Web-based questionnaire survey for exploring engagement characteristics of advance care planning in Japan: a cross-sectional study

OBJECTIVE

Definitive promotion of advance care planning (ACP) practices will require policy interventions tailored to the characteristics of the Japanese population and society. However, effective policies for promoting ACP are currently lacking in Japan. This study aimed to explore the characteristics of Japanese people who engaged in ACP activities through a web-based questionnaire survey, which was administered to individuals aged 25-64 years and classified into four occupational categories (non-medical/non-caregiving professionals [general population], physicians, nurses, and caregivers).

RESULTS

The total sample size was 1,648, with equal occupational category and age group distributions. Respondents in the general population group were less likely to discuss or document ACP than those in the other groups. Stepwise logistic regression analysis showed a significant difference in the adjusted odds ratio (aOR) of the independent variables of "attended cardiopulmonary resuscitation (CPR) training session(s)" (aOR: 1.93; 95% confidence interval [CI]: 1.18-3.15) and "having experience in performing CPR" (aOR: 2.61; 95% CI: 1.51-4.54) for respondents who discussed ACP with their families. A significant difference was observed in the aOR of the independent variable of "having experience in performing CPR" (aOR: 4.58; 95% CI: 2.30-9.13) for respondents who documented a written record of ACP.

The impact of COVID-19 lockdown measures on gendered mobility patterns in France

The COVID-19 crisis has upset the way of life of our society. The objective of this study was to apprehend the consequences of public health policies on mobility through the lens of gender. The analyses are based on a representative sample of 3000 people living in France. Travel behaviour was quantified using three mobility indicators (number of daily trips, daily distance travelled and daily travel time) that we regressed on individual and contextual explanatory variables. Two periods were studied: lockdown (March 17, 2020 until May 11, 2020), and post-lockdown (a curfew period: January-February 2021). For the lockdown period, our results show: (i) a statistically significant gender difference for the three mobility indicators. On average, women made 1.19 daily trips versus 1.46 for men, travelled 12 km whereas versus 17 km for men and spent less time on travel (23 min) than men (30 min); (ii) the degree of mobility was particularly sensitive to access to a car, according to a gender difference. For the post-lockdown period, our results reveal that: (i) women were more likely than men to make a higher number of daily trips (OR = 1.10, 95% CI = [1.04-1.17]); (ii) having only one or no car in the household impacted the mobility of women during the post-lockdown period; (iii) women regained some mobility but without reaching the pre-lockdown level. A better understanding of the factors influencing mobility behaviour, in lockdown and curfew periods, can provide some pathways to improve transport planning and help public authorities while tackling gender inequalites.

Frequency of social participation by types and functional decline: A six-year longitudinal study

Social participation is effective for preventing functional decline in older people. However, researchers have not fully explored how different frequencies of social participation by type. We aimed to clarify the relationship between the frequency of social participation by type and functional decline. We used data from the Japan Gerontological Evaluation Study, which consists of individuals aged 65 years and older who were not eligible to receive public long-term-care insurance benefits. From 13 municipalities, 51,968 respondents who met the criteria were included in the analysis. We used a sex-stratified Cox proportional hazards model. The outcome was the new incidence of functional decline during a six-year follow-up, and the exposure was the frequency of social participation of one of the following six types: sports, hobbies, volunteering, neighborhood, senior clubs, and industry groups. The frequency was categorized as "never," "a few times a year," "once or twice a month," and "once a week or more." We set non-participation in each activity as the reference, and we adjusted for 12 potential confounders (i.e., sociodemographic and health-related factors). After we adjusted for confounders, participation in sports and hobbies once or twice a month, once a week or more was protectively associated with functional decline. We found a similar association for participation in neighborhood a few times a year. Our findings demonstrate the importance of considering the effects of different types and frequencies of activities when promoting social participation among older people as part of public health policies.

