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Santos-Beneit G, Bodega P, de Cos-Gandoy A, de Miguel M, Rodríguez C, Orrit X, Carral V, Haro D, Carvajal I, Peyra C, Martínez-Gómez J, Fernández-Alvira JM, Fernández-Jiménez R, Fuster V. Effect of Time-Varying Exposure to School-Based Health Promotion on Adiposity in Childhood. J Am Coll Cardiol 2024; 84:499-508. [PMID: 39084824 DOI: 10.1016/j.jacc.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The results of most school-based health promotion initiatives are inconclusive. OBJECTIVES This trial assessed the effect of time-varying exposures to a multicomponent school-based health promotion intervention (SI! Program) on adiposity markers. METHODS A total of 48 schools in Madrid (Spain) were cluster randomized to receive the SI! Program through elementary education grades 1 to 6 (E1-6, 12 schools, 459 children), 1 to 3 (E1-3, 12 schools, 513 children), or 4 to 6 (E4-6, 12 schools, 419 children) or to receive the standard curriculum (control, 12 schools, 379 children). The primary endpoint was the between-group difference at 3- and 6-year follow-up in the change from baseline in adiposity markers and the overall knowledge-attitudes-habits (KAH) score. RESULTS At 3-year follow-up, children who had the intervention showed significantly lower increases than the control group in z-scores for body mass index (BMI), waist-to-height ratio (WHtR), and waist circumference (WC) (zBMI: -0.09; 95% CI: -0.16 to -0.03; P = 0.003; zWC and zWHtR: -0.19; 95% CI: -0.28 to -0.10; P < 0.001). At 6-year follow-up, the beneficial trend in zWC and zWHtR was maintained in the E1-6 and E1-3 groups: difference zWC control vs E1-6 (-0.19; 95% CI: -0.36 to -0.03; P = 0.020), control vs E1-3 (-0.22; 95% CI: -0.38 to -0.06; P = 0.009); difference zWHtR control vs E1-6 (-0.24; 95% CI: -0.41 to -0.06; P = 0.009), and control vs E1-3 (-0.29; 95% CI: -0.47 to -0.11; P = 0.001). No significant between-group differences were found in the change of overall KAH score. CONCLUSIONS Early elementary school interventions may be more effective than later interventions on abdominal adiposity. Further research should assess the sustainability effects of school-based health promotion programs.
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Affiliation(s)
- Gloria Santos-Beneit
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Patricia Bodega
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Amaya de Cos-Gandoy
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Mercedes de Miguel
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Xavier Orrit
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Vanesa Carral
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Domingo Haro
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Carlos Peyra
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jesús Martínez-Gómez
- National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Juan Miguel Fernández-Alvira
- National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain; Center for Biomedical Network Research: Cardiovascular Diseases (Centro de Investigación Biomédica En Red en enfermedades CardioVasculares [CIBERCV]), Madrid, Spain; Department of Cardiology, Hospital Clínico San Carlos, Health Research Institute of Hospital Clinico San Carlos (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [IdISSC]), Madrid, Spain.
