bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of personal protective equipment among farmers in Nebraska, Lithuania, Latvia, and Slovenia
Authors: Achutan C , Girdžiūtė L , Vasiliauskas G , Kampuss K , Starič J , Rautiainen R
Published: November 2019

Background

Farmers in the U.S. and in Europe are at a high risk for injury and illness. Farmers have an increased risk of respiratory disease, noise-induced hearing loss, skin disorders, and eye injuries. Many of these health risks can be prevented or reduced through proper use of personal protective equipment (PPE). However, studies show low compliance of PPE use among farmers. The purpose of this study was to identify barriers to wearing PPE, and current health and safety training as potential targets for future intervention, in farmers in Nebraska, Lithuania, Latvia, and Slovenia. The European Cooperation in Science and Technology and the Central States Center for Agricultural Safety and Health collaborated on this study.

Methods

We administered a 7-item questionnaire to 57 farmers in Nebraska (n = 10), Lithuania (n = 22), Latvia (n = 10) and Slovenia (n = 15). The farmers primarily grew crops (corn, soy) and some raised livestock.

Results

We found that gloves, respirators, and safety glasses were the PPE most commonly worn; use of face shields were only reported in Nebraska and Lithuania. Only 45% reported wearing PPE always when they needed them. In Nebraska and Latvia, most farmers reported not wearing PPE because they are not readily available although they have them on the farm; in Lithuania and Slovenia, farmers cited time to don PPE and discomfort as primary reasons. The percentage of farmers who reported receiving training on the selection, use, and maintenance of PPE varied widely-13% in Nebraska, 14% in Lithuania, 40% in Latvia, and 67% in Slovenia. Farmers purchased PPE over the internet, supermarkets, and agricultural cooperatives.

Conclusions

This study provided an opportunity to understand current perceptions of PPE use and challenges, among a cross section of farmers in the U.S. and Europe. We recommend enhancing training through creative modules to address the needs of farmers.

Key messages

By identifying why farmers do not always wear PPE, we can design effective interventions to overcome this barrier; by knowing where they purchase them, we can provide education at these venues. This study is a joint collaboration between U.S. and European researchers. This global cooperation has highlighted some similarities but also differences within European countries.
Implementation research to evaluate an educational intervention for people who inject drugs
Authors: Roux P , Magen C , Stranz R , Schatz E , Verdes L , Curado A , Tsiakou T , Roy E , Carrieri P
Published: November 2019

Objective

In the context of disseminating harm reduction (HR) programmes in Europe, the Eurosider project aims to study the transferability of an effective educational intervention for people who inject drugs (PWID) to four European countries (Bulgaria, Greece, Portugal and Romania). This intervention, entitled Individually-Tailored Support and Education for Safer Injection (ITSESI), has been shown to reduce HIV-Hepatitis C Virus (HCV) risk practices by offering educational supervision during all phases of the injection sequence, from pre- to post-injection.

Methods

The project employs mixed methods and implementation science. The exploratory first step used qualitative interviews and other available data in each country. The second step consists in implementing and evaluating the intervention using a 6-month study conducted among 300 PWID enrolled in the 4 countries. They are interviewed at baseline and at 6 months. The third step will consist in designing, promoting and disseminating all the tools necessary to transfer ITSESI at the European level.

Results

Results from the exploratory phase highlighted two main determining factors for the feasibility of implementing ITSESI: funding and a repressive legal context. Preliminary results from a quantitative analysis of data from the second step will provide a baseline description of the 300 PWID.

Discussion

Findings to date indicate that an exploratory phase is crucial to adapt and transfer the intervention to local contexts and to evaluate it. More globally, the Eurosider project will 1) help understand each local context to adapt the intervention accordingly; 2) assess the feasibility and effectiveness of ITSESI in different contexts; 3) promote and disseminate tools and training to implement the intervention at the European level.

Key messages

People who inject drugs in European countries report HIV-HCV risk practices and adequate prevention should be provided. The implementation of an innovative educational intervention for people who inject drugs may be one response but requires to take into account contextual factors: funding and repressive drug policy.
Screenings for children: international programmes & recommendations from evidence-based guidelines
Authors: Winkler R , Reinsperger I
Published: November 2019

Background

Children and adolescents are in general a healthy population group. However, they are exposed to a number of morbidities (physical illnesses and mental disorders) and social burdens (e.g. poverty, violence). In Austria, there are currently no routine screenings for children older than 6 years. The project aimed at providing an overview of international screening programmes and of recommendations from evidence-based guidelines for 6 to 14 years old children.

Methods

The overview of screening practices in nine selected (mostly European) countries is based on an (Internet) hand search and expert contacts. For the guideline overview, we conducted a search in guideline databases and on websites of institutions.