Big data-driven public health policy making: Potential for the healthcare industry

The use of healthcare data analytics is anticipated to play a significant role in future public health policy formulation. Therefore, this study examines how big data analytics (BDA) may be methodically incorporated into various phases of the health policy cycle for fact-based and precise health policy decision-making. So, this study explores the potential of BDA for accurate and rapid policy-making processes in the healthcare industry. A systematic review of literature spanning 22 years (from January 2001 to January 2023) has been conducted using the PRISMA approach to develop a conceptual framework. The study introduces the emerging topic of BDA in healthcare policy, goes over the advantages, presents a framework, advances instances from the literature, reveals difficulties and provides recommendations. This study argues that BDA has the ability to transform the conventional policy-making process into data-driven process, which helps to make accurate health policy decision. In addition, this study contends that BDA is applicable to the different stages of health policy cycle, namely policy identification, agenda setting as well as policy formulation, implementation and evaluation. Currently, descriptive, predictive and prescriptive analytics are used for public health policy decisions on data obtained from several common health-related big data sources like electronic health reports, public health records, patient and clinical data, and government and social networking sites. To effectively utilize all of the data, it is necessary to overcome the computational, algorithmic and technological obstacles that define today's extremely heterogeneous data landscape, as well as a variety of legal, normative, governance and policy limitations. Big data can only fulfill its full potential if data are made available and shared. This enables public health institutions and policymakers to evaluate the impact and risk of policy changes at the population level.

Temporal relationship between human and canine visceral leishmaniasis in an urban area in southeastern Brazil: An application of the ARIMAX model

Visceral leishmaniasis (VL) is a neglected disease of public and animal health importance. With the urbanization of the disease, there is evidence of a temporal correlation between the occurrence of human (HVL) and canine (CVL) visceral leishmaniasis, usually with cases in dogs preceding those in humans. In this context, the objective of this study was to develop a time series model suitable for canine-human transmission of Leishmania infantum. Monthly cases of HVL and CVL from 2006 to 2018 in Belo Horizonte, Minas Gerais, Brazil, were evaluated, and monthly health indicators were calculated for HVL and CVL, i.e., incidence coefficient (HVL_IC) and proportion of seropositive dogs (PSD), respectively. The temporal relationship was evaluated using an autoregressive integrated moving average with exogenous variable (ARIMAX) model for two different periods (January 2006-August 2013 and September 2013-December 2018). During the 13 years studied, 1115 new cases of HVL and 103,358 dogs seropositive for CVL were recorded. HVL_IC and PSD exhibited decreasing trends throughout the first study period (January 2006-August 2013). According to the ARIMAX model adjusted for this period, there was a temporal relationship between HVL_IC and PSD, with HVL_IC being influenced by HVL_IC for the last two and five months and by PSD for the third previous month. For the second study period (September 2013-December 2018), it was not possible to fit an ARIMAX model. This study highlights the improvements made by VL surveillance since 2006 in Belo Horizonte and contributes to a better understanding of the epidemiology of the disease by public health policy-makers, doctors and veterinarians involved in the prevention and control of zoonoses.

Comprehensive sentimental analysis of tweets towards COVID-19 in Pakistan: a study on governmental preventive measures

