Projects & Cooperations

Research Projects
  • Systematic Reviews on Public Health interventions
Cochrane Reviews on food taxation

Taxation of sugar or sugar added foods, sugar-sweetened beverages (SSBs), and food products high in saturated fat for reducing their consumption and preventing obesity or other adverse health outcomes
Among various dietary risk factors and sources of energy intake, sugar or sugar-added foods, sugar-sweetened beverages and food products with high content of saturated fat are in the limelight for negative impacts on health, in particular overweight, obesity, type 2 diabetes, and cardiovascular disease. Thus, several countries, such as France, Hungary, the United States, and Mexico, took action by implementing fiscal policies (e.g. taxation) to reduce consumption of certain food products high in sugar or fat. However, there is much uncertainty and ongoing scientific as well as political debate about the effectiveness of food policies to achieve general nutritional guideline recommendations as well as to support healthy diets at the population level. The purpose of this set of Cochrane reviews is to assess the health and broader societal impacts of taxation for (i) sugar or sugar added foods, (ii) sugar-sweetened beverages, and (iii) food products high in saturated fat. Evidence from these Cochrane reviews will be of interest to local, national and international public health policy makers, health researchers, health economists and economists at large.

ebph – project team [ebph – Projekt Team]
Thomas L Heise (contact author for “sugar-sweetened beverages” review)
Manuela Pfinder (contact author for “sugar added foods” review)
Stefan K Lhachimi (contact author for “food products high in saturated fat” review)

Collaborators [Kooperationspartner_innen]
Srinivasa V Katikireddi, University of Glasgow, UK
Frank Pega, University of Otago, New Zealand
Gerald Gartlehner, Danube University Krems, Austria
Candida Fenton, University of Glasgow, UK
Ursula Griebler, Danube University Krems, Austria
Isolde Sommer, Danube University Krems, Austria
Kylie Thaler, Danube University Krems, Austria

Cochrane Review on paying for performance for health interventions in LMICs

Paying for performance to improve the delivery of health interventions in low- and middle-income countries (Review update)
In the last decades, pay for performance has gained increasing interest as a mean to improve the performance of health systems, aligning the incentives of health workers and providers with public health goals. Pay for performance is a complex intervention that refers to the transfer of money or material goods conditional on achieving established performance targets or measurable actions. Pay for performance encompasses a wide range of interventions that differ in the level at which the incentives are targeted (users of health care, health providers and health organisation at national or sub-national level). Rewarded performance targets or actions may include achieving certain health outcomes, utilization of services (i.e. prenatal visits), delivery of interventions (i.e. immunisation) and quality of care. The objective of this systematic review is to assess the current evidence for the effect of paying for performance on the provision of health care and health outcomes in low- and middle-income countries (LMIC), focusing on interventions on the supply-side (individual health providers, health facilities and private or public sector health organisation at national or sub-national level). The results from this systematic review will contribute to increasing the available evidence on the benefits and potential harms of pay for performance interventions in LMICs.

ebph – project team [ebph – Projekt Team] Adrian Verbel (contact author)
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Atle Fretheim, Norwegian Institute of Public Health, Norway
Sophie Witter, Queen Margaret University, Scotland
Marit Johansen, Norwegian Institute of Public Health, Norway
Lara Christianson, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Germany

Systematic Review on cost-effectiveness analysis modelling of HPV vaccine in LMICs

Challenges in cost-effectiveness analysis modelling of HPV vaccines in low and middle income countries: A systematic review and practice recommendations
Low and middle income countries (LMICs) face a number of challenges in implementing cervical cancer prevention programme that do not apply in high income countries. These challenges in implementing and maintaining a comprehensive cervical cancer prevention strategy make it difficult to anticipate what programme coverage rates and cost of vaccination might be realised. Both are crucial parameters in most decision analytic models of HPV vaccination as they can determine whether vaccination is cost-effective or not. Accordingly, such analyses need to account for these distinct challenges that do not apply to high income countries to such an extent if the appropriate policy advice is to be given. The purpose of this review is to assess how context-specific challenges of implementing cervical cancer prevention strategies in LMICs where accounted for in existing cost-effectiveness analysis models of human papillomavirus (HPV) vaccination. The review will specifically examine the following questions: (1) Does the existing HPV vaccination cost-effectiveness literature acknowledge the particular challenges of LMICs? (2) How were the LMIC-particular challenges accommodated in the models? (3) Is the uncertainty among the parameters that are particularly sensitive to the implementation challenges in LMICs so large that the policy recommendations are affected?

