National Awareness Campaign Research Articles

An ecological approach to understanding stroke experience and access to rehabilitation services in Ghana: A cross-sectional study.

Despite a growing burden of stroke in low-middle-income countries, research on patient's experiences and access to rehabilitation services remains limited. This study explores the experiences of stroke patients in relation to access and use of stroke rehabilitation services, coping strategies and strategies to improve care in Ghana. A cross-sectional study was conducted. A total of 136 adult stroke patients hospitalised and subsequently discharged in three major referral hospitals in Ghana participated in the study. A paper-based questionnaire was used to collect data. Data were inputted into STATA version 12, cleaned and analysed using descriptive statistics and Chi-Square tests. Findings showed that stroke patients experience stroke differently. Early detection (awareness) of stroke symptoms at onset was low (29.4%). Hypertension was the major (58.1%) predisposing risk factor for stroke, followed by diabetes (14.7%). Multiple barriers impede access to outpatient rehabilitation services: high cost of medications (43.4%), transportation constraints (10.3%), long waiting time (6.6%), forgetfulness about appointment (4.4%), limited education on rehabilitation (20.6%), lack of community support (12.5%) and ineffective communication with healthcare providers (5.2%). Recommended strategies to improve access to rehabilitation care included public education on stroke and its associated risk, reduction in the cost of drugs and increased stroke rehabilitation funding by the NHIS, especially for physiotherapy consultation and training support to caregivers on patient care. Given the difference in stroke experience and barriers in accessing rehabilitation care, multi-level health policy and service delivery reforms are needed to improve access to rehabilitation care, including national public awareness campaigns on early signs of stroke and subsidised cost of stroke rehabilitation.

Patient expectations of pressure ulcer prevention in the NHS, healthcare demands and national policy: a critical commentary.

Preventive care was recently identified as a Government priority, which is likely to affect pressure ulcer (PU) preventive care in the NHS. Contemporary economic analyses of PU prevention interventions are undermined by factors including methodological challenges and poor inter-rater reliability of PU risk assessment tools. Healthcare demands on the NHS created by PU prevention remain unclear, although the burden is high, with litigation costs rising continuously. The poorly understood economics of PU prevention may create variation in practice. Patient expectations of PU prevention may be influenced by mainstream media, national awareness campaigns and the varied information and advice offered by professionals. Patient expectations and low levels of functional health literacy may create confusion and unrealistic expectations. This article critically examines the impact of recent changes in Government priorities related to PU prevention, considering the effects of healthcare demand, economics and patient expectations.

The impact of a suicide prevention awareness campaign on stigma, taboo and attitudes towards professional help-seeking

Background: In 2017, the European Alliance against Depression (EAAD) was introduced in The Netherlands through the creation of six Suicide Prevention Action Networks (SUPRANET Community). The intervention was launched with a national suicide prevention awareness campaign. This campaign aims to encourage the general public to talk about suicide. This study aimed to gain insight into the effectiveness of the campaign in achieving attitudinal change in the general public, as stigmas related to mental health disorders and -services are an important reason for insufficient help-seeking.Methods: A repeated cross-section design, using general population surveys (N = 6,773) to measure key variables over time. The survey includes questions on socio-demographic variables, campaign visibility, brand awareness of the Dutch helpline, perceived taboo on suicide, attitudes towards depression and help-seeking.Results: The public awareness campaign was predominantly visible among the younger generation. Respondents who indicated having seen the public awareness campaign showed more openness towards seeking professional help and were considerably more likely to be familiar with the Dutch helpline than those who reported not having seen the campaign. Campaign awareness also seemed to relate to a higher perceived taboo on suicide and a lower estimation of the value of professional help.Limitations: Due to the nature of the intervention, we used a quasi-experimental design. Self-report can lead to desirability bias, especially when measuring attitudes and stigmas.Conclusions: Our results strengthen the idea that awareness campaigns can make a contribution to informing the general public about mental health services and improving help-seeking behaviour.

Use of Social Media to Promote Cancer Screening and Early Diagnosis: Scoping Review.

