Background: Childhood obesity prevention interventions delivered by health professionals during the first 1,000 days show some evidence of effectiveness, particularly in relation to behavioural outcomes. External validity refers to how generalisable interventions are to populations or settings beyond those in the original study. The degree to which external validity elements are reported in such studies is unclear however. This systematic review aimed to determine the extent to which childhood obesity interventions delivered by health professionals during the first 1,000 days report on elements that can be used to inform generalizability across settings and populations. Methods: Eligible studies meeting study inclusion and exclusion criteria were identified through a systematic review of 11 databases and three trial registers. An assessment tool based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to assess the external validity of included studies. It comprised five dimensions: reach and representativeness of individuals, reach and representativeness of settings, implementation and adaptation, outcomes for decision making maintenance and/or institutionalisation. Two authors independently assessed the external validity of 20% of included studies; discrepancies were resolved, and then one author completed assessments of the remaining studies. Results: In total, 39 trials involving 46 interventions published between 1999 and 2019 were identified. The majority of studies were randomized controlled trials (n=24). Reporting varied within and between dimensions. External validity elements that were poorly described included: representativeness of individuals and settings, treatment receipt, intervention mechanisms and moderators, cost effectiveness, and intervention sustainability and acceptability. Conclusions: Our review suggests that more emphasis is needed on research designs that consider generalisability, and the reporting of external validity elements in early life childhood obesity prevention interventions. Important gaps in external validity reporting were identified that could facilitate decisions around the translation and scale-up of interventions from research to practice. Registration: PROSPERO CRD42016050793 03/11/16.
The early childhood period, encompassing prenatal and early stages, assumes a pivotal role in shaping cardiovascular risk factors. We conducted a narrative review, presenting a non-systematic summation and analysis of the available literature, focusing on cardiovascular risk from prenatal development to the first 1000 days of life. Elements such as maternal health, genetic predisposition, inadequate fetal nutrition, and rapid postnatal growth contribute to this risk. Specifically, maternal obesity and antibiotic use during pregnancy can influence transgenerational risk factors. Conditions at birth, such as fetal growth restriction and low birth weight, set the stage for potential cardiovascular challenges. To consider cardiovascular risk in early childhood as a dynamic process is useful when adopting a personalized prevention for future healthcare and providing recommendations for management throughout their journey from infancy to early adulthood. A comprehensive approach is paramount in addressing early childhood cardiovascular risks. By targeting critical periods and implementing preventive strategies, healthcare professionals and policymakers can pave the way for improved cardiovascular outcomes. Investing in children's health during their early years holds the key to alleviating the burden of cardiovascular diseases for future generations.
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In their first 100 days, CEOs should create a multifaceted and integrated narrative that lays out their strategic ambition as well as their transformation, stakeholder management, communications, and talent assessment plans. Most new CEOs talk about these topics. But when it comes to where they spend their time or resources in the first 100 days, many lean into their comfort zones or leadership styles. For example, CEOs who have risen through the ranks in sales or marketing may over invest in listening tours and spend too much time on the frontline. CEOs who have come up in finance and operations often lean into financial teardowns, investor feedback, and risk assessments. Fewer balance and integrate feedback from multiple stakeholders and emerge from their first 100 days with a 360 plan to be both a great company and a great stock.
The first 100 days concept can be useful at any inflection point for the business. A sharp decline in the share price, a sudden vulnerability to activist investors, or a recapitalization (such as a private-equity deal) are all opportunities for the CEO to step back and reset. The exercise applies equally well when business units or functions are in need of fresh thinking.
Rigorous 100-day planning requires trusted partners who will stimulate and challenge the CEO. At many companies, the chief HR officer, chief transformation officer, chief of staff, or CFO can play this role. Some CEOs, however, may find it difficult to be open with people already embedded in an organization that they are only starting to understand. They may prefer to work also with an outsider. Whatever their preference, it is critical for CEOs to develop the objective fact-driven assessment of the company, industry, and market. So long as CEOs and their team are committed to putting in the time, the work during the first 100 days will prepare the company for the next 1,000 and beyond.
