Explore the vast range of titles available.

Introducción: Dado que el sobrepeso y la obesidad en la población adolescente van en aumento, es necesario identificar las intervenciones para la prevención y manejo de estas condiciones en el grupo de jóvenes. Objetivo: Presentar la evidencia encontrada, en relación con las características de las intervenciones publicadas en revistas científicas indexadas, sobre la prevención y manejo del sobrepeso y de la obesidad, respecto de la nutrición y la actividad física, para ser utilizada en la toma de decisiones, en cuanto a políticas y programas de promoción y prevención de esta condición de salud. Materiales y Métodos: Se realizó la revisión sistemática de estudios cualitativos y cuantitativos (desde descriptivos hasta experimentales, que incluyeran tanto revisiones sistemáticas como meta-análisis), publicados en el período comprendido entre 2005 y 2017, a través de las bases de datos PubMed y ScienceDirect, las bibliotecas virtuales Ovid y SciELO, y el compendio de revisiones Cochrane. Resultados: Existe gran variedad en diseño e implementación de las intervenciones, en cuanto a componentes, teorías, escenarios, evaluación de los efectos, dosis, tiempo y seguimiento, que tienen efecto en los hábitos nutricionales, en la actividad física, en la autoeficacia y en el índice de masa corporal (IMC) de la población estudiada. Discusión: La efectividad de las intervenciones varía, dependiendo de los componentes y de la fidelidad en la aplicación de la misma, lo cual debe revisarse a la luz de los mejores efectos encontrados. Conclusiones: 47 estudios cumplieron los requisitos de inclusión. Las intervenciones se robustecen con el uso de una teoría que direccione y fundamente los hallazgos que permitan dar mayores y mejores resultados. Los componentes de las intervenciones incluyen: duración, dosis, intensidad de la intervención, respuesta y seguimiento. Los adolescentes prefieren metodologías participativas e interactivas; sin embargo, aún no existe una intervención concreta y claramente definida que pueda ser estandarizada para enfrentar este problema de salud

Perioperative goal-directed therapy is considered to improve patient outcomes after high-risk surgery. The association of compliance with perioperative goal-directed therapy protocols and postoperative outcomes is unclear. The purpose of this study is to determine the effect of protocol compliance on postoperative outcomes following high-risk surgery, after implementation of a perioperative goal-directed therapy protocol. Through a before-after study design, patients undergoing elective high-risk surgery before (before-group) and after implementation of a perioperative goal-directed therapy protocol (after-group) were included. Perioperative goal-directed therapy in the after-group consisted of optimized stroke volume variation or stroke volume index and optimized cardiac index. Additionally, the association of protocol compliance with postoperative complications when using perioperative goal-directed therapy was assessed. High protocol compliance was defined as ≥ 85% of the procedure time spent within the individual targets. The difference in complications during the first 30 postoperative days before and after implementation of the protocol was assessed. In the before-group, 214 patients were included and 193 patients in the after-group. The number of complications was higher in the before-group compared to the after-group (n = 414 vs. 282; p = 0.031). In the after-group, patients with high protocol compliance for stroke volume variation or stroke volume index had less complications compared to patients with low protocol compliance for stroke volume variation or stroke volume index (n = 187 vs. 90; p = 0.01). Protocol compliance by the attending clinicians is essential and should be monitored to facilitate an improvement in postoperative outcomes desired by the implementation of perioperative goal-directed therapy protocols.

ObjectivesTo evaluate the impact of radiographic examination on changes of treatment decision related to dental caries compared to decisions guided by visual inspection alone in primary molars.Materials and methodsA total of 126 children aged 3–6 years who had sought dental assistance were randomly selected and examined by two calibrated examiners using visual inspection. A treatment plan regarding dental caries was generated based on this assessment. The same examiners then evaluated two bitewing radiographs, creating an additional treatment plan guided by concurrent assessment of both visual and radiographic methods. Occlusal and proximal surfaces of primary molars received a treatment decision as follows: (i) no treatment, (ii) non-operative treatment, and (iii) operative treatment. The frequency of changes in the treatment decision after radiographic examination was calculated, with subsequent Poisson multilevel regression analysis to evaluate variables influencing such changes.ResultsChanges from “no treatment” decided with visual inspection to “non-operative treatment” after radiographic evaluation occurred in 52 surfaces (3.2%), and changes to “operative treatment” were observed in 46 dental surfaces (2.8%). Furthermore, 50 surfaces (6.2%) had their treatment decision changed from non-operative to operative treatment after radiographic assessment. In addition, changes were significantly more frequent in children with higher caries experience, on proximal surfaces and in 1st primary molars.ConclusionsThe impact of radiographic examination on changes in the treatment decision of primary molars made with visual inspection is modest. Changes are more frequent in children with higher caries experience and in proximal surfaces.Clinical relevanceThe benefits of the radiographic method for detecting caries in children, as a protocol in the diagnostic process, seem to be overestimated; the impact of this method on changes in treatment decision made by visual examination alone is low. Radiographs could be, however, useful in particular conditions, such as in children with high caries experience.

