bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional “hot topics” in studies published as SR/MA in cancer prevention between 2010 and 2018
Authors: Storman D , Bala M M , Koperny M , Zajac J , Tobola P , Swierz M , Staskiewicz W , Gorecka M , Skuza A
Published: October 2020

Background

The number of systematic reviews and meta analysis (SR/MA) is increasing, also in the field of nutrition.

Objectives

The aim of this work was to analyse the frequency of exploring the effects of specific nutritional interventions in studies published as SR/MA focused on cancer prevention.

Methods

The main study was a systematic survey of SR/MA on nutrition in cancer prevention published between 2010 and 2018 identified through search in 3 databases. The protocol of the study was registered (CRD42019121116 in PROSPERO). All steps of the survey were done by two reviewers independently with any conflicts resolved by discussion or by the third reviewer. The quality and risk of bias were assessed using AMSTAR 2 and ROBIS tools amid subsample of 101 SR/MA. We grouped all dietetic interventions by year and analysed frequency.

Results

Among 737 SR/MA meeting the inclusion criteria, an average number of publications was 83/year ranging from 38 (in 2010) to 118 (in 2015). The most commonly studied food categories were: non-alcoholic beverages (127 publications in total; on average 14/year) and vitamins and/or minerals (157 publications in total; on average 17/ year) with coffee as one of the most popular (on average 7 SR/MA per year). The most commonly analysed vitamins were vitamin D, C, and E, while amid minerals calcium and selenium. Red meat and processed meat were comparably popular with about 4 dedicated publications every year. SR/MA about fruits and vegetables and alcohol appeared on average about 8 times every year. The overall quality of SR/MA assessed in a subsample of randomly selected 101 of included articles was poor (97% were classified as having a low quality).

Conclusions

In SR/MA published between 2010 and 2018, each food category appears many times, while for example coffee - many times every year. Detailed analysis per food item may help identify potential research waste in the field of nutrition in cancer prevention.

Key messages

Currently, coffee is the ‘hottest’ nutritional topic in cancer prevention. The general quality of SR/MA published in the field of cancer prevention is low.
Improving Pupils' Health & Wellbeing: Team around the School Pilot and Evaluation
Authors: Brown M , Goulding A
Published: October 2020

Background

Permanent school exclusion in Gateshead doubled from 2014 - 2017. A Behaviour Conference was held in July 2017 to formulate an action plan to curb this trend, including piloting 'Team around the School' (TAS). TAS is a local network of services, meeting on a regular basis to have shared conversations about pupils where early help may prevent escalation. Resources from several agencies are pooled to provide support for families, focusing on solutions and encouraging resilience.

Aim

To prevent future complex crisis interventions, reduce a 'refer on' culture, and align Early Help with school improvement.

Methods

The pilot ran at one Gateshead secondary school from January 2018 to July 2018. There were 17 TAS meetings during the pilot period. Four families, three referrers, six pupils and two managers were interviewed from 16th July - 3rd August 2018. Structured surveys, interviews and administrative data were used to determine effectiveness.

Results

Professionals viewed the programme as 'successful', however, there were some logistical issues, including gaining consent, capacity (physical rooms, funding and staffing) and integrating wider services into the programme. Pupils found the experience helpful and improved their overall health and wellbeing, at home and in school. Some saw dramatic improvements in attendance, presentation, attitude and behaviour, along with a more stable home life. Referrers were happy with the process and outcomes, finding TAS to be helpful in early intervention, with quick turnarounds. Families felt empowered, with improved communication and positive outcomes. Three plans were made, and three cases stepped up to Early Help. Four cases closed after reduction in risk. Two children moved schools.

Conclusions

TAS appears to successfully provide early support and intervention, reducing the risk of escalation, while also providing families with increased autonomy.

Key messages

A pupil's health and wellbeing is closely linked with their home life and life in school. Close agency working can improve a pupil's outcome in school and overall health and wellbeing.
A review of social determinants of health for dashboard development for SDG 3.4 for sub-Sahara Africa
Authors: Adjanor O , Johnson J , Wuenstel W , Jamu S , Gabitiri L , Smith A , Greenhill R
Published: October 2020

Background

All sustainable developmental goals (SDGs) require implementing sustainable strategies and monitoring to track progress. But what is known of sub-Sahara Africa (SSA)'s efforts in following this stride to reduce by 30% mortality from non-communicable diseases (NCDs) through prevention (SDG 3.4), by considering the effect of social determinants of health (SODHs) on type 2 diabetes increasing prevalence?

Methods

Our search produced 2005 unique articles. Only 10 studies were used in the analysis of this study. These studies include 1 from Botswana, 2 from Ghana, 2 from Kenya, 3 from Nigeria and 2 from South Africa. The findings were evaluated in a greater extent.

