bluuebunny/crossref_metadata_2025 huggingface dataset:
Building a regional database of experiential knowledge on health promotion and digital tools, France
Authors: Sagni A , Villeval M , Hamant C , Cornibert A C
Published: October 2020

Issue

Digital technology has become an increasingly important aspect of our lives. This growth also creates a lot of concerns among professionals and families. In France, health promotion (HP) actors are more and more being called on to discuss and analyse the issue of health and digital technology, but knowledge on this subject is not always shared. Furthermore, there is no inventory about experiential knowledge which could explain how the interventions in this particular field are designed. The Good Ideas and Promising Practices (BIPP) approach has been elaborated by the Regional Health Promotion and Education Association in Auvergne Rhône Alpes (FRANCE) to fill this gap.

Description

The BIPP approach aims to identify interventions perceived as promising to inspire HP actors who support the digital practice of young people, as well as their parents and the educational community. The BIPP inventory process is based on 7 steps and relies on local partnership to identify innovative interventions. Collected actions are classified by major areas of intervention and offer HP actors a selection of what has been put in place in terms of digital tools. The most promising practices are selected to build a database of experiential knowledge.

Results

90 interventions were identified. 60 interventions were selected according to the validated criteria: sustainable, iterative interventions, empowering people and affecting vulnerable groups. A process of experience capitalisation, based on the adjusted method developed by a national multidisciplinary committee, has been carried out for the most notably promising interventions, and videos have been made to enhance knowledge transfer in HP and digital tools.

Lessons

The BIPP approach has produced a lot of contents that HP actors can draw inspiration from. The process shared within a partner network can easily be replicated in other settings and countries.

Key messages

In addition to scientific knowledge, experiential knowledge on digital tools interventions is useful and must be shared in HP community to enhance the quality of interventions. Promising practices in health promotion can be formalised by the BIPP replicable inventory process to build up and share knowledge to support other interventions, decisions and advocacy.
Integrating sustainability in professionals’ training in the field of health promotion and prevention
Authors: Lutz A , Pasche M , Zürcher K
Published: October 2020

Background

Climate change poses a number of threats and challenges to our societies and has direct impacts on human health. Raising awareness and training health professionals to sustainable development represents a major strategy in order to respond to climate challenges. This article describes a teaching experience conducted in the context of a Certificate of Advanced Studies (CAS) in public health at the University of Lausanne, where students have been trained to sustainable development, through theoretical lessons and practical exercises.

Objectives

The integration of the topic of sustainable development in the teaching of health promotion and prevention to the students of the CAS in public health aimed to foster students' knowledge and competences in relation to this emerging topic. The main objective was to transmit concepts, methods and practical resources allowing them to incorporate sustainability into everyday health promotion and prevention practices.

Results

Health promotion and sustainable development share common goals and methodologies. The experience of teaching sustainability to public health students shows that these two topics can be easily integrated within a public health training, if teachers provide students with a clear theoretical and methodological framework, allowing them to make the appropriate connections between the two fields. Social determinants of health, intersectorial action and multilevel governance represent key topics that teachers can address with students in order to show the connections between public health and sustainability.

Conclusions

As stated in the 2019 Lancet Countdown on health and climate change, climate change is both a threat and an opportunity for our societies. While it puts health systems and professionals under considerable pressure, it also represents an opportunity to innovate and transform professional training and practices, and generate new knowledge and know-how.

Key messages

Training health professionals to sustainable development represents a major strategy to respond to climate change and its health impacts. In order to integrate sustainable development in public health training, teachers should provide students with a clear theoretical and methodological framework.
Associations between labour market policies and work stressors
Authors: Lunau T , Rigó M
Published: October 2020

Background

Many studies have shown that psychosocial work stressors have a negative impact on health. It is therefore important to understand how psychosocial work stressors can be reduced. First cross-sectional studies have shown that working conditions are influenced at the political level. With this study, we want to extend the existing studies by specifically looking at the longitudinal dimension and test if changing labour market policies are related to changes in psychosocial work stressors.

Methods

We used comparative longitudinal survey data from the European Working Conditions Survey (27 countries; years 2005, 2010, 2015). The measure of psychosocial work stressors is based on two established work stress models: job strain and effort-reward imbalance. To measure labour market policies we used information on active (ALMP) and passive labour market policies (PLMP). 64659 participants were eligible for the ERI analysis and 67114 participants for the analyses on job strain. Estimation results are provided by three-level multilevel regressions.

Results

An increase in ALMP investments lead to a decrease of ERI and therefore to an improvement in psychosocial working conditions. The analyses for the subcomponents showed that these results are mainly driven by reward: an increase in ALMP investments lead to an increase in rewards. We didn't find significant associations between ALMP and job strain and between a change in PLMP measures and the observed work stressors.

