bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurodevelopmental multimorbidity and educational outcomes of 766,244 Scottish schoolchildren
Authors: Salim E , Fleming M , MacKay D F , Henderson A , Kinnear D , Clark D , King A , McLay J S , Cooper S A , Pell J P
Published: November 2019

Background

Neurodevelopmental conditions commonly co-exist in children but, in comparison with adults, childhood multimorbidity has attracted less attention in research and clinical practice.

Methods

Record linkage of five Scotland-wide databases produced a cohort of 766,244 children attending Scottish schools between 2009 and 2013. Autistic spectrum disorder (ASD) and intellectual disabilities were ascertained from records of special educational need in the annual Pupil Census and attention deficit hyperactivity disorder (ADHD) and depression through relevant encashed prescriptions.

Results

Neurodevelopmental multimorbidity (≥2 conditions) was identified in 4,789 (0·6%) children; with ASD and ADHD the most common combination. Multimorbidity was associated with significantly increased risk of school absenteeism (adjusted IRR 1·23, 95% CI 1·20-1·28), school exclusion (adjusted IRR 3·04, 95% CI 2·74-3·38), low attainment (adjusted OR 12·07, 95% CI 9·15-15·94) and unemployment (adjusted OR 2·11, 95% CI 1·83-2·45) with clear dose relationships evident between number of conditions (0, 1, ≥2) and the last three outcomes. The associations with multimorbidity were stronger in girls than boys. Co-existence of depression was the strongest driver of absenteeism and co-existence of ADHD the strongest driver of exclusion. Low attainment and unemployment were, in part, mediated by absence and attainment respectively, and were not driven by specific conditions but rather multimorbidity from any cause.

Conclusions

Structuring clinical practice and training around single conditions may disadvantage children with multimorbidity who are at significantly increased risk of adverse outcomes if their complex needs are not recognised and managed.

Key messages

Neurodevelopmental multimorbidity can have significant impacts on children’s education. A holistic healthcare approach is needed to reduce the address their needs and reduce the risk of adverse outcomes.
Job control and risk of disability pension in the nationwide Danish Work Life Course Cohort
Authors: Svane-Petersen A , Framke E , Sørensen J K , Rugulies R , Madsen I E H
Published: November 2019

Background

A large number of studies have found job control to be consistently associated with an increased risk of disability pension. However, most previous studies have measured job control by self-report, introducing possible reporting bias inflating the risk estimates. Furthermore, previous studies have not accounted for the potential selection of individuals with pre-existing risk factors for disability pensioning into low control jobs.

Methods

We analyzed data from the nationwide register-based Danish Work Life Course Cohort (DAWCO; n = 960,562 with approx. 6 million person-years). We measured job control annually by a job exposure matrix, based on a scale of five self-reported items from The Danish Work Environment Cohort Study, and disability pension using registers on public transfer payments. To account for potential selection into occupations with lower levels of job control, we included numerous life course confounders, including parental socioeconomic position and psychiatric and somatic diagnoses.

Results

Employees in jobs with lower levels of job control had increased risk of disability pensioning. The association attenuated after adjustment for confounders but was not explained by selection into job groups with lower levels of job control (hazard ratio: 1.16 (95% CI: 1.03-1.31).

Conclusions

Our findings suggest that lower levels of job control are associated with an increased risk of disability pension, and that this association is explained by neither reporting bias nor a selection of individuals with an increased risk of disability pensioning into job groups with lower levels of job control.

Key messages

Lower levels of job control appear associated with an increased risk of disability pension independent of life course confounders. Further research is needed on preventive measures in occupations with low levels of job control.
Epidemiological and nutritional transition in low- and middle-income countries
Authors: Stranges S
Published: November 2019

Issue/problem

In the last decades, the number of deaths from non-communicable diseases in developing countries has risen to those observed in developed countries.

Description of the problem

Nutritional research in developing countries has primarily focused on under-nutrition, particularly among vulnerable population subgroups such as women and children. However, while economic growth has a significant social impact at population level, there is suggestive evidence of an ongoing nutritional transition leading to concurrent under- and over-nutrition in the population.

Results

The ongoing nutritional transition in these settings has been mostly linked to the rapid process of urbanisation and westernization. Data from several developing countries suggest that improvements in developmental indicators is accompanied by higher availability of highly processed poorly nutritious foods. Regarding socioeconomic factors, results demonstrated that better education and better living standards were associated with higher odds of overweight/obesity after adjusting for confounders, including urban vs. rural setting. This is likely a consequence of the ongoing nutritional and epidemiological transition occurring in these settings. In fact, developing countries have not yet reached the same phase of nutritional transition as an economically affluent country, and while high-calorie diets comprising fast-food are the more economically affordable option in the latter, such diets are still reserved for the more affluent individuals in some developing countries, where economic growth has only just begun to allow affluent individuals to afford fast-food.

