Results from the Sweden 2016 Report Card on Physical Activity for Children and Youth

Background: The Sweden 2016 Report Card on Physical Activity (PA) for Children and Youth is a unique compilation of the existing physical and health related data in Sweden. The aim of this paper is to summarize the procedure and results from the report card. Methods: Nationally representative surveys and individual studies between 2005-2015 were included. Eleven PA and health indicators were graded using the Active Healthy Kids Canada grading system. Grades were assigned based on the percentage of children/youth meeting a defined benchmark (A: 81-100%, B: 61-80%, C: 41-60%, D: 21-40%, F: 0-20%, or incomplete (INC). Results: The assigned grades were: Overall Physical Activity, D; Organized Sport Participation, B+; Active Play, INC; Active Transportation, C+; Sedentary Behaviors, C; Family and Peers, INC; School, C+; Community and the Built Environment, B; Government Strategies and Investments, B; Diet, C-; and Obesity, D. Conclusion: The included data provides some support that overall PA is too low and sedentary behavior is too high for almost all age groups in Sweden, even with the many national policies as well as an environment that is favorable to the promotion of PA

Quantitative and qualitative evaluations of impacts and benefits of nine INHERIT case studies

The INHERIT report Quantitative and Qualitative Evaluations of Impacts and Benefits of Nine INHERIT Case Studies documents the findings relevant to potential impacts and benefits of nine case studies for health, equity and a more sustainable environment. It uses a mixed method approach with quantitative methods augmented in some cases by written responses to survey questions, or by focus group discussions on impacts, as appropriate. Each case study evaluation was led by a different INHERIT partner. In each case, partners formulated the research design appropriate to their case studies and the associated research questions identified within the framework of INHERIT. The coordinating partner, University College London (UCL), developed an evaluation framework to suit the range of case studies examined for impacts and benefits, the case specific logic models developed, and the research questions identified. The nine chapters describe the impact evaluations and findings from the nine case studies using the following format: Background; Overall aims; Context; Research Questions; Methodology; Results; Discussion; Limitations; Learning points for future research; Learning points for potential scale up and transferability

Creating triple-wins for health, equity and environmental sustainability: elements of good practice based on learning from the INHERIT case studies

This report draws out dimensions of good practice for building this triple-win, based on learning from the INHERIT project’s 15 case studies. In the context of the project, good practice refers to ways that support changing contexts and create conditions to enable behaviour change to reach the triple-win. This report summarises key information for consideration by governmental and non-governmental policy-makers and practitioners planning to work across sectors to achieve the triple-win through behaviour change at every level. INHERIT researchers have focused their evaluations of the 15 INHERIT case studies on implementation, intersectoral cooperation, impacts and cost benefits. The researchers have taken dimensions of good practice from INHERIT research to be those elements that appear to be promising or necessary in the contexts in which the INHERIT cases studies are implemented. The extent to which these elements of good practice can be generalised to other contexts merits consideration in developing future initiatives towards creating synergies across sectors. INHERIT researchers have drawn out lessons learned from information gathered in evaluations about triggers for the initiatives, key elements for implementation, success factors in intersectoral cooperation, what could have been done better, what should be done in the future, and the most important learnings from the evaluation of outcomes, costs and benefits

Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest

ImportanceThe Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens.ObjectivesTo investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA.Design, Setting, and ParticipantsThis study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing.InterventionsRandomization 1:1 to temperature control with targeted hypothermia at 33 °C or targeted normothermia and early treatment of fever (37.8 °C or higher).Main outcomes and measuresFunctional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes.ResultsAt 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P = .46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,−0.33 to 1.05; P = .37) and SDMT (mean difference, 0.06; 95% CI,−0.16 to 0.27; P = .62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%).ConclusionsIn this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common.Trial RegistrationClinicalTrials.gov Identifier: NCT0290830

Creating triple-wins for health, equity and environmental sustainability: elements of good practice based on learning from the INHERIT case studies

