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Presently, child-specific tools and instruments related to active school travel (AST) are lacking. This methodological shortcoming often contributes to suboptimal AST behaviour evaluations and intervention programming. The aim of this paper was to develop and validate a theoretically informed child-specific scale regarding multiple perceived barriers and enablers known to impact children's participation in AST. Mixed methods. A mixed-methods and multistudy scale development approach featuring the application of social-ecological theory, a validation pilot study (n = 80), and test-retest study (n = 96) was conducted in collaboration with children in Ontario, Canada. In tandem with completing cognitive interviews and online surveys, multiple analyses, including a qualitative thematic analysis, along with weighted Cohen's kappa, Cronbach's alpha, and confirmatory factor analysis were undertaken. Qualitative analyses of the developed tool addressed face validity concerns related to the response options and definitions of terms used. Following the reliability analyses of 40 items, two confirmatory factor analyses were run to assess the construct validation of perceived AST barriers and enablers, and resulted in the development of the 24-item Perceived Active School Travel Enablers and Barriers – Child (PASTEB-C) questionnaire. The developed PASTEB-C questionnaire may be used to inform the programming and development of AST interventions, as well as conduct child-specific AST research. [ABSTRACT FROM AUTHOR]

This study aimed to investigate how meeting international recommendations for screen time (<2 h/day), moderate-to-vigorous physical activity (MVPA; at least 60 min/day) and sleep (8–10 h/night), as well as media multitasking (MMI) as a form of screen time, impact academic achievement in early adolescence. A prospective design was used, where self-report measures were collected during the spring semester and academic achievement at the end of the school year. A total of 1208 grade 3 middle school students (M age = 13.55 years, SD age = 0.60) in 37 Swiss schools filled out a paper-and-pencil questionnaire including measures of screen time (covering watching television, playing video games, Internet use, smartphone use and social media use), MMI, sleep time and time for MVPA. To evaluate academic achievement, end-term grades were provided by the collaborating education administration for Italian, Maths, Science, History, Geography, Music and Visual arts. After adjustment for covariates, such as gender, socio-economic status, body mass index and stressful life events, multivariate linear mixed-effect models, nesting participants in schools, showed that meeting recommendations for screen time (B = 0.12, β = 0.105, P < 0.001) and MVPA (B = 0.09, β = 0.09, P = 0.001), but not sleep (B = 0.05, P = 0.087), were associated with higher academic achievement. Considering the number of recommendations met, meeting all three recommendations improved academic achievement the most (B = 0.24, β = 0.21, P < 0.001), followed by meeting the guidelines for screen time + MVPA (B = 0.20, β = 0.15, P < 0.001) and for screen time + sleep (B = 0.21, β = 0.13, P < 0.001). In the fully adjusted model, multitasking with two or more media was related to a worse academic achievement. Screen time (including MMI), sleep and MVPA impact academic achievement in adolescence; hence, governmental organisations and schools should raise awareness about the positive and negative effects of following or not recommendations for MVPA, sleep and screen time among adolescents and their parents. In addition, support should be provided to promote sufficient sleep and MVPA while limiting overall screen time and parallel device use. [ABSTRACT FROM AUTHOR]