Results

All studies (100%) showed non-adherence to exercise and poor glycemic control. 7 studies (70%) on education revealed lack of knowledge or misconceptions, 5 studies (50%) with obesity showed a strong linkage between obesity and type 2 diabetes, and 4 studies (40%) on diet, showed diets high in carbohydrates, saturated fats, and sodium predisposition to type 2 diabetes. All studies (100%) linked urbanization with an increased prevalence of type 2 diabetes.

Conclusions

Changes in SODHs seem to be contributing to the growing prevalence of diabetes in SSA. These changes with other key data should be considered and tailored to policy processes, environment, infrastructures, and norms for prevention strategies and informing dashboard development for SDG 3.4.

Key messages

Social determinants of health must reflect in relevant causal pathways, settings, and sectors for preventive intervention such as in taxation; regulation of food advertising, school, and healthcare. Analysis of the effect of the changing social determinants of health on type 2 diabetes, will assist in establishing indicators for the dashboard development for SDG 3.4 for sub-Sahara Africa.
Spatial distribution of gambling: two indexes in support of the reduction of health inequalities
Authors: Papineau E , Robitaille E , Prisca Samba C , Lemétayer F , Kestens Y , Raynault M-F
Published: October 2020

Background

Many studies have showed that disadvantaged areas residents have greater access to gambling sites and are more affected by gambling. Our research proposes an innovative method to characterize gambling environments in Quebec and addresses social inequality with respect to gambling exposure.

Methods

This cross-sectional ecological study was carried out in 3 stages: a Gambling Exposure Index (GEI) was built and is composed of 3 dimensions: spatial accessibility to gambling sites, density of gambling places, and relative risk associated with the types of game. The two-step floating catchment area (2SFCA) method was used to combine these dimensions into an overall GEI index. Data was retrieved from a geocoded directory of gambling sites and commercial databases. The relative risk of games is expressed by prevalence rates for those specific games in a Quebec population prevalence survey. A Vulnerability to Gambling Index (VGI) was produced based on 6 socio-economic proxies of problem gambling from the 2016 Canadian census, which were weighted and aggregated at the dissemination area (DA) level. Spatial and descriptive statistical analyses were conducted to explore the relationship between VGI and GEI, and to identify highly exposed and vulnerable areas.

Results

Our analyzes reveal significant associations between the GEI and the VGI in 2 599 out of 13 420 Quebec DAs (p < 0.05). Sectors with a high GEI show an average distance to the closest gambling sites of 2.8 km compared with 13.5 km for more advantaged sectors.

Conclusions

The interactive online mapping of the two indexes and statistical analysis of the results are beneficial to the professionals working in several fields such as risk monitoring, management of zoning, licensing and gambling distribution, prevention and treatment services. The method and the associated tools can be adapted to address the problem of increased accessibility to other unhealthy products in vulnerable neighborhoods.

Key messages

Two innovative ecological indexes show that increased accessibility to gambling correlates with a higher vulnerability to gambling in many Quebec regions. The online interactive map on gambling exposure and vulnerability provides reliable criteria to municipal, regional and governmental bodies for a safer distribution of gambling offer.
Difficulties in getting to sleep, late bedtime and sleep duration among adolescents in Latvia
Authors: Klavina-Makrecka S , Villerusa A , Gobina I , Pudule I , Velika B , Grinberga D
Published: October 2020

Background

Sleep is important for adolescent general wellbeing and different sleep domains like difficulties in getting to sleep, bedtime resistance and sleep duration can be studied. This study investigates the prevalence of weekly difficulties in getting to sleep in association with bedtime and sleep duration on schooldays and weekends among adolescents in Latvia.

Methods

Data from the HBSC Survey 2017/2018 of Latvia with 4412 respondents aged 11, 13 and 15 years were used for statistical analysis. Sleep duration less than 7h was classified as insufficient and bedtime at 0:00 or later as delayed bedtime. Age-adjusted logistic regression and adolescents without weekly difficulties in getting to sleep as a reference was used for studying the associations.

Results

On average, 43.6% of adolescents (38.0% boys and 49.1% girls) reported weekly difficulties in getting to sleep. Of those, 26.5% reported sleep duration <7h on schooldays but 5.6% on weekends. On average, difficulties in getting to sleep was associated with the increased odds of insufficient sleep duration on schooldays (OR = 2.16; 95%CI 1.84-2.54) and weekends (OR = 1.66; 95%CI 1.23-2.24), with higher odds in girls than boys. Delayed bedtime was significantly more prevalent among adolescents with sleep difficulties than for those without (33.7% vs 20.6%). The sleep duration <7h was more prevalent among those adolescents having sleep difficulties and delayed bedtime than in those with sleep difficulties and bedtime before 0:00, both on schooldays (72.1% vs 3.2%) and weekends (7.9% vs 0%).

