bluuebunny/crossref_metadata_2025 huggingface dataset:
Europeans’ willingness to pay for ending homelessness: a contingent valuation study
Authors: Loubiere S , Tinland A , Taylor O , Loundou A , Auquier P , Ornelas J
Published: November 2019

Objective

In Europe, 4 million people were homeless in 2009. The Staircase model of care targeted mental health, drug rehabilitation and housing readiness yields poor long-term housing results. Western countries are investing in a new model, Housing First (HF), which yields better clinical and social results. We aim to explore how much the European citizens are willing to pay for the HF model and what are the determinants of this valuation.

Methods

A nationally representative telephone survey conducted in 2017, targeted European adult citizens from France, Ireland, Italy, Netherlands, Portugal, Spain, Poland and Sweden. Respondent’s willingness-to-pay (WTP) (n = 5,631) for HF model was assessed through a contingent valuation method with bidding algorithm. Multivariate analyses using two-part models with a cluster and weighted design were conducted to predict: 1/ respondents’ refusal or incapacity to pay for the HF model; 2/ willingness-to-pay (continuum) for the HF model.

Results

42.3% of respondents were willing to pay more taxes to reduce homelessness through HF model; 30.3% were protest zero (don’t want to pay taxes (either contested the payment vehicle-taxes- or the survey instrument); huge differences being observed between countries (P<.001). Respondents were willing to pay €57 (+/- 9) through annual taxes for the HF model. Respondents with higher educational attainment, paying taxes on income, reporting positive attitudes about homelessness or practices to reduce homelessness (donations, volunteering), and those residing in a country with higher share of social protection expenditures on family benefits or higher at-risk-of-poverty rate were more likely to value the HF model.

Perspective

These results provide key stakeholders with an understanding of the level of support from the general population for the Housing First model; especially since the determinants of this valuation were studied according to the social and environmental context of each country.

Key messages

More than 42% of European citizens reported to be willing to pay for reversing homelessness. More than a three quarter of European citizens thought that Government spending on Homelessness is too little.
In the search of solutions to improve healthcare access for migrants and refugees in Athens, Greece
Authors: Gionakis N , Ntetsika M
Published: November 2019

Background

Migrants and refugees face many challenges in their effort to access the health services. The Metaplan© methodology was applied to generate and prioritize solutions and tools for pilot interventions to improve migrants’ healthcare access in Athens. Methods. The Metaplan sessions included three groups: professionals working with refugees and migrants, mixed gender French-speaking migrants and refugees, and unaccompanied minors (11-16yrs).

Results

Professionals prioritized the communication issue, particularly a proper delivery of the language courses, and the enhancement of cultural competence in professionals. Besides, the instrumentalization of ‘vulnerability’ was focused on the relocation assessment. They suggested trainings to improve the collaboration between interpreters and professionals and build cultural competence, along with creation of migrant-friendly hospitals. The migrants underscored a gap between their needs and the current efforts to support their integration, such as language courses, job consultancy, and general information. Their access to health services was hindered by the lack of language skills and intercultural competences of providers. The migrants prioritized initiatives to overcome the challenges of everyday life, raise awareness and sensitize the local community on their realities, and tackle racism. The unaccompanied minors underlined the lack of shelters and a long bureaucratic procedure for the placement in a shelter as some experienced homelessness. They also pointed out the inefficiency of emergency health services. The solutions as perceived by this group included a proper assignment of homeless minors to shelters, better emergency units and more information about the health services.

Conclusions

The trainings for both health professionals and interpreters for the interdisciplinary cooperation and enhanced cultural competence are needed, along with informative workshops and flyers on health rights and services.
Research Implications for future telemedicine studies and innovations
Authors: Timpel P , Harst L
Published: November 2019

Despite the increasing application of information and communication technologies (ICT) in health care, robust data on the effectiveness and implementation of digital health solutions is lacking. Therefore, the objective of this analysis is to identify and categorise implications for future research in order to inform policy and practice decisions.

Systematic reviews and meta-analyses of RCTs evaluating the effectiveness of telemedicine in chronic diseases, all identified via a recent umbrella review, were used as primary sources of information. Qualitative content analysis following Mayring (2000) was used to categorize future research topics mentioned in the discussion sections and conclusions of included research published after 2015. Parallel, independent data extraction and coding using inductive category development was performed by two researchers with previous coding experience. Any disagreements were solved by discussion.

Of the 25 included systematic reviews and meta analyses, 23 reported on future research implications. They were categorised as follows: (1) Need for high quality studies including specific outcome measures; (2) Need for comprehensive technology assessment; (3) Need for in-depth considerations of patients’ characteristics & more diverse study populations; (4) Ethics & Safety; and (5) Translation & implementation strategies. A codebook comprising descriptions and examples of those categories and sub-categories was developed.

