bluuebunny/crossref_metadata_2025 huggingface dataset:
A social cost-benefit analysis of two One Health interventions to prevent toxoplasmosis
Authors: Suijkerbuijk A W M , Over E A B , Opsteegh M , Deng H , van Gils P F , Marinovic AA Bonacic , Lambooij M , Polder J J , Feenstra T L , van der Giessen J W B , de Wit G A , Mangen M J
Published: November 2019

Background

In the Netherlands, toxoplasmosis ranks third in disease burden among foodborne pathogens, with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €44 million annually. We performed a Social Cost-Benefit Analysis (SCBA) to evaluate the net value of two potential interventions, freezing meat and improving biosecurity in pig farms, for the Dutch society.

Methods

We assessed the costs and benefits of the two interventions and compared them with the current practice of education, especially during pregnancy. A ‘minimum scenario’ and a ‘maximum scenario’ was assumed, using input parameters with least benefits to society and input parameters with most benefits to society, respectively.

Results

The freezing meat intervention was far more effective than the biosecurity intervention. Despite high freezing costs, freezing two meat products: steak tartare and mutton leg yielded net social benefits in both the minimum and maximum scenario, ranging from €10.6 million to €31 million for steak tartare and €0.6 million to €1.5 million for mutton leg. The biosecurity intervention would result in net costs in all scenarios ranging from €1 million to €2.5 millions.

Conclusions

From a public health perspective (i.e. reducing the burden of toxoplasmosis) freezing steak tartare and leg of mutton is to be considered.
Real world evidence for European health policy-making: making the case for interoperability
Authors: Bernal-Delgado E , Estupiñán-Romero F , Zeynep O , Lyons R , Ivanković D
Published: November 2019

Background

The foundations of evidence-based health policy-making are transitioning from the use of partial evidence yielded elsewhere and the application of heuristic rules, to the development of learning systems based on the reuse of routine data collected by the same institutions that have to implement those policies. Supporting that transition, the scientific production of real-world evidence (RWE) is becoming pivotal, particularly in international policy-making. However, leveraging the immense wealth of data curated in European public institutions, requires the development of a new world-class research infrastructure and a supporting interoperability framework (IOF).

Methods

Based on the European Interoperability Framework (EIF) legal, organizational, semantic, and technical issues are being assessed. While legal, organizational and technical topics are analyzed from the perspective of the type of infrastructure, centralized or federated, to be developed, semantic interoperability is explored using three case studies on the linkage of different real world data sources: for characterizing resilient populations, studying the burden of dementia, and the effectiveness of stroke care pathways.

Results

Preliminary assessments advocate for the development of a federated infrastructure where data remain in house and research questions, data access and interoperability services are shared according to the capacity of each specific partner in the federation. Interoperability services for such an infrastructure should cover: a) the development and maintenance of a common data model to assure semantic interoperability, b) the development of self-contained distributed analytical pipelines; and c) the implementation of a training program aimed at increasing the capacity of each RI hub.

Conclusions

An interoperable federated research infrastructure is required to leverage the potential of real world data for European health policy-making. InfAct is paving the way.
ParticipaTIC: Lessons from developing accessible on-line training for disabled people’s leaders
Authors: Cuenot M , Sherlaw W
Published: November 2019

The ParticipaTIC Erasmus+ project led by the EHESP School of Public Health in partnership with disability organizations and associations from France, Belgium, Switzerland, and Romania has co-designed an accessible digital platform. In line with the 2010-2020 European strategy and the United Nations Convention on the rights of disabled persons we aim to strengthen the competences of the leaders of disabled persons’ organizations to defend the rights of disabled people, and to develop participation. ParticipaTIC offers 4 modules on ‘What is disability?’, ‘Competencies for disability organization leaders’, ‘the United Nations Convention’ and ‘How to carry out a local accessibility analysis’. Different contrasts, font size, speech synthesis, captioned videos and content summaries in ‘Easy to read and understand’ French are available together with a cloned platform in Romanian and English. Two guides have also been produced on 1) on-line accessibility and 2) co-constructing an on-line accessible platform. Beyond the deliverables, adapting on-line instruction to the different capacities of people with disabilities raises many issues. New competencies for accessible design are needed. Tradeoffs between content, pedagogical style and accessibility seem inevitable. On-line activities need adaptations but these may be complex and costly. Taken-for-granted assumptions about what is attractive, and well-designed are called into question when designing for people with visual, auditory, and intellectual impairments. Lessons from ParticipaTIC are remarkably similar to those of participatory thinking design: advance in small steps, evaluating successive design phases with people with disabilities for fitness of purpose. Ultimately trainers need to redesign themselves to take into account unsuspected worlds, those of our fellow citizens with different capacities. Important lessons beyond the world of on-line instruction for the building of a truly inclusive society have emerged.
Disparities in smoking habits in Hungarian Roma and general populations
Authors: Fiatal S , Pikó P , Kósa Z , Sándor J , Ádány R
Published: November 2019

Background

Smoking status, dependence and cessation efforts of the disadvantaged Hungarian Roma living in segregated settlements were compared to those of the general population.

