bluuebunny/crossref_metadata_2025 huggingface dataset:
Health inequalities - Breaking down silos
Authors: Lindqvist N , Engström K
Published: October 2020

The Public Health Agency of Sweden has a national responsibility to ensure good public health. The agency's mission is to develop and support society's work to promote health, prevent illness and protect against various forms of health threats. The vision is to strengthen the development of society through good population health. The agency has a national responsibility to halt avoidable health gaps within a generation, through creation of favourable societal conditions designed to impact good and equal health for the population. Public health monitoring and reporting aims at providing a broader description of the state and trends of public health in Sweden through data linkages and data on self-reported health.

In 2018, the Swedish Government decided on a new public health goal and 8 target areas. The 8 areas reflect on various social determinants to achieve equitable health in Sweden within one generation. These determinants of health are influenced by political decisions as well as individual choices. The Public Health Policy is therefore a cross-sectoral target structure for the overall public health work and points out the need to focus on bridging inequality gaps in health and the social determinants of health. It is important to reflect upon how the advancement in monitoring tools and the new Public Health Policy goal can contribute to halting inequities. How do we know if we are reaching the goal?

The focus of the presentation is therefore to highlight Sweden's public health reporting today, the ongoing work to improve the reporting of health and its determinants, with regard to inequities in health. The presentation will also give examples of in-depth reports of different public health challenges, web-based indicator systems used for monitoring health trends in Sweden and public health reports. Examples of the Agency's coordination and support for regional and local public health work will also be discussed.
9.L. Workshop: Mental health of older people
Authors:   Organised by: EUPHA Public mental health section,   Chair persons: Johan Bilsen – EUPHA-PMH, Jutta Lindert – EUPHA-PMH
Published: October 2020

The world's population is aging rapidly. Globally, the population of older people will nearly double in the next 30 years, from 12% to 22%. Unfortunately, many elderly people are often vulnerable to the development of mental health problems. Besides the development of mental disorders (such as depression) or neurological disorders (such as cognitive impairment), they often experience several health ailments and loss of functionality, which negatively impacts their mental health and wellbeing. The WHO points out that mental health problems among this group of people are under-identified by healthcare professionals and by older people and their relatives themselves, and that stigma surrounding these conditions makes people often reluctant to seek help. Therefore, more scientific research and debate is needed on mental health of older persons, especially from a public health perspective. By bringing together researchers on this domain from different countries and background, this workshop aims to contribute to the scientific insight in this topic and finally to the improvement of the mental health and wellbeing of this growing group of people.

In this workshop, research findings on the prevalence of (undetected) mental health problems and the impact of organizational, social and physical conditions on these problems, among older persons, both institutionalized and not, will be presented and discussed by five researchers from different European countries. Dr. Sunwoo Lee (Czech Republic) will talk about the demographic, psychosocial, and health-related risk factors for suicidal ideation among older adults in 12 European countries. Dr. Patricia De Vriendt (Belgium) will give a presentation on the unnoticed mild cognitive problems in nursing homes in Flanders. Dr. Henriette van der Roest (the Netherlands) will show the relationship between organizational adaptions in Dutch nursing homes and cognitive improvement and quality of life among older persons with dementia. Dr. Jutta Lindert (Germany) will focus on the impact of social stress and strain on the episodic memory and executive functioning of the “Midlife in the United States (MIDUS) cohort. And finally Dr. Mauro Carta (Italy) will illustrate the positive effect of moderate physical activity on cognitive functioning and general wellbeing of older people.

Key messages

Mental health problems among the growing group of older people are prevalent and of different kind. More scientific insight is needed on the prevalence and determinants of these problems, in order to provide timely and adequate support and prevention.
Health promotion for migrants in Morocco: Progress, challenges et prospects
Authors: Maaroufi A
Published: October 2020

Morocco has become a land of permanent settlement for migrants. In promoting their health, we have made a significant progress with persistence of challenges

Progress: Development and implementation of a National Strategy to promote the health of migrantsFree access to primary care and emergency care and screening services;Free access to health coverage program for regular migrants.

Challenges: Development of a health surveillance system for the migrant populationStrengthening the skills of healthcare professionals to take care of the specific health needs of the migrant population (tropical diseases);Strengthening of medical, psycho-social assistance for migrants, protection of particularly vulnerable categories (women and children) and intersectoral coordination;Stimulate action by civil society and the community in promoting the health of migrants.

