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1.
Artigo em Inglês | MEDLINE | ID: mdl-33316905

RESUMO

Palestinian-Arab women are at increased risk of cardiovascular disease due to high prevalence of diabetes and other risk factors. The current study investigates the effectiveness of an intensive group-based intervention on lifestyle habits that can prevent diabetes and cardiovascular disease. To that end, we conducted a group-based intervention based on the diabetes prevention program in two consecutive phases. The first phase consisted of a quasi-experimental study and the second phase included community-wide dissemination, with a 6-month follow-up. Findings from the quasi-experiment indicate increased consumption of fruit, vegetables and whole grains, weight reduction (-2.21 kg, p < 0.01), and a significant increase in the average daily steps in the intervention group (from 4456 to 6404). Findings from the dissemination indicate that average daily vegetables consumption increased from 1.76 to 2.32/day as did physical activity and average daily steps (from 4804 to 5827). There was a significant reduction in blood pressure, total cholesterol and LDL. These gains were sustained over 6 months following the intervention. This community-based, culturally adapted, health-promotion intervention led to improved nutrition and physical activity which were maintained after 6 months. Collaboration with community centers and local community partners created an effective channel for dissemination of the program to pre-clinical individuals.


Assuntos
Árabes , Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Estilo de Vida , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Exercício Físico , Feminino , Promoção da Saúde/estatística & dados numéricos , Humanos , Disseminação de Informação , Israel/epidemiologia , Gravidez , Serviços Preventivos de Saúde/estatística & dados numéricos , Fatores de Risco , Perda de Peso
2.
Ann Agric Environ Med ; 27(4): 605-612, 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33356068

RESUMO

INTRODUCTION: Schools are important settings for the promotion of healthy diet and sufficient physical activity to prevent civilisation diseases related to lifestyle. OBJECTIVE: To describe school physical activity and nutrition environment in elementary schools in Poland, and to asses differences in school physical activity and nutrition environments, depending on school location and size. MATERIAL AND METHODS: Data was used from the World Health Organisation European Childhood Obesity Surveillance Initiative (COSI) conducted in 2016 in 135 Polish schools. Logistic regression was used to asses association between the location and individual school environment indicator. On the basis of answers to 20 questions about school physical activity and nutrition environment, a positive school environmental assessment index was compiled. RESULTS: Large, urban schools were characterised by a significantly greater availability of sweet snacks, whereas flavoured milk with added sugar was more often available in small and rural schools. The univariate logistics analysis parameters showed that an urban-rural location had a significant association for the availability of an indoor gym and existence of a canteen and a shop. Analysing the positive schools environmental assessment index, there were no statistically significant differences in mean values due to location, but statistically significant differences were found depending on the school size, with the highest level in large schools and the lowest in small schools. CONCLUSIONS: The factor which adversely differentiates the school environment in terms of healthy nutrition and physical activity is primarily the school size, and then the school location. Systemic and social solutions should aim at reducing the small school "exclusion syndrome", both in rural and in urban areas, also with regard to infrastructure and availability of conditions conducive to healthy nutrition and physical activity.


Assuntos
Exercício Físico , Estado Nutricional , Instituições Acadêmicas/estatística & dados numéricos , Criança , Promoção da Saúde/estatística & dados numéricos , Humanos , Polônia
3.
J Med Internet Res ; 22(11): e21501, 2020 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-33119536

