bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation, recommendation and implementation of the local hospital catering system
Authors: Barocco G , Germano D , Patussi V , Cella M , Tiziana L , Pernarcic A , Occoni E , Calabretti A , Bogoni P
Published: November 2019

According to the literature the prevalence of the risk of malnutrition o hospitalized people exceeds 25% of patients, this evidence is also related to low meal satisfaction. To reduce hospital malnutrition it is also important to improve the consumption of meals by implementing organoleptic and nutritional quality (O&NQ).

The Local Health Agency of Trieste (ASUITS) has conducted surveys to find out how to evaluate and improve the procurement qualifications of hospital catering systems (HCS) and how to implement O&NQ. The production processes of meals served in two clinics using Cook Chill (CC) and Cook/Fresh - Hot Hold (CFHH) production process, respectively, were evaluated from 2017 - 2019. The Nutrient Analysis Critical Control Point process was applied for the evaluation of two catering systems. In addition, the antiradicalic power (ARP) of 120 samples of meals by the University of Trieste was analysed. In 2019 an investigation was conducted to compare the satisfaction and ARP content of meals served to patients in two hospital wards (N = 60). The meals to patients of two wards respectively with CC Cold Plating Retherm (PR) and CC Hot PR were served.

Meals produced by the CC production process highlight the average loss of 50% of ARP compared to the CFHH. Meals produced by the CC Cold PR method limit the loss of ARP by 15-40% less compared to the CC Hot PR method. The satisfaction of patients who have consumed meals produced by the CC Cold PR method is double compared to that of patients who have consumed meals produced by the CC Hot PR method. The surveys have produced significant evidence to evaluate hospital meal production processes and to improve O&NQ. The results were used to develop recommendations for the drafting of tender specifications capable of also protecting nutritional variables.

The evaluation of the O&NQ of HCS represents a central determinant of food safety and nutrition security and must be taken into consideration in the procurements procedure.

Key messages

Hospital catering contracts must evaluate and guarantee organoleptic and nutritional quality. Integrated evaluation of organoleptic and nutritional quality is an integral part of hospital meals.
An Investigation of Family Nutrition and Physical Activity and Affecting Factors in Primary Schools
Authors: Ekici E , Ikiişik H , Ankarali H , Kozan E H , Yetim M
Published: November 2019

Background

In this study, it was aimed to determine the family nutrition and physical activity status of primary school students and some affecting factors.

Methods

In this descriptive and correlation-seeking research, mixed sampling methods were used. The sample size was not calculated, it was aimed to reach all students in three primary schools with different socioeconomic status (high, medium, low) in Uskudar, Istanbul. Data from 727 subjects were collected through an introductory information form and The Family Nutrition and Physical Activity Screening Tool (FNPA).

Results

In the study, data from 294 (49.7%) girls and 297 (50.3%) boys from three primary schools who studied first grade (n = 321, 54.3%) and 4th grade (n = 270, 45.7%), a total of 591 children were used. The total FNPA score of students in schools with high or middle socioeconomic status was significantly higher than the socioeconomically low school (P < 0.001). The mean score of the scale was significantly higher in those who doesn’t eat junkfood or snacks (P = 0.001), who had regular breakfast (P = 0.001) and people with regular meal time (P = 0.001). The mean BMI of children in the middle socioeconomic status school was found to be significantly higher than that of students in the low socioeconomic status school (P = 0.013). There was also a significant correlation between the mean BMI of mothers and the total FNPA score (P < 0.001).

Conclusions

In the study, as the socioeconomic status of schools increased, FNPA total score increased as well. Although some studies suggest that family income and socioeconomic status are inversely related to childhood obesity, in this research the mean BMI of children in the socioeconomically middle school was significantly higher than the students in the socioeconomically low school.

Key messages

The evaluation of the nutritional and physical activity status of the family as an element of the obesogenic environment, may be effective on identifying the causes of childhood obesity. Studies to determine the nutritional and physical activity of the family in preventing childhood obesity are essential.
Determination of Orthorexia Nervosa Symptoms and Eating Attitudes in Medicine Students
Authors: Erol Ö , Özer A
Published: November 2019

Background

Orthorexia Nervosa (ON) is defined as obsession with healthy eating. It is known that the purity is more important than amount or energies of consumed food in people with ON.With this condition,ON results in restrictions on food intake in individuals.According to the literature, health professionals are in the risk group of ON. The aim of this study is to examine orthorexia nervosa symptoms and eating attitudes of medicine students.

Methods

This cross-sectional study was conducted on 298 students who educated Inonu University Faculty of Medicine in 2017.Data collection tools were General Information Form,ORTO-15,EAT-40.SPSS 22.0 and Pearson Exact,Fisher’s,Chi-Square tests were used for statistical analysis.

