Can accreditation work as a tool for quality improvement in public health? A critical review

Public health departments play an important role in promoting and preserving the health of communities. The lack of a system to ensure their quality and accountability led to the development of a national voluntary accreditation program by Public Health Accreditation Board (PHAB). The concept that accreditation will lead to quality improvement in public health which will ultimately lead to healthy communities seems intuitive but lacks a robust body of evidence. A critical review of literature was conducted to explore if accreditation can lead to quality improvement in public health. The articles were selected from publically available databases using a specific set of criteria for inclusion, exclusion, and appraisal. To understand the relationship between accreditation and quality improvement, the potential strengths and limitations of accreditation process were evaluated. Recommendations for best practices are suggested so that public health accreditation can yield maximum benefits. A logic model framework to help depict the impact of accreditation on various levels of public health outcomes is also discussed in this thesis. The literature review shows that existing accreditation programs in other industries show limited but encouraging evidence that accreditation will improve quality and strengthen the delivery of public health services. While progress in introducing accreditation in public health can be informed by other accredited industries, the public health field has its own set of challenges. Providing incentives, creating financing strategies, and having a strong leadership will allow greater access to accreditation by all public health departments. The suggested recommendations include that continuous evaluation, public participation, systems approach, clear vision, and dynamic standards should become hallmarks of the accreditation process. Understanding the link between accreditation, quality improvement, and health outcomes will influence the successful adoption and implementation of the public health accreditation program. This review of literature suggests that accreditation is an important step in improving the quality of public health departments and in ultimately improving the health of communities. However, accreditation should be considered in an integrated system of tools and approaches to improve the public health practice. Hence, it is a means to an end - not an end unto itself.^

Study of rural leadership and implications for community participation and development in the health and family planning programs in Bangladesh

The vast majority of Bangladesh are poor and are unable even to provide for the most basic human needs. These are the landless and marginal farmers of Bangladesh. They constitute 70% of the rural population, which in turn constitute about 90% of the country's population.^ Effective development of Bangladesh would largely mean the development of the landless and marginal farmers. Past efforts of development in this section of the population, including that of the government, have not succeeded. One of the development goals of the government of Bangladesh is to improve the quality of life of the rural population through health and population control measures. Overpopulation, malnutrition and diarrhea are the major impediments to socioeconomic development in Bangladesh.^ The current study was designed to identify whether there is effective opinion leadership among the marginal and landless peasants affecting decisions on acceptance or nonacceptance of family planning methods and oral rehydration therapy (ORT) in the selected rural areas of Bangladesh. The study was conducted in eight randomly selected villages with funding from the Ministry of Health and Family Planning, government of Bangladesh. One hundred twenty-five opinion leaders were interviewed after they were identified by 408 rural couples owning land less than 2 acres and wives' age below 50. The study was conducted in two phases; couples' interview preceded that of the leaders.^ Findings of the study reveal that the opinion leaders influencing adoption of health and family planning among the landless and marginal farmers belong to the same class. Theses opinion leaders own land much less than the rich farmers and the formal leaders in the rural areas. Majority of these of opinion leaders are friends, neighbors and relatives, some are other persons who are businessmen and professionals like doctors, while the rest few are the field workers of health and family planning. Source of influence as a factor contribute most in differentiating use and non-use of family planning and ORT among both couples and leaders. The most frequent sources of influence referred by the couples and the leaders are the field workers of health and family planning, followed by the peer opinion leaders (friends, neighbors, relatives) and spouse.^ The opinion leaders do not differ much from the poor couples on land holding, a strong indicator of economic status, they however differ considerably on social factors such as family planning practice, education, and exposure to mass media.^ The study suggests that future development efforts in Bangladesh have to ensure community participation by the landless and marginal farmers and opinion leaders belonging to their class. ^

The role of a nursing home administrator's education in influencing quality of care in US nursing homes