Prospects for action: Integrate migrant health data into the health information system of health facilities and health programs;Develop and implement a health education plan adapted to the specificities of migrant populations;Establish a network of hospital units specializing in tropical pathology, acting as national reference teams;Define and implement a capacity building program for health professionals (doctors, nurses and social workers);Support civil society organizations to improve their intervention capacity in the area of migrant health.
Human trafficking among nationals, refugees and migrants in Tunisia
Authors: Sabri B
Published: October 2020

Human trafficking is a worldwide phenomenon organized by national and international gangs and generating important financial resources. Refugees and migrants constitute the main victims of such organized crimes. At national level, human trafficking is facilitated by poverty, social exclusion and all forms of vulnerability. School dropout at young age is among determinants of Child labor, organized begging, drug trafficking and involvement in criminal gangs. Economic and political migrants are easy targets to national and international traffickers.

The 2018 report shows that documented cases have increased from 28 in 2015 to 780 in 2018. Women and children represent the high majority respectively 75 % and 50 %. Criminal activities include forced employment (55 %), economic exploitation of children (33 %), sexual exploitation (10 %) and slavery like practice (2 %). Victims of human trafficking are from Tunisia (55 %), Ivory coast (40 %) and Caucasian countries (5 %).

The reported cases are provided social and health services by government and national and international civil society organizations active in Tunisia. Victims suffer stigmatization particularly for HIV carriers and also depression and psychological disorders. Civil society organizations in addition to service delivery, facilitate case notifications and encourage victims for self-reporting which remains low (10 %).

The objectives of the paper are to: Shed light on human trafficking in Tunisia particularly among refugees and migrantsAddress ways and means of preventing such criminal phenomenonInclude care of victims of human trafficking in the social and health package for refugees and migrants.
International Patient Summary Standards conveying immunization information
Authors: Pavlakis G
Published: October 2020

International Patient Summary (IPS) Standards represent a collaborative effort among Standards Development Organizations i.e. HL7, CEN, ISO, IHE to extract a snapshot of key information from Electronic Health Records including key conditions, allergies, medications, as well as immunization information. This information is associated with provenance information regarding when and how this information was produced, and who attests to its validity. Many mobile handset manufacturers support this functionality by default and empower citizens to receive safe care where and when needed. Patient summaries are also one of the key functionalities supported by Connected Europe, eHealth Digital Services Infrastructure, operated by European Union member states and the most recent initiative regarding the European Electronic Health Record Exchange Format, which explicitly includes laboratory observations (test results). With COVID-19 the immunization section of the IPS standard comes to play a critical role, empowering individuals to access and manage data related to their immunity, such as the tests carried out and their outcome. Additionally, consideration will be given to a key related question is how to standardize the representation of COVID19 tests and associated results. Already, the standards organizations SNOMEDCT International, LOINC, and CDISC have released guidance related to terminology and nomenclature.
The Amsterdam Healthy Weight Approach: A whole systems approach for tackling child obesity in cities
Authors: den Hertog K , Busch V
Published: October 2020

In search for successful overweight and obesity prevention, extensive research has shown that programs focused on individual behavior change are not effective enough. Many of the underlying determinants of overweight and obesity have social, environmental and economic origins, and extend even beyond the influence of the health sector and public health. This calls for a whole systems approach that covers a multi-sectoral, multi-stakeholder collaboration, where communities, professionals, government and industry are involved and are all part of the solution.

The Amsterdam Healthy Weight Approach (AHWA), initiated in 2012, is a local government led approach that has the objective to encourage healthy weight for children in a healthy environment. With a long-term vision, aimed at lasting change, the AHWA aims at developing interventions, changing policies and educating and informing both professionals and target groups within the communities that are most heavily burdened with the issue of child obesity (and related complex health/wellbeing issues). The strength of the AHWA lies in adopting a whole systems approach (WSA), in which the key is, to collaborate in an integrated, multi-level, multi sectoral way, with a variety of stakeholders from within and outside the field of public health.

The aim of the presentation is to inform participants from cities around the globe about the success factors, lessons learned and valuable elements of implementing the AHWA, and to provide tools which they can use in discussing their own approaches and bring these to a higher level of effectiveness
A collaborative learning network of cities
Authors: den Hertog K , Elstak P
Published: October 2020

Cities as local complex systems are uniquely equipped to, and increasingly looked upon, to battle 'wicked problems' such as the obesity epidemic. Applying a WSA, Amsterdam works to provide optimal conditions for children to grow up with healthy dietary, sleep and physical activity habits to stimulate healthy weight development. As a WSA, it does not consist of predictable, linear sequencing of events 'from input to impact', but rather of iterations of responsive actions within a complex adaptive system within its own policy context, enabling responsive program actions over time.

