants will be randomised VIP:TAU with a ratio 1:1, in order to detect a standardised difference of at least 0.5 between groups, using a mixed-effects linear-regression model with 90% power and a 5% significance level (adjusting for therapist clustering and potential drop-out). A cost-effectiveness analysis will incorporate intervention costs to compare overall health care costs and quality of life years between treatment arms. An embedded study will examine the impact of past trauma and engagement in safety behaviours and distress on the main outcomes. DISCUSSION: This trial should provide data on the clinical and cost-effectiveness of a CBT-informed psychological therapy for older victims of crime with anxiety and/or depressive symptoms and should demonstrate a model of integrated cross-agency working. Our findings should provide evidence for policy-makers, commissioners and clinicians responding to the needs of older victims of crime. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number, ID: ISRCTN16929670. Registered on 3 August 2016.
Asunto(s)
Ansiedad/terapia , Terapia Cognitivo-Conductual/economía , Terapia Cognitivo-Conductual/métodos , Víctimas de Crimen/psicología , Depresión/terapia , Costos de la Atención en Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Femenino , Estudios de Seguimiento , Humanos , Masculino , Calidad de Vida , Método Simple Ciego , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe help seeking behaviour from a medical doctor and antimicrobial use for common infections among rural residents of Anhui province, China. DESIGN: A cross-sectional retrospective household survey. SETTING: 12 administrative villages from rural Anhui, China. PARTICIPANTS: 2760 rural residents selected through cluster-randomised sampling using an interviewer administered questionnaire. METHOD: Logistic regression models were used to estimate associations between exposures (health insurance and antimicrobial-related knowledge), adjusted for confounders (sex, age and education), and help-seeking behaviour from a medical doctor and antimicrobial use following common infections, including acute respiratory tract infections (ARTIs), gastrointestinal tract infections (GTIs) and urinary tract infections (UTIs). RESULTS: In total 2611 (94.6%) rural residents completed the questionnaire. Help seeking from a medical doctor was highest for ARTIs (59.4%) followed by GTIs (42.1%), and UTIs (27.8%). Around two-thirds (82.3% for ARTIs, 87.0% for GTIs and 66.0% for UTIs) of respondents sought help within 3 days following symptom onset and over three quarters (88% for ARTIs, 98% for GTIs and 77% for UTIs) reported complete recovery within 7 days. Of the help-seeking respondents, 94.5% with ARTI symptoms recalled being prescribed either oral or intravenous antimicrobials (GTIs 81.7% and UTIs 70.4%). Use of antimicrobials bought from medicine shops without prescriptions ranged from 8.8% for GTIs to 17.2% for ARTIs; while use of antimicrobials leftover from previous illnesses or given by a relative ranged from 7.6% for UTIs to 13.4% for ARTIs. Multivariate logistic regression analysis revealed that respondents with a higher antimicrobial-related knowledge score and lack of insurance were associated with lower levels of help-seeking for ARTIs; while respondents with a higher antimicrobial-related knowledge score were less likely to be prescribed either oral or intravenous antimicrobials. CONCLUSIONS: Excessive antimicrobial use in the studied primary care settings is still prevalent.
Asunto(s)
Antibacterianos/uso terapéutico , Gastritis/tratamiento farmacológico , Aceptación de la Atención de Salud/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Farmacorresistencia Bacteriana , Femenino , Gastritis/epidemiología , Gastritis/microbiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Conducta en la Búsqueda de Información , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Estudios Retrospectivos , Población Rural , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología , Adulto JovenRESUMEN
BACKGROUND: Campylobacteriosis is a major public health concern. The weather factors that influence spatial and seasonal distributions are not fully understood. METHODS: To investigate the impacts of temperature and rainfall on Campylobacter infections in England and Wales, cases of Campylobacter were linked to local temperature and rainfall at laboratory postcodes in the 30 days before the specimen date. Methods for investigation included a comparative conditional incidence, wavelet, clustering, and time series analyses. RESULTS: The increase of Campylobacter infections in the late spring was significantly linked to temperature two weeks before, with an increase in conditional incidence of 0.175 cases per 100,000 per week for weeks 17 to 24; the relationship to temperature was not linear. Generalized structural time series model revealed that changes in temperature accounted for 33.3% of the expected cases of Campylobacteriosis, with an indication of the direction and relevant temperature range. Wavelet analysis showed a strong annual cycle with additional harmonics at four and six months. Cluster analysis showed three clusters of seasonality with geographic similarities representing metropolitan, rural, and other areas. CONCLUSIONS: The association of Campylobacteriosis with temperature is likely to be indirect. High-resolution spatial temporal linkage of weather parameters and cases is important in improving weather associations with infectious diseases. The primary driver of Campylobacter incidence remains to be determined; other avenues, such as insect contamination of chicken flocks through poor biosecurity should be explored.
