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Bauer J, Clark H, Coenen M, Klein C, Rehfuess EA, Ruther C, Voss S, Voigt-Blaurock V, Jung-Sievers C. [Participation in children's hospitals: approaches to participatory formats for paediatric patients]. Gesundheitswesen 2024. [PMID: 38653470 DOI: 10.1055/a-2270-2840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Based on the UN Convention on the Rights of the Child, children and young people have the right to participate in all matters and decisions that affect them. This applies in particular when they are patients in a children's hospital. In the international context, established formats for the participation of young patients regarding health issues already exist, for example "Children's Councils" or "Young Person's Advisory Groups". In Germany, such approaches are still mostly lacking. It thus remains important to develop suitable formats that enable meaningful and effective participation of young patients in the health system. These formats must be chosen in such a way that they can realistically be implemented in clinical settings as well as in pediatric research, and that they can be sustained in the long term. In order to strengthen the consideration of children's rights in the health system, the advancement of such participatory formats as well as their sustainable implementation and evaluation are desirable.
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Affiliation(s)
- Julia Bauer
- Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Medizinische Fakultät, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, München, Germany
- Dr. von Haunersches Kinderspital, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
- Pettenkofer School Public Health, Münchrn, Germany
| | - Holly Clark
- Dr. von Haunersches Kinderspital, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Michaela Coenen
- Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Medizinische Fakultät, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, München, Germany
- Pettenkofer School Public Health, Münchrn, Germany
| | - Christoph Klein
- Dr. von Haunersches Kinderspital, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Eva Annette Rehfuess
- Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Medizinische Fakultät, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, München, Germany
- Pettenkofer School Public Health, Münchrn, Germany
| | - Carolin Ruther
- Dr. von Haunersches Kinderspital, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Stephan Voss
- Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Medizinische Fakultät, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, München, Germany
- Pettenkofer School Public Health, Münchrn, Germany
| | - Varinka Voigt-Blaurock
- Dr. von Haunersches Kinderspital, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Caroline Jung-Sievers
- Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Medizinische Fakultät, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, München, Germany
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Stratil J, Biallas RL, Movsisyan A, Oliver K, Rehfuess EA. Anticipating & assessing adverse consequences of public health interventions - CONSEQUENT framework. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Despite the best intentions, public health (PH) interventions can have adverse and other unintended consequences (AUCs). AUCs may arise in novel PH interventions, as well as from known and tested PH interventions implemented in a new context. Despite their importance, this topic has been largely overlooked. Therefore, we used a structured value-guided as well as evidence-based approach, to develop a framework to support researchers, practitioners, and policy-makers in anticipating and assessing AUCs of PH interventions.
Methods
We employed the ‘best-fit’ synthesis approach starting with an a priori framework and iteratively revising this based on systematically identified evidence. The a priori framework was derived from both the WHO-INTEGRATE framework and the Behaviour Change Wheel, to root the framework in global health norms and values, established mechanisms of PH interventions, and a complexity perspective. The a priori framework was advanced based on theoretical and conceptual publications and systematic reviews on the topic of AUCs in PH. Thematic analysis was used to revise the framework and identify new themes. To validate the framework, it was coded against four selected systematic reviews of AUCs of PH interventions.
Results
The CONSEQUENT framework includes two components: the first focuses on AUCs and serves to categorise them; the second component highlights the mechanisms through which AUCs may arise. The first component comprises eight domains of consequences - health-related, health system, human and fundamental rights, acceptability- and adherence-related, equality- and equity-related, social and institutional, economic and resource-related, and environmental.
Conclusions
Both over- and underestimation of AUCs of PH intervention poses risks. The CONSEQUENT framework may facilitate classification and conceptualization of AUCs of PH interventions during their development or evaluation to support evidence-informed decision-making.
Key messages
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Affiliation(s)
| | | | | | - K Oliver
- Faculty of Public Health and Policy, LSHTM , London, UK
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3
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Pfadenhauer L, Rueb M, Strahwald B, Wabnitz KJ, Nothacker M, Rehfuess EA. Public Health Guideline to prevent and control SARS-CoV-2 in schools: development and evaluation. Eur J Public Health 2022. [PMCID: PMC9594338 DOI: 10.1093/eurpub/ckac130.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Issue/problem In times of high demand for scientific evidence for decision-making on COVID-19 mitigation measures, guidelines can be useful for translating scientific evidence into policy and practice. While guidelines are widely used in medical decision-making, they are novel to public health in Germany. Description of the problem Since December 2020, a guideline group has been working on a living, evidence- and consensus-based public health guideline on preventing and controlling SARS-CoV-2 transmission in schools. The group includes scientists across multiple disciplines as well as a broad range of stakeholders, including from the school family. Key features in the development of recommendations included a Cochrane rapid review and the WHO-INTEGRATE evidence-to-decision framework. The development and usefulness of the guideline for decision-making are being evaluated using a multi-method approach. Results The first version of the guideline containing nine recommendations was published in February 2021. The WHO-INTEGRATE framework facilitated the consideration of factors such as health benefits and harms, feasibility, acceptability and financial constraints. Preliminary findings of the evaluation suggest that under time pressure, developing few essential, consensus-based recommendations while assessing their societal implications is warranted. A shared understanding of evidence and of the purpose and limitations of guidelines is critical. To remain relevant, continuous integration of new evidence and updating of the guideline is necessary. Key messages
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Affiliation(s)
- L Pfadenhauer
- IBE, Ludwig-Maximilians University , Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians University , Munich, Germany
| | - M Rueb
- IBE, Ludwig-Maximilians University , Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians University , Munich, Germany
| | - B Strahwald
- IBE, Ludwig-Maximilians University , Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians University , Munich, Germany
| | - KJ Wabnitz
- IBE, Ludwig-Maximilians University , Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians University , Munich, Germany
| | - M Nothacker
- AWMF e.V., Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellsch , Berlin, Germany
| | - EA Rehfuess
- IBE, Ludwig-Maximilians University , Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians University , Munich, Germany
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Sell K, Rehfuess EA, Pfadenhauer LM. Implementation of integrated knowledge translation in NCD research: Examining intervention components. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Integrated knowledge translation (IKT) has been a cornerstone of the Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) with partners in Ethiopia, Germany, Malawi, Rwanda, South Africa, and Uganda. The consortium conducts research on preventing and treating non-communicable diseases as well as road traffic injuries. IKT is understood as the continuous engagement of decision-makers throughout the research process in order to build equitable, mutually beneficial partnerships to conduct policy-relevant research and, ultimately, strengthen evidence-informed decision-making (EIDM). Gradually, a structured “CEBHA+ IKT approach” was developed, including systematic stakeholder mapping and analysis, and the development of local IKT strategies.
Methods
We conducted a mixed-methods process and outcome evaluation of this IKT intervention. This comprised structured interviews, an online survey, and document analyses at two time points, two and four years after IKT initiation.
