Report On The Who Regional Technical Consult Ation On A Global Strategy To Reduce Harmful Use Of Alcohol

No Abstrac

Health impact assessment (HIA) and health in environmental assessments – Enhancing HIA practice in Portugal

Este documento tem co-autoria da Unidade de Promoção da Saúde, Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, IP, LisboaTo further support development of HIA in Portugal, the Ministry of Health of Portugal together with the National Health Institute of Doctor Ricardo Jorge initiated organization of a workshop within the Biennial Collaborative Agreement (BCA) with WHO EURO office in Bonn, Germany. The workshop convened in Lisbon, at the National Health Institute of Doctor Ricardo Jorge on November 13-15, 2017.Aim and objectives of the workshop: The importance of assessing the health implications of policies, plans, programmes and projects of different sectors has been long established. Through the Health 2020 approach, the European framework on health, adopted in 2012 by the Member States in the WHO European Region, the need for a whole‐of‐government and whole‐of‐society approach has been re‐emphasised. Within this approach health impact assessment (HIA) can play a crucial role by supporting decision‐makers inand outside of the health sector to address health impacts and inequalities, and ensure the health of future generations through the identification and estimation of possible impacts of proposed policies and activities. HIA can thus play an important role in achieving the Sustainable Development Goals (SDGs). The Ministry of Health of Portugal through its Directorate General is in the process of proposing a new Government Bill (nr 49/XIII) that defines the competencies of the Public Health Services. These competencies include among others the assessment of potential health impacts of proposed legislative acts. Therefore an implementation model for HIA in Portugal is proposed by the Committee for the National Public Health Reform to assess in a first step, policies of any sector and their potential impacts on health and well‐being. Through the implementation of HIA of policies, as well as of plans, programs and projects there is great potential for health gains. Several Member States in the WHO European Region have already established legal obligations for HIA but in the majority of countries HIAs are voluntarily conducted. Meanwhile, in many countries, including Portugal, legal obligations for environmental assessments exist which include the need to assess impacts on human health and on the population, as for example defined in the European Directives on Environmental Impact Assessment (EIA Directive 2014/52/EU) and on Strategic Environmental Assessment (SEA Directive 2001/42/EC) as well as the Espoo Convention on EIA in a Transboundary Context and its Protocol on SEA of the United Nations Economic Commission for Europe (UNECE). Public health authorities need to be prepared not only to assess the impacts of policies, plans, programs and projects of the health sector but also to engage in environmental assessments. To further support development of HIA in Portugal, the Ministry of Health of Portugal together with the National Health Institute of Doctor Ricardo Jorge initiated organization of a workshop within the Biennial Collaborative Agreement (BCA) with WHO EURO office in Bonn, Germany. The workshop convened in Lisbon, at the National Health Institute of Doctor Ricardo Jorge on November 13-15, 2017.Este relatório resume as discussões e principais conclusões do Workshop realizado em Lisboa, dias 13-15 de Novembro de 2017, no âmbito do BCA para Portugal (BCA 2016-2017), sobre desenvolvimento da cultura de HIA em Portugal. A reunião foi tecnicamente apoiada pela OMS – Europa.info:eu-repo/semantics/publishedVersio

Developing a model to estimate the potential impact of municipal investment on city health

This article summarizes a process which exemplifies the potential impact of municipal investment on the burden of cardiovascular disease (CVD) in city populations. We report on Developing an evidence-based approach to city public health planning and investment in Europe (DECiPHEr), a project part funded by the European Union. It had twin objectives: first, to develop and validate a vocational educational training package for policy makers and political decision takers; second, to use this opportunity to iterate a robust and user-friendly investment tool for maximizing the public health impact of 'mainstream' municipal policies, programs and investments. There were seven stages in the development process shared by an academic team from Sheffield Hallam University and partners from four cities drawn from the WHO European Healthy Cities Network. There were five iterations of the model resulting from this process. The initial focus was CVD as the biggest cause of death and disability in Europe. Our original prototype 'cost offset' model was confined to proximal determinants of CVD, utilizing modified 'Framingham' equations to estimate the impact of population level cardiovascular risk factor reduction on future demand for acute hospital admissions. The DECiPHEr iterations first extended the scope of the model to distal determinants and then focused progressively on practical interventions. Six key domains of local influence on population health were introduced into the model by the development process: education, housing, environment, public health, economy and security. Deploying a realist synthesis methodology, the model then connected distal with proximal determinants of CVD. Existing scientific evidence and cities' experiential knowledge were 'plugged-in' or 'triangulated' to elaborate the causal pathways from domain interventions to public health impacts. A key product is an enhanced version of the cost offset model, named Sheffield Health Effectiveness Framework Tool, incorporating both proximal and distal determinants in estimating the cost benefits of domain interventions. A key message is that the insights of the policy community are essential in developing and then utilising such a predictive tool

Index medicus for the Eastern Mediterranean region

The study provides the rationale, history and current status of the Index Medicus for the World Health Organization Eastern Mediterranean Region. The Index is unique in combining the geographic coverage of peer-reviewed health and biomedical journals (408 titles) from the 22 countries of the Region. Compiling and publishing the Index coupled with a document delivery service is an integral part of the WHO Regional Office's knowledge management and sharing programme. In this paper, bibliometric indicators are presented to demonstrate the distribution of journals, articles, languages, subjects and authors as well as availability in printed and electronic formats. Two countries in the Region (Egypt and Pakistan) contribute over 50% of the articles in the Index. About 90% of the articles are published in English. Epidemiology articles represent 8% of the entire Index. 15% of the journals in the Index are also indexed in MEDLINE, while 7% are indexed in EMBASE. Future developments of the Index will include covering more journals and adding other types of health and biomedical literature, including reports, theses, books and current research. The challenges and lessons learnt are discussed