RESUMO

BACKGROUND: The battle against COVID-19 remains ongoing, and social media has played an important role during the crisis for both communication and health promotion, particularly for health care organizations. Taiwan's success during the COVID-19 outbreak is well known and the use of social media is one of the key contributing factors to that success. OBJECTIVE: This nationwide observational study in Taiwan aimed to explore the use of Facebook by academic medical centers during the COVID-19 pandemic. METHODS: We conducted a nationwide observational study of all Facebook fan page posts culled from the official accounts of all medical centers in Taiwan from December 2019 to April 2020. All Facebook posts were categorized into either COVID-19-related posts or non-COVID-19-related posts. COVID-19-related posts were split into 4 categories: policy of Taiwan's Center for Disease Control (TCDC), gratitude notes, news and regulations from hospitals, and education. Data from each post was also recorded as follows: date of post, headline, number of "likes," number of messages left, number of shares, video or non-video post, and date of search. RESULTS: The Facebook fan pages of 13 academic medical centers, with a total of 1816 posts, were analyzed. From January 2020, the percentage of COVID-19 posts increased rapidly, from 21% (January 2020) to 56.3% (April 2020). The trends of cumulative COVID-19 posts and reported confirmed cases were significantly related (Pearson correlation coefficient=0.93, P<.001). Pages from private hospitals had more COVID-19 posts (362 versus 289), as well as more video posts (72 posts, 19.9% versus 36 posts, 12.5%, P=.011), when compared to public hospitals. However, Facebook pages from public hospitals had significantly more "likes," comments, and shares per post (314, 5, 14, respectively, P<.001). Additionally, medical centers from different regions displayed different strategies for using video posts on Facebook. CONCLUSIONS: Social media has been a useful tool for communication during the COVID-19 pandemic. This nationwide observational study has helped demonstrate the value of Facebook for academic medical centers in Taiwan, along with its engagement efficacy. We believe that the experience of Taiwan and the knowledge it can share will be helpful to health care organizations worldwide during our global battle against COVID-19.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Comunicação , Infecções por Coronavirus/epidemiologia , Promoção da Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Mídias Sociais/estatística & dados numéricos , Surtos de Doenças , Emoções , Hospitais , Humanos , Pandemias , Taiwan/epidemiologia
4.
BMC Public Health ; 20(1): 1478, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993598

RESUMO

BACKGROUND: Four decades of population-based tobacco control strategies have contributed to substantial reduction in smoking prevalence in Australia. However, smoking prevalence is still double in socially disadvantaged groups compared to those that are not. But not all tobacco control strategies successfully used in the general population is effective in specific high-risk population groups. Hence, an effective way to reduce smoking in high risk population groups may include targeting them specifically to identify and support smokers to quit. In this backdrop, we examined whether tobacco control interventions at the population-level are more effective in increasing life expectancy among Australians compared to interventions targeting a high risk group or a combination of the two when smoking prevalence is reduced to 10 and 0% respectively. METHODS: Using the risk percentiles approach, analyses were performed separately for men and women using data from various sources such as the 2014-15 National Health Survey linked to death registry, simulated data for high risk groups, and the Australian population and deaths data from the census. Indigenous status was simulated by preferentially assigning those who are indigenous to lower SES quintiles. The age-sex distribution of mental disorder status was simulated using its distribution from 2016 National Drug Strategy Household Survey with 25.9% of mentally ill being assigned to current smoking category and the rest to non-smoking category. The age-sex distribution of prisoners was simulated based on 2014 ABS Prisoners Australia survey with 74% of prisoners being assigned to current smoker category and the rest to non-smoker category. Homelessness status was simulated according to age, sex and indigenous status for 2011 census with all homeless being allocated to the lowest SES category. The age-sex distribution of total cholesterol level was simulated based on 2011-13 Australian Health Survey. RESULTS: The results showed that the combined approach for reducing smoking is most effective for improving life expectancy of Australians particularly for the socially disadvantaged and mentally ill groups both of which have high fraction of smokers in the population. For those who were mentally ill the gain in ALE due to reduction of smoking to 10% was 0.53 years for males and 0.36 years for females which were around 51 and 42% respectively of the maximal gains in ALE that could be achieved through complete cessation. CONCLUSIONS: Targeting high-risk population groups having substantial fraction of smokers in the population can strongly complement the existing population-based smoking reduction strategies. As population and high risk approaches are both important, the national prevention policies should make judicious use of both to maximize health gain.


