Fibrin glue and transanal rectal advancement flap for high transsphincteric perianal fistulas; is there any advantage?

BACKGROUNDS AND AIM: In recent decades, fibrin glue has appeared as an alternative treatment for high perianal fistulas. Early results seemed promising, with high success rates being reported. However, with increasing follow-up, the enthusiasm was tempered because of disappointing results. The aim of this retrospective study was to assess the additional value of fibrin glue in combination with transanal advancement flap, compared to advancement flap alone, for the treatment of high transsphincteric fistulas of cryptoglandular origin. MATERIALS AND METHODS: Between January 1995 and January 2006, 127 patients were operated for high perianal fistulas with an advancement flap. After exclusion of patients with inflammatory bowel disease or HIV, 80 patients remained. A consecutive series of 26 patients had an advancement flap combined with obliteration of the fistula tract with fibrin glue. Patients were matched for prior fistula surgery, and the advancement was performed identically in all patients. In the fibrin glue group, glue was installed retrogradely in the fistula tract after the advancement was completed and the fistula tract had been curetted. RESULTS: Minimal follow-up after surgery was 13 months [median of 67 months (range, 13-127)]. The overall recurrence rate was 26% (n=21). Recurrence rates for advancement flap alone vs the combination with glue were 13% vs 56% (p=0.014) in the group without previous fistula surgery and 23% vs 41% (p=0.216) in the group with previous fistula surgery. CONCLUSION: Obliterating the fistula tract with fibrin glue was associated with worse outcome after rectal advancement flap for high perianal fistula

Inequities in energy-balance related behaviours and family environmental determinants in European children : baseline results of the prospective EPHE evaluation study

Background: Tackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socio-economic status. Methods: This study is part of the Epode for the Promotion of Health Equity (EPHE) evaluation study, the overall aim of which is to assess the impact and sustainability of EPODE methodology to diminish inequalities in childhood obesity and overweight. Seven community-based programmes from different European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands) participate in the EPHE study. In each of the communities, children aged 6-8 years participated, resulting in a total sample of 1266 children and their families. A parental self-administrated questionnaire was disseminated in order to assess the socio-economic status of the household, selected energy balance-related behaviours (1. fruit and vegetable consumption; 2. soft drink/fruit juices and water consumption; 3. screen time and 4. sleep duration) of the children and associated family environmental determinants. The Mann-Whitney U test and Pearson's chi-square test were used to test differences between the low and high education groups. The country-specific median was chosen as the cut-off point to determine the educational level, given the different average educational level in every country. Results: Children with mothers of relatively high educational level consumed fruits and vegetables more frequently than their peers of low socio-economic status. The latter group of children had a higher intake of fruit juices and/or soft drinks and had higher screen time. Parental rules and home availability were consistently different between the two socio-economic groups in our study in all countries. However we did not find a common pattern for all behaviours and the variability across the countries was large. Conclusions: Our findings are indicative of socio-economic inequalities in our samples, although the variability across the countries was large. The effectiveness of interventions aimed at chancing parental rules and behaviour on health inequalities should be studied

Process evaluation outcomes from a global child obesity prevention intervention

Background: While it is acknowledged that child obesity interventions should cover multiple ecological levels (downstream, midstream and upstream) to maximize their effectiveness, there is a lack of evaluation data to guide the development and implementation of such efforts. To commence addressing this knowledge gap, the present study provides process evaluation data relating to the experiences of groups implementing the EPODE approach to child obesity prevention in various locations around the world. The aim of this exploratory study was to investigate the barriers and facilitators to program implementation in program sites around the world to assist in developing strategies to enhance program outcomes. Methods: An online survey that included open-ended questions was distributed to the 25 EPODE programs in operation at the time of the survey (May 2012). The survey items asked respondents to comment on those aspects of program implementation that they found challenging and to suggest areas for future improvement. Eighteen programs representing 14 countries responded to the request to participate in the survey, yielding a 72% response rate. The responses were analyzed via the constant comparative method using NVivo qualitative data analysis software.Results: The main concerns of the various EPODE programs were their ability to secure ongoing funding and their access to evidence-based intervention methods and policy advice relating to relationships with third parties. These issues were in turn impacted by other factors, including (i) access to user-friendly information relating to the range of intervention strategies available and appropriate evaluation measures; (ii) assistance with building and maintaining stakeholder relationships; and (iii) assurance of the quality, independence, and transparency of policies and practices. Conclusions: The findings are facilitating the ongoing refinement of the EPODE approach. In particular, standardized and tailored information packages are being made available to advise program members of (i) the various evaluation methods and tools at their disposal and (ii) methods of acquiring private partner support. Overall, the study results relating to the types of issues encountered by program members are likely to be useful in guiding the future design and implementation of multi-level initiatives seeking to address other complex and intractable health-related problems

Evaluation of support made available for the Healthy Schools programme. Round 2021, 2021–2022 school year