Results

%76.2 of students had orthorexia tendency, %11.1 of students had eating disorders. 24 aged students were found to less orthorexic than others and obese students tend to have less orthorexic than others. It was found that when reached true information about nutrition, individuals who changed their eating behavior always had more orthorexic than rarely. It was found that when reached true information about nutrition, individuals who changed their eating behavior always had more eating disorders rate (EDR) than others. It was found individuals who received information from book-scientific publications had EDR than others and individuals who received information from dietitians had higher EDR than those who did not (p < 0.05). In addition, %12.3 of the individuals who tend to orthorexia and %7 of the individuals who tend to without orthorexia were found to have eating disorders.However,the difference between groups was not statistically significant (p > 0.05).

Conclusions

According to our results, it is emphasized that question which “Is ON an eating disorder?”. In addition, we believe that our study will contribute to the literature because ON, eating attitudes and information sources of nutrition are examined together on medicine students.

Key messages

When individuals have access to nutritional information, behavior change states affect the tendency to orthorexia nervosa and eating disorders. Nutritional and psychotherapeutic interventions for behavioral regulation of individuals are thought to reduce the tendency of orthorexia nervosa and eating disorders.
Burden of disease attributable to exposure to aflatoxins in Portugal using Human biomonitoring data
Authors: Martins C , Vidal A , De Boevre M , De Saeger S , Nunes C , Torres D , Goios A , Lopes C , Alvito P , Assunção R
Published: November 2019

Human biomonitoring (HBM) is recognized as an important tool to assess the Human exposure to chemicals, contributing to describe trends and patterns of exposure over time and to identify population groups that could be under risk. Natural chemicals as mycotoxins, fungi metabolites that produce toxic effects in humans, are important compounds that could be found in foods usually consumed worldwide in a daily basis. Mycotoxins as aflatoxins (AFTs) are genotoxic, carcinogenic and immunosuppressive compounds. Hepatocellular carcinoma (HCC) is one of their main health toxic effects and is the third leading cause of cancer deaths worldwide. In Portugal, scarce data are available regarding exposure to AFTs and none previous study used HBM data to characterize comprehensively the burden associated to this exposure.

In the scope of the National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population (2015-2016), 24h-urine samples from 94 participants were analyzed by liquid chromatography-mass spectrometry (LC-MS/MS) for the simultaneous determination of AFTs (B1, B2, G1, G2, M1). A model was developed to estimate the health impact of the exposure of Portuguese population to aflatoxins, estimating the number of cases of HCC and DALYs attributed to AFTs exposure.

AFTs were detected in 12.8% (AFB1), 16.0% (AFB2) and 19.1% (AFM1) of the 24h-urine samples. The estimated number of extra cases of HCC attributed to this exposure ranged from 17 to 65 cases/year; the associated DALYs for the Portuguese population ranged from 284 to 1802 years.

The present study generated, for the first time and within a HBM study, reliable data regarding the exposure of the Portuguese population to AFTs. These data were crucial to characterize the health impact associated to AFTs exposure and to support risk managers to establish preventive policy measures that contribute to ensure the public health protection.

Key messages

Portuguese population is exposed to aflatoxins, chemical food contaminants that may be harmful (carcinogenic, immunotoxic, mutagenic, teratogenic, hepatotoxic) to humans. Human biomonitoring studies provide realistic data on internal exposure at individual level, contributing to a more accurate estimation of the burden derived from this exposure.
Social validity for work ability assessments and official decisions – clients’ experiences
Authors: Karlsson E , Sandqvist J , Ståhl C
Published: November 2019

Background

Professionals need to be able to express what is at stake during the decision-making process and the discrepancy between formal rules and practical rationality need to be bridgeable and transparent for outsiders. Investigations of social validity for work ability assessments are rare. However, the concept can provide valuable information upon the acceptability and comprehensibility of procedures and how professionals can increase clients’ participation.

The purpose of this study was to investigate social validity for work ability evaluations within the sickness insurance system and the official decisions they lead to.

Methods

This was a longitudinal qualitative study using telephone interviews and files from the Swedish Social Insurance Agency. Clients (n = 30) were interviewed after their participation in a work ability evaluation as well as after receiving an official decision upon eligibility for sickness benefits. Data was analyzed using a deductive content analysis.

Results

Preliminary findings show that clients’ comprehensibility of the different tests and their composition were depending on whether the specific tests were perceived as clearly related to the clients’ difficulties and what information they had received. In order to receive a fair description of the client’s work ability, clients state that the work ability evaluation needs to be individually adapted and that the standardized structure is not relevant for all. What is acceptable and fair to one client could be unacceptable to another, depending on what arguments and information case-managers and evaluation professionals provided.

