Objectives. To determine clusters of individuals who present similar health behaviors in terms of diet, physical activity, and sedentarism, in four countries of the Americas: Brazil (2013), Chile ...(2009), Mexico (2012), and the United States of America (2013). This makes it possible to determine which of these behaviors occur simultaneously, as well as the demographic and sociodemographic characteristics associated with each cluster. Methods. The individual-level data analyzed were drawn from national health interviews and health examination surveys in Brazil, Chile, Mexico, and the United States, for different time periods. Using international physical activity guidelines and national dietary guidelines, the health behaviors of each individual were assessed. A latent class analysis was conducted to classify individuals into clusters based on these behaviors, and was followed by multinomial regressions to determine the characteristics of those in each class. Results. Overall, most individuals belonged to the classes characterized by average or unhealthy diets but sufficient amounts of physical activity. However, large differences exist across countries and population groups. Men with higher socioeconomic characteristics were globally more likely to belong to the least healthy class in each country. Conclusions. Findings from this analysis support the implementation of more refined policy actions to target specific unhealthy behaviors in different population groups, defined by gender, age group, socioeconomic status, and, to some extent, place of residence. The at-risk populations identified through this paper are those that should be targeted by upcoming interventions. Keywords Epidemiology; diet; life style; exercise; Americas. Objetivos. Determinar conglomerados de personas que presentan comportamientos similares con respecto a la salud en materia de alimentacion, actividad fisica y vida sedentaria en cuatro paises de la Region de las Americas: Brasil (2013), Chile (2009), Estados Unidos de America (2013) y Mexico (2012). Esto permite determinar cuales de estos comportamientos se presentan simultaneamente, asi como las caracteristicas demograficas y sociodemograficas propias de cada conglomerado. Metodos. Los datos a nivel individual que se analizaron se obtuvieron de entrevistas nacionales de salud y encuestas sobre examenes de salud en Brasil, Chile, Estados Unidos y Mexico para diferentes periodos. Se evaluaron los comportamientos de cada persona con respecto a la salud a partir de directrices de actividad fisica internacionales y directrices alimentarias nacionales. Se realizo un analisis de clases latentes para clasificar a los personas en conglomerados basados en dichos comportamientos, seguido de regresiones polinomicas para determinar las caracteristicas de los integrantes de cada clase. Resultados. En terminos generales, la mayor parte de las personas pertenecian a las clases caracterizadas por una alimentacion promedio o insalubre, pero con niveles suficientes de actividad fisica. Sin embargo, hay grandes diferencias entre los distintos paises y grupos poblacionales. Los hombres con las caracteristicas socioeconomicas mas altas tenian mas probabilidades en general de pertenecer a la clase menos saludable de cada pais. Conclusiones. Los resultados de este analisis apoyan la ejecucion de acciones de politicas publicas mas refinadas, dirigidas a determinados comportamientos nocivos en diferentes grupos poblacionales, definidos por genero, grupo etario, nivel socioeconomico y, hasta cierto punto, lugar de residencia. Las proximas intervenciones deben dirigirse a los grupos poblacionales en riesgo establecidos en este articulo. Palabras clave Epidemiologia; dieta; estilo de vida; ejercicio; Americas. Objetivos. Determinar aglomerados de individuos com comportamentos de saude semelhantes quanto a alimentacao, atividade fisica e sedentarismo em quatro paises das Americas: Brasil (2013), Chile (2009), Mexico (2012) e Estados Unidos (2013) a fim de determinar os comportamentos que ocorrem simultaneamente e as caracteristicas demograficas e sociodemograficas associadas a cada aglomerado. Metodos. Os dados ao nivel do individuo analisados no estudo foram obtidos em entrevistas de saude nacionais e pesquisas de saude realizadas no Brasil, Chile, Mexico e Estados Unidos em diferentes periodos. Os comportamentos de saude de cada individuo foram avaliados segundo as diretrizes internacionais de atividade fisica e as diretrizes nacionais de alimentacao. Foi realizada uma analise de classes latentes para classificar os individuos em aglomerados de acordo com os comportamentos, seguida da analise por regressao polinomica para determinar as caracteristicas destes comportamentos em cada classe. Resultados. A maioria dos individuos pertencia a classes caracterizadas por alimentacao media ou pouco saudavel, porem com nivel suficiente de atividade fisica. No entanto, existem grandes diferencas entre os paises e os grupos populacionais. Verificou-se maior probabilidade de os individuos do sexo masculino de nivel socioeconomico mais alto pertencerem a classe menos saudavel em cada pais. Conclusoes. Os achados desta analise apoiam a implementacao de acoes de politica mais apuradas dirigidas a determinados comportamentos pouco saudaveis em diferentes grupos populacionais, definidos por genero, faixa etaria, condicao socioeconomica e, em certa medida, local de residencia. As populacoes em risco identificadas no estudo devem ser o principal alvo de intervencoes imediatas. Palavras-chave Epidemiologia; dieta; estilo de vida; exercicio; Americas.
