bluuebunny/crossref_metadata_2025 huggingface dataset:
Gaming behaviors among young people with visual impairment
Authors: Wrzesinska M , Tabała K , Stecz P
Published: October 2020

It has been reported that 60% of young people with visual impairment (VI) enjoy playing digital games (DGS) on the computer. However, little is still known about the new media patterns among young people with special needs. Hence, the aim of this study was to identify gaming behaviors among students with VI.

A self-administered questionnaire assessing variables regarding gaming behaviors adapted for students with special needs was prepared. Finally, 490 Polish respondents with VI from 9 special schools aged 13-24 (17.9 ± 2.48) were included. Purposive sampling was chosen during selection of the members of the population.

Almost 84% of students with VI had experience in playing DGs. Poor-sighted students were significantly more likely to be players than those who were blind (89% vs 11%; χ2 =22.471; P< .001). More male (57.1%) than female students (42.9%) reported playing DGs (χ2=17.913; P <.001). Students with siblings were more likely to play DGs than those without and they were more likely to play computer games if they lived with a parent whose education was at primary/secondary level (χ 2=7.340; P= .025) The most commonly chosen game genre was strategic (57.1%), whereas war games (37.7%) were less popular. Over 12% of the students took part in gaming sessions lasting 5 or more hours per day and the male students were 5.5 times more likely to report an excessive gaming than the female students (P=.000).

The survey indicated a tendency towards excessive gaming in a significant proportion of young persons with VI. Sociodemographic variables are important in predicting gaming behaviors in this group and they should be taken into consideration in the future preventive actions to reduce the risk of behavioral addiction.

Key messages

Young people with VI are the regular users of games and they also tend to have a high tendency to an excessive gaming. Sociodemographic variables are important factor to be taken in account when predicting gaming behaviors among people with VI.
Residents’ perspectives essential for creating healthy neighborhoods in deprived areas
Authors: Dierx J A J , de Bot C M A
Published: October 2020

Background

Health inequality is related to socio-economic differences as people living in deprived neighborhoods show more social and health problems resulting in more sick years and shorter life expectancy. This however has predominantly been studied from the perspective of health and wellbeing professionals, not from the perspective of residents. Interventions based on these professionals' perspectives appear to have little sustainable effects on health and wellbeing, which might be (partly) explained by not matching residents' perspectives. Aim of the present study is mapping perspectives of residents, letting them mobilize their assets and generating their own (sustainable) activities.

Methods

Using the Triple-I action research method, residents' assets and perspectives were mapped in deprived neighborhoods in Breda (N = 12) and Oss (N = 23). Subsequently, residents were motivated to organize activities themselves using their assets which were monitored and described.

Results

In both cities similar results were found. First, residents mention their ability to organize activities, wanting to “meet each other”, “doing activities together”, being “self-reliant”, “inclusive” and “multicultural”. Second, they want to run a community centre with no or little interference of health and wellbeing professionals with the stating argument: “they should first learn how to communicate between each other and with clients”. Third, residents want to create “a green clean and safe surrounding”, while safety was more an issue in Breda than in Oss. In both cities this resulted in a self-run community centre with in Oss over 30 activities involving weekly over 300 residents and in Breda over 8 activities involving over 60 residents.

Discussion

Present study shows that including the residents' perspective and involving their assets and participation are important elements in interventions improving health and wellbeing. However, a longitudinal follow-up is necessary for showing sustainability.

Key messages

Including residents' perspective in developing healthy neigborhoods is an essential element. Most important elements in deprived neighborhoods is the ability to meet other residents and feeling connected and useful.
Urbanisation is a main driver for Aedes aegypti dynamics and arboviral risk in Côte d’Ivoire
Authors: Zahouli J , Koudou B , Müller P , Utzinger J
Published: October 2020

Background

Aedes mosquito-borne arboviruses have (re-)emerged and caused considerable public health concerns in major sub-Saharan African cities subjected to rapid urbanisation. We assessed the effects of urbanisation on Aedes aegypti dynamics and biting pattern, and the risk of transmission of yellow fever (YF) and dengue (DEN) viruses along urban-rural gradient in Côte d'Ivoire.

Methods

We collected Aedes mosquitoes as eggs, larvae/pupae, and adults seasonally in urban, suburban and rural areas using ovitrap, larval survey and human-baited double net trap methods from January 2015 to December 2016. We sampled household data and characterised Aedes larval breeding sites. Ae. aegypti indices and biting rates were compared by area.

Results

Ae. aegypti was the most abundant species in all areas. It showed higher abundance in urban areas (n = 26,072; 99.4%). Larval indices were associated with human activities, including waste and water management. Tires and discarded containers were the most productive breeding sites in all areas. Household water receptacles displayed high Aedes-positive rate (23.6%) in urban areas. Positive ovitrap index was higher in urban (53.5%) compared to suburban (43.1%) and rural (29.7%). Stegomyia indices were highest in urban followed by suburban and rural areas, with respective house index of 67.2, 51.4 and 27.8, container index of 57.1, 43.5 and 19.7, and Breteau index of 95.2, 78.9 and 8.8. Biting rate was 4.3 and 2.7-fold higher in urban (83.5 bite/person/day) and suburban (52.1 bite/person/day) compared to rural (19.4 bite/person/day), respectively. Ae. aegypti indices were higher during rainy seasons.

