bluuebunny/crossref_metadata_2025_split huggingface dataset:
Public health and multiple sclerosis in Italy
Authors: Bezzini D , Battaglia M A , Ponzio M , Manacorda T , Zaratin P , Bandiera P 
Published: October 2020

Abstract

Background
Multiple Sclerosis (MS) is a complex and progressive disease of the central nervous system. In Italy, prevalence of MS ranges from 198 (continental Regions) to 370 (Sardinia) per 100,000. Despite a National Health System, differences among Regions cause inequalities in access to and quality of care, also involving chronic diseases and disabilities, including MS.

Methods
Interviews and focus groups involving persons with MS, caregivers, institutions, patients association and other stakeholders were conducted in 2019, to evaluate MS policy landscape, existing services, guidelines and care pathways regarding diagnosis, therapy, follow up, strenghts and weaknesses.

Results
600 MS specialized neurologists and 350 MS nurses operate in 240 MS Centers located in hospital neurology departments providing clinical care, disease modifying drugs (DMDs), interdisciplinary care. 13 Regions on 20 approved a PDTA (Diagnosis, Therapy, Care Pathway), other are due by 2020. A reference national PDTA has been already discussed by Regional Health Authorities Conference and Ministry of Health. Regional multistakeholder observatories will be organized. A national MS registry started in 2017, at present involving over 140 Centers and including data of 50% (60.000 patients) of estimated prevalence.

Discussion
MS specialized centers are recognized as the key component of MS care in Italy and the main refererral for 80% of patients, also taking in account that over 60% of patients receive a DMD. Access to rehabilitation is lacking and hospital, community and primary care linkage is needed, also considering transition from early stages to severe disability. Access to psycological support is variable and cost containment strategies restrict drug access and symptomatic care in some areas along with lacking of interdisciplinary management. It is mandatory to integrate health and social care pathways accordingly with the National Plan for Chronicity in which MS has to be included.

Key messages
MS specialized centers are the backbone care network in Italy. Integrated care pathways (PDTA) stated as National Health System rules define the right for the patients to receive the proper care.
Validation of a health promotion leadership self-efficacy measure in Jewish and Palestinian women
Authors: Karjawlly M , Greenberg K , Nubani Husseini M , Agbaria N , leiter E , Zwas D 
Published: October 2020

Abstract

Background
Health promotion (HP) leadership training is necessary to optimize health promotion in all sectors of society, and as in all interventions, there is a need for a measure to assess the effectiveness of leadership training and leadership self-efficacy. The current study aims to validate a 13-item self-report scale for use in health promotion leadership programs. The scale, in Hebrew and Arabic versions, assesses health-promotion leadership skills and self-efficacy (HPLSES).

Methods
Data for the Hebrew scale were collected as part of a leadership training program for women in Jerusalem and Beer Sheva workplaces (n = 38). The Arabic scale was administered as part of a healthy lifestyle and leadership training program conducted in community centers in East Jerusalem (n = 155). Data for both scales were collected at baseline and 6 months post-intervention. Validation of scales included a panel of experts to assess content validity, Cronbach's alpha to assess internal validity, and structural equation modeling (SEM) to assess construct validity. A specific model was designed to test predictive validity for both communities.

Results
Content validity was confirmed by a panel of experts. Preliminary correlation analysis between the instrument items showed high correlations for both time periods, which suggested difficulties in building distinct dimensions. Preliminary confirmatory models using exploratory/confirmatory models for the13 items showed reasonable loadings (Loading&gt;0.65). We obtained acceptable goodness-of-fit to the empirical data (Cronbach's alpha=0.90).

Conclusions
This scale demonstrated acceptable content, internal and construct validity for addressing leadership self-efficacy. It can be used in the evaluation of HP leadership training. Caution is advised in generalizing the results for the Jewish sample given the small sample size.

Key messages
This scale has been validated as a measure for assessing leadership self-efficacy. The scale can be used in evaluation of health promotion leadership trainings for the same population.
'I smoke and drink alcohol during pregnancy, but I'm a good enough mom': a mixed methods study
Authors: Satran C , Bord S , Sassoni- Bar-Lev O , Berkovich E , Madjar B 
Published: October 2020

Abstract

Background
Smoking and alcohol consumption during pregnancy is a major public health concern. The aims of this study were: 1) to examine smoking and alcohol consumption during pregnancy and to investigate their association with maternal attitudes and socio-demographic characteristics; 2) to explore maternal attitudes regarding smoking and alcohol consumption during pregnancy among pregnant and postpartum women in Israel.

Methods
This mixed methods study is comprised of a self-reported questionnaire for measuring attitudes and behaviors regarding smoking and alcohol consumption among 676 Jewish women, up to 9 months postpartum; and semi-structured interviews with 17 women who smoked cigarettes and/or consumed alcohol during their pregnancy.