Conclusions

Difficulties in getting to sleep among adolescents are highly prevalent and increases the odds of insufficient sleep duration, especially in girls. Delayed bedtime seems to modify the association between the difficulties in getting to sleep and sleep duration.

Key messages

Adolescents with difficulties in getting to sleep are at risk of delayed bedtimes and insufficient sleep duration. Further studies to explore the underlying mechanisms linking difficulties in getting to sleep and delayed bedtime are required.
Medical education in Brazil: public health as a didactic-pedagogical structure
Authors: Ribeiro Bizuti M , Eneida de Almeida M , Roberto Barbato P
Published: October 2020

Medical education in Brazil has a Flexnerian structure whose guidelines were instituted in the Americas in the early twentieth century, which led the academic to settle in the office and in the hospital with a focus on the biological processes of the health-disease process. However, since the 1970s, increasing social inequality in Brazil has led to marked poverty with a lack of access to basic health care for most of the Brazilian population. The 1988 Federal Constitution treats health as a democratic process where the social issue is fundamental to the development of the nation. The Italian health movement, guided by social studies by Giovanni Berlinguer, inspired the Brazilian Health Reform Movement. In this regard, the hospital-centered view began to be questioned. Wide critical-reflexive movements were being built in society and in the academy, looking for improvements in the population's quality of life. Issues related to promotion, treatment and prevention, both in medical training and in management and assistance, were gradually being incorporated into medical education. But it was in the national medical education change project that the National Curriculum Guidelines (DCN), launched in 2014, culminated. The medical course at the Federal University of Fronteira Sul - Chapecó campus (UFFS-Ch), in the state of Santa Catarina, was created in 2015, fully complies with the new guidelines and is supported by the Public Health. This orientation is guided by the political, economic and social development of the Country within a civilizing process that is based on the social and environmental determinants of health, with respect to the relations of society in its history and in its territory. In this way, medical training at UFFS has a vision of the health-disease process that transcends the individual and addresses the community, with a proposal to transform society based on democracy and social justice.

Key messages

To present a counterpoint between the Brazilian Health Reform and its inspiring one, an Italian, in the search to overcome social inequality, through a civilizing process based on Democracy and Health. To present a medical course based on the transformation of medical education with a structure in Public Health in order to provide a reduction in social inequality in Brazil.
The EU’s global health policy in times of Covid-19: challenges and prospects
Authors: Bergner S
Published: October 2020

The Covid-19 crisis has laid bare weaknesses in the capacity of the European Union (EU) to act as a global health player. Most of those challenges have existed prior to the pandemic and are linked to a limited implementation of the Sustainable Development Goals (SDGs) - the global agenda acknowledging interconnections between different policy fields. Despite the EU's commitment to implement the Agenda 2030 in its internal and external policies, there is a lack of visibility and sufficient reference to the SDGs on a strategic level as well as in the EU's actions and partnerships in global health. The Union has shown during the Covid-19 pandemic that it is a relevant global health actor; however, there seems to be a lack of strategic visions and resources.

The poster aims to illustrate on the one hand the weaknesses and challenges of the EU global health policies in times of Covid-19 and beyond. On the other hand, it identifies advantages of the EU in the field of global health and explores future pathways. Applying a mixed-method approach I did a review of academic and grey literature; content analysis of official EU documents and statements, expert interviews and gathered insights from events such as policy dialogues.

Preliminary results indicate that the EU has a strong focus on infectious disease control in its external health policies and hereby neglects the health system dimension and interlinkages with other foreign policies such as trade. Covid-19 has highlighted the importance of resilient health systems in a crisis and the interlinkages between different policies for an effective response. To pursue a genuine health-in-all-policies approach prioritising health system strengthening within a updated strategic roadmap is necessary. Moreover, efforts to ensure an equitable distribution of vaccines, therapeutics and diagnostics should be pushed through the development and implementation of respective criteria.

Key messages

The focus of the EU in global health should shift from a narrow health security lens towards health system strengthening including disease control. The EU should prioritize and implement the health-in-all-policies approach in its global health policies through an ambitious roadmap.
Trend of deaths from external causes in Campinas, Brazil (2000-2017): Joint Point Regression Analysis
Authors: Roa Caicedo M , Cordeiro R
Published: October 2020

Introduction

Deaths from external causes are caused by events or acute exposure to physical, chemicals agents or radiation; also due to the lack of essential agents for survival or injuries caused by oneself or others. The preventable nature of deaths from external causes has been pointed out mainly because there are related to violence.

Objective

To describe the trend and characteristics of mortality from external causes in the city of Campinas, São Paulo, Brazil from 2000 to 2017.

Methods

Descriptive, cross-sectional study. Information sources: The death mortality certificates from the Municipal Health Secretariat's Information System included in the chapter XX of the CID-10. Data analysis: External causes were divided into five groups: transportation, falls, suicides, homicides and others. The Standardized Mortality Coefficient (SMC) per 100,000 inhabitants was calculated taking as a reference the populations of the 2000 and 2010 censuses, stratified by age group and sex. The trend analysis for homicide was performed using a joinpoint regression model.

