bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of a video-based assessment to build authentic public health skills
Authors: Bhatti A
Published: October 2020

Background

Public health education should have strong connections to applied public health practice. Health communication, including an ability to interpret and transmit knowledge, are core competencies for public health graduates. These skills have traditionally been assessed via standard oral presentations. A diversity of tasks can increase student engagement and motivation about assessments. The use of video-based assessments is a relatively new assessment format in post-graduate education. An authentic task was created where post-graduate public health students at Macquarie University, Australia collaborated in groups to create an advocacy campaign video as part of an assessment. These videos were shown at a short film event and students additionally reflected on their experience.

Objective

Can use of a student-produced health promotion video as a team-based assessment task lead to development of: competency in delivering public health communication; technical skills in videography; skills in team engagement and foster deep reflective thought?

Results

On average student grades were higher in the video task than other unit tasks, demonstrating students' competency in delivering public health messages. Unit reflections across three years revealed student benefits included: task enjoyment; feelings of achievement; opportunities to apply learning and new teamwork and videography skills. Unit evaluations found 96% of students reported an increased understanding of advocacy and health promotion and 87% reported the reflective task further consolidated learning. Unit convenor reflections include enhanced student engagement due to novelty, more scope for original presentation of work and similar convening efforts compared to traditional presentations.

Conclusions

This simple innovative video assessment is a practical and authentic way of teaching graduate public health students how to communicate public health messages and could be replicated in other courses.

Key messages

A student-produced video advocacy campaign assessment can offer student engagement and authentic learning in graduate public health education. Implementation of this convenient video-based assessment could be adapted in other courses in public health education.
Reclassifying Deaths: Legal Intervention Deaths (Y35- ICD10) in the city of Sao Paulo (2014-2015)
Authors: Ryngelblum M , Tourinho Peres M F
Published: October 2020

Background

Police violence is a public health issue. Brazil is one of the most violent countries in the world and has one of the most violent police forces. The low reliability of official sources on police killings is recognized worldwide. In Brazil, the two official data sources on police killings are the Criminal Records (Security Department) and the Vital Statistics System that uses the death certificate coding (ICD10-Health Department). The Legal Intervention classification (Y35) presents underreporting when compared to the data from the Security Department. Our study aims to investigate the underreporting by health authorities of the deaths committed by police in the city of Sao Paulo between 2014 and 2015, seeking to identify the death cause coding used.

Methods

We performed a search of all death cases caused by police identified in the Criminal Records, but not classified in their death certificate as Legal Intervention (Y35). In divergent situations, we sought the ICD-10 classifications used. Mortality data were extracted from the death certificate records from the Vital Statistics System and the Security Department database. The databases were linked to identify the same record in both databases. For the linkage, we used the probabilistic method (RecLink software). The three key variables used to identify true pairs were: name of the victim, date of occurrence, and place of death.

Results

Through the linkage, we were able to find 726 true pairs. We highlight: Only 46% of deaths were classified as Legal Intervention (Y35);The other ICD-10 codings used were: Assault by Handgun Discharge- X93 (50%) and Other and Unspecified Firearm Discharge- Y24 (4%).

Conclusions

Our study made possible to reclassify deaths committed by police from the Vital Statistics System. Our method was able to expand the use of the category Legal Intervention (Y35) to more than 100%. The quality of data on police violence in Brazil must be improved.

Key messages

Our study made it possible to reclassify deaths committed by police. We expanded the use of the category Legal Intervention (Y35) in 100%. The data on police violence in Brazil must be improved. Police Violence is a public health issue. The low reliability of official sources is widely recognized. Reclassifying deaths committed by police it is essential for Vital Statistics System in Brazil.
Females and males requesting cervical or prostate cancer screening: Sex differences in self-efficacy
Authors: Gomez Rincon G , Garcia Aparicio L , Torres Ortiz M , Amaya Castellanos C , Idrovo Velandia A
Published: October 2020

Background

Cervical and prostate cancers have an important burden of disease, especially in developing countries. Self-efficacy for requesting screening is a key element in prevention activities. In this study we compared self-efficacy for requesting screening among Colombian females and males, to explore potential joint factors associated with both sexes.

Methods

A mixed study with development design was realized with 50 females and 50 males. First sociodemographic, medical data, and the cancer screening self-efficacy scale (original and ad hoc scale for males) were collected among participants. They were classified according to levels of self-efficacy and their risk factors were identified with robust regression. Semi-structured interviews with individuals with specific characteristics were realized to ascertain with detail about explanations for differences in requesting screening. Elements of the health belief model were the categories analyzed.

