PHN

Health problems are a big issue, i.e. the double / triple burden of diseases: On one side there is malnutrition present but also obese and nutrition defincies (anemia, stunting, wasting). It is important, that something is done about it. Aswell the economic burden (disease are costing a lot of money).

Socio-ecological models were developed to further the understanding of the dynamic interrelations among various personal and environmental factors.

It describes, which factors influence behaviour. I.e. Intrapersonal: attitudes, knowledge, self-efficacy, developmental history…

Interpersonal: social networks, social support (family, parents, co-workers, peers)

Organisational: social institutions with rules, regulations, policies and ethos that may promote health

Community: shared identities, relationships among organization, institutions and informational networks within defined boundaries

Environment/policy: Policies, advocacy, environments and structures that impact on health 

Goal i.e.: reduce exposure to second-hand tobacco smoke in children

Short-term objective i.e.: at the end of the first year of the program, 50% of the adults in xxx will be aware of messages about the hazards of secondhand tobacco smoke

Long-term objective i.e.: By the end of 2020, reduce by 25% the prevalence of adult smokers in the home. Criteria: SMART

Diet as a complex expsoure (we all have to eat..), Confounding in nutritional epidemiology, measurement error in nutritional epidemiology, exerimental studies often not feasible (also time-intensive, costly, problems with compliance, blinding difficult), preliminary or unconfirmed findings come to the attention of the media and the general public => no single study can provide a definitive answer and no study design is without limitations".

Mortality: the number of death in a population during a given time or place

current cases (new and preexisting cases)

 number of new events/cases in a defined population in a specific period of time

baseline risk for the outcome => Absolut Risk intervention group is divided by the absolute Risk of the control group, is this subtractet from 100% = Relative Risk Reduction

percentage of people with the outcome in a group. Is calculated for the intervention and control group and then compared = Absolute Risk Reduction. This defines the effectivness of an intervention.

(Risk before implicate the interverntion) is important to get to the absolut and the relative risk.

quantifies the strength of the association between two events, A and B

Result (i.e. NCDs)

 i.E. vegetable intake 

factor who influence another factor. I.e. People who eat more vegetables might have more physical activity usw. So you don't know, which factor has the most effect on the outcome (less coronary heart disease).

Strength of association, consistency of a finding in multiple studies and populations, presence of a dose-response gradient, appropriate temporal relationship, biologic plausibility, coherence with existing data

Detailed Describtion, high explanation, hypothesis generating. It characterize how and why things are happening. In-depth study of a smaller number of cases. Data is primarily text (less numeriical). Explores human experiences (life events), perceptions and feelings. Very interactive between the interviewer and the participant.

=> can be used throughout the Cycle:

In-depth interviews (open-ended questions, ask experiences, feelings, opinions, knowledge): free list questions, card sorting and rating, stimulus (photo, vignettes, writing sample), real-time experiences, thind-out-loud

Observations (Interpersonal interactions, observer's description of activities, bahviors, actions; process - how to do things; field notes). Participant in social setting.

Documents (written material and documents. EX: reports, program records, clinical records, diaries, publications, letters, written responses to questions, photographs, videos, social media posts. Data collected: text and visual data).

Focus Group Discussion (6-10ppl in one group, shared experience, data collected: transcripts or videos

Community Setting: Organisations, Services, Products: Structural and behavioral interventions are implemented in the community setting => where people access products and services.

Settings are Social = Social Setting: Schools, Universities, Day-care centers, workplace, church, community centers, grocery stores, open market/farmers markets, restaurants, local club, community group.

Monitoring: continuing function, shows early indications of progress or lack thereof, in the achievement of results (milestones, target). It is led by the management team

Evaluation: selective, attemps to systematically and objectively assess progress towards and the achievement of an outcome. Evidence function => done by an independent party.

Monitoring: does one have a quality program that is functioning as intended? Purpse: provide informationen on results achieved (activitites and outputs), actionable information that yields recommendation to improve or mage better the programm.