Objective: To identify attitudes towards pharmacy characteristics and promotional methods for selected pharmacy public health services (lifestyle advice and screening for cardiovascular risk factors) among different sectors of the general public. Study design: Cross-sectional survey, using a previously validated questionnaire. Methods: Three survey methods were used, across 15 areas of England, to maximize diversity: face-to-face; telephone; and self-completion of paper questionnaires. Responses to closed questions regarding characteristics and promotion were quantified and differences among sub-groups explored by univariate and multivariate analysis. Results: In total, 2661 responses were available for analysis: 2047 face-to-face; 301 telephone; and 313 paper. There were strong preferences for a pharmacy near to home or doctor's surgery and for long opening hours, particularly among employed people and nonwhites. Fifty percent preferred not to use a pharmacy in a supermarket, particularly older people, the retired, those of lower education and frequent pharmacy users. Personal recommendation by health professionals or family/friends was reported as most likely to encourage uptake of pharmacy public health services, with older people and males being less likely and frequent pharmacy users more likely to perceive any promotional method as influential. Posters/leaflets were preferred over mass-media methods, with fewer than 30% perceiving the latter as potentially influential. Conclusion: Pharmacists, pharmacy companies and service commissioners should use promotional methods favoured by potential users of pharmacy public health services and be aware of differences in attitudes when trying to reach specific population sub-groups. For personal recommendation to be successful, good inter-professional working and a pro-active approach to existing customers are needed. [ABSTRACT FROM AUTHOR]

Objectives: Physical inactivity is an established risk factor for non-communicable diseases (NCD) and identified as the major public health concern worldwide. However, nationally representative and internationally comparable data on physical activity (PA) are lacking in Bangladesh. The objective of this paper was to determine nationally representative prevalence of PA levels among Bangladeshi adults. Study design: Cross-sectional survey. Methods: Data, on PA for this paper, were analysed from the NCD risk factors survey 2010 in Bangladesh. A standardized approach known as STEPS (STEPSwise approach to Surveillance for NCD risk factors) was followed for this survey. A total of 9275 adults (aged ≥25 years) were interviewed. Data on PA were processed and analysed according to Global Physical Activity Questionnaire (GPAQ) version 2 analysis framework. Results: Of total 9275 respondents 4312 were men and 4963 women with a mean age of 42.4 (±13.5) years. Median MET-minutes of total PA in a typical week was double in rural areas (3360) than urban (1680) areas. The overall country wide prevalence of low PA was 34.5% (95% confidence interval, 33.5-35.5), urban 37.7% (36.3-39.1) and rural 31.6% (30.3-32.9). Women in general were more inactive (women, 53.6% [52.2-55.0], men 15.4% [14.9-17.1]). The main contributions to total PA were from work (urban 47.0%, rural 61.0%), and active commuting (38.0%, 30.0%) domains. Leisure-time PA represented only a small proportion (15.0%, 9.0%). Conclusions: Insufficient physical activity is highly prevalent among the Bangladeshi adult population. Promoting overall PA at leisure-time and commuting considering country context can be feasible options with special attention to the women. [ABSTRACT FROM AUTHOR]

This study was to examine the relationship between health literacy (HL) and health behaviors in the South Bohemia Region in the Czech Republic (CR) and compare them to HL and health behaviors in the Visegrád group countries (Czech Republic, Hungary, Poland, and Slovakia). The paper reports the results from the research in the CR. A quantitative descriptive study. The sample was stratified by sex and age and included a representative sample of 303 adults. The data were collected using the combination of a country-specific questionnaire with the HLS-EU-16 standardized questionnaire. Exercise was significantly associated with perceived health and HL; those with a lower level of HL did not exercise during the previous month. Based only on full answers (N = 251), inadequate HL was identified in 17.5% of the respondents (44), marginal HL in 31.5% (77), and adequate HL in 51% (128) of the respondents. Nearly 49% of the participants evaluated their health as 'good', 25.7% rated their health as 'very good' and 'satisfactory' by 25.7%. But 41.6% experienced one or more chronic diseases, 37.6% had some limitations to their health, and 20.5% smoked. For alcohol consumption, 26% drank weekly and 23% drank two to three times a month. Exercise varied from never (29.7%) to daily (7.9%). Based on our results, we conclude that health behavior risk factors are still present in the South Bohemia region of the CR regardless of levels of HL reported on the HLS-EU-16. • Inadequate health literacy (HL) was identified in 17.5% of the respondents, marginal HL in 31.5%. • Exercise was significantly associated with perceived health and HL. • For alcohol consumption, 26% drank weekly and 23% drank two to three times a month. • Health behavior risk factors are still present in South Bohemia region of the CR. • We still have not accomplished universal levels of adequate health literacy. [ABSTRACT FROM AUTHOR]