Despite increasing advocacy for WSAs in dealing with wicked problems, there is a need to further learn how they can be effectively implemented, evaluated and shaped as a dynamic, adaptive, self-learning system. Therefore, Amsterdam and London created a Collaborative Learning Network (CLN) to facilitate mutual learning and dynamic WSA-growth by exchanging knowledge and experiences, and creating a joint advocacy platform. This creates collective doing, e.g. a joint lobby and agenda setting, and collective learning, i.e. exchanging knowledge and experiences.

Despite these initial valuable results, a further expansion and evolution of the network is needed. Firstly, expansion means more advocacy power and more impactful actions, but also having a larger variety of political and policy contexts to learn from and distill more (in)effective ingredients. Secondly, it could involve policy makers as well as researchers, so that researchers can, in a scientifically valid way, distill lessons learned and test new ideas empirically. Conversely, this provides researchers with a 'living lab' to study and develop new approaches/interventions, and empirically evaluate them, potentially as a self-sustaining endeavor via joint research grant applications and local advocacy.

This workshop aims to discuss, and potentially advance, the purpose(s), operationalization and structural self-sustainability of the CLN.
A parameter-free population-dynamical approach to health workforce supply forecasting in EU countries
Authors: Klimek P , Gyimesi M , Ostermann H , Thurner S
Published: October 2020

Many countries face challenges like impending retirement waves, negative population growth, or a suboptimal distribution of resources across medical sectors and fields in supplying their healthcare systems with adequate staffing. An increasing number of countries therefore employs quantitative approaches in health workforce supply forecasting. However, these models are often of limited usability as they either require extensive individual-level data or become too simplistic to capture key demographic or epidemiological factors. We propose a novel population-dynamical and stock-flow-consistent approach to health workforce supply forecasting complex enough to address dynamically changing behaviors while requiring only publicly available timeseries data for complete calibration. We apply the model to 21 European countries to forecast the supply of generalist and specialist physicians until 2040. Compared to staffing levels required to keep the physician density constant at 2016 levels, in many countries we find a significant trend toward decreasing density for generalist physicians at the expense of increasing densities for specialists. These trends are exacerbated in many Southern and Eastern European countries by expectations of negative population growth. For the example of Austria, we generalize our approach to a multi-professional, multi-regional and multi-sectoral model and find a suboptimal distribution in the supply of contracted versus non-contracted physicians. It is of the utmost importance to devise tools for decision makers to influence the allocation and supply of physicians across fields and sectors to combat imbalances.

Key messages

The trend of increasing supply of physicians continues in most European countries—stronger for specialists than for general physicians. To avoid potential physician shortages, in particular in primary care, we need to combat imbalances of physicians across sectors and medical fields.
Factors associated with coinfection and reinfection by chlamydia, gonorrhoea and syphilis in Portugal
Authors: Pinho-Bandeira T , Ricoca Peixoto V , Dias S , Sá Machado R
Published: October 2020

In Europe, cases of chlamydia (CT), gonorrhoea (NG) and syphilis (TP) are rising and coinfections and reinfections are common. As there are limited data on factors associated with these events in Portugal, this study may be valuable to inform prevention strategies. We conducted an analytical cross-sectional study with all probable and confirmed cases of CT (including lymphogranuloma venereum), NG and TP notified in Portugal in the national system of epidemiological surveillance (SINAVE®) between January 1st, 2015 and December 31st, 2018. Descriptive and multivariable analyses were conducted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated.

Among 6506 cases in SINAVE®, 858 (13.2%) were coinfections and 204 (3.1%) were reinfections. Coinfections were found in 14.0% of males and 10.2% of females, while reinfections were present in 3.8% of males and 0.8% of females. In multivariable analysis, coinfections were positively associated with being younger than 26 (aOR 2.45, 95% CI 1.81-3.30), living in Lisbon area (aOR 1.43, 95% CI 1.13-1.81), being symptomatic (aOR 1.82, 95% CI 1.53-2.18), being men who have sex with men (MSM) (aOR 1.63, 95% CI 1.28-2.07), HIV+ status (aOR 1.46, 95% CI 1.19-1.80) and being diagnosed in an NGO (aOR 1.68, 95% CI 1.29-2.19). Reinfections were positively associated with living in Lisbon area (aOR 2.53, 95% CI 1.43-4.47), being symptomatic (aOR 2.37, 95% CI 1.66-3.37), being MSM (aOR 3.69, 95% CI 2.17-6.30) and HIV+ status (aOR 1.68, 95% CI 1.18-2.39).

This study contributes to identifying risk profiles for coinfection and reinfection by these STIs in Portugal. Younger age, living in Lisbon area, being MSM, HIV+ status and being diagnosed in an NGO are some of the associated factors. Targeted interventions are needed to tackle specific settings and populations to be successful in lowering STI's incidence in Portugal.

