bluuebunny/crossref_metadata_2025 huggingface dataset:
The challenge of defining chronic illness for health monitoring in children: opening a can of worms
Authors: Neuhauser H , Thamm R , Mauz E , Poethko-Müller C
Published: October 2020

Background

A straightforward health monitoring definition of chronic illness in children would have great utility for estimation of health care and social service needs as well as resource allocation.

Methods

This study analyses various definitions of chronic illness in children and adolescents in cross-sectional national health surveys in Germany based on: the Children with Special Health Care Needs (CSHCN) 14-item-questionnaire, a list of 15 self-reported medical diagnoses in the past 12 months, and a generic single-question parent-reported chronic condition from the Minimum European Health Module (MEHM), also used in EU-SILC and EHIS surveys.

Results

13.7% (95% CI 13.0-14.4) of children and adolescents aged 0-17 years had special health care needs in the first National Interview and Examination Survey in Children and Adolescents in Germany KiGGS 2003-2006. However, surprisingly, the prevalence was less than half in children with a migration background and was not associated with social status or income. The list of diagnoses identified a very high proportion of 31.5 (30.7-32.4) of children aged 0-17 years as chronically ill but does not take into account disease severity or impact. The generic MEHM-question in the KiGGS 2009-2012 survey identified 16.2% (15.3-17.1) of 0- to 17-year-olds as chronically ill, however, only one in five was affected in their daily activities. Parents denied chronic illness in 11.2% of children with epilepsy, 18.8% of children with asthma and 62.8% of children with attention deficit hyperactivity disorder.

Conclusions

None of the three definitions of chronically ill children is entirely satisfactory so far: CSHCN may need an adaptation of the German version to better capture inequalities, the disease list needs further severity differentiation and MEHM has recently shown low test-retest reliability (kappa 0.56) when administered twice within 6 months in a large Belgian sample and may need revisiting as well.
On the art of doing surveys among adolescents
Authors: Due P , Arnarsson A M , Lyyra N , Löfstedt P , Madsen K R , Thorsteinsson E B , Välimaa R , Torsheim T , Damsgaard M T , Eriksson C
Published: October 2020

The aim is to discuss methodological challenges for research on adolescent positive mental health. A first consideration is which questions should the measurement instrument answer. In the clinical context it should have the properties of giving enough information for making a diagnosis of high quality. In the public health context, its objective may be to give information that enables the researcher to describe trends at the population level and provide guidance on areas of intervention.

The HBSC study is monitoring the health and health behaviour of school-aged children in a public health context. It is a population survey, defined by the form of data collection and the method of analysis. The data is collected by questionnaire from a representative sample of school-aged children. It tries to answer descriptive questions (What, who, when?), but also tries to explore causal associations (Why?), given the limitations of the cross-sectional design.

Surveys have advantages: Good for gathering descriptive data; Can cover a wide range of topics. Are relatively inexpensive to use; Can include large number of respondents; and Can be analysed using a variety of existing software. Among the disadvantages can be mentioned: Self-report may lead to biased reporting; Data may provide a general picture but lack depth; Difficult to obtain adequate information on context; and Differences in understanding: it is difficult to formulate questions in such a way that it will mean exactly same thing to each respondent.

The choice of measurement tools or indicators involves both theoretical and practical issues. Multidisciplinary research teams may include different theoretical traditions, which is an asset but also make it necessary to be explicit regarding overall aims of the study. Most often the theoretical issues focus one of three topics: the value of the types of data; the relative scientific rigor of the data; or basic, underlying philosophies of evaluation.
The Swedish study on improved contraceptive counselling for immigrant women postpartum
Authors: Larsson E , Kilander H , Weinryb M , Vikström M , Petersson K
Published: October 2020

Contraceptive choices postpartum have not previously been studied in Sweden. Being foreign born is a risk factor for induced abortion. Improving postpartum contraceptive counseling could potentially fulfill unmet needs for contraception.

This is an organizational case study using a Quality Improvement Collaborative (QIC) within the regular healthcare setting at 3 maternal health clinics in Stockholm. The active phase of the study was Sep2018-Sep2019. Quantitative and qualitative methods were combined. Routine registration of choice of postpartum contraception was introduced at the clinics and analyzed focusing on Swedish born and foreign-born women. Midwives and researchers met continuously, and during the active phase every 2-3 months in learning seminars with around 20 participants. During the learning seminars PDSA-cycles were used and areas of improvements for continuous performance measures were chosen. The midwives decided on and tested multiple evidence-based changes in contraceptive counselling and services during action periods. Goals were set and competency building in areas chosen by the midwifes were held. In addition, both foreign- and Swedish born women gave their input to the improvement areas. Qualitative data was analyzed through content analysis from field notes and verbatim transcripts.

