bluuebunny/crossref_metadata_2025 huggingface dataset:
Parents' knowledge about complementary feeding: an integrative review
Authors: Oliveira E S , Cardoso MVLML , Lopes M M C O , di Moura A F , de Melo G M , Oliveira D T , Girão S G M , Bezerra C M
Published: October 2020

Currently, authorities and specialists in child development and public health have been concerned with the growth and nutritional status of children, especially due to the uncontrollable increase in overweight / obesity that has occurred in recent years. Obesity causes organic-functional complications, such as chronic-degenerative diseases (diabetes, high blood pressure, coronary heart disease), and psychosocial complications, such as withdrawal from social relationships, shame, exclusion and disturbances in body awareness. The objective was to identify in the literature the parents' knowledge about complementary feeding for infants. Integrative literature review based on the guidelines recommended by PRISMA. The search was carried out between the months of May and June 2017 by two researchers independently in the Scopus, PubMed, Scielo, LILACS and CINAHL databases. The following descriptors were used: “infant”, “complementary feeding”, “parents” and “knowledge” and “infant”, “complementary feeding”, “relatives” and “knowledge” in the DECs and MESH respectively. 1,012 studies were identified and a sample of 06 articles was obtained after applying the eligibility criteria. The knowledge evidenced was: use of appropriate utensils for feeding the child, not using cow's milk, caution with processed foods, issues related to breastfeeding and age of introduction of food and other liquids. Even so, there were still mistakes by parents regarding the recommendations of the main bodies dealing with food, such as the use of processed foods from the fourth month of life of the child and the relationship of the “fat” baby being the health model. It was concluded that the knowledge of parents / caregivers about complementary feeding is still permeated by mistakes. Thus, the nursing consultation should focus on health education and search for strategies that facilitate the process of introducing complementary feeding and help parents in this period.

Key messages

Targeting health strategies on complementary feeding in a timely manner. Guidance for the prevention of obesity in early childhood and the development of non-infectious diseases.
A systematic review of the impact of the Great Recession on food intake
Authors: Jenkins R H , Vamos E P , Taylor-Robinson D , Millett C , Laverty A
Published: October 2020

Background

The 2007-2009 Great Recession significantly impacted global economies, industries, and individuals around the world, with a potential impact on health behaviours including dietary intake. Given the global reach and severity of the Great Recession, changes in food intakes may impacted health and health inequalities internationally. We conducted a systematic review examining whether the Great Recession had an impact on food intakes.

Methods

We searched MEDLINE, Embase, PsycINFO, Health Management Information Consortium (HMIC), CINAHL and Web of Science databases, along with relevant grey literature, in June 2020. Primary quantitative studies with the Great Recession as the exposure and food intake as the outcome and with two time points were eligible for inclusion in this review, assessed independently by two reviewers. The Newcastle Ottawa scale was used for quality assessment. The study was registered with PROSPERO (CRD42019135864).

Results

Forty-one studies from twenty-five countries were included in this review. Studies were heterogeneous in methods and results. Nine of ten studies on energy intake found that total energy intake decreased over the recession. Eight of eleven studies on dietary quality found that the recession was associated with poorer diet. Thirty-four studies assessed impact on individual food groups. They found that consumption of fruits and vegetables, meat and fish, and fast food, confectionery and soft drinks generally decreased while egg and legume consumption increased and carbohydrate consumption exhibited little change. The impact was generally greater on those of lower socio-economic position.

Conclusions

While our review presents mixed findings about the impact of the Great Recession on food intake, there is consistent evidence of a negative impact on diets. Identifying effective policies which mitigate adverse changes in nutrition during economic downturns should be prioritised at the national and international level.

Key messages

Our systematic review of the Great Recession and food intakes demonstrates potential relationships between economic downturns and nutrition – these relationships may be important for health globally. Our systematic review demonstrates that it is important for policy-makers and public health professionals to consider mitigating potential nutritional impacts during economic recessions.
Lower-caloric intake but different nutrient profiles in cognition impaired and in frail elderlies
Authors: Wu S Y , Pan W H
Published: October 2020

Background

Frailty and dementia are two common geriatric syndromes associated with poor nutritional status. The nutritional role in the pathogenesis of frailty and dementia remains unclear. We examined the associations between energy intake and frailty/cognition impairment and also compared the nutrient intake between frail and cognition impaired elderlies by sex.

Methods

Data of 1,920 elderly adults (≧65y) from the 2014-2017 Nutrition and Health Survey in Taiwan was used. Frailty was defined using modified L. Fried criteria. The Chinese Mini-Mental State Examination score was grouped into tertiles: cognitive impairment (score ≦ 23), mild cognitive impairment (score = 24-27), and the normal (score ≧28). Total energy intake was grouped into tertiles. Logistic regression adjusted for age, sex, and sampling strata was used for association test. The trend test was performed using generalized linear model with age adjustment to examine whether various nutrient intake indicators had an ordered relationship with the severity of frailty and cognitive impairment.

