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Background The National Perinatal Epidemiology Unit in England has conducted five National Maternity Surveys (NMS) at varying intervals since 1995. This paper aims to describe the changes in NMS response rates over time and to compare the demographic characteristics of respondents to each NMS. Methods This paper is based on secondary data analysis of the NMS (cross-sectional postal surveys) from 1995 to 2018. All women aged 16 years and over who gave birth in England (and Wales in 1995) during specified time periods from 1995 to 2018 were eligible to be selected. For each survey, between 3570 and 16,000 women who were 3–6 months postpartum were selected at random by the Office for National Statistics, using birth registrations. Women could participate on paper, by telephone (from 2006) or online (from 2010). Results The response rate to the NMS decreased from 67% in 1995 to 29% in 2018. The decline was evident across demographic groups. In all NMS, response rates were higher in women who were older (crude prevalence ratios (PR) for 16–24 years versus 30–34 years = 0.51–0.73 (across surveys)), married (crude PR for sole versus married registrants = 0.41–0.62), born in the UK (crude PR for non UK-born versus UK-born = 0.70–0.84), and living in less deprived areas (crude PR for least versus most deprived = 0.42–0.63). However, the association between each demographic characteristic and response varied across surveys, with the youngest women, women who registered the birth of the baby in their sole name, and women living in the most deprived areas becoming relatively less likely to respond over time. In multivariable analysis in 2014 and 2018, the effects of age, marital status, country of birth and level of area deprivation on response were attenuated but all four demographic characteristics remained statistically significantly associated with response. Conclusions Response rates to the NMS have declined significantly during the last 23 years. The demographic characteristics associated with response were consistent across surveys, but the size of the effect varied significantly, with underrepresented groups becoming relatively less likely to participate over time. It is important to find strategies to increase response rates, particularly amongst underrepresented groups, and to validate the data collected.

Background Since 2013, China launched descending resources reform, which is a new attempt to correct unbalanced allocation of health resources through human capital spillovers and brand implantation from high-level hospitals. The purpose of this paper is to explore the patients’ hospital selection response to this reform with the focus of low-level hospitals to better understand the effect of this reform on correcting regional inequality of health resources allocation. Methods The European Consumer Satisfaction Index model (ECSI) was used to design a questionnaire, and cross-sectional data from 17 hospitals were collected through 1287 questionnaires from Zhejiang Province. Patient hospital selection (loyalty) is measured using ordinary variables by considering patient willingness to choose a low-level hospital when suffering an illness or severe illness. Analysis of variance (ANOVA) and the structure equation model are applied to examine the effect of reforms on patient behavior. Results The descending resources reform promotes improvements in the capabilities and medical environment of low-level hospitals, and descending doctors also have high accessibility. Perceived quality, patient expectations, and hospital image have significant positive effects on patient satisfaction, and the explanatory power of brand implantation from cooperative high-level hospitals and descending doctors is stronger than the image of the low-level hospital itself. And descending resources reform and patient satisfaction have significant positive impacts on patient’s choice for low-level hospitals with the existence of mediating effect of satisfaction. Conclusions This paper provides supporting empirical evidence of the descending resources reform’s impact on patients’ low-level hospital selection. This reform has been effective in improving the capabilities of low-level hospitals, and brand implantation of high-level hospitals shows strong explanatory power. China’s reform offers a distinct and valuable approach to correcting the uneven allocation of health resources. Besides, the findings also suggest that policymakers could pay more attention to the importance of information channels in impacting patient awareness, responses, and hospital selection.

Background Many diet-related surveys have been conducted in England over the past four to five decades. Yet, diet-related ill-health is estimated to cost the NHS £5.8 billion annually. There has been no recent assessment of the diet-related surveys currently available in England. This paper aims to fill this gap in the literature by providing researchers, especially those interested in conducting secondary (quantitative) research on diet, with a detailed overview of the major repeated cross-sectional and longitudinal surveys conducted in England over the last 48 years (1970–2018). Method A three-stage review process was used to identify and assess surveys and synthesise the information necessary for achieving the paper’s aim. Surveys were identified using the UK Data Service, Cohort and Longitudinal Studies Enhancement Resources (CLOSER), the Medical Research Council (MRC) Cohort Directory and the Consumer Data Research Centre (CDRC) online data repositories/directories. Surveys were summarised to include a brief background, the survey design and methodology used, variables captured, the target population, level of geography covered, the type of dietary assessment method(s) used, primary data users, data accessibility, availability and costs, as well as key survey features and considerations. Results The key considerations identified across the various surveys following the review include: the overall survey design and the different dietary assessment method(s) used in each survey; methodological changes and general inconsistencies in the type and quantity of diet-related questions posed across and within surveys over time; and differences in the level of geography and target groups captured. Conclusion It is highly unlikely that any survey dataset will meet all the needs of researchers. Nevertheless, researchers are encouraged to make good use of the secondary data currently available, in order to conduct the research necessary for the creation of more evidence-based diet-related policies and interventions in England. The review process used in this paper is one that can be easily replicated and one which future studies can use to update and expand upon to assist researchers in identifying the survey(s) most aligned to their research questions.

Background This methodological paper describes the integration of the ‘European Health Interview Survey wave 2’ (EHIS 2) into the ‘German Health Update’ 2014/2015 (GEDA 2014/2015-EHIS). Methods GEDA 2014/2015-EHIS is a cross-sectional health survey. A two-stage stratified cluster sampling approach was used to recruit persons aged 15 years and older with permanent residence in Germany. Two different modes of data collection were used, self-administered web questionnaire and self-administered paper questionnaire. The survey instrument implemented the EHIS 2 modules on health status, health care use, health determinants and social background variables and additional national questions. Data processing was conducted according to the quality and validation rules specified by Eurostat. Results In total, 24,824 questionnaires were completed. The response rate was 27.6%. The two-stage cluster sample method seems to have been successful in achieving a sample with high representativeness. The final micro data file was inspected, approved and certified by Eurostat. Access to micro data of the EHIS 2 can be provided by Eurostat via research contract and to the GEDA 2014/2015-EHIS public use file by the Research Data Centre of the Robert Koch Institute. First EHIS 2 results are available at the Eurostat website. Conclusions Integrating a multinational health survey into an existing national health monitoring system was a challenge in Germany. The national survey methodology for conducting the survey had to be further developed in order to meet the overarching goal of harmonizing the health information from national statistical offices and public health research institutes across the European Union. The harmonized EHIS 2 data source will profoundly impact international public health research in the near future. The next EHIS wave 3 will be conducted around 2019.

Background Several typologies and guidelines are available to address the methodological and practical considerations required in mental health research. However, few studies have actually attempted to systematically identify and synthesise these considerations. This paper provides an integrative review that identifies and synthesises the available research evidence on mental health research methodological considerations. Methods A search of the published literature was conducted using EMBASE, Medline, PsycINFO, CINAHL, Web of Science, and Scopus. The search was limited to papers published in English for the timeframe 2000–2018. Using pre-defined inclusion and exclusion criteria, three reviewers independently screened the retrieved papers. A data extraction form was used to extract data from the included papers. Results Of 27 papers meeting the inclusion criteria, 13 focused on qualitative research, 8 mixed methods and 6 papers focused on quantitative methodology. A total of 14 papers targeted global mental health research, with 2 papers each describing studies in Germany, Sweden and China. The review identified several methodological considerations relating to study design, methods, data collection, and quality assurance. Methodological issues regarding the study design included assembling team members, familiarisation and sharing information on the topic, and seeking the contribution of team members. Methodological considerations to facilitate data collection involved adequate preparation prior to fieldwork, appropriateness and adequacy of the sampling and data collection approach, selection of consumers, the social or cultural context, practical and organisational skills; and ethical and sensitivity issues. Conclusion The evidence confirms that studies on methodological considerations in conducting mental health research largely focus on qualitative studies in a transcultural setting, as well as recommendations derived from multi-site surveys. Mental health research should adequately consider the methodological issues around study design, sampling, data collection procedures and quality assurance in order to maintain the quality of data collection.

Objective A profile of adolescent alcohol use for China that specified gender, school type and a consistent definition of alcohol use. Method A total of 1,646 papers were identified in the Chinese- and English-language literature published 2007–2015 that reported Chinese adolescent drinking rates. Selection criteria were established a priori. Thirty-two papers met all the selection criteria. Five papers were eliminated because they were found to be duplicate reports of the same data. Result The resulting sample included 26 papers—24 in Chinese and two in English, 20 describing middle school students, 12 describing high school students, and six describing vocational high school students. Eleven papers described students in more than one type of school. Last 30 day use of alcohol was, as expected, highest among vocational high school students (44.7 % males, 28.8 % females) and drinking rates were higher for high school students (36.5 % males, 21.2 % females) than for middle school students (23.6 % males, 15.3 % females). Meta-regression identified factors associated with differences in drinking rates reported in individual studies as the definition of a drink and whether data were collected by trained personnel. Location appeared important, but its effects were inconsistent across different populations, which suggests that national estimates likely blur regional differences in patterns of alcohol use. Conclusion Rates derived from this meta-analysis provide a useful reference for scholars interested in China, alcohol use, adolescents, and patterns of use. The meta-regression analysis suggested practical ways to improve adolescent alcohol surveys in China.

Background Health interview surveys are important data sources for empirical research in public health. However, the diversity of methods applied, such as in the mode of data collection, make it difficult to compare results across surveys, time, or countries. The aim of this study was to explore whether the prevalence rates of health-related indicators amongst adults differ when self-administered paper mail questionnaires (SAQ-Paper), self-administered web surveys (SAQ-Web), and computer-assisted telephone interviews (CATI) are used for data collection in a health survey. Methods Data were obtained from a population-based mixed-mode health interview survey of adults in Germany carried out within the ‘German Health Update’ (GEDA) study. Data were collected either by SAQ-Paper (n = 746), SAQ-Web (n = 414), or CATI (n = 411). Predictive margins from logistic regression models were used to estimate the prevalence rates of chronic conditions, subjective health, mental health, psychosocial factors, and health behaviours, adjusted for the socio-demographic characteristics of each mode group. Results Socio-demographic characteristics were found to differ significantly between study participants who responded by SAQ-Paper, SAQ-Web, and CATI. Crude prevalence rates for health-related indicators also showed significant variation across all three survey modes. After adjusting for socio-demographic factors though, significant differences in prevalence rates between the two self-administered modes (SAQ-Paper and SAQ-Web) were found in only 2 out of the 19 health-related indicators studied. The differences between CATI and the two self-administered modes remained significant however, especially for indicators of mental and psychosocial health and self-reported sporting activity. Conclusions The findings of this study indicate that prevalence rates obtained from health interview surveys can vary with the mode of data collection, primarily between interviewer and self-administered modes. Hence, the type of survey mode used should be considered when comparing results from different health surveys. Mixing self-administered modes, such as paper-based questionnaires and web surveys, may be a combination to minimize mode differences in mixed-mode health interview surveys. Electronic supplementary material The online version of this article (doi:10.1186/2049-3258-72-46) contains supplementary material, which is available to authorized users.

