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Public Health Nutrition May 2015Adherence to a Mediterranean diet is associated with significant improvements in health status. However, to date no systematic review and meta-analysis has summarized... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Adherence to a Mediterranean diet is associated with significant improvements in health status. However, to date no systematic review and meta-analysis has summarized the effects of Mediterranean diet adherence on the risk of type 2 diabetes mellitus.
DESIGN
Electronic searches for randomized controlled trials and cohort studies were performed in MEDLINE, SCOPUS, EMBASE and the Cochrane Trial Register until 2 April 2014. Pooled effects were calculated by an inverse-variance random-effect meta-analysis using the statistical software Review Manager 5.2 by the Cochrane Collaboration.
SETTING
Meta-analysis of randomized controlled trials and cohort studies.
ELIGIBILITY CRITERIA
19+years of age.
RESULTS
One randomized controlled trial and eight prospective cohort studies (122 810 subjects) published between 2007 and 2014 were included for meta-analysis. For highest v. lowest adherence to the Mediterranean diet score, the pooled risk ratio was 0.81 (95 % CI 0.73, 0.90, P<0.0001, I 2=55 %). Sensitivity analysis including only long-term studies confirmed the results of the primary analysis (pooled risk ratio=0.75; 95 % CI 0.68, 0.83, P<0.00001, I 2=0 %). The Egger regression test provided no evidence of substantial publication bias (P=0.254).
CONCLUSIONS
Greater adherence to a Mediterranean diet is associated with a significant reduction in the risk of diabetes (19 %; moderate quality evidence). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of type 2 diabetes mellitus.
Topics: Cohort Studies; Diabetes Mellitus, Type 2; Diet, Mediterranean; Evidence-Based Medicine; Humans; Middle Aged; Nutrition Policy; Patient Compliance; Randomized Controlled Trials as Topic; Risk
PubMed: 25145972
DOI: 10.1017/S1368980014001542 -
Preventing Chronic Disease Jan 2016Health disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the... (Review)
Review
INTRODUCTION
Health disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity-related policy and environmental strategies for obesity prevention in rural communities.
METHODS
A literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity-related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers.
RESULTS
Of 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were "enhance infrastructure supporting walking" (n = 11) and "increase opportunities for extracurricular physical activity" (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes.
CONCLUSION
Seven of the 12 COCOMO physical activity-related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities.
Topics: Exercise; Humans; Obesity; Public Policy; Rural Population; United States
PubMed: 26741997
DOI: 10.5888/pcd13.150406 -
Bulletin of the World Health... Dec 2017To systematically review published studies of interventions to reduce people's intake of dietary trans-fatty acids (TFAs). (Review)
Review
OBJECTIVE
To systematically review published studies of interventions to reduce people's intake of dietary trans-fatty acids (TFAs).
METHODS
We searched online databases (CINAHL, the CRD Wider Public Health database, Cochrane Database of Systematic Reviews, Ovid®, MEDLINE®, Science Citation Index and Scopus) for studies evaluating TFA interventions between 1986 and 2017. Absolute decrease in TFA consumption (g/day) was the main outcome measure. We excluded studies reporting only on the TFA content in food products without a link to intake. We included trials, observational studies, meta-analyses and modelling studies. We conducted a narrative synthesis to interpret the data, grouping studies on a continuum ranging from interventions targeting individuals to population-wide, structural changes.
RESULTS
After screening 1084 candidate papers, we included 23 papers: 12 empirical and 11 modelling studies. Multiple interventions in Denmark achieved a reduction in TFA consumption from 4.5 g/day in 1976 to 1.5 g/day in 1995 and then virtual elimination after legislation banning TFAs in manufactured food in 2004. Elsewhere, regulations mandating reformulation of food reduced TFA content by about 2.4 g/day. Worksite interventions achieved reductions averaging 1.2 g/day. Food labelling and individual dietary counselling both showed reductions of around 0.8 g/day.