Results show a need for larger and more rigorous studies with longer intervention durations, mid- to long-term follow-ups as well as more heterogeneous study populations. More pragmatic study designs to evaluate multimodal and tailored interventions like telemedicine solutions are needed to develop an improved understanding on mechanisms and target-group specific effectiveness.

Key messages

We need a stronger focus on relevant and well-designed studies to improve the impact of telemedicine trials. Identified needs have the potential to inform future guidelines for the use of telemedicine.
Will the world be obese in 2050?
Authors: Borisch B
Published: November 2019

The workshop will be started by B. Borisch by providing a critical analysis of the obesity problem and approaches adopted.
The Italian case – reversing the obesity trend
Authors: Ricciardi W
Published: November 2019

W. Ricciardi will present the Italian scenario with a critical analysis of the causes and approaches that are needed/on going to reverse the obesity increase trend in a country always associated to healthy food.
Workshop: Quantifying burden of disease to support public health policy: exchange of views and experiences
Authors:   Organised by: University of Bordeaux Chair persons: François Alla - France, Jean-Claude Désenclos - France
Published: November 2019

Information on disease burden, risk factors, related healthcare costs and their variations over time represents a major concern for public health decision makers. These data could contribute to define priorities and strategies, to allocate resources and to evaluate health policies and interventions at regional and national levels. In this context, the use and synthesis of all available data is essential, whether these data were collected for the purpose of epidemiological surveillance, healthcare, research, and/or reimbursement. This process raises conceptual and methodological issues. The question of the use of these data by decision-makers is also essential and depends not only on their validity, but also on their credibility, their usability, and their capacity to respond to needs in the context of decision. There are now national experiences of production and use of these data. There are also international collaborations. In particular, the Global Burden of Disease (GBD) Study is an extremely structured process with extensive global collaboration.

The aim of this workshop is to exchange and share experiences on the different approaches, indicators, methods used in order to quantify the burden of disease; the use of health insurance databases as a source of data for quantifying burden of disease; the use of burden of disease information by public health decision-makers at national and local levels.

Key messages

Disease burden statistics are a resource for data-informed policy-making. Health insurance databases are a complementary source for quantifying disease burden.
The GBD project
Authors: James S
Published: November 2019

Presentation of the GBD project including data sources and methods, how it can be used to set priorities and develop a national public health policy.
Participation of disadvantaged school age children (7-18) in health inequality projects
Authors: Jovanovic M
Published: November 2019

The descriptive research was conducted in the period from September until December 2018 involving projects tackling health inequalities of children 8-17 years old. The sample included 10 projects funded by the Directorate General for Health and Consumer Protection from its 3rd Health Programme (2014-2020) listed on the Consumers, Health, Agriculture and Food Executive Agency website. The study methods involved desk review of 10 selected projects, 6 semi-structured questioners and 6 interviews. Data were analyzed according to 4 participatory principles: relationship building, storytelling, strategizing action and supporting organizational structures to support execution of these actions, as outlined in the Leadership, Organizing and Action: Leading Change course thought by the Harvard School of Public Health.

Results

The preliminary finding is that none of the ten selected projects have identified children 7-18 years old as a primary target group. Majority of the projects (4 out of 6) involve sort of relationship building with children, while storytelling is used by a smaller number of projects (2 out of 10). All projects (6 out of 6) involve children just in the implementation phase focusing on educating children and none of them in the project design phase. Moreover, children covered by the implementation are mainly included through schools (8 out of 10) due to a missing parent consent for interacting with most disadvantaged children that are not in schools.

Conclusions

There is a serious lack of awareness on the importance of meaningfully engaging disadvantaged children in health programming processes for decreasing existing health inequalities. Due to a significant lack of meaningful participation of disadvantaged children in majority projects tackling health inequalities of school-age children in Europe there is a serious risk of having these inequalities increased rather than overcome, despite significant financial and human investments.

Key messages

The most disadvantaged children should be meaningfully engaged in design, implementation and evaluation of health inequality projects that are of their immediate concern. There is a need for more in depth research on health inequalities faced by school age children (7-18) that are out of educational system.
Use of e-cigarettes by young people in Great Britain before and after Tobacco Products Directive
Authors: Moore G , Brown R , Page N , Hallingberg B , Gray L , Maynard O , McKell J , Bauld L
Published: November 2019

Background

Young people’s experimentation with e-cigarettes has increased in recent years, although regular use remains rare. In May 2016, the EU Tobacco Products Directive (TPD) introduced regulations aimed in part at preventing use by young people. It imposed warnings on e-cigarette packets, banned many forms of advertising, and restricted nicotine strength. This paper examines change in young people’s e-cigarette use after TPD, as well as complementary and alternative causal explanations for change, from young people’s perspectives.

Methods

Quantitative data sources were 2013, 2015 and 2017 School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and 2014 and 2016 Smoking Drinking and Drug Use surveys in England. Data were analysed using segmented binary logistic regression in Wales, with simpler before and after analyses in England. Results were considered alongside qualitative interview data from young people aged 14-15 years in England, Wales and Scotland, collected in 2017 and 2018.