Key messages

We identified factors associated with coinfection and reinfection by chlamydia, gonorrhoea and syphilis in Portugal, that can be used to target interventions. A study to identify the changes and problems in sexual attitudes and sexual behaviour may be useful to help us understand this paradigm.
Health promotion in Latin America: an institutional overview from planning to action
Authors: Tristão F I , Gomes I M
Published: October 2020

The 9th Global Health Promotion Conference held in Shanghai in 2016 resulted in the development of the Shanghai Declaration and the International Guide for Implementing the Shanghai Declaration, which addresses the context of Health Promotion for Sustainable Development considering the particularities of nations. Through these international instruments, countries commit themselves to build lines of action for the implementation of health promotion in their respective nations.

The objective of this work was to analyze the coherence of the countries of Latin America in the development of the actions for the implementation of health promotion in the context of sustainable development contemplated through instruments such as National Health Plans, National Policies and other institutional documents that aim to stimulate and strengthen transformational health policy commitments.

Data were obtained by searching for the existence of the instruments mentioned above on the official websites of the governments of the twenty countries of Latin America, including websites of the respective ministries of health. Once these instruments were found, the content was read to identify whether the context was consistent with international instruments.

The results showed that between the twenty countries in Latin America, seventeen presented a National Health Policy available on their websites. However, three of these Plans were not consistent with international instruments. In addition, eleven countries had specific Health Promotion Policies, but in one of these countries, this instrument was not in line with the international proposal. Finally, seven of the twenty countries also had guides or other specific materials designed to stimulate and strengthen transformative health policy commitments.

It is concluded that most of the countries in Latin America are engaged in enhancing health promotion, but there is still many gaps to be filled up to reach this goal in a satisfactory way.

Key messages

Most of the Latin America Countries seems to be engaged with health promotion, even when a few countries showed a lack of planning its policy instruments. Health Promotion requires more than planning, and it is possible to perceive that some countries develop his policies without rigorous criteria to make it happen.
Politicians’ view on their role in promoting health – developing a questionnaire
Authors: Svanholm S , Carlerby H , Viitasara E
Published: October 2020

Background

Although the political context is recognized as an important determinant of health, there is limited research on politicians' role in health promotion. No fitting questionnaire to study the subject could be identified, therefore a new questionnaire was developed.

Methods

An inductive approach was used and the first step was semi-structured interviews with six politicians. They represented two different municipalities and four different political parties from different sides of the Swedish political spectrum. The interviews focused on the politicians’ view on their role, responsibility and possibility to promote health. The data was analysed by means of qualitative content analysis. Five categories were created with several sub-categories each. The categories formed the sections of the questionnaire. Statements and questions were created to cover all the sub-categories. The statements were assigned Likert-scales (strongly agree to strongly disagree) for answers and some of the sentences were turned into questions. Lastly, face validity of the questionnaire was tested by the interviewees who filled out the questionnaires, two by thinking aloud as they did and three by filling out the online version of the questionnaire and leaving comments on the questionnaire.

Results

This resulted in a questionnaire with five sections focused on: Politicians view on health and health promotion; to affect health as a politician; collaboration between actors; the politics of health; the municipality/region organisation and prerequisites.

Conclusions

The questionnaire opens up for explorative studies on politicians' view on their role, responsibility and possibility to promote health. It is currently being used in a study exploring local and regional politicians in the north of Sweden and their role in health promotion.

Key messages

Politicians’ view on their role in health promotion is of importance to explore. The developed questionnaire can be used to study politicians’ role in health promotion.
Opportunities for drowning interventions using existing government policy and programmes in India
Authors: Gupta M , Zwi A , Jagnoor J
Published: October 2020

Background

Children living in coastal, rural India face a particularly high risk of drowning due to rurality, presence of open water, lack of accessible health systems and poor infrastructure. No drowning interventions are currently implemented in India. Interventions that build on existing policy targets or government programs are more likely to be sustainable and scalable.

Methods

For the first time to our knowledge for an injury-related issue in India, detailed content review of policy was conducted to identify both policy principles and/or specific government programs that may be leveraged for drowning interventions. The reach, enablers and barriers of these programs were assessed through a systematic literature review. Identified policies and programs were also assessed on how they catered for underserved groups and took into consideration equity.

Results

Three programs may be leveraged for drowning interventions: The Integrated Child Development Scheme (ICDS), Self-Help Group (SHG) and Accredited Social Health Activist (ASHA) programs. All three had high coverage and considered underserved groups such as women and rural populations.

Conclusions

Programs targeting specific health outcomes should consider interventions outside of the health sector that address social determinants of health. This may enable the program to better align with relevant government agendas and increase sustainability.

