Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Art of persuasion: an analysis of techniques used to market foods to children. Using qualitative comparative analysis in a systematic review of a complex intervention Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment Football Fans in Training: the development and optimization of an intervention delivered through professional sports clubs to help men lose weight, become more active and adopt healthier eating habits Using a behaviour change techniques taxonomy to identify active ingredients within trials of implementation interventions for diabetes care Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department Using logic model methods in systematic review synthesis: describing complex pathways in referral management interventions Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: Methods of a decision-maker-researcher partnership systematic review Strategies to Promote Physical Activity During Pregnancy Dietetic guidelines: diet in secondary prevention of cardiovascular disease. Processes of behavior change and weight loss in a theory-based weight loss intervention program: a test of the process model for lifestyle behavior change Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Breaking bad habits by improving executive function in individuals with obesity
Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : AIM Persuasive marketing techniques , such as promotional characters , influence children 's food preferences and requests for foods . The aim of this research was to describe the techniques used to market unhealthy foods and beverages to children on Sydney free-to-air television . METHODS Marketing techniques design ed to appeal to children were identified from international literature and summarised into a systematic coding tool . Using this tool , the marketing techniques used in a r and om sample of 100 unique food advertisements , broadcasted on Sydney free-to-air television , were coded . Frequency of marketing techniques was analysed overall and for use in advertisements marketing unhealthy foods , emotionally or verbally appealing to parents , or featuring child actors . RESULTS Advertisers ' use of persuasive techniques generally did not differ by type of food advertised . Marketing techniques with greater prominence in unhealthy food advertising were palatability ( 54 % of unhealthy food advertisements ) , convenience ( 52 % ) , fantasy/imagination ( 28 % ) , fun/happiness ( 17 % ) and cartoon characters ( 9 % ) . Advertisements emotionally appealing to parents ( 24 % ) were significantly more likely to make general health or nutrition statements ( 38 % vs. 17 % ) , and appealed to children concurrently through fun/happiness and fantasy/imagination appeals . Children were depicted in advertisements as eating with friends or family , situated within the home and frequently snacking on less healthy foods . CONCLUSIONS Food and beverage advertisers use a range of visual , audio and emotive techniques to appeal to children and their parents that do not discriminate by the type of food advertised . The range and complexity of these techniques complicate the restriction of their use in food advertising to children Background Systematic review s evaluating complex interventions often encounter substantial clinical heterogeneity in intervention components and implementation features making synthesis challenging . Qualitative comparative analysis ( QCA ) is a non-probabilistic method that uses mathematical set theory to study complex phenomena ; it has been proposed as a potential method to complement traditional evidence synthesis in review s of complex interventions to identify key intervention components or implementation features that might explain effectiveness or ineffectiveness . The objective of this study was to describe our approach in detail and examine the suitability of using QCA within the context of a systematic review . Methods We used data from a completed systematic review of behavioral interventions to improve medication adherence to conduct two substantive analyses using QCA . The first analysis sought to identify combinations of nine behavior change techniques/components ( BCTs ) found among effective interventions , and the second analysis sought to identify combinations of five implementation features ( e.g. , agent , target , mode , time span , exposure ) found among effective interventions . For each substantive analysis , we reframed the review ’s research questions to be design ed for use with QCA , calibrated sets ( i.e. , transformed raw data into data used in analysis ) , and identified the necessary and /or sufficient combinations of BCTs and implementation features found in effective interventions . Results Our application of QCA for each substantive analysis is described in detail . We extended the original review findings by identifying seven combinations of BCTs and four combinations of implementation features that were sufficient for improving adherence . We found reasonable alignment between several systematic review steps and processes used in QCA except that typical approaches to study abstract ion for some intervention components and features did not support a robust calibration for QCA . Conclusions QCA was suitable for use within a systematic review of medication adherence interventions and offered insights beyond the single dimension stratifications used in the original completed review . Future prospect i ve use of QCA during a review is needed to determine the optimal way to efficiently integrate QCA into existing approaches to evidence synthesis of complex interventions Purpose Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction ( BPO ) . Nowadays , modified surgical techniques and non-ablative techniques have emerged with the aim of preserving ante grade ejaculation . Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques , and mini-invasive non-ablatives techniques for BPO management . Methods A systematic review of the literature was carried out on the PubMed data base using the following MESH terms : “ Prostatic Hyperplasia/surgery ” and “ Ejaculation ” , in combination with the following keywords : “ ejaculation preservation ” , “ photoselective vaporization of the prostate ” , “ photoselective vapo-enucleation of the prostate ” , “ holmium laser enucleation of the prostate ” , “ thulium laser ” , “ prostatic artery embolization ” , “ urolift ” , “ rezum ” , and “ aquablation ” . Results The ejaculation preservation rate of modified-TURP ranged from 66 to 91 % . The ejaculation preservation rate of  modified-prostate photo-vaporization  ranged from 87 to 96 % . The only high level of evidence studies available compared prostatic urethral lift ( PUL ) and aquablation versus regular TURP in prospect i ve r and omized-controlled trials . The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34 % , respectively . Conclusions Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions Background The prevalence of obesity in men is rising , but they are less likely than women to engage in existing weight management programmes . The potential of professional sports club setting s to engage men in health promotion activities is being increasingly recognised . This paper describes the development and optimization of the  Football Fans in Training ( FFIT ) programme , which aims to help overweight men ( many of them football supporters ) lose weight through becoming more active and adopting healthier eating habits . Methods The MRC Framework for the design and evaluation of complex interventions was used to guide programme development in two phases . In Phase 1 , a multidisciplinary working group developed the pilot programme ( p-FFIT ) and used a scoping review to summarize previous research and identify the target population . Phase 2 involved a process evaluation of p-FFIT  in 11 Scottish Premier League ( SPL ) clubs . Participant and coach feedback , focus group discussion s and interviews explored the utility/acceptability of programme components and suggestions for changes . Programme session observations identified examples of good practice and problems/issues with delivery . Together , these findings informed redevelopment of the optimized programme ( FFIT ) , whose components were mapped onto specific behaviour change techniques using an evidence -based taxonomy . Results p-FFIT comprised 12 , weekly , gender-sensitised , group-based weight management classroom and ‘ pitch-side ’ physical activity sessions . These in-stadia sessions were complemented by an incremental , pedometer-based walking programme . p-FFIT was targeted at men aged 35 - 65 years with body mass index ≥ 27 kg/m2 . Phase 2 demonstrated that participants in p-FFIT were enthusiastic about both the classroom and physical activity components , and valued the camaraderie and peer-support offered by the programme . Coaches appreciated the simplicity of the key healthy eating and physical activity messages . Suggestions for improvements that were incorporated into the optimized FFIT programme included : more varied in-stadia physical activity with football-related components ; post-programme weight management support ( emails and a reunion session ) ; and additional training for coaches in SMART goal setting and the pedometer-based walking programme . Conclusions The Football Fans in Training programme is highly acceptable to participants and SPL coaches , and is appropriate for evaluation in a r and omised controlled trial Background Method ological guidelines for intervention reporting emphasise describing intervention content in detail . Despite this , systematic review s of quality improvement ( QI ) implementation interventions continue to be limited by a lack of clarity and detail regarding the intervention content being evaluated . We aim ed to apply the recently developed Behaviour Change Techniques Taxonomy version 1 ( BCTTv1 ) to trials of implementation interventions for managing diabetes to assess the capacity and utility of this taxonomy for characterising active ingredients . Methods Three psychologists independently coded a r and om sample of 23 trials of healthcare system , provider- and /or patient-focused implementation interventions from a systematic review that included 142 such studies . Intervention content was coded using the BCTTv1 , which describes 93 behaviour change techniques ( BCTs ) grouped within 16 categories . We supplemented the generic coding instructions within the BCTTv1 with decision rules and examples from this literature . Results Less than a quarter of possible BCTs within the BCTTv1 were identified . For implementation interventions targeting providers , the most commonly identified BCTs included the following : adding objects to the environment , prompts/cues , instruction on how to perform the behaviour , credible source , goal setting ( outcome ) , feedback on outcome of behaviour , and social support ( practical ) . For implementation interventions also targeting patients , the most commonly identified BCTs included the following : prompts/cues , instruction on how to perform the behaviour , information about health consequences , restructuring the social environment , adding objects to the environment , social support ( practical ) , and goal setting ( behaviour ) . The BCTTv1 mapped well onto implementation interventions directly targeting clinicians and patients and could also be used to examine the impact of system-level interventions on