Non-compliance with smoke-free law in public places: a systematic review and meta-analysis of global studies.

Introduction: Non-compliance with smoke-free law is one of the determinants of untimely mortality and morbidity globally. Various studies have been conducted on non-compliance with smoke-free law in public places in different parts of the world; however, the findings are inconclusive and significantly dispersed. Moreover, there is a lack of internationally representative data, which hinders the evaluation of ongoing international activities towards smoke-free law. Therefore, this meta-analysis aimed to assess the pooled prevalence of non-compliance with smoke-free law in public places. Methods: International electronic databases, such as PubMed/MEDLINE, Science Direct, Cochrane Library, CINAHL, African Journals Online, HINARI, Semantic Scholar, google and Google Scholar were used to retrieve the relevant articles. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA) guidelines. The Higgs I2 statistics were used to determine the heterogeneity of the reviewed articles. The random-effects model with a 95% confidence interval was carried out to estimate the pooled prevalence of non-compliance. Results: A total of 23 articles with 25,573,329 study participants were included in this meta-analysis. The overall pooled prevalence of non-compliance with smoke-free law was 48.02% (95% CI: 33.87-62.17). Extreme heterogeneity was observed among the included studies (I2 = 100%; p < 0.000). The highest non-compliance with smoke-free law was noted in hotels (59.4%; 95% CI: 10.5-108.3) followed by homes (56.8%; 95% CI: 33.2-80.4), with statistically significant heterogeneity. Conclusion: As the prevalence of non-compliance with smoke-free law is high in public places, it calls for urgent intervention. High non-compliance was found in food and drinking establishments and healthcare facilities. In light of these findings, follow-up of tobacco-free legislation and creating awareness that focused on active smokers particularly in food and drinking establishments is recommended.

[The use of sports facilities for physical activity: a public health and equity perspective]. / El uso de instalaciones deportivas para promover la actividad física: una perspectiva de salud pública y equidad.

Introduction: Background: despite multimillion-dollar investments in sports facilities, there is little information on their contribution to energy expenditure of the population. In this study, participation in 71 physical activities (PAs) and 31 different types of spaces was examined. Objectives: to evaluate which types of spaces are more effective from a public health perspective. Methods: a cross-sectional sample was designed, stratified and proportional to the adult population of Gran Canaria (n = 3,000, ≥ 18 years). PA was evaluated using a validated questionnaire. The spaces used were grouped into two categories: public open spaces and sport facilities. Descriptive statistics and multiple logistic regression were used to analyze the data. Results: the open public spaces accumulated a volume of hours for PA between 1.6 and 28.4 times higher than the sport facilities depending on the socio-demographic group analyzed. The indoor sport facilities were the ones that expressed the greatest associative strength with the achievement of PA recommendations (OR = 5.45, 95 % CI: 4.01; 7.40). Conclusion: a dilemma was posed from a public health perspective because the urban open public spaces reached more population and supported most of the population's energy expenditure, particularly in the groups with the highest health risk, but the indoor sport facilities were the ones that best contributed to achieving a healthy level of physical activity. This study suggests changes in the polices of construction and management of sport facilities and open public spaces to increase PA in groups at higher health risk.

Introducción: Introducción: pese a las inversiones multimillonarias en instalaciones para la actividad física-deportiva, hay poca información acerca de su contribución en el gasto energético poblacional. En este estudio examinamos la participación en 71 actividades físicas (AF) y 31 tipos de espacios diferentes. Objetivo: valorar qué tipos de espacios son más eficaces desde una perspectiva de salud pública y equidad. Método: muestra transversal aleatoria, estratificada y proporcional en género y edad a la población de adultos de Gran Canaria (n = 3.000, ≥ 18 años). La AF fue evaluada mediante cuestionario validado. Los espacios de AF fueron agrupados en dos categorías: espacios públicos abiertos (EPA) e instalaciones deportivas. Para analizar los datos se emplearon estadística descriptiva y regresión logística múltiple. Resultados: los EPA acumularon un volumen de horas de AF entre 1,6 y 28,4 veces mayor que las instalaciones deportivas dependiendo del grupo sociodemográfico analizado. Las instalaciones deportivas cubiertas fueron las que expresaron la mayor fuerza asociativa con el logro de las recomendaciones de AF (OR = 5,45, IC 95 %: 4,01; 7,40). Conclusiones: se planteó un dilema desde una perspectiva de salud porque los EPA urbanos llegaron a más población y dieron soporte a la mayor parte del gasto energético poblacional, particularmente, en los grupos de mayor riesgo de salud, pero las instalaciones deportivas cubiertas fueron las que mejor contribuyeron a lograr un nivel saludable de actividad física. Este estudio sugiere cambios en las políticas de construcción y gestión de instalaciones deportivas y EPA para aumentar la AF en los grupos de mayor riesgo de salud.