Nursing home literature links poor management practices to poor quality of care and resident outcomes. Since Nursing Home Administrators (NHAs) require an array of skills to perform their role, it is important to explore what makes a NHA effective. This research fills a gap in the literature and provides a possible option to improve the quality of care in nursing homes. Purpose of the study. The study examines whether NHAs with advanced education (defined as a Masters degree or more) are associated with better quality of care in licensed nursing homes (NHs). Design and Methods. Data was derived from the CDC’s 2004 National Nursing Home Survey, which is a representative sample of NHs across the US. A Donabedian- inspired structure-process-outcomes study model was created to explain how education relates to quality of care. Quality of care was defined as onsite oral care, employee influenza vaccination rates and staff recognition programs. Statistical analyses included multivariate logistic regression; covariates included facility-level variables used in similar peer-reviewed research but also included select measures from the Area Resource File to control for county-level factors. Results. Descriptive and analytical analyses confirm that NHAs with a Bachelor’s degree, Associate degree or high school diploma perform less well than NHAs with a Masters degree or more. NHAs with advanced education are more likely to have onsite dental care and recognition programs for staff than NHAs with a Bachelor’s degree (or less). Also NHAs with less than graduate education are more likely to provide off-site dental care. Employee vaccination rates are not impacted by education. Adding certification, tenure or years of experience to a NHA with advanced education gives them an advantage. In fact, certification and experience alone do not have a positive relationship to care indicators; however adding these to advanced education produces a significant result. Implications. This research provides preliminary evidence that advanced education for the NHA is associated with better quality of care. If future research can confirm these findings, there is merit in revisiting the qualifications. Education can be a legitimate option to support quality improvement efforts in US nursing homes. ^

Efficiency from pharmacy inventory technology: A means to improving quality in non-profit hospitals

Hospitals, like all organizations, have both a mission and a finite supply of resources with which to accomplish that mission. Because the inventory of therapeutic drugs is among the more expensive resources needed by a hospital to achieve its mission, a conceptual model of structure plus process equals outcome posits that adequate emphasis should be placed on optimization of the organization's investment in this important structural resource to provide highest quality outcomes. Therefore emphasis should be placed on the optimization of pharmacy inventory because lowering the financial investment in drug inventory and associated costs increases productive efficiency, a key element of quality. ^ In this study, a post-intervention analysis of a hospital pharmacy inventory management technology implementation at The University of Texas M.D. Anderson Cancer Center was conducted to determine if an intervention which reduced a hospital's financial investment in pharmaceutical inventory provided an opportunity to incrementally optimize the organization's mix of structural resources thereby improving quality of care. The results suggest that hospital pharmacies currently lacking technology to support automated purchasing logistics and perpetual, real-time inventory management for drugs may achieve measurable benefits from the careful implementation of such technology, enabling the hospital to lower its investment in on-hand inventory and, potentially, to reduce overall purchasing expenditures. ^ The importance of these savings to the hospital and potentially to the patient should not be underestimated for their ability to generate funding for previously unfunded public health programs or in their ability to provide financial relief to patients in the form of lower drug costs given the current climate of escalating healthcare costs and tightening reimbursements.^

Influence of Crop Load on Tree Growth, Yield, and Fruit Quality of Scab Resistant Apples at Harvest

Apple scab, caused by Venturia inaequalis, is a major disease affecting apple production. Breeding programs have developed over 30 releases of scab-resistant cultivars since 1970 with recent ones having much improved quality. Redfree and GoldRush are from a cooperative breeding program involving Purdue, Rutgers, and Illinois universities while Liberty was introduced from the Cornell University breeding program. For these cultivars to gain better acceptance, more information is needed on their cropping capacities and the effect of crop load on fruit quality attributes. Our study was conducted to determine the relationship between increasing crop load on tree growth, fruit size, and fruit quality variables of the three cultivars under Iowa conditions.