clinician and patient behaviour . Conclusions The BCTTv1 can be used to characterise the active ingredients in trials of implementation interventions and provides specificity of content beyond what is given by broader intervention labels . Identification of BCTs may provide a more helpful means of accumulating knowledge on the content used in trials of implementation interventions , which may help to better inform replication efforts . In addition , prospect i ve use of a behaviour change techniques taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective implementation interventions Background Despite the availability of evidence -based guidelines for the management of mild traumatic brain injury in the emergency department ( ED ) , variations in practice exist . Interventions design ed to implement recommended behaviours can reduce this variation . Using theory to inform intervention development is advocated ; however , there is no consensus on how to select or apply theory . Integrative theoretical frameworks , based on syntheses of theories and theoretical constructs relevant to implementation , have the potential to assist in the intervention development process . This paper describes the process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention . Methods A stepped approach was followed : ( i ) identification of locally applicable and actionable evidence -based recommendations as targets for change , ( ii ) selection and use of two theoretical frameworks for identifying barriers to and enablers of change ( Theoretical Domains Framework and Model of Diffusion of Innovations in Service Organisations ) and ( iii ) identification and operationalisation of intervention components ( behaviour change techniques and modes of delivery ) to address the barriers and enhance the enablers , informed by theory , evidence and feasibility/acceptability considerations . We illustrate this process in relation to one recommendation , prospect i ve assessment of post-traumatic amnesia ( PTA ) by ED staff using a vali date d tool . Results Four recommendations for managing mild traumatic brain injury were targeted with the intervention . The intervention targeting the PTA recommendation consisted of 14 behaviour change techniques and addressed 6 theoretical domains and 5 organisational domains . The mode of delivery was informed by six Cochrane review s. It was delivered via five intervention components : ( i ) local stakeholder meetings , ( ii ) identification of local opinion leader teams , ( iii ) a train-the-trainer workshop for appointed local opinion leaders , ( iv ) local training workshops for delivery by trained local opinion leaders and ( v ) provision of tools and material s to prompt recommended behaviours . Conclusions Two theoretical frameworks were used in a complementary manner to inform intervention development in managing mild traumatic brain injury in the ED . The effectiveness and cost-effectiveness of the developed intervention is being evaluated in a cluster r and omised trial , part of the Neurotrauma Evidence Translation ( NET ) program Background There is increasing interest in innovative methods to carry out systematic review s of complex interventions . Theory-based approaches , such as logic models , have been suggested as a means of providing additional insights beyond that obtained via conventional review methods . Methods This paper reports the use of an innovative method which combines systematic review processes with logic model techniques to synthesis e a broad range of literature . The potential value of the model produced was explored with stakeholders . Results The review identified 295 papers that met the inclusion criteria . The papers consisted of 141 intervention studies and 154 non-intervention quantitative and qualitative articles . A logic model was systematic ally built from these studies . The model outlines interventions , short term outcomes , moderating and mediating factors and long term dem and management outcomes and impacts . Interventions were grouped into typologies of practitioner education , process change , system change , and patient intervention . Short-term outcomes identified that may result from these interventions were changed physician or patient knowledge , beliefs or attitudes and also interventions related to changed doctor-patient interaction . A range of factors which may influence whether these outcomes lead to long term change were detailed . Dem and management outcomes and intended impacts included content of referral , rate of referral , and doctor or patient satisfaction . Conclusions The logic model details evidence and assumptions underpinning the complex pathway from interventions to dem and management impact . The method offers a useful addition to systematic review method ologies . Trial registration number PROSPERO registration number : CRD42013004037 Background Computerized clinical decision support systems are information technology-based systems design ed to improve clinical decision-making . As with any healthcare intervention with cl aims to improve process of care or patient outcomes , decision support systems should be rigorously evaluated before widespread dissemination into clinical practice . Engaging healthcare providers and managers in the review process may facilitate knowledge translation and uptake . The objective of this research was to form a partnership of healthcare providers , managers , and research ers to review r and omized controlled trials assessing the effects of computerized decision support for six clinical application areas : primary preventive care , therapeutic drug monitoring and dosing , drug prescribing , chronic disease management , diagnostic test ordering and interpretation , and