Preliminary results show that the proportion of women choosing an effective contraceptive method (SARC or LARC) among immigrant women increased from 40% to 55% when comparing the start and the end of the project. The midwives reported how they had changed their approach when counselling women who were skeptical about contraception and tried to find a new way to meet women's needs.

As much as the QIC showed positive results, it was a small-scale study in 3 clinics in one geographical area. A larger study to determine and explain the effectiveness of QIC on the proportion of immigrant women choosing an effective contraceptive method postpartum is planned for 2021-2024.
Applying translational behavioural science to improve people’s health
Authors: Nagyova I
Published: October 2020

Background

The rising burden of chronic diseases poses a challenge for the whole public health system, and to deal with this we need to address the socioeconomic, cultural, and behavioural aspects of health and its determinants. While a change in individual 'lifestyle' factors, such as diet, exercise, smoking, and alcohol are often the target of intervention design, there needs to be an acknowledgement that behavioural science is much more than just 'lifestyle choice' on the individual level.

Governments worldwide are increasingly incorporating the behavioural insights approach into policymaking. There has been an increasing interest in 'choice architecture' and 'nudging' to facilitate behaviour (change), often by manipulating elements of the environment. Designing interventions that target the most important determinants of behaviour, based on research evidence in the field of behavioural science, provide the best chance of changing behaviour and demonstrating a positive impact in terms of health outcomes and cost-effectiveness. However, knowing what works and how to apply it presents an ongoing challenge.

Results

The COM-B, EAST, and MOST are behaviour change models that were built on an impressive effort to synthesize available evidence regarding intervention development frameworks, behaviour change theories, and behaviour change techniques. They tackle determinants of behaviour in terms of capability, opportunity, and motivation on the level of the individual (micro level), alongside ways in which to intervene, at mezzo level (intervention functions) and macro level (policy categories).

Conclusions

These approaches take a holistic view of interventions and can contribute to the development of new scientific knowledge regarding mechanisms underlying effective knowledge mobilization in behaviour change. They are also expected to further support the adoption of the evidence-based practices within the field of public health.
The geriatric workforce: is there anybody out there to care in Romania?
Authors: Ungureanu M I , Paina L , Brînzac M G , Forray A , Donca V , Avram L , Crișan D
Published: October 2020

Background

Demographic changes - such as population ageing - pose great challenges to health systems around the world. For the Romanian health system, challenges might be particularly difficult to address. Facing a severe under-funding and significant workforce maldistribution, the health system in Romania is called to care about both the ageing population and the workforce taking care of the elderly. The aim of this paper is to apply the health labour market framework to the geriatric workforce in Romania.

Methods

The paper describes the composition and distribution of the geriatrics workforce in Romania based on data in the Healthcare Facility Activity report, policy documents and available reports.

Results

Geriatric care is provided in Romania mainly by geriatricians employed by public hospitals. The team around geriatricians is limited to nurses only, with other professions - such as psychologists, physiotherapists and social workers - almost absent. Even though the number of geriatricians has increased country-wide over recent years (from 149 to 242), there are significant differences in their distribution at a county level. Eleven counties out of the 41 reporting to have only 1 geriatrician for populations of hundreds of thousands. Training curricula for geriatrics residents fall short of addressing team work and inter-professional collaboration. Reports show growing concern over geriatrician burnout, caused in part by inadequate team work. Faced with burnout risk, many of them report considering changing specialties, which would further aggravate the lack of comprehensive elderly care.

Conclusions

The geriatrics workforce in Romania is poorly developed, and significant efforts are still needed to develop policies addressing geriatrics production, inflows and outflows, and maldistribution and inefficiencies. Moreover, addressing burnout by improving teamwork and collaboration is vital for maintaining and improving the workforce morale and motivation.
22.D. Workshop: The Food Environment Policy Index for the EU, Germany, the Netherlands, Norway and Poland
Authors:   Organised by: Pettenkofer School of Public Health (Germany),   Chair persons: Peter von Philipsborn - Germany, Karin Geffert - Germany
Published: October 2020

Unhealthy diets are a key risk factor for disease and premature death in Europe and worldwide. Moreover, the food system is a key driver behind many processes of global environmental change, including climate change, biodiversity and habitat loss. Accordingly, calls have been made for a transformation of the global food system. This requires action in a variety of policy fields and on all political levels. The creation of healthy food environments through public sector action on a national and regional level is an essential aspect of this.

The Food Environment Policy Index (Food-EPI) is an established methodological framework for the assessment, analysis and benchmarking of public policies influencing food environments, developed by INFORMAS, a global network of public-interest organizations.