Results

We identified four main screenings that were predominantly offered in the analysed countries: screenings of body weight & height, hearing & vision disorders, dental disease and mental disorders. The services are provided in school and/or in doctors’ practices, involving physicians and/or nurses. 50 evidence-based guidelines from 16 institutions met our pre-defined inclusion criteria. We identified recommendations for 24 diseases or risk factors. We found most recommendations on screening for overweight and dental disease. Further guidelines addressed infectious diseases, mental disorders, health and risk behaviour, and counselling.

Conclusions

The results are now used as a basis for discussion for the development of a new screening programme in Austria. The overview provides an international and evidence-based view. However, social determinants of health, such as education and living conditions, were hardly considered in the identified screenings, but should be increasingly addressed in a comprehensive programme.

Key messages

Screenings for overweight and dental disease were central in both the selected countries’ programmes and the guideline recommendations. Comprehensive programmes should not only focus on physical parameters, but should also take into account the social determinants of health.
Collaboration between midwives and dietitians in improving dietary intake of low SES women
Authors: Super S , Beulen Y , Wagemakers A
Published: November 2019

Background

A healthy dietary intake during pregnancy is important for maternal and child health. However, pregnant women with a low socioeconomic status (SES) are less likely to adhere to nutrition guidelines as compared to high SES groups. Midwives in the Netherlands experience limited opportunities to provide nutrition advice. Dietitians could play a role in providing nutrition advice to pregnant women, but collaborations between midwives and dietitians are limited. Therefore, this study aimed to investigate the opportunities and barriers for collaboration between midwives and dietitians in antenatal care for low SES women.

Methods

Questionnaires were administered amongst 134 dietitians to examine experiences of providing nutritional advice to pregnant women. Four focus groups were organised with midwives (2x) and dietitians (2x) to explore opportunities and barriers for collaboration.

Results

Questionnaire results indicated that 73% of the dietitians like to see pregnant women more often in their practices and 78% feels the necessity to strengthen the collaboration with midwives. The focus groups showed that dietitians and midwives wish to strengthen the collaboration, but they also experience barriers: a focus on food risks rather than healthy nutrition in antenatal care, lack of referral procedures for women without medical necessity to see a dietitian, negative connotations with referring women to dietitians, and lack of time to discuss nutrition in consults by midwives.

Conclusions

Midwives and dietitians recognise the importance of strengthening collaborations, but in order to do so, several challenges need to be overcome. In a follow-up of this study, pressure cooker sessions will be conducted to design an integral strategy in antenatal care to empower women to improve dietary intake.

Key messages

There is a great potential to strengthen collaborations between midwives and dietitians in antenatal care to empower low SES pregnant women to improve dietary intake. Several barriers need to be overcome to design in an integral strategy in antenatal care to improve the dietary intake of low SES prengant women.
Indications and practices of Cesarean Sections in a French region – The Robson classification
Authors: Laurent E , Lecuyer A I , Baron S , Diguisto C , Turpin D , Potin J , Grammatico-Guillon L
Published: November 2019

Background

Cesarian-section (CS) deliveries, although sometimes vital, are associated with increasing immediate- and long-term maternal and/or neonatal risks. The objective was to describe the indications of scheduled CS, measure the potentially avoidable CS and study the rate variations between maternities in one French region, Centre Val-de-Loire (CVL).

Methods

A cross-sectional study was conducted from September 2016 to February 2017. Information about all CS performed in the maternities of the region was collected: medical history, indication, schedule. Data collection was completed with the 2016 regional birth data repository (25,864 deliveries, including 19.2% of CS, among which 7.0% were scheduled). CS were classified according to the pre-existing risk high or low of CS as defined by the Robson classification.

Results

During the study period, 1,979 CS (18.6% of deliveries) were performed, of which 762 were scheduled (7.1% of deliveries). The main indications for planning a CS were: scarred uterus (60%, of which 56% with only one previous CS) or breech presentation (25%), considered at high risk of CS according to the Robson classification. For these two contexts, the regional birth repository showed decreasing scheduled CS rates from high to low level of maternities’ expertise. Remarkly, 22 nulliparous women with a single cephalic pregnancy in spontaneous labor before term (Robson’s low risk of CS) had a CS performed for unfavorable pelvimetry (0.2% of deliveries).

Conclusions

This study allowed identifying specific potential interventions: targeted CS on scarred uterus with only one previous CS or breech presentation, as recommended by national guidelines, and targeted use of radiologic pelvimetry. The Robson classification must be widely used to assess practices through cautious maternity comparisons to improve quality of care.

Key messages

Although potentially avoidable c-sections are rare, interventions were identified: targeted CS on uterus with one previous CS or breech presentation, targeted use of radiologic pelvimetry. The Robson classification must be widely used to assess practices, in order to improve healthcare quality.
Direct and the Indirect Determinants of Weight-Control Behaviours among Adolescents
Authors: Tur-Sinai A , Kolobov T , Tesler R , Baron-Epel O , Dvir K , Harel-Fisch Y
Published: November 2019

Background

Economic determinants such as socioeconomic inequalities and parents’ employment have a profound impact on the health of adolescents in terms of unhealthy weight-control behaviours (UWCB). In addition, various family factors may play a role in adolescents’ weight-control behaviours (WCB). This study examines the association among socioeconomic status, perceived family wealth, and number of employed parents and Israeli adolescents’ WCB and asks whether family variables (parental communication, monitoring, support, and family meals) mediate WCB.