| | - Valentin Fuster
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Prokop-Dorner A, Piłat-Kobla A, Ślusarczyk M, Świątkiewicz-Mośny M, Ożegalska-Łukasik N, Potysz-Rzyman A, Zarychta M, Juszczyk A, Kondyjowska D, Magiera A, Maraj M, Storman D, Warzecha S, Węglarz P, Wojtaszek-Główka M, Żabicka W, Bała MM. Teaching methods for critical thinking in health education of children up to high school: A scoping review. PLoS One 2024; 19:e0307094. [PMID: 39024294 PMCID: PMC11257347 DOI: 10.1371/journal.pone.0307094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024] Open
Abstract
According to the World Health Organization, the improvement of people's health literacy is one of the fundamental public health challenges in the 21st century. The key issue in teaching health literacy is to develop critical thinking skills. As health literacy and critical thinking should be developed at school age, we reviewed teaching methods or educational interventions used in empirical studies focused on the development of critical thinking regarding health and implemented by teachers in preschools, primary schools, or secondary schools. We searched seven databases (Medline, Embase, Web of Science, ERIC, ProqQuest, PsycArticles, and CINAHL) from inception to 20 September 2023 for any type of empirical studies. Due to the heterogeneity in interventions and inadequate reporting of results, a descriptive synthesis of studies was performed in addition to quantitative analysis. Of the 15919 initial records, 115 studies were included in the review. Most of the educational interventions focused on lifestyle-related health issues such as substance use, sexual and reproductive health, and nutrition. The popularity of health issues changed over time and depended on the geographical context. Six dimensions that differentiated the teaching methods were identified: central teaching component, central educator, pupils' activity level, teaching context, educational materials, and significance of critical thinking. Many educational interventions did not address the development of critical thinking skills in a comprehensive manner, and the significance of critical thinking varied greatly. Interventions in which critical thinking had high and very high significance applied mainly problem-solving methods and involved pupils' activity. The evidence on the effectiveness of the teaching methods that develop critical thinking is limited because most articles failed to provide detailed information on the teaching methods or did not examine their effects. We recommend that a checklist is developed to facilitate a detailed description of health educational interventions and thus promoting their replicability. Study registration: The protocol of the review was registered in the OSF Registries on 13 January 2022 (doi: https://doi.org/10.17605/OSF.IO/46TEZ).
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Affiliation(s)
- Anna Prokop-Dorner
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Piłat-Kobla
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | | | | | | | - Marianna Zarychta
- LIGHT Project, Institute of Sociology, Jagiellonian University, Kraków, Poland
| | - Albert Juszczyk
- Medical Faculty Student’s Research Group for Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Dominika Kondyjowska
- Medical Faculty Student’s Research Group for Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Magiera
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Małgorzata Maraj
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Dawid Storman
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Sylwia Warzecha
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Paulina Węglarz
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Magdalena Wojtaszek-Główka
- Medical Faculty Student’s Research Group for Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Wioletta Żabicka
- Medical Faculty Student’s Research Group for Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Małgorzata M. Bała
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
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Mederer-Hengstl B, Núñez-Delgado P, Bueno-Cavanillas A. Evaluation of Problem-Based Learning Experiences Addressing Health Promotion in the Fourth Grade of Primary School. CHILDREN (BASEL, SWITZERLAND) 2024; 11:807. [PMID: 39062257 PMCID: PMC11275087 DOI: 10.3390/children11070807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/03/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND The global issues of overweight and sedentary lifestyles require comprehensive responses from health systems. Despite this, health education remains fragmented and sporadic. This study aims to target primary school children to instil healthy habits using active learning strategies, with a specific focus on promoting a healthy diet and physical activity. METHODS This study employed problem-based learning (PBL) projects with fourth-grade primary students to encourage the acquisition of healthy habits. Conducted over four consecutive years at a two-line school, the study utilised an opportunity sample, evaluating intervention and control groups by comparing their corresponding scores. The control groups consisted of 54 students, while the intervention group included 159 students. Data collection involved pre-test and post-test questionnaires to measure outcomes. RESULTS Differential evaluation scores revealed significantly higher results in the intervention groups compared to the control groups, with an average score increase of 3.62 points in control groups and 6.94 points in intervention groups, particularly in attitudinal competencies. The strategies employed facilitated the development of crucial skills such as information search, synthesis, representation, analysis, decision making, teamwork, and intrapersonal awareness. Additionally, they significantly broadened the knowledge acquired regarding healthy habits. CONCLUSIONS The problem-based learning approach proved effective in helping children understand the importance of making healthy choices and encouraged the integration of such habits into their daily lives. These findings suggest that active learning strategies can significantly enhance health education and promote long-term healthy behaviours among primary school children.
