Forty-five minutes of physical activity at school each day? Curricular promotion of physical activity in grades one to four

Aim  

According to the US Department of Health and Human Services (2008) and the World Health Organization (2008), regular physical activity is essential to the healthy development of children and contributes to the reduction of chronic diseases throughout their life span. However, coordinated comprehensive national and international programs to promote physical activity and sports participation are lacking. According to the German Sports Federation (2006), physical education (PE) classes at German schools are increasingly being canceled or taught outside the school. "fit for pisa" is a German intervention developed in response to the demand for scientific evaluation of interventions like daily physical education. Its goal is to provide quality management-secured, structured and standardized PE instruction by qualified instructors.     

How active are we? Levels of routine physical activity in children and adults

The accurate measurement of physical activity is fraught with problems in adults, but more especially in children because they have more complex and multi-dimensional activity patterns. In addition, the results of different studies are often difficult to interpret and compare, because of the diversity of methodological approaches, differences in data analysis and reporting, and the adoption of varying definitions of what constitutes an appropriate level of activity. Furthermore, inactivity is seldom quantified directly. Although there exists an extensive literature documenting the health benefits of regular physical activity in adults, activity-health relationships in children are not clear-cut. Current recommendations reinforce the concept of health-related activity, accumulating 30 min moderate-intensity exercise on at least 5 d/week (adults) and 1 h moderate-intensity exercise/d (children). Evidence suggests a high prevalence of inactivity in adults, but whether or not inactivity is increasing cannot be assessed currently. Similarly, no definite conclusions are justified about either the levels of physical activity of children, or whether these are sufficient to maintain and promote health. Data to support the belief that activity levels in childhood track into adulthood are weak. Inactivity is associated with an increased risk of weight gain and obesity, but causality remains to be established. In children there is strong evidence to demonstrate a dose response relationship between the prevalence and incidence of obesity and time spent viewing television. Future research should focus on refining methodology for physical activity assessment to make it more sensitive to the different dimensions and contexts of activity in different age-groups.     

Editorial – Evaluation of health promotion programs: are we making progress?

The opportunity I have had in recent years to facilitate a number of training courses with health promotion practitioners, has affirmed the value that many place upon evaluation in program management, and provided insights into the perceived benefits, costs and risks that this may entail. As might be expected, course participants can readily identify the benefits to be gained from evaluation: finding out what works; improving how programs are delivered; adding to the evidence that others can use; increasing the prospects of future funding; and satisfaction and rewards for workers, among an array of others.     

Health enhancing physical activity in all policies? Comparison of national public actors between France and Belgium

Despite evidence on the benefits of health enhancing physical activity (HEPA), only few countries have developed “health in all policies” and specifically integrated HEPA policies. Paucity of studies have questioned the role of public national actors in PA policies enactment and delivery, the barriers and levers for adopting cross-sectoral HEPA. The present work seeks at comparing France and Belgium in regard to their competencies of ministries promoting HEPA, the presence of leadership and coordination in HEPA policies implementation, their key public legal entities working on HEPA. Expert interviews and document analysis were realized to complete the HEPA policy audit tool in each country. Results have shown that HEPA cross-sectoral policies are at their early stage. A broad diversity of sectors was implicated in HEPA policies: sport, health, transport, environment, and education, but often with weak activity. No leadership or coordination exist to implement HEPA policies, although different public legal entities could work on this aim. Ministries relationships were principally coming from formal co-interventions mandated by national public plans in France, where in Belgium relationships were punctual. Lobbying within each sector and in key public legal entities to promote HEPA is needed, and the development of official national coordination is essential.     

Achievements and challenges of medicare in Canada: Are we there yet? Are we on course?

Health care policy in Canada is based on providing public funding for medically necessary physician and hospital-based services free at the point of delivery ("first-dollar public funding"). Studies consistently show that the introduction of public funding to support the provision of health care services free at the point of delivery is associated with increases in the proportionate share of services used by the poor and in population distributions of services that are independent of income. Claims about the success of Canada's health care policy tend to be based on these findings, without reference to medical necessity. This article adopts a needs-based perspective to reviewing the distribution of health care services. Despite the removal of user prices, significant barriers remain to services being distributed in accordance with need-the objective of needs-based access to services remains elusive. The increased fiscal pressures imposed on health care in the 1990s, together with the failure of health care policy to encompass the changing nature of health care delivery, seem to represent further departures from policy objectives. In addition, there is evidence of increasing public dissatisfaction with the performance of the system. A return to modest increases in public funding in the new millennium has not been sufficient to arrest these trends. Widespread support for first-dollar public funding needs to be accompanied by greater attention to the scope of the legislation and the adoption of a needs-based focus among health care policymakers.     

