bluuebunny/crossref_metadata_2025 huggingface dataset:
Heatwave-related Mortality in Australia: Who's impacted the most?
Authors: Varghese B , Beaty M , Panchuk S , Mackie B , Chen C , Jakab M , Yang T , Bi P , Nairn J
Published: October 2020

Background

The impacts of heatwaves on the risk of mortality have been well-documented worldwide. However, impacts are not equally spread across the population with certain subgroups and locations affected more than others, warranting local evidence to guide and improve prevention and adaptation strategies. The objectives of this study were to identify the person and area-level socio-demographic, health, and environmental factors that modify the heatwave-mortality association in Australia.

Methods

Warm-season (October-March) mortality (2007-2017) were obtained from the Australian Bureau of Statistics. Heatwaves were defined using Excess Heat Factor, a normalised metric of heatwave severity. A time-stratified case-crossover design was used to model heatwave-mortality associations at the Statistical Areas 2 (SA2) spatial unit. Effect modification by person and area-level factors was assessed using interaction terms.

Results

Nationally, mortality increased by 2% (Relative Risk-RR 1.02; 95%CI: 1.01-1.03) during heatwaves with 1418 excess deaths (95%CI: 723-2113). But impacts varied with the highest effect observed in Adelaide (RR 1.08; 95%CI: 1.04-1.12) and Regional Tasmania (RR 1.11; 95%CI: 1.04-1.18). A gradient of impact was found within locations, for example, vulnerable SA2s in Adelaide were featured by a higher proportion of people in rental housing, inaccessibilities (vehicle and internet), low vegetation, newer houses, and a prevalence of respiratory and psychological diseases. Person-level factors included those: renting privately, with a low English-speaking ability, with chronic health conditions (diabetes, asthma/chronic obstructive pulmonary diseases) and using antidepressants, anxiolytics and sedative medications.

Conclusions

Our results, leveraging person and area-level linked data, highlight the need to consider contextual and individual risk factors and the importance of developing place-based targeted interventions to reduce heatwave health impacts.

Key messages

Heatwaves increase mortality in Australia. Heatwave-vulnerability is determined by individual and community-level factors.
Trajectories of socioeconomic inequality in social, cognitive, and motor development: A birth-cohort
Authors: Verheijen M S , Houweling A J , Oude Groeniger J , Jansen P W , Van Lenthe F J
Published: October 2020

Background

The World Health Organization's main strategy to reduce health inequalities in adulthood is preventing socioeconomic inequalities in early childhood. Yet, little is known about how children's socioeconomic position (SEP) shapes their development over time. Therefore, we investigated trajectories of socioeconomic inequality in early child development.

Methods

Data (n = 5104) was used from Generation R, a prospective population-based cohort in The Netherlands. SEP inequalities (defined by maternal education) in trajectories of internalizing and externalizing problems (mother reported Child Behavior Checklist at 1.5, 3, 5, and 9 years), and of language and motor development (mother reported Child Development Inventory at 0.5, 1, 1.5, 2, 3 and 4 years) were estimated using linear mixed models with standardized scores at each time point.

Results

Low SEP children had more internalizing (B = 0.72, 95%CI=0.51;0.95) and externalizing (B = 0.25, 95%CI=0.10;0.40) problems at 1.5 years, but better language skills at 1 year (B = 0.50, 95%CI=0.36;0.64), and better fine (B = 0.26, 95%CI=0.12;0.40) and gross motor (B = 0.40, 95%CI=0.25;0.55) skills at 0.5 years of age than high SEP children. For internalizing and externalizing problems, inequalities decreased over time. The low SEP advantage regarding language scores reversed in early childhood, and at 4 years of age, low SEP children (B=-0.38, 95%CI=-0.61;-0.15) had substantially worse language skills than high SEP children. For motor skills, the low SEP advantage at baseline decreased over time and disappeared around 4 years.

Conclusions

Socioeconomic inequalities in early child development differ by developmental domain: whereas inequalities in problem behavior and motor skills decreased over time, inequalities in language development increased. This indicates that low SEP children are already at a cognitive disadvantage before entering primary education, providing further evidence that interventions are needed before the age of 4.

Key messages

We investigated trajectories of socioeconomic inequality in early child development within a Dutch prospective birth cohort. Results showed that socioeconomic inequalities in child development decreased over time for emotional, behavioral and motor development, but increased for cognitive development.
Lessons in Public Health Leadership
Authors: Latif S
Published: October 2020

Background

The UK Faculty of Public Health (FPH) is a world leader in developing a dynamic competency-based curriculum and delivering high quality training and professional development of a multidisciplinary public health specialist workforce in the UK. This includes capacity building and shaping tomorrow's public health leaders.

Objectives

Strong Leadership is increasingly the need of the day to deal with the complex public health challenges in a rapidly evolving and shifting global landscape. Can a public health curriculum and training (like that of the FPH) provide the framework for the knowledge, skills, attitudes and behaviours required for producing world class public health systems leaders?