Technostress is an emergent phenomenon related to the pervasive use of technology and is associated with the increased computerisation and digitalisation seen over recent decades. This cross-sectional observational study aims to investigate the impact that stress from the use of technologies (i.e. technostress) has on the productivity and life of an individual. Cross-sectional study. Data were collected using a previously proposed and validated questionnaire. The questionnaire was translated into Italian and transformed into an online format with a Google Docs form. The questionnaire was then associated with a link and QR code (also available in paper format) and disseminated manually and through the use of e-mail and social networks, such as Facebook and Twitter. The study sample included 313 individuals, 54.6% of whom were women. The mean age of the sample participants was 34.7 years. The dependent variables were technstressors (i.e. techno-overload, techno-invasion, techno-complexity, techno-insecurity and techno-uncertainty), role stressors (i.e. role overload and role conflict) and productivity. In the multivariate analysis, techno-overload was significantly associated with female gender (β = 0.128; P = 0.018) and unemployment (β = −0.303; P < 0.001); techno-invasion was significantly associated with female gender (β = 0.098; P = 0.081) and degree-level education (β = 0.149; P = 0.008); techno-complexity was significantly associated with female gender (β = 0.107; P = 0.057) and being married (β = 0.113; P = 0.046); techno-uncertainty was significantly associated with unemployment (β = 0.337; P < 0.001); role overload was significantly associated with female gender (β = 0.160; P = 0.014) and productivity was significantly associated with degree-level education (β = 0.125; P = 0.057). This observational study evaluated the phenomenon of both work-related and non–work-related technostress of 313 individuals aged between 16 and 65 years. The present study investigated the impact of five techno-stressors, two role stressors and productivity. The results indicate that different techno-stressors are significantly associated with female gender, degree-level education and unemployment. Further research in this field is required to better understand and clarify the epidemiology, clinical presentation and determinants of technostress. • Technostress is an emergent phenomenon related to the pervasive use of technology in the current digital age. • Different techno-stressors are significantly associated with female gender, degree-level education and unemployment. • Further research is required on the epidemiology, clinical presentation and determinants of technostress. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a Europe-wide survey that investigates the impact of COVID-19 on Healthcare Clowning Organisations and encourages the healthcare community to reflect on the role of medical clowning within the healthcare system. Online survey. The survey was conducted in June 2020. Forty organisations from 21 countries across Europe responded through a mix of closed and open-ended answers. During the pandemic, 36 out of 39 of the surveyed organisations (with one non-response) had to postpone or cancel their artistic activities. As the crisis continued, 34 out of 40 of them managed to adapt their in-person activities, but the impact of virtual and distanced interactions with the beneficiaries was generally perceived as lower than that of in-person activities. In open responses, many Healthcare Clowning Organisations criticised the exclusion of medical clowns from healthcare institutions in times when the need for psychosocial support was particularly acute. The healthcare sector should reconsider the important role the medical clowns play within healthcare settings, and allow for more inclusive and flexible safety regulations that take into consideration the holistic well-being of vulnerable groups, especially children, the elderly, and medical staff. [ABSTRACT FROM AUTHOR]