How can public open spaces contribute to physical activity promotion? / Como os espaços públicos abertos podem contribuir para a promoção da atividade física?

Public open spaces (POSs) are means to ensure one's right to recreation and health. The objective of this essay is to present reflections and evidence on how these spaces contribute to promoting physi-cal activity (PA). Understanding how to access (proximity/distance), quantity and diversity, and the surrounding and internal conditions of places (quality, structure, aesthetics, safety) can affect the use of POSs is imperative for public management actions. Thinking of POS use beyond PA by recog-nizing its social, economic, and cultural benefits can be fundamental to reduce inequalities regarding access to these places. POS-related actions and demands are intersectoral, multiprofessional, and interdisciplinary, thus requiring political, academic, and community involvement and commitment for PA promotion

Espaços públicos abertos (EPA) são equipamentos que promovem o direito à recreação e à saúde. O objetivo deste ensaio é apresentar reflexões e evidências sobre como esses espaços contribuem para a promoção da atividade física (AF). Compreender como o acesso (proximidade/distância), a quantidade e diversidade, as condições do entorno e internas dos locais (qualidade, estrutura, estética, segurança), podem afetar o uso dos EPA é fundamental para ações da gestão pública. Pensar o uso do EPA para além da prática de AF, reconhecendo seus benefícios sociais, econômicos e culturais pode ser fundamental para diminuir as iniquidades de acesso a esses locais. Ações e demandas relacionadas aos EPA são intersetoriais, multiprofissionais e interdisciplinares, necessitando com isso envolvimento e comprometimento político, acadêmico e comunitário, a fim de promover AF

Dual contraception method utilization and associated factors among women on anti-retroviral therapy in public facilities of Bishoftu town, Oromia, Ethiopia.

INTRODUCTION: Dual contraception is a method used to prevent sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV) and unintended pregnancies. Prevention of unintended pregnancy in people living with HIV (PLHIV) and ART given to pregnant women to suppress viral load prevent transmission of HIV to children. Counseling and provision of dual contraceptive methods is a very cost-effective method to tackle this double burden among women living with HIV. However, little has been known about utilization of dual methods among HIV positive women in Bishoftu town and its surroundings. OBJECTIVE: The aim of this study was to assess dual contraception method utilization and associated factors among reproductive age women who were on antiretroviral therapy in public health facilities of Bishoftu town. METHODS: A facility based cross- sectional study was conducted from November 01 to December 30, 2020. The study participants were selected by using simple random sampling technique. Data were collected using a pretested and structured questionnaire through a face to face interview. Data were processed and analyzed using SPSS version 20. Frequencies and percentages were used to describe characteristics of participants. Bivariable and multivariable logistic regression analyses were used to identify variables which had an independent association with the dependent variable. The degree of association between dependent and independent variables were measured using odds ratio with 95% confidence interval. Level of significance was set at a p-value less than 0.05. RESULTS: The Magnitude of dual contraceptive utilization of women living with HIV in Bishoftu town was 56.9% (95% Cl (51.6, 62.1). Being married (AOR = 4.33; 95% Cl (1.67, 11.27), not getting pregnant since the start of chronic care follow up (AOR = 2.19; 95% Cl (2.90, 3.70), having a partner positive for HIV (AOR = 2.67; 95% Cl (1.34, 5.32) and having a partner negative for HIV (AOR = 2.38; 95% Cl (1.09, 5.20) were factors independently associated with dual method contraceptive use. CONCLUSION: The study showed that use of dual contraceptive methods was low; factors like marital status, partner HIV status, and pregnancy after chronic HIV care follow up were found to be significantly associated with dual contraceptive method use. In addition to ART, use of dual contraceptive methods utilization may play a role in prevention of HIV infection in children and is important in the prevention of unintended pregnancy.

Rational use of antibiotics for major elective gynaecological and obstetrical surgical procedures: quality improvement journey from a tertiary care public facility.

