Psychometric properties of the health literacy instrument in Brazil (HLS-EU-BR47).

BACKGROUND: Health literacy (HL) is a key component of health promotion and sustainability and contributes to well-being. Despite its global relevance, HL is an under-researched topic in South America but is now debuting its exploration in Brazil. To leverage its benefits for South America, the mere translation of validated tools into Portuguese is insufficient. Rather, it is necessary to examine their validity. This study aims to assess the psychometric properties of the European Health Literacy Questionnaire (HLS-EU-BR47) using the Item Response Theory (IRT) in a population-based sample of adults in Brazil. METHODS: A cross-sectional online study was conducted across Brazil and included 1028 participants aged 18 years and above (80% women). Cronbach's alpha, McDonald's omega, factor analysis, graded responses model, Item Characteristic Curve, HL levels based on this, HL standard calculation, IRT, and regular score correlation were computed. RESULTS: The instrument exhibit high reliability (Cronbach's alpha 0.95). Factor analysis yielded one factor. IRT was appropriate for data analysis because it allowed quality evaluation of items and constructed a scale to quantify HL. The 47 items and latent features of respondents in the same unit of measurement are positioned in the construction of the HLS-EU-BR47 instrument. The percentages of individuals at each HL level, calculated using IRT, were found to be comparable to those obtained through the standard computation, e.g., 3.2% of people reported very low HL versus 10.8% inadequate HL, 56.2% reported low HL versus 39.5% problematic HL, 31.1% had moderate HL versus 30.1% sufficient HL, and 9.5% had high HL versus 19.7% with excellent HL. The mean HL scores were comparable between women and men (33.9 vs. 33.7, P = 0.36). CONCLUSION: This study provides new evidence of the validity of a widely used HL instrument for the population of South America (in this case, Brazil). This tool can be utilized by citizens, health professionals, and regional/national policymakers to inform the development of initiatives to assess and improve the HL of individuals, groups, and communities. Further studies are needed to confirm and extend the findings and to explore the influence of local cultures and practices in the vast Brazilian territory on HL.

Promoção de saúde e qualidade de vida dos universitários em tempos de pandemia: a experiência de um curso de extensão

Objetivos: Este artigo apresenta o relato da experiência do curso/workshop RENASCERES®: saúde e qualidade de vida dos universitários em tempos de pandemia", realizado em uma universidade federal no Estado de Minas Gerais (MG), que teve o objetivo de criar espaço de diálogo, acolhimento, escuta e de construção de alternativas mediante demandas discentes, decorrentes do período de pandemia de COVID-19. Objetivou também fomentar propostas para a ampliação das condições de saúde e da qualidade de vida dos universitários e de suas famílias. Métodos: O curso foi estruturado em cinco encontros virtuais, com formato de workshop, fundamentados na metodologia dialógica e no método de Círculo de Cultura, articulando o conteúdo teórico aliado às atividades práticas e ao cotidiano dos participantes. Resultados: Participaram do curso 77 pessoas, incluindo universitários de diferentes cursos de graduação e profissionais. As reflexões sobre saúde e qualidade de vida e o atual contexto de pandemia, bem como as atividades práticas, geraram espaço de acolhimento, escuta-ativa, cuidado, acesso e troca de informações/novos conhecimentos. Conclusões: O curso/workshop possibilitou o reconhecimento da necessidade de investimentos em Promoção de saúde e qualidade de vida pelos participantes. Constatou-se, nesta atividade, a essencialidade do Método RENASCERES® como alternativa para dar suporte aos participantes nos cuidados em saúde, mudanças em suas rotinas e pilar para que as pessoas possam alcançar estilos de vida saudáveis.Palavras-chave: Educação para a saúde; Promoção da saúde; Qualidade de vida; Covid-19; Saúde Coletiva; Comunicação em saúde.