BackgroundSocial media is commonly used in public health interventions to promote cancer screening and early diagnosis, as it can rapidly deliver targeted public health messages to large numbers of people. However, there is currently little understanding of the breadth of social media interventions and evaluations, whether they are effective, and how they might improve outcomes.ObjectiveThis scoping review aimed to map the evidence for social media interventions to improve cancer screening and early diagnosis, including their impact on behavior change and how they facilitate behavior change.MethodsFive databases and the grey literature were searched to identify qualitative and quantitative evaluations of social media interventions targeting cancer screening and early diagnosis. Two reviewers independently reviewed each abstract. Data extraction was carried out by one author and verified by a second author. Data on engagement was extracted using an adapted version of the key performance indicators and metrics related to social media use in health promotion. Insights, exposure, reach, and differing levels of engagement, including behavior change, were measured. The behavior change technique taxonomy was used to identify how interventions facilitated behavior change.ResultsOf the 23 publications and reports included, the majority (16/23, 70%) evaluated national cancer awareness campaigns (eg, breast cancer awareness month). Most interventions delivered information via Twitter (13/23, 57%), targeted breast cancer (12/23, 52%), and measured exposure, reach, and low- to medium-level user engagement, such as number of likes (9/23, 39%). There were fewer articles about colorectal and lung cancer than about breast and prostate cancer campaigns. One study found that interventions had less reach and engagement from ethnic minority groups. A small number of articles (5/23, 22%) suggested that some types of social media interventions might improve high-level engagement, such as intended and actual uptake of screening. Behavior change techniques, such as providing social support and emphasizing the consequences of cancer, were used to engage users. Many national campaigns delivered fundraising messages rather than actionable health messages.ConclusionsThe limited evidence suggests that social media interventions may improve cancer screening and early diagnosis. Use of evaluation frameworks for social media interventions could help researchers plan more robust evaluations that measure behavior change. We need a greater understanding of who engages with these interventions to know whether social media can be used to reduce some health inequalities in cancer screening and early diagnosis.International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2019-033592

Stillbirth in Australia 4: Breaking the Silence: Amplifying Public Awareness of Stillbirth in Australia

Prevention of stillbirth remains one of the greatest challenges in modern maternity care. Despite this, public awareness is low and silence is common within families, the community and even healthcare professionals. Australian families and parent advocacy groups given a voice through the Senate Enquiry have made passionate and articulate calls for a national stillbirth awareness campaign. This fourth paper in the Stillbirth in Australia series outlines why stillbirth needs a national public awareness campaign; and provides an overview of good practice in the design, development and evaluation of public awareness campaigns. The cognitive and affective steps required to move from campaign awareness to action and eventually to stillbirth prevention are described. Using these best practice principles, learning from previous campaigns combined with close collaboration with aligned agencies and initiatives should assist a National Stillbirth Prevention Campaign to increase community awareness of stillbirth, help break the silence and contribute to stillbirth prevention across Australia.

Bill introduced to support mental health for medical workers

A bipartisan bill introduced by U.S. Rep. Fred Upton (R‐Michigan) and six other representatives would create grant programs designed to support the mental health of health care workers. The Dr. Lorna Breen Health Care Provider Protection Act is aimed at preventing burnout, depression, suicide and other mental and behavioral health conditions among health care professionals, The Holland Sentinel reported Aug. 27. Lorna Breen was a physician in the Columbia University Vagelos College of Physician & Surgeons in New York City, which was among the hardest‐hit areas in the United States by the COVID‐19 pandemic. Breen committed suicide in April. The bill would create grant programs for training health profession students, residents or health care professionals in strategies to reduce and prevent suicide, burnout, mental health conditions and substance use disorders. It would also create grants for employee education, peer‐support programming and mental and behavioral health treatment; health care providers in current or former COVID‐19 hotspots will be prioritized. It would establish a national education and awareness campaign targeting health care professionals to encourage them to seek support and treatment for mental and behavioral health concerns.

Knowledge and attitudes of Lebanese women towards Baby Friendly Hospital Initiative practices.