Methods

Data were collected through survey. Each study group consists of 500 randomly drawn subjects, and are representative of the adult (18-64) general and Roma population, living in two counties of North-East Hungary. Questions on smoking from the European Health Interview Survey were used with some modifications. Prevalence data were analysed according to age strata (18-29, 30-44 and 45-64 years) by chi2 test, and were compared to data from 2003 and 2014.

Results

In Roma the proportion of never smokers is much less compared to the general ones (men:27.27% vs.75%, women:38.6% vs.70.75%, p < 0.05). Less Roma reported never smoking in all age compared to 2014, increasing trend can be found in the general population since 2003. Smoking prevalence is higher in Roma in all ages (72.73% vs.20 83%; 68.42% vs.28.42%; 59.02 vs. 32.26%, p < 0.05, respectively). Interestingly, the prevalence of Roma men smokers is decreasing by age, in the general population the trend is the opposite. Heavy smoker status is the highest in 30-44 age group of both populations. Increasing trend of heavy smoking can be detected in the Roma, but the opposite holds for general population compared to 2014. Half of the Roma smoke within 5 minutes after wakeup (50% vs. 36.92%, p < 0.05), smoke hand-rolled cigarettes (68.91%vs 30.77%, p < 0.05), higher proportion of them tried to quit (34.78% vs. 23.38%, p < 0.05) but smaller proportion of them obtained advise on how to quit (48.53% vs.59.09%, p < 0.05). Initiation starts earlier age among them (men: 15.1 vs.16.6, women: 16.2 vs.18.2, p < 0.05).

Conclusions

Regular smoking (especially heavy) is much higher in the Roma and decreasing by age compared to the general in all age-groups. The 30-44 age group of Roma mean are exclusively heavy smokers but half of the Roma show effort to quit.

Key messages

Tailoring cessation programs for Roma men especially those belong to 30-44 age group is a priority to reduce tobacco-related adverse effects. Complex public health programmes that taking into account special socio-cultural environment and lower formal education level of the Roma are needed.
Perceived risks and barriers to care for international migrants in transit through Mexico
Authors: Larrea S , Leyva-Flores R , Guarneros-Soto N , Infante-Xibille C
Published: November 2019

Background

Mexico has implemented policies seeking to reduce barriers to care for migrants in transit; however, it is estimated that only 3% of migrants use public health services when needed. The main purpose of this study was to identify the barriers to access public health services faced by migrants in transit through Mexico.

Methods

Under the human security perspective, in 2018, a qualitative study was carried out in Mexican communities with high migrant mobility. 34 semi-structured interviews were conducted with migrants in transit, and personnel from public health services and migrant shelters (NGOs). Values and meanings related to risks, health problems, barriers to care, experiences of health services utilization, and opinions on facilitating elements to diminish these barriers were identified.

Results

Migrants in transit through Mexico face risks that affect all dimensions of human security. Perceived anti-migratory and discriminative attitudes during the journey were constantly mentioned in the interviews. Barriers to care were found in the four stages of health care access, classified according to the Tanahashi framework, with the majority related to accessibility and acceptability. The following facilitating elements were also identified: political willingness of local government, knowledge and talent management of health personnel, and strategies implemented for adapting local health care services to migrants.

Conclusions

Social and political conditions in Mexico disrupt any effort to reduce social risks and barriers to care for migrants in transit. Non-governmental actors are key players for facilitating interactions between migrants and local governmental health care institutions. However, the general anti-migratory context negatively affects access to health care and influence the perspectives of migrants, NGOs, and health personnel.

Key messages

The predominant perceived barriers to care are in counterpoint to local governmental pro-migrant rights perspectives. NGOs are key actors to promote access to public health care services.
Support for unaccompanied children and youth - Results from a systematic literature review
Authors: Ascher H , Backlund Å , Östlund P
Published: November 2019

Background

A systematic literature review about unaccompanied minors was done with the following focus: scientifically documented effects of supportexperiences of unaccompanied children and youth about positive and negative factors

Methods

2 210 abstracts were examined. Assessment of relevance and quality and the analysis were done according to SBU standard.

Results

No controlled study on effects were fulfilling the inclusion criteria. However, 29 articles with qualitative design were included. Seven overall themes were identified: Security and control: a basic requirementThe new country: both opportunities and difficultiesManaging difficulties: a balance between different strategiesEveryday environments: supportive relationships as well as influence in housing and access to schools and activities are importantRelationships: support and guidance from adults is important, contact with peers important, but also difficultSocial services and health and medical care: varying views on and experiences of support and needsIdentity and affiliation: getting together the past, the present and the future.