Conclusions

Understanding the underlying ecological and socioeconomic roots of both extremes of the nutritional status is vital to design successful public health interventions.
Geographical variations in access to expert centers for multiple sclerosis in France
Authors: Leray E , Mamadou F , Guilleux A , Roux J , Grimaud O
Published: November 2019

Background

Multiple sclerosis (MS) is a chronic neurological disease affecting about 100,000 persons in France. Disease management is mainly supervised by the neurologist, supported by the general practitioner (GP). The complexity of the disease, due to the variety of symptoms as well as the recent changes in the therapeutic arsenal, requires both a high level of expertise and coordination between the different health care providers. To face this challenge, integrated and coordinated network of services “MS expert centers” have been progressively set up from 2000 onwards. Our objectives are to describe referrals to MS expert centers over the 2010-2015 period, to look for geographic variations and if any, to identify potential determinants of access.

Methods

The analysis is performed on the French health insurance database which covers 97% of the French population. Geographic variations of access are explored, as well as association with the following parameters: demographics (age, sex), socio-economic characteristics (social deprivation index at residence, degree of urbanization), and density of health care services (GPs, neurologists, hospital beds).

Results

Overall, 112,415 people with MS (70% women, mean age 46 years) were included. Initial results show that over the study period, 98% of patient had at least one visit to GP, 87% to neurologist, and 36% in a CRC SEP.

Conclusions

The present study will assess to what extent MS patients have been able to take full advantage of an innovative organization of specialized care which was recently deployed in France. This model of care has been generalized by the French Ministry of Health in 2016 and 23 ‘competence and resource centers’ for MS (CRC SEP) are now covering the whole national territory. Further research will be performed to identify whether and how this has modified access to specialized coordinated MS care.
The EU Joint Action on Vaccination – capitalizing on existing knowledge
Authors: Sivela J
Published: November 2019

Vaccine hesitancy is considered a major global public health threat. Vaccine hesitancy stands for refusing or delaying the acceptance of vaccines, and it is influenced by matters, such as the lack confidence in the system providing the vaccines, inconvenience of vaccination services and individual risk perceptions. In a European context, the lack of confidence is often put forth as major reason behind low vaccine uptake. However, it is equally important to address matters relating to the accessibility and convenience of vaccination services.

The European Council and the European Commission have made several decisions aiming to strengthen vaccine confidence and uptake in Europe. The ongoing EU Joint Action on Vaccination (EU-JAV) is delivering a number of these. As a work package leader for the actions related to vaccine hesitancy and uptake, Jonas Sivelä will talk about the importance of capitalizing on existing knowledge and practices within Europe - and the potential we have in increased cooperation between countries, regions and actors. The EU-JAV develops a systematic overview and analysis of best practices, lessons learned and experiences from vaccine hesitancy and uptake related work. Such work can encompass different types of interventions and practices, for example, training of health care workers, communication policies, or initiatives aiming to increase the accessibility of vaccination services. The EU-JAV creates mechanisms and practical tools for disseminating the knowledge about this work for actors in the public health sector in order to strengthen their possibilities to encounter vaccine hesitancy.
3.L. Workshop: It’s time for timeliness in Health Technology Assessment
Authors:   Organised by: EUPHA (HTA), EUPHA (HSR) Chair persons: Chiara de Waure - EUPHA (HTA), Carlo Favaretti - EUPHA (HTA)
Published: November 2019

The timeliness of the release of results is one of the most critical issue regarding Health Technology Assessment (HTA) and its potential to support decision-making. This matter may reflect the deep conflict between HTA doers and users. HTA is a form of evidence-based research, expected to timely inform decision-making at several levels - from health policy (macro) to hospital and clinical management (meso and micro) - ensuring accuracy and assessment of both short- and long-term effects of a health technology. HTA purpose therefore is to respond to real world needs, while not overlook a correct methodology. Fast developing health technologies have rapidly spread over the past decades, hence increasing demand for timely assessment aimed at their prompt implementation and management, especially at meso and micro decisional levels. Furthermore, the need for quick answers is emphasized by the pressures placed on policy-makers when a health technology is publicly promoted or contested. Furthermore, an ill-timed assessment can lead to several consequences, among which possible inequalities in access to healthcare. In order to address the challenge of timeliness, organizations involved in HTA should set up models and tools to deliver timely information. The aim of this workshop is to point out the timeliness of HTA as crucial in the decision-making process as a mismanagement of HTA system could be an obstacle to an appropriate healthcare policy. Else more, the workshop would like to critically present examples where research was on time or too late to be included in the decision-making process and elaborate on possible models to successfully deal with timeliness of HTA deliverables in particular at hospital level.

