bluuebunny/crossref_metadata_2025 huggingface dataset:
Examples of lived experiences assessed by participative research
Authors: van Houtum L , Concincion S , Fernald F
Published: October 2020

Wicked problems and system thinking require solutions that are about changing the system dynamics in favourable ways. Randomized controlled trials (RCT), which traditionally have been seen as the 'gold standard' in evaluation research, are not the solution for this type of problem, as they are merely suited to evaluate single and multi-component interventions in a controlled setting. With system thinking, we recognize the complexity of the problem with multiple, interacting factors that are adaptive and dynamic over time. Crucial is participation of the target population.

Participatory action research (PAR) is an approach to research in communities that emphasizes participation and action of the target group. PAR increases feasibility and validity of research, and eventually the chance of designing successful interventions, as they are more likely to meet the target population specific needs and to change local practices. In addition, it contributes to personal development and self-efficacy among the stakeholders by prompting them to reflect on their lives and take shared action.

We will present three examples of lived experiences assessed by PAR, with a focus on childhood obesity. In the first project, we aim to develop, implement and evaluate an integrated action programme for 10-14-year-old adolescents in Amsterdam at the level of family, school, neighbourhood, health care and city, based upon a detailed insight into the characteristics of the population at stake (LIKE). The second project (Food4Smiles) aims to give children in their first 1000 days a good start in life regarding food, exercise, sleep and overall wellbeing. In this project, we work together with parents, grandparents and healthcare providers. The third project focuses on the healthcare for children with obesity. Goal is to understand which factors contribute to successful self-management behavior in children with obesity and their family and how youth nurses can empower and support this behavior.
Time trends in the geographical distribution of physicians, nurses and midwives in Europe
Authors: Winkelmann J , Maier C B
Published: October 2020

Background

Data on the supply of health professionals show large variations in the health workforce density among European countries based on national-level data. However, little attention has been paid to the comparison of health professional density at the regional level. This study aimed to analyse the density of physicians, nurses and midwives at regional level, using a cross-country comparative design and examine time trends.

Methods

Descriptive analysis of Eurostat data on the rate of health professionals per population at national and regional levels (NUTS 2 regions) for 2017 and time trends (2005-2017) and comparison to population density. To improve the cross-country comparability of data a set of criteria was applied, resulting in 15 European countries covered on physicians and eight for nurses and midwives. Changes over time in the regional distribution were analysed, using percentage change and compound annual growth rate (CAGR).

Results

We found a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria: 513, Poland 241.6 per 100.000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483). Differences by regions across Europe were higher and varied up to 4.5-fold both for physicians and nurses/midwives and did not improve over time. Results show that in all countries physician density levels are highest in densely populated regions, with capitals and/or major cities, while density of nurses and midwives tends to be higher in less populated areas. Overall, physician rates grew at a faster rate than the density levels of nurses and midwives.

Conclusions

International data should not only cover supply indicators at national level, but routinely collect regional data on the number of health professionals to demonstrate regional differences in workforce supply and to improve monitoring and workforce planning at regional levels.

Key messages

Despite increases in the density levels of physicians, nurses and midwives, time trends over a ten-year period showed no improvement in the geographical distribution within countries. The study is the first of its kind to descriptively analyse geographical density levels and time trends among health professionals across a selection of European countries using Eurostat data.
Assessment of pediatric hypercholesterolemia with a clinical data warehouse
Authors: Dhalluin T , De Luca A , Salpetrier C , Guillon L , Hankard R
Published: October 2020

Introduction

Familial hypercholesterolemia (FH) in children and adolescents is a genetic cause of premature coronary heart disease. Early detection of patients with FH could improve their management and life expectancy.

Methods

A retrospective observational study was conducted using our university hospital clinical data warehouse including children born after 01/01/2000, with at least one available lipid profile. Phenotypic diagnosis of hypercholesterolemia was defined by a plasma LDL-C level ≥5 mmol/L (190 mg/dL). Above-threshold children were compared with below-threshold children on available features: age, sex, weight and height, plasma total, HDL, LDL cholesterol, triglycerides, creatinine, urea, protein, albumin, thyroid stimulating hormone and cortisol levels.

Results

1,362 children were included, of whom 48 had at least one LDL-C measurement ≥5 mmol/L and 1,314 below (control). Only 2 children presented with a specific E78 hypercholesterolemia code versus 8 in the control group. Patients above the threshold were 1.5 years younger, with a mean cortisolaemia lower compared to the controls.

Discussion

Lipid profile is not routinely prescribed for children, and they are not routinely managed for their increased cholesterol levels. Lipid profile for children and adolescents were mainly prescribed in intensive care settings or in association with endocrine checkup. Hospital clinical data warehouse is an opportunity to specify practices in screening for Familial Hypercholesterolemia and lipid profile prescription in children.

