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BackgroundCervical cancer is a growing health concern, especially in resource-limited settings. ObjectiveThe objective of this study was to assess the burden of cervical cancer mortality and disability-adjusted life years (DALYs) in the Eastern Mediterranean Region (EMR) and globally between the years 2000 and 2017 by using a pooled data analysis approach. MethodsWe used an ecological approach at the country level. This included extracting data from publicly available databases and linking them together in the following 3 steps: (1) extraction of data from the Global Burden of Disease (GBD) study in the years 2000 and 2017, (2) categorization of EMR countries according to the World Bank gross domestic product per capita, and (3) linking age-specific population data from the Population Statistics Division of the United Nations (20-29 years, 30-49 years, and >50 years) and GBD’s data with gross national income per capita and globally extracted data, including cervical cancer mortality and DALY numbers and rates per country. The cervical cancer mortality rate was provided by the GBD study using the following formula: number of cervical cancer deaths × 100,000/female population in the respective age group. ResultsThe absolute number of deaths due to cervical cancer increased from the year 2000 (n=6326) to the year 2017 (n=8537) in the EMR; however, the mortality rate due to this disease decreased from the year 2000 (2.7 per 100,000) to the year 2017 (2.5 per 100,000). According to age-specific data, the age group ≥50 years showed the highest mortality rate in both EMR countries and globally, and the age group of 20-29 years showed the lowest mortality rate both globally and in the EMR countries. Further, the rates of cervical cancer DALYs in the EMR were lower compared to the global rates (2.7 vs 6.8 in 2000 and 2.5 vs 6.8 in 2017 for mortality rate per 100,000; 95.8 vs 222.2 in 2000 and 86.3 vs 211.8 in 2017 for DALY rate per 100,000; respectively). However, the relative difference in the number of DALYs due to cervical cancer between the year 2000 and year 2017 in the EMR was higher than that reported globally (34.9 vs 24.0 for the number of deaths and 23.5 vs 18.1 for the number of DALYs, respectively). ConclusionsWe found an increase in the burden of cervical cancer in the EMR as per the data on the absolute number of deaths and DALYs. Further, we found that the health care system has an increased number of cases to deal with, despite the decrease in the absolute number of deaths and DALYs. Cervical cancer is preventable if human papilloma vaccination is taken and early screening is performed. Therefore, we recommend identifying effective vaccination programs and interventions to reduce the burden of this disease.