Methods

Data from the cross-sectional questionnaire of the 2014 Israeli Health Behaviour in School-Aged Children study are analysed using structural equation modelling. The research population includes approximately 7,000 Israeli schoolchildren in grades 6, 8, and 10. The association among socioeconomic status (SES) factors (SES measures, parental employment), sociodemographic factors, and weight-control behaviours among adolescents is calculated.

Results

High family affluence and high perceived family wealth are negatively associated with unhealthy weight-control behaviour. Having two employed parents leads to lower levels of UWCB. Family-related variables like family communication and support and parental monitoring are found to mitigate unhealthy weight-control behaviours. Family meals have a significantly positive effect on healthy weight-control behaviour and a significantly negative impact on unhealthy weight-control activities.

Conclusions

The findings suggest that economic factors such as SES and number of employed parents are necessary strategies for long-term weight-control practice. The combination of WCB and family meals is the most effective method for adolescents’ healthy weight-control behaviour.

Key messages

The study highlights the importance of considering the quality of family communication and support as a health asset that may contribute to WCB among young people. Family affluence and perceived family wealth, which were two separate measurements, were perceived differently by adolescents.
The role of health literacy in explaining regional health differences among adolescents
Authors: Simonsen N , Wackström N , Roos E , Suominen S , Välimaa R , Tynjälä J , Paakkari L
Published: November 2019

Background

Health disparities in adolescence track forward to adulthood. In understanding disparities better, health literacy (HL) - as a broad range of health-related competencies - has been identified as a valuable construct. Higher HL has been associated with better health outcomes, also among adolescents. Not much is known about how language or region in a bilingual country is associated with HL, or how HL is associated with regional health disparities. The aim of this study, in a bilingual country, was a) to examine and compare HL and health levels among majority and minority language speaking adolescents in different regions of Finland, and b) to explore if HL explains possible regional health differences in these two language groups, taking into account other important structural stratifying factors.

Methods

The data of 13- and 15-year-olds were obtained from the Health Behaviour in School-aged Children study, conducted in Finnish- and Swedish-speaking schools in Finland in 2014 (N = 3853/1123; 85/83%). HL was measured with the HLSAC-instrument. The data were analysed by logistic regression and interaction analyses.

Results

In the total sample, 23% rated their health as excellent; 33% had a high and 10% a low HL. The preliminary findings showed no differences in health or HL between the language groups. However, regional health differences were found in both language groups: in the Finnish-speaking sample among boys, and in the Swedish-speaking sample among girls. Findings also showed regional differences in HL levels in both language groups, especially among the Swedish-speaking minority group. Comprehensive HL was an independent factor in explaining these regional health differences.

Conclusions

This study adds to prior studies on the role of HL as a modifiable health resource by showing that in addition to other structural stratifying factors comprehensive HL explains regional health disparities among adolescents in a bilingual country.

Key messages

This study in a bilingual country found regional health disparities and regional differences in HL levels among both majority and minority language speaking adolescents. In both language groups, taking into account other important structural stratifying factors, comprehensive HL was an independent factor in explaining the regional health differences.
Weight Control Practices in Turkish Adolescents and Factors Related with Over- Weight and Obesity
Authors: Atintas Sert B , Ergun A
Published: November 2019

Backgrounds

Over-weight and negative body perception that may develop during adolescence period cause many slimming experiences, especially the diet and as the state of discontent increases, the methods used are more unhealthy and dangerous. This study was conducted to determine the weight control practices and the factors related to over-weight-obesity in Turkish adolescents.

Methods

This cross-sectional study was conducted with 900 high school students aged between 14-18. The data were collected by using an introductory form including questions about socio-demographic characteristics and weight control, eating attitude test (EAT-26), Bergen Insomnia Scale and height-weight.

Results

In this study, it was found that 9.1% of the adolescents were overweight, 8.2% of them were obese, and 32.9% of them had a risky eating behavior (EAT-26 score > 20). It was found that 87.7% of adolescents who are overweight-obese and 40% of those with normal weight were wanted to lose weight. It was determined that 70.4% of adolescents exercise for weight control, 63.6% of them increased fluid consumption and 16.6% of them used weight loss dietary supplement. Adolescents who were overweight-obese had a higher proportion of those with a risk of eating behavior (EAT> 20) and those with insomnia problems than those with normal weight (p < 0.05). The factors related to overweight and obesity were found in female adolescents; standing snacking, angry negative moods and sometimes consuming irregular meals between meals, whereas in male students; watching TV, working while eating, standing snacking, late-night eating and insomnia (p < 0.05).

