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Aim: A novel corona virus disease 2019 (COVID-19) was declared as pandemic by WHO as global level and local levels in many countries. The movement of people might be one influencing factor, this paper aims to report the situation COVID-19 and spreading in Thailand, including influencing factors of spreading and control. Subject and method: Infected, confirmed COVID-19 data were obtained from the official website of the Department of Disease Control, Ministry of Public Health. Tourist data was downloaded from Ministry of Tourism and Sports. Researchers analyzed the situation from the first found case in Thailand until 15 April 2020 with the timeline of important influencing factors. Correlation coefficients of tourist data and infected case was calculated by person correlation coefficient. Results: The number of infected cases was significant associated (correlation coefficient > 0.7) with economic factor, namely; number of visitors, generated income from both Thai and foreigner tourist (p value <0.01). The influencing factors of slow increased rate were the enforcement and implementation of both central and local government regulation, the strength of the Thai health care system, the culture and social relation, the partnership among various governmental and private sectors. Conclusion: We found that the number of tourist and their activities were significant associated with number of infected, confirmed COVID-19 cases. The public education and social supporting were the key roles for regulation enforcement and implementation. [ABSTRACT FROM AUTHOR]

Aim: Obesity is prevalent in Puerto Rico due to intersecting structural inequalities such as poverty and unemployment. At the same time, type 2 diabetes mellitus is also highly prevalent on the island due to similar structural factors. The role of food access and identity contributes to the ways in which the illnesses interact. The two illnesses furthermore form part of a syndemic in Puerto Rico. The island's status as a US territory leaves Puerto Rico with limited economic resources from the US government for necessary programs like Medicare. As such, this paper proposes that obesity and diabetes form a syndemic in Puerto Rico. Subject and methods: Interviews were conducted with 75 Puerto Ricans, recruited from the Centro de Diabetes Para Puerto Rico. Results: Thirty-six participants had obesity, and an additional 14 were overweight. Sixty-five participants had type 2 diabetes. Study participants perceived that Puerto Rico's subaltern status deleteriously affected obesity rates due to limited US federal assistance for health insurance and for imported fresh foods and vegetables. Diabetes was due to both weight mismanagement and a lack of healthcare providers. Conclusions: Obesity and diabetes form a syndemic in Puerto Rico through multiple and interacting structural factors, such as crime, unemployment, and a broken healthcare system. Puerto Rico's economic and healthcare crises leave the island in a difficult situation, unable to support itself and without the resources to improve its situation. [ABSTRACT FROM AUTHOR]

Background: The Comparative Risk Assessment (CRA) framework comprehensively evaluates the impact of exposure to risk factors on health populations using the counterfactual causal approach. Methods: We propose a framework, Comparative Disease Assessment (CDA), for assessing the impact of exposure to morbidity from some diseases on health outcomes, particularly death from other (relevant) diseases. This framework has been developed following the ideas of the CRA framework and using the widely accepted concept that exposure to morbidity is usually a risk factor for health outcomes (morbidity/mortality) related to other diseases. Our framework uses a counterfactual and not a categorical approach when attributing the burden of health outcomes to potential causes. Results: This paper describes the different steps and assumptions required to implement the CDA framework, and an illustrative example is used considering diabetes mellitus morbidity as a risk factor for death from heart diseases. Conclusions: One advantage of the CDA framework is that it can be applied using multi-causal death registries. Some assumptions are needed to implement it in order to avoid biases, but at least it can provide preliminary estimations of the impact of exposure to diseases as risk factors for deaths from other diseases. Another main advantage is that the burden of deaths is no longer attributed to a single cause, the underlying cause, as it is almost always done. Finally, this framework provides information on the pattern of comorbidity in a (sub)population of subjects who is about to die. These patterns can be used as a reference for alternative patterns of the general population or patterns of other specific subpopulations. [ABSTRACT FROM AUTHOR]

Aim: There is a growing population of lung cancer survivors who may have unmet physical, psychological, and practical needs as they transition from active treatment into recovery. The specific needs and best ways to meet them are unclear in this population. This paper describes the development and outcomes of a program aimed to transition patients to survivorship. Subject and methods: Patients with early-stage lung cancer were assessed for the presence and severity of unmet physical, psychological, and practical needs at the end of active treatment. Patients also attended a multidisciplinary clinic visit to create an individualized survivorship care plan and provide appropriate referrals. They were surveyed 3 months later to assess effectiveness of the program. Results: Eighty-four participants were enrolled in the program. All reported at least one unmet need, with a mean of seven unmet needs, particularly related to breathing, fatigue, pain, and fear/anxiety. Following program participation, there were fewer and/or less severe needs. Conclusions: The Bridge program identified and decreased the number and severity of unmet needs through connecting survivors to local resources. Challenges to program implementation included hesitancy of providers to refer, time constraints of survivors and staff, and lack of community resources, especially for identified mental health needs. [ABSTRACT FROM AUTHOR]

Public health and health care science take on an important role in the further development of palliative care. This study examines to what degree palliative care is represented in the pertinent academic journals of public health and health care science and what the major subjects are. We analysed the European journals that were listed in the Journal Citation Reports in the categories health care science and services, public, environmental and occupational health, as well as health policy and services. The literature search was conducted in the journals identified for the years 1996 through 2005, using the terms palliative care*, palliative medicine*, terminal care* and hospice care*. The analyses were based on the quantity of publications in the journals, the publication years, the impact factors and the subjects focused on. There were 82 journals included. Altogether, 57,737 publications appeared during the analysis period; 166 papers were on palliative care (0.3% of all papers). The majority of palliative care articles (55%, n = 91) were concentrated in a very small circle of journals (4%, n = 3). The absolute quantity of palliative publications and their percentage among all publications have continuously increased from 0.1% in 1996/1997 to 0.4% in 2004/2005. The largest group of papers on the subject (42%, n = 70) appeared in journals with impact factors less than 1, whereas the largest group of all papers was found in journals with impact factors of 1–1.999 (51%, n = 15,732). Most papers focus on patient orientation and health professionals’ perspective and education; subjects such as health care utilization and barriers are less frequently covered. There is need for more research on palliative care relevant for public health and health care science in terms of reach and top-level impact. For example, the research questions should deal with health care utilization and potential social and cultural barriers. The interdisciplinary community of public health sets the stage for the required collaborative research activities. [ABSTRACT FROM AUTHOR]

The aim of the paper is to examine the health financing reform in Romania in order to find out to what extent the expected results were achieved, what were the main factors that influenced the reform process and in what way the main unsolved problems are to be sorted out. The paper describes the main features of the health financing reform outlining the factors that determined or influenced it, presents some of the reform outcomes and discusses the current health policy agenda. The main findings of this examination are the following: the expected results of the health care reform were not fully achieved (one of the main causes was the too high expectations that did not take into account the country’s low starting point at the beginning of the transition); the reform process was slowed down mainly by political instability, the funds for health increased over time, but this was not enough to increase health system performance and patient satisfaction, the health system reform finally became one of the main priorities on the government agenda. The paper concludes that it took quite a long time until the Romanian government took over its stewardship role of the health system, with the understanding that health reform cannot be a separate process but rather is in need of intersectorial action, clear and coherent legislative support and strong political backing. [ABSTRACT FROM AUTHOR]