Conclusions

In Côte d'Ivoire, urbanisation raised Ae. aegypti abundance and biting rate. As a result, YF and DEN risk indices were above WHO-established epidemic thresholds in urban area thus exposing local communities to high risk of getting diseases. Integrated community-based vector control programs should be applied to reduce arboviral risk.

Key messages

Urbanisation raises Aedes aegypti abundance and arboviral disease risk in Côte d’Ivoire. Integrated community clean-up actions are required to control Aedes vectors.
Variability in public health ethics education in EUPHA and ASPHER members
Authors: Butcher F , Schröder-Bäck P , Tahzib F
Published: October 2020

Background

Public health professionals face decisions that have far-reaching ethical implications. Despite this, the field of public health ethics is relatively new, and teaching and training in ethics for public health professionals is “highly variable in quantity and content” [Doudenkova et al 2017]. Building on a prior body of research, surveys of ASPHER and EUPHA members were undertaken to explore current levels of ethics education.

Methods

Online surveys were distributed to ASPHER and EUPHA members with the aims of a) exploring the current status of ethics education in public health courses in ASPHER institutions and b) understanding the ethics education of individual public health practitioners in EUPHA.

Results

The ASPHER survey was completed by teaching staff at 35 different institutions between April and August 2019. The EUPHA survey was completed by 232 professionals between October 2019 and January 2020. ASPHER Survey: 39% (n = 12) of institutions awarding master's degrees in public health had one or more degrees in which no ethics was taught. Only 48% (n = 13) of institutions had someone in their academic team formally qualified to teach ethics by holding a master's degree, PhD or further academic role in ethics. EUPHA Survey: Despite 79% (n = 165) of respondents encountering ethical dilemmas on at least a monthly basis, 21% (n = 48) reported that they had never had any ethics education or training, and 50% (n = 101) respondents thought that they had too little training in ethics for their professional role.

Conclusions

There remains a significant proportion of those studying or working in public health who do not receive any public health ethics training or education.

Key messages

Ethics education in public health remains variable among ASPHER organisations and EUPHA members, a significant minority lacking any ethics training. To ensure ethically reflective and sensitive public health practitioners, access to ethics education is key.
14.H. Workshop: Ecosystems of HIV risk among key populations in Europe: empirical findings and solutions
Authors:   Organised by: EUPHA Sexual and gender minority health section,   Chair persons: John Pachankis - USA, Kristefer Stojanovski - USA
Published: October 2020

Key populations, such as men who have sex with men and persons who inject drugs (PWID) have an increased risk of HIV. These same key populations experience extensive barriers in accessing HIV/AIDS services that are acceptable, accessible, and of high quality. These issues are particularly acute in Eastern Europe where stigma and structural barriers to HIV services are large. This workshop is important because of the rising incidence of HIV in Europe. This is particularly a challenge in Eastern Europe, the only geographical region in the world experiencing rising rates of HIV. Thus, understanding key population's specific HIV risk factors are crucial to address their needs and prevent new infections.

This workshop will give examples of studies on the health and HIV situation of key populations in Europe. The workshop will identify the social and structural contexts that create the specific determinants of HIV risks among the population in the region. The workshop will also discuss avenues and interventions to address their HIV risks. Kristefer Stojanovski (USA) will present results on a European analysis regarding the role of policy and laws in shaping HIV risk among MSM. Sladjana Baros (Serbia) will present findings on the barriers that persons living with HIV (PLHIV) in Serbia face, particularly stigma, that limits their access treatment and access to services. Elizabeth King (USA) will present on stigma's role in perpetuating HIV risk among women who inject drugs in Russia, including ways to address the issues. Lastly, Francisco Fernandes (Portugal) will present results from their work over the last 10 years providing community-based HIV and STI testing and counseling in Portugal.

After the individual presentations, the audience will be invited to a monitored open discussion on the papers, and how the findings can help inform public health and policy to address HIV in Europe. The situation for HIV and key populations in Europe is worrisome from a public health standpoint, especially as research shows how structural factors can drive HIV risk and infection. Our workshop aims to facilitate a conversation on understanding the structural situation and exploring ways to reduce the disproportionate health burden and risk factors. Given this year's theme of public health for the future of humanity, we believe our workshop asks salient questions to address HIV risk, globally.