Gezonde School helpt om een gezonde leefstijl op scholen in Nederland vanzelfsprekend te maken. De scholen kiezen zelf aan welk thema zij willen werken. Elk jaar kunnen zij daarvoor ook financiële en praktische begeleiding aanvragen . Dat kan voor de thema’s ‘Bewegen en sport’, ‘Voeding’, ‘Welbevinden’ en ‘Roken, alcohol- en drugspreventie’. Voor het basisonderwijs zijn ook de thema’s ‘Milieu en natuur’ en ‘Fysieke veiligheid’ beschikbaar. Gezonde School is er voor alle scholen in Nederland in het basis, speciaal en voortgezet onderwijs en het middelbaar beroepsonderwijs. Elk jaar kunnen 550 scholen deelnemen aan het ondersteuningsaanbod. Een school krijgt dan 10 uur advies en begeleiding van een Gezonde School-adviseur van de GGD(Gemeentelijke Gezondheidsdienst). Daarnaast wordt de school geleerd om te werken aan een gezonde leefstijl op school en in de lessen. Ook is er aandacht voor gezondheid in het schoolbeleid en omgeving van de school. Scholen krijgen hiervoor 3.000,- euro. Het RIVM evalueert elk jaar het ondersteuningsaanbod. Scholen blijken behoefte te hebben aan de financiële en praktische ondersteuning. Ze kunnen daarmee aandacht geven aan de thema’s die zij naast het reguliere onderwijs belangrijk vinden. In het schooljaar 2021-2022 voldeden 517 scholen aan de voorwaarden. Van hen was driekwart een basisschool. De deelnemende scholen kozen het meest voor de thema’s ‘Voeding’, ‘Bewegen en sport’ en ‘Welbevinden’. In het voortgezet onderwijs is vaker gekozen voor het thema ‘Roken, alcohol- en drugspreventie’ in plaats van ‘Bewegen en sport’; in het middelbaar beroepsonderwijs was meer behoefte aan het thema ‘Welbevinden’. Ruim driekwart van de scholen heeft van het budget Gezonde School-activiteiten gekocht, zoals lespakketten. Ruim de helft van de scholen gebruikte het voor de personeelskosten van degene die de Gezonde School-activiteiten coördineert. Meer dan 70 procent van de scholen heeft aandacht voor het gekozen thema vastgelegd in het beleid van de school. 89 procent van de deelnemende scholen was tevreden of zeer tevreden over het advies en de ondersteuning van de Gezonde School-adviseur van de GGD.The aim of the Healthy Schools programme is to help promote a healthy lifestyle as self-evident in Dutch schools. Schools are free to decide for themselves which theme to work on. To help them with this, they can apply for financial and practical support each year. The themes covered by the programme are ‘Exercise and sport’, ‘Nutrition’, ‘Well-being’ and ‘Smoking, alcohol and drug prevention’. Primary schools can work with the themes ‘Environment and nature’ and ‘Physical safety’ as well. Healthy Schools is available for all Dutch schools in primary, special, secondary and secondary vocational education. The programme accepts applications for support from 550 schools each year. Schools that submit a successful application receive 10 hours of advice and support from a Healthy Schools adviser employed by the Municipal Public Health Service (GGD). In addition, schools receive training on how to encourage a healthy lifestyle at school and in class. Attention is also paid to promoting health in the school’s policies and surroundings. Each school is allocated a budget of 3,000 euros for this. RIVM evaluates the support offer on an annual basis. This has revealed that schools need the aforementioned financial and practical support, as it allows them to teach pupils about themes that matter to the schools in addition to the regular curriculum. At the end of the 2021–2022 school year, 517 of the 550 schools met alle the conditions of the support offer. Three-quarters of these were primary schools. The most popular themes among participating schools were ‘Nutrition’, ‘Exercise and sport’ and ‘Well-being’. Secondary schools often preferred ‘Smoking, alcohol and drug prevention’ over ‘Exercise and sport’, whereas secondary vocational education institutions were more likely to opt for ‘Well-being’. More than three-quarters of the schools used the budget to procure Healthy Schools activities, such as teaching packages. More than half of the schools used it to pay a salary to the person coordinating the Healthy Schools activities. More than 70 per cent of schools incorporated the chosen theme into school policy. Of the participating schools, 89 per cent were either satisfied or very satisfied with the advice and support they received from the GGD’s Healthy Schools adviser

Evaluatie ondersteuningsaanbod programma Gezonde School. Ronde 2021, schooljaar 2021-2022

