The effects of the coronavirus disease 2019 (COVID-19) pandemic upon human health, economic activity and social engagement have been swift and far reaching. Emerging evidence shows that the pandemic ...has had dramatic mental health impacts, bringing about increased anxiety and greater social isolation due to the physical distancing policies introduced to control the disease. In this context, it is possible to more deeply appreciate the health consequences of loneliness and social isolation, which researchers have argued are enduring experiences for many people and under-recognised contributors to public health. In this paper, we examine the social and psychological consequences of the COVID-19 pandemic, with a focus on what this has revealed about the need to better understand and respond to social isolation and loneliness as public health priorities. Social isolation and loneliness are understood to be distinct conditions, yet each has been found to predict premature mortality, depression, cardiovascular disease and cognitive decline. Estimates of the prevalence and distribution of social isolation and loneliness vary, possibly ranging from one-in-six to one-in-four people, and the lack of knowledge about the extent of these conditions indicates the need for population monitoring using standardised methods and validated measures. Reviews of the evidence relating to social isolation and loneliness interventions have found that befriending schemes, individual and group therapies, various shared activity programs, social prescription by healthcare providers, and diverse strategies using information and communication technologies have been tried. There remains uncertainty about what is effective for different population groups, particularly for prevention and for addressing the more complex condition of loneliness. In Australia, a national coalition - Ending Loneliness Together - has been established to bring together researchers and service providers to facilitate evidence gathering and the mobilisation of knowledge into practice. Research-practice partnerships and cross-disciplinary collaborations of this sort are essential for overcoming the public health problems of loneliness and social isolation that have pre-existed and will endure beyond the COVID-19 pandemic.
Spinal metastases are becoming increasingly common because patients with metastatic disease are living longer. The close proximity of the spinal cord to the vertebral column limits many conventional ...therapeutic options that can otherwise be used to treat cancer. In response to this problem, an innovative multidisciplinary approach has been developed for the management of spinal metastases, leveraging the capabilities of image-guided stereotactic radiosurgery, separation surgery, vertebroplasty, and minimally invasive local ablative approaches. In this Review, we discuss the variables that should be considered during the management of these patients and review the role of each discipline and their respective management options to provide optimal care. This work is synthesised into a practical algorithm to aid clinicians in the management of patients with spinal metastasis.
Abstract Objectives The aim of this study was to estimate the weighted mean effect of vitamin D supplementation in reducing depressive symptoms among individuals aged ≥18 y diagnosed with depression ...or depressive symptoms. Methods A meta-analysis of randomized controlled trials (RCTs) in which vitamin D supplementation was used to reduce depression or depressive symptoms was conducted. Databases MEDLINE, EMBASE, psych INFO, CINAHL plus, and the Cochrane library were searched from inception to August 2013 for all publications on vitamin D and depression regardless of language. The search was further updated to May 2014 to include newer studies being published. Studies involving individuals aged ≥18 y who were diagnosed with depressive disorder based on both the Diagnostic and Statistical Manual of Mental Disorders or other symptom checklist for depression were included. Meta-analysis was performed using random effects model due to differences between the individual RCTs. Results The analysis included nine trials with a total of 4923 participants. No significant reduction in depression was seen after vitamin D supplementation (standardized mean difference = 0.28; 95% confidence interval, −0.14 to 0.69; P = 0.19); however, most of the studies focused on individuals with low levels of depression and sufficient serum vitamin D at baseline. The studies included used different vitamin D doses with a varying degree of intervention duration. Conclusions Future RCTs examining the effect of vitamin D supplementation among individuals who are both depressed and vitamin D deficient are needed.
Poor oral health literacy has been proposed as a causal factor in disparities in oral health outcomes. This study aims to investigate oral health literacy (OHL) in a socially and culturally diverse ...population of Australian adults visiting a public dental clinic in Western Sydney.
A mixed methods study where oral health literacy was assessed using the Health Literacy in Dentistry scale (HeLD-14) questionnaire and semi-structured interviews explored oral health related knowledge, perceptions and attitudes. Interviews were analysed using a thematic approach.
A sample of 48 participants attending a public dental clinic in Western Sydney was recruited, with a mean age of 59.9 (SD16.2) years, 48% female, 50% born in Australia, 45% with high school or lower education, and 56% with low-medium OHL. A subgroup of 21 participants with a mean age of 68.1 (SD14.6) years, 40% female, 64% born in Australia, 56% with a high school or lower education, and 45% with low-medium OHL completed the interview. Three themes identified from the interviews included 1) attitudes and perceptions about oral health that highlighted a lack of agency and low prioritisation of oral health, 2) limited knowledge and education about the causes and consequences of poor oral health, including limited access to oral health education and finally 3) barriers and enablers to maintaining good oral health, with financial barriers being the main contributor to low OHL.