Results

Ever-use of e-cigarettes almost doubled from 2013-15, though subsequent increases were smaller. In Wales, where pre-legislation time series data were available, under a range of assumptions, prior growth in e-cigarette ever-use did not continue post-TPD. Change in trend post-TPD did not reach significance (OR = 0.96; 95%CI=0.91 to 1.01), but became significant after adjusting for change in smoking rates across the time-series (OR = 0.93; 95%CI=0.88 to 0.98). Regular use did not increase significantly from 2015 to 2017 in Wales, although ever and regular use in England both increased from 2014 to 2016. Young people described limited interactions with core components of TPD, while commonly describing e-cigarette use as a fad which was beginning to run its course.

Conclusions

Growth in youth experimentation with e-cigarettes may be slowing. Qualitative data from young people provide a range of explanations which appear largely unrelated to TPD itself.

Key messages

Survey data provide preliminary evidence that use of e-cigarettes may be plateauing among young people in the UK after a rapid initial increase in experimentation. Explanations position e-cigarettes as a passing fad which is beginning to lose its appeal in UK youth. Longer term monitoring of trends and perceptions remain vital.
Multimorbidity and quality of life: longitudinal analysis of the European SHARE database
Authors: Makovski T , Le Coroller G , Putrik P , Stranges S , Huiart L , Zeegers M , van den Akker M
Published: November 2019

Multimorbidity defined most commonly as co-existence of 2+ diseases is one of the major challenges of an ageing society. It is often accompanied with declining quality of life (QoL). The study aims to 1) assess the relationship between increasing number of diseases and QoL over time, 2) explore the differences between several European countries. Longitudinal data analysis performed on the relevant waves (2004 to 2017) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Data were collected every two years among participants aged 50+. Health conditions were identified through an open-end questionnaire containing 17 prelisted conditions. QoL was evaluated by Control, Autonomy, Self-Realization and Pleasure questionnaire (CASP-12v). Maximum QoL score, describing the best state was 48; minimum, 12 points. Association between increasing number of diseases and QoL is being assessed with multilevel analysis accounting for time and clustering within household and country. Minimum follow-up is 2 time points. Confounding variables include age, sex, socio-economic status, social support and health care parameters.

Preliminary findings show that 20 countries and 87,087 individuals participated in at least 2 waves; 80,041 answered CASP at least twice. Number of diseases when first reported was on average 1.65 (IQR=0,2) and increased to 1.88 (IQR=1,3) when last reported. Similarly, between first and last reported point QoL decreased on average by -0.32 (SD: ± 5.9); estimated by non-rescaled CASP scale. Greece showed the strongest decrease of -1.73 (SD: ± 6.36), while QoL increased in some countries, the most in Portugal for 0.76 (SD: ± 5.62).

Our preliminary findings suggest high geographic variations in QoL, possibly driven by differential clustering of multimorbidity across Europe, design issues and other factors. This may underline the need for country-specific analysis and initiatives to address the growing burden of multimorbidity in our ageing populations.

Key messages

First longitudinal study to address this research questions across wide range of European countries using SHARE. Study accounts for large number of confounding factors owing to the abundance of collected information.
Distribution of Cancer cases and survival analysis results: A retrospective cohort study
Authors: Pehlivan E , Mete B , Söyiler V
Published: November 2019

Background

Cancer was the second leading cause of death in Turkey. The aim of this study is to examine the changes in the incidence of cancer cases and survival analysis in a region.

Methods

This retrospective cohort study was carried out on data of 977 people had been diagnosed with cancer between the years 2013-2015 in Bingol province located in the east of Turkey. All cancer cases are included in the study. The data of the patients were obtained from the Ministry of Health Cancer Registry System and International Disease Classification Oncology (ICD-O) codes published by World Health Organization were used. Patients were evaluated topographically (tissue originating from the lesion) in 41 categories. Kruskal Wallis, Mann Whitney U test, Chi-square test and Cox regression analysis were used to analyze the data.

Results

The mean age of the patients was 58.73 ± 16.80 (min: 1-max: 107). It was observed that 28.7% of the patients died during the follow-up period and 71.3% of the patients were alive. 30% of the cancer cases digestive system, 11% respiratory system, 23% female breast- genitalia, 15% blood-lymph-thyroid, 11.8% muscle-bone, 15,4% other cancer species. In men, lung, stomach, colon, prostate; breast, thyroid and skin cancers are more common in women respectively. The incidence rate for all age groups was 97 per hundred thousand in 2013, 161 per hundred thousand in 2015. The increase trend did not differ by gender. The mean follow-up period of the patients who died was 388 days and 1541 days for the living patients. The risk of death is increased significantly in patients who cannot be operated (RR = 2.779, HR = 3.048). In patients not receiving chemotherapy, the risk of death is reduced significantly (RR = 0.656, HR = 0.340).

