Obesity - an acknowledged public health challenge

As we face a difficult economic climate, in which inequalities may worsen, the PHA faces many challenges in its efforts to improve the health of the population. One such challenge is the issue of obesity. Recently, in the Draft Programme for Government and, again today, in anticipation of the publication of the Consultation on the Review of Health and Social Care Services in Northern Ireland, the specific issue of obesity has been highlighted in the media.The PHA is committed to playing a lead role in tackling this major health issue and has been systematically examining the evidence of best practice and effectiveness to ensure that investment and working in partnership will bring clear benefits. A welcome consequence of any success would be a reduction in the impact of the physical, and emotional costs of obesity related ill-health to individuals - and the financial costs to an overstretched healthcare system.A multi-facetted approach to tackling obesity is required for Northern Ireland. This will mean working across government departments, looking at relevant legislation, taxation, food standards and labelling, as well as supporting a raft of programmes within education, workplace, and at the local community level."The prevalence of overweight and obesity has risen dramatically in recent years in Northern Ireland and is now the norm to be overweight, rather than the exception. The Northern Ireland Health and Social Wellbeing Survey (2010-11) indicated that 36% of adults are overweight and a further 23% are obese; this means that approximately 3 in 5 adults in Northern Ireland carry excess weight. A similar proportion of males and females were obese (23%) however males were more likely to be overweight (44%) than females (30%).Data from the Northern Ireland Health and Wellbeing Survey (2010-11) reported that 27% of children aged 2-15 years are obese or overweight. The findings presented here are based on the guidelines put forward by the International Obesity Task Force. Using this approach, 8% of children were assessed as obese, with similar results for boys (8%) and girls (9%). Obesity has serious implications for health and wellbeing and is associated with an increased risk of heart disease and stroke, type 2 diabetes, some cancers, respiratory problems and joint pain.Evidence indicates that being obese can reduce life expectancy by up to 9 years; and it can impact on emotional and psychological well-being and self-esteem, especially among young people.Obesity also impacts on wider society through economic costs, loss of productivity and increased demands on our health and social care system. It is estimated that obesity in Northern Ireland is resulting in 260,000 working days lost each year with a cost to the local economy of £500 million.The good news is that the intentional loss of significant weight (approx 10kg) in overweight and obese adults has been shown to confer significant health benefits, decreased morbidity and may also reduce obesity-related mortality.Key programmes and interventions are undertaken by the PHA in order to prevent and reduce overweight and obesity. The programmes/interventions are supported by significant ongoing work at local level. Examples include:the promotion of breastfeeding; local programmes to increase awareness of good nutrition and develop cooking skills, for example 'Cook It!'; promotion of more active lifestyles, for example, Walking for Health' and 'Teenage Kicks'; development of community allotment schemes; programmes for primary school children, for example Skip2bfit and Eat, Taste and Grow; and sports and other recreation, for example 'Active Belfast'. The PHA's multi media campaign 'It all adds up!' to encourage children to become more active and understand the importance of keeping fit, in a fun and exciting way, ran until October 2011. It encouraged parents and carers to go to the website www.getalifegetactive.com and download the PHA logbook It all adds up! to plan activities as a family. The logbook helped children and parents plan and keep track of their participation in physical activity at school, home and in the community. PHA is currently developing a public information campaign and other supportive work to increase public awareness of obesity as well as to provide advice and support for those who want to make real changes. The campaign development is well underway and is anticipated for launch in late Spring 2012. Like many common health problems, people living in disadvantaged circumstances suffer most and the PHA is committed to tackling this aspect of health inequality. The good news is that even a modest weight loss, of 1-1 Â_ stones, can help to reduce the risk of many of the health problems resulting from being overweight or obese. Information on losing weight through healthier eating and being more active can be found on the PHA websites - www.enjoyhealthyeating.info and www.getalifegetactive.com . These websites provide help and advice for anyone who wants to improve their eating habits and fitness levels, by making small, sustainable, healthy changes to their lifestyle. The PHA leaflet, Small changes, big benefits is also available to download from the PHA website, 'Publications' section.

Public Health England Obesity

The Public Health England Obesity website provides a single point of contact for wide-ranging authoritative information on data, evaluation, evidence and research related to weight status and its determinants. They work closely with a wide range of organisations and provide support to policy makers and practitioners involved in obesity and related issues.

