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Introduction The Informed Health Choices (IHC) project developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore the educational context for teaching and learning critical thinking about health in Spanish primary schools. Methods During the 2020-2021 school year, we will conduct 1) a systematic assessment of educational documents and resources, and 2) semi-structured interviews with key education and health stakeholders. In the systematic assessment of educational documents and resources, we will include state and autonomous communities’ curriculums, school educational projects, and commonly used textbooks and other health teaching materials. In the semi-structured interviews, we will involve education and health policy makers, developers of learning resources, developers of health promotion and educational interventions, head teachers, teachers, families, and paediatric primary care providers. We will design and pilot a data extraction form and a semi-structured interview guide to collect the data. We will perform a quantitative and a qualitative analysis of the data to explore how critical thinking about health is being taught and learned in Spanish primary schools. Conclusion We will identify opportunities for and barriers to teaching and learning critical thinking about health in Spanish primary schools. We will formulate recommendations—for both practice and research purposes—on how to use, adapt (if needed), and implement the IHC resources in this context.

Antecedents Les revisions sistemàtiques (RS) utilitzen un mètode sistemàtic i explícit per sintetitzar l’evidència que respon a una pregunta d’investigació específica. La diversitat, complexitat i dispersió de recursos i mètodes disponibles per al seu desenvolupament fa necessari identificar, organitzar i posar en pràctica els recursos millors i més apropiats per a cada tipus de pregunta d’investigació. Objectius Els objectius d’aquest treball de tesi són descriure i aplicar les tècniques de revisió per a l’avaluació de l’atenció sanitària en qüestions de prevalença, pronòstic, exactitud diagnòstica i intervenció. Mètodes S’han realitzat quatre treballs amb diferents metodologies: 1) un recull de recursos per a la realització de revisions sistemàtiques de prevalença, pronòstic, precisió diagnòstica i d’intervenció, 2) una RS sobre l’efecte dels programes d’exercici en la funció física de la població fràgil d’edat avançada, 3) una RS Cochrane sobre l’efecte de la fisioteràpia respiratòria en la bronquiolitis aguda del lactant, i 4) una RS Cochrane de la precisió diagnòstica de la prova PET-CT per identificar l’afectació dels ganglis limfàtics toràcics en pacients amb càncer de pulmó de cèl·lula no petita (NSCLC) potencialment resecable. Resultats En la compilació de recursos es van identificar manuals metodològics desenvolupats per la Col·laboració Cochrane per desenvolupar RS de precisió diagnòstica i RS d’efectes de les intervencions. Així mateix, es van identificar manuals del Joanna Briggs Institute per desenvolupar RS pronòstic, i manuals del grup GRADE per a l’avaluació de la qualitat de l’evidència en la majoria de tipus de RS. Els manuals identificats es van complementar amb estudis primaris i guies de presentació d’informes. A la RS de fragilitat es van identificar 19 assaigs aleatoritzats, 12 comparaven l’exercici amb un control inactiu. La majoria dels programes d’exercici eren multicomponents. En comparació amb les intervencions de control, l’exercici millora la velocitat normal i ràpida de la marxa, i el rendiment físic. No es van obtenir resultats concloents per als desenllaços de resistència, equilibri i mobilitat funcional. L’evidència que compara diferents modalitats d’exercici és escassa i heterogènia. A la RS de la fisioteràpia respiratòria, es van incloure 12 assaigs aleatoritzats, que van comparar fisioteràpia amb no fer cap intervenció. Les tècniques d’espiració passiva forçada no van mostrar un efecte beneficiós en pacients amb bronquiolitis greu i estan relacionades amb un major risc de desestabilització respiratòria transitòria i vòmits durant el procediment (evidència d’alta qualitat). Es necessita més evidència de qualitat sobre l’efecte de les tècniques d’espiració passiva lenta, i les tècniques d’espiració passiva forçada en pacients amb bronquiolitis lleu a moderada A la RS de l’estadiatge de l’NSCLC, es van incloure 45 estudis, que van avaluar la prova PET-CT en 6095 participants. Les troballes recolzen les recomanacions actuals, segons les quals la PET-CT és útil en l’estadiatge ganglionar dels pacients amb NSCLC potencialment resecable, però per ella mateixa és insuficient per prendre decisions sobre tractament quirúrgic, i pot ser necessari complementar-la amb una biòpsia. Conclusions Encara que existeixen manuals i recursos metodològics per desenvolupar RS dels principals tipus epidemiològics, cal aprofundir en alguns aspectes poc desenvolupats com la valoració del risc de biaix en RS de prevalença, la valoració de la qualitat de l’evidència en RS de prevalença i models pronòstic, o les guies d’informe per a les RS pronòstiques. També és convenient que les RS publicades incorporin una política d’actualització, i fa falta més evidència