Body of the session

Key principles of developing systems leadership include providing an enabling environment, developing the right skill mix, acquiring relevant knowledge, framing placements with experienced supervision and appropriate coaching and mentoring are some of the elements built into the training opportunities for public health registrars, their supervisors and new consultants. This presentation will give an overview of some lessons in public health leadership, the skills and knowledge base required to perform effectively as a public health systems leader and explore some of the challenges faced by the world of public health. The panel will encourage interactive discussion to share the learning from other countries and systems required to develop the next generation of public health leaders.

Conclusions

Public health, of all specialties, lends itself best to lead across and beyond organisational boundaries, lead without authority and create change whilst not being in charge. It is imperative that systems are put in place to train, develop and build public health leaders for tomorrow.
Introduction of a new method for measuring young children’s mental health at child health clinics
Authors: Fält E , Fabian H , Tökés A , Sarkadi A
Published: October 2020

The Child Healthcare Services (CHS) in Sweden offer regular health check-ups and reach almost all 0-5-year-old children. Parents of all children aged 3 to 5 are invited for a free check-up around their child birthday. Although one of the objectives of the CHS is to detect mental health problems, evidence-based methods are not used for this purpose at the Child Health Clinics (CHC). Therefore, we assumed that introduction of a new instrument (the Strengths and Difficulties Questionnaire - SDQ) to assess children's emotional and behavioural problems through parent and teacher reports, would not only help to test the hypotheses in our population-based trail (Children and Parents in Focus), but it would also address CHC's needs to detect children's mental health problems.

Three months into the study, we realised that a lower than expected number of SDQs were returned by parents and teachers. We started exploring the problem through individual interviews with nurses, parents and preschool teachers. Results showed that nurses found it useful for their assessment to have access to preschool teachers' SDQ-ratings. Parents were also positive to the procedure but had concerns regarding confidentiality of the responses. Preschool teachers were least positive, fearing labelling of children and negative parental reactions. We used a range of facilitation strategies such as educational meetings, outreach visits and newsletter to support nurses in implementation of the new procedure. To address parental concerns, we removed some of the questions and redesigned the questionnaires. This resulted to an overall increase of 10-15% in the response rate.

The findings suggest that implementing the SDQ at CHCs to assess the mental health of 3-5-year-olds is feasible, but reaching all children remains a challenge that requires more attention.
Potential of standard perinatal data for measuring maternal integrity in childbirth
Authors: Miani C , Batram-Zantvoort S , Razum O
Published: October 2020

Background

Measuring the phenomenon of violation of maternal integrity in childbirth (e.g. obstetric violence) relies in part on the completeness of maternity care providers' data. The population coverage and linkage possibilities that they provide make for a great untapped potential. Although violation of integrity is a complex phenomenon best measured with dedicated instruments, standard data provide details about the birth and care received. Relevant variables include justifications of medical procedures (e.g. episiotomy) and characteristics of the birth process (e.g. length of labour). Demographic variables can be used for intersectional analyses to track potential discrimination -a dimension of violation of integrity in childbirth.

Methods

Using a baseline questionnaire and perinatal data obtained from hospitals, birth centres and midwifes in the BaBi study (Germany), we compared the completeness of integrity-relevant variables across providers and depending on the demographic and clinical characteristics of the women. We investigated potential for analysis from an intersectional perspective.

Results

Our analyses included 908 births, of which 32 outside hospital. There were 634 vaginal birth vs. 274 caesarean sections. We found poor reporting on demographic variables, in particular with regard to the 'region of origin' variable (correct origin recorded for half of the migrants). There was better reporting by midwives than by hospitals for “soft indicators”, such as the position of the women during birth (100% vs. 87.6%).

Conclusions

Putting more emphasis on completeness of standardised data could increase their potential for research. Healthcare setting, organisational culture and working conditions might determine what is judged important in terms of reporting; therefore, targeted education may improve this process. Next, we will interview care providers to understand data collection constraints and priorities and potential reporting bias in real-life settings.
Mental health among women victims of violence consulting at “Maison des femmes” (Women's Home), a French center providing multidimensional care
Authors: Hatem G , Roland N , Bardou M , El-Khoury F
Published: October 2020

Context

In Europe, at least one in three women experience physical and/or sexual violence in her lifetime. This gender-based violence affects the victim's physical and mental health. Women victims of violence are at risk of developing mental health disorders such as post-traumatic stress disorder (PTSD) and traumatic dissociation. However, few recent studies have examined the prevalence of PTSD and other mental health problems among women victim of violence, making the development of research interventions to manage these symptoms challenging.