Key messages

Key populations in Europe have an elevated risk of structurally induced stigma, which influences HIV risk. Disproportionate HIV burdens among key populations require urgent attention from public health professionals given the rising rates of HIV in Europe.
Learnings from a decade experience of a community-based HIV and STI testing and counseling center in Lisbon – Portugal
Authors: Fernandes F , Meireles P , Rocha M , Duque M , Barros H
Published: October 2020

Background

In the context of an increased number of men who have sex with men (MSM) being diagnosed with HIV infection in many European countries, it became a matter of maximum priority to consider new strategies to monitor and tackle the epidemic. In this scenario, CheckpointLX and a cohort study were projected as a sexual health and research center oriented towards MSM in Portugal.

Methods

In 2011 CheckpointLX was launched in Lisbon as a community-based center for anonymous and free rapid HIV and other sexually transmitted diseases (STI) testing with a strong component of counseling for sexual health, specially targeted at MSM. In the case of a reactive test, a medical appointment is proposed and scheduled. The Lisbon Cohort of MSM is an ongoing observational prospective study conducted at CheckpointLX. Collected data include sexual behaviors, preventive strategies, and history of STI.

Results

Until July 2019, 7,351 HIV-negative MSM chose to participate in the Lisbon Cohort of MSM. 3,523 had at least one follow-up visit. The median age was 29 (IQR 25 - 37), and 27% were born in a foreign country, including 15% born in Africa and South America. HIV incidence increased up until 2015, reaching 5 reactive tests per 100 tested annually. There has been a sustained decrease in HIV observed since 2015. The use of HIV prevention tools was provided: 31% used condoms consistently, 3% reported PrEP, and 4% PEP.

Conclusions

A decade since the beginning of this experience shows positive results, such as increased access and testing. We promoted a stigma-free service that facilitated MSM's and other key population's access to sexual health care. We contribute unique data for assisting in the monitoring of the Dublin Declaration in Portugal.
ChildMove: Transit experiences and mental health of unaccompanied refugee minors
Authors: Derluyn I , Verhaeghe F
Published: October 2020

Since early 2015, the media continuously confront us with images of refugee children drowning in the Mediterranean, surviving in appalling conditions in camps or walking across Europe. Within this group of fleeing children, a considerable number is travelling without parents, the unaccompanied refugee minors.

While the media images testify to these flight experiences and their possible huge impact on unaccompanied minors' wellbeing, there has been no systematic research to fully capture these experiences, nor their mental health impact. In this paper, we present the first results of the ERC-Starting Grant Project 'ChildMove', whereby we followed a large group of unaccompanied refugee minors (n = 200) over the course of two years in order to document their transit experiences and the mental health impact of these experiences. Our study started in different transit countries (i.e., Greece, Italy and Belgium; an additional cross-sectional study was carried out in Libya) and from there one we followed the minors wherever they went on their migration route. During this longitudinal follow, we collected data using a mixed-methods approach (i.e., self-report questionnaires on difficult experiences and mental health symptoms and in-depth interviews) at each of the three measurement moments. The data reveal that these youngsters experience a continued series of difficult events during their trajectories, such as being detained, violence at the borders (including borders within Europe), push-backs, abuse by smugglers and other persons, appalling living conditions, racism, etc., but also after (temporary or permanent) settlement in Europe. The participants also report over the course of the follow-up high levels of mental health problems (i.e., symptoms of depression, anxiety and posttraumatic stress).
Responding to COVID19 in Italy
Authors: Falkenbach M
Published: October 2020

While it is hard to predict what will have happened by the time of the conference, this round table will be tightly templated and coordinated. Each speaker will briefly address the challenges experienced by that country and the actions taken, and focus on explaining why those actions happened in order to draw comparative lessons about public health politics and governance.
Life expectancy inequalities and their evolution in Italy. How these impact on the equity of the pension system?
Authors: Ardito C , D'Errico A , Leombruni R , Ricceri F , Costa G
Published: October 2020

The article aims to present the most recent evidence on the life-expectancy differentials across socio-economic groups in Italy and discuss their implications in terms of equity and fairness of the pension systems. In fact, Italian pension rules are set according to average life expectancy, ignoring the shorter life expectancy at retirement observed in more disadvantaged socioeconomic groups, as well as in many occupations and economic sectors. This produces unintended consequences in terms of redistribution, which reinforce and exacerbate inequalities present in the labour market.

This article will present updated evidence on the evolution of life expectancy inequalities across job titles, sectors and occupational class in Italy to assess whether the social gap, already highlighted by previous scholars, has been widening or narrowing. Only a few studies are available in the literature on this subject, almost exclusively from the US, which suggest that the gap in terms of life expectancy at ages approaching retirement is increasing, mainly driven by a faster improvement in longevity across most advantaged groups. It is crucial to examine the trend in a country like Italy where retirement age has been strongly tightened and linked automatically to average life expectancy in the population. These results may be important in order to inform the public debate about future reforms on retirement rules and in particular for the definition of the so called “arduous and hazardous jobs” (in Italian: lavori gravosi), that could be exempted from the postponement of pension age.