Discussion

The study extends current knowledge with longitudinal information by showing that an increase in ALMP lead to an increase in rewards and a decrease of ERI. These longitudinal analyses are more closely related to a causal interpretation than previous cross-country analyses. The findings of this study may have important policy implications. Our main result suggests that investments into ALMP can improve certain working conditions and therefore improve workers' health.

Key messages

Psychosocial work stressors have a negative impact on health. Investments into active labour market policies can improve psychosocial working conditions.
Efficacy of an intervention based on workplace exercises regarding burnout and musculoskeletal pain
Authors: Amaral A P , Santos G , Pocinho M
Published: October 2020

Background

Work stress is associated with a wide range of mental and physical symptoms and presents a challenge in public health. In this study, we highlighted burnout syndrome and musculoskeletal pain. The main goal was to test the efficacy of an intervention based on compensatory workplace exercises in the reduction of burnout levels and musculoskeletal pain. The questions were: 1) How high are the levels of burnout and musculoskeletal pain before the intervention? 2) Does the intervention contribute to reduce the levels of burnout and musculoskeletal pain?

Methods

This study was conducted in a hospital and employed a pre pos-test design using the following measures: Maslach Burnout Inventory - General Survey and the Nordic Musculoskeletal Questionnaire. The participants are 49 administrative employees, 61.2% females with a mean age of 38.3 years (SD = 11.6). The intervention program consisted of 18 sessions of compensatory workplace exercises, held for five weeks, with a frequency of three sessions per week.

Results

In relation to burnout, the results obtained before the intervention (mean values) suggest moderate Exhaustion (2.50±0.94), higher Cynicism (3.27±0.92) and lower Professional Efficacy (1.81±0.41). Concerning musculoskeletal pain, it was more prevalent in the shoulders (69.4%) and back (upper 67.3% and lower 65.3%), followed by the thighs and neck (both 61.2%). After intervention, the results showed a significant (p < 0.05) decrease of burnout and all musculoskeletal symptoms evaluated.

Conclusions

The results support the effectiveness of the compensatory workplace exercises in the reduction of burnout and musculoskeletal symptoms contributing to mental and physical health of the workers involved. This study was innovative due to the studied link between burnout and compensatory workplace exercises. Moreover, this study led to changes in the hospital, which implemented better practices for a healthier life of the workers.

Key messages

The intervention based on compensatory workplace exercises reduced burnout and musculoskeletal pain in a sample of administrative employees and had impact in the health policies of the hospital. The implemented intervention promoted workers' physical and mental health and led to better health practices in the hospital.
Social relations and self-rated health in a multi-ethnic social housing area undergoing demolition
Authors: Kvorning M F , Srivarathan A , Nygaard S , Lund R
Published: October 2020

Background

During the coming years, selected social housing areas in Denmark will undergo large structural changes as part of a political agenda. Previous studies on the effects of such interventions are inconclusive. Residential areas are important for the development of social relations and health. The aim of this study was to explore the associations between social relations and self-rated health (SRH) and the interaction with country of origin in an ethnically diverse social housing area undergoing demolition, and compare results with the municipality.

Methods

Data include multilingual interviewer driven surveys with residents aged 45+ years before demolition began in 2018 (N = 209) and during the demolition in 2019 (N = 132), and a health survey on municipality level (N = 1638). Information on social relations include contact frequency with and support from family, friends and neighbors. SRH was dichotomized into high/low. Descriptive and multivariate logistic regression analyses adjusted for age, sex and Western/non-Western origin are presented.

Results

In cross-sectional analyses from 2018, low contact frequency and low support increased the risk of low SRH, OR = 1.44 (0.63-3.29) and OR = 1.23 (0.62-2.48), especially when also having non-Western origin compared to having high contact frequency or support and Western origin, OR = 6.27 (1.80-21.84) and OR = 4.43 (1.68-11.69), respectively. The same association was seen in 2019 and on municipality level.

Low contact frequency in 2018 was associated with higher risk of developing or maintaining low SRH in 2019 compared to the group with high contact frequency in 2018 in longitudinal analyses, OR = 3.04 (0.91-10.91).

Conclusions

Poor social relations increased the risk of low SRH, especially when also having non-Western origin. Having poor social relations before the demolition was associated with an increased risk of developing or maintaining low SRH during the demolition in an ethnically diverse social housing area.

