bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical activity promotion of elderly people as a complex intervention: supportive toolbox
Authors: Tillmann J , Vonstein C , Rossmann C , Halbach S , Acet S , Schmidt N , Langosch C , De Bock F 
Published: October 2020

Abstract

Issue
In EU countries, almost 20% of the population is aged 65 or older. This longer life expectancy offers many opportunities but health risks as well. Health promotion measures like physical activity are of central importance but only a small proportion of the elderly meets the minimum level of physical activity recommended by the WHO. The project “Ageing in balance” investigates how a complex intervention to promote physical activity in older people can be implemented and facilitated by making practical tools centrally available.

Description of the problem
A complex intervention following the steps of an ideal-typical process and combining behavioural and structural preventive approaches is implemented in several model regions in Germany over three years (2019-2021). As a service at the federal level, a toolbox comprising tools for needs assessment, interventions and information on physical activity, project management, legal issues and financing is built up to support the work of local decision-makers. It's evaluated how setting approaches to promote physical activity for elderly people can be successful, which supporting and impeding factors exist and how the process can be supported by a flexible toolbox provided at federal level.

Results
Socioeconomically deprived model regions (rural, town, city) were recruited and started to raise awareness and to perform needs assessment. Building of local steering committees and implementing interventions are the next steps. Currently the toolbox contains systematically identified instruments for needs assessment, an intervention database with a newly developed evidence ranking system and several information modules.

Lessons
Facilitating promotion of physical activity in the elderly is important as prioritization and resources at local level are often limited. Making the implementation of setting approaches successful and providing the potentially most promising support from federal level is still pioneering work.

Key messages
The effort is to build up a flexible support system for local stakeholders to promote physical activity in elderly people. It is evaluated how a complex behavioural and structural prevention effort for elderly people can be implemented.
Creating health enabling environments in large, complex and competitive food systems
Authors: Dancey J a n e , Brimblecombe Julie 
Published: October 2020

Abstract
Australia's largest university, Monash, is a complex food system, with &gt;70 000 students, 17000 staff, 50 food outlets, a supermarket and &gt;100 vending machines. Analysis of this food system in 2016 identified poor availability of healthy food and prompted the university to implement a local healthy eating framework, the Victorian Government's Healthy Choices Guidelines (HCGs). Australians consume a diet low in plant foods and high in discretionary foods: 67% of adults are overweight or obese. Our food environment is large, complex and competitive and akin to a shopping mall or small town and our findings are broadly applicable to these settings. In 2016 Monash commenced implementation of HCGs which classify foods using a traffic light system: Green (best choice), Amber (choose carefully) and Red (limit). To create health enabling environments, the guidelines recommend ≥50% Green and &lt;20% Red foods.
Three key strategies are explored: 1) Retail food healthiness assessments, 2) Vending changes and 3) Retail food healthiness labelling. Multiple implementation challenges arose in food retail.
In 2016, we conducted retail food healthiness assessments using HCGs. These assessments indicated the Monash food retail environment was 19% Green, 26% Amber and 55% Red. HCG vending was successfully implemented in 2017 using a commercial tender process. Healthy retail labelling was implemented with 32 retailers in 2018; the cost and complexities associated with menu assessments, retailer education and labelling fidelity present enormous challenges.
Local frameworks do not scale up in large, complex, competitive retail systems. Success with vending contracts indicates change to food retail may occur with contract clauses. Implementing change in established food retail is problematic.
Implementation challenges in large, complex, competitive retail settings require further exploration. Contract clauses show promise for implementing and sustaining change in complex food systems.

Key messages
Large, complex, competitive retail settings present challenges for food system change. Leasing clauses show promise for changes to large, complex, competitive, retail food systems.
The impact of economic sanctions on health and health systems in low- and middle-income countries
Authors: Suhrcke M , Pinna Pintor M , Hamelmann C 
Published: October 2020

Abstract

Background
Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs.

Methods
We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments.

Results
Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions.

Conclusions
Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority.