Strategies aimed at redressing disparities in oral health status should include improving access to oral health information. The focus should be on the impact poor oral health has on general health with clear messages about prevention and treatment options in order to empower individuals to better manage their oral health.
Organizational change theory BATRAS, DIMITRI; DUFF, CAMERON; SMITH, BEN J.
Health promotion international,
03/2016, Letnik:
31, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Sophisticated understandings of organizational dynamics and processes of organizational change are crucial for the development and success of health promotion initiatives. Theory has a valuable ...contribution to make in understanding organizational change, for identifying influential factors that should be the focus of change efforts and for selecting the strategies that can be applied to promote change. This article reviews select organizational change models to identify the most pertinent insights for health promotion practitioners. Theoretically derived considerations for practitioners who seek to foster organizational change include the extent to which the initiative is modifiable to fit with the internal context; the amount of time that is allocated to truly institutionalize change; the ability of the agents of change to build short-term success deliberately into their implementation plan; whether or not the shared group experience of action for change is positive or negative and the degree to which agencies that are the intended recipients of change are resourced to focus on internal factors. In reviewing theories of organizational change, the article also addresses strategies for facilitating the adoption of key theoretical insights into the design and implementation of health promotion initiatives in diverse organizational settings. If nothing else, aligning health promotion with organizational change theory promises insights into what it is that health promoters do and the time that it can take to do it effectively.
With the dramatically increasing contribution of Alzheimer's Disease and other forms of dementia to the global burden of disease, countries are being urged to address this as a public health ...priority. This study investigated whether Australian adults recognise this as an important health issue, and hold beliefs and knowledge that are consistent with recommendations concerning dementia risk reduction. This research was undertaken to guide national brain health awareness and education strategies.
A cross-sectional telephone survey was undertaken of 1,003 Australians aged 20-75 years. This measured the importance placed on dementia, beliefs and confidence related to risk reduction, knowledge of risk reduction methods, and the perceived age-relevance of these. In analysis the data were stratified by sex, age, educational attainment, household income, language preference and previous exposure to dementia. Multivariable logistic regression was undertaken to identify variables independently associated with beliefs and knowledge.
People aged 60 years and over identified dementia as very important (17.2%) more often than those aged 40-59 years (5.1%) or 20-39 years (2.1%). While 41.5% of respondents believed the risk of dementia could be reduced, 26.9% were very confident that they could achieve this. Mental activity (57.1%) was identified as beneficial much more often than physical activity (31.3%), healthy eating (23.3%) and other cardiovascular health behaviours. Women, people of English-speaking origin, and those having contact with a person with dementia, showed better knowledge of several health behaviours.
Growing attention is being given to population risk reduction to combat the dramatic increase in the burden of disease due to dementia. In Australia many people do not yet hold beliefs and knowledge that support this, which highlights the need for concerted awareness raising that dementia is not an inevitable aspect of ageing, and for education about the role of vascular health in dementia risk reduction.
Cash transfers (CTs) are now high on the agenda of most governments in low-and middle-income countries. Within the field of health promotion, CTs constitute a healthy public policy initiative as they ...have the potential to address the social determinants of health (SDoH) and health inequalities. A systematic review was conducted to synthesise the evidence on CTs’impacts on SDoH and health inequalities in sub-Saharan Africa, and to identify the barriers and facilitators of effective CTs. Twenty-one electronic databases and the websites of 14 key organizations were searched in addition to grey literature and hand searching of selected journals for quantitative and qualitative studies on CTs’impacts on SDoH and health outcomes. Out of 182 full texts screened for eligibility, 79 reports that reported findings from 53 studies were included in the final review. The studies were undertaken within 24 CTs comprising 11 unconditional CTs (UCTs), 8 conditional CTs (CCTs) and 5 combined UCTs and CCTs. The review found that CTs can be effective in tackling structural determinants of health such as financial poverty, education, household resilience, child labour, social capital and social cohesion, civic participation, and birth registration. The review further found that CTs modify intermediate determinants such as nutrition, dietary diversity, child deprivation, sexual risk behaviours, teen pregnancy and early marriage. In conjunction with their influence on SDoH, there is moderate evidence from the review that CTs impact on health and quality of life outcomes. The review also found many factors relating to intervention design features, macro-economic stability, household dynamics and community acceptance of programs that could influence the effectiveness of CTs. The external validity of the review findings is strong as the findings are largely consistent with those from Latin America. The findings thus provide useful insights to policy makers and managers and can be used to optimise CTs to reduce health inequalities.