sobre els criteris que han de regir les polítiques d’actualització (ja sigui basades en processos de priorització o en criteris temporals). Antecedentes Las revisiones sistemáticas (RS) utilizan un método sistemático y explícito para sintetizar la evidencia que responde a una pregunta de investigación específica. La diversidad, complejidad y dispersión de recursos y métodos disponibles para su desarrollo hace necesario identificar, organizar y poner en práctica los mejores recursos y los más apropiados para cada tipo de pregunta de investigación. Objetivos Los objetivos de este trabajo de tesis son describir y aplicar distintas técnicas de revisión para la evaluación de la atención sanitaria en cuestiones de prevalencia, pronóstico, exactitud diagnóstica e intervención. Métodos Se han realizado cuatro trabajos: 1) una compilación de recursos para la realización de revisiones sistemáticas de prevalencia, pronóstico, exactitud diagnóstica y de intervención, 2) una RS sobre el efecto de los programas de ejercicio en la función física de la población mayor frágil; 3) una RS Cochrane sobre el efecto de la fisioterapia respiratoria en la bronquiolitis aguda del lactante, y 4) una RS Cochrane de la exactitud diagnóstica de la prueba PET-CT para identificar la afectación de los ganglios linfáticos torácicos en pacientes con cáncer de pulmón de célula no pequeña (NSCLC) potencialmente resecable. Resultados En la compilación de recursos se identificaron manuales metodológicos desarrollados por la Colaboración Cochrane para desarrollar RS de exactitud diagnóstica y RS de efectos de las intervenciones. Asimismo, se identificaron manuales del Joanna Briggs Institute para desarrollar RS pronóstico, y manuales del grupo GRADE para la evaluación de la calidad de la evidencia en la mayoría de tipos de RS. Los manuales identificados se complementaron con estudios primarios y guías de presentación de informes. En la RS de fragilidad se identificaron 19 ensayos aleatorizados (ECA), 12 comparaban el ejercicio con un control inactivo. La mayoría de los programas de ejercicio eran multicomponentes. En comparación con las intervenciones de control, el ejercicio mejora la velocidad normal y rápida de la marcha, y el rendimiento físico. No se obtuvieron resultados concluyentes para los desenlaces de resistencia, equilibrio y movilidad funcional. La evidencia que compara diferentes modalidades de ejercicio es escasa y heterogénea. En la RS de la fisioterapia respiratoria, se incluyeron 12 ECA, que compararon fisioterapia con ninguna intervención. Las técnicas de espiración pasiva forzada no mostraron un efecto beneficioso en pacientes con bronquiolitis grave y están relacionadas con un mayor riesgo de desestabilización respiratoria transitoria y vómitos durante el procedimiento (evidencia de alta calidad). Se necesita más evidencia de calidad sobre el efecto de las técnicas de espiración pasiva lenta, y las técnicas de espiración pasiva forzada en pacientes con bronquiolitis leve a moderada En la RS del estadiaje del NSCLC, se incluyeron 45 estudios que evaluaron la prueba PET-CT (6095 participantes). Los hallazgos respaldan las recomendaciones actuales, según las cuales, la PET-CT es útil para el estadiaje ganglionar de los pacientes con NSCLC potencialmente resecable, pero por sí sola es insuficiente para tomar decisiones sobre tratamiento quirúrgico, y puede ser necesario complementarla con una biopsia. Conclusiones Aunque existen manuales y recursos metodológicos para desarrollar RS de los principales tipos epidemiológicos, es necesario profundizar en algunos aspectos poco desarrollados como la valoración del riesgo de sesgo en RS de prevalencia, la valoración de la calidad de la evidencia en RS de prevalencia y modelos pronóstico, o las guías de reporte para las RS pronósticas. También es conveniente que las RS publicadas incorporen una política de actualización, y falta más evidencia sobre los criterios que deben regir las políticas de actualización (basadas en procesos de priorización o en criterios temporales). Background Systematic reviews (SR) use a systematic and explicit method to synthesize the evidence that answers a specific research question. The diversity, complexity and dispersion of resources and methods available for its development makes it necessary to identify, organize and put into practice the best and most appropriate resources for each type of research question. Objectives The objectives of this thesis work are to describe and apply review techniques for the evaluation of health care in matters of prevalence, prognosis, diagnostic accuracy and intervention. Methods Four studies have been carried out with different methodologies: 1) a compilation of resources for conducting systematic reviews of prevalence, prognosis, diagnostic accuracy and intervention, 2) a SR on the effect of exercise programs on the physical function of the frail elderly population, 3) a Cochrane SR on the effect of chest physiotherapy in acute bronchiolitis in infants, and 4) a Cochrane SR of the diagnostic accuracy of the PET-CT test to identify thoracic lymph node involvement in patients with potentially resectable non-small cell lung cancer (NSCLC). Results In the compilation of resources, methodological