Key messages

The timeframe of HTA should ensure the accuracy of information and of methodological and legal steps, without forgetting the timeliness of delivery. Models and instruments should be implemented in order to guarantee the timeliness of HTA reports.
Workshop: A methodology for monitoring population health literacy in Europe – the HLS19 project
Authors:   Organised by: EUPHA (HP), Austrian Public Health Institute Chair persons: Jürgen M Pelikan - Austria, Dietscher Christina - Austria
Published: November 2019

Health literacy (HL) is a critical determinant of health (WHO-Shanghai Declaration, 2016), i.e. of healthy life styles, of indicators of health status and of use and results of health care services. For Europe the European Health Literacy Survey (HLS-EU) in 2011 demonstrated, that a considerable proportion of general populations in the researched 8 European countries (and in more countries in later surveys) had limited health literacy and that there was a considerable social gradient of health literacy. The HLS-EU study also showed that HL impacted certain health risks, important indicators of health status and of use of professional health services. But besides these general trends for all researched European countries, there existed considerable variations in distributions and associations of health literacy between the researched countries.

Thus, since knowledge on health literacy of populations is relevant for planning health policy, the Solid Facts - Health Literacy of WHO-Europe (2013) recommended regular monitoring of population health literacy by standardized procedures. Since HL now is understood as a relational concept, HL can be measured on a personal or an organizational systems level. Also measures to improve HL can try to improve personal HL by offering better opportunities for learning or by developing Health Literate Organizations or settings to be more sensitive to personal HL of their users and be less demanding and more supportive for users.

Therefore in 2017 the Action Network on Measuring Population and Organizational Health Literacy (M-POHL) was initiated under the umbrella of the European Health Information Initiative (EHII) by WHO-Europe. M-POHL from its beginning combines a policy with a research agenda. About 25 member states of WHO-Europe already joined M-POHL. As a first project the European Health Survey 2019 (HLS19) is ongoing with 15 countries participating.

The workshop will inform about the vision and mission of M-POHL, about the methodology of the on-going HLS19 survey and about the way selected countries are using monitoring of HL for their health policy. Following 5 short inputs (60′), including two more general ones M-POHL and HLS19 and three on perspectives from countries, participants will have the opportunity (30`) to ask questions and discuss what M-POHL and HLS19 means or could mean for health policy of their country and their personal research or policy interests.

Key messages

Health literacy is a critical determinant of health which has to be monitored for general populations in all countries of WHO-Europe as a basis for national and European health policy. The Action Network of Measuring Population and Organizational Health Literacy (M-POHL) of WHO-Europe has started the Health Literacy Survey 2019 to provide data for evidenced-based health policy.
Using data on population health literacy as a basis for evidence-informed health policy
Authors: Dietscher D
Published: November 2019

An increasing body of evidence suggests that health literacy (HL) is relevant for health-related decisions in relation to treatment, prevention, and health promotion and, consequently, for health and health care outcomes. At the same time, data illustrate that huge proportions of populations in many countries are concerned by low levels of HL. The improvement of HL should therefore be an issue of concern for health policy.

In the sense of “what doesn’t get measured doesn’t get done”, internationally comparative data on HL - like those provided by HLS-EU (2011) - can provide important guidance for health policy and administration on where best to intervene. Austria is one of the eight countries that participated in HLS-EU. According to the data analysis, the percentage of the Austrian population affected by low levels of HL came second-to-last in the survey. This was a wake-up call for Austrian health policy, and numerous activities were initiated as a result.·

In 2012, Austria launched a national health target on improving population HL. Since 2013, specific objectives to improve HL have been integrated into the ongoing national health care reform process. In 2015, a national HL alliance was launched to coordinated activities. Today, the alliance has 5 defined program lines that are in huge parts inspired by the analysis of HLS-EU data, and Austria will participate in the next European HL survey starting in Autumn 2019 to get new data.

The examples of other countries - including those represented in the workshop - confirm the importance of internationally comparative data to trigger national attention and to start coordinated action on HL. According to the Austrian experiences so far, data analysis can support evidence-informed action in defined fields of activity. To remain active in a continuous and systematic way requires national capacity-building as well as the identification of and collaboration with stakeholders across sectors.
Visualising the complex relationships between ethnic group and health in Scotland: 2001-2013
Authors: Gruer L , Stanaway F , Bhopal R
Published: November 2019

Background

With growing numbers of migrants worldwide, accurate data are needed to assess the health of migrants and ethnic minorities, highlight inequalities and evaluate relevant policies and actions. To summarise and reveal the complexity of the findings, we developed data visualisation techniques based on epidemiological principles.