Zoonoses have a different impact on public health, determined by geographical and socio-economic factors, which requires their prioritization for prevention and control purposes to be performed at the national level. Prioritization of zoonoses is a mechanism used in policy-making, primarily in allocating available resources. Aim of the paper is to compare two different methods used for prioritization of zoonoses by Institute of public health (IPH) and Food and Veterinary Agency (FVA). Material and methods: IPH used a method prepared by the U.S. Centers for Disease Control and Prevention (CDC), - One Health Zoonotic Disease Prioritization (OHZDP) tool, adapted to national conditions (2019). FVA used a standardized semi-quantitative method based on the OIE Methodological Manual (List and Categorization of priority diseases in animals including and those transmitted to humans). A total of 21 zoonoses have been selected, based on their importance for the human and veterinary sector. These diseases are ranked according to the stated criteria of the two previously conducted prioritizations and their comparison is performed. Results: With the prioritization conducted by IPH and FVA the first 5 ranked zoonoses are: Hemorrhagic fevers with renal syndrome, Leishmaniasis, Tularemia, Brucellosis and Listeriosis. With the prioritization carried out by the FVA the first 5 ranked zoonoses are: Bovine brucellosis, Bovine tuberculosis, Salmonellosis, Avian influenza and West Nile fever. A Cumulative Annual Incidence is taken as a control parameter. Regarding this, the 5 first ranked zoonoses are Echinococcosis, Brucellosis, Lyme fever, Leishmaniasis and Tularemia. Conclusions: A comparative analysis of the separate lists of priorities for human and veterinary medicine shows that only a certain percentage overlap. Also, the presence of a number of zoonoses with endemic character, but also a more pronounced risk of new emergent diseases, determines the need to provide consensus on the methodology of prioritization of zoonoses, and its formalization and institutionalization, as a crucial step towards identification and prioritization of zoonoses that would be the subject of joint programs and interventions., Зоонозите имаат различен импакт на јавното здравство, детерминирано од географските и социо-економските фактори, што условува нивната приоритизација за цели на превентива и контрола да биде изведена на национално ниво. Целта на трудот е да се споредат два различни методи што се користат за приоритизирање на зоонозите од Институтот за јавно здравје (ИЈЗ) и Агенцијата за храна и ветеринарство (АХВ). Материјал и методи: ИЈЗ користеше метод подготвен од U.S. Centers for Disease Control and Prevention (CDC), - One Health Zoonotic Disease Prioritization (OHZDP) tool, прилагодена на националните услови (2019). АХВ користеше стандардизиран полу-квантитативен метод заснован на методолошкиот прирачник на OIE (List and Categorization of priority diseases in animals including and those transmitted to humans). Селектирани се вкупно 21 зоонози, врз основа на нивната важност за хумaниот и ветеринарниот сектор. Овие зоонози се рангирани според наведените критериуми на двете претходно спроведени приоритизации и е извршена нивна споредба. Резултати Со приоритизација спроведена од ИЈЗ и АХВ (семи-квантитативна метода Rist CDC), први 5 рангирани зоонози се: Хеморагични трески со бубрежен синдром, Лајшманијаза, Туларемија, Бруцелоза и Листериоза. Со приоритизација спроведена од АХВ (модификација на квантитативниот методот на OIE), први 5 рангирани зоонози се: бруцелоза кај говеда, туберкулоза кај говеда, салмонелоза, авијарна инфлуенза и западнонилска треска. Како контролен параметар е земен кумулативна годишна инциденца (КГИ). Првите 5 рангирани зоонози согласно КГИ се: Ехинококоза, Бруцелоза, Лајмска треска, Лајшманијаза и Туларемија. Заклучоци: Споредбената анализа на одделните листи на приоритетни зоонози за хумана и ветеринарна медицина покажува дека само одредени зоонози се преклопуваат. Исто така, присуството на голем број зоонози со ендемичен карактер, но и поизразен ризик од појава на нови заболувања, ја одредува потребата да се обезбеди консензус за методологијата на приоритизација на зоонози, како и нејзина формализирање и институционализација, како клучен чекор кон идентификување и приоритизирање на зоонози кои би биле предмет на заеднички програми и интервенции.

Juvenile idiopathic arthritis (JIA) is the most common chronic disease in childhood. It manifests a heterogenic group of symptoms of arthritis, lasting at least 6 weeks and it appears before the age of 16. Patients who had no good therapeutic response to conventional therapy with Methotrexate were treated with biological therapy. The aim of this paper was to evaluate 9 patients who were receiving Tocilizumab at the Department of Rheumocardiology, University Clinic of Pediatric Diseases in Skopje. Materials and methods: Our study included 9 patients treated at our Department with biological therapy with Tocilizumab. Prior to initiation of the biological therapy, all patients underwent laboratory investigations, purified protein derivative (PPD) skin test for tuberculosis, X ray of the lungs and heart, and analysis of hepatitis markers. All patients were treated with amp. Actemra (tocilizumab) 8 mg/kg/tt i.v. Two of the patients had a severe form of the disease (one with severe systemic form and one with severe oligoarticular form of JIA). All presented patients had clinical remission of the disease. Conclusion: Therapy with tocilizumab in patients with juvenile idiopathic arthritis is a good therapeutic choice. The results obtained in our study have shown a significant therapeutic effect of tocilizumab even in severe forms of the disease.

Osteoarthritis is a rheumatic disease characterized by degeneration and decay of cartilage in the joints. As the disease worsens, the joint space narrows causing numbness and pain, which often impairs movement. In addition to pharmacological therapy, low-intensity laser (LILT), high-intensity laser (HILT) and exercise are used to treat osteoarthritis (OA) of the knee. HILT is a new modality in our country and the experience from its application is small, especially in the treatment of OA of the knee. Aim of the paper was to compare the effect of HILT with LILT in the treatment of OA of the knee. Material and methods: This was a randomized comparative unilateral blind study involving 72 patients divided into two groups. The first group was treated with HILT, the second group treated with LILT. Outcome measure was the visual analogue scale (VAS) for pain, which was made on the first and tenth day of treatment. Statistical significance was defined as p, Остеоартритисот е ревматолошко заболување кое се карактеризирасо дегенерација и распаѓање на 'рскавицата во зглобовите. Со влошување на болеста, зглобниот простор се стеснува предизвикувајќи вкочанетост и болка, што често го нарушува движењето. Освен фармаколошка терапија, во лекувањето на остеоартитисот (ОА) на коленото се применува нискоинтензивен ласер (НИЛТ), високоинтензивен ласер (ВИЛТ) и вежби. ВИЛТ е нов модалитет во нашата земја и искуството од неговата примена е мало, особено во лекувањето на ОА на коленото. Цел на трудот е да се спореди ефектот на ВИЛТ во однос на НИЛТ во лекувањето на болката кај остеоратитис на коленото. Материјал и методи: Рандомизирано, компаративно, еднострано слепо истражување во кое учествуваа 72 пациенти поделени во две групи. Првата група беше лекувана со ВИЛT, а втората група со НИЛТ. Како мерка за исход беше користена визуелно аналогна скала (ВАС) за болка, која беше направена на првиот и десеттиот ден од лекувањето. За статистичка значајност беше земено р

The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has presented itself as one of the most important health concerns of the 2020's, and hit the geriatric population the hardest. The presence of co-morbidities and immune ageing in the elderly lead to an increased susceptibility to COVID-19, as is the case for other influenza-like illnesses (ILI) or acute respiratory tract infections (ARI). However, little is known, about the impact of a previous or current infection on the other in terms of susceptibility, immune response, and clinical course. The aim of the "Prior Infection with SARS-COV-2" (PICOV) study is to compare the time to occurrence of an ILI or ARI between participants with a confirmed past SARS-CoV-2 infection (previously infected) and those without a confirmed past infection (naïve) in residents and staff members of nursing homes. This paper describes the study design and population characteristics at baseline., info:eu-repo/semantics/published

One year ago, the Archives of Public Health took a new start and became an electronic journal. We were successful in publishing four issues, each with three peer-reviewed articles, with editorials, book reviews and executive summaries of PhD dissertations. The topic of the papers covered a variety of public health issues. There were papers on public health nutrition [1,2], on mental health [3,4], on tobacco smoking [5,6], on occupational health [7], patient rights [8], divorce and health [9], primary care [10], health services research [11] and cancer screening [12]. The editor's favourite was the latter. Within this paper the results of four systematic reviews on respectively colorectal, breast, prostate, and cervical cancer screening are discussed in relation to the European guidelines and strategies for Belgium. In the current issue, the Archives of Public Health continues to present the richness of the diversity of public health research with papers on cognitive impairment screening in general practice [13], depression [14] and health care access for asylum seekers [15]. A public health topic which was not present in last year's volume and which cannot be found among recently submitted papers either is infectious diseases. This is somewhat unexpected given the very interesting congress on infectious disease and public health organised by the Belgian Association of Public Health in December 2008. During this congress, several outstanding papers on statistical methods in infectious disease surveillance and control were presented. The journal especially welcomes papers related to infectious disease surveillance. In the last editorial of 2008, the development of epidemiology and its relationship to the level of academic education and field training was discussed [16]. In Belgium, we still have a long way to go to match up with the other EU countries. This is also reflected in the position of Belgium as to the number of scientific publications and citations. In the SCImago Journal and Country Ranking (http://www.scimagojr.com), which compares EU countries for the period 1996-2007, Belgium only ranked 11th in the field of public health, environmental and occupational Health and 12th in the field of epidemiology. For epidemiology, the Belgian production level is only 20% compared to the Netherlands, France, Italy, Sweden. These observations make us wonder: why is Belgium lagging behind? Is it related to the academic education and the virtual non-existence of advanced training in public health? Is it caused by a lack of attractive research careers for young people? Is the investment in public health science too low and too little? Are the funding mechanisms too archaic? Or has it just something to do with the publication culture that is driving public health researchers and public health departments? Is public health research and epidemiology doing worse compared to other domains or is the Belgian position similar for all scientific domains? Within the health sector we observe for the same period that medicine in general is ranked at number 10, internal medicine at 11 and clinical genetics at 13. Some examples outside the health sectors are: mathematics at number 8, physics at 9 and social sciences at 10. In general, Belgium is never among the top 5 countries. However, even if the problem is not limited to public health, it is time that the public health community reacts. Universities, research institutes, funding agencies, governments and especially researchers themselves have to define what contributions they can make to remedy the current situation. The Belgian Association of Public Health should also be challenged by these figures and take this up as an urgent issue to be tackled.