BACKGROUND: Antibiotic resistance is a global problem. Irrational use of antibiotics is rampant. Guidelines recommend administration of single dose of antibiotic for surgical antimicrobial prophylaxis (SSAP) for elective obstetrical and gynaecological surgeries. However, it is not usually adhered to in practice. Majority of women undergoing elective major gynaecological surgeries and caesarean sections in the department of obstetrics and gynaecology of our tertiary level heavy case load public health facility were receiving therapeutic antibiotics (for 7-10 days) instead of recommended SSAP. Our aim was to increase the SSAP in our setting from a baseline 2.1% to more than 60% within 6 months. METHODS: After root cause analysis, we formulated the departmental antimicrobial policy, spread awareness and sensitised doctors and nursing officers regarding antimicrobial resistance and asepsis through lectures, group discussions and workshops. We initiated SSAP policy for elective major surgeries and formed an antimicrobial stewardship team to ensure adherence to policy and follow processes and outcomes. The point of care quality improvement (QI) methodology was used. Percentage of patients receiving SSAP out of all low-risk women undergoing elective surgery was the process indicator and percentage of patients developing surgical site infection (SSI) of all patients receiving SSAP was the outcome indicator. The impact of various interventions on these indicators was followed over time with run charts. RESULTS: SSAP increased from a baseline 2.1%-67.7% within 6 months of initiation of this QI initiative and has since been sustained at 80%-90% for more than 2 years without any increase in SSI rate. CONCLUSION: QI methods can rapidly improve the acceptance and adherence to evidence-based guidelines in a busy public healthcare setting to prevent injudicious use of antibiotics.

Differential Impact of COVID-19 on Cancer Diagnostic Services Based on Body Regions: A Public Facility-Based Study in Hong Kong.

PURPOSE: A reduction in cancer services during the coronavirus disease of 2019 pandemic has affected cancer diagnoses. The purpose of this study is to quantitatively determine the impact on cancer diagnostic service in public facilities across Hong Kong. Quantifying the temporal changes in the number of cancer diagnoses before, during, and after the outbreak is useful to establish the scale of the problem and assess if there has been an adequate level of response. METHODS AND MATERIALS: This is a retrospective cohort study using a territory-wide database in Hong Kong from 2017 to 2020, and consecutive specimens received for pathologic diagnosis in public laboratories in 41 hospitals were retrieved. RESULTS: In 2020, a total of 455,453 pathologic specimens were received, which amounted to a 15.5% reduction compared with the prior 3-year average (P < .001). An analysis of confirmed malignant pathologic diagnoses revealed a statistically significant reduction in colorectal (-10.0%; P < .001) and prostate (-19.7%; P < .001), nonsignificant reduction in lung (-3.0%; P = .0526), and a marginal but nonsignificant increase for breast (0.7%; P = .7592) regions. Based on time series projection data, the estimated missed cancers for the 3 regions with reduced investigations were colorectal (10.0%), lung (3.0%), and prostate (19.7%). CONCLUSIONS: Variable impact on actual malignant pathologic diagnoses based on 4 body regions was observed, with a statistically significant reduction in colorectal, lung, and prostate regions, and marginal but insignificant increase in breast regions. The findings could help public health policy with future planning and intervention.

The proportion of sports public service facilities based on the dea model in colleges and universities / A proporção de instalações de serviços públicos desportivos universitários com base no modelo dea / Investigación sobre la proporción de asignación de instalaciones de servicio público de deportes universitarios basada en el modelo de la dea

ABSTRACT In order to strengthen the physical education of college students, it is necessary to reasonably allocate university sports public service resources. In order to improve the allocation of university sports resources, this study constructs the Data Envelopment Analysis (DEA) model by analyzing the proportion of public sports service facilities in colleges and universities. Through the selection of input index and output index of sports public service facilities in colleges and universities, as well as selecting 20 colleges and universities as decision-making units, this paper constructs a DEA model, and studies the use of the DEA Tobit two-stage method to evaluate the matching efficiency of public sports service facilities in colleges and universities. The results show that the pure technical efficiency of sports public service facilities in colleges and universities is effective, and the scale efficiency of most colleges and universities is relatively high, and the proportion of sports facilities is relatively reasonable. However, there are still large problems in the proportion of public sports service facilities in colleges and universities, so it is necessary to adjust the proportion and scale of sports facilities allocation reasonably. This study verified the effectiveness of the DEA model in evaluating the proportion of public sports service facilities in colleges and universities, hoping to provide certain reference for improving the proportion of public sports service facilities in colleges and universities.