Strategic development review of health board food control laboratories

The Official Food Safety laboratories have a critical role in ensuring food safety and public health for the whole population of the Republic of Ireland. These public health laboratories are made up of 7 microbiological testing laboratories and 3 chemical or Public Analyst’s laboratories. The laboratories are regionally based and offer an accredited (INAB) service to 10 health boards thus spanning the country. The role of the laboratories is to test food for compliance with the relevant legislation and guidelines, identify food-borne hazards and disease outbreaks, provide essential risk assessment information for national and international needs, provide a food testing service for consumers and a water testing service on a national basis. They also participate in dedicated National and EU surveys under the auspices of the Food Safety Authority of Ireland (FSAI). There has been significant investment and development in food-related public health protection in Ireland in recent years. However, there are still a number of issues that have the potential to impact on these laboratories in delivering a fully effective public health service in a cost efficient manner. Building on what has been achieved to date, this strategic review identifies those issues to be addressed in order to ensure (1) a cost effective national co-ordinated food safety laboratory service, (2) that future laboratory service needs are accounted for in the delivery of their Public Health role, and (3) that this Service meets both national and international requirements and standards.

Tackling Health Inequalities through Action on the Social Determinants of Health: Lessons from Experience

Briefing 10 - Lessons from experience This document, commissioned by Public Health England, and written by the UCL Institute of Health Equity, sets out 12 points to consider when taking action locally on the social determinants of health. It is intended as a source of information on approaches to consider when devising local programmes and strategies to reduce health inequalities. It complements the other briefings and evidence reviews in this series, which provide more detail on action on specific social determinant areas, such as employment and early years interventions, including information on impacts and cost effectiveness where available. The 12 steps are divided across three parts. The first part sets out four strategies that help prioritise action on health equity. The next steps are principles of effective action on the social determinants of the health, presented in the second part. Finally, the steps in part three outline ways of ensuring that measures to increase health equity are sustainable and have impact over the long term. The briefing is available to download above. This document is part of a series. An overview document which provides an introduction to this and other documents in the series, and links to the other topic areas, is available on the ‘Local Action on health inequalities’ project page. A video of Michael Marmot introducing the work is also available on our videos page.

Understanding the Economics of Investments in the Social Determinants of Health

Briefing 9 - Understanding the economics of investments in the social determinants of health This document, commissioned by Public Health England, and written by the UCL Institute of Health Equity, examines how to use measures of economic investment to improve and increase local investment in the social determinants of health. The paper provides information to support decision-making on actions to address the social determinants of health and the development of business cases for investment. It supplements the evidence reviews in this series, which include information on the economic impacts of actions on health inequalities, and should help the reader to be an intelligent customer and commissioner of economic analyses and to understand their limitations. The paper covers: - The rationale for understanding, measuring and taking into account the economic impact of decisions and interventions that impact on the social determinants of health.- The benefits and limitations of various ‘economic measures of impact’ – commonly used terms which can be confusing, sometimes leading to misinterpretation of which measure of economic impact is appropriate for what purpose.- What is currently known about the economic impact of intervening in the social determinants of health.- Good practice and further resources which will support better decisions. The briefing is available to download above. This document is part of a series. An overview document which provides an introduction to this and other documents in the series, and links to the other topic areas, is available on the ‘Local Action on health inequalities’ project page. A video of Michael Marmot introducing the work is also available on our videos page.

A Study on Health Behaviours and Young People

Numerous reports have documented the health status of young people, concluding that the main threats to their health are predominantly the health risk behaviours and choices they make. Focussing on four of these, alcohol consumption, tobacco smoking, illicit drug use and sexual activity, this study seeks to assess their levels among a group of young people in Galway City with the aim of helping with the development of Health Education in these areas. In order to develop appropriate interventions, it is first of all necessary that accurate information on the extent of the problem, if any, be available. In 1989, studies on risk taking were carried out in the Muirhouse and Easterhouse areas of Glasgow and Edinburgh in Scotland. These areas were seen as underprivileged and had high and low rates of HIV infection respectively. In 1993, a similar study was carried out in the Westside area of Galway, an area which is also seen as under-privileged with high rates of unemployment. In 1996, a follow-up to the 1993 survey was carried out. This study also attempted to determine if there was a relationship between the behaviours reported and socio-economic class. This study is a follow-up to the previous two, with the addition that it attempts to investigate whether any relationship exists between the provision of health education in schools and subsequent health behaviour patternsThis resource was contributed by The National Documentation Centre on Drug Use.