Conclusions

Authorities need to express and motivate the reasons for a diverse range of steps during clients sick-leave process, not only regarding official decisions. Social validity for work ability evaluations is depending on the provided information and the applicability to the clients’ situation.

Key messages

Social validity is depending on the provided information and the applicability to the clients’ situation. Authorities need to communicate clearly with clients through the whole sick-leave process.
High mortality in manual occupations and the role of alcohol in 2001-2015 in Finland
Authors: Rinne H , Laaksonen M , Notkola V
Published: November 2019

Background

High mortality is concentrated in low socioeconomic positions which may largely be explained by excessive use of alcohol. The aim was to identify specific manual occupations with high mortality and to examine whether there are differences in the role of alcohol in explaining the excess mortality among manual occupations with high all-cause mortality.

Methods

A register-based study of employees aged 30-64, followed for mortality 2001-2015. Age standardized mortality ratios (SMR) were calculated to compare the mortality rates of manual occupations. The contribution of alcohol related mortality to excess mortality was obtained by comparing the excess mortality in all deaths and deaths not related to alcohol.

Results

Men had 31 and women 11 manual occupations with SMR statistically significantly over 120 compared to all employees. Mortality rates were highest among building construction labourers (SMR 180, 95% CI 163-199) among men and building caretakers (SMR 155, 95% CI 135-179) among women. With few exceptions, high mortality was a combination of high alcohol-related and high non-alcohol-related mortality. Among men, the contribution of alcohol-related mortality to the excess all-cause mortality compared to all employees was over 10% in half of the high mortality occupations. Among women excluding the alcohol-related deaths had a minor effect on all-cause mortality.

Conclusions

Diminishing the alcohol-related mortality would level excess mortality of high mortality manual occupations but not eliminate it. Targeting the improvement of working conditions and occupational health care to certain occupations would diminish the mortality differences between occupations and social classes.

Key messages

To prevent the high mortality of manual occupations, improvements should be targeted to several different aspects of working conditions. Occupational health care of manual occupations with high mortality should be improved and provide with early interventions towards risky alcohol behaviour.
Gender differences in managers’ attitudes toward depressed employees: a cross-sectional study
Authors: Mangerini I , Bertilsson M , de Rijk A E , Hensing G
Published: November 2019

Background

Depression is known to carry negative attitudes within society and organisations. In the workplace, managers are responsible for the psycho-social work environment and attitudes to depression will likely affect that environment. The few studies performed among managers have found that female, more educated and managers working in the public sector were less likely to report negative attitudes. However, these studies did not take organization characteristics into account. The aim was to investigate the association between gender and negative attitudes toward employees with depression controlling for individual and organisational factors.

Methods

A cross-sectional web-survey was sent to 4737 Swedish managers, aged 20-65 years in 2017, response rate 71%; We included those answering the “Managerial stigma toward employee depression” instrument, n = 2663 (901 women, 1762 men), consisting of 12 items tapping negative attitudes towards depression. The 3rd quartile was used as a cut-off. Multivariate logistic regression analyses on attitudes towards depression were performed (95% CI) to generate odds ratios (OR) adjusted for co-variates (individual and organisational characteristics).

Results

Male managers were more likely to report negative attitudes compared to female managers (OR 1.64, 95% CI 1.28 - 2.10) irrelevant of individual (age, education, current workplace management experience, lifetime experience in management, managerial position) or organisational (work sector, staff gender composition, presence of staff members with Common Mental Disorders) characteristics.

Conclusions

A gender difference in reporting negative attitudes was appraised regardless any of the co-variates included. To manage depression within the workplace, companies should also address managers’ attitudes towards depression.

Key messages

Important to heed managers’ attitudes to CMDs and their impact on RTW processes. Gender-tailored approach in managers’ training is suggested for awareness and knowledge on mental health.
Healthcare providers’ perceptions of difficulties related to frequent users of emergency departments
Authors: Grazioli V , Kasztura M , Chastonay O , Graells M , Schmutz E , von Allmen M , Lemoine M , Daeppen J-B , Hugli O , Bodenmann P
Published: November 2019

Background

Frequent users of emergency department (FUEDs; ≥ 5 ED visits/ year) are often vulnerable individuals cumulating medical, social and substance use problems. FUEDs often require complex and sustained care coordination generally unavailable in ED and are commonly considered contributing to ED crowding. In view of supporting ED health-care providers through specific training and interventions tailored to FUEDs, this study aimed to explore ED healthcare providers’ perceptions of difficulties related to FUEDs.

Methods

Participants (N = 208) were ED healthcare providers (i.e., nurses, physicians) from 75 university and community hospitals in Switzerland (71% of all EDs) who answered a questionnaire on FUEDs. They were asked to indicate the extent to which FUEDs represent a problem in their ED. Perceived difficulties related to FUEDs were elicited by an open-ended question. Conventional content analysis was used to extract common categories and themes.