RESUMO A fim de reforçar a educação física dos estudantes universitários, é necessário aloca de forma razoável os recursos públicos de serviços desportivos universitários. A fim de melhorar a alocação de recursos desportivos universitários, este estudo constrói o modelo de Análise por Envoltória de Dados (Data Envelopment Analysis — DEA) ao analisar a proporção de instalações de serviço esportivo público em faculdades e universidades. Através da seleção do índice de entrada e índice de saída de instalações de serviços públicos esportivos universitários, bem como da seleção de vinte faculdades e universidades como unidades de tomada de decisão, este estudo constrói um modelo DEA e estuda o uso do método DEA Tobit em duas fases para avaliar a respectiva eficiência das instalações de serviços públicos desportivos em faculdades e universidades. Os resultados mostram que a eficiência técnica das instalações de serviços públicos desportivos em faculdades e universidades é eficaz, e a eficiência em escala da maioria das faculdades e universidades é relativamente alta, e a proporção de instalações esportivas é relativamente razoável. No entanto, ainda há grandes problemas na proporção de instalações públicas de serviço desportivo em faculdades e universidades, pelo que é necessário ajustar razoavelmente a proporção e a escala das instalações desportivas atribuídas. Este estudo verificou a eficácia do modelo DEA na avaliação da proporção de instalações públicas de serviço desportivo em faculdades e universidades na esperança de fornecer certa referência para melhorar a proporção de instalações públicas de serviço desportivo nesses locais.

RESUMEN Para fortalecer la educación física de los estudiantes universitarios, es necesario asignar razonablemente los recursos del servicio público deportivo universitario. Con el fin de mejorar la asignación de recursos deportivos universitarios, este estudio construye el modelo Análisis Envolvente de Datos (Data Envelopment Analysis DEA) analizando la proporción de instalaciones de servicios públicos deportivos en colegios y universidades. Mediante la selección del índice de entrada y de salida de las instalaciones de servicio público deportivo en colegios y universidades, así como la selección de 20 colegios y universidades como unidades de toma de decisiones, este documento construye un modelo DEA y estudia el uso del método DEA Tobit de dos etapas para evaluar la eficiencia de emparejamiento de las instalaciones de servicios deportivos públicos en colegios y universidades. Los resultados muestran que la eficiencia técnica pura de las instalaciones de servicio público deportivo en los colegios y universidades es efectiva, y la eficiencia de escala de la mayoría de los colegios y universidades es relativamente alta y la proporción de instalaciones deportivas es relativamente razonable. Sin embargo, todavía existen grandes problemas en la proporción de instalaciones de servicios deportivos públicos en colegios y universidades, por lo que es necesario ajustar la proporción y la escala de la asignación de instalaciones deportivas de manera razonable. Este estudio verificó la efectividad del modelo DEA al evaluar la proporción de instalaciones de servicios deportivos públicos en colegios y universidades, con la esperanza de proporcionar cierta referencia para mejorar la proporción de instalaciones de servicios deportivos públicos en colegios y universidades.

Máscaras de tecido em locais públicos: intervenção essencial na prevenção da COVID-19 no Brasil / Cloth masks in public places: an essential intervention to prevent COVID-19 in Brazil

Resumo Acumulam-se evidências de que o uso de máscaras é uma medida indispensável de proteção à COVID-19, devido ao alto poder de transmissão do novo coronavírus por via respiratória, inclusive por indivíduos assintomáticos. Por sua vez, o uso das máscaras de tecido em locais públicos tem se consolidado como medida adicional de proteção às medidas de distanciamento social e higienização das mãos. Objetivou-se sistematizar as evidências científicas que justificam o amplo uso de máscaras de tecido como prevenção à COVID-19 e descrever a evolução dos posicionamentos contrários ou favoráveis ao seu uso em ambientes extradomiciliares, diante do avanço da pandemia do novo coronavírus pelo mundo. A triagem de artigos e documentos oficiais do Brasil e de outros países indica que o uso de máscaras em locais públicos tornou-se uma intervenção essencial graças ao potencial de reduzir a velocidade de propagação do novo coronavírus. Recomenda-se que o poder público adote estratégias para aumentar a oferta deste produto e fomente estudos para avaliação do impacto da medida no controle da pandemia no Brasil. É imperativo assegurar disponibilidade de máscaras a grupos socioeconomicamente desfavorecidos e garantir que determinados grupos raciais não sejam estigmatizados diante do uso de máscaras em ambientes extradomiciliares.

Abstract There is increasing evidence that the use of masks is an indispensable protective measure against COVID-19, given the high transmissibility of the new coronavirus through the respiratory system, including by asymptomatic individuals. The use of cloth masks in public places has been established as a protective measure to be adopted alongside social distancing and hand hygiene. This narrative review aims to systematize the scientific evidence that informs the widespread use of cloth masks as a preventive measure against COVID-19 and to describe the evolution of positions contrary to or in favor of its use outside the home, in view of the advance of the new coronavirus pandemic globally. The scientific articles, technical notes, governmental decrees and other documents analyzed indicate that widespread use of masks has the potential to reduce the spread of the new coronavirus. We recommend that the Brazilian government adopt strategies to increase the supply of reusable cloth masks to the public, especially to vulnerable populations and to support studies on the impact of this measure to control the pandemic in the country. Finally, it is imperative to ensure that use of masks does not exacerbate stigmatization of racial groups that already face prejudice.