Reading comprehension in nacional and internacional programs of educational assessment

El principal objetivo de este artículo es identificar distintos programas de evaluación educativa, tanto nacionales como internacionales, y describir sus características generales. Asimismo, analiza el modo en que se conceptualiza y evalúa la competencia lectora. Finalmente, este trabajo presenta los resultados que ha obtenido Argentina en esta área. Los programas analizados son: el Programa para la Evaluación Internacional de Alumnos (PISA, Programme for International Student Assessment) , el Segundo Estudio Regional Comparativo y Explicativo (SERCE) y, específicamente en nuestro país, el Operativo Nacional de Evaluación (ONE) y el Programa de Evaluación de la Calidad Educativa de la Provincia de Buenos Aires. Estos diferentes estudios sitúan la importancia de la lectura comprensiva en tanto "competencia para la vida" necesaria para la realización de otros aprendizajes, para el logro de una participación activa en la sociedad y ligada a la posibilidad de proyectar un futuro mejor. Los informes muestran la existencia de diferencias entre los resultados de distintos países y al interior de los mismos. El desarrollo de competencias desiguales aparece como un desafío a nivel nacional e internacional, ya que constituye un importante indicador de la situación crítica en la que se encuentran un número significativo de niños y adolescentes.

Reading comprehension in nacional and internacional programs of educational assessment

El principal objetivo de este artículo es identificar distintos programas de evaluación educativa, tanto nacionales como internacionales, y describir sus características generales. Asimismo, analiza el modo en que se conceptualiza y evalúa la competencia lectora. Finalmente, este trabajo presenta los resultados que ha obtenido Argentina en esta área. Los programas analizados son: el Programa para la Evaluación Internacional de Alumnos (PISA, Programme for International Student Assessment) , el Segundo Estudio Regional Comparativo y Explicativo (SERCE) y, específicamente en nuestro país, el Operativo Nacional de Evaluación (ONE) y el Programa de Evaluación de la Calidad Educativa de la Provincia de Buenos Aires. Estos diferentes estudios sitúan la importancia de la lectura comprensiva en tanto "competencia para la vida" necesaria para la realización de otros aprendizajes, para el logro de una participación activa en la sociedad y ligada a la posibilidad de proyectar un futuro mejor. Los informes muestran la existencia de diferencias entre los resultados de distintos países y al interior de los mismos. El desarrollo de competencias desiguales aparece como un desafío a nivel nacional e internacional, ya que constituye un importante indicador de la situación crítica en la que se encuentran un número significativo de niños y adolescentes.

Reading comprehension in nacional and internacional programs of educational assessment

El principal objetivo de este artículo es identificar distintos programas de evaluación educativa, tanto nacionales como internacionales, y describir sus características generales. Asimismo, analiza el modo en que se conceptualiza y evalúa la competencia lectora. Finalmente, este trabajo presenta los resultados que ha obtenido Argentina en esta área. Los programas analizados son: el Programa para la Evaluación Internacional de Alumnos (PISA, Programme for International Student Assessment) , el Segundo Estudio Regional Comparativo y Explicativo (SERCE) y, específicamente en nuestro país, el Operativo Nacional de Evaluación (ONE) y el Programa de Evaluación de la Calidad Educativa de la Provincia de Buenos Aires. Estos diferentes estudios sitúan la importancia de la lectura comprensiva en tanto "competencia para la vida" necesaria para la realización de otros aprendizajes, para el logro de una participación activa en la sociedad y ligada a la posibilidad de proyectar un futuro mejor. Los informes muestran la existencia de diferencias entre los resultados de distintos países y al interior de los mismos. El desarrollo de competencias desiguales aparece como un desafío a nivel nacional e internacional, ya que constituye un importante indicador de la situación crítica en la que se encuentran un número significativo de niños y adolescentes.