Assuntos
Promoção da Saúde/estatística & dados numéricos , Expectativa de Vida/tendências , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Austrália/epidemiologia , Feminino , Comportamentos Relacionados com a Saúde , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Dinâmica Populacional , Prevalência , Fatores de Risco , Distribuição por Sexo , Prevenção do Hábito de Fumar
5.
PLoS One ; 15(9): e0238730, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915827

RESUMO

BACKGROUND: The World Health Organization and United Nations Children's Fund launched the Baby Friendly Hospital Initiative (BFHI) to encourage best infant breastfeeding practices immediately after birth. In Lebanon, few hospitals are currently accredited as Baby Friendly. AIM: To assess the knowledge of Lebanese women of BFHI steps, and to explore their attitudes towards Baby Friendly Hospitals, Skin-to-Skin Contact and Kangaroo Care practices. METHODS: A cross-sectional survey of a random sample of healthy pregnant women from Lebanon's six governorates. RESULTS: The mean (SD) age of the participants (N = 517) was 28.6 (4.7) years. Most participants were unfamiliar with the terms Baby Friendly hospital (93.7%), skin-to-skin contact or kangaroo care (75%), or were inadequately instructed on how to initiate (54.2%) or continue (46.2%) breastfeeding. However, when provided with information about the benefits of BFHI practices, most mothers (> 90%) stated that they would deliver in Baby Friendly hospitals. About 68.4% of mothers refused to give donor human milk to their sick premature infants because of religious beliefs. Knowledge of Baby Friendly hospitals was significantly associated with university education (p = 0.029), higher monthly income (p = 0.042), and previous experiences of skin-to-skin contact (p<0.001), rooming in (p = 0.037), or breastfeeding support (p = 0.036). CONCLUSION: There is a need for national awareness campaigns that address both the numerous advantages of the BFHI practices and Lebanese women's knowledge gaps about these practices. Such knowledge will help scale up the implementation of BFHI practices in hospitals in Lebanon, thus increasing breastfeeding rates and positively impacting the health of infants and mothers.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Mães/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Líbano , Masculino , Cuidado Pós-Natal , Organização Mundial da Saúde
6.
PLoS One ; 15(8): e0236169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745081

RESUMO

In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind" are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Desenvolvimento Sustentável , Cobertura Universal do Seguro de Saúde/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Academias de Ginástica/organização & administração , Academias de Ginástica/estatística & dados numéricos , Reforma dos Serviços de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Índia , Atenção Primária à Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
7.
BMC Public Health ; 20(1): 1206, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32843022

RESUMO

BACKGROUND: Sedentary behaviour (SB) has been identified as an important mortality risk factor. Health organizations have recognised SB as a public health challenge with major health, social, and economic consequences. Researchers have alerted the need to develop specific strategies, to monitor, prevent, and reduce SB. However, there is no systematic analysis of the SB changes in European Union adults. We aimed to examine SB changes between 2002 and 2017 in the European Union (EU) adult population. METHODS: SB prevalence (>4h30mins of sitting time/day) of 96,004 adults as a whole sample and country-by-country was analysed in 2002, 2005, 2013, and 2017 of the Sport and Physical Activity EU Special Eurobarometers' data. The SB question of a modified version of the International Physical Activity Questionnaire was considered. SB prevalence between countries and within years was analysed with a χ2 test, and SB between genders was analysed with the Z-Score test for two population proportions. RESULTS: An association between the SB prevalence and the years was found (p < 0.001), with increases for the whole sample (2002: 49.3%, 48.5-50.0 95% confidence interval (CI); 2017: 54.5%, 53.9-55.0 95% CI) and men (2002: 51.2%, 50.0-52.4 95% CI; 2017: 55.8%, 55.0-56.7 95% CI) and women (2002: 47.6%, 46.6-48.7 95% CI; 2017: 53.4%, 52.6-54.1 95% CI) separately. The adjusted standardised residuals showed an increase in the observed prevalence versus the expected during 2013 and 2017 for the whole sample and women and during 2017 for men. For all years, differences were observed in the SB prevalence between countries for the whole sample, and men and women separately (p < 0.001). Besides, the SB prevalence was always higher in men versus women in the overall EU sample (p < 0.001). CONCLUSIONS: SB prevalence increased between 2002 and 2017 for the EU as a whole and for both sexes separately. Additionally, differences in SB prevalence were observed for all years between EU countries in the whole sample and both sexes separately. Lastly, SB was consistently higher in men than women. These findings reveal a limited impact of current policies and interventions to tackle SB at the EU population level.


