bluuebunny/crossref_metadata_2025 huggingface dataset:
Illicit drug use among Croatian university students
Authors: Miskulin I , Vcev I , Gaspar I , Juric A , Barac A , Banovic V , Lovric M , Vcev A , Miskulin M
Published: November 2019

Background

Illicit drug (ID) use among university students has been recognized as a global public health issue in recent years. It has been emphasized that during university years’ opportunities to experiment with ID increases due to the fact that this is a period of life characterized by transition, intense academic pressures as well as independence and separation from parental supervision. The aim of this study was to identify prevalence and characteristics of ID use among Croatian university students.

Methods

This was a multicentric, cross-sectional study that included five Croatian universities. A validated, anonymous online questionnaire containing questions regarding demographic and data regarding ID, alcohol and tobacco use was self-administered to cross-faculty representative student sample of University of Osijek, Zagreb, Rijeka, Split and Zadar during November 2018.

Results

The study sample included 888 students, the average age being 21.9 years (range 18-34); 18.4% males and 81.6% females. The overall prevalence of ID use among Croatian university students was 29.8%. The ID use was more frequent among males (p = 0.001) and among students who repeated the study year (p < 0.001). The study further revealed that there were 48.4% students who tried any type of ID during life. The majority of students tried ID for the first time during high school period (34.1%), when socializing with friends in open spaces such as parks (20.6%) and main reason for usage was to have fun (40.5%). The study also showed that there were statistically significant Spearman rank correlations between ID and alcohol use (p < 0.001) as well as between ID and tobacco use (p < 0.001).

Conclusions

The usage of ID is highly prevalent among Croatian university students in participating universities. Further studies are needed to identify and explain other possible risk factors for this phenomenon.

Key messages

Illicit drug use is an important but poorly investigated public health issue among Croatian university students. Better understanding of specific characteristic and possible risk factor for illicit drug use among university student population will ensure development of preventive programs.
The ICHOM standard set for patient reported outcomes in diabetes
Authors: Carinci F , Nano J , Okunade O , Whittaker S , Walbaum M , Massi Benedetti M
Published: November 2019

Background

Between 2017-2018, the International Consortium for Health Outcomes Measurement (ICHOM) conducted a targeted study to deliver a standard set of outcome measures in diabetes, including patient reported outcomes. Compared to other conditions, the study faced the challenge of a complex data collection in a highly prevalent multifactorial chronic disease.

Methods

We conducted a structured systematic review of outcome measures focusing on adults with either Type 1 or Type 2 diabetes, followed by a consensus-driven modified Delphi panel including a multidisciplinary group of academics, health professionals and patient representatives. The applicability of the standard set was explored by collecting external feedback from patients and health professionals worldwide.

Results

The panel identified an essential set of case-mix characteristics and clinical outcomes, including factors related to diabetes control, acute events, chronic complications, health services and survival that can be regularly measured using routine data and ad hoc data collection. Three validated instruments were recommended for ad-hoc data collection of patient-reported outcomes: the “WHO-5” for psychological wellbeing, the “PAID” for diabetes distress and the “PHQ-9” for depression. The feedback received from members of the panel highlighted substantial challenges with regards to the applicability of the approach at a large scale.

Conclusions

The standard set recommended for use to monitor, benchmark and improve diabetes care has received strong support from stakeholders involved in the process worldwide. However, substantial challenges remain on how to organize a systematic data collection worldwide, with implications on policy and practice that can equally apply across all areas of chronic care. Prioritization of selected targets may be useful to achieve practical results in the immediate future.

Key messages

A standard set for the data collection of person-centred outcomes in diabetes has been successfully delivered by ICHOM, including case-mix characteristics, clinical and person reported outcomes. The feedback received from a range of stakeholders highlight implications for policy and practice in the data collection of PROMs for person-centred chronic disease monitoring.
How to estimate mild Traumatic Brain Injury Incidence? The interest of Emergency Departments data
Authors: Bourdin V , Manitchoko L , Azouvi P , Hellmann R , Josseran L
Published: November 2019

Background

Traumatic brain injury (TBI) is a major public health issue, with a significant socio-economic burden. In France, very little is known about TBI epidemiology, and the TBI population is mainly described via studies carried out on the most severe patients. A large number of studies showed that a significant proportion of patients suffer from long-term disability after mild TBI (mTBI). This Post-Concussive Syndrome (PCS) remains poorly known by health professionals. Identifying early prognostic factors for the development of PCS is therefore essential, since it can ensure widespread clinical and economic benefits. This work aims at providing an updated description of the incidence of mild TBI (mTBI) based on data from Emergency Departments (ED) in the Ile-de-France (IDF) region (Paris area).

Methods

We estimated the mTBI incidence, using mainly data from the OSCOUR (Organisation de la Surveillance Coordonnée des Urgences) database from 01/01/2011 to 31/12/2015. The OSCOUR Network data collection methodology is based on the registration of all patients visiting the emergency services (ED) of participating hospitals. An extrapolation of the proportion of TBI patients visiting an OSCOUR ED to all ED of the IDF allowed us to compute a mTBI Annual Incidence Rate (AIR) in IDF.