Results

Lower energy intake (men <1540 Kcal or women<1182 Kcal) was significantly associated with frailty (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.45-2.66) and cognition impairment (OR: 1.88; 95%CI: 1.43-2.47), respectively. Larger number of micronutrients and food substances per Kg body weight exhibited decreasing trends with MCI (protein, fat, carbohydrate, vitamins B1, B2, B3, B6, B12, C, E, Ca, P, Fe, Mg, K, Zn, dietary fiber, and cholesterol) than with frailty (protein, vitamin B1, B3, B6, C, P, Mg, K, Zn, polyunsaturated fatty acids, and dietary fiber).

Conclusions

The lower the energy intake, the higher the odds ratio for frailty and for dementia. Dietary quality expressed by nutrient intake per Kg body weight was poorer in elderlies with cognition impairment than those with frailty.

Key messages

Lower energy intake is associated with MCI and with frailty, respectively. The MCI elderlies involve more micronutrient deficiencies than the frail counterpart.
Assessment of lead food contamination and dietary intake in a Northern Italian population
Authors: Malavolti M , Filippini T , Fairweather-Tait S J , Malagoli C , Vescovi L , Vinceti M
Published: October 2020

Background

Lead is a heavy metal naturally occurring in the environment and also released by some anthropogenic activities. Food is one the major sources of human exposure for non-occupationally exposed individuals. In this study, we aimed at characterizing lead (Pb) content in foods consumed in Northern Italy population, in order to estimate its dietary intake.

Methods

We measured lead content in 908 food and beverage samples bought at small shops and supermarkets of the Northern Italy provinces of Modena and Reggio Emilia, through inductively coupled plasma mass spectrometry. We used a validated semi-quantitative food frequency questionnaire to assess the dietary habits of a representative sample of 719 individuals (319 males and 400 females) aged 18-87 years residing in Northern Italy (Emilia Romagna). We estimated weekly dietary intakes of Pb, and we compared them with safety standards set by the European Food Safety Authority (EFSA).

Results

In this population, vegetables and vegetables products were the main contributors to Pb intake. The highest levels of Pb were in edible offal, and then in crustaceans, dry fruits, chocolate free sweet confectionery, and coffee and tea as beverages. In general, Pb levels in our samples were comparable and did not exceed the average contamination levels reported by EFSA in various European countries. We found a comparable average Pb intake in both sexes. Average weekly intake of Pb was below EFSA recommended provisional tolerable weekly intake.

Conclusions

Our study provides an updated assessment of lead exposure through diet in a Northern Italian community. Although environmental lead contamination and exposure have markedly decreased in the last decades, recent evidence pointed out that a safety threshold value cannot yet be established for prevention of adverse effects due to lead exposure, since even low levels of lead intake may still increase the risk of chronic renal disease and hypertension.

Key messages

Food is one the major lead sources of human exposure for non-occupationally exposed individuals. Lead levels in Northern Italian population studied are comparable and do not exceed the average contamination levels reported by European Food Safety Authority in various European countries.
Factors influencing food insecurity rates: A county by county observation from 2017 in New Jersey
Authors: Ignace K , Souza M , Borges C
Published: October 2020

This observational study aimed to investigate food insecurity prevalence for children under 18 in New Jersey using secondary data from 2017. Total food insecurity rates per county for children under 18 and all people were gathered from the NJ Department of Health. Age and Sex 5-year estimates for total population and children were collected from the US Census. The median income in the past 12 months from 2013-2017 was collected from the US Census in addition to family poverty status in the past 12 months from 2013-2017. Additional data was collected from the Social Capital Index. A bivariate analysis and a chi-square test revealed that nine independent variables were correlated to food insecurity prevalence by county in New Jersey among children under the age of 18. The significant variables were total food insecurity prevalence for all people in a county (p=.000), median income in the past 12 months in 2017 age-adjusted dollars (p=.000), percent of families below the poverty level (p=.000), county-level index (p=.000), family unity (p=.000), institutional health (p=.002), collective efficacy (p=.003), percent of adults over the age of 18 not covered under any type of health coverage (p=.006), and percent of families headed by a single parent (p=.000). Regarding the multivariate analysis, only two variables were still significant. Median income (p=.030) and poverty status (p=.007). These two variables are strongly associated with food insecurity prevalence among children under the age of 18. Health insurance status and household income are correlated with food insecurity. Food insecure children were more likely to live in areas with high deprivation and experience both individual-level poverty and neighborhood deprivation.