A Survey of Health Service Utilisation and Health Needs of a Population of Patient with HIV/ AIDS

This study described the demographic and medical characteristics of a population of patients with HIV/AIDS attending the department of Genito-Urinary Medicine (GUM) at a major Dublin hospital. The study population's utilisation of statutory and voluntary medical and social services at primary care level, satisfaction with services received and perceived need for services examined. The information obtained was used to make recommendations concerning the provision of care to patients with HIV/AIDS. The study was carried out between February and November 1994. Data was collected from a consecutive sample of eighty inpatients using n interviewer-administered questionnaire which contained both closed and open questions. The first forty patients interviewed were reviewed six months following the initial interview to document changes in physical condition and uptake of medical services over that time period. Data for the second part of the study was obtained by review of the patients' medical case notes and interview with the individual hospital medical social worker assigned to each patient. Over ninety percent of respondents were from the Greater Dublin Area. Almost three quarters were intravenous drug users (IVDUs), and the majority of these patients came from south inner city Dublin. The methodology was biased towards sampling patients with advanced disease and 73% had CDC Stage 4 disease. Twenty percent required some assistance with the activities of daily living when first interviewed. Most were reliant on informal carers. Social and physical dependency increased substantially over the six month period of the follow-up study of forty patients. Financial difficulties were identified as a particular area of need. Only ten percent of those interviewed were in current employment and over 80% were dependent on statutory payments. There is a need for greater co-ordination between the providers of services to patients HIV/AIDS and an improved system of data collection regarding patients' uptake of services and unmet needs is required to assist in future service planning.This resource was contributed by The National Documentation Centre on Drug Use.

Dublin Simon Community health audit. The complexities of homelessness.

The Dublin Simon Community Health Audit took place during a one week period from Tuesday October 27th to Monday November 2nd 2009. During this one week period the survey was conducted with representative sample of people using Dublin Simon services to provide a snapshot picture of the presenting needs and issues Dublin Simon Community work with on a daily basis. The information gathered builds up a picture of the complex nature of both homelessness and the physical/mental health needs of those experiencing homelessness. Specifically it looks at the physical health issues, diagnosed and undiagnosed; mental health issues, diagnosed and undiagnosed; and drug and alcohol use of those using Dublin Simon services over this one week period.This resource was contributed by The National Documentation Centre on Drug Use.

Global status report on alcohol and health 2011

The Global status report on alcohol and health (2011) presents a comprehensive perspective on the global, regional and country consumption of alcohol, patterns of drinking, health consequences and policy responses in Member States. It represents a continuing effort by the World Health Organization (WHO) to support Member States in collecting information in order to assist them in their efforts to reduce the harmful use of alcohol, and its health and social consequences.This resource was contributed by The National Documentation Centre on Drug Use.

Changing the future: experiencing adolescence in contemporary Ireland: sexual health and behaviour.

If we create the space in which children and young people can talk openly and in their own language even upon challenging subjects such as sex, then we are likely to learn more from what they tell usâ?T proposes the final UNICEF Ireland report which examines adolescent perspectives on sexual health and behaviour. Key findings in the report included: 63%, and 1 in 5 sixteen year old respondents, reported that they have had sex; 1 in 5 sexually active respondents reported that they did not use a condom the first time that they had sex; 2 in 5 girls who were sexually active reported that they had consumed alcohol before their first sexual experience, compared to 3 in 10 boys; The majority of respondents (54%) reported that they had watched pornography on the internet, and more than one third of the respondents who had watched pornography on the internet believed that it was accurate or educational; Only 1 in 5 respondents reported that they ever speak to their parents about sex. Noting â?~the broad spectrum from which young people living in Ireland draw down information about sexâ?T the UNICEF Ireland report concludes that â?~we must be sure that when a young person is making decisions about their sexual health and behaviour, every opportunity is afforded them in terms of open discussion, understanding, support, information and adviceâ?T Commenting on the Report, Amel Yucef a Youth Health Coordinator at the Base Youth Centre, Ballyfermot said â?oAs the participants in UNICEF Irelandâ?Ts survey have shown, many young people do not feel equipped with the information and support they need to make informed choices about their sexual health. Providing those supports is a priority for us at the Base.â? The Youth Health Programme, that Amel co-ordinates is a HSE funded initiative which was created to respond to the health needs of young people, as identified by the young people of the Dublin 10 area themselves. The Programme delivers community-based and youth-friendly health responses, based upon a harm-reduction model. The Youth Health Programme works towards building the capacity of young people to access health services, while also encouraging those services to deliver in an accessible and youth-friendly way.This resource was contributed by The National Documentation Centre on Drug Use.

