BackgroundIncreasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease.MethodsSeven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken.ResultsSixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes.Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance.ConclusionsSystems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6274-z) contains supplementary material, which is available to authorized users.
The objective of this study was to define the patterns of myoelectric activity that occur throughout the gastrointestinal tract during normal recovery from laparotomy. Electrodes were placed on the stomach, jejunum, and transverse colon of 44 patients undergoing laparotomy. Basal electric rhythms in all areas showed no changes in frequency after operation (up to 1 month). Gastric spike wave activity showed a gradient of increasing activity from fundus to antrum. Antral spike activity was unchanged during the study. Jejunal spike activity was present in the earliest recordings and occurred in 45.9% +/- 3.5% to 59.9% +/- 5.5% of slow waves. Recovery of normal colon discrete and continuous electric response activity occurred on postoperative day 5.9 +/- 1.5. Bowel sounds returned on day 2.4 +/- 0.5 and passage of flatus and stool occurred on day 5.1 +/- 0.2. The myoelectric parameters measured are not absolutely predictive of uneventful recovery from postoperative ileus but they are, as a group, more informative than any currently available clinical criteria.
Fifty-three horses, all but two of them over two years of age and varying in type, sex and liveweight (230 to 707 kg) were weighed and seven different body measurements were recorded in duplicate by a single operator. The best overall prediction of liveweight using an equation with two variables was found to be: liveweight (kg) = (umbilical girth [cm])1.78 X (length of body from tuber ischii to elbow [cm]0.97/3011). This equation had an adjusted R2 value of 94.9 per cent and was derived from the pooled data, because differences of sex, type and weight did not significantly affect the relationship. The stable behaviour of the relationship was demonstrated by the fact that about 95 per cent of the residuals lay within +/- 53 kg, giving an average error of 4.7 per cent. The accuracy of prediction of the equation was better than the accuracy of four other established equations. A nomogram based on the equation is given.
More account needs to be taken of the variations that occur between lay health worker programmes. This framework, with the mapping of key categories of difference, may enable better description of lay health worker programmes, which will in turn assist in building a shared evidence base. More research is needed to examine the transferability of the framework within different contexts.
Pancreatic protein and bicarbonate outputs were measured in dogs with pancreatic fistulas receiving intravenous secretin while individual L-amino acids or mixtures of L-amino acids were perfused into proximal intestine, Both phenylalanine and tryptophan were potent stimuli of pancreatic secretion; alanine, leucine, and valine increased protein outputs but their effects were small and not statistically significant. Six other amino acids were ineffective. Tryptophan perfused together with phenylalanine augmented responses to phenylalanine; methionine, ineffective when perfused alone, did not alter responses to phenylalanine when perfused with the latter. Responses to phenylalanine perfused at concentrations above 8 mM were dependent on load and were mediated by lengths of proximal bowel greater than 10 cm.
Background Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs). We carried out a systematic review of WSAs targeting obesity and other complex public health and societal issues. Methods Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. Results 65 articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. Conclusions Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations. Key messages Interventions working towards systems approaches are associated with a range of positive health outcomes. Evidence of systems science and systems thinking was less clear, even in the most “joined up” approaches.
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