Methods

We used published results from the Scottish Health and Ethnicity Linkage Study (SHELS), a retrospective cohort of 4.62 million people linking census ethnicity data to health service and death records during 2001-2013. In tables mainly using rate ratios, we employed different colours to show health advantage, disadvantage or equivalence; different colour shades to represent degree of certainty, combining effect size and precision of estimate; and different font sizes for absolute rates, to highlight more common conditions. We ranked health conditions by age-adjusted rate within each ethnic group to show differences in burden of disease and disease priorities.

Results

Using 30 health outcomes for up to 11 ethnic groups, we show that ethnic differences vary greatly depending on outcome, sex and ethnic group. The patterns are complex with some ethnic groups showing strong advantages for some outcomes and strong disadvantages for others. Using absolute rates highlighted differences in common conditions such as myocardial infarction, COPD, and falls. Ranking conditions within ethnic groups showed that most ethnic groups have largely similar disease priorities.

Conclusions

Our approach helps reveal and interpret the complexity of ethnic health differences. Simplistic generalisations that the health of migrants or ethnic minorities is worse or better than majority populations are often misleading and best avoided. Using absolute rates and ranking conditions within ethnic groups are useful as large relative differences in disease rates between ethnic groups may not translate into different disease priorities.

Key messages

Statements that the health of migrants or ethnic minorities is worse or better than majority populations are often misleading and best avoided. Large relative differences in disease rates between ethnic groups may not translate into different disease priorities.
The European Semester 2015-2018: themes and progress of country specific recommendations on health
Authors: Clemens T , Azzopardi-Muscat N
Published: November 2019

Background

The European Semester (ES) is a policy coordination and scrutiny framework at EU-level for surveillance of fiscal and macro-economic policies in Member States. Health systems have not evaded that scrutiny. The analysis focusses on how health systems reforms are being endorsed in Country Specific Recommendations (CSRs) and how the ES process links to planning and implementation of national health system reforms over the period 2015-2018.

Methods

A descriptive content analysis of CSRs with a search for the keywords and phrases ‘health’, OR ‘healthcare’, OR ‘long-term care’ was performed for the years 2015-2018. Furthermore, CSRs addressing health systems were classified according to whether they were targeting access, quality or sustainability; and categorized regarding organisation and governance, financing, physical and human resources, and provision of services. Finally, implementation progress on the health CSRs was rated according to EC’s own evaluation scheme derived from the preceding year’s country report.

Results

CSRs with health system recommendations have featured continuously in the ES process each year and have stabilised in number. The themes of health CSRs are still dominated by financial sustainability, cost-effectiveness and of financing, although other health system goals and domains, particularly access, are increasingly addressed. There is a high degree of consistency on the content of health CSRs over the years for each country addressed. Progress with implementation of health CSRs is disappointing so far, based on the EC evaluations. No clear link between discontinuation of health CSRs and evidence of progress in implementing the CSR can be discerned.

Conclusions

The results uncovered some of the links between national and European institutions leveraging the ES to push health system reforms. However, a more balanced and long-term view is needed for the ES to contribute solidly to complementing national efforts in a complex reform context.

Key messages

Health CSRs are still dominated by financial sustainability considerations while other health system goals and domains are increasingly addressed. Progress with implementation of health CSRs is disappointing so far, although a longer-term perspective is needed to pay tribute to the complex reform environment of health system reforms.
Could increasing income in lone-parent households reduce inequality in child mental health problems?
Authors: Chigogora S , Pearce A , Viner R , Morris S , Taylor-Robinson D , Hope S
Published: November 2019

Half of lone-parent families in the UK live in relative poverty (income <60% national median) compared to a quarter of two-parent families. Family hardship is associated with increased risk of child mental health problems (CMHP). Using data from the UK Millennium Cohort Study (∼18,000 children born 2000-02), we investigated whether equalising income between lone- and two-parent households could reduce prevalence and inequality in CMHP. Exposure was family structure (lone-/ two-parent household) at 9 months; mediator was equivalised weekly household income at 3 years(y); outcome was parent-report CMHP at 5y (Strengths and Difficulties Questionnaire; normal/ borderline-abnormal). The analytic sample comprised 11,193 children.

We modelled the relationship between family structure, income and CMHP in logistic marginal structural models, weighted for attrition to MCS at 5y, and adjusted for baseline and intermediate confounding. Prevalence of CMHP was assessed overall and according to family structure. Differences between lone and two-parent households were represented by risk ratios (RRs) and differences (RDs) [95% CIs]. We modelled a hypothetical increase in income for all lone-parent households, so that median income was equalised between lone- and two-parent households, and re-estimated prevalence, RRs and RDs.

