bluuebunny/crossref_metadata_2025 huggingface dataset:
Using AI for Mental Health Analysis and Prediction in School Surveys
Authors: Adnan H S , Srsic A , Venticich P M , Townend D M R
Published: October 2020

Background

Childhood and adolescence are critical stages of life for mental health and well-being. Schools are a key setting for mental health promotion and illness prevention. One in five children and adolescents have a mental disorder, about half of mental disorders beginning before the age of 14. Beneficial and explainable artificial intelligence can replace current paper-based and online approaches to school mental health surveys. This can enhance data acquisition, interoperability, data-driven analysis, trust and compliance. This paper presents a model for using chatbots for non-obtrusive data collection and supervised machine learning models for data analysis; and discusses ethical considerations pertaining to the use of these models.

Methods

For data acquisition, the proposed model uses chatbots which interact with students. The conversation log acts as the source of raw data for the machine learning. Pre-processing of the data is automated by filtering for keywords and phrases. Existing survey results, obtained through current paper-based data collection methods, are evaluated by domain experts (health professionals). These can be used to create a test dataset to validate the machine learning models. Supervised learning can then be deployed to classify specific behaviour and mental health patterns.

Results

We present a model that can be used to improve upon current paper-based data collection and manual data analysis methods. An open-source GitHub repository contains necessary tools and components of this model. Privacy is respected through rigorous observance of confidentiality and data protection requirements. Critical reflection on these ethics and law aspects is included in the project.

Conclusions

This model strengthens mental health surveillance in schools. The same tools and components could be applied to other public health data. Future extensions of this model could also incorporate unsupervised learning to find clusters and patterns of unknown effects.

Key messages

This model uses artificial intelligence to improve mental health surveillance and evaluation in school settings. Artificial intelligence can be applied more broadly in public health to harness the potential of predictive models.
Graduate students’ mental health: Exploring experiences of isolation and loneliness
Authors: Kalubi J , Bertrand Y , Dagenais B , Houde R , Marcoux S , Bujold M
Published: October 2020

Background

A student psychological health survey, conducted in 2015-2016 among over 10,000 students at the University of Montreal (UdeM), gives an alarming picture of psychological distress associated to feelings of loneliness. The objective of this phenomenological study is to better understand the experience of isolation from the perspective of UdeM graduate students.

Methods

As part of a qualitative methods course, five semi-directed interviews and a focus group (n = 8) were conducted with graduate students and a psychologist from UdeM. Hybrid thematic analysis of verbatim and inter-rater debriefing were conducted using NVivo 11 software.

Results

Thematic analysis illustrates that most graduate students feel isolated at some point during their studies, but also that the impact and the meaning of this loneliness feeling is variable. It can be perceived positively when it is sought, temporary and/or allows one to be more productive. It can be perceived negatively when it is involuntary, constant over time and/or does not improve academic effectiveness. Personality, academic and social contexts, as well as support by peers and supervisors appear to modify feelings of isolation.

Conclusions

This study demonstrates the importance of context for graduate students' feelings of isolation. Further research is needed to move towards saturation of perspectives around this phenomenon.

Key messages

Graduate students reported that the experience and the repercussions of isolation may differ in whether it is sought or involuntary. Factors that seem to influence the feeling of loneliness include academic context and supervisor support. Further research is needed to discriminate the impact of these different contextual factors.
The reliability of the Study burnout inventory among Medical students
Authors: Todorovic J , Terzic-Supic Z , Divjak J , Kocic S , Radovic S , Ukropina S , Mijatovic-Jovanovic V , Mirkovic M
Published: October 2020

Background

The burnout syndrome is increasingly recognized as the factor compromising the mental health of health-care workers. The demands of higher education were reported to influence the development of burnout syndrome among students. Medical students are a significant population as both future health care workers and students with high academic demands. The burnout among medical students has been studied using different questionnaires. The aim of this study was to assess the psychometric characteristics of the Study Burnout inventory for the assessment of burnout among medical students.

Methods

The cross-sectional study was conducted during December of 2019 among the fifth year Medical students at the five Universities in Serbia (University of Belgrade, Novi Sad, Kragujevac, Nis, and Kosovska Mitrovica). The questionnaire used was the Study Burnout Inventory, nine-item scale, measuring three dimensions of burnout (exhaustion from studying- EXH; cynicism toward the meaningfulness of studying-CYN; the sense of inadequacy as a student-INAD). Answers were given on a six-point Lickert scale. The assessment of psychometric characteristics of the questionnaire was done using the reliability analysis (Cronbach alpha-α) and test-retest reliability (intra-class coefficient-ICC). Sensitivity and specificity were assessed using the Receiver operation curves (ROC) compared to the total burnout assessed by the Copenhagen burnout inventory.