Results
Preliminary results show that partnerships with decision-makers were successfully established or strengthened. While continuous engagement was implemented, fidelity to formalised IKT strategies was variable. The development, monitoring and updating of the IKT strategies, originally conceptualised as an essential intervention component, has been helpful for some CEBHA+ researchers and may facilitate implementation. However, the vision for decision-maker engagement as well as emphasis on continuous engagement (defined as a deliverable) emerged as more important intervention drivers and may be conceptualised as intervention components.
Conclusions
A strong vision and continuous engagement with decision-makers are critical for strengthening EIDM. Formalised IKT strategies proved to be of moderate importance in current CEBHA+ research activities, but may turn out to be an essential intervention component if implemented from the start of a research project.
Key messages
• Continuous engagement with decision-makers has successfully strengthened or established partnerships between researchers and decision-makers.
• Formal IKT strategies to plan stakeholder engagement were developed but continuous stakeholder engagement and a strong vision proved to be of greater importance.
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Affiliation(s)
- K Sell
- IBE, LMU Munich , München, Germany
- PSPH, München, Germany
| | - EA Rehfuess
- IBE, LMU Munich , München, Germany
- PSPH, München, Germany
| | - LM Pfadenhauer
- IBE, LMU Munich , München, Germany
- PSPH, München, Germany
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5
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Rehfuess EA, Burns JB, Pfadenhauer LM, Krishnaratne S, Littlecott H, Meerpohl JJ, Movsisyan A. Lessons learnt: Undertaking rapid reviews on public health and social measures during a global pandemic. Res Synth Methods 2022; 13:558-572. [PMID: 35704478 PMCID: PMC9349463 DOI: 10.1002/jrsm.1580] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 12/04/2022]
Abstract
Public health and social measures (PHSM) have been central to the COVID‐19 response. Consequently, there has been much pressure on decision‐makers to make evidence‐informed decisions and on researchers to synthesize the evidence regarding these measures. This article describes our experiences, responses and lessons learnt regarding key challenges when planning and conducting rapid reviews of PHSM during the COVID‐19 pandemic. Stakeholder consultations and scoping reviews to obtain an overview of the evidence inform the scope of reviews that are policy‐relevant and feasible. Multiple complementary reviews serve to examine the benefits and harms of PHSM across different populations and contexts. Conceiving reviews of effectiveness as adaptable living reviews helps to respond to evolving evidence needs and an expanding evidence base. An appropriately skilled review team and good planning, coordination and communication ensures smooth and rigorous processes and efficient use of resources. Scientific rigor, the practical implications of PHSM‐related complexity and likely time savings should be carefully weighed in deciding on methodological shortcuts. Making the best possible use of modeling studies represents a particular challenge, and methods should be carefully chosen, piloted and implemented. Our experience raises questions regarding the nature of rapid reviews and regarding how different types of evidence should be considered in making decisions about PHSM during a global pandemic. We highlight the need for readily available protocols for conducting studies on the effectiveness, unintended consequences and implementation of PHSM in a timely manner, as well as the need for rapid review standards tailored to “rapid” versus “emergency” mode reviewing.
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Affiliation(s)
- E A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - J B Burns
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - L M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - S Krishnaratne
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - H Littlecott
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany.,DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - J J Meerpohl
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - A Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
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6
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Schöttle A, Coenen M, Rehfuess EA, Kaiser B, Wiedemann C, Pfadenhauer LM. [Development of an Integrated Community-Based Prevention Strategy in Freiham (Munich) from the Perspective of the Steering Group: A Qualitative Interview Study with Social Network Analysis]. Gesundheitswesen 2022; 85:e16-e31. [PMID: 35654400 DOI: 10.1055/a-1815-3254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The City of Munich is planning and implementing a "Prevention Chain" as an integrated community-based prevention strategy in the new district of "Freiham" in Munich. This is taking place while the district is being built. The "Prevention Chain Freiham" aims to create an environment that enables a healthy upbringing of all children and adolescents right from the start. In order to guide this project, an interdepartmental working group was formed within the City of Munich's administration. This study analyses the working group's structures, processes and its collaboration with a variety of stakeholders. METHODS We conducted a multimethod study comprising qualitative interviews and social network analysis. Between March and April 2018, we conducted semi-structured interviews with members of the working group. The study participants also generated ego-centred social network maps. The transcripts were analysed using qualitative content analysis as described by Schreier. The network maps were also analysed using qualitative content analysis and the results were visualized. Our preliminary findings were interpreted, discussed and validated in a workshop in June 2018 with study participants. RESULTS Ten members of the working group participated in the study. The interdepartmental, multiprofessional collaboration in the working group was perceived as beneficial for the process of developing and implementing the Prevention Chain. The external coordination by MAGs and the scientific expertise provided by the LMU Munich were considered highly supportive. Barriers to the planning and implementation of the Prevention Chain were mainly located at administration level. Most facilitators were attributed to the collaborative processes within the working group. After having mapped all stakeholders currently involved in the Prevention Chain (mainly actors within the City of Munich's administration), additional relevant stakeholders were identified by the members of the working group. CONCLUSION The organizational form of the working group as a formalized association of representatives of various departments that are jointly responsible for the Prevention Chain is considered beneficial for the success of the Prevention Chain. This is further supported by the external coordination and academic support. Advancing the development and implementation of the Prevention Chain will require support from all relevant departments across sectors and hierarchies.
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Affiliation(s)
- Anika Schöttle
- Lehrstuhl für Public Health und Versorgungsforschung, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
| | - Michaela Coenen
- Lehrstuhl für Public Health und Versorgungsforschung, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
| | - Eva Annette Rehfuess
- Lehrstuhl für Public Health und Versorgungsforschung, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
| | - Birgit Kaiser
- Lehrstuhl für Public Health und Versorgungsforschung, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
| | - Christine Wiedemann
- Lehrstuhl für Public Health und Versorgungsforschung, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
| | - Lisa M Pfadenhauer
- Lehrstuhl für Public Health und Versorgungsforschung, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
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7
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Schunk M, Le L, Syunyaeva Z, Haberland B, Tänzler S, Mansmann U, Schwarzkopf L, Seidl H, Streitwieser S, Hofmann M, Müller T, Weiß T, Morawietz P, Rehfuess EA, Huber RM, Berger U, Bausewein C. Effectiveness of a specialised breathlessness service for patients with advanced disease in Germany: a pragmatic fast-track randomised controlled trial (BreathEase). Eur Respir J 2021; 58:13993003.02139-2020. [PMID: 33509957 DOI: 10.1183/13993003.02139-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The effectiveness of the Munich Breathlessness Service (MBS), integrating palliative care, respiratory medicine and physiotherapy, was tested in the BreathEase trial in patients with chronic breathlessness in advanced disease and their carers. METHODS BreathEase was a single-blinded randomised controlled fast-track trial. The MBS was attended for 5-6 weeks; the control group started the MBS after 8 weeks of standard care. Randomisation was stratified by cancer and the presence of a carer. Primary outcomes were patients' mastery of breathlessness (Chronic Respiratory Disease Questionnaire (CRQ) Mastery), quality of life (CRQ QoL), symptom burden (Integrated Palliative care Outcome Scale (IPOS)) and carer burden (Zarit Burden Interview (ZBI)). Intention-to-treat (ITT) analyses were conducted with hierarchical testing. Effectiveness was investigated by linear regression on change scores, adjusting for baseline scores and stratification variables. Missing values were handled with multiple imputation. RESULTS 92 patients were randomised to the intervention group and 91 patients were randomised to the control group. Before the follow-up assessment after 8 weeks (T1), 17 and five patients dropped out from the intervention and control groups, respectively. Significant improvements in CRQ Mastery of 0.367 (95% CI 0.065-0.669) and CRQ QoL of 0.226 (95% CI 0.012-0.440) score units at T1 in favour of the intervention group were seen in the ITT analyses (n=183), but not in IPOS. Exploratory testing showed nonsignificant improvements in ZBI. CONCLUSIONS These findings demonstrate positive effects of the MBS in reducing burden caused by chronic breathlessness in advanced illness across a wide range of patients. Further evaluation in subgroups of patients and with a longitudinal perspective is needed.