Methods and implications

The “Maison des Femmes” institute (MdF; Women's Home) is the only one of its kind in France. It provides care and support for women victim of violence. The multidimensional services provided at MdF consists of physical and mental health care as well as social and judicial support in a confidential and secure environment. “AVeC-L”(Accompagnement des femmes Victimes de ViolenCes à La Maison des Femmes), is an intervention research project (pilot study + comparative trial) which aims to examine and compare the mental health of adult women consulting at MdF and in two local health centers. In the currently ongoing pilot study, we measure the presence of PTSD and its intensity using the PTSD Checklist for DSM-5 in 80 participants. We also measure traumatic dissociative symptoms, and quality of life, and substance use. Using qualitative research, we also examine the women's perception of the effect of the care provided at MdF and at the two others local health centers.

Expected results and implications

The “Avec-L” pilot study will estimate the prevalence of PTSD and dissociative symptoms among women victims of violence who consult at MdF. It will also provide information on women's perception of the provided care. These results will contribute to the design of a larger intervention trial (pre and post comparison) evaluating the effect of the multidimensional support and care at MdF on women's mental health.
Public Health measures to control the spread of COVID-19 amongst the migrant population in Malta
Authors: Melillo T , Medialdea-Carrera R M C
Published: October 2020

Issue

In the last 10 years, the migrant population residing in Malta has increased exponentially. The COVID-19 epidemic impacted disproportionally migrants which are often in disadvantaged positions due to the lower socioeconomic status, communication barriers and lower education levels.

Description of the Problem

During the COVID-19 epidemic migrants were particularly affected due to multiple factors including communication barriers, restriction measures imposed, loss of employment, challenges accessing the healthcare system, travel ban and mental health issues. Ports were closed preventing disembarkation of migrant boats and asylum request applications were put on hold.

Results

As of the 16th of June, a total of 30.2% (n = 198) confirmed COVID-19 cases were migrants. A strategy to support migrants was designed and implemented. The COVID-19 outbreak in a migrant centre resulted in all the 800 residents being placed in lock-down for 38 days (5th April till 13th May) and a total of 50 COVID-19 cases. Migrant boats that arrived before ports were closed were placed under quarantine. Migrants reported difficulties seeking healthcare, using the helpline, and higher exposure risk due to overcrowded living conditions.

Lessons

Migrants faced additional challenges due to the impact of the pandemic. The public health response measures implemented for the general population were not always feasible or accessible for the migrant population including hygiene recommendations, access to testing, isolation and quarantine and access to accurate scientific information. The mental health impact of COVID-19 among migrant populations was enhanced due to loneliness, lack of communication with their families and financial instability. Challenges accessing the healthcare system, understanding the restriction measures and the evolving public health recommendations were highlighted. Future strategies to control epidemics should always include specific plans to support migrant populations.

Key messages

The public health strategy must incorporate specific plans to support migrants in order to control and reduce the impact of the COVID-19 epidemic. Transdisciplinary policy needs to be developed considering the ethical, socio-economical, psychological and human right aspects of the migrant population.
The impact of ultra-processed food on carbon, water and ecological footprints of food in Brazil
Authors: da Silva J T , da Cruz G L , Rauber F , Louzada M L , Kluczkovski A R G , Frankowska A , Schmidt X , Reynolds C , Bridle S , Levy R B
Published: October 2020

Background

Ultra-processed foods (UPF) have been associated with major diet-related public health issues that share underlying drivers with climate change. Both challenges require major changes to the food system and so the potential benefits to health and the environment present a double motivation for transformation. Our aim is to assess the impacts of UPF on total greenhouse gas emissions (GHGE), water and ecological footprints in Brazil food purchases.

Methods

We have used data from 4 Brazilian Household Budget Surveys (1987, 1996, 2003, 2009). Each food item was classified into NOVA food groups (unprocessed/minimally processed, culinary ingredients, processed and ultra-processed). The information was linked to nutrition and footprint data. Purchases were converted into grams per capita per day to estimate total energy (kcal), percentage of energy from UPF, as well as total GHGE, water and ecological footprints. We performed linear regression to calculate year-adjusted means of footprints per 1000 Kcal by year-specific quintiles of UPF participation in the total energy. The data were analysed in R v.3.6.1 and STATA SE 14.1.

Results

The mean UPF participation in total energy varied from 13% (SD 2.4) in the 1st UPF quintile to 29% (SD 5.1) in the 5th quintile. The footprints increased linearly across quintiles: the mean g CO2eq varied from 1312 in the 1st to 1721 in the 5th UPF quintile (p-trend<0.001); the mean litres of water varied from 1420 in the 1st to 1830 in the 5th quintile (p-trend<0.001); the mean m2 varied from 9.4 in the 1st to 12.3 in the 5th quintile (p < 0.001).

Conclusions

The environmental impacts were higher for Brazilian diets with a larger fraction of energy from UPF. Specifically, low UPF diets seem to have lower GHGE, water and ecological footprints. Our findings offer new motivators for dietary change to simultaneously healthier and more sustainable eating patterns and will be of relevance to consumers and policymakers.