The seven themes could be grouped in three overarching levels: Basic living conditions and survivalDifficulties and opportunities in everyday lifeWeighting of bringing together existence on an overall plan

Conclusions

To our knowledge, this is the largest literature review about support for unaccompanied children and youth. In the absence of controlled effect studies, it is particularly important to pay attention to unaccompanied children and youths own experiences when providing guidance for how societýs support for this heterogeneous group can be designed, in accordance with their rights in the Convention on the Rights of the Child. The results of the review are compared to common policies in handling unaccompanied children and youth.

Key messages

Unaccompanied children have commonly experienced trauma and loss. A lack of basic security has a pronounced effect on the ability to cope with daily issues and difficulties as well as with the future. Unaccompanied children and youth have a great need for adult support and guidance.
Self-reported discrimination in health surveys: results from a scoping review
Authors: Kajikhina K , Sarma N , Schumann M , Lampert T , Santos-Hövener C
Published: November 2019

Background

Surveying perceived discrimination in the context of health monitoring can help to clarify the connection between unequal treatment and health. We aimed to review, identify and extract data on definitions and measures of discrimination.

Methods

A scoping review of both peer reviewed and grey literature was conducted. Survey instruments used in representative surveys in Germany were compared and discussed regarding their strengths and limitations. Ethical and methodical guidelines and policy reports by WHO, ECDC, EUPHA, migration research institutions and local NGOs were considered.

Results

Research from North America, South Africa and, to a lesser extent, European countries shows a clear link between discrimination and health. Various scales, individual items and instruments operationalize discrimination as worse treatment in everyday life or disadvantage in the structural field (authorities, housing market, working life). Possible reasons and frequencies of experiences are surveyed. Additional instruments are used to evaluate moderators such as vigilance or coping. Besides validity and reliability, ethical aspects such as voluntary self-disclosure, avoidance of external ascriptions and assessment of multiple dimensions of discrimination should be considered.

Conclusions

We propose a three-stage instrument for surveying perceived discrimination in German health surveys. First, the frequency of interpersonal experiences is surveyed by the everyday discrimination scale validated for different settings. Second, possible reasons for the reported experiences are asked, based on the categories of the German General Equal Treatment Act. Lastly, questions on discrimination in health care and by public authorities will address specific public health areas.

Key messages

Only few studies are available on discrimination and health in Europe, more is needed to effectively address health disparities. We propose to consider specific ethical and methodical aspects when surveying perceived discrimination as a health determinant.
Gender differences of health literacy in first and second generation migrants: A systematic review
Authors: Chakraverty D , Baumeister A , Aldin A , Monsef I , Jakob T , Seven ÜS , Anapa G , Skoetz N , Woopen C , Kalbe E
Published: November 2019

Background

Health literacy, defined as all skills and capabilities that enable a person to access, understand, appraise and apply health information, is a key factor regarding disease management, health outcomes, and health-decision-making. Internationally, migrants have been identified as a high-risk group for limited health literacy. However, it remains unclear if female and male migrants process health information differently. This systematic review aims to analyze gender differences in the health literacy of first and second generation migrants.

Methods

We performed a systematic review according to PRISMA guidelines. We searched OVID (MEDLINE), PsychInfo and CINAHL for original articles providing extractable data on the health literacy of male and/or female migrants. Two reviewers independently reviewed abstracts and full text articles for according to predefined inclusion criteria, including the use of a validated health literacy measurement tool, applying it to first and/or second generation adult migrants. We adapted a data extraction sheet from the Cochrane Collaboration for extracting relevant data. The included studies were evaluated against a standardized set of quality criteria.

Results

Our search yielded 3411 records. We included 48 studies, of which 37 were conducted in the USA and Canada, with 22 focusing Hispanic and Asian immigrants’ functional health literacy; the nine European studies examined a variety of work migrants and refugees using a comprehensive approach (e.g. measured by the HLS-EU-Q47). Thus, a strong heterogeneity in defining and measuring health literacy and in the populations examined can be stated. 15 studies exclusively examined the health literacy of women; none dealt with men only.

Conclusions

The heterogeneity in defining and measuring health literacy in migrants as well as the diversity of the populations studied make it difficult to compare international research in this area. There is a lack of research focusing male migrants.

