Health Equilibrium Initiative: a public health intervention to narrow the health gap and promote a healthy weight in Swedish children

Abstract

BackgroundInequity in health is a global concern. Even in Sweden there are considerable health gaps between different social groups, not least concerning life-style related conditions. Interventions drawing on Community-based participatory research (CBPR) have potential to build prerequisites for complex, supportive structures that constitute basis for implementation of sustainable health promoting programs. CBPR rests on principles of empowerment. The researchers are responsible for the scientific quality and that ethical standards are met. Health Equilibrium Initiative (HEI) aims at narrowing the health gap and promoting healthy weight in children; “healthy weight” including both anthropometric criteria and aspects having to do with self-esteem and self-efficacy. Evaluation objectives are to compare outcome between children in intervention and control areas, conduct health economic assessments (HEA) and evaluate the processes of the project.Methods/designHEI is a repeated cross-sectional and longitudinal study. The Program Logic Model is based on Social Cognitive Theory and Intervention Mapping. Primary contact groups are children in disadvantaged communities. Core efforts are to confirm and convey knowledge, elucidate and facilitate on-going health work and support implementation of continuous health work. Socioeconomic status is assessed on area level by the parameters yearly average income, degree of employment, tertiary education and percent of inhabitants born in countries where violent conflicts recently have taken place or were ongoing. Anthropometry, food patterns, physical activity and belief in ability to affect health; together with learning, memory and attention assessment will be assessed in 350 children (born 2006). Examinations will be repeated after two years, forming the basis of a health economic analysis. The process evaluation procedure will use document analysis (such as structured reports from meetings and dialogues, school/workplaces policies and curriculum, food service menus); key informant interviews and focus groups with parents, children and professionals.DiscussionInviting, awaiting and including local perspectives create mutual confidence and collaboration. Enhanced self-efficacy and access to relevant knowledge has potential to enable individuals and communities to choose alternatives that are relevant for their health and well-being in a long perspective. The economic of this study may contribute in decision- making processes regarding appropriate public health interventions.

Mortality from Unspecified Unintentional Injury among Individuals Aged 65 Years and Older by U.S. State, 1999–2013

“…Adapting techniques used in previous research [ 1 , 6 ], we used the proportion of unintentional injury deaths coded with an unspecified cause to estimate the precision in coding injury data for the cause of injury. Our analyses proceeded in three steps.…”

“…First, we described data concerning injury mortality rate not being given a specific cause in each U.S. state in both 1999 and 2013. We excluded states with unstable mortality rates from the above analyses since mortality rates based on fewer than 20 deaths are unstable and are not recommended by the CDC WISQARS™ [ 6 ]. Based on the extent of change in proportion of unspecified injury mortality at the state level, we divided states with stable mortality rates into four categories: (1) states with ≥60% increase; (2) states with 40%–59% increase; (3) states with 16%–39% increase, and states without significant change.…”

“…The National Center for Health Statistics (NCHS) within the U.S. Centers for Disease Control and Prevention has conducted special studies and expanded outreach to physicians and others completing birth and death certificates, with a goal to improve data quality and reduce the proportion of injuries coded with an unspecified cause of injury [ 4 ]. Much of this work has focused on older adults aged 65+, where a high proportion of errors occur, and two studies suggest these efforts have been successful over the last two decades at the national level [ 5 , 6 ]. Stevens and Rudd reported a trend toward more-specific reporting of circumstances for falls for Americans aged 65 years and older from 1999 to 2010, although total deaths remained unchanged [ 5 ].…”

“…Stevens and Rudd reported a trend toward more-specific reporting of circumstances for falls for Americans aged 65 years and older from 1999 to 2010, although total deaths remained unchanged [ 5 ]. Similarly, Hu and Mamady reported that the proportion of unspecified unintentional injuries decreased from 18.9% to 10.9% between 1999 and 2010 for the elderly aged 65+ at the national level, and that the decrease in unspecified unintentional injury mortality was correlated with changes in mortality rates from motor vehicle crashes, falls, poisonings, drownings, suffocations, fires/burns, and natural/environmental disasters [ 6 ]. These results suggest that efforts to improve specificity in reporting the cause of injury mortality may have resulted in improved data quality and more accurate tallying of the causes of injuries among older adults nationally.…”

Физичка Активност Ученика И Ученица Претпубертетског Узраста

“…Прекомерна тежина и гојазност, односно аспекти здраве исхране и користима физичке активности нису свим ученицима и њиховим родитељима приближени на адекватан начин, па се и то може сматрати једним од разлога слабијег укључивања деце у одређене спортске клубове, што се на крају одражава и на целокупну физичку активност деце, те се она уско доводи у везу са лошим животним навикама и гојазношћу деце (Gualdi-Russo, Zaccagni, Manzon, Masotti, Rinaldo & Khyatti, 2014). Са аспекта различитог социјалног статуса, постоје разлике у укључивању деце у спортске активности у Шведској (Magnusson, Hallmyr Lewis, Smaga-Blom, Lissner & Pickering, 2014) Сатница предмета часова физичке и здравствене културе у редовној настави је остала недовољна (три часа недељно, два часа физичког васпитања и један час слободних спортских активности за ученике од 5. до 8. разреда) у односу на хипокинезију и све мању потребу за кретањем омладине, јер им је све доступно за тили час преко интернета), што је разлог више потицања рада школских спортских друштава. Спортска друштва постоје, али их деца све мање посећују након редовних часова физичког васпитања (Anderson, 1996).…”