bluuebunny/crossref_metadata_2025 huggingface dataset:
Health coach online - health benefits on the citizens terms
Authors: Kuitunen M , Cavrak A
Published: November 2019

In Sweden, we know that half of the women and two thirds of the men have one or more unhealthy lifestyle habits. We also know that 90% of all diabetes type 2, 80% of all heart attacks and 30% of all cancer can be prevented, if one has a healthy lifestyle. Consultative conversations have been proved very helpful while changing ones habits. The lifestyle habits of Swedes are similar to those of other countries in Europe, and by making our research available and the concept known to other countries, the overall health in Europe can improve.

In August 2017 an online practice opened in a county in south west of Sweden, were we performed lifestyle interventions with people who applied and needed it. The practice specialized in eating habits, physical exercise, alcohol and tobacco use. We have 4-6 consultative meetings during 3 to 4 months, where we help our clients set realistic goals to reach, that work in their day to day life. While using coaching techniques and motivational interviewing, we have met over 200 people, and helped improve their lifestyle.

We have seen that in regarding to self-assessed health (1-10), our clients score is higher after both completed health coaching and a year after completed coaching than at start. Calculating QALY, we can see that the impact the coach makes on our clients is cost effective and one person being coached saves the amount in hospital costs that we can use to coach 30 more.

We have learned that online meetings are more cost effective and practical for this type of concept. Our clients feel more relaxed and open to the process at a location of their choosing and it saves time for them, time they might not have taken otherwise - therefore, we can help more people. Meetings online enables us to reach all over the Västra Götaland region, and not only the close proximity where the coaches are located.

Key messages

Online health coaching supports our health care and helps the citizens to improve their lifestyle habits and their overall health. The online method is cost effective and it saves money for both health care and society.
Contexts between mental health of fledged people and compassion competence in the care
Authors: Steiner S
Published: November 2019

The aim of this doctoral thesis is to investigate the extent to which the competence compassion has a positive influence on the mental health of refugees. The research question was raised in a first step by means of a questionnaire by Mohr & Müller, ‘Depression tendencies in the non-clinical context’. Eighty asylum seekers were questioned in a total of seventeen lodgings. In addition, a survey was conducted with employees and volunteers in refugee care. This survey included 102 people who were assessed using the standardized BOSS1 Burnout Screening Scale. With the help of the Santa Clara Briefing Scale, the differences in the population between people who are not volunteering and those who volunteer in refugee care are being investigated through an online survey. There were 818 people attending. The evaluation of the data showed that the competency compassion lowers the depressive tendencies among the refugees and they have a more positive sense of integration and hope for a better life. The competency of compassion reduces burnout factors and people who have committed themselves voluntarily have significantly higher values in compassion competency. Thus compassion can be confirmed as a valuable competence in refugee care, not only among the refugees, but also among employees and volunteers.

Key messages

The present study has shown that empathy skills reduce depressive tendencies in people who have escaped. Associations of compassion and low burnout factors confirmed by the study showed that persons with high compassion skills have low burnout scores.
An automatic platform to monitor Web 2.0 presence of Healthcare Providers in Italy
Authors: D’ambrosio A , Barbara A , Kakaa O , Falvo R , Parente P , Gualano M R , Silenzi A , Siliquini R
Published: November 2019

Background

Healthcare providers (HP) need to involve the population to spread correct and useful health information and to gather feedback on the perceived quality of the service. Web 2.0, based on the use of Social Networks (SN), allows direct communication between the HP and the population. We built an automatic platform which monitors Web 2.0 usage by Italian public and private HP.

Methods

For each HP the platform finds the relative website using Google searches and extracts the links to SN. For Facebook and Twitter, it retrieves one year of content and identifies common topics via natural language processing. Finally, it compares the Web 2.0 usage patterns and topics with the type of HP and geographical position.

Results

In 2017, on 540 HP screened 97.8% had a website (309 unique sites, many HP have a common site). 37.5% of the websites had links to SN in the homepage: Youtube (YT) was the most common (74.1%), then Facebook (FB, 72.4%) and Twitter (TW, 51.7%). The presence of SN was lower in the south (OR: 0.63; p < 0.001) while is higher for research centers (OR: 5.12; p < 0.001) and private hospitals (OR: 2.12; p = 0.004). Local Health Trusts were the most active on FB (1.86 more posts, p = 0.004) but research centers had more fans RR: 5.32; p = 0.003) and likes per post (RR: 4.95; p < 0.001). On TW private hospitals had the most followers (RR: 3.35; p = 0.002) and likes per tweet (RR: 3.95; p < 0.001). The most posted topics were on healthy behaviors and organizational changes, while a lower number of posts were on healthy food and vaccines. Posts on specific pathologies information and healthy behaviors received more likes.

Conclusions

We propose an automatic platform that monitors the internet presence of HP in Italy, helping to define the best strategies for effective health communication. We found that in the south and in the public sector the importance of this tool is less perceived, with a lower SN presence and a gap between posted topics and those appreciated by the public.