Results
Sixty-four women (9.6%) reported drinking alcohol during pregnancy, and 30 (4.8%) reported smoking. Women with a fewer children (OR 2.25; 99% CI: 1.30, 3.92) and those whose attitudes supported alcohol avoidance (OR 0.52; 99.9% CI: 0.36, 0.74) consumed less alcohol while pregnant. Educated women (OR 0.31; 99% CI: 0.14- 0.71) and women with anti-smoking attitudes (OR 0.50; 99% CI: 0.30, 0.82) were more likely to avoid smoking during pregnancy. Qualitative analyses reveals three major themes: 1) 'A good enough mom': The mothers presented risk-management practices in line with the conflict between their perception of ideal motherhood and that of being an independent person; 2) 'Social acceptance of smoking and alcohol consumption during pregnancy': Social attitudes of spouses, family and friends; 3) 'Lack of reliable information' from healthcare professionals.

Conclusions
Women's attitudes have a significant impact on their decision to drink alcohol and/or smoke during pregnancy. These attitudes may be a result of their risk management practices and the social acceptance of risk behaviors during pregnancy, and information provided (or not) by healthcare professionals.

Key messages
The results highlight the importance of creating a supportive environment and shaping health promoting attitudes among pregnant women. Reliable information given by healthcare professionals regarding risk behaviors during pregnancy is needed.
Higher rates of early initiation of breastfeeding associated with health facility delivery in Nepal
Authors: Dharel D , Bhattarai A , Paudel Y R , Acharya P , Acharya K 
Published: October 2020

Abstract

Background
Initiation of breastfeeding within one hour from birth is one of the five key essential newborn care messages, implemented along with birth preparedness package since 2008. This study aimed to determine the trend of early initiation of breastfeeding (EIBF) and to assess the effect of health facility delivery on EIBF in Nepal.

Methods
We analyzed the data from the last four nationally representative Nepal Demographic and Health Surveys (NDHS) conducted in 2001,2006,2011 and 2016. Data on the early initiation of breastfeeding was obtained from the mothers of infants born within 24 months prior to the survey. The explanatory variable was the place of delivery, dichotomized as either the health facility, or home delivery. Survey year had a significant interaction with the place of delivery. Multivariable logistic regression was conducted separately on pooled samples before (NDHS 2001 and 2006) and after (NDHS 2011 and 2016) the program implementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) for EIBF was calculated after adjusting for predetermined covariates.

Results
The rate of EIBF increased by 26.5% points (from 32.8% in 2001 to 59.3% in 2016) among infants delivered in a health facility, compared to an increase by 17.1% points (from 29.9% to 47.0%) among home born infants. EIBF increased by 32.5% points before, compared to 49.7% points after BPP. Delivery in a health facility was associated with a higher odd of EIBF in later years (AOR2.3, 95% CI 2.0,2.8), but not in earlier years (AOR1.3, 95% CI 0.9,2.0). Delivery by caesarean section, first-born infant, and lack of maternal education were associated with a lower rate of EIBF in both periods.

Conclusions
Higher EIBF was associated with health facility delivery in Nepal, only after programmatic emphasis on essential newborn care messages. This implies the need for explicit focus on EIBF at birth, particularly when mother is less educated, primiparous or undergoing operative delivery.

Key messages
The rate of initiation of breastfeeding within an hour from birth is increasing in Nepal, with higher rates in health facility delivery, as shown by the recent four nationally representative surveys. Programmatic focus on essential newborn care messages may have contributed to significant association of higher rates of early initiation of breastfeeding when delivered in health facility.
Gaining political will for actions to achieve health equity: lessons from Australia for advocates
Authors: Baum F , Townsend B , Fisher M , Freeman T , Harris P , Browne-Yung K , Friel S 
Published: October 2020

Abstract

Background
There has been an accumulation of evidence on the importance of action on the social determinants of health to reduce global and national health equity. Yet there has been little effective systematic action by governments. This is commonly attributed to the absence of political will. Despite its importance, however, little research has examined how political will might be created or prevented.

Methods
This paper reports on the results of eight case studies of the extent to which Australian public policy is likely to contribute to reducing health inequities. 192 participants were interviewed including public servants, politicians and their staff, non-government organisation workers and community members. The transcripts were interrogated with the assistance of NVivo software to determine lessons about the creation or destruction of political will. The case studies were of: national primary health care policy, crucial determinants of health (work conditions, internet access, urban planning, social welfare, trade) and an automotive plant closure.

Results
We found the following factors to be important in determining the extent of political will for health equity, whether: path dependency was present; the issue would impact on staying in or winning government; political philosophies stressed collectivism or individualism; there were negative or positive social constructions of groups affected by the policies; economic and/or biomedical framings were dominant; elites (especially business interests) lobbied against the policies; and there was effective civil society and policy advocacy in favour of the policies.