In order to estimate life expectancy differentials among different occupations, three of the largest Italian longitudinal studies will be used: the Turin Longitudinal Study (SLT), the Italian Longitudinal Study (SLI) and WHIP-Health Study, all studies where it is possible to conduct mortality follow-up through administrative record linkage with archives of mortality of large cohorts until recent years.
Understanding the relationship between alternative pension systems and healthy ageing: cross-national and quasi-natural experimental analyses of 27 EU countries
Authors: Stuckler D
Published: October 2020

How do pension systems contribute to healthy ageing? It is widely speculated that more generous and stable pensions could promote better ageing outcomes, as well as could potentially result in lowered healthcare costs. Yet little is known about how alternative pension regimes shape health and healthcare expenditures in older persons. Here, using multi-level, cross-country data from the European Survey on Health, Ageing and Retirement (SHARE, n = 140,000) covering 27 nations, we test the hypotheses that more generous pensions, as well as systems with defined benefit (which are predictable and more stable) compared with defined contributions, associate with improvements in self-reported health, quality of life, better physical and mental health scores, and lowered healthcare utilization. To do so we report the results of two sets of studies. In the first, we evaluate cross-national longitudinal SHARE integrated with OECD pension generosity and replacement rate data. In the second, we perform a series of quasi-natural experimental studies in Ireland, Germany, and Greece, taking advantage of pension reforms mostly involving budgetary reductions that occurred in the wake of the Great Recessions in Europe. For the proposed workshop we present our results, as well as provide methodological insight into how to perform such integrated epidemiological-economic analysis. We will further discuss the implications for policy and for future research investigating the relations between pension and health systems.
The Leefplekmeter – Capacity-building for municipalities with the Dutch Place Standard Tool
Authors: Acda A
Published: October 2020

After being introduced to the Place Standard the Netherlands were the first country to test and adapt the tool. In this presentation we will focus on the following subjects: The need for this tool in relation with the Dutch context of a national programme to tackle health inequalities, coinciding with new legislation focusing on integral plans for the physical environment and the need to involve citizens. Half of the Dutch local governments are committed to working jointly on a healthy environment, but the process of working together can be daunting. The Dutch adaptation of the Place Standard Tool called “Leefplekmeter” can help to bridge the gap between the two domains using the window of opportunity the new legislation offers.

The adaptations: which adaptations were made and what was the effect? The tool was simplified and stripped from some health content. This was a strategic choice which was thought to make it easier for professionals in the physical environment to pick up the tool.

Lessons learned: how was the tool introduced, used and which strategies were used to implement the tool? Currently the tool is in demand but the support structure could have been better.

Plans for the future: Several research consortia are asking for a digital version; additionally Pharos is looking into simplifying the tool even further to make it more attractive for people with lower literacy skills.
The potential of the Place Standard Tool to foster healthy urban & rural development with an equity lens
Authors: Koeckler H , Sammet T , Mekel O C L , Plantz C
Published: October 2020

The Joint Action on Health Equity Europe (JAHEE) identified municipalities as relevant level of intervention to promote health equity. Place and health are both determinants of inequity and could be influenced through policy fields such as urban or social planning. One major challenge of this health in all policies (HiAP) approach is inter-sectoral collaboration within administration, politics and with other stakeholders, including the public. Within different sectors, concepts of equity vary and are not on the agenda of everyday work. We explore the potential of the German adaptation of the Place Standard Tool to foster inter-sectoral multi-stakeholder dialogue on health equity in urban and rural contexts, and how it can possibly support local governance for health in all policies in Germany.

Our presentation is based on a transfer project of the Place Standard Tool to the German context within the JAHEE project. In 2020, the tool is pilot tested in four municipalities in Germany, which differ in size, urban and rural context and which are located in two federal states. It is applied in real municipal planning and participation processes. In this pilot study we also explore how the Place Standard Tool could be used to reach those people of the public who are usually underrepresented in healthy urban and rural development. This is essential to follow aspects of procedural justice and empowerment which are one dimension of health equity.
Exploring young professionals’ hesitation to joint German public health service – a mixed method study
Authors: Stratil J , Arnold L
Published: October 2020

Background

The “Öffentliche Gesundheitsdienst (ÖGD)” is the central public health institution in Germany. The ÖGD comprises of all public sector institutions responsible for protecting and monitoring the population health on the federal, state, county and municipal level. Its key functions contain identifying and addressing public health threats, and promoting the heath of the general population. Despite the important role, the ÖGD has not been successful in attracting and recruiting young professionals; a situation aggravated by an expected wave of retirements. We aimed to identify barriers and discuss solutions to promote the attractiveness of working in the German public health service among young professionals.

Methods

Firstly, we conducted a theory-based online-survey of medical and public health students enrolled in Germany. Secondly, we conducted key-informant interviews with a purposive sample of former public health students meanwhile working at the local health authority or a public health department as well as leading persons in the same institutions.