Key messages

Having low contact frequency before area demolition in a social housing area in Denmark increased the risk of developing or maintaining low self-rated health after demolition had begun. Having poor social relations and non-Western origin is associated with a strong increased risk of low self-rated health in a deprived ethnic diverse social housing area in Denmark.
Can Home Palliative Care services reduce Emergency Department visits? Piedmont Experience, 2013-2018
Authors: Scacchi A , Berchialla P , Dalmasso M , Gianino M M
Published: October 2020

Background

Home-based Palliative Care (HPC) ensures multi-disciplinary medical, nursing, rehabilitation and psychological assistance for people with severe disabilities or with progressive end-stage disorders like cancer, promoting the continuity of care in home setting. Emergency Department (ED) visits in palliative care patients are considered an indicator of poor quality in home care services, since ED visits in these patients are not essential and potentially avoidable. There is still no agreement in literature about the efficacy of HPC in reducing the use of ED. However, recent studies demonstrated that HPC increases patient satisfaction while reducing use of medical services like ED, symptom burden and medical costs. The objective of this study was to evaluate if patients assisted by HPC have a reduction of ED visits compared to the 90-day period before HPC admission.

Methods

A retrospective study using the administrative regional database of Piedmont (Italy) was conducted on the cohort of 4433 patients admitted to HPC from 2013 to 2018. ED visits during period A (90-days before HPC) and period B (during HPC) were compared for each patient, taking into account avoidable or unavoidable visits based on triage examination.

Results

During period A, patients had 2880 ED visits, 1934 were considered avoidable (67%). During period B, 2050 ED visits were recorded, 994 were considered avoidable (48%). Patients receiving HPC had a reduction of overall ED visits (IRR 0.87, IC 95% 0.82-0.92) as well as avoidable ED visits (IRR 0.63, IC 95% 0.58-0.67). Unavoidable ED visits increased during HPC (IRR 1.36, IC 95% 1.24-1.49), as a consequence of disease progression.

Conclusions

Home-based Palliative Care is associated with a significant reduction of the use of overall Emergency Department visits (-13%) and ED avoidable visits (-37%). Since it reduces medical care costs and burden of patients and caregivers at the end of life, Home-based Palliative Care delivery should be increased.

Key messages

Home-based Palliative Care is associated with a reduction of the use of overall Emergency Department visits and avoidable ED visits, reducing medical care costs and burden of patients and caregivers. Home-based Palliative Care delivery should be encouraged and increased, aiming to an early enrolment as well as an increase of the patients.
Setting indicators for oncological clinical pathways: a 2-round Delphi method and face-to-face meeting
Authors: Acampora A , Fauci A J , Cadeddu C , Angioletti C , De Belvis A G , Iannone P
Published: October 2020

Background

An ongoing project, promoted by “Gruppo Italiano di Reti Oncologiche” (GIRO) network and coordinated by the “Istituto Superiore di Sanità”, aims to apply Value Based Healthcare (VBH) for evaluating the performance of oncological healthcare providers. In this framework, the aim of this study was to define a set of indicators for assessing the overall clinical pathway for patients with colorectal cancer receiving healthcare in one of the seven GIRO referral centers.

Methods

A 2-round Delphi study was conducted involving experts from GIRO centers. A list of preliminary indicators, identified from national and international agencies, was firstly evaluated according to four criteria (relevance, evidence-based, measurability, actionability) using a 5-point Likert scale. Indicators receiving ≥50% of judgements ≥3 in 3/4 criteria went to selection process of the second round. The second survey firstly asked whether the indicator was to be included in the final set and, if yes, it was then evaluated on a balancing criterion. Indicators receiving ≥75% of agreement for inclusion and ≥50% of judgements ≥3 for balancing were confirmed for the final set. During the face-to-face meeting, a subset of indicators was prioritized for a pilot collection.

Results

After 1st-round consultation, all the 34 indicators in the preliminary list passed to the 2nd-round and 32 (94%) of these were included in the final set (16 colon;16 rectum). During the face-to face meeting, critical issues highlighted during the process (e.g. events occurring outside the referral center) were discussed and 16 (50%) indicators were prioritized for the pilot collection (8 colon;8 rectum).

Conclusions

Evaluating the overall clinical pathway for oncological patients is very important for achieving high-quality healthcare. Enhancing collaboration and networking among oncological referral centers is a main tool for the continuous improvement of healthcare outcomes in a VBH perspective.

Key messages

Evaluating the overall clinical pathway for oncological patients is very important for achieving high-quality healthcare. Enhancing collaboration and networking among oncological referral centers is a main tool for the continuous improvement of healthcare outcomes in a VBH perspective.
Multi-Morbidity and Mediterranean Diet in the Cypriot population
Authors: Kyprianidou M , Panagiotakos D , Kambanaros M , Makris K C , Christophi C A
Published: October 2020

Introduction

Knowledge about factors associated with multi-morbidity in a given population has important implications for prevention, diagnosis, treatment, and prognosis strategies.

Objectives

To examine the association of Mediterranean diet with multi-morbidity in the adult general population of Cyprus.

Methods

A representative sample of n = 1142 Cypriots over 18 years old was recruited during 2018-2019. Multi-morbidity was assessed using a validated questionnaire and diseases were classified according to the International Classification of Diseases, 11th Revision (ICD-11). Mediterranean diet was evaluated using the MedDiet score tool which included the weekly consumption of non-refined cereals, fruit, vegetables, legumes, potatoes, fish, meat and meat products, poultry, full fat dairy products, as well as olive oil and alcohol intake.