Key messages

We propose an automatic platform that reports and monitors the web 2.0 presence and usage by HP in Italy, helping to define the best strategies to spread effective health communication. In Italy the presence of SN among HP is lower in the south and in the public, while is higher for research centers. HP have to engage the population maximizing the potentiality of web 2.0.
Short-term and long-term effectiveness of an e-coaching application; the INHERIT project
Authors: Spelt H , Karnaki P , Tsiampalis T , Kouvari M , Petralias A , Zota D , Westerink J , Linos A
Published: November 2019

Background

Lifestyle e-coaching applications have the potential to be successful in changing people’s lifestyles although it is unclear whether such support would indeed help people with lower socioeconomic status (SES). The aim of the present study, conducted within the INHERIT EU project, was to investigate the effectiveness of a lifestyle e-coaching application in increasing physical activity (PA) in lower SES groups and whether such an increase is sustained after its prolonged use.

Methods

A two-site (Greece: N = 105, Netherlands: N = 89), two arm [Greece: 50 (experimental) and 55 (control), Netherlands: 45 (experimental) and 44 (control)], parallel group, randomized controlled trial proceeded in three phases over 19 weeks, comparing PA (as measured by the IPAQ questionnaire) of participants using a lifestyle e-coaching application with participants not using any such application. Inclusion criteria involved participants to be in low SES, have an age of 18-65 years and an estimated level of physical activity of less than 210 minutes/week, while they needed to possess a smartphone, willing to install the application and being fluent in Dutch or Greek.

Results

Results showed that the use of the app significantly improved participants’ PA in both countries, at 6 (Greece: p = 0.015, Netherlands: p = 0.003) and 19 weeks (Greece: p = 0.002, Netherlands: p < 0.001), while the effect was even higher for low physically active participants as measured at baseline, after both time periods. Compared to the control group, after adjusting for several characteristics, the experimental group achieved a better improvement of PA at 19 weeks compared to baseline (p = 0.006) and week 6 (p = 0.007).

Conclusions

Positive effects on participants’ PA after 19 weeks were observed, with the findings suggesting that the longer the application is used, the greater the improvement of PA, while the effect was more obvious among those following a sedentary lifestyle as measured at baseline.

Key messages

E-coaching applications could be useful in promoting physical activity among people from low SES. E-coaching applications are cost effective and environmentally friendly methods of promoting physical activity. Uptake by national health systems should be examined further.
Adverse pregnancy outcomes and long-term risk of maternal renal disease: a systematic review
Authors: Barrett P , McCarthy F P , Kublickiene K , Cormican S , Judge C , Evans M , Kublickas M , Perry I J , Stenvinkel P , Khashan A S
Published: November 2019

Background

Little is known about the long-term risk of renal disease following adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM) or preterm delivery. We aimed to investigate associations between adverse pregnancy outcomes and maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD), by synthesising results of relevant studies.

Methods

A systematic search of PubMed, EMBASE and Web of Science was done up to July 2018. Case-control and cohort studies were eligible for inclusion if they provided original effect estimates for associations between adverse pregnancy outcomes (HDP, GDM, preterm) and maternal renal disease (primary outcomes: CKD, ESKD; secondary outcomes: renal hospitalisation, renal mortality). Two independent reviewers extracted data and assessed risk of bias. Random effects meta-analyses were conducted to determine pooled adjusted odds ratio (AOR) and 95% confidence interval (95%CI) for each association.

Results

Of 5,120 studies retrieved, 21 studies met inclusion criteria (4,483,847 participants). HDP was associated with increased odds of ESKD (AOR 6.58, 95%CI 4.06-10.65), CKD (AOR 2.08, 95%CI 1.06-4.10), renal hospitalisation (AOR 2.29, 95%CI 1.42-3.71). The magnitude of association was dependent on HDP subtype: AOR for preeclampsia and ESKD was 4.87 (95%CI 3.01-7.87); gestational hypertension and ESKD was 3.65 (95%CI 2.34-5.67); other HDP (including chronic hypertension) and ESKD was 14.67 (95%CI 3.21-66.97). Preterm delivery was associated with increased odds of ESKD (AOR 2.16, 95%CI 1.64-2.85). GDM was associated with increased odds of CKD among black women (AOR 1.78, 95%CI 1.18-2.70), but not Caucasian women (AOR 0.81, 95%CI 0.58-1.13)

Conclusions

Women who experience adverse pregnancy outcomes have increased odds of renal disease, especially after HDP. Risk stratification and preventive interventions may be needed to reduce the risk of clinically significant renal disease in mothers.