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Affiliation(s)
| | - Pilar Núñez-Delgado
- Department of Didactics of Language and Literature, University of Granada, 18011 Granada, Spain;
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP-Spain), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Granada (IBS-Granada), 18012 Granada, Spain
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Timóteo AT, Cachulo MC, Dinis P, Negrão L, Barreiros-Mota I, Dores H, Gonçalves L. "O meu coração bate saudável" - Results from a pilot project for health education in Portuguese children. Rev Port Cardiol 2024; 43:301-310. [PMID: 37952926 DOI: 10.1016/j.repc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Childhood offers an excellent window of opportunity to start interventions to promote behavioral changes before unhealthy lifestyles become established, leading to cardiovascular diseases. The goal of this pilot educational project for children is the promotion of healthy lifestyles and cardiovascular health. METHODS This project was implemented in 4th grade children and included teacher-led classroom activities, a lesson given by a cardiologist and a practical lesson with dietitians. The teacher received a manual containing information on the topics to be discussed in class with the pupils and the children received a book that addresses cardiovascular risk factors and prevention. The components included were diet (D), physical activity (PA) and human body and heart awareness (BH). At the beginning and at the end of the schoolyear, a questionnaire was applied to the children to assess knowledge (K), attitudes (A) and habits (H) on these topics. RESULTS A total of 73 children from two schools from an urban district public school in Lisbon, in a low to medium income area, participated in the project. Following the intervention, there was a 9.5% increase in the overall KAH score, mainly driven by the PA component (14.5%) followed by the BH component (12.3%). No improvement was observed for component D. The benefits were also more significant in children from a lower income area, suggesting that socioeconomic status is a determinant in the response obtained. CONCLUSIONS An educational project for cardiovascular health can be implemented successfully in children aged 9 years, but longer and larger studies are necessary.
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Affiliation(s)
- Ana Teresa Timóteo
- Serviço de Cardiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal.
| | - Maria Carmo Cachulo
- Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Fundação Portuguesa de Cardiologia, Portugal
| | - Paulo Dinis
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coinbra, Portugal; Centro de Saúde Militar de Coimbra, Coimbra, Portugal
| | - Luís Negrão
- Fundação Portuguesa de Cardiologia, Portugal
| | - Inês Barreiros-Mota
- CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Nutrition & Metabolism Department, NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Hélder Dores
- NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Hospital da Luz, Lisboa, Portugal
| | - Lino Gonçalves
- Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coinbra, Portugal; ICBR, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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Mitra S. The cumulative effect of insufficient sleep on adolescent obesity: evidence from a Spanish cohort. Eur J Prev Cardiol 2023; 30:1289-1290. [PMID: 37216913 DOI: 10.1093/eurjpc/zwad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Sayan Mitra
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
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López-Gil JF, García-Hermoso A, Smith L, Gallego A, Victoria-Montesinos D, Ezzatvar Y, Hershey MS, Gutiérrez-Espinoza H, Mesas AE, Jiménez-López E, Sánchez-Miguel PA, López-Benavente A, Moreno-Galarraga L, Chen S, Brazo-Sayavera J, Fernandez-Montero A, Alcaraz PE, Panisello Royo JM, Tárraga-López PJ, Kales SN. A Cluster Randomized Controlled Trial of the Archena Infancia Saludable Project on 24-h Movement Behaviors and Adherence to the Mediterranean Diet among Schoolchildren: A Pilot Study Protocol. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040738. [PMID: 37189987 DOI: 10.3390/children10040738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/17/2023]
Abstract
Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention's "halo" effect on parents'/guardians' 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6-13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.
