Health Intervention Studies Research Articles

Using economic evaluations in implementation science to increase transparency in costs and outcomes for organizational decision-makers

BackgroundEconomic evaluations frequently are utilized to compare the value of different interventions in medicine and health in concrete terms. Implementation science also would benefit from the incorporation of economic evaluations, but such studies are rare in the literature. The National Cancer Institute has supported a special collection of articles focusing on economic evaluations in implementation science. Even when interventions are supported by substantial evidence, they are implemented infrequently in the field. Implementation costs are important determinants for whether organizational decision-makers choose to adopt an intervention and whether the implementation process is successful. Economic evaluations, such as cost-effectiveness analyses, can help organizational decision-makers choose between implementation approaches for evidence-based interventions by accounting for costs and succinctly presenting cost/benefit tradeoffs.Main textThis manuscript presents a discussion of important considerations for incorporating economic evaluations into implementation science. First, the distinction between intervention and implementation costs is presented, along with an explanation of why the comprehensive representation of implementation costs is elusive. Then, the manuscript describes how economic evaluations in implementation science may differ from those in medicine and health intervention studies, especially in terms of determining the perspectives and outcomes of interest. Finally, referencing a scale-up trial of an evidence-based behavioral health intervention, concrete case examples of how cost data can be collected and used in economic evaluations targeting implementation, rather than clinical outcomes, are described.ConclusionsBy gaining a greater understanding of the costs and economic impact associated with different implementation approaches, organizational decision-makers will have better transparency for future replication and scale-up. The use of economic evaluations can help to advance this understanding and provide researchers, purveyors or third-party intermediaries, and organizational decision-makers with essential information to facilitate implementation.

Developing and piloting a context-specified ethics framework for health technology assessment: the South African Values and Ethics for Universal Health Coverage approach.

While ethics has been identified as a core component of health technology assessment (HTA), there are few examples of practical, systematic inclusion of ethics analysis in HTA. Some attribute the scarcity of ethics analysis in HTA to debates about appropriate methodology and the need for ethics frameworks that are relevant to local social values. The "South African Values and Ethics for Universal Health Coverage" (SAVE-UHC) project models an approach that countries can use to develop HTA ethics frameworks that are specific to their national contexts. The SAVE-UHC approach consisted of two phases. In Phase I, the research team convened and facilitated a national multistakeholder working group to develop a provisional ethics framework through a collaborative, engagement-driven process. In Phase II, the research team refined the model framework by piloting it through three simulated HTA appraisal committee meetings. Each simulated committee reviewed two case studies of sample health interventions: opioid substitution therapy and either a novel contraceptive implant or seasonal influenza immunization for children under five. The methodology was fit-for-purpose, resulting in a context-specified ethics framework and producing relevant findings to inform application of the framework for the given HTA context. The SAVE-UHC approach provides a model for developing, piloting, and refining an ethics framework for health priority-setting that is responsive to national social values. This approach also helps identify key facilitators and challenges for integrating ethics analysis into HTA processes.

Gaps in health research related to sex work: an analysis of Canadian health research funding

ABSTRACT Public health is tasked with addressing the urgent global priority of promoting the health and human rights of adults engaged in sex work and research is critical to support this endeavor. ‘What’ is studied, ‘how’ research is done, and ‘who’ is centered in this research is reflected in how research funding is allocated. In this article, we interrogate funding allocation for sex work-related health research in Canada. Drawing on critical perspectives aimed at illustrating how stigma operates in society, we examine operating grants (N = 64) awarded by the federal health research funding agency between 2003 and 2020. We find that sex workers’ health is problematized disproportionately in a street marketplace context that centers on HIV and sexually transmitted infections. Limited work attends to the socio-structural context of sex work and instead perpetuates stigmatizing narratives about sex work. Public health intervention studies are rare, presenting a barrier for implementing and evaluating evidence-based health promotion strategies. Notably, the research projects were conducted by a small number of highly networked, geographically clustered researchers, illustrating gaps in research that considers the complexity of sex work. We propose that it is essential to consider funding as a process that may be limiting the range of health issues being addressed and privileging a small community of researchers, which can inadvertently serve to worsen health inequities among some sex work communities. Researchers and funding bodies may draw on this analysis to inform a research agenda that meaningfully supports the health, safety, and well-being of sex workers in Canada and globally.