Key messages

Diets high in UPF cause more climate impact than diets with lower levels of UPF. Healthy and sustainable dietary patterns should be low in ultra-processed foods.
Development of a web-platform for dynamic monitoring of population health in Geneva: Specchio project
Authors: Baysson H , Joost S , Attar Cohen H , Guessous I , Stringhini S
Published: October 2020

Background

In order to provide efficient public health decisions making, it is crucial to obtain reliable and recent data on the state of health of the population. For that purpose, a web-platform for the dynamic monitoring of the health status and well-being of the population is being developed in the Geneva canton.

Methods

Using a dedicated website, recruitment will be carried out over 5 years so as to enroll up to 20 000 volunteers, resident in Geneva and aged ≥ 18 years, followed-up for at least 10 years. Once connected to the website, participants will fill a general self-administered questionnaire on their socio-demographic and lifestyle characteristics, anthropometry, health status, physical activity and diet. Environmental, behavioral and occupational exposures will also be evaluated via more specific questionnaires. Current addresses of residence will be geocoded and linked to geographical databases to passively gather information on noise, air pollution, green areas, and other exposures. Surveillance of health events will be implemented via yearly self-administered on line questionnaires and potentially via passive linkage to medical databases (medical file) and health registries with the participants' consent. For a subsample of volunteers, biochemical samples and biomarkers will be collected.

Results

The pilot study shows that the project is feasible, potentially cost-effective but requires innovative methodologies for ensuring long term follow-up. Different communication strategies used for recruitment and long-term participation need to be implemented ensuring trust from participants, different levels of health literacy and the need of justice.

Conclusions

Specchio is a new project aimed at setting up a digital longitudinal health study in Geneva. Challenges concerns the determinants of participation, recruitment and attrition, quality of data and ethics. Long-term funding by the Directorate General of Health Geneva is currently under evaluation.

Key messages

This digital longitudinal health study will enable dynamic monitoring of the health status and well-being of Geneva residents and will enable efficient public health decision making. Specchio is a new project funded by the Directorate General of Health Geneva.
Disease burden of edentulism – Dental Clinic of Vojvodina, Serbia, 2008-2019
Authors: Lainović T , Novta E , Balázs Á , Maravić T , Dragosavljević S , Blažić L
Published: October 2020

Background

Although there is a decline in the global prevalence of edentulism over the past decade, the tendency is opposite in Serbia. The aim of this study was to estimate the disease burden of edentulism at the Dental Clinic of Vojvodina, tertiary referral public health institution of the northern province of Serbia.

Methods

Disease burden was expressed in disability-adjusted life years (DALYs). Prevalence (P) was calculated on the database of all patients from 2008 to 2019 at the Dental Clinic of Vojvodina using IBM SPSS Statistics. The number of diagnosed cases rehabilitated by complete dentures was an indicator of edentate people. A total sample of 76287 patients was examined, including 1620 patients restored with complete dentures (44.94% male, 55.06% female). Disability weight (DW) for severe tooth loss was taken from the “Disability weight for the Global Burden of Disease 2013 study”. The prevalence-based years lived with disability (YLD) were calculated as YLD = P x DW. Due to the non-fatal outcome of edentulism, DALY estimates were based on YLDs only (YLL=0).

Results

For the observed period, the total disease burden (per 1000) was 1.42 DALYs (0.64 for men and 0.78 for women). During observed years, DALYs increased (from 1.66 in 2008 to 1.73 in 2019), in association with population aging, and insufficient support from public health insurance for oral prevention and treatments. For both sexes, DALYs increased gradually with age. The results for age-stratified DALYs (per 1000) were: 0.005 (age 0-24), 0.049 (age 25-34), 0.55 (age 35-44), 2.66 (age 45-54), 4.41 (age 55-64), 7.89 (age 65-74), 8.04 (age 75-84) and 9.05 (age 85-94).

Conclusions

Considering the calculated disease burden, edentulism has been posing an increasing challenge for the health system in Serbia over the past decade. The quantified burden could contribute to the improvement of evidence-informed policymaking in public oral health in Serbia.

Acknowledgment

Supported by “Burden-EU” COST Action

Key messages

The calculated DALYs show an increase in burden of edentulism in Vojvodina, Serbia. DALYs calculations could improve the insufficient monitoring of oral health status in Serbia.
Self-Management Approach and Reciprocal Learning for Type 2 Diabetes (SMART2D) - the contextualisation of evaluation methods
Authors: Diavadanam M
Published: October 2020

The SMART2D aims to support self-management through community and facility interventions for people at risk of and with type 2 diabetes. The evaluation of implementation and impact were based upon a common theory of change, and common methodological frameworks. The focus of the presentation is on the methods and results of the contextualisation of evaluation tools and methods.
Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA) - the cost evaluation of life-style related NCD interventions
Authors: Koot J
Published: October 2020