Compilation of quality controlled nutrient profiles from the Mediterranean Sea

In the last decades, a striking amount of hydrographic data, covering the most part of Mediterranean basin, have been generated by the efforts made to characterize the oceanography and ecology of the basin. On the other side, the improvement in technologies, and the consequent perfecting of sampling and analytical techniques, provided data even more reliable than in the past. Nutrient data enter fully in this context, but suffer of the fact of having been produced by a large number of uncoordinated research programs and of being often deficient in quality control, with data bases lacking of intercalibration. In this study we present a computational procedure based on robust statistical parameters and on the physical dynamic properties of the Mediterranean sea and its morphological characteristics, to partially overcome the above limits in the existing data sets. Through a data pre filtering based on the outlier analysis, and thanks to the subsequent shape analysis, the procedure identifies the inconsistent data and for each basin area identifies a characteristic set of shapes (vertical profiles). Rejecting all the profiles that do not follow any of the spotted shapes, the procedure identifies all the reliable profiles and allows us to obtain a data set that can be considered more internally consistent than the existing ones.

Local relevancy evaluation in the accreditation bodies for engineering master's programs

Accreditation models in the international context mainly consider the evaluation of learning outcomes and the ability of programs (or higher education institutions) to achieve the educational objectives stated in their mission. However, it is not clear if these objectives and therefore their outcomes satisfy real national and regional needs, a critical point in engineering master's programs, especially in developing countries. The aim of this paper is to study the importance of the local relevancy evaluation of these programs and to analyze the main models of quality assurance and accreditation bodies of USA, Europe and Latin America, in order to ascertain whether the relevancy is evaluated or not. After a literature review, we found that in a free-market economic context and international education, the accreditation of master’s programs follows an international accreditation model, and doesn´t take in account in most cases criteria and indicators for local relevancy. It concludes that it is necessary both, international accreditation to ensure the effectiveness of the program (achievement of learning outcomes) and the national accreditation through which it could ensure local relevancy of programs, for which we are giving some indicators.

Experiments in context-sensitive analysis of modular programs

Several models for context-sensitive analysis of modular programs have been proposed, each with different characteristics and representing different trade-offs. The advantage of these context-sensitive analyses is that they provide information which is potentially more accurate than that provided by context-free analyses. Such information can then be applied to validating/debugging the program and/or to specializing the program in order to obtain important performance improvements. Some very preliminary experimental results have also been reported for some of these models which provided initial evidence on their potential. However, further experimentation, which is needed in order to understand the many issues left open and to show that the proposed modes scale and are usable in the context of large, real-life modular programs, was left as future work. The aim of this paper is two-fold. On one hand we provide an empirical comparison of the different models proposed in previous work, as well as experimental data on the different choices left open in those designs. On the other hand we explore the scalability of these models by using larger modular programs as benchmarks. The results have been obtained from a realistic implementation of the models, integrated in a production-quality compiler (CiaoPP/Ciao). Our experimental results shed light on the practical implications of the different design choices and of the models themselves. We also show that contextsensitive analysis of modular programs is indeed feasible in practice, and that in certain critical cases it provides better performance results than those achievable by analyzing the whole program at once, specially in terms of memory consumption and when reanalyzing after making changes to a program, as is often the case during program development.

A system for automatically generating documentation for (C)LP programs

We describe lpdoc, a tool which generates documentation manuals automatically from one or more logic program source files, written in ISO-Prolog, Ciao, and other (C)LP languages. It is particularly useful for documenting library modules, for which it automatically generates a rich description of the module interface. However, it can also be used quite successfully to document full applications. A fundamental advantage of using lpdoc is that it helps maintaining a true correspondence between the program and its documentation, and also identifying precisely to what version of the program a given printed manual corresponds. The quality of the documentation generated can be greatly enhanced by including within the program text assertions (declarations with types, modes, etc.) for the predicates in the program, and machine-readable comments. One of the main novelties of lpdoc is that these assertions and comments are written using the Ciao system assertion language, which is also the language of communication between the compiler and the user and between the components of the compiler. This allows a significant synergy among specification, documentation, optimization, etc. A simple compatibility library allows conventional (C)LP systems to ignore these assertions and comments and treat normally programs documented in this way. The documentation can be generated in many formats including texinfo, dvi, ps, pdf, info, html/css, Unix nroff/man, Windows help, etc., and can include bibliographic citations and images. lpdoc can also generate “man” pages (Unix man page format), nicely formatted plain ascii “readme” files, installation scripts useful when the manuals are included in software distributions, brief descriptions in html/css or info formats suitable for inclusion in on-line indices of manuals, and even complete WWW and info sites containing on-line catalogs of documents and software distributions. The lpdoc manual, all other Ciao system manuals, and parts of this paper are generated by lpdoc.