Asunto(s)
Infecciones por Campylobacter/epidemiología , Tiempo (Meteorología) , Animales , Pollos , Inglaterra/epidemiología , Humanos , Estaciones del Año , Gales/epidemiologíaRESUMEN
BACKGROUND: To understand the impact of weather on infectious diseases, information on weather parameters at patient locations is needed, but this is not always accessible due to confidentiality or data availability. Weather parameters at nearby locations are often used as a proxy, but the accuracy of this practice is not known. METHODS: Daily Campylobacter and Cryptosporidium cases across England and Wales were linked to local temperature and rainfall at the residence postcodes of the patients and at the corresponding postcodes of the laboratory where the patient's specimen was tested. The paired values of daily rainfall and temperature for the laboratory versus residence postcodes were interpolated from weather station data, and the results were analysed for agreement using linear regression. We also assessed potential dependency of the findings on the relative geographic distance between the patient's residence and the laboratory. RESULTS: There was significant and strong agreement between the daily values of rainfall and temperature at diagnostic laboratories with the values at the patient residence postcodes for samples containing the pathogens Campylobacter or Cryptosporidium. For rainfall, the R-squared was 0.96 for the former and 0.97 for the latter, and for maximum daily temperature, the R-squared was 0.99 for both. The overall mean distance between the patient residence and the laboratory was 11.9 km; however, the distribution of these distances exhibited a heavy tail, with some rare situations where the distance between the patient residence and the laboratory was larger than 500 km. These large distances impact the distributions of the weather variable discrepancies (i.e. the differences between weather parameters estimated at patient residence postcodes and those at laboratory postcodes), with discrepancies up to ±10 °C for the minimum and maximum temperature and 20 mm for rainfall. Nevertheless, the distributions of discrepancies (estimated separately for minimum and maximum temperature and rainfall), based on the cases where the distance between the patient residence and the laboratory was within 20 km, still exhibited tails somewhat longer than the corresponding exponential fits suggesting modest small scale variations in temperature and rainfall. CONCLUSION: The findings confirm that, for the purposes of studying the relationships between meteorological variables and infectious diseases using data based on laboratory postcodes, the weather results are sufficiently similar to justify the use of laboratory postcode as a surrogate for domestic postcode. Exclusion of the small percentage of cases where there is a large distance between the residence and the laboratory could increase the precision of estimates, but there are generally strong associations between daily weather parameters at residence and laboratory.