Prevalence of CMHP was 8.5%. Children from lone-parent households were more likely to exhibit CMHP (RR 1.73[1.28-2.19]; RD 5.70[2.44-8.97]). Equalising income reduced prevalence (8.2%), and differences in CMHP by family structure (RR, 1.37[0.90-1.83]; RD, 2.86[-0.06-6.31]). Sensitivity analyses showed that associations between exposure, mediator and outcome were comparable in more recent MCS sweeps, indicating that these relationships still hold today. Inequalities in CMHP between lone- and two-parent families in the UK are large. Levelling up income for lone-parents households could reduce differences in child mental health problems related to family structure.

Key messages

Inequalities in CMHP between lone- and two-parent families in the UK are large. Levelling up income for lone-parents households could reduce differences in child mental health problems related to family structure.
How to enhance collaboration between primary care and public health?
Authors: Rechel B
Published: November 2019

Background

There are almost universal calls for improved collaboration between public health and primary care, but it is less clear how this can be achieved in practice. This presentation summarises key findings from an Observatory policy brief on how to enhance collaboration.

Methods

The policy brief iss based on a systematic review of the academic literature on collaboration between public health and primary care, searching the databases Medline and Embase for articles published since 2010. After title, abstract and full-text screening, 46 articles were retained and included in the review.

Results

Most academic articles on collaboration between primary care and public health are concerned with the United States and Canada. From the European countries, the Netherlands and the United Kingdom are most strongly represented. There is also a very uneven timeline in publication, with a spike in articles published in 2012, following an influential Institute of Medicine report. Research has identified organizational models of primary care that are conducive to collaboration with public health, as well as systemic, organizational and interpersonal factors that can facilitate or hinder collaboration. However, the relative importance of these factors remains poorly understood. Improved collaboration between public health and primary care promises to bring major benefits, but these are rarely documented in the literature so far. Furthermore, collaboration may also bring certain risks, such as competition over scarce resources.

Conclusions

The literature on collaboration between public health and primary care points to many illustrative examples, but also identifies relevant principles and factors that can hinder or facilitate collaboration. Policy interventions to improve collaboration will need to be mindful of potential risks and should aim to demonstrate benefits, which will help to increase buy-in from primary care and public health professionals and the public.

Panelists: Ilana Ventura

Federal Ministry of Labour, Social Affairs, Health and Consumer Protection, Austrian Government, Vienna, Austria

Contact: ilana.ventura@sozialministerium.at

Birger Forsberg

International Health, Karolinska Institutet, Stockholm, Sweden

Contact: Birger.Forsberg@sll.se

Rémi Pécault-Charby

Caisse Nationale de l’Assurance Maladie, Paris, France

Contact: remi.pecault-charby@assurance-maladie.fr
A multicentre study of street foods purchased in urban areas of Central Asia: the FEEDCities Project
Authors: Sousa S , Lunet N , Gelormini M , Jewell J , Morais I , Albuquerque G , Casal S , Pinho O , Breda J , Padrão P
Published: November 2019

Background

Street food (SF) is a strong tradition in Central Asia, where urbanization and westernization of food habits is occurring. Research on SF consumption is scarce, and crucial to understand its implications for public health. This study aims to describe the SF purchases in urban areas of Tajikistan, Kyrgyzstan, Turkmenistan and Kazakhstan.

Methods

A cross-sectional study was conducted in Dushanbe, Bishkek, Ashgabat and Almaty in 2016/2017. SF markets (n = 34) and vending sites (n = 270) were selected by random and systematic sampling. Data on customers’ characteristics and food items purchased was collected by direct observation. Nutritional composition of the food items (n = 852) was obtained by laboratorial analysis (n = 582) or food composition tables and labels (n = 270).

Results

A total of 714 customers were identified. The most commonly purchased foods and beverages were savoury pastries/snacks (23.2%), main dishes (19.0%), sweet pastries/confectionery (17.9%), tea/coffee (11.3%) and soft drinks/juices (9.8%). Fruit was the least frequently purchased food (1.1%). Nearly one-third of customers purchased industrial food items; this proportion was significantly higher in Kazakhstan (43.2%) and Turkmenistan (32.3%). The median energy content of a SF purchase ranged between 352kcal (Tajikistan) and 568kcal (Turkmenistan). The median saturated (SFA) and trans fat contents were 4.74g and 0.36g, respectively; the highest values were 9.01g for SFA (Turkmenistan) and 0.60g for trans fat (Kazakhstan), accounting for 40.6% and 27.3% of the maximum daily recommendations, respectively. Sodium-potassium ratio was far above recommended, reaching the highest values of 6.57 and 5.17 in Tajikistan and Kyrgyzstan.

