The appraisal of public health interventions: the use of theory

Threlfall, Anthony; Meah, Soraya; Fischer, Asja; Cookson, Richard; Rutter, Harry; Kelly, Michael P.

doi:10.1093/pubmed/fdu044

Cited by 29 publications

(28 citation statements)

References 8 publications

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“…159 Currently, only a tiny fraction of the literature on diabetes prevention is informed by an appreciation of the social complexity underlying pathogenesis of diabetes. [160][161][162] The 2014 Foresight Report on Obesity was a model of good practice in teasing out the complex interactions between genetic, physiological, psychological, sociocultural, economic, and political determinants of obesity; it provided a strong and consistent message that short term "behaviour change" interventions were unlikely to succeed in isolation. 163 A comparable initiative for type 2 diabetes could add richness to our current understanding of the condition and help to inform the design of evidence based strategies aimed at influencing its "upstream" determinants.…”

Section: Future Workmentioning

confidence: 99%

Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions

Barry

Roberts

Oke

et al. 2017

BMJ

251

234

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ObjeCtivesTo assess diagnostic accuracy of screening tests for pre-diabetes and efficacy of interventions (lifestyle or metformin) in preventing onset of type 2 diabetes in people with pre-diabetes. DesignSystematic review and meta-analysis. Data sOurCes anD methODMedline, PreMedline, and Embase. Study protocols and seminal papers were citation-tracked in Google Scholar to identify definitive trials and additional publications. Data on study design, methods, and findings were extracted onto Excel spreadsheets; a 20% sample was checked by a second researcher. Data extracted for screening tests included diagnostic accuracy and population prevalence. Two metaanalyses were performed, one summarising accuracy of screening tests (with the oral glucose tolerance test as the standard) for identification of pre-diabetes, and the other assessing relative risk of progression to type 2 diabetes after either lifestyle intervention or treatment with metformin.eligibility Criteria Empirical studies evaluating accuracy of tests for identification of pre-diabetes. Interventions (randomised trials and interventional studies) with a control group in people identified through screening. No language restrictions. results 2874 titles were scanned and 148 papers (covering 138 studies) reviewed in full. The final analysis included 49 studies of screening tests (five of which were prevalence studies) and 50 intervention trials. HbA 1c had a mean sensitivity of 0.49 (95% confidence interval 0.40 to 0.58) and specificity of 0.79 (0.73 to 0.84), for identification of pre-diabetes, though different studies used different cut-off values. Fasting plasma glucose had a mean sensitivity of 0.25 (0.19 to 0.32) and specificity of 0.94 (0.92 to 0.96). Different measures of glycaemic abnormality identified different subpopulations (for example, 47% of people with abnormal HbA 1c had no other glycaemic abnormality). Lifestyle interventions were associated with a 36% (28% to 43%) reduction in relative risk of type 2 diabetes over six months to six years, attenuating to 20% (8% to 31%) at follow-up in the period after the trails. COnClusiOnsHbA 1c is neither sensitive nor specific for detecting pre-diabetes; fasting glucose is specific but not sensitive. Interventions in people classified through screening as having pre-diabetes have some efficacy in preventing or delaying onset of type 2 diabetes in trial populations. As screening is inaccurate, many people will receives an incorrect diagnosis and be referred on for interventions while others will be falsely reassured and not offered the intervention. These findings suggest that "screen and treat" policies alone are unlikely to have substantial impact on the worsening epidemic of type 2 diabetes. registratiOn PROSPERO (No CRD42016042920).

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Section: Future Workmentioning

confidence: 99%

Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions

Barry

Roberts

Oke

et al. 2017

BMJ

251

234

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“…De fato, para que melhores decisões sobre intervenções em saúde possam ser adotadas, é fundamental que exista um processo transparente e reprodutível, que considere, por exemplo, se uma intervenção é suficientemente incapaz de causar prejuízo mensurável. Geralmente, essas informações são provenientes de evidências geradas por estudos observacionais e, quando possível, avaliadas em nível experimental (por meio de ensaios clínicos randomizados -ECR), para que depois possam ser estimadas análises de custo-efetividade (22) .…”

Section: As Evidências No Contexto Da Saúde Coletivaunclassified

“…Nenhum método de pesquisa é capaz de, individualmente, oferecer respostas suficientes para a imediata aplicação de uma evidência no campo da coletividade (9,10,22,26) . Diferentemente da aplicação individual da informação advinda de ECR, a SC deve ser capaz de responder à demanda de populações extremamente heterogêneas, incluindo complexidade e variabilidade que, usualmente, não são generalizáveis a partir do resultado de estudos com foco apenas na eficácia de uma intervenção (9) .…”