Asunto(s)
Enfermedades Transmisibles/epidemiología , Tiempo (Meteorología) , Infecciones por Campylobacter/diagnóstico , Infecciones por Campylobacter/epidemiología , Enfermedades Transmisibles/diagnóstico , Criptosporidiosis/diagnóstico , Criptosporidiosis/epidemiología , Bases de Datos Factuales , Humanos , Laboratorios , Lluvia , Estaciones del Año , Temperatura , Gales/epidemiologíaRESUMEN
OBJECTIVES: To examine antibiotic-related knowledge and behaviors in rural Anhui, identify factors associated with knowledge, and explore the relationship between knowledge and antibiotic use. METHODS: Cross-sectional study of a random sample of 2760 residents of rural China using structured interviews. RESULTS: The response rate was 94.6%. A total of 2390 respondents (91.6%) believed that antibiotics can control viruses; 2007 (77.5%) respondents thought that a combination of antibiotics is more effective than a single class; and 590 (22.6%) were able to name at least one disbenefit of using antibiotics. Multivariate analysis revealed those with a higher educational level and younger age group had greater knowledge of antibiotics (OR 2.54 and 0.77, respectively). Self-medication was common with 1052 (out of 2274 responses, 46.3%) of participants use over the counter or leftover medicines for common infections. Greater knowledge was associated with buying drugs without prescription (aOR 2.02; 95% CI, 1.29-3.17) and using leftover medication (aOR 2.80; 95% CI, 1.55-5.06). CONCLUSION: Knowledge about antibiotics was low and reported use high. Worryingly those with greater knowledge had less desirable behaviors that highlights the urgent need for multifaceted interventions to change behavior.
Asunto(s)
Antibacterianos/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Población Rural/estadística & datos numéricos , Automedicación/estadística & datos numéricos , Adulto , Anciano , China , Estudios Transversales , Prescripciones de Medicamentos , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Encuestas y Cuestionarios/estadística & datos numéricos , Virosis/tratamiento farmacológicoRESUMEN
OBJECTIVE: To undertake a cost-utility analysis of a motivational multicomponent lifestyle-modification intervention in a community setting (the Healthy Eating Lifestyle Programme (HELP)) compared with enhanced standard care. DESIGN: Cost-utility analysis alongside a randomised controlled trial. SETTING: Community settings in Greater London, England. PARTICIPANTS: 174 young people with obesity aged 12-19 years. INTERVENTIONS: Intervention participants received 12 one-to-one sessions across 6 months, addressing lifestyle behaviours and focusing on motivation to change and self-esteem rather than weight change, delivered by trained graduate health workers in community settings. Control participants received a single 1-hour one-to-one nurse-delivered session providing didactic weight-management advice. MAIN OUTCOME MEASURES: Mean costs and quality-adjusted life years (QALYs) per participant over a 1-year period using resource use data and utility values collected during the trial. Incremental cost-effectiveness ratio (ICER) was calculated and non-parametric bootstrapping was conducted to generate a cost-effectiveness acceptability curve (CEAC). RESULTS: Mean intervention costs per participant were £918 for HELP and £68 for enhanced standard care. There were no significant differences between the two groups in mean resource use per participant for any type of healthcare contact. Adjusted costs were significantly higher in the intervention group (mean incremental costs for HELP vs enhanced standard care £1003 (95% CI £837 to £1168)). There were no differences in adjusted QALYs between groups (mean QALYs gained 0.008 (95% CI -0.031 to 0.046)). The ICER of the HELP versus enhanced standard care was £120 630 per QALY gained. The CEAC shows that the probability that HELP was cost-effective relative to the enhanced standard care was 0.002 or 0.046, at a threshold of £20 000 or £30 000 per QALY gained. CONCLUSIONS: We did not find evidence that HELP was more effective than a single educational session in improving quality of life in a sample of adolescents with obesity. HELP was associated with higher costs, mainly due to the extra costs of delivering the intervention and therefore is not cost-effective. TRIAL REGISTRATION NUMBER: ISRCTN9984011.
Asunto(s)
Análisis Costo-Beneficio , Promoción de la Salud/métodos , Estilo de Vida Saludable , Motivación , Obesidad/terapia , Años de Vida Ajustados por Calidad de Vida , Nivel de Atención , Adolescente , Adulto , Peso Corporal , Niño , Costos y Análisis de Costo , Dieta Saludable , Femenino , Educación en Salud , Promoción de la Salud/economía , Humanos , Londres , Masculino , Obesidad/psicología , Obesidad Infantil/psicología , Obesidad Infantil/terapia , Características de la Residencia , Autoimagen , Pérdida de Peso , Adulto JovenRESUMEN
OBJECTIVE: To assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England. DESIGN: Pathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data. SETTING: Data on CYP aged 2-18 years from the Health Survey for England 2006 to 2013. MAIN OUTCOME MEASURES: Clinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI ≥99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function). RESULTS: 11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13-18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management. CONCLUSIONS: There is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden.