Assuntos
Atitude Frente a Saúde , Exercício Físico/psicologia , Promoção da Saúde/estatística & dados numéricos , Promoção da Saúde/tendências , Estilo de Vida Saudável , Saúde Pública/estatística & dados numéricos , Comportamento Sedentário , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Características Culturais , União Europeia , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
8.
PLoS One ; 15(8): e0237571, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810195

RESUMO

BACKGROUND: Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. METHODS: Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. RESULTS: The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21-0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33-1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73-0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30-0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40-1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07-1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37-0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67-0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96-1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70-1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97-1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74-1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47-1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07-1.12; 2 studies; 530 women; very low-certainty evidence). CONCLUSION: PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.


Assuntos
Cuidado Pré-Concepcional , Resultado da Gravidez , Gravidez em Diabéticas/terapia , Feminino , Promoção da Saúde/métodos , Promoção da Saúde/normas , Promoção da Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Concepcional/organização & administração , Cuidado Pré-Concepcional/normas , Cuidado Pré-Concepcional/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez em Diabéticas/diagnóstico , Gravidez em Diabéticas/epidemiologia , Prognóstico , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Resultado do Tratamento
9.
BMC Public Health ; 20(1): 1086, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32652969

RESUMO

BACKGROUND: Inability to track children's vaccination history coupled with parents' lack of awareness of vaccination due dates compounds the problem of low immunization coverage and timeliness in developing countries. We evaluated the impact of two types of silicone immunization reminder bracelets for children in improving immunization coverage and timeliness of Pentavalent-3 and the Measles-1 vaccines. METHODS: Children < 3 months were enrolled in either of the 2 intervention groups (Alma Sana Bracelet Group and Star Bracelet Group) or the Control group. Children in the intervention groups were provided the two different bracelets at the time of recruitment. Each time the child visited the immunization center, a hole was perforated in the silicone bracelet to denote vaccine administration. Each child was followed up till administration of Measles-1 vaccine or till 12 months of age (if they did not come to the center for vaccination). Data was analyzed using the intention-to-treat population between groups. The unadjusted and adjusted Risk Ratios (RR) and 95% confidence interval (CI) for Pentavalent-3 and Measles-1 coverage at 12 months of age were estimated through bivariate and multivariate analysis. Time-to-Pentavalent-3 and Measles-1 immunization curves were calculated using the Kaplan-Meier method. RESULTS: A total of 1,445 children were enrolled in the study between July 19, 2017 and October 10, 2017. Baseline characteristics among the three groups were similar. Up-to-date coverage for the Pentavalent-3 /Measles-1 vaccine at 12 months of age was 84.6%/72.0%, 85.4%/70.5% and 83.0%/68.5% in Alma Sana Bracelet group, Star Bracelet group and Control group respectively but the differences were not statistically significant. In the multivariate analysis, neither the Alma Sana bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06), (adjusted RR: 1.05; 95% CI: 0.97-1.13) nor the Star bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06) (adjusted RR: 1.03; 95% CI: 0.95-1.11) was significantly associated with Pentavalent-3 vaccination or Measles-1 vaccination. CONCLUSION: Although we did not observe any significant impact of the bracelets on improved immunization coverage and timeliness, our findings add to the existing literature on innovative, low cost reminders for health and make several suggestions for enhancing practical implementation of these tools. TRIAL REGISTRATION: ClinicalTrials.gov NCT03310762 . Retrospectively Registered on October 16, 2017.


Assuntos
Promoção da Saúde/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Cooperação do Paciente/estatística & dados numéricos , Sistemas de Alerta/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Imunização , Lactente , Masculino , Sarampo/prevenção & controle , Paquistão , Projetos de Pesquisa , Vacinação/estatística & dados numéricos , Cobertura Vacinal
10.
BMC Public Health ; 20(1): 1110, 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32664859