Results

A total of 493 students filled-in the questionnaire. The mean score was 28.95±8.87/54. The Cronbach alpha for the total scale was α = 0.839, for the EXH scale was α = 0.724, for the CYN scale was α = 0.767, and for the INAD scale was α = 0.431. The test-retest reliability was ICC=0.750. The total area under the curve was 0.756 (95% CI: 0.711-0.800).

Conclusions

The Study Burnout Inventory has good reliability and can be used for rapid assessment of burnout among Medical students, as this scale is short and convenient for the participants.

Key messages

The Study burnout inventory has a good reliability as a total scale. This short scale is convenient for the participants and can be used for assessment of burnout.
Benefits and risks of sharing genetic data for research purposes: the views of patients and carers
Authors: Amorim M , Silva S , Maia T , de Freitas C
Published: October 2020

Background

Public health genomics research has the potential to predict, prevent, diagnose and treat a large number of diseases. This demands access to large genomic datasets. Understanding people's motivations for and concerns with sharing genetic data is essential to promote engagement and to develop ethical, legal and social frameworks for genomic research. This study aims to assess patients' and carers' views about the benefits and risks associated with genetic data sharing for research purposes.

Methods

A cross-sectional study was performed with 157 patients and 487 carers (participation rate=89.3%) followed at two rare genetic diseases reference centres in Portugal (June 2019-January 2020). Participants selected, from five options, the two most important benefits and risks associated with sharing genetic data for research. Data were analysed using descriptive and inferential statistics.

Results

Potential to discover a cure for untreatable diseases was viewed as the most relevant benefit by patients and carers (87%), followed by the possibility to develop new drugs and treatments (46%). Lack of security and control regarding access to information was the most reported risk (63%), particularly by patients, younger participants, students and those less willing to share their data (p < 0.05). The possibility of extracting information that exceeds the research objectives was the second most reported risk (58%), specifically by carers, participants with high education, employed, with upper white-collar occupations and who were involved in patient organizations (p < 0.05).

Conclusions

Young patients' concerns about data security and control may reduce their willingness to share genetic data. Socially advantaged carers worry about their data being used for purposes other than research. Assessing patients' and carers' views about genetic data sharing is important to meet their expectations for data protection and use and to guarantee respect for their rights.

Key messages

Patients and carers expect genetic research to contribute for discovering a cure for untreatable diseases and for developing new drugs and treatments. Patients are concerned about genetic data security and control and carers are worried about their genetic data being used for purposes other than research.
Extreme heat exposure in pregnancy and risk for preterm birth, low birth weight and stillbirths
Authors: Böckmann M , Chersich M F , Pham M D , Areal A , Haghighi M M , Manyuchi A , Swift C , Wernecke B , Robinson M , Hetem R S
Published: October 2020

Background

Exposure to high ambient temperatures during pregnancy may increase the risk of adverse pregnancy outcomes due to physiological and anatomical changes in pregnancy compromising the ability to thermoregulate.

Methods

A systematic review and meta-analysis of studies that assessed associations between ambient heat, and preterm birth, birth weight and stillbirths. Articles were identified through a search of Medline (PubMed) and Web of Science. Titles and abstracts were screened, eligible studies extracted and risk of bias assessed using the Joanna Briggs Institute appraisal tools.

Results

14,880 records were screened and a total of 70 studies included. In 40 of 47 studies, preterm births were more frequent at higher than lower temperatures. In random effects meta-analysis, the odds of a preterm birth rose 1.05-fold per 1 °C increase in temperature (95%CI=1.03, 1.07), and 1.16 fold during heat waves (95%CI=1.10, 1.23). Reduced birth weight associated with higher temperature was found in in 18 of 28 studies, with considerable heterogeneity. Studies on stillbirths (n = 8) all showed temperature-stillbirth associations, with stillbirths increasing 1.05-fold per 1 °C rise in temperature (95%CI=1.01, 1.08). Associations between temperature and outcomes were largest among women in lower socioeconomic groups and at age extremes. The multiple temperature metrics and lag analyses limited comparison between studies and settings.

Conclusions

As frequency of heat exposures is increasing, prevention for pregnant women during heat waves should become a standard aspect of heat adaptation.