Key messages

This is the first systematic analysis of both policy content and execution of government programs to provide comprehensive insights into possible implementation strategies for an injury intervention. This methodology may be applied by other researchers identifying sustainable intervention options supported by government policy and/or programs.
Risk factors for death within 90 days of Clostridium difficile infection
Authors: Koziol M K , Z.urek M Z
Published: October 2020

Background

The conducted analysis emphasizes increasing problem of Clostridium difficile infections (CDI) in Poland. There are no other publications based on Polish healthcare data that would more precisely indicate the impact of risk factors for death after the infection. The purpose of the analysis was to present the incidence of CDI in the overall population of Poland in the years 2009-2018 and to evaluate the risk factors for death within 90 days after CDI infection.

Methods

In order to detect the incidence of CDI the data of the National Health Fund from years 2009-2018 were used. Code A04.7 from International Classification of Diseases (ICD-10) allowed to identify CDI. Risk factor analysis was based on 14 212 patients' hospitalizations in the year 2017. The risk factors were related to patient's medical history and demographic profile. Logistic regression was applied to estimate the impact of the defined variables on the death within 90 days after CDI infection.

Results

CDI incidence increased from 952 hospitalizations in 2009 to 14 582 hospitalizations in 2018. Morbidity of CDI infections (48,3/10 000 patient days in 2017) indicated Poland as the country with the highest prevalence in the European Union (average 2,38/10 000 patient days in 2016). 37,1% of the patients died within first 90 days after CDI infection in 2017. The most important factors that increases the chance of death are: age (>85 OR = 25,8, 65-84 OR = 10,5, 50-64 OR = 4,7 in comparison to age <50), AIDS/HIV (OR = 4,6), metastatic cancer (OR = 4,6), weight loss (OR = 2,6) and alcohol abuse (OR = 2,1).

Conclusions

The results indicated increasing problem of CDI in Poland. It is important to take precautions and use more effective treatment methods particularly in case of the most exposed populations. Furthermore, policy makers should pay attention to compliance with the principles of restricted sanitary procedures and increase awareness of CDI epidemiology among doctors.

Key messages

CDI is an increasing problem, unmentioned in health policy. Restricted sanitary procedures should be implemented in case of hospitalizations of older patients with comorbidities.
Indigenous suicide in Brazil, the self-killing of a vulnerable population
Authors: Saldanha R C O , Abe G M , Abe A H M , Mariano M E O , Pierson I D S , Santana B F , Lima P H R O
Published: October 2020

Introduction

One of the Sustainable Development Goals is to promote mental health. It is then mandatory to know the death profile of this population and to develop public policies to reduce it.

Methods

Epidemiological descriptive study regarding the proportion of indigenous deaths according to the variables: age group, year of occurrence, gender, region, municipality and ICD-10 category, in the period 2008 to 2017 in Brazil, using data from the national database DATASUS.

Results

From 2008 to 2017, there were 5,489 indigenous deaths due to external causes in Brazil, with 1,107 (20.1%) due to self-caused lesions. The annual average was 110.7 cases per year: 100 in 2008, 95 in 2009, 93 in 2010, 97 in 2011, 90 in 2012, 113 in 2013, 117 in 2014, 132 in 2015, 120 in 2016, and 150 in 2017. Regarding causes, strangling/hanging/suffocation were 979 (88.4%), self-intoxication was 31 (2.8%) with other chemicals and 21 (1.8%) with pesticides. Regarding age group, 365 (32.9%) were between 15 to 19 years old, 325 (29.3%) between 20 to 29, 150 (13.5%) between 30 to 39, 131 (11.8%) between 10 to 14, and 136 (12.2%) in other age groups. Regarding gender, 807 (72.9%) were male, 299 (27.0%) were female, and 1 (0.09%) was ignored. Regarding region, the Northern Region had 575 (51.9%) cases and the Central-Western Region had 403 (36.4%) cases. The municipality of São Gabriel da Cachoeira was the one with the highest amount of cases: 132 (12.7%).

Conclusions

The 50% increase in the amount of deaths by suicide among indigenous people in the analyzed period reveals the infficacy of established public policies in Brazil. The number of deaths among the youth reveals the community trauma of exploration, violence and dignity loss. The Nothern and Central-Western regions had conflicts due to land demarcation and prospecting, which explain the high rates. The reduction of such tragedy demands capacitation of all the public spheres.

Key messages

Evaluate the aspects that promote it and to propose effective interventions in environments of difficult access and in a historically vulnerable population. Discuss some relevant characteristics among natives who are vulnerable to practicing self-made injuries, in order to make it possible to create new ways to protect this population.
A qualitative review of maternal health care provision for migrant and refugee women
Authors: Kasper A , Mohwinkel L-M , Nowak A C
Published: October 2020

Background

The number migrants increased worldwide. Pregnant migrant/refugee women are considered a vulnerable group. How do professionals manage their care? The aim was to summarize the current evidence regarding maternal health care provision for migrant/refugee women.