Results

Among the 208 participants, 134 (64%) reported that FUEDs represent a problem. Of those, 132 provided 1 to 5 answers to the open-ended question. Twenty-eight categories were identified and organized in 4 themes. First, participants reported difficulties related to FUEDs’ characteristics themselves (e.g., problem’s chronicity; behavioural difficulties) leading to healthcare complexity. Second, participants perceived negative consequences related to the presence of FUEDs in the ED (e.g., work overload, staff helplessness and fatigue). Third, ED healthcare offer was considered inappropriate and inefficient to respond to FUEDs needs and fourth collaborating with FUEDs’ existing healthcare network was perceived as difficult.

Conclusions

ED healthcare providers experience a wide range of difficulties related to the management of FUEDs. Providing training and implementing a case management intervention tailored to FUEDs might support ED health-care providers and contribute to address FUEDs’ complex needs.

Key messages

ED healthcare providers perceive FUEDs to represent a problem. Perceived difficulties might decrease through training and case management support might contribute to better address FUEDs complex needs.
Is there an association between social determinants and care dependency risk?
Authors: Schneider A , Blüher S , Grittner U , Anton V , Schaeffner E , Ebert N , Martus P , Kuhlmey A , Schnitzer S
Published: November 2019

Background

Despite a growing body of knowledge about the morbidities and functional impairment which frequently lead to care dependency, the role of social determinants is not yet well understood. The purpose of this study was 1) to examine the effect of social determinants on care dependency onset and progression, and 2) to analyse the effect of social determinants on various levels of care dependency.

Methods

We used data from the Berlin Initiative Study (BIS), a prospective, longitudinal, population-based cohort study including 2069 older participants (≥70 years of age) with visits in 2009, 2011 and 2013. Care dependency was assessed if participants require substantial assistance in at least two activities of daily living for 90 minutes daily (level 1) or three hours+ daily (level 2). Social determinants were defined as partnership status, education, income, age and gender. Data were analysed with multi-state time to event regression modeling which simultaneously model several competing events, as well as not only first but also second or third event in one model.

Results

During the study period, 556 participants (27.5%) changed their status of care dependency. Persons who reported having no partner at baseline were care-dependent more often than participants with a partner (43.7% ’no partner’ / 27.1% ’with partner’). In the multiple model having no partner compared to having a partner was associated with a higher risk of transition from no care dependency to level 1 (HR: 1.25, 95%CI: 0.97-1.64), however failed significance. The significant association between care dependency and income and between care dependency and education ceased as well after adjustment for co-morbidities.

Conclusions

Results indicate that older people without a partner tend to be on a higher risk of care dependency onset but not on a higher risk of care dependency progression. Inequality between education and income groups can be explained in terms of morbidity.

Key messages

The significant association between care dependency and income and between care dependency and education can be explained in terms of morbidity. Results indicate that older people without a partner tend to be on a higher risk of care dependency onset but not on a higher risk of care dependency progression.
Hospital volume and five-year survival after cancer surgery in 2007-2011 in Osaka, Japan
Authors: Okawa S , Tabuchi T , Morishima T , Koyama S , Taniyama Y , Miyashiro I
Published: November 2019

Background

The relationship between hospital volume (HV) and patient outcome is well-known evidence, and hospital volume is widely used as a quality indicator. In Japan, however, few studies are available on the associations between HV and survival after cancer surgery. This study aimed at examining the association between HV and longitudinal survival after surgeries of major cancer sites.

Methods

This is a retrospective observational study. Using the Osaka Cancer Registry database, we identified patients who were diagnosed as major sites of cancer (esophageal, gastric, colorectal, pancreatic, lung, breast, and uterus cancer) between 2007 and 2011, and undergone surgeries in Osaka. To define the quartiles of HV (high, medium, low, and very low-volume hospitals), we ranked hospitals by annual surgical volume, sorted patients in descending order of HV, and assigned them into four equal-sized groups. The study outcome was five-year survival from the diagnosis. We analyzed the associations between hospital volume and survival among eligible patients aged between 15 and 84 years old, using Cox proportional hazard models. In the models, we adjusted for characteristics of patient and treatment received by the patients.

Results

A sample of 86,867 patients were analyzed. The mortality hazards of patients treated at very low-volume hospitals were 1.4 - 2.1 times higher than that of patients treated at high-volume hospital in all selected cancers. However, absolute differences (percent points) in adjusted survival rates between high- and very low-volume hospitals were varied by cancer site: esophagus (24.2), stomach (14.9), colorectum (11.5), pancreas (9.2), lung (10.8), breast (2.4), and uterus (3.3).