Gezonde School helpt om een gezonde leefstijl op scholen in Nederland vanzelfsprekend te maken. De scholen kiezen zelf aan welk thema zij willen werken. Elk jaar kunnen zij daarvoor ook financiële en praktische begeleiding aanvragen . Dat kan voor de thema’s ‘Bewegen en sport’, ‘Voeding’, ‘Welbevinden’ en ‘Roken, alcohol- en drugspreventie’. Voor het basisonderwijs zijn ook de thema’s ‘Milieu en natuur’ en ‘Fysieke veiligheid’ beschikbaar. Gezonde School is er voor alle scholen in Nederland in het basis, speciaal en voortgezet onderwijs en het middelbaar beroepsonderwijs. Elk jaar kunnen 550 scholen deelnemen aan het ondersteuningsaanbod. Een school krijgt dan 10 uur advies en begeleiding van een Gezonde School-adviseur van de GGD(Gemeentelijke Gezondheidsdienst). Daarnaast wordt de school geleerd om te werken aan een gezonde leefstijl op school en in de lessen. Ook is er aandacht voor gezondheid in het schoolbeleid en omgeving van de school. Scholen krijgen hiervoor 3.000,- euro. Het RIVM evalueert elk jaar het ondersteuningsaanbod. Scholen blijken behoefte te hebben aan de financiële en praktische ondersteuning. Ze kunnen daarmee aandacht geven aan de thema’s die zij naast het reguliere onderwijs belangrijk vinden. In het schooljaar 2021-2022 voldeden 517 scholen aan de voorwaarden. Van hen was driekwart een basisschool. De deelnemende scholen kozen het meest voor de thema’s ‘Voeding’, ‘Bewegen en sport’ en ‘Welbevinden’. In het voortgezet onderwijs is vaker gekozen voor het thema ‘Roken, alcohol- en drugspreventie’ in plaats van ‘Bewegen en sport’; in het middelbaar beroepsonderwijs was meer behoefte aan het thema ‘Welbevinden’. Ruim driekwart van de scholen heeft van het budget Gezonde School-activiteiten gekocht, zoals lespakketten. Ruim de helft van de scholen gebruikte het voor de personeelskosten van degene die de Gezonde School-activiteiten coördineert. Meer dan 70 procent van de scholen heeft aandacht voor het gekozen thema vastgelegd in het beleid van de school. 89 procent van de deelnemende scholen was tevreden of zeer tevreden over het advies en de ondersteuning van de Gezonde School-adviseur van de GGD

Dissemination and implementation of the insights and products of the CIAO study

Overgewicht en obesitas bij kinderen vormen een belangrijk en complex volksgezondheidsprobleem. Het wordt veroorzaakt door verschillende met elkaar samenhangende individuele- en omgevingsfactoren. Preventie van overgewicht vraagt dan ook om een integrale aanpak, waarbij zowel de sociaal-culturele, economische en fysieke omgeving, als de kinderen en hun ouders zelf worden betrokken. Belangrijk bij het optimaliseren van deze integrale aanpak is de evaluatie ervan: een continu proces van ontwerpen, testen/monitoren, reflecteren en aanpassen. Binnen het Consortium Integrale Aanpak Overgewicht (CIAO) zijn vijf deelonderzoeken uitgevoerd, met als doel meer inzicht te geven in de relevante factoren die de integrale aanpak kunnen optimaliseren, namelijk politiek draagvlak, implementatie, opvoedingsondersteuning, sociale marketing en evaluatie. Deze deelonderzoeken hebben concrete instrumenten opgeleverd die de kans op een succesvolle integrale aanpak kunnen vergroten. Het doel van dit praktijkonderzoek is inzicht te geven in de manier waarop de kennis en de eindproducten van de vijf CIAO-onderzoeken verspreid en duurzaam geïmplementeerd kunnen worden, met als uiteindelijk doel het ondersteunen van gemeenten bij de aanpak van preventie van overgewicht en obesitas bij kinderen. De verspreiding van de producten zal plaatsvinden via de websites van de implementatieorganisaties, Nederlandstalige artikelen in relevante vakbladen, de adviseurs van de implementatieorganisaties, masterclasses, netwerkbijeenkomsten, congressen en trainingsmodules

Characterizing the EPODE logic model : unravelling the past and informing the future

EPODE (‘Ensemble Prévenons l'Obésité De Enfants’ or ‘Together let's Prevent Childhood Obesity’) is a large-scale, centrally coordinated, capacity-building approach for communities to implement effective and sustainable strategies to prevent childhood obesity. Since 2004, EPODE has been implemented in over 500 communities in six countries. Although based on emergent practice and scientific knowledge, EPODE, as many community programs, lacks a logic model depicting key elements of the approach. The objective of this study is to gain insight in the dynamics and key elements of EPODE and to represent these in a schematic logic model. EPODE's process manuals and documents were collected and interviews were held with professionals involved in the planning and delivery of EPODE. Retrieved data were coded, themed and placed in a four-level logic model. With input from international experts, this model was scaled down to a concise logic model covering four critical components: political commitment, public and private partnerships, social marketing and evaluation. The EPODE logic model presented here can be used as a reference for future and follow-up research; to support future implementation of EPODE in communities; as a tool in the engagement of stakeholders; and to guide the construction of a locally tailored evaluation plan