Literacia para a saúde para o uso da internet por profissionais de serviços hospitalares / Health literacy for internet use by hospital professionals / Alfabetización en salud para uso de internet por parte de profesionales del hospital

Objetivo: Conhecer o nível de literacia para a saúde dos profissionais para uso da internet na obtenção de informações apropriadas de saúde. Métodos: Estudo transversal de abordagem metodológica quantitativa, realizado com trabalhadores dos setores de Pronto Socorro Adulto e Infantil de um hospital público de ensino. Os dados foram coletados entre outubro e dezembro de 2017, utilizando questionário European Health Literacy Scale sobre Literacia para a saúde traduzido e em validação para o contexto brasileiro. Resultados: Os participantes expressaram usar a internet para buscar informações para questões relacionadas à saúde, julgaram ser um meio útil para ajudá-los a tomar decisões sobre sua saúde, porém, ao acessarem tais fontes de informação se sentem inseguros com a credibilidade das mesmas. Conclusão: Conclui-se que os participantes acessam e utilizam as informações de saúde para tomarem decisão nesta área. Os profissionais de saúde com maior grau de escolaridade possuem maior facilidade de acesso e utilização dos recursos da internet o que contribui para altos níveis de literacia para a saúde via internet. (AU)

Objective: Recognize the level of health literacy of professionals to use the internet to obtain appropriate health information. Methods: Cross-sectional study with a quantitative methodological approach, carried out with workers from the Adult and Child Care sectors of a public teaching hospital. Data were collected between October and December 2017, using the European Health Literacy Scale questionnaire on Health Literacy translated and validating for the Brazilian context. Results: The participants expressed using the internet to seek information for health-related issues, they thought it was a useful way to help them make decisions about their health, however, when accessing such sources of information they feel insecure with their credibility. Conclusion: It is concluded that the participants access and use health information to make decisions in this area. Health professionals with a higher level of education have easier access to and use of Internet resources, which contributes to high levels of health literacy via the Internet. (AU)

Objetivo: Conocer el nivel de alfabetización en salud de los profesionales para usar Internet para obtener información de salud adecuada. Métodos: Estudio transversal con un enfoque metodológico cuantitativo, realizado con trabajadores de los sectores de Cuidado de Adultos y Niños de un hospital público docente. Los datos se recopilaron entre octubre y diciembre de 2017, utilizando el cuestionario de la Escala Europea de Alfabetización en Salud sobre Alfabetización en Salud traducido y validado para el contexto brasileño. Resultados: Los participantes expresaron el uso de Internet para buscar información sobre temas relacionados con la salud, pensaron que era una forma útil de ayudarlos a tomar decisiones sobre su salud, sin embargo, al acceder a esas fuentes de información se sienten inseguros con su credibilidad. Conclusión: Se concluye que los participantes acceden y usan la información de salud para tomar decisiones en esta área. Los profesionales de la salud con un mayor nivel de educación tienen un acceso y un uso más fáciles de los recursos de Internet, lo que contribuye a altos niveles de alfabetización en salud a través de Internet. (AU)

[Assessment of health literacy in diabetic patients followed at a public outpatient clinic]. / Avaliação da literacia para a saúde de pacientes portadores de diabetes acompanhados em um ambulatório público.

Health literacy (HL) assumes individuals' knowledge, motivation, and competencies to access, understand, evaluate, and apply health information to make judgments and decisions in daily life, related to healthcare, prevention of diseases, and health promotion to maintain or improve quality of life. The study aimed to measure the level of HL and associated factors: sex, age, schooling, income, skin color, self-rated health status, type of diabetes, and presence of comorbidities. The authors assessed 107 adults with diabetes followed at a public outpatient clinic in the city of Rio de Janeiro, Brazil. The sample did not include first-time patients, patients without a diagnosis of diabetes, or with visual or hearing impairment. HL was assessed with the Brazilian version of the European Health Literacy Survey (HLS-EU-BR). Simple and multiple ordinal logistic regression models were constructed, considering four levels of HL as the dependent variables. The associations were expressed as odds ratios (OR). Approximately 95% of the sample showed poor or limited HL (94.8%; 95%CI: 90.3-99.3). Female gender, older age, and lower schooling were associated with lower odds of excellent HL. In the adjusted model, only schooling remained statistically significant in its effect on HL (adjusted OR = 0.41; 95%CI: 0.17-0.98; p < 0.05). Schooling was the characteristic most strongly related to level of HL.