Results

The average Mediterranean diet score was 15.5 ± 4.0 with males adhering more to the Mediterranean diet compared to females (p < 0.001). Being in the higher tertile of adherence to the Mediterranean diet was associated with lower odds of multi-morbidity at α = 0.10, even after adjusting for age, gender, educational status, smoking habits, and physical activity (OR = 0.72, 95% CI: 0.49, 1.06, p = 0.09), compared to the lower tertile.

Conclusions

To the best to our knowledge, this is the first study which provides evidence of an association between Mediterranean diet and multi-morbidity. Adherence to Mediterranean diet was associated with lower risk of multi-morbidity. Future prevention programs and practice guidelines in Cyprus and elsewhere should take into account the beneficial effects of a Mediterranean diet on multi-morbidity.

Key messages

This study provides the first evidence of an association between Mediterranean diet and multi-morbidity. health benefits in terms of multiple chronic diseases in an individual can be gained from Mediterranean diet pattern.
Comparison between indirect calorimetry and Harris-Benedickt formula
Authors: Comba M
Published: October 2020

Background

The benefits of providing optimal nutrition for recovery from illness and chronic health management are well documented. The measure of energy expenditure by indirect calorimetry or by predictive equations are two methods to assess energy needs. This abstract provides an overview of indirect calorimetry use in the outpatient setting. The study aims is to compare the results obtained with indirect calorimetry, with those obtained through the theoretical calculation with the Harris-Benedickt formula, by using t-student test.

Methods

This observational study was conducted from January 2019 to February 2020. The selected population is made up equally of men and women in the general population, from 18 to 65 years of age, without a specific disease, after having given informed consent. Our study was conducted in outpatient setting by using the fitmate pro to do the indirect calorimetry.

Results

A total of 50 patients were evaluated. The t-student test was used to evaluate whether there was a statistically significant difference in the population analyzed between the basal metabolic rate calculated with the Harris-Benedickt formula and the one measured by indirect calorimetry. The variables evaluated were gender, age (greater than or less than 38 years) BMI (greater than or less than 25).

Conclusions

A statistically significant results were found (with t-student less than 0.05) for patients over the age of 38 (0.006) and women (0.044). Not statistically significant results were found for the variables: male (0.64), under 38 years of age (0.98), BMI (0.15). Our study shows there are data in favor of the use of indirect calorimetry as a better method for assessing basal metabolic rate instead of Harris-Benedickt for a more targeted approach to the patient. Further studies may support results obtained in this study; furthermore, direct research is necessary in order to increase a personalized approach of the doctor towards the patient.

Key messages

Our study shows that there are data in favor of the use of indirect calorimetry as a patient-oriented approach to assessing basal metabolic rate. The study aims is to compare the results obtained with indirect calorimetry with those obtained through the theoretical calculation with the Harris-Benedickt formula.
Gender equality and inequalities in self-reported health in 27 European countries (2004 to 2016)
Authors: Roxo L , Bambra C , Perelman J
Published: October 2020

Background

Across Europe, women tend to report worse health than men, probably due to women's lower position in society. Although societal gender inequalities have decreased, differences persist regarding employment, income and use of time. This study aims to assess the evolution of gender-based inequalities in 27 European countries between 2004 and 2016, and to analyze the impact of societal gender equality in this evolution.

Methods

We used data from the Survey on Income and Living Conditions (EU-SILC), from subjects between 25 and 64 years old (N = 2,931,081) from 27 European countries. Logistic regressions were performed with bad self-reported health as dependent variable, first adjusted for age, country and year, and later also for education and employment. Interactions between gender and year were added to the models to assess changes over time. Countries were clustered according to their societal gender equality, based on their Gender Equality Index of 2005 and 2015 (GEI). Analyzes were stratified by education, employment and cluster of GEI.

Results

Women were 17% (OR = 1.17, 95%CI=1.15-1.19) more likely than men to report bad health. Considering education and employment, women were 3% less likely to report bad health (OR = 0.97, 95%CI=0.96-0.99). Gender-based inequalities were larger among the cluster with higher GEI (OR = 1.37, 95%CI=1.26-1.48) and those with lower education (OR = 1.21, 95%CI=1.18-1.24). Although the gender gap reduced from 26% (OR = 1.26, 95%CI=1.18-1.34) in 2004 to 16% (OR = 1.16, 95%CI=1.08-1.24) in 2016, the decrease was not significant. Differences between years were not significant when analyses were stratified for education, employment or cluster of GEI.

Conclusions

Gender-based inequalities persisted between 2014 and 2016 and were strongly related to differences in education and employment. The gender gap was larger among countries with greater societal gender equality.