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Affiliation(s)
- Michaela Schunk
- Dept of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany .,Pettenkofer School of Public Health, Munich, Germany
| | - Lien Le
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Zulfiya Syunyaeva
- Dept of Medicine V, University Hospital, LMU Munich, Munich, Germany.,Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Birgit Haberland
- Dept of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Tänzler
- Dept of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Mansmann
- Pettenkofer School of Public Health, Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Larissa Schwarzkopf
- Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany.,Health Economics and Health Care Management (IGM), Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Munich, Germany.,IFT (Institut für Therapieforschung), Munich, Germany
| | - Hildegard Seidl
- Pettenkofer School of Public Health, Munich, Germany.,Health Economics and Health Care Management (IGM), Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Munich, Germany.,Quality Management and Gender Medicine, München Klinik gGmbH, Munich, Germany
| | - Sabine Streitwieser
- Dept of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Miriam Hofmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thomas Müller
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Tobias Weiß
- Atem-und Physiotherapie Solln, Munich, Germany
| | | | - Eva Annette Rehfuess
- Pettenkofer School of Public Health, Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Rudolf Maria Huber
- Dept of Medicine V, University Hospital, LMU Munich, Munich, Germany.,Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Ursula Berger
- Pettenkofer School of Public Health, Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Dept of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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8
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Geffert K, von Philipsborn P, Stratil JM, Rehfuess EA. Evaluating food-related policies in Germany using the Food Environment Policy Index (Food-EPI). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Germany has seen as rising burden of diet-related adverse health outcomes. Policies for improving food environments and related infrastructure are essential to reduce this burden. A growing awareness of the interlinkages between sustainability and nutrition underlines the need for healthy, sustainable food environments. Therefore, we applied the Food Environment Policy Index (Food-EPI) with an additional domain on sustainability to monitor German food policies and to formulate actions for improvement.
Methods
For the evidence analysis information on food environment and infrastructure was collected from various sources. Results were validated with an expert group consisting of representatives of government agencies, non-governmental organizations and academia. The level of implementation, compared to international best practice examples, was ranked by the expert group through an online survey. A one-day workshop was conducted to identify actions to fill the gaps identified in the online ranking and to prioritize these actions in terms of importance and achievability.
Results
The application of the Food-EPI to German policies and interventions shows a nuanced picture of strengths and weaknesses of the German food environment and infrastructure. Some domains such as monitoring and surveillance are in line with international best practice, however other domains show considerable room for improvement. The recommended actions to improve the shortcomings of the German food environment includes a list with priority actions.
Conclusions
The results from the Food-EPI provides an in-depth analysis of German food environment policies and infrastructure, as well as a list of prioritized actions to improve it.
Key message
Integrating a sustainability domain into the Food-EPI offers opportunities to identify priority actions for the creation of healthy, sustainable food systems.
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Affiliation(s)
- K Geffert
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
| | - P von Philipsborn
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
| | - J M Stratil
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
| | - E A Rehfuess
- Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
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9
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Sell K, Pfadenhauer LM, Jessani N, Schmidt BM, Levitt N, Chapotera G, Akiteng AR, Mpando T, Ntawuyirushintege S, Rehfuess EA. Collaborative strategies for knowledge translation: the African-German CEBHA+ research network. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) is an NCD research consortium that seeks to engage policy-makers and practitioners throughout the research process in order to build lasting relationships, enhance evidence uptake and build long-term capacity among partner institutions in Ethiopia, Malawi, Rwanda, South Africa and Uganda. This integrated knowledge translation (IKT) approach includes the formal development and implementation of country-specific engagement strategies.
Methods
An early-stage evaluation is taking place in Mid-2020. Online surveys and qualitative interviews with researchers and policy-and-practice partners will inform adaptation of country-specific strategies, advance the initial programme theory and contribute to the science of IKT.
Results
We present three pertinent observations based on the development and implementation of an overarching CEBHA+ IKT approach and five country-specific strategies over the last two years: Despite being informed by an overarching IKT programme theory, the site-specific strategies and resulting partnerships vary markedly, representing the whole continuum of integrated knowledge translation.The diversity of approaches is due to different understandings of IKT, discontinuity of staff, lack of IKT training, and perceptions of usefulness (compared to ongoing research activities) among CEBHA+ researchers.The individual, dynamic and often pre-existing relationships of researchers and partners from policy and practice are central to IKT, but capturing these within the programme theory and monitoring them remains challenging.
Conclusions
These observations are useful to guide further evaluation and cross-country comparison. Close examination of relationships and conceptualisation of IKT as a continuum may provide valuable insights into the circumstances that make IKT efforts worthwhile.
Key messages
Translating evidence into policy and practice is reliant on partnerships between researchers and policy-and-practice partners. These can be formalised but the relationships remain complex and dynamic.