Literacia para a saúde (LS), ou literacia em saúde, pressupõe o conhecimento, a motivação e as competências dos indivíduos para acessarem, compreenderem, avaliarem e aplicarem as informações sobre saúde, a fim de fazer julgamentos e tomar decisões na vida diária, relacionadas aos cuidados de saúde, à prevenção de doenças e à promoção de saúde, para manter ou melhorar a sua qualidade de vida. O objetivo foi medir o nível de LS e seus fatores associados: sexo, idade, escolaridade, renda, cor da pele, autoavaliação do estado de saúde, tipo de diabetes e presença de comorbidades. Foram avaliados 107 adultos portadores de diabetes acompanhados em um ambulatório público, na cidade do Rio de Janeiro, Brasil. Não foram incluídos pacientes de primeira vez, pacientes sem diagnóstico de diabetes ou com limitações de visão ou audição. A LS foi avaliada pela versão brasileira do questionário European Health Literacy Survey (HLS-EU-BR). Modelos de regressão logística ordinal simples e múltiplos foram construídos, considerando-se, como variável dependente, os quatro níveis de LS. As associações foram expressas na forma de odds ratio (OR). Cerca de 95% da amostra apresentou nível de LS ruim ou limitado (94,8%; IC95%: 90,3-99,3). Sexo feminino, idades mais avançadas e menor escolaridade estiveram associados a uma menor chance de ter um nível de LS excelente. No modelo ajustado, apenas a variável escolaridade permaneceu estatisticamente significativa em relação ao seu efeito sobre a LS (OR ajustado = 0,41; IC95%: 0,17-0,98; p < 0,05). Escolaridade foi a característica que esteve mais fortemente relacionada ao nível de LS.

La alfabetización en salud (AS), o cultura en salud, presupone el conocimiento, la motivación y las competencias de los individuos para que accedan, comprendan, evalúen y apliquen información sobre salud, con el fin de realizar juicios y tomar decisiones en la vida diaria, relacionadas con los cuidados de salud, prevención de enfermedades, y con la promoción de salud, para mantener o mejorar su calidad de vida. El objetivo fue medir el nivel de AS y sus factores asociados: sexo, edad, escolaridad, renta, color de piel, autoevaluación del estado de salud, tipo de diabetes y presencia de comorbilidades. Se evaluaron a 107 adultos pacientes diabéticos, a quienes se les realizó un seguimiento en un ambulatorio público, en la ciudad de Río de Janeiro, Brasil. No se incluyeron pacientes que fueron la primera vez, pacientes sin diagnóstico de diabetes o con limitaciones visuales o auditivas. La AS se evaluó mediante la versión brasileña del cuestionario European Health Literacy Survey (HLS-EU-BR). Se construyeron modelos de regresión logística ordinal simple y múltiple, considerándose como variable dependiente los cuatro niveles de AS. Las asociaciones se expresaron en forma de odds ratio (OR). Cerca de un 95% de la muestra presentó un nivel de AS malo o limitado (94,8%; IC95%: 90,3-99,3). Sexo femenino, edades más avanzadas, y menor escolaridad estuvieron asociados con una menor oportunidad de tener un nivel de AS excelente. En el modelo ajustado, solamente la variable escolaridad fue estadísticamente significativa, en relación con su efecto sobre la AS (OR ajustado = 0,41; IC95%: 0,17-0,98; p < 0,05). La escolaridad fue la característica que estuvo más fuertemente relacionada con el nivel de AS.

Health Literacy and Health Behavior Among Women in Ghazni, Afghanistan.

Background: Health literacy is a determinant of health and assessed globally to inform the development of health interventions. However, little is known about health literacy in countries with one of the poorest health indicators worldwide, such as Afghanistan. Studies worldwide demonstrate that women play a key role in developing health literacy. Hence, this study's purpose is to explore health literacy of women in Afghanistan and the associated factors. Methods: From May to June 2017, we randomly recruited 7-10 women per day at the hospital in Ghazni, a representative province of Afghanistan. Two trained female interviewers interviewed 322 women (15-61 years old) orally in Dari or Pashto on a voluntary basis and assessed their health literacy using the HLS-EU-Q16, associated socio-demographics, and health behavior. Results: Health literacy of women (among educated and illiterates) is low even compared to other Asian countries. Health literacy is linked to age and education. We found mixed evidence of the relationship between health literacy and contextual factors, help-seeking, and health-related behavior. Conclusion: This study provides novel data on health literacy and astonishing insights into its association with health behavior of women in Afghanistan, thus contributing to health status. The study calls for recognition of health literacy as a public health challenge be addressed in Afghanistan and other low-income countries affected by crises.