Willingness to pay for primary health care at public facilities in the Western Cape Province, Cape Town, South Africa.

BACKGROUND AND OBJECTIVES: As facilities are being prepared for the implementation of National Health Insurance (NHI) in South Africa, there is a pressing need to understand how the public equates the provision of health services at Primary Health Care (PHC) centres with monetary value. Accordingly, this exploratory study was designed to ascertain the willingness to pay (WTP) for public primary healthcare services in South Africa and to identify factors that influence the WTP. METHODS: The study was conducted in Cape Town, South Africa, among 453 persons presenting at two public primary health care centres, namely Bothasig Community Day Centre (CDC) and Goodwood CDC. The study used the contingent valuation range methodology. Descriptive statistics, multiple logistic and tobit regression analyses were conducted to assess demographics, socio-economic, and health access factors that influence WTP. RESULTS: Overall, 60% of participants were willing to pay for services offered at the PHC facilities. The average willingness to pay for all participants was 49.44 ZAR, with a median of 25 ZAR. The multiple logistic regression for grouped facilities showed unemployment, public transport, and the facility attended to be significant while public transport, facility visits, and facility attended were the only significant variables in the tobit model. There was less willingness to pay for those unemployed in comparison with students, those using public transport rather than walking, those frequenting the facilities more than first-time visitors and those attending Goodwood facility in comparison with Bothasig. CONCLUSION: This study revealed factors related to the participants' WTP and to their willingness to contribute towards the health service, though at very low amounts. Understanding the economic value placed upon a service provided in a facility is essential in decision-making for quality care improvements, especially as the South African health system is making the facilities ready for NHI.

Indoor levels of polycyclic aromatic hydrocarbons (PAHs) from environment tobacco smoke of public bars.

In this work level of Polycyclic Aromatic Hydrocarbon (PAHs) from indoor Environment Tobacco Smoke (ETS) of pubic bars in Nigeria was investigated. Indoor air samples were obtained from different public bars using Polyurethane foam (PUF) passive samplers. Analysis of PAHs was carried out using GC-MS operated in selected ion monitoring mode. Result showed the average concentration range of 2.71-9.69 ng/m3 while the ∑ 16 PAHs range from 43.43 to 155.11 ng/m3. The incremental lifetime cancer risk (ILCR) values from inhalation of PAHs in these bars ranged from 2.4×10-7-5.2×10-7 while non-carcinogenic risk, Hazard Quotient (HQ) ranged from 2×10-4-4.5×10-4. Although these values are lower than WHO permissible limit, nevertheless the study underscores the danger associated with the inhalation of ETS in the public bars in Nigeria.

"Da cidade à rede, tem parada?": Estação Psicanálise na pandemia de Covid-19 / "De la ciudad a la red, ¿hay parada?": Estação Psicanálise en la pandemia Covid-19 / "From city to network, is there some stop?": Estação Psicanálise in the Covid-19 pandemic / "De la ville au réseau, Y a-t-il un arrêt?": Estação Psicanálise dans la pandémie duCovid-19

Este texto procura pensar o atravessamento da pandemia de Covid-19 no coletivo Estação Psicanálise, um grupo heterodoxo de psicanalistas que realizam atendimentos em espaço público na cidade de Campinas. Com as medidas de isolamento, nosso dispositivo se transformou. O texto procura pensar tais transformações, a partir de três leituras diferentes sobre o impacto da pandemia no dispositivo: sobre sua história, sobre a formação do analista e sobre os efeitos psíquicos nos sujeitos escutados pelos analistas do coletivo

El texto intenta pensar en los atravesamientos de la pandemia de Covid-19 en el colectivo Estação Psicanálise, un grupo heterodoxo de psicoanalistas que realizan atendimientos clínicos en espacio público en Campinas. Con las medidas de aislamiento social nuestro dispositivo se transformó. En este texto intentaremos pensar estas transformaciones, desde tres diferentes lecturas acerca de los impactos de la pandemia en nuestro dispositivo: en su historia, en la formación del analista y en los efectos psíquicos enlos sujetos escuchados por los analistas del colectivo