Conclusions

Frequent purchase of industrial food reflects a shift to a westernized dietary pattern. Public health policies in these settings should aim to increase fruit availability and to improve SF nutritional composition, namely its lipid profile and sodium content.

Key messages

A relevant proportion of customers bought industrial foods, while fruit was rarely purchased, reflecting the nutrition transition process that is occurring in developing countries. Street food meals showed concerning levels of saturated fat, trans-fat and sodium, which must be considered when designing strategies targeted to improve the urban food environment in these settings.
Evaluation of communication skills among physicians: A systematic review of existing assessment tools
Authors: Gosselin Boucher V , Gemme C , Dragomir A I , Bacon S L , Lavoie K L
Published: November 2019

Background

The importance of physician training in communication skills for behavior change counselling in the context of chronic disease management is increasingly recognized. However, little is known about the quality, utility and psychometric properties of existing communication assessment tools.

Objective

This study systematically reviewed existing assessment tools used to evaluate communication skills among physicians.

Methods

A systematic review was conducted in accordance with the PRISMA guidelines (CRD42018091932). Four databases (PUBMED, EMBASE, PsychINFO, SCOPUS) were searched up to December 2018, generating 3902 unique articles which were screened by two authors. A total of 57 articles met inclusion criteria and underwent full data extraction.

Results

Selected studies were published between 1990 and 2018. A total of 45 different assessment tools were identified. Only 47% of the studies mentioned any theoretical basis underlying the design of the tool. The most prevalent communication skills assessed were information giving (46%) or gathering (40%), eliciting patients’ perspective (44%) and agenda planning (37%). Forty-two percent were tool validation studies, but the majority (61%) reported on only one psychometric property. Study quality, using the modified COSMIN checklist, varied considerably, with an average score of 4.5/9 ± 1.3 representing moderate quality.

Conclusions

Despite identifying a high number of existing physician communication assessment tools, most were poorly validated and a high degree of heterogeneity in terms of skills assessed and study quality was observed. Most used in-person role-play exercises that are intrusive, expensive, and time-consuming, making them impractical for use within most medical contexts. Successful chronic disease management depends not only on feasible and effective communication skills training among physicians, but also on our ability to reliably assess skill acquisition.

Key messages

Training physicians’ behaviour change competencies is central to improving lifestyle changes among patients living with a chronic disease. Due to the major methodological shortcomings of existing communication assessment tools, we strongly recommend increased methodological rigor for the development of new tools.
Creating national guidelines for assessing functional and work capacity of recently settled persons
Authors: Henriksson M , Rask S , Anttila H , Kuusio H
Published: November 2019

Problem

The measurement of functioning in clinical practice should be systematic and comprehensive. However, different versions of the same functioning measure are used e.g. by physicians, psychologists, physiotherapists and occupational therapists. The TOIMIA network of experts aims to harmonize and develop the measuring of functioning in Finland.

Description of the problem

With increasing immigration to Finland, a specific need for guidelines on how to assess functional and work capacity of recently settled persons was identified. Led by the National Institute for Health and Welfare (mobiTARMO-project, 2017-2020), guidelines for assessing functional and work capacity in the integration phase are in preparation.

Results

The guidelines on assessing functional and work capacity in the integration phase include four principles: Functional and work capacity assessment should be done with culturally and linguistically appropriate methods.Assessment should be based on shared expertise of the professional and the client.Assessment should be comprehensive, and take into consideration physical, psychological, social and cognitive functional capacity, activities of daily living, and environmental factors.Assessment should be systematic and lead to further actions and necessary services.The national guidelines will be disseminated as free online access material in the Terveysportti health portal to professionals in clinical practice and research.

Lessons

There are specificities to the cross-cultural assessment of functional and work capacity of recently settled persons. National guidelines can be created through broad collaboration of different organizations, as in the TOIMIA network of experts in Finland.

Key messages

Jointly agreed principles on how to assess functional and work capacity in the integration phase benefit professionals and clients. National guidelines can be created, disseminated and taken into practice through broad collaboration.
Rural primary care: a scoping review
Authors: Bosmans M , Boerma W G W , Groenewegen P P
Published: November 2019

Background

Access to primary care is unequally distributed. Especially in rural and remote areas access to primary care services is problematic. As many countries, large and small, recognize the challenge of providing accessible and good quality primary care and implement different strategies to address this challenge, there are opportunities for cross-national learning. The main aim of this report is to provide information on best practices and solutions to counter the risk of a primary care vacuum in rural and remote areas.

