Effectiveness of food environment policies in improving population diets: a review of systematic reviews.

Unhealthy population diets contribute to the burden of non-communicable diseases. Policies targeting food environments (FE policies) may improve population diets. This review of systematic reviews aims to summarise recent evidence of the effectiveness of FE policies in improving diets. We searched PubMed for systematic reviews published from January 2010 onwards. Eligible FE policies included: nutrition and food labelling, provision of foods in public institutions or specific settings, price, marketing, nutrition quality and portion size, and availability of foods in retail and food service establishments. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) instrument was used to assess review quality. Reviews of critically low quality were excluded. Results were narratively reported in text and tables. The search identified 1102 records after removing duplicates. Following screening and quality assessment we included 12 systematic reviews. Two reviews focused on nutrition and food labelling, two on provision of foods in school settings, four on price, none on marketing policies, three on nutrition quality and portion size and one on the availability of foods in retail and food service establishments. Pricing policies (tax/subsidy) appear effective in altering intake and purchase of targeted foods and beverages. FE policies targeting the availability of foods in retail and food establishments, food provision in school settings, product reformulation and the size of portions/packages or items of tableware also appear effective. Overall, policies targeting food environments appear effective in improving population diets. However, there is a need for further high-quality evidence.

Searching Online for Methods of Suicide.

Background: Information on methods of suicide is available online, and access to information on methods of suicide appears to contribute to a small but significant proportion of suicides. There is limited documentation of how methods of suicide are being profiled, as well as what content exists in other languages than English. Aim: We aimed to analyze and compare how methods of suicide are profiled on Danish and English-language websites. Method: We applied a categorization and content analysis of websites describing methods of suicide. Sites were retrieved by applying widely used Danish and English-language search terms. Results: A total of 136 English-language websites and 106 Danish-language websites were included for analysis. Websites were more often categorized as prevention or support sites, academic or policy sites, and against suicide sites than dedicated suicide sites (i.e., pro-suicide sites), or information sites. However, information on methods of suicide was available, and 20.1% and 8.9% of the English and Danish-language sites, respectively, suggested that a particular method of suicide was quick, easy, painless, or certain to result in death. Limitations: Only one author coded and analyzed all websites. A further operationalization of the content analysis checklist is warranted to increase reliability. Conclusion: The websites primarily had a prevention or anti-suicide focus, but information on methods of suicide was available, requiring an increased focus on how to diminish the negative effects of harmful online content.

What is the effectiveness of systematic population-level screening programmes for reducing the burden of cardiovascular diseases?

Cardiovascular diseases (CVDs) remain the main cause of death in the WHO European Region. This systematic literature review assesses whether systematic screening programmes for CVD risk factors and preclinical CVDs across general populations can lower the CVD burden in society. Based on several high-quality randomized controlled trials with large numbers of participants, the results clearly showed that screening for CVD risk factors has no effect on lowering CVD morbidity and mortality in society. Studies showed that screening for preclinical CVDs slightly reduces mortality and negative outcomes related to abdominal aortic aneurysm; however, these results may be outdated, as smoking has declined and treatment has improved since the studies were completed. Results on screening for atrial fibrillation and other preclinical CVDs have not yet been published. In summary, the current evidence indicates that screening for CVD risk factors does not reduce the CVD burden.

Medication-related experiences of patients with polypharmacy: a systematic review of qualitative studies.

BACKGROUND: We aimed to synthesise qualitative studies exploring medication-related experiences of polypharmacy among patients with multimorbidity. METHODS: We systematically searched PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature in February 2020 for primary, peer-reviewed qualitative studies about multimorbid patients' medication-related experiences with polypharmacy, defined as the use of four or more medications. Identified studies were appraised for methodological quality by applying the Critical Appraisal Skills Programme checklist for qualitative research, and data were extracted and synthesised by the meta-aggregation approach. RESULTS: We included 13 qualitative studies, representing 499 patients with polypharmacy and a wide range of chronic conditions. Overall, most Critical Appraisal Skills Programme items were reported in the studies. We extracted 140 findings, synthesised these into 17 categories, and developed five interrelated syntheses: (1) patients with polypharmacy are a heterogeneous group in terms of needing and appraising medication information; (2) patients are aware of the importance of medication adherence, but it is difficult to achieve; (3) decision-making about medications is complex; (4) multiple relational factors affect communication between patients and physicians, and these factors can prevent patients from disclosing important information; and (5) polypharmacy affects patients' lives and self-perception, and challenges with polypharmacy are not limited to practical issues of medication-taking. DISCUSSION: Polypharmacy poses many challenges to patients, which have a negative impact on quality of life and adherence. Thus, when dealing with polypharmacy patients, it is crucial that healthcare professionals actively solicit individual patients' perspectives on challenges related to polypharmacy. Based on the reported experiences, we recommend that healthcare professionals upscale communicative efforts and involve patients' social network on an individualised basis to facilitate shared decision-making and treatment adherence in multimorbidpatients with polypharmacy.

What is the effectiveness of systematic population-level screening programmes for reducing the burden of cardiovascular disease? Summary

Cardiovascular diseases (CVDs) remain the main cause of death in the WHO European Region. This systematic literature review assesses whether systematic screening programmes for CVD risk factors and preclinical CVDs across general populations can lower the CVD burden in society. Based on several high-quality randomized controlled trials with large numbers of participants, the results clearly showed that screening for CVD risk factors has no effect on lowering CVD morbidity and mortality in society. Studies showed that screening for preclinical CVDs slightly reduces mortality and negative outcomes related to abdominal aortic aneurysm; however, these results may be outdated, as smoking has declined and treatment has improved since the studies were completed. Results on screening for atrial fibrillation and other preclinical CVDs have not yet been published. In summary, the current evidence indicates that screening for CVD risk factors does not reduce the CVD burden.