Exercise carried out by EuroHealthNet members, led by EuroHealthNet and the Dutch National Institute for Public Health and the Environment (RIVM)

Portugal - Survey respondents and Workshop participants: Caldas de Almeida, Teresa - National Institute of Health Doutor Ricardo Jorge, Head of Health Promotion Unit; Costa, Alexandra - National Institute of Health Doutor Ricardo Jorge, Senior Technical ExpertExecutive summary: recommendations for action: The COVID-19 pandemic caught the world unprepared and has changed the shape of public health – and of our lives – for the foreseeable future. A group of senior public health officials from national and regional public health agencies across Europe came together to discuss current developments, the interrelated complexities and implications for their work in the near and longterm future. This report reflects their insights into some of the most pressing societal challenges and trends for public health in the years ahead, adopting a broad definition of health which encompasses social and environmental factors. Challenges considered include the rise in social and health inequalities, the increasing pressure on health systems, and negative impacts on population mental health. They reflect both direct as well as indirect impacts of the crisis on health, such as for instance unemployment and its pathways to ill-health. Climate change and (further) environmental degradation were highlighted as key longterm challenges. The exercise also included setting out opportunities, such as the fact that public health has been put in the spotlight and is at the centre of political agendas and public mindsets. The group concluded that “building back better” from the pandemic could provide an opportunity to strengthen health promotion and disease prevention, to bring more sectors together around the topic of health, including mental health and to enable citizens to adopt healthier, more sustainable behaviours. The importance of community action and social cohesion during the pandemic also provides opportunities to boost local level initiatives and networks. Over the next months and years, actions need to be taken to tackle the challenges at the root level, cushion the impacts of crisis and mitigation measures and encourage positive developments. Public health actors and agencies continue to have a pivotal role to ensuring a resilient, inclusive and sustainable recovery from the pandemic. This foresight exercise led to a draft set of recommendations for how different actors can help bring this about. The recommendations were discussed and validated in a EuroHealthNet partnership workshop in November 2020 and reflect this exchangeAim: EuroHealthNet and its member organisations have important roles to play in the future of public health in Europe, as well as on the ground in their home countries. They monitor, analyse and act to protect and improve the health of the population. This foresight exercise aimed to understand and discuss some of the trends and challenges but also the potential opportunities that have arisen from the pandemic, to inform members’ strategies and their work. It also sought to provide input for EuroHealthNet’s strategy for the coming years and explore how the partnership can positively contribute to “building back better”. The exercise, and this report, also aims to be useful to the broader stakeholder community, working on or around public health at local, national and EU level.info:eu-repo/semantics/publishedVersio

A service evaluation of the “Open Wide and Step Inside” school oral health programme

Abstract Introduction To present a service evaluation of the “Open Wide and Step Inside” oral health programme delivered in Plymouth, UK. Aim To develop an oral health programme supporting Key Stage One of the National Curriculum for delivery to children aged 4–6 years in targeted schools. Methods The programme was designed and developed in partnership with stakeholders from a range of sectors using a community engagement approach. The programme has been delivered in schools in targeted areas of the city since 2014/15. Outcome (participation of schools and children) and process evaluations were carried out using a range of methods to collect feedback from children, teachers and parents. Results School adoption and engagement in the programme has been high exceeding the targets set for implementation. So far over 4000 children have participated in the programme and schools have welcomed support in delivering oral health as part of the national curriculum. Conclusion A community engagement approach can be highly valuable in developing oral health programmes that meet community needs through collaborative design and a participatory approach

Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies

Is brief advice in primary care a cost-effective way to promote physical activity?