Objectives The National Institute for Infectious Diseases 'Prof. Dr. Matei Balş' was the designated centre for managing Ebola alerts in Romania during the 2014 African outbreak. We surveyed Ebola knowledge, attitudes and perceptions (KAP) among the institute's healthcare workers. Study design This was a cross-sectional survey. Methods The study consisted of a self-administered paper-based anonymous questionnaire that included 24 closed-item questions and two scales of personal concern. Results Respondents were generally well informed; compared to nurses, doctors recorded a 1.9-fold higher rate of correct responses regarding Ebola transmission (P < 0.001), but both nurses and doctors correctly identified Ebola's aetiological agent. Nurses perceived higher personal (P = 0.008) and family (P < 0.001) risk than doctors. Respondents reporting high perceived risks were more likely to be less informed about Ebola (P = 0.019) and its prevention options (P = 0.033). Males were 6.7-fold more likely to volunteer than females (P = 0.001) and so were graduates of higher rather than lower education (1.5-fold more likely, P = 0.017) and doctors than nurses (1.7-fold more likely, P = 0.018). The institute ranked first among sources of information on Ebola; respondents who had received Ebola training in the institute 2 years previously were 1.2-1.3 times more likely to correctly identify transmission routes. Conclusions We have characterised KAP on Ebola disease among Romanian healthcare workers from a tertiary care hospital in Bucharest. Nurses, specialist physicians and laboratory personnel may need more frequent retraining than residents and senior physicians. [ABSTRACT FROM AUTHOR]

Objectives The objective of this survey was to analyse vaccination rates and attitudes towards vaccination among health care workers (HCWs). The period prevalence of self-reported acute respiratory infections in the influenza season 2014/2015 was examined. Study design A cross-sectional study was conducted among HCWs of a German university hospital using an anonymised questionnaire. Recruitment was performed by providing all medical and nursing staff a paper questionnaire with an invitation to participate. Methods Descriptive aggregated data were generated from digitalised questionnaires for all variables. Differences in categorical variables were analysed by Chi-squared test. Textual data were analysed by an iterative process based on the grounded theory by Glaser and Strauss. Results The response rate was 31% (677/2186). Probable influenza was described by 9% (64/677) of the participants. The overall self-reported vaccination rate was 55% (366/666). Self-reported vaccination rate was higher in physicians (172/239, 72%) than in nursing staff (188/418, 45%). HCWs in paediatrics (103/148, 70%) more likely received vaccines than HCWs in surgery (31/84, 37%). Most vaccinations were provided by medical staff on the wards (164/368, 45%). Self-reported lost work-time due to adverse events after vaccination was low (6/336, 2%). Eight categories for vaccine refusal were identified, whereof doubts about effectiveness and indication of the vaccine was most frequently mentioned (72/202, 36%). Conclusions Efforts to promote vaccination should focus on nursing staff and should provide scientific evidence on effectiveness, adverse effects, and the benefits of health care workers' vaccination for patients. Administering vaccines at the workplace proved to be a successful strategy in our setting. Studies are needed to assess the frequency of influenza causing disease in HCWs. [ABSTRACT FROM AUTHOR]

Objectives: Go-Golborne is a pilot intervention to prevent childhood obesity in the Royal Borough of Kensington and Chelsea between 2014 and 2018. It is a multistrategy approach targeting children aged 0 - 1 6 years and their families in all settings where children live, learn and play. This paper describes the methodology and the practical steps in the development of Go-Golborne. Study design: The programme uses a quasi-experimental design for the evaluation of changes in weight status using data from the extended National Child Measurement Programme across local schools. For specific behavioural change objectives, baseline self-reported lifestyle measures will be compared against annual follow-up data over the 3-year study period. Qualitative methods will be used to explore the perceptions of stakeholders and participants and organizational change. Methods: Go-Golborne aims to mobilize everyone in the community who has a role or interest in shaping the local environment, norms and behaviours across a range of sectors. A community network of local organizations has been established to codesign all programme activities. The Steering Group of Council officers support programme implementation and environmental changes. The programme has identified six specific behaviour change objectives representing the key areas of need in Golborne and all activities in the council and the community target these objectives during specific programme phases. Key components include community capacity building, community-wide social marketing, environment and policy change and evaluation. Results (Progress): The programme is currently at the beginning of its implementation phase with activities in the community and council targeting the first behaviour change objective. Conclusions: The pilot aims to test the effectiveness of this approach to support behaviour change and prevent unhealthy weight gain in children using multiple strategies. This programme will inform the development of an intervention model that defines essential programme components, accountability of partner organizations delivering obesity prevention programmes and the effective use of existing assets. [ABSTRACT FROM AUTHOR]