Methods

We conducted a systematic review and searched the databases PubMed (MEDLINE); CINAHL; PSYNDEX, PsycINFO and Cochrane Library. Studies were judged for eligibility: a study had to address maternal health care provision for migrant/refugee women who immigrated to an OECD member state. Publication date was restricted to 1990-2019, and language to English or German.

Results

16 primary (qualitative) studies were included. Heterogeneity of the included studies exists regarding e.g. origin of the women, migration background, receiving country. Nevertheless, synthesis can provide valuable information on challenges and how to deal with migrant/refugee women in maternal health care. Communication difficulties pose challenges on professionals (15 studies). Possibilities to deal with them: bridge-languages, non-verbal communication and interpreters. In addition, finding one's way in the unknown health care system is a barrier for women, which professionals can meet by informing the women and coordinating care (8 studies). The perceived diversity of women can lead to conflicts in care (10 studies). While some studies recommend 'cultural recipes', other authors emphasize the individuality of women and prefer a holistic care approach.

Conclusions

Professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers, coordinating care and handling women's diversity. Initiating and enhancing public health activities such as training courses for professionals that convey general principles such as woman-centered care, communication techniques are valuable opportunities to improve migrant/refugee women's maternal health care provision.

Key messages

Maternal health care professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers, coordinating care and handling women's diversity. Initiating and enhancing public health activities such as training courses for maternal health care professionals are valuable opportunities to improve migrant/refugee women’s maternal care.
A halve salt reduction intervention doesn’t affect the acceptance of school lunch
Authors: Liz Martins M , Freitas A S
Published: October 2020

Background

Considering the high salt consumption by children and their impact on future health, is utmost importance the salt reduction on school meals. Though, it is essential to evaluate the acceptance of less salty meals to guarantee that nutritional requirements are not compromised.

Methods

This case study was performed at a Portuguese primary school, in city of Porto, including all children aged between 3 and 10 years. Added salt per meal was determined for dishes and soups, during 5 consecutive days in 1st and 2nd phases, by weighing salt added during meals preparation and considering the average portion served to children. An intervention for salt reduction was performed by halve the added salt through cooks training. Meals acceptance was evaluated by plate waste determination, using the aggregated weighing method, in order to compare differences in acceptance of school lunch before and after salt reduction.

Results

A total of 475 meals was evaluated. Before intervention, it was observed a mean value for added salt of 0.786g (±0.073g) for soup and 1.156g (±0.411g) for dish, totalized 1.942g (±0.393g) of salt added per meal, value higher than recommended for lunch (about 1.5g). During intervention, it was experienced a reduction of added salt between 45.7% and 52.8% for soup and between 41.3% and 50.6% for dish. The salt mean value added per meal was 1.010g (±0.170g), allowed the achievement of recommendations. There were no differences neither in the dish plate waste (p = 0.094) nor in the soup waste (p = 0.838) between the two phases.

Conclusions

This study showed that a 50% reduction of added salt doesn't affect the acceptance of school lunch by children aged between 3 and 10 years old. The success of this intervention could be important for developing school food policies in order to offer balanced meals either with an adequate salt content to achieve World Health Organization goals for salt reduction and consequently enhance public health.

Key messages

It has been possible to halve added salt on school lunch without affect children’s consumption. School policies aiming to promote healthy eating habits by reducing meals salt availability could be effective.
Designing health risk assessment report for wellness clinic patients
Authors: Bhatnagar A
Published: October 2020

Introduction

With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the technical content of test reports, there are very few guidelines on a patient-friendly presentation of such laboratory reports. The complexity of lab test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for them.

Methodology

User feedback was obtained on the Lab Report / medical summaries of a tertiary level hospital based on a pre-tested questionnaire Health Risk Assessment Report was prepared with a view to address patient barriers Functionality enhancements were arrived at for estimating work effort by business analyst of the Customer Relationship Management team.

Results

Patients' health literacy, awareness of inherited diseases, e-health literacy and risk perception were found to be impacting the interpretation of lab results. Based on the user feedback (88% opting for graphical and pictorial presentation), 13 functionality enhancements have been arrived at and submitted to the Customer Relationship Management team for initiating a change management report taking into consideration the training load and cost implications.

Conclusions

Patient friendly systems (CRM) enhance the understanding on the criticality of their health conditions, impacting health seeking behavior. Effective CRMs help hospitals in providing cost effective health care to the community. The enhancements, however, have to be in adherence to the EHR standards of the country.