This article is made available through the Brunel Open Access Publishing Fund. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.Aim: This study models the cost-effectiveness of brief advice (BA) in primary care for physical activity (PA) addressing the limitations in the current limited economic literature through the use of a time-based modelling approach. Methods: A Markov model was used to compare the lifetime costs and outcomes of a cohort of 100 000 people exposed to BA versus usual care. Health outcomes were expressed in terms of quality-adjusted life years (QALYs). Costs were assessed from a health provider perspective (£2010/11 prices). Data to populate the model were derived from systematic literature reviews and the literature searches of economic evaluations that were conducted for national guidelines. Deterministic and probability sensitivity analyses explored the uncertainty in parameter estimates including short-term mental health gains associated with PA. Results: Compared with usual care, BA is more expensive, incurring additional costs of £806 809 but it is more effective leading to 466 QALYs gained in the total cohort, a QALY gain of 0.0047/person. The incremental cost per QALY of BA is £1730 (including mental health gains) and thus can be considered cost-effective at a threshold of £20 000/QALY. Most changes in assumptions resulted in the incremental cost-effectiveness ratio (ICER) falling at or below £12 000/QALY gained. However, when short-term mental health gains were excluded the ICER was £27 000/QALY gained. The probabilistic sensitivity analysis showed that, at a threshold of £20 000/QALY, there was a 99.9% chance that BA would be cost-effective. Conclusions: BA is a cost-effective way to improve PA among adults, provided short-term mental health gains are considered. Further research is required to provide more accurate evidence on factors contributing to the cost-effectiveness of BA.NICE Centre for Public Health Excellenc

Awareness, facilitators, and barriers to policy implementation related to obesity prevention for primary school children in Malaysia

Purpose: To assess the awareness, facilitators, and barriers to policy implementation related to obesity prevention for primary school children. Design: A cross-sectional study administered using an online questionnaire. Setting: Conducted in 447 primary schools in a state in Malaysia. Participants: One school administrator from each school served as a participant. Measures: The questionnaires consisted of 32 items on awareness, policy implementation, and facilitators and barriers to policy implementation. Analysis: Descriptive analysis was used to describe the awareness, facilitators, and barriers of policies implementation. Association between schools’ characteristics and policy implementation was assessed using logistic regression. Results: The majority (90%) of school administrators were aware of the policies. However, only 50% to 70% of schools had implemented the policies fully. Reported barriers were lack of equipment, insufficient training, and limited time to complete implementation. Facilitators of policy implementation were commitment from the schools, staff members, students, and canteen operators. Policy implementation was comparable in all school types and locality; except the policy on “Food and Drinks sold at the school canteens” was implemented by more rural schools compared to urban schools (odds ratio: 1.74, 95% confidence interval: 1.13-2.69). Conclusion: Majority of the school administrators were aware of the existing policies; however, the implementation was only satisfactory. The identified barriers to policy implementation were modifiable and thus, the stakeholders should consider restrategizing plans in overcoming them

Socially-marketed rapid diagnostic tests and ACT in the private sector: ten years of experience in Cambodia.

Whilst some populations have recently experienced dramatic declines in malaria, the majority of those most at risk of Plasmodium falciparum malaria still lack access to effective treatment with artemisinin combination therapy (ACT) and others are already facing parasites resistant to artemisinins.In this context, there is a crucial need to improve both access to and targeting of ACT through greater availability of good quality ACT and parasitological diagnosis. This is an issue of increasing urgency notably in the private commercial sector, which, in many countries, plays an important role in the provision of malaria treatment. The Affordable Medicines Facility for malaria (AMFm) is a recent initiative that aims to increase the provision of affordable ACT in public, private and NGO sectors through a manufacturer-level subsidy. However, to date, there is little documented experience in the programmatic implementation of subsidized ACT in the private sector. Cambodia is in the unique position of having more than 10 years of experience not only in implementing subsidized ACT, but also rapid diagnostic tests (RDT) as part of a nationwide social marketing programme. The programme includes behaviour change communication and the training of private providers as well as the sale and distribution of Malarine, the recommended ACT, and Malacheck, the RDT. This paper describes and evaluates this experience by drawing on the results of household and provider surveys conducted since the start of the programme. The available evidence suggests that providers' and consumers' awareness of Malarine increased rapidly, but that of Malacheck much less so. In addition, improvements in ACT and RDT availability and uptake were relatively slow, particularly in more remote areas.The lack of standardization in the survey methods and the gaps in the data highlight the importance of establishing a clear system for monitoring and evaluation for similar initiatives. Despite these limitations, a number of important lessons can still be learnt. These include the importance of a comprehensive communications strategy and of a sustained and reliable supply of products, with attention to the geographical reach of both. Other important challenges relate to the difficulty in incentivising providers and consumers not only to choose the recommended drug, but to precede this with a confirmatory blood test and ensure that providers adhere to the test results and patients to the treatment regime. In Cambodia, this is particularly complicated due to problems inherent to the drug itself and the emergence of artemisinin resistance