Nutrition and physical activity programs for obesity treatment (PRONAF study). methodological approach of the project

Este trabajo aborda la metodología seguida para llevar a cabo el proyecto de investigación PRONAF (Clinical Trials Gov.: number NCT01116856.) Background: At present, scientific consensus exists on the multifactorial etiopatogenia of obesity. Both professionals and researchers agree that treatment must also have a multifactorial approach, including diet, physical activity, pharmacology and/or surgical treatment. These two last ones should be reserved for those cases of morbid obesities or in case of failure of the previous ones. The aim of the PRONAF study is to determine what type of exercise combined with caloric restriction is the most appropriate to be included in overweigth and obesity intervention programs, and the aim of this paper is to describe the design and the evaluation methods used to carry out the PRONAF study. Methods/design: One-hundred nineteen overweight (46 males) and 120 obese (61 males) subjects aged 18–50 years were randomly assigned to a strength training group, an endurance training group, a combined strength + endurance training group or a diet and physical activity recommendations group. The intervention period was 22 weeks (in all cases 3 times/wk of training for 22 weeks and 2 weeks for pre and post evaluation). All subjects followed a hypocaloric diet (25-30% less energy intake than the daily energy expenditure estimated by accelerometry). 29–34% of the total energy intake came from fat, 14–20% from protein, and 50–55% from carbohydrates. The mayor outcome variables assesed were, biochemical and inflamatory markers, body composition, energy balance, physical fitness, nutritional habits, genetic profile and quality of life. 180 (75.3%) subjects finished the study, with a dropout rate of 24.7%. Dropout reasons included: personal reasons 17 (28.8%), low adherence to exercise 3 (5.1%), low adherence to diet 6 (10.2%), job change 6 (10.2%), and lost interest 27 (45.8%). Discussion: Feasibility of the study has been proven, with a low dropout rate which corresponds to the estimated sample size. Transfer of knowledge is foreseen as a spin-off, in order that overweight and obese subjects can benefit from the results. The aim is to transfer it to sports centres. Effectiveness on individual health-related parameter in order to determine the most effective training programme will be analysed in forthcoming publications.

Hybrid Contribution of JPEG200 Video Files for Professional Production Centers Reliability and Non-Reliability Transmission File Based in Image Quality Needed

ATM, SDH or satellite have been used in the last century as the contribution network of Broadcasters. However the attractive price of IP networks is changing the infrastructure of these networks in the last decade. Nowadays, IP networks are widely used, but their characteristics do not offer the level of performance required to carry high quality video under certain circumstances. Data transmission is always subject to errors on line. In the case of streaming, correction is attempted at destination, while on transfer of files, retransmissions of information are conducted and a reliable copy of the file is obtained. In the latter case, reception time is penalized because of the low priority this type of traffic on the networks usually has. While in streaming, image quality is adapted to line speed, and line errors result in a decrease of quality at destination, in the file copy the difference between coding speed vs line speed and errors in transmission are reflected in an increase of transmission time. The way news or audiovisual programs are transferred from a remote office to the production centre depends on the time window and the type of line available; in many cases, it must be done in real time (streaming), with the resulting image degradation. The main purpose of this work is the workflow optimization and the image quality maximization, for that reason a transmission model for multimedia files adapted to JPEG2000, is described based on the combination of advantages of file transmission and those of streaming transmission, putting aside the disadvantages that these models have. The method is based on two patents and consists of the safe transfer of the headers and data considered to be vital for reproduction. Aside, the rest of the data is sent by streaming, being able to carry out recuperation operations and error concealment. Using this model, image quality is maximized according to the time window. In this paper, we will first give a briefest overview of the broadcasters requirements and the solutions with IP networks. We will then focus on a different solution for video file transfer. We will take the example of a broadcast center with mobile units (unidirectional video link) and regional headends (bidirectional link), and we will also present a video file transfer file method that satisfies the broadcaster requirements.