Key messages

Median income and poverty status are strongly associated with food insecurity prevalence among children under the age of 18. Food insecure children were more likely to live in areas with high deprivation and experience both individual level poverty and neighborhood deprivation.
Herbal medicine use and its associated factors in the region of Sousse (Tunisia)
Authors: Limam M , Sahli J , Khalfallah I , Mellouli M , Ghardallou M , Mtiraoui A , Zedini C , Ajmi T
Published: October 2020

Background

Patients use medicinal plants as the first-line treatment for many chronic and acute medical conditions. The lack of access to conventional health care, historical, cultural and economic considerations contributes to the important use of these plants. The purpose was to identify medicinal plants used by primary Health Care Centers' visitors in the region of Sousse (Tunisia) and to assess its associated factors.

Methods

A cross-sectional descriptive study was conducted among Primary health care centers' visitors of the region of Sousse (Tunisia) in 2018. We randomly selected 18 primary health centers and 50 participants were chosen from each center. Data were collected using a pre-tested questionnaire, filled through a direct interview with participants which explores: socio-demographic variables and medicinal plants' use (name of plants, symptoms, methods of preparation, routes of administration, plant source, tolerance and side effects).

Results

900 persons were included with a female predominance (72.4%). The median age of participants was 48 years ranging from 18 to 93. 65.2% (n = 587) of them report using medicinal plants to heal. The most common sources of information were family (90.5%), beliefs and traditions (56.4%). Fifty-three (53) plants were used to treat different disorders. The most used plants are: verbena (81.6%), rosemary (53.3%), mint (52%) and thyme (45.1%). The most reported treated symptoms were: flu and gastro-intestinal disorders. Plants utilization was associated to: lower age, female gender, marital status, high level of education and social existence of protection coverage.

Conclusions

Plants use should be based on well-conducted scientific results specifying the mechanism of action of plants, the therapeutic and toxic dose through researches on local plants samples and extracts.

Key messages

It seems essential to train health professionals on herbal therapy during their studies and practice. The further step after this picture of the herbal medicine use in the Region of Sousse, is to evaluate the safety and the efficacy of their use.
Nutritional profile of ultra-processed foods advertised in small food retailers
Authors: Borges C A , Kikuta C , Jaime P C
Published: October 2020

Background

It is necessary to analyze the nutritional profile and advertising claims of ultra-processed foods available in small food retailers.

Methods

This is an observational cross-sectional study that carried out an audit on small food businesses. Information was collected on advertising, price, ingredient list, nutritional composition and portion size. All investigated foods were grouped according to the NOVA food classification. Food advertising was categorized into 11 different consumer appeals. The relationship between the type of advertising appeal of the ultra-processed food and its nutritional profile was analyzed. A comparison was made between the nutritional composition of the advertised food and the recommendations of sugar, saturated fat and sodium of the Pan American Health Organization (PAHO).

Results

The most prevalent ultra-processed foods in small retailers were sweets and treats (18.5%); sugary sweetened beverages (15.7%), sausages (12.0%) and baked goods (11.1%). Most of the advertising on the packaging of ultra-processed foods was about healthy eating and physical activity and sensory aspects of the product (color, flavor, texture). Foods classified as high in sugars had the highest number of advertisements related to healthy eating and physical activity, foods high in sugar and saturated fats, had the highest number of advertisements related to sensory aspects, healthy eating and physical activity and foods high in sodium and / or saturated fats, had more advertising related to convenience.

Conclusions

Identifying that advertising for ultra-processed foods is associated with health and well-being, physical activity and sensory aspects leads us to a better understanding of the factors that influence consumer perception in small businesses. Advertising for foods rich in sugar, saturated fat and sodium based on health and well-being should be better regulated by public agencies in Brazil, supporting consumers to make healthier choices.

Key messages

Ultra-processed foods induce to consume large quantities, due to the convenience and the advertising present in their packaging that stimulate a healthy life, physical activity and sensory aspects. It is necessary support and defend changes in nutrition labeling, in order to clarify the nutritional information to consumers.
Antibiotic resistance of bacteria isolated from Pagellus erythrinus microplastics and public health
Authors: Laganà P , Fazio E , Spanò N , Bonsignore M
Published: October 2020

Microplastics (MPs) are widespread in the aquatic environmental due to anthropogenic pollution and are ingested indifferently by fishes that confuse them with food. In aquatic environment, mechanical stress, UV radiations, chemical and biological actions cause a constant degradation and breakdown of plastic objects into smaller fragments. Mediterranean Sea is characterized by the highest densities of plastics in the world being a closed basin with a complex hydrodynamics.

