bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors of pregnancy morbidity in migrant women from Subsaharan Africa
Authors: Bezanahary H , Gutierrez B , Dumonteil S , Coste Mazeau P , Eyraud J L , Preux P M , Fauchais A L , Ly K , Aubard Y
Published: November 2019

Reduction of maternal mortality remains a major public health issue worldwide. In France, the latest national confidential enquiry regarding maternal mortality (2010-2012) stated a ratio of 10 /100 000 livebirths whereas the goal was 5/100 000. The risk of death among pregnant women from Subsaharan Africa (SSA) was 3 times higher.

We performed a monocentric observational retrospective study from 01/01/2009 to 01/09/2016 in order to better understand the factors of maternal morbidity among SSA pregnant women. Demographic characteristics as well as pregnancy outcomes were collected. Antenatal clinics attendance was scored (+1 if positive, +1 if done following the recommended schedule). A total 1 489 (7%) out of 20 755 pregnancies were registred among SSA women. Mean age was 29 years (14-48), mean gestity/parity were respectively 3.5 and 1.8. About 38% of pregnancies occured in overweight or obese women. Obstetrical complications were seen in 542 (36%) pregnancies: gestational diabetes (n = 206, 36,4%), hypertensive disorders (n = 122, 8,2%), 19 had both. Pre-eclampsia represented 4%, sepsis 5%, premature rupture of membrane 5% and post partum haemorrhage 3%. Livebirths was high (97%) with a mean gestational age of 37(22-41), a mean birth weight of 3150g (500-5000). The unique maternal death in this cohort was due to amniotic fluid embolism. Complication risk factors were age (30 versus 28 years; p < 0.0001), BMI (26 versus 25 kg/m2; p < 0.0001), past history of chronic hypertension and pregestational diabetes (p < 0,001). Furthermore, the score of antenatal care attendance was low in those who presented pregnancy morbidities (p = 0.0006) (adjusted with age, BMI> 25 and chronic hypertension).

Higher risk of maternal morbidity among SSA women is not only explained by individual risk factors but also by a lack of compliance to the recommended antenatal care even if they live in France. Further investigations including sociological studies are therefore needed.

Key messages

Maternal mortality and morbidity are higher among migrant women from Subsaharan Africa. Our study highlights a non compliance to the recommended antenatal care surveillance among risk factors.
Improving maternal healthcare in Georgia
Authors: Skhvitaridze N , Gamkrelidze A , Lobjanidze T
Published: November 2019

Improvement of reproductive health is a worldwide priority. Maternal and perinatal mortality and morbidity are frequently used as measure of quality of the healthcare. Thus, reduction of maternal morbidity and mortality are important goal for the SDGs. Hence, maternal and new-borns health are crucial to report accurately. The key requirement for progress is to have as much precise data as it is possible. Several tools are developed for quality surveillance; among them is the medical birth registry.

Georgia is a developing country which recently had healthcare in transition. Over the last decade, Georgia’s health sector has improved quality and embraced evidence-based medicine. Transformation and progress attributed reproductive healthcare. Country elaborated strategic plan and set achievable target for maternal and children’s mortality ratios for 2030. Georgia developed national maternal surveillance system. However, country has been lacking precise, comprehensive, and longitudinal data dealing with the reproductive health. Thus far, data on associated health services mainly derived from the sporadic on-demand surveys. Routine info on mortality and morbidity were available as aggregated data with a lack of epidemiological analysis.

In order to provide proper reproductive health profile, Georgia created a nationwide medical birth registry (GBR). GBR has made it possible to create a precise epidemiological analysis and to ensure the evidence-based reporting. To improve epidemiological research capacity, PhD projects were implemented a year after the GBR started operation, in the frame of cooperation of Norwegian and Georgian Universities. Moreover, universities initiated tracks for master students to have internship and graduate thesis in GBR related topics.

Overarching goals of the GBR are numerous. Although compilations of statistics and ensuring scientific bases for advice through generated researches are beneficial for universities and country as well.

Key messages

Studies, based on transparency of highly accurate medical statistics gives possibility for effective implementation of evidence-based public health interventions. Recommendations provided by registry based studies have a pivotal role in formulation and revision of relevant public health strategies.
The importance of relationships in adolescent risk behaviour prevention
Authors: Cooper C , Lhussier M
Published: November 2019

Health risk behaviours are a key contributing factor to adolescent morbidity and mortality. Furthermore, evidence shows that health behaviours begun in adolescence can impact on wellbeing across the lifespan. Current evidence suggests it is advantageous to target multiple health risk behaviours simultaneously, however efficacy testing remains the key focal point for research, with few studies exploring common underlying causal and contextual factors which may contribute to the success or failure of a programme.