Background: In a global comparison, in 2006 Germany was the first in the world to switch naratriptan to an OTC medication but since then only almotriptan has been switched. Therefore, Germany has fallen behind recently because of the failure to carry out further switches. Objectives: The aim of this extensive evaluation of various surveys among pharmacies, physicians, patients and stakeholders was to investigate whether there is an obvious need for an Rx-to-OTC switch of further triptans. In addition, reasons for or against such a switch should be evaluated. Setting: The surveys were distributed in several ways. Most were based on online tools and were performed in 2017, 2018 and 2019. Methods: Several surveys have been initiated using different methodologies. The pharmacist surveys were only conducted digitally. The physician surveys were first digitally based on an online platform. A paper form could also be edited manually and returned by fax. The respective questionnaires consisted of 5 to 17 questions on the topic of switching and could all be answered in about 5 to 10 min. BAH Health Monitor hosted the patient surveys and included telephone interviews. The stakeholder survey was performed by personal interviews. The surveys on economic calculations among patients were conducted digitally. Main outcome measure: Sumatriptan and other Rx triptans are suitable and should be switched to OTC status. Results: Nine hundred forty pharmacists and pharmaceutical technical assistants took part in the initial pharmacist survey. In the subsequent pharmacist surveys, the volume of participants was even higher and reached almost 4000. For the physician survey, 540 answers were received, and the BAH Health Monitor addressed about 1000 telephone interviews. Within the stakeholder survey, 24 interviews were carried out with 32 participants from a range of professional backgrounds; most are part of the German switch process. Finally, the patient survey related to economic calculations was based on 175 answers. Seventy percent of the participating physicians < 50 years old supported a switch of further triptans. For the question about how safe OTC triptans are, 41% of the 3568 participants from the Marpinion pharmacy survey voted that they are safe. Conclusion: With a Rx-to-OTC switch of further triptans, patients would have an easier, faster and safe way to treat their migraine attacks. Impact of findings on practice statements: The outcome of these surveys and interviews provides information for all participants in the German switch process about their decision-making behaviour. Furthermore, it allows deeper insights into patients' needs and may help to fulfil them. The results can provide information about the German process and German needs worldwide and stimulate discussion about Rx-to-OTC switches. [ABSTRACT FROM AUTHOR]

Aim: Child malnutrition is also associated with higher incidence of morbidity and mortality. Therefore, it is imperative to have knowledge of its correlates and determinants. The objective of this paper is to examine the association between demographic and socioeconomic factors and child nutritional status in Bangladesh. Subject and methods: A secondary data analysis was conducted using the 2014 Bangladesh Demographic and Health Survey data. The surveys used a stratified two-stage cluster sampling. In the first stage, 600 enumeration areas (EAs) were selected with probability proportional to the EA size. In the second stage of selection, a fixed number of 30 households per cluster will be selected with an equal probability systematic selection from the household listing. The sample constitutes 17,886 ever-married women age 15–49, with 34.38% and 65.62% from urban and rural areas respectively. The anthropometric indicators height-for-age, weight-for-age and weight-for-height z-scores were used as the primary and secondary outcome measures. Results: Results show that age and birth order of child is negatively associated with height-for-age, weight-for-age, and weight-for-height z-scores. However, the size of the child at birth is positively allied with the three anthropometric indicators. Mothers' BMI and educational level are positively connected with the nutrition z-scores, but these factors have differential effects at different points of the conditional distribution of the anthropometric z-scores. Moreover, the economic status of a family is an essential factor in determining the z-score of height-for-age, weight-for-age, and weight-for-height of a child. Conclusion: The age, size of child at birth, mother's BMI and educational status, and wealth index are very important determinants of the z-score of the anthropometric indicators of a child. In order to improve the nutritional status of children in Bangladesh, the authors suggest that a joint effort by the government, non-governmental organizations, and the community is absolutely essential. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this paper is to investigate the implementation of value-based care principles in the context of frailty in the perioperative process, highlighting the importance of an integrative perspective considering medical and patient-centric outcomes as well as costs. Subject and methods: This mixed-methods study employs a sequential design. Qualitative observational data were used to identify needs and barriers for implementing value-based principles, and quantitative methods were subsequently used to demonstrate the value of employing such an approach using data gathered from n = 952 patients. Propensity score matching was applied to identify the frailty-associated costs of the inpatient setting for n = 381 non-frail and n = 381 (pre-)frail patients, in particular considering patient-centric outcomes. Results: The qualitative analysis identified three main challenges when implementing value-based principles in the context of perioperative care and frailty, namely challenges related to the cost, patient-centric, and integrative perspectives. In addressing these shortcomings, a quantitative analysis of a propensity score-matched sample of patients undergoing surgery shows additional frailty-associated costs of 3583.01 [1654.92; 5511.04] EUR for (pre-)frail patients and the influence of individual patient-centric attributes. Effect size Cohen's d was 0.26. Conclusion: The results demonstrate that frailty should be considered from an integrative perspective, taking cost, patient-centered outcomes, and medical outcomes into account simultaneously. The results also show the value of a research design which uses qualitative data for the identification of needs and barriers, as well as quantitative data for demonstrating the usefulness of the conceived value-based approach to perioperative care delivery. [ABSTRACT FROM AUTHOR]

Aims: Although ambient assisted living (AAL) environments and serious games for healthcare have been proposed as solutions to meet the changing demographics, the two approaches are rarely combined. We present the development and empirical evaluation of two serious games for healthcare in AAL. The first uses a cooking scenario for training of cognitive functioning. The latter uses a gardening scenario and motion capture for training agility and endurance. As the frequent lack of social acceptance is a major challenge in consumer health technology, we integrated methods of technology acceptance research by means of the UTAUT2-model and intention to use into the evaluation. Subject and methods: We developed both games utilizing user-centered and participatory design methods ranging from low-fidelity paper prototypes to usability and acceptance evaluations of functional prototypes. In the final evaluation, each game prototype was evaluated by 64 participants form different age groups. Results: The results show that although performance decreases with age, the performance attained in the games is not decisive for social acceptance measured as intention to use. However, user diversity factors shape the evaluation of the games, and older people and people with low technical competence are in danger of being excluded from using serious games for healthcare. Conclusion: Exercise games, if designed right, can mitigate the negative effects of demographic change. Nevertheless, user diversity needs must be considered to ensure that the games are usable and used by a broad audience. The article concludes with guidelines and open research questions for the design of serious games in AAL environments. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to investigate online health information seeking and health literacy among non-medical college students in Egypt and the differences between the two genders. Subjects and methods: A cross-sectional descriptive design was used to collect data from 600 students through a self-administered questionnaire. Results: Most of the students searched for health information on the internet (82.3%). 90.3% of them used their mobile phones and 97.8% sought data via Google. Skin and hair problems was the most searched for topic (83.3%), followed by reproductive health (79.7%). Students perceived that rapid and easy access to information were the main advantages of health information seeking online (98.5% and 95.5%, respectively), while the lack of reliability and scarcity of information in the Arabic language were the main disadvantages (78.2% and 60.5%, respectively). Only 31.2% of the sample achieved an adequate literacy level. Females in our sample had a higher frequency of online health information seeking and a higher level of health literacy. They also had a higher percentage of searching for health data on YouTube and seeking nutrition information. On the other hand, males used online health applications more frequently and were more interested in physical fitness and smoking. Females perceived the high cost as the main disadvantage of online health information seeking, while males were more concerned about the reliability of information. Health literacy was positively related to female gender and frequency of online health information seeking. Conclusion: Using the internet to deliver health information according to each gender's preferences and concerns can encourage students to search for health information online and, therefore, raise their health literacy level. [ABSTRACT FROM AUTHOR]