Mental health and growing up factsheet. Drugs and alcohol - what parents need to know.

Information about drugs and alcohol - what parents need to know: information for parents, carers and anyone who works with young people. About this leaflet This is one in a series of leaflets for parents, teachers and young people entitled Mental Health and Growing Up. These leaflets aim to provide practical, up-to-date information about mental health problems (emotional, behavioural and psychiatric disorders) that can affect children and young people. This leaflet offers practical advice for parents, teachers and carers who are worried that a young person is misusing drugs or alcohol. Why do I need to know about a young person using drugs or alcohol? Many young people smoke, drink alcohol and may try drugs. It is important you are aware of this and do not ignore it as a time when they are just having fun or experimenting. It doesnââ,‰"¢t take much for the young people to soon lose control and to need help to recover from this problem. How common is it? By the age of 16, up to half of young people have tried an illegal drug. Young people are trying drugs earlier and more are drinking alcohol. What are the different types of drugs which cause problems? The most commonly used, readily available and strongly addictive drugs are tobacco and alcohol. There are numerous others that can be addictive. Alcohol and cannabis are sometimes seen as ââ,¬Ëogatewayââ,‰"¢ drugs that lead to the world of other drugs like cocaine and heroin. Drugs are also classed as ââ,¬Ëolegalââ,‰"¢ andââ,¬Ëoillegalââ,‰"¢. The obviously illegal drugs include cannabis (hash), speed (amphetamines), ecstasy (E), cocaine and heroin. Using ââ,¬Ëolegalââ,‰"¢ drugs (like cigarettes, alcohol, petrol, glue) does not mean they are safe or allowed to be misused. It just means they may be bought or sold for specific purposes and are limited to use by specific age groups. There are clear laws regarding alcohol and young people. For more detailed information on various drugs, their side-effects and the law, see ââ,¬ËoFurther Informationââ,‰"¢ at the end of the factsheet. Why do young people use drugs or alcohol? Young people may try or use drugs or alcohol for various reasons. They may do it for fun, because they are curious, or to be like their friends. Some are experimenting with the feeling of intoxication. Sometimes they use it to cope with difficult situations or feelings of worry and low mood. A young person is more likely to try or use drugs or alcohol if they hang out or stay with friends or family who use them. What can be the problems related to using drugs or alcohol? Drugs and alcohol can have different effects on different people. In young people especially the effects can be unpredictable and potentially dangerous. Even medications for sleep or painkillers can be addictive and harmful if not used the way they are prescribed by a doctor. Drugs and alcohol can damage health. Sharing needles or equipment can cause serious infections, such as HIV and hepatitis. Accidents, arguments and fights are more likely after drinking and drug use. Young people are more likely to engage in unprotected sex when using drugs. Using drugs can lead to serious mental illnesses, such as psychosis and depression. When does it become addiction or problem? It is very difficult to know when exactly using drugs or alcohol is more than just ââ,¬Ëocasualââ,‰"¢. Addiction becomes more obvious when the young person spends most of their time thinking about, looking for or using drugs. Drugs or alcohol then become the focus of the young personââ,‰"¢s life. They ignore their usual work, such as not doing their schoolwork, or stop doing their usual hobbies/sports such as dancing or football. How do I know if there is a problem or addiction? Occasional use can be very difficult to detect. If the young person is using on a regular basis, their behaviour often changes. Look for signs such as: ïâ?s§ unexplained moodiness ïâ?s§ behaviour that is ââ,¬Ëoout of character' ïâ?s§ loss of interest in school or friends ïâ?s§ unexplained loss of clothes or money ïâ?s§ unusual smells and items like silver foil, needle covers. Remember, the above changes can also mean other problems, such as depression, rather than using drugs. What do I do if I am worried? If you suspect young person is using drugs, remember some general rules. ïâ?s§ Pay attention to what the child is doing, including schoolwork, friends and leisure time. ïâ?s§ Learn about the effects of alcohol and drugs (see websites listed below). ïâ?s§ Listen to what the child says about alcohol and drugs, and talk about it with them. ïâ?s§ Encourage the young person to be informed and responsible about drugs and alcohol. ïâ?s§ Talk to other parents, friends or teachers about drugs - the facts and your fears and seek help. If someone in the family or close friend is using drugs or alcohol, it is important that they seek help too. It may be hard to expect the young person to give up, especially if a parent or carer is using it too. My child is abusing drugs. What do I do? ïâ?s§ If your child is using drugs or alcohol, seek help. ïâ?s§ Do stay calm and make sure of facts. ïâ?s§ Don't give up on them, get into long debates or arguments when they are drunk, stoned or high. ïâ?s§ Donââ,‰"¢t be angry or blame themââ,‰?othey need your help and trust to make journey of recovery. Where can I get help? You can talk in confidence to a professional like your GP or practice nurse, a local drug project or your local child and adolescent mental health. They can refer your child to relevant services and they will be able to offer you advice and support. You may also be able to seek help through a school nurse, teacher or social worker. You can find this information from your local area telephone book or council website, or ask for the address from your health centre. [For the full factsheet, click on the link above]This resource was contributed by The National Documentation Centre on Drug Use.