Conclusions

The incidence of cancer increases in the study area. Survival times vary according to treatment efficacy. Broad-based cohort studies evaluating the effects of treatment types on survival may be recommended.

Key messages

Cancer in the study area shows a significant increase from year to year. The average 5-year survival period of cancer patients was found is 71% as a good result.
Association between cancer and neurodegenerative disorders including dementias; a systematic review
Authors: Gagatsis L G , Ford E F , Bremner S B , Paudyal P P
Published: November 2019

Background

Several studies have examined associations between neurodegenerative disorders (ND) including dementia, and cancer. However, the associations and directions of these relationships vary by types of ND and cancer. In the current context of ageing populations and increased incidence of ND, dementia and cancer, and existing comorbidity between these disease groups, a better understanding of these relationships could, in future, inform prevention and therapeutics. This systematic review summarises the epidemiological evidence on these associations.

Methods

PubMed, MEDLINE, Embase, Scopus and Web of Science were searched to identify relevant studies published by 31/12/2018. The search strategy included a combination of search and MESH terms related to ND (e.g. Alzheimer’s, dementia), cancer and study design (case-control, cohort). The quality of included studies was assessed using the Newcastle-Ottawa scale (NOS).

Results

77 studies were eligible for inclusion. The majority of studies scored 6+ on the NOS scale and some reported significant associations between ND and cancer. The association with specific types of cancer was not as evident as with all cancers. An inverse relationship was found between NDs and particularly Alzheimer’s, Parkinson’s, and Dementia and Cancer. Only one study found no association between Vascular Dementia and Cancer.

Conclusions

The findings report an overall inverse association between NDs and all cancers but associations are less evident with specific cancer types. Results from this review can be helpful in recommending reporting standards for future research to reduce heterogeneity between studies.

Key messages

Exploring the intersection of neurodegenerative disorders/dementia and cancer might help redirect research to novel therapeutic approaches. A standardised approach in design and outcome measurement is necessary to reduce heterogeneity across the studies.
Impact of deprivation on hospital efficiency and financial balance in paediatrics
Authors: Michel M , Alberti C , Carel J C , Chevrel K
Published: November 2019

Background

In healthcare systems where hospital tariffs are based on average national length of stay (LOS), deprived patients may be a source of inefficiency for hospitals as deprivation has been shown to be associated with increased LOS. They may also negatively impact hospitals’ financial balance as few hospital payment methods include deprivation. Our objective was to study the impact of deprivation on hospital efficiency and financial balance.

Methods

A study was carried out using an exhaustive national hospital discharge database. All inpatient stays in mainland France between 2012 and 2014 by children over 28 days and under 18 in hospitals with a paediatric ward were included. Deprivation was estimated with an ecological deprivation index divided into national quintiles. Efficiency was assessed by variations in patients’ LOS compared to different mean national LOS (paediatric LOS, LOS of admissions for a similar condition...). Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level with the difference between all revenues and production costs for said hospital. Multivariate models assessed the association between those indicators and deprivation.

Results

4,124,510 inpatient stays were included. LOS was shorter than national means for less deprived patients and longer for the more deprived, and the difference was higher for diagnosis-related groups (DRGs) that included both adult and paediatric patients compared to paediatric-only DRGs. The multivariate model confirmed those significant associations. Deprivation also had a significant impact on hospitals’ financial balance, especially for hospitals with a percentage of paediatric patients in the two most deprived quintiles between 20% and 60%.

Conclusions

Measures to reform hospital payment methods must be encouraged to improve resource allocation efficiency and equity in access to good paediatric care.

Key messages

A reform of hospital funding to better account for deprivation is needed. A modulation of tariffs using an allocation key at the patient level must be considered to mitigate the effect of deprivation. DRGs specific to children should be encouraged to become the norm rather the exception to provide an adequate picture of resources used during admission and therefore an appropriate tariff.
The effect of an mhealth clinical decision-making support system on neonatal mortality in Ghana
Authors: Amoakoh H B , Klipstein-Grobusch K , Agyepong I A , Zuithoff P , Amoakoh-Coleman M , Kayode G A , Sarpong C , Reitsma J B , Grobbee D E , Ansah E K
Published: November 2019

Background

Mhealth interventions promise to bridge gaps in clinical care but documentation of their effectiveness is limited. We evaluated the utilization and effect of an mhealth clinical decision-making support intervention that aimed to improve neonatal mortality in Ghana by providing access to emergency neonatal protocols for frontline health workers.

Methods

In the Eastern Region of Ghana, sixteen districts were randomized into two study arms (8 intervention and 8 control clusters) in a cluster-randomized controlled trial. Institutional neonatal mortality data were extracted from the District Health Information System-2 during an 18-month intervention period. We performed an intention-to-treat analysis and estimated the effect of the intervention on institutional neonatal mortality (primary outcome measure) using grouped binomial logistic regression with a random intercept per cluster. This trial is registered at ClinicalTrials.gov (NCT02468310).