Key messages

Increase in extreme temperature events may have major implications for child health unless much more is done to provide heat adaptation services for pregnant women. Links between socio-economic status and study outcomes suggest higher vulnerability for already disadvantaged groups.
Public healthcare co-payments in Botswana: the dynamics and consequences of policy amnesia
Authors: Pagiwa V , Shiell A , Barraclough S
Published: October 2020

Background

When policy implementation is not regularly monitored and evaluated, it risks irrelevance to changing conditions and, over time, its original purpose can even be forgotten. In 1975, the government of Botswana instituted co-payments for public healthcare, a policy which has remained largely unaltered since its introduction with the exception of two increases in the fee-level. Therefore, this study aims to critically analyze the institutional design and operation of Botswana's co-payment policy for public healthcare.

Methods

Using documentary analysis and interviews with 32 key informants, Botswana's longstanding policy requiring a modest co-payment in public healthcare facilities was analysed. Data were analysed thematically in an inductive way.

Results

The findings revealed the policy was not monitored, rarely evaluated and became both ineffective and inefficient, costing more to administer than was received in revenue. The Ministry of Health and Wellness no longer had a copy of the original policy and there was no corporate memory of its original purpose. Informants were confused about the policy and why it was still in place after four decades. There was absence of requirements for monitoring and evaluation in the original policy. The top-down policy development failed to explain rationale for policy and mobilize popular support leading to civil society ignorant of the policy.

Conclusions

The consequences of policy amnesia in this study are evident. The lack of timely policy evaluation influenced discretionary powers for administrators applying the co-payment leading to the problems of partiality. Uneconomic financial returns as a result of inflation and poor enforcement mechanisms continued without causing concerns. That might have been undermined by placing emphasis on the role of central actors and ignoring the involvement and significance of the local actors, who are in a much better situation to propose and implement purposeful policies.

Key messages

Lack of regular policy monitoring and evaluation risks irrelevance to changing conditions, and overtime, the policy’s original purpose is easily forgotten. Requirements for policy monitoring and evaluation need to be explained with the initial policy and enforcement mechanisms put in place.
Knowledge transfer in Leadership, advocacy and analysis
Authors: Newton J
Published: October 2020

Background

The UK Faculty recognises the importance of the effective use of evidence and data in the past, present and future practice of public health. In setting standards for education and training and in its advocacy and leadership roles the Faculty emphasises use of three types of knowledge quantitative information from statistics and surveillance, research evidence and evidence from experience. To equip the public health workforce of the future it is important to understand likely knowledge requirements across these areas.

Objectives

To describe areas of work in current public health advocacy and leadership where knowledge transfer is being used to improve health and reduce health inequalities. To illustrate how the Faculty works with partner organisation to influence policy based on the best knowledge and evidence.

Body of the session

The session will briefly consider the current policy context for public health in the UK and propose a set of areas in which the Faculty sees a role for the use of data and evidence to improve health. The talk will give examples of how the Faculty works with partners such as the Academy of Royal Colleges, Government agencies, and other professional groups representing public health professionals to support individual professionals, to develop its own advocacy positions and to influence policy. A recent example of the English Government's Green Paper on prevention will be used to illustrate the approach.

Conclusions

Effective public health practice can greatly improve the quality and value of public health policy. However, to be effective public health leaders need to be trained and equipped to deliver the best advice effectively and have good access to the relevant evidence. They also need to be supported by strong leadership organisations such as the Faculty that have earned the respect of policy makers.
Using patient–centered approach for improving adherence to treatment in DS/DR–TB patients in Ukraine
Authors: Geliukh E , Tabunshchyk V , Kamenska N , Islam Z
Published: October 2020

Issue/problem

Ukraine is among 30 high MDR-TB burden countries with about 6500 laboratory confirmed MDR-TB cases annually. Ukraine provides full coverage for first- and second-line TB drugs from the state budget. Nevertheless, successful treatment outcomes are one of the lowest in EECA region - 49% in MDR/RR-TB cases and 37% in XDR-TB. High rates of lost to follow-up (15.8%), treatment failed (18%) and died (15.9%) among MDR-TB cases contribute to unsuccessful treatment outcomes.

Description of the problem

A new intervention was introduced aimed at improving patients' adherence to treatment. Medical-psycho-social services (MPSS) provision based on patient-centered approach is provided to all patients. In 2018, project funded by GFATM was launched in 8 oblasts of Ukraine. All patients are assessed on treatment adherence before discharge from hospitals. Those with low adherence are referred to NGOs. MPSS starts from the patient's needs assessment followed by development of individual plan of support. MPSS is provided during the whole period of outpatient treatment and may include DOT/VOT, social workers' permanent support, food kits, psychologist counselling, transport and/or cell reimbursement, housing, documents restore, legal services and other services as per patients' needs. Electronic depersonalized database SyrEx is used for the project related notes.

