Journal of Public Health Research <p><strong>The Journal of Public Health Research</strong> is an online Open Access, peer-reviewed scholarly journal in the field of public health science. The aim of the journal is to stimulate debate and dissemination of knowledge in the public health field in order to improve efficacy, effectiveness and efficiency of public health interventions to improve health outcomes of populations. This aim can only be achieved by adopting a global and multidisciplinary approach. <br><br> <strong>The Journal of Public Health Research </strong>publishes contributions from both the 'traditional' disciplines of public health, including hygiene, epidemiology, health education, environmental health, occupational health, health policy, hospital management, health economics, law and ethics as well as from the area of new health care fields including social science, communication science, eHealth and mHealth philosophy, health technology assessment, genetics research implications, population-mental health, gender and disparity issues, global and migration-related themes. In support of this approach, the Journal of Public Health Research strongly encourages the use of real multidisciplinary approaches and analyses in the manuscripts submitted to the journal. In addition to <em>Original research</em>, <em>Systematic Review,</em> <em>Meta-analysis</em>, <em>Meta-synthesis</em> and <em>Perspectives</em> and <em>Debate</em> articles, the Journal of Public Health Research publishes newsworthy <em>Brief</em> <em>Reports</em>, <em>Letters</em> and <em>Study Protocols</em> related to public health and public health management activities.</p> PAGEPress Scientific Publications, Pavia, Italy en-US Journal of Public Health Research 2279-9028 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> Understanding beverage taxation: Perspective on the Philadelphia Beverage Tax’s novel approach <p>Despite the growing global trend of sugar-sweetened beverage (SSB) taxes for their potential as an untapped source of revenue and as a public health boon, these legislative efforts remain controversial. Multiple articles have reviewed this trend in recent years from modeling of long-term impacts to short-term empirical studies, yet most comprehensive, long-term health impact assessments remain forthcoming. These multi-faceted efficacy studies combined with case-based assessments of the policy process, descriptive pieces highlighting unique features of the policy and reflective perspectives targeting unanswered questions create a comprehensive body of literature to help inform present and future legislative efforts. The passage of the Philadelphia Beverage tax required a mix of political entrepreneurs, timing and context; while uniquely employing a nonpublic health frame, specific earmarking and a broadened scope with the inclusion of diet beverages. This perspective on the Philadelphia Beverage Tax will describe the passage and novel features of the Philadelphia Beverage Tax with a discussion of the ethical questions unique to this case.</p> Ryan M. Kane Vasanti S. Malik ##submission.copyrightStatement## 2019-04-15 2019-04-15 8 1 10.4081/jphr.2019.1466 Changing trends in adolescent alcohol use among Czech school-aged children from 1994 to 2014 <p><em>Background:</em> For an efficient planning of public health policy, the regular monitoring over health-related behaviors among vulnerable population groups is necessary. The aim of this study is to examine the temporal trends in alcohol use among the Czech adolescent population. <br><em>Design and methods:</em> Data from the Health Behaviour in Schoolaged Children (HBSC) project conducted in Czechia from 1994 to 2014 were used. Adolescent alcohol use was assessed via two indicators: i) weekly alcohol use (beer, wine, and/or spirit), ii) repeated lifetime drunkenness (having been drunk on two or more occasions in life). Trends in alcohol use were modelled separately for boys and girls. Binary logistic regression was conducted with survey period as an independent predictor of the alcohol indicator. <br><em>Results:</em> There were significant changes in adolescent alcohol use since 1994. Between 1994 and 2010, there was a gradual upward in the prevalence. However, in the recent period of 2014, an unprecedented drop in alcohol use was recorded. <br><em>Conclusions:</em> Despite the significant drop in the prevalence of alcohol use among the Czech youth in recent years, alcohol drinking in adolescence remains an important challenge for the national health policy. Further research will show whether these changes in adolescent health-related behavior are of a temporary or a permanent nature.</p> Ladislav Kážmér Ladislav Csémy ##submission.copyrightStatement## 2019-04-15 2019-04-15 8 1 10.4081/jphr.2019.1493 Where else would I look for it? A five-country qualitative study on purposes, strategies, and consequences of online health information seeking <p><em>Background.