ebph – project team [ebph – Projekt Team]
Obinna Ekwunife (contact author)
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
James F O’Mahony, Trinity College Dublin, Dublin, Ireland
Andreas Gerber Grote, Department of Health, ZHAW, Winterthur, Switzerland
Christoph Mosch, University Witten/Herdecke, Germany
Tatjana Paeck, University of Bremen, Bremen, Germany

Funding [Finanzierung] Alexander von Humboldt Foundation

Systematic Review on repurposed existing drugs for Ebola

Repurposed therapeutic agents targeting the Ebola virus: a systematic review
The recent Ebola epidemic in western Africa developed into an acute public health emergency of unprecedented level in modern times. The treatment provided in most cases has been limited to supportive care, as no approved therapies are available to date. Several established, licensed drugs have been suggested as potential repurposed therapeutic agents for Ebola. However, scientific evidence on the efficacy of various repurposed drugs in treating Ebola is limited, and additional investigations to justify their use in the treatment of EVD are necessary. The purpose of this review is to systematically assess scientific evidence on potential drugs targeting Ebola. In specific, we aim to (1) identify drug library screens involving therapeutic agents targeting the Ebola virus, (2) list potential approved drugs identified from drug screens and review their mechanism of action against the Ebola virus and (3) summarise the outcome of preclinical and clinical trials investigating approved drugs targeting the Ebola virus.

ebph – project team [ebph – Projekt Team]
Obinna Ekwunife
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Hussein Sweiti, University of Düsseldorf / Klinikum Frankfurt Höchst, Germany (contact author)
Thomas Jaschinski, Witten/Herdecke University, Germany

Systematic Review on community gardening for preventing overweight and obesity

Community gardening, community farming and other local community based gardening interventions for preventing overweight and obesity as well as improving physical activity, quality of life, and nutritional intake
Overweight and obesity are among the major current health threats and one of the leading preventable causes of death worldwide. Meanwhile, these conditions are also strongly related to a wide range of negative health outcomes (e.g. including hypertension and diabetes mellitus type 2). Beside surgical and drug based treatments – that can be associated with manifold adverse effects – community-based initiatives to promote physical activity received much attention in recent years. From a Public Health perspective, interventions for preventing and controlling overweight and obesity in the general population should incorporate the complexity of this medical condition, aim at various health-related behaviours at the same time, and be low-risk and cost-effective – with the ultimate goal of sustainable positive long-term effects on health. Community gardening provides such a potentially powerful and sustainable intervention by combining physical activity, improved food supply and education to support culturally tailored healthy living in the local context. Objectives of this Systematic Review are as follows: (i) To examine the health effects of participation in community-based gardening on overweight and obesity as well as related outcomes, i.e. physical activity, nutritional intake, quality of life and health outcomes related to overweight and obesity in the general population and populations at risk for overweight and obesity; (ii) To examine the effects of community gardening interventions for different sub-groups of populations and settings (e.g. school, neighbourhoods, community facilities) according to different ways how these interventions are implemented; (iii) To assess the costs of community gardening interventions aimed at overweight and obesity prevention.

ebph – project team [ebph – Projekt Team]
Thomas L Heise (contact author)
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Agnes van den Berg, University Groningen, Netherlands
Matthias Romppel, University Bremen, Germany
Maike Schulz, University Bremen, Germany
Gerald Gartlehner, Danube University Krems, Austria

  • Health Impact Assessment & Health Economic Modelling Studies
Cost-effectiveness analysis of HPV vaccination in GAVI eligible African Countries

Cost-effectiveness analysis of Human Papilloma Virus (HPV) vaccination in GAVI eligible African Countries: Insights for evidence-based cervical cancer prevention policy
WHO recommends routine HPV vaccination for girls when the cost-effectiveness of vaccination strategies in the country or region has been duly considered. Although vaccination against HPV infection presents a good opportunity for primary prevention in most Africa countries, it is pertinent to ensure that HPV vaccination is cost-effective compared to cervical cancer screening particularly with low cost screening technologies such as visual inspection with acetic acid (VIA). Although the cost-effectiveness of a vaccination-only strategy in GAVI eligible African countries has undergone initial assessment as part of broad analysis of several countries, our study will consider new recommendations in cervical cancer prevention and will use more precise estimates of vaccinnation delivery cost and programme coverage rates. Thus this study will use patient level simulation to assess the cost-effectiveness of the following cervical cancer prevention strategies: (1) Treatment of cancers detected symptomatically (no prevention); (2) Screening with VIA and treatment of screen-detected and symptomatic lesions (screening only); (3) HPV16/18 vaccination of preadolescent 12-year old girls (vaccination only); (4) Combined screening and preadolescent HPV16/18 vaccination with treatment of screen-detected and symptomatic lesions (screening + vaccination).