The aim of this work is to evidence the occurrence of microbial adhesions on MPs found in edible Pagellus erythrinus (Linnaeus, 1758) bought in local Sicilian supermarkets and therefore highlight the potential role of microplastics in conveying antibiotic resistance by ingestion of food by humans. The composition and structural-morphological properties of MPs found in the excised gastrointestinal tract (GIT) and gills are identified using different techniques. In particular, microparticles of different nature (plastics, organic components, cellulose-based materials) have been determined following specific Raman signals on a large spectral range (300-3500 cm-1).

The Pagellus was dissected, open longitudinally, within a sterile glass Petri dish. The components deemed exogenous to the normal structure of the gills and GIT were collected. Optical microscopy images showed that both the GIT and the gill of Pagellus erythrinus contain MPs of different colors (black, dark blu) and mainly with a fibrous shape. At the moment, microbial assays show the adhesion of Citrobacter and E. coli in some fibers extracted by gills while Vibrio spp was mainly detected in the fibers present in GIT. Bacterial isolates were screened for susceptibility to antibiotics using the Kirby-Bauer test, choosing the molecules most used in human therapy.

The results obtained suggest that plastics may contribute to the spread of multiple antibiotic resistance in marine environments underline the relevance of future studies on this topic.

Key messages

Plastics can serve as vectors for the spread of multiple resistances to antibiotics across marine environments. Further studies on possible vehicles of multidrug-resistant germs carried by food of various kinds are desirable.
Zoonotic disease transmission risks in displacement
Authors: Braam D
Published: October 2020

Background

The novel coronavirus pandemic reiterates the risk of zoonoses - diseases transmittable between animals and humans - to global health. Meanwhile, climate change and conflict increasingly cause human and animal movement, affecting interspecies, intrahuman and interhuman barriers to disease. The dynamics and risks of zoonotic diseases among naive (host) populations and displaced communities are not well understood. This study aims to determine how displacement affects the vulnerability of displaced populations to zoonotic disease transmission, to improve policy development and humanitarian responses.

Methods

Following a literature review, countries for fieldwork were selected and visited based on zoonotic disease risk, livestock dependency and population displacement. Expert interviews were conducted in Jordan and Pakistan with policy makers and responders in public health, livestock and disaster management, and household interviews conducted with displaced. Data was analyzed using a conceptual framework considering biological, environmental, technological, social and political processes at national, local and individual level.

Results

Poverty and low socio-economic status are considered main determinants of people's vulnerability to disease, while disasters affect health services and staff, as well as disease pathogen, vector and host environments. Displacement exacerbates these risks, including the availability of water and sanitation, shelter and population density. The formal or informal status of refugees and internal displaced people influences their access to services, further affecting their health. Meanwhile, zoonotic disease dynamics are not sufficiently understood among stakeholders, and animals remain an afterthought in many humanitarian responses.

Conclusions

Zoonoses in displacement settings need to be addressed using a transdisciplinary, multilevel approach, addressing disease as well as underlying political, social and economic risk factors.

Key messages

Zoonotic disease transmission depends on complex ecological, political and socio-economic drivers, therefore zoonotic disease risk in displacement requires a multilevel, transdisciplinary approach. Among rural populations dependent on livestock, the presence of endemic zoonotic pathogens is likely to be constant. Displacement may increase disease risk by affecting animal and human immunity.
Health needs assessment for elderly in primary health care in Zagreb
Authors: Polic-Vizintin M , Marić Bajs M , Portolan Pajić I , Tucak J , Šostar Z
Published: October 2020

Background

The purpose of any health system is to guarantee access to care for the entire population served. Zagreb population is 'very old', with 17.3% older than 65. The aim is to assess health care needs for elderly in primary health care (PHC).

Methods

Data on morbidity and visits are recorded in PHC facilities Variation in the mortality rate in 1971-2014 period is analyzing, using descriptive method.

Results

The highest index of PHC utilization (88.1%) is recorded for the +65 age, with 14.3 visits per capita (vs 7.7 for general population). Acute respiratory infections ranked first in all age groups; the rate per 100 was considerably lower in the ≥65 group than in the 0-19 group (27.82/100 vs 111.20/100). Hypertensive diseases ranked second most common (23.09 per 100) in the age group ≥65, followed by intervertebral disk diseases and other dorsopathies (15.10/100), and neuroses and affective disorders (6.63/100). The prevalence of hypertensive diseases and of intervertebral disk diseases and other dorsopathies was significantly higher in the ≥65 group (χ2=27.3 and χ2=13.43, respectively; p < 0.05 both). Among mortality causes circulatory diseases and neoplasms showes a constant rise during the period 1971-2014 (circulatory diseases 26.4%; neoplasms 83.9%). The highest rise is recorded in group of endocrine and metabolic disease owing diabetes mellitus(159%).