Conclusions

It was determined that the majority of overweight-obese students wanted to lose weight and some of those had a risky eating habits and preferred unhealthy methods for weight control. These results indicate that was need programs of healthy weight control and prevention of obesity in the schools.

Key messages

Adolescents who were overweight-obese had a higher proportion of those with a risk of eating behavior (EAT> 20). There is a need for public health programs on healthy weight control and weight regulation practices for adolescents.
Using ’White Flags’ to categorize socio-cultural aspects in chronic pain
Authors: Winkelmann C , Schreiber T U
Published: November 2019

Issue

Persistent chronic pain is a major medical and health economic problem. To assess the individual pain situation, the classification of various factors (flags) has been established.

Description of the problem

Structural biomechanical factors are classified as “red flags”. Psychological or behavioral factors are summarized as “yellow flags”, psychiatric and mental illness as “orange flags”. Both last flags are important for planning adequate therapies or rehabilitation, as well as for decisions to prognoses and tailored reintegration programs. An extension of the flag model was achieved by naming personal factors at workplace as “blue flags”, and “black flags”, if there is a restriction for returning to work. All these groups do not consider other important reasons for unsuccessful rehabilitation or failed reintegration.

Results

In these cases, often described as ’therapy-refractory’, clients often exhibit a special subjective understanding of illness that reacts neither to psychological interventions nor to behavioral therapies. These include individual beliefs based, for example, on cultural socialization, religious education, or spiritual experiences. Since such individual mental illnesses are culturally ideologically or religiously justified, they should be classified in a separate group called ’white flags’.

Lessons

The advantages of categorizing sociocultural aspects separately from other flag classifications are avoidance of unnecessary therapies, including surgery,prevention of iatrogenisation,prevention of legal disputes.

It is important to realize that only health restrictions for insurance benefits can be taken into account and that individual socio-cultural circumstances or health convictions are not evaluated.

Main messages: A classification of ’white flags’ could contribute to a better classification of pain which are not accessible to various therapies and reduce reservations and misunderstandings by intercultural communication approaches.

Key messages

For medical professions it is important to recognize, that only health inabilities are taken into account for insurance compensation and not individual socio-cultural circumstances or health beliefs. In Future classifying ’white flags’ could help to properly assess persistent pain conditions.
Teaching Program for laymen and experts for neighborhood-based offers to elderly people living alone
Authors: Winkelmann C , Kasprick L
Published: November 2019

Background

For multimorbid very old people who are living alone, care networks are needed to ensure continuous and coordinated care across the sectors.

Objectives

The GeriNeTrainer (trainer in a geriatric network) is intended to preserve the day-to-day competences of elderly and to reduce the prevailing regional lack of help. Which content and structural aspects must include an educational concept that is aimed equally at laymen and experts (e g physiotherapists, nurses) and can be implemented sustainably? The competence profile was developed by an interprofessional staff of experts. According to the literature review, they rated the CanMeds role concept as the most relevant and suitable framework with regard to the holistic approach to care. Therefore, the teaching curriculum was developed based on this.

Results

Depending on the level of knowledge, interested laymen or experts enter the evident curriculum. The team of lecturers consists of physiotherapists, social workers, physicians, sports scientists, psychologists and speech therapists. As teaching and learning methods were defined: lectures, seminars, exercises, caseworks as well as compulsory homeworking in best practice facilities. The interprofessional imparting of knowledge as well as the exchange of experience between the individual occupational groups as well as the methodical inclusion of the perspective of laymen were evaluated as particularly beneficial and innovative. For sustainability, the certified graduates are supervised. Observation, a case study based on this, an electronic platform (Moodle) and annual conferences and symposia enable regular and practice-oriented communication and quality assurance in the sense of the continuous improvement process.

Conclusions

The graduates are connecting patient home with the health facilities. Increased professional, social and emotional competence in the quarter have positive effects of elderly people who are living alone.

Key messages

Valuable is the educational concept by conveying knowledge and exchange of experience of individual specialist groups as well as the lay perspective. Laymen and experts are learning together, their different perspectives are very helpful for the elderly.
Predicting musculoskeletal disorders risk using tree-based ensemble methods
Authors: Paraponaris A , Ba A , Gallic E , Liance Q , Michel P
Published: November 2019

Background

Musculoskeletal disorders (MSD) can cause short-term disorders and permanent disabilities which may all result in serious limitations in activities of daily living. According to the WHO, MSD are the second largest cause of disability worldwide. In France, preventing MSD became a challenge for both the sickness fund and the complementary health insurers as the MSD prevalence increased by more than 50% since 2003, the MSD representing more than 80% of the occupational diseases leading to sick-leaves or financial compensations in 2015.