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Affiliation(s)
- José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, 31006 Pamplona, Spain
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
- One Health Research Group, Universidad de Las Américas, Quito 170124, Ecuador
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, 31006 Pamplona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Alejandra Gallego
- Department of Applied Economics, Faculty of Economics and Business, University of Murcia, 30100 Murcia, Spain
| | | | - Yasmin Ezzatvar
- Department of Nursing, Universitat de València, 46007 Valencia, Spain
| | - Maria S Hershey
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
| | | | - Arthur Eumann Mesas
- Health and Social Research Center, Universidad de Castilla-La Mancha (UCLM), 16071 Cuenca, Spain
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina 86057-970, Brazil
| | - Estela Jiménez-López
- Health and Social Research Center, Universidad de Castilla-La Mancha (UCLM), 16071 Cuenca, Spain
| | - Pedro Antonio Sánchez-Miguel
- Grupo Análisis Comportamental de la Actividad Física y el Deporte (ACAFYDE), Departamento de Didáctica de la Expresión Musical, Plástica y Corporal, Facultad de Formación del Profesorado, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Alba López-Benavente
- Departamento de Expresión Plástica, Musical y Dinámica, Facultad de Educación, Universidad de Murcia, 30100 Espinardo, Spain
| | - Laura Moreno-Galarraga
- IdiSNA (Instituto de Investigación Sanitaria de Navarra), 31008 Pamplona, Spain
- Department of Pediatrics, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, 31008 Pamplona, Spain
| | - Sitong Chen
- Institute for Health and Sport, Victoria University, Melbourne 8001, Australia
| | - Javier Brazo-Sayavera
- PDU EFISAL, Centro Universitario Regional Noreste, Universidad de la República (UdelaR), Rivera 40000, Uruguay
- Department of Sports and Computer Science, Universidad Pablo de Olavide (UPO), 41013 Seville, Spain
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
- IdiSNA (Instituto de Investigación Sanitaria de Navarra), 31008 Pamplona, Spain
- Department of Occupational Medicine, University of Navarra, 31008 Pamplona, Spain
| | - Pedro Emilio Alcaraz
- Research Center for High Performance Sport, San Antonio Catholic University of Murcia, 30830 Murcia, Spain
- Faculty of Sport Sciences, San Antonio Catholic University of Murcia, 30107 Murcia, Spain
| | | | - Pedro J Tárraga-López
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla-La Mancha (UCLM), 02008 Albacete, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
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Santos-Beneit G, Fuster V, Fernández-Jiménez R. Uso de registros clínicos electrónicos en atención primaria con fines de investigación: ¿despegando? Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Santos-Beneit G, Fuster V, Fernández-Jiménez R. Use of primary care electronic medical records for research purposes: is it taking off? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:288-290. [PMID: 34953765 DOI: 10.1016/j.rec.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Gloria Santos-Beneit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Division of Cardiology, The Zena and Michael A, Wiener Cardiovascular Institute, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Valentín Fuster
- Foundation for Science, Health and Education (SHE), Barcelona, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Division of Cardiology, The Zena and Michael A, Wiener Cardiovascular Institute, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Lessons Learned From 10 Years of Preschool Intervention for Health Promotion. J Am Coll Cardiol 2022; 79:283-298. [DOI: 10.1016/j.jacc.2021.10.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022]
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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Pinto CJM, Fornari LS, Oyama SMR, Rodrigues MMD, Davanço T, Caramelli B. Children First Study II: an educational programme on cardiovascular prevention in public schools can reduce parents' cardiovascular risk. Rev Assoc Med Bras (1992) 2020; 66:1217-1224. [PMID: 33027448 DOI: 10.1590/1806-9282.66.9.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/22/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze whether the implementation of a multidisciplinary educational programme for cardiovascular prevention in public schools can contribute to reducing the FramINGHAM CARDIOVASCULAR RISK SCORE OF THE CHILDREN'S PARENTS AFTER ONE YEAR. METHODS This was a prospective, community-based, case-control study carried out in public schools in Sao Paulo, Brasil. Students were randomized to receive healthy lifestyle recommendations by two different approaches. The control group received written cardiovascular health educational brochures for their parents. The intervention group received the same brochures for the parents, and the children were exposed to a weekly educational programme on cardiovascular prevention with a multidisciplinary health team for one year. Clinical and laboratorial data were collected at the onset and end of the study. RESULTS We studied 265 children and their 418 parents. At the baseline, the rate of parents with intermediate or high Framingham scores (risk of cardiovascular disease over the next 10 years greater than 10%) was 6.9% in the control group and 13.3% in the intervention group. After one year, the rate of parents with intermediate or high Framingham risk score was reduced by 22.2% in the intervention group and increased by 33.3% in the control group (p=0.031). The cardiovascular risk factors that improved in the intervention group were blood pressure, LDL-cholesterol (low-density lipoprotein cholesterol), and glucose levels. CONCLUSION An educational programme on cardiovascular prevention for school-age children in public schools can reduce the cardiovascular risk of their parents.
