bluuebunny/crossref_metadata_2025 huggingface dataset:
Example B: Using online respondent-driven sampling among Moroccan immigrants in the Netherlands
Authors: Hamdiui N , van Steenbergen J E , Thorson A , Rocha L E C , Urbanus A , Meiberg A , Timen A , van den Muijsenbergh M
Published: November 2019

The Dutch Health Council recommended chronic hepatitis B (HBV) screening for first-generation immigrants originating from intermediate/high HBV endemic countries. The Council proposed two screening strategies; individual case finding by general practitioners and local screening programmes. Our aim was to explore knowledge and information needs regarding chronic HBV and its screening among Moroccan immigrants in the Netherlands, in order to provide Dutch Municipal Health Services insights on how to inform immigrants. We also studied a randomized recruitment method using respondent-driven sampling (RDS) for a better understanding on how to reach and recruit immigrants for an online questionnaire.

First- and second-generation Moroccan immigrants were asked to fill in an online questionnaire and forward this to four Moroccan contacts. Participants were randomized to one of three recruitment strategies; no incentive for filling in the questionnaire nor for successfully recruiting each contact, an incentive for filling in the questionnaire and for successfully recruiting each contact, and a gamified element as non-monetary incentive to stimulate peer-recruitment.

Preliminary analyses show a sample of 59 Moroccans (17-59 years), of which 63% was second-generation and 76% was female. Of these, 46% would like to have information about chronic hepatitis B, while the average knowledge score was 5.02 (0-10). Over 60% of the participants intends to participate in chronic HBV screening, and would also recommend this to their (grand)parents. Using a monetary incentive seemed to be the best recruitment strategy in terms of the number of waves (max: 3). A gamified non-monetary incentive was least effective in stimulating peer-recruitment (max: 0).

Despite the limited level of knowledge and information need, the majority of Moroccan immigrants had a positive screening intention. The next step is to determine whether our methodology could be applied to reach other immigrant groups.
Alyna Smith
Authors: Smith A
Published: November 2019

Ms Smith with discuss the range of structural barriers confronted by people who are undocumented, in accessing health services, at the policy and practical levels, including intersectional challenges (e.g., for undocumented sex workers, homeless, users of drugs, etc.).
The amended EIA directive creates opportunities for public health
Authors: Cave B , Mekel O , Nowacki J , Silva F , Xiao Y , Claßen T h , Martin-Olmedo P
Published: November 2019

Environmental Impact Assessment (EIA) is conducted by the developer as part of the process of seeking consent to proceed with the project. The developer may be a public authority or a private company. The Directive for Environmental Impact Assessment (EIA) (2011/92/EU) was amended in 2014 (2014/52/EU). The changes are now transposed into national regulations across European Union Member States. These changes have an influence beyond EU borders, for example, through the policies of the European Investment Bank and the European Bank of Reconstruction and Development. The amendments to the Directive create both opportunities and challenges for public health. The opportunities stem from the changes that have been made to the Directive. Population and human health are now on the list of core topics that must be considered in an EIA. The other core topics to be assessed are each ‘determinants of health’, for example: biodiversity; land, soil, water, air and climate; and material assets, cultural heritage and the landscape. The Directive now requires the interaction between these factors to be considered. The amended Directive includes other issues that are relevant to human health, for example, climate change and vulnerability (exposure and resilience) to major accidents and/or disasters. The developer’s assessment must be prepared by Competent Experts. The changes also pose challenges. These are technical. For example, human health needs to be assessed within the framework of EIA. The changes also pose challenges to the public health workforce. There is a need to ensure there is capacity to participate in EIA. The EIA is typically prepared by the developer and reviewed by the competent authority. There is a role for public health expertise in these complementary activities. This presentation will focus on the opportunities created by the changes to the Directive and the opportunities this creates. It will also touch on the challenges.
The Constances cohort
Authors: Zins M Z
Published: November 2019

The overarching objective of CONSTANCES is to constitute a research infrastructure based on a large population-based cohort to serve as a versatile, high quality and efficient platform for population health research. Constances is designed as a representative sample of 200,000 adults aged 18-69 at inception living in different regions of France. CONSTANCES, which is accessible to the national and international research community, enables the conduct of valid and well-powered studies in a wide range of scientific domains. For each participant, it combines detailed data collection at baseline, englobing lifestyle, environmental, social, and medical history information, with medical examinations, neuropsychological testing with the added advantage of linkage with two major national administrative data bases (SNDS and CNAV). Further, CONSTANCES collects information about changing lifestyles, environments, health behaviors and health conditions on a prospective ongoing basis. A biobank of blood and urine samples is in the process of being constituted. As of April 2018, 85 nested projects designed by French and international teams in many areas of biomedical and public health research were initiated. Constances participates in several French and international consortiums. We established relationships with public health institutions and industrial companies. In the next years, we plan to continue longitudinal follow-up CONSTANCES along the same lines by extending the follow-up of the cohort and by developing innovative new themes prioritizing the strengthening of certain “niches” where CONSTANCES can have international leadership.
The German National Cohort: aims, study design and current status
Authors: Ahrens W A
Published: November 2019