Key messages

Lipid profile is not routinely prescribed for children. Hospital clinical data warehouse is an opportunity to specify practices in screening for Familial Hypercholesterolemia.
Malignant mesotheliomas in residents in the National Priority Contaminated Sites in Tuscany
Authors: Chellini E , Martini A
Published: October 2020

Background

Asbestos is a well-known carcinogen. A law banning asbestos is active in Italy since 1992. A surveillance system on malignant mesothelioma is ongoing in Tuscany since 1988. The aim is to describe mesothelioma incidence in the specific regional areas defined as National Priority Contaminated Sites in order to have suggestions on specific environmental remediation activities focused on asbestos.

Methods

Malignant mesotheliomas diagnosed in residents during 1988-2019 in the above cited areas are extracted from the specific regional registry. Standardized incidence rates are calculated by area and gender using 2013 European as standard population. Standardized incidence ratios are also calculated by area in the whole period, using the regional rates as reference. The distribution of cases by exposure and areas are analyzed.

Results

In the examined areas 510 cases are registered (423 in men and 87 in women). Male incidence rates are 10.0 (IC90% 8.4-11.6), 5.8 (IC90%3.2-8.3), 5.5 (IC90% 4.1-6.9) and 1.7 (IC90% 0.0-3.9) respectively in Livorno, Piombino, Massa and Orbetello. Female incidence rates are far below than those observed for men. The highest standardized incidence ratio is observed in Livorno (3.1, IC90% 2.6-3.6). The vast majority of cases (no.393) are related to occupational asbestos exposure, mainly occurred in the same residence area. Asbestos familial and environmental exposure was attributed respectively to 22 and 4 cases.

Conclusions

The availability of a long series of incidence data on malignant mesotheliomas allowed to evaluate the asbestos impact among residents in Tuscan contaminated areas. The results obtained show the great importance of past occupational asbestos exposure.

Key messages

Malignant mesothelioma is a sentinel event of past asbestos exposure. The mesothelioma burden in the contaminated area is helpful to prioritise specific environmental remediation activities.
The effects of lockdown on lifestyle habits of adults during the coronavirus pandemic in Cyprus
Authors: Philippou E , Demetriou C , Heraclides A , Mosquera M C , Quattrocchi A , Derlagen A , Pinnawala N U , Kolokotronı O
Published: October 2020

Background

Despite widespread adoption of lockdown by governments in the COVID-19 response, research on how it affects the individual pillars of Lifestyle Medicine is limited. We aimed to explore the effects of COVID-19 lockdown on healthy eating, physical activity, sleep, stress, social support and use of risky substances.

Methods

This was a cross-sectional study on a convenient sample of adults who resided in Cyprus during the lockdown. An anonymous questionnaire was completed online in Greek or English comprised of five validated tools in relation to their behaviours before and during the lockdown. We compared median values for each variable/tool before and during lockdown, using Wilcoxon Signed Rank test, and performed stratified analyses for sociodemographic characteristics.

Results

Out of 745 respondents, 74% were female and median age was 39. Overall scores showed significantly increased sleep quality difficulty (4 v 5, p < 0.001), decreased social support (71 v 68, p < 0.001), and increased perceived stress (22 v 25, p < 0.001) between February 2020 and the month in lockdown. Mediterranean diet adherence increased significantly only in those who followed religious fasting during lockdown (6 v 7, p < 0.001). Total minutes spent sitting significantly increased (120 v 180, p < 0.001) although overall physical activity score did not significantly change. Smoking intensity (daily number of cigarettes and e-cigarettes) as well as frequency of alcohol consumption (daily number of drinks) increased significantly (p trend=0.029 and <0.001, respectively).

Conclusions

Many aspects of lifestyle were adversely affected by lockdown in Cyprus. As people return to their pre-lockdown routines, the outcomes described provide data to inform the design of lifestyle interventions that support changing or maintaining lifestyle habits. Such interventions can then help decrease people's risk for future poor health outcomes, including the risk for COVID-19 infection.

Key messages

This study describes aspects of lifestyle affected by the Cyprus COVID-19 lockdown, significant when considering future lockdowns and pre-, during or post-lockdown healthful lifestyle interventions. The outcomes provide data to inform the design of lifestyle interventions to support changing or maintaining healthy lifestyle habits.
Sugar-sweetened beverage intake in relation to reproductive parameters in young men
Authors: Kiwitt Cárdeas J , Mendiola Olivares J , Adoamnei E , Arense-Gonzalo J J , Torres Cantero A M
Published: October 2020

Background

There has been a decrease in male fertility in recent years. During the same period, there were important dietary changes, including an increase in sugar-sweetened beverage intake (SSB). The relation between SSB and male reproduction functions in humans are barely described in the literature.

Methods

Cross-sectional study with 209 participants (18-23 years old) recruited during one year in Murcia, Spain. All men provided semen and blood sample the same day. SSB consumption was evaluated using a 101-item validated food frequency questionnaire. Reproductive hormones were analyzed from serum samples, obtaining levels of follicle-stimulating hormone (FSH), inhibin B, luteinizing hormone (LH), estradiol (E2) and testosterone (T). The evaluation of semen analysis consisted of seminal volume, sperm concentration, total sperm count, percentage of morphologically normal sperm and percentage of motile sperm. SSB intake association with semen parameters and hormone levels were examined using linear regression, adjusting for possible confounders.