Results

Females and males were similar except in religion, occupation, and antecedents of Pap or rectal examination. Self-efficacy for requesting screening was higher among females (adj. β: -15.29, 95% CI:-18.36 to -12.21) and non-believers (adj. β: -5.38, 95% CI: -10.33 to -0.44). 27 individuals (18 males and 9 females) with low and high self-efficacy, and non-believers (atheists) were selected for interviews. Participants suggested that females are more susceptible than males because men need to feel symptoms. Shame and discomfort are barriers expressed by both sexes. Machismo is a strong barrier to request screening. Religion associate sex with impurity and it is a barrier among females. Health care services only focus on female screening.

Conclusions

Gender roles and religion (Catholicism and other Christian) elements are cultural expressions that determine the request of cancer screening. Further interventions should consider cultural elements to improve screening coverage.

Key messages

There are important sex differences in requesting cervical or prostate cancer screening. Culture (gender roles and religion) expressions determine cancer screening.
Uptake of cervical cancer screening in Kuwait: A cross-sectional study
Authors: Tolma E , Alawadhi E , Longenecker J , Al-Wotayan R , Tawheed E , Albahar S
Published: October 2020

Background

Despite the low incidence of cervical cancer in Kuwait in 2018, it is projected that it will increase by 48% by 2035. This is of concern considering that cervical cancer is a preventable disease if detected early. With limited research in this area in Kuwait, we sought to assess the prevalence of cervical cancer screening (CCS) among Kuwaiti women.

Methods

This study is part of the WHO's 2014 STEPS risk factor surveillance study. A representative random sample (n = 3915) of Kuwaiti citizens was recruited (response rate= 89.2%). CCS was assessed with the question “Have you ever had a screening test for cervical cancer using any of the methods described above”. All women aged 21-69 years who responded to the CCS question (n = 2183) were included in the analysis. Independent variables included age, area of residence, marital status, level of education, work status, smoking status, BMI level, history of CV disease, and history of diabetes. Statistical analysis included descriptive statistics, bivariate analysis, and multivariable logistic regression adjusted for participants' characteristics.

Results

The overall weighted CCS prevalence was 15.7% (95% CI [14.3-17.4]). CCS was associated with age (OR = 5.0 [2.5-10]) for age group 60-69, and OR = 3.1 [1.9-5.1] for age group 45-59 compared to the age group 21-29, area of residence (ORs ranged from 0.3 to 0.5 for those living in different governorates compared to those who lived in the Capital), marital status (OR = 4.4 for married and OR = 5.2 for divorced/widowed compared to those who were single), and level of education (ORs ranged from 2.7 to 2.9 for those who completed at least high-school education compared to those who did not).

Conclusions

The current uptake of CCS among Kuwaiti women is low. Disparities exist in terms of age, area of residence, level of education, and marital status. More efforts are needed to promote CCS through an organized screening program while considering the existing disparities.

Key messages

The current use of cervical cancer screening among Kuwaiti women is low. More efforts are needed to promote cervical cancer screening while paying attention to existing socioeconomic disparities.
Nutritional Status and Diet in Elderly with Low and High Socioeconomic Status
Authors: Zhu Y , Minović I , Dekker L H , Eggersdorfer M , van Zon S K R , Bakker S J L , Navis G J , Riphagen I J
Published: October 2020

Background

Socioeconomic status (SES) patterned health disparities have been related to differences in dietary intake, especially in the elderly. Still, it is not known to what extent these differences culminate in vitamin deficiencies, as most studies have assessed nutrient intake, instead of measuring nutritional biomarkers. Hence, we aimed to objectively assess nutritional status in elderly with low and high SES and to investigate whether potential differences therein were mediated by diet.

Methods

1605 individuals (60-75 years) were selected from the LifeLines Cohort Study to create two gender-matched groups with different SES. Nutritional status was assessed by measuring folic acid, vitamin B6, B12, D, A, E and K in the collected samples. SES-groups were defined according to highest completed education as high and low, and dietary quality was assessed the Lifelines Diet Score. Multiple linear regression and logistic regression were first used for the association between SES and vitamin status; and mediation analysis was used to explore the relationship of SES, diet and vitamin status.

Results

The overall prevalence of vitamin deficiency ranged from 4.1% (vitamin B6) to 19.5% (folic acid). The low SES group had significantly poorer status (p ≤ 0.04) of most vitamins, including the B vitamins (i.e., folic acid, B12 and B6) as well as multivitamin deficiencies (p ≤ 0.02). Low SES was independently associated with decreased folic acid, vitamin B6, vitamin B12, and vitamin A serum concentrations (p ≤ 0.03 for all). Diet quality was found to partially mediate the association between SES, and folic acid (39.1%), vitamin B6 (37.1%) and vitamin B12 (37.2%)(P ≤ 0.03).

Conclusions

Low SES is a risk factor for suboptimal nutritional status. The association between SES and nutritional status can be partially explained by diet quality, suggesting that policy makers can mitigate socioeconomic inequality in nutritional status by improving diet quality among elderly.