Sentiments are the key factors that lead to influence our behavior. Sentiment analysis is a technique that analyzes people's behaviors, attitudes, and emotions toward a service, product, topic, or event. Since 2020, no country has remained untouched by COVID-19, and the governing bodies of most countries have been applying several anti-pandemic countermeasures to combat it. In this regard, it becomes tremendously important to analyze people's sentiments when tackling infectious diseases similar to COVID-19. The countermeasures taken by any country to control the pandemic leave a direct and crucial impact on each sector of public life, and every individual reacts to them differently. It is necessary to consider these reactions to implement appropriate messaging and decisive policies. Pakistan has done enough to control this virus's spread like every other country. This research aims to perform a sentimental analysis on the famous microblogging social platform, Twitter, to get insights into public sentiments and the attitudes displayed towards the precautionary steps taken by the Government of Pakistan in the years 2020 and 2021. These steps or countermeasures include the closure of educational institutes, suspension of flight operations, lockdown of business activities, enforcement of several standard operating procedures (SOPs), and the commencement of the vaccination program. We implemented four approaches for the analysis, including the Valence Aware Dictionary and sEntiment Reasoner (VADER), TextBlob, Flair, and Bidirectional Encoder Representations from Transformers (BERT). The first two techniques are lexicon-based. Flair is a pre-trained embedding-based approach, whereas BERT is a transformer-based model. BERT was fine-tuned and trained on a labeled dataset, achieving a validation accuracy of 92%. We observed that the polarity score kept varying from month to month in both years for all countermeasures. This score was analyzed with real-time events occurring in the country, which helped understand the public's sentiment and led to the possible formation of a notable conclusion. All implemented approaches showed independent performances. However, we noticed from the classification results of both TextBlob and the fine-tuned BERT model that neutral sentiment was dominant in the data, followed by positive sentiment.

Deaths during the first year of the COVID-19 pandemic: insights from regional patterns in Germany and Poland

BACKGROUND

Given the nature of the spread of SARS-CoV-2, strong regional patterns in the fatal consequences of the COVID-19 pandemic related to local characteristics such as population and health care infrastructures were to be expected. In this paper we conduct a detailed examination of the spatial correlation of deaths in the first year of the pandemic in two neighbouring countries - Germany and Poland, which, among high income countries, seem particularly different in terms of the death toll associated with the COVID-19 pandemic. The analysis aims to yield evidence that spatial patterns of mortality can provide important clues as to the reasons behind significant differences in the consequences of the COVID-19 pandemic in these two countries.

METHODS

Based on official health and population statistics on the level of counties, we explore the spatial nature of mortality in 2020 in the two countries - which, as we show, reflects important contextual differences. We investigate three different measures of deaths: the officially recorded COVID-19 deaths, the total values of excessive deaths and the difference between the two. We link them to important pre-pandemic regional characteristics such as population, health care and economic conditions in multivariate spatial autoregressive models. From the point of view of pandemic related fatalities we stress the distinction between direct and indirect consequences of COVID-19, separating the latter further into two types, the spatial nature of which is likely to differ.

RESULTS

The COVID-19 pandemic led to much more excess deaths in Poland than in Germany. Detailed spatial analysis of deaths at the regional level shows a consistent pattern of deaths officially registered as related to COVID-19. For excess deaths, however, we find strong spatial correlation in Germany but little such evidence in Poland.

CONCLUSIONS

In contrast to Germany, for Poland we do not observe the expected spatial pattern of total excess deaths and the excess deaths over and above the official COVID-19 deaths. This difference cannot be explained by pre-pandemic regional factors such as economic and population structures or by healthcare infrastructure. The findings point to the need for alternative explanations related to the Polish policy reaction to the pandemic and failures in the areas of healthcare and public health, which resulted in a massive loss of life.

Improving the health of adolescents: the Nordic countries can help fill the evidence gap

While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature assessing the effects of policy measures designed to promote health. Using adolescent health promotion and efforts related to primary prevention of obesity as an example, this short commentary aims to illustrate the paucity of well-designed studies investigating the effects of public health policies affecting adolescents. This paper argues that the Nordic research community is in a good position to help fill this gap, and to contribute more widely to the international literature on evaluation of policy interventions.

Uneven stigma loads: Community interpretations of public health policies, 'evidence' and inequities in shaping Covid-19 stigma in Vietnam

The infectious spread of COVID-19 has been accompanied by stigma in both global and local contexts, sparking concern about its negative effect on individuals, communities, and public health responses. The changing epidemiological context of the COVID-19 epidemic and evolving public health responses during the first year of the pandemic (2020) in Vietnam serve as a case study to qualitatively explore the fluidity of stigma.