Key messages

This is the first study to summarise the long-term risk of renal disease among women who experience a range of adverse pregnancy outcomes. Women who experience hypertensive disorders in pregnancy, preterm delivery, or gestational diabetes are at increased odds of renal disease.
Peer support for socially vulnerable citizens with diabetes: Bridging the gap to the health system
Authors: Christensen U , Garn SD , Glumer C
Published: November 2019

Problem

Despite free universal healthcare, Copenhagen is challenged by inequality in the prevalence and implications of type 2-diabetes (T2D). To address the problem, the Municipality of Copenhagen has initiated a city action plan including a peer support program for socially vulnerable citizens with T2D. Such programs have shown to be an essential supplement to the established health system to reach groups, who have limited contact with the health system. However, research on the implementation of the programs is generally limited.

Description of the problem

This 6-months peer support program is based on an initial analysis, showing social vulnerability to be associated with co-morbidity, low level of education, unemployment, living in a disadvantaged district and living alone. The peers are matched with a volunteer peer supporter with T2D, who helps out every 14. day with social-, practical- or bridging activities to health services or the municipality.

We aim to evaluate the implementation with focus on contextual factors. We conduct in-depth qualitative interviews with peers (N = 12), peer supporters (N = 12), and relevant stakeholders (N = 6). Further, surveys with the peers and peer supporters (N = 45).

Results

Our preliminary results indicate how the peer supporters can bridge the gap between socially vulnerable citizens with T2D and the health system. However, contextual factors regarding the recruitment of peers have challenged the implementation process as the municipality has difficulty reaching them.

Lessons

To ensure a successful implementation, it is important to prioritize resources to ensure good collaboration with local stakeholders, who can be gatekeepers in the recruitment and get in contact with this group of citizens.

Key messages

The program has potential to bridge the gap between socially vulnerable citizens and the health system. The group is hard to reach without collaboration with local stakeholders.
Trends by gender and predictors of diabetes-related amputations: an Italian regional analysis
Authors: Scampoli P , Di Giovanni P , Meo F , Cedrone F , Di Martino G , Staniscia T
Published: November 2019

Background

Lower extremity amputations (LEAs) are common among people with diabetes, resulting in high disability and mortality. Understanding trends in diabetes-related LEAs is important for assessing the quality of care. Aim of this study was to evaluate predictors and time trends in LEAs in a region of Southern Italy, focusing on gender difference.

Methods

Hospital discharge records were used to identify all diabetic adult patients hospitalized for LEAs between 2006 and 2015. For each year, gender- and age-adjusted standardized hospitalization rates for major and minor amputations were calculated and time trends were analyzed by gender. Predictors of LEAs were estimated by a multivariable regression model.

Results

In the study period, 579 major and 1345 minor amputations were performed in Abruzzo. Gender- and age-adjusted standardized admission rates decreased for minor amputations among both males (-29.96%) and females (-5.33%), whereas major amputations rates decreased only for males (-44.73%). Males were at higher risk of undergoing major (Rate Ratio [RR] 1.41, 95%CI 1.19-1.67) and minor (RR 1.62, 95%CI 1.45-1.82) amputations, but the male-to-female rate ratio decreased for major and minor amputations. Peripheral vascular disease was the main predictor of major (adjOR 4.09, 95%CI 3.31-5.06) and minor amputations (adjOR 12.90, 95%CI 11.00-15.12). Age over 85 (adjOR 9.07, 95%CI 1.84-44.71) and more than 3 comorbidities (adjOR 2.51, 95%CI 1.75-3.60) were parameters associated only with major amputations.

Conclusions

Reducing the number of LEAs represents a healthcare priority. This study emphasizes the existence of gender disparities in LEAs, highlighting a significant reduction of LEAs for males and a lack of improvement for females. Thus, it is worthwhile to investigate potential clinical, behavioral and healthcare-related causes of this difference, in order to plan health system changes aimed at improving care and facilitating access to health care for women.

Key messages

Time trends in LEAs showed a substantial improvement only for males, highlighting the existence of gender difference. Understanding the underlying causes is essential to improve the quality of care.
Trends in diabetes prevalence, awareness, treatment, control in Yangon, Myanmar between 2004-2014
Authors: Aung W P , Bjertness E , Stigum H , Htet A S , Kjøllesdal M K
Published: November 2019

Background

In 2004, a survey in Yangon Region was conducted as the first STEP survey in Myanmar, which was repeated in 2014, assessing diabetes prevalence. Whether there have been any changes over time in the awareness, treatment and control status of diabetes is not known. The study aimed to assess changes in the prevalence, awareness, treatment and control of diabetes from 2004 to 2014, among adults in Yangon region.

Methods

The study was conducted in urban and rural areas of Yangon region, Myanmar, using two cross-sectional household based studies, in accordance with World Health Organization STEPS methodology. Men and women aged 25-74 years old participated in the studies (n = 4448 in 2004) and (n = 1372 in 2014). Logistic and linear regression were performed and outcome variables were diabetes and fasting plasma glucose.