Telemental Health For Youth With Chronic Illnesses: Systematic Review.

BackgroundChildren, adolescents, and young adults with chronic conditions experience difficulties coping with disease-related stressors, comorbid mental health problems, and decreased quality of life. The COVID-19 pandemic has led to a global mental health crisis, and telemental health has necessarily displaced in-person care. However, it remains unknown whether such remote interventions are feasible or efficacious. We aimed to fill this research-practice gap.ObjectiveIn this systematic review, we present a synthesis of studies examining the feasibility and efficacy of telemental health interventions for youth aged ≤25 years with chronic illnesses.MethodsPubMed, Embase, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews were searched from 2008 to 2020. We included experimental, quasiexperimental, and observational studies of telemental health interventions designed for children, adolescents, and young adults aged ≤25 years with chronic illnesses, in which feasibility or efficacy outcomes were measured. Only English-language publications in peer-reviewed journals were included. We excluded studies of interventions for caregivers or health care providers, mental health problems not in the context of a chronic illness, disease and medication management, and prevention programs for healthy individuals.ResultsWe screened 2154 unique study records and 109 relevant full-text articles. Twelve studies met the inclusion criteria, and they represented seven unique telemental health interventions. Five of the studies included feasibility outcomes and seven included efficacy outcomes. All but two studies were pilot studies with relatively small sample sizes. Most interventions were based on cognitive behavioral therapy and problem-solving therapy. The subset of studies examining intervention feasibility concluded that telemental health interventions were appropriate, acceptable, and satisfactory to patients and their parents. Technology did not create barriers in access to care. For the subset of efficacy studies, evidence in support of the efficacy of telemental health was mixed. Significant heterogeneity in treatment type, medical diagnoses, and outcomes precluded a meta-analysis.ConclusionsThe state of the science for telemental health interventions designed for youth with chronic illnesses is in a nascent stage. Early evidence supports the feasibility of telehealth-based delivery of traditional in-person interventions. Few studies have assessed efficacy, and current findings are mixed. Future research should continue to evaluate whether telemental health may serve as a sustainable alternative to in-person care after the COVID pandemic.

The Mediterranean diet and health: a comprehensive overview

The Mediterranean diet (MedDiet), one of the most studied and well-known dietary patterns worldwide, has been associated with a wide range of benefits for health. In the present narrative review, we aimed to provide a comprehensive overview of the current knowledge on the relation of the MedDiet to important health outcomes, considering both observational and intervention studies with both risk factors and clinical diseases as outcomes. In addition, we considered the clinical and public health impacts of the MedDiet on both human and planetary health. Earlier research confirmed by recent studies has provided strong evidence for the benefits of the MedDiet on cardiovascular health, including reduction in the incidence of cardiovascular outcomes as well as risk factors including obesity, hypertension, metabolic syndrome, and dyslipidaemia. There is also evidence that MedDiet is associated with lower rates of incident diabetes, and better glycaemic control in diabetic patients compared to control diets. In prospective studies, adherence to the MedDiet reduced mortality, especially cardiovascular mortality, hence increased longevity. In addition, it has been associated with less age-related cognitive dysfunction and lower incidence of neurodegenerative disorders, particularly Alzheimer's disease. Furthermore, the relatively low environmental impacts (water, nitrogen and carbon footprint) of the MedDiet is an additional positive aspect of the Mediterranean dietary model. It is likely that the combination of a healthy diet with social behaviours and the way of life of Mediterranean regions makes the MedDiet a sustainable lifestyle model that could likely be followed in other regions with country-specific and culturally appropriate variations.

Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence.