Background: The United States leads the world in several chronic health conditions (CHCs). Yet, CHCs are preventable. Aim: This paper examines influences on rating of the seriousness of CHCs among American adults. Subjects and Methods: The study involved 1011 American adults aged 18 or older. Data came from Obesity in the United States: Public perceptions. We explored factors that are associated with knowledge of the seriousness of CHCs, via a multiple linear regression analysis. Results: Significant associations were found between the rating of the seriousness of CHCs and obesogenic environment, age, sex, race, and education. For instance, respondents living in obesogenic environments rated CHCs as less serious. Younger people rated CHCs as less serious compared to older people. Also, Blacks and Hispanics rated CHCs as serious health issues facing America compared to Whites. However, the joint association of education and race showed that Blacks who had at most a high school degree rated CHCs as less serious compared to Whites and all college graduates. Conclusion: The determinants of rating of the seriousness of CHCs facing America may be complex and need more studies. However, inadequate knowledge of frequently occurring health conditions may possibly contribute to high incidence of CHCs. It is therefore necessary that Americans know about the seriousness of CHCs facing the United States. This knowledge may also help American adults buy into health policies geared toward health disparities reduction. [ABSTRACT FROM AUTHOR]

Aim: A comprehensive approach to health highlights its close relationship with the social and economic conditions, physical environment and individual lifestyles. However, this relationship is not exempt from methodological problems that may bias the establishment of direct effects between the variables studied. Thus, further research is necessary to investigate the role of socioeconomic variables, their composition and distribution according to health status, particularly on non-communicable diseases.Subjects and methods: To shed light on this field, here a systematic review is performed using PubMed, the Cochrane Library and Web of Science. A 7-year retrospective horizon was considered until 21 July 2017.Results: Twenty-six papers were obtained from the database search. Additionally, results from “hand searching” were also included, where a wider horizon was considered. Five of the 26 studies analyzed used aggregated data compared to 21 using individual data. Eleven considered income as a study variable, while 17 analyzed the effect of income inequality on health status (2 of the studies considered both the absolute level and distribution of income). The most used indicator of inequality in the literature was the Gini index.Conclusion: Although different types of analysis produce very different results concerning the role of health determinants, the general conclusion is that income distribution is related to health where it represents a measure of the differences in social class in the society. The effect of income inequality is to increase the gap between social classes or to widen differences in status. [ABSTRACT FROM AUTHOR]

Background: Healthcare is a serious issue confronting governments and households and calling for repeated deliberations in international forums. Ensuring good health for all was the predominant call of the millennium development goals (MDGs), re-echoed again in the sustainable development goals (SDGs). The first objective of this study is to evaluate and compare the impact of public and private health spending on life expectancy, and the second objective is to examine the causal link among public health expenditure, private health expenditure and life expectancy in Cameroon. Methods: We used annual time series data from 1980 to 2014. Ordinary least squares (OLS) regression was employed to evaluate the effect of public and private health expenditure on life expectancy while the Toda and Yamamoto causality test was used to examine the relationship among public health expenditure, private health expenditure and life expectancy in Cameroon. Results: The result shows that private health expenditure has a positive and significant impact on life expectancy while public health expenditure has no significant impact on life expectancy in Cameroon. The results of the causality test show a bidirectional causality between private health expenditure and life expectancy and a unidirectional causality running from life expectancy to public health expenditure. Conclusions: The findings of this study suggest that the Cameroonian government should continue to embark on its poverty reduction strategy elaborated in its Growth and Employment Strategy Paper (GESP) and in pursuing its vision of attaining the SDGs by 2030. In addition, establishing effective public-private partnerships in developing the health sector could go a long way to improve the health status of the population. [ABSTRACT FROM AUTHOR]

Background: The ongoing Boko Haram insurgency in northeastern Nigeria has depleted the country's capability to deliver quality healthcare to her citizenry. The ailing health sector is overwhelmed with a rising incidence and prevalence of infectious and non-communicable diseases. Aim: The aim of this paper was to determine the trend of kidney disease, end-stage renal disease (ESRD), anaemia, malnutrition and human immunodeficiency virus (HIV) in northeastern Nigeria. Materials and methods: Data covering different periods between 1999 and 2017 were obtained from the University of Maiduguri Teaching Hospital (UMTH), Maiduguri in northeastern Nigeria. This hospital is the largest tertiary healthcare facility in the region. The data were demographic in nature, i.e. sex, age or simply the registered cases. A quadratic model of time-series analysis was used to create the various trends of the respective diseases with the aid of Minitab software (version 18.0). t-Tests and analysis of variance (ANOVA) were also performed, with a p-value of less than or equal to 0.05 being considered significant. Results: About three out of every five patients treated for kidney disease were male, while three out of every five patients treated for HIV were female. Patients between the ages of 31 and 50 years were at the greatest risk of developing kidney disease. The mean distribution of disease incidence was the same for both sexes for kidney disease, anaemia, malnutrition and HIV. The mean distribution disease incidence was different between age groups for kidney disease but the same for anaemia. The incidence of anaemia and malnutrition reported was almost the same for both sexes. Children under the age of 10 years old were at the most risk of anaemia, with the distribution decreasing with increasing age. The trend analysis of the incidence of kidney disease, ESRD, anaemia and malnutrition showed that these ailments were on the increase, while the number of patients that were on antiretroviral therapy (ART) was on the decline in northeastern Nigeria. Conclusion: These increasing trends are evidences of the effect of Boko Haram on the public health of the people of northeastern Nigeria and will continue to be a public health concern for the region and the country as a whole. [ABSTRACT FROM AUTHOR]