Results

Total amount of TB/DR-TB patients treated in 2018-2019 is 8640 and 4246 accordingly. Cohort analysis is used for treatment outcomes assessment.

Intervention allowed reducing the number of patients lost to follow up in DS/DR-TB (to 1.2% and 2.5% accordingly), treatment failed (to 5.4% and 10.9%) and number of died (to 2.1% and 3.2%)

Lessons

MPSS based on patient-centered approach improved successful treatment outcomes: to 91% in DS-TB patients and 82.3% in DR-TB. Further initiative scale-up is required as well as transition of MPSS services from donor funding to domestic.
Poland
Authors: Löblová O , Moise A , Zabdyr-Jamróz M , Kowalska-Bobko I
Published: October 2020

Background

Research into the politics of health reforms usually looks at parties in a unidimensional way, in the classical left-right axis, where right parties are expected to marketize healthcare while left parties are expected to do the opposite. Populist Radical Right (PRR) parties do not neatly fit this unidimensional approach. The case of the Law and Justice party (PiS) in Poland is illustrative of the tenuous link between traditional neoliberal right-wing health policies and the PPR agenda.

Methods

We conducted a review of available primary sources (legal and policy documents) and secondary literature (academic, press, and think-tank publications). Resulting data was analysed thematically.

Results

Since its rise to power in 2015, PiS has departed from the previous center-right government's market-oriented healthcare policies. It retracted regulations aimed at commercialisation of public healthcare providers, introduced networks of hospitals to reduce internal market of providers and proposed the establishment of National Health Service (later abandoned). It continued the previous government's expansion of health coverage to universal by principle. In the 2019 election manifesto entitled “Polish Model of Welfare State” PiS explicitly states they “reject principles of neoliberalism”. Its most overtly right-wing stances were limited to strictly “cultural wars” context: reproductive health, sexual education, IVF reimbursement etc. Yet even in this instance the harshest proposals (such as stricter abortion laws) were not implemented.

Conclusions

PiS' health policies show that some PRR parties do not conform to a unidimensional left-right divide but rather combine left-wing redistributive policies with right-wing socially conservative stances. In many respects, the current government has enacted health policies that can be described as neo-Weberian and traditionally social-democratic.
8.K. Workshop: Shared impact: How to foster innovation in public health data
Authors:   Organised by: CanWaCH (Canada),   Chair persons: Jessica Ferne - Canada, Antu Hossain - Canada
Published: October 2020

In 2018, Canadian Partnership for Women and Children's Health (CanWaCH), a network of Canadian civil society, professional, and academic actors working collectively on global health and gender equality, launched 'The Canadian Collaborative in Global Health'. This initiative was designed specifically to build the capacity of Canadian actors, and their global partners, to better collect, analyze, synthesize and report data and evaluation activities through new, innovative approaches, in order to strengthen their impact in the areas of SDGs 3 and 5. Through this interactive workshop, participants will be able to (a) learn about the 3 diverse innovations that are being incubated under the Collaborative model through diverse multi-sectoral partnerships; (b) dive deeply into 3 innovative practices focusing on nutrition, sexual and reproductive health and rights, and adolescent health; and (c) explore how they might replicate this approach, and discuss critical issues relating to the fostering innovative thinking and approaches when it comes to data collection in public health. Representatives from civil society organisations, academic institutions, and private sector will outline strategies for how interdisciplinary collaborations can be effectively implemented and executed.

Key messages

CanWaCH’s innovative participatory methodology has generated significant new findings to guide accountability, programming, policy and advocacy. and can/should be replicated elsewhere. Three specific global health data innovations will be presented, featuring brand new tools, indicators, and strategies which can help participants with their work.
COVID-19 lockdown: housing built environment’s effects on mental health
Authors: Morganti A , Brambilla A , Amerio A , Aguglia A , Odone A , Costanza A , Signorelli C , Serafini G , Amore M , Capolongo S
Published: October 2020

Background

Since the World Health Organization (WHO) declared the coronavirus infectious disease 2019 (COVID-19) outbreak a pandemic on March 11th, severe 'lockdown' measures have been adopted by the Italian Government. For over two months of stay-at-home, houses became the only place where people slept, ate, worked, practiced sports, and socialized. As consolidated evidence exists on housing as a determinant of health, it is of great interest to explore the impact that COVID-19 response-related lockdown measures had on mental health and wellbeing.

