Journeys, Mobility and Flows:Accessibility Work in Berlin’s Public Transport

Demands for accessibility bring dis/abled bodies and in/accessible infrastructures together in mutually defining encounters. Through the case of accessibility in Berlin’s public transport system, I explore how these encounters figure in practice. Specifically, I present movement through public transport as an object of knowledge and intervention in accompaniment services and advocacy for accessibility. I analyze three forms in which this movement figures: Journeys, Mobility and Flows. Each of these forms delimits bodies and infrastructure in specific ways. Their limits and capacities are thus not self-evident givens, but variously known and negotiated in the critical work of creating and maintaining accessibility

Targeting population nutrition through municipal health and food policy: implications of New York City's experiences in regulatory obesity prevention

Abstract not availableJana Sisnowski, Jackie M. Street, Annette Braunack-Maye

Assessing the role of CAP for more sustainable and healthier food systems in Europe:A literature review

Today, the European food system is characterized by unhealthy dietary trends, environmentally unsustainable production, and a dependency on an ageing farming population. The ongoing reform of the Common Agricultural Policy (CAP) represents an opportunity to redress these issues. This literature review highlights trends in how academic and grey literature have received CAP attempts in addressing the (i) environmental issues, (ii) nutritional outcomes, and (iii) rural livelihoods. Additionally, future policy and research directions relating to the CAP have been identified from the selected literature. The reviewed literature varies in approach and perspective. In particular, since the environment and rural development are already part of the CAP, the reviewed studies analyze and propose improvements to existing mechanisms. While for nutrition, the reviewed studies assessed possible policy strategies for integrating this sphere within the CAP, highlighting both the complexity of this task as well as its potential benefits. Despite these differences, a clear commonality emerged from the policy recommendations: the CAP should promote the European Union (EU) policy integration and multi-disciplinary and participatory research as key strategies to meet food system sustainability targets.</p

Lessons from a community vaccination programme to control a meningococcal disease serogroup W outbreak in remote South Australia, 2017

Problem: From December 2016 to February 2017, two cases of invasive meningococcal disease and one case of meningococcal conjunctivitis, all serogroup W, occurred in Aboriginal children in the Ceduna region of South Australia. The clustering of cases in time and place met the threshold for a community outbreak. Context: The Ceduna region is a remote part of South Australia, with more than 25% of the population identifying as Aboriginal or Torres Strait Islander. Action: As part of the outbreak response, a community-wide meningococcal vaccination programme against serogroups A, C, W and Y was implemented in a collaboration among different agencies of the South Australia Department for Health and Well-being, Aboriginal health and community services providers, and other local service providers and government agencies. The programme comprised an outbreak vaccination schedule, targeting all people aged 3 2 months residing in the cases’ places of residence or in towns with close links. Outcome: Between March and June 2017, 3383 persons were vaccinated, achieving an estimated coverage of 71–85% of the target population, with 31% (n = 1034) of those vaccinated identifying as Aboriginal or Torres Strait Islander. No local cases of serogroup W occurred during the vaccination programme, but two further cases were notified by the end of 2018. Discussion: The participation of a large number of local and non-health-sector stakeholders in programme planning and implementation, a clear response management structure and high community acceptability were identified as key factors that contributed to the programme achieving high vaccination coverage. The need to develop standard operating procedures for community-based outbreak response interventions to ease logistical challenges was considered an important lesson learnt

Differences in school factors associated with adolescent HPV vaccination initiation and completion coverage in three Australian states.

BackgroundSchools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake.MethodsInitiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015-2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25thpercentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage.ResultsMedian initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates.ConclusionThis study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage

School-level variation in coverage of co-administered dtpa and hpv dose 1 in three Australian states

Background:Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states.Methods:HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage.Results:Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0).Conclusion:The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake

International evidence and experiences in regulatory approaches targeting nutritional aspects of population-level obesity prevention