Key messages

International research on health literacy with gender-specific data on migrants reveals a strong heterogeneity in defining and measuring health literacy. International research on health literacy with gender-specific data on migrants reveals a lack of studies regarding male migrants’ health literacy.
Episodes of violence suffered by migrants transiting Libya, Italy and France
Authors: Reques L , Rolland C , Aranda E , Grippon A , Fallet N , Bensimon C , Godard N , Reboul C , Gutton C , Luhmann N
Published: November 2019

Background

The Central Mediterranean is one of the most dangerous migration routes from Africa. Violence perpetrated to migrants in Libya and host countries has been documented but not rigorously quantified. The objective of the study was to estimate the prevalence of violence suffered in Libya, Italy and France by migrants consulting Médecins du Monde programs.

Methods

Monocentric cross-sectional study. Inclusion criteria: migrants over 18 years old, transiting through Libya, arrived in Europe from 2017 and consulting in Saint Denis Health Center. Exclusion criteria: psycotraumatic manifestations. A sample size of 72 individuals was calculated. An ad-hoc questionnaire was created through Kobo Collect. Proportion and frequency of physical, privation and sexual violence, as well as health care and shelter access were measured in each country.

Results

95 individuals were recruited and 72 were interviewed (16 refused 7 were excluded) from February to April 2019. 76.3% were men, mean age was 31.6 years, 76.4% had low educational level, 66.7% were from Ivory Coast and 58.3% left their country for security reasons. In Libya, length of stay was 180 days, global proportion of individuals suffering from violence (GPISV) was 98.1% for men and 88.2% for women. Prevalence of physical, privation and sexual violence was 94.1%, 84.3% and 17.6% for men, and 85.7%, 93.3% and 60.0% for women. Health care access in Libya was inexistent. In Italy, GPISV was 31.8% for men and 28.5% for women. Health care access was 41.4%. In France, GPISV was 20.0% for men and 12.5% for women and shelter access was 44.3%. 60.3% of the participants reported need of psychological support.

Conclusions

The vast majority of migrants testify suffering from direct violence during migration, specially dramatic in Libya. Women have a particular risk of sexual violence. In Europe, the main problems are the lack of health care access in Italy and precarious living conditions in France. Mental health support is urgent.

Key messages

The vast majority of migrants testify suffering from direct violence during migration, specially dramatic in Libya. In Europe, the main problems are related to lack of health care access in Italy and the precarious living conditions in France. Mental health support is urgent.
The impact of precarious employment on the health and wellbeing of immigrants: a systematic review
Authors: Muoka M , Lhussier M
Published: November 2019

Background

Migration and precarious employment are social determinants associated with adverse health outcomes. In the United Kingdom, migration policy and labour market characteristics mean that migrants are often engaged in precarious work. We synthesise evidence on the experiences of migrants and explore the effects of precarious employment on their health and wellbeing.

Methods

Electronic databases were searched for peer-reviewed qualitative studies describing the experiences of United Kingdom migrants in precarious employment. Title and abstracts were screened, followed by full text screening using pre-specified inclusion and exclusion criteria. Data on employment experiences and effects of working conditions on physical and mental health and perceived wellbeing were extracted. The Centre for Reviews and Dissemination (2009) framework was used to conduct a narrative synthesis.

Results

Out of 1577 unique citations, 5 met our inclusion criteria. All included studies reported negative outcomes on physical and mental health. 2 reported positive or negative outcomes for perceived wellbeing depending on pre-migration experience. Musculoskeletal pain, exhaustion, anxiety and depression were commonly reported effects of precarious employment. Communication difficulties and over qualification were identified as migrant specific factors influencing health outcomes.

Conclusions

Stress response theories and risk factors associated with occupational injury explain how employment specific factors influence health. Extrinsic factors such as immigration policies, pre-migration experience, responsibilities in home country and acculturation mediate precarious employment effect on health.

Key messages

Migrants feel isolated in precarious employment and are vulnerable to negative mental and physical health impacts. Broader migration related policies impact on experiences of employment and health.
Syndromic infectious disease surveillance of refugees in Greece: a mixed methods analysis
Authors: Graef J , Omar M , Abbara A
Published: November 2019

Background

An estimated 1,174,140 refugees have migrated into Greece, a main entry point for refugees into Europe, since 2014. Their infectious disease profile is monitored by a national-level ad-hoc syndromic surveillance system in refugee-migrant reception centres. The utility of this system is explored to contribute evidence to and improve syndromic surveillance in European refugee responses.

Methods

Proportional morbidities, numbers of cases and signals, cases above expected numbers, of 14 syndromes are collated from weekly reports between 2016-2019, graphed and analysed in the context of the humanitarian response. Semi-structured key informant interviews are conducted and thematically analysed.

Results

Between 20.06.2016 and 17.02.2019, 36358 cases and 116 signals occurred. Public health responses resulted and there were no significant outbreaks. On average 5% of all consultations in centres were on infectious syndromes. Respiratory infections with fever (57%), gastroenteritis (22%), suspected scabies (13%) and rashes with fever (5%) were most commonly reported. Every week, between 68-100% of 25-58 participating centres completed reporting adequately. 6 informants reported on their syndromic system user experience. The system’s benefits, providing information and safeguarding refugees, outweighed harms. Data was timely and complete, but likely under-reported for common conditions. Poor living conditions and inter-agency coordination complicated reporting and public health responses.