Results

Between 2011 and 2015, 95,910 mTBI patients visited the OSCOUR ED in IDF, and the AIR was estimated at 292.4/100,000 inhabitants (when reported to the French population scale: a total of 196,000 mTBI are supposed to happen each year).

Conclusions

The surprisingly high incidence rate of mTBI observed in this study requires an evaluation of public health measures to prevent these injuries and reduce their consequences. New screening procedures should be implemented to point out the patients at risk for complications and PCS. Alongside the care aspect, prevention should be developed to reduce the incidence of TBIs, and prevention policies should be assessed by reiterating our evaluation.

Key messages

Between 2011 and 2015, 95,910 mTBI patients visited the OSCOUR Emergency Departments in Ile de France, and the annual incident rate was estimated at 292.4/100,000 inhabitants. The mTBI high incidence rate requires an evaluation of public health measures to prevent these injuries and reduce their consequences, but also the implementation of new screening procedures.
Open Comparisons in Public Health Not Only a Report But Also a Practical Tool Package
Authors: Skoog Garas E , Makenzius M , Lundborg H , Forslund M , Lindqvist N
Published: November 2019

Sweden is a high-income country with about 10 million people 2018. The public health policy has a clear focus on equitable health throughout the population, and a goal to reduce avoidable health inequalities within a generation. The 21 regions and 290 municipalities in Sweden are political self-government and important as most of the welfare services that impact citizens’ lifelong health fall under their remit, for example; healthcare, childcare, education, social service, elderly care and support to people with disabilities, some emergency services, environmental issues urban planning. Therefore, the municipalities and regions need reliable data that can be compared.

Such data is available in the report Open Comparisons in Public Health (OCPH). The OPCH 2019 demonstrate large inequities in determinants of health and in health outcomes between municipalities in Sweden. Further work is needed to reduce these unjust and avoidable differences. The OPCH 2019 is not only a report, but rather a concept with additional practical tools to be used by local and regional public health officers, leaders and politicians. Following tools, developed in collaboration with stakeholders, are available in the concept OPCH.

OPCH 2019: various managementresearch review, result comparisons, suggested improvement areas

Factsheet: for leaders and politicians at policy level

Municipality reports: tailored for public health officers to save time

Socioeconomic compass: a tool to analyze differences in socioeconomics across municipalities

Kolada: the Swedish database for municipal benchmarking

Toolbox: tools to facilitate systematic interpretation and analysis

The National Public Health Agency: various statistics are available for additional analyses

Key messages

The OPCH and the tools contributes to initiate local/regional development, improvement, monitoring and analysis concerning the quality and efficiency of the services delivered by these organisations. Governmental policies are important structural links16, but according to the OCPH 2019 the reduction of health disparities also requires measures in each local community.
Preventing accidents in the offshore Oil and Gas industry: An interrupted time series analysis
Authors: Lamnisos D , Michail M , Stasinopoulos D , Giannakou K
Published: November 2019

Background

Oil and Gas industry suffers from high accident rates because of the dangerous working conditions. Eastern Mediterranean countries have an immature Oil and Gas industry and therefore it is crucial for preventing accidents in this early stage to implement internationally proven successful policies. The aim of this study was to investigate whether the accident prevention policies implemented by Norwegian government in 2001 were effective in reducing accident rates in the offshore Oil and Gas industry.

Methods

Data on the number of accidents, dates and type of facility (fixed or movable) for the years 1999-2006 were obtained from the Norwegian Petroleum Safety Authority (PSA). The effectiveness of the policy to reduce accident rates was estimated in interrupted time series analysis with post-intervention period the 1st of January 2001. Poisson regression was used to model the number of accident per months.

Results

The dataset had 96 months with a median number of accidents per month 6.5 (IQR: 4-10) for fixed facilities and 5.0 (IQR: 3-9) for movable facilities. The analysis suggested that there was a reduction in accident rates for fixed and movable facilities. Following the policy, there was a reduction in accidents of 45% for fixed facilities (rate ratio (RR) 0.55; 95% confidence interval (CI) 0.47-0.64), while for movable facilities there was a decrease of 67% (RR 0.33; 95% CI 0.28-0.39).

Conclusions

The policies implemented by Norwegian government in 2001 were effective in reducing the accident rates for fixed and movable facilities. The immature Oil and Gas industry of the Eastern Mediterranean countries will be benefited from studying and adopting some of the policies implemented by Norwegian government.

Key messages

Norwegian policies for accident prevention in the offshore Oil and Gas industry were successful. Oil and Gas industry of Eastern Mediterranean countries should adopt proven successful policies to prevent accidents.
Roma populations and health inequalities: a systematic review of multiple intersecting determinants
Authors: Orton L , Anderson de Cuevas R M
Published: November 2019

Background

Roma populations experience significantly poorer health than majority populations. Health outcomes are often worse than for others in similar social positions, suggesting differences are not simply the effect of poverty. Roma women are thought to be worst affected. However, data pertaining to the multiple social inequalities affecting Roma populations, their interaction and cumulative effect on health over time, have yet to be synthesised.