In this 90 min workshop, we will present the approach used by the Food-EPI and results from the implementation of the Food-EPI on the EU level and in Germany, the Netherlands, Norway and Poland, followed by a joint discussion of lessons learnt and key policy implications.

The Food-EPI has two components (policy and infrastructure support domains) covering a total of 13 domains and 47 indicators. For each indicator, policies and actions are compiled and benchmarked against international best practice by independent experts and stakeholders. Based on this assessment, priority actions for reform are identified. Policy makers and independent public health and nutrition experts are involved in key steps of the process to ensure policy relevance and impact.

Key messages

The systematic assessment and benchmarking of nutrition policies helps to identify priority actions to improve food environments and enhances government accountability for public health. Both on the EU level and in EU member states, governments have taken action to support healthy food environments, but considerable room for improvement remains.
Evaluating food-related policies in Germany using the Food Environment Policy Index (Food-EPI)
Authors: Geffert K , von Philipsborn P , Stratil J M , Rehfuess E A
Published: October 2020

Background

Germany has seen as rising burden of diet-related adverse health outcomes. Policies for improving food environments and related infrastructure are essential to reduce this burden. A growing awareness of the interlinkages between sustainability and nutrition underlines the need for healthy, sustainable food environments. Therefore, we applied the Food Environment Policy Index (Food-EPI) with an additional domain on sustainability to monitor German food policies and to formulate actions for improvement.

Methods

For the evidence analysis information on food environment and infrastructure was collected from various sources. Results were validated with an expert group consisting of representatives of government agencies, non-governmental organizations and academia. The level of implementation, compared to international best practice examples, was ranked by the expert group through an online survey. A one-day workshop was conducted to identify actions to fill the gaps identified in the online ranking and to prioritize these actions in terms of importance and achievability.

Results

The application of the Food-EPI to German policies and interventions shows a nuanced picture of strengths and weaknesses of the German food environment and infrastructure. Some domains such as monitoring and surveillance are in line with international best practice, however other domains show considerable room for improvement. The recommended actions to improve the shortcomings of the German food environment includes a list with priority actions.

Conclusions

The results from the Food-EPI provides an in-depth analysis of German food environment policies and infrastructure, as well as a list of prioritized actions to improve it.

Key message

Integrating a sustainability domain into the Food-EPI offers opportunities to identify priority actions for the creation of healthy, sustainable food systems.
Economic growth, population health and Sustainable Development Goal 8
Authors: Brunner E , Cable N , Iso H
Published: October 2020

High-income countries (HICs), including UK, Germany and Japan, are reducing CO2 output relative to economic growth. SDG8 refers to 'sustainable growth' but does not differentiate between low, middle- and high-income countries. The United Nations target is for net-zero CO2 emissions by 2050, therefore there is a strong case for exploring the implications of low or zero economic growth among HICs as a mechanism for limiting climate change. A key consideration is whether progress in population health would stall if HIC economies stopped growing.

We examined headline health statistics among HIC countries for evidence of divergence in health trends. We looked for associations between trajectories of national economies and health trends over the past four decades. Age-standardised death rates were calculated from all-cause and cause-specific rates in the WHO mortality database. All-cause mortality (ACM) rates declined in parallel in UK, France and Japan, from about 700 to 400/100,000 in the period 1980-2010, with the lowest rates in Japan. Decline in the ACM rate in USA was shallower 1980-2010. In the decade of austerity following the banking crisis, the ACM rate in USA and UK stopped declining. The Japanese ACM rate continued its rapid post-war decline in the two decades of economic stagnation after 1990. Trends in Japanese coronary heart disease, stroke and cancer mortality rates, but not those for suicide, were consistently favourable in the recent period.

The natural before-and-after experiment in Japan, of high economic growth in the decades to 1990, and low growth after 1990, is an example of a HIC with continuing progress in population health in a long period of low growth. Repeat measures of subjective, self-rated health from a population-based Japanese survey series (1986-2013) add to the evidence from objective mortality rate trends. Progress in population health does not need to stall if HIC economies focus on combatting climate change instead of growth.
Team-based Care for Improving Hypertension Management Among Outpatients
Authors: Santschi V , Wuerzner G , Pais B , Chiolero A , Schaller P , Cloutier L , Paradis G , Burnier M
Published: October 2020

Background

Innovative models of care are needed to reduce poor blood pressure (BP) control in European countries. The TBC-HTA study evaluated the effects of an interprofessional team-based care (TBC) intervention, involving nurses, community pharmacists, and physicians, on BP control compared to usual care.