Conclusions
Building on our insights from our case studies of action for political will, we conclude with a series of questions to guide the work of public health activists and policy advocates working to support existing and to create new political will in multiple contexts.

Key messages
The creation of political will is vital to the adoption of policies supportive of health equity. Analysis of 8 policy case studies points to how advocacy can most effectively create political will.
Systematic review examining the evidence for impact of school policies on physical activity
Authors: Volf K , Kelly L , García Bengoechea E , Gobis A , Lakerveld J , Zukowska J , Gelius P , Messing S , Forberger S , Woods C 
Published: October 2020

Abstract

Background
Epidemiological evidence has demonstrated that physical activity can have substantive health benefits for children and young people. The 'Policy Evaluation Network' is a multi-disciplinary research network across 7 European countries and New Zealand aimed at building capacity and evaluating the level of impact of policy interventions for promoting healthy lifestyles. The Toronto Charter identified 'whole-of-school' programmes as one of seven key investments for promotion of PA. This paper presents results of a SLR, designed to assess the level of evidence for policies within the school setting that contribute directly or indirectly to increasing PA.

Methods
Researchers searched six online databases for scientific literature regarding PA policy interventions in the school setting using key concepts of policy, school, PA and evaluation. Risk of bias will be assessed with tools appropriate to the design of the studies considered. Evidence of actual or potential positive PA outcomes arising directly or indirectly from policy actions will be catalogued.

Results
Preliminary searches identified 2327 unique scientific articles. 1938 (83.3%) were excluded on first reading and 189 (8.8%) were included for full text analysis. Initial findings suggest that organisational policies, for example avoiding overcrowding in playgrounds during school breaks, may be a promising policy action. Detailed analysis revealing other potential policy actions supported by evidence will be presented (SLR in progress).

Conclusions
Preliminary findings suggest that few studies link policy actions in the school setting to PA outcomes. However, studies that have investigated the effects of changes to the school environment on PA levels may provide evidence for policy actions. Preliminary recommendations include strengthening the evidence base for school-based PA policy by supporting studies into the effects of particular policy or legislative changes on PA outcomes.

Key messages
School physical activity policies are an underappreciated public health intervention. More studies should link policy changes to physical activity outcomes.
Healthy choices in New South Wales health facilities for staff and visitors: a policy evaluation
Authors: Trevena H , Munn E , King L , Thomas M , Shepherd L , Cranney L , Crino M , O'Connell T , Cobcroft M 
Published: October 2020

Abstract

Issue
Obesity and its determinants are risk factors for most leading causes of chronic diseases. In New South Wales (NSW), Australia, 1 in 2 adults and more than 1 in 5 children are above a healthy weight. As a key symbolic part of a suite of health eating policies, the NSW Ministry of Health implemented a Healthy Food and Drink in NSW Health facilities for Staff and Visitors Framework (Framework) across 18 Local Health Districts (LHDs). Many countries are grappling to understand the effectiveness of obesity prevention policies. Description 2: This policy evaluation synthesised evaluation study findings and internal records to assess the effectiveness of the Framework in achieving implementation targets: a) the removal of sugar-sweetened drinks (SSDs) from sale (Dec 2017), b) implementation of 12 food-based practices (Dec 2018).

Results
The overall implementation package was appropriate for the large, geographically dispersed, decentralised health system (160 health facilities; 927 food outlets;76 retailers) and variable retail arrangements. The Ministry provided LHDs with overall direction, phasing, and monitoring; the LHDs had local leadership, governance, cross-functional support and autonomy to implement in a way to suit them. Accountability and pace of implementation was driven most notably by monitoring and reporting using an electronic tool (PHIMS-N), and a 'network of practice' that was pivotal to problem solving. SSDs were removed from 96% (n = 606) of applicable food outlets; overall average achievement of all practices was high at 82% (22.4 SD). Nine in 10 (92%) consumers support the Framework, and retailers are accepting of its targets. Lessons: This was the right policy at the right time, with well-orchestrated implementation. Annual monitoring and reporting enabled by PHIMS-N is unique in this type of policy implementation and essential for tracking progress, informing decision making, and ensuring accountability.