Rising prevalence of BMI ≥40kg/m2: a high-demand epidemic needing better documentation

Whilst previously rare, some surveys indicate substantial increases in the population with body mass index (BMI) ≥40 kg/m2 since the 1980s. Clinicians report emerging care challenges for this population, often with high resource demands. Accurate prevalence data, gathered using reliable methods, are needed to inform health care practice, planning, and research. We searched digitally for English language sources with measured prevalence data on adult BMI ≥40 collected since 2010. The search strategy included sources identified from recent work by NCD‐RisC (2017), grey sources, a literature search to find current sources, and digital snowball searching. Eighteen countries, across five continents, reported BMI ≥40 prevalence data in surveys since 2010: 12% of eligible national surveys examined. Prevalence of BMI ≥40 ranged from 1.3% (Spain) to 7.7% (USA) for all adults, 0.7% (Serbia) to 5.6% (USA) for men, and 1.8% (Poland) to 9.7% (USA) for women. Limited trend data covering recent decades support significant growth of BMI ≥40 population. Methodological limitations include small samples and data collection methods likely to exclude people with very high BMIs. BMI ≥40 data are not routinely reported in international surveys. Lack of data impairs surveillance of population trends, understanding of causation, and societal provision for individuals living with higher weights

Evaluation of a type 2 diabetes prevention program using a commercial weight management provider for non-diabetic hyperglycemic patients referred by primary care in the UK

Objectives: To determine if a diabetes prevention program (DPP) delivered by a commercial weight management provider using a UK primary care referral pathway could reduce the progression to type 2 diabetes (T2D) in those diagnosed with non-diabetic hyperglycemia (NDH—being at high risk of developing T2D). Research design: This is a quasi-experimental translational research study. Methods: 14 primary care practices identified, recruited and referred patients with NDH (fasting plasma glucose ≥5.5 to ≤6.9mmol/L and/or glycated hemoglobin (HbA1c) ≥42 to 47mmol/mol (6.0%–6.4%)) and a body mass index (BMI) ≥30 kg/m2 to a DPP. Eligible patients were asked to contact Weight Watchers to book onto their DPP, an intensive lifestyle intervention which included a 90min activation session followed by the offer of 48 weekly Weight Watchers community group meetings. Patients’ blood tests were repeated by primary care, weight change plus self-reported data was recorded by Weight Watchers. Results: 166 patients were referred to the program and 149 were eligible. 79% of eligible patients attended an activation session (117 eligible patients) and 77% started the weekly sessions. The study sample was primarily female (75%), white (90%), with 5% living in the most deprived quintile in the UK. Using intention to-treat analysis, the DPP resulted in a mean reduction in HbA1c of 2.84 mmol/mol at 12 months (from 43.42±1.28 to 40.58±3.41, p<0.01). 38% of patients returned to normoglycemia and 3% developed T2D at 12 months. There was a mean weight reduction in BMI of 3.2 kg/m2 at 12 months (35.5 kg/m2 ±5.4 to 32.3 kg/ m2 ±5.2, p<0.01). Conclusion: A UK primary care referral route partnered with this commercial weight management provider can deliver an effective DPP. The lifestyle changes and weight loss achieved in the intervention translated into considerable reductions in diabetes risk, with an immediate and significant public health impact