Objectives: This paper describes and preliminarily evaluates the usefulness of the daily syndrome-specific absenteeism surveillance system (DSSASS) as an early warning system of school outbreaks in rural China. Study design: We conducted an experimental study in rural areas of Hubei Province from September 19, 2011 to December 31, 2011. Methods: Nine public elementary schools from two counties were selected as pilot sentinel schools. Daily monitoring data of the absent date and reason, sex, age and class of each absent student was collected and entered into a web database. Reported data were checked daily and field investigation was carried out when there was abnormal absentee aggregation. Descriptive analysis and preliminary evaluation were then conducted after the pilot study. Results: The findings showed that the total average of daily absenteeism rate was 3%, and the absenteeism rate differed by county, school level and grade level. The daily absenteeism rate in illness absentees was highest (2.74%), followed by business absentees (0.13%) and injury absentees (0.09%). The total timeliness report rate was 64.84% and the total incident report rate was 29.22%. One varicella outbreak and one influenza B outbreak were identified, but neither of them was detected by China Information System for Diseases Control and Prevention (CISDCP). The study shows syndrome-specific absenteeism data would be useful for early detection of unusual public health events or outbreaks in school. However, more efforts are needed to enhance the quality of surveillance data, and longer follow-up and more analysis are required to evaluate the system comprehensively. Our study might provide useful experience and evidence for other developing regions or counties establishing similar systems. [ABSTRACT FROM AUTHOR]

Objectives: An evaluation of the Cold Weather Plan (CWP) for England 2011-2012 was undertaken in April 2012 to generate the basis for further revisions. It is widely considered good practice to formulate and revise policy on the basis of the best available evidence. This paper examines whether the evaluation is an example of pragmatic evidence-based policy-making. Study design: A process evaluation with a formative multimethods approach. Methods: An electronic survey and national workshop were conducted alongside the production of a number of summary reports from the Health Protection Agency surveillance systems and Met Office meteorological data. The Department of Health and the Met Office were consulted on how the evaluation recommendations shaped the revised CWP and Met Office Cold Weather Alerting System respectively. Results: The Cold Weather Plan survey had 442 responses, a majority from Local Authorities, and from all regions of England. Thematic analysis generated qualitative data, which along with feedback from the workshop were synthesized into six main recommendations. Reviewing the new CWP and the Met Office Cold Weather Alerting System revealed significant modifications on the basis of the evaluation. Conclusions: The evaluation sets the context for cold weather and health during the 2011 -2012 winter. This study shows that the CWP 2012-2013 was revised on the basis of the national evaluation recommendations and is an example of pragmatic evidence-based policy-making. [ABSTRACT FROM AUTHOR]

Objectives: Crowded hospital emergency departments (EDs) can undermine the ability of a region's safety net to provide safe, timely care. However, data to measure hospital capacity community-wide is generally unavailable. This study aimed to assess hospital crowding, capacity and patient flow in an urban community using the newly developed hospital capacity assessment tool (HCAT). Study design: A survey of the eight acute care hospitals in the District of Columbia (DC) with active EDs. Methods: Existing emergency care assessment tools were reviewed. Eighteen of the 57 questions on the HCAT were adapted from existing hospital surveys, while the remaining 39 questions were constructed de novo for use in this assessment. Hospitals were provided with paper and electronic versions of the HCAT. Results: All eight DC hospitals completed the HCAT; however, three hospitals were unable to answer many of the questions due to a lack of regular data collection. The HCAT data shows throughput times in DC hospitals that are substantially longer than national averages. Conclusions: The HCAT is a promising tool for evaluating community-wide emergency care. Findings from the HCAT allowed for the introduction of new ED performance data into the local decision-making process. [ABSTRACT FROM AUTHOR]