IntroductionAdolescents and young adults (AYA) remain vulnerable to HIV‐infection and significant co‐morbid mental health challenges that are barriers to treatment and prevention efforts. Globally millions of AYA are living with HIV (AYALH) and/or have been affected by HIV in their families (AYAAH), with studies highlighting the need for mental health programmes. With no current guidelines for delivering mental health interventions for AYALH or AYAAH, a scoping review was undertaken to explore current evidence‐based mental health interventions for AYALH and AYAAH to inform future work.MethodsThe review, targeting work between 2014 and 2020, initially included studies of evidence‐based mental health interventions for AYALH and AYAAH, ages 10 to 24 years, that used traditional mental health treatments. Given the few studies identified, we expanded our search to include psychosocial interventions that had mental health study outcomes.Results and discussionWe identified 13 studies, seven focused on AYALH, five on AYAAH, and one on both. Most studies took place in sub‐Saharan Africa. Depression was targeted in eight studies with the remainder focused on a range of emotional and behavioural symptoms. Few studies used evidence‐based approaches such as Cognitive Behaviour Therapy; psychosocial approaches included mental health treatments, group‐based and family strengthening interventions, economic empowerment combined with family strengthening, group‐based mindfulness and community interventions. Eleven studies were randomized control trials with four pilot studies. There was variation in sample size, treatment delivery mode (individual focus, group‐based, family focus), and measures of effectiveness across studies. Most used trained lay counsellors as facilitators, with few using trained mental health professionals. Eleven studies reported positive intervention effects on mental health.ConclusionsDespite the need for mental health interventions for AYALH and AYAAH, we know surprisingly little about mental health treatment for this vulnerable population. There are some promising approaches, but more work is needed to identify evidence‐based approaches and corresponding mechanisms of change. Given limited resources, integrating mental health treatment into healthcare settings and using digital health approaches may support more standardized and scalable treatments. Greater emphasis on implementation science frameworks is needed to create sustainable mental health treatment for AYALH and AYAAH globally.

P10 A systematic review of current literature on interventions among first-year university students and how this may influence current policy on child obesity strategies within the UK

BackgroundWith the steady rise of obesity within the UK, the Government has been increasingly developing policy to curb these figures. Great focus has been put on early implementation of a wide range of interventions in educational settings, but results show little improvement.AimTo evaluate health interventions amongst first-year university students with the intention of influencing current policy on obesity prevention amongst children.MethodsA literature search, utilising PRISMA reporting guidelines, was carried out on health intervention studies that focus on first-year university students. To formulate the search strategy, UK obesity policy was input into a PICO Framework.ResultsEight studies met the inclusion/exclusion criteria. Results showed that when measuring weight-related outcomes, no significant improvement was found; secondary outcomes, especially those regarding physical activity demonstrated greater benefit but the link to obesity prevention proved to be relatively weak.DiscussionDue to differing demographics between where the studies were based as well as cultural differences regarding views on leisure and diet led to lack of applicability to UK students.Environmental factors between compulsory and higher education must also be considered as it may be a case of creating new strategies rather than re-applying a pre-established policy.Ultimately, the lack of comparable studies reflects on the lack of understanding of the overall issue of childhood obesity and thusly its prevention.ConclusionWith evidence-based policy increasing in popularity, it is questionable as to whether the target population for child obesity strategies could widen to include first-year university students.

Progressing Toward Adolescents’ Ovulatory-Menstrual Health Literacy: A Systematic Literature Review of School-Based Interventions

This study was designed to evaluate the extent to which school-based ovulatory-menstrual (OM) health interventions facilitate the Health Outcome Model’s domains of health literacy. Electronic databases and gray literature sources were searched from 1980 to 2019. Findings from 16 studies of school-based OM health interventions (n = >8800 adolescents aged 13–16 years) were collated. The results indicate that OM health education addresses the domains of health literacy to various degrees; critical health literacy skills are least often addressed. Future programs would benefit from positive teaching about the cycle as a health monitor and from engaging parents and healthcare providers.

ANALYSIS OF "LEARN-AS-YOU-GO" (LAGO) STUDIES.

In Learn-As-you-GO (LAGO) adaptive studies, the intervention is a complex multicomponent package, and is adapted in stages during the study based on past outcome data. This design formalizes standard practice in public health intervention studies. An effective intervention package is sought, while minimizing intervention package cost. In LAGO study data, the interventions in later stages depend upon the outcomes in the previous stages, violating standard statistical theory. We develop an estimator for the intervention effects, and prove consistency and asymptotic normality using a novel coupling argument, ensuring the validity of the test for the hypothesis of no overall intervention effect. We develop a confidence set for the optimal intervention package and confidence bands for the success probabilities under alternative package compositions. We illustrate our methods in the BetterBirth Study, which aimed to improve maternal and neonatal outcomes among 157,689 births in Uttar Pradesh, India through a multicomponent intervention package.