Results

The overall age-standardized prevalence of diabetes were 8.3% (95% CI 6.5-10.6) in 2004 and 10.2% (7.6-13.6) in 2014 (p = 0.296). The diabetes prevalence increased from 2004 to 2014 only among participants aged ≥60 years, from 14.6% (11.7-18.1) to 31.9% (21.1-45.0) (p = 0.009). Awareness of having diabetes increased between 2004 and 2014 (44.3% (39.2, 49.6) to 69.4% (62.9-75.2)) (p < 0.001). Among participants who were aware of having diabetes, the proportion under treatment had increased between 2004 and 2014 from 55.1% (46.8-63.1) to 68.6% (61.5-74.8) (p = 0.015). There were no increase between 2004 and 2014 in the proportion of participants with controlled diabetes. After adjustments for age, sex and education, mean fasting plasma glucose levels in 2014 was 0.56 mmol/l (0.26-0.84) higher than in 2004.

Conclusions

The studies to monitor the development of diabetes prevalence in Myanmar are needed. Preventive measures to halt increases prevalence, to increase the detection rate of undiagnosed DM also treatment rate and to help people with diabetes to control their situation are needed.

Key messages

Mean plasma glucose levels were higher in 2014 than in 2004, but an increase in DM prevalence during this period was seen only among the oldest participants. The proportion of women being aware of having DM, as well as the proportion under treatment for most groups, had increased, however not the proportion under control.
Understanding quality of care and analyzing different strategies to assure and improve it
Authors: Busse R , Panteli D , Quentin W
Published: November 2019

Assessing and improving quality of care presupposes an understanding of what it does and does not entail. Different definitions often specify relatively long lists of various attributes that they recognize as part of quality. Effectiveness, patient safety, and responsiveness/patient-centeredness seem to have become universally accepted as core dimensions of quality of care. The inclusion of a list of additional elements is confusing and often blurs the line between quality of care and overall health system performance. This presentation provides an in-depth look at this interplay, recognizing that the definition of quality changes depending on the level at which it is assessed. At the level of health services, there seems to be an emerging consensus that quality of care is the degree to which health services for individuals and populations are effective, safe, and people-centered. On the other hand, a health care system as a whole is of high quality when it achieves the overall goals of improved health, responsiveness, financial protection, and efficiency; here, there seems to be an international trend towards using the term health system performance.

The workshop looks at different strategies to assure or improve the quality of health care. To understand, analyze, compare and ultimately prioritize or align different quality strategies, this presentation will introduce a comprehensive framework, which includes the following lenses: i) the three core dimensions of quality: safety, effectiveness, and patient-centeredness; ii) the four functions of health care: primary prevention, acute care, chronic care, and palliative care; iii) the three main activities of quality strategies: setting standards, monitoring, and assuring improvements; iv) Donabedian’s triad: structures, processes, and outcomes; v) the five main targets of quality strategies: health professionals, technologies, provider organizations, patients, and payers.
External institutional strategies for health care organizations as a quality strategy
Authors: Berger E , Groene O , Shaw C
Published: November 2019

Accreditation, certification and supervision are quality strategies that intend to encourage the compliance of health care organizations with published standards through external assessment. The idea is that health care organizations will increase compliance with standards in advance of a planned external inspection. Despite several common characteristics of the three strategies, their origins and initial objectives differ. This presentation aims to disambiguate these concepts, inform on their utilization in European countries and discuss the evidence on their effectiveness, cost-effectiveness and implementation.

External assessment strategies have been widely implemented in Europe. Most countries make use of several strategies, including basic supervision as part of the licensing process for healthcare providers, coupled with certification or accreditation strategies to ensure and improve the quality of care. The scope of these strategies and their regulation differs substantially between countries. Despite this widespread uptake, there is little robust evidence to support their effectiveness and there is a complete absence of evidence on cost-effectiveness. Furthermore, due to the broad purpose range of external assessments and the lack of consensus in the use of terminology, implementation strategies are sparse or missing. However, this presentation highlights several facilitators and barriers that may affect the implementation of external assessment strategies in health care organizations as well as relevant insights for policy-makers.
Determinants of the intention to vaccinate with MMR among pregnant women from the City of Rome
Authors: Rosso A , Massimi A , Baccolini V , Pitini E , Marzuillo C , Vito C De , Villari P
Published: November 2019

Background

Further to the increase in measles cases reported in Italy since 2016, MMR vaccination became mandatory in 2017, leading to an increase in vaccination coverage in the Country. To guarantee sustained coverage, factors influencing the intention to vaccinate in the population should be better understood.

Methods

We conducted a cross-sectional survey to assess knowledge and attitudes on pediatric vaccinations and intention to vaccinate among pregnant women attending Antenatal Classes in Rome, through distribution of a self-administered questionnaire, which included a specific section on MMR vaccination. Multiple logistic regression analysis was performed to analyze the determinants of the intention to vaccinate with MMR.

Results

A total of 458 pregnant women attending CANs in 36 family health centers and two hospitals answered the survey. Intention to vaccinate with MMR was associated with having received information from a healthcare professional (OR 1.92, 95%CI 1.01-3.63), the perceived importance of vaccines to protect against measles (OR 4.68, 95%CI 2.48- 9.54) and rubella (OR 5.97, 95%CI 2.98-11.95), not believing in news about the risks of MMR vaccine (OR 2.75, 95%CI 1.38-5.50), and the sense of guilt in case the child should contract the disease (OR 2.56, 95%CI 1.16-5.62). Factors negatively associated with the intention to vaccinate were the use of alternative medicine (OR 0.34, 95%CI 0.16- 0.76), believing that MMR vaccine can have serious side effects (OR 0.37, 95%CI 0.00-0.29) and guilt in case of serious side effects (OR 0.40, 95%CI 0.21-0.76).

Conclusions

Fear of MMR side effects is a relevant driver of the intention to vaccinate, coupled with the perceived importance to vaccinate to protect against measles and rubella. Also the source of information plays an important role in shaping ideas on vaccines. Information and communication strategies should be promoted to increase trust in vaccines, with a direct involvement of healthcare workers.

Key messages

Fear of MMR side effects and perceived benefits of the vaccine influence the intention to vaccinate. Information and communication strategies to increase vaccination appectance involving healthcare workers are needed.
HCV test&treat in Milan prisons-an effective strategy for microelimination and health gaps reduction
Authors: Casigliani V , Giuliani R , Sebastiani T , Arzilli G , Scardina G , Tavoschi L , Ranieri R
Published: November 2019

Background

People in prison represent a high-risk population for HCV infection control due the overrepresentation of people with a history of intravenous drug use, psychiatric patients and other vulnerable populations who have often reduced access to healthcare. With the advent of new direct antiviral agents (DAAs) HCV micro-elimination in prison setting became a feasible strategy.

Methods

We conducted in 2017 and 2018 a cross-sectional evaluation of HCV treatment cascade in one detention prison, Opera (OP), and one pre-trial detention center, San Vittore (SV) in Milan. A dedicated protocol for HCV eligibility and care was applied. We collected data on demographics, HCV testing and treatment on all inmates on October 31st 2017 and 2018. Data collection ended on December 31st of each year.

Results

On October 31st 2017, 2366 inmates were living in the two facilities, 2369 in 2018, of these, 1036 (43,7%) were already present in 2017 (71,3% in OP; 28,7% in SV). In both years the majority were men (95.4%; 96,4%) with a median age of 41 years and Italians (57%; 61,9%). Prevalence of reported drug use remained high (46,5%; 44,2%). HCV screening coverage was 89% in both years, while HCV-RNA test coverage increased (90,6%; 99%). HCV Ab+ was stable (212, 10.1%; 194, 9,2%). At the end of 2017 and 2018, 106 (50%) and 117 (60,3%) started treatment eligibility process of which 90 (42,4%) and 106 (54,6%) completed DAAs in prison. Considering last available viremia, 41 inmates (19,3%) were viremic in 2017 (OP 16.1%; SV 24,4%), while only 13 inmates (6,7%) in 2018 (OP < 1%, SV 15,4%). On December 31st 2018, among HCV Ab+ detainees 122 (62,9%) were never linked to care before incarceration.

Conclusions

Our study shows the success of the HCV testing and treatment strategy to achieve HCV micro-elimination in a prison setting with a significant drop in the pool of viremic individuals. We highlight how prison health care may represent a unique point of access for vulnerable population.

Key messages

HCV micro-elimination is a feasible and effective strategy in prison settings. High-quality healthcare in prison contributes to reduce health gaps and improve access for socially deprived population.
Healthy behaviours and risk of all-cause mortality
Authors: Lahti J , Mauramo E , Lahelma E , Lallukka T , Pietiläinen O , Salmela J , Salonsalmi A , Rahkonen O
Published: November 2019

Introduction

Healthy behaviours are associated with better health in general but less is known about the combined associations of multiple healthy behaviours with mortality risk. We aimed to examine the associations of combined healthy behaviours with mortality risk over a 15-year follow-up among middle-aged employees.

Methods

Survey data, collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, was linked with complete register data on mortality from Statistics Finland (response rate 67%, written informed consent for register linkages 74%). Healthy behaviours included high leisure-time physical activity, non-smoking, no binge drinking and healthy food habits. Each healthy behaviour were dichotomized and assigned a value of one for healthy and zero for unhealthy. The number of healthy behaviours were summed together (score range 0-4). Cox regression models were fitted, and the follow-up continued until the end of 2015 (n = 6336). Confounders included age, sex, marital status, socioeconomic position and self-rated health.

Results

Of the respondents, 7% reported four healthy behaviours, 27% three, 34% two, 22% one and 9% no healthy behaviours. A total of 281 deaths occurred during the follow-up. Each healthy behaviour was individually associated with a reduced mortality risk, non-smoking having the strongest and healthy diet the weakest association. The combined association showed that those without any of the healthy behaviours (HR 2.8, 95% CI 1.51-5.29) and those with only one healthy behaviour (HR 1.89, 95% CI 1.04-3.43) had a higher mortality risk than those with four healthy behaviours. Instead, those with at least two healthy behaviours were not at an increased risk of mortality.