Health promotion preparedness for health crises - a 'must' or 'nice to have'? Case studies and global lessons learned from the COVID-19 pandemic.

The current COVID-19 pandemic has exposed missing links between health promotion and national/global health emergency policies. In response, health promotion initiatives were urgently developed and applied around the world. A selection of case studies from five countries, based on the Socio-Ecological Model of Health Promotion, exemplify 'real-world' action and challenges for health promotion intervention, research, and policy during the COVID-19 pandemic. Interventions range from a focus on individuals/families, organizations, communities and in healthcare, public health, education and media systems, health-promoting settings, and policy. Lessons learned highlight the need for emphasizing equity, trust, systems approach, and sustained action in future health promotion preparedness strategies. Challenges and opportunities are highlighted regarding the need for rapid response, clear communication based on health literacy, and collaboration across countries, disciplines, and health and education systems for meaningful solutions to global health crises.

The relationship of health literacy, wellbeing and religious beliefs in neglected and unequal contexts-Results of a survey study in central Afghanistan.

ISSUE ADDRESSED: While multiple studies worldwide reveal the strong impact of various determinants on health literacy, empirical data on the link between health literacy and other important dimensions of health equity (such as quality of life, beliefs and health literacy in crisis-affected religious countries such as Afghanistan) is scarce. To inform and develop promising health promotion for people in need, we analysed the relationship between health literacy, quality of life and spiritual and religious beliefs. METHODS: In this first study on health literacy in Afghanistan, we interviewed 522 men and 324 women in the Ghazni province. Besides the HLS-EU-16, we used Quality of Life (WHO-QoL-BREF) and the WHO-SRPB-BREF questionnaires in Dari and Pashto. We performed descriptive, uni- and multivariate analyses. RESULTS: The levels of HL, QoL and SRPB_coping are comparatively low among Afghan men from the Ghazni province, but higher among women on all scales. HL and QoL are positively associated with education and negatively with age (in the female subsample). HL and QoL show a moderate correlation among women but not among men. We found mixed results for the relationship between SRPB and HL or QoL. CONCLUSIONS: The study highlights that health literacy is not a singular factor but related to wellbeing. SO WHAT?: Health education might be promising while combining health literacy to the idea of quality of life of everyone, even those living in poor and illiterate environments.

Avaliação da literacia para a saúde de pacientes portadores de diabetes acompanhados em um ambulatório público / Assessment of health literacy in diabetic patients followed at a public outpatient clinic / Evaluación de la alfabetización en salud con pacientes diabéticos, cuyo seguimiento se realiza en un ambulatorio público

Resumo: Literacia para a saúde (LS), ou literacia em saúde, pressupõe o conhecimento, a motivação e as competências dos indivíduos para acessarem, compreenderem, avaliarem e aplicarem as informações sobre saúde, a fim de fazer julgamentos e tomar decisões na vida diária, relacionadas aos cuidados de saúde, à prevenção de doenças e à promoção de saúde, para manter ou melhorar a sua qualidade de vida. O objetivo foi medir o nível de LS e seus fatores associados: sexo, idade, escolaridade, renda, cor da pele, autoavaliação do estado de saúde, tipo de diabetes e presença de comorbidades. Foram avaliados 107 adultos portadores de diabetes acompanhados em um ambulatório público, na cidade do Rio de Janeiro, Brasil. Não foram incluídos pacientes de primeira vez, pacientes sem diagnóstico de diabetes ou com limitações de visão ou audição. A LS foi avaliada pela versão brasileira do questionário European Health Literacy Survey (HLS-EU-BR). Modelos de regressão logística ordinal simples e múltiplos foram construídos, considerando-se, como variável dependente, os quatro níveis de LS. As associações foram expressas na forma de odds ratio (OR). Cerca de 95% da amostra apresentou nível de LS ruim ou limitado (94,8%; IC95%: 90,3-99,3). Sexo feminino, idades mais avançadas e menor escolaridade estiveram associados a uma menor chance de ter um nível de LS excelente. No modelo ajustado, apenas a variável escolaridade permaneceu estatisticamente significativa em relação ao seu efeito sobre a LS (OR ajustado = 0,41; IC95%: 0,17-0,98; p < 0,05). Escolaridade foi a característica que esteve mais fortemente relacionada ao nível de LS.