Health at a glance: Europe 2012.

This second edition of Health at a Glance: Europe presents a set of key indicators of health and health systems in 35 European countries, including the 27 European Union member states, 5 candidate countries and 3 EFTA countries. The selection of indicators is based largely on the European Community Health Indicators (ECHI) shortlist, a list of indicators that has been developed by the European Commission to guide the development and reporting of health statistics. It is complemented by additional indicators on health expenditure and quality of care, building on the OECD expertise in these areas. Contents: Introduction 12 Chapter 1. Health status 15 1.1. Life expectancy and healthy life expectancy at birth 1.2. Life expectancy and healthy life expectancy at age 65 1.3. Mortality from all causes 1.4. Mortality from heart disease and stroke 1.5. Mortality from cancer 1.6. Mortality from transport accidents 1.7. Suicide 1.8. Infant mortality 1.9. Infant health: Low birth weight 1.10. Self-reported health and disability 1.11. Incidence of selected communicable diseases 1.12. HIV/AIDS 1.13. Cancer incidence 1.14. Diabetes prevalence and incidence 1.15. Dementia prevalence 1.16. Asthma and COPD prevalence Chapter 2. Determinants of health 49 2.1. Smoking and alcohol consumption among children 2.2. Overweight and obesity among children 2.3. Fruit and vegetable consumption among children 2.4. Physical activity among children 2.5. Smoking among adults 2.6. Alcohol consumption among adults 2.7. Overweight and obesity among adults 2.8. Fruit and vegetable consumption among adults Chapter 3. Health care resources and activities 67 3.1. Medical doctors 3.2. Consultations with doctors 3.3. Nurses 3.4. Medical technologies: CT scanners and MRI units 3.5. Hospital beds 3.6. Hospital discharges 3.7. Average length of stay in hospitals 3.8. Cardiac procedures (coronary angioplasty) 3.9. Cataract surgeries 3.10. Hip and knee replacement 3.11. Pharmaceutical consumption 3.12. Unmet health care needs Chapter 4. Quality of care 93 Care for chronic conditions 4.1. Avoidable admissions: Respiratory diseases 4.2. Avoidable admissions: Uncontrolled diabetes Acute care 4.3. In-hospital mortality following acute myocardial infarction 4.4. In-hospital mortality following stroke Patient safety 4.5. Procedural or postoperative complications 4.6. Obstetric trauma Cancer care 4.7. Screening, survival and mortality for cervical cancer 4.8. Screening, survival and mortality for breast cancer 4.9. Screening, survival and mortality for colorectal cancer Care for communicable diseases 4.10. Childhood vaccination programmes 4.11. Influenza vaccination for older people Chapter 5. Health expenditure and financing 117 5.1. Coverage for health care 5.2. Health expenditure per capita 5.3. Health expenditure in relation to GDP 5.4. Health expenditure by function. 5.5. Pharmaceutical expenditure 5.6. Financing of health care 5.7. Trade in health services Bibliography 133 Annex A. Additional information on demographic and economic context 143 Most European countries have reduced tobacco consumption via public awareness campaigns, advertising bans and increased taxation. The percentage of adults who smoke daily is below 15% in Sweden and Iceland, from over 30% in 1980. At the other end of the scale, over 30% of adults in Greece smoke daily. Smoking rates continue to be high in Bulgaria, Ireland and Latvia (Figure 2.5.1). Alcohol consumption has also fallen in many European countries. Curbs on advertising, sales restrictions and taxation have all proven to be effective measures. Traditional wine-producing countries, such as France, Italy and Spain, have seen consumption per capita fall substantially since 1980. Alcohol consumption per adult rose significantly in a number of countries, including Cyprus, Finland and Ireland (Figure 2.6.1).This resource was contributed by The National Documentation Centre on Drug Use.