Conclusions

A low number of healthy behaviours predicted mortality among middle-aged employees. Efforts should be made to promote multiple healthy behaviours among the middle-aged to enhance health and prevent premature mortality.

Key messages

Almost one third of the respondents had no or only one healthy behaviour. A low number of healthy behaviours was associated with an increased risk of mortality.
Electronic cigarette use and smoking reduction – longitudinal data from CONSTANCES cohort study
Authors: Gomajee R , El-Khoury F , Goldberg M , Zins M , Lemogne C , Wiernik E , Lequy-Flahault E , Romanello L , Kousignian I , Melchior M
Published: November 2019

Aims

Electronic cigarettes are often used by smokers to stop smoking and former smokers to prevent relapse. We examined whether electronic cigarette use lead to smoking reduction and cessation among smokers, and relapse among former smokers.

Design and Settings

The CONSTANCES cohort, France (2012 - ongoing).

Measurements

Among smokers (N = 5,400, average follow-up of 23.4 months), mixed regression models were used to examine whether electronic cigarette use was linked to a decrease in the number of cigarettes smoked per day and Poisson regression models with sandwich variance estimators were used to test smoking cessation. In parallel, Cox proportional hazards regression models were used to examine the relationship between electronic cigarettes use and smoking relapse among former smokers who stopped smoking since 2010 (N = 2,025, average follow-up of 22.1 months), year in which electronic cigarettes were introduced in France. All statistical analyses were adjusted for socio-demographic characteristics, duration of follow-up, and smoking characteristics.

Findings

There was a significantly higher decrease in the number of cigarettes smoked/day among smokers who used electronic cigarettes (decrease of 4.4 cigarettes/day) compared to those who did not (decrease of 2.7 cigarettes/day), as well as a higher relative risk of smoking cessation (adjusted RR: 1.67 [95% CI: 1.51-1.84]). At the same time, among former smokers, EC use was associated with an increase in the rate of smoking relapse (adjusted HR = 1.70 [95% CI: 1.25-2.30]).

Conclusions

After a follow-up of approximately 2 years, electronic cigarettes use among smokers was associated to a decrease in smoking level and an increase in smoking cessation attempts but among former smokers it was associated to a higher risk of smoking relapse.

Key messages

Among smokers, electronic cigarette use was associated to smoking reduction and smoking cessation. Among former smokers who quit smoking since 2010, electronic cigarette use was associated to a higher likelihood of relapse.
An innovative rehabilitating meals-on-wheels service for frail old people
Authors: Due A , Justesen L , Beck A
Published: November 2019

Background

Preparing meals are part of ordinary activities of daily living. However, frail old people receiving meals-on-wheels (MOW) may lose their functional abilities in relation to such preparation. No studies have investigated, whether it is possible for frail old people, receiving MOW to learn or relearn to manage own meals. The aim of this intervention is to investigate if a rehabilitating MOW service including an innovative food basket could have a positive effect on functional abilities in relation to the preparation of meals and thereby improve health-related quality of life in frail old people.

Methods

An 8-week randomized controlled trial. 76 old people (65+ years old) who receive MOW are randomized to either a control group receiving usual MOW service or an intervention group additionally receiving one of four different food baskets consisting of four different food ingredients and recipes with graduation in degree of complexity delivered twice a week. The recipes is chosen in accordance with level of function, assessed by means of AMPS and the old adult practice cooking skills under supervision of an experienced occupational therapist. Primary outcome is health-related quality of life measured by EuroQol-5D-5L, secondary outcomes are physical function (30 seconds chair-stand), Satisfaction with food-related quality of life questionnaire, Food related functional ability questionnaire, Meal quality questionnaire, dietary intake and body weight.

Results

The intervention is ongoing and planned to end July 2019. Data will undergo statistical analyses and presented in November 2019.

Conclusions

The study will contribute with new knowledge about whether a rehabilitating MOW service including an innovative food basket could have a positive effect on functional abilities in relation to the preparation of meals and thereby improve health-related quality of life in frail old people.
More variable food and nutrition services for young old
Authors: Mertanen E
Published: November 2019

Aging population means more costs on health services by frailty, illnesses and malnutrition. Good nutrition and suitable food services can prevent life quality loss and costly consequences. The young old, retired and home living, not receiving municipal services yet, could benefit minor nutritional support and new services helping them keep functionality. However, few services are targeting the young old. Providing new food or nutrition services for people still in good condition might prevent costly care later. The aim is to identify new service ideas and designs for the young old. The project started as part of Agefood-project (Valve et al 2018) and continued with students in 2019.

Methods

The service ideas and designs were produced in three future workshops, in Jyväskylä (n = 38, food service professionals, service developers, nutritionists), Mikkeli (n = 15, food service and home care professionals, elderly) and Lahti (n = 11, elderly and nutritionist) in 2018. In the next phase, service designs were further developed by students. The service ideas and designs are categorized and analyzed qualitatively.