Methods

This review used a customised realist approach, to explore how, why, for whom, and in what circumstances programmes are most successful in preventing multiple health risk behaviours in adolescents. The review synthesised evidence from published literature, along with qualitative data from stakeholders collected through focus groups with young people (n = 28) and school nurses (n = 22), and interviews with adolescent health and wellbeing practitioners (n = 8).

Findings: Across all the realist programme theories developed, the role of relationships was the most commonly occurring theme. This theme goes beyond the expected impact of the relationship between programme deliverers and recipients, and familial and peer attachments, also taking in to consideration the relationships between programme and school leaders and staff, support networks and collaborative relationships between staff, and wider social connectedness within the community. These in turn were impacted upon by wider contextual factors, such as family, community, culture, socioeconomic status, intersectionality, and health inequalities.

Conclusions

These findings provide important insight in to understanding how, why, for whom, and in what circumstances multiple risk behaviour prevention programmes succeed or fail. Further to this they highlight key areas for consideration in the development of future adolescent public health interventions.

Key messages

Relationships built on trust and genuine care can improve adolescent risk behaviour prevention outcomes. Broader sociocultural context provide key explanations for variations in programme outcomes.
Women’s experiences with labor companionship in public facilities in Arab countries
Authors: Kabakian-Khasholian T , Bashour H , El-Nemer A , Nameh N
Published: November 2019

Background

Childbirth in the Arab region is characterized by over-medicalization and inequities in access to-and provision of care. Hospital practices do not provide choices for women and respond to the convenience of providers rather than women’s needs. Provision of maternity care is reflective of existing social inequities which is manifested through mistreatment and disrespect of women within the health care system. One such example lies in the restriction of birth companions in public facilities in Arab countries despite being practiced in private settings and the strong evidence supporting its implementation globally.

Methods

A phased mixed-methods implementation research study was undertaken in three public hospitals in Lebanon, Egypt and Syria with the aim of developing a tailored labor companionship model and evaluating its implementation. Data presented emanate from the qualitative component of the study. Semi-structured interviews were conducted with women giving birth (n = 59) and their labor companions (n = 57) in three facilities. Thematic analysis was used.

Results

Beyond the introduction of the model into the system, women reported improvements in dimensions of respectful maternity care. Changes made in shared labor rooms improved women’s privacy. The presence of labor companions improved communication between health care providers, women and their families. Women reported feeling “dignified” and “strong” in the presence of companions. There was a “feedback loop” from the facility to the community with word spreading about labor companionship “just like in private hospitals”.

Conclusions

The labor companionship model improved equitable access to dignified and respectful maternity care through better rapport between women and health care providers, preservation of women’s privacy and having access to birth companion of choice. The provision of evidence-based care has potential implications on women’s experiences with the health care system.

Key messages

This labor companionship model ensured positive experiences for women giving birth in public facilities in Arab countries. Women perceived the model as type of care that reduces differential treatment based on social status and enhances respectful maternity care.
Type2 diabetes:changing patterns of use of antidiabetic drugs 8 years after starting treatment(snds)
Authors: Aguadé A S , Gastaldi-Ménager C , Karsenty D , Fontaine P , Fagot-Campagna A
Published: November 2019

Objective

To describe the changing patterns in the use of the various classes of antidiabetic drugs in a cohort of patients newly treated for diabetes from 2008 to 2015 on the basis of comprehensive health insurance data.

Methods

General scheme beneficiaries 45 years and older were identified in the French National Health Data System (SNDS) as newly treated when antidiabetic drugs were dispensed on at least 3 different dates in 2008 and at least once during the last 4 months of 2008, but were dispensed less than 3 times in 2006-2007. Treatment regimens for the last 4 months of each year were defined for this cohort.

Results

158,000 people (53% men, mean age 62 years) initiated antidiabetic drug therapy in 2008: monotherapy (without insulin): 74%, dual therapy: 17%, treatment with 3 or more drugs: 3%, and insulin therapy: 7%. The proportion of patients taking monotherapy decreased by 13 percentage points during the second year and only 32% of the cohort was treated by monotherapy 8 years after starting treatment. The proportions of patients taking dual therapy increased by 4 percentage points (21% in 2015), triple therapy increased by 8 percentage points (11%), a combination of insulin+other antidiabetics increased by 4 percentage points (7%) and insulin alone remained stable (4%). At the last quarter of 2015, 12% of patients did not receive any antidiabetic drugs and 13% had died. The creation of a cohort of diabetic patients newly treated in 2013 demonstrated changing prescribing practices: a lower proportion of monotherapy in the first year of treatment, but a growing use of metformin.

Conclusions

Treatment was intensified during the first 8 years for one half of the cohort. The maximal dosage of Metformin is not used before introducing a second antidiabetic in 1 case in 2. Insufficient use of Metformin, in general and in terms of dosage, was observed, although this use is improving.

Key messages

Initiation of antidiabetic drug therapy in people 45 years and older consisted of monotherapy in 3/4 of cases in 2008. Insufficient use of Metformin, in general and in terms of dosage, was observed, although this use is improving.
Preventive actions for the gradual reduction of excessive salt intake and its monitoring in Italy
Authors: Donfrancesco C , Bellisario P , Galeone D , Noce C Lo , Russo O , Palmieri L , Giampaoli S , Strazzullo P
Published: November 2019

Issue

The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI).

Description of the problem

According to the “Gaining Health” Programme, agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. The reduction of excessive salt intake is one of the main objective of the NPP 2014-2019 pursued by the Regions through initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators. The Italian Institute of Health conducts national surveys to estimate habitual salt intake in the general adult population by collecting 24h urine. Baseline assessment was in 2008-2012 from random samples of persons aged 35-79 years, resident in all 20 Regions. A new survey is ongoing (2018-2019) involving persons aged 35-74 years, resident in 10 Regions. Surveys are funded by the MoH-CCM; urinary sodium excretion is effected by a central lab at Federico II University of Naples, subjected to strict quality controls.

Results

The baseline survey showed a mean sodium excretion of 10.6 g/24h (95% confidence interval 10.5-10.8) in 1963 men and 8.2g/24h (8.1-8.4) in 1894 women. Results of the ongoing survey are expected in the coming months.

Lessons

In Italy preventive actions of salt reduction supported by the MoH have been implemented. Estimation of salt intake in diet by 24h/urine is included. Results of baseline and on-going surveys will allow to estimate the possibility of meeting the WHO salt reduction target by 2025.

Key messages

In Italy inter-sectors preventive actions of salt reduction are implemented. Results of the baseline and on-going surveys will allow to estimate in Italy the possibility of meeting the WHO salt reduction target by 2025.
Evaluating the effectiveness of a screening program for cardiovascular diseases in Kazakhstan
Authors: Bekbergenova Z , Derbissalina G , Umbetzhanova A , Koikov V , Bedelbayeva G
Published: November 2019

Background

Cardiovascular diseases (CVD) occupy leading positions in the mortality of the Republic of Kazakhstan (RK). In RK CVD screening is performed with 40-years of age. Objectives: to evaluate the effectiveness of screening over time.

Methods

We conducted a survey of 121 patients with CVD, identified on screening.

Results

The average age patients in survey-54.3 [95% CI: 52.64;55.96], of which 38% are men and 62%-women. Fact smoking mark 64 persons (52±8), alcohol-(37.2±11.6), family history-66 (54.5±8.1) daily physical activity-34 person (28.1±14.3). Middle systolic blood pressure (BP) is 144.3 [95% CI: 141.61;146.99] and diastolic BP 90.2 [95% CI: 89.02;91.38] mm.Hg. Most of the respondents have different degrees of obesity. The average BMI is 31.8 [95% CI: 30.93;32.67]. The average waist size is 89.1 [95% CI: 86.88;91.52], with the waist size of women over 80 cm (91.9 [89.03;94.77] and the waist size of men 86.1 [82.31; 89.89]. Mean values for total cholesterol of 5.9 [95% CI: 5.85;5.95]. To evaluate the effect of various factors on the increase in BP, we calculated the analysis of variance. According to our calculations, gender does not affect BP, however, age, BMI and waist size affect.

We interviewed patients for complaints, analyzed outpatient cards, a check-up journal: chest pains or interruptions in the heart during exercise are noted by 25 people (20.7±17.5), improvement of the subjective state-29 (24±15.9), regularly receive basic therapy-59 (48.8±9.1), call the ambulance team-43 (35.5±12), are urgently hospitalized for a year-31 (25.6±15.2) and 7 person participate in the school of CVD. There is a statistically significant relationship between gender and smoking, gender and alcohol, gender and regular intake of basic therapy at a significance level of p < 0.05.

Conclusions

Identifying the low effectiveness of CVD screening over time requires the revision of a comprehensive training program for doctors-nurses and the public.

Key messages

Patients in Kazakhstan generally do not change their lifestyle after screening for a disease. The effectiveness of the screening depends on the teamwork of the doctor, nurse and patient.
Citizens’ perceptions of the health-related neighbourhood environment in Limassol, Cyprus
Authors: Kleopa D , Panayiotou A , Kouta C , Middleton N
Published: November 2019

Background

“Place” can impact on health and quality of life. There is a growing interest in neighbourhood audits. In the context of developing the CyNOTes audit tool, a residents’ perception of the neighbourhood environment survey was performed.

Methods

A systematic random sample of ten adult residents (N = 150) across a stratified sample of fifteen neighbourhoods according to educational attainment as per census data responded to the “Place Standard” tool which assesses 14 aspects of the physical, built and social neighbourhood environment. Neighbourhoods were also audited using the 126-item CyNOTes.