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12
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Fernández-Jiménez R, Briceño G, Céspedes J, Vargas S, Guijarro J, Baxter J, Hunn M, Santos-Beneit G, Rodríguez C, Céspedes MP, Bagiella E, Moreno Z, Carvajal I, Fuster V. Sustainability of and Adherence to Preschool Health Promotion Among Children 9 to 13 Years Old. J Am Coll Cardiol 2020; 75:1565-1578. [PMID: 32241373 DOI: 10.1016/j.jacc.2020.01.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/03/2020] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Long-term evaluations of child health promotion programs are required to assess their sustainability and the need for reintervention. OBJECTIVES This study sought to explore the long-term impact of a preschool health promotion intervention delivered in an urban low-income area of Colombia (phase 1) and to assess the effect of a new community-based intervention (phase 2). METHODS In phase 1, a cross-sectional analysis of knowledge, attitudes, and habits (KAH) toward a healthy lifestyle and ideal cardiovascular health (ICH) scores of 1,216 children 9 to 13 years old was performed. Of the total, 596 had previously received a preschool health promotion intervention at 3 to 5 years old, whereas the remaining 620 were not previously intervened (intervention-naive group). In phase 2, all children were cluster randomized 1:1 to receive either a 4-month educational intervention (the SI! Program) to instill healthy behaviors in community centers (24 clusters, 616 children) or to control (24 clusters, 600 children). Previously intervened and intervention-naive children were not mixed in the same cluster. The primary outcomes were the change from baseline in KAH and ICH scores. Intervention effects were tested for with linear mixed-effects models. RESULTS In phase 1, ∼85% of children had nonideal cardiovascular health, and those who previously received a preschool intervention showed a negligible residual effect compared with intervention-naive children. In phase 2, the between-group (control vs. intervention) differences in the change of the overall KAH and ICH scores were 0.92 points (95% confidence interval [CI]: -0.28 to 2.13; p = 0.133) and -0.20 points (95% CI: -0.43 to 0.03; p = 0.089), respectively. No booster effect was detected. However, a dose-response effect was observed, with maximal benefit in children attending >75% of the scheduled intervention; the difference in the change of KAH between the high- and low-adherence groups was 3.72 points (95% CI: 1.71 to 5.73; p < 0.001). CONCLUSIONS Although overall significant differences between the intervention and control groups were not observed, high adherence rates to health promotion interventions may improve effectiveness and outcomes in children. Reintervention strategies may be required at multiple stages to induce sustained health promotion effects (Salud Integral Colombia [SI! Colombia II]; NCT03119792).
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro de Investigación Biomedica En Red en enfermedades CardioVasculares, Madrid, Spain
| | - German Briceño
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Jaime Céspedes
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia.