We conducted in-depth interviews with 38 individuals, (13 cases, 9 close contacts, and 16 community members) from areas affected by local outbreaks. Thematic analysis was conducted iteratively.

Our analysis indicates that the extent and impacts of COVID-19-related stigma were uneven. Adapting the clinical term 'viral load' as a metaphor, we describe this variation through the wide range of 'stigma load' noted in participants' experiences. Individuals encountering more acute stigma, i.e. the highest 'stigma load', were those associated with COVID-19 at the start of the local outbreaks. These intensively negative social responses were driven by a social meaning-making process that misappropriated an inaccurate understanding of epidemiological logic. Specifically, contact tracing was presumed within the public consciousness to indicate linear blame, with individuals falsely considered to have engaged in 'transgressive mobility', with onward transmission perceived as being intentional. In contrast, as case numbers grew within an outbreak the imagined linearity of the infection chain was disrupted and lower levels of stigma were experienced, with COVID-19 transmission and association reframed as reflecting an environmental rather than behavioural risk.

Our findings demonstrate the role of public health policies in unintentionally creating conditions for stigma to flourish. However, this is fluid. The social perceptions of infection risk shifted from being individualised to environmental, suggesting that stigma can be modified and mitigated through attending to the productive social lives of public health approaches and policies.

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Those associated with COVID-19 experienced variable degrees of stigma - 'stigma load'.

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Those linked to COVID-19 at the start of outbreaks experienced highest stigma load.

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Misinterpretation of public health strategies contributed to blaming discourses.

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Stigma receded when risk framed as environmental not behavioural.

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Fluidity of stigma suggests potential to allay stigmatising effect of interventions.

Global policy responses to the COVID-19 pandemic: results of the ICOH survey

Background

On the basis of its role for the development of occupational health research, information, good practices, the International Commission on Occupational Health (ICOH) launched the present survey to collect information on public health and prevention policies put in place by the governments of the countries in the world to contain the pandemic.

Methods

A cross-sectional study was conducted through an online questionnaire focused on COVID-19 data, public health policies, prevention measures, support measures for economy, work, and education, personal protective equipment, intensive care units, contact tracing, return to work, and the role of ICOH against COVID-19. The questionnaire was administered to 113 ICOH National Secretaries and senior OSH experts. Collected data refer to the period ranging from the beginning of the pandemic in each country to June 30, 2020.

Results

A total of 73 questionnaires from 73 countries around the world were considered valid, with a 64.6% response rate. Most of the respondents (71.2%) reported that the state of emergency was declared in their country, and 86.1% reported lockdown measures. Most of the respondents (66.7%) affirmed that the use of face masks was compulsory in their country. As for containment measures, 97.2% indicated that mass gatherings (meetings) were limited. Regarding workplace closing, the most affected sector was entertainment (90.1%).

Conclusion

The results of this survey are useful to gain a global view on COVID-19 policy responses at country level.

Experiences of long-term care and supportive living residents and families during the COVID-19 pandemic: "It's a lot different for us than it is for the average Joe"

Long-term care and supportive living (LTC/SL) residents are among the most at risk for severe outcomes of COVID-19. As such, early public health measures focused on this population. This study examined the experiences and perspectives of residents and family members of residents living in LTC/SL centres in Alberta, Canada during the COVID-19 pandemic. Between July and October 2020, we conducted semi-structured interviews with 14 residents and 18 family members of residents from 10 centres. Interviews were audio-recorded and analyzed using qualitative content analysis. Analysis revealed 5 categories from resident interviews (Living with Rules and Restrictions; COVID-19 Knowledge and Information; Wellbeing; Centre Operational Response; Criticisms and Suggestions for Improvement) and 6 categories from family interviews (Family Role; Navigating the New Normal; COVID-19 Knowledge and Information; Policy Limitations; Policy Impact; Centre Response). The results highlight the importance of engaging residents and families during pandemic preparation, response, and follow-up evaluation.