Conclusions

Infectious burdens and trends were provided by the system and allowed for timely responses. Data quality was adequate. The system was valuable and feasible to informants. The set-up of the humanitarian response, inadequate ownership and poor coordination of authorities reduced the system’s utility.

Key messages

Syndromic surveillance is useful for monitoring refugee infectious health. Structural barriers need to be resolved to improve systems’ data and user experience.
Country Assessments: Identifying gaps in policy and practice to address equity in health for migrants
Authors: Nordström C , Ingleby D , Dias S , Magnus J , Kumar B
Published: November 2019

Issue

The Joint Action on Health Equity in Europe (JAHEE) aims to address inequities in health across all groups. Work Package 7 Migration and Health (WP7) includes 13 partner countries and focuses on health inequities affecting the migrant population. The project started out by developing Policy Framework for Action (PFA), intended to form the basis for exploring opportunities for appropriate actions in the three-year implementation period of the action. The PFA formulated a ’road map’ encompassing six priorities identified in 22 ’soft policy’ documents that have been published by international /governmental organisations since 2007. It also discussed the state of the art in research on the causes of particular inequities undermining migrant health, as well as the measures that can be taken to tackle them.

Description of the problem

The main objective of the Country Assessments (CAs) is to identify the best opportunities (entry points) for developing country-specific actions. From this list, actions will be selected and implemented that are feasible within the constraints of JAHEE. The CAs will provide the information partners need in order to make informed choices. The assessments will indicate where the most serious inequities lie, what causes them, and what can be done about them. The CA Template was based on the PFA, reviewed by the Expert Group and then piloted in two countries (Norway and Italy) in March 2019. The 13 partners participating in WP7 are currently carrying out their assessments, which will be completed by July 2019.

Results

An overview of the main results of the CAs will be presented at the conference.

Lessons

Developing and piloting the Country Assessment Template has been participatory, with necessary revisions on the basis of experience. Completing these assessments for each participant is in itself is the first step towards action. Participants create an overview of available data, experiences and gaps in their countries.

Key messages

The Country Assessment Template is a tool that enables partners to take stock of the situation in their country. Analysis of data from the assessments will enable countries to make an appropriate choice of actions.
Digital marketing in healthcare
Authors: Grbic M , Stimac Grbic D , Stimac L , Sostar Z
Published: November 2019

We live in a digital world when people rely more on smart devices and dedicate their time to searching information online. According to some research, 85% of users now compare and check reviews of products or services prior to their selection, and Google states that as many as 77% of patients search the Internet before they are make decision. That is why more and more health organizations recognize the need for online presence and the use of digital channels to attract new clients. The age group of 15-35 which trusts social media and easier forms of communication when it comes to important decisions. This gives healthcare professionals a platform to engage with such an interactive audience easily.

Benefits - Health organization can either easily promote a product or service to the target group, as it is possible to determine who you want to target for preventive campaigns and services. In the digital world, you can easily measure and optimize results and gain accurate data as much as the range of activities.

Reach, Engagement, CPC? Reach shows how many users have seen the posting, and what is higher, it is spreading more widely. Engagement is the interaction you achieve with your target group. How can you determine that you have paid off and that you have achieved your goal? One of the real indicators of many parameters is certainly the CPC (Cost per Click). In digital marketing, CPC is an advertising payment model according to which an advertiser pays each time a user clicks on a link.

Conclusions

The Healthcare industry remains behind other industries in the scope of digital marketing efforts. In 2017, only 50% of the survey respondents reported using a CRM system, while significantly more (65%) report using a CRM in 2018. Use of a marketing tool has doubled from last year’s survey, from 23% to 48%. Advanced or emerging digital activities, such as wearables or beacon technology, are still not being used much by healthcare organizations.

Key messages

Social networks empowers health clients. Majority people between the age group 18-24 (90%) trust information shared on social media.
Promoting healthy sustainable societies through a circular analytical dialogue method
Authors: Paillard-Borg S
Published: November 2019

Background

The relationship between journalists and populations is complicated and the subject of “fake news” is one of these related issues. Despite the controversy, journalistic media are the ground to a well-informed society and as such journalists have the potential to be important actors in the pursuit of population health. At the same time, frustration against journalistic media has increased globally and vulnerable and so-called ’invisible’ groups feel neglected by the media.

Methods

The Circular Analytical Dialogue is an innovative method for examining the dialogue between journalists and citizens and investigating the role of journalism in promoting social cohesion, population health and democracy.