The German National Cohort (GNC) is a joint interdisciplinary endeavour of the Helmholtz and the Leibniz Association, universities, and other research institutes. It focuses on the causes of major chronic diseases, i.e. cardiovascular diseases, cancer, diabetes, neurodegenerative/psychiatric diseases, musculoskeletal diseases, respiratory and infectious diseases, and their sub-clinical stages or related functional health impairments. Less frequent disorders may be investigated by pooling studies. Random samples of regional populations were drawn by 18 study centres, including a total of 200,000 women/men aged 20-69 years. Starting in 2014, the baseline assessments included an extensive interview and self-completion questionnaires, a wide range of medical examinations and the collection of blood, urine, stool and nasal swabs stored in a central biorepository. A random subgroup of ≥ 40,000 participants participated in an intensified examination (’’Level 2’’) programme. Also, about 30,000 participants, who were in addition invited to Level 2, participated in a magnetic resonance imaging examination programme. In 2018 we began to invite all participants for a re-assessment that will be completed in 2023. Information about chronic disease endpoints is obtained through a combination of active follow-up (mailed questionnaires every 2-3 years) and record linkages with cancer registries, healthcare databases, the statutory pension fund and other social insurance data. The examination and questionnaire modules are partly harmonised with those of other large European cohorts to facilitate collaboration. Data access requires a formal application by researchers and will be granted according to the use-and-access regulation of the GNC. The GNC is planned for an overall duration of at least 25-30 years. It will provide a major epidemiological resource, and will help to identify new and tailored strategies for early detection, prediction, and primary prevention of major diseases.
Health literacy policy-making regarding children and adolescents
Authors: Okan O , Sørensen K , Bauer U
Published: November 2019

Background

There is an on-going and a well observable uptake of health literacy in the national and international agenda setting pertaining the development of new policy strategies to address the issue of promoting health literacy in whole societies. Even though children have been declared to be a priority target, no research is available that has analysed if and how children are addressed by these policy approaches. Therefore, the aim of this research is to analyse those policies on how they address children.

Methods

Policy documents on national levels that have been published by February 2019 were retrieved by using a two-pronged strategy comprising of (1) systematic review methods (database and online search) and (2) expert consultation.

Results

The search has identified 26 policies for 19 countries including case-laws and enacted statues, governmental strategies, polices driven by national key experts, and educational policies. No policies on children’s health literacy were found for South America and Africa. The policies differ in many ways, such as their embedding into general health policy making, policy and implementation processes, rationality and networks, and influence of governance. Children are either addressed by (1) specific programmes, (2) school health approaches, (3) their parents, (4) healthcare action, or (5) using a combination of those areas. However, there is almost no evaluation data available nor are these policies underpinned by health literacy evidence generated within the children`s population. Most policies are designed for adult populations rather than children.

Conclusions

Health literacy has developed into an important health policy-making target. While almost all policies address children somehow, several limitations make it difficult to evaluate the quality of the different policies. To secure and sustain more effective, child-focused policies, current knowledge gaps regarding research on children`s health literacy should be addressed.
Partnerships for public health between regional governments and academic institutions – status quo in European regions
Authors: Ihlebaek C , Ese J , Zambon F
Published: November 2019

The development of partnerships is described as an important tool for achieving goals in the 2030 Agenda for Sustainable Development. Partnerships between regional governments and academic institutions could be important for solving public health issues, as they are often complex, and both academic and practice-related knowledge is necessary. Such partnerships at the regional level might be especially important as many sub-national regions in Europe have considerable responsibility and power in decision-making on important areas such as prevention, health promotion, and health care. The overall aim of this project was to provide more knowledge about public health partnerships between regional governments and academic institutions in different regions within WHO’s Region for Health Network (RHN). Through a mixed methods research design, we wanted to identify and describe good examples of existing partnerships, and to investigate enabling factors, challenges, and lessons learned. Information on ongoing partnerships were collected by sending an electronical questionnaire to contact persons of the 43 members regions in the RHN. Based on the mapping, four regions were selected for group interviews with different stakeholders within regional universities and regional government. There were 31 regions (72%) who answered the questionnaire, and group interviews were carried out in Østfold (Norway), Varna (Bulgaria), Utrecht (the Netherlands), and Saskatchewan (Canada). In this presentation the results from the survey will be presented; describing the occurrence of partnerships, how public health partnerships are formalized and organized, important enablers, hindrances, how collaborations are carried out in practice, perceived benefits and successes, and experienced challenges.