Spatial analysis of food security in Iran: associated factors and governmental support policies

This study analyzes caloric intake in Iran as a proxy for food security to determine factors associated with caloric intake that could be impacted by policies. We modeled regional heterogeneity by analyzing a complete countrywide dataset disaggregated for rural intra-provincial areas using unique data from the Iranian Statistical Centre for 2007-2016. We applied logistic regression modeling and likelihood ratio tests to assess the association between socio-economic determinants and caloric intake among rural areas of all provinces. National policies (nation-wide food subsidies and a cash equivalent for food for each adult regardless of residence or income) had significant negative associations with caloric intake among all provinces. The detected spatial diversity suggests policies specific to each area could be more effective than a centralized national policy for food security. Rather than implementing one-size-fits-all policies, such as across-the-board cash food subsidies, the government should take a differential spatially targeted approach to directly support low-income households.

Learning from the past: Taiwan's responses to COVID-19 versus SARS

OBJECTIVES

To evaluate the prevalence of infection prevention behaviors in Taiwan-wearing facemasks and alcohol-based hand hygiene (AHH)-and compare their practice rates during SARS and COVID-19.

METHODS

We surveyed 2328 Taiwanese from July 29 to August 6, 2020, assessing demographics, information sources, and preventive behaviors during the 2003 SARS outbreaks, 2009 pandemic influenza H1N1, COVID-19, and with post-survey intentions. Characteristics associated with the practice of preventive behaviors in 2020 were identified through logistic regression.

RESULTS

Preventive behaviors were conscientiously practiced by 70.2% of participants. Compared with 2003 SARS/2009 H1N1, the percentages of facemask use (66.6% vs 99.2% [indoors], P < 0.001) and on-person AHH (44.2% vs 65.4% [hand sanitizers], P < 0.001) significantly increasedduring 2020 COVID-19. Highest adherence to preventive behaviors in 2020 was among females (adjusted odds ratio [aOR], 1.72), those receiving government COVID-19 information (aOR, 1.52), participants recruited from primary-care clinics (aOR, 1.43), and those who practiced AHH during 2003 SARS/2009 H1N1 (aOR, 1.37).

CONCLUSIONS

Government leadership, healthcare providers risk communication, and public cooperation rapidly mitigated the spread of COVID-19 in Taiwan even before vaccination. Future global efforts must implement such population-based preventive behaviors at a level above the viral-transmission-threshold, particularly in areas with fast-spreading SARS-CoV-2 variants.

Wastewater-based epidemiology as a useful tool to track SARS-CoV-2 and support public health policies at municipal level in Brazil

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) wastewater-based epidemiology (WBE) has been applied as a complementary approach for spatial tracking of coronavirus disease 2019 cases (COVID-19) as well as early warning of the occurrence of infected populations. The present study presents the result of the monitoring of sanitary sewerage in the municipality of Niterói, a metropolitan region of Rio de Janeiro (Brazil) and its use as a complementary indicator in the surveillance of COVID-19 cases, thus assisting actions of public health from local authorities. Twelve composite raw sewage samples were weekly collected from two wastewater treatment plants (WWTPs) and alternately from 17 sewer pipes (SP) from surrounding neighbourhoods and slums throughout 20 weeks (April 15th to August 25th, 2020). Two hundred twenty-three samples were concentrated using the ultracentrifugation-based method and SARS-CoV-2 RNA detected and quantified by RT-qPCR using primers and probe targeting the N2 genome. SARS-CoV-2 RNA was detected in 84.3% (188/223) of samples with a positive rate ranging from 42% (5/12) in the first week of monitoring to 100% during the peak of epidemic with viral concentration ranging from 3.1 to 7.1 log₁₀ genome copies _/100 mL throughout the studied period. Positive rates were higher in WWTPs when compared to SP, being useful tool for monitoring trends in the evolution of the COVID-19 curve, while SP data were more effective when health public interventions were needed. Whole-genome sequencing using Illumina MiSeq System confirmed the lineage of three genomes as B.1.1.33 (clade G) containing the nucleotide substitutions observed in strains that circulate in the Rio de Janeiro during the period of this study. In addition, geoprocessing tool was used to build heat maps based on SARS-CoV-2 data from sewage samples, which were weekly updated and available online to the general population as an indicator of the ongoing epidemic situation in Niterói city, raising public awareness.