Key messages
Implementation of the Framework has resulted in the removal of SSDs from sale, increased availability of healthier foods and decreased unhealthy foods as measured by 12 food-based practices. The Framework is feasible and effective in influencing retail practices in health facilities, has high consumer support for its goals, and overall acceptability and adoption amongst retailers.
24.G. Workshop: Reconstructing public health institutions in Somalia
Authors:   Organised by: Public Health Agency (Sweden),   Chair persons: Khalif Bile - Sweden, Kassim Abdi Jimale - Somalia
Published: October 2020

Abstract
The overall aim of this workshop is to present the ongoing efforts to restore central national public health institutions in Somalia like The National Institute of Health Somalia (NIHS), and to discuss critical factors to rebuild the health system and restore health institutions in fragile states using Somalia as an example. The workshop will focus on how to accelerate this process in order to reach the sustainable development goals and to help Somalia to achieve universal health coverage by 2020. The Public Health Agency of Sweden and The Norwegian Institute of Public Health organize this joint workshop in order to commemorate our late colleague and co-worker Mohamed Guled Farah, whós hard and tireless work was pivotal in the reestablishment of NIHS, with the ultimate goal of improving the health of the Somali people. The workshop will be chaired by Khalif Bile, who is a Senior Advisor to the Federal Ministry of Health Somalia. Bile has an outstanding experience in global public health in general and is very knowledgeable about the challenges and opportunities of the health system in Somalia and of the general health status of the population. Highly relevant presentations will be made by prominent key players and researchers in the field, followed by ample time for audience interaction. Kassim Abdi Jimale, Lecturer, Somali National University, will give an introduction and background to the restoration of the National Reference Laboratory and the process to establish the National Institute of Health Somalia. Somalia is a country that is affected by complex emergencies resulting from prolonged conflict, climate change, outbreaks of communicable diseases and a dysfunctional health system. The Public Health Agency Sweden, with the support of Sida (Swedish International Development Cooperation Agency), supports the Federal Ministry of Health Somalia to restore vital health institutions such as the National Institute of Health Somalia (NIHS) to provide effective public health services within a country disrupted by conflict. There are several partners involved in this process, and a great deal of effort is put in coordination of activities. Joining hands, finding synergies and coordination of efforts is another key function of this workshop.

Key messages
Reaching UHC and the SDGs in Somalia require support to the re-establishment of strong, sustainable public health institutions like the National Institute of Health Somalia. Strengthening the public health system of Somalia requires coordinated, long-term, sustainable commitments and partnerships.
The patients’ perspective on coordinated action for cancer and AMR
Authors: Apostolidis K 
Published: October 2020

Abstract
The speaker will present the perspective of the cancer patients, and the challenges they encounter across the spectrum of care and what measures they consider relevant in terms of prevention, diagnosis, treatment and, indeed, to raise awareness of the impact of AMR on rendering cancer treatments ineffective. She will elaborate on survivorship, and on the impact of AMR on the quality of life of patients, their carers, and families. Emphasis will be given on the implications of modern therapies, such as immunotherapy, representing a unique challenge in terms of better understanding the effect on overall health of patients, with the effect they have the immune system, further weakening the patient and leaving him/her exposed to infections potentially of higher risk than cancer itself.
The emergency to tackle tobacco smoking by Lebanese adolescents
Authors: Akel M , Salameh P , Ehlinger V , Godeau E 
Published: October 2020

Abstract
In Lebanon, tobacco use by adolescents remains a problem and is higher than among adults. This study sought to assess the experimentation of tobacco smoking practices among adolescents in Lebanon, and further to link health promotion at school-level (measured with the Hat Questionnaire) to the smoking behaviour at students-level (measured with the HBSC questionnaire). We relied on a cross-sectional observational study, conducted in 50 schools across Lebanon. The students' ages ranged from 11 to 18 years old (6th to 12th grade). They filled-in a confidential, anonymous self-questionnaire in class. In parallel, the school administration filled in the assessment questionnaire for health promotion. STATA Software was used for statistical analysis.7133 students were included (mean age 15.24±2.00 years). Overall, 24.5% had ever experimented cigarette smoking alone, boys more than girls (31.95% vs. 19.14%; p &lt; 0.001), mainly from Beirut (33.62%; p &lt; 0.001) and with poor health perception (29.12% vs. 19.87%; p &lt; 0.001). Overall, 33.98% had ever used water-pipe alone, again more boys (40.34% vs. 29.88%; p &lt; 0.001), from Beirut (39.55%, p &lt; 0.001), and with poor health perception (39.48% vs. 28.93%; p &lt; 0.001). Finally, 22.28% experimented both cigarettes and water-pipe. Around 70% of the involved schools offered health-related courses in their curricula. 72 % of them included interventions on the harm of smoking but not as an integral part of the curriculum. Less than half of them had developed plans to improve health promotion and review data to ensure the effectiveness of their programs. This alarming rate of use of tobacco products constitutes a major public health issue for Lebanese adolescents that needs urgent intervention. Further analysis will focus on the school-level questionnaires. Already our results will serve to foster the reinforcement of health promoting schools in Lebanon by the ministry of Education, in line with international recommendations.