Background To improve transmural palliative care for older adults acutely admitted to hospital, the PalliSupport intervention, comprising an educational programme and transmural palliative care pathway, was developed. This care pathway involves timely identification of palliative care needs, advance care planning, multidisciplinary team meetings, warm handover, and follow-up home visits. With this study, we evaluate changes in patient-related outcomes and transmural collaboration after implementation of the care pathway. Methods We conducted a before-after study, in which we compared 1) unplanned hospital admission and death at place of preference and 2) transmural collaboration before implementation, up to six months, and six to 18 months after implementation. Data from palliative care team consultations were collected between February 2017 and February 2020 in a teaching hospital in the Netherlands. Results The palliative care team held 711 first-time consultations. The number of consultation, as well as the number of consultations for patients with non-malignant diseases, and consultations for advance care planning increased after implementation. The implementation of the pathway had no statistically significant effect on unplanned hospitalization but associated positively with death at place of preference more than six months after implementation (during/shortly after adjusted OR: 2.12; 95% CI: 0.84–5.35; p-value: 0.11, long term after adjusted OR: 3.14; 95% CI: 1.49–6.62; p-value: 0.003). Effects on transmural collaboration showed that there were more warm handovers during/shortly after implementation, but not on long term. Primary care professionals attended multidisciplinary team meetings more often during and shortly after implementation, but did not more than six months after implementation. Conclusions The pathway did not affect unplanned hospital admissions, but more patients died at their place of preference after implementation. Implementation of the pathway increased attention to- and awareness for in-hospital palliative care, but did not improve transmural collaboration on long-term. For some patients, the hospital admissions might helped in facilitating death at place of preference.

Background In 2015, Mozambique piloted a new model of long-lasting insecticidal nets (LLINs) delivery in a campaign. The new delivery model was used in two rural districts were, and two others were considered as control, maintaining the old delivery model. The aim of this study is to compare the coverage of ownership and use of LLINs in intervention and control districts in Mozambique. Methods A before-after design with control group was carried out 6 months after LLINs distribution. Using systematic probabilistic sampling, 1547 households were surveyed by means of a questionnaire. To find associations between the district categories (intervention and control) and the main outcomes of the study (LLIN ownership, use, and universal coverage achievement), odds ratio (OR) and respective confidence intervals were calculated. Results Of the 760 households surveyed in the intervention districts, 98.8% had at least one LLIN; of the 787 households surveyed in the control districts, 89.6% had at least one LLIN [OR: 9.7, 95% (CI 4.84–19.46)]. Around 95 and 87% of households owning at least one LLIN reported having slept under the LLIN the previous night in the intervention and control districts, respectively [OR: 3.2; 95% (CI 2.12–4.69)]. Seventy-one percent of the households surveyed achieved universal coverage in the intervention districts against 59.6% in the control districts [OR: 1.6; 95% (CI 1.33–2.03)]. Conclusions The universal coverage campaign piloted with the new delivery model has increased LLINs ownership, use, and progression for reaching universal coverage targets in the community.

Background Chronic diseases are becoming more common due to an increasing ageing population. Patients with chronic conditions managed in outpatient clinics account for a large share of healthcare costs. We developed a 24-h access outpatient clinic offering 24-h telephone support and triaged access to the hospital for patients with acute exacerbation of four selected chronic diseases. The aim of this study was to conduct a 1-year before-after study of the acute healthcare utilisation in patients offered the 24-h access outpatient clinic intervention. Methods The study was conducted as an observational register-based cohort study. Data from the patient administrative register and the Danish National Health Service Register were extracted 12 months before and 12 months after implementation of the 24-h access intervention. Patients with chronic obstructive pulmonary disease, chronic liver disease, inflammatory bowel disease and heart failure managed in hospital outpatient clinics were enrolled in the study. Differences in healthcare utilisation were analysed for all patients, including the subgroup of high-risk patients with at least one acute admission in the year before enrolment. Results Length-of-stay remained unchanged for all diagnostic groups, except for patients with heart failure in whom a statistically significant reduction was observed. Statistically significant reductions of length of stay and acute admissions were observed in all high-risk groups, except for patients with chronic liver disease. A statistically significant reduction in the number of contacts to out-of-hours primary care was seen in patients with chronic obstructive pulmonary disease, whereas the level remained unchanged in the other diagnostic groups. Similar patterns were also seen in high-risk patients. Conclusions The 24-h access outpatient clinic did not increase the use of acute healthcare services inpatients with chronic disease. Significant reductions in hospital utilisation were seen in high-risk patients. These preliminary results should be interpreted with caution due to the observational before-after design of the study.