High prevalence of overweight and obesity remains a pressing health concern for most industrialised nations. As preventive approaches based on individuals’ capacity for behaviour change have largely failed to impact population weight, governments have begun to implement policies to regulate food environments with a view to improving nutrition and health outcomes. This thesis comprises four studies, presented as two peer-reviewed journal articles and two manuscripts, examining the evidence and experiences generated by Organisation for Economic Cooperation and Development jurisdictions’ regulatory targeting of the nutritional aspects of obesity prevention. Article 1 provides an overview of regulatory approaches addressing dietary risk factors for obesity enacted in the United States and the European Union since 2004. The findings from a systematic search of primary and secondary legislation databases demonstrate that such approaches are currently limited in reach and scope. No jurisdiction has enacted a comprehensive suite of complementary actions addressing different components of the food environment; however, the existence of discrete interventions indicates some political will for innovation. Article 2 employs a realist review perspective to systematically investigate the effect of “real-world” policies addressing population nutrition. The review examines: (1) the effect of interventions on average BMI/weight and calorie intake or proxy measures and (2) indicators measuring parameters on assumed causal pathways to changed consumption patterns. Results drawn from peer-reviewed articles and grey literature reports demonstrate that isolated regulatory interventions reliably improve intermediate outcomes, but fail to affect consumption at levels of clinical significance. Article 3 is a case study of obesity prevention in New York City. Combining a documentary review and key informant interviews, the analysis demonstrates that there is scope to redefine municipal responsibilities for public health. In particular, results indicate that policy change in the emerging and contested field of regulatory obesity prevention needs strong political leadership. Executive-driven nutrition policy is shown to offer an expedient mechanism to protect expert-designed measures from the influence of competing interests. The analysis also demonstrates the importance of building community support, the value of incremental change, and the impact of contentious public discussion on social norms around nutrition. Article 4 considers how local governments can prepare for systematic engagement in population-level obesity prevention, using the 2011 South Australian Public Health Act as an example. Analysis shows that South Australia can potentially employ a range of levers to address food environments and nutrition under this legislation; particularly through the Health Minister’s authority to issue Codes of Practice relating to specified industries or activities based on health concerns. The operationalization of this and other legal instruments for nutritional obesity prevention should be supported by a greater focus on whole-of-government responsibility for public health in general purpose legislation. Together, these studies give a nuanced picture of the current state of regulatory obesity prevention as it relates to nutrition policy and food environments. As well as indicating directions for future research, particularly regarding the long-term effects of existing interventions and the assessment of new policy approaches, this body of work provides insights and clear recommendations for future food and obesity prevention policy.Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Public Health, 2016

Prevention and control of sexually transmissible infections and other infectious diseases across multiple settings

This thesis summarises the results of five major projects completed from February 2017 to November 2018 to meet the requirements of the Master of Philosophy in Applied Epidemiology (MAE), the Australian Field Epidemiology Program. The majority of the work presented here was completed at the Kirby Institute for infection and immunity at the University of New South Wales, with two additional projects carried out at the Communicable Disease Control Branch, South Australia Department for Health and Wellbeing (SA Health). Chapter 1 provides an introduction to the primary field placement at the Kirby Institute and an overview of activities undertaken over the course of the MAE program. Chapter 2 presents an epidemiological research project investigating gaps in the adolescent vaccination program for human papillomavirus (HPV), a sexually transmissible infection, with a view to informing interventions to improve coverage. The study examined school-level correlates of low initiation and completion of the vaccination course in several school-based programs in three jurisdictions, using a dataset built from several data sources, including the Australian Bureau of Statistics, the Australian Curriculum, Assessment and Reporting Authority, and the National HPV Program Register. Univariable and multivariable logistic regression analyses were conducted to determine characteristics of schools and school populations associated with low vaccination initiation and completion. Chapter 3 has a methodological focus, describing the development of geographical maps at the small area level for the Kirby Institute's 2017 Annual Surveillance Report of HIV, viral hepatitis and sexually transmissible infections. This project involved an iterative process to define the most appropriate methodological approach to show differences in age-standardised notification rates that could be applied in future reports. The chapter documents the investigation of the effects of administrative areas of different size, different classification methods of notification rates, and several suppression methods using maps developed for HIV and chlamydia as two diseases with contrasting epidemiology. Chapter 4 presents a full evaluation of the operations of the South Australian surveillance system for Neisseria gonorrhoeae antimicrobial resistance in the years 2016-17, using the United States Centers for Disease Control and Prevention (US CDC) guidelines for the assessment of disease surveillance systems. Also within the US CDC framework, chapter 5 describes work undertaken to support the introduction of HIV subtype and resistance surveillance at the national level and discusses potential indicators and data sources for a future evaluation of the new surveillance system, once operational. Finally, chapter 6 outlines a descriptive case series investigation of a Salmonella Typhimurium phage type 44 cluster in South Australia which did not identify a common source of infection, but contributed evidence that Salmonella Typhimurium is an important cause of foodborne illness in the community. Collectively, the majority of projects within this thesis contribute to strengthening STI surveillance in Australia, and the identification of factors associated with low uptake of HPV vaccination has the potential to guide future research and public health programming to improve prevention