</em> Online health information (OHI) is widely available and consulted by many people in Western countries to gain health advice. The main goal of the present study is to provide a detailed account of the experiences among people from various demographic backgrounds living in high-income countries, who have used OHI. <br><em>Design and methods</em>. Thematic analysis of 165 qualitative semi-structured interviews conducted among OHI users residing in Australia, Israel, the Netherlands, Norway, and Switzerland was performed. <br><em>Results.</em> The lived experience of people using OHI seem not to differ across countries. The interviews show that searches for OHI are motivated from curiosity, sharing of experiences, or affirmation for actions already taken. Most people find it difficult to appraise the information, leading them to cross-check sources or discuss OHI with others. OHI seems to impact mostly some specific types of health behaviors, such as changes in diet or physical activity, while it only plays a complementary role for more serious health concerns. Participants often check OHI before seeing their GP, but are reluctant to discuss online content with health care personnel due to expected negative reception. <br><em>Conclusions.</em> This study adds to the body of knowledge on eHealth literacy by demonstrating how OHI affects overall health behavior, strengthens patients’ ability to understand, live with, and prepare themselves for diverse health challenges. The increasing digitalization of health communication and health care calls for further research on digital divides and patient-professional relations. Health care professionals should acknowledge OHI seeking and engage in discussions with patients to enable them to appreciate OHI, and to support shared decision making in health care. The professionals can utilize patient’s desire to learn as a resource for health prevention, promotion or treatment, and empowerment.</p> Nicola Diviani Eva Haukeland Fredriksen Corine S. Meppelink Judy Mullan Warren Rich Tobba Therkildsen Sudmann ##submission.copyrightStatement## 2019-04-15 2019-04-15 8 1 10.4081/jphr.2019.1518 Care of acute conditions and chronic diseases in Canada and the United States: Rapid systematic review and meta-analysis <p>This study tested the hypothesis that socioeconomically vulnerable Canadians with diverse acute conditions or chronic diseases have health care access and survival advantages over their&nbsp;counterparts in the USA. A rapid systematic review retrieved 25 studies (34 independent cohorts) published between 2003 and 2018. They were synthesized with a streamlined meta-analysis. Very low-income Canadian patients were consistently and highly advantaged in terms of health care access and survival compared with their counterparts in the USA who lived in poverty and/or were uninsured or underinsured. In aggregate and controlling for specific conditions or diseases and typically 4 to 9 comorbid factors or biomarkers, Canadians’ chances of receiving better health care were estimated to be 36% greater than their American counterparts (RR=1.36, 95% CI 1.35-1.37). This estimate was significantly larger than that based on general patient or non-vulnerable&nbsp;population comparisons (RR=1.09, 95% CI 1.08-1.10). Contrary to prevalent political rhetoric, three studies observed that Americans experience more than twice the risk of long waits for breast or colon cancer care or of dying while they wait for an organ transplant (RR=2.36, 95% CI 2.09-2.66). These findings were replicated across externally valid national studies and more internally valid, metropolitan or provincial/state comparisons. Socioeconomically vulnerable Canadians are consistently and highly advantaged on health care access and outcomes compared to their American counterparts. Less vulnerable comparisons found more modest Canadian advantages. The Affordable Care Act ought to be fully supported including the expansion of Medicaid across all states.&nbsp;Canada’s single payer system ought to be maintained and strengthened, but not through privatization.</p> Keren M. Escobar Dorian Murariu Sharon Munro Kevin M. Gorey ##submission.copyrightStatement## 2019-03-11 2019-03-11 8 1 10.4081/jphr.2019.1479 Patient and clinician engagement with health information in the primary care waiting room: A mixed methods case study <p><em>Background</em>. Primary care waiting rooms can be sites of health promotion and health literacy development through the provision of readily accessible health information. To date, few studies have considered patient engagement with televised health messages in the waiting room, nor have studies investigated whether patients ask their clinicians about this information. The aim of this study was therefore to examine patient (or accompanying person) and clinician engagement with waiting room health information, including televised health messages.</p> <p><em>Design and methods</em>. The mixed methods case study was undertaken in a regional general practice in Victoria, Australia, utilising patient questionnaires, waiting room observations, and clinician logbooks and interviews. The qualitative data were analysed by content analysis; the questionnaire data were analysed using descriptive statistics.</p> <p><em>Results</em>. Patients engaged with a range of health information in the waiting room and reportedly received health messages from this information. 