Key messages

Women’s disadvantage in self-reported health persisted in 2016 and was connected to socioeconomic differences. The gender gap is not smaller in countries with greater societal gender equality.
The wider consequences of obesity: estimated social and economic costs from Mendelian Randomization
Authors: Hughes A , Harrison S , Dixon P , Dickson M , Davies A , Rice F , Davies N , Howe L
Published: October 2020

Background

Obesity is a key public health issue worldwide. Accurate estimates of its full impacts on health, social, and economic outcomes are required, but are difficult to obtain due to bias from confounding and reverse causality (the impact of social and economic factors on obesity).

Methods

Using data from the UK Biobank and ALSPAC, we applied a genetic causal inference approach (Mendelian Randomization, MR) to estimate the impact of body mass index (BMI) on key social and economic outcomes. Because genetic variants are assigned before birth and cannot change, estimates from MR studies are less liable to confounding and reverse causation.

Results

Effects of higher BMI were often larger in MR than conventional (non-genetic) models, suggesting previous studies may have underestimated the impact of BMI. For example, in adolescents, MR models implied a standard deviation increase in BMI led to exam scores around 1/3 of a grade lower in all subjects at age 16, and 8.7% (CI: 1.8% to 16.1%) more school absence. In adults a 5kg/m2 increase in BMI corresponded, among other negative outcomes, to £2,778 less annual household income (CI: £1,864 to £3,693), less chance of owning one's home (-1.6%, CI: -2.4% to -0.8%), and higher chance of being lonely (2.4%, CI: 1.4% to 3.5%). At £21.22 (CI: £14.35 to £28.07) per person per marginal kg/m2 per year, MR estimates for inpatient hospital costs were around 40% higher than conventional estimates.

Conclusions

Findings from causal inference based on genetic variation indicate that high BMI has negative impacts on social and economic outcomes that may be larger than previously estimated. This evidence highlights the potential social and economic value of preventing high BMI across the life course.

Key messages

High BMI has considerable negative impacts not only for health, but for individuals’ education and socioeconomic outcomes, and overall health care costs. Previous attempts to quantify these effects may have underestimated BMI’s full impact.
Mobile Medical Applications and Cloud Federation Challenges
Authors: Patias I , Georgiev V
Published: October 2020

Issue

Given the importance, of cloud environments for mobile telemedicine information systems, focus is given in this paper on the challenges rising. We discuss the pros of the access to computing services and resources on demand without having own infrastructures, and the need of advanced interoperability data formats and application program interfaces (APIs) to facilitate the usage of the infrastructure.

Description of the problem

Cloud-Oriented Architecture (COA) describes the architecture, where applications act as services and serve other applications in the cloud environment. The aim is IT infrastructure and software applications to be optimized for their use in cloud computing environments. But what happens in the specific field of health as data interoperability for mobile telemedicine information systems?

Results

Two architectures were presented using a patient's compliance and engagement solution. A simple Representational State Transfer (REST) based architectural style was implemented in a three-layered architecture first and then compared to a cloud federation model. In the second the interaction goes through the federation via a middleware layer. Internal operations of cloud providers in the federation are still transparent to the cloud users. The middleware layer aims to coordinate the interaction with cloud users and providers in the federation. But, to avoid delays in those interactions interoperability of data formats and APIs.

Lessons

A Fast Healthcare Interoperability Resources (FHIR) based application was developed. Mobile telemedicine information systems are a strong instrument in patients' compliance. Many systems have proved that the used resources combined can solve clinical and administrative problems in a secure environment.

Key messages

The use of cloud is wide spread in the health sector. The challenge is to combine this infrastructure into one federated platform and maximize the added value by using advanced interoperability data formats and APIs.
Evidencing value of public health programmes to enable sustainable investment for health & wellbeing
Authors: Dyakova M , Stielke A , Ashton-Brown K , Daniels P , Kadel R , Cotter-Roberts A
Published: October 2020

Issue

Global sustainability challenges related to health, inequity, the environment and the economy require urgent innovative action and focus on prevention. Fair evidence-informed prioritisation of scarce resources is pivotal to ensure sustainable investment policies and practices. It is key to capture the value and return on investment of public health (prevention) programmes in order to show their wider benefit to people, communities, society, economy and our planet.

Description

The Evidencing Value project builds on a global and national drive towards measuring the value of health services and interventions. The World Health Organization Collaborating Centre for Investment in Health and Well-being (WHO CC) is developing an innovative approach and digital solution to assess the holistic (economic, social and environmental) value and return on investment of public health programmes. It uses a Social Return on Investment (SROI) approach, which involves key stakeholders from the beginning and measures what matters most. This helps to identify the wider impact and outcomes of different health protection, disease prevention and health promotion programmes. The evidence is embedded in an interactive digital database to inform investment prioritisation and quality improvement.