Methods

We conducted a pragmatic randomized controlled study in ambulatory clinics and community pharmacies in Lausanne and Geneva, Switzerland (ClinicalTrials.gov: NCT02511093). Uncontrolled treated hypertensive patients were randomized to TBC (N = 46) or usual care (UC: N = 43). The TBC intervention was led over 6 months. Nurses and pharmacists met patients every 6 weeks to measure BP, assess lifestyle and medication adherence, and provide health education. After each visit, they wrote a report with recommendations to the physician who could adjust antihypertensive therapy accordingly. The outcome was ambulatory BP measured at 6 and 12 months.

Results

A total of 60 men and 29 women [mean (SD) age: 61(12) year; mean (SD) number of antihypertensive drugs: 2 (1)] were included. At baseline, mean (SD) BP was 144(10)/90(8) and 147(12)/87(11) mmHg in the TBC and UC care groups. 76 patients were followed up to 12 months. At 6 months, the between-group difference in mean BP was -3/+2 mmHg [95% CI: -10 to + 5 / -2 to + 5]; BP control was 38% in the TBC group and 33% in the UC group, respectively. At 12 months, the between-group difference in mean BP was -8/-3 mmHg [95% CI: -14 to -1/-7 to + 1]; BP control was 34% in the TBC group and 20% in the UC group, respectively.

Conclusions

This TBC intervention helped long-term BP control among hypertensive outpatients in Switzerland. In line with recent European guidelines (ESC/ESH), this type of care should be more widely implemented.

Key messages

A TBC of hypertension helped control BP in a Swiss healthcare setting. Policymakers should evaluate how to implement such intervention.
Vaccination: where does the responsibility lie?
Authors: Ricciardi W
Published: October 2020

W. Ricciardi will discuss the immunization complex context within this era of outbreaks providing an in-depth analysis of where the responsibilities for uptake lie
Associated factors with death among young women exposed to intimate partner violence in Brazil
Authors: Pinto I V , Marinho F , Malta D C
Published: October 2020

Objective

The objective of this study was to identify associated factors with death among young women exposed to intimate partner violence in Brazil.

Methods

Case-control study used a linked database containing nearly 800,000 violence against women notifications in Notifiable Diseases Information System over the period 2011 to 2016 and 16,200 deaths over the period 2011 and September/2017. Cases were women from 15 to 29 years old with notification of violence by an current or former intimate partner and death for any basic cause. Controls were women of the same age group, type of notification and living in the same municipalities as the cases, but without death record in that period. Odds ratios were estimated by multivariate logistic regression.

Results

790 cases and 50,870 controls were included in the study. Most of the young women died from aggression (58,2%), transport accidents (6,1%) and malignant neoplasms (3,8%). According to the bivariate analysis, age, pregnancy, race, education, area of residence, disability, place of violence, means of aggression, nature of violence and chronic violence were significant. The results of the multivariate analysis showed that the greatest odds of death were in women whose violence was perpetrated by a firearm, a sharp or blunt weapons and residents of rural areas. Young women with disabilities also had an increased chance of death. On the other hand, the higher educational level appeared as a protective factor against death. A big effort is necessary to develop strategies to prevent these announced deaths. These findings may contribute to the surveillance system for violence in health services and its performance with the serviceś network for women in situation of violence.

Key messages

Young women exposed to intimate partner violence who lived in rural areas had an estimated odds to death higher than they who lived in urban areas. The higher educational level was a protective factor against death in young women exposed to intimate partner violence.
Quality of life and risk of feminicide in women victims of intimate partner violence in Campinas
Authors: Caicedo Roa M , Gabrielle Dalaqua L , Filizola P , Cordeiro R
Published: October 2020

Introduction

Violence against women is a public health problem with severe consequences. Most women in situations of domestic violence are emotionally involved and/or economically dependent of their intimate partners contributing to the perpetuation and acceptance of violence.

Objectives

1) To characterize the women who join the Reference and Support Center for Women (Ceamo) in Campinas, Southeast Brazil. 2) To measure the quality of life in women victims of intimate partner violence 3) To determine the risk of feminicide.

Methods

The Ceamo is a public specialized service from the mayor of Campinas, it provides psychological, social and legal guidance to women in situations of gender violence. Inclusion criteria: Women attending Ceamo services, speaking Portuguese, age ≥18 years old and having experienced intimate partner violence. Measure instruments: Danger assessment Scale and WHOQOL-BREF.