Results

Three in four participants were home owners and lived in the neighbourhood for over 10 years. With the exception of “identity and sense of belonging” (M = 5.8, SD = 2.0) and “opportunities for social interaction” (M = 5.3, SD = 2.1), physical and built aspects of the environment were rated close to the middle point on a scale 1: large to 7: little room for improvement. “Parks, playgrounds and green space” and “garbage, animal droppings and other physical disorder” were the most commonly mentioned priorities for action in the free text by one in three participants. The lowest score was recorded for “influence and sense of control” (M = 3.4, SD = 2.4). While on a 1-10 subjective perception of neighbourhood position, residents in lower education neighbourhoods gave a rating of 6.6 on average compared to 8.1 in the higher group, they tended to rate aspects of their neighbourhood more favourably. Even though the audit revealed a systematic pattern of less favourable conditions along the socio-economic continuum, the perception survey revealed a U-pattern with residents in the middle category more likely to give less favourable ratings.

Conclusions

The extent to which perceptions surveys may be affected by differential expectations across social groups is not clear. Neighborhood audits provide supplementary profiles of “place” independent of the perceptions of residents.

Key messages

Based on the Place Standard tool, Limassol residents’ rate social aspects of their neighbourhood environment more favourably than aspects of the built and physical environment. Neighbourhood observed-based audits, independent of residents’ perceptions surveys can supplement each other in city health profiling.
Evaluating implementation of an Heat-health action plan during 2018 heatwave in Amadora, Portugal
Authors: Leite A , Cabral M , Rodrigues E , Vaz D , Calé E , Silva A C
Published: November 2019

Issue

Heatwave-health effects are preventable. Heat-health action plans (HHAPs) include preventive measures aimed at protecting population. In Portugal, HHAPs exist since 2004 and have been operationalized at local level. Heatwaves occur infrequently, thus experience with HHAPs is relevant to countries implementing their own HHAPs.

Description

In the summer of 2018, Amadora (Lisbon, Portugal) issued a warning from the 2nd-6th August (highest level:4th-6th). Before/during the warning we implemented: 1.climatized shelter opened available upon request;2.text messages with recommendations and information on the walk-in clinic services available;3.information to nursing homes regarding available services (walk-in services/shelter);4.contact with individuals receiving home support and identified as vulnerable. Nationwide media publicity of individual protection measures was also ongoing. We aimed at evaluating these HHAP measures. We compared demand of walk-in clinic (primary care) and emergency department with existing capacity, updated during the heatwave. Mortality was analysed using an observed-expected ratio (O/E) of week 32 (following the heatwave) and 95% confidence interval (95%CI) under a Poisson distribution. Expected deaths were the average deaths in week 32 of the previous 4 years (2014-17).

Results

In the primary care walk-in clinic the demand was ½ of capacity; hospital emergency services demand did not increase. We had no requests for the shelter unit. Regarding mortality, O/E was 1.57 (95%CI:1.12-2.14). These results are preliminary; we are producing more detailed analyses of mortality data.

Lessons

We have no counterfactual to assess the effect of our HHAP but our results indicate the possibility to reduce heatwaves-mortality further and thus the need for additional measures. We did not observed the expected surge in service demand; the adequacy of supply-based measures is currently under debate. More detailed mortality analysis will provide further insights.

Key messages

We implemented several measures during a heatwave in Amadora, Portugal with no increased demand in available health services in the area. We detected an increased mortality following the heatwave, suggesting the need to implement further measures.
Occupational exposure assessment to per and trichloroethylene in dry cleaning in Sfax city (Tunisia)
Authors: Omrane F , Khadhraoui M , Abid A , Mitigui M , Elleuch B , Gargouri I
Published: November 2019

The use of chlorinated solvents in dry cleaning poses risks to human health. The current study is the first in Tunisia and Sfax city that aims to assess the occupational exposure and health risks of perchloroethylene (PCE) and trichloroethylene (TCE) in the dry cleaning industry. TCE was suspected to be used as it is not explicitly banned by law.

We identified dry cleaning facilities by door-to-door canvassing within a 5 Km radius from the city center of Sfax. We found 47 facilities, but only 33 accepted to join our study. Then, we randomly selected 16 facilities where the exposure assessment to these solvents was conducted by indoor air measurements. The exposure levels were compared to occupational exposure limit values (OELV) and toxicological reference values. Then, cancer risks were evaluated.

TCE was detected in all workplaces and their levels are close to the OELV (95% CI of the mean value [40.4-46 mg/m3]). The mean value of PCE concentrations is lower than the fifth of the OELV, but they are quite variable (95% CI of the mean value [5.1-43.4 mg/m3]). The overall results showed that inhalation exposure levels may induce many adverse effects that are probably threatening the occupationally exposed population and even the general one, because of the location of all facilities in residential settings. Among threshold effects, we noted high risks of neurological, renal, developmental and immune effects. As for carcinogenic effects, greatly high cancer risks were noticed if the lifetime exposure would have these average levels; 17 additional cases of kidney, hematologic or liver cancers are expected to occur in populations of 100.