Methods

We conducted a large web-based survey on 9261 subjects in Northern Italy, one of the Regions most heavily hit by the pandemic in Europe. Participants were recruited among university staff, faculty and students. The questions included socio-demographic features of the participants; international evaluation scales designed to recognize depressive-, anxiety- and sleep-related symptoms, impulsivity, quality of life; architectural parameters investigating housing physical characteristics.

Results

As emerges from our analysis poor housing is associated with increased risk of depressive symptoms during lockdown. In particular, living in apartments < 60 m2, with poor quality view and indoor area is associated with, respectively, 1.31 (95CI), 1.368 (95CI), and 2.253 (95CI) time the risk of moderate/severe and severe depressive symptoms. Subjects reporting worsened working performance from home were over four times more likely to also report depression (OR = 4.28, 95%CI).

Conclusions

Our findings suggest housing played a major role in influencing people mental health and wellbeing during COVID-19 pandemic. We argue strengthened multi-interdisciplinary approach involving urban planning, public mental health, environmental health, epidemiology, and sociology, is needed to inform the planning implementation and monitoring of housing policies centered on population health.

Key messages

COVID-19 lockdown mitigation measures strongly impacted on Mental Health. Living in apartments < 60 m2, with poor quality view and indoor area significatively increase the risk of moderate and severe depressive symptoms.
How to foster cities resilient to the COVID-19 pandemic through Urban Health strategies
Authors: Capolongo S , Buffoli M , D'Alessandro D , Fara G M , Appolloni L , Signorelli C
Published: October 2020

Background

The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make the systems and local capacities resilient to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities?

Methods

According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the “period” of physical distancing.

Results

Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services' plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism. Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services' network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders' awareness of the factors affecting Public Health in the cities.

Conclusions

The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments.

Key messages

The strategies described in this paper are at the basis of a social and infrastructural rethinking of the city, careful to the Welfare and Public Health needs. The physical distancing imposed, may have amplified population's social and health inequalities.
Mediterranean diet, sociodemographic factors and ultra-processed food consumption in Portugal
Authors: Moraes M M , Oliveira B , Afonso C , Santos C , Miranda R C , Rauber F , Levy R B , Rodrigues S
Published: October 2020

Background

Mediterranean diet has been shown to promote beneficial effects on health, while ultra-processed food (UPF) consumption has been associated with lower diet quality and higher risk for non-communicable diseases. Our aims were to explore the adherence to a Mediterranean dietary pattern (MDP) in Portugal and its association with sociodemographic factors and UPF consumption.

Methods

Participants were from the Portuguese National Food, Nutrition and Physical Activity Survey 2015-2016, aged 18-84y (n = 3,852). CAPI face-to-face interviews were used including 2 dietary 24-h recalls. UPF were identified using NOVA classification. Adherence to MDP was defined by the Mediterranean Diet Score (MDS), which may vary from 0 to 9. MDS≥6 was considered as high adherence. Weighted multivariate logistic regression analysis was used to explore associations of high adherence to MDP with sex, age, region, educational level, family income and dietary share of UPF groups.

Results

High adherence to MDP was observed for 19.6% of participants and was inversely associated with higher consumption of UPF, namely, sugar-sweetened beverages (OR = 0.924; 95%CI 0.883-0.966), confectionery (OR = 0.893; 95%CI 0.816-0.977), sweet snacks (OR = 0.953; 95%CI 0.923-0.985), cakes/desserts (OR = 0.956; 95%CI 0.934-0.978) and meat products (OR = 0.922; 95%CI 0.874-0.972). Being female (OR = 0.629; 95%CI 0.471-0.841) and not from the North or Alentejo regions were inversely associated with high adherence to MDP. There was no relation between income and adherence to MDP. The higher the level of education or age, the higher the odds of high adherence to MDP (OR = 2.573; 95%CI 1.741-3.803 and OR = 1.028; 95%CI 1.020-1.037, respectively).

Conclusions

Actions to improve adherence to MDP in Portugal should consider discouraging UPF consumption and be addressed to specific subgroups.

Funding

POCI-01-0145-FEDER-032090 (FCT/FEDER); FAPESP 2018/07391-9, 2019/05972-7 (MCR), 2016/14302-7 (FR).

Key messages

High adherence to a Mediterranean dietary pattern was observed for near 20% of Potuguese over 18 years old. The higher the level of education or age, the higher the odds of high adherence to MDP. High adherence to a Mediterranean dietary pattern was inversely associated with higher consumption of sugar-sweetened beverages, confectionery, sweet snacks, cakes/desserts and meat products.
The association between Internet use and health outcomes in the population of older adults
Authors: Szulc K , Duplaga M
Published: October 2020

Background

The Internet has become one of the primary sources of health-related information. Less is known about the impact of Internet access and use on health-related outcomes in the older population, which frequently suffer from a digital divide. The main objective of this study was the assessment of the associations between Internet use and variables reflecting health status, the use of health services and health behaviours in the population at least 50 years old.