Results

There were 65,831 institutional deliveries and 348 institutional neonatal deaths during the study period. Overall, 47·3% of deliveries and 56·9% of neonatal deaths occurred in the intervention arm. During the intervention period, neonatal deaths increased from 4·5 to 6·4 deaths and, from 3·9 to 4·3 deaths per 1,000 deliveries in the intervention arm and control arm respectively. The odds of neonatal death was non-significantly higher in the intervention arm compared to the control arm (odds ratio 2·10; 95% CI (0·77;5·77); p = 0·15). The correlation between the number of protocol requests and the number of deliveries per intervention cluster was 0·71 (p = 0·05).

Conclusions

Non-significant higher risk of neonatal death observed in intervention clusters may be due to problems with birth and death registration, unmeasured and unadjusted confounding, and unintended use of the intervention. The findings underpin the need for careful and rigorous evaluation of mhealth intervention implementation and effects.

Key messages

Supposedly effective interventions must be evaluated in context before they are scaled-up. Mechanisms influencing outcomes in context must be considered in the design and evaluation of interventions.
Best practices and training for preparedness and response at airports
Authors: Heidrich J , Angrén J , Schwarz D , Klahr A , Dirksen-Fischer M
Published: November 2019

Introduction

Airports are important points of entry (PoE). More than 2.5 billion passengers pass through Europe’s airports every year. The nature of airports provides manifold opportunities for interactions among persons from all over the world and their environment with the potential for exposure, transmission and spread of infectious disease. Therefore, training, preparedness and response (P&R) to public health risks and events at airports are of utmost importance. The EU Joint Action Healthy Gateways airports branch (HGair) aims to strengthen P&R at airports in a multidisciplinary way.

Methods

Based on the international health regulations (IHR) and on previous research, HGair investigates P&R using a multi-method approach and offers a variety of training activities. A survey to identify best practices on IHR core capacities, event detection, surveillance, management and contingency planning at airports is being carried out. Training methods include face-to-face trainings on European, national and local level, table-top and simulation exercises as well as web-based training.

Results

Main results of HGair are best practice catalogues, a tool for contingency plan development and assessment at airports, a depository of P&R training materials and table top/simulation exercises, standardized operation procedures for vector control at airports and for inspection of aircrafts for vectors, a web-based platform and network of experts to communicate and notify rapidly in case of cross-border risks to health at airports and in air travel. So far, completed questionnaires (n = 14) on best practices in P&R were received from designated airports in 13 European countries, showing variations in reported practices.

Conclusions

European airports report different P&R practices. Deliverables and results of HGair provide the opportunity to strengthen IHR core capacities at airports and to harmonize surveillance and management of cross-border health threats in the air travel sector.
Untethered lives: Barriers to societal integration as predictors of the sexual orientation disparity in suicidality
Authors: Bränström R , van der Star A , Pachankis J E
Published: November 2019

Background

Despite increasing legal protections and supportive attitudes toward sexual minorities (e.g., those who identify as lesbian, gay, and bisexual [LGB]) in recent decades, suicidality remains more common among this population than among heterosexuals. While barriers to societal integration have been widely theorized as determinants of suicidality for the general population, they have not been comprehensively explored to explain the sexual orientation disparity in suicidality and/or compared to more established contributors.

Methods

Data come from the cross-sectional Swedish National Public Health Survey, which randomly collected data from individuals (16-84 years of age) annually from 2010 to 2015 (1,281 (2.2%) self-identified as LGB). Analyses examined sexual orientation differences in suicidality (i.e., past-12-month ideation and attempts), and explored the role of barriers to societal integration (i.e., not living with a partner or children, unemployment, and lack of societal trust) in explaining this disparity over-and-above more commonly explored psychological (e.g., depression, substance use) and interpersonal (e.g., discrimination, victimization, lack of social support) suicidality risk factors.

Results

Compared to heterosexuals, suicidal ideation and attempts were more common among both gay men/lesbians (AORideation: 2.51; AORattempts: 4.66), and bisexuals (AORideation: 3.76; AORattempts: 6.06). Barriers to societal integration mediated the association between sexual orientation and suicidality even in models adjusting for established risk factors for suicidality.

Conclusions

The disproportionate barriers to societal integration that LGB individuals experience seem important contributors to the elevated risk of suicidality among sexual minorities. Preventive interventions should consider innovative ways to foster societal integration within sexual minority populations and to adjust hetero-centric social institutions to better include sexual minorities.
Sex, age and socioeconomic inequalities in older people’s unscheduled care
Authors: Levin K , Crighton E
Published: November 2019

Background

In Scotland, unscheduled care is usually received at hospital accident and emergency (A&E) departments or referral by GPs to medical assessment units (MAU). Almost a quarter attendances are for those aged 65 years+. Demand for unscheduled care will increase as the population ages. This study measures inequalities in unscheduled care presentations among those aged 65 years+.