Abstract: Health literacy (HL) assumes individuals' knowledge, motivation, and competencies to access, understand, evaluate, and apply health information to make judgments and decisions in daily life, related to healthcare, prevention of diseases, and health promotion to maintain or improve quality of life. The study aimed to measure the level of HL and associated factors: sex, age, schooling, income, skin color, self-rated health status, type of diabetes, and presence of comorbidities. The authors assessed 107 adults with diabetes followed at a public outpatient clinic in the city of Rio de Janeiro, Brazil. The sample did not include first-time patients, patients without a diagnosis of diabetes, or with visual or hearing impairment. HL was assessed with the Brazilian version of the European Health Literacy Survey (HLS-EU-BR). Simple and multiple ordinal logistic regression models were constructed, considering four levels of HL as the dependent variables. The associations were expressed as odds ratios (OR). Approximately 95% of the sample showed poor or limited HL (94.8%; 95%CI: 90.3-99.3). Female gender, older age, and lower schooling were associated with lower odds of excellent HL. In the adjusted model, only schooling remained statistically significant in its effect on HL (adjusted OR = 0.41; 95%CI: 0.17-0.98; p < 0.05). Schooling was the characteristic most strongly related to level of HL.

Resumen: La alfabetización en salud (AS), o cultura en salud, presupone el conocimiento, la motivación y las competencias de los individuos para que accedan, comprendan, evalúen y apliquen información sobre salud, con el fin de realizar juicios y tomar decisiones en la vida diaria, relacionadas con los cuidados de salud, prevención de enfermedades, y con la promoción de salud, para mantener o mejorar su calidad de vida. El objetivo fue medir el nivel de AS y sus factores asociados: sexo, edad, escolaridad, renta, color de piel, autoevaluación del estado de salud, tipo de diabetes y presencia de comorbilidades. Se evaluaron a 107 adultos pacientes diabéticos, a quienes se les realizó un seguimiento en un ambulatorio público, en la ciudad de Río de Janeiro, Brasil. No se incluyeron pacientes que fueron la primera vez, pacientes sin diagnóstico de diabetes o con limitaciones visuales o auditivas. La AS se evaluó mediante la versión brasileña del cuestionario European Health Literacy Survey (HLS-EU-BR). Se construyeron modelos de regresión logística ordinal simple y múltiple, considerándose como variable dependiente los cuatro niveles de AS. Las asociaciones se expresaron en forma de odds ratio (OR). Cerca de un 95% de la muestra presentó un nivel de AS malo o limitado (94,8%; IC95%: 90,3-99,3). Sexo femenino, edades más avanzadas, y menor escolaridad estuvieron asociados con una menor oportunidad de tener un nivel de AS excelente. En el modelo ajustado, solamente la variable escolaridad fue estadísticamente significativa, en relación con su efecto sobre la AS (OR ajustado = 0,41; IC95%: 0,17-0,98; p < 0,05). La escolaridad fue la característica que estuvo más fuertemente relacionada con el nivel de AS.

Health-related Sustainable Development Goals: countdown on alcohol use, smoking prevalence, child overweight and suicide mortality.

The Sustainable Development Goals (SDGs) are a set of goals that aspire to 'leave no one behind', adopted by all members of the United Nations and to be achieved by 2030. Now, four years after the SDGs entered into force, we examine the progress towards the health-related SDGs in the European region. In this region, least progress is made towards the targets set for alcohol consumption, smoking prevalence, child overweight, and suicide mortality. For each of these challenges we take stock of current policies, continuing challenges, and ways forward. Written from the perspective of European Public Health Association (EUPHA) we emphasize the potential contribution of civil society organizations in attaining the health-related SDGs.

Generic health literacy measurement instruments for children and adolescents: a systematic review of the literature.