Key messages
The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.
Socioeconomic differences in incident metabolic syndrome in adults: the mediation of health behaviors
Authors: Hoveling L A , Liefbroer A C , Bültmann U , Smidt N 
Published: October 2020

Abstract

Introduction
The incidence of metabolic syndrome (MetS) strongly varies by socioeconomic status (SES). Health behaviors could be one of the mechanisms explaining the SES-MetS relationship, but little is known about their mediating role. This study aims to longitudinally asses the association between SES measures, education, income and occupational prestige, and incident MetS and whether the associations are mediated by health behaviors, including physical activity, smoking, alcohol drinking and diet quality.

Methods
A subsample of the adult Lifelines Cohort Study, including 85,910 participants without MetS at baseline was used. MetS was measured at the second assessment (follow-up time 3.8 years) defined according to the NCEP-ATPIII criteria. Direct associations between SES, health behaviors and incident MetS were estimated using multivariable logistic regression analyses. The mediating percentages of health behaviors explaining the associations between SES and incident MetS were estimated using the Karlson-Holm-Breen method. Analyses were independent of age, sex, the other SES measures and follow-up time.

Results
Education (OR 0.92, 99% CI: 0.91-0.94) and occupational prestige (OR 0.94, 99% CI: 0.91-0.97) were inversely associated with MetS. Income was not associated with MetS. Health behaviors explained only partly (13.8%) the association between education and MetS, with smoking as the strongest mediating factor (8.6%). Health behaviors played a minor role (2.7%) in explaining occupational MetS differences, with physical activity as the strongest suppressing factor (-10.4%).

Conclusions
Individuals with more years of education or a higher occupational prestige showed a decreased risk of developing MetS. This was mainly because of non-smoking, less often excessive alcohol drinking and a higher diet quality; however, they were more often physically inactive.

Key messages
Education and occupational prestige are inversely associated with MetS incidence. Health behaviors explain a small part of the SES – MetS incidence pathway, with smoking as the largest contributor.
Can school-based, health behavioural interventions tackle health inequities in childhood?
Authors: Bosma H , Oosterhoff M , Vermeiren A P , Willeboordse M , Joore M A , van Schayck O C P 
Published: October 2020

Abstract

Background
To improve the health situation of children in primary school, many school-based interventions that are aimed at changing health behaviours, are being set up. Prior to knowing the (long-term) effectiveness of such intervention, we set out to examine whether there is room for such interventions to also tackle the health gap between children from high and low socioeconomic backgrounds.

Methods
Data from the Dutch quasi-experimental Health Primary School of the Future were used. All children from eight primary schools were included in the period 2015-2019. In the first cross-sectional phase, we studied whether there were socioeconomic differences in various health outcomes (e.g. body mass index) and whether these were smaller in children in the oldest groups (highest classes). In a two-year longitudinal approach, it was studied how socioeconomic differences in health outcomes developed in two years time and whether health behaviours could “explain” any socioeconomic differences in the outcomes. Linear and logistic regression analyses were used, including multilevel variants thereof, as well as mediation analyses.

Results
Both the cross-sectional and longitudinal analyses indicated substantial and consistent socioeconomic differences in various health outcomes. The socioeconomic differences in health appeared stronger in the oldest children (highest classes). Due to only small socioeconomic differences in health behaviours, such behaviours did not mediate the socioeconomic differences in the children's health outcomes.

Conclusions
The findings indicate substantial socioeconomic differences in health in primary school. That being longer at school did not attenuate the socioeconomic differences in health and that health behaviours did not mediate the socioeconomic differences in health suggests that there might not be much room for school-based, health behaviour interventions to easily tackle socioeconomic differences in health in childhood.

Key messages
We found substantial socioeconomic differences in child health in the Netherlands. But we found only little evidence that primary school-based, health behavioural interventions will easily tackle socioeconomic differences in child health.
Frequency and patient attributes associated with ED visits within 30 days after discharge
Authors: Salgado R , Moita B , Lopes S 
Published: October 2020

Abstract

Background
About 20%-25% of patients return to the emergency department (ED) within 30 days after inpatient discharge. This outcome is relevant since it may signal failures in inpatient care and care transitions. However, literature on the topic is still scarce. Our study aims to describe frequency and patient attributes associated with ED visits within 30 days (30d) of inpatient discharge in one public Portuguese hospital.