The World Health Organization and United Nations Children's Fund launched the Baby Friendly Hospital Initiative (BFHI) to encourage best infant breastfeeding practices immediately after birth. In Lebanon, few hospitals are currently accredited as Baby Friendly. To assess the knowledge of Lebanese women of BFHI steps, and to explore their attitudes towards Baby Friendly Hospitals, Skin-to-Skin Contact and Kangaroo Care practices. A cross-sectional survey of a random sample of healthy pregnant women from Lebanon's six governorates. The mean (SD) age of the participants (N = 517) was 28.6 (4.7) years. Most participants were unfamiliar with the terms Baby Friendly hospital (93.7%), skin-to-skin contact or kangaroo care (75%), or were inadequately instructed on how to initiate (54.2%) or continue (46.2%) breastfeeding. However, when provided with information about the benefits of BFHI practices, most mothers (> 90%) stated that they would deliver in Baby Friendly hospitals. About 68.4% of mothers refused to give donor human milk to their sick premature infants because of religious beliefs. Knowledge of Baby Friendly hospitals was significantly associated with university education (p = 0.029), higher monthly income (p = 0.042), and previous experiences of skin-to-skin contact (p<0.001), rooming in (p = 0.037), or breastfeeding support (p = 0.036). There is a need for national awareness campaigns that address both the numerous advantages of the BFHI practices and Lebanese women's knowledge gaps about these practices. Such knowledge will help scale up the implementation of BFHI practices in hospitals in Lebanon, thus increasing breastfeeding rates and positively impacting the health of infants and mothers.

Knowledge, attitude and practice on antibiotic use and resistance among the Italian population, 2019

Abstract Background Public knowledge, awareness and behaviors related to antibiotic use and antimicrobial-resistance (AMR) are vital to ensure the prudent use of these drugs. In this work, we present the top-line results of the first national survey of AMR among the Italian general population aged ≥18 years. Methods From August to September 2019, we conducted a population-based cross-sectional random survey through mixed CATI/CAMI/CAWI methodologies among representative samples of the general population, parents of children aged 0-11 years, adults ≥65 years and pet's owners. Results were summarized using relative frequencies. Results Of 1,400 persons interviewed, 47% and 68% respectively correctly said that it is false that antibiotics kill viruses and are effective at treating colds and flu. More than 80% of respondents considered themselves to be well-informed about antibiotics but only one in two people knew what is meant by AMR. While the vast majority (96%) of respondents said that they obtained the last course of antibiotics that they used from a medical prescription, 11% incorrectly said that they stopped taking antibiotics when they felt better or that they used those left over from a previous course. In addition, 55% of pet's owners said they obtained antibiotics without a prescription from a pharmacy or elsewhere. Almost all respondents (97%) believed that it's everyone's responsibility to use antibiotics wisely, with the 80% who expressed concerns about the potential of AMR to affect themselves and their families; however, 40% did not think that action at an individual level is the most effective way of tackling resistance to antibiotics. Conclusions Our findings show some improvement in Italians' knowledge, awareness and behaviors related to antibiotic use and AMR but there are needs to be a greater sense of responsibility to take charge of the AMR problem. These results may be drivers of structured national awareness campaigns. Key messages In 2019, we conducted the first national survey of AMR among the Italian population: &amp;gt;80% of respondents felt themselves well-informed about antibiotics but only 1/2 people knew what is meant by AMR. Almost all Italian sample believed that it's everyone's responsibility to use antibiotics wisely, but 40% did not think that action at an individual level is effective to tackle AMR.

Is It Time for a National Awareness Campaign for Peripheral Arterial Disease (PAD)?

Objective: There exists a knowledge gap in awareness of peripheral arterial disease (PAD). This encompasses a lack of knowledge of symptoms associated with the disease as well as its risk factors. The aim of this study was to examine knowledge of PAD in patients attending a tertiary hospital.

Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0–18 years

ObjectiveAfter a previous survey on the incidence of diabetic ketoacidosis (DKA) at onset of type 1 diabetes in children in 2013–2014 in Italy, we aimed to verify a possible decline...