Are treatments for cervical precancerous lesions in less-developed countries safe enough to promote scaling-up of cervical screening programs? A systematic review

Background  

Since the mid-1990s, there have been growing efforts to prevent cervical cancer in less-developed countries through the development of innovative screening approaches such as visual inspection of the cervix associated with same day management of cervical lesions with cryotherapy or loop electrosurgical excision procedure (LEEP). In the past, promising cancer screening interventions have been widely promoted despite incomplete evidence, only to become the subject of intense controversies about ensuing net health benefit. Because the efficacy and effectiveness of the new protocols for global cervical cancer screening have not been well characterized yet, and as a contribution to the evaluation of the balance between the benefits and risks of these protocols, we reviewed the literature on the safety of cryotherapy and LEEP for cervical intraepithelial neoplasia (CIN) in low- and middle-income countries.     

Sponsorship of physical activity programs by the sweetened beverages industry: public health or public relations?

The growing evidence on the association between consumption of sugar-sweetened beverages, obesity and other chronic diseases has highlighted the need to implement policy actions that go beyond programs exclusively focused on individual responsibility. In order to protect their commercial goals in Latin America, the sugar-sweetened beverage industry practices intense lobbying at high government levels in several countries across the region. This strategy is accompanied by corporate social responsibility programs that fund initiatives promoting physical activity. These efforts, although appearing altruistic, are intended to improve the industry's public image and increase political influence in order to block regulations counter to their interests. If this industry wants to contribute to human well being, as it has publicly stated, it should avoid blocking legislative actions intended to regulate the marketing, advertising and sale of their products.     

Obesogenic environments: Are neighbourhood environments that limit physical activity obesogenic?

The impact of obesogenic environments on adolescent health is poorly understood. This study examines if neighbourhood features related to physical activity are also related to unhealthy weight status. Adolescents (N=4587, age 15–17 years, 51.4% male) self-reported physical activity and neighbourhood perceptions. Trained researchers measured height and weight. Logistic regression identified if neighbourhood perceptions predicted overweight or obesity. Adolescents who reported convenient physical activity facilities were 2% less likely to be overweight/obese and 5% less likely to be obese, controlled for socio-demographic variables and clustering by school. Physical activity does not appear to directly influence or mediate the relationship between perceived convenient facilities and weight status.     

Are self-reported physical activity levels associated with perceived desirability of activity-friendly communities?

People living in activity-friendly communities (AFCs) are more active but the self-selection influence is unknown. From 4856 respondents we explored mediating variables with expressed desire to live in AFCs. Association with desire to live in AFCs included ages 18-24 years (odds ratio [OR]=1.9), African American (OR=1.9) or Hispanic (OR=1.5), and believing AFCs would support activity-based transportation (OR=2.4). Regular physical activity (PA) was marginally associated with desire to live in AFCs (OR=1.3). These findings suggest that PA may be a significant factor in communities of this style. Strategies for social marketing along with changes to the built environment to increase PA levels are discussed.     

Systematic review of economic evaluations of vaccination programs in mainland China: Are they sufficient to inform decision making?

The purpose of the study was to systematically review economic evaluations of vaccine programs conducted in mainland China. We searched for economic evaluations of vaccination in China published prior to August 3, 2015 in eight English-language and three Chinese-language databases. Each article was appraised against the 19-item Consensus on Health Economic Criteria list (CHEC-list). We found 23 papers evaluating vaccines against hepatitis B (8 articles), Streptococcus pneumoniae (5 articles), human papillomavirus (3 articles), Japanese encephalitis (2 articles), rotavirus (2 articles), hepatitis A (1 article), Enterovirus 71 (1 article) and influenza (1 article). Studies conformed to a mean of 12 (range: 6–18) items in the CHEC-list criteria. Five of six Chinese-language articles conformed to fewer than half of the 19 criteria items. The main criteria that studies failed to conform to included: inappropriate measurement (20 articles) and valuation (18 articles) of treatment and/or vaccination costs, no discussion about distributional implications (18 articles), missing major health outcomes (14 articles), no discussion about generalizability to other contexts (14 articles), and inadequate sensitivity analysis (13 articles). In addition, ten studies did not include major cost components of vaccination programs, and nine did not report outcomes in terms of life years even in cases where QALYs or DALYs were calculated. Only 13 studies adopted a societal perspective for analysis. All studies concluded that the appraised vaccination programs were cost-effective except for one evaluation of universal 7-valent pneumococcal conjugate vaccine (PCV-7) in children. However, three of the five studies on PCV-7 showed poor overall quality, and the number of studies on vaccines other than hepatitis B vaccine and PCV-7 was limited. In conclusion, major methodological flaws and reporting problems exist in current economic evaluations of vaccination programs in China. Local guidelines for good practice and reporting, institutional mechanisms and education may help to improve the overall quality of these evaluations.