Panelists: Klara Dokova

Faculty of Public Health, Medical University of Varna, Varna, Bulgaria

Contact: klaradokova@gmail.com

Liesbeth van Holten

Healthy urban living at Provincie Utrecht, Utrecht, Netherlands

Contact: liesbeth.van.holten@provincie-utrecht.nl

Cordell Neudorf

College of Medicine, University of Saskatchewan, Saskatoon, Canada

Contact: cory.neudorf@usask.ca

Anni Skipstein

Chief officer Public Health, Østfold county, Norway

Contact: annis@ostfoldfk.no
Italy: nationalist anti-migrant policies and emigration of Italian health professions
Authors: Pavolini E
Published: November 2019

Background

Traditionally Italy has been characterised by a limited investment in healthcare personnel, apart from physicians. The outcome has been a low health worker to population density; especially nurses and long-term care personnel face shortages. The outcome has been, at least until 2010 an increasing presence of migrant care workers. However, the situation has changed for several reasons. On one hand, since austerity policies have been implemented, the whole healthcare system has registered a freeze in new healthcare personnel hiring. One the other hand, in more recent years policies have started to be implemented, especially by the latest government (where one of the two governing parties is a radical right one) to make it more difficult for migrants to access the country.

Methods

The study draws on an analysis of administrative data and previous researches in the field, matched by qualitative interviews with key informants at the national level.

Results

Shortage of skilled workers in the health sector is likely to increase in future. It is becoming more difficult for foreigners to get access to work in this sector, while Italian healthcare workers are leaving the country. In recent years there has been a strong increase in healthcare professionals’ emigration toward North America and other EU countries.

Conclusions

Italy needs both a new effective strategy of health workforce governance and a more migrant-friendly policy to manage incoming and outgoing flows of health professionals.
Reproductive and contraceptive healthcare for vulnerable people in the Netherlands: Pregnant not now!
Authors: Rijlaarsdam C W , van Sambeek D W M , Rust L
Published: November 2019

Issue/problem

Unplanned and unwanted pregnancies are an important issue in public health. Especially when parents already are in complex or vulnerable situations, for example being homeless, having an addiction, serious psychiatric- or financial problems or intellectual disabilities. Although most of these parents are in contact with several professionals, family planning and contraceptives are rarely discussed.

Description of the problem

In 2014 a pilot programme was developed to support vulnerable adults on family planning and adequate use of contraception. In a qualitative explorative case study the pilot was evaluated.

Results

The pilot showed a significant increase in postponed pregnancies by using appropriate contraceptives. Over eighty percent of this population started contraception on a voluntary basis. The study showed 5 determinants influencing contraception use: responsibility, knowledge, finance, emotion and social environment. If needed, the programme played a role on all different determinants. The method of working was the key element in the success: addressing family planning and contraceptive use through an outreach practise orientated presence approach and empowerment. Another important factor for success was the collaboration between public health and medical doctors.

Lessons

The successful pilot became regular care for vulnerable (potential) parents in Tilburg. The pilot was replicated in two other cities, Rotterdam and Nijmegen, with similar results. In 2018-2021 the programme will be implemented nationwide with financial support of the Ministry of Health, Welfare and Sports, coordinated by GGD GHOR Nederland (the Association of GGDs (Regional Public Health

Services) and GHOR-(Regional Medical Emergency Preparedness and Planning) offices in the Netherlands).

Key messages

‘Pregnant not now!’ successfully supports vulnerable people with family planning and contraceptives, helping them to gain control over their future and preventing unplanned and unwanted pregnancies. The programme is unique and preventive, its innovative character is applicable in other communities in the Netherlands and possibly across Europe.
The health of asylum seekers in Finland: a total population health examination survey (TERTTU)
Authors: Skogberg N , Koponen P , Lilja E , Mustonen K-L , Garoff F , Ahmed A , Castaneda A E
Published: November 2019

Background

There is scarcity of representative population-based data on the health and wellbeing of asylum seekers in Europe. The Asylum Seekers Health and Wellbeing Survey (TERTTU) was launched to provide the evidence-base for developing services for asylum seekers as well as for planning and allocation of healthcare resources at a national level.