Les transferts de fonds (CT) figurent désormais parmi les priorités de la plupart des gouvernements des pays à revenu faible ou intermédiaire. Dans le domaine de la promotion de la santé, les CT constituent une saine initiative de politique publique puisqu’ils ont le potentiel de s’attaquer aux déterminants sociaux de la santé (DSS) et aux inégalités de santé. Une revue systématique a été réalisée dans le but de synthétiser les données sur les impacts des CT sur les inégalités de santé et les DSS en Afrique subsaharienne, et pour identifier les obstacles ainsi que les initiatives favorables à la mise en place de CT efficaces. Vingt et une bases de données électroniques et les sites Web de 14 organismes clés ont été consultés, en plus de la littérature grise et de la recherche manuelle de revues sélectionnées pour des études quantitatives et qualitatives sur les impacts des CT sur les DSS et les résultats de santé. Sur les 182 textes complets examinés pour leur recevabilité, 79 rapports présentant les résultats de 53 études ont été inclus dans l’examen final. Les études ont été menées dans le cadre de 24 transferts de fonds, à savoir, 11 transferts non conditionnels (UCT), 8 transferts conditionnels (CCT) ainsi que 5 UCT et CCT jumelés. L’étude a révélé que les CT peuvent être efficaces pour s’attaquer aux déterminants structurels de la santé tels que la pauvreté monétaire, l’éducation, la capacité de résilience des ménages, le travail des enfants, le capital social, la cohésion sociale, la participation civique et la déclaration des naissances. La revue a également révélé que les CT modifient les déterminants intermédiaires tels que la nutrition, la diversité alimentaire, le dénuement des enfants, les comportements sexuels à risque, la grossesse chez les adolescentes et les mariages précoces. En même temps que les transferts influent sur les DSS, des données de la revue tendent à prouver raisonnablement que les CT ont un impact sur la santé et la qualité de vie. La revue a également révélé de nombreux facteurs liés aux caractéristiques de conception de l’intervention, à la stabilité macroéconomique, à la dynamique des ménages et à l’acceptation par la collectivité des programmes susceptibles d’influer sur l’efficacité des CT. La validité externe des résultats de la revue est excellente, car les résultats sont en grande partie conformes à ceux de l’Amérique latine. Les résultats fournissent donc des indications utiles aux décideurs et aux gestionnaires et peuvent être utilisés pour optimiser les CT afin de réduire les inégalités en matière de santé.
现金转移支付 （CTs） 是目前许多中低收入国家政府的重要议 程。在健康促进领域, CTs是有利于健康的公共政策, 因为可 以影响健康的社会决定因素 （SDoH） 和健康不公平性。我们 进行了系统综述, 综合CTs对撒哈拉以南非洲地区SDoH和健康 不公平性的影响的证据, 寻找有效实施CTs的阻碍和促进因 素。检索21个电子数据库, 14个关键组织的网站, 检索灰色文 献, 手动检索选定的期刊, 查找关于CTs对SDoH和健康结局影 响的定量和定性研究。182篇文献进入全文筛选, 最终纳入79 篇文章, 报告了53个研究的发现。这些研究涉及24个CTs项目, 包括11个无条件CTs （UCTs）, 5个有条件CTs （CCTs） 和5个 UCTs与CCTs结合的项目。综述发现, CTs可有效影响健康的结 构决定因素, 例如贫困、教育、家庭恢复力、童工、社会资本 和社会凝聚力、公民参与, 以及出生登记。综述还发现, CTs 会改变中间决定因素, 例如营养、饮食多样性、儿童贫困、危 险性行为、青少年怀孕和早婚。除对SDoH的影响外, 本综述 还显示CTs对健康和生命结局质量的影响。综述还发现, 与干 预设计特征、宏观经济稳定性、家庭动态和社区接受程度相 关的许多因素会影响CTs的有效性。上述发现具有很强的外部 效度, 因为与拉丁美洲的研究发现大体上一致。本综述发现可 帮助决策者和管理者充分利用CTs来降低健康不平等。
Las transferencias en efectivo (TEs) están en una posición predominante en la agenda de la mayoría de los gobiernos de los países de ingresos bajos y medios. Dentro del campo de la promoción de la salud, las TEs constituyen una iniciativa de política pública saludable, ya que tienen el potencial para abordar los determinantes sociales de la salud (DSdS) y las desigualdades en la salud. Una revisión sistemática se realizó para sintetizar la evidencia de los impactos de las TEs sobre los DSdS y las desigualdades en el África sub-Sahariana, y para identificar las barreras y los facilitadores de las TEs efectivas. Se hicieron búsquedas en 21 bases de datos electrónicas y los sitios web de 14 organizaciones claves, en adición a la literatura gris y la búsqueda manual de revistas seleccionadas, para encontrar estudios cuantitativos y cualitativos sobre impactos de las TEs sobre los DSdS y sobre los resultados de salud. Además de 182 textos completos seleccionados como elegibles, 79 informes que informaron los resultados de 53 estudios se incluyeron en la revisión final. Los estudios se realizaron dentro de 24 TDs que comprenden 11 TEs incondicionales (TEIs), 8 TEs condicionales (TECs) y 5 TEls y TECs combinadas. La revisión encontró que las TDs pueden ser efectivas en la lucha contra los determinantes estructurales de la salud tales como la pobreza financiera, la educación, la capacidad de recuperación de los hogares, el trabajo infantil, el capital social y la cohesión social, la participación ciudadana, y el registro de nacimientos. La revisión encontró, además, que las TEs modifican los determinantes intermedios tales como la nutrición, la diversidad de la dieta, la privación del niño, los comportamientos sexuales de riesgo, el embarazo adolescente y el matrimonio precoz. En conjunción con su influencia en los DSdS, hay evidencia moderada del impacto de las TEs en los resultados de salud y calidad de vida. La revisión también encontró muchos factores relacionados con la intervención de las características de diseño, la estabilidad macroeconómica, la dinámica del hogar y la aceptación de la comunidad de programas que podrían influir en la eficacia de las TEs. La validez externa de los resultados de la revisión es fuerte ya que los hallazgos son ampliamente consistentes con los de América Latina. Los resultados proporcionan información útil a los formuladores de políticas y a los gestores y pueden ser usados para optimizar las TEs para reducir las desigualdades en salud.