Problem With limited global supplies of oral cholera vaccine, countries need to identify priority areas for vaccination while longer-term solutions, such as water and sanitation infrastructure, are being developed. Approach In 2017, Malawi integrated oral cholera vaccine into its national cholera control plan. The process started with a desk review and analysis of previous surveillance and risk factor data. At a consultative meeting, researchers, national health and water officials and representatives from nongovernmental and International organizations reviewed the data and local epidemiological knowledge to determine priority districts for oral cholera vaccination. The final stage was preparation of an application to the global oral cholera vaccine stockpile for non-emergency use. Local setting Malawi collects annual data on cholera and most districts have reported cases at least once since the 1970s. Relevant changes The government's application for 3.2 million doses of vaccine to be provided over 20 months in 12 districts was accepted in April 2017. By April 2018, over 1 million doses had been administered in five districts. Continuing surveillance in districts showed that cholera outbreaks were notably absent in vaccinated high-risk areas, despite a national outbreak in 2017-2018. Lessons learnt Augmenting advanced mapping techniques with local information helped us extend priority areas beyond those identified as high-risk based on cholera Incidence reported at the district level. Involvement of the water, sanitation and hygiene sectors is key to ensuring that short-term gains from cholera vaccine are backed by longer-term progress in reducing cholera transmission. Probleme En raison de stocks mondiaux reduits de vaccins anticholeriques oraux, les pays doivent identifier les zones prioritaires en matiere de vaccination tout en developpant des solutions a plus long terme, telles que des infrastructures d'alimentation en eau et d'assainissement. Approche En 2017, le Malawi a integre la vaccination anticholerique orale dans son plan national de lutte contre le cholera. Le processus a commence par un examen documentaire et une analyse des donnees disponibles concernant la surveillance et les facteurs de risque. Lors d'une reunion consultative, des chercheurs, les responsables nationaux des secteurs de la sante et de l'eau et les representants d'organisations non gouvernementales et internationales ont examine les donnees et les connaissances epidemiologiques locales pour determiner les districts oU devait etre pratiquee en priorite la vaccination anticholerique orale. L'etape finale a consiste a preparer une demande relative au stock mondial de vaccins anticholeriques oraux destines a etre utilises en dehors des situations d'urgence. Environnement local Le Malawi collecte des donnees annuelles sur le cholera et la plupart des districts ont signale des cas a au moins une reprise depuis les annees 1970. Changements significatifs La demande du gouvernement visant la fourniture de 3,2 millions de doses de vaccins pendant 20 mois dans 12 districts a ete acceptee en avril 2017. En avril 2018, plus d'un million de doses ont ete distribuees dans cinq districts. Une surveillance continue au sein des districts a revele un fait frappant, a savoir que les zones a risque epidemlologique eleve ayant fait l'objet d'une vaccination n'ont pas ete touchees par des epidemies de cholera, malgre une epidemie nationale en 2017-2018. Lecons tirees L'association de techniques avancees de cartographie a des informations locales nous a permis d'elargir les zones prioritaires audela de celles identifiees comme presentant un risque epidemiologique eleve en fonction de l'incidence du cholera signalee au niveau des districts. La mobilisation des secteurs de l'eau, de l'assainissement et de l'hygiene est essentielle pour garantir que les avantages a court terme des vaccins anticholeriques sont confirmes par un recul a plus long terme de la transmission du cholera. Problema Con suministros mundiales limitados de la vacuna oral contra el colera, los paises deben identificar las areas prioritarias para la vacunacion mientras se desarrollan soluciones a mas largo plazo, como las infraestructuras de agua y el saneamiento. Enfoque En 2017, Malawi integro la vacuna oral contra el colera en su plan nacional para el control del colera. El proceso empezo con un estudio preliminar y un analisis de los datos previos de vigilancia y factores de riesgo. En una reunion consultiva, investigadores, funcionarios nacionales de salud y agua y representantes de organizaciones no gubernamentales e internacionales revisaron los datos y el conocimiento epidemiologico local para determinar los distritos prioritarios para la vacunacion oral contra el colera. La etapa final fue la preparacion de una aplicacion a la reserva global de la vacuna oral contra el colera para usos de no emergencia. Marco regional Malawi recopila datos anuales sobre el colera y la mayoria de los distritos han registrado casos al menos una vez desde los anos setenta. Cambios importantes La solicitud del gobierno de 3,2 millones de dosis de vacunas para suministrarlas a lo largo de 20 meses en 12 distritos se acepto en abril de 2017. En abril de 2018, se habian administrado mas de 1 millon de dosis en cinco distritos. La vigilancia constante en los distritos mostro que los brotes de colera estuvieron notablemente ausentes en las areas vacunadas de alto riesgo, a pesar de un brote nacional en 2017-2018. Lecciones aprendidas El aumento de las tecnicas avanzadas de mapeo con informacion local ayudo a ampliar las areas prioritarias mas alla de las identificadas como de alto riesgo segun la incidencia del colera registrada a nivel de distrito. La participacion de los sectores del agua, el saneamiento y la higiene es clave para garantizar que las victorias a corto plazo de la vacuna contra el colera esten respaldadas por un progreso a mas largo plazo en la reduccion de la transmision del colera., Introduction Cholera continues to be a global public health threat, with 150 000 cases per year reported from sub-Saharan Africa. (1) While universal access to safe water and sanitation is [...]

Introduction: Evaluating a learning health system (LHS) encourages continuous system improvement and collaboration within the healthcare system. Although LHS is a widely accepted concept, there is little knowledge about evaluating an LHS. To explore the outputs and outcomes of an LHS model, we evaluated the COVID‐19 Evidence Support Team (CEST) in Saskatchewan, Canada, an initiative to rapidly review scientific evidence about COVID‐19 for decision‐making. By evaluating this program during its formation, we explored how and to what extent the CEST initiative was used by stakeholders. An additional study aim was to understand how CEST could be applied as a functional LHS and the value of similar knowledge‐to‐action cycles. Methods: Using a formative evaluation design, we conducted qualitative interviews with key informants (KIs) who were involved with COVID‐19 response strategies in Saskatchewan. Transcripts were analyzed using reflexive thematic analysis to identify key themes. A program logic model was created to represent the inputs, activities, outputs, and outcomes of the CEST initiative. Results: Interview data from 11 KIs were collated under three overarching categories: (1) outputs, (2) short‐term outcomes, and (3) long‐term outcomes from the CEST initiative. Overall, participants found the CEST initiative improved speed and access to reliable information, supported and influenced decision‐making and public health strategies, leveraged partnerships, increased confidence and reassurance, and challenged misinformation. Themes relating to the long‐term outcomes of the initiative included improving coordination, awareness, and using good judgment and planning to integrate CEST sustainably into the health system. Conclusion: This formative evaluation demonstrated that CEST was a valued program and a promising LHS model for Saskatchewan. The future direction involves addressing program recommendations to implement this model as a functional LHS in Saskatchewan. [ABSTRACT FROM AUTHOR]