This text aims to reflect on the effects of the Covid-19 pandemic on the collective Estação Psicanálise, an heterodox group of psychoanalysts that conducts appointments in public spaces in Campinas. Due to social distancing precautions our clinical device was transformed. The text aims to consider these transformations from three different perspectives about the pandemic's impact on our clinical device: on its history, on the formation of the analyst and on the psychological effects for the subjects attended to by our collective

Cet article analyse la traversée de la pandémie de Covid-19 dans le collectif Station Psychanalyse, un groupe hétérodoxe de psychanalystes qui fournissent des services dans l'espace public à Campinas. Avec les mesures d'isolement, notre dispositif a été transformé. Le texte présente des réflexions sur ces transformations, à partir de trois lectures différentes sur l'impact de la pandémie sur le dispositif: sur son histoire, sur la formation de l'analyste et sur les effets psychiques sur les sujets écoutés par les analystes du collectif

Compliance with Smoke-Free Policy and Challenges in Implementation: Evidence from Bengkulu, Indonesia.

BACKGROUND: Smoking is among the top contributors to deaths and disability-adjusted life years in Indonesia, particularly among males. In 2012, a presidential decree encouraged provinces and districts to implement a smoke-free policy (SFP). This study aims to evaluate compliance and explore the challenges in the implementation. METHODS: Through a mixed-methods design, we used quantitative methods to examine the compliance with six criteria including signage, no active smoking, no selling, no advertisement, no smoke, and no ashtray at SFP facilities in Bengkulu city. We observed SFP compliance at 105 facilities, including health/educational facilities, places of worship, workplaces, and indoor/outdoor public facilities. We also used a qualitative method to explore challenges in the implementation through interviews with the government and legislators. RESULTS: The compliance rate to all six criteria was 38% overall, ranging from 17% at outdoor public facilities to 67% at health facilities. We found no spatial patterning, as shown by non-significant differences in compliance rates between SFP facilities inside and outside of 1-kilometer around the provincial and city health offices. Implementation challenges included lack of sensitization, lack of coordination, and limited budget. CONCLUSION: The compliance was relatively low due to several challenges, which could serve as a tobacco control policy lesson in a lower-middle-income country.

Trends and patterns of second-hand smoke exposure amongst the non-smokers in India-A secondary data analysis from the Global Adult Tobacco Survey (GATS) I & II.

OBJECTIVES: The primary objective of the present study was to compare the prevalence and patterns of second-hand smoke (SHS) exposure in the home, workplace, public places, and at all three places amongst the non-smoker respondents between the two rounds of Global Adult Tobacco Survey (GATS) in India. The secondary objectives were to assess the differences in various factors associated with SHS exposure among non-smokers. STUDY DESIGN: This secondary data analysis incorporated data generated from the previous two rounds of the cross-sectional, nationally representative GATS India, which covered 69,296 and 74,037 individuals aged 15 years and above. Exposure to the SHS at home, workplace, and public places amongst the non-smokers were the primary outcome variables. Standard definitions of the surveys were used. RESULTS: The overall weighted prevalence of exposure to SHS amongst the non-smokers inside the home and public places reduced. In contrast, the prevalence in the workplace increased marginally in round II compared to I. The proportion of adults who were exposed to SHS at all three places did not change much in two rounds of surveys. A decrease in the knowledge of the respondents exposed to SHS at home and public places was observed about the harmful effects of smoking in round II. Age, gender, occupation, place, and region of respondents were found to be significant determinants of SHS exposure at all the three places on multinomial logistic regression analysis. CONCLUSIONS: The study calls for focused interventions in India and stringent implementation of anti-tobacco legislation, especially in the workplaces for reducing the exposure to SHS amongst the non-smokers and to produce encouraging and motivating results by next round of the survey.

Adesão à alimentação escolar e fatores associados em adolescentes de escolas públicas na região Sul do Brasil / Adherence to school food and associated factors among adolescents in public schools in the Southern region of Brazil

Resumo Objetivou-se analisar o índice de adesão à alimentação escolar e os fatores associados entre adolescentes matriculados em escolas públicas estaduais do município da Lapa, Paraná, sul do Brasil. De caráter transversal e analítico, incluiu 492 adolescentes de 10 a 19 anos de cinco escolas urbanas e cinco rurais do município. Foi aplicado um questionário sobre o consumo da alimentação escolar e de alimentos competitivos (aqueles comprados ou trazidos de casa) e realizada a avaliação antropométrica nos adolescentes. Os seus pais/responsáveis responderam um questionário demográfico e socioeconômico. Foi utilizado modelo de regressão de "odds" proporcionais ajustado para verificar as associações. O índice de adesão efetiva à alimentação escolar foi de 30,1% nas escolas rurais e de 23,7% nas urbanas. Não gostar das preparações servidas foi o principal motivo apontado para a não adesão. Observou-se menor adesão entre os adolescentes que possuíam maior renda familiar per capita e entre os que consumiam alimentos competitivos de 4 a 5x/semana. A adesão foi maior entre aqueles que consideravam a alimentação escolar saudável. Diante do baixo índice de adesão à alimentação escolar, a universalidade do atendimento não está sendo atingida. Os fatores apontados podem auxiliar em melhoras na execução do programa.