Effectiveness of Smartphone-Based Cognitive Behavioral Therapy Among Patients With Major Depression: Systematic Review of Health Implications.

BackgroundDepression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care.ObjectiveThe objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints.MethodsA systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified.ResultsThe studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life.ConclusionsNo clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies.

The Role of Implementation Science in Advancing Resource Generation for Health Interventions in Low- and Middle-Income Countries.

Low- and middle-income countries (LMICs) bear the brunt of communicable and non-communicable diseases and experience higher mortality and poor health outcomes compared to resource-rich countries. Chronic resource deficits in LMICs impede their ability to successfully address vexing health issues. Implementation science provides researchers with an approach to develop specific interventions that can generate and/or maximize resources to facilitate the implementation of other public health interventions, in resource-constrained LMIC settings. Resources generated from these interventions could be in the form of increased health workers’ skills, task shifting to free up higher-skilled health workers, increasing laboratory capacity, and using supply chain innovations to make medications available. Pivotal to the success of such interventions is ensuring feasibility in the LMIC context. We selected and appraised three case studies of evidence-based resource-generating health interventions based in LMICs (Zambia, Zimbabwe, and Madagascar), which generated or maximized resources to facilitate ongoing health services. We used a determinant implementation framework—Consolidated Framework for Implementation Research (CFIR) to identify and map contextual factors that are reported to influence implementation feasibility in an LMIC setting. Contextual factors influencing the feasibility of these interventions included leadership engagement, local capacity building and readiness for research and implementing evidence-based practices (EBPs), infrastructural support for multilevel scale-up, and cultural and contextual adaptations. These factors highlight the importance of utilizing implementation science frameworks to evaluate, guide, and execute feasible public health interventions and projects in resource-limited settings. Within LMICs, we recommend EBPs incorporate feasible resource-generating components in health interventions to ensure improved and sustained optimal health outcomes.

Digital Interventions for Depression and Anxiety in Older Adults: Protocol for a Systematic Review.

BackgroundThere is a high prevalence of older adults experiencing depression and anxiety. In response to heightened demands for mental health interventions that are accessible and affordable, there has been a recent rise in the number of digital mental health interventions (DMHIs) that have been developed and incorporated into mental health treatments. Digital interventions are promising in their ability to provide researchers, medical practitioners, and patients with personalized tools for assessing behavior, consultation, treatment, and care that can be used remotely. Reviews and meta-analyses have shown the benefits of DMHIs for the treatment and prevention of depression, anxiety, and other mental illnesses, but there is still a lack of studies that focus on the benefits and use of DMHIs in the older population.ObjectiveThe aim of this systematic review is to investigate the current evidence for the effect of technology-delivered interventions, such as smartphone/tablet applications, remote monitoring and tracking devices, and wearable technology, for the treatment and prevention of depression and anxiety in adults older than 50 years.MethodsThe academic databases SCOPUS, PsycINFO, AgeLine (EBSCO), and Medline (PubMed) will be searched from January 1, 2010, to the date of search commencement to provide a review of existing randomized controlled trial studies. The search will include 3 key concepts: “older adults,” “digital intervention,” and “depression/anxiety.” A set of inclusion criteria will be followed during screening by two reviewers. Data will be extracted to address aims and objectives of the review. The risk of bias for each study will be determined using appropriate tools. If possible, a random-effects meta-analysis will be performed, and the heterogeneity of effect sizes will be calculated.ResultsPreliminary searches were conducted in September 2020. The review is anticipated to be completed by April 2021.ConclusionsThe data accumulated in this systematic review will demonstrate the potential benefits of technology-delivered interventions for the treatment of depression and anxiety disorders in older adults. This review will also identify any gaps in current studies of aging and mental health interventions, thereby navigating a way to move forward and paving the path to more accessible and user-friendly digital health interventions for the diverse population of older adults.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020192532; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020192532International Registered Report Identifier (IRRID)PRR1-10.2196/22738