Methods

We searched four bibliographic databases (MEDLINE, Science Citation Index, Social Sciences Citation Index and Scopus), screened reference lists, consulted key informants and searched organisational websites for studies providing empirical evidence on more than one determinant of health for Roma populations in Europe. Two reviewers carried out screening, data extraction, quality appraisal and performed a narrative synthesis.

Results

From 2,043 bibliographic records, 37 studies met our inclusion criteria. The median number of influencing factors explored through qualitative and quantitative methodologies was 2 (range 1 - 5) and 3 (range 1 - 11), respectively. Quantitative studies focussed on poverty (10 studies) and other indicators of socio-economic status including education (13 studies), housing (9 studies) and employment (9 studies). Very few studies unpicked interactive effects instead testing each factor’s contribution to poor health independently. Qualitative studies tended to explore “Roma culture” (11 studies) and the impact of discrimination/racism on health behaviour (10 studies). There is a lack of gender-disaggregated data and little analysis of the impact of social policy on the health of Roma populations.

Conclusions

Evidence for associations between determinants and health outcomes among European Roma populations is patchy. Research needs to pay more attention to the health impact of social policies that have the potential to reinforce (as well as mitigate) the exclusion of Roma populations.

Key messages

This systematic review critically analyses the state and shape of research evidence on the multiple interacting axes of inequality that contribute to poor health among Europe’s Roma populations. There is a divergence between qualitative and quantitative studies, with the former providing some evidence on socio-economic status and the latter exploring aspects of culture and discrimination.
A comparison of stakeholder networks across two pricing policy debates using discourse analysis
Authors: Hilton S , Buckton C , Fergie G , Henrichsen T , Leifeld P
Published: November 2019

Background

Public health policy development is subject to a large number of stakeholders seeking to influence government thinking on policy options. One approach is via the news media. We compare the competing discourse coalitions evident in the UK public debate across two pricing policies, Minimum Unit Pricing (MUP) for alcohol and the Soft Drinks Industry Levy (SDIL).

Methods

Existing discourse network analyses (DNA) for MUP and SDIL were harmonised in Visone to allow direct comparison. We applied a common tie-weight threshold to reduce ties to robust argumentative similarities and to maximise the identification of both network structures. We used network measures (size, density and EI index) to compare the two networks and principal coalitions.

Results

Both networks involve a similar range of stakeholder types and form two discourse coalitions representing proponents and opponents of the policies. The SDIL network is larger, particularly the proponents coalition with over three times as many nodes and a lower EI index. Both networks show tight discourse coalitions of manufactures and commercial analysts acting in opposition to policy supporters. The only actors that appear in both debates are politicians, government advisors, commercial analysts and supermarkets. While public health actors appear in both debates they appear siloed in their interests.

Conclusions

DNA enabled direct comparison of the discourse coalitions across two highly contested pricing policy debates, visualising the complex network of actors and relationships operating to influence policy-making via the media. Use of comparative DNA across policy debates shows promise for better understanding the common tactics of different unhealthy commodity industries (UCIs) to disrupt public health policies. Public health actors could improve their response to UCIs by seeking to work across policy and commodity arenas.

Key messages

We compared the competing discourse coalitions across two pricing policy debates, MUP and SDIL. Public health advocates could improve their response by working across policy arenas.
Are Cypriot community pharmacists ready to offer hypertension screening interventions? A pilot study
Authors: Alexandrou R , Petrou C , Peletidi A
Published: November 2019

Background

Cardiovascular disease (CVD) is the leading cause of death in Europe. One of the most essential CVD risk factors is uncontrolled hypertension (HP), thus the management of HP can lead to lower CVD risk. Pharmacists (PHS) can actively contribute to various public health functions such as prevention and early detection of individuals with increased blood pressure (BP). This study aimed to assess the feasibility of a pharmacy-led HP screening programme in Cyprus.

Methods

The study was conducted in one community pharmacy in Nicosia. The sample (n = 87) was randomly selected. Inclusion criteria were adults, without any CVD, diabetes or hypercholesterolemia in addition to pregnant women. BP measurements of the participants (PS) were taken. PS whose BP reading was high-normal were advised to measure their BP regularly, those whose BP reading was 140-159/90-99 mmHg were offered a home BP monitoring (HBPM) to confirm the diagnosis of HP and those whose BP reading was higher than 160/100 mmHg were referred to a cardiologist.