Methods

A sample of all first-time asylum applicants between 19.2-30.11.2018 was drawn from the Finnish Immigration Services electronic asylum database. Altogether 784 adults aged 18 years and older took part in the standardised health examination and face-to-face interview with participation rate of 79%. Interviewed health measures included the Minimum European Health Module, conditions previously diagnosed by a physician, permanent injury due to violence or accident and somatization.

Results

Self-rated health was good among 66% (95% CI 62,5-69,1) and 42% (95% CI 38,5-45,4) reported having some self-reported long-term illness or health problem. The most common previously diagnosed conditions were diseases of the circulatory system (19%, 95% CI 16,5-22,0), musculoskeletal system (18%, 95% CI 15,6-21,1), mental and behavioural disorders (13%, 95% CI 10,9-15,6) and diseases of the respiratory system (10%, 95% CI 8,0-12,2 ). Nearly half (47%, 95% CI 43,7-50,8) reported having a permanent injury due to violence or accident. Somatisation was common: 23% (95% CI 20,3-26,2) reported having headache, 23% (95% CI 19,9-25,8) back ache and 13% (95% CI 10,8-15,6) other pains at least several times a week.

Conclusions

The overall health of newly-arrived asylum seekers was poorer compared with the general Finnish population and migrant origin populations from similar countries of origin permanently living in Finland. Significant differences in asylum seekers health were found by sex and region of origin. Survey data will be used for developing the national initial health assessment protocol for asylum seekers during 2019.

Key messages

The TERTTU Survey is the largest population-based health examination survey among newly-arrived asylum seekers in Europe to date. The extensive data gathered over the course of the survey will be used for developing services for asylum seekers at a national level and is of high relevance also to other European countries.
Health monitoring among refugees: a state-wide, cross-sectional, population-based study in Germany
Authors: Biddle L , Menold N , Bentner M , Nöst S , Jahn R , Ziegler S , Bozorgmehr K
Published: November 2019

Background

Health monitoring in Germany falls short on generating timely, reliable and representative data among migrants, especially transient groups such as asylum seekers and refugees (ASR). We aim to advance health monitoring approaches and obtain reliable estimates on health status and access to health services among ASR in Germany’s 3rd largest federal state.

Methods

We conducted a state-wide, cross-sectional, population-based health monitoring survey in nine languages among ASR in collective accommodation centres. Questionnaire items capturing health status, access to care and sociodemographic variables were taken from established surveys and translated using a team approach. Random sampling on the level of 1,938 accommodation centres was employed to draw a balanced sample. Multilingual field teams recruited eligible participants using a “door-to-door” approach.

Results

Fieldwork was conducted in 58 centres, obtaining a response rate of 42.2% (n = 412). Age, sex and nationality of the included sample were comparable to the population of asylum applicants in Germany. Adults reported longstanding limitations (16%), bad/very bad general health (19%), pain (25%), chronic illness (40%), and depressive (46%) and anxiety symptoms (45%). 52% utilised primary and 37% specialist care services in the previous 12 months, while reporting unmet needs for primary (31%) and specialist care (32%). Younger and male participants had above-average health status and below-average utilisation, in contrast to older and female ASR.

Conclusions

Our health monitoring survey yielded reliable estimates on health status and health care access among ASR, revealing relevant morbidities and patterns of care. Applying rigorous epidemiological methods in linguistically diverse, transient and marginalized populations is challenging, but feasible. Integration of this approach into state- and nation-wide health monitoring strategies is needed to sustain this approach as a health planning tool.

Key messages

Applying rigorous epidemiological methods in linguistically diverse, transient and marginalized populations is challenging, but feasible. Sustainable integration of multi-lingual epidemiological methods is required in state- and nation-wide health monitoring to capture health status and access to health services for ASR.
Establishment of Centre of competence “Leonardo Da Vinci” in Medical University of Pleven, Bulgaria
Authors: Yankulovska S , Tomov S l
Published: November 2019

Issue/problem

In 2016 Ministry of education and science initiated a call for projects for establishment of centres of competence aiming to increase the level and market orientation of the research activities in Bulgaria and to support the development of innovation capacity. The center of competence on personalised medicine, 3D and telemedicine, robotic and minimally invasive surgery in Medical University of Pleven is to be developed from 2018 to 2023.

Description of the problem

The objectives are: 1) To create a high-tech research and educational product with long-lasting tendencies to improve the community’s scientific development and level of public health; 2) To set up research teams of young researchers to write modern PhD theses and publications in high impact scientific journals; 3) Ð¢Ð3/4 integrate research results into the business.

Methods

classical and virtual microscopy, computer-assisted morphometry, clinical-genealogical method, functional endoscopic sinus surgery, laparoscopic transanal total mesorectal excision, hysteroscopic morcellation and others.