Conclusions

Very low-volume hospitals showed the poorest patient survival after cancer resections. Healthcare quality assessment at lower-volume hospitals and referrals to higher-volume hospitals are potential measures to improve survival of cancer patients.

Key messages

Patients treated at lower-volume hospitals had a higher mortality risk than those treated at higher-volume hospitals. Healthcare quality assessments and effective referrals of high-risk patients are potential interventions to improve patient survival.
How to engage French professionals to undertake social responsibility at a local level?
Authors: Gautier S , Bourgueil Y
Published: November 2019

Background

In France, primary care is organised according to the principles of private practice: independent providers, payment by fee for service, freedom of settlement... Successive reforms have introduced more regulation i.e. gatekeeping role for GPs, better recognition of professional groups, new forms of payment and promotion of team work and multi-professional practices. Today, the concept of Health Territorial and Professional Communities (HTPC) is becoming a key element of health care reform encouraging primary care professionals to meet with specialists and social workers at a larger level than practice. HTPC should address issues such as access to services, coordination of care and promoting of preventive actions toward populations. This implies change in the roles, skills, methods and resources needed on both professional and regulatory sides. This study explores levers of the professional commitment in the HTPC and resources necessary for it.

Methods

We conducted a qualitative multiple case study in three French regions. Data was collected from thirty semi-structured interviews with key national informants, regional regulators and health professionals themselves.

Results

Professional commitment emerges at a local level on a territory defined by the collaboration practices and habits following a bottom-up process. The integration of care relies on the size of the HTPC which allows them to know each other and to work together to improve access to care and patient’s disease management. In order to achieve that, professionals claim to have access to administrative health data and to be able to analyze it. They need to develop news skills in management and group animation. The function and training of coordination professionals appear to be essential.

Conclusions

The professional commitment in HTPC relies on professional empowerment toward collective activities. This requires autonomy, skills and new roles both for professionals and regulatory authorities.

Key messages

French government relies on professionals’ investment at the territorial level by implementing HTPC to guarantee access to care and respond to population needs in primary care. HTPC implementation implies radical change for the professionals to undertake social and populational responsibility for which public health professionals should help to meet the challenge.
Evaluation of minimum standards for communal catering in Styrian nursing homes
Authors: Lampl C , Aufschnaiter A L , Hatz M , Gunzer W , Fuchs-Neuhold B
Published: November 2019

Background

Nutritional standards in community catering facilities are essential for adequate quality of care. As part of the initiative GEMEINSAM G'SUND GENIESSEN of the Health Fund Styria, minimum standards for nursing homes were published. The aim was to investigate the current situation of the implementation of selected minimum standards for food and drink supply in Styrian nursing homes to create appropriate measures for healthy living for elderly people.

Methodology

Of 81 defined minimum standards, two thirds were examined in the study (n = 54; 66.6 %). To get detailed insights into the current degree of implementation, the project team worked with a mixed- methods-basis, consisting of an online survey (n = 94; 41.4% of all Styrian nursing homes), 46 guideline interviews and 169 weeks of menu analysis.

Results

Of the 54 minimum standards analysed, 34 were fulfilled (63.0%), nine were rather fulfilled (16.6%), five were rather not fulfilled (9.2%), four standards could not be fulfilled (7.4%) and two standards could not be investigated (3.7%). Nursing homes prefer seasonal and regional products, but pay less attention to the use of fair trade products or organic food. In addition, the food choice is determined by the preferences and acceptance of the residents, which are the main reasons for the low use of whole grain products and the rare offer of vegetarian dishes. With regard to the design of the menus, almost all plans are age-appropriate and attractively presented, but rarely meet the standard with regard to recommended labelling (e.g. alcohol aromas). Challenges in the daily practise are finding a way between the self-determination of the residents, the arranged diets as wells as meeting the minimum standards.

Conclusions

Results indicate that minimum standards in nursing homes are taken into account. In order to achieve a comprehensive implementation, further development of the standards as well as information and awareness-building interventions are needed.

Key messages

Challenges in the daily practise are finding a way between the self-determination of the residents, the arranged diets as wells as meeting the minimum standards. The range of vegetarian dishes, dishes with legumes and wholemeal products should be focused in the future. In addition, the provision of tools (age-and target-group- specific-menus) is recommended.
Paying attention to personnel in organizational changes: the impact of hospital mergers
Authors: Sisti L G , Mariani M , De Vito C , Isonne C , Nardi A , Mete R , Villari P , Ricciardi W , Damiani G
Published: November 2019

Background

The importance of paying attention to personnel satisfaction for the well-being of an organization is clearly stated also in healthcare organization. The trend of mergers of healthcare organizations represents an evident case of organizational change that could undermine personnel satisfaction if not adequately managed. The aim of our study was to investigate the impact of hospital merger on personnel perceptions and satisfaction.