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Affiliation(s)
- K Sell
- IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - L M Pfadenhauer
- IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - N Jessani
- Department of Global Health, Faculty of Medicine and Health Sciences, Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, South Africa
| | - B M Schmidt
- Cochrane Centre, South African Medical Research Council, Cape Town, South Africa
| | - N Levitt
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - G Chapotera
- School of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - A R Akiteng
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - T Mpando
- School of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - S Ntawuyirushintege
- College of Medicine and Health Sciences School of PH, University of Rwanda, Kigali, Rwanda
| | - E A Rehfuess
- IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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10
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Stratil J, Rehfuess EA, Geffert K. GH:ADT Project: developing a framework of Global Health concepts and a learning objectives catalogue. Eur J Public Health 2020. [PMCID: PMC7543552 DOI: 10.1093/eurpub/ckaa166.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Global Health (GH) is receiving increasing attention, in Germany, Europe and internationally. Despite an increased demand, teaching on GH remains fragmented and heterogeneous in the university landscape in German-speaking countries. Moreover, there is a lack of common understanding of GH and interpretations range from GH as tropical medicine to GH as everything related to health. This project aims to develop (A) a framework of different GH concepts, as a basis for (B) a set of GH learning objectives for German-speaking countries. Methods A review of publications providing GH definitions was carried out. Following a concept analysis approach, we developed a general framework of different and partially overlapping GH understandings. Building on these results we conducted an overview of reviews on learning objectives and curricula for GH to develop a set of learning objectives. Results The general framework distinguishes between GH concepts describing GH as (1)a set of global health issues (e.g. COVID-19), (2) a global ideal to strive for, (3 + 4) any activities relating to said global health issues or ideals (e.g. all activities contributing to health equity), and (5) sets of activities meeting various characteristics (e.g. being transdisciplinary and transnational). Within each concept, multiple sets of axes allow a more granular distinction of the concepts (e.g. regarding the relation to public health and tropical medicine). The list of key learning objectives shows considerable overlap with widely accepted public health core competencies. Differences include e.g. a (stronger) emphasis on intercultural and interdisciplinary collaboration, globalisation and transnational determinants of health. Conclusions A systematic reflection on commonalities and differences in the understanding of GH is important for a shared understanding. Based on the GH learning objectives we will develop core competencies for GH, including through an online survey of GH experts. Key messages The GH:ADT framework of global health concepts supports a systematic reflection on and recognition of the multi-dimensional nature of Global Health. The learning objectives identified in the GH:ADT project can be a valuable tool for curriculum development.
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11
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Stratil J, Oliver K, von Philipsborn P, Movsisyan A, Rehfuess EA. More harm than good? Building a framework to identify adverse effects of public health interventions. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
While the importance of adverse events of medical interventions is widely recognized, adverse effects of public health interventions remain a neglected topic. This project aims to develop a framework to guide researchers and decision-makers to systematically reflect on and identify potential adverse effects of public health interventions.
Methods
We conducted a mixed-method systematic review of theoretical and conceptual publications on adverse events of public health interventions to develop a preliminary framework employing best-fit framework synthesis. We used the WHO-INTEGRATE framework as a starting point for the synthesis, a multidimensional evidence-to-decision framework developed for complex interventions in complex systems.
Results
The framework includes two interlinked parts: The first maps domains in which potential adverse events might arise. Drawing on the WHO-INTEGRATE framework, these domains include aspects related to health, but also domains related to societal, economic, and environmental implications. The second part maps general mechanisms through which public health interventions can lead to adverse effects (e.g. reactive behaviour change, increase of labelling and stigmatization, and exposure to environmental risk-factors).
Conclusions
The framework will be advanced in the second phase of the project through empirical studies of harmful effects in public health interventions, which we will identify through an overview of systematic reviews. Adverse effects of public health interventions are currently not sufficiently considered in research and practice. Taking them into account is essential for informed decision-making and establishing appropriate countermeasures. Our framework could be a valuable asset for researchers and policy makers in developing, implementing and evaluating public health interventions.
Key messages
Awareness of the adverse effects of public health interventions is essential for informed decision-making and establishing countermeasures. This framework supports researchers and decision-makers in systematically reflecting on and identifying adverse events when developing, piloting, implementing or evaluating public health interventions.
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Affiliation(s)
| | - K Oliver
- Faculty of Public Health and Policy, LSHTM, London, UK
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12
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Stratil JM, Baltussen R, Scheel I, Nacken A, Rehfuess EA. Development of the WHO-INTEGRATE evidence-to-decision framework: an overview of systematic reviews of decision criteria for health decision-making. Cost Eff Resour Alloc 2020; 18:8. [PMID: 32071560 PMCID: PMC7014604 DOI: 10.1186/s12962-020-0203-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background Decision-making in public health and health policy is complex and requires careful deliberation of many and sometimes conflicting normative and technical criteria. Several approaches and tools, such as multi-criteria decision analysis, health technology assessments and evidence-to-decision (EtD) frameworks, have been proposed to guide decision-makers in selecting the criteria most relevant and appropriate for a transparent decision-making process. This study forms part of the development of the WHO-INTEGRATE EtD framework, a framework rooted in global health norms and values as reflected in key documents of the World Health Organization and the United Nations system. The objective of this study was to provide a comprehensive overview of criteria used in or proposed for real-world decision-making processes, including guideline development, health technology assessment, resource allocation and others. Methods We conducted an overview of systematic reviews through a combination of systematic literature searches and extensive reference searches. Systematic reviews reporting criteria used for real-world health decision-making by governmental or non-governmental organization on a supranational, national, or programme level were included and their quality assessed through a bespoke critical appraisal tool. The criteria reported in the reviews were extracted, de-duplicated and sorted into first-level (i.e. criteria), second-level (i.e. sub-criteria) and third-level (i.e. decision aspects) categories. First-level categories were developed a priori using a normative approach; second- and third-level categories were developed inductively. Results We included 36 systematic reviews providing criteria, of which one met all and another eleven met at least five of the items of our critical appraisal tool. The criteria were subsumed into 8 criteria, 45 sub-criteria and 200 decision aspects. The first-level of the category system comprised the following seven substantive criteria: “Health-related balance of benefits and harms”; “Human and individual rights”; “Acceptability considerations”; “Societal considerations”; “Considerations of equity, equality and fairness”; “Cost and financial considerations”; and “Feasibility and health system considerations”. In addition, we identified an eight criterion “Evidence”. Conclusion This overview of systematic reviews provides a comprehensive overview of criteria used or suggested for real-world health decision-making. It also discusses key challenges in the selection of the most appropriate criteria and in seeking to implement a fair decision-making process.