Key messages

Effective CRMs help hospitals in providing cost effective health care to the community. Patient friendly systems (CRM) enhance the understanding on the criticality of their health conditions, impacting health seeking behavior.
Health literacy among first-generation Italian immigrants in Norway
Authors: Terragni L , Calogiuri G , Finbråten H
Published: October 2020

Background

People with an immigration background often have poorer health than the general population. Italians in Norway have tripled throughout the past 15-years, but little is known about their health. Health literacy (HL) has been emerging as a fundamental construct in enabling citizens to play an active role in improving their own and theirs community's health. The objective of our study was i) to describe HL among first-generation Italian immigrants in Norway, ii) examine the association between HL and health-related empowerment, and iii) compare HL in Italian immigrants with the general Norwegian population's.

Methods

The data was retrieved from a cross-sectional survey (n = 321) conducted within the study Mens Sana in Corpore Sano (inclusion criteria: age ≥18 years, living in Norway permanently, having lived in Italy at least until age 16). HL was measured using the short form of the European Health literacy survey questionnaire (HLS-Q12; α = 0.83). Empowerment was assessed using a 4-items scale (α = 0.73), developed on basis the World Health Organization's definition of individual empowerment and aspects of patient empowerment. Additionally, information about gender, age, educational level, and self-rated health was collected.

Results

Preliminary results indicated that 8% had inadequate HL, whereas about 40% had marginal HL. No significant differences in HL were observed in relation to gender, age, education level or general health. A medium correlation was found between HL and empowerment (r = 0.42, p < 0.001). The Italian's HL was significantly lower than the general Norwegian population's (M±SD = 32.46±4.79 and 33.11 ± 4.12, respectively; p = 0.028).

Conclusions

This is the first study investigating HL and its associations with the health-related empowerment of first-generation Italian immigrants in Norway. More research is needed in order to better understand this phenomenon as well as the effectiveness of HL-enhancing initiatives.

Key messages

We investigated the levels of health literacy and health-related empowerment among first-generation Italian immigrants in Norway. The Italians’ heath literacy, which correlated with empowerment, was lower than the general Norwegian population’s. There were no differences across gender, age, education level or general health.
Quality Evaluation of Mobile Applications for Fine dust Management
Authors: Lee J B , Woo H K
Published: October 2020

Background

Recently, the use of fine dust management mobile applications has been on the rise in South Korea. The aim of this study is to describe the current status of fine dust and air pollution mhealth apps used in Korea and to make qualitative assessments of them.

Methods

App search contents analysis 400 apps were searched using PM2.5, PM10 and yellow dust, the main keywords related to fine dust, referring to the preceding reference from December 30, 2019 to January 2, 2020. Among the apps searched, apps that meet all six criteria, such as those with 1) user score ≥4.0, 2) n of review Top 50, 3) those that do not duplicated, 4) apps that are related to the topic, 5) apps set in Korean, and 6) apps that do not have errors, were selected for the study. App assessment The app evaluation of the study utilizes the MARS scale, an app assessment tool developed overseas. The assessment was conducted for a week from January 3, 2020 to January 10, 2020. Each of the apps averaged scores evaluated over a week for each category and averaged over five categories for an overall quality score.

Results

The standard deviation of the information and functionality of the 30 apps was similar, with 3.62 (SD 0.38) and 3.58 (SD 0.43), respectively. On the other hand, engagement was the lowest with an average of 3.1 (SD 0.44). The average of aesthetics was 3.4 (SD 0.64), indicating that deviations between apps were very large

Conclusions

It is deemed necessary to improve the user interface (UI) and configuration of the app to enhance the application's engagement and aesthetics in order to increase the use of fine dust apps by consumers and gain effect.

Key messages

This research provided information that consumers can reasonably use and select mobile health apps by evaluating and reviewing the contents of fine dust and air pollution mobile health apps. this study is important in that it can serve as a reference for app developers to consider in future app development.
Health care renunciation in Tunisian diabetic patients, 2016
Authors: Rejaibi S , Cherif I , Ben Mansour N , Zoghlami N , Saidi O , Skhiri A , Ben Slama F , Ben Romthane H , Turki Z , Aounallah-Skhiri H
Published: October 2020

Background

Diabetes management requires access to health care, patient awareness about hygiene and diet measures, and patient adherence to prescribed treatment. Health care renunciation (HCR) can make diabetes management really challenging. We aimed to determine the prevalence of HCR in diabetic Tunisian patients and assess associated factors.