Estudio de las dinámicas de pérdida de peso corporal en los programas de ejercicio físico y nutrición = Study of the dynamics of body weight loss in exercise and nutritional programs

Introducción. La obesidad puede definirse como una enfermedad metabólica crónica de origen multifactorial, lo que provoca trastornos o problemas físicos y psicológicos a la persona, con patologías asociadas que limitan la esperanza de vida y deterioran la calidad de la misma, siendo determinante para sus áreas sociales y laborales. Este trastorno metabólico crónico se caracteriza por una acumulación excesiva de energía en el cuerpo en forma de grasa, lo que lleva a un aumento de peso con respecto al valor esperado por sexo, edad y altura. La gestión y el tratamiento de la obesidad tienen objetivos más amplios que la pérdida de peso e incluyen la reducción del riesgo y la mejora de la salud. Estos pueden ser alcanzados por la pérdida modesta de peso (es decir, 10.5% del peso corporal inicial), la mejora del contenido nutricional de la dieta y un modesto incremento en la actividad física y condición física. La dieta es uno de los métodos más populares para perder peso corporal. El ejercicio es otra alternativa para perder peso corporal. El aumento de ejercicio provoca un desequilibrio cuando se mantiene la ingesta calórica. También tiene ventajas, como la mejora del tono muscular, la capacidad cardiovascular, fuerza y flexibilidad, aumenta el metabolismo basal y mejora el sistema inmunológico. Objetivos. El objetivo de esta tesis es contribuir en un estudio de intervención para aclarar la evolución del peso corporal durante una intervención de dieta y ejercicio. Para ello, se evaluaron los efectos de la edad, sexo, índice de masa corporal inicial y el tipo de tratamiento en las tendencias de pérdida de peso. Otro objetivo de la tesis era crear un modelo de regresión lineal múltiple capaz de predecir la pérdida de peso corporal después del periodo de intervención. Y, por último, determinar el efecto sobre la composición corporal (peso corporal, índice de masa corporal, la masa grasa, y la masa libre de grasa) de las diferentes intervenciones basadas en ejercicios (fuerza, resistencia, resistencia combinada con fuerza, y las recomendaciones de actividad física (grupo control)) en combinación con dieta de adultos con sobrepeso y obesidad, después de la intervención, así como los cambios de la composición corporal 3 años más tarde. Diseño de la investigación. Los datos empleados en el análisis de esta tesis son parte del proyecto “Programas de Nutrición y Actividad Física para el tratamiento de la obesidad” (PRONAF). El proyecto PRONAF es un estudio clínico sobre programas de nutrición y actividad física para el sobrepeso y la obesidad, desarrollado en España durante varios años de intervención. Fue diseñado, en parte, para comparar diferentes tipos de intervención, con el objetivo de evaluar su impacto en las dinámicas de pérdida de peso, en personas con sobrepeso y obesidad. Como diseño experimental, el estudio se basó en una restricción calórica, a la que, en algunos casos, se le añadió un protocolo de entrenamiento (fuerza, resistencia, o combinado, en igualdad de volumen e intensidad). Las principales variables para la investigación que comprende esta tesis fueron: el peso corporal y la composición corporal (masa grasa y masa libre de grasa). Conclusiones. En esta tesis, para los programas de pérdida de peso en personas con sobrepeso y obesidad con un 25-30% de la restricción calórica, el peso corporal se redujo significativamente en ambos sexos, sin tener en cuenta la edad y el tipo de tratamiento seguido. Según los resultados del estudio, la pérdida de peso realizada por un individuo (hombre o mujer) durante los seis meses puede ser representada por cualquiera de las cinco funciones (lineal, potencial, exponencial, logarítmica y cuadrática) en ambos sexos, siendo la cuadrática la que tiende a representarlo mejor. Además, se puede concluir que la pérdida de peso corporal se ve afectada por el índice de masa corporal inicial y el sexo, siendo mayor para las personas obesas que para las de sobrepeso, que muestran diferencias entre sexos sólo en la condición de sobrepeso. Además, es posible calcular el peso corporal final de cualquier participante involucrado en una intervención utilizando la metodología del proyecto PRONAF sólo conociendo sus variables iniciales de composición corporal. Además, los cuatro tipos de tratamientos tuvieron resultados similares en cambios en la composición corporal