Conclusions

Many of older people although independent, have multiple chronic conditions and meet criteria for fraility. The number of PHC visits is high, twice in comparison with general population. Health needs are very related to coping with appropriate organization and management of public health services, esspecially of senior- friendly primary care concept.

Key messages

The aging of the general population influences the type of morbidity and health care needs. The concept of senior-friendly primary care has to be promoted.
Tackling Sustainable Development Goals in Italian Regional Legislation: a Health in All Policies comparative analysis
Authors: Stirparo G , Rallo F , Gori D , Blandi L , Seidenari C , Bizzarro A , Gaetti G , Rossi D , Odone A , Signorelli C
Published: October 2020

Background

The Health in All Policies approach has been increasingly used to assess public health impact of rules and regulations. In 2015, all UN member States adopted 17 Sustainable Development Goals (SGDs) to achieve the 2030 Global Agenda. SDGs can be conceived in a practical way, as analytic tools to classify existing legislation. In the context of the ASPHER-ASPPH sponsored “This is Public Health in Italy” campaign, the Public Health Schools of University San Raffaele, University of Bologna, University of Pavia and University of Parma decided to monitor their own local governments' level of SDG compliance. The study aims at identifying a procotol for a Health in All Policies, SDG-driven analysis in two Northern Italy Regions: Lombardy and Emilia-Romagna. These two regions 4.45 millions and 10.04 million accounting for over 24% of national population.

Methods

Between November and December 2019, two teams were established for separate analyses of the 2 Regions. All laws were retrieved from the two Regional Council's offical websites. Exclusion criteria were set by ruling all healthcare-related laws out of the analysis. An agreement was reached to label each law with the most representatives SDG tackled. As a proxy for internal validity, results were double-blinded. Each Regional Group met collectively and double-checked the other group's anlysis. To minimise detection bias, results were sent anonymously to the Scientific Committee, who supervised the analytic process and solved disagreements.

Results

A total of 57 laws were examined, 26 issued by Lombardy Region and 31 by Emilia-Romagna Region. SDG-related laws number was: 11 (42%) in Lombardy Region, whereas in Emilia-Romagna Region the proportion was much higher (n = 22, 71%). The most addressed SGD in Lombardy Region was number 15 (Life on Land), while in Emilia-Romagna number 8 (Decent Work & Economic Growth).

Conclusions

SDGs can be considered an innovative indicator to measure governement's activities and monitor the progress towards achieving the 2030 Global Agenda.

Key messages

Sustainable Development Goals are useful tools for policy analysis. The “This is Public Health in Italy” campaign allowed for a survey of public health legislative initiatives.
Recent changes in smoking habits in France
Authors: Andler R , Guignard R , Richard J B , Pasquereau A , Quatremère G , Nguyen-Thanh V
Published: October 2020

Background

In 2018, smoking rate among French adults was 32.0%. This rate has been slowly decreasing over the past years but remains high compared to other European countries. In addition, smoking habits have changed over time and for instance roll-your-own tobacco (RYO) is both cheaper and seen as less dangerous. It is crucial to keep an eye on these changes in order for public health actors to adapt their actions in the fight against smoking.

Methods

Data come from the Santé publique France health Barometer, a national representative phone survey. In the 2005, 2010, 2014, 2017 and 2018 editions, respectively 28,224, 25,034, 15,186, 25,319 and 9,074 adults where asked about their smoking habits.

Results

In 2018, three quarters of smokers smoked cigarettes, over a third smoked RYO and about ten percent smoked hookahs. The proportion of smokers using exclusively RYO tobacco has more than doubled in recent years (from 8.1% in 2010 to 20.5% in 2018). Since 2010, RYO tobacco is taking shares over traditional cigarettes especially among the poorest smokers. In 2018, RYO tobacco users were more often young men or deprived individuals.

Conclusions

The share of cigarette smokers switching to RYO has increased over the past years. It seems to be both a result of changes in trends and a way for deprived smoker to cope with higher prices for cigarettes.

Key messages

Public health actions need to take into account the recent increase of popularity of RYO tobacco in France. taxes need to be adjusted in order to level up RYO tobacco prices compared to traditional cigarettes.
Health inequalities during school-to-work transitions among young adults: Mapping the evidence
Authors: Matos Fialho P , Dragano N , Reuter M , Metzendorf M I , Richter B , Richter M , Spallek J , Diehl K , Lampert T , Pischke C
Published: October 2020

Background

School-to-work transition is a sensitive period that can have a substantial impact on health over the life course. Previous studies suggest pronounced health inequalities during this period but little is known about the determinants at the individual, meso- and macro-levels. We aim to further elucidate possible health inequalities during school-to-work transitions with a focus on multilevel determinants, e.g. evidence on potential effects of contextual and compositional factors of specific institutions involved.