Vietnam, Myanmar, and Indonesia are trying to create innovative synergies within and between sectors to prevent and treat NCDs. Universal Health Coverage (UHC) is the objective of these countries. The challenge for decision makers in healthcare is to implement programmes and interventions that effectively contain NCDs at the lowest possible cost both in community-based and primary care facilities. The value of implementation and upscaling is assessed by estimating costs, savings and health gains. The presentation focuses on cost-effectiveness evaluation of the entire scaling-up, allowing for comparison within and among countries and generate recommendations for achieving UHC in low- and middle-income countries.
Mandatory immunization: Empirical examination of governance instruments in 28 Global NITAG Network (GNN) countries
Authors: MacDonald N , Harmon S H E , Faour D , Graham J , Steffen C , Henaff L , Shendale S
Published: October 2020

Background

In the Global Vaccine Action Plan 2017 Assessment Report, WHO's SAGE noted need to understand ways in which legislation and regulation are used to advance or undermine immunization. The NITAG Environmental Scan Project sought to address this in a pilot study.

Methods

Data was collected via a secure online survey of GNN members (40 countries Sept 2018). Respondents reporting a mandatory element were asked: (1) what vaccinations were required by law; and (2) what population groups were subject to mandates; (3) what grounds, if any, were available for requesting exemptions.

Results

28 (70%) countries responded, representing every WHO region and World Bank income level. While mandatory immunization programs / elements within broader NIPs were relatively common, jurisdictions varied with respect to immunizations required, population groups affected, grounds for exemptions, and penalties for non-compliance. We observed some loose associations with geography and income level. Children were the most common population group subject to mandates at some stage of childhood development (28/28); healthcare workers were second (8/15 (53%)). Sanctions for failure to immunize varied broadly, ranging from no penalty, to loss of access to social services e.g. admission to school, monetary fines, and incarceration. A variance between countries as to how strictly immunization mandates are enforced was noted.

Conclusions

A variety of approaches existed ranging from Narrow/Permissive to Broad/ Inclusive in scope with enforcement mapping loosely to this continuum from Loose/Permissive to Tight/Coercive. Jurisdictions with few/no vaccines mandated, and few/no target groups identified, Loose approach is expected; for those closer to Broad approach, Tighter controls expected. Coercive measures may be 'positive' (vaccination as a gateway to public services, with possible work-arounds), or 'negative' (failure to vaccinate = penalties).
Charting mandatory vaccination policies worldwide
Authors: Vanderslott S , Marks T
Published: October 2020

Background

Mandatory vaccination is becoming an increasingly important policy intervention for governments trying to address low vaccination rates. However, the evidence about which countries have mandatory vaccination policy worldwide and discussions surrounding their impact has largely been limited to high-income countries. While many recent publications discuss the issue, none provide a comprehensive list. This is an obvious gap in the discussion about the merits of introducing mandatory vaccination into countries.

Methods

We draw on extensive desk-based research analysing a mixture of sources, including national, regional, and international vaccination policy reports, international health institution websites, ministry of health websites, and media reports. We supplemented this material by contacting a variety of health authorities, such as PAHO and the WHO as well as country's ministries of health.

Results

We have compiled the first comprehensive list of vaccination policies worldwide, covering 149 countries. This list indicates whether a country has a mandatory vaccination policy and the strictness of the mandate on a scale ranging across four levels. We provide an overview of the state of mandatory vaccination across different countries, set out the general trends and issues, and engage into a discussion about why, how, and where mandatory vaccination is put in place. We also provide several case studies, which highlight the limitations of vaccine mandates because other factors such as exemptions, penalties or enforcement play an important role in their actual effect on immunisation rates.

Conclusions

Our key finding is that the majority of low- and middle- income countries have mandatory vaccination policies but low vaccination rates because of problems with vaccine supply, delivery, and access.
9.K. Workshop: Public health monitoring and reporting – Examples of how to fill the gaps of health inequalities
Authors:   Organised by: Public Health Agency of Sweden,   Chair persons: Fatima Azerkan - Sweden
Published: October 2020

There is a need for cross national border exchange of experience by sharing best practices for monitoring and reporting on public health with a sustained driving force, to ensure that evidence-based approaches are continuously improving and informing best practices for reducing inequality and inequity gaps.

By doing this, the emerging field of evidence based public health programming, covering different aspects of inequalities and unequal distribution of determinants of health, is improved. The workshop intends to introduce a global and intercontinental collaborative approach to jointly identify necessary tools and understand the mechanisms of monitoring and reporting on public health, to combat health inequalities.

The workshop will encourage the building of practical culture and community of public health professionals to share lessons, evidence and best practices. It will also enable the support of ongoing assessment, communication of gaps in health that are emerging and caused by barriers at different levels of societies. There is need for an increased understanding of the emerging public health threats in contexts, such as increasing inequalities in health and social determinants of health, climate change disasters, disease outbreaks, influx of migration and political popularism threatening evidence informed decision making and policies.

Despite being high-income countries with universal health coverage Australia, Canada and Sweden share similar public health challenges. The interactive workshop intends to contribute to an exchange of experiences from countries that are geographically located far from each other with differently organized health systems but united with a common agenda to act on health inequalities.