ebph – project team [ebph – Projekt Team]
Obinna Ekwunife (contact author)
Stefan K Lhachimi

Funding [Finanzierung]
Alexander von Humboldt Foundation

HIA of processed meat pricing policy

Modelling potential effects on chronic disease outcomes of a hypothetical policy increasing prices on processed meat in Germany
Last year, the International Agency for Research on Cancer has classified processed meat to be carcinogenic, supporting the recommendation to limit its intake. Price increases could give an economic discouragement to consume processed meat. Therefore, the objective of this study is to explore the use of population health modelling to examine to what extend price increase for processed meat (ham, sausages etc.) has the potential to improve populations´ health outcomes. Baseline processed meat consumption is taken from the German National Nutrition Survey II. The expected change in processed meat consumption following a hypothetical price increase implementation is estimated applying price elasticities for processed meat. These are calculated from the Association for Consumer Research´s consumer panel. Effects on health are based on relative risk estimates, relating processed meat consumption to health outcomes, taken from the Global Burden of Disease study. Policy-attributable prevented disease incidence (CHD, diabetes, colorectal cancer) and effects on life expectancy are calculated using a multi-state life table spreadsheet.

ebph – project team [ebph – Projekt Team]
Johanna-Katharina Schönbach
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Silke Thiele, Department of Food Economics and Consumption Studies, University of Kiel, Germany

HIA of a fat tax in Germany

Health impact assessment of a hypothetical “fat tax” in Germany: Modelling potential effects on BMI and associated chronic disease outcomes by household income
The implementation of fiscal policies, such as the taxation of unhealthy food, has been proposed as an approach to improve population diets and enhancing health outcomes. Several countries have already applied a range of food taxes. However, concerns have been raised regarding substitution patterns and differential impacts on income subgroups. Therefore, this study aims to model the potential impact of taxing saturated fat on BMI and, in turn, a range of associated chronic diseases (IHD, stroke, diabetes, cancer) for different household income groups in Germany. In the model, baseline food intake and food price elasticities for German households by income are based on the Association for Consumer Research´s consumer panel. These are then used to predict the change in food consumption and energy supply following the implementation of a hypothetical tax of 2.15 € per kg of saturated fat. Change in energy intake is translated into shift in BMI by applying a dynamic calorie-to-weight model to individual weight and height baseline data, derived from the Socio-Economic Panel (SOEP). Health impact assessment is performed using DYNAMO-HIA software, which incorporates demographic and epidemiological information of the German population, and dynamically projects effects on health outcomes.

ebph – project team [ebph – Projekt Team]
Johanna-Katharina Schönbach
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Silke Thiele, Department of Food Economics and Consumption Studies, University of Kiel, Germany

HIA of EU-policy-induced alteration of fruit and vegetable prices

Health impact assessment of a hypothetical EU-policy-induced alteration of fruit and vegetable prices: Modelling potential effects on chronic disease outcomes for countries of the European Union
This study aims to model and quantify the potential impact of EU-policy-induced changes in fruit and vegetable prices on a range of associated chronic diseases (ischemic heart disease, stroke, diabetes, lung-, breast-, oral-, colorectal-, esophageal cancer) for a range of EU countries. In the model, baseline fruit and vegetable intake data is derived from the European Food Safety Authority (EFSA) Comprehensive Food Consumption Database. Food price elasticities identified from the literature are utilized to predict the change in fruit and vegetable consumption following a hypothetical policy-induced fruit and vegetable price alteration. Relative risks, which relate various levels of fruit and vegetable consumption with mortality and different types of diseases, are identified through the literature. Health impact assessment is performed using DYNAMO-HIA software, which incorporates population´s demographic and epidemiological information for a range of European countries, and dynamically projects effects on health outcomes such as ischemic heart disease, stroke, diabetes and cancer.