Results

The preliminary results of a pilot study in Japan on the topic of migration, using the Circular Analytical Dialogue, show that the dynamic between the participants and the journalists was valued by all parties as it allowed a profound and valuable dialogue. The journalist was most appreciative of the feedback of the participants as it opened alternative perspectives that were not considered beforehand.

Conclusions

The Circular Analytical Dialogue has the dual ambition to be a research as well as a journalistic tool and the knowledge generated with this method is intended to be used to strengthen understanding about the importance of journalism for healthy democratic societies.

Key messages

The Circular Analytical Dialogue method reinforces the importance of academic activism strongly related to sustainable societies. The Circular Analytical Dialogue method can potentially contribute to the empowerment of populations fundamental to population health.
The role of micro-insurance in the field of public health
Authors: Novakovic T , Jevtic M , Popović L j , Ćosić D j
Published: November 2019

Issue/problem

It is recognized that is very important to have an instrument to mitigate risks and reduce the vulnerability of poor and low-income households, especially in disasters. Health risks are often identified by the poor people as the greatest and costliest risks they face. Millions of people worldwide fall into poverty as a result of excessive healthcare costs because the state doesn’t provide them health insurance. Health problems not only impact household budget, but also reduce the productivity and reduce the opportunity for growth. Therefore the reform of social systems poses a considerable challenge.

Description

In order to remedy the situation, global actors like World Health Organization (WHO, International Labour Organization (ILO), the World Bank (WB) advocate for a special category of insurance, health micro-insurance (HMI), as a medium term solution for health care financing, that tends to access equitable and quality health care. HMI was created to promote insurance coverage among economically vulnerable sections of society. It is one of the potential ways that might provides the protection of low-income people against specific perils in exchange for regular premium payment proportionate to the likelihood and cost of the risks involved.

Results

As a health care financing mechanism, HMI has a short history, but offers the following benefits: it can improve the access of certain vulnerable populations to healthcare, develop more suitable services, facilitate the participation of civil society and limit fraud, educate populations about social security.

Lessons

This instrument has not been conceptualized to compete or replace public social protection. Rather, it is most effective when embedded into a comprehensive social protection framework which includes informal, private and other risk management strategies of preventive measures, mitigation and suitable coping strategies.

Key messages

HMI can mitigate the risks of population and groups, ill health and provides hope that the poor will receive reliable and adequate access to affordable health care. HMI can be seen as a tool for better public health in vulnerable and poor communities.
Bridging the Atlantic Projects: nursing students learning to work globally with vulnerable groups
Authors: Brisbois M , Pereira H
Published: November 2019

Background

Providing care for vulnerable groups requires the development of competencies such as openness to diversity, cultural sensitivity and equity. Health education institutions face the challenge of preparing students in developing these competencies in a global world. The Bridging the Atlantic program, a partnership between the University of the Azores (Portugal) and the University of Dartmouth (MA, US) in the field of Community Nursing, was created to respond to this need. Students from both universities work collaboratively to develop competencies in providing health care to vulnerable groups based on the IN-STEP (International Student Exchange Partnership) Framework.

Objectives

(i) to contribute to the improvement of the health status of vulnerable groups; (ii) to develop clinical competencies addressing vulnerable groups among nursing students.

Results

Between 2015 and 2019, 110 students were involved in health promotion projects carried out with aggregates of elderly immigrants, deportees, fishermen, children from low income schools. The benefits for the vulnerable groups were mainly related to raise awareness in the communities concerning the problems these groups face. Regarding the impact of the program on training, students reported they developed competencies on: (i) understanding cultural differences; (ii) recognizing different health care systems; (iii) reconsidering the role of the nurse; (iv) building teamwork; (v) integrating theory into practice; and, (vi) peer mutual learning.

Conclusions

Engaging in health promotion projects globally through collaborative efforts seemed to be effective for the improvement of health of vulnerable groups and student development.

Key messages

Universities need to deepen the development of competencies in students to intervene with vulnerable groups in a global world. Although designed for nursing students in a community context, this model can be used in similar ways by other fields of health or social intervention.
Scale-up integrated care for diabetes and hypertension in Cambodia, Slovenia and Belgium
Authors: Klipstein-Grobusch K , Poplas Susič T A , Por I , Wouters E , Makivič I , Te V , Martens M , Danhieux K , Remmen R , Van Olmen J ,   on behalf of the SCUBY consortium
Published: November 2019

Many countries struggle to find the best way to treat hypertension (HT) and type 2 diabetes (T2D). As a result, many patients receive suboptimal care, especially vulnerable groups in society. The SCale up Integrated Care for diaBetes and hYpertension (SCUBY) project addresses this important societal issue, by examining the scale-up of existing evidence-based interventions for the control of HT and/or T2D.