Monitoring the impacts of anthropogenic threats and interventions to mitigate these threats is key to understanding how to best conserve biodiversity. Ecologists use many different study designs to monitor such impacts. Simpler designs lacking controls (e.g. Before–After (BA) and After) or pre‐impact data (e.g. Control–Impact (CI)) are considered to be less robust than more complex designs (e.g. Before–After Control‐Impact (BACI) or Randomized Controlled Trials (RCTs)). However, we lack quantitative estimates of how much less accurate simpler study designs are in ecology. Understanding this could help prioritize research and weight studies by their design's accuracy in meta‐analysis and evidence assessment. We compared how accurately five study designs estimated the true effect of a simulated environmental impact that caused a step‐change response in a population's density. We derived empirical estimates of several simulation parameters from 47 ecological datasets to ensure our simulations were realistic. We measured design performance by determining the percentage of simulations where: (a) the true effect fell within the 95% Confidence Intervals of effect size estimates, and (b) each design correctly estimated the true effect's direction and magnitude. We also considered how sample size affected their performance. We demonstrated that BACI designs performed: 1.3–1.8 times better than RCTs; 2.9–4.2 times versus BA; 3.2–4.6 times versus CI; and 7.1–10.1 times versus After designs (depending on sample size), when correctly estimating true effect's direction and magnitude to within ±30%. Although BACI designs suffered from low power at small sample sizes, they outperformed other designs for almost all performance measures. Increasing sample size improved BACI design accuracy, but only increased the precision of simpler designs around biased estimates. Synthesis and applications. We suggest that more investment in more robust designs is needed in ecology since inferences from simpler designs, even with large sample sizes may be misleading. Facilitating this requires longer‐term funding and stronger research–practice partnerships. We also propose ‘accuracy weights’ and demonstrate how they can weight studies in three recent meta‐analyses by accounting for study design and sample size. We hope these help decision‐makers and meta‐analysts better account for study design when assessing evidence. Foreign Language Japanese 生物多様性の保全を効果的に行うためには、人為的脅威の影響や保全対策の効果を適切に評価することが重要となる。生態学ではこのような評価を行うために、様々な研究デザインが用いられている。対照区が存在しないBefore‐After (BA)デザインやAfterデザイン、また処理以前のデータが存在しないControl‐Impact (CI)デザインなど簡素な研究デザインは、Before‐After Control‐Impact (BACI)デザインやランダム化比較試験（RCTs: Randomized Controlled Trials)などの複雑なデザインよりも頑健さに劣ると考えられている。しかしながら、生態学においてこれら簡素な研究デザインがどれだけ正確度に劣るのか、定量的な評価はこれまで行われていない。研究デザインの正確度を定量的に評価することで、メタ解析やエビデンスの評価を行う際に、用いられた研究デザインの正確度に基づいて各研究の優先順位付けや重み付けを行うことが可能になるだろう。 本研究では、環境変化が個体群密度に及ぼす影響を、5種類の研究デザインがどれだけ正確に推定することができるのか、シミュレーションを用いて検討した。より現実に即した状況を再現するため、シミュレーションで用いたパラメータは、47の生態学的データから抽出した。各研究デザインの正確度は、シミュレーションにおいて、（１）推定された効果サイズの95％信頼区間に真の効果が含まれる割合、（２）推定された効果が真の効果の方向・程度と一致した割合、を算出することによって評価した。またサンプルサイズの違いが各研究デザインの正確度に及ぼす影響も検討した。 シミュレーションの結果、BACIデザインはランダム化比較試験に対して1.3–1.8倍、BAデザインに対して2.9–4.2倍、CIデザインに対して3.2–4.6倍、Afterデザインに比較すると7.1–10.1倍も正確に真の効果を推定できる（推定された効果が真の効果の方向と一致し、且つ真の効果の ± 30%内に含まれる）ことが明らかになった（比較値のばらつきはサンプルサイズによる）。BACIデザインの正確度はサンプルサイズが小さい場合には低下したが、それでもほとんどの指標において他のデザインよりも高い正確度を示していた。サンプルサイズを増やすことでBACIデザインの正確度は向上したが、他の研究デザインでは偏った推定値の精度が向上するだけであった。 Synthesis and applications. 例えサンプルサイズが十分であったとしても、簡素なデザインに基づいた推論は正確でない可能性があるため、生態学においてもより頑健な研究デザインの利用を推進していく必要があると考えられる。頑健な研究デザインの利用を推進するためには、長期に渡る研究資金の確保や、研究と実践の間でのより強固な連携が必要となるだろう。本研究では更にこれらの結果に基づいて、メタ解析において研究デザインとサンプルサイズに基づいて各研究の重み付けをする手法を提案し、近年行われた３つのメタ解析を用いてその実用例を提示した。これらの結果は、意思決定者やメタ解析を行う研究者が、研究デザインを考慮したエビデンスの評価を行うために有用となるだろう。 We suggest that more investment in more robust designs is needed in ecology since inferences from simpler designs, even with large sample sizes may be misleading. Facilitating this requires longer‐term funding and stronger research–practice partnerships. We also propose ‘accuracy weights’ and demonstrate how they can weight studies in three recent meta‐analyses by accounting for study design and sample size. We hope these help decision‐makers and meta‐analysts better account for study design when assessing evidence.