Childhood obesity is growing as one of the most important public health issues that affects individual and population health but also puts heavy burden on the health systems. It is frequently associated with immediate adverse consequences, such as psychological problems, and a higher risk of many harmful comorbidities later in life, such as type 2 diabetes, dyslipidemia, non-alcoholic fatty liver disease, hypertension, and coronary heart disease. Comparability of anthropometric data is crucial to track the changes over time. The aim of this paper was to present prevalence of thinness, overweight, and obesity in 7-year-old schoolchildren in North Macedonia in 2010 and 2019, and the changes in their nutritional status during thatperiod. Material and methods: Anthropometric measurements of body height and body weight were performed to the nationally representative sample of 7-year-oldchildren in school years 2010/2011 and 2018/2019. Measurements followed the Childhood Obesity Surveillance Initiative (COSI) protocol and data collecting procedures. In total, 2737 children (1317 girls and 1420 boys) in 2010 and 2059 children (1045 girls and 1014 boys) in 2019 were measured. WHO Growth references were used to determine the growth and nutritional status of children. Results: The average height of children in the observed period has increased by 1.7 cm, weight for 1.2 kg and the BMI for 0.3 kg/m2. As for the weight classification, thinness prevalence is significantly increased for 0.3%. Overweight (including obesity) significantly increased (p=0.0377) from 34.4% (95% CI 32.6%-36.2%) in 2010 to 37.3% (95% CI 35.2%-39.5%) in 2019. Obesity significantly increased (p=0.040) from 16.3% (95% CI 14.9%-17.7%) in 2010 to 18.4% (95% CI 16.7%-20.1%) in 2019. The main driver of that increase was the highly significant (p=0.0004) increase of almost 7% of overweight (including obesity) in girls. Conclusion: There is unfavorable rising trend which indicates deterioration of the situation with childhood obesity in the country. Focused and more comprehensive public health nutrition actions are needed to plateau or reverse the trends. The childhood obesity national monitoring system is well established and should continue to beone of the key public health monitoring systems that provide evidence for actions., Детската дебелина прераснува во едно од најважните јавноздравствени прашања кои влијаат на индивидуалното и популациското здравје, но и силно ги оптоваруваат здравствените системи. Често е поврзана со негативни последици како психолошки проблемии со зголемен ризик од многу други коморбидитети подоцна во животот како што се дијабетес мелитус тип 2, дислипидемија, замастување на црниот дроб кое не е предизвикано од алкохол, хипертензија и коронарна болест на срцето. Споредливоста на антропометриските податоци е клучна за да се прикажат промените низ времето. Цел на овој труд беше да ја прикаже преваленцијата на слаби, како и на деца со зголемена телесна тежина и дебелина во Северна Македонија, на возраст од 7 години, во 2010 и 2019 година, како и променитево нивниот нутритивен статус во тој временски период. Материјал и методи: Беа направениантропометрискимерења на телесната висина и тежина кај национално репрезентативен примерок на 7-годишни деца во училишните години 2010/2011 и 2018/2019. Мерењата ги следеа процедурите и пропишаниот протокол на Иницијативата за следење на дебелината кај децата (COSI). Вкупно беа измерени2737 деца (1317 женскии 1420 машки) во 2010 и 2059 деца (1045 женскии 1014 машки) во 2019. Референците за раст на СЗО беа користени за утврдување на растот и нутритивниот статус на децата. Резултати: Висината на децата за време на испитуваниот период се зголемила за 1,7 cm, тежината за 1,2 kg, а ИТМ за 0,3 kg/m2. Во однос на класификацијата на тежината, преваленцијата на слабосткај децата незначајно пораснала за 0,3%. Зголемената телесна тежина (вклучувајќи дебелина) значајно пораснала (p=0,0377) од 34,4% (95% CI 32,6%-36,2%) во 2010 на 37,3% (95% CI 35,2%-39,5%) во 2019. Дебелината значајно пораснала (p=0,040) од 16,3% (95% CI 14,9%-17,7%) во 2010 на 18,4% (95% CI 16,7%-20,1%) во 2019. Главен двигател на тоа зголемување била значајно зголемената телесна тежина (вклучувајќи дебелина) од скоро 7% кај девојчињата. Заклучок: Постои неповолен растечки тренд кој индицира влошување на ситуацијата со детската дебелина во земјата. Потребни се насочени и посеопфатни јавноздравствени акции во исхраната ре или смени насоката на трендот. Системот на следење на детската дебелина во државата е добро воспоставен и треба да продолжи како еден од клучните јавноздравствени системи на следење кој обезбедува докази за идни акции.

BackgroundComprehensive data is key for evidence-informed policy aiming to improve the lives of persons experiencing different levels of disability. The objective of this paper was to identify the environmental barriers — including physical, social, attitudinal, and political barriers — that might become priorities for cross-cutting policies and policies tailored to the needs of persons experiencing severe disability in Cameroon.MethodsA secondary analysis of data obtained with the WHO Model Disability Survey was completed in the Bankim Health District (N = 559) using random forest regression to determine and compare the impact of the environmental factors on the experience of disability.ResultsThe physical environment had by far the highest influence on disability, with transportation, toilet of the dwelling, and the dwelling itself being the most important factors. Factors inside one’s own home (toilet of the dwelling, and the dwelling itself) were the most important for persons with moderate and severe disability, followed by attitudes of others and issues with accessing health care.ConclusionOur study provides country policy makers with evidence for setting priorities and for the development of evidence-informed policies for the Bankim Health District in Cameroon.

Background Knowledge Translation (KT) and data visualization play a vital role in the dissemination of data and information to improve healthcare systems. A better understanding of KT and its utility requires examining its processes, and how these interact with available data tools and platforms and various users. In this context, the aim of this paper is to understand how relevant users interact with data visualization tools, in particular Global Burden of Disease (GBD) visualizations, while also examining KT processes related to data visualization. Methods A qualitative case-study consisting of semi-structured interviews with eight policy officers. Interviewees were selected by the Institute for Health Metrics and Evaluation (IHME) from three countries: Canada, Kenya and New Zealand. Data were analyzed through framework coding, using qualitative analysis software. Results Policy officers’ responses indicated that data can prompt action by engaging users, and effective delivery and translation of data was enhanced by data visualization tools. GBD was considered valuable for use in policy (e.g., planning and prioritizing health policy; facilitating accountability; and tracking and monitoring progress and trends over time and between countries). Using GBD and data visualization tools, participants quickly and easily accessed key information and turned it into actionable messages; engaging visuals captured decision-makers’ attention while providing information in a digestible, time-saving manner. However, participants emphasized an overall disconnect between research and public health. Functionality and technical issues, e.g., absence of tool guides and tool complexity, as well as lacking buy-in and awareness of certain tools from those less familiar with GBD, were named as major barriers. In order to address this “know-do” gap, user-friendly knowledge translation tools were stated as crucial, as was the importance of collaboration and leveraging different insights from data generators and users to inform health policy. Conclusions Policy officers aware of KT are willing to utilize data visualization tools as they value them as an engaging and important mechanism to foster the use of GBD data in policy-making. To further facilitate policy officers’ efforts to effectively use GBD data in policy and practice, further research is required into how users perceive and interact with data visualization and other KT tools.

Considering complicity in ecological health and social aspects of industrial contaminated sites (ICSs), the methodologies and approaches of health impact assessments are very heterogeneous. ICSHNet together with WHO recommend two main methodological approaches: health risk assessments and epidemiological studies. Some countries have necessary experience for impact assessment of ICSs, but others have limited resources and less intensity studies. In the Republic of North Macedonia, 16 ICSs are identified, but one of them, lindane dumpsite in OHIS Plant is characterized as the most ecological and public health risk. The general aim: Systematic review of literature data about methodological approaches for health risk assessment of ICSs on international and national level in order to make comparative analysis of current methodological approaches in the Republic of North Macedonia using the case study of ICS OHIS PLANT SKOPJE. Material and methods: The review of scientific and grey literature was performed. The selected scientific studies were searched in the PubMed and Medline databases from 2000-2017, in English and Macedonian. The selected studies and data were analyzed by required information for identification of hazards, exposure assessment and risk characterization. Additionally, the review was performed on published reports of risk assessment of OHIS Plant. Results: A total of 14 original papers were investigated. Continuous monitoring systems for gathering environmental data related to ICSs were used only in two cases and in other studies the concentrations of contaminants in the source were calculated or several ad hoc monitoring campaigns were performed. Exposure assessment was conducted according to qualitative definition for the presence/absence of a source, distance to a source and biomonitoring in the study. Mortality, cancer incidence, congenital abnormalities and hospitalizations were used health data. The study of risk assessment of OHIS Plant has ecological design and indirect quantitative exposure assessment model was used. Conclusion: All investigated studies used three main methodological approaches for exposure assessment: measurement of hazard concentration, distance from source and biomonitoring. Comparable, conducted risk assessment of OHIS Plant follows the recommendations of US EPA and ATSDR with weakness of no existing continual monitoring process and also deficiency of health data and this is the reason for limitation of health impact assessment and setting up EPHT or other public health surveillance system.

On behalf of the European Food Safety Authority (EFSA), Kass and Lodi recently published a letter purporting to ‘refute’ our July 2019 analysis of EFSA’s December 2013 assessment of the risks of aspartame. We had previously claimed inter alia that the EFSA panel had evaluated studies that had indicated that aspartame might be harmful far more sceptically than those that had not indicated harm. We reported that EFSA had deemed every one of 73 studies suggesting harm to have been unreliable. Kass and Lodi provided a tabulation with figures that differed from ours in every detail. This commentary shows that, while Kass and Lodi provided a response to our analysis, they have not come close to refuting it. Our analysis provided detailed characterisations of each of the studies and how the panel interpreted them, but Kass and Lodi provide no corresponding information at all. Kass and Lodi claim that EFSA deemed 21 of 35 studies that had indicated possible harm to have been reliable. But if that is so, we now ask: why did the EFSA panel not recommend that aspartame should be banned, or at least tightly restricted? Supplementary Information Supplementary information accompanies this paper at 10.1186/s13690-020-00489-w.

