Manuscritos científicos en formato RAW: Desarrollo de un modelo para la presentación de las evidencias en actuaciones de salud comunitaria

En el año 2011 se remitió el siguiente manuscrito para la sección “Notas metodológicas” de Gaceta Sanitaria. En él se trataba de presentar una pequeña herramienta que pudiera servir como modelo de la presentación de la evidencia científica de diferentes actividades comunitarias en salud incluidas en Asturias Actúa en Salud (un proyecto desarrollado desde el Observatorio de Salud en Asturias de la Dirección General de Salud Pública de Asturias). Sobre sobre todo pensando en posibles trabajos colaborativos con redes de actuaciones comunitarias en salud (el proyecto de trabajo que se describe sigue en marcha y este año se ha iniciado un proceso colaborativo con el PACAP)
El artículo no fue aceptado para su publicación. Aunque llevamos tiempo (Blanca Botello y yo) con la idea de poder retomar los consejos de los revisores, y de estructurar mejor algunos aspectos, no hemos sido capaces de ponernos a ello.
He pensado que mientras tanto (si hay un tanto!) una buena forma de compartir el texto es colgarlo en el blog en “formato RAW“. Es decir, dejarlo disponible en formato “crudo” y en abierto, con sus imperfecciones y perfecciones, pero tal cual fue remitido a Gaceta Sanitaria y con la apreciación editorial y los comentarios enviados de los dos revisores.
Esperamos que pueda ser de cierta utilidad y que los comentarios ayuden, como a nosotros nos ayudaron, para seguir aprendiendo sobre el tema.

Acceso al texto íntegro del manuscrito
Figuras del manuscrito
Acceso al comentario editorial.
Comentarios revisor/a #1
Comentarios revisor/a #2 (Se han mantenido los datos anonimizados)

Título:
Desarrollo de un modelo para la presentación de las evidencias en actuaciones de salud comunitaria

Autores:
Blanca Botello (1), Rafael Cofiño (2)(3)

Resumen:
Durante el desarrollo de la Estrategia para la Participación Comunitaria de Salud en Asturias se elabora una red con diferentes actividades comunitarias en salud (ACS). La caracterización de cada una de ellas se realiza incluyendo una descripción del proyecto, geolocalización, vínculo con estrategias del plan de salud, con determinantes de salud y la valoración de los niveles de evidencia y efectividad.
La descripción de este último punto en las ACS constituye uno de los elementos nucleares. Para ello se desarrolla una herramienta metodológica inspirada en modelos de referencia de Salud Pública basada en la Evidencia, y utilizando una secuencia de pregunta, búsqueda (tipo de publicación, contextos cercanos, aceptación y transferibilidad) y evaluación crítica.
El modelo de caracterización y descripción de las ACS incluidas en la red de salud comunitaria de Asturias, así como la herramienta metodológica para la revisión de evidencias presentado podrían servir como criterios para la unificación de las diferentes redes de salud comunitaria que se desarrollan en nuestro contexto

Palabras clave:
Salud Publica basada en la evidencia; Salud Comunitaria; Promoción de la Salud

Agradecer finalmente a Gaceta Sanitaria y a todo su equipo el enorme trabajo realizado para mantener una publicación científica en el ámbito de la salud pública.

(1) Servicio de Medicina Preventiva y Salud Pública. Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva (UCEIMP). Hospital Universitario Virgen del Rocío. Sevilla. (2) Servicio de Salud Poblacional. Dirección General de Salud Pública y Participación. Gobierno de Asturias (3) Programa de Actividades Comunitarias en Atención Primaria (PACAP). Sociedad Española de Medicina Familiar y Comunitaria

La calidad en promoción de la salud

Presentación realizada por Javier Gállego Diéguez , de la Dirección General de Salud Pública de Aragón, en I Simposium Promoción de la Salud en el Arco Mediterráneo. Girona, 29 y 30 de mayo de 2012.
Javier Gállego y el trabajo que viene realizando su equipo desde hace tiempo en promoción de la salud en Aragón, es una de las grandes referencias en esta materia en nuestro país.

Interventions targeting social isolation in older people

Vía PulsE

With an increasing proportion of older people in the population, addressing social isolation in this group is a public health concern. This review looked at 32 studies (16 RCTs and 16 quasi-experimental) assessing the effectiveness of interventions designed to address social isolation and/or loneliness in older people. Interventions were delivered in groups (n=19), one-to-one (n=11), and a combination of group and one-to-one (n=1), and one provided an alternative type of nursing home care. The interventions were categorised as offering activities, support, internet training, home visiting or service provision. Three outcome domains were considered – social, mental and physical health. An improvement in at least one outcome domain was shown in 79% of group-based interventions, compared to 55% with one-to-one interventions. Participatory interventions and those classified as having a theoretical basis were more likely to show a beneficial effect than non-participatory interventions or those without a theoretical basis. The reviewers concluded that future interventions incorporating all of these three factors (group-based, participatory and with a theoretical basis) may be more successful at targeting social isolation.

Dickens AP, Richards SH, Greaves CJ, Campbell JL. Interventions targeting social isolation in older people: a systematic review. BMC Public Health 2011;11:647.

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¿Cómo podemos conocer las evidencias científicas de nuestras actuaciones comunitarias en salud?

Technical report de los ECDC. Evidence-based methodologies for public health. How to assess the best available evidence when time is limited and there is lack of sound evidence
Texto muy interesante que hemos conocido a través Blanca Botello, compañera preventivista y salubrista  andaluza, con la que tuvimos la suerte de poder desarrollar la herramienta metodológica para iniciar la revisión de las evidencias de las actividades comunitarias de la red “Asturias Actúa”
El esquema básico que utilizamos,siguiendo la bibliografía disponible, es el siguiente:

(Botello B. Cofiño R. Desarrollo de un modelo para la presentación de las evidencias en actuaciones de Salud Comunitaria)

El texto original de la “herramienta” se envió a Gaceta Sanitaria pero debido a que el manuscrito no estaba suficientemente bien desarrollado y estructurado para comprender su pertinencia en nuestro entorno y debido a la gran cantidad de manuscritos remitidos en GS, no fue aceptado para publicación.