Results

In Campinas during the studied period occurred 12,175 deaths from external causes (80.4% male, 19.6% female). The most important causes of mortality for men were homicides (50%) and traffic accidents (27%) and for women it was falls (35%), traffic accidents (24%) and homicides (22 %). The SMC trend towards homicides shows a decrease in male events and stability in women homicides. It is noteworthy the lack of change in the trend of the female coefficient, regarding the male SMP, we identify three significant changes in the trend.

Conclusions

The decrease in the number of deaths from external causes in Campinas is principally due to the decrease in homicides in male population. The SMP was able to analyze deaths adjusted to the characteristics of the population, being an important tool for the analysis of deaths from external causes.

Key messages

In Campinas deaths from external causes are important causes of mortality. The Standardized Mortality Coefficient and joint point regression method are useful tools for the analysis of deaths from external causes.
Preventable newborn deaths: analysis of the newborn infection component in Brazil from 2007 to 2017
Authors: Oliveira E S , di Moura A F , Viana T R F , Oliveira N R , Barbosa L P , Almeida P C , Cardoso MVLML
Published: October 2020

The Universal Agenda 2030 was developed by representatives of all countries as an action plan covering the three dimensions of sustainable development: economic, social and environmental. 17 objectives were agreed upon, highlighting objective 03, which aims to ensure a healthy life and promote well-being for all at all ages, having as one of the established goals to end preventable deaths of newborns by 2030. Infections neonatal care reflects deficits in health care, covering the entire perinatal period, and it is necessary to understand its causes in order to promote quality preventive and health promotion actions. The question is: what are the causes that make up the indicator of early neonatal mortality, due to preventable causes in Brazil between 2007 to 2017? Retrospective study carried out between September and October 2019 using secondary data collection from Department of Informatics of the Unified Health System - SUS (DATASUS). The outcome variable was early neonatal mortality from preventable causes and the independent variable was the infections component of the newborn). Twelve preventable causes of death have been identified in this category: congenital rubella syndrome; congenital syphilis; neonatal tetanus; diphtheria; haemophilus and non-haemophilus meningitis; human immunodeficiency virus diseases; neonatal infections; pneumonia; acute infections of lower airways; bacterial diseases and intestinal infectious diseases. The main cause of preventable death was infections from the neonatal period, which include congenital viral diseases (cytomegalovirus and herpes simplex); newborn bacterial septicemia; congenital parasitic diseases; omphalitis of newborn with or without mild hemorrhage; intra-amniotic infection of the fetus, neonatal infection of the urinary tract and/or skin. There is a need for more effective public health actions to modify the neonatal mortality situation, as well as health surveillance actions.

Key messages

Warn about causes of perinatal mortality that can be avoided. Strengthen the fulfillment of objective 3 of the 2030 Agenda to ensure and promote health in the perinatal period.
Potential years of life lost in Campinas-Brazil between 2000-2017 due to external causes of death
Authors: Komoda D S , Fernández M R B , Cordeiro R C
Published: October 2020

The Potential Years of Life Lost indicator is an alternative to the use of traditional indicators to evaluate impacts of external causes of death for its ability to evaluate the magnitude of premature death. This study aims to evaluate the impact in the PYLL of premature deaths due to external causes in Campinas, between 2000 and 2017, and to show selectiveness of violence targeting the poor.

We performed a cross-sectional epidemiological study describing the PYLL due to external causes in the city of Campinas between 2000 and 2017. Amongst the variables studied, focus was given to the Human Development Index by Neighborhood (HDIN) of each individual (obtained by relating addresses to the official HDIN census), to evaluate impact of poverty in PYLL, mainly in homicides. A total of 12175 people died from external causes between 2000 and 2017. The distribution of the PYLL in the year 2000 indicated a loss of 35.8 years for every 1000 inhabitants with a high decrease until 2005 to an average of 17.45 from 2005 to 2017. Although we observed this decrease in PYLL, analysis by social strata shows disparities between PYLL of the rich and poor. When all external causes were considered, low and very low-HDI population had the most significant PYLL (27 and 30.3 respectively) compared to high and very high-HDI population (18.3 and 9.9 respectively), and when only homicides were taken into account, an even greater disparity was observed between the lower-HDI and higher-HDI stratas (overall average of 16.55 and 5.55 respectively).

Through PYLL analysis, we could observe the selectiveness of violence towards the low and very low-HDI population, which shows that, public policies that aim improve population health cannot be restricted to health sectors, but also include socio-economic actions against social inequalities and income concentration.