Schizophrenia trials in China: a survey

OBJECTIVE: China's biomedical research activity is increasing and this literature is becoming more accessible online. Our aim was to survey all randomized control schizophrenia trials (RCTs) in one Chinese bibliographic database. METHOD: Chinese Academic Journals was electronically searched for RCTs and all relevant citations were also sought on PubMed to ascertain global accessibility. RESULTS: The search identified 3275 records, of which 982 were RCTs relevant to schizophrenia. A total of 71% (699) could be found by using English phrases. All the main body of text of the 982 papers was in Mandarin. On average, these trials involved about 100 people, with interventions and outcome measures familiar to schizophrenia trialists worldwide. Four of the 982 records (<1%) were identified on PubMed. CONCLUSION: Those undertaking systematic reviews should search the Chinese literature for relevant material. Failing to do this will leave the results of systematic reviews prone to random error or bias, or both

'I think that it's a pain in the ass that I have to stand outside in the cold and have a cigarette': representations of smoking and experiences of disapproval in UK and Greek smokers

Smokers in Greece and the UK are habitually exposed to different levels of social disapproval. This qualitative study explored the accounts of smoking and disapproval offered by 32 UK and Greek smokers. Accounts were framed with reference to a highly moralized construction of smoking. Participants were sensitive to social disapproval of their smoking. While disapproval from those close to them was accepted, disapproval from the general public was not. Two discursive repertories 'smoking works for me now' and 'the struggle to quit' were identified as resources that participants drew upon to enable continued smoking while acknowledging the health issues. While there were many similarities in the accounts provided, there were important differences that seem to reflect the different 'smoking worlds' inhabited. Copyright 2006 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution

Measuring activities in tobacco control across the EU. The MAToC

BACKGROUND: Objectives of this study are (a) to develop a comprehensive and economic tool to estimate tobacco control (TC) activities in single EU member states, (b) to compare TC activities between member states of the EU. This article provides the questionnaire and gives a benchmark of EU member states according to their perceived TC activities. Methods: An international workshop was specifically initiated to develop the questionnaire "Measuring Activities in Tobacco Control (MATOC)". TC experts from 8 European countries participated and chose 40 items to cover 11 general topics of TC. At the World Conference of Tobacco or Health in Helsinki 2003 participants were asked to fill out the questionnaire. N = 142 participants from EU-member states returned questionnaires. RESULTS: Subjects from the tobacco field in Finland gave the highest TC values to their country, followed by Sweden, Ireland, the UK and the Netherlands. The least active countries in TC were Greece and Germany, behind Austria, Spain, Belgium and Portugal. Italy, France and Denmark constituted the middle field. CONCLUSION: The MATOC provides a profile of TC across European countries and delivers results that are plausible and fit into the existing findings. The data presented here fulfils the purpose to illustrate what is possible with the MATOC and underlines the value of such an approach in delivering information for policy makers and TC advocates how TC is perceived in each country. Yet, further validity testing is necessary, the number of experts per country differs and is partly rather small. Further research with the MATOC should encounter these limitations. The procedure though could serve as model of practice for alcohol and legal drug policy as well

Evaluation of collaborative TB/HIV activities in a general hospital in Addis Ababa, Ethiopia

<p>Abstract</p> <p>Background</p> <p>Ethiopia has had mechanisms for TB/HIV collaborative activities since 2002. However, no published account has defined the role of these collaborative efforts in strengthening linkages between HIV and TB management units at the point-of-care level. Our objective was to assess the extent of linkages between the two programs at the patient management level at Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Between January and December 2008, the registers of 241 TB patients were reviewed to determine the HIV testing rate, the treatment charts of 238 randomly selected patients were reviewed for providers' compliance with evaluation criteria, and exit interviews were conducted with 309 TB/HIV co-infected clients to validate providers' compliance.</p> <p>Results</p> <p>From register review, it was determined that the HIV testing acceptance rate was 95%, and that 70% of patients received post-test counseling. A review of the patient chart revealed that of 51 patients with a complaint of cough, duration for cough was recorded in 35 (68.6%) cases and cough > 2 weeks was recorded in 25 (49.0%) cases. Seventy two percent (18 of 25) were linked for sputum microscopy. Linkage to cotrimoxazole prophylactic treatment was 81%, but only 47% of eligible patients were linked to isoniazid preventive therapy (IPT). Correct diagnosis was accomplished at a rate of 100% for smear positive pulmonary TB, 23% for smear negative pulmonary TB and 88% for extra pulmonary TB patients. Both chart review and exit interviews indicated that history of TB contact and cough > 2 weeks predicted TB disease.</p> <p>Conclusion</p> <p>The rates of HIV testing and linkage to cotrimoxazole prophylactic therapy were high. Improvement is needed in the areas of recording patient information, screening HIV positives for TB, initiation of IPT, referral, linkages, and TB diagnostic capacity.</p

Health care reform and job satisfaction of primary health care physicians in Lithuania

BACKGROUND: The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. METHODS: Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%), working at Kaunas primary health care level establishments, in October – December 2003. RESULTS: 15 men (7.9%) and 176 women (92.1%) participated in the research, among which 133 (69.6%) were GPs and 58 (30.4%) physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale). Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09), social status (3.36), and workload (3.93) turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio) was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458. CONCLUSION: Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job