Methods
The study included adult patients discharged in 2016. Admissions of deceased or transferred patients were excluded. The rate of 30d ED visits after discharge was computed for selected patient (gender and age) and admission attributes [urgent, Major Diagnostic Category (MDC)]. Number of days from discharge to ED visit was determined. Logistic regression was used to compute crude and age-gender adjusted odds-ratios (cOR, aOR) for each selected admission attribute.

Results
From the 21744 admissions included (median age: 58y; 40% male), for 5058 there was at least one ED visit within 30d after discharge (23%). The majority of ED visits were triaged urgent (n = 2286; 45%) or very urgent (n = 1499; 30%). Time to first ED visit was, on average, 11 days. The risk of ED visit was increased among men (cOR = 1.180; 95% confidence interval - 95%CI: 1.103-1.262) and patients aged 75 or older (cOR = 1.704; 95%CI: 1.557-1.866). After controlling for gender and age differences, admissions with mental diseases (aOR = 1.807; 95%CI: 1.452-2.247), respiratory diseases (aOR = 1.786; 95%CI: 1.535-2.078), endocrine diseases (aOR = 1.758; 95%CI: 1.374-2.250) showed increased risk of visiting ED after discharge.

Conclusions
ED visits after inpatient discharge are frequent and mostly due to urgent and very urgent needs. Older age, mental, respiratory and endocrine conditions are relevant patient risk factors for returning hospital for ED care shortly after discharge.

Key messages
Improved quality of inpatient care and care transitions that reduce ED visits after discharge may benefit a significant part of patients. Future initiatives to reduce adverse events after discharge may target patients with older age or with mental conditions.
Patients’ perception of role of pharmacists in health promotion
Authors: Kazaryan I , Amirkhanyan A , Sevikyan A , Vardanyan L , Melikyan M 
Published: October 2020

Abstract

Background
Perceptions of patients is very important for accepting new role pharmacists play. The objective of this work was to study opinion of patients about role of community pharmacists in health promotion in Armenia.

Methods
Visitors (N = 2066) of community pharmacies in Yerevan were interviewed according to previously designed questionnaire.

Results
Some respondents suppose that pharmacists already provide advices on diet and physical activity for preventing obesity (32.1%), advices on healthy lifestyle for preventing cardiovascular diseases and cancer (30.9%), in promoting healthy lifestyle for preventing chronic diseases (27.5%). The number of patients who thinks that pharmacists are involved in providing advices on smoking cessation (38.1%) is significantly higher than the number of those who believe that pharmacists participate in campaigns on smoking cessation (27.1%) (p &lt; 0,001). Part of respondents wish that community pharmacists would be involved in providing advices on smoking cessation (55.9%), advices for preventing obesity (57.7%), cardiovascular diseases and cancer (57.2%), promoting healthy lifestyle for preventing chronic diseases (51.5%).

Conclusions
Most of patients are interested that community pharmacists would be involved in implementing activity in the area of health promotion. The number of patients who wish pharmacist would be involved in health promotion is higher than the number of those who suppose that pharmacists already have such functions.

Key messages
Patients are interested in receiving advices related to health from community pharmacists. It is important to improve education of pharmacists in the area of health promotion.
18.G. Workshop: Feasible and effective anti-corruption for public health: from analysis and advocacy to action
Authors:   Organised by: LSHTM (UK),   Chair persons: Martin McKee - UK, Dina Balabanova - UK
Published: October 2020