acute care management ; and to identify study characteristics that predict benefit . Methods The review was undertaken by the Health Information Research Unit , McMaster University , in partnership with Hamilton Health Sciences , the Hamilton , Niagara , Haldim and , and Brant Local Health Integration Network , and pertinent healthcare service teams . Following agreement on information needs and interests with decision-makers , our earlier systematic review was up date d by search ing Medline , EMBASE , EBM Review data bases , and Inspec , and review ing reference lists through 6 January 2010 . Data extraction items were exp and ed according to input from decision-makers . Authors of primary studies were contacted to confirm data and to provide additional information . Eligible trials were organized according to clinical area of application . We included r and omized controlled trials that evaluated the effect on practitioner performance or patient outcomes of patient care provided with a  computerized clinical decision support system compared with patient care without such a system . Results Data will be summarized using descriptive summary measures , including proportions for categorical variables and means for continuous variables . Univariable and multivariable logistic regression models will be used to investigate associations between outcomes of interest and study specific covariates . When reporting results from individual studies , we will cite the measures of association and p-values reported in the studies . If appropriate for groups of studies with similar features , we will conduct meta-analyses . Conclusion A decision-maker- research er partnership provides a model for systematic review s that may foster knowledge translation and uptake Physical activity during pregnancy has been associated with significant health benefits ; however , most women in the United States do not meet the current guidelines . This systematic review evaluates evidence for interventions to improve physical activity during pregnancy in order to identify best practice s and inform future research . Electronic data bases ( PubMed , CINAHL , SportD ISCUS , Embase , ERIC , Psych Info , and ISI Web of Science ) were search ed in July 2011 for peer- review ed journal articles . Studies were included if they were English- language r and omized control trials that measured the efficacy of an intervention targeted at pregnant women and were design ed to change physical activity as a primary or secondary outcome . Out of 777 studies identified through the systematic search , 9 interventions were selected for inclusion by multiple review ers . Data were abstract ed using an abstract ion form modeled after the “ Guide to Community Preventive Services . ” Of the 9 interventions included in the review , 3 reported statistically significant positive results for physical activity . Although the interventions included a variety of strategies and techniques , none were uniquely associated with positive outcomes . Overall , this review suggests that little is known about the efficacy of interventions for physical activity during pregnancy . This study provides several recommendations for future research and intervention design AIM To produce dietetic guidelines summarizing the systematic review evidence on dietary advice for secondary prevention of cardiovascular disease . METHODS The Cochrane Library , MEDLINE and EMBASE were comprehensively search ed for systematic review s on aspects of diet and heart health . Review s were included if they search ed systematic ally for r and omised controlled trials relating to diet and secondary prevention of cardiovascular disease . Two members of the UK Heart Health and Thoracic Dietitians Group critically appraised each review . The quality and results of each review were discussed and summarized in a whole group meeting . The guidelines were trialled in seven dietetic departments and modified where necessary . RESULTS Providing evidence -based dietary information ( including increasing omega-3 fat plus fruit and vegetable intake ) to all people after myocardial infa rct ion will save more lives than concentrating dietary advice on those in need of weight loss or lipid lowering . The practice of prioritizing dietetic time to those with raised lipids is out of date since the advent of statin therapy . CONCLUSION There is good systematic review evidence that dietary advice to those with cardiovascular disease can reduce mortality and morbidity as well as modify risk factors .  Dietary advice that does this most effectively should be prioritized Background Process evaluation is important for improving theories of behavior change and behavioral intervention methods . The present study reports on the process outcomes of a pilot test of the theoretical model ( the Process Model for Lifestyle Behavior Change ; PMLBC ) underpinning an evidence -informed , theory-driven , group-based intervention design ed to promote healthy eating and physical activity for people with high cardiovascular risk . Methods 108 people at high risk of diabetes or heart disease were r and omized to a group-based weight management intervention targeting diet and physical activity plus usual care , or to usual care . The intervention comprised nine group based sessions design ed to promote motivation , social support , self-regulation and underst and ing of the behavior change process . Weight loss , diet , physical activity and theoretically defined mediators of change were measured pre-intervention , and after four and 12 months . Results The intervention result ed in significant improvements in fiber intake ( M between-group difference = 5.7 g/day , p < .001 ) but not fat consumption ( −2.3 g/day , p = 0.13 ) , that