Results

Men in the highest quartile of the SSB intake had higher percentage of morphologically normal sperm, 37,4% [6.1, 68.3] than men in the lowest quartile (P, trend= 0.047) and higher estradiol levels than those in the first quartile (9,5% [-3.5, 22.5] (P, trend=0.047)). SSB intake was unrelated to other semen quality parameters or reproductive hormone levels.

Conclusions

Our results indicate that sperm morphology and estradiol levels may be associated with sugar-sweetened beverage intake. These findings might be explained by physiological metabolism homeostasis, though more studies are required to confirm these results and draw conclusions in other male populations.

Key messages

Fertility is an increasing Public Health Problem. Sugar-sweetened beverage intake is increasing amongst the population.
Is the consumption of sweets a risk factor for thyroid cancer?
Authors: Ferrante M , Okatyeva V , Lo Bianco S , Oliveri Conti G , Zuccarello P , Copat C , Caltabiano R , Fiore M
Published: October 2020

Background

Several studies have investigated the role of diet as a risk and/or protective factor on the development of the thyroid cancer but the results are unclear. The aim of this study was to investigate the role of eating habits on the risk of thyroid cancer.

Methods

We carried out a hospital-based case-control study. The eating habits of the participants were investigated through a validated Lifestyles Questionnaire. The frequency of consumption of the different types of food was reported on a 4-level scale (never, 1 time per week, 2-3 times a week, 6 times a week). Logistic regression models were used to estimate the ORs and their 95% confidence intervals adjusted for age, gender and BMI. Statistical data analysis was conducted using the IBM SPSS Statistics 21.0 program.

Results

One hundred and six cases (91.2% CA papillary type) and 217 controls were recruited. A positive association was observed for BMI (OR: 1.085; IC95% = 1.022-1.152), consumption of complex carbohydrates (OR: 2,324; IC95%: 1,364-3,960) and a low consumption of legumes, cereals, potatoes, fruit and vegetables (OR: 2.285, 95% CI: 1.330-3.926). The consumption of sweets decreased with age (Rho: -0.445, N = 318, p = 0.000), but at the same age the cases had a higher consumption than controls. In particular, the consumption of sweets was higher in the age group between 39 and 52 years old.

Conclusions

Our study adds new and relevant information to support the hypothesis that a sugar rich diet may increase the risk of developing thyroid cancer.

Funding

This research was funded by Intradepartmental Research Plan 2016/2018 of Department of Medical, Surgical and Advanced Technologies, University of Catania, grant number: 5C722012104.

Key messages

Future studies need to clarify the mechanisms that associate the diet with the risk of thyroid cancer. More research is also needed to explain the differences in thyroid cancer among women and men.
Evaluation of public health literacy in adults who applied for primary health care in Turkey
Authors: Kılınç A , Çam C , Aydoğan Gedik S , Oktar D , Taşcıoğlu U , Öznur Muz F N , Önsüz M F , Metintaş S
Published: October 2020

Background

The climate change, conflicts, mass migrations and global epidemics happening in today's world shows that it's necessary for the communities to implement public health decisions. In this context, the degree of obtaining and complying with the information required for individuals to process, understand and evaluate public health decisions has revealed the concept of public health literacy. The aim of the study was to determine the public health literacy (PHL) levels in adults applying for health care.

Methods

This is a cross-sectional study conducted on 1672 adults who applied for primary health care in Eskişehir in 2019. Public Health Literacy Knowledge Scale (PHLKS) which is created with a WHO initiative was used to assess the PHL levels. The scores that can be obtained from this scale ranges from 0 to 17 and higher score implies higher literacy levels. In the study group, Cronbach's alpha value was 0.72 for the PHLKS. Multiple linear regression was used to determine the variables that affect PHLKS score.

Results

In the study group; 924 (55.3%) were male, 399 (23.9%) were living in a rural area, their ages ranged from 18 to 87 and the mean age was 40.94 ± 15.22. The median score from the PHLKS was 13.0 and mean score was 12.38 ± 2.99. Among the participants, 27.8% of them had a correct response rate of ≥ 90% for the items of the scale. Variables related to PHLKS were found to be high level of education, to exercise regularly and to perceive the general health status as good (F = 28.869, p < 0.001, R2 = 0.161). Education level was the most important variable related with PHL level (Standardized β coefficient: 0.34 95% CI: 0.28-0.39).

Conclusions

PHL levels of the participants was thought to be moderate. Education level and the lifestyle choices were related to PHL.