Results

68 PS (78%) had normal BP, 14 PS (16%) were detected with high normal BP while 5 (6%) were identified with a BP reading higher than 140/90mmHg. 2 PS were diagnosed with HP grade 2 after PHS’s referral to a cardiologist while 2 PS were diagnosed with HP grade 1 after the HBPM. An estimation of a CVD risk conducted indicated that 84% (n = 73) of the sample appeared to have no risk at all, 12% (n = 10) had low risk, 3% (n = 3) had a moderate risk and 2% (n = 1) showed moderate to high risk.

Conclusions

The fact that 4 PS were diagnosed with HP and 14 more were given lifestyle advice can indicate Cypriot PHS’ potential contribution to the prevention and early diagnosis of HP. As the sample was small and the results may not be generalised, similar programmes should be conducted with a higher number of PHS and PS in different cities in Cyprus to identify replication of the results.

Key messages

Cypriot pharmacists have the potential to screen individuals with high blood pressure. Pharmacists’ intervention can lead to early diagnosis of hypertension.
Caregivers of non-dependent old person: perceived loneliness is associated with poor health status
Authors: Arlotto S , Gentile S , Durand A C , Bonin Guillaume S
Published: November 2019

Objectives

Informal care has poor effects on caregivers’ health status. Several studies targeted informal caregivers of dependent or severely ill old persons. But, few of them analysed non-dependent old persons caregivers and their perceived loneliness. We hypothesized that perceived loneliness is an independent factor that worsen the caregiver burden and perceived health status. The aim of this study is to analyze factors associated to the perceived loneliness of caregivers of the non-dependent old persons.

Methods

A Cross-sectional study has been conducted among 876 dyads. Old persons over 70 years of age, non-dependent, living at home and their caregiver eligible for social support by retirement and occupational health insurance in South-east of France were included. Caregivers were assessed by the Mini-Zarit Scale for the burden, and with 5-point -Likert scales for loneliness and perceived health status. A multivariate logistic regression model was performed to analyze explanatory variables related to loneliness.

Results

Characteristics of the caregivers were: 64.5% female, 29% spouse, 61% children; 64% with frailty and 38% with high burden, 10.5% of them felt often or always lonely. Loneliness was positively associated to (OR; CI 95%): caregiver’s poor health status (3.40; 1.60-7.23), burden (4.06; 1.99-8.27), sleep disorders (3.75; 1.85-7.60), anxiety (6.64; 3.23-13.65) and a bad relationship with the old persons (2.17; 1.11-4.25). Loneliness was negatively associated to a good family support (0.33; 0.17-0.63) and living alone (0.34; 0.16-0.76).

Discussion

Loneliness should be differentiated from social isolation. Caregivers loneliness is not very frequent but highly correlated to a poor health status perception. Thus, it is essential that health care providers assess for caregivers’ perceived loneliness to implement specifics supporting actions to improve health status.

Key messages

Caregivers loneliness is not very frequent but highly correlated to a poor health status perception. It is essential that health care providers assess for caregivers’ perceived loneliness to implement specifics supporting actions to improve health status.
Convergence in disability policies in the welfare states Denmark, Sweden, the UK and Australia?
Authors: Jensen N K , McAllister A , Wadiwel D , Elliot A , Hwang G
Published: November 2019

Background

A state’s relation to citizens who are not able to support themselves due to illness is one of the cornerstones of welfare states. However, rising numbers of people on disability benefits is a challenge in many welfare states. The first aim is to investigate how policies around eligibility to disability benefits articulate a concept of ’incapacity to work’ across social democratic (Denmark and Sweden) and liberal welfare states (Australia and the UK). Secondly, we wish to explore how the conceptualisation of capacity and incapacity to work shapes prevailing constructions of disability.

Methods

In this study, we analyse official policy documents from governments, legislation, scientific and grey literature on disability benefit reforms in the selected countries. The analytical framework introduces the notion of decommodification of labour for people with disability and the ’social model of disability’ in relation to the constructions of disability in current disability benefit reforms.

Results (preliminary)

Restricting access to disability benefits has been a key feature of the recent reforms across all different types of welfare states. Liberal welfare states are more pervasive in reassessment of previously granted benefits compared to social democratic welfare states. The construction of disability in recent reforms is at odds with the social model of disability.

Conclusions (preliminary)

Across both liberal and social democratic welfare states eligibility for disability benefits is articulated around notions of incapacity to work. Retrenchment of benefits is, overall, most pervasive in liberal welfare states.

Key messages

The convergence in social policies across both social democratic and liberal welfare states speaks to the pervasiveness of neo-liberal notions in current social policy. The tightening of eligibility criteria for disability benefits poses great financial and health risks to people with illness struggling to support themselves.
The Portuguese HIV/AIDS Programme under austerity
Authors: Figueiredo Augusto G , Aldir I , Bettencourt J , Dias S , Abrantes A , Oliveira Martins M
Published: November 2019

Background

The HIV/AIDS Programme has been a core health programme in Portugal leading the country’s response to the HIV epidemics since the 1980s. In 2011, the severe financial and economical context forced the government to reorganize central services, including the Ministry of Health, aiming to improve efficiency and reduce costs. All vertical programmes were reformed, including the HIV/AIDS Programme.