BACKGROUND: Health literacy is an important health promotion concern and recently children and adolescents have been the focus of increased academic attention. To assess the health literacy of this population, researchers have been focussing on developing instruments to measure their health literacy. Compared to the wider availability of instruments for adults, only a few tools are known for younger age groups. The objective of this study is to systematically review the field of generic child and adolescent health literacy measurement instruments that are currently available. METHOD: A systematic literature search was undertaken in five databases (PubMed, CINAHL, PsycNET, ERIC, and FIS) on articles published between January 1990 and July 2015, addressing children and adolescents ≤18 years old. Eligible articles were analysed, data was extracted, and synthesised according to review objectives. RESULTS: Fifteen generic health literacy measurement instruments for children and adolescents were identified. All, except two, are self-administered instruments. Seven are objective measures (performance-based tests), seven are subjective measures (self-reporting), and one uses a mixed-method measurement. Most instruments applied a broad and multidimensional understanding of health literacy. The instruments were developed in eight different countries, with most tools originating in the United States (n = 6). Among the instruments, 31 different components related to health literacy were identified. Accordingly, the studies exhibit a variety of implicit or explicit conceptual and operational definitions, and most instruments have been used in schools and other educational contexts. While the youngest age group studied was 7-year-old children within a parent-child study, there is only one instrument specifically designed for primary school children and none for early years. CONCLUSIONS: Despite the reported paucity of health literacy research involving children and adolescents, an unexpected number of health literacy measurement studies in children's populations was found. Most instruments tend to measure their own specific understanding of health literacy and not all provide sufficient conceptual information. To advance health literacy instruments, a much more standardised approach is necessary including improved reporting on the development and validation processes. Further research is required to improve health literacy instruments for children and adolescents and to provide knowledge to inform effective interventions.

Tobacco still a major killer-will we achieve the end game?

The game of tobacco use began in Europe in 1560 when the first tobacco seeds were sent from Lisbon to the king of France, by Jean Nicot. From kings' and nobles' exclusive use, it gradually and progressively became popular among the public, as a new player. Eighty-eight years ago (1929), Fritz Linkint, an extraordinary researcher in Germany, while reviewing existing evidence regarding a wide range of cancers potentially caused by smoking, indicated that smoking was a cause of respiratory disease. Despite the overwhelming accumulated evidence of the negative effects of nicotine intake, the prevalence of tobacco use is not expected to decline in the near future. What have we missed thus far in the game that claims more than seven million deaths annually worldwide? Although tobacco use is recognized as a major health problem, the persistent habit creates a dissonance between public health initiatives to reduce tobacco consumption and the choices citizens are making. To understand this dissonance, consideration first must be given to the social meaning attributed to smoking. Second, the political dissonance between health imperatives and social agendas is discussed with regard to relevant theory. Third, health promotion strategies can make a strong contribution to win the game from a negentropic perspective, that is to say, a public health vision that is structured towards an overarching goal.

Health literacy in childhood and youth: a systematic review of definitions and models.

BACKGROUND: Children and young people constitute a core target group for health literacy research and practice: during childhood and youth, fundamental cognitive, physical and emotional development processes take place and health-related behaviours and skills develop. However, there is limited knowledge and academic consensus regarding the abilities and knowledge a child or young person should possess for making sound health decisions. The research presented in this review addresses this gap by providing an overview and synthesis of current understandings of health literacy in childhood and youth. Furthermore, the authors aim to understand to what extent available models capture the unique needs and characteristics of children and young people. METHOD: Six databases were systematically searched with relevant search terms in English and German. Of the n = 1492 publications identified, N = 1021 entered the abstract screening and N = 340 full-texts were screened for eligibility. A total of 30 articles, which defined or conceptualized generic health literacy for a target population of 18 years or younger, were selected for a four-step inductive content analysis. RESULTS: The systematic review of the literature identified 12 definitions and 21 models that have been specifically developed for children and young people. In the literature, health literacy in children and young people is described as comprising variable sets of key dimensions, each appearing as a cluster of related abilities, skills, commitments, and knowledge that enable a person to approach health information competently and effectively and to derive at health-promoting decisions and actions. DISCUSSION: Identified definitions and models are very heterogeneous, depicting health literacy as multidimensional, complex construct. Moreover, health literacy is conceptualized as an action competence, with a strong focus on personal attributes, while also recognising its interrelatedness with social and contextual determinants. Life phase specificities are mainly considered from a cognitive and developmental perspective, leaving children's and young people's specific needs, vulnerabilities, and social structures poorly incorporated within most models. While a critical number of definitions and models were identified for youth or secondary school students, similar findings are lacking for children under the age of ten or within a primary school context.

Associations between physical activity and self-rated wellbeing in European adults: A population-based, cross-sectional study.