Methods

A&E and MAU attendance data between April 2017 and March 2018 for Glasgow residents were analysed. Data were modelled using poisson modelling for outcome measures attendances, rate of attendance and length of stay, adjusting for agegroup, sex and deprivation. A second set of models also adjusted for time of day, month and referral source, including interaction terms.

Results

While there was a higher number of attendances among females (RR and 95% CI = 0.30 (0.28, 0.32)), and among those aged 65-69 years compared with older ages (RR = 0.03 (0.01, 0.06)), modelling rates showed that males were significantly more likely to attend (RR = 0.14 (0.13, 0.16)) and that likelihood rose with age, eg RR for 85+ years significantly greater than 80-84 years, significantly greater than for 75-79 years etc. There was no gender difference in length of stay but this increased with increasing age. Attendance was significantly more likely for those living in the most deprived quintile of deprivation (RR = 0.30 (0.27, 0.34) compared with the most affluent quintile). SES inequalities in attendance and length of stay became less pronounced with increasing age. Referrals via 999 emergency services increased with age while referrals by GP and NHS24 reduced with age. Attendance was more likely in December (RR = 0.15 (0.11, 0.18)) and likelihood of a morning attendance reduced significantly with increasing age and deprivation.

Conclusions

Inequalities in attendance, length of stay and methods of referral are observed which should be considered when planning to meet the demand for unscheduled care.

Key messages

Age, sex and socioeconomic inequalities in unscheduled care exist even at the oldest ages. When planning to meet the demand of future unscheduled care, patterns of current use and population projections should be considered in tandem.
Body mass index and mortality in relation to age and follow-up of 30 years in large Austrian cohorts
Authors: Nagel G , Peter R S , Föger B , Concin H
Published: November 2019

Background

Obesity and its health consequences will dominate health care systems in many countries during the next decades. Prevention programs have been implemented. However, the optimum body mass index (BMI) in relation to all-cause mortality on population level is still a matter of debate.

Material and Method

Data 1/1989-6/2005 of the Vorarlberg Health Monitoring & Prevention Program (VHM&PP,) and 8/2005-12/2015 for Vorarlberg provided by the Main Association of Austrian Social Security Institutions were analyzed. In both cohorts, information was available on age, sex, measured height and weight as well as the date and cause of death. Generalized additive models were used to model the mortality rate as function of calendar time, age and follow-up.

Results

The VHM&PP cohort consisted of 85,488 men and 99,873 women and the later of 129,817 men and 152,399 women. In the second cohort, men (mean age 48 (SD16.9) vs. 45.3 (SD 15.5) and women (48.3 (SD 17.7) vs. 45.6 (SD 16.6) years) were slightly older than in the VHM&PP cohort. The average BMI was slightly higher in men (26.1 (SD4.0) vs. 25.7 (SD3.8) kg/m2) but not in women (24.6 (SD 4.8) vs. 24.7 (SD 4.9) kg/m2), respectively. In the VHM&PP cohort more ever smokers were found in both men (40.3 vs. 22.4%) and women (24.8 vs. 18.4%) than in the subsequent cohort.

BMI optimum increased slightly between 1985 and 2015, from 24.9 (95%-CI: 24.0-25.9) to 26.4 (25.3-27.3) in men and from 22.4 (21.8-23.1) to 23.3 (22.5-24.5) kg/m2 in women. However, age and follow-up had major impact on the increase. In younger age the associations are quite stable, while in men over 50 years and in women over 60 years the BMI optimum decreased with length of follow-up.

Conclusions

Overall the BMI optimum increased slightly over time. However, age and follow-up had major impact on the association. These results suggest, that prognosis of obesity related diseases has improved over time. To detangle this further research is necessary.

Key messages

In Austria the BMI optimum increased slightly over time. Age and follow-up time had major impact on the association.
Association between psychosocial stress and obesity among migrant and non-migrant Ghanaians
Authors: Baratin C , Beune E , van Schalkwijk D , Agyemang C
Published: November 2019

Background

Psychosocial stress is associated with obesity in some populations, but it is unclear whether the association is related to migration.

Aim

This study explored associations between psychosocial stress and obesity among Ghanaian migrants in Europe and non-migrant Ghanaians in Ghana.

Methods

Cross-sectional data from the RODAM study were used, including 5898 Ghanaians residing in Germany, the UK, the Netherlands, rural Ghana, and urban Ghana. Perceived discrimination, negative life events and stress at work or at home were examined in relation to body mass index (BMI) and waist circumference (WC). Linear regression analyses were performed separately for migrants and non-migrants stratified by sex.