Results

In the survey of more than 2400 students, among others identified barriers included: students not being aware of the ÖGD and its activities, negative images of the ÖGD, and unattractive job profiles. In the interviews, some participants expressed or experienced a strong preference within the ÖGD to attract medical students to the detriment of public health students. A lack of appreciation and strictly hierarchical work contexts were identified as further obstacles.

Conclusions

The survey and interviews identified several potential barriers and obstacles for young professionals to join the public health workforce in Germany. Likely, major reforms within the ÖGD as well as in the education of medical and public health students is necessary to overcome this challenge. The results of the qualitative study identify several potential solutions for improvement.

Key messages

We conducted a mixed-method study of medical and public health students and young professionals to explore the challenges of the German public health service to attract young professionals. Our study shows that major reforms are likely necessary to increase the attractiveness of the German public health service.
Capture-recapture study to estimate the true incidence of tuberculosis in Portugal, 2018
Authors: Perez Duque M , Hansen L , Antunes D , Sá Machado R
Published: October 2020

Accurate estimation of the true number of cases of an infectious disease is essential to plan and efficiently allocate available resources. This study aims to improve the Portuguese surveillance system for tuberculosis (TB) by identifying gaps in TB epidemiological surveillance at the national level. We estimated annual TB incidence using a capture-recapture method to assess the sensitivity of national TB surveillance.

Using probabilistic record linkage between two data sources, the National Epidemiological Surveillance System (SINAVE) and National Tuberculosis Program Surveillance System (SVIG-TB), we extracted TB diagnosed cases data for calendar year 2018. All reported TB cases were included, classified as confirmed, probable or possible. A two-source capture-recapture analysis using a log-linear model was performed to estimate the number of unobserved TB cases in Portugal and of the proportion identified by the current TB surveillance system.

Between the two datasets, we found 896 TB cases (of a total of 2170 cases) that could not be matched (37.5% SINAVE only, 62.5% SVIG only). Based on the log-linear model, it was estimated that there were 148 unobserved TB cases (95% confidence interval 127.96 - 171.31). Therefore, the estimated true number of TB cases in 2018 is 2318, so current surveillance has a sensitivity of 93.6%. Based on these findings, the TB incidence in Portugal is estimated to be 22.55 cases per 100 000 inhabitants.

Capture-recapture methods are useful in estimating annual TB incidence in high-resource settings. Although the two TB surveillance systems capture the majority of TB cases in Portugal, we might still be underestimating the true number of TB cases. Because TB is a high impact infectious disease, precise incidence estimates are crucial to allocate treatment and prevention resources and guide health policies.

Key messages

CRC method showed that Portugal is a TB low incidence country. Epidemiological surveillance systems should have a high sensitivity in order to allocate efficiently resources available.
Cost-effectiveness of targeted screening for active pulmonary tuberculosis among asylum-seekers
Authors: Wahedi K , Biddle L , Bozorgmehr K
Published: October 2020

Background

Screening asylum-seekers for active pulmonary tuberculosis is common practice among many European countries with low incidence of tuberculosis. The reported yields vary substantially, partly due to the heterogeneous and dynamic nature of asylum-seeking populations. Some countries apply targeted screening measures based on the incidence of tuberculosis in the country of origin. Evaluations of such approaches with respect to (cost)-effectiveness is scarce.

Methods

Using screening data from a large German state over 14 years (2002-2015), we evaluate the cost-effectiveness of targeted screening based on WHO-reported incidence of tuberculosis in country of origins (from thresholds of 50 to 250/100,000 inhabitants). Incremental cost-effectiveness is measured as cost per case found and cost per case prevented.

Results

Incremental cost-effectiveness ratios (ICERs) of screening asylum-seekers from countries with an incidence of 50 to 250/100,000 range between 15,000€ and 17,000€ per additional case found when compared to lower thresholds. The ICER for additional screening of asylum-seekers from countries with an incidence <50/100,000 is 112,000€ per additional case found. Costs per case prevented show a similar increase in costs.

Conclusions

The high cost per case found or case prevented in the <50/100,000 threshold scenario suggests this threshold to be a sensible cut-off for targeted screening. Acknowledging that no screening measure can find all cases of tuberculosis, and that reactivation of latent infections makes up a large proportion of foreign-born cases, targeting asylum-seekers from countries with an incidence above 50/100,000 is likely to be a more reasonable screening measure for the prevention and control of tuberculosis than indiscriminate screening measures.

Key messages

We challenge the widespread belief that indiscriminate tuberculosis screening programmes are placed at an acceptable balance between costs and benefits. Targeting asylum-seekers from countries with an incidence above 50/100,000 is likely to be a reasonable screening measure for the prevention and control of tuberculosis.
Industry funding of patient groups: a systematic review
Authors: Fabbri A , Parker L , Colombo C , Mosconi P , Barbara G , Lau E , Kroeger C M , Lunny C , Salzwedel D M , Mintzes B
Published: October 2020

Background

Patient groups play an important role in health care and policy. Concerns have been raised about the financial ties between the pharmaceutical industry and patient groups, because of potential threats to the groups' independence. We conducted a systematic review to synthesise studies that explored pharmaceutical or medical device industry funding of patient groups.