Background e-health literacy can facilitate the uptake of benefits of health for older adults. In this review, we aimed to tabulate the types and outcomes of the theory-based e-health interventions that had been applied to improve the e-health literacy of older adults. Methods In this systematic review, theory-based e-health literacy interventions that published up to April 2020 were retrieved from several online electronic databases, including Medline via PubMed, Cochrane Library, ProQuest, and EMBASE. The published papers were included in this study, if the study had been conducted on older adults, a theory-based intervention aimed at promoting e-health literacy, and had been written in English language in the timeframe of 2008–2020. Results A total of 1658 records were identified initially, of which, 12 articles met the inclusion criteria. The systematic review identified the using of variety of intrapersonal, interpersonal, and societal level conceptual models in enhancing of e-health literacy in older adults, and the concept of self-efficacy was applied in the most of interventions as the main conceptual theoretical framework. Conclusions Despite the paucity of conceptual models, which are specifically designed for e-health literacy interventions, based on our findings, we recommend self-efficacy as a powerful concept that can play an important role in improving e-health literacy in older adults.

Goldenhar's syndrome (GS) is a complex syndrome characterized by a combination of abnormalities: hemifacial macrosomia, mandibular hypoplasia, ocular dermoids, ear abnormalities, and vertebral disorders. The incidence of GS is about 1 in 5000 to 25,000 live births. The male to female ratio is 3: 2.The etiology of this rare disease is not fully understood. The treatment protocol depends on the age of the patient and systemic clinical presentations. This paper presents a case of a 46-year-old woman with Goldenhar syndrome, which manifested with facial asymmetry, epibulbar dermoid, hearing loss, and scoliosis. Because it is a congenital syndrome, these people's lives are complex from an early age. There is a need for timely recognition of this syndrome and a multidisciplinary approach in treating these patients, with a team of specialist physicians, to enable them as much optimal functioning as possible in the environment. By presenting this case report, we would like to attract the attention of GS, which would be of educational significance for all physicians, primarily ophthalmologists, as well as otolaryngologists and orthopedists.

MRI is a basic tool in patient selection for preoperative neoadjuvant treatment of rectal carcinoma, with assessment of stage reduction. The aim of the paper was to evaluate chemoradiotherapy effects in advanced stage rectal carcinoma by comparison of MRI findings before and after chemoradiotherapy. Material and methods: Prospectively, MRI findings of 15 patients with rectal carcinoma confirmed at colonoscopy, were evaluated. In all patients preoperative neoadjuvant treatment was done and MRI restaging was performed after 6 to 8 weeks. MRI standard protocol was done on 1.5T machine, sagital T2WI, axial T1WI, T2WI and DWI. On MRI was assessed tumor and nodal stage, presence of extra-mural vascular invasion (EMVI), tumor localization within the rectum (low, medium, high rectum, recto-sigmoid junction). Computer tomography was performed in all patients for distant metastases assessment. Results: Out of 15 patients, 12 (66.7%) were male, and 3 (33.3 %) were female, with a mean age of 65 years (range 50 to 80years). Six cases had middle rectum localization, 6 cases in low rectum, and 3 patients had recto-sigmoid localization. At initial MRI, 7 cases (46.6%) had MR signs for T3 stage, and 8 cases (53.3%) had T4 stage. Comparison of MRI results before and after chemoradiotherapy showed stage decreasing in 5(33.3%), from T4 to T3 stage. In 11 patients (73.7%), EMVI after therapy became negative with a statistically significant difference before and after chemoradiotherapy. All patients before therapy had different numbers of metastatic lymph nodes in mesorectum, with number reduction in all cases after therapy and two patients were without metastatic lymph nodes. Conclusion: MRI has a significant value in pre- and post-neoadjuvant therapy assessment of resection margins involved by tumor, positive extramural vascular invasion, and metastatic lymph node around resection margins. This is important for operative planning in order to avoid extensive resection with surgery techniques that preserve the anal sphincter.

Background In 2018 the first Belgian Health Examination Survey (BELHES) took place. The target group included all Belgian residents aged 18 years and older. The BELHES was organized as a second stage of the sixth Belgian Health Interview Survey (BHIS). This paper describes the study design, recruitment method and the methodological choices that were made in the BELHES. Methods After a pilot period during the first quarter of the BHIS fieldwork, eligible BHIS participants were invited to participate in the BELHES until a predefined number (n = 1100) was reached. To obtain the required sample size, 4918 eligible BHIS participants had to be contacted. Data were collected at the participant’s home by trained nurses. The data collection included: 1) a short set of questions through a face-to-face interview, 2) a clinical examination consisting of the measurement of height, weight, waist circumference, blood pressure and for people aged 50 years and older handgrip strength and 3) a collection of blood and urine samples. The BELHES followed as much as possible the guidelines provided in the framework of the European Health Examination Survey (EHES) initiative. Finally 1184 individuals participated in the BELHES, resulting in a participation rate of 24.1%. Results for all the core BELHES measurements were obtained for more than 90% of the participants. Conclusion It is feasible to organize a health examination survey as a second stage of the BHIS. The first successfully organized BELHES provides useful information to support Belgian health decision-makers and health professionals. As the BELHES followed EHES recommendations to a large extent, the results can be compared with those from similar surveys in other EU (European Union) member states.

Dental care prevention involves prophylactic oral health practices and strategies that are primarily targeted to diseases of the oral tissues with the focus on prevention of certain conditions. Not enough attention has been given to the communication between the dentist and the patient as well as the ability or the inability to understand patient's health information. The aim of this paper is to present the current practices and regulations related to the effective communication between oral healthcare professionals and patient population, and their representation and influence in improving and raising the profile of the oral health on a national level. Materials and method:A systematic literature search was conducted including published scientific articles between 1977 and 2018. Studies discussing the improvement of oral health in the function of general health and well-being in the patient population of all ages were analyzed. The main focus was put on the commitment of the oral health community in the global agenda and the importance of integrating multifactorial approaches to prevention. Particular attention was paid to the representation of the skills for effective communication between health care professionals and patient population, and the medical education (health education), which should result in the individual's health literacy. Results: During the global struggle to improve the oral health, efforts are being made to enhance current practices and share knowledge about preventive care and treatment in oral health science and education in order to ensure the general health and well-being of the patient population of all ages. Unfortunately, the commitment to take action in raising effective communication and oral health literacy is minimal. Conclusion: Improving the communication between the oral health care professionals and the patient population in the direction of an interactive, dynamic and flexible process, as well as raising the level of oral health literacy among the population through targeted and carefully developed medical education should be the first step in any preventive program for raising the level of oral health.

Children with cleft palate/lip are exposed to risk for verbal communication disorders that include resonance, articulation, voice disorders, and expressive language. The aim of this paper was to evaluate the changes in the voice quality of the children with cleft palate in relation to children without anomaly. The study included 52 participants, 26 with previously corrected cleft palate / lip, and 26 respondents without anomaly who are between 3 and 6 years old. Subjective assessment of voice quality was performed by using the GRBAS scale. Perceptual scales are important in assessing the voice quality, determining the degree and severity of voice disturbance, and deciding on further clinical procedures. Although the instrumental approach to voice examination is relevant because it provides objectivity, the subjective impression in assessing voice quality is crucial. Statistical processing was performed by groups, group structure (gender and age), a certain highest value, as well as percentage participations. The results showed that 50% of the participants were diagnosed with certain changes in the voice. Children aged 3-5 years have a 2.25 times higher incidence of voice changes than children aged 6-8 years. The largest number of participants belong to group 0 - There is no change in voice quality which represents as much as 50% of the total number of patients in the first group. While "3 - Pronounced changes in the voice" were not identified in the respondents aged 3-5 years. In 50% of the total number of participants there is no change in voice quality and these are located in girls aged 3-5 years., Децата со расцеп на непце /усна се изложени на ризик од нарушувања во вербалната комуникација кои вклучуваат резонанца, артикулација, нарушувања на гласот и експресивниот јазик. Целта на овој труд беше да се согледаат промените на квалитетот на гласот кај децата со расцеп на непце во однос на децата без аномалија. Во истражувањето беа вклучени 52 испитаници од кои 26 сопретходно корегиран расцеп на непце/усна, а 26 испитаници без аномалија на возраст од 3 до 6 години. Субјективна проценка на квалитетот на гласот е извршена со примена на скалата Грбас. Перцептивните скали се значајни во проценка на квалитетот на гласот, одредување на степенот и тежината на пореметувањето на гласот, како и во одлучување за понатамошните клинички постапки. И покрај тоа што инструменталниот пристап во испитувањето на гласот е релевантен бидејќи обезбедува објективност, субјективниот впечаток во проценка на квалитетот на гласот е клучен. Извршена е статистичка обработка по групи, структура на групите (пол и возраст), одредена e највисока вредност, како и процентуални учества. Резултатите покажаа дека кај 50% од испитаниците се дијагностицирани одредени промени во гласот. Децата на возраст од 3-5 години имаат 2,25 пати поголема инциденца на промени на гласот во однос на деца на возраст од 6-8 години. Најголемиот број на испитаници спаѓаат во групата 0 - Не постои промена во квалитетот на гласот кој што претставува дури 50% од вкупниот број на пациенти во првата група. Додека „3 - Изразени промени во гласот“,не се идентификувани кај испитаниците на возраст од 3-5 години. Кај 50% од вкупниот број на испитаниците не постои промена во квалитетот на гласот и овие се лоцирани кај девојчиња на возраст од 3-5 години.

