Municipal policies and plans of action aiming to promote physical activity and healthy eating habits among schoolchildren in Stockholm, Sweden: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Promoting physical activity and healthy eating habits by structural measures that reach most children in a society is presumably the most sustainable way of preventing development of overweight and obesity in childhood. The main purpose of the present study was to analyse whether policies and plans of action at the central level in municipalities increased the number of measures that aim to promote physical activity and healthy eating habits among schoolchildren aged six to 16. Another purpose was to analyse whether demographic and socio-economic characteristics were associated with the level of such measures.</p> <p>Methods</p> <p>Questionnaires were used to collect data from 25 municipalities and 18 town districts in Stockholm County, Sweden. The questions were developed to capture municipal structural work and factors facilitating physical activity and the development of healthy eating habits for children. Local policy documents and plans of action were gathered. Information regarding municipal demographic and socio-economic characteristics was collected from public statistics.</p> <p>Results</p> <p>Policy documents and plans of action in municipalities and town districts did not seem to influence the number of measures aiming to promote physical activity and healthy eating habits among schoolchildren in Stockholm County. Municipal demographic and socio-economic characteristics were, however, shown to influence the number of measures. In town districts with a high total population size, and in municipalities and town districts with a high proportion of adults with more than 12 years of education, a higher level of health-promoting measures was found. In municipalities with a high annual population growth, the number of measures was lower than in municipalities with a lower annual population growth. Another key finding was the lack of agreement between what was reported in the questionnaires regarding existence and contents of local policies and plans of action and what was actually found when these documents were scrutinized.</p> <p>Conclusion</p> <p>Policy documents and plans of action aiming to promote physical activity and healthy eating habits among schoolchildren aged six to 16 in municipalities and town districts in Stockholm County did not seem to have an impact on the local level of measures. Demographic and socio-economic characteristics of the municipalities and town districts were on the other hand associated with local health-promoting measures.</p

Efficacious, effective, and embedded interventions: Implementation research in infectious disease control

Background: Research in infectious disease control is heavily skewed towards high end technology; development of new drugs, vaccines and clinical interventions. Oft ignored, is the evidence to inform the best strategies that ensure the embedding of interventions into health systems and amongst populations. In this paper we undertake an analysis of the challenge in the development of research for the sustainable implementation of disease control interventions. Results: We highlight the fundamental differences between the research paradigms associated with the development of technologies and interventions for disease control on the one hand and the research paradigms required for enhancing the sustainable uptake of those very same interventions within the communities on the other. We provide a definition for implementation research in an attempt to underscore its critical role and explore the multidisciplinary science needed to address the challenges in disease control. Conclusion: The greatest value for money in health research lies in the sustainable and effective implementation of already proven, efficacious solutions. The development of implementation research that can help provide some solutions on how this can be achieved is sorely needed

Association between childhood community safety interventions and hospital injury records: a multilevel study

Study objective: To study municipal variations in children's injury risk and to assess the impact of safety promotion measures in general municipal, preschool, school, and leisure activity settings, on injury outcome. Design: A cohort study based on individual data on children's consumption of hospital care as a result of injury, the age and sex of each child, and socioeconomic data on each child's mother. Municipal characteristics—that is, population density and municipal safety measures—were also used. Connections between individual and community level determinants were analysed with multilevel logistic regression. Setting: Twenty five municipalities in Stockholm County in Sweden were studied. Participants: Children between 1 and 15 years old in 25 municipalities in Stockholm County, identified in the Total Population Register in Sweden. The study base included 1 055 179 person years. Main results: Municipality injury rates varied between 3.84–7.69 per 1000 person years among 1–6 year olds and, between 0.86–6.18 among 7–15 year olds. Implementation of multiple safety measures in a municipality had a significant effect on the risk of injury for preschool children. In municipalities that implemented few safety measures, the risk of injury was 33% higher than in municipalities that implemented many. A similar effect, though insignificant, was observed in the school aged children. Conclusions: This study shows that how municipalities organise their safety activities affect injury rates. Sweden has a comparatively low injury rate and thus, in a European perspective, there is an obvious potential for municipal safety efforts