al final del período de intervención, con la única excepción de la masa libre de grasa, siendo los grupos de entrenamiento los que la mantuvieron durante la restricción calórica. Por otro lado, sólo el grupo combinado logra mantener la reducción de la masa grasa (%) 3 años después del final de la intervención. ABSTRACT Introduction. Obesity can be defined as a chronic metabolic disease from a multifactorial origin, which leads to physical and psychological impacts to the person, with associated pathologies that limit the life expectancy and deteriorate the quality of it, being determinant for the social and labor areas of the person. This chronic metabolic disorder is characterized by an excessive accumulation of energy in the body as fat, leading to increased weight relative to the value expected by sex, age and height. The management and treatment of obesity have wider objectives than weight loss alone and include risk reduction and health improvement. These may be achieved by modest weight loss (i.e. 5–10% of initial body weight), improved nutritional content of the diet and modest increases in physical activity and fitness. Weight loss through diet is one of the most popular approaches to lose body weight. Exercise is another alternative to lose body weight. The increase of exercise causes an imbalance when the caloric intake is maintained. It also has advantages such as improved muscle tone, cardiovascular fitness, strength and flexibility, increases the basal metabolism and improves immune system. Objectives. The aim of this thesis is to contribute with an interventional study to clarify the evolution of the body weight during a diet and exercise intervention. For this, the effects of age, sex, initial body mass index and type of treatment on weight loss tendencies were evaluated. Another objective of the thesis was to create a multiple linear regression model able to predict the body weight loss after the intervention period. And, finally, to determine the effect upon body composition (body weight, body mass index, fat mass, and fat-free mass of different exercise-based interventions (strength, endurance, combined endurance and strength, and physical activity recommendations group (control group)) combined with diet in overweight and obese adults, after intervention as well as body composition changes 3 years later. Research Design. The data used in the analysis of this thesis are part of the project "Programs of Nutrition and Physical Activity for the treatment of obesity" (PRONAF). The PRONAF project is a clinical trial program about nutrition and physical activity for overweight and obesity, developed in Spain for several years of intervention. It was designed, in part, to compare different types of intervention, in order to assess their impact on the dynamics of weight loss in overweight and obese people. As experimental design, the study was based on caloric restriction, which, in some cases, added a training protocol (strength, endurance, or combined in equal volume and intensity). The main research variables comprising this thesis were: body weight and body composition outcomes (fat mass and fat-free mass). Conclusions. In this thesis, for weight loss programs in overweight and obese people with 25-30% of caloric restriction, the body weight was significantly decreased in both sexes, regardless the age and type of followed treatment. According to the results of the study, the weight loss performed by an individual (male or female) during six months can be represented by any of the five functions (linear, power law, exponential, logarithmic and quadratic) in both sexes, being the quadratic one which tends to represent it better. In addition, it can be concluded that the body weight loss is affected by the initial body mass index and sex condition, being greater for the obese people than for the overweight one, showing differences between sexes only in the overweight condition. Moreover, it is possible to calculate the final body weight of any participant engaged in an intervention using the PRONAF Project methodology only knowing their initial body composition variables. Furthermore, the four types of treatments had similar results on body composition changes at the end of the intervention period, with the only exception of fat-free mass, being the training groups the ones that maintained it during the caloric restriction. On the other hand, only the combined group achieved to maintain the fat mass (%) reduced 3 years after the end of the intervention.