Asunto(s)
Cirugía Bariátrica/estadística & datos numéricos , Enfermedades Cardiovasculares/prevención & control , Encuestas de Atención de la Salud , Obesidad Infantil/epidemiología , Atención Primaria de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Programas de Reducción de Peso , Adolescente , Cirugía Bariátrica/economía , Enfermedades Cardiovasculares/epidemiología , Niño , Preescolar , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Obesidad Infantil/economía , Obesidad Infantil/prevención & control , Derivación y Consulta/economía , Atención Secundaria de Salud , Factores Socioeconómicos , Programas de Reducción de Peso/economíaRESUMEN
OBJECTIVE: Approximately 7% of children and young people aged 5-15 years in the UK have obesity at a level likely to be associated with comorbidities. The majority of multicomponent lifestyle programmes have limited applicability and generalisability for British adolescents.The Healthy Eating and Lifestyle Programme (HELP) was a specific adolescent-focused intervention, designed for obese 12 to 18-year-olds seeking help to manage their weight. Participants were randomised to the 12-session HELP intervention or standard care. The primary outcome was difference in mean body mass index (BMI) (kg/m2) between groups at week 26 adjusted for baseline BMI, age and sex. SUBJECTS: 174 subjects were randomised (87 in each arm), of whom 145 (83%) provided primary outcome data at week 26. RESULTS: At week 26 there were no significant effects of the intervention on BMI (mean change in BMI 0.18 kg/m2 for the intervention arm, 0.25 kg/m2 for the control arm; adjusted difference between groups: -0.11 kg/m2 (95% CI -0.62 to 0.40), p=0.7). At weeks 26 and 52 there were no significant differences between groups in any secondary outcomes. CONCLUSION: At minimum this study reinforces the need for higher level, structured interventions to tackle the growing public health burden of obesity in the UK and internationally.The HELP intervention was no more effective than a single educational session for reducing BMI in a community sample of obese adolescents.Further work is needed to understand how weight management programmes can be delivered effectively to young people from diverse and deprived backgrounds in which childhood obesity is common. The study has significant implications in terms of informing public health interventions to tackle childhood obesity. TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN99840111.
Asunto(s)
Estilo de Vida Saludable , Entrevista Motivacional/métodos , Obesidad Infantil/prevención & control , Adolescente , Índice de Masa Corporal , Servicios de Salud Comunitaria/métodos , Femenino , Humanos , Masculino , Cooperación del Paciente , Factores de RiesgoRESUMEN
BACKGROUND: Improved data linkages between diverse environment and health datasets have the potential to provide new insights into the health impacts of environmental exposures, including complex climate change processes. Initiatives that link and explore big data in the environment and health arenas are now being established. OBJECTIVES: To encourage advances in this nascent field, this article documents the development of a web browser application to facilitate such future research, the challenges encountered to date, and how they were addressed. METHODS: A 'storyboard approach' was used to aid the initial design and development of the application. The application followed a 3-tier architecture: a spatial database server for storing and querying data, server-side code for processing and running models, and client-side browser code for user interaction and for displaying data and results. The browser was validated by reproducing previously published results from a regression analysis of time-series datasets of daily mortality, air pollution and temperature in London. RESULTS: Data visualisation and analysis options of the application are presented. The main factors that shaped the development of the browser were: accessibility, open-source software, flexibility, efficiency, user-friendliness, licensing restrictions and data confidentiality, visualisation limitations, cost-effectiveness, and sustainability. CONCLUSIONS: Creating dedicated data and analysis resources, such as the one described here, will become an increasingly vital step in improving understanding of the complex interconnections between the environment and human health and wellbeing, whilst still ensuring appropriate confidentiality safeguards. The issues raised in this paper can inform the future development of similar tools by other researchers working in this field.