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Affiliation(s)
- J M Stratil
- 1Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - R Baltussen
- 2Department for Health Evidence, Radboud University Medical Center, P.O.Box 9101, 6500 HB Nijmegen, The Netherlands
| | - I Scheel
- 3Department of Global Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - A Nacken
- 1Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - E A Rehfuess
- 1Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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13
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Burns J, Boogaard H, Polus S, Pfadenhauer LM, Rohwer AC, van Erp AM, Turley R, Rehfuess EA. Interventions to reduce ambient air pollution and their effects on health: An abridged Cochrane systematic review. Environ Int 2020; 135:105400. [PMID: 31855800 DOI: 10.1016/j.envint.2019.105400] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/11/2019] [Accepted: 12/06/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND A broad range of interventions have been implemented to improve ambient air quality, and many of these have been evaluated. Yet to date no systematic review has been conducted to identify and synthesize these studies. In this systematic review, we assess the effectiveness of interventions in reducing ambient particulate matter air pollution and improving adverse health outcomes. METHODS We searched a range of electronic databases across multiple disciplines, as well as grey literature databases, trial registries, reference lists of included studies and the contents of relevant journals, through August 2016. Eligible for inclusion were randomized and cluster randomized controlled trials, as well as several non-randomized study designs often used for evaluating air quality interventions. We included studies that evaluated interventions targeting industrial, residential, vehicular and multiple sources, with respect to their effect on mortality, morbidity and the concentrations of particulate matter (PM - including PM10, PM2.5, coarse particulate matter and combustion-related PM), as well as several criteria pollutants, including ozone, carbon monoxide, nitrogen oxides, nitrogen dioxide, nitric oxide and sulphur dioxide. We did not restrict studies based on the population, setting or comparison. Two authors independently assessed studies for inclusion, extracted data and assessed risk of bias. We assessed risk of bias using the Graphic Appraisal Tool for Epidemiological studies (GATE) for correlation studies, as modified and employed by the UK National Institute for Health and Care Excellence. We synthesized evidence narratively, as well as graphically using harvest plots. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS We included 42 studies assessing 38 unique interventions. These comprised a heterogeneous mix of interventions, including those aiming to address industrial sources (n = 5; e.g. the closure of a factory), residential sources (n = 7; e.g. coal ban), vehicular sources (n = 22; e.g. low emission zones), and multiple sources (n = 4; e.g. tailored measures that target both local traffic and industrial polluters). Evidence for effectiveness was mixed. Most included studies observed either no significant association or an association favoring the intervention, with little evidence that the assessed interventions might be harmful. CONCLUSIONS Given the heterogeneity across interventions, outcomes, and methods, it was difficult to derive overall conclusions regarding the effectiveness of interventions in terms of improved air quality or health. Some evidence suggests that interventions are associated with improvements in air quality and human health, with very little evidence suggesting interventions were harmful. The evidence base highlights the challenges related to establishing the effectiveness of specific air pollution interventions on outcomes. It also points to the need for improved study design and analysis methods, as well as more uniform evaluations. The prospective planning of evaluations and an evaluation component built into the design and implementation of interventions may also be particularly beneficial.
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Affiliation(s)
- J Burns
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany; Pettenkofer School of Public Health, LMU Munich, Germany.
| | - H Boogaard
- Health Effects Institute, Boston, MA, USA
| | - S Polus
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany; Pettenkofer School of Public Health, LMU Munich, Germany
| | - L M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany; Pettenkofer School of Public Health, LMU Munich, Germany
| | - A C Rohwer
- Centre for Evidence-based Health Care, Division Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - R Turley
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - E A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany; Pettenkofer School of Public Health, LMU Munich, Germany
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14
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Berner-Rodoreda A, Rehfuess EA, Klipstein-Grobusch K, Cobelens F, Raviglione M, Flahault A, Casamitjana N, Fröschl G, Skordis-Worral J, Abubakar I, Ashrafian H, Agardh A, Visser L, Schultsz C, Plasència A, Jahn A, Norton R, van Leeuwen R, Hagander L, Bärnighausen T. Where is the 'global' in the European Union's Health Research and Innovation Agenda? BMJ Glob Health 2019; 4:e001559. [PMID: 31646008 PMCID: PMC6781967 DOI: 10.1136/bmjgh-2019-001559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 11/26/2022] Open
Abstract
Global Health has not featured as prominently in the European Union (EU) research agenda in recent years as it did in the first decade of the new millennium, and participation of low-income and middle-income countries (LMICs) in EU health research has declined substantially. The Horizon Europe Research and Innovation Framework adopted by the European Parliament in April 2019 for the period 2021-2027 will serve as an important funding instrument for health research, yet the proposed health research budget to be finalised towards the end of 2019 was reduced from 10% in the current framework, Horizon 2020, to 8% in Horizon Europe. Our analysis takes the evolvement of Horizon Europe from the initial framework of June 2018 to the framework agreed on in April 2019 into account. It shows that despite some improvements in terms of Global Health and reference to the Sustainable Development Goals, European industrial competitiveness continues to play a paramount role, with Global Health research needs and relevant health research for LMICs being only partially addressed. We argue that the globally interconnected nature of health and the transdisciplinary nature of health research need to be fully taken into account and acted on in the new European Research and Innovation Framework. A facilitated global research collaboration through Horizon Europe could ensure that Global Health innovations and solutions benefit all parts of the world including EU countries.
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Affiliation(s)
- Astrid Berner-Rodoreda
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Eva Annette Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU München, München, Germany
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Mario Raviglione
- Global Health Centre, Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Antoine Flahault
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Núria Casamitjana
- Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Günter Fröschl
- Division of Infectious Diseases and Tropical Medicine, LMU München, München, Germany
| | | | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Leo Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Constance Schultsz
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Antoni Plasència
- Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Albrecht Jahn
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Robyn Norton
- The George Institute for Global Health, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Remko van Leeuwen
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Lars Hagander
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Africa Health Research Institute (AHRI), Somkhele and Durban, KwaZulu-Natal, South Africa
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15
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Zink A, Schielein M, Wildner M, Rehfuess EA. 'Try to make good hay in the shade - it won't work!' A qualitative interview study on the perspectives of Bavarian farmers regarding primary prevention of skin cancer. Br J Dermatol 2019; 180:1412-1419. [PMID: 30861096 DOI: 10.1111/bjd.17872] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extensive exposure to solar ultraviolet radiation (UVR) is the main risk factor for keratinocyte carcinoma (KC), making outdoor workers, including farmers, a high-risk population for KC. The use of sun protection is crucial for KC prevention but is not typically implemented by outdoor workers during their daily tasks. OBJECTIVES To explore the attitudes of Bavarian farmers regarding sun-protective measures in their daily work and to understand perceived barriers and unmet needs. METHODS Farmers were recruited through the Bavarian Farmers Association in Bavaria, Southern Germany. Qualitative semi structured interviews were conducted with participants between December 2017 and March 2018. Interviews were recorded, transcribed verbatim and analysed using qualitative content analysis. RESULTS Twenty farmers (11 women, nine men; nine aged 18-30 years, 11 aged > 60 years) participated. Knowledge and awareness of UVR exposure and KC, perceived individual barriers to implementing sun-protective measures, individual experiences and farm life-specific circumstances emerged as key areas influencing the perspectives of farmers regarding the primary prevention of KC. Female farmers tended to take a more positive stance on sun protection, whereas male farmers showed a lower overall interest. CONCLUSIONS Knowledge and awareness of KC and UVR exposure is very limited in Bavarian farmers with serious perceived barriers due to the demands of daily agricultural work. Further qualitative studies are needed to identify intervention options that can increase skin cancer awareness and that can successfully overcome real barriers to implementing sun protection.