Methods

Data from the IRDES 2012 health and social welfare survey (ESPS, enquête santé et protection sociale) was matched with individual care consumptions from the French health insurance. The ESPS survey is a national representative survey including 23,047 CATI/CAPI interviewed individuals (participation rate: 66%). Respondents self-assessed their health status, including MSD among other health troubles. Prediction of MSD risk was designed as a supervised binary classification problem, with the help of Random Forest (RF) and Gradient Boosting Machine (GBM) methods.

Results

Variable importance scores based on the squared error criterion over all trees were computed for the continuous and categorical variables supposed to be associated with MSD: the consumption of medicines, physiotherapists’ and GPs’ services, medical imaging, biomedical analyses, dental care, and sociodemographic features (occupation, age and income). Slightly better results were obtained with GBM compared to RF (overall test accuracy rate: 70% for both methods).

Conclusions

Machine learning methods with merged survey and registry data may help health insurers to better identify the individual MSD risk and prevent the occurrence and the disabling consequences of MSD with the help of individualized prevention strategies.

This research is financially supported by Malakoff Mederic Humanis, life & health French insurance for employees and individuals.

Key messages

The use of machine learning methods may be of interest to improve the ability to predict the MSD risk and help to identify insured people whom individualized prevention strategies can be offered to. Matching survey and health insurance liquidation data improves the ability to identify people at improved risk of MSD and gives the opportunity to provide them resources to prevent and to cope with.
Elevated fatty liver index as a risk factor for all-cause mortality in HIV-HCV co-infected patients
Authors: Barré T , Protopopescu C , Bani-Sadr F , Piroth L , Sogni P , Salmon-Ceron D , Wittkop L , Lacombe K , Serfaty L , Marcellin F
Published: November 2019

Background

Thanks to innovation in treatment, people living with HIV and/or HCV now live longer but are growingly facing non-communicable disease burden. HIV-HCV co-infected patients are at high risk of metabolic complications and liver-related events, which are both associated with hepatic steatosis and its progressive form, non-alcoholic steatohepatitis (NASH), a known risk factor for mortality. The fatty liver index (FLI), a non-invasive steatosis biomarker, has recently drawn attention for its clinical prognostic value, but has never been applied to HIV-HCV co-infected patients. We aimed at testing whether elevated FLI (≥60) was associated with all-cause mortality in co-infected patients.

Methods

Our study is based on data from ANRS CO13 HEPAVIH, a French national prospective cohort of HIV-HCV co-infected patients. Socio-behavioral and clinical data from patients clinically followed-up were used in the analysis. Using a Cox proportional hazards model for mortality from all causes (983 patients; 4,432 visits), we computed hazard ratios associated with risk factors and confounders.

Results

After multiple adjustment, individuals with FLI≥60 had almost double the risk of all-cause mortality (adjusted hazard ratio [95% confidence interval]: 1.91 [1.17-3.12], p = 0.009), independently of HCV cure (0.21 [0.07-0.61], p = 0.004), advanced fibrosis (1.77 [1.00-3.14], p = 0.05), history of hepatocellular carcinoma and/or liver transplantation (7.74 [3.82-15.69], p < 10-3), history of indirect clinical signs of cirrhosis (2.80 [1.22-6.41], p = 0.015), and HIV CDC clinical stage C (2.88 [1.74-4.79], p < 10-3).

Conclusions

An elevated fatty liver index is a risk factor for all-cause mortality in HIV-HCV co-infected patients independently of liver fibrosis and HCV cure. In the present era of nearly 100% HCV cure rates, these findings encourage the more systematic use of non-invasive steatosis biomarkers to help identify co-infected patients with higher mortality risk.

Key messages

A FLI≥60 is strongly associated with mortality in HIV-HCV co-infected patients. FLI could be calculated routinely to identify most at-risk patients.
Diabetes in Israel- do all patients receive equal care?
Authors: Wolff Sagy Y , Krieger M , Horwitz E , Ben-Yehuda A , Paltiel O , Ravel-Vilk S , Manor O , Calderon-Margalit R
Published: November 2019

Background

Diabetes Mellitus (DM) is associated with micro- and macro-vascular complications, leading to high burden of morbidity and mortality. Populations of low socioeconomic position (SEP) in various countries were found to have increased prevalence of the disease, worse glycemic control, and increased complications. We aimed to examine whether there are social disparities in diabetes care in Israel, as reflected in a national program for quality indicators.

Methods

The Israel National Program for Quality Indicators in Community Healthcare obtains data from electronic medical records from all health plans, covering the entire Israeli population. In 2017, 497,397 individuals aged >18 years were identified with DM. DM prevalence, quality of care indicators, including process and intermediate outcomes were explored by SEP categories (1-10), determined according to residential addresses.