The rights of patients are based on the general human rights and are an important segment in the process of "Europeanization" of the Republic of Macedonia. The main goal of this study was to analyze the legislative framework of human rights in the health care in the Republic of Macedonia and its implementation in practice. Material and methods: The study was designed as a descriptive-analytical cross sectional study, in which a public health approach, an information-analytical method and evidence synthesis method were applied for the analysis of the relevant legislation. A survey was conducted on a representative stratified sample of patients in the Polog Region in the period from October to November 2017 in the Clinical Hospital Tetovo and the General Hospital Gostivar. Results: The legal system of the Republic of Macedonia was analyzed and compared with 6 transition countries, which had undergone a series of substantial reforms in recent years. The legislative framework in the Republic of Macedonia is a comprehensive frame for protection of patients’ rights, with which the patient is guaranteed legal rights in the process of treatment, respect and protection of his/her personality and integrity. The implementation of patients' rights in practice in this paper was analyzed by implementation of two rights of patients: the right on information about the recommended medical interventions and the right to accept and reject certain medical intervention. 85.2% of the interviewed patients had information on the right to information about the recommended medical interventions, and 14.8% didn’t have. 72.1% of the interviewed patients had personal experience for this right, and 27.9% didn’t have. Regarding the right to accept and reject certain medical intervention, 77% of the interviewed patients had information on this right, while 23% didn’t have. Personal experience was significantly smaller with this right, i.e. only 32.8% of the interviewed patients had personal experience, and 67.2% didn’t have. These differences were significant for both rights, for information and for personal experience. Conclusions: The human rights in the health care in the Republic of Macedonia are reflected in the national legislation, which is harmonized with the European and international legislation. However, it is necessary to improve the implementation of patients' rights in practice by raising the citizens' awareness about the knowledge of patients' rights and encouraging medical staff to respect the rights of patients and their compulsory application in practice., Правата на пациентите произлегуваат од општите човекови права и се важен сегмент во процесот на ,,европеизација“ на Република Македонија. Главна цел на оваа студија беше да се анализира легислативната рамка на човековите права во здравствената заштита во Република Македонија и имплементацијата во пракса. Материјал и методи: Студијата е дизајнирана како дескриптивно–аналитичка студија на пресек, во која беше применет јавноздравствен пристап, информатичко-аналитичен метод и метод на синтеза на евиденција (evidence synthesis) за анализа на релевантната легислатива. Беше спроведено анкетно истражување на репрезентативен стратифициран примерок на пациенти во Полошкиот Регион, во период од два месеци, октомври-ноември во 2017 година, во Клиничката болница во Тетово и Општата болница во Гостивар. Резултати: Беше анализиран правниот систем на Република Македонија и беше спореден со 6 држави во транзиција, кои претрпеа низа суштински реформи во последниве години. Легислативната рамка во Република Македонија претставува сеопфатна рамка за заштита на правата на пациентот, со која на пациентот му се загарантирани законски права во процесот на лекувањето, почитувањето и заштитата на неговата личност и интегритет. Во овој труд имплементацијата на правата на пациентите во пракса беше анализирана преку имплементацијата на две права на пациентите, и тоа: право на информираност за препорачаните медицински интервенции и право на прифаќање и одбивање на определена медицинска интервенција. 85,2% од анкетираните пациенти имале информации за правото на информираност за препорачаните медицински интервенции, а 14,8% немале. 72,1% од анкетираните пациенти имале лично искуство за ова право, додека 27,9% немале. Во однос на правото на прифаќање и одбивање на определена медицинска интервенција, 77% од анкетираните пациенти имале информации за ова право, а 23% немале. Значително помало беше личното искуство за ова право, односно само 32,8% од анкетираните пациенти имале лично искуство, а 67,2% немале. Разликите беа сигнификантни во одговорите за двете права, и за информацијата и за личното искуство. Заклучок: Човековите права во здравствената заштита во Република Македонија се рефлектирани во националната легислатива која е хармонизирана со европската и меѓународната. Меѓутоа, потребно е подобрување на имплементацијата на правата на пациентите во пракса, преку подигнување на свеста на граѓаните за познавање на правата на пациентите и поттикнување на медицинскиот персонал за почитување на правата на пациентите

Materiovigilance is a system applied for the purpose of detecting, gathering, monitoring, assessing and responding to new data on safety of medicinal products and related to the use of medical device related to possible incidents during use. The aim of this paper was to show the characteristics of the system of materiovigilance in the Republic of Macedonia compared to four other jurisdictions (US, EU, Japan and China), the recognition of the advantages and disadvantages of the systems and their impact on public health. Material and methods: For the realization of the aim of the study, we conducted an analysis of data published on the web pages of regulatory authorities related to the existing legal framework and review of the literature available on the network for scientists and researchers ResearchGate. General dialectical method as well as legal methods (dogmatic and normative method) were used in this study in order to determine the content, the meaning and the importance of the legal norms which regulate the system of materiovigilance. Results: The five systems of materiovigilance have several features that include monitoring of adverse events caused by medical device that have been granted a marketing authorization. Globally, these systems provide different, shared responsibility of all stakeholders. Thus, the scope of responsibilities of producers is significantly higher in Japan and China, opposed to the EU and Macedonia, where the responsibility is passed on to distributors, health professionals and other for-profit entities. United States is in the middle between these two extreme systems of materiovigilance, where the FDA has the responsibility to protect the public health forecasting responsibilities to the industry. Conclusion: There are significant variations in the regulation system of materiovigilance in the Republic of Macedonia and the analyzed legal systems. To date, there is no empirical evidence that one system is better than another, but it is indisputable that each system has its advantages and disadvantages regarding the protection of public health. Within the analyzed systems of materiovigilance three best practices can be seen that contribute to the improvement of public health: transparency, repeating the examination of medical device and central versus local control.

Purpose of the paper: To determine the effect of alcohol consumption on the emergence and treatment of hypertensive brain hemorrhages and the harmful effects on morbidity and mortality of patients. Material and methods: A retrospective study of 61 patients was performed at the University Clinic of Neurosurgery from 2011 to 2016 with various manifestations of brain bleeding. Patients were divided into 2 groups: with and without emphasized risk factors. In the group with emphasized risk factors 15 examinees consumed alcohol. The following variables were examined: sex, age, bleeding volume, compression, the outcome of treatment and functional mobility. Results: The results indicate that alcoholism significantly affects the onset of brain bleeding, especially in patients who consume more than 200 ml of alcohol per day. The most likely cause is liver damage and hemostasis disorder. Conclusion: Alcoholism as a socio-medical factor has a significant role in the occurrence of brain hemorrhages., Цел на трудот: Да се утврди влијанието на консумирањето алкохол во појавата и лекувањето на хипертензивните мозочни крвавења и штетните последици врз морбидитетот и морталитетот на пациентите. Материјал и методи: Беше изведена ретроспективна студија кај 61 пациент на ЈЗУ Универзитетска клиника за неврохирургија од 2011 до 2016 год. со различни манифестации на мозочни крвавења. Пациентите беа поделени во 2 групи: со и без нагласени ризик-фактори.Во групата со нагласени ризик-фактори се утврди дека 15 испитаници консумирале алкохол.Беа испитувани следниве варијабли: пол, возраст, волумен на крвавењето, компресија, исход на лекувањето и функционална мобилност. Резултати: Резултатите укажуваат дека алкохолизмот значително влијае на појавата на мозочните крвавења, особено кај болните што консумираат повеќе од 200 ml алкохол дневно. Најверојатна причина е оштетувањето на црниот дроб и нарушувањето на хемостазата. Заклучок: Алкохолизмот како социомедицински фактор има сигнификантна улога во појавата на мозочните крвавења

Background Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. However, disparities in the population of children are rarely studied. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services. Methods This is a cross-sectional study on 202 children with ASD conducted in 2019 in two provinces including Ardabil and East-Azerbaijan, in the North-West of Iran. A structured, valid questionnaire was used to collect data on demographic, SDH status, quality of services, and access to services in a population of children with ASD aged 2–16-year-old. Around 77% participants were male and the mean age of children was 2 years and 6 months. Structural Equation Modeling (SEM) were used to assess the relationship. Results Based on the results of this study, the overall mean scores of the quality of services, access to services, and SDH status were 61.23 (30.01), 65.91 (21.89), and 29.50 (22.32) out of 100, respectively. All the associations between the quality and access dimensions and quality (B: 0.464–0.704) and access (B: 0.265–0.726) scales were statistically significant (P P = 0.004). Finally, the associations between SDH score with service quality (P = 0.039) and access (P Conclusions There are socioeconomic disparities in the quality of and access to services among children with ASD, who use ASD services, in the North-West of Iran. We recommend health/medical centers, where children are diagnosed with ASD, conducting SDH screening and providing families of low-SDH status with specific information about the quality of and access to services for children with ASD. Additionally, medical universities must have a plan to routinely monitor the quality of and access to services provided for the children with low SDH.

Background Systematic reviews, considered the gold standard for the assessment of scientific evidence, may present conflicting findings for the same clinical issue, and such dissent may be justified by the forms of elaboration of the electronic search strategy. This paper aims to validate a search strategy to identify randomized clinical trials related to periodontitis. A gold standard reference set was developed to validate the identified clinical trials using the relative recall method. The choice of periodontitis is due to the fact that this disease has a high prevalence among chronic non-communicable diseases, is considered the second most common oral disease in the world, is associated with several health problems, such as cardiovascular diseases and diabetes, and, principally, has not been investigated sufficiently to prevent possible damages resulting from it. Methods A validation study was developed in MEDLINE/PubMed. In Stage 1, a methodological filter recommended by the Cochrane Collaboration to identify randomized clinical trials was applied. Stage 2 identified articles related only to periodontitis (gold standard reference set) from among the articles retrieved using the eligibility criteria. In Stage 3, a search statement for the retrieval of periodontitis-related articles was elaborated by experts. Stage 4 defined the proposed search strategy comprising of the combination of the search statement developed with the aforementioned methodological filter and subsequent application in MEDLINE/PubMed. The obtained data were analyzed using the set of articles identified in Stage 2, as the gold standard reference set. The following performance values were calculated - sensitivity, specificity, accuracy, and number needed to read - with their respective 95% confidence interval (95%CI). Results The search strategy under evaluation compared to the gold-standard showed a sensitivity of 93.2% (95%CI, 83.8–97.3), specificity of 99.9% (95%CI 99.8–99.9), and a precision of 77.5% (95%CI, 66.48–85.63). In addition, the number needed to read was 1.3. Conclusion According to the proposed methodological approach, the search strategy under evaluation performed well in the identification of randomized clinical trials related to periodontitis.

Background Community engagement (CE) has been regarded as a critical element of successful health programs to achieve “the health for all” goals. Numerous studies have shown that it plays a significant role in reducing inequalities, improving social justice, enhancing benefits, and sharing responsibility towards public health. Despite this, the extant literature of community engagement in public health (CEPH) has topic-focused boundaries and is scattered across disciplinary. Large-scale studies are needed to systematically identify current status, hotspots, knowledge structure, dynamic trends, and future developments in this field. Methods The bibliometric techniques were applied in the analysis of publications on CEPH in Web of Science Core Collection from Thomson Reuters. One thousand one hundred two papers out of 70.8 million publications over the period of 1980 to 2020 and their 15,116 references were retrieved as the sample set. First, basic characteristics of publications, including distributions of geography, journals and categories, productive authors and frequently cited articles, etc. were obtained. Then, four bibliometric methods, i.e. social network analysis, co-citation analysis, co-occurrence clustering, and burst detection, were further conducted to sketch the contours of the structure and evolution of CEPH. Results Between Jan 1, 1980, and Apr 25, 2020, CEPH has attracted a sharp increase in interest all over the world. Total 117 countries or regions have participated in the field of CEPH and the contributions are geographically and institutionally distinct. The United States is the key region performing such research, which accounts for more than half of the total number of publications. Developing countries, such as South Africa, India, Brazil and China also contributed a lot. The advancements of CEPH are marked by historically momentous public health events and evolved from macroscopic strategies to mesoscopic and microscopic actions. Based on keyword clustering and co-citation clustering, we propose a 4O (i.e. orientation, object, operation, and outcome) framework of CEPH to facilitate a better understanding of the current global achievements and an elaborate structuring of developments in the future. Conclusion This study draws an outline of the global review on the contemporary and cross-disciplinary research of CEPH which might present an opportunity to take stock and understand the march of knowledge as well as the logical venation underlying research activities which are fundamental to inform policy making.