Asunto(s)
Contaminación del Aire , Cambio Climático , Internet , Mortalidad , Programas Informáticos , Humanos , Londres , InvestigaciónRESUMEN
Involuntary migration is a crucially important global challenge from an economic, social, and public health perspective. The number of displaced people reached an unprecedented level in 2015, at a total of 60 million worldwide, with more than 1 million crossing into Europe in the past year alone. Migrants and refugees are often perceived to carry a higher load of infectious diseases, despite no systematic association. We propose three important contributions that the global health community can make to help address infectious disease risks and global health inequalities worldwide, with a particular focus on the refugee crisis in Europe. First, policy decisions should be based on a sound evidence base regarding health risks and burdens to health systems, rather than prejudice or unfounded fears. Second, for incoming refugees, we must focus on building inclusive, cost-effective health services to promote collective health security. Finally, alongside protracted conflicts, widening of health and socioeconomic inequalities between high-income and lower-income countries should be acknowledged as major drivers for the global refugee crisis, and fully considered in planning long-term solutions.
Asunto(s)
Patógenos Transmitidos por la Sangre , Salud Global , Política , Prejuicio/psicología , Refugiados , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Emigración e Inmigración , Etnicidad , Europa (Continente) , Disparidades en Atención de Salud , Humanos , Dinámica Poblacional , Salud Pública , MigrantesRESUMEN
BACKGOUND: Limited data suggest that crime may have a devastating impact on older people. Although identification and treatment may be beneficial, no well-designed studies have investigated the prevalence of mental disorder and the potential benefits of individual manualized CBT in older victims of crime. AIMS: To identify mental health problems in older victims of common crime, provide preliminary data on its prevalence, and conduct a feasibility randomized controlled trial (RCT) using mixed methods. METHOD: Older victims, identified through police teams, were screened for symptoms of anxiety, depression or post-traumatic stress disorder (PTSD) one (n = 581) and 3 months (n = 486) after experiencing a crime. Screen positive participants were offered diagnostic interviews. Of these, 26 participants with DSM-IV diagnoses agreed to be randomized to Treatment As Usual (TAU) or TAU plus our manualized CBT informed Victim Improvement Package (VIP). The latter provided feedback on the VIP. RESULTS: Recruitment, assessment and intervention are feasible and acceptable. At 3 months 120/486 screened as cases, 33 had DSM-IV criteria for a psychiatric disorder; 26 agreed to be randomized to a pilot trial. There were trends in favour of the VIP in all measures except PTSD at 6 months post crime. CONCLUSIONS: This feasibility RCT is the first step towards improving the lives of older victims of common crime. Without intervention, distress at 3 and 6 months after a crime remains high. However, the well-received VIP appeared promising for depressive and anxiety symptoms, but possibly not posttraumatic stress disorder.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Víctimas de Crimen/psicología , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Crimen/estadística & datos numéricos , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/etiología , Persona de Mediana Edad , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Reino Unido/epidemiologíaRESUMEN
The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains-responsible use, surveillance, and infection prevention and control-and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions.