A Pedagogical approach of schistosomiasis an experience in health education in Minas Gerais, Brazil

The experience described here is part of an extensive program that aims to stimulate schools to develop health integrated projects from theme generators, i.e., themes that have a meaning for the community. It was developed in Jaboticatubas, a town in the metropolitan region of Belo Horizonte, capital of the state of Minas Gerais, Brazil, and the focus was schistosomiasis. The selection was based on the expressive and historical prevalence of this disease in the county, which has been known as the "capital of schistosomiasis", in a national press release since the 1960's. Schistosomiasis is also a theme pointed out by teachers as requiring more information and methodologies to work with their students, most of them living in areas of high risk of transmission. In addition, during the last years, this disease has been transmitted silently through an increasing rural tourism in that region, requiring integrated and effective control actions. The developed strategy included four schools, whose teachers, students, and families took part in the process. It emphasizes in a critical pedagogy approach, which focuses on health issues as themes that may mobilize the school community and awake the population to a work which integrates environment, health, and citizenship. The results demonstrate that teachers and students not only acquired new knowledge and methodological skills, but also gained confidence in their ability to improve their health conditions. Thus, the project promotes a critical education that can result a more permanent effect on the control of schistosomiasis as well as other benefits for the schools and for the population.

Hiding the evidence: The State and spatial inequalities in health in Ireland

The Irish State has consistently reduced its production of publicly accessible disease / mortality maps over the last fifty years. State health statistics, and the small number of disease / mortality maps that have been produced in official publications, show a declining level of detail and are routinely out of date. Following a review of the production of disease / mortality maps in Ireland by the State and allied health agencies, two reasons are suggested for this decline. The first explanation relates to spatial inequalities in healthcare provision and to the absence of a health funding formulae in Ireland. The second explanation focuses on the potential politicisation of spatial inequalities in health status. Researchers in these fields are urged to disseminate information widely on spatial inequalities in healthcare provision, healthcare access and health status, both within and outside of the academic literature. Researchers in these fields are also urged to adopt an advocacy role on these issues, or to develop strategic alliances with such advocates.����

The Marmot Review: Updated data and information 2 years on

To mark the two year anniversary since The Marmot Review ('Fair Society, Healthy Lives') was published, on the 15th of February the UCL Institute of Health Equity published new data on key health inequalities indicators at local authority level in England.Main Findings:Life Expectancy – this has historically been one of the main indicators of health inequalities.The Marmot Indicators from this year’s charts show the average life expectancy for eachlocal authority and the level of inequality within each authority area (7):-While overall life expectancy at birth in England increased by 0.3 years for both menand women between 2007-9 and 2008-10, inequalities in life expectancy betweenneighbourhoods increased by 0.1 years for men and showed no change for women-Among the 150 upper tier local authorities in England, life expectancy improved inthe majority of cases (133 areas saw improvements for men and 125 sawimprovements for women). However inequalities also increased in the majority ofareas (104 for men and 92 for women).-The largest increase in inequality in life expectancy was in West Berkshire for men(2.0 years) and inMiddlesbrough for women (2 years). The largest decreases ininequality were in Kensington and Chelsea for both men and women (1.9 and 1.1years respectively. To find out more, please read: - The press release, including key figures and main findings. - A blog by Michael Marmot about the data and it's implications. - Press coverage of the data in national and local newspapers and websites. - A powerpoint presentation on the key findings.