44% of the questionnaire respondents (33 of 74) reported watching the television health program, and half of these reported receiving a take home health message from this source. Only one of the clinicians (<em>N</em>=9) recalled a patient asking about the televised health program.</p> <p><em>Conclusions</em>. The general practice waiting room remains a site where people engage with the available health information, with a televised health ‘infotainment’ program receiving most attention from patients. Our study showed that consumption of health information was primarily passive and tended not to activate patient discussions with clinicians. Future studies could investigate any link between the health infotainment program and behaviour change.</p> Cara Penry Williams Kristine Elliott Jane Gall Robyn Woodward-Kron ##submission.copyrightStatement## 2019-03-11 2019-03-11 8 1 10.4081/jphr.2019.1476 Vaccine hesitancy: An overview on parents' opinions about vaccination and possible reasons of vaccine refusal <p><em>Background</em>. Vaccine hesitancy has increased worldwide with a subsequent decreasing of vaccination rates and outbreaks of vaccine-preventable diseases (<em>i.e.</em> measles, poliomyelitis and pertussis) in several developed countries, including Italy.</p> <p><em>Design and Methods</em>. We conducted a survey to investigate the attitudes of a parents’ sample about vaccinations by the distribution of questionnaires in six lower secondary schools of the Italian city of Messina.</p> <p><em>Results</em>. Regarding vaccinations carried out on children, the declared vaccination coverage rates ranged widely between good coverage percentages for some vaccinations (Measles-Mumps-Rubella, Diphtheria-Tetanus-Pertussis), and very low coverage rates for others, especially for “new” vaccinations (HPV, meningococcal, pneumococcal). The vaccinations carried out correlated negatively with both parents’ age and their level of education. Moreover, a favourable parents’ opinion was strongly influenced by a favourable opinion of the physician, while an unfavourable parents’ opinion seemed conditioned by a direct or indirect knowledge of people harmed by vaccines. In addition, our data show that parents do not often know or partially know the real composition of the vaccines and the diseases prevented by vaccinations.</p> <p><em>Conclusions</em>. Data analysis shows that parents are, theoretically, favourable towards vaccinations but have little knowledge of such practices, sometimes not being unaware of the types of vaccines administrated to their children. Health education and communication of correct information are certainly the cornerstones to improve the situation and to fight the widespread and non-grounded fears about vaccines.</p> Alessio Facciolà Giuseppa Visalli Annalisa Orlando Maria Paola Bertuccio Pasquale Spataro Raffaele Squeri Isa Picerno Angela Di Pietro ##submission.copyrightStatement## 2019-03-11 2019-03-11 8 1 10.4081/jphr.2019.1436 Social egg freezing under public health perspective: Just a medical reality or a women’s right? An ethical case analysis <p>In recent years, a social trend toward delaying childbearing has been observed in women of reproductive age. A novel technomedical innovation was commercialized for non-medical reasons to healthy, ostensibly fertile women, who wished to postpone motherhood for various reasons such as educational or career demands, or because they had not yet found a partner. As a consequence, these women may be affected by age-related infertility when they decide to conceive, and fertility preservation techniques can be obtained through the so-called <em>social egg freezing</em>. This paper examines, from an ethical point of view, the impact of social egg freezing under some aspects that can involve policy making and resources allocation in public health. Due to the increasing demand for this procedure, some debated issues regard if it is reasonable to include social egg freezing in Public Healthcare System and consequently how to manage the storage of cryopreserved oocytes also from individual donors, how to support these egg banks and how to face, in the future, with the possibility that egg freezing will play a role in enabling childbearing for gays, lesbians, and unmarried persons. Social freezing may be advertised to harmonise gender differences, but we wonder if it is the proper solution to the problem or if it could also create further challenges. An ethical argumentation on these topics should address some questions that will be discussed.