manuals developed by the Cochrane Collaboration to develop SRs of diagnostic accuracy and SRs of the effects of interventions were identified. Likewise, Joanna Briggs Institute manuals were identified to develop prognostic SR, and GRADE Group manuals for evaluating the quality of evidence in most types of SR. The identified manuals were supplemented with primary studies and reporting guidelines. In the frailty SR, 19 randomized trials were identified, of which 12 compared exercise with an inactive control. Most of the exercise programs were multicomponent. Compared with control interventions, exercise improves normal and fast gait speed, and physical performance. No conclusive results were obtained for endurance, balance, and functional mobility outcomes. The evidence comparing different exercise modalities is scarce and heterogeneous. In the chest physiotherapy SR, 12 randomized trials were included, which compared physiotherapy with no intervention. Forced passive expiration techniques did not show a beneficial effect in patients with severe bronchiolitis and are associated with an increased risk of transient respiratory destabilization and vomiting during the procedure (high-quality evidence). More evidence of good quality is needed on the effect of slow passive expiration techniques, and forced passive expiration techniques in patients with mild to moderate bronchiolitis In the NSCLC staging SR, 45 studies were included that evaluated the PET-CT test in 6095 participants. The findings support current recommendations that PET-CT is useful for lymph node staging in patients with potentially resectable NSCLC, but is insufficient by itself to make decisions about surgical treatment, and may need to be supplemented with a biopsy. Conclusions Although there are manuals and methodological resources to develop SRs of the main epidemiological types, further research is needed into some yet underdeveloped aspects such as the assessment of the risk of bias in prevalence SRs, the assessment of the quality of the evidence in prevalence SR and prognostic models SRs, or reporting guidelines for prognostic SRs. It is also convenient that the published SRs incorporate an updating policy, and there is a lack of more evidence on the criteria that should govern updating policies (based on prioritization processes or temporal criteria). Universitat Autònoma de Barcelona. Programa de Doctorat en Metodologia de la Recerca Biomèdica i Salut Pública

BackgroundFood allergy is an abnormal immunological response following exposure (usually ingestion) to a food. Elimination of the allergen is theprinciple treatment for food allergy, including allergy to fruit. Accidental ingestion of allergenic foods can result in severe anaphylacticreactions. Allergen-specific immunotherapy (SIT) is a specific treatment, when the avoidance of allergenic foods is problematic. Recently,studies have been conducted on different types of immunotherapy for the treatment of food allergy, including oral (OIT) and sublingualimmunotherapy (SLIT).ObjectivesTo determine the efficacy and safety of oral and sublingual immunotherapy in children and adults with food allergy to fruits, whencompared with placebo or an elimination strategy.Search methodsThe Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and AMED were searched for published resultsalong with trial registries and the Journal of Negative Results in BioMedicine for grey literature. The date of the most recent search wasJuly 2015.Selection criteriaRandomised controlled trials (RCTs) comparing OIT or SLIT with placebo or an elimination diet were included. Participants were childrenor adults diagnosed with food allergy who presented immediate fruit reactions.Data collection and analysisWe used standard methodological procedures expected by the Cochrane Collaboration. We assessed treatment effect through risk ratios(RRs) for dichotomous outcomes. Main resultsWe identified two RCTs (N=89) eligible for inclusion. These RCTs addressed oral or sublingual immunotherapy, both in adults, with an allergyto apple or peach respectively. Both studies enrolled a small number of participants and used different methods to provide these differingtypes of immunotherapy. Both studies were judged to be at high risk of bias in at least one domain. Overall, the quality of evidence wasjudged to be very low due to the small number of studies and participants and possible bias. The studies were clinically heterogeneous andhence we did not pool the results. A study comparing SLIT with placebo for allergy to peach did not detect a significant difference betweenthe number of patients desensitised at six months following a double-blind placebo-controlled food challenge (RR 1.16, 95% confidenceinterval (CI) 0.49 to 2.74). The second study, comparing OIT versus no treatment for apple allergy, found an effect on desensitisation infavour of the intervention using an oral provocation test at eight months, but results were imprecise (RR 17.50, 95% CI 1.13 to 270.19).Neither study reported data on evidence of immunologic tolerance. In both studies, the incidence of mild and moderate adverse eventswas higher in the intervention groups than in the controls. In the study comparing SLIT with placebo, patients in the intervention groupexperienced significantly more local adverse reactions than participants in the control group (RR 3.21, 95% CI 1.51 to 6.82), though therewas not a significant difference in the number of participants experiencing systemic adverse reactions (RR 0.81, 95% CI 0.22 to 3.02). Inthe study of OIT, two of the 25 participants in the intervention group reported relevant side effects, whereas no participants in the controlgroup reported relevant side effects. COL0059567