CONCLUSION
Multicomponent interventions including legislation to eliminate TFAs from food products were the most effective strategy. Reformulation of food products and other multicomponent interventions also achieved useful reductions in TFA intake. By contrast, interventions targeted at individuals consistently achieved smaller reductions. Future prevention strategies should consider this effectiveness hierarchy to achieve the largest reductions in TFA consumption.
Topics: Animals; Diet; Dietary Fats; Female; Food Labeling; Humans; Marketing; Nutrition Policy; Trans Fatty Acids
PubMed: 29200523
DOI: 10.2471/BLT.16.189795 -
AIDS and Behavior Dec 2017One of the four national HIV prevention goals is to incorporate combinations of effective, evidence-based approaches to prevent HIV infection. In fields of public... (Review)
Review
One of the four national HIV prevention goals is to incorporate combinations of effective, evidence-based approaches to prevent HIV infection. In fields of public health, techniques that alter environment and affect choice options are effective. Structural approaches may be effective in preventing HIV infection. Existing frameworks for structural interventions were lacking in breadth and/or depth. We conducted a systematic review and searched CDC's HIV/AIDS Prevention Research Synthesis Project's database for relevant interventions during 1988-2013. We used an iterative process to develop the taxonomy. We identified 213 structural interventions: Access (65%), Policy/Procedure (32%), Mass Media (29%), Physical Structure (27%), Capacity Building (24%), Community Mobilization (9%), and Social Determinants of Health (8%). Forty percent targeted high-risk populations (e.g., people who inject drugs [12%]). This paper describes a comprehensive, well-defined taxonomy of structural interventions with 7 categories and 20 subcategories. The taxonomy accommodated all interventions identified.
Topics: Capacity Building; Centers for Disease Control and Prevention, U.S.; HIV Infections; Health Policy; Humans; Public Health; Social Determinants of Health; United States
PubMed: 29159594
DOI: 10.1007/s10461-017-1965-5 -
British Journal of Sports Medicine Jun 2018Interventions to promote walking have focused on individual or group-based approaches, often via the randomised controlled trial design. Walking can also be promoted... (Review)
Review
OBJECTIVE
Interventions to promote walking have focused on individual or group-based approaches, often via the randomised controlled trial design. Walking can also be promoted using population health approaches. We systematically reviewed the effectiveness of population approaches to promote walking among individuals and populations.
DESIGN
A systematic review.
DATA SOURCES
10 electronic databases searched from January 1990 to March 2017.
ELIGIBILITY CRITERIA
Eligibility criteria include pre-experimental and postexperimental studies of the effects of population interventions to change walking, and the effects must have been compared with a 'no intervention', or comparison group/area/population, or variation in exposure; duration of ≥12 months of follow up; participants in free-living populations; and English-language articles.
RESULTS
12 studies were identified from mostly urban high-income countries (one focusing on using tax, incentivising the loss of parking spaces; and one using policy only, permitting off-leash dogs in city parks). Five studies used mass media with either environment (n=2) or community (n=3) approaches. Four studies used environmental changes that were combined with policies. One study had scaled up school-based approaches to promote safe routes to schools. We found mass media, community initiatives and environmental change approaches increased walking (range from 9 to 75 min/week).
Topics: Environment; Health Policy; Health Promotion; Humans; Mass Media; Motivation; Program Evaluation; Public Health; Schools; Walking
PubMed: 29858468
DOI: 10.1136/bjsports-2017-098953 -
Health Research Policy and Systems Mar 2015Burden of disease (BoD) studies have been conducted in numerous international settings since the early 1990's. Two national BoD studies have been undertaken in... (Review)
Review
BACKGROUND
Burden of disease (BoD) studies have been conducted in numerous international settings since the early 1990's. Two national BoD studies have been undertaken in Australia, in 1998 and 2003, although neither study estimated the BoD specifically for Indigenous Australians. In 2005 the Australian Government Department of Health and Ageing Office for Aboriginal and Torres Strait Islander Health formally commissioned the University of Queensland to undertake, in parallel with the second national BoD study, the "Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples" study, drawing on available data up to 2003. This paper aims to explore the policy context and narrative in the lead up to commissioning the Indigenous BoD (IBoD) study, focusing on relevant contextual factors and insights regarding the perspectives of key stakeholders and their anticipated value of the study. It is part of a broader project that examines the uptake of evidence to policy, using the IBoD study as a case study.