A review and analysis of the components of potentially effective perinatal mental health interventions for infant development and mother-infant relationship outcomes

Children of mothers with serious mental health difficulties are at increased risk of developing mental health difficulties themselves in their own lifetime. Specialist interventions delivered in perinatal mental health services offer an opportunity to support the infant's development and long-term mental health. This review aimed to systematically evaluate the shared elements of successful perinatal mental health interventions that underpin improved outcomes for infants whose mothers experience perinatal mental health difficulties. Nine electronic databases were searched comprehensively for relevant controlled studies of perinatal mental health interventions, and a narrative synthesis undertaken to assess whether statistically significant benefits were noted. Sixteen studies, trialing 19 interventions, were analyzed using a narrative approach and grouped according to reported effectiveness. Eight interventions demonstrated significant improvements in infant outcomes and/or mother-infant relationship outcomes and were used to inform the analysis of the included interventions' components. While the interventions identified were diverse, there were common components which potentially underpin successful interventions for infants whose mothers are experiencing mental health difficulties, including: facilitation of positive Mother×Infant interactions; helping mothers to understand their infant's perspective or inner world; and the use of video feedback.

Integrated Review of Psychosocial and Behavioral Health Assessments and Interventions in Pulmonary Hypertension.

The medical management of patients with pulmonary hypertension (PH) has advanced, with few evidence-based recommendations about psychosocial and behavioral health interventions. There is also a lack of comprehensive understanding of PH psychosocial and behavioral health needs. Some psychosocial and behavioral health interventions have been tested; however, there is a gap in the systematic evaluation of nonpharmacological complementary approaches to augment PH management when addressing psychosocial and behavioral health needs. The objectives are to explore psychosocial and behavioral health needs and describe psychosocial and behavioral health interventions for patients with PH. We conducted an integrative systematic review of publications between January 1, 2010, and January 31, 2020, obtained from electronic databases: EMBASE, PubMed, Cumulative Index of Nursing and Allied Health Literature, Cochrane, PsycINFO, and Web of Science. The literature searches focused on empirical literature reporting psychosocial needs and psychosocial and behavioral health interventions for adult PH patients. We included peer-reviewed studies published in English. Search terms used in the study were: "hypertension," "pulmonary hypertension," "psychosocial," "depression," "anxiety," "quality of life," "behavioral health," "self-management," "psychosocial intervention," and "psychological distress." Excluded were opinion and discussion publications, reviews, non-PH populations, and pediatric articles. We used the constant comparison method to guide the synthesis of reports applying the Joanna Briggs quality assessment guidelines. A total of 44 articles meeting the criteria were included for final consideration. We conducted an integrative systematic review of 27 quantitative studies, narrative synthesis of 10 qualitative studies, and 7 psychosocial and behavioral health intervention studies. PH patients reported psychosocial needs, such as financial, social connections, sexual health, and palliative care needs, as well as levels of psychological distress symptoms. The results from both quantitative and qualitative studies revealed similar overarching psychosocial and behavioral health conceptual categories. Patients described their ongoing needs in PH management by relying on their psychosocial and behavioral health capabilities to adjust to changes at each stage of disease progression. Patients had high levels of psychosocial and behavioral health needs requiring interventions beyond medical treatment. Pilot studies testing psychosocial and behavioral health interventions reported improvement in levels of anxiety and depression and health-related quality of life. Larger scale studies are needed to advance this knowledge. Psychosocial and behavioral health interventions with cognitive-guided foci have the potential of meeting these unmet needs.