De todas formas con las aportaciones realizadas por diferentes compañeros y revisores trataremos de difundirlo lo más pronto posible para que sirva como herramienta para las personas que trabajan en la construcción de evidencias, como bien dice el texto del ECDC, y como nos pasaba en Asturias, en escenarios de tiempos (y recursos limitados.

Bibliografía de referencia:

(1). Proyecto de desarrollo del Observatorio de Salud en Asturias.  Dirección General de Salud Pública y Participación. Consejería de Salud y Servicios Sanitarios. Gobierno de Asturias; 2011.

(2) Population Health Institute. University of Wisconsin. What Works for Health - An Evidence Based Resource. Policies and Programs to Improve Wisconsin´s Health [Internet].  [cited 2010 Jul 20]; Disponible en:  http://whatworksforhealth.wisc.edu/

 (3). Weightman A, NHS Health Development Agency. Grading evidence and recommendations for public health interventions: developing and piloting a framework [Internet].  London: Health Development Agency; 2005. Available from:  http://saludcomunitaria.files.wordpress.com/2007/01/grading_evidence.pdf 

 (4). NICE public health guidance. Community engagement to improve health [Internet]. 2008 Feb [cited 2010 Feb 7];Available from: http://guidance.nice.org.uk/PH9/Guidance/doc/English 

(5) Cofiño Fernández R, Alvarez Muñoz B, Fernández Rodríguez S, Hernández Alba R. Promoción de la salud basada en la evidencia: ¿realmente funcionan los programas de salud comunitarios?. Aten Primaria. 2005 May 31;35(9):478- 483. 

(6) Morales Asencio J. Salud Pública basada en la evidencia. Recursos sobre la efectividad de intervenciones en la comunidad. Rev Esp Salud Pública. 2008;82(1):5-20 

(7) Jenicek M, Stachenko S. Evidence-based public health, community medicine, preventive care. Med. Sci. Monit. 2003 Feb;9(2):SR1-7  

(8) Mikton C, Butchart A. Child maltreatment prevention: a systematic review of reviews. Bull World Health Org. 2009 5;87(5):353-361

(9)  Buffett, Ciliska, Thomas. Tool for Assessing Applicability and Transferability of Evidence. [Internet] Hamilton: National Collaborating Centre for Methods and Tools (NCCMT), 2007. Available from: : http://www.nccmt.ca/pubs/A&T_Tool_-
_FINAL_English_Oct_07.pdf.

Consumer-oriented interventions for evidence-based prescribing and medicines use: an overview of systematic reviews

Vía Sax Institute: PulsE e-bulletin evidence

Numerous systematic reviews exist on interventions to improve consumers’ medicines use, but this research is distributed across diseases, populations and settings. Such differences create challenges for decision makers seeking review-level evidence to inform decisions about medicines use. The objective of the review was to synthesise the evidence from systematic reviews on the effects of interventions which target healthcare consumers to promote evidence-based prescribing for, and medicines use by, consumers. Evidence on the effects on health and other outcomes for healthcare consumers, professionals and services was considered. The review included 37 reviews (18 Cochrane, 19 non-Cochrane). Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation, skills acquisition and information provision. Medicines adherence was the most commonly reported outcome, but others such as clinical (health and wellbeing), service use and knowledge outcomes were also reported. The evidence was sparse for several populations, including children and young people, carers, and people with multi-morbidity. Promising interventions to improve adherence and other key medicines use outcomes (e.g. adverse events, knowledge) included self-monitoring and self-management, simplified dosing and interventions directly involving pharmacists. Other strategies including reminders, education combined with self-management skills training and counselling, showed promise in relation to adherence but their effects were less consistent. For some interventions, such as information or education provided alone, the evidence suggested ineffectiveness; for many others there was insufficient evidence to determine effects on medicines use outcomes. No interventions were found to be effective to improve all medicines use outcomes across all diseases, populations or settings. Despite the large number of included reviews there are many gaps in the assembled evidence on medicines use strategies, such as those focussing on children, young people or carers, or those for people with more than one coexisting health problem. The authors concluded that decision makers faced with implementing interventions to improve consumers’ medicines use can use this overview to inform these decisions and also to consider the range of interventions available; while researchers and funders can use this overview to determine where research is needed. However, the limitations of the literature relating to the lack of evidence for important outcomes and specific populations, should also be considered.

Ryan R, Santesso N, Hill S, Lowe D, Kaufman C, Grimshaw J. Consumer-oriented interventions for evidence-based prescribing and medicines use: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2011, Issue 5.

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007768/frame.html

Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations

Vía Sax Institute: PulsE e-bulletin evidence

The prevention of falls and mobility-related disability among older people is an urgent public health challenge, with one third of people aged 65 and over falling once or more annually. Due to increasing proportions of older people in the population, the impact of falls on older individuals, their carers and health services will continue to grow into the future. Trials and systematic reviews have provided clear evidence that falls in older people can be prevented with appropriately designed interventions. This systematic review update includes 54 randomised controlled trials, including 10 additional eligible trials, and focuses on exercise as a single falls prevention intervention. The findings of the meta-analysis remained unchanged, confirming that that exercise as a single intervention can prevent falls (RR 0.84, 95% CI: 0.77 to 0.91). Programs that included balance training, contained a higher dose of exercise and did not include walking training had the greatest effect on reducing falls. However trials with and without walking training led to a reduction in falls if they also included balance training and a high dose of exercise. An exploratory meta-analysis from trials conducted in residential care settings found that exercise resulted in a 7% reduction in fall rates (RR 0.93, 95% CI: 0.78 to 1.11). The authors recommend that exercise for falls prevention should provide a moderate or high challenge to balance, must be of a sufficient dose to have an effect and be undertaken for at least 2 hours per week on an ongoing basis. Additionally it is recommended that falls prevention exercise should be targeted at the general community as well as those at high risk for falls, and that walking training may be included in addition to balance training, but high risk individuals should not be prescribed brisk walking programs. The authors suggest that the above recommendations also apply to people in residential aged care and  to people with cognitive impairment, however modification of implementation approaches are required to ensure safety and efficacy of exercise interventions in residential care settings and for those with cognitive impairment.