Raising standards for hospitality and tourism education in Malaysia

PurposeThe purpose of this paper is to present a briefing on milestones of Malaysia Centre of Tourism and Hospitality Education (MyCenTHE) regarding its role as a nation-building exercise in developing human capital talent for future sustainable hospitality and tourism in Malaysia. Under a national initiative by the ministry of education, hospitality and tourism educational institutes in the country have set out to better prepare graduates for industry. MyCenTHE aspires to build a hospitality and tourism cluster (threefold) so that Malaysia is able to increase its annual output of hospitality and tourism personnel from 20,000 in 2009 to 50,000 in 2020 and increase the share of graduates with diploma- or degree-level awards from 13% to 50% by 2020. These expectations can only be achieved by creating a sustainable pool of workers for this sector. It was in this context for which “MyCenTHE” was conceived.Design/methodology/approachThe current study is based on documentary analysis of secondary sources, qualitative in nature, and presents a case study of MyCenTHE with its key accomplishments in promoting hospitality and tourism education in Malaysia.FindingsThe hospitality and tourism industry in Malaysia is set to create 600,000 new job opportunities and in so doing, will need many more skilled, work-ready graduates in the coming decade. This paper highlights the collective efforts of the private higher education sector together with some selected public institutions (polytechnics) under the umbrella of the ministry of education through the MyCenTHE platform in promoting hospitality and tourism education nationwide via national awareness campaigns, conferences, skill competitions, seminars, forums and corporate social responsibility projects.Originality/valueThis paper is of value in its own context and in particular support from ministry and related authorities, 26 institutions of higher education working together, approaches to hundreds of local schools and thousands of audiences/participants in awareness campaigns.

International promotion of e-Bug, an infection prevention and control educational intervention: survey of partners across 14 countries.

BackgroundAntimicrobial resistance (AMR) is a global threat to public health. e-Bug is an educational resource developed and promoted by a network of international partners. e-Bug seeks to reduce the spread of infection and use of antimicrobials in young people and the community, so helping to control AMR. This study aimed to explore how e-Bug is promoted by international partners and observe barriers to promotion, including the extent of education about antibiotics in schools.MethodsA total of 29 e-Bug partners were invited to complete online questionnaires on (i) methods they use to promote e-Bug; and (ii) antibiotic topics covered in the national curriculum in their countries.ResultsFourteen and 15 of 29 e-Bug partners across Europe and Palestine completed the promotional activities and curriculum questionnaires respectively. The most frequently reported methods of promotion included endorsement and collaboration with government and non-government sectors and involvement in national and global health awareness campaigns. Barriers to promotion included a lack of time and funding. The curriculum survey data showed variation in antibiotic education across Europe and Palestine, lack of antibiotic education for children under 11 years of age and little change in antibiotic topics included in the curriculum since 2006.ConclusionsFuture and existing e-Bug partners should be encouraged to follow promotional activities reported in this paper, including ministry endorsement, educator training, international campaigns and youth programmes. We encourage all countries to increase antibiotic topics in the school curriculum across all ages.

The Perception of Coronary Artery Disease and Cardiac Catheterization in Saudi Arabia: “What the Public Know”

ObjectiveCoronary artery disease (CAD) constitutes a significant health hazard in middle-aged individuals in Saudi Arabia. We sought to assess the level of knowledge of cardiovascular risk factors and describe the perception of coronary intervention among the general population in the city of Jeddah in the western part of Saudi Arabia.MethodsA cross-sectional study was conducted in the city of Jeddah during the period from April 2019 to September 1, 2019, by using a structured online questionnaire to assess the participants’ awareness of risk factors for CAD and coronary intervention. The survey included questions about socio-demographic data, risk factors of cardiovascular diseases, symptoms of heart attack, knowledge of coronary catheterizations, as well as resources of knowledge about coronary heart disease.ResultsThe study included 984 participants. The majority of the participants had university diplomas (78.1%). Only 38.5 % were healthcare workers. Dyslipidemia and smoking were identified by 70.5% and 66.7%, respectively, as a recognized risk factor for CAD. Diabetes was mentioned by 32.1%. Participants without CAD risk factors had a significantly lower level of knowledge regarding the strong association between diabetes mellitus (DM) II and CAD (p-value=0.02). Healthcare professionals had a significantly lower level of knowledge regarding cardiac catheterization as compared to non-healthcare professionals. A higher percentage of healthcare professionals would agree to have cardiac catheterization if indicated (p-value=0.003). Awareness campaigns were the most common source of information for the public.ConclusionThe current level of knowledge of CAD in the western part of Saudi Arabia is fair. National awareness campaigns are required to improve the level of healthcare education.