Key messages

Although external causes of death seems to be decreasing in Campinas, violence seems to target the poor. Any policy that aims to prevent violent causes of death must necessarily take into account social disparities.
Housing deterioration: a multi-dimensional index and validation in shared refugee accommodation
Authors: Mohsenpour A , Biddle L , Krug K , Bozorgmehr K
Published: October 2020

Background

Asylum seekers and refugees (ASR) are struggling for residential autonomy while awaiting the results of their asylum case. As housing is a known upstream determinant of and fundamental resource for health, it is important to monitor housing quality of state-provided shared refugee accommodation. We constructed, validated and field-tested a new and quick-to-apply index to measure the degree of Small-area Housing Environment Deterioration (SHED).

Methods

Conceptualizing housing quality as characteristics and maintenance of physical environment, we developed the SHED based on the “Broken Windows”-index (BWI). We conducted a validation study with seven raters at two time points, assessing measures of inter-/intra-rater reliability and internal consistency, complemented by cognitive interviews. Further, we field-tested the index in a random sample of 58 shared refugee accommodations and assessed its convergent validity against ASR's satisfaction with their living places (EUROHIS QOL).

Results

SHED assesses five domains (windows/glass, walls/roof, garbage, graffiti, outside spaces), complemented by a rating of the overall living environment. The validation study delivered an 'almost perfect' prevalence- and bias-adjusted Kappa (PABAK) of 0.87 (0.82-0.91) for intra-rater, 'substantial' to 'almost perfect' PABAK's between 0.71 (0.52-0.91) and 0.91 (0.87-0.91) depending on the rater (all p < 0.001), and a Cronbach's α of 0.80. The index's construct validity is based on the BWI and converges with the ASR's subjective satisfaction with their living places. Cognitive interviewees enjoyed the simplicity and speed of the SHED and guided the creation of a manual for future use.

Conclusions

The index demonstrated high measures on objectivity, reliability, and internal consistency. It proved its applicability in a field-test and showed convergent validity with ASR's satisfaction with their living place within shared refugee accommodation.

Key messages

We have constructed an objective, reliable, internally consistent and valid index assessing the degree of deterioration of small-area housing environment. SHED offers opportunities for monitoring the physical quality of collective accommodation centres and filling the research gap on associations between housing quality and health.
Air pollution and social deprivation as the risk factors of cardiovascular diseases in Poland
Authors: Poznanska A , Seroka W , Stokwiszewski J , Wojtyniak B
Published: October 2020

Background

The prevalence of cardiovascular diseases (I00-I99; ICD-10) is known to be higher in deprived and polluted areas. This Polish district-level study focuses on a possible synergistic effect of deprivation and PM-10 concentration on mortality and hospitalised morbidity due to I00-I99 in 2015-2017.

Methods

This study concerns all 141 districts where PM-10 has been monitored by the Chief Inspectorate of Environmental Protection. The Generalized Linear Model method was used to assess the contribution of PM-10 concentration, the deprivation index (DI, a published synthetic measure of district's social status), the percentage of urban dwellers in the district, and their interactions with PM-10 to age-standardised mortality and hospitalisation rates. Demographic data come from Statistics Poland, and the hospitalisation ones from NIPH-NIH. The analysis was conducted for males, females, their 65+ aged subcohorts, and general population.

Results

For all cohorts, PM-10 pollution significantly contributes to the increase in both hospitalisation and mortality rates (e.g. for males 7% [95%CI: 2-12%] and 12% [3-21%] per 10μg/m3, respectively). The deprivation impact is also significant (e.g. for males p = 0.004 and 0.006), the DI standardised regression coefficients exceed 2-3-fold these of PM-10. The PM-10 effect was found stronger in rural areas than in the urban ones. In the case of hospitalisation, no synergy was found between PM-10 and DI, while negative synergy effect was observed for mortality (e.g. p = 0.030 for males, 0.011 for males aged 65+).

Conclusions

Both deprivation and PM-10 concentration increase hospitalised morbidity and mortality due to I00-I99, however, only for hospitalisation is the effect additive. Unexpectedly, the impact of air pollution on mortality is lower in deprived areas. This effect is even stronger for older population.

Key messages

The impact of social status on mortality and hospitalised morbidity due to cardiovascular diseases in Poland exceeds that of the environmental factor (PM-10 concentration). The negative synergic effect of deprivation index and PM-10 concentration on mortality was identified - the impact of air pollution is lower in deprived areas.
Strengthening partnerships for Roma children’s participation in health policy and practice in Europe
Authors: Larkins C , Saitovic M , Milkova R , Bereményi A
Published: October 2020

Background

Whilst some Roma children thrive, many experience poor health, housing and nutrition. This is linked to antigypsyism, economic inequalities, poor experiences of healthcare and other denials of social citizenship. Children globally are demonstrating about climate change, an issue of particular importance to those Roma children living in the most polluted and hazardous conditions affected by environmental waste and climate related risks. Academic and policy discourse recognises that finding solutions requires involvement of Roma children and young people, but to date there is very little research in this field. This paper explores how Roma children (aged below 18) can guide policy and practice to promote public health and sustainable development goals.