This report draws out dimensions of good practice for building this triple-win, based on learning from the INHERIT project’s 15 case studies. In the context of the project, good practice refers to ways that support changing contexts and create conditions to enable behaviour change to reach the triple-win. This report summarises key information for consideration by governmental and non-governmental policy-makers and practitioners planning to work across sectors to achieve the triple-win through behaviour change at every level. INHERIT researchers have focused their evaluations of the 15 INHERIT case studies on implementation, intersectoral cooperation, impacts and cost benefits. The researchers have taken dimensions of good practice from INHERIT research to be those elements that appear to be promising or necessary in the contexts in which the INHERIT cases studies are implemented. The extent to which these elements of good practice can be generalised to other contexts merits consideration in developing future initiatives towards creating synergies across sectors. INHERIT researchers have drawn out lessons learned from information gathered in evaluations about triggers for the initiatives, key elements for implementation, success factors in intersectoral cooperation, what could have been done better, what should be done in the future, and the most important learnings from the evaluation of outcomes, costs and benefits

Quantitative and qualitative evaluations of impacts and benefits of nine INHERIT case studies

The INHERIT report Quantitative and Qualitative Evaluations of Impacts and Benefits of Nine INHERIT Case Studies documents the findings relevant to potential impacts and benefits of nine case studies for health, equity and a more sustainable environment. It uses a mixed method approach with quantitative methods augmented in some cases by written responses to survey questions, or by focus group discussions on impacts, as appropriate. Each case study evaluation was led by a different INHERIT partner. In each case, partners formulated the research design appropriate to their case studies and the associated research questions identified within the framework of INHERIT. The coordinating partner, University College London (UCL), developed an evaluation framework to suit the range of case studies examined for impacts and benefits, the case specific logic models developed, and the research questions identified. The nine chapters describe the impact evaluations and findings from the nine case studies using the following format: Background; Overall aims; Context; Research Questions; Methodology; Results; Discussion; Limitations; Learning points for future research; Learning points for potential scale up and transferability

När hjärtat ändrar livets riktning : Individers upplevelser av det dagliga livet efter en hjärtinfarkt

Bakgrund: Varje år dör miljoner människor i världen av hjärtinfarkt, men i Sverige har överlevnaden ökat. För de som överlever följer en fysisk och psykisk anpassning i vardagen.Vårdtiderna på sjukhus har kortats. Sjuksköterskans möjlighet att förbereda personen på livet efter hemgången är därmed tidsmässigt begränsad och sker när personen är starkt känslomässigt påverkad. Symtom som följer med sjukdomen riskerar att sänka livskvaliteten och stödet är avgörande för återhämtningen. Syfte: Syftet med studien var att belysa individers upplevelser av det dagliga livet efter en hjärtinfarkt. Metod: Studien genomfördes som en kvalitativ litteraturstudie och baserades på tio vetenskapliga artiklar. Analysen av artiklarna genomfördes med en analysmetod inspirerad av Elo och Kyngäs. Resultat: I resultatet framkom huvudkategorierna hjärtinfarkten en omvälvande insikt, förändrad syn på sin existens, begränsningar i vardagen, sårbar utan stöd samt fysisk hälsa och intimitet påverkade livskvaliteten. Hjärtinfarkten innebar att attityden till livet förändrades, existentiella frågor väcktes och tankar på framtiden kunde vara svåra. Rädsla och extrem trötthet skapade oöverkomliga hinder i vardagen. Livsstilsförändringar som var nödvändiga kunde väcka negativa känslor och vara svåra att genomföra. Utan stöd, privat och professionellt, blev individerna sårbara och en del vände sig till högre makter för hjälp. För en del förbättrades den fysiska hälsan. Med överlevnaden blev samlivet förändrat, intimiteten ökade och tillfredsställelsen blev högre. Slutsats: Livet efter hjärtinfarkten präglades för många av en vardag fylld av existentiella tankar, rädsla och trötthet som skapade svåröverkomliga hinder. För att inte tappa fotfästet, isolera sig socialt och aldrig komma tillbaka i arbetslivet, och för att klara nödvändiga livsstilsförändringar, krävs ett omfattande stöd från sjuksköterskan och närstående.En del överlevande kände en stark livslust och upplevde att de fått en andra chans, som gav dem möjlighet att omprioritera i livet