RESUMO

BACKGROUND: In 1988, the 41st World Health Assembly (WHA) marked the launch of the Global Polio Eradication Initiative (GPEI) for the eradication of polio. A key component of the GPEI has been the development and deployment of a skilled workforce to implement eradication activities. In 1989, the Stop Transmission of Polio (STOP) was initiated to address skilled human resource gaps and strengthen poliovirus surveillance. This paper describes the role of the STOP 52 team in technical capacity building and health system strengthening in the implementation of polio eradication strategies in Kenya following the outbreak of Circulating Vaccine-derived Poliovirus type 2 (cVDPV2). METHODS: Overview of the STOP program, deployment, and the modality of support are described. Descriptive analysis was conducted using data collected by the STOP 52 team during integrated supportive supervisory visits conducted from July 2018 to September 2019. Analyses were carried out using Epi-Info statistical software (Version 7.0) and maps were developed using Quantum Geographic Information System (Q-GIS) (version 3.12.0). RESULTS: The STOP 52 team supportively supervised 870 health facilities on Expanded Program on Immunization (EPI), and Acute Flaccid Paralysis (AFP) and other Vaccine-Preventable Diseases (VPDs) surveillance in 16 (34.1%) of the 47 counties during the study period. AFP surveillance was conducted in all health facilities supervised leading to the detection and investigation of 11 unreported AFP cases. The STOP 52 team, as part of the outbreak response, provided technical support to five successive rounds of polio Supplementary Immunization Activities (SIAs) conducted during the study period. Moreover, in addressing programmatic data needs, the STOP 52 Data Manager played a valuable role in enhancing the quality and use of data for evidence-based planning and decision-making. The STOP 52 team contributed to the development of operational plans, guidelines and training manuals, and participated in the delivery of various Training of Trainers (TOT) and On-the-Job Training (OJT) on EPI, AFP and other VPDs surveillance including data management. CONCLUSION: The STOP 52 team has contributed to polio eradication efforts in Kenya by enhancing AFP and other VPDs surveillance, supporting polio SIAs, strengthening EPI, use of quality EPI, AFP and other VPDs data, and capacity building of Frontline Health Workers (FLWs). The use of Open Data Kit (ODK) technology during supportive supervision, and AFP and other VPDs surveillance was found to be advantageous. A national STOP program should be modeled to produce a homegrown workforce to ensure the availability of more sustainable technical support for polio eradication efforts in Kenya and possibly other polio-affected countries.


Assuntos
Erradicação de Doenças/organização & administração , Surtos de Doenças/prevenção & controle , Promoção da Saúde/métodos , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Poliomielite/prevenção & controle , Vacinação/estatística & dados numéricos , Países em Desenvolvimento , Erradicação de Doenças/estatística & dados numéricos , Promoção da Saúde/estatística & dados numéricos , Humanos , Quênia , Vigilância da População
11.
BMC Public Health ; 20(1): 1019, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600296

RESUMO

BACKGROUND: This review examines the effectiveness of diet and physical activity interventions to reduce cardiometabolic risk among Chinese immigrants and their descendants living in high income countries. The objective of this review is to provide information to help build future interventions aimed at improving diet and increasing physical activity levels among Chinese immigrants. METHODS: Outcomes included BMI, weight, waist circumference (WC), waist-hip ratio (WHR), cholesterol (LDL, HDL), systolic and diastolic blood pressure (SBP, DBP), hemoglobin A1c (HgbA1c), fasting blood glucose (FBG), and HOMA-IR. Six databases were systematically searched from database inception to date of search (February 2020). Meta-analyses used random effect models to estimate pooled effects of outcomes with 95% confidence intervals. The outcomes assessed were changes in mean outcomes (post-intervention versus baseline) among the intervention group versus control groups. RESULTS: Twenty-one articles were included for synthesis, and eight of these were included in the meta-analysis. Among children/adolescents, there were no significant effects of intervention for any of the outcomes having sufficient data for meta-analysis (BMI, WHR, SBP, and DBP). Among adults, the pooled effect including three studies showed significant changes in BMI (effect size = - 1.14 kg/m2; (95% CI: - 2.06, - 0.21), I2 = 31%). There were also significant effects of intervention among adults in terms of changes in SBP and DBP, as the pooled effect across three studies was - 6.08 mmHg (95% CI - 9.42, - 2.73), I2 = 0% and - 3.81 mmHg (95% CI: - 6.34, - 1.28), I2 = 0%, respectively. Among adults there were no other significant effects among the meta-analyses conducted (weight, WC, LDL, HgbA1c, and FBG). CONCLUSIONS: This review is the first to summarize the effectiveness of diet and physical activity interventions specifically designed for Chinese immigrants living in high income countries. There were clinically meaningful changes in BMI and blood pressure among adults, but evidence was weak for other cardiometabolic outcomes (weight, WC, LDL, HgbA1c, and FBG), and among children, there was no evidence of effect for any cardiometabolic outcomes. Given our mixed findings, more work is needed to support the design of successful interventions, particularly those targeting children and their families. TRIAL REGISTRATION: The systematic review protocol was registered in PROSPERO on December 17, 2018, the international prospective register of systematic reviews (registration number: CRD42018117842 ).