Repeated Cross-Sectional Survey of Knowledge and Attitudes to Colorectal Cancer Screening in Lebanon

The continuous awareness campaigns about Colorectal Cancer (CRC) directed towards the Lebanese population in order to foster preventive medicine are on the rise. The impact has been positive and reported in previous research, although the number of victims is still high. This paper aims to perform a recent cross-sectional study of Lebanese residents’ CRC awareness by comparing the findings of two studies carried out in the years 2016 and 2018. The samples of the current study include 1140 (2016) and 993 (2018) participants who completed a simple structured questionnaire directed to assess their knowledge of colon cancer and the behavioral intentions of obtaining CRC screening. Upon comparing results, the percentage of those who know about CRC has increased significantly from 40.4% in 2016 to 78.7% in 2018, the proportion of respondents who believed that family history is the major risk factor for CRC did increase significantly from 47.7% in 2016 to 90.8% in 2018. Likewise, the proportions of respondents who believed that overweight, age, and stress are among the major risk factors for CRC increased from 26.9%, 26.7% and 11.3% in 2016 to 86.2%, 52.1% and 21.51% in 2018, respectively. On the other hand, the proportions for the risk factors related to alcohol and smoking have dropped from 37.7% and 37.3% to 27.4% and 24.2%, respectively. Moreover, the most important source of information for CRC was friends (18.4% in 2016 versus 73.8% in 2018), followed by family (18.7% in 2016 versus 56.7% in 2018), and then physicians (18.9% in 2016 and 40.2% in 2018). In fact, the efforts of the non-governmental organization (NGO) SAID (118 different major activities in the span of 3 years) did make a significant difference in what relates to CRC awareness among the Lebanese population. These findings are used to encourage and support other NGOs to adopt targeted new awareness campaigns which have proven successful, and to present evidence based on facts to government officials in the Ministry of Health to support and possibly sponsor national awareness campaigns and preventive efforts to mitigate CRC levels.

Correlates of HIV testing among men from the Democratic Republic of Congo: an analysis of the 2014 Demographic Health Survey

ABSTRACT Human immunodeficiency virus (HIV) testing is a cornerstone in preventing HIV infections and accessing treatment for HIV. However, HIV testing remains low among men in the Democratic Republic of Congo (DRC). The purpose of this study was to assess the correlates of HIV testing among men in the DRC. Data from the 2014 DRC Demographic Health Survey were analyzed to assess the relationships between HIV testing and the correlates of HIV testing among 7830 men aged 15–59 years. Although more than half (4763 or 63.7%) knew of an HIV testing site, only one-sixth (1187 or 16.6%) reported ever being tested for HIV. The multivariate logistic regression indicated that men aged between 25 and 34 years were more likely to have tested for HIV than those aged between 15 and 24 years (aOR = 1.70; 95% CI: [1.23–2.34]). In addition, men with college experience were 5.47 more likely to have tested for HIV than men with no formal education (aOR = 5.47; 95% CI: [2.53–11.84]). The results highlight the need for a national HIV testing awareness and uptake campaign for Congolese men to increase HIV testing among this group and prevent HIV infections.