Evidence-based Public Health Policy Models Development and Evaluation using Big Data Analytics and Web Technologies

Introduction.

According to WHO, “health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society”. Although policymaking is important to be based on scientific evidence, in many countries, evidence-informed decision-making remains the exception rather than the rule.

Aim:

This work presents a cloud-based Decision Support System for public health decision-making.

Methods:

In CrowdHEALTH, the concept of a Public Health Policy (PHP) is directly connected with one or more Key Performance Indexes (KPIs). The design and technical details of the system implementations are reported, along with use case scenarios.

Results:

The Policy Development Toolkit presents a unique interface and point of reference for policymakers, allowing them to create policy models and obtain analytical results for evidence-based decisions and evaluations.

Conclusions:

The hierarchical structure of the Public Health Policy Model offers versatility in the creation and handling of the policies, resulting in Health Analytics Tools Results Objects which offer quantitative policy support and provide the basis for meta-analytic operations.

Policy determinants of COVID-19 pandemic-induced fatality rates across nations

Objectives

Coronavirus disease 2019 (COVID-19) is the most devastating pandemic to affect humanity in a century. In this article, we assessed tests as a policy instrument and policy enactment to contain COVID-19 and potentially reduce mortalities.

Study design

A model was devised to estimate the factors that influenced the death rate across 121 nations and by income group.

Results

Nations with a higher proportion of people aged 65+ years had a higher fatality rate (P = 0.00014). Delaying policy enactment led to a higher case fatality rate (P = 0.0013). A 10% delay time to act resulted in a 3.7% higher case fatality rate. This study found that delaying policies for international travel restrictions, public information campaigns, and testing policies increased the fatality rate. Tests also impacted the case fatality rate, and nations with 10% more cumulative tests per million people showed a 2.8% lower mortality rate. Citizens of nations who can access more destinations without the need to have a prior visa have a significant higher mortality rate than those who need a visa to travel abroad (P = 0.0040).

Conclusion

Tests, as a surrogate of policy action and earlier policy enactment, matter for saving lives from pandemics as such policies reduce the transmission rate of the pandemic.

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A model estimated factors influencing the death rate from COVID-19.

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Nations with more people aged 65+ years have a higher fatality rate.

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More tests per million people leads to a lower death rate.

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A 10% delay time to act results in a 3.6% higher case fatality rate.

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Policies to contain the spread of COVID-19 have other public health effects.

A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes

BACKGROUND

A country level exploratory analysis was conducted to assess the impact of timing and type of national health policy/actions undertaken towards COVID-19 mortality and related health outcomes.

METHODS

Information on COVID-19 policies and health outcomes were extracted from websites and country specific sources. Data collection included the government's action, level of national preparedness, and country specific socioeconomic factors. Data was collected from the top 50 countries ranked by number of cases. Multivariable negative binomial regression was used to identify factors associated with COVID-19 mortality and related health outcomes.

FINDINGS

Increasing COVID-19 caseloads were associated with countries with higher obesity (adjusted rate ratio [RR]=1.06; 95%CI: 1.01-1.11), median population age (RR=1.10; 95%CI: 1.05-1.15) and longer time to border closures from the first reported case (RR=1.04; 95%CI: 1.01-1.08). Increased mortality per million was significantly associated with higher obesity prevalence (RR=1.12; 95%CI: 1.06-1.19) and per capita gross domestic product (GDP) (RR=1.03; 95%CI: 1.00-1.06). Reduced income dispersion reduced mortality (RR=0.88; 95%CI: 0.83-0.93) and the number of critical cases (RR=0.92; 95% CI: 0.87-0.97). Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people. However, full lockdowns (RR=2.47: 95%CI: 1.08-5.64) and reduced country vulnerability to biological threats (i.e. high scores on the global health security scale for risk environment) (RR=1.55; 95%CI: 1.13-2.12) were significantly associated with increased patient recovery rates.

INTERPRETATION

In this exploratory analysis, low levels of national preparedness, scale of testing and population characteristics were associated with increased national case load and overall mortality.

FUNDING

This study is non-funded.

National panorama of adolescent pregnancy in Mexico: lessons learned in a six-year period

Globally, adolescent pregnancy constitutes a serious public health problem of a multifactorial nature. Specifically for women, it entails various educational, economic and social implications that affect their life project and widen the social gaps in this age group. Furthermore, adolescent girls are more vulnerable because of the health risk involved with pregnancy at a younger age. According to the World Health Organization, "the probability of maternal death is twice as high in adolescents in comparison with women aged between 20 and 30 years, and for those younger than 15 years, the risks are five times higher". In general, adolescents are in great need for education on sexual and reproductive health issues, which should be aimed at increasing information and knowledge about correct use and access to modern contraceptive methods, as well as at demystifying fears and beliefs around their possible side effects. Ensuring proper counseling with trained personnel is equally vital. Public institutions have a social responsibility to support efforts aimed at preventing adolescent pregnancy, based on relevant lines of action and health policies.

Need for public health policies in the elderly population: indicators of aging in a Social Security Institute in Mexico

Introduction

An integral diagnosis of population contemplates within its components the population demographic analysis that is indispensable in the formulation of public policies. Population policy has a clearly transversal nature, since all actions in the economic, social, political, cultural, geographical, and obviously, demographic fields, have direct or indirect repercussions on it.

Objectives

To determine the population dynamics and the global growth of the older adult population (OAP) of 60 years and more.

Materials and methods

Cross-sectional, retrospective study. The information was obtained from the statistical yearbooks of the institute of security and social services of state workers, Mexico (1999-2015). Several demographic ageing indicators were analyzed.

Results

There was a constant increase in percentage points in the proportion of OAP, index of ageing, demographic dependency ratio of old age, global index of dependence, index of dependence of old people, and index of the active population structure (6, 19.2, 15.5, 8.5, 8.2 and 31.2%, respectively). The indicator global index of dependence and masculinity showed a decrease (0.6 and 3.1%, respectively).

Conclusions

Our data provide evidence that suggests modifying and generating public policies according to OAP.

Priority setting for mental health research in Chile

Background

Scientific knowledge is a fundamental tool for making informed health policy decisions, but the link between health research and public policy decision-making is often missing. This study aims to identify and prioritize a national set of research gaps in mental health.

Methods

A multi-approach method to identify gaps in knowledge was developed, including (1) document analysis and identification of possible research questions, (2) interviews to Ministry of Health key informants, (3) focus groups with different stakeholders, and (4) a web consultation addressed to academics. The identified gaps were translated to a standardized format of research questions. Criteria for prioritization were extracted from interviews and focus groups. Then, a team of various professionals applied them for scoring each question research.

Findings

Fifty-four people participated in the knowledge gaps identification process through an online consultation (n = 23) and focus groups (n = 18). Prioritization criteria identified were: extent of the knowledge gap, size of the objective population, potential benefit, vulnerability, urgency and applicability. 155 research questions were prioritized, of which 44% were related to evaluation of systems and/or health programs, and 26% to evaluation of interventions, including questions related to cost-effectiveness. 30% of the research questions came from the online consultation, and 36% from key informants. Users groups contributed with 10% of total research questions.

Conclusion

A final priority setting for mental health research was reached, making available for authorities and research agencies a list of 155 research questions ordered by relevance. The experience documented here could serve to other countries interested in developing a similar process.

Electronic supplementary material

The online version of this article (doi:10.1186/s13033-017-0168-9) contains supplementary material, which is available to authorized users.

