RESUMEN
INTRODUCTION: Behavioral weight management interventions (BWMIs) are an evidence-based strategy for addressing childhood obesity. Targeting eating behavior traits (EBTs; individual tendencies determining food intake/occasions) could play a pivotal role in improving the effectiveness of these behavioral interventions. The present study describes a systematic review and meta-analysis of the impact of BWMIs on eating behavior traits in children with overweight or obesity. METHODS: Seven databases were searched, and eligible studies included randomized controlled trials reporting EBT outcomes following BWMIs delivered to children with overweight or obesity (<18 years of age). Random effects meta-analyses were conducted to compare EBT outcomes for intervention and control groups. Synthesis without meta-analysis (SWiM) was applied for EBTs where meta-analysis was not feasible. RESULTS: The review identified eight trials characterizing the impact of BWMIs on 15 EBTs. Meta-analyses of data from three trials at intervention completion and post-intervention (average of 28 weeks [±8]) revealed positive short-term increases in dietary restraint (SMD random effect 0.42 [95% CI 0.13, 0.70]). However, these effects were not sustained at follow-up. Improvements in emotional eating, external eating, food responsiveness, and enjoyment of food were shown in studies which could not be pooled quantitatively. CONCLUSION: BWMIs in children living with overweight/obesity are beneficial for the improvement of some EBTs at intervention completion including dietary restraint, emotional eating, external eating, food responsiveness, and enjoyment of food. However, this remains a relatively unexplored area and more research is needed to strengthen understanding of the multifaceted impact of child BWMIs on a comprehensive range of EBTs.
Asunto(s)
Neoplasias Cutáneas , Cirujanos , Humanos , Neoplasias Cutáneas/cirugía , Piel , Rayos Ultravioleta , Protectores SolaresRESUMEN
AIMS: In July 2022, NICE updated the guidelines on the management of melanoma by lowering the number of follow-up appointments and sentinel lymph node biopsy (SLNB) but increasing the number of scans. This study aims to evaluate the implications of executing the new guidelines in terms of cost-effectiveness and personnel. METHODS: All patients newly diagnosed with melanoma in 2019 at a regional skin cancer specialist center were reviewed. Data were analyzed for their journey on an idealized pathway modeled over a 5-year follow-up period when adhering to both the previous and new guidelines. Differences in the management of melanoma were elucidated by comparing these changes. The cost was quantified on a perpatient basis and the financial implication on each department was considered. RESULTS: One hundred and ten patients were diagnosed with melanoma in 2019, stages I-III. The changes ease the burden on plastic surgery and dermatology; however, increased pressure is faced by radiologists and histopathologists. An overall cost benefit of £141.85 perpatient was calculated, resulting in a decrease of 1.22 hospital visits on average and an increase in the time spent there (19.55 min). The additional expenses of implementing the new guidelines due to the added BRAF tests, CT, and ultrasound scans are outweighed by savings from the reduction in follow-up appointments and SLNB. CONCLUSION: The focus has shifted to less invasive procedures for lower melanoma stages and fewer follow-up appointments, at the expense of more genetic testing and imaging. This paper serves as a useful baseline for other centers to plan their service provision and resource allocation to adhere to the updated guidelines.