Infrastructure, policy and regulatory interventions to increase physical activity to prevent cardiovascular diseases and diabetes: A systematic review

Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circum‑ stances in which physical activity occurs may promote physical activity at a population level. We assessed the efects of infrastructure, policy or regulatory interventions for increasing physical activity. We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), con‑ trolled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the efects of these interven‑ tions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evi‑ dence based on efect direction

Defining and conceptualising data harmonisation: a scoping review protocol

Abstract Background Data harmonisation is an important intervention to strengthen health systems functioning. It has the potential to enhance the production, accessibility and utilisation of routine health information for clinical and service management decision-making. It is important to understand the range of definitions and concepts of data harmonisation, as well as how its various social and technical components and processes are thought to lead to better health management decision-making. However, there is lack of agreement in the literature, and in practice, on definitions and conceptualisations of data harmonisation, making it difficult for health system decision-makers and researchers to design, implement, evaluate and compare data harmonisation interventions. This scoping review aims to synthesise (1) definitions and conceptualisations of data harmonisation as well as (2) explanations in the literature of the causal relationships between data harmonisation and health management decision-making. Methods This review follows recommended methodological stages for scoping studies. We will identify relevant studies (peer-reviewed and grey literature) from 2000 onwards, in English only, and with no methodological restriction, in various electronic databases, such as CINAHL, MEDLINE via PubMed and Global Health. Two reviewers will independently screen records for potential inclusion for the abstract and full-text screening stages. One reviewer will do the data extraction, analysis and synthesis, with built-in reliability checks from the rest of the team. We will use a combination of sampling techniques, including two types of ‘purposeful sampling’, a methodological approach that is particularly suitable for a scoping review with our objectives. We will provide (a) a numerical synthesis of characteristics of the included studies and (b) a narrative synthesis of definitions and explanations in the literature of the relationship between data harmonisation and health management decision-making. Discussion We list potential limitations of this scoping review. To our knowledge, this scoping review will be the first to synthesise definitions and conceptualisations of data harmonisation in the literature as well as the underlying explanations in the literature of the causal links between data harmonisation and health management decision-making

Effectiveness of control measures to prevent occupational tuberculosis infection in health care workers: a systematic review

Background A number of guideline documents have been published over the past decades on preventing occupational transmission of tuberculosis (TB) infection in health care workers (HCWs). However, direct evidence for the effectiveness of these controls is limited particularly in low-and middle-income (LMIC) countries. Thus, we sought to evaluate whether recommended administrative, environmental and personal protective measures are effective in preventing tuberculin skin test conversion among HCWs, and whether there has been recent research appropriate to LMIC needs. Methods Using inclusion criteria that included tuberculin skin test (TST) conversion as the outcome and longitudinal study design, we searched a number of electronic databases, complemented by hand-searching of reference lists and contacting experts. Reviewers independently selected studies, extracted data and assessed study quality using recommended criteria and overall evidence quality using GRADE criteria. Results Ten before-after studies were found, including two from upper middle income countries. All reported a decline in TST conversion frequency after the intervention. Among five studies that provided rates, the size of the decline varied, ranging from 35 to 100%. Since all were observational studies assessed as having high or unclear risk of bias on at least some criteria, the overall quality of evidence was rated as low using GRADE criteria. Conclusion We found consistent but low quality of evidence for the effectiveness of combined control measures in reducing TB infection transmission in HCWs in both high-income and upper-middle income country settings. However, research is needed in low-income high TB burden, including non-hospital, settings, and on contextual factors determining implementation of recommended control measures. Explicit attention to the reporting of methodological quality is recommended. Trial registration This systematic review was registered with PROSPERO in 2014 and its registration number is CRD42014009087

Health economic evidence in clinical guidelines in South Africa: a mixedmethods study

Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa.This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players - evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified

Covid-19 research evidence: An international survey exploring views on useful sources, preferred formats, and accessibility

INTRODUCTION: In a pandemic, stakeholders such as policy makers, clinicians, patients, and the public need access to high-quality, timely, relevant research evidence in a format that is understandable and applicable. OBJECTIVES: An online survey was used to determine where a global audience finds research evidence about COVID-19 and how they prefer to keep up to date. METHODS AND MATERIALS: We conducted an online survey of people interested in research in English and Spanish. We used a convenience sample of people visiting websites and social media accounts of Cochrane, an international organisation that collates systematic reviews of research.  RESULTS: 831 people with various roles and locations responded over a short period with little active promotion. Healthcare professionals, members of the public, and policy influencers wanted research evidence to inform decisions about COVID-19. More than half found research evidence from government websites (52%), international organisations (57%), journals (56%), and evidence collation organisations (60%) useful. People wanted research evidence about COVID-19 formats such as lay summaries (60%), online systematic reviews (60%), short summaries with commentaries (51%), and visual summaries (48%). People preferred to be kept up to date about COVID-19 research via email updates and newsletters, tailored to people’s interests (34%), traditional media (13%) and social media (12%). CONCLUSIONS: It was feasible to collect feedback rapidly using a simple online survey. Websites from official organisations were key sources of COVID-19 research evidence. More research is needed on how best to provide evidence that is easy to access and understand

Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis of recipient and provider views