Methods

We searched Medline, Embase, Web of Science, Scopus and Google Scholar (from inception to January 2018). We included observational studies reporting at least one of the following outcomes: prevalence of industry funding; proportion of industry funded patient groups which disclosed information about this funding; association between industry funding and organisational positions on health and policy issues. We carried out duplicate independent data extraction and assessed study quality.

Results

26 cross-sectional studies were included. Fifteen studies assessed the prevalence of industry funding, which ranged from 20% (12/61) to 83% (86/104). The proportion of patient groups which disclosed funding information on their websites was low (27% [95% CI: 24%-31%]). Few patient groups had formal policies governing corporate sponsorship (range from 2% (2/125) to 64% (175/274)). Among the few studies examining funding status versus organisational position, industry sponsored groups tend to hold positions consistent with sponsors' interests.

Conclusions

We found widespread indications of industry funding of patient groups. Transparency of funding is inadequate and the prevalence of policies governing corporate sponsorship is low. Research on policy impact is still limited. Considering the important role that patient groups play in health, strategies to prevent biases that may favour commercial interests above those of patients need to be implemented.

Key messages

Industry funding of patient groups is common in high income countries. Transparency of funding is inadequate and the prevalence of policies governing corporate sponsorship is low. Considering the important role that patient groups play in health care and policy, strategies to prevent biases that may favour commercial interests above those of patients need to be implemented.
Cardiovascular diseases burden in Italy, 1990–2017: the Global Burden of Disease Study
Authors: Fornari C , Cortesi P A , Madotto F , Conti S , Crotti G , Mazzaglia G , Monasta L , Giampaoli S , Mantovani L G ,   on behalf of the GBD 2017 Italy CVDs Collaborators
Published: October 2020

Background

Cardiovascular diseases (CVDs) are still the leading cause of mortality, morbidity and disability in Europe. Consequently, an exhaustive estimation of CVDs burden and cardiovascular risk factors impact is crucial for healthcare planning and resource allocation. In Italy, data on CVDs burden are sparse. This study aims to assess the global Italian CVDs burden and to analyze time changes from 1990 to 2017 within the country and in comparison to other European states.

Methods

We used data from the 2017 Global Burden of Diseases (GBD) study to estimate CVDs prevalence, mortality and disability-adjusted life-years (DALYs) in Italy from 1990 to 2017. We also analyzed burden attributable to CVDs-related risk factors. Finally, Italian estimations were compared to those of the other 28 European Union countries.

Results

CVDs were still the first cause of death (34.8% of total mortality) in Italy in 2017. A significant decrease in CVDs burden was observed since 1990: age-standardized prevalence (-12.7%), mortality rate (-53.75%), and DALYs rate (-55.54%) all decreased. Similar patterns were observed also in the majority of European countries. Despite these trends, all-ages CVDs prevalent cases increased from 5.75 million to 7.49 million. More than 80% of CVDs burden could be attributed to known modifiable risk factors such as high systolic blood pressure, dietary risks, high LDL cholesterol, and impaired kidney function.

Conclusions

Data showed a decline in cardiovascular mortality and DALYs, which reflects the success in terms of reducing disability, premature death and early incidence of CVDs. However, the burden of CVDs is still high, as population aging and the increased prevalent cases require more access to care and generate more years lived with disability, which in turn leads to higher costs for the National Health Service and society. More efficient prevention strategies at community and individual level are needed.

Key messages

Despite decreasing trends in CVDs mortality and DALYs, the burden of CVDs is still high in Italy. A joined approach of the National Health System stakeholders is needed to keep reducing the CVDs burden.
Infections in diabetics: a ten-year analysis on hospital discharge records in an Italian region
Authors: Meo F , Di Giovanni P , Cedrone F , D'Addezio M , Di Martino G , Masciarelli M , Scampoli P , Staniscia T
Published: October 2020

Background

Patients with diabetes mellitus (DM) have increased risk of developing infections and complications from infections that require hospitalization and greater healthcare utilization. This study aimed to analyze hospitalizations in DM patients with a diagnosis of infection and to assess the burden of infections on the regional healthcare system in terms of length of stay and in-hospital mortality.

Methods

A retrospective cross-sectional study was performed from 2006 to 2015 in Abruzzo, an Italian region. Data were collected from hospital discharge records (HDRs) of patients with a diagnosis of DM. All the admissions with an ICD-9 infection diagnostic code were identified. Logistic regression models were implemented to evaluate the association between infections and the study outcomes.