Results

About 2500 patients will be treated in the centre for 5 years. Diagnostic panels will be developed for different cancer types and the most common hereditary diseases within Bulgarian population. Individual orthotics suitable for 3D printing will be developed and patented. Tissue transplants will be created for body models that will be used for training on robotic surgical simulator. The telemedicine center will allow distant consultations with other centers, specialized training and research in virtual reality. The teams are experienced in the genetic testing and robotic surgery. Till 2015 all robotic surgeries in Bulgaria were performed in Pleven. The proportion for 2016, 2017 and 2018 was respectively 81.1%, 71.5% and 32% due to the increase of number of robotic surgery centres. Pleven’s centre has strong training traditions to guarantee the high quality of planned 72 workshops and seminars.

Key messages

The introduction of new technologies requires new models of training of health professionals to develop the necessary skills to take full advantage of their benefits. Better dissemination of innovations increases the access of population to health care of good quality and the achievement of highest attainable standard of physical health.
Final Products: a regional integrated output assessment in Public Health services, 2017-19 Italy
Authors: Smaniotto C , Del Bianco F , Giardinelli E , Bravo G , Oppi C , Campanale C , Cinquini L , Brusaferro S
Published: November 2019

Issue/problem

The classification of Public Health services (PHS) and related healthcare information systems (HIS) in Friuli Venezia Giulia, Italy, are complex and non-homogeneous. Since 2017 the Region has been realigning HIS according to the new Final Products (FP) System to classify PHS. The aim is to implement an integrated FP-based HIS, easing data transmission and improving the quality of planning, scheduling and expense reporting activities.

Description of the problem

From June 2017 to October 2018 68 Public Health professionals (PHP) from 10 Public Health areas outlined 102 PF from HIS through flowcharts and technical dossiers. Afterwards (10/5th-10/29th 2018) they assessed HIS through a questionnaire of 24 items. Statistical analysis was performed with Fisher’s Exact Test, stratifying 4 categories (physician, veterinarian, prevention technician, other professional). In June-July 2019, through a matrix-based assessment, PHP of regional PHS were invited to weight each FP activity on the basis of involved personnel and possible required transfer (valorisation phase).

Results

The questionnaire got 45/68 responses (66%). Among responders, 27% reported a HIS for their PHS not being available at all; 65% of responders agreed on the usefulness of an integrated regional HIS for PHS. Fisher’s Test showed significant differences in HIS features according to profession, as interoperability with national/regional databases (p = 0.0144), mobile usability for external activities (p = 0.0302), real correspondence between monitored data and performed activities (p = 0.0215). Valorisation was performed by 445/557 PHP (80%).

Lessons

PHS currently often deal with functional flaws or inappropriateness of HIS when compared to real activities. Valorisation data will be submitted to the attention of policymakers in October 2019 in order to apply an integrated classification of PHS considering both effectiveness and generation of value of activities performed in Public Health.

Key messages

Healthcare is a multilayered product and measuring healthcare outputs requires managerial skills and tools, to assess need of resources and to plan activities. The regional Final Products project defines a uniform classification of Public Health services and implements a standardised accounting system for activities performed in Public Health.
Southeastern Regional Health Information System: a mapping tool for public health actors
Authors: Jardin M , Kurkdji P , Dagnet L , Tonnaire G , Nauleau S , Verger P , Guagliardo V
Published: November 2019

Issue/problem

Local public health actors often need to identify public health priorities in their territories to guide public health policy and/or action.

Description of the problem

The Southeastern Health Regional Observatory (ORS Paca) has been developing since 2006 a health information system for Southeastern France (SIRSéPACA). The objective of this mapping tool is to give access to regional and local public health actors to public health indicators for various population groups and geographical scales (municipality, districts...) within the region.

Results

Indicators are displayed under the format of maps and tables on the following topics: morbidity, mortality, health social, economic or environmental determinants. Indicators are constructed using national and regional databases (open or accessible through agreements). SIRSéPACA is in free access (www.sirsepaca.org) and regularly updated. A function allows the users to obtain a portrait for a defined geographical area and to obtain in one click a description of various indicators (socio-economic and demographic characteristics, mortality and morbidity causes, health care and prevention, environmental health). Indicators for a given territory can be compared to the regional average (or another area). SIRSéPACA is regularly used to provide a description of the main public health characteristics of territories (“territorial diagnose”), e.g. to help health professionals intending to set up of a multidisciplinary group practice designing their project.

Lessons

Trainings on how to use the tool, interpret the maps produced, and about territorial diagnoses implementation are regularly done. We are also developing a similar tool for all French regions for the Ministry of Health.