Evaluation: Is there a credible linage between the intervention undertaken and achievements of outcomes? Decision-making: do we continue to fund the program, do we expand the program or do we shut it down?

Outcome: observable, relevant changes achieved during (and because of) the lifecycle of the project (Anthropometry, biochemical, physical activity, dietary behaviors)

Ouputs:the results of program/intervention activities

Change process: make significant changes in the way they operate

Monitoring: You need something to monitor, before you start monitoring. You need information on the results achieved. For example if the products are not getting to the population, you can call them and ask what is happening? Monitoring needs time, so it is expensive

Evaluation: You only evaluate, if you have a working program. The entire spectrum of the work is evaluated.

Monitoring: strategies and tools based on pragram needs for tracking results and ability to make changes

Evaluation: Designs vary depending on program, outcomes and context and level of cerainty required.

Cardiovascular diseases, Diabetes, Chronic respiratory diseases, cancer, chronic neurological disease like dementia (Alzheimer), Arthitis and chronic disease of the muscoskeletal system. The incidence of cancer is higher in man than in woman (probably due to lifestyle and hormones). Incidence is probably increasing,

Because it is influencing the body. Unhealthy eating, excess alcohol, physical inactivity and tobacco use have all an impact to the body. It is leading to overweight / obesity, alcohol and tobacco are toxic for the cells.

Risk factors: Excess calroies, overweight/obesity, alcohol, food processing, red and processed red meat, salt, refined sugars (e.g. from SSBs), refined carbohydrates (e,g, white bread, pasta, rice), unhealthy fats, food contamination

Individual: assessment, examination => focus on disease

Population: Salutogenesis. Not only the individual but also the envirement (workplace, structural, policies, social envirement) => are they favoral for an individual to stay healthy. => prevention

Primary prevention (healthy environment, prevent risk factors): not targeted

Secondary prevention (i.e. smoking, alcohol and obesity prevention, assess and minimize health risks): targeted

Tertiary prevention (especially in elderly population i.e. person after stroke: increse the immobility, that he can care after himself. Slow down progression of disease, avoid complications, relaps.

• Educational approach
• Social, economical, organizational approach
• Political, legal, regulatory approach => the more effective, the less autonomy

In liberal countries it is almost not possible to be very restrict, except people understand the meaning of it and that it is helpful.

Structural is only possible theoretical based on other countries. So the"public health model" is not working

The prevalence is rising globaly, mostly in islands and the arab countries, latine america and the USA.

In CH there are possibly social reasons, that the prevalence is higher in men. In CH there is a low prevalence compared to other countries. In other countries is the prevalence higher in woman (africa, arab) than in men or sometimes it is equal => but these are mostly selfreported data, so there could be a bias.

Social background / education has the bigger impact than nationality

Adults: waist circumfence or BMI >25 = overweight, BMI >30 = obesity

Children: Percentile. It is more important, to see how the child is moving in between the percentile.

CVD, Stroke, respiratory disease. It reduces the overall life expectency, but this is also depending on the health care system

Overweight influece the incidence of cancer less, except for GIT-Organs and sexual organs (because the fat-tissues is hormonactive).

Increased mortality rate is not only depending on the BMI, but also on other riskfactors like smoking, physical activity, alcohol

Environment has a bigger potential to be changed than intrapersonal factors. Architecture and environment planing has aswell a big impact on healthy behaviour (for example in terms of physical activity) => all accessibly by car, big malls and so on. TV consumtion is highly associated with obesity. Labeling has a big impact aswell => it looks "healthier"

Nutriscore: Problem: the product remains ultraprocessed because the ingrediens are just ajusted to get a better score. Consumer perception is influenced. But it could lead to new formulas (like less sugar).

SIGA: Based on processing status and ingrediant

I.e. tobacco / AIDS / Drunk driving => warning labeling, media campaign, tax, restrict food advertising on children, restrict sale of high calorie beverages in schools, offer candy-free checkout lines in grocery stores, counseling on nutrition and physical activity/behavioral weight loss counselling, provide fresh fruits and vegetables to school children in classrooms.