Objective To assess the efficiency and the mechanism of fractional erbium:yttrium aluminum garnet (Er:YAG) laser for the treatment of morphea in mouse model. Background Morphea is a rare autoimmune disease characterized by excessive collagen deposition in skin. Fractional Er:YAG laser treatment is a promising treatment to improve morphea, despite limited studies about the therapeutic effect and underlying mechanism. Methods The mouse model of morphea was established by subcutaneously injecting with bleomycin (BLM). A total of 24 mice received fractional Er:YAG laser treatment once a week for 4 weeks. Objective measurement employed was ultrasonic imaging to measure dermal thickness. Subjective measures included scoring according to the adjusted Localized morphea Cutaneous Assessment Tool (LoSCAT); hematoxylin and eosin (H&E) staining to evaluate the histological grade of fibrosis; and quantitative morphometric studies to determine the expression of transforming growth factor‐β1 (TGF‐β1) and matrix metalloproteinase‐1 (MMP1) by immunohistochemistry. Results In this self‐controlled study, fractional Er:YAG laser treatment significantly ameliorate the severity of morphea, including lower clinical score (p < 0.01), decreased dermal thickness (p < 0.001), declined histological grade of fibrosis (p < 0.001), increased MMP1 (p < 0.001), and reduced TGF‐β1 (p < 0.01) expression. Conclusions We found that fractional Er:YAG laser treatment of morphea has good clinical, ultrasonic, and histopathologic efficacy, which may be a promising treatment in the future.

Comorbid depression and depressive symptoms are common in patients with chronic low back pain (CLBP). Duloxetine is clinically effective in major depressive disorder and several chronic pain states, including CLBP. The objective of this post hoc meta-analysis was to assess direct and indirect analgesic efficacy of duloxetine for patients with CLBP in previous clinical trials. Post hoc path analyses were conducted of 3 randomized, double-blind, clinical studies of patients receiving duloxetine or placebo for CLBP. The primary outcome measure for pain was the Brief Pain Inventory, average pain score. A secondary outcome measure, the Beck Depression Inventory-II, was used for depressive symptoms. The changes in score from baseline to endpoint were determined for each index. Path analyses were employed to calculate the proportion of analgesia that may be attributed to a direct effect of duloxetine on pain. A total of 851 patients (400 duloxetine and 451 placebo) were included in this analysis. Duloxetine significantly improved pain scores compared with placebo ( <0.001). It also significantly improved depressive scores compared with placebo ( =0.015). Path analyses showed that 91.1% of the analgesic effect of duloxetine could be attributed to a direct analgesic effect, and 8.9% to its antidepressant effect. Similar results were obtained when data were evaluated at weeks 4 and 7, and when patients were randomized to subgroups based on baseline pain scores, baseline depressive symptoms scores, and gender. Duloxetine significantly improved pain in patients with CLBP. Path analyses results suggest that duloxetine produced analgesia mainly through mechanisms directly impacting pain modulation rather than lifting depressive symptoms. This effect was consistent across all subgroups tested.