The exchange of shared knowledge and experiences between the participating countries will shed light and focus on functionality of public health monitoring and reporting mechanisms and tools used in the above-mentioned countries. This will be a way of identifying areas of improvement in addressing inequality gaps. Evidence based interventions in public health depend on solid monitoring, analysis and reporting frameworks. With continuous changes in the public health environment, improvements on what and how public health is analysed is needed to identify existing gaps. To further address equity, with a focus on vulnerable groups for improved public health, solid public health monitoring and reporting mechanisms are vital to supporting credible advocacy and policy actions.

Key messages

Monitoring and reporting health and social determinants of health are imperative ingredients of decision-making. A joint approach to use monitoring tools to improve global public health is needed. Countries geographically located far from each other, with differently organized health systems but similar public health challenges are united with a common agenda to act on health inequalities.
Brain drain of Tunisian competencies: The case of health professionals
Authors: Labidi L
Published: October 2020

The world is witnessing mobility of human resources facilitated by globalization and by international agreements on trade in services GATS. The advanced demographic transition in developed economies and increase in aging population have put pressures on demand of professionals from countries of the south to sustain economic growth. Health systems in countries of the south are facing increasing rate of migration of health workforce including physicians and allied personnel. Such situation led WHO to promote the code of ethical recruitment of international health professionals. The optional nature of the code did not allow its wider implementation.

The brain drain of scare resources represents a real challenge for health systems in several countries including Tunisia. Since 2011, the pace of migration of Tunisian health professionals and particularly physicians have increased because of worsening working conditions, limited career path and uncertainty about the future. Europe and particularly France, Canada, Germany and Gulf states constitute the main destination of Tunisian migrants partly explained by cultural aspects including Arabic and French languages and similarity of Francophone model of medical education.

The present qualitative study including focus group discussions with main stake holders aims at: Measuring the brain drain of Tunisian health professionalsAssessing the impact of brain drain on the Tunisian health systemSharing initiatives aimed at retaining health professionals in public sector and inside the country.Learning lessons from other countries on working models for well organized and mutually beneficial migration of health professionals.
How upstream policy reforms enable the use of industry data and science
Authors: Gilmore A
Published: October 2020

Corporations have worked to promote and embed policymaking reforms which increase reliance on and provide a conduit for industry-favourable science. Such systems have become increasingly mainstream in policy making across the world, yet most are unaware of the corporate influence behind them.

We will present evidence that diverse corporations worked collectively to promote and embed 'Better Regulation' (now known as 'Smart Regulation') in the European Union. The desired outcome was to reduce policymakers' ability to pass public health policies which could be detrimental to corporate interests and profits. We will illustrate how these regulatory frameworks have now been embedded. Delegates will hear examples of the ways in which corporations have gone on to use these systems to feed misleading science into the policymaking process, ultimately in attempts to dilute, delay or prevent public health policies.
The role of public procurement in promoting healthy and sustainable diets
Authors: Bergmann Madsen Betina
Published: October 2020

For diets to meet the FAO definition of sustainable, they must be accessible and secure. One aspect of this is the food available in supermarkets and in people's homes; another is that available in public institutions such as schools, hospitals and workplaces. Public procurement officers are responsible for sourcing food in such spaces; it is therefore necessary for these agents to be empowered with knowledge on sustainable and healthy diets. Ministries need to unite around the common goal that is sustainability.

In Copenhagen an innovative approach has been adopted to drive this. The Copenhagen Food Strategy is a multisectoral initiative that has been embedded at the contractual level, changing mindsets and practices with a two-way dialogue between those providing the food and those delivering it.

It is important to communicate good examples to demonstrate how policy can work to achieve sustainable and healthy diets for all. A practical manual has been developed to train procurement officers so that best practice can be disseminated across the country. Using the SDGs as a common language, processes can be streamlined and disseminated across multiple sectors and councils to achieve healthy and sustainable diets for all.
Health workforce financing in Uganda: challenges and opportunities
Authors: Koutsoumpa M , Odedo R , Banda A , Meurs M , Hinlopen C , Kramer K , Bemelmans M , Omaswa F , Ojoome V , Kiguli-Malwadde E
Published: October 2020

Background

For health systems to operate well and improve people's health by leaving no one behind, they need a fit-for-purpose health workforce. Shortage of health workers leads to reduced access to healthcare, health inequities, and adverse outcomes in the population's health. A key challenge in many low-income countries is mobilising the needed investment for health workforce development. This study evaluated the policy environment of the health workforce in Uganda, analysed its current status, and identified financing mechanisms and management practices that affect the country's health resource envelope.

Methods

The study was conducted in 2018/19. It entailed literature review, key informant interviews and stakeholder consultations for validation of the findings.