Methods

The analysis was carried out on the data set from the telephone-based survey in a sample of 1000 respondents representative for targeted age strata of Polish society. The effects of Internet use were assessed with logistic regression models after adjusting for key socioeconomic variables.

Results

Mean age (standard deviation) of respondents was 64.2 (9.6). In the study group, 51.1% respondents were Internet users, 19.4% - persons with disabilities, 21.2% were hospitalised at least once, and 51.0% visited health care facilities at least six times in preceding 12 months. The respondents being Internet users less frequently reported chronic diseases (OR, 95%CI: 0.21, 0.16-0.30), disability status (0.52, 0.37-0.72) and higher self-assessed health status (1.64, 1.24-2.16). They also less often used health services in the preceding 12 months (0.77, 0.60-0.99. Internet use was not associated with hospital admission in the preceding year (1.04, 0.76-1.41) and most of the health behaviours (smoking: 1.06, 0.77-1.45, physical activity: 0.85, 0.63-1.15, the consumption of fruits and vegetables: 0.73, 0.50-1.07). Interestingly, Internet users drunk more alcohol (1.52, 1.14-2.02).

Conclusions

In the population of older adults, the use of the Internet is associated with variables reflecting health status and the utilisation of health services. Higher health status and lower prevalence of chronic conditions among Internet users were found after adjusting for age and other socioeconomic factors.

Key messages

It was shown that Internet use may be related with more favourable health outcomes. The reported association should trigger further research on the impact of Internet in elderly persons.
Developing a national framework for community involvement in health promotion in Tajikistan
Authors: Prytherch H , Karimova G , Schueth T , Egamberdiev M , Fischer O , Sadonshoeva G , Djamalova M , Shabalina G , Mukhtarova P , Aminov O
Published: October 2020

Background

In rural Tajikistan, various approaches have been taken to involve communities in health promotion, but many of them survived only as long as there was outside donor support.

Methods

In 2017, these approaches were examined and conceptualized, leading to the development of a “Guideline on Partnership with Communities on Health Issues” that was put into practice in 11 rural districts of the country.

Results

The Guideline sees Primary Health Care (PHC) staff trained as facilitators so as to conduct Participatory Reflection and Action (PRA) sessions with their local communities. Based on health priorities identified through these PRA sessions, and on national health priorities, the Health Promotion Institute chooses annual community activities facilitating behavioral change. Community Health Teams (CHTs) are formed, and the facilitators train them in disease prevention activities, and in how to plan initiatives to promote better health and well-being at village level. In the 5 initial districts, CHTs successfully mobilized community members to take part in activities related to identified health priorities e.g. health actions on Hypertension and Diabetes including free screenings. Furthermore, CHTs started to address determinants of health e.g. by supporting disabled people in their communities, organizing weekly waste removals, and initiating womens' walking groups.

Conclusions

Engaging communities by forming and capacitating teams, leads them to become a partner to the PHC system, and empowers them to tackle local determinants of health through their own initiatives. The capacity built in the local primary health care and health promotion structures hold potential for an expansion of this community-based approach to health promotion throughout the country. So what? By encouraging a government-recognized approach to community involvement in health, capacity and ownership of local institutions and stakeholders has increased, providing promise for long term sustainability.

Key messages

Community involvement in health remains central to primary health care. A government-recognised approach provides promise for sustainability.
Effectiveness of protective measures on dental care utilization: analysis from linked database
Authors: Berete F , Van der Heyden J , Demarest S , Charafeddine R , Van Oyen H , Bruyère O
Published: October 2020

Background

Financial accessibility to healthcare is a cornerstone in the Belgian health care system. A whole range of financial protectives measures are applied to ensure accessibility to all residents by minimizing the medical costs including a higher reimbursement for vulnerable population groups and protective measures for people with high health expenses due to chronic diseases. This study examines the effectiveness of such protective measures on the use of dental care among a representative sample of Belgian adults.

Methods

Data from the participants of the Belgian health interview survey (BHIS) 2013 aged 18 years and over were individually linked with data from the Belgian compulsory health insurance data (BCHI), (n = 8,668). Multivariate logistic regression was applied to assess the impact of the financial measures on the use of dental care.