Results

Together 443 new service ideas were produced, and 56 preliminary service designs. The student group produced 77 service designs. The categories of ideas are: choosing possibilities, developing meal quality, guiding and education, technological possibilities, eating together, support, and old services. The service designs were classified the following groups: home delivered food, service supports eating at home, technological solutions, eating together.

Discussion

Many ideas and designs need co-operation with public health people and business. The service ideas and designs need further development, but some are very promising, like personal nutrition trainer, e-learning for elderly care personnel. Better and more variable food and nutrition services can help people live at home longer. The ideas and service designs mirror the public discussion on the time.
Greening the European Public Health conferences – The Green Club
Authors: Mamo J
Published: November 2019

EUPHA members prepared a discussion paper on EUPHA’s “health and environment awareness” in 2015, presented it to the EUPHA section council, and conducted a workshop at the European Public Health (EPH) conference in Vienna 2016. Following this initiative, the Association determined that greening the conferences is one of the objectives for the EPH Conference strategy for 2017-2020. A “Green club” was set up by the Executive director in 2017.

For reducing the environmental impact of the conference, the following were some of the early objectives and actions (2016): Catering - Coffee and tea served in recycled cups; most lunch ingredients from regional and organic origin. Reduced printing - Switching to E-Posters, digital marketing and email communication. Paperless communication - Abstract submission, registration and invoicing became fully web-based; the Conference Programme and abstracts could henceforth be accessed online. The Conference Bag was made of recycled materials.

With the EPH conferences in Stockholm 2017 and Ljubljana 2018, advised by the Green Club, the following initiatives were taken: Lunches and Conference Dinner no longer served beef; vegan and vegetarian menus were introduced. Reduced printing - By 2018, the option to have a hard copy of the list of delegates was no longer offered. The conference Foundation encouraged its suppliers to limit the environmental impact of their products and services. In Stockholm, all restaurants at the venue were licensed to use the Nordic Ecolabel. All delegates and participants were encouraged to travel CO2 neutral.

For Ljubljana in 2018, the Green club consulted the WHO Europe publication “Planning Healthy and Sustainable Meetings” and considered initiatives that participants could do for compensating their environmental impact. For the 2019 conference, discussions are intended to involve a wider conference participation.
Strengthening public health research capacity to inform evidence-based policies in Tunisia / CONFIDE
Authors: Bozdog M E , Coman M A , Oltean O , Chereches R M
Published: November 2019

Introduction

Over the past 15 years, Tunisia has experienced considerable development in the political and economic areas. In this context, important reforms in the field of public health have been made, with the Tunisian universities (University of Sfax, University of Tunis el Manar, University of Sousse) on their way to educate the public health professionals who can contribute to the modernization of the health system. Funded by the EC through Erasmus+ programme, the CONFIDE project (coordinated by Babes-Bolyai University, having European partners the Southern Denmark University and Trnava University) has 3 major objectives: develop Centres for Evidence into Health Policy (C4EHPs) designed to ease future collaborations; strengthen institutional capacity to deliver state-of-the-art research into policy training program; consolidate national and local partnerships between the public health academic and non-academic sector.

The progress

The partners have jointly contributed to the following activities: development of the Centre for Evidence into Public Health Policy, 3 train-the-trainer sessions, 9 train-the-trainees sessions, internships for trainees, one policy game. To this date, 18 trainers have been trained by European partner universities and they trained 29 Tunisian trainees in the field of public health research, health promotion and evidence-based public health policy. The trainees will participate in internships in local and regional health institutions, to practice what they have learned. A policy game will be organized, to simulate collaboration between researchers and policy makers, for public health policy elaboration.

Conclusions

The Research into Policy training program has been implemented in all 3 Tunisian partner universities. The expected long-term changes are: young workforce trained into public health and evidence-based policies fields; university curricula modifications by introducing public health courses and developing of Masters of Public Health.
Centres for Evidence-base Public Health in Tunisia- development, tasks and opportunities
Authors: Fatma C , Mokni A , Ayadi A , Ghorbel F , Bouthelja N , Mseddi A , Elleuch E , Trabelsi J , Mustapha A
Published: November 2019

Introduction

As a part of the CONFIDE project, 3 Centres for Evidence into Health Policy (C4EHPs) were established in the Universities of Sfax (Head Office), of Tunis El Manar and of Sousse in Tunisia. The tasks of the C4EHPs include development of training programs, establishment of a national network of public institutions and NGOs, which will offer internship placements for the centres’ trainees as well as enhance public health development in Tunisia in general.

The progress

The 3 Centres were established, each with the necessary infrastructures of specially designated rooms equipped with computers, books, etc. A communication platform was launched and is regularly updated. Partnership agreements with NGOs and private institutions have been signed. The C4EHPs have supported three Train-the-Trainer modules for 18 Tunisian trainers ran by the 3 European CONFIDE partners, autumn 2018. The centres have each further trained 29 Trainees under the supervision of the European partners, spring 2019.