Results

Project outputs include: (i) structured evidence repository detailing the value of public health services and interventions; (ii) interactive digital database for storage, manipulation and presentation of data; (iii) SROI pilots; and (iv) generalised framework for investing in public health/prevention to be used by other public bodies and countries.

Lessons

It is essential to understand the wider impact and value of public health programmes to facilitate Universal Health Coverage and sustainable investment for health and wellbeing. This project uses an innovative approach and digital solution to enable evidence informed resource allocation and decision-making focused on prevention.

Key messages

Evidencing value of public health supports the case for investing in prevention. Using innovative methods and digital solutions is essential to inform sustainable investment for health.
First results on the efficacy of a digital life-skills program for substance use prevention
Authors: Paz Castro R , Haug S
Published: October 2020

Background

Life-skills trainings conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones might represent a more economic and scalable approach.

Methods

The efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents is currently tested in comparison to an assessment only control group, within a cluster-randomised controlled trial with follow-up assessments after 6 and 18 months. The fully automated program is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Participants of the intervention group receive up to 4 individually-tailored text messages per week for a period of 6 months. The study started in 2019 and aims for 1,312 study participants between the ages of 14 and 16 years from approx. 100 secondary school classes in Switzerland. Outcomes are 1) problem drinking, 2) cigarette smoking, 3) perceived stress and 4) interpersonal competences.

Results

So far, 1'611 students within 88 secondary school classes were invited to participate in the study. Of these, 1,450 (90.0%) consented to participate. To date, 24 out of 726 (3.3%) participants of the intervention group discontinued the program and 945 (65.2%) were invited for 6-month follow-up. Of these, 752 (79.6%) completed the assessment. Preliminary analyses showed a beneficial effect of the intervention for the subscale negative assertion, assessed by the brief version of the Interpersonal Competence Questionnaire.

Conclusions

A large proportion of adolescents participated in this first study testing the efficacy of a mobile phone-based life-skills training for substance use prevention and the majority of them participated at 6-month follow-up.

Key messages

A novel, mobile phone-based life-skills training seems widely accepted by secondary students. Given its effectiveness, it could be economically implemented within secondary schools.
mHealth for Pneumonia Prevention
Authors: Mahmood H , Sheraz S Y , Kiani H , Mckinstry B , Fairhust K , Luz S , Hazir T , Hamneed R
Published: October 2020

Introduction

Pneumonia contributes to 14% of under-five mortality in Pakistan. Delayed care seeking is one of the causes of death due to this disease. One of the most impactful strategies can be timely healthcare-seeking through CHW's. We, therefore propose to develop an intervention package for educating caregivers on pneumonia by Lady Health Workers (LHWs).

Methodology

This first phase of the feasibility study comprised of a systematic review (SR) on best mobile health-based approaches for CHWs on the management of childhood illness followed by formative research (FR). In the systematic review, 6 databases were searched, and 22 articles were included. Based on findings of SR and FR along with guidelines of WHO and UNICEF, a mobile application-based intervention package will be developed in the second phase. Recruited LHWs will use the mobile application in their monthly visits for 6 months. Text and voice messages will be sent to each caregiver. Pre and Post-intervention surveys will be conducted with the recruited caregivers to assess the impact of the intervention and FGDs with the recruited LHWs to get feedback on the intervention.

Findings

Findings of the systematic review suggest that the most common approaches of mobile health for community health workers is the use of a customized application for disease management and data collection. Findings of formative research suggest that the majority of the caregivers were not aware of the danger signs of pneumonia. Respondents agreed to the importance of an educational intervention package on pneumonia and its prevention by LHWs through mHealth.

Acknowledgment

This research was commissioned by the National Institute of Health Research using Official Development Assistance (ODA) funding. The views expressed in this publication are those of author(s) and not necessarily those of NHS, the National Institute of Health Research, or the development of Health.

Key messages

mHealth intervention employing community health workers can be a useful mode of improving healthcare services. Use of technology to raise awareness and delivered health-related information at community level can prove tremendously helpful for illness management.
Measuring Health Literacy in Tuscany through the Italian risk factor surveillance system (PASSI)
Authors: Zanobini P , Lorini C , Caini S , Lastrucci V , Masocco M , Minardi V , Contoli B , Bonaccorsi G
Published: October 2020

Background

Health literacy (HL) can be defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. A module to measure HL has been implemented in Tuscany since 2017 within the Italian risk factor surveillance system (PASSI). Here, we aimed to assess HL levels and their relations with social determinants and health behaviours.

Methods

During 2017-2018, a representative sample (N > 7000, aged 18 to 69 years) of the Tuscan population was interviewed in PASSI. HL was measured using the Italian version of the short-short form (HLS-EU-Q6) of the HLS-EU-Q47. Multivariate analysis was performed to investigate associations between HL, social determinants and selected health behaviours (diet and physical activity).