Results

Five percent of the population reported having delayed dental care in the past 12 months due to financial barriers. Results from the multivariate model show that irrespective of gender, age, and educational level, individuals who have preferential reimbursement are more likely to postpone their dental care (OR = 3.32, 95% CI: 1.87-5.92), while those who can account on measures for high health expenses due to chronic diseases are less likely to do so (but not significantly).

Conclusions

Findings suggest that vulnerable people have more postponement despite the fact that they have a preferential reimbursement and, high expenses as a result of chronic diseases are not associated with more postponement of dental care. More targeted financial interventions should be necessary to reduce postponement of dental service utilization.

Key messages

Current health interventions are not yet effective for vulnerable people in dental care use. High expenses as a result of chronic diseases are not associated with more postponement of dental care.
The contribution of case mix, skill mix and care processes to the outcomes of community hospitals
Authors: Lenzi J , Adja K Y C , Pianori D , Reno C , Fantini M P
Published: October 2020

Background

The rapid increase in the proportion of older people underscores the need for new organizational models to face the unmet needs of frail patients with multiple conditions. Community hospitals (CHs) could be a solution to tackle these needs and foster integration between acute and primary care. The aim of this study was to investigate which patients' characteristics and which care processes affect clinical outcomes, in order to identify who could benefit the most from CH care and the best skill mix to deliver in this setting of care.

Methods

This study included all patients aged ≥65 and discharged in 2017 from the 16 CHs of Emilia-Romagna, northern Italy. Data sources were the regional CH informative system and hospital discharge records. CH skill mix and processes of care were collected with a survey; 3 non-respondent CHs were excluded. The study outcome was in-hospital variation of the Barthel index (BI) (≥10 vs. <10). We performed a 2-level random-intercept logistic regression analysis, and used the variance partition coefficient (VPC) to quantify the proportion of BI improvement that lay at CH level.

Results

Of the 13 CHs, 7 admitted ≥150 patients, 8 had a general practitioner medical support model, and 6 had >12 nurses' working hours/week/bed. Overall, 53% of the patients had a BI improvement ≥10 (4% to 71% across CHs). The patient case mix (i.e. baseline BI, female, older age, transfer from acute care) explained a portion of variability across CHs, as shown by the VPC that decreased from 0.32 to 0.26. Skill mix and processes of care were not associated with BI change, and the VPC resulting from controlling for these variables was virtually unchanged (0.28).

Conclusions

Patients' characteristics explained part of between-CH variation in BI improvement. Professional skill mix and processes of care, albeit fundamental to achieve appropriate care and respond to the unmet needs of the frail elderly, did not account for differences in CH-specific outcomes.

Key messages

A combination of quantitative and qualitative methods might better explain the outcome variability across intermediate care services. Multidisciplinary CH teams and services can be helpful to address the unmet needs of older people, but further studies are necessary.
Understanding corporate influence on science and the use of science - presentation of a new typology
Authors: Legg T , Hatchard J , Gilmore A
Published: October 2020

Corporations responsible for so-called 'industrial epidemics' go to great lengths to stifle policymaking concerning their products and practices, including through interactions with science. Here we present a newly-created typology which illustrates the ways in which industries attempt to influence science and the use of science.

Our analysis of the literature identified sectors of industry involved, strategies used by industries, and key relationships between these strategies. Eight sectors of industry attempted to influence science and the use of science: tobacco, alcohol, processed food and drink, pharmaceuticals and medical technologies, gambling, chemicals and manufacturing, fossil fuels, and the extractive industry. We identified five macro strategies widely used by industries: influence on conduct and publication of science, influence on interpretation of science, influence on reach of science, influence on the use of science in policymaking, and over-arching supporting strategies.

Across eight sectors of industry, strategies used in order to influence science are strikingly similar. When taken together, these appear to represent attempts to permeate and mould systems through which science is created, interpreted and used. This typology provides an accessible way to understand the strategies used by industry to influence science and the use of science. It can be used to pre-empt and counter future industry activity within contexts including academia, healthcare, and regulatory decision-making
10.D. Workshop: Health Impact assessment of climate change: monitoring and experiences
Authors:   Organised by: EUPHA Health impact assessment section, EUPHA Public health monitoring and reporting section, Public Health Wales,   Chair persons: Piedad Martin-Olmedo - Spain, Liz Green - UK
Published: October 2020

Most scientific communities and governments accept that a global warming process is occurring, and are concerned about its alarming potential environmental and health consequences. The extreme conditions associated to climate change such as severe storms, floods and prolonged heatwaves and droughts, are expected to increase considerably the burden of climate-sensitive diseases (e.g. heat-related illness, new and emerging infectious diseases, respiratory diseases or threats to food security). Poor countries are most at risk, but developed economies can also be strongly affected as illustrated by the large number of deaths associated to the European heat wave of 2003.