| | - Sarha Vargas
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia
| | | | | | - Marilyn Hunn
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | | | - Emilia Bagiella
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zorayda Moreno
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Isabel Carvajal
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Santos-Beneit G, Marrodán Serrano MD. ¿Estamos en el camino correcto para reducir la obesidad infantil? Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Latina J, Fernandez-Jimenez R, Bansilal S, Sartori S, Vedanthan R, Lewis M, Kofler C, Hunn M, Martin F, Bagiella E, Farkouh M, Fuster V. Grenada Heart Project-Community Health ActioN to EncouraGe healthy BEhaviors (GHP-CHANGE): A randomized control peer group-based lifestyle intervention. Am Heart J 2020; 220:20-28. [PMID: 31765932 DOI: 10.1016/j.ahj.2019.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of cardiovascular (CV) risk factors is increasing globally, with a disproportionate burden in the low and low-middle income countries (L/LMICs). Peer support, as a low-cost lifestyle intervention, has succeeded in managing chronic illness. For global CV risk reduction, limited data exists in LMICs. AIM The GHP-CHANGE was designed as a community-based randomized trial to test the effectiveness of peer support strategy for CV risk reduction in the island of Grenada, a LMIC. METHODS We recruited 402 adults from the Grenada Heart Project (GHP) Cohort Study of 2827 subjects with at least two CV risk factors. Subjects were randomized in a 1:1 fashion to a peer-group based intervention group (n = 206) or a self-management control group (n = 196) for 12 months. The primary outcome was the change from baseline in a composite score related to Blood pressure, Exercise, Weight, Alimentation and Tobacco (FBS, Fuster-BEWAT Score), ranging from 0 to 15 (ideal health = 15). Linear mixed-effects models were used to test for intervention effects. RESULTS Participants mean age was 51.4 years (SD 14.5) years, two-thirds were female, and baseline mean FBS was 8.9 (SD 2.6) and 8.5 (SD 2.6) in the intervention and control group, respectively (P = .152). At post intervention, the mean FBS was higher in the intervention group compared to the control group [9.1 (SD 2.7) vs 8.5 (SD 2.6), P = .028]. When balancing baseline health profile, the between-group difference (intervention vs. control) in the change of FBS was 0.31 points (95% CI: -0.12 to 0.75; P = .154). CONCLUSIONS The GHP-CHANGE trial showed that a peer-support lifestyle intervention program was feasible; however, it did not demonstrate a significant improvement in the FBS as compared to the control group. Further studies should assess the effects of low-cost lifestyle interventions in LMICs.
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15
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Santos-Beneit G, Marrodán Serrano MD. Are we on the right track to reduce childhood obesity? ACTA ACUST UNITED AC 2020; 73:277-279. [PMID: 31932233 DOI: 10.1016/j.rec.2019.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Gloria Santos-Beneit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, United States; Grupo de Investigación EPINUT-UCM, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.
| | - María Dolores Marrodán Serrano
- Grupo de Investigación EPINUT-UCM, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; Departamento de Biodiversidad, Ecología y Evolución, Facultad de Biología, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto Universitario de Ciencias Ambientales, Universidad Complutense de Madrid (UCM), Madrid, Spain
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16
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Different Lifestyle Interventions in Adults From Underserved Communities. J Am Coll Cardiol 2020; 75:42-56. [DOI: 10.1016/j.jacc.2019.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022]
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17
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Bodega P, Fernández-Alvira JM, Santos-Beneit G, de Cos-Gandoy A, Fernández-Jiménez R, Moreno LA, de Miguel M, Carral V, Orrit X, Carvajal I, Storniolo CE, Tresserra-Rimbau A, Doménech M, Estruch R, Lamuela-Raventós RM, Fuster V. Dietary Patterns and Cardiovascular Risk Factors in Spanish Adolescents: A Cross-Sectional Analysis of the SI! Program for Health Promotion in Secondary Schools. Nutrients 2019; 11:E2297. [PMID: 31561533 PMCID: PMC6835512 DOI: 10.3390/nu11102297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 01/31/2023] Open
Abstract
Previous studies on the association between dietary habits and cardiovascular risk factors (CVRF) in adolescents have generated conflicting results. The aim of this study was to describe dietary patterns (DP) in a large sample of Spanish adolescents and to assess their cross-sectional relationship with CVRF. In total, 1324 adolescents aged 12.5 ± 0.4 years (51.6% boys) from 24 secondary schools completed a self-reported food frequency questionnaire. DPs were derived by cluster analysis and principal component analysis (PCA). Anthropometric measurements, blood pressure, lipid profile, and glucose levels were assessed. Linear mixed models were applied to estimate the association between DPs and CVRF. Three DP-related clusters were obtained: Processed (29.2%); Traditional (39.1%); and Healthy (31.7%). Analogous patterns were obtained in the PCA. No overall differences in CVRF were observed between clusters except for z-BMI and z-FMI values, total cholesterol, and non-HDL cholesterol, with the Processed cluster showing the lowest mean values. However, differences were small. In conclusion, the overall association between DPs, as assessed by two different methods, and most analyzed CVRF was weak and not clinically relevant in a large sample of adolescents. Prospective analysis may help to disentangle the direction of these associations.