Evaluation of a national lung cancer symptom awareness campaign in Wales

BackgroundLung cancer is the leading cause of cancer mortality in Wales. We conducted a before- and after- study to evaluate the impact of a four-week mass-media campaign on awareness, presentation behaviour and lung cancer outcomes.MethodsPopulation-representative samples were surveyed for cough symptom recall/recognition and worry about wasting doctors’ time pre-campaign (June 2016; n = 1001) and post-campaign (September 2016; n = 1013). GP cough symptom visits, urgent suspected cancer (USC) referrals, GP-ordered radiology, new lung cancer diagnoses and stage at diagnosis were compared using routine data during the campaign (July–August 2016) and corresponding control (July–August 2015) periods.ResultsIncreased cough symptom recall (p < 0.001), recognition (p < 0.001) and decreased worry (p < 0.001) were observed. GP visits for cough increased by 29% in the target 50+ age-group during the campaign (p < 0.001) and GP-ordered chest X-rays increased by 23% (p < 0.001). There was no statistically significant change in USC referrals (p = 0.82), new (p = 0.70) or early stage (p = 0.27) diagnoses, or in routes to diagnosis.ConclusionsSymptom awareness, presentation and GP-ordered chest X-rays increased during the campaign but did not translate into increased USC referrals or clinical outcomes changes. Short campaign duration and follow-up, and the small number of new lung cancer cases observed may have hampered detection effects.

Frequency of Breast feeding among working women of Multan.

Objectives: To determine the frequency of exclusive breast feeding among working women of Multan and to identify associations between socio demographic factors and exclusive breast feeding. Study Design: Descriptive cross sectional study. Setting: Public and private organizations of Multan city. Period: From 22-07-2017 to 25-05-2018. Material &amp; Methods: The total 227 working women were enrolled by nonprobability purposive sampling technique. Data was collected on a predefined questionnaire. Results pertaining to rates were reported as frequencies and percentages. Post stratification Pearson chi square test was applied to identify significance of associations between socio demographic factors of working women and exclusive breast feeding. Result: Mean age of our study cases was 28.24 ± 9.01. The frequency of exclusive breast feeding was noted as 44.5%. Post stratification Pearson chi square test revealed statistically significant associations between of certain socio demographic factors and exclusive breast feeding. Working women of younger than 30 years of age, urdu speaking ethnicity, banker by profession, living in nuclear family, more than 36 hours of work in a week, more than three children and shorter than two years of inter pregnancy interval were less likely to practice exclusive breast feeding. Conclusion: The frequency of exclusive breast feeding was below the rate of exclusive breast feeding in the general population of Pakistan as well as below those recommended by World Health Organization (WHO). Evaluations of national health policy and awareness campaigns are needed to increase the rate of exclusive breast feeding in working women.

The impact of a national public awareness campaign on dementia knowledge and help-seeking in Ireland

Abstract Background Dementia is a growing public health issue in Ireland primarily due to the ageing population. Increasing public knowledge of dementia has been identified as a key priority to reduce disease burden. This study evaluated the impact of a dementia communication campaign on dementia knowledge and help-seeking intention among the general public in Ireland. Methods In 2016, a nationally-representative sample of over 1,200 adults in Ireland was surveyed to inform a nationwide dementia awareness campaign entitled Understand Together. Multiple factors were examined including sociodemographic characteristics, dementia advertising awareness, dementia knowledge and help-seeking intention. A similar survey (N = 1,003) was conducted in 2018 to evaluate public awareness of the campaign and its association with dementia knowledge and help-seeking intention. Data from the 2016 and 2018 surveys were analysed using univariable analysis and logistic regression, adjusted for sociodemographics. Results Awareness of dementia advertising increased from 17% (2016) to 32% (2018) (p &amp;lt; 0.001). Women (OR 1.51, 95%CI 1.14-2.00), rural residents (OR 1.48, 95%CI 1.10-2.00), respondents aged 40-59 years (OR 1.96, 95%CI 1.40-2.74) or 60+ years (OR 2.18, 95%CI 1.47-3.22), and those who knew someone with dementia (OR 2.06, 95%CI 1.55-2.75) were more likely to be aware of the campaign. Very good or good dementia knowledge and awareness that dementia risk is modifiable increased from 24% to 33% (p &amp;lt; 0.05) and 46% to 52% (p &amp;lt; 0.05), respectively. There was a linear association between campaign awareness and both help-seeking (OR 1.81, 95%CI 1.36-2.40) and holding a positive view of the potential benefits of early diagnosis (OR 1.97, 95%CI 1.35-2.88). Conclusions The ongoing campaign, as well as future communication strategies, should continue to focus on increasing awareness of modifiable risk to support prevention. Campaign messaging/modalities should be targeted at harder to reach population groups. Key messages Public communication on dementia can improve knowledge and help-seeking. Health communication campaign evaluation can identify, and inform the targeting of, hard to reach population groups.