Results

61% of the interviewees had an adequate HL level, 30% problematic and 9% inadequate. In the multivariate analysis, the odds of inadequate HL level increased for all social determinants except gender and loneliness. The strongest association was observed for foreign citizenship (OR 3.38, 95% CI 2.63-4.34) followed by financial problems (OR 2.10, 95% CI 1.73-2.55), low education (OR 1.91, 95% CI 1.58-2.32), being aged 50-69 years (OR 1.51, 95% CI 1.18-1.94) and unemployment (OR 1.42, 95% CI 1.17-1.72). With regard to health behaviours, subjects with inadequate HL level had the lowest odds of engaging in regular physical activity (OR 0.59, 95% CI 0.49-0.71) and one of the lowest odds of eating at least three portions of fruit and vegetables (OR 0.79, 95% CI 0.65-0.95).

Conclusions

Our findings suggest that HL is strongly associated with social determinants and has major influence on health behaviours. Our study is still ongoing, with the next step being to build a conceptual model to depicting the effect of HL as a mediator of the association between social determinants and health behaviours.

Key messages

Health Literacy is strongly associated with social determinants. Health Literacy has major influence on health behaviours.
21.H. Workshop: Incentivising vaccination uptake in Europe
Authors:   Organised by: EUPHA, CHAFEA, DG SANTE,   Chair persons: Anne-Marie Yazbeck - CHAFEA
Published: October 2020

Vaccination is the main tool for primary prevention of disease and one of the most cost-effective public health measures available. Immunisation through vaccination is the best defence we have against serious, preventable, and sometimes deadly, contagious diseases.

However, we have witnessed measles outbreaks in the last years that could have been avoided if vaccination rates had been sufficiently high. The vaccination rate against seasonal influenza for older people also remains much below the recommended level (75%) in most EU countries.

We have also seen countries taking policy measures, such as introducing mandatory vaccination against certain childhood diseases (France, Italy, Germany), while other countries retain high vaccination rates without establishing such measures (e.g. Sweden, Denmark, Portugal).

This session will bring together policy-makers at various levels (national, regional), experts and civil society (e.g. health care professional associations) to showcase recent policy initiatives, good practices and innovative collaborations aiming at increasing the vaccination rates for key vaccines and taking a life course approach.

Key messages

Vaccination is the main tool for primary prevention of disease and one of the most cost-effective public health measures available. Immunisation through vaccination is the best defense we have against serious, preventable, and sometimes deadly, contagious diseases.
On the time trends among school-aged children in the Nordic countries
Authors: Löfstedt P , Arnarsson A M , Corell M , Lyyra N , Madsen K R , Torsheim T , Thorstensson E B , Välimaa R , Damsgaard M T , Eriksson C
Published: October 2020

Long-term trends in mental health of school-aged children can be analysed in the HBSC study. In Sweden the proportion of the children that report at least two weekly health complaints during the last six months has increased from the first data collection 1985/1985 to the latest 2017/2018 among all age groups for both girls and boys. Among the 11-year-old it reached 41 % among girls and 30 % boys, and among 15-year-old girls 62 % and boys 35 %. Can we trust this?

The prevalence of two or more weekly health complaints showed large differences by country over time and especially in 2014, when Iceland and Sweden showed an almost 10%-point larger prevalence of multiple weekly symptoms (about 35%) than Denmark, Finland and Norway (about 25%). Norway was the only country to show a decline during 2002-2014.

The prevalence of sleep difficulties has increased over the 12-year period in Denmark, Iceland, and Finland. In Sweden the prevalence fell from 26% to 21% from 2002 to 2006 but rose by 10% points from 2010 to 2014. Only Norway showed a positive development over the 12-year period; the prevalence declined in 2014 to 17% the lowest prevalence of sleep difficulties in any of the five Nordic countries.

The trend of excellent self-rated health for Nordic adolescents indicates a small overall improvement between 2002 and 2006 but a stable trend in the following periods up until 2014. Finland and especially Sweden shows a decline in the prevalence of students having an excellent self-rated health. The only country to show a positive development in the prevalence of students having excellent self-rated health from 2002 to 2014, is Norway. The overall prevalence of adolescents having high life satisfaction has declined in most of the Nordic countries examined.
Brief interventions for NCDs risk factors
Authors: Breda J
Published: October 2020

Background

Brief interventions (BIs) are short, structured, nonconfrontational conversations to motivate and support individuals to consider and plan changes in unhealthy behaviours. Noncommunicable diseases (NCDs) are a huge global burden responsible for a large number of premature deaths and other economic and social challenges. The WHO “Best Buys” report highlights BIs as an effective tool to address NCD risk factors in the general population. BIs are not quick fixes, but part of a long-term behavior change strategy. An integrated BI package is needed to prevent unintended consequences, such as increased physical activity leading to increased consumption of unhealthy foods. BIs can be applied in a wide range of settings, including primary care in the general population, prisons and other settings for vulnerable groups.