Methods

We are currently conducting a scoping review (funded by the German Research Foundation) to map the evidence on the above mentioned topic among young adults (aged 16-24 years), following the methodological framework proposed by Arksey and ÓMalley and PRISMA. The literature search was performed in Ovid MEDLINE, Web of Science, ILO and NIOSH, using sensitive search strategy developed by text-analysis. Only articles published between January 2000 - February 2020 and written in English or German are considered. The selection process is conducted following a two-step approach:1) screening of titles and abstracts 2) screening of full-texts by two independent reviewers. Any discrepancies in the selection process are resolved by a third researcher.

Preliminary Results

Following the five stages of the methodological framework, the scoping review is currently in stage 3 (study selection-screening phase). We found 25,069 potentially relevant articles in our primary search. 15,508 articles remained after the duplicates were removed. Up to now, 8,825 papers were screened of which 7,629 were excluded and 1,176 included which qualified for full-text reading. Complete results of the scoping review will be presented at the conference.

Conclusions

This scoping review will improve our knowledge about the emergence and development of health inequalities during school-to-work transitions by examining health of individuals in different institutional contexts.

Key messages

Improving our knowledge of health inequalities during school-to-work transitions. the role of determinants at the individual, meso- and macro-levels during this stage will also be examined.
Ageing and inequality: unintentional death in the elderly in Campinas in the 21st century
Authors: Komoda D S , Geronimo C , Bravo M , Cordeiro R C , Ruiz A M P
Published: October 2020

According to WHO falls are the second leading cause of preventable unintentional death and people older than 65 years of age are more likely to suffer from fatal falls. Low and middle-income countries are most affected with 80% of fall related deaths. This study provides an overall view of fall-related deaths in the city of Campinas, Brazil, with special attention to the elderly in the last 2 decades. This study aims to highlight the unequal distribution of deaths related to fall, concerning the elderly in Campinas (total population of around 1,000,000), which in 2010 had a very high Human Develop Index (0.805), but also a very high inequality rate (Gini index of 0.56 in 2010).

This ecological study in Campinas evaluates fall-related deaths in the elderly between years 2000 and 2018. Trend analysis were applied to the specific mortality ratios related to falls obtained from Brazil's official databases. Specific mortality trends were also analyzed regarding Human Development Index by neighborhood. The number of deaths due to fall in the elderly throughout the period totaled 1700 (1 million of population). The annual average was 85 (minimum of 31 in 2000 and maximum of 157 in 2018). Although trend analysis of mortality in the elder due to “overall external causes” and of mortality due to “fall in the elderly” didn't show clear growing tendencies (R2=0.546 and R2=0.622), the ratio between “number of deaths due to fall in the elderly” and “total deaths due to fall” shows a reliable average of 1.17% increase per year (from 3.73% in 2000 to 26.03% in 2018, R2=0.93). Trend-analysis based on community HDI mortality rates additionally shows a tendency of increase both in “number of deaths” and “mortality rate” in low-HDI elder (with R2=0.85 and R2=0.786).

Despite decreasing violence levels in Campinas, fatal deaths due to fall seem to target low-HDI elder population. Effort must be taken in all levels of the healthcare system as well as in policies to soften inequality's effect.

Key messages

Violent, unintentional causes of death in the elderly population are increasing along with population ageing. Politicians and health managers must pay attention to inequality-related health problems and take into account population ageing for a sustainable universal health system coverage.
Health Literacy in people with intellectual disabilities – is there a need for an adapted concept?
Authors: Bruland D , Vetter N , Latteck ÄD
Published: October 2020

Background

Health literacy (HL) is a crucial factor in terms of health and health-related outcomes. HL refers to personal and social resources as well as the abilities to access, understand, appraise and apply health information to make self-determined health decisions. Due to reduced resources including cognitive abilities it is assumed that HL in people with intellectual disabilities (PWID) is low. Up to 3% of the general population have an ID (IQ < 70).

Methods

Current state of the art is presented via a mixed-method literature review published in 2019. Against that, results from 5 target group orientated groups are presented (n = 50).

Results

Literature Review (12 studies incl.): HL does not go beyond a purely functional understanding. Studies assume that the HL level of PWID is very low, but fail to mention a reference source. Overall, studies are mainly from the health professionals' perspective and exceptions directly questioned or focused people with ID. People with ID still seems to be a 'hidden' population in HL research. Group discussions: An introducing quiz about health-related topics turns into a discussion within the group of PWID. Topics were physical activity, nutrition and health advices from health professionals like GPs. Instructions of physicians were discussed; a critical view of health advices were taken. Bassed on experiences own health decisions are described. Trained caregivers like nurses are stated as an own professional HL resource. Communicative and critical HL have been demonstrated.