Do descriptive norms messaging interventions backfire? Protocol for a systematic review of the boomerang effect

BackgroundDescriptive norms messaging interventions are used to motivate people to adopt or maintain desirable behaviors. Such interventions provide people with information that describes an undesirable behavior as uncommon or a desirable behavior as prevalent within a relevant social group. Descriptive norms messaging interventions have shown promise in increasing individual and social benefit for a broad range of health and sustainability programs. However, evidence suggests that people who have adopted desirable behaviors sometimes regress to undesirable behaviors after receiving descriptive norms messages due to the type of information provided in the messages. This phenomenon is called the boomerang effect. We aim to conduct a systematic review of boomerang effects on health and environmental sustainability behaviors resulting from exposure to descriptive norms messaging interventions.MethodsWe will employ our search strategy to identify studies of descriptive norms messaging interventions published prior to December 31, 2020. We will search the Cochrane Library, Campbell Library, PsycINFO, PubMed, Social Science Research Network (SSRN), and Web of Science to retrieve peer-reviewed articles published in English. We will restrict inclusion to studies (e.g., randomized and non-randomized controlled trials, quasi-experimental studies, and observational studies) of health and environmental sustainability interventions that assess behaviors before and after exposure to descriptive norms messaging. Two reviewers will independently extract data about study populations and design, intervention components, and behavioral measures. We will use the revised Cochrane Risk of Bias assessment tool (RoB2) and Risk Of Bias in Non-randomized Studies—of Intervention (ROBINS-I) to assess the risk of bias, and the Liverpool Quality Assessment Tool (LQAT) to assess the quality of evidence. We will conduct thematic analyses to codify interventions, and examine intervention effects across subgroups of individuals based on their behavior prior to intervention exposure (e.g., those practicing desirable behaviors vs. undesirable behaviors). We will also conduct moderator analyses to determine whether boomerang effects are contingent upon other factors including intervention framing and delivery modality.DiscussionThis systematic review will provide information about descriptive norms messaging intervention effects across subgroups of individuals and elucidate factors that potentially moderate boomerang effects. The review will yield evidence-based recommendations for the structure and content of descriptive norms messages that can be employed to avoid unintended boomerang effects within the context of health and sustainability programming.Systematic review registrationPROSPERO CRD42020156989

The Effectiveness of Social Media Support for Caregivers: A Systematic Review

<p><strong>Background:</strong> Caring for patients living with long term conditions is a long-term task. The augmenting use of social media (SM) supports for health information and communication has created new opportunities for new models of health-care. <strong>Objectives:</strong> This study aimed to explore the effectiveness of SM support for caregivers. <strong>Methods:</strong> This systematic review mainly includes research over the past decade on caregivers for chronic diseases, with the results focusing on SM support for caregivers. <strong>Results:</strong> This literature review found that SM-based interventions can meet caregivers’ needs and have a positive impact on caregiver burden (CB) of chronic diseases such as cancer, dementia and stroke. Experimental studies of health interventions for stroke caregivers (SCs) through WeChat interventions have been limited. <strong>Conclusion:</strong> More quantitative studies are needed in the future to explore the effectiveness of WeChat as an intervention in the burden of SCs.</p>

Scaling up population health interventions from decision to sustainability \u2013 a window of opportunity? A qualitative view from policy-makers

BackgroundWhile known efficacious preventive health interventions exist, the current capacity to scale up these interventions is limited. In recent years, much attention has focussed on developing frameworks and methods for scale-up yet, in practice, the pathway for scale-up is seldom linear and may be highly dependent on contextual circumstances. Few studies have examined the process of scaling up from decision to implementation nor examined the sustainability of scaled-up interventions. This study explores decision-makers’ perceptions from real-world scaled-up case studies to examine how scale-up decisions were made and describe enablers of successful scale-up and sustainability.MethodsThis qualitative study included 29 interviews conducted with purposively sampled key Australian policy-makers, practitioners and researchers experienced in scale-up. Semi-structured interview questions obtained information regarding case studies of scaled-up interventions. The Framework Analysis method was used as the primary method of analysis of the interview data to inductively generate common and divergent themes within qualitative data across cases.ResultsA total of 31 case studies of public health interventions were described by interview respondents based on their experiences. According to the interviewees’ perceptions, decisions to scale up commonly occurred either opportunistically, when funding became available, or when a deliberate decision was made and funding allocated. The latter scenario was more common when the intervention aligned with specific political or strategic goals. Decisions to scale up were driven by a variety of key actors such as politicians, senior policy-makers and practitioners in the health system. Drivers of a successful scale-up process included good governance, clear leadership, and adequate resourcing and expertise. Establishing accountability structures and appropriate engagement mechanisms to encourage the uptake of interventions were also key enablers. Sustainability was influenced by evidence of impact as well as good acceptability among the general or target population.ConclusionsMuch like Kingdon’s Multiple Streams Theory of ‘policy windows’, there is a conceptually similar ‘window for scale-up’, driven by a complex interplay of factors such as political need, strategic context, funding and key actors. Researchers and policy-makers need to consider scalability from the outset and prepare for when the window for scale-up opens. Decision-makers need to provide longer term funding for scale-up to facilitate longer term sustainability and build on the resources already invested for the scale-up process.