Methods

For the period 2009-2018, we analyse the outcomes of core HIV prevention programmes managed by the National Programme for HIV/AIDS Infection: the syringe exchange programme, HIV testing, the distribution of preventive materials, and financial support to private non-for-profit organisations.

Results

This paper describes the main features of that reform and analyses selected outcomes, as well as how those financial constraints affected the response to HIV/AIDS. Despite some transitory cuts in spending, the National Programme for HIV/AIDS Infection was able to successfully expand testing and prevention interventions. Strategic partnerships with non-governmental and community-based organisations were crucial to continue delivering adequate HIV testing services and reaching most-at-risk groups.

Conclusions

The main goals of the National Programme for HIV/AIDS Infection for the term 2012-2016 were reached, including the decrease of new HIV infections, new AIDS cases and AIDS-related deaths, and the country is in a good position to meet UNAIDS’s 90-90-90 targets by 2020. Scaling-up access to pre-exposure prophylaxis, improving access and adherence to antiretroviral therapy, and continuously promoting access to HIV testing services and HIV self-testing stand as the main challenges of the National Programme for HIV/AIDS Infection in the near future.

Key messages

Prioritise spending under financial constrains can be cost-effective. Besides transitory cuts, HIV programme was able to meet its goals.
Transformative governance for public health: A scoping review
Authors: Schreurs F , Bekker M P M , Helderman J K , Jansen M , Ruwaard D
Published: November 2019

Background

As coordination issues arise in an increasingly complex health domain with a growing number of stakeholders involved in health initiatives, WHO proposed a transformation towards a Whole of Society approach. However, this abstract approach lacks practical guidelines to tackle these issues. In domains such as the environmental policy sector, similar transformations were established by applying governance strategies. This study aims to answer, which conditions and arrangements are found in the governance literature for the coordination and evaluation of the transformation of health towards a Whole of Society approach?

Methods

A systematic search was conducted by combining ’governance’, with adjectives as ’collaborative’, ’adaptive’, ’experimentalist’ and ’reflexive’ in order to target relevant governance theories in JStor, Web of Science, EBSCO and Google Scholar. Based on inclusion criteria two reviewers independently selected articles following PRISMA.

Results

Analysis of 56 articles showed that transformation should be coordinated by stimulating favourable conditions such as learning and experimenting in networks that cut across traditional boundaries. These conditions and methods can be divided into three categories. First, establish collaborations with government as equal partner by making the inclusion and decision-making process open and transparent. Second, stimulating innovation by engaging local initiatives, and supporting learning, experimentation, reflection and adaptation. Third, ensuring the sustainability of innovation by enabling institutional change.

Conclusions

To coordinate and evaluate the transformation of health towards a Whole of Society approach, conditions may consist of a combination of collaboration, innovation and institutional change.

Key messages

To bring together the fragmented resources for public health, we present emerging conditions for the coordination of a Whole of Society approach as transformative governance strategy. The transformative capacity of governance can be found in the combination of the theories as adjectives: collaborative, adaptive, experimentalist and reflexive.
Knowledge, Attitudes and Beliefs towards Electronic Cigarettes among University Students in Austria
Authors: Paudyal P , Movia M
Published: November 2019

Background

The popularity of e-cigarette is increasing recently, both as an alternative nicotine delivery tool or smoking cessation aid. Austria is a country with a high smoking prevalence; 28% of the population are current smoker and 21% have tried e-cigarettes at least once. In this current context, it is important to understand the opinion regarding e-cigarettes.

Methods

This cross-sectional survey examined the use, knowledge, attitudes and beliefs towards e-cigarettes among undergraduate students from Carinthia University of Applied Sciences in Austria. The anonymous questionnaire was handed out in 29 classrooms during compulsory lecturers, and completed questionnaire was returned to a provided box in the front of the classroom. Descriptive summary statistics was used to summarize the results using SPSS 24. Statistical significance was considered at p < 0.05.

Results

A total of 528 students were approached and all returned the questionnaire giving a 100% completion rate. 83.7% were female and half (50.2%) were in the age group 20 and 24. 96.6% of students reported being aware of e-cigarettes and 32.4% mentioned trying e-cigarettes at least once. 71.2% reported of ever smoking tobacco. 53.8% disagreed that e-cigarettes are an effective way for smoking cessation and only 10.3% agreed recommending it to a friend or family for smoking cessation. 78.1% believed that e-cigarettes are harmful to the health of those who use them and 58.2% disagreed that the use of e-cigarettes should be prohibited on University Campus premises.

Conclusions

To our knowledge, this study is the first of its kind performed in Austria. Our study shows that self-reported ever use of e-cigarettes is 1.5 times higher among this population than among the general population in Austria. Majority of participants disagreed that e-cigarettes are an effective way for smoking cessation. There seems a gap in knowledge regarding the e-cigarette which needs to be addressed among the university students.