Sherrington C, Tiedemann A, et al. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bulletin 2011;22(4):78-83.

http://www.publish.csiro.au/view/journals/dsp_journal_fulltext.cfm?nid=226&f=NB10056

Printed educational materials: effects on professional practice and health care outcomes

Vía Sax Institute: PulsE e-bulletin evidence

Printed educational materials (PEMs) are widely used passive dissemination strategies to improve knowledge, awareness, attitudes, skills, professional practice and patient outcomes. Traditionally they are presented in paper formats such as monographs, publication in peer-reviewed journals and clinical guidelines, and appear to be the most frequently adopted method for disseminating information. The objective of this review was to determine the effectiveness of printed educational materials (PEMs) in improving process outcomes (including the behaviour of healthcare professionals) and patient outcomes, and to explore whether particular characteristics of PEMs (e.g. source, content, format, mode of delivery, timing/frequency, complexity of targeted behaviour change) can influence process outcomes. The review included RCTs, controlled clinical trials, controlled before and after studies and interrupted time series analyses that evaluated the impact of printed educational materials on healthcare professionals’ practice and/or patient outcomes. Any objective measures of professional performance (e.g. number of tests ordered, prescriptions for a particular drug), or patient health outcomes (e.g. blood pressure) were included. Twenty-three studies were included in this review. Evidence indicated that PEMs appear to have small beneficial effects on professional practice. RCTs comparing PEMs to no intervention observed an absolute risk difference median: +4.3% on categorical process outcomes (e.g. x-ray requests, prescribing and smoking cessation activities) (range -8.0%to +9.6%, 6 studies), and a relative risk difference +13.6% on continuous process outcomes (e.g. medication change, x-rays requests per practice) (range -5.0% to +26.6%, 4 studies). In contrast, the median effect size was -4.3% for patient outcome categorical measures (e.g. screening, return to work, quit smoking) (range -0.4% to -4.6%, 3 studies). Two studies reported deteriorations in continuous patient outcome data of depression score, smoking cessation attempts. One study comparing PEMs with educational workshops observed minimal differences. Two studies comparing PEMs and education outreach did not have statistically significant differences between the groups. The authors concluded that when compared to no intervention, PEMs when used alone may have a beneficial effect on process outcomes but not on patient outcomes. However the clinical significance of the observed effect sizes is not known and there is insufficient information about how to optimise educational materials. It is also not known under what circumstances and contexts PEMs are more effective or what specific characteristics of printed educational materials make them more effective.

Farmer AP, Légaré F, Turcot L, Grimshaw J, Harvey E, McGowan J, Wolf FM. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008, Issue 3.

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004398/frame.html

Monografía sobre evaluacion en Salud Publica

Monográfico publicado en Gaceta Sanitaria sobre “Evaluación en Salud Pública“.

- Valorando la efectividad de las intervenciones en salud pública: la fuerza de los «diseños evaluativos débiles»
Manel Nebot y César Victora
- Evaluación de la efectividad en salud pública: fundamentos conceptuales y metodológicos
Manel Nebot, Mª José López, Carles Ariza, Joan R. Villalbí y Anna García-Altés
- Diseños evaluativos en salud pública: aspectos metodológicos
Mª José López, Marc Marí-Dell’Olmo, Anna Pérez-Giménez y Manel Nebot
- Evaluación de políticas y planes de salud
Joan R. Villalbí y Ricard Tresserras
- Evaluación económica de intervenciones de salud pública
Anna García-Altés, Encarna Navas y Mª Jesús Soriano
- La evaluación del proceso en relación con la evaluación de la efectividad: experiencias de programas en el medio escolar
Carles Ariza, Joan R. Villalbí, Francesca Sánchez-Martínez y Manel Nebot
- La evaluación de tecnologías sanitarias en intervenciones de salud pública: ¿más vale prevenir que curar?
Mireia Espallargues, Joan M.V. Pons, Caridad Almazán y Oriol de Solà-Morales
- Evaluación de la efectividad de los programas de vacunación
Eva Borràs, Àngela Domínguez y Lluis Salleras

Guías, evidencias y causas de las causas en Salud Bucodental

Presentación realizada con Jose María Blanco (responsable del Programa de Salud Bucodental en Asturias) en el XVIII Congreso Nacional de la Sociedad Española de Epidemiología y Salud Pública Oral, el pasado día 02 de abril del 2011.

Una reflexión sobre las guías de práctica clínica, las guías en salud pública, la evidencia, las causas de las causas de la caries (al estilo Diez-Roux) y alguna que otra cosa más…

El arte de la guerra

“Por tanto, existen cinco maneras de conocer al futuro vencedor. Ganan los que saben cuándo luchar y cuándo no. Los que saben discernir cuando utilizar muchas o pocas tropas. Los que tienen tropas cuyos rangos superiores o inferiores tienen el mismo propósito. Los que se enfrentan con preparativos a enemigos desprevenidos. Los que tienen generales competentes y no están limitados por sus gobiernos. Estas cinco con las maneras de conocer al futuro vencedor”

El arte de la Guerra. Sun Tzu. Versión de Thomas Cleary

vía @fmiguelgarcia

Nuevo número de PulsE: evidencias en salud pública

PulsE is a quarterly eBulletin that provides information about newly published systematic reviews of public health and health services interventions. The reviews are drawn from a range of open access sources and are selected for inclusion in the eBulletin because of their relevance to local health policy priorities. More information about the development of PulsE is available here.

Click here to subscribe to PulsE.

Previous issues of the eBulletin can be viewed in the PulsE archive, and a print version of the current issue can be downloaded Click Here.

 

The effectiveness of interventions to change six health behaviours: a review of reviews

Several world health organisation reports over recent years have highlighted the high incidence of chronic diseases. The aim of this review was to systematically collate, evaluate and synthesize review-level findings on the effectiveness of interventions to change unhealthy behaviours or promote healthy behaviours (…)

Jepson R G, Harris F M, PlattS, Tannahill C. The effectiveness of interventions to change six health behaviours: a review of reviews. BMC Public Health 2010,10:538

http://www.biomedcentral.com/1471-2458/10/538/abstract/

Interventions to increase influenza vaccination rates of those 60 years and older in the community

Although influenza vaccination is promoted by many health authorities,   there is uncertainty about the effectiveness of interventions to increase influenza vaccination rates in those people 60 years or older in the general population (…)

Thomas RE, Russell M, Lorenzetti D. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2010, Issue 9.