Abstract The scope of this study was to analyze adherence to school food and associated factors among adolescents from public state schools in the municipality of Lapa, Paraná, in the Southern region of Brazil. The study uses a cross-sectional and analytical design and includes 492 male and female adolescents aged 10 to 19 years from five urban and five rural schools in the municipality. The students underwent anthropometric assessment and answered a questionnaire about school food and alternative food intakes (purchased or home-cooked). Their parents/guardians answered a questionnaire about their demographic and socioeconomic characteristics. An adjusted proportional odds regression model investigated the associations. The effective adherence to school food was 30.1% in rural schools and 23.7% in urban schools. Dislike of the food preparation was the main reason for non-adherence. The results showed lesser adherence among adolescents with higher per capita family income who consumed alternative food products four to five times per week. Adolescents who considered school food healthy showed higher adherence. Low adherence to school food indicates the inadequate universality of the program. The factors revealed may help to improve program planning and execution.

Support for smoke-free public places among adults in four countries in sub-Saharan Africa.

INTRODUCTION: There is no known safe level of secondhand smoke exposure; yet, less than 30% of the global population is covered by comprehensive smoke-free policies as of 2016 and there are few smoke-free policies in sub-Saharan Africa (SSA). This study examines the support for smoke-free public places in SSA and delineates their correlates. METHODS: Data collected through the Global Adult Tobacco Survey (2012-2017) were analyzed using SAS for descriptive and multivariable analyses, with a significance level set at p < .05. RESULTS: No SSA country had comprehensive smoke-free policies, defined as a prohibition of smoking in eight public places. In the four countries whose Global Adult Tobacco Survey data were analyzed (Nigeria, Cameroon, Kenya, and Uganda), support for the prohibition of smoking in public places was over 90% in all eight public places except bars. Support for smoking prohibition in bars was 65.8%, 81.1%, 81.4%, and 91.0% in Nigeria, Cameroon, Kenya, and Uganda, respectively. Factors associated with support for smoke-free bars differed across the four countries, but in all countries, current smokers had decreased odds of support for smoke-free bars. Knowledge of secondhand smoke harm and living in smoke-free homes were associated with increased odds of support for smoke-free bars in all countries except Kenya. CONCLUSION: The high support for smoke-free public places should inform the efforts of the public health community and policymakers in these four SSA countries toward meeting their obligations of Article 8 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). IMPLICATIONS: Much of the population in SSA is not protected by comprehensive smoke-free policies. It was found that the overwhelming majority of adults in four large countries in SSA support the prohibition of smoking in public places and that knowledge of the health dangers of smoking and exposure to secondhand smoke and home smoking rules increased support for the prohibition. High support for the prohibition of smoking in these four SSA countries suggests tobacco control proponents should advocate for comprehensive smoke-free policies.

Scale-Up and Scale-Out of a Gender-Sensitized Weight Management and Healthy Living Program Delivered to Overweight Men via Professional Sports Clubs: The Wider Implementation of Football Fans in Training (FFIT).

Increasing prevalence of obesity poses challenges for public health. Men have been under-served by weight management programs, highlighting a need for gender-sensitized programs that can be embedded into routine practice or adapted for new settings/populations, to accelerate the process of implementing programs that are successful and cost-effective under research conditions. To address gaps in examples of how to bridge the research to practice gap, we describe the scale-up and scale-out of Football Fans in Training (FFIT), a weight management and healthy living program in relation to two implementation frameworks. The paper presents: the development, evaluation and scale-up of FFIT, mapped onto the PRACTIS guide; outcomes in scale-up deliveries; and the scale-out of FFIT through programs delivered in other contexts (other countries, professional sports, target groups, public health focus). FFIT has been scaled-up through a single-license franchise model in over 40 UK professional football clubs to 2019 (and 30 more from 2020) and scaled-out into football and other sporting contexts in Australia, Canada, New Zealand, England and other European countries. The successful scale-up and scale-out of FFIT demonstrates that, with attention to cultural constructions of masculinity, public health interventions can appeal to men and support them in sustainable lifestyle change.