Key messages

Revealed that low SES was a risk factor for a suboptimal nutritional status among the elderly and a possible self-reinforcing trap has formed which causes low SES and hidden hunger to persist. Highlighted the importance of diet quality in socioeconomically patterned health disparities and indicating the need for SES-tailored public health strategies.
Diabetes vulnerability in Rome
Authors: Vaccaro C , Addonisio A , Lenzi A , Napier D , Volkmann A M , Dotta F , Crialesi R , Frontoni S , Baroni M , Morviducci E
Published: October 2020

Background

To understand the presence and impact of social and cultural factors on health vulnerability it is important for improving diabetes care and management. In fact, through the social dimension, it is possible to identify the priorities and attitudes towards diabetes and diabetes care among those living with the condition.

Methods

The study was carried out as part of the global Cities Changing Diabetes programme, involved a sample of individuals living with diabetes in the Rome metropolitan area and employed mixed-method and qualitative approaches to data collection and analysis (survey, sorting procedure and focus group).

Results

Four specific sub-groups of participants have been identified, each with distinct but shared priorities and attitudes towards diabetes: Health conscious thanks to the context; Medicalized elderly people; Fatalistic citizens; Worried but undisciplined young people. The connection between the place where you live and the possibility to adopt a healthier lifestyle was confirmed. For these patients, the disease is mainly characterized by its relationship with food and its connections with psychological aspects are also relevant.

Conclusions

An important issue concerns information and the different understandings of diabetes. A clear need emerged for further elaboration of the various aspects of a disease that tends to be underestimated also by those who have it. Another aspect concerns the importance of the living environment and consequently of the actions on its urban planning, mobility, but also in everyday life organization, as factors that can make a difference in properly managing the disease. These results are very important to promote a joint action, that have to involve public and private stakeholders, in order to improve treatment opportunities and quality of life of people facing diabetes every day in the Rome metropolitan area.

Key messages

An important issue concerns information. A clear need emerged for further elaboration of the various aspects of a disease that tends to be underestimated also by those who have it. The living environment in important too and the actions on its urban planning, mobility, in everyday life organization, as factors that can make a difference in properly managing the disease.
The macro determinants of medical abortion rates in Europe: a matter of gender equality?
Authors: Miani C
Published: October 2020

Background

Medical abortion is one of the WHO recommended methods for safe and effective first trimester abortion. It is often seen as an emancipating procedure allowing women to be more in control of their abortion, as opposed to surgical procedures where the surgery is “done to” the woman by a doctor. In countries where medical abortion is legal and available, rates of medical abortion (vs. surgical abortion) vary greatly, e.g. in Europe from 24% to 98%. We hypothesised that these differences may mirror how empowered women are in different aspects of their lives and be in part explained by gender (in)equality at the country level.

Methods

We conducted correlation and regression analyses to assess the association between medical abortion rates and gender inequality in Europe, using several macro-level markers of gender equality such as national gender equality indices and rates of violence against women. The relevance of other structural factors, such as health system and abortion care characteristics was also investigated.

Results

Seventeen countries were included. Although the sample size was small, results pointed toward an association between several markers of economic gender equality and medical abortion rates. The Gender Gap Index (corr. coeff: 0.52, p = 0.03) and its economic component (corr. coeff: 0.64, p = 0.005), as well as the economic component of the Gender Equity Index (corr. coeff: 0.68, p = 0.003), were all positively associated with the outcome. Other dimensions of gender equality (e.g. political participation; violence against women) and health system factors (e.g. date of introduction of the method; type of abortion providers) were not associated with the outcome.

Conclusions

Our results suggest that women's empowerment in the economic sphere may have repercussions on the use of abortion care, potentially influencing what method of abortion the women ask for and what method they are offered.

Key messages

Barriers to the use of medical abortion go beyond the law (if a method is legal/available or not) and include structural determinants, such as gender equality. Higher levels of economic gender equality are associated with higher rates of medical abortion, highlighting the relationship between gender equality and choice of method of abortion.
Trajectories of socio-economic position over four time points and mortality: The role of gender
Authors: Koupil I , Goodman A , Heshmati A , Mishra G
Published: October 2020

Background

Studies investigating the effect of social mobility on mortality in Sweden have used socioeconomic position (SEP) at only two time points and traditional methodological approaches. Our recent study has used SEP at four time points, but not employed latent class analyses when investigating the relationship between SEP trajectories and mortality in later life.

Methods

A cohort of 14,192 live births at Uppsala University Hospital between 1915-1929, of whom 97% were traced through parish records until routine registers became available in the 1960s. 5729 men and 5607 women were alive and living in Sweden in 1980. SEP was measured as social class of the head of household: at birth, in childhood (age 10, +/- five years), in adulthood (age 30-45, in the 1960 Census), and in later life (age 50-65, in the 1980 Census). Latent class analysis was employed to identify social class trajectories and Cox proportional hazard models used to estimate all-cause and cause-specific mortality (data from Causes of Death Register).

Results

Compared to men and women with stable high SEP trajectories, we found a higher risk of death from circulatory disease among men with stable low (HR 1.56, 95%CI 1.29-1.87), stable middle (HR 1.28, 95%CI 1.06-1.55) and upwardly mobile from low (HR 1.35, 95%CI 1.10-1.66) SEP trajectories, as well as in women with stable low or mobile from low to middle SEP trajectory (HR 1.27, 95%CI 1.02-1.59). SEP trajectories and total mortality showed similar, albeit, weaker associations in both genders. SEP trajectories were gender-specific and associations of SEP trajectories with circulatory disease mortality tended to be weaker in women.

Conclusions

Men's and women's socioeconomic position during childhood and over the life course affect their risk of late life all-cause mortality, and death from circulatory disease in particular. Improvements in social conditions at early stages of the life course are likely to contribute to reducing mortality at old age.

Key messages

Men’s and women’s socio-economic position during childhood and over the life course affect their risk of late life all-cause mortality and mortality from circulatory disease in particular. Trajectories of socioeconomic position across life course appear to be related to cause specific and total mortality in a gender specific pattern.
Revisiting the social determinants of health agenda from the global South
Authors: Borde E
Published: October 2020

Background

One of the most marked characteristics of the global social structure is the existence of substantial social inequalities in wealth, which also find expression in health inequalities between and within countries. In an effort to provide an overview of the conceptual debates shaping the mobilisation around social determinants of health and health inequities, two of the most influential approaches in the field are compared: the WHO Commission on Social Determinants of Health approach (CSDH), strongly influenced by European Social Medicine, and the Latin American Social Medicine and Collective Health (LASM-CH) Social determination of the health-disease process approach, hitherto largely invisibilized.

Methods

A comprehensive literature review was conducted in three databases (Lilacs, Scielo, Medline/Pubmed), reference lists of selected papers, and citations in Google Scholar, including book titles.

Results

It is argued that the debates shaping the SDH agenda do not merely reflect terminological and conceptual differences, but essentially different ethical-political proposals that define the way health inequities are understood and proposed to be transformed.

Conclusions

While the health equity and SDH agenda probably also gained momentum due to the broad political alliance it managed to consolidate, it is necessary to make differences explicit as this allows for an increase in the breadth and specificity of the debate, facilitating the recognition of contextually relevant proposals towards the reduction of health inequities.

Key messages

Debates shaping the SDH agenda do not merely reflect terminological or conceptual differences, but distinct ethical-political proposals. Differences need to be discussed and made explicit to guide the development of contextually relevant efforts to reduce health inequities.
Exploring the relation between socioeconomic position and DNA methylation in a European population
Authors: Petrovic D , Carmeli C , Bodinier B , Chadeau-Hyam M , Ehret G , Dhayat N , Ponte B , Pruijm M , Bochud M , Stringhini S
Published: October 2020

Background

Previous investigations have reported that adverse socioeconomic circumstances across the life-course lead to the alteration of major biological processes, eventually resulting in a higher disease risk and premature death. In particular, a low life-course socioeconomic position (SEP) has been associated with a modified epigenetic signature of loci involved in inflammation, the physiological response to stress, and other regulatory processes.

Methods

In this study, we investigated the association between nine indicators of SEP across the life-course and the differential methylation of 451'000 genome-wide CpG markers, using data from 690 adults included in a Swiss population-based study. We further examined the interrelations between the SEP-related CpGs, and the biological pathways in which the identified markers are involved.

Results

Three SEP indicators in adulthood were associated the differential methylation of 161 genome-wide CpG markers, whereby 156 CpGs were less methylated in people with low versus high SEP. Among the identified CpGs, a substantial proportion of markers were no longer associated with SEP upon accounting for health behaviors and cardiometabolic disorders. In addition, the identified CpGs were found to be involved in immune, inflammatory, and cancer-related processes.

Conclusions

Our results support the hypothesis that adverse socioeconomic circumstances may lead to the dysregulation of inflammatory processes, eventually resulting in the occurrence of serious chronic conditions such as atherosclerosis, diabetes, or cancer.

Key messages

Socioeconomic position is a major determinant of health-related outcomes. Epigenetic modifications may constitute a biological mechanism through which socioeconomic circumstances affect health.
Contradictory explanatory models of doctors and ischemic heart patients with low health literacy
Authors: Rasmussen A , Overgaard C
Published: October 2020

Background

Health literacy has been used to explain the social inequalities in ischemic heart disease that exists globally. However, most conceptualizations of health literacy employ an isolated focus on the patient's cognitive abilities without considering the social context. By using the cultural health capital framework, this paper aims at exploring how differences in social dispositions influence the interaction between doctors and ischemic heart patients with low health literacy and low socioeconomic status.

Methods

The paper is based on 30 qualitative interviews with Danish ischemic heart patients with low health literacy and low socioeconomic status and supplementary, contextual observations. The data collection was nationwide and carried out between October 2018 and August 2019.

Results

The findings showed that the patients and the doctors derived from different social spheres, which meant that they had developed dissimilar habitus and therefore used different explanatory models to understand and articulate the patient's problem. The doctors were primarily oriented towards the biomedical understanding of the malfunctioning of the body and therefore less aware of the patients' psychosocial illness experience. For the patients, these contradictions resulted in feelings of not being acknowledged, lack of trust in the healthcare system and disruption of treatment.

Conclusions

The findings suggest that to understand barriers for treatment of socially disadvantaged ischemic heart patients it is not only relevant to look at the patient's individual cognitive abilities but also to explore class-based contradictions in explanatory models between the patients and doctors.

Key messages

Health literacy should be understood as something embedded in the interplay between social structures and interpersonal dynamics. Contradictions in explanatory models may help explain barriers for treatment of socially disadvantaged ischemic heart patients.
The use of health services by non-resident patients in a border region with mixed health systems
Authors: Pumi Alliana F , Nampo F
Published: October 2020

Background

Access to health services in Brazil is universal, comprehensive, and equate, offering free healthcare to anyone, regardless of its country of residence. Cross-border patients may theoretically overload the healthcare services, mainly when the health systems or healthcare quality differ between countries. Sometimes, Brazilian politicians of border areas claim that non-residents overload local health services.

Methods

We collected data on the medium and high complexity Oncology and Cardiology care provided to in-patients by a reference Brazilian hospital located in the most populous international border of the country. This border is a conurbation that includes the cities of Foz do Iguassu (Brazil), Ciudad del Este (Paraguay), and Puerto Iguazu (Argentina), totaling around 900,000 inhabitants, of which 264,044 live in Foz do Iguassu. In addition to the poor migration control of citizens crossing these borders - especially the border with Paraguay - the Brazilian Unified Health System differs from that of the other two countries for being free of charge, and also for offering better healthcare.

Results

From January 2014 to December 2018, 107,434 procedures were performed, of which 240 (0.22%) on non-resident patients (Paraguay, [n = 236]; Argentina [n = 4]). Additionally, 238 (0.22%) other procedures were performed on foreign patients who did not declare their city/country of origin (Paraguay [n = 229]; Argentina [n = 8]; Portugal [n = 1]).

Conclusions

The use of medium and high complexity procedures by the non-residents on the Brazilian side of its most populous international border is low. Non-residents may benefit from medium and high complexity healthcare services of neighboring countries without overloading the health system.

Key messages

Advocating that non-residents overload medium and high complexity health services in Brazil is dishonest and may segregate people. Efforts should move toward integrating healthcare in border regions.
SosCaregivers: piloting of a psycho-social service for family caregiver in a hard-to-reach setting
Authors: Graffigna G , Barello S , Morelli N , Gheduzzi E , Masella C , Corbo M , Ginex V
Published: October 2020

Background

”Ageing-in-place” may improve elderly citizens' quality of life and the sustainability of welfare systems. In this process engaging family caregivers is crucial.

Methods

A community-based participatory research in the remote area of Vallecamonica was enacted. First, we surveyed unmet needs of family caregivers. Then, a scoping literature review on existing interventions for engaging family caregivers was performed. Third, 4 co-design workshops were conducted to co-generate a new service. Finally, the service was piloted for a period of 6 months and evaluated.

Results

51 caregivers participated in the survey: they were mainly females, mean 60 y.o and with medium-low level of education. The scoping review resulted in only 14 interventions targeted to elderly's caregivers in remote areas. The workshops involved 27 caregivers and co-designed a new psycho-social service (SOSCargivers) articulated into: 1) a structured informative platform to facilitate health literacy and information seeking; 2) a tailored educational program focused on medical and practical aspects related to elderly care; 3) a set of peer-to-peer meetings for experience sharing and mutual support; 4) a “caregivers board” was created to lead the service. In the piloting 5 training sessions, 5 peer-to-peer meetings, 3 meeting with the “citizens board” were enabled.

Conclusions

The service was positively received by caregivers, although participation wasn't high. Co-designing the service with its expected users facilitates the depth understanding of local people's needs and expectations. SOSCaregivers may support family caregivers of elderly citizens in hard to reach areas by both delivering more value and giving them an active role in the social-care network.

Key messages

Family caregivers’ engagement is crucial for integrated and sustainable services in hard to reach communities. Co-designing the service with its expected users facilitates the Department understanding of local people’s needs and expectations.
Measures to manage, reduce and prevent medicines shortages in European countries in 2020
Authors: Vogler S , Fischer S
Published: October 2020

Background

Several countries have seen an increase in medicines shortages that constitute a major public health threat as they can negatively impact the health outcomes of patients. The study aims to survey measures that European countries apply or consider introducing to address medicines shortages.

Methods

A questionnaire was sent to the public authorities, as involved in the Pharmaceutical Pricing and Reimbursement Information (PPRI) network, in 47 countries, thereof 44 countries of the WHO European region. Respondents were asked to report measures in place or being discussed as of the first quarter of 2020.

Results

Preliminary data from 8 countries (Albania, Austria, Finland, Germany, Italy, the Netherlands, Romania, Sweden; further responses are expected) show that national registers to which manufacturers notify, usually on a mandatory basis, upcoming and existing shortages (including end dates and causes in some countries) are common (all countries but Albania). Medicine reserve supplies that have to be kept for defined medicines exist in Albania and Finland; they are being established the Netherlands and are under discussion in Germany and Sweden. Finland and Italy allow issuing export bans for targeted medicines; this possibility is before implementation in Austria, was planned and then withdrawn in Romania and is under discussion in the other countries (except Albania). Further measures include simplified import permits (with patient information leaflets in foreign language), working groups with relevant stakeholders and financial sanctions for manufacturers in case of non-supply.

Conclusions

Governments have been reacting to shortages by implementing appropriate measures and adapting existing ones. Actions taken differ with regard to stakeholders addressed, the degree of obligation and the focus (optimising the management of existing shortages vs. prevention of future supply limitations).

Key messages

A mix of measures to address medicine shortages is applied in European countries. Recently, the number of measures increased, and actions requested from stakeholders tend to have become mandatory.
FinChildren Register: National monitoring of child and adolescent health and well-being in Finland
Authors: Lundqvist A , Haapala E , Jääskeläinen S , Sundman J , Mäntymaa P , Nieminen T , Ruokokoski E , Peltomäki H
Published: October 2020

Background

Comprehensive and up-to-date data on child and adolescent health and well-being is essential for monitoring, service development and decision-making. Although nearly all children and adolescents in Finland attend annual health check-ups at child health clinics and school healthcare, the utilization of collected data has been limited. The objective is to produce timely and representative information on the health and well-being of children, adolescents and their families based on routinely collected register data.

Methods

Data are collected from health check-ups performed at child health clinics and school health care. Recorded data are transferred through patient information systems to the Register of Primary Health Care Visits. The data can be linked to other national registers with personal identity codes. The first phase aimed to evaluate the availability and quality of register-based data through inspection of data coverage on height and weight data of children and adolescents aged 2 to 16 years.

Results

In 2018, the coverage of height and weight data ranged from 0% to 100% between municipalities depending on age group. Results were published through an interactive map application and municipality-specific summaries by gender and age group at national and municipality levels. The data enabled reporting up-to-date results on the prevalence of child and adolescent overweight and obesity in Finland.

Conclusions

Data from health check-ups form an excellent database for monitoring child and adolescent health and well-being in Finland. The challenges of utilizing register data are mainly caused by difficulties in data transfer from patient information systems resulting in insufficient data coverage. Publishing local-level reports on data coverage as well as on the results promotes data availability and quality while enabling evaluation of actions needed for promoting the health and welfare of children and their families.
Setting the scene: controversies on trends in mental health among adolescents in the Nordic countries
Authors: Eriksson C , Arnasson A M , Lyyra N , Madsen K R , Torsheim T , Thorsteinsson E B , Välimaa R , Damsgaard M T , Due P
Published: October 2020

At present there are different positions regarding trends in adolescent mental health. Can we trust trend data on the mental health among adolescents in the Nordic countries? Some question the trustworthiness of adolescent self-reports, which describe ordinary daily hassles as health complaints, which cannot be interpreted as signs of mental disorders. In addition, today there is a more open climate for talking about mental issues, which can lead to an overestimation of the prevalence of mental disorders.

Statistics on mental health services statistics report increased psychopharmaceutic prescriptions as well as consumption of professional care. Such data argues for increased governmental investment in adolescent mental health services. Is this pattern due to increased availability of mental health services and/or increased prevalence of mental health problems in the adolescent population?

A concern is that data availability influences policymaking and allocation of resources. If there is an emphasis on self-reported data from adolescents that may an increased risk of medicalization of young people's dealing with their daily lives. If on the other hand the reported problems among young people is disregarded, this would be against the UN Child Convention.

The survey data has important qualities especially if the data is analysed and reported properly. The validation of survey measure has been done both regarding psychometric quality and content validity. Advanced analysis of the data can draw a more nuanced picture. Moreover, some screening instruments have been developed as a first step towards making diagnosis. Instead the HBSC surveys ask boys and girls about their health and well-being, social environment and health behaviours. HBSC uses findings at national and international levels to gain new insights into young people's health and wellbeing, understand the social determinants of health, and inform policy and practice to improve young people's lives.
What methods and challenges for taking account of context when transferring complex interventions?
Authors: Villadsen S , Dias S
Published: October 2020

For complex public health interventions to be effective their implementation needs to adapt to the situation of those implementing and those receiving the intervention. While context matter for intervention implementation and effect, we still insist on learning from cross-country comparison of implementation. Next methodological challenges include how to increase learning from implementation of complex public health interventions from various context. The interventions presented in this workshop all aims to improve quality of reproductive health care for immigrants, however with different focus: contraceptive care in Sweden, group based antenatal care in France, and management of pregnancy complications in Denmark. What does these interventions have in common and are there cross cutting themes that help us to identify the larger challenges of reproductive health care for immigrant women in Europe? Issues shared across the interventions relate to improved interactional dynamics between women and the health care system, and theory around a woman-centered approach and cultural competence of health care providers and systems might enlighten shared learnings across the different interventions and context. Could the mechanisms of change be understood using theoretical underpinnings that allow us to better generalize the finding across context? What adaption would for example be needed, if the Swedish contraceptive intervention should work in a different European setting? Should we distinguish between adaption of function and form, where the latter might be less important for intervention fidelity? These issues will shortly be introduced during this presentation using insights from the three intervention presentations and thereafter we will open up for discussion with the audience.
Benchmarking the implementation of recommended food environment policies in Norway using the Healthy Food Environment Policy Index (Food-EPI)
Authors: Torheim L E , Løvhaug A L , Henjum S , Terragni L , Roos G
Published: October 2020

Background

Obesity prevalence in Norway has increased over the past decades despite political objectives and strategies for obesity prevention. Healthy food environments have the potential to improve the diet of the population and decrease the burden of disease. Governments play a critical role to form such environments. The aim of the study was to assess the efforts of the Norwegian Government towards creating healthier food environments and suggest actions using the Healthy Food Environment Policy Index (Food-EPI) methodology.

Methods

Evidence of policy implementation was assembled and verified by government stakeholders for 45 good practice indicators across 12 policy and infrastructure support domains. Independent public health nutrition experts from academia and civil society (n = 34) assessed the level of implementation of each indicator compared with international best practices, using an online tool.

Results

Most indicators were rated at “medium” level of implementation (51%). An almost equal number of indicators were rated at “high” and “low” level of implementation (21% and 28%, respectively). None of the indicators were rated as “very low, if any” level of implementation. More indicators under the infrastructure domain were rated at “high” or “medium” as compared with the policy domain. The expert panel developed a list of priority actions that should be implemented to improve the food environment, including actions regarded as most effective in decreasing social inequalities in diet. The top priority action was that the Government should to a larger extent use price and taxes to change food consumption.

Conclusions

The Food-EPI framework and process can be used to identify gaps in national policy implementation and to develop recommendations for strengthened policy action supported by a coalition of public health experts.
Patients’ first experiences with the German psycho-oncological care programme isPO
Authors: Cecon N , Salm S , Dresen A , Krieger T
Published: October 2020

Background

The new, complex care programme 'integrated cross-sectoral Psycho-Oncologý (isPO) aims to reduce anxiety and depression in newly diagnosed cancer patients. It offers psycho-oncological care after diagnosis for twelve months dependent on patients' individual needs. Parallel, it is externally evaluated with a tripartite mixed methods evaluation design that includes a prospective, formative and summative evaluation. In 2019, isPO was implemented in four newly established care networks of certified oncological center hospitals cooperating with local oncological practices in North-Rhine Westphalia, Germany. During the formative evaluation, quantitative data on patients' first experiences in the new programme were collected that reflect the first year of its implementation (optimisation phase).

Methods

During the first year of its implementation, 372 newly diagnosed cancer patients were contacted three months after their enrollment, to complete a questionnaire concerning patientś experiences with the programme and further patient reported outcomes, e.g. quality of life. Preliminary analyses were conducted descriptively.

Results

The questionnaire was completed by 219 patients (response rate: 58.9%). Results show that the majority of surveyed patients were satisfied with their care in isPO (79,5% n = 174; missings n = 24) and felt support was provided according to their individual needs (69,9% n = 153; missings n = 30). 49,3% of patients (n = 108; missings n = 34) report that their quality of life improved due to the isPO care and 59,4% (n = 130; missings n = 28) wouldn't have utilised psycho-oncological care by themselves without the active offer to enroll in isPO.