An amendment to this paper has been published and can be accessed via the original article.

Background Summary measures of population health are increasingly used in different public health reporting systems for setting priorities for health care and social service delivery and planning. Disability-adjusted life years (DALYs) are one of the most commonly used health gap summary measures in the field of public health and have become the key metric for quantifying burden of disease (BoD). BoD methodology is, however, complex and highly data demanding, requiring a substantial capacity to apply, which has led to major disparities across researchers and nations in their resources to perform themselves BoD studies and interpret the soundness of available estimates produced by the Global Burden of Disease Study. Methods BoD researchers from the COST Action European Burden of Disease network reflect on the most important methodological choices to be made when estimating DALYs. The paper provides an overview of eleven methodological decisions and challenges drawing on the experiences of countries working with BoD methodology in their own national studies. Each of these steps are briefly described and, where appropriate, some examples are provided from different BoD studies across the world. Results In this review article we have identified some of the key methodological choices and challenges that are important to understand when calculating BoD metrics. We have provided examples from different BoD studies that have developed their own strategies in data usage and implementation of statistical methods in the production of BoD estimates. Conclusions With the increase in national BoD studies developing their own strategies in data usage and implementation of statistical methods in the production of BoD estimates, there is a pressing need for equitable capacity building on the one hand, and harmonization of methods on the other hand. In response to these issues, several BoD networks have emerged in the European region that bring together expertise across different domains and professional backgrounds. An intensive exchange in the experience of the researchers in the different countries will enable the understanding of the methods and the interpretation of the results from the local authorities who can effectively integrate the BoD estimates in public health policies, intervention and prevention programs.

Background Three different diagnostic criteria are used to identify children aged 6 to 59 months with acute malnutrition: weight-for-height (WHZ), middle upper arm circumference (MUAC) and bilateral pitting oedema. Prevalence of malnutrition from surveys is among the most-used decision support data, however not all diagnostic criteria are used to calculate need, creating a mismatch between programme planning and implementation. With this paper, we investigate if such discrepancies are observed in Mozambique. Methods Population-based nutritional anthropometric surveys from 45 districts in Mozambique conducted by the Technical Secretariat for Food Security and Nutrition (SETSAN) and UNICEF between 2017 and 2019 were analysed. We used Cohen’s kappa coefficient to measure inter-rater agreement between WHZ and MUAC, Spearman’s rank-order coefficient to assess the correlation, binary logistic regression to investigate factors influencing WHZ and MUAC diagnostic classification. We compared acute malnutrition caseload estimates by WHZ, MUAC and oedema to caseloads from combined prevalence estimates. Results WHZ and MUAC rarely agree on their diagnostic classification (κ = 0.353, ρ ρ ρ ρ ρ ρ ρ Conclusions Given the discrepancy in diagnostic classification between WHZ and MUAC in Mozambique, using either one alone for calculating burden underestimates the real number of children in need of treatment and negatively affects nutrition programme planning. We recommend that use of the combined prevalence estimates, based on the three diagnostic criteria of WHZ, MUAC and oedema, be officially adopted. Further analysis is needed to detail the programmatic impact of this change.

The aim of the paper was to evaluate clinical characteristics of COVID-19 in children and the success of the treatment. Material and methods: The study included 218 pediatric patients suspected for COVID-19 hospitalized at the Institute for Pulmonary Diseases in Children-Skopje, during the period from 16th of March to 19th of June 2020. All patients were tested for presence of SARS-CoV-2 virus in nasopharyngeal swab with real-time reverse transcription polymerase chain reaction (RT-PCR) in the Institute of Public Health of Republic of North Macedonia. Clinical symptoms, X-ray and laboratory findings were included in the study. Results: From 218 hospitalized patients, only 9 (4.13%) were positive for COVID-19 and 59% of them were males. Infants, with moderate pulmonary disease were 44.4% of the patients. Fever and gastrointestinal symptoms were present in 66.6% and 22.2% of the children, respectively. Macrolides were therapy of choice in 88% of the treated patients, 77% received intravenous therapy, 33% were on inhaled bronchodilator. Conclusions: A small number of children had COVID-19. All infected children were with mild to moderate pulmonary symptoms and reacted satisfactory to the treatment. However, the importance of transmitting the virus and influence over children’s health remains uncertain.

Background During the last decade, the European Union initiated several projects in the domains of public and environmental health. Within this framework, BRIDGE Health (Bridging Information and Data Generation for Evidence-based Health policy and Research) and HBM4EU (European human biomonitoring initiative) have been implemented. Whereas, the focus of BRIDGE Health was towards a sustainable and integrated health information system (HIS), the aim of HBM4EU is to improve evidence of the internal exposure of European citizens to environmental chemicals by human biomonitoring (HBM) and the impact of internal exposure on health. As both, environmental and public health determinants are important for health promotion, disease prevention and policy, BRIDGE Health and HBM4EU have overlapping aims and outcomes. In order to improve health information regarding public health and environmental health issues, best use and exchange of respective networks and project results is necessary. Methods Both projects have implemented health information (HI) and HBM tasks in order to provide adequate environmental and public health information of the European population. Synergies of the projects were identified in the working progress and because of overlapping networks and experts a focused analysis of both projects was envisaged. This paper elaborates on the aims and outcomes of both projects and the benefit of merging and channelling research results for the use of better health information and policy making that may be of relevance for any other project in these research fields. Results The need for focused exchanges and collaborations between the projects were identified and benefits of exchanges were highlighted for the specific areas of indicator development, linkage of data repositories and the combination of HBM studies and health examination surveys (HES). Further recommendations for a European wide harmonisation among different tasks in the fields of public health and environmental health are being developed. Conclusions Lessons learned from HBM4EU and BRIDGE Health show that continuous efforts must be undertaken, also by succeeding projects, to guarantee the exchange between public health and environmental health issues. Networks covering both are essential to provide better evidence of knowledge. The experiences from BRIDGE Health and HBM4EU give a valuable input for any future activity in these domains. Avoiding overlaps and streamlining further exchange of public health and environmental health contributes to best use of research results and allows to develop new strategies and tools for improvement of health information and thus enhances people’s health and well-being.

Background Health literacy is increasingly being recognized as a widespread public health challenge in Europe. This commentary explores the importance of health literacy amongst cancer patients (ie, cancer literacy) and examines how cancer literacy can be improved through the practical application of health literacy principles within the context of providing timely, patient-centered, value-based care in Europe. Main body Despite implementation of evidence-based cancer prevention programs and increased cancer survival rates, low cancer literacy may impact the personal capacity to manage risks and adversely impact behavior and outcomes. Cancer literacy poses a unique set of challenges compared to other types of health literacy, as patient decisions regarding screening, treatment, and side effect management are often complex, and timely decision-making is more critical. Accordingly, European health policies increasingly recognize the importance of health literacy. The European Patients Forum, European Cancer Patient Coalition, and the Association of European Cancer Leagues supported a joint statement, “Europe Let’s Do More for Health,” which emphasizes the need to empower citizens and patients by addressing health literacy, self-management, and shared decision-making. Implementation of comprehensive programs and strategies will be important to improve health literacy. Cancer literacy can be improved through application of health literacy principles in the communication and cooperation with professionals, patients and caregivers for providing timely, patient-centered, value-based care. Recommendations are made for further action to improve cancer literacy in Europe through coordinated efforts among providers, organizations, patients, and research. A policy paper developed by the European Joint Action on Cancer Control provides practical recommendations that Member States can take to reduce social inequalities in cancer care and defines focus areas that are closely connected with the need to improve cancer literacy. Conclusion Improved personal cancer literacy combined with health literate organizations and systems can potentially improve the quality of care and health outcomes among patients with cancer. National Cancer Control Plans and Europe’s Beating Cancer Plan can strengthen cancer literacy.

Background The Rapid Assessment of Hearing Loss (RAHL) survey protocol aims to measure the prevalence and causes of hearing loss in a low cost and rapid manner, to inform planning of ear and hearing services. This paper reports on the first field-test of the RAHL in Gao’an County, Jiangxi Province, China. This study aimed to 1) To report on the feasibility of RAHL; 2) report on the estimated prevalence and causes of hearing loss in Gao’an. Methods A cross-sectional population-based survey was conducted in September–October 2018. Forty-seven clusters in Gao’an County were selected using probability-proportionate-to-size sampling. Within clusters, compact segment sampling was conducted to select 30 people aged 50+. A questionnaire was completed covering sociodemographics, hearing health, and risk factors. Automated pure-tone audiometry was completed for all participants, using smartphone-based audiometry (hearTest), at 0.5, 1, 2, 4 kHz (kHz). All participants had their ears examined by an Ear Nose and Throat (ENT) doctor, using otoscopy, and probable causes of hearing loss assigned. Prevalence estimates were age and sex standardised to the Jiangxi population. Feasibility of a cluster size of 30 was examined by assessing the response rate, and the proportion of clusters completed in 1 day. Results 1344 of 1421 eligible participants completed the survey (94.6%). 100% of clusters were completed in 1 day. The survey was completed in 4.5 weeks. The prevalence of moderate or greater hearing loss (pure-tone average of 0.5, 1, 2, 4 kHz of > = 41dBHL in the better ear) was 16.3% (95% CI = 14.3, 18.5) and for any level of hearing loss (pure-tone average of > = 26dBHL in the better ear) the prevalence was 53.2% (95% CI = 49.2, 57.1). The majority of hearing loss was due to acquired sensorineural causes (91.7% left; 92.1% right). Overall 54.0% of the population aged 50+ (108,000 people) are in need of diagnostic audiology services, 3.4% were in need of wax removal (7000 people), and 4.8% were in need of surgical services (9500 people). Hearing aid coverage was 0.4%. Conclusion The RAHL survey protocol is feasible, demonstrated through the number of people examined per day, and the high response rate. The survey was completed in a much shorter period than previous all-age surveys in China. Some remaining challenges included assignment of causes of probable sensorineural loss. The data obtained from this survey can be used to scale-up hearing services in Gao’an.