Conclusions

There is only little knowledge about HL in PWID. Promoting HL could be highly beneficial for managing health information with a positive impact on PWID themselves (empowerment), their (family) caregivers, and the health care system (reducing health costs). A debate to conceptualize HL for PWID is mandatory. This must be based on valid data, consider the perspectives of PWID and have to respect the resources of PWID. Future directives will be discussed.

Key messages

People with ID communicative and critical health literacy is is available but not yet explored how it can be increased. A target-adapted health literacy of people with intellectual disabilities is beneficial, it it takes the perspectives of this target group into account.
Health and culture: National and individual drivers of preference for professional medical help
Authors: Leijen I , van Herk H
Published: October 2020

Background

Preferences for professional medical healthcare in case of non-acute medical situations influence a major amount of healthcare use, and vary strongly across countries. Personal values and country culture have been shown to be important predictors of human preferences in many areas. We therefore investigated the impact of both individual and country-level characteristics across Europe on individual healthcare preferences related to non-acute medical conditions.

Methods

Data from 17,710 individuals from 16 European countries were analysed using a multi-level approach, simultaneously including individual- and country level predictors.

Results

Healthcare preferences were explained by both human values (Conservation γ = 0.097, p < .01, Self Enhancement γ = 0.038, p < .05) and trust in the doctor (γ 0.054, p < .01). Socio-demographics played a minor role. Societal tightness-looseness (TL) strongly predicted healthcare use preferences on the country level (γ 0.109, p < .05). Also TL enhanced the relation between conservation and preference (γ 0.024, p <.05), and decreased the relation between self-enhancement and preference (γ -0.021, p <.01).

Conclusions

Our results suggest that healthcare behavior is related to people's motivations and the extent to which the society they live in is more tight or loose. Stronger conservation values increase preference for professional medical care, while self-transcendence- and openness-to-change values decrease preference. Societal tightness is positively related to preference on the country level. Furthermore, in tight societies the effect of conservation is enhanced and the effect of self enhancement is suppressed, related to an additional higher preference for professional medical help. Our results may help key actors within the health system to predict and channel healthcare choice behavior across and within nations.

Key messages

Culture plays an important role in developing a preference for medical help, on both individual as well as country level. Personal values the as well as cultural tightness looseness are fruitful tools for the analysis of national and international health care research.
An example of involving lay people to enhance complex public health intervention evaluations
Authors: Southby K , Rushworth S , South J , Coan S , Woodward J , Bagnall A M , Button D
Published: October 2020

Background

Despite growing interest in understanding complex systems and public health interventions, research methodologies that take account of system-wide action are relatively underdeveloped. Community-based participatory research (CBPR) is steered and conducted by people with lived experience of the issues being researched. This paper explores the value of CBPR in complex public health intervention evaluations. The 'Local People' and 'Local Conversations' programmes use a community empowerment approach in 50 communities across the UK experiencing social disadvantage to increase social connections and collective control, improve health and wellbeing, and reduce inequalities (linked to SDG 3 and 11).

Methods

Evaluation of the programmes followed a mixed-methods design, including qualitative case studies, longitudinal survey, process appraisal, and CBPR. Residents from 10 communities across the programmes each undertook 2 rounds of CBPR. These projects resulted in written reports, which were analysed thematically alongside other data sources.

Results

There was some variation in the scope and design of the 20 completed CBPR projects. Whilst projects did not generally extend beyond the scope of the overall evaluation, peer research provided information from residents that were inaccessible to other data collection streams. Gathering community (lay) knowledge improved understanding of local priorities and actions within the programmes. However, the utility of CBPR was less consistent for community-researchers and local communities, often failing to support project development. Some community-researchers felt unprepared for the activity despite support from the academic team.

Conclusions

Conducted appropriately, CBPR can elicit data that would be less accessible through externally led research. This study highlights the value of CBPR in complex programme evaluations, enabling a deeper understanding of social context in which interventions occur.

Key messages

CBPR complements more traditional research methodologies in complex public health evaluation designs. CBPR can enable a deeper understanding of social processes necessary for the success of complex public health interventions that might be beyond the scope of other methodologies.
Social determinants of health, adverse childhood experiences, and maternal-infant relationship
Authors: Kapp J , Frech A , Hall B , Kemner A
Published: October 2020

Background

Low strength of maternal-infant relationship (MIR) is consistently associated with early childhood obesity risk. Because obesity often persists once it develops, primary prevention is needed early. Home visiting programs support families with social determinants of health (SDH) and adverse childhood experiences (ACEs); SDH and ACEs contribute to health inequities. Addressing SDH and ACEs may facilitate improvements in MIR and ultimately mitigate early childhood obesity risk. Limited to no research has examined the association between ACEs, SDH, and MIR. In the context of a national, evidence-based home visiting program, we asked: are SDH and ACEs associated with low MIR?