ebph – project team [ebph – Projekt Team]
Johanna-Katharina Schönbach
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Silke Thiele, Department of Food Economics and Consumption Studies, University of Kiel, Germany

  • Survey and Qualitative research
Alcohol during pregnancy

The Effect of Alcohol Consumption during Pregnancy on Offspring Overweight, Obesity, and Problem Behaviours over the Early Lifecourse
Maternal alcohol intake during pregnancy is the major cause of non-genetic determined birth defects. Maternal alcohol intake during pregnancy causes various disorders associated with FASD. There are research gaps with respect to the relation between maternal alcohol intake during pregnancy and overweight, obesity, diabetes and problem behaviors. This research project aims to investigate the association between maternal alcohol intake during pregnancy and overweight, obesity, diabetes, and problem behaviors respectively. Moreover, we will study whether some of these associations are modified by pre- and postnatal conditions, such as smoking during pregnancy and postnatal diet, and whether there are dose-response relationships. LifeLines data will be used to answer the questions raised. We will apply multivariate logistic regressions to determine the association between overweight, obesity, diabetes, and problem behaviors respectively and levels of maternal alcohol intake during pregnancy. To investigate effect modifications of some of these associations by pre- and postnatal conditions, we will add interaction terms to the adjusted models.

ebph – project team [ebph – Projekt Team]
Manuela Pfinder
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Bart Klijs, Department of Epidemiology, University Medical Center Groningen
Nynke Smidt, Department of Epidemiology, University Medical Center Groningen

Links
https://www.lifelines.nl/lifelines-research/general

Research Priority Setting for Public Health in Germany

Prioritizing potential Systematic Review topics in Public Health with Public Health stakeholders: A systematic review priority setting study in Switzerland as a framework for systematic review priority setting
Research Priority Setting (RPS) studies in health help to investigate which potential research options are most important and beneficial according to certain criteria, while taking current research evidence into account. It supports future health research to be in accordance with both health and evidence needs. A structured RPS exercise specifically focused on public health themes in Germany has not been conducted yet. Therefore, this study investigates which research topics are prioritized by public health stakeholders in Germany. Furthermore, the study will analyze which criteria are predominantly used in the assessment of potential research topics and which differences exist between the preferences of different stakeholder groups. A multi-stage and multi-method process is proposed for this study, combining both metrics- and consensus-based techniques. A two-wave modified Delphi technique is applied, incorporating an online structured questionnaire with an open-ended part for the discussion of the synthesized results. The results of this study provide guidance for future research directions and proposals within public health, both for research teams and research funding agencies. The study is conducted in collaboration with the German Association of Public Health (DGPH).

ebph – project team [ebph – Projekt Team]
Dyon Hoekstra (contact author)
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Ansgar Gerhardus, Institute for Public Health und Health Care Research, University Bremen, Germany
German Association of Public Health (Deutsche Gesellschaft Public Health):
Beate Blättne, University of Applied Sciences Fulda, Germany
Gudrun Faller, University of Applied Sciences Bochum, Germany
Gabriele Bolte, University Bremen, Germany
Marie-Luise Dierks, Medical University of Applied Sciences, Hannover, Germany
Christoph Dockweiler, University Bielefeld, Germany
Burkhard Gusy, Free University Berlin, Germany

Prioritizing Potential Systematic Review Topics in Public Health in Switzerland

Prioritizing potential Systematic Review topics in Public Health with Public Health stakeholders: A systematic review priority setting study in Switzerland as a framework for systematic review priority setting
Research Priority Setting (RPS) studies help to investigate which potential research options are most important while taking current research evidence into account. It supports future health research to be in accordance with both health and evidence needs. Cochrane Public Health Europe (CPHE) also aims to conduct relevant and prioritized systematic reviews according to public health policy and research needs. This study will conduct a public health RPS exercise to assess which systematic review topics are prioritized by public health stakeholders in Switzerland. Furthermore the study will analyze which criteria are predominantly used in the assessment of potential review topics and which differences exist between the preferences of different stakeholder groups. Moreover, this study will create awareness and understanding among stakeholders for the research work of CPHE. The approach in this study must be scalable to other European countries and elsewhere. A multi-stage and multi-method process is proposed for this study, combining both metrics- and consensus-based techniques. A two-wave modified Delphi technique is applied, incorporating an online structured questionnaire with an open-ended part for the discussion of the synthesized results. The study will firstly provide a clear insight in which review topics are prioritized by public health stakeholders and secondly in the criteria that public health stakeholders use to assess the importance of potential review topics. The study is conducted in collaboration with Cochrane Public Health Europe (CPHE).