The study undertaken in countries with very different health systems, i.e. a developing health system in a low-middle income country - Cambodia; a former socialist high-income country with a centralised health system - Slovenia; and a Western European federal country with a decentralised system- Belgium, develops, implements and assesses roadmaps for the scale-up of an integrated chronic care package (ICP). The ICP consists of (a) identification of people with HT or T2D, (b) subsequent treatment in primary care services, (c) health education, (d) self-management support to patients and caregivers, and (e) collaboration between caregivers. Analysis of the organisational capacity to scale-up the ICP for T2D and HT and to assess contextual barriers and facilitators to do so, informs the development of the roadmaps. Implementation and evaluation of the 3 roadmaps, one per country, assesses the impact on health outcomes and quality of care through the scale-up of the ICP aimed to contribute to sustainable coverage of T2D and HT interventions for more people in each country.

The project is innovative because it compares different scale-up strategies for a contextualised common intervention package. It applies the conceptual insights from scale-up science to the field of non-communicable diseases and involves policy-makers, professionals and patients to ensure local relevance and impact. It will generate new knowledge on how to scale-up the ICP for T2D and HT in diverse contexts. The lessons on scale-up will benefit policy-makers in countries with similar contexts.

Key messages

Innovative strategies are needed to scale up integrated chronic care for non-communicable diseases. The SCUBY project develops, implements and assesses roadmaps for the scale-up of an integrated chronic care package for hypertension and diabetes.
Assessment of Adolescent and Youth Friendly Health Services in Sri Lanka using WHO’s ‘4S’ Framework
Authors: Wickramasinghe N , Vithana C , Lokubalasooriya A , Hemachandra N
Published: November 2019

Background

The Adolescent and Youth Friendly Health Services (AYFHS) in Sri Lanka (SL) are provided via three service models, viz., hospital-based, field-based and centre-based. This study assessed the implementation status of AYFHS in SL.

Methods

A panel of experts conducted the review by adopting a participatory approach. Policies and supporting documents were collected from the relevant sectors of the Ministry of Health using electronic and manual search and by visiting institutions/resource persons. The strengths and weaknesses of the AYFHS were identified using the WHO’s ’4S’ Framework consisting strategic information (S1), supportive evidence-informed policies (S2), strengthening services for adolescents (S3) and strengthening collaboration with other sectors (S4).

Results

While recent development of guidelines, standards and protocols in line with WHO/UNAIDS ’Global Standards for Quality Health-care Services for Adolescents’ was the main strength on S1, gaps in timeliness, completeness and accuracy of the data; and the gaps in effective utilization of sub-national level data addressing area specific problems were the main weaknesses. On S2, SL has a strong, supportive policy environment to promote adolescent health. Lack of coherence in existing health related policies was the main gap. A comprehensive health care package was a strength on S3, while difficulty in reaching the vulnerable groups, curative service oriented service package and underutilization of the health services by adolescents were the weaknesses. On S4, lack of sustained political commitment identifying adolescent health as a priority development issue across multi-stakeholders and their silo mentality to maintain the accountability/ownership of cross-cutting programmatic activities were the weaknesses.

Conclusions

Despite numerous imposing challenges, with mainstreaming and constructive monitoring, the AYFHS in SL will remain as one of the best adolescent health programmes in the region.

Key messages

Assessment of Sri Lankan AYFHS according to the WHO’s ’4S’ Framework revealed multiple strengths such as updated guidelines, supportive policy environment and comprehensive care package. Despite numerous imposing challenges, with mainstreaming and constructive monitoring, the AYFHS in SL will remain as one of the best adolescent health programmes in the region.
Smoking and substance abuse prevalence in adolescents in a city of Turkey
Authors: Mete B , Pehlivan E , Söyiler V
Published: November 2019

Background

The aim of this study was to determine the prevalence of smoking and abuse of substance among young people aged 14-18 in a city of Turkey and to determine the relationship between smoking and substance abuse risk.

Methods

This cross-sectional study was conducted on high school students studying in Bingöl city center. The universe of the study consists of 14000 students studying in 14 high schools. The minimum sample size required to be reached in the sample size analysis with reference to 80% power and 99% confidence interval was found to be 1235. According to the stratified sampling method, the students were randomly reached in schools and questionnaires were conducted under supervision by taking their consent. Chi-square test, Binary Logistic Regression test were used for data analysis.