Methods

This sample includes 6,972 children ages 0–<24 months enrolled in the Parents as Teachers home visiting program across the United States from sites using the Life Skills Progression (LSP) instrument through February 2020. Low MIR is dichotomized from a 1-5 scale, with low scores reflecting low nurturing, bonding, and responsiveness. We used the literature, theory, and a stepwise logistic regression model-building process to identify a parsimonious model for MIR.

Results

Preliminary results reflect 34.2% Hispanic or Latino, 22.7% non-Hispanic Black, 35.3% non-Hispanic Other race; 83.9% low income; 36.9% low education; and 13.4% mothers scoring low for MIR. Notable findings from modeling include: physical ACEs, captured here as child abuse or neglect (OR: 5.01, 95% CI: 4.10-6.11); mental illness ACEs, captured here as a mother/parent with mental illness (OR: 1.31, 95% CI: 1.05-1.63), or the mother/parent treated violently (OR: 1.95, 95% CI: 1.56-2.40). Protective associations include mothers' support of child development and self-esteem scores.

Conclusions

Understanding the complex interplay of SDH, ACEs, and MIR is critical for developing interventions that address “upstream” family characteristics in order to mitigate early childhood obesity risk. ACEs play a predominant role.

Key messages

This is the first known study to concurrently examine maternal-infant relationship, social determinants of health, and adverse childhood experiences. Home visiting programs may be critical partners in addressing these needs given their reach.
Community based medical education – specific needs of elderly population
Authors: Musil V , Majer M , Kujundžić Tiljak M , Jureša V
Published: October 2020

Background

Many countries in the world are facing problem of population ageing. As a part of medical education regarding that matter, The Community Health Course, based on line that main fields of work for physicians are communities, not physician's consulting rooms, has been conducted at School of Medicine University of Zagreb.

Objectives

Students of last (sixth) year of study attend The Course through one week in rural and semi-urban areas of Croatia. They have insight in living conditions and needs of elderly population trough participation in work with community nurses, family doctors/general practitioners and gerontology house helpers. Students evaluate activities by anonymous questionnaire, giving a grade (from one-very bad to five-outstanding) and writing a short description of experience. For the purpose of this paper we analysed student's evaluation from academic year 2018./19.

Results

Very good and outstanding found 94% of students (N = 299) work with community nurse, 92% with gerontology helpers and 87% with physicians. The value of activities they described as: “ we got an insight into functioning and organization of healthcare outside clinical hospital centres and Zagreb, we entered homes of people and saw how and in what conditions they live”, “being able to participate in work with gerontology helpers and community nurses, first-hand learning, we learned a lot about community”, “extremely valuable insight into lives of people in very difficult life situations and evidenced value of gerontology home helpers”, “I saw differences of living conditions and health care between countryside and city”.

Conclusions

The results of evaluation showed students recognition of importance community oriented medical education, emphasising awareness about specific needs of elderly population.

Key messages

Community oriented medical education could motivate students to choose work in countryside areas in future carriers. Students recognized importance of community oriented medical education, emphasising awareness about specific needs of elderly population.
Parental engagement in social entrepreneurship by participatory action research at school of Nepal
Authors: Maharjan G , Devkota B , Gjotterud S , Bastien S L
Published: October 2020

School education has immense role for the better future of a country. However, schools such as in a developing, country like Nepal face many barriers in demand creation as well as quality in classroom delivery. Students enter the school with mental stress and family problems. This restricts the educational outcome of schooling. Social entrepreneurship (SE) is an alien idea still in most schools in Nepal. By this venture, School social entrepreneurship can help the students and society to detect the skill of life which changes their life standard in future. It helps students to be regular in school, improve their health and ultimately bring change in overall educational achievement. In contrary to this, because of students poor economic condition they are neither able to have proper breakfast nor lunch which leads to sleepiness and inability to concentrate in the class room. Hence their learning outcome is poor. Following a Participatory Action Research (PAR) paradigm, the first author spent more than a year with rigorous field engagement in Janajivan Secondary school at Chitwan district of Nepal in order to understand the context and real need of SE. The school has own building and enough land where opportunity to develop entrepreneurship activities with the concept of 'supporting livelihood of parents through SE' approach. To dig out the reasons, We used informal talk, focused group discussion, observation and interview with teachers, students, community members, school management committee and parents. The study finding indicates that lack of time, teacher's fear of commercialism, impeding educational structures and sustainability were some of the challenges integrating SE in school. Experiential earning and learning based activities can be practiced in school outside the classroom. Having SE at school with parental involvement can be innovative pedagogical approach in school education of Nepal.

Key messages

Entrepreneurship linking with health education. Promote livelihood with entrepreneurship by participatory action research.