Methods

A review of literature on participatory practice with Roma children and young people was combined with a qualitative European survey (conducted Feb - June 2020) in English and Bulgarian. Critical realist analysis of data identified mechanisms that enabled inclusive and impactful participation in public health related matters, for whom and in which circumstances.

Results

Preliminary results, illustrated with examples from three European countries, indicate that participatory practices are more inclusive where Roma children lead identification of the issues they wish to address; there are explicit links to current service and policy opportunities; intergenerational and intersectional alliances are built; opportunities are community- based, not simply engaging with children in education; and pathways towards employment are offered. Partnership with Roma and Pro-Roma NGOs is vital.

Conclusions

Success in public health related participatory practice with Roma children is promoted by using inclusive methods and making links between everyday challenges and local, national and international policy (reflecting on structural inequalities). There is need to build decision-makers' capacity and commitment.

Key messages

Roma children can be effective partners in public health policy and practice. Supporting Roma youth leadership enables inclusiveness.
How does reserve capacity influences transition into upper secondary school among adolescent Finns?
Authors: Koivusilta L , Acacio-Claro P , Rimpelä A
Published: October 2020

Background

Educational inequalities occur when differences in educational outcomes are more strongly related to students' background than their own academic efforts. During adolescence, psychosocial resources such as social support and self-efficacy, collectively termed “reserve capacity” may serve as a pathway to educational transitions and help reduce educational inequalities. We study how reserve capacity affects transition of adolescents into upper secondary school in terms of non-placement or placement into vocational or academic track.

Methods

We use data from 9th graders in 128 schools at the 14 municipalities of Helsinki Metropolitan region who participated in the MetLoFin follow-up survey in 2014 (n = 7,344 students). The data were linked with the national Joint Application Registry containing information on whether student was placed in academic (65%) or vocational (32%) track or had no placement (3%) for upper secondary schools. Multinomial logistic regression models, adjusted for sex and school, were fitted to analyse the effect of students' background and reserve capacity on type of educational placement.

Results

Students whose parents had low education were more likely to be in vocational than academic track compared to those whose parents had high education (OR = 2.5 95% CI: 2.1-3.0). Having a foreign background increased the risk of having no placement than academic placement (OR = 1.5 95% CI: 1.1-2.2) compared to native students. Low social support and low self-efficacy predicted vocational placement of students relative to academic track but not no placement compared to academic placement. Academic grades remained strongest predictor of placement.

Conclusions

Students' background still determine educational outcomes, but psychosocial resources could likely reduce educational inequalities and ensure successful educational transitions in adolescence.

Key messages

Social backgrounds impact adolescents’ educational transitions. Adding students’ psychosocial resources could reduce educational inequalities.
Mortality inequalities in Rome: the role of individual education and real estate market
Authors: Cesaroni G , Venturi G , Paglione L , Angelici L , Marino C , Davoli M , Agabiti N
Published: October 2020

Background

Several indicators at individual and area level have been used to stratify the population. The aim of this work was to investigate the association between real estate prices, education and health status in Rome.

Methods

We used the administrative cohort of residents in Rome at the 2011 census. We followed subjects aged 18+ from 2011 to 2016 using anonymous record linkage procedures with administrative databases. The census includes several individual information, comprising sex, age, education, and residential urbanistic zone. From mortality register we collected date and cause of death. Real estate prices (€/m2) were available for each urbanistic zone. We classified the population in five categories according to the quintile of the distribution (1=highest prices, 5=lowest prices). We used adjusted Cox regression models to estimate the hazard ratios (HRs) and 95%CIs.

Results

We selected 2,053,668 subjects, not living in institutions at the time of the census survey. Women were 54% of the population; the mean age was 52 years (sd 18), 22.5% had a high education (university degree) and 37% a low education (≤ junior high school). During the follow-up, 126,548 subjects died. As expected educational level was strongly associated with all-cause mortality (39% higher risk of low vs. high educated). The mortality risk increased with decreasing real estate prices, taking account of age and sex. Compared to subjects living in highest prices areas, those living in level 2 areas had a HR = 1.08 (95%CI: 1.06-1.10), those in level 3 had a HR = 1.14 (95%CI: 1.12-1.16), those in level 4 a HR = 1.16 (95%CI 1.14-1.18), and finally those living in the cheapest areas a HR = 1.22 (95%CI: 1.20-1.25). When we considered both education and real estate prizes, the HRs marginally decreased.

Conclusions

There is an independent association of both individual education and socioeconomic characteristics of the area of residence and all-cause mortality.