were predictive of weight loss at both four months ( M between-group difference = −1.98 kg , p < .01 ; R2 = 0.2 , p < 0.005 ) , and 12 months ( M difference = −1.85 kg , p = 0.1 ; R2 = 0.1 , p < 0.01 ) . The intervention was successful in improving the majority of specified mediators of behavior change , and the predicted mechanisms of change specified in the PMBLC were largely supported . Improvements in self-efficacy and underst and ing of the behavior change process were associated with engagement in coping planning and self-monitoring activities , and successful dietary change at four and 12 months . While participants reported improvements in motivational and social support variables , there was no effect of these , or of the intervention overall , on physical activity . Conclusions The data broadly support the theoretical model for supporting some dietary changes , but not for physical activity . Systematic intervention design allowed us to identify where improvements to the intervention may be implemented to promote change in all proposed mediators . More work is needed to explore effective mechanisms within interventions to promote physical activity behavior BACKGROUND Correctly staging lung cancer is important because the treatment options and prognosis differ significantly by stage . Several noninvasive imaging studies and invasive tests are available . Underst and ing the accuracy , advantages , and disadvantages of the available methods for staging non-small cell lung cancer is critical to decision-making . METHODS Test accuracies for the available staging studies were up date d from the second iteration of the American College of Chest Physicians Lung Cancer Guidelines . Systematic search es of the MEDLINE data base were performed up to June 2012 with the inclusion of selected meta-analyses , practice guidelines , and review s. Study design s and results are summarized in evidence tables . RESULTS The sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were approximately 55 % and 81 % , respectively , confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis . For PET scanning , estimates of sensitivity and specificity for identifying mediastinal metastasis were approximately 77 % and 86 % , respectively . These findings demonstrate that PET scanning is more accurate than CT scanning , but tissue biopsy is still required to confirm PET scan findings . The needle techniques endobronchial ultrasound-needle aspiration , endoscopic ultrasound-needle aspiration , and combined endobronchial ultrasound/endoscopic ultrasound-needle aspiration have sensitivities of approximately 89 % , 89 % , and 91 % , respectively . In direct comparison with surgical staging , needle techniques have emerged as the best first diagnostic tools to obtain tissue . Based on r and omized controlled trials , PET or PET-CT scanning is recommended for staging and to detect unsuspected metastatic disease and avoid noncurative resections . CONCLUSIONS Since the last iteration of the staging guidelines , PET scanning has assumed a more prominent role both in its use prior to surgery and when evaluating for metastatic disease . Minimally invasive needle techniques to stage the mediastinum have become increasingly accepted and are the tests of first choice to confirm mediastinal disease in accessible lymph node stations . If negative , these needle techniques should be followed by surgical biopsy . All abnormal scans should be confirmed by tissue biopsy ( by whatever method is available ) to ensure accurate staging . Evidence suggests that more complete staging improves patient outcomes Background Two primary factors that contribute to obesity are unhealthy eating and sedentary behavior  . These behaviors are particularly difficult to change in the long-term because they are often enacted habitually . Cognitive Remediation Therapy has been modified and applied to the treatment of obesity ( CRT-O ) with preliminary results of a r and omized controlled trial demonstrating significant weight loss and improvements in executive function . The objective of this study was to conduct a secondary data analysis of the CRT-O trial to evaluate whether CRT-O reduces unhealthy habits that contribute to obesity via improvements in executive function . Method Eighty participants with obesity were r and omized to CRT-O or control . Measures of executive function ( Wisconsin Card Sort Task and Trail Making Task ) and unhealthy eating and sedentary behavior habits were administered at baseline , post-intervention and at 3 month follow-up . Results Participants receiving CRT-O demonstrated improvements in both measures of executive function and reductions in both unhealthy habit outcomes compared to control . Mediation analyses revealed that change in one element of executive function performance ( Wisconsin Card Sort Task perseverance errors ) mediated the effect of CRT-O on changes in both habit outcomes . Conclusion These results suggest that the effectiveness of CRT-O may result from the disruption of unhealthy habits made possible by improvements in executive function . In particular , it appears that cognitive flexibility , as measured by the Wisconsin Card Sort task , is a key mechanism in this process . Improving cognitive flexibility may enable individuals to capitalise on interruptions in unhealthy habits by adjusting their behavior in line with their weight loss goals rather than persisting with an unhealthy choice . Trial registration The RCT was registered with the Australian New Zeal and Registry of Clinical Trials ( trial i d : ACTRN12613000537752 )
A wide range of techniques have been evaluated and some show promise for use in weight management interventions .
OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .