The impact of mass-media campaigns on physical activity: a review of reviews through a policy lens

BACKGROUND

This review of reviews aimed to: (1) summarize the evidence from published reviews on the effectiveness of mass-media campaigns to promote physical activity (PA) or PA-related determinants (intermediate psychological and proximal outcomes) and (2) to identify policy-relevant recommendations related to successful PA campaigns.

METHODS

An extensive literature search was performed on 1 March 2021. Reviews that evaluated the impact of campaigns on distal (e.g. PA) and/or proximal outcomes of PA (awareness, knowledge, etc.) and that targeted the general population or subsets were included. Quality of reviews was assessed using the AMSTAR-2 tool. Policy-relevant recommendations were systematically derived and synthesized and formulated as good practice statements. A protocol was registered beforehand (ID: CRD42021249184).

RESULTS

A total of 1915 studies were identified, of which 22 reviews were included. The most consistent evidence was found for the effectiveness of mass-media campaigns on proximal outcomes, while the evidence for distal outcomes was mixed. Good practice statements were derived: (1) to achieve behaviour change, mass-media is an important component of larger, multilevel and multicomponent strategies; (2) mass-media strategies should be coordinated and aligned at local- and national-level and be sustained, monitored and resourced at these levels and (3) media should be tailored to reduce socioeconomic inequalities.

CONCLUSIONS

Mass-media can play an important role in the promotion of PA. In general, evidence was more inconsistent for effectiveness on distal outcomes than for proximal outcomes. Policy-relevant recommendations include that mass-media strategies should be resourced, coordinated, aligned, sustained, monitored and evaluated on the local and national level.

Dietary behaviour and physical activity policies in Europe: learnings from the Policy Evaluation Network (PEN)

The European Policy Evaluation Network (PEN), initiated in autumn 2018, aimed at advancing the evidence base for public policies impacting dietary behaviour, physical activity and sedentary behaviours in Europe. This is needed because non-communicable diseases-the leading cause of global mortality-are substantially caused by physical inactivity and unhealthy dietary behaviours, which in turn are driven by upstream factors that have not yet been addressed effectively by prevention approaches. Thus, successful policy interventions are required that target entire populations and tackle the 'causes of the causes'. To advance our knowledge on the effective implementation of policies and their impact in terms of improving health behaviours, PEN focused on five research tasks: (i) Adaptation and implementation of a Food Environment Policy Index (Food-EPI) and development of a Physical Activity Environment Policy Index (PA-EPI); (ii) Mapping of health-related indicators needed for policy evaluation and facilitating a harmonized pan-European approach for surveillance to assess the impact of policy interventions; (iii) Refining quantitative methods to evaluate the impact of public policies; (iv) Identifying key barriers and facilitators of implementation of policies; and (v) Advance understanding the equity impact of the development, implementation and evaluation of policies aimed at promoting physical activity and a healthy diet. Finally, and in order to provide concrete evidence for policymaking, existing exemplary policies, namely sugar-sweetened beverages taxation, active transport policies and school policies on nutrition and physical activity were assessed in consideration of these five tasks. At the end of the PEN project's formal runtime, considerable advancements have been made. Here, we present an overview of the most important learnings and outputs.

The Physical Activity Environment Policy Index for monitoring government policies and actions to improve physical activity

BACKGROUND

A multifaceted response, including government action, is essential to improve population levels of physical activity (PA). This article describes the development process of the 'Physical Activity Environment Policy Index' (PA-EPI) monitoring framework, a tool to assess government policies and actions for creating a healthy PA environment.

METHODS

An iterative process was undertaken. This involved a review of policy documents from authoritative organizations, a PA policy audit of four European countries, and a systematic review of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops were conducted, where quantitative and qualitative data, alongside theoretical and pragmatic considerations, were used to inform PA-EPI development.

RESULTS

The PA-EPI is conceptualized as a two-component 'policy' and 'infrastructure support' framework. The two-components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development and health-in-all-policies. Forty-five 'good practice statements' or indicators of ideal good practice within each domain conclude the PA-EPI. A potential eight-step process for conducting the PA-EPI is described.

CONCLUSIONS

Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI good practice statements will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.

The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity

Background

Insufficient physical activity (PA) is a global issue for health. A multifaceted response, including government action, is essential to improve population levels of PA. The purpose of this study was to develop the ‘Physical Activity Environment Policy Index’ (PA-EPI) monitoring framework to assess government policies and actions for creating a healthy PA environment.

Methods

An iterative process was undertaken. This involved a review of policy documents from authoritative organisations, a policy audit of four European countries, and systematic reviews of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops where quantitative and qualitative data alongside theoretical and pragmatic considerations were used to inform PA-EPI development.

Results

The PA-EPI is conceptualised as a two-component ‘policy’ and ‘infrastructure support’ framework. The two components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development, and health-in-all-policies. Forty-five ‘good practice statements’ (GPS) or indicators of ideal good practice within each domain concludes the PA-EPI. A potential eight-step process for conducting the PA-EPI is described.

Conclusions

Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI GPS will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.

S09-4 The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity

Background

Insufficient physical activity (PA) is a global issue for health. A multifaceted response, including government action, is essential to improve population levels of PA. The purpose of this study was to develop the ‘Physical Activity Environment Policy Index’ (PA-EPI) monitoring framework to assess government policies and actions for creating a healthy PA environment.

Methods

An iterative process was undertaken. This involved a review of policy documents from authoritative organisations, a policy audit of four European countries, and systematic reviews of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops where quantitative and qualitative data alongside theoretical and pragmatic considerations were used to inform PA-EPI development.

Results

The PA-EPI is conceptualised as a two-component ‘policy’ and ‘infrastructure support’ framework. The two components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development, and health-in-all-policies. Forty-five ‘good practice statements’ (GPS) or indicators of ideal good practice within each domain concludes the PA-EPI. A potential eight-step process for conducting the PA-EPI is described.

Conclusions

Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI GPS will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.

S09 Insights into the development of the physical activity environment policy index, a tool for benchmarking implementation of public policies to create healthy physical activity policy environments

The UN Sustainable Development Goals' (https://sustainabledevelopment.un.org/) and the Global Action Plan on Physical Activity (https://www.who.int/ncds/prevention/physical-activity/gappa) highlight the need to move beyond individual behaviour change to broader policy and system approaches, focusing not only on health but also on sustainability. Recently, policy responses to the epidemics of physical inactivity and sedentary behaviour have grown. The Global Observatory for Physical Activity (GoPA) reports that by 2013, 139 countries were members of its physical activity advocacy alliance and 26.6% of these countries had already published a stand-alone physical activity plan. The ‘Policy Evaluation Network' is a multi-disciplinary European research network aimed at understanding the impact of public policy for promoting healthy lifestyles in an effort to prevent non-communicable disease. To understand the progress governments are making in creating healthy policy environments, the benchmarking of best practice has proven effective for advancing the food policy agenda; however its usefulness for physical activity requires evaluation. Individual country results promote mutual learning between countries. This symposium will take a deep look at public policy in physical activity. It will summarise evidence from systematic literature reviews and present a tool for benchmarking progress. It will also discuss the potential next steps for addressing the inactivity, obesity and climate challenges through policy solutions in a systematic way.

The Chair will give an overview of context within which this symposium takes place e.g. GAPPA, Policy developments etc. They will also explain the symposium's purpose and objectives, introduce the speakers and direct questions.

Symposium Objectives

1. To review evidence for the contribution of transport, sport and mass media policy to the promotion of physical activity.

2. To show how evidence generate in each of these reviews contributed to the development of the physical activity environment policy index (PA-EPI).

3. To discuss the next steps for addressing inactivity by using policy intervention as a tool to catalyse change.

Abstract 1: Which transport policies increase physical activity of the whole of society? A Systematic Review.

Abstract 2: The impact of mass-media campaigns on physical activity: a review of reviews through a policy lens.

Abstract 3: Evidence of the impact of Sport Policies on physical activity and sport participation: A Systematic Mixed Studies Review.

Abstract 4: The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity.

The Discussant summarizes the presentations and provides insights on the specific topic area, generating an interactive discussion with the audience for at least 15 minutes, moderated by the Chair. (15 minutes) Conclusions: Some discussion of the possible contribution to, or implications for, the advancement of HEPA related goals.

S09-2 The impact of mass-media campaigns on physical activity: a review of reviews through a policy lens

Background

This review of reviews aims to summarize the evidence from published reviews on the effectiveness of mass-media campaigns to promote physical activity (PA), or PA-related determinants, and identify policy-relevant recommendations related to successful PA campaigns.

Methods

An extensive literature search was performed on March 1st, 2021. Reviews that evaluated the impact of campaigns on distal (e.g., PA) and/or proximal outcomes of PA (awareness, knowledge etc.) and that targeted the general population or subsets were included. Quality of reviews was assessed using the AMSTAR-2 tool. Policy-relevant recommendations were systematically derived and synthesized, and formulated as good practice statements. A protocol was registered beforehand (ID: CRD42021249184).

Results

A total of 1,915 studies were identified, of which 22 reviews were included. Results indicate that the most consistent evidence was found for the effectiveness of mass-media campaigns on proximal outcomes, while the evidence for distal outcomes was mixed. Good practice statements were derived: 1) to achieve behaviour change, mass-media is an important component of larger, multilevel, and multicomponent strategies, 2) mass-media strategies should be coordinated and aligned at local- and national-level, and be sustained, monitored and resourced at these levels, 3) media should be tailored to reduce socioeconomic inequalities.

Conclusions

Mass-media can play an important role in the promotion of PA. In general, evidence was more inconsistent for effectiveness on distal outcomes than for proximal outcomes. The policy-relevant recommendations identified will serve to inform the PA environment policy index (PA-EPI), a tool for monitoring, evaluating and benchmarking government progress in implementing public policies.

S09-1 Which transport policies increase physical activity of the whole of society? A Systematic Review

Background

There is strong evidence of the links between car-dependence and the global physical inactivity epidemic. If eliminated, physical inactivity would remove between 6% and 10% of major non-communicable diseases that are the leading cause of death globally, killing 38 million people each year. Research consistently shows that unlike passive transport (e.g. driving a car), active transport (i.e., walking, cycling) is associated with higher total daily physical activity (PA). While there are public policies that support PA in transport and, as a result, overall PA levels, the specific quantitative effect of such policies on PA behaviour has not been sufficiently investigated. The aim of this systematic review is to determine the level and type of evidence for policies in the area of transport that contribute to higher PA levels of society at large.

Methods

Six databases (MEDLINE (Ebsco), SportDiscus, Cinahl, Cochrane library, Web of Science, and Scopus) were searched for key concepts of policy, transport, evaluation and PA. Methodological quality was assessed using standardised tools. The strength of the evidence of policy impact was described based on pre-determined categories of positive, negative, inconclusive or untested.

Results

17 of 2,549 studies were included in the data synthesis. The authors identified three main transport policy areas with 60 individual policy actions that had a direct or indirect effect on PA. The policy areas were: convenient transport infrastructure development, active travel promotion and shift of transport mode. These areas correspond to Haddon's methodological approach of the transport system division in to three elements (human, vehicle, road). More than half of the policy actions identified (53%) had a positive effect on PA. Study quality ratings were moderate to good.

Conclusions

PA levels can be increased by implementing policies that provide convenient, safe, and connected walking and cycling infrastructures, promote active travel and give strong support to public transport. There is also clear evidence that active travel policies work best when implemented in a comprehensive way (very often as a combination of several policies). This may include infrastructure and facility improvements as well as educational programmes to achieve substantial shifts towards active modes of travel.

S09-3 Evidence of the impact of Sport Policies on physical activity and sport participation: A Systematic Mixed Studies Review

Background

Sport is recognised as a potential public health intervention through its influence on physical activity (PA) levels and consequent health benefits. International policy actors such as the Council of Europe, the World Health Organisation and the International Society for Physical Activity and Health have recommended that sport for all is promoted both for public health and as a basic right.

Purpose: This review aims to provide evidence to support the development of policies aimed at maximising the opportunity to participate in PA and sporting activity.

Methods

We systematically searched six electronic databases for quantitative, qualitative, and review studies investigating how public sport policy affects PA and sport participation outcomes”. The scientific literature was screened according to predetermined eligibility criteria. Following study selection and data extraction, the quality was assessed using modified versions of existing quality assessment tools. Results were synthesised narratively.

Results

Database searches identified 3705 unique articles. A total of 93 full-text articles were assessed, with 31 meeting our inclusion criteria. Fourteen unique policy actions were identified and were categorised into the policy areas Build Sport Facilities, Reduce Financial Barriers, Build Capacity and Establish Partnerships with Sport Sector, and Promote Public Interest in Sports.

Conclusions

Policy actions to promote physical activity and sport participation have demonstrated qualified success but there is limited evidence of success in reaching hard to reach groups. Therefore, policymakers utilising sport to increase physical activity should treat it as a complementary intervention alongside other policy actions based on a systems perspective.

O6-6 The added value of using the HEPA PAT for physical activity policy monitoring: A four-country comparison

Background

Public policy is increasingly recognized as an important component of physical activity (PA) promotion, as policy actions to address lifestyle behaviours have the potential to in?uence the health and well-being of an entire population. However, our knowledge about the current status, implementation and effectiveness of PA policies in individual countries is still very limited, and there is consequently no clear guidance on which policies governments should preferably use in different settings or under various preconditions. In order to improve the evidence-base, we conducted a detailed assessment of existing PA policies in four EU Member States using WHO's HEPA Policy Audit Tool (PAT) in the context of the Policy Evaluation Network (PEN).

Methods

We employed a six-step process to administer the HEPA PAT Version 2 in Ireland, the Netherlands, Germany, and Poland. This involved identifying stakeholders, pre-filling parts of the tool using existing survey data and desk-research, approaching select institutions to verify details, and obtaining expert opinion via workshops, interviews, and/or questionnaires. Based on the four completed PATs, we performed a comparative analysis to identify similarities and differences between countries and with previous studies using the tool.

Results

In all four countries, the health and sport sector were found to be most active in PA promotion, followed by education, transport, and environment/urban planning. All countries have national systems to monitor population PA levels, and three out of four already have national PA recommendations. The study also showed that policy context (e.g. ministry portfolios, importance of subnational governments) varies substantially between countries. This influences policy implementation and made it necessary to employ a bespoke approach in each country to obtain the required information.

Conclusions

Our findings largely confirm results of previous studies using the PAT in other countries. They also indicate that using the tool in combination with other policy monitoring tools, e.g. the EU Monitoring Framework for HEPA across Sectors, may provide added value and help countries monitor policy progress more consistently. Our experience also confirms some known limitations of the PAT, e.g. regarding subnational policies and a high level of dependence on cooperation from key policy actors.

Policy Evaluation Network (PEN): Protocol for systematic literature reviews examining the evidence for impact of policies on physical activity across seven different policy domains

Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity contributes an estimated 9% to this figure. Global responses have included the Sustainable Development Goals (SDGs) and the Global Action Plan on Physical Activity (GAPPA). Both point to policy action on physical activity (PA) to address change, yet the impact of policy on PA outcomes is unknown.  The protocol described outlines the methodology for systematic literature reviews that will be undertaken by the Policy Evaluation Network (PEN) to address this knowledge gap. Methods: The seven best investments for promotion of population PA identified in the Toronto Charter highlighted seven policy domains (schools, transport, urban design, primary health care systems, public education, community-wide programmes and sport) which will form the basis of these PEN reviews. Seven individual scientific literature searches across six electronic databases will be conducted. Each will use the key concepts of policy, PA, evaluation and a distinct concept for each of the seven policy domains. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined criteria. Conclusions: Each review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, each review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by GAPPA. Registration:  PROSPERO CRD42020156630 (10/07/2020).

The evidence for the impact of policy on physical activity outcomes within the school setting: A systematic review

BACKGROUND

Despite the well-established health benefits of physical activity (PA) for young people (aged 4-19 years), most do not meet PA guidelines. Policies that support PA in schools may be promising, but their impact on PA behavior is poorly understood. The aim of this systematic review was to ascertain the level and type of evidence reported in the international scientific literature for policies within the school setting that contribute directly or indirectly to increasing PA.

METHODS

This systematic review is compliant with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Six databases were searched using key concepts of policy, school, evaluation, and PA. Following title and abstract screening of 2323 studies, 25 progressed to data synthesis. Methodological quality was assessed using standardized tools, and the strength of the evidence of policy impact was described based on pre-determined codes: positive, negative, inconclusive, or untested statistically.

RESULTS

Evidence emerged for 9 policy areas that had a direct or indirect effect on PA within the school setting. These were whole school PA policy, physical education, sport/extracurricular PA, classroom-based PA, active breaks/recess, physical environment, shared use agreements, active school transport, and surveillance. The bulk of the evidence was significantly positive (54%), 27% was inconclusive, 9% was significantly negative, and 11% was untested (due to rounding, some numbers add to 99% or 101%). Frequency of evidence was highest in the primary setting (41%), 34% in the secondary setting, and 24% in primary/secondary combined school settings. By policy area, frequency of evidence was highest for sport/extracurricular PA (35%), 17% for physical education, and 12% for whole school PA policy, with evidence for shared use agreements between schools and local communities rarely reported (2%). Comparing relative strength of evidence, the evidence for shared use agreements, though sparse, was 100% positive, while 60% of the evidence for whole school PA policy, 59% of the evidence for sport/extracurricular PA, 57% of the evidence for physical education, 50% of the evidence for PA in classroom, and 50% of the evidence for active breaks/recess were positive.

CONCLUSION

The current evidence base supports the effectiveness of PA policy actions within the school setting but cautions against a "one-size-fits-all" approach and emphasizes the need to examine policy implementation to maximize translation into practice. Greater clarity regarding terminology, measurement, and methods for evaluation of policy interventions is needed.

Policy Evaluation Network (PEN): Protocol for systematic literature reviews examining the evidence for impact of policies on physical activity across seven different policy domains

Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity contributes an estimated 9% to this figure. Global responses have included the Sustainable Development Goals (SDGs) and the Global Action Plan on Physical Activity (GAPPA). Both point to policy action on physical activity (PA) to address change, yet the impact of policy on PA outcomes is unknown.  The protocol described outlines the methodology for systematic literature reviews that will be undertaken by the Policy Evaluation Network (PEN) to address this knowledge gap. Methods: The seven best investments for promotion of population PA identified in the Toronto Charter highlighted seven policy domains (schools, transport, urban design, primary health care systems, public education, community-wide programmes and sport) which will form the basis of these PEN reviews. Seven individual scientific literature searches across six electronic databases will be conducted. Each will use the key concepts of policy, PA, evaluation and a distinct concept for each of the seven policy domains. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined criteria. Conclusions: Each review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, each review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by GAPPA. Registration:  PROSPERO CRD42020156630 (10/07/2020).

The added value of using the HEPA PAT for physical activity policy monitoring: a four-country comparison

BACKGROUND

Public policy is increasingly recognized as an important component of physical activity promotion. This paper reports on the current status of physical activity policy development and implementation in four European countries based on the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) developed by WHO. It compares the findings to previous studies and discusses the general utility of this tool and its unique features in relation to other instruments.

METHODS

The study was conducted as part of the Policy Evaluation Network ( www.jpi-pen.eu ) in Germany, Ireland, the Netherlands and Poland. Data collection built upon information obtained via the EU Physical Activity Monitoring Framework survey, additional desk research and expert opinion. Data analysis employed Howlett's policy cycle framework to map and compare national physical activity policies in the four countries.

RESULTS

In all countries under study, policy agenda-setting is influenced by prevalence data from national health monitoring systems, and the sport and/or health sector takes the lead in policy formulation. Key policy documents were located mainly in the health sector but also in sport, urban design and transport. Physical activity programmes implemented to meet policy objectives usually cover a broad range of target groups, but currently only a small selection of major policies are evaluated for effectiveness. National experts made several suggestions to other countries wishing to establish physical activity policies, e.g. regarding cross-sectoral support and coordination, comprehensive national action plans, and monitoring/surveillance.

CONCLUSIONS

This study provides a detailed overview of physical activity policies in the four countries. Results show that national governments are already very active in the field but that there is room for improvement in a number of areas, e.g. regarding the contribution of sectors beyond sport and health. Using the HEPA PAT simultaneously in four countries also showed that procedures and timelines have to be adapted to national contexts. Overall, the instrument can make an important contribution to understanding and informing physical activity policy, especially when used as an add-on to regular monitoring tools like the EU HEPA Monitoring Framework.

Policy Evaluation Network (PEN): Protocol for systematic literature review examining the evidence for impact of policies across seven different policy domains

Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity contributes an estimated 9% to this figure. Global responses have included the Sustainable Development Goals (SDGs) and the Global Action Plan on Physical Activity (GAPPA). Both point to policy action on physical activity (PA) to address change, yet the impact of policy on PA outcomes is unknown.  The protocol described outlines the methodology for systematic literature reviews that will be undertaken by the Policy Evaluation Network (PEN) to address this knowledge gap. Methods: The seven best investments for promotion of population PA identified in the Toronto Charter highlighted seven policy domains (schools, transport, urban design, primary health care systems, public education, community-wide programmes and sport) which will form the basis of these PEN reviews. Seven individual scientific literature searches across six electronic databases will be conducted. Each will use the key concepts of policy, PA, evaluation and a distinct concept for each of the seven policy domains. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined criteria. Conclusions: Each review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, each review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by GAPPA. Registration:  PROSPERO CRD42020156630 (10/07/2020).

Short-term immediate post-shock pacing in adult advanced life support – a feasibility study of modified ALS algorithm

Introduction

It is well known that the majority of patients remains transiently pulseless after successfull defibrillation shock during routine advanced cardiovascular life support (ACLS). The post-shock asystole is longer than 120 seconds in as many as 25% of patients. Not only asystole, but also profound postshock bradycardia and high degree AV blocks are described as common.

The need for post-shock pacing (PSP) in adult ACLS is unknown, but there is extensive use of that feature in implantable cardioverters – defibrillators (ICD). PSP feature is widely used in these devices. The wide utilisation of PSP in ICD patients warrants the research towards any possible benefit of it during ACLS measures.

Material and methods

We performed high-fidelity simulation study including 60 paramedic at 20 scenarios. The participants were asked to perform routine resuscitation scenarios according to the AHA ACLS algorithm.

In the control group paramedics had to resume compressions after each shock. In experimental group simultaneously with the compressions, transcutaneous pacing with 200 mA output and rate of 80 ppm was delivered. Several parameters were monitored: chest compression fraction, compressions depth and rate, percent of recoiled compression, compressions on correct depth, and other.

Results

There were no statistically significant differences between both groups in respect of compressions depth and rate, time needed to achieve advanced airway, initiate and achieve intravenous line, administer medications (Table 1). The detailed results are presented in Table 1.

Discussion

According to the best of the authors knowledge, this is the first study describing the feasibility of PSP in resuscitation. The quality of resuscitation depends on adherence to the protocol. Any additional element in the protocol can negatively affect the outcome. In the presented study we present that major ACLS steps are delivered without significant delay when PSP is utilised.

Conclusions

The implementation of PSP had no negative impact on adherence to ACLS protocol. The authors see the need for further intensive research in this area.

Figure 1. Design of the study.

Funding Acknowledgement

Type of funding source: None

Policy Evaluation Network (PEN): Protocol for systematic literature review examining the evidence for impact of school policies on physical activity

Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity attributes an estimated 9% to this figure. Global responses have included the sustainable development goals and the global action plan on physical activity. Both point to policy action in physical activity (PA) to address change, yet the impact of policy is unknown.  The protocol described outlines a systematic literature review that will be undertaken by the Policy Evaluation Network to address this knowledge gap. Protocol: This review of school PA policies is the first of seven planned reviews. The seven best investments for promotion of population PA identified in the Toronto Charter (whole-of-school programmes, transport policy, urban design policy, primary health care policy, public education policy, community programmes and sport programmes) will form the basis of these reviews. Seven individual scientific literature searches across six electronic databases, using key concepts of policy, PA, evaluation and a distinct concept for each area will be conducted. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined categories. Conclusions: The review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, this review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by the 'Global Action Plan on Physical Activity'. Registration:  PROSPERO CRD42020156630 (10/07/2020).

Systematic review examining the evidence for impact of school policies on physical activity

Background

Epidemiological evidence has demonstrated that physical activity can have substantive health benefits for children and young people. The 'Policy Evaluation Network' is a multi-disciplinary research network across 7 European countries and New Zealand aimed at building capacity and evaluating the level of impact of policy interventions for promoting healthy lifestyles. The Toronto Charter identified 'whole-of-school' programmes as one of seven key investments for promotion of PA. This paper presents results of a SLR, designed to assess the level of evidence for policies within the school setting that contribute directly or indirectly to increasing PA.

Methods

Researchers searched six online databases for scientific literature regarding PA policy interventions in the school setting using key concepts of policy, school, PA and evaluation. Risk of bias will be assessed with tools appropriate to the design of the studies considered. Evidence of actual or potential positive PA outcomes arising directly or indirectly from policy actions will be catalogued.

Results

Preliminary searches identified 2327 unique scientific articles. 1938 (83.3%) were excluded on first reading and 189 (8.8%) were included for full text analysis. Initial findings suggest that organisational policies, for example avoiding overcrowding in playgrounds during school breaks, may be a promising policy action. Detailed analysis revealing other potential policy actions supported by evidence will be presented (SLR in progress).

Conclusions

Preliminary findings suggest that few studies link policy actions in the school setting to PA outcomes. However, studies that have investigated the effects of changes to the school environment on PA levels may provide evidence for policy actions. Preliminary recommendations include strengthening the evidence base for school-based PA policy by supporting studies into the effects of particular policy or legislative changes on PA outcomes.

Key messages

School physical activity policies are an underappreciated public health intervention. More studies should link policy changes to physical activity outcomes.

Sub-national structures matter when evaluating physical activity promotion: Lessons from Germany

Background

Public policies are increasingly acknowledged as important part of promoting physical activity (PA). However, especially in states with sub-national administrative structures such as Germany, national and sub-national approaches differ considerably. In Germany, sport for all (SfA) promotion is mostly organized at sub-national level, which is usually not covered in national evaluations. Knowledge of these structures helps to understand national outcomes, enables comparisons and learning within and between countries, and assists in identifying support structures for effective PA promotion.

Methods

Data were collected in the PEN Policy Evaluation Network project. In addition to the WHO HEPA PAT, a questionnaire was sent to the sports representatives of the 16 federal states. Responses of 11 state representatives were included and overarching issues were identified using inductive thematic analysis.

Results

PA promotion in Germany is organized in three areas: SfA, professional sports and school sports. SfA promotion at sub-national level is assigned to different administrative bodies (ministries, senate administration, state chancellery) and policy areas: culture, health and care, home affairs with various aspects, education, social affairs and family. The priorities of the federal states are more diverse and specific compared to the national level. There is an overlap in the topics: urban planning, cycling, health prevention and targeting children. Cooperation mechanisms and partners vary between federal states, but some partners are active at sub-national and national level.

Conclusions

The results provide an insight into the complexity of PA and especially SfA promotion at sub-national level in Germany. Our results suggest that a broader range of approaches is used in the 16 German states than national overviews would suggest. These particularities must be taken into account when assessing and comparing the results from different countries.

Key messages

The promotion of SfA at German sub-national level is much more diverse than represented at national level evaluations. Knowledge of sub-national structures enables the understanding of national outcomes, the promotion of cross-national learning and the identification of supportive structures for effective PA promotion.

Self-organizing maps classification of epidemiological data and toenail selenium content monitored on cancer and healthy patients from Poland

This paper deals with epidemiological multivariate statistical analysis of cancer and health patients from Pomeranian and Lubuskie Voivodships, Poland. The anthropometric and epidemiologic data include 8 parameters: toenail selenium concentration, sex, age, body mass index (BMI), smoking status, taking of Se supplements, health state, and family history of cancer. The self-organizing maps (SOM) are used for simultaneous classification of parameters and patients with relation to cancer diagnosis. Three different patterns (groups) of patients with cancer diagnosis are outlined: (i) older, smoking men with low toenail selenium concentration; (ii) older smoking women with family relation to cancer and toenail selenium deficiency; (iii) middle, aged nonsmokers with high level of selenium toenail concentration. The simultaneous classification of parameters and patients makes it possible to determine discriminating parameters for each pattern and relations between parameters. The relation of each parameter to cancer disease is discussed as special attention is paid to toenail selenium deficiency. More than 80% of patients with cancer diagnosis possess toenail selenium deficiency, accompanied by old age and smoking.

Methodological evaluation of method for dietary heavy metal intake

Exposure to environmental pollutants is an important problem of environmental toxicology. Heavy metals are regarded as toxic to living organisms because of their tendency to accumulate in selected tissues. Moreover, their presence is a causative agent of various sorts of disorders, including neuro-, nephro-, carcino-, terato-, and immunological. Exposures of human to environmental chemicals can occur simultaneously from various sources. One exposure route is ingestion of hazardous chemicals through contaminated food and beverages. Considering the above-mentioned menace, efforts should be focused on the estimation of dietary intakes of potential toxic agents by consumers. Dietary exposure assessment to nonnutrients is usually performed by combining 2 sets of data-the concentration of elemental contaminants in various food products and the consumption data of these food items. A variety of approaches exist for evaluating exposure to food chemicals, and the method chosen is influenced, among others, by the intended goal, the availability of data, cost, and time frame. Moreover, it is also important to note how accurate and detailed the information concerning toxic elements intake needs to be. There are a number of sources of food consumption data currently used in exposure assessments, which range from 1 d to habitual intake. Frequently, the heavy metals for which dietary exposure is of interest are present in trace and ultra-trace quantities. Hence, an analytical technique with sufficient sensitivity is required for the accurate determination of these chemicals in food samples. It is important to remember that the accuracy of quantitative analysis is strongly dependent on the sampling and preparation steps.