Results

Perceived discrimination was not associated with BMI and WC in both migrants and non-migrants. However, negative life events were positively associated with BMI (β = 0.78, 95% CI, 0.34 to 1.22) and WC (β = 1.96, 95% CI, 0.79 to 3.12) among male Ghanaian migrants. Among non-migrant Ghanaians, in contrast, stress at work or at home was inversely associated with BMI and WC in both males (β=-0.66, 95% CI, -1.03 to -0.28; β=-1.71 95% CI, -2.69 to -0.73, respectively) and females (β=-0.81, 95% CI, -1.20 to -0.42; β=-1.46, 95% CI, -2.30 to -0.61, respectively).

Conclusions

Negative life events are associated with increased body weight among Ghanaians in European settings, whereas stress at work or at home is associated with reduced body weight among Ghanaians in Ghana. More work is needed to understand the underlying factors driving these differential associations in order to assist prevention efforts.

Key messages

Negative life events are associated with increased body weight among Ghanaians in European settings, whereas stress at work or at home is associated with reduced body weight among Ghanaians in Ghana. More work is needed to understand the underlying factors driving these differential associations in order to assist prevention efforts.
Association between detection of non-diabetic hyperglycaemia and vascular complications
Authors: Palladino R , Tabak A G , Khunti K , Valabhji J , Majeed A , Millett C , Vamos E P
Published: November 2019

Background

The benefit of screening for non-diabetic hyperglycaemia (NDH) is still debated. Furthermore, the associated risk of vascular complications following a diagnosis of Type 2 diabetes (T2D) in people previously detected as NDH in real-world settings is not known. We examined the presence of vascular disease in newly diagnosed T2D individuals by glycaemic status within 3 years of diagnosis.

Methods

We identified 159,736 individuals diagnosed with T2D from the Clinical Practice Research Database in England between 2004 and 2017. We used logistic regression models to compare presence of microvascular (retinopathy and nephropathy) and macrovascular (coronary artery events, cerebrovascular and peripheral arterial disease) disease at the time of T2D diagnosis by prior glycaemic status. Models were adjusted for age, sex, ethnicity, deprivation, smoking status, blood pressure, cholesterol, and number of primary care visits.

Results

There was a strong association between baseline glycaemic status and presence of microvascular complications at diabetes diagnosis (normoglycaemia 30.7%, no glycaemic test 36.7%, NDH 42.4%). Similarly, prevalence of macrovascular disease was lower for those with normoglycaemia(26.9%) compared with NDH(29.8%). Compared with individuals with normoglycaemia, those detected with NDH before the diagnosis of T2D had 76% and 53% increased odds of retinopathy and any microvascular complications (AOR 1.76, 95%CI 1.69-1.85; AOR 1.53, 95%CI 1.41-1.65), and 7% higher odds of diagnosis of acute coronary events (OR 1.07, 95%CI 1.03-1.12) at time of diagnosis of T2D.

Conclusions

Microvascular and macrovascular diseases are detected in 40 and 20% of newly diagnosed T2D. NDH before the diagnosis of T2D was more likely associated with microvascular complications and acute coronary events. Detection of NDH might represent opportunities for reducing the burden of microvascular disease through heightened attention to screening for microvascular complications.

Key messages

Detection of non-diabetic hyperglycaemia before the diagnosis of Type 2 diabetes was more likely associated with microvascular complications and acute coronary events. Detection of non-diabetic hyperglycaemia might represent opportunities for reducing the burden of microvascular disease through heightened attention to screening for microvascular complications.
Strategies and practical examples
Authors: Schmitt T
Published: November 2019

Various tools and mechanisms can help to increase the use of scientific evidence in policy development by making policymakers appreciate, understand and incorporate such scientific information into policy decisions. As part of this process, it is crucial that researchers and public health practitioners acquire the ability to translate their knowledge and become skilled on communicating the evidence effectively.

The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health-care systems in Europe. It engages directly with policy-makers and experts, and works in partnership with research centers, governments and international organizations to analyze health systems and policy trends.

In this presentation, concrete strategies will be given for advocating scientific evidence. The focus will lie particularly on the process of real-life applications of evidence-informed policy-making. By this way, it will help the participants to analyze to whom they are targeting, what are their interests and how to communicate scientific information to a decision-maker effectively based on specific examples from the European Observatory on Health Systems and Policies.
Earnings among people with multiple sclerosis in Sweden, by education and occupation
Authors: Murley C , Wiberg M , Tinghög P , Alexanderson K , Palmer E , Hillert J , Stenbeck M , Friberg E
Published: November 2019

Background

Multiple sclerosis (MS) may affect the individual’s working life. We aimed to 1) investigate the mean levels and distributions of earnings among people with MS (PwMS) before and after MS diagnosis compared to people without an MS diagnosis, and whether such differences in earnings were associated with educational level or occupation and 2) assess the prevalence of sickness absence (SA) and disability pension (DP).