Causes of distraction leading to supervision lapses in cases of fatal drowning of children 0–4 years in Australia: A 15‐year review

Supervision is a strategy for preventing drowning among children. However, supervision lapses continue to be a contributory factor in child drowning. This study aims to identify, describe and analyse the causes of distraction leading to lapses in supervision in child drowning. A total population survey of all fatal unintentional drownings among children aged 0-4 years between 1 July 2002 and 30 June 2017 was undertaken using data from the Australian National Coronial Information System. Among closed coronial cases, causes of distraction leading to lapses in supervision were collected as free text from closed case documentation and subsequently thematically grouped into categories. Univariate and χ2 analysis was undertaken (P < 0.01). A total of 447 children drowned during the study period (62.0% male; 66.9% aged 1-2 years; 53.3% swimming pools; 79.4% falls into water). Of the 426 (95.3%) closed cases, common supervision lapses were due to indoor household duties (27.6%), outdoor household duties (12.6%) and talking/socialising (11.9%). This study has identified common scenarios for distractions leading to supervision lapses including the link between indoor household duties and bathtub drowning deaths and talking/socialising for deaths in swimming pools and at rivers. Challenges include medical issues impacting sole carers. The 7% of cases where a supervision lapse occurred due to miscommunication are opportunities to further reinforce the need for a designated supervisor, particularly with two or more adults present. Study findings on distraction causes, and strategies to minimise them, should be incorporated into national public awareness campaigns aimed at parents and care givers of this at-risk group.

A cross-sectional study of the public health response to non-alcoholic fatty liver disease in Europe

Non-alcoholic fatty liver disease (NAFLD) is a growing public health problem worldwide and has become an important field of biomedical inquiry. We aimed to determine whether European countries have mounted an adequate public health response to NAFLD and non-alcoholic steatohepatitis (NASH). In 2018 and 2019, NAFLD experts in 29 European countries completed an English-language survey on policies, guidelines, awareness, monitoring, diagnosis and clinical assessment in their country. The data were compiled, quality checked against existing official documents and reported descriptively. None of the 29 participating countries had written strategies or action plans for NAFLD. Two countries (7%) had mentions of NAFLD or NASH in related existing strategies (obesity and alcohol). Ten (34%) reported having national clinical guidelines specifically addressing NAFLD and, upon diagnosis, all included recommendations for the assessment of diabetes and liver cirrhosis. Eleven countries (38%) recommended screening for NAFLD in all patients with either diabetes, obesity and/or metabolic syndrome. Five countries (17%) had referral algorithms for follow-up and specialist referral in primary care, and 7 (24%) reported structured lifestyle programmes aimed at NAFLD. Seven (24%) had funded awareness campaigns that specifically included prevention of liver disease. Four countries (14%) reported having civil society groups which address NAFLD and 3 countries (10%) had national registries that include NAFLD. We found that a comprehensive public health response to NAFLD is lacking in the surveyed European countries. This includes policy in the form of a strategy, clinical guidelines, awareness campaigns, civil society involvement, and health systems organisation, including registries. We conducted a survey on non-alcoholic fatty liver disease with experts in European countries, coupled with data extracted from official documents on policies, clinical guidelines, awareness, and monitoring. We found a general lack of national policies, awareness campaigns and civil society involvement, and few epidemiological registries.