Methods

A systematic review of the literature was carried out by querying scientific databases and grey literature. A search string was built using keywords including: merger, healthcare, personnel, satisfaction and synonyms. Inclusion criteria were primary studies reporting the outcome of interest and set in hospitals that has undergone a merger. Studies characteristics such country setting, design and time frame of the study, number and role of personnel interviewed and main findings were extracted and narratively synthesized.

Results

Search resulted in 3662 studies of which 9 were finally included in the analysis. Studies were mainly represented by post-merger qualitative research (77.8%) of which 55.6% semi and 54.4% structured interviews. Sample size ranged from 14 to 3119 and was represented by unspecified employees (55.6%), nurses and hospital executives (22.2% both). Findings showed that hospital executives consider merger positively especially regarding increased negotiation skills and costs reduction. Conversely, the other personnel mainly expressed critical issues as differences in organization of hospitals merged, goals and confirmation uncertainty, communication impairment and especially no involvement in follow-up in the post-merger phase.

Conclusions

The merger process strongly impacts healthcare personnel satisfaction, depending on the role played in the organization. If an initial enthusiasm and staff engagement in pre-merger phase is seen, this is not generally followed by their proper involvement over time.

Key messages

As personnel satisfaction and perceptions are strongly related to healthcare quality, they represent a central point in the merger process of healthcare organization. More attention must be paid to follow-up staff satisfaction after the merger in a continuous staff engagement to ensure the success of merger process as well as that of all organizational changes.
The social and economic benefit of health literacy interventions in the WHO EURO region
Authors: Stielke A , Dyakova M , Ashton K , van Dam T
Published: November 2019

Background

Health literacy (HL) allows people to make informed decisions regarding their health, enabling them to understand health promotion activities and to self-manage their disease or complication without requiring support from healthcare services. HL has the potential to support sustainability in health systems by decreasing healthcare spendings stemming from lowered disease occurrence and progression, it can also impact on the rest of peoples’ lives and their surroundings by allowing them to be more independent. This study researched the evidence for return on investment and the social return on investment for health literacy interventions within the WHO EURO region.

Methods

A narrative literature review on published peer-reviewed reviews and grey literature was conducted by use of keywords and MeSH terms. Google, Google Scholar and PubMed were used find literature. The search on PubMed was restricted to reviews, published within the last 10 years (2009-2019), in English.

Results

In total, 450 publications were screened 12 publications that analysed the economic or social aspect of HL interventions were identified. Five discussed the cost-effectiveness of health literacy, three the return on investment (ROI) and the remaining three the social return on investment (SROI) of HL. Types of HL interventions ranged from health promotion campaigns, web-based HL programs, prevention systems to education-based interventions. Cost-effectiveness differed between studies and fields. Evidence for ROI was found, the return ratios ranged from 0.62 to 27.4. Findings show SROI between 4.41 and 7.25, indicating additional value of social benefit next to improved health.

Conclusions

A link between cost-effectiveness and HL interventions was established and ROI and SROI showed positive ratios. Further research is required in order to investigate whether HL interventions consistently achieve a positive returns.

Key messages

A link between health literacy interventions and positive investment returns has been established. Health literacy interventions show potential for sustainable development of health systems.
Development of health management system with recording daily living habits and body compositions
Authors: Shibata T , Sata K , Oroguchi T , Ishii N
Published: November 2019

It is difficult for university students to maintain their health. Department of health management was opened at April 2018 in Tokai university, Japan. About two hundred students entered it last year. Health management system was developed to maintain their health through the college life. The system is named THINKss (Tokai Health INtelligence Knowledge Support System). The number of registered students increased about four hundred this year. Every student can record their daily physical and mental conditions, meal photos with the time, body temperature, blood pressure, bone density, body compositions on their smartphone. If they use activity trackers with a wrist-based heart rate sensor (Garmin co. ltd.), their daily activities and sleeping status are corrected through API automatically. The weather information around university is also recorded everyday. Every student can browse own measurements on their smartphones. Because physical status includes cold symptoms (sneeze, throat pain, cough, fatigue, articular pain, muscle pain, chill, and body temperature), the system can recommend visiting a clinic. Because three meal photos are shown alongside, the balance of the meals is known. It may improve their meals. Because the activity tracker records advanced sleeping status (rem, light, deep, and moving), the relationships between mental conditions and sleeping status should be analyzed. Our previous study for common workers showed that mental status related with sleeping status, taking lunch of convenience-store, standard deviation of time of taking lunch, and oversensitivity to noise. Relationships between body composition changes and the lifestyles should be analyzed for university students. Some alert logics for body composition changes and exacerbating mental conditions may be provided based on the evidences from cumulative data of the health management system. These evidence-based alerts will contribute to maintain student’s health through a college life.