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Affiliation(s)
- A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - M Wildner
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany.,Bavarian Health and Food Safety Authority, Munich, Germany
| | - E A Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
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Montgomery P, Movsisyan A, Grant SP, Macdonald G, Rehfuess EA. Considerations of complexity in rating certainty of evidence in systematic reviews: a primer on using the GRADE approach in global health. BMJ Glob Health 2019; 4:e000848. [PMID: 30775013 PMCID: PMC6350753 DOI: 10.1136/bmjgh-2018-000848] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 12/31/2022] Open
Abstract
Public health interventions and health technologies are commonly described as 'complex', as they involve multiple interacting components and outcomes, and their effects are largely influenced by contextual interactions and system-level processes. Systematic reviewers and guideline developers evaluating the effects of these complex interventions and technologies report difficulties in using existing methods and frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE). As part of a special series of papers on implications of complexity in the WHO guideline development, this paper serves as a primer on how to consider sources of complexity when using the GRADE approach to rate certainty of evidence. Relevant sources of complexity in systematic reviews, health technology assessments and guidelines of public health are outlined and mapped onto the reported difficulties in rating the estimates of the effect of these interventions. Recommendations on how to address these difficulties are further outlined, and the need for an integrated use of GRADE from the beginning of the review or guideline development is emphasised. The content of this paper is informed by the existing GRADE guidance, an ongoing research project on considering sources of complexity when applying the GRADE approach to rate certainty of evidence in systematic reviews and the review authors' own experiences with using GRADE.
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Affiliation(s)
- Paul Montgomery
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Ani Movsisyan
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Sean P Grant
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, USA
| | | | - Eva Annette Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig Maximilian University, Munich, Germany
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17
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Petticrew M, Knai C, Thomas J, Rehfuess EA, Noyes J, Gerhardus A, Grimshaw JM, Rutter H, McGill E. Implications of a complexity perspective for systematic reviews and guideline development in health decision making. BMJ Glob Health 2019; 4:e000899. [PMID: 30775017 PMCID: PMC6350708 DOI: 10.1136/bmjgh-2018-000899] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/02/2018] [Accepted: 08/26/2018] [Indexed: 01/03/2023] Open
Abstract
There is growing interest in the potential for complex systems perspectives in evaluation. This reflects a move away from interest in linear chains of cause-and-effect, towards considering health as an outcome of interlinked elements within a connected whole. Although systems-based approaches have a long history, their concrete implications for health decisions are still being assessed. Similarly, the implications of systems perspectives for the conduct of systematic reviews require further consideration. Such reviews underpin decisions about the implementation of effective interventions, and are a crucial part of the development of guidelines. Although they are tried and tested as a means of synthesising evidence on the effectiveness of interventions, their applicability to the synthesis of evidence about complex interventions and complex systems requires further investigation. This paper, one of a series of papers commissioned by the WHO, sets out the concrete methodological implications of a complexity perspective for the conduct of systematic reviews. It focuses on how review questions can be framed within a complexity perspective, and on the implications for the evidence that is reviewed. It proposes criteria which can be used to determine whether or not a complexity perspective will add value to a review or an evidence-based guideline, and describes how to operationalise key aspects of complexity as concrete research questions. Finally, it shows how these questions map onto specific types of evidence, with a focus on the role of qualitative and quantitative evidence, and other types of information.
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Affiliation(s)
- Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James Thomas
- EPPI-Centre, SSRU, Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Eva Annette Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | - Ansgar Gerhardus
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Germany,Department of Health Services Research, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Harry Rutter
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK,Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Elizabeth McGill
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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18
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Stratil JM, von Philipsborn P, Marckmann G, Pfadenhauer LM, Zeeb H, Rehfuess EA. Advancing Germany's new global health strategy. BMJ Glob Health 2018; 3:e001140. [PMID: 30613429 PMCID: PMC6304092 DOI: 10.1136/bmjgh-2018-001140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/31/2018] [Accepted: 11/17/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jan M Stratil
- Pettenkofer School of Public Health; Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Peter von Philipsborn
- Pettenkofer School of Public Health; Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Georg Marckmann
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Munich, Germany
| | - Lisa M Pfadenhauer
- Pettenkofer School of Public Health; Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Germany, Bremen, Germany
| | - Eva Annette Rehfuess
- Pettenkofer School of Public Health; Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
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19
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Nacken A, Rehfuess EA, Paul I, Lupapula A, Pfadenhauer LM. Teachers' competence, school policy and social context-HIV prevention needs of primary schools in Kagera, Tanzania. Health Educ Res 2018; 33:505-521. [PMID: 31222361 DOI: 10.1093/her/cyy036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 08/05/2018] [Accepted: 09/17/2018] [Indexed: 06/09/2023]
Abstract
Sub-Saharan Africa carries a high burden of the HIV epidemic, with young adults being particularly affected. Well-designed school-based HIV prevention interventions can contribute to establishing protective behaviour. The aim of this study was to explore the needs of primary school students and teachers in the region of Kagera, Tanzania, regarding an HIV prevention intervention in the primary school setting. The needs assessment was structured according to the PRECEDE component of the PRECEDE-PROCEED model. Qualitative data was collected in six focus group discussions with primary school students and teachers. Key informant interviews with seven experts were conducted. We employed qualitative content analysis to analyse data in MAXQDA. The findings suggest that teachers need to be adequately trained to provide HIV and sex education and to support HIV-positive students. Enabling structural factors, such as an appropriate syllabus, are required. Stigmatization has been reported a major barrier to HIV prevention in schools. Teachers and students identified a more trustful relationship between each other as well as to legal guardians of children as a basis for HIV prevention. These findings will inform the development of a tailored HIV prevention intervention.
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Affiliation(s)
- A Nacken
- Pettenkofer School of Public Health, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchioninistr. 15, Munich, Germany
| | - E A Rehfuess
- Pettenkofer School of Public Health, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchioninistr. 15, Munich, Germany
| | - I Paul
- Jambo Bukoba NGO Office Tanzania, Jambo Bukoba e.V., Aerodrome Road, Bukoba, Tanzania
| | - A Lupapula
- Department of Kiswahili, St. Augustine University of Tanzania, Mwanza, Tanzania
| | - L M Pfadenhauer
- Pettenkofer School of Public Health, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchioninistr. 15, Munich, Germany
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Delius M, Rehfuess EA, Paudel D, Maskey MK, Shah R. Barriers to institutional delivery in rural areas of Chitwan district, Nepal: A qualitative study. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Delius
- LMU München, Department of Obstetrics and Gynecology, München, Deutschland
- LMU München, Center for International Health, München, Deutschland
| | - EA Rehfuess
- LMU München, Center for International Health, München, Deutschland
- LMU München, Institute für Medical Information Processing, Biometry and Epidemiology, München, Deutschland
| | - D Paudel
- LMU München, Center for International Health, München, Deutschland
- Save the Children, Kathmandu, Nepal
| | - MK Maskey
- Nepal Public Health Foundation, Kathmandu, Nepal
| | - R Shah
- LMU München, Center for International Health, München, Deutschland
- Nepal Public Health Foundation, Kathmandu, Nepal
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Sclar GD, Penakalapati G, Caruso BA, Rehfuess EA, Garn JV, Alexander KT, Freeman MC, Boisson S, Medlicott K, Clasen T. Exploring the relationship between sanitation and mental and social well-being: A systematic review and qualitative synthesis. Soc Sci Med 2018; 217:121-134. [PMID: 30316053 DOI: 10.1016/j.socscimed.2018.09.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/16/2018] [Accepted: 09/14/2018] [Indexed: 11/18/2022]
Abstract
The WHO defines health not as the absence of disease but as a "state of complete physical, mental, and social well-being." To date, public health research on sanitation has focused mainly on the impact of sanitation on infectious diseases and related sequelae, such as diarrhea and malnutrition. This review focuses on the mental and social well-being implications of sanitation. We systematically searched leading databases to identify eligible studies. Qualitative studies were assessed using a 17-point checklist adapted from existing tools, while quantitative studies were assessed using the Liverpool Quality Appraisal Tool. We followed a best-fit framework synthesis approach using six a priori well-being dimensions (privacy, shame, anxiety, fear, assault, and safety), which were examined using line-by-line coding. Two additional dimensions (dignity and embarrassment) inductively emerged during coding for a total of eight well-being outcomes. We then synthesized coded text for each dimension into descriptive themes using thematic analysis. For quantitative studies, we extracted any measures of association between sanitation and well-being. We identified 50 eligible studies covering a variety of populations and sanitation contexts but many studies were conducted in India (N = 14) and many examined the sanitation experience for women and girls (N = 19). Our synthesis results in a preliminary conceptual model in which privacy and safety, including assault, are root well-being dimensions. When people perceive or experience a lack of privacy or safety during open defecation or when using sanitation infrastructure, this can negatively influence their mental and social well-being. We found that perceptions and experiences of privacy and safety are influenced by contextual and individual factors, such as location of sanitation facilities and user's gender identity, respectively. Privacy and safety require thorough examination when developing sanitation interventions and policy to ensure a positive influence on the user's mental and social well-being.