METHODS
A systematic review of the literature was undertaken in late 2013 and early 2014, and the findings triangulated with 38 key informant interviews with Indigenous and non-Indigenous academics, researchers, statisticians, policy advisors, and policymakers, conducted between 2011 and 2013.
FINDINGS
Contextual features which led to commissioning the IBoD study included widespread recognition of longstanding Indigenous disadvantage, lower life expectancy than non-Indigenous Australians, and the lack of an adequate evidence base upon which to determine priorities for interventions. Several anticipated benefits and expectations of key stakeholders were identified. Most informants held at least one of the following expectations of the study: that it would inform the evidence base, contribute to priority setting, and/or inform policy. There were differing or entirely contrasting views to this however, with some sharing concerns about the study being undertaken at all.
CONCLUSIONS
The IBoD study, in concept, offered the potential to generate much desired 'answers', in the form of a quantified ranking of health risks and disease burden, and it was hoped by many that the results of the study would feed into determining priorities and informing Indigenous health policy.
Topics: Australia; Cost of Illness; Health Policy; Humans; Interviews as Topic; Native Hawaiian or Other Pacific Islander; Research
PubMed: 25890380
DOI: 10.1186/s12961-015-0004-0 -
International Journal of Environmental... Jan 2022Active ageing is defined as the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. The design...
Active ageing is defined as the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. The design of active ageing policies intersects with different overarching societal challenges, especially ageing populations, social rights and sustainability. However, there are no previous attempts to review active ageing policies in the light of these challenges and the international policy objectives and targets that are guiding the international community. The aim of this study is to systematically identify, review and analyse all national and regional policies on active ageing adopted in Italy, by applying a conceptual framework derived from main international policy initiatives in the three areas. The research was conducted in two stages. First, a case study analysis was carried out per each relevant national institution and regional government. Standardised interviews were combined with policy document search, selection and analysis. Second, we performed a policy analysis in the light of a conceptual framework adopted. This latter was composed by nine policy domains, selected and integrated from principles and objectives of three overarching international frameworks on ageing-i.e., the Regional Implementation Strategy (RIS) commitments of the Madrid International Plan of Action on Ageing (MIPAA), social rights-i.e., the European Pillar of Social Rights and sustainability-i.e., the Sustainable Development Goals (SDGs) of the Agenda 2030 for Sustainable Development. Results pointed out that out of the identified nine policy fields, the major intervention areas by Italian policy makers concerned labour market participation, life-long learning, social and economic inequalities, health and well-being. Less attention had been given to issues such as gender and equal opportunities and sustainable cities. This systematic policy review is a milestone for understanding how active ageing policies contribute to address major societal challenges and what domains need further policy development.
Topics: Aging; Humans; Italy; Public Policy; Quality of Life; Sustainable Development
PubMed: 35010853
DOI: 10.3390/ijerph19010600 -
BMC Health Services Research Jul 2014Wheelchairs for disabled children (≤ 18 years) can provide health, developmental and social benefits. World Health Organisation and United Kingdom Government reports... (Review)
Review
BACKGROUND
Wheelchairs for disabled children (≤ 18 years) can provide health, developmental and social benefits. World Health Organisation and United Kingdom Government reports demonstrate the need for improved access to wheelchairs both locally and internationally. The use of health economics within this field is lacking. Provision of wheelchairs based on cost-effectiveness evidence is not currently possible. We conducted the first systematic review in this field to incorporate evidence of effectiveness, service user perspectives, policy intentions and cost-effectiveness in order to develop a conceptual framework to inform future research and service development.
METHODS
We used an adapted EPPI-Centre mixed-method systematic review design with narrative summary, thematic and narrative synthesis. 11 databases were searched. Studies were appraised for quality using one of seven appropriate tools. A conceptual framework was developed from synthesised evidence.