Aim: Non-pharmaceutical interventions such as lockdowns have played a critical role in preventing the spread of the Covid-19 pandemic, but may increase psychological burden. This study sought to examine emotions reflected in social media discourse following the introduction of social contact restrictions in Central Europe. Subjects and methods: German-language Twitter posts containing '#corona' and '#covid-19' were collected between 2020/03/18 – 2020/04/24. A total of 79,760 tweets were included in the final analysis. Rates of expressions of positive emotion, anxiety, sadness and anger were compared over time. Bi-term topic models were applied to extract topics of discussion and examine association with emotions. Results: Rates of anxiety, sadness and positive emotion decreased in the period following the introduction of social contact restrictions. A total of 16 topics were associated with emotions, which related to four general themes: social contact restrictions, life during lockdown, infection-related issues, and impact of the pandemic on public and private life. Several unique patterns of association between topics and emotions emerged. Conclusion: Results suggest decreasing polarity of emotions among the public following the introduction of social contact restrictions. Monitoring of social media activity may prove beneficial for an adaptive understanding of changing public concerns during the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

Aim: Despite major advances in maternal and child health care initiatives in India, the Millennium Development Goal (MDG)-4 targeting a two-third reduction in under-five mortality appears to be unattainable by 2015. This paper assesses India’s feasibility towards averting infant (0–11 months) and child (0–4 years) mortality by 2015 across regions and major states. Subjects and methods: Using statewise estimates on infant mortality rate (IMR) during 1990–2009 and child mortality rate (CMR) during 1990–2008 from the Sample Registration System of India, this paper estimates average annual rate of reduction (AARR) in IMR and CMR across regions and major states. The estimates are also provided for the shortfall in IMR and CMR from the projected estimates of 2015 and the required AARR for the successive years up to 2015. Results: Estimated figures suggest that India has experienced a substantial decline in the IMR and CMR since 1990. However, an AARR of around 10 and 8 % is required for reducing infant (during 2010–2015) and child mortality (during 2009–2015), respectively, in order to achieve a two-third reduction in the IMR and CMR from the level of 1990. Conclusion: Although the MDG-4 target is based on U5MR in totality, this study draws attention towards the progress in major components of the U5MR separately, and advocates for disaggregation of MDG target at national level in terms of focus (region-specific) towards achieving required reduction in separate components of under-five mortality. [ABSTRACT FROM AUTHOR]

Aim: Risky sexual behaviours (RSB) among adolescents is one of the major public health concerns globally. These behaviours–RSB have adverse effects on their future health and well-being. Therefore, in this paper, our aim was to assess the determinants of RSB among in-school Namibian adolescents using the 2013 Global School-based Health Survey. Methods: The data was extracted and analysed with STATA version 14.2. Both bivariate and multivariable analyses were done to generate results that infomed the discussion. The results were presented as odds ratios and adjusted odds ratios (AOR) with their respective 95% confidence intervals (CI). Level of statistical significance was declared at a p-value of < 0.05. Results: Our results showed that of the 2846 adolescents surveyed, 51.8% reported they have ever had sexual intercourse. Fifty-eight percent reported having multiple sexual partners and 23.2% reported not using a condom during their last sexual intercourse. The multivariable analysis showed that age [AOR = 2.50; CI = 1.99–3.14], sex [AOR = 0.40; CI = 0.34–0.47], grade [AOR = 1.80; CI =1.38–2.36], suicidal ideation [AOR = 1.44; CI =1.16–1.79], bullying [AOR = 1.36; CI = 1.15–1.62], hunger [AOR = 1.39; CI = 1.17–1.64], alcohol use [AOR = 1.57; CI = 1.31–1.89], marijuana use [AOR = 1.98; CI = 1.14–3.45] and parental knowledge of activity [AOR = 0.82; CI = 0.68–0.99] showed statistically significant influence on sexual experience. Sex [AOR = 0.43; CI = 0.33–0.55], grade [AOR = 1.58; CI = 1.15–2.18], alcohol use [AOR = 1.37; CI =1.07–1.75], marijuana use [AOR = 2.23; CI = 1.11–4.46] and parental supervision [AOR = 0.76; CI = 0.59–0.98] were associated with multiple sexual partners. There was also statistically significant association between age [AOR = 0.32; CI = 0.21–0.48], loneliness [AOR = 1.49; CI = 1.04–2.14], number of close friends [AOR = 0.60; CI = 0.37–0.96] and parental supervision [AOR = 0.43; CI = 0.32–0.60] on non-condom use. Conclusion: These findings underscore the need for a pragmatic approach in addressing RSB among adolescents by adopting substance use prevention and mental health promotion programmes and by encouraging more parental involvement in activities of their adolescents. [ABSTRACT FROM AUTHOR]

Aim: Gambling harm is a serious public health issue affecting the health, financial security, and social well-being of millions of people and their close relations around the world. Despite its population health implications, gambling harm is not typically viewed and treated as a public health policy issue. This paper critically reviews the evolution of the public health perspective on gambling harm. It also considers how gambling harm can be operationalized within a public health model. Methods: A critical historical review of the emerging public health perspective on gambling harm was conducted. Key documents covering three decades of development were reviewed and appraised through a process of deliberation and debate over source impact in the fields of research, policy, and programming internationally. Results: The first decade mainly focused on identifying gambling harm and framing the public health issue. The second decade featured the expansion of health assessment and emerging areas of policy and program development. The third decade saw an increased focus on public health frameworks that advanced understanding of harm mechanics and impact. As reflected by the essential functions of a general public health model, gambling harm prevention efforts emphasize health promotion over other key functions like health assessment and surveillance. Conclusion: Gambling harm is a public health issue requiring greater attention to health assessment and surveillance data development. [ABSTRACT FROM AUTHOR]

Aim: To carry out a systematic review based on the analysis of national and international publications in the scientific literature about the occurrence of oral manifestations in patients with anorexia and bulimia nervosa. Methods: We searched for evidence in the PubMed, Scopus, Web of Science, VHL Regional Portal, and Embase databases. We included case–control studies that analyzed oral manifestations such as dental caries, periodontitis, malocclusion, dental erosion, and soft-tissue lesions in individuals of both sexes with anorexia and bulimia nervosa. The method for quality assessment of each study was according to Downs and Black criteria. Results: We identified 1958 studies. Excluding repeated studies, 1045 papers remained. We removed those that did not approach the theme proposed and applied the exclusion criteria, leaving 66 surveys. We analyzed abstracts in duplicate, excluding those with inconsistent results, or which were biased or unclear, and those that did not meet the standards established. Conclusion: The final number of studies was six; all of them dealt with the question of oral manifestations found in patients with anorexia and bulimia nervosa, and presented validity and consistency in their methodological structure and results. [ABSTRACT FROM AUTHOR]

Subject and aims: This paper reports on the development and evaluation of a stress prevention program for adolescents of grades 8 and 9. The program is based on the problem-solving approach and was developed on the basis of several evaluation studies. It consists of eight weekly training sessions with durations of 90 min each and is accompanied by an e-learning platform. Evaluation studies: The first section of the paper reports on a preceding demand analysis and the initial development and evaluation of the stress prevention program. The second section summarizes the results of providing an additional e-learning platform. Eight online-lessons were designed in correspondence to the training sessions of the face-to-face intervention. The last section of the paper focuses on the results of an evaluation of an optimized training version including the successful elements of the face-to-face and the e-learning platform. Results and conclusion: The results of the final evaluation study showed clear knowledge and self-efficacy improvement and reduction of stress symptoms. Moreover, the training led to positive assessments by most adolescents. Possible actions in contributing to an increase of the training effects beyond those already apparent in the current evaluation studies are additionally discussed. [ABSTRACT FROM AUTHOR]