Key messages

In Austria, e-cigarettes use is 1.5 times higher among university students compared to the general population. Knowledge gap regarding e-cigarettes needs to be addressed among the university students.
Smoking habits among 5th and 6th degree medical students
Authors: Erden Cengiz C , Ay P , Aigbovbiosa M , Yıldırım K , Guder S
Published: November 2019

Smoking is the most common cause of preventable mortality and morbidity worldwide. In the fight against tobacco physicians take active role. The objective of this study is to determine the rate and patterns of tobacco use among students of Marmara University School of Medicine (MUSM). This is a cross sectional study carried out in MUSM. The study population were all students studying in the 5th and 6th grades. Data were collected through questionnaires. The questionnaire form included sociodemographics, tobacco usepatterns, quitting attitudes and experiences. Among 410 students, 328 participated. Among all 56.1% were 5th year and 43.9% were 6th year students. The median age was 24 and 55.8% were female. 22.6% of the participants were current smoker. 33.8% of males and 13.7% of females are smoking (p:0,001). Common reasons for starting to smoke were the influence of close friends (11.3%), curosity (8.2%), stress (4.6%). Of the participants, 8.5% had smoked waterpipe. 28.4% of the current smokers still smoke waterpipe, 46.2% had tried to quit more than once and 13.5% wished to quit but had never tried to quit. 40.2% of the participants whose close friend smokes and %44.4 whose partner smokes are current smokers (p:0.001). %70 of current smokers tried at least one time electronic cigarette (p:0.001).

Approximately one fourt of the students are current smokers, higher in men. Those who smoked cigarettes had high affinity for waterpipe, electronic cigarettes. Electronic cigarette is fast rising trend daily. Starting smoking and quitting is influenced by close friends and partners.

Key messages

The primary goal should be to stop the smokers and prevent the start of the smokers. Information should be made on the harms of electronic cigarettes and the community should be informed.
Reliability and Validity of Disability Literacy Scale for Medical School Students
Authors: Aydoğan S , Atay E , Metintaş S , Demirtaş Z , Öcal E E , Pala S Çalışkan , Oktar D , Mutlu A , Önsüz M F
Published: November 2019

Background

Disability literacy is the ability to perceive definition of disabled person, their characteristics, difficulties in daily life and solution suggestions, their rights and false thoughts and orientations about them. The aim of the study was to develop the Disability Literacy Scale (DLS) to determine the disability literacy of medical school students with a high probability of encountering disabled people.

Methods

This study was conducted in 1110 medical school students in 2018-2019 academic year. By using literature 97 questions were collected. DLS was created with 22 questions by taking expert opinions. Correct answer was scored as 1, while wrong or ’do not know’ answer as 0. In order to evaluate the reliability of the scale, item total score correlation and internal consistency (Cronbach’s alpha) analyzes and exploratory and confirmatory factor analysis were used for construct validity.

Results

Of the 51.1% students were female and their age ranged from 17-40, the mean was 21.1±2.2. After the scale development study, the scale consisted of 14 items and 3 sub-dimensions. Scale items explain 43.21% of total variance and factor loadings ranged from 0.37-0.80. The Cronbach’s alpha coefficient was 0.61, 0.64, 0.51 for communication, health problems and social life sub-dimensions, and 0.68 for the whole scale. The fit of scale and the fit index were found to be acceptable after confirmatory factor analysis. In the last form of the scale, the score that can be taken from scale range 0-14. It was accepted that by increasing of the score, disability literacy level was increased. The mean score of students was 9.79±2.57 and the median was 10.0. The scores obtained from DLS were found to be lower in the first 3 grades (p < 0.001), low level mother and father education (p < 0.001/p=0.012) and who have not yet taken lesson about disability (p = 0.021).

Conclusions

DLS is a valid-reliable tool for assessing disability literacy levels of medical school students.

Key messages

It is essential to place disability related lessons from the earliest grades of medical school curriculum. In the literature, DLS seems the first scale about disability literacy and needs to be tested in large communities.
Validating a model & self-assessment tool to measure organizational health literacy in hospitals
Authors: Pelikan J , Nowak P
Published: November 2019

Background

The European Health Literacy Survey (HLS-EU) demonstrated that in many European countries a considerable proportion of the population has limited health literacy (HL), that there is a social gradient for HL and that HL is associated with use of health services. Furthermore research mostly from the US also showed that HL of patients has detrimental effects not only on use but also on outcomes of health care. Therefore in the US the concept of the Health Literate Health Care Organization (HLHCO) has been developed by IOM to make health services more sensitive to the needs of patients with limited HL.

Methods

Based on the IOM concept, a more comprehensive model of a Health Literate Health Care Organization fulfilling criteria of WHÓs health promoting setting approach has been developed. A set of standards and indicators according to quality management criteria (ISQUA) to measure the organizational HL of a hospital has been constructed, tested and validated in 9 different kinds of hospitals by a team in Vienna. This model and measurement tool has been translated to English and other languages and been used and validated also in other countries (Belgium, Italy, Taiwan). By an international working group of the international Health Promoting Hospitals and Health Services network an international version of the model and tool has been developed and will be tested in different countries.