Results

DM prevalence in Israeli adults in 2017 was 9.7%, showing a strong SEP gradient, with higher prevalence in individuals of lower SEP. No SEP disparities were observed in process indicators with overall rates of documentation of hemoglobin A1c (HbA1c) of 90.9%, ophthalmologic examinations of 72.5%, and kidney function examinations of 92.5%. However, strong SEP disparities were observed in the prevalence of uncontrolled diabetes (HbA1c≥9%), with an overall rate of 10.0%, and a 5.4-times higher rate in diabetics of the lowest SES level (23.5%) compared with the highest SEP level (4.3%). A somewhat weaker gradient was seen for the well-control of DM (HbA1c<7-8%, according to duration of disease and age), with an overall rate of 69.7%, and a 1.7 ratio, comparing diabetics of the highest vs the lowest SEP level.

Conclusions

These findings suggest that access to care does not explain SEP disparities in diabetes control in Israel. There is a need to explore the underlying social, cultural, and possibly the benefits-policy determinants of poor control among individuals of low SEP.

Key messages

Wide socioeconomic disparities are present among Israeli adults in diabetes mellitus prevalence and control rates, but not in care processes indicators. These findings call for a deeper understanding of the determinants and perhaps a revision of current social benefits policy, which may encourage lack of glycemic control.
Rising prevalence of diabetes: evidence from the national registry in North Macedonia
Authors: Stamenova A , Stevanovski G , Spasovski M
Published: November 2019

Background

Disease reporting and data collection are key tools for the health care systems in order to identify opportunities to address burden of diseases. The country’s diabetes patients register was the first registry to be integrated with the e-health system in North Macedonia in 2017. We aimed to estimate type 2 diabetes mellitus prevalence and effectiveness of diabetes control as one of the proposed national priorities in tackling the non-communicable diseases.

Methods

Cross-sectional descriptive study was conducted on patients entered in the National Diabetes Register in 2017/2018. Patients’ socio-demographic and anthropometric characteristics in association with diabetes’ complications and outcomes were determined by Pearson correlation coefficient (P < 0.0001, 95% CI).

Results

This study identified a total of 35541 patients with a diagnosis of diabetes, out of which 32888 with type 2. This corresponds to a prevalence rate of 1583.9 per 100,000 population. The prevalence increased with age (65+) and was higher among females than males (56.8% vs. 43.2%). Over 80% of type 2 patients were overweight out of which 34.5% obese (BMI>30kg/m2). Diabetic retinopathy is reported as first diagnosed complication in diabetic patients, followed by neuropathies and vascular complications. Patient’s low level of education and higher BMI were associated with increased number of early and late-onset complications.

Conclusions

Evidence accumulating suggests high burden of complications in type 2 diabetic patients, indicating that the patients understanding of diabetes care, treatment adherence and healthy lifestyle are important topics to be address by health professionals in order to avoid complications and premature deaths in people with diabetes.

Key messages

Integrated reporting of non-communicable diseases and risk factors is needed to complete current information gaps, from completeness of data to quality and comparability. The action plan for chronic diseases should specifically address diabetes control, as most of the patients with diabetes have high prevalence of comorbidities, complications and unfortunate outcomes.
Socioeconomic inequalities in cognitive performance among early ageing people: The Constances cohort
Authors: Letellier N , Carrière I , Cadot E , Berkman L , Goldberg M , Zins M , Berr C
Published: November 2019

Background

In spite of the recent awareness of environmental characteristic’s impact on brain aging, links between contextual socioeconomic status and cognitive performance (CP) remains unclear. The objective was to investigate the influence of individual and contextual deprivation on cognitive performance in order to better characterize vulnerable population.

Methods

We performed cross-sectional analyses on 44,762 participants (45-70 y) of the French Constances cohort. Cognitive performance was assessed using a global cognitive score calculated with 6 cognitive tests evaluating global cognitive function, episodic verbal memory, language abilities, and executive functions. Poor performance was defined as a score below or equal to the 25th percentile of the distribution. We approached the deprivation by two validated multidimensional index: at individual level with the EPICES score (deprived if < 30.17) and contextual level with the FDep09 score divided in quintile (Q5 being the most deprived). Associations were estimated with multilevel logistic regressions.

Results

At the individual level, participants more deprived had poorer CP independently to sex, age, education and health status (OR 1.58 [1.48; 1.69]). At the contextual level, the more people lived in deprived environment, the poorer their CP (p<.0001), even after adjustment on individual deprivation and other individual characteristics (Q5 vs Q1: OR 1.28 [1.15; 1.41]).

Conclusions

In this large cohort of early-ageing people, area-based disparities in cognitive impairment were highlighted. A better understanding of the influence of living environment deprivation level on cognitive aging could help to define new strategies in prevention by targeting at-risk populations in interventions studies in order to reduce social health inequalities.