Asunto(s)
Farmacorresistencia Bacteriana , Política de Salud , Crianza de Animales Domésticos/métodos , Animales , Antibacterianos/uso terapéutico , Atención a la Salud/organización & administración , Atención a la Salud/normas , Medicina Basada en la Evidencia , Reforma de la Atención de Salud , Promoción de la Salud , Humanos , Control de Infecciones/métodos , Evaluación de Programas y Proyectos de SaludRESUMEN
BACKGROUND: Adiposity in childhood is associated with later cardiovascular disease (CVD), but it is unclear whether this relationship is independent of other risk factors experienced in later life, such as smoking and hypertension. Carotid-intima media thickness (cIMT) is a measure of subclinical atherosclerosis that may be used to assess CVD risk in young people. The aim of this study was to examine the relationship between adiposity and cIMT in children and adolescents. METHODS: We searched Medline, Embase, Global Health, and CINAHL Plus electronic databases (1980-2014). Population-based observational studies that reported a measure of association between objectively-measured adiposity and cIMT in childhood were included in this review. RESULTS: Twenty-two cross-sectional studies were included (n = 7,366 children and adolescents). Thirteen of nineteen studies conducted in adolescent populations (mean age ≥ 12 years, n = 5,986) reported positive associations between cIMT and adiposity measures (correlation coefficients 0.13 to 0.59). Three studies of pre-adolescent populations (n = 1,380) reported mixed evidence, two studies finding no evidence of a correlation, and one an inverse relationship between skinfolds and cIMT. Included studies did not report an adiposity threshold for subclinical atherosclerosis. CONCLUSIONS: Based on studies conducted mostly in Western Europe and the US, adiposity does not appear to be associated with cIMT in pre-adolescents, but may be associated in adolescents. If further studies confirm these findings, a focus on cardiovascular disease prevention efforts in pre-adolescence, before arterial changes have emerged, may be justified.
Asunto(s)
Adiposidad/fisiología , Aterosclerosis , Índice de Masa Corporal , Grosor Intima-Media Carotídeo , Adolescente , Aterosclerosis/diagnóstico , Aterosclerosis/epidemiología , Aterosclerosis/etiología , Salud Global , Humanos , Morbilidad/tendencias , Factores de RiesgoRESUMEN
OBJECTIVE: To explore the acceptability of implementing an online tool for the assessment and management of childhood obesity (Computer-Assisted Treatment of CHildren, CATCH) in primary care. DESIGN AND SETTING: An uncontrolled pilot study with integral process evaluation conducted at three general practices in northwest London, UK (November 2012-April 2013). PARTICIPANTS: Families with concerns about excess weight in a child aged 5-18 years (n=14 children). INTERVENTION: Families had a consultation with a doctor or nurse using CATCH, which assessed child weight status, cardiometabolic risk and risk of emotional and behavioural difficulties and provided personalised lifestyle advice. Families and practitioners completed questionnaires to assess the acceptability and usefulness of the consultation, and participated in semistructured interviews which explored user experiences. OUTCOME MEASURES: The primary outcome was family satisfaction with the tool-assisted consultation. Secondary outcomes were practitioners' satisfaction, and acceptability and usefulness of the intervention to families and practitioners. RESULTS: The majority of families (86%, n=12) and all practitioners (n=4) were satisfied with the consultation. Participants reported that the tool was easy to use, the personalised lifestyle advice useful and the use of visual aids beneficial. Families and practitioners identified a need for practical, structured support for weight management following the consultation. CONCLUSIONS: The results of this pilot study indicate that an online tool for assessment and management of childhood obesity can be implemented in primary care, and is acceptable to patients, families and practitioners. Further development and evaluation of the tool is warranted.
Asunto(s)
Internet , Obesidad Infantil/terapia , Atención Primaria de Salud , Evaluación de Programas y Proyectos de Salud/métodos , Derivación y Consulta , Adolescente , Niño , Preescolar , Femenino , Humanos , Entrevistas como Asunto , Estilo de Vida , Londres , Masculino , Sobrepeso/terapia , Aceptación de la Atención de Salud , Satisfacción del Paciente , Proyectos Piloto , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Overweight children are at an increased risk of premature mortality and disease in adulthood. Parental perceptions and clinical definitions of child obesity differ, which may lessen the effectiveness of interventions to address obesity in the home setting. The extent to which parental and objective weight status cut-offs diverge has not been documented. AIM: To compare parental perceived and objectively derived assessment of underweight, healthy weight, and overweight in English children, and to identify sociodemographic characteristics that predict parental under- or overestimation of a child's weight status. DESIGN AND SETTING: Cross-sectional questionnaire completed by parents linked with objective measurement of height and weight by school nurses, in English children from five regions aged 4-5 and 10-11 years old. METHOD: Parental derived cut-offs for under- and overweight were derived from a multinomial model of parental classification of their own child's weight status against school nurse measured body mass index (BMI) centile. RESULTS: Measured BMI centile was matched with parent classification of weight status in 2976 children. Parents become more likely to classify their children as underweight when they are at the 0.8th centile or below, and overweight at the 99.7th centile or above. Parents were more likely to underestimate a child's weight if the child was black or South Asian, male, more deprived, or the child was older. These values differ greatly from the BMI centile cut-offs for underweight (2nd centile) and overweight (85th). CONCLUSION: Clinical and parental classifications of obesity are divergent at extremes of the weight spectrum.