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005188/frame.html

 

Influenza vaccination for healthcare workers who work with the elderly

Health care workers influenza rates, although currently unknown, may be similar to  the general population’s and may contribute to transmission of influenza among patients. The objective of the review was to identify studies of vaccinating health care workers and its effect on the incidence of influenza its complications and influenza-like illness (ILI) in individuals in long term care facilities who are aged 60 years and older (…)

Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who work with the elderly. Cochrane Database of Systematic Reviews 2010, Issue 2.

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005187/frame.html

Interactive computer-based interventions (ICBI) for sexual health promotion

There is current thought that given the public health challenges of sexual health promotion, there is potential for health promotion to be delivered via technology-based mediums. The objective of the review was to determine the effects of interactive computer-based interventions for sexual health promotion, considering cognitive, behavioural, biological and economic outcomes (…)

Bailey JV, Murray E, Rait G, Mercer CH, Morris RW, Peacock R, Cassell J, Nazareth I. Interactive computer-based interventions for sexual health promotion. Cochrane Database of Systematic Reviews 2010, Issue 9.

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006483/frame.html

 

Interventions for preventing falls in older people living in the community

Approximately 30% or people over 65 years of age living in the community fall each year.   Although it may not be possible to prevent falls completely, it is possible that interventions can be implemented to enable people to fall less often. The objective of this review was to assess the effects of interventions to reduce the incidence of falls in older people living in the community (…)

Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2009, Issue 2. Comment added to review, published in Issue 10, 2010

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007146/frame.html

Reduction of diabetes risk in routine clinical practice: Are Physical Activity and Nutrition Interventions feasible and are the outcomes from reference trials replicable? A Systematic Review and meta-analysis

Although the clinical effectiveness of lifestyle interventions in preventing or delaying the onset of diabetes has been demonstrated from previous studies, the challenge is to translate them into routine clinical settings. The objective of this review was to determine whether lifestyle interventions delivered to high-risk adult patients in routine clinical care settings are feasible and effective in achieving reductions in risk factors for diabetes (…) T

Cardona-Morrell M, Rychetnik L , Morrell S L, Espinel P T, Bauman A. Reduction of diabetes risk in routine clinical practice: Are Physical Activity and Nutrition Interventions feasible and are the outcomes from reference trials replicable? A Systematic Review and meta-analysis BMC Public Health 2010, 10:653

http://www.biomedcentral.com/1471-2458/10/653/abstract

Integrando investigación cualitativa e investigación cuantitativa

En el último congreso de la Sociedad Española de Epidemiología se ha planteado de nuevo este dilema al presentar las evaluaciones de determinadas intervenciones de salud comunitaria (esa gran ausente en un congreso nacional de estas características). El dilema también se plantea a la hora de combinar, en los diagnósticos comunitarios iniciales, la información cualitativa con la información cuantitativa.

El tema es interesante y allí por el 2004 mandamos algo a Atención Primaria reflexionando sobre el tema de cómo conseguir esa aproximación cualitativa en la evaluación de intervenciones donde lo cuantitativo no es suficiente y sobre todo en términos de la evaluación de la efectividad de las intervenciones en promoción de la salud, donde las jerarquias utilizadas en la Medicina Basada en la Evidencia no sirven para la Salud Pública o la Salud Comunitaria basada en la evidencia. En esta línea una de nuestras referencias favoritas es el Grading Evidence for Public Health Interventions de los NICE.

Un artículo remitido hace unos días por María José Fernández de Sanmamed al grupo de los Seminarios de Innovación en Atención Primaria, aporta más claves sobre esta necesidad de integrar lo cuali con lo cuanti. Aquí van los dos articulitos:

View this document on Scribd

View this document on Scribd

Revisiones en Salud Pública del PulsE eBulletin

Nuevo número del PulsE eBulletin:

PulsE is a quarterly eBulletin that provides information about newly published systematic reviews of public health and health services interventions. The reviews are drawn from a range of open access sources and are selected for inclusion in the eBulletin because of their relevance to local health policy priorities. More information about the development of PulsE is available here.

Effectiveness of legislative smoking bans: Legislative smoking bans lead to a reduction in exposure to passive smoking, particularly among hospitality workers, and improved health outcomes. Read more…

Smoke-free policies to reduce tobacco use: Policies which prohibit the smoking of tobacco products are effective in reducing tobacco use when implemented in worksites and communities. Read more…

Worksite-based incentives and competitions to reduce tobacco use: Worksite-based incentives and competitions, when combined with additional interventions to support individual cessation efforts, are effective in reducing tobacco use among workers. Read more…

Effects of worksite health promotion interventions on employee diets: While worksite interventions appear to have a positive, but small, effect on dietary behaviour, more well-conducted studies are required to reliably determine their effectiveness. Read more…

Point of decision prompts to increase stair use: There is strong evidence that point-of-decision prompts contribute to modest increases in the percentage of people choosing to take the stairs rather than an elevator or escalator. Read more…

Effectiveness of primary care interventions for weight management in children and adolescents: Behavioural interventions can be effective in managing weight in obese children and adolescents, and combined behavioural-pharmacological interventions may be useful in very obese adolescents. Read more…

Revisiones sistemáticas en salud pública e intervenciones en servicios sanitarios

Número de febrero de PulsE , boletín electrónico trimestral editado por el australiano Sax Institute. El boletín presenta información las nuevas revisiones sistemáticas publicadas sobre salud pública y sobre intervenciones en servicios sanitarios.