</p> Ana Borovecki Pamela Tozzo Nicoletta Cerri Luciana Caenazzo ##submission.copyrightStatement## 2018-12-20 2018-12-20 8 1 10.4081/jphr.2018.1484 Unreasonable obstinacy: Ethical, deontological and forensic medical problems <p>Especially in oncology and in critical care, the provision of medical care can require therapeutic choices that could go beyond the patient’s will or intentions of the protection of his health, with the possible adoption of medical behaviors interpreted as <em>unreasonable obstinacy</em> or, at the opposite extreme, as euthanasia. In some cases, the demand for obstinate therapeutic services could come from the patient or from his relatives, in which case the dilemma arises for the health professional between rejecting such a request, in respect of their professional autonomy, or abiding by it for fear of a professional care responsibility for therapeutic abandonment. We analyzed and commented on emblematic clinical cases brought to court for alleged wrong medical conduct due to breach of the prohibition of <em>unreasonable obstinacy</em>. In healthcare it is impossible to fix a general rule defining any therapeutic act as appropriate, because on one hand there are technical assessments of medical competence, and on the other the perception of the patient and of his family members of the usefulness of the health care provided, which may be in contrast. The medical act cannot make treatments that are inappropriate for the needs of care or even be <em>unreasonable</em>; conversely, before the request by the patient or by his family members for disproportionate health services in relation to the results they may give in practice, in compliance with the legislative and deontological provisions, the doctor can refuse them, thus safeguarding both his decision-making autonomy and, therefore, his professional dignity.</p> Claudia Casella Vincenzo Graziano Pierpaolo Di Lorenzo Emanuele Capasso Massimo Niola ##submission.copyrightStatement## 2018-12-20 2018-12-20 8 1 10.4081/jphr.2018.1460 Perceptions of health professionals about the quality of communication and deliberation with the patient and its impact on the health decision making process <p>The information process is considered a core element in decision-making and an obligatory matter of concern for the health professional. Rather than information <em>per se</em>, we should perhaps mention the need for communication between the health professional and the patient, which should be appropriate to each specific case and situation. Interaction and communication during the relationship generates a degree of trust that contributes to improving care quality and health-related results. The aim of this study is to know the perception of professionals on the quality of communication and its impact on the decision-making process of the patient and the degree of involvement of health professionals in the process of communication with the patient. A sample of 2186 health professionals (1578 nurses, 586 physicians, and 22 pharmacists) was studied. A questionnaire composed of 20 items dealing with the process of communication with the patient and obtaining informed consent was administered. Our study revealed the high consideration that professionals hold of their communication skills with patients since almost 80% of those surveyed, think they are sufficiently skilled in this area. Professionals refers that nurses are most skilled at communicating with patients. Communication in the clinical relationship must not only serve as a way for the professional to obtain information from the patient on their pathology, but also as a means to inform patients so that they understand their illness. Patients also like to feel that they are being listened to and are co-participants in the care process. Communication should be a continuous object of study for all health professionals, both in primary and specialised attention.</p> Eduardo Osuna Antonio Pérez-Carrión María D. Pérez-Cárceles Francisco Machado ##submission.copyrightStatement## 2018-12-20 2018-12-20 8 1 10.4081/jphr.2018.1445 Analysis of the information in mandatory reporting in victims of gender violence <p>The healthcare professional plays a key role in the detection and subsequent channeling of a situation of violence to a judicial level for appropriate investigation. The mandatory reporting of gender violence has become a controversial issue among health care practitioners and victims. The objective of this study was to analyze the quality of the way in which injury reports on victims of gender violence is completed, through an analysis of the information they include, the readability and the degree to which the document can be understood. A retrospective study in a sample of 197 injury reports were performed from health services (primary care, hospital services and emergency services). We analyzed 22 variables related to the content, readability of the document, the victim’s identification data as well as identification of the doctor responsible for assistance, the moment of assistance and the characteristics of the injury. The most frequent deficiencies in the data are identification of the doctor responsible for medical attention, the date on which the aggression occurred, a description of the injuries and the judgment of compatibility between the cause of injury (according to the victim) and the actual injury they have. The injury reports do not conform to the legal requirements needed in a document of such extraordinary importance. Greater awareness in health professionals concerning the importance of the injury report as a medicolegal document is needed so that the correct information can be provided to the relevant judicial authority.</p> Belen Reynaldos Faustina Sánchez-Rodríguez Isabel Legaz Eduardo Osuna ##submission.copyrightStatement## 2018-12-20 2018-12-20 8 1 10.4081/jphr.2018.1443