Conectar
Obesity and related cardiometabolic comorbidities, including hypertension, dyslipidaemia, diabetes, metabolic dysfunction-associated steatotic liver disease and atherosclerotic cardiovascular disease, are increasingly prevalent among individuals with inflammatory bowel disease (IBD). These conditions influence disease activity, therapeutic response, surgical outcomes and overall quality of life, yet evidence remains fragmented. The Modulate Obesity and relateD metabolic complIcations For Yielding improvements in IBD outcomes (MODIFY-IBD) initiative aims to synthesise evidence and generate consensus recommendations to guide practice and future research in this area. This study describes a protocol for a structured evidence synthesis and Research ANd Development/University of California, Los Angeles (RAND/UCLA) Appropriateness Method (RUAM) consensus process.
We will conduct three systematic reviews and a structured evidence synthesis organised into three domains: (1) the impact of obesity on IBD outcomes, (2) the burden of cardiometabolic complications in IBD and (3) the management of overweight, obesity and cardiometabolic comorbidities in IBD. A multidisciplinary international panel of gastroenterologists, surgeons, endocrinologists, hepatologists, cardiologists and dietitians will assess each statement using the RAND/UCLA appropriateness method. Panellists will rate the appropriateness of each statement (only those that fall within their area of expertise) on a 1–9 scale (1–3=inappropriate, 4–6=uncertain and 7–9=appropriate), with medians rounded up (eg, 6.5=appropriate). Agreement will be assessed using the RAND Disagreement Index (DI
This study will not involve direct patient participation, as it is based on evidence synthesis and expert consensus; therefore, formal research ethics committee approval will not be required. Patient representatives will contribute to the consensus process to provide contextual perspectives but no identifiable data will be collected.
Findings will be disseminated through publication in peer-reviewed journals, presentation at major gastroenterology and IBD conferences and communication with professional societies. A lay summary and patient-friendly infographic will also be developed to facilitate translation of recommendations into clinical practice.
CRD420251178843: a systematic review of the impact of obesity on inflammatory bowel disease outcomes.
CRD420251178799: a systematic review of cardiometabolic complications in inflammatory bowel disease.
CRD420251174653: management of overweight, obesity and cardiometabolic comorbidities in inflammatory bowel disease: a systematic review.
by Sudim Sharma, Anjali Neupane, Dikshya Kandel, Pratibha Chalisay, Sabina Marasini, Budhi Setiawan, Deepak Chandra Bajracharya, Shyam Raj Upreti, Leela Khanal, Haruko Yokote, Chahana Singh, Kshitij Karki
BackgroundHome-Based Records (HBRs) are personal health documents intended to improve continuity of care and caregiver engagement across reproductive, maternal, newborn, and child health (RMNCH) services. In Nepal, both standalone (sHBR) and integrated (iHBR) models are implemented, yet comparative evidence on their utilization and implementation challenges is limited. This study examined utilization patterns and system-level barriers associated with sHBR in Madhesh Province and iHBR in Koshi Province.
MethodsWe conducted a comparative qualitative study with descriptive quantitative profiling between May 17 and August 27, 2024. A total of 100 semi-structured in-depth interviews were completed with caregivers, health workers, Female Community Health Volunteers, and program managers across two provinces. The study applied “kuragraphy,” an ethnographic approach integrating interviews and field observations to construct contextual case narratives. Socio-demographic data were analyzed descriptively using the statistical package for the social Sciences (SPSS). Informed by the Human Centered Design (HCD) approach, the qualitative data were thematically analyzed in Excel using the Journey to Health and Immunization (JTHI) framework.
ResultsCaregivers widely perceived HBRs as essential documents, primarily for immunization tracking and future service access. The iHBR was viewed as more comprehensive and user-friendly, particularly due to its illustrations, which improved comprehension among low-literacy users. However, understanding remained limited among illiterate and marginalized populations. Family involvement in record management was minimal and largely confined to mothers. Implementation barriers included inadequate training – particularly for iHBR use, limited decision-making authority among frontline health workers, incomplete documentation of non-immunization components, poor material quality of sHBR, and concerns regarding the sustainability of donor-supported iHBR initiatives.
ConclusionHBR utilization in Nepal is shaped by caregiver literacy, gender dynamics, and health-system readiness. Strengthening training, supportive supervision, user-centered design, and sustainable supply mechanisms will be essential to optimize HBR effectiveness and support equitable RMNCH service delivery.
FreshRSS 