Conclusions

Findings indicate that the new care programme isPO is well accepted by most patients during the first three months of their care. However, this does not apply for all patients. Further findings may help to optimise the new programme.

Key messages

The care programme isPO is well accepted by most cancer patients as they feel supported according to their needs. Understanding why patients aren’t satisfied, might lead to programme optimisation.
Unified Agenda of the Golden August: a perspective to promote breastfeeding in Mato Grosso, Brazil
Authors: Carvalho R C O , Fonseca L B , Pires R R , Taveira J K V , Gajardo Y Z , Souza K S
Published: October 2020

Issue

Mato Grosso, Brazil has a low average of exclusive breastfeeding. Breastfeeding promotion actions usually focus on transmitting information to pregnant or nursing mothers about the benefits of breast milk, although cultural factors interfere in this practice, and so, needs to be more explored by public health actions and policies.

Description of the problem

Since 2013, Mato Grosso State Department of Health annually carries out, in August, the project 'Unified Agenda of the Golden August', whose goal is to organize and to publicize in a map all breastfeeding promotion actions carried out by the municipalities of the state. To focus on the cultural meanings of breastfeeding, in 2019 the project was expanded with the inclusion of an artistic-cultural activity.

Results

The First Week of Art and Culture of Breastfeeding was an action lasting 30 days, which included four short courses, the exhibition and debate of the film 'Tigers', the musical show 'Strength Woman', the art exhibition 'The Breastfeeding Art' with ceramic sculptures, canvas paintings, photographs and installations, guided tour and a special invitation from elementary school students. The central issue of all activities was breastfeeding. All actions were free with the participation of 30 regional artists. For the first time, in 2019, the project mobilized 140 of the 141 municipalities in the state, totaling 475 actions and 15,485 participants. We highlight the participation of a curricular internship in the nutrition course of a public university and volunteer students in the project, which contributed to the exchange of knowledge between management/service and academia.

Lessons

This practice allowed us to reflect on the act of breastfeeding from the perspectives of art and culture, taking the theme to other age groups and institutional spaces. This practice provided the opportunity to promote breastfeeding among the entire community and mobilized almost all municipalities in the state.

Key messages

Breastfeeding may be promoted by different perspectives and methods, not only in healthcare centers and with the transmission of information. Health policies about breastfeeding promotion may include people of all age groups and sex.
Trends in socioeconomic inequalities in childhood BCG immunization coverage in Pakistan
Authors: Zaheer S , Kanwal S , Shafique K
Published: October 2020

Background

Although, WHO notes that there has been 'tremendous progress' towards controlling spread of Tuberculosis (TB) by 2015, situation in endemic countries like Pakistan need global attention. Pakistan currently ranks fifth among TB-high burden countries and it accounts for 61% of the TB burden in the WHO Eastern Mediterranean Region. We aim to explore the trends in relative and absolute socioeconomic inequalities in BCG vaccination coverage.

Methods

Data from Pakistan Demographic and Health Surveys (PDHS) 2006-7 (n = 9177 data used 8442), and 20012-13 (n = 13558, used n = 6982) were used. Information was collected from all mothers in reproductive age group, regarding BCG vaccination of their children aged < 5 years. Wealth index and education were used to assess socioeconomic position. Socioeconomic inequalities for BCG vaccination coverage were assessed by calculating Relative Index of Inequality (RII) and Absolute Index of Inequality (SII).

Results

Although reported frequency of not getting the child BCG vaccinated has decreased over the decade (25% in 2006, 18% in 2013). Nevertheless, socioeconomic inequalities in BCG vaccination have significantly widened over the last decade. Education related inequalities [2006-7 Urban: SII=-1.34 (-0.91, -1.76); 2012-13 Urban: SII=-1.88 (-1.43, -2.32)]; [2006-7 Rural: SII=-1.31 (-0.96, -1.65); 2012-13 Rural: SII=-1.54 (-1.13, -1.94)] have increased. Similarly, wealth related inequalities [2006-7 Urban: SII=-1.27 (-0.91, -1.62); 2012-13 Urban: SII=-1.75 (-1.37, -2.12)]; [2006-7 Rural: SII=-1.19 (-0.98, -1.39); 2012-13 Rural: SII=-1.72 (-1.43, -2.00)] have increased.

Conclusions

Widening absolute inequalities in BCG vaccination coverage among children over the last decade in a TB-high burden country gives rise to global concern, at a time when world aims for tuberculosis free future. The results warrant the essential public health efforts to avoid further widening in TB related socioeconomic inequalities in Pakistan.

Key messages

The results warrant the need to continue monitoring of TB control at population level. Study findings may help to improved TB management programs to initiate evidence-based guidelines for maternal and child health.