Results

During the 11 months of the study, 78 new users were recruited. Average age 38.3 years old, mostly married/stable union, most of them with children (88%). 64% of women do not work and 36% live with the abusive partner. Prevalent types of violence suffered during by the victims in the last year were psychological n = 76, physical n = 62, moral n = 54 and sexual n = 23. The domain most affected in the assessment of quality of life was the environment (average 42% /100%) and psychological domain (42%/100%). 49% of women were classified with increased risk, 22% with severe risk and 1% with extreme risk of femicide. The questions with the most positive answers were those related to believing that the partner can kill her (77%), jealous of the partner (76%) and controlling behavior (73%), being followed/spied by the partner (67%) and threat death (65%).

Conclusions

The service in general receive very vulnerable women with low perception of their own quality of life, precarious material conditions and high risk of femicide.

Key messages

The women in domestic violence situation attended by the Ceamo service are at high risk of femicide. Service users have very low perception of their quality of life and poor social conditions.
Burden of occupational injuries occurred in Italy, 1900-2017
Authors: Ariani F , Baldasseroni A , Rondinone B , Ferrante P , Levi M , Balzi D , Romeo G , Biffino M , Cipriani F
Published: October 2020

Background

The GBD study allows comparison of health conditions among different societies and cultures. This permits also to estimate health variations over a long time in a single nation, overcoming the difficulties deriving from social and economic changes. INAIL, the National Institute for Insurance against Accidents at Work, provides since 1884, detailed data about the number of events and their consequences, age and sex of injured workers, and the total number of insured workers. Such data allow us to estimate DALYs in terms of incidence and prevalence, and under different mortality models.

Methods

1.8 mln. individual injury records occurred in 1990-2015 were transcoded into GBD injury categories. YLLs and YLDs were calculated considering life expectancy, DWs and duration, then distributed by compensation category. The YLLs and YLDs of permanent disabilities have been assessed with reference both to the life expectancy of the GBD 2017 and, in a competitive mortality model, to mean values at the time of the accident. Estimated DALYs were assessed both in terms of incidence and prevalence.

Results

Around 1900, an industrial worker suffered on average 0.087 incident DALY/year for occupational injuries, or 0.058 in a competitive mortality model. These values remained almost stationary until WWII when they showed a peak around 0.11, then declined to about a third in the 1970s, and to about a twentieth in 2017. The YLL / DALY ratio was 0.82 around 1900, then slowly decreased to less than 0.5 in the late 1930s, rose to a new peak around 0.8 in WWII, then diminished again to 0.32 in 2017. Considering prevalence, variations are much slower, due to the expected average durations of permanent disabilities, between 32.5 and 52 years. Risk breakdown by main industry sectors is ongoing.

Conclusions

DALY rate and YLL/DALY injuries declined largely along time. Nevertheless, such events continue to leave a very long-term legacy of disabilities.

Key messages

INAIL data permit to estimate burden for occupational injuries occurred in Italy along over a century. Injury burden declined over time, but continues to leave a legacy of long-term disabilities.
Challenges and leverages to strengthen vaccination in African countries
Authors: Amofah G
Published: October 2020

G. Amofah will provide examples of challenges and leverages to strengthen vaccination in Africa.
Addressing social determinants of noncommunicable diseases in primary care: a scoping review
Authors: Allen L N , Smith R W , Simmons-Jones F , Roberts N , Honney R , Currie J
Published: October 2020

Background

Noncommunicable diseases (NCDs) are the leading cause of global mortality, and their risk factors largely manifest at the community level. In collaboration with public health, primary care is well placed to assess and address the local social determinants of NCDs (SDONCDs). Post-Astana, many countries are reorienting their primary care systems to incorporate these traditional public health functions, but there is little evidence to guide reform. We aimed to collate examples of primary care organisations that already engage in this activity.

Methods

Following Cochrane guidance, PubMed, MEDLINE, Embase & HMIC were searched from inception to 28/7/2019, along with hand-searching of references for any study designs that examined international primary care organisation(s) that addressed local SDONCDs. Independent dual review was used for screening, data extraction, and quality assessment - for which we used ROBINS-i.

Results

Searches identified 666 studies of which 17 studies from Canada, South Africa, UK, and USA were included. All used descriptive study designs. Individual-level surveys and interviews were the most common SDONCD data collection methods reported. Fewer studies collated population-level data held by external agencies. Actions ranged from individual-level interventions to novel representation of primary care organisations on system-level policy and planning committees. Several enablers and barriers to collecting and mobilising social determinant data within well- and under-resourced primary care settings were identified.

Conclusions

Several models of integrated public health and primary care already exist that fulfil the Astana mandate of developing place-based preventive services, tailored to local needs. Public health input at this granular level is required to support primary care services as they extend their scope of practice, and to assist with monitoring and evaluation of new initiatives to mitigate unmet health and social needs.