Falls prevention in nursing homes and hospitals: Multi-factorial interventions reduce falls and risk of falling in hospitals, and may also do so in nursing care facilities. Read more…

Interventions for promoting physical activity among European teenagers: School-based physical activity promotion programs appear to be effective in the short term with European adolescents. Read more…

School-based programs to reduce bullying: The most important elements of anti-bullying programs appear to be parent training/meetings, disciplinary methods, longer program duration, and greater program intensity. Read more…

Addressing social disadvantage to reduce teenage pregnancy: Early childhood interventions and youth development programs appear to be effective for reducing unintended teenage pregnancy. Read more…

Motivational interviewing for smoking cessation: Motivational interviewing may assist smokers to quit, particularly when delivered by a general practitioner. Read more…

Psychosocial interventions for reducing injection and sexual risk behaviour among drug users: Multi-session psychosocial interventions do not appear to be more beneficial than standard education for encouraging safer injecting or sexual behaviour. Read more…

Children’s views about obesity, body size, shape and weight: Children often do not view body shape as an immediately relevant issue, and do not emphasise the health implications of being overweight. Read more…

Home-based versus centre-based cardiac rehabilitation: Cardiac rehabilitation in home and centre settings appears to be equally effective in improving clinical and quality of life outcomes. Read more…

Community Toolbox: potente recurso en la red

• Community Toolbox (en inglés)
• Caja de Herramientas Comunitaria (en castellano)

El Community Toolbox o la Caja de Herramientas Comunitaria es un potente recurso online desarrollado desde la Universidad de Kansas. El espacio se creó como una herramienta para dar información sobre elementos clave que ayuden al desarrollo de comunidades saludables. La “caja de herramientas” se agrupa en varias secciones:

- Tabla de contenidos: donde en 46 capítulos se desarrollan áreas de marcos teóricos de las actuaciones comunitarias, cómo implementar las mismas, la evaluación, cómo desarrollar estrategias de participación, planificación, etc…
- Unas guías rápidas que ante la pregunta “¿Qué desea hacer usted hoy?” facilita información sobre aspectos claves en el desarrollo de actividades comunitarias: cómo organizar una reunión o cómo evaluar problemas o detectar áreas de mejora.
- Otra serie de guías rápidas para dar respuestas a problemas que puedan ir surgiendo en el desarrollo de actividades comunitarias.
- En el apartado “Usar enfoques prometedores” se ofrecen dos recursos: el primero es una especie de ciclo de mejora continua de la calidad (figura de abajo) y secuencia de planificación, aplicado al modelo de actuacioones comunitarias donde se destacan y desarrollan 12 elementos clave del proceso. Similar, pero más desarrollado, al modelo propuesto por PACAP en sus recomendaciones para la puesta en marcha de actividades comunitarias. El segundo recurso de este apartado son diferentes enlaces a bases de datos de conocimiento sobre actuaciones comunitarias.
- Finalmente “Conectar con otros” permite hacer consultas online a asesores y acceder a diversos enlaces (nuestro blog incluido) sobre Salud Comunitaria y Promoción de la Salud.

PulsE: boletín de revisiones sistemáticas en Salud Pública

Boletín de Noviembre del PulsE (Policy relevant evidence): Quarterly eBulletin of public health and health services systematic reviews, editado desde el Sax Institute. Incluye las siguientes revisiones comentadas:

Vitamin D for fall prevention

Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. British Medical Journal 2009;339:b3692. http://www.bmj.com/cgi/content/full/339/oct01_1/b3692

Traffic calming measures to prevent road injuries

Bunn F, Collier T, Frost C, Ker K, Steinbach R, Roberts I, Wentz R. Area-wide traffic calming for preventing traffic related injuries. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003110. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003110/frame.html

Screening for breast cancer with mammography

Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD001877. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001877/frame.html

Interventions to reduce the spread of respiratory viruses

Jefferson T, Del Mar C, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Foxlee R, Rivetti A. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. Br Med J 2009;339:b3675. http://www.bmj.com/cgi/content/full/bmj.39393.510347.BEv1

School-based cognitive behavioural interventions to promote mental health

Kavanagh J, Oliver S, Caird J, Tucker H, Greaves A, Harden A, Oakley A, Lorenc T, Thomas J. Inequalities and the mental health of young people: a systematic review of secondary school-based cognitive behavioural interventions. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London; 2009. http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=2418&language=en-US

Effects of drug substitution programs on offending among drug addicts

Egli N, Pina M, Skovbo Christensen P, Aebi MF, Killias M. Effects of drug substitution programs on offending among drug-addicts. Campbell Systematic Reviews 2009:3. DOI: 10.4073/csr.2009.3. http://test.c2admin.org/download/675/

Interventions for preventing unintended pregnancies among adolescents

Oringanje C, Meremikwu MM, Eko H, Esu E, Meremikwu A, Ehiri JE. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD005215. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005215/frame.html

Home safety equipment to reduce unintentional injuries to children at home

Pearson M, Garside R, Moxham T, Anderson R. Systematic reviews of effectiveness and cost-effectiveness of home safety equipment and risk assessment schemes. Exeter UK: Peninsula Technology Assessment Group (PenTAG); August 2009. http://www.nice.org.uk/guidance/index.jsp?action=download&o=45196

Mobile phone-based interventions for smoking cessation

Whittaker R, Borland R, Bullen C, Lin RB, McRobbie H, Rodgers A. Mobile phone-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006611. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006611/frame.html

Forthcoming Reviews

Flexible working conditions and employee wellbeing (The Cochrane Collaboration)

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008009/frame.html

Cultural competency educational interventions to improve outcomes for culturally diverse individuals with disabilities (The Campbell Collaboration)

http://test.c2admin.org/download/687/

Reduction versus abrupt cessation in smokers who want to quit (The Cochrane Collaboration)

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008033/frame.html

Education focusing on sexual health and alcohol (UK National Institute for Health and Clinical Excellence)

http://www.nice.org.uk/guidance/index.jsp?action=download&o=38609

Dietary and physical exercise modification for overweight and obese adults (The Cochrane Collaboration)

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008066/frame.html

Other Resources

Database of health systems systematic reviews

The PPD/CCNC Database is a searchable repository of over 800 systematic reviews about governance, financial and delivery arrangements within health systems. The database was developed by McMaster University’s Program in Policy Decision-Making (PPD) in partnership with the Canadian Cochrane Network and Centre (CCNC). The database provides links to abstracts, user-friendly summaries and full-text reports whenever possible.

http://www.researchtopolicy.ca/Search/Reviews.aspx

PulsE: Policy relevant Evidence

PulsE es un boletín electrónico trimestral editado por el australiano Sax Institute. El boletín presenta información las nuevas revisiones sistemáticas publicadas sobre salud pública y sobre intervenciones en servicios sanitarios.