Key messages

Our study evidenced a strong socio-economic gradient of cognitive performance identifiable on both individual and contextual level, in a large sample of middle-aged volunteers. Independently to individual deprivation and other individual characteristics, living in a deprived environment may be detrimental to the brain health.
Cancer incidence in the vicinity of a waste incineration plant in the Nice area between 2005-2014
Authors: Mariné Barjoan E , Doulet N , Chaarana A , Festraëts J , Viot A , Géloen C , Ambrosetti D , Mounier N , Bailly L , Pradier C
Published: November 2019

Introduction

Few studies on cancer incidence have been conducted since the EU 2000/76/EC Waste incineration directive.

Objective

To measure cancer incidence among the population exposed to atmospheric emissions from the Ariane waste incineration plant near Nice, in the Alpes-Maritimes (AM), compared to the unexposed AM population.

Methods

All primary invasive cancers and malignant haematological conditions diagnosed among AM residents from 01/01/2005 to 31/12/2014 recorded by the CRISAPPACA Cancer Observatory, public and private hospitals and the ONCOPACA-Corsica Network were included. The exposed area, based on an average dioxin deposition model, was that with a concentration ≥4.25ng/m2/year. Each case was geolocated and assigned to a predefined geographic unit (IRIS): 36 units in the exposed area, 462 in the unexposed area. The adjusted incidence rate, the standardized incidence ratio (SIR) and the Comparative Morbidity Figure (CMF) were calculated for two periods: 2005-2009/2010-2014.

Results

We recorded 80,865 new cancers in the AM population (1,083,974 residents; 87,462 exposed). For the 2005-2009 period, among exposed women, excess SIR were recorded of acute myeloid leukaemia (SIR = 1.81 [1.03-2.93]), myelodysplastic syndromes (SIR = 2.58 [1.70-3.76]) and myeloma (SIR = 1.64 [1.09-2.37]); in exposed men, of soft tissue sarcomas (SIR = 1.65 [1.05-2, 48]), myeloma (SIR = 2.04 [1.39-2.90]) and lung cancer (SIR = 1.19 [1.03-1.36]). For the 2010-2014 period, there was no excess SIR among women, while among men an excess SIR of myeloma (SIR = 1.76 [1.21-2.47]) and lung cancer (SIR = 1.24 [1.08-1.41]) was observed.

Conclusions

The higher incidence of myeloma and lung cancer in both periods can be explained by their long latency and by other risk factors. The EU Directive appears to have resulted in limiting atmospheric emissions from the incinerator.

Study funded by the Nice Côte d’Azur Metropolis and with the support of the South-PACA Regional Health Agency.

Key messages

Few studies on cancer incidence have been conducted since the EU 2000/76/EC Waste incineration directive. The EU Directive appears to have resulted in limiting atmospheric emissions from the incinerator.
Towards a better integration of health in urban development project: from theory to action
Authors: Roue-Le Gall A , Deloly C , Clement B , Nassiet C , Romagon J , Thomas M-F
Published: November 2019

Background

Despite a well knowledge about links between urban planning and health, practices’ analyze highlights the difficulty to upgrade health into urban planning decisions. To overcome this issue, the EHESP has initiated a specific research dedicated to the development of tools for a better integration of health & wellbeing at different decision-making-level (urban planning & urban development project). The objective of this presentation is to focus on one dedicated research, Isadora project, and to share how the project was carried out to enable the production of an operational tool dedicated to urban planners to better integrate health issues into their practices.

Methods

The scientific management team mixed various skills from public health, environment and urban planning sectors which makes easier the implementation of two key-principles of research: (i) to adopt a systemic approach to health determinants, (ii) to address urban settings through an integrated approach to public health, environment and sustainable development issues. The implementation of this interdisciplinary and intersectorial project is based on a close collaboration with a national working group composed of various professionals and academics (urban planning, environment, and health). The Isadora project deliverables results from an iterative process between all the stakeholders involved in the project.

Results and conclusions

First, we will present how we facilitated the working group throughout the deliverables development process and how we overcame the challenges of implementing intersectorality. Then, we will present the operational tool structured around of 15 key sheets with health focus to help professionals to integrate health at each step of an urban development project.

Key messages

ISadOrA project aspires to promote an evolution of urban planner’s practices in order to achieve a healthy urban development project. This ambition requires the translation of concepts into actions.
Neighborhood environment and physical activity among rural Japanese older adults
Authors: Okuyama K , Abe T , Nabika T
Published: November 2019

Background

Physical inactivity is one of the global health concerns. Rural populations in general tend to be more physically inactive and have higher risk for chronic conditions. Although numerous studies have assessed the association between neighborhood environment and physical activity to implement population level intervention, most are limited to urban adults. This study investigated potential neighborhood environment associated with physical activity for rural older adults in Japan.

Methods

The study subjects were from Shimane where is a rural-mountainous region in Japan. Those agreed to participate in the Shimane CoHRE study as of baseline (2010) and followed-up after 5 years were included in the analysis (mean age=71, n = 717). Subjects were asked if they engage in 30 minutes exercise more than twice a week at baseline and follow-up surveys. As a primary exposure, we computed mean land slope within 500 m street network buffer from residential point of each subject by geographic information system. Multiple logistic regression was conducted to estimate the odds of exercise engagement after 5 years by slope categorized in tertile, adjusting for age, BMI, and exercise habit at baseline.