Section: As Evidências No Contexto Da Saúde Coletivaunclassified

“…Ao analisar toda a evidência disponível através de um processo transparente, explícito, reprodutível, rigoroso e abrangente, as RS reduzem os riscos de viés e erros randômicos (22,29,30) . As RS permitem a identificação da natureza e da qualidade das evidências disponibilizadas por estudos primários, a consistência do efeito estudado e a evidência de causalidade, especialmente quando os resultados de múltiplos estudos são controversos ou conflitantes (29) .…”

Section: As Evidências No Contexto Da Saúde Coletivaunclassified

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Da prática baseada em evidências para a saúde coletiva informada por evidencias: revisão narrativa

Wachholz¹,

Lima²,

Boas³

2018

RBPS

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Este artigo está publicado em acesso aberto (Open Access) sob a licença Creative Commons, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho seja corretamente citado. RESUMOObjetivo: Revisar na literatura a descrição dos conceitos e o emprego das evidências científicas no âmbito da Saúde Coletiva (SC). Métodos: Realizou-se uma revisão narrativa utilizando e combinando as palavras-chave "Saúde Pública" OR "Saúde Coletiva"; "Medicina baseada em evidências" e "Política informada por evidências" por meio da consulta as bases de dados Lilacs, SciELO e MedLine. As buscas foram limitadas ao período entre janeiro de 1990 a dezembro de 2016, no idioma português e/ou inglês. A seleção dos estudos foi realizada por dois autores, de modo independente, por meio da leitura do título, resumo e texto completo. Para o processo de síntese, as temáticas encontradas foram agrupadas em três grandes eixos norteadores: as evidências e a prática em saúde, as evidências em SC, e os avanços e desafios da Saúde Coletiva Informada pelas Evidências (SCIE). Resultados: Os achados desta revisão apontam que as tomadas de decisão na SC são mais complexas do que as decisões clínicas individuais, pois envolvem avaliações de impactos orçamentários e políticos, reforçando a relevância da adoção de práticas informadas pelas evidências neste campo. Conclusão: Os meios de apropriação e emprego das evidências no campo da SC são complexos, pois envolvem pressupostos de plausibilidade e adequação nem sempre observados em intervenções individuais. Ainda assim, o campo beneficia-se da aproximação observada na SCIE e, em particular, na tomada de decisões em saúde. ABSTRACT Objective: To review the literature about the description of concepts and the use of scientific evidence in Public Health (PH). Methods:A narrative review was carried out using and combining the keywords "Public Health" OR "Collective Health"; "Evidence-based medicine" and "Evidence-informed policy" to consult the Lilacs, SciELO and MedLine databases. The searches were limited to articles published between January 1990 and December 2016 in Portuguese and/or English. The studies were selected by two independent authors who read the title, abstract and full text. For the synthesis process, the themes found were grouped into three main guiding axes: health evidence and practice, PH evidence, and the advances and challenges of Evidence-Informed Public Health (EIPH). Results: The findings of this review point out that decision making in PH is more complex than individual clinical decisions as it involves assessment of budgetary and political impacts, thus reinforcing the relevance of adopting evidence-informed practice in this field. Conclusion: The means of appropriation and use of evidence in the PH field are complex because they involve assumptions of plausibility and adequacy that are not always observed in individual interventions. Yet, the field benefits from the approach observed in EIPH and, particularly, in health decision making. Descript...

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“…This suggests that a decision-theoretic approach will be required (and may be sufficient by itself) in some circumstances, such as where the intervention could not conceivably cause harm, and where the likely effect size would produce an estimate of cost effectiveness that is well below currently acceptable thresholds. 19,20 For example, in a hand washing intervention designed for use in an influenza pandemic, 21 international dissemination of a fully automated digital intervention to reduce spread of respiratory infection would likely result in healthcare savings and wider health and socioeconomic benefits so great that the cost of the intervention becomes negligible.…”

Section: Medical Research Council Framework For Complex Interventionsmentioning

confidence: 99%

Designing and Undertaking a Health Economics Study of Digital Health Interventions

McNamee

Murray

Kelly

et al. 2016

American Journal of Preventive Medicine

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The appraisal of public health interventions: the use of theory

Cited by 29 publications

References 8 publications

Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions

Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions

Da prática baseada em evidências para a saúde coletiva informada por evidencias: revisão narrativa

Designing and Undertaking a Health Economics Study of Digital Health Interventions

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