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Affiliation(s)
- Patricia Bodega
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
| | | | - Gloria Santos-Beneit
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Amaya de Cos-Gandoy
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
- Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain.
| | - Luis Alberto Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Science, University of Zaragoza, 50009 Zaragoza, Spain.
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
| | - Mercedes de Miguel
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
| | - Vanesa Carral
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
| | - Xavier Orrit
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
| | - Carolina E Storniolo
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, 08028 Barcelona, Spain.
| | - Anna Tresserra-Rimbau
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana. Hospital Universitari Sant Joan de Reus, Institut d'Investigació Pere Virgili (IISPV), 43201 Reus, Spain.
| | - Mónica Doménech
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Ramón Estruch
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Rosa María Lamuela-Raventós
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, 08028 Barcelona, Spain.
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Fernandez-Jimenez R, Santos-Beneit G, Tresserra-Rimbau A, Bodega P, de Miguel M, de Cos-Gandoy A, Rodríguez C, Carral V, Orrit X, Haro D, Carvajal I, Ibañez B, Storniolo C, Domènech M, Estruch R, Fernández-Alvira JM, Lamuela-Raventós RM, Fuster V. Rationale and design of the school-based SI! Program to face obesity and promote health among Spanish adolescents: A cluster-randomized controlled trial. Am Heart J 2019; 215:27-40. [PMID: 31277052 DOI: 10.1016/j.ahj.2019.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/28/2019] [Indexed: 12/18/2022]
Abstract
Unhealthy habits in adolescents are increasing at an alarming rate. The school offers a promising environment in which to implement effective preventive strategies to improve adolescents' lifestyle behaviors. The SI! Program is a multilevel multicomponent school-based health-promotion intervention aimed at all stages of compulsory education in Spain. We present the study design of the SI! Program for Secondary Schools, targeting adolescents aged 12 to 16 years. AIM The main goal of this study is to evaluate the impact of the SI! Program educational intervention on adolescent lifestyle behaviors and health parameters. METHODS The study was designed as a cluster-randomized controlled intervention trial and enrolled 1326 adolescents from 24 public secondary schools in Spain, together with their parents/caregivers. Schools and their students were randomly assigned to the intervention group (the SI! curriculum-based educational program over 2 or 4 academic years) or to the control group (usual curriculum). The primary endpoint will be the change from baseline at 2-year and 4-year follow-up in the composite Ideal Cardiovascular Health (ICH) score, consisting of four health behaviors (body mass index, dietary habits, physical activity, and smoking) and three health factors (blood pressure, total cholesterol, and glucose). Secondary endpoints will include 2-year and 4-year changes from baseline in ICH score subcomponents, the Fuster-BEWAT health scale, adiposity markers (waist circumference and body composition), polyphenol and carotenoid intake, and emotion management. DISCUSSION The overarching goal of the SI! Program is to instill healthy behaviors in children and adolescents that can be sustained into adulthood. The SI! Program for Secondary School is a comprehensive health-promotion intervention targeting 12-16-year-old adolescents and their immediate environment. The present study addresses the optimal timing and impact of the educational intervention on health in adolescence.
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Affiliation(s)
- Rodrigo Fernandez-Jimenez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Anna Tresserra-Rimbau
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Pere Virgili Health Research Center, Universitat Rovira i Virgili, Reus, Spain; Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain
| | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Mercedes de Miguel
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Amaya de Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Vanesa Carral
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Xavier Orrit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Domènech Haro
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), Madrid, Spain; IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Carolina Storniolo
- Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, Barcelona, Spain
| | - Mónica Domènech
- Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain; Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ramon Estruch
- Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain; Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Rosa Maria Lamuela-Raventós
- Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, Barcelona, Spain.
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, United States.
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Udell JA. Socioeconomics and Atherosclerosis: Where There's Smoke, There's Fire. J Am Coll Cardiol 2019; 74:536-537. [PMID: 31345428 DOI: 10.1016/j.jacc.2019.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jacob A Udell
- Cardiovascular Division, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
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