Conducting health impact assessment of climate change (HIA-CCh) requires the analyses of complex interactions between humans and natural ecosystems, demanding an interdisciplinary approach and a wide range of tools and techniques. Those analyses should be simultaneously context specific and extend over time to track not only the full dimension of health impacts but also the efforts needed to adapt and build resilience. Standard indicators for climate-sensitive health outcomes alone will not adequately capture the changing risks typically related to climate change. In addition to them, indicators of vulnerability and exposure, adaptation planning and resilience for health, and learning and knowledge management are required.

The present workshop aims at analysing and sharing expertise on how to conduct an HIA-CCh, with the following elements for discussion: Definition of the scope (both temporal and spatial) and the interdisciplinary team to be involved in the processSelection of indicators that will allow not only characterization of health impacts but also promoting and tracking adaptation activities at national and local health departmentsForesight climate change scenarios and how this can be incorporated into the decision-making processVulnerability risk in relation to impact assessment and health / health equity in the context of climate changeHow the proper HIA-CCh can have an impact on learning and changes in management frameworks

Key messages

Increasing public health’s adaptive capacity to face climate-sensitive threats is needed. Conducting HIA-CCh requires innovative management strategies and proper selection of indicators.
Understanding vulnerability in the context of climate change – a Health impact Assessment Framework
Authors: Haigh F , Harris-Roxas B , de Leeuw E
Published: October 2020

The climate emergency is resulting in differential exposures to health risks across populations. Where the 'standard' determinants of (ill) health are already socio-economically distributed, the impacts of a changing climate will have even greater effects on the most vulnerable in society and further exacerbate health equity gaps. Building on a conceptualisation of health inequity as 'the unfair and avoidable differences in health between groups in the population' we argue that phenomena like high temperatures, extreme weather and rising sea levels do not affect everyone equally; and that policies and interventions need to be cognisant of distributed and differential patterns of health risk exposure and responses.

Vulnerability can be conceptualised across three dimensions. Firstly, some populations are vulnerable because they have higher levels of exposure. Secondly, some populations have higher levels of vulnerability because they are more sensitive. The final type of vulnerability is particularly important and relates to health equity adaptive capacity - people's ability to prepare for and respond to health threats. For example, people who are economically less well-off are: more likely to live in poor quality housing and in areas with relatively less access to resources; less likely to know how to respond (health literacy), or if they do know, less likely to be able to acquire and afford mitigation measures; have less capacity to advocate; and are less likely to be listened to. These vulnerabilities tend to cluster and accumulate, reinforcing and exacerbating health inequities. These same communities also have capacities and assets that can support recovery and resilience.

We can utilise Health Impact Assessments to understand context specific climate emergency vulnerabilities and to develop strategies to respond. In this presentation a climate vulnerability framework and associated tools for HIA will be described and discussed.
Sarphati Amsterdam: a dynamic research infrastructure
Authors: Ujcic-Voortman J K , Hall J T , Johannes M , Seidell J C , Verhoeff A P
Published: October 2020

Sarphati Amsterdam is a collaboration between the city of Amsterdam and four Amsterdam research institutions, focusing on innovative multidisciplinary research beneficial to preventing non-communicable diseases effectively and sustainably. With the Sarphati Cohort, Sarphati Amsterdam has established a dynamic cohort study that systematically monitors growth and its determinants from birth until adulthood, in order to 1) identify causes of overweight and 2) evaluate interventions to combat overweight.

Data collection is linked to routine Youth Health Care consultations with all ∼150,000 Amsterdam children (0-18y). Thus, making selected care data on growth and development available for research. After informed parental consent, anonymised data can be used to systematically monitor children. Additional data is collected through age-specific questionnaires. The sub-cohort structure facilitates more extensive data collection in subpopulations, including interviews, observations, and biosamples.

Up until March 2020 over 5,130 children enrolled. The continuous inclusion of new-borns gives the Sarphati Cohort its dynamic character. This enables the incorporation of innovative research designs to evaluate interventions.With over 170 different nationalities Amsterdam has a highly diverse population, both in terms of cultural and socio-economic background. The data collection strategies and tailored tools are developed to meet the level of adaptability this design requires.

Embedding research in this manner enriches it way beyond clinical settings and provides an unparalleled depth and breadth of data. With the Sarphati Cohort, Sarphati Amsterdam facilitates innovative research in the field of obesity that will contribute to the ambitious policy objectives of the city of Amsterdam to promote healthy behaviour and improve the quality of life of young people.