Thank you

A scientific journal exists only because of the good will and assistance of its reviewers. We can only publish less than a fifth of the papers we receive and, in making our decisions, we depend on the expertise of many people. This year a total of 315 reviewers have helped us to decide about the papers that we should publish. Their names are listed below and we would like to take this opportunity to thank them. The list refers to reviewers assigned until the 6th December 2006

Identification of potential opinion leaders in child health promotion in Sweden using network analysis

Background: Opinion leaders are often local individuals with high credibility who can influence other people. Robust effects using opinion leaders in diffusing innovations have been shown in several randomized controlled trials, for example regarding sexually transmitted infections (STI), human immunodeficiency virus (HIV) prevention, mammography rates and caesarean birth delivery rates. In a Cochrane review 2010 it was concluded that the use of opinion leaders can successfully promote evidence-based practice. Thus, using opinion leaders within the public health sector might be one means to speed up the dissemination of health promoting and disease preventing innovations. Social network analysis has been used to trace and map networks, with focus on relationships and positions, in widely spread arenas and topics. The purpose of this study was to use social network analysis in order to identify potential opinion leaders at the arena of child health promotion in Sweden. Results: By using snowball technique a short e-mail question was spread in up to five links, starting from seven initially invited persons. This inquiry resulted in a network consisting of 153 individuals. The most often mentioned actors were researchers, public health officials and paediatricians, or a combination of these professions. Four single individuals were mentioned by five to seven other persons in the network. These individuals obviously possess qualities that make other professionals within the public health sector listen to and trust them. Conclusions: Social network analysis seemed to be a useful method to identify influential persons with high credibility, i.e. potential opinion leaders, at the arena of child health promotion in Sweden. If genuine opinion leaders could be identified directed measures can be carried out in order to spread new and relevant knowledge. This may facilitate for public health actors at the local, regional and national level to more rapidly progress innovations into everyday practice. However, effectiveness studies of opinion leaders in the public health sector still have to be performed. © 2012 Guldbrandsson et al.Art. No.: 424</p

Design of a process evaluation of the implementation of a physical activity and sports stimulation programme in Dutch rehabilitation setting: ReSpAct

Background: There is a growing interest to study the transfer of evidence-based information into daily practice. The evidence-based programme Rehabilitation, Sports and Exercise (RSE) that aims to stimulate an active lifestyle during and after a rehabilitation period in people with a disability and/or chronic disease is prepared for nationwide dissemination. So far, however, little is known about the implementation of a new programme to stimulate physical activity in people with a disability in a rehabilitation setting. Therefore, a process evaluation of the implementation of the RSE programme within 18 Dutch rehabilitation centres and hospitals is performed in order to gain more insight into the implementation process itself and factors that facilitate or hamper the implementation process. This paper describes the study design of this process evaluation.Methods: During a three-year period, the adoption, implementation and continuation of the RSE programme is monitored and evaluated in 12 rehabilitation centres and 6 hospitals with a rehabilitation department in The Netherlands. The main process outcomes are: recruitment, reach, dose delivered, dose received, fidelity, satisfaction, maintenance and context. The process outcomes are evaluated at different levels (organisational and patient) and different time points. Data collection includes both quantitative (online registration system and questionnaires) and qualitative (focus groups and semi-structured interviews) methods.Discussion: The nationwide dissemination of an evidence-based programme to stimulate physical activity and sports during and after a rehabilitation period is extensively monitored and evaluated on different levels (organization and patients) using mixed methods. The study will contribute to the science of translating evidence-based programmes into daily practice of the rehabilitation care. The results of the study can be used to further optimize the content of the RSE programme and to facilitate the implementation in other health facilities. Furthermore, the results of the study can help future implementation processes in the rehabilitation setting.Trial registration: The study is registered by The Netherlands National Trial Register: NTR3961