Conclusions

The 3 C4EHPs will act as an open source for all trainees interested in enhancing their practical work experience, networking between academic and non-academic environment and facilitating the implementation of the trainee internships. They will also market the CONFIDE products in Tunisia with the aim to sustain the public health development also after CONFIDE. In addition, the centres will search for further international funding for both training and collaborative research, according to the research domain of each faculty. The C4EHP of Sfax will be specialized in the areas of addiction, obesity, emerging infectious diseases and the quality of public health management in rural areas. The challenges of this work include lack of infrastructure and economic resources in Tunisia, lack of multi-level and cross-sectorial collaboration in public health as well as lack of stakeholder collaboration with NGOs and other non-governmental actors in public health.
Workshop: Best practice portals for public health policies and interventions
Authors:   Organised by: Federal Centre for Health Education, Germany, National Institute of Public Health, Netherlands, EuroHealthNet
Published: November 2019

Background

To support policy and practice with evidence-based information, several countries have best practice portals for public health interventions. Some of the portals were started recently (France) and other portals exist already for several years now (Netherlands). All the countries face the same challenges, which relate to how to identify the relevant practices, the assessment of the practices (how to achieve an inclusive portal while maintaining high quality), and the implementation and the use of the practices by professionals and policymakers (integrity vs. adaptation of the best practices). In addition to best practice portals the organisations are also working on the development of What works approaches.

Objective

The organisers will share their experiences with the development and implementation of best practice portals, and discuss the successes and challenges with the workshop participants.

Three countries (the Netherlands, France and Germany) will present the successes and challenges of their best practice portal, and, as an example of a joint European approach, EuroHealthNet will discuss both joint and independent approaches from a European perspective. At the end of the workshop we will discuss the challenges and invite other countries to share their experiences and successes with best practice portals and providing evidence for policy and practice.

With the objective to: Present the procedure and the assessment criteria of evaluating practices for inclusion in the portalsPresent the implementation and the use of best practices as well as the acceptance of the portalsDiscuss the issues of integrity and adaptation and how to assess the core elements of effective interventionsDiscuss the development of what works approaches (description of evidence in a short and accessible way) and their added value to best practice portalsDiscuss the value added of best practice portals, including promotion of their use by professionals and policymakers

Key messages

This workshop will give participants insight into best practice portals developed across Europe. It will discuss how countries identify and select good practice and evidence-based preventive interventions as well as the successes and challenges of such portals.
Development and use of best practice portals: a European perspective
Authors: Maassen A , Maassen A
Published: November 2019

Across Europe, a number of best practice portals are in different stages of planning, implementation, and evaluation. At the European level, joint best practice initiatives are also underway, notably the Best Practice Portal of the Steering Group on Health Promotion and Disease Prevention managed by the European Commission’s Directorate General of Health and Food Safety (DG SANTE), as well as topic-specific portals such as the Xchange portal managed by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and best practice databases from European projects (such as INHERIT on health and sustainability) or Joint Actions (CHRODIS). This presentation will look at how joint European initiatives such as these can successfully link with initiatives at the national level, as well as how they can support the achievement of international objectives such as the United Nations’ Sustainable Development Goals (SDGs).

This presentation will also provide an overview of learnings and key takeaways from the Developing Health Promotion and Disease Prevention Best Practice Portals workshop, hosted by BZgA and EuroHealthNet in Cologne, Germany in June 2019. We will present further collaboration and learning conducted by participants subsequent to the June workshop.

Finally, the presentation will kick off the debate following the presentations on the value added of best practice portals and how to promote awareness, engagement, and uptake by professionals and policymakers - both of specific best practices and the portals themselves. This exercise will draw on examples from countries across Europe, as well as from European projects such as CHRODIS+, and look at ways to evaluate the success of portals, as well as practical concerns such as transferability, ownership and scalability.
The changing context of public health in Europe
Authors: McKee M
Published: November 2019

From a public health perspective there is much to celebrate. Europe enters the third decade of the 21st century with a population that has never been healthier. Advances in knowledge, from basic sciences to public health, have transformed our ability to tackle the diseases that afflict our populations. It would be easy to become complacent. Yet, at the same time, our world is transforming rapidly and profoundly. Changing demographics, globalization, technological developments, climate change, shifting public opinions on the value of scientific evidence, a political arena that increasingly seems to focus on highlighting differences rather than looking for common ground: all these trends result in massive and complex societal challenges, which will place great strain on our public health and health care services. In addition, deep and persistent health inequalities within and between countries continue to demand action. New threats (e.g. fake news) are surfacing, old threats (e.g. measles and TB) are coming back and EUPHA and its members need to adapt. This presentation will survey the changing public health landscape in Europe and globally, highlighting key issues for EUPHA to address.