Methods

In this scoping review of the literature on primary care in rural areas we made an inventory of evidence from research of the past 10 years. The research literature from January 2008 to June 2018 was captured through searches of the databases of Medline, Cochrane and EMBASE. In addition, we included relevant grey literature from within the WHO European region.

Results

The following four groups of strategies have been identified and can be used to address rural primary care shortages: substituting roles within multidisciplinary primary care teamssmart recruitment, retention and training strategies focused on staff in rural areasimplementing technological innovations in information and communicationas a short term solution: promoting the mobility of health care workers and patients

Conclusions

The evidence base with regard to interventions to improve access to primary care in rural areas is narrow, lacking sufficient methodologically sound research, making definitive conclusions about their effectiveness impossible. Additionally, the available evidence is biased towards programmes targeting physicians. Nevertheless, the literature does offer indications of promising intervention types, and provides valuable recommendations for their implementation.

Key messages

Implementation of strategies should always be accompanied by systematic monitoring of outcomes. Interventions should include primary care workers other than physicians.
Income inequality in disability-free life expectancy in Denmark
Authors: Brønnum-Hansen H , Foverskov E , Andersen I
Published: November 2019

Background

The state old-age pension in Denmark is adjusted in line with the projected increasing life expectancy without taking social inequality in health and life expectancy into account. The purpose of the study was to estimate income disparities in life expectancy and disability-free life expectancy (DFLE) at age 50.

Methods

By linking nationwide register data on income and mortality each individual at any age was divided into equivalised disposable income quartiles and life tables were constructed for each quartile. Data from the Danish Survey of Health, Ageing and Retirement in Europe (SHARE) was linked to register data providing access to information on respondents equivalised disposable income. Finally, data from the life tables were combined with prevalence on activity limitations by income quartiles from SHARE to estimate DFLE by Sullivan’s method. Differences in DFLE were investigated and decomposed into contributions from mortality and disability effects.

Results

A clear social gradient was seen for life expectancy as well as DFLE. Thus, life expectancy at age 50 differed between the highest and lowest income quartile by 8.0 years for men and 5.0 years for women. The difference in DFLE was 11.8 and 10.3 years for men and women, respectively. For men the mortality effect from the decomposition contributed by 4.1 years to the difference of 11.8 years in DFLE and 3.9 years to the difference in expected years with disability of 3.8 years while the disability effect contributed by 7.7 years.

Conclusions

The study quantifies social inequality in health in Denmark. Although income inequality in life expectancy and DFLE can partly be explained by loss of income due to chronic diseases, one would expect a welfare state to provide better financial security for citizens with health problems. Furthermore, the marked social disparity when approaching retirement age is questioning the fairness of implementing a pension scheme independently of socioeconomic position.

Key messages

Disability-free life expectancy differs between income quartiles by more than 10 years. Pension age follows the projected increasing life expectancy independently of socioeconomic position. This seems unfair.
Skills building seminar: Making the elevator pitch work: how to convince a policymaker in less than 2 minutes
Authors:   Organised by: EUPHA, EUPHAnxt Chair persons: Dineke Zeegers Paget - EUPHA, Maaike Droogers - EUPHA
Published: November 2019

Since a number of years, EUPHA, the European Public Health Conference and other associations, have been working hard to translate the evidence in a such a format that policymakers take notice. The work by WHO Europe on ‘telling the public health narrative’ or providing factsheets and infographics is an example. EUPHA has organised several skills building workshops on translation of evidence in the past years (e.g. 2018: You say tomatoe, I say tomato). The European Public Health Conference introduced the so-called pitch presentations (at Glasgow 2014), where researchers are asked to present their work in 5 minutes with maximum 5 slides (no animations), a way to learn to present key messages from research in just a few minutes.

But what should you do, if you meet your policymaker in the hallway or in an elevator? Can you present your work, including key messages, without slides? And in less than 2 minutes? You should be able to.

In this skills-building workshop, we will select a number of abstracts that have been accepted by the International Scientific Committee as posters and we will invite the presenting authors to this dare: present your work and key messages in less than 2 minutes. In order to see whether the policymaker is convinced, we are organising a small panel of policymakers and ask them to give their feedback. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work?

Key messages

Being able to present your key messages anywhere, anytime is needed.

Panelist

Anne-Marie Yazbeck

Chafea, Luxembourg

Contact: Anne-Marie.YAZBECK@ec.europa.eu

Ivan Erzen

Slovenia

Contact: Ivan.Erzen@nijz.si
Role of nurses to improve self-care in heart failure patients: a systematic review and meta-analysis
Authors: Massimi A , De Vito C , Rega M L , Villari P , Damiani G
Published: November 2019

Introduction

Heart Failure (HF) is a pandemic chronic disease with a prevalence up to 3% in the general population, representing the main cause of hospitalization for people over 65. Self-care plays a central role in the management of patients with HF, showing evidence of effectiveness in reducing re-hospitalization rates and mortality.