The aim of this paper is to provide a discussion on how the public health policy process can be influenced by both civil society groups and by public health practitioners. A discussion expressing the views of the author supported by the relevant literature drawn from a wide range of sources and using international case study material on influencing public policy. The first part of the paper discusses the role of empowerment in improving health outcomes. The second part of the article discusses the policy development process, and the third part explains, step by step, the opportunities that exist to influence this process by both practitioners and people in civil society. The paper concludes with the question: ‘To what extent can external public action have an effect on defining the policy concerns of government?’ and draws on the evidence presented in the paper to provide some solutions. The paper will be of interest to the planners and evaluators of public health programmes interested in improving effectiveness and promoting community empowerment approaches. [ABSTRACT FROM AUTHOR]

In a first step this paper outlines the global context of and international influences on nurse migration. Liberalization of health markets is identified as a trigger point steering movements of nurses globally. Facts and figures concerning nurse migration are highlighted in a second section focusing on developments in the USA and UK, which are recruiting nurses from Europe and overseas on a large scale, and adding the latest European approaches and policies concerning this issue. Projections are presented that highlight growing demands for the next 2 decades. The third part explores the impact of nurse migration on nursing care and professional standards. The article is based on an extensive literature review and the analysis of quality issues in the nursing field. The number of nurse migrations in the last decades show that the issue of nurse migration is already of high importance for many countries. This will be enhanced by future accelerated development of nursing shortages in many countries. Boosted global recruitment of nurses will be the consequence.The paper concludes that the recruitment of international nurses has not yet taken quality issues and indicators in health-care settings profoundly into consideration. Economical gains by not training nurses and recruiting them from abroad might have a severe impact on already existing problems concerning patient safety issues and nurse-sensitive outcomes in health-care settings. [ABSTRACT FROM AUTHOR]

Considerable time and energy are expended in the scientific community to discuss the validity, importance, and applicability of the results of clinical trials. Depending on the goals, perspectives, and other motivating factors, protagonists and skeptics come to different conclusions, even when using the same methods and tools for critical appraisal. The aim of this study was to complement existing methods and tools with minor modifications to provide a prototype instrument that generates commonly accepted versions of critical appraisals. As a pilot experiment, one university-based and one industry-based referee independently completed the twin assessment of five trials published in well-recognized journals. They identified the study questions, defined the simplest, i.e., ideal, study designs to answer these questions, and checked eight validity criteria. Identical positive or negative answers of both referees increased or decreased the validity score. A maximum of two disagreements (0 score) was allowed. This procedure, which had been tested by two referees in a pilot experiment, was repeated with 19 third-year medical students and their supervisor at the Universidade Federal Fluminense, Niterói/RJ, Brasil. Four students each played the roles of the industry-based and university-based referees and finally recorded their consensus. The two referees of the pilot experiment agreed in all but one answer to the five investigated publications. The points of criticism differed in various papers. The consensus reached by the students considerably differed from the consensus reached by the referees. A consensus score generated by two referees or by two groups of students is feasible, but the achieved result is not necessarily reproducible. The critical appraisal of the study question in connection with the applied study design deserves special attention. It is time consuming but possible to identify and describe the possible flaws in the design conduct and report of clinical trials, but it is unlikely to reach a reproducible interpretation. These data indicate the problems with even evidence-based assessments and appraisals: the assessments may well be reproducible, but not the appraisals. Quality scores that include also the appraisal may therefore be interpreted with caution. Appraisals or quality scores may be used for interim decisions until data are available that confirm under real-world conditions what was predicted by the results generated under ideal but artificial conditions of a clinical trial. [ABSTRACT FROM AUTHOR]

The aim of this paper is to provide a summary of the present state of discussion concerning a way forward for public health programming that is more empowering and more effective at achieving its goals as we move into the future. A discussion expressing the views of the author supported by the relevant literature drawn from a wide range of sources on public health programming. The first part of the paper discusses the present state of public health programming and why it has had only modest success in achieving its goals. The second part discusses why the planning of public health programmes in the future will have to take into account at least three important agendas. The third part of the paper discusses why the delivery of public health programming in the future will have to include the following design elements: engage communities to share priorities; build community capacity; mechanisms for flexible funding; evaluate sharing information and ideas; be creative to expand on successful local initiatives. The paper concludes with a reflection on the most rational way forward and on the role of practitioners in achieving a more empowering and effective public health. The paper will be of interest to the planners and evaluators of public health programmes interested in improving the effectiveness of public health. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to understand the dietary diversity in the selected tribal population, identify and document the available non-timber forest products (NTFPs) and locally available food resources (LAFRs) in the selected tribal area, review the functional and nutritional properties of the food resources, and promote them as functional foods in achieving food and nutrition security. Subjects and methods: The selected Irula tribes were located at the base of the Western Ghats region of Southern India. Background information was collected using a pre-tested questionnaire and a direct interview schedule. A dietary survey was carried out using the 24-h recall method and a food frequency questionnaire for individuals in the 18–65 year age group (n = 400) in consultation with senior women in the families. A scientific review process was adopted to identify the functional properties and nutritional values of the NTFPs and LAFRs. Results: The review process of the NTFPs and LAFRs revealed the presence of active compounds, including enzymes, pigments, and polyphenols, and anti-oxidant, anti-inflammatory, cardioprotective, immune-boosting, anti-cancer, anti-diabetic, gastroprotective, anti-anaemia, and anti-diarrheal functional properties. For the past few decades, a simultaneous reduction in tribal dietary diversity has been observed, with acute shortcomings in macro and micronutrients in the most vulnerable age groups. Conclusion: Efforts to document and promote the best utilization of NTFPs and LAFRs with functional food and nutritional value will help to achieve food and nutrition security in the selected population. Promotion of NTFPs and LAFRs through education and dietary interventions would be a possible solution. [ABSTRACT FROM AUTHOR]

Introduction: Infant and child mortality are considered as one of the most important indicators of social and economic development of the nation. This paper intends to shed light on the prevalence of infant and under-five death rates with special reference to differentials in SCs, STs, and non-SCs/STs population in India. In addition, to determine the factors affecting child immunization and institutional delivery by different background characteristics. Data source and methods: The present study has used Census 2001 and 2011 for estimating the infant and under-five mortality. The National Family Health Survey (2015–16) has been used to assess the gaps in institutional delivery and coverage of child full immunization between SC, ST, and other caste population and also to assess the covariates of insitutional delivery and full immunization. Results: The study observed the high infant mortality rate and under-5 mortality among Scheduled Caste and Scheduled Tribe, while it is much lower among non-SC/ST population in 2011 census. The result of logistic regression suggests that caste has significant impact on access to institutional delivery and child immunization, adjusted for other socio-economic variables. All the castes are more likely to gain access to both institutional delivery and child immunization compared to scheduled tribe population. Conclusion: The study result shows the persistent poor health outcome among the SC/ST population in India. There is need to focus on this section of the population to achieve the sustainable development goals of child health and its core agenda "No one left behind". [ABSTRACT FROM AUTHOR]