Results

Significantly higher odds of exercise engagement was observed among those living in the hilly area compared to moderately hilly area after 5 years adjusting for baseline age, BMI, and exercise habit, (Odds ratio (OR): 1.71, 95% Confidence Interval (95%CI): 1.119, 2.616). There was no significant difference of odds between those in flat area and moderately hilly area (OR: 1.137, 95%CI: 0.738, 1.751).

Conclusions

This finding suggests that people living in hilly neighborhoods are more likely to maintain or start engaging in exercise after 5 years. Considering other potential environmental factors and farming culture within rural areas, future studies should capture various forms of environmental components and physical activity to dissect the mechanism.

Key messages

There are limited studies focus on rural older adults. Unique geographic feature in rural areas, i.e. hilly neighborhood might be associated with physical activity.
Environmental noise levels and noise annoyance in Novi Sad, 2012-2016
Authors: Zivadinovic E , Jevtic M , Dragic N , Bijelovic S
Published: November 2019

Objective

Increased noise level represents a significant public health problem in urban environments. The aim of this paper is to examine the annoyance of the population by road traffic noise in the City of Novi Sad.

Methods

The results of 161 24-hour noise measurements in Novi Sad were analyzed. Measurements were done by Public Health Institute of Vojvodina, according to accredited and standardized national methodology during 2012 - 2016.

Results

Total noise indicator (Lden) / night noise indicator (Lnight) ranged from 61,1 dB / 50,7 dB in residential, up to 66,3 dB / 58,1 dB in recreation / hospital areas, 68,0 dB / 60,3 dB in city traffic areas and 70,2 dB / 62,7 dB in business and residential areas. Taking into account the results and using methodology prescribed by national regulations, the percentage of highly annoyed population (% HA) was found to be in the range 11-25% during the day, and 6-13% during the night. Using ISO 1996-1:2016, prevalence of a population highly annoyed (PHA) was established to be in the range 9,2-33,9% in residential; 18,4-45,7% in recreation / hospital areas 22,9-50,6 in city traffic; 27,7-55,4% in business and residential areas.

Conclusions

The results confirm that urban noise seriously disturbs people. It was established that about a half of the population was highly annoyed which poses a serious challenge for public health. The results have social, health and economic importance for the population. Activities to reduce the noise level could also stimulate economic, health, social and community programs for sustainable development aiming to preserve and improve human health.

Acknowledgment: Supported by the Ministry of Education and Science of the Republic of

Serbia - Project “Biosensing Technologies and Global System for Continuous Research and

Integrated Management”, No.43002

Key messages

Continous noise monitoring is important for understanding the impact of noise on human health. About a half of the population was highly annoyed by noise, which poses a big challenge for public health in urban areas.
Evaluation of growth monitoring activity in Yopougon-Est Health District (Abidjan, Côte d’Ivoire)
Authors: Gbogbo F , Thonneau P
Published: November 2019

Background

Malnutrition represents 11% of disease burden in the world and is an underlying cause of 45% of under-5 deaths. Prevention is paramount in the fight strategy. That is why, “growth monitoring” which goal is to prevent and to detect malnutrition, has been integrated into health programs. In Côte d’Ivoire, although this activity is carried out in the health centers and despite the existence of Guidelines to improve services, under-5 malnutrition prevalence remains above thresholds. Our purpose was to assess the gap between the National Guidelines for growth monitoring and the practices of health workers.

Methods

A descriptive cross-sectional study was conducted in all the 6 public health centers of Yopougon-Est District, from August 22 to September 05, 2018. Data were collected using an observation grid developed from the Guidelines and 3 questionnaires. Six growth monitoring sessions were observed; 6 responsibles, 9 health workers assigned to the activity and 133 mothers came to monitor their child were interviewed after informed consent.

Results

The growth monitoring sessions were held every working day in 4 centers. Half of health workers assigned to the activity had not received training. All centers had baby scale, 5 had horizontal height, but only one had vertical height and person scale. Most health workers (78%) were not aware of Guidelines. The steps of “interrogation and examination” component were only 58% completed. The steps for weight measurement were completed at 96% and at 70% for size. The nutritional status of children was evaluated in only one center. In no center, health workers traced growth curve. Nearly half of the mothers surveyed (45%) had not received counseling during their visits.

Conclusions

The study highlighted shortcomings that do not allow the achievement of growth monitoring objectives. This study cannot be extrapolated however it raises real questions about the quality of the services provided in health centers.

Key messages

An evaluation at large scale needs to be conducted and corrective actions to be taken to improve the growth monitoring activity for effective prevention and early detection of malnutrition. Growth monitoring will be effective in preventing malnutrition only if it is well conducted by health workers.