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•This study reviews the evidence on the impact of food safety policies to prevent foodborne diseases in catering services.•Food safety interventions are associated with a microbial ...reduction of 28.6% (95% CI: −30.6% to −26.7%).•Analyses by organism, sample origin, food establishment and collection time show consistent results with the main analysis.•Sensitivity analyses confirm the overall strength of the results and the related policy recommendations.
Despite being largely preventable, foodborne diseases continue to be of major concern worldwide. Research has shown that interventions relying on food handling training programs and standard food safety practices have a direct impact on food handler’s knowledge and attitudes. However, to date, evidence on the effectiveness of policies in reducing microbial count in food is sparse and inconclusive. This systematic review and meta-analysis aims to summarize the evidence on the potential of food safety policies in catering establishments as a means to prevent foodborne diseases. A search for relevant publications was conducted in PubMed, Scopus, CENTRAL, ProQuest, CINAHL and ERIC databases. Retrieved studies were summarised in terms of context, population, outcome, methodology, risk of bias and intervention type. Eight studies were included in the qualitative analysis and the meta-analysis. Food safety interventions were associated with a statistically significant microbial reduction of 28.6% (95% CI: −30.6% to −26.7%). Four subgroup analyses were conducted: by type of microorganism screened, by sample origin, by type of food establishment, and by sample collection time post-intervention. Microbial reductions were consistent across each of the subgroups. Findings suggest that policies such as programs based on the Hazard Analysis and Critical Control Points (HACCP) could be effective strategies to prevent foodborne diseases from occurring in foodservice establishments at the end of the food supply chain. However, the underlying evidence suffers from risk of bias and more randomized controlled trials and controlled before-and-after studies are needed in this field.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In this ...report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health-care expenditures. These strategies include health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity; fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy foods rich in fibre; and regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. A package of measures for the prevention of chronic diseases would deliver substantial health gains, with a very favourable cost-effectiveness profile. PUBLICATION ABSTRACT
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Summary
This paper reviews the effectiveness of four types of front‐of‐pack nutrition labels (FoPLs) in influencing calorie purchases. The four FoPL types are poised for unified implementation across ...European countries. Further, this study extends its analysis to evaluate the impacts of the voluntary adoption of these FoPLs within 27 EU nations. Nutri‐Score displays higher potential for yielding positive health and economic outcomes, compared with other FoPLs. Across EU countries, Nutri‐Score is projected to avert nearly two million cases of non‐communicable diseases, in total, between 2023 and 2050. Keyhole demonstrates effects of a similar magnitude but with no statistical significance. Nutri‐Repere shows smaller impacts, while Nutri‐Couleurs has non‐significant effects. Nutri‐Score is projected to significantly lower annual healthcare spending by 0.05%, whereas the other labels have negligible impacts. By reducing cases of disease, FoPLs have the potential to improve employment and work productivity. Nutri‐Score surpasses the other labels with an estimated annual gain of 10.6 full‐time equivalent workers per 100,000 individuals of working age across EU countries. In all, mandatory implementation of any of the four labels would lead to greater effects than those obtained with a voluntary implementation, providing evidence to inform legislation proposal for an EU‐wide nutrition labelling system.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
•Financial strategies were associated with improved antibiotic prescription in the short-term.•Pay-for-performance initiatives were effective in changing prescribing behaviours.•The risk for bias ...across studies encourages further research to identify causal mechanisms.•Financial strategies can be part of efforts to tackle the emergence and spread of antimicrobial resistance.
Improving prudent use of antibiotics is one way to limit the spread of antimicrobial resistance (AMR). The objective of this systematic review was to assess the effects of financial strategies targeting healthcare providers on the prudent use of antibiotics.
A systematic review of the literature was conducted searching PubMed, Embase and Cochrane databases, and the grey literature. Search terms related to antibacterial agents, drug resistance, financial strategies, and healthcare providers and/or prescribers.