Aim: The present paper aims to understand the fear of falling (FOF) and risk factors associated with FOF in community-dwelling individuals aged over 60 years in Pune, India. Subjects and methods: The study examined a random sample of 351 community-dwelling older adults. Data on demographic characteristics, health conditions, history of falls, and psychological factors were collected using a pre-tested, structured questionnaire. The Falls Efficacy Scale International (FES-I) was used to measure FOF. Univariate and bivariate logistic regression analyses were carried out to examine associations between various factors and FOF. Results: A high FES-I score was significantly associated with older age, females, unmarried status, education less than 6 years, living alone, unstable balance and gait, hypertension, arthritis, previous falls, self-reported loss of confidence, and depression. Adults older than 70 years of age (odds ratio, OR = 2.411), those with a history of falls (OR = 2.285), those reporting loss of confidence in the past 6 months (OR = 6.766), who had answered yes to the direct question of FOF (OR = 4.632), and had unstable balance (OR = 2.522) were also more likely to have higher FES-I values. Conclusion: A large number of older adults expressed concerns about falling and we also found several factors to be associated with developing FOF, supporting the need for screening. Thus, further research is needed in order to understand the relationship between severity of FOF and actual fall events for developing preventive measures which can be implemented before FOF becomes a problem. [ABSTRACT FROM AUTHOR]

Aim: Long-term invasively ventilated patients exhibit exceptional and resource-intensive healthcare needs. However, major knowledge gaps in Germany complicate appropriate approaches to best address these demands. This paper evaluates available information on the patient group and their healthcare needs from German data sources and derives implications for healthcare planning and regulation by national/federal self-governing bodies, political decision-makers, and specialized providers. Methods: Based on the concept of needs, we addressed the normative dimension typically characterized by epidemiological data. Based on existing German health system data resources, an explorative approach was utilized to identify and characterize available databases providing information on the patient group and/or their healthcare. Results: To date, no available database provides information on the healthcare needs of this patient group. As of the reporting year 2017, the diagnosis-related groups (DRG) statistics will provide hospital-specific data on home invasive ventilation interventions, but the data do not provide information on long-term care. Claims data may be a promising source for cross-sectoral evaluation of healthcare needs but feature methodological challenges. These results call for efforts to address limited data eligibility, adopt a broader understanding of healthcare needs, and identify actions needed to evidence informed and needs-oriented healthcare. Conclusion: Future approaches on needs-oriented specialized healthcare should close the existing knowledge gap based on reliable data. In addition to normative information, they should consider subjective dimensions on a life course perspective and quantitative and qualitative service performance characteristics across multiple sectors and professions. [ABSTRACT FROM AUTHOR]

Antiretroviral therapy (ART) for HIV/AIDS patients has become a standard in developed countries and a generally accepted objective in developing countries. Major funding agencies, such as USAID and the Global Fund to Fight AIDS, Tuberculosis and Malaria, are supporting ART programmes in developing countries as a non-negotiable element of a basic health care package. Recently a few papers have challenged whether this investment is rational as ART is expensive and the long-term consequences of resistance cannot be neglected. This paper intends to contribute to this discussion from a health economic perspective. It analyses the opportunity costs, the sustainability and the ethics of ART as well as the absorption capacity of existing health care services in developing countries. There is no justification for the so-called “exceptionality” of HIV/AIDS. ART might be an essential element of a basic health care package, but it should pass the same procedure as any other intervention to be included into the basic package. Financing a comprehensive health care package would require more international input—an important vision of a “Global Fund to Promote Health” as the offspring of the existing Global Fund. [ABSTRACT FROM AUTHOR]

The number of natural disasters and the severity of their impact have increased in recent decades. These developments highlight the need for improved preparedness and response in the health sector, inter alia, and the important role of public health in disaster management. The purpose of this paper, which is based on a literature review, is to provide background information about the general framework of disaster management and present the core concepts of disaster preparedness and response in health systems. Three different strategies were used to collect information for this article. First, information was collected from various international databases. Then, the virtual health library for disasters provided by the World Health Organization (WHO) and the WHO Health Action in Crisis (HAC) online sources were reviewed for relevant WHO and Pan American Health Organization (PAHO) books, working papers and reports. Finally, PubMed abstracts were searched with key words and phrases. For greater completeness, five disaster journals were hand searched. Additional sources such as text books, working papers, and articles were included, relying on the bibliography of the original study mentioned in the introduction to this paper. The studies reviewed indicated that fragmented and response-oriented approaches have begun to change world wide, at least in the literature. Despite the publication of increasing numbers of research projects in disaster issues, there are still gaps in sharing experience through scientific papers, such as systematic evaluation of activities in different phases of disaster situations. [ABSTRACT FROM AUTHOR]

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A Correction to this paper has been published: https://doi.org/10.1007/s10389-021-01488-z [ABSTRACT FROM AUTHOR]

A Correction to this paper has been published: https://doi.org/10.1007/s10389-021-01482-5 [ABSTRACT FROM AUTHOR]

Aim: Substantial progress has been made towards the 90–90–90 global targets; however, the pace at which new infections are declining remains undesirable to meet the UNAIDS 2020 global targets of below 500,000 new infections annually. We discussed the possibility of continued HIV incidence amidst remarkable scores in the 90–90–90 global targets. Subject and methods: A game theory simulation was used to explain micro-level sexual interactions in situations of imperfect information on each partner's HIV status. A non-cooperative sex game tree was constructed following the Harsanyi transformation in two scenarios; scenario one: a player assigns higher subjective probability that the partner is HIV negative; and in scenario two: a player assigns higher subjective probability that the partner is HIV positive. Subjective expected utilities were computed using hypothetical payoffs. Results: Accepting unprotected sex is a pure strategy for both players in scenario 1. Player2 is likely to acquire HIV/AIDS. Accepting protected sex is a mixed strategy equilibrium for both players in scenario 2. Player2 is likely to avoid HIV infection. Conclusion: Choice for safe or risky sex is a function of subjective probabilities individuals attach to their partners being infected or uninfected. More efforts towards addressing factors affecting individual probability distributions on riskiness of their sexual partners is required, especially for young women in Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

A Correction to this paper has been published: https://doi.org/10.1007/s10389-021-01635-6 [ABSTRACT FROM AUTHOR]

Aim: Refugees often face barriers to accessing health services, especially after resettlement. The aim of this study is to identify key elements of effective public health interventions that address barriers to health services for refugees. Methods: Key online databases were searched to identify studies published between 2010 and 2019. Six studies met the inclusion criteria: two qualitative, one quantitative and three mixed-methods studies. An adapted narrative synthesis framework was used which included thematic analysis for systematic reviews. Results: Five themes were identified: peer support, translation services, accessible intervention, health education and a multidisciplinary approach. Conclusion: These key elements identified from this review could be incorporated into public health interventions to support refugees' access to health services. They could be useful for services targeting refugees generally, but also supporting services targeting refugee resettlement programmes such as the Syrian resettled refugees in the UK. Future research is needed to evaluate the impact of public health interventions where these elements have been integrated into the intervention. [ABSTRACT FROM AUTHOR]