Results

The shortage of health workers is persevering, despite efforts of the Ugandan Government and development partners. The health workforce is not keeping up with the population growth, nor the epidemiologic changes and demographic trends. Paradoxically, there is a large pool of qualified and licensed health professionals, who remain unabsorbed. Notably, even if all of them were absorbed, Uganda would be still far from the international requirements for universal health coverage. The issues are recognized at the policy level, but insufficient funding and poor management are impeding the recruitment and retention of health workers. Domestic resources are insufficient to fund a health system which can offer a minimum healthcare package and most donors are reluctant to contribute to health workers' salaries. Besides, Uganda is lacking a national health insurance scheme, which keeps out-of-pocket spending on health at very high rates. Moreover, increases in external financing have been accompanied by decreases in domestic government financing, despite economic growth.

Conclusions

The health sector financing is influenced by a complex political economy, which impedes investments in the health workforce.

Key messages

The problems and gaps of the Ugandan human resources for health are persisting due to the insufficient financial allocation and the poor management of the health workforce and existing funds. The shortage of health workers is a global health issue that goes beyond national borders and the health sector. It is an essential requirement for exercising the universal right to health.
Agreement towards task sharing among gynecologist and general practitioners in north-eastern Germany
Authors: Schuster A , Grittner U , Dini L
Published: October 2020

Background

In Germany, a higher life expectancy of women coincides with shortages of health professionals. Besides gynecologists (Gyns), the main providers of ambulatory healthcare for women 50+ are general practitioners (GPs), which do not provide gynecological care. However, GPs and Gyns willingness share tasks has not yet been analysed systematically. The aim of this research project is to explore approval among and consent between GPs and Gyns for task sharing in women 50+.

Methods

In a quantitative postal survey (March-May 2018), a random sample of 66% of all GPs (n = 3,514) and all Gyns (n = 1,031) in the three German states was interviewed. The response rate was 25.5% for GPs and 51.2% for Gyns. The approval for task sharing (yes/no) was collected for 21 medical consultation themes (83 sub items) regarding women's health and general health of women 50+. For each sub item, the approval rates among and consent between the professional groups was calculated and sub items were group into medically coherent modules for interprofessional care. Multivariable regressions were calculated in order to explore the association of professional group with the medically coherent modules adjusted for covariates.

Results

In both professional groups, highest approval was reached for shared care of urinary incontinence, vaginal complaints and recurrent urinary tract infections. High approval and consent was present only for the sub items counselling for sexual health (GP = 52.30%, Gyn=48.91%) and colorectal cancer screening (GP = 48.66%, Gyn=44.70%). Approval was higher for counselling as compared to diagnostics and therapy. Cancer related task went along with low approval rates in both professional groups. Approval towards task sharing was higher among Gyns for all modules except for cancer screening.

Conclusions

The analysis identified single tasks for sharing in both groups and allows setting priorities through the classification according to approval and consent.

Key messages

Task sharing among GPs and Gyn could be an opportune answer to improve access to care of women 50+. Knowledge on GPs and Gyns attitudes towards task sharing can serve as common empiric ground for meaningful dialogues between research, policy and practice.
Are international travelers from Portugal aware of malaria? Pre-travel assessment between 2019-2020
Authors: Malcata F , Faria B , Saldanha G , Antunes D
Published: October 2020

Background

Malaria is the main cause of death by infection among travelers. It may be prevented via chemoprophylaxis and personal protection. In 2017, European Centre for Disease Prevention and Control reported 8401 cases in Europe-8023 imported (99,8% travel-related). Misperception of the risk and inadequate pre-travel preparation are some of the reasons for these case numbers. The main goal of this study was to assess travelers' knowledge of malaria to improve medical advice in pre-travel consultations in the Oporto international vaccination centre (OIVC), minimizing the risk among travelers going to malaria endemic regions.

Methods

Before their pre-travel consultation in OIVC, 452 travelers filled the questionnaire with demographic issues, journey characteristics and answers about malaria's etiology, prevention and treatment. All travelers signed an informed consent form. Data were collected between July 2019 and January 2020 and analyzed via descriptive statistics and hypothesis test for comparing two populations proportions for each question.

Results

40,4% of travelers age was 26 - 35 years; 52,3% were female; and 67,5% of the planned trips were 1-3 week-long, mainly for tourism (n = 285). For most of malaria questions, travelers holding a university degree (n = 352) exhibited a statistically significant difference (p < 0,005) in knowledge with an average of 70,5% correct answers compared to 58.5% of those with lower education level. However, regarding previous pre-travel appointments: for the majority of questions knowledge was similar (p > 0,005) comparing to those who had first pre-travel consultation (n = 287), with an average of correct answers of 73,7% and 65,5%, respectively.

Conclusions

A stronger focus on malaria in pre-travel medical advice is necessary to increase travelers' knowledge. It is also essential to adapt malaria information to travelers' characteristics- in view of the lower percentage of correct answers by those with a lower education level.