This study is significant for better understanding of the dry cleaning industrial sector in Tunisia and for the progress of future risk assessment studies. Indeed, it responded to many interrogations and suspicions about the qualitative and quantitative exposure conditions and thus the health status of dry cleaning workers in Sfax.

Key messages

Our study is the first health risk assessment study of the exposure to chlorinated solvents in dry cleaning in Sfax city. It revealed high levels of trichloroethylene that is a carcinogen to humans. The high exposure levels to per and tri-chloroethylene, in dry cleaning in Sfax city, may induce adverse health effects to workers and even the general population due to residential exposure.
Attitudes, norms and behaviors enhancing unhealthy food choices of high school students in Armenia
Authors: Aslanyan L A , Demirchyan A D
Published: November 2019

Background

Negative attitudes towards healthy eating behaviors are common among school-aged children. Given the scarcity of studies investigating eating behaviors among adolescents in Armenia, the current study sought to explore eating behaviors among high school students and assess the attitudes, norms and behaviors enhancing unhealthy food choices among them. Theory of Planned Behavior (TPB) was applied as a theoretical framework.

Methods

A qualitative study with focus group discussions and in-depth interviews was conducted using semi structured interview guides developed based on TPB framework. The study covered high school students aged 15-18 years old, their parents, teachers and school canteen staff, residing in cities and villages of Shirak province, Armenia. Direct content analysis with deductive approach was used for data analysis.

Results

The most preferred foods by the adolescents were fast foods, sweets, salads and sugar sweetened beverages. Taste was the most powerful attitudinal factor influencing their food choices. Friends and advertisements were the main role models affecting adolescents’ eating behaviors. Knowledge on unhealthy food choices and the consequences of unhealthy diet on one’s health were adequate among all participants, but unlike rural participants, this factor did not result in healthy eating behavior among urban participants. Lack of time, high cost of food, seasonal changes in food availability, limited food choices in school canteens and low coverage of schools with canteens, especially in the villages, had considerable impact on adolescent’s food choices.

Conclusions

According to the study results, most of the TPB constructs played role in shaping unhealthy eating behaviors among adolescents. Based on the findings, recommendations were made to conduct social advertising of healthy food choices and healthy eating behaviors among adolescents, empower school cafeterias and increase the coverage of schools with cafeterias.

Key messages

In Armenia, adolescents’ eating behaviors are mainly influenced by taste, availability, and affordability of food choices, eating behavior of peers and advertisements. Government needs to increase the coverage of schools with cafeterias and empower school cafeterias, so that they suggest healthy, tasty and affordable food choices.
Integrated guide for public procurement and private contracts of collective catering system and SDGs
Authors: Barocco G , Patussi V , Cella M , Germano D , Pernarcic A , Longo T , Occoni E , Steinbock D , Calabretti A
Published: November 2019

Surveys (2008-2018) carried out by the Local Health Agency of Trieste (ASUITS) in local collective catering (CC) services of schools, hospitals, nursing homes, and workplaces (25.000 daily meals) have shown some non - adherence to healthier food choices, food standards, procedures and green and social procurement as recommended by the WHO, FAO, UE, Ministry of Health and of Environment.

The purpose of this project is to support local public and private organizations in transforming the national and regional catering services food standards related to health, nutrition, environment and social criteria into food procurement and food contracts specifications. This has been done by compiling the major obstacles to improved standards observed during surveys, and by sharing critical and relevant examples with major public contractors across local, regional and national level.

The guidelines (GL) for public procurement of CC consist of five chapters: the elaboration of specifications; a response module to present the offer of services; selection and award criteria, an evaluation system of offers, and the technical specifications attached. Technical information fixes the constituent elements of the service in order to have similar and directly comparable offers. GL cover both the purchasing of food and the contracting of catering services. In this way public or private institutions are able to prepare tender documents suitable to respond to health, economic needs and Sustainable Development Goals (SDGs).

The development of the GL has increased the awareness and real potential that local organizations have in enhancing the strategic use of purchasers to boost food qualification, jobs, growth and investment. As well as to create a more innovative economy, to be resource and energy efficient, and to be socially-inclusive.

To meet population nutrient intake goals and SDGs it is necessary to increase co-operation and the sharing of the objectives of ’Health in All Policies’.

Key messages

Contractors need practical tools to apply sustainable development goals criteria in collective catering. The integrated collective catering guide is a key to improving capacity building in institutions.
Cost-effectiveness analysis of low-dose computed tomography screening for lung cancer in Hungary
Authors: Voko Z , Molnar A , Valay V , Moizs M , Kerpel-Fronius A , Bajzik G , Horvath I , Nagy B
Published: November 2019

Background

Hungary has the highest incidence of lung cancer in the world (GLOBOCAN, 2018). Since lung cancer is rarely treatable in its advanced stage, one possible way to reduce mortality is early diagnosis and subsequent treatment. The possibility and necessity of introducing low-dose computed tomography (LDCT) lung cancer screening as a public health programme is a current and relevant health policy issue.