ebph – project team [ebph – Projekt Team]
Dyon Hoekstra (contact author)
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Cochrane Public Health Europe (CPHE):
Eva A. Rehfuess, Institute for Medical Informatics, Biometry and Epidemiology and Pettenkofer School of Public Health, Ludwig-Maximilians-University, Munich
Christina Kien, Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Austria
Gerald Gartlehner, Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Austria
Margot Mütsch, Department for Epidemiology, Biostatistics and Prevention, Institute University of Zurich, Switzerland
Ansgar Gerhardus, Institute for Public Health und Health Care Research, University Bremen, Germany

Stakeholder perceptions on rapid reviews

Understanding and use of rapid reviews by stakeholders in the public health and health care sector
Systematic reviews are considered as the gold-standard in evidence-based medicine. Public health, health care and health systems policy-makers, however, often need access to timely, independent and reliable health information for decision-making and cannot wait for the completion of full systematic reviews. Rapid reviews are accelerated forms of evidence synthesis. Several research initiatives have gathered information to describe the current forms of rapid reviews that are being produced by different agencies around the world. Attempts to provide definitions for these different forms of rapid reviews have been made. Little is known about the actual usefulness and implementation of rapid reviews or other rapid synthesis products for stakeholders in the public health and health care sectors, e.g. political health care and health system decision-makers, health insurance agencies, guideline panels, doctors, patients, nursing staff and groups representing them. Furthermore, it is unclear to what extent stakeholders are aware of trade-offs that are involved when using rapid review products as evidence base for decisions compared to full systematic reviews. The aim of this project is to explore the use, understanding, perceptions, and needs of stakeholders regarding rapid review/rapid synthesis products as evidence basis for decisions in the public health and health care sector.

ebph – project team [ebph – Projekt Team]
Stefan K Lhachimi

Collaborators [Kooperationspartner_innen]
Ursula Griebler, Danube University Krems, Austria (contact author)
Christina Kien, Danube University Krems, Austria
Gerald Gartlehner, Danube University Krems, Austria
Margot Mütsch, University of Zurich, Switzerland
Milo Puhan, University of Zurich, Switzerland
Laura K Busert, LMU Munich, Germany

Research Cooperations
Cochrane Public Health Europe

Cochrane Public Health Europe (CPHE)
CPHE was established in 2015 to support and disseminate the work of Cochrane Public Health in Europe and beyond. Over the past years, several initiatives have emerged in Europe, including in Germany, Austria and Switzerland, with the common goal to promote the development and use of evidence-based methods in public health (e.g. through the German Network for Evidence-Based Medicine and the European Summer School in Evidence-Based Public Health). In line with these initiatives CPHE will: (i) Support CPH authors in Europe and encourage potential review authors to engage in a CPH review; (ii) Provide editor support via the assistant managing editor; (iii) Assist in the recruitment of CPH editors in Europe; (iv) Undertake methodological peer-review of CPH reviews conducted in Europe and beyond; (v) Engage with national and Europe-based public health institutions, in particular WHO and the European Centre for Disease Prevention and Control; (vi) Disseminate up-to-date public health evidence in appropriate formats; (vii) Contribute to a formal prioritisation process for the CPH. Beyond their contribution to the CPH, the partners of CPHE envisage broader joint activities to promote evidence-based public health in their countries and in Europe, in particular methods development for systematic reviews in the public health field and capacity-building. Furthermore, the partners will contribute to workshops and conferences in Europe and develop joint research proposals.

ebph – project team [ebph – Projekt Team]
Thomas L Heise
Stefan K Lhachimi
Manuela Pfinder

Collaborators [Kooperationspartner_innen]
Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich (LMU), Germany
Cochrane Austria (CA) and Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Austria Gerald Gartlehner, Danube University Krems, Austria
Cochrane Switzerland (Cochrane CH) comprising Institute of Social and Preventive Medicine, Lausanne University Hospital and Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Switzerland
Health Sciences Bremen (HSB) comprising Institute for Public Health and Nursing Research, University of Bremen and Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany

Links
http://ph.cochrane.org/cochrane-public-health-europe