The health educator network as a nutrition education strategy: the example of the EDALNU programme (1963-1994)

Food and nutrition education is an essential tool to ensure public health. The year 1961 saw the launch of the Food and Nutrition Education Programme (EDALNU), which helped Spanish population to complete their nutrition transition. The aim of this study was to analyze the characteristics of the health education network which was created as part of the program. A total of 46,752 people, 94% of whom were women, received training on food and nutrition. Of these, 89.54% obtained the basic certificate, and 8.80% were awarded the diploma. Some 1,407 courses were given, reaching a peak in 1979 with 131 courses and 4,029 students. The most active provinces were Madrid, with 26.65% of the courses; Valencia, with 7.60%; Murcia, with 7.53%, and Malaga, with 6.75%. The Spanish Ministry of Culture and Education organized the largest number of courses (26.23%), followed by the Women’s Section (11.16%) and Catholic Action (5.12%). Diploma courses were taught for 160 hours, while basic courses lasted 40 hours. The training delivered was affected by changes in the EDALNU program and the Spanish administrative and political structure. Our research revealed that the development and gender balance of the network of trainers presented regional inequalities, and that a wide range of institutions were involved in delivering the courses

Research and lobbying conflicting on the issue of a front-of-pack nutrition labelling in France

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

Sensory impact of lowering sugar content in orange nectars to design healthier, low-sugar industrialized beverages

The presence of added sugars (AS) in the diet is associated with increased risk of obesity and other chronic diseases. We assessed sensory impact of lowering AS in orange nectar, aiming at new WHO sugar guideline. Ideal sweetness by just-about-right (JAR) tests (60 consumers), difference and rejection thresholds (36 and 35 assessors), and acceptance and sensory profile by Check-all-that-apply (CATA) tests (100 consumers) were performed. JAR test comprised six concentrations of AS from 12% down to 4.5%. Thresholds tests comprised orange nectars at reference sugar concentration (10%) and at lower sugar levels. Acceptance and CATA tests compared reference, ideal sweetness and thresholds concentrations. There were two groups of consumers; one with ideal sweetness lower at 5.5% AS and another with ideal sweetness at standard 10.5% AS. The average ideal sweetness among all consumers was 7.3% AS. The difference threshold from the reference at 10.5% AS was at 8.5% AS and the rejection threshold was 7.2%. Overall acceptance of nectar with 8.5% and 7.2% AS was similar to reference and higher than acceptance of nectar with 5.5%. However, after cluster analysis, nectars with 5.5% AS did not differ from nectars with 8.5% or 7.2% AS, suggesting the possibility of a gradual reduction until 5.5% in the long term. Lowering AS to 7.2% or 5.5% caused significant changes in viscosity, sweet odor, bitterness and sweetness in comparison to the reference concentration. Lowering sugar from 10% to 8.5% did not affect acceptance or sensory attributes, and could be indicated for a first reduction. Results indicate that a gradual reduction to 7.2% and 5.5% would be feasible. Reductions can remove 3150-9450 tons of sugar per year from the Brazilian diet resulting in healthier beverages.

The impact of HIV/AIDS on children in developing countries

HIV infection and AIDS among children continues to be a significant problem in developing countries despite the progress that has been made in HIV prevention and AIDS treatment elsewhere during the past two decades. The reasons for this difference are complex and multifactorial. They include the higher background prevalence of infection among adults in some communities in developing countries, the slow implementation in many countries of prenatal HIV screening programs and prophylaxis which can reduce the transmission to infants during labor and delivery, the social and health consequences of not breastfeeding, and the economic realities associated with expensive diagnostic testing and antiretroviral treatment. While the world waits for an effective HIV/AIDS vaccine, to reduce the prevalence of HIV in the community, public health programs need to continue to emphasize proven methods of HIV transmission prevention among groups with a high-risk of HIV acquisition, as well as provide counselling for the general population about personal protection and the provision of compassionate care for those affected.