This study compared "Structured Controversy" (a semi-formal debate like small group activity) with a traditional open discussion format for medical and physical therapy students. We found that those students who had participated in Structured Controversy changed their personal opinion on the topic more than those who were in the Open Discussion groups. Students in the Structured Controversy group also commented more often that being "forced" to explore both sides of the topic made a difference to their learning. We conclude that the time and effort invested in organizing the Structured Controversy experience for students is worthwhile because it encourages students to more seriously consider many aspects of an argument and helps promote sustained change of opinion. (Contains 3 tables and 1 figure.)

Capacity, defined as knowledge, skills, commitment, and resources of individuals and organizations to plan, implement, and evaluate health promotion, was measured through surveys of 27 health-care practitioners and organizations in Saskatchewan. Results were used to develop checklists of organizational capacity for health promotion. (Contains 18 references.) (SK)

The Saskatchewan Heart Health Program's approach to assessment of the learning needs of health promotion contacts included developing of survey instruments based on think-tank discussions and profiling of the target audience. The approach blended formal and informal, qualitative and quantitative methods and included collaboration with learners. (SK)

Objective: To assess the maintenance of physical activity (PA) and health gains among participants in a class-based (CB) or home-based (HB) PA intervention over a 12-month study period. Methods: A total of 172 adults aged 50 years and older were randomly allocated to either a CB or an HB intervention, each involving an intensive 3-month phase with a 9-month follow-up period. Measures at baseline, 3, 6, and 12 months included self-reported PA and health, body mass index, waist circumference (WC), blood pressure, cardiovascular endurance (6-min walk test), physical function, and functional fitness (senior fitness test). Outcomes were analyzed using generalized estimating equations. Results: Maximum improvement was typically observed at 3 or 6 months followed by a modest diminution, with no differences between groups. For body mass index, waist circumference, 6-min walk test, and senior fitness test, there was progressive improvement through the study period. Greater improvement was seen in the CB group compared with the HB group on three items on the senior fitness test (lower body strength and endurance [29% vs. 21%, p <.01], lower body flexibility [2.8 cm vs. 0.4 cm, p <.05], and dynamic agility [14% vs. 7%, p <.05]). Conclusion: The interventions were largely comparable; thus, availability, preferences, and cost may better guide program choice. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore cross-sectional relationships between self-reported physical activity (PA) and personal, social, and environmental factors in community-dwelling adults aged 50 years and older. Accounting for clustering by neighborhood, generalized estimating equations were used to examine associations between selected correlates and the Physical Activity Scale for the Elderly (PASE) score while adjusting for confounders. Data for 601 participants were analyzed: 79% female, 37% married, mean age 76.8 (± 8.7) years, mean PASE score 112.6 (± 64.8). Age, living in seniors' housing, using nursing/home care services, receiving encouragement to be active, and having benches available in the neighborhood were inversely associated with PASE. Self-efficacy, SF-12 score, PA barriers, social support, and the presence of trails showed positive associations. Several personal, social, and environmental factors associated with PA were identified. The inverse association between PA and living in seniors' housing units should be considered when developing PA programs for older adults. [ABSTRACT FROM AUTHOR]

This study explored the relationship between physical activity, marital status, income, education, and chronic disease in older women to determine which individuals are at risk of being inactive and to identify potential moderators of physical activity behavior. This was an analysis of cross-sectional data from a convenience sample of 271 community-dwelling women aged 65 to 79 years. Self-reported physical activity was measured using the Physical Activity Scale for the Elderly. Socio-demographic characteristics (including age, gender, marital status, education, employment, and income) and self-reported health were measured using previously validated instruments. To avoid seasonal variations in physical activity, data were collected during the summer months. Physical activity was negatively associated with age and the presence of cardio-respiratory disease and positively associated with income greater than $20,000 (p < 0.05). After controlling for other co-variates, no significant differences were observed in physical activity between married and unmarried individuals. Given the strong association between cardio-respiratory disease and income with physical activity, women 65 years of age and older in lower income brackets and suffering from these health conditions should be targeted for exercise counseling and support. Intervention research is needed to determine the most effective means to decrease inactivity among these women. KEYWORDS physical activity, health, chronic disease, correlates, older women DOI: 10.1080/03630242.2010.506150