Results

The model and self-assessment tool has been demonstrated to be acceptable, feasibly, valid and useful to start self-assessment and improvement of organizational HL in different types of hospitals and health care systems.

Conclusions

Organizational HL of health services matters for use and quality of health care of patients. Measuring organizational HL of hospitals by a validated instrument can support development of a more health literate health care organization and by that improve quality of care and tackle the health gap.

Key messages

Health literacy matter for health care and can be measured and improved on a personal and on an organizations or systems level to improve quality of care and tackle the health gap. A model and self-assessment instrument to measure organizational health literacy of hospitals has been developed and validated to support hospitals to improve their organizational health literacy.
Interventions for gestational diabetes prevention: An umbrella review of meta-analyses of RCTs
Authors: Giannakou K , Constantinou E , Lamnisos D
Published: November 2019

Background

Gestational diabetes mellitus (GDM) is a common pregnancy complication, defined as glucose intolerance with onset or first recognition during pregnancy, in women without diabetes history during pregnancy. It is a major cause for adverse maternal and fetal outcomes and affects around 15% of all pregnancies. GDM is considered to be a risk factor for future metabolic conditions and cardiovascular disease.

Methods

An umbrella review was performed to identify systematic reviews and meta-analyses of randomized controlled trials for GDM prevention in order to summarize evidence and evaluate the validity of the interventions. We searched PubMed, the Cochrane library and ISI Web of Science from inception to March 2019. For each meta-analysis we estimated the summary effect size by random-effects and fixed-effects models, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity expressed by I2, evidence of small-study effects and evidence of excess significance bias.

Results

Six-teen eligible papers were identified providing data on 39 associations. Eighteen (46%) associations had nominally statistically significant findings at P < 0.05, while only one (3%) remain significant at P < 10-6 under the random-effects model. Eight (21%) associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in 5 (13%) and 2 (5%) associations, respectively. Only one intervention presented robust evidence for a convincing association: prenatal exercise compared with no exercise (RR 0.62, 95% CI: 0.52-0.75). It was supported by > 500 cases, 95% prediction intervals excluding the null, no large heterogeneity, small-study effects, or excess of significance.

Conclusions

Prenatal exercise shows the strongest consistent evidence. The findings from our study highlight the importance of patient education about lifestyle modifications to reduce risk of GDM.

Key messages

Prenatal exercise could lower the risk of GDM based on solid epidemiologic evidence. Obesity, pregnancy hypertension and other metabolic conditions could be prevented as well.
Impact of an excise tax on the consumption of sugar-sweetened beverages in Catalonia, Spain
Authors: Bordonada MA Royo , Escobar C Fernández , Simón L , Barbero B Sanz , Padilla J
Published: November 2019

Background

Sugar-sweetened beverage consumption is contributing to the obesity epidemic. On 28 March 2017, Catalonia enacted a law levying an excise tax on sugar-sweetened beverages for public health reasons. The purpose of this study is to assess the impact of the tax on the consumption of sugar-sweetened beverages in Catalonia (Spain).

Methods

Before-and-after study to assess changes in the prevalence of consumption of sugar-sweetened beverages among 1929 persons aged 12 to 40 years residing in low-income neighbourhoods of Barcelona (intervention) and Madrid (control). Beverage consumption frequency was ascertained via a validated questionnaire administered during the month prior to the tax’s introduction (May 2017) and again at one year after it had come into force. The effect of the tax was obtained using Poisson regression models with robust variance.

Results

While the prevalence of regular consumers of taxed beverages fell by 41% in Barcelona as compared to Madrid, the prevalence of consumers of untaxed beverages remained stable. The main reason cited by more than two-thirds of those surveyed for reducing their consumption of sugar-sweetened beverages was the increase in price, followed by a heightened awareness of their health effects.

Conclusions

The introduction of the Catalonian excise tax on sugar-sweetened beverages was followed by a reduction in the prevalence of regular consumers of taxed beverages.

Key messages

This is the first study to show the efficacy of the Catalonian excise tax to reduce the prevalence of regular consumers of sugar sweetened beverages by residents of low-income neighbourhoods in Spain. Our results, along with the remaining scientific evidence on the subject, would justify the extension of the measure to the rest of Spain for public health reasons.
How the French Nutri-Score can impact sales of processed-foods? A complex system perspective
Authors: Breton E , Ode O , Oikonomidi T ,   the EHESP MPH working group on Nutri-Score
Published: November 2019

Background

Nutri-Score (NS) is France Front-of-Pack Food Labelling System to provide at-a-glance information about the nutritional quality of pre-packaged food products. Based on the Food Standards Agency nutrient profiling system, its algorithm generates a score by taking into account the presence of both the harmful and beneficial contents in food. In this presentation, we report on our analysis of the logic model of NS and on its potential impact on the production and marketing of processed foods.