En el último número las revisiones que difunde son las siguientes:

• Effectiveness of macro-level interventions for reducing alcohol consumption
  • Goyder L, Chilcott J, Payne N, et al. Prevention and Early Identification of Alcohol Use Disorders in Adults and Young People (Report 1). Macro Level Interventions for Alcohol Use Disorders: Effectiveness Review. Sheffield: The University of Sheffield , School of Health and Related Research (ScHARR); May 2009. http://www.nice.org.uk/nicemedia/pdf/MacroLevelInterventionsEffectivenessReview.pdf
• Impact of social norms interventions on alcohol misuse among students
  • Moreira MT, Smith LA, Foxcroft D. Social norms interventions to reduce alcohol misuse in University or College students. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006748. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006748/frame.html
• Benefits of decision aids to facilitate treatment and screening decisions
  • O’Connor AM, Bennett CL, Stacey D, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD001431. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001431/frame.html
• Factors influencing participation in workplace health promotion programs
  • Robroek SJW, van Lenthe FJ, van Empelen P, Burdorf A. Determinants of participation in worksite health promotion programmes: a systematic review. International Journal of Behavioral Nutrition and Physical Activity 2009;6:26 (20 May 2009). http://www.ijbnpa.org/content/6/1/26
• Impact of point-of-care computer reminders on clinical practice
  • Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD001096. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001096/frame.html
• Effectiveness of school-based interventions to prevent smoking
  • Uthman O, Yahaya I, Pennant M, et al. School-Based Interventions to Prevent the Uptake of Smoking among Children and Young People: Effectiveness Review. Birmingham : West Midlands Health Technology Assessment Collaboration, University of Birmingham ; April 2009. http://www.nice.org.uk/nicemedia/pdf/SchoolBasedInterventionsPreventSmokingEffectivenessReviewFullReport.pdf
• Effectiveness of interventions conducted by community health workers.
  • Viswanathan M, Kraschnewski J, Nishikawa B, et al. Outcomes of Community Health Worker Interventions. Evidence Report/Technology Assessment No. 181. Rockville, MD: Agency for Healthcare Research and Quality; June 2009. http://www.ahrq.gov/downloads/pub/evidence/pdf/comhealthwork/comhwork.pdf

Suscripciones aquí:
Danielle.Campbell@saxinstitute.org.au
Números anteriores:

• Issue 1, September 2007
• Issue 2, November 2007
• Issue 3, March 2008
• Issue 4, June 2008
• Issue 5, August 2008
• Issue 6, November 2008
• Issue 7, February 2009
• Issue 8, May 2009

Evidencias en Salud Pública y Promoción de la Salud

Nos escriben a menudo preguntándonos sobre revisiones de algún que otro tema de salud pública/comunitaria.
También hay una discusión muy interesante aquí y en ciertos círculos acerca de las evidencias y sobre las evidencias de las intervenciones comunitarias o de promoción de la salud. Esta semana hemos tenido una anécdota muy simpática cuando a un grupo de residentes les pararon una propuesta de intervención comunitaria “apelando a la evidencia”.
El tema tiene miga. Este es un listado muy completito extraido del Cochrane Public Health Group con diversas websites con revisiones sistemáticas en salud pública y promoción de la salud (algunos muy específicos y al final del listado otros más generales).

Páginas web para localizar revisiones sistemáticas en Promoción de la Salud y Salud Pública

Cochrane Public Health Group
The Campbell Collaboration
Evidence for Policy and Practice Information Centre (EPPI-Centre)
Health Evidence
EvidenceNetwork
NHS Centre for Reviews and Dissemination
NHS Economic Evaluation Database
Health Evidence Bulletins – Wales
The Effective Public Health Practice Project
National Institute for  Health and Clinical Evidence – Evidence Base Information Resource
Medical Research Council Social & Public Health Sciences Unit
The Community Guide – Guide to Community Preventive Services – Systematic Reviews and Evidence-Based Recommendations
PulsE A quarterly e-bulletin that provides information about newly published systematic reviews of public health and health services interventions. The reviews are drawn from a range of sources and are selected for inclusion in the e-bulletin because of their relevance to local (Australian) health policy priorities

Informed Health Online
Centre for Reviews and Dissemination, University of York
Medical Research Council Social and Public Health Sciences Unit
NICS Guide to the Cochrane Library

Other Database Links

1. Databases available through the EPPI-Centre.

These are:

• Database of education research
• Bibliomap
• Database of Promoting Health Effectiveness Reviews (DoPHER)
• Trials Register of Promoting Health Interventions (TRoPHI)
• Database of Personal Development Planning evaluation studies
• Current Educational Research in the United Kingdom (CERUK)

2. The National Research Register
3. TRIP database
4. Knowledge Finder
5. Health Promotion Research Internet Network (HPRIN)
6. OVID databases
7. National Library for Public Health

Hacer público que se sufre un problema de salud puede tener efectos indeseables (al menos en el caso de los “famosos”)

Revisión del artículo publicado en Gestión Clínica y Sanitaria (vol 10, número 4. Invierno 2008). Comentado por Román Villegas de la Agencia de Evaluación de Tecnologías Sanitarias de Andalucía.

Artículo original: Kelaher M, Cawson J, Miller J, Kavanagh A, Dunt D, Studdert DM. Use of breast cancer screening and treatment services by Australian women aged 25-44 years following Kylie Minogue´s breast cancer diagnosis. International Journal of Epidemiology 08;37:1326-1332.

“El hecho de hacer público el diagnóstico de cáncer de mama de Kylie Minogue influyó en el comportamiento de los consumidores y de los proveedores, aumentando estos últimos el número de biopsias solicitadas sin que esto aumentara el número de intervenciones. Aunque esto puede ser una oportunidad para la salud pública, también deberían tenerse en cuenta los posibles efectos indeseables”

Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial

BMC Public Health 2009, 9:207doi:10.1186/1471-2458-9-207

Background

In London and the rest of the UK, diseases associated with poor diet, inadequate physical activity and mental illness account for a large proportion of area based health inequality. There is a lack of evidence on interventions promoting healthier behaviours especially in marginalised populations, at a structural or ecological level and utilising a community development approach. The Well London project financed by the Big Lottery ‘Wellbeing’ Fund and implemented by a consortium of London based agencies led by the Greater London Authority and the London Health Commission is implementing a set of complex interventions across 20 deprived areas of London. The interventions focus on healthy eating; healthy physical activity and mental health and wellbeing and are designed and executed with community participation complementing existing facilities and services.