Key messages

It was thought that new and improved tools to measure public health literacy levels are needed. Societies should improve their education levels and invest in health education programs for more effective public health interventions.
Patient-assessed quality of care in type 2 diabetes in a German nationwide health survey 2017
Authors: Baumert J , Schmid G L , Du Y , Paprott R , Carmienke S , Stühmann L M , Frese T , Heidemann C , Scheidt-Nave C
Published: October 2020

Background

Patient-assessed quality of chronic illness care is important to guide medical care for patients with diabetes and other complex chronic diseases, but information from epidemiological studies is scarce. Thus, we examined self-assessed quality of care among adults with type 2 diabetes (T2D) based on a population-based design.

Methods

The study population was drawn from a nationwide survey on diabetes-related knowledge and information needs conducted in Germany in 2017 and included participants aged ≥18 years with known type 2 diabetes (T2D) in the last 12 months (n = 1,328). A German short version of the “Patient assessment of chronic illness care (PACIC-DSF)” consisting of 9 items based on 5-point Likert scale was applied to assess self-reported quality of care in diabetes which was operationalized by a standardized PACIC sum score ranging from 1 to 5. Linear regression with different stages of adjustment was applied to assess the association of basic characteristics and diabetes-related factors with the PACIC score.

Results

Quality of care was assessed less favorably by women than by men (PACIC score: 2.38 vs. 2.47) overall and decreased along with age. The PACIC score significantly increased in participants with insulin use (β = 0.16, p = 0.024), ever participating in a diabetes education program (β = 0.33, p < 0.001), following a diet plan at least once a week (β = 0.33, p < =0.001) as well as performing daily self-examination of feet (β = 0.14, p = 0.023), self-control of blood glucose (β = 0.34, p < 0.001), and being physically active for at least 30 min (β = 0.21, p < 0.001) compared to participants without the respective trait.

Conclusions

Self-assessed quality of care by adults with known T2D from this population-based study is moderate and seems lower compared to findings from clinical studies.

Key messages

An active involvement of people with type 2 diabetes into the implementation of care is essential and may contribute to improved self-perceived quality of care. To identify and overcome obstacles in diabetes care based on the patient’s perspective remains a public health challenge.
Impact of clinical risk management in pediatric intensive care units: a systematic review
Authors: Di Pilla A , Specchia M L , Perilli A , Tofani N , Carini E , Ricciardi W , Damiani G
Published: October 2020

Background

Clinical risk is the probability that a patient is the victim of an adverse event attributable to medical care, albeit unintentionally; clinical risk management is therefore a key area for the quality of healthcare, especially in care-intensive settings; even more for pediatric patients. The objective of this review is to assess the impact of the application of tools and methodologies for clinical risk management in pediatric care-intensive settings.

Methods

Pubmed and Web of Science were queried to carry out a systematic review, using the PICO methodology to formulate the research strategy and query (June 2019). Application experiences of clinical risk management that had quantitative and qualitative impacts in pediatric intensive care units were included.

Results

A total of 1178 papers were reviewed and 22 articles were included, most of them from the US (8). Out of the 22 experiences described, 11 were related to reactive management tools, 7 to proactive tools; 4 experiences reported the use of both reactive and proactive tools; 11 articles made explicit a reduction in adverse events following the intervention in the study (29.8%-78.8%, p < 0.001); 8 articles made explicit organizational changes triggered by the intervention; 2 proactive tools were also used in order to specifically assess the economical savings related to the changes that occurred as a result of the intervention; 1 article compared two reactive clinical risk management systems in the same context, underlining that a more innovative system tended to highlight more systemic errors, while a more traditional one focused on errors that were less common but potentially more dangerous; 14 studies were specifically dedicated to risk in drug management.

Conclusions

The application of clinical risk management tools made changes in pediatric intensive care units; the integrated use of different methodologies, both proactive and passive, for the management of clinical risk is highlighted in many studies.

Key messages

Methodologies for clinical risk management can have significant impacts on organizational processes and outcomes of pediatric intensive care units, improving safety of patient and operators. The simultaneous use of several clinical risk management tools, both proactive and reactive, is increasingly widespread.
The challenges of communicating vaccination benefit and risk in the family
Authors: Bouder F
Published: October 2020

Public perceptions of vaccination are complex and ambivalent. People often fear the vaccine more than the disease itself. They fear the unknown substance or adjuvants, worry that vaccines weaken their immunity system, or resent the involuntariness of mandated vaccination. The risk of the disease, on the other hand is often attenuated. Many vaccine-preventable diseases are rarely encountered in everyday situations and remain abstract concepts. Others, like influenza, may not be taken seriously; it is often seen as nothing worse than a “bad cold”. The sensationalist coverage of disease outbreaks is often perceived first as apocalyptic, then as “false alarms”. To fight these cognitive biases many risk communicators have focused on top-down persuasion, for instance telling parents that they must give the vaccine to their children and blaming them for not doing so. From a risk science perspective, however, it is well established that top-down persuasion that neglects to address negative perceptions is counter-productive. Any effort to bridge cognitive gaps and improve vaccine communication requires to understand perceptions. It is essential to understand the drivers that motivate parents' decision making and the dilemma they face between vaccinating and not vaccinating. The immunisation of children is particularly difficult because the communication's recipient are typically adults, which calls for strategies to talk to parents as well as reach children. Variations are observed across age as well as countries, which raises questions about national attitudes towards different types of vaccination affecting different age groups. This creates a more complex environment that is particularly challenging for healthcare professionals who have been identified as the primary “go to” authoritative source of information for adults. Obstacles to effective communication therefore needs to be addressed in a science-informed manner, if the objective is truly to ensure better uptake rates.
A lay provider delivered behavioral intervention for Syrian refugees and their children in Jordan
Authors: Bryant R , Giardinelli L , Bawaneh A , Awwad M , Hadeel N , Whitney C , Akhtar A
Published: October 2020

Background

Refugees and their children are exposed to many distressing events, including detention in refugee camps. Not surprisingly, refugees are at high risk for common mental disorders. A major barrier to addressing mental health problems in refugees is that most host countries lack sufficient mental health specialists to provide high-intensity treatments.

A recent trend has focused on training non-specialists to deliver simple psychosocial programs to those with distress. One such program is Problem Management Plus (PM+) which was developed by the World Health Organization; it comprises 5 small-group sessions that teach behavioural skills to reduce distress. This study reports the first evaluation of group PM+ in a refugee camp. We investigated the extent to which PM+ provided to adult Syrian refugees can benefit their children.

Methods

480 Adult Syrian refugees in the Azraq Refugee Camp were randomized to either PM+ or Treatment as Usual (TAU). Participants were independently assessed prior to the program, immediately following the program, and 3 months later. Outcome variables included anxiety, depression, functioning, posttraumatic stress, and grief and parenting behaviours. Children's psychological wellbeing was assessed in one child of each participant.

Results

Of the 650 adult refugees were screened in the camp, 96% met the cut-off for psychological distress and 76% met criteria for functional impairment. 480 participants were randomized to PM+ or TAU. The baseline assessment indicated 85% of refugees met criteria for depression, 84% met criteria for anxiety, and 84% met criteria for posttraumatic stress disorder. The 3-month assessment will be presented following linear mixed modelling to determine the relative gains made by refugees and their children in PM+ and TAU.

Conclusions

These findings will be discussed in terms of implementation of scalable programs in refugee settings, and specifically how these can benefit participants and their children.
Two-way labour market integration? Perspectives on youth with a refugee background and employers
Authors: Lytinen E
Published: October 2020

Background

In this study, the experiences of youth with a refugee background are explored in terms of their education and (un)employment in Finland. Moreover, the experiences of employers at employing people with a refugee background are analysed. The study contributes to the analysis of the double challenge of (un)employment that people face as refugees and as youth, and to the critical literature on employment and integration.

Methods

A total of 38 interviews were conducted between 2016 and 2018 in Finland. The analysis consists of 13 life story interviews with youth with a refugee background and 12 thematic interviews with employers. Additionally, 13 other experts were interviewed for contextualisation. The interviews were analysed by using narrative approach and qualitative content analysis.

Results

The refugee youths' educational paths differ significantly particularly due to their age at the time of arrival. They have found employment through various mechanisms and personal networks. The periods of unemployment have been difficult, even traumatic. The employers' recruitment strategies were numerous and the factors determining recruitment vary in different sectors. Even though bureaucracy of hiring refugees was a significant challenge, the experiences of hiring refugees were predominantly positive.

Conclusions

Even if the pressure is still largely on the refugees to integrate with the Nordic labour markets, there are encouraging signals about how the employers are also adapting. Yet, there is reason to be cautious as the Nordic countries are transitioning from welfare state to workfare state. Their refugee protection is politicised due to increasingly conditioning it on employment status. Employment can be important for integration, but integration is much more than just employment.
Climate Change, Public Health impacts and the role of the new digital technologies
Authors: Velez Lapão L
Published: October 2020

Health evidence should drive health policies towards health determinants targets. Amongst the environmental health determinants, climate change represents now a clear public health threat. The constant increase of temperatures has multiple consequences on population health, already observed in Europe and elsewhere. The role of healthcare services is paramount, moreover the use of new technologies that can mitigate CO2 emissions and reduce costs while improving healthcare coverage.

Reducing the impacts of climate change on the environment and population health is a challenge affecting everyone: it is therefore essential to get actors from all sectors, moreover from the technology side.

A scoping review addressed the impact of digital health services on climate change mitigation. Leveraging from previous work on telemedicine and health digital services an impact analysis was done covering both the CO2 mitigation and Costs. An example from a 20 years' telemedicine service is used to exemplify the impact.

The impact of a Telecardiology service, as an example of digital service, was addressed and the CO2 mitigation calculated. This service has so far avoided about 2000 flights from Africa to Europe, which means a reduction of more than 16 000 Tons of CO2. From this analysis is complemented with a scoping review showing the evidence from other digital health cases. The optimization of resources is critical in healthcare. In this regard, it is important to assess the actual benefits obtained with the health digital services, giving evidence on the righteousness of the decision-making.