Twenty-two articles were included in the review, reporting on capitation and salary reimbursement, cost containment interventions, pay-for-performance initiatives, penalties, and a one-off bonus payment. There was substantial variation in the reported outcomes describing prescribing behaviours, including proportion of patients prescribed antibiotics, antibiotic prescriptions per patient, and number of cases treated with recommended antibiotic therapy. All financial strategies were associated with improvements in the appropriate prescription of antibiotics in the short-term, although the magnitude of observed effects varied across financial strategies. Financial penalties were associated with the greatest decreases in inappropriate antibiotic prescriptions, followed by capitation models and pay-for-performance schemes that paid bonuses upon achievement of performance targets. However, the risk of bias across studies must be noted.
Findings point to the viability of financial strategies to promote the prudent use of antibiotics. Measuring the downstream impact of prescriber behaviour changes is key to estimating the true value of such interventions to tackle AMR. Research efforts should continue to build the evidence on causal mechanisms driving provider prescribing patterns for antibiotics and the long-term impact on antibiotic prescriptions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background: Insufficient infection prevention and control (IPC) practices in healthcare settings increase the SARS-CoV-2 infection risk among health workers. This study aimed to examine the level of ...preparedness for future outbreaks. Methods: We modelled the experience from the COVID-19 pandemic and assessed the return on investment on a global scale of three IPC interventions to prevent SARS-CoV-2 infections among health workers: enhancing hand hygiene; increasing access to personal protective equipment (PPE); and combining PPE, with a scale-up of IPC training and education (PPE+). Our analysis covered seven geographic regions, representing a combination of World Health Organization (WHO) regions and the Organisation for Economic Co-operation and Development (OECD) countries. Across all regions, we focused on the first 180 days of the pandemic in 2020 between January 1st and June 30th. We used an extended version of a susceptible-infectious-recovered compartmental model to measure the level of IPC preparedness. Data were sourced from the WHO COVID-19 Detailed Surveillance Database. Findings: In all regions, the PPE + intervention would have averted the highest number of new SARS-CoV-2 infections compared to the other two interventions, ranging from 6562 (95% CI 4873–8779) to 38,170 (95% CI 33,853–41,901) new infections per 100,000 health workers in OECD countries and in the South-East Asia region, respectively. Countries in the South-East Asia region and non-OECD countries in the Western Pacific region were poised to achieve the highest level of savings by scaling up the PPE + intervention. Interpretation: Our results not only support efforts to make an economic case for continuing investments in IPC interventions to halt the COVID-19 pandemic and protect health workers, but could also contribute to efforts to improve preparedness for future outbreaks. Funding: This work was funded by WHO, with support by the German Federal Ministry of Health for the WHO Research and Development Blueprint for COVID-19.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Summary The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable ...morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis—leadership, prevention, treatment, international cooperation, and monitoring and accountability—and the delivery of five priority interventions—tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
BackgroundAntimicrobial resistance is widely considered an urgent global health issue due to associated mortality and disability, societal and healthcare costs.AimTo estimate the past, current and ...projected future proportion of infections resistant to treatment for eight priority antibiotic-bacterium combinations from 2000 to 2030 for 52 countries.MethodsWe collated data from a variety of sources including ResistanceMap and World Bank. Feature selection algorithms and multiple imputation were used to produce a complete historical dataset. Forecasts were derived from an ensemble of three models: exponential smoothing, linear regression and random forest. The latter two were informed by projections of antibiotic consumption, out-of-pocket medical spending, populations aged 64 years and older and under 15 years and real gross domestic product. We incorporated three types of uncertainty, producing 150 estimates for each country-antibiotic-bacterium-year.ResultsAverage resistance proportions across antibiotic-bacterium combinations could grow moderately from 17% to 18% within the Organisation for Economic Co-operation and Development (OECD; growth in 64% of uncertainty sets), from 18% to 19% in the European Union/European Economic Area (EU/EEA; growth in 87% of uncertainty sets) and from 29% to 31% in Group of Twenty (G20) countries (growth in 62% of uncertainty sets) between 2015 and 2030. There is broad heterogeneity in levels and rates of change across countries and antibiotic-bacterium combinations from 2000 to 2030.ConclusionIf current trends continue, resistance proportions are projected to marginally increase in the coming years. The estimates indicate there is significant heterogeneity in resistance proportions across countries and antibiotic-bacterium combinations.
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