Methods

We reviewed the scientific and grey literature on NS to identify its potential mechanisms and loci of change. We also appraised the policy against Meadow’s leverage points for system change.

Results

The official adoption of the NS algorithm is instrumental in modifying both consumer food-related behaviours and food industry corporate practices. The algorithm takes 3 forms: 1) the front-of-pack logo indicating an integrated colour/letter score for the product, 2) mobile device applications which help consumers assess the nutritional value of food products even without an affixed logo, 3) nutritional parameters which influence food manufacturing decision-making in the industry. NS can trigger different drivers of corporate practice. From the current uptake trends, small and medium size food manufacturers appear more likely to welcome the NS Logo as a means to stand out against the multinational corporations presently dominating the market. As for the capacity of NS to transform the existing systems of producing and marketing processed foods, we find that it is mostly by changing the flow of information. NS presents new information, previously inaccessible to consumers, to support the population in making healthier food choices by providing a means for nuanced nutritional comparisons between food products of the same category.

Conclusions

We conclude on the potential evolution of Nutri-Score and how its uptake by food corporations may be fostered.

Key messages

Nutri-Score’s impact is through: the front-of-pack logo; nutrition apps; and as a parameter of food industry decision-making. Nutri-Score impacts the flow of information of the processed-food system.
The Trends of Underweight in South Korean between 1998 and 2015
Authors: Lee Kyung Jin , Lim Juwon
Published: November 2019

Background

Underweight is associated with increased mortality, relative to the normal weight category. The importance of managing underweight patients has not yet been recognized seriously in South Korea, and little information is available on the prevalence of underweight and its associated risk factors. This study aims to investigate changes in the prevalence of underweight by gender and age and analyze its trend.

Methods

Data were obtained from individuals aged >20 years, from the Korean National Health and Nutrition Examination Survey between 1998 and 2015. The subjects of this study included 134,613 adults (male, 61,152; female, 73,461). The prevalence of underweight was determined as defined by the Asia-Pacific Perspective, and socioeconomic factors associated with a predisposition to underweight were analyzed using the chi-squared test and multiple logistic regression analysis.

Results

Among Korean adults, the age-adjusted prevalence of underweight (body mass index <18.5 kg/m2) was 3.1% in men and 6.3% in women. Overall, a U-shaped relationship was established between the prevalence of underweight by gender and age. There was no significant difference in socioeconomic factors related to the prevalence of underweight in men and women in their twenties. The prevalence of underweight in women aged 20-59 years showed an increasing trend (P for trends <0.05).

Conclusions

In individuals aged 20-29 years, the prevalence of being underweight was higher in women than in men. Recently, there has been an increasing trend in the prevalence of underweight young women of reproductive age. This requires national public health attention.

Key messages

Underweight in old age and young age requires nation wide public health attention. Especially thinness in young women in reproductive age must be considered as global health issue.
Evaluation of Malnutrition and Depression in Elderly People: An Epidemiological Study in Turkey
Authors: Aydoğan S , Ünsal A , Arslantaş D
Published: November 2019

Background

Malnutrition is an important cause of morbidity and mortality. Malnutrition increases the number of hospitalizations and prolongs the length of hospitalization by disrupting organ functions, increasing the number and severity of infections and delaying wound healing. The aim of this study was to determine the frequency of suspected malnutrition in the elderly, to examine some related variables and to evaluate the depression.

Methods

The study is a cross-sectional study conducted between March-April 2019 in individuals aged 60 years and older living in Sivrihisar. Sample size was calculated as 579. Cluster sampling method used. Data was collected by door to door in 4 neighborhoods determined by randomly. Mini Nutritional Assessment Test-Short Form (for malnutrition), Katz Daily Living Activities Scale (for dependency) and Geriatric Depression Scale-Short Form (for depression) were used. Chi-square test, Mann Whitney U test and logistic regression analysis were used for the analyzes.

Results

The study group consisted of 220 (38%) women and 359 (62%) men. The mean age was 68.9±6.4 (ranged 60-93). Frequency of suspected malnutrition was 25% (n = 145). Being 80 years of age or older (OR:3.24, CI:1.53-6.85), having a primary and lower education level (OR:2.54, CI:1.32-4.90), history of chronic illness (OR:2.34, CI:1.33-4.03), using dentures (OR:1.62, CI:1.03-2.55) and suspected depression (OR:4.97, CI:3.17-7.78) are important risk factors for malnutrition. Those with suspicion of malnutrition had lower scores on DLA (z = 8.982;p=0.001).

Conclusions

Malnutrition was found to be an important health problem for the elderly. The frequency of suspected malnutrition is higher in individuals with depression. Those with suspected malnutrition have higher level of dependency. In order to reduce the frequency of malnutrition, it may be beneficial to increase the awareness of the elderly and caregivers and to give importance to the elderly nutrition of primary health care providers.

Key messages

Depression is an important risk factor for malnutrition. Malnutrition increases the dependence of the individual on daily activities.