Key messages

There are strong socioeconomic inequalities in Rome. A simple indicator such as real estate prices can be used to tackle inequalities.
Processes of co-producing a complex community based intervention in a disadvantaged neighborhood
Authors: Termansen T
Published: October 2020

Background

Empowerment-based community interventions which may include co-production in local decision-making have become more and more common to address health and social inequalities. However knowledge concerning how best to develop and implement such interventions in a disadvantaged neighborhood is sparse. The purpose of this study is to look into the processes and potentials of co-producing a community restaurant in the socially disadvantaged neighborhood Tingbjerg in Copenhagen. The study is part of the initiative Tingbjerg Changing Diabetes which is based on the Supersetting approach involving multiple stakeholders in Tingbjerg. The purpose of the Restaurant is to engage residents and building capacity through participation in cooking workshop, social dining and co-production processes.

Methods

The study is based on Community Action Research (CAR). It mixes in depth ethnographic fieldwork and participation in the processes of developing the restaurant with participatory methods engaging residents in the development process, interviews with stakeholders and residents and using program theory to guide the process. The study is still ongoing, but data from five months participant observation and interviews with 5 stakeholders has been gathered to date with participatory methods planned.

Preliminary findings

Findings show that processes of co-producing and implementing a community restaurant in Tingbjerg through a Supersetting approach are characterized by agility, context sensitivity, adaptability and trust building, and that these have the potential to ensure resident participation, capacity building and sustainability.

Conclusions

Adaptability, context sensitivity and engaging multiple stakeholders in a long term commitment are imperative when working to build community capacity. In addition, participation and co-production are concepts that have to be carefully considered and applied stepwise and over a long period of time when working with vulnerable groups.

Key messages

Sustainable and effective community interventions in disadvantaged neighborhoods rely on strong and long term commitments by multiple partners, adaptability and context sensitivity. Co-production with vulnerable groups has the potential of being empowering, but only when applied contextually and stepwise.
Developing a literature-based systems map of determinants of dietary intake in low-income groups
Authors: Sawyer A , van Lenthe F , Kamphuis C , Poelman M , Djojosoeparto S , Roos G , Terragni L , Nicolaou M , Waterlander W , Stronks K
Published: October 2020

Background

Inequalities in obesity and related non-communicable diseases pertain in part to less healthy dietary intake in disadvantaged groups. Examining determinants of intake as a complex adaptive system - i.e. interconnected determinants exerting non-linear influence on outcomes - honours the complexity of dietary choices, behaviours and intake, and could inform policies. This study used literature to map the complex system underlying dietary intake in low-income groups, to identify system structure and goals perpetuating poorer dietary outcomes.

Methods

A systematic umbrella literature review examined determinants of dietary outcomes in children, adolescents and adults. Inclusion criteria were: • Low-income sample; analysis by income (Non-)systematic review of quantitative/qualitative, observational/intervention studiesHigher/upper-middle-income countriesExposures: individual, sociocultural, physical, political determinants/correlates; effect modifiers

Excluded outcomes were: breastfeeding, alcohol and neophobia.

Using causal loop diagramming, extracted data on determinants, associations and interpretation were embedded in a systems map of mechanisms driving dietary intake. System structure (e.g. sub-systems) and goals (e.g. feedback loops) were analysed.

Results

A systems map of hypothesised mechanisms driving dietary intake in low-income groups was developed from 43 reviews and expert consensus. The system comprised sub-systems: 1) accessibility, 2) household resources, 3) financial constraints, 4) health/biology, 5) knowledge, attitudes and beliefs, 6) sociocultural influences. Identified sub-system goals could undermine healthy intake opportunities, e.g. energy-dense food choices for cost-efficiency, heightened exposure to energy-dense foods determining preferences.

Conclusions

The literature-based systems map articulates the systemic basis of poorer dietary outcomes in low-income groups. Understanding system structure and goals will inform equitable policy.

Key messages

Dietary intake in low-income groups is driven by a complex system of mechanisms which may perpetuate poorer dietary outcomes. Existing literature was synthesised as a systems map; identification of structures and goals of the system can inform health equity policies.
Period poverty in rural Uganda; an exploration of the challenges and the need for intervention
Authors: Kennedy C , Severe J
Published: October 2020

Background

Period poverty refers to a lack of access to safe means of managing menstruation. It affects the education, health and dignity of millions of women and girls globally. This study aims to identify the barriers facing menstruating girls in rural Uganda, investigate the effects of period poverty in this demographic and assess the need to implement a programme to tackle challenges identified.

Methods

A qualitative study was undertaken in a community setting. 42 Participants were selected in Bududa, Uganda using convenience sampling. School-age girls supported by The Shelo Foundation (charity no.1155142) who had begun menstruating and adults in positions of responsibility in the community were interviewed to gain a cross sectional understanding of the questions posed. Data was collected prospectively in semi-structured interviews over a four-week period in July 2013. Questions focused on access to essential hygiene materials, challenges faced when menstruating (with a focus on accessing education) and possible solutions to the barriers reported. Interview transcripts were analysed; the common concepts were identified, and conclusions drawn from the results.