Determinación de la capacidad antioxidante total de alimentos y plasma humano por fotoquimioluminiscencia: Correlación con ensayos fluorométricos (ORAC) y espectrofotométricos (FRAP)

La determinación de la capacidad antioxidante es útil para valorar la calidad de un alimento, la cantidad de antioxidantes presentes en un sistema, o la biodisponibilidad de compuestos antioxidantes en el cuerpo humano. Los métodos disponibles realizan la determinación del efecto potencial de las sustancias antioxidantes, presentes en los alimentos y en el organismo humano, contra las reacciones de oxidación. El objetivo fue comparar los resultados de la detección de la capacidad antioxidante total (CAT) en muestras de alimentos y plasma humano, mediante la quimioluminiscencia por fotosensibilización (PCL), en contraste con métodos que cuantifican la capacidad de absorbancia del radical de oxígeno (ORAC) y el poder antioxidante reductor del hierro (FRAP). Se obtuvieron extractos hidrosolubles y liposolubles de salvado de arroz estabilizado (SAE) y de harina de Ulva clathrata (HUC). El plasma se obtuvo de muestras de sangre humana (PHU). Se procesaron tres muestras en cada caso. Los resultados se analizaron mediante análisis de varianza de una vía y correlación de Pearson, p < 0.05. La CAT determinada mediante PCL fue: SAE 246.37 ± 5.37, HUC 21.05 ± 0.41 y PHU 90.59 ± 1.17 equivalentes Trolox (ET) μmol /100 g ó 100 mL, p < 0.05; ORAC: SAE 5015.62 ± 12.83, HUC 852.37 ± 3.45 y PHU 2563.31 ± 39.47 ET μmol /100 g ó 100 mL, p < 0.05. FRAP: SAE 519.37 ± 0.04, HUC 52.78 ± 0.01 y PHU 90.26 ± 0.01 equivalentes Fe2+ (EFe2+) µmol /100 g ó 100 mL. Se observaron correlaciones entre PCL y ORAC, r = 0.99; y la PCL y FRAP, r = 0.94, ambas estadísticamente significativas (p < 0.05). La PCL mostró ser un método confiable y alternativo para cuantificar la CAT, que se puede aplicar en estudios de alimentos y de intervenciones en salud.

Seen and Ignored: Are We Undermining Studies of Brain Health Interventions Before We Start?

Seen and Ignored: Are We Undermining Studies of Brain Health Interventions Before We Start?

A protocol for retrospective translational science case studies of health interventions.

The critical processes driving successful research translation remain understudied. We describe a mixed-method case study protocol for analyzing translational research that has led to the successful development and implementation of innovative health interventions. An overarching goal of these case studies is to describe systematically the chain of events between basic, fundamental scientific discoveries and the adoption of evidence-based health applications, including description of varied, long-term impacts. The case study approach isolates many of the key factors that enable the successful translation of research into practice and provides compelling evidence connecting the intervention to measurable changes in health and medical practice, public health outcomes, and other broader societal impacts. The goal of disseminating this protocol is to systematize a rigorous approach, which can enhance reproducibility, promote the development of a large collection of comparable studies, and enable cross-case analyses. This approach, an application of the "science of translational science," will lead to a better understanding of key research process markers, timelines, and potential points of leverage for intervention that may help facilitate decisions, processes, and policies to speed the sustainable translational process. Case studies are effective communication vehicles to demonstrate both accountability and the impacts of the public's investment in research.