Key messages

Health management system was developed to maintain student’s health through the college life. Evidence-based alerts will contribute to maintain student’s health through a college life.
A new health professional profile in Switzerland: the county practitioner?
Authors: Motamed S
Published: November 2019

In the vogue to provide Geneva with a health and social system with intermediate structures between practitioners and hospitals, many proposals have been made. All have the characteristic of omitting the fact that the general physician, central element of the system, could be set to one side. A family doctor remains a clinician, and is manager of the disease. The proposals lack what we call the community dimension and do not approach citizens from the point of view of their health.

Some components of this new professional profile are at the individual level and already form part of the primary care physician’s activity. Others, on the other hand, are akin to collective or community-based interventions, so are not generally included in the primary care practice. Thus, in collaboration with the central structures of the canton and the authorities, activities such as medicine at school or nursing home, epidemiological surveillance, participation in development projects and actions dealing with the environment, etc., could represent the community part of this new practice.

In view of this, the concept of ’county practitioner’ was implemented in the framework of a global project emanating from the authorities of a county of the state of Geneva in Switzerland, which aimed to develop social links, well-being and health through the complete restructuring of the village center. Other projects, in other municipalities, were inspired by this first experience, although the ’country practitioner’ is currently limited to a role of “health adviser”. Several examples could be presented.

The conditions for bringing into being such a profile are numerous: the drafting of specifications, the political will and the benevolence of fellow practitioners fearing a loss of power. Once again, the community doctor does not replace the attending physician, he completes his action mainly in the field of community health.

Key messages

The concept of ’county practitioner’ was implemented in the framework of a global project emanating from the authorities of a county of the state of Geneva. The conditions for implementing such a profile are numerous.
FINDRISK and occupation: need of prevention of diabetes type 2 at the workplace
Authors: Lyubomirova K , Tabanska M , Hristova L , Samuneva M , Yancheva M , Tzacheva N
Published: November 2019

Background

Diabetes mellitus is a risk factor for atherosclerosis, cardiovascular morbidity and increased mortality. Identifying people at a high risk of developing diabetes determine the prognosis and quality of life of the patients and prevent the development of macrovascular complications of diabetes. Within the framework of an international project, the ten-year risk of developing type 2 diabetes mellitus in two age groups workers (up to 25 and over 55) of four economic sectors (construction, clothing, hairdressing and cosmetics, and healthcare) has been estimated.

Methods

The survey included 150 workers from four economic activities. The FINDRISK questionnaire was distributed among them. Plasma glucose and serum lipids (HDL, LDL, triglycerides) were analyzed. The statistical analysis of the results was done using SPSS 16.

Results

The mean FINDRISK score for the age group up to 25 years is 3.6 ± 3.8, and for respondents above 55 years - 10.1 ± 5.0. The analysis highlights the higher risk of developing diabetes among healthcare workers, where the score of older workers is 11.63 ± 6.61, as well as in the textile and clothing industry (11.17 ± 4.3). These results call attention to a potential link between the occupation and the risk of developing type 2 diabetes in these sectors of the economy and the need for additional measures to search for causes and prevention.

Conclusions

A significant proportion of the participants over 55 years old in the healthcare and textile and clothing sectors are at an increased risk of developing type 2 diabetes, which requires a change in lifestyle, as well as the identification of workplace hazards that lead to these results. The FINDRISK questionnaire can serve as an indirect assessment of the cardiovascular risk of older workers. Additional preventive measures are needed to limit the risk of developing type 2 diabetes mellitus as well as cardiovascular risk in the identified risky occupations.

Key messages

Occupation could contribute to the life style risk factors for developing diabetes type 2. Occupational risk reduction measures and health promotion are needed to protects workers.
Socioeconomic and health differences in physical activity: a cross sectional study in Lithuania
Authors: Dedele A , Miskinyte A
Published: November 2019

Background

Physical activity (PA) influences people’s individual health and quality of life and contributes to prevent non-communicable diseases. Research shows that only one third of the EU inhabitants satisfy the World Health Organisation’s recommendations for PA levels. Global decline in PA levels is associated with economic development, an increase in urbanization, communication technologies and the use of passive modes of transport. The aim of the study was to assess the levels of PA depending on socioeconomic factors and health among adults.

Methods

A cross sectional study of a random sample of Kaunas residents was conducted to investigate the habits of PA. A representative sample of 1111 individuals who completed the questionnaire were included in the study. Validated questionnaires were used to collect data. Multivariate logistic regressions were used to assess the relationship between the levels of PA and socioeconomic factors and health, adjusting for confounders.