Assuntos
Doenças Cardiovasculares/prevenção & controle , Emigrantes e Imigrantes/estatística & dados numéricos , Promoção da Saúde/estatística & dados numéricos , Adolescente , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Peso Corporal , Doenças Cardiovasculares/etiologia , Criança , China/etnologia , Colesterol/sangue , Países Desenvolvidos , Dieta , Exercício Físico , Hemoglobina A Glicada/análise , Humanos , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Circunferência da Cintura
12.
BMC Public Health ; 20(1): 1127, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680490

RESUMO

BACKGROUND: Previous studies show large variations in physical activity (PA) levels among adolescents. However, the number of studies is limited and even fewer studies have assessed PA in adolescents by accelerometer devices. This study aimed to describe accelerometer-measured PA levels in adolescents in a population-based cohort in Northern Norway. METHODS: In 611 students aged 16-17 years attending the Fit Futures Study, PA was measured by Actigraph GT3X for seven consecutive days. PA was expressed as total PA volume (counts per minute, CPM), time spent in intensity zones, steps per day, and fulfilment of WHO recommendation (i.e. accumulation of 60 min or more of at least moderate intensity PA per day). Potential correlates of PA such as sex, socioeconomic status, study program, self-perceived health, and PA variations by weekday versus weekend were also examined. RESULTS: 16% of the girls and 25% of the boys fulfilled current WHO-recommendations. Total PA volume (CPM) was higher in boys than in girls (353 (SD 130) versus 326 (SD 114) CPM, p < 0.05). PA levels differed with study program and increased with better self-perceived health, but were not associated with socioeconomic status. Both boys and girls were more active on weekdays than weekends (altogether; 350 (SD 124) versus 299 (SD 178) CPM, p < 0.05). CONCLUSIONS: In this cohort of adolescents, less than 25% of 16-17-year-old boys and girls fulfilled the WHO recommendations. The levels of physical activity in 16-17-year-old adolescents are similar to previous data reported in adults.


Assuntos
Actigrafia/estatística & dados numéricos , Exercício Físico , Fidelidade a Diretrizes/estatística & dados numéricos , Promoção da Saúde/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Estudos de Coortes , Estudos Transversais , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Noruega , Prevalência , Organização Mundial da Saúde
15.
PLoS One ; 15(7): e0235264, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658921

RESUMO

OBJECTIVE: To identify health systems-level barriers to treatment for women who screened positive for high-risk human papillomavirus (hrHPV) in a cervical cancer prevention program in Kenya. METHODS: In a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya in 2018-2019, women underwent hrHPV testing offered through community health campaigns, and women who tested positive were referred to government health facilities for cryotherapy. The current analysis draws on treatment data from this trial, as well as two observational studies that were conducted: 1) periodic assessments of the treatment sites to ascertain availability of resources for treatment and 2) surveys with treatment providers to elicit their views on barriers to care. Bivariate analyses were performed for the site assessment data, and the provider survey data were analyzed descriptively. RESULTS: Seventeen site assessments were performed across three treatment sites. All three sites reported instances of supply stockouts, two sites reported treatment delays due to lack of supplies, and two sites reported treatment delays due to provider factors. Of the 16 providers surveyed, ten (67%) perceived lack of knowledge of HPV and cervical cancer as the main barrier in women's decision to get treated, and seven (47%) perceived financial barriers for transportation and childcare as the main barrier to accessing treatment. Eight (50%) endorsed that providing treatment free of cost was the greatest facilitator of treatment. CONCLUSION: Patient education and financial support to reach treatment are potential areas for intervention to increase rates of hrHPV+ women presenting for treatment. It is also essential to eliminate barriers that prevent treatment of women who present, including ensuring adequate supplies and staff for treatment.