Methods

Data were obtained from the 2016 Tunisian Health Examination Survey, a household survey stratified at three degrees. For each household, two people aged 18 and over were randomly selected. Data were collected using: a household questionnaire and an individual questionnaire (risk behaviours and medical history). Diabetic patients were asked whether, they had renounced any health care service, the last time they needed to seek healthcare. Data analysis was performed with R software.

Results

A total of 880 diabetic patients were included in this survey, with a mean age of 61±12 years and a sex ratio M/F equal to 0.9. The prevalence of HCR was 4.9% (95% CI [3.3-6.5]), higher in men (7.4% VS 2.6% in women, p = 0.003) and higher in urban areas (5.4% VS 3.1 in rural areas, p = 0.09). After multivariate adjustment (taking into consideration age, gender, profession, health insurance and place of residence as independent variables), having no health insurance and being aged more than 50, were significantly associated to HCR, with adjusted Odds Ratios equal to (3.8, 95% CI [1.4-9.2]) and (3.4, 95% CI [1.9-10.1]), respectively.

Conclusions

Our study has highlighted a relatively low prevalence of HCR compared to literature data (4.9% VS 10-15%), explained mostly by methodological differences regarding HCR assessment. HCR in diabetic patients is mostly explained by economic reasons, which show how important is a better organisation of Tunisian public health system to ensure equity in access to health care.

Key messages

Health care renunciation in diabetic Tunisian patients is explained mainly by financial reasons (having no health insurance). Moving further towards improving universal health coverage is a key pillar in the proper management of chronic diseases such as diabetes.
A tool to identify potential primary care presentations in the hospital emergency department
Authors: Schütze H , Rees R , Asha S , Eagar K
Published: October 2020

Background

Access to primary care has an impact on health outcomes and is a significant public health issue. Limited access to primary care has seen non-urgent presentations to hospital emergency departments continue to rise globally. A lack of a universal workable definition of what a primary care presentation is has impeded national and international estimations of the true burden. Our aim was to develop a standardised code frame to identify potential primary care patients in the emergency department to allow accurate data estimations to be made, and help inform future interventions.

Methods

An audit of medical records was conducted in two major hospitals in Sydney, Australia. A code frame was developed, tested and applied retrospectively to five years of data.

Results

Of 601,168 presentations to the emergency department, 171,906 (29%) were deemed to be potential primary care presentations. The code frame had a sensitivity of 99.9% and a specificity of 49.0%.

Conclusions

This standardised code frame enables accurate retrospective local and national data estimations of the impact of primary care presentations in the emergency department, which was previously not available. The code frame could be used prospectively to evaluate interventions such as diverting patients to primary care settings, and to identify populations for specifically targeted interventions. The conservative nature of the code frame ensures that only those that can safely receive care in a primary care setting are identified as potential primary care.

Key messages

This robust tool will enable more accurate data estimations of primary care appropriate presentations in the emergency department, which can assist planning and policy efforts. It can be easily adapted to incorporate triage codes in international settings and provides a useful tool for comparing international trends.
Association between ward-transfers and hospital-acquired infection: a study using routine data
Authors: Boncea E , Expert P , Costelloe C
Published: October 2020

Ward-transfers have become more common as hospital staff balance patient needs with bed availability on specific wards. However, increased movement through the hospital may leave patients more vulnerable to potential infectious pathogen transmission routes via increased exposure to contaminated surfaces and more contacts with individuals. This may increase their risk of hospital-acquired infections (HAIs), an adverse event associated with greater antibiotic resistance, patient costs, morbidity, and mortality. This study aimed to quantify the association between the number of ward-transfers undergone during a hospital spell and the outcome of HAI. As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, analysis was focused on people over 65-years old.

A retrospective case-control study was undertaken using data extracted from electronic health records and microbiology cultures of non-elective medical admissions to a London hospital trust between January 2016 and December 2018 (n = 24,439). Logistic regression was used to obtain the odds ratio for developing a HAI as a function of the number of ward-transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for covariates including length of stay, procedures and comorbidities. Each additional ward-transfer increased the odds of developing a HAI by 8% (OR 1.08; 95%CI:1.04-1.12).

The hospital is a complex environment, and interventions should be viewed in light of their impact on the system as a whole. These findings indicate that non-essential ward-transfers of elderly patients should be minimised. This may lower the incidence of infections in this population, potentially reduce the number of pathogen transmission routes in hospitals and alleviate staff burden incurred by ward-transfer associated procedures.

Key messages

We analysed 3 years of patient movement and microbiology data of elderly patients in a London hospital trust. Each ward-transfer increased the risk of developing a hospital-acquired infection by 8%. Reducing the number of non-essential ward-transfers patients undergo may lower the incidence of hospital-acquired infections; the decision to move a patient should therefore be carefully considered.