Results

The mean age of the students was 15.71 ± 1.16 (min-max: 14-18) and 49.5% were male. The prevalence of smoking among all students is 15.8%, addictive substance use / trial frequency 5% except smoking. The prevalence of smoking among male students is 24.1%, in female students 7.7%. The rate of using addictive substance was found to be 8.2% for male students and 1.9% for female students except smoking. According to the results of Logistic Regression; substance abuse increases 8 (95% CI:3,32-19,95) fold in smokers (p = 0,001) and 2.5 (95% CI:1,10-5,38) fold in men (p = 0,027). The risk of substance use increases 1.05 (95% CI:1,02-1,08) fold as the number of cigarettes smoked daily (p = 0,001). Substance abuse risk of 18-year-olds shows increase 1.5 (95% CI:1,06-1,93) fold according to 14 years old (p = 0,021).

Conclusions

Smoking and addictive substance use in adolescents are particularly remarkable in male students (8.2%). This result is higher than the data reflecting Ä°stanbul (7%). This may be due to the fact that the province is located at the crossing point of drug traffic. Smoking increases the risk of other addictive substances (marijuana, heroin, etc.).

Key messages

Smoking and substance abuse is an important health problem in adolescents according to this study. Male students smoke are at risk of substance abuse more than female.
Sequence of cigarette and e-cigarette initiations and daily smoking in adolescents (HBSC 2018)
Authors: Dujeu M , Lebacq T , Pedroni C , Desnouck V , Holmberg E , Moreau N , Castetbon K
Published: November 2019

Background

Electronic cigarette may help adults quit smoking. For adolescents, the concern is whether e-cigarette initiation is a gateway to subsequent smoking. Our objectives were to describe the sequence of conventional cigarette and e-cigarette initiations among adolescents who had already used both products, and to analyse the current smoking behaviour according to the first experienced product.

Methods

Analyses were based on a two-stage random sample of 9,937 12-20-year-old adolescents included in the French-speaking Belgian 2018 Health Behaviour in School-aged Children cross-sectional survey. Cigarette and e-cigarette initiations and its sequence, current daily smoking and other characteristics were collected through a self-administered questionnaire. Associations, adjusted for demographic data, were estimated using logistic regression and weighted. Sampling design was considered in analyses.

Results

In 2018, 66.0% of adolescents reported never having tried a cigarette and e-cigarette, 8.1% having experimented cigarettes only, 9.2% e-cigarette only and 16.6% having experimented both. Among adolescents who tried both products, eight out of ten smoked cigarettes before trying the e-cigarette (78.2%). In the whole sample, 6.8% of adolescents were smoking every day. Daily smoking was observed in 19.8% of adolescents who initiated e-cigarette and cigarettes and in 6.4% of those who initiated cigarettes only. Adolescents who first smoked cigarettes were more likely to further smoke daily (aOR: 2.48 [1.69-3.64]) than those who first used e-cigarette. The risk of daily smoking was not different between adolescents who first used e-cigarette compared with those who tried cigarettes only (aOR: 1.23 [0.76-2.00]).

Conclusions

In French-speaking Belgium, conventional cigarette was the first step in the initiation and continuation of tobacco smoking. These findings help understand smoking patterns among adolescents and will support the development of smoking prevention strategies.

Key messages

Our findings suggest that health promotion interventions should remain focused on conventional cigarette. Based on a cross-sectional study, they should however be confirmed by prospective studies.
How do male students perceive their role in contraception and the protection against STDs?
Authors: Van Der Heijde C M , Veldhoven M , Vonk P
Published: November 2019

Background

A lot of research has been done on women and contraception. How men perceive their role regarding contraception is largely unknown. Previous research shows that factors like intentions, communication and knowledge are of importance. The aim of this study is to get more insight that could provide us with more starting points for preventing unwanted pregnancies and STDs.

Methods

Eight semi-structured interviews with male students from Amsterdam, The Netherlands (aged 18-25, different study programs) were conducted based on a, previously developed, topic list. Convenience sampling was used to select respondents. The interviews were processed with thematic content analysis. Open, axial, and selective coding was used to analyze the interviews.

Results

Four themes emerged from the data: openness of parents, making an informed decision, prevention of pregnancy and STDs and durance of relationship. Men do not have a clear view on their role in contraception regarding responsibility and are still struggling with the autonomy of their partner, also in relation to the length of the relationship. When in a relationship they feel their role should be to support and communicate with their partner, but not to make the final contraceptive choice. When not in a committed relationship, men feel their role is solely to protect themselves against fatherhood and, to a much lesser extent, STDs.

Conclusions

Communication is key in preventing unwanted pregnancies and STDs, and working towards a shared responsibility. Following up on the role of parents in communicating well about these subjects, both men and women should take their responsibility in communicating. Furthermore, fear of unwanted pregnancy seems much larger than fear for STDs for male students. These subjects can be addressed in a university institutional context in a variety of ways (f.i. via flyers, projects, student counselors, student health services).

Key messages

More attention for the role of both men and women in communicating about contraception and STDs is necessary in a student population within the university institutional context. More attention for the dangers of STDs and the importance of protection against STDs is necessary in a student population within the university institutional context.