Results

Inability to access sanitation products, due to financial poverty and local availability, was the main challenge highlighted throughout the analysis of the interview transcripts. The other common themes included lack of suitable hygiene facilities, absence of education on menstruation and the vulnerability of menstruating girls to abuse and stigma. Analysis found that on average girls were missing three days of school a month due to their periods, equalling 18% of the academic year.

Conclusions

Period poverty disadvantages school-aged females in Bududa, Uganda. Financial poverty, lack of education and stigma contribute to period poverty. An intervention programme including accessible sanitation products and education is recommended to tackle this gender inequality for girls in this population.

Key messages

A lack of sanitation products, subpar education and stigma contribute to period poverty in Uganda and negatively impact female education with menstruating students missing up to 18% of a school year. An intervention programme incorporating access to sanitation products alongside education is recommended to tackle period poverty in this population and improve women’s health and female education.
Equity impacts of interventions to increase physical activity: A health impact assessment
Authors: Schoenbach J-K , Bolte G , Czwikla G , Manz K , Mensing M , Muellmann S , Voelcker-Rehage6 C , Lhachimi S K
Published: October 2020

Background

Behavioural interventions may increase social inequalities in health. This study aimed to project the equity impact of physical activity interventions that have differential effectiveness across education groups on the long-term health inequalities among older adults in Germany.

Methods

We created six hypothetical intervention scenarios targeting adults aged 55 years and above: Scenarios #1 to #4 applied realistic intervention effects that varied by education. Under scenario #5, the lower and medium educated group adapted the physical activity pattern of the higher educated. Under scenario #6, all persons increased their physical activity level to the recommended 300 minutes weekly. The number of incident ischemic heart disease, stroke and diabetes cases as well as deaths from all causes was simulated under each of these six intervention scenarios for males and females over a 10-year projection period using the DYNAMO-HIA tool, and compared against a reference scenario with unchanged physical activity pattern.

Results

For males, the highest reduction of disease cases and deaths would be achieved under scenario #4 (most effective in higher educated persons), while increasing inequalities between education groups. For females, the highest reduction would be achieved under scenario #3 (most effective in lower educated persons), while decreasing inequalities between education groups. Scenarios #1 to #4 would prevent only a fraction of the disease cases and deaths that would be avoided under scenario #5 or scenario #6.

Conclusions

This modelling study shows how the overall population health impact varies, depending on how intervention-induced physical activity changes differ across education groups. For decision-makers, both the assessment of health impacts overall as well as within a population is relevant, as interventions with the greatest population health gain might be accompanied by an unintended increase in health inequalities.

Key messages

Health impact assessments with a focus on equity are essential for decision-makers. In order to correctly project population health effects, and choose between options of intervention types from a public health perspective, data on subgroup-specific intervention effects are needed.
The Expanded Immunization Program (EPI): On which exogenous factors does it depend its success?
Authors: Urquidi C , Valenzuela M T
Published: October 2020

Background

EPI is one of the successful public health programs for the control and prevention of infectious diseases worldwide. In Latin America and the Caribbean, EPI achieved high rates of vaccination and reached both the eradication of poliomyelitis (1994) and the elimination of the indigenous transmission on the measles virus (2016). Between 2006 and 2011, 174. 000 deaths were also avoided.

Objective

To identify exogenous conditions that were in place before the establishment of the EPI, which contributed to a better implementation of the program and increased vaccine coverage levels since 1980.

Methods

an exploratory mixed ecological study with information from twenty-five Latin American and the Caribbean countries were studied in 1980. The exogenous variables were: Number of nurses per 10.000 inhabitants (as a proxy level for the level of development of the health services), Infant mortality (progress of health conditions), Annual GDP (Economy growth in production), and Human Development Index (HDI). The primary outcome was vaccine coverage (measles and OPV3) from 1980 to 2013, and secondary outcomes were inter and intersectoral coordination of PNI. The effects were estimated through regression models.

Results

In the univariate models, there was a positive relationship between HDI and vaccination coverage, and an inverse effect of infant mortality; an obvious situation since it is expected that as vaccination coverage increased, infant mortality declines. The number of nurses had a positive relationship between inter and intersectoral coordination. In the multivariate model, three of the four exogenous variables explained 35.7% of the increase in coverage: number of nurses, HDI, and GDP.

Conclusions

Exogenous factors played an essential role in the improvement of the immunizations program in Latin America and the Caribbean countries, as well as could be for other public health interventions.

Key messages

Economy growth and Human Development are essential for the implementation of public health programs. The level of development of health services contributes to the success of a public health program.