Results

Our findings showed that non-workers were three times (OR 3.16; 95% CI 1.23-8.13) more likely to reach the levels of recommended PA compared to workers. The results revealed that car disposal and the increase in body mass index (BMI) were the two most important factors that reduced odds of reaching recommended levels of PA by 64 % (OR 0.36; 95% CI 0.14-0.93) and 13 % (OR 0.87; 95% CI 0.80-0.96).

Conclusions

The differences in PA levels by individual socioeconomic factors and health were investigated in this study. The European Commission actively promotes Sustainable Urban Mobility Planning by developing guidelines for the local authorities to promote active mobility and increase PA.

Key messages

The study highlights the importance of considering different individual characteristics when assessing PA and evaluating related health effects. It is important to improve the accessibility of urban areas and create cleaner and more sustainable transport modes to increase PA.
Health relay students’ goals, training and assessment: result from a French national consensus
Authors: Gerbaud L , Born E , Gourbeuil M , Perrève A ,   Bureau ADSSU
Published: November 2019

Issue

Health relay students (HRS) is one of the prevention policy rapidly increasing for the French students. It is mainly based on peer effects, peer to peer communication, but the state of play show very various practices.

Description of the problem

The variety of practices may imply heterogeneity, and actions that are too disparate. In October 2016, the national association of directors of Health Services for Students (SSU) decided to make a formal consensus process (based on single scripting strategies developed in parallel by 10 to 20 people) involving 61 persons (physician, nurses, prevention officer, members of prevention associations) from 29 French universities and based on three axes: goals; training and assessment.

Results

No disagreement was left. The goals must be validated by the SSU, as it is the unit that is able to link students ’associations wishes and health policy objectives. This need a constant dialogue with the university board, students associations, local authorities and health administration. The HRS are also important to help to know the students practices, notably thanks to their presence on social networks. Institutional policies for HRS must be consistent to the goals, and HRS must be managed by specific prevention officers. Training always associate health education topics and health prevention knowledge. It may be more or less intensive according to the goals, but need the help of association of health prevention and a validation by the SSU. HRS must be diverse, in genders and type of studies. The training must encourage HRS autonomy and creativity in their actions, while accepting to respect the University health policy. Creativity means also to open any way of communication wanted by HRS, such as social networks.

Assessment is based on lean management, HRS satisfaction and University satisfaction (institution as well as teachers, administrative workers and students). HRS empowerment is perhaps the main criteria of assessment.

Key messages

Health relay students policies are very varied and need a consensual framework under the control of health services for students. Training must associate health education and prevention objectives, develop students’ empowerment.
Free access to nicotine substitutes and e-cigarette for tobacco cessation: STOP a pilot intervention
Authors: Héron M , Melchior M , El-Khoury F
Published: November 2019

Background

Smoking rates in France are high, and present a substantial socio-economic gradient. Smokers with low socio-economic position (SEP) may be more dependent on nicotine, and have more financial difficulties to buy nicotine substitutes. Tailored approaches are therefore needed.

Methods

STOP (Sevrage Tabagique à l’aide d’Outils dédiés selon la Préférence) is an ongoing pilot study, examining the acceptability of a smoking cessation intervention. Smokers with low SEP are recruited in six healthcare centres in Greater Paris area by health professionals and are offered substitute(s) of their choice for 4 weeks. Participants can choose between different types of nicotine substitutes (NS; patches, inhalers, etc.) and/or an e-cigarette delivered free of charge. The acceptability of this approach is examined in patients and doctors, using a mixed-method approach.

Results

So far, 30 smokers have been included in our study, 20% chose e-cigarettes, 36% chose NS, 36% chose both, and 2 participants (8%) chose neither. More than half of participants quit smoking (66%) at one week after inclusion, with 11 reporting tobacco abstinence out of 16 participants followed for 4 weeks. The average number of cigarettes smoked decreased from 15(sd = 10) at inclusion to 8.5 (sd = 5) among those who didn’t quit at four week. In qualitative interviews, one of the facilitators highlighted by health professionals was the perceived “met need” of smokers with low SEP when given free quitting aids without upfront-payment. One of the reported obstacles is the difficulty in scheduling consecutive follow-up meetings in short time.

Discussion

It is feasible to implement a smoking cessation programme aimed at smokers with low SEP, and embedded in the healthcare system. If proven effective, this intervention could contribute to decreasing social inequalities with regard to tobacco use. Recruitment in a randomised controlled multicentre trial based on this pilot study will start at the end of 2019.

Key messages

It is feasible to put in place a smoking cessation intervention among socially-disadvantaged in healthcare centres. Free access to nicotine substitutes and e-cigarettes could be a promising smoking cessation intervention among smokers with low socio-economic position.