Methods

The programme will be evaluated through a cluster randomised controlled trial. Forty areas across London were chosen based on deprivation scores. Areas were characterised by high proportion of Black and Minority Ethnic residents, worklessness, ill-health and poor physical environments. Twenty areas were randomly assigned to the intervention arm of Well London project and twenty ‘matched’ areas assigned as controls. Measures of physical activity, diet and mental health are collected at start and end of the project and compared to assess impact. The quantitative element will be complemented by a longitudinal qualitative study elucidating pathways of influence between intervention activities and health outcomes. A related element of the study investigates the health-related aspects of the structural and ecological characteristics of the project areas. The project ‘process’ will also be evaluated.

Discussion

The size of the project and the fact that the interventions are ‘complex’ in the sense that firstly, there are a number of interacting components with a wide range of groups and organisational levels targeted by the intervention, and secondly, a degree of flexibility or tailoring of the intervention, makes this trial potentially very useful in providing evidence of the types of activities that can be used to address chronic health problems in communities suffering from multiple deprivation. Current Controlled Trials ISRCTN68175121

Metodologías: lo que conocemos y lo que creemos conocer

(unas notas antiguas de un curso de hace un año)

- La integración de metodologías cualitativas y cuantitativas

Integrating qualitative research with trials in systematic reviews. BMJ 2004;328:1010-1012 (24 April)

- Construcción de evidencias en Salud Pública: problemas metodológicos

- Methodological Problems in Constructing the Evidence Base in Public Health

-  Grading evidence and recommendations for public health interventions: developing and piloting a framework

- Getting Evidence into Practice in Public Health: This publication describes how the Health Development Agency (HDA) has established systems and protocols to develop the evidence base in public health and to produce guidance materials based on that evidence. It also outlines the proposed basis for changing public health practice using that evidence and guidance. Several important questions are raised:

• What is the best way to develop evidence in public health?
• What is the definition of evidence?
• How may evidence best be usedto produce guidance for practice?
• What are the practicalities involved in putting evidence into practice?
• And what are the best ways of stimulating change in practice?

This account acknowledges the complexity of the processes. It also describes some of the underlying theory and debates in the fields of producing evidence of effective public health interventions, developing practical guidance, and supporting change within the evidence-into-practice cycle.

SWITCH: intervencion comunitaria y obesidad infantil en Estados Unidos

• SWITCH: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to childhood obesity
  BMC Public Health 2008, 8:223doi:10.1186/1471-2458-8-223
• SWITCH webpage
  

Background
Although several previous projects have attempted to address the issue of child obesity through school-based interventions, the overall effectiveness of school-based programs on health-related outcomes in youth has been poor. Thus, it has been suggested that multi-level interventions that aim to influence healthy lifestyle behaviors at the community, school and family levels may prove more successful in the prevention of childhood obesity.
Methods/Design
This paper describes the rationale, design, and implementation of a community-, school-, and family-based intervention aimed at modifying key behaviors (physical activity, screen time (Internet, television, video games), and nutrition) related to childhood obesity among third through fifth graders in two mid-western cities. The intervention involves a randomized study of 10 schools (5 intervention and 5 control schools). The intervention is being conducted during the duration of the academic year – approximately 9 months – and includes baseline and post-intervention measurements of physical activity, dietary intake, screen time and body composition.
Discussion
We hope this report will be useful to researchers, public health professionals, and school administrators and health professionals (nurses and physical/health educators) seeking to develop similar prevention programs. It is obvious that more collaborative, inter-disciplinary, multi-level work is needed before a proven, effective intervention package to modify behaviors related to childhood obesity can be generally recommended. It is our hope that SWITCH is a step in that direction.

Community-based interventions to reduce overweight and obesity in China

Journal of Public Health 2008 30(4):436-448; doi:10.1093/pubmed/fdm057

Background Overweight and obesity pose a challenge to public health in China. According to Chinese definition, 303 million Chinese are overweight (body mass index, BMI 24 kg m^–2). Among them, 73 million are clinically obese (BMI 28 kg m^–2). In line with the global trend, the rate of obesity in China continues to increase, with associated morbidity and mortality. This study was to identify interventions, which are effective in Mainland Chinese society.

Methods All non-drug-controlled interventions (3 months) in Mainland China, which used anthropometric outcome measures, were selected from three Chinese and nine international electronic databases (before May 2006) and included in this systematic review.

Results A total of 20 studies met the selection criteria and were included in the review. Among them only one was published in an international journal. Most studies combined at least physical activity, dietary intervention and health education. Seventeen studies (85%) reported significant effects in anthropometric measurement outcomes.

Conclusions Comprehensive interventions with at least physical activity, dietary intervention and health education may be effective in reducing obesity in Chinese children. The role of grandparents as carers in the one-child society is worth considering further. Current evidence of effective interventions for adults is limited. Publication bias in Chinese databases should be taken into account.

NICE Public Health Guidance Updated

Click on the links below to see details of all the Public health programme and intervention guidance, published or in development, in this topic area.

Completed public health programme guidance

• Behaviour change
• Community engagement
• Maternal and child nutrition
• Physical activity and the environment
• Smoking cessation services

Completed public health intervention guidance

• Brief interventions and referral for smoking cessation
• Four commonly used methods to increase physical activity
• Interventions to reduce substance misuse among vulnerable young people
• Preventing the uptake of smoking by children and young people
• Prevention of sexually transmitted infections and under 18 conceptions
• Promoting physical activity in the workplace
• School-based interventions on alcohol
• Social and emotional wellbeing in primary education
• Workplace interventions to promote smoking cessation

---

Public health programme guidance in development

• Alcohol-use disorders (prevention)
• Contraceptive services for socially disadvantaged young people
• Looked after children
• Management of long-term sickness and incapacity for work
• Personal, social and health education focusing on sex and relationships and alcohol education
• Prevention of cardiovascular disease
• Promoting physical activity for children

Public health intervention guidance in development

• Effective weight maintenance following childbirth
• Identifying and supporting people most at risk of dying prematurely
• Mental wellbeing and older people
• Needle and syringe programmes
• Preventing children’s unintentional injuries in the home
• Preventing children’s unintentional injuries on the road
• Prevention of excessive weight gain in pregnancy
• Promoting mental wellbeing at work
• Promoting young people’s social and emotional wellbeing in secondary education
• Providing public information to prevent skin cancer
• Reducing differences in the uptake of immunisations
• Reducing infant mortality among those living in disadvantaged circumstances
• School-based interventions to prevent the uptake of smoking

Guía NICE sobre Participación Comunitaria

NICE acaba de publicar dentro de su colección de guías de salud pública “Community engagement to improve health”.
La guía parte como un encargo específico realizado a NICE para conocer una guía sobre las estrategias de desarrollo y participación comunitaria para mejorar la salud.
La guía está dirigida a todas aquellas personas que trabajan de forma directa o indirecta en participación comunitaria. Esto incluye a trabajadores de autoridades locales y de la comunidad, voluntarios y sector privado.