Methods

A Markov cohort model was built to assess the cost-effectiveness of such a risk group screening programme in Hungary. The model was populated with transition probabilities and resource utilization data derived from the HUNCHEST Hungarian lung cancer screening trial. The model results are presented in incremental cost-effectiveness ratio.

Results

A closed cohort of 10,000 smokers with the average starting age of 59 years was followed over life-time horizon and screened for lung cancer annually until the age of 74. Compared to the current scenario of no organized lung cancer screening in Hungary, the model resulted in an additional 0.1614 life-year gained per individual and an additional 0.2924 disease-free life-year gained per individual with annual screening frequency. The incremental cost-effectiveness ratio was EUR 608 indicating that assessed intervention is cost-effective in the analyzed setting. Sensitivity analyses confirmed the robustness of the model results.

Conclusions

Results suggest that introducing low-dose computed tomography screening for lung cancer is a cost-effective intervention in Hungary. Considering the exceptionally high incidence and mortality of lung cancer in Hungary, the population could benefit from such a risk group screening programme.

Key messages

Low-dose computed tomography screening for lung cancer is cost-effectiveness in the Hungarian setting. Policy makers are encouraged to consider the introduction of a risk group screening programme.
Evaluation of the Health impact assessment (HIA) deployment process in a French region
Authors: Jabot F , Romagon J , Dardier G
Published: November 2019

Background

Health impact assessment is a method aimed at identifying the potential health impacts of policies and projects before their implementation and suggesting proposals in order to mitigate negative impacts and enhance positive ones. HIA is growing in France mainly at the local level. The Pays de la Loire Regional Health Agency (PDL-HRA) took an early interest in HIA and supported three experiments proposed by the town councils. An assessment was performed to judge its added value, identify success factors and draw lessons for the development of the practice.

Methods

An evaluation framework was built based on standards and literature. Using a qualitative multiple case study design, a cross-sectional analysis of the HIAs was carried out in order to compare the implementation process in their respective contexts, the governance arrangements and the changes introduced as a result of the HIA. Evaluation draws upon HIA reports, workshops, field observation and 40 interviews that were analysed with NVivo.

Results

While the conduct of HIAs is generally in line with standards of practice, the analysis of the relevance of HIA and impact characterization remain insufficiently documented. Implementation and success factors depend on the political context, the culture of institutions, actors and the purpose of HIA. Recommendations have been taken into account and changes are emerging. The stakeholders indicate their interest in HIA insofar as it is a meeting point between the concerns of institutions regarding health equity and democracy and it provides tools for action.

Conclusions

Although the approach is unanimously valued, it faces time, resource and competition with other activities. The continuation of the approach depends on the HRA policy specifying the aims, resources, fields of application and positioning with regard to the partners.These findings are consistent with other French work and literature data. French experience coulfd benefit from that of other countries.

Key messages

Skills of professionals have to be reinforced in order to make appropriate and quality HIAs. Evaluation is useful for understanding the development of an emerging practice and for supporting a decision-making in terms of scaling up, integration, role assigned to the health sector.
Different designs of additional payments for new technologies: The approach of Germany and the USA
Authors: Henschke C
Published: November 2019

Background

Health systems have to balance access to technologies, ensure safety and quality, and manage expenditures. As payment rates of prospective payments do not reflect higher costs of technologies, additional payments were implemented. The study aims at comparing the principles of Medicare’s New Technology Add-on Payments (NTAP) and payments for new diagnostic and treatments methods in Germany (NUB), and analyzing the development of additional payments over time.

Methods

A literature review was conducted using public domains of regulatory bodies and databases to compare payment approaches according to a) technologies’ eligibility criteria, b) their designs, c) implemented reforms, and d) conducted evaluations. Published data of responsible institutions was used to descriptively analyze the number of technologies authorized for additional payments in hospitals (2005-2018).

Results

Major differences between payment approaches were identified. The design differs regarding application and payment processes. While in Germany, a single hospital wishing to use the technology has to request for authorization, in the US the manufacturer starts the application process. The NUB-approach allows for payment negotiations per technology between insurers and a certain hospital, the amount of NTAP-payments is calculated per case using a calculation scheme based on real hospital costs. Hospitals, thus, may only be partially compensated for the higher costs of technologies. Only limited evidence exists on the effects of these payments.

Conclusions

Both approaches improve access to technologies compared to prospective payments. However, different designs indicate different incentive structures, which can affect patient’s access. Implicitly, both designs seem to limit excessive technology utilization. Further studies are necessary to evaluate the impact of additional payments on real utilization rates, outcomes and expenditures in order to optimize the design of those payments.