Helicobacter pylori causes gastritis, which has been attributed to the development of H. pylori–specific T cells during infection. However, the mechanism underlying innate immune detection leading to ...the priming of T cells is not fully understood, as H. pylori evades TLR detection. Here, we report that H. pylori metabolites modified from host cholesterol exacerbate gastritis through the interaction with C-type lectin receptors. Cholesteryl acyl α-glucoside (αCAG) and cholesteryl phosphatidyl α-glucoside (αCPG) were identified as noncanonical ligands for Mincle (Clec4e) and DCAR (Clec4b1). During chronic infection, H. pylori–specific T cell responses and gastritis were ameliorated in Mincle-deficient mice, although bacterial burdens remained unchanged. Furthermore, a mutant H. pylori strain lacking αCAG and αCPG exhibited an impaired ability to cause gastritis. Thus H. pylori–specific modification of host cholesterol plays a pathophysiological role that exacerbates gastric inflammation by triggering C-type lectin receptors.
The World Health Assembly has adopted the World Health Organization's (WHO) recommended target of achieving a 15% reduction in physical inactivity by 2030. The WHO Global Action Plan on Physical ...Activity provides a framework for countries to achieve this, using a systems-based approach to address the social and environmental determinants of physical inactivity. Lack of progress in many countries indicates a need to identify new ways of addressing this public health priority. WHO continues to highlight the importance of legislative and regulatory measures within the multicomponent and multisectoral action needed to reduce physical inactivity. Yet research into the role of law for addressing physical inactivity has been limited, in contrast to the legal approaches to other major non-communicable disease risk factors such as smoking and alcohol use. Conceptual frameworks for public health law offer a method for mapping and understanding the determinants, mechanisms and outcomes of law-making for the promotion of physical activity within populations. We describe the development and application of a framework that aligns legal strategies with the WHO Global Plan policy objectives. This new framework the Regulatory Approaches to Movement, Physical Activity, Recreation, Transport and Sport - can help policy-makers to use the untapped potential of legal interventions to support or strengthen a whole-system response for promoting physical activity. The framework illustrates the role of legal interventions to improve physical activity and identifies opportunities for research to advance understanding, implementation and evaluation of legal responses to this issue.
Although community engagement (CE) is widely used in health promotion, components of CE models associated with improved health are poorly understood. This study aimed to examine the magnitude of the ...impact of CE on health and health inequalities among disadvantaged populations, which methodological approaches maximise the effectiveness of CE, and components of CE that are acceptable, feasible, and effective when used among disadvantaged populations.
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out methodological assessments of the included studies using rating scales. The analysis focussed on model synthesis to identify the key CE components linked to positive study outcomes and comparative analysis between positive study outcomes, processes, and quality indicators of CE.
Out of 24 studies that met our inclusion criteria, 21 (87.5%) had positively impacted health behaviours, public health planning, health service access, health literacy, and a range of health outcomes. More than half of the studies (58%) were of good quality, whereas 71% and 42% of studies showed good community involvement in research and achieved high levels of CE, respectively. Key CE components that affected health outcomes included real power-sharing, collaborative partnerships, bidirectional learning, incorporating the voice and agency of beneficiary communities in research protocol, and using bicultural health workers for intervention delivery.
The findings suggest that CE models can lead to improved health and health behaviours among disadvantaged populations if designed properly and implemented through effective community consultation and participation. We also found several gaps in the current measurement of CE in health intervention studies, which suggests the importance of developing innovative approaches to measure CE impact on health outcomes in a more rigorous way.
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