Las recomendaciones se realizan a cuatro grandes grupos de agentes que trabajan en salud (desde el ámbito de la planificación estratégica al ámbito del desarrollo de actividades con la comunidad) y se agrupan en doce recomendaciones clave: desarrollo de políticas, organización y cambios culturales, niveles de participación y actuación,…
En el documento se señalan, así mismo, las limitaciones en las evidencias estudiadas (tanto por la limitación de estudios de investigación al respecto como las metodologías utilizadas para estudiar determinadas intervenciones).
El formato de presentación, como siempre en NICE, en versión larga y en versión rápida.
Muy interesante y una brecha más en las tecnologías sanitarias a tener en cuenta….

SMILE study

SMILE es un estudio de cohortes prospectivo con un periodo de seguimiento de 15 años, orientado a recoger información sobe aspectos de enfermedad, salud y estilos de vida de personas que viven en Eindhoven. El estudio es único en sus características, ya que la estrategia de recogida de información es combinada: por un lado datos de mortalidad, morbilidad, prescripción farmacológica y utilización de servicios sanitarios que se recogen desde archivos electrónicos que se utilizan en nueve centros de atención primaria. Por otro lado, información sobre estilos de vida y sobre determinantes de salud-enfermedad, sociodemográficos, psicológicos y características sociales y consecuencias de enfermedades crónicas. Esta segunda información se recopila periódicamente a través de cuestionarios. La población diana del estudio es de unas 30.000 personas mayores de 12 años.
Acceso a información sobre el estudio en BMC Public Health (open access)

SMILE is a large prospective cohort study, focusing on a broad range of aspects of disease, health and lifestyles of people living in Eindhoven, the Netherlands. This study is unique in its kind, because two data collection strategies are combined: first data on morbidity, mortality, medication prescriptions, and use of care facilities are continuously registered using electronic medical records in nine primary health care centers. Data are extracted regularly on an anonymous basis. Secondly, information about lifestyles and the determinants of (ill) health, sociodemographic, psychological and sociological characteristics and consequences of chronic disease are gathered on a regular basis by means of extensive patient questionnaires. The target population consisted of over 30,000 patients aged 12 years and older enrolled in the participating primary health care centers.

NICE: Evidencias en Salud Pública: alcohol y jóvenes

Dentro de la colección de guías de intervención en Salud Pública, NICE ha presentado en el mes de diciembre su guía sobre “Intervenciones en escuela para prevenir y reducir el consumo de alcohol entre niños y jóvenes”. Las recomendaciones se centran en tres ejes:
-Reforzar a los niños para no beber.
-Retrasar la edad en la que los jóvenes inician el consumo de alcohol.
-Disminuir los riesgos entre aquellos que ya han empezado a consumir alcohol.

This NICE guidance on school based interventions to prevent and reduce alcohol use is aimed at anyone who works with children and young people in schools and other education settings. It gives advice on incorporating alcohol education into the national science and personal, social and health education (PSHE) curricula, and helping children and young people access the right support. It also looks at how to link these interventions with community initiatives, including those run by children’s services.

Y más (o menos) vacuna del papilomavirus…

Enlaces interesantes de resumen sintetizando la información sobre el debate en la vacuna:
1. El post del 29 de octubre de Vicente Baos en El supositorio donde reseña, entre otros, el debate abierto desde MEDFAM-APS.
2. El post de Rafa Bravo en Primum non nocere, donde presenta un jugoso cuadrito del CMAJ publicado el 28 de agosto (ver más abajo)
3. La nota de prensa del Ministerio de Sanidad donde se informa por unanimidad de la inclusión de la vacuna del VPH en el calendario vacunal del SNS.
4. Lo ya publicado en Salud Comunitaria el 5 de septiembre: resumen de la OMS y monografía más extensa sobre el tema
5. Y finalmente la iniciativa de recogida de firmas del CAPS para solicitar una moratoria en la aplicación de la vacuna en España.

Guía NICE sobre conductas saludables

Dentro de las guías de Salud Pública, NICE publica en Octubre las recomendaciones sobre modificación de las conductas poblacionales, comunitarias e individuales para mejorar la salud.

La guía oferta una serie de principios básicos que pueden ser usados para la planificación, implementación y evaluación de actividades de salud pública orientadas a mejorar las conductas saludables de la población.
Como es habitual, la presentación de la guía se hace en un formato extenso y en una guía rápida.

El futuro de la Salud Pública en Europa

En el número de julio de Gaceta Sanitaria se presentan las conclusiones de una serie de seminarios organizados pora la European Public Health Association, donde se reflexionó sobre la “nueva salud pública”. Los puntos clave de las conclusiones son los siguientes:

1. La futura salud pública sólo se alcanzará si la sociedad en conjunto invierte en ella: es esencial establecer coaliciones
2. Las autoridades responsables de crearlas normas deben contemplar seriamente los beneficios a largo plazo de la salud pública
3. La salud pública debe formar parte esencial del programa político en todos los sectores
4. Las directrices de salud pública deben basarse en los valores o ventajas más que en la enfermedad
5. La investigación sigue siendo una sólida base para el desarrollo de la práctica clínica y de las directrices de salud pública
6. La investigación debe prestar atención a las necesidades de las directrices y a la práctica clínica
7. Los investigadores deben aprender cómo interaccionar con los expertos responsables de establecer las directrices y los médicos
8. Es preciso alentar formas innovadoras de promover la salud
9. Práctica clínica de la futura salud pública: pensamiento global, acción local
10. Papel clave de la EPHA en el desarrollo y apoyo a la salud pública en Europa.