Clearly digital health services should be promoted to tackle both health coverage from distance patients and to mitigate climate change footprint and should motivate policy-makers to take this challenge more seriously.

This work is contributing to SDG3, improving health, to SDG4, allowing to provide distance health education at relatively low cost and to SDG 13, by reducing the CO2 footprint.
Workplace violence, early neurological symptoms, and metabolic or psychiatric disorders
Authors: Magnavita N , Angelillo A , Anniballi A , Cavalieri S , Di Prinzio R R , Pompei A , Ragozzino R , Rallo G , Voza C
Published: October 2020

Workplace violence is ubiquitous. Neuropsychological symptoms, such as headaches and sleep problems, may be the earliest consequences of violent acts, and in turn are associated with an increased risk of cardiovascular and psychiatric disorders. Systematic research on this topic can help treatment and prevention.

905 health & social workers (male 331, 36.6%; mean age 46 + 11.4 years), during their periodical medical examination in the workplace, were asked to fill in a standardized questionnaire containing the Violent Incident Form on the episodes of violence suffered, the Headache Impact Test on headache and the PSQI on sleep problems. Anxiety and depression were evaluated with the Goldberg scale.

Workers reported having suffered physical assaults (5.2%), threats (11.5%), and harassment (10.2%) in the previous year. Workers who experienced violence had an increased risk of headaches (OR 2.80, CI95% 1.55-5.05 for physical violence, OR 1.83 CI95% 1.21-2.78 for threats, OR 2.46 CI95% 1.59-3.96 for harassment) and of sleep problems (OR 2.46, CI95% 1.33-4.57 for physical violence, OR 2.81 CI95% 1.82-4.33 for threats, OR 5.09 CI95% 3.04-8.51 for harassment).

Headache and sleep problems were significantly correlated with the components of the metabolic syndrome (hypertension, dyslipidemia, hyperglycaemia, obesity): Pearson's r was 0.069 for headache (p < 0.05), 0.142 for sleep quality (p < 0.001). Head and sleep problems were also correlated with anxiety (r = 0.519 and 0.670, respectively) and with depression (r = 0.457 and 0.619).

Violence at work was associated with an increased risk of headaches and sleep problems. These symptoms were associated with the components of the metabolic syndrome, with anxiety and with depression.

Early detection of symptoms such as headaches and sleep problems allows individual treatment measures to be put in place. The identification of the causes of these morbid phenomena allows to implement primary prevention measures in the workplace.

Key messages

Workplace violence causes headache and sleep problems, which, in turn, are associated with metabolic and psychiatric disorders. Periodic surveillance of workers is useful for improving public health.
Cancer care coordinators in Poland: activities and role in the system. A cross-sectional study
Authors: Dela R , Dubas-Jakóbczyk K , Domagała A , Sowada C h
Published: October 2020

Background

Coordination of care provision has become an important health policy objective in numerous countries. In Poland, the function of cancer care coordinator (CCC) was introduced in 2015, under the oncological care organization reform, and they are mainly employed by hospital care providers. The objectives of the study were to: identify the scope of activities carried out by CCCs in Poland and assess their practical role in the oncological care system.

Methods

We conducted a cross sectional study covering the whole population of CCCs in Poland (employed in 403 healthcare units formally participating in the oncological care system in 2018). The questionnaire was developed based on existing literature, adjusted to Polish settings, and validated. It covered three parts: (1) characteristic of the provider institution; (2) overview of the CCC position (e.g., number of persons employed/working hours; background education); (3) the scope of activities and perceived barriers in the process of cancer care coordination. The survey was conducted between 11/2018 and 02/2019.

Results

A total number of 102 questionnaires were analysed (filled-in by CCCs employed in 92 different hospitals). The dominant education of CCCs was: nursing, public health, and other medical studies. A CCC's activities can be divided into four categories, related to communication with patients, medical staff, and other providers, and different administrative activities. More than 43% of respondents indicated realization of additional tasks, not related to cancer care coordination. The majority of respondents indicated the existence of interpersonal and system-level barriers in the process of cancer care coordination (59% and 54% respectively).

Conclusions

There is a need to better define the role of CCCs in Poland and provide them with adequate support (trainings, administrative and management tools).

Key messages

Although CCCs in Poland actively participate in communication processes related to both diagnosis and treatment of cancer patients, their role is limited to the hospital care provision. Numerous, system-level challenges exist in the process of cancer care coordination which should be addressed by policy-makers.
The 8-item Morisky medication adherence scale: validation of a Portuguese version in HIV patients
Authors: Aguiar A , Piñeiro C , Serrão R , Duarte R
Published: October 2020

Background

Antiretroviral therapy (ART) has the most effective treatment for people with HIV, but its effectiveness depends on the individual medication adherence. Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used scales to assess patient adherence. Thus, we aimed to validate a Portuguese version of MMAS-8 and determine its psychometric properties in HIV positive patients.