Key messages

Additional payments can improve access to technologies compared to prospective payments, but seem to limit excessive technology utilization at the same time. Different designs come along with different incentive structures to use technologies. Further empirical research is needed to analyze effects on real utilization rates, outcomes and expenditures.
Diurnal rhythms of cortisol and melatonin in night eating and non-night eating male police officers
Authors: Sørensen J K , Jensen M A , Hansen ÅM , Rugulies R , Garde A H
Published: November 2019

Background

Working during the night has in previous studies been associated with behavioural changes and diseases. Disturbance between behavioural and biological circadian rhythms have been suggested as a possible mechanism linking night work with cardiovascular diseases and pre-diabetic changes. The aim of this study was to investigate if night eating during two, four and seven consecutive night shifts is associated with differences in the diurnal rhythms of cortisol and melatonin in male police officers in Denmark.

Methods

We conducted an experimental study among 37 male police officers in Denmark who all collected data on the last night shift in three different work schedules with two, four and seven consecutive night shifts, respectively. Night eating was self-reported and defined as eating at least one main meal between midnight and early morning. Differences in the diurnal rhythms of concentrations of cortisol and melatonin in saliva were tested by phase changes and amplitude differences.

Results

Sixteen (43.2%) police officers ate a main meal during the last night shift in all three work schedules. The timing of the lowest cortisol concentration was on average delayed with 2:10 hours (95% CI 0:24-3:56 hours) and the level of the lowest cortisol concentration was on average supressed with 66% (95% CI 47-94%) for night eaters compared to non-night eaters. There was no association with number of consecutive night shifts. The phase and amplitude of melatonin were not statistically significantly different between night eaters and non-night eaters.

Conclusions

Night eating behaviour is associated with differences in the diurnal rhythm of cortisol in Danish male police officers working during the night. The difference in cortisol rhythm between night eaters and non-night eaters on night shifts is not affected by the number of consecutive night shifts.

Key messages

Night eating behaviour is associated with differences in the diurnal rhythm of cortisol. Future studies should focus on potential health outcomes of night eating behaviour among night workers.
The risk of emergency department visits in adults living in rural France
Authors: Mercier G , Rodwin Victor , Quantin Catherine , Chernew Michael , Gusmano Michael
Published: November 2019

Background

Individuals living in rural areas have poorer health outcomes due to complex causal pathways related to socio-economic status, health behaviors and lower use of primary care. Emergency department visits without inpatient admission (hereafter ED visits) are an indirect measure of access to primary care.

Objective

To analyze the determinants of ED visits among French adults living in rural areas.

Methods

We analyze survey data from the CONSTANCES cohort study, a representative sample of French adults aged 18-69 years. These data on individuals’ demographics, self-reported and physician-reported clinical indicators, and individual socio-economic status, are linked to France’s claims database (SNIIRAM). We analyze the risk of having at least one ED visit, in 2016, using a multivariate logistic regression model.

Results

Among 12,834 adults included in the study, 1,412 (11%) had at least one ED visit in 2016. After adjustment, the ED visit risk was associated negatively with female gender (OR = 0.87; p < 0.01), age (OR = 0.97; p < 0.01), secondary education (OR = 0.85; p = 0.03), higher use of GPs (OR = 0.99; p = 0.02); and positively associated with the number of comorbidities (OR = 1.1; p < 0.01), poorer self-reported health status (OR = 1.01; p = 0.02), a higher self-reported depression score (OR = 1.01; p = 0.02), and acute care inpatient admissions (OR = 2.4; p < 0.01).

Conclusions

These results suggest that, among adults living in rural France, those with a lower educational level are at higher risk of ED visits.

Policy implications: To reduce health disparities among rural and urban areas, policymakers and primary care professionals should focus on targeted outreach strategies to identify high-needs individuals.

Key messages

The risk of emergency department visit varies significantly among adult living in rural France. Among adults living in rural France, those with a lower educational level are at higher risk of ED visit.
Accessibility of early diagnostics for children with a developmental disorder in Flanders, Belgium
Authors: Cloet E , Leys M
Published: November 2019

Background

20% of all children suffer a neurodevelopmental delay or disorder (NDDD) worldwide. Early multidisciplinary diagnostics, early intervention and timely diagnostics along the rehabilitation trajectory are needed to improve the child’s functioning and participation. In Flanders, Belgium, 6 types of public organizations (164 service points in the region) offer multidisciplinary diagnostics of NDDD for children. However the objective of timely diagnostics for the population is not realized.

Methods

A qualitative thematic analysis identifies the criteria of Federal and Flanders’ regulations for publicly accredited and funded organizations providing multidisciplinary diagnostics for children with (suspected) NDDD. A survey was sent in different settings on waiting periods and perceived determinants hampering early diagnostics These results were discussed and validated by experts in focus groups.