Background: This paper examined the connection between residential histories and obesity in Ghana. In the last two decades, low- and middle-income countries (LMICs) have witnessed the fastest growth in obesity incidence. These obesity trends in many LMICs including Ghana are associated with rapid economic growth and urbanisation. Features of the urban food and built environments contribute to obesity in LMICs in many ways, including exposure to unhealthy foods, sedentary lifestyles, and passive transportation. Methods: The analytical sample consisted of 4368 adults (aged 18 and above) drawn from the World Health Organisation's Study on Global Ageing and Health in Ghana. We employed descriptive statistics and multivariate regression models to examine the relationship between residential histories and obesity in later life using STATA 14. Results: Significant differences were observed among respondents, based on their childhood and adult residential histories. For instance, 44% of respondents who spent their childhood and adult life in the same urban area were obese, compared to 18% of those who spent their childhood and adulthood in the same rural area. Multivariable analysis revealed that cumulative exposure to urban environment was significantly associated with obesity. For example, respondents who spent their childhood and adulthood in different urban areas and childhood and adulthood in the same urban area were significantly more likely to be obese than respondents who lived in rural areas during childhood and adulthood (OR = 2.37, p < 0.001 and OR = 1.44, p < 0.001, respectively). Conclusion: Our findings show that urban residence during childhood and later in life may present cumulative risks for adult obesity. Locally appropriate public health strategies that encourage healthy lifestyles among urban dwellers will be critical in the fight against obesity. [ABSTRACT FROM AUTHOR]

Aim: To reveal inequity in health in India. Subject and methods: The global paradigm of the knowledge economy propounds that growth and equity will occur if there is a free-market economy without state intervention and if patents are provided as incentives for innovation. In this paper, we explore the veracity of this thesis by investigating growth in the pharmaceutical and biotech sectors in India, and by looking at equity issues through the lens of gender health and health costs for poor consumers. We used data from current publications to support this thesis. Results: We found that growth has been characterized by multiple handicaps and oligopoly, with the nature of expansion not having relevance for the disease profiles in India. The scenario of gender health and health costs of the poor is grim due to state retrenchment and neglect of the provision of public good, such as in health matters. Conclusion: One can conclude that equity has not occurred under a growing pharmaceutical sector. This finding has huge implications for public policy in India and other emerging nations. [ABSTRACT FROM AUTHOR]

Aim: The present umbrella review aimed to take stock of the situation on the considerable literature concerning the main socio-demographic risk factors of adolescents involved in road traffic crashes. Methods: The following bibliographic databases were searched: PubMED, Scopus and Cochrane Library. Systematic reviews and meta-analyses published between January 2000 and March 2017 and written in English were included. Results: The search identified 13 systematic reviews and 1 meta-analysis. The papers found general agreements of the socio-demographic risk factors at the international level. Males, especially in Africa, Asia and the Arab World, take more risks related to death and injuries; low socio-cultural status and living in deprived socioeconomic areas were characteristics for being at greater risk of motor vehicle crashes worldwide. No unequivocal conclusion has been reached worldwide on the possible effect of different age subgroups: a significant reduction of the number of crashes was obtained in 16 and 17 year olds in the USA after implementing driver's license testing requirements. Conclusion: The findings clearly showed the need to develop specific injury prevention strategies on the basis of educational level, income and social status. Furthermore these aspects represent the main reasons for inequalities and different levels of efficacy of road safety interventions among the adolescents worldwide. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to track the efficacy of the Test and Treat model of human immunodeficiency virus (HIV) prevention adopted by the government of India, 2015-16, using the last two rounds of National Family Health Survey, providing community-based insights in the testing of HIV prevalence in 2005-06 and 2015-16.Methods: The survey collected information from a nationally representative sample of 69,751 men and 124,385 women in 2005-06 and 103,411 men and 121,118 women age 15-49 in 2015-16 respectively. Both descriptive and multivariate techniques have been used.Results: The 'test and treat' model of HIV in India portrays a women-centric effort to ensure HIV testing as part of their ANC, resulting in a substantial increase in ever being tested for HIV. Women who are educated, living in urban areas, and in economically better households are more prone to have ever undergone HIV testing, it is a welcome change given the existing HIV scenario, with a continuously narrowing gender gap in new HIV infections (NFHS-4). Women and men having positive attitude towards stigma and discrimination to people living with HIV (PLHIV) are in better agreement to ever being tested. Further, women and men having knowledge about antiretroviral therapy (ART) are 1.6 times (p < 0.001) and 1.8 times (p  < 0.001) more likely to have ever been tested for HIV.Conclusions: Despite an improvement in coverage of HIV testing, the existing disparities in HIV testing and treatment require policy instruments with an integrated approach. Government should work in close collaboration with communities/key stakeholders, and efficiently use their resources to provide evidence-based HIV prevention and treatment interventions. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to compare single-level and multilevel regression analysis to obtain risk-adjusted outcomes from mental health care providers.Subject and methods: The study population consisted of adult patients receiving treatment for common mental health disorders. The outcome was self-reported symptom level at post-test. Risk adjustment models were developed using single- and multilevel regression analysis. In the multilevel approach, a random intercept for each provider was included. The intraclass correlation coefficient was used to estimate the proportion of variability in treatment outcome between providers. Spearman correlation coefficient of ranks was used to compare results between the two approaches.Results: The effects of most casemix variables on outcomes were similar for the two models. The ranking of providers in both methods was also quite similar (ρ = .99). The multilevel model estimated that 5.4% of total variability in adjusted post-test scores was explained by the provider factor.Conclusions: The findings of risk adjustment of mental health outcomes are quite robust for the use of single-level or multilevel regression analysis in the current study. However, given the small but significant amount of variation in outcomes that is attributable to providers, the multilevel approach is recommended for dealing with outcomes when patients are clustered within providers. [ABSTRACT FROM AUTHOR]