Key messages

SIRSéPACA facilitates access to and overview of a lot of indicators and data for local public health actors. This regional experience has been expanded to national level.
Sleep habits and sleep characteristics at 1 year-old in the ELFE birth cohort study
Authors: Messayke S , Franco P , Forhan A , Dufourg M N , Charles M A , Plancoulaine S
Published: November 2019

Infant sleep plays a critical role in his/her normal development. Sleep problems, including sleep onset difficulties (SOD) and night waking (NW), ranges from 20% to 30% in infants and young children and are partially persistent over time up to adulthood. French young children seem to have longer sleep durations and less sleep troubles than their counterparts worldwide. We here aimed at describing infants sleep characteristics (duration/24h (TST), NW, and SOD) and associated sleep habits in infants aged 1 year old from the French nationwide birth cohort ELFE.

This study included 11,571 infants with information on both sleep characteristics and sleep habits (parental presence when falling asleep, eating to fall asleep, sucking pacifier or finger to sleep and the location where the infant falls asleep and ends his/her sleep). Associations were studied using multinomial logistic regressions adjusted for familial and infant characteristics.

Mean TST was 13hrs36 including 2hrs54 of naps, 20% of the infants had TST ≤12hrs/24h. About 46% did not present SOD or NW, while 16% had frequent SOD and 22% had NW > 1 night over 2. Parental presence, feeding to fall asleep and infants sleep location were more frequent in infants having short sleep duration (≤12h/24h), NW and SOD. Non-nutritive sucking was associated with NW, SOD and TST>14h/24h.

This work provides new information regarding infant sleep location and non-nutritive sucking that should be accounted for when considering sleep behaviors. In addition, most of identified sleep habits associated with poor sleep characteristics are accessible to prevention.

Key messages

French infants present better sleep characteristics than their counterparts. Most sleep habits associated with poor sleep are accessible to prevention.
Estimation of direct cost related to asthma among school-age children with asthma
Authors: Dardouri M , Mallouli M , Amara A , Sahli J , Limem M , El Ghardallou M , Zedini C , Bouguila J , Ajmi T , Mtiraoui A
Published: November 2019

Background

Childhood asthma still imposes a substantial burden on the health care system and community. Its management requires a significant direct cost. Several factors can influence the cost of asthma management, particularly severe asthma. There is scant information about the predictors of asthma-related cost. Thus, the purpose of this study was to estimate direct asthma-related cost among children with chronic asthma and to identify factors that have the greatest contribution to change it.

Methods

This cross-sectional study was carried out in Farhat Hached University Hospital in Sousse (Tunisia, Africa) over a period of three months (April-June 2018) among children with asthma aged 7-17 years. The direct cost was defined as the costs of health resources utilization and medication related to asthma in the past 12 months. Purchasing power parity technique was used to convert TND to USD. Multiple linear regression was performed to examine the association between dependent and independent variables.

Results

A total of 90 subjects participated in the study. The mean age was 9.81±2.56 and 55.6% were male. The annual mean of the total direct cost was USD 616.71±454. Multivariate analysis showed that the severity of asthma, inhalation technique and emotional domain of QOL predict asthma cost and that the latter was the best predictor (p = 0.005, p = 0.03, p = 0.004, respectively). This data indicates that for one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months.

Conclusions

This study showed that higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma. These results are useful for health care providers and community since they provide information about the impact of modifiable risk factors on direct asthma cost.

Key messages

For one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months. Higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma.
Income-related inequalities in mental health in Sweden and the role of social determinants
Authors: Fritzell S , Källberg H , Busch H , Gustafsson P
Published: November 2019

Background

Mental health is an increasing concern in all European countries as the burden of mental disorders continue to grow and cause substantial suffering and costs to societies. Furthermore, research shows there are social inequalities in the distribution of mental illness. This study aims to increase knowledge on income-related inequalities in mental health in Sweden and the role of social determinants.

Methods

Drawing on a national survey (Health on Equal Terms) representative of the population aged 16-84, years 2010-2015 (n = 57107) we quantify the income-related inequality in mental health and estimate the contribution of social determinants of the inequality. Poor mental health is defined as a value of at least 3, based on the general health questionnaire (GHQ)-12. Income is measured as yearly disposable income. Income related inequalities in mental health are quantified by the concentration index and decomposed using the Wagstaff-type decomposition analysis.

Results

Preliminary results show that the income inequalities in mental health, as measured by the overall concentration index in mental health was - 0,16 (95% CI -0.17 to -0.15), indicating income inequalities to the disadvantage of those less affluent. The determinants that contributed most to the inequalities were employment, financial strain and experiencing harassment. Together they explained 43 % of the income inequalities in mental health. Generally, socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance.