Results

Average waiting times for diagnostics run up to 1 year before a diagnostic trajectory can be started. Regional differences occur in the availability of diagnostic services. Formal regulations hamper the development of collaborative networks and an integrated health services model offering accessible diagnostics along NDDD trajectories. The field lacks public health services strategies to provide accessible, efficient and effective diagnostics for a complex range of NDDD target groups

Conclusions

Coordination of services providing multidisciplinary diagnostics for children with (suspected) NDDD is needed. A health services approach supporting mandated regional networks will improve the accessibility of early and timely diagnostics.

Key messages

Development of collaborative networks of different types of services offering diagnostics will improve the accessibility of early and timely multidisciplinary diagnostics for children with NDDD. Better accessibility to multidisciplinary diagnostics will improve long term outcome for children with NDDD.
Individual Versus Area Level Social Risk Measurement in the General French Population
Authors: Mercier G , Quantin C , McWilliams M
Published: November 2019

Background

Ongoing health policy changes include a move towards alternative delivery and payment models. In addition, the emphasis is put on social determinants as part of performance measurement and payment calibration. Most payers and policy makers rely on area-level socio-economic data, which can lead to sub-optimal. However, little is known about the agreement between individual and area-level variables. The objective was to assess the agreement between individual and area-level social risk variables in the general French population.

Methods

We used data from the CONSTANCES general-purpose cohort, a randomly selected representative sample of French adults aged 18-69 years. Data collected include socioeconomic and demographic characteristics, behaviors, and health data. We assessed the correlation or agreement between individual and area-level variables for 4 dimensions: household annual pretax income, secondary education completion, occupational group (workers), and unemployment.

Results

115,263 individuals were included in the study, 53% female and aged 48 years on average. The median annual household income was 42,000 Euros (USD 50,400), 73% had completed secondary education, 7% were unemployed, and 9.3% were workers. The correlation between income measured at the individual and area level was positive but moderate (Rho=0.20; p < 0.01). Individuals having completed secondary education had a higher area-level median completion rate compared to those having a lower education level (48% versus 41%; p < 0.01). Unemployed individuals had a slightly higher area-level median unemployment rate compared to employed ones (11% versus 10%; p < 0.01). Lastly, workers had a higher area-level median probability to be a worker rate compared to other individuals ones (25% versus 18%; p < 0.01).

Conclusions

In the general French population, area-level socio-economic variables are poor proxies for individual-level social risk.

Key messages

Area-level socio-economic data is a poor proxy for individual data. Researchers and policy makers should move towards individual data.
The economic burden of NCDs due to low fruit and vegetables consumption in the Russia in 2016
Authors: Mukaneeva D , Kontsevaya A , Balanova Y , Myrzamatova A , Khudyakov M
Published: November 2019

Introduction

A significant risk factor for NCDs is low fruit and vegetables (F/V) consumption, which leads to economic and social costs in all countries, regardless of income level.

Aim

To evaluate the economic burden of NCDs associated with low F/V consumption in the RF in 2016, including the direct costs and the economic losses caused by reduced productivity.

Materials and Methods

An analytical review of the literature on the search for relative risks (RR) of morbility and mortality from NCDs associated with low F/V consumption was carried out. Based on data on the prevalence of low F/V consumption in the RF (41.9%) and RR, the attributive risk for the population (PAR) was calculated for CVD, diabetes and several types of cancer. To assess the economic burden, the proportion of risk factor in morbidity and mortality from NCDs included in the analysis based on PAR was determined. Direct costs were calculated on the basis of tariffs for the provision of medical care in the RF in 2016 and the amount of disability benefits. Indirect costs included the loss of gross domestic product due to premature mortality and disability.

Results

PAR of low F/V consumption in the RF in 2016 in mortality for all CVD was 5%, in morbility about 7%, in morbility of stroke - 10%. PAR of low F/V consumption in morbility of diabetes was 6%, COPD - about 5%. PAR of low F/V consumption in mortality for ovarian cancer was 27%, for kidney cancer - 20%, in morbility from 3% for stomach cancer to 40% for pancreatic cancer. The economic burden associated with low F/V consumption in the RF in 2016 amounted to about 162 billion rubles (0.19% of GDP). A significant contribution to the economic burden was made by cancer: pancreatic cancer (38.2%), colorectal cancer (21.3%), ovarian cancer (26.3%), kidney cancer (26.4%).

Conclusions

An assessment of the economic burden will be an argument for justifying the feasibility of investing in the prevention of NCDs associated with low F/V consumption.

Key messages

To evaluate the economic burden of NCDs associated with low F/V consumption in the RF in 2016, including the direct costs and the economic losses caused by reduced productivity. The economic burden associated with low F/V consumption in the RF in 2016 amounted to about 162 billion rubles (0.19% of GDP).