Background: There is limited evidence on the efficacy and social utility of cognitive training. To address this, we have designed a randomized controlled trial to assess the effectiveness of memory training workshops for healthy older people in terms of their short- and long-term impact on cognitive function, health-related quality of life, and functionality. Methods/design: A randomized controlled trial will be performed in health care centers in Barcelona (Spain) through comparison of a group of individuals participating in memory training workshops (experimental group) with another group with similar characteristics not participating in the workshops (control group). The intervention will consist of twelve 90-minute group sessions imparted once a week by a psychologist specialized in memory training. The groups will each comprise approximately 15 people, for a total number of 230 patients involved in the study. Each session has its own objectives, materials and activities. The content of the intervention is based on memory training from different perspectives, including cognitive and emotional aspects and social and individual skills. Data will be collected at baseline, at 3-4 months and at 6 months. To assess the efficacy of the intervention on cognitive function, health-related quality of life and functionality, a statistical analysis will be performed by fitting a repeated-measures mixed effects model for each main outcome: Self-perceived memory, measured by a Subjective Self-reported Memory Score (from 0 to 10) and by the Memory Failures in Everyday life questionnaire (MFE); Everyday memory, measured using the Rivermead Behavioural Memory Test-3 (RBMT-3) and Executive control abilities, measured in terms of visual-perceptual ability, working memory and task-switching ability with the Trail Making Test (TMT) and with the digit span scale of the Wechsler Adult Intelligence Scale III (WAIS III). Discussion: The results of this study will be highly useful for social and public health policies related to older people. Given the continuous increase in the prevalence of older people, a large number of interventions targeting memory loss are funded by public resources. To ensure transparency and effective prioritization, research such as the present study is needed to provide evidence of the effectiveness and usefulness of these interventions. Trial registration: Number: NCT02431182.

There is limited evidence on the efficacy and social utility of cognitive training. To address this, we have designed a randomized controlled trial to assess the effectiveness of memory training workshops for healthy older people in terms of their short- and long-term impact on cognitive function, health-related quality of life, and functionality. A randomized controlled trial will be performed in health care centers in Barcelona (Spain) through comparison of a group of individuals participating in memory training workshops (experimental group) with another group with similar characteristics not participating in the workshops (control group). The intervention will consist of twelve 90-minute group sessions imparted once a week by a psychologist specialized in memory training. The groups will each comprise approximately 15 people, for a total number of 230 patients involved in the study. Each session has its own objectives, materials and activities. The content of the intervention is based on memory training from different perspectives, including cognitive and emotional aspects and social and individual skills. Data will be collected at baseline, at 3-4 months and at 6 months. To assess the efficacy of the intervention on cognitive function, health-related quality of life and functionality, a statistical analysis will be performed by fitting a repeated-measures mixed effects model for each main outcome: Self-perceived memory, measured by a Subjective Self-reported Memory Score (from 0 to 10) and by the Memory Failures in Everyday life questionnaire (MFE); Everyday memory, measured using the Rivermead Behavioural Memory Test-3 (RBMT-3) and Executive control abilities, measured in terms of visual-perceptual ability, working memory and task-switching ability with the Trail Making Test (TMT) and with the digit span scale of the Wechsler Adult Intelligence Scale III (WAIS III). The results of this study will be highly useful for social and public health policies related to older people. Given the continuous increase in the prevalence of older people, a large number of interventions targeting memory loss are funded by public resources. To ensure transparency and effective prioritization, research such as the present study is needed to provide evidence of the effectiveness and usefulness of these interventions. Number: NCT02431182 .