Key messages

Primary care organisations are increasingly being encouraged to assess and address local social determinants of noncommunicable diseases but there is weak evidence to guide reform. The different approaches described in our review can help policymakers tasked with integrating public health functions into primary care.
WFPHA advocacy for vaccination
Authors: Lomazzi M
Published: October 2020

M. Lomazzi will give an overview of the on-going vaccination advocacy activities and policies by the World Federation of Public Health Associations.
Managed care for reducing lower extremity amputations in Type 2 diabetes: a systematic review
Authors: Meza-Torres B , Carinci F , Heiss C , Joy M , de Lusignan S
Published: October 2020

Background

There is limited evidence on the effect of organizational arrangements on foot complications in diabetes. We evaluated the effectiveness of different organizational arrangements in the delivery of care for the reduction of lower extremity amputations (LEA) among people with Type 2 Diabetes (T2D) affected by foot ulcers.

Methods

We conducted a systematic review of the scientific literature published between 1999-2019 on Medline and Embase, using the following key terms as search criteria: people with T2D, diagnosed with diabetic foot ulcer, treated with specific processes and pathways of care, experiencing LEA as an outcome.

Results

A total of 57 studies were eligible for the study, investigating the following organizational aspects: dedicated teams; care pathways and protocols; multidisciplinary teams; and combined interventions. Among the retrieved papers, only 7 could be used for binary outcome meta-analysis. Overall, intervention groups showed a 29% reduced risk of any type of LEA (OR = 0.71, 0.52- 0.96). The effect was larger when focusing on major LEA alone, leading to a 48% risk reduction (OR = 0.52, 0.30-0.91).

Conclusions

Specific organizational arrangements may help reduce the burden of T2D among subjects affected by foot ulcers, particularly in terms of major amputations. Further studies should use standardized criteria for the investigation of care arrangements. Implications for practice are that organizational settings highlighted from the literature as potentially effective could be mapped to the local routine and continuously followed-up using data to verify their advantages in real world conditions.

Key messages

Specific organizational arrangements can have a positive impact on the reduction of LEA among people with T2D affected by foot ulcers. Continuous monitoring and benchmarking between different practices using routine observational data may identify sources of heterogeneity among services following the same set of clinical guidelines.
Lessons towards the roadmap on implementation and sustainability of cancer control actions
Authors: Albreht T
Published: October 2020

The speaker will present the Innovative Partnership for Action Against Cancer (iPAAC) Joint Action (JA), which is aiming to develop innovative approaches to advances in cancer control and a Roadmap on Implementation and Sustainability of Cancer Control Actions, identifying areas of relevance to AMR. The issue of AMR is an important issue in view of cancer management. It pertains both to the control of one of the pathogens clearly identified as conducive to cancer - Helicobacter pylori as well as to the issues arising from the vulnerability of the cancer patients in the course of oncological treatment. In the previous JA on Cancer Joint Action on Cancer Control (CanCon), an expert consensus process led to the conclusion that population-based screening for Helicobacter pylori, followed by antibiotic treatment at large scale could trigger AMR, even if it could offset some morbidity due to stomach cancer. It is clear that further research activity is necessary to explore this issue since stomach cancer remains a public health challenge. This is important because of late stage detection, resulting in poor survival. The other important issue is the need to protect cancer patients in treatment and beyond by securing effective antibiotic treatment for infections arising from their condition and/or following their treatment.
From Point-of-Care Testing (PoCT) and vaccination to changing the care paradigm: the role of primary care
Authors: Petelos E , Lionis C
Published: October 2020

The speaker will discuss the role of primary care for all patients and cancer patients, elaborating on prescribing patterns vaccinations, recommendations for Over-The-Counter medicines (OTCs) nutritional supplements, and as well as its contribution of behavioural change to raise awareness and change prescription practice. The role of PoCT for reducing the threat of AMR and for improving the differential diagnosis will be discussed, according to the WHO Approach of “diagnostic stewardship” for the appropriate use of microbiological diagnostics to guide therapeutic decisions. In the context of syndromic surveillance and preparedness, as well as in terms of protecting cancer patients at times of epidemics, methods of specimen collection for limited community transmission and for the timely pathogen identification along with accurate, timely reporting of results to guide patient treatment will be discussed. The role of behavioural modification interventions will be discussed, incl. in relation to vaccination and the role it can play in AMR. Improvement of the survivorship experience will be examined in the context of improving health literacy. The case of Greece, currently having the highest antibiotic consumption in Europe and the fourth highest globally, along with an increasing trend on antibiotic use will also be discussed.
Adolescents’ stress - a challenge for adults in charge - The Improve the Youth project
Authors: Kleszczewska D , Mazur J , Dzielska A , Gaspar T , Gaspar de Matos M
Published: October 2020