Assuntos
Crioterapia/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/terapia , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Crioterapia/economia , Detecção Precoce de Câncer/economia , Feminino , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Promoção da Saúde/economia , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Quênia/epidemiologia , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Estudos Observacionais como Assunto , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Educação de Pacientes como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , População Rural/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia
16.
BMC Public Health ; 20(1): 1003, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32586309

RESUMO

BACKGROUND: Community-based weight loss programs may have potential to address overweight and obesity at the population level. However, participation patterns and individual outcomes from these programs are understudied. This study examined repeat participation patterns and participant weight change between contests over seven years of an Aboriginal Australian team-based program in order to identify (1) predictors of repeat participation and (2) associations with weight change between contests. METHODS: Data for the 12 contests from 2012 to 2018 were merged, with probabilistic record matching. A total of 7510 enrolments were registered for the 12 contests, representing 4438 unique people. Contest lengths varied from 10 to 16 weeks in duration. Non-repeat participants were those who only competed once in the program by the end of 2018, and repeaters were those who competed in at least two contests. Associations between repeat participation and participant baseline (i.e., first participation occasion) characteristics, change in diet and physical activity and percent change in weight during the first participation occasion were examined using crossed random effects (for person and team) regression adjusted for exposure to the program. Weight percentage change between contests was calculated for consecutive participation occasions occurring at least three months apart, converted to percent change per month. Weight change was regressed on number of repeat participation occasions adjusted for age, gender, baseline weight at first participation occasion, and weight percent change in the immediately preceding contest. RESULTS: One-third of the 4433 participants participated more than once, with women more likely than men to repeat. A 1% reduction in weight during a competition was associated with an increase in weight of 0.05% per month between competition end and subsequent participation. Regain was smaller the heavier participants were at their first participation. CONCLUSIONS: While individuals benefit from weight loss through program participation, strengthening strategies for weight loss maintenance within or following the program could improve long-term weight outcomes and reduce weight cycling.


Assuntos
Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Sobrepeso/terapia , Perda de Peso , Programas de Redução de Peso/estatística & dados numéricos , Adulto , Austrália , Dieta/estatística & dados numéricos , Exercício Físico , Feminino , Promoção da Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo
17.
BMC Public Health ; 20(1): 927, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539702

RESUMO

BACKGROUND: Leisure-time physical activity (LTPA) is an important contributor to total physical activity and the focus of many interventions promoting activity in high-income populations. Little is known about LTPA in sub-Saharan Africa (SSA), and with expected declines in physical activity due to rapid urbanisation and lifestyle changes we aimed to assess the sociodemographic differences in the prevalence of LTPA in the adult populations of this region to identify potential barriers for equitable participation. METHODS: A two-step individual participant data meta-analysis was conducted using data collected in SSA through 10 population health surveys that included the Global Physical Activity Questionnaire. For each sociodemographic characteristic, the pooled adjusted prevalence and risk ratios (RRs) for participation in LTPA were calculated using the random effects method. Between-study heterogeneity was explored through meta-regression analyses and tests for interaction. RESULTS: Across the 10 populations (N = 26,022), 18.9% (95%CI: 14.3, 24.1; I2 = 99.0%) of adults (≥ 18 years) participated in LTPA. Men were more likely to participate in LTPA compared with women (RR for women: 0.43; 95%CI: 0.32, 0.60; P < 0.001; I2 = 97.5%), while age was inversely associated with participation. Higher levels of education were associated with increased LTPA participation (RR: 1.30; 95%CI: 1.09, 1.55; P = 0.004; I2 = 98.1%), with those living in rural areas or self-employed less likely to participate in LTPA. These associations remained after adjusting for time spent physically active at work or through active travel. CONCLUSIONS: In these populations, participation in LTPA was low, and strongly associated with sex, age, education, self-employment and urban residence. Identifying the potential barriers that reduce participation in these groups is necessary to enable equitable access to the health and social benefits associated with LTPA.