Methods

We carried out a systematic review and meta-analysis to assess the efficacy of nurse-led educational interventions Vs usual care in improving self-care skills of patients with chronic HF. The main biomedical databases were searched for Randomized Control Trials (RCTs) of nurse-led educational interventions performed on adults with a previous diagnosis of HF. Improvement of HF self-management skills (self-care level) was summarized by calculating the standardized mean difference (SMD) and 95% confidence intervals (CI) stratified for the length of the follow-up.

Results

Globally, 14 RCTs were included involving 2078 participants. Ten studies showed the efficacy of the interventions at 3 months (short term) with a SMD of 0.78 (95% CI 0.38-1.18) in favor of the self-care education interventions. Five studies reported on self-care abilities at 6-9 months (medium term), not showing statistically significant results (SMD 0.35, 95%CI 0.11-0.81). The long-term effect of the educational interventions showed no statistically significant improvement in self-care behaviors (three studies, SMD 0.05, 95CI% 0.12 - 0.22).

Conclusions

These results show that nursing educational interventions improve self-care behaviors in HF, but mainly in the short term. Intensive educational interventions led by nurses, associated with appropriate continuity and transition of care, can determine the best outcomes for patients with HF, strengthening self-care behaviors over time. This approach could have a major impact not only on individual level, but on the general reduction of complications, hospitalization, medical costs and ultimately mortality.

Key messages

Nurse-led educational programs have a short-term efficacy in enhancing self-care behaviors among heart failure patients. Post-discharge repeated educational interventions, along with timely and shared plans ruling the transition between the hospital and the other providers, are strongly needed.
Rural and urban general practice: a comparison in 34 countries
Authors: Groenewegen P , Bosmans M , Boerma W
Published: November 2019

Background

Rural areas have problems in attracting and retaining primary care workforce. Comparable problems but with a different background occur in deprived urban areas. Here we focus on primary care practices that do work in rural areas and not on the shortage or lack of access for the rural population. We answer the question whether these practices have a different organisation, lack resources and have different service profiles, compared to practices in semi-rural and urban areas.

Methods

We used data from the QUALICOPC study, conducted among approximately 7,000 GPs in 34 (mainly European) countries, on the organisation of practices, their human resources and equipment and their service profiles. Data were analysed using multilevel regression analysis, with countries and GPs as levels.

Results

In general the practices in rural areas are more often single-handed and have less other primary care workers available. In most countries they have more equipment and their service profiles are broader, in particular as compared to inner-city urban practices.

Conclusions

The combination of increasing demand for care and undersupply of health care services can lead to a primary care shortage in rural areas. However, the practices that are currently located in rural area in most countries seem to be able to cope with the situation by providing a broader range of services, compared to service-rich urban areas. Against growing health needs of an ageing and often poorer population, there is a risk of lack of facilities and equipment and ageing staff. Until now this is not manifest in the primary care practices in most countries.
eHealth solutions to regional shortages in the health workforce
Authors: Velez-Lapão L , Maia M , Dussault G
Published: November 2019

Background

Healthcare systems are facing significant challenges, from demographics, shortage of health professionals to increasing costs that are associated with increasing demand. New technologies are thought to be a solution to these problems. However, the question is if the digitalization of healthcare will mitigate these problems and the shortage of health professionals in Europe.

Methods

This study provides a scoping review on existing health digital services aiming to cope with health professional shortage in Europe. The main challenges, from workforce performance, services quality, patient-interaction to technology use are addressed. The databases of Pubmed and Ebsco were searched.

Results

38 papers were selected and analysed addressing eHealth with impact on the workforce performance. It highlights the challenges associated with the digitalization of healthcare, the implementation of digital services, considering the design online service, and the impact of digitalization on healthcare workforce performance. An overview of the major effects of transformative technologies (e.g. eHealth services, Internet of Things solutions, Artificial Intelligence) on the healthcare workforce are addressed. Moreover, what are the major implications of technological change for future skill needs and competences of the public health workforce? Are there any reliable projections on how technologies will change the structure of the labour market for health professionals? And to what extent is the workforce equipped to adapt to the changes?

Conclusions

Proper digitalization of healthcare will enable changes in the paradigm of healthcare delivery as well as in the mechanism for patients’ participation and engagement. Sustainable implementation of eHealth is an important opportunity to address health workforce shortage but it is not enough.