School-related physical activity interventions and mental health among children:a systematic review and meta-analysis

BACKGROUND: Low levels of physical activity, sedentary behaviour and mental health problems are issues that have received considerable attention in the last decade. The aim of this systematic review and meta-analysis was to investigate effects of interventions targeting school-related physical activity or sedentary behaviour on mental health in children and adolescents and to identify the features of effective interventions. METHODS: Scientific articles published between January 2009 and October 2019 fulfilling the following criteria were included: general populations of children and adolescents between age 4 and 19, all types of school-related efforts to promote physical activity or reduce sedentary behaviour. Study selection, data extraction and quality assessment were done by at least two authors independently of each other. Data were analysed with a random effects meta-analysis and by narrative moderator analyses. RESULTS: The literature search resulted in 10265 unique articles. Thirty-one articles, describing 30 interventions, were finally included. Eleven relevant outcomes were identified: health-related quality of life, well-being, self-esteem and self-worth, resilience, positive effect, positive mental health, anxiety, depression, emotional problems, negative effect and internalising mental health problems. There was a significant beneficial effect of school-related physical activity interventions on resilience (Hedges' g = 0.748, 95% CI = 0.326; 1.170, p = 0.001), positive mental health (Hedges' g = 0.405, 95% CI = 0.208; 0.603, p = < 0.001), well-being (Hedges' g = 0.877, 95% CI = 0.356; 1.398, p = < 0.001) and anxiety (Hedges' g = 0.347, 95% CI = 0.072; 0.623, p = 0.013). Heterogeneity was moderate to high (I2 = 59-98%) between studies for all outcomes except positive effect, where heterogeneity was low (I2 = 2%). The narrative moderator analyses of outcomes based on 10 or more studies showed that age of the children moderated the effect of the intervention on internalising mental health problems. Interventions in younger children showed a significantly negative or no effect on internalising mental health problems while those in older children showed a significant positive or no effect. Moreover, studies with a high implementation reach showed a significant negative or no effect while those with a low level of implementation showed no or a positive effect. No signs of effect moderation were found for self-esteem, well-being or positive mental health. Risk of publication bias was evident for several outcomes, but adjustment did not change the results. CONCLUSIONS: School-related physical activity interventions may reduce anxiety, increase resilience, improve well-being and increase positive mental health in children and adolescents. Considering the positive effects of physical activity on health in general, these findings may reinforce school-based initiatives to increase physical activity. However, the studies show considerable heterogeneity. The results should therefore be interpreted with caution. Future studies should report on implementation factors and more clearly describe the activities of the control group and whether the activity is added to or replacing ordinary physical education lessons in order to aid interpretation of results. TRIAL REGISTRATION: PROSPERO, CRD42018086757

Ten Lessons for Good Practice for the INHERIT Triple Win: Health, Equity, and Environmental Sustainability.

The world's challenges of climate change, damage to ecosystems, and social and health inequalities require changes in human behaviours at every level of organisation, among governments, business, communities, and individuals. An important question is how behaviour change can be enabled and supported at the scale and speed required. The research reported in this paper describes important lessons for good practice in changing contexts to modify behaviours for a triple win for health, equity and environmental sustainability. Authors synthesised learning from qualitative, quantitative and cost benefit evaluations of 15 case studies conducted in 12 countries in Europe. The case studies address ways of living (green spaces and energy efficient housing), moving (active transport) and consuming (healthy and sustainable diets) that support the triple win. Ten lessons for good practice were identified. These include bringing a triple win mindset to policy and practice in planning interventions, with potential to improve environmental sustainability, health and equity at the same time. The lessons for good practice are intended to support governmental and non-governmental actors, practitioners and researchers planning to work across sectors to achieve mutual benefits for health and environmental sustainability and in particular to benefit poorer and more socio-economically disadvantaged groups