Abstract
Being able to identify corruption and call corrupt officials, health workers and citizens to account is critical in ensuring that public health policy and practice is shaped by evidence and reason rather than by powerful political forces. Despite substantial financial investments by bilateral and multilateral agencies to combat corruption, twenty years of initiatives based on good governance, improving law and changing regulatory approaches have been hugely disappointing - failing to effect significant changes in low- and middle-income countries. Public health activism on corruption is stepping up, diverse groups of actors are organizing around the threat that corruption creates to UHC, equity, social justice and the drive for global solidarity. They cannot rely on traditional good governance accountability and transparency approaches that pay insufficient attention to combinations of poor policy, under-funding and powerful interests that shape health systems, create perverse incentives, the need for survival corruption. To be effective, we need evidence of feasible and effective anti-corruption strategies. In this workshop, building on two years of theory development, qualitative and quantitative data collection and analysis in health services in LMICS we will set how feasible and effective anti-corruption strategies can be crafted and implemented. The session will introduce the Anti-Corruption Evidence ('ACE approach') and the idea of “developmental governance”. These have been used in other sectors but this is the first time that they have been applied to health. The approach is innovative in its targeted approach and focus on welfare-enhancing policies, seeking out space where for action that simultaneously tackles corruption and improves health systems but which is also politically and institutionally feasible to introduce. These strategies mark a shift away from blue-prints, interventions applied across countries without attending to context. We will use this workshop to show participants how to attend to the ways in which power and politics, culture and social networks shape health seeking and health care provision and how targeted, politically sensitive strategies offer the best anti-corruption solutions.

Key messages
New approaches to anti-corruption are critical for public health. Context-sensitive politically feasible, welfare-enhancing interventions offer the best way forward for anti-corruption.
Toward a new framing of corruption in health systems in LMICs: what questions should we be asking?
Authors: Balabanova D 
Published: October 2020

Abstract
Understanding and addressing corruption is critical for equitable and socially just development, and is therefore central to the realisation of the SDGs including the creation of responsive and trusted heath systems. Some conventional definitions of corruption do not reflect the complex reality in LMICs. Corruption is often conflated with poor governance, weak accountability or inefficiency but each manifestation has different structural and institutional causes, triggers and so requires different strategies to address it. 'Survival corruption' can be an informal coping strategy, other forms are manifest as reciprocal social exchanges within networks which may benefit wider groups of people and mask or contain health system dysfunctions. A proposition is made that we ask new questions that move away from a focus on the individual transaction towards locating it within health system and societal contexts that ultimately consider power and individual actor motivation.
Targeted anti-corruption in LMICs: developmental governance and health systems research
Authors: Hutchinson E 
Published: October 2020

Abstract
Traditional approaches to anti-corruption have relied upon broad-based legal change and the introduction transparency and accountability measures. The evidence to date shows that these have been unsuccessful in reducing corruption in health and other sectors in low and middle income countries. Traditional approaches often assume that corruption is driven by individual greed, immorality or opportunism caused by a lack of accountability measures and that once corruption is rendered visible that there will be a channel through which it can be acted upon. In many LMICs, however, corruption and rule breaking is widespread and much better understood as a systemic problem. In these settings, health workers often break rules to solve the problems of working in overstretched, underfunded health systems. In these settings, policy often does not match the realities of an underfunded health system, and so sticking to the rules can have harm career progression or the ability to care for ones family. New approaches to anti-corruption based on Mushtaq Khan's idea of developmental governance take these context specific factors into account and look for targeted, feasible and high impact action that can create improvements of rule abiding behaviour that benefit the health system and the delivery of care. This presentation examines how it can be applied to the health system and the adaptations that it makes in the ways that we work on anti-corruption in health. It examines the ways in which policy can be changed so that groups of actors in the system are be incentivised to engage in abiding behaviour as they recognize that it is in their interests to do so.
Coronavirus disease (COVID-19) outbreak: can HTA improve preparedness and response in emergencies with a high degree of uncertainty?
Authors: Timen A , Miglietta A 
Published: October 2020

Abstract
Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and irrefutable evidence may be lacking. The Coronavirus disease (COVID-19) outbreak is determining a scenario of uncertainty for public health decision-making with fragmented and different responses also within countries (i.e. regional level), which are implemented quickly, sometimes not fully supported by the necessary body of scientific evidence. In such a situation, following a common line and having a shared tool that would allow to include evidence in public health decision-making, would be strategic to strengthen the impact of interventions, enabling stakeholders and decision makers taking actions based on the best available evidence through a process which is systematic and transparent. The objective of this presentation is to use the example of the COVID-19 outbreak, in order to explore how HTA can improve preparedness and response in emergencies with a high degree of uncertainty, representing the mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies, addressing the link between scientific evidence and decision-making in public health emergencies, overcoming the key challenges faced by public health experts when advising decision makers, including strengthening and accelerating knowledge transfer through rapid HTA, improving networking between actors and disciplines.