Introduction: The COVID‐19 Evidence Support Team (CEST) was a provincial initiative that combined the support of policymakers, researchers, and clinical practitioners to initiate a new learning health cycle (LHS) in response to the pandemic. The primary aim of CEST was to produce and sustain the best available COVID‐19 evidence to facilitate decision‐making in Saskatchewan, Canada. To achieve this objective, four provincial organizations partnered to establish a single, data‐driven system. Methods: The CEST partnership was driven by COVID‐19 questions from Emergency Operational Committee (EOC) of the Saskatchewan Health Authority. CEST included three processes: (a) clarifying the nature and priority of COVID‐19 policy and clinical questions; (b) providing Rapid Reviews (RRR) and Evidence Search Reports (ESR); and (c) seeking the requestors' evaluation of the product. A web‐based repository, including a dashboard and database, was designed to house ESRs and RRRs and offered a common platform for clinicians, academics, leaders, and policymakers to find COVID‐19 evidence. Results: In CEST's first year, 114 clinical and policy questions have been posed resulting in 135 ESRs and 108 RRRs. While most questions (41.3%) originated with the EOC, several other teams were assembled to address a myriad of questions related to areas such as long‐term care, public health and prevention, infectious diseases, personal protective equipment, vulnerable populations, and Indigenous health. Initial challenges were mobilization of diverse partners and teams, remote work, lack of public access, and quality of emerging COVID‐19 literature. Current challenges indicate the need for institutional commitment for CEST sustainability. Despite these challenges, the CEST provided the Saskatchewan LHS with a template for successful collaboration. Conclusions: The urgency of COVID‐19 pandemic and the implementation of the CEST served to catalyze collaboration between different levels of a Saskatchewan LHS. [ABSTRACT FROM AUTHOR]

Abstract The Canadian Society for Exercise Physiology, in partnership with the Public Health Agency of Canada, has initiated a review of their physical activity guidelines to promote healthy active living for Canadian children, youth, adults and older adults; previous guidelines were released in 2002, 2002, 1998 and 1999 respectively. Several background papers from this project were published recently and provide foundation evidence upon which to base new guidelines. Furthermore, comprehensive systematic reviews were completed to ensure a rigorous evaluation of evidence informing the revision of physical activity guidelines for asymptomatic populations. The overall guideline development process is being guided and assessed by the AGREE II instrument. A meeting of experts was convened to present the evidence complied to inform the guideline revisions. An independent expert panel was assembled to review the background materials and systematic reviews; listen to the presentations and discussions at the expert meeting; ask for clarification; and produce the present paper representing their interpretation of the evidence including grading of the evidence and their identification of needs for future research. The paper includes also their recommendations for evidence-informed physical activity guidelines.

Background: The study aimed to compare the effectiveness of a class-based (CB) and home-based (HB) exercise program for older adults with chronic health conditions. Methods: 172 sedentary older adults with overweight or obesity, type 2 diabetes, hypertension, dyslipidemia, or osteoarthritis were enrolled in a randomized controlled trial with a 3-month follow-up. Results: A significant increase was seen in the CB group in the Physical Activity Scale for the Elderly (PASE) scores and SF-12 Physical and Mental Health scores. In both groups, significant increases were seen in 6-minute walk distance, Physical Performance Test (PPT), and Functional Fitness Test (FFT), and significant reductions were seen in systolic and diastolic blood pressure but not body mass index or waist circumference. Except for a greater increment in the FFT in the CB group, the degree of improvement was not significantly different between the 2 groups. Conclusion: After a 3-month intervention, both the CB and HB program produced comparable significant improvements in outcome measures. [ABSTRACT FROM AUTHOR]

Background: Engaging sedentary individuals in physical activity (PA) is challenging and problematic for research requiring large, representative samples. For research projects to be carried out in reasonable timeframes, optimum recruitment methods are needed. Effective recruitment strategies involving PA interventions for older adults have not been determined. Purpose: To compare the effectiveness of recruitment strategies for a PA intervention. Methods: Two recruitment strategies, print media and personal contact; targeted health-care professionals and the general public. Results: The strategies generated 581 inquiries; 163 were randomized into the study. Advertising to the general public via print materials and group presentations accounted for 78% of the total inquiries. Referrals from physicians and health-care professionals resulted in 22% of the inquiries. Conclusion: Mass distribution of print material to the general public, enhanced by in-person contact, was the most effective recruitment strategy. These findings suggest various recruitment strategies targeting the general population should be employed. [ABSTRACT FROM AUTHOR]