Although self-rated wellbeing is an indicator of health status, it has been receiving little attention; its relationship with physical activity among adults remains inconclusive. The purpose of this study was to analyse the relationship between physical activity and several dimensions of self-rated wellbeing in European adults. This cross-sectional study was based on data from the European Social Survey round 6, 2012, comprising 40,600 European adults (18,418 men, 22,186 women) from 27 countries, with mean age 42.1±13.3. Meeting physical activity guidelines was assessed using World Health Organization criteria. Six dimensions of the self-rated wellbeing were assessed (evaluative wellbeing, emotional wellbeing, functioning, vitality, community wellbeing, supportive wellbeing). Men and women who attained physical activity recommended levels had better evaluative wellbeing (men, p=0.009; women, p<0.001), emotional wellbeing (men, p<0.001; women, p<0.001), functioning (men, p<0.001; women, p<0.001), vitality (men, p<0.001; women, p<0.001), supportive relationships (men, p<0.001; women, p<0.001), and wellbeing total score (men, p<0.001; women, p<0.001). Physical activity frequency was linearly associated with self-rated wellbeing in the 6 dimensions as well as the wellbeing total score (p<0.001). Attaining recommended physical activity levels is related to better self-rated wellbeing, and more frequent physical activity is linearly associated with better self-rated wellbeing in its 6 dimensions.

Prevalence of physical activity in European adults - Compliance with the World Health Organization's physical activity guidelines.

BACKGROUND: Adults are recommended to engage in at least 150 min/week of moderate-to-vigorous physical activity (PA). PURPOSE: This study aimed to examine the level of compliance with PA recommendations among European adults. METHODS: Using data from European Social Survey round 6, PA self-report data was collected from 52,936 European adults from 29 countries in 2012. Meeting PA guidelines was assessed using World Health Organization criteria. RESULTS: 61.47% (60.77% male, 62.05% female) of European adults reported to be engaged in moderate to vigorous PA at least 30 min on 5 or more days per week. The likelihood of achieving the PA recommended levels was higher among respondents older than 18-24. For those aged 45-64 years the likelihood increased 65% (OR=1.65, 95% CI: 1.51-1.82, p<0.001) and 112% (OR=2.12, 95% CI: 1.94-2.32, p<0.001) for males and females, respectively. Those who were high school graduates were more likely to report achieving the recommended PA levels than those with less than high school education (males: OR=1.19, 95% CI: 1.12-1.27, p<0.001; females: OR=1.13, 95% CI: 1.06-1.20, p<0.001). CONCLUSION: Although about 60% of European adults reported achieving the recommended levels of PA, there is much room for improvement among European adults, particularly among relatively inactive subgroups.

Priorities for mental health promotion during pregnancy and infancy in primary health care.

The perinatal period (shortly before and after birth) is a particularly significant stage, providing a sound base for healthy development. Primary health care should accompany the individual through the entire life cycle, and mental health problems constitute a public health threat that calls for the development of mental health promotion initiatives in primary health care. Responding, in 2004 our team initiated an action research project with the aim of reorganising primary health care during pregnancy and the first year of life. The aim is to enable health professionals to support families in the transition to parenthood, thereby promoting children's mental health. In order to plan this reorganisation, we developed a two-step decision-making process: 1. assessment of antenatal health care; 2. joint reflection concerning the priorities for change. The study goal was to assess the particular characteristics and needs of families during the perinatal period as well as the kind of care they were actually receiving. We designed a cross-sectional quantitative-qualitative study that collected data from users and health professionals using questionnaires and semi-structured interviews. The reflection step took place during a workshop that aimed to analyse the results and discuss priorities. The study confirmed the need to search for mental health problems during pregnancy, particularly to prevent a disturbed mother/child bonding process, and the importance of emphasising issues such as communication, information provision and the adequate availability of health professionals for antenatal care. The findings led to the following conclusions: 1. risk and needs assessment regarding mental health and options for family support should be included in the protocols of antenatal care; 2. primary health care professionals should be enabled to undertake diagnostic work and problem solving related to mental health; 3. collaboration between different levels of health care and between health sector and community resources should be increased.The highly participative decision-making process used led to a selection of priorities and strategies that was meaningful to users and health professionals and should contribute to the implementation and sustainability of changes for mental health promotion.