RESULTS
22 studies and 14 policies/guidelines were included. Powered wheelchairs appear to offer benefits in reduced need for caregiver assistance; improved communicative, personal-social and cognitive development; and improved mobility function and independent movement. From 14 months of age children can learn some degree of powered wheelchair driving competence. However, effectiveness evidence was limited and low quality. Children and parents placed emphasis on improving social skill and independence. Participation in wider society and development of meaningful relationships were key desired outcomes. Policy intentions and aspirations are in line with the perspectives of children and parents, although translation of policy recommendations into practice is lacking.
CONCLUSIONS
There is a distinct lack of high quality effectiveness and economic evidence in this field. Social and health needs should be seen as equally important when assessing the mobility needs of disabled children. Disabled children and parents placed highest priority on independence and psychosocial outcomes of wheelchair interventions. Translation of policy and guidelines into practice is lacking and more effective implementation strategies are required to improve services and outcomes. Future research should focus on outcome measure development, developing economic evaluation tools and incorporating these into high quality studies to address known research gaps. The novel conceptual framework maps current gaps in evidence and outlines areas for development.
Topics: Child; Cost-Benefit Analysis; Disabled Children; Evidence-Based Medicine; Health Policy; Health Services Needs and Demand; Humans; Wheelchairs
PubMed: 25034517
DOI: 10.1186/1472-6963-14-309 -
Australian and New Zealand Journal of... Apr 2018To assess current approaches to inclusion of equity in economic analysis of public health interventions and to recommend best approaches and future directions. (Review)
Review
OBJECTIVES
To assess current approaches to inclusion of equity in economic analysis of public health interventions and to recommend best approaches and future directions.
METHODS
We conducted a systematic review of studies that have used socioeconomic position (SEP) in cost-effectiveness analyses. Studies were identified using MedLine, EconLit and HEED and were evaluated based on their SEP specific inputs and methods of quantification of the health and financial inequalities.
RESULTS
Twenty-nine relevant studies were identified. The majority of studies comparing two or more interventions left interpretation of the size of the health and financial inequality differences to the reader. Newer approaches include: i) use of health inequality measures to quantify health inequalities; ii) inclusion of financial impacts, such as out-of-pocket expenditures; and iii) use of equity weights. The challenge with these approaches is presenting results that policy makers can easily interpret.
CONCLUSIONS
Using CEA techniques to generate new information about the health equity implications of alternative policy options has not been widely used, but should be considered to inform future decision making. Implications for public health: Inclusion of equity in economic analysis would facilitate a more nuanced comparison of interventions in relation to efficiency, equity and financial impact.
Topics: Cost-Benefit Analysis; Health Policy; Health Status Disparities; Humans; Public Health; Socioeconomic Factors
PubMed: 28898490
DOI: 10.1111/1753-6405.12709 -
International Journal of Public Health 2022Effective public policy to prevent falls among independent community-dwelling older adults is needed to address this global public health issue. This paper aimed to... (Review)
Review
Improving Policy for the Prevention of Falls Among Community-Dwelling Older People-A Scoping Review and Quality Assessment of International National and State Level Public Policies.
Effective public policy to prevent falls among independent community-dwelling older adults is needed to address this global public health issue. This paper aimed to identify gaps and opportunities for improvement of future policies to increase their likelihood of success. A systematic scoping review was conducted to identify policies published between 2005-2020. Policy quality was assessed using a novel framework and content criteria adapted from the World Health Organization's guideline for Developing policies to prevent injuries and violence and the New Zealand Government's Policy Quality Framework. A total of 107 articles were identified from 14 countries. Content evaluation of 25 policies revealed that only 54% of policies met the WHO criteria, and only 59% of policies met the NZ criteria. Areas for improvement included quantified objectives, prioritised interventions, budget, ministerial approval, and monitoring and evaluation. The findings suggest deficiencies in a substantial number of policies may contribute to a disconnect between policy intent and implementation. A clear and evidence-based model falls prevention policy is warranted to enhance future government efforts to reduce the global burden of falls.
Topics: Aged; Humans; Independent Living; New Zealand; Public Policy; Violence
PubMed: 35832390
DOI: 10.3389/ijph.2022.1604604