Multiple myeloma treatment patterns and clinical outcomes in the Latin America Haemato-Oncology (HOLA) Observational Study, 2008-2016.

Limited data are available regarding contemporary multiple myeloma (MM) treatment practices in Latin America. In this retrospective cohort study, medical records were reviewed for a multinational cohort of 1103 Latin American MM patients (median age, 61 years) diagnosed in 2008-2015 who initiated first-line therapy (LOT1). Of these patients, 33·9% underwent autologous stem cell transplantation (ASCT). During follow-up, 501 (45·4%) and 129 (11·7%) patients initiated second- (LOT2) and third-line therapy (LOT3), respectively. In the LOT1 setting, from 2008 to 2015, there was a decrease in the use of thalidomide-based therapy, from 66·7% to 42·6%, and chemotherapy from, 20·2% to 5·9%, whereas use of bortezomib-based therapy or bortezomib + thalidomide increased from 10·7% to 45·5%. Bortezomib-based therapy and bortezomib + thalidomide were more commonly used in ASCT patients and in private clinics. In non-ASCT and ASCT patients, median progression-free survival (PFS) was 15·0 and 31·1 months following LOT1 and 10·9 and 9·5 months following LOT2, respectively. PFS was generally longer in patients treated with bortezomib-based or thalidomide-based therapy versus chemotherapy. These data shed light on recent trends in the management of MM in Latin America. Slower uptake of newer therapies in public clinics and poor PFS among patients with relapsed MM point to areas of unmet therapeutic need in Latin America.

Government-subsidized restaurants in Brazil: an evaluation within the framework of food and nutrition security / Restaurantes populares brasileiros: avaliação no âmbito da segurança alimentar e nutricional

ABSTRACT Objective The objective was to evaluate government-subsidized restaurants in southern Brazil according to current regulations and the National Food and Nutrition Security Policy. Methods An evaluation matrix was developed on the basis of a literature review, logic model, immersion in a government-subsidized restaurant, and workshops with experts in the field. The Government-Subsidized Restaurant Evaluation Matrix contemplates two dimensions: Political/Organizational, composed of the subdimensions Administration, Structure, and Target Groups; and Technical/Operational, composed of the subdimensions Meal Quality, Food and Nutrition Education, and Extended Social Support. Subdimensions comprised 24 indicators. Data were gathered through an online survey of the 35 government-subsidized restaurants operating in southern Brazil. Results Of the 35 government-subsidized restaurants in southern Brazil, 86% (n=30) participated in the study. Meal Quality and Administration received the highest score in 73% and 60% of government-subsidized restaurants, respectively, whereas Food and Nutrition Education and Extended Social Support received the lowest score in 47% and 40%, respectively. Conclusion Advances are needed in the understanding of government-subsidized restaurants as public facilities for ensuring food and nutrition security and the human right to adequate food.

RESUMO Objetivo O objetivo do estudo foi avaliar os restaurantes populares da região Sul do Brasil utilizando como parâmetros as diretrizes e normativas em vigor e a Política Nacional de Segurança Alimentar e Nutricional. Métodos Avaliação do tipo normativa. Para isso, foi utilizada a Matriz Avaliativa elaborada por meio das seguintes etapas: revisão sistematizada; elaboração do Modelo Teórico-Lógico; processo de imersão em um restaurante popular e oficinas de consenso com especialistas na temática. A matriz avaliativa contempla duas dimensões: Político-Organizacional, organizada nas subdimensões Administração, Estrutura e Público Frequentador; e Técnico-Operacional, organizada nas subdimensões Alimentação Adequada, Educação Alimentar e Nutricional e Assistência Ampliada ao Público Frequentador. Foram elencados 24 indicadores, coletados por meio de questionário online respondido pelos gestores dos restaurantes. Resultados Dos 35 restaurantes existentes na região Sul, 86% (30) participaram da pesquisa. As subdimensões mais bem avaliadas foram Alimentação Adequada e Administração, com 70% e 63% dos restaurantes avaliados como "bom", respectivamente. As subdimensões com piores avaliações foram Educação Alimentar e Nutricional e Assistência Ampliada ao Usuário, com 47% e 40% dos restaurantes classificados como "ruim", respectivamente. Conclusão Destaca-se a boa avaliação dos itens referentes à administração, estrutura e ao processo de produção de refeições, em detrimento aos aspectos relacionados à garantia dos direitos dos usuários.