Background

The project was an answer to the results of the HBSC (Health Behaviour of School-aged Children) study 2013/2014 which indicated an alarming situation regarding the adolescents' mental health. The aim was to investigate mental health problems of Polish and Portuguese youth and to create tools and materials which can be a professional help in this matter. Improve the youth project consisted of two main elements: research and implementation phase. The mixed-method approach was applied in the project. Quantitative and qualitative research methods were used. 2004 pupils (aged 13-19) were surveyed in 89 schools in 2017/ 2018 in Poland. Findings form qualitative study were guidelines for quantitative research. Perception of stress among young people was selected as the leading subject. Short Form Perceived Stress Scale (PSS-4) in a shorter version of 4-statement were used. There were two advisory boards: first - practitioners (psychologists, pedagogists, teachers, social workers) and second - adolescents. Both were consulted to prepare all materials.

Results

Stress levels are higher in girls than in boys, and they increase with age: between 13 and 19 year of age the increase in the prevalence of high stress level was 5,3% in boys and 12.5% in girls. Family affluence, school achievements and school burden were identified as stress determinants of adolescents.

Materials presenting the data and giving practical information and tools on how to support adolescents in coping with stress: guide for adults, guide for youth created by youth and scenario of workshops.

20 workshops for young people run by young people were organised in both countries for about 200 adolescents

Results and materials were presented to youth organizations, social institutions and decision makers responsible for youth policy during two 'Improve the Youth' conferences in Poland and in Portugal.
Comparing trends of perinatal mortality in two rural areas of Matlab, Bangladesh
Authors: Rahman A , Anwar I , Austin A
Published: October 2020

The study conducted in a rural sub-district, Matlab, Bangladesh among adolescent motherhood (10-19 years) in the International Centre for Diarrhoeal Disease Research, Bangladesh included total of 4,996 adolescent mothers in the analysis. Chi-square tests and binary logistic regression were used to document adolescent pregnancy trends and the differences in and causes of perinatal death. The fertility rate was 27 per 1000 adolescent mothers in ISA and 20 per 1000 adolescent mothers in GSA, during the 9 year of study period. The adjusted odds of an adolescent mother having a perinatal death in ISA, relative to GSA was 0.69 (95% CI: 0.52 - 0.91, p-value<0.05). Significant determinants of perinatal death among adolescent mothers were: maternal education, paternal education, mothers' age at first birth, asset score and distance from nearest facility. Dr. Rahman will raise the importance of addressing these determinants in designing health policy interventions targeting this specifically vulnerable group.
A new public health agenda for Europe: health under a sustainable development framework
Authors: Nogales Crespo K A , Abrantes A , Dias S
Published: October 2020

Background

As a science and normative framework, sustainable development attempts to comprehend and regulate the interaction between the global economy, society, and environment. The connection between health and sustainable development is widely recognized by the Sustainable Development Goals (SDGs), challenging the way we understand and do public health. In the absence of operationalizing tools, the SDGs would have limited value. Using policy documents (PDs), this study aims to diagram a new public health agenda for sustainable development in the WHO European Region.

Methods

32 PDs ranging from 2010 to 2018 were identified and selected using the contents of the 2015-2018 Sessions of the Regional Committee for Europe. Based on the alignment of PDs and health-related SDG targets, a content analysis was used to characterize a new public health agenda.

Results

Preliminary results show several pathways of bidirectional contribution between heath, the environment, and economy. Closing the health inequity gap demands upstream measures to combat behavioral risk factors using a life-course and gender approach and a mix of cost-effective universal and target interventions. A transformative process of health and health delivery systems to provide people-centered, demand drive interventions are necessary. Addressing the determinants of health requires strong leadership in the health sector and partnerships for policy coherence. Preparedness to human and environmental induced emergencies requires tackling the root causes of climate change and violence and investing in systems and individual's resilience.

Conclusions

A public health agenda under the SDGs invites stakeholders to re-think policymaking, understanding health as a pattern of relations intertwined with the environment and economy. Moving beyond the treatment of diseases, this agenda calls for upstream interventions to tackle the determinants of health and improve health delivery systems to close the gap on health equity.

Key messages

The SDGs challenge the way we understand and do public health. A public health agenda for the SDGs conceives health as a shared responsibility across governance levels and policy sectors.
Exploring the use of nudging in public health lifestyle interventions: A literature review
Authors: Ledderer L , Kjaer M , Madsen E , Busch J , Fage-Butler A
Published: October 2020

Background

The concept of nudging has been imported from behavioral economics into the public health context to correct 'unhealthy behaviours' and produce health-promoting behavior changes in individuals. However, there is lack of clarity as to what constitutes a nudge and whether nudging techniques in public health lifestyle interventions are effective. The aim of this literature review is to identify nudging techniques used in public health lifestyle interventions and to investigate whether nudging techniques induce expected healthy lifestyle changes in interventions that relate to diet, exercise, sleep, alcohol and smoking.