Results

A total of 182,709 HDRs of DM patients were identified, 12,381 (6.78%) of which related to an infectious disease. The number of admissions with a diagnosis of infection increased during the study period (+4.0%). Respiratory infections were the most common (69.8%), followed by sepsis (9%), and skin and soft tissue infections (8.7%). Factors associated with the infection were age<18 (aOR=1.88; 95%CI:1.42-2.47), age≥65 (aOR=1.29; 95%CI:1.23-1.35), and DM type 2 (aOR=1.19; 95%CI:1.12-1.26). Diabetic patients with an infectious disease had a longer median length of stay (days:10; IQR:6-16) than those without infections (days:7; IQR:3-12) (p < 0.001), and showed higher in-hospital mortality (aOR=2.67; 95% CI:2.5-2.8).

Conclusions

Over the study period, hospitalizations related to infections among diabetics rose. The increase was registered mostly among the youngest and the oldest subjects. Infectious disease diagnosis was associated with longer length of stay and higher in-hospital mortality. Cost-effective strategies for infection prevention in patients with DM are needed in order to reduce morbidity and the impact of these conditions on the healthcare system.

Key messages

Patients with diabetes have increased risk of developing infections. In our study, infectious disease diagnosis was associated with longer length of stay and higher in-hospital mortality. Cost-effective strategies for infection prevention in patients with diabetes are needed in order to reduce morbidity and the impact of these conditions on the healthcare system.
Depression, suicidal ideation and stress among Italian medical students: PRIMES multicentre study
Authors: Lo Moro G , Bert F , Corradi A , Gualano M R , Leombruni P , Siliquini R , PRIMES Collaborating Group
Published: October 2020

Background

Depression represents a public health priority and a major contributor to suicide worldwide. Medical students (MS) have been reported as a high-risk group and data are required to implement action plans. This study aimed to investigate depressive symptoms (DS), suicidal ideation (SI) and perceived stress (PS), and analyse factors that may impact on such conditions.

Methods

In 2018, a multicentre cross-sectional study (PRIMES) was carried out in 12 Medical Schools, reaching 2513 MS throughout Italy. Socio-demographic data and psychometric tests were collected. Main outcomes were measured by Beck Depression Inventory-II (DS and SI) and Perceived Stress Scale (PS). Mostly, multivariable logistic and linear regressions were run (p < 0.05 as significant).

Results

The prevalence of DS and SI was 29.5% and 14%. The mean PS score was 18.6 (SD = 7.8), within a range to 0 from 40. Preliminary results showed that the variables associated with a higher risk of reporting all outcomes (DS, SI, PS, respectively) were: increasing age (p = 0.004, p = 0.016, p = 0.003), bisexuality (p = 0.002, p < 0.001, p < 0.001), poor economic status (p = 0.010, p = 0.014, p < 0.001), psychiatric family history (p = 0.007, p = 0.003, p = 0.029), negative judgment about medical school choice (all p < 0.001), unsatisfying classmates' friendships (p = 0.027, p < 0.001, p < 0.001) and classmates' climate competitive and hostile (all p < 0.001). An excellent family bond reduced the odds instead (all p < 0.001). Other socio-demographic and university-related items resulted associated to the outcomes in different ways.

Conclusions

PRIMES showed a high prevalence of DS and SI among MS, with alarming PS levels. Since this issue seems common worldwide, further analyses to understand the determinants are needed and a population-based approach pertaining to public health must be addressed, e.g. to increase resilience. Universities must realize interventions, offer counselling and improve modifiable factors, such as learning climate.

Key messages

Italian medical students reported a prevalence of depressive symptoms and suicidal ideation of 29.5% and 14% respectively, both higher than the prevalence among same-aged general population. Depression, suicidal ideation and stress were mainly influenced by age, sexuality, finances, psychiatric family history, judgment on medical school, family bond, classmates’ friendships and climate.
Assessing the digital health transformation with the SCIROCCO Exchange tool in Puglia Region
Authors: Mingolla S , Pantzartzis E , Graps E A
Published: October 2020

Have we progressed integrated care in Europe? The EU Health Programme funded project, SCIROCCO Exchange addresses this question by providing online self-assessment tool for integrated care. Among the project partners, Puglia Region and the Strategic Regional Agency for Health and Social Care (AReSS), assessed the integrated care maturity level of the six Puglia' Local Health Authorities.

The SCIROCCO Exchange project provides a 12-dimensions online tool for European regions to assess their maturity in the provision of integrated care, including identification of strengths, weaknesses and areas for improvement. The methodology provides the following steps: 1) selection of key stakeholders participating in the assessment; 2) conducting the individual assessments; 3) building the consensus among the involved stakeholders. The outcomes of the assessment were captured in the form of spider diagrams, highlighting Puglia' strengths and weaknesses in integrated care.

The research has provided a multi-dimensional representation of the integrated care maturity level of the Puglia' Local Health Authorities. With reference to the SCIROCCO Exchange tool dimensions, major strengths include: Digital Infrastructure; Population Approach; Process Co-ordination; and Citizen Empowerment. Among the areas for improvement: Finance & Funding; Removal of Inhibitors; and Evaluation Methods were identified.