Conclusions

The income related inequalities in mental health are substantial in Sweden. Recently, a national target of reducing the preventable inequalities in health within a generation was adopted. To improve surveillance of inequalities and inform policy we need to closely follow the development of inequalities in mental health and to disentangle the contribution of specific social determinants.

Key messages

Income-related inequalities in mental health in Sweden are considerable. Socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance.
Trends in the co-occurrence of cardiovascular risk factors by education in Finland, 1997–2017
Authors: Paalanen L , Härkänen T , Kontto J , Tolonen H
Published: November 2019

Background

Understanding on sociodemographic variation of the co-occurrence of cardiovascular disease (CVD) risk factors is crucial for planning public health policy and future prevention strategies. We aimed at examining 1) the co-occurrence of smoking, hypertension, elevated cholesterol and obesity by education, and 2) the trends in educational differences in the co-occurrence of these risk factors in Finland.

Methods

We used cross-sectional health examination surveys carried out every five years among the general adult population: for 1997-2012 the National FINRISK Study and for 2017 the FinHealth 2017 Survey. Respondents aged 25-64 years were included in the analyses (n = 25,036). Current smoking, obesity (BMI≥30 kg/m2), hypertension (≥140/≥90 mmHg or medication) and elevated serum total cholesterol (≥5.0 mmol/l or medication) were used for the risk factor accumulation score with categories 1) zero, 2) one, 3) two, and 4) three or four elevated risk factors. Multinomial logistic regression was used to estimate predicted probabilities for each category.

Results

Overall, the risk factor score was more favourable among women than men, and among high education groups than low education groups in both sexes. The lowest risk factor score class became more prevalent in all education groups in both sexes over time. The change in educational differences was not significant. However, the intermediate education group approached the highest education group over time.

Conclusions

Our data indicate an overall transition towards a more favourable risk factor score in Finland, in 1997-2017. The score among the intermediate education group approached that among the highest education group. The tendency of risk factor accumulation among those with least education remained during the study period, which raises a need to develop and implement interventions and public health policies that would be effective in decreasing the risk factor burden particularly in this group.

Key messages

Overall, a favourable trend of diminishing risk factor prevalence was seen. The tendency of accumulation of major CVD risk factors among the least educated subjects remained from 1997 to 2017.
Recruitment of women from disadvantaged areas to a smoking cessation intervention: preliminary findings from the We Can Quit2 (WCQ2) cluster randomised controlled trial
Authors: Hayes C
Published: November 2019

Background

Recruitment of participants into community randomised controlled trials (RCTs) is problematic; however, recruitment of participants from disadvantaged backgrounds to community smoking cessation trials is especially challenging. This paper will present recruitment and retention rates, successes and challenges in the We Can Quit2 (WCQ2) community intervention trial of smoking cessation in disadvantaged women.

Methods

We Can Quit, is a smoking-cessation behavioural support intervention delivered by community facilitators through 12-weekly group sessions, with free Nicotine Replacement Therapy, against a form of usual care. Sample size was estimated at 194 in total (97 per arm). Four matched pairs of districts of approximately 10,000 women in each (eight clusters) were identified from which eligible women could be recruited. The recruitment target was 24-25 per cluster. Consent was obtained prior to cluster randomisation. Individual participants were recruited via print media such as leaflets, posters, information stands in local facilities e.g. creches as well as through local and social media e.g. radio and targeted Facebook advertisements. A small financial incentive was provided to aid retentions.

Results

208 women registered for the study. Women heard about WCQ2 mainly via Facebook or Twitter (30.4%), and personal networks (16%) 184 (84.5%) were eligible with living outside the area being the most common reason for ineligibility. 125 (67.9% of eligible women; 65.5% of target) consented. Retention rates will be presented. Barriers to recruitment included time of year. Successful strategies included application of in-depth knowledge of local communities to target eligible women. Social media helped target younger women. Recruitment occurred over four waves, allowing for the application of iterative learning.

Conclusions

Recruitment to a community based RCT was challenging however, local community engagement, use of social media, and personal networks were successful strategies. Early and active engagement with local stakeholders with in-depth knowledge of the community is important.

Key messages

Intense planned community mobilisation is needed to recruit disadvantaged women to smoking cessation trials. Social media an important route to recruitment of younger women.
Online health information seeking by parents for their children. A systematic review
Authors: Kubb C , Foran H
Published: November 2019

Background

Parents commonly use the internet to search for information about their child’s health-related symptoms and guide parental health-related decisions. Despite the importance of parental search behaviors, this area of research remains understudied and no comprehensive review of this research area has been conducted. Our aim is to summarize the existing findings on searched topics and search experience of online health information seeking among parents for their children with focus on building an agenda for further research and recommendations for public health.