Background Programmes that introduce rapid molecular tests for tuberculosis and tuberculosis drug resistance aim to bring tests closer to the community, and thereby cut delay in diagnosis, ensure early treatment, and improve health outcomes, as well as overcome problems with poor laboratory infrastructure and inadequately trained personnel. Yet, diagnostic technologies only have an impact if they are put to use in a correct and timely manner. Views of the intended beneficiaries are important in uptake of diagnostics, and their effective use also depends on those implementing testing programmes, including providers, laboratory professionals, and staff in health ministries. Otherwise, there is a risk these technologies will not fit their intended use and setting, cannot be made to work and scale up, and are not used by, or not accessible to, those in need. Objectives To synthesize end‐user and professional user perspectives and experiences with low‐complexity nucleic acid amplification tests (NAATs) for detection of tuberculosis and tuberculosis drug resistance; and to identify implications for effective implementation and health equity. Search methods We searched MEDLINE, Embase, CINAHL, PsycInfo and Science Citation Index Expanded databases for eligible studies from 1 January 2007 up to 20 October 2021. We limited all searches to 2007 onward because the development of Xpert MTB/RIF, the first rapid molecular test in this review, was completed in 2009. Selection criteria We included studies that used qualitative methods for data collection and analysis, and were focused on perspectives and experiences of users and potential users of low‐complexity NAATs to diagnose tuberculosis and drug‐resistant tuberculosis. NAATs included Xpert MTB/RIF, Xpert MTB/RIF Ultra, Xpert MTB/XDR, and the Truenat assays. Users were people with presumptive or confirmed tuberculosis and drug‐resistant tuberculosis (including multidrug‐resistant (MDR‐TB)) and their caregivers, healthcare providers, laboratory technicians and managers, and programme officers and staff; and were from any type of health facility and setting globally. MDR‐TB is tuberculosis caused by resistance to at least rifampicin and isoniazid, the two most effective first‐line drugs used to treat tuberculosis. Data collection and analysis We used a thematic analysis approach for data extraction and synthesis, and assessed confidence in the findings using GRADE CERQual approach. We developed a conceptual framework to illustrate how the findings relate. Main results We found 32 studies. All studies were conducted in low‐ and middle‐income countries. Twenty‐seven studies were conducted in high‐tuberculosis burden countries and 21 studies in high‐MDR‐TB burden countries. Only one study was from an Eastern European country. While the studies covered a diverse use of low‐complexity NAATs, in only a minority of studies was it used as the initial diagnostic test for all people with presumptive tuberculosis. We identified 18 review findings and grouped them into three overarching categories. Critical aspects users value People with tuberculosis valued reaching diagnostic closure with an accurate diagnosis, avoiding diagnostic delays, and keeping diagnostic‐associated cost low. Similarly, healthcare providers valued aspects of accuracy and the resulting confidence in low‐complexity NAAT results, rapid turnaround times, and keeping cost to people seeking a diagnosis low. In addition, providers valued diversity of sample types (for example, gastric aspirate specimens and stool in children) and drug resistance information. Laboratory professionals appreciated the improved ease of use, ergonomics, and biosafety of low‐complexity NAATs compared to sputum microscopy, and increased staff satisfaction. Challenges reported to realizing those values People with tuberculosis and healthcare workers were reluctant to test for tuberculosis (including MDR‐TB) due to fears, stigma, or cost concerns. Thus, low‐complexity NAAT testing is not implemented with sufficient support or discretion to overcome barriers that are common to other approaches to testing for tuberculosis. Delays were reported at many steps of the diagnostic pathway owing to poor sample quality; difficulties with transporting specimens; lack of sufficient resources; maintenance of low‐complexity NAATs; increased workload; inefficient work and patient flows; over‐reliance on low‐complexity NAAT results in lieu of clinical judgement; and lack of data‐driven and inclusive implementation processes. These challenges were reported to lead to underutilization. Concerns for access and equity The reported concerns included sustainable funding and maintenance and equitable use of resources to access low‐complexity NAATs, as well as conflicts of interest between donors and people implementing the tests. Also, lengthy diagnostic delays, underutilization of low‐complexity NAATs, lack of tuberculosis diagnostic facilities in the community, and too many eligibility restrictions hampered access to prompt and accurate testing and treatment. This was particularly the case for vulnerable groups, such as children, people with MDR‐TB, or people with limited ability to pay. We had high confidence in most of our findings. Authors' conclusions Low‐complexity diagnostics have been presented as a solution to overcome deficiencies in laboratory infrastructure and lack of skilled professionals. This review indicates this is misleading. The lack of infrastructure and human resources undermine the added value new diagnostics of low complexity have for recipients and providers. We had high confidence in the evidence contributing to these review findings. Implementation of new diagnostic technologies, like those considered in this review, will need to tackle the challenges identified in this review including weak infrastructure and systems, and insufficient data on ground level realities prior and during implementation, as well as problems of conflicts of interest in order to ensure equitable use of resources

Rapid molecular tests for tuberculosis and tuberculosis drug resistance: provider and recipient views

Objectives This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To synthesize end‐user and professional user perspectives and experiences with low‐complexity nucleic acid amplification tests (NAATs) for detection of tuberculosis and tuberculosis drug resistance. Review question What are the perspectives and experiences of people providing and receiving low‐complexity NAATs to diagnose tuberculosis and tuberculosis drug resistance? Answering this question will allow us to identify the implications for effective implementation and health equity

Infrastructure, policy and regulatory interventions to increase physical activity to prevent cardiovascular diseases and diabetes: a systematic review

Abstract Background Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity at a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity. Methods We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction. Results We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence). Conclusions Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings. Trial registration PROSPERO 2018 CRD42018093429

Knowledge translation interventions for facilitating evidence-informed decision-making amongst health policymakers

No abstract available