Methods

A systematic literature review on the concept “nudging” in public health lifestyle interventions was conducted, applying a free text search strategy on a set of search terms in three databases: PubMed, CINAHL and PsycINFO. Articles meeting the inclusion criteria were included in our data set, and we performed a meta-synthesis to construct interpretative explanations.

Results

66 original studies published in international peer-reviewed journals were identified. The findings showed that most nudging interventions involved diet/nutrition (n = 55), were carried out as single experiments, lasted for a short period of time and that the majority had the intended effects. Specific nudging techniques were identified and sorted into eight broader categories. The most commonly used nudging technique involved making healthier food items more apparent and accessible than less healthy foods.

Conclusions

The synthesis showed that these studies were limited with regard to their design, target groups, duration of the intervention, measures of effectiveness and critical reflection on ethical issues.

Key messages

Nudging may be effective in producing immediate behavioral changes; however, there is little evidence that nudging interventions result in lasting behavioral changes outside the setting of the studies. Further critical discussions about the implications of nudging in public health lifestyles intervention are required.
A diabetes focused inter-sectoral approach to a more equal and healthy living environment in Turin
Authors: Costa G , Pilutti S , Di Monaco R , Gnavi R
Published: October 2020

The purpose of the project is to pilot an innovative intervention aiming to enroll the local actors in the responsibility to reduce inequalities in the epidemic of diabetes in the city. In the next few years, all the actors of the diabetes pathway (mostly the health professionals but also the local non-health actors) should analyse and recalibrate their organization and functioning, revising primary care system in the light of the paradigm of pro-active medicine

At first, a community of practice of health professionals involved in diabetes is being convened with the mandate to revise the process of generation, recognition and treatment of diabetes in order to identify the mechanisms potentially able to create inequalities. At the same time a community of practice of local non-health actors is being convened to react to the analysis of mechanisms of the community of practices of health professionals, with the mandate to interpret the data and enrich the diagnosis on mechanisms, relevance and responsibility. The two communities of practice will elaborate a plan of innovation involving the responsibility of the institutions and actors that are playing a role in the mechanisms generating diabetes inequalities, setting targets, assigning responsibilities, orienting resources. The Turin Longitudinal Study will serve as a tool for monitoring the process and assessing results and impact of this innovation. The expected results concern two types of effects, which are monitored. Firstly, improving the care system and collaboration among different services should have an impact on the accessibility and quality of care. These improvements will be introduced concerning specific problems that emerge from the analysis. Secondly, social capital should increase thus increasing the resources available to people, especially the most fragile and isolated ones. The results of this pilot on diabetes will be replicated for the other chronic diseases of the National Plan for Chronic Disease.
“Nudge” in Lucca’s Hospital: separate waste collection improvement and cigarettes dumping reduction
Authors: Canale A , Giardi F , Gandolfo S , Lorenzi V , Corda V , Farneti S , Taddeucci M , Maielli M , Privitera G , Mencaroni S
Published: October 2020

Background

Positive behaviour and user's collaboration improved by using choices orientation techniques; in Lucca's Hospital (North-West Tuscany Sanitary Authority) this approach has improved separate waste collection execution and has decreased cigarettes dumping in commons areas.

Objectives

Phase 1 (May 2019): amendment of choices architecture recyclable waste bins in commons areas and into the wards were boosted, with “islands” clearly visible from any point of common paths; in the transit areas were installed exclusively multi-material and paper bins, equipped with signs that clearly indicate which products deliver; residual waste bins were allowed exclusively in certain points.ashtrays at the hospital entrances were eliminated and replaced with signage indicating smoking cessation benefits and the presence of areas “put your cigarette out” along the structure approach routes.

Phase 2 (scheduled for May 2020): “nudge” action

Spreading in community (using press and social-media) and locally (using poster) of the slogan “In San Luca we are taking a step forward: don't lag behind!”. This message stimulate the perception of an ongoing change to join.

Results

A decrease in residual waste collection and in instances of non-compliance in separate waste collection was detected. Decorum in the outdoor environments improved, with a reduction of user's reports and extra-cleaning interventions.

Conclusions

The described actions have improved user's collaboration, management efficiency of waste disposal and cleaning service, perceived quality and cost.

Key messages

Imitating a social model appears to be successful motivator of virtuous behaviours. Choices architecture and “nudge” techniques may improve citizens’ care pathways governance.