Methods

A cross-sectional survey was conducted in Centro Hospitalar Universitário São João (Porto, northern Portugal) at the infectious diseases department. After authorization to use the scale - granted by the author - and, a standard forward-backwards procedure to translate MMAS-8 to Portuguese, the questionnaire was applied to 233 patients with HIV doing ART. Reliability was assessed using Cronbach's alpha and test-retest reliability. Three levels of adherence were considered: 0 to < 6 (low), 6 to < 8 (medium), 8 (high).

Results

In the studied sample, the mean age was 45.03 years (SD = 11.63), 80.3% men, 19.3% women and 1 transgender, and 53.8% had ≤9 years of education. The mean number of prescribed ART per patient was 1.76. The mean score for the medication adherence scale was 7.29 (SD = 6.74). For the reliability analysis, 12 patients were excluded due to missing data (n = 221). Regarding the level of adherence, 22.5% were low adhering, 71.6% medium and 5.9% high. Corrected item-total correlations showed that 1 item does not correlate very well with the overall scale and was dropped. Scale reliability analysis for the remaining 7 items revealed an overall Cronbach's alpha of 0.661. Women had a protective effect on adherence (OR = 0.31;95%CI:0.15-0.66). Number of years doing ART, age of participants, and type of residence didn't show to be correlated with adherence.

Conclusions

MMAS-8 is a reliable and valid measure to detect patients at risk of non-adherence. A satisfactory Cronbach's alfa (0.661) was obtained. In general, adherence to medication was medium or high.

Key messages

This scale can be applied nationwide in other different hospitals, as it could serve as a tool for measuring adherence to ART that can allow for better health care to the ones that are low adhering. A Portuguese version of the MMAS-8 was created for measuring adherence to ART that maintained a similar structure to the original MMAS-8 and good psychometric properties.
Use of general health care by people with substance use disorders in Belgium (2008-2017)
Authors: Van Baelen L , Devleesschauwer B , De Ridder K , Plettinckx E , Gremeaux L
Published: October 2020

Background

Substance use disorders (SUD) are associated with an increased use of general health care services (e.g. use of emergency departments (ED), visits to GP or use of inpatient services). However, little is known about the extent to which people with SUD are using these services compared to people without SUD.

Methods

Data from the national register of people who were in specialized treatment for SUD between 2011 and 2014 (N = 30,905) was linked to health insurance data. Four comparators were matched on sex, age and region to each subject in treatment for SUD (N = 123,620). For people with alcohol (AUD), opiate (OUD), cocaine (CoUD) and cannabis (CaUD) use disorders and their respective comparators we analyzed the contacts with GP, psychiatrist, ED and days in hospital between 2008 and 2017. Negative binomial regression was used to obtain incidence rate ratios (IRRs) in the four different settings both for all drugs combined and for each drug separately.

Preliminary results

People with SUD were significantly more likely to contact a GP (IRR 1.9 95%CI 1.9-2.0, p < 0.0001), a psychiatrist (IRR 7.4 95%CI 7.0-7.7, p < 0.0001), an ED (IRR 4.2 95%CI 4.2-4.3, p < 0.0001) or to be hospitalized (IRR 6.4 95%CI 6.3-6.5, p < 0.0001), compared to people who were not in specialized treatment for SUD. Differences were stable over time and always highest for people with AUD and lowest for people with CaUD, except for visits to the GP where the differences were highest for people with OUD (IRR 2.6 95%CI 2.5-2.7, p < 0.0001).

Conclusions

People with SUD have between 2 and 7 times more contacts with general health services than people without SUD. SUD is not a specialty health issue but affects all health service settings.

Key messages

People with SUD have a 2-7 times higher use of general health care services than people without SUD. All health professionals should have the competencies to support people with SUD adequately.
Sexual assault, sense of belonging, depression and suicidality among LGBQ college students
Authors: Backhaus I , Lipson S K. , Fisher L B. , Kawachi I , Pedrelli P
Published: October 2020

Background

There has been growing concern about the poor mental health of college student of gay, lesbian, bisexual, or questioning/queer (LGBQ) sexual orientation. Factors believed to negatively influence LGBQ student's health include discrimination and victimization such as sexual assault, whereas factors believed to positively influence mental health include cohesiveness and a sense of belonging. Little is known about how these might interact with each other. Therefore, the objective of this study was to compare the effect of sexual orientation, history of sexual assault and sense of belonging on depression and suicidality among LGBQ and heterosexual students.

Methods

This is a secondary data analysis using a subset of available data from the 2017-2018 Healthy Minds Study dataset. The dataset was encompassed of self-report data from about 60,200 college students across 60 campuses in the United States. Descriptive statistics and three-way interaction analysis using PROCESS macro models in SPSS were performed.