Key messages

Malaria is a potential health risk for international travellers and an important cause of death among them. This may be caused by inaccurate perception of risk and sub-optimal pre-travel preparation. This study is the largest in Portugal to assess traveleŕs knowledge about malaria. It is crucial in order to improve medical advice and minimize the risk.
The epidemiology of chlamydia, gonorrhoea and syphilis in Portugal: where do we go from now?
Authors: Pinho-Bandeira T , Cabral Veríssimo V , Sá Machado R
Published: October 2020

Chlamydia (CT), gonorrhoea (NG) and syphilis (TP) infections are rising and have an important burden in the EU/EEA. This study aims to describe the epidemiology of these infections in Portugal, between 2015 and 2018, in order to set a baseline for the recently created National Strategy for STI Control and to generate hypothesis on areas for improvement.

We analysed data from the national system of epidemiological surveillance (SINAVE®) and described all probable and confirmed cases of CT, NG and TP notified in Portugal between January 1st, 2015 and December 31st, 2018.This reports the overall case evolution as well as specific characteristics of different groups.

Throughout the analysed 4-year period there were 1267 cases of CT, 1917 of NG and 3240 of TP (probable and confirmed). Of CT cases, 70% (n = 891) occurred in males, 66.3% (n = 840) in people aged 18-35, 52.9% (n = 670) in heterosexuals and 42.9% (n = 543) in men who have sex with men (MSM). Of NG cases, 87.9% (n = 1686) were males, 90.8% (n = 1741) were <45 years-old and 51.2% (n = 982) were MSM. Of TP cases, 76.0% (n = 2462) were males, 64.8% (n = 2101) were <45 years-old, 41.1% (n = 1333) were heterosexuals and MSM accounted for 39.9% (n = 1294). The notified cases have doubled from 2015 to 2018 (1159 to 2354) and tripled in MSM (440 to 1312), with a 7.9, 4.1 and 1.6-fold increase in CT, NG and TP, respectively. For each infection, symptomatic cases contributed to 42.9% (CT), 14.6% (NG) and 81.9% (TP) of the overall.

In similarity to European trends, CT, NG and TP infections seem to be rising in Portugal. Changes in patient behaviour, clinical practice, screenings, settings of diagnosis and notification should be further explored to better understand this trend, including clinical features. From our results, MSM and people aged <45 should be prioritised within the National Strategy for STI Control. A surveillance system evaluation could be considered for sensitivity and usefulness.

Key messages

The number of chlamydia, gonorrhoea and syphilis reported cases in Portugal raised in the four-year period between 2015 and 2018, with MSM accounting for 54.6% (1312/2403) of the cases in 2018. This sets up a baseline to guide the adoption of specific measures and the prioritisation of interventions. MSM should be given special attention when addressing new prevention strategies.
Clinical profile of home-based care patients in a Brazilian cohort
Authors: Botelho A P P P , Netto F C B , Silva R M , Filho C G , Chiesa D , Probo D R G , Santos M C L , Queiroz B L , Sales J M O , Vasconcelos L B
Published: October 2020

Background

The concern with increasing healthcare expenditures and the quality of life of chronically dependent of invasive mechanical ventilation (IMV) patients, led to the emergence of home-based care services (HBCS), which aims the humanization of health services and the reduction of hospital length of stay. Knowledge about the models used in HBCS and the results achieved is essential to identify, plan and execute actions that minimize obstacles to the adequate provision of this service.

Methods

Descriptive, longitudinal and retrospective study, in a HBCS provided by a private hospital in Fortaleza, Brazil. The medical records of 98 adult patients from the HBCS in need of IMV were analyzed.

Results

In 2019, 156 patients went through the HBCS. Of these, 58 were under 18 years-old and not included in the sample. Of the adult patients, 42 (42,8%) were male and 56 (57,1%) female. The age range varied from 28 to 102 years-old and the median age was 85 years. 57 (58,2%) patients were admitted throughout 2019, and 16 (28,1%) of them had, at least, 1 hospital readmission in 2019. 41 (41,8%) patients had been admitted before 2019, and 6 (14,6%) of them had, at least, 1 readmission in 2019. These facts may suggest that the need of hospitalization tend to happen more at the beginning of home-based care. In 2019, 13 (13,3%) patients died. 8 (61,5%) of these were admitted in 2019, and 5 (38,4%) were already in the HBCS before that year. The main diagnosis were: Dementia (21,4%), Chronic Encephalopathy (9,1%) and Multiple Sclerosis (8,2%).

Conclusions

The study shows that, even in an elderly and dependent cohort, the need of re-hospitalization and mortality rates are low, which points to the need of further studies of HBCS in order to reduce hospital stay and expenditures.

Key messages

It is important to deepen studies related to home-based care models, in association with payment expenses inquiries, as this type of assistance seems to develop humanized and safe care. The mortality rate of the HBCS studied was 13% and the overall re-hospitalization rate was 22,4%, which points this as a promising model for IMV dependent patients.