Methods

We conducted a comprehensive systematic literature review of parental online health information seeking studies in the databases of PsycInfo, JMIR and PubMED. Studies from 1994 to June 2018 were considered.

Results

A total of 33 studies met the eligibility criteria, including 8665 parents. Findings suggest that parents worldwide are heavy online users of health-related information for their children across highly diverse circumstances. Parents report wishing for more guidance especially from their pediatrician on how to find online health information; however, studies found parents rarely report discussing online health information with their healthcare providers. Only five studies investigated health anxiety related to online health information and prevalences ranged from 14% and 52%, three examined theoretical models, and only three examined consequences of search behaviors more in-depth.

Conclusions

Results of this systematic review identify important gaps in theoretical models, risk factors to predict search behaviors, and health outcomes associated with parental search behaviors. An agenda for future research will be presented.

Key messages

Parents are heavy users of the health-related web, but more research is needed to support them in effective use. Tailored digital public health approaches could empower parents to make better use of online resources and improve health-related decision making.
“Patient participation”: Towards a conceptual model and dimensions’ descriptions
Authors: Ortiz Halabi I , Scholtes B , Voz B , Bragard I , Pétré B
Published: November 2019

Background

An extensive body of literature has emerged advocating concepts on the collaboration between patients and healthcare systems, such as patient-centred care, patient engagement and patient participation. Several authors have attempted to provide clear definitions of these concepts but no consensus has been agreed upon. This may have hampered their developments and implementation. We thus aim to propose an integrative conceptual model of “patient participation” and a description of its dimensions.

Methodology

Recently, a scoping review studied transversally the concepts related to this collaboration under a generic term “patient participation”. Based on this review a conceptual model and a description of its dimensions was developed. A summative approach was used to produce the dimensions’ description and consisted in systematically adding every new information mentioned in the 38 articles of the scoping review to the final description. The conceptual model was developed based on the theorization methodology of Paillé & Mucchieli (2016).

Results

The model included 28 dimensions, 6 influencing factors and 4 expected outcomes. They were described and modeled at the three levels of the healthcare system (micro, meso and macro). The model illustrate the relation between: (1) the healthcare professionals’ (HPs) and patients’ attitudes and skills, and the collaboration between these healthcare actors (micro level); (2) the organisational structure of healthcare institutions and the HPs’ and patients’ training and access to resources (meso level); (3) results at the macro level did not provide enough information to relate the retrieved dimensions.

Discussion: The production of a conceptual model and the description of its dimension may allow a consensus on the dimensions related to “patient participation”. Despite its complexity, this model may favour “patient participation’s” implementation and operationalization at all levels of the healthcare system.

Key messages

The results of this study address the confusion existing in the scientific literature on the generic concept of “patient participation”. The results of this study provide a global overview of “patient participation” and may impact clinical practice and can be a base for training programs for healthcare professionals and patients.
Environmental Burden of Disease in the Netherlands
Authors: Hilderink H , Schram D , Plasmans M
Published: November 2019

Background

RIVM-National Institute for Public Health and the Environment published as part of the 2018 Dutch Public Health Foresight report, an update of the Disease Burden, including the Environmental Burden of disease. This report is not only relevant for the Ministry of Health but also for other policy arenas, to support policy making with the objective of improving health.

Methods

Environment factors are distinguished by indoor and outdoor environment. The following environmental factors have been taken into account; Air pollution (PM10/NO2), UV radiation, noise, second-hand smoking, carbon monoxide poisoning and indoor dampness. The effects of chemical substances are not included. Making use of the population attributable fraction, the fraction part of mortality, disease burden and health care expenditures attributable to environmental factors is calculated. For this method, data on exposure as well as the dose-response relationship (relative risks) are used.

Results

Some 4% of the disease burden in the Netherlands is caused by environmental factors and that costs us more than 1 billion euros of care per year. This corresponds with 200,000 DALYs; of which 175,000 by outside environment and 25,000 by indoor environment. In total, almost 13000 deaths can be attributed to environmental factors. Air pollution causes by far most of this disease burden. After that, exposure to UV radiation and second-hand smoking rank highest.

Conclusions

A considerable disease burden, number of deaths and health expenditures is attributable to environmental factors and could at least in theory be avoided by improving our environment. Air pollution in particular plays an important role in this. In addition, even a greater health gain could be achieved if environment factors are tackled and healthy behavior is at the same time stimulated.