Results

Students identifying as LGBQ reported more frequently to have experienced sexual assault, to suffer from depressive symptoms and to have suicidal thoughts than heterosexual students. Significant three-way interaction effects were found for sexual orientation, sexual assault and sense of belonging predicting depressive symptoms (b= -.06, p= .042, CI: -.12; -.00), and suicidality (b= -.10, p= .004, CI: -.01; -.003). The effect of sexual assault on mental health differed depending on sexual orientation and sense of belonging. Particularly among LGBQ students, high sense of belonging was protective in the presence of sexual assault, and its absence had a deleterious effect on mental health.

Conclusions

There is a need to reduce mental health problems and sexual assault on college campuses and to foster a sense of belonging. Enhancing sense of belonging may represent a strategy to mitigate depression and suicidality, particularly among LGBQ students.

Key messages

Mental health problems such as depression and suicidal ideation among sexual minority students remain highly prevalent in the United States. Increasing sense of belonging may moderate symptoms such as depressiveness and suicidal ideation.
Tapping the perspective of employees with lower levels of education on sustainable employability
Authors: Houkes I , Hazelzet E , Mignon P , de Rijk A
Published: October 2020

Background

Sustainable employability (SE) is top priority. However, employers find it difficult to develop SE interventions. Measures based on the employee perspective of SE that would give direction to interventions, currently fall short, particularly for the understudied group of employees with lower levels of education (1/3 of the Dutch labor population). Earlier, the Maastricht Instrument for SE (MAISE-NL) was developed and validated in a sample of high-educated employees. This study aims to adjust and validate MAISE-NL for use among Lower Educated employees (MAISE-LE).

Methods

By means of focus groups consisting of employees with lower levels of education, items and response categories of MAISE have been aligned with the perceptions of these employees. Other items from subscales such as job control, self-efficacy and lifestyle were added. Language was checked for clarity and ambiguity. A questionnaire containing these items, as well as proxy variables (health and vitality) and demographics, was answered online by 944 lower educated employees from five organizations (response rates 44-64%). Construct validity, reliability and criterion validity were tested through PCA, CFA, Cronbach's alpha and correlations.

Results

MAISE-LE comprises 10 scales divided over four areas: (1) Level of SE; (2) Factors affecting my SE; (3) Overall responsibility for SE; and (4) Responsibility for factors affecting my SE. Preliminary results indicate that reliability, construct and criterion validity were adequate to good. Employees' SE was moderate to high, and was generally considered a shared responsibility of employee and employer. The latter varies per factor though. Employees wish to participate more in decisions regarding their work.

Conclusions

The MAISE-LE appeared to be reliable and valid. We recommend that employers use the MAISE-LE as a needs assessment in order to develop SE interventions that will be readily accepted and effective for employees with lower levels of education.

Key messages

MAISE-LE (Maastricht Instrument for Sustainable Employability) is a new instrument for measuring SE and the responsibility for SE from the perspective of employees with lower levels of education. The MAISE-LE will facilitate employers in the development of effective SE interventions, which align with the needs of this vulnerable group of employees.
Trajectories of sickness absence and disability pension in colorectal cancer: a Swedish cohort study
Authors: Chen L , Alexanderson K
Published: October 2020

Background

Working-aged colorectal cancer (CRC) patients have a much better survival nowadays, indicating the importance of their future work situation. We aimed to investigate trajectories of sickness absence and disability pension (SADP) days before and after CRC diagnosis and in references, and risk factors associated with different trajectories.

Methods

A longitudinal, population-based matched cohort study of 4735 CRC survivors in Sweden aged 19-62 when first diagnosed with CRC in 2008-2011, and 18,230 matched references was conducted, using microdata linked from several nationwide registers. The annual SADP net days for 2 years before through 5 years after diagnosis date were computed. A group-based trajectory model was used to depict SADP trajectories. Associations between trajectory membership, and sociodemographic and clinical variables were tested by chi2 test and multinomial logistic regression.

Results

Four trajectories of SADP days/year for CRC survivors were identified: “only increase around diagnosis” (52% of all, n = 2481), “slight increase after diagnosis” (27%), “high then decrease moderately after diagnosis” (13%), and “constantly very high” (8%). Educational level (R2=0.022), Charlson's Comorbidity Index (R2=0.029), and prediagnostic mental disorders (R2=0.066) were the strongest factors determining the SADP trajectory groups. In references, three trajectories (”constantly low” (80% of all), “constantly moderate and decrease gradually” (12%), and “very high then decrease overtime” (8%)) were identified.

Conclusions

Approximately 80% of CRC survivors return to a low level of SADP (0-60 days/year) at 5 years postdiagnosis. Prediagnostic status of mental disorders, somatic comorbidity, and low educational level are good indicators of future high SADP levels for CRC survivors.

Key messages

Most of working-age colorectal cancer survivors have low levels of sickness absence and disability pension days five years after their diagnosis. Trajectory analyses based on population-based register data can be used as a good approach in understanding future work situation regarding sick leave among working-age cancer survivors.