Asunto(s)
Padres/psicología , Obesidad Infantil , Servicios de Salud Escolar/estadística & datos numéricos , Índice de Masa Corporal , Niño , Preescolar , Estudios Transversales , Demografía , Inglaterra/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Masculino , Obesidad Infantil/diagnóstico , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & control , Obesidad Infantil/psicología , Percepción Social , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Rapid international spread of emerging infections has increased interest in strategic collaborations, as they may be the best way to protect populations. Strategic collaborations can build capacity in less-resourced settings. As specialised institutions that provide a stable locus of expertise, continuity of experience, scientific knowledge, and appropriate human, technical, and financial resources, national public health institutes (NPHIs) are well-prepared to tackle public health challenges. We describe how a collaboration between the NPHIs of England and South Africa built a mutually beneficial professional relationship to help implement the WHO International Health Regulations, build capacity for health protection, and promote the exchange of information, advice, and expertise. We illustrate how this can be achieved in a mutually beneficial way.
Asunto(s)
Salud Global , Relaciones Interinstitucionales , Cooperación Internacional , Administración en Salud Pública , Creación de Capacidad , Conducta Cooperativa , Inglaterra , Epidemiología/organización & administración , Humanos , Vigilancia en Salud Pública , SudáfricaAsunto(s)
Salud Pública , Adolescente , Servicios de Salud del Adolescente/organización & administración , Inglaterra , Ambiente , Conductas Relacionadas con la Salud , Disparidades en el Estado de Salud , Fuerza Laboral en Salud/organización & administración , Humanos , Determinantes Sociales de la SaludAsunto(s)
Personal de Salud/ética , Derechos Humanos , Personal Militar , Prisiones/ética , Humanos , Estados UnidosRESUMEN
BACKGROUND: Small-scale evaluations suggest that the provision of feedback to parents about their child's weight status may improve recognition of overweight, but the effects on lifestyle behaviour are unclear and there are concerns that informing parents that their child is overweight may have harmful effects. The aims of this study were to describe the benefits and harms of providing weight feedback to parents as part of a national school-based weight-screening programme in England. METHODS: We conducted a pre-post survey of 1,844 parents of children aged 4-5 and 10-11 years who received weight feedback as part of the 2010-2011 National Child Measurement Programme. Questionnaires assessed general knowledge about the health risks associated with child overweight, parental recognition of overweight and the associated health risks in their child, child lifestyle behaviour, child self-esteem and weight-related teasing, parental experience of the feedback, and parental help-seeking behaviour. Differences in the pre-post proportions of parents reporting each outcome were assessed using a McNemar's test. RESULTS: General knowledge about child overweight as a health issue was high at baseline and increased further after weight feedback. After feedback, the proportion of parents that correctly recognised their child was overweight increased from 21.9% to 37.7%, and more than a third of parents of overweight children sought further information regarding their child's weight. However, parent-reported changes in lifestyle behaviours among children were minimal, and limited to increases in physical activity in the obese children only. There was some suggestion that weight feedback had a greater impact upon changing parental recognition of the health risks associated with child overweight in non-white ethnic groups. CONCLUSIONS: In this population-based sample of parents of children participating in the National Child Measurement Programme, provision of weight feedback increased recognition of child overweight and encouraged some parents to seek help, without causing obvious unfavourable effects. The impact of weight feedback on behaviour change was limited; suggesting that further work is needed to identify ways to more effectively communicate health information to parents and to identify what information and support may encourage parents in making and maintaining lifestyle changes for their child.