Methods

Population-based cohort study (10 years prior to 5 years after MS diagnosis) using microdata linked from nationwide Swedish registers of all individuals aged 30-54 with MS diagnosed in 2003-2006 (n = 2553) and references without MS (n = 7584) randomly selected by stratified matching (sex and age). Annual mean earnings, by educational level and type of occupation, were compared with t-tests. Tobit regressions investigated the associations of earnings with individual characteristics. Lastly, the proportions on SA and DP, stratified by educational level and type of occupation, were examined in the diagnosis year and 5 years later.

Results

Differences in earnings between PwMS and references were observed beginning one year prior to diagnosis and increased with time. PwMS had lower mean earnings for the diagnosis year (difference=SEK 28,000, p-value<0.05), and the difference had more than doubled (p-value<0.05) 5 years later. These differences remained after taking educational level and type of occupation into account. PwMS with university education and/or more qualified occupations had mean earnings most like their respective references’. PwMS had higher prevalence of SA and DP than the references, in both the diagnosis year and 5 years later.

Conclusions

Earnings of people with MS were lower than references’ already one year before diagnosis, and the gap increased thereafter. Results indicate that educational level and type of occupation are of importance for earnings. Moreover, SA and DP were more common among people with MS.

Key messages

Our results indicate that working-aged people with MS have less earnings than references already one year before diagnosis and that thereafter this gap in earnings increases with time. Education and occupation were influential in explaining the people with MS’ heterogeneous earnings, with a hierarchal ordering of who maintained similar earnings to their respective peers.
Implementation of health promotion activities in mental health care in Denmark
Authors: Møller J E , Møller A , Ledderer L
Published: November 2019

Background

People suffering from serious mental illness face a high risk of lifestyle-related health problems, and higher mortality and morbidity rates than the rest of the population. The solution to the problem has been to integrate health promotion initiatives in mental health care. In Denmark psychiatric departments have implemented a new strategy and mental health nurses are now asked to screen for risk factors. The aim of this study is to explore how mental health nurses experience working with the screening of risk factors amongst patients with mental illnesses as part of their health promotion activities.

Methods

We employed a qualitative research design using an interactive approach. Two focus group interviews (n = 7; n = 5) were conducted with mental health nurses attending a mental health specialist training in Denmark in 2018. The interviews lasted 1 ½ hours, were recorded and transcribed verbatim. Data were organized using NVivo 12 software and a qualitative content analysis was used to describe experiences in a conceptual form.

Results

The implementation of health promotion activities in mental health care created two different types of dilemmas for the mental health nurses: 1) dilemmas related to health promotion that involved discrepancies between patients’ autonomy and wishes, and the health promotion activities that were offered; 2) system-related dilemmas originated from structural factors and working with screening for risk factors. The mental health nurses developed various strategies and found new solutions to navigate these dilemmas.

Conclusions

Mental health nurses found it challenging to implement health promotion activities in mental health care, although they generally found these activities meaningful. They developed new strategies to overcome the dilemmas.

Key messages

Health promotion initiatives need to be adapted to mental health nurses’ existing mental healthcare practices in order for them to be meaningful. Screening of risk factors is insufficient as a health promotion activity in mental health care.
Workshop: Bridging the Gap in Digital Public Health in Europe
Authors:   Organised by: EUPHA (DH) Chair persons: Luís Velez-Lapão - Portugal, Anthony Staines - Ireland
Published: November 2019

Europe is facing several health challenges and public health plays an important role in it. However, to address the increasing demand for public health services, public health institutions need to tackle digitalization in a proper and evidence-based way. Digital health comprises both an organizational and a technological component. While the technological one has been widely addressed, the organizational one got little attention so far. This is due to a lack of knowledge regarding the understanding of the new role of organizations that provide digital health services. Public health is a field deeply dependent on data and with an important opportunity to leverage information technology. Digital health could, within 10 years establish a new paradigm in public health. The public health professionals need urgently to tackle digital health to bridge the gap with others areas of healthcare. Moreover, since public health is a multi-disciplinary activity we want to take the opportunity to debate digital public health with European experts from different fields of knowledge.

Three presentations from the point of view of People, Technology and Services. Digital health should be addressed as an evidenced-based approach towards both improving health professionals performance and quality of life of patients.

This workshop aims at: To create the momentum towards the proper use of digital technologies in public health by discussing the main challenges and opportunities for European Public Health.To establish a forum to discuss digital public health solutions based on evidence to better improve the adoption of these tools in the public health profession;To have a serious discussion after 3 presentations that will clarify the main challenges and opportunities;After de presentations, a debate will be guide to help identify the main challenges for digital public health in Europe;

Key messages

Public Health Digitalization is essential to address health inequalities in Europe. The workshop identifies what are the main priorities for a sustainable EU public Health digitalization. Mutual learning, knowledge and good practice exchange in using digital technology can be organised in various ways – we show practical current examples on how it has been done.