Background Healthcare providers’ accreditation is one of the standard means of assuring quality services. This paper examines the pattern of National Health Insurance Scheme accreditation results among private healthcare providers in Ghana. Methods A cross-sectional quantitative analysis of administrative data from seven National Health Insurance Scheme healthcare provider accreditation surveys over the 2009–2012 period. Data on private healthcare providers that applied for formal accreditation between the study period were retrieved from the NHIS accreditation database using a checklist. Proportions were used to examine pattern of private healthcare provider accreditation results by region, type of care provider, and grade. Results Overall, 1600 healthcare providers applied for accreditation over the study years, of which 1252 (78%) passed and were accredited. Majority of healthcare providers that passed the healthcare facility assessment were in Ashanti, Greater Accra, and Western regions, and were significantly higher than those in the other regions. Among the healthcare providers that passed the assessment, pharmacies (22%) and clinics (18%) constituted the largest groups, and were significantly higher than the other types of healthcare providers. Similarly, among those that passed, majority (62%) obtained grade C and D, representing a score of 50–59% and 60–69%, respectively, and were significantly higher than those that obtained the top three grades of A+ (90–100%), A (80–89%) and B (70–79%). Conclusions Majority of healthcare providers accredited to provide services to the insured are concentrated in three regions of the country, and are mainly pharmacies and clinics. Moreover, substantial proportion of the healthcare providers obtain average scores of the healthcare facility assessment, an indication that these care providers fall below the National Health Insurance Scheme applicable-predetermined standards. Electronic supplementary material The online version of this article (doi:10.1186/s13690-017-0205-9) contains supplementary material, which is available to authorized users.

Background There is strong evidence to indicate that regular moderate intensity physical activity is associated with health benefits. Furthermore, sedentary behavior has been related with an increased risk for all-cause mortality. The accurate measurement of physical activity and sedentary behavior is therefore vital to evaluate their health impact and provide evidence for the development of public health recommendations. This paper describes the methodology used for assessing physical activity and sedentary behavior in the Belgian population in the context of the Belgian National Food Consumption Survey 2014 (BNFCS2014). Results Data about physical activity and sedentary behavior were collected as part of the cross-sectional BNFCS2014 between February 2014 and May 2015. A nationally-representative sample of children (3–9 years) and adolescents (10–17 years) were asked to wear an accelerometer (Actigraph® GT3X) during their waking hours for 7 consecutive days. Data were recorded in 15-second epochs and respondents with at least 2 valid week days (i.e., 10 h of wear-time) and 1 valid week-end day (i.e., 8 h of wear-time) were retained for the analyses. The Evenson cut points were used to assess the time spent in each physical activity intensity level: sedentary, low, moderate and vigorous. Complementary, diaries were provided to register the activities performed when the accelerometer was removed; these activities were added to the measures provided by the accelerometers. In addition, age-specific self-reported questionnaires (ToyBox and FPAQ) were completed to provide contextual information about the type of activities performed. Due to financial constraints, physical activity in adults (18–64 years) was assessed and described through the self-reported International Physical Activity Questionnaire (IPAQ long version) only. Conclusion Data were collected in the context of the BNFCS2014 to provide a comprehensive picture of the physical activity and sedentary behavior in the Belgian population, with a special focus on children (3–9 years) and adolescents (10–17 years). Levels of physical activity and sedentary behavior can be compared to international guidelines and analyzed according to several background variables, such as age, gender, Body Mass Index, education level and region. Such results are aimed to underpin future policies in the field of physical activity.

Background The European Core Health Indicators (ECHI) are a key source of comparable health information for the European Union (EU) and its Member States (MS). The ECHI shortlist contains 88 indicators which were developed by experts from MS and international organisations. Most indicators are derived from data sources at the EU’s statistical office (Eurostat), the World Health Organisation (WHO) and the Organisation for Economic Co-operation and Development (OECD) and are available for most MS. The remaining indicators on the shortlist are at different stages of conceptual and/or methodological development. The indicators have been reviewed in the past against scientific developments, changes in data collections and emerging policy needs, yet not as part of a systematic and sustainable procedure. There is also no regular inventory of problems met by the MS in collecting the necessary data. Work package 4 of the BRIDGE Health project aimed at updating and improving the existing ECHI-indicator knowledge and expertise and at strengthening the scientific base that supports the effective development and use of health indicators for health policy evaluation and prioritization by the EU and its MS. The aim of this paper is to present a first overview of its outcomes and to explore issues concerning the ECHI data availability, content and policy relevance, update process and accessibility to stakeholders, in light of working towards a sustainable future. Methods Two surveys were conducted within the framework of the BRIDGE Health project to reassess the status of the ECHI shortlist. The first survey focused on data availability in EU MS, candidate countries and European Free Trade Association (EFTA) countries. The second survey evaluated current needs and criteria with respect to content and policy relevance of the ECHI shortlist. Exploring potential new indicator topics was part of both surveys. All evaluations were supported by an advisory network of national and international experts. Results Of the 36 countries (EU MS, candidate and EFTA countries) contacted for the data availability mapping, 23 countries (63%) participated in the survey. Data availability from preferred data sources varied between chapters. Availability was highest for the chapter on demography and socio-economic situation, followed by the chapter on health status, where data were available for most indicators from more than 90% of the participating countries. Problems experienced by MS relating to the incorporation of ECHI into their health systems were also identified through the survey. Findings from the survey on policy relevance point at the need for strengthening the links with policy (priorities) and for exploring a possible format change of the list to accommodate actionability. It also showed support for embedding ECHI in a sustainable health information structure; this may practically be aided by a web-based single point of access to an information repository. Conclusion Policy relevance is an essential but not systematically developed criterion for the inclusion of indicators into the ECHI shortlist. Data availability is crucial for the actual implementation of indicators and has considerably increased for ECHI in the last decade. The data availability mapping provides a structured overview of the current status of data availability for implemented indicators. The ECHI shortlist can contribute to the collection of comparable policy-relevant health data in Europe, foster evidence-based public health and contribute to Member States learning from each other. Flexible and systematic incorporation of policy relevance in the ECHI shortlist review and revision process may substantiate ECHI as a core component of a future sustainable European health information infrastructure. Electronic supplementary material The online version of this article (10.1186/s13690-018-0298-9) contains supplementary material, which is available to authorized users.

Background Despite the variances in abortion laws accounting for differences in incidence of abortion among African countries, it appears there is absence of literature on other factors that may also account for the differences in incidence of abortion. Specifically, there is paucity of information on how socio-demographic factors account for the disparities in prevalence of pregnancy termination among women of reproductive age in sub-Saharan Africa. In view of this, this paper examined how socio-demographic factors influence pregnancy termination among women in reproductive age in Mozambique and Ghana. Methods The study made use of data from the 2014 Ghana and 2011 Mozambique Demographic and Health Survey for the study. For the purpose of this study a sample of 9375 and 13,660 made up of women in their reproductive ages (15–49) in Ghana and Mozambique respectively was used. The results on the analysis of the association between socio-demographic factors and pregnancy termination are presented as odds ratio (OR) with 95% confidence intervals (CI). Results The results revealed that about 25% of the respondents in Ghana and 9% of the respondents in Mozambique reported ever had a pregnancy terminated. In both countries, the odds of pregnancy termination were high among women with primary education, those in the older age groups, women who were Christians and women who were employed. Similarly, higher odds of pregnancy termination were found among ever married women, those who less than four births or more and those who have had access to social media (radio and television). Conclusion To reduce unintended pregnancies that could lead to pregnancy termination, there is a need for regular integrated community-based outreach programs targeted at generating community responsiveness of effective contraception and prevention of unintended pregnancy.

Background Although gabapentin has been licensed in the European Union only for neuropathic pain and epilepsy for patients who have partial seizures, it has also been prescribed in treatment for substance use disorders. Many studies report the potential risk of abuse of gabapentin by people with substance use disorders. The objective of this paper is to determine if people who have been in treatment for substance use disorders bought gabapentin in a time span that could indicate consumption at a dose that exceeded the maximum approved dose of 3600 mg/day. Methods This analysis is the result of an observational cross-sectional descriptive study with matching. Two datasets were used and linked at individual level. Subjects were selected based on their first registration in the database of the Treatment Demand Indicator (TDI) between 2011 and 2014, without any exclusion criteria concerning nationality or age. Through linkage with the database of the InterMutualistic Agency (IMA) information on health service use and medication use was determined. In addition, each subject was matched on age, sex and place of residence to four comparators from the general population who were not in specialized treatment. The prevalence of gabapentin purchases in the period between 2008 and 2014 for both populations were compared. Quantification of the amount of gabapentin between two consecutive purchases was used as a proxy for potential abuse. Results Out of 30,905 patients in treatment for substance use disorders 2.7% had bought at least once gabapentin in a public pharmacy or received it from a hospital pharmacy, compared to 0.7% in the comparison group (n = 122,142). In both populations, more than half of the patients bought only once or twice gabapentin and about 10.0% bought at least once gabapentin in a time span that could indicate potential abuse. A limitation of the study is that it is only based on reimbursed medication without clinical information. Conclusion Through the linkage of the TDI-database and the database of the Belgian health insurance companies, no evidence was found for regular abuse of prescribed gabapentin in Belgium by people in treatment for substance use disorders.

Background Not much is known about the health seeking behavior of people with substance use disorders before they enter specialized treatment and afterwards. This paper explains in detail the protocol that has been followed to establish the Belgian TDI-IMA-database, which is linking two separate databases: the Treatment Demand Indicator (TDI) and the database of the Intermutualistic Agency (IMA). The Treatment Demand Indicator is measuring incidence of people with substance use disorders entering drug treatment. The IMA-database covers data, collected in the framework of the compulsory Belgian health care and benefits insurance program, on reimbursed medication and the use of reimbursed health services. The linkage results in pharmacoepidemiological and health service data for people who were in treatment for substance use disorders and for a group of comparators. Methods The TDI-database was linked to the IMA-database for the period between 01/01/2008 and 31/12/2017, based on the national identification number of patients who have been in alcohol or drug treatment between 01/01/2011 and 31/12/2014. Through this linkage, pharmacoepidemiological and health service data became available for at least 3 years before the first registered episode in the TDI-database till at least 3 years after the first episode. For each person in TDI four comparators, who were not in specialized treatment, were matched on age, sex and place of residence. Discussion The TDI-IMA-database allows for an analysis of health seeking behavior and health care pathways of people before and after they entered specialized alcohol and drug treatment. The presented protocol could be used in other European countries to establish a linkage between existing health databases. This will allow for a better understanding of the health care needs of patients with substance use disorders.