A Correction to this paper has been published: https://doi.org/10.1007/s10389-020-01410-z [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is an established cause of preventable death and often initiated during adolescence. We estimated the short- and long-term costs of cigarette smoking among currently smoking adolescents in Nigeria. Methods: A cross-sectional survey among adolescents in Oyo state, Nigeria and a review of mortality records of patients managed for lung cancer in a tertiary facility in Ibadan, Nigeria were conducted. Short-term costs estimated were: (a) average weekly costs of purchasing cigarettes by currently smoking adolescents, and (b) costs of managing at least an episode of chronic cough occurring within 12 months of the survey. Long-term costs were limited to: (a) life-time expenditure on purchasing cigarettes, and (b) direct medical and non-medical (transportation) costs of managing lung cancer. Long-term costs were first projected to the approximate year when the adolescents (mean age:16.0 ± 1.8 years) might be diagnosed with lung cancer based on the average age at presentation with symptoms of lung cancer obtained from the records (59.8 years), and then discounted to 2020 prices. This was estimated as 44 years from the base year (2020). Costs were reported in 2020 prices in Nigerian Naira (NGN) and US dollar (USD) equivalent using the Central Bank of Nigeria, June 2020 exchange rate of USD 1: NGN 360.50. Results: Approximately 3.8% of the adolescents were current cigarette smokers. Average weekly expenditure on cigarettes was NGN 306.82 ± 5.74 (USD 0.85 ± 0.02). About 26% had experienced at least an episode of chronic cough which cost them an average of NGN 1226.81 ± 6.18 (USD 3.40 ± 0.02) to manage. Total future costs of cigarette smoking in 2020 prices for the 43 adolescents who were current smokers in the event that they develop lung cancer were approximately NGN 175.7 million (USD 487.3 thousand), NGN 871.8 million (USD 2.4 million) and NGN 4.6 trillion (USD 12.7 million) at assumed annual inflation rates of 10%, 15%, and 20% respectively and discount rate of 4.25%. Conclusion: The estimated economic costs of smoking were very high. Efforts to prevent smoking initiation among adolescents in our study area should be intensified. Interventions to subsidize the medical cost of health-related consequences of cigarette smoking are also required, especially as treatment costs are currently largely borne out-of-pocket. [ABSTRACT FROM AUTHOR]

Aim: Keeping shared toilets clean is a key public health challenge household users face in urban slum settlements of most developing countries. This paper provides insights on the cleanliness of households' shared toilets and the factors that influence their cleanliness, as well as influencing the inclination of the users to keep them clean. Subjects and methods: This analysis is part of a cross-sectional study conducted in 50 randomly selected slums in Kampala, Uganda between October and November 2010. A total of 1,500 respondents were interviewed, using a semi-structured questionnaire. Results: Out of 1,019 respondents using shared toilets, less than 12 % reported having very clean toilets. Some of the significant factors influencing the cleanliness of shared toilets are: the ease or difficulty in keeping shared toilets clean, the number of households sharing a toilet room, effortful cleaning behaviour and cleaning intention on the part of the users. Conclusion: The findings show that most slum dwellers use toilets that are not hygienic. [ABSTRACT FROM AUTHOR]

Objective: Problematic access to and use of sexual and reproductive health (SRH) services potentially endanger the well-being of adolescents and retards progress towards attainment of United Nations health-related Sustainable Development Goals. Drawing on a qualitative research approach, this paper examines the level of SRH-related knowledge, service access and use among school-going adolescents in Kumasi Metropolis, Ghana.Methods: We conducted 12 focus group discussions and 18 in-depth interviews with 132 in-school adolescents and six healthcare providers in the metropolis. A thematic analytical framework was used to analyse the data.Results: Findings suggest that the majority of adolescents had good knowledge about the available SRH services, with an emphasis on the different forms of contraceptives. However, the use of the various SRH services was challenging and reduced to counselling services. Adolescents were faced with various difficulties in their bid to access SRH services, including social stigma, attitude of service providers, fear of teachers and the anticipated negative response of parents due to the complex socio-cultural structure of Ghanaian society. Discussion with elders about SRH issues was considered a taboo.Conclusion: Whilst social negotiation with parents, teachers and SRH service providers as well as school curricula alignment could arrest the barriers to adolescents’ access to SRH services, eHealth services such as the ‘Bisa’ Health App could potentially provide easy and cost-effective access to SRH information among in-school adolescents. [ABSTRACT FROM AUTHOR]

Aim: In 2014, Sally Davis, England’s Chief Medical Officer, proposed a paradigm shift in public health—the 5th Wave—which should focus on the culture of health. Her paper was meant to spark a debate, but this has been largely absent until now. This article argues why the concept of the culture of health needs to be incorporated into the theory of public health and shows a possible direction for applying it in practice.Subjects and methods: Review of theoretical approaches and knowledge synthesis.Results: Applying the culture of the health approach to change health behavior requires taking several different strands of thought into account. Any proposed effective intervention should be based on a framework including the ‘behavioral system,’ ecosocial theory, complex systems science, and school health promotion approaches. Changing culture is impeded by its complexity, but to solve this wicked problem, the focus should likely be on health promotion in schools.Conclusion: To make interventions more effective, it is necessary for public health professionals to have an extensive debate on the interpretations of the role of the culture of health as highlighted in this article. [ABSTRACT FROM AUTHOR]

Purpose: The Millennium Development Goals (MDGs), an initiative by the United Nations, consisted of eight broad goals, which were envisaged to improve the living conditions of the world’s populations. In spite of the momentum and investments made to achieve the MDGs, significant challenges still exist at the global and national levels. In Ghana, the attainment of some MDGs was uneven across the goals and within the country. This paper critically reviews the implementation of the health MDGs in Ghana: specifically, MDG 4, MDG 5 and MDG 6. The study focuses on drawing key lessons from the national implementation strategies and institutional reforms adopted by Ghana towards achieving these health MDG targets.Methods: The study uses content analysis of policy documents in selected programmatic interventions which have been deemed influential in reaching the health MDGs in Ghana.Results: In brief, the results indicate that 73% of the 37 MDG indicators for Ghana were either achieved or could show significant progress. Ghana did not achieve MDG 4 and MDG 5 due to the slow progress it made in improving child and maternal health. The study indicates that key investments need to be made in the health sector, especially in the areas of access to good quality care, to narrow gaps in access and financing.Conclusions: Reducing maternal and child mortality in Ghana will require transforming the sectors that drive development, such as energy, agriculture and transportation. It is expected that the lessons learnt will enhance evidence-based policy-making towards achieving the SDGs in Ghana. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is an infectious disease, which is a significant global public health concern. The use of directly observed therapy of short course (DOTS) is the strategy recommended by the World Health Organization (WHO) to cure TB. In this paper, the effectiveness of the DOTS is assessed using data collected in 2014 from the Gazan Province, Saudi Arabia (SA). The assessment is impacted by migration from high prevalence countries into SA. The association between immigration and TB is not well documented and studied in the literature. We will address this problem and identify other factors influencing the success of DOTS.Methods: Descriptive methods are used in this study. The logistic regression model is used to identify significant factors of success or non-success of the DOTS. The data has missing observations. Multiple imputations were carried out to fill in missing outcomes and completed data sets are analyzed further.Results: The results show that none of the predictors have a significant role in treatment outcome. The cure rate for the study population is 90.3% after excluding defaulters and deportees. If we include 29 defaulters and 68 deportees assuming treatment failed for these cases, the cure rate is 67%, which is far below the WHO goal of 85%. After multiple imputations, the cure rate is 91.7%.Conclusions: Increasing number of migrants into low prevalence countries may affect TB epidemiology. In view of the huge gap, 67 versus 91.7% in the cure rates, we firmly recommend that health and immigration authorities in SA work together to see that TB treatment is completed before deportation. [ABSTRACT FROM AUTHOR]