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Affiliation(s)
- G D Sclar
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - G Penakalapati
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - B A Caruso
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - E A Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - J V Garn
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA; School of Community Health Sciences, University of Nevada Reno, 1664 N Virginia St, Reno, NV, 89557, USA
| | - K T Alexander
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA; CARE, 151 Ellis St NE, Atlanta, GA, USA, 30303
| | - M C Freeman
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - S Boisson
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1202, Genève, Switzerland
| | - K Medlicott
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1202, Genève, Switzerland
| | - T Clasen
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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Burns J, Polus S, Brereton L, Chilcott J, Ward SE, Pfadenhauer LM, Rehfuess EA. Looking beyond the forest: Using harvest plots, gap analysis, and expert consultations to assess effectiveness, engage stakeholders, and inform policy. Res Synth Methods 2017; 9:132-140. [PMID: 29106058 DOI: 10.1002/jrsm.1284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/04/2017] [Accepted: 10/23/2017] [Indexed: 11/09/2022]
Abstract
We describe a combination of methods for assessing the effectiveness of complex interventions, especially where substantial heterogeneity with regard to the population, intervention, comparison, outcomes, and study design of interest is expected. We applied these methods in a recent systematic review of the effectiveness of reinforced home-based palliative care (rHBPC) interventions, which included home-based care with an additional and explicit component of lay caregiver support. We first summarized the identified evidence, deemed inappropriate for statistical pooling, graphically by creating harvest plots. Although very useful as a tool for summary and presentation of overall effectiveness, such graphical summary approaches may obscure relevant differences between studies. Thus, we then used a gap analysis and conducted expert consultations to look beyond the aggregate level at how the identified evidence of effectiveness may be explained. The goal of these supplemental methods was to step outside of the conventional systematic review and explore this heterogeneity from a broader perspective, based on the experience of palliative care researchers and practitioners. The gap analysis and expert consultations provided valuable input into possible underlying explanations in the evidence, which could be helpful in the further adaptation and testing of existing rHBPC interventions or the development and evaluation of new ones. We feel that such a combination of methods could prove accessible, understandable, and useful in informing decisions and could thus help increase the relevance of systematic reviews to the decision-making process.
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Affiliation(s)
- J Burns
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - S Polus
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - L Brereton
- The School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.,College of Health and Social Sciences, University of Lincoln, Lincoln, UK
| | - J Chilcott
- The School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - S E Ward
- The School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - L M Pfadenhauer
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - E A Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Pfadenhauer LM, Burns J, Rohwer A, Rehfuess EA. Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water: A systematic review. Environ Res 2016; 147:525-36. [PMID: 26990846 DOI: 10.1016/j.envres.2016.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 05/19/2023]
Abstract
OBJECTIVES The objective of this systematic review is to assess the effectiveness of regulatory, environmental and educational interventions for reducing blood lead levels (BLLs) and associated health outcomes in children, pregnant women and the general population. METHODS Searches were run in MEDLINE, EMBASE and the Global Health Library up until August 2015. Studies were eligible for inclusion if they assessed the impact of regulatory, environmental or educational interventions, stand-alone or in combination, on BLLs among children, pregnant women or the general population through randomized controlled trials (RCT), controlled before-after (CBA), interrupted time series (ITS), uncontrolled before-after (UBA) or repeated cross-sectional studies. Studies assessing the impact of interventions to reduce exposure to lead in paint or household dust as well as studies concerned exclusively with environmental concentrations of lead were not included. As documented in a detailed protocol, screening, data extraction and quality appraisal were largely undertaken according to Cochrane standards. Harvest plots were used to graphically summarize evidence of effectiveness. RESULTS The searches yielded 6466 unique records, of which five met our eligibility criteria; two additional eligible studies were identified by experts. We did not find any studies regarding the effectiveness of regulatory, educational or environmental interventions targeting exposure to lead in consumer products. Evidence regarding the effectiveness of interventions in reducing BLLs from exposures through drinking water is limited in both quantity and quality. Stand-alone targeted educational interventions showed no statistically significant reductions in children's BLL (two RCT) when compared to general educational interventions. Likewise, instructing women to reduce or eliminate lead-contaminated drinking water showed no effect on BLL (one RCT). Stand-alone environmental interventions appeared more promising in reducing BLL (three UBA). Combining educational and environmental interventions and targeting multiple settings may be effective in reducing BLL, as suggested by one uncontrolled before-after study. No studies examining the effectiveness of regulatory interventions were found. CONCLUSIONS The limited quantity and quality of the evidence measuring BLL and associated health outcomes points to an urgent need for more robust research into the effectiveness of interventions to reduce lead exposure from consumer products and drinking water, especially for regulatory interventions.