Background: Research conducted by Ward, Muller, Tsourtos, et al. (Soc Sci Med 72(7):1140-1148, 2011) has led to the development of the psycho-social interactive model of resilience, which reveals the interaction between individual resilience factors (i.e. coping, confidence and self esteem) and external resilience environments (i.e. employment, supportive family environments and health promoting policies) in facilitating the development of resilience. This present study explored the utility of this model of resilience for understanding how people self-manage type-2 diabetes. Methods: Data were collected via 14 semi-structured life-history interviews with women and men living with type-2 diabetes mellitus (T2DM). Participants varied according to socio-demographics (gender, age, education level, income) and were recruited based on their self-reported management (or lack thereof) of T2DM. Results: The inter-play of internal traits and external resources with additive and subtractive resilience strategies were consistent with the psycho-social interactive model of resilience. Self-management was influenced by life history. Differences in self-management and material disadvantage were also identified. Alongside increased disadvantage are higher levels of external barriers to self-management practices. Conclusions: This paper supports the concepts of additive and subtractive resilience strategies for use with diabetes populations; providing health professionals and policy makers with an increased understanding of how to recognize and foster patient resilience for the improvement of self-care, disease management and ultimately health outcomes. Refereed/Peer-reviewed

Background This paper evaluated the implementation West Central Alabama Area Health Education Center programs for high school students in grades 9–12 through participant-reported evaluations and feedback during the September 1st, 2013 to August 31st, 2014 fiscal year. The programs targeted racial/ethnic minorities and/or rural individuals interested in pursuing a career as a healthcare provider in medically underserved counties of Alabama. Methods Students participated in enrichment activities related to prospective health careers that included: successful college preparedness, knowledge about health careers, and the types of primary care health professions that are needed in underserved Alabama communities. The curriculum studied 593 (ACT preparation: n = 172, AHEC 101: n = 56, FAFSA: n = 109, Health Career Exploration: n = 159, College Career Readiness: n = 67, Dixie Scholars NERD: n = 30) baseline measures for the programs to evaluate effectiveness when rated by participants both quantitatively and qualitatively. Results Interactive activities with video incorporation, hands-on experiences, and group discussions paired with student motivation and interest in specific health career-related activities provided the highest program ratings. Conclusions It is important to use a variety of successful program strategies when forming healthcare workforce development interventions. Student evaluations can help adapt methods for future program implementation to ultimately achieve strategies for health professional recruitment, training, and retention in areas that lack access to quality healthcare.

Background Misuse of alcohol, including single risky occasion drinking (RSOD) is associated with a number of health, social and economic consequences. While research demonstrates that many factors contribute to individuals’ drinking practices, little is known about risk factors that contribute to RSOD in the Canadian population. The objectives of this study are to examine the patterns of RSOD in Canada, to identify factors associated with RSOD, and to explore policy implications. Methods The Canadian Community Health Survey (CCHS) 2009–2010 annual component was used to conduct all the analyses in this paper. We used two models: (1) a binary logistic regression model, and (2) a multinomial logistic regression model, to identify factors that were significantly associated with our dependent variables, RSOD engagement and frequency of RSOD, respectively. Results Daily smokers were 6.20 times more likely to engage in frequent RSOD than those who never smoke. Males were 4.69 times more likely to engage in risky RSOD. We also found significant associations between the frequency of RSOD and Province/Territory of residence, income and education, marital status and perceived health status. Finally, stress was associated with engaging in infrequent RSOD. Conclusions Our finding associating daily smoking with risk alcohol intake specifically suggests the possibility of combining public health interventions for both. The study findings also indicate that education is a protective factor, further supporting the role of education as a major determinant of health. The significant provincial variation we found also point to the need to study this issue further and understand the links between provincial level policies and RSOD.

Background The adequacy of micronutrient intake is a public health concern, as both insufficient and excessive intake levels may result in adverse health effects. Data on dietary intake are needed to evaluate potential problems regarding inadequate intake at population level and to formulate effective public health and food safety recommendations. Assessing the intake of micronutrients in population subgroups such as infants, toddlers, pregnant and lactating women is challenging and requires specific approaches. This paper describes the Belgian VITADEK study, developed to assess fat-soluble vitamin intake from the consumption of food, fortified foods and supplements in four vulnerable groups namely infants, toddlers, pregnant and lactating women. Methods Subjects were selected according to a multi-stage stratified sampling design with a selection of clusters proportionate to the population size. Recruitment occurred in collaboration with Belgian child health consultation centres and obstetric clinics. Participants were asked to complete a self-administered online food frequency questionnaire (FFQ) or to answer the questionnaire by phone if online participation was not possible. The questionnaire was tailored to the specific diet of the different target populations. In order to capture vitamin intake from the consumption of foods, fortified foods and supplements, a market study was conducted to take an inventory of the fortified foods and supplements available on the Belgian market. The food list of the FFQ was based on both this inventory and the top 90% food groups that contribute to fat-soluble vitamin intake. Since fortification differs at brand level, food groups and subgroups were split up to the level of the brand of foods. Brand pictures were used as mnemonics to facilitate the recall of the consumed food items and portion pictures were used to facilitate the reproduction of the consumed portion sizes. Finally a composition table was compiled allowing for the computation of vitamin intake from all sources providing as such more accurate estimates of fat-soluble vitamin intake. Discussion The results will allow assessing inadequate micronutrient intake by comparison of vitamin intake with dietary reference values. The data will further allow describing the most contributing food groups as well as the contribution of fortified foods and supplements to total vitamin intake. The data will enable evaluating whether infants, toddlers, pregnant and/or lactating women are reached by the actual Belgian fortification and supplementation programmes. Finally the retrieved data will reveal the potential for voluntary fortification and the need for future fortification and supplementation programmes. Electronic supplementary material The online version of this article (doi:10.1186/s13690-017-0199-3) contains supplementary material, which is available to authorized users.

Front-of-pack nutrition labelling has been highlighted as a promising strategy to help consumers making healthier food choices at the point of purchase. In France, a simplified front-of-pack nutrition labelling system was proposed in 2014, the 5-Colour Nutrition Label (5-CNL). It is supported by studies evaluating the various dimensions of the validation of both its underlying classification algorithm and its format. Opposed by agro-industry and retailers, multiples lobbying strategies have been deployed to stop or at least delay the implementation of the 5-CNL. Various alternative nutrition labels were proposed, and a full-scale trial was successfully argued for. This paper retraces the various steps of the opposition between public health and agro-industry lobbies on the topic of front-of-pack nutrition labelling in France.

Background This paper presents design and findings from the process evaluation of a randomized controlled trial (RCT) testing the effectiveness of Smarter Lunchrooms Movement (SLM) interventions to encourage consumption of either fruit, vegetables, or unflavored milk in middle school cafeterias (grades 6–8, typically children ages 10–14 years). Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework adapted for environmental interventions, the process evaluation monitored fidelity to SLM protocol, determined barriers and facilitators influencing fidelity, and identified the training and support needs of implementers. Methods Under research team guidance, community partners (interventionists) assisted school food service staff (providers) with a six week implementation of protocol items in 13 public middle school cafeterias (two milk treatment, three vegetable treatment, four fruit treatment, and four control) in New York State during the 2013–2014 academic year. Process evaluation measures included semi-quantitative measures of implementation and maintenance (lunchroom audits) and qualitative data (environmental assessments and semi-structured interviews with school food service staff). Analyses identified challenges and opportunities for improving intervention delivery. Results Approximately 75 % of enrolled students participated in school lunch programs and thus were exposed to the SLM intervention. Findings indicated potential contamination by other nutrition-related activities in the lunchroom and larger school environment may have affected the intervention impact. Modest implementation fidelity scores were observed for intervention treatments. Providers reported treatments were acceptable and feasible, however interventionists confirmed motivation and perceived effectiveness varied among schools. Post-intervention audits revealed limited maintenance of intervention protocols. Strategies to enhance buy-in and communication among providers and increased interventionist support are recommended. Conclusions RE-AIM was a valuable framework for this process evaluation. Results highlighted implementation barriers and facilitators, and findings will enhance interpretation of forthcoming outcome data. Results will inform future iterations of the SLM RCT and provide valuable insights for those designing environmental interventions in school cafeterias.

Background Registration of patients with substance use disorders is of key importance to get insights and to study trends in patients characteristics and substance use patterns. The Treatment Demand Indicator (TDI) is gathering this information at European level since 2000. In Belgium, this registration started at national level in 2011 and an increasing number of facilities of different types are participating in this data collection since then. Methods/Design This surveillance register collects information on every treatment episode started by patients for their substance use disorder. Information is collected on socio-demographic characteristics of the patient, treatment history and substance use patterns. Patients are identified uniquely using their national identification number in order identify multiple episodes followed by a same person. A large range of treatment facilities have the possibility to participate in this registration to allow a wide coverage of the population. Discussion The objective of the paper is to facilitate the use of data by authorities or researchers by correctly describing all aspects of the indicator. The case definition, the variables collected and the way data should be reported are of key importance to use and interpret the data correctly. An overview of the data registered in 2014 gives also an idea of the content of the database. The article also pictures the strengths and limitations of the register and foresees some future improvements.

Background A domain-specific physical activity questionnaire (EHIS-PAQ) was developed in the framework of the second wave of the European Health Interview Survey (EHIS). This article presents the EHIS-PAQ and describes its development and evaluation processes. Methods Research institutes from Belgium, Estonia and Germany participated in the Improvement of the EHIS (ImpEHIS) Grant project issued by Eurostat. The instrument development process comprised a non-systematic literature review and a systematic HIS/HES database search for physical activity survey questions. The developed EHIS-PAQ proposal was reviewed by survey experts. Cognitive testing of the EHIS-PAQ was conducted in Estonia and Germany. The EHIS-PAQ was further tested in a pilot survey in Belgium, Estonia and Germany in different modes of data collection, face-to-face paper and pencil interview (PAPI) and computer assisted telephone interview (CATI). Results The EHIS-PAQ is a rather pragmatic tool aiming to evaluate how far the population is physically active in specific public health relevant settings. It assesses work-related, transport-related and leisure-time physical activity in a typical week. Cognitive testing revealed that the EHIS-PAQ worked as intended. The pilot testing showed the feasibility of using the EHIS-PAQ in an international health interview survey setting in Europe. It will be implemented in all 28 European Union Member States via European Union implementing regulation in the period between 2013 and 2015. This will be a first opportunity to get comparable data on domain-specific physical activity in all 28 EU MS and to publish indicators at the EU level. Conclusions The EHIS-PAQ is a short, domain-specific PA questionnaire based on PA questions which have been used in large-scale health interview surveys before. It was designed by considering the respondents’ perspective in answering PA questions. Electronic supplementary material The online version of this article (doi:10.1186/s13690-015-0110-z) contains supplementary material, which is available to authorized users.