The experience of using the SCIROCCO Exchange Tool have demonstrated benefits and added value of the Tool in guiding involved stakeholders towards the implementation of integrated care in Puglia and in stimulating multi-stakeholders discussions and participants' engagement. The assessment results will be used to orient an Action Plan to facilitate much more effective and tailored knowledge transfer process and provide better digital care services in Puglia.
Dietary and lifestyle behaviours in the preconception period
Authors: Schoenaker D
Published: October 2020

Observational studies have shown strong associations of preconception nutrition and lifestyle behaviours with maternal and child health outcomes; however, awareness of these links among lay people, policy makers and health professionals is very limited. Poor nutrition and obesity are common among women of reproductive age, and the preconception period therefore has underutilised potential as a point of intervention. Intervention studies to improve dietary intake and physical activity during pregnancy have not been successful in reducing adverse maternal and newborn health outcomes, but relatively few interventions have examined effects of modifying diet and lifestyle prior to pregnancy. Despite limited evidence from human clinical trials, increasing evidence from observational studies and from animal trials for the benefits of optimal preconception health suggests public health efforts to increase awareness and improve preconception health behaviours are needed as strategies for disease prevention across generations. This presentation will provide an overview of the evidence for the impact of nutrition and lifestyle behaviours on short and long-term maternal and child health outcomes. This will provide workshop participants with an understanding of health behaviours across the life course that should be considered when building preconception care into existing health services.
Spatial analysis of vaccination coverage in Paraíba in 2016
Authors: Martins L , Cunha N , Baebieri C , Pamplona Y , Loureiro N , Olinda R , Moschini L
Published: October 2020

Introduction

Immunization is a human right, being considered an action of the most successful and cost-effective in public health. In Brazil, it is an action that is linked to primary health care, In Brazil, the National Immunization Program (PNI), created in 1973, is recognized as a world reference of public health policy, as it offers all vaccines recommended by the World Organization health care in its national vaccination calendar.

Objective

Spatial analysis of vaccination coverage of children aged 0 to 11 months in Paraíba in 2016.

Methods

Cross-sectional study, with information on doses applied to children under 1 year of age obtained at the PNI, by municipality of Paraíba. Live birth data from the Live Birth information system (SINASC). Descriptive analysis, chi-square test, spatial analysis.

Results

In Paraíba, 54.3% of the municipalities had adequate vaccination coverage, for BCG we have 68%, Hepatitis B (34.5%), Hib and DTP (35%), Polio (29.6%), pneumococcal (46.6%) and meningococcal (42.6%). The sertão paraibano is the mesoregion with the largest number of municipalities in the state with adequate vaccination coverage (p < 0.01), the paraiba forest is the region with the highest number of municipalities with very low coverage (p < 0.01).

Conclusions

Thus, Paraíba does not present a homogeneous vaccination coverage, not having 'herd immunity'. This fact leaves the state vulnerable to the return of immunopreventable diseases and thus at risk of raising infant morbidity and mortality, constituting an important public health problem.

Key messages

Immunization is a human right, being considered an action of the most successful and cost-effective in public health. Paraíba does not present a homogeneous vaccination coverage, not having 'herd immunity'.
Child drowning mortality in the Sundarbans, India: Applying the Community Knowledge Approach
Authors: Gupta M , Bhaumik S , Roy S , Panda R , Peden M , Jagnoor J
Published: October 2020

Background

The Sundarbans in India is a rural, forested region where children are exposed to a high risk of drowning due to its waterlogged geography. Current data collection systems capture few drowning deaths in this region due to its remoteness and poor coverage of health and police systems. Household methodology was found to be resource and time intensive, and so a Community Knowledge Approach was used and applied to calculate injury mortality for the first time.

Methods

A community-based survey was conducted in the Sundarbans to determine the drowning mortality rate for 1-4 and 5-9 year old children. A Community Knowledge Approach was applied. Meetings were held with law community residents and key informants to identify drowning deaths in the population. Identified deaths were verified by the child's household through a structured survey, inquiring on the circumstances around the drowning death.

Results

The drowning mortality rate for children aged 1-4 years old was 243.8 per 100,000 children and 38.8 per 100,000 children for 5-9-year olds. 58.0% of deaths were of 1-2-year-old children. Most children drowned in ponds within 50 metres of their homes. Children were usually unaccompanied with their primary caretaker engaged in household work. Only one third of deaths were reported to hospitals or civil registration systems. Of deaths listed by community members, 63.0% were identified by both residents and by at least one key informant, 25.6% by key informants only, and 11.4% (n = 79) by community residents only.

Conclusions

Drowning is a major cause of death among children in the Sundarbans, particularly those aged 1-4 years old. The results illustrate how routine data collection systems grossly underestimate drowning deaths, emphasising the importance of community-based in rural low-and middle-income country contexts.

Key messages

Drowning is likely the largest killer of 1-9 year old children in the Sundarbans region, emphasising the need to better understanding drowning epidemiology in similar rural LMICs contexts. The Community Knowledge Approach provides a low-resource, valid method for capturing injury mortality data.