Assuntos
Exercício Físico/psicologia , Promoção da Saúde/estatística & dados numéricos , Atividades de Lazer/psicologia , Fatores Socioeconômicos , Adulto , África ao Sul do Saara , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Inquéritos e Questionários , Adulto Jovem
19.
BMC Public Health ; 20(1): 608, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32357871

RESUMO

BACKGROUND: Risk adjustment models are employed to prevent adverse selection, anticipate budgetary reserve needs, and offer care management services to high-risk individuals. We aimed to address two unknowns about risk adjustment: whether machine learning (ML) and inclusion of social determinants of health (SDH) indicators improve prospective risk adjustment for health plan payments. METHODS: We employed a 2-by-2 factorial design comparing: (i) linear regression versus ML (gradient boosting) and (ii) demographics and diagnostic codes alone, versus additional ZIP code-level SDH indicators. Healthcare claims from privately-insured US adults (2016-2017), and Census data were used for analysis. Data from 1.02 million adults were used for derivation, and data from 0.26 million to assess performance. Model performance was measured using coefficient of determination (R2), discrimination (C-statistic), and mean absolute error (MAE) for the overall population, and predictive ratio and net compensation for vulnerable subgroups. We provide 95% confidence intervals (CI) around each performance measure. RESULTS: Linear regression without SDH indicators achieved moderate determination (R2 0.327, 95% CI: 0.300, 0.353), error ($6992; 95% CI: $6889, $7094), and discrimination (C-statistic 0.703; 95% CI: 0.701, 0.705). ML without SDH indicators improved all metrics (R2 0.388; 95% CI: 0.357, 0.420; error $6637; 95% CI: $6539, $6735; C-statistic 0.717; 95% CI: 0.715, 0.718), reducing misestimation of cost by $3.5 M per 10,000 members. Among people living in areas with high poverty, high wealth inequality, or high prevalence of uninsured, SDH indicators reduced underestimation of cost, improving the predictive ratio by 3% (~$200/person/year). CONCLUSIONS: ML improved risk adjustment models and the incorporation of SDH indicators reduced underpayment in several vulnerable populations.


Assuntos
Promoção da Saúde/economia , Promoção da Saúde/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Aprendizado de Máquina/economia , Aprendizado de Máquina/estatística & dados numéricos , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Risco Ajustado
20.
BMC Public Health ; 20(1): 597, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32357876

RESUMO

BACKGROUND: Making the case for investing in public health by illustrating the social, economic and environmental value of public health interventions is imperative. Economic methodologies to help capture the social value of public health interventions such as Social Return on Investment (SROI) and Social Cost-Benefit Analysis (SCBA) have been developed over past decades. The life course approach in public health reinforces the importance of investment to ensure a good start in life to safeguarding a safe, healthy and active older age. This novel review maps an overview of the application of SROI and SCBA in the existing literature to identify the social value of public health interventions at individual stages of the life course. METHODS: A systematic scoping review was conducted on peer-reviewed and grey literature to identify SROI and SCBA studies of public health interventions published between January 1996 and June 2019. All primary research articles published in the English language from high-income countries that presented SROI and SCBA outputs were included. Studies were mapped into stages of the life course, and data on the characteristics of the studies were extracted to help understand the application of social value methodology to assess the value of public health interventions. RESULTS: Overall 40 SROI studies were included in the final data extraction, of which 37 were published in the grey literature. No SCBA studies were identified in the search. Evidence was detected at each stage of the life course which included; the birth, neonatal period, postnatal period and infancy (n = 2); childhood and adolescence (n = 17); adulthood (main employment and reproductive years) (n = 8); and older adulthood (n = 6). In addition, 7 studies were identified as cross-cutting across the life course in their aims. CONCLUSION: This review contributes to the growing evidence base that demonstrates the use of social value methodologies within the field of public health. By mapping evidence across stages of the life course, this study can be used as a starting point by public health professionals and institutions to take forward current thinking about moving away from traditional economic measures, to capturing social value when investing in interventions across the life course.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Promoção da Saúde/economia , Investimentos em Saúde/economia , Investimentos em Saúde/estatística & dados numéricos , Saúde Pública/economia , Saúde Pública/estatística & dados numéricos , Valores Sociais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Saúde Global , Promoção da Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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