GC_1000 will generate evidence-based knowledge about the integration of complex interventions into diverse health care systems. The 4-year project also will pave the way for sustained implementation of GC, significantly benefitting populations with adverse pregnancy and birthing experiences as well as poor outcomes.
Newborns also are at particular risk during child birth and the postpartum period. In 2019, 2.4 million babies died in their first month of life [8]. While children are at greatest risk of death during the first 28 days after birth [8], the first years of life lay the foundation for physical and mental well-being from infancy to and throughout adulthood [9]. Thus, accessible and high-quality antenatal and postnatal care are not only a human right [10], but together they can build the basis for healthy development over the life span [11]. While this has the potential to ultimately foster a healthy population and reduce health expenses in the long-term, access to high-quality maternal health care services remains a privilege. Key factors preventing women from receiving appropriate care include poverty, distance to facilities, lack of information, harmful cultural beliefs and practices and poor quality, disrespectful, or lack of humanized care [7, 12]. Poor quality of services often results from shortage of staff and resources, as well as hierarchies and power dimensions within health care and an inattention to human rights [6, 7, 12],
The overall aim of GC_1000 is to co-create and disseminate evidence-based implementation strategies and tools to support successful implementation and scale-up of GC in the first 1000 days in health systems throughout the world, with particular attention to the needs of vulnerable populations. The project takes place in seven countries and has five specific objectives:
To allow systematic and consistent identification of the interplay between intervention characteristics and the context in which the intervention is implemented, we chose the Consolidated Framework for Implementation Research (CFIR) as the basic analytical framework guiding the GC_1000 project [35]. The CFIR was developed to guide systematic assessment of multilevel implementation contexts and to identify factors that might influence intervention implementation and effectiveness. The CFIR describes five interacting domains for studying implementation and capturing learning [35]. These are:
Throughout GC_1000, we examine which constructs listed in the CFIR may influence the implementation of GC and consequently implementation outcomes. This will enable us to develop theory-based adaptation and implementation strategies for GC. The methods/methodologies that are used in the different steps are detailed below.
A multi-phase sequential design to implementation has been adopted to achieve our objectives. The GC_1000 consortium is grouped into five inter-related work packages (WPs) with specific tasks, objectives and deliverables, as seen in Fig. 2 (and on the website: ).
Within RQI, an interdisciplinary team of local and external researchers collects data at the implementation site for a short period of time (approximately 1 week) using multiple methods. For the GC_1000 situational analyses, data were collected using semi-structured interviews and focus groups with providers and recipients of GC and other relevant stakeholders (e.g. policy-makers, community leaders), document analysis and surveys. Iterative adjustment of the data collection strategy occurs in frequent meetings where the collected data are pre-analysed. This procedure enables tailoring of the further data collection (e.g. add questions to topic guide, contact more participants). Research tools and qualitative data analysis will draw on the CFIR [35], allowing for comparison of findings from different sites/countries which will eventually enable the development of blueprints in WP5.
Preliminary findings of the RQIs will be used by WP2 for the development of tailored implementation strategies and adaptations to the GC model. For this purpose, the cultural sensitivity model will be employed [40]. It distinguishes between surface and deep structure adaptations. Surface adaptation involves matching programme materials and messages to the characteristics of the target populations ensuring cultural sensitivity and responsiveness. Deep structure adaptations stimulate the effectiveness of the intervention by incorporating elements that influence the behaviour of participants in and beneficiaries of the intervention, such as cultural, social and environmental aspects. For the process of adaptation, core questions include when and how to adapt the intervention and which stakeholders to involve in the process [41, 42]. In line with our participatory approach, we will work in close collaboration with women, their partners and families, health care professionals and other stakeholders in the community as well as health systems to adapt GC. 589ccfa754
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