Results

BI deliver immediate and long-term health, economic and social benefits. For example, BIs for smoking cessation can help individuals increase their life expectancy by up to 10 years, as well as reducing the risk of NCDs including stroke, lung cancer and CHD. Economic benefits include increased personal income and higher productivity, whilst social benefits include improved relationships and children being less likely to take up smoking.

Conclusions

WHO have published reports and training packages focused on the 5As and 5Rs brief interventions model in four major NCD risk factors: smoking, alcohol, unhealthy nutrition and physical inactivity. However, BI implementation remains low. To address this, WHO are currently working on a Manual for Integrated BI for NCD risk factors to support countries to implement, establish and promote BIs in their primary health care setting. It will contain information on health systems organization, intervention delivery, training and capacity building for healthcare professionals, referrals and follow-up, health literacy, and monitoring and evaluation strategies.
What can lifespan variation tell us about trends in life expectancy in high income countries?
Authors: Hiam L , Minton J , McKee M
Published: October 2020

Building on the findings of presentations 1 and 2, we turn to two further measures of population health: life expectancy at birth and lifespan variation. Life expectancy at birth provides a single figure that captures the overall mortality experience of a nation, and, in the absence of data artefact, a wide-scale environmental event such as war or natural disaster, a disease epidemic or mass migration, life expectancy can be expected to continue to improve in HICs. Concurrently lifespan variation, which measures the average gap between the age at death of an individual and the remaining life expectancy at that age, should decrease as life expectancy increases.

Recent analysis of life expectancy improvements in HICs by the Office for National Statistics, using Human Mortality Database data, found that while Japan continues to see improvements, the UK and the USA fell to the bottom of the rankings. Economically, both the UK and Japan have experienced 'lost decades' of poor economic growth, in 1990s and 2010s respectively. Yet, while Japan continued to see life expectancy improvements, in the UK life expectancy stalled, and both countries saw an increase in lifespan variation.

In this presentation, we will present the analysis of lifespan variation of 5 HICs: the USA, where life expectancy has declined, the UK, where gains in life expectancy have trailed behind those in other industrialised countries, Japan, which has seen sustained progress, and France and Canada, neighbours of the UK and USA respectively, which lie in the middle. We will examine what can be determined from these measures over periods of poor economic growth, and the implications for achieving 'sustainable growth'.
Patterns of risky driving behaviors among Tuscan adolescent drivers: a cluster analysis
Authors: Lastrucci V , Innocenti F , Lorini C , Berti A , Silvestri C , Gnaulati L , Voller F , Bonaccorsi G
Published: October 2020

Background

Adolescents have a high risk of road traffic accident (RTA) because of their high engagement in risky driving behaviors (RDBs); to date, very few studies have investigated the patterns of RDBs. The aim of the study is to identify distinctive RDBs patterns and to examine their associations with RTAs in a sample of adolescent drivers

Methods

The EDIT project is a cross-sectional survey carried out in a representative sample (6.824) of Tuscany Region students aged 14-19 years. The study analyses a subsample of students who reported to drive/ride at least once a week (2764). Self-reported frequency in the last year of the following RDBs was determined: talking on phone; texting; using GPS; talking to passengers; smoking; eating; listening to loud music; fatigued driving; speeding; and driving under the influence (DUI) of alcohol or drugs. A cluster analysis was conducted to identify RDBs patterns. A multivariate model was used to evaluate the difference in the risk of RTA across clusters; ANOVA and post-hoc pairwise comparisons were used to further characterize cluster membership

Results

Four distinct RDBs clusters were identified: “safe”(45.6%), “average”(21.8%), “careless but not DUI”(21.5%) and “reckless and DUI”(11.2%) drivers. When compared with “safe” drivers, “careless but not DUI” and “reckless and DUI” drivers showed a significantly higher risk of RTA (respectively, OR 1.68, 95%CI 1.29-2.18, p < 0.001; OR 2.88; 95%CI 2.10-3.95, p < 0.001). Clusters were characterized by several significant differences in sociodemographic variables, cell-phone use, quality of the relationships with parents, school performances, mental health and well-being, health behaviors, gaming, bullying and risky sexual behaviors

Conclusions

RDBs evidently occur in typical patterns that are linked with different RTA risks. Several domains of adolescent life seem to be involved in cluster membership. An awareness of this clustering enables to better targeting adolescents at higher risk of RTA

Key messages

RDBs occur in patterns in adolescents, and indicators of risky behaviors and of mental and social well-being may help to identify RDBs clusters at high risk of road traffic accidents. Multimodal prevention approaches in risky driving behaviors are likely to be more successful than targeting a single behavior in adolescents.