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Affiliation(s)
- Lisa Maria Pfadenhauer
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Jacob Burns
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Anke Rohwer
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany; Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl drive, Parow, 7500, South Africa
| | - Eva Annette Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
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Pfadenhauer LM, Mozygemba K, Gerhardus A, Hofmann B, Booth A, Lysdahl KB, Tummers M, Burns J, Rehfuess EA. Context and implementation: A concept analysis towards conceptual maturity. Z Evid Fortbild Qual Gesundhwes 2015; 109:103-14. [PMID: 26028447 DOI: 10.1016/j.zefq.2015.01.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 02/01/2023]
Abstract
Context and implementation of health interventions have received increasing attention over the past decade, in particular with respect to their influence on the effectiveness and reach of complex interventions. The underlying concepts are both considered partially mature, limiting their operationalization in research and practice. We conducted systematic literature searches and pragmatic utility (PU) concept analyses to provide a state-of-the-art assessment of the concepts of "context" and "implementation" in the health sciences to create a common understanding for their use within systematic reviews and HTA. We performed two separate searches, one for context (EMBASE, MEDLINE) and the other for implementation (Google Scholar) to identify relevant models, theories and frameworks. 17 publications on context and 35 articles on implementation met our inclusion criteria. PU concept analysis comprises three guiding principles: selection of the literature, organization and structuring of the literature, and asking analytic questions of the literature. Both concepts were analyzed according to four features of conceptual maturity, i.e., consensual definitions, clear characteristics, fully described preconditions and outcomes, and delineated boundaries. Context and implementation are highly intertwined, with both concepts influencing and interacting with each other. Context is defined as a set of characteristics and circumstances that surround the implementation effort. Implementation is conceptualized as a planned and deliberately initiated effort with the intention to put an intervention into practice. The concept of implementation presents largely consensual definitions and relatively well-defined boundaries, while distinguishing features, preconditions and outcomes are not yet fully articulated. In contrast, definitions of context vary widely, and boundaries with neighbouring concepts, such as setting and environment, are blurred; characteristics, preconditions and outcomes are ill-defined. Therefore, the maturity of both concepts should be further improved to facilitate operationalization in systematic reviews and HTAs.
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Affiliation(s)
- Lisa Maria Pfadenhauer
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany.
| | - Kati Mozygemba
- Institute of Public Health and Nursing Research, University of Bremen, Germany; Health Sciences Bremen, University of Bremen
| | - Ansgar Gerhardus
- Institute of Public Health and Nursing Research, University of Bremen, Germany; Health Sciences Bremen, University of Bremen
| | - Bjørn Hofmann
- Centre for Medical Ethics, University of Oslo, Norway
| | | | | | | | - Jacob Burns
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany
| | - Eva Annette Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany
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Pfadenhauer LM, Burns J, Rohwer A, Rehfuess EA. A protocol for a systematic review of the effectiveness of interventions to reduce exposure to lead through consumer products and drinking water. Syst Rev 2014; 3:36. [PMID: 24731516 PMCID: PMC4049510 DOI: 10.1186/2046-4053-3-36] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/27/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The toxic heavy metal lead continues to be a leading environmental risk factor, with the number of attributable deaths having doubled between 1990 and 2010. Although major sources of lead exposure, in particular lead in petrol, have been significantly reduced in recent decades, lead is still used in a wide range of processes and objects, with developing countries disproportionally affected. The objective of this systematic review is to assess the effectiveness of regulatory, environmental and educational interventions for reducing blood lead levels and associated health outcomes in children, pregnant women and the general population. METHODS/DESIGN The databases MEDLINE, Embase and the Global Health Library (GHL) will be searched using a sensitive search strategy. Studies in English, German, French, Spanish, Italian or Afrikaans will be screened according to predefined inclusion and exclusion criteria. We will consider randomized and non-randomized studies accepted by the Cochrane Effective Practice and Organization of Care (EPOC) Group, as well as additional non-randomized studies. Screening of titles and abstracts will be performed by one author. Full texts of potentially relevant studies will be independently assessed for eligibility by two authors. A single author will extract data, with a second reviewer checking the extraction form. Risk of bias will be assessed by two researchers using the Graphical Appraisal Tool for Epidemiological studies, as modified by the Centre for Public Health at the UK National Institute for Health and Care Excellence. Any inconsistencies in the assessment of eligibility, data extraction or quality appraisal will be resolved through discussion. Where two or more studies report the primary outcome blood lead levels within the same population group, intervention category and source of lead exposure, data will be pooled using random effects meta-analysis. In parallel, harvest plots as a graphical method of evidence synthesis will be used to present findings for blood lead levels and secondary outcomes. DISCUSSION This systematic review will fill an important evidence gap with respect to the effectiveness of interventions to reduce lead in consumer products and drinking water in the context of new WHO guidelines for the prevention and management of lead poisoning. It will also contribute to setting a future research agenda.
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Affiliation(s)
- Lisa Maria Pfadenhauer
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
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Goyder E, Brereton ML, Gardiner C, Mozygemba K, Sacchini D, Oortwijn WJ, Lysdahl KB, Rehfuess EA, van der Wilt GJ. Using the best available evidence to inform decision making on complex interventions: Building the future through increasing public and patient involvement in Health Technology Assessment. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Goyder
- ScHARR, University of Sheffield, Sheffield, United Kingdom
| | - ML Brereton
- ScHARR, University of Sheffield, Sheffield, United Kingdom
| | - C Gardiner
- ScHARR, University of Sheffield, Sheffield, United Kingdom
| | - K Mozygemba
- Department of Health Services Research, University of Bremen, Bremen, Germany
| | - D Sacchini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - WJ Oortwijn
- ECORYS Nederland B.V., Rotterdam, The Netherlands
| | - KB Lysdahl
- Institute for Health and Society, University of Oslo, Oslo, Norway
| | - EA Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany
| | - GJ van der Wilt
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
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Rehfuess EA, Tzala L, Best N, Briggs DJ, Joffe M. Solid fuel use and cooking practices as a major risk factor for ALRI mortality among African children. J Epidemiol Community Health 2009; 63:887-92. [PMID: 19468017 DOI: 10.1136/jech.2008.082685] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Almost half of global child deaths due to acute lower respiratory infections (ALRIs) occur in sub-Saharan Africa, where three-quarters of the population cook with solid fuels. This study aims to quantify the impact of fuel type and cooking practices on childhood ALRI mortality in Africa, and to explore implications for public health interventions. METHODS Early-release World Health Survey data for the year 2003 were pooled for 16 African countries. Among 32,620 children born during the last 10 years, 1455 (4.46%) were reported to have died prior to their fifth birthday. Survival analysis was used to examine the impact of different cooking-related parameters on ALRI mortality, defined as cough accompanied by rapid breathing or chest indrawing based on maternal recall of symptoms prior to death. RESULTS Solid fuel use increases the risk of ALRI mortality with an adjusted hazard ratio of 2.35 (95% CI 1.22 to 4.52); this association grows stronger with increasing outcome specificity. Differences between households burning solid fuels on a well-ventilated stove and households relying on cleaner fuels are limited. In contrast, cooking with solid fuels in the absence of a chimney or hood is associated with an adjusted hazard ratio of 2.68 (1.38 to 5.23). Outdoor cooking is less harmful than indoor cooking but, overall, stove ventilation emerges as a more significant determinant of ALRI mortality. CONCLUSIONS This study shows substantial differences in ALRI mortality risk among African children in relation to cooking practices, and suggests that stove ventilation may be an important means of reducing indoor air pollution.
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Affiliation(s)
- E A Rehfuess
- Department of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany.
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